Zimbabwe MOHCW Male Circumcision Programme Supply Chain Management Dr. O. Mugurungi, Director AIDS&TB Programme Ministry of Health and Child Welfare June

2 OUTLINE (Logistics Cycle applied to MC commodities) 1.Background 2.Funding 3.Product Selection 4.Forecasting 5.Procurement 6.Storage and Distribution 7.Next Steps

3 1. BACKGROUND In 2009, overall adult HIV prevalence in Zimbabwe was 13.71% Approximately 10.3% of adult males reported to be circumcised (ZDHS ) In 2009, MOHCW started actively promoting Male Circumcision (MC) as part of a comprehensive HIV prevention strategy MC pilot phase started May 09 with 5 sites represented different models of service delivery 2,805 procedures performed between May09 and Dec09 at 5 pilot sites (351/ month) 2258 MC procedures performed between Jan and April 2010 ( 567/month) 56,000 procedures planned over 12 months at approximately 22 sites 3

4 2. FUNDING Currently approximately 60,000 new HIV infections per year Achieving target of scale up of MC to 80% of males in 15 to 29 age group will result in: – 2015: 5000 infections/year averted – 2020 :15,000 infections/year averted – 2025:30,000 infections/year averted Estimated funding to achieve this target: – US $80 million between 2011 to 2015 – Commodity costs approximately US $40 million USAID Support to National Programme – PSI: programmatic – SCMS: commodities and Supply Chain : $1.5M for Y1 MOHCW engaged Bill & Melinda Gates Foundation, WHO, UNFPA Commodities cost per procedure is estimated at US$43.45 in first year (MC Kits: $16.95; balance : bulk surgical item, infection prevention, waste disposal and emergency kits; equipments)

5 3. PRODUCTS SELECTION Based on recommendations and standard kits from “PEPFAR Nov 2009 “Male Circumcision Partners’ Meeting Commodities and Improved Coordination of Male Circumcision for HIV Prevention” Zimbabwe MOHCW selection (based on experience in pilot phase) : Kit Option 3: Forceps guided surgical technique - Kit of fully disposable surgical Instruments and consumables Products supplied by SCMS consolidated procurement mechanism (lower prices, increased coordination between suppliers and recipients, and improved product quality) 83 items MC kits and commodities categorized as follows: – MC surgical instrument and consumable sterile kits – 1 Item – MC surgical procedure bulk items – 12 Items – Infection prevention and waste disposal items – 20 Items – Emergency toolkit - 36 Items – Equipment – 14 Items

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7 4. FORECASTING Quantities of commodities to be procured quantified in coordination with: – MOHCW AIDS&TB MC Programme – MOHCW Directorate of Pharmacy Services Logistics SubUnit – PSI Zimbabwe – SCMS Quantities needed by MC procedures based on – PEPFAR Guideline – Discussions with MC clinics doctors and nurses – Observed consumption at selected sites – PSI Zimbabwe’s experience with procurement of MC commodities during pilot phase

8 5. PROCUREMENT Programme Start up (Apr June 2010) – Kits, related commodities and equipments procured by PSI (USAID and UNFPA funding) Programme Scale up (Jul 2010 – June 2015) – Kits, related commodities and equipments procured by SCMS (USAID Funding) 5,000 kits to arrive in Zimbabwe in July/August ,900 kits, related commodities ordered and to arrive between Jul – Dec 2010 – Equipments procured by PSI (USAID) and UNFPA

9 6. STORAGE AND DISTRIBUTION Storage at NatPharm (MOHCW Central Medical Stores) Distribution : MC commodities to put included on MOHCW-LSU ARV ordering and distribution system supported by SCMS Forced ordering system : maximum (4 months stock) minimum (2 months stock) Emergency orders placed when stock falls below 1 month of stock Bi-monthly review period and reporting Logistics management information systems including stock cards and consumption/requisition forms (patient and logistics data) ARV availability at site level > 99%

10 To ensure continuous availability, MC commodities divided into three categories 1.Equipment i.e. operating table; diathermy machine One off supply recorded on facility asset register –Replenishable items included in infection prevention and waste disposal kit and emergency tool kit Supply of one kit per year No buffer at central level Recorded on receipt voucher 3. Sterile MC Kits and replenishable items Frequently used items Buffer stock kept at central and facility level Consumption, loss and adjustment and stock on hand tracked on stock cards and reported on Consumption/Requisition form STORAGE AND DISTRIBUTION (Ctd.)

11 June 2010 : MC commodity ordering and distribution will be incorporated into the MC strategic plan June 2010: Develop SOPs ordering and distribution system June 2010: Develop training curriculum for ordering and reporting July 2010: Print revised Logistics Management Information System (LMIS) forms Aug 2010: Train staff from existing and new sites on ordering and distribution system Aug 2010: Facilities placing first order – August 2010 Sep - Oct 2010: continue resource mobilization with partners based on updated consumption data from LMIS NEXT STEPS

12 THANK YOU! 12