PEPFAR's annual planning process is done either at the country (COP) or regional level (ROP).
PEPFAR's programs are implemented through implementing partners who apply for funding based on PEPFAR's published Requests for Applications.
Since 2010, PEPFAR COPs have grouped implementing partners according to an organizational type. We have retroactively applied these classifications to earlier years in the database as well.
Also called "Strategic Areas", these are general areas of HIV programming. Each program area has several corresponding budget codes.
Specific areas of HIV programming. Budget Codes are the lowest level of spending data available.
Expenditure Program Areas track general areas of PEPFAR expenditure.
Expenditure Sub-Program Areas track more specific PEPFAR expenditures.
Object classes provide highly specific ways that implementing partners are spending PEPFAR funds on programming.
Cross-cutting attributions are areas of PEPFAR programming that contribute across several program areas. They contain limited indicative information related to aspects such as human resources, health infrastructure, or key populations programming. However, they represent only a small proportion of the total funds that PEPFAR allocates through the COP process. Additionally, they have changed significantly over the years. As such, analysis and interpretation of these data should be approached carefully. Learn more
Beneficiary Expenditure data identify how PEPFAR programming is targeted at reaching different populations.
Sub-Beneficiary Expenditure data highlight more specific populations targeted for HIV prevention and treatment interventions.
PEPFAR sets targets using the Monitoring, Evaluation, and Reporting (MER) System - documentation for which can be found on PEPFAR's website at https://www.pepfar.gov/reports/guidance/. As with most data on this website, the targets here have been extracted from the COP documents. Targets are for the fiscal year following each COP year, such that selecting 2016 will access targets for FY2017. This feature is currently experimental and should be used for exploratory purposes only at present.
This activity is related to activities CT 9156, HTXD 9117, HLAB 9254, and HBHC 9136.
The Supply Chain Management System (SCMS) project will support MOH to strengthen its logistics management of the medicines and consumable supplies necessary for a range of HIV/AIDS prevention, care, and treatment services such as antiretroviral (ARVs) medicines for treatment and PMTCT, HIV test kits, laboratory reagents and consumables, medicines for the treatment of opportunistic infections, items for home-based care kits, etc. All of the activities are related to increasing the ability of MOH staff at all levels to collect and use information for decision-making and will contribute directly to improving the availability of drugs and related medical supplies.
SCMS will assist the CMAM (the MOH Central Medical Stores), in collaboration with other MOH departments, programs and sectors, such as DAM (the MOH Department that supervises hospitals), and Laboratory section and to strengthen the capacity of the appropriate MOH staff in the following areas:
ARV - for treatment and MTCT - Quantification and Procurement: SCMS will assist CMAM in forecasting ARV needs through at least one complete forecast annually and quarterly updates and train CMAM Staff in Quantimed (quantifying ARV needs) and PipeLine (scheduling procurement shipments to maintain appropriate inventory levels) software; analyze the basic processes in each software package to theoretical concepts and practical processes that can be integrated into the existing systems currently used at CMAM.
Procurement: CMAM would like to move to more flexible contracting mechanisms in its own procurement. SCMS will provide short-term technical assistance to CMAM to develop its capacity in procurement.
Importation: Because SCMS will procure and transport ARVs for use in Mozambique, it will need to provide CMAM/Medimoc with all of the necessary documentation for importation of the commodities. SCMS will prepare a process map of the importation process to become fully aware of the applicable Mozambican regulations and requirements affecting drug importation, in order to be able to provide a high level of customer service to MISAU, evidenced by shipments of PEPFAR funded ARVs arriving on time.
Distribution and Storage: Given the increasing volume and value of ARVs and other drugs procured by MISAU and to be donated under PEPFAR, SCMS will work with CMAM to improve the quality and security of storage facilities at central, provincial, and district warehouses, as well as at individual ART sites which are expected to expand from approximately 45 (end April 2006) to nearly 105 sites by the end of 2006. ARV SOP Development: CMAM currently calculates the number of ARV drugs to be received by each ART site (a ‘push' system). However, as the number of sites increases, CMAM staff will be increasingly challenged to keep up with this level of centralized calculation. SCMS can support CMAM´s need to design a decentralized ("pull") ARV logistics system that is flexible and responsive to support scale up efforts, and to institutionalize the system through creation of tools and training for staff at all levels of the supply chain. Logistics Information System Implementation: SIGM is an information management tool which will greatly increase the quality of management data available to CMAM and provinces in managing MOH´s integrated logistics system for all medicines, including ARVs. The SIGM software has been developed with previous USAID funding through release 2, and has been implemented at the Central level sites of CMAM and Medimoc Headquarters, and the three Central Warehouses. During COP07, SCMS will assist CMAM in implementing the SIGM at 10 provincial warehouses, 3 central hospitals and 3 general hospitals, fund a service-level agreement (SLA) including help desk support, develop release 3 of the SIGM software and Support CMAM´s ability to use information produced by SIGM for monitoring, management and evaluation. To support the collection of ARV data through the SIGM, SCMS will develop an additional module of the SIGM specifically for the unique needs for ARV data.
Supply of Nevirapine (NVP) for single dose prophylaxis to antenatal care (ANC) services were most PMTCT services have been provided so far, has been supported by MOH CMAM for some sites, by NGOs involved in PMTCT service provision at other sites. With the introduction of AZT and the development of a prophylactic drug protocol that includes
more than one drug, only those ANC or PMTCT services located in physical proximity to Day Hospitals were able to introduce this new prophylactic regimen. In FY07, the MOH PMTCT program and PMTCT partners intend to more rapidly expand the provision of NVP-AZT dual prophylaxis to a larger number of PMTCT service sites, not all of them co-located with treatment sites, as there are currently more antenatal care sites providing PMTCT services than treatment sites.
In addition, protocols for prophylaxis and treatment for pregnant women continue to undergo frequent changes and are generally moving towards more complex protocols with a use of combinations of drugs, the Mozambique program following and carefully analyzing revised WHO recommendations each time, which pose a challenge to the MOH PMTCT program and CMAM staff in terms of the need for re-adjustments. SCMS will provide technical assistance to the MOH in this process
Additional Funds to SCMS will be used supplement activities planned in FY07 to strengthen the CMAM (Central medical stores) system for procurement and distribution of OI medicines to health facilities in the country. PLus-up funds in particular will allow SCMS to assist CMAM to quantify for a selected group of OI drugs taking into consideration the increase in service capacity of the national health system, given the massive rollout of training in the OI STGs within training institutions and in-service training to health system staff
This activity is related to activities HVCT 9156, HTXD 9117, HLAB 9254 and MTCT9142.
More than 120 commodities are required to provide prevention, care and treatment to people living with HIV. SCMS will assist CMAM (the MOH Central Medical Stores) and other PEPFAR implementing partners to support improved logistics for a number of commodities such as drugs for opportunistic infections, palliative care kits, TB drugs, therapeutic supplements, and any other drug or medical supply related to the care and treatment of people living with HIV.
SCMS will conduct a needs assessments to define specific commodities to be the focus of system improvement activities; develop action plans to improve the logistics management of specific commodities; assist CMAM in preparing annual forecasts for specific items, as identified; regularly monitor the stock levels of specific items in the supply chain, as identified and conduct formal or on-the-job training in logistics management of specific commodities as defined in the action plan.
SCMS will build CMAM and relevant program staff capacity to better quantify needs of specific products, improve ability to resolve distribution problems, and take actions in time to prevent logistic bottlenecks.
Some patients do not have a sustained response to antiretroviral agents for multiple reasons, including poor adherence, drug toxicities, drug interactions, or initial acquisition of a drug-resistant strain of HIV-1 and, therefore, the lack of OI Drugs in treatment facilities will continue to cause substantial morbidity and mortality in patients with HIV-1 infection.
Information collected in two of the three uniformed services treatment facilities (Military & Police) show that around 70% of their HIV patients present some kind of opportunistic infection. This information makes us believe that the situation will most certainly be the same in the military treatment facility recently opened in Nampula. We can estimate that the 3 facilities will be providing care to around 5,500 people registered as seropositive. Some of them will need both ARV and OI drugs.
Prophylaxis against specific OIs continues to provide survival benefits even among persons who are receiving ARV drugs. Preventing and treating opportunistic infections not only helps HIV-positive people to live longer, healthier lives, but can also help prevent TB and other transmissible opportunistic infections from spreading to others.
Despite the fact that most of the OIs can be prevented or treated, DOD knows that most Mozambican military and police seropositive patients are not receiving proper care for OIs due to unavailability of drugs. Therefore, the proposed funds will be used to cover part of the needs for OI drugs expecting that the needs will be completed with drugs received through MOH channels of distribution.
Reprogramming October 2007 - An increase of funds is being proposed for SCMS to provide additional test kits and STI medications through CMAM, the Center of Medications
and Medical Articles. Given the very large increases in the number of people being tested for HIV and the large percentage of HIV-positive individuals who are co-infected with one or more sexually transmitted infections, the USG believes it is in an unique position to assist the Government as well as ensure that both the GRM and PEPFAR are able to meet testing and treatment targets.
Plus-up: A HIV rapid test kits need forecasting exercise performed by SCMS, taking into account the MOH new ANC-PMTCT testing protocols demonstrated that more HIV rapid test kits the initially foressen would be needed. Additional Funds to SCMS will be used for the procurement of additionnal HIV rapid test kits and to supplement activities planned in FY07 to strengthen the CMAM (Central medical stores) system for forecasting and distribution of HIV rapid test kits to health facilities in the country in the anticipation of testing scale-up in maternities and family planning services. SCMS will also assist MOH in the procurement and logistical support for hemoglobinometers.
Original COP: This activity is related to activities HTXD 9117, HLAB 9254, HBHC 9136, and MTCT 9142.
DAM (the MOH Department that supervises hospitals). National Institute of Health Lab, the Lab Section and CMAM (the MOH Central Medical Stores) have repeatedly stated the need for assistance in resolving various logistics challenges they face with regard to the logistics management of rapid HIV test kits. The Lab Section at DAM is in the process of drafting a new Laboratories Strategic Plan for 2007-2011. The technical assistance activities proposed will support the systems strengthening goals set out in the strategic plan.
SCMS will facilitate a participatory process to support MOH in developing Standard Operating Procedures for the inventory control, information system, and storage procedures necessary for improved logistics management of laboratory reagents and supplies. While tests required for HIV/AIDS prevention, care and treatment services such as PMTCT and to enroll and manage patients on ART will be a priority, the scope may be comprehensive given the integrated nature of laboratory services in Mozambique.
SCMS will Support the integration of management of laboratory reagents and consumable supplies into the CMAM Computerized Drug Management System (SIGM) and will train the Staff from Laboratory Sector, CMAM, Provincial Warehouses and Hospitals to manage laboratory reagents and consumable supplies using the SIGM system.
SCMS will supply the MoH with HIV rapid test kits for about 425,000 clients to be tested in FY07. This includes 4,250 Determine rapid test kits and 5,313 UNIGOLD 20 tests per kit; test kits for an estimated 106250 determine test results.) This supply will provide an estimated 40% of the total HIV test kits requires nationwide to support HIV testing in both provider initiated and client centered CT sites
This activity is related to activities HVCT 9156. HLAB 9254, HBHC 9136 and MTCT 9142.
ARV logistics ($ 5,027.159): SCMS will assist the CMAM (the MOH Central Medical Stores), in collaboration with other MOH departments, programs and sectors, such as DAM (the MOH Department that supervises hospitals), and Laboratory section and to strengthen the capacity of the appropriate MOH staff in the following areas:
ARV Quantification and Procurement: SCMS will assist CMAM in forecasting ARV needs through at least one complete forecast annually and quarterly updates and train CMAM Staff in Quantimed (quantifying ARV needs) and PipeLine (scheduling procurement shipments to maintain appropriate inventory levels) software; analyze the basic processes in each software package to theoretical concepts and practical processes that can be integrated into the existing systems currently used at CMAM.
Distribution and Storage: Given the increasing volume and value of ARVs and other drugs procured by MISAU and to be donated under PEPFAR, SCMS will work with CMAM to improve the quality and security of storage facilities at central, provincial, and district warehouses, as well as at individual ART sites which are expected to expand from approximately 45 (end April 2006) to nearly 105 sites by the end of 2006.
ARV SOP Development: CMAM currently calculates the number of ARV drugs to be received by each ART site (a ‘push' system). However, as the number of sites increases, CMAM staff will be increasingly challenged to keep up with this level of centralized calculation. SCMS can support CMAM´s need to design a decentralized ("pull") ARV logistics system that is flexible and responsive to support scale up efforts, and to institutionalize the system through creation of tools and training for staff at all levels of the supply chain.
Logistics Information System Implementation: SIGM is an information management tool which will greatly increase the quality of management data available to CMAM and provinces in managing MOH´s integrated logistics system for all medicines, including ARVs. The SIGM software has been developed with previous USAID funding through release 2, and has been implemented at the Central level sites of CMAM and Medimoc Headquarters, and the three Central Warehouses. During COP07, SCMS will assist CMAM in implementing the SIGM at 10 provincial warehouses, 3 central hospitals and 3 general hospitals, fund a service-level agreement including help desk support, develop release 3 of the SIGM software and Support CMAM´s ability to use information produced by SIGM for monitoring, management and evaluation. To support the collection of ARV data through the SIGM, SCMS will develop an additional module of the SIGM specifically for the unique needs for ARV data.
Provincial Logistics Advisors to support the Provincial Health Directorates (DPS) of Sofala and Zambézia : Because the ministry of health has requested PEPFAR to focus on the two
provinces of Sofala and Zambezia, SCMS proposes to place a Provincial Logistics Advisor (PLA) to support the DPS in each of these provinces. The PLAs will build provincial level capacity for use of the SIGM, institutionalize updated SOPs for management of ARVs, implementation of new SOPs for Lab reagents and consumable supplies, troubleshoot logistics problems related to drugs for opportunistic infections and manage the implementation of $100,000 in funds earmarked for improving storage conditions and security in warehouses and medicine storerooms in each of these two provinces.
Sustainability: SCMS will assist MAM and the Laboratory Sector to develop improved logistics processes, procedures and tools and build the capacity of their staff to use these, with the goal of improving the capability and performance of the existing MISAU supply chains that deliver the approximately 120 medicines, laboratory reagents, and other consumable supplies. The activities to be implemented by SCMS are all in support of the 2007 MOH Annual Operational Plans being prepared by CMAM and the Laboratory Sector.
Capacity Building : The most critical resource in the supply chain (after the valuable supplies!) is the people that make the system work. The CMAM staff transition plan has placed a large number of new technical staff in all departments of the organization who are at the beginning of their careers. The logistics functions of the supply chain are relatively new to them. Proposed work plan activities will provide opportunities for structured on-the-job training, formal training courses, and mentoring by experts in logistics management of HIV/ÃIDS commodities for MISAU staff at all levels of the supply chain, as appropriate.
ARV Procurement ($ 9,177,359): Through SCMS the USG will procure anti-retroviral drugs in support of MOH's treatment program for AIDS for 2007 and subsequent years. ARV needs for Mozambique were quantified for calendar year 2006, 2007, and 2008 using a combination of the Quantimed and Pipeline software packages. Quantimed, developed by the Rational Pharmaceutical Management Plus Project of MSH, quantifies overall drug needs. Inputs to Quantimed are available through the ARV database established by CMAM which include the drugs, regimens, and percentages of patients on each regimen. Future consumption assumes that 55,000 total patients (including 5,000 children<14) will be treated with ARVs by the end of 2006, 96,000 (including 9,642 children<14) patients in 2007 and 132,000 (including 13,228 children<14) patients in 2008, based on targets set in the National Strategic Plan (PEN).
In order to ensure that Mozambique receives ARVs of good quality, MOH requires that ARVs be WHO pre-qualified and/or USFDA or USFDA tentatively approved.
Pipeline Software, developed by the Deliver Project of JSI, Inc., takes the data from Quantimed and the known stock currently on hand and all known shipments already expected and suggests additional new shipments to ensure that the ARV supply chain is appropriately stocked. Inputs to Pipeline are available through data from Medimoc and from CMAM. Future shipments are based on keeping about 4 months of supply in the entire system at any one time.
For COP 2006, SCMS has been provided $6.3 million for procurement, which will fund ARVs to support 2007 treatment targets. SCMS anticipates the COP 07 funding need to be approximately $9.2 million for procurement of PEPFAR funded ARVs to support 2008 treatment targets.
This activity is related to activities HVCT 9156, HTXD 9117,HBHC 9136, and MTCT 9142.
DAM (the MOH Department that supervises hospitals). National Institute of Health Lab, the Lab Section and CMAM (MOH Central Medical Stores) have repeatedly stated the need for assistance in resolving various logistics challenges they face with regard to the logistics management of rapid HIV test kits as well as other laboratory reagents and consumables needed for managing patients on ART. The Lab Section at DAM is in the process of drafting a new Laboratories Strategic Plan for 2007-2011. The technical assistance activities proposed will support the systems strengthening goals set out in the strategic plan. The SCMS activities will focus on the national laboratory system which will complement the activities being planned by DAM and American Public Health Labs (APHL), which is receiving funding from CDC to specifically support the HIV/AIDS rental equipment supply system in place at 10 sites.
SCMS will facilitate a participatory process to support MOH in developing Standard Operating Procedures for the inventory control, information system, and storage procedures necessary for improved logistics management of laboratory reagents and supplies. SCMS will define the scope for capacity building activities by developing a list of essential equipment, reagents, and consumables needed for a list of key tests. While tests required for HIV/AIDS prevention, care and treatment services such as PMTCT and to enroll and manage patients on ART will be a priority, the scope may be comprehensive given the integrated nature of laboratory services in Mozambique. SCMS will conduct a laboratory logistics system assessment that focuses on the items on the list defined above. SCMS will facilitate a design workshop for staff from CMAM, the Laboratory Sector, Provinces, GATV (VCT) sites and Day Hospitals, to decide on the operating parameters for a decentralized logistics management system for labs, outline the logistics procedures, design a logistics reporting and ordering form. A steering committee will be established with broad representation of all levels of the Laboratory supply chain for the approval of all new SOPs and reporting forms resulting from the design workshop. SCMS will create SOP Manual for management of Laboratory logistics, with a review by the steering committee, create training curriculum and produce materials including printing of training manuals, SOPs, and logistics reporting and ordering forms. SCMS will facilitate a training of trainers workshop for training in the use of SOPs and the logistics reporting and ordering form and in logistics management of Laboratory supplies in general. SCMS will organize training of staff from laboratories, including refresher training as needed to assure compliance with standard operating procedures and to ensure that all new staff is trained and train provincial-level supervisors.
A designated staff from the Lab Section to be seconded to CMAM will be the primary counterpart for leadership and implementation of the various activities as well as coordinating the nominations of candidates to be trained as trainers and person to be trained. Design and approval activities will have broad representation in support of decentralized decision making. At the end of the activities described above, all staff involved in logistics management of rapid HIV Test Kits and other laboratory reagents and consumables throughout the MISAU supply chain will have the tools, knowledge and skills required to make informed logistics management decisions.
Given the nature of laboratory reagents-short shelf--lives, heavy and bulky packaging, complicated definition of units--MISAU faces repeated challenges in creating accurate forecasts and in developing procurement plans that take into account the special nature of these items. SCMS proposes to assist MISAU in improving the Forecasting and Procurement Planning of HIV/Test Kits and other laboratory reagents and consumables required for supporting HIV/AIDS services by providing training in the use of ProQ (software package designed specifically for forecasting HIV tests for VCT, PMTCT, sentinel
surveillance, and clinical diagnosis purposes) and in PipeLine software (scheduling procurement shipments to maintain appropriate inventory levels) and by facilitating annual HIV tests forecast and procurement planning process and at least one 6-month update
SCMS will Support the integration of management of laboratory reagents and consumable supplies into the SIGM system and will train the Staff from Laboratory Sector, CMAM, Provincial Warehouses and Hospitals to manage laboratory reagents and consumable supplies using the SIGM system.
Reprogramming October 2007 - As PEPFAR and non-PEPFAR partners increase the number of people on treatment, additional laboratory products are necessary to stage PLWHA for eligibility. Increased funding will ensure that PEPFAR partners are better able to respond to the urgent and pivotal needs of the laboratory sector in order to ensure more people are enrolled in treatment services. The quality of the services will also be enhanced as clinicians will have better access to tools and results that will better inform their decision making on staging, enrollment, and treatment options.
