Improving Procurement and Supply Management of HIV-Related Commodities

However, funding landscapes are evolving, and Global Fund resources are becoming more limited. Kazakhstan has already graduated from eligibility for Global Fund funding, and Kyrgyzstan and Tajikistan are entering into the realm of the Global Fund's New Funding Model, which emphasizes increased efficiencies and accountability of grant funds. A significant portion of Kazakhstan, Kyrgyzstan, and Tajikistan's HIV response budgets is allocated to procurement of antiretrovirals (ARVs) and laboratory supplies for testing and clinical monitoring. Ensuring that these systems are streamlined and well-functioning is essential to using funds wisely. The Quality Project identified two areas of management as particularly weak: supply management of reagents and medications, particularly those that involved the cold chain, and forecasting of appropriate types and amounts of ARVs. Inefficient management of these systems led to waste and resulted in patients suffering. In response to these challenges, the Quality Project provided two tracks of technical assistance. The first track involved an assessment of warehousing and supply chain management in Kyrgyzstan and Tajikistan, focusing on cold chain management in transport and warehouse settings. An international procurement and supply management expert conducted technical assistance visits to each country, in partnership with the United Nations Development Programme Global Fund Grant Implementation Units. Follow-up recommendations were provided to UNDP units, along with tools and draft documentation to improve supply management. The second track introduced a specialized ARV forecasting software to allow for appropriate management of individual patient records as well as facility-based and centralized stocks of medications. Initially introduced only in Republican AIDS Centers, the software was expanded to the southern region of Kyrgyzstan in 2012 and a fully networked version was introduced throughout Tajikistan in 2014. Technical assistance was provided for installation of software and training of AIDS Center staff, and remote assistance was provided on an ongoing basis. The outcomes of the Quality Project's technical assistance include the introduction of third-party management of cold chain in Kyrgyzstan, detailed analysis of Tajikistan's PSM system presented to UNDP partners, and the first systematic program for tracking antiretroviral stocks introduced in Kazakhstan, Kyrgyzstan, and Tajikistan. The project also led to improved forecasts for ARVs provided by AIDS Centers to UNDP partners procuring medications, lowering the likelihood of stock-outs or treatment gaps. Significant challenges remain in the field of procurement and supply management in both Kyrgyzstan and Tajikistan. Partners at UNDP would benefit from ongoing support in this area of implementing effective Global Fund grants. Assistance is needed at the central level to bolster the capacity of local UNDP staff and system, as well as at the oblast and implementation level, where the capacity of individuals who oversee storage and management of stocks may be lacking. The establishment and enforcement of regular standards for PSM, in line with international standards, should be a first priority, while ongoing capacity-building should also be considered.