OVC Next Gen - Program Description.pdf

DRAFT – Program Description Orphans and Vulnerable Children (OVC) Next Generation

Health Office, USAID/Tanzania

List of Acronyms

ACHIEVE Adolescents and Children, HIV Incidence-reduction, Empowerment, and Virus Elimination

AGYW Adolescent Girls and Young Women ART Antiretroviral Therapy C/ALHIV Children/ Adolescent Living with Human

Immunodeficiency Virus CDCS Country Development Cooperation Strategy CYLWS Children and Youth Living or

Working on the Streets CSO Civil Society Organization DE Developmental Evaluation DO Development Objective DP Development Partners FSW Female Sex Workers GBV Gender Based Violence GFATM Global Fund to Fight AIDS, Tuberculosis, and

Malaria GoT Government of Tanzania HTS HIV Testing Services HEI HIV Exposed Infants HIV Human Immunodeficiency Virus MEL Monitoring Evaluation and Learning MOHCDGEC Ministry of Health Community Development, Gender, Elderly and Children NSGPR National Strategy for Growth and Poverty

Reduction NBS National Bureau of Statistics NICMS National Integrated Case Management

Systems OVC Orphans and vulnerable children PEPFAR

President’s Emergency Plan for AIDS Relief PEPFAR President's Emergency Plan for AIDS Relief PLHIV People Living with Human Immunodeficiency

Virus PMTCT Prevention of mother-to-child Transmission of HIV PO-RALG President’s Office –

Regional Administration and Local Government

SNU Sub National Units

TDHS/MIS Tanzania Demographic and Health Survey/Malaria Indicator Survey

THIS Tanzania Health Information Survey USAID United States Agency for

International Development VAC Violence Against Children WHO World Health Organization UNAIDS United Nations Programme on

HIV/AIDS

UNICEF United Nations Children's Fund USG United States Government

1. INTRODUCTION AND PURPOSE

PEPFAR/Tanzania is committed to supporting the Government of Tanzania (GoT) to achieve HIV epidemic control. The purpose of the Orphans and Vulnerable Children (OVC) Next Generation Activity in the North Eastern Zone and Lake Zone is to increase access to and use of health/HIV, social, and protection services among OVC and youth in order to contribute to 95-95-95 goals: 95% of PLHIV know their HIV status; 95% of PLHIV are on treatment; and 95% of PLHIV on treatment are virally suppressed, by 2030. The OVC Next Generation Activity funding opportunity is for up to two cooperative agreements each for five years to support GoT and community systems and structures to improve the health, well-being, and protection of OVC and youth in high HIV burden communities within the North Eastern Lake Zones of Tanzania.

2. BACKGROUND

Tanzania country context

Tanzania continues to make progress in improving the health and well-being of persons living with HIV (PLHIV) across the country; however, HIV outcomes among children and adolescents lag behind those of adults. The results of the Tanzania 2016-2017 HIV impact survey (THIS) showed that only 52.2% of PLHIV in Tanzania self-reported knowledge of their HIV status and only 47% of PLHIV were on treatment; viral suppression is lower among children (12%) than adults (42%); and HIV prevalence is higher among women (6.2%) than men (3.1%).

Tanzania has 3.2 million OVC, including children living with HIV; children living with a PLHIV parent, caregiver, or adult in the household; and children orphaned due to HIV/AIDS (MEASURE Evaluation, 2018). Children who are living with ill caregivers and orphans due to HIV/AIDS continue to face an increased risk of physical and emotional abuse as compared with other children, including other orphans, which increases vulnerability to HIV infection. Therefore, OVC are more likely to move from being affected by HIV to becoming infected, as well as facing other social, emotional, and associated health risks.

There are 6.2 million adolescent girls and young women (AGYW) aged 15-24 years in Tanzania.

According to THIS, this population is at considerable risk of HIV infection. A variety of factors – including harmful social and gender norms, lack of education, and GBV – mean that adolescent girls are more than twice as likely as their male counterparts to become infected. According to the 2015-16 Tanzania Demographic and Health Survey/Malaria Indicator Survey (TDHS/MIS), 27% of girls aged

15-19 have begun child bearing. These statistics are even higher in some regions where PEPFAR implements the DREAMS program, which strives to prevent HIV infections among AGYW 10-24 years, such as Shinyanga (34%) and Mbeya (33%). TDHS/MIS further indicated that knowledge of family planning is inadequate, with 43% of young women aged 15-24 being unaware of any modern contraceptive method.

The Tanzania Violence Against Children Survey (VACS, 2009) showed that nearly 3 in 10 females and approximately 1 in 7 males in Tanzania have experienced sexual violence prior to the age of 18.

Nearly one-third (29.1%) of females reported that their first sexual intercourse was unwilling- forced, or pressured. Almost three quarters of both females and males had experienced physical violence prior to the age of 18 years by an adult or intimate partner and a quarter have experienced emotional violence by an adult during childhood. In addition, Tanzania has one of the highest child marriage rates in the world. Per TDHS/MIS, on average almost two out of five girls will be married before their 18th birthday.

Vulnerability Snapshot

3.2 million OVC

46% pediatric HIV treatment gap

42% viral suppression among 15-24 year olds

26% of girls <18 years have experienced sexual violence

28% of girls <18 years have given birth

29% of children 5-17 years are engaged in child labor Source: MEASURE Evaluation (2017) and NBS (2015/16)

Relationship to the GoT and Other Donors

The OVC Next Generation Activity in the North Eastern Zone and Lake Zone is aligned with the Tanzania Health Sector Strategic Plan 2015-2020, whose goal is to reach all Tanzanian households with essential health services. It is also in line with the National Strategy for Growth and Poverty Reduction (NSGPR) II’s commitment to reduce poverty. PEPFAR and the Global Fund to Fight AIDS, Tuberculosis, and Malaria (GFATM) are the largest donors to Tanzania’s HIV program. Other donors include UN agencies such as UNAIDS, UNICEF, and WHO as well as the World Bank. The OVC Next Generation Activity in the North Eastern Zone and Lake Zone will closely coordinate and collaborate with the Ministry of Health, Community Development, Gender Elderly and Children (Department of Social Welfare (MOHCDGEC) in Mainland and Zanzibar, and President’s Office- Regional Administration and Local Governments’ (PO-RALG) Department of Social Welfare Services, with a focus on rolling out the National Integrated Case Management System (NICMS). In addition, the Activity will advance implementation of the GoT’s National Plan of Action to End Violence Against Women and Children, complementing and coordinating program investments and activities with those of GoT and UNICEF.

Relationship to USG/USAID Priorities and Other Programs

This activity is aligned with the current PEPFAR/Tanzania Strategy and USAID/Tanzania’s Country Development Cooperation Strategy (CDCS) Development Objective (DO)1 “Tanzania women and youth empowered”, intermediate result 1.2 “Health status improved improved”; 1.2.1: access to quality, integrated health services, with a focus on maternal, neonatal, and child health increased”; and IR 3.1: Citizen engagement made more effective. This activity will also support DO3 “Government delivery of services improved”, which aims to increase access to citizen information, to strengthen the institutional capacity of civil society (CSOs), and to enable CSOs’ successful oversight of government at national and sub-national levels.

The OVC Next Generation Activity in the North Eastern Zone and Lake Zone will promote integration of activities in councils, wards, and villages where activities are co-located by creating synergies with USAID, USG, and other development partners’ (DP) activities including health, HIV, agricultural, WASH, education and nutrition. In particular, this Activity will be supported and complemented by the Adolescents and Children, HIV Incidence-reduction, Empowerment, and Virus Elimination (ACHIEVE) activity, which aims to strengthen the capacity of the national and community-level social services workforce, systems, and structures to ensure quality services for OVC, at-risk AGYW, and PLHIV. In addition, the Activity will ensure program linkages and integration with other PEPFAR partners, namely DREAMS and clinical care and treatment partners, in order to increase access to and uptake of vital HIV prevention, care, and treatment services among OVC and youth. It is expected that the implementer(s) will jointly plan, collaborate, and routinely share program information and data with other PEPFAR implementing partners (and vice versa) in order to compound results, bring good practices to scale, and ensure that OVC and youth, and their families, benefit from the integration of PEPFAR activities.

3. RATIONALE FOR THE OVC NEXT GENERATION ACTIVITY

Kizazi Kipya has measurably improved health/HIV, well-being, and protection outcomes among OVC and youth. However, gaps persist in maximizing the OVC platform’s contribution to the pediatric clinical cascade; scaling up prevention of HIV and sexual violence interventions for 9-14 year old girls and boys; expanding access to the DREAMS HIV prevention service package for at-risk AGYW 10- 14 years; and strengthening the socio-economic capacity and status of AGYW and OVC households to meet their own needs. The Activity will be family-focused and client-centered in order to improve the health, well-being, and protection of OVC and youth in high HIV burden communities. The OVC Next Generation North Eastern Zone and Lake Zone Activity’s primary purpose is to seamlessly continue the delivery of high-quality OVC for children and caregivers currently served by Kizazi Kipya in the North Eastern and Lake zones while refining OVC service packages and support in order to advance OVC program contribution to HIV epidemic control. In line with PEPFAR priorities

4. PROGRAM DESCRIPTION

Goal and development hypothesis

The OVC Next Generation in the North Eastern Zone and Lake Zone Activity’s goal is to improve the health, well-being, and protection of OVC and youth in high HIV burden communities.

The development hypothesis is that:

● If OVC platforms are maximized for pediatric case finding, linkage to treatment and viral suppression, and

● If OVC and youth have increased access to HIV prevention and sexual violence prevention interventions, and

● If at-risk AGYW and OVC caregivers have improved socio-economic capacity

● Then OVC and youth in high HIV burden communities will have greater access to and use of health/HIV prevention, care and treatment, protection, education, and socio-economic services social, and protection services which will lead to improved health, well-being, and protection among OVC and youth.

The Activity’s key objectives are to:

1) Increase use of OVC platforms for pediatric HIV case finding, linkage to treatment, and viral suppression

2) Increase access to HIV prevention and violence prevention services among OVC and youth

3) Improve socio-economic capacity of at-risk adolescent girls and young women (AGYW) and OVC caregivers

In addition, the following four guiding principles must be mainstreamed across all project activities:

1) Support for GoT and community systems and structures

2) Gender integration and meaningful youth engagement

3) Routine use of data for continuous quality improvement

4) Integration with other PEPFAR programs (with a focus on clinical programs) in order to improve efficiency as well as compound results and investments

Geographic coverage

The OVC Next Generation North Eastern Zone Activity will focus on 22 PEPFAR priority councils in six regions (Arusha, Dodoma, Kilimanjaro, Morogoro, Pwani, and Tanga). The OVC Next Generation Lake Zone Activity will focus on 24 PEPFAR priority councils in four regions (Geita, Kagera, Mara, and Mwanza); this will include DREAMS implementation in Kahama, Msalala, Shinyanga DC, Shinyanga MC, Ushetu, Bukoba, Nyamagana, and Muleba councils. Appendix 1 includes the draft list of target councils per zone and region.

Approach

In line with PEPFAR OVC Guidance, the OVC Next Generation in the North Eastern Zone and Lake Zone will apply two distinct but complementary OVC program strategies in order to address children’s vulnerabilities across the lifecycle. First, the successful applicant is expected to provide more intensive and holistic services to address children’s and families’ multiple risks and vulnerabilities in the domains of health, safety, schooling, and stability; which is the OVC Comprehensive program.

Comprehensive programming focuses on OVC recruitment through PEPFAR clinical services to identify children already in HIV treatment (especially those newly enrolled), infants of mothers at risk of loss-to-follow-up in the PMTCT cascade, (especially adolescent mothers), and biological children of female adult index cases.

Other priority OVC sub-populations include children who are survivors of sexual violence, children in child-headed households, and children of key populations such as female sex workers (prioritizing children of HIV+ FSW), all of whom may be identified through child welfare and community-based referrals. OVC case workers should conduct formal assessments of all children and families in the comprehensive program as well as regularly monitor child and family well-being through case management, including routine home visits. Case files for each family should include specific care plans with benchmarks in the domains of healthy, stable, safe, and schooled, to be monitored over time in order to facilitate family graduation based on improved outcomes.

Second, the OVC Next Generation Activity North Eastern Zone and Lake Zone will provide evidence-based violence and HIV prevention interventions to the wider community of at-risk girls and boys in high burden SNUs during the critical window between ages nine to fourteen; which is an OVC Preventive program. The main focus for this group is evidence-based programming that prevents sexual violence, delays sexual debut, and prevents HIV infection. These interventions engage parents and community members, including faith and traditional leaders, in protecting adolescents from violence as well as support healthy decision-making as children mature. Children in the OVC preventive program area should be recruited in groups from community settings of high burden SNUs, such as schools, community centers, and faith-based groups. Monitoring of this target population is distinctly different from the comprehensive program, and does not involve providing case management or monitoring against graduation benchmarks.

In addition, the OVC Next Generation Activity Lake Zone will include implementation of the DREAMS program for at-risk AGYW 10-14 years in 8 councils in the Lake Zone. The Activity will ensure the delivery of the DREAMS primary package of services for 10-14 year old AGYW, as well as secondary services as needed, and contextual services as appropriate.

5. RESULTS AND OUTCOMES OF IMPLEMENTATION

The OVC Next Generation North Eastern Zone and Lake Zone Activity’s interventions will support HIV epidemic control by ensuring the delivery of critical health/HIV, social welfare, and protection services for OVC, youth, and their families in high HIV burden communities. The aim is to ensure that 90% of children who are in treatment are being supported. 100% of these children and AGYW who are living with, affected by, and vulnerable to HIV infection know their sero-status; are linked to care and treatment; are retained in care and adherent to ART; and achieve viral suppression in order to prevent new infections, while promoting overall health, well-being, and resilience.

The Activity’s principal entry point will be the family and community levels and will primarily engage the social welfare workforce (including Community Case Workers and Lead Case Workers). This will also include coordination and integration with the health workforce and PEPFAR clinical partners in order to improve bi-directional referrals between clinic and community for efficient HIV service delivery with complementary social service delivery. The Results Framework below details expected results per objective.

Objective 1: Increase use of OVC platforms for pediatric HIV case finding, linkage to treatment, and viral suppression

Finding “well” or asymptomatic children living with HIV who are undiagnosed, HIV treatment coverage, and viral suppression among children and adolescents in Tanzania remain a challenge. The OVC program platform offers a significant opportunity to improve clinical outcomes among C/ALHIV and HEI as well as to support their overall health, well-being, and protection. Coordination and integration with health facilities, PEPFAR clinical and Key Populations (KP) partners, as well as Local Government Authorities (LGAs) is crucial to closing the gap in pediatric HIV diagnosis, treatment, and viral suppression. In line with PEPFAR guidance, the Activity will ensure that: OVC case workers conduct assessments of HIV positive mothers, all biological children<19 years of HIV-positive women receive HIV testing services, and those children have a documented HIV test result.

In collaboration with PEPFAR-supported facilities and partners, the Activity will use a bi-directional referral system in order to increase the enrollment of C/ALHIV and HEI in the OVC comprehensive program. The Activity will provide HIV-inclusive case management with routine home visits in order to regularly monitor child well-being; provide knowledge and skills-building with OVC caregivers in order to support treatment adherence and retention in care among both C/ALHIV and HIV-positive caregivers; and will deliver differentiated OVC service packages for enrolled C/ALHIV, HEI, and their families that address their unique health, nutrition, education, protection, psychosocial, and economic strengthening needs.

The applicant should propose innovative, evidence-based interventions to achieve the following outcomes:

● Increased enrollment of C/ALHIV, HEI, and children of HIV-positive caregivers in the comprehensive OVC program

● Increased number of C/ALHIV and HIV-positive caregivers who receive optimized ART.

● Improved rates of retention and adherence among C/ALHIV and HIV-positive caregivers

● Improved rates of viral suppression among C/ALHIV and HIV-positive caregivers

Objective 2: Increase access to HIV prevention and violence prevention services among OVC and youth

Preventing HIV risk and violence is critical to reducing HIV incidence and the prevalence of violence against children (VAC), including sexual violence, which is a driver of the HIV epidemic.

The OVC Next Generation Activity North Eastern Zone and Lake Zone will implement a suite of interventions designed to: prevent HIV and sexual violence among 9-14 year old girls and boys in high burden communities; increase education access, retention, and progression among at-risk AGYW;

increase access to VAC and GBV services and support, including comprehensive post-violence care;

and deliver a robust DREAMS package of services targeting vulnerable AGYW 10-14 years (in select councils of the Lake zone) for more intensive HIV prevention.

In line with PEPFAR guidance, the OVC Preventive program will deliver the following evidence-based interventions targeting 9-14 year old boys and girls: Parenting for Lifelong Health (also known as Furaha in Tanzania), Coaching Boys Into Men (CBIM), IMPower (also known as No Means No), and/or Stepping Stones (developmentally appropriate adaptations based on the 3rd South African Edition). The Activity will engage parents and community members, including faith and traditional leaders, in protecting adolescents from violence as well as strengthen children’s ability to make healthy decisions. In addition, the Activity will advance implementation of the GoT’s National Plan of Action to End Violence Against Women and Children, working with Violence Against Women and Children Protection Committees (VAWC-PCs) at ward level in order to strengthen the prevention of and response to VAC and GBV. Finally, the Activity will implement the DREAMS program for vulnerable AGYW 10-14 years in 8 councils in the Lake zone. It will deliver and ensure the completion of the DREAMS primary package of services for all enrolled DREAMS beneficiaries 10-14 years in 11 councils; provide secondary services as needed based on individual needs; and implement contextual interventions as appropriate.

The applicant should propose innovative, evidence-based interventions in line with PEPFAR guidance to achieve the following outcomes:

● Reduced incidence of HIV infection among OVC and youth, especially among AGYW

● Increased school enrollment, regular attendance, and progression among AGYW

● Reduced prevalence of VAC and GBV among OVC and their caregivers

● Increased access to comprehensive clinical and community-based post-violence care and support among survivors of violence.

● Increased access to ASRH services among OVC and youth, especially AGYW

● Increased completion of the DREAMS primary package among DREAMS beneficiaries 10-14 years.

● Improved community norms change for HIV prevention and violence prevention

Objective 3: Improve socio-economic capacity of at-risk adolescent girls and young women (AGYW) and OVC caregivers

HIV diminishes economic security among families and impairs their ability to meet children’s needs by disrupting income streams, depleting assets, and increasing dependency ratios. Strengthening the economic capacity of AGYW and OVC households is critical to reducing HIV risk as well as to enabling access to and retention in HIV care. Participation in economic strengthening activities also provides a platform for vulnerable AGYW and OVC caregivers to access vital social support and build social capital which helps improve socio-emotional well-being and strengthen family resilience. The OVC Next Generation Activity North Eastern Zone and Lake Zone will contribute to and advance USAID/Tanzania’s CDCS Development Objective (DO)1: “Tanzania women and youth empowered” because economic strengthening support will target vulnerable AGYW and OVC caregivers, the vast majority of whom are female.

Economic strengthening targeting AGYW will include: conducting a youth labor market assessment as a basis for guiding enhanced economic strengthening within DREAMS. Economic strengthening support will include; providing gender-specific financial literacy training for 10-14 year olds and for 15-17 year olds also includes; developing marketable skills; providing post-training start up support through seed funding; facilitating savings groups for older AGYW who may have income streams; and facilitating access to coaching and mentoring opportunities in collaboration with the private sector and other business networks. Household economic strengthening interventions for OVC families will be targeted according to a household vulnerability assessment. For OVC households experiencing the highest level of economic vulnerability (including households whose caregivers are elderly or disabled), the focus will be on increasing temporary consumption support and linkage to social protection services. For families with more moderate vulnerability, the Activity will enable access to financial literacy training and savings and credit opportunities through Village Savings and Loans Associations (VSLAs). For households prepared to grow, the Activity will focus on diversified opportunities for increasing income and assets, including building business capacity and low-risk microenterprise opportunities. The Activity’s comprehensive economic strengthening approach will enable improved OVC household stability, ability to meet their own needs, and family graduation from PEPFAR support.

The applicant should propose innovative, evidence-based interventions in line with PEPFAR guidance to achieve the following outcomes:

● Improved financial literacy and money management skills among AGYW and OVC caregivers

● Improved access to and participation in social protection/safety net programs

● Improved access to employment opportunities among AGYW

● Improved savings, income, and assets among OVC households

● Improved social assets and social capital among AGYW and OVC caregivers

● Improved OVC household capacity to access money (without selling productive assets) to cover children’s educational and medical costs

6. CROSS - CUTTING ELEMENTS

Environmental Analysis

The interventions under this Activity are covered by the Initial Environmental Examination (IEE) for all health related activities, which was approved on April 22, 2016 and will expire in December 2021.

This approved IEE (in tactic categories 4 and 5) includes training, facilitating referral linkages for OVC to access health, social welfare, and HIV/AIDS services; supporting HIV/AIDS infected households to ensure adherence and retention to care; facilitating formation and functioning of saving and lending societies. Such activities are therefore recommended for negative determination with conditions.

Looking at this Activity, there are a number of interventions from training and support to facilitate linkage to treatment, and viral suppression and to improve socio-economic capacity of at-risk adolescent girls and young women (AGYW) and OVC caregivers. With this case, both Categorical Exclusion and negative determination with conditions are recommended for interventions under this OVC Next Generation Activity in the North Eastern Zone and Lake Zone.

However, if the implementer proposes any new activities outside the scope of the approved Regulation 216 environmental documentation, they shall prepare an amendment to the documentation for USAID to review and approve. Any activities that will be determined to be outside the scope of the approved Regulation 216 environmental documentation shall be halted until an amendment to the documentation is submitted and written approval is received from USAID.

Climate Risk Analysis

The climate change risk analysis for this award relies very much upon the Tanzania Climate Risk Profile prepared for USAID under the Climate Change Adaptation, Thought Leadership, and Assessments Task Order. This Profile indicates that Tanzania is facing rising temperatures, longer dry spells, more intense rainfall, and sea level rise, all of which make Tanzania the 26th most vulnerable country to climate risks according to USAID’s climate risk profile1. Changes in climatic conditions such as higher temperatures and heavier rainfall events can promote the spread of various diseases including malaria, diarrhea, cholera and typhoid. This award however, is not expected to significantly contribute to, or be impacted by, changing climatic conditions and is therefore considered to be at low risk.

Gender and Women’s Empowerment

Gender impacts all development outcomes for women and men; to be most effective, health programs must take a gender lens in all stages of programming – planning, implementation, monitoring, and evaluation – and at all points along the HIV continuum. For OVC programming, it is critical that risk vulnerability factors for girls and boys, access to OVC services, designing of interventions and support be considered.

In Tanzania, for example, in most traditional households, men control decisions regarding the use of contraception and access to health services. Men control women’s access to health services, because

1 USAID Climate Risk Profile Tanzania. 2018.

https://www.climatelinks.org/sites/default/files/asset/document/20180629_USAID-ATLAS_Climate-Risk- Profile-Tanzania.pdf.

they are the primary household decision-makers and control the majority of household economic resources. Gender-based violence is also widespread in Tanzania, and it limits women and girls’ ability to negotiate safer sexual practices, access to services, and disclose any health issue that they may be experiencing.

Gender equality and women’s empowerment are essential for achieving the results of the OVC Next Gen Activity. Recipient will implement interventions that include the identification and correction of gender-based inequities in AGYW and OVC service delivery. These should address the underlying reasons for gender-based differences and gender-sensitive approaches when designing, implementing, monitoring, and evaluating their work. All of the applicant’s interventions should assert and uphold the right of all individuals to quality health services. The activity will be expected to:

● Implement programs that explicitly seek to shift gender norms—called “gender transformative” programming— which are more effective in improving health outcomes than those that do not.

Investing in transforming gender norms can also be cost-effective and improve program sustainability.

● Pay particular attention to any potential increases in gender-based violence; know referral pathways to provide adequate support to survivors.

● Ensure that male engagement efforts do not compromise women’s safety and ability to make decisions and access services. Track this carefully through monitoring and evaluation reports and participation

Youth Inclusion

The USAID Youth in Development Policy aims to strengthen youth programming, participation, and partnership in support of Agency development objectives and to mainstream and integrate youth issues and engage young people across Agency initiatives and operations. In Tanzania, youth empowerment and inclusion are critical cross-cutting issues throughout the Mission’s CDCS results framework.A sound local knowledge base is essential to understanding the factors that influence the vulnerability of youth. The activity will use national and council-level data to understand the extent of the epidemic with respect to both females and males and analyse factors that define their vulnerability to HIV infection. The OVC Next Gen response will ensure the identified vulnerability factors are addressed to increase support for both female and male children, youth and families affected or living with HIV.

The OVC Next Gen will employ evidence-based, comprehensive approaches that address the multiple factors that impact violence, both factors that increase risk of violence and factors that buffer against risk and promote positive youth development and well-being.The designed interventions will improve GBV/VAC case identification and response among children and adolescents. Expand access to antiretroviral treatment, prevention and treatment of opportunistic infections for children and young people using family centred approaches and improve access to early infant HIV diagnosis as well as nutritional support. Furthermore, this activity will accelerate the provision of prevention services for young people using evidenced-based models such as DREAMS and those that aim to scale up access to primary prevention within families, including HIV status awareness, reduction of factors that place youth at risk for perpetrating violence and promote factors that protect youth at risk for violence. In addition, address all types of influences on youth violence: individual, relationship, community, and society.

Sustainability and the Journey to Self-Reliance

USAID defines self-reliance as a country’s ability to plan, finance, and implement solutions to solve its own development challenges. The Journey to Self-Reliance has been characterized by two mutually reinforcing factors: local capacity and commitment. Commitment is defined as the degree to which a country’s laws, policies, actions, and informal governance mechanisms – such as cultures and norms

– support progress towards self-reliance. Capacity is defined by a country’s ability to efficiently and effectively manage the human, financial, and technical resources it must have to meet its public health goals. Effective development partnerships are characterized by a collective shared vision between funders and local actors, common definitions of success, shared contribution of resources, and mutual accountability to communities and beneficiaries.

The foundational assumption of the OVC Activity is that the empowerment of indigenous stakeholders by supporting locally generated and driven interventions with a framework of accountability will result in sustainable achievements that will far outlast the period and level of USAID/Tanzania investment.

With this in mind, for Years 4 and 5 of the award, the Recipient must provide a Sustainability Plan as an annex to its Annual Implementation Plan (i.e., work plan).

Activity Integration

Integration is a key component of USAID/Tanzania’s Country Development Cooperation Strategy (CDCS). The CDCS advances USAID’s core values of empowerment and inclusion and key principles of engagement which include partnership, capacity building, integration, and learning.

USAID/Tanzania recognizes the complexity of Tanzania’s development challenges and the value of addressing them using multiple tools and perspectives that cross sectors. Integration is defined broadly as “Partnering to apply sound development principles and practices to address political, economic, social and governance factors across sectors to improve the sustainability of development investments and results.” In short, the applicant should seek opportunities to partner and collaborate across sectors to improve the sustainability and impact of planned outcomes and results.

7. MONITORING EVALUATION AND LEARNING (MEL)

Under the results-focused OVC Next Gen Activity, the applicant is required to create a Monitoring, Evaluation, and Learning (MEL) Plan detailing how it will ensure robust monitoring of all activities.

The MEL plan will be used to measure and assess activity results with appropriate performance indicators and target outputs and outcomes for each level of the results framework. Data quality is critical, and the applicant must use systems that ensure quality data within short timeframes and be prepared for regular data quality assessments. Any experimental and/or quasi-experimental research designs must be clearly reflected in the applicant’s MEL plan. The applicant is also expected to integrate Developmental Evaluation (DE) activities within the project, developing a DE plan that includes intervention areas to be monitored and evaluated for real time, continuous program improvement throughout the life of the project.

The MEL Plan will feed into USAID/Tanzania’s CDCS Performance Management Plan and incorporate indicators currently collected through the Agency’s annual Performance Plan and Report.

To ensure data-driven decision-making, the applicant will track and analyze progress against activity targets and also consider other data collected through GOT and USG monitoring and evaluation systems and findings from periodic and national population and community-based surveys conducted by other entities. The USG will continue to compile and analyze data concerning the achievements and performance of all its OVC implementing partners in comparison with the national and data from other donor-funded programs working in support of A/CLHIV areas.

USAID/Tanzania is required to report semi-annually to PEPFAR on the following OVC MER indicators: OVC_SERV and OVC_HIVSTAT. In addition, USAID/Tanzania will report semi-annually to USAID/Washington on the following custom indicators, and the Applicant must inform this reporting:

1. OVC_OFFER

2. OVC_ENROLL

3. OVC_SERV_SUBPOP

4. OVC_DREAMS_OVERLAP

5. OVC_HIVSTAT_18+

6. OVC_HIVSTAT_UNKNOWN

7. OVC_TST_ASSESS

8. OVC_TST_RISK

9. OVC_TST_REFER

10. OVC_TST_REPORT

11. OVC_VL_ELIGIBLE

12. OVC_VLR

13. OVC_VLS

The Applicant may also be required to contribute to USAID/Tanzania’s high frequency reporting (HFR) for PEPFAR-supported programming, as appropriate.

(End of Program Description)

Appendix: List of Target Councils

Zone Region Council

North Eastern

Arusha Arusha CC

Arusha DC

Dar es Salaam

Ilala MC

Kigamboni MC

Kinondoni MC

Temeke MC

Ubungo MC

Dodoma Dodoma MC

Kongwa DC

Kilimanjaro Moshi DC

Mjini Magharibi Mjini

Morogoro

Morogoro MC

Kilombero DC

Kilosa DC

Mvomero DC

Pwani

Chalinze DC

Kibaha TC

Mkuranga DC

Tanga

Korogwe DC

Lushoto DC

Muheza DC

Tanga CC

Lake Geita Bukombe DC

Chato DC

Geita DC

Geita TC

Mbogwe DC

Kagera

Biharamulo DC

Bukoba DC

Karagwe DC

Kyerwa DC

Missenyi DC

Muleba DC

Ngara DC

Mara

Bunda DC

Musoma DC

Musoma MC

Rorya DC

Serengeti DC

Mwanza

Ilemela MC

Nyamagana MC

Buchosa DC

Kwimba DC

Magu DC

Misungwi DC

Sengerema DC

Ukerewe DC

DRAFT – Program Description