The goal of the SPS program is to assure the availability of quality pharmaceutical products and effective pharmaceutical services to achieve desired health outcomes. SPS aims to promote and utilize a systems strengthening approach consistent with GHI, which will result in improved and sustainable health impact. According to WHO (2007), medical products, vaccines and technology are one of the 6 health systems building blocks. The SPS program is designed to reflect a dynamic relationship among the five building blocks with a Medical Products building block overlay. The above goal is linked to the PFIP key intervention area which aims to decentralize and improve quality of care and treatment services in order to increase access and improve outcomes for PLWHA through improved supply chain management (selection, procurement, distribution/storage, and use). SPS aims to contribute to this objective by ensuring the availability of trained pharmacy professionals, information systems and high quality essential medicines and commodities across the key intervention area of decentralized care & treatment services. SPS will provide central and facility level support to strengthen pharmaceutical and supply chain systems. ART program site support will be provided in collaboration with ICAP at 3 regions (Lubombo, Hhohho and Manzini) and Medecins San Frontieres (MSF) at Shiselweni region. Priority populations will be the people living with HIV/AIDS (adult and children), health workers, prisoners, military personnel, women and girls. Activities will be planned to support the sustainable availability of commodities for the Medical Male Circumcision program.

In order to ensure the continuous availability of essential medicines for priority health conditions in the country, the supply chain system should be so robust that it ensures an uninterrupted supply. The key priority intervention for the next two years is to revise the full spectrum of the supply chain system in the country. The SIAPS program will work to improve coordination, integration and accountability within the governments supply chain system. The Central Medical Stores will be restructured to improve operational efficiencies and accountability. Infrastructure improvements will be carried out to ensure the availability of appropriate space for storage and dispensing of medicines at both HIV treatment initiation and refill sites. With the expansion of HIV care and treatment service points, SIAPS will work to ensure that there is an uninterrupted supply and rational use of all medicines for opportunistic infections and the management of pain. SIAPS will continue the work started by SIAPS in ensuring availability of Co-trimoxazole and Fluconazole for the comprehensive management of opportunistic infections. Working with the Malaria Control Program, SIAPS will monitor the availability and use of malaria products. SIAPS will also work with the Central Medical Stores to improve the management and distribution of supplies for the Home Based Care (HBC) program. Support will be provided to local palliative care service providers to promote the rational use of opiod and non-opiod analgesics for terminally ill patients. SIAPS will work to improve the rational use of medicines through providing technical support to Pharmacy and Therapeutics Committees (PTC) at the 4 hospitals in the country. These committees are tasked with managing the selection of medicines for the formulary, evaluating the medicines' use and then implementing strategies to improve their use at facilities.

SIAPS will support the supply chain of the National TB Control Program to strengthen the implementation of the 3 Is of TB management. Activities will also be targeted at providing information for the management of TB and surveillance of DR TB. The SPS program has in the past worked directly with the National TB Control Program to ensure an uninterrupted supply of TB medicines and the availability thereof at health facilities including ART treatment clinics. The focus of support activities has been on quantification, estimation and improving the overall procurement planning of first line and second line drugs procured through Global Drug Facility mechanism. The support will also focus on improving the quantification and procurement of second line drugs (MDR-TB drugs). During the next two years, SIAPS will work to support the implementation of the Isoniazid Prophylaxis Therapy (IPT). The SIAPS program will work with MOH and partners to ensure anti-TB medicines and diagnostic commodities are available to support the TB program. With the introduction of Gene-Xpert®, the case load for DR-TB is expected to increase as the confirmation of the DR strain will be quicker. Gene-Xpert® (Xpert) is currently procured by various partners Global Fund round 10 and MSF. The SIAPS program will support the MOH in ensuring the availability of commodities for this instrument. The logistics management information system for TB medicines will be improved to ensure that reporting and requisition of TB medicines is integrated into the national supply chain systems. A system of commodity tracking will be developed to monitor the availability of commodities at all levels of the supply chain. The target activities in the next two years will be to ensure the continuous availability of CPT and IPT including vitamin B6. Through support to the Pharmacy and Therapeutic committees, SIAPS will support the facilities to ensure the availability of supplies for Infection Prevention Control. SIAPS will train health workers and develop job aids to support the health workers in dispensing of TB medicines to children.

A well functioning laboratory supply chain will enhance the availability of essential commodities and supplies required to provide necessary laboratory services towards achieving health outcomes. Laboratory supply chain is an essential element in the scale up of treatment and care services. It is also critical in ensuring the quality of the diagnostic services provided in the country. With additional resources and activities aimed at scaling up treatment and care services, such as the introduction of point of care equipment and the Xpert technology for DR-TB diagnosis, it is critical that the commodities and supplies of highest quality be available consistently. SIAPS will support the supply chain management in the laboratory system, capacity building in the logistics management system, policy guidance in procurement of reagents and equipment, logistics information systems. SIAPS will work with University Research Council (URC, LLC) to improve the management of laboratory supplies and commodities in support of program scale up and expansion. Activities will be focused on ensuring an uninterrupted availability of laboratory commodities for HIV&AIDS (including HTC commodities for the Medical Male Circumcision program), TB and Malaria programs. SIAPS will work with partners such as MSF, CHAI and URC / APHL to ensure commodity security for the laboratory services (POC, Xpert). The Supply Chain Technical Working Group will work to develop a commodity security strategy for laboratory services. This will also coordinate all inputs from donor and government to ensure an uninterrupted availability of commodities.

SIAPS will work closely with the National AIDS Program to improve the quality of pharmaceutical services provided in the countrys ART initiation and refill sites. A total of over 500 health workers have been trained under the SIAPS program on ARV supply chain management, HIV Pharmaceutical Management and also general principles of inventory management. Personnel from the countrys 234 facilities [clinics, hospitals and health centres] have been trained. In addition, funds will go to support a pharmacy training program at UNISWA. SIAPS will work with the 4 regional pharmacists in the country to improve medicines' use at facilities with the development of Standard Operating Procedures and other interventions to improve quality pharmaceutical services at clinics and health centers. The capacity and skills of these regional pharmacists will be improved to provide supportive supervision and systems approach mentoring. The SIAPS program procured storage equipment for the 9 newly constructed additional medicines dispensaries and stores to improve the storage capacity for essential medicines. Additional storage facility refurbishments at peripheral facilities will be undertaken under the SIAPS program in support of the decentralization of ART services. The focus on these refurbishments will be on medicine storage space, equipment and supplies for dispensing medicines. In the next two years, SIAPS will work to rationalize the use of storage space for essential medicines and laboratory commodities. SIAPS will work to support ART scale-up services at additional facilities to ensure the provision of quality pharmaceutical services at these facilities. Projects such as the NARTIS (Nurse ART initiation in Swaziland) will be supported on aspects of adherence monitoring, pharmacovigilance and other aspects of quality pharmaceutical services.

SIAPS will work to support the expansion of pediatric HIV Care and Support services through strengthening the supply chain and rational use of medicines for the management of opportunistic infections. SIAPS will support the early access to services, diagnosis and care for exposed infants through improvement in the commodity availability to support pediatric care programs. Support is provided as part of the comprehensive, family oriented approach where medicines for children, care-givers to manage their condition opportunistic infection - are available in a one-stop centre. The most common causes of death amongst children with HIV are pneumonia and diarrhea. SIAPS will work with the MOH in improving the management of childhood illnesses through the implementation of treatment guidelines which are linked to the IMCI (Integrated Management of Childhood Illnesses). In the development of these guidelines, conditions such as pneumonia, diarrhea, malaria, measles and other HIV infections are considered as key conditions that should be managed appropriately at primary health care (PHC) level. Medicines for these conditions will be monitored to ensure continuous availability at all PHCs according to the national essential medicines list. These medicines include, antibiotics, co-trimoxazole, zinc supplements. SIAPS will work to ensure an uninterrupted supply of Co-trimoxazole; appropriate forecasting, and quantification principles will be used. Providers will be mentored on stock monitoring and dosing of pediatric co-trimoxazole. The co-trimoxazole is available to all eligible patients (infants and caregiver) at no cost. SIAPS will support MOH budgeting and procurement functions in view of the transitioning out of the UNITAID/CHAI that has been procuring CTX for the national program.