In FY06 the CDC Office procured all rapid test kits used in PEPFAR sites and commodities were managed out of the CDC office. In FY07, all funds will be transitioned to SCMS. The CDC office will work closely with SCMS and MOH during the transtion to ensure that there are no breaks in services. The CDC Office will continue its repsonsibilites for quality assurance for rapid testing in all PEPFAR programs.

The comprehensive logistics and management of the supply chain for PEPFAR commodities including laboratory supplies and anti-retrovirals has transitioned smoothly to the Supply Chain Management Contract through the great efforts of both SCMS as well as FHI/GHARP over the last year. Developed in cooperation with both the Government of Guyana and the USG team, the SCMS/MOH joint vision is described as the following: to transform health care delivery by ensuring that quality medicines and health care commodities reach the people living with and affected by HIV/AIDS in Guyana.

In collaboration with in-country and international partners, SCMS will 1) Deploy innovative solutions to assist programs to enhance their supply chain capacity; 2) Ensure accurate supply chain information is collected, shared and used; and 3) Provide quality, best-value, health care products to those who need them.

The SCMS integrated approach in Guyana emphasizes forums and processes for regular information sharing among partners and key stake holders and the strengthening of coordination to ensure that accurate and reliable information is shared in a transparent manner at all levels. SCMS plans to help create an enabling environment for effective supply chain management. This includes working together with and strengthening the efficiency of key players in the supply chain from within the MOH, from FBOs/NGOs, and from other government ministries such as Trade and Customs, which have roles to play in the legal frameworks and enforcement of policies which may effect supply chain management.

Components of a commodities management system include: product selection, procurement, quality assurance, freight forwarding, warehousing, distribution, and a management information system to monitor these activities. SCMS held a joint strategy development workshop with the MOH and this workshop reinforced that SCMS will concentrate their activities in FY07 in the following technical areas: quantification, procurement, warehousing and distribution, and management information systems. Strategies for each functional and cross cutting area have been identified and developed to ensure secure, reliable, cost-effective and sustainable supply chains to meet the care and treatment needs of people living with or affected by HIV and AIDS in Guyana. The activities and technical assistance in these areas will first focus on the improvement of the MOH Materials Management Unit (MMU) and other central level facilities and then later move the emphasis to regional level.

Quantification: SCMS activities will ensure accurate, routine national quantification of medicines and consumables for data-driven decision making to improve the accuracy of facility level requirements and orders. National level forecasting and quantification will not only provide the needs based on the actual usage but also will be able to help the donors to allocate their budgets in a more efficient and accurate manner with an understanding of what the actual ARV and related HIV/AIDS commodity needs are. Consumption data collection is required as part of the information system at each site provided with pharmaceuticals, and facilities will be accountable for the accuracy of their information. The ARV dispensing tool (ADT) is currently being piloted at the GUM Clinic in Georgetown which sees over 70% of Guyana's ART patients and will be launched in other sites next year. Sites receiving pharmaceuticals will continue to be trained in the information and reporting system to assure data accuracy and completeness. SCMS has trained a cadre of key staff from USG partners and the MOH in the use of quantification software and established a users group that will continue to meet monthly.

Procurement: SCMS will procure medications for adult 1st and 2nd line antiretroviral (ARV) therapy (1st line procurements will be dependent on whether the supply of drugs procured through GFATM are sufficient), drugs for opportunistic and sexually transmitted infections, and pediatric ARV 1st and 2nd line therapies to assure continued availability of medications and avoid stock-outs. Annual procurement levels will be based on the national quantifications carried out with all key stakeholders. A coordinated and unified procurement will be beneficial and result in the selection of quality products with better pricing, which on a longer term will have an impact on the budget. While Guyana's need and procurements are relatively small compared with the global market SCMS will leverage the scale of all its global procurement to secure lower prices for health commodities for Guyana. SCMS will make all efforts to procure the cheapest available drugs that meet US government quality standards. SCMS will also work to enhance the procurement capacity

within the MMU. As part of the Global Fund/World Bank/USG initiative to coordinate procurement, SCMS will work together with the MMU to facilitate joint procurement planning among all donors.

Warehousing and Distribution: The new annex warehouse has been established and operational since July 2006 under SCMS management and staff. An MOU has been signed with the Ministry of Health (GFATM, WB, MOH) and Initiatives (Safe Medical Injections) and SCMS management of the annex facility. USG and GFATM medications and supplies are already flowing through the annex warehouse in direct partnership with the MMU and following Standard Operating Procedures that the MMU has also adopted. SCMS will continue to work with the MMU and the annex warehouse to track products usage rates at USG supported HIV treatment and care facilities. Just as systems and procedures at the annex warehouse have been integrated with the MMU; technical assistance, infrastructure support, and capacity building will continue to support the primary MMU site as well. The technical assistance to the MMU includes: strengthening the national/central warehouse to effectively manage inventory; strengthening the storage and inventory management at the sub-warehouse and facility-level and establishing an effective distribution system to ensure timely, reliable delivery. SCMS will continue to manage the daily operations of the annex warehouse and aim to establish a single warehousing management where ordering, receiving and updated records form part of proper inventory tracking systems and good warehouse practices are demonstrated in storage and management of ARVs, and HIV commodities.

Management Information Systems: Establishing MIS strategies and improving the information system at both the central and facility level is vital in having a secure and reliable supply chain to make sure that accurate information is generated and systematically reported. SCMS plans to improve the central and facility level information system for supply chain management and ensure strategic information is made readily available to drive decisions for key stakeholders, e.g. MOH, MOF, donors, and implementing partners. (Cost allocations under SI)

Finally, SCMS will provide support and assistance to MMU to develop their performance management and evaluation capacity. Establishing key performance indicators and benchmark performance metrics will help support the continued improvement of the MMU and form the basis for a sustainable monitoring and evaluation plan that the MOH can utilize over the long term.

CDC Guyana supports laboratory functions on multiple levels through funding, procurement and distribution of various commodities including rapid test kits, reagents, basic laboratory equipment and supplies and consumables such as gloves and blood tubes. In FY06 CDC supplied CD4 reagents for all treatment sites and 25% of all hematology and chemistry reagents used at the Georgetown Public Hospital treatment site. In FY07 this support will be extended to 2 additional MOH regional treatment sites. Funds in FY07 will be shifted from direct support to the MOH via the Cooperative Agreement to support through the SCMS. CDC Guyana will coordinate closely with MOH and SCMS during this transition to ensure that there are no interruptions in service delivery.

Supply Chain Management Systems (SCMS) and the Ministry of Health held a joint strategy development workshop to establish that SCMS would focus on the following technical areas in FY07: Quantification; Procurement; Warehousing and distribution; and Management Information Systems (MIS). Strategies for each functional and cross cutting area have been identified and developed to ensure secure, reliable, cost-effective and sustainable supply chains to meet the care and treatment needs of people living with or affected by HIV/AIDS in Guyana. The activities and technical assistance in these areas will first focus on the improvement of the MOH Materials Management Unit (MMU) and other central level facilities and then later move emphasis to regional level.

Establishing MIS strategies and improving the information system at both the central and facility level is vital in having a secure and reliable supply chain to make sure that accurate information is generated and systematically reported. SCMS will provide technical assistance to improve the central and facility level information system for supply chain management to ensure strategic information is readily available to drive decisions for key stakeholders, e.g. Ministry of Health, Ministry of Finance, donors, and implementing partners. Training will take place with MMU and other MOH staff in MIS to transfer skills and capacity to host-country and improve the ability to track program performance over time.

The plans to improve the central level information system include the determination of the enterprise resource system requirements at the MMU which will include the ability to manage the warehouse, support warehouse procurements and distributions to down stream facilities. The chosen solution will be implemented and at a minimum should be able to maintain national stock status indicators and detailed consumption information using web based tools. A preference will be given towards a commercial off the shelf modular enterprise resource system and the solution will link procurement and distribution decisions to morbidity methods rather than using only existing consumption methods.

At the facility level, a simplified and integrated data collection and reporting system will be established and staff at the facility and MMU levels will be trained to use the information for decision-making that will lead to a more effective and efficient supply chain.

Targets

Target Target Value Not Applicable Number of local organizations provided with technical assistance for  strategic information activities Number of individuals trained in strategic information (includes 10
M&E, surveillance, and/or HMIS)

Table 3.3.13: