One Health Strategic Plan 2015 – 2020

1.0 Introduction ............................................................................................................... 7

1.1 Country Profile ............................................................................................................................................................. 7

1.1.1 Geography and Population ..................................................................................................................................... 7

1.1.2. Economic activities .................................................................................................................................................... 8

1.1.3 Economic development ............................................................................................................................................. 9

1.1.4 Administrative structure........................................................................................................................................... 9

1.1.5 Wildlife .......................................................................................................................................................................... 11

1.2 Overview of Zoonotic Diseases in Tanzania..................................................................................................... 11

1.2.1 Societal factors .......................................................................................................................................................... 11

1.2.2 Burden of Zoonoses in Tanzania ........................................................................................................................ 12

1.2.3 Potential Routes of Exposure............................................................................................................................... 15

1.2.4 Zoonotic Disease Control Efforts ........................................................................................................................ 17

1.3 Evolution of One Health Approach ..................................................................................................................... 18

1.3.1 Global Steps Toward One Health...................................................................................................................... 18

1.3.2 Economics of One Health ...................................................................................................................................... 19

2.0 Situational Analysis ................................................................................................... 21

2.1 International Health Regulations (IHR) 2005 .................................................................................................. 21

2.3 Strengths, Weaknesses, Opportunities and Threats Analysis for One Health Implementation in Tanzania.............................................................................................................................................................................. 23

3.0 Five Year Plan ........................................................................................................... 29

3.1 Background on the National One Health Strategic Plan .............................................................................. 29

3.1.2 Core Values ................................................................................................................................................................. 29

3.2 Guiding Principles..................................................................................................................................................... 29

3.3 Vision, Mission and Goals ...................................................................................................................................... 30

3.4 Objectives and Strategies ...................................................................................................................................... 31

3.4.1 Thematic Area 1: Training, advocacy and communication .................................................................... 31

3.4.2 Thematic Area 2: Preparedness and Response ............................................................................................ 32

3.4.3 Thematic Area 3: Research................................................................................................................................... 34 3.4.4 Thematic Area 4: Disease surveillance, prevention and control ......................................................... 36

3.4.5 Thematic Area 5: Coordination........................................................................................................................... 38

3.5 One Health Strategic Framework ........................................................................................................................ 41

3.5.1 Strategic Interventions ........................................................................................................................................... 41

4.0 Organizational Chart and Functions ........................................................................... 54

4.1 PMO Organizational Chart .................................................................................................................................... 54

4.2 Functions ..................................................................................................................................................................... 55

4.2.1 ONE HEALTH STEERING COMMITTEE .............................................................................................................. 55

4.2.2 Technical Working Groups (TWG) ..................................................................................................................... 56

4.2.3 One Health Coordinating Unit............................................................................................................................. 60 References ..................................................................................................................... 61 Annex 1: Provisional list of reported zoonotic disease in Tanzania .................................. 65 1 UNITED REPUBLIC OF TANZANIA List of Abbreviations AIDS Acquired Immune Deficiency MUHAS Muhimbili University of Health and Syndrome Allied Sciences ARU Ardhi University NCA Ngorongoro Conservation Area CDC Centers for Disease Control and NCAA Ngorogoro Conservation Area Prevention Authority CSO Civil Society Organization NIMR National Institute for Medical Research DPG Development Partners’ Group NM-AIST Nelson Mandela African Institute of Science and Technology DTA Data Transfer Agreement OECD The Organisation for Economic Co- operation and Development EAC East African Community OH One Health EID Emerging Infectious Diseases OIE World Organization for Animal Health FAO Food and Agriculture PHEIC Public Health Emergencies of Organization International Concern GCLA Government Chemist Laboratory PMO Prime Minister's Office Agency GIS Global Implementation Solutions RALG Regional Administration and Local Government GPD Gross Domestic Product SSA Sub-Saharan Africa HIV Human Immunodeficiency Virus SUA Sokoine University of Agriculture IHI Ifakara Health Institute TALIRI Tanzania Livestock Research Institute IHR International Health Regulations TANAPA Tanzania National Parks IUCN International Union for TAWIRI Tanzania Wildlife Research Institute Conservation of Nature KCRI Kilimanjaro Clinical Research TDV Tanzania Development Vision Institute MAF MDG Acceleration Framework TFDA Tanzania Food and Drug Authority MDG Millennium Development Goals TFELTP Tanzania Field Epidemiology Laboratory Training Program MIC Middle Income Country TLU Tropical Livestock Units MLFD Ministry of Livestock and TOR Terms of Reference Fisheries Development MNRT Ministry of Natural Resources TPDF Tanzania People's Defense Force and Tourism MoFEA Ministry of Finance and Economy TVLA Tanzania Veterinary Laboratory Affairs Agency MoHSW Ministry of Health and Social TWG Technical Working Group Welfare MoU Memo of Understanding UDSM University of Dar es Salaam MTA Material Transfer Agreement URT United Republic of Tanzania MTEF Medium Term Expenditure WHO World Health Organization Frameworks 2 UNITED REPUBLIC OF TANZANIA Foreword Recent global disease events have highlighted the increasing effects of zoonotic pathogens on human and animal health. It has also become evident that changes in the environment, including agricultural intensification, population growth, urbanization, climate change, and human encroachment into wildlife habitats are drivers for such zoonotic disease emergence. The One Health approach has been recognized as a major element of disease control and prevention strategies as it emphasizes the relatedness of human, animal, and environmental health and the importance of transdisciplinary efforts. This has also been demonstrated in the recent major Rift Valley Fever outbreak in Tanzania in 2007, where enhanced cross-sectoral communication during the outbreak led to the effective handling of the response. Similar efforts were seen in the preparation of the Tanzania National integrated avian and human influenza pandemic emergency preparedness planning document in 2006. This is the first “National One Health Strategic Plan” to be developed using a multisectoral approach and has drawn expertise from various sectors reflecting shared commitment to enhanced collaboration among animal, wildlife and human health sectors to reduce the burden of zoonotic diseases. The coordination of the development of this plan was done by the Prime Minister’s Office of the United Republic of Tanzania. This strategic plan is a whole-of-government guiding document aimed at summarizing operations and activities among various stakeholders. This strategic plan also aims to create and maintain active collaboration between the sectors for the prevention and control of zoonotic diseases to ensure that there is timely preparedness, and a consistent and coordinated response in the event of an occurrence of a zoonotic event. To achieve this, the plan proposes the establishment of a “National Coordinating Unit” which will continue to evolve, enhance, and refocus One Health programs to meet existing and impending challenges. To support the unit, a One Health Steering Committee and technical working groups will be created. Successful implementation of the strategic plan will contribute significantly to the overall goal of improving public health, food safety and security, and the livelihoods of our people. It is in this regard that we call upon other government departments, development partners, institutions of higher learning, civil society, private sector and the Tanzanian community to 3 UNITED REPUBLIC OF TANZANIA join us in this noble One Health initiative. This strategic plan should be considered a “living document” and is open for feedback, additions and revisions based on changing needs. Permanent Secretary Prime Minister’s Office 4 UNITED REPUBLIC OF TANZANIA Acknowledgements The Prime Minister’s Office wishes to thank all those who contributed to the successful completion of the strategic plan for the implementation of One Health in Tanzania. Special appreciation goes to the team that worked tirelessly to write this Plan, including the following: Dr. Abdu Hayghaimo MLFD Dr. Emmanuel Swai MLFD Dr. Janneth Mghamba MoHSW Dr. Mary Kitambi MoHSW Dr. Fausta Mosha MoHSW Dr. Victor Muchunguzi MoHSW Dr. Geofrey Mchau MoHSW Mr. Elibariki Mwakapeje MoHSW Mr. Harrison Chinyuka PMO Mr. Ewald Boniface PMO Dr. Idrissa Chuma MNRT Dr. Henry Magwisha TVLA Dr. Joseph Masambu TVLA Dr. Chanasa Ngeleja TVLA Dr. Victor Kakengi TAWIRI Dr. Zablon Bugwesa Katale TAWIRI Dr. Leonard Mboera NIMR Prof. Japhet Kilewo MUHAS Mr. Heribert Kaijage MUHAS Dr. Simon Mamuya MUHAS Dr. Charles Mwanziva TPDF 5 UNITED REPUBLIC OF TANZANIA Dr. Ruth Jonathan TPDF Captain Daudi Kadigi TPDF Dr. Alphoncina Nanai WHO Dr. Ahmed Abade TFELTP Dr. Fredrick Salukele Ardhi University Dr. Steven Mbuligwe Ardhi University Mr. Huka Duba GIS facilitator Prof. Menoris Meshack GIS facilitator Ms. Kaitlin Sandhaus GIS facilitator Ms. Janie Goldstien GIS facilitator Ms. Kerrie Kirtland GIS facilitator Dr. Michelle Roland CDC Tanzania Dr. Rachel Eidex CDC Tanzania Ms. Marcelina Mponela CDC Tanzania Dr. Robert Fyumagwa TAWIRI In addition, we wish to thank the Cooperative Biological Engagement Program (CBEP) of the United States Department of Defense for providing financial assistance for the development of the strategic plan. 6 UNITED REPUBLIC OF TANZANIA

1.0 Introduction

1.1 Country Profile

1.1.1 Geography and Population Tanzania, officially the United Republic of Tanzania (URT), is a country in East Africa in the Great Lakes region and lies between 3°S and 12°S and 26°E and 41°E. It borders the Indian Ocean to the East (800km), and has a long international border of approximately 3,900km shared with eight countries including Kenya (796 km) and Uganda (396 km) to the North, Rwanda (217 km), Burundi (451 km), the Democratic Republic of Congo (478 km) to the West, Zambia (338 km) to the South West, Malawi (475 km) and Mozambique (750 km) to the South. The total area including inland water and Zanzibar is 947,303 km2, of which 886,040 km2 is land and 62,050 km2 is water (Lake, 2013). Tanzania is the 13th largest country in Africa and the 31st largest in the world. The climate varies with geographical zones: tropical on the coast where it is hot and humid (rainy season March-May); semi-temperate in the mountains with short rains November- December and long rains February – May; while it is drier in the plateau region with considerable seasonal variations in temperature. Total rainfall increases towards the north around Lake Victoria. Rainfall is well distributed throughout the year reaching its peak during the period of March through May. Such diverse climate attracts a wide range of vectors of veterinary and public health importance. Tanzania is endowed with 95.5 million hectares of land, of which 44 million hectares are classified as suitable for agriculture. Only 10.6 million hectares are under cultivation. The major crops are sugar cane, tea, tobacco, cashew nuts, coffee, cotton, maize and rice. Approximately 50 million hectares of rangelands are suitable for livestock grazing, but only 24 million hectares are currently being utilized, supporting 14.6 million ruminant Tropical Livestock Units (TLUs)[1TLUs~ 1 Adult cattle]. The remaining land suitable for livestock grazing is currently not being utilized due to the presence of tsetse flies. 7 UNITED REPUBLIC OF TANZANIA The population of Tanzania consists of 125 ethnic groups (Levinson, 1998). According to the 2012 census, the total population was 44,928,923. Density varies from 12/ km2 in less populated regions, such as Katavi, to 3,133/ km2 in highly populated regions, such as Dar es Salaam (National Bureau of Statistics, 2013). The overall population growth rate is estimated to be 2.9% per year with the urbanization growth rate standing at 4.77% per year. Agriculture supports the livelihoods of 82% of the population, 70% of which is rural (National Report, Dar es Salaam, Prime Minister’s Office, 2007/2008). About 37% (1,745,776 out of 4,901,837) of the households keep livestock. The < 15 age group represents 44.1% of the population (Tanzania National Bureau of Statistics, 2013).

1.1.2. Economic activities Tanzania’s Gross Domestic Product (GDP) recorded an average growth rate of about 7% between 2001 and 2010. The sectors that recorded high growth rates of more than 10% in 2010 were communications (22%), construction, electricity and gas (10.2 %) and financial intermediation (10.1%). Overall however, trading and repairs, tourism, agriculture, manufacturing and real estate and business services drove GDP growth. As of 2014, Tanzania's GDP was estimated at $36.6 billion, or $86.4 billion on a purchasing power parity (PPP) basis (Tanzania International Monetary Fund, 2014). The per capita GDP was $1,813 (PPP) which is 32% below the average of $2,673 for the 45 sub-Saharan African countries and ranked 23rd among those countries (Tanzania International Monetary Fund, 2014). From 2009 through 2013, Tanzania's per capita GDP (based on constant local currency) grew an average of 3.5% per year; higher than any other member of the East African Community (EAC) and exceeded only by nine countries in Sub-Saharan Africa (GDP per capita growth, November 2014). Livestock farming is one of the major agricultural activities in the country. The livestock industry’s contribution to the Agricultural Gross Domestic product is about 13%, and 4.0% of the National Gross Domestic Product in 2009, compared to 4.7% in 2008. Livestock plays important roles in Tanzanian’s socio-economic development and contributes towards household food and nutritional security. Tanzania’s animal wealth, according to 2014/15 budget’s speech, included 22.8 million cattle, 15.6 million goats, 7 million sheep, 2.01 million pigs, 0.3 million donkeys and 60 million poultry, together with very small numbers of domestic buffalo and humped camels (URT budget speech for the Ministry of livestock and Fishery development 2014-2015). More than 99% of these livestock are kept in 8 UNITED REPUBLIC OF TANZANIA low input/low output systems, owned and managed by resource-poor mixed and pastoral producers who operate under the traditional husbandry system with little or no access to good and reliable animal husbandry practices and reliable veterinary services.

1.1.3 Economic development The thrust of Tanzania's development agenda, since independence, has been on economic growth, and fighting illiteracy, poverty and disease burden. Since the mid 1980’s, the Tanzanian economy has been undergoing gradual and fundamental transformations towards a market-based economy. The macro-economic policy reforms have required a redefinition of the roles of the public and private sectors in livestock development and health service provisions. These changes have paved the way for the withdrawal of government involvement in subsidies and non-participation in private good inputs and services provision, which can be better performed by the private sector. Based on challenges associated with those transformations, Tanzania developed Vision 2025, a blue print to consolidate the three major challenges of illiteracy, poverty and disease and articulate a long-term development agenda for the country. Vision 2025 outlines the country’s social, economic and political aspirations for the first quarter of the 21st century with an underlying drive to reach the middle-income country (MIC) status with a per capita income of $3,000 USD through a cycle of short and mid-term plans. These short and mid- term plans incorporate inputs from Sector Strategic Plans, Medium Term Expenditure Frameworks (MTEFs), Millennium Development Goals (MDG), MDG Acceleration Framework (MAF) and other national and international initiatives. The targeted average GDP growth rate for the FYDP period is 8 percent per annum (equivalent to a 5 percent per capita growth target), building up from 7 percent in 2010, and thereafter sustaining growth rates between 8 and 10 percent until 2025. Specific sectors’ targets include agriculture to increase its average annual growth rate from 4.4 percent to 5.6 percent, manufacturing from 8 percent to 12.1 percent, industry from 8.6 percent to 9.4 percent, and services from 7.5 percent to 7.8 percent.

1.1.4 Administrative structure Tanzania is divided into thirty regions; twenty-five on the mainland and five in Zanzibar (three on Unguja, two on Pemba). In total, there are 169 districts, also known as local 9 UNITED REPUBLIC OF TANZANIA government authorities. Of these, 34 districts are urban units, which are further classified into five city councils (Dar es Salaam, Arusha, Tanga, Mbeya, and Mwanza), 19 municipal councils, and 12 town councils. Since 1986, the government has undergone several reforms in sectors, including Public, Agriculture and Local government. The Public Sector reforms identify functions that will continue to be provided by the central government and those that can best be performed by other actors, such as local governments, service boards, executive agencies, NGOs and the private sectors. The Agricultural Sector reforms have a main objective of rationalizing agricultural sector development functions so that they can be operated more efficiently under a changed macro-economic policy. The Local Government reforms, which started in 1999, have the main purpose of establishing a new local government system, capable of responding to the current macro-policies, namely, the introduction of multi-party democracy and the adoption of a free market economy. The new local government system is therefore based on political devolution and decentralization of functions and finances within the framework of a unitary state. Decentralization will make service providers more accountable to communities and the local government. Sectors involved in One Health activities function at both the national and local governments. Within the devolved governance, veterinary services are managed under the Ministry of Livestock and Fisheries Development (MoLFD); public health service is managed under the Ministry of Health and Social Welfare (MoHSW) at the national level and at sub national (regional) level, by the Prime Minister’s Office Regional and Local Administration (PMORALG), while the wildlife service is managed by the Ministry of Natural Resources and Tourism (MNRT). Affiliated institutions or agencies within each respective ministry provide technical support. Such agencies and institutions include Tanzania Veterinary Laboratory Agency (TVLA), Tanzania Livestock Research Institute (TALIRI), National Institute for Medical Research (NIMR), Tanzania Food and Drug Authority (TFDA), Government Chemist Laboratory Agency (GCLA) for Public Health, Tanzania Wildlife Research Institute (TAWIRI), Tanzania National Parks Authority (TANAPA), Ngorongoro Conservation Area Authority (NCAA) and the Tanzania Fisheries Research Institute (TAFIRI). 10 UNITED REPUBLIC OF TANZANIA

1.1.5 Wildlife Wildlife refers to the flora and fauna of Tanzania. The country is among the four mega- biodiversity nations in the world, alongside Brazil, Indonesia and the Democratic Republic of Congo (DRC). Approximately 38% of the land area is set aside in protected areas for conservation, including 16 national parks, 31 game reserves, 38 game controlled areas, Ngorongoro Conservation Area (NCA) and Selous-Niassa Wildlife Corridor (Tegegn, 2014). The various types of protected areas are interwoven with agro-pastoral and pastoral community lands, some of which also support substantial biodiversity. Tanzania contains 20% of the species of Africa’s large mammal population, found across its national parks, reserves, conservation areas and marine parks. These species are spread over an area of more than 370,000 km2, forming more than one-third of the country's territory (Arce, 2009). In many protected areas, including major national parks (Ruaha & Serengeti) and conservation areas, livestock, wildlife and people intersect forming complex interactions and potential for disease transmission. The Ngorongoro Conservation Area (NCA) is a multiple land use area where livestock and wildlife are legally allowed to live together and in Game Controlled Areas, limited human activities like livestock keeping and temporary shelters are allowed. Many protected areas are also part of the wetlands of Tanzania. Wild animals tend to be closer to the wetlands, particularly the water loving species such as the hippopotamus, waterbucks, common warthogs, elephants, crocodiles, Sitatungas (marshbucks), as well as water birds including flamingoes and ducks. Tanzania is also home to about 130 amphibian and over 275 reptile species, many of them being strictly endemic and classified as endangered species, or under threat of extinction by the International Union for Conservation of Nature's (IUCN) (Kamukala, 1993). The wildlife resources in Tanzania provide an annual income of $30 million USD to the national exchequer, and an income of $9 million USD as revenue from leasing companies.

1.2 Overview of Zoonotic Diseases in Tanzania

1.2.1 Societal factors Animals (domesticated or wildlife) and humans often live close together throughout the developing world. People are especially dependent on livestock and poultry for food, clothing, fertilizer, draught power, and an important degree of financial security. At the 11 UNITED REPUBLIC OF TANZANIA same time, these animals and their products create disease risks for the populations, most of whom depend on them. Approximately 61% of human diseases are zoonotic (Latham, Woolhouse; 2001) but public health practitioners rarely consider the implication of these types of infections in humans. According to the World Health Organization (WHO), neglected zoonoses (the term “neglected” highlights that diseases affect mainly poor and marginalized populations in low-resource settings) affect about 2.7 billion people worldwide every year, and are commonly associated with poverty and impact the lives and livelihoods of millions of poor livestock keepers or those living in peri-urban slums primarily in developing countries. The dual impact of a substantial burden in terms of human and livestock health and the economic implications to community livelihoods exacerbates the poverty cycle in the most marginalized livestock-dependent communities. Agro-ecosystem change, especially forest fragmentation and edge effects land use patterns, globalisation (movement of people, goods, animal and animal products to different parts of the world), climate change, eating habits due to urbanisation and increased incomes can increase pathogen flow between people, livestock and wildlife, and increase zoonotic disease risk.

1.2.2 Burden of Zoonoses in Tanzania In developing countries such as Tanzania, little is known about the incidence of many zoonoses. The Technical Working Group (TWG) (Annex 1) has drafted a provisional list of twenty-three zoonotic diseases affecting Tanzania for future prioritization and revision. Estimated incidence of diseases such as brucellosis in Tanzania in general is not known but reports from pastoralists in northern Tanzania indicate that about 7.7% of people are infected (Crump et al., 2013), and in wildlife in the Serengeti ecosystem 24% of buffaloes (Syncerus caffer) and 17% of wildebeest (Connochaetes taurinus) are seropositive for brucellosis. In the past, attempts to control these diseases have been carried out without involving key players on human and animal health. Although some successes were registered, the gains have not been sustained. This calls for an interdisciplinary, cross- disciplinary and multi-sectoral approach to understand the complex dynamics of these zoonoses in order to help design appropriate interventions to address them. Neglected parasitic, bacterial and viral zoonotic diseases are among some of the most common infections affecting animals and humans. Reports indicate that over 50% of the 12 UNITED REPUBLIC OF TANZANIA new infectious diseases in humans are caused by pathogens originating from animals or animal products, of which 70% have their roots in wildlife (WHO World Health Statistics, 2012). Wildlife hunting, trading, and consumption increase the opportunity for the transmission of diseases from wildlife to humans, thus the emergence of zoonotic diseases (Karesh 2005; Wolfe 2005; Karesh and Noble 2009). Human contact with animals during rearing, hunting, butchering, product handling (storage, transportation) and trading is an established method of transmission of pathogens from animals to humans (Wolfe et al. 2005). Some of the zoonoses are transboundary, complicating efforts to detect and control outbreaks of zoonotic disease. Furthermore, specific programmes and interventions to address some of the priority zoonotic diseases are non-existent or sporadic. It is important that comprehensive research be undertaken to establish facts of the spread and effect on vulnerable human populations and livestock production systems. Livestock production is regarded as the cultural heritage of many resource-poor rural communities in Africa. It serves as a major source of livelihood and a pathway out of poverty for many African farmers. Apart from providing a rich source of animal protein, many livestock are kept as “bank on hooves.” These animals are sold to earn hard cash necessary to settle important family problems. In addition, livestock are also used to accomplish many cultural and traditional religious practices such as marriage dowry, naming ceremonies, tribal rituals and religious sacrifices. Africa is known to be endemic for viral hemorrhagic fevers including Ebola, Marburg, and West Nile virus with bats considered potential reservoirs of these deadly viruses (Towner et al. 2004; Leroy et al. 2005; Towner et al. 2007; 2009). In addition, other zoonotic viruses more commonly found in Asia such as the Heniparviruses (including Nipah virus) have also been identified in Africa, suggesting their distribution may be wider than originally thought (Pernet 2014). The fast growing human population in sub-Saharan Africa is increasing demand for animal protein and therefore wildlife, including bats, are increasingly hunted for meat causing risk of emerging infections, such as the Ebola virus, being transmitted to humans (Hayman et al. 2010). 13 UNITED REPUBLIC OF TANZANIA WHO reports indicate that Q fever in humans is another bacterial zoonosis, affecting about 3.5 million people worldwide each year (Prabhu et al. 2011; Grace et al. 2012). The bacterium Coxiella burnetii, the cause of Q fever, is excreted in milk, urine, and feces of the infected animals; infection of humans usually occurs through inhalation of these organisms in contaminated environments, with the average prevalence in East Africa estimated at 10% (Prabhu et al. 2011; Grace et al. 2012). In Tanzania, febrile syndromes caused by zoonotic diseases, such as leptospirosis, brucellosis and Q-fever, are often misdiagnosed as malaria with mistreatment leading to prolonged illness and increased disease burden, as well as inappropriate use of antimalarial therapies. Approximately 20% of febrile illness cases admitted to hospitals in Tanzania are reported to be due to brucellosis, leptospirosis and Q- fever as opposed to 1.6% with malaria as the causative agent (Biggs et al. 2011; Bouley et al.2011). Plague (caused by Yersinia pestis) is a highly contagious disease with an extremely high mortality rate if left untreated, and can be used as a weapon of biological warfare. Plague is now commonly found in sub-Saharan Africa and Madagascar, which now account for over 95% of reported cases in the world (Prentice et al. 2004; Little, 2007). In Tanzania, the disease is endemic in the Western Usambara Mountains where outbreaks have been reported from time to time (Laudisoit et al.2007). Recently, Mbulu and Karatu districts have reported sporadic outbreaks (Ziwa et al., 2013). However, the prevalence of the disease in the endemic regions in the country is not documented. Anthrax is an endemic bacterial zoonosis caused by Bacillus anthracis in many sub-Saharan Africa countries, and most often humans are infected through contact with infected animals, wool, meat, or hides. The disease may present as cutaneous, gastrointestinal, or as an inhalant (Lembo et al. 2011). In pastoral communities in northern Tanzania, mortality rates are high for individuals who get infected due to consumption of dead animals (Rao et al. 2010; Lembo et al. 2011). In wildlife-protected areas, the disease is associated with drought and outbreaks are often predictable. In the Serengeti ecosystem in northern Tanzania, seroprevalence was noted in herbivorous species often hunted for bushmeat (meat that comes from wild animals captured for consumption), including buffalo (14-46%) and wildebeest (4-19%) (Lembo et al. 2011). 14 UNITED REPUBLIC OF TANZANIA Some bacterial infections like Brucella spp are contagious resulting from consumption of infected raw milk or meat, or close contact with infected animal fluids. The disease can often lead to serious complications including arthritis, endocarditis and encephalitis lasting from a few weeks to years (Fyumagwa et al. 2009). Recent reports have shown that 7.7% of humans and over 50% of livestock in northern Tanzania tested positive for Brucella abortus (Crump et al. 2013). Spillover infections to wildlife can sustain the disease and become a source of spillback infection to humans and livestock. Rift Valley fever (RVF) is an acute vector borne zoonotic viral disease presenting a potential threat to the human and animal population mainly in sub-Saharan Africa. RVF affects mainly livestock, especially sheep, goats and cattle causing abortion in females and a high mortality rate in newborn animals leading to considerable economic losses. Eastern and Southern African countries had reported several RVF outbreaks that resulted into substantial losses of animals and humans. During the last outbreak in 2006/07 in Tanzania, Kenya and Somalia, more than 1,000 infections in humans and 323 deaths were reported. RVF is a notifiable disease under the Tanzanian Animal Disease Act since 1980 (Ecosystem Health Research in Tanzania, 2010-20110) and according to the Integrated Disease Surveillance and Response (IDSR) Guidelines of the Tanzania Ministry of Health and Social Welfare since 2011.

1.2.3 Potential Routes of Exposure In Tanzania, illegal hunting of wild herbivores for game meat is very high. For example, in the Serengeti ecosystem between 30,000 and 100,000 wild herbivores are illegally hunted every year for commercial purpose targeting both local and foreign market (Hofer et al., 1996; Loibooki et al., 2002). The growing demand and increased trade of bushmeat for consumption creates increased opportunities for pathogen transmission to humans from wildlife (Liegeois et al 2012). In the 2014 Ebola epidemic in West Africa, more than 20,000 were infected with more than 8,500 deaths by end of December 2014, and the source of the epidemic is suspected to be from bats or non-human primates. Tanzania is at risk of many zoonotic diseases because it has the largest wildlife population in Africa including bats and non-human primates (Chaber et al. 2010; Smith et al. 2012). 15 UNITED REPUBLIC OF TANZANIA Bats are usually considered inedible by most groups of people in East Africa because of their preference to nocturnal habits and associations with witchcraft and/or death. However, people in Pemba, Tanzania appear to be unique in that they hunt and eat bats (Walsh, 2009). At least 11 species of bats (Order Chiroptera) are found on Pemba Island. The most sought-after species is the endemic Pemba Flying Fox, Pteropus voeltzkowi, followed by the Straw-coloured Fruit Bat, Eidolon helvum. A recent study in Morogoro, a city in the southern highlands of Tanzania, has reported a high (19.4%) prevalence of leptospirosis in bats (Mgode et al., 2014). The authors concluded that bats are a potential reservoir and transmitter of Leptospira serovar Sokoine (the serovar name “Sokoine” has been designated for this specific new Leptospira isolate). Another group of scientists assessed exposure of straw-coloured fruit bats (Eidolon helvum) to selected zoonotic pathogens in Tanzania. They detected antibodies to Henipaviruses in E. helvum populations in Dar es Salaam and Morogoro, with an average seroprevalence of 57% and 1% in adults and sexually immatures, respectively. Antibodies to lagos Bat Virus (lBV) were also detected in E. helvum populations and the average seroprevalence was 50% and 32% in adults and sexually immatures, respectively. They concluded that "Spill-over" transmission of these viruses to other mammalian species, including humans, is likely to occur (http://e-library.costech.or.tz/greenstone/collect/reports1/). The high interaction among humans, livestock and wildlife can easily result in interspecies transmission of zoonotic diseases. The large human population and increased demand for land, food and use of natural resources is the root cause of increased transmission of diseases. Zoonotic diseases are of great importance at the interface among humans, livestock and wildlife, especially in self-identified populations that primarily rely on raising livestock on ‘natural’ pasture that has been unimproved by human intervention, otherwise referred to as “pastoral communities” (Salzman 2004). These nomadic communities consume raw milk and medium cooked meat, which is a potential source of infections (Crump et al. 2013). Exposure levels to these zoonotic pathogens in rural populations and those at occupational risk are widespread. 16 UNITED REPUBLIC OF TANZANIA

1.2.4 Zoonotic Disease Control Efforts Many African countries lack adequate policies, technologies and resources to curb the incidence of zoonotic diseases. Most of the neglected zoonoses in Tanzania, such as Tuberculosis (TB), Brucellosis, Cysticercosis, Plague, Salmonellosis and Anthrax are making a strong comeback, causing devastating effects on livestock and adversely affecting human health. However, the prevalence of these zoonoses on the continent and within countries is not clear. For example, in Botswana, it is estimated that 10% of the estimated 1.7 million cattle are infected with Cysticercus bovis. This is profound in small scale farming communities, which account for a large percentage of the country’s cattle population. Huge financial losses are incurred in beef export due to condemnation of infected carcasses and the zoonotic risk to pastoral communities in this country is high as well. However, in Tanzania, which is a third country in Africa for cattle population (22 million) and where majority of livestock is kept by semi-nomadic pastoralists, the problem of bovine cysticercosis is not clearly documented. Among health care providers in Tanzania, knowledge of these diseases as cause of febrile illness is extremely limited (Swai and Schoonman, 2009) and this lack of awareness is confounded by the limited data on zoonosis and the capacity for diagnosis of these agents. The problem is further compounded by the lack of understanding of the underlying complexity of social, economic, and environmental factors as key drivers of zoonoses persistency in Tanzania. These drivers may be acting at local, regional and global levels; however, they greatly influence livestock ownership and management practices in many cultural settings in Tanzania. The rapid growing concern of urbanization is another driving demand for meat and milk products among the growing affluent population, also leading to changing patterns of urban livestock keeping. The consequence of these changes in livestock-keeping practices and zoonotic disease risks are almost unknown. Many neglected zoonoses can be controlled and treated by providing safe and effective drug treatments to individuals in affected communities concurrent with public health education to avoid re-infection. The diseases thrive in places with poor sanitation and limited access to basic health care. They cause severe pain and life-long disabilities, and are 17 UNITED REPUBLIC OF TANZANIA often less visible and have a low priority. Many pastoral and agro-pastoral communities have little knowledge of the epidemiology of most of these zoonoses. Consumption of raw meat, milk and blood is reported to be a common practice. Sanitation conditions are poor due to, among other things, lack of knowledge and nomadic lifestyle. Furthermore, the medical, public health system and veterinary sectors operate in a fragmented manner thus efforts to control these zoonoses are often fragmented and uncoordinated.

1.3 Evolution of One Health Approach

1.3.1 Global Steps Toward One Health The One Health concept is a worldwide strategy for expanding interdisciplinary collaborations and communications in all aspects of health care for humans, animals and the environment. The synergism achieved will advance health care for the 21st century and beyond by accelerating biomedical research discoveries, enhancing public health efficacy, expeditiously expanding the scientific knowledge base, and improving medical education and clinical care. When properly implemented, it will help protect and save untold millions of lives in our present and future generations. Recognizing that human health (including mental health via the human-animal bond phenomenon), animal health, and ecosystem health are inextricably linked, One Health seeks to promote, improve, and defend the health and well-being of all species by enhancing cooperation and collaboration between physicians, veterinarians, other scientific health and environmental professionals and by promoting strengths in leadership and management to achieve these goals. Around the World, the One Health Initiative is a call to action for the establishment of closer professional interactions, collaborations, and educational and research opportunities across the health science professions and related disciplines to improve health of people, animals, plants, and the environment. Our changing environment now often increases human and animal contact creating significant challenges. These challenges require integrated solutions and call for collaborative leadership. The World Health Organization (WHO) revised the International Health Regulations (IHR) in 2005 to provide a new framework for the coordination of events that may constitute a public health emergency of international concern, and for improving the capacity of 18 UNITED REPUBLIC OF TANZANIA countries to assess and manage acute public health risks. The IHR 2005 guidelines require that unusual health events, including zoonoses, be addressed by effective national surveillance and the establishment of human-animal coordinated response mechanisms at all levels. The IHR 2005 guidelines also require the inclusion of veterinary officers and wildlife experts in the national and sub-national public health emergency management committees when dealing with zoonotic events. At the 61st World Health Assembly in 2008, WHO adopted 20 key indicators for monitoring IHR core capacity at the national level, including two indicators specific to One Health. First, each country is required to establish a mechanism for coordinating all relevant sectors in the implementation of IHR 2005. Second, each country must establish a system for surveillance of zoonoses and potential zoonotic events. In addition, the World Organization of Animal Health (OIE) has advocated for improved governance of zoonotic diseases by its member countries and has recognized improved collaboration between the public and animal health sectors as key in this process. In February of 2006, a tripartite agreement between Food and Agriculture Organization (FAO), OIE, and WHO created the global early warning system for the prediction, prevention, and controlling disease threats including zoonoses. Adoption and implementation of this One Health Strategy will help Tanzania with implementation of the 2005 IHR.

1.3.2 Economics of One Health The case for control of zoonotic diseases (zoonoses) is compelling. A 2011 report by the OECD shows that pandemics are a prime global catastrophic threat—a finding that is consistent with a number of other assessments (OECD 2011). Potential losses resulting from a severe influenza pandemic, for instance, which may lead to 71 million human fatalities would be $3 trillion, or 4.8 percent of the global GDP. In addition, tackling endemic zoonoses would reduce a major source of human suffering and economic losses that disproportionately affects many of the poorest households in developing countries. Echinococcosis, for instance, imposes a human and economic burden in developing countries that each year costs at least 1.5 million healthy life-years, as well as US$2 billion in livestock losses. Control of a zoonosis requires early and rapid actions. A typical episode may involve a pathogen that originates in wildlife, then passes to livestock, and is then 19 UNITED REPUBLIC OF TANZANIA transmitted from livestock to humans. Exposure to the pathogen in animals could be followed by symptoms in animals. Then there is a rise of exposure in humans, who subsequently could develop symptoms, may seek treatment, and infect each other. If the disease reaches the point of spreading among humans, the disease will have already done substantial damage. Moreover, the spread of the disease among humans at that point may be difficult to slow or reverse, and the cost of disease control will usually increase rapidly. This pattern of progression is evident from the high and rising cost of controlling HIV/AIDS, which is also of zoonotic origin. Thus, effectiveness of zoonotic disease control requires early detection at the source of the disease in animals, an early and accurate diagnosis, and rapid disease control measures. Delays substantially reduce effectiveness. The more effective an approach is, the more lives it will save, and the higher the benefits in terms of avoided losses. Authorities too often start looking for the disease in animals and undertake diagnostic and control efforts only after human cases and deaths have been observed. When disease surveillance and control take this form, humans essentially serve as a sentinel species—human death and illness act as indicators of disease in animals. Because surveillance, diagnosis, and control of zoonotic disease take place at the interface between animals and humans, systematic communication and substantial coordination between human, wildlife, and veterinary health services is an important practical necessity. And this communication and coordination also needs to extend to those services that monitor food safety. One Health is an approach to ensure that this critically important interdisciplinary collaboration occurs. This collaboration reduces the gaps between institutions and disciplines that can cause costly delays, and even failures, in disease detection and control. One Health refers to “the collaborative efforts of multiple disciplines working locally, nationally and globally to attain optimal health for people, animals and our environment.” 20 UNITED REPUBLIC OF TANZANIA

2.0 Situational Analysis

2.1 International Health Regulations (IHR) 2005 Member States use IHR 2005 to govern surveillance of public health emergencies of international concern. These guidelines were enacted in 2005 and came into force on 15 June 2007 and are legally binding for WHO Member States. In 2006, the Resolution AFR/RC56/R2 of the Regional Committee for Africa in Addis Ababa called for the implementation of the IHR (2005) in the context of the Integrated Disease Surveillance and Response (IDSR). IHR 2005 has an expanded scope to include all public health emergencies of international concern (including zoonoses). Successful implementation of IHR 2005 requires the fulfillment of 8 core capacities including legislation, policy and coordination, surveillance, preparedness, response, risk communications, laboratory and human resources for all levels including Point of Entries, as well as Potential hazards (zoonotic events). A developed checklist and indicators for monitoring progress in the development of IHR Core Capacities in State Parties have been developed and have been defined using capability levels (i.e. the level of performance attained by a State Party for a given indicator, component and core capacity). The aim of the checklist is to enable self-assessment of the status of States Parties’ core capacity development and identify areas for strengthening. The recommended checklist for monitoring progress of IHR core capacity development in zoonotic events according to capability levels is as follows: Capability Level 1: Foundational  Coordination exists within the responsible government authority (ies) on the detection of, and response to zoonotic events.  List of priority zoonotic diseases with case definitions available.  A regularly updated roster (list) of experts that can respond to zoonotic events is available. Capability Level 2: Inputs and processes  National policy, strategy or plan for the surveillance and response to zoonotic events are in place. 21 UNITED REPUBLIC OF TANZANIA  Focal point(s) responsible for animal health (including wildlife) designated for coordination with the Ministry of Health and compliance with IHR 2005  Systematic and timely collection and collation of zoonotic disease data is done.  Access to laboratory capacity, nationally or internationally (through established procedures) to confirm priority zoonotic events is available.  A mechanism for response to outbreaks of zoonotic diseases by human and animal health sectors is established. Capability Level 3: Outputs and outcomes  Functional mechanisms for intersectoral collaborations that include animal and human health surveillance units and laboratories are established.  Zoonotic disease surveillance that includes a community component is implemented.  Timely and systematic information exchange between animal surveillance units, human health surveillance units and other relevant sectors regarding potential zoonotic risks and urgent zoonotic events.  Timely response to more than 80% of zoonotic events of potential national and international concern. Capability Level 4: Additional achievements Country experiences and findings related to zoonotic risks and events of potential national and international concern have been shared with the global community 22 UNITED REPUBLIC OF TANZANIA

2.3 Strengths, Weaknesses, Opportunities and Threats Analysis for One Health Implementation in Tanzania ONE HEALTH COORDINATING BODY STRENGTHS WEAKNESSES  Informal coordination amongst institutions exist (for some zoonotic diseases)  Uncoordinated/fragmented habit of doing work  Presence of stakeholders of varied level of responsibilities and interest  Low perception of burden of zoonoses among public/policy makers and  Existence of disease surveillance and reporting system in place politician  Coordination and communication through PMO  Criteria for resource allocation are not in favour of zoonotic diseases  Early prediction, detection and response  Weak multisectoral coordination  Timely response to disasters/ disease outbreaks  Lack of funds for supporting the unit (sustainability)  Availability of trained staff/manpower in specific areas  Inadequate laboratory capacity for diagnosis all infectious pathogens  Existence of Laboratory infrastructure (biosafety level)  Existence of accredited labs  Lack of coordination unit and lack of funds to support the suggested  Rational use of resources coordination unit (sustainability)  Capacity and knowledge sharing  Lack of comprehensive National One Health Strategic Plan  Availability of experts (multidisciplinary/multisectoral)  Lack of One Health Policy guidelines  Availability of facilities (Infrastructure, labs, Institutions, etc.)  Lack of enough human resource capacity  High political willingness (support from PMO is high)  Lack of appreciation of One Health Concept among policy makers  Existence of contingency plans (National Avian Pandemic Influenza Plans , RVF  Misconception/conflicting roles of One Health Concept among experts contingency plan, Preparedness Plan for Public Health Risks and Emergencies)  Inadequate integration of One Health Concept in University/Institutions  Existence of One Health Initiatives in different sectors (OHCEA, SACIDS, Afrique Curriculum One, etc.)  Poor economy  Availability of Disaster and Emergency committees  Bureaucratic barrier among different sectors  Legal power to coordinate and command  Competing priorities  Power of resource mobilization.  Resources are project oriented with starting and ending dates  Presence of multisectoral expertise (Animal, Human, Environmental health.)  Inadequate skilled staff  Existence of National Task Force committees in various sectors to respond to public health events including zoonotic diseases 23 UNITED REPUBLIC OF TANZANIA OPPORTUNITIES THREATS  One health approach issues in regional and global resolutions which country has  Conflicting interests on priority setting amongst key players signed and adopted  Conflicting interests in different ministries and change of personnel  New policy on One Health under PMO is forthcoming  Unstable organizational Structure  Presense of (multiple) emerging and re-emerging zoonotic diseases such as  Global economic crisis Ebola  Political instability among neighbouring countries  Inclusion of one health approach issues within government sectors as well as in  Competing Priorities the University training curriculum  Existence of parallel projects with different priorities.  Presence of PMO disaster management unit  Inadequate of own resources  Existence of some legal and policy framework  Existence of large expertise base (trained human resource)  Availability of surveillance systems in all involved ministries  Availability of basic institutional set up within involved ministries  Existence of potential development partners and local support  Existence of multisectoral coordination activities/projects  Availability of contingency plans which involve different sectors  Presence of the political will and stability  Existence of various local One Health implementing partners  Strong inter-ministerial cooperation through newly developed TWG  Recognized needs for the multisectoral collaboration 24 UNITED REPUBLIC OF TANZANIA ONE HEALTH RESEARCH STRENGTHS WEAKNESSES  Participating institutions are conducting relevant and reliable research  Each institution is conducting research in isolation related to One Health  Lack of enough multidisciplinary research expert  Existence of multidisciplinary/sectoral research experts  Inadequate information sharing among institutions on One Health research  Political will on importance of research  Duplication of research by different institutions  Availability of basic infrastructure and resources for research  Inadequate support by policy makers  Existence of research information sharing system  Inadequate and scattered lab facilities and infrastructure  Existence of rich and diverse natural resources for use in research  Inadequate streamlined research priority  Output of One Health research is not used to inform appropriate policies  National research agendas do not address One Health issues OPPORTUNITIES THREATS  Occurrence of emerging/re-emerging pandemic threats  Many research projects are not demand driven  Baseline information on one health are existing in different collaborating  Lack of availability of renewable material resources institutions  Global economic crisis  Existence of external funding agencies  Competing priorities of the donor and local institutions  Interest of development partners and innovation  Diversity of one health group formulation  Political will  Lack of government commitment after donor withdrawal  Presence of PMO-Disaster Management unit  Inadequate communication between researchers and policy makers  Existence of EAC One Health forum  Customs and culture  Existence of forum (e.g. RMO/DMO meetings; TAWIRI, TVA, NIMR, TAWIR conferences) that can be used to provide policy briefs 25 UNITED REPUBLIC OF TANZANIA ONE HEALTH TRAINING, ADVOCACY AND COMMUNICATION STRENGTHS WEAKNESSES  Existence of human and animal health training institutions  Weak information sharing mechanism  Existence of Integrated Diseases Surveillance and Response (IDSR) strategy  Weak multi-sectoral coordination  Availability of multisectoral expertise  Lack of One Health policy  Existence of disaster management committees from national level to  Lack of national One Health strategy plan grassroots levels  Lack of appreciation of One Health concept among policy makers  Availability of some One Health demonstrations sites  Lack of One Health harmonized curriculum among institutions  Availability of One Health long and short courses (SUA, MUHAS)  Inadequate resources  Academics rigid to adopt to new initiatives  Primary and secondary school do not capture elements of One Health OPPORTUNITIES THREATS  Political will  Unstable organizational structure of ministries (similarly to departments,  Existence of national contingency plan (AI, RVF and National Pandemic directorates and units) Preparedness Plan)  Political instability among neighbouring countries  Possibility of funding from government and donors  Conflicting interests in priority setting among key players and participating  Various channels of communication exist, which will assist in education of agencies the public through vibrant education media outlets  Customs and culture  High need and demand for capacity building 26 UNITED REPUBLIC OF TANZANIA ONE HEALTH DISEASE SURVEILLANCE, PREVENTION AND CONTROL STRENGTHS WEAKNESSES  Existence of legal and policy framework  Habit to work in silos o Animal Disease Act (2003)  Weak coordination of activities o Public Health Act (2009)  Lack of knowledge of laboratory capacity throughout the different sectors o National Livestock Policy (2006) (health, livestock, wildlife) o Wildlife Policy (2009)  Lack of intersectoral laboratory sharing policy  Existence of disease surveillance guidelines  Lack of harmonized disease surveillance guidelines o IDSR/IHR (2005)  Lack of National OH policy and strategic plan o OIE  Inadequate human resource at subnational levels o FAO  Low disease awareness at lower levels (Famers/livestock keepers)  Existence of contingency plan for some diseases  Inadequate information sharing (between sectors) o RVF Contingency Plan  Inadequate surveillance data feedback (between sectors and o HPAI farmers/livestock keepers) o H5N1  Lack of integrated SOPs and guidelines focuses for zoonotic diseases  Laboratory infrastructure with some diagnostic capacity  Well trained and capable staff at all National levels  Multiple disease challenges  Funds are being allocated OPPORTUNITIES THREATS  Good communication infrastructure  Conflicting political interests o ICT exists which supports reporting via mobile  Conflicting and / competing interests on priority setting and resource  Existence of various surveillance tools allocation  Enhanced collaborations among stakeholders focused on zoonotic diseases  Diversity of disease reservoir  Presence of potential donors to support disease surveillance and  Unpredictable weather / climate change prevention  Fragmented chain of command 27 UNITED REPUBLIC OF TANZANIA EPIDEMIC PREPAREDNESS AND RESPONSE STRENGTHS WEAKNESSES  Existence of Multisectoral Preparedness plans on RVF and Avian Influenza  Epidemic preparedness plans are not exhaustive and those present are not  Existence of multisectoral disaster management committees at region and tested district levels  No joint outbreak investigation guidelines  Existence of preparedness and response teams at national level and  The existing multisectoral emergency preparedness teams are not being selected subnational levels utilized and are not functioning  Existence of Diagnostic and treatment facilities  Limited financial and human resources  Existence of IDSR guidelines  Emergency preparedness teams are not functional in absence of outbreaks  Trained personnel in outbreak investigation and response  No proper coordination of teams during outbreaks (within ministries and  Allocated funds for epidemic interministerial)  Inadequate laboratory capacity for diagnosis of all infectious pathogens (biosafety level)  Weak information sharing during outbreaks  Lack of isolation facilities  Lack of well trained staff at subnational levels OPPORTUNITIES THREATS  Increasing occurrence of zoonotic disease  Existence of different groups (ministries, private sector, NGOs, universities,  Existence of partners willing to support etc.) addressing one health activities which are not coordinated  Existence of regional collaboration (EAPHLN, ECSA, SADC, EAC)  Change of patterns of emerging and re-emerging diseases  Existence of diagnostic facilities  TVLA has become an agency to support diagnosis of zoonotic diseases  Existence of Tanzania Vaccine Institute under TVLA  Existence of TFDA  Establishment of Mobile Laboratory for Pathogens up to Risk Group 4 within National Institute for Medical Research 28 UNITED REPUBLIC OF TANZANIA

3.0 Five Year Plan

3.1 Background on the National One Health Strategic Plan

3.1.2 Core Values The following are the core values that will guide the implementation of this strategic plan:  Collaboration – promote engagement and collaboration to achieve the strength of a united force working for the benefit of all  Adaptability – flexible, innovative and responsive to meet the changing needs of our society  Excellence – promote the highest standards of performance throughout the scope of One Health to ensure quality and continuous improvement at all levels  Teamwork- close working relationship with all stakeholders for synergy  Transparency - openness and willingness to promote and share in executing One Health  Resilience - recognising the varied staff, programmes, disciplines, sectors and backgrounds with the ultimate aim of reaching a common goal

3.2 Guiding Principles The following principles will guide the implementation of this plan:  Prevention and control of zoonoses is a national public good and requires strong political and financial commitment at national and county levels  Sustainable utilization of existing institutions and whenever possible drawing on lessons learnt  Use of a multidisciplinary approach to realize technical, political, and regulatory frameworks required to effectively manage zoonoses  Science-based and continually adjust to new information and technologies  Recognize and respect cultural diversity 29 UNITED REPUBLIC OF TANZANIA

3.3 Vision, Mission and Goals VISION: A nation with optimal health for people, animals and the environment achieved through collaborative efforts locally, nationally, regionally and globally. MISSION: Improve the well-being of the United Republic of Tanzania by promoting collaboration in addressing One Health country priorities. GOALS: 1) Increase awareness on One Health for professionals, policy-makers and the community 2) Strengthen preparedness planning and improve the ability to respond to zoonotic disease outbreak at all levels (community, District, Regional and National) 3) Improve the health of human, animal and environment through evidence-based research 4) Provide functional and quality integrated human and animal health systems, at all levels, to reduce the burden of zoonotic diseases 5) Strengthen institutional framework to support One Health implementation 30 UNITED REPUBLIC OF TANZANIA

3.4 Objectives and Strategies

3.4.1 Thematic Area 1: Training, advocacy and communication Goal: Enhance awareness on One Health for professionals, policy-makers and the community Objective Strategy Strategic activities Indicators Means of verification 1. To increase 1.1. Developing and a) Prepare Communication and Communication and awareness on One operationalizing One communication and Advocacy Strategy in place Advocacy Strategy Health to 80% of at Health Advocacy Strategy risk population from Communication and document identified priority Advocacy Strategy b) Disseminate Workshops and seminars Quarterly and annual zoonotic diseases communication and held nationally, regionally reports areas at all levels, by Advocacy strategy and in the districts to June, 2020 through workshops, disseminate seminar, etc. communication and Advocacy strategy

1.2. Sensitization on a) Develop a Plan for awareness Work plans One Health through dissemination plan to creation is developed and different media and create awareness available other forum b) Develop sensitization Types and number of Financial records, materials (print, social materials developed samples of materials media, electronics etc.) c) Conduct dissemination Number of Meeting reports; and sensitization meetings/sensitization Quarterly reports meetings meetings 2. To increase the 2.1. Developing One a) Curriculum review and Number of curriculum Availability of curricula; knowledge base Health training development workshops review and development Meeting and Progress focused on One materials workshops held reports Health initiatives in b) To integrate existing Integrated and updated Copies/samples of 80% of pre-service One Health curriculum One health curriculum is developed curriculum 31 UNITED REPUBLIC OF TANZANIA and 30% of in-services among institutions available in all institutions available at institutions trainings by July 2018 c) Develop OH materials Number of training Availability of copies of to conduct training to institutions have materials in institutions human health and same/common training animal health workers materials developed for their trainees

2.2 Conducting a) Conduct capacity Number of institutions and Training reports; training to in- building to institution tutors trained Inventory of institutions service/on-job tutors and tutors with skills on human and animal OH trainings health workers b) Conducting Training of Type and number of ToTs Training reports; Trainers (ToT) for Inventory of TOT on OH cascaded OH training 3. To increase 3.1. Lobbying and a) Conduct sensitization Number of sensitization Advocacy briefs; Progress awareness about One advocacy to policy meetings / workshops meetings and workshops reports Health to 100% of and decision makers held to lobby and advocate policy and decision on One Health to policy makers by July 2020 and decision makers b) Dissemination of One Number of copies of One Copy of strategies Health Strategy Health strategy documents distributed policy and decision makers

3.4.2 Thematic Area 2: Preparedness and Response Goal: To strengthen preparedness planning and improve the ability to respond to zoonotic disease outbreak at all levels (community, District, Regional and National) Objective Strategy Strategic activities Indicators Means of verification 1. Develop a 1.1. Setting up a) Establish coordinated Presence of TORS and TORs available, framework for system to ensure and functional functional multidisciplinary outbreak investigations improving capacity for availability of Multidisciplinary Emergency preparedness reports available 32 UNITED REPUBLIC OF TANZANIA preparedness to sustainable emergency teams and number of respond to Zoonotic resources preparedness and outbreaks responded within disease outbreak to all response teams with a specified time levels by 2016 TORS b) Create a joint human Common HR mobilization HR policy resource mobilizing mechanism developed mechanism through the PMO from involved ministries and agencies c) Identify and develop a Mechanism for fund raising Fund raising strategy sustainable mechanism developed for soliciting operational funds for emergency preparedness and response d) Establish emergency Availability of emergency Presence of Emergency preparedness funds preparedness funds preparedness funds account and funds available in the account.

1.2 Develop exercise a) Conduct tabletop Gap analysis report Simulation exercises response plans simulation exercises report b) Conduct field Gap analysis report Training Report simulation exercises 2.To strengthen the 2.1. Develop a) Develop integrated Integrated One health Copies of guidelines coordination of coordinating guidelines and guidelines and emergency emergency mechanism for contingency plans for preparedness and response preparedness and emergency coordinated emergency plans are available among response to zoonotic preparedness and preparedness and all collaborating ministries disease outbreak response to response of zoonotic and partners among relevant zoonotic outbreak diseases. 33 UNITED REPUBLIC OF TANZANIA ministries and b) Develop coordinated Emergency preparedness Copies of SOPs available agencies by 2020 standard operating and response SOPs are procedures for developed and emergence disseminated among all preparedness and stakeholders response.

3.4.3 Thematic Area 3: Research Goal: Improve the health of human, animal and environment through evidence based research Objective Strategy Strategic activities Indicators Means of verification 1) To enhance 1.1 Strengthening a) Develop, review and Evidence of MoUs and MoUs and MTA/DTAs Institutional and establish revise MoUs and MTA/DTAs developed collaborative Research institutional MTAs/DTAs to reflect among research institutions projects on One agreement on one health among Health by 60% in 2020 collaborative relevant research research projects on institutions and One Health by 2020 laboratories services b) Conduct inventory on Data-base of inventory on Inventory of research existing capacity - existing institutional projects develop database research capacity developed

1.2. Improve a) Procure laboratory Inventory of procured lab Inventory of equipment existing laboratory requirements based on equipment and supplies are and supplies and human research needs available resources capacities b) Training of research Training report on types, Training reports/records teams modules, venue and names of personnel trained with details of cadre is available c) Harmonize Harmonized policies and MoUs, policy and Institutional policy and regulations regulations regulations on utilization 34 UNITED REPUBLIC OF TANZANIA of laboratory services to integrated use (human/ animals) 2) To coordinate the 2.1. Establish a) Streamline joint OH Proceedings of consultative OH research priority list setting of One Health national One Health research priorities meetings held research priorities research agenda A national priority list of OH among all institutions research is available by 2020 b) Develop joint OH Evidence of joint available Project progress reports research proposals proposals being undertaken c) OH coordination Number, venue, dates and Workshop records of workshops agenda of OH research OH coordination and workshop proceedings 3) Enhance 3.1. Communicating a) Participate and Conference proceedings Proceedings communication One Health concepts present at existing fora, linkages between One to policy and such as (RMO/DMO, Health researchers decision makers TAWIRI, TVA, NIMR, and policy makers by TAFIRI, TPHA, MUHAS, 2020 UDOM, etc.) to communicate research findings b) Use of media/ Evidence of research Journals publications agencies/ websites to publications in journals and and manuscripts, disseminate research media and number of times booklets, Brochures result to the public they have appeared. c) Convene policy Proceedings of Proceedings of the dialogues to policy meetings/workshops/prese meetings and /Policy makers on policy briefs ntations convened for briefs policy makers/bureaucrats and their numbers 35 UNITED REPUBLIC OF TANZANIA d) Conduct Proceeding of meetings Proceeding of meetings dissemination meeting to communities

3.4.4 Thematic Area 4: Disease surveillance, prevention and control Goal: Functional and quality integrated human and animal health systems to reduce the burden of zoonotic diseases Objective Strategy Strategic activities Indicators Means of verification 1) To promote and 1.1 Establish an a) Take inventory of the Availability of the inventory Surveillance tools strengthen integrated integrated zoonotic existing zoonotic disease of zoonotic disease surveillance, disease surveillance surveillance tools surveillance tool prevention and system at national, b) Develop risk map for Risk map for priority Current or updated risk control of zoonotic zonal/regional and priority zoonotic diseases zoonotic disease is available maps diseases in 12% of the district levels and in use districts annually by c) Develop guidelines for Guidelines for surveillance Guidelines 2020 disease surveillance of existing zoonotic based on the existing diseases are developed and disease surveillance being used. guideline (OIE, WHO, FAO, etc.)

1.2. Enhance a) Conduct trainings Number of training Training and progress integrated zoonotic conducted at national, reports disease surveillance regional and community at national, level on zoonotic disease zonal/regional, surveillance district and b) Raise community Number and types of Progress reports community levels awareness on zoonotic community awareness diseases raising approaches used to enhance zoonotic diseases surveillance at all levels. c) Develop an integrated Availability of a database Database in place zoonotic disease 36 UNITED REPUBLIC OF TANZANIA database d) Conduct quarterly Number of meetings Report zoonotic disease surveillance meetings at national, regional and district level

1.3 Strengthen a)Participate in quarterly Number of meetings Report cross-border sharing cross-border surveillance attended of information on committee meetings zoonotic diseases b) Identify and develop a Evidence of list of priority Records list of priority zoonotic zoonotic disease through diseases inventory or publications c) Develop guidelines Availability of strategies Unit plans and and SOPs for integrated developed by the unit for strategies prevention and control prevention and control of for selected priority priority zoonotic disease zoonotic diseases d) Incorporate and Evidence of implementation Implementations plans implement integrated of zoonotic disease and reports zoonotic disease prevention and control prevention and control strategies strategies into LGA and other institutions e) Conduct training on Number of trainings Training reports zoonotic disease conducted on zoonotic prevention and control disease prevention and to regional, district and control for regions, districts stakeholder institution and institutions staff 2) To enhance 2.1. Strengthen a) Take inventory of Inventory of diagnostic Inventory records 37 UNITED REPUBLIC OF TANZANIA zoonotic disease laboratory capacity diagnostic laboratories laboratories diagnostic capacity at b) Build laboratory Number of laboratories Inventory and reports national (100%), capacities (physical, built, equipped and staffed zonal/regional (60%) financial and human) and district (30%) c) Develop laboratory Number of laboratories Inventory levels by 2020 network with networks among themselves and collaborating in delivery of research and services d) Develop and SOPs developed and SOPs harmonize SOPs harmonized for enhanced standards e) Conduct training Number of trainings Training reports conducted for laboratory staff to enhance quality and strengthen their capacity f) Establish quality Quality management Quality assurance audit management system in system in place report all laboratories dealing Number of labs/tests with zoonotic disease accredited diagnosis

3.4.5 Thematic Area 5: Coordination Goal: Strengthen institutional framework to support One Health implementation. Objective Strategy Strategic activities Indicators Means of verification 1) By July 2016, a cost 1.1. Roles and a) Establish a One Health coordination Minutes of meetings effective and efficient responsibilities of secretariat for secretariat is established One Health coordination unit coordination of One and working (functional) coordinating Unit defined and agreed Health involving 80% of upon b) Develop terms of Detailed TOR for One TOR stakeholders reference for the One Health secretariat that 38 UNITED REPUBLIC OF TANZANIA established in the Health secretariat defines roles and DMD PMO’s office responsibilities is available c) Enlist and identify Inventory of all List of stakeholders professionals and stakeholders represented in agencies that are the One Health coordination is main stakeholders available d) Develop concept Evidence of fund raised and List of funded proposals notes and proposals to proposal making is available raise funds to manage the secretariat e) To secure and equip the OH office

1.2. Technical a) Identify the number An inventory of names and List of members of Working Groups and sectors brought number of ministries, TWGs: progress reports (TWG) are functional together under each sectors and partners and active and well TWG working with TWGs is coordinated readily available at the secretariat b) Define roles for the Clearly defined functions Defined roles of TWGs TWGs and roles of each TWG is available c) Define and agree on Minutes of meetings and Minutes of meetings frequency of meetings their scheduled dates are held for each TWGs available d) To establish One ToR establishing the forum ToR and minutes of Health National Forum and minutes of meetings meetings held. 2) By 2020, establish a 2.1. Establish and a) Identify leadership Membership and chair of Minutes of meetings of mechanism to operationalize a TWG for each Technical each TWG is identified and TWGs facilitate and of all stakeholders Working Group communicated 39 UNITED REPUBLIC OF TANZANIA collaborate One b) Develop MoU with MoU binding each partners MoUs Health activities with each ministry, and their roles are available the relevant institutions and ministries, agencies partners as members of and other TWGs organizations by c) Establish linkages Evidence of formal working MoUs, Reports average of 60% between TWGs from relationship between national, regional to TWGs, regional and districts district levels coordination units is available 40 UNITED REPUBLIC OF TANZANIA

3.5 One Health Strategic Framework The aim of the OH approach is to diminish the threat of emerging infectious diseases and to minimize the impact of endemic zoonoses. This OH strategic plan is based upon recognition of the intimate linkages among the human, animal and ecosystem health domains. It proposes an interdisciplinary, cross-sectoral approach to disease surveillance, monitoring, prevention, control and mitigation of endemic and emerging diseases. Pooling resources will lead to economies of scale and enable common problems across systems to be addressed in a targeted manner without duplication. This OH strategic plan will be achieved by pursuing three broad approaches. First, to enhance capacity for zoonotic disease prevention and control, particularly in the animal sector that has traditionally been under-resourced. Secondly, to facilitate collaboration between animal and human health sectors, as well as players in the ecosystem in areas of common interest. These include disease surveillance, early detection, rapid response, education and research. Finally, to conduct applied research at the human-animal- ecosystem interface to fill gaps in the understanding of mechanisms of transmission of zoonotic diseases in order to better formulate prevention and control strategies for these diseases.

3.5.1 Strategic Interventions Tanzania’s One Health Strategic Plan 2015 – 2020 focuses on five thematic areas in consonance with its objectives as outlined below: 1. Training, advocacy and communication 2. Preparedness and response 3. Research 4. Disease surveillance, prevention and control 5. Coordination

3.5.1.1 Training, advocacy and communication Goal: Enhance awareness on One Health for professionals, policy-makers and the community 41 UNITED REPUBLIC OF TANZANIA The aim of this goal is to train in order to increase awareness of One Health for professionals, policy makers and the community in Tanzania. With little knowledge of zoonotic diseases, the extent of how they spread, or the health and socio-economic impact on the nation and society at large, it will be difficult for policy makers to accept and appreciate the public health implications of zoonosis and allocate appropriate resources for control, management and prevention. Not only do professionals fail to appreciate the epidemiological and relational nature of the zoonosis, but they also function within a disorganized and disintegrated system. The current system is unaware of the best approach to integrated management and coordination that will help articulate management measures. This would undermine rational utilization of the scarce national resources to control and prevent existing and emerging zoonosis. Further, the community continues to bear the burden of diseases that regularly cause major public health hazards, social disruption and economic stress. Under this strategic goal, issues related to education, advocacy and communication for awareness and information are emphasized and given proper attention. Three strategic objectives have been identified to achieve the above goals. These are: 1. To increase awareness about One Health to 80% of at risk population from identified priority zoonotic disease areas at all levels, by June, 2020 2. To increase the knowledge base focused on One Health initiatives in 80% of pre- service and 30% of in-services trainings by July 2018 3. To increase awareness about One Health to 100% of policy and decision makers by July 2020 Objective 1: To increase awareness about One Health to 80% of at risk population from identified priority zoonotic disease areas at all levels by June 2020 Increasing awareness will be a nationwide event beginning from the top policy makers to regional and districts leadership, partners and stakeholders stretching all the way down to the community and villages across the country. Since the One Health concept is new within the country’s context, it is essential that all stakeholders and communities are well informed, educated and equipped to respond appropriately. The importance to leaders and policy makers cannot be over emphasized. They are the best placed to influence the 42 UNITED REPUBLIC OF TANZANIA direction the nation could take and are the most trusted source of information as the peoples’ representatives. These groups are also influential at the level of resources mobilization and lobbying for the best legislation. The community is the one that feels the immediate effect of zoonotic diseases. A unified and integrated approach to health care of the affected, prevention and control is better achieved through inclusive and appropriate communication system at all levels. Approaches to achieve this objective include the development and operationalization of One Health communication strategy and sensitization of communities through different media for information, communication and education to enhance changes in behavior. Objective 2: To increase the knowledge base focused on One Health initiatives in 80% of pre- service and 30% of in-services trainings by July 2018 Building and developing the knowledge and skill base of professional and technical staff in institutions of higher learning countrywide is a necessary and essential intervention that will ensure that the country has the human resource capacity needed to respond to and manage zoonotic diseases well. Including One Health teaching within all institutions of higher learning, such as colleges and universities will help ensure that both new and in-service professionals are well coached, informed and trained in approaches to One Health in Tanzania. This will further reduce the cost and save resources invested in recurrent workshop and short courses. There are two strategies to achieve this objective. The first is to develop or adopt One Health training curriculum in all institutions of higher learning across the country. The second relates to conducting relevant training to in-service human and animal health workers to ensure they have the right knowledge and skills to appropriately respond to and manage zoonosis. Objective 3: To increase awareness about One Health to 100% of policy and decision makers by July 2020 Engaging policy makers, including the political class, funders and decision makers, is essential and necessary if the One Health approach is to function efficiently and attract attention, resources and succeed in implementation. Legislation, regulations and policies will only pass when each of these groups are adequately sensitized, engaged and convinced to consider the intervention as a priority. Lobbying and advocacy by technical teams and 43 UNITED REPUBLIC OF TANZANIA other stakeholders interested in pursuing the issues to the benefit of larger society will ensure the sustainability of the proposed One Health activities. It is only when the hearts and minds of such leaders are won, that influence is assured, leading to allocation of the required resources. 3.5.1.2: Preparedness and response Goal: Strengthen preparedness planning and improve the ability to respond to zoonotic disease outbreak at all levels (community, District, Regional and National) Current emergency preparedness teams in Tanzania are not multi-sectoral and coordinated, except under very specific circumstances in which different sectors come together due to highly sensitive outbreaks (H1N1). However, even during outbreaks, there is no proper coordination mechanism for the teams. Emergency preparedness teams are almost non- functional in the absence of outbreaks. Many government agencies and major stakeholders are addressing One Health activities in isolation. With a weak information sharing mechanism, lack of integrated and coordinated investigation guidelines and incomplete preparedness plans, response to outbreaks remains a huge challenge. Amidst these challenges, inadequate laboratory capacity for diagnosis of all infectious pathogens (biosafety level) is common, coupled with limited financial and human resources. In addition, lack of isolation facilities for patients where highly infectious diseases are handled remains a major deterrent to response, amidst the changing patterns of emerging and re-emerging diseases. Two strategic objectives have been identified to achieve the above goals. These are: 1. To develop a framework for improving capacity for preparedness to respond to zoonotic disease outbreaks at all levels by 2016 2. To strengthen the coordination of emergency preparedness and response to zoonotic disease outbreak among relevant ministries and agencies by 2020 Objective 1: To develop a framework for improving capacity for preparedness to respond to zoonotic disease outbreaks at all levels by 2016 44 UNITED REPUBLIC OF TANZANIA A One Health framework will provide a mechanism for improving human resource capacity through tabletop and field trainings, as well as support emergency response teams. The Prime Minister’s Office can help coordinate teams from relevant ministries based on response needs for emergencies. The framework will also be used as a tool for funding priorities and inform decisions about establishing government supported emergency preparedness funds. As funding remains a major challenge, initiating a robust and efficient mechanisms to mobilize resources is essential. One strategy will focus on setting up systems to ensure the availability of sustainable resources. To achieve this, relationships with both external and internal technical institutions, experts, funding agencies, donors and other interested parties will be pursued vigorously through sensitization meetings and interministerial meetings. Objective 2: To strengthen the coordination of emergency preparedness and response to zoonotic disease outbreaks among relevant ministries and agencies by 2020 Coordinating emergency preparedness and response to disease outbreaks and emergencies related to zoonosis is an essential component of the disease management process. Experts within the health, livestock and wildlife fields can be utilized to develop integrated disease- specific data collection documents, guidelines and contingency plans. Developing integrated guidelines will allow multi-sectoral teams to conduct disease outbreak investigations using the same tools and means of documentation and reporting. Revising Standard Operating Procedures (SOP) for preparedness and response to outbreaks, to include both human and livestock health elements will ensure that information is streamlined and easily distributed to all relevant ministries. 3.5.1.3: Research Goal: Improve the health of human, animal and environment through evidence-based research There is generally a lack of well-coordinated approaches to conducting research by different institutions due to the lack of streamlined research priorities. Many of the research projects conducted by different sectors are not need-driven and are conducted irregularly by the sectors. Subsequently, research is conducted in isolation, which unknowingly creates 45 UNITED REPUBLIC OF TANZANIA duplication due to lack of coordination. Even after research is conducted and published, information on research findings are not shared between institutions or policy makers, as there is a lack of a well-established channel of communication. Policy makers lack essential information and knowledge of the importance of One Health research, thereby they fail to make it a priority at the governance level. Stand-alone projects fail to gain enough funding from the government once donors withdraw their support upon the end of a project. Failure to prioritize One Health research also impacts the number of research facilities and infrastructure, as well as creates a shortage of multidisciplinary research experts. Research forms an important part of building evidence for knowledge and decision-making. Conducting research in a collaborative and integrated manner helps different institutions, departments and partners to improve efficiency in terms of information sharing, the establishment of commonality in implementation of programs related to One Health and cost minimization. Three strategic objectives have been identified to achieve the above goals. These are: 1. To enhance institutional collaborative research projects on One Health by 60% in 2020 2. To coordinate the setting of One Health research priorities among all institutions by 2020 3. To Enhance communication linkages between One Health researchers and policy makers by 2020 Objective 1: To enhance institutional collaborative research projects on One Health by 60% in 2020 Enhancing collaborative efforts among institutions implementing One Health research programs will support more robust and complete findings without duplication of effort. Research conducted by experts from complementary fields will provide unique data focused on zoonotic diseases and will also increase communication among relevant ministries, stakeholders and research partners. As institutions and ministries agree to conduct 46 UNITED REPUBLIC OF TANZANIA collaborative research, Memos of Understanding, or other official contracts must be agreed upon, including roles and responsibilities, as well as data and material management. When efforts are combined, resources are more effectively utilized and waste is reduced, while knowledge and information is shared. One of the strategies under this objective is to improve existing laboratory and human resource capacity by investing in appropriate equipment and supplies. Capacity building of technical personnel through training ensures availability of personnel that are competent and qualified to be able to conduct the required research. To ensure that research efforts are in line with priorities and that findings are shared in the most effective manner, Tanzania should have an accurate inventory of past and current research, as well as current research proposals. Collecting and organizing information about research conducted in laboratories and research facilities will serve as an indicator for emerging priorities. Objective 2: To coordinate the setting of One Health research priorities among all institutions by 2020 This objective reflects the need to identify research themes and the zoonotic diseases that have maximum impact on the health of the population to attract the desired attention and invest accordingly. Collaborating relevant ministries, partners and institutions can maximize utilization of resources by proposing research programs that will contribute to the reduction of the disease burden. The strategy involves the establishment of a national One Health research agenda that acts as a roadmap based on the country’s zoonotic disease priorities. Another strategy includes holding workshops to discuss barriers to coordinated research and to explore concrete approaches to overcoming them, as well as discuss methodologies and research results, and lay the groundwork for future research and publication. Objective 3: To enhance communication linkages between One Health researchers and policy makers by 2020 This effort will ensure strengthened knowledge and appreciation among leaders. When leadership is fully engaged and involved, the opportunity for lobbying to increase resource allocation and dissemination of information is boosted. As a strategy, communicating One 47 UNITED REPUBLIC OF TANZANIA Health concepts to policy and decision makers will be implemented through meetings, conferences, workshops and seminars, and information will be shared through briefs. 3.5.1.4: Disease surveillance, prevention and control Goal: Establish functional and quality integrated human and animal health systems to reduce the burden of zoonotic diseases Disease surveillance is the continuous systematic collection, analysis and interpretation of health-related data needed for the planning, implementation, and evaluation of public health practice. It is also critical for detecting and managing outbreaks, monitoring the impact of interventions and reducing disease. Surveillance can serve as an early warning system for impending public health emergencies; help document the impact of an intervention, or track progress towards specified goals; and strengthen monitoring and evaluation of the epidemiology of health problems, to allow priorities to be set and to inform public health policy and strategies (WHO). A weak coordination mechanism, exacerbated by the behavior of different sectors preferring to work in isolation, remains a hiderance to better surveillance, prevention and control of diseases. Lack of or poor coordination, lack of harmonized disease surveillance, poor intersectoral laboratory sharing policy and a lack of harmonized disease surveillance guidelines cause apparent inefficencies in governance. While laboratory human resource capacity and infrastructure is insuffient, lack of adequate financial resources continue to undermine improvement, as no progress can be made without funding. From the national level to the regions and districts and to basic community levels including villages and households, information sharing among and between sectors is lacking. There is a general failure to adhere to prevention and control guideliens due to a lack of knowldege, information and skills that would enahnce prevention mechanisms at all levels of society. Numerous and diverse disease reservoirs continue to contribute to an upsurge in new and emerging zoonotic diseases. Two strategic objectives have been identified to achieve the above goals. These are: 1. To promote and strengthen integrated surveillance, prevention and control of 48 UNITED REPUBLIC OF TANZANIA zoonotic diseases in 12% of the districts annually by 2020 2. To enhance zoonotic disease diagnostic capacity at the national level (100%), zones and regions (60%) and district levels (30%) by 2020 Objective 1: To promote and strengthen integrated surveillance, prevention and control of zoonotic diseases in 12% of the districts annually by 2020 Communication and coordination among national disease surveillance and response networks are vital in ensuring timely response to a public health event. Globally, zoonoses account for the majority of emerging infectious disease events, and domestic animals and wildlife are well-known reservoirs of many diseases of public health significance. Effective multi-sectoral One Health networks play key roles in disease detection, identification, reporting, and response leading to a decrease in disease burden on both human and animal health. Although systematic information sharing between the human and animal health sectors can help decision makers detect and respond to zoonotic diseases rapidly, resource constraints and other barriers often prevent efficient cross-sector coordination. Success of any multi-sectoral zoonotic collaboration is reliant on identifying and establishing, or building upon, current modes of communication across traditional and non- traditional public and animal health stakeholders to combat priority zoonotic diseases and establishing and implementing robust national strategies on the prevention, detection, and control of zoonotic pathogens. An important activity to support enhanced surveillance it to map the laboratory and surveillance networks currently in place for detecting and reporting priority zoonotic diseases in Tanzania. Mapping of zoonoses and the burden of such diseases can help identify hotspots where zoonoses cause significant burdens on health but also where efforts can be focused to improve prevention, communication, and coordination across veterinary and human health. Objective 2: To enhance zoonotic disease diagnostic capacity at the national level (100%), zones and regions (60%) and district levels (30%) by 2020 To enhance zoonotic disease diagnostic capacity, both medical (human) and veterinary laboratories will be strengthened countrywide. To do this successfully, laboratory 49 UNITED REPUBLIC OF TANZANIA infrastructures will be expanded and improved; modern equipment and supplies provided and human resource capacity be developed through training. Developing a working group to build a framework for cross-border surveillance in order to enable formal sharing of information across borders is an important aspect of building diagnostic capacity. Interministerial meetings with border country leadership will enable improvement of cross-border detection and reporting of infectious disease outbreaks, epidemiological investigations, surveillance-specific laboratory capabilities and communications systems, as well as surveillance and epidemiology related training. 3.5.1.5: Coordination Goal: Strengthen institutional framework to support One Health implementation. Coordination of One Health initiatives and activities under one national umbrella is essential for providing effective leadership, efficient response to epidemics and better management of resources. Through the One Health coordination body, it is envisaged that institutions will be strengthened, collaboration enhanced, resources mobilized, research coordinated and information availed on time. Due to the lack of multisectoral One Health coordination, there is nothing to unify the different sectors and institutions that perform similar roles in an integrated manner. Ministries, sectors, departments and institutions continue to work in isolation, while also dealing with bureaucratic barriers. Low perception of the burden of zoonoses among policy makers, politicians and the general public is common, and there is inadequate integration of One Health in University/Institutions curriculum. Lack of funds for supporting a coordination unit from the government perspective is due to the lack of prioritization, poor economy, policy and strategy gaps. Furthermore, under the current situation, resource allocation is project oriented. Laboratories are few and lack capacity (human, infrastructural and financial) for diagnosis of all infectious pathogens (biosafety level). Misconception and conflicting roles of One Health among experts is another hindrance to a better approach to achieve a common goal. Two strategic objectives have been identified to achieve the above goals. These are: 50 UNITED REPUBLIC OF TANZANIA 1. To establish a cost effective and efficient One Health coordinating unit involving 80% of stakeholders, to be housed within the DMD PMO’s office by July 2016 2. To establish a mechanism to facilitate and collaborate One Health activities with the relevant ministries, agencies and other organizations by average of 60% by 2020 Objective 1: To establish a cost effective and efficient One Health coordinating Unit involving 80% of stakeholders, to be housed within the DMD PMO’s office by July 2016 The Coordination of One Health will be through the Prime Minster’s Office (PMO), DMD department. This department is already responsible for coordination of other important and related government activities specifically disaster management. With vast experience and influence, it will be a unifying entity as the trust has been built and responsibility fully defined. A mechanism for facilitation and collaboration of One Health activities with the relevant ministries and other stakeholders will be established and operationalized. To achieve this, roles and responsibilities of the coordination unit will be defined and agreed upon by the stakeholders who are mainly the technical sectors and institutions brought together for the purpose. A Technical Working Group (TWG) will be formed to identify roles and contribution expected of each sector. The TWGs are charged with specific technical duties required of them and will meet regularly and advise the coordination unit as appropriate. By playing their role as required, each TWG will bring the positive contribution to the steering committee and add more value to functioning of the coordination unit. The strategy will provide guidelines on all resource mobilisation that the zoonotic disease control unit will engage in. A TWG to provide oversight and coordination shall meet on quarterly basis. Funding concept papers and proposals will be developed and submitted to groups and organizations based on outcomes of advocacy meetings. Proposals for support to zoonosis control interventions will continue to be submitted to development partners and funding agencies. The TWG will engage with potential donors, government and other funding agencies to advocate for more resource allocation from national and county governments. The coordination unit along with TWG will facilitate review of the programme performance, address implementation challenges and review the available resources against the program 51 UNITED REPUBLIC OF TANZANIA needs. Regular performance reporting on grants will be institutionalized using a standard format. The unit will further engage partners locally, regionally and internationally for behaviour change at the community level, resource mobilization and to advocate for policy and legislative environment. Objective 2: To establish a mechanism to facilitate and collaborate One Health activities with the relevant ministries, agencies and other organizations by average of 60% by 2020 The role of the coordinating body will mainly be that of providing oversight including supervision, setting policies and related strategies, as well as legislation and regulations. The unit will play a coordination role to convene meetings, communicate agenda and provide venue to host them. The unit will closely work with the technical working groups and steering committee to coordinate implementation of One Health among ministries, agencies, institutions and other organizations to articulate matters of national priority as related to One Health and facilitate resource mobilization effort. The success of a national One Health coordination will largely depend on a well functional unit that is better equipped, well-staffed with competent and technically enriched personnel that will provide management/coordination oversight. It is therefore essential that such competence be identified from the diverse background that will enrich the unit in order to ensure adequate representation of the relevant technical sectors that will compose the unit. It is also equally important later on to compose a well-integrated team of regional and district expertise for smooth implementation and One Health projects at the lower levels. Staff capacity and abilities will be enhanced through involvement in national, regional and international conferences, meetings, workshops and trainings. This will not only enhance their knowledge, but also strengthen their capacity to learn and articulate state of the art zoonotic disease prevention and control technologies, policies and strategies for 52 UNITED REPUBLIC OF TANZANIA implementation of efficient and technically sound program. The working environment will further be improved through identification and equipping of office infrastructure, plant, logistics, equipment, utilities, communication and connectivity. To discharge its coordination role effectively, the unit will take the lead in supporting, coordination and facilitation of TWGs while at the same time conducting regular performance monitoring and review meetings. 53 UNITED REPUBLIC OF TANZANIA

4.0 Organizational Chart and Functions

4.1 PMO Organizational Chart 54 UNITED REPUBLIC OF TANZANIA

4.2 Functions

4.2.1 One Health Steering Committee The One Health Steering Committee will be comprised of the Permanent Secretaries of the following offices:  Prime Minister Office – Chair  Ministry responsible for Livestock  Ministry responsible for Public Health and Social Welfare  Ministry responsible for Tourism and Natural Resources (Wildlife)  Ministry responsible for Environment  Ministry responsible for Agriculture, Food Security and Cooperatives  Ministry responsible for Education and Vocational Training  Ministry responsible for Finance and Economy Affairs  Ministry responsible Home Affairs (Internal Security, Immigration)  Ministry responsible for Defence and National Service  Ministry responsible for Communication/Broadcasting Others may include:  Development Partners’ Group (DPG) Tanzania  World Health Organization  Faith-based Organisations  Private Sector  Humanitarian Organisations  Food Agriculture Organisations The roles and responsibilities of the steering committee are to:  Receive proposals from the Secretariat/Technical Working Groups (TWGs)  Make decisions regarding proposals submitted by Secretariat/TWGs  Provide guidance on policy and technical directions/directives  Mobilise resources The One Health Steering Committee will meet twice a year. 55 UNITED REPUBLIC OF TANZANIA

4.2.2 Technical Working Groups (TWG)

4.2.2.1 Training, Advocacy and Communication TWG The Training, Advocacy and Communication TWG will be comprised of members from the following institutions: INSTITUTIONS MEMBERS Universities 5 members from MUHAS, SUA, UDSM, ARU & NM-AIST Ministries 6 members from MoHSW (Health education unit), MoLFD, MNRT, PMO-RALG, MoFEA, TPDF, Ministry of Information, Youth, Culture and Sports VPO-DoE 1 members PMO-DMD Secretariat NEMC 1 members COSTECH 1 members Development Partners (DPs) 5 Members from IHI, KCRC, UN-agencies, Bilateral organisations, CSOs The roles and responsibilities of the Training, Advocacy and Communication TWG are to:  Operationalize OH strategy under respective thematic area  Prepare annual plan as per strategy  Report to steering committee on the progress to the implementation of OH strategy  Develop curriculum  Organize training  Develop and implement communication and advocacy strategies  Each representative will provide updates on ongoing activities and will provide technical advice to OH Steering Committee (One more focal person selected as deputy from respective units will represent in the absence of focal person) Funding: Members will be paid by their organisations and institutes. The Secretariats will be responsible to facilitate quarterly meetings. The Training, Advocacy and Communication TWG will meet quarterly. 56 UNITED REPUBLIC OF TANZANIA

4.2.2.2 Research and Development TWG The Research and Development TWG will be comprised of members from the following institutions: INSTITUIONS MEMBERS Universities 6 members from MUHAS, SUA, UDSM, ARU & NM-AIST Ministerial Research Institutes 4 members from NIMR, TAWIRI, TAFIRI, TVLA PMO-DMD Secretariat VPO-DoE 1 members NEMC 1 members Ministry of Defence 1 members COSTECH 1 members Development Partners (DPs) 5 Members from IHI, KCRI, UN-agencies, Bilateral organisations, CSOs The roles and responsibilities of the Research and Development TWG are to:  Operationalize OH strategy under respective thematic area  Prepare annual plan as per strategy  Quarterly meeting  Report to steering committee on the progress to the implementation of OH strategy  Proposal writing  Each representative will provide updates on ongoing activities and provide technical advice to the One Health Steering Committee (One more focal person selected as deputy from respect units to represent in the absence of focal person) Funding: Members will be paid by their organisations and institutions. The Secretariats will be responsible to facilitate quarterly meetings.

4.2.2.3 Surveillance TWG The Surveillance TWG will be comprised of members from the following institutions: 1. Assistant Director Epidemiology (MoHSW) 57 UNITED REPUBLIC OF TANZANIA 2. National Epidemiologist (MoLFD) 3. Director of Research (TAWIRI) 4. Principal Veterinary Officer (TANAPA) 5. Director of Preventive Services (TPDF) 6. Director (NIMR) 7. 3 Representatives (Universities) 8. Director (TMA) 9. Representative (NHLQATC, TVLA, NIMR, etc) 10. Development partners The roles and responsibilities of the Surveillance TWG are to: 1. Identify and advise on priority zoonotic diseases 2. Prepare guidelines for zoonotic disease surveillance 3. Proposal preparations for different surveillance programs 4. Provide technical surveillance guidance to SC and OHU 5. To monitor and evaluate surveillance programme 6. To review disease surveillance reports from OHU 7. Prepare agenda for SC 8. Prepare early warning system 9. Meeting schedule: Quarterly/when needed Funding: Members will be paid by their organisations and institutions. The Secretariats will be responsible to facilitate quarterly meetings.

4.2.2.4 Preparedness and Response TWG The Preparedness and Response TWG will be comprised of members from the following institutions: 1. Representative (PMO-DMD) 2. Assistant Director Epidemiology (MoHSW) 3. Assistant Director Emergency and Preparedness Section (MoHSW) 4. Director of Veterinary Services (DVS-MoLFD) 5. Director of Research (TAWIRI) 58 UNITED REPUBLIC OF TANZANIA 6. Principal Veterinary Officer (TANAPA) 7. Director of Preventive Services (TPDF) 8. Representative (NIMR) 9. 3 Representatives (Universities) 10. Director (TMA) 11. Representative (NHLQATC, TVLA, NIMR, etc) 12. Representative (Relevant Sectors e.g. National Security, Water, Transport, Immigration, etc) 13. Development partners 14. Assistant Director – Health Education and Promotion Section (MoHSW) The roles and responsibilities of the Preparedness and Response TWG are to: 1. Prepare guidelines/SOPs for preparedness and response 2. Proposal preparations for preparedness and response and resource mobilization 3. Provide technical guidance to SC and OHU 4. Advice and develop on better communication strategies 5. To monitor, evaluate and facilitate preparedness and response plans 6. Prepare agenda for Steering Committee Funding: Members will be paid by their organisations and institutions. The Secretariats will be responsible to facilitate quarterly meetings. 59 UNITED REPUBLIC OF TANZANIA

4.2.3 One Health Coordinating Unit The One Health Coordinating Unit will be housed within the PMO- Disaster Management Department. The Unit will comprised of 5 individuals. They will include:  OH National Coordinator – With experience in DM and OH issues  Senior Medical Officer – With knowledge on OH issues experience in disease surveillance and outbreak investigations  Senior Veterinarian - With knowledge on OH issues, experience in disease surveillance and outbreak investigations  Supporting staff (Administrative Secretary and Driver)  Data Manager – With knowledge in IT and experience in Database Management particularly in health The roles and responsibilities of the One Health Coordinating Body are to:  Mobilise resources  Facilitate intersectoral coordination of zoonoses surveillance  Facilitate intersectoral coordination of outbreak investigation of zoonoses  Request experts as needed  Coordinate M&E  Provide Secretariat to the National OH Steering Committee and TWGs  Facilitate interministerial social mobilization/psychosocial Funding: The respective Ministries will cover salaries of National OH Coordinator, Medical Officer and Veterinarian. 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Annex 1: Provisional list of reported zoonotic disease in Tanzania Category Disease Etiological agent Rabies Lyssavirus, Rhabdovirus RVF Virus, Phlebovirus, Viral Rift valley fever Bunyaviridae HPAI H1N1, H5N7, H5N1 Plague Yersnia pestis Salmonellosis Salmonella spp Bovine tuberculosis Mycobacterium bovis Anthrax Bacillus anthracis Brucellosis Brucella species Campylobacteriosis Thermophilic campylobacters Bacterial Verotoxigenic Escherichia coli Escherichia coli O:157 Shigellosis Shigella spp Tick borne replasing fever Borrelia spp Q-fever Coxiella burnetii Spotted fever Rickettsia –typhus group Leptospirosis Leptospira spp Cryptosporidiosis Cryptosporidia spp Sleeping sickness Trypanosome spp Porcine cysticercosis/Taeniasis Taenia solium Toxoplasmosis Toxoplasma gondii Bovine cysticercosis Taenia bovis Parasitic Hydatidosis Echnococcus granulosus Trichnellosis Trichnella spiralis Trematodosis (Faciliosis) Fasciolla spp Giardiasis Giadia lamblia Visceral and Ocular larva migrans Toxocara canis Schistosomiasis Schstosoma spp Dermatophytoses (Ring worm) Epidemophyton, Microsporum, and Fungal Trichophyton spp. Sporotrichosis Sporothrix schenckii 65