The goal of the Supply Chain Management System Project (SCMS) is to ensure an uninterrupted supply of HIV/AIDS prevention and treatment commodities to government and nongovernmental organization (NGO) facilities in Zambia. In 2013, SCMS has 6 main objectives:

1. Procure cost-effective, high quality commodities that include: ARV drugs for HIV/AIDS treatment, PMTCT and post-exposure prophylaxis (PEP) for victims of rape; HIV rapid test kits; opportunistic infection (OI) drugs including cotrimoxazole; sexually transmitted infection (STI) drugs; male circumcision (MC) kits; and laboratory supplies.

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

3. Support Ministry of Health (MOH) in the continued implementation of a supply chain for laboratory commodities at all levels.

4. Continue providing innovative solutions for data transfer including computerization of the laboratory logistics system at key service delivery points (SDPs) and cell phone technology.

5. Support the MOH to implement the National HIV/AIDS Commodity Security (HACS) Strategy.

6. Continue to increase adequate, safe, secure storage at targeted district health office facilities through procurement and installation of storage-in-a-box solutions.

SCMS continues to support systems that are managed by the MOH and Government of the Republic of Zambia (GRZ) parastatal, Medical Stores Limed (MSL) by providing capacity building and quality monitoring. SCMS strives to make the project more efficient by coordinating efforts with the MOH and all implementing and cooperating partners in Zambia involved in supply chain management-related activities at the central, provincial, and district level.

The purpose of this activity is to procure OI and STI drugs (with a special emphasis on cotrimoxazole) in support of the GRZs 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.

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, benzathine penicillin, and others, pending discussion with partners and the MOH. Drugs for post-exposure prophylaxis to prevent HIV and STI infection in rape victims will also be procured under this activity.

SCMS procurements benefit all nine provinces in Zambia. USG-funded OI/STI drugs will be placed in MSL, where all public sector and accredited NGO/Faith Base Organizations (FBO) /Community Base Organizations (CBO)/work-place/private sector HIV/AIDS programs will have access to these critical supplies.

SCMS will work to ensure that USG, Global Fund/UNDP, GRZ, and other partners HIV/AIDS laboratory commodities are in sufficient supply and available at service delivery sites through an efficient and accountable ART laboratory logistics and supply chain system. SCMS will conduct the following vital activities:

Increase ownership of the forecasting and quantification process at MOH central level as indicated by the MOH staff facilitating 90% of the quantification sessions and inputting 60% of quantification numbers. Quantification activities will include considerations for the PMTCT-only facility point-of-care CD4 equipment and 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.

Continued implementation of a computerized HIV/AIDS laboratory LMIS to another 20 service delivery sites. To complete these activities, SCMS will collaborate with GRZ, GFATM principal recipients, and other partners to train up to 40 key personnel at 20 sites in the computerized laboratory logistics management system.

Provide quality assurance monitoring of the institutionalized supply chain course that is now part of the biomedical science schools' syllabus.

Maintain M&E as a key activity where at least 90% of the site visits are conducted with MOH supervisory staff, allowing them to have a better hands-on understanding of how well the laboratory logistics system is functioning and to build MOH capacity.

SCMS procures essential HIV/AIDS laboratory commodities in support of the national ART program which includes facilities of MOH, NGO, FBO, CBO, and Zambia Defense Forces. To ensure an uninterrupted supply of laboratory commodities, it is estimated that $4 million of COP 2012 will be spent in FY 2012 and $3 million in the first quarter of FY 2013, which represents 59% of the total funds contributed in calendar year 2012. Even with the USG government contribution of $7 million in calendar year 2012, there will be a gap of $400,000.

Without increased COP 2012 funding or early release funding for COP 2013, there would be a gap of $17 million in calendar year 2013.

SCMS strives to strengthen health systems in Zambia by ensuring HIV/AIDS commodity security (HACS). The HACS strategy involves key policymakers and stakeholders to identify all potential impacts on the uninterrupted supply of HIV/AIDS commodities into the country and to address bottlenecks in the supply chain. With COP12 funding (in FY 2013), SCMS will be assisting in the implementation of the HACS Strategy which was developed by GRZ policy makers, National HIV/AIDS/STI/TB Council, MOH, Ministry of Finance and National Planning, and other relevant stakeholders. The implementation will include 1) advocacy for HACS at all levels of the health care system; 2) facilitating GRZ and donor coordination to analyze and make recommendations to harmonize various inputs into the national HIV/AIDS procurement systems; and 3) enhancing GRZs commitment to provision of these essential commodities through increased budgetary support.

In order to increase adequate, safe, and secure storage at targeted district health office facilities, SCMS will procure and install an additional 10 storage-in-a-box solutions at an approximate cost of $500,000.

In FY 2011 and FY 2012, SCMS supported the implementation of the national MC program as part of HIV/AIDS prevention. Key activities included technical assistance to the national technical working group on MC strategies. SCMS supported the development and adoption of a national MC communication strategy to attract adult males to go for MC. In addition, SCMS procured 14,900 MC kits and the supporting consumable commodities to support the ZPCT II. These kits and consumable commodities support the Zambian MC methodology: the dorsal slit method.

A key challenge in FY 2011 was accountability of use of consumable products. There is no means of ensuring that these individual products procured outside of the kit are used at the hospital for MC only. Commodities required that are outside of the current kit include, but are not limited to, disposable surgical supplies and instruments, gloves, gauze, surgical tape, and local anesthesia. In FY 2012, SCMS will review the pricing of the different MC products and determine if procuring complete kits which include all consumables is the most cost-effective strategy.

In FY 2013, SCMS will continue to procure the most cost-effective MC kit using SCMS's global procurement capability. A key part of SMCS's monitoring and evaluation activities, as it concerns MC in FY 2013, will be to ascertain if health facilities are using the kits solely for MC.

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. In FY 2013, it is expected that annual and quarterly MC forecasting and quantification activities will be supported by SCMS. As part of the National HIV/AIDS Commodity Security Strategy, SCMS will continue to support resource mobilization, including advocating for the inclusion of procurement of MC kits in Zambias Global Fund bids.

In FY 2013, SCMS will continue to support the MOH's HIV testing program by improving national and service delivery point (SDP) stock levels of HIV test kits. SCMS will maintain its strong collaboration with GRZ, Global Fund/United Nations Development Program (UNDP), and other implementing and cooperating partners to assist the national HIV testing programs in fulfilling demand for these products. On behalf of the USG, SCMS will procure three types of test kits for various testing procedures based on the GRZs 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. The HIV testing sites are MOH, NGO, FBO, CBO, and private sites addressing testing and counseling, PMTCT, prevention of HIV in rape victims, and diagnostic testing programs located in all nine provinces in Zambia.

In FY2012, USG's $2,000,000 contribution currently represents the sole funding available for national procurement of HIV tests to support an estimated 1,400+ testing sites conducting 2.6 million screening tests. Even with a USG contribution of $2,000,000, there will still be an estimated funding gap of over $1,000,000. The current prediction indicates that, without additional funding from another source or COP 2012 early funding release, the country would stockout of the screening test (Determine) in June 2012.

SCMS will work closely with MOH Laboratory Services and other implementing and cooperating partners to support the continued rollout and use of the point-of-care CD4 count testing machines at PMTCT-only health facilities by including the reagents in the logistics system.

SCMS will also continue the successful placement of Peace Corps Volunteers (PCVs) in each SCMS/DELIVER provincial office to support MOH and collaborate with partners by providing technical guidance and advice on public health commodity logistics, with a focus on PMTCT activities. By increasing the number of M&E visits to PMTCT sites, PCVs will better ensure that ARVs, point-of-care CD4 machines and reagents, contraceptives, and malaria treatment drugs, rapid tests and bed nets are in correct supply.

During these visits, PCVs will gather real-time data that can be compared to nationally reported data. The visit will also provide an opportunity to build capacity by providing on-the-job training when necessary.

This activity is budgeted under the Laboratory Infrastructure budget code.

The purpose of this activity is to procure ARV drugs including ARV drugs for PMTCT and PEP in support of the GRZ national ART program. In FY 2011, USAID | DELIVER PROJECT provided the technical assistance to strengthen the national ARV drug forecasting, quantification, procurement, and in-country supply chain systems. In 2012, SCMS will bring over $30 million of ARV drugs for the national program in accordance with GRZ and USG rules and regulations.

With FY2012 and FY2013 funding, the SCMS will continue its strong collaboration with GRZ, Global Fund/UNDP, and other implementing and cooperating partners to assist the national ART programs in fulfilling demand for ART services. On behalf of the USG, SCMS will purchase adult and pediatric first line and second line ARV drugs. The current cost per first line patient is estimated at $30-40/month depending on regimen; however SCMS will continue to minimize prices through its global procurement capacity and the procurement of generic drugs.

To ensure an uninterrupted supply of ARVs, it is estimated that 39% ($12 million) of the COP 2012 funds will be used in calendar year 2012 and the remaining 61% (18.6 million) will be used in calendar year 2013. The $18.6 million will represent 24% of the total ARV procurement need for calendar year 2013. With the estimated GFATM Round 8 and 10 funds available, there will be no gap in calendar year 2012 or 2013.

Purchases may change as: 1) additional ARV drugs are approved by the Food and Drug Administration and registered in Zambia; 2) the Global Fund/UNDP ARV drug donations change; 3) the GRZ increases its purchases of ARVs, and 4) the GRZ national ART or PMTCT guidelines change.

SCMS procurements benefit all nine provinces in Zambia. USG-funded ARV drugs will be placed in MSL, where all public sector and accredited NGO/ FBO / CBO/work-place/private sector HIV/AIDS programs will have access to these critical supplies.

added as part of $3M treatment plus up.

Dry Blood Spots bundles will be made available in order to strengthen early infant diagnosis of HIV and improve health outcomes by initiating full HAART at six weeks if found HIV positive. There are 70,000 exposed infants on a yearly basis and as such, more efforts should be made to capture them by making the DBS cards readily available.There has been an erratic supply of DBS cards in 2012 as there was no funding commitment from the Ministry and other stakeholders. Forecast estimates for the year 2012 determined a need for 43,200 cards but the need is likely to increase in 2013 and beyond. It is in this vain that USG is contributing $1,000,000 to enhance commodity availability.