2. Rapid Assessment of District and Community HIV and AIDS Response Challenges, Constraints and Prospects Biannual Joint Review on HIV/AIDS Main Review meeting Nov. 2008

3. Objectives 1. To generate community-based experiences regarding the implementation of NMSF in terms of what worked well and what needs to be improved 2. To assess progress in community and district responses for HIV & AIDS and the key issues 3. To assess prospects and challenges for district and community response to HIV and AIDS

4. Sharing the tool with Stakeholders (TACAIDS and DPG-AIDS) 4.To share findings with Key Stakeholders Objectives cont.

5. DISTRICT AND COMMUNITY HIV and AIDS RESPONSE Coverage of Assessment 6 teams (1 or 2 consultant(s) + 1 LGA staff per team): 3 regions per team and 1 district in each region – Lake Zone (Muleba, Ukerewe, Tarime) – Central Zone (Iramba, Kondoa and Kahama) – Southern Zone (Rungwe, Makete and Tunduru) – Western Zone (Kibondo, Nkasi, Nzega) – Northern Zone (Kiteto, Rombo and Monduli) – Eastern Zone (Mkuranga, Temeke and Ulanga) Plus: – Regional level – National level

6. Methodology Qualitative in-depth interviews were administered to respondents from: – Households, – Umbrella Civil Society Organisations including the Private and Informal sector where applicable; – Council Multisectoral Committees, – LGA- Districts – Regions and – National levels

7. Findings from interviews at different levels What has worked well

8. Institutional arrangements Formation of Technical AIDS Committees (TACs) in MDAs is a positive development Most of the CMACs are in place and working. Formation of Regional Multisectoral HIV and AIDS Committees is a positive development. Public - Private and Civil Partnership in HIV and AIDS is a positive development e.g. The Health Development Foundation (HEDOFO) in Tunduru Rapid Assessment of District HIV&AIDS Response 7

9. Coordination CMACs meetings are conducted regularly in all districts CHAC and DACC work together and cooperate with some CSOs. Formation of Regional Multisectoral HIV and AIDS Committees is a positive development. Rapid Assessment of District HIV&AIDS Response 8 CMAC members

10. Planning and Budgeting All district councils have plans and budget lines for HIV and AIDs All councils use the multisectoral approach in planning and budgeting. All districts use tools provided by the Government- MTEF/PlanRep Rapid Assessment of District HIV&AIDS Response 9

11. Management and Implementation PLHIV groups more proactive in the provision of Home Based Care as Volunteers and as agents of awareness creation Councils and CSOs support education for OVC/MVCs Rapid Assessment of District HIV&AIDS Response 10

12. Management and Implementation 2 In Tarime CMAC provided each Ward with Tsh. 350,000 for supporting PLHIV in their respective wards specifically for food supply CMAC sent experts to check PLHIV for TB CMAC organised meeting with Community Leaders and established PLHIV Clubs with Global Fund funding CHAC during the interview in Tarime

13. Management and Implementation 3 Advocacy activities Where Mobile CTCs are available they are good Regional Cinema vans are used for awareness campaigns for HIV and AIDS. Regional Secretariats support LGA activities in the districts. Regional Secretariat - Musoma Rapid Assessment of District HIV&AIDS Response 12

14. Monitoring and Evaluation; and Reporting Good system for data collection The development of TOMSHA and LGMD is positive In some regions, TOMSHA data collecting tools are available at the lower levels O&OD and PRA are in use Capacity building in HIV and AIDS programme Monthly, Quarterly and Annual reports are prepared, submitted to appropriate levels Interview with CMACs Rapid Assessment of District HIV&AIDS Response 13

15. Resource mobilisation, resource tracking and Auditing Worked well All LGAs visited have set aside budgets for CMAC activities from own sources Some Councils have mobilized resources There is CSO mapping done by CMACs. The Tanzania Government, Development partners and other actors provide funds for HIV and AIDS programmes. PLHIV – IGAs supported by TASAF Rapid Assessment of District HIV&AIDS Response 14

16. Findings from interviews at different levels Challenges and Gaps

17. Communities and Households

18. Perceptions from Community / Households – Service provision Challenges and Gaps: Inadequate food supply for the PLHIV Lack of sustainable development projects for supporting PLHIV – need of community initiated and owned Income Generating Activities (IGAs) Apart from free ARVs, prescribed drugs for Opportunistic Infections are not adequate and not free Household interview

19. Perceptions from Community / Households – Service provision 2 Challenges and Gaps Poverty level is very high in rural areas – therefore adherence to ARVs becomes difficulty Insufficient number of Home Based Care Providers to meet the demand at the community level No specific HIV and AIDS activities for the Disabled Limited involvement of community in planning process Disabled in Ukerewe

20. Perceptions of Community / Households: stigma, access to information Challenges and Gaps Overdependence fuels stigma and discrimination Existence of social / cultural practices that fuel the spread of HIV and AIDS Unaware of current HIV AND AIDS Plans by Council / CSOs Inadequate understanding of H/H on structures / roles and responsibilities of WMACs / VMACs / CSOs, although H/H mentioned Councillors, WEOs, VEOs as leading the response PLHIV – amputated due to gangrene – using her eating utensils

21. Perceptions by Community / Households – Access to resources / sources of funding Challenges and Gaps Unequal distribution of resources favouring those closer to service delivery locations – No food No Strength to Dig the Farm Lack of support to Disabled PLHIV (Wheel Chairs / Artificial Limbs) Inadequate funds available to Community Based Organizations dealing with HIV and AIDS activities The PLHIV come from long distance (fare costs up to 4,000) which they cannot afford to pay for each visit (out of pocket expenditures) PLHIV with milk goat donated by TACAIDS

22. Perceptions by Community / Households – Traditional Healers (THs) and Traditional Birth Attendants (TBAs) Challenges and Gaps THs and TBAs - Limited knowledge on HIV and AIDS THs and TBAs do not keep clients records on their respective local areas of operation Lack of bylaws to fight on HIV and AIDS PLHIV – MVC - Guardian

23. CSOs, Private and Informal Sector Meeting with CSOs at regional level in Arusha

24. CSOs – Capacity and support received Challenges and Gaps Limited support / capacity to carry out their campaigns for HIV and AIDS prevention activities in the community Missed opportunities e.g. “Umbrella organisations” having inadequate skills regarding roles and responsibilities (capacity building, financial management and resource tracking, M&E, Proposal development and Report Writing) therefore unable to support members and add value to Council HIV&AIDS plan Meeting with NGO and PLHIV Association

25. CSOs – Good Governance and coordination Challenges and Gaps: Lack of transparency, information flow and cooperation – CSOs do not report on the funds received from different Partners Bureaucracy in accessing support from higher levels Insufficient coordination: LGAs do not hold regular meetings with implementing agencies Interviewing PLHIV Association in Monduli

26. CSOs – Access to resources and sources of funding Challenges and Gaps Lack of sufficient funding Limited community contributions (in kind and cash) Delays in release of funds for approved HIV and AIDS planned activities Bureaucratic procedures by the funding agencies Funding agencies often do not provide (timely) feedback on whether proposals are approved or need to be altered FBO taking care of orphans in Rombo with CHAC and Regional Focal Point

27. Council Multisectoral AIDS Committees (CMACs)

28. CMACs – capacity and support received Challenges and Gaps Inadequate capacity building of CMACs, WMACs and VMACs members due to inadequate funds Change of CMAC members affected the performance of the CMAC Receives less funds as it had been promised Lack of understanding of the HIV and AIDS Act Lack of sense of urgency: insufficient political will at district level Shortage of staff in the Council Interviewing VMAC in Monduli District

29. CMACs – needs and resources available Challenges and Gaps Increased number of OVCs/ MVC (burden) Inadequate budgets for HIV and AIDS activities Lack of regular supervision by LGAs of interventions Lack of transport: Bicycles, Motorbikes, Boats to travel the long distances to reach the clients HIV/AIDS vehicle in District

30. CMACs – Service delivery Challenges and Gaps CTCs: Insufficient number of centres for measuring CD 4 CTCs: capacity in current centres insufficient: need for more training on the use of the methodology CTCs: overloading / overcrowding of the CTC clinic in the hospital as some clients refuse to attend other clinics! Feedback meeting at Muleba

31. Local Government Authorities (LGAs)

32. LGAs –Policies, Guidelines, Planning and Coordination Challenges and Gaps: Inadequate capacity building of LGAs in planning processes Most of the LGAs are unaware of various planning guidelines related to HIV and AIDS Lack of accurate data for planning: TOMSHA and LGMD not yet fully functional Difficulty to send reports or feedback to the villages Inadequate information flow amongst LGA actors regarding type and sources of support received from Regional and National levels Inadequate funding and/or late release of funding for approved HIV and AIDS Interventions

33. LGAs – Overall implementation Challenges and Gaps Target groups are not well reached in the hard to reach areas (OVC, PLHIV, MVC, Widows / Widowers, Youths and Disabled) Counsellors at the Ward level not well supported in terms of resources to undertake their tasks WMACs and VMACs : Lack awareness on their roles and responsibilities as Key Implementers Limited involvement of CBOs in educating the community on HIV and AIDS Briefing with DED and LGA staff

34. LGAs – Service delivery Challenges and Gaps Inadequate number of VCTs and CTCs in council (need to be closer to the clients) Clients and providers have to travel long distances travelled to reach the services Shortage of staff (human resource constraints) Stigma among the service delivery providers DACC Rombo, Regional Focal Point Arusha Region and TACAIDS staff

35. LGAs – Monitoring & Evaluation Challenges and Gaps Local Government Monitoring Database (LGDM) and TOMSHA are not well known to most of the LGA staff Mixed reaction but almost all of LGA staff interviewed were “not sure” of receiving feedbacks of the reports Variations of reporting procedures in the councils. M&E activities are not budgeted in the LGAs planned activities No regular monitoring visits by LGA staff to interventions and implementing partners

36. Regional level

37. Regional level – Planning, Technical support to LGA, Coordination and M&E Challenges and Gaps Human resource constraints Lack of transport facilities: difficult to reach remote areas Limited follow-up of HBC / PMCTC at the family level Mindset of the community – resistant to change! (Behaviour Change Communication) Sometimes difficult to track resources because the resources are sent directly to council No regular coordination meetings between Regional Focal Point and partners Lack of linkages in monitoring and evaluation systems between regional level and district levels (no regular monitoring visits by Regional level)

38. National level CSOs at national level

39. National level – Policies, Guidelines, Coordination and M&E Challenges and Gaps Lack of clear Guidelines for LGAs and CSOs on best practises Councils do not involve partners or communities sufficiently in their planning processes LGAs do not coordinate regularly with partner agencies and or share information. At Ministerial level, Technical AIDS Committees do not seem particularly active. LGAs do not monitor regularly the activities implemented by non- state actors (such as CSOs) TOMSHA is not operational. None of CSOs interviewed (e.g. TAF, Action Aid, Concern, NACOPHA) had received (sufficient) forms Partners provide reports to LGAs and to national level authorities, including TACAIDS, but do not receive feedback

40. Recommendations

41. Recommendations: Coordination LGA: Coordination LGAs should identify partners and establish mechanisms for Public Private Partnership with all other stakeholders working on HIV and AIDS activities LGAs should strengthen the existing coordination mechanisms for CMACs, WMACs and VMACs LGAs should strengthen information flows on HIV and AIDS to and from household and community levels in order to plan effective interventions aimed at reducing the spread of the epidemic which focus more on social behaviour studies that can inform policies, strategies and activities.

42. Recommendations: Coordination 2 LGAs should involve all sectors and stakeholders to participate in the process of developing HIV&AIDS district comprehensive plans in order to enhance the community response Coordination mechanisms for CSOs, Private and Informal Sectors should be developed through consultation between LGAs and CSOs, Private and Informal Sectors working in HIV and AIDS programmes in order to ensure that the activities that are carried out are complimentary to the council comprehensive plans CSOs and other stakeholders implementing HIV and AIDS activities should be transparent and accountable to the beneficiaries’ community by 2010.

43. Recommendations: Planning and Budgeting LGAs should strengthen information flow on HIV and AIDS to and from Household and community levels in order to plan effective interventions aimed at reducing the spread of the epidemic which focus more on social behaviour studies that can inform policies, strategies and activities. CSOs and other stakeholders implementing HIV and AIDS activities should be transparent and accountable to the beneficiaries’ community by 2010. LGAs should involve all sectors and stakeholders to participate in the process of developing HIV&AIDS district comprehensive plans in order to enhance the community response

44. Recommendations: Management and Implementation LGAs incorporate IGAs projects in the district comprehensive HIV&AIDS plan in order to improve the livelihoods of the PLHIV and MVCs. LGAs should establish mechanisms for the enforcement of existing bylaws in order to protect the rights of infected and affected populations LGAs and CSOs should scale up the training of Traditional Healers and the Traditional Birth Attendants on HIV and AIDS l LGAs, CSOs and other Actors should promote and expand CTC / VCT / HCT services in order to increase access at all levels

45. Recommendations: M&E, Resource Mobilisation, tracking and auditing M&E PMO-RALG / TACAIDS should build capacity of Actors in order to effectively use TOMSHA and the LGMD reporting systems in order to be able to effectively use them in planning, implementing and reporting HIV and AIDS activities Resource mobilisation, resource tracking and auditing PMO-RALG /TACAIDS should scale up Good governance practices on HIV and AIDS programmes in all TACs, LGAs and CSOs in order to achieve effective accountability, transparency, information flow and coordination of resources

46. Recommendations: Institutional arrangements and reporting Institutional arrangements: Regional Secretariat and LGAs should budget, provide, scale up and sustain capacity building for the MACs in terms of knowledge on HIV and AIDS, Advocacy, Planning, Implementation, M&E and Coordination in order to enhance their performance based on available resources and best practices Reporting: PMO-RALG/ TACAIDS / RS / LGAs/ CSOs should provide timely reports and give feedbacks in order to improve performances in the planning, implementation and coordination of HIV and AIDS activities

47. Recommendations: Research Operational Research TACAIDS should support RS and LGAs to develop and prioritise their research agenda which addresses programmatic and operational issues on HIV and AIDS LGAs should budget for research in their MTEF plans

48. CSOs (PLHIV Group) involved in HIV and AIDS education / Home Based Care services Rapid Assessment of District HIV&AIDS Response 47

49. Let us continue to strengthen our Partnership in enhancing community response ! Rapid Assessment of District and Community HIV&AIDS Response 48

50. Please don’t forget to balance the burden now! Thank you very much for listening Rapid Assessment of District and Community HIV&AIDS Response 49