Tanzania has a HIV epidemic at an estimated range of approximately 12% of the adult population (15-49 years) being infected. The epidemic is still increasing and there are few signs that the epidemic will level off in the near future. Until 2000 the response to the epidemic was the responsibility of NACP, the National AIDS Control Programme, within the MoH. As the epidemic and the insight of the impact of the epidemic on society progressed the health approach changed to a multi-sectoral response – still led by the MoH. However, as in other countries with a significant HIV epidemic it was decided to move the response of the epidemic to the highest level of government. The multi-sectoral approach thus underwent a transformation from a strategy of the MoH to a strategy of GOT by placing the responsibility under the Prime Ministers’ Office. In this transition the TACAIDS was formed to provide the leadership of GOT’s fight on HIV/AIDS in 2001. TACAIDS is placed within the PM’s Office and has slowly started to become operational. In January 2002 the commissioners were appointed and the first meeting will take place in February. The NACP is undergoing a transformation from being the body for the national response of all sectors in society to be part of the response from the MoH. The new role of NACP is still being developed, but it has been decided that the NACP in the future will operate under the authority of the CMO in the MoH. The task within the health sector is huge since the health sector is the first to be impacted by the epidemic and many of the cost-effective preventive measures to combat the epidemic, such as STI treatment, and the care of an increasing number of people being sick and dying from HIV/AIDS, fall on this sector to be appropriately dealt with in partnership with civil society and other stakeholders. The timing of the mission is appropriate as far as HIV/AIDS is concerned. Great expectations are attached to TACAIDS to ensure leadership and the MoH can now concentrate on improving the provision of services in the health sector where it has a comparative advantage. At the same time new money are being made available from the donors in the basket fund for district health services and new resources are soon going to be available for HIV/AIDS activities: the Global Fund for AIDS, the HIPC money, and the TMAP – perhaps effective from 2003. The opportunity to consolidate the achievements in the health sector has never been greater. It is the objectives of the review to assess the performance of the health sector’s response to HIV/AIDS; main challenges regarding the consequences and combat of HIV/AIDS; and based on this recommend actions in the short and medium term. The scope of work includes a review the performance of the National Aids Control Programme
and the opportunities lying ahead for TACAIDS. Further the review on HIV/AIDS will assess constraints and opportunities within the health sector with regard to both preventive and care interventions including MTCT and HAART treatment. The response is assessed with regard to the capacity of the health care sector. In all these areas the following should be considered: Experience within Tanzania with a view to possible best practices and lessons learned. Cost implications should be considered, with a particular view to opportunity cost in areas where there would be a choice. Private sector possible contribution and specific problems The team, Adeline Kimambo, medical doctor and Anita Alban, health economist, hold international and national experience in the field of HIV/AIDS. The team carried out a review of existing documentation, including policies and guidelines, and interviews were carried out with key people within MOH, PORALG, TACAIDS and civil society (NGOs for PLWHA). Further a field trip was undertaken to a district that is part of the health sector reform process. For the Health District Reform to succeed it needs an effective facilitated response from the MoH and cooperation from all stakeholders in the process – not least PRORALG. The report reflects this approach by reviewing and assessing both the new opportunities and obstacles of the MoH in the transition from a multi-sectoral response to a consolidated health sector response and the progress of the decentralisation process at district level. Further the team has made a strategic choice in focusing on the HIV/AIDS interventions that can make a significant difference if scaled up. In the time available for the team a choice also had to be made between assessing MTCT interventions and the introduction of anti-retroviral drugs into the care agenda. We chose the latter since it is the greatest investment challenge to the MoH.