The DELIVER project has been operating in Malawi since 2006 with the primary aim of strengthening the national health procurement and supply chain management (PSM) systems. DELIVER has assisted the MOH in key PSM strengthening activities such as improving quantification, supply planning and forecasting, commodity distribution, supervision, and logistics management information systems. These goals support the implementation of Malawis Global Health Initiative (GHI) strategic priorities of reducing mortality and morbidity, as well as strengthening human resources for health and leadership, governance, management and accountability. PSM strengthening is also central to achieving the Partnership Framework Implementation Plan goals.DELIVERs programs focus on strengthening PSM and logistics information and management systems primarily at the national level, with complementary activities at the zonal, district and facility level in selected areas. By investing in systems and human capacity, DELIVER seeks to increase the efficiency of PSM in Malawi while ensuring availbility of key commodities. Monitoring and evaluation activities include routine tracking and dissemination of commodity availability over time and periodic progress reviews with the Government of Malawi and stakeholders. No additional vehicle needs are anticipated for FY12.

Global Fund / Programmatic Engagement Questions

1. Is the Prime Partner of this mechanism also a Global Fund principal or sub-recipient, and/or does this mechanism support Global Fund grant implementation? Yes2. Is this partner also a Global Fund principal or sub-recipient? Neither3. What activities does this partner undertake to support global fund implementation or governance?

Budget Code Recipient(s) of Support Approximate Budget Brief Description of ActivitiesHTXS MOH, NAC, Health Facilities 200000 Provide TA to PRs to meet GF PSM related CPs

Malawi's weak procurement and supply chain system continues to threaten access to health commodities and services which are key to the success of HIV prevention, care and treatment. Although HIV commodities are currently delivered through a parallel system, weaknesses in the national system continue to adversely affect the security commodities for treating HIV as well as related services such as family planning, malaria, and opportunistic infections.Since 2006, the DELIVER project has been assisting various components of Ministry of Healths (MOH) procurement and supply chain management (PSM) system, helping to overcome significant barriers toward improving overall health governance, management and accountability in Malawis health system. DELIVER addresses these barriers by providing both technical assistance for systems strengthening, as well as direct support to improve commodity security and availability for malaria, family planning, and maternal and child health services, and HIV treatment-related commodities (e.g., basic clinical supplies and drugs for opportunistic infections). Technical assistance focuses on strategic planning; quantification supply planning and forecasting; logistics management information systems and national stock status reporting; supervision; and supply chain-related policy and reform efforts.FY12 OHSS funds will support these ongoing technical assistance efforts, including the placement of two senior PSM advisors to the Health Technical Support Services (HTSS) section of MOH, which oversees pharmaceutical policy and PSM systems. The advisors will support the MOHs effort to overhaul the health PSM system, particularly in the area of logistics management information systems and supervision. DELIVER will also continue providing ongoing support for national quantification and forecasting including for HIV commodities including condoms, ARVs and HTC kits.

PEPFAR Malawi plans to conduct up to 70,000 voluntary male circumcisions in the coming year. Given current weaknesses in the public sector supply system including the Malawi Central Medical Stores, Male Circumcision (MC) kits and all accompanying commodities such as drugs and tents will need to be received, packed, stored and distributed in parallel by independent agents. For the upcoming campaign, implementing partners providing VMMC services will manage the storage and distribution of MC kits and accompanying commodities once they are in the country. However, as commodities will be procured through SCMS and consigned to the US Embassy, an agent will be required to clear, receive, re-pack and store MC kits and commodities until they can be distributed to partners. Since 2006, the DELIVER project has been assisting various components of Ministry of Healths (MOH) procurement and supply chain management (PSM) system, and since late 2010 DELIVER has managed a parallel distribution system accountable for receiving and distributing US Government-procured malaria and family commodities directly to over 600 health facilities around the country. In addition, the DELIVER project is the delivery agent for essential drug kits procured by UNICEF which are being distributed to primary health care facilities around the country to address ongoing drug shortages. FY12 CIRC funds will enable DELIVER to facilitate the receipt and any necessary re-packing, storage and delivery of MC kits and relate commodities to implementing partners.

The long-term success of Malawis PMTCT program depends in part on the availability of commodities for both HIV care and treatment and related services, This, in turn, requires a national procurement and supply chain management (PSM) system capable of both delivering, managing, and monitoring supply availability nationwide. Since 2006, the DELIVER project has been assisting various components of the Ministry of Healths (MOH) PSM system. In FY11, DELIVER assisted the MOH in the quantification and forecasting of key health commodities (including HIV test kits and drugs for opportunistic infections), conducted training of health workers on logistics management, and facilitated access to health facility stock and consumption data.Malawi's new integrated ART/PMTCT guidelines (Option B+) have doubled the number of ART sites by extending services to all ANC clinics. Additionally, adoption of the 350 CD count threshold has increased the total number of HIV positive people who are eligible for ART. Both of these new policies will affect the demand for supporting commodities handled by the PSM system. In FY12, with PEPFAR and other health resources, DELIVER will second two senior PSM advisors to MOH's Health Technical Support Services Department, which oversees pharmaceutical policy and PSM systems. The advisors will support the MOHs effort to overhaul the health PSM system, particularly in the area of logistics management information systems and supervision. In FY12, DELIVER will also continue providing ongoing support for national quantification and forecasting for HIV commodities, including condoms, ARVs and HTC kits.In collaboration with other stakeholders including the HIV Unit, DELIVER will support the MOH to effectively manage the health PSM system, improve the availability of data and monitoring, and strengthen supply management within the public system. USG support is aimed at strengthening the national system to reinforce and improve the efficiency of HIV commodity management efforts under the parallel system.

The continued scale-up of Malawis successful HIV treatment program will not be possible without continued funding for ARV procurement and distribution from the Global Fund (GF). As part of GFs Phase II renewal decision of Malawis HIV grant, more than 19 conditions were imposed. Malawi must meet several benchmarks to maintain compliance with the grant. Of those, the majority (12) were related to procurement and supply chain management (PSM) issues, underscoring the priority the GF places on Malawis ongoing PSM reform process and the resolution of chronic system weaknesses. Particularly given the postponement of Round 11, Malawis ability to meet the terms and conditions precedent for its ongoing grants will be critical for the future of the national treatment program.Resources requested in FY12 will enable DELIVER to expand capacity-building, training, mentorship support, and related technical assistance to the Government of Malawi (GOM) to better respond to GF concerns related to PSM. Priorities include direct support to respond to GF grant requirements, such as the development of strategies and plans of action to address PSM weaknesses. In addition, DELIVER will provide on-site support to strengthen the logistics management information system (LMIS) and related supervision structures by placing two technical advisors within the Ministry of Healths (MOH) pharmaceutical services section. Improved LMIS systems and processes will lead to enhanced data quality and availability within the PSM system, enabling Malawi to provide more reliable information for decision-making as well as reporting within the supply chain.This assistance expands DELIVERs current areas of support continuing from FY11, focusing primarily on national level systems and institutions, but expanding support as needed to additional zones, districts, and facilities. Building the capacity of key actors within the system from staff in the MOHs pharmaceutical services section to zonal, district, and facility level managers and supply clerks will be key to enhancing national ownership and making sustainable improvements to the system.