Detailed Mechanism Funding and Narrative

Details for Mechanism ID: 4338
Country/Region: Rwanda
Year: 2007
Main Partner: Management Sciences for Health
Main Partner Program: NA
Organizational Type: NGO
Funding Agency: USAID
Total Funding: $2,360,000

Funding for Care: Adult Care and Support (HBHC): $0

[CONTINUING ACTIVITY FROM FY2006 -- NO NEW FUNDING IN FY2007] See related activities: MCAP BHC (2799), PBF BHC (2815), FHI BHC (4767), CRS BHC (4838), EGPAF BHC (5111), and Capacity/IntraHealth BHC (5112).

These funds will procure OI drugs for 127 EP-supported health facilities providing HIV/AIDS care. RPM-Plus will ensure cost-efficient procurement, storage and distribution of all OI and other palliative care drugs on behalf of USG and its implementing agencies for 127 health facilities (ART and non-ART RPM-Plus will ensure that procurement of all HIV-related drugs is done according to EP, GOR, and international quality standards. Product selection will conform to the GOR's minimum package of care but will also provide a cost-effective stock of OI and other palliative care drugs up to a total average cost of $5,000 per year, and $25,000 USD per district hospital per year. RPM-Plus will assure these drugs are equitably distributed to USG-supported health facilities based upon level of care and numbers of PLWHAs, as well as assure that sites document that PLWHAs are receiving needed care for OIs.

To ensure an appropriate and adequate supply of OI and other HIV-related medications at all levels, RPM-Plus will provide support to CAMERWA, district pharmacies, and EP partners and their supported sites in quantification, storage, distribution and stock management. This will include support for monitoring and supervision of data quality, inventory management, distribution, and reporting at all levels, development of tools and procedures to ensure data quality and good dispensing practices, and establishment of a mechanism for regular inventory control, including monthly reporting to districts and to CAMERWA. Building on the coordinated procurement system, the Quantification Committee (with support from RPM-Plus) will assist the MOH to quantify needed OI drugs. RPM-Plus will develop a plan for M&E of HIV/AIDS pharmaceutical management, including development of pharmaceutical indicators related to consumption and use of OI drugs as well as ARVs and other HIV/AIDS related commodities.

During COP05 the EP partner supported a full-time pharmacist at CAMERWA, who was responsible for monitoring and reporting on the coordinated procurement and who will continue with this role in COP06. Senior short-term international TA from the RPM-Plus Kigali office and Arlington headquarters will provide support.

This activity directly supports the Rwanda EP five-year strategy by strengthening supply chains and quality assurance through direct technical assistance to CAMERWA. This TA will improve commodity forecasting, procurement procedures, storage and distribution, quantification and information systems.

Funding for Care: TB/HIV (HVTB): $250,000

In FY06, the Emergency Plan supported a range of activities in TB pharmaceutical management in Rwanda. These include capacity building of district pharmacists with MSH RPM+, renovation of district hospital pharmacies with the district support block grant, and central level support with SCMS and CAMERWA. As the EP extends its geographic coverage in the country (22 out of 30 districts will receive direct EP support by the end of 2007), and in response to the GOR decision to reorient WB MAP support to other priority sectors, facilities demand for TB commodities will increasingly strain the existing passive drug distribution system. To date, all health facilities offering TB/HIV services are required to place orders for and collect commodities from Kigali. In FY 2007, the EP will support the national medical stores medium term objective of establishing an semi-active commodity distribution system by providing technical and financial assistance to upgrade existing 2 district pharmacies into regional pharmacies, which will have additional warehousing space, cold chain etc to stock sufficient commodities for all sites offering TB/HIV services in their respective provinces. MSH/RPM+, in collaboration with CAMERWA, MOH and SCMS, will strategically select the pharmacies to be upgraded. It is expected that these regional facilities will serve as warehouses and as regional medical stores for health facilities in their respective geographic areas, thereby reducing strain on the central level warehouse, and sharply cutting down on costs for re-stocking of drugs and other commodities. MSH/RPM+ will also support the adaptation of information systems for stock-management at regional pharmacy level. This information will improve the data for forecasting demand of TB drugs, ARV's and related commodities, and provide stronger data on site level consumption patterns. This activity supports the EP five-year strategy for national scale-up and sustainability, and the Rwandan Government administrative and TB/HIV integration plan by strengthening capacity of districts and sub-national institutions.

Funding for Prevention: HIV Testing and Counseling (HVCT): $0

[CONTINUING ACTIVITY FROM FY2006 - NO NEW FUNDING IN FY2007]

This activity relates to all other CT activities. RPM-plus will procure rapid HIV test kits for all EP implementing partners that provide PMTCT and CT. RPM-plus will be responsible for ensuring the most cost-efficient procurement, storage and distribution of all HIV rapid test kits for approximately 120 EP-supported CT and PMTCT sites and for EP supported mobile testing to test 370,000 individuals including pregnant women.

RPM-plus Rwanda, supported by the Procurement Unit based in Arlington HQ, will ensure that procurement of all test kits is done in accordance with USG, GOR and international requirements and quality standards and at the lowest possible cost. Quantities of HIV/AIDS rapid test kits will be procured based on EP partner targets, EP targets and historical trend data. To ensure an appropriate and adequate supply of HIV rapid test kits RPM-plus will provide support to CAMERWA, district pharmacies, and EP partners and their supported sites in quantification, storage, distribution and management of stocks of HIV test kits. RPM-plus will support monitoring and supervision of data quality, inventory management, distribution, and reporting at all levels, the development of tools and procedures to ensure data quality, and establishment of a mechanism for regular inventory control, including monthly reporting to districts and CAMERWA. Building on the coordinated procurement system and through support from RPM-plus, the quantification committee will assist in the quantification of test kits. RPM-plus will develop a plan for monitoring and evaluating the management of rapid test kits stocks, through the development of pharmaceutical indicators on consumption and use of HIV rapid test kits.

This activity will assure the availability of rapid HIV test kits for CT and PMTCT activities. This activity also directly supports the Rwanda EP five-year strategy to strengthen supply chains through direct technical assistance to CAMERWA. Technical support will improve commodity forecasting, procurement procedures, storage and distribution, quantification and information systems. ****PLUS-UPS**** $650,000 - This activity includes $200,000 for procurement of approximately 130,000 HIV test kits and confirmatory testing for USG partners and $450,000 for approximately 250,000 HIV test kits and confirmatory testing at Global Fund sites.

Additional HIV test kits are needed by USG partners due to anticipated increased uptake based upon provider initiated testing.

The Global Fund under Round 1 awarded a grant to fund approximately 120 VCTI sites in Rwanda. These 120 sites, which are located throughout the country, are a critical complement to USG ART services. In addition, these VCTI sites are essential to achieving overall country targets. Round 1 grants will expire in June 2006. The Global Fund will reprogram some of its Round 5 funds in order to ensure that these sites do not stop functioning. However, the Rwanda Global Fund program does not have enough funds to continue providing services to all 120 sites during this year. In order to ensure continuity of services, the USG Rwanda program has agreed to a joint procurement of HIV test kits.

The Global Fund and GOR will be responsible for personnel and clinical infrastructural operations at GF sites. With the provision of HIV test kits, the Global Fund should be able to reach country targets and continue to provide essential services without an adverse impact on the Rwanda program.

Funding for Treatment: ARV Drugs (HTXD): $0

[CONTINUED ACTIVITY IN FY 2006 - NO NEW FUNDING IN FY 2007.]

This activity relates to activities #2757, #2777, #2772, #2787, #2798, #2783, #4849, #4003, and #4972. RPM+ will ensure the procurement, storage, and distribution of ARVs for 88 EP-supported ART sites, reaching 20,000 total (8,000 new) ART patients. This activity comprises two components: (1) ($7.6 million) Financing to procure ARV drugs for ART service delivery for EP-supported ARV sites; (2) ($1.3 million) TA to the GOR ARV coordinated procurement system developed in 2004 and 2005.

RPM-plus will strengthen the procurement, quantification, distribution and dispensing of ARVs through training and TA to GOR institutions, USG partners and their ART-supported sites and other ARV purchasers.

RPM-plus will support EP and its implementing partners, CAMERWA, TRAC, the Department of Pharmacy, and the USS in all activities associated with the management of the GOR coordinated procurement and ARV supply chain, including quantification, supplier selection, QA of ARVs, appropriate storage, and distribution. RPM+ will ensure that procurement of ARVs is conducted in accordance with national and international quality standards and policies. In collaboration with EP and GOR, RPM+ will ensure that ARV procurement is in line with EP rules and regulations, including the procurement of only FDA-approved or tentatively approved branded or generic drugs with EP funds. Quantification of procured ARVs will be based on clinic records, USG program plans, facility capacity, and trends of ART uptake, with the global target of reaching 20,000 patients by March 2007. RPM-plus will contract CAMERWA's services for pharmaceutical storage of ARVs which will simplify the coordination between RPM+ and CAMERWA with regard to its other procurement and system strengthening activities, mentioned above. A full-time pharmacist seconded to CAMERWA who is currently in charge of the monitoring and reporting system for the coordinated procurement will continue with this role in COP06. In addition, senior short-term international TA of RPM+ from the Kigali office and Arlington headquarters will provide support.

RPM+ will continue its TA to Rwanda's coordinated procurement system and to related TWGs to ensure good governance and administrative practices and a reliable and appropriate supply of ARVs at all ART sites (USG, Global Fund, MAP, MSF, Lux, Clinton Foundation and all other ARV providers in Rwanda). RPM+ will support the revision of governance procurement documents and reporting systems as needed and will respond to requests from the EP, MOH, CNLS or other partners, will organize meetings and provide TA for troubleshooting. (See ARV Drugs Country Context). RPM+ will provide TA to the quantification committee in quantification methods, supervision and QA of the quantification exercises, training as needed for local capacity building, and dissemination of quantification reports to the EP, implementing partners, GOR partners, and other non-EP donor stakeholders. RPM+ will also provide TA to the coordinated ARV procurement governing committee regarding procurement and distribution of ARVs, including QA, good procurement practices and systems for appropriate and timely distribution of ARVs to all levels of service delivery.

RPM-plus will strengthen the pharmaceutical management information system for reliable and valid site-level data collection and reporting, good ARV dispensing practices, and strengthening of stock management of ARVs (See Activity 2761). RPM-plus will also conduct joint monthly inventories at CAMERWA to review stocks on hand, expiration dates, and to identify any problems or potential stock outs, which would be reviewed and resolved in collaboration with the relevant governing committee. RPM-plus will also train district depot pharmacies and ARV site pharmacies to track ARV drug stocks. RPM-plus will also provide reports and updates on the national pipeline of ARVs, distribution and consumption figures, and status of partners' orders to the updated list of products procured throughout the coordinated system. RPM+

Funding for Treatment: Adult Treatment (HTXS): $1,450,000

In FY06, the Emergency Plan supported a range of activities in pharmaceutical management in Rwanda. These include capacity building of district pharmacists with MSH RPM+, renovation of district hospital pharmacies with the district support block grant, and central level support (SOP's, improved stock management, etc) with SCMS and CAMERWA. As the EP extends its geographic coverage in the country (22 out of 30 districts will receive direct EP support by the end of 2007), and in response to the GOR decision to reorient WB MAP support to other priority sectors, facilities demand for HIV commodities will increasingly strain the existing passive drug distribution system.

To date, all health facilities offering ART are required to place orders for and collect commodities from Kigali. In FY 2007, the EP will support the national medical stores medium term objective of establishing an semi-active commodity distribution system by providing technical and financial assistance to upgrade existing 2 district pharmacies into regional pharmacies, which will have additional warehousing space, cold chain etc to stock sufficient commodities for all sites offering ART in their respective provinces.

MSH/RPM +, in collaboration with CAMERWA, MOH and SCMS, will strategically select the pharmacies to be upgraded. It is expected that these regional facilities will serve as warehouses and as regional medical stores for health facilities in their respective geographic areas, thereby reducing strain on the central level warehouse, and sharply cutting down on costs for re-stocking of drugs and other commodities. MSH/RPM+ will also support the adaptation of information systems for stock-management at regional pharmacy level. This information will improve the data for forecasting demand of ARV's and related commodities, and provide stronger data on site level consumption patterns. This activity supports the EP five-year strategy for national scale-up and sustainability, and the Rwandan Government administrative and ART decentralization plan by strengthening capacity of districts and sub-national institutions.

Funding for Health Systems Strengthening (OHSS): $660,000

Reprogramming 8/07: With these reprogrammed funds RPM+ in collaboration with PMI, TRAC and APHAR will provide TA to the Ministry of Health for a small scale program of passive surveillance of adverse events related to ARVs and OI drugs. RPM+ will coordinate short term TA from African countries who have experience in pharmacovigilance as well as short training to Rwandan professionnals for routine monitoring reporting, and interepretation of use of data on adverse events resulting from ARV and OI druds use.This activity will contribute to the quality of HIV services in Rwanda.

In FY 2006, the EP, through RPM-Plus, is beginning to support the NDA, which has recently been approved as an official entity by the MOH. The NDA is responsible for certifying and monitoring the quality of drugs that are domestically manufactured and imported from other countries. RPM-Plus is seconding a technical staff to the NDA to assist in establishing a new government agency. A major accomplishment is the training of staff in drug registration file management.

In FY 2007, the EP will scale up its support to the NDA by focusing on three components.

First, the EP will provide technical and management support to the NDA. RPM-Plus will help develop two plans: one for implementation and another for strategic planning. The implementation plan will delineate and define the roles and responsibilities of a pharmaceutical regulatory authority. This plan will identify, define and prioritize a mix of technical activities to support the Rwanda's regulatory system; assess the conditions and resources necessary for a comprehensive pharmaceutical system; assist the NDA through regional collaboration and training on financial, technical and human resources topics. RPM-Plus will recommend priorities for the NDA, including the scope of product coverage; gaps in human, technical, financial, legal, and information technology resources; and the role of NDA within the MOH structure. RPM-Plus will develop a second plan on strategic planning. This plan will establish activities for a drug registration system; create nationwide QA in testing, inspection, and monitoring; support policies and procedures for drug regulation. Additionally, RPM-Plus will help to develop a fee structure for commercial registration of drugs, including pricing policy and plans for financial audits.

Second, the EP will assist the GOR in establishing a pharmacovigilance system at the central and district level. This will be coordinated with APHAR, PFSCM and other partners as necessary. RPM-Plus will work with the NDA to create the procedures and forms to be completed by health providers. A regulatory team will compile and analyze information and oversee any adverse events due to HIV/AIDS drugs.

Third, the EP will focus on building the capacity of pharmacists. RPM-Plus will support the institutional strengthening of APHAR by providing materials and training of pharmacists. RPM-Plus will also support the University of Butare's School of Pharmacy to integrate HIV/AIDS pharmaceutical management into its pre-service curriculum.

The direct output will be capacity building on policy development for three organizations and eight people under this activity, as well as institutional capacity building for four organizations and 14 people.

This activity reflects the Rwanda EP five-year strategy and supports the GOR's national strategy of human resources and organizational capacity building

Funding for Health Systems Strengthening (OHSS): $0

In FY06, the Emergency Plan supported a range of activities in pharmaceutical management in Rwanda. These include capacity building of district pharmacists with MSH RPM+, renovation of district hospital pharmacies with the district support block grant, and central level support (SOP's, improved stock management, etc) with SCMS and CAMERWA. As the EP extends its geographic coverage in the country (22 out of 30 districts will receive direct EP support by the end of 2007), and in response to the GOR decision to reorient WB MAP support to other priority sectors, facilities demand for HIV commodities will increasingly strain the existing passive drug distribution system.

To date, all health facilities offering ART are required to place orders for and collect commodities from Kigali. In FY 2007, the EP will support the national medical stores medium term objective of establishing an semi-active commodity distribution system by providing technical and financial assistance to upgrade existing 2 district pharmacies into regional pharmacies, which will have additional warehousing space, cold chain etc to stock sufficient commodities for all sites offering ART in their respective provinces.

MSH/RPM +, in collaboration with CAMERWA, MOH and SCMS, will strategically select the pharmacies to be upgraded. It is expected that these regional facilities will serve as warehouses and as regional medical stores for health facilities in their respective geographic areas, thereby reducing strain on the central level warehouse, and sharply cutting down on costs for re-stocking of drugs and other commodities. MSH/RPM+ will also support the adaptation of information systems for stock-management at regional pharmacy level. This information will improve the data for forecasting demand of ARV's and related commodities, and provide stronger data on site level consumption patterns. This activity supports the EP five-year strategy for national scale-up and sustainability, and the Rwandan Government administrative and ART decentralization plan by strengthening capacity of districts and sub-national institutions.