Capacity Building in Supply Chain Management of ARV Drugs and HIV Tests

SCMS procures and distributes essential medicines and health supplies, works to strengthen existing supply chains in the field, and facilitates collaboration and the exchange of information among key donors and other service providers. SCMS is an international team of 16 organizations funded by the US President's Emergency Plan for AIDS Relief (PEPFAR). The project is managed by the US Agency for International Development. SCMS delivered $431.4 million in products in 3,835 shipments to 34 countries in FY14. Health systems strengthening (HSS) measures improved throughout the fiscal year, with order fill rate increasing from 65 percent in FY14 Q1 to 80 percent in Q4, and facility reporting rates rising from 66 percent in Q1 to 79 percent in Q4. On-time delivery to clients presented challenges in several quarters during FY14, falling below the 80 percent target in Q1, Q2, and Q4, although it was at an all-time high of 85 percent in Q3. Over the year, client on-time delivery for core products reached 78 percent, against the 80 percent target. Supply situations for several active pharmaceutical ingredients (APIs) impacted SCMS throughout the year. Shortages of APIs for Tenofovir/Lamivudine/Efavirenz led to manufacturing delays in Q1 and Q2, with these issues mostly resolved with the addition of four tentative FDA-approved manufacturers in Q3. In Q3, Zidovudine API and intermediates were in short supply due to environmental constraints imposed on Chinese manufacturers by their government, resulting in delivery delays through Q3 and Q4. SCMS now highlights a similar potential risk of an API shortage for Lopinavir/Ritonavir-based regimens as demand increases and generic manufacturers show reduced interest in these products. SCMS contributed significantly to the IATT Optimal Formulary List for Pediatric ARVs, which provides advice and guidance to implementing partners to enable programs to deliver the best care in accordance with the current WHO Regimen Guidance. David Jamieson served as a contributing author to both the formulary list and policy brief to alert implementers to supply chain challenges for pediatric Stavudine and Didanosine. The policy brief was published in September. SCMS supplied first orders to Afghanistan and Liberia during Q3 and Q4, respectively. The organization responded to ARV shortages in several countries, supplying emergency orders to countries including Mozambique ($7.5 million), Ghana ($3.8 million), Namibia ($2.5 million), and Haiti ($1 million). During the second half of the year, due to falling levels of response, SCMS restructured the client satisfaction survey, significantly reducing the number of questions, with the objective of increasing response rate. Regrettably, this has not been successful, with return rates less than 10 percent in the first 8 countries piloted with the new survey. As a result, SCMS has insufficient data to report on client satisfaction. Additional quarterly highlights and concerns include delivering $99.5 million of commodities, with a record high value of $42 million in August. Determine rapid test kits (RTKs) supplied to Tanzania by SCMS were discovered in Cameroon, and SCMS is investigating how this happened to prevent it from happening again. Due to the Ebola outbreak, SCMS saw significant restrictions in regional and international movements, resulting in an unexpected hike in airfreight rates, which increased up to 30 percent for airlines still servicing the West African region. SCMS was able to maintain planned deliveries despite these difficulties. In Rwanda, SCMS completed the eLMIS rollout to all 537 service delivery points (SDPs) in the country, in collaboration with the Logistics Management Office (LMO).