In FY06, the Partnership for Supply Chain Management Systems (SCMS) was assigned as the primary procuring agent for PEPFAR-funded commodities and was also funded as the principal TA provider for commodities forecasting and management under the EP.

SCMS technical assistance helped ensure adequate management of HIV/AIDS products and other health commodities and strengthened the National Public Health Pharmacy (PSP) commodities management unit. In collaboration with the Ministry of Health and other partners, SCMS also reviewed and disseminated key commodities-management tools (computerized and paper-based) and standard operating procedures (SOPs) for district and facility levels.

With FY07 funds, SCMS will work to ensure that all PMTCT sites primarily supported by the EP through implementing partners EGPAF and ACONDA are able to generate regular, accurate commodities reports using improved management tools. SCMS will also ensure that all new sites are rapidly equipped, trained, and supported to use these commodities-management tools and produce regular reports.

SCMS will also procure PMTCT-related commodities in coordination with EP implementing partners and the Ministry of Health.

Table 3.3.01:

Since May 2005, the Emergency Plan/Cote d'Ivoire program has rapidly scaled up care and treatment across the country. Roughly 34,200 patients will receive treatment from one of the 72 PEPFAR-supported treatment sites by March 2007. Palliative care coverage has expanded from 7,228 to 52,757 patients (as of June 2006). As the program expands, it is critical that accurate and frequent commodities forecasts are done and real-time stock management at facility and central levels takes place.

In FY06, SCMS transitioned into the primary procuring agent for the EP-funded commodities and principle TA provider for commodity forecasting and management in Cote d'Ivoire. EP service delivery partners, including the APHL and CDC direct interventions, have either discontinued or limited their commodities purchases to emergency orders to fill unforeseen small gaps. SCMS procured ARVs, laboratory reagents and supplies, OI drugs and standardized packages for palliative care and OVC support, and equipment for EP existing and scale-up sites. Following an MOH directive to coordinate procurement to maximize efficiency and numbers of patients treated, EP and GF are following a cooperative procurement and management strategy for essential HIV-related commodities with the national authorities and the GF Principle Recipient, UNDP. The Government of Cote d'Ivoire also purchases small amounts of commodities with its own funds for this national "virtual pipeline".

This approach is monitored through an evolving joint implementation plan and a joint procurement plan including all commodities for MOH-accredited treatment and service delivery sites in the country. Due to recurring difficulties by the GF to deliver critical products to the National Program on time, SCMS and other EP partners have also procured these products through several emergency orders throughout the year. The interdependent nature of the program placed all EP-supported patients and sites at risk of stocking-out. The emergency orders also threatened the clinical monitoring of treatment, while it also diverted program funds from other essential activities.

During 2006, SCMS procured OI drugs and HIV-related commodities to support the expansion of programs from providing palliative care to 7228 patients, to over 52757 patients (in june 2006). The SCMS project also procured and delivered a basic package of support materials to 2465 OVCs as part of an integrated care and support program for vulnerable children. SCMS technical assistance also enhanced the institutional capacity of PSP-CI, health districts and target service facilities to ensure adequate management of HIV/AIDS products and other health commodities.

SCMS also strengthened the PSP commodities management unit to better forecast and manage commodities for all services sites in the National Program. More Specifically, in collaboration with the MOH and other partners, SCMS: 1. Disseminated commodity management tools (computerized and paper-based) and standard operating procedures (SOPs) for district and facility levels. 2. Provided ongoing supervision and quality control at all sites. 3. Strengthened capacity of the PSP to supervise commodity management at peripheral sites and to monitor use of OI drugs, including needs forecasting and procurement management. 4. Trained and supervised pharmacists and stock managers in commodity management at peripheral treatment sites, VCT centers and MTCT facilities. 5. Provided TA to GF and recipients in effective commodities management and facilitated regular coordination of joint procurement planning and tracking by the PSP.

FY07 funds will continue strong technical and management support to the PSP leadership and coordination role in the National HIV/AIDS Program. SCMS will ensure that all new scale-up sites are fully functional and technically supported in commodities tracking software, and that all sites are able to provide accurate monthly commodity reports. This will become routine by the end of FY07 activities. To improve decision making, SCMS will develop or adapt and roll out additional management tools for forecasting, procurement and management at the facility, district and national level. SCMS will continue to provide TA to the GF and sub-recipients as key partners in the National Program and seek continual improvements in data and decision quality and coordination.

Specifically, SCMS will use FY07 funds to: Ensure all existing treatment sites, including those primarily supported by the EP and those

supported by the GF, are able to generate regular, accurate OI and palliative care related commodity reports using improved management tools. SCMS will also ensure that all new sites are rapidly equipped, trained and supported to use these commodity management tools and produce regular reports. This will also make SCMS's collaboration with the MOH and GF in maintaining updated joint national commodities procurement and management plans for OI drugs and other palliative care commodities. SCMS will also procure OI drugs and other basic palliative care commodities for 34200 patients at 326 EP-supported sites. Specific needs projections and menu of OI drugs and materials for basic care will be negotiated with the MOH, GF and other partners in support of the overall target of 42640 OI patients, as well as 34200 infected individuals receiving a basic package of palliative care and basic support materials for 2465 OVCs by March 2008.

Despite its complex political crisis, CI continues to make rapid progress in scaling up comprehensive HIV treatment services. The national HIV program seeks to rapidly scale up quality comprehensive services and has embraced the EP five-year target of 77,000 persons under ARV by end 2008. As of end June 2006, 23,698 persons had initiated ART with direct support from an EP partner, and 18,234 were in active ART follow-up. As of end December 2005, 1,633 patients were under ART at sites where GF was the only major source of support. After delays in approval of the second phase of the GF HIV project, an active data-collection process is underway at all sites to verify or (at GF-only sites) collect data. In the first nine months of 2006, the EP was the only major funding source for the national program's HIV treatment services and commodities. By end March 2007, it is projected that the EP will support 75 sites and 34,200 patients on ART, with client accrual of more than 1,500 per month.

In FY06, SCMS was assigned as the primary procuring agent for PEPFAR-funded commodities and was also funded as the principal TA provider for commodities forecasting and management under the EP. Service delivery partners, such as EGPAF, either discontinued or limited their commodities purchases to emergency orders to fill unforeseen small gaps. SCMS procured ARVs, laboratory reagents and supplies, OI drugs and standardized packages for palliative care and OVC support, and equipment for the EP existing and scale-up sites. Following the MOH directive to coordinate antiretroviral procurement to maximize efficiency and numbers of patients treated, the EP and the GF are following a cooperative procurement and management strategy for ARVs and other essential HIV-related commodities, led by the national authorities. Originally, under this agreement the EP was primarily responsible for buying the majority of 2nd line and pediatric ARV formulations, plus around five percent of all first line ARVs for all MOH-accredited treatment sites in the country. This was the most cost-effective portion given current FDA approved medications and USG procurement regulations. The GF procured all first-line ARVs for the sites.

Due to recurring difficulties with GF procurements, SCMS and other EP partners, notably EGPAF, procured substantial amounts of these products through several emergency orders throughout FY06. With the interdependent nature of the program, this placed all EP-supported sites at risk of stocking-out of crucial products. It also diverted programmed funds from other essential activities. To avoid this situation in the future, SCMS is assisting the MOH in improving coordination and monitoring, to minimize unplanned procurements.

During FY06, SCMS technical assistance enhanced the institutional capacity of the PSP, health districts and target service facilities by ensuring adequate management of HIV/AIDS products and other health commodities. The program strengthened the PSP commodities management unit to support the health district depots and pharmacies in managing their commodities. More Specifically, in collaboration with the MOH and other partners, SCMS: 1. Reviewed and disseminated key commodity management tools (computerized and paper-based) and standard operating procedures (SOPs) for district and facility levels. 2. Provided ongoing supervision and quality control at all sites. 3. Strengthened capacity of the PSP to supervise commodity management at peripheral sites and to monitor use of ARV and HIV/AIDS related commodities, including commodity needs forecasting and procurement management. 4. Trained and supervised pharmacists and stock managers in commodity management at peripheral treatment sites, VCT centers and MTCT facilities. 5. Provided TA to Global Fund and recipients in effective commodities management and facilitated regular coordination of joint procurement planning and tracking by the PSP.

FY07 funds will continue strong technical and management support to the PSP leadership and coordination role in the National HIV/AIDS Program. SCMS will ensure that all new scale-up sites are fully functional and technically supported in using the SIMPLE I tracking software, and that all sites are able to produce accurate monthly commodity reports. SCMS aims to make this routine for each site by the end of FY07; and hopes to turn the management of this process over to the PSP in the future. To improve available data, SCMS will provide additional management tools that have been tailored for forecasting, procurement and management at the facility, district and national level. This forecasting and tracking will be closely tied to the electronic patient record to monitor use of drugs compared to actual prescriptive practices, as well as enabling more practical tracking of drug expiration and specific costs. SCMS will continue to provide TA to the GF and

sub-recipients as key partners in the national program and seek continual improvements in data and decision quality and coordination.

In FY07, SCMS will maintain up to date information on USG-approved drugs, commodities and manufacturers, including generic products, and advise the EP country team and MOH on evolving purchase options and cost analysis of key program components. SCMS will also advise the MOH and partners on current pharmaceutical market developments, manufacturing capacity and issues effecting delivery of essential products.

Exact needs projections of each drug and product will be negotiated with the MOH, GF and other partners in support of the overall target of 49,280 ARV patients, as well as other service targets for March 2008.

With the approval of additional plus-up funds, SCMS will expand to procure for an additional 10 new treatment sites in the North, which will provide ART to 3,000 additional patients and strengthen continuum-of-care activities in hard-to-reach settings. In addition, due to the continued blockage of the Global Fund Round 2 Phase 2 HIV/AIDS grant, PEPFAR is obligated to provide additional commodities, notably ARVs, to ensure that GF-supported patients continue to receive treatment without interruption. SCMS will expand to procure for lab commodities, including reagents and test kits, for an additional 10 new treatment sites in the underserved North, which will provide ART to 3,000 additional patients and strengthen continuum-of-care activities in hard-to-reach settings. In addition, due to the continued blockage of the Global Fund Round 2 Phase 2 HIV/AIDS grant, the EP is obligated to provide additional commodities, notably lab supplies and test kits, to ensure continued treatment services at 42 GF-supported sites.

Since May 2005, the EP/Cote d'Ivoire program has rapidly scaled up care and treatment across the country, from 24 to 72 treatment sites and an estimated 34,200 people receiving ART as of March 2007, all of whom require regular laboratory monitoring to ensure quality treatment. As of June 2006, there were over 52,757 enrolled in HIV/AIDS care, with 23,500 ever receiving ART and 18,235 on ART. As the program continues to expanded, it will be critical to ensure accurate and frequently updated commodities forecasts and to improve real-time stock management at facility and central levels.

In FY06, SCMS transitioned into the primary procuring agent for EP-funded commodities and principle TA provider for commodity forecasting and management in Cote d'Ivoire. EP service delivery partners, including the APHL and CDC direct interventions, have either discontinued or limited their commodities purchases to emergency orders to fill unforeseen small gaps. SCMS procured ARVs, laboratory reagents and supplies, OI drugs and standardized packages for palliative care and OVC support, and equipment for EP existing and scale-up sites. Following an MOH directive to coordinate procurement to maximize efficiency and numbers of patients treated, EP and GF are following a cooperative procurement and management strategy for essential HIV-related commodities with the national authorities and the GF Principle Recipient, UNDP. The Government of Cote d'Ivoire also purchases small amounts of commodities with its own funds for this national "virtual pipeline".

This approach is monitored through an evolving joint implementation plan and a joint procurement plan including all commodities for MOH-accredited treatment and service delivery sites in the country. Due to recurring difficulties by the GF to deliver critical products to the National Program on time, SCMS and other EP partners have also procured these products through several emergency orders throughout the year. With the interdependence nature of the program, this has placed all EP-supported patients and site at risk of stock-outs and gaps in appropriate clinical monitoring of treatment, as well as diverting programmed funds from other essential activities.

As a crucial component of treatment scale-up, the program has ensured adequate laboratory monitoring for patients receiving ARV and OI treatment at each EP-supported site. During 2006, in collaboration with the RETRO-CI project and other partners, SCMS provided equipment and supplies to expand VCT services from 55 to 72 sites, OI treatment from 24 to 72 sites, and increased lab capacity in 12 new ART sites.

During FY06, SCMS technical assistance enhanced the institutional capacity of PSP-CI, health districts and target service facilities to ensure adequate management of HIV/AIDS products and other health commodities. SCMS also strengthened the PSP commodities management unit, to better forecast and manage essential lab supplies for all services sites in the National Program. More specifically, in collaboration with the MOH and other partners, SCMS: 1. Integrated rapid test kits and other lab supplies into all commodity management tools (computerized and paper-based) and standard operating procedures (SOPs) for district and facility levels. Maintained a database of all lab equipment provided by SCMS to assist in planning regular maintenance. 2. Strengthened capacity of the PSP to supervise commodity management at peripheral sites and to monitor use of lab monitoring and related commodities, including commodity needs forecasting and procurement management. 5. Trained and supervised pharmacists and stock managers in commodity management at peripheral treatment sites, VCT centers and MTCT facilities. 7. Provided TA to GF and recipients in effective commodities management and facilitated regular coordination of joint procurement planning and tracking by the PSP.

FY07 funds will continue strong technical and management support to the PSP leadership and coordination role in the National HIV/AIDS Program. SCMS will ensure that all new scale-up sites are fully functional and technically supported in commodities tracking software, and that all sites are able to provide accurate monthly commodity reports. This will be routine by the end of FY07. To improve decision making, SCMS will develop or adapt and roll out additional management tools for forecasting, procurement and management at the facility, district and national level. SCMS will continue to provide TA to the GF and sub-recipients as key partners in the National Program and seek continual improvements in data and decision quality and coordination.

SCMS will use FY07 funds to ensure that all existing treatment sites, including those primarily supported by the EP, and those supported by the GF, are able to: generate regular, accurate commodities needs reports, using improved management tools. SCMS will ensure that all new sites are rapidly equipped, trained and supported to use these commodity management tools and produce regular reports. SCMS will also provide TA and collaborate with the MOH and GF to maintain updated, joint national commodities procurement and management plans for lab testing materials and reagents. These plans will include other essential patient monitoring commodities as well.

SCMS will act as the central USG procurement agent for rapid test kits, lab testing materials and reagents and other essential commodities for adequate patient monitoring at EP-supported sites. SCMS will procure lab equipment and supplies for 18 new ART sites, 216 new OI treatment facilities and 18 new VCT services in coordination with the RETRO-CI project and other technical laboratory partners. SCMS aims to install infrastructure and equipment, while reinforcing capacity by providing the necessary training and supervision. Specific needs projections will be negotiated with the MOH, GF and other partners in support of the overall target of 49,280 ARV patients, as well as other service targets for March 2008.

Since May 2005, the Emergency Plan Cote d'Ivoire program has rapidly scaled up care and treatment across the country, from 17 to 72 treatment sites and an estimated 34,200 people receiving ART as of March 200. Palliative care coverage expanded from 7228 to 38605 patients. As of June 2006, there were over 52,757 enrolled in HIV/AIDS care. As the program expands, maintaining accurate real-time information on both the available stocks and projected needs of all essential commodities is critical to maintaining uninterrupted services. Data required to ensure the overall supply chain are simple, and available at various levels of the program. However, a concerted effort is needed to ensure this information is gathered and analyzed regularly, and shared with all partners involved in commodities procurement and management, essentially EP, Global Fund through UNDP and the MOH. The Supply Chain Management Systems Partnership (SCMS) is providing the USG with a one-stop shop for technical assistance and procurement services. Therefore, the USG team will ensure that SCMS has the appropriate SI expertise available in-country, the right technology and tools tailored for the country context, and the appropriate level of investment in improving information management.

Following an MOH directive to coordinate procurement, the EP and the GF Fund have formed a cooperative procurement and management strategy for essential HIV-related commodities with the national authorities and the GF Principle Recipient, the UNDP. The Government of Cote d'Ivoire has purchased small amounts of commodities with its own funds for this national "virtual pipeline". This approach is now being monitored through an evolving joint implementation plan and a joint procurement plan. This plan includes all commodities for MOH-accredited treatment and service delivery sites in the country. All partners are participating in this joint exercise in good faith, but much work remains to be done to ensure smooth operation. Due to recurring difficulties by the GF to deliver critical products to the National Program on time and the prior lack of information sharing on GF order delays, SCMS and other EP partners had to procure critical products through emergency orders. It is clear however, that even with improved information sharing between stakeholders, more sophisticated systems for feeding information up on commodity needs are needed. Otherwise, with the interdependent nature of the program, poor forecasts or a lack of the appropriate information could create stock-outs or shortages.

To improve this situation, SCMS has focused on improving commodity information management and transparent coordination of supplies and needs of all partners in the national HIV/AIDS program. SCMS installed and supervised commodities tracking software at 21 of the planned March/08 all ART sites supported by the EP and Global Fund. SCMS created enormous improvements in the availability of reliable data for decision making, needs projections, and stock management at all levels of the national program. Site-specific commodity and ARV use data are being integrated and analyzed together with new electronic patient records to provide a more complete clinical and management picture of the care and treatment program. SCMS technical assistance is also enhancing the institutional capacity of the PSP (the central medical stores and director of the joint procurement plan in Cote d'Ivoire), health districts, and target facilities. SCMS is ensuring the adequate management of HIV/AIDS products and other health commodities at all levels. The project installed the Orion warehouse management system at the PSP to help the Government manage the movements and security of all HIV-related (and other) commodities processed through the central warehouse. The ongoing TA to the PSP has strengthened its ability to forecast and manage commodities to identify and correct supply problems before they occur. SCMS also provided TA to the GF to help improve commodities planning and management, and facilitated regular coordination of joint procurement planning and tracking by the PSP.

For several years, the MOH and partners have been working to develop an integrated facility-based health information system (HIS) as part of a strategic information plan in support of the national AIDS program. Many partners are supporting specific components of this effort, including RETRO-CI, MEASURE-Evaluation, and EGPAF in collaboration with the MOH-DIPE (the Directorate of Information, Planning, and Evaluation) and the PNPEC (the National HIV/AIDS Care Program). SCMS will collaborate with these partners to prevent duplication, and to ensure complementarity. Strong elements of the required information management systems already exist, including IT hardware and networks in most EP and GF-support sites. For instance, one local treatment partner, ACONDA, is implementing a computerized patient record system at all of its 17 sites with

comprehensive records for all patients registered in the program (whether on ART or not). To gather accurate forecasting data for ACONDA, the HIS, and the new Orion software provided to the PSP will interface.

The HIV/AIDS Alliance currently has a well-developed information system in Cote d'Ivoire to manage indicators from community based organizations reporting data to the MLS. A sub-partner under SCMS, Voxiva, since 2006 has collaborated with Alliance to improve their database to allow sub grantees to directly report M&E indicator data electronically via either cell phone or Internet. In FY07, this data will inform more accurate national forecasts.

FY07 funds will continue strong technical and management support to the PSP leadership and coordination role in the National HIV/AIDS Program. SCMS will ensure that all new scale-up sites are fully functional and technically supported in commodities tracking software, and that all sites are able to provide accurate monthly commodity reports. This will be routine by the end of FY07. To improve and refine the data that is available for decision making, SCMS will develop and in most cases adapt additional management tools for forecasting, procurement and management at the facility, district and national level. SCMS will continue to provide TA to the GF as key partners in the National Program and seek continual improvements in data and decision quality and coordination.

Specifically, SCMS will use FY07 funds to: Ensure that all existing treatment sites, including those primarily supported by the EP and those supported by the Global Fund, are able to generate regular, accurate commodities use, stock and needs reports using improved management tools. SCMS will rapidly equip new sites and train staff on the use of computerized or paper-based commodity management tools that will allow them to generate regular monthly reports.

SCMS will work with the PSP to spot check all partners on their data gathering. Quarterly analyses will be made available to stakeholders for better coordination and decision-making. Together with the PSP and relevant partners, SCMS will conduct regular supervision visits to all treatment sites to ensure commodities data systems are operating, and stocks are being stored, dispensed and tracked correctly. In conjunction with these visits, SCMS will provide ongoing TA and guidance to the National Program (PNPEC) and PSP to strengthen and refine its commodities forecasting, procurement management and tracking capacity for ARV, OI drugs, lab supplies and other HIV-related commodities for the national program.