THIS IS AN ONGOING ACTIVITY. THE NARRATIVE IS UNCHANGED EXCEPT FOR UPDATED

REFERENCES TO TARGETS AND BUDGETS.

1. LIST OF RELATED ACTIVITIES

This activity relates to activities in HIV Treatment: ARV drugs (#6989) and Laboratory Infrastructure

(#6990).

2. ACTIVITY DESCRIPTION.

The USAID funded Strengthening Pharmaceutical Systems Project (SPS), implemented by Management

Sciences for Health, will continue to strengthen, improve and maintain the national logistics and distribution

system for HIV clinical care, support and the prevention of TB. Through system strengthening, training and

monitoring, the National Leprosy and Tuberculosis Program (NLTP) will be enabled to improve case

detection rates, establish Diagnostic Counseling and Testing (DTC) and provide integrated TB/HIV

treatment and referral. Under the KEMSA support, SPS proposes to continue supporting Central NTLP and

peripheral NTLP activities and at the same time, develop plans to capacitate NTLP to assume key

administrative and operational activities. As with other MOH programs and services which have continued

to request technical support for quantification and forecasting, the NLTP has also expressed a need in

these areas. Specifically, NLTP would benefit from greater knowledge and skills in quantification and

forecasting so as to move away from annual historical projections for commodities that contribute to

perennial stock outs and/or over supply. In 2006, 115,173 active cases of tuberculosis were notified to the

NLTP. National HIV/TB co-infection rate stands at 52%. Provincial and District TB and Leprosy

Coordinators need to have access to not only TB drugs but also HIV tests for DCT, and prophylaxis

treatment regimes such as cotrimoxazole. These integrated HIV commodities will be added into the TB

logistics system, so as to provide a fully integrated TB/HIV service. Tight financial management and

accountability is the key to the success of the program as can be seen through present efforts as well as the

TB program on which this program design was based.

2. CONTRIBUTIONS TO OVERALL PROGRAM AREA

This activity will support the distribution and logistics systems for equipment, supplies (such as laboratory

equipment and pharmaceuticals including cotrimoxazole and isoniazid), and training necessary to

implement the National TB program for integrated TB/HIV activities. Targets for patients treated as a result

of these activities are listed under the activities funded through the NLTP and other partners collaborating in

the implementation of integrated TB/HIV activities.

3. LINKS TO OTHER ACTIVITIES

This activity also relates to activities in ARV drugs (#6989) and Laboratory Infrastructure (#6990), which

concentrate on improving logistics for the various HIV/AIDS related commodity groups from condoms, home

-based care kits, laboratory equipment and reagents to other associated health commodities.

4. POPULATIONS BEING TARGETED

The main beneficiaries are people living with HIV/AIDS.

5. EMPHASIS AREAS

The major emphasis area for this component is logistics serving to enhance the availability of anti-TB

drugs. Minor areas of emphasis include quality assurance and support supervision and training.

THIS IS AN ONGOING ACTIVITY. THE NARRATIVE IS UNCHANGED EXCEPT FOR UPDATED

REFERENCES TO TARGETS AND BUDGETS.

1. LIST OF RELATED ACTIVITIES

This activity relates to HLAB (#6990) and TB/HIV (#8713) services implemented by MSH/RPM+, the ARV

procurement contract to be awarded by USAID through a mission competitive procurement (#6997), and

HLAB (#8763), MTCT (#8757) and HVCT (#8783) activities by SCMS.

2. ACTIVITY DESCRIPTION

The USAID funded Strengthening Pharmaceutical Services Project (SPS), implemented by Management

Sciences for Health (MSH) will do forecasting and quantification of antiretroviral drugs and other

pharmaceuticals, as well manage logistics management information (LMIS) systems to track procurement,

warehousing, and distribution of these commodities. Specifically, SPS will continue to support overall ART

and other HIV/AIDS-related medical and pharmaceutical commodity supply requests from Emergency Plan

partners, institutions, and assist the USAID ARV procurement contractor with appropriate procurement

requests and distribution planning for ART sites. MSH/SPS will continue to assist with provision of strategic

information from ART and other commodity sources including importers and manufacturers. At the national

level, SPS will provide technical assistance in commodity management to the USAID ARV procurement

contractor, KEMSA, NASCOP and the Department of Pharmaceutical Services to strengthen commodity

supply chain systems supporting ART and other medical and pharmaceutical commodities related to

HIV/AIDS. To assist in capacity building for commodity management, SPS will continue to implement

curricula for training ART healthcare workers at all levels of care. SPS will also strengthen systems by

developing and applying Standard Operating Procedures for commodity management tools. In the 2008

COP implementation period, SPS will continue to work directly with KEMSA and its staff at the Logistics

Management Unit (LMU) in order to support their activities that were previously supported under the

MSH/RPM+ project. This includes managing the LMIS system of parallel commodities. SPS will maintain

this database and help distribute reports to relevant divisions and agencies on stock status until it is ready

to be transitioned to and maintained by KEMSA. When this transition happens, it will entail: expansion of the

LMIS database to include all products warehoused and distributed by KEMSA, finalization of the LMIS user

manual, training KEMSA and users from MOH departments (NASCOP, KEPI, RH, NLTP and essential drug

programs) on how to use the LMIS and implementing facility based forms and tools for recording and

summarizing commodity usage data. This component is part of the continued development of the national

medical and pharmaceutical supply chain system that distributes ARVs and other medical and

pharmaceutical commodities from the national warehouses to district warehouses and points of service.

Over 400 points of service - public, private, mission and NGO are served by this system. SPS will work with

key partners to update product selection according to MOH standard treatment guidelines, verify registration

status, quantify requirements and update forecasts to enable uninterrupted procurement. The LMIS system

will enable timely and accurate collection and reporting of ARV drug and other commodities to the National

AIDS and STD Control Program (NASCOP), KEMSA, the new USAID ARV procurement contractor,

divisions of the MOH, and other partners. These integrated activities will be jointly funded with non-

HIV/AIDS funds to support the entire national procurement and distribution system, with a key emphasis on

reliable distribution of HIV/AIDS commodities down to the "last mile." Key partners with whom SPS will work

include: KEMSA, the Kenya Government organization responsible for procuring and distributing medical

supplies to government facilities and currently responsible for distribution of all pharmaceuticals procured

with resources from the Government of Kenya and the Global Fund, the Supply Chain Management System

contract (SCMS), the major procurement and distribution partner of PEPFAR, the National AIDS and STD

Control Program (NASCOP), the program with overall responsibility for management of the GOK program;

the Mission for Essential Drugs (MEDS), a key distribution agent serving the NGO community with ARV

drugs. SPS will also work with the Department of Pharmaceutical Services and its institutions to support the

policy and practice reform agenda aimed at strengthening national skills and capacity in commodity

selection, quantification, procurement, distribution, quality assurance and appropriate use of commodities

needed for the treatment and care of PLWHA. SPS will also support activities by the pharmacy professional

associations, the NGO/private sector aimed at improving access and use of ARVs and other medicines in

support of the national ART programme. These will include implementation of the revised National Drug

Policy to include components supportive of the provision of effective ART commodity management services;

preparation of the national strategic plan to guide the pharmaceutical sub-sector; implementation of the

Strategic Plan for Pharmaceuticals services, support to stakeholders in the development and dissemination

of various ART policy guidelines; and advocacy for linkages between the Department of Pharmaceutical

Services, NASCOP, PPB , KEMSA, NQCL in cross-cutting issues such pharmaco-vigilance, ART drug

procurement and Quality Assurance. At site level, SPS will continue to provide technical assistance in the

development and adaptation of SOPs and forms; use of inventory management tools for patient medication

counseling for adherence; commodity management M&E systems, including Drug Utilization Reviews

(DUR); the design and implementation of ART Drug Management Information Systems; and training and

monitoring for performance improvement at site level employing the MTP methodology.

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA

These activities will support forecasting, procurement and tracking of supplies of antiretroviral drugs and

other pharmaceuticals for at least 160,000 people. It will also help establish a sustainable national supply

chain system capable of managing medical and pharmaceutical supplies in proportion to the national

epidemic.

4. POPULATIONS TARGETTED

The main populations targeted are people living with HIV/AIDS, health workers in both the public and

private sector, and MOH policymakers and managers.

5. EMPHASIS AREAS

The major emphasis area is commodity procurement. Minor emphasis areas are logistics, QA/QI/SS,

Strategic Information, and Training.

THIS IS AN ONGOING ACTIVITY. THE NARRATIVE IS UNCHANGED EXCEPT FOR UPDATED

REFERENCES TO TARGETS AND BUDGETS.

The only changes to the program since approval in the 2007 COP are (complete all that are relevant; delete

those that do not apply)

+ prime partner Management Sciences for Health has been competitively selected to implement the activity

under the Strengthening Pharmaceutical Systems (SPS) project mechanism.

+ other (NON-SUBSTANTIVE) change will include the following:

MSH will assist in the implementation of the national Lab policy and strategy particularly regarding local

performance standards for labs. In addition MSH will provide support to the local accreditation of peripheral

labs assisting in classifying labs that are suitable to provide support to HIV patients.

1.LIST OF RELATED ACTIVITIES

This activity is related to the HVTB activity (#8713).

2.ACTIVITY DESCRITION

Management Sciences for Health (MSH) has worked in Kenya for the last 19 years and in other parts of

Africa and the world for 34 years. MSH through its Rational Pharmaceutical Management (RPM) Plus

program and other activities (e.g. Gates Funded SEAM Program), has worked at three Mombasa sites and

elsewhere in Sub-Saharan Africa including Rwanda, Zambia, Namibia, Ethiopia and Uganda to improve

laboratory management and quality of anti-retroviral therapy (ART) services. Under COP 2005, RPM Plus

supported the National Public Health Laboratory Services (NPHLS) and the National AIDS and STD Control

Programme (NASCOP) to develop a national laboratory policy and strategic plan. The NPHLS is the

department of the Kenya Ministry of Health (MOH) charged with providing technical and tactical oversight

for all laboratory services in Kenya. As the lead Cooperative Agreement (CA) mandated by the Ministry of

Heath NPHLS to guide laboratory system strengthening efforts through at the head of the Systems

Interagency Coordinating Committee (ICC) sub-committee, RPM Plus will continue to apply lessons learnt

in Mombasa to support sites' implementation of good laboratory practices as stipulated in the national

laboratory policy. This will involve supporting NPHLS and NASCOP to improve existing laboratory

management information systems (MIS); strengthen laboratory commodity management systems in support

of ART; roll out implementation of Standard Operating Procedures (SOPs) for quality and efficiency of

laboratory services; train providers in Good Laboratory Practices (GLP); strengthen management and

coordination of the laboratory network; contribute to the development and implementation of a standardized

in-service laboratory training curriculum; and implement internal and external quality assurance/control

procedures. RPM Plus will provide technical assistance to strengthen laboratory services in support of ART

by working synergistically with the Laboratory ICC and other stakeholders. All RPM Plus laboratory activities

will be conducted under the auspices of the NPHLS. This includes support for national-level activities such

as those mentioned above as well as the implementation of the national laboratory policy; implementation of

a national laboratory policy strategic plan; and development of institutional capacity by institutionalizing

laboratory SOPs. RPM Plus will also support NPHLS activities aimed at strengthening and scaling up

laboratory activities at priority ART sites. Activities include: refurbishment of 10 priority laboratories

(including the proposed Central Microbiology laboratory at the NPHLS), training laboratory staff in skills for

ART, SOPs and good laboratory practices such as improved handling, transportation of specimens and

return of results as well as universal precautions, and improved laboratory record keeping and MIS. In

addition, this project will assist laboratories by providing guidance on the ART policy, professional and

operational information and materials as needed; developing SOPs on equipment maintenance, and

strengthening 10 sites to implement internal and external quality assurance procedures. The project will

also provide support to laboratory supervisors to strengthen their management and coordination of

laboratory services (supervisory check lists, job aids, monitoring tools, operational planning guides), and will

help institutionalize laboratory quality assurance procedures including performance of internal quality

controls (QCs) and calibration of equipment; training on the laboratory MIS, monitoring and evaluation

(M&E) tools and the use of routine laboratory data. Additional activities include maintaining essential

activities of the former JSI/DELIVER project, primarily maintaining an LMIS system to track warehousing

and distribution of laboratory commodities in collaboration with the MOH and KEMSA. It will also include

forecasting and quantification of laboratory procurement commodities as needed. MSH/RPM Plus will

closely collaborate with NASCOP, NPHLS, KEMRI, CDC, KEMSA, UON, AMREF, FHI KMTC, AKMLSO,

KMLTTB, CDC, JSI, Clinton Foundation, USG HIV care and support grantees, private sector organizations

and other stakeholders comprising the National Laboratory Inter-agency Coordinating Committee (ICC).

3. CONTRIBUTIONS TO OVERALL PROGRAM AREA

This activity will result in improving access and use of quality diagnostic laboratory services through

improved laboratory policies and management, including use of SOPs and implementation of QA/QC

systems. A total of 300 laboratory technologists will be trained in proper laboratory management, and labs

in 10 ART sites will be refurbished and strengthened on requisite quality assurance procedures.

4. LINKS TO OTHER ACTIVITIES

This activity links to the HVTB activity (#8713).

5. POPULATIONS TARGETED

The populations targeted are laboratory technicians at priority Ministry of Health ART centers, and

policymakers and division heads in the MOH. 6. EMPHASIS AREAS The main emphasis area is Training,

with minor emphases on Strategic Information and QA/QI/SS.