The Supply Chain Management System (SCMS) Project has a goal to ensure an efficient supply chain management system for HIV commodities in Ethiopia. Two objectives support this: 1) Support most of PEPFAR commodities purchases, storage and distribution and 2) In collaboration with stakeholders support GOE in strengthening the national logistics framework. In COP 2012 SCMS will nationally procure drugs for STIs, opportunistic infections, infection prevention materials, laboratory equipment consumables and reagents, therapeutic and supplementary food and commodities for Health Systems Strengthening(HHS)-which include but are not limited to supplies geared to strengthen the natl warehouse network. SCMS works with the PFSA which is the national authority to procure, store and distribute all health commodities for the public sector in Ethiopia. SCMS will procure and donate vehicles for PFSA with FY 2011 funds and will hand over its existing fleet to PFSA or the follow-on award at the end of COP 2012. This is aligned with the GHI HHS strategy for commodity and logistics systems and the PF's Goal III: Health systems necessary for universal access. PEPFAR collaborates with GFATM for HIV commodities procurements via monthly supply coordination committee meetings. SCMS will continue strengthening the warehouse network, integrate program commodity lines into one and assist PFSA in improving its MIS system. SCMS also works with the Ethiopian Health and Nutrition Research Institute (EHNRI) providing laboratory supply chain management TA and procurement services. To leverage resources and ensure cost effectiveness, SCMS will work closely with UNICEF on cold chain improvements, food supplement distribution and improvements to PFSA regional and central warehouse network.

In COP2012, SCMS will continue procuring drugs for opportunistic infections (OI) and Food by Prescription commodities, ensuring availability for target beneficiaries. The quantities needed for OI drugs exceed identified funding sources, hence PEPFAR will continue coordinating with the Global Fund (GF), via a monthly supply coordination committee. PEPFAR allocated $1,411,762 to provide vital antifungal commodities such as fluconazole and miconozole in full supply. Cotrimoxozole and other OIs will be purchased by GF. $14,570,307 was disbursed in September 2011, and $23,602,633 has been requested as part of the RCC, Phase 2 proposal, which is pending approval.

PEPFAR, UNICEF and WFP are the major donors contributing to specialized food supplementation programs for malnourished PLWHAS. In COP2012, SCMS will procure ready-to-use therapeutic food (RUTF) for severely malnourished adults and children, and ready-to-use supplementary food (RUSF) for moderately malnourished individuals; 44,111 clients are targeted. The procurement of the therapeutic food products will be completed by SCMS, with Save the Children (Food by Prescription, project prime partner) and World Food Program providing technical assistance to the selected sites. SCMS will procure from both international and domestic markets. In COP2012, PEPFAR will work closely with UNICEF, collaborating on storage and distribution of RUTF and RUSF within the PFSA network, leveraging transportation resources and expertise from each other. All commodities in the PFSA distribution network are accounted and resupplied through the national Integrated Pharmaceutical Logistics System (IPLS). IPLS is currently in more than 1,200 facilities. All PEPFAR facilities have been trained and are successfully using the IPLS.

SCMS will procure Early Infant Diagnosis (EID) commodities for approximately 500 health facilities that provide Dried Blood Spot (DBS) sample collection services. The commodities include DBS sample collection kits and related consumables such as gloves, gauze, cotton, and antiseptics. The money will also be used for procurement of DBS sample transport boxes for the facilities. Additionally,SCMS will purchase deoxyribonucleic acid-polymerase chain reaction (DNA-PCR) reagents with accompanying consumables for referral laboratories (currently 7 but this is expected to be increased to 10 in COP2012). The money also serves as a potential gap filler as the Clinton Foundation phases out its pediatric support, transitioning to the MOH in December 2011. According to the RCC, Phase 1, $3,617,050 was disbursed in September 2011. The RCC, Phase 2 submission requests for $3,953,572 to procure supplies and consumables for 82,160 tests. SCMS will regularly review PFSA stock information and will advise PEPFAR if EID commodities are needed.

The focus of laboratory infrastructure funding will be to continue to provide supportive supervision and technical assistance for the strengthening of supply chain systems for integrated quality lab services. The Pharmaceutical Fund and Supply Agency (PFSA) will play an increasingly central role in the logistics management of these supplies. In addition, SCMS will focus on strengthening lab commodity forecasting and lab logistics information management to ensure an uninterrupted supply, which is integrated with other program commodities within PFSA. Integrated training focusing on site-level lab commodity management will also be conducted in coordination with implementing partners.

In COP2012, SCMS will spend $100,000 to establish a supply mechanism for microbiology reagents and consumables for selected laboratories supported by CDC and $50,000 will be spent to procure reagents and supplies for HIV drug resistance testing at the national reference laboratory. An additional $500,000 will be allocated for External Quality Assurance (EQA) panels procured and distributed for the Ethiopian Health and Nutrition Research Institute (EHNRI) and $293,885 for lab technical assistance. Quality assurance and supportive supervision to ensure effective procurement and quality products will be carried out by USG and SCMS staff.

SCMS works with the Pharnaceutical Fund and Supply Agency (PFSA) to strengthen their capacity to manage the implementation of the national logistics framework. The project works in collaboration with USAID logistics partners: USAID/Deliver and Systems for Improved Access to Pharmaceuticals and Services (SIAPS), as well as UNICEF, in cold chain, warehousing and transportation.

The PFSA priorities for the next five years include: 1) improve availability of quality pharmaceuticals; 2) expand and strengthen warehousing and distribution infrastructure; and 3) focus on capacity building and good governance.

Therefore in COP2012, SCMS will concentrate on the following: improve PFSA infrastructure by supplying and installing equipment in ten new regional hub warehouses after they are built; complete the roll-out of the Pharmaceutical Information Management System (PIMS) and generate ownership of the data within PFSA; continue transport planning functions to ensure the national goal of integrated distribution to 3,000 health facilities; develop the processes of stock flow management to optimize the relationship between procurement, storage and distribution at PFSA; and develop and implement processes/infrastructure for the reconstitution of TB laboratory reagents and processes for import and distribution of short shelf life laboratory supplies. Additionally, SCMS will complete the Quick Win project to transition management of the logistics functions from SCMS to PFSA including: finalize the alignment of PFSA and SCMS job descriptions for management of program commodities and transition the management roles from SCMS to PFSA staff; and, develop and put in place a suitable contract so that PFSA can fully manage the import, clearance, storage and distribution of PEPFAR procured commodities and receive appropriate fees for providing services.

PEPFAR will continue procuring infection prevention materials, coordinating closely with the Global Fund (GF). According to the 2010 five year quantification, $57,998,821 is needed annually for full support of infection prevention materials in country. GF disbursed $3,077,622 in September 2011, and $3,718,418 is requested under the RCC, Phase 2 to be reviewed in May 2012. PEPFAR will contribute $3,394,044 in COP2012.

The current PEPFAR procurement list includes but is not limited to: bleach, bins for waste segregation, gloves, sharp containers and plastic buckets. The prevention TWG reviews the feedback from the field quarterly and adjusts procurement accordingly. Additionally, a national review of quantification assumptions with the supply coordination committee will take place in March 2012. PEPFAR and GF will then be able to address priorities and adjust procurement lists.

However, international funding cannot resolve the remaining gap and a mix of strategies, including working with facilities to allocate funding for locally available infection prevention materials, will be employed to ensure sufficient coverage. The new public health sector finance reform that allows facilities to retain a certain proportion of their budget can be instrumental in identifying sustainable ways to ensure availability of these essential supplies.

COP2012 funds will supplement private sector and community based prevention partners with 375,000 rapid test kits (RTKs). Over the years, PEPFAR noticed that the private sector and community based interventions run by the civil society are not well integrated with public sector procurement and distribution channels. To supplement the national effort, PEPFAR has allocated $250,000 to provide part of the private sector and community based testing needs to ensure that RTKs are available for partners working with the most at risk population. PEPFAR will continue to advocate for stronger recognition of the partnership role that the private sector plays within the national HIV response.

In COP2011, SCMS procured STI drugs per the needs identified in the national quantification. These drugs were partly distributed in loose form to health centers and hospitals in high prevalence areas, such as transportation corridors and urban areas. The rest of the drugs were packaged into 200,000 kits by the PEPFAR supported Population Services International (PSI). Kits for urethral, vaginal discharge and genital syndrome treatment were distributed through public and private pharmaceutical channels.

In COP2012, as part of the coordinated procurement approach between PEPFAR and GF, STI drugs will be procured by PEPFAR for an estimated 300,000 clients. Drugs will be procured, packaged into kits by PSI and distributed through PFSA to health facilities in urban and high prevalence areas.

Due to barriers, created by the lack of basic maternal-child health commodities, in COP2012 SCMS will continue working closely with the MOH to support improvements in service delivery at PEPFAR sites. In COP2010 the USG started a multi-year national initiative to supply PMTCT/ANC areas in 1,000 health facilities with essential equipment for various levels of health facilities. The lists were decided upon by the interagency TWG. This effort complements the MOHs procurement of similar equipment with MDG funding. A rapid assessment of sites was conducted by SCMS; site specific missing equipment will be procured and distributed door-to-door, avoiding potential bottlenecks inside the central distribution system. UNICEF, also working in this area, mostly supplies health posts, complementing PEPFAR efforts, which concentrate on hospitals and health centers. In COP2010, SCMS procured equipment and consumables for 115 high volume health centers. With COP2011 funds, equipment will be procured for 81 zonal and district hospitals. In COP2012, this initiative will continue in lower volume health centers.

It takes about a year for a new facility to be fully embedded into the PFSA central distribution network. To alleviate the initial strain to expand the PMTCT network, $250,000 worth of infection prevention materials and $500,000 worth of rapid test kits (RTK) will be procured and distributed to PMTCT community level partners. PEPFAR will supplement 50% of these partners targets. Basic laboratory supplies for PMTCT sites will be procured and distributed via the PFSA centralized network. The approach is meant to supplement and not disrupt the government logistics system and assist the countrys PMTCT acceleration plan. This will likely be a one-time intervention, as the PFSA logistics system matures and stabilizes. Ethiopia has adopted PMTCT WHO guidelines and GF will take care of the pharmaceutical costs for the roll-out of the activity.

Currently PEPFAR provides full support for laboratory reagents required for patient monitoring. For adult and pediatric treatment, SCMS will procure CD4, chemistry, hematology and viral load reagents, as well as lab consumables. Estimated quantities were determined from consumption reports. Quality is assured by continuous supportive supervision by treatment partners. All commodities are accounted for and resupplied through the Integrated Pharmaceutical Logistics System (IPLS) that is currently rolled out in more than 1,200 sites, covering the entire PEPFAR footprint in addition to some government-owned facilities. Future discussions with the GOE need to define more sustainable ways to secure laboratory reagents for ART monitoring.