Noted April 21, 2008: Due to an increased level of testing, additonal RTKs are needed to meet the new

demand level.

Continuing Activity

CDC is responsible for providing all rapid test kits (RTK) for Ministry of Health programs. In FY07, all funds

for the RTK were provided to SCMS. During FY07 CDC and SCMS worked closely with the MOH to

establish necessary capacity such as forecasting, consumption data, and ordering systems. Funds for

procurment of RTK in FY08 will again be provided to SCMS. SCSM will continue to provide techncial

assistance and traning in procurement systems to the MOH. SCMS and CDC will continue to work closely

on forcasting and ordering to ensure that there are no stock-outs. The CDC Office will continue its

responsibilities for quality assurance for rapid testing in all PEPFAR programs.

Continuing Activity

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 (if

the current partnership with Clinton Foundation partnership does not continue) 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, and 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. The Ministry of Health has recently identified the

land for the final facility and a joint donor procurement committee has agreed to jointly support the design

(SCMS), construction (IDB), internal equipment (SCMS/WB/GFATM), and possible management contract

(MOH).

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)

Activity Narrative:

Sustainability: SCMS will support the MOH in securing long term sustainability and support for the MMU and

to prioritize among potential MMU activities by conducting interviews, data analysis, and documentation

which has commenced; followed by a strategic/business planning document; and finally conduct of

validation exercises to the findings and preferred options to in order to obtain consensus and support for

implementation plan timelines.

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.

Over the last three years CDC Guyana has supported laboratory functions on multiple levels including

funding for laboratory supplies, supply procurement and distribution of various commodities like reagents,

basic laboratory equipment and supplies and consumables such as gloves and blood tubes. In FY08 CDC

will continue this support, through SCMS, to supply CD4 reagents for all treatment sites and 25% of all

hematology and chemistry reagents used at the Central Medical Laboratory at Georgetown Public Hospital

and the four other regional laboratories. CDC Guyana will continue to coordinate closely with MOH and

SCMS on reagent forecasting, procurement orders and auditing to ensure that there are no interruptions in

service delivery.

Continuing Activity and funded by Core Funds:

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.

System requirements have been determined, a solution vendor identified and hired, and the first stage of

preparation and installation of the system along with relevant training has been accomplished. This will be

implemented and at a minimum should be able to maintain national stock status indicators and detailed

consumption information using web based tools. 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.

Next steps include:

•Implementation of the central and regional level WH Management and information system. First by

developing a Master Project Plan with targeted go-live date, then selection and training of WMS supervisors

from both MMU and Annex. Next, they will execute proper First Expiry First Out (FEFO) control, resource

management, more accurate stock counts (including cycle counts), enhanced warehouse management and

automated WMS activity reporting in both MMU and ANNEX warehouses and develop a platform where the

warehouse management system information can be made readily available and eventually directly interface

with planned MACS Procurement, Contract and Tenders system.

•Improving information transfer between facility and central level to identify needs and role in data sharing

and to determine a mechanism to transfer information from facilities to central level.

•Ensuring strategic information is made readily available to drive decisions for key stakeholders, e.g. MOH,

MOF, donors, implementing partners. First, they will identify needs and roles in data sharing, and then

determine a mechanism to transfer such information from facilities to central level