TUNAJALI is a Swahili word connoting We Care. As caring people TUNAJALI II is committed to providing Comprehensive and Sustainable Clinical and Community HIV/AIDS Services to People Living with HIV/AIDS (PLHIVs) in the country so as to save lives. This five-year locally driven response is implemented by Deloitte Consulting Limited (DCL) and its main technical partner, Christian Social Services Commission (CSSC). The program is generously supported by the American people through the United States Agency for International Development (USAID) as part of the U.S. President's Emergency Plan for AIDS Relief (PEPFAR).
TUNAJALI II is a continuation of the concluded TUNAJALI programme. As part of our commitment to the provision of quality HIV prevention, care and treatment services TUNAJALI I trained 2,638 health community workers, renovated service delivery facilities, trained 2,160 volunteers for home-based care, installed solar power in 42 rural facilities and equipped laboratories.
Since most of PLHIVs were financially challenged, TUNAJALI I introduced Savings and Internal Lending Community (SILC) services to them and till the conclusion of the programme there were 323 SILC groups with a total membership of 8,289 and a total savings amounting to 859,232,464 shillings thus improving lives of many PLHIVs and their families.
Communities provide sustainable quality care and support to People Living with HIV.
To empower local Councils, communities and household members to mitigate the impact of HIV & AIDS and provide quality integrated and quality continuum of HIV care and support services provision.
The Program provides HIV/AIDS services at health facility, community and household levels in all districts of these five regions. TUNAJALI II serves as a catalyst to energize and empower local government councils, Faith Based Institutions, and Civil Society Organizations to deliver these services.
By doing so, TUNAJALI II contributes to national’s efforts to address HIV related prevention, care, treatment and support challenges including service accessibility, availability and quality. This includes supporting the authorities to maintain and scale-up HIV services to reduce HIV morbidity and mortality through investments in care, treatment, and support services; support in reducing new HIV infections; and building capacity to improve planning, coordination, gender mainstreaming, accountability and sustainable leadership and management for an effective HIV and AIDS response. The program ensures that other critical health issues such as relevant reproductive, maternal and neonatal health issues are addressed through increased service integration and coordination.
• Commitment to high quality care
• Establishment of effective networks, partnerships and referral mechanisms for comprehensive care
• Accountability and results-focus
• Enhancement of community ownership and drive
• Maintenance of client dignity, confidentiality and rights
• Ensure sustainability
The TUNAJALI Core Partners
Deloitte: The Prime and lead for finance management and grants. With growing world reputation for building management capacity in the developing world, and its’ growing portfolio of managing grants for large HIV/AIDS.
TUNAJALI Technical Assistance Partners
African Palliative Care Association (APCA): Palliative care and capacity building for TPCA
Center for Counseling, Nutrition and Health (COUNSENUTH): Nutritional support
Muhimbili College of Health Sciences (MUCHS): Stigma and discrimination issues
National Network of Tanzanian Women Living with HIV/AIDS (NETWO+): Stigma and significant involvement of PLHA in HIV/AIDS care and support
Overarching Program Approach
The goal of TUNAJALI is to deliver core palliative care and support packages to an increasing number of HIV/AIDS-affected households in Tanzania. We will achieve this by:
• increasing the accessibility and availability of care and support services;
• strengthening the capacity of civil society organizations (CSOs) to deliver palliative care and OVC support services in collaboration with communi ties and government health and social welfare systems;
• establishing effective linkages and supply systems;
• ensuring the application of national policies and guidelines; and ensuring that TUNAJALI lessons learned.
We will create Community Networks offering integrated, comprehensive, high-quality, and accessible care and support services for PLHA and OVC. Anchored at the district-level, these networks will enable scale-up of existing activities. Community Networks will be implemented in all districts of the selected regions and will expand service coverage within the catchment areas of Care and Treatment Clinics (CTC) in line with the Ministry of Health and Social Welfare’s (MoHSW) decentralization strategy for care and treatment services (health centers will evolve into CTC sites for initiation, refill or out-reach services).
In each district, we will build on and link current initiatives and local resources across the public health sector, CSO (FBOs and CBOs), and community systems. We will build local capacity to provide comprehensive services at these three levels. TUNAJALI will strengthen CSOs to provide a core package of palliation and support to PLHA as well as provide OVC with an age-specific core package of support services. To ensure provision of quality health care, the TUNAJALI program will empower both the CSOs and the health care facilities to integrate and internalize the concepts and functions of palliative and comprehensive care by strengthening referral and supportive supervision systems. We will ensure that quality nursing care is provided to all patients in need of palliation, hence CSO HBC supervisors, who are qualified nurses, will be trained and will mentor and supervise volunteers in the TUNAJALI communities. Formal partnerships with multisectoral institutions at the district level will be established to maximize support and ensure that the comprehensive needs (psychosocial, spiritual, legal support, income generation assistance (IGA), and nutrition support) of PLHA and OVC are met.
Headquarter of HACOCA, one of TUNAJALI Program sub - grantees in Mvomero District providing counselling services.
To enhance sustainability of Community Networks, the team will promote local ownership by engaging stakeholders (government, CBOs, FBOs, communities, PLHA groups, women’s groups, traditional and religious leaders, and caregivers) in the design, implementation, and evaluation of TUNAJALI activities. Community Networks will be ultimately supported at district and community levels by coordinating structures—Council Multisectoral AIDS Committees (CMAC) and Council Health Management Teams (CHMT). Accordingly, TUNAJALI will build the planning, coordination, monitoring and supportive supervision capacity of these local government bodies, and ensure the integration of CSO activities in district plans.
Ensuring beneficiaries access and enter the continuum of care provided by the Community Networks will be a high priority for TUNAJALI. We will promote the importance of personal knowledge of HIV status; strengthen referral mechanisms to and from health centers and community-based institutions; and reduce stigma and discrimination. Multiple entry points to TUNAJALI services, such as voluntary counseling and testing (VCT) sites, provider-initiated counseling at outpatient departments, tuberculosis (TB), maternal and child health (MCH), and pediatric wards in the catchment area will be reinforced along the care continuum.
At all points, linkages with these medical and social services will be established and promoted to maximize all opportunities to reach those in need. In addition, TUNAJALI will promote a household-centered approach wherein HBC volunteers will proactively train and support selected family members in the households to care for the sick and vulnerable children. Orphans and vulnerable children will be identified through a nationally standardized community-based identification process in collaboration with the Most Vulnerable Children Committees (MVCC).
TUNAJALI framework and approaches are based on the following principles:
• Evidence-based interventions and approaches
• Community ownership
• Gender equity
• Reduction of stigma and discrimination
• Quality assurance
• Continuum of care
• Collaboration with other donors and multisectoral partners
Integration of TUNAJALI in the Regionalization Approach for Care and Treatment
TUNAJALI will seamlessly integrate care and support activities into treatment activities in line with the regionalization policy of the MoHSW. TUNAJALI is well-placed to integrate health facility-based care and treatment services with community-based services, thus truly ensuring a continuum of care for affected individuals.
At the district level, TUNAJALI will coordinate closely with treatment facilities (supported by treatment partners) through joint progress meetings to ensure referral mechanisms between facilities and communities are in place and implemented effectively. Synergies created through the direct involvement of TUNAJALI partners in treatment activities include facilitating access of TUNAJALI care and support clients (children and adults) to CTC services at hospitals and, increasingly, to rural health centers, which will be providing treatment initiation, refill or outreach services through an initiative spearheaded by Deloitte and FHI in Tanzania.
This initiative will help address transport challenges (reported by Tumaini volunteers as a key challenge) experienced by rural family members in need of CTC services.