1. 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

2. 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

3. 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

4. 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

5. 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)

6. 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.

7. 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

8. 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

9. 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

10. 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

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

12. 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.

13. 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.

14. 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

15. 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

16. 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

17. 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

18. 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

19. 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

20. 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

21. 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

22. 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

23. 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)

24. 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.

25. 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

26. 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

27. 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)

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