1. Introduction

Trans Tanz is a charitable organisation registered with the UK Charities Commission. Trans Tanz aims to provide access to healthcare facilities for communities affected by HIV/AIDS in Tanzania through working in partnership with the Government of Tanzania and community based organisations.

Our goal is to increase communities affected by HIV/AIDS’ access to healthcare facilities and Anti Retroviral Treatment. Each Trans Tanz project is led, designed and implemented by the community in partnership with the Government of Tanzania. Trans Tanz provides the technical expertise and fundraising capacity to realise community objectives.

2. Background of the Project

2.1 Problem to address

HIV/AIDS and related infections such as Tuberculosis (TB) continue to devastate lives and societies throughout Sub-Saharan Africa. In Tanzania, the HIV prevalence rate is approximately 5.3% (Tanzanian Bureau of Statistics, 2008), affecting not only the lives of those infected, but their families and the societies in which they live.

Despite medication to control the disease being available free of charge from selected public health facilities throughout the country; ART rollout has reached only 18% of those who need it in rural Tanzania (WHO, 2007).

Centres for Treatment and Care (CTCs), which are health centres with staff trained to provide HIV treatment and support, are generally only located in urban or semi-urban areas. In Pwani region, 79% of people are rurally based (http://www.tanzania.go.tz/census/), and live up to 180Km from the nearest CTC centre, ruling out access by foot for the vast majority of Tanzanians.

In many rural areas of Tanzania there are no structured bus services, or reliable public transport system. Most people have to depend on private mini buses that are unreliable, especially during the wet seasons. In some remote areas transport is non-existent therefore, even for those who may be able to afford the fare; there may be no possibility of accessing health services. The unreliable and relatively expensive transport fares also pose a problem in fulfilling the adherence requirements and repeated visits required for patients receiving care and treatment for HIV.

The process of obtaining treatment for HIV can involve three or four appointments at a CTC before ART can be prescribed. After this, patients must commit to attending the CTC a minimum of once a month for repeat prescriptions, in addition to attending for treatment of opportunistic infections. For some rurally-based patients, a round trip to the nearest CTC can cost over $10 in bus fares.

Tanzania is one of the poorest counties in the world, with many rural Tanzanians earning less than $1 a day. Given the average income, for many Tanzanians, the possibility of committing to such an expensive timetable for ART is unfeasible, meaning that many people simply die in their villages without ever attending a CTC clinic or even being diagnosed.

Poverty is likely to be one of the main factors contributing to poor adherence to ART in resource limited settings. Poor adherence is detrimental to the health of the PLHIV and also increases the risk of resistance.

PLWH also face health problems that often make it impossible to use public bus services even where they are available. Poor health can lead to lack of mobility and stamina, as well as the possibility of contracting common infections or spreading more serious infections such as Tuberculosis on overcrowded buses.

3. Rationale for intervention

The Connecting Communities to Healthcare project was designed to demonstrate that poor accessibility of sites is a major factor in low-uptake and poor adherence of ART. By removing barriers like cost, distance and provisions for the day, we hope to increase accessibility to ART to 100% for those who need it in the North of Bagamoyo district.

4. Performance Review

4.1 Patients Breakdown

We have been able to establish a mechanism which will help us to identify the number of patients we are serving per quarter, then annually. We have opened the register book in which every day of clinic, new patients are recorded. Not only that we have been able to reregister all the patients who are using Trans Tanz services.

Trans Tanz has been able to serve the total of 202 of patients in this quarter. Among these, adults were 192 where 134 were female and 42 were male. Children made a total of 10 where 7 were girls and 3 were boys. In this quarter we had 16 new members where 14 were females and 2 were males. The distribution of the patients served by Trans Tanz is summarised in the following table

CTC’s   Adults   Children   New Adults   Total

   Female   Male   Girls   Boys   Female   Male   

Miono   83   20   4   2   6   O   115

Chalinze   51   22   3   1   8   2   87

Total   134   42   7   3   14   2   202

We still have a challenge of getting the records of those who have passed away. Some dies at home then relative don’t inform the hospital. Some dies from the hospital but in their records difficult to identify if they were using Trans Tanz service.

The attendance has been good among the patients. There adherence has been more than 80%. Some patients refill their ARV monthly.

4.2. Budget compliance

The total budget of this quarter was 7,323,347.90 Tsh. The total expenditure was 6,041,000 Tsh. Out of this the project expenditure was 48.6% (2,937,000.00). Fuel for the bus formed 54.5% of the project expenditure (1,600,000.00). Management expenditure made a total of 51.4% of the total budget. Staff salaries made slightly more than a half of the management costs, i.e. 56.9% (1,765,000.00).This is because the project is still thin on the ground and has not fully exploited economies of scale.

4. 3. Expenditure breakdown

4.3.1 Kilometers per month

The total distance covered per month was 2,089 kilometers. This exclude the distance covered during bus maintenance. The bus normally has ten routes per month.

4.3.2 Litters per kilometer

The bus consumption is an average of 6.9 kilometers per liters. This excludes the distance covered by the bus during the services.

4.3.3 Maintenance tracking

Bus maintenance has costed a total of 16.6% (1,001,000.00) of a total budget. The major cost was buying five new tires of the bus which cost 730,000.00 Tsh. All five tires were in bad state and there was no any option for that.

4.3.4 Cost of food per patients.

Food and water cost around 950.00 Tsh per patient per day. This is for breakfast, lunch snack and water. We normally had an average of 12 patients per trip.

4.3.5 Cost per patient ratios

The total budget cost ratio per patient is 29,905.94 Tsh for this quarter.

5.0 Feed back meeting from the patients

At Miono, I had a meeting with our patients as part our quarterly feedback from the patients: The following issues were raised by the patients;

5.1 Food

The first complain was about the food we give them. They said it is not enough. They suggest if they would get real food instead of snacks during lunch time. This means an additional 700.00 shillings per patient. I told them that at the moment our organisation cannot afford that. I advised them to take some extra food from their home or to agree to take one big meal. Majority opted for breakfast and lunch snacks.

5.1 Unavailability of other drugs apart from ARV’s

It has been a common challenge for the patients to miss other medicine apart from ARV. This has been so common in government health centres. Patients have been reporting on this. Sometimes when they are sick, the doctor prescribe drugs which are sometimes not found in the hospital. Patients are asked to go and buy drugs from the pharmacy. In most cases the patients don’t have money to buy drugs. This has been reported by the patients who attend Miono CTC.

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5.2 Monthly meeting

This has been a concern of the peer educators from the CTC’s that our patients miss a lot. We have not been able to bring our patients to the end of the month meeting of the people living with HIV/AIDS. There is end of the month meeting to all the CTC’s. This meeting comprise different stakeholders from the government, religious institution and other stake holders from different organisation. It has been noted that some of our patients don’t know how to live positively. Through the monthly meetings, patients get different knowledge and living testimony which bring moral to their daily living. Not only life skills, but also through these meeting they get different information concerning different opportunities which can be vital to their businesses.

TT has not been in a position to provide transport to its patients. Attending the monthly meeting has much implication in terms of cost i.e., fuel cost and increased mileage thus frequent services. Providing transport to our patients for that meeting implies doubling the number of normal routes. This is a challenge we have been facing through all this year.

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6.2. Opening of new CTCs.

Two new CTCs were opened by the government within this new quarter. This has the implication for closing down the Southern route (the route towards Chalinze CTC)

The opening up of the new CTC has been perceived differently among the patients. Some were happy to be transferred to their near by CTC, but others do not want. This has been made clear to them; that they are free to continue attending the old CTC, but at their own cost. TT will not offer the service to the patients who are residing closer to the CTCs.

We are facing the challenge of providing food to our patient to those who don’t have any other alternative of getting food

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