This activity was reduced by 5,291,000 and the funds moved towards ART rennovation activity ID 28182

(HTXS) towards construciton of a regional warehouse.

Procurement and Distribution of ARV Drugs and Related Commodities

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

Under COP09, SCMS will not support regional warehouse construction. Funds planned for warehouse

construction under COP08 will be utilized in consultation with USAID/Washington. Despite the large

pipeline, the reduced funding means that PEPFAR capacity to respond to HIV commodity gaps in Ethiopia

will be substantially reduced.

The central medical stores have been reintegrated fully into the public sector and renamed the

Pharmaceutical Fund and Supply Agency (PFSA). SCMS is the primary technical assistance (TA) provider

to PFSA. Support under COP08 included all vehicles needed for national Pharmaceutical Logistics Master

Plan (PLMP) implementation, as well as warehouse design and distribution network planning. Under

COP09, TA to PFSA will extend to site level, with SCMS assuming logistics support previously provided by

Management Sciences for Health/Strengthening Pharmaceutical Systems (MSH/SPS).

In earlier years, PEPFAR Ethiopia supported procurement of second line adult ARV drugs, all pediatric

formulations and reserved funds for emergency purchases ARVs. The Ministry of Health (MOH) supplied

adult first line drugs using Global Fund To Fight AIDS, Tuberculosis and Malaria (GFATM) funds. In 2008,

the Clinton HIV/AIDS Initiative (CHAI) assumed responsibility for procuring pediatric and adult second line

ARVs formerly supplied by PEPFAR, with SCMS handling customs clearance and distribution support costs

for all PEPFAR, GFATM and CHAI-procured products. .CHAI support for second line ARVs ends in 2009.

It is possible that PEPFAR will reassume this responsibility, estimated at $9.5 million for 2009, with about

half that amount to cover COP09.

Under COP08, the shift in ARV funding allowed PEPFAR to fund a portion of the large commodity gap in

critical areas such as opportunistic infection (OI) drugs, ready-to-use therapeutic food (RUTF), home-based

care (HBC) kits, supplies and equipment for prevention of mother-to-child transmission (PMTCT), and

infection prevention (IP) materials. SCMS supported the two National HIV Commodity Quantification

Exercises during 2007; under COP09, SCMS will continue support for these annual exercises.

This quantification of all HIV commodities showed $477 million total need for 2009, with only $160 million

committed to cover projected needs for universal access to HIV services. The $317 million gap highlights

the need to prioritize key commodities and quantities to be procured, and to look for new funding sources.

SCMS was funded with $122 million under COP06/07/08. As of September 2008, $56 million had been

expended, with a pipeline of $66 million. Spending projections estimate that the entire remaining pipeline

will be expended by the end of 2009.

Of total funding, $64.3 million is committed to cover part of the commodity gap: $19 million for OI drugs, $16

million for IP, $10.5 million for laboratory, $6 million for RUTF, $4.8 million for PMTCT, and $4 million for

HBC kits.

SCMS will use around $6 million of the proposed $26.5 million under COP09 for operations and TA to

support systems strengthening. Under COP08, PEPFAR procured all vehicles needed by national and

regional warehouses to distribute commodities to site level. COP09 efforts will focus on development of the

logistics management information system (LMIS), as well as training in the new system. SCMS also covers

the $7 million distribution costs for all HIV commodities in the country. Under COP09, PEPFAR commodity

procurement will be substantially reduced from COP08, with $13 million available to maintain PEPFAR's

Memorandum of Understanding (MOU) commitment for a 10% emergency buffer ARV fund, as well as for

RUTF.

The ARV buffer is a USG commitment under the MOU with the Government of Ethiopia (GOE), which

defines commitments in some commodity areas. Around $4.5 million of emergency ARV support was

procured in 2008. While the buffer may be fully utilized, it is hoped that a substantial portion of the $12

million fund will be available for gap-filling support.

USG assistance in developing GFATM proposals to fill commodity gaps, and to fund PLMP TA, will be

critical to the success of HIV program efforts. Procurement TA is essential if the MOH is to more effectively

use GFATM funds allocated for the commodity procurement.

SCMS will coordinate as needed with other PEPFAR partners, taking a lead role to ensure delivery of the

full range of HIV commodities to service delivery sites. This collaboration will occur until such time as the

PLMP is fully operational.

COP08 Narrative

The main focus of this activity is to support the quantification, supply planning, procurement and distribution

of ARV, drugs for opportunistic infections (OI) and other commodities to treat HIV/AIDS, and to ensure

sufficient supply and availability of commodities at service delivery points. Commodities will be procured in

accordance with the Government of Ethiopia's (GoE) national ART and other program protocols, and USG

rules and regulations. PEPFAR funds the Partnership for Supply Chain Management/Supply Chain

Management Systems (PFSCM/SCMS) that undertakes commodity procurement based on high-volume

aggregated purchasing on behalf of HIV/AIDS care and treatment programs. SCMS leverages economies of

scale and offers clients certainty of competitive prices, high quality product standards, and reliable delivery

dates.

Activity Narrative: Ethiopia's national target of universal access to ART and primary health care by 2010 has translated into a

rapid scale-up of ART services which places pressure on the national HIV/AIDS program to reach more

facilities providing ART services. The challenge presented under this scale-up is two-fold: 1) the need to

ensure systematic quantification, forecasting and procurement planning so that adequate quantities of

commodities of appropriate quality are available; and 2) the need to have a reliable logistics system capable

of responding to the geographic and programmatic conditions across Ethiopia. The latter also includes the

need to consider the limited capacity at health facility stores to handle the volume of drugs needed for the

growing number of patients and their related therapeutic and palliative care, and to begin to ensure the

development of a sustainable logistics system aligned with the national Pharmaceutical Logistics Master

Plan (PLMP). SCMS is coordinating with diverse partners to support this effort, and is one of the primary

technical assistance providers for the PMLP, including personnel support at both national and regional

levels, and planned support in improving regional warehouses.

In FY07, in conjunction with the Ministry of Health's HIV/AIDS Prevention and Control Office (HAPCO),

SCMS facilitated a National HIV/AIDS Commodities Quantification Exercise. The results provided input into

the Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM) Round 7 proposal and included

requirements for antiretrovirals (ARVs), rapid testing kits for counseling and testing (CT), drugs to treat OI

and sexually transmitted infections (STI), male and female condoms, laboratory supplies, PMTCT and

infection prevention materials, as well as ready-to-use therapeutic food (RUTF). SCMS spearheaded the

exercise, additionally utilizing it to begin an open-ended supply planning process, to be institutionalized

through HAPCO's HIV Commodity Supply Management Committee, with technical support from SCMS and

a Commodity Security Advisor seconded to HAPCO. The quantification and costing results, updated in June

2007, showed a total of $272 million needed to cover all HIV commodities for Calendar Year 2008, in

support of the Ministry of Health's Road Map II: Accelerated Access to HIV/AIDS Prevention, Care and

Treatment in Ethiopia. This plan for universal access has a $159 million gap in funding to cover

commodities for the country, more than PEPFAR can cover during FY08. Prioritization of commodities will

be important, as many services cannot be effectively implemented without key products.

Collaboration in commodity provision between the various partners was continued in FY07 with GFATM

continuing to provide funds for the supply of first line adult ARV. In FY07, an arrangement was reached

whereby the supply of pediatric 1st and 2nd line ARV formulations and adult 2nd line ARV formulations,

previously provided by PEPFAR, was transferred to UNITAID through the Clinton HIV/AIDS Initiative

(CHAI). PEPFAR Ethiopia continues to support ARV commodity procurement through the provision of a

reserve stock of first line adult ARV drugs, and will add reserve stocks of 1st and 2nd line pediatric ARV,

2nd line adult ARV, and rapid test kits, in case planned supplies from other donors are not available. SCMS

provided support to the procurement process by developing quarterly forecasts of requirements and

updating supply plans. In FY2007 SCMS procured drugs for the treatment of OI, infection prevention

materials and PMTCT supplies to address the continued shortage of these commodities, key in the

provision of quality services for PLWHA and HIV-positive pregnant mothers.

In FY07 SCMS provided support for logistics systems strengthening for ARV drugs, OI drugs, laboratory

reagents and equipment, rapid test kits and other PMTCT products. In FY08, SCMS will continue to provide

TA and support to Pharmid and the Ethiopian Health and Nutrition Research Institute (EHNRI) in developing

an integrated logistics management system for ARV, rapid test kits (RTK), PMTCT supplies, drugs for OI,

condoms and other commodities, in close collaboration with the FMOH, MOH/HAPCO and other partners.

SCMS worked with Pharmid to support the clearing, warehousing and distribution planning of ARV drugs

and related commodities purchased by PEPFAR Ethiopia and other sources. SCMS began to play a major

role in procurement of commodities with GFATM funds, procuring around $8 million, mainly in RTK, during

FY07. Also in FY07, SCMS recruited and seconded 10 Logistics Associates to regional Pharmid hubs, and

completed the transitioning of the distribution of commodities to sites from RPM Plus to SCMS. SCMS in

collaboration with RPM Plus established a system for compiling and transmitting facility level patient and

stock data to facilitate distribution planning as well as systematic quantification and procurement. SCMS

also provided support to central Pharmid to establish state-of-the-art warehouse and distribution operations

to manage HIV/AIDS commodities. Responding to emergency shortages of commodities, SCMS

collaborated with MOH and other partners to begin implementation of an emergency, transitional inventory

control system for HIV commodities, to alleviate these problems until the PMLP is fully implemented.

In FY08, SCMS will continue its efforts to support the strengthening of the supply chain management

system for HIV/AIDS commodities. Attention will be focused on support to regional Pharmid hubs in

developing effective warehouse and distribution operations, and integrating information and planning

functions with the central headquarters. Assuming the appropriate waiver for construction can be obtained,

SCMS will support the capacity expansion needs of Pharmid to meet the growing demand placed by

HIV/AIDS commodities management, as well as the organizational development to ensure a sustainable

institutionalization of logistics practices. SCMS will also support investment in inventory control and

warehouse management to support flexible and quality logistics operations. In addition, SCMS will work in

conjunction with the MOH implementation of the PLMP to support the development of Pharmid's

procurement capacity. In FY08, SCMS will make substantial investments in procurement and logistics, with

the aim of supporting national ART targets for numbers of patients, and hospital and health center sites

providing ART services. During FY08, PEPFAR Ethiopia will procure up to $25,500,000 of ARV, OI, IP and

lab supplies through SCMS, as well as RUTF, and will spend up to $14,000,000 to strengthen the capacity

of Pharmid and to support implementation of the PMLP from national to site level. Capacity building may

include substantial provision of information technology (IT) resources at appropriate sites, as well as

support for adequate storage space for commodities. Commodity procurements will be defined in

conjunction with the MOH's HIV Commodity Advisory Group/Supply Management Committee, as the lack of

funds to cover all commodity needs for universal access goals requires prioritization to ensure optimum use

of existing resources. The exact mix of commodities to be procured will not be known until this analysis is

complete, and will shift depending on availability of funds from other sources, actual usage levels in MOH

facilities, etc.

To ensure sustainability, SCMS will build the capacity of staff of the MOH and Pharmid through technical

Activity Narrative: assistance, training, and skills transfer to effectively forecast, procure, and deliver essential medicines,

laboratory supplies, and other health commodities, and to collect, use, and share supply chain information,

and will second staff at national and regional level to further those processes.

This activity will contribute to the upstream achievement of essentially all PEPFAR programs areas which

depend on commodities for success.

This activity will ensure that health commodities for HIV programming, including ARV, are cost-effectively

procured and effectively managed. ARV drug and other commodity requirements will be appropriately

quantified, projected and costed. In-country systems for procurement, distribution and monitoring of ARV

and other commodity needs will be developed and supported.

This activity is linked to other donor and partner resources through an accountability matrix designed to

coordinate the implementation of a national PLMP. Close integration with JSI/DELIVER activities funded by

USAID with Population funding will be continued and strengthened. Partners include GFATM, UNICEF,

UNFPA, GAVI, CHAI, and WHO.

PFSCM/SCMS will ensure consistent and timely delivery of HIV/AIDS commodities to public sector sites

providing prevention, care and treatment services to patients nationwide. PLWHA will be among the

beneficiaries.

To ensure reliable and sustainable logistics systems, PFSCM/SCMS will focus on building the capacity of

Pharmid to carry out supply chain management functions.

New/Continuing Activity: Continuing Activity

Continuing Activity: 16660

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

16660 10532.08 U.S. Agency for Partnership for 7493 5499.08 PSCMS $39,684,200

International Supply Chain

Development Management

10532 10532.07 U.S. Agency for Partnership for 5499 5499.07 PSCMS $34,562,102

International Supply Chain

Development Management

Table 3.3.15:

Laboratory Reagents, Supplies, Equipment and Logistics Management

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:

SCMS functioned effectively during the last year providing CD4, chemistry and hematology reagents and

related supplies to antiretroviral treatment (ART) monitoring sites at hospitals in Ethiopia. Additionally, large

amounts of rapid test kits (RTKs) were procured for the Ministry of Health (MOH), using both PEPFAR and

Global Fund To Fight AIDS, Tuberculosis and Malaria (GFATM) funds. Additionally, staff from the Ethiopian

Health and Nutrition Research Institute (EHNRI), the national reference laboratory, was trained in

quantification of commodity needs, and a laboratory logistics management information system (LLMIS) was

designed and implemented, with staff trained in its use. Regional Laboratory Logistics Associates (RLLAs)

continued to be deployed at key ART facilities, helping ensure that stock-outs of key monitoring supplies

were minimized at these sites. Close collaboration with the Centers for Disease Control and Prevention

(CDC) and the Clinton HIV/AIDS Initiative (CHAI), under the leadership of EHNRI, helped ensure that

multiple stakeholders were involved in quantification and other joint activities.

Substantially increased investments are required for COP09 support to hematology, chemistry and CD4

monitoring for HIV positive patients. The CD4 limit for patients to begin antiretroviral treatment has been

raised to 350 per cubic millimeter, from the earlier national guideline of 200. Funding to cover the basic

needs for all ART and pre-ART patients under Ethiopia's Road Map for universal access to HIV programs

has increased to $12,135,000, with an additional $2.1 million needed for SCMS operations and technical

assistance to ensure an effective supply chain for all laboratory commodities.

Given funding limitations under COP09, it will not be possible for SCMS to procure equipment or provide

funding for preventative maintenance or repair of equipment, other than bundling arrangements with

manufacturers which may supply maintenance support as part of reagent procurement agreements.

Distribution support will increase to 138 hospital networks and related health centers. RLLAs will increase

from five to eight.

While SCMS provided strong support in procurement of rapid test kits under COP08, purchasing almost $6

million of these with PEPFAR funds as a stop-gap measure, funding decreases will not allow this support to

continue under COP09. SCMS can continue its support for procurement using GFATM monies, if the MOH

makes these funds available. Close coordination of procurement will be critical to the success of these

efforts, given resource limitations.

Pharmid has been reorganized and renamed the Pharmaceutical Fund and Supply Agency (PFSA). SCMS

will continue its work with PFSA and EHNRI to develop a strong distribution system for lab commodities,

ultimately integrated in the overall national system covering all health commodities. With the exception of

the adjustments described above, other activities will be as described in the COP08 Activity Narrative.

COP08 Activity Narrative

This is a continuing activity from FY07. In FY08, it is expected that the demand and cost of laboratory

monitoring will continue to increase. This is due both to the scale-up of Ethiopia's prevention, care and

treatment (including antiretroviral treatment or ART) programs as it strives to reach universal access goals,

as well as the PEPFAR Ethiopia focus on increasing the quality of services in FY08. To meet the demand

and provide quality laboratory services to all sites, substantial investments will be necessary.

The main focus of this activity is to ensure that laboratory supplies procured by the USG and the

Government of Ethiopia (GOE) with Global Fund To Fight AIDS, Tuberculosis and Malaria (GFATM) and

PEPFAR monies are in sufficient supply, of superior quality, and are moving efficiently through a supply

chain that will support the scale-up of ART. The PEPFAR Partnership for Supply Chain

Management/Supply Chain Management Systems (PFSCM/ SCMS) will procure laboratory supplies,

including reagents, consumables and limited equipment, and develop the capacity of personnel at the

national, regional and local levels to implement an efficient supply chain management system for laboratory

commodities. These commodities, in conjunction with the supplies procured by the Ministry of Health (MOH)

and complemented by SCMS technical assistance in supply chain management, will improve the capacity of

laboratories nationally to support ART services. SCMS will procure reagents at optimal prices, and will

collaborate with Pharmid, Ethiopia's public sector central medical store, to support storage, inventory,

monitoring, and distribution of reagents for CD4, hematology, and chemistry testing. SCMS technical

assistance and supplies procured with SCMS support will reach at least 131 hospital networks, including

national, regional, hospital and health centers laboratories throughout Ethiopia. While the Government of

Ethiopia-U.S. Government Memorandum of Understanding on the use of PEPFAR and GFATM funds does

not specify one party responsible for laboratory commodities, PEPFAR will support strongly in this area,

although it is likely that PEPFAR resources are insufficient to provide all commodities needed for Ethiopia's

ambitious goal of universal access for ART and other HIV services by 2010.

In FY07, SCMS supported the Ethiopian Health and Nutrition Research Institute (EHNRI), the national

reference laboratory, in designing and beginning implementation of a laboratory logistics management

system. This work was carried out in close collaboration with Pharmid as well as the Management Sciences

for Health Rational Pharmaceutical Management Plus (RPM Plus) activity, the Clinton HIV/AIDS Initiative

(CHAI), and other relevant USG and non-USG partners. SCMS supported a Senior Laboratory Logistics

Advisor seconded to EHNRI and five Regional Laboratory Logistics Associates (RLLAs) seconded to

Regional Laboratories, working closely with all relevant stakeholders to ensure that the laboratory logistics

management system functioned smoothly. During FY07, SCMS worked with Pharmid to strengthen its

central and regional hub capacity to handle the special logistics needs for laboratory supplies, including cold

chain requirements. In FY08, SCMS will continue to support Pharmid in the integration of cutting-edge lab

commodities logistics and distribution management practices and technologies in its standard logistics

system, as well as EHNRI in its key oversight role.

Activity Narrative: In FY2007, PEPFAR Ethiopia supported the national ART program by purchasing large quantities of

laboratory equipment and test reagents for diagnosis and treatment monitoring of HIV/AIDS patients. A total

of $9,403,323 million in lab monitoring supplies (CD4, hematology and chemistry profiles) was procured and

distributed by SCMS. Additionally funds were allocated to support the expansion of the hospital networks to

cover 131 hospital networks (131 hospitals and 240 health centers); this included budgeting for related

equipment and semi-durable supplies and consumables. PEPFAR Ethiopia in FY2008 has allocated up to

US$12,562,178 for the procurement of the following laboratory reagents, test kits and supplies through

SCMS: (1) Chemistry test reagents for monitoring patients on treatment: alanine

aminotransferase/glutamate pyruvate transaminase (ALT/GPT), creatinine, cholesterol, blood urea nitrogen

(BUN), and glucose; (2) Hematology test reagents for monitoring patients on treatment; (3) CD4 (cluster of

differentiation-4) test reagents for monitoring patients on ART treatment and pre-ART patients including

pregnant women; (4) Pregnancy test kits; (5) Syphilis tests; (6) Deoxyribonucleic acid (DNA) polymerase

chain reaction (PCR) test kits for diagnosis of pediatric patients less than 18 months of age; (7) HIV rapid

test kits, as an emergency stock; (8) Reagents and staining solutions of microscopic diagnosis of

opportunistic infections (Acid-fast bacillus smear, culture, and sensitivity, malaria, stool parasites); (9) Other

supplies including gloves, tubes, pipette tips, disinfectants.

SCMS will continue to support an integrated approach to procurement and distribution of laboratory

commodities in FY08, working with appropriate national, regional and sub-regional counterparts and

partners. SCMS will work with laboratory and GOE stakeholders to support the implementation of the

national laboratory logistics systems, under the auspices of Pharmid and with technical input as appropriate

from EHNRI. SCMS will work closely to support the system for distribution of supplies direct to testing and

other service delivery sites, in line with a national standardized system for supply chain management.

Supportive supervision will be provided to ensure reporting through a robust laboratory logistics

management information system (LMIS), which will be substantially strengthened. A system for reporting

and using the laboratory LMIS to support appropriate inventory control systems, proper quantification,

forecasting and timely procurement, as well as responsive distribution of supplies, will be developed. The

RLLAs will continue to contribute to capacity development at the site level to carry out laboratory LMIS

functions, and to ensure sustainability of services. In these ways, SCMS will assist in strengthening of the

national and local supply chain management system.

To ensure long term sustainability of interventions, SCMS will assist in improving national capacity through

training and skills transfer to EHNRI, the Federal MOH, regional laboratories, Pharmid and

nongovernmental organization (NGO) partner staff, and will ensure that the interventions are consistent with

the vision and capacity of the MOH and the Pharmaceutical Logistics Master Plan (PLMP). SCMS will

continue to use training as an important means of achieving the above objectives.

This activity will support a unified approach to procurement and distribution of laboratory commodities,

coordinating with its support for availability of other critical HIV/AIDS commodities to support the prevention,

care and treatment program. Sustainable lab commodity management systems will be developed through

integration into and strengthening of in-country systems for managing these commodities.

This activity is linked to other donor and partner resources to coordinate the implementation of a national

Pharmaceutical Logistics Master Plan. Close integration with the SCMS and RPM Plus ART drug activities

(ID 10532, ID 10534) as well as other PEPFAR laboratory support partners will be continued and

strengthened. Other linkages include GFATM, CHAI and WHO.

PFSCM/SCMS will ensure consistent and timely delivery of laboratory commodities to public sector sites

providing prevention, care and treatment services to patients who need them throughout Ethiopia. PLWHA

will be among the beneficiaries.

The primary emphasis of this activity will be to ensure robust logistics systems for lab commodities.

Capacity of sites and Ethiopian organizations such as Pharmid will be strengthened to ensure the

sustainability of a national supply chain system for lab commodities. EHNRI's ability to provide the

necessary technical inputs to inform laboratory commodity procurement planning will also be strengthened.

New/Continuing Activity: Continuing Activity

Continuing Activity: 16661

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

16661 5655.08 U.S. Agency for Partnership for 7493 5499.08 PSCMS $14,437,102

International Supply Chain

Development Management

10602 5655.07 U.S. Agency for Partnership for 5499 5499.07 PSCMS $11,030,919

International Supply Chain

Development Management

5655 5655.06 HHS/Centers for US Centers for 3792 3792.06 $2,550,000

Disease Control & Disease Control

Prevention and Prevention

Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $200,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.16: