The Partnership for Supply Chain Management (SCMS) is funded to procure all HIV-related commodities on behalf of the USG and USG partners, as well as strengthen the supply chain management of HIV, laboratory, and other health commodities through direct technical assistance to the Central Medical Stores (CMAM) and the laboratory department at the MOH in forecasting and supply planning; warehouse management and distribution; and use of logistics management information for decision making and planning. SCMS works primarily at central level supporting CMAM, as well as provides support to Beira Central Warehouse in Sofala Province. SCMS will intensify its support to monitor and strengthen capacity in LMIS use in all provinces, in collaboration with implementing partners. USG/Mozambique did not conduct a costing or expenditure analysis (EA) for SCMS. This is planned for the next costing/EA exercise. SCMS will increase the cost share between JSI/DELIVER PMI and reproductive health projects.In previous years, the partner had low burn rates and high pipeline, leading to annual reductions in funding levels. In FY12, the partner will have spent down all previous funding levels, due to increased burn rates, requiring higher funding levels to implement priority activities. Due to scale-up for treatment targets and lack of consistency in drug supply through GRM and GFATM, the USG funded additional resources for ARV Drugs in 2012-13 noting the scale-up gaps and needs across the country. Purchased/leased under this mechanism from the start of the mechanism through COP11- 1New requests in COP FY 12-4 Total planned/purchased/leased vehicles for the life of this mechanisms-54 vehicles used for project administration. 1 new vehicle for regional presence.

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 ActivitiesOHSS MOH programs 675 Support to quantification and gap analyses for Global Fund; Support to quantification and gap analyses, supoprt to CMAM to strengthen system to receive Global Fund grant disbursements and Secondment of a staff person at the Global Fund unit at the MOH

In line with USG and GOM goals to ensure access to essential HIV medicines for treatment and care of HIV-related opportunistic and other infections, SCMS will receive funds to procure medicines for the prevention and treatment of OIs and STIs. USG will contribute $600,000 USD to the national OI commodity needs and $1,200,000 USD for STI drugs, providing up to 75% of the national need. In FY 12, USG will commit $200,000 USD to the procurement of cotrimoxazole, based on a recent forecasting exercise for all essential medicines, which demonstrated full supply of CTX through the first half of 2013.Global Fund, through the Round 9 Grant with Mozambique, will contribute to the majority of OI needs for HIV care and treatment, while the remaining needs will be covered with SWAP donor funding and State budget.

SCMS will also support strengthening the supply chain for CTX, OI, and STI drugs through OHSS funds. Provision and availability of OI and STI medicines, including CTX, have been challenged by the overall weak supply chain, limited visibility of stocks throughout the country, poorly trained staff in standard operating procedures for drug management, and limited financial resources within the Ministry. The roll-out of the Integrated Logistics Management Information System (SIMAM) will significantly strengthen the supply chain for all commodities, in particular for essential medicines. In 2011 and Q1 of 2012, DELIVER Project and SCMS will conduct a large-scale national training in standard operating procedures (SOPs) for stock management at all levels of the supply chain, in collaboration with implementing partners. SCMS will support CMAM, and leverage clinical partners to address logistics challenges around essential medicines, through improving forecasting, data availability, and support to a new audit unit designed to monitor the supply chain and adherence to SOPs. SCMS will provide greater focus on strengthening STI and OI forecasting and distribution in coordination with clinical partners and MOH program counterparts.

In line with the USG and GOM goals for strengthening diagnostic capacity and access to TB medicines amongst TB/HIV co-infected patients, SCMS will locally procure diagnostic equipment and reagents on behalf of the TB program, including Gene Expert, Laboratory reagents, 30 LED microscopes, and an X-Ray machine.

In addition, the Global Drug Facility has committed to cover the needs for TB patients until the end of 2012. However, there is no committed financing beyond this period, with no comitment by the Global Fund to disburse Round 7 funds. Stock outs of TB medicines would be a national emergency, further exacerbating the challenges Mozambique faces with MDR-TB. As such, SCMS has included $600,000USD to cover the costs of first line TB medicines to ensure a continued supply of TB medicines for TB patients in the event of an emergency.

An additional $100,000 USD will be allocated to support the SCMS in-country procurement operations.

SCMS supports the clinical laboratory network with direct support of equipment, reagents, commodities and maintenance contracts for HIV diagnostic and monitoring tests. SCMS provides technical assistance to MOH to strengthen the laboratory commodity supply system and will increase capacity building efforts within the MOH in areas of forecasting, procurement, distribution, and inventory management.

SCMS will procure CD4, hematology, biochemistry, microbiology and molecular biology equipment and commodities for HIV diagnostics and monitoring tests for 56 laboratories across all 11 provinces. SCMS is implementing a paper-based LIMS in labs receiving USG-funded commodities which will be expanded to all MOH labs as a strategy to improve the flow and validity of information coming from site level. At the central level, SCMS will build capacity to receive, analyze, and utilize these data to inform forecasting, procurement, and distribution decisions by placing SCMS staff as technical advisors within the MOH. SCMSs supply chain strengthening activities are aligned to the National Laboratory Strategic Plan, the USG PF, and the Global Health Initiative which calls for USG/GOM collaboration to Improve commodity procurement and distribution systems at all levels. Supply chain strengthening activities also align to the next generation laboratory indicators by: 1) ensuring adequate numbers of labs have capacity to diagnose HIV and monitor therapy and 2) supporting the laboratory accreditation process which requires that labs have an inventory control system for supplies with appropriate documentation and a standardized system for reporting.

Laboratory commodity logistics and inventory management are key elements of good laboratory management. SCMS will collaborate with other lab partners in country to support the curriculum development and facilitation of this subject in the USG supported laboratory management in-service trainings. In addition, they will adapt the in-service module to be included in the MOH pre-service laboratory course curriculum.

Currently, USG funded lab commodities are managed in a vertical system outside of the national system. SCMS will build capacity within CMAM to utilize USG funds to manage all lab commodities using the national system. These activities will be in line with the recently approved PLMP to strengthen the countrys logistic system for all medical commodities and lead to a more sustainable system for commodity management that transitions ownership and responsibility to MOH.

HIV Surveillance is a key tool for monitoring progress towards reducing HIV infections in Mozambique, the first goal outlined in the Partnership Framework. During the latest round in 2011, sentinel surveillance is being conducted at 36 sites throughout the country and dry blood spot (DBS) technology, BED incidence assays, and threshold ARV resistance monitoring are being continued. Data from the sentinel surveillance round are used to describe the current burden of disease among pregnant women and to produce estimates of the burden and impact of HIV/AIDS in the country and to monitor disease trends over time. Sentinel surveillance data, adjusted by national survey data, are the cornerstone for allocating resources in the country. This year integrated bio-behavioral surveillance surveys (IBBS) are also being conducted in three most at risk populations (mineworkers, truck drivers, female sex workers). These surveys will provide the basis for assessing disease burden in these populations and also determining their contribution to the national epidemic.This activity will support procurement of 1) commodities to support a future round of IBBS ($90,000), 2) commodities for the 2013 round of ANC surveillance ($210,000), 3) technical assistance from SCMS to the National Institute of Health to improve their internal procurement systems ($100,000). These activities will be partially supported through existing FY11 pipeline funds, thus a total of $400,000 is being requested in additional FY12 funds to cover all activities.Funding for procurement of specimen collection and testing supplies and materials and test kits to support a second round of IBBS in one group is planned in FY12; the MOH intends to institutionalize the IBBS system by implementing surveillance activities in one key group per year for a more continuous system of surveillance in key populations. Results from the current round of three IBBS surveys should be available in 2012 and will help guide the design of the MOH MARPs HIV surveillance system.Since 2001, CDC has provided complete financial and technical support for sentinel surveillance activities in Mozambique with PEPFAR funds. In 2009, HIV surveillance moved from the HIV program to the National Institute of Health with continuing financial support from CDC. Funds are planned in FY12 to procure sample collection equipment and supplies, sample processing equipment and supplies, and test kits necessary to conduct sentinel surveillance and related activities (HIV, syphilis, BED and Avidity tests for recent HIV infection, and threshold drug resistance testing) in 2013. The surveys typically include about 13,000 pregnant women.Starting in 2009, procurement of these supplies has been routed through SCMS in order to improve long-term sustainability of surveillance activities. Starting in 2012, SCMS will provide technical assistance to INS to improve internal procurement practices related to surveys.Materials may be procured locally, internationally or a combination of both, depending on costs and technical considerations.

The Government of Mozambique and USG programs have been hampered by chronic weaknesses in the supply chain, associated with lack of qualified human resources, underfunding for distribution and operations at all levels of the supply chain, and poor program-Central Medical Stores (CMAM) coordination. These weaknesses have resulted in chronic stock outs, expired product, and waste of GOM and donor resources. A recent rapid assessment of CMAM and the central supply chain system supported the following recommendations: an improved policy, legal and human resource environment and framework to improve efficiencies in the supply chain, including administrative and financial autonomy; considerations for outsourcing distribution and warehousing; improved monitoring and evaluation, and communication; and information systems for decision-making. During FY 11, the MOH in collaboration with partners will revise and finalize the strategic plan for the sector, previously known as the Pharmaceutical Logistics Master Plan, initiated by SCMS. This plan will eventually be the basis around which all financing will be determined. For FY 2012, SCMS will be focusing its activities in line with the rapid assessment recommendations as well as previous recommendations from the PLMP. This includes: warehouse and distribution support, including improving controls of warehouse processes; strategy development for increased autonomy; intensifying its collaboration with clinical partners for strengthening logistics management information for decision making in provinces and districts; and focusing efforts to foster better coordination for forecasting. Significant efforts have been made to foster improved communication and coordination between CMAM and Ministry departments for quantification, supply planning and monitoring, particularly for GFATM. During 2011, quantification sub-groups were created; SCMS will increase its efforts to build capacity of the MOH programs in quantification and planning, and help develop terms of references and roles and responsibilities for the different groups and their members.SCMS and USG clinical partners have continued to implement the logistics management information system (SIMAM) in all provinces, and in several districts. In FY 2012, SCMS will solidify use and Ministry ownership of the SIMAM system through a formalized collaboration with the M-OASIS project, the technical support to the MOH Department of Information Systems, funded by CDC. To improve use of SIMAM, SCMS will hire one data entry clerk per provincial warehouse, and will leverage USG's scholarship program to identify graduating students from the pharmacy schools to be absorbed into the system. Partner collaboration will be enhanced starting in FY11 into FY 12 through the development of partner-SCMS Memoranda of Understanding (MOU) in various provinces. SCMS will work with IPs to conduct a rapid logistics assessment per province around different program commodity areas to identify barriers and solutions. SCMS contributes to the cross-cutting areas of Human Resources for Health. Building on the large-scale national training planned for FY 2011, SCMS will provide additional support to the newly established audit unit within CMAM, tasked to monitor adherence to standard operating procedures, and provide procurement technical assistance in laboratory procurement.

A new activity for SCMS in FY12 is to support some of the critical commodity and equipment needs for the national MC program. The commodities and equipment, disposable MC kits and mobile unites, are part of a strategy to increase efficiencies and permit more males to be circumcised. Disposable MC kits, which contain pre-packaged surgical instruments for single MC procedures, were recently approved by MOH and will be procured for the first time in the coming year. The kits alleviate the need for the surgical teams to assemble and clean the equipment needed for MC. This time-savings makes it easier to circumcise more men and is particularly beneficial during peak periods of demand. SCMS will procure 50,000 kits to support the governments goal to adopt a combination of disposable and reusable kits. SCMS will also procure two mobile MC units to respond to increased demand. The mobile units are self-contained MC clinics with two procedure beds. The clinics will be used to support existing sites and in the future may be available for campaigns.

SCMS works primarily at central level supporting CMAM, as well as provides support to Beira Central Warehouse in Sofala Province. SCMS will intensify its support to monitor and strengthen capacity in LMIS use in all provinces, in collaboration with implementing partners.

SCMS will procure HIV rapid test kits to support the USG and MOH efforts to expand facility and community based HIV counseling and testing activities and increase testing uptake. The total national need for FY 2012 -2013 is estimated to cost $11 million USD for all areas of CT, including PMTCT, provider initiated testing and counseling (PICT), blood safety, community testing, and CT campaigns. This budget code will be used for HIV testing in non-ANC settings. In FY 2012, USG will focus significant efforts to increase testing via PICT and will contribute to national testing targets through MC scale up activities. USG will contribute to the overall national need along with other donors, including Global Fund Round 9, World Bank Health Commodity Security Project, and a small portion from Clinton Foundation for pediatric testing. 3,616,666USD will contribute to testing more than 3 million people in Mozambique

To support the USG and the GOM in their efforts to scale up quality CT services, increased efforts are required to improve the supply chain of HIV test kits. During the last years, Mozambique has faced challenges in the supply of HIV rapid test kits due in large part to insufficient supply, poor consumption data for forecasting and distribution planning, unreliability of other donor funds and large scale up of testing activities at health facilities and in communities. In addition, weak coordination at central level MOH programs and Central Medical Stores (CMAM) for forecasting and distribution planning has led to interruptions in supply due to inappropriate distribution to provinces

USG will be funding a new partner, Village Reach, in FY 2012 to provide focused efforts in strengthening the RTK logistics system through identification of key barriers at different levels of the supply chain, and working with the MOH program, CMAM and provinces to develop strategies to address these barriers. SCMS will collaborate with Village Reach by continuing to support the overall supply chain, strengthening overall forecasting and warehouse management of test kits; and working with clinical partners to ensure RTK consumption information is routinely collected and included in the LMIS (SIMAM) to improve distribution planning and forecasting. Clinical partners will support facility and district level RTK stock management through supervision visits, distribution support, identify barriers at provincial and district levels to improved RTK logistics, and provide recommendations for strengthening RTK logistics.

Nationwide expansion of quality PMTCT services with increased access to more effective PMTCT regimens is a key goal for the GOM and supported by the USG as a critical intervention in the fight against HIV. In addition, since early 2011, the GOM has started implementation of the new WHO guidelines for Option A, provision of AZT to HIV-infected pregnant women starting at 14 weeks and daily NVP to the infant. To support these efforts, SCMS will receive funds to procure PMTCT related commodities, including ARV drugs for combination ARV prophylaxis for pregnant women and exposed infants in line with Option A; HIV rapid test kits for pregnant women and their partners; CD4 reagents, Point of Care technology, syphilis tests, and other laboratory supplies and reagents for screening and monitoring HIV-infected pregnant women.

SCMS will enhance its support to the PMTCT program at central level by providing focused training in quantification and planning for PMTCT-related commodities; by monitoring PMTCT-related stocks and their distribution; and by working with clinical partners to strengthen implementation of the new protocols at site level and ensuring PMTCT logistic challenges are addressed.

While not directly impacting targets, procurement of PMTCT-related commodities, and strengthening of the logistics system for PMTCT, will support USG and the GOM in achieving their goals outlined in the joint acceleration plan for averting pediatric infections, and ensuring universal access to treatment to pregnant women and their families.

SCMS works primarily at central level supporting CMAM, as well as provides support to Beira Central Warehouse in Sofala Province. SCMS will intensify its support to monitor and strengthen capacity in LMIS use in all provinces, in collaboration with implementing partners.

The MOH ART program estimates there will be 319,976 ART patients by the end of 2013, of which approximately XXXX will be children. USG will contribute 279,676 patients planned with an additional scale-up predicted to be 40,300, 85% of the overall treatment targets. The Target for PMTCT is 35,000 with newly planned targets for scale-up at 29,500.Mozambique MOH standard treatment guidelines (STGs) for ART services include the following components: first line ART with AZT/3TC/NVP for adults and for TB/HIV co-infected patients, universal treatment of TB/HIV co-infected patients and children < 2 years diagnosed with HIV.Based on these STGs, and using historical and estimated consumption and treatment scale up rates, the national forecasted need for FY 2012 will cost $38 million, with a current gap of $9.5 million USD including Global Fund Round 9, Phase 1. One month of shipment for current patients costs approximately $2.5 to 3 million USD. SCMS will receive funds to procure adult first line ARVs ($23.5 million USD), and 2nd line ARV needs following the phase out of CHAI UNITAID funding ($300,000 USD). The rgovernment will be requantifying the need in June 2012 with expanded service points and using CD4 count of < 350 for pregnant women. The remaining gap of ARVs for 2013 will need to be by PEPFAR and covered by Global Fund Round 9 phase 2 funds and any early FY 12 funds to total over 60 million USD per submission, but all funds combined will not reach this target funding need. CHAI will continue to donate 100% of the national need for pediatric ARV formulations until the end of CY 2013. Other donors will negotiate contributions over the coming year.Allocations of PEPFAR financing for ARVs are based on the assumption that Global Fund disbursements will happen. Mozambique has faced chronic insecurity around global fund grant implementation since 2009. As part of the USG/Mozambique Partnership Framework with the Government of Mozambique, USGs goal is to decrease support to commodity procurement while increasing its support to systems strengthening, infrastructure and other priorities outlined by the MOH, with an expectation that commodity needs will be financed primarily by Global Fund or other sources. Due to the insecurity with Global Fund grants, USG/Mozambique has increased its allocation of ARV funds in FY 2012 to cover the scale up needs and ongoing supply of ARVs while supporting Global Fund grant implementation in country.Through health system strengthening funds, SCMS will provide technical assistance to Central Medical Stores (CMAM) to strengthen the national supply chain, including the ARV supply chain, through improved warehouse management, use of LMIS and their data for decision-making; and improved program-CMAM coordination for quantification and distribution planning. SCMS will strengthen its efforts to foster coordination and joint planning between the MOH ART program and CMAM to forecast ARV needs for Global Fund applications as well as to conduct quarterly updates and supply planning. SCMS will work with CMAM and leverage implementing partners in the provinces to strengthen the use and reporting of the antiretroviral resupply system (MMIA) by ART sites. In addition, SCMS will conduct a technical analysis on a revised distribution system, to move from monthly to quarterly distribution for ARVs as well as to support patient adherence by provision of 2-3 months of ARVs in the periphery.

This is a new activity in FY 12 for SCMS to provide support to the Ministry of Health in ensuring supply of ARVs and their distribution meet the MOH and USG goals for treatment scale up. This will include support to periodic stock verification of ARVs in country, supporting CMAM to provide routine information to the MOH treatment programs on stock levels and early warning of risks of ARV stock outs, and support to the ART program's goals to improve treatment retention rates through a more responsive, flexible, and reliable supply system for ARVs. This will include identifying strategies and requirements for the resupply of 2-3 months ARV supply for patients, participation in the expansion of the GAAC strategy, and supporting strategic planning and tools development for the resupply of ARVs in the context of task shifting of treatment. These funds will directly support SCMS technical assistance Logistics Advisor, including supervision and stock verification visits to the provinces and districts. SCMS has modified its approach to technical assistance in order to increase performance as well as skills transfer in the following way: SCMS will embed its technical assistance to increase the transfer of skills to key Government counterparts at CMAM and the Ministry of Health and will develope a capacity building plan for each area of support. At the same time, SCMS will hire critical human resources to support CMAMs need for qualified staff to gain control in the warehouses and regain donor confidence. SCMS will also increase collaboration with Ministry programs to institutionalize quantification and joint planning. SCMS will continue its efforts to transfer capacity of the laboratory department to manage the CD4 network system. Through improved engagement with programs via PSM groups, SCMS will increase its support to strengthen PMTCT logistics, OI/STI quantification, RTKs, and laboratory, in collaboration with Implementing Partnerss.