Detailed Mechanism Funding and Narrative

Years of mechanism: 2008 2009

Details for Mechanism ID: 6703
Country/Region: Guyana
Year: 2009
Main Partner: Partnership for Supply Chain Management
Main Partner Program: NA
Organizational Type: Private Contractor
Funding Agency: USAID
Total Funding: $2,862,000

Funding for Biomedical Prevention: Blood Safety (HMBL): $0

Continuing Activity

Quantification, forecasting, and procurement of those necessary lab and testing supplies needed for the

Blood Safety, Track One funded program.

New/Continuing Activity: New Activity

Continuing Activity:

Table 3.3.04:

Funding for Testing: HIV Testing and Counseling (HVCT): $315,562

Continuing Activity

CDC is responsible for providing all rapid test kits (RTK) for Ministry of Health programs. In FY08, all funds

for the RTK were provided to SCMS. During FY08 CDC and SCMS worked closely with the MOH to

establish necessary capacity such as forecasting, consumption data, and ordering systems. Funds for

procurment of RTK in FY09 will again be provided to SCMS. SCSM will continue to provide techncial

assistance and traning in procurement systems to the MOH. SCMS and CDC will continue to work closely

on forcasting and ordering to ensure that there are no stock-outs. The CDC Office will continue its

responsibilities for quality assurance for rapid testing in all PEPFAR programs.

New/Continuing Activity: Continuing Activity

Continuing Activity: 12747

Continued Associated Activity Information

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

System ID System ID

12747 8497.08 U.S. Agency for Partnership for 6703 6703.08 Supply Chain $319,500

International Supply Chain Management

Development Management System

8497 8497.07 U.S. Agency for Partnership for 4772 4025.07 Supply Chain $200,000

International Supply Chain Management

Development Management System

Table 3.3.14:

Funding for Treatment: ARV Drugs (HTXD): $2,165,032

Continuing Activity

Important to note that in FY09 there will be an increased level of effort focused on the completion of a joint-

donor funded warehouse facility with SCMS providing technical support and internal fittings/equipment upon

completion. Also, in FY09, costs previously funded through HQ core funding have been transferred to field

budgets.

Back ground

The Supply Chain Management System (SCMS) Guyana Strategic Planning Workshop for 2008 and

Beyond was held in March 2008 to identify challenges and opportunities for SCMS intervention to address

some of Guyana's most pressing health commodity supply chain issues. Participants included a broad base

of stakeholders and other experts from across the Guyanese health commodity supply chain infrastructure

including the Ministry of Health, its operational units including its Management Information Unit, Materials

Management Unit, and Food and Drug Department, as well as technical experts from SCMS. Participants

then oriented their discussions around the elements of the SCMS Logistics Framework. The results of

these discussions provides the basis for SCMS working planning activities for 2008 and beyond. Moving

forward, activities identified have been incorporated into SCMS work planning activities. The work plan has

drawn from these strategic discussions and planning process , examined each of the logistics component

areas using the SCMS Logistics Framework. It also captured the long-term strategies to resolve each of the

identified technical and cross-cutting issues .

Activities

In close partnership with the MOH and with other incountry and international stakeholders and donors

SCMS in its vision to transform health care delivery ensuring that quality medicines and health care

commodities reach the people living with and affected by HIV/AIDS in Guyana. SCMS will strengthen the

national supply chain systems and by doing so, innovative solutions will be deployed to assist the MOH to

enhance their supply chain capacity in the areas of product selection, quantification, procurement, inventory

control, warehousing and storage, transport and distribution, product use and MIS and to ensure that

accurate supply chain information is collected, shared and used. While work on these and other activities

continues, SCMS has also established an effective relationship with the MoH and works especially closely

with the MMU toward the improvement of MMU capacity as well as the capacity of supply chain

implementing partners across the broader Guyanese Health Commodities Logistics System. Following are

the planned and continued/extended activities of SCMS Guyana based on the Strategic Review and

Planning session in March 08.

Product selection : Defined as the processes that are followed in the selection of products that support

prevention, treatment, and care. Product Selection has been identified as an essential area for support

because it focused on ensuring that HIV/AIDS patients received the right medicines and therapies. SCMS

will support Guyana to implement Standard Treatment Guidelines and promote rationale drug use through

Education, and Monitoring and evaluation (M&E). Will also enhance drug registration capability.

Quantification : Ongoing national level forecasting, quantification and supply planning of ARVs, RTKs and

Lab reagents represented a good opportunity for streamlining, simplifying, and thus improving the national

health commodities logistics systems and effective contributions towards an integrated procurement

planning. .SCMS will improve the accuracy of accurate, routine national quantification of medicines and

consumables for data-driven decision making to improve the accuracy of facility level requirements and

orders. National level forecasting and quantification will not only provide the needs based on the actual

usage but also will be able to help the donors to allocate their budgets in a more efficient and accurate

manner with an understanding of what the actual ARV and related commodity needs are. SCMS plans to

establish a primary and secondary data requirements for a Central Data Repository and a Service Delivery

Point dispensing tool that aids quantification covering patient, morbidity and consumption data. SCMS

strives to promote accurate data collection and dissemination for use in completing quantifications, building

capacity to conduct quantifications and transferring skills, plans to train leaders from within the MOH and

donor programs in the application of quantification tools .

Procurement : SCMS will continue its work in harmonizing and integrated procurement planning with all

donors and with the MOH. By developing 2 years quantification and a years rolling supply plans with

quarterly reviews of the forecast assure continued availabiulity, averting imminent stockout situations and

avoidance of stock outs in country. SCMS will procure medications for adult 1st and 2nd line antiretroviral

(ARV) therapy (1st line procurements will be dependent on whether the supply of drugs procured through

GFATM are sufficient or when supplies do not arrive timely due to several reasons ) and also will be

resuming procurement of both 1st. and 2nd. line Paediatrics when Clinton foundation withdraws its support

in 2009. SCMS will support MMU/MOH in the area of Procurement focused on training/capacity building,

harmonizing/ centralizing the procurement function. SCMS will also continue procurement of CDC funded

commodities as RTKs, Labs Reagents for FXB and NBTS. Training of the clients in the order management

tool ( Client Resource Manager ) will also provide better services to clients in keeping track of their orders.

SCMS's collaborative efforts with CDC and MOH to establish a National standard list of medical/lab

supplies and equipments also will help in the standardization of all supplies and equipments and to develop

service contracts for maintaining equipments.

Inventory Control , Warehousing and Storage : SCMS has been providing a continuous technical support to

the operations and management of MMU through both in country, external TA and trainings. SCMS strives

to build capacity and develop tools and training to streamline inventory control and warehousing and

storage procedures. Technical support to establish effective inventory control and warehousing processes is

another major area of support SCMS has provide. With the implementation and introduction of the MACS

inventory management system since October of 2007. location mapping, accuracy of all receipts,

transactions, dispatches, replenishments has improved enormously. SCMS will continue to support the

operations management of the annex warehouse and aim to establish a single warehousing management

where ordering, receiving and updated records form part of proper inventory tracking systems and good

Activity Narrative: warehouse practices are demonstrated in storage and management of ARVs, and HIV commodities. The

joint warehouse operations and management and an ongoing transfer of skills and cross fertilization in

good warehousing practices and maintaining systems and disciplines has helped the MOH overall

inventory, warehousing and storage management at the central level.

SCMS has engaged in a partnership with the MMU to enhance technical skills in the areas of warehouse

and inventory management, data management and procurement. SCMS has also worked closely with the

MMU to increase capacity in terms of new facilities and equipment. Most recently, SCMS has worked with

MMU leadership to support the design and construction of a new, consolidated warehouse and distribution

center. SCMS will provide technical support, supervision and to assist in the provision of a multi donor

funding partnership for the state of the art facility for warehousing of all pharmaceuticals and medical

supplies in one fit for purpose facility. While building capacity, SCMS also aims to develop options for

establishing total Quality Management Systems at the MMU. QMS is a set of policies, processes and

procedures required for planning and execution of core functions of an organization.

Transport and Distribution : Distribution plans for some programs, regions and facilities are in place and in

existence, but due to exist, geographic and environmental constraints there is an inefficient and ineffective

use of available vehicles. SCMS will support in the area of transport and distribution focused on assessing

distribution processes and rationalizing equipment used for distribution and conducting a cost/benefit

analysis of transportation functions. This is important and critical as MMU wants to ensure that all health

commodities are received and distributed with integrity, with routine/timely dispensing to site and that they

all maintain product integrity with optimum storage for transport facilities from point of receipt to point of

dispensing SCMS will complete a cost benefit analysis of in-house and out sourcing of transportation

functions including collaboration with NGOs and use of marine and air options.

Strategic Information--INCLUDED IN SI SECTION-- (Logistics Management Information System): Improving

the information system at both the central and facility level is vital in having a secure and reliable supply

chain to make sure that accurate information is generated and systematically reported. SCMS provide

support in the area of MIS/LMIS focused on harmonizing policy, advocacy and establishing data collection

and data communication systems. The ability to collect accurate data and communicate that data through

MIS systems are a key part of the overall MIS strategy and an area where SCMS has been providing

support. SCMS has provided technical assistance to improve the central a level information system for

supply chain management to ensure strategic information is readily available to drive decisions for key

stakeholders, e.g. Ministry of Health, Ministry of Finance, donors, and implementing partners. For the

remote site connectivity and in improving information transfer between central and facility level, a pilot inter

based option of transferring facility level requisition for Pharmaceuticals and commodities to the central level

and an IT infrastructure assessment has been completed. SCMS will develop a phase wise migration plan

in discussion with the MOH for options to transfer information from facilities to central level.

Performance Management : The comprehensive and integrated approach of SCMS has reached a broader

context in not only improving the systems nor building capacity through transfer of skills and training

programs but also from the sustainability and quality assurance perspectives, SCMS will be developing a

performance management strategic framework to facilitate the aggregation of M&E data from the field level

to the overall project level. SCMS will provide support and assistance to MMU to develop their performance

management and evaluation capacity. Establishing key performance indicators and benchmark

performance metrics will help support the continued improvement of the MMU and form the basis for a

sustainable monitoring and evaluation plan that the MOH can utilize over the long term.

New/Continuing Activity: Continuing Activity

Continuing Activity: 14080

Continued Associated Activity Information

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

System ID System ID

14080 3153.08 U.S. Agency for Partnership for 6703 6703.08 Supply Chain $2,250,000

International Supply Chain Management

Development Management System

8209 3153.07 U.S. Agency for Partnership for 4772 4025.07 Supply Chain $2,750,000

International Supply Chain Management

Development Management System

3153 3153.06 U.S. Agency for Partnership for 4025 4025.06 Supply Chain $2,775,000

International Supply Chain Management

Development Management System

Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $324,750

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Program Budget Code: 16 - HLAB Laboratory Infrastructure

Total Planned Funding for Program Budget Code: $992,788

Total Planned Funding for Program Budget Code: $0

Program Area Narrative:

USG supports Guyana's laboratory structure and core functions. PEPFAR funding has increased access to HIV testing and

clinical monitoring for the HIV treatment program in-country. FY09 laboratory infrastructure plans build on laboratory activities from

FY08 and will continue to rely on technical assistance from the Ministry of Health (MOH), CDC, Supply Chain Management

System (SCMS), Association of Public Health Laboratories (APHL), American Society for Clinical Pathology (ASCP), FXB, and

AIDSRelief. Guyana has a National Strategic Plan for Laboratories (2008-2012) as well as a newly built National Public Health

Reference Laboratory. This facility was handed over by the USG to the GOG on the 3rd of July 2008. The MOH appointed the

Director of the NPHRL on the 17th of September 2008. CDC has employed a PhD level senior laboratory advisor to provide

technical support to the NPHRL and coordinate all PEPFAR laboratory activities in-country.

The current public laboratory system consists of five levels: health post, health center, district hospital laboratory, regional hospital

laboratory, and tertiary laboratory. Previously the Central Medical Laboratory (CML-clinical laboratory of Georgetown Public

Hospital) performed the functions of a referral laboratory and these will now be transitioned to the NPHRL. There are a total of 4

regional laboratories in Guyana (Linden, Suddie, West Demerara, and New Amsterdam). Health posts and centers perform only

malaria smears and possibly hemoglobin, while district level facilities can perform basic testing such as hemoglobin, complete

blood count (CBC), urinalysis, and blood glucose. Regional laboratories have the capacity to provide automated chemistry and

hematology. No microbiology or serology studies (except syphilis) are available except at the tertiary level, which includes only the

CML and National Infectious Diseases Laboratory (NIDL-National Blood Transfusion Centre) at present and the NPHRL once the

later is operational. All diagnostic and clinical monitoring functions for PEPFAR programs currently performed at CML and NIDL

will transition to the NPHRL in FY09. Currently, no laboratory can conduct testing for Pneumocystis Carinii pneumonia (PCP), or

Herpes Simplex Virus (HSV) infections, prevalent among HIV-positive patients. CML has developed the capacity to conduct

Cryptococous and Chlamydia testing. The NPHRL will be supported to become a centre of excellence for diagnosis of STIs and

OIs associated with HIV. Two of the five regional hospitals are old wooden structures in poor condition with chronic problems with

utilities and maintenance. These regional hospitals, as well as the five geographic regions without a regional hospital, are

completely dependent on the Georgetown facilities for all but the most basic testing, the setting of standards, storage of

commodities, and training of staff.

Supporting the NPHRL remains a key element of the Guyana PEPFAR program. The NPHRL represents the fulfillment of the joint

commitment by the USG and the Government of Guyana to upgrade the healthcare system. It is expected that the NPHRL will

provide a new level of infrastructure for labs in Guyana, and build systems and standards into the greater public health system

while providing essential support to the expanding HIV/AIDS program. It will be the hub for laboratory activities in Guyana and will

be the national reference lab and provide the link for international referral services. As a public health laboratory it will carry out

reporting on diseases of public health significance. In light of the role of NPHRL, capacity building of NPHRL staff will be a key

area of support by USG.

The Global Fund in Guyana is providing support for laboratory equipment but due to delays in the national procurement process,

the proposed equipment for the NPHRL is yet to be procured. The NPHRL currently has 6 medical technologists who have

transferred over from other MOH programs, and 3 medical technologists (CD4) have transferred from FXB. However in light of the

expanding role of NPHRL these staff numbers will not be sufficient. USG will support additional technical and some key

administrative staff at NPHRL through the MOH CoAg.

CDC continues to fund laboratory support to all care and treatment programs in-country in coordination with FXB and AIDSRelief.

CD4 testing is available for all treatment sites but is conducted at the NPHRL (3 FACSCounts provided by CDC). NPHRL will

continue to participate in EQA for CD4 testing. Treatment centers will continue to transfer specimens to Georgetown through the

existing specimen transport system. With the introduction of the NPHRL and provision of laboratory services to hinterland regions,

it will be necessary to develop a stronger sample transportation and courier system. In FY09 AIDSRelief will provide CD4 testing

at 3 care and treatment sites (1 Guava, 2 manual). In FY09 NPHRL will provide CD4% testing for pediatric staging. Clinton

Foundation will support provision of these reagents until the end of 2009. In FY 08 CDC in collaboration with MOH established

External Quality Assurance programs and proficiency testing for HIV rapid testing and for core parameters of

chemistry/hematology at all regional laboratories and 10 VCT sites. Guyana National Bureau of Standards has adopted the

ISO15189 standard as the basis for certification of clinical laboratories and CDC will support the certification of NPHRL and two

regional laboratories in FY09. Through collaboration with ASCP, CDC will continue to provide technical assistance on routine

chemistry/hematology (regional roll-out), advanced hematology (NPHRL) and lab management (NPHRL). In FY09 the twinning of

NPHRL with North Carolina State Laboratory of Public Health (NCSLPH) will continue and NCSLPH will continue to provide

technical assistance on all aspects of public health laboratory services. The QA department established at the MOH has

transitioned to NPHRL. NPHRL will be providing EQA and training for all care and treatment related laboratory services. CDC will

support funding for routine fieldwork and travel associated with EQA and regional training associated with clinical monitoring, DBS

collection, and TB smear microscopy.

Hematology and chemistry profiles needed for the monitoring of patients on ARV are available at the CML and will be available at

NPHRL. CDC will continue to provide 25% of chemistry /hematology reagents to the CML and all chemistry/hematology reagents

to NPHRL once the latter takes over HIV-related routine clinical monitoring. Routine monitoring is hampered at the regional

hospital laboratories due to the lack of reliable equipment, inadequate implementation of maintenance protocols, and recurrent

shortages of reagents. CDC will continue work with SCMS and MMU, MOH to ensure a better supply chain management system

for these reagents and other laboratory supplies during FY09. In FY09, CDC will support the development of laboratory

infrastructure and procurement of chemistry/hematology reagents for the 4 regional laboratories. CDC will coordinate with World

Bank to ensure the provision of automated Chemistry/Hematology equipment at regional labs. The ASCP, in collaboration with

CDC, began providing training in chemistry and hematology testing in FY07 that will continue in FY09.

USG works closely with other agencies in Guyana to support and coordinate laboratory services. The Canadian Society for

International Health (CSIH) has implemented TB culturing at the CML and TB smears at all regional laboratories. This program

ended in Sep 07 and has been taken over by MOH/GF but greater support is required particularly in the areas of advanced

diagnostics (drug susceptibility testing for MDR-TB). The NPHRL is a Biological Safety Level II facility designed to be easily

modified to a BSL III level in the future. In FY09 CDC will support the NPHRL to develop of molecular tests for MDR-TB and

implement fluorescence microscopy to enhance diagnosis of TB in the presence of HIV. The availability of fluorescence

microscopy will also assist in enhancing diagnosis of other OIs and STIs by the use of direct fluorescence assays.

The Clinton Foundation did not support the purchase of equipment to conduct DNA polymerase chain reaction (PCR) for infant

testing in FY08, however they have, with MOH, implemented an EID program where samples are sent to NICD in South Africa.

The effectiveness of this system (specimen collection, transport, delivery, result turn around times) will be evaluated in FY09 and

capacity strengthened as needed. DNA PCR equipment will be procured by GF in FY09 and EID established at NPHRL so that

Guyana will no longer have to send samples overseas. CF will fund DNA PCR reagents until the end of 2009. In order to ensure

continuity of this activity, USG will support this activity for the remainder of FY 09. This technology will be accessible to patients

from all care and treatment sites in the non-profit sector. These specialized services will occur under the control of the NPHRL to

ensure uniform coverage, minimize duplication, and enforce strong QA/QC standards. Presently there is no HIV drug resistance

monitoring in Guyana. A clinical and laboratory protocol will be developed by MoH in FY09 and CDC will support linkages with

certified laboratories for initial testing until drug resistance monitoring becomes available at NPHRL.

Human resource shortages remain a primary limitation for implementation and sustainability of programs in Guyana. USG will

work closely with MOH on strategies for staff retention. Through both a new technologically advanced physical structure and a

clear institutional vision and plan, the NPHRL will serve as an incentive for laboratory staff to stay and work in Guyana. USG will

advocate for efforts to link the University of Guyana laboratory programs to the new national laboratory in order to enhance pre-

service training and create segues to the public health laboratory system; through the ASCP CDC will also support the

development of an approved certification program, and required courses, for lab personnel as well as for training for identified

critical positions. A NPHRL training strategy will be developed and used to prioritize training for PEPFAR supported priorities.

These enhancements will aid in recruitment of new graduates and provide opportunities for professional advancement in Guyana

as an alternative to emigration. GOG has recognized ASCP to be sole certifying body for medical technologists in Guyana. GSCP

was launched as an arm of ASCPi. This will provide an impetus for the medical technology body of Guyana in terms of

professional development and international recognition for local medical technologists. A pre-service curriculum needs

assessment done by ASCP.

Table 3.3.16:

Funding for Laboratory Infrastructure (HLAB): $281,406

Over the last four years CDC Guyana has supported laboratory functions on multiple levels including

funding for laboratory supplies, supply procurement and distribution of various commodities like reagents,

basic laboratory equipment and supplies and consumables such as gloves and blood tubes. In FY09 CDC

will continue this support through SCMS. In FY09 SCMS will procure and distribute CD4 reagents required

for CD4 enumeration for clients accessing care and treatment at all MOH care and treatment sites. CD4

enumeration will be done centrally at National Public Health Reference Laboratory. SCMS will procure and

distribute 25% of all hematology and chemistry reagents used at the Central Medical Laboratory

(Georgetown Public Hospital) and four regional laboratories. Routine hematology and chemistry testing for

national care and treatment sites which do not have chemistry/hematology capacity (including National Care

and Treatment Centre) will be done at NPHRL and SCMS will also procure the required reagents for this

activity. NPHRL is expected to become a centre of excellence for diagnosis of opportunistic infections.

SCMS will assist MOH with the procurement of specialized reagents and consumables required to fulfill this

role. SCMS will also work closely with the MOH to identify gaps in equipment/reagent support at NPHRL

and regional/district laboratories and assist in the procurement of those items required for delivery of quality

laboratory services in support of HIV care and treatment programs. SCMS will continue to coordinate

closely with MOH and CDC on reagent forecasting, procurement orders and auditing to ensure that there

are no interruptions in service delivery."

New/Continuing Activity: Continuing Activity

Continuing Activity: 12748

Continued Associated Activity Information

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

System ID System ID

12748 8211.08 U.S. Agency for Partnership for 6703 6703.08 Supply Chain $146,650

International Supply Chain Management

Development Management System

8211 8211.07 U.S. Agency for Partnership for 4772 4025.07 Supply Chain $200,000

International Supply Chain Management

Development Management System

Emphasis Areas

Health-related Wraparound Programs

* Safe Motherhood

Human Capacity Development

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.16:

Funding for Strategic Information (HVSI): $100,000

Continuing Activity:

Incredible strides have been made in FY08 with the highly successful implementation of the Warehouse

Management Information System component of the LMIS plan. This system has revolutionized the

warehousing and stock management systems. It is serving now as a springboard for integration of

consumption reporting, site-stock taking, and the ARV Dispensing Tools, all of which are electronic at

available levels

Improving the information system at both the central and facility level is vital in having a secure and reliable

supply chain to make sure that accurate information is generated and systematically reported. SCMS

provide support in the area of MIS/LMIS focused on harmonizing policy, advocacy and establishing data

collection and data communication systems. The ability to collect accurate data and communicate that data

through MIS systems are a key part of the overall MIS strategy and an area where SCMS has been

providing support. SCMS has provided technical assistance to improve the central a level information

system for supply chain management to ensure strategic information is readily available to drive decisions

for key stakeholders, e.g. Ministry of Health, Ministry of Finance, donors, and implementing partners. For

the remote site connectivity and in improving information transfer between central and facility level, a pilot

inter based option of transferring facility level requisition for Pharmaceuticals and commodities to the central

level and an IT infrastructure assessment has been completed . SCMS will develop a phase wise migration

plan in discussion with the MOH for options to transfer information from facilities to central level.

New/Continuing Activity: Continuing Activity

Continuing Activity: 14082

Continued Associated Activity Information

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

System ID System ID

14082 9105.08 U.S. Agency for Partnership for 6703 6703.08 Supply Chain $0

International Supply Chain Management

Development Management System

9105 9105.07 U.S. Agency for Partnership for 4772 4025.07 Supply Chain $400,000

International Supply Chain Management

Development Management System

Emphasis Areas

Human Capacity Development

Estimated amount of funding that is planned for Human Capacity Development $75,000

Public Health Evaluation

Food and Nutrition: Policy, Tools, and Service Delivery

Food and Nutrition: Commodities

Economic Strengthening

Education

Water

Table 3.3.17:

Cross Cutting Budget Categories and Known Amounts Total: $399,750
Human Resources for Health $324,750
Human Resources for Health $75,000