This is a continuing activity from FY 2007.

In FY 2007, SCMS worked closely with CAMERWA for the procurement, storage and distribution of all HIV-

related commodities, including laboratory. This consolidated approach to procurement will increase cost

savings and improve efficiencies in procurement and distribution of commodities. In FY 2007, RPM+ and

SCMS supported the CPDS. Under the CPDS, donors, including GFATM, MAP, and others, purchase

portions of Rwanda's national ARV needs based on a national quantification and according to their

individual procurement restrictions and patient targets. The CPDS also meets regularly to forecast next

year's needs and ensure that proper planning and ordering takes place to avoid any gaps in supply. In FY

2007, RPM+ ensured a smooth functioning of the CPDS system, quality data for quantification, and strong

communication between sites, districts and CAMERWA. This activity will be continued by SCMS in FY

2008.

Partners will work in close collaboration through joint planning and work plan development, particularly for

activities that support the LMIS and active distribution system. This activity comprises three components:

procurement of OI and preventive care drugs; TA; and procurement for HBC kits. For OI drug procurement,

SCMS will work with CAMERWA to procure, store and distribute OI drugs for all PLHIV at EP-supported

sites. The EP, through SCMS, will support costs not covered by GFATM mutuelles to ensure that sites are

supplied with all necessary equipment.

In FY 2007, SCMS provided training in quantification, forecasting, procurement, information systems,

warehouse management and supply planning for CAMERWA staff. Modules included training in Quantimed

software systems, forecasting methodology and reporting. SCMS provided on site capacity building and

training with tender preparation and evaluation for procurement of ARVs, OI drugs, test kits and laboratory

supplies in line with EP procurement regulations. In FY 2007, SCMS provided short term technical

assistance to CAMERWA in Warehouse Operations Management. This included inventory management

and control, management information system upgrade, cold chain management, storage and distribution

best practice, security upgrade and capacity building and knowledge transfer. In FY 2007, CAMERWA

moved from passive distribution to active distribution and delivered drugs and commodities to district

pharmacies. This is a significant change as pharmacists from districts and clinics traditionally came to

collect drugs at CAMERWA. SCMS also supported CAMERWA's Active Distribution Program with short

term technical assistance to assist CAMERWA with the development of an active distribution strategy

defining how drugs will be moved from central level to the district pharmacy level.

In FY 2008, SCMS will continue to provide ongoing TA to CAMERWA for quantification, EP procurement

regulations and for appropriate distribution of products to all sites. Product selection will also conform to

GOR's minimum list of preventive care, OI and other palliative care medications, as well as to WHO

standards for QA. SCMS will support CAMERWA and the NRL to conduct quality assurance of OI

medication arriving in country through TLC and use of mini-labs. As OI drugs will be integrated into the

CPDS, SCMS will provide TA and support to the relevant committees of the CPDS to develop a

procurement and distribution plan for OI and palliative care drugs, to conduct quantification, monitor

consumption patterns and stock levels, and to provide regular reports to donors.

In FY 2008, SCMS will work closely with GFATM, MOH, CAMERWA, and districts to ensure the continuous

availability and management of drugs and supplies included in the nationally defined HBC kits on an as

needed basis. SCMS will also work with community and clinical partners, CAMERWA, and the MOH to

review and revise tools to support the storage, distribution, and tracking of HBC kits from CAMERWA to the

community level.

This activity addresses the legislative area of wrap around through leveraging funds from the GFATM for

membership coverage of PLHIV for health insurance schemes. This will increase access to essential OI

medicines for PLHIV. It also directly supports the Rwanda EP five-year strategy for ensuring sustainability

by improving commodity forecasting, procurement procedures, storage and distribution, and information

systems.

PFSCM procures all EP commodities working in close colloboration with CAMERWA. PFSCM will provide

TA and funding for procurement, storage and distribution of all medicines, equipment and laboratory

supplies for TB and other EP program areas.

In FY 2007, SCMS through the partnership of supply chain management procured microtomes, waterbaths,

microscopes biosafety cabinets and hood for the Kigali teaching hospital for the diagnosis of

extrapulamonary TB through examination of lymphnodes aspirate.

In FY 2008, SCMS will procure consumables for the pathology laboratory at Kigali teaching hospital to

continue pathology diagnosis activity and expand this support to Butare University hospital. The

consumables will include reagents for histology and materials of embedding paraffin. This activity is done in

collaboration with AIDSRelief who provides through Institute of Human Virology trainings to lab technicians

and physicians for better lymphnodes aspiration; and Columbia UTAP who renovate the lab and another

pathology laboratory at Butare University teaching hospital. This activity will enable timely diagnosis of

extrapulmonary TB among PLWA and is in line with EP strategy to decrease the burden of TB on PLWA.

This activity contributes to the Rwanda EP five-year strategy goal of integrating TB and HIV services by

strengthening TB diagnostic capacity at Rwanda's major reference hospitals.

This activity is continuning from FY 2007.

In FY 2007, the EP transitioned towards a consolidated approach for procurement of HIV-related

commodities through the use of SCMS and NRL as the primary procurement partners. In addition, the GOR

has expanded the CPDS to include all HIV-related commodities, including OI drugs and diagnostics, test

kits and CD4. SCMS worked closely with CAMERWA for the procurement, storage and distribution of all

HIV-related commodities, including laboratory. This consolidated approach to procurement has increased

cost savings and improved efficiencies in procurement and distribution of commodities. In addition, partners

worked in close collaboration through joint planning and work plan development, particularly for activities

that supported the LMIS and active distribution system.

In FY 2008, SCMS will work closely with CAMERWA for the procurement, storage, and distribution of rapid

test kits and supplies (gloves, lancets, filter paper) for EP-supported health facilities, to target all CT and

PMTCT clients. In addition, SCMS will procure additional test kits for GFATM sites, continuing EP's ongoing

support to GFATM, begun in FY 2005. Test kits will be procured in line with the national testing protocol,

which includes Determine, First Response, Unigold, Capillus, OraQuick and others that may be

incorporated into the national algorithm. SCMS will coordinate and regularly communicate with USG

partners to ensure they have adequate information for the quantification and distribution of test kits, as well

as to discuss issues related to test kit procurement, distribution and management.

SCMS will take over the support to the CPDS to ensure smooth functioning of the CPDS system, quality

data for quantification, and strong communication between sites, districts and CAMERWA. As CPDS

increasingly expands to include other commodities, SCMS will work closely with CPDS to ensure

appropriate integration of kits into the system, including development of a procurement plan that integrates

test kits, support for national quantification in collaboration with NRL and other members of the

Quantification Committee and integrated distribution to sites. SCMS ensures appropriate integration of test

kit information into LMIS at all USG-supported sites and district pharmacies, and to ensure appropriate

stock management of test kits.

As the country continues to strengthen its CT strategy and implementation, SCMS will work with

CAMERWA to analyze and report on district pharmacy and health facility stock levels on a regular basis to

monitor for trends, potential stock outs, and make any revisions to procurement plans and projections.

In FY 2006, EP began its transition towards a consolidated procurement system for HIV-related

commodities through SCMS and NRL. SCMS has been supporting CAMERWA, the PTF, and NDA to

strengthen warehousing, procurement, management and distribution. In FY 2007, EP procured all

commodities, including laboratory supplies, through SCMS working in close collaboration with CAMERWA

in order to increase cost savings and improve efficiencies. In addition, SCMS extended its support to the

CPDS to ensure proper functioning of the CPDS system, availability of quality data for quantification, and

improved information sharing between sites, district pharmacies and CAMERWA. SCMS, RPM+, DELIVER

and PMI have been coordinating their activities in support of the LMIS and active distribution system. In FY

2007, CAMERWA moved from passive distribution to active distribution and delivered drugs and

commodities to district pharmacies. This is a significant change as pharmacists from districts and clinics

traditionally came to collect drugs at CAMERWA.

In FY 2008, funds for this activity will continue to support three components:

Under the first component, SCMS will work closely with CAMERWA, the NDA, and PTF for the

procurement, warehousing, storage, and active distribution of EP-financed ARVs procured through the

CPDS for 149 EP-supported ART sites and 40,439 patients, including 6,056 HIV-positive pregnant women.

A key difference from FY 2007 is that SCMS will take over support from RPM+ for district pharmacies and

oversee proper management of drugs from the district level to the facilities.

Under the second component, SCMS will be the lead TA agency to build the capacity of the CPDS. SCMS

will provide technical support and supervision to the Quantification Committee, the Resource Management

Committee and the Implementation Committee to ensure optimal use of funds. This will include continued

funding of key positions within CAMERWA and one position in CPDS responsible for reporting to the GOR.

This activity will also support coordination between donors and implementing partners and conduct data

analysis of pipelines and stock movements. SCMS will also continue to participate in quarterly data quality

control visits with TRAC and the districts. This will support the implementation of the LMIS between districts

and CAMERWA and will collaborate with DELIVER for harmonization with FP, malaria, and other health

commodities.

Under the third component, SCMS will collaborate with SPS to strengthen QA systems. It is critical that all

drugs reaching patients are safe, effective and meet quality standards. SCMS will work with SPS, the NDA,

CAMERWA and the CPDS to ensure prudent supplier and product selection and certification, and other

components of the WHO Certification Scheme. SCMS will support the establishment of Thin-Layer

Chromatography (TLC) and mini-labs in collaboration with the NDA, University of Butare and the NRL to

test the quality of ARVs.

In FY 2007, RPM+ supported the active and decentralized distribution and management of commodities by

hiring, training and supervising 16 district pharmacists. RPM+, in collaboration with SCMS, also adapted

tools for decentralized drug inventory management, including SOPs for requisition, distribution and stock

management, and provided TA for development of appropriate storage norms, training for nurse pharmacy

staff and strengthening pharmaceutical management capacity. With RPM+ support, 18 district hospitals

established DTCs to support the rational use of ARVs and support adherence to the Essential Drugs List.

RPM+ expanded its pharmacy support activities, including their Monitoring-Training-Planning approach, to

an additional eight districts. RPM+ also trained pharmacists and nurse pharmacists on basic and advanced

pharmaceutical management, as well as strategic management and leadership. At the national level,

RPM+, in collaboration with SCMS, provided TA to assist CAMERWA and the CPDS in quantification of

HIV/AIDS commodities.

In FY 2008, a number of the activities will be phased-out because all district pharmacies in the country will

undergo renovations in collaboration with the GFATM. Furthermore, the GOR will take over some of the

salaries of RPM+ seconded pharmacists in 2008. All other ongoing activities relating to training of

pharmacists on pharmaceutical management, TA in distribution practices, monitoring district pharmacies

and stock-out prevention will be supported by SCMS in FY 2008. Beginning in FY 2007, CAMERWA moved

to an integrated and comprehensive active distribution system where it began delivering commodities and

drugs to district pharmacies. However, SCMS will continue to ensure that reporting systems include ARVs,

OI drugs, lab commodities, and other health commodities data. SCMS will also ensure that sites provide

timely and accurate data on pipeline analyses, consumption patterns, and patient uptake rates to districts

and CAMERWA.

In addition, SCMS will be responsible for providing all TA and quantification assistance at the central level

for CAMERWA, the CPDS and more broadly the MOH. SCMS will take over the role of strengthening the

CPDS by providing support to the CPDS Coordinator and integrate the role of the Coordinator to ensure

that other commodities (OI drugs and diagnostic commodities, HIV test kits, FP commodities and anti-

malarials, etc.) are included in the CPDS. This includes assistance in national quantification activities and

setting-up appropriate software to help the GOR make informed decisions related to quantification,

procurement, distribution and stock management.

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 GOR administrative and ART decentralization plan by

strengthening capacity of districts and sub-national institutions.

This is a continuing activity from FY 2007.

In FY 2008, SCMS will work in close colloboration with the Central Medical Stores of Rwanda (CAMERWA)

for the procurement of all EP commodities, warehousing, and distribution of all medicines, equipment and

laboratory supplies, which includes biosafety equipment. This consolidated approach to procurement will

increase cost savings, and improve efficiencies in procurement and distribution of commodities. SCMS will

continue to support the coordinated procurement and distribution system (CPDS), which includes: MOH;

Management Science for Health (MSH); GFATM; Multi-sectoral AIDS Program (World Bank) (MAP); Clinton

Foundation; Luxembourg Corporation; logistic management information system (LMIS) activities; and paper

-based laboratory information systems (LIS), which ensures smooth functioning of the CPDS and quality

data for quantification; and strong communication between districts and CAMERWA.

During FY 2007, CAMERWA increased their staff to 70 employees working at the organization and

performed a restructuring to become more efficient. A team of employees spent time in South Africa to

learn how to improve services and created a master plan for the restructuring on their return. CAMERWA

owns and rents warehouse space. In FY 2007, they will increase their own warehouse space by 5000 cubic

meters and are working to decentralize logistics to strengthen the health districts in Rwanda. They currently

have a cold room with a backup generator and will be adding a room where supplies that need to be stored

at 15-25C will be kept.

Nationally, quantifications for commodities have been occurring every six months. The management plan is

for CAMERWA to also take over the bi-annual quantification of ARV, equipment and laboratory supplies in

FY 2007 in a stepwise manner and to be in charge of quantification in FY 2008. In FY 2008, overhead

charges that had been paid centrally in the past for SCMS services will now be absorbed by the country.

These costs are included in the SCMS budget along with funds provided for technical assistance for

quantification.

SCMS working closely with CAMERWA will conduct all commodity procurement for EP-supported site

laboratories, including equipment, supplies, and reagents for biochemistry, hematology, parasitology, and

biosafety. SCMS will procure all CD4 kits and supplies for the estimated 175,000 tests needed in FY 2008

for EP-supported patients. National ART treatment guidelines call for viral load testing in cases of suspected

treatment failure. SCMS will procure viral load reagents sufficient to cover the estimated needs of 6,000 EP-

supported patients. In addition to this site-level laboratory procurement, SCMS will procure equipment,

supplies and reagents for specific central-level activities and functions, including: (1) 6,000 PCR kits and

supplies for the national early infant diagnosis program; (2) an estimated 1,000 additional viral load kits and

associated supplies for the laboratory component of the national ART program impact evaluation; (3) test

kits and supplies for continuing HIV serology and CD4 testing QA systems; (4) PCR equipment, supplies

and reagents for expansion of PCR capacity to CHUB; (5) supplies and reagents for OI diagnostics for

regional and district-level trainings as well as supplies for ongoing parasitology.