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16
Nov

National Milestone

National Response Milestone


In Tanzania the first AIDS cases were reported in the Northwest region of Kagera. The following are the key milestones accomplished since the emergence of HIV and AIDS in Tanzania:
1983: First AIDS cases reported
1985: AIDS Task Force
1985- 1986: Short Term Plan (STP)
1987: NACP established  and launched in 1988 to coordinate the implementation
1987-1991: First Medium Term Plan (MTP - I)
1992-1996: Second Medium Term Plan (MTP - II)
1998-2002: Third Medium Term Plan (MTP - III)
2001: TACAIDS established
2003: The National Care and Treatment Plan for HIV and AIDS (NCTP)
2003–2006: Health Sector Strategy for HIV/AIDS (HSS)
2003-2007:- National Multi- Sectoral Strategic Framework on HIV/AIDS(NMSF)
2008: The HIV and AIDS (Prevention and Control) Act, 2008
2008- 2012: The Second National Multi-Sectoral  Strategic framework on HIV and AIDS
2008- 2012: Health Sector HIV and AIDS Strategic Plan - II (HSHSP-II)

1983: First AIDS cases reported
The first AIDS cases in Tanzania were reported in the Northwest region of Kagera in 1983. This is also the region where the highest levels of prevalence were detected in the late eighties. In the following years HIV spread to all regions of Mainland Tanzania and at a slower rate to the regions of Zanzibar.

1985: AIDS Task Force
Institutional efforts to combat HIV/AIDS started in Tanzania by establishing a National AIDS Task Force within the Ministry of Health (MOH) in May 1985, which later became the National AIDS Technical Advisory Committee. This was so because the HIV/AIDS epidemic was first perceived as a health problem and the initial control efforts were formulated and based within the health sector. This Task Force developed a short-term plan.

1985 - 1986: Short Term Plan (STP)
The Chama Cha Mapinduzi (CCM) Party Executive Committee discussed the problem of AIDS in its National Executive Committee in April 1986 and from early 1989 decided to include AIDS in its regular NEC meetings agenda. With assistance from the World Health Organisation/Global Programme on AIDS (WHO/GPA), a short Term Plan (STP) was formed for the period 1985 - 1986 which aimed at the mobilization of health sector through training health workers and establishing blood safety measures.

1987: NACP established  and launched in 1988
In 1987, the Tanzania National AIDS Control Programme (NACP) was established and formally launched in 1988 with the overall aim of reducing the incidence of HIV infection and its associated morbidity and mortality.

1987 - 1991: Medium Term Plan One (MTP - I)
A five-year Medium Term Plan one (MTP-1) for AIDS Control was developed by MOH with advice from the World Health Organization in March 1987 and it was implemented for the period of 1987 - 1991. The NACP which administratively was established within the Department of Preventive Services of the Ministry of Health began implementing MTP- I in April 1988. Four technical units and one management unit were established within the NACP to guide implementation of the MTP- I. These were:

  • Information, Education and Communication (IEC)
  • Laboratory and Blood Transfusion
  • Clinical Services
  • Epidemiology and Research
  • Management


Management
Later on, a sexually transmitted diseases (STD) component was added to the Clinical Services Unit as a response to the increasing recognition that STDs facilitated HIV transmission. A sixth Unit- Counseling and Social Support was established in 1990 after a number of AIDS patients became more prominent. Sub- Committees were formed for each unit to provide technical support.

The objectives of the NACP's First MTP- I were centered around the following three main areas:

  1. Reducing HIV infection through prevention
    • To decrease sexual transmission of HIV
    • To decrease transmission by blood products
    • To reduce transmission by injection and skin piercing objects
    • To prevent HIV infection through contact with infected materials
    • To reduce mother to child transmission
  1. Monitoring and Research
    • To assess the status of the epidemic
    • To monitor progression of the epidemic
    • To improve research activities
  1. Coping with HIV/AIDS
    • To ensure optimal quality of life of AIDS patients
    • To improve diagnostic capacities

Decentralization in MTP - I
In 1987 Heads of Departments from the MOH, Regional Medical Officers (RMOs), and other health officials met to discuss the implementation of MTP- 1. Starting with the appointments of 20 Regional and 103 District AIDS Control Co-coordinators (RACCS and DACCS) in 1987, AIDS activities were first decentralized to the regional level. The process took about two years to reach the districts.

The need for a Multi-Sectoral response to HIV/AIDS has been evident since the MTP I, when it was realized that prevention and control of HIV/AIDS were far beyond the capacity of the health sector alone and would require active involvement of all sectors at all levels.

Review of MTP -1 in 1991
The review team visited many organizations, regions and districts, interviewing scores of senior CCM and government leaders, donor agency representatives, government and non-government field workers, shopkeepers, barmaids, hotel keepers and many others. They assessed constraints and recommended future directions for the Program.

Experience during MTP - 1 clearly showed that one sector could not act effectively if it is working on behalf of another sector. Each sector needed to have a central focus for planning and managing AIDS control activities, which fall within its sphere of influence. The review observed that the Programme had a vertical structure. The numerous recommendations of the review advocated decentralization, Multi-Sectoral involvement, community mobilization and NGO involvement as the main strategies of MTP - II.
1992 - 1996: Medium Term Plan Two (MTP - II)

MTP I evaluation was undertaken in 1991 and the evaluation recommendations were used in designing MTP II which was implemented for the period of 1992- 1996. In April 1991 the framework for MTP -II (1992- 1996) was established. During a workshop attended by government Ministries, NGO's and donors, roles and responsibilities were assigned to the different actors who would be involved in MTP - II. Decentralization was re- emphasized and in order to facilitate for district planning, detailed intervention proposals also known as frontline packages were developed.

Other major characteristics of MTP - II was the involvement of non- health sectors, which formulated their plans for inclusion in MTP - II.

From 1989, AIDS Control efforts were decentralized to the regions and districts, and from 1992, control efforts started also to be initiated within non-health sectors. The non-health sectors, which joined the NACP, included:

  1. Prime Ministers Office
  2. Ministry of Regional Administration and Local Government
  3. Justice Division
  4. Ministry of Education and Culture
  5. Ministry Community Development, Women Affairs and Children
  6. Ministry of Labor and Youth Development
  7. Youth Development Department
  8. Social Welfare Department
  9. Organization of Tanzania Trade Unions (OTTU)
  10. Ministry of Defense and National Services
  11. Chama Cha Mapinduzi (CCM) and Party Organizations
  12. Parent Associations (WAZAZI)
  13. Youth Organization (VIJANA)
  14. Ministry of Information and Broadcasting
  15. Ministry of Home Affairs
  16. Police
  17. Prisons

 

The main strategies and thrusts of MTP- II

  • Multisectoral involvement, through broadening of actors involved in AIDS control and prevention to all government Ministries and sectors, NGOs and private sector.
  • Decentralisation of Programme activities to the regional and district level to focus on local communities.
  • Community mobilization and involvement with community based IEC activities directed at risk groups especially the youth.
  • More emphasis on STD control and prevention.

 

By the year 2000 there were 23 other sectors that had joined the National Response to HIV/AIDS, and have developed AIDS action plans including all the districts in the country. During all this time the National AIDS Control Programme, remained the central co-coordinating unit as a Secretariat to the National AIDS Committee (NAC). In addition to Co-ordination, the NACP continued to serve as the main implementing agent for Ministry of Health as well as responding to needs of other non-health sectors.

1998 - 2002: Third Medium Term Plan (MTP - III)

In July 1998 the MOH published a strategic framework for MTP III for the prevention and control of HIV/AIDS/STIs for the period 1998 - 2002. In 26 March 1999, the Prime Minister Hon. F. Sumaye, launched the Third Medium Term Plan (MTP III) with the main objective of providing Multisectoral co-ordination from the national to the community levels.

Each public Institution was to establish a Technical AIDS Committee (TAC) to address HIV/AIDS issues within the context of their institutional activity. He also announced the formation of the National Advisory Committee (later the National Advisory Board on AIDS (NABA). The NABA under the chairmanship of the former President His Excellency Ali Hassan Mwinyi held their first meeting in September 1999.

Objectives of MTP - III

  • To protect and support vulnerable groups against HIV/AIDS.
  • To mitigate the Social-economic impacts of HIV/AIDS.
  • To strengthen the capacity of institutions communities and individuals to arrest the spread of the HIV/AIDS epidemic and mitigate its impacts.

Priority Areas

The MTP - III focused on 11 priority areas providing a framework for an expanded, Multisectoral response to the HIV/AIDS epidemic in Tanzania.

  1. Provide Appropriate STD Case Management Services
  2. Reduce unsafe Sexual Behavior among highly mobile population groups
  3. Reduce HIV Transmission among Commercial Sex Workers
  4. Prevent Unprotected Sexual activity among the Military
  5. Reduce vulnerability of Youth to HIV/AIDS/STD
  6. Maintain Safe Blood Transfusion Services
  7. Reduce Poverty Leading to Sexual Survival Strategies
  8. Promote acceptance of Persons Living with HIV/AIDS
  9. Reduce Unprotected Sex among men with Multiple Sex Partners
  10. Improve Education Opportunities especially for girls
  11. Reduce vulnerability women in adverse cultural environment

 

2001: - TACAIDS established
Established in 2001, TACAIDS became operational as the central coordinating structure for the HIV and AIDS National Response in Tanzania Mainland.   TACAIDS under the auspices of the Prime Minister's Office was mandated to lead Multi-Sectoral response. The role of TACAIDS is to intensify the national response through strategic leadership, policy guidance and co-coordinating public, voluntary, private and community efforts.

 

2003: The National Care and Treatment Plan for HIV and AIDS (NCTP): 2003-2008

  1. The first goal of the plan which started in October 2004 is scaling up HIV care and treatment services aiming at having more than 400,000 patients on ART by the end of the fifth year of the program. At the same time, some 1.2 million HIV+ persons not clinically eligible for HAART would be treated and monitored to track disease progression.
  2. Second goal is to strengthen the health care infrastructure through the expansion of human resources, facilities, equipment and comprehensive training in the care and treatment of PLHIV.
  3. Third goal is to foster information, education and communication efforts focusing on increasing public understanding care and treatment, reducing stigma and supporting on going prevention campaign.
  4. Fourth goal is strengthening social support for care and treatment of PLHIV in Tanzania, through home based Care. Local support groups and treatment partners.

2003–2006: Health Sector Strategy for HIV/AIDS (HSS)
The Health Sector Strategy for HIV/AIDS translates the health-related interventions in the National HIV/AIDS Multisectoral Strategic Framework (NMSF) developed by TACAIDS into concrete and detailed activities.

While the NACP remains a technical arm of the Ministry of Health, to spearhead the leadership in the health sector response to the HIV/AIDS epidemic, other sectors are increasingly taking up their roles in the spirit of the "Multisectoral response". The overall national Multisectoral response is being co-coordinated by TACAIDS. As a result of that, NACP will mainly focus the Health related activities in the control and prevention of HIV/AIDS/STIs in the country. The NACP is specifically responsible for the following areas in the response to the HIV/AIDS epidemic:

Implementation of health sector HIV/AIDS/STIs prevention and care interventions. These interventions include:

  • patient care (hospital based and home based care;
  • STD services,
  • Blood safety;
  • Public health education;
  • Voluntary counseling and testing.
  • Research co-ordination on HIV/AIDS/STIs
  • Surveillance of HIV/AIDS/STD Epidemic
  • Procurement and distribution of supplies and commodities
  • Technical support to other Sectors and Agencies

2003 – 2007- National Multi- Sectoral Strategic Framework on HIV/AIDS(NMSF)
The NMSF was formulated in line with the National Policy on HIV/AIDS, to guide the overall national response to HIV and AIDS. The overall national Multisectoral response is being co-coordinated by TACAIDS.
2008: HIV AND AIDS (PREVENTION AND CONTROL) 2008
An Act to provide for prevention, treatment, care, support and control of HIV and AIDS, for promotion of public health in relation to HIV and AIDS; to provide for appropriate treatment, care and support using available resources to people living with or at risk of HIV and AIDS and to provide for related matters, enacted by Parliament of the United Republic of Tanzania.  This Act was passed in the National Assembly on 1st February 2008 and it will apply to Mainland Tanzania. The Act is divided into 12 sections:

  • Part I: Preliminary Provisions
  • Part II: General Duties
  • Part III: Public Education and Programs on HIV and AIDS
  • Part IV: Testing and Counseling
  • Part V: Confidentiality
  • Part VI: Health and Support services
  • Part VII: Stigma and Discrimination
  • Part VII: Rights and obligations of persons living with HIV and AIDS
  • Part IX: Establishment of Research Committee
  • Part X: Monitoring and Evaluation
  • Part XI: Offences and Penalties
  • Part XII: Miscellaneous Provisions

2008- 2012: The Second National Multi-Sectoral  Strategic framework on HIV and AIDS
The NMSF guides the approaches, interventions and activities which will be undertaken by all actors in the country.

2008- 2012: Health Sector HIV and AIDS Strategic Plan- II (HSHSP-II)
The HSHSP-II will provide guidance to the operations of the sectoral response in the next five years. The theme of HSHSP is “Universal access to Preventive, Care, Treatment and Support services.”

 

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