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 NARRATIVE HAS BEEN COMPLETELY REVISED
TITLE: Supply Chain Management Systems (SCMS) for Blood Safety
NEED and COMPARATIVE ADVANTAGE: Tanzania is establishing a centralized coordinated blood
transfusion system, which largely depends on a pool of voluntary non-remunerated blood donors who are
recruited through mobile sessions. The need for dependable forecasting, quantification and procurement
services will be even more crucial to the success of the national blood 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 enable SCMS to provide procurement
services to the National Blood Transfusion Service (NBTS) to assure availability of blood service supplies
and reagents in the future.
ACTIVITIES: In FY 2008, the National Blood Transfusion Service (NBTS) is establishing a centralized
transfusion transmittable infection (TTI) testing and expanding blood components production. This
expansion requires the continuous availability of test kits, reagents and other supplies to complement the
supplies purchased through the government Medical Store Department (MSD). In consultation with the
National Blood Transfusion Services (NBTS) SCMS will assist in procuring test kits, reagents and selected
supplies for blood screening and component production. This procurement assistance will be important as
the NBTS expands its coverage to not only meet the increasing demand for blood in referral and regional
hospitals , but also to district hospitals and health centers that are not currently reached. A recent
quantification done by NBTS for 2007-2008 showed an expected increase in demand each year.
ACCOMPLISHMENTS: In 2008 SCMS has been ask to procure and install personal digital assistant
(PDAs) for the NBTS. Additional PDAs are requested to be procured and installed through SCMS with 2009
funds. These procurements will contribute to the development of additional satellite blood collection sites in
2009 increasing the capacity of the national program.
LINKAGES: This activity is closely linked to NBTS-PPP-phone for health, NBTS-RPSO-Renovation, and it
will be closely managed by the appropriate technical leads on the USG team.
M&E: Performance in this activity will be measured by the availability of supplies and PDAs to support
service delivery. Quantities and volumes procured and distributed will be reported to NBTS headquarters in
order to track SCMS's performance.
New/Continuing Activity: Continuing Activity
Continuing Activity: 16510
Continued Associated Activity Information
Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds
System ID System ID
16510 16510.08 U.S. Agency for Partnership for 6548 4790.08 $34,450
International Supply Chain
Development Management
Table 3.3.04:
THIS IS A NEW ACTIVITY.
TITLE: Injection Safety
NEED AND COMPARATIVE ADVANTAGE: To help promote injection safety, the safe handling and
processing of sharp instruments, and the correct handling and disposal of medical waste; SCMS will utilize
its expertise in bulk procurement to supply IPC/IS commodities to the Ministry of Health and Social Welfare
through the IPC/ IS project and all Public and Faith Based health facilities for preventative services.
ACCOMPLISHMENTS: This is a new activity; therefore, there are no accomplishments to report from FY
2008.
ACTIVITIES: SCMS's work in this area will primarily focus on the procurement of commodities such as
single use needles, sharps boxes, protective boots, utility gloves, plastic aprons, color coded bin liners, and
disinfectant solutions for curative and preventive services as requested by the Ministry of Health and Social
Services
In FY 2009, SCMS will focus on the managers responsible for forecasting and procurement to ensure the
right types and quantities of injection safety and infection prevention commodities are promptly procured
and delivered. An emphasis will be placed on the transfer of IP/IS commodity management skills to key
health center workers who manage health centers commodities and can work routinely with phlebotomists,
health care workers, and clinical waste handlers to improve stock keeping practices that fit health facilities
demands.
SCMS will work with the MOHSW, the MSD and partners by ensuring districts understand the procedures
for re-supplying and reporting on stock data in a routine manner. SCMS will rely on the MSD to distribute
commodities for the injection safety programs, it is expected that distribution will improve with improved
inventory reporting.
LINKAGES: SCMS will work with Ministry of Health and Social Welfare (MOHSW), Center for Disease
Control(CDC), World Health Organization(WHO), Medical Stores Department(MSD), Tanzanian Food and
Drug Authority (TFDA) and Tanzania Bureau of Standards(TBS) to select approve procure and distribute
products that promote injection safety to help mitigate the spread of HIV.
SUSTAINABILITY: SCMS will also enhance ownership and sustainability of the injection safety commodity
system with the MOHSW, the MSD and partners by ensuring districts understand the procedures for
budgeting, re-supply and reporting on stock data in a routine manner. By improving the ability of the GOT
and other partners to forecast, procure and distribute injection safety and infection prevention supplies,
these programs will become more self-sustaining.
New/Continuing Activity: New Activity
Continuing Activity:
Table 3.3.05:
ACTIVITY HAS BEEN REVISED SIGNIFICANTLY FROM FY 2008 COP.
TITLE: Supply Chain Management of Key HIV/AIDS Care Commodities
NEED and COMPARATIVE ADVANTAGE: Only a small fraction of the estimated 2.4 million people living
with HIV/AIDS in Tanzania receive palliative care. While USG programs serve over 400,000 enrolled
patients through community home-based care (HBC), a large proportion of these programs do not have the
full supply of commodities needed to provide both facility and home-based care services. To support a basic
package of care services through PEPFAR implementing partners, the USG will procure needed medicines,
medical supplies and other essential commodities for palliative care programs through SCMS while
strengthening the system for managing these drugs.
The essential drug system in Tanzania is currently very weak primarily because it is under-resourced. The
essential drug logistics management information system does not provide reliable data at the central level
for planning, and if reliable data did exist, there is currently insufficient funding to provide a full supply of
critical OI drugs for all health programs operating within the national health system. The procurement of OI
drugs depends primarily on the availability of funds from the Government of Tanzania (GOT) which is
largely dependent on Global Fund. The most recent quantification of OI drugs done in May 2008 by
National Aids Control Program (NACP) with technical assistance provided by SCMS estimated the national
OI drug requirements for 2009 to provide all HIV patients on treatment and identified infected individuals
with cotrimoxizole prophylaxis and other OI treatments to be 23,617, 685 USD. There are Global Funds
available to cover 2 million USD and the USG plans to cover another 2 million of the 2009 requirement.
GOT is tackling this challenge of a funding gap of 19 million USD through Global fund Round 8. However,
PEPFAR implementing partners will continue to experience unreliable OI supplies until additional funding
from Global Fund or other donor sources is secured.
ACTIVITIES: In order to improve the supply of OI drugs, the USG will procure 2 million USD worth of
cotrimoxizole or other OI drugs as requested by GOT. Because these drugs will be donated to the MSD
system for distribution within the country; SCMS will also work closely with MSD and NACP to strengthen
the logistics management information system for these commodities. The logistics management
information system requires care and treatment centers to report on inventory and ordering of essential
medicines to regional MSD stores. The regional MSD stores have stocks of OI drugs available for free
distribution through the public sector. MSD also maintains a supply of OI drugs from private sources that
may be purchased by facilities. Poor ordering and management practices at some HIV/AIDS centers create
challenges in accessing the free supplies of OI drugs. SCMS will provide targeted technical assistance at
identified care and treatment centers with identified challenges to assist them in submitting correct and
timely order forms to allow delivery of free MSD stocks for distribution at the care and treatment centers. It
is expected this work will improve forecasting and procurement planning, but there will still be a gap in the
supply of critical drugs which the USG will work closely with GOT in coordination with SCMS to find a
funding solution to meet the overall national OI drug supply need.
ACCOMPLISHMENTS: In FY 2008, SCMS procured cotrimoxizole and worked closely with MSD and NACP
to strengthen the logistics management information system for essential medicines.
LINKAGES: This activity links directly with other care and treatment partners who will utilize the
commodities in their programs. The activities will also link closely with MSD and NACP.
Geographic Coverage Areas: (Regions)
National
April 2009 Reprogramming:
$200,000 reprogrammed from DOD/WARAIR HTXS ($50K from mech id 1138.09, $75K from mech id
1135.09, and $75k from mech id 1139.09) to support procurement of lab reagents through SCMS,
Continuing Activity: 13559
13559 9237.08 U.S. Agency for Partnership for 6548 4790.08 $2,500,000
9237 9237.07 U.S. Agency for Partnership for 4790 4790.07 $1,864,000
Table 3.3.09:
ACTIVITY HAS BEEN MODIFIED IN THE FOLLOWING WAYS:
NEED and COMPARATIVE ADVANTAGE: Counseling and Testing services have formed the bedrock of
HIV AIDS interventions in Tanzania. The roll-out of the new National Testing Campaign by the GOT aimed
to reach over 4 million individuals. New guidelines on Provider initiated testing and counseling (PITC) has
come when a new national testing algorithm has been rolled out to service sites. These changes compound
the needs and challenges associated with the strengthening of supply chain management systems for test
kit commodities, and the need for technical support to the national program in the area of logistics
management. SCMS has the technical expertise and comparative advantage in this area. SCMS offers the
USG the appropriate tools for the quantification and procurement of rapid test kits, as well as the needed
technical assistance.
ACCOMPLISHMENTS: The USG supported the procurement and management of HIV test kit supplies
through the annual quantification and periodic review of the test kit needs. SCMS procured 51 percent of all
test kit procurements in Tanzania in 2008, while the GOT and the Japanese International Cooperation
Agency (JICA) covered 49 percent of the procurements. Increased trends in testing have resulted from the
successful national testing campaign, introduction of PITC and expansion of PMTCT all of which USG
supported. This has heightened the need for SCMS to provide continued support in monitoring of test kit
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.
The policy on PICT provides for a more proactive identification of HIV infected persons and their placement
into the care and treatment program. This approach to HIV testing is projected to increase the number of
HIV test kits used in the COP 2009 year. It is projected that $1,037,500.00 of these funds will be for
purchase of test kits while the remainder will cover the cost associated with procurement and transportation
of the test kits to MSD in Tanzania. In accordance with the national testing guidelines, SCMS will procure
SD Bioline for screening tests; as well as Determine for confirmatory tests and finally Unigold for any tie-
breaker tests that are needed. With COP 2009 support, SCMS will determine test kit product purchase mix
in consultation with GOT. All test kits that are procured for the national program are provided to the Medical
Stores Department which distributes the kits to zonal stores and then testing sites.
SCMS works with NACP to collect information on test kit availability and usage. The project conducts an
analysis of the data as a basis for determining the national requirements for HIV test kits and related
supplies. 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. There is the need for a responsive re
-supply system that procures on a timely basis for HIV testing programs. SCMS will support the
development and implementation of a strengthened laboratory logistics management system within the
framework of the integrated logistics system (ILS). The ILS will improve forecasts by making them more
data driven and reflective of data on test kit usage and ordering.
LINKAGES: SCMS will continue to work with NACP in quantifying requirements for testing commodities;
including the procurement plans developed for both the GOT's own resources and those obtained through
GFATM grants.
SCMS continues to share information with JICA and synchronize procurement plans to ensure commodity
availability is coordinated and to ensure an uninterrupted supply of test kits and related supplies. 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 medical stores department (MSD) to improve its forecasting and procurement
planning for these to ensure that the necessary synergy between 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, including
the timeliness of SCMS procurements.
SUSTAINABILITY: Capacity building in supply chain management for HIV testing supplies is ongoing
through the training of health care workers at various levels 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 with their use. Through supply chain
monitoring advisors that are positioned in zonal stores, support will be provided to sites and the MSD zonal
stores to improve logistics activities and to improve reporting and overall data quality.
*END ACTIVITY MODIFICATION*
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.
Activity Narrative: ACTIVITIES: While SCMS does not provide direct services to clients in counseling and testing, its work
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
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.
Continuing Activity: 13557
13557 8667.08 U.S. Agency for Partnership for 6548 4790.08 $2,500,000
8667 8667.07 U.S. Agency for Partnership for 4790 4790.07 $600,000
Table 3.3.14:
ACTIVITY HAS BEEN REVISED SIGNIFICANTLY FROM FY 2008 COP
TITLE: Procurement of ARV Medicines
NEED and COMPARATIVE ADVANTAGE: There are currently 234 care and treatment centers providing
antiretroviral therapy, and the GOT hopes to increase the total number of sites to over 700 in 2009. The
Supply Chain Management System (SCMS), supported by the USG, has provided technical assistance in
forecasting and procurement of antiretroviral (ARV) drugs for treatment and PMTCT. The GOT political
leadership has set a goal of placing 440,000 patients on ARV treatment by the end of 2009. The need for
dependable forecasting and quantification services will be crucial to the success of the national care and
treatment program goal. 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 ARV procurements during the past year have been done through
SCMS and its partners; amounting to over eighteen million dollars of ARVs in 2008. This amounts to nearly
22 percent of the total estimated ARV need in Tanzania. USG support, through SCMS, has ensured that
the Tanzania ARV treatment program has not experienced any major stock-outs.
ACTIVITIES: With FY 2009 funding, the key SCMS activity in this program area will be the procurement of
ARVs. The funding for the ARV supply for the national program is generally divided between the
Government of Tanzania (GOT) via Global Fund and the USG, with contributions from the Clinton
Foundation and other donors. The USG's share of procurement is based on a Memorandum of
Understanding (MOU) with the GOT. According to the MOU, the USG's contributions are second line ARV
drugs with the ability to provide limited emergency procurements of first line ARV. $17,321,752.35 of the
budgeted amount contained in this activity will be used for the purchase of ARV drugs; $500,000 of which is
specifically allocated for the support of PMTCT services. The remainder of the budget will cover the cost
associated with procurement and transportation of the drugs to the Medical Stores Department (MSD) - the
central medical stores in Tanzania.
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
strengthening the warehousing and distribution of ARV drugs. National forecasts for ARVs and other drugs
are conducted annually and revised quarterly, after which the GOT and USG revise the supply plan and
split the procurement according to the MOU. PEPFAR Treatment Partners obtain their supply of ARVs from
the national pool of drugs which is managed by the MSD. SCMS will be focused on strengthening the
capacity of the GOT, other partners and will coordinate with other donors to ensure the ARV supply system
is strengthened. A more detailed description of SCMS's linkages to GOT efforts, other partners, and other
donors can be found in the Other Policy and Systems Strengthening section of the 2009 COP.
M&E: The funding in this section is purely for the purchase of ARV drugs, the cost associated with
procurement and transportation of the drugs to MSD. M&E activities related to ARV procurement are
budgeted in the Other Policy and Systems Strengthening section of the 2009 COP. While this section does
not budget for these activities, it is important to emphasize the following efforts to specifically monitor ARV
procurement and supply chain management will be made: SCMS's procurement and ARV delivery
performance will be monitored and evaluated through routine supervision by the USG Commodities and
Logistics Advisor and other key USG team members. Delivery reports showing the number of on-time and
late SCMS-procured deliveries will be submitted to the USG on a regular basis. National stock status
reports generated by both the GOT and by the SCMS regional Supply Chain Monitoring Advisors (explained
in greater detail in the OHPSS section of the 2009 COP) will also be shared with the USG team for
monitoring and planning purposes. These reports are compared against work plans. SCMS will also be
working with NACP and MSD to select key logistics indicators that will assist National Aids Control Program
(NACP), the USG and SCMS in identifying specific supply challenges. Finally, PEPFAR treatment partners
have access to the USG Commodities and Logistics Advisor and other key USG team members to report
ARV and other drug stock-outs at care and treatment centers.
SUSTAINAIBLITY: As mentioned above, the funding in this section is purely for procurement and
associated freight costs; however, capacity building activities will be an integral part of SCMS activities in
Tanzania including training and retraining care and treatment centers in quantifying their ARV drugs needs.
In addition, SCMS will train zonal store managers and other key MSD staff in inventory control systems,
logistics management information systems, and drug quantification techniques (all of which apply to the
improved management of ARV drugs as well as other essential medicines).
APR 2009 REPROGRAMMING:
$499,999 reprogrammed (to OHSS Mechanism id 1441.09) based on site visits and PMTCT audit USG
determined a need to provide additional TA in strengthening ART pharmaceutical management systems at
facility level.
$525,000 (to OHSS mechanism id 12210.09) to support the construction of a warehouse in Mwanza to
increase storage capacity of the Medical Stores Department. This will be a local solicitation.
$3,841,578 additional M & O funds held in reserve (from unallocated mechanism id 11472.09) will be used
for ARV procurements in emergency stockout situations. Gap in funding is projected. Funds are to be
reprogrammed to SCMS to fill this gap.
Continuing Activity: 13558
13558 3433.08 U.S. Agency for Partnership for 6548 4790.08 $23,568,743
7733 3433.07 U.S. Agency for Partnership for 4790 4790.07 $18,969,657
3433 3433.06 U.S. Agency for Partnership for 5555 5555.06 SCMS $14,293,966
Table 3.3.15:
ACTIVITY UNCHANGED FROM FY 2008 COP.
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.
Continuing Activity: 13560
13560 8233.08 U.S. Agency for Partnership for 6548 4790.08 $0
8233 8233.07 U.S. Agency for Partnership for 4790 4790.07 $190,000
Program Budget Code: 17 - HVSI Strategic Information
Total Planned Funding for Program Budget Code: $8,631,021
Total Planned Funding for Program Budget Code: $0
Program Area Narrative:
Program Area Context: HVSI - Strategic Information:COP 2009:Table 3.3: Program Planning Table of Contents:Program Area:
Strategic Information:Budget Code: HVSI: Program Area Code: 13: Program Area Context:SI OVERVIEW
To ensure quality and sustainable HIV/AIDS programs, PEPFAR Tanzania collects and uses strategic information for program
planning and decision making. The USG supports the "Third One" in Tanzania's national response to the HIV/AIDS epidemic.
The USG's SI strategy is incorporated in to and guided by the National Multi-Strategic Framework (NMSF) for M&E: supporting
human and infrastructural capacity strengthening to conduct SI activities at the national and sub-national levels including:
harmonization of indicators and data systems; collection, analysis and timely reporting of quality data; and promotion of data use
for planning and implementation of HIV interventions, and to inform policy. Strengthened systems with quality data and sufficient
human capacity are cornerstones of improved health interventions and ultimately a reduction in HIV-related morbidity and
mortality.
Achievements in FY 2008 included: conducting HIV surveillance activities that provided information for intervention and resource
planning; strengthening national health information systems (HIS) in selected program areas; initiating a PEPFAR reporting
system; improving quality of PEPFAR data and reporting; building a network of M&E professionals from the GoT and
implementing partner organizations; enhancing the analysis of PEPFAR data to estimate coverage of services; evaluating ART
services and their related costs through both PHE and basic program evaluation; and triangulating data from multiple sources to
answer key questions about the epidemic. Challenges anticipated for FY 2009 include: training of new SI staff; integration,
quality, utilization and feasibility of reporting systems across GoT and PEPFAR Tanzania; supporting a culture of data utilization
and enhanced data quality in GoT and PEPFAR Tanzania; and enhancing SI infrastructure in GoT. Activities below are designed
to respond to these challenges.STRATEGIC INFORMATION TEAM:Under the Staffing for Results structure, the USG SI team
includes an SI Liaison, the lead for the Program Strengthening Strategic Unit, an HIS advisor, two surveillance/survey officers,
and four M&E staff. In addition, the USG is supported by a PHE coordinator who coordinates program evaluation and public
health evaluation projects. In FY 2009, one M&E staff will be added at USAID. SI technical assistance (TA) is provided through
the in-country team, the M&E Resident Technical Advisor (formerly MEASURE Evaluation), and through USG agencies
headquarters. During FY 2008, the SI team underwent several staff changes. Currently, all previously vacant positions have
been filled, and the team will be complete and fully functioning by the end of 2008. The role of the USG SI team is to support the
USG and build the capacity of GoT and local partners through the following activities: provide TA in the implementation of
activities funded under SI; support program-area specific HIS and M&E; provide resources and TA for ongoing survey and
surveillance activities, including implementation of drug resistance surveillance among ART patients, and new Respondent-Driven
Sampling (RDS) and Behavioral Surveillance Survey (BSS) activities for most at risk populations. In addition, the role of the USG
SI team is to: participate and provide SI expertise to each of the Inter-agency Technical Teams (ITTs); provide oversight for
internal USG activities related to indicators, target setting, reporting, partner performance, and management of the COP process;
and support the development and implementation of appropriate evaluation activities. ITTs set targets based on input of partners,
program officers, and SI staff. ITTs review cost-per-target, previous achievements, and budget levels. PEPFAR-Tanzania has
shifted to setting targets for the performance period to enable direct comparison of results against targets.With the increased
focus on public health evaluations (PHEs) in FY 2009, the PHE coordinator in collaboration with the SI team will provide additional
analytical expertise to ITTs in planning and implementing PHEs with partners and GoT. In addition, the SI team will coordinate
and provide technical expertise for basic program evaluations to support program improvement and enhance evidence-based
decision-making. The basic program evaluation (BPE) activity narrative describes the process for selecting and prioritizing
BPEs.DATA QUALITY, RESULTS REPORTING, and DATA UTILIZATION :Improving the quality of data and enhancing data
utilization nationally and sub-nationally and within the USG continues to be a priority for SI in FY 2009. Ongoing and planned
activities include: collaboration with the M&E Resident Technical Advisor to implement use of data quality (DQ) tools; capacity
building in DQ through a USG Partner M&E group; and DQ assessments with selected partners, including the HMIS Unit of the
Ministry of Health and Social Welfare (MOHSW). During FY 2008, data quality assessments (DQA) were conducted with ten
USAID implementing partners (IPs) and selected sub-grantees. These activities will be expanded in FY 2009, and closely
coordinated with ongoing DQA activities to be undertaken by other USG agencies with their implementing partners. Support will
continue to the SI Units of the National and Zanzibar AIDS Control Programmes (NACP and ZACP respectively) for capacity
building, coordination of programs, training in data collection tools, and use of data. With support from the USG, the World Health
Organization (WHO) has hired a Resident Advisor to provide TA across all M&E activities at NACP. The USG anticipates
expansion of its support of NACP and other GoT ministries in the coming year to bolster the systematic collection, analysis, and
dissemination of data for decision making. To further enhance data utilization, a first round of triangulation of data from multiple
sources including routine program and survey data took place during FY 2008. During FY 2009, a second round will take place
with incorporation of newly available survey data from the Tanzania HIV/AIDS and Malaria Indicator Survey (THMIS) and
additional program data on ARV services. In FY 2009, new triangulation activities will also focus on regional level epidemics and
programs. The effort is coordinated through NACP and the Tanzania Commission for AIDS (TACAIDS) and links with the Global
Fund five-year impact evaluation for which Tanzania is a primary data collection country. Also, see OPSS for a description of
GIS/mapping activities to be carried out through NIMR, as these will be incorporated into and closely coordinated with all data
utilization activities for SI. To further improve data quality, results reporting, and use of PEPFAR data for planning, the USG will
implement the Monitoring and Evaluation of Emergency Plan Progress (MEEPP) partner reporting system during 2008. With a
long-term view, the USG Tanzania team will work with OGAC to consider a field-based extension of COPRSII with a goal for it to
be fully functional for reporting for APR 2009. The USG will share results and maps generated from MEEPP with GoT and
Development Partners. PEPFAR ARV services data will also be submitted to NACP through an electronic transfer developed by
the University of Dar es Salaam Computing Centre (UCC) with USG funds. INFORMATION SYSTEMS:Standardized national
monitoring and reporting systems exist for ART, PMTCT, TB/HIV, CT, OVC, blood safety, and laboratory programs. The PMTCT
system is being modified to accommodate new guidelines while the HBC system is in development stages with GoT and USG
partners. The USG is working with prevention partners to refine operational definitions and to develop standardized data
collection tools. During the coming year, the USG, on behalf of the GoT, will support the convening of a stakeholder meeting to
initiate development of a strategy for harmonizing data collection across implementing partners and linking national monitoring
and reporting systems across program areas. The USG provides support to NACP and ZACP to promote ownership and use of
data from these national systems. Data from MEEPP, developed with USG funds, will be transmitted to the national system
through the MOHSW reporting stream or electronically to national databases. Facilities are responsible for reporting to NACP or
ZACP, and MOHSW through the districts and regional teams. Partners report to the USG at least semi-annually. Centrally-
funded ART and blood safety partners report to the USG quarterly. Community-level M&E systems will harmonize with the
Tanzania Output Monitoring System for HIV/AIDS (TOMSHA), which collects non-health sector HIV service statistics data in a
national HIV database. A national monitoring system for community-based support programs has been developed, with the paper
-based tools ready for field testing in two districts. Development of a computerized national data system based on the experience
with the paper-based system is also underway with USG support and rollout to all regions is planned for FY 2009.The Phones for
Health (P4H) Public-Private Partnership (PPP) initiative will improve timeliness and quality of reporting by enabling use of
computer and cell phone technology to transmit data from local to central levels. More than 4,000 health facilities have been geo-
coded and are included in the database. To ensure continued local ownership and build sustainability, the University of Dar es
Salaam Computing Centre (UCC), collaborates in this initiative and ensures that the national electronic databases will interface.
Support for the maintenance of the wide area network (WAN) in eight regions will transfer to MOHSW during
2009.SURVEILLANCE AND SURVEYS:
Surveys: The results from the USG-supported Tanzania HIV and Malaria Indicator Survey (THMIS, 2007/2008) will be further
analyzed and utilized for program planning in 2009, with a focus on regional applications. In 2009, the USG will continue support
to the Ifakara Health Institute for mortality surveillance using Sample Vital Registration with Verbal Autopsy (SAVVY). This was
conducted in FY 2008 through four existing demographic sentinel sites, and expansion to additional sites is planned for FY 2009.
During 2009, planning for implementation of the next round of the Demographic and Health Survey (DHS) using bio-markers will
occur. Also, program monitoring for HIV drug resistance (HIVDR) among ART patients, co-funded by WHO, will be continued at
selected sentinel sites. Surveillance: The USG will continue to support NACP to conduct antenatal surveillance in all 21 regions on
mainland Tanzania. NACP will also conduct a HIVDR threshold survey among ANC attendees in Dar es Salaam region and two
additional regions in 2009. During 2008, planning was initiated for BSS with biological markers among commercial sex workers
(CSWs) in Dar es Salaam. This survey, which will take place in early 2009, will provide an opportunity to build capacity in
Mainland Tanzania to undertake BSS using RDS among most at risk populations (MARPS) and inform prevention activities.
During 2009, planning will take place for additional BSSs among select high risk populations in other urban sites. The USG will
continue to support ZACP for ANC surveillance in ten districts. During 2009, ANC surveillance in Zanzibar will continue to be
integrated within PMTCT activities in order to link all HIV-infected pregnant women with interventions. As Zanzibar has a
concentrated epidemic, there has been an increased focus on behavioral surveillance among most at-risk populations (MARPs)
and overlapping populations. In FY 2007, the ZACP, with USG support and TA from Tulane University, conducted surveys among
men who have sex with men (MSM), Intravenous Drug Users (IDUs), and CSWs using RDS. Other surveys among prison
inmates and additional MARPS are planned for 2009. During 2009, selected surveys will begin using personal data assistants
(PDAs) to enhance data collection. Additional commodities for surveillance and surveys will be purchased through RPSO.
EVALUATION:During 2009, USG SI will implement a process by which programmatic ITTs can identify and prioritize key
questions that can be answered through basic program evaluation projects. USG will also work with GoT counterparts to prioritize
questions. Projects will be coordinated through the SI ITT, and will include four to five small scale projects during FY 2009. In
addition, several PHEs are being proposed for FY 2009 including the following: cost effectiveness of HIV treatment; effectiveness
of infant diagnosis; models of condom distribution; PHAs as change agents; impact of drug resistance on regimen failure; use of
counseling and testing to increase patient enrollment; impact of task shifting for ART delivery; interventions to reduce early
mortality; ART patient retention; PMTCT effectiveness; and prevention effectiveness in a counseling and testing context. As per
OGAC guidelines, regulations pertaining to human subjects for all participating USG agencies will be followed for all SI activities,
and SI will ensure that the entire USG team has the ability to support these activities. LINKAGES WITH GoT AND DONORS:In
addition to funding for GoT as described above, USG's SI activities support the TACAIDS National M&E Roadmap, an integrated
and costed work plan. USG SI staff serve on the TACAIDS and NACP M&E Technical Working Groups (TWGs). The USG
communicates regularly with WHO, UNAIDS, PharmAccess International, and the World Bank, in addition to participating in the
Development Partners M&E Group. SUMMARY:In summary, PEPFAR-Tanzania has 24 narratives in SI as well as narratives in
program areas to support specific HIS and M&E activities, including capacity building of M&E officers to increase demand for data.
Two narratives in OPSS support pre-service training in epidemiology and M&E training of Tanzanians. Capacity building in
Tanzania for public health evaluations is further described in OPSS narratives under NIMR and the MUHAS School of Public
Health entries. HIS-focused narratives in the SI section include: P4H, MoHSW-HMIS, UCC, MEEPP, and WAN. Narratives
describing surveillance and survey activities include ANC, BSS for MARPs in Zanzibar and Dar es Salaam, SAVVY, HVDR, and
RPSO for commodities. Measure Evaluation will continue to provide support for data quality. M&E narratives include SI
strengthening (TBD, formerly MEASURE Evaluation), and triangulation. Capacity-building efforts will be implemented through the
following narratives: NACP, ZACP, and WHO Advisor support to NACP. In addition, all treatment partners fund M&E activities
and support capacity building at the sub-national levels.
Table 3.3.17:
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
Continuing Activity: 13561
13561 9593.08 U.S. Agency for Partnership for 6548 4790.08 $100,000
9593 9593.07 U.S. Agency for Partnership for 4790 4790.07 $550,000
All of the technical assistance activities from activities: 8233, 8667, 9237, 12381 and 3433 have been
combined into this narrative under OHSS.
TITLE: Supply Chain Management Systems Strengthening through Technical Assistance
With the rapid expansion of Tanzania's HIV/AIDS prevention, treatment, care, and support program, there
are few things that are more important than a reliable source of commodities. While the United States
Government (USG) is committed to using the central drug supply system for the distribution of HIV related
commodities, the public supply system is struggling to expand its capacity, even while the resources
managed by the Medical Stores Department (MSD) supply systems have grown to ten times the size they
were a decade ago. USG support to the Government of Tanzania's (GOT) supply system must go beyond
procurement because the AVAILABILITY of products is imperative for the success of PEPFAR programs
which rely fully on the central supply system for ARVs and test kits. Despite the fact that the central system
is still tackling existing challenges, care and treatment services will continue to be scaled up to five hundred
new sites, according to the GOT's ambitious goal (in addition to the 234 current care and treatment sites).
Supply Chain Management System (SCMS) will work at multiple levels to strengthen the public drug
procurement distribution system. This assistance will range from continuing to strengthen the ARV, HIV test
kit and essential medicines supply system at the care and treatment center level, to strengthening the
regional and central MSD supply systems. In addition, SCMS will provide critical technical support to the
central wings of the GOT that coordinate the procurement of most HIV/ADIS commodities: the National
AIDS Control Programme (NACP), Pharmaceutical and Supply Unit (PSU) of the Ministry of Health and
Social Welfare (MOHSW), and MSD.
Technical Assistance at the Service Delivery Level
The GOT is aiming to roll out the current logistics management information system for HIV commodities to
approximately 1200 sites by the end of 2009. This is an ambitious goal, as many sites continue to struggle
with timely and accurate logistics information reporting. To meet the current reporting challenges, SCMS
will continue to work with the NACP, MSD and other USG care and treatment partners to introduce new
care and treatment centers to the mainly paper-based reporting system through on-the-job and classroom
training. This training for care and treatment centers will enable commodity managers, pharmacists, and
laboratory managers to improve their reporting of stock level data to the zonal MSD stores. SCMS
estimates that it will reach all of the new sites while also retraining approximately 270 existing sites. It is
anticipated that 1560 personnel will be trained with on-the-job or classroom training. Support from the 2009
COP will also allow SCMS to expand the training to incorporate reporting on opportunistic infection drugs,
which should improve the supply and availability of these drugs. SCMS will continue to assist NACP in
printing logistics management information system tools and reporting forms that are a critical part of the site
-level logistics management information system.
Furthermore, SCMS will continue to monitor the performance of the logistics information management
system at the site level through newly hired Supply Chain Monitoring Advisors. Eight of these advisors
should be positioned by the end of FY 2009. The advisors will be stationed in regional stores and will
provide supervision and monitor reporting from the sites. These advisors will also be able to act as an early
warning system for potential stock-outs at the care and treatment centers as well as at the regional
warehouses.
Technical Assistance at the Regional Level
At the regional level, the SCMS hired Supply Chain Monitoring Advisors will assist with the roll out of the
computerized Integrated Logistics System (ILS), while monitoring for potential supply shortages or potential
stock-outs. Through the advisors, SCMS will support MSD regional stores in defining inventory
management procedures to ensure adequate levels of stocks to distribute to care and treatment centers. In
addition, SCMS will sponsor and organize a course in inventory control systems, logistics management
information system, and quantification for regional store managers (as well as other central HIV/AIDS
commodity managers at MSD).
During 2009, SCMS will complete the conversion of all regions from the old logistics system called Indent,
to the new ILS. While SCMS is supporting the roll-out of the ILS, it will also continue to provide input on any
necessary enhancements to the system, such as adding new drugs, new sites or other critical logistics
information.
At the regional level, SCMS will also work with the PSU at the MOHSW and MSD to identify the needs for
more efficient and robust drug packing lines in MSD regional stores through comprehensive assessments of
selected stores that will receive recommendations on improved picking and packing models. SCMS will
specifically purchase and install packing lines for two more regional stores in the COP 2009 period.
Technical Assistance at the National Level
As HIV/AIDS programs expand and new drugs regimens or testing protocols are introduced in national
guidelines, accurate forecasting and quantifications become increasingly important. The limitation of the
current ARV and HIV test kits logistics systems is the lack of a central level database that analyzes and
organizes logistics data into feedback reports for program managers at NACP. SCMS will develop a
database in collaboration with NACP and MSD that will analyze reports from service delivery points (SDPs)
and provide valuable information on consumption and stock status of HIV/AIDS commodities. The database
will be physically installed at MSD and will include MSD's stock data. This database will provide information
on reporting and non-reporting facilities, discrepancies between ordered and supplied quantities of
products, delays in re-supply, availability of stocks at MSD, among other reports.
Activity Narrative: SCMS will continue to provide technical assistance to NACP, primarily by leading the quantification process
within the national quantification teams composed of NACP, Diagnostics Unit at the MOHSW, MSD, Clinton
HIV/AIDS Initiative (CHAI) and SCMS. These teams jointly work together to determine the national ARV,
drugs for opportunistic infections (OIs), sexually transmitted infections (STIs), laboratory supply and HIV test
kits requirements and then a supply plan is created that splits procurement responsibilities among the
different stakeholders. SCMS will continue to introduce and train national counterparts in conducting
accurate quantifications and forecasts for OI and STI drugs. SCMS will also work closely with the USG in
procuring a portion of the national supply plan according to COP plans and the memorandum of understand
(MOU) that was written between the USG and GOT. This is of particular importance because the USG is
committed to centralizing the procurement of key HIV/AIDS commodities through SCMS who will coordinate
with all other procuring partners. The budget contained in this program area is key to providing SCMS with
the technical expertise in supply chain management for a wide range of commodities to work in multiple
areas. While most of assistance provided by the SCMS office in Tanzania will focus on ARV drug
($3,000,000.00), OI drug ($500,000.00) and rapid test kit ($250,000.00) supply chains; SCMS will also
coordinate with prevention of mother to child transmission ($500,000.00), blood safety programs, injection
safety programs, home-based care programs, (including feeding and nutritional support efforts), strategic
information, and laboratory programs ($60,000.00) as SCMS prepares to procure commodities for a wide
range of HIV services.
Laboratory Logistics System Strengthening
The technical assistance that SCMS will offer the GOT and laboratory partners deserves special mention,
because while it is similar to other technical assistance efforts around ARV, OI drugs and test kits, it will
focus on a supply system that has largely been separate from other HIV/AIDS commodities. The
management of the general laboratory supply and reagent system falls under the mandate of the Laboratory
and Diagnostics Unit of the Ministry of Health and Social Welfare. While NACP is responsible for
overseeing the management of CD4 machines and supplies, hematology and biochemistry reagents for
HIV/AIDS patients; there are chronic shortages of lab supplies. Lack of coordination has meant a
proliferation of multiple systems of ordering, procurement and record keeping resulting in a lack of
information on stock availability, and widespread commodity shortages. SCMS will build the capacity of
laboratory partners to implement a logistics management information system that will develop the
management of commodities by improving lab commodity forecasting, quantifications and supply planning.
While CD4 reagents are the only items currently ordered through logistics information forms, this
information is not fed into the national system to improve procurement planning or appropriate distribution.
SCMS will work to strengthen laboratory logistics system by focusing first on care and treatment centers
that manage reagents and consumables for CD4 counting, hematology and biochemistry testing and
integrating reporting on the relevant supplies into one reporting format. With the help of SCMS, the
Diagnostics Unit will prepare curriculum and a roll-out strategy to train key staff at the care and treatment
centers on lab commodity reporting. More specifically, key staff at care and treatment centers will be
trained on order and re-supply procedures, tools for collecting and reporting consumption, and stock status
data for lab reagents and consumables.
ACCOMPLISHMENTS:
The USG through SCMS supported the design and roll out of new logistics management systems for HIV
test kits and ARVs. This included capacity building for 1560 health care workers for 692 care and treatment
sites currently providing services in Tanzania. Additional training was provided to 972 primary health facility
personnel in the integrated logistics system. This is expected to improve the availability of essential
medicines, as well as reproductive health and family planning products in the facilities involved.
NACP with technical assistance and support from SCMS conducted a series of quantifications (forecasting
and procurement planning) of national needs of ARVs, OI's and HIV test kits for all programs. Based on the
quantification findings SCMS worked with NACP to procure ARVs and HIV test kits as stipulated in the
MOU. Additionally, technical assistance was provided to NACP in the quantification of HIV/AIDS
commodities for the development of the GOT's Global Fund for HIV/AIDS, Tuberculosis and Malaria
(GFATM) round eight proposal.
Finally in collaboration with MSH, SCMS facilitated a warehouse management training for MSD Zonal
managers. This training is expected to improve the skills and abilities of the zonal manager to allow for
overall improvement of warehouse operations.
LINKAGES: SCMS will work with Ministry of Health and Social Welfare (MOHSW), Centers for Disease
Control (CDC), World Health Organization (WHO), Medical Stores Department (MSD), Tanzanian Food and
Drug Authority (TFDA), Tanzania Bureau of Standards (TBS), GFATM, Japanese International Cooperation
Agency (JICA), DANIDA and other donors as appropriate to provide technical assistance to strengthen the
national procurement and distribution system in Tanzania. USG through SCMS also coordinates with
treatment partners and MSH to provide technical assistance at the facility level.
Emphasis Areas
Human Capacity Development
Estimated amount of funding that is planned for Human Capacity Development $2,586,000
Public Health Evaluation
Food and Nutrition: Policy, Tools, and Service Delivery
Food and Nutrition: Commodities
Economic Strengthening
Education
Water
Table 3.3.18:
