This is a continuing activity from COP 2009. The focus of the Partnership for Supply Chain Management (PSCM) for COP 2010 will be to consolidate efforts to support quality of care at the facility level through systems strengthening in three areas: (1) the supply chain management capacity of the Pharmaceutical Fund and Supply Agency (PFSA), from quantification/supply planning/procurement to distribution and management information systems; (2) public sector capacity to effectively manage logistics activities that affect product availability; and (3) the national laboratory system and its ability to provide technical support in the management of lab commodities.

In COP 2009, PSCM launched the implementation of a "Quick Win" distribution/capacity building strategy. This approach intends to leverage tools and systems tested for HIV/AIDS commodities and industry best practices in supply chain management, such as warehouse operations, fleet and distribution management, inventory control, order processing. The goal for COP 2010 is to institutionalize modern and robust supply chain management practices in PFSA.

In COP 2010, PSCM begin to withdraw staff providing technical assistance for systems development and replace them with trained and experienced PFSA employees. To support this transition, PSCM will work closely with other USG logistics partners to ensure that integrated information systems are in place, linking facilities with PFSA branches. It is also expected that PFSA will have made significant strides in the expansion/construction of hub warehouses and in central level procurement. PSCM will ensure that standard operating practices and systems are successfully transferred to the new locations. PSCM will continue to support the development of a comprehensive management information system (MIS) with PFSA, linking inventory control systems with systems supporting PFSA's financial and fund management needs. The latter will support PFSA's major goal to establish a functioning revolving drug fund capable of recovering costs while sustaining a continuous supply of essential medicines.

Systems strengthening will focus on maximizing the impact of partner coordination mechanisms established in COP 2009, between PSCM and USG implementing partners, local institutions (with support from seconded PSCM staff), and other stakeholders. Impact will be measured in terms of durable strengthening of public health facilities, subsequent to intensive partner and government support at site level, efficient and effective assignment of partner resources, prioritization of vital HIV/AIDS commodities to ensure full supply in high-volume health facilities, and stronger, systematic linkages between the RHBs/health facilities and PFSA hubs. PSCM, in coordination with USG logistics partners, will also ensure that regions and facilities are effectively implementing the commodity tracking/pharmaceutical information management system developed with PFSA. Finally, PSCM will maintain its emphasis on supporting the achievement of targets in prevention, care and treatment, contributing essential supplies and contingency funding.

In the area of laboratory systems, PSCM will aim to consolidate its support to the Ethiopian Health and Nutrition Research Institute (EHNRI), regional laboratories and PFSA to transition out of technical assistance in this area, promoting inclusion of laboratory logistics in the integrated national supply chain system. Focus will be placed on capacity building/mentoring, and institutionalization of public-sector laboratory logistics systems as part of the system managed by PFSA

PSCM will continue to provide gap-filling supplies of essential HIV/AIDS commodities to the national program from USG funding sources. It is important to note that PEPFAR funds are insufficient to fill the large gaps in the supply needed to support Ethiopia's universal access goals, or even more modest program expansion. PSCM will procure laboratory supplies, including reagents for ART monitoring and pediatric/early infant diagnosis, selected drugs for OI and STI management, essential supplies for PMTCT services, as well as infection prevention, home-based care, ready-to-use therapeutic food and other selected commodities. PSCM will maintain a an ARV and commodity fund to address emergency needs for ARVs and other critical HIV commodities, and in some cases to fill a portion of gaps in HIV commodities procured through other sources such as the GFATM. PSCM will support the phase-out of Clinton Foundation support for pediatric ARVs. In addition to supply planning/monitoring and procurement, PSCM will assure delivery of products to all eligible sites, with this responsibility to be assumed by PFSA during COP 2010.

Finally, through coordination and a focus on leaving sustainable systems in place, PSCM will maintain its operations at cost-efficient levels. A performance monitoring plan, building on plans from COP 2008 and COP 2009, will be developed and used to routinely report on achievement of goals and desired outcomes.

PSCM COP 10 funding will be supplemented with $7,876,894 of COP09 pipeline funding, to fully support the ARV and Commodity Fund, Early Infant Diagnosis commodities, Health Systems Strengthening including pharmaceutical management, laboratory logistics and reagents for ART monitoring, and nutrition commodities. It will be necessary to increase COP11 funding to fully support several of these critical areas.

COP 2010 will support HIV programs with procurement of home-based care (HBC) supplies, opportunistic infection (OI) drugs and Food by Prescription (FBP) commodities, ensuring availability for targeted beneficiaries. The quantities needed exceed identified funding sources, hence the Partnership for Supply Chain Management (PSCM) will coordinate with other stakeholders to cost national HIV commodity needs, and procure products. PSCM will work with Government of Ethiopia (GOE) counterparts and implementing partners to pursue attainable program objectives given available resources. PEPFAR Technical Working Groups have defined funding levels for these commodities under COP2010.

Including a full supply of Cotrimoxazole, PSCM will procure up to 100% of the estimated annual need for 30 key OI commodities, of 76 identified as necessary to address OIs. Procurement will focus on complementing GOE expenditures to fill gaps for highly prevalent OIs. It is expected that 475,000 patients will be reached with OIs through the estimated funding level of $4,969,526.

Unlike the increasing OI drug need, projections for HBC indicate reductions in bed-ridden patients, thus procurement will focus on commodities needed to ensure integrated lab testing, and to increase retention and adherence. The estimated funding of $2,372,036 covers approximately 23,325 patients for one year.

Nutrition procurement will cover annual targets set by the FBP activity to ensure a complete supply of ready-to-use therapeutic food and fortified blended flours. The estimated funding of $1,714,450 will cover approximately 50,000 beneficiaries for one year. PSCM pipeline funds will be used to cover $770,965 of this amount, with $943,485 coming from COP 2010. Under COP 2011, full funding will require additional funds. For all commodities, price hikes during the year will reduce the number of beneficiaries which can be covered.

No PEPFAR national/essential reported indicators are pertinent to this activity; relevant individualized indicators will be developed during COP 2010. No training, clinical services or adherence activities occur under this activity. Quality assurance and supportive supervision will be carried out by USAID and PSCM headquarters staff.

The additional 1,745,550 is for pocurement of food products

The focus of this activity will be to procure lab commodities to support HIV lab testing for HIV positive individuals on antiretroviral treatment (ART) and pregnant HIV positive women.

Despite the expected expansion of ART monitoring to health centers, it is not expected that the number of tests conducted nationally and hence the supplies needed will increase significantly, as commodity forecasts have been principally based on patient targets; hospital sites have been shouldering the majority of testing requirements to date. Consumption of testing supplies has been far less than quantified and the consumption based approach to quantification is likely to streamline needed funding levels for ART lab supplies. Hence, COP 2009 funding levels are perceived as adequate to meet increasing patient and testing targets. It is expected that targets of 14.48 million tests (CD4, Chemistry, Hematology, and "Tests, Various" combined), a 57% increase from targets set in COP 2009, can be achieved under a flat line budget.

Further analysis of the product pipeline for commodities, as well as the factors mentioned above, carried out with the Centers for Disease Control (CDC) laboratory team, indicate that a funding level of $11,791,062 will cover 100% of estimated COP 2010 ART monitoring testing needs, including viral load and consumables.

ART lab monitoring has been prioritized for full coverage, given the importance of this activity in maximizing the effectiveness of ART. Notwithstanding this prioritization, the proposed funding level of $9,377,447 represents only 79.5% of the estimated need under COP 2010, with the balance to be covered by pipeline. Under COP 2011, full funding will require additional funds. The PEPFAR Technical Working Groups have set the funding level based on an analysis balancing available funding with technical priorities.

No PEPFAR national/essential reported indicators are relevant to this activity. Relevant individualized indicators will be developed during COP 2010. No training, clinical services or adherence activities occur under this activity. Quality assurance and supportive supervision to ensure effective procurement and quality products will be carried out by USAID and PSCM headquarters staff.

As the Clinton HIV/AIDS Initiative (CHAI) support for pediatric treatment commodities, including early infant diagnosis (EID), ends on December 31, 2010, the Partnership for Supply Chain Management (PSCM) will cover the transition period until the Government of Ethiopia (GOE) takes over procurement of these product categories using Global Fund To Fight AIDS, Tuberculosis and Malaria (GFATM) monies.

PSCM will work closely with CHAI, the Ethiopian Health and Nutrition Research Institute (EHNRI), the Pharmaceutical Fund and Supply Agency (PFSA), the Centers for Disease Control and Prevention (CDC) and other implementing partners and regions to procure complementary supplies for the program as needed, and to continue to strengthen the logistics system for forecasting, quantifying, procuring, distributing, storing and dispensing these products.

Assuming availability of funds, any budgetary shortfalls in this area are expected to be covered through the antiretroviral (ARV) and commodity fund described in Budget Code 15 Treatment ARV Drugs, which is used to cover any potential gap in the procurement of essential treatment commodities needed by pediatric ART patients, including EID supplies and ARVs.

The funding level to support EID supplies has been defined by the PEPFAR Technical Working Groups, through close collaboration and analysis with the CDC laboratory team, as $420,652. For COP 2010, $380,328, to cover 90% of the gap left by CHAI's withdrawal from funding, has been determined as the amount available, balancing availability of funds with technical priority; $40,324 from pipeline funds will cover the remainder. For COP 2011, additional funding above the COP 2010 funding level will likely be required to assure full supply of EID commodities.

No PEPFAR national/essential reported indicators are relevant to this activity. Relevant individualized indicators will be developed during COP 2010. No training, clinical services or adherence activities occur under this activity. Quality assurance and supportive supervision to ensure effective procurement and quality products will be carried out by USAID and PSCM headquarters staff.

The additional 464,451 will be used for procurement of food products

The COP 2010 focus will be systems strengthening in three areas: 1) supply chain management capacity of the Pharmaceutical Fund and Supply agency (PFSA); 2) public sector capacity to manage activities that affect logistics management and product availability; and 3) the national laboratory system's ability to provide technical support in management of lab commodities.

In COP 2010, it is expected that the Partnership for Supply Chain Management (PSCM) will complete implementation of a "Quick Win" transition strategy grounded on the build-operate-transfer principle, launched in COP09. This approach will leverage systems for best practices in supply chain management. The goal is to institutionalize robust supply chain management practices in PFSA. PSCM will begin to pull out staff providing technical assistance (TA) for systems development and replace them with trained PFSA employees. PSCM will work closely with other USG logistics partners to ensure that management information systems (MIS) are in place. Support will be provided for development of an MIS linking inventory control systems with financial management systems.

Systems strengthening will maximize the impact of partner coordination mechanisms established between PSCM, USG implementing partners, PFSA and other stakeholdersPSCM will aim to consolidate support to the Ethiopia Health and Nutrition Research Institute (EHNRI), regional lab departments and PFSA, to transition out of TA in the lab area and promote integration of lab logistics in the new national system.

Funding of $6,375,000 is estimated to be needed to support COP 2010 activities. Pipeline of $2,515,990 will be used to support these, supplementing the funding level set by the PEPFAR Technical Working Group. For COP 2011, additional funds above the COP 2010 level may be required to fully support this priority area.

Through a focus on partnership and leaving sustainable systems, PSCM will maintain operations at cost-efficient levels. A performance monitoring plan will be used to routinely report on achievement of goals.

No clinical services or adherence activities occur under this activity. Quality assurance and supportive supervision will be carried out by USAID and PSCM headquarters staff.

This is a new Budget Code under COP 2010. Focus will be procurement of infection prevention (IP) materials.

While minor funding for infection prevention commodities has been included in Global Fund To Fight AIDS, Tuberculosis and Malaria (GFATM) grants, it is not clear that the Ministry of Health (MOH) has procured these successfully to date. The Partnership for Supply Chain Management (PSCM) will strengthen capacity of the Pharmaceutical Fund and Supply Agency (PFSA) to procure infection prevention commodities, and given the major gap between available GFATM funding and quantified needs, will procure them under COP09-10. With COP09 funds, PEPFAR expects to procure $6,838,550 in these products, about 10% of quantified need.As indicated above, demand for the 45 IP materials will exceed available funds. These items are critical in promoting quality and safety of facility-based services. Funding for COP 2010 ($5,683,845) covers 7.7% of COP 2010 estimates for the total commodity cost to support 112 hospitals and 790 health centers. RPR tests, the cost of which is estimated at $77,771, would also be procured and are included in this total amount.

The Prevention Technical Working Group (TWG), in consultation with four other PEPFAR TWGs, has determined the funding level for IP materials, since they provide cross-cutting support for safety/quality.

No PEPFAR national/essential reported indicators are relevant to this activity. Relevant individualized indicators will be developed during COP 2010. No training, clinical services or adherence activities occur under this activity. Quality assurance and supportive supervision to ensure effective procurement and quality products will be carried out by USAID and PSCM headquarters staff.

This is a new Budget Code under COP 2010. Focus will be procurement of sexually transmitted infection (STI) drugs.

While funding for STI drugs has been included in Global Fund To Fight AIDS, Tuberculosis and Malaria (GFATM) grants for several years, the Ministry of Health (MOH) hasn't procured these successfully to date. The Partnership for Supply Chain Management (PSCM) will strengthen the capacity of the Pharmaceutical Fund and Supply Agency (PFSA) to procure 16 essential STI drugs, as defined by group of technical experts at the MOH's annual National HIV Commodity Quantification Exercise, and quantified by PSCM, and will procure them under COP09-10.

With COP 2009 funds, PEPFAR expects to procure the full annual need for these products ($1,799,239). Under COP 2010, PEPFAR will fund 50% of the annual national need ($947,413), using the Partnership Framework to communicate that funding will not be provided under COP 2011, with the Government of Ethiopia (GOE) expected to fulfill the 2006 USG-GOE Memorandum of Understanding (MOU) that gives it full responsibility for STI procurement.

PSCM will also work to introduce systems to collect site level information on STI drug use. During COP 2010, efforts to track STI and non-STI use for these cross-cutting commodities will be carried out, in collaboration with the MOH and other relevant stakeholders.

The Prevention Technical Working Group (TWG) has agreed on the funding level for STI drugs, in order to provide stock until such time as the MOH is capable of procuring these effectively.

No PEPFAR national/essential reported indicators are relevant to this activity. Relevant individualized indicators will be developed during COP 2010. No training, clinical services or adherence activities occur under this activity. Quality assurance and supportive supervision to ensure effective procurement and quality products will be carried out by USAID and PSCM headquarters staff.

This is a new Budget Code for this mechanism. The COP 2010 focus will be procurement of essential supplies and equipment to support achievement of facility-based targets for Prevention of Mother-to-Child Transmission of HIV (PMTCT).

The Partnership for Supply Chain Management (PSCM) will work closely with the Ministry of Health (MOH) and other stakeholders to support improvements in service delivery at target sites, since the lack of basic maternal-child health (MCH) commodities is among the barriers to expanding PMTCT. Spending levels for this area from will decrease from $3,872,729 (COP 2010) to $1,007,550 under COP 2010.

The COP 2010 funding will cover a full package of 37 essential equipment and supply items required for effective PMTCT services at 23 of the estimated 902 sites expected during COP 2010, as well as $41,137 of PMTCT lab inputs. This represents 2.5% of the 112 hospitals and 790 health centers expected to provide PMTCT services under a reasonable scale-up scenario from the current 632 health centers. COP 2009 PEPFAR funding will cover approximately 74 sites, with an additional 68 to be covered by Global Fund To Fight AIDS, Tuberculosis and Malaria (GFATM) funds, for a total of 18% of the 902 sites by FY 2011. An assessment will be carried out before distribution, so that sites already possessing some items will not be resupplied.

The PEPFAR/Ethiopia TWG determined the level of support to be provided, attempting to achieve balance between technical assistance and commodities, since funding is not sufficient to cover all needs. If assessment indicates that additional funds are required to provide critical supplies and equipment, reprogramming may occur during the COP 2010 implementation period.

PEPFAR will focus its support in sites with high HIV prevalence, high antenatal care (ANC) patient loads and high population.

No PEPFAR national/essential reported indicators are relevant to this activity. Relevant individualized indicators will be developed during COP 2010. No training, clinical services or adherence activities occur under this activity. Quality assurance and supportive supervision to ensure effective procurement and quality products will be carried out by USAID and PSCM headquarters staff.

The additional 100,000 is for procurement of food products

The focus of this area will be to continue to provide supportive supervision and technical assistance for the strengthening of supply chain systems for integrated lab services designed and introduced in COP 2009. The Pharmaceutical Fund and Supply Agency (PFSA) will play an increasingly central role in the logistics management of these supplies. In addition, the Partnership for Supply Chain Management (PSCM) will focus on strengthening lab commodity forecasting and lab logistics information management to ensure uninterrupted supply. In order to support the overall national goal of quality lab infrastructure, integrated trainings focusing on site level lab commodity management will be conducted in coordination with implementing partners.

PSCM will work to achieve the integration of lab logistics in the comprehensive national logistics system being developed with PFSA, as indicated to the Ethiopian Health and Nutrition Research Institute (EHNRI) by PEPFAR/Ethiopia when this assistance began in 2006. A parallel lab logistics system will not be supported in the medium term.

Funding for COP 2010 set at $864,000 will not support the estimated annual need for the logistics technical assistance of $1,000,000; thus $136,000 of pipeline funds will be used this year. For COP 2011, additional funds above the COP 2010 level may be required to fully support this highly prioritized area. The activities listed above meet the capacity building goals under PEPFAR.

The PEPFAR national/essential reported indicators are not relevant to this activity. Relevant individualized indicators will be developed during COP 2010. No training, clinical services or adherence activities occur under this activity. Quality assurance and supportive supervision to ensure effective procurement and quality products will be carried out by USAID and PSCM headquarters staff.

The Partnership for Supply Chain Management (PSCM) focus under COP 2010 will be to procure antiretrovirals (ARVs) and other essential HIV commodities as needed on an emergency basis.

It is projected that starting in June 2010, a commodity gap will be created by the phase-out of support by the Clinton HIV/AIDS Initiative (CHAI) for adult second-line ARVs. PSCM will fill the approximately $1.5 million gap, enabling achievement of second-line ARV treatment targets projected at 1.5-2% of patients. Actual funding amounts will be based on review of existing national stock levels at the time of phase-out.

In order to promote timely procurement, collaboration with the Government of Ethiopia (GOE) and other stakeholders will continue for commodity forecasting and pipeline reviews. In Ethiopia, the primary source of funding for ARVs is the Global Fund To Fight AIDS, Tuberculosis and Malaria (GFATM).

Given the history of periodic delays in GFATM procurement by the GOE, PSCM will provide an ARV and commodity fund to provide partial coverage for potential emergency gaps that result from delays in procurement or other factors. The level of funding for this purpose is expected to be similar to earlier years, around 10% of the total estimated annual ARV cost ($9,000,000). During the last two years, as a result of procurement problems or unexpected spikes in demand, PEPFAR has expended $15 million from this fund for ARVs and rapid test kits.

Under COP 2010, $2,000,000 of pipeline funds will be used to reach the $9,000,000 level, with $7,000,000 of COP 2010 funds designated for the fund. Additional funding above the COP 2010 funding level will be needed in COP 2011 to reach the 10% level. If the fund is not fully expended during COP 2010, it will be utilized to cover a portion of the large gap in other HIV commodities such as infection prevention materials.

No PEPFAR national/essential reported indicators are relevant to this activity. Relevant individualized indicators will be developed during COP 2010. No training, clinical services or adherence activities occur under this activity. Quality assurance and supportive supervision will be carried out by USAID and PSCM headquarters staff.

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