The goal of the Supply Chain Management System (SCMS) project is to ensure an uninterrupted supply of HIV/AIDS prevention and treatment commodities to government and NGO facilities in Zambia. To accomplish this goal, SCMS has six main objectives:

1. Procure required ARV drugs for HIV/AIDS treatment and post-exposure prophylaxis (PEP) for victims of rape, HIV rapid test kits, opportunistic infection (OI) drugs including cotrimoxazole, sexually transmitted infection (STI) drugs, and laboratory supplies in an efficient manner.

2. Ensure forecasting and procurement planning mechanisms for laboratory commodities are in place at the central level.

3. Support Ministry of Health (MOH) in the establishment of inventory control procedures, a logistics management information system (LMIS), and storage and distribution policies and procedures for all levels for laboratory commodities.

4. Support MOH in the implementation of an efficient and effective male circumcision (MC) supply chain.

5. Ensure forecasting and procurement planning mechanisms for MC are in place at the central level.

6. Support the MOH to develop and implement a National HIV AIDS Commodity Security (HACS) Strategy.

7. Continue to conduct detailed assessments of storage needs at SDP which include financial estimates for laboratories.

SCMS activities and procurements benefit all nine provinces in Zambia. USG-funded ARV drugs including ARV drugs for PEP in victims of rape, HIV rapid test kits, OI/STI drugs and laboratory commodities will be placed in the Government of the Republic of Zambia's (GRZ) central warehouse, Medical Stores Limited (MSL), where all public sector and accredited Non Governmental Organizations (NGO)/Faith Base Organizations (FBO) /Community Base Organizations (CBO)/work-place/private sector HIV/AIDS programs will have access to these critical supplies.

SCMS strives to strengthen health systems in Zambia by ensuring HIV/AIDS commodity security. The HACS strategy involves key policymakers and stakeholders to identify all areas that could impact the uninterrupted supply of HIV/AIDS commodities into the country and address bottlenecks in the supply chain.

SCMS focuses on improving the in-country supply chains for laboratory commodities and MC products. To achieve these activities, SCMS works on improving the supply chain knowledge of health care workers in Zambia. SCMS supports training of health care workers in the National ART Laboratory Commodity Logistics System for rollout in the expected 200 or more laboratories nationwide.

The activities SCMS conducts link with many activities conducted under the USAID | DELIVER PROJECT. SCMS strives to make the project more efficient by coordinating efforts with all cooperating partners in Zambia involved in supply chain management-related activities. SCMS utilizes the HACS coordinating committee to align activities of key stakeholders and cooperating partners such as GRZ; the Centre for Infectious Disease Research in Zambia (CIDRZ); Catholic Relief Services/AIDS Relief; Churches Health Association of Zambia (CHAZ); Zambia Prevention, Care and Treatment Partnership (ZPCT); Global Fund of AIDS, Tuberculosis and Malaria (GFATM); and the Clinton Foundation.

SCMS incorporates a vision of sustainability into all activities. In particular, SCMS focuses on support to the MOH with forecasting and procurement planning. SCMS works with key counterparts at the MOH to instill the knowledge of how the quantification process is implemented. Additionally, SCMS is working with the Biomedical Science schools to integrate logistics into the current curriculum.

Monitoring and evaluation is a key activity throughout SCMS technical assistance activities. Routine site visits and on-the-job training are offered in support of the MOH. SCMS, in conjunction with the MOH, conducts site visits to review the implementation of the logistics system at the 200+ laboratories nationwide.

The purpose of this activity is to procure OI and STI drugs (with a special emphasis on cotrimoxazole) in support of the GRZ's national ART program. Cotrimoxazole is used both as a prophylaxis and as a treatment for opportunistic infections. Following WHO recommended guidelines, Zambia has adopted the policy of adding cotrimoxazole to the new national ART guidelines which have been disseminated by the National HIV/AIDS/STI/TB Council (NAC). This commodity has been added to the national ARV ordering and reporting system to better ensure its availability for ART patients. With approximately 35% of FY 2010 funding, roughly 225,000 HIV-positive adults will receive cotrimoxazole.

Also included in this activity is the procurement of STI drugs to treat herpes, syphilis, gonorrhea, and chlamydia, which are the most common STIs in Zambia, and the most critical to treat for HIV/AIDS prevention. Additionally, SCMS will procure OI drugs to treat common infections such as pneumonia, meningitis, candidiasis, skin infections, toxoplasmosis and septicemia. Possible drugs to be procured include: amoxicillin, amphotericin B, ceftriaxone, ciprofloxacin, acyclovir, erythromycin, fluconazole, gentamycin, doxycycline, benzathine penicillin, and others, pending discussion with partners and the MOH. Drugs for post-exposure prophylaxis to prevent HIV infection in rape victims will also be procured under this activity.

The purpose of this activity is to procure HIV test kits in support of the GRZ testing and counseling (T&C), prevention of mother to child transmission (PMTCT), prevention of HIV in rape victims, and diagnostic testing programs. With FY 2009 funding, the USAID | DELIVER PROJECT provided support in strengthening the national HIV test kit forecasting, quantification, and procurement systems, while the U.S. Government (USG) through SCMS purchased $2 million worth of HIV test kits for the national program in accordance with GRZ and USG rules and regulations.

With FY 2010 funding, USG will continue its strong collaboration with GRZ, GFATM, and the Clinton Foundation/UNITAID to assist the national HIV testing programs in fulfilling demand for these products. On behalf of the USG, SCMS will purchase three types of test kits for various testing procedures based on the GRZ's 2006 revised HIV testing algorithm: screening (Determine), confirmatory (Unigold), and tie-breaker (Bioline). All three tests are non-cold chain HIV rapid tests that enhance the overall accessibility and availability of HIV testing in Zambia.

Furthermore, USG-funded HIV test kits will be placed in the GRZ's central warehouse, Medical Stores Limited (MSL), where all the public sector and accredited NGO/FBO/CBO HIV testing programs will have access to these critical supplies. It is estimated that over 1,200 testing sites will be accessing these donated supplies. Assuming that the number of annual tests stabilizes at 2010 figures, the USG's HIV test kit contribution will meet an estimated 59% of the projected national need, allowing for approximately 1,800,000 HIV tests to be conducted.

The purpose of this activity is to provide support to GRZ policy makers, the National HIV/AIDS/STI/TB Council (NAC), the MOH, the Ministry of Finance and National Planning (MOFNP), and other relevant stakeholders to implement the HIV/AIDS Commodity Security (HACS) Strategy which was developed with assistance from SCMS and the USAID | DELIVER PROJECT.

The development and initial implementation of a national HACS Strategy was based on a comprehensive HACS needs assessment conducted in consultation with key MOH managers, policy makers, and cooperating partners. The process has provided GRZ policy makers, NAC, donors, and other partners with a strategic plan detailing priority interventions to better ensure a sustained, appropriate supply of essential HIV/AIDS commodities required for the continuation of the national HIV/AIDS program following intensive PEPFAR support.

With FY 2010 funding, SCMS will continue working with the HACS Working Group and the 20 member organizations. In order to support the national HACS Working Group, and its implementation of the national strategy, SCMS will provide the following assistance with FY 2010 funding: 1) full-time support to the working group to ensure that the group remains a viable entity; 2) continuous review, monitoring, and updating of the implementation of the HACS Strategy; 3) advocacy for HACS at all levels of the health care system; 4) facilitate GRZ and donor coordination to analyze and make recommendations to harmonize various inputs into the national HIV/AIDS procurement systems; 5) enhance GRZ's commitment to provision of these essential commodities through increased budgetary support; and 6) conduct a supplementary analysis identified in the strategy such as market segmentation, ability to pay, and diversifying the funding base which would inform a longer term national sustainability strategy that could be less dependent on donors for vital HIV/AIDS commodities.

The USG, GRZ, GFATM, Clinton Foundation, and other partners are committed to creating an environment that will allow for the sustained availability of these critical supplies; long-term implementation of the HACS Strategic Plan will greatly assist in achieving this goal.

FY 2009 funds were used in the area of supply chain support for the implementation of a national program to support MC as part of the prevention of HIV/AIDS. Key activities included sending staff to the different national meetings focused on MC to ensure that supply chain issues were addressed as the program expanded, conducting a national exercise where the first agreed upon list of MC commodities was defined, monitoring the supply situation of MC products at Medical Stores Limited (MSL), and reporting back to the different partners on product availability.

Quantification of the MC needs for these products will continue to be a challenge in FY 2010 as there is no means to ensure that these products are used at a hospital only for MC. Moreover, currently there are no MOH defined targets for male circumcisions to be performed. Commodities required include, but are not limited to, disposable and reusable surgical supplies and instruments, local anesthesia, broad spectrum antibiotics for post-operative infections, STI drugs, and HIV test kits.

With FY 2010 funding, SCMS will review the pricing of the different MC products and determine if procuring complete kits is the most cost efficient manner, as the scale-up of the national program warrants greater funding support for commodity purchases. There will also be a need to determine if MC kits should be managed within the new Essential Drugs Logistics System, or kept separately to address the specific needs of the MC program. SCMS will also conduct more field visits to ascertain the stock situation as more health facilities initiate MC activities and will review use of these products for MC at hospitals. Another key activity will be to review the national logistics strategic plan for the support of MC activities; this plan will become increasingly important as more organizations begin supporting MC activities throughout the nation.

The purpose of this activity is to procure essential HIV/AIDS laboratory commodities in support of the national ART program which includes MOH, NGO and Zambia Defense Forces (ZDF).

The project will work to ensure that USG, GFATM, GRZ, and other partners' HIV/AIDS laboratory commodity procurements are in sufficient supply and available at service delivery sites through an efficient and accountable ART laboratory logistics and supply chain system.

To better ensure that these valuable commodities will be available in the correct condition, quantity, location and time, SCMS has been working to improve the national ART laboratory commodity logistics system through the design and implementation of the new lab logistics system. The new system includes a computerized central management information system that was installed at the MOH Logistics Management Unit.

With FY 2010 funding, SCMS will continue to procure laboratory commodities in bulk. SCMS will procure at least 50% of the national quantification for laboratory commodities; which will support the ART target of 323,020 patients. SCMS will also continue to strengthen and expand the national HIV/AIDS laboratory logistics system through the following activities:

1) Quantification and procurement of USG-funded HIV/AIDS laboratory commodities consistent with resources and policies for rapidly scaling-up HIV/AIDS clinical services, developing procurement planning capacity within the MOH and other key national stakeholders;

2) Continued implementation of a computerized HIV/AIDS laboratory logistics management information system (LMIS) in at least 50 service delivery sites. To complete these activities, SCMS will collaborate with GRZ, GFATM principal recipients, and other partners, to train up to 100 key personnel in the computerized laboratory logistics management system;

3) Provide technical assistance and funding support for the creation of service and maintenance contracts for laboratory equipment; which has been identified as a vital need by all stakeholders;

4) Maintain a system for monitoring the function and condition of laboratory equipment, providing an early warning system for the MOH when repairs or replacements are needed;

5) Increase the monitoring and evaluation of the HIV/AIDS laboratory supply chain as a whole, and will make improvements and recommendations as needed, taking full advantage of the recently established seven provincial offices;

6) Create a more sustainable national ART laboratory logistics system by integrating the laboratory logistics curriculum into the biomedical science schools pre-service curricula; and

7) Continue to conduct detailed assessments of storage needs at SDP which include financial estimates for laboratories.

The purpose of this activity is to procure ARV drugs including ARV drugs for PEP in support of the GRZ national ART program. In FY 2009, USAID | DELIVER PROJECT provided assistance in strengthening the national ARV drug forecasting, quantification, and procurement systems. With their support, the USG purchased over $23 million worth of ARV drugs for the national program in accordance with GRZ and USG rules and regulations.

With FY 2010 funding, the USG will continue its strong collaboration with GRZ, GFATM, UNITAID and the Clinton Foundation to assist the national ART programs in fulfilling demand for ART services. On behalf of the USG, SCMS will purchase the following drugs: zidovudine (AZT) 300mg, zidovudine/lamivudine 300/150mg, didanosine (ddI) 100mg, efavirenz (EFV) 200mg, EFV 600mg, lopinavir/ritonavir (LPV/r) 200/50 mg, nevirapine (NVP) 200mg, tenofovir/emtricitabine (TDF/FTC) 300/200mg, tenofovir/lamivudine (TDF/3TC) 300/300mg, abacavir (ABC) 300mg, lopinavir/ritonavir (LPV/r) 200/50mg. The cost per patient is estimated at $30-40/month depending on regimen, based on the new national treatment protocols enacted at the end of 2007.

To ensure an uninterrupted supply of ARVs, it is estimated that 66% ($18 million) of the FY 2010 funds will be needed for procurement before April 2010 in order to meet the 2010 ARV procurement gap. Furthermore, the remaining 34% ($ 9.16 million) of FY 2010 funding, combined with the estimated GRZ, GFATM and UNITAID funding, will only enable Zambia to meet approximately 85% of the targeted 323,020 patients expected to be on ART by the end of 2010. The estimated funding gap for ARV procurement for 2010 is between $10-11 million.

Purchases may change as: 1) additional ARV drugs are approved by the Food and Drug Administration (FDA) and registered in Zambia; 2) the GFATM and Clinton Foundation ARV drug donations change; and, 3) the GRZ increases its purchases of ARVs.