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.
INTEGRATED ACTIVITY FLAG:
This RPM Plus PMTCT activity relates to other RPM Plus activities in ARV Drugs and Services (#7558 and #7559) and TB/HIV (#7856). In addition, RPM Plus is a member of the Partnership for Supply Chain Management (#8107 and #7935).
SUMMARY:
Management Sciences for Health's (MSH) Rational Pharmaceutical Management Plus (RPM Plus) Program will strengthen the pharmaceutical component of the Prevention of Mother-to-Child Transmission (PMTCT) services at the facility level and the role of pharmacy personnel in promoting and supporting PMTCT services. Three activities have been identified: conduct focused provincial assessment of the pharmaceutical component of PMTCT services; assist with the review of National PMTCT standard treatment guidelines (STGs); and train primary healthcare pharmacy personnel to increase their role in supporting National Department of Health (NDOH) prevention efforts. The major emphasis area is needs assessment, and minor emphasis areas include human resources, linkages with other sectors, logistics and training. Target populations include women, infants, family planning clients, people living with HIV and AIDS (PLHIV), policy makers, national program staff, and public doctors, nurses, pharmacists, and other healthcare workers.
BACKGROUND:
In South Africa, the implementation of PMTCT services is one of the key HIV and AIDS interventions, as prevention remains the cornerstone of the country's response to HIV and AIDS. PMTCT services are available through hospitals, midwife obstetric units, community health centers and primary healthcare clinics. In 2003, RPM Plus received funds from the USAID Child Survival program to assist in strengthening the "pharmaceutical component" of the PMTCT program. An in-depth analysis of existing policies and practices was conducted and an assessment tool was developed in collaboration with the National and all nine Provincial Departments of Health. This tool is being field tested at pilot facilities in selected provinces. RPM Plus is also providing support to the National Department of Health Pharmaceutical Policy and Planning Cluster (NDOH-PPP) and the Medicines Control Council (MCC) of the Medicines Regulatory Authority (MRA) with the selection, review of the drug(s) and regimen of choice for PMTCT.
ACTIVITIES AND EXPECTED RESULTS:
ACTIVITY 1: Needs Assessment
RPM Plus will assist provinces and local government in identifying strengths and limitations of the pharmacy components of PMTCT services at the facility level and also resolving issues related to coordination and collaboration between department/directorates at the provincial level. The assessments will examine: (1) The management of nevirapine donations (Free State, KwaZulu-Natal, and Northern Cape provinces); (2) The availability of cotrimoxazole, infant formula and rapid HIV test kits; (3) The use of nevirapine single-dose regimens and identification of women requiring immediate access to combination regimens (without going through the antiretroviral treatment (ART) readiness program); (4) The integration of PMTCT commodities in the provincial supply chain; and (5) The role of pharmacy personnel in supporting PMTCT and counseling and testing (CT) services.
The assessment will identify critical issues in the systems and policies that may facilitate expanded access to PMTCT commodities and provide recommendations for strengthening the role of national and provincial pharmaceutical services in supporting PMTCT services at all levels.
The recommended approach combines an indicator-based assessment with in-depth analysis of critical pharmaceutical and commodity management areas. Input from various partners, counterparts and stakeholders will be sought, including the National and Provincial PMTCT Directorates and Committees, Pharmaceutical Services, the Health Information Evaluation and Research Directorate and staff at service delivery facilities. The
findings and recommended options for strengthening pharmaceutical and commodity management for PMTCT services will be communicated to partners, counterparts and stakeholders. At the request of the NDOH, these assessments will be conducted in all nine provinces using FY 2007 PEPFAR funding.
ACTIVITY 2: Dissemination of findings
RPM Plus will conduct one national workshop for PMTCT program managers and nine provincial workshops for pharmacists, pharmacist assistants and nurses to address issues identified during the assessment of PMTCT services and will include an update to health staff on recommended ART regimen(s) for pregnant women and the associated clinical pharmacology (i.e., drug of choice, adverse-drug-event while on ART). The focus of the provincial workshops will be on training primary healthcare (PHC) level workers, as PHC sites constitute one of the primary sites for prevention, and also diagnosis, staging, referral and routine follow-up of HIV-infected patients. Quantification of PMTCT related medicines and commodities will also be addressed during the training.
ACTIVITY 3: Technical Assistance
RPM Plus will continue the ongoing support provided to the NDOH Essential Drugs List Committee in reviewing PMTCT drug(s) of choice and standard treatment guidelines (STGs), to the MCC on regulatory issues, and to the NDOH PMTCT Task Force in planning implementation of the strategy. This activity also includes the review and development of training modules to include new PMTCT STG's in the training conducted by RPM Plus (e.g., HIV and AIDS management and Pharmaceutical and Therapeutic Committee training).
These activities contribute to the PEPFAR 2-7-10 goals by improving the quality of the PMTCT services provided at the facility level.
This activity relates to the RPM Plus activities under ARV Services (#7559), PMTCT (#7854), and TB/HIV (#7856). In addition, RPM Plus is a member of the Partnership for Supply Chain Management (#8107 and #7935).
With FY 2007 PEPFAR funds, Management Sciences for Health's (MSH) Rational Pharmaceutical Management (RPM Plus) project will continue and expand activities already underway in South Africa to support the effective management of ARV medicines. RPM Plus will continue to positively impact drug provision by improving estimation of needs for ARV, opportunistic infections (OI) and STI drugs; implementing systems to support drug supply management activities and to monitor drug availability at the institution and district levels; and developing a highly skilled pool of pharmacy personnel to manage them. The objective is also to strengthen the South African Government's (SAG) Drug Supply Management Information Systems at all levels. The major emphasis area for these activities is training, but the project also includes logistics, needs assessment, policy/guidelines and quality assurance and supportive supervision. Target populations include National AIDS Control Program staff, other National and Provincial Department of Health (DOH) staff, nurses, pharmacists and pharmacist assistants.
Since FY 2004, RPM Plus has been working in close collaboration with the National Department of Health Pharmaceutical Policy and Planning (NDOH-PPP) unit, and Provincial and Local Government Pharmaceutical Services to support the delivery of pharmaceutical services at all levels (national, provincial, district, and institutional). The following activities are a continuation of the activities initiated since FY 2004. Systems and models for drug supply management have been developed and tested. In FY 2007, RPM Plus will continue the implementation of these systems on a larger scale and will monitor the impact on the delivery of ART at accredited sites. These activities have received the full support of the NDOH-PPP unit and the Provincial Pharmaceutical Services.
ACTIVITY 1: Drug supply management information system
RPM Plus has developed an integrated, computerized drug supply management information system (RxSolution) to assist hospital, community health center and district level pharmacy personnel to manage drug supply activities from hospital bulk stores to the patients through satellite pharmacies (outpatient and inpatient), wards and down referral clinics. This supports the management of purchase orders, inventory, issues to clients (satellite pharmacies, wards, and primary health care (PHC) clinics), and budgets. It also supports the management of patient records, prescriptions and quantities dispensed directly to the patient or through down referral sites. Data links with electronic patient registers have been tested.
The RxSolution system is currently used in 5 provinces (Eastern Cape, Mpumalanga, Gauteng, North West and Free State) at government and local government sites. In the Eastern Cape alone, the existing sites have contributed to the treatment of 15,000 patients. Three referral sites have been established. These referral sites are hospitals that have established a unit to down refer patients to a primary health care institution, typically patients on chronic medication or stabilized ARV patients. The main objectives are to reduce the burden on the hospital and decrease the cost for the patient. Some of the ARV sites using RxSolution have shown great improvement in the management of their supplies for ART and non-ART medicines.
As a result, more ART accredited sites (hospitals, wellness centers) have requested to use this system. As RPM Plus scales up, different approaches will be used to ensure adequate support and maintenance. In Mpumalanga, a memorandum of understanding has been signed between MSH and a private IT service contractor (Faranani) to provide training, support and maintenance for the deployment of RxSolution. In the Free State, the
government is hiring a pharmacist/IT manager to support RxSolution. RPM Plus developed an interface between RxSolution and the new provincial warehouse management system. RPM Plus will assist the NDOH-PPP with the management of the provincial deployment of the warehouse system that will start in early 2007.
ACTIVITY 2: Training in quantification
RPM Plus is constantly improving and developing new models to estimate and monitor drug needs using morbidity and consumption data. These models are specifically tailored to the South African National Standard Treatment Guidelines (STGs) for HIV and AIDS, sexually transmitted infections (STIs), opportunistic infections (OIs), other priority diseases and post-exposure prophylaxis (PEP). RPM Plus has trained provincial staff responsible for the submission of provincial estimates, provincial pharmaceutical warehouse managers and pharmacists responsible for the procurement of ARVs, and medicines used for the treatment of OIs and STIs at the institutional level (hospital, community health center and district). In FY 2007, training in quantifying ARV-related drug requirements will continue through national and provincial workshops. These workshops provide an opportunity to establish a national network to discuss and report consumption trends and issues, to maintain a dialogue with representatives from the pharmaceutical industry and to prepare reports for the National Comprehensive Care, Management and Treatment of HIV and AIDS (CCMT) forum. Training in quantification needs to be an ongoing function, especially in the public sector in South Africa where community service pharmacists are often in charge of the ARV pharmacy for their year of service, then leave the public sector for the private sector without plans for succession.
ACTIVITY 3: Data for decision-making
With FY 2007 PEPFAR funding, RPM Plus will continue the training of pharmacy personnel in using their data for decision-making to ensure that the increasing demand for drugs required for the care and treatment of HIV and AIDS and other related programs is met, and to monitor national drug supply management indicators. This will also provide an opportunity to strengthen the working relationship between pharmacists and other program managers. Individuals from the Provincial Pharmaceutical Services and from the National Pharmaceutical Policy and Planning unit will be trained.
All the activities above will indirectly support all HIV-infected clients who will be receiving care and treatment at government ARV accredited sites through the improvement of the delivery of pharmaceutical services. These activities support PEPFAR 2-7-10 goals as well as the vision outlined in South Africa's Five-Year Strategy by facilitating the national ARV rollout.
This activity relates to activities under ARV Drugs (#7558), PMTCT (#7854), and TB/HIV (#7856). In addition, RPM Plus is a member of the Partnership for Supply Chain Management (#8107 and #7935).
Management Sciences for Health's (MSH) Rational Pharmaceutical Management (RPM Plus) project will support of the South African Government's (SAG) Operational Plan for Comprehensive HIV and AIDS Care, Management and Treatment (CCMT). RPM Plus improves the reliable provision of ARV services and other related services; monitors progress towards full compliance with pharmaceutical legislation and ARV accreditation requirements for provincial health facilities; trains pharmacists and pharmacist assistants in basic principles of HIV and AIDS management; trains health personnel in conducting medicine use evaluations, using adherence to antiretroviral treatment (ART) measurement tools; supports the review of national standard treatment guidelines (STGs) for HIV and AIDS, TB, STI and other diseases; strengthens the provincial implementation of pharmaceutical therapeutic committees and medicine information centers; and strengthens pharmacovigilance reporting. The major emphasis area for these activities is training, but the project also includes logistics, human resources and policy and guidelines. Target populations include National AIDS Control Program staff, policy makers, public and private health care workers (especially pharmacists), people living with HIV (PLHIV) and their families, OVC and the general population of children, youth and adults. RPM Plus will work in all nine provinces to support national, provincial and local government pharmaceutical services.
Since FY 2004, RPM Plus has been working in close collaboration with the National Department of Health Pharmaceutical Policy and Planning (NDOH-PPP) Unit, and provincial and local government pharmaceutical services to support the delivery of pharmaceutical services at all levels. The following activities are a continuation of the activities initiated since FY 2004. Systems and models have been developed and tested. In FY 2007, RPM Plus will continue the implementation of these on a larger scale and monitor the impact on the delivery of ART at accredited sites. These activities have received the full support of the NDOH-PPP unit and the provincial pharmaceutical services.
ACTIVITY 1: Accreditation
RPM Plus will continue the assistance provided to all provinces in monitoring progress towards compliance with SAG legislative requirements to deliver pharmaceutical services and will contribute towards the accreditation of health institutions (hospitals, community health centers) to provide ART by strengthening the pharmaceutical component of the accreditation criteria. This addresses issues related to infrastructure, human resources, equipment and systems. This activity includes developing a monitoring system and conducting periodic reviews with the provinces, starting with a baseline assessment, and ending with compliance reports for provincial and institutional staff.
ACTIVITY 2: Pharmacovigilance The CCMT recognizes the importance of strengthening pharmacovigilance measures to ensure the safe and effective use of ARVs and other medicines used in HIV and AIDS patients. The identification, diagnosis, management and reporting of HIV medication-related adverse effects are critical. RPM Plus is working with the national and provincial health departments and other key stakeholders to develop training materials to meet this need. This training program builds capacity by providing skills and knowledge to HIV and AIDS program managers and the Medicine Regulatory Authority (MRA) on the principles of public health pharmacovigilance and the safety of antiretroviral agents. In addition, RPM Plus will assist and advise facility-based HIV and AIDS programs on the planning and implementation of pharmacovigilance surveillance activities, with subsequent follow-up at the provincial and national levels; support scientific research relating to key
drug safety issues identified in the region; assist in the communication of information obtained from pharmacovigilance systems and research managed by the national and local HIV and AIDS programs; and establish networks linking pharmacovigilance programs in the region with each other in order to encourage information exchange and skills transfer.
ACTIVITY 3: ART adherence
Since August 2005, RPM Plus has been working in collaboration with the national and Eastern Cape HIV and AIDS units and other key stakeholders to improve treatment outcomes and prevent resistance to antiretrovirals (ARVs) through the development of ART adherence measurement tools and determining best practices. These are being piloted and a national workshop is scheduled to take place in 2006. With FY 2007 PEPFAR funds, these tools will be implemented on a larger scale. Clinical staff (doctors, nurses and pharmacists) will be trained in providing: patient education on HIV, AIDS and ART; provider education on HIV, AIDS and ART; psychological and social screening of patients to assess readiness for treatment; and support services to facilitate resolution of barriers to adherence. These efforts will also contribute to the overall strengthening of the health system as medication adherence monitoring and support measures are generic tools that may be applied to settings providing treatment for other chronic diseases. In the long-term the goal is to develop a network of expertise and facilities, and establish South Africa as a Regional Pharmaceutical Technical Collaboration Center (RPTCC) for ARV adherence-related matters.
ACTIVITY 4: Review of STGs
The revised edition of the South Africa adult and pediatric STGs for the hospital level has just been published. These STGs include new chapters on HIV and AIDS care and treatment. RPM Plus will assist the NDOH in reviewing these STGs on an ongoing basis, and the provinces in promoting these new STGs. RPM Plus will also conduct provincial workshops on rational drug use; strengthen provincial, district and institutional pharmaceutical and therapeutic committees (PTCs); assist with the development of provincial formularies; and train staff in basic principles of pharmacy economics and the use of evidence-based principles for drug selection. Through these activities RPM Plus will also assist the DOH in reviewing their infection control policies and guidelines.
ACTIVITY 5: Down referral
There is a need to accelerate the implementation of the CCMT plan. One strategy of the NDOH is to down refer stabilized patients on ART to their nearest primary health care (PHC) facility. The other long-term approach is to initiate the treatment at the PHC level. RPM Plus will support these two critical initiatives by implementing and strengthening down referral systems and training pharmacist assistants on HIV and AIDS management and drug supply management.
ACTIVITY 6: Technical assistance to local counterparts
Since its start in 2003, RPM Plus has been regularly asked by government and non-government (e.g. South African Pharmacy Council) counterparts to provide ad hoc technical assistance for a wide range of services such as staffing norms for pharmaceutical services, accreditations of facilities, regulations and norms for dispensing practices, pricing committee implementation, and public-private partnership service level agreements. In FY 2007 RPM Plus will continue to respond to these matters and emerging issues such as managed care, low-income medical schemes, and monitoring and evaluation.
All these activities will build South African capacity and support the improvement of health services. This will contribute to the achievement the overall PEPFAR goals of reaching 10 million people with care and 2 million with treatment.
