PEPFAR's annual planning process is done either at the country (COP) or regional level (ROP).
PEPFAR's programs are implemented through implementing partners who apply for funding based on PEPFAR's published Requests for Applications.
Since 2010, PEPFAR COPs have grouped implementing partners according to an organizational type. We have retroactively applied these classifications to earlier years in the database as well.
Also called "Strategic Areas", these are general areas of HIV programming. Each program area has several corresponding budget codes.
Specific areas of HIV programming. Budget Codes are the lowest level of spending data available.
Expenditure Program Areas track general areas of PEPFAR expenditure.
Expenditure Sub-Program Areas track more specific PEPFAR expenditures.
Object classes provide highly specific ways that implementing partners are spending PEPFAR funds on programming.
Cross-cutting attributions are areas of PEPFAR programming that contribute across several program areas. They contain limited indicative information related to aspects such as human resources, health infrastructure, or key populations programming. However, they represent only a small proportion of the total funds that PEPFAR allocates through the COP process. Additionally, they have changed significantly over the years. As such, analysis and interpretation of these data should be approached carefully. Learn more
Beneficiary Expenditure data identify how PEPFAR programming is targeted at reaching different populations.
Sub-Beneficiary Expenditure data highlight more specific populations targeted for HIV prevention and treatment interventions.
PEPFAR sets targets using the Monitoring, Evaluation, and Reporting (MER) System - documentation for which can be found on PEPFAR's website at https://www.pepfar.gov/reports/guidance/. As with most data on this website, the targets here have been extracted from the COP documents. Targets are for the fiscal year following each COP year, such that selecting 2016 will access targets for FY2017. This feature is currently experimental and should be used for exploratory purposes only at present.
Years of mechanism: 2007 2008 2009
ACTIVITY IS NEW IN FY 2009.
The overall goal of this activity is to decrease new HIV infections in the Rwanda Defense Forces (RDF)
through the expansion of male circumcision (MC) services with emphasis that MC be offered as part of an
expanded approach to reduce HIV infections in conjunction with other prevention programs, including HIV
testing and counseling, treatment for other sexually transmitted infections, promotion of safer-sex practices,
and condom distribution. MC will not replace other known methods of HIV prevention and will be considered
as part of a comprehensive HIV prevention package.
In FY 2009, SCMS, in collaboration with Drew University and the Rwandan Center for Essential Drug
Procurement (CAMERWA), will quantify and procure male circumcision (MC) kits for Rwandan military
personnel and their families. Drew University forecasts that an average of 50 males per week in five sites
(250 total procedures per week) will be circumcised. It is thus estimated that 13,000 MC kits per year will
be needed. The demand for MC procedures and kits could vary and will be closely monitored.
The provision of male circumcision procedures and male condoms for military personnel and their families,
is in direct support of PEPFAR and Government of Rwanda prevention strategies
New/Continuing Activity: New Activity
Continuing Activity:
Table 3.3.07:
ACTIVITY UNCHANGED FROM FY 2008:
SCMS partners work in close collaboration through joint planning and work plan development, particularly
for activities that support the Logistic Management Information System (LMIS) and active distribution
system. This activity comprises three components: procurement of OI and preventive care drugs; TA; and
procurement for home-based care (HBC) kits. For OI drug procurement, SCMS works with CAMERWA to
procure, store and distribute OI drugs for all PLHIV at PEPFAR-supported sites. The PEPFAR, through
SCMS, supports costs not covered by GFATM mutuelles to ensure that sites are supplied with all necessary
equipment.
In FY 2008, SCMS continued to provide ongoing TA to CAMERWA for quantification, PEPFAR procurement
regulations and for appropriate distribution of products to all sites. Product selection conforms to GOR's
minimum list of preventive care, OI and other palliative care medications, as well as to WHO QA standards.
SCMS supports CAMERWA and the NRL in conducting quality assurance of OI medication arriving in
country through TLC and use of mini-labs. As OI drugs are integrated into the CPDS, SCMS provides TA
and support to the relevant CPDS committees to develop a procurement and distribution plan for OI and
other drugs for basic care and support (BCS) services, to conduct quantification, monitor consumption
patterns and stock levels, and to provide regular reports to donors.
In FY 2008, SCMS worked 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 also worked 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.
Above activities address 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. They also directly support the PEPFAR Rwanda five-year strategy for ensuring
sustainability by improving commodity forecasting, procurement procedures, storage and distribution, and
information systems.
New/Continuing Activity: Continuing Activity
Continuing Activity: 12865
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
12865 8716.08 U.S. Agency for Partnership for 6320 4741.08 SCMS $500,000
International Supply Chain
Development Management
8716 8716.07 U.S. Agency for Partnership for 4741 4741.07 SCMS $1,620,000
Table 3.3.08:
THIS IS A CONTINUING ACTIVITY FROM FY 2008, ALREADY APPROVED
Continuing Activity: 16862
16862 16862.08 U.S. Agency for Partnership for 6320 4741.08 SCMS $1,100,000
Table 3.3.09:
procure, store and distribute OI drugs for all PLHIV including children at PEPFAR-supported sites. The
PEPFAR, through SCMS, supports costs not covered by GFATM mutuelles to ensure that sites are supplied
with all necessary equipment.
In FY 2009, SCMS will continue to 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.
Table 3.3.10:
ACTIVITY UNCHANGED FROM FY 2008.
PFSCM (Partners For Supply Chain Management), working in close collaboration with CAMERWA,
procures all PEPFAR commodities. PFSCM provides technical assistance and funding for procurement,
storage and distribution of all medicines, equipment and laboratory supplies for TB and other PEPFAR
program areas.
In FY 2008, SCMS will procure consumables for the pathology laboratory at Kigali Teaching Hospital to
continue diagnosis activities and expand support to the Butare University Hospital. The main focus will be
on consumables for FNA (fine needle aspiration) to include needles, syringes, masks, reagents for histology
and paraffin. This activity is conducted in collaboration with AIDSRelief, who provides trainings through the
Institute of Human Virology, for laboratory technicians and physicians for improved lymph node aspiration.
Collaborative efforts will also assist with laboratory renovation for Columbia UTAP as well as another
pathology laboratory at Butare University teaching hospital. These endeavors will enhance timely diagnosis
capabilities for extrapulmonary TB among PLHIV in line with PEPFAR strategy to decrease the burden of
TB on PLHIV.
In FY 2009, such equipment as a microtome, water bath, tissue processor, IPOX, microscopes, biosafety
cabinets, hood, centrifuge with safety cups, and a replacement fluorescence microscope will be purchased.
In addition, other CHK laboratory consumables, such as auramine stains for TB diagnosis will be procured.
Maintenance and repair contracts will also be purchased for the above equipment.
These activities contributes to the Rwanda PEPFAR five-year strategy goal of integrating TB and HIV
services by strengthening TB diagnostic capacity at Rwanda's major reference hospitals
Continuing Activity: 12866
12866 8664.08 U.S. Agency for Partnership for 6320 4741.08 SCMS $650,000
8664 8664.07 U.S. Agency for Partnership for 4741 4741.07 SCMS $140,000
Table 3.3.12:
This is a continuing activity from FY 2008. Narrative required as the mechanism is above the single partner
limit
In FY 2007, PEPFAR 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 works closely with CAMERWA for the procurement, storage, and distribution of rapid
test kits and supplies (gloves, lancets, filter paper) for PEPFAR-supported health facilities, to target all CT
and PMTCT clients. In addition, SCMS procures additional test kits for GFATM sites and is continuing
PEPFAR's support to GFATM that began 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 supports 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 is continuing tol work closely with the 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 PEPFAR-supported sites and district pharmacies, and to ensure appropriate stock
management of test kits.
As the country continues to strengthen its TC 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.
Continuing Activity: 12867
12867 8167.08 U.S. Agency for Partnership for 6320 4741.08 SCMS $500,000
8167 8167.07 U.S. Agency for Partnership for 4741 4741.07 SCMS $1,025,000
Emphasis Areas
Gender
* Addressing male norms and behaviors
* Increasing gender equity in HIV/AIDS programs
Human Capacity Development
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.14:
ACTIVITIES UNCHANGED FROM FY 2008
In FY 2009, funds for ARV medications will continue to support three components:
1. Under the stewardship of the Ministry of Health, the Supply Chain Management System (SCMS) works
closely with the Centrale d'Achats des Medicaments Essentials du Rwanda (CAMERWA) and the
Pharmacy Task Force (PTF) to procure, warehouse, store, and actively distribute PEPFAR financed ARVs.
These drugs are procured through the Coordinated Procurement and Distribution System (CPDS) for 149
PEPFAR-supported ART sites and 40,439 patients, including 6,056 HIV-positive pregnant women. In FY
2008, SCMS has begun to provide support previously provided by Strengthening Pharmaceutical Systems
(SPS) for district pharmacies and oversees proper management of medications from the district level to the
facilities.
2. SCMS is the lead agency building the capacity for the CPDS. SCMS provides technical support and
supervision to the Quantification Committee, the Resource Management Committee and the
Implementation Committee to ensure optimal use of funds. This includes continued funding of key positions
within CAMERWA and one position in CPDS responsible for reporting to the GOR. This activity also
supports coordination between donors and implementing partners and includes conducting data analysis of
pipelines and stock movements. SCMS also continues to participate in quarterly data quality control visits
with theCIDC and the district health facilities in support of the coordination of the Laboratory Management
Information System (LMIS) between districts and CAMERWA. In addition, SCMS collaborates with
DELIVER for harmonization with family planning, malaria, and other health commodities.
3. SCMS collaborates with SPS to strengthen quality assurance (QA) systems. It is critical that all
medications reaching patients are safe, effective and meet quality standards. SCMS works with SPS, the
PTF, CAMERWA and the CPDS to ensure prudent supplier and product selection and certification, and
other components of the World Health Organization (WHO) Certification Scheme. SCMS also supports the
establishment of Thin-Layer Chromatography (TLC) and mini-laboratories in collaboration with the MOH,
University of Butare and the National Reference Laboratory (NRL) to test the quality of ARVs.
New and significantly more expensive treatment regimens, including Tenofovir (TDF), Zidovudine (AZT),
and Stavudine (d4T), will be prescribed in Rwanda beginning July 2009 for new patients starting on ARVs
as well as patients determined to be failing on currently prescribed ARV regimens. Consequently, the need
to identify additional funds for ARV treatment must be addressed and carefully planned for. PEPFAR funds
are being utilized to purchase first-line treatment regimens. As many as 13,200 or more patients per year
(with increased testing efforts identifying new positives) could be prescribed the new and more expensive
second-line regimen. TDF will cost approximately $613 per patient per year; AZT $163 per patient per year;
and d4T $88.51 per patient per year. Prescribing the new regimen to this number of patients could by itself
amount to over $12,000,000 a year in the PEPFAR funded sites. Close monitoring and coordination with
other partners whose financial support helps pay for ARV medications in Rwanda's 159 non-PEPFAR-
funded ARV sites, along with ongoing evaluation of the impending regimen changes will be of critical
importance for continued ARV treatment success across the country.
Continuing Activity: 12868
12868 8170.08 U.S. Agency for Partnership for 6320 4741.08 SCMS $9,900,000
Table 3.3.15:
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS
1. Elaboration of activities
In FY 2009, SCMS will work in close collaboration with the Central Medical Stores of Rwanda (CAMERWA)
for the procurement of all PEPFAR 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 (LIMS) activities; and paper
-based laboratory information systems (LIS) which ensures smooth functioning of the CPDA and quality
data for quantification; and strong communication between districts and CAMERWA..
In FY 2007, CAMERWA increased its staff to 70 employees 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. In FY 2007 - 2008, they increased 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 15-25oC will be kept.
Nationally, quantifications for commodities occur every six months. The management plan will have
CAMERWA take over the bi-annual quantification of ARV, equipment and laboratory supplies in a stepwise
manner and to be in charge of quantification in FY 2009. Overhead charges for SCMS services that were
previously paid through Washington will now be absorbed by the country. These costs along with funds
provided for technical assistance for quantification are included in the SCMS budget.
SCMS working closely with CAMERWA will conduct all commodity procurement for PEPFAR-supported site
laboratories, including equipment, supplies and reagents for biochemistry, hematology, mycology,
bacteriology, parasitology and biosafety. SCMS will procure all CD4 kits and supplies for the estimated
175,000 tests needed in FY 2009 for PEPFAR-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 PEPFAR-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) kits and supplies for 6,000 PCR tests 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 CD testing QA systems; 4) PCR equipment, supplies and reagents for
expansion of PCR capacity to CHUB and as backup for NRL; 5) supplies and reagents for OI diagnostics
for regional and district-level laboratories as well as supplies for ongoing parasitology.
Continuing Activity: 12869
12869 8189.08 U.S. Agency for Partnership for 6320 4741.08 SCMS $3,526,448
8189 8189.07 U.S. Agency for Partnership for 4741 4741.07 SCMS $4,357,880
Table 3.3.16:
