PEPFAR's annual planning process is done either at the country (COP) or regional level (ROP).
PEPFAR's programs are implemented through implementing partners who apply for funding based on PEPFAR's published Requests for Applications.
Since 2010, PEPFAR COPs have grouped implementing partners according to an organizational type. We have retroactively applied these classifications to earlier years in the database as well.
Also called "Strategic Areas", these are general areas of HIV programming. Each program area has several corresponding budget codes.
Specific areas of HIV programming. Budget Codes are the lowest level of spending data available.
Expenditure Program Areas track general areas of PEPFAR expenditure.
Expenditure Sub-Program Areas track more specific PEPFAR expenditures.
Object classes provide highly specific ways that implementing partners are spending PEPFAR funds on programming.
Cross-cutting attributions are areas of PEPFAR programming that contribute across several program areas. They contain limited indicative information related to aspects such as human resources, health infrastructure, or key populations programming. However, they represent only a small proportion of the total funds that PEPFAR allocates through the COP process. Additionally, they have changed significantly over the years. As such, analysis and interpretation of these data should be approached carefully. Learn more
Beneficiary Expenditure data identify how PEPFAR programming is targeted at reaching different populations.
Sub-Beneficiary Expenditure data highlight more specific populations targeted for HIV prevention and treatment interventions.
PEPFAR sets targets using the Monitoring, Evaluation, and Reporting (MER) System - documentation for which can be found on PEPFAR's website at https://www.pepfar.gov/reports/guidance/. As with most data on this website, the targets here have been extracted from the COP documents. Targets are for the fiscal year following each COP year, such that selecting 2016 will access targets for FY2017. This feature is currently experimental and should be used for exploratory purposes only at present.
Years of mechanism: 2007 2008 2009
09.T.AT10: SCMS - PIMS Support
CONTINUING ACTIVITY UNDER PERFORMANCE PASS
From COP08:
The Botswana National ART Programme is supported by a multidimensional community mobilization
initiative called MASA. The goal of MASA is to ensure universal access to HIV/AIDS treatment care and
services to the citizens of Botswana who require such. The programme is funded and supported by various
partners which include the government, PEPFAR, African Comprehensive HIV/AIDS Partnership (ACHAP).
The MASA ARV Programme currently has over 90,000 patients on HAART in the public and private sectors
and hopes to reach 110,000 patients on HAART by 2009 and 125,000 patients by 2010. These patients will
be served at both the Ministry of Health (MOH) and Ministry of Local Government (MLG) managed sites.
The MOH has established 32 sites which prescribe and dispense ARVs while the MLG has 60 sites
providing ARV prescription and dispensing services and is rolling out to other sites within the system.
For this rapid expansion to be successful, there is need to have a very strong and robust patient
management cum inventory management system deployed at the facilities where ARVs are dispensed.
Patient clinical and dispensing data are currently being managed with two software systems in the
Botswana ART sites - Meditech developed in South Africa and the MASA system developed in Botswana.
The Meditech system is deployed at 4 pilot facilities but as currently deployed, the system is unable to
provide very useful information on patient regimen ratios and inventory management which are crucial for
forecasting and quantification purposes. In addition, it is not available at district clinics. The MASA system is
deployed in most of the other facilities dispensing ARVs. The system has been very useful to the ART
programme for programmatic purposes. However, like the Meditech system, it is unable to provide useful
information on patient regimen ratios and inventory management for quantification purposes. Both programs
need further customization to improve their effectiveness to enable them generate the specific type of
information required for quantification purposes. The two systems are not interfaced making programmatic
data integration and analysis a problem
The challenges faced by the current data capture system for ARVs in the country include poor quantification
capabilities and inadequate tools for data analysis and reporting. This results in poor information flow to
Central Medical Stores (CMS) and MASA thereby affecting quantification of ART resource needs and
management. The CMS and MASA are concerned about these challenges and improving on these
parameters through the use of user friendly software which can be easily customized to the needs of the
Botswana ART programme will make CMS and MASA more responsive to the needs of a rapidly scaling up
programme. CMS currently faces huge challenges in projecting demand for ARVs at sites due to unreliable
logistic information flow and hence supporting hospitals and clinics to build capacity for effective supply
chain management will be the major determinant for ensuring a sustainable supply chain needed for HIV
prevention, care and treatment programs. SCMS will provide technical support to the MOH for the
development of a HIV/AIDS commodities tracking system. This activity will be for support to the national
MASA program in its initiative of developing a Patient Information Management System (PIMS) by
engagement of design consultants to develop the pharmacy module for the PIMS.
New/Continuing Activity: Continuing Activity
Continuing Activity: 19652
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
19652 19652.08 U.S. Agency for Partnership for 7711 5286.08 SCMS $500,000
International Supply Chain
Development Management
Table 3.3.09:
09.T.PT06: SCMS - Infant Formula Supply Logistics
The Botswana national PMTCT program provides all babies born to HIV-positive mothers with free infant
formula until they are 12 months old. Tins of powdered formula are provided and picked up by mothers at
public health clinics. During FY 2007, 13,000 babies received free formula. The program distributes infant
formula to three warehouses, which in turn distribute formula as it is ordered by districts, which then
distribute to clinics. At the national level, infant formula shortages occurred in 2005 and 2006 and
emergency formula supplies were purchased by PEPFAR. Causes of the shortages include difficulties with
government procurement processes and regional supply shortages. There is no infant formula manufacturer
in Botswana, and formula is usually procured from South Africa via local contractors (though bids from other
manufacturers are accepted). The national PMTCT program has no formal training in supply management,
no contingency plans for purchasing substitute foods for infants and no plan for formula rationing in times of
shortage. Improvements in formula supply chain difficulties are a high priority for the national program.
2007 Accomplishments
An assessment completed by UNICEF and CDC (with SCMS) highlighted the near lack of systems for
forecasting, procurement planning, storage, distribution and general stock management of the product at
the three warehouses and the clinics where it is given out. The new system developed to meet this need
requires maintenance and quality assurance. In April 2007, SCMS began supporting the PMTCT Unit in
procurement planning, process management, and forecasting of infant formula requirements and providing
technical support for designing a more viable and sustainable supply system.
2008 Plans
SCMS will conduct the following activities in FY2008: 1) Design an operational supply and distribution
management system using a robust Logistic Information Management System (LMIS). 2) Assist the PMTCT
Unit in procurement management for bid documents preparation, evaluation criteria and definition of
deliverables for effective supply contract performance management. 3) Train supply officers in inventory
and distribution management, demand management and forecasting, commodity tracking. 4) SCMS
logistics experts will provide continuing on-site mentoring support to entrench tools and standard operating
procedures introduced. All of these will address shortfalls identified in the assessment.
Continuing Activity: 17278
17278 17278.08 U.S. Agency for Partnership for 7711 5286.08 SCMS $240,000
Emphasis Areas
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $240,000
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.11:
09.T.PT05: SCMS-Supplies for Early Infant Diagnosis
2007 accomplishments
Procurement of laboratory supplies, reagents, and equipment is done through MOH's Central Medical
Stores (CMS). Gaps in the system result in delayed receipt of the laboratory equipment, reagents, and
supplies at the end point. In FY2006, the nationwide roll-out of early infant diagnosis began and continued
through FY 2007 with USG support.
The USG will continue this support to the program by procuring laboratory supplies, reagents, and
equipment for the PMTCT program. 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 implementation of EID nationally as well as equip the second laboratory in Francistown.
These activities will be supported through the in-country SCMS team.
Continuing Activity: 17313
17313 17313.08 U.S. Agency for Partnership for 7711 5286.08 SCMS $200,000
Estimated amount of funding that is planned for Human Capacity Development $200,000
Program Budget Code: 12 - HVTB Care: TB/HIV
Total Planned Funding for Program Budget Code: $5,452,214
Total Planned Funding for Program Budget Code: $0
Program Area Narrative:
In response to the challenges that HIV and AIDS present to Botswana, efforts continue to be made to diversify approaches, fine
tune technical support, and plan for future program sustainability with the support of the Presidents' Emergency Plan for AIDS
Relief (PEPFAR). The national HIV prevalence rate is 23.9% among adults ages 15 to 49, according to recent UNAIDS data, and
an estimated 300,000 are living with HIV/AIDS. About 53.2% of Batswana know their HIV status up from 25% in 2004, 95% of
pregnant mothers gaining that information through the Prevention of Mother to Child Transmission program. The Botswana 2007
Sentinel Survey indicated that HIV prevalence among pregnant women (15-49 years) is 33.7%, though the overall trend appears
to be decreasing from 37.4% in 2003. The Department of HIV/AIDS Prevention and Care reports that, as of the end of July 2008,
a total of 109,991 patients were receiving HAART, 97% of the 113,000 patients estimated to require treatment. Challenges
remain, however, with prevention, particularly the issue of multiple concurrent partnerships, alcohol abuse, nascent civil society,
and human capacity development.
Botswana has made impressive progress in scaling up a comprehensive national response to the HIV/AIDS epidemic, including
an antiretroviral therapy program that now treats an estimated 97% of eligible Batswana. Strong political and financial commitment
to the national Isoniazid Preventative Therapy (IPT) program by the Government of Botswana, coupled with USG funding and
technical support, have resulted in the first and most comprehensive national program in Africa, which has enrolled more than
72,000 PLWHA since its inception in 2001. Botswana now accounts for 80% of all PLWHA in the world on IPT who are reported to
the World Health Organization (WHO). Tuberculosis (TB) case detection rates of new smear positive cases remain high at 80%
and the country regularly reports 100% geographical DOTS coverage. With USG support, Botswana is one of the few countries
that has regularly conducted national drug resistance surveys (DRS), and the fourth such survey was conducted in 2007/2008.
Results are pending.
Despite these achievements, tuberculosis (TB) remains a major challenge and is the leading cause of death among people living
with HIV/AIDS (PLWHA). In 2006, the country reported 8,519 cases of all forms of TB, a notification rate of 453 cases per 100,000
population. It is estimated that the prevalence of HIV infection among TB patients is 60-86%. Among new smear positive cases
reported in 2005, the treatment success was 70% while 7% of these patients died. The IPT program was evaluated with FY08
funding, and the findings highlighted challenges in the areas of data management and treatment adherence. It proposed to
remediate the data deficiencies with FY09 funding.
A major drawback to an effective response was the absence of a national medium-term strategic plan to address TB in Botswana.
This has been developed through a collaborative process involving the Botswana National Tuberculosis Program (BNTP), USG
agencies, the World Health Organization (WHO) and other key stakeholders, including USG-funded partners. The strategic plan is
based on the WHO New Stop TB Strategy and prioritizes the national response to TB, TB/HIV and drug-resistant TB. PEPFAR
support covers the whole range of activities in the plan, particularly in TB/HIV and drug-resistant TB. FY09 funds will support the
printing and dissemination of the strategy document. To maximize USG resources, avoid duplication and maximize efficiency, a
USG interagency TB/HIV technical working group was formed in FY08 and conducted peer performance reviews. An expanded
TB/HIV TWG chaired by the BNTP and comprising of all implementing and funding partners was also formed and has met
regularly. USG-funded technical support was provided in the development of the Phase II application for Botswana's Round 5
GFATM grant, which focuses on scaling up community TB care, strengthening TB/HIV collaborative activities, and monitoring and
evaluation.
Recently revised national HIV and TB policies clearly describe the joint care of TB/HIV dually-infected patients, including guidance
for their referral between the TB and HIV/AIDS programs and for routinely testing TB patients for HIV and screening HIV clients
for TB. Tebelopele, a local NGO established with PEPFAR funding that provides voluntary counseling and testing services, has
piloted, with USG-funded technical assistance, a TB screening questionnaire that is currently being used in their sites. Data about
the number of TB patients identified through this active case finding method are awaited. At program level, reliable and accurate
data about joint TB/HIV care remain elusive. An assessment of the referral system between TB and HIV services to identify and
address barriers contributing to the low uptake of ART among eligible TB patients was planned with FY08 funding. Due to the
unusually high staff turnover at all levels of the Department of Public Health and Disease Control Unit in early 2008, the BNTP
postponed this project to late 2008/early 2009.
In the Electronic TB Register (ETR), HIV testing among TB patients is now 70% but ART uptake remains low among HIV-infected
TB patients and there are no data on cotrimoxazole preventative therapy for these patients. There are several contributing factors.
HIV services do not routinely record the number of HIV-infected clients screened or referred for diagnosis and treatment of TB.
Masa regularly assess their HIV-infected clients for TB during their regular review visits but there is no systematic capture of these
activities. The national TB policy follows WHO recommendations to defer ART in HIV-infected TB patients until the end of anti-TB
treatment (ATT) for all but very ill patients. When such TB patients eventually commence ART after completing ATT, they are not
recorded in the BNTP reporting system. With growing evidence for the benefit of commencing ART early during ATT (further
confirmed by the Starting Antiretrovirals at three Points in Tuberculosis (SAPIT) trial in South Africa), advocacy will be advanced
for a review of the national policy to enable more TB patients to receive ART. Though TB registers (paper and electronic) were
modified to enable collection of TB/HIV data, the quality of recording and reporting by the TB coordinators is poor, and many
records are incomplete. Trainings, support and supervisory visits of TB coordinators and trainings on TB/HIV surveillance will be
intensified in FY09 to address this deficiency. I-TECH receives USG funding for information management officers, who are placed
in every district. Through the expanded TB/HIV TWG, discussions are underway between I-TECH and BNTP on the best
utilization of these cadres to improve the quantity and quality of TB/HIV data. FY09 funds will continue supporting the
maintenance and upgrading of the ETR to facilitate better reporting and analysis of joint TB/HIV care activities, and will support
the post of an officer responsible for TB/HIV activities in BNTP.
A recent ominous threat is multi-drug resistant TB (MDR-TB). The number of confirmed MDR-TB patients is 160 but the true
extent of this emerging epidemic is likely significantly greater, and more worryingly, sporadic drug outages have increased the risk
of amplification of resistance, although the principal source of MDR-TB is likely failed drug-sensitive TB therapy. In January 2008,
Botswana became the first African country besides South Africa to report extensively drug resistant TB (XDR-TB), when 3 cases
were confirmed, one of whom died before commencing treatment. USG funds enabled the procurement of essential drugs for the
identified XDR-TB patients as an interim measure, and TA in the development of an application to the Green Light Committee of
the WHO, which enables access to 2nd line TB drugs for pre-approved countries. FY2009 funds will strengthen TB/HIV clinical
care and management of MDR-TB patients through University of Pennsylvania (UPenn) and I-TECH and allow the expansion of
clinical support for MDR-TB management to Maun and Serowe, two new centers designated by the Government of Botswana.
The programmatic MDR-TB management will be promoted through TBCAP, who will provide technical support on programmatic
organization of MDR-TB services, and through the implementation of laboratory-based database for routine surveillance of drug-
resistant TB which will benefit from the ongoing drug-resistance survey currently supported under COP 08 funds. A new partner,
the University Research Corporation (URC) will further strengthen drug-resistant management in selected districts and will work
with BNTP to address cross-border issues in TB control, MDR/XDR TB advocacy, communication and social mobilization
activities and implementation of infection control guidelines.
A significant deficit in Botswana is the absence of national TB infection control guidelines and a dedicated TB hospital. USG funds
have supported the development of draft national TB infection control guidelines and infection control trainings, technical
assistance (TA) to resuscitate the national TB infection control committee, as well as the bulk of funding for the renovation of the
Princess Marina Hospital TB isolation ward. In addition, technical assistance from Atlanta in this crucial area has been invaluable
over the past year. Initiatives in TB infection control this year will focus on printing the national TB infection control manual, roll-out
infection control trainings and provision of three porta-cabins appropriately fitted for infection control. Contingency funds will be
requested for anticipated requests for emergency IC measures (e.g., ultraviolet light fittings, fans, respirators) in the MDR-TB sites
and in selected Infectious Disease Care Clinics (IDCC). In FY2008, UPenn received funding from ACHAP to initiate a pilot TB
screening program for health care workers, and has received USG-funded technical input in developing the protocol.
To address the perennial threat of inadequate human resources for TB control, PEPFAR I funding has supported key positions in
the national IPT program, in training partners such as the International Teaching and Education Center on HIV (I-TECH), with
adult and pediatric clinical care specialists through the UPenn and the Botswana Baylor College Center of Excellence (BBCCOE),
and through mechanisms such as the TB Control Assistance Program (TBCAP). Principal activities this year will focus on adult
and pediatric TB/HIV and MDR-TB case management and promote linkages to community-based care through contact tracing
pilots supported by TA from CHOP and Baylor, and outreach clinical care and mentoring of health care providers extended to
Maun, Bobirwa, Serowe and to Francistown local clinics. USG support has enhanced capacity by funding the development of
national TB/HIV curricula (developed by I-TECH during 2007 and 2008) and the rolling out of national and district trainings on
case management, infection control, IPT, joint TB/HIV care, community based TB care and monitoring and evaluation.
Through the Partnership for Supply Chain Management Systems (SCMS), PEPFAR strengthened TB diagnostic capacity by
procuring laboratory equipment and reagents for microscopy, culture and drug susceptibility testing for the National TB Reference
Laboratory (NTRL). Equipment, reagents and trainings to prepare for the introduction of liquid culture and rapid diagnosis of MDR-
TB are well under way with USG support. TA by the American Society of Microbiologists (ASM) and American Public Health
Laboratory (APHL) has strengthened laboratory external quality assurance and a national QA team has been constituted to
improve the quality of sputum smear technicians and will begin nationwide site visits in the coming year. FY09 funding is
requested to continue the support. A no-cost extension is requested to support training of laboratory personnel at regional training
center for HIV/TB diagnostic services to be set up by the International Laboratory Branch of CDC/Atlanta, CDC/South Africa and
the South African National Institute for Infectious Diseases/National Health Laboratory Services.
FY2009 funds will be requested to provide TA from CDC Atlanta for activities to follow up the DRS; to locate patients with INH
monoresistant TB identified in the DRS in order to improve their treatment outcomes; to evaluate of relapse/reinfection rates as a
follow-up to the DRS; refine and improve the MDR database; a pilot project to intensify TB case finding in health facilities in
Francistown; an assessment of infection control in the national prison network; remediation of the IPT data issues; and a project to
reduce TB transmission in outpatient care settings.
The activities proposed above continue USG support in maintaining the momentum in the scale-up of HIV testing, care and
treatment for TB patients and suspects, and will enable Botswana to attain a position as a regional center of excellence for TB/HIV
control.
Table 3.3.12:
09.C.TB09: SCMS - Strengthening Lab Capacity
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:Funding from FY2009 will be used to
procure TB infection control equipment and supplies for distribution to selected health care facilities in
consultation with the Ministry of Health (MOH).
2007 Achievements
Prefabricated laboratories and additional laboratory personnel were provided by another stakeholder to
improve the TB diagnostic capacity in the country. FY2007 funds (including Plus Up funds) were used to
provide laboratory supplies, equipment and improve laboratory space for TB in the primary and district
hospital laboratories, the construction of the second culture and DST laboratory in Francistown and for the
reconstruction of the NTRL isolation room. The support improved quality control and quality assurance
systems in the laboratory network, resulting in enrolment of the reference laboratory for accreditation and
the commencement of the national drug resistance survey in July 2007.
FY2008 funds to SCMS will serve to procure equipment and laboratory supplies for TB culture and DST at
the NTRL, and to expand these services to the NRH laboratory. FY08 PEPFAR funds will support the
procurement of additional equipment and supplies to the new laboratories, including laboratories under the
MLG. The funds will also help to improve the transport of sputum and results from clinics to the laboratories
and the laboratories to clinics and hospitals.
Continuing Activity: 17731
17731 17731.08 U.S. Agency for Partnership for 7711 5286.08 SCMS $800,000
Construction/Renovation
Health-related Wraparound Programs
* TB
09.T.AD02: Supply Chain Management System - ARV Drugs
CONTINUING ACTIVITY UNDER A PERFORMANCE PASS
The GOB through its MASA program currently provides antiretroviral treatment to 90,478 patients at 32
hospitals and 30 satellite clinics. It is projected that this number will grow to 104,900 patients by September
2008. The number of satellite clinics will increase to 80 by March 2008 and 128 by March 2009.
HIV/AIDS commodities used in prevention, care and treatment are procured and distributed by CMS which
is charged with managing the entire supply chain for the country. CMS receives direct support from
PEPFAR for commodity procurement and this contribution is estimated to be equivalent to about 15% of the
total ARV procurement cost in the country. CMS has also been supported to train and hire staff to support
ART scale-up and to increase procurement of pediatric formulations.
Currently most ARVs used in the country are innovator brands as donations from multinational companies
(Merck) and the rest are procured with government funds. The government receives USG support through
DRU to strengthen systems for generic ARV registration in order to lower cost of ARVs. NDQCL received
support to augment their technology and skills capacity for quality testing of generic ARVs. The Clinton
Foundation has promised to donate pediatric ARVs for FY2007 and FY2008. SCMS proposes to continue
supporting all these organizations in FY2008 to augment capacities needed to build sustainable HIV/AIDS
supply chains in Botswana. SCMS will work as a partner to these organizations within the existing systems
and not develop any parallel systems.
This proposes activity has several components. One component provides technical assistance and support
to CMS to efficiently carry out its responsibility of procurement, quality assurance, storage and distribution
of HIV/AIDS related commodities for all government, mission, mine and non-government organizations in
Botswana. The second component will be on provision of technical assistance to the DRU in its mission to
assure quality of ARVs and related commodities used in care and treatment. The third activity supports the
national MASA program in its role to harmonize and coordinate all partners by ensuring the supply chain is
ready to support and sustain the new treatment guidelines and treatment objectives of the program.
In FY2007, SCMS worked with CMS to strengthen management systems through the development of clear
management quality performance indicators and a continuous monitoring and evaluation plan. Additionally,
support improved the IT infrastructure for commodity tracking at the stores and in the procurement and
distribution pipeline. Two key staff at CMS were trained at the SCMS Regional Distribution Center in South
Africa in good warehousing practices plus exchange visits to regional medical stores for benchmarking
purposes. Ten other staff were trained in procurement planning and forecasting at one of the tailor made
SCMS training programs that also covered use of specific software programs: Quantimed for forecasting
and Pipeline for procurement planning. CMS' in house Quality Assurance Unit received in-house training to
ensure quality of ARVs and related commodities that are provided along the supply chain up to the end
user. Other support provided related to the general operations management at the warehouse based on the
findings and recommendations of the Boehringer-Ingelheim Assessment Report that was adopted by
government. SCMS also supported the STI Unit at the MOH by procuring Acyclovir tablets worth $200,000.
DRU received technical assistance to assess registration systems for generic ARVs and training of in-house
staff in dossier review. Evaluation of application dossiers helped clear the back log in the registration
process.
PEPFAR through SCMS supported CMS and other partners in FY2007 to develop national forecasts for
ARVs needs for the next 24 months and set in place a system for continuous updates of these forecasts as
regular activity. In addition, 10 persons were trained in ARV and related commodities forecasting and
procurement planning. Working through the MASA program SCMS supported the setting up and facilitation
of an ARV Working Group that brings together all partners in the sector - MOH, MOLG, CMS, BOTUSA,
MASA, GFATM, Clinton Foundation, ACHAP, Harvard Program and the others for better harmonization of
forecasting and procurement planning. SCMS continues to assist in providing analyzed supply chain
information on both demand and supply sides that can be relied on to make decisions on resource
mobilization and scale up rates.
2008 plans
SCMS working in collaboration with partners will continue to support planned activities helping to further
enhance systems at the national level. Working with CMS, SCMS will provide support for strengthening the
distribution system for ARVs and related commodities including investigating options for a more effective
distribution structure which CMS can adopt to ensure continuous supply in an efficient manner to all the
ART sites (128 clinics under MLG and 32 hospitals under MOH) spread across the whole country. There will
be more focus on building capacity at the treatment site level for the 32 hospitals offering ART and working
with health clinics under the MLG. This work will involve development of tools for inventory management
and transactions tracking; electronic inventory and dispensing records; training of pharmacy staff in
quantification, product requisition; general inventory management training; commodity transactions tracking
information collection and analysis in order to make the supply system be fully pull based.
CMS currently faces huge challenges in projecting demand for ARVs at sites due to unreliable logistic
information flow and hence supporting hospitals and clinics to build capacity for effective supply chain
management will be the major determinant for ensuring a sustainable supply chain needed for HIV
development of a HIV/AIDS commodities tracking system; implementation of a revamped LMIS; train staff in
collection, analysis and use of information; and provide analyzed information to feed into product
forecasting, procurement planning and distribution management (supply and demand management). SCMS
will support the roll out of whatever technological solution is adopted by the MOH that is also in line with the
Activity Narrative: general health management information systems of the country. SCMS will continue to work with the DRU
to strengthen systems for quality assurance of ARVs in the country's supply chain. The support will include
short term technical assistance for in-house mentoring of DRU staff; training in post marketing surveillance
of ARVs and adoption of technology solution for maintaining the drug register.
GOB is strengthening its activity related to preventive care for HIV positive women. The newly revised care
and treatment guidelines recommends annual PAP smear screening for HIV positive women. A PAP smear
screening clinic is being put up for this purpose. Lack of basic equipment is making implementation difficult.
An amount of $80,000 is earmarked for purchase of PAP smear screening equipment so that the clinic
becomes fully operational.
Continuing Activity: 17801
17801 17801.08 U.S. Agency for Partnership for 7711 5286.08 SCMS $1,580,000
Estimated amount of funding that is planned for Human Capacity Development $900,000
Program Budget Code: 16 - HLAB Laboratory Infrastructure
Total Planned Funding for Program Budget Code: $5,854,615
The public laboratory network in Botswana is a referral system with 35 government laboratories, three mission hospital
laboratories, and three mine hospital laboratories. Government of Botswana laboratories include seven clinic laboratories, 16
primary hospital laboratories, six district hospital laboratories, one national health laboratory, two referral hospital laboratories, and
three reference laboratories. In addition, there are 15 private laboratories as well as about 35 VCT center laboratories.
Challenges include weakness in transporting specimens and results from the clinics to the laboratories and back from the
laboratories to the clinics. The distances between health posts, clinics and laboratories delay and compromise the integrity of the
specimens and also increase drastically the turn around time of the results. Data management is paper based in all public
laboratories. In FY2008 five pilot sites for the Meditech Laboratory Information System (LIS) computerized laboratory data system
were rolled out and plans for expansion in FY2009 are described.
The procurement system remains a burden for the laboratory system and other programs which run out of reagents and supplies
on a regular basis, thereby compromising turn around time and quality of service. Specimen transport and dispatching of result
remain a burden for the referral system in the country. The PEPFAR supported Supply Chain Management Systems group
(SCMS) is addressing it in FY2007 and will continue in FY2008, but it remains an issue. Resolution requires management and
supervision commitment from the Ministry of Health (MOH) and Ministry of Local Government (MLG).
The decentralization of CD4 has improved patient enrollment in the national ART program, Masa. Currently, a total of 29
laboratories (all districts hospital laboratories and some primary hospital laboratories with bigger catchments areas) are improving
the quality of service to the patients and the quality of the results. The decentralization of viral load (VL) testing depends on the
renovation of eight selected sites which is ongoing. The addition of new equipment at the two national HIV reference laboratories
has improved the turn around time but challenges still remain due to frequent break down, stock out of reagents and specimens
transport from clinics to the laboratory and the results from the lab to the clinics.
In FY2008, funds were requested to develop a Specimen Management and Results Tracking system and a technical working
group comprised of MOH, MLG and different stakeholders was formed. The Terms of Reference (TOR) of the TWG were to:
a. Review findings and recommendations of the assessment report on lab logistics conducted in
2007.
b. Define a system and processes on specimen and results management.
c. Review and finalize the draft specimen collection manual and distribute to users (lab staff,
clinicians and relevant health care providers).
d. Develop standard operating procedures (SOP) for laboratory specimen and results
management and train end users.
e. Review the requisition forms and other documents to include provision for documenting chain
of custody and other critical information.
f. Prepare a plan of action with timelines for the deliverables and facilitate implementation of the
new system.
FY2009 funds are requested to continue the development, implementation and training on the system developed with previous
years of PEPFAR support. AFB microscopy and TB EQA plan was developed in FY2008 to train and monitor laboratories doing
AFB microscopy. Roll out of the training has started and will continue in FY2009. The National TB Reference Laboratory was
strengthened with PEPFAR funds and as a result the national Drug Resistance Survey for TB was able to be completed after two
years of suspension after strengthening the laboratory. There is a plan to continue the improvement the laboratory by
development rapid diagnostic tools and molecular diagnostic capacity. FY2009 funds will be used to support the TB diagnostic
laboratory network and equip the second TB culture laboratory built in Francistown with USG support.
FY2007 and FY2008 funding strengthened the Nyangabgwe HIV reference laboratory for the northern area and an infant
diagnosis capability was set up which is improving the turn around time and the quality of the tests. FY2009 funds will continue
development of the infant diagnosis capability by providing human resources and additional equipment and enough reagents to
the program. With the development of Hematology and Chemistry capacity for the monitoring of ARV patients in the district, the
laboratory will be able to process all laboratory tests for the follow up and monitoring of ARV patients, CD4, Viral Load,
Hematology and Chemistry. The monitoring of the laboratory by an external body will continue in FY2009.
The decentralization of testing in FY2007 and FY2008 to Princess Marina Hospital clinical laboratory was done in order to release
the National Health Laboratory (NHL) from routine activities. A prefab laboratory was provided to the Princess Marina Hospital for
TB microscopy and microbiology testing for opportunistic infections (OIs). FY2009 fund will continue supporting Princess Marina
Hospital clinical laboratory by providing equipments and technical support as well as continue the accreditation process.
FY2009 funds will develop an integrated NHL for various public health activities and mainly support HIV surveillance and
strengthening OIs and STIs diagnostics. The NHL will also be strengthened to support and conduct quality assurance and quality
control (QA/QC) activities by providing field training and frequent onsite visit and monitoring. Over the last few years, Botswana
has followed the baseline report recommendations developed in 2002 intent on establishing a robust national quality assurance
program. In FY2008, USG supported the Botswana Quality Assurance program, providing technical assistance to the MOH
through short term on-site consultations in the areas of quality systems, TB and PMTCT. A review on the current status has been
developed to establish the program made towards the goal of establishing a strong quality assurance program. In FY2009,
funding is requested to continue with the provision of technical assistance in this area to further develop the quality of Botswana's
laboratory services to meet PEPFAR objectives. Plans are also in development to leverage CDC-BOTUSA local expertise
developed by the CDC Division of HIV Prevention Lab Group in viral load testing and genotyping to provide QA/QI to the national
Viral Load and Sequencing Laboratory at Princess Marina Hospital. Technical assistance and capacity is also planned to develop
a national surveillance strategy for drug-resistant HIV.
There is a need for robust Laboratory Information Systems (LIS) at Ministry of Health (MOH) administered laboratories throughout
Botswana. Purchase of a commercial LIS and a piloting phase to three sites was done in FY2008. In FY2009, APHL will provide
project management expertise to assist CDC/BOTUSA and the Botswana MOH in the effective implementation and management
of a pilot laboratory information system (LIS).
FY2009 funds will serve to develop a comprehensive national laboratory strategic plan that clearly describes a vision, mission,
strategic initiatives and essential implementation activities including delegation of authorities and responsibilities, objectives and
outcomes, timelines and proposed budgets for the organization of a Botswana National Laboratory Network that assures quality
laboratory services in support of Botswana's health priorities and supports improved health of the people of Botswana. This plan
should propose an organization and infrastructure that integrates public health laboratory services including disease specific
services for HIV, TB and malaria; reference testing services; quality management and biosafety; in service training and human
resources development; equipment maintenance and repair; and facility design and support.
Table 3.3.16:
09.T.LS05: SCMS Laboratory Procurement
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:
In FY 2007, SCMS conducted an assessment of the national laboratory commodity management system
that identified priority areas and results, and formed the basis for the on-going implementation plan. To
address the frequent difficulties of "stock outs" of laboratory commodities, SCMS supported procurement of
key reagents, equipment and supplies for BOTUSA supported programs and worked with the National
Health Laboratory (NHL) to re-design a more efficient and effective laboratory supply chain & logistics
management system capable of supporting a sustainable prevention, care and treatment HIV program in
the country, including a system for specimen and results handling, which had also been reviewed.
Physicians at treatment sites had continuously expressed a need to streamline the system for specimen
and results handling, which led, at times, to multiple tests being requested for the same patient with no
results coming back from the referral labs. Movement of specimens and results requires similar logistical
support as moving reagents and other supplies, plus the commodity tracking information, and was a major
area addressed in FY2008.
Other FY2008 activities focused on operationalizing the laboratory commodity logistics system at both at the
national and the testing sites levels. Activities implemented included:
1. a demand forecasting and procurement planning capacity;
2. an inventory management systems at all levels, meaning both the national and treatment site, consistent
with Good Inventory Management Practices (GIMP);
3. a robust logistics management information system (LMIS) that provided reliable information to feed into
the forecasting and procurement planning, plus decision making processes; that supported the
management of lab reagents and supplies, and included finding the right technological solution compatible
with the general HMIS of the country to roll out to all the laboratories;
4.the development and institutionalization of Standard Operating Procedures (SOP) for managing supplies
and key reagents used in HIV prevention, care and treatment;
5. the training and mentoring of key personnel in the existing laboratories to augment their skills and
capabilities for effective management of laboratory supplies and reagents;
6. the introduction and institutionalization of continuous monitoring and evaluation plans with clear indicators
to measure performance improvements initiated;
7. support to NHL and BOTUSA with procurement of reagents, medical and laboratory equipment for NHL
and other PEPFAR projects, taking advantage of the preferential prices that SCMS negotiates leveraging its
economies of scale for multiple country procurement.
8. the promotion of sustainability, through SCMS-initiated discussions with key stakeholders, including
MOH, Central Medical Stores (CMS), NHL, and BOTUSA, to integrate laboratory commodity including
procurement, warehousing and distribution into Central Medical Stores within the conditions set by both
NHL and CMS.
9. support BOTUSA HIV Prevention Research (HPR) and Global AIDS Program (GAP) with procurement of
equipment, supplies and reagents to develop a genotyping capacity at CDC/BOTUSA, in order to carry on
with the monitoring of drug resistance of patients on anti-retrovirals (ARV) and support the Ministry of Health
(MOH) genotyping laboratory by providing training and quality control and quality assurance capacity.
In FY2009, SCMS will continue to support both the procurement and system strengthening functions
including:
1. establishing a robust computerized logistics information management system (LMIS) which is capable of
interfacing with laboratory information system (LIS) and/or patient information management system (PIMS).
2. strengthening an integrated inventory control systems and LMIS for both Ministry of Health (MOH) and
Ministry of Local Government (MLG), at the central and health facilities levels, to facilitate the proper
management of laboratory reagents and supplies.
3. supporting the development of standardized procedures, policies and guidelines on logistics systems at
MOH and MLG for test kits and HIV-related commodities.
4. supporting NHL Services and MLG to develop standards for storage facilities and infrastructure upgrades
to meet those standards.
5. strengthening the logistics office at NH is responsible for collating and analyzing the information for
forecasting and procurement planning and decision making, by increasing the staffing level and advocating
for absorption of the staff by MOH.
6. continuing to strengthen local capacity in forecasting and quantification of laboratory commodities.
7. continuing to support NHL, BOTUSA and other PEPFAR supported programs in procurement of test kits,
laboratory reagents and other supplies.
8. developing and implementing a monitoring and evaluation plan with clear indicators to measure
performance, then using information to make improvements in the supply chain functions.
9. $200,000 will be used to build a laboratory for genotyping resistance results.
Additionally, SCMS will liaison with NHL to support the Biomedical Engineering Services Unit at MOH to
strengthen systems for equipment maintenance and support the standardization of laboratory instruments.
They will also support implementation of recommended improvements, including procurement of
refurbished porta-cabins, based on findings of the laboratory commodity warehousing infrastructure and
conditions assessment carried out in FY2008.
In FY 2007 SCMS supported procurement of key reagents, equipment and supplies for USG supported
programs; assessed, recommended and worked with NHL to re-design a more efficient and effective
laboratory supply chain and logistics management system capable of supporting a sustainable prevention,
care and treatment HIV program in the country including a system for specimen and results handling. An
additional activity in 2007 was to review the system for specimen and results handling between site
laboratories and referral laboratories. Physicians at treatment sites have continuously expressed a need to
Activity Narrative: streamline the system for specimen and results handling which leads at times to multiple same tests being
requested for the same patient with no results coming back from the referral laboratories. Movement of
specimens and results requires almost similar logistical support as moving reagents and other supplies plus
the commodity tracking information and that is why SCMS was asked to help find a solution to this
challenge.
2008 activities will focus more on operationalizing the system across the country, both at the national level
and the testing sites. This will include:
1) Demand forecasting and procurement planning capacity;
2) Inventory management systems at all levels (national coordination and treatment site) consistent with
Good Inventory Management Practices (GIMP);
3) A robust logistics management information system (LMIS) that provides reliable information to feed into
the forecasting and procurement planning plus decision making processes; that supports the management
of laboratory reagents and supplies, this will include supporting NHL to find the right technological solution
that is compatible with general HMIS of the country and help in its roll out to all the laboratories;
4) development and institutionalization of Standard Operating Procedures for managing supplies and key
reagents used in HIV prevention, care and treatment;
5) Training and mentoring of key personnel in the existing laboratories to augment their skills and
6) Introducing and institutionalizing continuous monitoring and evaluation plan with clear indicators of
performance to measure and using information derived from this process to make improvements in the
supply chain functioning;
7) SCMS will also continue supporting NHL and BOTUSA with procurement of reagents especially for
conducting surveillance and BAIS III (for an estimated amount of $300,000), medical and laboratory
equipments in the interim as NHL strengthens its capacity to undertake all procurement activities at the
country level. Even as NHL takes on this role, SCMS will provide an opportunity for the country to take
advantage of preferential prices that SCMS has negotiated with several manufacturers leveraging its
economies of scale for multiple country procurement potential.
Continuing Activity: 17279
17279 10260.08 U.S. Agency for Partnership for 7711 5286.08 SCMS $2,200,000
10260 10260.07 U.S. Agency for Partnership for 5286 5286.07 SCMS $1,400,000
