NOTICE - Per the recommendation from OGAC that Malawi as an FY2008 Compact Country, submit a mini

-COP (i.e. program area level narratives only), this activity level narrative has not been updated prior to the

submission of the FY09 Full COP. The Malawi country team anticipates updating narratives upon

completion and final approval of the negotiated 5-year Compact between the United States Government

and the Government of Malawi.

Summary

The activities proposed within this area are aimed at overall capacity-building and support for the Central

Medical Stores (CMS) system to better procure, supply, and manage the distribution of HIV/AIDS-related

commodities such as HIV test kits, drugs for Opportunistic Infections (OI's) and ultimately antiretrovirals

(ARV's) to points of service. The DELIVER Project will second Regional Logistics Officers (RLO) to provide

support to the District and Service Delivery Points (SDP) levels; and support targeted minor improvements

to commodity facilities when needed. In addition to the activities focused on CMS, the project also

proposes to develop a supply chain logistics Pre-Service Training Curriculum with local partners, including a

component for handling of HIV/AIDS-related commodities.

Background

The role of CMS is the procurement, storage, and distribution of public medical supplies. Under the health

Sector Wide Approach (SWAp), the Ministry of Health and its collaborating partners recognize the need for

efficient reforms of the drug and supply system to improve access to drugs and are committed to, among

other things, improving stock management controls and strengthening accountability mechanisms at CMS

and RMS. The USG through the DELIVER Project has been supporting supply chain system strengthening

since 2000 with special focus on the lower levels of the distribution system using reproductive health

funding. This is a wrap-around project that combines EP funding with PMI and reproductive health

resources to build an integrated supply chain management system within the MoH.

Under the DELIVER Project, USG funds were used to computerize processing of MoH logistics data from

400+ service delivery points at 26 district-level facilities using Supply Chain Manager, which was in turn

used to order electronically contraceptives, sexually transmitted infection (STI) products, EHP drugs, and

other products from the RMS's. Use of the computerized system resulted in improved availability of

contraceptives and information for decision making for other essential drugs at the SDPs. In the first year of

the DELIVER Project, the USG funds had been used to assist the MOH including CMS to use effectively

the available information to guide their forecasting and quantification exercise for selected drugs and

medical supplies.

With FY 2008 EP funding, the DELIVER Project will provide assistance at the national and regional levels to

strengthen the capacity of CMS to manage and distribute HIV related commodities like HIV Test kits, OI's

and eventually the system will have the capacity to support management of ARV's which until now are

managed through a parallel system. The activities will also contribute to ensuring continuous, uninterrupted

and adequate supply of approved quality and affordable HIV/AIDS commodities.

Activity 1: Secondment of three Regional Logistics Officers

The first activity under this is to support the logistics function at Malawi's three Regional Medical Stores by

seconding a Regional Logistics Officer (RLO) to each office. The Regional Logistics Officer will be

responsible for maintaining a sound, efficient, and effective drug storage (warehousing) and distribution

system for all commodities, including HIV/AIDS-related commodities, handled by the RMS. In addition,

he/she will provide direct support to districts and health centers through constant supervisory visits and on-

the-job training to ensure that drugs are requisitioned, stored and issued/dispensed properly. The RLO will

prepare and submit regular (monthly and quarterly) progress reports to the Pharmacist In-Charge for

onward submission/transmission to the Director.

These positions are a continuation of positions created in 2007, and will eventually be funded from within

CMS.

Activity 2: Curriculum development

The second activity will be to develop a Pre-Service Curriculum for Pharmacy Technicians, Nurses, and

other Service Delivery Point (SDP) workers. The curriculum will focus on integrating a logistics module/unit

into the training programs for each group, focused on Standard Operating Procedures for HIV/AIDS-related

and other health commodities. This curriculum follows the National Training Strategy developed by the

project in 2007, and will be developed in partnership with the appropriate units at the Ministry of the Health,

the national universities, pre-service trainers, and non-university training programs.

Key components of the proposed curriculum will include:

• Introduction to basic principles of supply chain logistics for health commodities

• Overview of Malawi's supply chain for HIV/AIDS-related and other health commodities

• In-depth, position-specific training on forms for ordering, reporting, and record-keeping

• Storage requirements for ARVs, test kits, and other commodities

• Training on Supply Chain Manager and other LMIS software as needed for district-level pre-service

personnel and pharmacists

• Testing and evaluation criteria for the module/unit

Activity 3: Storage improvements

The third activity in the area is general storage improvements for facilities at the RMS, District, and SDP

levels with specific focus on the improvements required for improved management of ARVs, HIV/AIDS Test

Activity Narrative: Kits, and Laboratory supplies. As part of the supervisory visits, Regional Logistics Officers (activity 1 in this

area), will also be asked to regularly report any areas in need of minor improvements. In addition, facilities

at any level reporting the need for minor improvements will be eligible for improvements on a case by case

basis, as requested by CMS. This could include, for example, shelving units or added security for high-

demand commodities.

New/Continuing Activity: Continuing Activity

Continuing Activity: 17133

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

17133 11261.08 U.S. Agency for John Snow, Inc. 7666 5660.08 JSI CSH $150,000

International

Development

11261 11261.07 U.S. Agency for John Snow, Inc. 5660 5660.07 JSI CSH $55,166

International

Development

Program Budget Code: 16 - HLAB Laboratory Infrastructure

Total Planned Funding for Program Budget Code: $2,993,000

Total Planned Funding for Program Budget Code: $0

Program Area Narrative:

Overview

In order to address the issues of equity and improved access to health care services in the public sector, Malawi developed a

national health care strategy that focuses on the minimal essential services that could be efficiently delivered at a District level, the

Essential Health Package (EHP). Complementary to the EHP is the Essential Medical Laboratory Services (EMLS) package.

The EMLS was designed to provide tiered laboratory services at the district and primary health care unit levels, addressing issues

such as physical infrastructure, personnel, training, equipment, reagents and supplies. However, both the EHP and the EMLS

programs were developed in 2002 prior to the rapid expansion of HIV/AIDS services which started in 2003. These two important

national programs have not met the ever increasing needs of HIV/AIDS-related services. Funding for implementation of both the

EHP and the EMLS has been effected through the Sector Wide Approach (SWAp) mechanism; unfortunately, this plan has not

been fully funded. In addition, the national laboratory policy for implementation of the EMLS expired in June 2008. With the

scaling-up of ART, PMTCT, HCT, TB/HIV and malaria services, the need for laboratory capacity to support these interventions

has increased both in scope and complexity. It is therefore necessary to strengthen laboratory capacity and quality assurance to

meet both the current and the anticipated program needs.

Previous USG Support

Previous USG laboratory support to Malawi focused on the following four main areas: 1) pre-service training, 2) strengthening the

National Reference Laboratory, 3) increasing access to laboratory services at high throughput laboratories, including support to

pregnant mothers and babies, and 4) Improving supply chain management of laboratory commodities.

i. Pre-service training

USG has made it a priority to increase the number as well as skills of trained laboratory technicians by investing in pre-service

training at two of the main laboratory training institutions in the country, Malawi College of Heath Sciences and Malamulo College

of Health Sciences. Support included continued funding for critical faculty, expansion of the curriculum to cover new technologies,

renovation of physical space, and providing upgraded equipment and supplies for training purposes.

ii. National Reference Laboratory

The National Reference Laboratory (NRL) within the Community Health Sciences Unit (CHSU) of the Ministry of Health (MOH)

has been a USG partner since 2001. The NRL has the national mandate to assure the quality of laboratory services throughout

the country. The USG support had focused on providing funding for critical laboratory and epidemiology staff and assisting with

the implementation of the NRL mission. The support had allowed the NRL to develop national standards such as the national HIV

rapid testing algorithm as well as continue with in-service training of laboratory staff at national, regional and district levels. USG

has supported the NRL to develop and implement a national Quality Assurance program for HIV rapid tests. They have also

implemented programs that integrate HIV testing within routine laboratory services. With support from PEPFAR, the NRL has

been instrumental in the initiation of the early infant diagnosis programs, expansion of CD4 capability, and development and

implementation the first national surveillance system to detect emerging ART drug resistance. The NRL has also been an

indispensable partner in supporting special studies such as the national ante-natal HIV survey and other epidemiological studies.

iii. Improved access to services at point-of-care settings

With very limited resources, USG supported two of the four regional laboratories; Kamuzu Central Hospital (KCH) in Lilongwe and

Queen Elizabeth's Central Hospital (QECH) in Blantyre. Support at these two laboratories involved improved diagnostics for HIV,

TB, Malaria, OIs, as well as CD4 capabilities, basic hematology, and basic chemistries. A special focus was placed on CD4-

based staging for pregnant women and PCR-based early infant diagnosis. These laboratories as "centers of excellence" not only

provided support to the high throughput AIDS patient sites, they also provided training, technical assistance and referral services

to the surrounding districts. With support from USG, the NRL implemented a CD4 quality assurance program in FY08 at eight

central and district hospital laboratories to monitor the quality of CD4 testing services.

iv. Supply Chain Management

A critical bottleneck in the delivery of laboratory services in Malawi is the breakdown of the supply chain management system

operated by the Central Medical Stores (CMS). It has been extremely difficult to adequately forecast laboratory commodity needs,

and incorrect reagents are sometimes procured. Even when reagents and supplies are available, the very weak distribution

system has made laboratory services unreliable, especially in public institutions. In FY08, USG leveraged Presidents Malaria

Initiative (PMI) resources to revitalize CMS. Through a national assessment and training in forecasting and re-building capacity at

the CMS by USAID/Deliver, laboratory commodities were procured and distributed in a manner that greatly improved the quality of

laboratory services.

FY09 USG Support

i. Technical support for laboratory services

HIV/AIDS treatment and care services are becoming increasingly complex in Malawi. With significant resources being allocated

to this program area, a USDH position has been created for the PEPFAR team. This previously approved position will be filled in

FY09.

ii. Support for expanded laboratory services

With very limited financial resources in previous years, USG assisted Malawi in making significant contributions to the provision of

laboratory services at the central, regional, and district levels in the country. In addition, USG continues to provide technical

support to the Malawi Defense Force multi-agency laboratory partnership funded primarily through Foreign Military Financing

(FMF). These efforts have not only benefited HIV/AIDS patients it has served to improve health care delivery in general. In FY09,

USG will work to consolidate those gains while exploring other opportunities to improve and expand services. Critical to this is

updating and costing an integrated national laboratory strategy that reflects the expanding HIV/AIDS needs. USG will provide

technical assistance and play a leadership role in the development and implementation of an updated laboratory strategy. The

focus of the new strategy will be on a tiered approach that matches laboratory support to the programmatic needs at the central,

regional, and district levels.

iii. Pre-service training

USG will continue to work with Howard University, our primary implementing partner to strengthen pre-service laboratory training,

continue to support key faculty, and complete the renovation of Malamulo College's training laboratory. In response to the severe

shortage of laboratory staff in the country, USG will work with Howard University and the MOH to develop plans for placing and

retaining qualified technicians who graduate from the training institutions.

iv. Enhanced support to the national laboratories

USG will continue to work with the Central Health Services Unit (CHSU) to improve their epidemiology and national reference

laboratory capability and capacity. This will include continued funding support to the two technical assistant positions in both

epidemiology and laboratory services. USG will continue to support the NRL in their role of in-service training and quality

assurance of critical analytes at the national, regional, and district levels. The NRL will also be supported to continue their role as

the national reference laboratory with active involvement in special epidemiology studies such as the antenatal clinic (ANC)

surveys and ART drug resistance monitoring. Through mentorship and management training, efforts will be made to develop

stronger leadership at the NRL so that they can earn national recognition and assume a greater leadership role befitting their

national mandate.

Through support to Howard University, two additional regional laboratories will be added to KCH and QECH as centers of

excellence with upgraded equipment, reagents, supplies and training capacity. Howard University will continue to provide critical

staff to these institutions as a temporary measure while local staff are trained and mentored into leadership positions. Similarly,

Howard University will work with the EMLS to ensure that laboratory tests for the EHP in all of the 28 districts are provided along

with those tests that support HIV/AIDS programs such as ART and PMTCT.

While the major areas of program support from FY08 will not change dramatically, increased emphasis will be placed on

supporting laboratories at central hospitals and those linked to high throughput sites, intensifying high quality training, recruiting

and retaining high level management and technical staff, and strengthening quality assurance programs. USG will leverage

resources from other interested partners, and Clinton-Hunter AIDS Initiative, WHO, DFID, UNICEF have expressed interest in

working with USG and the MOH to address these important laboratory needs.

In order to strengthen procurement and distribution of laboratory commodities, USG will fund Deliver to scale-up its current

activities. Deliver will recruit a Laboratory Focal Person (LFP) to provide in-country support and activity monitoring. The Deliver

Lab Logistics advisor will continue to oversee the roll out of the lab logistics system and focus on building the capacity of the

Diagnostics Department of the MOH, and Deliver will continue to support CMS in managing lab commodities.

In FY09, USG will build the capacity of the MOH and CMS to lead the annual laboratory quantification and mid-term review, using

the logistics data from the FY08 funded system to inform the quantification. The project will also support integrating laboratory

quantification teams into the national health commodities quantification process. Standard Operating Procedures, a preliminary

training curriculum for system users in the handling and ordering of laboratory supplies, and a roll-out plan targeting all District

laboratory technicians will also be developed. A Performance Improvement Specialist will be placed in Malawi to provide

capacity building to the project.

Compact Funding Program Plans

GOM and PEPFAR have discussed a framework under which a new partnership agreement will be developed using FY08 and

FY09 Compact funds. In September 2008, a Concept note was submitted to OGAC, and the country team was given approval to

begin developing a partnership compact with the GOM. Increasing laboratory services is a priority under consideration.

While PEPFAR has provided significant support and capacity building to laboratory services in Malawi, these investments have

been strategic but too limited in scope to meet the increasing needs of the expanding HIV/AIDS services. Of high importance is

ensuring that laboratory support for HIV/AIDS interventions also contribute to the overall improvement of laboratory services in the

country. With additional funding through the Compact, there is an opportunity to dramatically improve laboratory services

throughout Malawi. The additional funds would allow USG to work with other partners to provide strategic support to laboratory

services with a focus on expanding access to these services while maintaining their quality. Central to this effort is the new

strategic plan for laboratory services. This document with its anticipated focus on tiered laboratory services would serve as the

roadmap for USG contribution to expanding laboratory services in Malawi.

For this approach to be successful it is important that there is strong leadership at the NRL/MOH with the vision, seniority and

management capability to oversee the implementation of the new laboratory strategic plan. USG would identify an appropriate

technical assistant to the NRL/MOH provided the MOH identifies and places an appropriate, high level Malawian counterpart.

By providing additional technical staff and technical assistance at the NRL, USG will support expansion of the national reference

capability, training, national quality assurance of important analytes including HIV, TB, malaria, OIs, chemistries, and hematology.

The NRL would also expand their ability to support special studies such as new assay evaluations, ART resistance monitoring,

and epidemiological surveys.

At the four central hospital laboratories, USG would support the expansion of diagnostics including HIV, TB, malaria, early infant

diagnosis of HIV, and OIs. We would also support the expansion of CD4 capability for laboratory staging especially of pregnant

women to determine their eligibility for ART. With additional PEPFAR funding, USG would provide support for limited hematology

and chemistries.

With the de-centralization of services to the districts in Malawi, additional compact funds will be used to expand sustainable

laboratory services to the Malawi Defense Force and major public and Christian Health Association of Malawi (CHAM) hospitals in

all 28 districts of the country. Because the intent is to establish sustainable systems, USG support would be aligned with the

minimal tiered requirements of the updated EHP and the ELMS packages. At the district-level hospital laboratory HIV, TB, and

malaria diagnosis will be supported, and CD4 capability will be provided to all these laboratories. Simple methods for measuring

hemoglobin and chemistries such as liver function tests would also be made available.

This effort will require the deployment of a large number of laboratory technicians throughout the country. Increased efforts will be

made to link graduates from the laboratory training institutions with the expanded laboratory services. USG will work with MOH to

develop non-monetary incentives for staff deployed to hardship posts.

Table 3.3.16:

NOTICE - Per the recommendation from OGAC that Malawi as an FY2008 Compact Country, submit a mini

-COP (i.e. program area level narratives only), this activity level narrative has not been updated prior to the

submission of the FY09 Full COP. The Malawi country team anticipates updating narratives upon

completion and final approval of the negotiated 5-year Compact between the United States Government

and the Government of Malawi.

Summary

Critical to any functional national laboratory system is a well-designed and managed supply chain system.

Malawi has encountered many challenges with the national laboratory system mostly resulting from a very

inefficient forecasting, procurement, and distribution system managed by the Central Medical Stores (CMS).

This program proposes a baseline assessment to discern the supply chain's present capacity to handle

laboratory supplies, as well as to identify any gaps in the system. Once the assessment has been

conducted, the information will be used to advocate for a comprehensive strategic plan and policy for

laboratory supplies, including a standardization exercise for laboratories that will provide the basis for a

laboratory logistics system redesign and an implementation strategy. In order to better facilitate all of these

activities, the project would also hire a dedicated focal person.

Background

While improved laboratory services was included as a vital element of Malawi's Essential Health Package

(EHP) in 2002, laboratory infrastructure development has lagged behind other components as national

implementation plans have moved forward. The DELIVER project's technical assistance (TA) has been

requested by the Ministry of Health (MoH) through the Health and Technical Support Services department

to implement more effectively this element of the EHP. Strengthening of laboratory supply chain

management also will support care and treatment programs, improving the laboratory infrastructure upon

which care and treatment depend. Once implemented, it is expected that these activities will help improve

laboratory services and thereby contribute to the success of the EHP.

Activity 1: Lab Focal Person

The DELIVER project will recruit and place a locally-based Laboratory Focal Person (LFP) to provide in-

country support and activity monitoring. The LFP will serve as the main point of contact with the MoH and

CMS for laboratory-related issues. The LFP will directly monitor each of the activities outlined herein. If

necessary, the LFP will receive training in logistics and supply chain management to increase his/her

efficacy. The project will discuss the possibility of transitioning the LFP into a government position within

the MoH when proposing the position. In addition to the LFP, the Country Director and Resident Logistics

Advisor will also play a large part in conducting these activities.

Activity 2: Base Line Assessment

The DELIVER project will conduct a baseline assessment of the current supply chain capacity for laboratory

supplies management, using a laboratory assessment tool, ATLAS, in order to identify needs and gaps in

the system. As the current laboratory system has not yet undergone a full assessment, this activity will

provide essential information regarding context and system structure as well as informing all of the

additional activities planned for FY 2009. The system-wide assessment will include counterparts from the

MoH and CMS. To be initiated in early FY 2009, this activity will draw upon TA from both the local office

(Lilongwe) and headquarters (Washington DC) of the DELIVER project.

Activity 3: Lab Supply Chain Management

The DELIVER project will facilitate the development of a strategic plan and policy on laboratory supply chain

management issues. This will be through advocacy meetings and strategic planning sessions with key

stakeholders, including the MoH, CMS, Regional Medical Stores, District Laboratory Technicians, and

potential counterparts from the private sector. To ensure long-term commitment to policy implementation,

the formation of a laboratory logistics working group will be strongly recommended. As part of this activity,

drawing on members of the logistics working group, a standardization exercise will be conducted to provide

the foundation for future quantification and system design work.

Activity 4: National Forecasting

The DELIVER project will work with the MoH on a national forecasting exercise to estimate laboratory

commodity requirements and identify any funding gaps for the current and next fiscal year. This activity will

include TA from the local office (Lilongwe) and headquarters (Washington, DC) of the DELIVER project.

Representatives from the MoH, CMS, and other potential members of the laboratory working group will

participate in the exercise and assist in drafting a plan to help address any funding gaps.

Activity 5: Lab Supply Logistics System

The DELIVER project will design a national logistics system for laboratory supplies, in collaboration with

Regional Medical Stores, CMS, and the MoH. In addition to filling the gaps identified by the baseline

assessment (Activity 2), the new design will include special requirements for monitoring and handling of

those supplies that cannot be distributed with other essential commodities. Also, the system will incorporate

key indicators identified as part of the initial assessment for monitoring purposes.

Activity 6: Standard Operating Procedures (SOPs)

The DELIVER project will develop Standard Operating Procedures and a preliminary training curriculum for

system users in the handling and ordering of laboratory supplies. In conjunction with the curriculum, a

training roll-out plan targeting all District Laboratory Technicians, will be developed. A preliminary training

Activity Narrative: of trainers will be rolled out to at least one group of potential local trainers, identified from among local

laboratory technicians, the CMS, and Regional Medical Stores staff. A Performance Improvement

Specialist from the Washington, DC office will join local staff to help develop and give the training of

trainers. This activity will begin in FY 2009 with definite implications for continuation into FY 2010.

New/Continuing Activity: Continuing Activity

Continuing Activity: 17137

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

17137 17137.08 U.S. Agency for John Snow, Inc. 7666 5660.08 JSI CSH $400,000

International

Development

Table 3.3.16:

NOTICE - Per the recommendation from OGAC that Malawi as an FY2008 Compact Country, submit a mini

-COP (i.e. program area level narratives only), this activity level narrative has not been updated prior to the

submission of the FY09 Full COP. The Malawi country team anticipates updating narratives upon

completion and final approval of the negotiated 5-year Compact between the United States Government

and the Government of Malawi.

Summary

As part of the Deliver project's ongoing system strengthening work in Malawi, the project proposes to

develop the infrastructure and personnel capacity required to facilitate more timely data collection remotely.

In addition, the project will also address the need for updates to the District-level Supply Chain Manager to

meet the requirements of the HIV/AIDS system design from the previous year as well as the laboratory

system design proposed for 2008-2009.

Background

Despite computerizing (automating) management of information at district level country wide, through the

first Deliver Project using Supply Chain Manager software, the central level (Central Medical Stores (CMS)

and its Regional Medical Stores (RMS)) have maintained a manual information system where electronically

processed data at the lower level is handled manually at RMS and CMS level. It is against this background

that the following activities are being proposed to improve on availability of strategic information at the

central level to be used in decision making. The need to develop the MIS system at the Central and

Regional medical stores level stems from the fact that until recently CMS/RMS were not responsible for

managing the distribution of PMTCT supplies including test kits and other OI drugs. It is hoped that the

success resulting from these activities will facilitate integration of ARV's into the supply chain system, which

until now continues to be parallel.

As a result of the activities proposed under Strategic Information, with FY 2008 USG support, all 26 Health

Districts will have functioning internet connections in order to facilitate more timely data reporting and

transmission to the central level. In addition, Supply Chain Manager software will be modified to improve its

features on reporting and monitoring for HIV test kits, OI's and eventually, ARV's as well.

Activity 1: Logistics Management Information System

The first activity will be development of standardized recording, reporting and transaction forms that will be

used to collect information for program and planning purposes. The existing forms will be modified or

changed to take into consideration the introduction of HIV/AIDS related commodities like HIV test kits, OI's

and other related commodities into the Logistics Management Information System for both the service

delivery level and that of the regional and central medical stores. This will also necessitate modifications to

the existing supply chain manager software at the district level, to accommodate the new developments.

Activity 2: Supply Chain Manager Software

The second activity will be modifying the existing Supply Chain Manager Software (currently in place at all

District-Level facilities) to fully integrate all HIV/AIDS related drugs and medical supplies into the system, as

well as to develop any specific reporting requirements needed to help monitor and improve the system.

Though ARV's are currently managed in a parallel structure, they will be included in the reporting and

recording forms to make available consumption and other related information useful for decision making at

the central level.

Activity 3: Strategic Information

The third activity under Strategic Information will be to facilitate the districts ability to send data to the central

level remotely. Many of the 26 Health Districts in Malawi have no system put in place to enable information

transfer using the Internet, greatly increasing the amount of time it takes to send reporting and ordering

information to the Central Medical Stores and Regional Medical Stores. This activity will provide to districts

and if need be to central hospitals as well, phone lines and hand sets in the pharmacy to facilitate dial up

connections. However, since files to be sent through the email system will be bigger, software like WinZip

11.0 will be used to split files of bigger size into smaller sized files that can be sent over a dialup internet

connection with less difficulty. The activity will take advantage of the recently introduced MTL dialup system

which is freely available with no Internet Service provider fees attached.

Activity 4: Pharmacy Technicians

The fourth activity will be to train the pharmacy technicians and other cadres responsible for the

management of information at various levels in the supply chain to be able to use the internet in sending the

information to the central level.

New/Continuing Activity: Continuing Activity

Continuing Activity: 17134

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

17134 11272.08 U.S. Agency for John Snow, Inc. 7666 5660.08 JSI CSH $200,000

International

Development

11272 11272.07 U.S. Agency for John Snow, Inc. 5660 5660.07 JSI CSH $15,500

International

Development

Table 3.3.17: