Detailed Mechanism Funding and Narrative

Years of mechanism: 2010 2011 2012 2013 2014 2015 2016 2017 2018

Details for Mechanism ID: 10703
Country/Region: eSwatini
Year: 2012
Main Partner: Management Sciences for Health
Main Partner Program: NA
Organizational Type: NGO
Funding Agency: USAID
Total Funding: $1,468,100

The goal of the SPS program is to assure the availability of quality pharmaceutical products and effectivepharmaceutical services to achieve desired health outcomes. SPS aims to promote and utilize a systemsstrengthening approach consistent with GHI, which will result in improved and sustainable health impact.According to WHO (2007), medical products, vaccines and technology are one of the 6 health systemsbuilding blocks. The SPS program is designed to reflect a dynamic relationship among the five buildingblocks with a Medical Products building block overlay. The above goal is linked to the PFIP keyintervention area which aims to decentralize and improve quality of care and treatment services in orderto increase access and improve outcomes for PLWHA through improved supply chain management(selection, procurement, distribution/storage, and use). SPS aims to contribute to this objective byensuring the availability of trained pharmacy professionals, information systems and high quality essentialmedicines and commodities across the key intervention area of decentralized care & treatment services.SPS will provide central and facility level support to strengthen pharmaceutical and supply chain systems.ART program site support will be provided in collaboration with ICAP at 3 regions (Lubombo, Hhohho andManzini) and Medecins San Frontieres (MSF) at Shiselweni region. Priority populations will be the peopleliving with HIV/AIDS (adult and children), health workers, prisoners, military personnel, women and girls.Activities will be planned to support the sustainable availability of commodities for the Medical MaleCircumcision program.

Global Fund / Programmatic Engagement Questions

1. Is the Prime Partner of this mechanism also a Global Fund principal or sub-recipient, and/or does thismechanism support Global Fund grant implementation? Yes2. Is this partner also a Global Fund principal or sub-recipient? Neither3. What activities does this partner undertake to support global fund implementation or governance?

Recipient(s) of ApproximateBudget Code Brief Description of ActivitiesSupport BudgetSupport and monitor implementation ofHTXD NERCHA 0grant activities especially those that relate

to pharmaceutical and health productsupply chain management. The supportincludes technical guidance in monitoringand improving grant performance.

Funding for Care: Adult Care and Support (HBHC): $194,200

In order to ensure the continuous availability of essential medicines for priority health conditions in thecountry, the supply chain system should be so robust that it ensures an uninterrupted supply. The keypriority intervention for the next two years is to revise the full spectrum of the supply chain system in thecountry. The SIAPS program will work to improve coordination, integration and accountability within thegovernment's supply chain system. The Central Medical Stores will be restructured to improveoperational efficiencies and accountability. Infrastructure improvements will be carried out to ensure theavailability of appropriate space for storage and dispensing of medicines at both HIV treatment initiationand refill sites. With the expansion of HIV care and treatment service points, SIAPS will work to ensurethat there is an uninterrupted supply and rational use of all medicines for opportunistic infections and themanagement of pain. SIAPS will continue the work started by SIAPS in ensuring availability ofCo-trimoxazole and Fluconazole for the comprehensive management of opportunistic infections.Working with the Malaria Control Program, SIAPS will monitor the availability and use of malariaproducts. SIAPS will also work with the Central Medical Stores to improve the management anddistribution of supplies for the Home Based Care (HBC) program. Support will be provided to localpalliative care service providers to promote the rational use of opiod and non-opiod analgesics forterminally ill patients. SIAPS will work to improve the rational use of medicines through providingtechnical support to Pharmacy and Therapeutics Committees (PTC) at the 4 hospitals in the country.These committees are tasked with managing the selection of medicines for the formulary, evaluating themedicines' use and then implementing strategies to improve their use at facilities.

Strategic Area Budget Code Planned Amount

Funding for Care: TB/HIV (HVTB): $200,000

SIAPS will support the supply chain of the National TB Control Program to strengthen the implementationof the 3 I's of TB management. Activities will also be targeted at providing information for themanagement of TB and surveillance of DR - TB. The SPS program has in the past worked directlywith the National TB Control Program to ensure an uninterrupted supply of TB medicines and theavailability thereof at health facilities including ART treatment clinics. The focus of support activities hasbeen on quantification, estimation and improving the overall procurement planning of first line and secondline drugs procured through Global Drug Facility mechanism. The support will also focus on improvingthe quantification and procurement of second line drugs (MDR-TB drugs). During the next two years,SIAPS will work to support the implementation of the Isoniazid Prophylaxis Therapy (IPT). The SIAPSprogram will work with MOH and partners to ensure anti-TB medicines and diagnostic commodities areavailable to support the TB program. With the introduction of Gene-Xpert®, the case load for DR-TB isexpected to increase as the confirmation of the DR strain will be quicker. Gene-Xpert® (Xpert) is

currently procured by various partners - Global Fund round 10 and MSF. The SIAPS program willsupport the MOH in ensuring the availability of commodities for this instrument. The logisticsmanagement information system for TB medicines will be improved to ensure that reporting andrequisition of TB medicines is integrated into the national supply chain systems. A system of commoditytracking will be developed to monitor the availability of commodities at all levels of the supply chain. Thetarget activities in the next two years will be to ensure the continuous availability of CPT and IPTincluding vitamin B6. Through support to the Pharmacy and Therapeutic committees, SIAPS willsupport the facilities to ensure the availability of supplies for Infection Prevention Control. SIAPS willtrain health workers and develop job aids to support the health workers in dispensing of TB medicines tochildren.

Strategic Area Budget Code Planned Amount

Funding for Care: Pediatric Care and Support (PDCS): $48,550

SIAPS will work to support the expansion of pediatric HIV Care and Support services throughstrengthening the supply chain and rational use of medicines for the management of opportunisticinfections. SIAPS will support the early access to services, diagnosis and care for exposed infantsthrough improvement in the commodity availability to support pediatric care programs. Support isprovided as part of the comprehensive, family oriented approach where medicines for children,care-givers to manage their condition - opportunistic infection - are available in a one-stop centre. Themost common causes of death amongst children with HIV are pneumonia and diarrhea. SIAPS will workwith the MOH in improving the management of childhood illnesses through the implementation oftreatment guidelines which are linked to the IMCI (Integrated Management of Childhood Illnesses). Inthe development of these guidelines, conditions such as pneumonia, diarrhea, malaria, measles andother HIV infections are considered as key conditions that should be managed appropriately at primaryhealth care (PHC) level. Medicines for these conditions will be monitored to ensure continuousavailability at all PHCs according to the national essential medicines list. These medicines include,antibiotics, co-trimoxazole, zinc supplements. SIAPS will work to ensure an uninterrupted supply ofCo-trimoxazole; appropriate forecasting, and quantification principles will be used. Providers will bementored on stock monitoring and dosing of pediatric co-trimoxazole. The co-trimoxazole is available toall eligible patients (infants and caregiver) at no cost. SIAPS will support MOH budgeting andprocurement functions in view of the transitioning out of the UNITAID/CHAI that has been procuring CTXfor the national program.

Strategic Area Budget Code Planned Amount

Funding for Laboratory Infrastructure (HLAB): $97,100

A well functioning laboratory supply chain will enhance the availability of essential commodities andsupplies required to provide necessary laboratory services towards achieving health outcomes.Laboratory supply chain is an essential element in the scale up of treatment and care services. It is alsocritical in ensuring the quality of the diagnostic services provided in the country. With additionalresources and activities aimed at scaling up treatment and care services, such as the introduction ofpoint of care equipment and the Xpert technology for DR-TB diagnosis, it is critical that the commoditiesand supplies of highest quality be available consistently. SIAPS will support the supply chainmanagement in the laboratory system, capacity building in the logistics management system, policyguidance in procurement of reagents and equipment, logistics information systems. SIAPS will workwith University Research Council (URC, LLC) to improve the management of laboratory supplies andcommodities in support of program scale up and expansion. Activities will be focused on ensuring anuninterrupted availability of laboratory commodities for HIV&AIDS (including HTC commodities for theMedical Male Circumcision program), TB and Malaria programs. SIAPS will work with partners such asMSF, CHAI and URC / APHL to ensure commodity security for the laboratory services (POC, Xpert). TheSupply Chain Technical Working Group will work to develop a commodity security strategy for laboratoryservices. This will also coordinate all inputs from donor and government to ensure an uninterruptedavailability of commodities.

Strategic Area Budget Code Planned Amount

Funding for Health Systems Strengthening (OHSS): $100,000

SIAPS will use these funds to start a pharmacy training program at UNISWA. Their efforts will ensurethat there is capacity, equipment and the required human resources to implement the program in amanner that meets MOH guidelines and staffing requirements. SIAPS has engaged a consultant toconduct a feasibility assessment of the training of pharmacy personnel in the country. This assessmentwill determine the market requirements and recommend the ideal curriculum to be adopted in Swaziland.A training proposal and curriculum is currently being developed to be submitted to UNISWA for approvalin May 2012. It is planned that the first intake of learners on this curriculum will occur in the academicyear starting in August 2012. A two year program is proposed with an initial intake of 20 learners tograduate in September/October 2014.

Strategic Area Budget Code Planned Amount

Funding for Treatment: ARV Drugs (HTXD): $485,500

SIAPS will work closely with the National AIDS Program to improve the quality of pharmaceuticalservices provided in the country's ART initiation and refill sites. A total of over 500 health workers havebeen trained under the SIAPS program on ARV supply chain management, HIV PharmaceuticalManagement and also general principles of inventory management. Personnel from the country's 234facilities [clinics, hospitals and health centres] have been trained. SIAPS will work with the 4 regionalpharmacists in the country to improve medicines' use at facilities with the development of StandardOperating Procedures and other interventions to improve quality pharmaceutical services at clinics andhealth centers. The capacity and skills of these regional pharmacists will be improved to providesupportive supervision and systems approach mentoring. The SIAPS program procured storageequipment for the 9 newly constructed additional medicines dispensaries and stores to improve thestorage capacity for essential medicines. Additional storage facility refurbishments at peripheral facilitieswill be undertaken under the SIAPS program in support of the decentralization of ART services. Thefocus on these refurbishments will be on medicine storage space, equipment and supplies for dispensingmedicines. In the next two years, SIAPS will work to rationalize the use of storage space for essentialmedicines and laboratory commodities. SIAPS will work to support ART scale-up services at additionalfacilities to ensure the provision of quality pharmaceutical services at these facilities. Projects such asthe NARTIS (Nurse ART initiation in Swaziland) will be supported on aspects of adherence monitoring,pharmacovigilance and other aspects of quality pharmaceutical services.

Strategic Area Budget Code Planned Amount

Funding for Treatment: Adult Treatment (HTXS): $294,200

SIAPS will work closely with the National AIDS Program to improve the quality of pharmaceuticalservices provided in the country's ART initiation and refill sites. A total of over 500 health workers havebeen trained under the SIAPS program on ARV supply chain management, HIV PharmaceuticalManagement and also general principles of inventory management. Personnel from the country's 234facilities [clinics, hospitals and health centres] have been trained. In addition, funds will go to support apharmacy training program at UNISWA. SIAPS will work with the 4 regional pharmacists in the countryto improve medicines' use at facilities with the development of Standard Operating Procedures and otherinterventions to improve quality pharmaceutical services at clinics and health centers. The capacity andskills of these regional pharmacists will be improved to provide supportive supervision and systemsapproach mentoring. The SIAPS program procured storage equipment for the 9 newly constructedadditional medicines dispensaries and stores to improve the storage capacity for essential medicines.Additional storage facility refurbishments at peripheral facilities will be undertaken under the SIAPSprogram in support of the decentralization of ART services. The focus on these refurbishments will be

on medicine storage space, equipment and supplies for dispensing medicines. In the next two years,SIAPS will work to rationalize the use of storage space for essential medicines and laboratorycommodities. SIAPS will work to support ART scale-up services at additional facilities to ensure theprovision of quality pharmaceutical services at these facilities. Projects such as the NARTIS (NurseART initiation in Swaziland) will be supported on aspects of adherence monitoring, pharmacovigilanceand other aspects of quality pharmaceutical services.

Strategic Area Budget Code Planned Amount

Funding for Treatment: Pediatric Treatment (PDTX): $48,550

SIAPS will work to support the expansion of pediatric HIV Care and Support services throughstrengthening the supply chain and rational use of medicines for the management of opportunisticinfections. SIAPS will support the early access to services, diagnosis and care for exposed infantsthrough improvement in the commodity availability to support pediatric care programs. Support isprovided as part of the comprehensive, family oriented approach where medicines for children,care-givers to manage their condition - opportunistic infection - are available in a one-stop centre. Themost common causes of death amongst children with HIV are pneumonia and diarrhea. SIAPS will workwith the MOH in improving the management of childhood illnesses through the implementation oftreatment guidelines which are linked to the IMCI (Integrated Management of Childhood Illnesses). Inthe development of these guidelines, conditions such as pneumonia, diarrhea, malaria, measles andother HIV infections are considered as key conditions that should be managed appropriately at primaryhealth care (PHC) level. Medicines for these conditions will be monitored to ensure continuousavailability at all PHCs according to the national essential medicines list. These medicines include,antibiotics, co-trimoxazole, zinc supplements. SIAPS will work to ensure an uninterrupted supply ofCo-trimoxazole; appropriate forecasting, and quantification principles will be used. Providers will bementored on stock monitoring and dosing of pediatric co-trimoxazole. The co-trimoxazole is available toall eligible patients (infants and caregiver) at no cost. SIAPS will support MOH budgeting andprocurement functions in view of the transitioning out of the UNITAID/CHAI that has been procuring CTXfor the national program.

Subpartners Total: $0
Luvit Solutions: NA
Key Issues Identified in Mechanism
Increasing gender equity in HIV/AIDS activities and services
enumerations.Malaria (PMI)
Safe Motherhood
Tuberculosis
Family Planning