Plus ups: SCMS will procure Combivir, Nevirapine and HAART for NUMAT and EGPAF supported PMTCT activities. With a combined target of 6,900, HAART will be procured for an estimated 10% of the HIV positive women. All HIV positive women and children will be targeted for complete course of prophylaxis. Test kits needed to support couseling and testing within the PMTCT supported sites will be procured through the National Medical Stores. The USG continues to support the capacity of the national program to procure ARVs. Procurement responsibilities will be transferred to NMS once they have demonstrated their capacity to effectively procure and distribute ARVs.

Table 3.3.01:

This activity is linked to Palliative care: TB/HIV (8995), Counseling & testing (8882), Treatment: ARV drugs (8933) and Laoratory Support (8984). The SCMS project will provide critical logistics technical assistance to the key providers of HIV care, treatment, diagnosis and prevention in Uganda, including the Ministry of Health, JCRC, IRCU and other PEPFAR NGO partners including the new program in 2006 targeting northern conflict zones. This will include forecasting and quantification, procurement tracking, product delivery and warehouse system improvement and delivery tracking for decision making. Procurement for ARV drugs for IRCU at a level of 1,000,000 is included this year. Commodities to be included under SCMS technical support include ARVs, HIV test kits, condoms, cotrimoxazole, Nevirapine and other PMTCT drugs, STI & OI drugs, and lab reagents and consumables for diagnosis. Uganda has made major advances in ARV treatment, diagnosis and prevention, but much remains to be done as patient numbers increase, access is brought closer to the local level, policies such as HIV routine testing, TB and HIV integration and new treatment for PMTCT mothers is adopted nationwide. Systems need to expand rapidly, be flexible to adjust to new policy demands and to be able to cope with emergency threats to the HIV/AIDS supply chain.

SCMS will continue to provide HIV/AIDS logistics technical assistance formally provided by the DELIVER project (ending Nov 2006) to the Ministry of Health, JCRC, IRCU and other USG supported programs. SCMS will continue to work closely with CDC in national lab supplies, as well as expand the technical assistance to other PEPFAR supported palliative care providers in FY07 especially in provision of the basic care package. This technical support includes systems development, assisting in forecasting/quantification, product procurement, tracking of procurement and delivery to the national level from multiple sources, product integration into national systems where necessary, distribution planning from national level to facilities, system efficiency improvement, development of logistics data collection tools, upgrading computerized logistics information systems and integrating or linking them with HMIS and other relevant information systems. SCMS will also provide technical assistance to bridge the information gap between MOH, NGO's and other partners especially NMS/JMS by strengthening the areas of joint program/project planning, forecasting/quantification, shipment planning, and warehousing and distribution system management with programs/projects. Our overall objectives are to improve harmonization, develop systems and improve competencies to ensure that right HIV/AIDS-related and other key health commodities are available at the right place at the right time in the right quantities, and advocate for the need for logistics planning.

Logistics technical support will be provided for the following HIV/AIDS commodities: Essential drugs (including specific palliative care commodities (i.e. morphine), STI drugs, cotrimoxozole for prophylaxis, OI drugs and laboratory supplies which support HIV/AIDS prevention and treatment), ARVs, HIV test kits, Nevirapine for PMTCT, and TB commodities as part of the HIV/TB collaboration. This is done on a national scale for all the above products for the MOH, and for selected products with JCRC, IRCU and other NGO organizations. Indirect targeted populations include those living with HIV/AIDS, adult and infant populations seeking to know their status, pregnant women, TB patients, male and female young adults and infants with HIV/AIDS. All targets (except training) are indirect targets because our work is in systems development, but it includes 42,000 MOH ARV patients, 38,000 JCRC ARV patients, 900,000 people tested for HIV status, 170,000 pregnant women receiving HIV tests, 80 million condoms used in public sector, 59,000 TB patients and untold numbers of patients receiving laboratory tests. SCMS will also provide training to 4,500 individuals in logistics - ARVs, TB, labs.

Regarding palliative care SCMS will work with palliative care providers within the USG portfolio, including Hospice Africa Uganda, the Ministry of Health, AFFORD, PSI and other implementers to effectively forecast, procure, distribute and monitor HIV palliative care commodities, including morphine for pain management. In the next year the SCMS project, we will be focusing on adapting the existing logistics systems to the changing policies (new PMTCT policy, ART site expansion, etc.) and environments, integrating parallel systems (where possible) into existing systems and procurement of HIV/AIDS commodities. A major constraint to our logistics work is the dependency on donors to procure supplies for MOH according to schedule. If supplies are available at the national level, country logistics systems can perform to make supplies available at health facilities. If supplies are simply not available, the country is vulnerable to stock outs and disrupted health services

This activity is linked to Palliative care: basic (8862), Counseling & testing (8882), Treatment: ARV drugs (8933) and Laboratory Support (8984).The SCMS project will provide critical logistics technical assistance to the key providers of TB treatment, diagnosis and prevention in Uganda, including the Ministry of Health, JCRC, IRCU and other PEPFAR NGO partners including the new program in 2006 targeting northern conflict zones. This will include forecasting and quantification, procurement tracking, product delivery and warehouse system improvement and delivery tracking for decision making. Procurement for ARV drugs for IRCU at a level of 1,000,000 is included this year. Commodities to be included under SCMS technical support include ARVs, HIV test kits, condoms, cotrimoxazole, Nevirapine and other PMTCT drugs, STI & OI drugs, and lab reagents and consumables for diagnosis. Uganda has made major advances in ARV treatment, diagnosis and prevention, but much remains to be done as patient numbers increase, access is brought closer to the local level, policies such as HIV routine testing, TB and HIV integration and new treatment for PMTCT mothers is adopted nationwide. Systems need to expand rapidly, be flexible to adjust to new policy demands and to be able to cope with emergency threats to the HIV/AIDS supply chain.

TB is very often a co-infection of HIV/AIDS. At present, an estimated 50% of TB patients are also co-infected with HIV. The MOH launched a policy for TB/HIV collaborative activities which aims at improving care for TB and HIV patients. The policy intends among other things to foster TB screening among HIV positives and HIV screening among TB clients. The policy also advocates for Isoniazid preventive therapy (IPT) where appropriate. These interventions have implications for the current logistics systems in place. The SCMS project will work with the TB program ensure a sustainable availability of anti-TB drugs including Isoniazid at the ARV sites and TB treatment centers. This will entail cross-system coordination and adapting the current TB logistics system and reporting to support the TB/HIV collaborative activities.

The SCMS project will provide technical assistance to the TB program in the quantification, procurement planning and tracking for supplies needed for TB/HIV collaborative activities (including Isoniazid) to ensure continuous availability of these supplies. This is critical as the requirements will continue to change as the program evolves.

The laboratory logistics system will be strengthened to ensure availability of lab supplies (including Skin testing) to enable TB screening among HIV positives and also HIV screening among TB patients. As the policy continues to be implemented, the number of clients screened for HIV will increase, and there will be need to ensure availability of HIV testing kits in all TB diagnostic centres. The current laboratory logistics system will have to be adapted to achieve this objective.

This activity is linked to Palliative care: basic (8862), TB/HIV (8995), Treatment: ARV drugs (8933) and Laboratory Support (8984). The SCMS project will provide critical logistics technical assistance to the key providers of counseling and testing services, ARV treatment, diagnosis and prevention in Uganda, including the Ministry of Health, JCRC, IRCU and other PEPFAR NGO partners including the new program in 2006 targeting northern conflict zones. This will include forecasting and quantification, procurement tracking, product delivery and warehouse system improvement and delivery tracking for decision making. Procurement for ARV drugs for IRCU at a level of 1,000,000 is included this year. Commodities to be included under SCMS technical support include ARVs, HIV test kits, condoms, cotrimoxazole, Nevirapine and other PMTCT drugs, STI & OI drugs, and lab reagents and consumables for diagnosis. Uganda has made major advances in ARV treatment, diagnosis and prevention, but much remains to be done as patient numbers increase, access is brought closer to the local level, policies such as HIV routine counseling & testing, TB and HIV integration and new treatment for PMTCT mothers and newborns is adopted nationwide. Systems need to expand rapidly, be flexible to adjust to new policy demands and to be able to cope with emergency threats to the HIV/AIDS supply chain.

Counseling and testing services by the MOH, AIC, JCRC, IRCU and other PEPFAR NGO's have more than tripled in the past two years. This expansion in the volume of tests now available, numbers of patients tested, and in the number of sites where tests are done has put substantial pressure on the distribution system for HIV tests. Maintaining adequate supplies of test kits requires logistics systems that can collect logistics information used for defining commodity needs, and tracking national level procurement from multiple sources. To maintain the effectiveness of this information, emphasis needs to be put on data quality which will be maintained by implementing support supervision and on the job training.

Logistics technical support will be provided by Supply Chain Management System (SCMS) project which will offer commodity procurement services, systems development, assisting in forecasting/quantification, product procurement, tracking of procurement and delivery to the national level from multiple sources, product integration into national systems where necessary, distribution planning from national level to end user, system efficiency improvement, development of logistics data collection tools, upgrading computerized logistics information systems and integrating or linking them with HMIS and other relevant information systems. SCMS will provide technical assistance to both NMS and AIC in supply chain management of counseling and testing commodities. IRCU will also receive technical assistance to develop an emergency procurement system which the organization can use in case of shortages in the national system. Continued support to deal with test kit shortfalls, and emergency distribution requirements, logistics implications in product selection, and meeting specific donor (PTMCT) reporting requirements. Some key areas of focus will be on adapting logistics systems to the policy change from VCT to RCT (Routine Counseling & Testing) and integrating reporting/ordering with the lab credit line. SCMS will also provide training to 4,500 individuals in logistics - ARVs, TB, and Labs.

Through USAID logistics support, technical assistance is available to help design, maintain and revise national systems. We expect the numbers of tests done this year to exceed 1 million through the MOH national RCT program with partner support. Because HIV testing is the entry point into the ART program, the provision of adequate HIV tests is a necessity to ensure the success of the ART program.

This activity is linked to Pall care: basic (8862), TB/HIV (8995), CT (8882) and Lab (8984). For the Inter Religious Council of Uganda's network of faith based sites, SCMS will provide forecasting planning, commodity ordering training for site staff and general logistics training for senior IRCU staff, computer systems for tracking ARV use, delivery scheduling and ARV patient reporting. This type of logistics support is available for other PEPFAR-sponsored NGOs. In addition, SCMS will procure ARV drugs for clients through the IRCU network.

The SCMS project will provide critical logistics technical assistance to the key providers of ARV treatment, diagnosis and prevention in Uganda, including the Ministry of Health, JCRC, IRCU and other PEPFAR NGO partners including the new program in 2006 targeting northern conflict zones. This will include forecasting and quantification, procurement tracking, product delivery and warehouse system improvement and delivery tracking for decision making. Procurement for ARV drugs for IRCU at a level of 1,000,000 is included this year. Commodities to be included under SCMS technical support include ARVs, HIV test kits, condoms, cotrimoxazole, Nevirapine and other PMTCT drugs, STI & OI drugs, and lab reagents and consumables for diagnosis. Uganda has made major advances in ARV treatment, diagnosis and prevention, but much remains to be done as patient numbers increase, access is brought closer to the local level, policies such as HIV routine testing, TB and HIV integration and new treatment for PMTCT mothers is adopted nationwide. Systems need to expand rapidly, be flexible to adjust to new policy demands and to be able to cope with emergency threats to the HIV/AIDS supply chain. SCMS will provide on-going technical support to the national program under the MoH in the design of logistics systems, periodic system review, product forecasting & quantification, coordination and tracking of procurement from multiple sources, distribution planning from the national level to end user, efficiency improvement and computerized logistics information systems. With multiple partners, overlapping treatment systems and expanding demand, harmonization and coordination among all partners will be a key objective. SCMS will provide specialized TA to both MOH and PEPFAR procurement planning, NMS and JMS warehouse upgrading and operational efficiency, NMS & JMS delivery scheduling, consolidation of the new MOH lab supply system, procurement and ARV delivery for selected organizations, very rapid expansion of HIV testing, access to palliative care supplies, integration of TB and HIV testing and treatment and computerized logistics IT systems. The partnership can provide very specialized technical assistance such as bar coding, warehouse operational management, delivery costing, or lab operational analysis and it can also provide the on-going technical support such as stock status reports, delivery schedule adjustments, on-the-job training and support supervision. SCMS will build on the logistics work done by the DELIVER Project, adding support supervision, bar coding, warehouse efficiency, expanded training and revised delivery scheduling. PEPFAR NGOs will be a special emphasis as USG ARV treatment targets grow, with expanded procurement and delivery needs. The OGAC review report has requested an early analysis of USG procurement current status and future options to harmonize and improve efficiencies which will take place in 2006. Upstream logistics will be a new focus, including work on improving the efficiency of customs clearance and work with the National Drug Authority to speed up post shipment testing to ensure prompt ARV delivery. In 2006 work with the National Drug Authority will begin with a focus on improving laboratory space.

New PMTCT treatment protocols will need special emphasis to integrate ARV treatment drugs to reach ARV+ pregnant women at critical stages. Increasing PEPFAR and MOH efforts to reach pediatric patients will need improved delivery for child ART. $400,000 funds will be provided to support the national program delivering PMTCT and HIV care and treatment to pregnant women and children. Uganda as a country has been able to provide ART treatment to approximately 75-85,000 patients from public, NGO and private clinics. Demand however, is substantially higher and improved efficiency, minimal wastage, reduction of systems overlap, accurate delivery systems and the best possible prices will be required to provide for the increasing numbers of ARV positive patients. Good logistics systems are critical to reach these targets. Prevention in the form of HIV testing, blood safety, injection safety, and PMTCT ARV treatment is a critical component to control the future numbers of patients needing HIV/AIDS services.

For the IRCU's network of faith based sites, SCMS will provide forecasting planning,

commodity ordering training for site staff and general logistics training for senior IRCU staff, computer systems for tracking ARV use, delivery scheduling and ARV patient reporting. This type of logistics support is available for other PEPFAR-sponsored NGOs. In addition, SCMS will procure ARV drugs for clients through the IRCU network. IRCU plans to utilize FY07 funds to sustain the 4,000 individuals on therapy through fifteen faith based hospitals and health centers IVs. The number of people on therapy is likely to increase as the cost of drugs continues to fall, especially as more FDA approved generic drugs enter the Ugandan market. There are approximately 90,000 Ugandans country wide that are eligible for treatment with no available source of therapy. The IRCU approach is to integrate the ART services with existing HIV care and overall health services rather than create a parallel program which mounts additional strain on the already overstretched capacity of its implementing partners. In this regard, IRCU plans to continue procuring drugs through the Joint Medical Stores (JMS) a mechanisms currently used by faith-based organizations to buy drugs and other essential health commodities. IRCU has already initiated a partnership with the SCMS to procure the required FDA approved drugs, which will be shipped to JMS where they will stored and later collected by respective implementing partners bimonthly after submitting accurate reports to IRCU. Learning from preceding ART programs, prompt forecasting and ordering will be paramount for the smooth running of the ART program. This will avoid stock out of drugs and any interruptions in the supply chain management. The SCMS will offer technical support and training to the health unit staff in forecasting, supply chain management as well as drug recording and storage.

OGAC: How is SCMS assessment proceeding with all of the USG partners? Planned assessment for 2nd quarter FY2007. The SOW will be jointly agreed by the USG PEPFAR team and we look forward to working with SCMS and OGAC on these issues. How is the GFATM linked here? SCMS will provide support to MoH and NMS to improve drug distribution systems. USG support is leveraging GF drugs/inputs in an overall approach to support Uganda's national care and treatment program. We will continue to address logistics support issues for drugs and commodities coming in from GF to avert stock outs.

*Support the Nat'l ART Committee to revise the nat'l ART policy and disseminate tx guidelines, M&E framework, surveillance of drug resistance, consolidation of procument for ARVs and CD4 machines, and build capacity of local partners in supply chain management of HIV/AIDS commodities. Support MoH and NMS to respond to emergency stock outs of ARVs in public health facilities.

plus ups: This activity will support the National Anti-Retroviral Treatment Committee under the Ministry of Health(MoH) to revise the national ART policy and disseminate treatment guidelines, monitoring and evaluation framework including activities to measure quality fo ART programs including cohort reporting, surveillance of HIV-drug resistance, consolidation of procument mechanisms for ARVs and CD4 machines, and build capacity of local partners in supply chain management of HIV/AIDS commodities. The program will also support MoH and National Medical Stores to develop mechanisms for responding to emergency stock outs of ARVs in public health facilities.

Table 3.3.11:

This activity is linked to Palliative care: basic (8862), TB/HIV (8995), Counseling and testing (8882) and Treatment: ARV drugs (8933).The SCMS project will provide critical logistics technical assistance to the key providers of laboratory services, diagnosis and prevention in Uganda, including the Ministry of Health, JCRC, IRCU and other PEPFAR NGO partners including the new program in 2006 targeting northern conflict zones. This will include forecasting and quantification, procurement tracking, product delivery and warehouse system improvement and delivery tracking for decision making. Procurement for ARV drugs for IRCU at a level of 1,000,000 is included this year. Commodities to be included under SCMS technical support include ARVs, HIV test kits, condoms, cotrimoxazole, Nevirapine and other PMTCT drugs, STI & OI drugs, and lab reagents and consumables for diagnosis. Uganda has made major advances in ARV treatment, diagnosis and prevention, but much remains to be done as patient numbers increase, access is brought closer to the local level, policies such as HIV routine testing, TB and HIV integration and new treatment for PMTCT mothers is adopted nationwide. Systems need to expand rapidly, be flexible to adjust to new policy demands and to be able to cope with emergency threats to the HIV/AIDS supply chain.

In the past year, Uganda with USG support has made incredible advances in improving laboratory services. Training has been done, quality control measures are being put in place, equipment procurement is under way, five regional lab centers of excellence have been established, laboratory reagents/consumables are now available and being distributed to 900+ labs and which will triple the number of tests possible. Supply Chain Management System (SCMS) will continue assistance in the design and management that was started with the DELIVER project. SCMS will help raise funds, provide coordination among donors and help raise visibility of logistics services. Distribution of lab reagents started in May 2006, but extensive logistics technical assistance will be required to consolidate this new system. SCMS will provide technical assistance in; the development/improvement of logistics systems with an emphasis on transport of samples to and results back from lab centers of excellence, strengthening distribution mechanisms to limit stock outs (especially from district to rural health centers), logistics management (especially distribution) of quality assurance commodities, data collection and analysis to guide forecasting and quantification, improving laboratory management, build capacity within the Central Public Health Laboratory and NGO PEPFAR recipients in joint forecasting and quantification, harmonized procurement with multiple donors (PEPFAR, Global Fund, etc.), developing standardized systems for mixing reagents, coordinating with various programs (TB, malaria, HIV/AIDS) for requirements, site level training, and support supervision including on the job training.

With laboratory tests for HIV related illnesses, TB, and malaria among other tests needed of accurate clinical management, the laboratory supply system now needs to work efficiently to enable labs to manage their role in the comprehensive HIV care and treatment package.