USAID is consolidating its support to Uganda's supply chain management system to improve coordination

and build upon the work of the three implementing partners that currently provide technical assistance on

logistics management in the country. It is expected that procurement services for ARVs and other HIV/AIDS

commodities will continue to be provided by SCMS to ensure that there is no disruption in ART patient

treatment. The new mechanism will provide technical assistance (only) to improve the functioning of the

national supply chain for ARVs and other HIV/AIDS health commodities including improved forecasting and

quantification of overall country program needs and the needs of implementing partners; transparent

procurement mechanisms to ensure the right products are purchased in a timely manner; quality assurance

of commodities; proper storage and timely distribution to the end user health facilities; and complete and

accurate logistics information at all levels of the supply chain. The new mechanism will work with key

Government of Uganda entities (Ministry of Health (MOH), National Medical Stores (NMS), National Drug

Authority (NDA), district health offices and health facilities, Joint Medical Stores (JMS), and in-country and

international partners.

The Supply Chain Management System (SCMS) partnership was established to strengthen or establish

secure, reliable, cost-effective and sustainable supply chains to meet the care and treatment needs of

people living with or affected by HIV and AIDS. In collaboration with in-country and international partners,

SCMS works toward deploying innovative solutions to assist programs to enhance their supply chain

capacity; ensuring that accurate supply chain information is collected, shared and used; and providing

quality, best-value, health care products to those who need them. In Uganda, SCMS is providing technical

assistance to the Ministry of Health, Joint Medical Stores, and National Medical Stores as well as some

PEPFAR programs. SCMS also provides procurement services for the Inter-Religious Council of Uganda

(IRCU), and the Northern Uganda Malaria AIDS and TB program (NUMAT) and emergency procurement for

the Ministry of Health. SCMS provides support the Ministry of Health's ART coordination mechanism, and

continues to strengthen logistics information system through formal and on-going training during supervisory

visits

This activity is linked to PMTCT, Adult Care and Treatment, Pediatric Care and Treatment, Counseling and

Testing, Laboratory Infrastructure, TB/HIV

In FY 2008, the SCMS project provided procurement services and technical assistance to the Inter-

Religious Council of Uganda (IRCU), Northern Uganda Malaria AIDS and TB program (NUMAT), and

UPHOLD (now ended) to improve the availability and management of ARV drugs in their sites. SCMS also

provided funds to the MOH for emergency ARV procurements. To-date, a total of $1,795,000 of ARVs and

related commodities has been procured through SCMS for these partners. SCMS will also procure ARVs for

EGPAF. NUMAT, in partnership with SCMS, established logistic management systems and procedures for

ARV supply in its ART sites and a working arrangement was developed with Joint Medical Stores, a central

warehouse for FBOs and other private sector organizations, to deliver to the partner sites based upon

requisition. NUMAT technical officers trained and mentored ART teams in logistics management to ensure

smooth system performance and logistics tools and materials adopted from MOH formats were distributed

to the ART sites to ensure proper reporting of drug consumption. During the period, two cycles were

delivered of first and second line adult ARV formulations for 17 existing ART sites and later for 6 additional

newly accredited ART sites in the nine districts. Gaps in pediatric support were identified, which led to

negotiations with Baylor Children College (Uganda) to provide the ART clinics with ARV formulations for

young children. The choices of ARV drugs selected by the program were determined by the current GoU

ARV policy that took into consideration efficacy, adverse effect profile, and pill burden. The ARV drugs

selected also took into consideration needs of the clients gaining entry through the other program areas of

PMTCT and TB.

SCMS also procured ARVs and drugs for opportunistic infections for the IRCU program. Technical staff

have been trained in forecasting drug needs for the program and on the ARV logistics management system.

A computerized logistics management information system was installed using standard soft ware to track

consumption and stock levels at the individual sites. Thirteen implementing sites are currently submitting

bimonthly ARV drug reports and orders to the IRCU Logistics Officer. The partnership with SCMS and JMS

has been successful to date and has guaranteed steady availability of ARVs at all IRCU supported sites. In

addition, as a result of this partnership, IRCU has been able to procure quality ARVs at the most

competitive rates available on the market, guaranteeing that its clients are accessing quality products and,

with the savings, enabling the program to recruit more ART clients.

At the national level, SCMS provided technical assistance to the MOH to forecast and quantify the country's

ARV needs, coordinate procurement with donors, and train new district and new ART site staff on logistics

management and reporting. SCMS also assisted in support supervision activities at district level to improve

facility level performance. Specific achievements include 683 health workers country-wide trained on the

redesigned MOH ART logistics management system, 28 MOH regional pharmacists and senior dispensers

trained on management of ART logistics activities, and 92 health workers from 38 newly accredited ART

sites trained on the logistics management system. The SCMS supervisory team visited a total of 174 ART

sites to monitor performance and provide on-the-job support to health workers charged with logistics

management. Efforts to harmonize ARV procurement among PEPFAR partners and communicate supply

issues continued through various technical working groups and technical support was provided to the

GFTAM third party procurement agent (WHO/UNICEF). In FY08, technical assistance was provided to JMS

to completely overhaul its warehousing and inventory management system including installation and

training in the new warehouse management information system (MACS) and the financial system (SAGE)

software. Support was also provided to NMS to assess its warehousing and inventory management system,

the recommendations of which were endorsed by the NMS Board of Directors.

In FY2009, SCMS will continue to provide procurement services to buy ARVs (and other HIV/AIDS

commodities as required) for USAID-supported partners including IRCU, NUMAT, the new partners

implementing the three district-based HIV/AIDS/TB programs, and EGPAF. SCMS will also continue to buy

ARV buffer stocks for the MOH. NUMAT will continue to improve access by working with MOH to accredit

both public and private health facilities not currently served by other USG supported agencies.

Activity Narrative: USAID/Uganda's partnership with IRCU ends in June 2009. USAID/Uganda plans to initiate a follow on

program to build upon and further expand the current achievements of IRCU.

Capacity building in ARV logistics management will continue in FY 2009 at the sites and national level but

through the new partner (TBD). This new partner will provide the logistics management technical assistance

that SCMS used to provide, including commodity forecasting and quantification, procurement planning,

donor coordination, and strengthening the logistics management information systems for ARVs and other

HIV/AIDS related commodities. The ART procurement harmonization exercise begun in FY 2008 will

continue in FY 2009 to achieve a consolidated supply plan for all PEPFAR partners offering ART services.

TBD will continue to participate in technical working groups to address emerging issues that impact on

logistics management systems, e.g. changes in treatment protocols. Logistics advisors will work closely

with MOH technical programs, the Pharmacy Division and NMS to build capacity and facilitate the transition

of logistics management functions to local counterparts. To improve central level management and

distribution of ARVs and other commodities, TBD will work the NMS and other donors to implement the key

recommendations of numerous NMS assessments including installation and training on new systems

software, and hardware procurement (e.g. computers, software, warehousing equipment, odometer

readers) to improve efficiency and cost-effectiveness of operations. JMS will also receive technical support

as needed to complete implementation of their new warehousing systems. At the policy level, TBD will work

with the MOH, NMS and other GoU ministries, e.g. Ministry of Finance, to address the well-documented

legal, regulatory, and financial issues that negatively affect the national supply chain system. An important

area of focus will be to improve accountability and enforcement of procedures, laws and regulations

regarding leakage of public health commodities. At the district and lower level, more TBD technical

assistance will be focused on on-job training and support to DHO, HSD and health facility staff in carrying

out their logistics management operations including planning and tracking their expenditures and submit

timely reports to keep the system moving. A special area of focus will be the development and testing of a

scalable model to improve "last-mile" distribution to health centers in selected districts.

The Uganda National Treatment Guidelines have been revised and the recommended first line choice of

therapy is Nevirapine (NVP) + Zidovidine (AZT) + Lamuvidine (3TC) as a combination pack or blister pack

called Combi-pack. In the event of failure on this combination, the alternative combination recommended,

albeit more costly, is Truvada + Nevirapine + Efavirenz. Unless changed, the follow-on program will follow

the same prescription protocols. Other than Truvada, generic versions of all other drugs recommended by

MOH for use as first line have been approved by FDA. This has helped to standardize care and compliance

with the national treatment guidelines, especially in health facilities receiving support from PEPFAR and

Global Fund. In situations of stock-outs in the MOH ART program, PEPFAR drugs are used as a buffer to

ensure that patients receive uninterrupted treatment. Development of ART drug resistance threshold

monitoring mechanisms at representative sentinel sites will ensure that we supply drugs that remain

efficacious. In FY 2010 the activities will continue unchanged.

New/Continuing Activity: New Activity

Continuing Activity:

Table 3.3.15: