Rehema sits down carefully, holding onto the chair for added support. She looks tired; her bones are clearly visible through her baggy dress and her face is covered with small red bumps, a rash common in HIV-positive individuals. As Rehema begins to discuss her experiences with HIV, however, it is clear that the disease has not taken her spirit or her hope for the future.

Every week, this 42-year-old Tanzanian visits the Pastoral Activities and Services for People with AIDS in Dar es Salaam (PASADA) to get medicines that help her cope with a variety of opportunistic infections, to access support for her four children, or to visit with an HIV counselor.

Established in 1992 after a small group of people with HIV gathered together to seek mutual aid and support, PASADA is a faith-based organization that offers spiritual, social, medical, and material relief for people living with AIDS in Dar es Salaam, Tanzania. Since its founding, PASADA's services and client base have expanded tremendously; today, it serves more than 800,000 people every year through its Upendano Clinic and 15 diocesan health facilities located throughout the capital city. Operating under the Roman Catholic Archdiocese of Dar es Salaam, PASADA targets the poorest of the poor, offering comprehensive care and support to all people living with AIDS, regardless of religious affiliation. These services include voluntary counseling and testing; home-based care; educational psychological, social, and economic support to orphans and vulnerable children; diagnosis and treatment of opportunistic infections; and prevention of mother to child transmission (PMTCT) in eight of its 15 sites.

In 2003, PASADA was running out of HIV-testing kits, functioning without some necessary laboratory equipment and lacking quality data to manage its programs. Meanwhile, some PASADA staff felt they lacked sufficient knowledge to fully support orphans and other vulnerable children—particularly victims of physical and sexual abuse. A one-year grant provided by the Rapid Funding Envelope (RFE), established by the Tanzanian Commission for HIV/AIDS and eight international donors¹ with management support from Management Sciences for Health's Management and Leadership Program and Deloitte & Touche, has enabled PASADA to fill some of these critical gaps. As a result, patients like Rehema and her children continue to receive the quality care PASADA is known for.

Project Outcomes   Improved information collection and management to better address patient needs   Enhanced skills of PASADA staff, enabling them to improve assistance for people living with AIDS   Helped to establish support network between PASADA and social welfare professionals to advocate for abused children's rights   Established vocational training program for orphans and vulnerable children   Satisfied increased demand with new equipment and purchasing of HIV test kits

In 1999, Rehema spent several months caring for her dying husband. She suspected he had AIDS, though he had never been tested. After his death, Rehema fell ill and became increasingly concerned about her own HIV status. She confided in a friend, who recommended she go to PASADA for help. Rehema visited the Upendano Clinic in 2000 and after a long session with counselor Edwick Msemakweli, she decided to take an HIV test. One week later, she returned to learn she was HIV-positive: "It was hard to accept, but looking after my husband for so long helped me to accept." Rehema subsequently brought her four children, ranging in age from 11 to 21, to be tested. Though they all tested negative, PASADA provides them school uniforms and food when Rehema cannot.

Supporting families like Rehema's takes coordination and teamwork. Previously, PASADA was having difficulty keeping track of patients. Recent training in information systems provided under the RFE grant, however, has changed this. New computers sit in all the clinics and staff meet more regularly to share information. As PASADA's director said: "We had a terrible data collection system. Now we are getting off the ground, collecting data and better able to make decisions. We can now track everything and can plan programs based on needs." Coupled with purchases of new medical equipment and HIV test kits, the training has helped staff like HIV counselor Edwick better manage his work: "This training has given me hope and is helping [us] to cope better with the situation."

PASADA's support to orphans and vulnerable children has also improved. Almost 100 young people are now enrolled in vocational training courses, building their skills and offering them new possibilities for the future: "[This] has opened us up and helped [us] know that we can do something with our lives." PASADA staff have also received refresher courses in drug abuse, teenage pregnancy, and counseling, enabling them to better address orphans' needs. Finally, workshops that include PASADA staff as well as police, lawyers and other social welfare professionals have not only shared strategies to better address the special needs of abused children, but—an unexpected benefit—they have created a support network that communicates regularly and works together to address those needs.

Filling a critical funding gap has enabled PASADA to continue to fulfill its mission: "The [RFE] grant has complemented all of PASADA's work. It has given us something fundamental on which to build." Most importantly, the passion and dedication of PASADA staff continues to offer hope to the thousands of patients it serves. As Rehema reflects on the help her family has received she says: "My husband wanted to be educated. If I can educate my children, then I have left them something. Since I have visited PASADA, I feel healthy and my children are being helped. The demand [on PASADA] is great but the help is good."

¹ Canadian International Development Agency, Ireland Aid, Swiss Agency for Development and Co-operation, Embassy of Finland, Royal Netherlands Embassy, Royal Danish Embassy, Royal Norwegian Embassy, United States Agency for International Development

For more information about the RFE, please contact:
Grant Manager, Deloitte & Touche
10th Floor, PPF Tower PO Box 1559
Dar es Salaam, Tanzania
Email: RFE@deloitte.co.tz

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