imtroductïoin

Of the 40 million persons living with HIV/AIDS worldwide, approximately 1.9 million live in Tanzania.1 In 2003, only 2% of adults in need of antiretroviral therapy (ART) in Africa were receiving it.2 Several programmes have been established to improve access to ART, including the Global Fund to Fight AIDS, Tuberculosis, and Malaria and the United States' President's Emergency Plan for AIDS Relief. The World Health Organization (WHO) and its partners have promoted a target of treating three million peoplewith ART by the end of 2005. Kilimanjaro Christian Medical Centre (KCMC) is the referral hospital for the Northern Zone of Tanzania. With its community partner organization Kikundi cha Wanawake Kilimanjaro Kupambana na UKIMWI (KIWAKKUKI; Women Against AIDS in Kilimanjaro), KCMC plays a central role in provision and capacity building for scale-up of HIV/AIDS treatment and care services for Northern Tanzania. In an effort to understand and address the capacity and capability for delivery of HIV/AIDS treatment and care in Northern Tanzania, we conducted a survey of health-care facilities in the Northern Zone

Methods

A standardized questionnaire was developed to gather data about human capacity and capability, clinical facilities and services, and laboratory capacity with respect to the delivery of ART and HIV treatment and care services. A sample of 20 health-care facilities was selected from a government list of over 50 facilities in the Northern Zone to provide geographic representation of the KCMC catchment area. The 20 selected facilities weregrouped into fourgeographical areas, each visited bya survey team of 2 -4 people. Each team included either a medical doctor or nurse and either a laboratory staff member or a pharmacy staff member. Teams were instructed to complete one questionnaire at each facility by interviewing the facility director or most senior medical staff person available and the most senior laboratory staff person available. Completed questionnaires were entered and analysed using Epilnfo 2002 software (Stone Mountain, GA, USA). There are five levels of health-care facilities in the Tanzanian public health-care system. From the highest to the lowest levels of service, they are referral hospitals, regional hospitais, district hospitals, health centres, and dispensaries. Non-government facility types include mission hospitals and factory hospitals. Data were stratified and analysed by regional and non-regional healthcare facilities. 

Results

Visits were completed at 19 Northern Zone health-care facilities by the survey teams between 15 July and 31 August, 2004. Of the 19 facilities, five (26%) were regional hospitals, five (26%) were mission hospitals, seven (37%) were district hospitals, one (5%) was a national tuberculosis referral hospital, and one (5%) was a factory hospital. Facilities surveyed had a median (range) of 150 (54-450) inpatient beds with a median occupancy of 75% (50-100%) in 2003. A median of 600 (20-40,000) outpatients were reported to be seen at the facilities each week.