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.
Years of mechanism: 2008 2009
This is a continuing activity under COP09.
THE NARRATIVE BELOW REPLACES THE NARRATIVE FROM PREVIOUS YEARS.
This activity relates to the following activities: SCMS HVCT, OHSS, HTXD, HLAB, and HBHC, and to
PMTCT activities for all treatment partners providing PMTCT services. There will be a more focused
emphasis during this funding period on the procurement of PMTCT-specific commodities.
The Partnership for Supply Chain Management (SCMS) is mandated and funded to procure all HIV-related
commodities on behalf of the USG and USG partners. SCMS also provides technical assistance to CMAM
and the MOH in forecasting and supply planning, procurement procedures, warehousing and distribution,
and LMIS for all essential medicines and laboratory reagents. SCMS works closely with the JSI/DELIVER
Project through PMI and Reproductive Health/family planning program ensure an integrated approach to
supply chain management systems building. Forecasting and supply planning of commodities is conducted
jointly with CMAM and Clinton Foundation/CHAI.
This activity comprises two components: 1) Procurement of PMTCT-related commodities ($995,056); and 2)
technical assistance $100,000 (other technical assistance funds are budgeted in other program areas).
1. Procurement of PMTCT-related commodities
The Governments of Mozambique and United States have placed high priority for improving the quality and
scale up of PMTCT services. Budgets for PMTCT have increased since the previous year and USG
estimates reaching X number of pregnant women for HIV testing and X number of HIV+ women with AZT
prophylaxis. SCMS will receive funding ($995,056) for the procurement of PMTCT specific commodities for
all USG partner supported PMTCT sites, including rapid test kits ($500,000) in line with the country's
national HIV testing algorithm in ANC settings, ARVs for combination PMTCT prophylaxis regimens
($100,000), CTX for eligible pregnant women in line with national care and treatment guidelines ($200,000),
and where necessary, funds for the procurement of lab-related supplies such as RPR tests and
Hemoglobinometers for hemoglobin testing of pregnant women ($195,056.279).
Clinton Foundation (CHAI) through the UNITAID Program will donate CTX syrup for all exposed infants, as
well as pediatric-related ARVs including AZT syrup for exposed infant prophylaxis. SCMS and the US
Government coordinate regularly with CHAI to ensure non-duplication of commodities donated and conduct
quantification and supply planning exercises jointly with CMAM.
2. Technical Assistance
In addition to commodity procurement, SCMS will provide technical assistance ($100,000) in the area of
quantification and procurement to CMAM, ensuring that national PMTCT targets are taken into account
during national planning, and will provide assistance to USG partners supporting the provinces and the
MOH to ensure PMTCT sites also have capacity to manage commodities.
In FY09, SCMS will continue to support partners and the MOH in managing and collecting data through the
redesigned logistics system for rapid test kits for all testing settings. SCMS Mozambique staff will
collaborate with programs that use PMTCT-related commodities, CMAM, CHAI, and any other sources of
financing and procurement of PMTCT-related commodities for the MOH by providing technical assistance in
the monitoring and management of the incoming PMTCT-related commodity pipelines and their distribution
in country, including RTKs, lab reagents, and CTX. SCMS will facilitate annual HIV test and other
commodity forecasts and quarterly updates to the national supply plans, enabling timely identification and
response to any inbound supply constraints that may arise.
Along with USG's overall strategy to support the decentralization of activities, SCMS will expand its existing
central level activities to support the work of provincial pharmaceutical and laboratory advisors funded by
USG under the treatment partners. Specific activities for supporting the provincial level warehouses and
distribution will depend largely on the result of the PLMP that has not yet been developed. SCMS will serve
as a resource for the orientation and capacity building of these staff. These provincial advisors will
participate in all national logistics systems building activities implemented by SCMS, such as potential
training of trainers for rollout of LMIS SOPs for ARVs, Via Classica, RTKs, and clinical Lab reagents and
consumables. SCMS will work closely with these advisors to strengthen the ability of the provincial health
management teams to provide training, supervision, and monitoring of logistics management of key
HIV/AIDS medicines, reagents, and consummables. In addition, CMAM conducts routine supervision and
monitoring visits to provincial warehouses. SCMS will support CMAM's efforts in supervision and monitoring
of these warehouses in collaboration with Provincial Advisors.
This addresses gender equity in HIV/AIDS programs through the procurement of CTX specifically for
eligible pregnant women, as well as necessary laboratory reagents, as pregnant women often have
difficulties accessing follow-up care and treatment services. This activity also addresses safe motherhood
wrap around through the procurement of RPR test kits for syphilis testing and reagents and equipment for
Hemoglobin testing, both services that are components of a basic ANC package of care.
New/Continuing Activity: Continuing Activity
Continuing Activity: 14554
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
14554 9142.08 U.S. Agency for Partnership for 6868 3650.08 Supply Chain $600,855
International Supply Chain Management
Development Management System
9142 9142.07 U.S. Agency for Partnership for 5045 3650.07 Supply Chain $875,000
Emphasis Areas
Gender
* Increasing gender equity in HIV/AIDS programs
Health-related Wraparound Programs
* Safe Motherhood
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $50,000
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.01:
April09 Reprogramming: Increased $400,000.
THIS IS A CONTINUING ACTIVITY IN COP09. THE NARRATIVE BELOW REPLACES THE COP2008
NARRATIVE.
Rapid test kits have not been budgeted under this program area in FY09 as they were in FY08, and 100%
of funds are being allocated to the procurement and technical assistance for the management of OI and STI
drugs, CTX, and other palliative care medicines. .
SCMS is the lead procurement agent for the majority of HIV-related commodities for USG and USG
partners, including ARVs, rapid test kits (RTKs), and OI and other palliative care medicines. Procurement of
lab reagents and equipment was transferred to SCMS's responsibility from APHL in FY 08. SCMS also
provides technical assistance to the Center for Medicines and Medical Supplies (CMAM) and the MOH in
logistics management, including forecasting and supply planning, procurement procedures, warehousing
and distribution, and LMIS for all essential medicines and laboratory reagents. The CMAM-managed supply
chain is a fully integrated system, which handles the essential drugs program, in addition to all consumable
commodities for all priority programs, including HIV, TB, and Malaria. 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.
This activity supports the procurement of OI and STI drugs, including CTX ($1,550,000), and technical
assistance ($50,000), which is cost shared across program areas.
During FY 08, SCMS purchased $2,553,700 of 22 priority OI, STI and palliative care drugs, including CTX
for the prevention and treatment of OIs and other HIV-related illnesses. This accounts for 51% of the
national procurement need. Clinton Foundation procures 100% of pediatric and exposed infant
cotrimoxazole needs, and CMAM procures the remaining adult needs through Global Fund and Common
Fund resources.
For FY 09, SCMS will procure $1,600,000 worth of priority OI and STI drugs, including CTX. This represents
x% of the national HIV need, and 16% of the total national need for all diseases. Clinton Foundation/CHAI
through UNITAID will continue to procure 100% of CTX needs for pediatric and exposed infant care, and
CMAM will be responsible for filling in the gap through Common Fund resources.
While some USG partners have continued to receive small funding amounts for procurement of various
commodities in previous fiscal years, such as CTX, for FY 09 no additional funds have been allocated to
treatment partners for procurement of commodities. This avoids duplication of funding and maximizes
economies of scale and efficiencies in HIV-commodity procurement.
Technical Assistance:
Technical assistance activities are cost-shared across OHSS, HTXD, and PMTCT.
Data for forecasting OIs and other HIV-related medicines, including CTX, is limited and unreliable, which
has led to an underestimation of the total national need for both HIV and non-HIV purposes. In addition,
CMAM has had cash flow problems, which has delayed procurement of essential medicines in line with the
joint supply plan. Sites throughout the country have complained of stock-outs of CTX. SCMS is currently
working with CMAM to strengthen its forecasting methodologies and to improve the existing LMIS to better
track needs specific for HIV as well as the overall national need to ensure sufficient quantity of stocks in
country.
During FY 09, SCMS will continue to work with CMAM and partners to improve forecasting and the existing
LMIS for OIs and other palliative care drugs. SCMS will facilitate quarterly updates to the national forecast
and supply plan, enabling timely identification and response to any inbound supply constraints that may
arise. SCMS will help CMAM to facilitate communication between the MOH and PEPFAR partners
regarding OI and STI drug availability, particularly availability of CTX.
This will complement USG's assistance to the MOH in financial management through Abt Associates to
improve MOH's ability to access donor funds and manage their resources, including resources for
commodities.
central level support to support the work of provincial pharmaceutical and laboratory advisors funded by
participate in all national logistics systems building activities implemented by SCMS, such as training of
trainers for rollout of LMIS SOPs for ARVs, Via Classica, RTKs, and clinical Lab reagents and
Continuing Activity: 14555
14555 9136.08 U.S. Agency for Partnership for 6868 3650.08 Supply Chain $2,500,000
9136 9136.07 U.S. Agency for Partnership for 5045 3650.07 Supply Chain $1,129,015
Estimated amount of funding that is planned for Human Capacity Development $20,000
Table 3.3.08:
NEW ACTIVITY
Pediatric care and treatment is a major focus area of the Government of Mozambique, including expansion
of pediatric HIV diagnostic testing such as EID, CD4 testing for HIV-infected infants and other pediatric
services.
Since FY 07, SCMS has been the lead procurement agent for the majority of HIV-related commodities for
USG and USG partners, including ARVs, rapid test kits (RTKs), and OI and other palliative care medicines.
Procurement of lab reagents and equipment was transferred to SCMS's responsibility from APHL in FY 08.
FY 09 funds will be used to procure EID DBS PCR testing equipment and other laboratory consumables
specific for pediatric uses such as pipettes, EDTA tubes and other blood collection tubes. DBS PCR
reagents are 100% supported by Clinton Foundation/CHAI.
New/Continuing Activity: New Activity
Continuing Activity:
Table 3.3.11:
This is a new activity under this program area under COP09. In previous COP years, procurement of test
kits for TB patients was incorporated into other program areas.
Mozambique has a high TB burden. In the 2007 Global TB Report (WHO, 2008), Mozambique was ranked
17th among high burden countries with an estimated incidence of 443 cases/100,000 population. The
National TB Program (NTP) recognizes the importance of expanding TB/HIV services in Mozambique and
progress in implementing these activities have been improving. The MoH endorses routine HIV testing to
all TB patients using a provider-initiated model, provision of cotrimoxazole at TB clinics to all HIV-infected
TB patients, including referrals for ART services and screening HIV+ patients for TB in all care settings:
VCT, home-based care, and health facilities providing HIV treatment. To date, TB/HIV policies, training
materials, and new reporting formats have been developed and implemented countywide. In FY08, USG
funds (through PEPFAR and USAID TB-CAP resources) were used to provide technical assistance to MoH
to continue and expand TB/HIV integration activities. A significant focus of these activities include the
integration of HIV counseling and testing of TB patients - the "CT in Health" (CTH) model which has
replaced the VCT model in Mozambique.
The Partnership for Supply Chain Management (SCMS) will receive a total of $65,000 for the procurement
of HIV rapid test kits and TA. This amount will specifically cover HIV testing for approximately 37,800 TB
patients, including 8000 persons with a confirmatory test based on a 40% prevalence rate among this
population, and will be integrated into the TB/HIV program. This does not account for all TB patients who
will be tested during FY 2009 but specifically related to this funding amount. As HIV test kit funds are
allocated across different program areas and quantifications for testing for the country took into account all
HIV testing activities, RTK needs for the TB program are also accounted for in the SCMS HVCT activity
narrative.
In addition, SCMS will provide TA support to the MOH TB program for the overall management of test kits
and in implementing the redesigned logistics system for HIV rapid test kits. MOH program staff involved in
integrating HIV testing into TB services will be oriented in the laboratory and rapid test kit guidelines that
were developed during the previous funding period. SCMS will also include relevant staff involved in
management of the TB/HIV program in logistics management trainings, develop a logistics management
training module for the NTP, and will serve as a resource to provincial level advisors and USG partners
involved in TB/HIV integration for improving the management of supplies for the TB program.
TA funding is allocated primarily under the HVCT program area, with a small amoung allocated under TB
HIV to ensure that staff from the TB program are included in trainings.
The support provided by SCMS to strengthen the MOH pharmaceuticals and medical supplies systems also
complements and reinforces the efforts of the Presidential Malaria Initiative to ensure a reliable supply of
anti-malarial drugs and test kits. Because SCMS is co-located with the USAID/DELIVER project, there is
close collaboration and synergy between both mechanisms that support logistics system strengthening of
CMAM.
Estimated amount of funding that is planned for Human Capacity Development $5,000
Program Budget Code: 13 - HKID Care: OVC
Total Planned Funding for Program Budget Code: $16,257,235
Total Planned Funding for Program Budget Code: $0
Program Area Narrative:
With a general prevalence rate of 16%, nearly 1.6 million people are living with HIV/AIDS in Mozambique. The southern region is
reported to have the highest HIV prevalence rates at 21% compared to the central region with 18% and the northern region at 9%.
Within the southern region, Gaza and Maputo Provinces have the highest prevalence rates, 27% and 26%, respectively.
A 2006 UNICEF report on Childhood Poverty in Mozambique estimates that approximately 5.3 million children (50% of all
children) are highly vulnerable. Of these children, 1.9 million are considered orphaned, with an estimated 400,000 (21%)
orphaned due to HIV/AIDS. 100,000 children under 15 are living with HIV/AIDS, and only 7049 (SAPR08) children are on ART.
Sofala and Manica provinces have the highest percentages of both maternal and paternal orphans and dual (both parents
deceased) in the country. More than half of all orphans live in households headed by women.
Services:
In FY09 PEPFAR implementing partners will continue to: 1) improve the quality of life for orphans and other vulnerable children
affected by HIV/AIDS by assuring the provision of a comprehensive package of basic services as required by the National Action
Plan for OVC (PACOV) and OGAC Guidance for OVC programming; 2) provide quality OVC programs through the
implementation of best practices in the area of OVC programming adapted to Mozambique's cultural context, and 3) strengthen
the capacity of the community and community-based organizations to access needed services to ensure quality care for children.
Implementing partners will continue to provide services to children infected and affected by HIV/AIDS. In FY09, USG will target a
total of 220,000 orphans and vulnerable children; most of whom will benefit from at least 3 of the 7 essential services: 1) Food and
Nutritional Support 2) Shelter and Care 3) Protection 4) Health Care 5) Psychosocial Support 6) Education and Vocational
Training and 7) Economic Opportunity/Strengthening.
FY09 Priorities:
To ensure comprehensive, cost-effective, coordinated, and quality care for orphans and vulnerable children, FY09 activities will
focus on establishing strategic partnerships that can be leveraged to ensure a continuum of care. OVC partners will implement
programs as part of a consortium, strengthening community capacity to care and support children living with HIV and AIDS. These
strategic partnerships will be required to establish memoranda of understanding with clinical partners providing services in their
geographic area of implementation. The goal of this approach is to ensure that all vulnerable children in a catchments area are
able to access services across the continuum of care including PMTCT, counselling and testing, pediatric treatment, home-based
care, child survival interventions, IMCI, general prevention and positive prevention for adolescents.
These consortia will include multiple organizations with a comparative advantage in the 7 service areas. The lead organization,
with oversight by the PEPFAR team, will be tasked with mapping services together with district health and social welfare
authorities, to ensure that children access comprehensive care and support services within functional referral mechanisms in their
service areas.
Zambezia and Nampula provinces present a unique opportunity to provide a comprehensive care package leveraging USG
resources from Title II (Food Security) and other health programs within the context of major infrastructure investments financed
by the Millennium Challenge Corporation. Peace Corps volunteers will provide training to local CBO and NGO in the technique of
perma-culture, improving food security for the vulnerable households, while ensuring minimal labour output. This activity will also
improve food security and nutrition for the household.
Food and Nutrition Technical Assistance (FANTA), cross-funded across several programs areas, will assist PEPFAR
Mozambique, along with government and implementing partners, to effectively address the issue of food and nutrition within the
context of HIV and AIDS. FANTA TA will support development and/or revision of training manuals, as necessary, to ensure more
effective nutritional counselling during home visits, including education about exclusive breast-feeding and infant nutrition for HIV-
infected or HIV-exposed children.
Focus on scale-up:
In order to ensure scale-up, sustainability, and support for the ever-growing number of OVC, alliances and partnerships with the
private sector will be crucial. USG will collaborate with key private sector entities in areas where a common vision is shared and
each partner's key resources and expertise are complementary. Such opportunities include training for OVC head of households
in particular skills required by private sector partners (e.g. tourism, construction), the introduction of technology in OVC training,
and linking trained OVC with employment opportunities.
USG continues to support the Ministry of Women and Social Action (MMAS) in the testing and scale-up of standardized age-
appropriate community-level psychosocial support materials implemented through community volunteers, or "para social-workers."
These materials were developed with input from the National Technical Working Group for OVC and with contributions from all
major stakeholders. The training system to support their dissemination will be national in scope. This is particularly useful in
establishing guidelines for what activities, at a minimum, should be included in a psychosocial support intervention.
Improve quality:
To more effectively support HIV-infected youth, an assessment of the value and effectiveness of psychosocial support
interventions (including life skills, peer education, and mentoring) will be conducted with support from the Project Search
mechanism. In 2008, Mozambique embarked on the process of defining quality standards for OVC services, with buy-in and
support from MMAS and the National Technical Working Group for OVC. The process, continuing in 2009, and led by MMAS with
support from USG, will not be limited to PEPFAR implementing partners but will include broad participation from national and
international stakeholders, including OVC. The defined standards will greatly improve ability to cost, compare, and evaluate OVC
activities with greater consistency across interventions.
Outreach to Especially Vulnerable Children:
In FY09 there will be greater emphasis on addressing the social, economic, and health needs of youth and adolescents. A
partnership with the Ambassador's Girls Scholarship program will be expanded and target districts with the lowest retention rates
for elementary school girls. The scholarships, coupled with mentoring and psychosocial support provided by OVC implementing
partners, will provide the support girls need to remain in school longer and reduce the pressures to engage in high-risk behavior.
Strengthen Capacity:
Through technical assistance and organizational capacity building, the USG will continue to strengthen the Ministry of Women's
Affairs and Social Action to more effectively lead the in-country response to OVC. AED Capable Partners will build the capacity of
CBOs providing OVC and HBC services to structure their organizations so that they can plan, implement and monitor their
programs effectively and access and retain funds.
Build knowledge:
Responding appropriately to the needs of OVC requires not only reliable data, but skills by key decision-makers in the
Government of Mozambique to analyze this data and use it as a key tool in advocacy and decision-making. With USG support,
and in partnership with UNICEF, MMAS developed a standard data collection tool, which captures basic information about OVC
served (disaggregated by age, sex, and service received). All PEPFAR implementing partners will use this data form to report
OVC served to MMAS at provincial level, which will then filter the information to national level. MEASURE Phase III will continue
support to MMAS from FY08 to FY09 to build its capacity for M&E. MEASURE will also work with the Armed Forces of
Mozambique (FADM), adapting the database developed for MMAS, to help FADM track the OVC of its members and ensuring
that the military OVC data are fed into MMAS database without duplication. This work will help the FADM provide referrals and
improve follow up of OVC from deceased military personnel.
MMAS, with support from USG, UNICEF and international donor organizations, will conduct a human-resource and capacity-gap
analyses to identify what is needed to implement its women and child welfare services. This exercise will analyze structure and
staffing of the ministry in relation to its core mandate and build on work done by UNDP in 2007.
Referral and Linkages:
Mozambique will continue to establish strategic linkages with the President's Malaria Initiative to ensure full insecticide-treated
nets (ITN) coverage for OVC. Partners will also link, to the extent possible, with the World Food Program (WFP) to ensure short-
term food support for OVC through referral, and to Title II and MMAS livelihood activities where feasible. OVC will also benefit
from WFP school feeding programs. Implementing partners will ensure that all children in their OVC programs access national
campaigns for de-worming, vitamin A supplements and vaccinations.
Policy:
The current National Action Plan for OVC and the National Action Plan for Children will come to term in 2010. USG along with the
international donor community and local stakeholders will actively participate in the process of revising a new Action Plan for OVC
and for Children. PEPFAR will support OVC and their caregivers by helping to mobilize and build the capacity of local
organizations already working in the area of children, women and human rights. The goal is to bolster the capacity of these local
organizations to more effectively lobby for laws and policies that provide protection to OVC. This activity will coordinate closely
with USG advocacy efforts against trafficking in persons and promoting human rights.
USG will continue active participation in the monthly, national-level Technical Working Group, hosted by MMAS, which discusses
policy and other issues as it relates to OVC. USG is one of five core members of the PARPA (Annual Poverty Reduction Plan)
TWG, formed in 2008 to provide guidance and support to MMAS as it prepares inputs to the PARPA. This TWG is also a forum
to discuss coordination of donor support to MMAS.
Table 3.3.13:
Funds for procurement of test kits were allocated in previous COP years under other program areas but not
under HVCT.
The Ministry of Health (MOH) Center for Medicines and Medical Supplies (CMAM) is responsible for
managing and implementing logistics for all medical and laboratory supplies. The CMAM-managed supply
commodities for all priority programs, including HIV, TB, and Malaria. All commodities procured regardless
of the funding source or procurement source enter into the national importation and distribution system.
The Partnership for Supply Chain Management (SCMS) is the lead procurement agent for the majority of
HIV-related commodities for USG and USG partners, including ARVs for treatment and PMTCT prophylaxis,
rapid test kits (RTKs), and OI and other palliative care medicines. Procurement of lab reagents and
equipment was transferred to SCMS's responsibility from APHL during FY 2008. In addition, SCMS
provides significant technical assistance to CMAM and the MOH in logistics management, including
forecasting and supply planning, procurement procedures, warehousing and distribution, and LMIS for all
essential medicines and laboratory reagents.
commodities, for FY09 no additional funds have been allocated to treatment partners for procurement of
commodities. This avoids duplication of funding and maximizes economies of scale and efficiencies HIV-
commodity procurement
This activity comprises two components: 1) procurement of test kits ($1,000,000); and 2) technical
assistance ($200,000).
Procurement of rapid test kits:
Rapid test kits are used to support the following programs: Blood Safety, CT, PMTCT, Clinical Diagnosis,
and sentinel surveillance. In FY 08, SCMS has procured RTKs totaling $ 2,216,405.22, representing 86.6%
of the RTKs imported into Mozambique in 2008. For FY 09, USG has allocated $1,000,000 of funds to
support the procurement of 1,015,000 test kits to reach X clients tested in different settings. This represents
a total of 49% contribution in this program area (the total funding allocation for RTKs across program areas
is 1,565,000, or a 70% contribution to the national need and a 15% reduction in USG contribution). Clinton
Foundation/CHAI will procure test kits for testing of children in pediatric settings and CMAM, with Global
Fund money, will procure the remaining rapid test kit needs.
SCMS provides technical assistance in the forecasting, supply planning, monitoring and management of the
incoming HIV test kit pipeline and distribution of HIV test kits in country. In 2007 and 2008 coordinated
procurement enabled adjustments to supply plans that ensured a full supply of RTKs when the MOH was
having financial management problems that prevented them from procuring these commodities on time.
During FY 09, SCMS will continue to provide technical assistance to CMAM and other partners in
forecasting, supply planning, and management of rapid test kits. SCMS will facilitate quarterly updates to
the national forecast and supply plan, enabling timely identification and response to any inbound supply
constraints that may arise. SCMS will help CMAM to facilitate communication between the MOH and
PEPFAR partners regarding RTK availability. The planned FY09 rollout of the rapid test LMIS and SOPs
will greatly improve availability of essential logistics data for improved distribution, accountability, and
quantification of needs.
In addition, along with USG's overall strategy to support the decentralization of activities, SCMS will expand
its existing central level support to support the work of provincial pharmaceutical and laboratory advisors
funded by USG under the treatment partners. Specific activities for supporting the provincial level
warehouses and distribution will depend largely on the result of the PLMP that has not yet been developed.
SCMS will serve as a resource for the orientation and capacity building of these staff. These provincial
advisors will participate in all national logistics systems building activities implemented by SCMS, such as
training of trainers for rollout of LMIS SOPs for all HIV-related commodities, including RTKs. SCMS will
work closely with these advisors to strengthen the ability of the provincial health management teams to
provide training, supervision, and monitoring of logistics management of key HIV/AIDS medicines, reagents,
and consummables. In addition, CMAM conducts routine supervision and monitoring visits to provincial
warehouses. SCMS will support CMAM's efforts in supervision and monitoring of these warehouses in
collaboration with Provincial Advisors.
Estimated amount of funding that is planned for Human Capacity Development $125,000
Table 3.3.14:
THIS IS A CONTINUING ACTIVITY UNDER FY09. Due to recent activities during the current funding
period, however, the narrative below replaces all previous narratives.
Since FY 07, the Partnership for Supply Chain Management (SCMS) has been the lead procurement agent
for the majority of HIV-related commodities for USG and USG partners, including ARVs, rapid test kits
(RTKs), and medicines for opportunistic infections (OIs) and other palliative care medicines. Procurement of
lab reagents and equipment was transferred to SCMS's responsibility from the Association of Public Health
Laboratories (APHL) in FY 08. In addition, SCMS provides the bulk of the technical assistance to Central
de Medicamentos e Aartigos Medicos (CMAM) and the MOH in logistics management, including forecasting
and supply planning, procurement procedures, warehousing and distribution, and Logistics Management
Information Systems (LMIS) for all essential medicines and laboratory reagents. The support provided by
SCMS to strengthen the Ministry of Health (MOH) pharmaceuticals and medical supplies systems also
complements and reinforces the efforts of the Presidential Malaria Initiative (PMI) to ensure a reliable supply
of anti-malarial drugs and test kits. Because SCMS is co-located with the USAID/DELIVER PROJECT,
there is close collaboration and synergy between both mechanisms that support logistics system
strengthening of Central de Medicamentos e Artigos Médicos (CMAM).
During FY 08 SCMS has so far procured $10,138,019.97 of ARVs, accounting for 72% of the national ARV
need. This amount is less than the originally approved amount, as $1,000,000 were re-programmed for the
procurement of rapid test kits to cover a shortfall in that area. These funds covered the bulk of the adult first
line regimen need (d4T/3TC/NVP), 95% of which were generic ARV drugs. Clinton Foundation/CHAI
through UNITAID covered almost 100% of pediatric formulations and adult 2nd line regimen ARV drugs.
Remaining needs were to be procured directly by CMAM using Global Fund money and Common Fund
resources. Due to cash flow problems and difficulties accessing Global Fund money, however, CMAM has
not been able to adhere to its ARV drug procurement commitment for the current fiscal year, requiring USG
to continue to fund the majority of first line adult regimen needs of the country.
In addition, during the current funding period, SCMS has conducted several technical assistance activities,
which have helped inform budget and activity planning for the next 3-5 years. This includes a situational
analysis of SIGM, the current national LMIS for managing commodities between the provinces and CMAM,
and a recent warehouse design and operations assessment, which highlighted key problems in the current
warehouse operations. During the current fiscal year, SCMS will provide emergency support and
renovations to the Beira Warehouse and significant technical assistance to the transfer from the temporary
warehouse from Adil to Zimpeto.
The country is also facing challenges with distribution from CMAM to the provinces and from provinces
down to the districts and sites, demonstrating a fundamental weakness in the overall supply chain system.
These assessments and the current vulnerabilities in the existing supply chain system require significant
technical support and long-term strategic planning for systems building.
FY 09 funds will support two components: 1) procurement of ARV drugs ($11,600,000), and 2) technical
assistance ($1,550,000).
Procurement of ARV drugs:
SCMS will procure ARV drugs for X patients. This amounts to a 15% reduction from the initial FY 08 funding
allocation and represents about 50% contribution to the overall national need. SCMS procured ARVs will
cover first line adult regimens, and a portion of the 2nd line adult regimen needs to fill the gap in second line
ARV drug needs after Clinton Foundation transitions out in FY2010. Clinton Foundation/CHAI will continue
to support almost 100% of pediatric ARV needs through end of December 2010 (last shipment to arrive
during Q1 of 2011), and 100% of 2nd line ARV drugs through December 2009 (last shipment to arrive
during Q1 of 2010). CMAM through Global Fund money and Common Fund sources will procure the
remaining ARV needs with technical assistance from SCMS.
commodity procurement.
SCMS will continue to provide technical assistance to CMAM in forecasting and supply planning,
procurement, warehousing and distribution, and LMIS for ARV drugs, RTKs, laboratory reagents, and OI,
CTX, and other palliative care drugs. In addition, given the recent assessment findings and current
vulnerabilities, USG is requesting greater emphasis in long-term capacity building in procurement and
provincial level support.
Starting in FY08 and continuing with FY 09 funding, SCMS will conduct the following activities:
Central level Technical Assistance:
Pharmaceutical Logistics Master Plan (PLMP):
FY 08 and 09 will see the beginning of the implementation of an emergency central warehousing
improvement plan that will lead into a 3-5 year Pharmaceutical Logistics Master Plan. The objective for the
execution of a PLMP is to ensure that vital and essential drugs and health commodities of approved quality
will be readily available to public sector health facilities, for use in the prevention, diagnosis, and treatment
of priority health problems, in adequate quantities and at the lowest possible cost. The PLMP looks at the
whole supply chain and the external factors influencing the quality and performance of this supply chain.
This includes areas as procurement, warehousing, distribution but also finances, coordination &
harmonization, policy and legislation and human resource management. USG and SCMS will engage other
donors and stakeholders to leverage support for its development and implementation.
Activity Narrative: The PLMP will be the overall guiding strategy for the following activities:
- Forecasting and supply planning: SCMS will continue to provide technical assistance in the area of
supply planning and forecasting. SCMS will strengthen its efforts to provide training and TA to a larger
number of CMAM staff and other relevant technical people participating in the forecasting process, including
a forecasting/quantification training in Maputo by quantification experts. SCMS will provide specific training
in forecasting of laboratory reagents to CMAM as this is a new area of management for the organization, as
well as improved forecasting for OI and palliative are drugs.
- Procurement: An overall goal of USG is that CMAM has the capacity to manage procurement of public
health commodities for the country, including establishing adequate supplier relations, managing lead time,
and following good procurement practices. SCMS will assess CMAM's procurement systems in early 2009,
and developing a procurement capacity building plan to support supply-chain improvements. A particular
focus will be given to the overlap of procurement financing mechanisms, management of lead time, and
procurement methodologies to support supply planning and good warehouse management practices, such
as flexible contracting. With FY 09 funds, SCMS will continue to support these procurement strengthening
activities.
- Human Resources: SCMS will support CMAM to strengthen its human resource capacity, by conducting
an HR skills assessment to identify the current strengths and weaknesses in the current staffing. In addition,
SCMS will identify staffing requirements, job descriptions and criteria for all levels of CMAM, such as staff
for managing the central warehouse and procurement staff.
- Warehousing Infrastructure and Management Systems: Given the weak state of CMAM's infrastructure,
systems, and staff capacity, SCMS technical assistance will include focus on all areas of warehouse
management with the goal of establishing good warehousing practices at CMAM as tracked by key
performance indicators. A new SCMS strategy is the placing of technical advisors to work along side
CMAM staff to conduct systems building and mentoring in the key technical areas of warehouse
management, material handling and operations, IT systems, procurement, process development, while
directly contributing to achieve improved performance. These advisors will be key contributors to the PLMP
and drivers of its implementation. An important focus will be the continued support to the transfer and
management of operations from Adil, the current temporary central warehouse to Zimpeto, a state-of-the art
warehouse that is in its final stages of completion.
- Pharmaceutical logistics information systems: SCMS has implemented the Integrated Pharmaceutical
Management System (SIGM) at the Maputo, Zambézia, and Sofala, Cabo Delgado and Niassa Provincial
Warehouses. In FY 08, SCMS supported CMAM to re-implement the SIGM at the Central Warehouses.
This was needed following the transfer of management mandate to CMAM, and the Maputo stocks
consolidation move to the temporary central warehouse. The Situational Analysis of the SIGM followed by
the Warehouse and Distribution Needs Assessment identified the need for an alternative logistics
management information system that responds to the needs of today's CMAM. With the modernization of
the central warehouses, and the future PLMP, a warehouse management system such as MACS (XXXXX)
that supports key functionality required for modern warehouse management, such as fluid bin location and
bar-coding, will need to be implemented.
- Distribution and Transportation: Transportation is one of the greatest bottlenecks facing distribution from
Central to Province and within the provinces. A main area of focus for the PLMP is to assess and redesign
a distribution network to improve the effectiveness and efficiency of transportation of medicines, lab
reagents and other medical consumables throughout the health system in Mozambique.
- Monitoring and Evaluation/Key Performance Indicators: SCMS will assist CMAM to develop a monitoring
and evaluation plan including classic supply chain key performance indicators (KPIs). To measure
improvements in the supply chain delivering ARVs, RTKs, OIs STIs, and lab reagents and consummables,
a nationally representative facility-based stock availability indicator survey will be conducted as a baseline.
Follow up surveys will be conducted during PLMP implementation.
Provincial-level support
Coordination, Support and Information Sharing with USG and USG partners:
SCMS will continue to organize 3-4 ½ day Coordination and Information Sharing Forums for PEPFAR
Agencies and Implementing Partners with the objective of sharing progress on supply chain improvements,
issues requiring coordination, and HIV/AIDS commodity security information. They will also continue to
provide important updates to partners and USG as they arise, and participate or organize ad-hoc meetings
to discuss emergent problems or topics of USG and USG partner interest.
SCMS Mozambique Office in Maputo:
SCMS expatriate staff will include a Lead Resident Advisor (Country Director, shared with USAID/DELIVER
Activity Narrative: PROJECT), a Deputy Director for Commodity Security, a Senior HIV/AIDS Advisor, a Laboratory Logistics
Advisor, and a Procurement Manager. From 4-5 technical advisors in warehousing, distribution, and
procurement will be placed at CMAM for 2-3 years, beginning in FY 09 to build systems in these functional
supply chain areas. A number of other technical staff, primarily Mozambicans, with specific capacity in IT,
information systems, warehousing, and forecasting, supply planning, supply chain monitoring, training and
capacity building in key HIV/AIDS commodity areas will work for SCMS supporting either PEPFAR
procurement or technical assistance to build the CMAM systems. SCMS technical staff will be supported by
a Finance and Administration Team shared with the USAID|DELIVER PROJECT. SCMS Mozambique
managerial and technical backstopping will be provided by a Country Program Manager, a Program
Coordinator, LMIS and Lab technical advisors at SCMS in Washington, and Financial and Administrative
backstopping provided through JSI/Washington.
Continuing Activity: 14557
14557 5232.08 U.S. Agency for Partnership for 6868 3650.08 Supply Chain $21,017,161
9117 5232.07 U.S. Agency for Partnership for 5045 3650.07 Supply Chain $14,204,518
5232 5232.06 U.S. Agency for Partnership for 3650 3650.06 Supply Chain $7,800,000
Estimated amount of funding that is planned for Human Capacity Development $700,000
Table 3.3.15:
April09 Reprogramming: Increased $2,345,976.
THIS IS A CONTINUING ACTIVITY FROM under COP09.
The narrative has been replaced.
This activity is linked to activities implemented by APHL, ASM, MoH, and Brazilian TBD partner.
In July 2008, the responsibility for the procurement of PEPFAR funded CD4 reagents transitioned from
APHL to SCMS. Hematology and biochemistry reagents transitioned to SCMS in October of 2008. SCMS
will continue to work with APHL to ensure the transition continues to go smoothly. APHL will continue to
provide technical assitance and advice to SCMS regarding site readiness, prior to equipment installation
and will advise on types of equipment appropriate for placement in a given laboratory. Furthermore, SCMS
will work with APHL to incorporate logistics and lab inventory management components into Lab
Management Workshops to be conducted by APHL, such that trainees will benefit from from both partners'
areas of expertise. SCMS also provides technical assistance to the Center for Medicines and Medical
Supplies (CMAM) and the MOH in logistics management, including forecasting and supply planning,
procurement procedures, warehousing and distribution, and LMIS for all essential medicines and laboratory
reagents. The CMAM-managed supply chain is a fully integrated system, which handles the essential drugs
program, in addition to all consumable commodities for all priority programs, including HIV, TB, and Malaria.
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.
Two components are included under this activity: 1) procurement of lab reagents, supplies and equipment
($3,554,024; and 2) technical assistance to CMAM and Provinces ($400,000).
Procurement of laboratory reagents, consummables and equipment
SCMS will procure and deliver CD4, hematology, and biochemistry instruments, reagents and associated
consumables to support the testing at PEPFAR supported sites. Instrument maintenance and servicing
contracts for PEPFAR supported instruments will be managed as well. SCMS will procure equipment and
reagents for new laboratories as the PEPFAR supported laboratory network expands, as determined by the
MoH and PEPFAR. By end of FY2008, USG supports CD4 testing in 26 labs; biochemistry in 20 labs; and
hematology in 18 labs, resulting in 250,000 CD4 tests and 800,000 biochemistry and hematology tests
performed. By end of FY2009, as physical infrastructure projects are completed and additional equipment is
placed, these numbers are expected to increase to 350,000 for CD4 and 1,100,000 for biochemistry and
hematology. Further expansion of testing capacity will be reduced in FY2009 as the emphasis shifts to
systems strengthing and quality improvement.
Technical Assistance
As part of the PEPFAR reagents procurement activity, SCMS designed a paper-based laboratory LMIS and
a distribution management tool which is being piloted in the PEPFAR supported network, and which will be
assessed for rollout to the national clinical laboratory network. The LMIS will provide consumables
consumption, stock and hand, and losses data to inform forecasting, procurement, and resupply decisions,
and enable the collection and reporting of key performance indicators, such as data on stockouts. An
equipment maintenance log will enable tracking of equipment down time, reason for equipment failure, and
resolution of the problem. SCMS will maintain a updated database listing equipment inventory and
contractual status by site. The pilot phase will be monitored through two logistics supervision site visits to
each laboratory per year.
With the transition of laboratory commodity logistics responsibilities to CMAM, SCMS will provide technical
assistance to CMAM to support them with this additional mandate expansion. Laboratory commodities will
be included in the 3-5 year PLMP, and as such, key steps in the prioritization, harmonization, and
standardization of the testing and methods will be included. SCMS technical assistance will aim to improve
information flow, availability and quality of essential logistics data for decision making, and best practice
logistics management for laboratory reagents by:
- Implementing a national LMIS for Lab reagents and consumables, managed by CMAM, to enable tracking
and monitoring of real consumption, to inform more accurate forecasting, procurement and distribution to
provinces and individual laboratories, based on consumption data, and resulting in fewer stockouts.
- Collaborating with other partners in the training of provincial laboratory technical advisors and
laboratorians to support LMIS implementation, supervision, and institutionalization
- Support the integration of laboratory reagents and consumables into the warehouse management and
inventory control system to be implemented in Zimpeto and Beira.
Continuing Activity: 14558
14558 9254.08 U.S. Agency for Partnership for 6868 3650.08 Supply Chain $2,530,000
9254 9254.07 U.S. Agency for Partnership for 5045 3650.07 Supply Chain $914,709
Estimated amount of funding that is planned for Human Capacity Development $300,000
Table 3.3.16:
This is a new activity under COP09.
SCMS systems strengthening activities have been budgeted under other program areas in previous funding
years. Many of the activities described below are also described under the SCMS HTXD activity narrative.
USG in line with Government of Mozambique strategic plans and policies has increased its efforts and
contributions towards overall systems strengthening activities. A significant focus of USG systems
strengthening activities include human resource development and capacity building, integration and overall
systems building, financial management, and support to decentralization of services and monitoring and
evaluation. The support provided by SCMS to strengthen the MOH pharmaceuticals and medical supplies
systems also complements and reinforces the efforts of the Presidential Malaria Initiative to ensure a
reliable supply of anti-malarial drugs and test kits. Because SCMS is co-located with the USAID/DELIVER
PROJECT, there is close collaboration and synergy between both mechanisms that support logistics
system strengthening of CMAM.
Since early FY 2007, SCMS has also been providing significant technical assistance to CMAM and the
MOH in logistics management, including forecasting and supply planning, procurement procedures,
warehousing and distribution, and LMIS for all essential medicines and laboratory reagents. The CMAM-
managed supply chain is a fully integrated system, which handles the essential drugs program, in addition
to all consumable commodities for all priority programs, including HIV, TB, and Malaria. All commodities
procured regardless of the funding source or procurement source enter into the national importation and
distribution system.
During FY 08, SCMS has conducted several technical assistance activities, which have helped inform
budget and activity planning for the next 3-5 years. This includes a situational analysis of SIGM, the current
national LMIS system for managing commodities between the provinces and CMAM, and a recent
warehouse design and operations assessment, which highlighted key problems in the current warehouse
operations. During the current fiscal year, SCMS will provide emergency support and renovations to the
Beira Warehouse and significant technical assistance to the transfer from the temporary warehouse from
ADIL to Zimpeto.
With FY 09 funding, SCMS will continue its support to strengthening overall systems in the area of
pharmaceutical and laboratory logistics management through ongoing technical assistance to the Center for
Medicines and Medical Supplies (CMAM) and the MOH and by expanding support to the provinces.
Funding for these activities has been allocated across other program areas (HTXD, PMTCT, HVCT, HLAB).
Total technical assistance funds amount to USD 3,100,000, not including technical assistance to the blood
safety program. Activities are described below:
Central Level TA.
FY 2009 will see the beginning of the implementation of an emergency central warehousing improvement
plan that will lead into a 3-5 year Pharmaceutical Logistics Master Plan. The objective for the execution of a
PMLP is to ensure that vital and essential drugs and health commodities of approved quality will be readily
available to public sector health facilities, for use in the prevention, diagnosis, and treatment of priority
health problems, in adequate quantities and at the lowest possible cost. The PMLP looks at the whole
supply chain and the external factors influencing the quality and performance of this supply chain. This
includes areas as procurement, warehousing, distribution but also finances, coordination & harmonization,
policy and legislation and human resource management. USG and SCMS will engage other donors and
stakeholders to leverage support for its development and implementation.
The PMLP will be the overall guiding strategy for the following activities:
1. Procurement: An overall goal of USG is that CMAM has the capacity to manage procurement of public
as flexible contracting. With COP 2009 funds, SCMS will continue to support these procurement
strengthening activities.
This activity will be complementary technical assistance provided by Abt Associates in financial
management for to the MOH.
2. Human Resources: SCMS will support CMAM to strengthen its human resource capacity, by conducting
3. Warehousing Infrastructure and Management Systems: Given the weak state of CMAM's infrastructure,
Activity Narrative: CMAM staff to conduct systems building and mentoring in the key technical areas of warehouse
management of operations from ADIL, the current temporary central warehouse to Zimpeto, a state-of-the
art warehouse that is in its final stages of completion. 4. Pharmaceutical logistics information systems:
SCMS has implemented the Integrated Pharmaceutical Management System (SIGM) at the Maputo,
Zambézia, and Sofala, Cabo Delgado and Niassa Provincial Warehouses. In 2008, SCMS supported
CMAM to re-implement the SIGM at the Central Warehouses. This was needed following the transfer of
management mandate to CMAM, and the Maputo stocks consolidation move to the temporary central
warehouse. The Situational Analysis of the SIGM followed by the Warehouse and Distribution Needs
Assessment identified the need for an alternative logistics management information system that responds to
the needs of today's CMAM. With the modernization of the central warehouses, and the future PLMP, a
warehouse management system such as MACS that supports key functionality required for modern
warehouse management, such as fluid bin location and bar-coding, will need to be implemented.
5. Distribution and Transportation: Transportation is one of the greatest bottlenecks facing distribution from
6. Monitoring and Evaluation/Key Performance Indicators: SCMS will assist CMAM to develop a monitoring
improvements in the supply chain delivering ARVs, RTKs, OIs STIs, and lab reagents and consumables, a
nationally representative facility-based stock availability indicator survey will be conducted as a baseline.
Provincial-Level Support
HIV/AIDS medicines, reagents, and consumables. In addition, CMAM conducts routine supervision and
Sustainability planning
The USG is strengthening its efforts at ensuring sustainability through implementation of site graduation and
performance based financing through clinical treatment partners. SCMS will support these activities
developing pharmaceutical and logistics management criteria and indicators for determining sustainability of
sites, and by contributing to the development of assessment tools.
Summary of deliverables include: a pharmaceutical logistics master plan; training in laboratory quantification
and logistics, warehousing, ARV and OI/essential medicines logistics, and LMIS; workshops for provincial
advisors and supervision/support to provinces; development of key performance indicators (KPIs); human
resource skills assessment and strategic plan for CMAM; placement of key technical staff to sit in CMAM.
Estimated amount of funding that is planned for Human Capacity Development $250,000
Table 3.3.18:
