zanzibar aids commission (zac) - Global HIV M&E Information

ZANZIBAR AIDS COMMISSION (ZAC)
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TERMS OF REFERENCE (TOR) FOR CONTINUATION OF CONTRACT FOR ZAC HIV M&E
TECHNICAL ADVISOR FROM APRIL 20 TH 2007 TO APRIL 19 TH 2008
1. Introduction and background information:
Zanzibar’s first three AIDS cases were officially reported in 1986 at Mnazi Mmoja Hospital. By 2002 1
the HIV prevalence was 0.6% among the general population, at the end of 2002, a cumulative total of
2,500 AIDS cases were officially reported and about 180 people were diagnosed with HIV infection
annually. Based on the validation survey of 2002, it is estimated that 6,000 adults, which is 0.6% of
Zanzibar’s general population of 1,000,000 persons, are currently living with HIV, of which there are 4-6
times more women than men infected with HIV. HIV prevalence among pregnant women attending
antenatal care was between 1% in 2002 and 0.87% in 2005. HIV prevalence among Tuberculosis patients
also grew from 8.7% in 1994 to 25% in 2000; and HIV prevalence increased among blood donors from
0.7% in 1996 to 1.4% in 1999.
In 2005 the HIV sentinel surveillance at antenatal clinics established that HIV prevalence amongst
pregnant women was 0.87% 2 . In the same year research by the Ministry of Health and Social Welfare
(MoHSW) proved that the HIV epidemic in Zanzibar is a concentrated epidemic that is severely affecting
three main Most At Risk Populations (MARPs) in particular Injecting Drug Users (IDUs); Sex Workers
(SW) and their clients; and Men who have Sex with Men (MSM). The evidence available is alarming, for
instance HIV prevalence among needle sharing IDUs was reported at 26.2% 3 .
With support from many development partners and implementing agencies, the Revolutionary
Government of Zanzibar (RGoZ) has since put in place many programmes to prevent the spread of HIV
and mitigate its impacts among people living with and affected by HIV&AIDS (PLHA) in Zanzibar.
Between 1987 and 1988, RGoZ designed and carried out an Emergency Short Term Plan. This was
followed by the Medium Term Plans I and II which lasted from 1989 to 1996. The first two medium term
1 Source Zanzibar MOHSW population survey 2002
2 Source Zanzibar MOHSW ANC surveillance 2005
3 Source HIV Predisposing Behaviour Among Substance Users in Zanzibar Tanzania 2005
TOR for ZAC M&E Advisor April 20 th 2007 to April 19 th 2008

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plans were health oriented with a focus on: Motivating behavior change; Ensuring blood safety;
Counseling and caring for PLHA; and Community involvement. In 1998 to 2000 the RGoZ Medium
Term Plan III then provided a framework for a multisectoral response to fight HIV&AIDS with the
recognition that HIV is not only a health problem but also a major social and economic crisis.
In 2002 RGoZ established the Zanzibar AIDS Commission (ZAC) with the mandate of leading, managing
and coordinating the National Multisectoral Response to HIV in Zanzibar through the development and
implementation of the five year Zanzibar National HIV&AIDS Strategic Plan 2004/5- 2008/9 (ZNSP).
Today, Zanzibar has mobilized all sectors with a lot of achievements in all areas of implementing the
ZNSP. The ZNSP recognises the need for intensifying Monitoring and Evaluation of the national
HIV&AIDS response in the Isles. As such ZAC, with main support from The World Bank 4 , UNAIDS,
and other stakeholders has established and has commenced to implement key components of a
comprehensive national multisectoral HIV M&E system.
The Zanzibar National Multisectoral HIV M&E System
The Goal of the Zanzibar National Multisectoral HIV M&E System is to enable ZAC and its partners to
monitor the spread and impact of the epidemic in Zanzibar, to monitor the efficiency of the national
response to HIV, and to evaluate the effectiveness of the national response to HIV, using relevant and
accurate HIV data for use in planning effective interventions. This would result in an evidence based
multisectoral approach towards planning for the interventions against HIV. The objectives of the System
are to:
i. Develop clear M&E strategies that will enable systematic collection of data that can be used to
detect changes in the epidemic and effects of interventions (efficiency and effectiveness) and then
inform and guide the national HIV response.
ii. Define the roles of stakeholders – ZAC, Ministries, Departments and Agencies, local government,
networks and umbrella organizations and Civil Society organizations (CSOs) – in the systematic
collection, collation, analysis and use of HIV data in order to avoid duplication of efforts.
iii. Improve information sharing and dissemination of information and the use of data in planning
interventions.
4 This includes financial and technical support from World Bank Tanzania and World Bank Global AIDS M&E Team (GAMET)
TOR for ZAC M&E Advisor April 20 th 2007 to April 19 th 2008

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iv. Promote creation of partnerships and linkages between various development stakeholders at
various levels of implementation.
v. Promote coordination of HIV services, and ensure equity in the provision of, access to and
utilization of HIV services.
vi. Monitor the success of the national response as well as identifying lessons learnt and best practices
for scaling up.
The main achievements and challenges of the Zanzibar National Multisectoral HIV M&E system
currently include:
(a) HIV M&E staffing: An appropriate number and quality of staff have been placed at ZAC M&E
unit to coordinate M&E work in Zanzibar, although the recruitment process took long and delayed
the staff capacity assessment and capacity strengthening that was planned for 2006. District
HIV&AIDS Focal Persons (DHAPs) have been assigned tasks to manage HIV M&E activities at
sub national levels. However the DHAPs and HIV M&E staff in ZAC, ZACP 5 and HMIS 6 have
expressed a need for technical assistance and capacity building in various areas of managing and
coordinating the operations of the national multisectoral HIV M&E system.
(b) HIV M&E Partnerships: ToR was been developed and the M&E Task Team for HIV&AIDS in
Zanzibar (METTHAZ) was established. Although at one point METTHAZ was growing weak,
since the ZAC M&E unit all came on board the METTHAZ is now functional and vibrant with
regular meetings and members taking part in overseeing various M&E functions. But there is
need to mobilize more participation of international development partners in METTHAZ
activities.
(c) M&E documentation: A lot of M&E documentation has been developed, printed and launched in
Zanzibar. These documents include but are not limited to: Zanzibar National HIV M&E
Operational Framework volume 1 and 2; Zanzibar National HIV&AIDS Programme Monitoring
System (ZHAPMoS) Guidelines; Data auditing and supervision guidelines; Coasted National HIV
M&E Road Map; Packages for training stakeholders in M&E concepts and ZHAPMoS. This
documentation has been disseminated widely and stakeholders have been trained and generally
5 Zanzibar AIDS Control Programme
6 Health Management Information System
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there is a good understanding of the M&E system among the actors. However the coasted road
map still requires funding commitment for certain key activities contained in it.
(d) Data sources: There are several data sources in Zanzibar to name a few: Biological and
behavioral surveillance being managed by ZACP; Workplace survey managed by MOL 7 and
ZAC; HMIS managed by MoHSW 8 ; ZHAPMoS managed by ZAC; and PER 9 managed by MOF 10
and ZAC. All these data sources are functioning quite well, except that ZHAPMoS is fairly new
and ZAC and the DHAPs require technical support in increasing and regulating ZHAPMoS
reporting by implementers, and generating user friendly information products from the ZHAPMoS
system.
(e) Zanzibar National HIV Database: TOR, a plan and budget was developed, and UCC 11 was
contracted by ZAC to develop the Zanzibar National HIV Database. It took a long time to identify
and select the database consultants because of the shortage of firms offering this service in
Tanzania, but now the construction of the database is ongoing and once finished then there will be
need to train ZAC staff and selected key stakeholders on how to use and manage the database.
(f) Data auditing and supervision: Guidelines have been developed for undertaking data auditing
and supervision. Data auditing and supportive supervision will be done through ZHAPMoS
system by ZAC staff for the DHAPs and, by the DHAPs for the implementers within the Districts.
MoHSW staff and the DHAPs still need some more technical guidance to fully empower them on
how to plan and undertake data auditing and supportive supervision.
(g) Harmonized capacity building: Zanzibar trained 18 TOTs 12 who in turn have trained all key
HIV organizations in M&E concepts and ZHAPMoS. These organizations included: District and
Shehia authorities; CSOs 13 ; Private sector organizations; and Government MDAs 14 . The
organizations trained have a general understanding of the national M&E system and their roles and
7 Ministry of labour
8 Ministry of Health and Social Welfare
9 Public expenditure review
10 Ministry of Finance
11 University Computing Centre University of Dar Es Salaam
12 Trainers of trainers
13 Civil Society Organizations (CSOs) is used to include all NGOs, FBOs, CBOs
14 Ministries Departments and Agencies
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responsibilities. However, some of the community based CSOs organizations will need additional
mentorship visits to establish systems which collect accurate and reliable M&E data on a daily
basis. Also the District capacity strengthening plan lists out areas in which Districts/DACCOMs 15
will require more capacity building in order to effectively manage multisectoral HIV M&E
activities at sub national levels.
(h) Learning, research and evaluation: ZAC undertook a national information needs assessment in
2004 which proposed for the establishment of a national HIV information resource centre, and
mainstreaming of HIV into the four main libraries in Zanzibar. The information resource centre is
now being equipped in ZAC office but adequate amounts of HIV information in hard and
electronic forms still need to be sourced for the resource centre and libraries. Also currently
Zanzibar needs to develop and implement a prioritized research and learning plan; as currently
research is being done but is not always formally and jointly planned and coordinated based on
evidence generated from ZAC, ZACP, HMIS and OCGS 16 . A major evaluation of the
implementation of ZNSP has just taken place in Zanzibar and is anticipated to provide suggestions
on even further strengthen the AIDS interventions being undertaken in Zanzibar.
(i) Advocacy and communication for HIV M&E: Through ZHAPMoS ZAC has developed
various communication and advocacy brochures and materials as well as an M&E advocacy and
communication plan. ZAC has undertaken advocacy and communication targeting heads of all the
key HIV organizations in Zanzibar. The organizations heads now appreciate and support HIV
M&E work. Also advocacy for HIV M&E has been included as one of the objectives of the
Zanzibar National HIV advocacy and communication strategy. A lot of advocacy work for HIV
M&E has been done but there is need for deliberate and conscious efforts to systematically
implement and report on the HIV M&E advocacy and communications plan that was developed
by ZAC.
(j) Data dissemination and data use: Some amount of research has taken place and some M&E
reports and data has been generated through various data sources in Zanzibar. The data produced
is often in complicated technical jargon that is not always friendly for most readers. This data now
15 District AIDS Coordinating Committees
16 Office of the Chief Government Statistician
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needs to be synthesized regularly and consolidated into one user friendly and easy to understand
information product which supports the policy and decision makers to understand what they know
about the drivers and determinants of HIV&AIDS in Zanzibar and how they can best respond in
the fight HIV in the Isles. This way the policy makers will make deliberate and conscious
reference to M&E data and information when designing activities, allocating resources and setting
laws and polices.
Main areas in which the ZAC M&E Advisor has provided technical support to ZAC and
stakeholders in the past one year from 10 th April 2006 to 9 th April 2007 have included:
a. HIV M&E Human Resource: Gave advice, facilitated discussions and documentation to:
Review roles, M&E unit structure, and job descriptions; Shortlist and interview ZAC Head of
M&E Unit, Data Officer, M&E Officer Pemba; Induct the ZAC M&E staff and UNV 17 in key
aspects of their M&E tasks within the M&E system; Develop formats for setting M&E staff
performance targets; Develop M&E staff capacity assessment tools; Develop M&E unit
assessment tool; Support ZNSP review consultant for M&E theme to adapt the tool used in
Tanzania Mainland for assessing the Zanzibar national HIV M&E system.
b. HIV M&E Partnerships: Facilitated: METTHAZ meetings to understand, analyze, review and
approve M&E documents and; Training sessions for METTHAZ members to understand the M&E
system and ZHAPMoS.
c. HIV M&E Documentation: Reviewed, updated and edited the Zanzibar National HIV M&E
framework volume 1 and volume 2, the data auditing and supervision guidelines, the ZHAPMoS
guidelines, and the coasted road map. And developed text for M&E operational framework
popular version, the ZHAPMoS popular version, and the M&E brochure.
d. HIV M&E Road Map: Reviewed and finalized the coasted M&E road map, and gave advice to
development and writing up the critical path activity lists in 2006.
17 United Nations Volunteer seconded to ZAC by UNDP
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e. Data Sources: Gave technical support for data sources by: Developing TOR and plans for work
place survey when working with ZAC, MoL, METTHAZ; Educating stakeholders and advocating
for ZHAPMoS reporting; Facilitating sessions for training METTHAZ and Districts to plan and
manage implementation of ZHAPMoS; Giving technical input for budget tracking activities
supported by ZAC and IDASA; Developing TOR and plan and reviewing CSO mapping exercise
reports.
f. National HIV Database: Gave technical advice to ZAC by participating in technical discussions
to: Review plans, budgets and TOR for database construction and; select, interview and contract
the database consultants from UCC.
g. Data auditing and supportive supervision: Supported ZAC to review and make input into
guidelines, and explain to selected DACCOM members how to undertake data auditing and
supportive supervision.
h. Harmonized capacity building: Supported capacity strengthening of stakeholders in M&E
through: Reviewing and updating HIV M&E training curriculum’s, facilitators guides, participants
notes and training materials in Zanzibar; Preparing materials and facilitating different training
sessions for national facilitators, TOTs, District staff, CSOs under CARF 18 , uniformed personnel,
METTHAZ, and Ministries and; Providing technical guidance to ZAC M&E staff in all areas of
HIV M&E.
i. Advocacy and communication for M&E: Supported ZAC by: Reviewing and updating the
M&E advocacy and communication plan; Participating in advocacy and communication meetings
with CSOs and Districts; Developing text for M&E brochure and PowerPoint presentation for
M&E advocacy and communication; Writing up some M&E sections of the national HIV
advocacy and communication strategy; Developing CARF operational manual and reviewing the
M&E section of the manual; and Participating in a workshop and updating GFATM 19 dashboard
report.
18 World Bank funded Community AIDS Response Fund (CARF) is a component of TMAP programme
19 Global Fund for AIDS Tuberculosis and Malaria
TOR for ZAC M&E Advisor April 20 th 2007 to April 19 th 2008

2. Specific objective of this TOR:
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To extend the contract of the ZAC M&E Technical Advisor to provide technical support and build
capacity of stakeholders in Zanzibar in implementing the Zanzibar National HIV M&E system for one
year from April 20 th 2007 to April 19 th 2008
3. Specific tasks of the consultant:
Zanzibar AIDS Commission (ZAC) will take overall responsibility for providing required resources
coordinating and overseeing the activities related to this TOR on a day to day basis. On the other hand
the consultant’s specific tasks will involve:
(A) M&E human resource and harmonized capacity building
1. Work with ZAC Head of M&E unit to undertake a capacity assessment of ZAC M&E staff and
unit, and to develop and manage implementation of a capacity strengthening plan
2. Support ZAC Head of M&E unit to undertake joint planning and staff performance appraisal in a
routine systematic manner
3. Support DHAPs to manage and implement the District HIV M&E capacity strengthening plan
4. Support HMIS and ZACP to develop TOR for their M&E Advisor
5. Support efforts to secure resources for the appointment of an M&E advisor for HMIS and ZACP
sections at MoHSW
6. Review and update training materials and facilitate a training workshop for ZAC and AIDS
Business coalition staff and the Inter Faith Forum to understand the Zanzibar National HIV M&E
system and ZHAPMoS
7. Support the efforts of the Zanzibar M&E Association to build a cadre of skilled M&E trainers, and
to secure funding to train HIV implementers in M&E concepts and principles
Formatted: Bullets and Numbering
Deleted:
(B) M&E costed road map
8. Advice ZAC M&E team when reviewing progress and updating, road map annually and critical
path activity list quarterly
9. Support ZAC M&E unit to prepare materials and facilitate meeting of DHAPs to review progress
and update, district road map annually and critical path activity list quarterly
Formatted: Bullets and Numbering
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10. Support ZAC Head of M&E unit and DHAPs to include road map activities and budgets into their
MTEF plans each year
(C) Strategic information flow
11. Support ZAC Head of M&E unit to review the workplace survey report
12. Give technical advice to ZAC M&E team and DACCOMs in managing and coordinating
implementation of ZHAPMoS
13. Support ZAC Data Officer to develop the ZAC data management policy
14. Provide technical support to TANESA M&E staff to plan and ensure that all CARF project
recipients adhere to M&E system
(D) National HIV database
15. Assist ZAC Data Officer to develop a plan for (i) Linking the national HIV database to other
databases in Zanzibar (ii) Building stakeholder capacity to understand and use the national HIV
database
Formatted: Bullets and Numbering
Deleted: review
Deleted: Support ZAC Head of
M&E unit to review and finalize Quarter
Service Coverage Report (QSCR) each
quarter
Support ZAC M&E and IEC teams
to develop newspaper reports for
disseminating QSCR
Support ZAC M&E team to develop
text for quarterly brochure
Formatted: Bullets and Numbering
(E) Advocacy and communication for HIV M&E
16. Support ZAC M&E team to review and finalize all M&E advocacy and communication
documents produced by ZAC
17. Support the team to identify and capitalize on opportunities to ensure that
(F) Information dissemination and use
18. Support ZAC Head of M&E unit to review and finalize Quarter Service Coverage Report (QSCR)
each quarter
19. Support ZAC M&E and IEC teams to develop newspaper reports for disseminating QSCR
20. Support ZAC M&E team to develop text for quarterly brochure
Formatted: Bullets and Numbering
Formatted: Indent: Left: 18 pt
Formatted: Bullets and Numbering
(G) Other M&E related issues
21. Support the review of the Health Sector HIV strategy and the ZNSP midterm review
Formatted: Font: Italic
Formatted: Font: Italic
Formatted: Bullets and Numbering
Formatted: Indent: Left: 18 pt
4. Supervision and reporting:
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The consultant will primarily report to the Executive Director of ZAC with strong operational linkages to
the Head of Policy Planning and National Response Division and the ZAC Head of M&E Unit.
5. Logistical and administrative arrangements:
The consultant will be provided with all the financial, human and material resources required to
implement this TOR by ZAC. The consultant will implement the TOR for 15 days a month starting from
20 th April 2007 to 19 th April 2008. For each of the 15 days a month, the consultant will be paid a total net
fee of 250 US Dollars per day; and ZAC will also pay the consultant DSA for the days spent when
working from Zanzibar.
TOR for ZAC M&E Advisor April 20 th 2007 to April 19 th 2008