PEPFAR's annual planning process is done either at the country (COP) or regional level (ROP).
PEPFAR's programs are implemented through implementing partners who apply for funding based on PEPFAR's published Requests for Applications.
Since 2010, PEPFAR COPs have grouped implementing partners according to an organizational type. We have retroactively applied these classifications to earlier years in the database as well.
Also called "Strategic Areas", these are general areas of HIV programming. Each program area has several corresponding budget codes.
Specific areas of HIV programming. Budget Codes are the lowest level of spending data available.
Expenditure Program Areas track general areas of PEPFAR expenditure.
Expenditure Sub-Program Areas track more specific PEPFAR expenditures.
Object classes provide highly specific ways that implementing partners are spending PEPFAR funds on programming.
Cross-cutting attributions are areas of PEPFAR programming that contribute across several program areas. They contain limited indicative information related to aspects such as human resources, health infrastructure, or key populations programming. However, they represent only a small proportion of the total funds that PEPFAR allocates through the COP process. Additionally, they have changed significantly over the years. As such, analysis and interpretation of these data should be approached carefully. Learn more
Beneficiary Expenditure data identify how PEPFAR programming is targeted at reaching different populations.
Sub-Beneficiary Expenditure data highlight more specific populations targeted for HIV prevention and treatment interventions.
PEPFAR sets targets using the Monitoring, Evaluation, and Reporting (MER) System - documentation for which can be found on PEPFAR's website at https://www.pepfar.gov/reports/guidance/. As with most data on this website, the targets here have been extracted from the COP documents. Targets are for the fiscal year following each COP year, such that selecting 2016 will access targets for FY2017. This feature is currently experimental and should be used for exploratory purposes only at present.
Years of mechanism: 2008 2009
Continuing Activity
Quantification, forecasting, and procurement of those necessary lab and testing supplies needed for the
Blood Safety, Track One funded program.
New/Continuing Activity: New Activity
Continuing Activity:
Table 3.3.04:
CDC is responsible for providing all rapid test kits (RTK) for Ministry of Health programs. In FY08, all funds
for the RTK were provided to SCMS. During FY08 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 FY09 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.
New/Continuing Activity: Continuing Activity
Continuing Activity: 12747
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
12747 8497.08 U.S. Agency for Partnership for 6703 6703.08 Supply Chain $319,500
International Supply Chain Management
Development Management System
8497 8497.07 U.S. Agency for Partnership for 4772 4025.07 Supply Chain $200,000
Table 3.3.14:
Important to note that in FY09 there will be an increased level of effort focused on the completion of a joint-
donor funded warehouse facility with SCMS providing technical support and internal fittings/equipment upon
completion. Also, in FY09, costs previously funded through HQ core funding have been transferred to field
budgets.
Back ground
The Supply Chain Management System (SCMS) Guyana Strategic Planning Workshop for 2008 and
Beyond was held in March 2008 to identify challenges and opportunities for SCMS intervention to address
some of Guyana's most pressing health commodity supply chain issues. Participants included a broad base
of stakeholders and other experts from across the Guyanese health commodity supply chain infrastructure
including the Ministry of Health, its operational units including its Management Information Unit, Materials
Management Unit, and Food and Drug Department, as well as technical experts from SCMS. Participants
then oriented their discussions around the elements of the SCMS Logistics Framework. The results of
these discussions provides the basis for SCMS working planning activities for 2008 and beyond. Moving
forward, activities identified have been incorporated into SCMS work planning activities. The work plan has
drawn from these strategic discussions and planning process , examined each of the logistics component
areas using the SCMS Logistics Framework. It also captured the long-term strategies to resolve each of the
identified technical and cross-cutting issues .
Activities
In close partnership with the MOH and with other incountry and international stakeholders and donors
SCMS in its vision to transform health care delivery ensuring that quality medicines and health care
commodities reach the people living with and affected by HIV/AIDS in Guyana. SCMS will strengthen the
national supply chain systems and by doing so, innovative solutions will be deployed to assist the MOH to
enhance their supply chain capacity in the areas of product selection, quantification, procurement, inventory
control, warehousing and storage, transport and distribution, product use and MIS and to ensure that
accurate supply chain information is collected, shared and used. While work on these and other activities
continues, SCMS has also established an effective relationship with the MoH and works especially closely
with the MMU toward the improvement of MMU capacity as well as the capacity of supply chain
implementing partners across the broader Guyanese Health Commodities Logistics System. Following are
the planned and continued/extended activities of SCMS Guyana based on the Strategic Review and
Planning session in March 08.
Product selection : Defined as the processes that are followed in the selection of products that support
prevention, treatment, and care. Product Selection has been identified as an essential area for support
because it focused on ensuring that HIV/AIDS patients received the right medicines and therapies. SCMS
will support Guyana to implement Standard Treatment Guidelines and promote rationale drug use through
Education, and Monitoring and evaluation (M&E). Will also enhance drug registration capability.
Quantification : Ongoing national level forecasting, quantification and supply planning of ARVs, RTKs and
Lab reagents represented a good opportunity for streamlining, simplifying, and thus improving the national
health commodities logistics systems and effective contributions towards an integrated procurement
planning. .SCMS will improve the accuracy of 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 commodity needs are. SCMS plans to
establish a primary and secondary data requirements for a Central Data Repository and a Service Delivery
Point dispensing tool that aids quantification covering patient, morbidity and consumption data. SCMS
strives to promote accurate data collection and dissemination for use in completing quantifications, building
capacity to conduct quantifications and transferring skills, plans to train leaders from within the MOH and
donor programs in the application of quantification tools .
Procurement : SCMS will continue its work in harmonizing and integrated procurement planning with all
donors and with the MOH. By developing 2 years quantification and a years rolling supply plans with
quarterly reviews of the forecast assure continued availabiulity, averting imminent stockout situations and
avoidance of stock outs in country. 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 or when supplies do not arrive timely due to several reasons ) and also will be
resuming procurement of both 1st. and 2nd. line Paediatrics when Clinton foundation withdraws its support
in 2009. SCMS will support MMU/MOH in the area of Procurement focused on training/capacity building,
harmonizing/ centralizing the procurement function. SCMS will also continue procurement of CDC funded
commodities as RTKs, Labs Reagents for FXB and NBTS. Training of the clients in the order management
tool ( Client Resource Manager ) will also provide better services to clients in keeping track of their orders.
SCMS's collaborative efforts with CDC and MOH to establish a National standard list of medical/lab
supplies and equipments also will help in the standardization of all supplies and equipments and to develop
service contracts for maintaining equipments.
Inventory Control , Warehousing and Storage : SCMS has been providing a continuous technical support to
the operations and management of MMU through both in country, external TA and trainings. SCMS strives
to build capacity and develop tools and training to streamline inventory control and warehousing and
storage procedures. Technical support to establish effective inventory control and warehousing processes is
another major area of support SCMS has provide. With the implementation and introduction of the MACS
inventory management system since October of 2007. location mapping, accuracy of all receipts,
transactions, dispatches, replenishments has improved enormously. SCMS will continue to support the
operations management 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
Activity Narrative: warehouse practices are demonstrated in storage and management of ARVs, and HIV commodities. The
joint warehouse operations and management and an ongoing transfer of skills and cross fertilization in
good warehousing practices and maintaining systems and disciplines has helped the MOH overall
inventory, warehousing and storage management at the central level.
SCMS has engaged in a partnership with the MMU to enhance technical skills in the areas of warehouse
and inventory management, data management and procurement. SCMS has also worked closely with the
MMU to increase capacity in terms of new facilities and equipment. Most recently, SCMS has worked with
MMU leadership to support the design and construction of a new, consolidated warehouse and distribution
center. SCMS will provide technical support, supervision and to assist in the provision of a multi donor
funding partnership for the state of the art facility for warehousing of all pharmaceuticals and medical
supplies in one fit for purpose facility. While building capacity, SCMS also aims to develop options for
establishing total Quality Management Systems at the MMU. QMS is a set of policies, processes and
procedures required for planning and execution of core functions of an organization.
Transport and Distribution : Distribution plans for some programs, regions and facilities are in place and in
existence, but due to exist, geographic and environmental constraints there is an inefficient and ineffective
use of available vehicles. SCMS will support in the area of transport and distribution focused on assessing
distribution processes and rationalizing equipment used for distribution and conducting a cost/benefit
analysis of transportation functions. This is important and critical as MMU wants to ensure that all health
commodities are received and distributed with integrity, with routine/timely dispensing to site and that they
all maintain product integrity with optimum storage for transport facilities from point of receipt to point of
dispensing SCMS will complete a cost benefit analysis of in-house and out sourcing of transportation
functions including collaboration with NGOs and use of marine and air options.
Strategic Information--INCLUDED IN SI SECTION-- (Logistics Management Information System): 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 provide
support in the area of MIS/LMIS focused on harmonizing policy, advocacy and establishing data collection
and data communication systems. The ability to collect accurate data and communicate that data through
MIS systems are a key part of the overall MIS strategy and an area where SCMS has been providing
support. SCMS has provided technical assistance to improve the central a 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. For the
remote site connectivity and in improving information transfer between central and facility level, a pilot inter
based option of transferring facility level requisition for Pharmaceuticals and commodities to the central level
and an IT infrastructure assessment has been completed. SCMS will develop a phase wise migration plan
in discussion with the MOH for options to transfer information from facilities to central level.
Performance Management : The comprehensive and integrated approach of SCMS has reached a broader
context in not only improving the systems nor building capacity through transfer of skills and training
programs but also from the sustainability and quality assurance perspectives, SCMS will be developing a
performance management strategic framework to facilitate the aggregation of M&E data from the field level
to the overall project level. 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.
Continuing Activity: 14080
14080 3153.08 U.S. Agency for Partnership for 6703 6703.08 Supply Chain $2,250,000
8209 3153.07 U.S. Agency for Partnership for 4772 4025.07 Supply Chain $2,750,000
3153 3153.06 U.S. Agency for Partnership for 4025 4025.06 Supply Chain $2,775,000
Emphasis Areas
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $324,750
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Program Budget Code: 16 - HLAB Laboratory Infrastructure
Total Planned Funding for Program Budget Code: $992,788
Total Planned Funding for Program Budget Code: $0
Program Area Narrative:
USG supports Guyana's laboratory structure and core functions. PEPFAR funding has increased access to HIV testing and
clinical monitoring for the HIV treatment program in-country. FY09 laboratory infrastructure plans build on laboratory activities from
FY08 and will continue to rely on technical assistance from the Ministry of Health (MOH), CDC, Supply Chain Management
System (SCMS), Association of Public Health Laboratories (APHL), American Society for Clinical Pathology (ASCP), FXB, and
AIDSRelief. Guyana has a National Strategic Plan for Laboratories (2008-2012) as well as a newly built National Public Health
Reference Laboratory. This facility was handed over by the USG to the GOG on the 3rd of July 2008. The MOH appointed the
Director of the NPHRL on the 17th of September 2008. CDC has employed a PhD level senior laboratory advisor to provide
technical support to the NPHRL and coordinate all PEPFAR laboratory activities in-country.
The current public laboratory system consists of five levels: health post, health center, district hospital laboratory, regional hospital
laboratory, and tertiary laboratory. Previously the Central Medical Laboratory (CML-clinical laboratory of Georgetown Public
Hospital) performed the functions of a referral laboratory and these will now be transitioned to the NPHRL. There are a total of 4
regional laboratories in Guyana (Linden, Suddie, West Demerara, and New Amsterdam). Health posts and centers perform only
malaria smears and possibly hemoglobin, while district level facilities can perform basic testing such as hemoglobin, complete
blood count (CBC), urinalysis, and blood glucose. Regional laboratories have the capacity to provide automated chemistry and
hematology. No microbiology or serology studies (except syphilis) are available except at the tertiary level, which includes only the
CML and National Infectious Diseases Laboratory (NIDL-National Blood Transfusion Centre) at present and the NPHRL once the
later is operational. All diagnostic and clinical monitoring functions for PEPFAR programs currently performed at CML and NIDL
will transition to the NPHRL in FY09. Currently, no laboratory can conduct testing for Pneumocystis Carinii pneumonia (PCP), or
Herpes Simplex Virus (HSV) infections, prevalent among HIV-positive patients. CML has developed the capacity to conduct
Cryptococous and Chlamydia testing. The NPHRL will be supported to become a centre of excellence for diagnosis of STIs and
OIs associated with HIV. Two of the five regional hospitals are old wooden structures in poor condition with chronic problems with
utilities and maintenance. These regional hospitals, as well as the five geographic regions without a regional hospital, are
completely dependent on the Georgetown facilities for all but the most basic testing, the setting of standards, storage of
commodities, and training of staff.
Supporting the NPHRL remains a key element of the Guyana PEPFAR program. The NPHRL represents the fulfillment of the joint
commitment by the USG and the Government of Guyana to upgrade the healthcare system. It is expected that the NPHRL will
provide a new level of infrastructure for labs in Guyana, and build systems and standards into the greater public health system
while providing essential support to the expanding HIV/AIDS program. It will be the hub for laboratory activities in Guyana and will
be the national reference lab and provide the link for international referral services. As a public health laboratory it will carry out
reporting on diseases of public health significance. In light of the role of NPHRL, capacity building of NPHRL staff will be a key
area of support by USG.
The Global Fund in Guyana is providing support for laboratory equipment but due to delays in the national procurement process,
the proposed equipment for the NPHRL is yet to be procured. The NPHRL currently has 6 medical technologists who have
transferred over from other MOH programs, and 3 medical technologists (CD4) have transferred from FXB. However in light of the
expanding role of NPHRL these staff numbers will not be sufficient. USG will support additional technical and some key
administrative staff at NPHRL through the MOH CoAg.
CDC continues to fund laboratory support to all care and treatment programs in-country in coordination with FXB and AIDSRelief.
CD4 testing is available for all treatment sites but is conducted at the NPHRL (3 FACSCounts provided by CDC). NPHRL will
continue to participate in EQA for CD4 testing. Treatment centers will continue to transfer specimens to Georgetown through the
existing specimen transport system. With the introduction of the NPHRL and provision of laboratory services to hinterland regions,
it will be necessary to develop a stronger sample transportation and courier system. In FY09 AIDSRelief will provide CD4 testing
at 3 care and treatment sites (1 Guava, 2 manual). In FY09 NPHRL will provide CD4% testing for pediatric staging. Clinton
Foundation will support provision of these reagents until the end of 2009. In FY 08 CDC in collaboration with MOH established
External Quality Assurance programs and proficiency testing for HIV rapid testing and for core parameters of
chemistry/hematology at all regional laboratories and 10 VCT sites. Guyana National Bureau of Standards has adopted the
ISO15189 standard as the basis for certification of clinical laboratories and CDC will support the certification of NPHRL and two
regional laboratories in FY09. Through collaboration with ASCP, CDC will continue to provide technical assistance on routine
chemistry/hematology (regional roll-out), advanced hematology (NPHRL) and lab management (NPHRL). In FY09 the twinning of
NPHRL with North Carolina State Laboratory of Public Health (NCSLPH) will continue and NCSLPH will continue to provide
technical assistance on all aspects of public health laboratory services. The QA department established at the MOH has
transitioned to NPHRL. NPHRL will be providing EQA and training for all care and treatment related laboratory services. CDC will
support funding for routine fieldwork and travel associated with EQA and regional training associated with clinical monitoring, DBS
collection, and TB smear microscopy.
Hematology and chemistry profiles needed for the monitoring of patients on ARV are available at the CML and will be available at
NPHRL. CDC will continue to provide 25% of chemistry /hematology reagents to the CML and all chemistry/hematology reagents
to NPHRL once the latter takes over HIV-related routine clinical monitoring. Routine monitoring is hampered at the regional
hospital laboratories due to the lack of reliable equipment, inadequate implementation of maintenance protocols, and recurrent
shortages of reagents. CDC will continue work with SCMS and MMU, MOH to ensure a better supply chain management system
for these reagents and other laboratory supplies during FY09. In FY09, CDC will support the development of laboratory
infrastructure and procurement of chemistry/hematology reagents for the 4 regional laboratories. CDC will coordinate with World
Bank to ensure the provision of automated Chemistry/Hematology equipment at regional labs. The ASCP, in collaboration with
CDC, began providing training in chemistry and hematology testing in FY07 that will continue in FY09.
USG works closely with other agencies in Guyana to support and coordinate laboratory services. The Canadian Society for
International Health (CSIH) has implemented TB culturing at the CML and TB smears at all regional laboratories. This program
ended in Sep 07 and has been taken over by MOH/GF but greater support is required particularly in the areas of advanced
diagnostics (drug susceptibility testing for MDR-TB). The NPHRL is a Biological Safety Level II facility designed to be easily
modified to a BSL III level in the future. In FY09 CDC will support the NPHRL to develop of molecular tests for MDR-TB and
implement fluorescence microscopy to enhance diagnosis of TB in the presence of HIV. The availability of fluorescence
microscopy will also assist in enhancing diagnosis of other OIs and STIs by the use of direct fluorescence assays.
The Clinton Foundation did not support the purchase of equipment to conduct DNA polymerase chain reaction (PCR) for infant
testing in FY08, however they have, with MOH, implemented an EID program where samples are sent to NICD in South Africa.
The effectiveness of this system (specimen collection, transport, delivery, result turn around times) will be evaluated in FY09 and
capacity strengthened as needed. DNA PCR equipment will be procured by GF in FY09 and EID established at NPHRL so that
Guyana will no longer have to send samples overseas. CF will fund DNA PCR reagents until the end of 2009. In order to ensure
continuity of this activity, USG will support this activity for the remainder of FY 09. This technology will be accessible to patients
from all care and treatment sites in the non-profit sector. These specialized services will occur under the control of the NPHRL to
ensure uniform coverage, minimize duplication, and enforce strong QA/QC standards. Presently there is no HIV drug resistance
monitoring in Guyana. A clinical and laboratory protocol will be developed by MoH in FY09 and CDC will support linkages with
certified laboratories for initial testing until drug resistance monitoring becomes available at NPHRL.
Human resource shortages remain a primary limitation for implementation and sustainability of programs in Guyana. USG will
work closely with MOH on strategies for staff retention. Through both a new technologically advanced physical structure and a
clear institutional vision and plan, the NPHRL will serve as an incentive for laboratory staff to stay and work in Guyana. USG will
advocate for efforts to link the University of Guyana laboratory programs to the new national laboratory in order to enhance pre-
service training and create segues to the public health laboratory system; through the ASCP CDC will also support the
development of an approved certification program, and required courses, for lab personnel as well as for training for identified
critical positions. A NPHRL training strategy will be developed and used to prioritize training for PEPFAR supported priorities.
These enhancements will aid in recruitment of new graduates and provide opportunities for professional advancement in Guyana
as an alternative to emigration. GOG has recognized ASCP to be sole certifying body for medical technologists in Guyana. GSCP
was launched as an arm of ASCPi. This will provide an impetus for the medical technology body of Guyana in terms of
professional development and international recognition for local medical technologists. A pre-service curriculum needs
assessment done by ASCP.
Table 3.3.16:
Over the last four 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 FY09 CDC
will continue this support through SCMS. In FY09 SCMS will procure and distribute CD4 reagents required
for CD4 enumeration for clients accessing care and treatment at all MOH care and treatment sites. CD4
enumeration will be done centrally at National Public Health Reference Laboratory. SCMS will procure and
distribute 25% of all hematology and chemistry reagents used at the Central Medical Laboratory
(Georgetown Public Hospital) and four regional laboratories. Routine hematology and chemistry testing for
national care and treatment sites which do not have chemistry/hematology capacity (including National Care
and Treatment Centre) will be done at NPHRL and SCMS will also procure the required reagents for this
activity. NPHRL is expected to become a centre of excellence for diagnosis of opportunistic infections.
SCMS will assist MOH with the procurement of specialized reagents and consumables required to fulfill this
role. SCMS will also work closely with the MOH to identify gaps in equipment/reagent support at NPHRL
and regional/district laboratories and assist in the procurement of those items required for delivery of quality
laboratory services in support of HIV care and treatment programs. SCMS will continue to coordinate
closely with MOH and CDC on reagent forecasting, procurement orders and auditing to ensure that there
are no interruptions in service delivery."
Continuing Activity: 12748
12748 8211.08 U.S. Agency for Partnership for 6703 6703.08 Supply Chain $146,650
8211 8211.07 U.S. Agency for Partnership for 4772 4025.07 Supply Chain $200,000
Health-related Wraparound Programs
* Safe Motherhood
Incredible strides have been made in FY08 with the highly successful implementation of the Warehouse
Management Information System component of the LMIS plan. This system has revolutionized the
warehousing and stock management systems. It is serving now as a springboard for integration of
consumption reporting, site-stock taking, and the ARV Dispensing Tools, all of which are electronic at
available levels
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
provide support in the area of MIS/LMIS focused on harmonizing policy, advocacy and establishing data
collection and data communication systems. The ability to collect accurate data and communicate that data
through MIS systems are a key part of the overall MIS strategy and an area where SCMS has been
providing support. SCMS has provided technical assistance to improve the central a 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. For
the remote site connectivity and in improving information transfer between central and facility level, a pilot
inter based option of transferring facility level requisition for Pharmaceuticals and commodities to the central
level and an IT infrastructure assessment has been completed . SCMS will develop a phase wise migration
plan in discussion with the MOH for options to transfer information from facilities to central level.
Continuing Activity: 14082
14082 9105.08 U.S. Agency for Partnership for 6703 6703.08 Supply Chain $0
9105 9105.07 U.S. Agency for Partnership for 4772 4025.07 Supply Chain $400,000
Estimated amount of funding that is planned for Human Capacity Development $75,000
Table 3.3.17:
