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

Links:

• trans tanz
• twitter
• photos

GG Final Update

As some of you are no doubt aware I am leaving Tanzania and Trans Tanz, at the end of September. It has been a challenging but rewarding two years during which we have managed to help over 250 patients access health care services for HIV/AIDS. Without our work and your support there is no doubt that a large number of these patients would no longer be with us, leaving broken families and communities behind.

We are still a small organisation but the plans have been put in place for our continuation after I leave. We have employed a highly capable Tanzanian Project Manager, Rosemary Sokile, hired office space and formalised our relationships with our partner organisations in anticipation of a successful funding application to provide mobile testing and treatment of HIV in rural Tanzania.

This expansion and the simultaneous drop in funding has hit our plans hard however. With less money available in the UK there is a chance that we will not be able to continue with our work due to lack of funds. This would be tragedy, both for the patients we support, most of whom would not be able to access treatment and would therefore die more quickly than if they had not started the treatment in the first place, and for the organisation which has made really strong progress in establishing itself over the last couple of years.

Trans Tanz has a budget per year of just £13,000, most of which goes directly to supporting patients (and definitely not into over paid charity workers’ pockets), any amount you can give on a one off or regular basis will really help us get through this transition and emerge stronger in 2010. If you’re doing any running/swimming/dancing etc over the next few months please consider us as a recipient. You could do a lot worse.

There will be a ‘fun’draiser on Dec 5th in London to which everyone is invited to attend. (Check the website for details)

Please if you haven’t already done so, pledge as much as you can spare by visiting the website and donating through Global Giving.

Pictures:

• Rosemary outside the new office (JPG)

Trans Tanz’s work continues week-in and week-out to help over a hundred HIV patients living in rural villages in Bagamoyo district, Tanzania to regularly access the treatment they need to survive.

In the last few months we have helped to identify and refer twelve new HIV patients who are now registered and receiving treatment regularly. Four of these patients are living in villages to which Trans Tanz has only recently expanded, as news of our service spreads and demand grows. Two of these villages, Mashala and Stamico have no access to public transport at all. Without our service, weak and immuno-compromised HIV patients, would face the choice of either walking the 10-15kms to the main road, and paying up to three days wages for the overcrowded public bus, or dying without being able to access free treatment.

This, for many presents too much of a challenge to commit to attending a regular monthly appointment to receive medication in a clinic up to 60km away. By supporting our service you are helping to provide door-to-door transport, social support, food and clean water for over a hundred vulnerable HIV patients, many of whom are women, supporting families by themselves after their partners have died.

One of our first patients, Regina Mtego, who can be seen in the attachment, started using the service over a year ago and recounted to me recently, how the service has changed and expanded in her village:

“At that time (in November 2007) the nearest Care and Treatment Centre (CTC) for HIV was in Chalinze (90km away) and so I couldn’t afford to travel there to get treatment. I was very happy when Trans Tanz started the service and I was one of the three patients from Mkange (a small village just outside the Saadani national park) to use the service when it first started. Now there are eight of us who use the service regularly.’’

“We are helping to stop other people contracting HIV by being open about our HIV status and changing attitudes in our village.”

Without your support Regina would probably not be alive today to help fight the disease in her village, so thank you so much for your support. By keeping our patients alive you are helping to keep families together and giving the next generation of Tanzanians the chance of a better childhood.

Please let me know any comments or suggestions on the updates or the project in the comments section. Thanks again for reading and for your support,

Duncan Skelton

Project Manager

Trans Tanz

16/2/09

Pictures:

• Regina Mtego (JPG)

Hi again, thanks for reading and keeping up with Trans Tanz.

Our pilot project in Bagamoyo district in Tanzania continues with new people using the bus-service to access treatment for HIV each week. The patients who use the service are without exception quite poor and face many struggles each day, just to survive. In rural villages throughout Africa opportunities are scarce. Education, employment and access to good quality health care are limited. Being HIV positive multiplies the difficulties people must face in their daily lives. If you are too ill to work, dependant on others for your food and accommodation and stigmatised for being HIV positive, an already difficult life becomes even more gruelling.

I admire our patients for having the courage to come forward and use the bus service, despite the added problems it may bring in the short-term. Anti-retroviral Therapy (ART) is not an easy regimen to maintain. For example, one of our patients, from Saadani on the very traditional and conservative Swahili coast, arrived at the hospital with what, to the untrained eye (i.e. mine) appeared to be third degree burns covering her entire body. She was in a great deal of pain. It turned out that the skin condition was a bad reaction to one of the drugs provided, Septrin. Without our service she would not have been able to get to the hospital on public transport due to here lack of mobility and skin condition and would not have recovered to the extent that she has this week.

Added to the problems caused by side-effects of the treatment regimen, are the problems many patients face in looking after their family, earning money and getting sufficient nutrients to allow the ART to work. They are the bravest people I have ever come across. Trans Tanz is making accessing treatment easier for hundreds of people in Bagamoyo and therefore helping to keep people alive, families together and give people living with HIV a chance at a more normal life. While the patients we help have a difficult life, we are helping to make it a bit easier by removing one of the barriers to staying alive and healthy.

Thanks for reading and your support,

Best wishes,

Duncan Skelton

Project Manager

Pictures:

• One of our younger patients (JPG)

Hi there, this is the first update from the field for Trans Tanz. As you may have seen from the organisational profile, Trans Tanz is primarily concerned with increasing access to treatment for HIV for the large rural population of Bagamoyo district in Tanzania. Our free bus service visits ten villages regularly to take patients for their scheduled appointments to refill their Anti-Retroviral Treatment (ART) but is also used to generally strengthen the response to HIV by increasing the mobility of our partners in Bagamoyo.

We are in our tenth months of service in Bagamoyo district and thus far the project has been very successful, helping over 200 patients gain access to ART and treatment for opportunistic infections and significantly reducing the number of patients who discontinue treatment for financial reasons.

Two weeks ago UKUN, our local partners who provide Home Based Care (HBC), took our bus out on a mobile Voluntary Counselling and Testing trip where they tested over one hundred patients in the area in which we work, identifying ten new patients who will benefit from HBC provided by UKUN and access to treatment provided by Trans Tanz. Due to initiatives such as these the numbers of patients using the bus is growing every week and we are close to capacity on every trip.

Patients also use the service to access treatment for opportunistic infections which occur frequently in immuno-compromised patients. In many cases the bus is literally a lifesaver. Patients are often too weak and sick even to arrive at the village meeting points meaning the bus will visit their home and they will be assisted on the trip by our HBC volunteer.

Last week there was an example of just how necessary your support is to many of these very sick patients. One of our regular passengers had requested a home pick-up due to his failing health. When he arrived at the Care and Treatment Centre (CTC) he was admitted for observation and treatment. Due to a lack of resources in Tanzanian hospitals, the quality of care is generally low; patients are given only small amounts of very basic food stuffs which are often indigestible or unsuitable for HIV patients. So, as part of our commitment to our patients, we provided some suitable food and drinking water to help sustain him during his stay in hospital until we alerted his family of his admission, so that they were able to visit and support him. The following week he was sufficiently recovered to return home with the bus. Without our service he would almost certainly have died at home due to a lack of transport options and if not, subsequently, due to a lack of suitable food.

These are just two examples of ways in which access to transport provided by Trans Tanz is improving the ability of people in Bagamoyo to deal with the devastating effects of HIV and AIDS in their communities. With your help we will be able to continue our work in Bagamoyo as well as introducing new, innovative projects to the rest of the region in the near future. Thanks for your support, from Trans Tanz and all of our patients.

Duncan Skelton

Project Manager

Trans Tanz

12/10/2008

Pictures:

• UKUN counsellor performs VCT in a home in Bagamoyo district (JPG)

Trans Tanz is excited to be involved in Global Giving's Access to Health Campaign 2008. Limited Access to Health has provided the foundation for our work, and we feel a raised awareness and support for new innovative ideas in increasing access is integral to individual's standard of living around the world.

The bus that Trans Tanz runs is only one idea in which we can increase people's access to badly needed services. Over the next few months, however, Trans Tanz will be exploring more cost-effective and efficient ways in which we can deliver access and improve the lives of the communities we work with.

We will post these updates as developments occur. Updates will also be available on our website www.transtanz.org. In the meantime, thank you for your continued support.