VZCZCXRO4275
RR RUEHBZ RUEHDU RUEHJO RUEHMR RUEHRN
DE RUEHDR #0110/01 0481351
ZNR UUUUU ZZH
R 171351Z FEB 09
FM AMEMBASSY DAR ES SALAAM
TO RUEHC/SECSTATE WASHDC 8272
INFO RUEKJCS/SECDEF WASHDC
RUEAUSA/DEPT OF HHS WASHINGTON DC
RUCNSAD/SOUTHERN AF DEVELOPMENT COMMUNITY COLLECTIVE
RUEHNR/AMEMBASSY NAIROBI 1163
RUEHKM/AMEMBASSY KAMPALA 3325
RUEHLGB/AMEMBASSY KIGALI 1253
RUEHJB/AMEMBASSY BUJUMBURA 2809

UNCLAS SECTION 01 OF 04 DAR ES SALAAM 000110 
 
SIPDIS 
 
AF/E FOR JLIDDLE 
STATE PASS USAID & Peace Corps 
DOD FOR WRAIR 
HHS FOR CDC 
 
E.O. 12958:  N/A 
TAGS: EAID KHIV TZ
SUBJECT: PEPFAR/TANZANIA:  CDC, AID, State, DOD & Peace 
Corps Partner with the GoT (and one another) to Save 
Lives 
 
REF: 2008 Dar es Salaam 727 
 
¶1.  Summary & Introduction:  The U.S. Mission to Tanzania 
is assistance-driven, with the largest part of that 
assistance devoted to the health sector.  The Secretary 
cited our success in combating malaria and HIV/AIDS 
during her confirmation hearings.  This message reviews 
our strategies and progress to date in the treatment, 
care and prevention of HIV/AIDS.  The Tanzanian public is 
well aware of the role of the American people in fighting 
this disease.  The goodwill engendered by our partnership 
with the Tanzanian government and public contributes 
greatly to our influence on a range of diplomatic issues 
outside the health sphere.  PEPFAR discussions with the 
Tanzanian government on a formal Compact will further 
expand this synergy. 
 
¶2.  At the inception of PEPFAR/Tanzania in 2004, adult 
prevalence was estimated at 7 percent.  It is now 
estimated at 5.7 percent. Other key statistics include 
1.4 million people living with HIV/AIDS; an estimated 
440,000 individuals clinically eligible for 
antiretroviral treatment; and an estimated 1 million 
orphans and vulnerable children (OVC) in need. 
 
¶3.  As of September 2008, PEPFAR/Tanzania has achieved 
the following: 
 
-- 138,000 individuals receiving antiretroviral 
treatment; 
-- 352,000 individuals receiving palliative care; 
-- 290,000 orphans and vulnerable children (OVC) directly 
served; 
-- 34,000 HIV-positive pregnant women receiving 
antiretroviral prophylaxis; 
-- 2,650,000 annual counseling and testing encounters; 
and -- 2,800,000 individuals reached with outreach 
HIV/AIDS prevention programs. 
 
The USG supports every medical and nursing institution in 
Tanzania and works with the GoT on strategies for 
sustainable health service delivery. The collaborative, 
mutually supportive modus operandi of the PEPFAR agencies 
contributes greatly to setting a "one government" tone 
throughout this Mission. End Summary & Introduction. 
 
The Scope of the Epidemic 
------------------------- 
 
¶4.  Adult (15-49 year old) HIV prevalence in Tanzania is 
estimated at 5.7 percent.  An estimated 1,400,000 
Tanzanians are living with HIV/AIDS with 96,000 
Tanzanians dying each year from AIDS-related causes, 
resulting in further increases to the population of HIV 
orphans and vulnerable children (OVC), currently 
estimated at about one million.  There is wide regional 
variation in prevalence, from 15.7 percent in Iringa 
(Southern Highlands) to 0.8 percent in Unguja, the main 
island of Zanzibar (Source: 2007-08 THMIS). 
 
Our Team:  Who Does What 
------------------------ 
 
¶5. The PEPFAR agencies accomplish their goals through 
close collaboration with the Tanzania Commission for AIDS 
(TACAIDS) and the Ministry of Health and Social Welfare 
(MOHSW) on the mainland and Zanzibar AIDS Commission 
(ZAC) and MOHSW/Zanzibar in Zanzibar (both the islands of 
Unguja and Pemba), regional officials and a large number 
of Tanzanian and international non-governmental 
organizations.  The Chief of Mission (currently the 
Charge d?affaires) is responsible for the overall 
leadership of the PEPFAR/Tanzania program.  He is 
supported by a Country Coordinator.  The four agency 
heads (CDC, USAID, DoD/Walter Reed, & Peace Corps) along 
with the Coordinator comprise the Interagency HIV 
Coordinating Committee (IHCC), which provides overall 
program direction and strategy guidance. The IHCC is 
chaired by the Chief of Mission.  The Coordinator chairs 
 
DAR ES SAL 00000110  002 OF 004 
 
 
the management and operations group which addresses 
program implementation and interagency coordination and 
collaboration. 
 
¶6.  The PEPFAR agencies are active members of the Public 
Outreach Working Group, which coordinates our messages to 
the Tanzanian public.  These messages emphasize the close 
USG-GoT-civil society partnership and that the work is 
funded by the generosity of the American people.  We 
emphasize one brand, ?the American People,? to the 
Tanzanian public, while communicating to Washington the 
accomplishments of individual agencies on the PEPFAR 
team. 
 
¶7.  PEPFAR partner agencies have the following broad 
roles: 
 
Department of State: Provides overall in-country 
strategic planning and coordination through the Chief of 
Mission; Leads public diplomacy efforts and leverages the 
impact of PEPFAR as a public diplomacy tool; Houses the 
PEPFAR Tanzania Coordination Office; Serves as the public 
affairs and communications support arm of PEPFAR 
Tanzania. 
 
CDC:  Provides direct technical assistance to the 
Government of Tanzania, particularly the Ministry of 
Health and Social Welfare and contributes credible 
scientific and technical advice and assistance in public 
health response, surveillance, epidemiology, laboratory 
strengthening, disease prevention and control and 
implementation of care and treatment; Undertakes and 
provides technical assistance in the development and 
implementation of public health evaluations. 
 
USAID:  Supports expanded and strengthened non- 
governmental engagement; Provides a range of acquisition 
and assistance instruments for implementation flexibility 
across the PEPFAR program; Contributes expertise in care, 
health systems strengthening, prevention, primary care, 
TB and malaria; Provides expertise in community-based 
strategies and long-term development; Leverages non- 
PEPFAR funding in ?wrap-around? areas including maternal 
and child health, economic growth, water and sanitation, 
and democracy and governance. 
 
DoD/Walter Reed:  Administers care, treatment and 
prevention programs to the general public.  Conducts HIV 
vaccine research; Serves as the lead PEPFAR liaison to 
the military, the Tanzania Peoples Defense Forces; 
Leverages vaccine research assets to provide lab quality 
assurance/quality control technical assistance to DoD and 
other USG treatment partners. 
 
Peace Corps:  Accesses target groups who implement 
programs in local communities.  Encourages Peace Corps 
Volunteers (PCVs) to implement prevention, care and 
nutrition wrap-around programs, including through 
permaculture and community gardening concepts.  Provides 
small grants for project implementation to communities 
hosting PCVs. 
 
Results to Date 
--------------- 
 
¶8.  Care:  Care activities in Tanzania include adult and 
pediatric care and support, support for TB and HIV 
program integration, and support to OVC.  By September 
2010, TB clinics in 132 districts will provide TB/HIV 
services with 49,680 TB patients expected to be served. 
The program is focusing on improving the quality and 
comprehensiveness of OVC services, which cover the full 
spectrum of child development needs from birth to age 18. 
 
¶9.  Treatment: Treatment activities include the provision 
of free ARV drugs, adult and pediatric services, and 
laboratory support.  The USG is improving broad 
geographic coverage, operating efficiencies, and 
enhancing service linkages between facilities and 
 
DAR ES SAL 00000110  003 OF 004 
 
 
communities while improving the quality and 
comprehensiveness of services.  Pediatric treatment 
activities identify HIV-positive infants and children and 
provide pediatric treatment services. Our ART program is 
on track to provide direct treatment support to at least 
180,000 adults and children by December 2010. 
 
¶10.  Systems Strengthening:  One of our highest 
priorities in FY 2009 is to address the shortage of 
health care workers in Tanzania.  Funding has prioritized 
support for the training of new health care workers and 
enhanced quality of pre-service training. To address 
retention issues, we will develop interventions that 
address key reasons workers leave the health sector.  We 
support information systems, capacity building for 
monitoring and evaluation, and direct assistance for 
disease surveillance activities.  We also engage with the 
GoT to ensure the provision of drugs and commodities 
required for effective prevention, care and treatment, 
providing capacity building in logistics management 
functions.  We collaborate with the Health Ministry to 
strengthen national and point-of-service laboratory 
capacity, including HIV diagnosis, and therapeutic 
monitoring. 
 
¶11.  Prevention: We will continue to support the scale up 
of quality prevention of mother-to-child transmission 
(PMTCT) services and promote the use of more efficacious 
regimens.  In sexual prevention, we focus on the key 
geographic areas, populations, and behaviors which are 
driving the Tanzanian epidemic: in particular, adults and 
high-risk youth within high prevalence regions.  With 
most at-risk populations, including sex workers, our 
focus includes community-based outreach, access to 
counseling and testing, condom promotion, and STI 
services.  To prevent medical transmission, we strengthen 
systems for blood collection, testing, and storage, 
including support to strengthen the National Blood 
Transfusion Service. We also support the scale up of the 
Infection Prevention and Control/Injection Safety 
programs, with a focus on training, procurement, waste 
management, and health care worker safety. 
 
¶12.  We play key roles in the HIV sector beyond program 
implementation.  We chair the Development Partners? 
Group-HIV/AIDS.  We have strong representation on the 
Tanzania National Coordinating Mechanism, which monitors 
the implementation of grants from the Global Fund to 
fight AIDS Tuberculosis and Malaria.  We have developed a 
model public-private partnership approach to leverage 
additional resources. 
 
The Compact:  The Future of the USG/GoT Partnership 
--------------------------------------------- ------ 
 
¶13.  Our team has been working closely with the GoT to 
define six core goals which will serve as the basis for a 
compact. These areas are: 
 
-- service maintenance and scale up; 
-- prevention; 
-- leadership and management; 
-- sustainable and secure HIV drug and commodity supply; 
-- human resources; and 
-- evidence-based and strategic decision making. 
 
Achievement of these goals will remedy systematic 
weaknesses that have, to date, prevented the GoT from 
addressing the HIV epidemic more independently. 
 
¶14.  Despite the enormous gains achieved by our PEPFAR 
team and their Tanzanian partners, well ahead of their 
projected results, there remains a large unmet need in 
this country for care, treatment and prevention services. 
While the compact has the ultimate aim of turning full 
responsibility for these programs over to the Tanzanian 
government, it must also ensure that progress is made 
towards this unmet need.  There are two major obstacles 
that the compact must address: weak health delivery 
 
DAR ES SAL 00000110  004 OF 004 
 
 
structures that need time to absorb the enormous scale-up 
achieved over the last five years and the fact that 60 
percent of health sector jobs are vacant due to lack of 
capacity to train an adequate number of health care 
providers and "brain-drain" losses. Our efforts focus on 
increasing the capacity of Tanzania to cope with the 
epidemic. 
 
¶15.  Despite enormous challenges, PEPFAR/Tanzania has 
achieved remarkable results, including increasing GoT 
political support and commitment for HIV/AIDS and strong 
USG-GoT collaboration.  All targets have been met or 
exceeded, and the PEPFAR team has been noted as a model 
of Staffing for Results.  Through positive, open 
engagement, public perceptions in Tanzania regarding 
PEPFAR are very positive.  Given the size of 
PEPFAR/Tanzania relative to the rest of the USG presence 
in Tanzania, the collaborative, mutually supportive modus 
operandi of the PEPFAR agencies contributes greatly to 
setting a "one government" tone throughout this Mission. 
 
ANDRE