The Supply Chain Management System (SCMS) Guyana Strategic Planning Workshop for 2008 and Beyond was held in March 2008. The purpose was to identify the challenges and opportunities for SCMS interventions in addressing Guyana's 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 (MOH), MOH/Management Information Unit, MOH/Materials Management Unit (MMU), and Food and Drug Department, as well as technical experts from SCMS. The result of these discussions has provided the basis for SCMS work planning activities for 2008 and beyond.

The goal for SCMS in Guyana is to transform health care delivery by ensuring that quality medicines and health care commodities reach the people living with and affected by HIV/AIDS in Guyana.

Using the SCMS Logistics Framework, the COP 10 workplan includes a continuation of the systems strengthening activities for sustainable supply chain and logistics management information systems both at the central and the peripheral systems. The long-term strategy of strengthening the supply chain system in the country is not only taken into consideration in the vision and mission statements of the key participants but it also features in the foundational strategy and policy of the Guyana Ministry of Health.

In close partnership with the MOH, in-country and international stakeholders, as well as with donors, SCMS aims to transform health care delivery by ensuring quality medicines and health care commodities reach the people living with - and affected by - HIV/AIDS. SCMS' innovative solutions are deployed to assist the MOH enhance their supply chain capacity in the following technical and cross cutting areas.

( A ) Technical Areas

Product Selection

Quantification

Procurement

Inventory control

Warehousing and storage

Transport and distribution

LMIS

( B ) Cross Cutting Areas

Coordination and Information Sharing

Enabling Environment

( C ) Performance Management

To achieve these objectives, SCMS established an effective relationship with the MoH and works closely with the key counterpart, Material Management Unit to improve itscapacity as well as the capacity of supply chain implementing partners across the broader Guyanese Health Commodities Logistics System and thus maximizing HIV funds and resources to improve and strengthen the Supply Chain Systems capacity for all essential commodities for all MOH programs for all people of Guyana

Continuing Activity

CDC is responsible for providing all rapid test kits (RTK) for Ministry of Health programs. In FY09, all funds for the RTK were provided to SCMS. During FY09 CDC and SCMS worked closely with the MOH to establish necessary capacity such as forecasting, consumption data, and ordering systems. Funds for procurement of RTK in FY 2010 will again be provided to SCMS. SCSM will continue to provide technical assistance and training in procurement systems to the MOH. SCMS and CDC will continue to work closely on forecasting 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.

(a) Improving information systems at both the central and facility levels are vital components of a secure and reliable supply chain. The ability to collect accurate data and communicate that data through MIS systems is a key part of the MOH MIS strategy and an area where SCMS has been providing support. For example, SCMS has provided technical assistance to improve the central 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. In COP 10, a national level Supply Chain and Logistics Management Information Systems design workshop for all essential drugs will be conducted to ensure that a Guyana specific National LMIS plan is developed with the participation of key users from facilities at all level of health care together with the decision makers at the MOH. This will provide the MOH with the opportunity to choose appropriate software and tools to enhance and improve the flow of logistics information at all levels of care in all regions supporting the central logistics management information systems

(b) Performance Management : SCMS has developed an internal performance management strategic framework to facilitate the aggregation of M&E data from the field level to the overall project level. Using this framework, SCMS will provide support and assistance to the MMU to integrate and develop their own performance management plan. Establishing key performance indicators and benchmarks for performance metrics will help support the continued improvement of the MMU and will also form the basis for a sustainable monitoring and evaluation plan that the MOH can utilize over the long term.

(a) Inventory Control , Warehousing and Storage : SCMS has been providing continuous technical support to the operations and management of the MMU. SCMS strives to build capacity at the MMU and to develop tools and training to streamline inventory control, warehousing and storage procedures. With the implementation and introduction of the MACS inventory management system, in October of 2007, location mapping, accuracy of receipts, transactions, dispatches, and replenishments have improved enormously. SCMS will continue to support the operations management of the Annex warehouse. SCMS aims to establish a WMS where ordering, receiving and updating records form part of the inventory tracking system. Furthermore, the MMU will follow good warehouse practices that will be demonstrated in storage and management of ARVs and HIV commodities. Already, the MMU warehouse operations has helped the MOH in managing overall inventory, warehousing and storage management at the central level.

An integral component of SCMS work in inventory control, warehousing and storage is the construction of a new, consolidated warehouse and distribution center. SCMS will provide technical support and supervision of the 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. The technical assistance and oversight for the construction of the new MMU facility will continue in 2010 with an expected completion in mid-2010. Relocation and migration of both the Kingston and the Farm MMU facilities will be planned and assisted by SCMS. SCMS will also provide appropriate change management process training of the MMU staff so they are able to adjust to a changed environment. A facility inventory management system assessment is in process in collaboration and support with the MOH and with the involvement of MMU, RHS, DAC of the MOH. This will lead to the facility level inventory management system strengthening and training of personnel from the regions and the facilities to ensure sustainability of interventions. Improvements of the Regional warehouses operations and inventory management and capacity building of the regional warehouse personnel will also be undertaken. .

(b) Transport and Distribution : Distribution plans for some programs, regions and facilities are in place, but due to geographic and environmental constraints there is an inefficient and ineffective use of available vehicles for distribution. SCMS will support the strengthening of systems in the area of transport and distribution by conducting a cost/benefit analysis of transportation functions. This is a critical activity as the MMU wants to ensure that all health commodities are received and distributed with integrity, routine/timely dispensing to site, optimum storage for transport facilities from point of receipt to point of dispensing. The SCMS cost benefit analysis will encompass in-house and out sourcing of transportation functions including collaboration with NGOs and use of marine and air options.

(c) SCMS will also support MMU/MOH through capacity building. This will focus on harmonizing and centralizing procurement functions in the MOH. SCMS's collaborative efforts with CDC and MOH to establish a National standard list of medical/lab supplies and equipment will assist in the standardization of all procured supplies and equipment. SCMS staff responsible for the ordering and procurement of ARV and HIV related commodities will receive procurement training at the PMO/W in preparation for the transition of procurement functions. Field Office managed procurement is one of the key activities for Task Order 3. SCMS will also continue to support lab logistics management including quantification and supply planning.

(d) Quality Assurance: SCMS is committed to ensuring that quality is an integral part of the supply chain. In this regard, SCMS has supported the establishment of a mini-lab site at the current MMU warehouse, where a total of 40 drugs are screened on a regular sampling. SCMS will continue to support this activity as well as expand the testing capacity of the mini-lab site following the migration and transition to the new warehouse. Interventions to strengthen the FDD, in both areas of quality inspections and quality control testing are expected to continue.

(e) Environmental Health Mitigation : In response to US environmental regulations (22 CFR 216) requiring evaluation, SCMS had developed an EMR under an Environmental Threshold Decision (ETD) designated at the Strategic Objective level. In relation to the construction of the new MMU warehouse, and in support of the warehousing and storage of ARVs and related commodities, SCMS will regularly continue to monitor as per the monitoring plan from the Environmental Mitigation Plan/Report (EMP/EMR) and will ensure programmatic compliance with 22 CFR 216 by meeting the conditions specified in the applicable ETDs authorized by the USAID Latin America and the Caribbean (LAC) Bureau Environmental Officer (BEO) for the USAID Guyana FY2009-FY2013 Strategy.

The Partnership for Supply Chain Management (SCMS) will continue to support the Guyana National Blood Transfusion Service (NBTS) with the procurement of laboratory materials, supplies and equipment. As in FY2010, SCMS will also provide technical advice to NBTS on questions involving stock management, needs assessments and the projection of future needs. In FY2010, the relationship with SCMS has granted NBTS new autonomy to manage its Emergency Plan resources and avoid administrative delays associated with the Ministry of Health's procurement system.

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 FY 2010 CDC will continue this support through SCMS. In FY 2010 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 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."

This includes product selection, quantification and procurement. PEPFAR through SCMS has committed procurement for Adult 2nd. line ARVs. Due to the withdrawal of Clinton Foundation support for the procurement of 1st. and 2nd. line Paediatric ARVs at the end of 2009, PEPFAR will recommence the procurement of Pediatric ARVs in 2010. The budget also includes funds for emergency procurement of ARVs in situations where the delays of Global Fund procurement can result in stock out, leading to disruption of treatment. SCMS will continue to work towards an integrated procurement planning process to include both donors and the MOH. This will be accomplished by developing a two year quantification and a one year rolling supply plan. There will be quarterly reviews of the forecast to ensure not only continued availability but also to avert stock-out situations.

(a ) Product selection: Product Selection has been identified as an essential area for support because it focuses on ensuring that HIV/AIDS patients receive the right medicines and therapies. It is essential that proper processes in the selection of products for the prevention, care and treatment of HIV/AIDS are in place not only for ARVs but also for treatment of OIs, STIs and other medical conditions. These drugs are from the national essential drugs lists. SCMS will continue to support Guyana to implement National Standard Treatment Guidelines and to promote rational drug use through education, training, and monitoring and evaluation (M&E). SCMS will also enhance drug registration capability and support for pharmacovigilance activities.

(b ) Quantification : Ongoing national level forecasting, quantification and supply planning of ARVs, RTKs and Lab reagents represent an opportunity for streamlining, simplifying, and improving the national health commodities logistics systems. SCMS will assist in improving the accuracy of routine national quantifications of core commodities for the TB and Malaria programs and essential medicines and consumables. These quantifications will contribute to data-driven decision making. It will also improve the accuracy of facility level requirements and orders. For example, national level forecasting and quantification will not only forecast needs based on the actual usage but will also help the donors allocate their budgets in a more efficient and accurate manner.

In COP 10, SCMS will work towards establishing a primary and secondary data requirement 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. SCMS also plans to train leaders from within the MOH and donor programs in the application of quantification tools.

(c) Procurement : SCMS will continue to work towards an integrated procurement planning process to include both donors and the MOH. This will be accomplished by developing a two year quantification and a one year rolling supply plan. There will be quarterly reviews of the forecast to ensure not only continued availability but also to avert stock-out situations. 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). SCMS will be resuming procurement of both 1st. and 2nd. line pediatrics when the Clinton Foundation withdraws its support at the end of 2009. Furthermore, in FY10, SCMS will continue procurement of CDC funded commodities of RTKs and Labs Reagents for CD4, NBTS and the NPHRL.