1. Supply Chain Management

2. Nigeria: FBOs/NACA PEPFAR support for SCMI through EXIOS /FHI The CHAN formed a partnership with above to ensure adequate commodities at facilities CHAN had partnership with CRS-2005 to now National Agency for Control of AIDS in Nigeria had funds for GFATM withdrawn and then this was restored later-and NACA went into partnership with JSI who would coordinate SCMS-procurements –Crown Agents Chan Medi-Pharm logistics and distribution And IDA-procurement

3. Nigeria Delays in port clearance Manual systems at the Federal Medical Stores Lack of Stock management for ART HRH and staff attrition

4. CHAZambia One national plan on which commodity procurement plan is developed contributes to the national plan Coordinated by JSI- CHAZ represents its own constituency CHAZ indicates what resources they have to contribute to the total need PEPFAR/GFATM contribute to the pool of funds for HIV, TB and Malaria Government procures essential medicines CHAZ uses Crown Agents for procurements-

5. Uganda Types of health care facilities – Public sector – Private not for profit – Private for profit All the facilities would receive stocks from Govt National Medical stores (CDC) and from joint medical stores (FBOs/NGOs)-USAID Now there is a rationalization exercise And now there is an allocation of which facilities get medicines from where

6. Challenges to access of ARVs Expiration of drugs-some of it could be demand creation that is needed to make sure people come out to access services and then to make sure the supply side is ready to put patients on treatment Specialization of treatment services and few sites treating patients And still the issue of stigma and discrimination That keeps people away from seeking services

7. Challenges of access to ARVs Estimates of indicators on calculation of need Transmission rates have gone down because deaths have gone down and incidence has gone down Stocks management-stock out and overstocking Sustainability of procurements beyond donor support

8. Recommendations One national quantification and planning exercise- depends on accurate estimates-and this brings together all players including FBOs Procurement should be decentralized so that there is not one large procurement in line with the national plan in an open, transparent and accountable manner-FBOs should be allowed to procure LMIS-logistics Management Information System should be available Address access issues: – Geographic – Financial – Deal with stigma and discrimination – Issues of confidentiality – Integration