Reporting Requirements and Indicators for Supply Chain Management of HIV Diagnostics & Medicines: Kenya and Nigeria Yasmin Chandani, Coordinator for HIV/AIDS Technical Initiatives JSI/DELIVER

Background Desk review of reporting requirements for supply chain management by the Global Fund and PEPFAR Global level Two country focus: Kenya and Nigeria Supplemented by interviews with JSI country teams Limited time for document compilation and review

Outline PEPFAR SCM Indicators GFATM SCM Indicators Conclusions Global Country Specific Findings & Comparison GFATM SCM Indicators Conclusions LMIS Records & Reports ART Sites, Kenya JSI/DELIVER Global Indicators

PEPFAR Global SCM Indicators Indicator: Number of tests performed at USG-supported laboratories during the reporting period: HIV testing and HIV disease monitoring What it Measures: # of tests performed (not # of kits or reagents purchased). Measurement is undertaken by reviewing laboratory records maintained at each site, and project records and documents. The document review only identified one that was specific to SCM

Country Specific SCM Indicators for PEPFAR: Kenya & Nigeria Report on JSI/DELIVER’s supply chain related support to MOH, not supply chain support provided by other USG recipients Developed in conjunction with MOH in both countries Indicators organized within 5 program areas: 4 common to both countries, HIV/AIDS Treatment/ARV Drugs (Nigeria only) Cross Cutting Activities (Kenya only)

Comparison of PMTCT Indicators Kenya Nigeria Number of sites where HIV tests are available Number of PMTCT sites with continuous full supply of centrally procured HIV test kits and prophylactic ARVs (no stockouts) Number of sites where Nevirapine is in stock Number of PMTCT sites following proper storage and inventory management of HIV test kits and prophylactic ARVs Reporting rate (for LMIS reports) Number of PMTCT site pharmacists and service providers trained in logistics management Number of supervisors trained in PMTCT logistics system supportive supervision and provided with supervisory tools Semi-annual reviews of quantification of and procurement plans for HIV test kits and ARVs required for PMTCT sites I’ll quickly go through some tables that list side by side the types of indicators that were selected by each country to report on. An interesting point is that indicators selected within a similar program area (for example PMTCT) were not identical, although in some cases there were similarities between them.

Comparison of Other Preventive Area Indicators Kenya Nigeria Number of condoms distributed Number of ART and PMTCT sites with continuous full supply of condoms (no stockouts) Number of GON and NGO facilities following proper storage of and inventory management of condoms

Comparison of Palliative Care Indicators Kenya Nigeria Number of kits distributed Number of DOTS implementing sites with continuous full supply of TB drugs (no stockouts) Number of DOTS implementing sites following proper storage and inventory management of TB drugs Re-designed logistics management system for the national TB program Number of TB program zonal, state, LGA TB coordinators and service providers trained in logistics management Number of supervisors trained in TB program logistics system supportive supervision and provided with supervisory tools

Comparison of Lab Infrastructure Indicators Kenya Nigeria No. of labs fully equipped for HIV testing/ARV ass Number of ARV program laboratories with continuous full supply of HIV of selected laboratory supplies (no stockouts) Number of ARV program laboratories sites following proper storage of and inventory management of HIV and TB testing products Number of ARV program laboratory technicians trained in logistics management

HIV/AIDS Treatment/ARV Drugs Indicators Nigeria Number of expansion ART sites assessed for ART service provision readiness Number of ART sites with continuous full supply of ARVs (no stockouts) Number of ART sites observed to be following proper storage and inventory management of ARVs Number of ART site pharmacists and storekeepers trained in logistics management Number of supervisors trained in ART logistics system supportive supervision and provided with supervisory tools

Cross Cutting Indicators Kenya Information and tracking system in place - % reporting Stockout rates of HIV tests

GFATM Global SCM Indicators The proportion of randomly selected retail outlets and service delivery points that have condoms in stock at the time of a survey, or all retail outlets and service delivery points selected for survey % of drug distribution nodes reporting on stock status (repletion, shortage, consumption, quality, losses) on a monthly basis. Treatment guidelines and utilization manuals developed and available at service sites Number or % of districts or other administrative unit with at least one drug distribution center % of drug distribution nodes/facilities reporting no drug shortage % of project service delivery points with sufficient drug supplies Unit cost(s) of project drug(s) and commodities Number of project services deliverers trained in procurement and supply management There were a total of 8 identified during the document review.

Country Specific SCM Indicators for GFATM: Kenya & Nigeria In Kenya, JSI consortium member to sub-recipient to MOF/GOK for a Global Fund grant in Round II In Nigeria, JSI is not involved in any Global Fund activity (no JSI specific indicators). Also no supply chain indicators were discovered during the desk review of two GFATM grants for Nigeria. The Global Fund relies on country ownership for the program design and implementation, each grant recipient decides which indicators are most suitable to measure performance toward program objectives. For example, in Kenya, JSI is part of a consortium that is a sub-recipient to the Ministry of Finance of the Government of the Republic of Kenya for a Global Fund grant in Round II. However, in Nigeria JSI is not involved in any Global Fund activity and therefore there are no indicators specific to JSI, or indeed any supply chain related indicators that were available during the desk review of two GFATM grants for Nigeria.

SCM Indicators for GFATM Recipient in Kenya Time and length of procurement Cost, number and type of items procured Number of items delivered Supply Chain efficiency including warehousing and storage conditions Stockout of commodities

Summary of Country Specific Findings For PEPFAR: Even within common program areas, indicators selected by each country are not identical Neither country selected the global indicator as one to measure supply chain performance For Global Fund: Only two indicators selected by recipient in Kenya are similar to global indicators

Conclusions No convergence between SCM indicator for PEPFAR and those proposed by GFATM In the absence of globally mandated indicators, each country selected their own SCM performance measures Based on a review of the indicators recommended and used in the two countries, it is clear that there are differences in defining and measuring certain indicators, for example product availability

Conclusions The indicators selected by PEPFAR and GFATM globally and at country level are not comprehensive for measuring SCM functions For example, GFATM recommended indicators include some outcome indicators (relating to product availability) as well as some process indicators (e.g., relating to availability of guidelines and training of providers) but not the full range of either process or outcome indicators related to procurement and supply chain management functions. The indicators selected by countries cannot be fully compiled using routine information systems but rely on site visits as well

Overview of Records & Reports Used for SCM by Public Sector/MOH ART Sites in Kenya Potential source of monitoring indicators based on routine data available through LMIS

LMIS Records & Reports for ARV Drugs in Kenya: Health Facilities Daily Activity Register for Antiretroviral drugs Monthly Facility LMIS Report for Antiretroviral drugs Counter Requisition & Issue Voucher Stock Card Monthly ART Patient Summary Sheet Daily Activity Register – Drugs for Opportunistic Infections Monthly Facility LMIS Report- Drugs for Opportunistic Infections I wanted to provide a quick snapshot of the number and types of records and reports maintained at MOH sites in Kenya for supply chain management of ARV drugs

LMIS Records & Reports for ARV Drugs in Kenya: Districts Monthly District LMIS Report for Antiretroviral drugs Monthly District LMIS Report- Drugs for Opportunistic Infections Counter Requisition & Issue Voucher Issue & Receipt Voucher Stock Card

LMIS Records & Reports for ARV Drugs in Kenya: Central Warehouse Stores Ledger Card Bin Card Stock Adjustment Card Counter Requisition & Issue Voucher Issue & Receipt Voucher Counter Receipt Voucher Summary Feedback Reports I wanted to provide a quick snapshot of the number and types of records and reports maintained at MOH sites in Kenya for supply chain management of ARV drugs

Standardized M&E Indicators for SCM Used by JSI Indicators based on a combination of routine data from LMIS and data collected via site visits

Monitoring Indicators used by JSI/DELIVER Related Indicators: Percentage of facilities stocked out or any product on day of visit Percentage of facilities fully stocked (all products) on day of visit Mean number of products stocked out/in on day of visit Percentage of products stocked out/not stocked out at any time during past 6 (or 12) months Mean number of times each method was stocked out in the past 6 (or 12) months Mean duration of stockouts Main Indicator: Percentage of facilities that experienced a stock-out at any point during a given time period Definition: This indicator measures the percentage of facilities (service delivery points, warehouses) that experienced a stock-out of a method/brand/product expected to be provided or issued by that site at any time during a specified period (e.g. the past 6 or 12 months)

Monitoring Indicators used by JSI/DELIVER Related Indicators: Percentage of facilities meeting all (or a desired percent) of the storage conditions Main Indicator: Percentage of facilities that maintain acceptable storage conditions Definition: This indicator measures the percentage of storage facilities that meet acceptable storage conditions.

Monitoring Indicators used by JSI/DELIVER Related Indicators: Average duration of time between the date an order was placed and when it was received Percentage of facilities that received their last four orders according to schedule Main Indicator: Percentage of facilities that receive the quantity of products ordered Definition: For all products that the program is committed to supplying, this indicator measures the percentage of difference between the amount ordered in the last order period (or other defined period of time) and the amount received for that period

Monitoring Indicators used by JSI/DELIVER Related Indicators: Percentage of facilities that keep accurate logistics data for inventory management Percentage of facilities that completed and submitted an LMIS report for the most recent reporting period Main Indicator: Accuracy of Logistics Data for Inventory Management Definition: For each method/brand/product of interest, this indicator measures the accuracy of logistics data as the percentage of discrepancy between (1) physical stock count and stock record count, and (2) stock record count and logistics management information system (LMIS) report count

Monitoring Indicators used by JSI/DELIVER Related Indicators: Percentage of time during a given period that each product of interest is adequately stocked (this indicator requires an automated LMIS system or extensive review of historical stock ledgers) Percentage of facilities with all full supply products adequately stocked for near-term availability Percentage of facilities that are understocked, adequately stocked, and overstocked Main Indicator: Percentage of facilities whose stock levels ensure near-term product availability Definition: This indicator measures the percentage of facilities with stock levels greater than zero and below the established maximum level for each full supply method/brand/product of interest, at a specified point in time (e.g. the day of visit)

Questions? Thank you for your attention Thanks To: Jaya Chimnani, M&E Advisor, JSI/DELIVER Elizabeth Bunde, M&E Advisor, JSI/DELIVER