This is a new activity to support the Ministry of Health & Social Services (MoHSS) Primary Health Care Services Directorate to strengthen the supply chain management system including procurement & distribution of home-based care kits. This activity relates to other Basic Care & Support activities: MoHSS Basic Care (#7331), Comforce Basic Care (#8024), PACT Basic Care link (#8043), DAPP/TCE Basic Care link (#7326) as well as SCMS ARV drugs (Activity #7449) & CDC systems strengthening (#7360).

The main focus of this activity is to provide support to the Primary Health Care Directorate of the Ministry of Health & Social Services (MoHSS) to ensure that Home Based Care (HBC) Kits are in sufficient supply & moving through a supply chain that will ensure that the kits are available in the right quantities & at the right places at the right time. Specifically funding will be provided to conduct a comprehensive assessment of the logistics & management systems in place at the MoHSS for the management of the quantification, procurement, inventory management & distribution of HBC kits to service delivery points. Following this assessment, the SCMS project will facilitate the design of a new logistics management system for the HBC kits. This design will be developed in close collaboration with all key stakeholders.

Procurement of HBC kits is currently satisfactorily being done through a local firm, Commodity Exchange, with support from the Global Fund; this indicates positive implications on long term sustainability. However, there are no effective HBC kits supply chain management supportive systems & coordinated mechanisms at the national & regional levels, for forecasting, quantification, storage, distribution, recording, monitoring & evaluation. Regions decide when, what & how much to order, intermittently & in unspecified periods, thus placing a heavy burden both on national & regional PHC management. Community-based organizations who deliver basic care in Namibian communities rely upon this national kit supply, including PEPFAR-funded FBOs, NGOs & CBOs. However, stock-outs are common & PEPFAR partners are often unable to replenish basic supplies necessary to delivering home-based nursing care for PLWHA, especially for clients who are bedridden. Anecdotal reports indicate that community & home-based caregivers are unable to fully protect themselves or their clients from HIV transmission due to the lack of basic gloves, training & supplies essential for universal precautions. Other key weakness in the national HBC kit program includes lack of training of volunteers on appropriate & rational use of the kits, inventory management & control, monitoring utilization, monthly reports & supportive supervision.

This activity will therefore focus on strengthening the effectiveness & efficiency of a revised HBC kits logistics system by ensuring that: 1) Forecasting & procurement planning capacity is developed & coordinated at the central level; 2) HBC kits are quantified & procured in a manner consistent with resources & policies for scaling up; 3) Inventory control procedures are consistently used at site & central level; 4) A logistics management information system (LMIS) is in place at all levels & the central level database provides the aggregated national data that is used for decision making; 5) Logistics policies & procedures are documented in a standardized procedures manual that is available & used at all sites; 6) All key personnel are trained in these logistics policies & procedures; 7) A monitoring & evaluation plan with identified short & long term indicators & data sources is in place to monitor the supply chain & make adjustments as needed; 8) Interventions to remedy identified problems & issues in the system are being implemented; 9) PEPFAR partners responsible for community & home-based palliative care (PACT Basic Care Activity (#8043) & DAPP Basic Care (#7326)) are able to request, receive, use & track kit supplies necessary for implementation. Additionally, SCMS will provide support to conduct a multi-year forecast & quantification of HBC kits, which will be revised periodically to provide for the accurate budgeting of needed funds for procurement of HBC kits. These activities will ensure that there is an uninterrupted supply of HBC kits to support the scale-up of ART services in Namibia. To ensure long term sustainability of interventions, SCMS will assist in improving national capacity through training & skills transfer to MoHSS staff, & will ensure that the interventions are consistent with the vision & capacity of the MoHSS. This component will provide support to one MoHSS division, & training for about 30 personnel.

The MoHSS is currently reviewing the national standard for HBC kit contents in partnership with key stakeholders & the Global Fund. The current components are designed to assist caregivers & their clients to maintain personal hygiene, provide basic wound care, ensure

basic universal precautions & infection control, monitor basic signs (e.g. thermometers) & symptoms, distribute condoms with balanced ABC messaging, ensure referrals for essential HIV/AIDS services (e.g. CT, ART, PMTCT, family planning, TB, etc) & provide basic medications & commodities to manage basic symptoms related to HIV/AIDS (e.g. Step 1 analgesics such as panadol & ORS). SCMS will work closely with the MoHSS (#7331) & Comforce Basic Care (#8024), Global Fund, Commodity Exchange, USG/Namibia & PEPFAR partners to promote availability of commodities necessary for delivery of the preventive care package & other key palliative care services in communities. However, current regulations prohibit non-professional community caregivers from prescribing or distributing medications for prophylaxis & management of OIs, malaria medications, symptom-relieving medications, & Step 2 & 3 analgesics. Essential medications & supplies for palliative care will be available at hospital & clinic levels (including medications for prophylaxis & management of OI, pain & symptoms [SCMS activity #7449 in ART section & CDC systems strengthening (#7360)]; thus highlighting the need for bi-directional referrals & stronger partnerships between facility-based caregivers & community caregivers to ensure that PLWHA receive & adhere to essential services at both facility & community/home levels of care. Malaria prevention strategies (which is seasonal & in parts of Namibia) is leveraged with Global Fund & includes insecticide-treated bed nets (ITNs) for pregnant women & children under 5. In COP07, the USG plans to work with the Ministry of Agriculture & Rural Development & Global Fund to explore the feasibility & cost of leveraging appropriate safe water strategies for PLWHA.

The main focus of this activity is to provide support to the Social Marketing Association (SMA), which represents Population Service International (PSI) in Namibia, to 1) develop and implement a logistics system for rapid test kits, and 2) procure required rapid test kits to test for HIV/AIDS in Namibia. These Rapid Test Kits will be in accordance with the Government of the Republic of Namibia's (GRN) national ART program protocols, and will be procured in a manner that follows all USG rules and regulations. Funding will be specifically provided a situational analysis of the current commodity management system in place at SMA. Following the assessment, a new system will be designed in collaboration with relevant stakeholders and staff of the VCT centers. The logistics systems developed will be documented and manuals developed for use in quantification, inventory management, ordering and information management. Training will be provided for personnel of the VCT Centers and SMA's procurement and stores staff in the new policies and procedures. A monitoring and evaluation system with appropriate indicators will be developed in addition to institutionalization of a supportive supervision system. Thus ensuring that stock outs, and over stocks, leading to obsolescence and expiry are minimized. Procurement of Rapid Test Kits will be done through SCMS to leverage the benefits of the SCMS approach to procurement which is based on aggregated purchasing on behalf of HIV/AIDS care and treatment programs. By creating a consolidated procurement mechanism, SCMS leverages economies of scale, provides the best value and increases efficiency. SCMS offers clients certainty of price, quality standards, and delivery dates. In FY 2007, USG will purchase three types of test kits for various testing procedures: screening (currently Determine), confirmatory (currently Unigold) and tie breaker (currently Hema-Strip). All HIV test kits purchased will be in accordance with GRN testing protocols and will be purchased from USG-approved vendors. All test kits will go directly to the SMA where it will be used in the USG funded VCT program. It is estimated that the USG procurement will provide the needed tests kits in FY 2007 to meet the target of 75,600 tests delivered to 14 VCT Centers. The procurement process will be closely linked with the development of a rigorous logistics management information system (LMIS) and the use of software to monitor stock levels on a monthly basis. To ensure sustainability, SCMS will build the capacity of staff of SMA through technical assistance, training, and skills transfer to effectively forecast, procure, and deliver rapid test kits and other health commodities, and to collect, use, and share supply chain information. SCMS will make full use of its Regional Distribution Center (RDC) in South Africa to allow for immediate shipping of test kits on a more frequent basis which will diminish the storage capacity needs of SMA and reduce the procurement lead time. The use of the RDCs to cost-effectively deliver frequent, small shipments rather than large annual or semi-annual shipments will effectively increase the throughput of the supply chain without adding physical infrastructure.

This activity has several different components. One component is to continue the work initiated by MSH/RPM plus to provide technical assistance and support to the Central and Regional Medical Stores of Namibia for the development of modern logistics practices and technologies to efficiently carry out its immediate responsibility of procurement and distribution of MoHSS, USG and GFATM HIV/AIDS related commodities. This funding will go specifically to support the training of stores personnel for the implementation of SOPs and job aids developed by MSH/RPM Plus during FY 2006. This training will improve the skills and knowledge of stores personnel in stores management and inventory control and improve storage practices. Following the adoption by the MoHSS of the Procurement Policy and Procedures Manual developed by RPM Plus during FY 2006, USG will support the implementation of the revised policies, procedures, guidelines and systems for procurement. Implementation of the draft policy will improve procurement practices of the MoHSS thus establishing an efficient procurement system that will attract the participation of a wider supplier base and guarantee competitive prices and improved supplier performance. In FY 2006 MoHSS requested RPM Plus to link the RMS to the CMS as one operational unit. In response to this request, SCMS will facilitate the redesign of the distribution system. The proposed reorganization of the management and technical structure for the CMS/RMS will create a comprehensive medical stores system with the RMS as depots of the CMS. A design, budget and plan of action will be developed through a consultative process. A field trip and a comprehensive training program will be organized for senior management of the CMS, RMSs and Pharmaceutical Services Division of the MoHSS to visit the SCMS Regional Distribution Center (RDC) in South Africa, to acquaint them with modern warehouse layouts and practices. Additionally, USG in FY 2007 will continue to provide support to ensure the continual functioning of the computerized inventory control system, Syspro™ and provide for the upgrading of Syspro™ from the current Version 6 to Version 9 to accommodate additional functionality required for the proposed integration of the medical stores system. During FY 2006, USG supported the installation of a CCTV system in the CMS to promote the security of goods in storage. During FY 2007, support will be provided to develop innovative interventions aimed at ensuring the continued security of goods both in storage and in transit. In FY 2007, USG will support the setting up of a coordinated mechanism for national level forecasting, quantification, and procurement planning for MoHSS, USG and GFATM funded HIV/AIDS related commodities. This will entail the development of 12-monthly procurement plans in collaboration with MoHSS, USG and GFATM, that will be updated quarterly to inform the procurement of commodities by the various funding mechanisms. Quantification of ARVs will be done using Quantimed®, an MSH/RPM Plus quantification tool. This activity which links with the pipeline monitoring activity of SCMS will ensure that both CMS and SCMS procurement activities are accurately timed as to avoid potential stock outs or stock overages. All quantification and procurement decisions will be made by a group of stakeholders to ensure that there is no unnecessary duplication of purchases and that timing of the procurement and receipt of the different components of combination treatments are correct. This component of the activity will provide support for 3 medical stores, work to train 30 individuals in stores management, 3 management personnel in warehouse management and 6 individuals in procurement, and provide support for the procurement and distribution of ARVs to about 32,000 individuals on treatment. The second component of this activity is to provide support to strengthen quality assurance systems for HIV/AIDS related commodities. The Quality Surveillance Laboratory (QSL) of the MoHSS has the responsibility of ensuring that all medicines including ARVs, TB and Malaria drugs moving in commerce in Namibia comply with international standard requirements. In FY 2007, USG funding will specifically support the QSL for the development and institutionalization of a Quality Surveillance System, including the provision of reference standards. Support will also be provided to introduce the MiniLab system in Namibia to monitor the quality of the products when they are received, and after transportation to treatment sites. The MiniLab is a simple effective and cost saving system that can be used to conduct simple quality tests at any point within the supply chain. Additionally, SCMS will facilitate the development of a Laboratory Information System (LIMS) to enhance the process of data collection and control, and likely decrease the turn around time in quality procedures. Training will be provided to 2 personnel of the QSL to ensure that they are up to date with regulations and techniques to ensure sustainability and support capacity development in the principles of quality assurance in supply chain management. SCMS will constantly monitor the progress of registration of FDA-approved generics in Namibia, and where relevant encourage and facilitate the registration process, and also advocate for their use in Namibia. This component will

ensure that the quality of ARVs and other HIV/AIDS related commodities are assured throughout the supply chain. The main focus of the third component of this activity is to procure ARVs to treat HIV/AIDS in Namibia, and to ensure sufficient supply and availability to Namibians at treatment sites. These ARVs will be procured in accordance with the Government of the Republic of Namibia's (GRN) national ART program protocols, and USG rules and regulations. Procurement of ARVs will be done through a dual mechanism. 1) The GRN will be provided funds under the CDC cooperative agreement with the GRN to procure ARVs, and 2) Procurement through the SCMS to leverage the benefits of the SCMS approach to procurement which is based on aggregated purchasing on behalf of HIV/AIDS care and treatment programs. By creating a consolidated procurement mechanism, SCMS leverages economies of scale, provides the best value and increases efficiency. SCMS offers clients certainty of price, quality standards, and delivery dates. SCMS will procure of a minimum of 25% of the USG contribution of ARVs to the GRN, amounting to about $1,500,000. This proportion may increase during the course of the program year based on a combination of factors including the capacity of the GRN to obtain these products through the normal tender mechanisms of the CMS and potential advantages of using the SCMS mechanism vis-à-vis the CMS tender system. These ARV drugs will go directly to the Central Medical Store and will be accessed by all public sector ART programs. The USG contribution is estimated to cover approximately a third of the ARV procurement needs to reach a target of 32,000 patients on treatment. The procurement process is closely linked with the development of a rigorous logistics management information system and the use of software to monitor stock levels on a monthly basis. SCMS will make full use of its Regional Distribution Center (RDC) in South Africa to allow for immediate shipping of products on a more frequent basis which will diminish the storage capacity needs of CMS. The use of the RDCs to cost-effectively deliver frequent, small shipments rather than large annual or semi-annual shipments will effectively increase the throughput of the supply chain without adding physical infrastructure.

The main focus of this activity is to provide support to the Namibia Institute of Pathology (NIP) to ensure that laboratory supplies are in sufficient supply and moving through a supply chain that will support the scale-up of the ART program. The NIP is a para-statal mandated to provide laboratory services in Namibia, and operates 34 laboratories across the country. In FY 2007, the SCMS project will facilitate the design of a new laboratory logistics management system for the NIP. This design will be developed in close collaboration with all key stakeholders, including USG-funded implementing organizations and other donor organizations such as the Global Fund. This activity will therefore focus on strengthening the effectiveness and efficiency of a revised laboratory supplies logistics system by ensuring that: 1) Forecasting and procurement planning capacity is developed and coordinated at the central level; 2) Required HIV/AIDS laboratory supplies are quantified and procured in a manner consistent with resources and policies for scaling up; 3) Inventory control procedures are consistently used at site and central level; 4) A logistics management information system (LMIS) is in place at all levels and the central level database provides the aggregated national data that is used for decision making; 5) Logistics policies and procedures are documented in a standardized procedures manual that is available and used at all laboratories supporting ART; 6) All key personnel in the existing laboratories are trained in these logistics policies and procedures; 7) A monitoring and evaluation plan with identified short and long term indicators and data sources is in place to monitor the supply chain and make adjustments as needed; 8) Interventions to remedy identified problems and issues in the system are being implemented. Additionally, SCMS will provide support to a conduct multi-year forecast and quantification of laboratory supplies, which will be revised periodically. The quantification is essential for the accurate budgeting of needed funds for procurement of laboratory reagents and supplies. These activities will ensure that there is an uninterrupted supply of laboratory supplies to support the scale-up of ART services in Namibia, thus ensuring that the proper supplies, in the right condition and quantities get to the appropriate places at the correct time and at the appropriate cost. To ensure long term sustainability of interventions, SCMS will assist in improving national capacity through training and skills transfer to NIP staff, and will ensure that the interventions are consistent with the vision and capacity of the NIP. In summary, the SCMS project will place emphasis on developing the capacity of personnel at the national and local levels to implement an efficient supply chain management system for laboratory supplies.

The main focus of this activity is develop and implement a Logistics Management Information System (LMIS) capable of monitoring national pipelines of ARVs, Test Kits, Laboratory Supplies and other HIV/AIDS related commodities. The system will provide relevant data to support forecasting, quantification and procurement and supply planning. One of the most significant challenges of rapid scale-up is capturing and analyzing critical logistics data. Well-developed information systems are required to track orders, ensure the visibility of inventory, monitor product shortages or losses, report defects, and manage donations. While data capture is critical and time consuming, even more important is the use of these data to create meaningful information that supports decision making. MSH/RPM Plus has developed an Antiretroviral Therapy Commodities Tracking System (ACTS), for the accurate collection and collating of data on patients on various ART regimens, to monitor the availability of HIV/AIDS related commodities and supplies and to obtain data for the quantification of needs. In FY 2007, USG will support the systems analysis and design of a system to collect, transmit, collate and present the information in real time, building on existing tools and systems in country. Specifically funding will be provided to conduct a systems and options analysis of available tools, and following acceptance of the concept, the design of a system in collaboration with the MoHSS and relevant partners. By the end of FY 2007, USG will have facilitated, through a collaborative process, the design, costing and the development of an implementation plan for a comprehensive LMIS which will be capable of linking with the national HMIS to provide timely data and information on the HIV/AIDS supply chain in Namibia to all stakeholders. Consensus would have been obtained and funding sources secured for implementation. To ensure sustainability, SCMS will build the capacity of staff of MoHSS through technical assistance, training, and skills transfer to effectively forecast, procure, and deliver rapid test kits and other health commodities, and to collect, use, and share supply chain information.