SCMS is funded by the President's Emergency Plan for AIDS Relief (PEPFAR), and brings together 13 private sector, nongovernmental and faith-based organizations that are among the most trusted names in supply chain management and international public health and development. With offices in 17 countries and 350 dedicated staff members around the world, we are helping to improve the lives of people living with HIV/AIDS in some of the countries most severely impacted by the pandemic. SCMS procures essential medicines and supplies at affordable prices; helps strengthen and build reliable, secure and sustainable supply chain systems; and fosters coordination of key stakeholders. Our Approach • Working with and strengthening existing systems, not creating parallel or duplicate systems • Building local capacity, empowering in-country partners to enhance and develop sustainable and appropriate responses for their own communities • Delivering quality HIV/AIDS medicines and supplies at the best value by leveraging industry best practices for planning, procurement, storage and distribution

• Promoting transparency to ensure accurate and timely supply chain information is collected, shared and used to improve decision making • Collaborating with in-country and international partners to identify needs, fill gaps, avoid duplication and share best practices SCMS in Nigeria As of the end of 2008, 250,000 of estimated 3.6 million adults and children in Nigeria living with HIV/AIDS were receiving antiretroviral therapy (ART). The government of Nigeria (GON) has set an ambitious goal to provide antiretroviral (ARV) treatment to 540,000 recipients by the end of 2014. Strengthening the country's supply chain system for ARVs is essential to making this happen. Nigeria's HIV/AIDS supply chain is made up of multiple supply chains—many of which include separate procurement, warehousing, and distribution systems—owned and operated by various federal, state, nongovernmental, and faith-based stakeholders with oversight from the Federal Ministry of Health (FMOH) and the National Agency for the Control of AIDS (NACA). To improve visibility and coordination across these disparate supply chains, SCMS is working with the FMOH and PEPFAR-funded agencies and IPs to strengthen quantification and procurement planning, logistics data collection and management, inventory control, storage and distribution, and supply chain coordination for HIV/AIDS commodities.

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS

SCMS Nigeria provides procurement, systems strengthening (SS) services and strategic information for USG and PEPFAR Implementing Partners (IPs). It also provides systems strengthening services for building logistics management capacity to 4 main GON departments (NASCP, FDS, DPRS, and NACA).

SCMS support PEPFAR programs in Nigeria by providing increased access to quality HIV/AIDS related commodities. Key SCMS activity under this program area includes: procurement, shipment, clearing, distribution and delivery of medical supplies and equipments used in ARV services and other commodities used to extend and optimize the quality of life of HIV infected adults and their families. SCMS also provides other supply chain management related activities such as technical assistance (TA) and system strengthening activities for PEPFAR IPs and the Department of Defense (DoD) to strengthen or build their supply chain management capacity within their respective programs. Through its continuous support to and strengthening of commodity security in PEPFAR treatment programs, SCMS works towards ensuring availability of needed commodities required by the PEPFAR supported programs to the target population of people living with HIV/AIDS and the general population through their families.

In COP09, SCMS procured medical supplies and equipments used in ARV services. Other commodities for the prevention, management and clinical monitoring of opportunistic infections (OI), except tuberculosis (TB); other HIV/AIDS related complications, including malaria, and the management of sexually transmitted infections (STIs) were also procured. Example of such commodities are pharmaceuticals (OI drugs, pain killers), insecticide treated nets, laboratory equipment and consumables, home based care kits, water guard, gloves and therapeutic food. SCMS also procured other medical and non medical supplies used in treatment and basic health care and support services (including home- based care), used to extend and optimize the quality of life of HIV infected adults and their families for two IPs and DoD. In COP 10, SCMS will continue to procure these materials as required by the IPs and DoD.

The funds allocated to SCMS by the IPs and DoD, for these services is as follows: DOD (#554.08), $XXX; CRS AidsRelief (#3688.08), $ XXX; Columbia University/ICAP (#2768.08), $ XXX; and University of Maryland (#632.08), $ XXX. The present budget will cover the cost of commodities, logistical and administrative services from the field office for the coordination and management of the procurements undertaken by SCMS and the cost of TA and SS.

In COP 10, SCMS will continue to support the IPs and DoD in the following areas of the supply chain cycle: product selection in accordance with the Federal Government of Nigeria's (GoN) national testing guidelines, marketing authorization status (NAFDAC registration) and GoN importation regulation. SCMS

will also be responsible for ensuring that commodities procured meet eligibility criteria under the USG acquisition rules and regulations including source and origin waivers and approvals or tentative approvals by the US Food and Drug Administration or other relevant stringent drug regulatory authorities. SCMS will assist in quantification and forecasting of requirements and will support the development of long term supply plans (considering in country stocks and anticipated consumption rates) for stock management, monitoring of stock levels and usage through the deployment of pipeline databases and delivery planning. Additionally SCMS will monitor product safety and maintain a tracking system for recalls (pharmacovigilance). Requests for commodities will continue to be addressed to and coordinated with SCMS field office directly.

Several challenges are still associated with the procurement of Opportunistic Infections (OI) drugs. A number of key OI medicines still remain banned from importation into Nigeria and hence by default, need to be procured from local manufacturers. However, the fact that none of these locally manufactured OI drugs (and indeed other pharmaceuticals products) has stringent drug regulatory authority approval places the PEPFAR IPs in a difficult situation. In COP 09, SCMS was able to secure approval to import some quantities of Cotrimoxazole. The actual quantity to be imported will depend on the requirements of each IP. In COP 10, SCMS will work with the IPs and GoN to identify key OI drugs that are required by PEPFAR supported treatment programs and initiate the process of pre-qualification towards identifying local sources. SCMS will also continue to work with GoN towards defining the modalities for use of opioids for pain management by HIV/AIDS programs. SCMS intervention in this area will ensure that required materials for Palliative care are available for use of the programs, thus improving the quality of life of PLWHA.

SCMS will continue to identify suitable sources of supply both internationally and nationally. SCMS will work with IPs in Nigeria to locally procure products that are either banned for importation or for which local procurement represents a key advantage in terms of cost, delivery and/or associated services (i.e. maintenance service).

SCMS will coordinate with the USG team to ensure selected products are appropriately registered in Nigeria. For products not yet registered by NAFDAC, SCMS will make suitable recommendations including waiver applications where appropriate. SCMS will take the lead to communicate with manufacturers on registration gaps in Nigeria.

SCMS procurement leverages global spend to provide best value and offers clients certainty of competitive prices and international quality standards. SCMS procurement strategy is articulated around buying generics whenever possible, pooling procurement for HIV/AIDS care, prevention and treatment programs across PEPFAR focus countries and negotiating long term contracts with suppliers.

SCMS will be responsible for the shipment of procured commodities into Nigeria through Abuja or other points of entry as required. SCMS will continue to follow laid down procedures for customs clearance as appropriate including management of the CC1, CC2 or CC3 duty exemption forms. SCMS will coordinate with the USG team to fulfill importation requirements and provide needed documentation to allow customs clearance in an efficient and timely manner.

Where appropriate, commodities requested by the IPs and USG will be supplied through the SCMS Regional Distribution Center (RDC) in Ghana. The warehousing of commodities in the RDC is a critical component of the SCMS technical solution. The use of the RDC will significantly reduce lead times and provide an important buffer between the supply from manufacturers and demands from the PEPFAR programs in Nigeria. The RDC also ensure that shipment quantities do not overwhelm their recipients in country, an increasing challenge in the context of program scale up. The RDC concept also brings an increased flexibility in stock management thus reducing risk of stock obsolescence or need for emergency replenishments, resulting in important savings. Finally, the RDC approach serves regional and national sustainability, as the RDC is designed to be a commercially viable entity, available to other health (and non-health) programs, whose benefit will last beyond SCMS. Where possible and appropriate, SCMS will road freight from the RDC Ghana to Abuja; a mode of delivery that provides further significant savings over airfreight. For local warehousing needs, SCMS will continue to use its pharmaceutically compliant warehouse (primarily as a cross-docking facility) in Abuja which additionally will be capable of redirecting potential overstocked items, if necessary, to avoid expiry and waste.

Delivery arrangements will continue to be negotiated with the IPs; SCMS will either deliver to a central location or to point of services as needed. It should however be noted that the current distribution system for GoN programs and IPs is still sub-optimal. In COP 09, SCMS commenced implementation of the recommendations from the distribution options study (conducted in COP 08). In COP 10, SCMS with support of USG and the IPs will design and implement a more harmonized transport system for identified commodities to be delivered to a series of regional warehouses from which each IP or site will pick up its commodities. This will result in significant reduction of distribution costs by eliminating overlapping IP- specific distribution routing from various regions to Abuja. It is envisaged that this area will provide an opportunity to work with private sector providers and support collaboration between them and the GoN and IPs in mutually rewarding Public Private Partnerships. It will also follow a model already in place in which GoN and GF commodities are distributed by private-sector third-party logistics providers. Finally in COP 10, SCMS will analyze last mile delivery options to further reduce redundancies in PEPFAR commodity distribution to sites in subsequent years, and to harmonize with the GON system as a step toward eventual integration. In order to efficiently manage the delivery of commodities as appropriate, SCMS will competitively source for and utilize the service of an efficient and safe in-country courier

services operator.

SCMS provides TA and SS services in all areas of the supply chain including product selection, marketing authorization status (NAFDAC registration), quantification, forecasting, supply planning, procurement, warehousing, customs clearance and delivery. In COP 10, SCMS will continue to provide TA and SS services to DoD and the IPs through training in the use of the ProQ or Quantimed forecasting and Pipeline supply planning tools. SCMS will continue to provide TA and SS services to DoD based on the recommendations that came out of a supply chain system's assessment carried out in COP07 including the establishment of a government owned, contractor operated warehouse, as part of SCMS strengthening of the host government's HIV program which is expected to bring a long term solution contributing to the sustainability of the military HIV/AIDS programs in Nigeria. By providing training and supporting capacity building of local organizations, SCMS addresses the emphasis area of human capacity development.

In COP 10, SCMS will continue to provide the USG team and the IPs with regular reports on medical supplies and equipments used in ARV services and other related commodity purchase as well as monthly financial reports and also assist IPs to monitor/report on stock levels and usage through the deployment of Pipeline databases. SCMS will also support the Supply Chain Support Teams (made up of technical SCMS staff and GoN or IP staff as appropriate) constituted by SCMS to work with the IPs in providing their trained logisticians with the capacity to monitor and support the performance of the supply chains at various levels. The Supply Chain Support Teams will use standardized indicators of logistics performance, to track performance of the supply chains and together, act as an early warning system to identify impending or imminent supply chain breakdowns and act to forestall these. By developing methodologies and tools for conducting these activities, SCMS will work with GoN and IPs to establish and institutionalize this activity thereby building the capacity to identify these problems and resolve them before service delivery is compromised. The automated web based procurement tracking database will ensure that the USG team and IPs have adequate visibility on SCMS procurement status since it provides an easy access to accurate and up to date information on procurement. It is envisaged that further procurement automation and harmonization will be facilitated through linkages with the Logistic and Health Program Management Information Platform system.

In COP07, SCMS undertook, under DoD's request, a feasibility study for a Government Owned Contractor operated (GOCO) warehousing facility to be used by HIV/AIDS Nigerian military and DoD programs. SCMS will provide technical oversight for the construction and managing the equipment of the facility, while the NMoD will finance the construction of the facility, DoD will finance the equipment of the warehouse through COP allocations to SCMS in the range of $XXX. The establishment of a GOCO, as part of SCMS system strengthening to the host government's supply chain system, will bring a long term

solution contributing to the sustainability of the military HIV/AIDS programs in Nigeria. By providing training and supporting capacity building of local organization, SCMS addresses the emphasis area of human capacity development.

Under this program area, SCMS does not have targets of its own but supports PEPFAR IPs and DoD reaching their care planned targets.

EMPHASIS AREA Human capacity development.

None

None

None

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS SCMS Nigeria provides procurement, systems strengthening (SS) services and strategic information for USG and PEPFAR Implementing Partners (IPs). It also provides systems strengthening services for building logistics management capacity to 4 main GON departments (NASCP, FDS, DPRS, and NACA).

SCMS supports PEPFAR programs in Nigeria by fostering increased access to quality HIV/AIDS related

commodities. Key SCMS activities under this program area includes: procurement, shipping, clearing, distribution and delivery of commodities for use in delivering paediatric ARV services (commodities for training, clinical monitoring, and community adherence services). SCMS is also involved with as other supply chain management related activities such as technical assistance (TA) and systems strengthening (SS) activities for PEPFAR IPs and the Department of Defense (DoD) to strengthen or build their supply chain management capacity within their respective programs. Through its continuous support to and strengthening of commodity security in PEPFAR treatment programs, SCMS works towards ensuring availability of ARV drugs required by the PEPFAR supported programs to provide care and treatment services for the target population of people living with HIV/AIDS.

In COP09, SCMS procured materials for use in providing paediatric ARV services (i.e. commodities for training, clinical monitoring, and community adherence services). In COP 10, SCMS will continue with this. The funds allocated to SCMS by the IPs and DoD, for these services is as follows: DOD (#554.08), $XXX; Harvard University School of Public Health (HSPH)/APIN+ (#544.08), $ XXX; University of Maryland (#632.08), $ XXX; CRS AidsRelief (#3688.08), $ XXX; Columbia University/ICAP (#2768.08), $ XXX; GHAIN (#XXXX.08), $ XXX; LMS (#XXXX.08), $ XXX; CHAN NiCAB (#XXXX.08), $ XXX; PFD (#XXXX.08), $ XXX; and URC (#XXXX.08), $ XXX. The budgets will cover the cost of commodities as well as logistical and administrative services from the field office for the coordination and management of the procurements undertaken by SCMS. The budget also supports the cost of TA and SS.

In COP 10, SCMS will continue to support the IPs and DoD in the following areas of the supply chain management cycle: product selection in accordance with the Federal Government of Nigeria's (FGoN) national treatment guidelines, marketing authorization status (NAFDAC registration) and FGoN importation regulation. SCMS will also be responsible for ensuring that commodities procured meet eligibility criteria under the USG acquisition rules and regulations including source and origin waivers and approvals or tentative approvals by the US Food and Drug Administration. SCMS will assist in quantification and forecasting of requirements and will support the development of long term supply plans (considering in country stocks and anticipated consumption rates) for stock management, monitoring of stock levels and usage through the deployment of pipeline databases and delivery planning. Additionally SCMS will monitor product safety and maintaining a tracking system for recalls (pharmacovigilance). Requests for commodities will continue to be responded to and coordinated with SCMS field office directly.

SCMS will identify suitable sources of supply and will coordinate with the USG team to ensure selected commodities are appropriately registered in Nigeria. For commodities not yet registered by NAFDAC, SCMS will make suitable recommendations including waiver applications where appropriate. SCMS will take the lead to communicate with manufacturers on registration gaps in Nigeria.

SCMS procurement leverages global spend to provide best value and offers clients certainty of competitive prices and international quality standards. SCMS procurement strategy is articulated around buying generics whenever possible, pooling procurement for HIV/AIDS care, prevention and treatment programs across PEPFAR focus countries and negotiating long term contracts with suppliers.

SCMS will be responsible for the shipment of procured commodities into Nigeria through Abuja or other points of entry as required. SCMS will continue to follow official procedures for customs clearance as appropriate including management of the CC1, CC2 or CC3 duty exemption forms. SCMS will coordinate with the USG team to fulfill importation requirements and provide needed documentation to allow customs clearance in an efficient and timely manner.

Where appropriate, commodities requested by the IPs and USG will be supplied through the SCMS Regional Distribution Center (RDC) in Ghana. The warehousing of commodities in the RDC is a critical component of the SCMS technical solution. The use of the RDC will significantly reduce lead times and provide an important buffer between the supply from manufacturers and demands from the PEPFAR programs in Nigeria. The RDC also ensure that shipment quantities do not overwhelm their recipients in country (an increasing challenge in the context of program scale up). The RDC concept also brings an increased flexibility in stock management thus reducing risk of stock obsolescence or need for emergency replenishments, resulting in important savings. Finally, the RDC approach serves regional and national sustainability, as the RDC is designed to be a commercially viable entity, available to other health (and non-health) programs, whose benefit will last beyond SCMS. Where possible and appropriate, SCMS will road freight from the RDC Ghana to Abuja; a mode of delivery that provides further significant savings over airfreight. For local warehousing needs, SCMS will continue to use its pharmaceutically compliant warehouse (primarily as a cross-docking facility) in Abuja which additionally will be capable of redirecting potential overstocked items, if necessary, to avoid expiry and waste.

Delivery arrangements will continue to be negotiated with the IPs; SCMS will either deliver to a central location or to point of services as needed. It should however be noted that the current distribution system for GoN programs and IPs is still sub-optimal. In COP 09, SCMS commenced implementation of the recommendations from the distribution options study (conducted in COP 08). In COP 10, SCMS with support of USG and the IPs will design and implement a more harmonized transport system for identified commodities to be delivered to a series of regional warehouses from which each IP or site will pick up its commodities. This will result in significant reduction of distribution costs by eliminating overlapping IP- specific distribution routing from various regions to Abuja. It is envisaged that this area will provide an opportunity to work with private sector providers and support collaboration between them and the GoN and IPs in mutually rewarding Public Private Partnerships. It will also follow a model already in place in

which GoN and GF commodities are distributed by private-sector third-party logistics providers. Finally in COP 10, SCMS will analyze last mile delivery options to further reduce redundancies in PEPFAR commodity distribution to sites in subsequent years, and to harmonize with the GON system as a step toward eventual integration. In order to efficiently manage the delivery of commodities as appropriate, SCMS will competitively source for and utilize the service of an efficient and safe in-country courier services operator.

In COP 10, SCMS will continue to provide TA and SS services to DoD and the IPs through training in the use of the ProQ or Quantimed forecasting and Pipeline supply planning tools. SCMS will continue to provide TA and SS services to DoD based on the recommendations that came out of a supply chain system's assessment carried out in COP07 including the establishment of a government owned, contractor operated warehouse, as part of SCMS strengthening of the host government's ARV program which is expected to bring a long term solution contributing to the sustainability of the military HIV/AIDS programs in Nigeria.

In COP 10, SCMS will continue to provide the USG team and the IPs with regular reports on procured commodities as well as monthly financial reports and also assist IPs to monitor/report on stock levels and usage through the deployment of Pipeline databases. SCMS will also support the Supply Chain Support Teams (made up of technical SCMS staff and GoN or IP staff as appropriate) constituted by SCMS to work with the IPs in providing their trained logisticians with the capacity to monitor and support the performance of the supply chains at various levels. The Supply Chain Support Teams will use standardized indicators of logistics performance, to track performance of the supply chains and together, act as an early warning system to identify impending or imminent supply chain breakdowns and act to forestall these. By developing methodologies and tools for conducting these activities, SCMS will work with GoN and IPs to establish and institutionalize this activity thereby building the capacity to identify these problems and resolve them before service delivery is compromised. The automated web based procurement tracking database will ensure that the USG team and IPs have adequate visibility on SCMS procurement status since it provides an easy access to accurate and up to date information on procurement. It is envisaged that further procurement automation and harmonization will be facilitated through linkages with the Logistic and Health Program Management Information Platform system.

Under this program area, SCMS does not have targets of its own but supports PEPFAR IPs and DoD reaching their planned treatment targets.

None

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS SCMS Nigeria provides procurement, systems strengthening services and strategic information for USG, PEPFAR IPs and GON (strengthening institutional capacity for logistics management in the following government departments: NASCP, FDS, DPRS, and NACA).

In COP 09, SCMS continued to build the capacity of PEPFAR Implementing Partners (IPs) and the Government of Nigeria (GoN) to manage a well-functioning HIV/AIDS program logistics system by providing supply chain services where necessary as well as technical assistance and capacity building in logistics functions to enhance management skills in analysing logistics data for decision-making. The capacity to plan and synchronize procurements to reduce product stock outs risks and expiration was improved while the project continued to assist appropriate national coordinating bodies and IPs to provide leadership role for logistics activities and where necessary, stimulate the formulation of appropriate frameworks and policies in the area of forecasting, procurement, distribution, storage, and logistics management information management practices to support a well-functioning HIV/AIDS program logistics system. All these activities were informed by several assessments conducted jointly with GoN, USG and other stakeholders.

To sustain these technical interventions, a variety of activities are planned for COP 10 to further build the capacity of GON to design, manage, lead and finance various technical interventions required to support a well-functioning HIV/AIDS program logistics system.

In COP 09, SCMS supported and provided an enabling environment for the coordinating committees (Logistic Technical Working Group, LTWG and the Logistic Steering Committee, LSC) established in COP 08, to function optimally. Specifically, SCMS hosted the secretariats and provided mentorship for members to strengthen the logistics management system as well as monitoring and supervisory activities for GoN ART centers. Working with SCMS, these oversight and technical bodies used logistics data from the various programs to make decisions to avert stock outs and also conduct National joint quantifications to develop robust long term (5 year) projections for ARVs and RTKs in a bid to ensure commodity security and also drive procurement actions. In COP 10, SCMS will continue to support these bodies (although the Honorable Minister for Health inaugurated a task force for HIV/AIDS, Malaria and

TB which has subsumed the LSC but with SCMS being recognized as a key player), and where appropriate, ensure that their membership are expanded to include other stakeholders (to help strengthen stakeholder coordination under the leadership of GON). Quarterly review of the consumption data will be held to update the 5 year forecasts and to inform procurement activities for identified HIV/AIDS commodities. This will enable the determination of identified national HIV/AIDS commodity requirements and improve medium to long term planning and resource mobilization, thus ensuring HIV/AIDS Commodity Security, an initiative begun in COP 08.

SCMS will use the environment created by these coordinating bodies to explore the options for more technical innovations, such as Coordinated Pooled Procurement (CPP) of HIV/AIDS commodities (in concert with GoN and other stakeholders) to support their HIV/AIDS program. In COP 09, SCMS (with support of USG and the IPs) expanded its pooled procurement portfolio from RTKs to include two commonly used ARVs in Nigeria i.e. Truvada and AZT/3TC/NVP (fixed dosed combination). This resulted in significant cost savings in transport, ensured more efficient order processing and it provides for a more reliable supply, that is flexible to absorb fluctuations in demand (whether positive or negative) therefore minimizing/eliminating the risk of stockouts of critical commodities. In COP 10, with approval of USG and the support of the IPs, additional ARVs and OIs will be included in the pooled procurement initiative. SCMS will also continue to work with clients to coordinate demand and synchronize procurements so as to take advantage of the economies of scale inherent in its client base.

The responsiveness of SCMS to USG and the IP procurement needs has been steadily improving. In COP 10, SCMS will continue to fine tune its procurement systems, to ensure that the gains are further consolidated. Local Indefinite Quantity Contracts and Bulk Procurement Agreements will be established as appropriate. These interventions will ultimately ensure that commodities continue to be available on- time and thus prevent stock-outs.

Several challenges are still associated with procurement of Opportunistic Infections (OI) drugs. Key OI medicines still remain banned from importation into Nigeria and hence by default, need to be procured locally. However, none of these locally manufactured OI drugs has stringent drug regulatory authority approval, this places the SCMS in a difficult situation. In COP 09, SCMS was able to secure approval to import some quantities of Cotrimoxazole. In COP 10, SCMS will work with the IPs and GoN to initiate the process of pre-qualification of identified key OI drugs required by PEPFAR supported programs and also continue to work with GoN towards defining the modalities for pain management by HIV/AIDS programs. SCMS intervention in this area will ensure that required materials for Palliative care are available for use of the programs, thus improving the quality of life of PLWHA.

Commodity warehousing and effective distribution are crucial determinants to optimal supply chain

performance. During COP09, SCMS leased a pharmaceutically compliant warehouse from MDS in order to improve its commodity receipt, storage, handling and distribution to IPs. This has enabled SCMS to hold larger volumes of commodities (including buffer stocks of some commodities in country by the project in order to effectively deal with emergent needs) for slightly longer periods than anticipated. This activity will also align and link with the Government Owned Contractor Operated (GOCO) initiative developed in COP08 for the Nigeria Ministry of Defense with support from the US Department of Defense HIV program. In COP 10, SCMS will continue to maintain the warehouse, work with the IPs to ensure they maintain proper warehousing and storage conditions in line with international standards. Appropriate warehouse management tools will be deployed as may be required by the IPs. In collaboration with GoN and other stakeholders, SCMS will develop, implement and institutionalize a system of certification and re-certification for warehouses in the country. These activities will ensure that commodities are properly managed (thereby minimizing damages and avoiding expiry that can arise from over stock) and stored in such a way to optimize the quality of the commodities.

The Federal Central Medical Stores (CMS) is crucial to the success of HIV/AIDS and other programs that depend on it for commodity handling and distribution. Hence it is a key determinant in ensuring the sustainability of various health interventions. However, an earlier assessment of the CMS had showed that it has a weak capacity to respond to the demands for warehousing, storage and distribution of products. In COP 09, while taking cognizance of the support from other partners such as the WHO, the SCMS project provided a series of on-going technical assistance to CMS to help in dejunking the stores, institutionalizing good warehouse practices to improve working practices. SCMS also provided focused training in warehouse management to 2 staff of the CMS and assisted the CMS to develop a strategic plan to guide future strengthening activities, particularly those related to infrastructure improvement and equipment installation included in the GF R8 HSS grant.

In COP 10, SCMS will assist in identifying warehousing requirements and also conduct a feasibility study for a warehouse in Abuja for use of both the USG and GON programs using the "warehouse in a box" approach. A longer term vision is that the CMS staff in Lagos will rotate through this Abuja warehouse to acquire relevant professional experience that will enhance their productivity. SCMS will also provide support to improve logistics data processing capability of the CMS to enhance its operational efficiency.

The current distribution system for GoN programs and IPs is still sub-optimal. In COP 09, SCMS commenced implementation of the recommendations from the distribution options study (conducted in COP 08). In COP 10, SCMS with support of USG and the IPs will design and implement a more harmonized transport system for identified commodities to be delivered to a series of regional warehouses from which each IP or site will pick up its commodities. This will result in significant reduction of distribution costs by eliminating overlapping IP-specific distribution routing from various regions to

Abuja. It is envisaged that this area will provide an opportunity to work with private sector providers and support collaboration between them and the GoN and IPs in mutually rewarding Public Private Partnerships. It will also follow a model already in place in which GoN and GF commodities are distributed by private-sector third-party logistics providers. Finally in COP 10, SCMS will analyze last mile delivery options to further reduce redundancies in PEPFAR commodity distribution to sites, and to harmonize with the GON system toward eventual integration.

The use of logistic data to monitor the performance of health supply chains and inform required remedial actions that are needed in a timely manner is crucial to avoid disruptions or interruptions to program delivery. However, the skill and commitment to such monitoring is lacking in the country. In COP 09 SCMS was to introduce the concept of Supply Chain Support Teams (SCST) comprising technical SCMS staff, GoN and IP staff as appropriate in the Nigeria program. They are to provide the capacity to monitor and support the performance of supply chains at various levels using standardized indicators of logistics performance to track performance of the supply chains and together, act as an early warning system to identify impending or imminent supply chain breakdowns and also take appropriate actions to forestall these. SCMS will continue to pursue this activity in COP 10, it will establish and institutionalize this capacity in collaboration with GoN and other stakeholders by developing monitoring plans, tools and a reporting template. It will also identify and recommend appropriate software packages that may be required at various levels of the supply chain. Support will also be provided to train ten logistics operators in the use of these software packages.

In order to provide the required manpower needed to manage local supply chains to support the rapid scale up of various health interventions in Nigeria and ensure a broader understanding of Supply chain issues, SCMS has been organizing in-country SCM courses to build the capacity of logistic operators since 2008. This highly effective and well tested course had always been oversubscribed since it commenced. In COP 10, SCMS will conduct its annual SCM overview course to train 48 individuals from GoN and the Implementing Partners, as well as refresher training on the national HIV/AIDS commodity logistics system. SCMS will sponsor 2 senior GoN staff on various International courses on SCM. Furthermore, SCMS will provide capacity building for SCM practitioners by supporting quarterly seminars during the meeting of the Association of Public Health Logisticians, Nigeria Chapter, whose membership now exceeds 40.

A supportive policy environment is required to enhance sustainability of SCM activities, SCMS will continue to collaborate with relevant GoN agencies and other stakeholders on the development of a harmonized national logistics policy. SCMS will identify various National policies and legislation that needs to be reviewed and actively work with GoN and the IPs to resolve them. This will lead to an improved environment for HIV/AIDS services delivery and uptake.

SCMS has been supporting GoN in taking a leading role in the transition to and implementation of a National Logistics system for use by all partners. In COP 09, SCMS worked with a few IPs on LMIS based on the result of the assessment conducted for the IPs. In COP 10, SCMS will continue to work with the IPs and GoN to ensure full adoption of the National Logistic system and also organize a refresher training for 44 persons (one from each of the GoN sites). The lab logistics system will also be developed and piloted. SCMS intervention will ensure that inventory control procedure and logistic management information systems are harmonized with the national system and strengthen information sharing among all players.

In COP 09, SCMS initiated activities geared towards harmonization of laboratory equipments, supplies and reagents by collecting data from sites on the type of equipment and reagents being used. The results will be presented to stakeholders to reach a consensus on assumptions to inform quantification for lab supplies, reagents and equipment. Thereafter, a series of workshops will be organized where manufacturer's representatives will meet with end users and others who can objectively evaluate the performance of the equipment, supplies and reagents. This intervention will be the basis for developing a guide towards harmonization and ensure that end users get greater value for their equipment and supplies. SCMS will continue to support this activity in COP 10.

IPs and GoN programs source their commodities from a wide variety of suppliers. Unfortunately, the quality of these commodities (especially drugs and laboratory materials) sourced locally from the open market has not been determined. This has obvious implications for the quality of laboratory results and treatment outcomes. In COP 10, SCMS will set up minilabs in collaboration with appropriate GoN agencies. Other options (e.g. liaising with external laboratories for QA activities, etc) to enhance quality assurance of laboratory materials and drugs will also be explored.

Currently, one major component that is lacking in various health interventions is the availability of facility for disposal of expired products (drugs or laboratory materials). This is because national capacity for doing this is either totally lacking or very weak where they exist. In COP 10, SCMS will work with GoN and other partners as appropriate.

SCMS will continue to maintain its office operations and staff development activities to ensure that required human resources are available to support the provision of the various technical interventions as planned.

None

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS

SCMS Nigeria provides procurement, systems strengthening (SS) services and strategic information for USG and PEPFAR Implementing Partners (IPs). It also provides systems strengthening services for building logistics management capacity to 4 main GON departments (NASCP, FDS, DPRS, and NACA).

SCMS supports PEPFAR programs in Nigeria by providing increased access to quality HIV/AIDS related commodities. Key SCMS activity under this program area includes: procurement, shipment, clearing, distribution and delivery of PMTCT related supplies and equipments including ARV prophylaxis for HIV- infected pregnant women and newborns, rapid test kits (RTKs), laboratory supplies and equipments, as well as other medical and non medical supplies used in PMTCT services. SCMS is also involved with other supply chain management related activities such as technical assistance (TA) and systems strengthening (SS) activities for PEPFAR IPs and the Department of Defense (DoD) to strengthen or build their supply chain management capacity within their respective programs. Through its continuous support to and strengthening of commodity security in PEPFAR treatment programs, SCMS works towards ensuring availability of needed commodities required by the PEPFAR supported programs for the target populations of pregnant women and children under 5 years old.

In COP09, SCMS procured PMTCT related supplies and equipments including ARV prophylaxis for HIV- infected pregnant women and newborns, rapid test kits (RTKs), laboratory supplies and equipments, as well as other medical and non medical supplies used in PMTCT services, for IPs and DoD through a pooled procurement arrangement. In COP 10, SCMS will continue to procure these PMTCT related supplies, equipments and medical supplies for IPs and DoD using the pooled procurement mechanism.

The budget is broken out as follows: 1) Provision of HIV test Kits to all PEPFAR PMTCT programs ($XXX): DoD (#554.08); Columbia University (CU)/ICAP (#2768.08); Family Health International (FHI)/GHAIN (#552.08); Harvard University School of Public Health (HSPH)/APIN+ (#544.08); University of Maryland (UMD)/Institute of Human Virology (IHV)/ACTION (#632.08); Catholic Relief Services (CRS)/AIDSRelief (#3688.08); Catholic Relief Services (CRS)/ 7 Dioceses (#3689); The International Foundation for Education and Self-Help (IFESH) (#555.08); LMS (#7144.08); Africare (#XXX); Society for

Family Health (SFH) (#XXX), TB-CAP (#XXX) and USAID's APS (#5236.08); and CDC's RFA (#5230) upon award. 2) Provision of other PMTCT related supplies, equipment or technical assistance for two IPs and DoD, each of which has attributed specific funds to SCMS for these services: DoD (#554.08), $XXX; ICAP(#2768.08), $ XXX, UMD/ACTION (#632.08), $ XXX; USAID's APS (#5236.08); and CDC's RFA (#5230) upon award $ XXX. The present budget will cover the cost of commodities as well as well as logistical and administrative services from the field office for the coordination and management of the procurements undertaken by SCMS related to this area of work. The budget also supports the cost of TA and SS as may be requested by DoD and the IPs.

SCMS will support the IPs and DoD in the following areas of the supply chain management cycle: product selection in accordance with the Federal Government of Nigeria's (FGoN) national HIV testing algorithm, marketing authorization status (NAFDAC registration) and FGoN importation regulation. SCMS will also be responsible for ensuring that commodities procured meet eligibility criteria under the USG acquisition rules and regulations including source and origin waivers and approvals or tentative approvals by the US Food and Drug Administration or other relevant stringent drug regulatory authorities, depending on the type supply or equipment.

SCMS will assist in quantification and forecasting of requirements and will support the development of long term supply plans (considering in country stocks and anticipated consumption rates) for stock management, monitoring of stock levels and usage through the deployment of pipeline databases and delivery planning. Additionally SCMS will monitor product safety and maintain a tracking system for recalls (pharmacovigilance). Requests for commodities will continue to be addressed to and coordinated with SCMS field office directly.

In addition to procuring required test kits for both training and use, SCMS will handle all the test kits donated by GoN to support PEPFAR programs.

SCMS will continue to identify suitable sources of supply both internationally and nationally. SCMS will work with IPs in Nigeria to locally procure products that are either banned for importation or for which local procurement represents a key advantage in terms of cost, delivery and/or associated services (i.e. maintenance service).

SCMS will coordinate with the USG team to ensure selected products are appropriately registered in Nigeria. For products not yet registered by NAFDAC, SCMS will make suitable recommendations including waiver applications where appropriate. SCMS will take the lead to communicate with manufacturers on registration gaps in Nigeria.

SCMS procurement leverages global spend to provide best value and offers clients certainty of competitive prices and international quality standards. SCMS procurement strategy is articulated around buying generics whenever possible, pooling procurement for HIV/AIDS care, prevention and treatment programs across PEPFAR focus countries and negotiating long term contracts with suppliers.

SCMS will be responsible for the shipment of procured commodities into Nigeria through Abuja or other points of entry as required. SCMS will continue to follow official procedures for customs clearance as appropriate including management of the CC1, CC2 or CC3 duty exemption forms. SCMS will coordinate with the USG team to fulfill importation requirements and provide needed documentation to allow customs clearance in an efficient and timely manner.

Where appropriate, commodities requested by the IPs and USG will be supplied through the SCMS Regional Distribution Center (RDC) in Ghana. The warehousing of commodities in the RDC is a critical component of the SCMS technical solution. The use of the RDC will significantly reduce lead times and provide an important buffer between the supply from manufacturers and demands from the PEPFAR programs in Nigeria. The RDC also ensure that shipment quantities do not overwhelm their recipients in country, an increasing challenge in the context of program scale up. The RDC concept also brings an increased flexibility in stock management thus reducing risk of stock obsolescence or need for emergency replenishments, resulting in important savings. Finally, the RDC approach serves regional and national sustainability, as the RDC is designed to be a commercially viable entity, available to other health (and non-health) programs, whose benefit will last beyond SCMS. Where possible and appropriate, SCMS will road freight from the RDC Ghana to Abuja; a mode of delivery that provides further significant savings over airfreight. For local warehousing needs, SCMS will continue to use its pharmaceutically compliant warehouse (primarily as a cross-docking facility) in Abuja which additionally will be capable of redirecting potential overstocked items, if necessary, to avoid expiry and waste.

Delivery arrangements will continue to be negotiated with the IPs; SCMS will either deliver to a central location or to point of services as needed. It should however be noted that the current distribution system for GoN programs and IPs is still sub-optimal. In COP 09, SCMS commenced implementation of the recommendations from the distribution options study (conducted in COP 08). In COP 10, SCMS with support of USG and the IPs will design and implement a more harmonized transport system for identified commodities to be delivered to a series of regional warehouses from which each IP or site will pick up its commodities. This will result in significant reduction of distribution costs by eliminating overlapping IP- specific distribution routing from various regions to Abuja. It is envisaged that this area will provide an opportunity to work with private sector providers and support collaboration between them and the GoN and IPs in mutually rewarding Public Private Partnerships. It will also follow a model already in place in which GoN and GF commodities are distributed by private-sector third-party logistics providers. Finally in

COP 10, SCMS will analyze last mile delivery options to further reduce redundancies in PEPFAR commodity distribution to sites in subsequent years, and to harmonize with the GON system as a step toward eventual integration. In order to efficiently manage the delivery of commodities as appropriate, SCMS will competitively source for and utilize the service of an efficient and safe in-country courier services operator.

In COP 10, SCMS will continue to provide TA and SS services to DoD and the IPs through training in the use of the ProQ or Quantimed forecasting and Pipeline supply planning tools. SCMS will continue to provide TA and SS services to DoD based on the recommendations that came out of a supply chain system's assessment carried out in COP07.

In COP 10, SCMS will continue to provide the USG team and the IPs with regular reports on commodity procurement as well as monthly financial reports and also assist IPs to monitor/report on stock levels and usage through the deployment of Pipeline databases. SCMS will also support the Supply Chain Support Teams (made up of technical SCMS staff and GoN or IP staff as appropriate) constituted by SCMS to work with the IPs in providing their trained logisticians with the capacity to monitor and support the performance of the supply chains at various levels. The Supply Chain Support Teams will use standardized indicators of logistics performance to track performance of the supply chains and together act as an early warning system to identify impending or imminent supply chain breakdowns and act to forestall these. By developing methodologies and tools for conducting these activities, SCMS will work with GoN and IPs to establish and institutionalize this activity thereby building the capacity to identify these problems and resolve them before service delivery is compromised. The automated web based procurement tracking database will ensure that the USG team and IPs have adequate visibility on SCMS procurement status since it provides an easy access to accurate and up to date information on procurement. It is envisaged that further procurement automation and harmonization will be facilitated through linkages with the Logistic and Health Program Management Information Platform system.

Under this program area, SCMS does not have targets of its own but supports PEPFAR IPs and DoD reaching their PMTCT planned targets.

EMPHASIS AREA Human capacity development.

None

ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS SCMS Nigeria provides procurement, systems strengthening (SS) services and strategic information for USG and PEPFAR Implementing Partners (IPs). It also provides systems strengthening services for building logistics management capacity to 4 main GON departments (NASCP, FDS, DPRS, and NACA).

SCMS supports PEPFAR programs in Nigeria by fostering increased access to quality HIV/AIDS related commodities. Key SCMS activities under this program area includes: procurement, shipping, clearing, distribution and delivery of antiretroviral (ARV) drugs. SCMS is also involved with as other supply chain management related activities such as technical assistance (TA) and systems strengthening (SS) activities for PEPFAR IPs and the Department of Defense (DoD) to strengthen or build their supply chain management capacity within their respective programs. Through its continuous support to and strengthening of commodity security in PEPFAR treatment programs, SCMS works towards ensuring availability of ARV drugs required by the PEPFAR supported programs to provide care and treatment services for the target population of people living with HIV/AIDS.

In COP09, SCMS procured ARV drugs (adult and pediatric formulations used in first and second line treatment regimens, salvage therapy, and post exposure prophylaxis) for IPs and DoD. SCMS also provided technical assistance in the area of product selection for GoN Product Selection Committee. Two commonly used ARVs in the PEPFAR supported programs in Nigeria were procured under a pooled procurement arrangement which resulted in significant cost savings and more efficient order processing. In COP 10, SCMS will continue with the pooled procurement of these ARVs and with guidance from USG, the number of ARVs to be procured using the pooled mechanism will be increased from the current 2 ARVs to XX. The funds allocated to SCMS by the IPs and DoD, for these services is as follows: DOD (#554.08), $XXX; Harvard University School of Public Health (HSPH)/APIN+ (#544.08), $ XXX; University of Maryland (#632.08), $ XXX; CRS AidsRelief (#3688.08), $ XXX; Columbia University/ICAP (#2768.08), $ XXX; GHAIN (#XXXX.08), $ XXX; LMS (#XXXX.08), $ XXX; CHAN NiCAB (#XXXX.08), $ XXX; PFD (#XXXX.08), $ XXX; and URC (#XXXX.08), $ XXX. The budgets will cover the cost of commodities as well as logistical and administrative services from the field office for the coordination and management of the procurements undertaken by SCMS. The budget also supports the cost of TA and SS for USG and PEPFAR partners.

In COP 10, SCMS will continue to support the IPs and DoD in the following areas of the supply chain management cycle: product selection in accordance with the Federal Government of Nigeria's (FGoN) national treatment guidelines, marketing authorization status (NAFDAC registration) and FGoN importation regulation. SCMS will also be responsible for ensuring that commodities procured meet eligibility criteria under the USG acquisition rules and regulations including source and origin waivers and approvals or tentative approvals by the US Food and Drug Administration. SCMS will assist in quantification and forecasting of requirements and will support the development of long term supply plans (considering in country stocks and anticipated consumption rates) for stock management, monitoring of stock levels and usage through the deployment of pipeline databases and delivery planning. Additionally SCMS will monitor product safety and maintaining a tracking system for recalls (pharmacovigilance). Requests for ARV drugs will continue to be responded to and coordinated with SCMS field office directly.

SCMS will identify suitable sources of supply and will coordinate with the USG team to ensure selected ARV drugs are appropriately registered in Nigeria. For ARV drugs not yet registered by NAFDAC, SCMS will make suitable recommendations including waiver applications where appropriate. SCMS will take the lead to communicate with manufacturers on registration gaps in Nigeria.

SCMS procurement leverages global spend to provide best value and offers clients certainty of competitive prices and international quality standards. SCMS procurement strategy is articulated around buying generics whenever possible, pooling procurement for HIV/AIDS care, prevention and treatment programs across PEPFAR focus countries and negotiating long term contracts with suppliers.

SCMS will be responsible for the shipment of procured commodities into Nigeria through Abuja or other points of entry as required. SCMS will continue to follow official procedures for customs clearance as appropriate including management of the CC1, CC2 or CC3 duty exemption forms. SCMS will coordinate with the USG team to fulfill importation requirements and provide needed documentation to allow customs clearance in an efficient and timely manner.

Where appropriate, commodities requested by the IPs and USG will be supplied through the SCMS Regional Distribution Center (RDC) in Ghana. The warehousing of commodities in the RDC is a critical component of the SCMS technical solution. The use of the RDC will significantly reduce lead times and provide an important buffer between the supply from manufacturers and demands from the PEPFAR programs in Nigeria. The RDC also ensure that shipment quantities do not overwhelm their recipients in country (an increasing challenge in the context of program scale up). The RDC concept also brings an increased flexibility in stock management thus reducing risk of stock obsolescence or need for emergency replenishments, resulting in important savings. Finally, the RDC approach serves regional and national sustainability, as the RDC is designed to be a commercially viable entity, available to other

health (and non-health) programs, whose benefit will last beyond SCMS. Where possible and appropriate, SCMS will road freight from the RDC Ghana to Abuja; a mode of delivery that provides further significant savings over airfreight. For local warehousing needs, SCMS will continue to use its pharmaceutically compliant warehouse (primarily as a cross-docking facility) in Abuja which additionally will be capable of redirecting potential overstocked items, if necessary, to avoid expiry and waste.

Delivery arrangements will continue to be negotiated with the IPs; SCMS will either deliver to a central location or to point of services as needed. It should however be noted that the current distribution system for GoN programs and IPs is still sub-optimal. In COP 09, SCMS commenced implementation of the recommendations from the distribution options study (conducted in COP 08). In COP 10, SCMS with support of USG and the IPs will design and implement a more harmonized transport system for identified commodities to be delivered to a series of regional warehouses from which each IP or site will pick up its commodities. This will result in significant reduction of distribution costs by eliminating overlapping IP- specific distribution routing from various regions to Abuja. It is envisaged that this area will provide an opportunity to work with private sector providers and support collaboration between them and the GoN and IPs in mutually rewarding Public Private Partnerships. It will also follow a model already in place in which GoN and GF commodities are distributed by private-sector third-party logistics providers. Finally in COP 10, SCMS will analyze last mile delivery options to further reduce redundancies in PEPFAR commodity distribution to sites in subsequent years, and to harmonize with the GON system as a step toward eventual integration. In order to efficiently manage the delivery of commodities as appropriate, SCMS will competitively source for and utilize the service of an efficient and safe in-country courier services operator.

In COP 10, SCMS will continue to provide TA and SS services to DoD and the IPs through training in the use of the ProQ or Quantimed forecasting and Pipeline supply planning tools. SCMS will continue to provide TA and SS services to DoD based on the recommendations that came out of a supply chain system's assessment carried out in COP07 including the establishment of a government owned, contractor operated warehouse, as part of SCMS strengthening of the host government's ARV program which is expected to bring a long term solution contributing to the sustainability of the military HIV/AIDS programs in Nigeria.

In COP 10, SCMS will continue to provide the USG team and the IPs with regular reports on ARV drugs as well as monthly financial reports and also assist IPs to monitor/report on stock levels and usage through the deployment of Pipeline databases. SCMS will also support the Supply Chain Support Teams (made up of technical SCMS staff and GoN or IP staff as appropriate) constituted by SCMS to work with the IPs in providing their trained logisticians with the capacity to monitor and support the performance of the supply chains at various levels. The Supply Chain Support Teams will use standardized indicators of

logistics performance, to track performance of the supply chains and together, act as an early warning system to identify impending or imminent supply chain breakdowns and act to forestall these. By developing methodologies and tools for conducting these activities, SCMS will work with GoN and IPs to establish and institutionalize this activity thereby building the capacity to identify these problems and resolve them before service delivery is compromised. The automated web based procurement tracking database will ensure that the USG team and IPs have adequate visibility on SCMS procurement status since it provides an easy access to accurate and up to date information on procurement. It is envisaged that further procurement automation and harmonization will be facilitated through linkages with the Logistic and Health Program Management Information Platform system.

Under this program area, SCMS does not have targets of its own but supports PEPFAR IPs and DoD reaching their planned treatment targets.

None