Rombo District Experience

8th Annual CDC/HRSATrack 1.0 Partners Meeting

Dr. Criston NkyaDistrict Medical Officer

Rombo District, Kilimanjaro, Tanzania

Header Bullet 1

Bullet 2 Bullet 3

Outline• Background• District Approach• Achievements• Strengths and challenges• Way forward

Background• Rombo 1 out of 7 districts forming Kilimanjaro region• Covering about 1,442 km² of mainly mountainous area • Population 305,289; mainly subsistence farmers• Growth rate 2.8%• 43 health facilities:

– 2 Hospitals (FB; 1 acts as designated DH)– 4 Health Centres (all GOT)– 37 Dispensaries (21 GOT; 8 FB; 8 private)

• HIV prevalence 1.9%* - 2.9%** • 6 Health Facilities offer CT services

* Tanzania HMIS 2007-08, Kilimanjaro region** Jan-June 2010 EGPAF PMTCT program data

Background (2)• First USG support (ICAP) started in Jan. 2004– Facility approach to the designated DH

• After regionalization, EGPAF support from Oct. 2006 onwards– District Approach– Sub-grants for PMTCT (USAID) and C&T (CDC)– District-wide support including LLHF

• C&T (CDC) support includes– Ped HIV, TB/HIV, LAB, EID, SCM, CL, TCB, M&E, QI

District Approach• Sub-grants with mainly District Authorities: Council

Health Management Teams (CHMT)• Annual contract renewal workshops

– Workplan and budget development– U.S. Govt. rules and regulations

• District Executive Director signs the sub-grant• DMO oversees program• In line with MOHSW policies of decentralization• Builds capacity of existing local systems and

stakeholders• Increases ownership and sustainability• Allows rapid expansion of high quality patient services

up to LLHF

Achievements• Established 6 CTC centres (and 32 PMTCT centres)• Renovated 2 CTC facilities• Procured 1 vehicle and 2 motorcycles• Improved specimen transportation (CD4 / DBS PCR)• Procured FACS Count, Haematology and Biochemistry

machines and their reagents • Increased availability of drugs for opportunistic

infections and test kits• District-owned and -organized trainings• Community sensitization on HIV and related programs

Achievements (2)• Care– Cumulative 3,187 patients; 472 children (15%)– Current 1,927 patients; 309 children (16%)

• ART– Cumulative 1,618 patients; 201 children (12%)– Current 1,172 patients; 165 children (14%)

• HCW’s trained for C&T (CDC funded)– 21 HIV and ART (including pediatrics)– 3 District Mentors– 28 IMAI– 42 HCW’s in EID, plus 3 TOT’s– 34 Lay Counsellors

Achievements (3)

Q406 Q107 Q207 Q307 Q407 Q108 Q208 Q308 Q408 Q109 Q209 Q309 Q409 Q110 Q2100

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CUMULATIVE ON ART; PEDS COMPARED WITH ALL PATIENTS ON ARTCU

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Strengths• Involvement and capacity building of all district

managers• Training of trainers and ownership of trainings at

District Level• Improves regular supportive supervision and on-site

mentorship• Strengthens capacity to monitor both U.S. Govt. and

MOHSW funds• Strengthens logistical and SCM capacity• Contributes to sustainable health systems strengthening

Challenges• Nation-wide challenges

- Human resources shortages and high turn-over- Inadequate physical infrastructures- Lack of equipment

• Delays in program implementation due to bureaucracy at District level– But procedures are necessary to follow rules and

regulations• Challenges in the National SCM systems

Way Forward• Further strengthening of CHMTs– Financial and managerial capacity– Technical expertise

• Through– Initiatives to increase the workforce– On the job and classroom training of DMO,

District AIDS Control Coordinators, Health Care Providers, and other key stakeholders

Asanteni sana!