The overarching goal of the MSH activity in Swaziland is to strengthen national pharmaceutical services and supportive health systems in order to improve the delivery of high quality treatment and care services to PLWHA. Support is provided at three levels: strengthening health worker capacity to support the ART program, supporting ART commodity procurement, and monitoring ART commodities and patient care. This activity is crucial to the success of both the NSF and Partnership Framework in terms of efforts to decentralize quality care and treatment services and to build capacity for improved response management.

MSH supports the ART program at the national level, in 26 facilities, 13 laboratories and 20 TB diagnostic facilities across the country. With decentralization, another 40 primary health care sites will be phased in for support. Target populations include national program staff, and public doctors, nurses, pharmacists, pharmacy technicians and other healthcare workers.

To ensure a cost effective program, this activity will build on existing systems, use whenever feasible local and regional expertise and leverage resources from other sources (e.g., Global Fund).

TB and Malaria as health wraparounds are cross cutting key issues for this activity. MSH provides technical assistance and support to the national TB and malaria programs in terms of supply chain management, ensuring the availability of drugs and proper inventory management.

MSH/SPS has its own internal M&E system to track progress towards project objectives. Using the results framework, the outcome and output indicators listed for each activity are measured each quarter to ascertain progress towards targets and goals. Specific monitoring guidelines and reporting requirements will be developed to monitor the impact of MSH/SPS activities in Swaziland on the achievement of national HIV and AIDS treatment targets. A full time regional M&E Officer will provide support to the MSH office in Swaziland.

MSH/SPS will increase the capacity of health facilities to deliver quality responsive pharmaceutical services thereby improving access to medicines and other commodities.

This will involve:

Strengthening the capacity of pharmacy personnel to support patients

Promoting the use of standardized approaches for quantification of medicines required for treatment of Opportunistic Infections (OIs) and other essential related commodities.

Training health care workers to capture patient clinical data on OIs and the procurement and dispensing of related medicines and commodities through the implementation of the patient management information systems (RxPMS)

MSH/SPS will continue to conduct workshops for pharmacists, pharmacist's assistants and nurses. This training includes update to health staff on recommended ART regimen(s) and the associated clinical pharmacology (e.g. medicine of choice, adverse-drug-event while on ART).

At all levels, training will be followed by on-site mentorship and monitoring visits. For COP 010, the focus will be at the primary healthcare (PHC) level workers, as ART services are expected to be expanded to that level.

MSH/SPS in collaboration with the MOH has reviewed and updated their computerized patient management information system (RxPMS) to optimize patient clinical data capturing in order to provide critical strategic information to support the M&E component of the National ART program. RxPMS will be deployed at PHC sites and staff will be trained.

MSH/SPS will continue to carry out theses activities to support this program area:

Training of pharmacists, pharmacy technicians and other key personnel involved in the provision of pharmaceutical services at all levels. The training programs covers best drug supply management practices (e.g. assessing reorder level, optimized inventory management) and rational drug use with focus and will include sessions specific to the management of HIV and AIDS (e.g. adherence monitoring, counseling, adverse drug event monitoring). This will include pharmacy staff from public, private and mission hospitals.

Supporting RxPMS and RxSolution system upgrade, on-site training and follow-up support visits, development of new management reports. SPS will also train health workers on improving patient management and monitoring through the use of the system at the facility and national level. In FY10 the training will focus on strengthening health facility staff capacity to analyze and use the data generated by RxPMS and RxSolution to support the decision making process. Additional public and private sites are expected to use the system.

Supporting the implementation of the Adherence to ART monitoring tool to assist pharmacy personnel to develop an adherence improvement plan tailored to patient needs.

MSH/SPS will increase the capacity of health facilities to deliver quality responsive pediatric pharmaceutical services as to improve access to medicines and other commodities. This will involve:

Strengthening the capacity of pharmacy personnel to support patients from the Pediatric Care and Support programs

Promoting the use of standardized approaches for quantification of medicines required for treatment of Opportunistic Infections (OIs) and other essential related commodities.

Training health care workers to capture patient clinical data on OIs and the procurement and dispensing of related medicines and commodities through the implementation of the patient management information systems (RxPMS)

The support provided by MSH/SPS under adult treatment covers also pediatric patients; however, below is outlined specific aspects of the support tailored to pediatric patient care.

Train health workers on drug supply management and HIV/AIDS management, including specific modules on pediatric treatment.

Implement integrated patient management and dispensing system (RxPMS and RxSolution):

MSH/SPS systems that accommodate patients of all ages. Separate reports for pediatric patients will be developed and generated.

Provide technical assistance to facility-based HIV/AIDS programs on the planning and implementation of surveillance activities in this area of pharmacovigilance. SPS will support focused surveillance activities and operational research relating to key pediatric drug safety issues through collaboration with other USG and non-USG funded partners

MSH/SPS will continue to provide support to the management of laboratory reagents and equipments for the National Clinical Laboratory Services (NCLS) as follows:

Support the implementation of the laboratory supplies management information system to assist with the monitoring of procurement, storage and distributions activities at the National Laboratory Store.

Support the NCLS with the Tender of lab reagents (review of tender list, quantification, costing, tender adjudication and supplier performance monitoring).

Work with the NCLS and all facilities to monitor the availability, stock levels and use of all laboratory commodities on a monthly basis. This includes the monitoring of performance indicators.

Train laboratory personnel involved in the provision of laboratory services at all levels. The training programs covers best inventory management practices (e.g. assessing reorder level, optimized inventory management).

Activities will be continued and expanded to support the MOH in the delivery of pharmaceutical services throughout the country at public, private and mission owned health facilities. Specifically, MSH will continue the following activities:

Supporting the implementation of medicines supply management systems (both manual and computerized) to ensure availability of essential medicines, optimize reorder level, monitor expenditures and strengthen the accountability of stock at all levels. SPS will also continue to build National and regional counterparts capacity to maintain and support the system.

Training pharmacists, pharmacy technicians and other key personnel involved in the provision of pharmaceutical services at all levels. The training programs covers best drug supply management practices (e.g. assessing reorder level, optimized inventory management) and rational drug use. This will include pharmacy staff from public, private and mission hospitals.

Strengthening quantification practices and the monitoring of estimates vs. purchases vs. morbidity data for medicines used for HIV/AIDS, TB, STIs, OIs.

Strengthening the Swaziland National Medicine Advisory Committee (SNMAC) by working with NDAC to implement a transparent and efficient tender system and to ensure access to cost-effective product of the highest quality from reliable suppliers. This also includes the promotion of the implementation of the Essential Medicines list.

Working with the CMS and all facilities to monitor the availability, stock levels and use of all ARVs and TB medicines on a monthly basis. This includes the monitoring of performance indicators.

Supporting the CMS and peripheral service and drug storage sites with the upgrade of their computerized system and providing technical assistance in the following areas:

? Quantification (including drug monitoring of estimates vs. purchases)

? Supplier performance monitoring

? Inventory management

? Distribution and logistics

? Data management for decision making

? Product Quality Assurance