Strategic Plan and Action Plan for the prevention and control of non communicable diseases in Tanzania 2016 - 2020

1.1 Global Burden of Non Communicable Diseases .............................................1

1.2 Burden of Non Communicable Diseases in Tanzania .....................................2

1.3 Approaches to Prevention of NCDs ...............................................................6 2 Situation Analysis (SWOTS) .................................................................................... 7 3 The Strategic Plan .................................................................................................. 17

3.1 Introduction .................................................................................................17

3.2 Scope ...........................................................................................................17

3.3 Time frame ..................................................................................................18

3.4 Vision ..........................................................................................................18

3.5 Mission ........................................................................................................18

3.6 Goal .............................................................................................................18

3.7 Principles .....................................................................................................18

3.8 Objectives ....................................................................................................19

3.9 Expected outcomes.......................................................................................19

3.10 Strategies and indicators of success ...............................................................20

3.11 Resources .....................................................................................................42

3.12 Assumptions and Risks .................................................................................42 4 References .............................................................................................................. 43 5 Annexes .................................................................................................................. 45

5.1 Annex 1: Summary of Indicators for Monitoring and Evaluation .................45

5.2 Annex 2: Implementation Status of Key NCD Prevention Legislations in Tanzania .......................................................................................................50

5.3 Annex 3: National NCD Action Plan 2016/17 - 2020/21 ............................53

5.4 Annex 4: Unit Cost for Common GFS Codes ..............................................55

5.5 Annex 5: Result Based Budget ......................................................................57

5.6 Annex 6: Result Based Budget ......................................................................73

5.7 Annex 7: Activity Costs ................................................................................92

5.8 Annex 8: People who contributed to the formulation of the National NCD Strategic and Action Plan 2016/17-2020/21 ..............................................114 STRATEGIC PLAN AND ACTION PLAN 2016-2020 Page i Abbreviations BMC Bugando Medical Centre CONSENUTH Centre for Counseling, Nutrition and Health Care COPD Chronic Obstructive Pulmonary Disease CVD Cardiovascular Disease DALYS Disability Adjusted Life Years DANIDA Danish International Development Agency DCC Drug Control Commission DMFT index Decayed, Missing, Filled, Teeth index EPI Expanded Program on Immunization ERS European Respiratory Society FCTC Framework Convention on Tobacco Control GBD Global Burden of Disease HBV Hepatitis B Virus HPV Human Papilloma Virus IARC International Agency for Research on Cancer IEC Information Education and Communication IHI Ifakara Health Institute KASH Korean Association on Smoking and Health KCMC Kilimanjaro Christian Medical Centre MDM Medicine Del Mundo MEHATA Mental Health Association of Tanzania MEWATA Medical Women Association of Tanzania MKUKUTA Mkakati wa Kukuza Uchumi na Kupunguza Umaskini Tanzania MMED Master of Medicine MNH Muhimbili National Hospital MOHCDGEC Ministry of Health Community Development Gender Elderly and Children community Development, Gender, Elderly and children Page ii STRATEGIC PLAN AND ACTION PLAN 2016-2020 MOI Muhimbili Orthopedic Institute MTEF Medium Term Expenditure Framework MUHAS Muhimbili University of Health and Allied Sciences NCDs Non Communicable Diseases NGO Non- Governmental Organization NIMR National Institute for Medical Research NSGRP National Strategy for Growth and Reduction of Poverty ORCI Ocean Road Cancer Institute OSHA Occupational Safety and Health Agency PAL Practical Approach to Lung Health PASADA Pastoral Activities and Services for people with AIDS in Dar es Salaam RITA Registration, Insolvency and Trusteeship Agency RTA Road Traffic Accident SCD Sickle Cell Disease SP Strategic Plan TAF Tanzania Asthma Foundation TANCDA Tanzania Non Communicable Diseases Alliance TBS Tanzania Bureau of Standards TFDA Tanzania food and drug authority TFNC Tanzania Food and Nutrition Centre TPCA Tanzania Palliative Care Association TPRA Tobacco Products Regulatory Act TTCF Tanzania Tobacco Control Forum UICC Union for International Cancer Control WAMA Wanawake na Maendeleo Foundation WHO World Health Organization STRATEGIC PLAN AND ACTION PLAN 2016-2020 Page iii Foreword The Government of the United Republic of Tanzania believes every Tanzanian citizen is entitled to a healthy life and attaches a top priority to matters related to health. Healthy people enable the country as a whole to attain accelerated development and achieve the sustainable development goals (SDGs) as agreed by other nations worldwide. This will ensure a high standard of living to its citizens, and realize a prosperous, modern and peaceful nation. Previously the health sector priority has been on the fight against communicable diseases, which have imposed an immense burden on our society, while also improving hospital services both in terms of infrastructure, human resource development and delivery of high quality health services. With the rising burden of non-communicable diseases, emphasis is now shifting from treatment or curative services to preventive services. Non-communicable diseases such as cardiovascular diseases, diabetes, cancer and chronic respiratory diseases now contribute about a third of all deaths in the country and are a source of an increasing disability in Tanzania. And while secondary causes may not always be documented, it does, however, lead to disability and increased need of physical rehabilitation service. The indicated new approach of focusing on prevention and control of non-communicable diseases marks the beginning of a new era on the provision of affordable health service while keeping equity and quality health services operational including those affected for life by chronic diseases and disability. The major non-communicable diseases are chronic in nature and are all linked up by a group of common modifiable risk factors. This plan presents a concrete and well-coordinated raft of measures, which will assist the Government to holistically bring about substantial reduction in morbidity and mortality due to non-communicable diseases in Tanzania. This requires action both as a nation and on an individual basis. Ministry of Health, Community Development, Gender, Elderly and Children (MoHCDGEC) is committed to provide leadership and support to bring together all the efforts of different partners and therefore appeals to all interested partners working in different action areas of their focus to collaborate and complement government’s efforts in this fight against non-communicable diseases. It is with pleasure that this strategy for the prevention and control of non-communicable diseases is hereby presented as a rock solid step for an increased emphasis on preventive services in Tanzania. _____________________ Dr. Mpoki M. Ulisubisya Permanent Secretary Page iv STRATEGIC PLAN AND ACTION PLAN 2016-2020 Acknowledgements The Ministry of Health, Community Development, Gender, Elderly and Children would like to take this opportunity to first and foremost thank the Tanzania Non Communicable Diseases Alliance (TANCDA) for funding the development of this strategic plan. Special thanks are also extended to members of the NCD Section at the Ministry of Health, Community Development, Gender, Elderly and Children for overseeing and coordinating the development of this plan. The Ministry would like to recognize the contributions made by partners in health represented by their organizations: Tanzania Diabetes Association (TDA), World Health Organisation, (WHO), Tanzania Cancer Association (TCA), Tanzania Association for Respiratory Diseases (TARD), Heart Foundation of Tanzania (HFT) and World Diabetes Foundation (WDF) for their spirited efforts in making this plan a reality. Special thanks are also extended to Prof. Andrew Swai, Chairman Tanzania Diabetes Association, Dr. Kaushik Ramaiya, Hon. Secretary General Tanzania Diabetes Association and Prof. Ayoub Magimba for their tireless efforts in bringing this plan to fruition. Lastly the Ministry would like to recognize Dr Mwanaisha Nyamkara, Dr Mary Mayige, for coordinating the various stakeholders who took part in the development of this strategy and also working on all editorial aspects of the strategy. ___________________________ Prof. Muhammad Bakari Kambi Chief Medical Officer STRATEGIC PLAN AND ACTION PLAN 2016-2020 Page v Executive Summary The purpose of this plan is to set a course for the Ministry of Health, Community Development, Gender, Elderly and Children, collaborating Ministries, other relevant Governmental and Non- Governmental Agencies, all interested partners and the public at large, to help achieve national goals for the prevention and control of non-communicable diseases (NCDs) in Tanzania. The National NCDS Strategic Plan II (2016-2020) for the Prevention and Control of NCD has been prepared in response to the growing problem of NCDs in Tanzania. It is estimated that NCDs now account for 27% of all deaths. The new Strategic Plan was developed after the previous Strategic Plan period ended. The same opportunity was used to incorporate results from STEP Survey and taking into consideration various guidelines and policy documents developed during this previous terms such as HSSP IV, BRN and SDG), WHO global action plan and Health Sector Strategic Plan IV of 2015-2020 and Global Sustainable Goals. The WHO STEPS survey which was carried out in the country in 2012 showed that the levels of risk factors are high: current tobacco users (15.9%), current alcohol drinkers (29.3%), overweight and obese (34.7%), raised cholesterol (26%) and raised triglycerides (33.8%). The study also revealed a high prevalence of diabetes (9.1%) and hypertension (25.9%). Immediate measures are needed to prevent an increase in the burden of disease due to NCDs. NCDs are largely preventable and the long term solution for this impending crisis is to focus on prevention. The plan builds upon the achievements already made by different stakeholders in tackling NCDs and the achievements made by the Ministry of Health, Community Development, Gender, Elderly and Children (MoHCDGEC) and its partners in implementing the 2009-2015 Strategic Plan for NCDs. The plan highlights the government commitment to fight NCDs by involving all relevant stakeholders for a unified action in the fight against NCDs through prevention, detection and treatment. It emphasizes the need for investment in evidence guided cost effective approaches from policy, creating enabling environment to reduce population exposures to modifiable risk factors, to provision of quality health care to the individuals suffering from NCDs. The plan is aligned with the 2016-2020 Global Action Plan for the Prevention and Control of NCDs and has a total of 4 objectives as listed below. a. To Advocate for NCD prevention and control as a National Priority by 2020 b. To strengthen leadership, governance, multisectoral collaboration and accountability for prevention and control of NCDs by 2020. c. To strengthen and reorient health systems to address NCD though promotive, preventive, curative and rehabilitative services by 2020. d. To strengthen national capacity for NCD surveillance, research for evidence based planning, monitoring and evaluation by 2020. Page vi STRATEGIC PLAN AND ACTION PLAN 2016-2020 1 Introduction

1.1 Global Burden of Non Communicable Diseases Noncommunicable diseases (NCD) are now a global growing problem, including Africa and in low-income countries like Tanzania. The NCD burden constitutes one of the major challenges to socioeconomic development as it causes a big burden to both the economy and to the health care systems. NCDs accounted for an estimated 36 million deaths, or 63% of the 57 million deaths that occurred globally in 2008, comprising mainly cardiovascular diseases (48%), cancers (21%), chronic respiratory diseases (12%) and diabetes (3.5%)(Alwan et al., 2010). WHO projects that NCD deaths will Global Mortality increase by 15% globally between 2010 • About 36 million (63% of all 57 million) deaths in and 2020 from 36 to 44 Million deaths. 2008 were due to NCDs The highest increase is projected to occur • About 80% of all NCD deaths in 2008 occurred in low- in the African region (WHO, 2008). and middle-income countries Similarly, the burden of disease due to • About a half of NCD deaths in low- and middle-income NCDs is increasing, as measured by the countries are under the age of 70 Disability Adjusted Life Years (DALYs), • From 1990 to 2010 the proportion of all deaths and calculated as the sum of years of life lost disability (DALYs) due to NCDs increased from 47% to and years lived with disability. The Global 54%. Burden of Disease (GBD) Study showed • Without intervention, NCD deaths will increase by that in 1990 47% of DALYs were from 15% from 36 to 44 million between 2010 and 2020 communicable, maternal neonatal and nutritional disorders, 43% from non- communicable diseases and 10% from injuries, but by 2010 the trend had shifted to 35%, 54% and 11% respectively (Murray et al., 2012). Cancer is a major public health problem, being the second leading cause of death in developed countries and one of the three leading causes of death for adults in developing countries. It is estimated that if no efforts are made to curb the current trend in the global rise of NCDs the current cancer incidence of 12.7 million new cases will rise by 70% to 21.4 million cases by 2030 (Ferlay et al., 2010). Two thirds of those occurrences will be in low and middle-income countries. The burden of diabetes is expected to increase from 366 million people living with diabetes in 2011 to 522 million by 2030 (Whiting et al., 2011). Regarding high blood pressure, in the year, 2000 over 900 million people were hypertensive of whom about 60% were from developing countries. This number is predicted to increase to a total of 1.56 billion people by 2025 (Kearney et al., 2005). STRATEGIC PLAN AND ACTION PLAN 2016-2020 Page 1 A direct consequence of diabetes and hypertensive diseases is the development of renal failure. Chronic kidney disease is a major determinant of poor health outcome of major NCDs. In 2010 it was estimated that the number of deaths where chronic renal failure is listed as the main cause of death has increased by 82% compared to 1990 (Lozano et al., 2012). The main modifiable risk factors for NCDs are Global Disease Determinants behavioral; unhealthy diet, low levels of physical • Estimates in 2012 showed that the leading activity, smoking and excessive alcohol intake, and risk factors for global disease burden are subsequent biological risk factors such as raised blood high blood pressure (7%), tobacco smoking pressure, raised blood glucose, obesity and raised (6.3%), and household air pollution from cholesterol. solid fuels (4.3%). The rise in the global NCD burden in developing • Dietary risk factors and physical inactivity countries is due in part to the socio-demographic together account for 10% of the global disease transition with population growth and a shift towards burden. The highest dietary risks were diets low in fruits and those high in salt. older age groups. In addition to cardiovascular diseases, diabetes, cancer and chronic respiratory diseases, the African region identified sickle cell disease, oral health, mental health and substance abuse, violence and trauma as priority non communicable diseases in the region (WHO-AFRO (2011). The burden of sickle cell diseases is Other Disease Priorities for Africa especially high in Africa. According to • Globally over 300,000 babies are born with sickle cell each WHO, 5% of the world population year with the highest burden in Africa. carries trait genes of hemoglobin disorders mainly sickle cell disease and • From 60-90% of school children in developed countries thalassemia (WHO, 2011b). It is further have oral problems. In developing countries fewer children reported that over 300,000 babies are are affected but the number is expected to rise in Africa born with sickle cell disease each year due to increasing consumption of sugars and low exposure with the highest burden in Africa. In May to fluorides (WHO, 2013a) 2006 at the 59th World Health Assembly • From 76% to 85% of people in low and middle income (WHA), resolution WHA 59.20 of the countries receive no treatment for their mental disorders World health Organisation (WHO) was (Demyttenaere K, 2004) to develop, implement and reinforce • 91% of the of the world fatalities from road traffic integrated national programs for the accidents occur in low and middle income countries who prevention and management of sickle have approximately only half of the world’s vehicles. 50% cell disease (SCD). The WHO strongly of those dying on the roads are vulnerable road users; urges that countries where the birth rate pedestrians, cyclists and motorcyclists (WHO, 2013b) of affected infants is above 0.5 per 1,000 to develop disease oriented (as opposed to integrated in general health services) national programmes for the management and prevention of the disease. Oral diseases are still a global health problem especially among underprivileged populations in both developed and developing countries. The major global oral health problems include periodontal diseases and dental carries. The main risk factors for oral health problems include dietary (excessive intake of sugars, leading to dental carries and diet low in fruit and vegetables which may predispose to oral cancers), smoking and low levels of exposure to fluorides (which protect against dental carries) (WHO, 2013a). A number of people in the world are affected by mental health disorders. In 2004 (WHO, 2008), mental disorders are said to have accounted for 13% of the global burden of disease. Page 2 STRATEGIC PLAN AND ACTION PLAN 2016-2020 Injuries and violence also comprise a significant problem to global health. Violence can take many forms including child maltreatment, youth violence, intimate partner violence, elder abuse, and sexual abuse. The global burden of disease study (Lozano et al., 2012) estimates that Injuries including violence account for 5.1 million deaths annually which is 9.6% of all deaths. The contribution of injuries to the global burden of disease has increased compared to the situation in 1990. Among injuries, road traffic, self-harm, and interpersonal violence increased substantially in both absolute and relative terms, whereas drowning decreased. As mentioned earlier NCDs are now major health challenges in Tanzania: below is an account of the burden of these diseases in the country.

1.2 Burden of Non Communicable Diseases in Tanzania Injuries CVD Cancers In Tanzania like many developing 8% 12% 3% countries the burden of NCDs has Respiratory been increasing steadily (Mayige M, diseases 3% 2012). WHO country estimates of Diabetes 2010 showed that NCDs account for 2% 27% of all deaths in Tanzania (WHO, Other NCDs 2011a). In 2008, it was estimated that 7% NCD caused a total of 75.7 and 58.8 deaths per 1000 population, of which 42.8% and 28.5 were below the age of 60years among males and females respectively. Age standardized death Communicable, maternal, rates per 100,000 were 874 and 614.3 perinatal and in males and females respectively nutritional conditions (WHO, 2011a). Figure 1 below shows 65% the distribution of NCD as percentage of all deaths. The figure shows that FIGURE 1: PROPORTION OF MORTALITY AS A PROPORTION OF ALL DEATHS IN TANZANIA (WHO, 2011A) communicable diseases account for about 65% of all deaths. NCD such as CVD, Injuries, cancer, respiratory diseases and diabetes accounted for 12%, 8%, 3%, 3% and 2% respectively. This data represent the overall burden for all ages, but previous studies had demonstrated that NCDs contribute higher burden among the older age groups (AMMP, 1997). Risk Factors for NCDs in Tanzania A recent survey on the burden of NCD risk factors in Tanzania showed that the burden of diabetes and cardiovascular diseases is high with the prevalence of hypertension estimated to be around 26%. The prevalence of hyperglycemic disorders (pre-diabetes and diabetes) was high at all ages with estimated total prevalence of around 20%(MOH, 2012). The use of tobacco is on a steep rise in Tanzania. The prevalence of tobacco smoking has nearly doubled in the past four years. Between 2008 and 2012 the prevalence of tobacco smokers jumped from 7.9% to 14.1%. According to the latest data, 28% of males use tobacco. While smoking is the predominant way to use tobacco, other forms than cigarettes are becoming popular such as the snuff. Data on tobacco use among youth is not available and needs to be collected. It is very likely that prevalence of tobacco use among youth is high and there are very little differences between males and females. STRATEGIC PLAN AND ACTION PLAN 2016-2020 Page 3 Cancer Tanzania, like many other countries, has Key facts for Tanzania an increasing number of people who are • Levels of risk factors are high: current tobacco users developing cancer due to diverse reasons. (15.9%), current alcohol drinkers (29.3%), ate less than At present about 35,000 people develop 5 servings of fruit and/or vegetables on average per day cancer each year, and recent forecasts (97.2%), overweight and obese (26%), raised cholesterol suggest that by 2020 this number will (26%) and raised triglycerides (33.8%) (2012 STEPS increase by 50% (UICC, 2005). This will survey (MOH, 2012)). cause increasing strain on already stretched • High prevalence of diabetes (9.1%) and hypertension health systems and resources. (25.9%). The number of cases indicated here may • Cancer is now the 5th cause of death among adult men however not depict the actual situation in and 2nd among female adults (WHO, 2004) the country due to the fact that about 80- • High birth prevalence of sickle cell: Tanzania Ranks 4th 90% of cancer patients are unable to access globally with almost 11,000 births per year. diagnostic and treatment facilities. It is also a matter of concern that about 75-80% of the patients attend to hospitals at advanced stages when it is not amenable to curative options. In Tanzania the leading cancers for both sexes are carcinoma of cervix, Kaposi’s sarcoma and breast cancer (IARC, 2002). Sickle Cell Disease Globally there are 300,000 births with sickle cell disease (SCD) each year. Tanzania is the fourth country in the world with the highest birth prevalence of SCD individuals in the world, after Nigeria, Democratic Republic of Congo and India. Within Tanzania, the regions that are most effected are on the Eastern coast, Southern and Lake Regions of Tanzania. The majority of children born with SCD will not know that they have SCD. It is estimated that without treatment between 50-90% of children will die in childhood and that the contribution of SCD to the under-five mortality in Africa is 6.4%. The leading causes of childhood deaths in SCD include infections (pneumoccal and malaria) and severe anaemia. These deaths are preventable with appropriate interventions. The introduction of newborn screening and provision of comprehensive care has reduced childhood mortality by 70% in high-income countries. Tanzania aims to develop a strategy to introduce these interventions. The number of SCD individuals may be higher as many children die undiagnosed and many individuals are not aware that they may SCD without being symptomatic. Currently, definitive diagnosis of SCD is at Muhimbili National Hospital (MNH) with diagnostic capacity being developed in Bugando Medical centre and Mkapa Hospital in Dodoma. Tanzania has consolidated SCD services at MNH, and has developed a systematic framework for comprehensive research that is integrated into health care provision. The aim is to develop evidence- based policies to improve health services. Since 2004, there has been an almost 300% increase in the number of patients with SCD. Over 6,000 SCD patients have been seen, with an average of 150 patients seen per week. Efforts are being made to strengthen comprehensive care programs for SCD at all levels of health care. This will include specialized centers at referral and regional hospitals with high number of SCD patients and integrated services at district hospitals and primary health care facilities. As Tanzania goes through a health transition, it is expected that the number of individuals with chronic, non-communicable diseases such as SCD will significantly rise. Therefore, the government of Tanzania is developing a strategy for SCD as part of the national strategy for NCDs in Tanzania. Although the birth rate is 6 per 1000 per year and the WHO urges that countries where the birth rate of affected infants is above 0.5 per 1,000 to develop disease oriented (as opposed to integrated in general health Page 4 STRATEGIC PLAN AND ACTION PLAN 2016-2020 services) national programmes for the management and prevention of the disease. This is to ensure that the strategy for SCD for Tanzania fits within the resources available within the health system. Injuries and Trauma In a hospital study to assess the burden of injuries and trauma in Tanzania a total of 9316 injury patients were seen between November 2011 and December 2012. The distribution of injury patients by hospital was MOI 49.4%, Morogoro 23.7%, Musoma 10.4%, Korogwe 7.5%, Mtwara 5.1% and Kigoma 3.9%. Majority (71.7%) was male and 55% belonged to the productive age group (18 to 45 years). Of the 9316 patients seen, 66.7% were admitted, 30.9% treated and sent home and 2.4% died at the casualty. The leading cause was road traffic crashes (47.5% of all injuries), followed by falls 27.9% and Assaults 17.4%. Passengers accounted for a greater proportional of road traffic crash victims (38.2%) followed by pedestrians (31.9%). Motorcycles accounted for 47.3% of all road traffic crashes. Males accounted for 74.2% of assault victims. Oral Health In Tanzania the prevalence of gingivitis (early gum infection) is 80% of the whole population yet its advanced form, has low prevalence. The National Oral Health survey done in 2005 among 18 year olds or more reported that 47.9% of them had calculus (dental stone) of varying severity and among them 3.5% had deep pockets (more than 5mm). The recognition of the relationship of periodontal diseases and inflammatory heart diseases as well as the association of periodontal diseases with low birth weight babies is growing in importance. Dental caries, the second most common oral disease, which affects an increasing percentage of the population with age, has a much lower prevalence at all ages in both urban and rural areas. The current WHO classification grades Tanzania in the lowest category of caries lesion experience. In 2005, the caries experience in permanent dentition was 1.8, out of which Decayed (D)-component was 1.1 and the missing (M) component was 0.7. The caries experience among school age children has been below a mean DMFT (Decayed, Missing, Filled, Teeth index) score of 0.8 in the last two decades. Eye Health The prevalence of any form of ocular morbidity in a general population is estimated to be 15 –20%. Tanzania 2012 census reported 1.9% of the population experienced difficulty in seeing: this was the most reported form of disabilities (2012 national Census). It is estimated that 0.7% of Tanzanians are blind and 2.1% are visually impaired: major causes being cataracts, glaucoma, retinal diseases including diabetic retinopathy, childhood blindness, refractive errors, trachoma and corneal opacities. More than 80% of the causes are preventable or curable (Pascolini, 2010). Mental Health Mental health services have traditionally been underdeveloped, poorly resourced and stigmatized. Services are predominantly under the public health system but very limited. Before introducing the health sector reforms, government policy dictated that mentally ill people were one of the vulnerable groups that deserved free treatment. Although the intention was to relieve the treatment burden for patients and their families, coverage was always very low because of scarcity of services. Support for children with intellectual disability is highly dependent on parent organizations. These children are being supported by NGOs in collaboration with three ministries. They are Community Development, Gender and Children, Education and Health and Social Welfare ministries. STRATEGIC PLAN AND ACTION PLAN 2016-2020 Page 5 It is estimated that at least 1% of the population suffers from severe mental disorders needing attention at any given time. With a population of over 34 million (2002 census) there are at least 340,000 patients with severe mental illness. By 2005 the public health sector could hardly cover 90,000, which are, mainly severe cases from urban communities and those who can access the few existing treating facilities. Common mental disorders are rarely diagnosed and treated even where psychiatric treatment facilities exist. Because of overstretched resources there is a tendency to focus on severe mental illnesses and epilepsy in those facilities. Disability NCD are intrinsically linked to disability and physical rehabilitation, for example strokes, amputation and blindness. The WHO World Report on Disability Africa estimates a prevalence of moderate and severe disability of 15.3% of the population. Governments are progressively indicating their commitment to disability rights through the enactment of policies on disability. In addition to being a signatory to the United Nations Convention on the Rights of Persons with Disabilities (CRPD), the United Republic of Tanzania, enacted its 2010 Disability Act, underpinning a social model of disability.

1.3 Approaches to Prevention of NCDs NCDs prevention and control has been a challenge globally. The challenges in Tanzania, which may be common to other developing countries, include: low level of community and stakeholders awareness and knowledge, absence of multi-sectoral responses to the diseases, inadequate resources (human, infrastructures and funds), lack of legislations and/or enforcement mechanisms, poor NCD surveillance and monitoring and evaluation systems, poor governance and leadership, and low capacity of health service providers in terms of knowledge, skills and numbers, and pre-occupation with communicable diseases. However, despites those challenges NCDs can Evidence show that with the current proven cost-effective be greatly reduced if appropriate preventive strategies and collective efforts targeting eliminating and curative interventions can be efficiently shared risk factors, mainly tobacco use, unhealthy diet, physical inactivity and the harmful use of alcohol, the and effectively implemented. This can be NCDs burden of heart disease, stroke, and type2 diabetes achieved through engaging sectors beyond and over a third of cancers can be prevented by 80% health. (WHO, 2005)). Surveillance, primary prevention, multi- Cancer of the cervix and breast cancer can be screened sectoral collaboration and strengthened health and detected and treated in their early stages if effective systems are key for the prevention and control affordable cancer control programs are put in place of NCDs. The following section provides an analysis of the current situation in Tanzania for the prevention and control of NCDs. Page 6 STRATEGIC PLAN AND ACTION PLAN 2016-2020 2 Situation Analysis (SWOTS) Prevention and control of non-communicable diseases require multi stakeholders’ action and a focus on population-based interventions. Therefore, implementers of this strategy include institutions within and outside the health sector. Some of the main institutions within the health sector include the Tanzania Food and Nutrition Centre (TFNC), Tanzania Food and Drug Authority (TFDA), and Tanzania Bureau of Standards (TBS). Also there are disease specific programs that are already addressing issues related to NCDs including diabetes, cancer, sickle cell, oral health, CVD, mental health, injuries and trauma. Others include academic and research institutions and well as a network of health facilities form primary to tertiary care levels. Civil Societies and advocacy groups also exist that are useful for addressing some of the challenges in tackling NCDs. Apart from institutions, there is legislation in place for tobacco control, alcohol consumption and control of food standards. Table 1 shows the current status of each of the disease areas and the main risk factors for NCDs. A detailed review of the legislation related to NCD control including the WHO recommended NCD prevention interventions is presented in Annex 2: Implementation Status of Key NCD Prevention Legislations in Tanzania. This action plan will focus on moving forward the agenda of NCD prevention and control capitalizing on the existing resources and building upon the existing strengths and opportunity. STRATEGIC PLAN AND ACTION PLAN 2016-2020 Page 7 Page Disease/Risk Factor Strengths Weakness Opportunities Threats 8 Diabetes • Institutional Framework: • Limited resources • Certificate Course on • Uncertain sustainability Ministry of Health (financial, human and Diabetes Management at • Misleading quacks Community Development material) MUHAS • Counterfeit drugs and Gender Elderly and • Poor outreach • Community screening medical products Children, health facilities, • Limited advocacy programs • Tanzania Diabetes • Greater focus at • Awareness campaigns , Association (established secondary and tertiary annual commemoration of 1985, Tanzania NCD care facilities World Diabetes Day Alliance (TANCDA), • Microfinance projects National Diabetes Project • Limited focus on primary prevention & continuum for families with children expanding diabetes and having type 1 diabetes NCD services up to district care level • Active TANCDA • Child and Adolescent • External funding sources Diabetes Clinics • Global NCD Alliance STRATEGIC PLAN AND ACTION PLAN 2016-2020 • Developed NCD training manuals for different levels of health care providers, training ongoing by zones • IEC materials on diabetes and NCDs developed and disseminated • Training of health workers (workshops, fellowship programs, exchange visits to centers of excellence in diabetes STRATEGIC PLAN AND ACTION PLAN 2016-2020 Disease/Risk Factor Strengths Weakness Opportunities Threats Cardiovascular • Institutional Framework: • Limited services in • Establishment of research • Uncertain sustainability MOH&SW, Heart primary and secondary centre at MNH • Misleading quacks Foundation of Tanzania, health facilities. • Planned East African • Counterfeit drugs and Muhimbili National • Currently no specific Center of Excellence for medical products Hospital (MNH), activities for primary cardiovascular diseases. • Establishment of Cardiac prevention • Master’s course in Care Center at Muhimbili • Limited resources Cardiology at MUHAS National Hospital (financial, human and • Active TANCDA • Secondary and tertiary material) prevention services at • Poor outreach the Muhimbili National • Limited advocacy Hospital, Bugando Medical Center and KCMC. • Greater focus at secondary and tertiary • Provision of Outreach care facilities consulting services to regional and district • Limited focus on primary hospitals prevention & continuum care • Newly established association Page 9 Page Disease/Risk Factor Strengths Weakness Opportunities Threats 10 Cancer • Institutional framework: • Few cancer centres • High political will and • Socio-cultural beliefs and Ocean Road Cancer • Few specialists in cancer high level government norms Institute (ORCI) and • Limited focus on commitment • Uncertain sustainability Referral hospitals, NGO’s, prevention • MMED clinical oncology • Misleading quacks PASADA, TTCF, TPCA, course and bachelor Tanzania Breast cancer • Inadequate funding • Counterfeit drugs and allocation from the degree in radiation therapy medical products Foundation, MEWATA, technology established at TANCDA and Hospitals, parliament/ government MUHAS Cancer Society established • Lack of national cancer policy (currently its • Commitment by PACT since 1991 and other international • Hepatitis B immunization embedded in non- communicable disease development partners under EPI for prevention of to support strategy liver cancers policy) development • Cancer Registry at MNH • Lack of adequate human and financial resources to • Various partners working in since 1966, ORCI since cervical and breast cancer 2000 and population based implement work already STRATEGIC PLAN AND ACTION PLAN 2016-2020 undertaken by ORCI and prevention and control registry at KCMC since programs 1998. partners • Limited expansion of • Linking and consolidating • National Cancer Control existing primary health care strategy in place cancer diagnosis and treatment facilities facilities • National palliative care Policy Guidelines in place • Limited budget allocated for cancer control services • National Cervical Cancer Prevention Strategy in place • Workforce shortage • Budgetary limitation • Weak referral system for cancer patients STRATEGIC PLAN AND ACTION PLAN 2016-2020 Disease/Risk Factor Strengths Weakness Opportunities Threats • Cervical screening (using visual inspection with Acetic Acid or Lugol’s Iodine) and Breast cancer screening initiatives, both at ORCI and during outreach services in 13 regions, There are also different partners involved in cervical cancer screening which are PATH, TPHS, MDH, Marie Stopes, UMATI, PSI, JHPIEGO • 50 plus campaign for prostate cancer awareness • Government funded cancer prevention and control initiatives, started in 2006. Carries out outreach services to regions, by 2010, 13 regions covered. • Treatment of cancer mainly at ORCI , now services expanded to Bugando Referral Hospital • Limited cancer research carried out at ORCI, MUHAS, NIMR, BMC • Enabling national health Page policy 11 Page Disease/Risk Factor Strengths Weakness Opportunities Threats 12 • Existing healthcare Infrastructure from dispensaries to national and specialised hospitals • The civil societies focusing on cancer control initiatives • Hospital- and population- based cancer control activities undertaken by ORCI and partners Respiratory • Institutional Framework: • lack of resources • Utilizing the existing • Sociocultural beliefs and MoHCDGEC, Tanzania • limited advocacy and infrastructure of National norms Association of Respiratory outreach TB & Leprosy Program • Uncertain sustainability Diseases, TANCDA • lack of training manuals • Linkages with existing • Misleading quacks and IEC materials International organizations/ • Counterfeit drugs and STRATEGIC PLAN AND ACTION PLAN 2016-2020 • no adequate information networks medical products on burden of disease • Linkages with OSHA Sickle Cell • Institutional Framework:, • lack of resources • Research programs • Sociocultural beliefs and MNH, MoHCDGEC, • limited advocacy in collaboration with norms Sickle Cell advocacy groups, • Limited outreach MUHAS • Limited access to care Close collaboration with • Health programs to and treatment services NCD groups • Limited information establish newborn • At MNH there is a well- • Good quality services screening with RCH unit, established sickle cell care limited to MNH MoHCDGEC and treatment service. • Effective interventions • Awareness campaigns • MUHAS has established not implemented in most health facilities. • Educational programs in excellence in SCD research hematology and blood and training transfusion STRATEGIC PLAN AND ACTION PLAN 2016-2020 Disease/Risk Factor Strengths Weakness Opportunities Threats Renal • Institutional Framework: • lack of resources • Awareness campaigns • Sociocultural beliefs and MoHCDGEC, Tanzania • limited advocacy and especially during norms Kidney Foundation outreach commemoration of world • Uncertain sustainability • Established renal unit at • lack of training manuals kidney day • Misleading quacks MNH, able to provide and IEC materials • Networking with • Counterfeit drugs and dialysis services • no adequate information international organizations medical products • Establishment of Centre of on burden of disease Excellence at Dodoma and Mbeya Oral Health • Institutional Framework: • lack of resources • Limited access to care Tanzania Dental Association, • limited advocacy and and treatment services MNH, MOH&SW outreach • Upgraded dental clinics in • lack of training manuals all the region and district and IEC materials hospitals • no adequate information • Outreach services done on burden of disease whenever possible • Awareness campaigns especially during the oral health week and commemoration of world oral health day • National Oral Health Survey carried out in 2010 • Strategic oral health plan 2012- 2017 in place Page 13 Page Disease/Risk Factor Strengths Weakness Opportunities Threats 14 Injuries and Trauma • Institutional Framework: • Lack of resources • Masters course in • Uncertain sustainability Muhimbili Orthopedic • Limited outreach Orthopaedic and Institute (MOI), MNH, programs Neurosurgery MOH&SW • International collaborations • Police force • Construction of more • Injury prevention campaigns trauma centres Mental Health and • Institutional framework: • Availability of anti- • Masters Course in • Sociocultural beliefs and substance abuse MOHCDGEC, Mental psychotic drugs Psychiatry norms Health Association of • lack of resources • AMO Psychiatry • Uncertain sustainability Tanzania (MEHATA), • limited advocacy and • Nursing course in • Misleading quacks MNH outreach Psychiatry • Counterfeit drugs and • Mental Health Strategy in • lack of implementation of • Construction of drug medical products place the FTC detoxication centre at • Stigma and • Alcohol policy in place Mirembe, Itega discrimination STRATEGIC PLAN AND ACTION PLAN 2016-2020 • Interministerial committee • Harm reduction program for substance abuse in place in place • Specialized Mental Health • Inter-agency collaboration Hospital in place • Established drug addiction treatment centers now operational at MNH, Ilala, Temeke and Mwananyamala municipal hospitals • Availability of integrated mental health services into primary health care services • Availability of outreach services at the regional and district levels. Disease/Risk Factor Strengths Weakness Opportunities Threats STRATEGIC PLAN AND ACTION PLAN 2016-2020 • Mental Health Act and Regulations enacted (2008) • Existing mental health rehabilitation centers at tertiary level (Vikruti, Homboro, Rutindi) Tobacco use • Institutional framework: • FCTC not yet • Strong push from the • Tobacco industry Interventions: MoHCDGEC, Tanzania implemented international networks • Farmers • Tax increases Tobacco Control Forum, • Lack of enforcement • Conflict of interest for • Smoke free • WHO FCTC ratified of regulations under the government environment • Justification available for Tanzania Tobacco action Products Regulatory Act • Health information (2003) and warnings • Limited community • Bans on advertising awareness • Lack of options for alternative cash crops Harmful alcohol use • Institutional framework: • Several acts related to • Networking with • Industry • Tax increases MoHCDGEC, Alcohol harmful use of alcohol in international organizations • Conflict of interest for • Restricted access Anonymous, Health place but not adequately • Sensitizations at the government institutions implemented community gatherings • Producers of traditional • Bans on advertising • Limited number of • Sensitizations at religious liquor facilities for Alcohol gatherings • Availability of cheap Disorders Treatment, • Existing Liqour Act 1968 products Care and Rehabilitation • Sale of alcohol to minors • Alcohol policy in process • Advertisement and • Lack of Alcohol Sponsorship to be Regulatory Authority uncontrolled Page • Existing Liqour Act 1968, needs amendment/re- 15 drafting Page Disease/Risk Factor Strengths Weakness Opportunities Threats 16 Unhealthy diet • Institutional Framework: • Suboptimal functioning • Training institutions • Food industry • Reduced salt and MoHCDGEC, TFNC, nutritional rehabilitation • Ministry of Agriculture • Food vendors sugar intake CONSENUTH, Tanzania centers • Replacement of trans Bureau of Standards, TFDA, fats with pufas Tanzania Consumers Association • Increased intake of fibre (fruits • National Nutrition Policy & & vegetables, no Guidelines refining of foods) • Public awareness Physical Inactivity • Institutional Framework: • Lack of infrastructure • Ministry of Education – • Misuse of open spaces • Public awareness MoHCDGEC, • No National Policy on policy on physical activity • Enabling physical activity • International networks environment • Training institutions (degree in physical STRATEGIC PLAN AND ACTION PLAN 2016-2020 education) • Ministry of sports Ministry of Health • NCD section established at • Bureaucracy • NCD activities currently • Much dependence on Community the ministry, currently with • Limited resources funded by DANIDA donor funds Development Gender only 7 staff. • Lack of inter-ministerial • Selected accomplished • Unstable staff Elderly and Children • NCD interdepartmental NCD coordinating activities to date include; coordination committee in mechanism o Completion of first place & functional NCD STEPS survey • National NCD Steering o Conducted NCD committee established baseline survey • MTEF includes NCD o Developed National dietary guidelines • Developed NCD sensitization and advocacy strategy 3 The Strategic Plan

3.1 Introduction This Strategic Plan targets NCDs namely diabetes, cardiovascular diseases, cancer, chronic respiratory diseases, mental health, sickle cell diseases, injury and trauma and associated disability. The plan seeks to address the above issues by identifying possible strategic means for reaching the intended goal and vision. It involved a review of the previous action plan, identifying and building on the areas of success and finding solutions for failures. In this plan, four objectives will be pursued under the guidance of nine principles. Each specific objective will have strategic interventions, to be employed, priority actions and activities to be done and indicators to show that the specific objective has been partially or fully achieved. The plan has also identified risks that could limit the success of the goal and proposed solutions to mitigate each risk. Furthermore, a list of expected outcomes after pursuing all objectives will also be given. It is envisaged that if the set of actions in this Plan are realized, the growing public-health burden imposed by NCDs will be tackled. In order for the plan to be implemented successfully, high-level political commitment and the concerted involvement of governments, communities and health-care providers are required.

3.2 Scope Four categories of NCDs – cardiovascular diseases, cancer, chronic respiratory diseases and diabetes – make a substantial contribution to NCD morbidity and mortality and are the main focus of this Plan covering the period 2016-2020. The four categories of NCDs can be largely prevented or controlled. by means of effective interventions that tackle shared risk factors, namely: tobacco use, unhealthy diet, physical inactivity and harmful use of alcohol as well as through early detection and treatment. The priorities for action cut across all national sectors, Major NCDs and their risk factors are reflecting similar challenges in many areas: inter-sectoral considered together in the National NCD collaboration, partnerships and networking, capacity 2016–2020 Action Plan in order to strengthening in national sectors, resource mobilization, and emphasize shared etiological factors and strategic support for collaborative research. common approaches to prevention. This Strategic Plan is aligned and integrated with key policy documents including the following: • Framework Convention on Tobacco Control • WHO strategy on diet and physical activity • MKUKUTA • Vision 2025 • Health Policy • Mental Health Strategy STRATEGIC PLAN AND ACTION PLAN 2016-2020 Page 17 • National Tobacco control strategy • Health Promotion strategy • National Nutrition strategy • National Cancer Control strategy • National Palliative care policy guideline • Cervical Cancer prevention and Control Strategy • WHO World Disability Report 2012.

3.3 Time frame This action plan will be implemented from 2016 through 2020 in line with WHO global action plan and Health Sector Strategic Plan IV of 2015-2020.

3.4 Vision Tanzania free of avoidable non-communicable diseases

3.5 Mission To improve the quality of lives of all Tanzanians by reducing the suffering, disease and death caused by NCDs with focus on access to quality, sustainable and equitable services.

3.6 Goal To reduce the burden (morbidity, disability and premature mortality) related to noncommunicable diseases in Tanzania by 20% by 2020.

3.7 Principles This strategic plan will be guided by the following principles: a. Primary health care approach: NCD prevention, treatment and care services will be available, accessible and affordable at all levels of care from the community level. b. Universal coverage: All people should have full access to health care and other services for prevention control of NCDs based on needs regardless of age, gender , economic and social (political, cultural, religious) status, presence of disability and ability to pay. c. Continuum of care: NCDs prevention and control services must be provided along the continuum of care with services spanning from primary, secondary and tertiary prevention levels. d. Life course approach: NCDs prevention activities must take into account that the risk of NCDs starts earlier on in life and starts at pre-conception, during pregnancy at infancy and continue throughout adult life. a. Multisectoral approach: NCD interventions should be initiated and implemented with relevant stakeholders including public and private employers, civil society and the international community. Public sector engagement should include health-in-all policies and whole of government approaches. b. Evidence based: Strategies for prevention and control of NCDs should be guided by scientific evidence and public health principles and must be protected from undue influence by any form of vested interest. Page 18 STRATEGIC PLAN AND ACTION PLAN 2016-2020 c. Empowerment of people: People should be empowered and involved in activities for prevention and care of NCDs. d. Integrated approach: given the shared determinants and characteristics of several diseases and the resource constraints, an integrated approach focusing on functions rather than on disease categories should be favoured. Opportunities for integration into existing services should also be exploited. e. Accountability: The implementation of the NCDs Strategic plan II (2016 – 2020) will not be possible without strong, accountable and effective leadership and every stakeholder. The strategy uses existing structures to ensure accountability to government, funding partners and the communities served in terms of resource utilization, service provision and health outcomes achieved at all levels of the health sector. This will ensure that all actors are doing the right thing the right way.

3.8 Objectives For significant achievements in NCD prevention and control, the plan will aim to realize the following four objectives: a. Advocate for NCD prevention and control as a National Priority b. To strengthen leadership, governance, multisectoral collaboration and accountability for prevention and control of NCDs by 2020. c. To strengthen and align health systems to address NCD though promotive, preventive curative and rehabilitative services by 2020 d. To strengthen national capacity for NCD surveillance, research for evidence based planning, monitoring and evaluation by 2020

3.9 Expected outcomes The overall target agreed by WHO and MoHCDGED is reduction of NCD related mortality by 25% from baseline by 2025. We can reduce mortality in the short term through improved care of those with disease. The ultimate aim however, is to reduce the occurrence of disease through reduction of the modifiable risk factors: tobacco use, physical inactivity, obesity, intake of salt, low intake of fruits and vegetables, saturated fat and harmful use of alcohol. This action plan will employ both strategies and aim to achieve the following targets by 2020. a) Community Interventions plus legislation • 30% reduction in the prevalence of tobacco use by 2020 compared to baseline 2012 STEPS data. • 10% relative reduction in persons aged 15+ per capita consumption of alcohol from baseline. • Reduction in the mean population intake of salt to less than 5gms per day. b) Community Interventions • 0% increase in obesity prevalence from baseline • 10% reduction from the baseline in the proportion of individuals who are physically inactive • 50% increase from the baseline in the proportion of patients detected with early cancer (health facility level) STRATEGIC PLAN AND ACTION PLAN 2016-2020 Page 19 • 25% reduction from baseline in the prevalence of raised blood pressure • 10% reduction from baseline in the proportion of individuals with raised total cholesterol • 10% reduction from baseline in the prevalence of diabetes • 50% increase from the current level of community awareness on NCDs • 70% increase from baseline in the level of community awareness of sickle cell • 10% of couples in affected regions receive pre-marital SCD screening • To increase by 20% the proportion of cavity free 6 year olds • To reduce by 20% the DMPT particularly the D component at age 12 • To reduce by 20% the number of teeth loss due to periodontal disease for juveniles up to 18 year old. c) Improved facility care • Implement and achieve 80% coverage for HPV vaccine for school girls (9-13 yrs) • 50% of people diagnosed with stroke or heart disease use aspirin for prevention of further cardiovascular diseases • 50% increase from baseline access to essential medicines for those diagnosed with the major NCDs • 50% increase in the proportion of newborns at health facilities screened for Sickle Cell Disease • 70% increase from baseline in the proportion of SCD patients receiving standardized care and treatment • 50% patients with diabetes or hypertension receive urine tests for proteins at least yearly d) Overall Outcome (Mortality) • 20% reduction in mortality among people less than 70 years due to cardiovascular disease, chronic respiratory disease, cancer and diabetes • 10% reduction from baseline of suicide rates in the general population • 50% increase from baseline in survival rates of SCD patients (20% WHO) • Reduce by 20% from baseline the overall mortality from injuries and trauma.

3.10 Strategies and indicators of success

3.10.1 Objective 1: To Advocate for NCD prevention and control as a National Priority by 2020

3.10.1.1 Rationale Strong and continuous national leadership by heads of state or governments to ensure that NCDs are a whole-of government priority is important for any NCD prevention programs to be successful since programs and policies in other sectors affect health outcomes. The NCDs accounts for 27% of all deaths in Tanzania and their risk factors are closely related to poverty. The 2030 Agenda for Sustainable Development adopted at the United Nations Summit on Sustainable Development in September 2015 recognizes non communicable Page 20 STRATEGIC PLAN AND ACTION PLAN 2016-2020 diseases (NCDs) as a major challenge for sustainable development. Goal three which is Health carries three NCDS targets which are; By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being; Strengthen the prevention and treatment of substance abuse, including narcotic drug abuse and harmful use of alcohol and By 2020, halve the number of global deaths and injuries from road traffic accidents Furthermore, there is a limited financing and resources allocated for NCDs at all levels. This raises a need for advocacy to raise priority status of NCDs within the health sectors and non- health sectors. Various financing options are available, for funds mobilization to support the strategic plan. An example is an additional surcharge on tobacco which has raised revenue in many countries. There is need to generate evidence to support claims of the raising burden of NCDs and their implications to the health care system and to the country’s economy as a whole. Data for the health, social, and economic effects of NCDs; the cost and cost effectiveness of interventions; and the future costs of not acting are helpful to build support for multisectoral policy action and law reform by governments and to ensure sustainable financing of the NCD prevention and control activities. A review of available policy and legislation carried out this year showed that more efforts are needed to sensitize the various stakeholders and to enforce the implementation of the various policies and legislations. Strong leadership is essential including involvement of civil society organizations and advocacy groups to resist attempts by powerful organizations with vested interests (e.g. the tobacco, food, and alcohol industries) to undermine the development and implementation of effective policies. This strategy will advocate to policy, decision makers and development partners at all levels to obtain their commitment and increase resources on NCDs control. The NCD unit will also focus on ensuring availability of sufficient financial coverage and support for full equitable access of NCDs preventive, curative, rehabilitative and palliative services.

3.10.1.2 Strategic interventions i. Attain political commitment with increased and sustained financing for NCDs. ii. Review existing policy and legislation to increase resources and improve prevention and control of NCDs, 3.10.1.2.1 Priority actions and activities for Strategic interventions to: Attain political commitment with increased and sustained financing for NCDs STRATEGIC PLAN AND ACTION PLAN 2016-2020 Page 21 SN Priority actions Activities 3.10.1.2.1.1 Secure adequate financial a. Generate and disseminate evidence- resources for NCD based data to document the burden of prevention and control NCDs services in the country b. Conduct resource needs assessment in order to inform the development of national NCD plan and budget c. Conduct advocacy meetings with key policy and decision makers MoHCDGEC management team, PMORALG and development partners d. Conduct Sensitization meetings with RHMTs and CHMTs on adequate financial and other resources allocation in CCHPs for NCDs e. Conduct proposal writing workshop for fund mobilization 3.10.1.2.1.2 Market NCDs strategic a. Conduct a workshop to orient and align plan to partners for all stakeholders on the NCDs Strategic mobilizing resources Plan b. Identify potential resources of Non governments funding calls for proposal c. Conduct a meeting to sensitize businesses for funding through corporate social responsibility funds d. Conduct schedules partnership meeting to mobilize and leverage resources for NCDs based on burden of disease data 3.10.1.2.2 Priority actions and activities for Strategic interventions to: Review existing policy and legislation to improve prevention and control, to NCDs services SN Priority actions Activities 3.10.1.2.2.1 Review various policies and a. Review, update and implement health legislation insurance schemes for universal coverage b. Advocate for review of various policies and legislation e.g. tobacco, alcohol c. Disseminate evidence for appropriate taxation Page 22 STRATEGIC PLAN AND ACTION PLAN 2016-2020 Indicators of success - Number of partners involved in NCD prevention and control - Number of sensitization meeting conducted - Number of stakeholders oriented on NCDs SP 2016-2020 - NCD policy document formulated - Number of reports and policy briefs for policy and action developed and disseminated - Annual percentage increase in NCD budgetary allocations and resources earmarked for NCD activities - Percentage increase in the coverage of health insurance Expected outcomes - More partners are involved in NCD prevention and control activities - NCD programs are well funded and functional - Increased access to care for NCDs and other diseases through improved access to health care financing mechanisms

3.10.2 Objective 2: To strengthen leadership, governance, multisectoral collaboration and accountability for prevention and control of NCDs by 2020

3.10.2.1 Rationale NCDs have been receiving minimal funding from MoHCDGEC for about 15 years. Government (public) will take lead in stewardship, where NCDs Control will be elevated to higher levels of the development agenda within the MoHCDGEC. The established section for prevention and control of NCDs inside the ministry of health needs to be funded and also provided with adequate staff with necessary technical skills and capacity for successful implementation of NCDs. The NCDs section needs to coordinate action of multiple fronts and provide oversight to achieve universal access to promotion, preventive, curative and rehabilitative NCD services. Since the major determinants of no communicable diseases lie outside the health sector, collaborative efforts and partnerships must be intersectoral and must operate “upstream” in order to ensure that a positive impact is made on health outcomes in respect of NCDs. The multi-sectorial coordination need to be strengthened. The MoHCDGE should seek support from the Government to be empowered and get political mandate for the health ministry officials to work with their counterparts in other ministries to ensure multi-sectoral coordination and implementation of key policies in prevention and control of NCDs In this strategic plan, policy guidelines for multisectoral coordinating will be develop with clear roles and responsibility to guide them to oversee implementation of NCDs in their respective levels. The Inter-Ministerial committee and multisectoral coordinating committee at national, regional and district levels will be established and meet bi-annual to discuss progress of implementation, availability of supply and commodities for NCDs, human resource including adequate resources mobilization for NCDs. The effective implementation of the Strategic plan II will not be possible without strong, accountable and effective leadership at all levels of the healthcare delivery system. The strategy uses existing structures to ensure accountability to government, funding partners and the STRATEGIC PLAN AND ACTION PLAN 2016-2020 Page 23 communities served in terms of resource utilization, service provision and health outcomes achieved. This will ensure that all actors are doing the right thing the right way.

3.10.2.2 Strategic Interventions I. Establish a sustainable coordination system of multi sector approach to address NCDs prevention and control at all levels II. Strengthen (NCD) unit capacity to coordinate and manage NCDs prevention and control services 3.10.2.2.1 Priority Actions and activities for a sustainable coordination system of multi sector approach to address NCDs prevention and control SN Priority actions Activities 3.10.2.2.1.1 Establish a high-level inter- a. Develop national Multisectoral ministerial committee framework and operational platform for to facilitate and monitor NCD coordination and collaboration Multispectral action for with clear roles and responsibilities NCD prevention and b. Identify key Inter-Ministerial stakeholders control c. Launch Inter-Ministerial Coordinating committee for NCDs d. Conduct bi- annual high level Inter- Ministerial coordination committee meetings 3.10.2.2.1.2 Establish/Strengthen a. Develop TOR/policy guidelines for NCD Multisectoral coordinating multisectoral coordination committee at Committee at all levels national regional and district levels b. Conduct sensitization meeting to partners, PMORALG including RHMTs and CHMTs on NCDs on the multisectoral coordination committee ToR/policy guidelines c. Launch national, regional and district multisectoral coordinating committee 3.10.2.2.1.3 Support multisectoral a. Conduct bi-annual multisectoral coordination committee coordinating committee meetings at meetings at national, national level regional and district b. Conduct bi-annual multisectoral coordinating committee meetings at regional level c. Conduct bi-annual multisectoral coordinating committee meetings at district level d. Conduct national -annual multisectoral technical meeting Page 24 STRATEGIC PLAN AND ACTION PLAN 2016-2020 Indicators of success - Inter-ministerial committee for NCDs established and functional - Multisectoral coordinating committee at national, regional and district level established and functioning - Number of qualified staff allocated to the national NCDs section - national framework for NCDs multisectoral in place - Number of regions allocate funds for NCDs - Number of policy and decision markers sensitized Expected outcomes - NCDs activities are well coordinated within the relevant ministries - NCDs section fully functional and capable of coordinating establishment and implementation of various NCDs interventions - implementation NCD prevention and control activities is being monitored and evaluated and prompt feedback given to appropriate authorities

3.10.3 Objective 3: To strengthen and align health systems to address NCD through promotive, preventive, curative and rehabilitative services by 2020

3.10.3.1 Rationale Implementation of the NCD interventions needs a functioning health-care system and a stepwise approach. Many health services are inadequate in terms of governance arrangements and health planning processes; health financing; health workers with appropriate knowledge and skills; essential drugs and technologies; health-information systems; and health services delivery models for long-term patient-centred care that is universally accessible. A key requirement is a comprehensive approach to health-systems strengthening to deliver services for all common diseases during the lifetime, with a patient-centred model of delivery. There is limited access to major NCDs services. For instance 80-90% of cancer patients are unable to access diagnostic and treatment facilities. In addition, 75-80% of the patients attend to hospitals at advanced stages when it is not amenable to curative options. In the case of Sickle Cell Disease, Tanzania ranks 4th globally, with almost 11,000 births per year. However, many children die undiagnosed since currently only MNH can definitively diagnose SCD and there is no universal newborn screening. In the case of respiratory diseases there is no integrated management of respiratory conditions and the burden of the condition in the country is not known. In this strategic plan, the MoHCDGEC, will introduce practice approach to lung health (PAL) in phased manner to strengthen management of respiratory conditions as integrated management in primary health care. Respiratory diseases are responsible for suffering and death in all age groups worldwide. Account for 11 million death worldwide in 2002 this translate to mortality rate equal to 183 per 100 000 population (WHO 2005). In recent years their incidence has increased. This may be attributed to increase in risk factors such as tobacco smoking, HIV, atmospheric pollution, industrialization and deterioration of social economic conditions. WHO recommends country to introduce practice approach to lung health (PAL) as integrated management of respiratory conditions in primary health care. STRATEGIC PLAN AND ACTION PLAN 2016-2020 Page 25 In the case of accessible physical rehabilitations services, to provide a continuum of services for NCD patients suffering from life–long disability, there is (1) insufficient access to multidisciplinary approach to the provision of assistive devices, such as wheelchairs, crutches, prosthesis and orthotics and (2) there is a need for an overall policy document linked to standards of quality physical rehabilitation services. The latter is intrinsically linked in the quest for Universal Health Coverage and the need to spur commitment from insurance companies to cover disability services. Tuberculosis and diabetes collaborative activities The link between tuberculosis (TB) and diabetes is becoming prominent in developing countries including Tanzania. The relationship between TB and diabetes is a challenge in management of patients. Studies show that people with diabetes have increased risk of developing TB compared to the general population. Likewise TB patients who have diabetes have high risk of unfavorable treatment outcome including failure, relapse and death. The growing burden of Diabetes is contributing to sustained high levels of TB in the community, and the proportion of TB cases attributable to Diabetes globally is likely to increase over time. A study done in Mwanza in 2009 showed that the prevalence of diabetes among Pulmonary TB patients was 16.7% and 9.4% among community without TB However, more comprehensive national wide data on the burden of TB/diabetes are yet to be realized. Efforts to address the growing burden of the co-occurrence -morbidity of TB and DM are underway. The MoHCDGEC has developed a National Guideline for collaborative care and control of tuberculosis and diabetes to enable NCD section in collaboration with NTLP and other stakeholders to effectively plan, implement, and monitor collaborative TB/diabetes activities at different levels of health care delivery. In regards to reduce modifiable NCD risk factors and creates health promoting environment: It has been demonstrated in literature that the four major risk factors namely smoking, unhealthy diet, alcohol consumption and physical inactivity contributes significantly to the growing NCD disease burden. Reduction in the levels of these risk factors in the population significantly reduces the disease burden due to NCDs. WHO identified interventions to reduce smoking, harmful use of alcohol, promotion of healthy diet and increased levels of physical activity as the ‘best buy’ interventions (reference WHO best buy doc), meaning that these interventions will require less resources and have greater impact in the long run. Table 2 gives a summary of the best buy interventions. TABLE 2: WHO BEST BUY INTERVENTIONS FOR THE PREVENTION AND CONTROL OF NCDS Risk Factor/ Disease Intervention Tobacco Use • Tax increases • Smoke-free indoor workplaces and public places • Health information and warnings • Bans on tobacco advertising, promotion and sponsorship Harmful alcohol use • Tax increase • Restricted access to retailed alcohol • Bans on alcohol advertising Unhealthy diet and • Reduced salt intake physical inactivity • Replacement of trans fats with polyunsaturated fats • Public awareness through mass media on healthy diet and physical activity Page 26 STRATEGIC PLAN AND ACTION PLAN 2016-2020 Risk Factor/ Disease Intervention Cardiovascular disease • Counseling and multi-drug therapy for people with high and diabetes risks of developing heart attacks and strokes, including those with established CVD • Treatment of heart attacks with aspirin Cancer • Hepatitis B immunization to prevent liver cancer (already scaled up) • Screening and treatment of pre-cancerous lesions to prevent cervical cancer The strategic implementation of the modifiable risks factors are explained in detail and carried out in the respective strategy: National Tobacco control, Mental Health, National Nutrition strategy, National Cancer strategy, National palliative care policy and strategy, Breast Cancer strategy, Cervical Cancer strategy and Alcohol policy. Only key strategies on modified risks factors have been included in the NCD SP II (2016-2020). The NCD section will monitor implementation of the modifiable risks in the respective strategies

3.10.3.2 Strategic interventions i. Increase access for major non communicable diseases ii. Scale up centres of excellence for NCDs in zonal referral hospitals iii. Integrate NCD services into existing health care services at all levels of care including community participation iv. Implement Practical Approach to Lung Health (PAL) v. Reduce modifiable NCD risk factors and create health promoting environment vi. Strengthen physical rehabilitation services and palliative care vii. Implement TB/Diabetes collaborative activities. 3.10.3.2.1 Priority actions and activities for strategic interventions to: Increase access for major NCDs SN Priority actions Activities 3.10.3.2.1.1 Scale up NCDs services at a. Conduct facility needs assessment for primary levels NCDs scale up at primary level b. Sensitize RHMTs and CHMTs on scaling up plan and implementation c. Strengthen facilities to provide quality NCDs services d. Develop plan for NCDs scale up at primary level e. Update guideline for package of services (pocket booklet) for NCDs scale up f. Print and distribute NCDs package of services guidelines STRATEGIC PLAN AND ACTION PLAN 2016-2020 Page 27 SN Priority actions Activities 3.10.3.2.1.2 Capacity building to a. Review and update NCDs training HCWs to implement curriculum to include current NCDs services in scaled up recommendations districts b. Train health workers from targeted health facilities on management of major NCDs c. Conduct supervision and mentorship to the trained staff 3.10.3.2.1.3 Ensure uninterrupted a. Engage a consultant to review logistics supply of major NCDs and supply chain management for major drugs and commodities NCDs drugs and commodities b. Review assumptions and update national forecast for major NCDs drugs and commodities c. Review/Develop quantification tools for major NCDs drugs and palliative care d. Build capacity of staff on forecast quantification and use of tools 3.10.3.2.2 Priority actions and activities for strategic intervention to: Scale up centre excellence for NCDs (cancer, renal, sickle cell and cardiac center) in zonal referral hospitals SN Priority actions Activities 3.10.3.2.2.1 Refurbish identified a. Conduct facility assessments in hospitals targeted zone referral that will be centre of excellence for hospital to provide quality cancer, renal, sickle cell and cardiac care for NCDs cancer, services Diabetes, renal, and b. Renovate and upgrade selected zonal cardiovascular referral hospitals with necessary, furniture, equipment and supplies. 3.10.3.2.2.2 Build capacity of health a. Deploy qualified staff to support cancer, workers from targeted zone renal, sickle cell and cardiovascular referral hospital to provide services cancer, renal, sickle cell b. Collaborate with centre of excellence to and cardiovascular services Identify and train HCWs c. Collaborate with centre of excellence to conduct supervision and mentorship to the trained staff 3.10.3.2.2.3 Support centers of a. Provide uninterrupted drugs excellence in the b. Support centers with equipment and decentralized zonal referral reagents hospitals c. Monitor implementation of services in line with national guidelines Page 28 STRATEGIC PLAN AND ACTION PLAN 2016-2020 3.10.3.2.3 Priority actions and activities for strategic interventions to: Integrate NCD services into existing health care services at all levels of care including community participation. SN Priority actions Activities 3.10.3.2.3.1 Incorporate comprehensive a. Conduct advocacy meetings with training inclusion of NCDs institution for incorporation of NCDs prevention and control services in school curricula services in health training b. Develop NCDs training component to curricula be included into health training curricula 3.10.3.2.3.2 Incorporate NCDs relevant a. Conduct meetings with RCH/PMTCT, component to be reflected NACP, NTLP, EPI) programme and in (RCH/PMTCT, NACP, other key stakeholders to incorporate NTLP, EPI ) training relevant NCDs component manuals b. Develop and disseminate an integration plan outlining services to be provided at all levels of care c. Orient health care providers from RCH/ PMTCT, NACP, NTLP, EPI) on NCDs 3.10.3.2.4 Priority actions and activities for strategic interventions to: Implement Practical Approach to Lung health (PAL) SN Priority actions Activities 3.10.3.2.4.1 Introduce PAL as a. Adopt WHO and develop PAL strategy integrated management in collaboration with NTLP in primary health care b. Establish PAL national Technical in order to Strengthen Working group management of respiratory c. Conduct needs assessment on current disease management of respiratory diseases in different level of health facilities d. Develop PAL standardize clinical practice guidelines /training materials for respiratory conditions e. Develop PAL phase implementation plan f. Conduct biannual meeting for PAL National Technical Working Group 3.10.3.2.4.2 Support Health facility to a. Procure necessary equipment for PAL implement PAL in phase b. Train HCWs on PAL clinical practice manner guidelines c. Provide PAL d. Conduct supportive supervisor e. Evaluate implementation of PAL f. Scale up PAL countrywide STRATEGIC PLAN AND ACTION PLAN 2016-2020 Page 29 3.10.3.2.5 Priority actions and activities for strategic intervention to: Reduce modifiable NCDs risk factors and create health promoting environment SN Priority actions Activities 3.10.3.2.5.1 Advocacy communication a. Deploy ACSM focal person at NCD and social mobilization section Strategic plan (ACSM) to b. Develop ACSM strategic plan sensitize community on c. Sensitize /involve community based on NCDs the ACSM strategic plan 3.10.3.2.5.2 Promote community a. Advocate for exercise centers/rooms at based approaches and workplaces, community and schools sensitization for prevention b. Advocate for health diet at schools, and control for NCDs hospitals, hotels/ restaurants and other food courts c. Commemorate NCDs world international days (Cancer, Kidney, Hypertension, Diabetes and sickle cell) to raise community awareness d. Conduct community sensitization on health diet and physical activities e. Develop IEC materials on modifiable risks f. Print and disseminate IEC materials g. Develop and broadcast health messages on major NCDs and modifiable risks in radios, TV stations and mobile phones h. Develop and broadcast panel discussion, TV documentaries, radio and TV spots on major NCDs i. Sensitize alternative healers on sign and symptoms of major NCDs 3.10.3.2.5.3 Implement school a. Develop school education modules on education modules on healthy living healthy living b. Sensitize District School Health Coordinators on the modules on healthy living c. Sensitize school health teachers on the modules on healthy living d. Teach school children on the modules on healthy living Page 30 STRATEGIC PLAN AND ACTION PLAN 2016-2020 SN Priority actions Activities 3.10.3.2.5.4 Early detection and a. Develop comprehensive screening policy appropriate management guidelines of NCDs (Cancer, b. Develop screening tools including Diabetes, Cardiovascular, registers for NCDs Sickle Cell, Renal, Mental c. Orient health care workers on screening health, and respiratory) of NCDs to high risk groups d. Conduct screening programs/campaigns to high risk groups including family members e. Strengthen referral and linkages at all levels for continuum of care 3.10.3.2.5.5 Provide preventive therapy a. Facilitate preventive vaccinations for NDCs (Cardiovascular, and therapy such as HPV, HPB) Cancer, Respiratory, Renal pneumococcal , Rheumatic fever and and Mental health (aspirin, statins b. Provision preventive for those at high risk of renal diseases 3.10.3.2.5.6 Support promotion of a. Collaborate with relevant institutions laws and legislations that to raise public awareness on road safety, prevent the rise of NCDs tobacco and alcohol use b. Review and adapt tobacco protocol regulation act of 2003 c. Develop smoke quit programs and guidelines d. Develop guidelines for alcohol and substance abuse prevention and control e. Review Occupational and environmental policy and legislations to reduce exposure through air, water and food to chemical hazards that cause NCDs STRATEGIC PLAN AND ACTION PLAN 2016-2020 Page 31 3.10.3.2.6 Priority actions and activities for strategic interventions to: Strengthen physical rehabilitation and palliative care SN Priority actions Activities 3.10.3.2.6.1 Support rehabilitation a. Create of a Physical Rehabilitation services at levels of care Office within the Ministry of Health that manages the platform of all stakeholders within the sector b. Develop rehabilitation guidelines for major NCDs c. Train rehabilitation workers on major NCDs guidelines. d. Equip rehabilitation workshops with machines and raw materials for manufacturing of assistive devices e. Support outreach services for rehabilitation 3.10.3.2.6.2 Support a. Review and update national palliative Palliative care care policy guidelines and strategy b. Oversee implementation of palliative care policy guidelines and strategy 3.10.3.2.6.3 Strengthen community a. Adapt, develop and print Community based rehabilitation and Based Rehabilitation guidelines palliative care b. Orient community health workers on the guideline c. Develop simple SOPs for rehabilitation and palliative care for Community care workers d. Build capacity of Community Health Workers for Community based rehabilitation (CBR) and palliative care e. Review /develop and print patients’ self- management care booklets for chronic diseases such as diabetes, hypertension, cancer, renal, sickle cell disease. f. Provide Community Health Workers with enablers and logistical support for community based rehabilitation and palliative care g. Strengthen/establish community based rehabilitation referral linkages for continuum of care Page 32 STRATEGIC PLAN AND ACTION PLAN 2016-2020 3.10.3.2.7 Priority actions and activities for strategic intervention to: Implement Collaborative TB/diabetes SN Priority actions Activities 3.10.3.2.7.1 Establish TWG for a. Conduct a meeting with NTLP and plan collaborative TB diabetes establishment of TWG at all levels at all levels b. Launch TWG for Collaborative TB/ diabetes at all levels Review M&E systems to a. Develop diabetes card with unique include information on identification number and include TB/ TB/diabetes diabetes information b. Review recording and reporting tools to include information on TB/diabetes 3.10.3.2.7.2 Support Health facility to a. Develop TB/Diabetes training materials implement collaborative b. Train health care providers on TB/activities collaborative/TB diabetes c. Select regions and sites for phase implementations of TB/diabetes d. Strengthen referral and linkages mechanisms between TB and diabetes clinics e. Ensure availability drugs and supplies for TB/diabetes services f. Conduct joint supportive supervision g. Conduct evaluation of the pilot phase and disseminate findings h. Scale up TB/diabetes services Indicators of Success - Number of health facilities with Integrate NCD services - Number of NCD community groups - Number of health facilities with integrated Practical Approach to Lung Health (PAL) - Number of hospital with rehabilitation services - Number health facilities reported interrupted supply of commodities and medicines for NCDs - Number of training materials developed - Number of ASCM strategies developed - Number of health care providers trained on NCDs - Number of community sensitized on NCDs - Number of school teachers train health modules - Number of health facilities implementing collaborative TB/diabetes services - Number of people with diabetes screened for TB STRATEGIC PLAN AND ACTION PLAN 2016-2020 Page 33 - Number of people with diabetes diagnosed with TB - Number of people with diabetes on TB treatment - Age standardized mean population intake of salt (sodium chloride) in grams in persons aged 18+ years - Age standardized mean proportion of total energy intake from saturated fatty acids in persons aged 18+ years - Age standardized prevalence of persons (aged 18+ years) consuming less than five total servings (400g) of fruit and vegetables per day - Proportion of mothers practicing exclusive breastfeeding - Number and type of public campaigns and social marketing carried out - School health programs evaluation reports - Legislation implementation reports on food marketing and labeling - Market surveys Expected Outcomes - A 30% reduction in mean salt consumption - 30% reduction in the proportion of individuals population consuming less than five total servings (400g) of fruit and vegetables per day from baseline - Increased proportion of mothers practicing exclusive breastfeeding from baseline - Increased community awareness of healthy food - NCD health education implemented in schools - Policies for nutrition labeling of processed food and meals in place and are implemented Modifiable risk factors Indicators of Success - ACSM strategy for NCD developed - Number of community sensitized on major NCDs and modifiable risks - Number of communities, workplace and schools with centers for exercise - Alcohol related morbidity and mortality among adolescents and adults - Number of reported deaths from injuries and trauma - Number of health facilities provide rehabilitation and palliative care Expected outcomes - NCD health education implemented in schools - 10% reduction in the prevalence of insufficient physical activity - A 10% reduction in the harmful use of alcohol - Proportion of women between the ages of 30-49 screened for cervical cancer at least once - Coverage of HPV vaccine among school girls aged 9 to 13 years - Reduced exposure to environmental hazards - NGO’s and civil society organizations are engaged and are implementing NCD prevention and control activities Page 34 STRATEGIC PLAN AND ACTION PLAN 2016-2020

3.10.3.3 Summary of Priority Intervention for the Major Conditions The above section outlines all that could be done in the various areas of NCD prevention and control, with the underlying focus on modifiable risk factors through population based approaches. Table 3 indicates the priority interventions for the specific disease groups in Tanzania given resource limitations. Disease Goal by 2020 Priority area of Partners/ Group Action Stakeholders Diabetes • 10% relative • Community MoHCDGEC, TDA, reduction in the sensitization on IDF, TANCDA, prevalence of healthy diet and Training institutions, diabetes from physical activity. Professional baseline • Early detection associations, WDF, • 20% reduction and appropriate Global NCD in the overall management of Alliance, DANCDA, mortality from diabetes at all levels community support diabetes • Early detection and groups, MEDIA management of acute and chronic complications (foot, DKA, infections) Cardiovascular • 25% relative • Community MoHCDGEC , reduction in sensitization on PMORALG, the prevalence healthy diet and Heart Foundation, of raised blood physical activity. Health facilities, pressure from • Early detection Training institutions, baseline and appropriate Professional • 10% reduction management of associations, from cardiovascular community baseline total diseases support groups Cholesterol • Preventive and other NGOs, • 20% reduction treatment for Media, TANCDA, in the overall stroke and MI DANCDA mortality from (aspirin, statins) cardiovascular • Preventive diseases treatment for (hypertension, Rheumatic fever heart failure, (penicillin) stroke, rheumatic fever, rheumatic heart disease STRATEGIC PLAN AND ACTION PLAN 2016-2020 Page 35 Disease Goal by 2020 Priority area of Partners/ Group Action Stakeholders Cancer • Proportion • Community MoHCDGEC , of patients sensitization on PMORALG, detected with healthy diet and TCA,MEWATA, early cancer physical activity. 50 PLUS, Tanzania increased by • Early detection Palliative Care 50% from the and appropriate association, Health baseline (health management of facilities, Training facility level) cancers institutions, • Implement & • Preventive Professional Achieve 80% vaccination (HPV, associations, coverage for HPB) community HPV vaccine support groups • Advocacy at the and other NGOs, for school girls higher level to (9-13 years) Media, TANCDA, support palliative DANCDA, WAMA, • 20% reduction care services in the in the overall PINK RIBBON country including ALLIANCE, mortality from availability of cancer International Atomic morphine and Energy • Palliative other drugs care - 60% of cancer and HIV patients accessing palliative care services Respiratory • 20% reduction • Community MoHCDGEC, in the overall sensitization on PMORALG, mortality indoor and outdoor TIIDO, from chronic pollution, healthy World LUNG respiratory diet and physical FOUNDATION, diseases activity OSHA, IFHI, • Early detection Training / Research and appropriate institutions, management of Tanzania ASTHMA respiratory diseases Foundation, • Preventive European Respiratory vaccination Society, TANCDA, (pneumococcal) DANCDA Page 36 STRATEGIC PLAN AND ACTION PLAN 2016-2020 Disease Goal by 2020 Priority area of Partners/ Group Action Stakeholders Sickle Cell • 50% increase • Community MoHCDGEC, from baseline sensitization on PMORALG, in survival rates sickle cell disease Training / Research for SCD (20% • Early detection institutions WHO) and appropriate e.g. MUHAS, management and Tanzania Sickle comprehensive care Cell Foundation, SCD including World Sickle Cell oral penicillin and Federation, wellcome pneumococcal trust, NIH vaccination • Sickle cell screening and counseling program for the community • Screening for SCD screening at health facilities among newborns in high prevalence areas. Renal • 50% increase • Community MoHCDGEC, from baseline sensitization TANCDA, Training in the number healthy diet and institutions, Professional of hypertensive physical activity. associations, WDF, and diabetes • Early detection Global NCD Alliance, patients and appropriate DANCDA, community receiving annual management of support groups, MEDIA, screening for patients with renal Tanzania Kidney urinary protein disease Foundation, World • Preventive Kidney Foundation treatment for those at high risk of renal diseases such as hypertensive and diabetes patients STRATEGIC PLAN AND ACTION PLAN 2016-2020 Page 37 Disease Goal by 2020 Priority area of Partners/ Group Action Stakeholders Mental Health • reduce suicide • Community MoHCDGEC, and substance rate by 10% sensitization on PMORALG, Training Abuse • reduce healthy diet and / Research institutions, depression by physical activity TANCDA, DANCDA, 10% from the • Early detection MEHATA, World baseline and appropriate Health Federation, • Increase by management MDM, DCC, MoHome 20% from • Strengthen effective Affairs, MoSports, the base line leadership and provision of governance for comprehensive, mental health integrated and • Implement responsive strategies for mental health promotion and and social care prevention in services in the mental health community • Strengthen information systems, evidence and research for mental health Injuries and • Reduce by 20% • Raise community • Muhimbili Trauma from baseline awareness on safe Orthopedic Institute the overall road use (MOI), MNH, mortality from • Improve post MOH&SW, Police injuries and injury care by force, PMORALG trauma training health care workers on managing acute injuries • Promote laws and legislations that ensure road safety e.g use of safety belts, child restraint, speed limits, drinking and driving laws etc Page 38 STRATEGIC PLAN AND ACTION PLAN 2016-2020 Disease Goal by 2020 Priority area of Partners/ Group Action Stakeholders Oral Health • An Increase by • Community MOH&SW, TANCDA, 20% proportion sensitization on Tanzania Dental of cavity free 6 healthy diet and Association, MNH year olds avoidance of sugary • A 20% foods reduction • Early detection by 20% and appropriate the DMTP management particularly the of oral health D component problems • A reduction • Strengthen effective by 20% in the leadership and proportion of governance for oral individuals health aged 18 with • Implement teeth loss due strategies for to periodontal promotion disease from prevention in oral baseline health

3.10.4 Objective 4: To Strengthen the National Capacity for NCD surveillance, monitoring and evaluation and research for evidence based planning by 2020

3.10.4.1 Rationale A framework for national and global monitoring, reporting, and accountability, with agreed sets of indicators, is essential to ensure that the returns on investments in NCDs meet the expectations of all partners. The Ministry will adopt and define the Global NCD targets to a minimum set of national targets and indicators including health-system performance indicators for measuring progress of NCD prevention. The indicators listed for each of the above areas of the plan are quantified and summarized in Annex 1. Technical support will be sought to strengthen monitoring framework and the M&E systems. National research agenda will be developed and implemented in collaboration with academia, and research institutions to answer specific problems and to generate data that will support efforts for resource mobilization. The conducted research will be disseminated and used to inform policy for decision making. In additional, population survey will be conducted regular at the recommended interval to monitor trend in key risk factors for NCD and the uptake of priority interventions. The implementation of this strategic plan II (2016 -2020) will be monitored to guide the NCD section to meet the targets in the plan. Surveillance data will be collected and used to inform policy, monitor and evaluate progress towards achieving targets. NCDs supportive supervision and mentoring will be conducted in cascade approach: The national will supervise regions on annual basis. The regions will supervise districts and districts will supervise health facilities on quarterly basis as per RHMTs and CHMTs schedules. NCD supervision tool will be incorporated into the regional and district tools. STRATEGIC PLAN AND ACTION PLAN 2016-2020 Page 39 Technical progress report on quarterly, semi-annual and annual basis will prepare and used. The reports will be submitted to development partners/donors based on their reporting calendar. Annual stakeholders meeting will be conducted to review progress on implementation including identifications of shortfalls. A plan to address shortfalls will be prepared and implemented. In addition, mid and end term review will be conducted to offer an opportunity to learn from the experience of the first two years of the plan, taking corrective measures where actions have not been effective and reorienting parts of the plan in response to unforeseen challenges and issues.

3.10.4.2 Strategic interventions i. Strengthen capacity for surveillance system monitoring and evaluation of the strategic plan ii. Promote research in NCDs (including injuries and violence) in collaboration with key stakeholders iii. Monitor and evaluate progress of the strategic plan. Strategies Indicators of success - Minimum set of indicators for monitoring implementation of NCD prevention and control are in place and shared with stakeholders for action - A functional Monitoring framework for NCD surveillance is in place Expected outcome - Surveillance of NCD risk factors carried out every 4 years to monitor trends - Surveillance systems for NCDs are well coordinated and functional - National registries for cancer, diabetes and other chronic diseases are in place and up to date - National monitoring framework in place - National NCD research agenda in place and disseminated - Capacity for data management at all levels of care are strengthened and data is submitted timely Page 40 STRATEGIC PLAN AND ACTION PLAN 2016-2020 3.10.4.2.1 Priority actions and activities for strategic intervention to: Promote research in NCDs (including injuries and violence) in collaboration with key stakeholders SN Priority actions Activities 3.10.4.2.1.1 Strengthen coordination a. Establish position for research focal between NCD section and person at NCD section research institutions and b. Establish national NCD research academia committee with other stakeholders c. Conduct a workshop with research institutions and academia to develop a national research agenda for NCDs and identify previous researches conducted and it utilization d. Mobilize funding within and from international agencies to support research priority areas e. Conduct operational research and survey on identified priority areas in collaboration with research institutions and other stakeholders 3.10.4.2.1.2 Build NCD section a. Conduct refresher training to NCD staff capacity to conduct on operational research methodology operational research b. Seek technical assistance to develop research proposal including survey 3.10.4.2.1.3 Promote research and a. Develop a framework to monitor NCD utilization to inform policy research and its utilize and practice b. Disseminate research findings locally and internationally c. Publish research finding in peer review locally and internationally 3.10.4.2.2 Priority actions and activities for strategic intervention to: Monitor and evaluate progress of the strategic plan SN Priority actions Activities 3.10.4.2.2.1 Review and update a. Seek technical assistance/consultant monitoring and evaluation to review and update monitoring and systems and framework for evaluation systems and framework NCDs b. Conduct workshop to Review data collection tools for major NCDs to incorporate WHO recommendations a minimum set of national targets and indicators c. Support/coordinate review District Sentinel Survey (DSS) tools to incorporate NCD data variables STRATEGIC PLAN AND ACTION PLAN 2016-2020 Page 41 SN Priority actions Activities 3.10.4.2.2.2 Build capacity for a. Develop standardized training protocol data management and for routine surveillance and tracking utilization at all levels system of NCDs b. Train clinicians on the protocol for routine surveillance including recording, reporting, data analysis and utilization at point of care c. Print and distribute R&R tools for NCDs d. Conduct post training supportive supervision 3.10.4.2.2.3 Monitor implementation a. Conduct joint supportive supervision of the NCD strategic plan with partners to regions on NCDs annually b. Ensure regional and district supportive supervision tools include NCDs c. Develop technical progress reports: quarter, semi-annual and annual d. Conduct annual meeting with key stakeholders to review progress of implementation e. Conduct midterm and end term review of the strategic plan II

3.11 Resources The activities included in the action plan will be financed by the Ministry of Health Community Development Gender Elderly and Children (MOHCDGEC) annual budget through its Medium Term Expenditure framework (MFEF) that distribute both government funding and partners funding through the basket funds and funds from civil societies (e.g. TANCDA) and other donors.

3.12 Assumptions and Risks The underlying assumptions for the successful implementation of this plan is that there will be political commitment to spearhead the NCD activities, also there will be positive environment that will foster multi-stakeholder involvement in the planned activities. Availability of funding also could affect the implementation of the plan. The plan assumes that NCD prevention and control will be mainly at population level addressing the major risk factors through legislations and high risk/individual approach by treating those affected or at high risk, by means of evidence based approaches. The major risks to this plan are the lack of political will and unavailability of funds, unfavorable sociocultural norms and the industry i.e. cigarette, alcohol, beverage food industries. Page 42 STRATEGIC PLAN AND ACTION PLAN 2016-2020 4 References 1. Alwan, A., Maclean, D. R., Riley, L. M., D’espaignet, E. T., Mathers, C. D., Stevens, G. A. & Bettcher, D. 2010. Monitoring and surveillance of chronic non-communicable diseases: progress and capacity in high-burden countries. The Lancet, 376, 1861-1868. 2. AMMP 1997. Policy Impications of the Adult Morbidity and Mortality Project. Tanzania. 3. Demyttenaere K, B. R., Posada-Villa J. et al 2004. Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization world mental health surveys. JAMA, 291, 2581-2590. 4. Ferlay, J., Shin, H.-R., Bray, F., Forman, D., Mathers, C. & Parkin, D. M. 2010. Estimates of worldwide burden of cancer in 2008: GLOBOCAN 2008. International Journal of Cancer, 127, 2893-2917. 5. IARC 2002. GLOBOCAN. 6. Kearney, P. M., Whelton, M., Reynolds, K., Muntner, P., Whelton, P. K. & He, J. 2005. Global burden of hypertension: analysis of worldwide data. The Lancet, 365, 217-223. 7. Lim, S. S., Vos, T., Flaxman, A. D., Danaei, G., Shibuya, K., Adair-Rohani, H., et al. 2012. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990?2010: a systematic analysis for the Global Burden of Disease Study 2010. The Lancet, 380, 2224-2260. 8. Lozano, R., Naghavi, M., Foreman, K., Lim, S., Shibuya, K., Aboyans, V., et al. 2012. Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: a systematic analysis for the Global Burden of Disease Study 2010. The Lancet, 380, 2095-2128. 9. Mayige M, K. G., Ramaiya K, Swai A. 2012. Non communicable diseases in Tanzania: a call for urgent action Tanzania Journal of Health Research, Tanzania Journal of Health Research, 14. 10. MOH 2012. STEPS Survey of NCD Risk Factors. Dar es Salaam. Tanzania: Ministry of Health Community Development Gender Elderly and Children. 11. Murray, C. J. L., Vos, T., Lozano, R., Naghavi, M., Flaxman, A. D., Michaud, C., et al. 2012. Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990?2010: a systematic analysis for the Global Burden of Disease Study 2010. The Lancet, 380, 2197-2223. 12. UICC 2005. Global Action Against Cancer. UICC. 13. Whiting, D. R., Guariguata, L., Weil, C. & Shaw, J. 2011. IDF diabetes atlas: global estimates of the prevalence of diabetes for 2011 and 2030. Diabetes Res Clin Pract, 94, 311-21. 14. WHO-AFRO 2011. The Brazzaville Declaration on Noncommunicable Diseases Prevention and Control In the Who African Region. Brazzavile, Congo: World Health Organisation, African Region. 15. WHO 2004. Global Burden of Disaese Report. Geneva: World Health Organisation. STRATEGIC PLAN AND ACTION PLAN 2016-2020 Page 43 16. WHO 2005. Preventing Non Communicable Diseases: A vital Investment. Geneva: World Health Organisation. 17. WHO 2008. The Global Burden of Disease: 2004 update. Geneva: World Health Organisation. 18. WHO. 2011a. NCD Country Profiles [Online]. Geneva: World Health Organisation. Available: http://www.who.int/nmh/countries/tza_en.pdf [Accessed September 2013]. 19. WHO. 2011b. Sickle Cell and Other Hemoglobin Disorders [Online]. Geneva: World Health Organisation. Available: http://www.who.int/mediacentre/factsheets/fs308/en/ [Accessed 2013. 20. WHO. 2013a. Oral Health: What is the Burden of Oral Disease? [Online]. Geneva: World Health Organisation.Available: http://www.who.int/oral_health/disease_burden/global/en/index.html 2013]. 21. WHO. 2013b. Road Traffic Injuries [Online]. Geneva: World Health Organisation. Available: http://www.who.int/mediacentre/factsheets/fs358/en/index.html [Accessed September 2013]. 22. Pascolini D, Mariotti SPM. Global estimates of visual impairment: 2010. British Journal Ophthalmology Online First published December 1, 2011 as 10.1136/bjophthalmol-2011-300539 Page 44 STRATEGIC PLAN AND ACTION PLAN 2016-2020 5 Annexes

5.1 Annex 1: Summary of Indicators for Monitoring and Evaluation Indicator Level Priority Actions / Indicators 2016/17 2017/18 2018/19 2019/20 2020/21 A. Attain political commitment with increased and sustained financing for NCDs a) % increase in the proportion of budget available for NCD prevention and control b) Decrease in the number of days essential medicines are out of stock in public facilities c) % increase in the annual budgetary allocations and resources earmarked for NCD activities d) % increase in the proportion of population covered by health insurance B. Review existing policy and legislation to improve prevention and control, to NCDs services a) Number of new/revised NCDS related legislation implemented *See list below this table C. Establish a sustainable coordination system of multi sector approach to address NCDs prevention and control a) % of planed multisectoral actions that are implemented D. Strengthen (NCD section) capacity to coordinate and manage NCDs prevention and control services a) % of planned monitoring visits accomplished STRATEGIC PLAN AND ACTION PLAN 2016-2020 Page 45 Indicator Level Priority Actions / Indicators 2016/17 2017/18 2018/19 2019/20 2020/21 E. Increase access for major non communicable diseases a) % of health facilities with Integrate NCD services b) % of hospitals with NCD related patient/ community support groups c) % of health facilities without reported interrupted supply of commodities and medicines for NCDs d) % of health care providers trained on NCDs e) % of adults in the community sensitized on NCDs f ) % of school teaching health modules g) % of health facilities implementing collaborative TB/diabetes services F. Scale up centre excellence for NCDs (cancer, renal, sickle cell and cardiac center) in zonal referral hospitals a) % of planned supportive supervision sessions conducted by zonal centres G. Integrate NCD services into existing health care services at all levels of care including community participation. a) % of health training manuals/curricula revised to comprehensively include NCDS H. Reduce modifiable NCDs risk factors and create health promoting environment I. Advocacy communication and social mobilization Strategic plan (ACSM) to sensitize community on NCDs a) At least 80% coverage of HPV vaccine among school girls aged 9 to 13 years b) % of population with preventive pneumococcal vaccination c) % of workplaces meet legal environmental standards d) % of adult population sensitized on major NCDs and modifiable risks e) % of urban workplaces with centers for exercise Page 46 STRATEGIC PLAN AND ACTION PLAN 2016-2020 Indicator Level Priority Actions / Indicators 2016/17 2017/18 2018/19 2019/20 2020/21 J. Promote community based approaches and sensitization for prevention and control for NCDs a) Number of NGO’s and civil society organizations engaged and implementing NCD prevention and control activities K. Implement school education modules on healthy living a) NCD health education implemented in schools L. Early detection and appropriate management of NCDs (Cancer, Diabetes, Cardiovascular, Sickle Cell, Renal, Mental health, and respiratory) a) Proportion of women between the ages of 30-49 screened for cervical cancer at least once b) Proportion of patients detected with early cancer increased by 50% from the baseline (health facility level) c) % of newborns screened and mothers counseled on sickle cell in high prevalence areas d) % of adults screened for hypertension and diabetes M. Strengthen physical rehabilitation and palliative care a) % of hospitals with rehabilitation services N. Promote research in NCDs (including injuries and violence) in collaboration with key stakeholders a) Surveillance of NCD risk factors carried out every 4 years to monitor trends b) National registries for cancer, diabetes and other chronic diseases are in place and up to date c) % of indicator data routinely collected through the HIMS system d) % of new policies are evidence based e) % of identified priority research carried out STRATEGIC PLAN AND ACTION PLAN 2016-2020 Page 47 Indicator Level Priority Actions / Indicators 2016/17 2017/18 2018/19 2019/20 2020/21 O. Monitor and evaluate progress of the strategic plan a) % of expected reports are submitted on time Impact and Outcome Indicators of Success for both Monitoring and Evaluation P. Overall Outcome (Mortality) a) 20% reduction in mortality among people less than 70 years due to cardiovascular disease, chronic respiratory disease, cancer and diabetes b) 10% reduction from baseline of suicide rates in the general population c) 50% increase from baseline in survival rates of SCD patients (20% WHO) d) Reduce by 20% from baseline the overall mortality from injuries and trauma e) 20% reduction in alcohol related morbidity and mortality among adolescents and adults Q. Community Interventions plus legislation a) 30% reduction in the prevalence of tobacco use by 2020 compared to baseline 2012 STEPS data. b) 10% relative reduction in persons aged 15+ per capita consumption of alcohol from baseline c) Reduction in the mean population intake of salt to less than 5gms per day. (A 30% reduction in mean salt consumption) R. Community Interventions a) 0% increase in obesity prevalence from baseline b) 10% reduction from the baseline in the proportion of individuals who are physically inactive c) 50% increase from the baseline in the proportion of patients detected with early cancer (health facility level) d) 25% reduction from baseline in the prevalence of raised blood pressure Page 48 STRATEGIC PLAN AND ACTION PLAN 2016-2020 e) 10% reduction from baseline total Cholesterol Indicator Level Priority Actions / Indicators 2016/17 2017/18 2018/19 2019/20 2020/21 f ) 10% reduction from baseline in the proportion of individuals with raised total cholesterol g) 10% reduction from baseline in the prevalence of diabetes h) 50% increase from the current level of community awareness on NCDs i) 70% increase from baseline in the level of community awareness of sickle cell j) 10% of couples in affected regions receive pre-marital SCD screening k) To increase by 20% the proportion of cavity free 6 year olds l) To reduce by 20% the DMPT particularly the D component at age 12 m) To reduce by 20% the number of teeth loss due to periodontal disease for juveniles up to 18 year old. n) 30% reduction in the proportion of individuals population consuming less than five total servings (400g) of fruit and vegetables per day from baseline o) Increased proportion of mothers practicing exclusive breastfeeding from baseline S. Improved facility care a) Implement and achieve 80% coverage for HPV vaccine for school girls (9-13 yrs) b) 50% of people diagnosed with stroke or heart disease use aspirin for prevention of further cardiovascular diseases c) 50% increase from baseline access to essential medicines for those diagnosed with the major NCDs d) 50% increase in the proportion of newborns at health facilities screened for Sickle Cell Disease e) 70% increase from baseline in the proportion of SCD patients receiving standardized care and treatment STRATEGIC PLAN AND ACTION PLAN 2016-2020 Page 49 Indicator Level Priority Actions / Indicators 2016/17 2017/18 2018/19 2019/20 2020/21 f) 50% patients with diabetes or hypertension receive urine tests for proteins at least yearly g) % of patients with hypertension and diabetes with annual reviews for complications

5.2 Annex 2: Implementation Status of Key NCD Prevention Legislations in Tanzania NCD Prevention Interventions Legislations Reductions in prevalence of smoking The Tobacco Products (Regulation) Act 2003 a) Full implementation of the WHO Framework Partial Convention on Tobacco Control (FCTC) and in particular b) Demand reduction measures at the highest level Implemented though not at highest level for tobacco product tax c) Large pictorial health warning labels Absent d) Comprehensive smoke-free legislation Present e) Bans on all forms of tobacco advertising, Present promotion and sponsorship Challenge: Enforcement of the legislation in place by the stakeholders. The history of tobacco control in Tanzania dates back to 2003, when the country enacted the Tobacco Products (Regulation) Act, (TPRA, 2003). Unfortunately TPRA (2003) is flawed, with loopholes that give a leeway to the tobacco industry to continue its advertising, promotion and sponsorship activities that have resulted into increasing tobacco use, especially among the youth. Tanzania also ratified the WHO Framework Convention on Tobacco Control (FCTC) in 2007. Sadly, even six years after ratification of the FCTC, Tanzania is yet to come up with effective tobacco control legislation in line with the Convention. Reduction in alcohol consumption Traditional Liquor (Control of Distillation) Act, The Spirits Act, The Potable Spirits (Compounding ) Act, Intoxicating Liquors Act a) Implementation and enforcement of effective Partial and cost-effective alcohol policies b) pricing policies to decrease affordability of Present alcohol c) legally binding restrictions on alcohol advertising Present d) marketing of alcoholic beverages Absent e) restrictions on access to alcoholic beverages Present Page 50 STRATEGIC PLAN AND ACTION PLAN 2016-2020 NCD Prevention Interventions Legislations Challenge: Enforcement of the legislation in place by the stakeholders Salt reduction interventions Tanzania Food and Nutrition Act, Tanzania Bureau of Standards Act, The Tanzania Food, Drugs and Cosmetics Act (2003) a) including mass media campaigns to inform and Partial empower consumers to make informed choices b) product reformulation to reduce the salt content Present of processed foods c) population level interventions which increase Absent physical activity and improve poor diet d) including by reducing salt intake Absent Challenge: Awareness is low, enforcement of regulations is an issue, quality of salt produced at salt producing mines is not meeting the required standards and future sustainability of potassium iodate is not yet guaranteed Reduction in cervical cancer Policy stage a) good-quality cervical cancer screening programs Present b) vaccination against HPV 16 and 18 Present c) population-based screening programs Present d) access to cervical cancer screening Limited Challenge: Inclusion of HPV vaccines in National immunization programs, awareness of cervical cancer, coordination of cervical cancer prevention programs. Reduction in fat consumption The Tanzania Food, Drugs and Cosmetics Act (2003) a) Reduction of industrially produced trans-fatty Partial acids (and their virtual elimination) b) legislation limiting trans-fatty levels in foods Partial c) food labeling initiatives Present Challenge: Enforcement of the present legislation and awareness Optimal diet a) achieving a balance between energy intake from Absent food and energy expenditure from physical activity to maintain a healthy weight b) limiting energy intake from total fats (not to Absent exceed 30 per cent of total energy intake) c) shifting fat consumption away from saturated Absent fats to unsaturated fats d) elimination of trans fatty acids Partial STRATEGIC PLAN AND ACTION PLAN 2016-2020 Page 51 NCD Prevention Interventions Legislations e) limiting intake of free sugars Absent f ) limiting sodium consumption from all sources Partial g) ensuring that salt is iodized Present h) increasing the consumption of fruits legumes, Absent whole grains and nuts Challenge: Awareness which will ideally lead to creation of the much needed legislation to this effect Physical activity Road construction (foot and bicycle paths) Absent Sports activities (in schools and work places) Present Town Planning (open spaces) Absent Challenge: Awareness which will ideally lead to creation of legislation to this effect, Physical Education in the curriculum not taken seriously Injury Prevention (RTA) Penalty system for drivers Yes, partially enforced National Speed limits Yes, partially enforced National drink–driving law Yes, partially enforced National motorcycle helmet law Yes, partially enforced National seat-belt law Yes, partially enforced National child restraint law No National law on mobile phones while driving No Challenge: The existing legislations are not fully enforced Page 52 STRATEGIC PLAN AND ACTION PLAN 2016-2020

5.3 Annex 3: NATIONAL NCD ACTION PLAN 2016/17 - 2020/21 BUDGET SUMMARY Objective / Actions Amount (TZS) Objective 1: To Advocate for NCD prevention and control as a National Priority by 2020 $WWDLQSROLWLFDOFRPPLWPHQWZLWKLQFUHDVHGDQGVXVWDLQHG¿QDQFLQJIRU1&'V 6HFXUHDGHTXDWH¿QDQFLDOUHVRXUFHVIRU1&'SUHYHQWLRQDQGFRQWUROVHUYLFHVLQWKH 3,030,655,000 country 0DUNHW1&'VVWUDWHJLFSODQWRSDUWQHUVIRUPRELOL]LQJUHVRXUFHV 468,560,000 5HYLHZH[LVWLQJSROLF\DQGOHJLVODWLRQWRLPSURYHSUHYHQWLRQDQGFRQWUROWR NCDs services 5HYLHZYDULRXVSROLFLHVDQGOHJLVODWLRQ 153,200,000 2EMHFWLYH7RVWUHQJWKHQOHDGHUVKLSJRYHUQDQFHPXOWLVHFWRUDOFROODERUDWLRQ and accountability for prevention and control of NCDs by 2020 Establish a sustainable coordination system of multi sector approach to address NCDs prevention and control at all levels (VWDEOLVKDKLJKOHYHOLQWHUPLQLVWHULDOFRPPLWWHHWRIDFLOLWDWHDQGPRQLWRU 73,860,000 0XOWLVSHFWUDODFWLRQIRU1&'SUHYHQWLRQDQGFRQWURO (VWDEOLVK6WUHQJWKHQ0XOWLVHFWRUDOFRRUGLQDWLQJ&RPPLWWHHDWDOOOHYHOV 691,600,000 Support multisectoral coordination committee meetings at national, regional and 12,470,800,000 district 6WUHQJWKHQ 1&'VHFWLRQ FDSDFLW\WRFRRUGLQDWHDQGPDQDJH1&'VSUHYHQWLRQ and control services Implement NCD human resource management plan 0 %XLOG1&'VHFWLRQVWDIIFDSDFLW\WRDFTXLUHQHFHVVDU\VNLOOVDQGFRPSHWHQFHVWR 142,120,000 implement NCD SP LPSURYH1&'VHFWLRQZRUNLQJFRQGLWLRQ 28,000,000 2EMHFWLYH7RVWUHQJWKHQDQGUHRULHQWKHDOWKV\VWHPVWRDGGUHVV1&'V WKURXJKSURPRWLYHSUHYHQWLYHFXUDWLYHDQGUHKDELOLWDWLYHVHUYLFHVE\ Increase access for major NCDs 6FDOHXS1&'VVHUYLFHVDWSULPDU\OHYHOV 388,360,000 &DSDFLW\EXLOGLQJWR+&:VWRLPSOHPHQW1&'VVHUYLFHVLQVFDOHGXSGLVWULFWV 16,890,795,000 (QVXUHXQLQWHUUXSWHGVXSSO\RIPDMRU1&'VGUXJVDQGFRPPRGLWLHV 0 6FDOHXSFHQWHUVRIH[FHOOHQFHIRU1&'V FDQFHUUHQDOVLFNOHFHOOGLDEHWHV and cardiac) in zonal referral hospitals 5HIXUELVKLGHQWL¿HGWDUJHWHG]RQHUHIHUUDOKRVSLWDOWRSURYLGHTXDOLW\IRUFDQFHU 55,000,000 GLDEHWHVUHQDODQGFDUGLRYDVFXODU %XLOGFDSDFLW\RIKHDOWKZRUNHUVIURPWDUJHWHG]RQHUHIHUUDOKRVSLWDOWRSURYLGH 0 FDQFHUUHQDOVLFNOHFHOODQGFDUGLRYDVFXODUVHUYLFHV 6XSSRUWFHQWHUVRIH[FHOOHQFHLQWKHGHFHQWUDOL]HG]RQDOUHIHUUDOKRVSLWDOV 622,800,000 ,QWHJUDWH1&'VHUYLFHVLQWRH[LVWLQJKHDOWKFDUHVHUYLFHVDWDOOOHYHOVRIFDUH LQFOXGLQJFRPPXQLW\SDUWLFLSDWLRQ ,QFRUSRUDWHFRPSUHKHQVLYH1&'VSUHYHQWLRQDQGFRQWUROVHUYLFHVLQKHDOWKWUDLQLQJ 29,175,000 curricula ,QFRUSRUDWH1&'VUHOHYDQWFRPSRQHQWWREHUHÀHFWHGLQ 5&+307&71$&3 29,835,000 NTLP, EPI ) training manuals STRATEGIC PLAN AND ACTION PLAN 2016-2020 Page 53 ,PSOHPHQW3UDFWLFDO$SSURDFKWR/XQJKHDOWK 3$/ Introduce PAL as integrated management in primary health care in order to 25,590,000 6WUHQJWKHQPDQDJHPHQWRIUHVSLUDWRU\GLVHDVH 6XSSRUW+HDOWKIDFLOLW\WRLPSOHPHQW3$/LQSKDVHPDQQHU 0 5HGXFHPRGL¿DEOH1&'VULVNIDFWRUVDQGFUHDWHKHDOWKSURPRWLQJHQYLURQPHQW $GYRFDF\FRPPXQLFDWLRQDQGVRFLDOPRELOL]DWLRQ6WUDWHJLFSODQ $&60 WRVHQVLWL]H 2,297,515,000 community on NCDs 3URPRWHFRPPXQLW\EDVHGDSSURDFKHVDQGVHQVLWL]DWLRQIRUSUHYHQWLRQDQGFRQWURO 23,764,295,000 IRU1&'V LPSOHPHQWVFKRROHGXFDWLRQPRGXOHVRQKHDOWK\OLYLQJ 2,577,570,000 (DUO\GHWHFWLRQDQGDSSURSULDWHPDQDJHPHQWRI1&'V &DQFHU'LDEHWHV 10,515,000 &DUGLRYDVFXODU6LFNOH&HOO5HQDO0HQWDOKHDOWKDQGUHVSLUDWRU\ 3URYLGHSUHYHQWLYHWKHUDS\IRU1'&V &DUGLRYDVFXODU&DQFHU5HVSLUDWRU\5HQDO 0 and Mental health 6XSSRUWSURPRWLRQRIODZVDQGOHJLVODWLRQVWKDWSUHYHQWWKHULVHRI1&'V 204,000,000 6WUHQJWKHQUHKDELOLWDWLYHDQGSDOOLDWLYHFDUH &UHDWHRID3K\VLFDO5HKDELOLWDWLRQ2I¿FHZLWKLQWKH0LQLVWU\RI+HDOWKWKDWPDQDJHV 10,955,000 WKHSODWIRUPRIDOOVWDNHKROGHUVZLWKLQWKHVHFWRU 6XSSRUWSDOOLDWLYHFDUH 7,920,000 6WUHQJWKHQFRPPXQLW\EDVHGUHKDELOLWDWLRQDQGSDOOLDWLYHFDUH 415,585,000 3URYLGH&RPPXQLW\+HDOWK:RUNHUVZLWKVXSSOLHVIRUFRPPXQLW\EDVHGUHKDELOLWDWLRQ 0 DQGSDOOLDWLYHFDUH Implement Collaborative TB/diabetes (VWDEOLVK7:*IRUFROODERUDWLYH7%GLDEHWHVDWDOOOHYHOV 110,250,000 5HYLHZ0 (V\VWHPVWRLQFOXGHLQIRUPDWLRQRQ7%GLDEHWHV 0 6XSSRUW+HDOWKIDFLOLW\WRLPSOHPHQWFROODERUDWLYH7%DFWLYLWLHV 0 2EMHFWLYH7R6WUHQJWKHQWKH1DWLRQDO&DSDFLW\IRU1&'VXUYHLOODQFH PRQLWRULQJDQGHYDOXDWLRQDQGUHVHDUFKIRUHYLGHQFHEDVHGSODQQLQJE\ 3URPRWHUHVHDUFKLQ1&'V LQFOXGLQJLQMXULHVDQGYLROHQFH LQFROODERUDWLRQ ZLWKNH\VWDNHKROGHUV 6WUHQJWKHQFRRUGLQDWLRQEHWZHHQ1&'VHFWLRQDQGUHVHDUFKLQVWLWXWLRQVDQG 12,080,000 academia Build NCD section capacity to conduct operational research 70,800,000 3URPRWHUHVHDUFKDQGXWLOL]DWLRQWRLQIRUPSROLF\DQGSUDFWLFH 0 0RQLWRUDQGHYDOXDWHSURJUHVVRIWKHVWUDWHJLFSODQ 5HYLHZDQGXSGDWHPRQLWRULQJDQGHYDOXDWLRQV\VWHPVDQGIUDPHZRUNIRU1&'V 33,590,000 %XLOGFDSDFLW\IRUGDWDPDQDJHPHQWDQGXWLOL]DWLRQDWDOOOHYHOV 0 0RQLWRULPSOHPHQWDWLRQRIWKH1&'VWUDWHJLFSODQ 68,560,000 Total (TZS)  Total (US$)  Page 54 STRATEGIC PLAN AND ACTION PLAN 2016-2020

5.4 Annex 4: Unit Cost for Common GFS Codes Code GFS Code Description Unit of Unit Cost of Measure Inputs 1 $GYHUWLVLQJDQG3XEOLFDWLRQ $GYHUW 2,000,000 2 Air conditioners Unit 2,000,000 3 $LU7UDYHO7LFNHWV,QWHUQDWLRQDO Person 4,000,000 4 $LU7UDYHO7LFNHWV/RFDO Person 700,000 5 %HQH¿WIRU3/+,9 Monthly 100,000 6 Bicyles Person 500,000 7 %RRNV5HIHUHQFHDQG3HULRGLFDOV Monthly 1,500,000 8 Cleaning Supplies Monthly 500,000 9 &RPSXWHUVSULQWHUVVFDQQHUV RWKHUUHODWHGHTXLSPHQW Unit 2,000,000 10 Consultancy Fees Personday 472,000 11 Diesel Litre 2,200 12 Direct labour (contracted or casual hire) Lot 1,500,000 13 ([WUD'XW\ Day 30,000 14 )RRGDQG5HIUHVKPHQWV Person 20,000 15 Furniture and Fittings Lumpsum 10,000,000 16 *LIWV3UL]HV Person 500,000 17 *URXQG7UDYHO %XV5DLOZD\7D[LHWF Person 100,000 18 +HDY\(TXLSPHQW Lot 5,000,000 19 +LULQJRI7UDLQLQJ)DFLOLWLHV Lot 500,000 20 ,QVXUDQFHH[SHQVHV Year 2,500,000 21 Internet and Email Connections Month 1,500,000 22 Laboratory Supplies Unit 3,000,000 23 Library Books Copy 50,000 24 Medical Gases and Chemicals Carton 1,000,000 25 0RWRU9HKLFOHVDQG:DWHU&UDIWV Unit 2,000,000 26 1HZV6HUYLFH)HHV Paper 2,500,000 27 1HZV6HUYLFHV)HHV $LUWLPH Hour 500,000 28 1HZVSDSHUVDQG0DJD]LQHV Month 500,000 29 2I¿FH&RQVXPDEOHV VWDWLRQDULHV Lot 700,000 30 2I¿FH&RQVXPDEOHV VWDWLRQDULHV 3DUWLFLSDQWV Person 5,000 31 2XW¿W$OORZDQFH Person 300,000 32 Per Diem - Domestic (DSA) Day 120,000 33 Printing and Photocopying Costs Page 200 34 3URGXFWLRQDQG3ULQWLQJRI7UDLQLQJ0DWHULDOV Lot 500,000 35 Programs Transmission Fees Hour 1,000,000 36 5HQWRI9HKLFOHVDQG&UDIWV Day 200,000 37 6FLHQWL¿F(TXLSPHQW Unit 1,000,000 38 6WDII8QLIRUP Person 100,000 39 7HFKQLFDO6HUYLFH)HHV Lumpsum 1,000,000 40 Telephone Charge (Land Lines) Month 2,000,000 41 7UDYHOWLFNHWV'RPHVWLF Person 80,000 42 Tuition Fees Person 3,000,000 43 Venue Day 400,000 STRATEGIC PLAN AND ACTION PLAN 2016-2020 Page 55 44 Visa Application Fees Person 400,000 45 Water charges Month 800,000 90 5HKDELOLWDWLRQRIEXLOGLQJV Building 91 67(366XUYH\ 400,000,000 92 Internal handling ([FKDQJHUDWH86 7=6 Page 56 STRATEGIC PLAN AND ACTION PLAN 2016-2020

5.5 Annex 5: RESULT BASED BUDGET Quantities per planning period 2016/17 2017/18 2018/19 2019/20 2020/21 SN Priority Actions / Activities Task Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Objective 1: To Advocate for NCD prevention and control as a National Priority by 20 Attain political commitment with increased DQGVXVWDLQHGÀQDQFLQJIRU1&'V 1 6HFXUHDGHTXDWHÀQDQFLDOUHVRXUFHVIRU NCD prevention and control services in the country a) Generate and disseminate evidence based Task Team for desk review 1 data to support burden of NCDs (1 person from each major diseases, diet, physical activity) STRATEGIC PLAN AND ACTION PLAN 2016-2020 b) Conduct resource needs assessment in order Task team for desk review 1 to inform the development of national NCD (clinician, economist, public plan and budget health specialist) c) Conduct advocacy meetings with key Meetings 1 policy and decision makers MoHCDGEC management team, PMORALG and development partners d) Conduct Sensitization meetings with RHMTs Meetings (16 team members 30 30 30 30 30 RQDGHTXDWH¿QDQFLDODQGRWKHUUHVRXUFHV + 2 TAs) allocation in CCHPs for NCDs e) Conduct Sensitization meetings with CHMTs Meetings (8 team members + 170 170 170 170 170 RQDGHTXDWH¿QDQFLDODQGRWKHUUHVRXUFHV 2 TAs) allocation in CCHPs for NCDs f) Conduct proposal writing workshop for fund Meetings for proposal 5 5 5 5 5 mobilization development (5 people for each area) 2 Market NCDs strategic plan to partners for mobilizing resources Page a) Conduct a workshop to orient stakeholders on Workshop (120 people for 3 1 57 NCDs Strategic Plan days) Page Quantities per planning period 2016/17 2017/18 2018/19 2019/20 2020/21 58 SN Priority Actions / Activities Task Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 b) Identify potential resources of Non ,QWHUQDOZRUNLQJRI1&'2I¿FH 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1 governments funding calls for proposal at MoH c) Conduct a meeting to sensitize Private Meeting of 50 people including 30 30 30 30 30 Business community for funding through 5 TAs corporate social responsibility d) Conduct schedules partnership meeting to Meetings with partners (4 1 1 1 1 1 mobilize and leverage resources for NCDs DUHDVRI¿FHUVIURPHDFK based on burden of disease data area, 40 partners) Review existing policy and legislation to improve prevention and control, to NCDs services 3 Review various policies and legislation a) Review and update Health Insurance Attend scheduled meetings schemes for universal coverage b) Advocate for review of various policies and Meeting to review legislations 8 legislation (tobacco, alcohol, diet, physical (20 people per meeting for LQDFWLYLW\URDGWUDI¿FRFFXSDWLRQDOKHDOWKDQG each area) built environment) c) Disseminate evidence for appropriate Consultancy to prepare 6 taxation position papers (one consultant per area) Meetings to agree/review 6 6 recommendations of the position paper (one meeting for each area) Objective 2: To strengthen leadership, governance, multisectoral collaboration and accountability for prevention and control of NCDs by 2020 Establish a sustainable coordination system of multi sector approach to address NCDs prevention and control at all levels STRATEGIC PLAN AND ACTION PLAN 2016-2020 Quantities per planning period 2016/17 2017/18 2018/19 2019/20 2020/21 SN Priority Actions / Activities Task Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 4 Establish a high-level inter-ministerial committee to facilitate and monitor Multispectral action for NCD prevention and control a) Develop national Multisectoral framework for Consultancy b NCD coordination and collaboration with clear Meeting of consultant with roles and responsibilities stakeholders (40 people from each area, 8 partners ) Meeting to adopt the recommended framework (Partners, Ministries, MDAs) c) Identify key Inter-Ministerial stakeholders Internal handling d) Launch Inter-Ministerial Coordinating Meetings (2 people from each committee for NCDs ministry, all members of the STRATEGIC PLAN AND ACTION PLAN 2016-2020 committee) e) Conduct bi- annual high level Inter-Ministerial Meetings of the committee 1 1 1 1 1 coordination committee meetings (every six months) 5 Establish/Strengthen Multisectoral coordinating Committee at all levels a) Develop TOR/policy guidelines for NCD See above multisectoral coordination committee at national, regional and district levels b) Conduct sensitization meeting to partners, Meetings (once) 16 members 30 PMORALG including RHMTs on NCDs on RI¿FHUIRUP5$6IRU5+07 the multisectoral coordination committee ToR/policy guidelines c) Conduct sensitization meeting to partners, Meetings 8 members + 4 69 PMORALG including CHMTs on NCDs on RI¿FHUV&RXQFLOIURPIRU the multisectoral coordination committee CHMTs ToR/policy guidelines d) Launch national, regional and district Internal handling multisectoral coordinating committee Page 59 Page Quantities per planning period 2016/17 2017/18 2018/19 2019/20 2020/21 60 SN Priority Actions / Activities Task Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 6 Support multisectoral coordination committee meetings at national, regional and district a) Conduct bi-annual multisectoral coordinating Meetings of the committee 1 1 1 1 1 1 1 1 1 1 committee meetings at national level (every six months) b) Conduct bi-annual multisectoral coordinating Meetings of the committee 30 30 30 30 30 30 30 30 30 30 committee meetings at regional level (every six months) c) Conduct bi-annual multisectoral coordinating Meetings of the committee 169 169 169 169 169 169 169 169 169 169 committee meetings at district level (every six months) d) Conduct national -annual multisectoral Meetings of the committee 1 1 1 1 1 1 1 1 1 1 technical meeting (every year) Strengthen (NCD section) capacity to coordinate and manage NCDs prevention and control services 7 Implement NCD human resource management plan a) Conduct human resource needs assessments Internal consultation with DAP at NCD section b) Develop human resources management plan Internal consultation with DAP c) 5HFUXLWDQGVXVWDLQDSSURSULDWHTXDOL¿HG Internal consultation with DAP human resources at national level to implement NCD Strategic plan d) Review the organizational structure based on Internal consultation with DAP the need 8 Build NCD section staff capacity to acquire necessary skills and competences to implement NCD SP a) Train coordinators on project management, Training session: 40 people + 1 5 strategic planning and proposal development consultant b) Support staff to attend short and long term Technical training: 1 perosn 2 5 5 technical and management courses relevant weeks in country for NCDs control in the country STRATEGIC PLAN AND ACTION PLAN 2016-2020 Quantities per planning period 2016/17 2017/18 2018/19 2019/20 2020/21 SN Priority Actions / Activities Task Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 c) Support staff to attend short and long term Technical training (1 person 2 2 2 2 technical and management courses relevant weeks outside the country) for NCDs control outside the country 9 Improve NCD section working condition a) Procure 4 new desktops computers, 4 lap Computers, printers, scanners 8 tops for existing and new staff & other related equipment b) Procure 1 photocopy machines, 1 printer and Computers, printers, scanners 1 1 scanner & other related equipment c) Procure 1 vehicles for NCDs logistic support Internal handling such as travel for conducting supportive supervision, workshops, training d) 3URFXUHRI¿FHIXUQLWXUH Furniture and Fittings 1 Objective 3: To strengthen and reorient STRATEGIC PLAN AND ACTION PLAN 2016-2020 health systems to address NCDs through promotive, preventive, curative and rehabilitative services by 2020 Increase access for major NCDs 10 Scale up NCDs services at primary and higher supporting levels a) Conduct facility needs assessment for NCDs Consultancy 1 scale up at primary level b) Sensitize RHMTs and CHMTs on scaling up Meetings 30 plan and implementation c) Provide district hospitals, health centres and Equipment (per hospital) 100 100 dispensaries with equipment for quality NCDs services d) Support centers with equipment and reagents 6FLHQWL¿F(TXLSPHQW e) Procure necessary equipment for PAL 6FLHQWL¿F(TXLSPHQW f) Equip rehabilitation workshops with machines Equipment and raw materials for manufacturing of Page assistive devices 61 Page Quantities per planning period 2016/17 2017/18 2018/19 2019/20 2020/21 62 SN Priority Actions / Activities Task Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 g) Provide Community Health Workers with 6FLHQWL¿F(TXLSPHQW enablers and logistical support for community based rehabilitation and palliative care h) Develop plan for NCDs scale up at primary Internal consultation level 11 Capacity building to HCWs to implement NCDs services in scaled up districts a) Update guideline for package of services Task Team 1 (pocket booklet) for NCDs scale up b) Print and distribute NCDs package of services Production and Printing of 1 guidelines Training Materials c) Review and update NCDs training curriculum Task Team 1 to include current recommendations d) Train health workers from targeted health Training Sessions: 40 people 30 30 30 30 30 30 30 30 30 30 30 facilities on management of major NCDs per class e) Conduct supervision and mentorship to the Supervision visits 240 240 240 240 240 240 240 240 240 trained staff 12 Ensure uninterrupted supply of major NCDs drugs and commodities a) Engage a consultant to review logistics and Internal handling supply chain management for major NCDs drugs and commodities b) Review assumptions and update national Internal handling forecast for major NCDs drugs and commodities c) 5HYLHZ'HYHORSTXDQWL¿FDWLRQWRROVIRUPDMRU Internal handling NCDs drugs and palliative care d) Build capacity of staff on forecast Internal handling TXDQWL¿FDWLRQDQGXVHRIWRROV Scale up centers of excellence for NCDs (cancer, renal, sickle cell, diabetes and cardiac) in zonal referral hospitals STRATEGIC PLAN AND ACTION PLAN 2016-2020 Quantities per planning period 2016/17 2017/18 2018/19 2019/20 2020/21 SN Priority Actions / Activities Task Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 13 5HIXUELVKLGHQWLÀHGWDUJHWHG]RQHUHIHUUDO hospital to provide quality for cancer, diabetes, renal, and cardiovascular a) Conduct facility assessments in hospitals that Internal handling will be centre of excellence for cancer, renal, sickle cell and cardiac services b) Renovate/ construct building Rehabilitation of buildings 1 1 1 1 1 c) Renovate and upgrade selected zonal referral Furniture and Fittings 1 1 1 1 1 d) hospitals with necessary, furniture, equipment 6FLHQWL¿F(TXLSPHQW 1 1 1 1 1 and supplies. Internal handling 14 Build capacity of health workers from targeted zone referral hospital to provide cancer, renal, sickle cell and STRATEGIC PLAN AND ACTION PLAN 2016-2020 cardiovascular services a) 'HSOR\TXDOL¿HGVWDIIWRVXSSRUWFDQFHUUHQDO Internal handling sickle cell and cardiovascular services b) Collaborate with centre of excellence to Training Sessions Identify and train HCWs c) Collaborate with centre of excellence to Supervision visits conduct supervision and mentorship to the trained staff 15 Support centers of excellence in the decentralized zonal referral hospitals to monitor implementation of services a) Provide uninterrupted drugs Internal handling b) Support centers with equipment and reagents See above c) Monitor implementation of services in line with Supervision visits 30 30 30 30 30 30 30 30 national guidelines Integrate NCD services into existing health care services at all levels of care including Page community participation 63 Page Quantities per planning period 2016/17 2017/18 2018/19 2019/20 2020/21 64 SN Priority Actions / Activities Task Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 16 Incorporate comprehensive NCDs prevention and control services in health training curricula a) Conduct advocacy meetings with training Meetings to adopt curricula 1 institution for incorporation of NCDs services in school curricula b) Develop NCDs training component to be Task Team 1 included into health training curricula 17 Incorporate NCDs relevant component to EHUHÁHFWHGLQ 5&+307&71$&317/3 EPI ) training manuals a) Conduct meetings with RCH/PMTCT, NACP, Meetings 1 NTLP, EPI) programme and other key stakeholders to incorporate relevant NCDs component b) Develop and disseminate an integration plan Task team 1 outlining services to be provided at all levels of care c) Orient health care providers from RCH/ Meetings PMTCT, NACP, NTLP, EPI) on NCDs ,PSOHPHQW3UDFWLFDO$SSURDFKWR/XQJ KHDOWK 3$/ 18 ,QWURGXFH3$/DVLQWHJUDWHGPDQDJHPHQW in primary health care in order to Strengthen management of respiratory disease a) Adopt WHO and develop PAL strategy in Task Team collaboration with NTLP b) Establish PAL national Technical Working Internal handling group c) Conduct needs assessment on current Task Team 1 management of respiratory diseases in different level of health facilities STRATEGIC PLAN AND ACTION PLAN 2016-2020 Quantities per planning period 2016/17 2017/18 2018/19 2019/20 2020/21 SN Priority Actions / Activities Task Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 d) Develop PAL standardize clinical practice See above 1 guidelines /training materials for respiratory conditions e) Develop PAL phase implementation plan Internal handling f) Conduct biannual meeting for PAL National Meetings Technical Working Group 19 6XSSRUW+HDOWKIDFLOLW\WRLPSOHPHQW3$/ in phase manner a) Procure necessary equipment for PAL See above b) Train HCWs on PAL clinical practice Training sessions guidelines c) Provide PAL Internal handling d) Conduct supportive supervision Supportive supervision STRATEGIC PLAN AND ACTION PLAN 2016-2020 e) Evaluate implementation of PAL Consultancy Fees f) Scale up PAL countrywide Internal handling 5HGXFHPRGLÀDEOH1&'VULVNIDFWRUVDQG create health promoting environment 20 Advocacy communication and social mobilization Strategic plan (ACSM) to sensitize community on NCDs a) Deploy ACSM focal person at NCD section Internal handling b) Develop ACSM strategic plan Task team 1 c) Sensitize /involve community based on the Mass media event ACSM strategic plan TV 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 Radio 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 Newspapers 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 Mobile messages 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 30 21 Promote community based approaches and Page sensitization for prevention and control for NCDs 65 Quantities per planning period Page 2016/17 2017/18 2018/19 2019/20 2020/21 66 SN Priority Actions / Activities Task Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 a) Advocate for healthy diet and exercise School health program centers/ rooms at workplaces, community, Community 300 300 300 300 300 300 300 300 300 300 300 300 300 300 300 300 300 300 300 schools, hotels and restaurants Workplaces 300 300 300 300 300 300 300 300 300 300 300 300 300 300 300 300 300 300 300 Hotels/restaurants 300 300 300 300 300 300 300 300 300 300 300 300 300 300 300 300 300 300 300 Food vendors 300 300 300 300 300 300 300 300 300 300 300 300 300 300 300 300 300 300 300 b) Commemorate NCDs world international days Mass media event with 30 (Cancer, Kidney, Hypertension, Diabetes and screening sickle cell) to raise community awareness c) Conduct community sensitization on health Mass media event 30 diet and physical activities d) 'HYHORS,(&PDWHULDOVRQPRGL¿DEOHULVNV Task team 1 e) Print and disseminate IEC materials Production and Printing of 100 Training Materials f) Develop and broadcast health messages on Mass media event PDMRU1&'VDQGPRGL¿DEOHULVNVLQUDGLRV79 stations and mobile phones g) Develop and broadcast panel discussion, TV Task team with a consultant documentaries, radio and TV spots on major NCDs h) Broadcast panel discussion, TV Mass media event documentaries, radio and TV spots on major NCDs 22 Implement school education modules on healthy living a) Develop school education modules on healthy Task team 1 living b) Sensitize District School Health Coordinators Training sessions 5 on the modules on healthy living c) Sensitize school health teachers on the Training sessions 200 modules on healthy living d) Teach school children on the modules on Task team to review curiculum 1 healthy living STRATEGIC PLAN AND ACTION PLAN 2016-2020 Quantities per planning period 2016/17 2017/18 2018/19 2019/20 2020/21 SN Priority Actions / Activities Task Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 23 Early detection and appropriate management of NCDs (Cancer, Diabetes, Cardiovascular, Sickle Cell, Renal, Mental health, and respiratory) a) Develop comprehensive screening policy Task Team 1 guidelines and screening tools b) Orient health care workers on screening of Training sessions NCDs to high risk groups c) Conduct screening programs/campaigns to Screening camps high risk groups including family members d) Strengthen referral and linkages at all levels Internal handling for continuum of care 24 Provide preventive therapy for NDCs (Cardiovascular, Cancer, Respiratory, STRATEGIC PLAN AND ACTION PLAN 2016-2020 Renal and Mental health a) Facilitate preventive vaccinations and Meetings therapy such as HPV, HPB) pneumococcal , Rheumatic fever and (aspirin, statins) b) Provision preventive therapy for those at high Internal handling risk of complications (renal, heart, eye, foot) 25 Support promotion of laws and legislations that prevent the rise of NCDs a) Collaborate with relevant institutions to raise Meetings 30 public awareness on road safety, tobacco and alcohol use b) Develop smoke quit programs and guidelines Task team c) Develop guidelines for alcohol and substance Task team abuse prevention and control Strengthen rehabilitative and palliative care 26 Support rehabilitation services at levels Page of care 67 Page Quantities per planning period 2016/17 2017/18 2018/19 2019/20 2020/21 68 SN Priority Actions / Activities Task Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 a) &UHDWHRID3K\VLFDO5HKDELOLWDWLRQ2I¿FH Internal handling 1 within the Ministry of Health that manages the platform of all stakeholders within the sector b) Develop rehabilitation guidelines for major Task team 1 NCDs c) Train rehabilitation workers on major NCDs Training sessions guidelines. d) Equip rehabilitation workshops with machines See above 1 and raw materials for manufacturing of assistive devices e) Support outreach services for rehabilitation Internal handling 27 Support palliative care a) Review and update national palliative care Task team 1 policy guidelines and strategy b) Oversee implementation of palliative care Supervission policy guidelines and strategy 28 Strengthen community based rehabilitation and palliative care a) Adapt, develop and print Community Based Task team 1 Rehabilitation guidelines b) Develop simple SOPs for rehabilitation and See above 1 palliative care for Community care workers c) Build capacity of Community Health Workers Training sessions for Community based rehabilitation (CBR) and palliative care d) Review /develop and print patients self- Task team 1 management care booklets for chronic diseases such as diabetes, hypertension, cancer, renal., sickle cell e) Provide Community Health Workers with See above 100 100 100 100 enablers and logistical support for community based rehabilitation and palliative care STRATEGIC PLAN AND ACTION PLAN 2016-2020 Quantities per planning period 2016/17 2017/18 2018/19 2019/20 2020/21 SN Priority Actions / Activities Task Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 29 Provide Community Health Workers with supplies for community based rehabilitation and palliative care a) Strengthen/establish community based Internal handling rehabilitation referral linkages for continuum of care Implement Collaborative TB/diabetes 30 Establish TWG for collaborative TB diabetes at all levels a) Conduct a meeting with NTLP and plan Internal handling establishment of TWG at all levels b) Launch TWG for Collaborative TB/diabetes at Meetings 30 all levels STRATEGIC PLAN AND ACTION PLAN 2016-2020 31 Review M&E systems to include information on TB/diabetes a) Develop diabetes card with unique Internal handling LGHQWL¿FDWLRQQXPEHUDQGLQFOXGH7%GLDEHWHV information b) Review recording and reporting tools to Internal handling include information on TB/diabetes 32 Support Health facility to implement collaborative TB/activities a) Develop TB/Diabetes training materials See above b) Train health care providers on collaborative/ Training sessions TB diabetes c) Select regions and sites for phase Internal handling implementations of TB/diabetes d) Strengthen referral and linkages mechanisms Internal handling between TB and diabetes clinics e) Ensure availability drugs and supplies for TB/ Internal handling Page diabetes services f) Conduct joint supportive supervision Supportive supervission 69 Page Quantities per planning period 2016/17 2017/18 2018/19 2019/20 2020/21 70 SN Priority Actions / Activities Task Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 g) Conduct evaluation of the pilot phase and Task team with a consultant GLVVHPLQDWH¿QGLQJV h) Scale up TB/diabetes services Internal handling Objective 4: To Strengthen the National Capacity for NCD surveillance, monitoring and evaluation and research for evidence based planning by 2020 Promote research in NCDs (including injuries and violence) in collaboration with key stakeholders 33 Strengthen coordination between NCD section and research institutions and academia a) Establish position for research focal person at Internal handling NCD section b) Establish national NCD research committee Internal handling with other stakeholders c) Conduct a workshop with research institutions Meeting and academia to develop a national research agenda for NCDs and identify previous researches conducted and it utilization d) Mobilize funding within and from international Internal handling agencies to support research priority areas e) Conduct operational research and survey on Internal handling 1 LGHQWL¿HGSULRULW\DUHDVLQFROODERUDWLRQZLWK research institutions and other stakeholders 34 Build NCD section capacity to conduct operational research a) Conduct refresher training to NCD staff on Training session operational research methodology b) Seek technical assistance to develop Consultancy Fees 6 6 6 6 6 research proposal including survey STRATEGIC PLAN AND ACTION PLAN 2016-2020 Quantities per planning period 2016/17 2017/18 2018/19 2019/20 2020/21 SN Priority Actions / Activities Task Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 35 Promote research and utilization to inform policy and practice a) Develop a framework to monitor NCD Internal handling research and its utilize b) 'LVVHPLQDWHUHVHDUFK¿QGLQJVORFDOO\DQG Internal handling internationally c) 3XEOLVKUHVHDUFK¿QGLQJLQSHHUUHYLHZORFDOO\ Internal handling and internationally Monitor and evaluate progress of the strategic plan 36 Review and update monitoring and evaluation systems and framework for NCDs STRATEGIC PLAN AND ACTION PLAN 2016-2020 a) Finalize and harmonise monitoring framework Task team with a consultant 1 and establish indicator and annualized targets b) Seek technical assistance/consultant to Task team with a consultant review and update monitoring and evaluation systems and framework c) Conduct workshop to Review data collection Task team 1 tools for major NCDs to incorporate WHO recommendations a minimum set of national targets and indicators d) Support/coordinate review District Sentinel Task team 1 Survey (DSS) tools to incorporate NCD data variables 37 Build capacity for data management and utilization at all levels a) Develop standardized training protocol for Internal handling routine surveillance and tracking system of NCDs b) Train clinicians on the protocol for routine Training session Page surveillance including recording, reporting, data analysis and utilization at point of care 71 Quantities per planning period Page 2016/17 2017/18 2018/19 2019/20 2020/21 72 SN Priority Actions / Activities Task Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4 c) Print and distribute R&R tools for NCDs Production and Printing of Training Materials d) Conduct post training supportive supervision Supervision sessions 38 Monitor implementation of the NCD strategic plan a) Conduct joint supportive supervision with Task team with a consultant partners to regions on NCDs annually b) Ensure regional and district supportive Internal handling 1 supervision tools include NCDs c) Develop technical progress reports: quarter, Internal handling semi-annual and annual d) Conduct annual meeting with key Meetings 1 1 1 1 1 stakeholders to review progress of implementation f) Conduct midterm and end term review of the Task team with a consultant 1 1 1 strategic plan II STRATEGIC PLAN AND ACTION PLAN 2016-2020

5.6 Annex 6: RESULT BASED BUDGET Budget per year (TZS) Cumulative Funding Requirements (TZS) 2016/17 2017/18 2018/19 2019/20 2020/21 2016/17 2017/18 2018/19 2019/20 2020/21 SN Priority Actions / Activities Objective 1: To Advocate for NCD prevention and control as a National Priority by 2020 Attain political commitment 981,435,000 672,325,000 753,925,000 725,605,000 672,325,000 756,635,000 1,428,960,000 2,101,285,000 2,826,890,000 3,499,215,000 with increased and sustained ÀQDQFLQJIRU1&'V 1 6HFXUHDGHTXDWH¿QDQFLDO resources for NCD prevention and control services in the country a) Generate and disseminate 12,595,000 0 0 0 0 12,595,000 12,595,000 12,595,000 12,595,000 12,595,000 evidence based data to support STRATEGIC PLAN AND ACTION PLAN 2016-2020 burden of NCDs b) Conduct resource needs 12,595,000 0 0 0 0 12,595,000 12,595,000 12,595,000 12,595,000 12,595,000 assessment in order to inform the development of national NCD plan and budget c) Conduct advocacy meetings with 5,840,000 0 0 0 0 5,840,000 5,840,000 5,840,000 5,840,000 5,840,000 key policy and decision makers MoHCDGEC management team, PMORALG and development partners d) Conduct Sensitization meetings 105,000,000 105,000,000 105,000,000 105,000,000 105,000,000 105,000,000 210,000,000 315,000,000 420,000,000 525,000,000 ZLWK5+07VRQDGHTXDWH¿QDQFLDO and other resources allocation in CCHPs for NCDs e) Conduct Sensitization meetings 476,000,000 476,000,000 476,000,000 476,000,000 476,000,000 476,000,000 952,000,000 1,428,000,000 1,904,000,000 2,380,000,000 ZLWK&+07VRQDGHTXDWH¿QDQFLDO and other resources allocation in CCHPs for NCDs Page f) Conduct proposal writing 18,925,000 18,925,000 18,925,000 18,925,000 18,925,000 18,925,000 37,850,000 56,775,000 75,700,000 94,625,000 workshop for fund mobilization 73 Page Budget per year (TZS) Cumulative Funding Requirements (TZS) 2016/17 2017/18 2018/19 2019/20 2020/21 2016/17 2017/18 2018/19 2019/20 2020/21 74 SN Priority Actions / Activities 2 Market NCDs strategic plan to partners for mobilizing resources a) Conduct a workshop to orient 53,280,000 0 0 53,280,000 0 53,280,000 53,280,000 53,280,000 106,560,000 106,560,000 stakeholders on NCDs Strategic Plan b) Identify potential resources of 0 0 0 0 0 0 0 0 0 0 Non governments funding calls for proposal c) Conduct a meeting to sensitize 68,700,000 68,700,000 68,700,000 68,700,000 68,700,000 68,700,000 137,400,000 206,100,000 274,800,000 343,500,000 Private Business community for funding through corporate social responsibility d) Conduct schedules partnership 3,700,000 3,700,000 3,700,000 3,700,000 3,700,000 3,700,000 7,400,000 11,100,000 14,800,000 18,500,000 meeting to mobilize and leverage resources for NCDs based on burden of disease data Review existing policy 112,400,000 0 40,800,000 0 0 112,400,000 112,400,000 153,200,000 153,200,000 153,200,000 and legislation to improve prevention and control, to NCDs services 3 Review various policies and legislation a) Review and update Health 0 0 0 0 0 0 0 0 0 0 Insurance schemes for universal coverage b) Advocate for review of various 57,440,000 0 0 0 0 57,440,000 57,440,000 57,440,000 57,440,000 57,440,000 policies and legislation (tobacco, alcohol, diet, physical inactivity, URDGWUDI¿FRFFXSDWLRQDOKHDOWK and built environment) c) Disseminate evidence for 14,160,000 0 0 0 0 14,160,000 14,160,000 14,160,000 14,160,000 14,160,000 appropriate taxation 40,800,000 0 40,800,000 0 0 40,800,000 40,800,000 81,600,000 81,600,000 81,600,000 STRATEGIC PLAN AND ACTION PLAN 2016-2020 Budget per year (TZS) Cumulative Funding Requirements (TZS) 2016/17 2017/18 2018/19 2019/20 2020/21 2016/17 2017/18 2018/19 2019/20 2020/21 SN Priority Actions / Activities Objective 2: To strengthen leadership, governance, multisectoral collaboration and accountability for prevention and control of NCDs by 2020 Establish a sustainable 3,225,220,000 2,502,760,000 2,502,760,000 2,502,760,000 2,502,760,000 3,225,220,000 5,727,980,000 8,230,740,000 10,733,500,000 13,236,260,000 coordination system of multi sector approach to address NCDs prevention and control at all levels 4 Establish a high-level inter-ministerial committee to facilitate and monitor Multispectral action for NCD prevention and control STRATEGIC PLAN AND ACTION PLAN 2016-2020 a) Develop national Multisectoral 2,360,000 0 0 0 0 2,360,000 2,360,000 2,360,000 2,360,000 2,360,000 framework for NCD coordination and collaboration with clear roles and responsibilities b) 6,800,000 0 0 0 0 6,800,000 6,800,000 6,800,000 6,800,000 6,800,000 12,100,000 0 0 0 0 12,100,000 12,100,000 12,100,000 12,100,000 12,100,000 c) Identify key Inter-Ministerial 0 0 0 0 0 0 0 0 0 0 stakeholders d) Launch Inter-Ministerial 9,600,000 0 0 0 0 9,600,000 9,600,000 9,600,000 9,600,000 9,600,000 Coordinating committee for NCDs e) Conduct bi- annual high level 8,600,000 8,600,000 8,600,000 8,600,000 8,600,000 8,600,000 17,200,000 25,800,000 34,400,000 43,000,000 Inter-Ministerial coordination committee meetings Page 75 Page Budget per year (TZS) Cumulative Funding Requirements (TZS) 2016/17 2017/18 2018/19 2019/20 2020/21 2016/17 2017/18 2018/19 2019/20 2020/21 76 SN Priority Actions / Activities 5 Establish/Strengthen Multisectoral coordinating Committee at all levels a) Develop TOR/policy guidelines 0 0 0 0 0 0 0 0 0 0 for NCD multisectoral coordination committee at national, regional and district levels b) Conduct sensitization meeting 117,000,000 0 0 0 0 117,000,000 117,000,000 117,000,000 117,000,000 117,000,000 to partners, PMORALG including RHMTs on NCDs on the multisectoral coordination committee ToR/policy guidelines c) Conduct sensitization meeting 574,600,000 0 0 0 0 574,600,000 574,600,000 574,600,000 574,600,000 574,600,000 to partners, PMORALG including CHMTs on NCDs on the multisectoral coordination committee ToR/policy guidelines d) Launch national, regional and 0 0 0 0 0 0 0 0 0 0 district multisectoral coordinating committee 6 Support multisectoral coordination committee meetings at national, regional and district a) Conduct bi-annual multisectoral 13,600,000 13,600,000 13,600,000 13,600,000 13,600,000 13,600,000 27,200,000 40,800,000 54,400,000 68,000,000 coordinating committee meetings at national level b) Conduct bi-annual multisectoral 372,000,000 372,000,000 372,000,000 372,000,000 372,000,000 372,000,000 744,000,000 1,116,000,000 1,488,000,000 1,860,000,000 coordinating committee meetings at regional level c) Conduct bi-annual multisectoral 2,095,600,000 2,095,600,000 2,095,600,000 2,095,600,000 2,095,600,000 2,095,600,000 4,191,200,000 6,286,800,000 8,382,400,000 10,478,000,000 coordinating committee meetings at district level d) Conduct national -annual 12,960,000 12,960,000 12,960,000 12,960,000 12,960,000 12,960,000 25,920,000 38,880,000 51,840,000 64,800,000 multisectoral technical meeting STRATEGIC PLAN AND ACTION PLAN 2016-2020 Budget per year (TZS) Cumulative Funding Requirements (TZS) 2016/17 2017/18 2018/19 2019/20 2020/21 2016/17 2017/18 2018/19 2019/20 2020/21 SN Priority Actions / Activities Strengthen (NCD section) 103,340,000 17,900,000 24,440,000 24,440,000 0 103,340,000 121,240,000 145,680,000 170,120,000 170,120,000 capacity to coordinate and manage NCDs prevention and control services 7 Implement NCD human resource management plan a) Conduct human resource needs 0 0 0 0 0 0 0 0 0 0 assessments at NCD section b) Develop human resources 0 0 0 0 0 0 0 0 0 0 management plan c) Recruit and sustain appropriate 0 0 0 0 0 0 0 0 0 0 TXDOL¿HGKXPDQUHVRXUFHVDW national level to implement NCD Strategic plan STRATEGIC PLAN AND ACTION PLAN 2016-2020 d) Review the organizational 0 0 0 0 0 0 0 0 0 0 structure based on the need 8 Build NCD section staff capacity to acquire necessary skills and competences to implement NCD SP a) Train coordinators on project 33,000,000 0 0 0 0 33,000,000 33,000,000 33,000,000 33,000,000 33,000,000 management, strategic planning and proposal development b) Support staff to attend short 17,900,000 17,900,000 0 0 0 17,900,000 35,800,000 35,800,000 35,800,000 35,800,000 and long term technical and management courses relevant for NCDs control in the country c) Support staff to attend short 24,440,000 0 24,440,000 24,440,000 0 24,440,000 24,440,000 48,880,000 73,320,000 73,320,000 and long term technical and management courses relevant for NCDs control outside the country 9 Improve NCD section working Page condition 77 Page Budget per year (TZS) Cumulative Funding Requirements (TZS) 2016/17 2017/18 2018/19 2019/20 2020/21 2016/17 2017/18 2018/19 2019/20 2020/21 78 SN Priority Actions / Activities a) Procure 4 new desktops 16,000,000 0 0 0 0 16,000,000 16,000,000 16,000,000 16,000,000 16,000,000 computers, 4 lap tops for existing and new staff b) Procure 1 photocopy machines, 1 2,000,000 0 0 0 0 2,000,000 2,000,000 2,000,000 2,000,000 2,000,000 printer and 1 scanner c) Procure 1 vehicles for NCDs 0 0 0 0 0 0 0 0 0 0 logistic support such as travel for conducting supportive supervision, workshops, training d) 3URFXUHRI¿FHIXUQLWXUH 10,000,000 0 0 0 0 10,000,000 10,000,000 10,000,000 10,000,000 10,000,000 Objective 3: To strengthen and reorient health systems to address NCDs through promotive, preventive, curative and rehabilitative services by 2020 Increase access for major NCDs 2,973,555,000 5,444,800,000 5,344,800,000 2,270,400,000 1,245,600,000 2,973,555,000 8,418,355,000 13,763,155,000 16,033,555,000 17,279,155,000 10 Scale up NCDs services at primary and higher supporting levels a) Conduct facility needs assessment 2,360,000 0 0 0 0 2,360,000 2,360,000 2,360,000 2,360,000 2,360,000 for NCDs scale up at primary level b) Sensitize RHMTs and CHMTs 186,000,000 0 0 0 0 186,000,000 186,000,000 186,000,000 186,000,000 186,000,000 on scaling up plan and implementation c) Provide district hospitals, health 100,000,000 100,000,000 0 0 0 100,000,000 200,000,000 200,000,000 200,000,000 200,000,000 centres and dispensaries with equipment for quality NCDs services d) Support centers with equipment and reagents e) Procure necessary equipment for PAL STRATEGIC PLAN AND ACTION PLAN 2016-2020 Budget per year (TZS) Cumulative Funding Requirements (TZS) 2016/17 2017/18 2018/19 2019/20 2020/21 2016/17 2017/18 2018/19 2019/20 2020/21 SN Priority Actions / Activities f) Equip rehabilitation workshops with machines and raw materials for manufacturing of assistive devices g) Provide Community Health Workers with enablers and logistical support for community based rehabilitation and palliative care h) Develop plan for NCDs scale up at 0 0 0 0 0 0 0 0 0 0 primary level 11 Capacity building to HCWs to implement NCDs services in scaled up districts STRATEGIC PLAN AND ACTION PLAN 2016-2020 a) Update guideline for package 12,795,000 0 0 0 0 12,795,000 12,795,000 12,795,000 12,795,000 12,795,000 of services (pocket booklet) for NCDs scale up b) Print and distribute NCDs package of services guidelines c) Review and update NCDs training curriculum to include current recommendations d) Train health workers from targeted 2,049,600,000 4,099,200,000 4,099,200,000 1,024,800,000 0 2,049,600,000 6,148,800,000 10,248,000,000 11,272,800,000 11,272,800,000 health facilities on management of major NCDs e) Conduct supervision and 622,800,000 1,245,600,000 1,245,600,000 1,245,600,000 1,245,600,000 622,800,000 1,868,400,000 3,114,000,000 4,359,600,000 5,605,200,000 mentorship to the trained staff 12 Ensure uninterrupted supply of major NCDs drugs and commodities a) Engage a consultant to review 0 0 0 0 0 0 0 0 0 0 logistics and supply chain Page management for major NCDs drugs and commodities 79 Budget per year (TZS) Cumulative Funding Requirements (TZS) Page 2016/17 2017/18 2018/19 2019/20 2020/21 2016/17 2017/18 2018/19 2019/20 2020/21 80 SN Priority Actions / Activities b) Review assumptions and update 0 0 0 0 0 0 0 0 0 0 national forecast for major NCDs drugs and commodities c) 5HYLHZ'HYHORSTXDQWL¿FDWLRQ 0 0 0 0 0 0 0 0 0 0 tools for major NCDs drugs and palliative care d) Build capacity of staff on forecast 0 0 0 0 0 0 0 0 0 0 TXDQWL¿FDWLRQDQGXVHRIWRROV Scale up centers of excellence 11,000,000 166,700,000 166,700,000 166,700,000 166,700,000 11,000,000 177,700,000 344,400,000 511,100,000 677,800,000 for NCDs (cancer, renal, sickle cell, diabetes and cardiac) in zonal referral hospitals 13 5HIXUELVKLGHQWLÀHGWDUJHWHG zone referral hospital to provide quality for cancer, diabetes, renal, and cardiovascular a) Conduct facility assessments 0 0 0 0 0 0 0 0 0 0 in hospitals that will be centre of excellence for cancer, renal, sickle cell and cardiac services b) Renovate/ construct building 0 0 0 0 0 0 0 0 0 0 c) Renovate and upgrade selected 10,000,000 10,000,000 10,000,000 10,000,000 10,000,000 10,000,000 20,000,000 30,000,000 40,000,000 50,000,000 d) zonal referral hospitals with 1,000,000 1,000,000 1,000,000 1,000,000 1,000,000 1,000,000 2,000,000 3,000,000 4,000,000 5,000,000 necessary, furniture, equipment and supplies. 0 0 0 0 0 0 0 0 0 0 14 Build capacity of health workers from targeted zone referral hospital to provide cancer, renal, sickle cell and cardiovascular services a) 'HSOR\TXDOL¿HGVWDIIWRVXSSRUW 0 0 0 0 0 0 0 0 0 0 cancer, renal, sickle cell and cardiovascular services b) Collaborate with centre of 0 0 0 0 0 0 0 0 0 0 excellence to Identify and train STRATEGIC PLAN AND ACTION PLAN 2016-2020 HCWs Budget per year (TZS) Cumulative Funding Requirements (TZS) 2016/17 2017/18 2018/19 2019/20 2020/21 2016/17 2017/18 2018/19 2019/20 2020/21 SN Priority Actions / Activities c) Collaborate with centre of 0 0 0 0 0 0 0 0 0 0 excellence to conduct supervision and mentorship to the trained staff 15 Support centers of excellence in the decentralized zonal referral hospitals to monitor implementation of services a) Provide uninterrupted drugs 0 0 0 0 0 0 0 0 0 0 b) Support centers with equipment 0 0 0 0 0 0 0 0 0 0 and reagents c) Monitor implementation of services 0 155,700,000 155,700,000 155,700,000 155,700,000 0 155,700,000 311,400,000 467,100,000 622,800,000 in line with national guidelines Integrate NCD services into 59,010,000 0 0 0 0 59,010,000 59,010,000 59,010,000 59,010,000 59,010,000 existing health care services STRATEGIC PLAN AND ACTION PLAN 2016-2020 at all levels of care including community participation 16 Incorporate comprehensive NCDs prevention and control services in health training curricula a) Conduct advocacy meetings with 16,400,000 0 0 0 0 16,400,000 16,400,000 16,400,000 16,400,000 16,400,000 training institution for incorporation of NCDs services in school curricula b) Develop NCDs training component 12,775,000 0 0 0 0 12,775,000 12,775,000 12,775,000 12,775,000 12,775,000 to be included into health training curricula 17 Incorporate NCDs relevant FRPSRQHQWWREHUHÁHFWHGLQ 5&+307&71$&317/3(3,  training manuals a) Conduct meetings with RCH/ 17,360,000 0 0 0 0 17,360,000 17,360,000 17,360,000 17,360,000 17,360,000 Page PMTCT, NACP, NTLP, EPI) programme and other key 81 stakeholders to incorporate relevant NCDs component Page Budget per year (TZS) Cumulative Funding Requirements (TZS) 2016/17 2017/18 2018/19 2019/20 2020/21 2016/17 2017/18 2018/19 2019/20 2020/21 82 SN Priority Actions / Activities b) Develop and disseminate an 12,475,000 0 0 0 0 12,475,000 12,475,000 12,475,000 12,475,000 12,475,000 integration plan outlining services to be provided at all levels of care c) Orient health care providers from 0 0 0 0 0 0 0 0 0 0 RCH/PMTCT, NACP, NTLP, EPI) on NCDs Implement Practical Approach 25,590,000 0 0 0 0 25,590,000 25,590,000 25,590,000 25,590,000 25,590,000 WR/XQJKHDOWK 3$/ 18 ,QWURGXFH3$/DVLQWHJUDWHG management in primary health care in order to Strengthen management of respiratory disease a) Adopt WHO and develop PAL 0 0 0 0 0 0 0 0 0 0 strategy in collaboration with NTLP b) Establish PAL national Technical 0 0 0 0 0 0 0 0 0 0 Working group c) Conduct needs assessment on 12,795,000 0 0 0 0 12,795,000 12,795,000 12,795,000 12,795,000 12,795,000 current management of respiratory diseases in different level of health facilities d) Develop PAL standardize clinical 12,795,000 0 0 0 0 12,795,000 12,795,000 12,795,000 12,795,000 12,795,000 practice guidelines /training materials for respiratory conditions e) Develop PAL phase 0 0 0 0 0 0 0 0 0 0 implementation plan f) Conduct biannual meeting for PAL 0 0 0 0 0 0 0 0 0 0 National Technical Working Group 19 Support Health facility to LPSOHPHQW3$/LQSKDVH manner a) Procure necessary equipment for 0 0 0 0 0 0 0 0 0 0 PAL STRATEGIC PLAN AND ACTION PLAN 2016-2020 Budget per year (TZS) Cumulative Funding Requirements (TZS) 2016/17 2017/18 2018/19 2019/20 2020/21 2016/17 2017/18 2018/19 2019/20 2020/21 SN Priority Actions / Activities b) Train HCWs on PAL clinical 0 0 0 0 0 0 0 0 0 0 practice guidelines c) Provide PAL 0 0 0 0 0 0 0 0 0 0 d) Conduct supportive supervision 0 0 0 0 0 0 0 0 0 0 e) Evaluate implementation of PAL 0 0 0 0 0 0 0 0 0 0 f) Scale up PAL countrywide 0 0 0 0 0 0 0 0 0 0 5HGXFHPRGLÀDEOH1&'V 11,381,895,000 4,368,000,000 4,368,000,000 4,368,000,000 4,368,000,000 11,381,895,000 15,749,895,000 20,117,895,000 24,485,895,000 28,853,895,000 risk factors and create health promoting environment 20 Advocacy communication and social mobilization Strategic plan (ACSM) to sensitize community on NCDs STRATEGIC PLAN AND ACTION PLAN 2016-2020 a) Deploy ACSM focal person at 0 0 0 0 0 0 0 0 0 0 NCD section b) Develop ACSM strategic plan 17,515,000 0 0 0 0 17,515,000 17,515,000 17,515,000 17,515,000 17,515,000 c) Sensitize /involve community 0 0 0 0 0 0 0 0 0 0 based on the ACSM strategic plan 90,000,000 120,000,000 120,000,000 120,000,000 120,000,000 90,000,000 210,000,000 330,000,000 450,000,000 570,000,000 90,000,000 120,000,000 120,000,000 120,000,000 120,000,000 90,000,000 210,000,000 330,000,000 450,000,000 570,000,000 90,000,000 120,000,000 120,000,000 120,000,000 120,000,000 90,000,000 210,000,000 330,000,000 450,000,000 570,000,000 90,000,000 120,000,000 120,000,000 120,000,000 120,000,000 90,000,000 210,000,000 330,000,000 450,000,000 570,000,000 21 Promote community based approaches and sensitization for prevention and control for NCDs a) Advocate for healthy diet and 0 0 0 0 0 0 0 0 0 0 exercise centers/ rooms at 729,000,000 972,000,000 972,000,000 972,000,000 972,000,000 729,000,000 1,701,000,000 2,673,000,000 3,645,000,000 4,617,000,000 workplaces, community, schools, hotels and restaurants 729,000,000 972,000,000 972,000,000 972,000,000 972,000,000 729,000,000 1,701,000,000 2,673,000,000 3,645,000,000 4,617,000,000 729,000,000 972,000,000 972,000,000 972,000,000 972,000,000 729,000,000 1,701,000,000 2,673,000,000 3,645,000,000 4,617,000,000 Page 729,000,000 972,000,000 972,000,000 972,000,000 972,000,000 729,000,000 1,701,000,000 2,673,000,000 3,645,000,000 4,617,000,000 83 Page Budget per year (TZS) Cumulative Funding Requirements (TZS) 2016/17 2017/18 2018/19 2019/20 2020/21 2016/17 2017/18 2018/19 2019/20 2020/21 84 SN Priority Actions / Activities b) Commemorate NCDs world 163,500,000 0 0 0 0 163,500,000 163,500,000 163,500,000 163,500,000 163,500,000 international days (Cancer, Kidney, Hypertension, Diabetes and sickle cell) to raise community awareness c) Conduct community sensitization 120,000,000 0 0 0 0 120,000,000 120,000,000 120,000,000 120,000,000 120,000,000 on health diet and physical activities d) Develop IEC materials on 12,795,000 0 0 0 0 12,795,000 12,795,000 12,795,000 12,795,000 12,795,000 PRGL¿DEOHULVNV e) Print and disseminate IEC 5,000,000,000 0 0 0 0 5,000,000,000 5,000,000,000 5,000,000,000 5,000,000,000 5,000,000,000 materials f) Develop and broadcast health 0 0 0 0 0 0 0 0 0 0 messages on major NCDs and PRGL¿DEOHULVNVLQUDGLRV79 stations and mobile phones g) Develop and broadcast panel 0 0 0 0 0 0 0 0 0 0 discussion, TV documentaries, radio and TV spots on major NCDs h) Broadcast panel discussion, TV 0 0 0 0 0 0 0 0 0 0 documentaries, radio and TV spots on major NCDs 22 Implement school education modules on healthy living a) Develop school education 11,195,000 0 0 0 0 11,195,000 11,195,000 11,195,000 11,195,000 11,195,000 modules on healthy living b) Sensitize District School Health 141,200,000 0 0 0 0 141,200,000 141,200,000 141,200,000 141,200,000 141,200,000 Coordinators on the modules on healthy living c) Sensitize school health teachers 2,416,000,000 0 0 0 0 2,416,000,000 2,416,000,000 2,416,000,000 2,416,000,000 2,416,000,000 on the modules on healthy living d) Teach school children on the 9,175,000 0 0 0 0 9,175,000 9,175,000 9,175,000 9,175,000 9,175,000 modules on healthy living STRATEGIC PLAN AND ACTION PLAN 2016-2020 Budget per year (TZS) Cumulative Funding Requirements (TZS) 2016/17 2017/18 2018/19 2019/20 2020/21 2016/17 2017/18 2018/19 2019/20 2020/21 SN Priority Actions / Activities 23 Early detection and appropriate management of NCDs (Cancer, Diabetes, Cardiovascular, Sickle Cell, Renal, Mental health, and respiratory) a) Develop comprehensive screening 10,515,000 0 0 0 0 10,515,000 10,515,000 10,515,000 10,515,000 10,515,000 policy guidelines and screening tools b) Orient health care workers on 0 0 0 0 0 0 0 0 0 0 screening of NCDs to high risk groups c) Conduct screening programs/ 0 0 0 0 0 0 0 0 0 0 campaigns to high risk groups including family members STRATEGIC PLAN AND ACTION PLAN 2016-2020 d) Strengthen referral and linkages 0 0 0 0 0 0 0 0 0 0 at all levels for continuum of care 24 Provide preventive therapy for NDCs (Cardiovascular, Cancer, Respiratory, Renal and Mental health a) Facilitate preventive vaccinations 0 0 0 0 0 0 0 0 0 0 and therapy such as HPV, HPB) pneumococcal , Rheumatic fever and (aspirin, statins) b) Provision preventive therapy for 0 0 0 0 0 0 0 0 0 0 those at high risk of complications (renal, heart, eye, foot) 25 Support promotion of laws and legislations that prevent the rise of NCDs a) Collaborate with relevant 204,000,000 0 0 0 0 204,000,000 204,000,000 204,000,000 204,000,000 204,000,000 institutions to raise public Page awareness on road safety, tobacco and alcohol use 85 Page Budget per year (TZS) Cumulative Funding Requirements (TZS) 2016/17 2017/18 2018/19 2019/20 2020/21 2016/17 2017/18 2018/19 2019/20 2020/21 86 SN Priority Actions / Activities b) Develop smoke quit programs and 0 0 0 0 0 0 0 0 0 0 guidelines c) Develop guidelines for alcohol and 0 0 0 0 0 0 0 0 0 0 substance abuse prevention and control Strengthen rehabilitative and 29,460,000 105,000,000 100,000,000 100,000,000 100,000,000 29,460,000 134,460,000 234,460,000 334,460,000 434,460,000 palliative care 26 Support rehabilitation services at levels of care a) Create of a Physical Rehabilitation 0 0 0 0 0 0 0 0 0 0 2I¿FHZLWKLQWKH0LQLVWU\RI+HDOWK that manages the platform of all stakeholders within the sector b) Develop rehabilitation guidelines 5,955,000 0 0 0 0 5,955,000 5,955,000 5,955,000 5,955,000 5,955,000 for major NCDs c) Train rehabilitation workers on 0 0 0 0 0 0 0 0 0 0 major NCDs guidelines. d) Equip rehabilitation workshops 0 5,000,000 0 0 0 0 5,000,000 5,000,000 5,000,000 5,000,000 with machines and raw materials for manufacturing of assistive devices e) Support outreach services for 0 0 0 0 0 0 0 0 0 0 rehabilitation 27 Support palliative care a) Review and update national 7,920,000 0 0 0 0 7,920,000 7,920,000 7,920,000 7,920,000 7,920,000 palliative care policy guidelines and strategy b) Oversee implementation of 0 0 0 0 0 0 0 0 0 0 palliative care policy guidelines and strategy STRATEGIC PLAN AND ACTION PLAN 2016-2020 Budget per year (TZS) Cumulative Funding Requirements (TZS) 2016/17 2017/18 2018/19 2019/20 2020/21 2016/17 2017/18 2018/19 2019/20 2020/21 SN Priority Actions / Activities 28 Strengthen community based rehabilitation and palliative care a) Adapt, develop and print 3,675,000 0 0 0 0 3,675,000 3,675,000 3,675,000 3,675,000 3,675,000 Community Based Rehabilitation guidelines b) Develop simple SOPs for 5,955,000 0 0 0 0 5,955,000 5,955,000 5,955,000 5,955,000 5,955,000 rehabilitation and palliative care for Community care workers c) Build capacity of Community 0 0 0 0 0 0 0 0 0 0 Health Workers for Community based rehabilitation (CBR) and palliative care d) Review /develop and print patients 5,955,000 0 0 0 0 5,955,000 5,955,000 5,955,000 5,955,000 5,955,000 self-management care booklets for chronic diseases such as STRATEGIC PLAN AND ACTION PLAN 2016-2020 diabetes, hypertension, cancer, renal., sickle cell e) Provide Community Health 0 100,000,000 100,000,000 100,000,000 100,000,000 0 100,000,000 200,000,000 300,000,000 400,000,000 Workers with enablers and logistical support for community based rehabilitation and palliative care 29 Provide Community Health Workers with supplies for community based rehabilitation and palliative care a) Strengthen/establish community 0 0 0 0 0 0 0 0 0 0 based rehabilitation referral linkages for continuum of care Implement Collaborative TB/ 110,250,000 0 0 0 0 110,250,000 110,250,000 110,250,000 110,250,000 110,250,000 diabetes 30 Establish TWG for collaborative TB diabetes at all levels Page a) Conduct a meeting with NTLP 0 0 0 0 0 0 0 0 0 0 87 and plan establishment of TWG at all levels Page Budget per year (TZS) Cumulative Funding Requirements (TZS) 2016/17 2017/18 2018/19 2019/20 2020/21 2016/17 2017/18 2018/19 2019/20 2020/21 88 SN Priority Actions / Activities b) Launch TWG for Collaborative TB/ 110,250,000 0 0 0 0 110,250,000 110,250,000 110,250,000 110,250,000 110,250,000 diabetes at all levels 31 Review M&E systems to include information on TB/diabetes a) Develop diabetes card with unique 0 0 0 0 0 0 0 0 0 0 LGHQWL¿FDWLRQQXPEHUDQGLQFOXGH TB/diabetes information b) Review recording and reporting 0 0 0 0 0 0 0 0 0 0 tools to include information on TB/ diabetes 32 Support Health facility to implement collaborative TB/ activities a) Develop TB/Diabetes training 0 0 0 0 0 0 0 0 0 0 materials b) Train health care providers on 0 0 0 0 0 0 0 0 0 0 collaborative/TB diabetes c) Select regions and sites for phase 0 0 0 0 0 0 0 0 0 0 implementations of TB/diabetes d) Strengthen referral and linkages 0 0 0 0 0 0 0 0 0 0 mechanisms between TB and diabetes clinics e) Ensure availability drugs and 0 0 0 0 0 0 0 0 0 0 supplies for TB/diabetes services f) Conduct joint supportive 0 0 0 0 0 0 0 0 0 0 supervision g) Conduct evaluation of the pilot 0 0 0 0 0 0 0 0 0 0 SKDVHDQGGLVVHPLQDWH¿QGLQJV h) Scale up TB/diabetes services 0 0 0 0 0 0 0 0 0 0 STRATEGIC PLAN AND ACTION PLAN 2016-2020 Budget per year (TZS) Cumulative Funding Requirements (TZS) 2016/17 2017/18 2018/19 2019/20 2020/21 2016/17 2017/18 2018/19 2019/20 2020/21 SN Priority Actions / Activities Objective 4: To Strengthen the National Capacity for NCD surveillance, monitoring and evaluation and research for evidence based planning by 2020 Promote research in NCDs 14,160,000 26,240,000 14,160,000 14,160,000 14,160,000 14,160,000 40,400,000 54,560,000 68,720,000 82,880,000 (including injuries and violence) in collaboration with key stakeholders 33 Strengthen coordination between NCD section and research institutions and academia a) Establish position for research 0 0 0 0 0 0 0 0 0 0 STRATEGIC PLAN AND ACTION PLAN 2016-2020 focal person at NCD section b) Establish national NCD research 0 0 0 0 0 0 0 0 0 0 committee with other stakeholders c) Conduct a workshop with research 0 12,080,000 0 0 0 0 12,080,000 12,080,000 12,080,000 12,080,000 institutions and academia to develop a national research agenda for NCDs and identify previous researches conducted and it utilization d) Mobilize funding within and from 0 0 0 0 0 0 0 0 0 0 international agencies to support research priority areas e) Conduct operational research and 0 0 0 0 0 0 0 0 0 0 VXUYH\RQLGHQWL¿HGSULRULW\DUHDV in collaboration with research institutions and other stakeholders 34 Build NCD section capacity to conduct operational research Page a) Conduct refresher training to 0 0 0 0 0 0 0 0 0 0 NCD staff on operational research 89 methodology Page Budget per year (TZS) Cumulative Funding Requirements (TZS) 2016/17 2017/18 2018/19 2019/20 2020/21 2016/17 2017/18 2018/19 2019/20 2020/21 90 SN Priority Actions / Activities b) Seek technical assistance to 14,160,000 14,160,000 14,160,000 14,160,000 14,160,000 14,160,000 28,320,000 42,480,000 56,640,000 70,800,000 develop research proposal including survey 35 Promote research and utilization to inform policy and practice a) Develop a framework to monitor 0 0 0 0 0 0 0 0 0 0 NCD research and its utilize b) 'LVVHPLQDWHUHVHDUFK¿QGLQJV 0 0 0 0 0 0 0 0 0 0 locally and internationally c) 3XEOLVKUHVHDUFK¿QGLQJLQSHHU 0 0 0 0 0 0 0 0 0 0 review locally and internationally Monitor and evaluate progress 40,390,000 6,800,000 18,320,000 18,320,000 18,320,000 40,390,000 47,190,000 65,510,000 83,830,000 102,150,000 of the strategic plan 36 Review and update monitoring and evaluation systems and framework for NCDs a) Finalize and harmonise monitoring 23,115,000 0 0 0 0 23,115,000 23,115,000 23,115,000 23,115,000 23,115,000 framework and establish indicator and annualized targets b) Seek technical assistance/ consultant to review and update monitoring and evaluation systems and framework c) Conduct workshop to Review 6,800,000 0 0 0 0 6,800,000 6,800,000 6,800,000 6,800,000 6,800,000 data collection tools for major NCDs to incorporate WHO recommendations a minimum set of national targets and indicators d) Support/coordinate review District 3,675,000 0 0 0 0 3,675,000 3,675,000 3,675,000 3,675,000 3,675,000 Sentinel Survey (DSS) tools to incorporate NCD data variables STRATEGIC PLAN AND ACTION PLAN 2016-2020 Budget per year (TZS) Cumulative Funding Requirements (TZS) 2016/17 2017/18 2018/19 2019/20 2020/21 2016/17 2017/18 2018/19 2019/20 2020/21 SN Priority Actions / Activities 37 Build capacity for data management and utilization at all levels a) Develop standardized training 0 0 0 0 0 0 0 0 0 0 protocol for routine surveillance and tracking system of NCDs b) Train clinicians on the protocol 0 0 0 0 0 0 0 0 0 0 for routine surveillance including recording, reporting, data analysis and utilization at point of care c) Print and distribute R&R tools for 0 0 0 0 0 0 0 0 0 0 NCDs d) Conduct post training supportive 0 0 0 0 0 0 0 0 0 0 supervision STRATEGIC PLAN AND ACTION PLAN 2016-2020 38 Monitor implementation of the NCD strategic plan a) Conduct joint supportive 0 0 0 0 0 0 0 0 0 0 supervision with partners to regions on NCDs annually b) Ensure regional and district 0 0 0 0 0 0 0 0 0 0 supportive supervision tools include NCDs c) Develop technical progress 0 0 0 0 0 0 0 0 0 0 reports: quarter, semi-annual and annual d) Conduct annual meeting with key 6,800,000 6,800,000 6,800,000 6,800,000 6,800,000 6,800,000 13,600,000 20,400,000 27,200,000 34,000,000 stakeholders to review progress of implementation f) Conduct midterm and end term 0 0 11,520,000 11,520,000 11,520,000 0 0 11,520,000 23,040,000 34,560,000 review of the strategic plan II 18,955,305,000 13,310,525,000 13,293,105,000 10,190,385,000 9,087,865,000 18,842,905,000 32,153,430,000 45,405,735,000 55,596,120,000 64,683,985,000 Page 9,477,653 6,655,263 6,646,553 5,095,193 4,543,933 9,421,453 16,076,715 22,702,868 27,798,060 32,341,993 91

5.7 Annex 7: ACTIVITY COSTS Priority actions Activities Code Units Days Cost Objective 1: To Advocate for NCD prevention and control as a National Priority by 2020 $WWDLQSROLWLFDOFRPPLWPHQWZLWKLQFUHDVHGDQGVXVWDLQHGÀQDQFLQJIRU1&'V 6HFXUHDGHTXDWH¿QDQFLDO Generate evidence based Task Team for desk review (1 person 12,595,000 resources for NCD data for advocacy on from each major diseases, diet, prevention and control burden of NCDs physical activity) services in the country Ground Travel (Bus, Railway, Taxi, etc) 17 11 5 5,500,000 2I¿FH&RQVXPDEOHV VWDWLRQDULHV  30 15 1 75,000 Participants Food and Refreshments 14 15 5 1,500,000 Venue 43 1 5 2,000,000 Per Diem - Domestic (DSA) 32 4 6 2,880,000 Travel tickets - Domestic 41 4 2 640,000 Conduct resource needs Task team for desk review (clinician, 12,595,000 assessment in order to economist, public health specialist) inform the development of national NCD plan and budget Ground Travel (Bus, Railway, Taxi, etc) 17 11 5 5,500,000 2I¿FH&RQVXPDEOHV VWDWLRQDULHV  30 15 1 75,000 Participants Food and Refreshments 14 15 5 1,500,000 Venue 43 1 5 2,000,000 Per Diem - Domestic (DSA) 32 4 6 2,880,000 Travel tickets - Domestic 41 4 2 640,000 Conduct advocacy Meetings 5,840,000 meetings with key policy Per Diem - Domestic (DSA) 32 4 2 960,000 and decision makers MoHCDGEC management Ground Travel (Bus, Railway, Taxi, etc) 17 36 1 3,600,000 team, PMORALG and 2I¿FH&RQVXPDEOHV VWDWLRQDULHV  30 40 1 200,000 development partners Participants Food and Refreshments 14 40 1 800,000 Venue 43 1 1 400,000 Rent of Vehicles and Crafts 36 1 1 200,000 Travel tickets - Domestic 41 4 2 640,000 Conduct Sensitization Meetings (16 team members + 2 TAs) 3,500,000 meetings with RHMTs on Per Diem - Domestic (DSA) 32 2 2 480,000 DGHTXDWH¿QDQFLDODQG other resources allocation Ground Travel (Bus, Railway, Taxi, etc) 17 20 1 2,000,000 for NCDs 2I¿FH&RQVXPDEOHV VWDWLRQDULHV  30 20 1 100,000 Participants Food and Refreshments 14 20 1 400,000 Travel tickets - Domestic 41 2 2 320,000 Rent of Vehicles and Crafts 36 1 1 200,000 Conduct Sensitization Meetings (8 team members + 2 TAs) 2,800,000 meetings with CHMTs on DGHTXDWH¿QDQFLDODQG other resources allocation for NCDs Page 92 STRATEGIC PLAN AND ACTION PLAN 2016-2020 Priority actions Activities Code Units Days Cost Per Diem - Domestic (DSA) 32 2 2 480,000 Ground Travel (Bus, Railway, Taxi, etc) 17 14 1 1,400,000 2I¿FH&RQVXPDEOHV VWDWLRQDULHV  30 16 1 80,000 Participants Food and Refreshments 14 16 1 320,000 Travel tickets - Domestic 41 2 2 320,000 Rent of Vehicles and Crafts 36 1 1 200,000 Conduct proposal writing Meetings for proposal development (5 3,785,000 workshop for fund people for each area) mobilization Per Diem - Domestic (DSA) 32 2 6 1,440,000 Ground Travel (Bus, Railway, Taxi, etc) 17 3 5 1,500,000 2I¿FH&RQVXPDEOHV VWDWLRQDULHV  30 5 1 25,000 Participants Food and Refreshments 14 5 5 500,000 Travel tickets - Domestic 41 2 2 320,000 Market NCDs strategic Conduct a workshop to Workshop (120 people for 3 days) 53,280,000 plan to partners for Orient stakeholders on Per Diem - Domestic (DSA) 32 12 4 5,760,000 mobilizing resources NCDs Strategic Plan Ground Travel (Bus, Railway, Taxi, etc) 17 120 3 36,000,000 2I¿FH&RQVXPDEOHV VWDWLRQDULHV  30 120 1 600,000 Participants Food and Refreshments 14 120 3 7,200,000 Venue 43 1 3 1,200,000 Travel tickets - Domestic 41 12 2 1,920,000 Rent of Vehicles and Crafts 36 1 3 600,000 Identify potential resources ,QWHUQDOZRUNLQJRI1&'2I¿FHDW0R+ of Non governments funding calls for proposal Conduct a meeting to Meeting of 50 people including 5 TAs 2,290,000 sensitize Private Business Ground Travel (Bus, Railway, Taxi, etc) 17 5 1 500,000 community for funding through corporate social Venue 43 1 1 400,000 responsibility Food and Refreshments 14 50 1 1,000,000 2I¿FH&RQVXPDEOHV VWDWLRQDULHV  30 50 1 250,000 Participants Travel tickets - Domestic 41 4 2 640,000 Conduct schedules Meetings with partners (4 areas 2 3,700,000 partnership meeting to RIÀFHUVIURPHDFKDUHDSDUWQHUV mobilize and leverage Per Diem - Domestic (DSA) 32 4 2 960,000 resources for NCDs based on burden of disease data Ground Travel (Bus, Railway, Taxi, etc) 17 5 1 500,000 2I¿FH&RQVXPDEOHV VWDWLRQDULHV  30 40 1 200,000 Participants Food and Refreshments 14 40 1 800,000 Venue 43 1 1 400,000 Travel tickets - Domestic 41 4 2 640,000 Rent of Vehicles and Crafts 36 1 1 200,000 STRATEGIC PLAN AND ACTION PLAN 2016-2020 Page 93 Priority actions Activities Code Units Days Cost Review existing policy and legislation to improve prevention and control, to NCDs services Review various policies Review and update Health Attend scheduled meetings and legislation Insurance schemes for universal coverage Advocate for review of Meeting to review legislations (20 7,180,000 various policies and people per meeting for each area) legislation ( tobacco, Per Diem - Domestic (DSA) 32 4 3 1,440,000 alcohol, diet, physical LQDFWLYLW\URDGWUDI¿FEXLOW Ground Travel (Bus, Railway, Taxi, etc) 17 16 2 3,200,000 environment) 2I¿FH&RQVXPDEOHV VWDWLRQDULHV  30 20 1 100,000 Participants Food and Refreshments 14 20 2 800,000 Venue 43 1 2 800,000 Travel tickets - Domestic 41 4 2 640,000 Rent of Vehicles and Crafts 36 1 1 200,000 Prepare position papers Consultancy to prepare position papers 10 1 5 2,360,000 on appropriate taxation (one consultant per area) Disseminate evidence for Meetings to agree/review 6,800,000 appropriate taxation recommendations of the position paper (one meeting for each area) Per Diem - Domestic (DSA) 32 4 2 960,000 Ground Travel (Bus, Railway, Taxi, etc) 17 36 1 3,600,000 2I¿FH&RQVXPDEOHV VWDWLRQDULHV  30 40 1 200,000 Participants Food and Refreshments 14 40 1 800,000 Venue 43 1 1 400,000 Travel tickets - Domestic 41 4 2 640,000 Rent of Vehicles and Crafts 36 1 1 200,000 Objective 2: To strengthen leadership, governance, multisectoral collaboration and accountability for prevention and control of NCDs by 2020 Objective 2: To strengthen leadership, governance, multisectoral collaboration and accountability for prevention and control of NCDs by 2020 Establish a high- Develop national Consultancy 10 1 5 2,360,000 level inter-ministerial Multisectoral framework committee to facilitate for NCD coordination and and monitor Multispectral collaboration with clear action for NCD prevention roles and responsibilities and control Develop consensus on Meeting of consultant with 6,800,000 National Multisectoral stakeholders (40 people from each framework for NCD area, 8 partners ) coordination and Per Diem - Domestic (DSA) 32 4 2 960,000 collaboration Ground Travel (Bus, Railway, Taxi, etc) 17 36 1 3,600,000 2I¿FH&RQVXPDEOHV VWDWLRQDULHV  30 40 1 200,000 Participants Food and Refreshments 14 40 1 800,000 Venue 43 1 1 400,000 Travel tickets - Domestic 41 4 2 640,000 Rent of Vehicles and Crafts 36 1 1 200,000 Page 94 STRATEGIC PLAN AND ACTION PLAN 2016-2020 Priority actions Activities Code Units Days Cost Adopt a National Meeting to adopt the recommended 12,100,000 Multisectoral framework framework (Partners, Ministries, for NCD coordination and MDAs) collaboration Per Diem - Domestic (DSA) 32 10 2 2,400,000 Ground Travel (Bus, Railway, Taxi, etc) 17 60 1 6,000,000 2I¿FH&RQVXPDEOHV VWDWLRQDULHV  30 60 1 300,000 Participants Food and Refreshments 14 60 1 1,200,000 Venue 43 1 1 400,000 Travel tickets - Domestic 41 10 2 1,600,000 Rent of Vehicles and Crafts 36 1 1 200,000 Identify key Inter- Internal handling 92 1 1 0 Ministerial stakeholders Launch Inter-Ministerial Meetings (2 people from each ministry, 9,600,000 Coordinating committee all members of the committee) for NCDs Per Diem - Domestic (DSA) 32 10 2 2,400,000 Ground Travel (Bus, Railway, Taxi, etc) 17 40 1 4,000,000 2I¿FH&RQVXPDEOHV VWDWLRQDULHV  30 40 1 200,000 Participants Food and Refreshments 14 40 1 800,000 Venue 43 1 1 400,000 Travel tickets - Domestic 41 10 2 1,600,000 Rent of Vehicles and Crafts 36 1 1 200,000 Conduct bi- annual high Meetings of the committee (every six 8,600,000 level Inter-Ministerial months) coordination committee Per Diem - Domestic (DSA) 32 10 2 2,400,000 meetings Ground Travel (Bus, Railway, Taxi, etc) 17 30 1 3,000,000 2I¿FH&RQVXPDEOHV VWDWLRQDULHV  30 40 1 200,000 Participants Food and Refreshments 14 40 1 800,000 Venue 43 1 1 400,000 Travel tickets - Domestic 41 10 2 1,600,000 Rent of Vehicles and Crafts 36 1 1 200,000 Establish/ Strengthen Develop TOR/policy See above Multisectoral coordinating guidelines for NCD Committee at all levels multisectoral coordination committee at national regional and district levels Conduct sensitization 0HHWLQJV RQFH PHPEHUVRIÀFHU 3,900,000 meeting to partners, form RAS for RHMT PMORALG including Per Diem - Domestic (DSA) 32 2 2 480,000 RHMTs on NCDs on the multisectoral coordination Ground Travel (Bus, Railway, Taxi, etc) 17 20 1 2,000,000 committee ToR/policy 2I¿FH&RQVXPDEOHV VWDWLRQDULHV  30 20 1 100,000 guidelines Participants Food and Refreshments 14 20 1 400,000 Venue 43 1 1 400,000 Travel tickets - Domestic 41 2 2 320,000 Rent of Vehicles and Crafts 36 1 1 200,000 STRATEGIC PLAN AND ACTION PLAN 2016-2020 Page 95 Priority actions Activities Code Units Days Cost 0HHWLQJVPHPEHUVRIÀFHUV 3,400,000 Council from for CHMTs Per Diem - Domestic (DSA) 32 2 2 480,000 Ground Travel (Bus, Railway, Taxi, etc) 17 16 1 1,600,000 2I¿FH&RQVXPDEOHV VWDWLRQDULHV  30 16 1 80,000 Participants Food and Refreshments 14 16 1 320,000 Venue 43 1 1 400,000 Travel tickets - Domestic 41 2 2 320,000 Rent of Vehicles and Crafts 36 1 1 200,000 Launch national, regional Internal handling 92 1 1 0 and district multisectoral coordinating committees Support multisectoral Conduct bi-annual Meetings of the committee (every six 6,800,000 coordination committee multisectoral coordinating months) meetings at national, committee meetings at Per Diem - Domestic (DSA) 32 4 2 960,000 regional and district national level Ground Travel (Bus, Railway, Taxi, etc) 17 36 1 3,600,000 2I¿FH&RQVXPDEOHV VWDWLRQDULHV  30 40 1 200,000 Participants Food and Refreshments 14 40 1 800,000 Venue 43 1 1 400,000 Travel tickets - Domestic 41 4 2 640,000 Rent of Vehicles and Crafts 36 1 1 200,000 Conduct bi-annual Meetings of the committee (every six 6,200,000 multisectoral coordinating months) committee meetings at Per Diem - Domestic (DSA) 32 2 2 480,000 regional level Ground Travel (Bus, Railway, Taxi, etc) 17 38 1 3,800,000 2I¿FH&RQVXPDEOHV VWDWLRQDULHV  30 40 1 200,000 Participants Food and Refreshments 14 40 1 800,000 Venue 43 1 1 400,000 Travel tickets - Domestic 41 2 2 320,000 Rent of Vehicles and Crafts 36 1 1 200,000 Conduct national -annual Meetings of the committee (every year) 6,480,000 multisectoral technical meeting Per Diem - Domestic (DSA) 32 4 2 960,000 Ground Travel (Bus, Railway, Taxi, etc) 17 36 1 3,600,000 2I¿FH&RQVXPDEOHV VWDWLRQDULHV  30 40 1 200,000 Participants Food and Refreshments 14 40 1 800,000 Venue 43 1 1 400,000 Travel tickets - Domestic 41 2 2 320,000 Rent of Vehicles and Crafts 36 1 1 200,000 Page 96 STRATEGIC PLAN AND ACTION PLAN 2016-2020 Priority actions Activities Code Units Days Cost Strengthen (NCD section) capacity to coordinate and manage NCDs prevention and control services Implement NCD human Conduct human resource Internal consultation with DAP resource management needs assessments at plan NCD section Develop human resources Internal consultation with DAP management plan Recruit and sustain Internal consultation with DAP DSSURSULDWHTXDOL¿HG human resources at national level to implement NCD Strategic plan Review the organizational Internal consultation with DAP structure based on the need Build NCD section staff Train coordinators on Training session: 40 people + 1 6,600,000 capacity to acquire project management, consultant necessary skills and strategic planning and Per Diem - Domestic (DSA) 32 40 6 28,800,000 competences to proposal development implement NCD SP Consultancy Fees 10 1 5 2,360,000 2I¿FH&RQVXPDEOHV VWDWLRQDULHV  30 40 1 200,000 Participants Food and Refreshments 14 40 5 4,000,000 Venue 43 1 5 2,000,000 Travel tickets - Domestic 41 40 2 6,400,000 Rent of Vehicles and Crafts 36 1 1 200,000 Support staff to attend Technical training: 1 perosn 2 weeks 3,580,000 short and long term in country technical and management Technical Service Fees 39 1 1 1,000,000 courses relevant for NCDs control in the country Per Diem - Domestic (DSA) 32 1 14 1,680,000 Ground Travel (Bus, Railway, Taxi, etc) 17 1 2 200,000 Air Travel Tickets - Local 4 1 1 700,000 Support staff to attend Technical training (1 person 2 weeks 12,220,000 short and long term outside the country) technical and management Technical Service Fees 39 1 1 1,000,000 courses relevant for NCDs control outside the country Per Diem - Domestic (DSA) 32 1 56 6,720,000 Visa Application Fees 44 1 1 400,000 Air Travel Tickets - International 3 1 1 4,000,000 Ground Travel (Bus, Railway, Taxi, etc) 17 1 1 100,000 Improve NCD section Procure 4 new desktops Computers, printers, scanners & other 9 1 1 2,000,000 working condition computers, 4 lap tops for related equipment existing and new staff Procure 1 photocopy Computers, printers, scanners & other 9 1 1 2,000,000 machines, 1 printer and 1 related equipment scanner Procure 1 vehicles for Internal handling 92 1 1 0 NCDs logistic support such as travel for conducting supportive supervision, workshops, training 3URFXUHRI¿FHIXUQLWXUH Furniture and Fittings 15 1 1 10,000,000 STRATEGIC PLAN AND ACTION PLAN 2016-2020 Page 97 Priority actions Activities Code Units Days Cost Objective 3: To strengthen and reorient health systems to address NCDs through promotive, preventive, curative & rehabilitative services by 2020 Increase access for major NCDs Scale up NCDs services Conduct facility needs Consultancy at primary and supporting assessment for NCDs levels scale up at primary level Sensitize RHMTs and Meetings 6,200,000 CHMTs on scaling up plan Per Diem - Domestic (DSA) 32 2 2 480,000 and implementation Ground Travel (Bus, Railway, Taxi, etc) 17 38 1 3,800,000 2I¿FH&RQVXPDEOHV VWDWLRQDULHV  30 40 1 200,000 Participants Food and Refreshments 14 40 1 800,000 Venue 43 1 1 400,000 Travel tickets - Domestic 41 2 2 320,000 Rent of Vehicles and Crafts 36 1 1 200,000 Provide district hospitals, Equipment (per hospital) 37 1 1 1,000,000 health centres and dispensaries with equipment for quality NCDs services Develop plan for NCDs Internal consultation scale up at primary level Update guideline for Task Team 12,795,000 package of services Per Diem - Domestic (DSA) 32 4 6 2,880,000 (pocket booklet) for NCDs scale up Ground Travel (Bus, Railway, Taxi, etc) 17 11 5 5,500,000 2I¿FH&RQVXPDEOHV VWDWLRQDULHV  30 15 1 75,000 Participants Food and Refreshments 14 15 5 1,500,000 Venue 43 1 5 2,000,000 Travel tickets - Domestic 41 4 2 640,000 Rent of Vehicles and Crafts 36 1 1 200,000 Print and distribute NCDs Production and Printing of Training 34 100 1 50,000,000 package of services Materials guidelines Capacity building to Review and update Task Team 17,360,000 HCWs to implement NCDs training curriculum Per Diem - Domestic (DSA) 32 4 4 1,920,000 NCDs services in scaled to include current up districts recommendations Ground Travel (Bus, Railway, Taxi, etc) 17 36 3 10,800,000 2I¿FH&RQVXPDEOHV VWDWLRQDULHV  30 40 1 200,000 Participants Food and Refreshments 14 40 3 2,400,000 Venue 43 1 3 1,200,000 Travel tickets - Domestic 41 4 2 640,000 Rent of Vehicles and Crafts 36 1 1 200,000 Page 98 STRATEGIC PLAN AND ACTION PLAN 2016-2020 Priority actions Activities Code Units Days Cost Train health workers from Training Sessions: 40 people per class 34,160,000 targeted health facilities Per Diem - Domestic (DSA) 32 36 5 21,600,000 on management of major NCDs Ground Travel (Bus, Railway, Taxi, etc) 17 4 4 1,600,000 2I¿FH&RQVXPDEOHV VWDWLRQDULHV  30 40 1 200,000 Participants Food and Refreshments 14 40 4 3,200,000 Venue 43 1 4 1,600,000 Travel tickets - Domestic 41 36 2 5,760,000 Rent of Vehicles and Crafts 36 1 1 200,000 Conduct supervision and Supervision visits 2,595,000 mentorship to the trained Per Diem - Domestic (DSA) 32 3 3 1,080,000 staff Ground Travel (Bus, Railway, Taxi, etc) 17 3 5 1,500,000 2I¿FH&RQVXPDEOHV VWDWLRQDULHV  30 3 1 15,000 Participants Ensure uninterrupted Engage a consultant Internal handling 92 1 1 0 supply of major NCDs to review logistics and drugs and commodities supply chain management for major NCDs drugs and commodities Review assumptions and Internal handling 92 1 1 0 update national forecast for major NCDs drugs and commodities Review/Develop Internal handling 92 1 1 0 TXDQWL¿FDWLRQWRROVIRU major NCDs drugs and palliative care Build capacity of staff on Internal handling 92 1 1 0 IRUHFDVWTXDQWL¿FDWLRQDQG use of tools Scale up centers of excellence for NCDs (cancer, renal, sickle cell, diabetes and cardiac) in zonal referral hospitals 5HIXUELVKLGHQWL¿HG Conduct facility Internal handling 92 1 1 0 targeted zone referral assessments in hospitals hospital to provide quality that will be centre of services for cancer, excellence for cancer, diabetes, renal, and renal, sickle cell and cardiovascular cardiac services Renovate/ construct Rehabilitation of buildings 90 1 1 0 building Procure furniture for Furniture and Fittings 15 1 1 10,000,000 selected zonal referral hospitals Procure equipment for 6FLHQWL¿F(TXLSPHQW 37 1 1 1,000,000 selected zonal referral hospitals Procure laboratory Internal handling 92 1 1 0 supplies for selected zonal referral hospitals STRATEGIC PLAN AND ACTION PLAN 2016-2020 Page 99 Priority actions Activities Code Units Days Cost Build capacity of health 'HSOR\TXDOL¿HGVWDII Internal handling 92 1 1 0 workers from targeted to support cancer, zone referral hospital renal, sickle cell and to provide cancer, cardiovascular services renal, sickle cell and cardiovascular services Collaborate with centre of Training Sessions 34,160,000 excellence to Identify and Per Diem - Domestic (DSA) 32 36 5 21,600,000 train HCWs Ground Travel (Bus, Railway, Taxi, etc) 17 4 4 1,600,000 2I¿FH&RQVXPDEOHV VWDWLRQDULHV  30 40 1 200,000 Participants Food and Refreshments 14 40 4 3,200,000 Venue 43 1 4 1,600,000 Travel tickets - Domestic 41 36 2 5,760,000 Rent of Vehicles and Crafts 36 1 1 200,000 Collaborate with Supervision visits 2,595,000 centre of excellence to Per Diem - Domestic (DSA) 32 3 3 1,080,000 conduct supervision and mentorship to the trained Ground Travel (Bus, Railway, Taxi, etc) 17 3 5 1,500,000 staff 2I¿FH&RQVXPDEOHV VWDWLRQDULHV  30 3 1 15,000 Participants Support centers of Provide uninterrupted Internal handling 92 1 1 excellence in the drugs decentralized zonal referral hospitals Support centers with 6FLHQWL¿F(TXLSPHQW 37 1 1 1,000,000 equipment Monitor implementation Supervision visits 2,595,000 of services in line with Per Diem - Domestic (DSA) 32 3 3 1,080,000 national guidelines Ground Travel (Bus, Railway, Taxi, etc) 17 3 5 1,500,000 2I¿FH&RQVXPDEOHV VWDWLRQDULHV  30 3 1 15,000 Participants Integrate NCD services into existing health care services at all levels of care including community participation Incorporate Conduct advocacy Meetings to adopt curricula 16,400,000 comprehensive NCDs meetings with training Per Diem - Domestic (DSA) 32 36 2 8,640,000 prevention and control institution for incorporation services in health training of NCDs services in school Ground Travel (Bus, Railway, Taxi, etc) 17 4 1 400,000 curricula curricula 2I¿FH&RQVXPDEOHV VWDWLRQDULHV  30 40 1 200,000 Participants Food and Refreshments 14 40 1 800,000 Venue 43 1 1 400,000 Travel tickets - Domestic 41 36 2 5,760,000 Rent of Vehicles and Crafts 36 1 1 200,000 Develop NCDs training Task Team 12,775,000 component to be included Per Diem - Domestic (DSA) 32 4 6 2,880,000 into health training curricula Ground Travel (Bus, Railway, Taxi, etc) 17 11 5 5,500,000 2I¿FH&RQVXPDEOHV VWDWLRQDULHV  30 15 5 375,000 Participants Food and Refreshments 14 15 5 1,500,000 Venue 43 1 5 2,000,000 Page 100 STRATEGIC PLAN AND ACTION PLAN 2016-2020 Priority actions Activities Code Units Days Cost Travel tickets - Domestic 41 2 2 320,000 Rent of Vehicles and Crafts 36 1 1 200,000 Incorporate NCDs Conduct meetings with Meetings 17,360,000 relevant component to RCH/PMTCT, NACP, Per Diem - Domestic (DSA) 32 4 4 1,920,000 EHUHÀHFWHGLQ 5&+ NTLP, EPI) programme PMTCT, NACP, NTLP, and other key stakeholders Ground Travel (Bus, Railway, Taxi, etc) 17 36 3 10,800,000 EPI ) training manuals to incorporate relevant 2I¿FH&RQVXPDEOHV VWDWLRQDULHV  30 40 1 200,000 NCDs component Participants Food and Refreshments 14 40 3 2,400,000 Venue 43 1 3 1,200,000 Travel tickets - Domestic 41 4 2 640,000 Rent of Vehicles and Crafts 36 1 1 200,000 Develop and disseminate Task team 12,475,000 an integration plan Per Diem - Domestic (DSA) 32 4 6 2,880,000 outlining services to be provided at all levels of Ground Travel (Bus, Railway, Taxi, etc) 17 11 5 5,500,000 care 2I¿FH&RQVXPDEOHV VWDWLRQDULHV  30 15 1 75,000 Participants Food and Refreshments 14 15 5 1,500,000 Venue 43 1 5 2,000,000 Travel tickets - Domestic 41 2 2 320,000 Rent of Vehicles and Crafts 36 1 1 200,000 Orient health care Meetings 7,720,000 providers from RCH/ Per Diem - Domestic (DSA) 32 2 5 1,200,000 PMTCT, NACP, NTLP, EPI) on NCDs Ground Travel (Bus, Railway, Taxi, etc) 17 2 2 400,000 2I¿FH&RQVXPDEOHV VWDWLRQDULHV  30 40 4 800,000 Participants Food and Refreshments 14 40 4 3,200,000 Venue 43 1 4 1,600,000 Travel tickets - Domestic 41 2 2 320,000 Rent of Vehicles and Crafts 36 1 1 200,000 ,PSOHPHQW3UDFWLFDO$SSURDFKWR/XQJKHDOWK 3$/ Introduce PAL as Adopt WHO and Task Team 12,795,000 integrated management develop PAL strategy in in primary health care collaboration with NTLP in order to Strengthen management of respiratory disease Per Diem - Domestic (DSA) 32 4 6 2,880,000 Ground Travel (Bus, Railway, Taxi, etc) 17 11 5 5,500,000 2I¿FH&RQVXPDEOHV VWDWLRQDULHV  30 15 1 75,000 Participants Food and Refreshments 14 15 5 1,500,000 Venue 43 1 5 2,000,000 Travel tickets - Domestic 41 4 2 640,000 Rent of Vehicles and Crafts 36 1 1 200,000 Establish PAL national Internal handling 92 1 1 0 Technical Working group STRATEGIC PLAN AND ACTION PLAN 2016-2020 Page 101 Priority actions Activities Code Units Days Cost Conduct needs Task Team 12,795,000 assessment on current Per Diem - Domestic (DSA) 32 4 6 2,880,000 management of respiratory diseases in different level Ground Travel (Bus, Railway, Taxi, etc) 17 11 5 5,500,000 of health facilities 2I¿FH&RQVXPDEOHV VWDWLRQDULHV  30 15 1 75,000 Participants Food and Refreshments 14 15 5 1,500,000 Venue 43 1 5 2,000,000 Travel tickets - Domestic 41 4 2 640,000 Rent of Vehicles and Crafts 36 1 1 200,000 Develop PAL standardize Task Team 12,795,000 clinical practice guidelines Per Diem - Domestic (DSA) 32 4 6 2,880,000 /training materials for respiratory conditions Ground Travel (Bus, Railway, Taxi, etc) 17 11 5 5,500,000 2I¿FH&RQVXPDEOHV VWDWLRQDULHV  30 15 1 75,000 Participants Food and Refreshments 14 15 5 1,500,000 Venue 43 1 5 2,000,000 Travel tickets - Domestic 41 4 2 640,000 Rent of Vehicles and Crafts 36 1 1 200,000 Develop PAL phase Internal handling 92 1 1 0 implementation plan Conduct biannual meeting Meetings 3,675,000 for PAL National Technical Per Diem - Domestic (DSA) 32 4 2 960,000 Working Group Ground Travel (Bus, Railway, Taxi, etc) 17 11 1 1,100,000 2I¿FH&RQVXPDEOHV VWDWLRQDULHV  30 15 1 75,000 Participants Food and Refreshments 14 15 1 300,000 Venue 43 1 1 400,000 Travel tickets - Domestic 41 4 2 640,000 Rent of Vehicles and Crafts 36 1 1 200,000 Support Health facility to Procure necessary 6FLHQWL¿F(TXLSPHQW 37 1 1 1,000,000 implement PAL in phase equipment for PAL manner Train HCWs on PAL Training sessions 11,760,000 clinical practice guidelines Per Diem - Domestic (DSA) 32 4 3 1,440,000 Ground Travel (Bus, Railway, Taxi, etc) 17 36 2 7,200,000 2I¿FH&RQVXPDEOHV VWDWLRQDULHV  30 40 1 200,000 Participants Food and Refreshments 14 40 2 1,600,000 Venue 43 1 2 800,000 Travel tickets - Domestic 41 2 2 320,000 Rent of Vehicles and Crafts 36 1 1 200,000 Provide PAL Internal handling 92 1 1 0 Page 102 STRATEGIC PLAN AND ACTION PLAN 2016-2020 Priority actions Activities Code Units Days Cost Conduct supportive Supportive supervision 2,595,000 supervision Per Diem - Domestic (DSA) 32 3 3 1,080,000 Ground Travel (Bus, Railway, Taxi, etc) 17 3 5 1,500,000 2I¿FH&RQVXPDEOHV VWDWLRQDULHV  30 3 1 15,000 Participants Evaluate implementation Consultancy Fees 10 1 5 2,360,000 of PAL Scale up PAL countrywide Internal handling 92 1 1 0 5HGXFHPRGLÀDEOH1&'VULVNIDFWRUVDQGFUHDWHKHDOWKSURPRWLQJHQYLURQPHQW Advocacy communication Deploy ACSM focal person Internal handling 92 1 1 0 and social mobilization at NCD section Strategic plan (ACSM) to sensitize community on NCDs Develop ACSM strategic Task team 17,515,000 plan Consultancy Fees 10 1 10 4,720,000 Per Diem - Domestic (DSA) 32 4 6 2,880,000 Ground Travel (Bus, Railway, Taxi, etc) 17 11 5 5,500,000 2I¿FH&RQVXPDEOHV VWDWLRQDULHV  30 15 1 75,000 Participants Food and Refreshments 14 15 5 1,500,000 Venue 43 1 5 2,000,000 Travel tickets - Domestic 41 4 2 640,000 Rent of Vehicles and Crafts 36 1 1 200,000 Sensitize /involve Mass media event 4,000,000 community based on the TV 35 1 1 1,000,000 ACSM strategic plan Radio 35 1 1 1,000,000 Newspapers 35 1 1 1,000,000 Mobile messages 35 1 1 1,000,000 Promote community Advocate for healthy diet Advocacy meetings with communities 810,000 based approaches and exercise centers/ Ground Travel (Bus, Railway, Taxi, etc) 17 2 2 400,000 and sensitization for rooms at workplaces, prevention and control community, schools, hotels 2I¿FH&RQVXPDEOHV VWDWLRQDULHV  30 2 1 10,000 for NCDs and restaurants Participants Food and Refreshments 14 40 0 0 Venue 43 1 1 400,000 School health program 810,000 Community 810,000 Workplaces 810,000 Hotels/restaurants 810,000 Food vendors 810,000 STRATEGIC PLAN AND ACTION PLAN 2016-2020 Page 103 Priority actions Activities Code Units Days Cost Commemorate NCDs Mass media event with screening 5,450,000 world international Mass media 4,000,000 days (Cancer, Kidney, Hypertension, Diabetes Screening camps and sickle cell) to raise Ground Travel (Bus, Railway, Taxi, etc) 17 10 1 1,000,000 community awareness 2I¿FH&RQVXPDEOHV VWDWLRQDULHV  30 10 1 50,000 Participants Food and Refreshments 14 10 1 200,000 Rent of Vehicles and Crafts 36 1 1 200,000 Conduct community Mass media event 4,000,000 sensitization on health diet and physical activities Develop IEC materials on Task team 12,795,000 PRGL¿DEOHULVNV Per Diem - Domestic (DSA) 32 4 6 2,880,000 Ground Travel (Bus, Railway, Taxi, etc) 17 11 5 5,500,000 2I¿FH&RQVXPDEOHV VWDWLRQDULHV  30 15 1 75,000 Participants Food and Refreshments 14 15 5 1,500,000 Venue 43 1 5 2,000,000 Travel tickets - Domestic 41 4 2 640,000 Rent of Vehicles and Crafts 36 1 1 200,000 Print and disseminate IEC Production and Printing of Training 34 100 1 50,000,000 materials Materials Develop and broadcast Mass media event 4,000,000 health messages on major 1&'VDQGPRGL¿DEOHULVNV in radios, TV stations and mobile phones Develop material for Task team with a consultant 17,515,000 panel discussion, TV Consultancy Fees 10 1 10 4,720,000 documentaries, radio and TV spots on major NCDs Per Diem - Domestic (DSA) 32 4 6 2,880,000 Ground Travel (Bus, Railway, Taxi, etc) 17 11 5 5,500,000 2I¿FH&RQVXPDEOHV VWDWLRQDULHV  30 15 1 75,000 Participants Food and Refreshments 14 15 5 1,500,000 Venue 43 1 5 2,000,000 Travel tickets - Domestic 41 4 2 640,000 Rent of Vehicles and Crafts 36 1 1 200,000 Broadcast panel Mass media event 4,000,000 discussion, TV documentaries, radio and TV spots on major NCDs Page 104 STRATEGIC PLAN AND ACTION PLAN 2016-2020 Priority actions Activities Code Units Days Cost Implement school Develop school education Task team 11,195,000 education modules on modules on healthy living Per Diem - Domestic (DSA) 32 4 6 2,880,000 healthy living Ground Travel (Bus, Railway, Taxi, etc) 17 11 5 5,500,000 2I¿FH&RQVXPDEOHV VWDWLRQDULHV  30 15 1 75,000 Participants Food and Refreshments 14 15 5 1,500,000 Venue 43 1 1 400,000 Travel tickets - Domestic 41 4 2 640,000 Rent of Vehicles and Crafts 36 1 1 200,000 Sensitize District School Training sessions 28,240,000 Health Coordinators on the Per Diem - Domestic (DSA) 32 36 5 21,600,000 modules on healthy living Ground Travel (Bus, Railway, Taxi, etc) 17 4 2 800,000 2I¿FH&RQVXPDEOHV VWDWLRQDULHV  30 40 1 200,000 Participants Food and Refreshments 14 40 4 3,200,000 Venue 43 1 4 1,600,000 Travel tickets - Domestic 41 4 2 640,000 Rent of Vehicles and Crafts 36 1 1 200,000 Sensitize school health Training sessions 12,080,000 teachers on the modules Per Diem - Domestic (DSA) 32 4 3 1,440,000 on healthy living Ground Travel (Bus, Railway, Taxi, etc) 17 36 2 7,200,000 2I¿FH&RQVXPDEOHV VWDWLRQDULHV  30 40 1 200,000 Participants Food and Refreshments 14 40 2 1,600,000 Venue 43 1 2 800,000 Travel tickets - Domestic 41 4 2 640,000 Rent of Vehicles and Crafts 36 1 1 200,000 Teach school children on Task team to review curiculum 9,175,000 the modules on healthy Per Diem - Domestic (DSA) 32 4 6 2,880,000 living Ground Travel (Bus, Railway, Taxi, etc) 17 11 2 2,200,000 2I¿FH&RQVXPDEOHV VWDWLRQDULHV  30 15 1 75,000 Participants Food and Refreshments 14 15 5 1,500,000 Venue 43 1 5 2,000,000 Travel tickets - Domestic 41 2 2 320,000 Rent of Vehicles and Crafts 36 1 1 200,000 Early detection and Develop comprehensive Task Team 10,515,000 appropriate management screening policy Per Diem - Domestic (DSA) 32 4 5 2,400,000 of NCDs (Cancer, guidelines and screening Diabetes, Cardiovascular, tools Ground Travel (Bus, Railway, Taxi, etc) 17 11 4 4,400,000 Sickle Cell, Renal, Mental 2I¿FH&RQVXPDEOHV VWDWLRQDULHV  30 15 1 75,000 health, and respiratory) Participants Food and Refreshments 14 15 4 1,200,000 Venue 43 1 4 1,600,000 Travel tickets - Domestic 41 4 2 640,000 Rent of Vehicles and Crafts 36 1 1 200,000 STRATEGIC PLAN AND ACTION PLAN 2016-2020 Page 105 Priority actions Activities Code Units Days Cost Orient health care workers Training sessions 6,800,000 on screening of NCDs to Per Diem - Domestic (DSA) 32 4 2 960,000 high risk groups Ground Travel (Bus, Railway, Taxi, etc) 17 36 1 3,600,000 2I¿FH&RQVXPDEOHV VWDWLRQDULHV  30 40 1 200,000 Participants Food and Refreshments 14 40 1 800,000 Venue 43 1 1 400,000 Travel tickets - Domestic 41 4 2 640,000 Rent of Vehicles and Crafts 36 1 1 200,000 Conduct screening Screening camps 5,450,000 programs/campaigns to high risk groups including family members Strengthen referral and Internal handling 92 1 1 0 linkages at all levels for continuum of care Provide preventive Facilitate preventive Meetings 6,480,000 therapy for NDCs vaccinations and therapy Per Diem - Domestic (DSA) 32 4 2 960,000 (Cardiovascular, Cancer, such as HPV, HPB, Respiratory, Renal and pneumococcal, rheumatic Ground Travel (Bus, Railway, Taxi, etc) 17 36 1 3,600,000 Mental health fever and (aspirin, statins) 2I¿FH&RQVXPDEOHV VWDWLRQDULHV  30 40 1 200,000 Participants Food and Refreshments 14 40 1 800,000 Venue 43 1 1 400,000 Travel tickets - Domestic 41 2 2 320,000 Rent of Vehicles and Crafts 36 1 1 200,000 Provision preventive Internal handling 92 1 1 0 therapy for those at high risk of complications (renal, heart, eye, foot) Support promotion of Collaborate with relevant Meetings 6,800,000 laws and legislations that institutions to raise public Per Diem - Domestic (DSA) 32 4 2 960,000 prevent the rise of NCDs awareness on road safety, tobacco and alcohol use Ground Travel (Bus, Railway, Taxi, etc) 17 36 1 3,600,000 2I¿FH&RQVXPDEOHV VWDWLRQDULHV  30 40 1 200,000 Participants Food and Refreshments 14 40 1 800,000 Venue 43 1 1 400,000 Rent of Vehicles and Crafts 36 1 1 200,000 Travel tickets - Domestic 41 4 2 640,000 Review and adapt tobacco Task team 5,955,000 protocol regulation act of Per Diem - Domestic (DSA) 32 4 3 1,440,000 2003 Ground Travel (Bus, Railway, Taxi, etc) 17 11 2 2,200,000 2I¿FH&RQVXPDEOHV VWDWLRQDULHV  30 15 1 75,000 Participants Food and Refreshments 14 15 2 600,000 Venue 43 1 2 800,000 Page 106 STRATEGIC PLAN AND ACTION PLAN 2016-2020 Priority actions Activities Code Units Days Cost Rent of Vehicles and Crafts 36 1 1 200,000 Travel tickets - Domestic 41 4 2 640,000 Develop guidelines for Task team 5,955,000 alcohol and substance Per Diem - Domestic (DSA) 32 4 3 1,440,000 abuse prevention and control Ground Travel (Bus, Railway, Taxi, etc) 17 11 2 2,200,000 2I¿FH&RQVXPDEOHV VWDWLRQDULHV  30 15 1 75,000 Participants Food and Refreshments 14 15 2 600,000 Venue 43 1 2 800,000 Rent of Vehicles and Crafts 36 1 1 200,000 Travel tickets - Domestic 41 4 2 640,000 Review Occupational and Task team 5,955,000 environmental policy and Per Diem - Domestic (DSA) 32 4 3 1,440,000 legislations to reduce exposure through air, Ground Travel (Bus, Railway, Taxi, etc) 17 11 2 2,200,000 water and food to chemical 2I¿FH&RQVXPDEOHV VWDWLRQDULHV  30 15 1 75,000 hazards that cause NCDs Participants Food and Refreshments 14 15 2 600,000 Venue 43 1 2 800,000 Rent of Vehicles and Crafts 36 1 1 200,000 Travel tickets - Domestic 41 4 2 640,000 Strengthen physical rehabilitation and palliative care Support rehabilitation Create of a Physical Internal handling 92 1 1 0 services at levels of care 5HKDELOLWDWLRQ2I¿FHZLWKLQ the Ministry of Health that manages the platform of all stakeholders within the sector Develop rehabilitation Task team 5,955,000 guidelines for major NCDs Per Diem - Domestic (DSA) 32 4 3 1,440,000 Ground Travel (Bus, Railway, Taxi, etc) 17 11 2 2,200,000 2I¿FH&RQVXPDEOHV VWDWLRQDULHV  30 15 1 75,000 Participants Food and Refreshments 14 15 2 600,000 Venue 43 1 2 800,000 Rent of Vehicles and Crafts 36 1 1 200,000 Travel tickets - Domestic 41 4 2 640,000 Train rehabilitation workers Training sessions 11,280,000 on major NCDs guidelines. Per Diem - Domestic (DSA) 32 36 2 8,640,000 Ground Travel (Bus, Railway, Taxi, etc) 17 4 1 400,000 2I¿FH&RQVXPDEOHV VWDWLRQDULHV  30 40 1 200,000 Participants Food and Refreshments 14 40 1 800,000 Venue 43 1 1 400,000 Rent of Vehicles and Crafts 36 1 1 200,000 Travel tickets - Domestic 41 4 2 640,000 STRATEGIC PLAN AND ACTION PLAN 2016-2020 Page 107 Priority actions Activities Code Units Days Cost Equip rehabilitation Equipment 18 1 1 5,000,000 workshops with machines and raw materials for manufacturing of assistive devices Support outreach services Internal handling 92 1 1 0 for rehabilitation Support palliative care Review and update Task team 7,920,000 national palliative care Per Diem - Domestic (DSA) 32 40 1 4,800,000 policy guidelines and strategy Ground Travel (Bus, Railway, Taxi, etc) 17 5 2 1,000,000 2I¿FH&RQVXPDEOHV VWDWLRQDULHV  30 40 1 200,000 Participants Food and Refreshments 14 40 1 800,000 Venue 43 1 1 400,000 Rent of Vehicles and Crafts 36 1 2 400,000 Travel tickets - Domestic 41 2 2 320,000 Oversee implementation Supervission 2,595,000 of palliative care policy Per Diem - Domestic (DSA) 32 3 3 1,080,000 guidelines and strategy Ground Travel (Bus, Railway, Taxi, etc) 17 3 5 1,500,000 2I¿FH&RQVXPDEOHV VWDWLRQDULHV  30 3 1 15,000 Participants Strengthen community Adapt, develop and Task team 3,675,000 based rehabilitation and print Community Based Per Diem - Domestic (DSA) 32 4 2 960,000 palliative care Rehabilitation guidelines Ground Travel (Bus, Railway, Taxi, etc) 17 11 1 1,100,000 2I¿FH&RQVXPDEOHV VWDWLRQDULHV  30 15 1 75,000 Participants Food and Refreshments 14 15 1 300,000 Venue 43 1 1 400,000 Rent of Vehicles and Crafts 36 1 1 200,000 Travel tickets - Domestic 41 4 2 640,000 Develop simple SOPs for Task team 5,955,000 rehabilitation and palliative Per Diem - Domestic (DSA) 32 4 3 1,440,000 care for Community care workers Ground Travel (Bus, Railway, Taxi, etc) 17 11 2 2,200,000 2I¿FH&RQVXPDEOHV VWDWLRQDULHV  30 15 1 75,000 Participants Food and Refreshments 14 15 2 600,000 Venue 43 1 2 800,000 Rent of Vehicles and Crafts 36 1 1 200,000 Travel tickets - Domestic 41 4 2 640,000 Build capacity of Training sessions 12,080,000 Community Health Per Diem - Domestic (DSA) 32 4 3 1,440,000 Workers for Community based rehabilitation (CBR) Ground Travel (Bus, Railway, Taxi, etc) 17 36 2 7,200,000 and palliative care 2I¿FH&RQVXPDEOHV VWDWLRQDULHV  30 40 1 200,000 Participants Food and Refreshments 14 40 2 1,600,000 Page 108 STRATEGIC PLAN AND ACTION PLAN 2016-2020 Priority actions Activities Code Units Days Cost Venue 43 1 2 800,000 Rent of Vehicles and Crafts 36 1 1 200,000 Travel tickets - Domestic 41 4 2 640,000 Review /develop and print Task team 5,955,000 patients self-management Per Diem - Domestic (DSA) 32 4 3 1,440,000 care booklets for chronic diseases such as diabetes, Ground Travel (Bus, Railway, Taxi, etc) 17 11 2 2,200,000 hypertension, cancer, 2I¿FH&RQVXPDEOHV VWDWLRQDULHV  30 15 1 75,000 renal., sickle cell Participants Food and Refreshments 14 15 2 600,000 Venue 43 1 2 800,000 Rent of Vehicles and Crafts 36 1 1 200,000 Travel tickets - Domestic 41 4 2 640,000 Provide Community Health 6FLHQWL¿F(TXLSPHQW 37 1 1 1,000,000 Workers with equipment for community based rehabilitation and palliative care Strengthen/establish Internal handling 92 1 1 0 community based rehabilitation referral linkages for continuum of care Implement Collaborative TB/diabetes/HIV Establish TWG for Conduct a meeting Internal handling 92 1 1 0 collaborative TB diabetes with NTLP and plan and HIV at all levels establishment of TWG at all levels Launch TWG for Meetings 3,675,000 Collaborative TB, diabetes Per Diem - Domestic (DSA) 32 4 2 960,000 and HIV at all levels Ground Travel (Bus, Railway, Taxi, etc) 17 11 1 1,100,000 2I¿FH&RQVXPDEOHV VWDWLRQDULHV  30 15 1 75,000 Participants Food and Refreshments 14 15 1 300,000 Venue 43 1 1 400,000 Rent of Vehicles and Crafts 36 1 1 200,000 Travel tickets - Domestic 41 4 2 640,000 Review M&E systems to Develop diabetes card Internal handling 92 1 1 0 include information on ZLWKXQLTXHLGHQWL¿FDWLRQ TB, diabetes & HIV number and include TB, diabetes & HIV information Review recording and Internal handling 92 1 1 0 reporting tools to include information on TB, diabetes & HIV STRATEGIC PLAN AND ACTION PLAN 2016-2020 Page 109 Priority actions Activities Code Units Days Cost Support Health facility to Develop TB, Diabetes & Task team 3,675,000 implement collaborative HIV training materials Per Diem - Domestic (DSA) 32 4 2 960,000 TB, diabetes & HIV activities Ground Travel (Bus, Railway, Taxi, etc) 17 11 1 1,100,000 2I¿FH&RQVXPDEOHV VWDWLRQDULHV  30 15 1 75,000 Participants Food and Refreshments 14 15 1 300,000 Venue 43 1 1 400,000 Rent of Vehicles and Crafts 36 1 1 200,000 Travel tickets - Domestic 41 4 2 640,000 Train health care providers Training sessions 6,800,000 on collaborative TB, Per Diem - Domestic (DSA) 32 4 2 960,000 diabetes & HIV Ground Travel (Bus, Railway, Taxi, etc) 17 36 1 3,600,000 2I¿FH&RQVXPDEOHV VWDWLRQDULHV  30 40 1 200,000 Participants Food and Refreshments 14 40 1 800,000 Venue 43 1 1 400,000 Rent of Vehicles and Crafts 36 1 1 200,000 Travel tickets - Domestic 41 4 2 640,000 Select regions and sites Internal handling 92 1 1 0 for phase implementations of TB, diabetes & HIV Strengthen referral and Internal handling 92 1 1 0 linkages mechanisms between TB, diabetes & HIV clinics Ensure availability drugs Internal handling 92 1 1 0 and supplies for TB, diabetes & HIV services Conduct joint supportive Supportive supervission 2,595,000 supervision 32 3 3 1,080,000 17 3 5 1,500,000 30 3 1 15,000 Conduct evaluation Task team with a consultant 11,520,000 of the pilot phase and Consultancy Fees 10 1 10 4,720,000 GLVVHPLQDWH¿QGLQJV Per Diem - Domestic (DSA) 32 4 2 960,000 Ground Travel (Bus, Railway, Taxi, etc) 17 36 1 3,600,000 2I¿FH&RQVXPDEOHV VWDWLRQDULHV  30 40 1 200,000 Participants Food and Refreshments 14 40 1 800,000 Venue 43 1 1 400,000 Travel tickets - Domestic 41 4 2 640,000 Rent of Vehicles and Crafts 36 1 1 200,000 Scale up TB, diabetes & Internal handling 92 1 1 0 HIV services Page 110 STRATEGIC PLAN AND ACTION PLAN 2016-2020 Priority actions Activities Code Units Days Cost Objective 4: To Strengthen the National Capacity for NCD surveillance, monitoring & evaluation and research for evidence based planning by 2020 Promote research in NCDs (including injuries and violence) in collaboration with key stakeholders Strengthen Establish position for Internal handling 92 1 1 0 coordination between research focal person at NCD section and NCD section research institutions and academia Establish national NCD Internal handling 92 1 1 0 research committee with other stakeholders Conduct a workshop with Meeting 12,080,000 research institutions and Per Diem - Domestic (DSA) 32 4 3 1,440,000 academia to develop a national research agenda Ground Travel (Bus, Railway, Taxi, etc) 17 36 2 7,200,000 for NCDs and identify 2I¿FH&RQVXPDEOHV VWDWLRQDULHV  30 40 1 200,000 previous researches Participants conducted and it utilization Food and Refreshments 14 40 2 1,600,000 Venue 43 1 2 800,000 Rent of Vehicles and Crafts 36 1 1 200,000 Travel tickets - Domestic 41 4 2 640,000 Mobilize funding within Internal handling 92 1 1 0 and from international agencies to support research priority areas Conduct operational Internal handling 92 1 1 0 research and survey on LGHQWL¿HGSULRULW\DUHDVLQ collaboration with research institutions and other stakeholders Build NCD section Conduct refresher Training session 2,125,000 capacity to conduct training to NCD staff on Per Diem - Domestic (DSA) 32 1 14 1,680,000 operational research operational research methodology 2I¿FH&RQVXPDEOHV VWDWLRQDULHV  30 1 1 5,000 Participants Food and Refreshments 14 1 14 280,000 Travel tickets - Domestic 41 1 2 160,000 Seek technical assistance Consultancy Fees 10 1 5 2,360,000 to develop research proposal including survey Promote research and Develop a framework to Internal handling 92 1 1 0 utilization to inform monitor NCD research and policy and practice its utilize Disseminate research Internal handling 92 1 1 0 ¿QGLQJVORFDOO\DQG internationally 3XEOLVKUHVHDUFK¿QGLQJ Internal handling 92 1 1 0 in peer review locally and internationally STRATEGIC PLAN AND ACTION PLAN 2016-2020 Page 111 Priority actions Activities Code Units Days Cost Monitor and evaluate progress of the strategic plan Review and update Seek technical assistance/ Consultancy Fees 10 1 10 4,720,000 monitoring and evaluation consultant to review and systems and framework update monitoring and for NCDs evaluation systems and framework Conduct workshop to Task team 6,800,000 Review data collection Per Diem - Domestic (DSA) 32 4 2 960,000 tools for major NCDs to incorporate WHO Ground Travel (Bus, Railway, Taxi, etc) 17 36 1 3,600,000 recommendations a 2I¿FH&RQVXPDEOHV VWDWLRQDULHV  30 40 1 200,000 minimum set of national Participants targets and indicators Food and Refreshments 14 40 1 800,000 Venue 43 1 1 400,000 Rent of Vehicles and Crafts 36 1 1 200,000 Travel tickets - Domestic 41 4 2 640,000 Support/coordinate review Task team 3,675,000 District Sentinel Survey Per Diem - Domestic (DSA) 32 4 2 960,000 (DSS) tools to incorporate NCD data variables Ground Travel (Bus, Railway, Taxi, etc) 17 11 1 1,100,000 2I¿FH&RQVXPDEOHV VWDWLRQDULHV  30 15 1 75,000 Participants Food and Refreshments 14 15 1 300,000 Venue 43 1 1 400,000 Rent of Vehicles and Crafts 36 1 1 200,000 Travel tickets - Domestic 41 4 2 640,000 Build capacity for data Develop standardized Internal handling 92 1 1 0 management and training protocol for routine utilization at all levels surveillance and tracking system of NCDs Train clinicians on the Training session 6,800,000 protocol for routine Per Diem - Domestic (DSA) 32 4 2 960,000 surveillance including recording, reporting, data Ground Travel (Bus, Railway, Taxi, etc) 17 36 1 3,600,000 analysis and utilization at 2I¿FH&RQVXPDEOHV VWDWLRQDULHV  30 40 1 200,000 point of care Participants Food and Refreshments 14 40 1 800,000 Venue 43 1 1 400,000 Rent of Vehicles and Crafts 36 1 1 200,000 Travel tickets - Domestic 41 4 2 640,000 Print and distribute R&R Production and Printing of Training 34 100 1 50,000,000 tools for NCDs Materials Conduct post training Supervision sessions 2,595,000 supportive supervision Per Diem - Domestic (DSA) 32 3 3 1,080,000 Ground Travel (Bus, Railway, Taxi, etc) 17 3 5 1,500,000 2I¿FH&RQVXPDEOHV VWDWLRQDULHV  30 3 1 15,000 Participants Page 112 STRATEGIC PLAN AND ACTION PLAN 2016-2020 Priority actions Activities Code Units Days Cost Monitor implementation of Finalize and harmonise Task team with a consultant 23,115,000 the NCD strategic plan monitoring framework and Consultancy Fees 10 1 20 9,440,000 establish indicator and annualized targets Per Diem - Domestic (DSA) 32 4 6 2,880,000 Ground Travel (Bus, Railway, Taxi, etc) 17 11 5 5,500,000 2I¿FH&RQVXPDEOHV VWDWLRQDULHV  30 11 1 55,000 Participants Food and Refreshments 14 16 5 1,600,000 Venue 43 1 5 2,000,000 Travel tickets - Domestic 41 4 2 640,000 Rent of Vehicles and Crafts 36 1 5 1,000,000 Conduct joint supportive Supervision sessions 2,595,000 supervision with partners Per Diem - Domestic (DSA) 32 3 3 1,080,000 to regions on NCDs annually Ground Travel (Bus, Railway, Taxi, etc) 17 3 5 1,500,000 2I¿FH&RQVXPDEOHV VWDWLRQDULHV  30 3 1 15,000 Participants Ensure regional and Internal handling 92 1 1 0 district supportive supervision tools include NCDs Develop technical Internal handling 92 1 1 0 progress reports: quarter, semi-annual and annual Conduct annual meeting Meetings 6,800,000 with key stakeholders Per Diem - Domestic (DSA) 32 4 2 960,000 to review progress of implementation Ground Travel (Bus, Railway, Taxi, etc) 17 36 1 3,600,000 2I¿FH&RQVXPDEOHV VWDWLRQDULHV  30 40 1 200,000 Participants Food and Refreshments 14 40 1 800,000 Venue 43 1 1 400,000 Rent of Vehicles and Crafts 36 1 1 200,000 Travel tickets - Domestic 41 4 2 640,000 Conduct midterm and Task team with a consultant 11,520,000 end term review of the Consultancy Fees 10 1 10 4,720,000 strategic plan II Per Diem - Domestic (DSA) 32 4 2 960,000 Ground Travel (Bus, Railway, Taxi, etc) 17 36 1 3,600,000 2I¿FH&RQVXPDEOHV VWDWLRQDULHV  30 40 1 200,000 Participants Food and Refreshments 14 40 1 800,000 Venue 43 1 1 400,000 Travel tickets - Domestic 41 4 2 640,000 Rent of Vehicles and Crafts 36 1 1 200,000 STRATEGIC PLAN AND ACTION PLAN 2016-2020 Page 113

5.8 Annex 8: People who contributed to the formulation of the National NCD Strategic and Action Plan 2016/17-2020/21 Name Organization Dr Bushiri Rajab Amana Hospital Mrs Salma Chingwile Amana Hospital, Patient Ms Berezy Makaranga Association of Private Health Facilities in Tanzania Tumaini A Kiyola Association of Tanzania Employers Dr Godwin Ndamugoba Christian Social Services Commission Ms Zohra Lukmanji Consultant, Dietitian Waziri Juma Ndonde FIAT Dr Delilah Chanes Kimambo Heart Foundation of Tanzania Ms Zubeda A Kondo Home Affairs Dr Theonest K Mutabigwa Hubert Kairuki Memorial University Mary Mwangome Ifakara Health Institute Masuma Mamdani Ifakara Health Institute Dr Evaristo Lupumbwe Iringa Regional Referral Hospital Dr Nyasatu Chamba Kilimanjaro Christian Medical Centre Dr John Edes Korogwe District Hospital Dr Praxeda Swai Medical Association of Tanzania Samson Marwa Medical Stores Department Dr Belinda Balandya Medical Women Association of Tanzania Dr Frank Masao Mental Health Association of Tanzania Dr David Johns Pwele Ministry of Communications, Science and Technology Upendo Sianga Ministry of Communications, Science and Technology Alex Sawe Ministry of Health and Social Welfare Alice J Mwandu Ministry of Health and Social Welfare Anne Sekiete Ministry of Health and Social Welfare Beatreice Fungamo Ministry of Health and Social Welfare Catherine Sungura Ministry of Health and Social Welfare David Edward Ministry of Health and Social Welfare Dr Ahadiel Senkoro Ministry of Health and Social Welfare Dr Anna Nswilla Ministry of Health and Social Welfare Dr Auson Rwehumbiza Ministry of Health and Social Welfare Dr Ayoub R Magimba Ministry of Health and Social Welfare Dr Beatrice Mushi Ministry of Health and Social Welfare Dr Bernadetha Shilio Ministry of Health and Social Welfare Dr Fausta Mosha Ministry of Health and Social Welfare Dr Norman Sabuni Ministry of Health and Social Welfare Dr Rukia Ali Ministry of Health and Social Welfare Page 114 STRATEGIC PLAN AND ACTION PLAN 2016-2020 Name Organization Dr Vida Mmbaga Ministry of Health and Social Welfare Josephine Bernard Ministry of Health and Social Welfare Justo Mwandelile Ministry of Health and Social Welfare Ms Grace Roy Moshi Ministry of Health and Social Welfare Nyamate Mageni Ministry of Health and Social Welfare Rudia Magoma Ministry of Health and Social Welfare Witness E Tella Ministry of Health and Social Welfare Frank Ngoda Ministry of Industry and Trade Eliachim Y Mahenge Mji mwema Health Centre, Songea Dr Kayuni G MLFD Ephron P Sanga MOCLA Stephen Pancras MOHA Sabas A Mhina MOLE Dr Sitileyila Kibayasi Mt Meru Regional Hospital, Arusha Dr Elisha Osati Muhimbili National Hospital Dr Kigocha Okeng’o Muhimbili National Hospital Dr Linda Ezekiel Muhimbili National Hospital Mr Deus T Kajuna Muhimbili National Hospital Ms Matilda Mgemela Mrina Muhimbili National Hospital Mrs Marie Msellemu Riwa Muhimbili National Hospital, Patient Dr Fredirick L Mashili Muhimbili University of Health and Allied Sciences Dr Nurdin Mavura Mwananyamala Hospital Dr Mary Mayige National Institute for Medical Research Gibson B Kagaruki National Institute for Medical Research Dr Onesmo A Kisanga Nephrology Sociaty of Tanzania Dr Crispin Kahesa Ocean Road Cancer Institute Prof Twalib Ngoma Ocean Road Cancer Institute Dr Liggyle Vumilia OCS -TM Dr Monica Appollo Paediatric Association of Tanzania Anna Temu Pharmacy Council of Tanzania Ruth Kanoni Nkuza Shinyanga Regional Hospital Dr Deogratius Soka Sickle Cell Foundation of Tanzania Mr Emmanuel Kandusi Tanzania 50 Plus Benjamin N M Nkonya Tanzania Association of Managers and Owners of Non- government Schools and Colleges Dr Digna Riwa Tanzania Association of Respiratory Diseases Dr Hedwiga Francis Swai Tanzania Association of Respiratory Diseases Dr Meshack Shimwela Tanzania Association of Respiratory Diseases Mr Richard Silumbe Tanzania Association of Respiratory Diseases STRATEGIC PLAN AND ACTION PLAN 2016-2020 Page 115 Name Organization Ms Keziah Rhobi Makoro Tanzania Breast Cancer Foundation Dr Julius Mwaiselage Tanzania Cancer Association Dr Germana Lyimo Tanzania Dental Association Dr Rachel Mhavile Tanzania Dental Association Beatrice Mhango Tanzania Diabetes Association Dr Andrew M Swai Tanzania Diabetes Association Dr Kaushik Ramaiya Tanzania Diabetes Association Herieth Nganga Tanzania Diabetes Association John Gardner Tanzania Diabetes Association Lilian Mkwawa Tanzania Diabetes Association Mary Mosha Tanzania Diabetes Association Mr Ramadhan Mongi Tanzania Diabetes Association Mr Zacharia Ngoma Tanzania Diabetes Association Pendo Merengo Tanzania Diabetes Association Sophie Ilondo Tanzania Diabetes Association Adeline Munuo Tanzania Food and Nutrition Centre Dr Tatizo Waane Tanzania NCD Alliance Happy Nchimbi Tanzania NCD Alliance Lena M Mfalila Tanzania Nursing and Midwifery Council Dr Diwani Bakari Msemo Tanzania Palliative Care Association Dr Bertha T Maegga Tanzania Public Health Association Dr Faustin Njau Tanzania Public Health Association Dr Mashombo Mkamba Tanzania Public Health Association Erick G Moshi Tanzania Public Health Association Dr Deogratias Soka Tanzania Sickle Cell Foundation Dr Julie Makani Tanzania Sickle Cell Foundation Ms Lutgard Koku Kagaruki Tanzania Tobacco Control Forum Suma Mwaitenda Tanzania Tobacco Control Forum Mwasiti Omari TNBC Dr Cyprian Ntomoka TOS Dr Stanley Mlay Ulanga District Council Dr Bwijo Bwijo United Nations Development Program Dr Sara Maongezi WAMA Foundation Dr Alphoncina Nanai World Health Organization Page 116 STRATEGIC PLAN AND ACTION PLAN 2016-2020 Page 118 STRATEGIC PLAN AND ACTION PLAN 2016-2020