Tanzania

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Tanzania, the largest country in East Africa, has a population of more than 35 million people. More than three-quarters of the population lives in rural areas of the country. With a per capita income of only $320 USD, the country suffers high levels of malnutrition and food poverty. More than one-fifth of its people are underweight and 39 percent live below the basic needs poverty line.

Health Care System
Tanzania’s public health care system is based on a referral system extending from national specialized hospitals through regional and district hospitals to more than 3,000 local dispensaries or clinics. With only 822 doctors and 13,292 nurses for the entire country, Tanzania’s health care system suffers chronic personnel shortages. Life expectancy averages 48 years of age.

HIV/AIDS in Tanzania
Tanzania has an estimated 2.2 million people living with HIV/AIDS, or a seroprevalence rate of approximately 6.5 percent. HIV/AIDS has also orphaned an estimated 1.1 million children. Urban areas of the country have the highest infection rates at up to 19 percent. Changes in seroprevalence patterns, however, indicate that, by 2010, rural areas may account for twice the number of new infections as in urban areas. A recent rise in injecting drug use is also expected to contribute to increased infection rates.

ICAP in Tanzania
In July 2004, Tanzania launched a national HIV/AIDS care and treatment program. More recently, it announced plans to expand HIV services from 200 to 700 healthcare facilities. The number of patients to be initiated on antiretroviral therapy (ART) is expected to increase from 440,000 in 2008, to 600,000 in 2012. In support of these goals, the International Center for AIDS Care and Treatment Programs (ICAP) at Columbia University’s Mailman School of Public Health has been working with the Tanzania Ministry of Health and Social Welfare since 2004 to build broad capacity for HIV/AIDS services at the national and local levels. Supporting sites in Kagera, Kigoma, and Pwani Regions, as well as in Zanzibar, ICAP provides a range of technical and financial support, including: infrastructure development, renovations of clinics and laboratories, and provision of equipment and supplies clinical training and supportive supervision of multidisciplinary teams assistance with laboratory, pharmacy, and medical records systems and the establishment of services and programs to enhance patient enrollment, follow-up, and adherence.

Support for Programmatic Activities
ICAP activities in Tanzania are comprehensive and designed to build sustainable programs. They include:

  • Supporting comprehensive HIV/AIDS services for children and adults, including counseling and and testing, prevention of mother-to-child transmission (PMTCT) of HIV, ART, and prophylaxis for opportunistic infections, and adherence support systems;
  • Strengthening human resource capacity, including training and mentoring of health care workers, and assisting districts in developing HIV/AIDS programs;
  • Developing specialty services, including early infant HIV diagnosis capability, management of HIV-related malignancies, and palliative care services for HIV-positive people;
  • Designing supportive services, including computerization of patient records.

ICAP supports Tanzania’s district network approach to bring HIV/AIDS services to remote portions of the country. HIV-infected individuals are identified through PMTCT and counseling and testing services at health centers and dispensaries, and subsequently linked with HIV care and ART at higher level facilities. In addition, ICAP is supporting the government’s effort to decentralize HIV/AIDS services from district hospitals to local health centers in rural areas. To this end, ICAP pioneered a “fast-track” approach for the rapid initiation of HIV/AIDS services at rural health facilities.

Goals
By 2009, ICAP expects to support more than 150 facilities providing PMTCT services and more than 60 facilities (including 35 primary health centers) providing HIV/AIDS services. Further development of partnerships with faith-based and community organizations will also strengthen links between ICAP-supported sites and nutrition and orphan programs, as well as psychosocial care and other support services.

Partners
ICAP has established partnerships with numerous government and community organizations, including all 22 districts in the four regions of Zanzibar, Kagera, Kigoma, Pwani, and numerous faith- based and private sector clinics. In addition, ICAP supports the Ocean Road Cancer Institute in its efforts expand palliative care nationally and is working with Bugando Medical Center on a national expansion of laboratory services for early infant diagnosis. Several other non-governmental organizations are also key partners, including the Zanzibar Association of People Living with HIV/AIDS group, the Zanzibar Non-Governmental Organization Cluster, and many others.

ICAP-supported Sites in Tanzania

TB/HIV Job Aids and Booklets