The Supply Chain Management System (SCMS) will supply best quality ARV drugs, medicines for opportunistic infections, laboratory equipment and commodities for diagnosis and enrollment of patients under the VCT, PMTCT, pediatric diagnosis, laboratory support for HIV positive patients enrolled in HAART as well as quality assurance (QA) and quality control (QC). Commodities include: i) Drugs including (a) all ARVs used in the national program, b) prophylaxis drugs such as INH, Vitamin B6, Cotrimoxazole and multivitamins, c) other antibiotics, antifungal and anti-parasitic drugs for treatment of the most common infections in HIV/AIDS patients, d) supportive drugs for symptoms such as fever, cough, diarrhea, headache, and pain; ii) Rapid Tests, confirmatory testing, reagents and supplies including HIV and syphilis rapid tests, CD4 tests and controls, Hematology reagents and controls, Chemistry reagents and controls, Murex, Enzyme-Linked ImmunoSorbent Assay (ELISA), Western Blot HIV tests, Polymerase Chain Reaction (PCR) tests as well as the corresponding supplies and equipment needed throughout the specified program areas; iii) Nutritional support such as Ready-to-Use Therapeutic Foods; and iv) Basic items needed for laboratory, dispensing and storage of commodities. SCMS will provide needs assessment, forecasting, purchasing, shipping, warehousing and distribution of the commodities to ensure on time availability. Monitoring and evaluation, training, and capacity building in logistics management complete the scope of activities. The activities will be carried out at USG supported sites across the country in all ten geographical departments. SCMS will also take steps to transfer skills and build the capacity of MOH counterparts in supply chain management.

SCMS will provide procurement and logistics management for high quality commodities including:

(i) Drugs including (a)prophylaxis drugs such as INH, Vitamin B6, Cotrimoxazole and multivitamins, (b) other antibiotics, antifungal and anti-parasitic drugs for treatment of the most common infections in HIV/AIDS patients, (c) supportive drugs for symptoms such as fever, cough, diarrhea, headache, and pain;

(ii) Laboratory equipment and commodities including HIV and syphilis rapid tests, CD4 tests and controls, hematology reagents and controls, chemistry reagents and controls, Murex, Enzyme-Linked ImmunoSorbent Assay (ELISA), Western Blot HIV tests, Polymerase Chain Reaction (PCR) tests, PPD and AFB smear microscopy for TB/HIV; (iii) Basic items needed for laboratory, dispensing and storing commodities.

SCMS will provide complementary logistics activities, including assessment of needs, forecasting, purchasing, shipping, warehousing and distribution of the commodities to ensure on time availability. In an effort to integrate supply chain management activities in Haiti, SCMS will operate a single coordinated commodity procurement and management plan that includes other stakeholders, particularly the Global Fund. This will mainly forecasting, supply planning, product selection and harmonization, warehousing and distribution.

SCMS will provide technical assistance to the MOH at the National AIDS Control Program for ongoing coordination of procurement planning and stock management. We will provide periodic formal training in logistics and stock management with emphasis on HIV commodities for drugs and lab commodities and continue to conduct continuous on-site training. SCMS will assist also the DPM and the departmental warehouses in their regulatory and management activities. Quarterly, SCMS will update commodity needs forecasting based on monthly stock and patient data and have at least one annual update with all the partners and the stakeholders. This activity will contribute to improve supply chain and treatment services throughout all treatment centers countrywide. Specific target populations include people living with HIV/AIDS, HIV positive pregnant women, HIV positive infants and children, public and nongovernmental health workers, pharmacists and nurses. The activities will be carried out at USG-supported sites across the country .

SCMS will provide high quality ARV drugs, opportunistic infections medicines and laboratory equipment and. The list of needed commodities includes:

(i) Drugs including (a) all ARVs used in the pediatric national norms, (b) prophylaxis drugs such as INH, Vitamin B6, Cotrimoxazole and multivitamins, (c) other antibiotics, antifungal and anti-parasitic drugs for treatment of the most common infections in HIV/AIDS patients, (d) supportive drugs for symptoms such as fever, cough, diarrhea, headache, and pain;

(ii) Rapid Tests, confirmatory testing, reagents and supplies for diagnosis and enrollment of patients under the Pediatric diagnosis;

(iii) Nutritional support such as Ready-to-Use Therapeutic Foods; and

(iv) Basic items needed for laboratory, dispensing and storing commodities.

SCMS will provide assessment of needs, forecasting, purchasing, shipping, warehousing and distribution of the commodities to ensure on time availability. The primary emphasis areas for these activities are commodity procurement and logistics management. Specific target populations include HIV positive infants and children. The activities will be carried out at USG supported sites across the country in all ten geographical departments.

SCMS will support the procurement of Genexpert TB diagnostics platforms, as well as cartridges for a pilot during that will continue into the COP12 period. Implementing partners include FHI/CHAMP, Health through Walls, MSH/SDSH and International Child Care (ICC). Evaluation this pilot will inform the national lab strategy for Haiti as it relates to TB diagnostics.

SCMS activities related to care and support include the following:

(i) Drugs including (a) all ARVs used in the pediatric national norms, (b) prophylaxis drugs such as INH, Vitamin B6, Cotrimoxazole and multivitamins, (c) other antibiotics, antifungal and anti-parasitic drugs for treatment of the most common infections in HIV/AIDS patients, (d) supportive drugs for symptoms such as fever, cough, diarrhea, headache, and pain;

(ii) Rapid Tests, confirmatory testing, reagents and supplies for diagnosis and enrollment of patients under the Pediatric diagnosis;

(iii) Nutritional support in the form of Ready-to-Use Therapeutic Foods; and

(iv) Basic items needed for laboratory, dispensing and storing commodities.

SCMS will provide assessment of needs, forecasting, purchasing, shipping, warehousing and distribution of the commodities to ensure on time availability. The primary emphasis areas for these activities are commodity procurement and logistics management. Specific target populations include infants and children living with HIV/AIDS, HIV positive pregnant women, public and nongovernmental health workers, pharmacists and nurses. The activities will be carried out at USG supported sites across the country in all ten geographical departments.

SCMS activities guarantee the availability of laboratory equipment and commodities including HIV and syphilis rapid tests, CD4 tests and controls, hematology reagents and controls, Murex, Enzyme-Linked ImmunoSorbent Assay (ELISA), Western Blot HIV tests, Polymerase Chain Reaction (PCR) tests as well as the corresponding supplies needed throughout the above-mentioned integrated program areas. The list of needed commodities relate to (i) tests, (ii) confirmatory testing, reagents and supplies for diagnosis and enrollment of patients under the VCT, PMTCT, pediatric diagnosis, laboratory support for HIV positive patients enrolled in HAART, (iii) basic items needed for laboratory, dispensing and storing infrastructure improvements. The primary emphasis area for these activities is commodity procurement including equipment and associated first-year maintenance contracts, distribution, as well as managing a central warehouse and distribution. The activities will be carried out at USG supported sites in all ten departments.

1) Procurement of laboratory commodities: In close collaboration with CDC/Haiti and Haitis National Public Health Laboratory, PfSCM will assess needs, quantify, procure and distribute HIV commodities and basic lab supplies; procure lab equipment; provide technical assistance for the departmental laboratories and health centers across the country in managing and rational utilization of their supplies; to train lab technicians across the PEPFAR sites in HIV commodity management with emphasis on lab tests, reagents and supplies. These activities will support PMTCT, VCT, adult and pediatric treatment, TB, palliative care, CD4 and other monitoring, in line with programmatic strategy and guidelines.

To strengthen laboratory infrastructure and systems, PfSCM will procure reagents, test kits, equipment and lab supplies necessary to train lab personnel and healthcare workers at the national lab.

2) Systems strengthening and capacity building: After the successful implementation of the CD4 referral system pilot using the BD FACS Count as the technical platform, SCMS will continue supporting the MOH in standardization of laboratory equipment and expansion of the CD4 program at the national level. We will assist in the harmonization of all technical platforms by level of care and produce through the CAGIL committee all needed procedures and work tools as part of the quality assurance system being implemented by the national laboratory.

3) PSCM will coordinate and deliver all HIV commodities and basic lab items to USG-supported laboratories.

SCMS will implement and operate a single data collection tool for patient and drug consumption management. In FY 2006 and the first part of FY 2007, SCMS/Haiti staff in collaboration with the software developers and managers at MSH/CPM in Arlington updated the ADT software (SIMPLE) to be able to integrate Opportunistic infections Drugs and patient data. It has now evolved into EDT (Electronic Dispensing Tool) that takes into account HIV and opportunistic infections treatment protocols, an expanded list of drugs for HIV and drugs for the treatment of malaria and tuberculosis. The collaboration with the University of Washington in Seattle succeeded in establishing and piloting the interface between EDT and the iSanté EMR during FY10. During FY12, the program will use this tool at all ART sites in the great metropolitan area and up to 25 sites. This effort will continue through FY13. The aim is to implement this system at all ART sites across the country including the new upgrades. This ill allow for accurate and current data on type, frequency of diseases / opportunistic infections and on most frequently used treatments as well as reducing duplication and time spent on data entry and at facility by the patients. All the above will contribute to a better management of drugs and their availability at all times.

Health Systems Strengthening activities are conducted by SCMS under various technical narratives aiming mainly at building the Ministry of Healths capacity to manage and oversee a national supply chain in most of its components: product selection, quantification, supply planning, warehousing, distribution and quality assurance.

PfSCM has included activities towards that goal under the various budget codes: MTCT, HBHC, PDCS, HLAB, HVSI and HMBL. The activities will be conducted with various directorates within the MoH such as Direction de Santé Familiale (DSF), Direction de Pharmacie, du Medicament et de la Medecine Traditionnelle (DPM/MT), Laboratoire National de Santé Publique (LNSP).

DSF : we will support capacity building activities at the central level to enable the department to manage a multi-sectorial committee on logistics and take the lead in quantification and managing multi-donor commodities.

DPM/MT: through embedding technical and clerical personnel within this department, we will continue to build the ministrys capacity to fully manage different aspects of the supply chain such as drug registration, quality assurance, quantification, etc& We will also assist at no less than three departmental warehouses in completing the full refurbishing of the facilities, training of personnel and providing them with the necessary paper and electronic tools to manage the stocks.

LNSP: we will increase the capacity of the national lab in harmonizing the technical platforms, producing and implementing standard procedures and instructions to help enforce the quality assurance program initiated by the national lab with the assistance of various donors.

The activities will be conducted in at least four geographical departments for Ministry of Health personnel.

SCMS is responsible for the procurement of laboratory supplies and equipment needed for reaching the established national objectives on blood safety. The supplies will be delivered to the Haitian Red Cross on behalf of the National Program (PNST) that manages the National Blood Center laboratory and with the agreement of the USG team. The Haitian Red Cross will screen every unit of blood collected nationwide for HIV, HCV, HBV, syphilis, and HTLV-1 and 2. Quality control supplies are part of this procurement mechanism and a percentage of the supplies will go to GHESKIO-IMIS, which performs this particular aspect of the activity. Additional supplies will be procured to support a network of up to 30 blood collection centers and blood banks around the country. This activity targets the general population and blood transfusion lab technicians as well as National Blood Transfusion Program and Red Cross staff. The activities will be carried out at the central blood bank and all transfusion centers across the country in all ten geographical departments.

SCMS will receive and process orders for supplies from the Haitian Red Cross, GHESKIO and the National Blood Safety Program in support of PEPFAR blood safety activities in Haiti. PfSCM will create needs assessment, standard supply list, quantification and supply planning and purchase orders for needed supplies. SCMS will further support the delivery of these supplies to Haiti (customs clearance), interim warehousing for internationally and locally procured commodities and their distribution to the Haitian Red Cross or the National Reference Laboratory, as appropriate.

Training in stock management of technicians running the various blood transfusion sites will be part of our activities particularly for the new hires and any other requiring refresher courses. We will encourage the national program and the Red Cross to identify senior technicians to act as trainers so we can increase their capacity by training of trainers to take over the training activities.

SCMS will provide high quality commodities, particularly rapid tests and confirmatory testing for enrollment of patients for PMTCT and reagents and supplies for Polymerase Chain Reaction tests for early infant diagnosis. This includes assessment of needs, forecasting, purchasing, shipping, warehousing and distribution of the commodities to ensure on time availability. SCMS will work closely with the MoH and support its expansion of the PMTCT program to include up to 125 sites in FY2012. SCMS will act as secretariat for the PMTCT subcommittee on commodities and will coordinate donations to the program from various sources by providing assistance in customs clearance, warehousing and active and passive distribution to all national sites. Specific target populations include health workers, HIV positive pregnant women and HIV positive infants. The activities will be carried out at all PMTCT USG supported sites as well as other sites designated by the Ministry for distribution of commodities in all ten geographical departments and at two reference laboratories (National Lab and GHESKIO-IMIS).

SCMS conducts assessment of needs, forecasting, purchasing, shipping, warehousing and distribution of needed commodities. The list of needed commodities includes all ARVs used in the national program for adults, children and pregnant women. These activities will build on PEPFARs success in maintaining, since 2006, a stock of ARVs sufficient for the needs of about two thirds of total ART patients without interruption.

1) Procurement of ARVs: SCMS will procure drugs included in the national treatment guidelines for adult, pediatric and PMTCT patients. SCMS will make every effort to coordinate timing and quantities of ordering with Global Fund counterparts. The national authorities are still expressing high interest with plans to centralize all ARV procurement into a single purchasing and distribution system, using PfSCM as the mechanism to achieve that goal. SCMS will continue to provide national forecasting that is updated quarterly based on monthly stock and patient data and have at least one annual update with all the partners and the stakeholders. This activity will contribute to improve supply chain and treatment services throughout all treatment centers countrywide, facilitate planning, procurement and reduce double reporting on patients, thus decreasing MOH and donor redundancy.

2) Logistics Strengthening: SCMS will provide technical assistance to the MOHs AIDS Program for ongoing coordination of procurement planning and stock management. We will provide periodic formal training in logistics and stock management with emphasis on HIV commodities and continue to conduct continuous on-site training, technical assistance, follow up to training and supervision of stock activities. These activities will encompass public and NGO-operated sites across the country. SCMS will include system strengthening activities to assist the central Ministry authorities in conducting regulatory activities and enable them to incorporate permanently commodity management activities and supervision within the ministry. We will assist also the departmental CDAIs to maintain an integrated logistics system within their department.

3) Managing a Central Warehouse and Commodity Distribution Network: PfSCM will continue to manage a central warehouse facility ensuring quality and security for HIV commodities purchased and stored by the project and maintaining the chain of custody up to the point of delivery.