Detailed Mechanism Funding and Narrative

Years of mechanism: 2007 2008 2009

Details for Mechanism ID: 5414
Country/Region: Côte d'Ivoire
Year: 2008
Main Partner: Partnership for Supply Chain Management
Main Partner Program: NA
Organizational Type: Private Contractor
Funding Agency: USAID
Total Funding: $37,336,486

Funding for Biomedical Prevention: Prevention of Mother to Child Transmission (MTCT): $300,000

Since May 2005, the EP Cote d'Ivoire program has rapidly scaled up care and treatment across the country.

Implementing partners plan to provide PMTCT services to a year-end total of 15,000 women (ARV

prophylaxis) in FY08. SCMS and EP implementing partners will coordinate closely with UNFPA and other

donors planning to support PMTCT services and commodities at non-EP-supported sites. The EP program

will collaborate with reproductive-health and family-planning activities of other donors to strengthen

wraparound services at PMTCT sites, improve quality of care and client satisfaction, and decrease drop-

outs.

With FY08 funds, SCMS will continue to procure and deliver lab consumables for PMTCT that are not

provided by the AXIOS donation program (based on a projected 215,000 pregnant women to be tested, at

$2 per woman). These supplies are in addition to other testing materials to be procured for non-PMTCT CT

services. It is the responsibility of the MOH National HIV/AIDS Care and Treatment Program (PNPEC) to

submit timely and correct client-use reports to the AXIOS donation program to maintain the supply of those

free commodities.

ARV drugs for treatment-eligible women identified through the PMTCT program are included among

PEPFAR ARV commodities elsewhere in the COP08. Other commodities and support to be provided to HIV

-positive women identified through PMTCT services, as well as to their children, are included in OVC,

Palliative Care, and other sections of the COP08.

Following directives from the Ministry of Health, all incoming commodities are delivered to the Public Health

Pharmacy (PSP). The PSP will ensure delivery of these commodities to each PMTCT service site.

Funding for Care: Adult Care and Support (HBHC): $2,493,750

Since FY06, SCMS has been the primary procurement agent for PEPFAR-funded commodities and the

principal provider of technical assistance for the commodities supply chain, especially for forecasting and

management, in Cote d'Ivoire. In the FY07 program year, SCMS procured ARVs for 49,280 patients and OI

drugs for 34,000 patients on behalf of PEPFAR. The growth of the National HIV/AIDS Care and Treatment

Program in Cote d'Ivoire has been impressive, with an increase of almost 70% in the number of adults on

ART over the past 12 months. About 70% of all adult ARV patients are enrolled at PEPFAR-supported sites.

By March 2009, at least 60,000 patients will be on ART at one of 234 PEPFAR-supported sites.

Similarly, SCMS procured OI drugs and HIV-related commodities in 2006-07 to support the expansion of

palliative care programs from 7,228 patients to more than 52,750 patients (in June 2007). The SCMS

project also procured and delivered a basic package of support materials for 2,465 OVC as part of an

integrated care and support program for vulnerable children.

Following directives from the Ministry of Health (MOH), all incoming commodities are delivered to the Public

Health Pharmacy (PSP) for distribution to service sites. Following MOH policy to coordinate procurement,

and in an effort to improve efficiency, both PEPFAR and the Global Fund (GF) have followed an approach

of integration and "complementarity" under which more than one donor provides inputs to a given site. The

government of Cote d'Ivoire also buys small amounts of commodities with its own funds. The

interdependent nature of the national program promotes the collaboration desired by the USG, but it also

greatly increases the vulnerability of the PEPFAR program to under-performance of GF counterparts. To

succeed, this approach requires aggressive and regular data collection from all service sites and pro-active,

transparent information sharing among all stakeholders.

The Global Fund program experienced recurring difficulties in 2006 and 2007 and was unable to deliver

critical products on time. This caused commodities-dependent services at many GF sites to virtually shut

down for many months and placed all PEPFAR-supported patients and sites at risk of stock-out of GF-

provided supplies. Throughout this period, it was also extremely difficult to obtain reliable data on GF-

supported site and patient numbers, stocks, and expected delivery dates of pending orders of critical

commodities, either from the GF principal recipient (UNDP) or from the MOH. This lack of critical partner

information rendered the coordinated procurement and management approach virtually impossible and

made national service and commodities forecasting extremely difficult. As a result, SCMS and other

PEPFAR partners procured these products through several emergency orders throughout the year,

incurring millions of dollars in unforeseen program costs. These emergency measures were disruptive to

services and damaged the credibility of the national program and key implementing partners.

Several things have happened as a result of this: 1) GF has replaced UNDP with CARE International as the

principal recipient of its HIV grant; 2) CARE is in the process of placing its first ARV order with SCMS as its

GF procurement agent; 3) SCMS has become the official primary TA provider for supply chain management

for both the PEPFAR and GF programs; 4) SCMS will procure most drugs, lab supplies, and palliative care

and other commodities for PEPFAR implementing partners; and 5) PEPFAR will fund and require additional

regular situation reports from more aggressive data gathering and analysis systems supported by SCMS,

even while basic MOH systems are being strengthened. A critical component of SCMS support is

strengthening the data management and leadership capacity of the MOH to play its national oversight role

more effectively. SCMS will ensure that regular, detailed, and concrete commodities data and analyses are

available to inform all stakeholders and empower the MOH to make appropriate evidence-based decisions.

FY08 Activities

In addition to procuring most HIV-related drugs and consumables for PEPFAR/Cote d'Ivoire, SCMS will

continue strong technical and management support to the PSP leadership and coordination role in the

national HIV/AIDS program. SCMS will be held accountable for specific performance results and will adjust

its operational plan together with the USG team and PSP as the situation in Cote d'Ivoire evolves. (SCMS

becoming the principal procurement agent for CARE International as PR of the Global Fund HIV grant, for

example, is expected to cause fundamental changes in the availability of dispensing and patient information

for joint forecasting and monitoring.) SCMS will regularly update national ARV forecasting calculations

based on actual use patterns and will provide ongoing analysis of commodities consumption compared to

patient treatment data. This is critical to ensure rational commodities management and realistic scale-up

planning. SCMS will also advise the MOH and partners on current pharmaceutical market developments,

USG-approved products and suppliers, and manufacturing capacity as it affects supply to Cote d'Ivoire.

SCMS will provide (non-procurement) technical assistance, training, and systems/infrastructure

development to the MOH and key PEPFAR partners for ARV management as described below. This total is

distributed among the COP program areas of ARV Drugs, Lab Infrastructure, and Strategic Information.

This will cover all SCMS staff, consultants, operations and overhead, and technical assistance and training.

• Procurement

SCMS will procure and deliver a standard package of palliative care materials to the PSP central

warehouse and ensure prearranged distribution planning for all incoming orders to facilitate in-country

management. The program will ensure that a rational distribution plan is pre-calculated for each site, based

on prior consumption and validated at least quarterly using client data and physical inventory spot-checks.

In FY08, SCMS will procure cotrimoxazole for 126,000 adults and children (in syrup form for infants),

covering all identified PLWHA (both ART patients and non-ART patients) who should receive cotrimoxazole

prophylaxis according to pre-established guidelines (adults with CD4 counts <500 and children according to

WHO guidelines). In addition, SCMS will procure insecticide-treated bed nets for 90,000 patients and clean-

water kits (container and chemical products) for 36,000 patients, for targeted distribution to those at highest

risk (children under age 5, pregnant women, areas with poor water quality).

Technical Assistance and Training

SCMS will continue to improve the quality, accuracy, and frequency of palliative care commodities

forecasting and supply planning in partnership with the Global Fund, Clinton Foundation, and others through

support to the PSP Cellule ARV. These systems-strengthening costs are included under the Strategic

Information, ARV Drugs, and Lab Infrastructure sections of the COP08. The same systems that track and

manage ARVs will be expanded to include these other commodities.

Wraparound Programs

Activity Narrative: The PEPFAR/Cote d'Ivoire team will collaborate closely with other programs, notably the Global Fund HIV,

TB, and Malaria programs, to map the specific non-ARV support available for HIV-infected and -affected

people. The malaria program plans to distribute a number of insecticide-treated bed nets, which can be

targeted to pregnant women, young children, and PLWHA, for example. In its role as the primary source of

technical expertise for commodities forecasting and supply chain management, SCMS will support more

rational, coordinated planning of inputs from other donors, including EU, GF, and Clinton Foundation. The

USG team is working with USAID/West Africa and OGAC to broker technical assistance to the Global Fund

TB program to develop its required Procurement Supply Management (PSM) Plan to avoid blockage of

disbursements from Geneva.

Funding for Care: Orphans and Vulnerable Children (HKID): $506,200

Since May 2005, PEPFAR Cote d'Ivoire has rapidly scaled up HIV/AIDS care and treatment across the

country. Care and support for orphans and vulnerable children (OVC) has grown from 2,199 OVC in 2005 to

24,234 as of March 2007. As the Cote d'Ivoire program expands, accurate and frequent commodities

forecasts and real-time stock management at facility and central levels are essential.

In FY06, the Partnership for Supply Chain Management Systems (SCMS) was assigned as the primary

procuring agent for PEPFAR-funded commodities and was funded as PEPFAR's principal technical-

assistance provider for commodities forecasting and management.

In 2006 and 2007, SCMS procured and delivered a basic package of support materials for 2,465 children as

part of an integrated care and support program for OVC. SCMS technical assistance enhanced the

institutional capacity of the Public Health Pharmacy (PSP), health districts, and targeted 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

service sites in the National HIV/AIDS Care and Treatment Program.

With FY08 funds, SCMS will continue strong technical and management assistance to support the PSP in

its leadership and coordination role in the national HIV/AIDS program. In the program area of OVC, SCMS

will procure and deliver a standard package of commodities to support orphans and vulnerable children

through the community activities of other EP partners. Specific needs projections will be negotiated with the

Ministry of Health, the National OVC Program (PNOEV) of the Ministry of the Family, Women, and Social

Affairs, and other partners in support of the overall target of 63,000 OVC. SCMS will ensure that a rational

distribution plan is pre-calculated for each partner, based on prior consumption and validated at least

quarterly using client data and physical inventory spot-checks.

To facilitate effective commodities forecasting, SCMS will support the inclusion of systematic OVC kit

forecasting and supply planning into a coordinated procurement system at the PSP.

It is anticipated that no supplementary funds will be needed to support this program component.

Funding for Treatment: ARV Drugs (HTXD): $26,864,486

SCMS is the primary procurement agent for Emergency Plan-funded commodities in Cote d'Ivoire and the

principal provider of technical assistance for the commodities supply chain, especially for forecasting and

management. As the EP-supported HIV/AIDS care and treatment program scales up, SCMS procures most

drugs, lab supplies, and other commodities for EP implementing partners. In FY07, SCMS is procuring

ARVs for 49,280 patients and OI drugs for 34,000 patients. A critical component of SCMS support is

strengthening the data-management and leadership capacities of the Ministry of Health (MOH) to enable it

to play its national oversight role more effectively. SCMS will ensure that regular, detailed, and concrete

commodities data and analyses are available to inform all stakeholders and empower the MOH to make

appropriate evidence-based decisions.

During the past two years, SCMS has provided technical assistance to strengthen the institutional capacity

of the Public Health Pharmacy (PSP) and of selected health districts and HIV/AIDS care and treatment sites

to improve the management of drugs and commodities. SCMS has:

• Provided ongoing technical and management support to ARV supply-chain coordination at the central

level. This includes preparing detailed 24-month national ARV forecasts and supply plans and periodic

national forecast updates with MOH and Global Fund (GF) data. In collaboration with Alliance Cote d'Ivoire

and other partners, SCMS has conducted an assessment of data-reporting requirements for HIV/AIDS.

SCMS has strengthened commodities-management systems and practices at the district level. SCMS has

also reviewed and disseminated an ARV dispensing tool (SIMPLE-1 software) to treatment sites. Several

GF sites still do not have SIMPLE-1 to automate the roll-up of ARV dispensing data, but the needed IT

hardware is in place, and installation will begin soon.

• Conducted an assessment of warehousing and distribution functions of the PSP and selected treatment

sites. SCMS has worked to upgrade the physical infrastructure of the PSP and district warehouses and to

prepare for installation of the MACS computerized warehouse-management system at the PSP. SCMS has

also assisted the PSP with the development and implementation of new standards of practice for

commodities management at the PSP warehouse.

• Conducted a commodities-management training of trainers at the PSP and set up a system for tracking

ARVs and laboratory commodities through the PSP to treatment sites. SCMS has recruited two full-time

staff members to second to the PSP. SCMS has also conducted commodities-management training for 425

nurses, midwives, and PSP staff at the treatment-site level, as well as training on warehouse management

for two PSP staffers. In addition, SCMS has provided support to the PSP for on-site supervision and

training.

FY08 Activities

In addition to procuring most HIV/AIDS-related drugs and consumables for the EP/Cote d'Ivoire, SCMS will

use FY08 funds to continue strong technical and management assistance in support of the PSP's

leadership and coordination role in the national program. SCMS will be held accountable for specific

performance results and will adjust its operational plan, in consultation with the USG team and the PSP, as

the situation in Cote d'Ivoire evolves. SCMS will regularly update national ARV forecasting calculations

based on actual use patterns and will provide ongoing analysis of commodities consumption compared to

patient treatment data. This is critical to ensure rational commodities management and realistic scale-up

planning. SCMS will also advise the MOH and partners on current pharmaceutical market developments,

USG-approved products and suppliers, and manufacturing capacity as it affects supply to Cote d'Ivoire.

SCMS will provide (non-procurement) technical assistance, training, and systems/infrastructure

development to the MOH and key EP partners for ARV management as described below. This total is

distributed among the COP program areas of ARV Drugs, Lab Infrastructure, and Strategic Information.

This will cover all SCMS staff, consultants, operations and overhead, and technical assistance and training.

• Procurement

SCMS will procure and deliver ARVs to the PSP central warehouse and will ensure that a rational

distribution plan is pre-calculated for each site, based on prior consumption, and validated at least quarterly

using client data and physical inventory spot-checks. SCMS will procure ARVs for 60,000 year-end patients

for the FY08 year. The EP program expects to be providing ART for 46,500 patients by October 2008;

SCMS will procure drugs for 12 full months for this cohort, plus drugs for 13,500 new ART patients, with a

five-month buffer supply. SCMS will also procure a further buffer stock of ARVs covering about 5,400

patients.

In addition to ARVs, SCMS will procure cotrimoxazole (CTX), insecticide-treated bed nets, and clean-water

products for PLWHA.

• Commodities Forecasting

SCMS will continue to refine and improve the quality, accuracy, and frequency of ARV and other

commodities forecasting and supply planning in partnership with the GF, Clinton Foundation, and others

through support to the PSP Cellule ARV. The project will perform these updates in collaboration with PSP

staff, RETRO-CI, and the national reference laboratory to continue transferring these skills, and will conduct

regular cross-over analyses to compare commodities dispensed by the PSP and specific sites with the

actual patient data to inform clinical-services decisions.

To strengthen transparency and national ownership of supply-chain responsibilities, SCMS will generate

regular monthly reports showing all pending orders and deliveries, specific quantities, and expected delivery

dates to the PSP. The project will also provide monthly inventory and dispensing reports from each EP-

supported treatment site. These reports and analyses will signal to care and treatment stakeholders anytime

the projected virtual stock of any ARV or HIV-related commodity will be less than three months at the

national level or at any site. (Projected virtual stock is the sum of current inventory and expected

consumption, plus realistically expected new deliveries.) SCMS will ensure that regular monthly reporting

and computerized proactive supply-chain management systems include detailed information on OI drugs,

lab reagents, and testing materials, as well as commodities for palliative care and OVC support.

In collaboration with the MOH and other partners, SCMS will establish and maintain a Web-based ordering

and inventory tracking system for EP-procured HIV commodities. Service sites and other authorized

Activity Narrative: partners will be able to log in and place orders from the PSP, track their delivery progress, and confirm

historical data on consumption and projected scale-up at their sites. This is expected to greatly enhance

transparency of commodities management and decrease stock-outs and emergency orders due to

inadequate forecasting at all levels.

• PSP and MOH Capacity Building

At the PSP, SCMS will deploy a site quality-assurance manager to oversee upgrades to physical

infrastructure and management systems. SCMS will complete the planned physical upgrades to the ARV

warehouse at the PSP and will prepare comprehensive SOPs for all ARV-related PSP tasks. The program

will prepare, coordinate, and manage on-the-job warehouse staff training for basic operations of receiving,

picking, checking, packing, and dispatch as well as supervision, security, and safety. SCMS will install the

MACS warehouse management system at the PSP to improve central management of EP commodities and

will train PSP staff in its effective use. SCMS will also support upgrades to the PSP vehicle fleet and

associated commodities handling equipment to improve the efficiency of distribution systems and the safety

and security of EP commodities. SCMS will commence physical upgrades to high-volume storage facilities

to ensure the safety and security of EP commodities.

To ensure timely data for critical planning, SCMS will ensure that SIMPLE-1 or a compatible program is

installed and providing computerized monthly dispensing and inventory reports from all EP-supported ART

sites. SCMS will procure and install IT hardware where needed and will train and provide ongoing

supervision to site-based staff. In any instance where monthly data are not reported on time, SCMS will

ensure that those data are gathered and transmitted to PSP to generate a full and accurate picture of the

end-use of all EP-procured commodities.

To strengthen the technical autonomy of the PSP, SCMS will continue on-the-job training and will hire a full-

time warehouse floor manager to second to the PSP. SCMS will also support the preparation of a long-term

restructuring and investment funding plan for PSP operations.

Wraparound Programs

SCMS will support more rational, coordinated planning of inputs from other donors, including the European

Union, GF, Clinton Foundation, and others. EP support for improved information management at site and

national levels will also directly enhance the ability of other health services to manage essential

commodities, including contraceptives and TB and malaria drugs.

Funding for Laboratory Infrastructure (HLAB): $6,672,050

SCMS is the primary procurement agent for Emergency Plan-funded commodities in Cote d'Ivoire and the

principal provider of technical assistance for the commodities supply chain, especially for forecasting and

management. As the EP-supported HIV/AIDS care and treatment program scales up, SCMS is procuring

most drugs, lab supplies, and other commodities for EP implementing partners. In FY07, SCMS is procuring

ARVs for 49,280 patients and OI drugs for 34,000 patients. A critical component of SCMS support is

strengthening the data-management and leadership capacities of the Ministry of Health (MOH) to enable it

to play its national oversight role more effectively.

During the past two years, SCMS has provided technical assistance to strengthen the institutional capacity

of the Public Health Pharmacy (PSP) and of selected health districts and HIV/AIDS care and treatment sites

to improve the management of drugs and commodities. SCMS has:

• Provided ongoing technical and management support to ARV supply-chain coordination at the central

level. This includes preparing detailed 24-month national ARV forecasts and supply plans and periodic

national forecast updates with MOH and Global Fund (GF) data. In collaboration with Alliance Cote d'Ivoire

and other partners, SCMS has conducted an assessment of data-reporting requirements for HIV/AIDS.

SCMS has strengthened commodities-management systems and practices at the district level. SCMS has

also reviewed and disseminated an ARV dispensing tool (SIMPLE-1 software) to treatment sites. Several

GF sites still do not have SIMPLE-1 to automate the roll-up of ARV dispensing data, but the needed IT

hardware is in place, and installation will begin soon.

• Conducted an assessment of warehousing and distribution functions of the PSP and selected treatment

sites. SCMS has worked to upgrade the physical infrastructure of the PSP and district warehouses and to

prepare for installation of the MACS computerized warehouse-management system at the PSP. SCMS has

also assisted the PSP with the development and implementation of new standards of practice for

commodities management at the PSP warehouse.

• Conducted a commodities-management training of trainers at the PSP and set up a system for tracking

ARVs and laboratory commodities through the PSP to treatment sites. SCMS has recruited two full-time

staff members to second to the PSP. SCMS has also conducted commodities-management training for 425

nurses, midwives, and PSP staff at the treatment-site level, as well as training on warehouse management

for two PSP staffers. In addition, SCMS has provided support to the PSP for on-site supervision and

training.

FY08 Activities

In addition to procuring most HIV/AIDS-related drugs and consumables for the EP/Cote d'Ivoire, SCMS will

use FY08 funds to continue strong technical and management assistance in support of the PSP's

leadership and coordination role in the national program. SCMS will be held accountable for specific

performance results and will adjust its operational plan, in consultation with the USG team and the PSP, as

the situation in Cote d'Ivoire evolves. SCMS will regularly update national ARV forecasting calculations

based on actual use patterns and will provide ongoing analysis of commodities consumption compared to

patient treatment data. This is critical to ensure rational commodities management and realistic scale-up

planning. SCMS will also advise the MOH and partners on current pharmaceutical market developments,

USG-approved products and suppliers, and manufacturing capacity as it affects supply to Cote d'Ivoire.

While SCMS has performed well in rapid procurement of ARV drugs, its first major order of lab supplies for

all partners in FY07 suffered extensive delays due to numerous factors, causing important disruptions to

services at many EP sites. Now that detailed specifications and sources of these items have been

integrated into the SCMS procurement system, it is expected that future orders will move much more

quickly. It is critical that SCMS and the PSP be proactive in generating monthly (at least) reports on

inventories, pipelines, the delivery status of all items in the annual procurement plan, in order to inform the

service-delivery planning of all partners. SCMS will aggressively focus on ensuring that regular, detailed,

and concrete commodities data and analyses are available to inform all stakeholders and empower the

MOH to make appropriate evidence-based decisions.

SCMS will provide (non-procurement) technical assistance, training, and systems/infrastructure

development to the MOH and key EP partners for ARV management as described below. This total is

distributed among the COP program areas of ARV Drugs, Lab Infrastructure, and Strategic Information.

This will cover all SCMS staff, consultants, operations and overhead, and technical assistance and training.

• Procurement

SCMS will continue to procure and deliver rapid test kits, lab testing materials and reagents, and other

essential commodities for adequate patient monitoring at EP-supported sites, including lab equipment and

supplies for new treatment sites. SCMS will install infrastructure and equipment while reinforcing capacity

by providing the necessary training and supervision. Specific needs projections will be negotiated with the

MOH, Global Fund, and other partners in support of the EP's FY08 service-delivery targets, including the

target of 60,000 patients on ART. SCMS will ensure that a rational distribution plan is pre-calculated for

each site, based on prior consumption, and validated at least quarterly using client data and physical

inventory spot-checks, with a special focus on the development of rapid local procurement capacity for

these products in Cote d'Ivoire.

Under the Lab Infrastructure component, SCMS procurements will include:

- Lab supplies for monitoring of ART patients (at $30 per patient for initial screening and $30 per year for

existing patients).

- Supplies to train and retrain lab technicians (at an estimated cost of $108 per lab technician trained).

- Lab supplies to monitor palliative-care patients (at $25 per patient).

- Test kits and supplies for CT clients (based on $5 per client tested)

- Equipment for new labs at care and treatment sites.

• PSP and MOH Capacity Building

At the PSP, SCMS will deploy a site quality-assurance manager to oversee upgrades to physical

infrastructure and management systems. SCMS will complete the planned physical upgrades to the ARV

Activity Narrative: warehouse at the PSP and will prepare comprehensive SOPs for all ARV-related PSP tasks. The program

will prepare, coordinate, and manage on-the-job warehouse staff training for basic operations of receiving,

picking, checking, packing, and dispatch as well as supervision, security, and safety. SCMS will install the

MACS warehouse management system at the PSP to improve central management of EP commodities and

will train PSP staff in its effective use. SCMS will also support upgrades to the PSP vehicle fleet and

associated commodities handling equipment to improve the efficiency of distribution systems and the safety

and security of EP commodities. SCMS will commence physical upgrades to high-volume storage facilities

to ensure the safety and security of EP commodities.

To ensure timely data for critical planning, SCMS will ensure that SIMPLE-1 or a compatible program is

installed and providing computerized monthly dispensing and inventory reports from all EP-supported ART

sites. SCMS will procure and install IT hardware where needed and will train and provide ongoing

supervision to site-based staff. In any instance where monthly data are not reported on time, SCMS will

ensure that those data are gathered and transmitted to PSP to generate a full and accurate picture of the

end-use of all EP-procured commodities.

To strengthen the technical autonomy of the PSP, SCMS will continue on-the-job training and will hire a full-

time warehouse floor manager to second to the PSP. SCMS will also support the preparation of a long-term

restructuring and investment funding plan for PSP operations.

Funding for Strategic Information (HVSI): $500,000

Since May 2005, the Emergency Plan has rapidly scaled up HIV/AIDS prevention, care, and treatment

across Cote d'Ivoire. As the program expands, maintaining accurate real-time information on available

stocks and projected needs of essential commodities is critical to ensuring uninterrupted, comprehensive

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 that this information is gathered and analyzed

regularly and shared with all partners involved in commodities procurement and management - essentially

the EP, the Global Fund through new principal recipient CARE International, and the Ministry of Health

(MOH). The Partnership for Supply Chain Management Systems (SCMS) is charged with providing the

USG with a one-stop shop for procurement services and related technical assistance.

Following an MOH directive to coordinate procurement, the EP and GF have formed a cooperative

procurement and management strategy for essential HIV-related commodities with national authorities. The

government of Cote d'Ivoire buys small amounts of commodities with its own funds for this national "virtual

pipeline." This approach is being monitored through an evolving joint implementation plan and a joint

procurement plan. The procurement plan includes all commodities for MOH-accredited 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 the GF's recurring difficulties in delivering critical products to

the national program on time, coupled in the past with a lack of information-sharing on GF order delays,

SCMS and other EP partners had to procure critical products through emergency orders. It is clear that

even with improved information-sharing among stakeholders, more sophisticated systems for feeding

information up on commodities needs are required to ensure transparent coordination of supplies and

needs of all partners in the national HIV/AIDS program.

The program has strengthened commodities-management systems and practices at the district level in

three health districts, aiming to ensure continuing availability of commodities needed at service-delivery

points. This involved the installation of the SIMPLE1 and SIMPLE2 ARV dispensing software at 21

treatment sites and the training of 50 pharmacy staff and data-entry operators in their use.

SCMS has 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 commodities and ARV

use data are being integrated and analyzed together with new electronic patient records by installing MACS

software at the Public Health Pharmacy (PSP) to provide a more complete clinical and management picture

of the care and treatment program. SCMS technical assistance has also enhanced the institutional capacity

of the PSP (the central medical store and director of the joint procurement plan in Cote d'Ivoire), health

districts, and targeted facilities by training 15 trainers at the central level and 325 service providers at

districts and treatment sites on HIV/AIDS commodities management and introducing ARV dispensing tools

(ADT) at all treatment sites. SCMS is working to ensure the adequate management of HIV/AIDS products

and other health commodities at all levels. The project installed the MACS warehouse-management system

at the PSP to help the government manage the movements and security of all commodities processed

through the central warehouse. Ongoing TA has strengthened the PSP's ability to forecast and manage

commodities and thus avoid supply problems. SCMS has also provided TA to the GF to help improve

commodities planning and management, and has 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

management information system (HMIS) as part of a strategic information plan in support of the national

HIV/AIDS program. Many partners are supporting specific components of this effort, including RETRO-CI,

Measure Evaluation, and EGPAF, in collaboration with the MOH/DIPE (Directorate of Information, Planning,

and Evaluation) and the National HIV/AIDS Care and Treatment Program (PNPEC). SCMS will collaborate

with these partners to prevent duplication and ensure complementarity. Important elements of the required

information systems already exist, including IT hardware and networks at most EP- and GF-supported sites.

For instance, one treatment partner, ACONDA, is implementing a computerized patient-record system at all

of its sites, with comprehensive records for all patients registered in the program (whether on ART or not).

To gather accurate forecasting data for ACONDA, the HMIS and the new MACS software provided to the

PSP will interface.

In addition to procurement of most HIV-related drugs and consumables for the EP program, FY08 funds will

continue technical and management support to the PSP in its leadership and coordination roles. SCMS will

be held accountable for specific performance results and will adjust its operational plan, in consultation with

the USG team and the PSP, as the situation in Cote d'Ivoire evolves. SCMS will regularly update national

ARV forecasting calculations based on actual use patterns and will provide ongoing analysis of commodities

consumption compared to patient treatment data. This is critical to ensure rational commodities

management and realistic scale-up planning. SCMS will also advise the MOH and partners on current

pharmaceutical market developments, USG-approved products and suppliers, and manufacturing capacity

as it affects supply to Cote d'Ivoire.

SCMS will provide (non-procurement) technical assistance, training, and systems/infrastructure

development to the MOH and key EP partners for ARV management as described below. This total is

distributed among the COP program areas of ARV Drugs, Lab Infrastructure, and Strategic Information.

This will cover all SCMS staff, consultants, operations and overhead, and technical assistance and training.

To further improve the quality of SCMS' technical inputs, the project will also elaborate a monitoring and

evaluation plan using HIV/AIDS pharmaceutical management indicators. At district and treatment-site

levels, SCMS will ensure that ARV tracking and management software is installed and staff are trained so

that ARV commodities management improves and all sites are able to generate accurate monthly reports

on commodities inventories and consumption. The SCMS FY08 target is to ensure that all treatment sites

are reporting regularly, with a view to handing over the management of the process to PSP in the future.

• Commodities Forecasting

SCMS will continue to refine and improve the quality, accuracy, and frequency of ARV and other

commodities forecasting and supply planning in partnership with the GF, Clinton Foundation, and others

through support to the PSP Cellule ARV. The project will perform these updates in collaboration with PSP

staff, RETRO-CI, and the national reference laboratory to continue transferring these skills, and will conduct

regular cross-over analyses to compare commodities dispensed by the PSP and specific sites with the

Activity Narrative: actual patient data to inform clinical-services decisions.

To strengthen transparency and national ownership of supply-chain responsibilities, SCMS will generate

regular monthly reports showing all pending orders and deliveries, specific quantities, and expected delivery

dates to the PSP. The project will also provide monthly inventory and dispensing reports from each EP-

supported treatment site. These reports and analyses will signal to care and treatment stakeholders anytime

the projected virtual stock of any ARV or HIV-related commodity will be less than three months at the

national level or at any site. (Projected virtual stock is the sum of current inventory and expected

consumption, plus realistically expected new deliveries.) SCMS will ensure that regular monthly reporting

and computerized proactive supply-chain management systems include detailed information on OI drugs,

lab reagents, and testing materials, as well as commodities for palliative care and OVC support.

In collaboration with the MOH and other partners, SCMS will establish and maintain a Web-based ordering

and inventory tracking system for EP-procured HIV commodities. Service sites and other authorized

partners will be able to log in and place orders from the PSP, track their delivery progress, and confirm

historical data on consumption and projected scale-up at their sites. This is expected to greatly enhance

transparency of commodities management and decrease stock-outs and emergency orders due to

inadequate forecasting at all levels. SCMS will train the PSP, PNPEC, DIPE, and national reference

laboratory staff as well as NGO staff in forecasting and supply planning for ARVs, OI drugs, lab

commodities, and care kits.

Cross Cutting Budget Categories and Known Amounts Total: $1,400,000
Food and Nutrition: Commodities $1,400,000