Tanzania

Established in 1984, HKI's office was the organization's first in Africa and was set up to provide primary eye care services in central Tanzania. The Kongwa field office was also the cradle for the WHO-endorsed S.A.F.E. strategy for trachoma.

HKI has since expanded its role and currently offers programs to prevent blindness, and improve nutrition. Current programs include:

• Vitamin A supplementation >>more
• Zinc supplementation >>more
• Trachoma control using the S.A.F.E strategy >>more
• Treatment of cataract including Vision 2020 >>more
• Onchocerciasis control >> more
• School health programming >> more

Program Descriptions:

Vitamin A Supplementation (VAS): Since 2003, HKI has collaborated with the micronutrient programs of USAID, MOST, and the A2Z Project to strengthen vitamin A supplementation (VAS). In 2004, HKI conducted a study which established that twice yearly VAS is highly cost-effective when compared to other public health care interventions at fighting vitamin A deficiency. Since then, deworming of children ages 1-5 has been combined with VAS further increasing cost-effectiveness.

HKI advocates for a high-level commitment to twice-yearly VAS, and works to strengthen the sustainability of this critical health intervention. HKI promotes district level-ownership and accountability for VAS through capacity building in planning, budgeting, advocacy and social mobilization. In 2007, HKI conducted a sustainability assessment to identify program weaknesses and the means to address them. Advocacy, training District Health Management Teams about budgeting approaches, and ensuring adequate resources are allocated for VAS are critical components. HKI works with health service providers to update their knowledge on VAS, help implement the twice-yearly events, and to encourage their commitment. Communication materials and tools increase the knowledge of mothers and community leaders on the benefits of vitamin A so that VAS is demand-driven. Special attention is given to improving the performance of underserved and low coverage districts. This strategy has resulted in coverage of VAS above 90% since 2001, saving an estimated 30,000 child lives each year.

Zinc Supplementation: HKI, in partnership with the A2Z Project and MOST, provides technical assistance and advocates for zinc supplementation as an adjunct therapy for diarrhea treatment. As a direct result of these efforts, zinc treatment has been integrated in the National IMCI Guidelines for Diarrhea Management and into the National Standard Therapeutic Guidelines.

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Trachoma Control: HKI implements trachoma programs based on the WHO-endorsed S.A.F.E. strategy ( Surgery, Antibiotics, Facial cleanliness, and Environmental improvements). HKI played a pioneering role in strengthening community-based trichiasis surgery in Tanzania by training over 150 surgeons, who have collectively performed more than 20,000 surgeries in the last 10 years. Recent efforts include monitoring the quality of surgery, and providing refresher trainings and support for trichiasis surgery camps.

Trachoma can be prevented through face-washing, and so HKI focuses on improving the knowledge and practices of school children on trachoma and its prevention. A trachoma curriculum has been developed in collaboration with the Tanzania Institute of Education (TIE) and the Ministries of Education and Health and has been integrated into the National Primary School Curriculum. This curriculum is currently being rolled out in 15 highly trachoma-endemic districts. School books and communication materials for children have also been developed. In addition, HKI facilitates partnerships with the Ministry of Health and other organizations and institutions to conduct school screenings and provide access to water and sanitation infrastructure in schools and communities.

Treatment for Cataract:In collaboration with the National Eye Care program in the Ministry of Health (MOH) and the Kilimanjaro Centre for Community Ophthalmology (KCCO), HKI has been working in the Singida and Tanga regions since 2004 to prevent blindness caused by cataract, trachoma and onchoceriasis. Cataract is the leading cause of blindness in Tanzania, responsible for one-half of all cases. Eye care services in Tanzania are characterized by a large backlog of cataract cases, unequal distribution of ophthalmologists and cataract surgeons between urban and rural areas, and an inability to reach out and mobilize to remote communities in need. HKI implements the VISION 2020 program's 3-pronged approach to eliminate blindness in the region by developing appropriate programs at the community level, developing the human resources to deliver eye care services, and putting in place the appropriate technology and infrastructure required to eliminate blindness.

HKI has helped to establish an effective community outreach strategy through Direct Referral Sites to increase the access of underserved rural populations to primary eye health services and to identify patients for cataract surgery. The program provides training of cataract surgeons and health workers, infrastructure improvements such as the development of ophthalmic operating rooms, and high-quality equipment in both regions. Efforts are also underway to improve financial and organizational sustainability, advocacy, and management training. The cataract surgical rate in Singida and Tanga Regions has more than doubled due to the combined effects of these interventions.

Onchoceriasis Control: Since 2000, HKI has been working with the African Program for Onchoceriasis Control (APOC) and the MOH to support onchocerciasis activities in the Tanga Region. There are three endemic districts in the region, with a total of 357,000 people needing treatment. HKI has been supporting the MOH in development of information, education, and communication materials, training, and supervision activities. The coverage rate of the people treated with the drug Mectizan is between 70% and 85% in the region since 2001. Since 2003, HKI has been working with the Community Directed Distributors (CDD) in the Tanga region to provide them additional training in primary eye care activities. These CDDs have also be trained to test community members for visual acuity and to refer patients to health facilities for refractive error screening and correction

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School Health: HKI also partners with the TIE and the Ministries of Education and Health to develop a school health program in the Dodoma Rural District. District officials, Ward Education Coordinators and school teachers in 40 schools have been trained to apply a school health and nutrition curriculum in all schools. About 80% of children in 20 schools have been dewormed twice a year, and children in 20 schools have also benefited from refractive error screening. A new partnership was forged with World Vision to activate integrate nutrition and health issues into existing school clubs.

Program Partners

• Comprehensive Community Based Rehabilitation in Tanzania
• Government of Tanzania, Ministry of Health and Social Welfare and Ministry of Education and Vocational Training
• Ifakhara Health, Research and Development Centre
• International Trachoma Initiative
• Johns Hopkins University
• Kilimanjaro Centre for Community Ophthalmology
• The Lions Club, Dar es Salaam chapter
• Sight Savers International
• The Starr Foundation
• Tanzania Food and Nutrition Center
• Tanzania Institute of Education
• UNICEF
• USAID Mission in Tanzania

Key Staff

• Laura D’Alessandro - Country Director
• Frowin Chittanda – Dodoma Field Coordinator
• Stephano Chima llo – School Health Coordinator
• Joseph Mugyabuso – Nutrition Coordinator
• Neema Wilson – Nutrition Coordinator
• Temina Abeid - Nutrition Administrative Assistant
• Farida Kippingu - Office Administrator
• Mhangi Kissuku - Finance Manager

Last updated: October, 2008