Building resilient and sustainable systems for health to support the National response

Quality Improvement of HIV and AIDS services

To ensure sustainability of QI initiatives, the MOHCDEGC has instructed RHMTs, CHMTs and HFs to incorporate and budget for QI activities in their annual plans to improve coordination of QI activities and refrain from piecemeal implementation which resulted into duplication of effort (especially supervision and reporting) in some geographical areas, while others were not reached at all

Priority

• Maintain patient-centred quality improvement as an integral part of HIV and AIDS service provision and general health care
• Coordinate efforts of implementing partners to optimize the use of resources, standardize quality, meet specific regional and council priorities and harness the benefits of technical support from all partners
• Designate QI focal persons with well-defined roles across all levels of care to improve the quality of services
• Coordinate and harmonise implementation of QI related activities including BRN star rating, supportive supervision, mentoring and coaching cycles

Medicine and Technologies

The Procurement and Supply Chain Management (PSCM) system for HIV commodities in Tanzania is among core functions of the MOHCDGEC implemented through the NACP. It comprises both supply chain management (product selection, demand planning, procurement, inventory management and monitoring at central level) and pharmacovigilance, and is jointly coordinated by the Pharmaceutical and Laboratory Services Unit (PLSU) at the NACP, the LMU under the Pharmaceutical Services Section (PSS) of the MOHCDGEC, and key partners in the HIV commodities supply chain to ensure uninterrupted supply of medicine. Product selection is done in alignment with the WHO recommendation adopted in the National Guidelines with specifications based on the country requirements, namely; quantification to establish needs for HIV commodities; resource mobilization from development partners and government for procurement, storage and distribution; supply chain monitoring to ensure sufficient stock levels at all MSD stores, timely delivery of shipments to MSD and onward distribution to health facilities; and timely reporting of quality logistics information by health facilities and MSD.

Priority

• Strengthen coordination, monitoring and management of supply chain for HIV and related commodities
• Advocacy for increased allocation of domestic funds in the national budget for the AIDS Trust Fund
• Increased allocation of ATF budget for the procurement of HIV commodities.
• Strengthen the resource mobilization mechanism to ensure timely and sufficient financial resources for the procurement of HIV and related commodities.
• Improve national forecasting, quantification, procurement and delivery of HIV commodities
• Strengthen Integration of eLMIS and pharmacy module to improve availability and consistency of data
• Strengthen the capacity of the HCWs to manage medicines and commodities
• • Strengthen collaboration between government and implementing partners to avoid parallel Systems
• Improve MSD capacity in terms of infrastructure and transportation to ensure the timely delivery of HIV and related commodities.
• Expand the scope and mandate of Health facility therapeutic committees to include oversight for HIV and AIDS related commodities
• Build the capacity of health care workers on rational use of medicines
• Strengthen supportive supervision for health facility management and mentoring for prescribers
• Introduce prescription audit and feedback (analyzing prescription appropriateness and then giving feedback), peer review and group processes to support prescribers to understand and correct their weaknesses

Healthcare Equipment Maintenance (Laboratory Equipment)

The maintenance of HIV laboratory equipment is performed according to the Planned Preventive Maintenance (PPM) schedule because the equipment is used to test important parameters that monitor the progress of clients on ART. Efficient equipment maintenance prevents the likelihood of interrupted service provision and ensures accuracy of tests results.

Priority

• Establish a national system for monitoring the functional status of laboratory equipment and inform decision making at all levels
• Establish a pre-qualified and negotiated procurement system between government and suppliers for HVL and EID machines using the placement system or reagent rentals.
• Strengthen the health care equipment unit at the MOHCDGEC and zonal equipment maintenance workshops to facilitate PPM of laboratory equipment
• Ensure regular and timely PPM to ensure uninterrupted services at health facilities
• Advocate for sufficient resources for laboratory PPM
• Ensure timely procurement and supply of reagents – including use of reagents rentals or equipment placement approaches.

Laboratory Services

Laboratory services are an important integral part of HIV and AIDS prevention, care, treatment and support services as laboratory tests provide important information on an individual’s HIV status, CD4 count as baseline test, clinical chemistry, and haematology and HVL which help in the detection of treatment failure and/or HIVDR (toxicities and adverse reactions)

Priority

• Expand and improve laboratory infrastructure (buildings and equipment) at district and lower  health facility level
• Expand the scope of the SLMTA approach to include the strengthening of HIV laboratory quality assurance systems and coverage to district and lower health facilities
• Scale up HIV Viral Load testing through conventional technology and POC testing
• Strengthen Work Improvement Team (WIT) at CTC and Laboratory level to ensure quality of service provision related to HIV services
• Strengthen the laboratory supply chain management to ensure regular availability HIV related laboratory commodities
• Strengthen the sample transportation system from facility to the hub and from the hub to HVL testing laboratories
• Strengthen laboratory information system to capture all HIV related laboratory data for planning

HIV Strategic Information

Strategic Information (SI) is crucial for assessing progress in the implementation of various components of HIV and AIDS interventions. It is also necessary for target setting and prioritization of services to maximize coverage and ensure equity as it provides evidence to inform decisions. Key component of SI includes data collection and processing, data quality improvement and control, and timely reporting.

Priority

• Harmonize the parallel and vertical data recording and establish inter-databases management systems, in particular HTS, Viral Load Monitoring and care and treatment
• Improve coverage for data management platforms, including mobile services provision points which are securely linked to central electronic database
• Strengthen HIV Commodities reporting systems to provide timely and consistent data
• Designate and capacitate human resources for data management systems for the benefit of multiple disease programs
• Develop and utilize standard operating procedures for data dissemination and use
• Designate broad dissemination of Strategic Information based on programmatic routine data, disease surveillance and operational research results)
• Strengthen coordination and promote utilization of health sector HIV research and evaluation agenda; so as to build evidence for decision making and improvement of program performance

Community Based Health System

Community participation is the core principle of the community-based health program (CBHP) in Tanzania that differentiates it from other health programs’ approaches. CBH interventions give priority to re-organization of the local people before they are implemented. Organizing the people in community-based approach comprise activities such as education or advocacy, building systems and strong leadership formation from the village level. CBHP ensures people’s participation in the planning, implementation and evaluation of their health. Thus, the success of CBHP will depend on the people’s participation at all levels.

Priority

• Strengthen institutional capacity to mobilize and manage resource for CBHP
• Finalize process of Formalization of CHW Cadre
• Strengthen management and coordination mechanism of CBHP at all levels
• Strengthen advocacy, communication and social mobilization • Strengthen support systems for effective implementation of CBHP