By end of September 2009, at least 121,666 patients in the national ART program were receiving antiretroviral treatment through 32 ART sites, 109 satellite clinics and the public private partnership outsourcing scheme (MASA Monthly Report Sept 09). The Supply Chain Management System (SCMS) was established in-country in 2007, through PEPFAR funding, to provide technical support to Central Medical Stores (CMS), Drug Regulatory Unit (DRU), Drug Management Unit (DMU) and National Drug Quality Control Laboratory by establishing or strengthening logistics management systems for ARVs and related commodities. CMS is the main government of Botswana entity charged with the responsibility of procuring, storing and distributing health commodities to public, missions and mines health facilities countrywide. However, the DRU has the mandate to ensure that all medicines produced, imported, exported or used in Botswana are of good quality, efficacious and safe, and therefore have local market authorization. CMS and DRU are supported by the NDQCL through testing of medical samples submitted for tenders or registration purposes.

In FY2010, SCMS will collaborate with relevant MOH and Ministry of Local Government departments to strengthen logistics systems by:

Establishing A Logistics Management Unit

SCMS will support the design and set up of a logistics management unit (LMU) to be based at CMS. The LMU will serve as a central processing point to guide stock replenishment and ensure the continuous availability of commodities.

Strengthening Inventory Management At SDPs

SCMS will train 150 pharmacy personnel in the logistics requirements to support forecasting and re-supply activities. COP-10 training for the pharmacy officers will strengthen their capacity to use PIMS II.

CMS Management Support

MOH requested that PEPFAR provide a team of expert senior managers to manage CMS. The team started in September 2009 as change agents in this process while managing the CMS. In COP10, SCMS will provide short-term TA to priority areas in procurement, finance, warehousing and IT system complimenting government efforts.

Distribution Support: SCMS will support the hub and spoke concept as an alternative distribution systems.

Procurement Support: SCMS will support a Short Term TA team to have dedicated focus to assist with the implementation of the Procurement Strategy action which is required to transform Central Medical Stores.

IT System review: short term TA for reviewing and suggesting a suitable improvement plan for the warehousing and inventory management software currently in use at CMS will be provided.

Laboratory Infrastructure

SCMS will support laboratories earmarked for ISO accreditation and capacity building of Biomedical Engineers. Upgrading of storage capacity at SDPs and implementation of standard warehousing practices at NHL will continue under COP10.

SCMS in collaboration with NHL and BOTUSA Lab Technical team will continue supporting lab commodity specification and subsequent procurement.

Condom Logistics

CMS is to initiate integration of both female and male condom logistics management into the national commodity supply chain management system, through providing TA to national institutions, engaging government stakeholders (NACA, MOH, MoLG) and mobilizing development partners (ACHAP, UNFPA, PSI, RTI, Tebelopele) to jointly plan for continuous availability of condoms to all eligible users.

Strengthening Capacity For Medicines Quality Assurance

Collaboration between the University of Botswana Chemistry Department, North West University and USFDA to build NDQCL capacity to meet pharmaceutical analyses and microbial limit testing requirements for CMS tendering processes and DRU market authorizations will be undertaken.

Prevention Of Mother To Child Transmission

The PMTCT program needs extensive support to manage all aspects of infant formula supply chain including, forecasting, procurement planning, distribution management and commodity tracking.

In COP10 will support the roll out of the implementation and monitoring of the infant formula at district level.

In COP 10 PEPFAR funds will strengthen logistics capacity at NHL and CMS including strengthening reporting mechanisms for logistics data to feed into forecasting and quantification of these commodities. SCMS will also continue to support procurement of dried blood spots collection kits.

In accordance with the Partnership Framework this commodity management function will fully transfer to the Government of Botswana in the near future.

Promoting Health Information Sharing

The focus for COP-10 will be an integrated data collection, collation, aggregation and transmission system required to link the facilities with the centre and the storage hubs

10.X.SI17: SCMS - Optical Character Recognition - 163,625.00

The focus for FY10 will be an integrated system for data collection, collation, aggregation, and transmission. For the logistics system, what is required involves linking the SDPs with the CMS and developing regional storage hubs. The aim is to improve the flow, processing and analysis of logistical data, thus leading to the production of accurate and reliable information for supply chain decision making. The budget will support the following: ·Support for an extract, transform and load (ETL) programmer to facilitate the process of automated extraction of data from the various information systems used in the monitoring of different programs. Among the many positive outcomes of a central HIV data warehouse, is that the data will also be compared to CMS data and used for large scale forecasting and quantification of needs. ·Support for the introduction of Optical Character Recognition (OCR) tools to facilitate the transmission of data that often comes as hard copies (usually faxed, but often mailed) from facilities. These forms then have to be converted into an electronic format for capture in the data warehouse. OCR software should help streamline this process of data re-entry. ·Support for STTA to facilitate the design and implementation of the data transmission systems that will transmit logistics data from the facilities to the logistics management unit will be called upon. Procurement of data transmission equipment required to support the systems set up may also be necessary.

10.X.SS28: SCMS - CMS support - 2,337,500.00

The Central Medical Stores (CMS) has a mandate of procuring, storing and distributing medicines and related commodities to over 700 facilities. The GOB recognized the need to streamline and strengthen the management of CMS and transition the institution from its current status to a semi-autonomous body with PEPFAR support. MOH requested that USG/PEPFAR provide a team of expert senior managers to manage the CMS. The team that commenced duty in September 2009 was requested to be change-agents in this process while managing the CMS as a functional MOH unit providing uninterrupted supplies of medical and laboratory commodities to the nation's health facilities. SCMS supported the recruitment of each of the following positions; Chief Operating Officer, Operational Director, Finance Director, HR Director, Procurement Director and the Quality Assurance Director. In COP10, SCMS will continue to employ the recruited Managers and provide short term technical assistance to already identified priority areas in procurement, finance, warehousing and IT system that compliment government efforts. Capacity will be built to enable the expatriate management team to be replaced with local hires by September 30, 2012. Distribution Support: SCMS will support the hub and spoke concept as an alternative distribution systems through implementation of the recommendations of the hub and spoke assessment. Procurement Support: SCMS will support a Short Term Technical Assistance team comprising of procurement consultant, procurement analyst, tendering advisor and contracts advisor, who will be able to have dedicated focus to assist with the implementation of some elements of the Procurement Strategy action which is required to transform Central Medical Stores. IT System review: The current warehousing and inventory management software has been noted to be contributing to stock discrepancies at CMS that affect commodity availability to the end user. SCMS will provide short term technical assistance for reviewing and suggesting a suitable improvement plan for the warehousing and inventory management software (Oracle and Pulse) currently in use at CMS.

10.P.OP26: SCMS Condom Logistics - 327,250.00

In FY10, SCMS will take a central role in coordinating the constitution of the National Standing Committee on Condom (NSCC) and mobilizing development partners to implement recommendations from the USAID report by Xavier Tomsej of May 2009. With FY10 funds, SCMS will closely collaborate with CMS to initiate integration of both female and male condom logistics management into the national commodity supply chain management system. This will be done through providing technical assistance to key national institutions involved in managing the core functions of condom logistics, engaging key government stakeholders (National AIDS Coordinating Agency, Ministry of Health and Ministry of Local Government) and mobilizing development partners currently supporting some aspect of condom management to jointly plan for continuous availability of condoms to all eligible users. In FY10, SCMS will undertake the following strategic interventions with supporting activities: Streamline Policy and Coordination mechanism

Mobilize stakeholders to review and finalize the National Condom Strategy 2009-2011 to provide the necessary framework for partner coordination and support, including identifying and recruiting human resources to guide the technical process Organize joint annual planning and budgeting meetings, including establishment of sub-committees to undertake quarterly annual plan reviews Develop standardized tools for sharing information among stakeholders as a means of promoting coordination among stakeholders Provide short-term technical assistance (STTA) for establishment of the NSCC secretariat and transition the role to a nominated government partner

Improve commodity availability at the central level and service delivery points (SDPs)

Provide STTA for establishing a system for undertaking accurate condom forecasting Develop (or review and improve on existing) tools for reporting on condom utilization trend and data management to feed into national forecasts Provide technical assistance for reviewing existing procurement mechanisms and guiding processes of adopting an efficient procurement system that suits the Botswana market dynamic and is in line with the Public Procurement and Asset Disposal Board Ensure appropriate storage and timely distribution

Review existing warehousing and distribution system(s) for both female and male condoms utilized by each partner and share success stories for efficiently managed system(s) to promote necessary improvement among all partners Provide support for integrating condom warehousing and distribution into on-going reforms at Central Medical Stores Support review of the existing system for inventory management and initiate subsequent development/rollout of recommended system Quality Assurance

Support the Drug Regulatory Unit (DRU) to establish standardized systems for condom registration and market surveillance that will guarantee that only approved condoms are utilized in the country Provide STTA and human resources to the National Drug Quality Control Laboratory to strengthen capacity for condom testing and timely dissemination of results to relevant stakeholders Create awareness for quality monitoring among in-country suppliers of various brands of condoms and establish a mechanism for reporting quality related issues noted in the market

10.T.PT05: SCMS - Supplies for Early Infant Diagnosis - 205,700.00

Since receiving PEPFAR support for Early Infant Diagnosis (EID) commodities in FY07, SCMS has successfully procured and delivered rapid test kits, instruments and reagents, thereby alleviating previously prolonged periods of stock out crises. In FY08 and FY09, SCMS upgraded the commodity storage capacity at the National Health Lab (NHL) and streamlined the distribution of EID commodities. In FY10, SCMS will strengthen its logistics capacity at the NHL and Central Medical Stores (CMS), including the improving reporting mechanisms for logistics data to feed into the forecasting and quantification of these commodities and fully transfer commodity management from being PEPFAR-funded to being NHL/CMS funded. SCMS will also continue to support the procurement of dried blood spot (DBS) collection kits. It is expected that this activity will be phased out in the near future and that the Government of Botswana will be able to assume these tasks. Since the implementation of this activity, there have been several challenges experienced, which include: (a) a lack of commodity management capacity in the Ministry of Health's PMTCT Program; (b) the slow pace of consolidation of commodity management into CMS; and (c) the poor submission of logistics reports by service delivery points. The current proportion of infants tested by two months of age stands at 75%. The aim is to reach at least 85% of infants by the end of FY10. The target population benefiting from this activity is HIV-exposed infants either in utero and perinatally. These newborns are tested six weeks after delivery or at any point of contact thereafter, using DBS and PCR.

10.T.LS05: SCMS - Laboratory Procurement - 1,748,450.00

In FY09, SCMS supported both the procurement of laboratory equipment and system strengthening functions, including the development of a logistics management information system (LMIS) and the integration of the Logistic Information System with the Laboratory Information System. With FY09 funds, the National Laboratory Services and the Ministry of Local Government developed standards for storage facilities and infrastructure upgrades to meet those standards, and organized training on demand forecasting the use of the new LMIS tools. FY10 funding is requested to: 1. Continue the integration of the laboratory supply management activities at NHL into the Central Medical Stores. 2. Continue to strengthen the local capacity in forecasting and quantification of laboratory commodities. 3. Continue to support the MOH and PEPFAR-supported programs in the procurement of test kits, laboratory reagents, other supplies and equipment. 4. Strengthen the logistics office at the NHL, which is responsible for collating and analyzing the information for forecasting, procurement planning and decision making, by increasing the staffing level and advocating for the absorption of the staff by the MOH. 5. Develop and implement a monitoring and evaluation plan to measure performance and improve the supply chain in the country. 6. Work with the National Health Laboratory and the Biomedical Engineering Services Unit at the MOH to strengthen the systems for equipment maintenance and calibration, and support the standardization of laboratory instruments. 7. Develop a maintenance contract plan with the Biomedical Engineering and vendors to service the existing equipment procured with PEPFAR funds.

10.T.AD02: SCMS - ARV Drugs - 654,500.00

In FY10, SCMS will focus on systems strengthening, monitoring and evaluation to ensure the continuous availability and sustainability of ARV access through: · Implementing the CMS QMS Manual by training and mentoring CMS staff. · Conducting a comprehensive review of the current CMS procurement system, including supplier prequalifications, and training staff to improve efficiency. · Establishing a Logistics Management Unit to coordinate ARV data compilation, analysis and reporting. · Conducting a new medicines logistics design, training SDPs staff, and rolling out on-site logistics support visits. · Supporting the establishment of regional warehouses and hubs through the provision of warehouse management training and inventory management of equipment and tools. · Strengthening the quantification and supply planning for HIV/AIDS-related commodities through training and mentoring in Quantimed® and Pipeline®. · Supporting the establishment of a semi-autonomous Medicines Regulatory Authority through staff capacity building, advocacy, stakeholder consultation, policy formulation and staff training, including the setting up of a robust QMS. · Supporting the establishment of systems for the post marketing surveillance of registered medicines and the combating of counterfeit medicines in collaboration with the DRU. · Strengthening NDQCL pharmaceutical and microbial analysis through development of a collaborative mechanism comprised of the University of Botswana's Chemistry Department and North West University's Center for Quality Assurance of Medicines (CENQAM). · Strengthening the ARV Procurement and Supply Management M & E system through staff training.

10.C.TB09: SCMS - Strengthening lab capacity - 556,325.00

Previous assessments and audits of the TB laboratories have shown the need for laboratory equipment and supplies in order to improve the AFB microscopy in the satellite laboratories and TB diagnosis at the National TB Reference Laboratory (NTRL). Microscopes were not maintained properly, parts were missing, and TB sputum specimens were processed without any safety precaution. The National TB Program has also experienced challenges in commodity management. With funding from PEPFAR beginning in FY07, SCMS has continuously supported the Laboratory TB Program to strengthen the logistics system for laboratory commodities and build the capacity of personnel in laboratory commodity management through technical assistance and training, when required. SCMS has also supported the procurement of equipment, reagents and supplies for TB diagnosis, including microscopy and identification. In FY10, SCMS will continue to support commodity logistics systems, monitor the supply pipeline for uninterrupted delivery and commodity security, and undertake the procurement of essential TB commodities for the laboratory, when needed. As part of the national quality assurance program, SCMS will support equipment maintenance and calibration at NTRL, which will also facilitate the preparation for accreditation.