As part of the initial Central America Partnership Framework discussions, the USG and governments in the region identified supply chain management as a priority. Following successful work of SCMS in Honduras with bilateral funds, regional activities started in June 2010 to support the strengthening of the Guatemala supply chain. SCMS is building capacity through TA in inventory control, quantification, logistics management information systems, warehousing and distribution of MOH health commodities of the MOH, with emphasis in HIV, TB and malaria programs but also benefitting the nutrition, reproductive health and respiratory infections programs.

In FY2011 SCMS began development of similar activities in Nicaragua and Panama. Work began with a situational assessment of their supply chains. A Country Plan will be created in close coordination with the MOH and Social Security of each country. In FY2012 activities will also begin in El Salvador with a situational analysis of the supply chain for ARVs.

The SCMS work in this region provides a lowcost, country-owned solution which is a critical part of a GHI approach in general and ties to the GHI Strategy specifically in Guatemala.

Sustainability: All SCMS technical assistance is designed to empower local MOHs to manage their own supply systems. For example, after training and technical assistance in Panama, the MOH has established its own mechanism to do ARV estimation and projections for future years based on data to avoid overstock or stockouts. The length of time it will take to build the necessary skills in each country will vary- for instance work in Guatemala and Nicaragua will be more involved while assistance in Panama and El Salvador is limited due to a more advanced system already in place.

Global Fund / Programmatic Engagement Questions

1. Is the Prime Partner of this mechanism also a Global Fund principal or sub-recipient, and/or does this mechanism support Global Fund grant implementation? Yes2. Is this partner also a Global Fund principal or sub-recipient? Neither3. What activities does this partner undertake to support global fund implementation or governance?

Budget Code Recipient(s) of Support Approximate Budget Brief Description of ActivitiesHVSI MOH 190661 MOH:M&E for HIV, Malaria and TB Programs in Guatemala, Nicaragua and Panama. MOH:LMIS Assesment for HIV, Malaria an TB in Guatemala, Nicaragua and Panama.OHSS Ministry of Health (MOH), HIVOS 277002 MOH:National Programs Warehouse renovation process: workshop and meetings, preliminary design, final design, evaluation of the renovation process, creation of warehouse guidelines in Guatemala, Nicaragua and Panama. MOH:Equip the National Programs Warehouse in Guatemala, Nicaragua and Panama. MOH & HIVOSIn-Service Training for HIV, Malaria and TB Programs in quantification, warehouse best practices in Guatemala, NIcaragua and Panama.

In Guatemala SCMS will work to improve (LMIS) for HIV, Malaria and TB programs. SCMS supported the MOH with an LMIS assessment in November 2011. This provided the basis to harmonize the MOH LMIS across programs. The improved LMIS will benefit the quantification of commodities with more accurate data, which will lead to less stock outs and optimize the use of resources. The improvement of the LMIS will also contribute to a better inventory control. SCMS will support the MOH with supportive supervision and in service training in the LMIS and other logistic components including warehousing, distribution, quantification etc. The M&E staff will regularly visit all health levels that provide ARVs. They will work in improving the accurate capture of data and use LMIS at health regions, health centers and hospitals which provide special care for HIV patients. In 2012 SCMS will provide technical assistance to the new National Programs Warehouse in the design of a Warehouse Management System (WMS) that will be used for all the MOH Programs that buy their commodities centrally. SCMS will provide in service training for all the users of the new WMS system for the NPW. Improved information availability at the warehouse coupled with and harmonized LMIS across programs should dramatically improve the efficiency of the supply chain.

In Nicaragua, key interventions will include supporting ongoing efforts by the USAID | DELIVER PROJECT to integrate MOHs ARVs into the existing LMIS.

Unlike its neighbors in Central America, Panamas challenges are not as extensive in Supply Chain. For this reason, its expected that activities will focus on interventions aimed at alleviating specific problems that will have the greatest impact. Activities will improve available data for decision making as well improved quantification methods.

Keeping in line with GHI principals SCMS will work to create in house capacity for Quantification at the MOH across the region, working towards a sustainable future. SCMS will also collaborate, when appropriate, with PRSIMA a Logistics Training Institute working with both the MOH and the USAID | DELIVER PROJECT.

In 2010 in Guatemala the Global Fund evaluated the MOH capacities to manage the HIV grant. The evaluation highlighted the need to make improvements in the processes of storage and distribution for medicines. While in recent years the Central American region has increased investment to ensure the availability of drugs for the treatment of HIV, the investment in storage facilities and operational improvements have not followed the same pace. Following the Global Fund evaluation, at the request of the MOH, SCMS conducted an assessment in Guatemala and identified different flows of information for each program within the MOH and recommended the harmonization of this information. Based on these findings SCMS will work in three strategic areas: 1. Support the MOH to improve the National Programs Warehouse (NPW) conditions and the distribution system for their health programs. The MOH will use part of its GF grant to renovate the NPW, and SCMS will donate equipment and provide technical assistance for preliminary design, final design, evaluation during the construction process, and capacity building. 2. Improve the logistics information system (LMIS) for HIV, TB and malaria medicines. To achieve this SCMS will support the MOH with an LMIS assessment and supervision visits at all health levels. 3. Improve the quantification and procurement process for medicines and rapid test kits for HIV, TB and malaria. SCMS will conduct trainings and workshops in order to build the skills of MOH staff in this area.

Note that all SCMS activities in the country are in alignment with the GF logistics work plan for Guatemala, and are consistent with the Country Coordinating Mechanism objectives.

In Nicaragua SCMS will leverage support of the Global Fund to Malaria, TB and HIV , and work with leadership and staff of Central Medical Stores (CMS) to improve working and storage conditions. SCMS in partnership with USAID Powering Health will employ a green analysis of warehousing and distribution to reduce energy consumption at the warehouse complex. Efforts will combine an attempt to reduce temperatures as well as energy consumption in key CMS facilities.

In Panama SCMS will provide technical assistance in warehousing, information systems, distribution and conduct build on workshops in human resources, estimation of needs and best practices for supply chain.

SCMS will also begin targetted activities in El Salvador and will focus on supporting the National Aids Program needs in logistics in the coming year.

In all countries, SCMS will provide in service training on Quantification, and LMIS.