Management Sciences for Health/Health Commodities and Services Management Program (HCSM) will work collaboratively with NACC and MOH, implementing partners and other stakeholders to support management of the commodities used for HIV diagnosis, care and treatment to promote universal access and quality patient care. HCSM will continue work peripherally to strengthen systems for health commodity management primarily to the health facility level and to the community level to a limited extent in line with the community strategy. At the peripheral level, HCSM will work to support the county and district health teams to provide stewardship and oversight on commodity management interventions. The system strengthening activities will target decentralization, strengthening of peripheral level structures and task shifting activities.

To improve quality of care and retention of ART patients, HCSM will promote adherence through improved appointment keeping, adherence monitoring, defaulter tracking and reporting of adverse drug reactions and post-market surveillance of ARVs.

At the national level HCSM will support development and implementation of policies and structures that will guide and oversee health commodity management and related services. HCSM will work to promote quality pre-service, internship and continuous professional development programs for efficient supply chain of HIV and other health commodities and quality service delivery.

Key expected results include improved integration of services, national level commodity requirements planning and use of data for decision making, facility commodity usage reporting of ARV medicines(>90%) and HIV laboratory reagents (75%). This activity supports GHI/LLC and is funded completely with pipeline funds in this budget cycle.

MSH/HCSM will work with MOMS/MOPHS and other stakeholders to strengthen the delivery of services at the community level in line with the comprehensive service delivery approach and the community strategy as envisioned in the National Health Sector Strategic Plan and HIV & AIDS Services Decentralization Policy guidelines. This approach is meant to enhance community participation and partnership to allow for continuity of care and treatment across all levels of care. Primarily, HCSM will support providers to improve delivery of the basic care package at this level mainly health promotion, disease prevention and home based care. Activities at this level will therefore focus on improving access, medication adherence support, appropriate use and management of health commodities.

To improve access to and management of health commodities, HCSM will continue to work collaboratively with the Department of Primary Health Care, Division of Community Services, HIV/AIDS implementing partners and other stakeholders in the ongoing development and implementation of the commodity management curricula for community health workers. This will target providers to equip them with the basic knowledge and skills needed for accountability and effective management of their designated health commodities. At the policy level, MSH/HCSM will support the selection of health commodities for use at this level and strengthen mechanisms for ordering, monitoring use, reporting, and re-supply.

To support care and appropriate use of health commodities, MSH/HCSM will build on the on-going efforts to develop and disseminate guidelines, tools and materials such as simplified job aids targeting providers at this level. Specifically, MSH/HCSM will continue working with the MOMS/MOPHS, NASCOP, regional implementing partners, PHMTs and DHMTs in the dissemination and monitoring the use of the National Clinical Management and Referral Guidelines for community level [KEPH level 1] and other guidelines.

To address the growing need for medication safety monitoring at all levels, HCSM will collaborate with the Department of Pharmacy and the Pharmacy and Poisons Board and Priority Health Programs to expand pharmacovigilance and medicine quality assurance systems to the community level. This will entail implementation of a consumer reporting system for ADRs and poor quality medicinal products adequately supported through advocacy, community education, IEC materials and appropriate reporting tools. In addition MSH/HCSM will work collaboratively with regional implementing partners, community and patient groups to implement strategies that promote adherence and appropriate medicine use.

To ensure that providers at community level are adequately supported and linked to facility-based services, MSH/HCSM will work to build the capacity of PHC level facilities in health commodity management through training, mentorship and on-the-job-training (OJT) which will enhance implementation and functionality of the referral system between these two levels.

MSH/HCSM will work with the MoH and other stakeholders to strengthen effective laboratory supply chain and commodity management at central, regional and facility level thereby improving good laboratory practices in line with the national laboratory policy and strategic plan.

At central level, HCSM will support and strengthen the established National Lab commodity security committee (NLCSC) that oversees and directs all lab commodity management activities, including the development of the lab commodity essential and tracer lists. This will guide selection of lab commodities for procurement at all levels of care. HCSM will strengthen capacity within MoH, specifically NPHLS, NASCOP and other programs in forecasting & quantification, and procurement planning for HIV lab commodities. HCSM will also support the committee to develop the national budget for lab commodity requirements as a tool for resource mobilization as well as supporting the national Lab ICC to disseminate and implement the finalized approved national laboratory policy and strategic plan.

HCSM will collaborate with training institutions to develop and implement pre-service and in-service laboratory training curricula, and develop a pool of trainers on lab commodity management to cascade training to peripheral levels. For effective tracking of commodity availability and use, HCSM will support NPHLS to develop and implement manual and electronic tools at central and service delivery levels. This includes strengthening and scaling up the laboratory commodity tracking tool from the current six sites to an additional 10 sites, as well as use of routine laboratory data for decision-making at the central and peripheral levels.

At regional level, HCSM will also support and strengthen the established regional and district laboratory commodity TWGs to oversee and strengthen commodity management systems at the facility level. The regional teams will ensure that the facilities have the necessary lab commodity management tools and skills on use to sustain good inventory management. Together with the regional MoH teams and regional partners, HCSM will work to capacitate lab commodity management champions at regional (county, district) and facility level to provide mentorship, OJT and integrated support supervision for continued performance improvement and sustainability. The champions/mentors will disseminate the lab commodity management SOPs and job aids, including those on maintenance of cold chain, and support facilities on their use. As a result reporting rates for HIV test use is expected to improve from 60% to 75%

HCSM will work with district and facility commodity management teams and community-based organizations to strengthen advocacy and systems for accessing lab commodities and commodity tracking at the community level, including development of simple commodity tracking tools.

In collaboration with MoH and other stakeholders HCSM will implement monitoring systems to review the level of access to essential lab tests at the community level. Performance monitoring plan will be developed in line with the NPHLS, PEPFAR and HCSM project indicators to monitor the progress of the implemented activates as corrective action are taken from the lesson learned as provided by progress report for continual improvement towards achieving the project objectives.

MSH/HCSM will work collaboratively with other stakeholders and implementing partners to support the various HIV/AIDS services offered by the various MOH departments (NASCOP, NPHLS, DDFS, DLTLD, KEMSA, DOP and DRH). The system strengthening activities under COP 2012 will target decentralization, strengthening of peripheral level structures and task shifting activities, including their support policies and guidelines.

At the peripheral level, MSH/HCSM will work to support the county and district health teams to provide stewardship, and oversight on commodity management interventions by strengthening/establishing health commodity committees. This will include but not limited to mentorship, provision of tools, on-the-job training on specific areas, strengthening planning skills and use of data for decision making. An important aspect to this will be the use of performance based approaches to address the commodity management challenges.

At facility level, MSH/HCSM will work collaboratively with the peripheral level health managers, other implementing partners and other stakeholders to implement interventions that ensure improved systems resulting in increased access to quality pharmaceutical and laboratory services, rational use of commodities and reduced stock outs. Interventions will include mentorship programs for commodity management, operationalization of institutional medicines end therapeutics committees, provision of commodity management tools and job aids, improving use of data for decision making, improving appropriate use of health commodities, training on specific areas of health commodity management among others. MSH/HCSM will also work with the district health teams to improve the commodity management practices at the district stores.

At the national level, MSH/HCSM will work through the national level structures at Ministry of Medical Services (MOMS), Ministry of Public Health and Sanitation (MOPHS), NACC, to strengthen technical working groups in policy formulation/implementation and oversight activities for ensuring improved management of HIV/AIDS health commodities and related services. MSH/HCSM will also work to strengthen leadership and coordination in implementation of HIV/AIDS commodity management interventions. This will include support to development/implementation of policy documents and guidelines, integration of HIV/AIDS commodity management into the overall health services and private sector involvement in cross-cutting issues such as commodity financing, pharmaco-vigilance, procurement and Quality Assurance. MSH/HCSM will also work with other stakeholders to support the rollout of harmonized systems (manual and electronic) for commodity ordering and reporting.

In implementing, monitoring and evaluating interventions for system strengthening, MSH/HCSM will seek to collaborate with stakeholders and leverage for available resources. Stakeholders for the collaboration will include USAID partners, CDC partners, WHO, DANIDA, GTZ, World Bank, Clinton Health Access Initiative, MOMS/MOPHS and its affiliated institutions among others.

Management Sciences for Health/Health Commodities and Services Management Program (MSH/HCSM) will work closely and collaboratively with the USG team, KEMSA, NASCOP and other stakeholders to ensure consistent availability of critical medicines for HIV/AIDS services at all service delivery points. This will involve supporting national HIV/AIDS commodity requirements planning, quantification/forecasting, procurement planning, distribution resource planning, generation of routine strategic information on stock status and monitoring of commodity utilization/consumption for prevention, care and treatment services.

At the national/central level, HCSM will provide technical assistance to USG agencies and partners, NASCOP, Department of Pharmacy (DOP), Division of Reproductive Health (DRH), and DLTLD to support policy implementation, and strengthen commodity supply chain systems supporting HIV/AIDS. MSH/HCSM will strengthen systems by applying tried and tested commodity management tools and approaches including SOPs, on-the-job-training, mentorship, M&E and facilitative supervision in support of HIV/AIDS decentralization.

To strengthen pharmaceutical care and management systems in the private/NGO health sector using private-public partnerships, MSH/HCSM will work collaboratively with the DOP, professional associations, private health institutions thereby improving rational use of medicines, and strengthening control of antimicrobial resistance. Typical activities will include implementation of the revised National Pharmaceutical Policy; dissemination of revised ART guidelines; strengthening of hospital based drugs and therapeutics committees; advocate for linkages between the DOP, NASCOP, PPB , KEMSA, NQCL in cross-cutting issues such pharmaco-vigilance, ART drug procurement planning, monitoring and quality assurance.

At regional and facility level, MSH/HCSM will continue to support NASCOPs capacity building efforts on commodity management, including supply chain management, functioning of the national medicines and therapeutics committees. This will involve implementation of Commodity management tools and approaches to support the national program particularly in the area of quantification and forecasting, Pipeline monitoring, continuing medical education and point of service dispensing. MSH/HCSM will also support implementation the ART standard treatment guidelines; update MIS and M&E commodity management indicators and instruments; patient medication counseling materials and methodologies; implementation of quality of care indicators; and adherence measuring systems.

MSH/HCSM will continue to provide technical assistance at all health levels in the commodity systems strengthening such as development and/or adaptation of SOPs and forms; use of inventory management tools patient medication counseling for adherence; commodity management monitoring and evaluation systems, including ART Drug Utilization Reviews (DUR); the design and implementation of ART commodity management information systems; on-going training and monitoring for performance improvement at site level employing the monitoring-training-planning (MTP), a performance improvement approach.

Management Sciences for Health/Health Commodities and Services Management Program (MSH/HCSM) will work collaboratively with MOH departments (NASCOP, NPHLS, DLTLD, DRH, PPB and Department of Pharmacy), implementing partners and other stakeholders to support the various HIV/AIDS services towards achieving universal access and quality patient care.

MSH/HCSM will continue to participate and provide technical support to NASCOP & NACC taskforce committees and technical working groups. MSH/HCSM will support development/implementation of capacity building approaches/materials with a focus on HIV health commodity management and services.

MSH/HCSM will continue work with the regulatory authorities (PPB, KMDPB, KMLLTB, and NCK) and the training institutions to promote quality pre-service, internship and continuous professional development programs for efficient supply chain of HIV and other health commodities and quality service delivery. In addition MSH/HCSM will continue to work with Pharmaceutical Society of Kenya (PSK), Kenya Medical Association (KMA) and other professional associations to improve the policy and practice environment surrounding HIV/AIDS commodity management and related services.

MSH/HCSM will build on the achievements made towards strengthening human resources for health through pre-service, in-service and continuous professional development programs. MSH/HCSM will scale-up capacity-building strategies in health commodities management and services that will include systematically implemented task-shifting strategies which combine pre- and in-service training programs; regional trainers, mentorship and preceptorship programs; job aids, standard operating procedures (SOPs) and on-site supportive supervision.

To improve quality of care and retention of patients started on ART, MSH/HCSM will work with NASCOP to build on lessons learned to promote adherence through improved appointment keeping, adherence monitoring and defaulter tracking. This will entail scale up of the use of electronic dispensing tool and mobile technology. To promote patient safety, MSH/HCSM will work with PPB, NASCOP, NQCL and other stakeholders to implement a robust pharmacovigilance system for management, monitoring and reporting of adverse drug reactions (ADRs) and post-market surveillance of ARVs and other medicinal products. In collaboration with other stakeholders MSH/HCSM will continue to support strategies that curb HIV drug resistance.

To promote HIV/TB collaboration, MSH/HCSM will work with NASCOP, DLTLD and other stakeholders to support development and implementation of TB/HIV policy guidelines and commodity management curricula and tools.

MSH/HCSM will cover the public, private and faith based sectors and will advocate for linkages between all key stakeholders in addressing cross-cutting commodity management and service provision challenges.

MSH/HCSM will develop a clear M&E plan that will utilize systems strengthening approach and continuous quality improvement approach (MTP) to design, implement, monitor and evaluate interventions. The expected outcomes will be strengthened commodity management at peripheral health care facilities and at central level; improved pharmaceutical policy and service delivery and strengthened laboratory commodity management at all levels.