Towards Stigma-Free Health Facilities in Tanzania: Guide for Trainers

The project, funded by the U.S. Agency for International Development (USAID) and the President's Emergency Plan for AIDS Relief (PEPFAR), is adapting and testing a stigma and discrimination reduction package for high-prevalence countries. This package includes an additional adolescent-specific component. The project involves conducting baseline assessments of stigma and discrimination in two health facilities in the Morogoro region. These assessments will provide evidence to design tailored stigma and discrimination reduction interventions, which will then be piloted in the two facilities. An endline assessment will be carried out three months later to assess the impact of the stigma and discrimination reduction interventions. The training guide for trainers is a key component of the intervention. It has been written for the training of trainers (TOT) component and will be used as the primary resource at the Training of Trainers Workshop for Stigma Reduction in the two participating health facilities. The guide was originally developed in English and translated into Swahili for finalization and use in Tanzania. The overall goal of the guide is to eradicate stigma and discrimination in health facilities through participatory capacity development for all levels of facility staff. The training program is focused on action, not just understanding stigma and discrimination, but concrete action to stop stigma and discrimination. Each exercise is intended to "trigger" participants to change their attitudes, adopt new behaviors, and take action to address stigma and discrimination in their health facilities. The steps for change outlined in the guide include: 1. Recognizing that stigma does not just occur, but is a result of individual behavior and attitudes. 2. Acknowledging that health facility staff may be driving clients away from health facilities due to their behavior and attitudes. 3. Reflecting on personal experiences of stigma and listening to other stories to gain empathy and understanding. 4. Realizing that everyone has a role to play in reducing stigma and discrimination. The guide provides a comprehensive framework for reducing stigma and discrimination in health facilities. It includes a range of exercises and activities designed to help health facility staff change their attitudes and behaviors, and take concrete action to address stigma and discrimination. The guide is intended to be used by health facility staff who have the capacity to facilitate stigma and discrimination reduction workshops for their fellow staff members. The HP+ project is working in collaboration with the Tanzania Ministry of Health, Community Development, Gender, Elderly and Children, and other partners to implement the stigma and discrimination reduction package. The project is also adapting and building on existing key documents, including the Facilitator's Training Guide for a Stigma-Free Health Facility and the Understanding and Challenging HIV Stigma: Toolkit for Action. The guide includes a range of appendices, including picture tools, a timetable template for training, and a post-training debrief. These resources are designed to support facilitators in preparing teaching materials and delivering the training program. Overall, the HP+ project in Tanzania is making significant efforts to reduce stigma and discrimination in health facilities through a comprehensive package of interventions. The training guide for trainers is a key component of this effort, providing a framework for health facility staff to change their attitudes and behaviors, and take concrete action to address stigma and discrimination.