SIAPS- (Pillar IV) Ebola End of Project Report October 2015–December 2017 February 2018

SIAPS-Mali (Pillar IV) Ebola End of Project Report

This report is made possible by the generous support of the American people through the US Agency for International Development (USAID), under the terms of cooperative agreement number AID-OAA-A-11-00021. The contents are the responsibility of Management Sciences for Health and do not necessarily reflect the views of USAID or the United States Government.

About SIAPS

The goal of the Systems for Improved Access to Pharmaceuticals and Services (SIAPS) Program is to ensure the availability of quality pharmaceutical products and effective pharmaceutical services to achieve desired health outcomes. Toward this end, the SIAPS result areas include improving governance, building capacity for pharmaceutical management and services, addressing information needed for decision-making in the pharmaceutical sector, strengthening financing strategies and mechanisms to improve access to medicines, and increasing quality pharmaceutical services.

Recommended Citation

This report may be reproduced if credit is given to SIAPS. Please use the following citation. SIAPS-Mali (Pillar IV) Ebola End of Project Report, February 2018. Submitted to the US Agency for International Development by the Systems for Improved Access to Pharmaceuticals and Services (SIAPS) Program. Arlington, VA: Management Sciences for Health.

Key Words

Ebola, GHET, USAID, GHSA, SIAPS, Mali, DPM, Dashboard, OSPSANTE, EOC, Quantification, IPC, LMIS

Systems for Improved Access to Pharmaceuticals and Services Pharmaceuticals and Health Technologies Group Management Sciences for Health 4301 North Fairfax Drive, Suite 400 Arlington, VA 22203 USA Telephone: 703.524.6575 Fax: 703.524.7898 E-mail: [email protected] Website: www.siapsprogram.org

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ACRONYMS

CNAM Centre National d’Appui à la lutte Contre la Maladie COU Center des Opérations d'Urgences DOU-SP Département des Opérations d’Urgences en Santé Publique DPM Department of Pharmacy and Medicines EOC Emergency Operations Center IPC infection prevention and control LMIS logistics management information system MoH Ministry of Health OSPSANTE Outil de Suivi des Produits de Sante SIAPS Systems for Improved Access to Pharmaceuticals and Services USAID US Agency for International Development

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TABLE OF CONTENTS

Acronyms ...... iii Background ...... 1 Activities and Results ...... 3 Challenges ...... 5 Lessons Learned and Recommendations ...... 5 Annex A: Locations of Operation ...... 6 Annex B: Project Indicators ...... 8

iv

BACKGROUND

In October 2014, a case of Ebola was detected in Mali, raising concerns about the possibility of an outbreak in the country. A child was brought from Guinea and died in the northwestern city of . By mid-November, Mali had traced more than 100 people who had contact with the child, but no additional cases were discovered. That same month, a second unrelated outbreak occurred in Mali’s capital city, . Several people at a clinic were thought to have been infected by a man traveling from Guinea. On January 18, 2015, Mali was declared Ebola-free after 42 days with no new cases. In total, there were eight cases and six deaths.

As of late 2014, the Ebola epidemic in Mali’s southern neighbors (Liberia, Sierra Leone, and Guinea) had led to thousands of deaths. Mali, a country of approximately 16.5 million people, was ranked as one of the top four countries at risk for an outbreak prior to its first reported case.

The financial resources that were available to Mali through its participation in the Global Health Security Agenda allowed the country to accelerate its progress toward strengthening health security by implementing the International Health Regulations. These resources, provided by the US Government (USG), focused on prioritize coordinated action and specific measurable steps to prevent epidemics; detect biological threats early; and respond rapidly to disease outbreaks, whether naturally occurring, intentionally produced, or accidentally caused.

USG support may include infection prevention and control (IPC) activities, safe burial teams, case management and infection control training, the distribution of infection control commodities, and support to the Government of Mali’s newly established Ebola Emergency Operations Center (EOC).

Government MOH, other ministries, regulators, policy makers

Governance Sustainable Health Outcomes and Analysis Impact Service Human Improved International Evidence- Delivery Resources Improved coverage & aligned with: health initiatives Medical access of based health system Country Local context Products evidence- strategy performance based Strategic Plans Health status interventions and Health systems USG/USAID Financing Information Health-Specific Results

Providers Community public/private, NGO, patients, consumers, commercial sector, caregivers, civil society professional associations

Monitor and Evaluate Performance

Figure 1. The SIAPS pharmaceutical system strengthening framework

1 SIAPS-Mali (Pillar IV) Ebola End of Project Report

This SIAPS guiding framework represents a set of dynamic relationships among the five health systems building blocks (governance, human resources, information, financing, and service delivery) with a medical products building block overlay to provide technical focus and identify areas of concern and related corrective interactions. This framework was designed to inform country-specific results that are aligned with our partner country strategic plans and USG/USAID-related goals.

The US Agency for International Development (USAID) Mission in Mali requested that the Systems for Improved Access to Pharmaceuticals and Services (SIAPS) Program provide technical assistance to Mali to conduct an inventory and needs assessment for IPC commodities and provide recommendation to the EOC/Center des Opérations d'Urgences (COU), which was established on November 14, 2014, as part of the response to health emergencies in Mali. In this context, the EOC is the central coordinating mechanism of information and resources for the strategic and operational management of events and public health emergencies, especially those that may constitute a public health emergency of international scope.

The Mission also asked SIAPS to provide technical assistance and training on forecasting, storage, and distribution of Ebola commodities to USAID partners and health centers in USAID- supported districts.

SIAPS Mali was funded by USAID for a two-year project beginning in October 2015 and ending on December 31, 2017, to provide technical assistance to the Ministry of Health (MoH) and the National Medical Stores in the above specific areas.

The objectives of the technical assistance were to:

 Strengthen the pharmaceutical management capacity of individuals, institutions, organizations, and networks

 Ensure that innovative and proven tools were broadly available and used

To accomplish these objectives, SIAPS worked with the MoH and other partners to provide technical support on a national scale (central, regional, district, and peripheral levels) to re- establish the conditions for a quick return to a more resilient and sustainable pharmaceutical supply system in line with the SIAPS pharmaceutical systems strengthening framework. Most activities in this work plan included technical assistance for local partner institutions, including:

 Support to the MoH through the EOC/COU to conduct a needs assessment for IPC commodities

 Technical assistance and training on forecasting, storage, and distribution of Ebola commodities to USAID partners and health centers in USAID-supported districts

 Adding HIV and IPC commodities to the existing dashboard, Outil de Suivi des Produits de Sante (OSPSANTE), to facilitate aggregation of logistic data for decision making

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ACTIVITIES AND RESULTS

Conduct a Needs Assessment for IPC Commodities

To quickly identify existing IPC products and priority outbreak response needs, SIAPS provided the EOC with support for an inventory and needs assessment of IPC products at all levels of the health system.

SIAPS provided support to the Ebola Working Group to design a rapid situation analysis and incorporate its planned activities into the emergency action plan, which included an assessment of priority needs for IPC of Ebola at selected sites with a focus on border areas to avoid outbreak risks. As part of the assessment, the MoH organized several meetings.

In June 2016, a rapid situation analysis was carried out with financial and technical support from SIAPS in the regions of Kayes, , , and Bamako. SIAPS technical advisors from these regions accompanied the situation analysis teams. One component of this activity was the inventory of Ebola control products in border health facilities and corridors sites.

Conduct a Quantification of IPC Commodities

Following the assessment, SIAPS supported the EOC to plan the quantification process, which was carried out by the quantification subcommittee of the National Coordination Committee, including MoH institutions (Department of Pharmacy and Medicines (DPM), Central Medical Store, National Directorate of Health, INRSP, National Information Center for Education and Communication) and partners (USAID, Centers for Disease Control and Prevention, Catholic Relief Services, International Medical Corps, Médecins Sans Frontières).

The quantification workshop was held June 15–21, 2016. The results of the IPC commodity inventory were used for the quantification. The following recommendations were made by the Quantification Committee:

 Determine and reach consensus on the services provided, such as the number of Ebola treatment centers, number of transit and observation centers, and number of isolation rooms that the MoH plans to open

 Strengthen the national technical coordination committee

The quantification report was finalized and presented at the National Coordinating Committee meeting on August 4, 2016, to inform future forecasting and supply decisions.

Integrate IPC Commodities into OSPSANTE to Facilitate Aggregation of Logistics Data for Decision Making

SIAPS supported the DPM and the EOC to develop a module for Ebola commodities in OSPSANTE. During the implementation of this activity, all health personnel involved in the

3 SIAPS-Mali (Pillar IV) Ebola End of Project Report

Ebola response in Mali attended a stakeholder meeting on October 14, 2016. SIAPS presented OSPSANTE, a web-based platform designed to collect, analyze, and generate reports to improve decision making in pharmaceutical management. Following the presentation, the list of Ebola products developed during the quantification exercise was shared, allowing participants to select a list of Ebola tracer products to be included in OSPSANTE for close monitoring. The participants discussed the indicators of the health management information system and the logistics management information system (LMIS) to be included in OSPSANTE in the country profile and logistics reports. Ebola commodities management forms, including information on available stock and expiry dates, are included in OSPSANTE. Due to the unique nature of Ebola products, which are not commonly used by other programs, SIAPS advised stakeholders to use expiry dates to control the availability of products.

After the integration of Ebola products into OSPSANTE, SIAPS supported the DPM and the EOC to organize a demonstration workshop of the newly created Ebola module in OSPSANTE.

SIAPS regional technical advisors received an orientation on the management of the new Ebola module on December 13, 2016.

Training on Ebola Commodities Supply Chain Management and Roll-out of New Ebola Module in OSPSANTE at the Regional and Peripheral Levels

SIAPS supported the MoH through the Department of Public Health Emergency Operations (Département des Opérations d’Urgences en Santé Publique (DOU-SP)) and DPM to organize the training workshop for stakeholders at the peripheral level on pharmaceutical management. The national LMIS SOPs, including storage conditions; LMIS tools, such as stocks cards, logistics reporting tools, and requisition forms; and how to calculate commodity needs were the main sessions.

The training took place September 18–21, 2017, at the Infectious Diseases Training Center (Centre de Formation sur les Maladies Infectieuses) of the National Disease Center (Centre National d’Appui à lutte Contre la Maladie (CNAM)). The objective of this training was to build the capacity of stakeholders to enter Ebola commodities data into OSPSANTE and monitor their availability using OSPSANTE and the national LMIS SOPs.

During the training, participants entered into OSPSANTE commodities data collected in May 2017 during the physical inventory in the regions of Kayes, Koulikoro, and Sikasso.

In addition to participants at the central level, this activity involved:

 Pharmacists and the Ebola focal points from the Regional Directorates of Health of the Kayes, Koulikoro, and Sikasso regions

 Depot managers and Ebola district focal points from three districts in the , two in the , and four in the

4 Activities and Results

As a result, 35 stakeholders were trained, including 4 women and 31 men. They have built the necessary skills to use OSPSANTE in general and the Ebola module in particular to monitor the availability of health commodities.

SIAPS also supported the regional health directorate to follow up on the implementation of the workshop recommendation to enter monthly Ebola commodity data into OSPSANTE. SIAPS regional advisors worked with the district teams to enter the monthly Ebola data in to OSPSANTE from June to November 2017. This allows stakeholders to monitor the availability of Ebola commodities in the facilities.

Challenges

Making information about Ebola commodities on hand available has been very difficult in Mali. In response to this challenge, SIAPS developed a portal to record Ebola commodities on hand and their expiry dates in OSPSANTE. SIAPS trained stakeholders to conduct physical inventories of Ebola commodities at health facilities in the corridors and to enter data every month into OSPSANTE.

With the end of SIAPS, the major challenge that remains for the district teams is to regularly complete data entry in OSPSANTE for all districts.

Lessons Learned and Recommendations

The recent physical inventory showed that most Ebola products kept at the borders had been damaged because of poor storage conditions, which has significantly impacted the effectiveness of the Ebola response at the borders. Most Ebola units at the borders were not functional. The National Ebola Coordination Committee has recommended replacing all defective equipment and commodities at the borders to make the Ebola units more functional.

Ebola commodities data entered into OSPSANTE during the workshop helped service providers see that regular data entry makes it possible to have data in real time on the availability of commodities to inform decision making and help prevent problems such as expiration.

The DOU-SP recommended that depot managers and Ebola focal points of the districts enter Ebola commodities data monthly into OSPSANTE.

The availability of Ebola commodities data in OPSANTE requires constant monitoring of the DPM and DOU-SP to ensure that the data entry is completed regularly.

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ANNEX A: LOCATIONS OF OPERATION

Health Commodity Dashboard

Facility List

Mali - All Region - All District - All Facility Type – Ebola

Facility SL# Code Facility Name Facility Type Region District MLI1453 PPM Central Central Warehouse Bamako Bamako MLI0133 Depot de Kayes District Warehouse Kayes Kayes MLI0180 Depot de Kenieba District Warehouse Kayes Kenieba MLI0203 Depot de Kita District Warehouse Kayes Kita MLI0361 Depot de Kangaba District Warehouse Koulikoro Kangaba MLI0445 Depot de Koulikoro District Warehouse Koulikoro Koulikoro MLI0891 Depot de District Warehouse Sikasso Bougouni MLI0932 Depot de District Warehouse Sikasso Kadiolo MLI0968 Depot de District Warehouse Sikasso Kolondieba MLI1030 Depot de Selingue District Warehouse Sikasso Selingue MLI1040 Depot de Sikasso District Warehouse Sikasso Sikasso MLI1080 Depot de District Warehouse Sikasso Yanfolila MLI1497 Depot de Sagabary District Warehouse Kayes Sagabary MAL1215 CSREF Kéniéba Health Facility Kayes Kenieba MAL1218 CSREF Kita Health Facility Kayes Kita MAL1252 CSREF Kangaba Health Facility Koulikoro Kangaba MAL1274 CSREF Sélingué Health Facility Sikasso Selingue MAL1280 CSREF Kadiolo Health Facility Sikasso Kadiolo MAL1287 CSREF Yanfolila Health Facility Sikasso Yanfolila MLI0063 Hôpital du Mali Hospital National Bamako Commune 6 MLI0094 Mahina Health Facility Kayes Bafoulabe MLI0148 Health Facility Kayes Kayes MLI0196 Health Facility Kayes Kenieba MLI0258 Gogui Health Facility Kayes Nioro MLI0909 I Health Facility Sikasso Bougouni MLI0910 Garalo II Health Facility Sikasso Bougouni MLI1029 Binko Health Facility Sikasso Selingue MLI1454 Hopital Foussyni Daou Health Facility Kayes Kayes MLI1457 CSCom de Faléa Health Facility Kayes Kenieba MLI1458 CSCom de Fadougou Health Facility Kayes Kenieba MLI1460 CSCom de Sitanikoto Health Facility Kayes Kita MLI1461 CSCom de Sirakoro Health Facility Kayes Kita MLI1462 CSCom de Goro Health Facility Kayes Kita MLI1463 CSREF Sagabary Health Facility Kayes Sagabary MLI1465 CSCom de Kabéléa Health Facility Kayes Sagabary MLI1466 CSCom de Baléa Health Facility Kayes Sagabary MLI1467 CSCom de Galé Health Facility Kayes Sagabary MLI1470 CSCom de Kéniègoué Health Facility Koulikoro Kangaba MLI1471 CSCom de Kourémalé Health Facility Koulikoro Kangaba MLI1472 CSCom de Health Facility Koulikoro Kangaba MLI1473 CSCom de Tombola Health Facility Koulikoro Kangaba

6 Annex A: Locations of Operation

Facility SL# Code Facility Name Facility Type Region District MLI1476 CSCom de Tagan Health Facility Sikasso Selingue MLI1479 CSCom de Kalana Health Facility Sikasso Yanfolila MLI1480 CSCom de Badogo Health Facility Sikasso Yanfolila MLI1481 CSCom de Health Facility Sikasso Yanfolila MLI1482 CSCom de Guélénikoro Health Facility Sikasso Yanfolila MLI1483 CSCom de Kabaya Health Facility Sikasso Yanfolila MLI1486 CSCom de Bougouni Est Health Facility Sikasso Bougouni MLI1487 CSCom de Manakoro Health Facility Sikasso Bougouni MLI1492 CSCom de Zégoua Health Facility Sikasso Kadiolo MLI1493 CNAM Health Facility Bamako Bamako MLI1494 Chu-Point G Health Facility Bamako Bamako MLI1495 Chu-Iota Health Facility Bamako Bamako MLI1496 Laboratorie Serefo Health Facility Bamako Commune3 MLI1519 Koflatie Health Facility Koulikoro Kangaba MLI1539 CSCom ballan massalla Health Facility Koulikoro Kangaba MLI1540 CSCom central de kenieba Health Facility Kayes Kenieba (Mahinamine) MLI0136 PPMR de Kayes Regional Warehouse Kayes Kayes MLI0447 PPMR de Koulikoro Regional Warehouse Koulikoro Koulikoro MLI1038 PPMR de Sikasso Regional Warehouse Sikasso Sikasso

Liste Des Cordons Essentiels A Maintenir Par Region

Région de Koulikoro Nom du cordon Profil agent Nombre Observation Cordon de Koflatiè Technicien de Sante (TS) 6 TS Kangaba 2 équipes par cordon Cordon Djoulafondo TS 6TS Kangaba Cordon Kouremalé Douane TS 6TS Kangaba Un cordon pas aussi nécessaire compte tenu de sa position géographique Cordon Nougani TS 6TS Kangaba Kourémalé Région de Kayes Mahinamine TS 6 TS Kayes/Diboli TS 6TS Gogui TS 6TS Région de Sikasso Garalo 1 TS 6 TS Bougouni Selekegny TS 6TS Selekegny Zégoua TS 6TS Kadiolo Badogo TS 6 TS Yanfolila District de Bamako Aéroport Modibo keita Médecin et TS 2 Médecin et 12 TS Région de Gao Labbezanga TS 6TS Région de Ménaka Anderaboucane TS 6TS

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ANNEX B: PROJECT INDICATORS

INDICATOR DEFINITION SOURCE OF DATA # of quantification exercises conducted or updated 1 Needs assessment report # of persons trained in pharmaceutical management 130 Technical report Training report % of HFs that completed and submitted an LMIS report for the most 80% Technical reports recent reporting period

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