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: 2008 2009
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:
This activity will no longer be implemented as the NDOH has decided to incorporate condom LMIS within
the NDOH pharmaceuticals. The IT component of the activity will be taken over by the NDOH IT Unit.
Therefore no FY 2009 funding is requested.
----------------------
SUMMARY:
John Snow Inc. (JSI), through the SCMS Project, will continue to support the STI, HIV and AIDS Prevention
Unit within the National Department of Health (NDOH) and provincial Departments of Health, by providing
logistics management technical assistance in the procurement, quality assurance, warehousing, distribution
and tracking of male and female condoms, targeting underserved, vulnerable and most at risk populations.
JSI has already begun an intensive capacity building phase and during FY 2007 period, the SCMS Project
will focus on human capacity development within the NDOH to make the condom distribution program
sustainable once funding comes to an end. Although it was anticipated that this process could be completed
in FY 2007, it is clear that given the NDOH's constraints in terms of hiring qualified staff, coupled with
substantial attrition of staff generally, that at least an additional year of USAID support will be required to
implement an effective transition that will ensure program sustainability. The need for continued support
beyond the original timeframe has been exacerbated from a programmatic perspective due to a recent
bribery and corruption scandal between the South African Bureau of Standards (SABS), where all public
sector condom batches are compliance-tested for quality assurance purposes, and a local manufacturer,
where some batches were passed for procurement and distribution by the SABS that actually failed quality
standards. After seven years of building public confidence and increasing condom distribution dramatically,
this scandal is likely to have a significant negative impact in terms of eroding this hard won public
confidence in the government's prevention program and the NDOH will need assistance in rebuilding public
perception. The emphasis area for this activity will be human capacity development through training, and
the target populations are youth, adults, family planning clients, the military and correctional services,
mobile populations (high transmission areas) and persons in sex work.
BACKGROUND:
In 2000 the NDOH requested USAID support in addressing two critical weaknesses in the South African
Government's (SAG) HIV prevention program relating to condom procurement and distribution: the poor
quality of condoms that were distributed in South Africa and the frequent and prolonged shortages and
stock-outs in the provinces - both problems which resulted in negative media towards, and an erosion of
public confidence in, the SAG HIV prevention program. JSI, co-located within the NDOH, and in close
collaboration with national and provincial counterparts, has successfully developed and implemented a
package of technical solutions to these two critical shortcomings. First, JSI-supported systems have
eliminated poor quality issues by ensuring compliance testing to World Health Organization specifications
and standards of all production batches regardless of local or overseas manufacture, thus guaranteeing that
only high quality public sector condoms are distributed in South Africa. Second, the JSI-developed Logistics
Management Information System (LMIS) has enabled the NDOH to eliminate shortages and stock-outs in
the provinces by establishing and servicing 172 primary distribution sites across all provinces. These two
achievements were crucial in empowering the SAG to sustain its HIV prevention focus in its response to
HIV and AIDS epidemic and maintain its long-term goal of ensuring that people, who are currently HIV-
negative, remain negative. PEPFAR funds will be concentrated on ensuring the NDOH's technical know-
how needed to efficiently operate the supply chain and sustain the focus on most at-risk populations.
ACTIVITIES AND EXPECTED RESULTS:
The funds originally destined for the USAID DELIVER Project will be reprogrammed under the SCMS
project. This decision was taken (effectively ending the USAID DELIVER Project presence in South Africa)
in order to reduce the Mission's financial burden of having two separate centrally-funded projects with
similar mandates and similar management structures. SCMS will continue to provide technical assistance in
the procurement, quality assurance, warehousing, distribution and tracking of approximately 30 million
condoms per month to sexually active youth, adults and family planning clients, with a particular focus on
non-traditional outlets for high risk, marginalized populations. SCMS will intensify efforts within the NDOH to
establish appropriate government posts for quality assurance and logistics management, and provide formal
and informal, on the job training. The expected result of this skills transfer is that the NDOH will be able to
fully operate and sustain the program once USG/LCS support ceases. It is recognized that it is critical from
the USG and SAG perspectives that this successful program is sustained into the future. SCMS will
contribute substantially towards the vision in the USG Strategic Plan for South Africa by building human
capacity within the NDOH in procurement, quality assurance, supplier contract management, warehousing
and distribution, while maintaining a zero stock-out rate for the primary distribution sites.
ACTIVITY 1: Supply chain strengthening at the Provincial level
This project will strengthen the condom distribution program at the provincial level, by engaging more
directly with provincial Departments of Health to further develop local organization capacity. In coordination
with the NDOH, SCMS will conduct an assessment of the supply chain at the Primary Distribution Sites that
the NDOH is responsible for servicing and at the secondary and community distribution sites. This will
include inventory control, good warehousing practices, reporting procedures, and distribution & tracking
systems. SCMS will synthesize practical recommendations in collaboration with provincial counterparts and
will provide TA as requested to implement supply chain best practices and standard operating procedures
(SOPs).
ACTIVITY 2: Provincial level LMIS development
Activity Narrative: During the re-development of the NDOH's LMIS in FY 2007, functionality will be added to allow provincial
access to the LMIS and information related to condom distribution nationally. Authorized users will be able
to report on condom distribution and inventory and will be allowed to generate management reports. In FY
2008 SCMS will facilitate the establishment of a provincial level LMIS that will enable more efficient
distribution and tracking of condoms to the secondary and community level outlets. This strategy will enable
the program to reach more people and promote improved reporting since the provincial DOH counterparts
will be given more responsibility for condom distribution management. This activity will include in-service
training in LMIS and logistics management.
New/Continuing Activity: Continuing Activity
Continuing Activity: 14260
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
14260 14260.08 U.S. Agency for Partnership for 6756 4132.08 $0
International Supply Chain
Development Management
Table 3.3.03:
John Snow, Inc.'s (JSI) Supply Chain Management System (SCMS) project does not plan on continuing
with this activity, as it involves expertise with patient information systems development, which is not a core
mandate of the SCMS project. However, while SCMS does not currently have the technical expertise or
staff in country to lead and oversee this type of initiative, SCMS has stated that they could continue this
activity if requested by the U.S. Government. Therefore no FY 2009 funding is requested.
----------------------------------
John Snow, Inc. (JSI), through SCMS, is using PEPFAR funds to strengthen ARV patient information and
reporting capabilities utilizing a system based on biometric fingerprinting to ensure data verification and
smart cards as a mobile, patient-retained medical record. The prototype system that was successfully pilot
tested as a proof of concept was named STAT (Secure Technology Advancing Treatment). SCMS is further
developing the STAT system as a cost-effective system that is both scaleable and sustainable. The
emphasis areas are human capacity development, local organizational capacity building and strategic
information. The primary target populations are people living with HIV (PLHIV) and public and NGO
healthcare providers.
The lack of verified program reporting data/performance indicators and use of cumbersome and often
incomplete paper-based patient medical records continue to present major challenges in scaling up
antiretroviral treatment (ART) programs. Under the DELIVER project, JSI developed a public-private
partnership with a local biometrics and smart card leader to design and field test a prototype patient
information and reporting system, named STAT, based on combination biometrics and smart card
technology. The system was successfully demonstrated in a static clinic environment and also in an offline,
remote, rural setting for both ART and care and support services. In order to address emerging issues
during the pilot phase around proprietary software, licensing fees, and data transmission costs, which made
large-scale implementation impractical, SCMS developed new partnerships in FY 2006 to continue the
development of the STAT system in an open source environment, eliminate licensing fees, and design a
data transmission mechanism that was both scaleable and sustainable. Specifically, SCMS partnered with
Right to Care (RTC), a leading PEPFAR-funded ART provider and their IT collaborator Therapy Edge, to
develop a smart card component in the context of a much needed down referral system where patients can
be down referred from specialist ART initiation sites to primary health care facilities. Of particular concern in
expanding ART services is the reality that large accredited ART sites are becoming overburdened with
patient follow-up and are struggling with the human capacity to add new patients. Under these
circumstances, the development of effective down referral systems where patients can receive follow-up
care and drug re-supply closer to their local communities is critical. The STAT system offers several crucial
components to a successful down referral model: from a clinical and quality of care perspective it enables
doctors who have stabilized ART patients to track patients over time, quickly assess them, and make
clinical treatment adjustments when patients are referred back to the initiating ART treatment site in case of
treatment failures; from a patient perspective it enables patients to easily access ARV services at multiple
service delivery sites; and from a program performance perspective, it enables program managers and
funding agencies to access verified (i.e. high quality) PEPFAR indicators at any time, providing virtually real
time reporting and strategic information capabilities. Using FY 2007, SCMS focuses on implementing the
solution at the RTC initiation site at Helen Joseph Hospital and several down referral sites that are currently
being identified. It is anticipated that this activity will result in a model demonstration system in which SCMS
will have developed an open source solution and a standard for smart card systems in health care. This
effort is important as the National Department of Health (NDOH) has included biometrics and smart cards in
its long-term strategic plan for developing an electronic patient medical record for South Africa. SCMS will
continue to build on their collaborative relationships with the SAG, and will also explore potential
deployment of the STAT system in private sector environments..
ACTIVITIES AND EXPECTED RESULTS FY 2008:
Specific activities will include STAT system training for ARV service providers, implementation and
maintenance of the STAT system at sites, and the development of sustainable financial support
mechanisms to ensure STAT remains after PEPFAR funding has been utilized to introduce the system and
provide the initial implementation. The focus of activities will include technical assistance and human
capacity development.
Activity 1: Technical Assistance
It is anticipated that once the demonstration system for down referral at RTC/Helen Joseph Hospital and its
down referral sites is fully operational and documented in FY 2007, that the Gauteng DOH will support
expansion of the down referral system across the province. This may involve the utilization of the Therapy
Edge/Smart Card as is from the demonstration site, or it may involve a full scale tendering process. Either
way SCMS will have made a significant contribution as even in the event of a tender, SCMS will be able to
provide the smart card standards that are required for successful systems development and integration. In
addition to Gauteng province, the Reproductive Health Research Unit (RHRU) and the Foundation for
Professional Development (FPD) have both expressed interest in the smart card concept to assist in down
referral systems development. SCMS will follow up on the feasibility of expanding the system to RHRU
and/or FPD sites once these PEPFAR partners and others have experienced and evaluated the
demonstration project
Activity 2: Human Capacity Development
Training on the patient information system for ARV service providers and data capturers will be conducted
Activity Narrative: for all those participating in the expansion program. Follow-up supervision and technical assistance will be
provided and evaluated. It is expected that overall quality of care will be improved by the system's ability to
track patient information including ARV initiation, drug regimen changes, and treatment outcomes. SCMS
will contribute significantly towards meeting the vision of the NDOH in developing an electronic patient-
retained record and will also contribute significantly towards meeting the vision of the USG PEPFAR Task
Force Five-Year Strategy for South Africa by providing a state-of-the-art system to facilitate the virtual real
time collection, analysis and reporting of the required PEPFAR M&E indicators for ART for thousands of
patients.
Continuing Activity: 14258
14258 8107.08 U.S. Agency for Partnership for 6756 4132.08 $0
8107 8107.07 U.S. Agency for Partnership for 4480 4132.07 Supply Chain $3,000,000
International Supply Chain Management
Table 3.3.09:
While a major activity for SCMS in most SCMS focus countries, procurement in South Africa is unique due
to the strict regulatory environment on parallel importing and registration of medicines. All medicines
procured need to be registered with the Medicinal Control Council (MCC) in South Africa besides the USG
FDA approval requirement. Procurement in South Africa takes place using local suppliers and at Single Exit
Price (SEP), a set price at which drugs must be sold. Thus the SCMS mechanisms to drive prices down
through use of generics and bulk buying directly from manufacturers do not apply to the South African
situation. This also means that this activity has been scaled back, and the activities below will be funded
using SCMS pipeline funds. Therefore no FY 2009 funding is requested.
In South Africa, John Snow Inc. (JSI), through the JSI/SCMS Project will also work closely and
collaboratively with Management Sciences for Health's (MSH) Strengthening Pharmaceutical Systems
(SPS) in order to ensure there is no duplication of effort between JSI/SCMS and MSH/SPS technical
assistance or other activities, JJSI/SCMS will work closely with the USG and MSH/SPS in coordinating work
plan development and implementation.
ACTIVITY 1: Drugs and Related Commodity Procurement
Upon request, JSI/SCMS will procure drugs and related commodities for PEPFAR-supported care and
treatment partners in consonance with USG agreements with the Government of South Africa regarding
adherence to SEP and will make these commodities available via the South African domestic market.
JSI/SCMS will continue to focus procurement activities with SANDF. JSI/SCMS started procuring ARVs for
the South African National Defense Force (SANDF) at the beginning of this reporting period using a locally
developed procurement strategy specific to the South African regulatory environment. As of end of July
2008, JSI/SCMS has processed a total of seven orders for the SANDF and one for the Centre for AIDS
Program Research in South Africa (CAPRISA). A total of 37,359 units at a value of ZAR 3.608 million
(roughly $533,000) have been procured to date.
JSI/SCMS was looking forward to assisting the provincial Government of the Western Cape (PGWC) with
ARV procurement, but application to Treasury made by PGWC for additional funds required to expand the
ARV program in that province was unexpectedly granted thus allowing for the expansion of ART services
without JSI/SCMS assistance.
JSI/SCMS will only explore the feasibility of procuring for other partners with the USG's concurrence. A
small amount of commodity funds have been put aside to assist with future ad hoc or emergency requests
from IPs, if necessary. JSI/SCMS will continue to assist implementing partners (IPs) with strategic supply
chain information and link them to relevant resources as requested and appropriate.
ACTIVITY 2: Assistance to the Provinces
Technical assistance (TA) to the provinces will focus on the following areas: warehousing, quality
assurance, inventory management, and distribution logistics management information systems. JSI/SCMS
will collaborate closely with MSH/SPS project to avoid duplications and to fill-in the gaps. TA will be
provided by local staff and partners with possible support from international JSI/SCMS staff. TA will focus
initially on Mpumalanga province where the Department of Health and Social Services has requested
JSI/SCMS assistance in establishing their new Provincial Pharmaceutical Depot in Middleburg. JSI/SCMS
has also been requested by the Limpopo Provincial Government to conduct an assessment of their depot
and to make recommendations on system improvements. Other provinces such as Gauteng have also
expressed interest along similar lines.
JSI/SCMS offers expertise in a comprehensive range of technical areas relating to warehousing and
distribution including needs assessment, capacity planning, structural and systems improvement, human
resource skills assessment and development, security and risk evaluation, standard operating procedures
(SOP) development, and Good Manufacturing Practices (GMP) audit process design.
While official government letters expressing interest in JSI/SCMS's technical assistance have been
received, no commitments have been made for these activities to date. JSI/SCMS has shared this
information with USAID and further actions will be considered only if provincial MOUs are secured.
ACTIVITY 3: Human Capacity Development
JSI/SCMS offers a unique training opportunity in supply chain management in collaboration with its South
African partner, the Fuel Group, as it has established a state-of-the-art pharmaceuticals freight forwarding
and logistics service at its Regional Distribution Center (RDC) in Centurion. This facility is also utilized as an
on-the-job training site. The Fuel Group's Pharmaceuticals & Healthcare Distributors (PHD) division
operates the RDC and offers warehousing and distribution training through practical, hands-on work in the
RDC itself.
---------------------------------
The Supply Chain Management Systems (SCMS) Project is tasked with supporting PEPFAR by
strengthening secure, reliable, cost-effective, and sustainable supply chains that procure and deliver high-
quality antiretroviral drugs (ARVs) and related commodities to meet the care and treatment needs of people
living with HIV (PLHIV). The major emphasis areas are human capacity development and local organization
Activity Narrative: capacity building.
In September 2005, SCMS was awarded an agreement by USAID to support PEPFAR in terms of
strengthening supply chains for ARVs and related commodities, with an initial focus on fourteen African
countries, including South Africa. In collaboration with in-country and international partners, the SCMS
mandate is to deploy innovative solutions to enhance supply chain capacity, ensure accurate supply chain
information is gathered, shared and used, and provide quality, best-value healthcare products. The SCMS
project team includes three organizations based in South Africa: the Fuel Group, where SCMS has
established a regional distribution center to service Southern Africa and beyond; North West University
which houses the only WHO-accredited quality assurance laboratory in sub-Saharan Africa; and Affordable
Medicines for Africa (AMFA) which has provided medicines to faith-based organizations throughout Africa
for many years.
The SCMS Project will work closely and collaboratively with Management Sciences for Health's (MSH)
Strengthening Pharmaceutical Services (SPS) project in assisting PEPFAR treatment and palliative care
partners to improve the cost-effectiveness of their supply chains for the following: ARVs and related
commodities, including drugs for opportunistic infections and palliative care; drugs for sexually transmitted
infections (STIs); drugs and supplies for home-based care; drugs for TB; rapid HIV test kits; laboratory
equipment and supplies; and other medical supplies. In order to ensure there is no duplication of effort
between SCMS and SPS technical assistance or other activities, SCMS will work closely with the USG in
coordinating work plan development and implementation. SCMS activities will focus on technical assistance
and human and organizational capacity building in supply chain management and related areas and is
prepared to assist the National Department of Health (NDOH) and provincial health departments should it
be requested.
Activity 1: Drugs and Related Commodity Procurement
Upon request, SCMS will procure drugs and related commodities for PEPFAR-supported care and
adherence to Single Exit Pricing (SEP) and will make these commodities available via the South African-
based Regional Distribution Center on an ongoing basis. All procurement will follow SEP pricing unless and
until the PEPFAR Task Force is open to SCMS attempting to leverage lower pricing in South Africa that the
project is able to secure through direct negotiations with manufacturers on a global basis. SCMS will also
provide quality assurance for all commodities procured through the regional distribution center utilizing
SCMS partner North West University drug quality assurance laboratories where appropriate. SCMS will
focus procurement initially on Western Cape and the South Africa National Defense Force (SANDF) but will
explore the feasibility of procuring for other provinces and PEPFAR treatment NGOs.
Activity 2: Technical Assistance
Technical assistance (TA) will focus on the following areas: quantification and forecasting, procurement,
quality assurance, freight forwarding and inventory management, distribution (including pharmacy services
for individual patient treatment packs), logistics management information systems, and assistance to
manufacturers and suppliers. TA will be provided by local partners as well as international SCMS staff. TA
will focus initially on Mpumalanga Province where the Departments of Health and Social Services has
requested SCMS assistance in establishing a Provincial Pharmaceutical Depot in Middleburg. SCMS will
explore similar opportunities in other provinces.
Activity 3: Human and Organizational Capacity Development
SCMS will provide training as requested in technical areas of supply chain management for both PEPFAR
treatment partners and provincial and NDOH counterparts. SCMS will take advantage of the in-house
capacity of the Fuel Group's state-of-the-art Regional Distribution Center facilities and supply chain
expertise, and the North West University's quality assurance laboratories and expert training staff to provide
hands-on training and experience in freight forwarding and inventory management and quality assurance.
Training will also be provided by international SCMS staff.
Activity 4: Pain and Symptom Control
Anecdotal evidence suggests that PLHIV in PEPFAR-supported care and treatment programs experience
pain and symptoms related to HIV disease, opportunistic infections and/or side effects of ARV therapy
which are not adequately addressed by health providers. Increasingly, ART clients are switched to second-
line ARV treatment regimens due to medication side effects or other symptoms, raising questions as to
whether symptoms could be more effectively managed first, without resorting to sudden changes in
treatment regimens. In FY 2007 SCMS will assist the USG PEPFAR Task Force and its partners to review
the occurrence of common symptoms and pain experienced by PLHIV, current strategies to manage
symptoms and pain, including indications for switching PLHIV to second line treatment regimens.
Activity 5: Western Cape Support
In FY 2007 Plus Up Funds will enable PEPFAR to assist the Western Cape Department of Health with
procurement of ARV commodities. Western Cape requested assistance from the USG to expand ART
services to 13 new sites covering an anticipated 800 children and 7,000 adults. Specifically Western Cape
requested trained ART staff for the new sites, funding to pay for the required HIV testing, and ARVs - the
USG in turn requested SCMS to procure the ARVs. SCMS has a procurement plan in place for this
procurement and is ready to initiate the procurement once Western Cape has approval from the National
Activity Narrative: Treasury to accept this donation within the strict tendering and related regulatory environment which
governs the pharmaceutical marketplace in South Africa.
FY 2008 COP Activities:
ACTIVITY 1: Procurement
If the Western Cape procurement is successful, it is anticipated that additional provinces will request
procurement assistance. For example, Limpopo Province is unable to keep pace with the influx of new ART
patients, many of whom are entering South Africa from neighboring countries, especially Mozambique and
Zimbabwe. Indeed the demand for services continues to outstrip the ability to respond across South Africa.
Clearly, provision of adequate supplies of ARVs will be critical to expanding the national response.
ACTIVITY 2: Technical Assistance
SCMS will continue to provide technical assistance (TA) in warehousing and supply chain. Assuming the
successful establishment of the Provincial Pharmaceutical Depot in Mpumalanga Province in FY 2007 (TA
already requested from SCMS), it is anticipated that additional provinces will request TA in warehousing
design, equipment specification, as well as inventory control, commodity tracking, and management
systems. SCMS offers expertise in a comprehensive range of technical areas relating to warehousing and
(SOP) development, and Good Manufacturing (GMP) audit process design. SCMS will also provide TA in
quantification, forecasting, quality assurance, and logistics management systems. SCMS will work closely
with SPS colleagues and the USG in coordinating these TA activities to ensure there is no duplication of
effort.
ACTIVITY 3: Training
SCMS offers a unique training opportunity in supply chain management in collaboration with its South
and logistics service at its Regional Distribution Center (RDC) in Centurion, and this facility is also utilized
as an on the job training site. The RDC is currently distributing PEPFAR-funded ARVs and related
commodities on behalf of SCMS to several sub-Saharan countries. The Fuel Group's Pharmaceuticals &
Healthcare Distributors (PHD) division operates the RDC and offers warehousing and distribution training
through practical, hands-on work in the RDC itself, where trainees learn about and experience best
practices in action and develop work plans for how their new skills and knowledge can be transferred to
practical systems improvements in their own workplaces in their home countries. Trainees to date have
generally been from national warehouses. In the South African context, where there is no national
warehouse, SCMS will offer the Warehousing and Distribution Excellence Course (one month) to interested
Provincial Depots, starting with Mpumalanga Province that has already requested technical assistance and
can benefit significantly from the RDC training. SCMS will contribute significantly towards meeting the
PEPFAR goals by assisting treatment and palliative care partners to establish and sustain secure, reliable,
and cost-effective supply chains of high quality products to meet the needs of HIV-infected care and support
and ARV treatment patients.
Continuing Activity: 14257
14257 7935.08 U.S. Agency for Partnership for 6756 4132.08 $4,849,952
7935 7935.07 U.S. Agency for Partnership for 4480 4132.07 Supply Chain $6,700,000
Table 3.3.15: