Rapidly Expanding Access to Care for hiv in Tanah Papua (reach) 2012 2016

2.6 Component 2: Supply chain management

Overarching objective: To decrease stock outs and increase efficiency of strengthened supply chain management of HIV-related commodities.

Sub-Component 2.1: Provincial level

Sub-component objective: To strengthen supply chain management systems for HIV-related commodities in Tanah Papua.

Outcome: Functioning and sustainable decentralized supply chain management for HIV-related commodities in Tanah Papua.

Why are we doing this?

The scale up of HIV-related services in the Papuan provinces as a result of REACH will put pressure on supply chain systems for drugs and other commodities required for TB and STI services. REACH will need to ensure that supply chain systems for TB and STI drugs and commodities are adequate. SCM work for these types of commodities is not currently being undertaken by CHAI Phase II.

How will we do it?

CHAI will conduct a preliminary assessment of the adequacy of existing provincial level SCM systems for TB and STI commodities. The assessment will document existing work processes and responsibilities, identify barriers to effective coordination and management and propose new ways of working. REACH will work with current supply chain mechanisms rather than create new ones. This will include working with MoH programs to ensure alignment and resolve disease-specific supply chain constraints. Key activities for REACH will be:

• 
  collaboration with PHOs and DHOs to improve coordination, especially for planning, quantification and forecasting; and
  
• 
  training and mentoring of treatment sites on best practice for quantification, storage, inventory recording and reporting and drug handling.
  

Will it work?

Building good coordination and cooperation among stakeholders will be essential to achieve this objective since CHAI will be building upon current supply chain systems. If these relationship are managed well, the risk of failure is largely mitigated.

How will we know?

Existing methods used by CHAI to evaluate HIV-related SCM effectiveness will be used such as recording incidences of stock outs at treatment sites. CHAI staff in the Papuan provinces and CoE staff will monitor the adequacy of supplies in health facilities.

Will the benefits last?

By using existing supply chain systems the likelihood of sustainability will be enhanced.

Sub-Component 2.2: National level

Sub-component objective: To strengthen national and decentralised supply chain management systems for HIV-related commodities

Outcome: Functioning and sustainable supply chain management for HIV-related commodities at national level and in 16 decentralized provinces.

Why are we doing this?

As national efforts to scale up HIV treatment continue, ensuring availability of drugs through effective SCM systems continues to be a high priority for the AIDS Sub Directorate. In the interest of sustainability, CHAI will plan and implement a phased transition of its SCM support to the AIDS Sub Directorate, with a full transition being achieved by the end of REACH in mid-2016. Completion of technical assistance projects that began in Phase I and Phase II will put the national program on a good footing for the future.

There will need to be a particular focus on strengthening SCM for ARVs in the Papuan provinces to cope with the expected significant increase in the number of people on treatment.

How will we do it?

CHAI has used a two-track SCM strategy which has involved improving the centralised national SCM system managed by the MoH’s AIDS Sub Directorate and a decentralised pilot in four provinces.

REACH will conduct the following activities:

• 
  Expansion of the final phase of decentralised ARV SCM to an additional 12 provinces, including West Papua. (Papua is one of the existing decentralised provinces.)
  
• 
  Development of best practices methods (SOPs, templates and tools) for forecasting and quantification of HIV commodities including ARVs, OI and STI drugs, and HIV rapid tests, accompanied by detailed training.
  
• 
  Provision of training to provinces and districts that will not be a part of ARV SCM decentralization to improve the quality of site reporting.
  
• 
  Strengthened reporting and recording of HIV data and improved utilization of the online Inventory Order Management System to monitor hospital performance.
  
• 
  Implementation of a national reporting system to manage the supply chain for HIV rapid tests.
  
• 
  Improvement of supply planning and stock out avoidance.
  
• 
  Establishment of indicators for SCM performance to monitor the quality of work carried out by implementing agencies.
  

In the Papuan provinces, intensive efforts will be needed to improve supply chain management. While the decentralised system in Papua Province is working effectively, the significant expansion of treatment sites will pose challenges. CHAI’s core SCM activities for HIV-related commodities conducted at the national level will be replicated in the Papuan provinces through strengthening of the decentralization model in Papua and establishment of the decentralised model in West Papua. An assessment and gap analysis will be conducted at a sample of treatment sites to identify the best methods to improve SCM capacity. Key activities will be to:

• 
  Establish a SOP for SCM processes in the Papuan provinces, based on the national SOP and training curricula.
  
• 
  Train and assist treatment sites to improve the quality of SCM.
  
• 
  Train PHOs and DHOs in managing HIV-related commodities, including best practices methods of forecasting and quantification and site reporting.
  
• 
  Establish indicators for SCM performance to monitor the quality of work carried out by implementing agencies.
  

Will it work?

The activities under REACH build on the work undertaken in CHAI Phases I and II which have proven to be successful. Given the long history between CHAI and the AIDS Sub Directorate, relationships and trust are in place to jointly implement these activities. The AIDS Sub Directorate is aware of the transition plan and that they will need to take full responsibility for SCM from mid-2016. They will need to operationalize their commitment by securing adequate resources.

For the work focussed on SCM in the Papuan provinces, CHAI will apply lessons learned from its national level experience in implementing SCM capacity building during CHAI Phase II and at CHAI-supported sites in Jayapura and Wamena.

How will we know?

At the national level, the major measure of success for this objective will be how many of the activities CHAI has outlined will be able to be driven and led by the AIDS Sub Directorate, rather than driven and led by CHAI with the endorsement of the Sub Directorate. The key indicator will be strong leadership from the AIDS Sub Directorate in SCM, with use of CHAI technical assistance as needed.

For the work in the Papuan provinces, the key outcome will be an effective and efficient SCM system that will be measured by key performance indicators. Increased awareness on SCM management at treatment sites and emergence of strong commitment and leadership from PHOs and DHOs will also be monitored.

Will the benefits last?

At the national level, done properly, the long-term benefit will be an effective system and processes in place that ensure commodity availability. This includes management methods, best practise, SOP working process and monitoring performance indicators to ensure the quality of work. By working to ensure that the system builds in the right mechanisms to manage the supply chain, the benefits will last.

In the Papuan provinces, the benefits can be sustained by ensuring that local capacity building for SCM is aligned and integrated with the broader health system supply chain systems and by building the commitment of PHOs and DHOs to SCM.

Sub-Component 2.3: One Gate

Sub-component objective 1 To support the medium to long term shift of incorporating supply chain management of HIV-related commodities within the national one gate policy.

Outcome: Ensure future long term sustainability by engaging the Pharmaceutical Directorate on the development and implementation of the One Gate policy.

Why are we doing this?

The MoH’s Pharmaceutical Directorate is continuing to develop its One Gate policy, which is intended to coordinate drug procurement and possibly other supply chain activities across the MoH. The One Gate policy has the potential to be a unifying theme to drive integration. However, the extent to which One Gate will integrate with other supply chain systems within the MoH has not been decided. The AIDS Sub Directorate will increasingly need to rely on the Pharmaceutical Directorate and its ability to manage health commodities across Indonesia as the number of its donor supported supply chain staff is likely to decrease. By focusing on strengthening SCM in the broader health system, the national HIV CST program will be better positioned to deal with waning donor support for HIV SCM.

How will we do it?

The parameters of the One Gate policy require development and definition. The implication is that this area of work is exploratory in nature. Decisions on future directions will need to be made at senior levels within the MoH, with input from the Pharmaceutical Directorate and national programs. The key activity under REACH will be provision of technical assistance to develop a road map that identifies the major issues that need to be considered in developing and defining the One Gate policy. The road map will identify options and a process for how they can be further explored and developed.

If good progress is made, CHAI could then conduct the following type of indicative activities:

• 
  Work with the Pharmaceutical Directorate and the AIDS Sub Directorate to define how planning, procurement and drug management can be coordinated or integrated at national, provincial, and district levels and with vertical programs such as HIV, TB, and malaria.
  
• 
  Improve human resources for supply chain management at the provincial and district level by strengthening the network and providing training for warehouse managers as HIV and other program areas are better coordinated with or integrated into the mainstream drug management system.
  
• 
  Pilot a One Gate policy standard in the Papuan provinces to:
  

• 
  Establish and implement a standardized planning method for commodities in PHOs and DHOs
  
• 
  Establish and implement standardised order processing, distribution and storage systems at the province and district levels.
  

Will it work?

CHAI began working with the Pharmaceutical Directorate in 2011. Increasingly, the Pharmaceutical Directorate views CHAI as a useful partner to address some of its key challenges in working with vertical programs and integrating them into the mainstream drug management system. CHAI is well-positioned to assist both the Pharmaceutical Directorate and the AIDS Sub Directorate. It is, however, recognised that progress in this areas will be dependent on decision making within the MoH. While CHAI can facilitate that process by assisting with the development of a high quality road map, the MoH will be responsible for decisions and timelines for this will be beyond CHAI’s control.

How will we know?

The major measure of success for this objective will be agreed, clear definition of responsibilities for the coordination or integration of planning, procurement, and distribution and translation of these responsibilities into a realistic implementation plan. If successful, the Pharmaceutical Directorate will take a stronger leadership role in overall drug management for all programs, including HIV.

Will the benefits last?

There is significant potential for long-lasting benefits under this initiative. The Pharmaceutical Directorate has the mandate, human resources, and financial resources to improve the health supply chain system. Its current leadership is committed to bringing things in order, and can lay the groundwork for a solid future.

Programmatic needs for supply chain management post 2016

As indicated in 2.6.2 above, it is expected that the AIDS Sub Directorate and PHOs and DHOs will have taken on full responsibility for SCM by the end of REACH in mid-2016. There may be a possible need for higher level, non-day-to-day technical assistance in SCM. The most likely area where this would apply would be further development of the One Gate policy and its implementation.