P0106 Infant formula supply logistics: SCMS

This activity is has USG Team Botswana Internal Reference Number P0106. This activity links to the following: C0613 & P0101 & P0102 & P0103 & P0104.

The main focus of this activity is to provide support to MOH's PMTCT unit to develop and implement a logistics system for the procurement and distribution of infant formula. This will ensure that the commodities are in sufficient supply and moving through a supply chain that will support the infants enrolled in the program. The MOH's PMTCT unit is responsible for the procurement, using the GOB's tender regulations, and distribution of infant formula to all HIV-positive mothers for the first year of a baby's life. In FY06, approximately 14,000 babies were benefiting from the program. The unit manages a network of 3 warehouses located in Francistown, Gaborone, and Kang for the storage and distribution of the infant formula. However, currently there are no functional inventory control and logistics management information systems in place in the warehouses, and no formal ordering and distribution system.

The PMTCT unit lacks the personnel and expertise to efficiently conduct tenders for procurement, and adequately maintain the supply chain of the infant formula it is mandated to supply. The EP is not planning to fund the procurement of infant formula during FY07 but will support the MOH PMTCT unit to facilitate the procurement and distribution of these essential commodities.

During FY07, UNICEF will support a situational analysis of the commodity management system in place at the PMTCT unit. SCMS will review the findings and recommendations of this assessment, and where necessary conduct targeted analyses of aspects of the supply chain. A supply chain management system will be designed in collaboration with relevant stakeholders and staff of the PMTCT unit. The management system will ensure that quantification, procurement, storage, and distribution are done in a formal manner with an associated logistics management information system. The logistics systems developed will be documented, and manuals will be developed for use in quantification, inventory management, ordering, and information management. Training will be provided for procurement and stores personnel of the PMTCT unit in the new policies and procedures. A M&E system with appropriate indicators will be developed, and a supportive supervision system will be institutionalized. This will ensure that stock outs, and over stocks, leading to obsolescence and expiry are minimized.

This activity has USG Team Botswana Internal Reference Number C0611. This activity links to the following: C0610.

Botswana has a well established STI syndromic managent and STI/ HIV sentinel surveillance system in pregnant women since 1992, but STI Syndromic surveillance and the quality of STI Syndromic managent remains weak.

The prevalence of genital herpes among the GUD clients remains high and roll out activity of the acyclovir for treatment of HSV2 in the trained facilities has been delayed. There were 24,260 GUD cases reported ( 2003 STI statistics) about 17,816 new GUD cases reported in 2004 ( Monthly notifiable disease report 2004) and 60% of which are believed to be due to HSV2 ( 2002 Study). The relationship between HSV2 and HIV is well understood. Faliure to provide effective treatment to GUD case can contribute to the spread of both STI/HIV.

Currently MOH/DHAPC/STI Control program has completed training in about 20 Health districts on the revised STI Guidelines but implementation has been constraint by the delayed on acyclovir distribution to the facilities.

The evaluation of the STI training on the revised guidelines cannot be done without implementation of the recommended strategies of the revised guidelines.

Therefore, the need to urgently procure and distribute the acyclovir to the trained districts/facilities. The GOB/CMS will continue with the supply when logistics have been put in place. An adequate supply of acyclovir in all facilities of 24 districts will be provided.

Table 3.3.06:

An assessment of the TB laboratories has revealed needs in laboratory equipment and supplies in order to improve the AFB microscopy in satellite laboratories. Microscopes are not maintained properly and parts are missing. TB sputum tests are run without any safety precautions.

The plus-up funds will help to procure laboratory commodities for the satellite laboratories as well as establish a first-line maintenance system for microscopes and other laboratory equipment. These procurements will be done in accordance with Government of Botswana national protocols and USG rules and regulations.

Funding will be used to provide infection control equipment and improve space for the isolation of TB patients in selected district hospitals and HIV care settings. Through the Partnership for Supply Chain Management, a portacabin will be procured and equipped with extractor fans, ultraviolet lighting and other infection control equipment for the isolation of patients with infectious TB, including drug-resistant strains.

Home-based Counseling and Testing. USD $200,000 will be used to bring door-to-door HIV counseling and testing to additional clients in Selebi-Phikwe and Bobirwa districts. The program, the Counseling and Testing Outreach project, aims to provide intensive professional risk-reduction counseling and rapid HIV testing to everyone in two entire villages, to facilitate referrals to care and treatment and to involve the community at every step. Effectiveness will be assessed with an integrated program evaluation. At present, with FY 2006 and 2007 funds, the project will reach approximately 10,000 people. With addtional plus-up funding, we will reach approximately 4,000 more clients.

07-T1005: Supply Chain Mgt System (SCMS)

This activity has USG Team Botswana Internal Reference Number T1005. This activity links to the following: T1001 & T1003 & T1004 & T1111 & T1112.

Activity 1: Technical assistance to CMS The first component is to provide technical assistance and support to MOH's CMS to efficiently carry out its responsibility for procurement, quality assurance, storage, and distribution of HIV/AIDS related commodities for all government, mission, mine and non-government organizations in Botswana.

During FY06, Boehringer-Ingelheim conducted an assessment of the supply chain management system of Botswana. The USAID-funded organization entitled SCMS will review the findings of the prior assessment, and if required conduct specific targeted reviews of aspects of the supply chain systems for HIV/AIDS-related commodities. In FY07, SCMS will provide support to review the draft CMS Quality Manual and its implementation, which will involve reviewing the commodity flow processes of the CMS, and strengthening the product flow and operational processes of the CMS. SOPs and manuals will be developed, and training will be provided to all personnel to build capacity.

In addition, in FY07 a field trip and comprehensive training program for the management of the CMS and Pharmaceutical Services Division will be arranged by the SCMS Regional Distribution Center (RDC) in South Africa to acquaint management personnel with modern warehouse layouts and practices. Additionally, support will be provided to the CMS to review and strengthen transport logistics systems. To avoid stock-outs or stock overages, and to encourage efficient use of procurement resources, supporting FY07 SCMS will set up a coordinated mechanism for national level forecasting, quantification, and procurement planning for the GOB, Global Fund to fight Tuberculosis, AIDS, and Malaria (GFTAM) and USG-funded HIV/AIDS related commodities. This will entail developing 12 monthly procurement plans in collaboration with the CMS, USG, GFTAM, and other stakeholders. This plan will be updated quarterly to inform the procurement of commodities by the various funding mechanisms. Training will be provided to CMS procurement personnel in the use of Quantimed®, a quantification tool for the quantification of ARVs and Pipeline®, a JSI/DELIVER tool for continuous pipeline monitoring of HIV/AIDS-related commodities.

Activity 2: strengthen quality assurance systems for HIV/AIDS related commodities The second component is to provide support to strengthen the quality assurance systems for HIV/AIDS-related commodities, and to ensure that the quality of ARVs and other HIV/AIDS-related commodities are assured throughout the supply chain. The Quality Assurance Unit (QAU) of the CMS has responsibility for ensuring that all medicines procured and distributed by the CMS comply with international standards. FY07 funds will support the QAU to strengthen their procedures and systems to ensure that products procured by the CMS are of high quality, and that they are stored and transported in a manner that will ensure and maintain quality throughout the supply chain.

To support these activities, SCMS will set up an in country supply chain management team that will be funded initially by SCMS core funds. A portion of EP funds will be used to continue supporting these positions during FY07.

07-T1119: Supply Chain Mgt System (SCMS)-supplies for early infant diagnosis.

This activity has USG Team Botswana Internal Reference Number T1119. This activity links to the following: T1113 & T1114.

Procurement of laboratory supplies, reagents, and equipment is done through MOH's CMS. Gaps in the system result in delayed receipt of the laboratory equipment, reagents, and supplies at the end point.

In FY06 the nationwide rollout of early infant diagnosis began; in FY07 EP will continue this support to the program by procuring laboratory supplies, reagents, and equipment for the PMTCT program. These commodities will be procured in accordance with the GOB national protocols, and USG rules and regulations. About 5,000 infant diagnostic DNA PCR kits will be purchased to support the early infant diagnosis roll out as well as equipment for the second laboratory set up in Francistown.

To support these activities, SCMS will set up an in country supply chain management team that will be funded initially by SCMS core funds. A portion of EP funds will be used to continue supporting these positions during FY07.

07-1205: SCMS-Laboratory Procurement.

This activity has USG Team Botswana Internal Reference Number T1205. This activity links to the following: T1201.

Procurement of laboratory supplies, reagents, and equipment is done through MOH's CMS. Gaps in the system result in delayed receipt of the laboratory equipment, reagents, and supplies at the end point.

The main focus of this activity is to provide support to the CMS's laboratory section and the Botswana NHL to ensure that laboratory supplies are in sufficient supply, and moving through a supply chain that will support the scale-up of the ARV treatment program. A warehouse with adequate infrastructure will be put into place, and the SCMS program will facilitate the design of a new laboratory logistics management system to assure good storage and distribution. A cold room will be provided to the NHL for a good cold chain system to ensure the reagents are kept in optimum cold temperature.

Procurement of laboratory supplies, reagents, and equipment for the national ARV treatment program and the extension of the laboratory system will also be done through SCMS. These commodities will be procured in accordance with the GOB national protocols, and USG rules and regulations. To ensure long term sustainability of the intervention, SCMS will assist in improving national capacity through training and skills transfer to NHL staff.

VL, CD4, hematology and chemistry machines will be purchased through SCMS for the decentralized laboratories, the Quality Control laboratory at the NHL, and the early infant diagnostic laboratory in Francistown. Five thousand CD4 and VL kits to support the national ARV treatment program, and about 5,000 infant diagnostic DNA PACR kits will be purchased to support the early infant diagnostic roll out.

Laboratory supplies and equipment (e.g., centrifuges, Biosafety cabinets, and water distillers) will be purchased to strengthen the district and primary hospitals where these commodities are currently not available.

To support these activities, SCMS will set up an in country supply chain management team that will be funded initially by SCMS core funds. A portion of EP funds will be used to continue supporting these positions during FY07.