TITLE: Supply Chain Management for PMTCT

NEED and COMPARATIVE ADVANTAGE: The effectiveness of the set of interventions implemented under

the PMTCT program has long been recognized as a key component of a comprehensive response against

the HIV/AIDS pandemic. The main interventions includes counseling and testing pregnant women, followed

by the use of appropriate medications to women who test positive and to their newly born infants as

appropriate. Recent modifications of the guidelines for implementing the PMTCT program in Tanzania will

introduce more effective treatment protocols involving the use of combination therapy using Lamivudine and

Zidovudine. SCMS's capacity and expertise in this area will be of great use in leveraging activities for the

benefit of the PMTCT program.

ACCOMPLISHMENTS: The USG team has supported the strengthening of the drug and commodity logistic

system through implementation of the integrated logistic system and supporting the logistics management

of HIV Test Kits and related supplies. Activities undertaken include: rolling out the ILS in 5 regions, ARV

logistics training, annual quantification of ARVs, test requirements (including those for the PMTCT program)

and a review of these needs.

ACTIVITIES: The SCMS objective in the area of PMTCT is to support PEFAR programs in Tanzania

through the provision of high quality HIV/AIDS related commodities to support service delivery as described

in the National Standard Treatment Guidelines (STGs). This will include the quantification, procurement and

delivery of commodities to support of PMTCT activities. It will also include the Technical Assistance and

Logistics Capacity Building activities provided to the MOHSW and the Implementing Partners. The current

PMTC testing target is 750,000 clients, in 700 sites. SD Bio-line will be used as the screening test, and

Determine will be used as the confirmatory test. Treatment protocols will adhere to National STGs. In the

COP08, SCMS will undertake specific quantification of Test Kit and ARV needs for the PMTCT program. In

the past, these have been taken within the broader context of quantification of requirements for the NACP.

However with the modifications in the STGs for the PMTCT program, ARV commodity requirements will be

much higher and more comprehensive, demanding more specific attention in this area of work. SCMS will

procure PMTCT supplies and equipment including ARV prophylaxis for HIV infected pregnant women and

their infants, drugs for the treatment of Opportunistic Infections, Test Kits and other related laboratory

supplies. SCMS will work with the PMTCT Unit within the NACP to provide better tracking and

accountability for commodities used. This will be accomplished by building Supply Chain Management

capacity within the PMTCT program, through using existing models of Logistics management support within

the national program and continue the national roll-out of the Integrated logistics system. SCMS will work to

enhance the availability and quality of data on commodity usage for decision making and program

monitoring and planning.

LINKAGES: SCMS will continue to work with the NACP in quantifying requirements for testing commodities

and will inform the procurement plans developed for both the GOT's own resources and those obtained

through GFATM grants and other partners. SCMS will continue to share information and synchronize

procurement plans among the different partners to ensure coordination of commodity availability and an

uninterrupted supply of Test Kits and related supplies. In 2006/2007 Abbott made significant donations of

test kits to Tanzania in addition to the targeted donation for the PMTCT program. SCMS will provide support

to track donations of test kits and related supplies to avoid overstock. Other supplies, such as lancets,

gloves, etc. are as important to a testing program as are the test kits themselves. SCMS will work with the

MSD and donors to improve forecasting and procurement planning to ensure that there is the necessary

synergy between these supply sources.

M&E: Performance in this activity will be measured by the availability of supplies to support service delivery.

Quantities and volumes procured and distributed will be reported to track commodity performance. In part,

most of the M&E activities will be initiated from the Supply Chain Management Field teams.

SUSTAINAIBLITY: Capacity building in various areas of Supply Chain Management for PMTCT Supplies is

on-going through training of health care workers at various levels of the supply chain in functions relevant to

their work. Through support from SCMS for the roll out of the Integrated Logistics System (ILS); sites will

have greater control on the supply of commodities by determining their needs and placing orders consistent

with their requirements. Through Supply Chain Monitoring Teams, support will be provided directly to the

sites and the MSD zonal stores to improve logistics activities and generate a sustain and accurate reporting

system.

TITLE: Supply Chain Management Systems (SCMS) for Blood Safety

NEED and COMPARATIVE ADVANTAGE: Tanzania is establishing a centralized coordinated blood

transfusion system, which depends mainly on building a pool of voluntary non-remunerated blood donors

who are mainly recruited through mobile sessions. In the past, the recruitment and intake information was

often collected through paper-based tools which are eventually recorded into a computer database. The

process is time consuming, requires a lot of labor, and has a very large potential for transcription error. In

FY 2008, the National Blood Transfusion Service (NBTS) is looking to explore various methods to automate

some of the recruitment processes by utilizing personal digital assistant (PDA) equipment in the field, which

would enable users to send information back to the central computer database at the mere click of a button.

With long-standing capacity and experience in negotiations concerning the supply chain management,

SCMS will support the NBTS to procure and instal PDA equipment.

ACCOMPLISHMENTS: SCMS has experience in procurement of different items for PEPFAR supported

programs. In FY08 NBTS plans to ease the process of data collection in the field especially in mobile

donation sessions through use of PDAs.

ACTIVITIES: SCMS will procure PDAs for integration, convenience, and accuracy of many different types of

data.

LINKAGES: This activity is closely linked to NBTS-PPP-phone for health, and NBTS-RPSO-Renovation

M&E: Performance in this activity will be measured by the availability of supplies to support service delivery.

Quantities and volumes procured and distributed will be reported to NBTS headquarters in order to track

performance, assess convenience of electronic tools compared to manual tools for information transfer.

TITLE: Supply Chain Management for Counseling and Testing

NEED and COMPARATIVE ADVANTAGE:

Counseling and Testing services have formed the bedrock of HIV AIDS interventions in Tanzania. New

interventions introduced recently such as the National Testing Campaign in 2007 aimed at testing over four

million individuals over a period of 4 - 5 months and PITC occurring at a time when a new national testing

algorithm has just been introduced and training is ongoing, highlights the challenges in supply chain

management and the need for significant technical support to the national program in the area of logistics

management. SCMS has the technical expertise and comparative advantage in this area. Tools for

quantification and procurement planning as well contracts with manufacturers as exists within the SCMS

project will be a useful resource.

ACCOMPLISHMENTS: USG has supported the logistics management of HIV test kits and related supplies

through quantification of annual requirements and periodic review of these needs vis-à-vis the trends

observed by monitoring trends of national usage in FY 2006 and FY 2007 and will continue to be provided

into the future. The introduction of new initiatives such as provider-initiated counseling and testing, as well

as testing campaigns, heightened the need for closer monitoring of stocks.

ACTIVITIES: While SCMS does not provide direct services to clients in counseling and testing, its work

provides crucial support to ensure the availability of products for all service provider partners in this area.

SCMS works with the NACP to collect information on test kit availability and usage and conducts analysis of

this data as a basis for determining the requirements for HIV test kits and related supplies. This includes the

use of State-of-the-art technology and the knowledge of the nature of these commodities to inform decisions

on forecasts. SCMS has deployed the ProQ software application in Tanzania and will continue to support

the use of this tool and others for the production of robust quantifications.

The policy on provider initiated counseling and testing provides for a more proactive identification of HIV

infected persons and their subsequent recruitment into the care and treatment program. This innovative

approach is projected to become the more dominant area of use for HIV test kits by the start of the COP

2008 year. There is the need for a nimble and agile supply chain to meet the needs of this activity within the

HIV care and treatment program. SCMS proposes to support the development and implementation of a

strengthened laboratory logistics management system within the broader framework of the integrated

logistics system. This will lead to a stronger use-driven, order-based, and accountable supply system for

commodities required for counseling and testing services.

Building on linkages and collaboration with other partners in this area will be crucial for a successful

transformation of the laboratory logistics system from its current state to the desired. It is projected that

$4,800,000 of these funds will be for procurement of commodities.

LINKAGES:

SCMS will continue to work with the NACP in quantifying requirements for testing commodities and these

will inform the procurement plans developed for both the GOT's own resources and those obtained through

GFATM grants.

SCMS will continue to share information with the Japanese International Cooperation Agency (JICA) and

synchronize procurement plans to ensure that commodity availability is coordinated to ensure an

uninterrupted supply of test kits and related supplies.

In 2006/2007 Abbott made significant donations of test kits to Tanzania in addition to the targeted donation

for the PMTCT program. SCMS will provide support to track donations of test kits and related supplies to

achieve this end.

Other supplies such as lancets and gloves are as important to a testing program as are the test kits

themselves. SCMS will work with the the medical stores department (MSD) to improve its forecasting and

procurement planning for these to ensure that the necessary synergy between these supply sources is

optimized.

M&E: Performance in this activity will be measured by the availability of supplies to support service delivery.

Quantities and volumes procured and distributed will be reported to track performance.

SUSTAINABILITY:

Capacity building in various areas of supply chain management for HIV testing supplies is on-going through

training of health care workers at various levels of the supply chain in functions relevant to their work.

Through support for the roll-out of the integrated logistics system sites will have greater control on the

supply of commodities by determining their needs and placing orders consistent and with their use. Through

supply chain monitoring teams, support will be provided closer to sites and the MSD zonal stores to improve

logistics activities.

TITLE: Procurement and Supply Chain Management of ARV Medicines.

NEED and COMPARATIVE ADVANTAGE: There are 200 care and treatment centers providing

antiretroviral therapy, expected to increase to over 700 sites during 2007. The Supply Chain Management

System (SCMS), supported by the USG, has provided technical assistance in forecasting and procurement

of antiretroviral (ARV) drugs. More that 100,000 patients will be on ARV treatment by the start of the FY

2008, and the need for dependable forecasting and quantification services will be ever more crucial to the

success of the national care and treatment program. It is also critical that technical assistance be provided

to align the multiple sources of funding for drugs and related commodities, and ensure a smooth functioning

distribution system from port to patient. SCMS has the technical expertise and comparative advantage in

this area. Tools for quantification and procurement planning, as well as a global framework and long term

contracts with manufacturers, will be crucial for scaling up and maintaining ARV availability in the future.

ACCOMPLISHMENTS: All the USG procurements during the past year have been done through SCMS and

its partners. USG support, through SCMS, has ensured that the Tanzania ARV treatment program has not

experienced any stock-out situation since its inception in October 2004 and SCMS is committed to

maintaining this level of performance.

ACTIVITIES: With FY 2008 funding, key SCMS activities include:

1) Procurement of ARVs: procurements are divided between the Government of Tanzania (GoT) and USG,

based on a Memorandum of Understanding (MOU). For ARVs that will be procured by the USG as its

contribution to the pool, SCMS will be the procurement mechanism. Nearly 85% of the total budget is for the

ARV procurements.

2) National quantification and procurement planning activities for ARV supplies: this will involve working

with the National AIDS Control Programme (NACP) and the Medical Stores Department (MSD) to

accurately quantify all ARVS for first- and second-line patients.

3) Strengthening of the logistics system: ARVs supplies are delivered to the Care and Treatment Clinics

(CTCs) through a PULL system, which has sites placing orders monthly and MSD making shipments

directly to the sites through a system of Report and Requests submitted monthly. The system has an in-built

buffer stock at the site level to make up for growth in consumption and to provide for the time taken for order

processing and delivery by MSD. While no major breakdowns affecting service delivery has occurred to

date, the system is not as smooth running as desired. SCMS will provide training of new sites and refresher

training as well as make improvements to the system to enhance efficiency

Also, in late FY 2007, SCMS will establish a Supply Chain Monitoring Teams in all the MSD zones in the

country. These teams will provide logistics capacity building support to CTCs and their respective MSD

zonal stores, as well as Regional and Council (district) Health Management Teams. Support through on-the-

job training and coaching will enable sites to implement tasks in logistics management as required. SCMS

will foster collaboration with other partners in the area of clinical care to enhance the overall quality of care

delivered at the CTCs. By partnering with Care and Treatment partners in the regions, comprehensive site

support will be provided to CTCs.

4) Complete the implementation of the Integrated Logistics System (ILS): the ILS has now been

implemented in seven regions, and several more are in transition to the ILS. For cost-efficient handling of

commodities, facilities need to have greater control of the supply of commodities by determining their

specific needs and placing orders consistent and with their use (i.e., phase out the pre-packed kit system).

The USG will support expansion of this system into the remainder of regions by the end of 2008.

5) Address program complexities: the expansion to over 700 sites delivering ART services will require a

rethink of some of the technical aspects of the distribution system in place. For instance, the need for MSD

to deliver to all 700 sites on a monthly basis with all the complexities introduced by late and non-reporting

and a lack of synchronization of reporting and delivery times will make the ARV logistics system

cumbersome and difficult to implement.

6) Develop/strengthen a Pharmacovigilance system: In March 2007, the World Health Organization put out

an alert about some of the untoward effects associated with the use of Stavudine 40mg formulations. This

and other events, such as the recall of Viracept formulations in April/May 2007, prompt discussions on the

recommended treatment guidelines and the need to put out guidance from the national level to guide

clinicians in their work across the nation. Such events also often highlight the lack of a systematic

mechanism of collecting and reporting data on drug use at the country/local level to guide such discussions.

SCMS will work with the Ministry of Health and Social Welfare/Tanzanian Food and Drug Authority/NACP to

develop/strengthen a national Pharmacovigilance system for collecting important data on the use of ARVs

at the national level to guide decision making on safety, efficacy and related matters derived from

widespread use of these drugs in the population.

LINKAGES: SCMS works very closely with the NACP and provides technical leadership and capacity

building in Supply Chain Management functions. Strong collaboration with the MSD is also essential to

strengthen the warehousing and distribution of ARV drugs. The design and implementation ARVs Logistics

Management Information System are done in concert with these two key partners. Annual national forecasts

are conducted and procurement is either by GoT or USG, dictated by the terms of an MOU between the

USG and the GOT. SCMS is the procurement mechanism used by the USG and this is expected to remain

so in FY 2008 period, though SCMS is expecting to play a larger role in mobilizing the drug procurement

funds from other donors. PEPFAR Treatment Partners obtain their supply of ARVs from the national pool of

drugs. Capacity of Partner-supported sites to manage the logistics system adequately has been ensured

through system strengthening activities by SCMS.

CHECK BOXES: As more sites are trained to implement ART services (nearly all of the 700 sites will soon

be under the USG treatment partners), SCMS will continue to support the capacity building of these sites in

Supply Chain Management.

M&E: Performance in this activity will be measured by the availability of supplies to support service delivery.

Quantities and volumes procured and distributed, as well as stock out situations, will be reported to track

Activity Narrative: performance.

SUSTAINAIBLITY: Capacity building in various areas of Supply Chain Management for ARV medicines is

ongoing through training of health care workers at various levels of the supply chain in functions relevant to

their work. Through support for the roll out of the Integrated Logistics System sites will have greater control

on the supply of commodities by determining their needs and placing orders consistent and with their use.

Through Supply Chain Monitoring Teams, support will be provided closer to sites and the MSD zonal stores

to improve logistics activities.

TITLE: Support for Treatment /ARV Services

NEED and COMPARATIVE ADVANTAGE:

The low coverage of ARV treatment services are widely recognized. Less that 20% of Adults and 15% on

children in need of ARV currently receive the service. The provision of Co-trimoxazole for the

chemoprophylaxis of opportunistic infections in HIV positive persons have long been demonstrated as a

cost-effective intervention. The treatment of opportunistic infections is known to slow the progression of the

disease and to provide an enhanced quality of life to people living with HIV. With its positioning in the supply

sector, SCMS will be able to procure and distribute high quality pharmaceuticals to support the HIV AIDS

services of all treatment partner

ACCOMPLISHMENTS: Quantification of all the key commodity requirements for the care and treatment

program within NACP was completed in May 2007 through technical support from SCMS. Among these are

Co-trimoxazole and other medicines for the treatment of OIs. Support has also been provided to coordinate

procurement plans for GOT, USG and JICA to improve commodity availability. This type of support will be

increased in COP 08

ACTIVITIES

Collection of data on commodity use and analyzing these for use as the basis for forecasting requirements

is crucial for ensuring uninterrupted supply of drugs and related commodities for HIV/AIDS care. Beyond the

quantification of requirements, procurement planning and its implementation has been weak in the past

years. The result has been that the effective and known strategy of cotrimoxazole prophylaxis has not been

universally implemented as will be desired. SCMS will work on improving the policy development and

implementation on the use of cotrimoxazole prophylaxis as well as undertake commodity procurements

where necessary to support this initiative. In addition to making adequate quantities of the products

available at the central level, internal distribution bottlenecks contribute significantly to the poor performance

at the service delivery level. Similar support will be provided in respect of other commodities necessary for

the provision of care to HIV/AIDS patients. Through support for the ILS and the use of SCMTs, SCMS will

improve commodity availability at service delivery levels by improving logistics management.

Focus will be on the provision of uninterrupted supply of cotrimoxazole through effective procurement and

strengthened in-country distribution systems for us at all care and treatment centers for the benefit of HIV

positive individuals, HIV-TB co-infected patients, pregnant women who are HIV positive and HIV exposed

children

Most of the commodities for the management of OIs are the routinely used essential medicines. SCMS will

work with the Pharmaceutical and Supplies Unit (PSU) of the MOHSW to build capacity in the area of

logistics management to improve the availability and use of essential medicines. $2,000,000 of the funds

requested will be used for commodity procurements while the remaining is used in the provision of TA

LINKAGES: Collaboration will be fostered through the NACP as the coordinating entity with all Care and

Treatment sites. Implementing partners including track one partners will be engaged for the success of this

intervention.

CHECK BOXES:

M&E: Performance in this activity will be measured by the availability of supplies to support service delivery.

Quantities and volumes procured and distributed will be reported to track performance

SUSTAINAIBLITY: Capacity building in various areas of Supply Chain Management for HIV Supplies is on-

going through training of health care workers at various levels of the supply chain in functions relevant to

their work. Through support for the roll out of the Integrated Logistics System sites will have greater control

on the supply of commodities by determining their needs and placing orders consistent and with their use.

Through Supply Chain Monitoring Teams, support will be provided closer to sites and the MSD zonal stores

to improve logistics activities

TITLE: Supporting Laboratory Infrastructure Development

NEED and COMPARATIVE ADVANTAGE: Laboratory support for a comprehensive HIV care program

cannot be overemphasized. A National HIV Quality Assurance Laboratory and Training Center is being

developed to address parts of this need. There is need for the provision of uninterrupted supplies of

reagents and other supplies needed for the smooth running of the laboratory. SCMS is positioned to

undertake these procurements and to assist in the quantification and re-supply of reagents and supplies.

ACCOMPLISHMENTS: In 2007 USG provided for support for the procurement of various reagents and test

kits for HIV surveillance. These include the HIV Rapid test Kits and ELISA kits, PCR, CD4 count, Chemistry

and Hematology as well as tests for Syphilis, Hepatitis and opportunistic infections. Funds intended for this

activity will be used in FY 2008 since the quality assurance and training centre laboratory was not yet ready

in FY 2007.

ACTIVITIES: Under guidance of the USG team SCMS will undertake technical capacity building in Supply

Chain Management and provide procurement support to the National Quality Assurance and Training

Center.

Commodity groups will include various laboratory supplies, reagents and kits for HIV rapid testing, ELISA

kits, PCR, CD4 count, Chemistry, Hematology, Hepatitis, Syphilis and other opportunistic infections will be

procured.

In FY 20O8 As the NQA&TC becomes fully functional, it is envisaged that emergent needs relating to the

laboratory platforms and testing technologies will arise. SCMS will collaborate with information sharing in

respect of the logistics implications, such as cold chain, open or closed systems, etc of selecting particular

platforms and technologies, to inform choices made.

SCMS will build capacity in the implementation of an appropriate logistics management information system

for the management of commodities used in the lab, such as reagents, test kits and supplies.

LINKAGES: Work in this area will be coordinated mainly through CDC, the Laboratory and Diagnostics unit

of the MOHSW and the NHQALTC. The national laboratory network will be served through a referral system

of testing providing unusual reactions such as indeterminate reactions for HIV

CHECK BOXES: SCMS work in this area is mainly for procurement and system strengthening in nature.

Performance will be measured and reported in overall procurement values. However indicators in the area

of Lab infrastructure will be reported by service providing partners.

SUSTAINAIBLITY: Sustainability will be achieved through capacity building and transfer of skills in supply

chain activities to the management and staff of the NHQATC. The envisaged close technical cooperation

with the personnel of the lab will assure all activities are done in a collaborative manner and skills in

forecasting and quantification are transferred.

TITLE: SCMS - Personal Digital Assistants (PDAs) for surveillance and surveys

NEED and COMPARATIVE ADVANTAGE: Targeting the response against the HIV pandemic requires a

clear understanding of the epidemic and any changes that may be occurring in the rates of infection and

distribution with the population. Over the years, USG has provided support to the National AIDS Control

Program (NACP) for the surveillance activities. Through funding for the antenatal clinic (ANC), HIV Sentinel

annual survey, and the HIV Drug Resistance (HIVDR) monitoring, USG support has fostered a better

understanding of HIV in Tanzania and helped guide efforts in the fight against the epidemic. With the

expansion of programs and strengthening of monitoring systems, USG is introducing technologies to

improve the flow, feedback and dissemination of data through the establishment of the Phones for Health

system. SCMS will provide some of the equipment necessary to build the various components of this

national system. Commodity requirements to support surveys are crucial to the success of these activities,

and SCMS provides novel supply chain solutions for these commodities.

ACCOMPLISHMENTS: Previous funding in this area were used for the procurement and supply of a range

of commodities, including Rapid Test Kits, Enzyme-linked immunoassay (EIA) test kits, filter paper, pipettes,

dried blood spot (DBS) cards, and gloves, Providing technical support for the supply chain management

activities involved in the distribution and use of these commodities was crucial to the success of the ANC

surveillance. The funding was also used to purchase personal digital assistants (PDAs) for use of ART site

assessments.

ACTIVITIES: SCMS will procure PDAs and supporting equipment for data collection activities in Tanzania.

This will be developed from the program or work plan for the implementation of the ANC surveillance and

other surveys, such as the HIVDR threshold survey.

LINKAGES: The activity supports planned NACP activities