TECHNICAL PROPOSAL: USAID TANZANIA-06-003-RFA
Community Care for People Living with HIV/AIDS and Orphans/ Vulnerable Children.
The TUNAJALI Program
July 18, 2011September 2, 2008
Kenneth P. LuePhang
Agreement Officer
USAID/Tanzania
Mikocheni
Dar es Salaam
Tanzania
Re: Community Care for People Living with HIV/AIDS and Orphans/ Vulnerable
Children (USAID TANZANIA-06-003-RFA)
Dear Mr. LuePhang
Deloitte Consulting Limited, along with partners, Family Health International, Catholic Relief Services, and Africare, is pleased to present our technical proposal in response to the above referenced RFA. In the last five years Deloitte has successfully managed more than five awards in Tanzania, in the area of HIV/AIDS, amounting to over US$ 25 million. These awards ranges from the management of the multi donor funded Rapid Funding Envelope for HIV/AIDS to the costing of the national HIV/AIDS strategic plans in Zanzibar and main land Tanzania.
Our TUNAJALI team aims to scale-up the national HIV/AIDS response by increasing the number of persons living with HIV/AIDS and orphans/vulnerable children receiving care and support services. Our strategic approach takes into account empowering existing local capacity and working towards sustainable progress. We demonstrate this commitment to sustainability through the partnerships we have established with local technical assistance partners, who will provide important technical contributions to the program, and through our commitment to provide 55% of the total RFA funds to local partners.
We stand ready to respond to any queries you may have regarding this RFA.
We remain,
Yours sincerely,
Joe Eshun,
Director
CONTACT SHEET
Deloitte Consulting Limited
Contact Address : P O Box 1559
Dar es Salaam
Tanzania
Delivery : 10th Floor, PPF Towers
Cnr. of Ohio Street & Garden Avenue
Dar es Salaam
Tanzania
Telephone : (255 – 22) 2116006
Facsimile : (255 –22) 2116379
E-Mail :
Contact People for this Proposal:
Director: Joe Eshun Tel: (255 - 22) 2116006
Senior Consultant: Rhoda Mshana Tel: (255 - 22) 2116006
Our Client Service Standards
1. Determine, on each engagement, who our clients are and directly ascertain their expectations for our performance.
2. Analyze our clients’ needs and professional service requirements.
3. Develop client service objectives that will enable us to fulfill our professional responsibilities, satisfy our clients’ needs, and exceed their expectations. Prepare an appropriate client service plan to achieve these client service objectives.
4. Execute the client service plan in a manner that ensures commitments are met, potential problems anticipated, and surprises avoided.
5. Establish effective and creative communication, both internal and external, to enhance client perceptions of value and quality of our service.
6. Provide management with insights on the condition of their business and meaningful suggestions for improvement.
7. Continually broaden and strengthen our relationships with key management personnel to facilitate effective communication and foster client loyalty.
8. Ensure that any professional, technical, or client service problem is resolved promptly with timely consultation in an environment of mutual respect.
9. Obtain from the client, either formally or informally, a regular assessment of our performance.
10. Receive fees that reflect the value of services provided and responsibilities assumed and are considered fair and reasonable by our clients.
This application includes data that shall not be disclosed outside the U.S. Government and shall not be duplicated, used, or disclosed – in whole or in part – for any purpose other than to evaluate this application. If, however, a grant is awarded to this applicant as a result of – or in connection with – the submission of these data, the U.S. Government shall have the right to duplicate, use, or disclose the data to the extent provided in the resulting grant. This restriction does not limit the U.S. Government’s right to use information contained in these data if it is obtained from another source without restriction. The data subject to this restriction are contained in this proposal.
Abbreviations and Acronyms
ABC / Abstinence, Be Faithful, CondomsAIDS / Acquired Immune Deficiency Syndrome
AIDSCAP / AIDS Care and Prevention Project
APCA / African Palliative Care Association
ART / Anti Retroviral Therapy
ARV / Antiretroviral
BCC / Behavior Change Communication
C&G / Contracts and Grants
CA / Cooperating Agency
CBO / Community Based Organization
CDC / Centers for Disease Control and Prevention
CHMT / Council Health Management Team
CMAC / Council Multisectoral AIDS Committees
COC / Continuum of Care
COP / Chief of Party
COPE / Community-Based Orphan Care, Protection and Empowerment Project
COUNSENUTH / Centre for Counseling, Nutrition, and Health Care
CRS / Catholic Relief Services
CSO / Civil Society Organization
CTC / Care and Treatment Clinic
DFID / Department for International Development (UK)
DHS / Demographic and Health Survey
DMS / Data Management System
DSW / Department of Social Welfare
DSWO / District Social Welfare Officer
EMG / Emerging Markets Group Limited
ENA / Essential Nutrition Actions
EPI / Expanded Program on Immunizations
EU / European Union
F&A / Finance and Administration
FBO / Faith Based Organization
FHI / Family Health International
FP / Family Planning
GAP / Global AIDS Program
GOT / Government of Tanzania
HAART / Highly Active Antiretroviral Therapy
HBC / Home Based Care
HIV / Human Immunodeficiency Virus
HR / Human Rights
IA / Implementing Agency
ICRW / International Centre for Research on Women
IDU / Injecting Drug Use
IEC / Information, Education, and Communication
IGA / Income Generating Activities
IMAI / Integrated Management of Adult Illnesses
IMCI / Integrated Management of Childhood Illnesses
IMPACT / Implementing AIDS Prevention and Control Project
IR / Intermediate Result
ITN / Insecticide Treated bedNet
LOA / Letter of Agreement
LOI / Letter of Intent
M&E / Monitoring and Evaluation
MCH / Maternal and Child Health
MIS / Management of Information Systems
MOH / Ministry of Health
MOHS&W / Ministry of Health and Social Welfare
MOU / Memorandum of Understanding
MTCT / Mother-to-Child Transmission
MUCHS / Muhimbili University College of Health Sciences
MVC / Most Vulnerable Children
MVCC / Most Vulnerable Children Committee
NACP / National AIDS Control Program
NETWO+ / National Network of Tanzanian Women with HIV/AIDS
NGO / Non Governmental Organization
OGAC / Office of the Global AIDS Coordinator
OI / Opportunistic Infection
OPD / Outpatient Department
OR / Operations Research
ORT / Oral Rehydration Therapy
OVC / Orphans and Vulnerable Children
PASADA / Pastoral Activities and Services for People with AIDS in Dar es Salaam Archdiocese
PHC / Primary Health Care
PLWHA/PLHA / Person Living with HIV/AIDS
PMP / Performance Monitoring Plan
PMTCT / Prevention of Mother to Child Transmission of HIV
Pride Tanzania / Promotion of Rural Initiatives and Development Enterprises Limited
PSS / Psychosocial Support
QA / Quality Assurance
RCH / Reproductive and Child Health
RFA / Request for Applications
RFE / Rapid Funding Envelope for HIV/AIDS
RH / Reproductive Health
SO / Strategic Objective
SOP / Standard Operating Procedures
SRH / Sexual Reproductive Health
STD / Sexually Transmitted Disease
STI / Sexually Transmitted Infection
TA / Technical Assistance
TACAIDS / Tanzania Commission for AIDS
TAWLA / Tanzanian Women Lawyers Association
TB / Tuberculosis
TBD / To be Determined
THIS / The HIV Indicators Survey in Tanzania
TOCAT / Technical and Organizational Capacity Assessment Tool
TOR / Terms of Reference
TOT / Training of Trainers
TPCA / Tanzania Palliative Care Association
U5 / Under 5 years of age
UN / United Nations
UNAIDS / Joint United Nations Program on HIV/AIDS
UNFPA / United Nations Fund for Population Activities
UNICEF / United Nations Children’s Education Fund
UNIFEM / United Nations Development Fund for Women
USAID / United States Agency for International Development
USG / United States Government
VCT / Voluntary Counseling and HIV Testing
VMAC / Village Multisectoral AIDS Committees
VSO / Voluntary Service Organization
WHO / World Health Organization
ZAC / Zanzibar AIDS Commission
ZACP / Zanzibar AIDS Control Program
TABLE OF CONTENTS
INTRODUCTION 1
TECHNICAL APPROACH 2
1.0 Background and Challenges 2
2.0 Tunajali Team 3
3.0 Overarching Program Approach 3
4.0 Integration of TUNAJALI in the Regionalization Approach for Care and Treatment 6
5.0 Objectives and Activities 6
7.0 Monitoring and Evaluation Plan 16
MANAGEMENT 17
A. Organizational Structure 17
B. Partner Roles 18
C. Program Management 19
D. Grants Management 20
E. Financial Management 21
KEY PERSONNEL 21
A. Chief of Party 22
B. Technical Advisor 22
C. Program Director 22
D. Finance and Grants Director 23
E. Grants Coordinator 23
C. Long and Short-Term Technical Assistance 23
INSTITUTIONAL CAPACITY 24
Appendices
Appendix 1: Curriculum Vitae: Key Personnel
Appendix 2: Letters of Support
Appendix 3: Letters of Corporate Collaboration and Support
Appendix 4: Pain Management Tool
Appendix 5: TUNAJALI Supervisory System
Appendix 6: Sample Referral Tool
Appendix 7: Performance and Monitoring Plan
Appendix 8: TUNAJALI Monitoring and Evaluation Framework
Appendix 9: Quality Assurance System
Appendix 10: Letters of Commitment: Key Personnel
Appendix 11: TUNAJALI Skills Matrix
Appendix 12: TUNAJALI Past Performance References
Appendix 13: Comprehensive Exist Strategy for Local Partner Sustainability
© 2006 Deloitte Consulting Community Care for PLHAs and OVC Program. vi
INTRODUCTION
Deloitte Consulting Limited proudly presents this proposal to implement the Community Care for People Living with HIV/AIDS and Orphans/Vulnerable Children or TUNAJALI “We Care” Program. The TUNAJALI Team includes: Deloitte as the prime partner; Family Health International (FHI), as lead technical partner; Catholic Relief Services (CRS); and Africare. With our key technical assistance partners, the African Palliative Care Association (APCA), Centre for Counselling, Nutrition, and Health Care (COUNSENUTH), Muhimbili University College of Health Sciences (MUCHS), National Network of Tanzanian Women with HIV/AIDS (NETWO+), Promotion of Rural Initiatives and Development Enterprises Limited (Pride Tanzania), and the Tanzanian Association of Women Lawyers (TAWLA), and up to 45 local implementing partners, the TUNAJALI team offers both continuity and innovation in developing the high quality and integrated health services called for under this program.
Our Team’s competitive edge: The TUNAJALI approach informed by our significant experience in the target geographic areas—over 20 combined years of experience—fully recognizes the challenges faced by the HIV/AIDS response in Tanzania. Our realistic strategy leverages each partner’s unique strengths and expertise to address these challenges; Deloitte in management systems, including grants and financial management of HIV/AIDS programs; FHI in HIV/AIDS comprehensive care technical leadership and experience in Dodoma, Iringa, and Morogoro; CRS in bringing the strengths of faith-based networks to bear on the HIV/AIDS response and its nine years of multisectoral experience in Mwanza; and Africare’s OVC expertise, and wrap-around program experience and established working relationships in Zanzibar. Our collective strengths include a thorough understanding of the local health care environment, and a sound and practical technical approach that: integrates our own lessons learned as well as global experiences; builds on existing United States Government (USG), Government of Tanzania (GOT) and private investments; and develops capacity of local organizations with a focus on sustainable progress. Our coherent strategic approach ensures that fragmentation among partners is reduced, activity overlap is eliminated, and gaps are addressed in existing community services programs.
An evidence-based technical approach that achieves results: Our technical approach will create district-based Community Networks of comprehensive and high-quality services provided by the public health system and civil society organizations (CSOs). We will focus attention on five regions of mainland Tanzania and Zanzibar. Activities will contribute to the U.S. President's Emergency Plan for AIDS Relief targets by achieving the following key results:
· 90,720 persons living with HIV/AIDS (PLHA) reached with home-based palliative care
· 103,680 OVC reached with care and support services
· Up to 45 CSOs with technical and organizational capacity to provide care and support services, and at least five CSOs empowered to receive direct funding from USG
The TUNAJALI team has extensive expertise in quickly engaging local partners with significant reach to provide essential services along the prevention-care-treatment continuum. The management team of TUNAJALI is made up of local and international experts with relevant experiences (see Appendix 1 for Curriculum Vitae of our Key Personnel). Ours is a management team that has earned the trust and support of a wide range of Tanzanian government authorities, civil society and community partners essential for success (see pledges of support from current and potential future partners in Appendix 2).
TECHNICAL APPROACH
1.0 Background and Challenges
With an estimated 1.4 million persons living with HIV[1], Tanzania bears a large share of the global HIV/AIDS burden. The epidemic has reached critical levels with prevalence rates as high as 13.4% in Iringa region, 7.3% in Coast, 7.2% in Mwanza, 5.4% in Morogoro, 4.9% in Dodoma and 0.6% in Zanzibar (2004 Tanzania HIV/AIDS Indicator Survey). Alarmingly, Tanzania also has a growing proportion of children orphaned by HIV, currently estimated at 6% of all children (0-17)[2]. Beyond orphans, approximately 110,000 children1 (0-14 years) are living with HIV/AIDS and many are caring for chronically ill household members.
Efforts to control the HIV/AIDS epidemic in Tanzania have been met with many diverse challenges. High levels of stigma prevent vulnerable persons from knowing their status and from accessing health services. Under the Tumaini Program, less than 20% of the PLHA reached by the program knew their serostatus. Health behavior data show that a low proportion of men compared to women, access care and treatment services. Furthermore, access to information and health care is limited in Tanzania. The public health system, characterized by inadequate infrastructure, shortages of qualified staff, insufficient and inconsistent supply of essential drugs and other supplies and, most importantly, a lack of knowledge and skill in palliative care and support for PLHA, cannot effectively respond to the growing demand for clinical and community care and support services. To date, only 70,789 of the estimated 500,000 persons living with HIV (PLHA) in need of care services are enrolled in care and treatment programs of whom 34,623 have been started on ARTs. Less than a quarter of the 500,000 persons have been reached with home-based care (HBC) services.
As the number of orphans and vulnerable children (OVC) continues to increase, traditional family and community safety structures are now inadequate in meeting their needs. Orphaned and vulnerable children have become a burden to their caregivers or become caregivers themselves and are relied upon to be wage earners. Their limited access to health services and poor nutrition contribute to an increase in their vulnerability to illnesses. Although primary education is compulsory and without charge, there are other expenses that may deter school attendance, such as costs for uniforms, textbooks, and other fees.