Detailed Mechanism Funding and Narrative

Years of mechanism: 2008 2009

Details for Mechanism ID: 5973
Country/Region: eSwatini
Year: 2009
Main Partner: U.S. Centers for Disease Control and Prevention
Main Partner Program: NA
Organizational Type: Own Agency
Funding Agency: HHS/CDC
Total Funding: $475,000

Funding for Care: Adult Care and Support (HBHC): $20,000

N/A

New/Continuing Activity: New Activity

Continuing Activity:

Table 3.3.08:

Funding for Treatment: Adult Treatment (HTXS): $60,000

N/A

New/Continuing Activity: Continuing Activity

Continuing Activity: 18494

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

18494 18494.08 HHS/Centers for US Centers for 7983 5973.08 PEPFAR staff $20,000

Disease Control & Disease Control (salary/benefits)

Prevention and Prevention

Table 3.3.09:

Funding for Care: Pediatric Care and Support (PDCS): $10,000

N/A

New/Continuing Activity: New Activity

Continuing Activity:

Table 3.3.10:

Funding for Treatment: Pediatric Treatment (PDTX): $30,000

N/A

New/Continuing Activity: Continuing Activity

Continuing Activity: 18524

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

18524 18524.08 HHS/Centers for US Centers for 7983 5973.08 PEPFAR staff $30,000

Disease Control & Disease Control (salary/benefits)

Prevention and Prevention

Table 3.3.11:

Funding for Care: TB/HIV (HVTB): $30,000

N/A

New/Continuing Activity: New Activity

Continuing Activity:

Table 3.3.12:

Funding for Prevention: HIV Testing and Counseling (HVCT): $30,000

N/A

New/Continuing Activity: Continuing Activity

Continuing Activity: 18167

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

18167 11721.08 HHS/Centers for US Centers for 7983 5973.08 PEPFAR staff $30,000

Disease Control & Disease Control (salary/benefits)

Prevention and Prevention

11721 11721.07 HHS/Centers for US Centers for 5973 5973.07 CDC USDH staff $50,000

Disease Control & Disease Control in Swaziland

Prevention and Prevention

Program Budget Code: 15 - HTXD ARV Drugs

Total Planned Funding for Program Budget Code: $520,000

Total Planned Funding for Program Budget Code: $0

Program Area Narrative:

The Ministry of Health and Social Welfare (MOHSW) introduced free antiretroviral treatment in December 2003, with the full cost

of the ARVs (and some other medicines for opportunistic infections) covered by the Global Fund (PEPFAR/Swaziland does not

procure ARVs). The Swaziland National AIDS Program (SNAP) estimates that, thus far, close to 30,000 people had been initiated

on treatment, out of a total estimated 62,769 eligible.

National and facility-level stock-outs of medicines, medical supplies and lab reagents are not uncommon. Procurement and supply

chain management of medicines and medical supplies is typically handled by the MOHSW's Central Medical Stores (CMS).

However, CMS has a long-standing history of weak and inconsistent performance due to a number of challenges, including

severe infrastructural and human resource limitations. The same applies to the MOHSW's National Laboratory Services (NLS)

which is responsible for the procurement and management of lab reagents and supplies. Because of the above, for the

commodities that are procured with Global Fund funding a parallel system was put in place. The Principal Recipient, the National

Emergency Response Council for HIV/AIDS (NERCHA), directly procures the commodities based on requisitions from the

MOHSW's CMS or NLS. Once procured, the commodities are routed through CMS or NLS to the clinics and labs. It is clear,

however, that there are critical communication gaps between NERCHA and the MOHSW and that the parallel system has resulted

in additional layers of bureaucracy and not necessarily produced the expected results. Of recent, there appears to be a general

consensus that efforts should be directed at addressing the long term issues of CMS and NLS, rather than adding even more

parallel and/or temporary systems to try and resolve problems.

Since January 2006, through Management Sciences for Health (MSH), PEPFAR has worked with the MOHSW to implement a

drug supply management and tracking system (initially for ARVs only) at the public and private ARV clinics. In addition to helping

meet the Global Fund conditions precedent regarding Swaziland's eligibility for ARV procurement, this system has strengthened

the accountability of ARV stocks at all levels and optimized the quantification of drug needs and the estimation of re-order levels.

The roll-out of the drug supply management and tracking system is following the roll-out of ARV treatment services to a gradually

increasing number of health facilities in the country. Using the same successful approach, PEPFAR has also started working on

the quantification and supply chain management of other products (i.e. for PMTCT+, TB, other OI prophylaxis and management,

pain management, and lab). In addition, the PEPFAR has worked with the MOHSW on policy changes to strengthen the National

Drug Advisory Committee (NDAC) and to review the procurement practices for medicines and other commodities in order to

implement a transparent and efficient tendering and procurement system. MSH has revised existing formularies, promoted

adverse drug event reporting, and implemented pharmaceutical and therapeutics committees in treatment facilities.

All these successes have been achieved through close, ongoing collaboration between the PEPFAR, NERCHA, MOHSW (SNAP,

ART Program, TB Program, CMS, NLS, etc.) and other partners and stakeholders. PEPFAR has played a crucial role in

strengthening communication and collaboration within the MOHSW, between the MOHSW and NERCHA, and sometimes,

between NERCHA and Global Fund/Geneva.

With FY09 funding, support in this area will continue and will be in line with the new National Strategic Framework for HIV/AIDS

(NSF) for 2009-2013 that is currently under development.

1) In collaboration WHO, MSH has been working with the MOHSW and other stakeholders to review existing regulations and

legislation relevant to the procurement and distribution of medicines. This work is already well on the way as the first draft of the

medicines legislation is almost completed. However this is a long term activity. In FY09, MSH will continue to assist the MOHSW

to complete legislation and to implement the Swaziland Medicines Regulatory Authority (SMRA) to regulate the importation,

procurement, storage and distribution of medicines for the public and private sector.

2) MSH has been working with the NDAC to review procurement practices for medicines and other commodities in order to

implement a transparent and efficient tender system and to ensure access to cost-effective product of the highest quality from

reliable suppliers. In FY09, MSH will continue to strengthen the tendering process and assist the NDAC in monitoring supplier

performance, reviewing facilities expenditures and improving financing mechanism. A cost comparison analysis will be carried out

and presented.

3) MSH will continue to strengthen medicine and commodity needs quantification practices and the monitoring of needs estimate

vs. purchase vs. morbidity data for medicines and other commodities. The decentralization of the quantification process is one of

the key success factors; therefore facility level procedures will be further developed and implemented.

4) MSH will continue to expand and roll-out its drug supply management and tracking systems (both manual and computerized) to

ensure availability of essential medicines, optimize reorder level, monitor expenditures and strengthen the accountability of stock

at all levels. To date, MSH has implemented its computerized inventory and dispensing system (RxSolution) at 19 sites (including

private sites) to support access to ART. The system is expected to be deployed to additional sites during FY09. MSH will continue

to provide support to the system implementation and improvement and to building capacity at the site level to ensure that the

system is fully functional and used to collect data to support management. The implementation of the drug supply management

and tracking system is expected to go beyond the management of ARVs and will progressively include other medicines and

commodities.

5) MSH will assist the MOHSW in developing key performance indicators to monitor critical areas of the delivery of pharmaceutical

services at all levels (Central, district and facility). These indicators will feed into the national indicators. Standard operating

procedures (SOPs) will be developed to report on these indicators on a quarterly basis and will be included in the overall M&E

plan. SPS will also train pharmacy personnel in monitoring and evaluation principles.

Products/outputs:

•Medicines legislation and functional National Medicines Regulatory Authority

•Improved drug tendering process and functional National Medicines Advisory Committee

•National standard treatment protocols and guidelines and revisions of formularies

•Drug supply management and tracking system producing reports at facility, district and central level.

•Drug Committees formed and operational at treatment facilities

•M&E plan for pharmaceutical services

Planned activities in this program area are included within pre-Compact funding levels.

Table 3.3.15:

Funding for Treatment: ARV Drugs (HTXD): $20,000

N/A

New/Continuing Activity: Continuing Activity

Continuing Activity: 18523

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

18523 18523.08 HHS/Centers for US Centers for 7983 5973.08 PEPFAR staff $20,000

Disease Control & Disease Control (salary/benefits)

Prevention and Prevention

Table 3.3.15:

Funding for Laboratory Infrastructure (HLAB): $75,000

N/A

New/Continuing Activity: New Activity

Continuing Activity:

Table 3.3.16:

Funding for Strategic Information (HVSI): $50,000

N/A

New/Continuing Activity: Continuing Activity

Continuing Activity: 18168

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

18168 11833.08 HHS/Centers for US Centers for 7983 5973.08 PEPFAR staff $50,000

Disease Control & Disease Control (salary/benefits)

Prevention and Prevention

11833 11833.07 HHS/Centers for US Centers for 5973 5973.07 CDC USDH staff $50,000

Disease Control & Disease Control in Swaziland

Prevention and Prevention

Table 3.3.17:

Funding for Management and Operations (HVMS): $150,000

This includes three-quarters of costs associated with salary and benefits for the USDH CDC Country

Director who arrived at post inSeptember 2007 and whose role includes overall coordination and

management of the CDC program in Swaziland, as well as specific responsibilities for the PEPFAR SI

activities (the latter is reflected in the SI narrative and budgets).

Note: Salary and benefits for the PEPFAR/CDC Management Specialist (100% attribution to M&S) are not

covered here, as the request for these costs was included in the FY08 Compact "reprogramming".

Note: Salary and benefits for the CDC Program Specialists (USPSC in Care and Treatment, LES in

Laboratory, and LES in Epidemiology), are covered exclusively under relevant program areas.

All CDC PEPFAR staff will participate as members of the PEPFAR Steering Committee and will coordinate

partners in their respective technical areas to ensure complementary and synergistic activities. The CDC

Country Director will be a member of the PEPFAR Advisory Committee.

New/Continuing Activity: Continuing Activity

Continuing Activity: 18169

Continued Associated Activity Information

Activity Activity ID USG Agency Prime Partner Mechanism Mechanism ID Mechanism Planned Funds

System ID System ID

18169 11752.08 HHS/Centers for US Centers for 7983 5973.08 PEPFAR staff $200,000

Disease Control & Disease Control (salary/benefits)

Prevention and Prevention

11752 11752.07 HHS/Centers for US Centers for 5973 5973.07 CDC USDH staff $36,950

Disease Control & Disease Control in Swaziland

Prevention and Prevention

Table 3.3.19: