Activity and Product Status Report Project Year 7

Activity and Product Status Report

Project Year 7, Quarter 4 July - September 2007

Management Sciences for Health is a nonprofit organization strengthening health programs

This report was made possible through support provided by the U.S. Agency for International Development, under the terms of Cooperative A report on quarterly Agreement Number HRN-A-00-00-00016-00. The progress achieved opinions expressed herein are those of the author(s) towards activities, and do not necessarily reflect the views of the U.S. products, and results Agency for International Development. November 2007

Rational Pharmaceutical Management Plus Program Activity and Product Status Report July - September 2007

November 2007

Rational Pharmaceutical Management Plus Program Center for Pharmaceutical Management Management Sciences for Health

This report was made possible through support provided by the U.S. Agency for International Development, under the terms of cooperative agreement number HRN-A-00-00-00016-00. The opinions expressed herein are those of the author(s) and do not necessarily reflect the views of the U.S. Agency for International Development.

About RPM Plus

RPM Plus works in more than 20 developing and transitional countries to provide technical assistance to strengthen pharmaceutical and health commodity management systems. The program offers technical guidance and assists in strategy development and program implementation both in improving the availability of health commodities—pharmaceuticals, vaccines, supplies, and basic medical equipment—of assured quality for maternal and child health, HIV/AIDS, infectious diseases, and family planning and in promoting the appropriate use of health commodities in the public and private sectors.

Recommended Citation

This document may be reproduced if credit is given to RPM Plus.

Rational Pharmaceutical Management Plus. 2007. Rational Pharmaceutical Management Plus Program: Activity and Product Status Report, July - September, 2007. Published for the U.S. Agency for International Development by the Rational Pharmaceutical Management Plus Program. Arlington, VA: Management Sciences for Health.

Rational Pharmaceutical Management Plus Program Center for Pharmaceutical Management Management Sciences for Health 4301 North Fairfax Drive, Suite 400 Arlington, VA 22203-1627 USA Phone: 703-524-6575 Fax: 703-524-7898 E-mail: [email protected] RPM Plus Activities and Products Status Report

TABLE OF CONTENTS ACRONYMS AND ABBREVIATIONS...... VI GLOBAL PROGRAMS...... 1 SO2: MATERNAL HEALTH AND NUTRITION...... 1 SO3: CHILD SURVIVAL...... 3 SO4: HIV/AIDS...... 6 SO5: ANTIMICROBIAL RESISTANCE...... 8 SO5: MALARIA...... 10 SO5: TUBERCULOSIS ...... 11 MAINSTREAMING INITIATIVE...... 14 SUPPORT TO GLOBAL FUND TO ADDRESS BOTTLENECKS...... 15 REGIONAL PROGRAMS ...... 17 AFRICA BUREAU: CHILD SURVIVAL ...... 17 ASIA AND THE NEAR EAST ...... 19 CENTRAL ASIA REGION...... 22 EAST AFRICA REGION ...... 24 LATIN AMERICA AND CARIBBEAN— AMAZON MALARIA INITIATIVE...... 26 LATIN AMERICA AND CARIBBEAN—SOUTH AMERICAN INFECTIOUS DISEASE INITIATIVE...... 29 LATIN AMERICA AND CARIBBEAN—TUBERCULOSIS...... 32 MALARIA ACTION COALITION (MAC) ...... 33 WEST AFRICA REGIONAL PROGRAM (WARP)...... 35 COUNTRY PROGRAMS...... 37 ALBANIA ...... 37 ANGOLA—PMI ...... 38 ARMENIA...... 39 BRAZIL...... 41 DOMINICAN REPUBLIC ...... 43 HONDURAS ...... 44 KENYA—KEMSA & PUBLIC SECTOR...... 45 KENYA—PEPFAR...... 47 KENYA – PMI...... 49 LESOTHO ...... 51 MALAWI- PMI ...... 53 NAMIBIA - PEPFAR ...... 55 NICARAGUA ...... 57 RWANDA - PEPFAR...... 58 RWANDA - PMI ...... 61 SENEGAL- PMI...... 63 SOUTH AFRICA...... 64 SOUTHERN SUDAN...... 67 SWAZILAND...... 69 TANZANIA - PEPFAR ...... 71 TANZANIA—PMI...... 73 UGANDA - PMI...... 74 FINANCIAL INFORMATION...... 76

ACRONYMS AND ABBREVIATIONS

AB Africa Bureau ACCESS Access to Clinical and Community Maternal, Neonatal and Women’s Health Services [program—USAID-funded consortium] ACT Artemisinin Combination Therapy ACTMalaria Asian Collaborative Training Network for Malaria AFR/SD/HRD Bureau of Africa/Office of Sustainable Development [USAID] AFRO Regional Office for Africa [WHO] AIDS Acquired Immunodeficiency Syndrome ALu Artemether Lumefantrine AMI Amazon Malaria Initiative AMR antimicrobial resistance AMTSL Active Management of the Third Stage of Labor ANE Asia and Near East [Bureau, USAID] APP Adherence Promotion Planning APUA Alliance for the Prudent Use of Antibiotics ARCH Applied Research for Child Health [Project] ART antiretroviral therapy ARV antiretroviral BASICS Basic Support for Institutionalizing Child Survival [Project] BASICS II Basic Support for Institutionalizing Child Survival II [Project] BGH USAID Bureau of Global Health CA cooperating agencies CAMEWA Centrale d’Achat des Médicaments Essentials du Rwanda CCM country coordinating mechanisms C-DMCI Community Level Drug Management for Childhood Illness C-IMCI Community-Integrated Management of Childhood Illness CDC U.S. Centers for Disease Control and Prevention CPDS Coordinated Procurement and Distribution System CPG Clinical Practice Guidelines CNM National Malaria Center CPM Center for Pharmaceutical Management CRHC Commonwealth Regional Health Community CRHCS Commonwealth Regional Health Community Secretariat CTT Commodity Tracking Tool DFID Department for International Development [U.K.] DILSAT District Integrated Logistics Self-Assessment Tool DMCI Drug Management for Childhood Illness DMIS Drug Management Information System DOMC Division of Malaria Control [Kenya] DR Dominican Republic DQI Drug Quality and Information DTC Drug and Therapeutics Committee ECSA East, Central, and Southern Africa E&E Europe and Eurasia [Bureau, USAID] EDM See WHO/EDM E&E/EEST/HRHA Bureau for Europe and Eurasia, Office of Environment, Energy and Social Transition, Health Reform and Humanitarian Assistance Division (USAID) RPM Plus Activities and Products Status Report

FDC fixed-dose combination FHI Family Health International FHI/IMPACT FHI/Implementing AIDS Prevention and Care [Project] FPLM Family Planning Logistics Management [Project] FY fiscal year GDF Global Drug Facility GFATM Global Fund for AIDS, Tuberculosis and Malaria GTZ Deutsche Gesellschaft für Technische Zusammenarbeit (German Technical Cooperation Agency) IC infection control ICIUM International Conference on Improving Use of Medicines IMCI Integrated Management of Childhood Illness INRUD International Network for Rational Use of Drugs IPT intermittent preventive treatment IT information technology IUATLD International Union Against Tuberculosis and Lung Disease JSI John Snow, Incorporated KEMSA Kenya Medical Supplies Agency KfW German Development Bank (German acronym) LAC Latin America and the Caribbean LFA local funding agency MAC Malaria Action Coalition MCH maternal and child health MEDS Missions Essential Drugs Store MNH Maternal and Neonatal Health [Project] MoH Ministry of Health MOU Memorandum of Understanding MSD Medicines Stores Department MSH Management Sciences for Health MTP monitoring, training, planning (methodology) NACC National Antibiotic Coordinating Committee [Nepal] NFHP National Family Health Program NGO nongovernmental organization NIS Newly Independent States NMCC National Malaria Control Center NMCP National Malaria Control Program NMS National Medical Stores NTP national tuberculosis program OECS Organization of Eastern Caribbean States OHA Office of HIV/AIDS Services (USAID) PAHO Pan American Health Organization PEPFAR President’s Emergency Plan For AIDS Relief PHC primary health care PHN Population, Health and Nutrition [Center for, USAID] PMI President’s Malaria Initiative PMTCT prevention of mother-to-child transmission POPPHI Prevention of Postpartum Hemorrhage Initiative PPH postpartum hemorrhage PRDU Promoting Rational Drug Use PY Project Year QA quality assurance

Acronyms vii RPM Plus Activities and Products Status Report

RBM Roll Back Malaria REDSO Regional Economic Development Support Office [USAID] RMU rational medicine use RPM Rational Pharmaceutical Management [Project] RPM Plus Rational Pharmaceutical Management Plus [Program] SEAM Strategies for Enhancing Access to Medicines [Program] SO Strategic Objective [USAID] SOPs standard operational procedures S/P sulfadoxine-pyrimethamine SSO Strategic Support Objective STGs standard treatment guidelines STI sexually transmitted infection TA technical assistance TB tuberculosis TBCTA USAID TB Coalition for Technical Assistance TOR terms of reference TOT Training-of-Trainers TRAC Treatment and Research AIDS Center UK United Kingdom UNFPA United Nations Population Fund UNICEF United Nations Children’s Fund USAID U.S. Agency for International Development USAID/G/PHN U.S. Agency for International Development/Global Bureau Center for Population Health and Nutrition USG U.S. Government USP U.S. Pharmacopeia VCT Voluntary HIV/AIDS Counseling and Testing [USAID initiative] WHO World Health Organization

Acronyms viii RPM Plus Activities and Products Status Report

GLOBAL PROGRAMS

SO2: Maternal Health and Nutrition

Overview

RPM Plus continues to provide technical assistance to the Prevention of Post-Partum Hemorrhage Initiative (POPPHI) in drug and supply management issues that might hinder active management of the third stage of labor (AMTSL) to prevent PPH. POPPHI is a consortium of partners comprised of PATH, RTI International, EngenderHealth, the International Confederation of Midwives (ICM) and the International Federation of Gynecology and Obstetrics (FIGO). Supporting partners include RPM Plus, HealthTech, and JHPIEGO’s Access to Clinical and Community Maternal, Neonatal and Women’s Health Services (ACCESS). These partners work together at the policy and program levels to both support interventions through expanded use of Active Management of the Third Stage of Labor (AMTSL) and to develop structures that sustain the continued emphasis on the practice over the long term.

RPM Plus has been focusing SO2 activities in West Africa. Some countries in W. Africa namely Ghana, Senegal, Burkina Faso, Benin and Mali have introduced and expanded the use of AMSTL. Others have recently begun expanding use with support from earlier USAID-funded activities. Major hurdles related to the range of drugs, their availability and routes of administration exist to prevent AMSTL from becoming a universally available intervention. RPM Plus is supporting the expansion of means to make AMTSL more widely available through addressing some of these hurdles.

RPM Plus activities under USAID/G/PHN SO2 focus on three main technical objectives:

Objective 1: Through strategic partnerships with and technical leadership to USAID and USAID- supported CAs working in maternal health, improve maternal health program planning and service delivery with respect to drug and commodity management issues.

Objective 2: Enhance the capacity of government and non-governmental organizations to manage drugs and supplies for key maternal health services.

Objective 3: Improve capacity and awareness of global maternal health initiatives and partners in addressing Maternal Health pharmaceutical and supply management issues.

Major Activities This Quarter

BENIN – On July 18, RPM Plus in coordination with PATH/POPPHI, USAID Benin and the MoH/Division of Family Health (DSF) presented AMTSL study findings to 39 stakeholders working to promote AMTSL in Benin, including international organizations and MoH representatives. A number of recommendations were agreed upon and are yet to be validated by the Director of the DSF. During this visit, RPM Plus and POPPHI also met individually with a number of key partners working in Benin including, MoH/DSF and CAME (Central Medical

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Stores), PSI, WHO, UNICEF, UNFPA, URC/QAP and URC/PISAF. The Benin Study Report has been finalized and will be translated into English. A secondary dissemination for zonal-level health administrators and health care providers is tentatively scheduled for mid-November 2007.

MALI – In July, RPM Plus Regional Technical Adviser visited Mali to follow-up discussions surrounding proposed solutions to address previously gaps identified in the management of uterotonics. During his visit, the regional technical advisor met with the MOH (DPM, PPM, and Division of Reproductive Health) and with partners POPPHI, IntraHealth, PATH, ATN, and CARE. RPM Plus will continue to give support to DSR in coordination with other partners, in the following areas:

1. Development of protocols for storage and use of uterotonics in the delivery room, 2. Quantification of the needs on uterotonics as the program will expand, and 3. Support of training materials and training of health workers on uterotonics management.

GHANA – Data collection for the AMTSL Study was completed in July. The process of data cleaning and analysis has begun. The Study Coordinator will be collaborating with the Benin Study Coordinator and the Global AMTSL Study Principal Investigator to conduct a complete audit and analysis of data in October.

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SO3: Child Survival

Overview

In many developing countries, child mortality remains unacceptably high. Childhood diseases such as malaria, diarrheal diseases, acute respiratory infections, measles, and malnutrition, in addition to HIV/AIDS, contribute substantially to infant and child mortality. In response to the high mortality caused by these main childhood illnesses, the Integrated Management of Childhood Illness (IMCI) strategy, developed jointly by WHO and the United Nations Children’s Fund (UNICEF), has been implemented in numerous countries to offer program managers and service providers an integrated approach to effectively manage childhood illness. Notwithstanding considerable efforts to make essential IMCI drugs and other commodities available, significant gaps and management problems persist at various levels of the health system in many developing countries.

RPM Plus child survival activities funded under SO3 are complementary to USAID/Africa Bureau child survival interventions and both sets of activities support SSO3 and corresponding intermediate results. The activities are conducted through synergistic funding to produce greater impact and the two workplans share the same technical objectives.

RPM Plus activities under USAID/G/PHN SO3, “increased use of key child health and nutrition interventions,” focus on four main technical objectives during year 4 (FY03):

1. To enable decision makers, managers, and service providers to identify and monitor strengths and weakness in drug management for child health through the use of tools targeting public and private providers and caregivers

2. To increase the capacity of decision makers and service providers to design and apply appropriate interventions to improve availability and use of child health drugs in the public sector

3. To increase access to and use of child health drugs through initiatives involving the private sector.

4. To contribute toward shaping global child health strategy to include drug management through collaboration with international bodies and other organizations

Through its Strategic Objective 3, USAID supports interventions and activities to address child survival problems. In response to the USAID initiatives, RPM Plus has established a strong working relationship with groups and organizations to develop activities aimed at improving the

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IMCI drug management system in countries of interventions. IMCI is implemented as a comprehensive strategy including preventive and curative interventions to ensure high quality of care to sick children and to facilitate behavior changes of caregivers for children. However, the supply and management of essential drugs and vaccines have been identified as critical pieces to allow an effective management of childhood illness. In many countries, the lack or absence of essential drugs and resources for IMCI is a constant impediment. In other countries, essential drugs are poorly managed if they exist at all, and treatment decisions and behaviors are not rational. Moreover, limitation to access IMCI services is often coupled with weakness of the pharmaceutical systems, where service providers and managers are poorly trained, resulting in ineffective drug and commodity management practices. These issues—both in the public and private sector and at household level—are a focus for RPM Plus activities in the child survival portfolio, as well as advocating for pharmaceutical management being part of global, regional and national child survival agendas.

Major Activities This Quarter

During this quarter, private sector work advanced in Tanzania and Senegal. In Tanzania, RPM Plus continued with activities related to the integration and scale up of the child health component within the Accredited Drug Dispensing Outlet (ADDO) program. A total of 642 ADDO dispensers, 21 regional Council Health Management Team (CHMT) members and 3 national representatives were trained in 5 districts of the Morogoro region. In three of these districts, the child health training was conducted alone because the dispensers had previously received the core ADDO training. In two districts, RPM Plus supported the Ministry of Health and Social Welfare to conduct an integrated training which included the child health session as the sixth module of the complete ADDO training package. The ADDO curriculum will now be taught with the integrated child health session for all subsequent roll-out activities. In addition to the trainings, the baseline quantitative report on the ADDO program was completed. In Senegal, the final report of the private sector counter assistant’s trainings was completed. A consultant has been identified to lead the private sector follow-on work to investigate progress and track the impact of the training which was provided to 290 private sector counter assistants.

In addition to these key activities focused on the private sector, RPM Plus continued involvement in the integration and roll-out of zinc treatment for diarrheal disease management. Barriers to zinc registration which have been identified as the main cause of delay in implementation activities were discussed in meetings with USAID Washington and representatives from Benin, Ethiopia, Uganda, Nepal, Tanzania and DRC. A meeting with Nutriset, the main global supplier of zinc, has been scheduled in France with USAID and RPM Plus for early next quarter to discuss some of the registration challenges. At the regional level, USAID and RPM Plus agreed to hold a workshop in Eastern Africa to bring together medicine regulatory authorities of interested countries to discuss developing common criteria for zinc registration. At the country level, in DRC forms were developed and reviewed for reporting adverse effects and to monitor the use of zinc treatment within health facilities. RPM Plus provided technical input to develop materials for health workers in the community and at the facility level for training on zinc treatment as part of diarrheal disease case management. In Tanzania, RPM Plus participated in a meeting of the national zinc task force. Items discussed included: reviewing the progress of the country plan for national adoption of zinc treatment,

Global Programs 4 RPM Plus Activities and Products Status Report reviewing results of formative research conducted in country, sharing experiences with zinc introduction in other countries, and strategizing next steps towards scale up of zinc treatment.

At the international level, RPM Plus continued to increase involvement with the Partnership for Maternal, Newborn and Child Health (PMNCH). RPM Plus joined the general membership of the Country Support Working Group and also nominated a MSH candidate for an open seat on the PMNCH Board for an NGO representative.

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SO4: HIV/AIDS

Overview

The availability of pharmaceutical drugs and commodities is an essential component of HIV/AIDS health strategies in developing countries. However, the vast majority of people living with HIV/AIDS in developing countries do not have access to the pharmaceutical products that could prolong and improve their lives. Improving access to HIV/AIDS-related pharmaceutical products presents many challenges, including those that are directly related to pharmaceutical commodity management. RPM Plus activities under USAID/G/PHN SSO4, “increased use of improved, effective and sustainable responses to reduce HIV transmission and mitigate the impact of the HIV/AIDS pandemic,” focus on four main technical objectives:

1. To increase the capacity of USAID and USAID-funded cooperating agencies (CAs) to procure quality drugs and commodities for HIV/AIDS programs and provide assistance in addressing contextual issues 2. To increase the capacity of USAID and USAID-funded CAs to identify, prioritize and address commodity management issues to support the introduction or scaling up of HIV/AIDS programs and services 3. To provide technical leadership to USAID to identify key issues, form strategic partnerships and to develop and support approaches and initiatives to address HIV/AIDS-related commodity management issues at global and regional levels 4. To increase the capacity of national governments and the private sector to identify, prioritize and address commodity management issues to improve access to and use of quality drugs and commodities for HIV/AIDS programs

Major Activities This Quarter

During this quarter, the Adherence Promotion Planning tool was finalized. This was a product developed under the activity to promote operations research to improve adherence to ARVs funded under FY05 core funds. The tool will be pilot-tested in a facility in the field and it is expected that this will be done during the next quarter using country-funds.

The online publication of the HIV test kits procurement information document was finalized during this quarter. Work will continue during the next quarter to include the HIV test kits that have been added to the waiver list since the finalization of the previous document.

The finalized document “Managing Pharmaceuticals for TB/HIV Collaboration: Lessons Learned from a Five-Country Study in East Africa” has been sent to the RPM Plus editorial review team for finalization and printing. Findings from this study will be disseminated during the upcoming Union congress meeting in Cape Town, South Africa.

In August 2007, RPM Plus reviewed the feedback sent to the editors at the Elizabeth Glaser Pediatric AIDS Foundation (EGPAF) and prepared the second drafts of the two chapters. The

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EGPAF editors will review the second drafts and then send them out to the authors, then RPM Plus will respond and prepare the third drafts as needed.

The second draft of the VCT commodity planning guide was prepared and sent to the co-authors at Family Health International (FHI) for review and update. RPM Plus met with the representatives at FHI at the end of the third quarter in order to finalize next steps. It is expected that RPM Plus will receive the comments at the beginning of October 2007. The updated document should be finalized by the end of 2007.

RPM Plus continued to contribute to the development of an “Operations Manual for Delivery of HIV Prevention, Care and Treatment at Primary Health Centers in High Prevalence, Resource Constrained Settings” and accompanying country “Adaptation Guide” as part of a WHO-USG collaboration around the scale-up of HIV services in resource-constrained settings of high HIV prevalence. Activities in this quarter included reviewing and commenting on the drafts of all ten chapters of the Operations Manual and the second draft of the Supply Management chapter of Adaptation guide while also sharing tools and approaches developed by RPM Plus to support PEPFAR-funded programs. During the next quarter, RPM Plus will continue to work with the WHO-USG expert committee on Supply Management to finalize the document.

Also in this quarter RPM Plus continued to work with UNICEF to assist in finalizing the WHO/UNICEF publication “Programming Framework to Scale up Pediatric Care, Support and Treatment in Resource-Constrained Settings.” RPM Plus was invited to join a new working group formed to provide input in and direction to the “Interagency Task Team (IATT) on the Prevention of HIV Transmission to Pregnant Women, Mothers, and their Children” on issues specific to essential health services for children, including access to HIV care and treatment. A two-day meeting was held at the end of July to agree on the terms of reference for the group and the first task was to review the programming framework. RPM Plus revised the section on Supply Management, one of the six strategic components of the document to incorporate feedback from the group. RPM Plus will also assist UNICEF in finalizing the Framework and will also provide input into developing a document that looks at scaling up access to Cotrimoxazole Preventive Therapy (CPT) in HIV Exposed and Infected Infants and Children

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SO5: Antimicrobial Resistance

Overview

The problem of antimicrobial Resistance (AMR) is severely threatening our ability to treat infections. AMR is a serious, complex health-care problem occurring worldwide and is dramatically increasing. Resistance makes infections more difficult to treat, raises levels of morbidity/mortality, and increases health-care costs. So, a concerted global action is required to combat this problem in an effective and timely manner.

Under USAID results framework (BGH SS05 – increased use of effective interventions to reduce the threat of infectious diseases of major public health importance), RPM Plus is currently working on several activities towards addressing AMR problems in developing countries. The following is a brief narrative of the progress made on these activities in FY06-PY7 Q3.

Major Activities This Quarter

Substantial progress was made during this quarter towards finalizing two RPM Plus tools developed to complement the country-level AMR approach: (1) The AMR Operational Guide (previously titled “AMR Workbook”) was finalized. (2) A technical consultant with experience working at USAID mission was engaged for a final review of the “AMR Field Guide for USAID Missions”.

In Zambia, a popular segment called “Your Health Matters” run by the Zambia National Broadcasting Corporation televised three antimicrobial use- and AMR-related mass-media programs at prime times in Zambia. Each of these programs, developed by MOH with TA from AMR Advocacy Working Group and RPM Plus, were telecast several times in July.

The second edition of Zambian STG was finalized and the activity was reported in the July 17th issue of Times of Zambia. RPM Plus coordinated final preparations with Links Media and APUA for a media training course on AMR in Ethiopia in early October.

Also during this quarter RPM Plus facilitated two training courses in July, one on DTC in Shandong province in China and the other on TOT for rational medicines use in Armenia. Additionally, RPM Plus provided substantial follow TA to DTC alumni Sital Shah in developing and giving an oral presentation at this year’s Beijing FIP Conference on the topic “Taking action on antimicrobial resistance: experience of Pharmacy and Therapeutics Committee in a Kenyan hospital”.

Follow up assistance to the Pharmaceutical Regulatory Authority (PRA) and CHAZ to support their product quality assurance efforts was maintained during this quarter, including a TA visit to Lusaka by an RPM Plus technical staff. In recent months PRA has made substantial improvements in its inspection processes—documentation and visual inspection of all products are now carried out according to established SOPs. Records indicated that 145 batches of different products were inspected between July and August.

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In Swaziland and South Africa, RPM Plus conducted support visits to pilot hospitals for infection control activities. RPM Plus and QA Directorate of South Africa’s NDOH conducted a successful infection control (IC) review workshop in September in Kimberley. Participants shared experiences and lessons learned from implementing the IC activities and developed plans for scaling up the approach. A national follow up plan was also agreed, including quarterly follow up site visits by national managers, finalization and dissemination of a hand hygiene poster, finalizing adaptation of the RPM Plus IC self-assessment tool to South African context, a national TOT workshop, and countrywide dissemination and implementation of the tool.

Also during this quarter, the first of the two AMR courses for USAID E-learning Center was completed and reviewed by USAID. USAID subsequently gave approval to upload it on the website. This web uploading will begin in October.

Field test of the draft RPM Plus manual “How to investigate antimicrobial drug use in hospitals: selected indicators” has started in Uganda. The manual will be revised and finalized incorporating experiences obtained from this field test.

Technical report on the ART adherence measurement tool development and validation was completed and disseminated to USAID Washington and South Africa.

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SO5: Malaria Overview

The Roll Back Malaria (RBM) Partnership was established for the specific objective of supporting the rapid scaling up of anti-malaria interventions at the country level. The role of the RBM Partnership secretariat is “to ensure the activities of individual RBM partners are coordinated and focused on the expressed needs of countries and are in line with the best technical approaches”1. In addition, the RBM partnership Secretariat supports the Malaria Commodity Services which aims to facilitate access to ACTs, rapid diagnostic tests (RDTs), and insecticide treated nets (ITNs).

Despite successful interventions using appropriate approaches and effective methods as well as an increased level of global resources for the procurement of malaria commodities through The Global Fund, the World Bank Booster Program, the President Malaria Initiative and other interventions, the burden of malaria has not decreased leading to a mounting pressure on RBM partners to act swiftly in a coordinated manner and ensure that best practices are being followed for optimal impact on mortality and morbidity of the disease.

In this context, the USAID through RPM Plus supports the RBM Secretariat to ensure that pharmaceutical management and rational use issues are appropriately addressed in the planning, implementation and evaluation of malaria interventions. RPM Plus provides support to the RBM Partnership to consolidate capacity building assistance, disseminate approaches and tools developed and implemented at the country level and reinforce synergies among global partners for country level impact. This support will ensure that pharmaceutical management standards and practices are globally and locally disseminated and that lessons learned from the field are communicated and incorporated into policy, strategic and implementations plans. Activities specifically identified with the RBM Partnership are related to facilitating access to affordable quality antimalarial medicines and other essential supplies such as mosquito nets, RDTs, and insecticides.

Major Activities This Quarter

• Translated the English version of the PMM manual into Spanish. • Reviewed the Global ACT subsidy proposal • In this quarter, RPM Plus hosted the RBM PSM working group meeting in Arlington offices, during this meeting, RPM Plus was elected to be one of the co chairs of the working group. RPM Plus continues to provide technical assistance in developing work plan and budgets for the working group. • Discussed with RBM on hiring a consultant who would develop deliverables and finalize the sources and prices guide

1 RBM Partnership Secretariat Proposed Mission Statements and Goals (14 October 2004). www.RBM.who.int.

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SO5: Tuberculosis

Overview

Even with joint efforts of many international organizations such as those in the Stop TB partnership, control of Tuberculosis (TB), endemic in many countries worldwide, needs much more support. National TB programs are learning mechanisms to improve case detection, how different treatment regimens such as fixed-dose combination products and patient kits can improve patient and prescriber compliance, and importance of case management monitoring and reporting. However, this has become complicated when the number of cases increases due to changes in population migration and number of patients co-infected with HIV/AIDS.

Since 2000, RPM Plus has worked to bring the issues of pharmaceutical management for TB to national agendas. Through international organizations like the Stop TB working groups RPM Plus contributed to the Global Plan to Stop TB for 2006 – 2015. The most significant achievement for RPM Plus with USAID/BGH funding to date has been providing ongoing technical leadership and assistance to the GDF/GLC. RPM Plus activities with the GDF/GLC increase the availability and access to DOTS in priority countries thus contributing to DOTS expansion and strengthening. The development of human capacity in TB commodity management has also been a focus of RPM Plus work. The demand in RPM Plus training from NTPs and WHO regional offices currently exceeds RPM Plus capacity and available funding. The tools and methodologies developed by RPM Plus are available to country programs and NTPs through the RPM Plus website and dissemination of documents during international TB meeting such as IUATLD World Congress.

RPM Plus has identified three technical objectives which are key to meeting the challenge of strengthening local TB drug management capacity:

1. Objective 1: Improve capacity and awareness of TB global initiatives and partners in managing pharmaceuticals for TB programs 2. Objective 2: Increase the human capacity of TB programs to design, apply, and monitor appropriate interventions to ensure uninterrupted supply of quality TB commodities for expanding DOTS programs 3. Objective 3: Increase the evidence base for improvements in TB commodity management

Major Activities This Quarter

Using FY 05 Funding

Develop a guidance document on effective commodity management to compliment WHO TB/HIV guidelines

The finalized document “Managing Pharmaceuticals for TB/HIV Collaboration: Lessons Learned from a Five-Country Study in East Africa” has been sent to the RPM Plus editorial

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review team for finalization and printing. Findings from this study will disseminated during the upcoming Union congress meeting in Cape Town, South Africa.

Using FY06 Funding

Technical Assistance to GDF Regular support to GDF was provided by RPM Plus Senior Program Associate, permanently based in Geneva, especially on procurement and management issues. RPM Plus also conducted day to day activities on procurement, N.B. ongoing vacancy position of Procurement Team Leader. RPM Plus prepared a tender letter for RFP (Request for Proposals = tender) for 1st line TB drugs and a short listing of suppliers and products eligible to bid according to prequalification outcomes. RPM Plus provided assistance to Procurement Agent (GTZ) to float the same (launch date 3 September), while updated Product Specifications and Supplier Instructions for all GDF products and packaging and performed ISO Quality management internal audit.

RPM Plus Manager for TB portfolio participated in a technical review meeting on July 16, in DRC. Also during this quarter, RPM Plus Senior Program Associate, upon an urgent request for bottle neck GFATM, made preparations for GDF/MSH mission to Guyana to implement the use of TB fixed dose combination drugs.

RPM Plus also provided assistance in developing a checklist for consultants to conduct GDF/GLC mission in countries on drug management. This checklist will be field tested and then put into place next quarter.

Technical Assistance to GLC RPM Plus Senior Program Associate facilitated two sessions during The Stop TB Working Group on MDR-TB in Tbilisi, Georgia. The objective of this working group was to find a way to speed up the prequalification of suppliers of second line drugs, to understand the size of the global market, to find additional second line drug suppliers and others. The two sessions RPM Plus facilitated were on working group on drug management and on recording & reporting. The partners group of The Stop TB Working Group wants to establish a subgroup drug management committee and MSH to a part of it.

RPM Plus also worked with GLC on updating PSM plans for 2nd line drugs management.

Technical Assistance to Stop TB and Global Initiatives There has been an on-going preparation for IUATLD Congress to take place in Cape Town in November 2007. RPM Plus developed presentations for the full-day workshop at the UNION Congress on management of TB pharmaceuticals and commodities.

Finalize retooling roadmap paper During this quarter, Second and Third draft of Stakeholder Engagement document, a follow on to the retooling guide, was presented to the Retooling Task Force. Appropriate case studies were developed through literature search and interviews for the purpose of document. Checklist of key actions for ‘Liquid Culture- Drug Susceptibility Testing System’ was refined through

Global Programs 12 RPM Plus Activities and Products Status Report interviews and feedback. RPM Plus also participated in two conference calls with Task Force members to report on progress of assignment and seek guidance on how best to move forward.

Strengthen Pharmaceutical Management Capacity RPM Plus TB portfolio manager conducted sessions on integrated TB/HIV management for WHO course for TB consultants in Sondalo, Italy. RPM Plus Principal Program Associate prepared workshop materials for MDR-TB workshop with WHO WPRO Region to take place in November 2007. Another two workshops have been planned for the next quarter, totaling in three: Sondalo, Warsaw, and Manila.

Disseminate RPM Plus TB Tools The RPM Plus TB website has been updated on a regular basis, while various TB tools continue to be in demand. The “Managing of TB Medicines at Primary Level” guide has been finalized and 100 copies have been printed for dissemination.

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MAINSTREAMING INITIATIVE Overview

Overview The Health System Strengthening Mainstreaming Initiative was kicked off in 2004. The purpose of the Mainstreaming Initiative is to identify cost-effective ways to put the combined knowledge, expertise and tools from USAID’s health system strengthening projects at the service of USAID’s large bilateral health service delivery projects and to improve the capacity of these projects to achieve USAID’s health impact objectives. The need for this initiative came from the observation that in many cases PHN officers are ill-equipped to identify and address systems issues that could impact on their efforts, and that many bilateral programs have not been availing themselves of existing proven tools and methods. In this way, the Mainstreaming Initiative represents an effort to systematize the lessons from these past experiences that have applicability at the service delivery level and identifies enhancing health system capacities as a core programmatic objective.

Major activities in this quarter

A draft of the e-leaning materials based on the HSA tool was presented for review and comment to USAID. The E-learning program managers have also reviewed and provided initial feedback. It is anticipated that a complete draft will be distributed for final review by November, 2007.

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Support to Global Fund to Address Bottlenecks

Malaria USAID set aside $12 Million in 2006 to provide technical assistance (TA) to Country Coordinating Mechanisms (CCMs) and Principle Recipients (PRs) in selected countries to improve the GF functioning of grants. 13 vendors/partners were identified for providing TA. RPM Plus and MAC were two of the 13 partners identified. The technical assistance is meant to be short-term and goal oriented to alleviate specific bottlenecks that are causing the grant to falter in implementation. The TA areas identified were: o governance, including aspects of the functioning of CCM; o program management; o financial management systems; o procurement and logistics management; o multi-sectoral implementation; and/or o monitoring and evaluation of performance. $500,000 has been set aside for RPM Plus under the MAC mechanism for DRC, Ethiopia, Kenya, Nigeria and Senega1.

Major Activities this Quarter

Nigeria • Finalized and disseminated to partners the report for the February stakeholder’s workshop

Senegal • Represented RPM Plus in a workshop to discuss the findings of feasibility studies on RDT use in the health system by the Dakar University. The study supports the use of RDTs in the health system to diagnose malaria. • Provided assistance in developing the SOPs manual on pharmaceutical management and the training manual on inventory and stock management. The training manual was developed based on the previously developed Community health workers training module. The manuals were validated by the National Committee overseeing the implementation of the GF mission’s recommendations. • Supported the NMCP to train/orient the Regional and district teams of Kolda, Ziguinchor and Tambacounda on the SOPs Manual. The meetings provided an opportunity to identify training needs for districts’ pharmacy dispensers • RPM Plus supported the NMCP to draft TORs for the Long lasting Insecticides nets (LLINs) management workshop intended to define strategies to sustain the availability of LLINs, secure distribution channel and identify data collection mechanisms at the operational level. • Continued to refine the pharmaceutical inventory management guidelines for heath centers and posts • In September, RPM Plus traveled to Mali to support the PPM to plan for ACT and RDT procurement using GF round 6 phase 1 malaria grants. In addition to discussing with the PPM team, RPM Plus collected information needed for quantification of ACTs and RDT

DRC • RPM Plus assisted the PNLP and the Drug regulatory authority to organize a workshop for the private sector involvement in ACT policy implementation and monotherapy ban workshop report including recommendations was finalized.

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• The division of pharmacy, medicines and medical plants was assisted to organize meeting to communicate the interdiction of the monotherapy drug use against uncomplicated malaria. • Assistance was also provided to the PNLP to develop training materials on quantification for GFATM supported Health zones and to plan for the training

HIV/TB

Vietnam During this quarter, RPM plus conducted a training on TB commodity procurement and processes to build capacity and skills of NTP and MOH staff working involved in TB procurement. Workshop also focused on the revised bidding documents prepared for TB commodity procurement. This concludes the procurement activity in Vietnam.

RPM plus finalized and translated the guide “TB commodity distribution planning, monitoring and Evaluation: National Tuberculosis Program Guide” which provides stepwise instructions on quantification and distribution planning for TB medicines and laboratory consumables for different service levels in the country. An Excel based estimation tool was also developed to complement the guide. Documents are presently been reviewed by NTP.

RPM Plus finalized the standard operating procedures (SOPs) for warehousing, receiving and issuing of TB medicines. This document will be used by NTP to standardized warehouse and distribution services and to build capacity of warehouse staff. This documents is presently been translated to Vietnamese.

Next steps include another visit to Vietnam in October to develop an implementation plan for the SOPs with NTP and make final changes. A workshop on quantification and M&E is also planned in October to build capacity of NTP staff responsible for this activity.

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REGIONAL PROGRAMS

Africa Bureau: Child Survival

Overview

RPM Plus child survival activities funded under USAID/Africa Bureau child survival are complementary to SSO3 interventions and both sets of activities support SO3 and corresponding intermediate results. The activities are conducted through synergistic funding to produce greater impact and the two workplans share the same technical objectives.

RPM Plus activities under USAID/Africa Bureau child survival focus on four main technical objectives:

• To enable decision makers, managers, and service providers to identify and monitor strengths and weakness in drug management for child health through the use of tools targeting public and private providers and caregivers

• To increase the capacity of decision makers and service providers to design and apply appropriate interventions to improve availability and use of child health drugs in the public sector

• To increase access to and use of child health drugs through initiatives involving the private sector.

• To contribute toward shaping global child health strategy to include drug management through collaboration with international bodies and other organizations

RPM Plus has established a strong working relationship with groups and organizations to develop activities aimed at improving the IMCI drug management system in countries of interventions. IMCI is implemented as a comprehensive strategy including preventive and

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curative interventions to ensure high quality of care to sick children and to facilitate behavior changes of caregivers for children. However, the supply and management of essential drugs and vaccines have been identified as critical pieces to allow an effective management of childhood illness. In many countries, the lack or absence of essential drugs and resources for IMCI is a constant impediment. In other countries, essential drugs are poorly managed if they exist at all, and treatment decisions and behaviors are not rational. Moreover, limitation to access IMCI services is often coupled with weakness of the pharmaceutical systems, where service providers and managers are poorly trained, resulting in ineffective drug and commodity management practices. These issues—both in the public and private sector and at household level—are a focus for RPM Plus activities in the child survival portfolio, as well as advocating for pharmaceutical management being part of global, regional and national child survival agendas.

Major Activities This Quarter

This quarter, RPM Plus continued collaboration with WHO to investigate incorporation of pharmaceutical management components into standard guidelines, trainings and surveys. Data analysis sheets in English, French and Spanish were finalized for the IMCI Health Facility survey drug management component and shared with WHO. Discussions continued regarding incorporating the drug management component (including the analysis spreadsheets) into the standard IMCI Health Facility survey package. In addition, RPM Plus reviewed and commented on draft training material being developed by WHO to assist child health program managers.

In country level activities, RPM Plus continued to provide technical support in advancing the community case management program in DRC. Partners agreed on the final version of the community case management implementation guide. A session on diarrheal disease case management including the treatment of zinc was developed for the training of community health workers. RPM Plus provided technical assistance to organize the community case management review workshop scheduled for Oct 22-27, 2007. In addition, data collection began to monitor availability of key medicines at community sites (an indicator that has been a challenge to collect during regular reporting).

To encourage dissemination of lessons learned during community case management programs, RPM Plus initiated contact with other organizations to coordinate a panel submission for the Annual Global Health Council Conference in 2008. RPM drafted an abstract based on the DRC community case management experience and the added value of incorporating pharmaceutical management.

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Asia and the Near East

Overview

RPM Plus has been providing technical assistance in pharmaceutical management of malaria, TB, HIV/AIDS, and child survival in the ANE region since 2000. This technical assistance has included identifying problematic household and providers behaviors in the diagnosis and treatment of malaria, strengthening TB pharmaceutical management in China, and addressing issues in pharmaceutical management of HIV/AIDS.

Whereas in years 2002-2005, much of the emphasis was on developing appropriate methodologies to gather information, RPM Plus efforts are now focused on assisting counterparts to utilize this information to guide decision-making in malaria program management, and to critically evaluate implementation of ACT drug policy. RPM Plus technical assistance will complement efforts undertaken under the Global Fund and focus on hot spots of antimicrobial resistance.

In late 2004, the National Center for Tuberculosis Control and Prevention (NCTB) in China initiated a program of activities to strengthen TB drug management in collaboration with WHO Beijing and RPM Plus of Management Sciences for Health. In 2006, new standard operating procedures (SOPs) and a training program to improve TB pharmaceutical management were developed and implemented at provincial, prefecture, and county levels in Henan Province, China. In addition, RPM Plus provided general training on TB drug management to pilot facility staff. Based on feedback received from participants, SOPs manuals were refined to make them more effective and user friendly. The introduction of new systems was supervised by NCTB officers based in Henan province and Beijing.

As countries in Southeast Asia and the Pacific embark on HIV/AIDS treatment and care programs, it is clear that effective management of HIV/AIDS medicines, including antiretroviral drugs (ARVs), and related commodities remain huge hurdles and constraints to maximizing the number of patients treated. There is also a keen need to coordinate pharmaceutical management of HIV/AIDS medicines and other commodities, regardless of their source, given global initiatives, such as PEPFAR and GFATM. RPM Plus will collaborate with WHO/WPRO to conduct a regional workshop on quantification, and identify countries that would benefit from follow up technical assistance.

RPM Plus Technical Objectives and Rationale

Objective 1: Strengthen the capacity of regional, national, country and local decision makers to systematically identify, prioritize and monitor pharmaceutical problems that promote the emergence of antimicrobial resistance

Objective 2: Enhance the capacity of governmental and NGO counterparts to utilize indicator- based information to guide the development and implementation of drug management systems strengthening strategies

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Objective 3: Expand the evidence base for developing and implementing effective drug interventions in commodity management for infectious diseases

Objective 4: Increase the capacity of USAID, governmental or NGO counterparts to maximize the efficient and effective use of resources for HIV/AIDS-related health commodities in support of an expanded response to the HIV/AIDS pandemic

Major Activities This Quarter

Subsequent to the Pharmaceutical Management of Malaria (PMM) course in Cambodia in December 2006, ACT Malaria requested that RPM Plus conduct a regional course in Hanoi, Vietnam in late November to early December 2007. To address common issues in the management of antimalarials, the course will include general pharmaceutical management topics, and a focus on quantification training at the national level. The course will also provide participants the opportunity to evaluate country-specific pharmaceutical management issues, including implementation of Global Fund grants for malaria, and allow participants to revise PSM plans, or develop practical improvement plans for addressing those issues. RPM Plus will participate in the first bi-annual Mekong malaria partners meeting in Thailand in late October 2007 designed to facilitate partner discussion and development of complementary work plans to address malaria priority issues in the region.

In June 2007, RPM Plus staff, in collaboration with the World Health Organization (WHO) and the Chinese national HIV/AIDS program, conducted an exploratory visit to several HIV/AIDS facilities in Yunnan Province to learn about current anti-retroviral (ARV) and opportunistic infections (OI) medicines supply operations. RPM Plus reported details of the visit and subsequent recommendations to WHO and USAID/RDMA; these will serve as the basis for a one day workshop featuring discussions on strengthening pharmaceutical management of ARVs and other HIV/AIDS commodities in October 2007.

In June 2007, RPM Plus also met with governmental, INGO, Global Fund, and other counterparts in Laos to learn about current and planned activities for implementation of antiretroviral therapy (ART) under Global Fund Round 6, current management of ACTs and TB medicines, and visited a provincial site, where ART has been implemented by Médecins Sans Frontières (MSF). In September 2007, RPM Plus participated with counterparts in a round table discussion regarding the transfer of ARV operations from MSF to the MOH. RPM Plus also evaluated potential options for the distribution of ARVs and other commodities, procured through the Global Fund.

RPM Plus continues to provide technical assistance to the Chinese National Center for Tuberculosis Control and Prevention (NCTB) in scaling-up use of standard operating procedures (SOP) for TB pharmaceutical management. Chinese counterparts requested that RPM Plus provide assistance in developing training guides on topics including general pharmaceutical management, receiving medicines, storekeeping, dispensing and quantification to facilitate the

Regional Programs 20 RPM Plus Activities and Products Status Report scale-up of SOP use. RPM Plus will introduce and provide technical assistance in implementing the completed materials during a visit in late November or early December.

Preparations are also well under way for the planned workshop, “Pharmaceutical Management of Multi-Drug Resistant Tuberculosis”, to be held in Manila, the Philippines, November 19-23, 2007. RPM Plus is collaborating on the workshop with WHO/WPRO, WHO/Geneva, the GDF, and the Green Light Committee.

One of the issues in implementing a strategy and activities for strengthening pharmaceutical management in countries in the RDMA region is the lack of human resource capacity. RPM Plus met with Thai counterparts to discuss options for creating a sustainable network in the South- East Asia region to build pharmaceutical management capacity at both the pre-professional and professional levels. RPM Plus also discussed with partners potential organizations in the region that may serve as models or centers for capacity strengthening activities.

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CENTRAL ASIA REGION RPM Plus participated in the TBCTA TB survey carried out in the countries of Eastern Europe and Central Asia in 2002. In 2003, RPM Plus reported the findings regarding the status of TB Program implementation in these countries, during the conference in Bishkek, Kyrgyzstan. The findings demonstrated a serious need for improvement in the drug management practices in the surveyed countries. USAID E&E Bureau has provided funding for the follow-up technical assistance in TB drug management for these countries.

Recently, the governments of Uzbekistan, Tajikistan, Kyrgyzstan, and Kazakhstan have been concerned about the quality of procured TB medicines. Emergence of new global initiatives, such as GFATM, implied additional support for DOTS expansion that enables the governments (including Uzbekistan, Tajikistan, and Kyrgyzstan) to carry out procurement efforts. Recognition of the need for large procurement efforts, coupled with the concerns about the quality of TB medicines and raising MDR-TB rates led to a major shift in the priorities of the CAR governments towards TB Drug Quality Assurance (QA). In Kazakhstan, health officials were concerned about a possible impact of an upcoming decentralization of the drug procurement on the quality of procured TB medicines and possible consequences of procuring substandard TB medicines. Lack of QA mechanisms was identified as a challenge to successful DOTS implementation, according to the TBCTA survey for CAR countries.

To address the needs of Kazahkhstan, Uzbekistan, Kyrgyzstan, and Tajikistan, RPM Plus carried out a regional training in TB Drug Quality Assurance for the national drug regulatory authorities (DRA) from these countries, on November 7-11, 2005. The RPM Plus regional training activity was covered by USAID Mission funds for CAR (regional), Uzbekistan, Tajikistan, and Kyrgyzstan. The training was carried out in collaboration with the USP DQI and AED. Minilabs and sets of laboratory reagents and supplies were provided for the countries participating in the training. The follow-up TA in TB DQA in the countries, which earlier participated in the TBCTA survey, will be leveraged from the E&E Bureau funding provided for the TA following up the TBCTA survey. In August 2007, RPM Plus was contacted by the US Department of State regarding a visit of Kazakh delegation. Based on further discussion with USAID, it was agreed that the funding for activities in TBCTA countries, in addition to funding for CAR activities will be redirected towards organizing a high level meeting with Kazakh Delegation.

Major Activities This Quarter

On August 29, 2007, RPM Plus hosted a meeting with seven high-level medical professionals and officials responsible for TB control in Kazakhstan. This meeting was funded also through the remaining mission funding of CAR, agreed through the missions. The group of Kazakh was on a three-week State Department-sponsored International Visitor Leadership Program, entitled "Multi-Drug Resistant Tuberculosis,” during which they visited health facilities, NGOs, private sector entities, and state and local government offices to learn about tuberculosis control efforts in the United States. During the one-day meeting hosted at the MSH Arlington office, RPM Plus presented sessions and facilitated discussions on pharmaceutical management for MDR-TB,

Regional Programs 22 RPM Plus Activities and Products Status Report including procurement options and the importance of drug quality assurance programs in preventing the development and spread of resistant strains of tuberculosis. The discussions were built around the findings of a joint TB assessment conducted in Kazakhstan by WHO, RPM Plus and partners in the field in May 2007; and from a global market research of second-line TB medicines conducted by RPM Plus jointly with the Green Light Committee. The session on drug quality assurance programs included discussion concerning Minilabs as an element of Drug Quality Assurance program, results of Minilab implementation in Kazakhstan, and next steps to be planned by the MOH and TB Institute to ensure effective use of Minilabs in the country. RPM Plus also discussed new technologies in TB control, the Stop TB framework for adoption, introduction and implementation of new technologies for TB control, and lessons learned from other health and disease programs. In addition, RPM Plus made a presentation of its latest web- based TB Case and Commodity Management tool for Multi-drug Resistant Tuberculosis (MDR- TB). The tool is currently adopted in Brazil, Romania, and Moldova, and is used by national TB programs to ensure proper registration of cases, prescription, adherence to treatment, patient follow-up, and timely quantification and supply of TB medicines. The visiting team requested an access to a test version of the tool, specifically its pharmaceutical management part, to analyze possible integration of this tool into the locally developed solutions.

Next steps

Upon return to Kazakhstan and discussion with other MOH officials, the visiting team will contact RPM Plus CAR activity manager to discuss specific technical assistance needs for further activities with regard to drug management information systems and Minilabs.

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EAST AFRICA REGION

Overview

Since 2000, USAID/REDSO PHN office and the Bureau for Africa, Office of Sustainable Development (AFR/SD/HRD) have funded the Rational Pharmaceutical Management Plus (RPM Plus) program to support their strategic objectives (SO) in health in the ECSA region. In particular, SO7 – “Enhanced regional capacity to improve health systems in the ECSA Region” and Strategic Objective 8 – “Strengthened HIV/AIDS Programs in Region” have received technical assistance (TA) to strengthen pharmaceutical management systems with the aim of increasing access to quality pharmaceuticals and health commodities.

TA has been provided to regional organizations through dissemination of assessment tools, better practices and strategic information on drug management and logistics. The TA and support has been channeled through the Regional Logistics Initiative (RLI), a unit established by the then USAID/REDSO (now USAID/EA).

To facilitate activities, the Regional Pharmaceutical Forum (RPF) was established in 2003, at the ECSA Health Community Secretariat. The RPF has four Technical Working Groups (TWGs), namely, Policy, Legal Framework and Management Support; the Procurement and Distribution Systems; the Promoting Rational Drug Use (PRDU), and HIV/AIDS-related Pharmaceuticals.

In FY 04 and FY 05, the TWGs developed several documents; Standard Treatment Guidelines for HIV/AIDS, TB and malaria, a Regional Medicines Formulary and a Generic National Medicines Policy. These documents are intended to serve as entry points for the promotion of other pharmaceutical management activities e.g. pooled procurement. In addition, malaria control activities, particularly in support of ACT policy implementation, were undertaken.

Most recently efforts are being directed at disseminating and advocating for country buy-in so that application and implementation of these documents and tools is achieved.

Technical Objectives

1. To develop and advocate for implementation of enabling policies for efficient commodity management systems to increase access to pharmaceuticals; 2. To increase the capacity for providing effective drug management; 3. To apply commodity management tools aimed at strengthening country-level pharmaceutical systems; 4. To document and disseminate strategic pharmaceutical management information and better practices.

Major Activities This Quarter

Activities were principally dissemination but also sharing of best practices in pharmaceutical management.

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• Interviewed policy makers and collected data in 4 EAC states for the pooled procurement feasibility study (July 2nd – 15th); • Attended a Working Meeting (29/07– 4/08) to compile the report on the Situation analysis and Feasibility Study on Regional Pooled Procurement of Essential Medicines for EAC. Partners supporting the initiative are WHO, JSI, MSH and UNDP. • Disseminated the work of the RPF to a Meeting on “Strengthening the capacity of Drug Regulatory Authorities in ECSA” (3rd – 4th Sept.). Recommendations from this Meeting were presented to the 2007 Directors Joint Consultative Committee (DJCC) Meeting for upward transmission to the Regional Health Ministers Conference, the top organ of the ECSA HC. • Participated in the 2007 DJCC (4th -7th Sept.), which doubled up as the 1st Regional forum on Best Practices in Health Care. In recognition of the work of the RPF, RPM Plus was requested to introduce the sub-theme “Improving access to Essential medicines”. • Participated in the “East African Regional Medicines Pricing Policy and Proposed Regional Joint Pooled Bulk Procurement of Essential Medicines Workshop” (17th- 19th Sept.). The Report on the Situation analysis and feasibility study on Pooled Procurement of Essential Medicines for EAC” was presented by the 4 partners engaged in the activity. Participants, comprising key stakeholders in the pharmaceutical sector, received and made recommendations on the report. They chose the Group contracting model of pooled procurement and made recommendations to the EAC Council of Ministers for its adoption • Planned for the 4th Meeting of the RPF, scheduled for 30 Sept– 2 October 2007, to review the “Pharmaceutical Strategy 2004 – 2007” and develop one for 2008 – 2010.

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LATIN AMERICA AND CARIBBEAN— AMAZON MALARIA INITIATIVE Overview

The Amazon region began to experience a reemergence of malaria in the early 1990s, including the appearance of Plasmodium falciparum and resistance to inexpensive, first-line antimalarial medicines. In response to increasingly high malaria incidence and treatment failure rates, the U.S. Agency for International Development (USAID) launched the Amazon Malaria Initiative (AMI) in 2001, specifically to address the problems of ineffective control and treatment of malaria in the Amazon Basin countries of Bolivia, Brazil, Colombia, Ecuador, Guyana, Peru, Suriname, and Venezuela. Since then, with the support of AMI, these countries have changed their medicine policies for malaria to include new, more efficacious combination therapies. Strengthening the core elements of pharmaceutical management—including the policy and legal framework, selection, procurement, distribution, use, and managerial support—is essential to the effective implementation of these new policies.

RPM Plus has been AMI’s technical partner for pharmaceutical management since 2002. Other partners include the Pan American Health Organization (PAHO) Division of Disease Prevention and Control, the U.S. Centers for Disease Control and Prevention (CDC), the U.S. Pharmacopeia Drug Quality and Information (USP DQI) Program, national malaria control programs in the Amazon region, and the local USAID Missions. RPM Plus collaborates with these partners and local counterparts to develop and implement strategies to strengthen pharmaceutical management for malaria in the region, particularly related to the new treatment policies.

Since 2002, RPM Plus has developed training materials focusing on how to assess and improve the management of antimalarials; conducted three regional workshops on priority areas in pharmaceutical management; provided country-specific technical assistance to five countries to assess and improve their pharmaceutical supply systems for antimalarial medicines; contributed to AMI’s technical documents and study protocols; participated in annual meetings, regional workshops and dissemination activities; and served on the initiative’s Steering Committee.

FY06 funds are being used to continue providing technical assistance and building the capacity of the AMI country counterparts to improve their pharmaceutical supply systems for malaria and to manage them effectively. The focus in FY06 will be on using the information that countries generated in their pharmaceutical assessments with RPM Plus to plan and implement activities, which will improve the availability and use of malaria medicines and supplies.

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Major activities this Quarter

Senior Program Associate Melissa Thumm left RPM Plus in September 2007; Senior Program Associate Dr. Edgar Barillas will lead the AMI portfolio.

Provide follow-up technical assistance to five Initiative countries to plan and implement activities that will strengthen the availability and use of malaria medicines

RPM Plus began a technical review of Ecuador’s “Good Storage Practices” manual based on information gathered at RPM Plus’ pharmaceutical management workshops. RPM Plus made arrangements for a Peruvian consultant to review and provide comments to the Ecuador MoH.

Develop and translate training materials and conduct a regional workshop on supply chain management for malaria medicines and supplies

The regional supply chain management workshop, which had been tentatively scheduled for September 20-22, 2007 in Lima, Peru was postponed to align the contents and timing with the reviewed strategic plan of AMI. The work shop is tentatively scheduled for the first quarter of 2008.

Collaborate with other Initiative partners on activities related to pharmaceutical management

RPM Plus and USP-DQI continued to collaborate on developing materials and an agenda for a regional drug quality assurance workshop scheduled for September 17-19, 2007 in Lima, Peru. The workshop was postponed until early 2008 to allow PAHO to add its expertise in drug quality in Latin America, and to align the contents and timing with the reviewed strategic plan of AMI.

Participate in annual, steering committee and other regional meetings with Initiative countries and technical partners

In September 2007, RPM Plus participated in the AMI Steering Committee meeting in Washington, DC. At this meeting, participants reviewed technical partners’ and initiative countries’ workplans for the upcoming year. The SC decided to draft a 4 year strategic work plan, to align all countries and partners future activities to shared “end-points”. RPM Plus, PAHO and the USP will draft a proposal for the “drug access and use” thematic area. It is expected this document will be completed in October 2007.

RPM Plus will be in contact with the AMI Regional Coordinator (Roberto Montoya) and well as initiative countries to define technical assistance needs in greater detail; RPM Plus made plans to attend a work-planning session in Brazil in October 2007.

Document and disseminate AMI results, experiences and lessons learned (including external evaluation)

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RPM Plus presented the AMI strategic framework and activities at the SPS Project Launch; attendees included RPM Plus staff and SPS partners and associates.

The RPM Plus AMI webpage is in the process of being edited and approved before being posted online.

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LATIN AMERICA AND CARIBBEAN—SOUTH AMERICAN INFECTIOUS DISEASE INITIATIVE

Overview

Antimicrobial resistance (AMR) is threatening to undermine the advances achieved through priority health programs including tuberculosis, malaria, and HIV/AIDS, by rendering currently available treatments ineffective. AMR is the result of an increased exposure of microorganisms to antimicrobial medicines and the subsequent development of survival mechanisms in these microorganisms. The consequences of AMR include an increase in mortality, morbidity and in the cost of health care worldwide. Among the many factors that influence the development of AMR, the major contributors from a public health perspective are the unnecessary use of antimicrobials for common conditions, the use of inappropriate doses of antimicrobials in cases when they are required, and the proliferation of poor quality or substandard medicines. Health systems contribute to this situation by lacking the proper legal frameworks to ensure the quality and appropriate use of antimicrobials, and by implementing poor managerial mechanisms for proper selection, procurement, distribution and use of these valuable medicines. Physicians, pharmacists and drug vendors contribute to unnecessary use of these drugs by prescribing and selling inappropriate treatments. Likewise, patients experienced with the benefits of antimicrobials tend to self-medicate inappropriately. The implication is that new strategies and more resources for second-line medicines may be needed in the near future for these highly prevalent diseases as conventional treatments fail. An example of AMR of particular concern is multi-drug resistant tuberculosis (MDR-TB). The existence of strains of the TB bacteria that are resistant to multiple medicines traditionally used to treat TB is evidence of AMR in progress. Unfortunately, the prevention and containment of MDR-TB presents additional challenges to health systems because not only are the usual concerns regarding the appropriate use of antimicrobials applicable but because of the lengthy duration of the standard TB treatment (6 months), patient adherence also becomes an important issue. The emergence and spread of MDR-TB has serious implications for a national TB control program: treatment is longer and less effective than treatment of non-resistant tuberculosis and is significantly more costly.

In response to this growing challenge, the USAID Bureau for the Latin America and Caribbean Region (USAID/LAC/SD) has proposed a sub-regional strategy for the Andean countries and Paraguay, called the South American Infectious Disease Initiative or SAIDI. The general objective of this initiative is to contain the emergence and spread of AMR by improving the availability and the use of antimicrobials of assured quality. Thus, the central focus of SAIDI is rational use of antimicrobials and AMR control, with a special emphasis on preventing the emergence of MDR-TB. Since FY04, RPM Plus and the other SAIDI international partners have been working with national counterparts in Bolivia, Peru and Paraguay to create a new, evidence-based and stepwise approach to local solutions for containing AMR. This approach considers the factors contributing to AMR within the context of existing systems and not in isolation, and thereby takes advantage of the interaction among stakeholders. To date, national working AMR working groups have been formed in Peru and Paraguay. These groups, in conjunction with SAIDI international partners, conducted various assessment activities which lead to a holistic local view of the factors contributing to AMR. Currently, international and

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national partners are working together to develop and implement intervention strategies to address these contributing factors.

Major Activities This Quarter

In Peru, RPM Plus continued to support SAIDI activities described in the Peru logical framework : Standard Treatment Guidelines for Respiratory Infections in Children under 5 were reviewed by members of the local APUA chapter and presented to the DISA for distribution; local hospitals’ plans to improve infection control practices were presented and reviewed by DISA-Callao and VIGIA; drug information center (DIC) personnel were trained and additional support materials/equipment were provided; and work to improve the regional warehouse continued. AIS, the organization administering funds for SAIDI Peru communications activities, received their second payment and continued working with the SAIDI communications group to develop materials and plan for the official project launch. A local RPM Plus consultant developed guidelines for the pharmaceutical management of MDR-TB medicines and shared a draft of these guidelines with the National TB Program. The results of the study on the availability of TB medicines in private pharmacies were also discussed with the National TB Program and other local SAIDI partners. Unfortunately, many activities were postponed or delayed due to the earthquake in August 2007.

In Paraguay, RPM Plus continued support of DIC-coordinated trainings in basic pharmaceutical management (with an emphasis on good storage practices) with pharmacists and facility managers in three regions; these trainings will be expanded in the coming quarters. SAIDI Paraguay communications activities continued; RPM Plus supported these activities by providing two computers and printers to hospitals in order to create a regional network to promote rational pharmaceutical management and monitor antimicrobial resistance in Paraguay. RPM Plus Senior Program Associate Edgar Barillas conducted a rapid evaluation of the national procurement system at the request of the Ministry of Health; recommendations and next steps were discussed with government authorities. In August 2007, RPM Plus Program Associate Silas Holland (with a Bolivian consultant) traveled to Paraguay to follow up on SAIDI activities and carry out an assessment of the implementation of individualized TB treatment kits. RPM Plus met with the National TB Program and surveyed 41 regional health centers; a formal report will be developed in October 2007.

In Bolivia, an RPM Plus consultant completed an assessment of the pharmaceutical management of 1st-line TB medicines at the facility level in Santa Cruz and coordinated a Training of Trainers with regional TB nurses to implement the individualized TB treatment kits strategy. In August 2007, RPM Plus traveled to Bolivia to follow up on these activities and participate in a CDC course on MDR-TB.

Regionally, RPM Plus supported the participation of 60 Peruvian and Paraguayan pharmacists in a virtual course on pharmaceutical management. RPM Plus continued to coordinate the Cochrane course on critical analysis. RPM Plus also collected SAIDI products from partners and participated in the Steering Committee Meeting in August 2007; partners shared their workplans for the upcoming year and discussed SAIDI short-, mid-, and long-term goals/objectives.

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RPM Plus Senior Program Associate Beth Yeager reviewed the Infection Control Assessment Tool (ICAT), assisted in translating it into Spanish, and continued planning for a workshop in December 2007 with 3-4 hospitals in Guatemala to implement the activity.

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Latin America and Caribbean—Tuberculosis

Overview

Since FY03, RPM Plus has provided technical assistance on TB Pharmaceutical Management to prioritized countries in LAC. With FY04 USAID LAC Bureau resources RPM Plus adapted, translated and disseminated TB Pharmaceutical Management Guidelines, and provided technical assistance to the NTP in Ecuador and Paraguay. Remaining FY04 resources (US$ 7,000.00) will be used to respond to specific requests from both countries.

Major Activities this Quarter

The remaining pipeline for this portfolio was planed to be used to support RPM Plus participation in the Regional TB Managers Meeting (Lima, Peru August 22 – 25). The meeting was re-scheduled to December 2007 because of the earthquake Pisco, Peru.

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Malaria Action Coalition (MAC)

Overview

Access to early and effective therapies for appropriate case management of malaria and the effective provision of intermittent preventive therapy (IPT) to women during pregnancy are fundamental to achieving substantial reductions in mortality and morbidity due to malaria. Effective case management for malaria requires that populations at risk seek, obtain, and properly use effective antimalarials. This is dependant on the timely accessibility of high quality, effective pharmaceuticals in the appropriate formulations and amounts and the appropriate use of these pharmaceuticals according to a correct regimen.

The burden of malaria has been intensified by the appearance of Chloroquine and sulfadoxine pyrimethamine-resistant Plasmodium falciparum forcing countries to change their first line therapies for malaria. To address this challenge, the World Health Organization (WHO) recommended that all countries, revising their first-line treatment policies for malaria, should opt for a combination treatment preferably an Artemisinin-based Combination Therapy (ACT)2. In accordance with this recommendation, the Global Fund for HIV, TB and Malaria (GF) has urged countries that have obtained grants for malaria and recommending treatments other than ACTs to reprogram their funds to accommodate ACTs, which requires a more systematic approach to antimalarial pharmaceutical supply and use. As countries continue to receive GF awards for ACTs, the increased volume of antimalarial pharmaceuticals will place more pressure on pharmaceutical systems to ensure their proper management and use than the use of Chloroquine did. ACT pharmaceutical management challenge is even greater as these products have a two year shelve life, they are ten times more expensive than Chloroquine and the manufacturers’ production capabilities are progressively being developed to meet the demand and the GMP requirements.

Given the current context of malaria in Africa, the Malaria Action Coalition (MAC)3 underwent a strategic reorientation in 2004, placing a greater focus on technical assistance related to ACT policy design and implementation in order to effectively respond to these changes. In addition, MAC interventions have been divided into two separate but complementary components 1) Malaria in pregnancy, and 2) malaria case management where RPM Plus is focusing its technical assistance.

Officially USAID has ended MAC; however, at country level some missions still have remaining funds as well as a small amount of core funding that can be utilized for the same IRs. The RPM Plus Malaria MAC portfolio has been developed as a result of a joint work plan among the MAC partners and the work plan reflects activities exclusively planned under the MAC “core” funds (1.1 million).

2 WHO (2004). Position of WHO's Roll Back Malaria Department on malaria treatment policy 3 The MAC is a partnership among; The Centers for Disease Control and Prevention, the MSH/Rational Pharmaceutical Management-Plus Program, the JHPIEGO/ACCESS Program, and the World Health Organization (both Geneva and AFRO offices)

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Major Activities This Quarter

• Continued to support MAC partner coordination through conference calls and sharing of documents produced by partners. Also a draft of the MAC ( 2002-2007) final report was developed and sent to partners for inputs and comments • Continued with developing of the M&E guide for pharmaceutical management aspects of ACT policy implementation. The documents will be field tested in one country in the coming year • Finalized and disseminated the GFATM case studies reports including a synthesis of the case studies, a summary report, individual country reports and a discussion paper for the GFATM to consider in their dialogue with recipient countries. RPM Plus traveled to Geneva to discuss the studies with GFATM • RPM Plus organized with the PMI team a technical meeting in Washington on severe malaria medicine quantification, including the review of product specifications, quantification methods and available data and studies for the adoption of consistent quantification approaches among PMI countries • A malaria team meeting was organized with RPM Plus malaria team members based in Sudan, Senegal, Kenya, Tanzania, Washington, DRC and Uganda to orient the new members on relevant malaria experiences, approaches and tools in the evolving context of ACT implementation at the global, regional and country levels. • As a co chair of the PSMWG, RPM Plus participated in RBM Work plan harmonization meeting in Geneva. RPM Plus also participated in the ACT subsidy task force meeting and presented at the implementers meeting in Geneva. RPM Plus continues to support the PSMWG. • Supported the preparation and chaired the NMCP Best Practice Sharing Workshop held in Kenya. 17 African countries implementing artemether-lumefantrine as first line ACT were represented. Aside from sharing best practices, countries developed a checklist for ensuring efficient distribution, inventory management and ACT tracking. RPM Plus strategies and achievements were acknowledged at the meeting, as part of country strategies and achievements.

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West Africa Regional Program (WARP)

Overview

Generic pharmaceutical management (PM) training materials were developed by CPM for two regional training institutons Institut Regional de Santé Publique (IRSP)/Benin and Centre Africain d'Etudes Superieures en Gestion (CESAG)/Senegal, for use in the two institutions. The target audience for this material is pharmacists, doctors, and health managers who are students undergoing postgraduate health management studies at these regional institutions. During the review and testing of the draft PM training material, CESAG and IRSP expressed the need for training trainers who will use the PM training materials to teach the course in the two institutions. This request was included in the RPM Plus 2007 work plan that was submitted to USAID/WA. MSH/RPM Plus was then mandated by USAID/WA to organize a Training of Trainers for the two institutions

USAID/WA has agreed to support Global Fund activities in Guinea through the RPM Plus project. During the current year, RPM Plus has also budgeted for country level support activities that can be drawn upon for this type of activity. RPM Plus and the Leadership Management and Sustainability (LMS) Project proposed a methodology whereby the LMS team will be working closely to examine the operation of the CCM in Guinea and to identify areas for CCM strengthening. In the same way, RPM Plus will examine the in-country procurement and supply system and develop appropriate recommendations to strengthen Global Fund Programs.

Major Activities This Quarter

RPM Plus carried out an assessment of pharmaceutical supply management of three Global Fund programs HIV/AIDS, TB and Malaria in Guinea Conakry. The assessment took place from July 16 to July 27, 2007. Overall, the assessment revealed that implementation of the three GF programs in Guinea was affected by the absence of very basic instruments and mechanisms necessary to support effective pharmaceutical supply management. Gaps identified and appropriate interventions to close those gaps are described in the assessment report.

The RPM Plus/WA planning meeting took place on September 20, 2007. The objectives of the meeting were to develop a technical multi-year approach/strategy for work in West Africa that supports USAID/WA’s strategy for the region, develop a framework/basis for the FY 2007 work plan and to discuss specific country strategies based on current technical information, pipeline, and technical resources. The strategy for West Africa in 2007 and subsequent years will be to capacitate regional organizations and training institutions such as WAHO, ACAME, CESAG and IRSP. The West Africa regional technical resource collaboration (W/RTRC) initiative shall be integrated into the overall strategy for the sub region. Leveraging country-specific funds where available and exploring opportunities for coordination with the Malaria and MCH teams, and other MSH projects such as Global Fund Technical Support project shall be pursued to create synergy. The FY07 work plan shall focus on capacity building with the goal of increasing

Regional Programs 35 RPM Plus Activities and Products Status Report capacity of local institutions and networks to provide pharmaceutical management technical assistance.

Regional Programs 36 RPM Plus Activities and Products Status Report

COUNTRY PROGRAMS

ALBANIA Overview

RPM Plus Program activities in Albania started in 2001 with a reconnaissance visit to design a program of activities. The areas of work proposed included: (1) improving provision of drugs used in hospitals; (2) creating and implementing Standard Treatment Guidelines for general practitioners; and (3) improving the system of drug subsidies for ambulatory patients. After initial appraisal with USAID, RPM Plus decided to concentrate on improvement of drug use for general practitioners. It was decided that a Drug of Choice (DoC) list should be developed to improve prescribing practice. The DoC list should complement Clinical Practice Guidelines (CPG) being developed with USAID funding by the PHR Plus program of Apt Associates Inc, but there was limited interest at the time [2001-2005] in drug procurement and treatment guidelines, and uncertainty whether the timing was right to continue until more progress had been made in primary health care and related health financing reforms. There was also confusion on how the DoC list would fit together with the CPG prepared by PHR Plus. RPM Plus revisited Albania in 2006 to assess how remaining funds could best be spent to improve pharmaceutical management in Albania. Building on USAID funded work it appeared most effective to support the development of a national appraisal system that will adapt existing Clinical Practice Guidelines for the use at national level. With a change in leadership at the MOH and with the World Bank also providing funding for the development of an appraisal system, USAID suggested to shift the emphasis of RPM Plus activities.

Major Activities this Quarter

In July 2007 a MSH consultant visited Albania to explore how MSH could collaborate with URC/PRO Shëndetit to improve the rational use of medicines in the community while focussing on the capacity of nurses. This exploratory trip was conducted from July 1-6, 2007, and at the end the RPM Plus consultant, URC/PRO Shëndetit, and USAID, Albania, agreed, that RPM Plus work should support the development of training sessions for the Continuing Medical Education of nurses working at Primary Health Care level in the five prefectures supported by the URC/PRO Shëndetit program with USAID funding.

After the summer break a list of CME training sessions was agreed between URC/PRO Shëndetit and the Tirana Medical University Faculty of Nursing. Five training sessions were earmarked to be developed by MSH.

MSH has drafted a session outline for all five selected CME sessions which shall be used to develop the respective training materials.

Next steps: The next step is for RPM Plus to contract a lecturer from the Tirana Faculty of Nursing to prepare CME training materials according to the session outline prepared by MSH.

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ANGOLA—PMI Overview

In August 2005 USAID/PMI conducted an initial assessment to identify appropriate areas for PMI investment in Angola. An important consideration was the Global Fund grant obtained by Angola to support the national malaria control program and procure 1.1 million ACTs. The treatments were distributed in 9 of the 18 provinces in Angola but preparations to appropriately receive, distribute, manage and use the ACTs at the health facility level and in the distribution system were not completed. In light of this, RPM Plus was solicited to improve the ACT implementation and recommended the integration of ACT management into the Essential Drug Program (EDP) system with the subsequent adaptation of their procedures and tools to train the health agents. RPM Plus also developed a draft ACT distribution plan and proposed strategic approaches to finalize the plan with PMI partners, including a coordinated procurement and distribution system, the consolidation of the pharmaceutical information system and support to Angomedica.

Major Activities This Quarter

• MSH/RPM Plus consultant traveled to Angola to provide technical assistance to National Essential Medicine Program (PNME) training on essential medicine procedures. He provided inputs to facilitators to ensure that the training materials are appropriately used and that correct and consistent messages on pharmaceutical management are given to participant attending the trainings through out the country. He also visited three health centers where staffs were trained on the ACT management procedures to verify if the National Malaria Control Program (PNCM) and PNME information management forms and procedures are being followed as presented during previous trainings. • The consultant also collaborated with PMI, PNMC, and PNME, WHO, UNDP and partners to update the ACT quantities needed for all targeted health facilities. • Work is ongoing to revise training materials on the kit system procedures for the European Union and the National Essential Medicine Program (PNME) • Provided inputs to the PMI / Angola news letter prepared by the Centers for Disease Control ( CDC)

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ARMENIA Overview

RPM Plus received FY05 Armenia Mission funds to support technical activities in pharmaceutical management. Upon completion of a rapid assessment of the pharmaceutical system in Armenia carried out by RPM Plus team, three streams of activities were proposed for RPM Plus support. These included improving prescribing practices for key PHC and Family Medicine diagnoses/conditions, analyzing the availability of essential medicines for selected standard treatment guidelines (STGs) and their costs, and exploring alternative supply chain strategies for the Basic Benefits Package (BBP). To analyze the options for improving pharmaceutical supply and use of medicines in PHC, baseline data of current practices and costs were collected in 2006, in collaboration with local institutions. On November 21, 2006, RPM Plus carried out a workshop with main stakeholders (policy makers, including MOH, SCDMTE, SHA; local providers, international organizations, local departments of health and Yerevan Municipal health department etc) to validate the findings from the study and obtain feedback from main stakeholders. RPM Plus prepared a technical report, based on the findings and the feedback received during the workshop, that outlines the way forward to improve pharmaceutical management system. In February-March 2007, RPM Plus team met with local stakeholders to discuss the RPM Plus recommendations and coordinate next steps. Based on a series of discussions with the key stakeholders (USAID, MOH, PHCR, NOVA, WHO, World Bank, YSMU and NIH), a decision was made to carry out two workshops, to disseminate the results of the study and RPM Plus technical report (one for the NIH, and the other – for a larger stakeholder group) and provide a training on Rational Drug Use in July 2007. Various local stakeholders advised to hold these events in the end of June or in July.

Major Activities This Quarter

During this quarter, RPM Plus carried out the following activities: 1. Conducted two one-day workshops, “Supply and Use of Medicines for PHC in Armenia”, to continue dissemination of the RPM Plus technical report. First workshop was organized for experts from the National Institute for Health (NIH) and was held on July 27, 2007. The participants included 27 experts from clinical departments, Department for Normative Documents Development, Pharmacy Department, and senior management team. The NIH provided a conference room and equipment. Second workshop was carried out for a larger stakeholder audience on August 1, 2007. The participants, a total of 37, included MOH officials, SHA,, YSMU, SCDMTE, USAID partners (PHCR, World Vision), marz health authorities and USAID team. RPM Plus team presented key results of the analysis of supply chain costs and findings from the study of prescribing practices, discussed cost implications of current practices and use of modeling for the health services planning, and provided recommendations to improve pharmaceutical management practices. During the second workshop, Professor Ushkalova, former USP Program Coordinator for Russia, shared the results and lessons from DTC implementation in various oblasts in Russia that demonstrated the effectiveness of DTCs in light of improvements in quality of care and reductions in costs. 2. To develop local capacity in understanding and addressing drug use issues, RPM Plus carried out a Training of Trainers (TOT) on Rational Use of Medicines on July 16-20, 2007. The training participants included 27 experts from YSMU, NIH, SHA, AUA, SCDMTE, and a group

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of recommended by PHCR physicians, who serve as preceptors for family physicians at PHC facilities. The 5-day course covered the following topics: formulary management, drug use problems, learning about irrational drug use (quantitative and qualitative methods, indicator studies, ABC/VEN analysis); evaluating drug use; strategies, including STGs, to address and improve drug use; and sessions on TOT and Drug and Therapeutics Committee (DTCs). The course was based on the materials from two international courses, Drug and Therapeutics Committee TOT course developed by RPM Plus in collaboration with the WHO and Promoting Rational Drug Use (PRDU) course developed by WHO and International Network of Rational Use of Drugs (INRUD). The course materials were revised, updated, adapted for Armenia context, and translated into Armenian. The participants practiced new skills during the practicum, working with the data sets. The participants were provided with RPM Plus technical report, visual aids, additional reference materials, and a manual “Drug and Therapeutics Committee: A Practical Guide” developed by WHO in collaboration with RPM Plus/MSH, as well as CDs with the training materials and reference sources.

Next steps RPM Plus is planning to continue its activities aimed to develop local capacity in understanding and addressing use of medicines, specifically provide a follow up technical assistance for the participants of the TOT on RDU that was carried out on July 16-20, 2007. Based on previous meetings with the management of the NIH and YSMU, it is anticipated that the course materials will be incorporated in the training programs offered by these institutions. The training participants confirmed their interest in including the course materials in the training programs of their respective institutions, which will allow for institutionalizing new knowledge and building local capacity in addressing drug use issues. RPM Plus can provide initial technical assistance, guidance, and feedback for these participants as well as provide TA for those trainees, who are planning to implement new methods, such as ABC/VEN analysis, and DUE. RPM Plus will follow up with the trainees, in order to identify TA needs and plan future activities in the country.

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BRAZIL Overview

WHO ranks Brazil among the 22 highest burden countries for tuberculosis (TB) in the world. Brazil’s national TB program estimates that it has approximately 110,000 cases annually with 3,000 TB patients dying each year. In 1995 the Government of Brazil (GOB) moved TB control back to the federal level and established the currently existing Program for the Control of Tuberculosis (PCT). In early 2003 as part of its TB management reform, the GOB appointed the Hélio Fraga TB Reference Center (Helio Fraga TB Center) as the matrix for controlling the quality of TB diagnostics and treatment in the GOB’s national Single Health System (Sistema Única de Saúde). Overall, the Helio Fraga TB Center is responsible for developing, analyzing and transferring technologies to combat TB in the country and to monitor the approximately 1,300 cases of multi-drug resistant TB (MDR-TB).

RPM Plus has identified two technical objectives which are key to meeting the challenge of strengthening local TB drug management capacity:

1. Objective 1: Improve the appropriate use of TB drug regimens 2. Objective 2: Strengthen the national TB control program

Major Activities This Quarter

TB and MDR-TB experts met in September in São Paulo with the Brazilian Society of Pneumology and Tysiology to discuss the agenda for defining the needed updates of the national TB guidelines and to harmonize the edition of these guidelines with official norms of the MoH for TB. The issue of the needed changes in the re-treatment scheme was addressed and there is a consensus reached on suppression of the first R1 re-treatment regimen (2RHZE/4RHE).

RPM Plus met with the new NTP coordinators: the next workplan for FY07 was approved, with a special emphasis on the need for the TB program to address the re-treatment regimens changes as a priority.

RPM Plus met with the technical expert group in charge of developing a scope of South-to-South collaboration in TB area for pharmaceutical related issues. Final report from the TB meeting held in October 2006 in South Africa was officially endorsed by the three participating countries.

After an extensive work on raw material characterization, Farmanguinhos acquired quality assured rifampicin salts from a certified supplier to initiate fabrication of the pilot batch of 2 in 1 tablets FDC of rifampicin and isoniazid. Farmanguinhos also developed a new formulation on sachets for the 3 in 1 FDC –adult form.

RPM Plus provided technical assistance to NTP and MoH / SVS to evaluate potential use of sachets for adults TB treatment. RPM Plus also provided some support for the implementation of

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capillary electrophoresis methodology at Farmanguinhos and INCQS to allow expanded testing of drug samples.

RPM Plus consultant with a specialty in laboratories continues to work with the new reference laboratory at Helio Fraga and National Institute for Quality Control with the following accomplishments this quarter: finalized process of development of technical SOPs for the Quality Manual;prepared a personnel training in biosafety issues; assisted laboratory during process of an external audit.

A training course on ISO IEC 17025 Norm for drug quality testing was held in August 2007 at the Public Health Laboratory of Amapa state, in partnership with INCQS.

Quality control testing program for TB drugs is awaiting further definition from Anvisa to start a new round. NTP requested assistance to RPM Plus for testing the new batches of first line TB drugs recently procured: information on how to carry out the process and interaction with INCQS was provided.

For the work in expanding DMIS surveillance system for managing MDR-TB patients, RPM Plus consultants contributed to validate data entered electronically to the DMIS from state MDR- TB reference centers level. Now, all modules of the MDR-TB case management system have been validated, while some new functionalities recently developed for data analysis and drug management are still on a validation process. RPM Plus consultants also extracted data from the electronic DMIS database and contributed to format a MDRTB surveillance bulletin (descritptive data). The current validated functions of DMIS are being used to extract epidemiological information (reports, tables and graphics) to be employed in trainings and conferences, and also to be further used by the MoH for MDRTB surveillance and further published in national scientific bulletins. A training was conducted in Bahia State MDRTB Reference Centers to review to increase capacity building on system procedures and flows, and to review the MDRTB medical charts in order to update the patient information and available data in the DMIS database. New trainings are being planned for November and December 2007 to cover all the country using the same methodology. Alongside these activities, the System User Manual has been updated and the case control module was retested and validated during the pilot training carried out in Bahia State. RPM Plus consultants have been assisting the firm contracted by CRPHF which scope of work is to develop a specific web site to host the DMIS.

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DOMINICAN REPUBLIC Overview

The Dominican Republic (DR) National TB Program (NTP) is currently receiving support from the USAID Mission in Santo Domingo to expand the implementation of the WHO-supported strategy Directly Observed Treatment Short Course (DOTS). One of the main pillars for the success of DOTS is to ensure the continuous supply of quality medicines and pharmaceutical supplies for TB and their appropriate use according to standardized treatment regimens.

With USAID DR funds, the Management Sciences for Health Rational Pharmaceutical Management Plus (RPM Plus) Program is currently providing technical assistance to the NTP in DR to strengthen the Pharmaceutical Management Information System (PMIS), and to introduce fixed dose combinations (FDC).

Major Activities this Quarter

RPM Plus visited Dominican Republic from July 16th to 20th to facilitate a training workshop on the management and use of fixed dose combinations medicines. Thirty seven managers from 19 provinces, and the central level participated in the workshop that was held in the V Centenario Hotel on July 18th. The modality used was a training of trainers, so the participants were instructed in strategies to replicate the training and provided with educational materials.

RPM Plus estimated the availability of TB medicines, based on information produced by the Drug Management Information System and data collected from the central medical store. For all medicines, with the exception of Rifampicin, there is enough working and security stock for more than 12 months. The next procurement to the GDF should be planned early next year. RPM Plus will assist the NTP in the estimation of needs.

The second shipment of FDC, to cover 50% of the cases, arrived on the third week of July; immediately after the workshop.

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HONDURAS Overview

RPM Plus has been providing technical assistance to the TB control program in Honduras since 2001. During that year, RPM Plus trained regional TB coordinators in data collection for TB medicine availability and inventory management. In October 2003 RPM Plus organized a regional training course in Tegucigalpa on Managing Medicines and Pharmaceutical Supplies for Tuberculosis; two managers from the Honduras National Tuberculosis Program (NTP) participated in the course. Honduras professionals also participated in a workshop on Pharmaceutical Management for Multi-Drug Resistant TB, held in Mexico in May 2004. During the rest of 2004 and 2005, activities were on hold due to the tragic death of the NTP manager and conflicting agendas with the new NTP administration. In 2006, the NTP requested that RPM Plus support pharmaceutical management at the peripheral level by organizing a workshop specifically designed for local managers responsible for warehousing, transportation and inventory control. This workshop, Distribution of Medicines and Pharmaceutical Supplies, was co-financed by the GFATM and USAID Mission resources and took place in Tegucigalpa on March 14 – 16, 2006.

Using remaining resources from FY01, one participant from Honduras attended a regional workshop on TB Pharmaceutical Management (San Jose, Costa Rica, June 5-7, 2007) that emphasized procurement and the use of fixed dose combinations (FDC). As a result of that meeting, the NTP manager requested that RPM Plus analyze the current situation related to TB pharmaceutical management in Honduras and provide TA on the feasibility for the introduction of fixed dose combination medicines.

Major Activities this Quarter

RPM Plus visited Tegucigalpa from September 17-21 to analyze and discuss with local counterparts the situation of TB pharmaceutical management, the feasibility of the introduction of fixed dose combinations and the implementation of alternative mechanisms to procure TB pharmaceuticals and commodities. By the end of the visit RPM Plus discussed with the TB manager and staff the main findings of the rapid assessments and alternatives to improve the programming and information systems.

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KENYA—Kemsa & Public Sector

Overview The Kenya Medical Supplies Agency (KEMSA) is a state corporation that was established and mandated by Legal notice to operate a commercial service for procurement and sale of high quality drugs and medical supplies while providing a secure source of drugs and medical supplies to Public health institutions, and advising health management boards and general public on matters relating to procurement, cost effectiveness and rational use of drugs and other medical supplies. To date, KEMSA has not fully realized its mandate owing to a myriad of constraints such as lack of funds to develop requisite systems, inadequate physical facilities, existence of parallel procurement systems owing to the presence of vertical MoH programs with different financial and information inflows, etc. To its credit, KEMSA has been able to successfully undertake several reform initiatives including the appointment of an independent board, development of a business plan, etc. These modest gains made by KEMSA provide fertile ground for further improvements.

MSH/RPM Plus technical assistance would aim at capitalizing on these gains as it works collaboratively with KEMSA and selected MoH Divisions that manage vertical/parallel programs to strengthen commodity management systems assist them realize the MoH objective of making quality medicines available in a timely manner.

Major Activities This Quarter

Support for the use of pharmaceutical/logistics information system (P/LMIS) • RPM Plus continued to support the use of the P/LMIS by the MoH divisions in commodity re-supply decisions. • Three MoH divisional staff recently posted to the LMU were oriented on the Logistics Information system concept. Data & Information processing Standard Operating Procedures (SOPs) were finalized and implemented at the LMU. Personnel at the LMU underwent training on Excel as the standard data analysis package using data imported from the LMIS. • The initial draft of the Commodity Logistics & LMIS Concepts training materials for LMIS program managers, decision-makers and users was developed and are undergoing peer review. Provision of focused / targeted technical assistance to strengthen capacity for effective commodity management in KEMSA and various MoH divisions • RPM Plus supported NASCOP pharmaceutical staff to develop Guidelines on Decentralization of Commodity management. • As part of the ART decentralization initiative, the results of the Baseline Assessment of 21 ART Central sites were presented to the pharmaceutical staff from NASCOP ART program. The assessment served to identify the gaps in commodity management and formulate the strategic options for improving the commodity management at the district level.

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• The draft Integrated Commodity Management Curriculum was developed, followed by an internal peer review of the curriculum. The curriculum was finalized and used as a resource material for the DRH Trainer’s manual for RH commodity management. • RPM Plus continued to provide support for the MoH divisions to improve communication and reporting by MoH staff in the health facilities to the central level by providing staff with mobile airtime and courier services.

Provide TA and support to the development/strengthening and implementation of harmonized Commodity Management M&E system and tools • RPM Plus worked collaboratively with MoH divisions to sustain availability of existing commodity management tools. • DRH commodity reporting tools were printed and have been distributed to the health facilities. The regional disseminations are planned for the next quarter. • RPM Plus prepared a DRH commodity stock report showing stock receipts, distribution, stock status and consumption of RH commodities.

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KENYA—PEPFAR Overview

The President’s Emergency Plan for AIDS Relief (Emergency Plan) was started in 2003 and emphasizes prevention of HIV infection, care for HIV-infected individuals and AIDS orphans and treatment of HIV-infected people through provision of antiretroviral drugs on a large scale in the poorest, most afflicted countries. The Emergency Plan identified fourteen priority countries which have the highest prevalence of HIV infection and account for nearly 20 million HIV- infected men, women and children. Kenya is one of these priority countries. MSH/RPM Plus is among the partners that were assigned the task of implementing the plan

Under COP 2006, RPM Plus continues to work with USG PEPFAR Team, Ministry of Health(MOH)/NASCOP, MOH/NPHLS, MOH/Department of Pharmaceutical Services, NGOs, Private sector, and other ART implementation partners to strengthen the commodity management system with an aim of improving access to , and use of health commodities for the treatment and care of those affected by HIV/AIDS.

Major Activities This Quarter

Support to PEPFAR Supply Chain Management RPM Plus worked collaboratively with NASCOP, MEDS and the Inter-agency team in ensuring that the ARV drugs were distributed to PEPFAR supported sites for over 82,000 patients in 283 sites. Additionally 301 PMTCT sites receive ARVs with the assistance of RPM Plus. RPM Plus supported MEDS in coordinating distribution of Clinton Foundation-procured pediatric ARV drugs to sites, and in the quantification for procurement of additional pediatric ARV drugs.

Support to NASCOP, ART Programs and Division of Pharmacy In support of NASCOP, MSH/RPM Plus supported development of commodity management protocols for decentralization of ART services nationally. Secondly, 9 job aids and 12 standard operating procedures for ART commodity management previously developed by RPM Plus were identified and adapted nationally. RPM Plus supported training of health care workers in collaboration with ART partners as follows: • A total of 56 health care workers from 34 ART sites were trained on ART commodity management, • 28 from 24 sites were trained in training skills, • 21 staff from 13 sites received training on principles of supportive supervision for ART commodity management • 26 staff from 17 sites were trained on implementation and use of the ART dispensing tool. • In support of Division of Pharmacy, RPM Plus conducted a 2nd training session for HIV/AIDS Practitioners in private and community settings on Rational Drug use, in

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Mombasa in which 54 practitioners (doctors, pharmacists, nurses, clinical officers and pharmaceutical technologists) participated.

Strengthening of laboratory systems at national and site level to support ART services: RPM Plus continued to provide TA to strengthen laboratory services in support of ART as follows; In collaboration with NPHLS, KEMRI, UoN, and Beckton & Dickson, trained 29 laboratory technologists on CD4 Enumeration from 21 ART sites and the KEMRI HIV and ART labs, Continued to pilot- testing the use of the Lab Electronic tool in 2 facilities in Nairobi, MSH continued to field test the MTP approach in selected facilities and document lessons learned to support scale up of these efforts in the country. The MTP approach is hampered by attrition of staff, especially those who had learned and become champions of applying good commodity management practices, Trained 21 personnel from NPHLS and 6 ART sites and 1 warehouse on commodity management practices. Provided technical leadership and logistic support in the design, editing, review, and finalization of the lab tests and commodity usage tools in readiness for field testing in response to NPHLS’s strategic objective to capture, and track lab information for accurate quantification and forecasting of needs.

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KENYA – PMI Overview

RPM Plus with support from the USAID mission has been supporting the Division of Malaria Control through the process of implementing the new antimalarial policy and has been working with the DOMC to establish robust but practical M&E systems that will ensure that the limited resources it invests in malaria prevention and treatment are used in the most cost-efficient, effective and equitable way. With FY06 funding provided by the USAID Kenya mission, RPM Plus will continue to provide support to the Division of Malaria Control in the early diagnosis and prompt treatment of malaria using effective medicines while achieving RPM Plus technical objectives on how to improve the supply and quality of antimalarials and related supplies and improve the management and use of antimalarials.

Major Activities This Quarter

• Developed a draft RPM Plus Kenya Malaria FY 07 work plan, in close consultation with the Kenya DOMC and USAID/Kenya. Continued with weekly and biweekly coordination meetings • Provided financial and technical support in special Malaria Inter-agency Coordination Committee (MICC) meetings where the Malaria Business Plan was finalized and revised versions of the plan under different themes were consolidated. • RPM Plus provided technical and financial support for a half-day Research Technical Working Group meeting to discuss how at least two sites for monitoring insecticide resistance and two for monitoring efficacy of first and second-line antimalarial drugs will be established. The RTWG met again in September to finalize/harmonize the pre-IRS reports and to draft proposals for post IRS evaluation in the eight districts chosen for the exercise. • Support was also provided to the M&E Technical Working Group meeting. The meeting was convened to provide an update on the MIS, the MIAS and addressing challenges in collecting routine malaria-related information. The interim MIAS system will be used to provide feedback in preparing the requirements of the main MIAS system. In this regard, DOMC staffs have been trained in Microsoft Office applications as well as in the use of the interim system. In addition, new database reporting formats were created to enable further reporting required for GF Round 4 Phase 1. • Participated in the interim Report Meeting on the Malaria Indicator Survey (MIS). The DOMC shared with stakeholder’s preliminary results. The data set is currently being weighted and cleaned by the Centers for Disease Control and Prevention (CDC) and the Kenya National Bureau Statistics (KNBS). • RPM Plus supported the DOMC in launching the Malaria Interventions Impact report by developing a policy brief, Power Point presentations and the drafting of a press release. The report was launched by the Minister for Health; USAID was represented by Dr. Mike Strong who acknowledged MSH’s efforts. • The Kenya malaria team held discussions with Kathy Webb on developing a guide and tools for monitoring progress in ACT policy implementation

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• Supported the monitoring and documentation of AL availability in public health facilities in Kenya 6 months after the start of implementation. Following the completion of data entry and analysis, report writing is ongoing. • Assisted the DOMC in developing its website in close collaboration with website design partners. There is a demo website which is in operation and available to the DOMC for feedback on changes that need to be made on website content and style. The website is expected to be launched in October. • Facilitated collecting data for the development of the 2006 Malaria Program annual Report. Also facilitated the transfer of DOMC’s Internet and Email access services to new providers. • Supported the creation of linkages between the Pharmacy & Poisons Board (PPB), DOMC and international agencies to better combat fake antimalarial drugs in the market. RPM Plus also provided a DVD for the DOMC head to provide background information in meetings with the press. • Designed a questionnaire that will be used to collect data for developing a Malaria stakeholders database and recruited two research assistants to collect data • Hosted a quantification workshop to determine antimalarial drug quantities for the 2nd year of ACT policy implementation. Present were the DOMC, WHO EDM representative, the Kenya Medical Supplies Agency, the Mission for Essential Drugs and Supplies, JSI/Deliver and RPM Plus. A report of the workshop is under development • RPM Plus supported the DOMC in the collation of national malaria control data requested by the Global Malaria Programme. This data will feed into the WHO’s World Malaria Report 2007. • Participated in the Afrihealth 2007 Conference together with one DOMC staff. The conference was the first on ICT in Health to be held in Kenya. • Participated in DOMC M&E meetings to discuss global fund reporting, MIS survey, MIAS and monitoring of distribution of nets in the new ITN distribution campaign. Other meetings include; pharmacovigilance meetings and HMIS meeting to discuss the issue of the new registers rollout to facilities countrywide in view of the urgent need to capture data on ITN distribution at that level. The HMIS head agreed to include columns to the existing registers to enable capturing of the relevant indicator. Community access meeting that was held to discuss a minimum set of indicators to be used in evaluating the success of pilot projects intended to expand access to antimalarial medicines at the community level. RPM Plus was asked to contribute to developing the indicators related to medicines availability and management at non-facility outlets such as general retail shops. Attended Antimalarial Survey Meeting held to discuss progress on report writing for this activity. The DOMC and the PPB with WHO support commissioned a survey of antimalarial availability and quality in 2006. The DOMC faced a number of hurdles in preparing the report, from ensuring the quality of the data to what indicators to use in the final analysis. During this meeting, RPM Plus recommended data to be re-entered and also developed dummy tables to be used in the analysis and final write up

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LESOTHO Overview

The Regional HIV/AIDS program (RHAP) works in 10 countries in the southern region of Africa including five President’s Emergency Plan for AIDS Relief focus countries and five non- focus countries. The program has special focus in non-presence countries such as Lesotho and Swaziland which have HIV prevalence rates among the highest in the world. In these two countries, the program aims at increasing access to the full package of prevention, treatment, care and support activities necessary to accomplish the goals outlined in the Emergency Plan.

Following previous year’s funding, RPM Plus uses allocated RHAP FY06 to continue improving and strengthening medicine and commodity supply systems in support of the scale-up of HIV/AIDS programs in Lesotho. Through this, it aims to address some of Lesotho’s immediate health challenges, including HIV and AIDS, TB, child health, and primary health care services. RPM Plus works collaboratively with the Ministry of Health and Social Welfare (MOHSW) by offering technical assistance, training, the development of tools and the implementation thereof.

Major Activities This Quarter

During this quarter, RPM Plus attended the M & E training held on August 8 and 10 for USG partners as well as the USG Partners meeting held on 27th of August. The program presented its activities at the PEPFAR Partners’ meeting held with Ministry of Health & Social Welfare (MOHSW) on September 5th. During the COP08 target setting meeting of September 19, the plan for COP08 was initiated and ultimately submitted to the USG team. Also during this period, interviews were conducted with prospective candidates for a Senior Program Associate (SPA)/Lesotho position as RPM Plus will be opening a permanent office in Lesotho.

The USG team proposed an assessment for pharmaceutical and laboratory commodities in Lesotho. The assessment will be jointly carried out by RPM Plus/SA and SCMS/DC. The terms of reference were developed, submitted and approved. Field work for this assessment is scheduled to begin October 22md for two weeks.

The completed questionnaires for the baseline assessment were collected from counterparts as they have just completed the data collection process. The process for data compilation and analysis will now be initiated. Meanwhile, a request was received from the National Drug Services Organisation (NDSO) to provide them with TA in support to the development of their Strategic Plan and Performance Management System.

The quantification tool that is in use in Lesotho was updated, and now includes quantification for the treatment of pregnant women affected by AIDS. Training on quantification was conducted on July 19. It was carried out by the local partner already trained by RPM Plus and using the quantification tool developed also by RPM Plus (32 people trained).

In addition, in support to the implementation of the National ART program, a series of trainings were conducted for pharmacy personnel working at ART sites. These trainings included:

• HIV/AIDS pharmaceutical training - August 13-16, 2007 (33 participants). • Quantification training - August 21, 2007 (32 people participants). • Drug supply management training - August 22-23, 2007 (31 participants)

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A Therapeutic Committee workshop was held in the Berea district from July 11-13, 2007. The workshop was attended by seven (7) participants. As a result, a work plan for therapeutic committee activities was developed by the participants. The report of the workshop is now available.

On the other hand, an Rx Solution training workshop was held on August 20 in Maseru for 32 participants (users). Also during this period, Rx Solution was installed on 20 computers representing four ART sites and the National office. Participants were given the opportunity to familiarize themselves with the program before the new version is rolled out. Tentative plans have now been developed by the district for the roll-out of the program.

To ensure continuing support for the Rx Solution, site support visits were conducted to Berea ARV clinic, Mafeteng ARV clinic, Leribe Main Pharmacy & ARV clinic and HAHPCO. Also the Lesotho National Product List was obtained from the NDSO. The list will now serve to specify the product file for all installations in the Lesotho sites.

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MALAWI- PMI Overview

Malawi is one of the high malaria burden countries in sub-Saharan Africa that has been selected in the second round of beneficiary countries by the United States Government President’s Malaria Initiative (PMI). In May 2006, in preparation for PMI country planning and implementation, the US Government conducted a rapid assessment and subsequently requested RPM Plus to provide support to key technical areas of the Malawi PMI Country Operational Plan. RPM Plus activities will support technical including regulatory and operational aspects of national artemisinin-based combination therapy (ACT) policy implementation. Activities will focus on supporting the drug supply and pharmaceutical management with a comprehensive implementation plan to address regulation, procurement, storage, distribution and rational use of ACTs.

Major Activities This Quarter

• RPM Plus facilitated the ACT logistic sub committee workshop to review the draft Operational Plan, Participants Training Manual and Facilitators Guide for the implementation of new malaria treatment policy in Malawi. The Manuals were finalized and endorsed by the sub committee. Printing of the Facilitators Guide (Pharmaceutical component) of and Participant’s Manual commenced and is expected to be completed by end of this quarter.

• At the request of USAID/Malawi, a smaller group within the ACT logistic sub committee was formed (constituting RPM Plus, USAID, USAID | Deliver and CMS) to closely follow up the ACT procurement and distributions process. RPM Plus continues to support both committees

• In collaboration with CMS, RPM Plus finalized the ACT Operational Plan which details the distribution plan including ACTs allocation per facility and responsibilities of the various organizations in ACT implementation.

• A joint RPM Plus/ USAID | Deliver assessment mission commenced on 20th August 2007. The joint team reviewed Malawi’s readiness to receive first ACT consignment and made recommendations on improving storage space, technical assistance needs, tools, training and restructuring which are required to meet ACT distribution targets in the short, medium and long term. Following the TDY, RPM Plus identified a warehouse to provide extra storage space in addition to the Regional Medical Store in Northern region.

• Participated in a meeting with NMCP to plan for health care workers training in new ACT treatment policy. At RPM Plus recommendation, NMCP agreed to include Pharmacy Technicians to the TOT trainings at regional level.

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• With regards to ACT distribution, RPM Plus acquired district maps of the health facilities and major roads to facilitate the planning of the distribution schedule and provided TA in finalizing the facility allocations and distribution schedule. This information was shared with CMS.

• Started the printing of SOPs (one page instructions for facilities on how to handle the ACT’s and stock cards) in order to ensure standardized way in handling the ACT’s since they will arrive at facilities before staff ‘s training. Stock cards for the four treatment packs which will accompany the deliveries.

• RPM Plus team participated in the official ceremony for the arrival of the ACT’s in Malawi which was also witnessed by The Minister of Health, The US Ambassador, the USAID Mission Director and UNICEF Deputy Res Rep.

Next Steps

• In collaboration with NMCP, RPM Plus/SPS will participate in the national TOT training in the new ACT treatment policy. RPM Plus/SPS staff will provide technical assistance in the training (pharmaceutical management component) in Northern and Southern regions.

• In collaboration with NMCP, planning for the training of district-level health care workers will be finalized and training on pharmaceutical management for malaria will be conducted soon after the national TOT.

• As part of ACT sub committee provide technical assistance in the PMI/NMCP M&E plan (pharmaceutical management indicators) implementation.

• As part of the logistic sub committee team, RPM Plus/SPS will participate in the tracking of the distributed ACT and conduct spot check in the health facilities around the country.

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NAMIBIA - PEPFAR

Overview

The Rational Pharmaceutical Management (RPM) Plus Program of Management Sciences for Health (MSH) received additional funds from USAID/Namibia under the President’s Emergency Plan for AIDS Relief Country Operational Plan (COP 07) to continue its technical assistance activities initiated in previous years with PMTCT, Track 1.5, Track 2.0, COP 05, COP06 funding. COP 07 funds will ensure the continued assistance to the Ministry of Health and Social Services of Namibia and will continue to assist with the development and implementation of various activities that aim to strengthen pharmaceutical management systems in Namibia in order to continue to scale-up and sustain HIV/AIDS activities.

These interventions are grouped into four main objectives. The first is to strengthen relevant policies, legal framework and national management systems that support the implementation of the National Medicine Policy. The second is to strengthen human resources through filling key public pharmacy positions and also through training and capacity development of pharmacy cadres for the management of HIV/AIDS-related pharmaceuticals. The third objective aims to strengthen commodity management through the implementation of the ART commodity tracking systems and improved inventory management at treatment facilities. The fourth aims to strengthen the rational use of HIV/AIDS-related pharmaceuticals through the implementation of proven strategies that promote rational use of medicines.

Major Activities This Quarter

During the quarter under review the first Namibia Pharmacovigilance Training of Trainers (TOT) workshop was conducted in July 2007. The two-day training involved 23 participants including regional directors, regulators from MCC secretariat, medical officers from treatment facilities and the DSP and USG partners. The training covered 4 modules and 14 Sessions contain presentations, trainers guide, demonstrations and interactive slides and case studies. The materials contained a session on background into Therapeutics consultation, the rest of the modules and sessions contained detailed materials on the science and practice of Pharmacovigilance (PV) and Pharmacoepidemiology. The training was highly evaluated and participants felt well equipped to serve as future trainers for the upcoming national Pharmacovigilance training.

Continuing on support provided to the Pharmacy Management Information System (PMIS) taskforce since 2005, during the quarter RPM plus collaborated with the pharmaceutical services division for the successful launch of the PMIS. RPM Plus also provided other supports to the PMIS including; support for the development and adoption of the manual and tools, provision of computer hard wares to all the 13 regions, training of regional healthcare teams, and support for the development of PMIS data collection software. The PMIS will ensure timely and appropriate availability of data required in decision making for the improvement of pharmaceutical care at treatment facilities, regional and national level.

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RPM Plus has continued to rollout the ART Dispensing Tool (ADT) to more treatment facilities. The tool has now been implemented in a total of 24 facilities covering 68.7% out of 35 facilities. This coverage implies that about 70% of all patients on ART in Namibia are now being managed with this tool. The use of the ADT has provided national program managers with the benefit of reliable and timely data on ARV consumption in Namibia. Treatment facilities using the ADT reported many benefits of the tool including; generation of daily expected patient lists which help track defaulters, improved inventory management of ARVs, and reduction in dispensing time and dispensing errors.

RPM plus continue to work with five Therapeutic Committees (TC’s) to improve rational use of medicines. A total of 90 staffs were trained on functioning of TCs, interventions to improve rational use and pharmaceutical care. The TC’s were supported to hold regular meetings and implement specific interventions they identified to address medicine use problems in their respective facilities. Some of the interventions included, improving inventory management practices and developing regional formularies. The key achievements include formation of a formulary review committee that is currently reviewing the regional formulary. This committee has been instrumental in driving the formulary review process. RPM Plus collaborated with DSP, ITECH, CHS and other partners by providing technical assistance in ART adherence issues. RPM Plus is being recognized by partners as a key collaborator and a major expert in adherence activities in Namibia. RPM Plus also supported the MoHSS ART Technical Advisory Committee and participated in the review and finalization of the Namibia ART and PMTCT guidelines.

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NICARAGUA Overview

USAID/Nicaragua has been supporting Rational Pharmaceutical Management Plus (RPM Plus) technical assistance in pharmaceutical management since 2002 as part of the overall support to health sector reform. RPM Plus analyzed the Nicaraguan Ministry of Health’s (MoH) pharmaceutical supply system. As a result of this study and following workshops, the MoH decided to support the establishment of private sector mechanisms modeled after the “Programa de Ventas Sociales de Medicamentos” (VSM) to promote the creation of a network of retail outlets to sell low-cost quality-assured essential medicines. RPM Plus has supported the strengthening of the VSM network in the areas of financial management, pharmaceutical quality assurance, and the training of dispensers. Standardized procedures for each of these areas were developed in FY05. For FY06 RPM plus will support the implementation and evaluation of these proposals.

Major Activities this Quarter

Local RPM Plus consultants finished and presented the baseline studies before the implementation of the Quality Assurance Manual and the Standardized Manual for the Training of Dispensers.

The implementation of the Quality Assurance Manual is in an advances stage. There were delays, though, in the introduction of the Minilab ® because of difficulties in international shipping and port clearance. The Minilab ® is already in Nicaragua and RPM Plus has programmed a training workshop on October 23rd – 25th.

During this quarter there was just a partial implementation of the “Standardized Manual for the Training of Dispensers”. RPM Plus supported the training of trainers on the proper use of the educational methodology, but just one of the three VSM networks – Accion Medica Cristiana (AMC)- actually implemented the training of dispensers, and just the 1st phase. The other two organizations alleged conflicting agendas and financial difficulties. The completion of the training for AMC dispensers will take place before the end of 2008.

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RWANDA - PEPFAR Overview

RPM Plus Program has received funds from the USAID Mission in Rwanda under the PMTCT and the President’s Emergency Plan for AIDS Relief initiatives to meet health commodity needs in support of the expansion of HIV/AIDS programs. During the Country Operational Plans 04 and 05 RPM Plus assisted the Ministry of Health with interventions to strengthen the pharmaceutical system at both national and peripheral levels. At national level RPM Plus has provided technical assistance to the Direction of Pharmacy, to the Central Medical Stores (CAMERWA), and to the Training and Research AIDS Center (TRAC) in order to integrate the components of pharmaceutical management in national strategies for improving access to ART, and especially those related to quantification, procurement, distribution, and MIS. At the peripheral level, RPM Plus has taken the lead in developing curricula and conducting training in pharmaceutical management to pharmacy staff from all ART delivery sites. RPM plus also collaborated with the National Reference Laboratory in the development of the National Laboratory Policy as well as in the development of Standard Operating Procedures of the laboratory tests required to monitor patients under ART.

In addition to these activities, RPM Plus has been the lead agency for putting in place the Coordinated Procurement and Distribution System (CPDS) for ARVs. The CPDS emerged at the beginning of 2005 as an initiative of the Government of Rwanda with the aim of maximizing the purchasing power of donor funds and ensuring quality products through a centralized supply for ARVs. During COP06 the structure of the MOH will be radically modified according to the approved decentralization policy. Under this policy the roles and responsibilities of some institutions of the MOH such as TRAC are being redefined, and the Directions of the MOH such as the Direction of Pharmacy are evolving into technical agencies with more restricted functions called the Task Forces (Pharmacy Task Force).

RPM Plus activities will focus on three main technical objectives:

1. Provide technical support to the USG and Government of Rwanda partners in the establishment and consolidation of a Coordinated Procurement and Distribution System of ARVs and other HIV/AIDS commodities

2. Provide technical support to the MOH and to CAMERWA in order to improve equitable accessibility of pharmaceuticals at the district level, and the quality of the pharmaceuticals available in the public sector.

3. Build the capacity of the districts for assuming increasing responsibilities in the area of pharmaceutical management, under the new policy of health care decentralization.

4. Procure, store and distribute ARVs, test kits and medicines for opportunistic infections in behalf of the USG.

Major Activities This Quarter

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As COP06 comes to a close and COP07 starts, RPM Plus brings to completion several key activities under COP06, while it begins the process of work plan development with the Mission and key stakeholders for COP07. RPM Plus’ TA and support to the CPDS has successfully resulted in the integration of OIs, Lab Regeants, and Test Kits into the CPDS. RPM Plus provided TA and support for the completion of the 1st quantification of Lab Regeants and Test Kits under the CPDS.

RPM Plus facilitated the development of reporting tools/instructions for OIs to be utilized at the health facility level. The tool was approved and training on the use of the tool was facilitated by RPM Plus in collaboration with PTF to 30 district pharmacy managers. An implementation plan for the OIs tool is currently being developed in collaboration with PTF, the committees of the CPDS, and other stakeholders.

RPM Plus conducted refresher quantification training for several members of the Quantification Committee (TRAC, CF, and CAMERWA) and provided TA and oversight for the national quantification of ARVs for the 5th CPDS procurement. The quantification was finalized in June 07. RPM Plus recruitment process to hire the CPDS Coordinator concluded with the hiring and seconding of the CPDS Coordinator to the MOH. The coordinator is scheduled to commence work on the 1st of October 07. Under COP07 RPM Plus will continue to render TA and support to the CPDS Coordinator.

Throughout COP06, RPM Plus provided a range of TA to CAMERWA in an effort to support the effective planning and implementation of active distribution. Several joint technical and management meetings (CAMERWA, RPM Plus, and SCMS) were held at CAMERWA. RPM Plus drafted and provided to CAMERWA a comprehensive outline of a strategic and operational plan to facilitate better the planning for active distribution. RPM Plus and SCMS identified the need for additional support to CAMERWA for the development of the strategic and operational plan, as well as to assist CAMERWA with assessing the readiness of its warehouses for active distribution, identification of gaps and assistance need to resolve the noted gaps. RPM Plus assisted SCMS with the finalization of the TORs for two consultants which were provided by SCMS. RPM Plus procured several equipments for CAMERWA to facilitate its readiness for active distribution. CAMERWA is still in the process of finalizing its plans for active distribution.

RPM Plus facilitated the development of a reporting system which will allow for effective communication between the central, district, and health facility levels. PTF, CAMERWA, and staff of RPM Plus participated in the development of the tools and instructions. RPM Plus in collaboration with PTF conducted a training on the reporting system for representatives of 30 districts in August 07.

In regards to the implementation of decentralization policy, RPM Plus has hired, trained, and seconded 8 district pharmacists to the MOH, all of which are integrated and functioning effectively in their assigned districts. RPM Plus continues it technical supervision and support of the pharmacists in collaboration with PTF. In addition, during COP06 RPM Plus rehabilitated and equipped a total of 9 district pharmacies.

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RPM Plus in collaboration with PTF conducted a series of trainings in various aspects of pharmaceutical management both at the district and health facility levels in support of the decentralization policy. A total of 386 individuals (nurses, general pharmacy staff, and pharmacy managers) were trained during COP06. In addition, RPM Plus continued its support to 8 hospitals that are in various stages of establishing or strengthening existing DTCs. During the reporting period Kibagabaga Hospital convened its very first DTC meeting with the support of RPM Plus.

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RWANDA - PMI Overview

Rwanda is one of the high burden malaria countries in sub-Saharan Africa that was selected by the United States Government (USG) in May 2005 to benefit from the President’s Malaria Initiative (PMI). Malaria is the leading cause of morbidity and mortality in Rwanda, with over 1.4 million outpatient cases, 127,000 hospitalizations, and 888 deaths reported in 2005 (PNILP annual report 2005). Malaria caused nearly half of the cases and half of the deaths among the ten highest causes of morbidity and mortality in 2005. Children under five years of age are especially vulnerable; in 2005, they represented one-third of consultations and 40% of hospital deaths due to malaria. In May 2005 USAID/PMI team conducted an initial assessment to identify appropriate areas for PMI investment in Rwanda. An important consideration was that Rwanda is the recipient of Rounds 3 and 5 of Global Fund grant to support the national malaria control program, including the procurement of ACTs, training providers, and establishing a viable distribution system, among other activities.

RPM Plus activities will focus on two main technical objectives: 1) Improving the case management and use of appropriate anti malarias 2) Improving the supply and quality of anti malarias and related supplies

Major Activities This Quarter

• Participated in a 10 days technical meeting with the USAID PMI/HQ team and CDC to review work plans in preparation of next FY’s MOP08. Also participated in several meetings to discuss issues related to pharmacovigilance (PV), private sector approach, harmonizing commodities management (between PNILP, RPM Plus and DELIVER) and Commodities in the HBM. • The new Senior Program Associate began working in July, after her orientation an introductory period plan was developed. • Discussed with the PNILP on data to be reported by district pharmacies and needed modifications in the drafted reporting tools. Officially requested the PNILP for copies of third quarter data reported by District Pharmacies. • With regards to training of CHWs on home based management of malaria (HBM), RPM Plus reviewed the drug management section of the training manual and provided technical advice on the TOT methodology and critical Job Aids to be used. RPM Plus also supervised the trainings in Kirehe, Nyanza and Gasabo. Supervision report and recommendations has been shared with HBM implementing partners and PNILP. In order to monitor ACT compliance in HBM, RPM Plus met with EIP to talk about developing HBM monitoring tool that would include elements of compliance monitoring • During this quarter, the PNILP’s comments to the malaria reporting tools were incorporated into the initial draft and subsequently, a draft plan for introducing the reporting tools at the district and FOSA levels was developed. Both the revised reporting tools and the draft plan were submitted to the PNILP. • In efforts to develop a coordinated procurement and distribution system, RPM Plus assessed the system, a preliminary report is being developed for internal discussions

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Country Programs 62 RPM Plus Activities and Products Status Report

SENEGAL- PMI Overview

In May 2006, the US Government conducted a rapid assessment in preparation for PMI country planning and implementation and subsequently requested the support of Rational Pharmaceutical Management Plus (RPM Plus) Program of Management Sciences for Health (MSH) to support Senegal PMI Country Operational Plan. RPM Plus activities will focus on supporting the drug supply and pharmaceutical management and address the issues related to quantification, storage, and distribution.

Major Activities This Quarter

• Provided technical assistance to the NMCP in conducting formative supervision visits in Thies region. RPM Plus oversaw the pharmaceutical management aspects in the districts depots and health centers where it was noted that bin cards were not correctly filled out, severe malaria was not appropriately managed and monotherapies were available despite their ban. • Presented to the National Management Information System (NMIS) a draft of the formative supervision guide on pharmaceutical management. The head of NMIS supported the initiative and indicated that the guide will also be useful in data analysis and decision making. The guide was also shared with the MOH and other NGOs to share a draft of the supervision guide. Following this meeting, the PNA assigned its technical person to organize a two days workshop to finalize the document. The PNA is advocated to lead and coordinate future supervisions. With the available tools, the PNA can plan for a countrywide supervision and solicit participation of other partners. • The NMCP hired external providers (18 providers and 3 supervisors) in order to strengthen supervision in the private sector and at the district level. RPM Plus provided support in developing Terms of Reference (TORs), candidate selection and in recruitment process. • Participated in the antimalarial quality surveillance coordination committee meeting of the ministry of health. The meeting was held in response to reports regarding of stock levels Adolescents ACT/12 in many PRA and at the central medical store. • Participated in the planning meeting for MOP year 2 of PMI. RPM Plus also participated in NMCP organized quarterly review meeting. Participants included district health officials, regional medical team, PNLP, PNA and partners. Presentations and discussions focused on malaria treatment, IPT, ITN distribution and ACT management. An official report of the meeting addressing issues related to ACTs that are about to expire, RDT training, ADR reporting and data collection and analysis in health facilities is being done.

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SOUTH AFRICA Overview

The mission of RPM Plus/South Africa is to strengthen national and provincial pharmaceutical services to support the “Operational plan for comprehensive HIV and AIDS care, management and treatment for South Africa”. The delivery of pharmaceutical services is one of the key components of this plan which emphasizes accreditation of pharmacies at service points; availability of a sufficient number of personnel who have the necessary competencies; procurement and distribution of appropriate medicines; pharmacovigilance; drug information and systems for the monitoring and evaluation of the aforementioned.

Using FY06 funding, RPM Plus continues to focus on strengthening the National, Provincial and Metropolitan (Metro) Pharmaceutical Departments in support to the “Comprehensive Plan”. RPM Plus continues to build on MSH experience and the lessons learned under previous years funding including COP05. The program continues to coordinate and collaborate with the Pharmaceutical Policy and Planning Cluster of the National Department of Health, USAID and local partners to address key pharmaceutical priority areas, at the national and provincial levels. RPM Plus activities in South Africa can be categorized under three technical objectives: a) to increase the capacity of health facilities located in the provinces and Metro areas to deliver quality responsive pharmaceutical services; b) to improve the availability and the appropriate use of ARVs and HIV and AIDS- related commodities at service delivery points providing services to HIV and AIDS patients and: c) to improve the availability and accessibility of information on medicines used for HIV/AIDS treatment and prevention

Major Activities This Quarter

During this reporting period, staff meetings were held in July and in September. The September meeting also served for strategic planning. Several staff attended the RPM Plus Retreat and SPS Launch held in Arlington, USA from August 6–15 during which several presentations were made on different key pharmaceutical themes. During the quarter, the COP08 was developed and submitted. Two new members of staff were hired, took up their positions and were orientated. Also, a candidate for the vacant post at the Medicine Information Centre (MIC) at Rhodes University was identified and arrangements were made for an interview to be held.

During the Infection Control Committee (ICC) meeting of September 26, it was agreed that Infection Control will be one of the main themes of the next Steering Committee meeting. RPM Plus was requested to do a presentation on work done on the Infection Control Assessment Tool (ICAT) at this meeting.

RPM Plus attended the Strategic Planning conference for Free State Pharmaceutical Services, September 28-29, 2007. A coordinating mechanism for integrating the RPM Plus work plan for the Free State with the sub directorate’s business plan was developed.

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In the area of facility compliance, a meeting was held on July 2 with the Acting Chief Director of Pharmaceutical Policy and Planning. The purpose was to report on the National Compliance Workshop held with the provinces at the end of June, and to discuss the way forward following the workshop. Also, the questionnaire for facility pharmacy audit was amended and supplied to the Department of Correctional Services as well as to the Eastern Cape Province. Re-auditing of facilities in the Eastern Cape for legislative compliance commenced during this quarter. Also in support to compliance, three workshops, focused on legislation, were held in the Northern Cape. One workshop was held in Upington on July 18 with 18 participants attending and two workshops were held in Kimberley with a total of 47 participants.

In the area of pharmaceutical policy strengthening, respective SPAs participated and provided technical inputs to technical meetings of the Medicines Control Council (MCC), Clinical Trials Committee and MCC Scheduling Committee.

A number of HIV/AIDS related trainings and material development took place:

• Limpopo 10 – 13 July 2007 (25 people trained) • Mpumalanga 16 – 19 July 2007 (21 people trained) • North West 20 – 23 August 2007 (14 people trained) • Western Cape 27 – 30 August 2007 (23 people trained) • Western Cape 10 – 13 September 2007 (26 people trained)

Participants included pharmacists, pharmacy interns, pharmacists doing community service and pharmacist’s assistants employed at ART treatment sites as well as some case managers.

The MTP Follow up for the Free State training took place on 23rd July with 9 participants attending. Also, the MTP follow up for the Limpopo training took place on August 7th. The provincial Head of Pharmaceutical Services (HOPS) attended the session along with 27 participants. Finally, the MTP follow-up for the Mpumalanga training was held on August 23rd with 17 participants attending.

A workshop was held on September 20–21 to review the HIV/AIDS Training Material and the approach taken in the training. The workshop also served to introduce the training materials to new RPM Plus staff. Additional amendments were made to the training materials incorporating the feedback received from the South African Pharmacy Council (SAPC).

RPM Plus continued to support the Western Cape project for the provision of ARVs by pharmacist’s assistants at PHC clinics. The document detailing the legislative requirements was finalized. Support continued on check lists, standard operating procedures for dispensing and counseling of patients by PAs, and supervisory visits to the PHC clinics. Meanwhile, TA was provided to the Rustenburg Provincial Hospital in the North West specifically for the implementation of ARV dispensing and information management systems for new and down- referred ART patients.

A plenary lecture on HIV/AIDS Pharmacovigilance was presented at the Adverse Drug Reaction and Lipodystrophy Workshop held in Sydney, Australia (19 -21 July). The presentation focused

Country Programs 65 RPM Plus Activities and Products Status Report

on implementation of cohort event monitoring systems in HIV/AIDS programs with particular reference to resource limited settings.

During this quarter, it was agreed to roll out the HIV/AIDS adherence tool to all nine (9) provinces. Some adjustments were made to the tool that is being provided to the provincial coordinators responsible for the roll-out. Several coordinating meetings have been held with the coordinators to provide support.

In support to KZN project for the dispensing of chronic prescriptions, RPM Plus participated in the joint planning of activities related to the development and finalization of the criteria for the approval of private community pharmacies and for the development of SOPs and checklists. Support to the implementation of Rx Solution continued in the Free State Province, Mpumalanga, Eastern Cape and Gauteng. In the Free State, an implementation plan was developed for the deployment of RxSolution in 39 sites. Four training workshops were held in Bloemfontein in July. A total of 47 people were trained. In Mpumalanga, Ermelo Hospital is being used as the RxSolution Pilot site for the province. The Paab interface was deployed and is operational. A stock-taking procedure was developed and put into place. Assistance was provided in a stock-take which was done on pharmaceuticals during the period September 17 – 20. In the Eastern Cape, a users meting was held in Umthatha on August 22. The opportunity was provided for users to share their experiences and receive training and support. Finally, in Gauteng, six members of staff at Baragwanath Hospital were trained on the dispensing module.

In support to the PTC activity, TA was provided to the Free State Provincial PTC on August 1st. An ABC Analysis report was prepared for the province and presented. TA and support continued to be provided to the provincial PTC in the Northern Cape and the PTC of the Kimberley Hospital Complex.

In the area of Infection control, RPM Plus provided assistance to the national level as well as to the pilot sites in Kimberley, Kuruman and Rustenburg. An ICAT Review workshop was held in Kimberley. It was attended by 20 participants from pilot sites as well as from two other provinces. New scale-up plans were developed and the National Plan adjusted. Meanwhile, the ICAT tool was presented to the Gauteng Provincial Infection Control Committee.

After feedback had been received from the South African Pharmacy Council (SAPC) regarding the submission for approval of the PTC course, the PTC training materials were refined to address issues identified in the evaluation. The resubmission was finalised and sent to the SAPC.

Country Programs 66 RPM Plus Activities and Products Status Report

SOUTHERN SUDAN Overview

USAID Sudan Field Office (SFO) has mandated RPM Plus, to provide support to the Ministry of Health (MOH) in establishment of a functional National Malaria Control Program (NMCP). Under RPM Plus support, the MOH is establishing a NMCP to coordinate and direct all malaria control activities in the country. Some key elements in establishing the program include; developing national malaria control policies, technical guidelines and other operational tools. Additionally, building technical capacities, strengthening partner coordination mechanisms, equipping the program with basic infrastructure and equipment and establishing M&E systems are key components of RPM Plus support.

RPM Plus activities under USAID/G/BGH SSO5 focus on the following technical objectives: 1. Support the development of effective antimalarial drug policies at the global, regional and country level 2. Enhance the understanding by policy makers of household and community antimalarial drug use by effective development of interventions for implementation of drug management 3. Enhance the rational use of antimalarials through interventions at global, regional and country provider and user levels 4. Enhance the capacity of prenatal services to improve the treatment and prevention of malaria in pregnant women

Major Activities This Quarter

• RPM Plus supported MOH and the malaria Technical Working group (TWG) to finalize and submit a malaria proposal in response to round 7 GFATM call for grant applications. Subsequently, the CCM Southern Sudan was facilitated to respond to clarifications from GFATM and evaluate the proposal development process. • Support was provided to the MOH to review the “Laws of Southern Sudan Malaria control and Treatment Bill, 2007” and to proof-read the first print out of the “Guidelines for Management of Malaria in Southern Sudan. • In collaboration with key partners, a guideline for distributing ITNs through the public sector was developed. The guideline will be utilized in the planned distribution of over 1 million ITNs in the next quarter. In addition, MOH/NMCP was supported to review the PSI-led strategy for distribution of 1.0 million LLINs that are being procured under the MDTF/MOH Program. • To ensure smooth running of the National Malaria Control Program (NMCP) and safeguard RPM Plus assets, an Office Manager was recruited and on-job orientation in MSH/RPM Plus systems and operations facilitated. • RPM Plus supported MOH/NMCP and other programs within the Directorate of Preventive Medicine in the development of 2007/8 health sector plans • RPM Plus made a presentation on “Home Management of Malaria (HMM) - key considerations in implementation” to the malaria TWG meeting. Subsequently, RPM supported MOH to develop Terms of Reference (TORs) for a Task Force to design the HMM strategy. The TORs were discussed and agreed upon within the malaria TWG.

Country Programs 67 RPM Plus Activities and Products Status Report

• RPM Plus facilitated the sensitization of 30 health workers in Eastern Equatoria state on the new malaria treatment policy. In the same state, 20 health workers including doctors, clinical officers and senior nurses were trained in the management of both uncomplicated and severe malaria. This high cadre of trained staff will help to coordinate training of other health workers. An additional 20 health workers in were also trained in the management and prevention of malaria in Central Equatoria State. • MOH/NMCP was facilitated to undertake support supervision visits to Unity and Upper Nile States. • To provide direct support to the Pharmaceutical Management Directorate of MOH, a full time Pharmaceutical Management Advisor was recruited and oriented in MSH/RPM Plus systems and tools. Subsequently, RPM Plus held consultations with key pharmaceutical management partners to identify and agree on areas of support for RPM Plus. • RPM Plus supported the Directorate of Pharmaceutical Services (DPS) to restructure its organogram, describe its key functions, and outline TOR for the Director General of Pharmaceutical Services. In addition, support was provided to summarize the Pharmacy Policy for presentation to the Parliament by the Minister of Health. • RPM Plus supported the DPS to draft a three-year Pharmaceutical Master Plan (2007-2010 Short/Mid-term Work Plan). The master plan was presented to Cabinet by the Minister for Health. • The DPS was also supported to organize a capacity building workshop on HIV and AIDS care, prevention and treatment. The three day workshop conducted by Howard University Continuing Education (HUCE) through USAID-funding for the ROADS Project, was attended by 40 participants mainly pharmacists from all the 10 states. RPM Plus facilitated discussions and made 3 technical presentations on managing medicines supply and training the adult learner. Two of these presentations were adaptations of MSH materials.

Country Programs 68 RPM Plus Activities and Products Status Report

SWAZILAND

Overview

Following previous year’s funding, RPM Plus uses allocated RHAP FY06 to continue improving and strengthening medicine and commodity supply systems in support of the scale-up of HIV/AIDS programs in Swaziland. Through this, it aims to address some of Swaziland’s immediate health challenges, including HIV and AIDS, TB, child health, and primary health care services. RPM Plus works collaboratively with the Ministry of Health and Social Welfare (MOHSW) by offering technical assistance, training, the development of tools and the implementation thereof.

Major Activities This Quarter

During this quarter, RPM Plus staff attended the USG Partners’ meeting held July 20. The proposal for COP08 was developed and submitted. Regular updates were provided to the USG HIV/AIDS team on RPM Plus in-country activities. Also, communication took place with COHSASA following their assessment of health facilities, in order to coordinate activities addressing infection control and pharmaceutical services in Swaziland.

The program continued to pursue MSH registration in the country. In the interim, a pharmacy consultant was hired to support overall implementation of in-country activities, also earlier an MIS consultant was also hired to provide specific support to the roll-out of RxSolution. Orientation was provided to the two consultants. In the meantime, office premises were secured and quotations for their equipment were obtained.

A meeting was organized with all stakeholders to follow-up on the legislation workshop conducted in June, 2007. A tender document including a prequalification document for suppliers along with tendering guidelines were rewritten and submitted to the Ministry of Health in April 2007. During this quarter, assistance was provided to the 2007/08 tender; a spreadsheet to assist in the adjudication of submitted tenders was finalized and provided to the counterpart.

RPM Plus provided technical assistance in drafting pharmaceutical and medical devices donation guidelines. Based on this, a memorandum was sent out to the facilities. Also, RPM Plus provided assistance to address issues related to the supply of prophylactic co-trimoxazole in the country; a meeting was held with ICAP and USG and an agreement was reached to assist CMS and MOH&SW to strengthen the product supply system.

Country Programs 69 RPM Plus Activities and Products Status Report

Following a previous TOT HIV/AIDS pharmaceutical training, an MTP follow-up session was held on 4 September with seven participants attending. Participants presented feedback on their implementation of the training they had received and identified key areas for program improvement. Also training on the development of ARV SOPs was provided.

The generic training materials for the TB Drug Supply Management (DSM) course were adapted to make them appropriate for Swaziland’s treatment regimens and procurement policies. Also some explanatory text was added to the course.

In support to the Anti-microbial resistance and related infection control efforts supported mainly through core funds, the program continued to provide support to the ICAT pilot sites. So far, interventions at the site levels included adequate dealing with waste management (a new incinerator was donated to Mbabane Government Hospital by BD, a private company), improvement of hand hygiene and the development of infection control policies. A poster relating to hand hygiene was finalized and a questionnaire relating to hand hygiene practices was prepared and field tested. Contact was made with the Swaziland Nurses Association who supplied ICAT pilot sites with infection control materials. Preparations were also made for the ICAT Review workshop.

A PTC presentation was made at Mbabane Government Hospital following which a hospital PTC has now been launched. Subsequently, guidelines were provided on the supply of antibiotics and injection to the wards.

The new RxSolution module relating to the ART Patient Monitoring system (APMR) has now been implemented at the four pilot sites i.e. RFM, King Sobhuza II Clinic, Dovokolwako and Emkhuzweni. The new module allows for the integration of the patient management system and Rx Solution. The on-site training of users, including M&E personnel, continued during this quarter. A meeting was held with case managers, CMS and the IT department. Job distribution and responsibilities were defined for the accomplishment of the project by March 2008. Meanwhile, further refinements were made to the APMR module and work on the APMR User’s Manual for Swaziland was initiated.

Country Programs 70 RPM Plus Activities and Products Status Report

TANZANIA - PEPFAR Overview

The accredited drug dispensing outlet (ADDO) program was developed by the Ministry of Health and Tanzania Food and Drug Authority (TFDA) with support from MSH/SEAM and the Bill & Melinda Gates Foundation. The program design involves transforming duka la dawa baridi (DLDB) into ADDO through standards-setting and accreditation process. The primary goal of the ADDO program is to improve patient care through access to affordable, quality medicines and pharmaceutical services in retail drug outlets in rural or periurban areas where there are few or no registered pharmacies.

In the past two years, RPM Plus program has laid the groundwork in Morogoro to develop ADDOs and prepare them to support palliative care programs for HIV/AIDS. The work done to date has primarily focused on ensuring accreditation and establishing linkages with the newly awarded Tunajali home-based care/orphan and vulnerable children program in Morogoro. ADDOs, in collaboration with community-based organizations and NGOs, can provide HBC services to remote and rural areas through provision of HBC kits and services that might otherwise not be available in rural areas. Selected ADDOs would be assigned a catchment area where they would work with HBC volunteers (identified by district sub-grantees) to support HBC kits distribution and refer patients to the closest HIV/AIDS Care and Treatment Clinic when appropriate. The proposed role of ADDOs in community-based HIV/AIDS prevention and care would also include dissemination of HIV/AIDS information whereby ADDOs would become centers for providing basic HIV/AIDS information to the public.

Although limited in scope for now, RPM Plus continues to provide support to NACP and USG partners on HIV/AIDS pharmaceutical management system strengthening to ensure efficient, effective supply and use of ARVs and other related commodities. In support of regionalization strategy in Tanzania, RPM Plus will work collaboratively with partners in ART sites in Arusha, Kilimanjaro, Tabora Manyara, Tanga and Dodoma regions. RPM Plus will collaborate with SCMS to provide technical support in ART Pharmaceutical Management through sharing of the developed tools, dissemination of lessons learned and approaches successfully applied in other countries.

In effort to improve efficiency and effectiveness of ART Pharmaceutical management systems in countries, Regional Training Resource Collaboration (RTRC) was established. RTRC is implemented through continued and enhanced human capacity development. RPM Plus in collaboration with the National AIDS Control Program will provide technical support to the Tanzania RTRC to implement training programs in HIV/AIDS Pharmaceutical Management.

Major Activities Accomplished this Quarter

• In collaboration with TFDA RPM Plus provided technical support in the training of 22 District Drug Technical Committees’ (DDTCs) members for Mvomero and Morogoro Rural. 65 local ward inspectors for Kilombero district were also trained.

Country Programs 71 RPM Plus Activities and Products Status Report

• In collaboration with TFDA, RPM Plus conducted the final pre- accreditation inspection and facilitated the first DDTC meeting in Mvomero and Morogoro Rural districts to review ADDO applications. Out of 212 applications,, 112 satisfied all the required basic accreditation standards and were approved. The remaining ADDO applicants were given a two months extension to finalize premise upgrade and renovation. The DDTC will then evaluate this group and grant accreditation as seen appropriate.

• In collaboration with TDFA, selected 242 (out of 300 applicants) successful candidates for dispensers’ training course in Mvomero and Morogoro rural districts. The four weeks training is ongoing.

• A joint RPM Plus and FHI Tunajali team field visit to Kilosa district was carried out from 9th – 11th August 2007 to familiarize each program’s activities and finalize the designing of the ADDO-HIV/AIDS palliative care services link in Morogoro region. The team held discussions with Kilosa district officials, FHI contracted sub-grantee in Mikumi, ADDOs owners and dispensers and briefed them about the proposed ADDO/HBC linkage collaboration between FHI/Tunajali and RPM Plus/SPS to support strengthening of HBC services in the district.

• RPM Plus provided technical support to TFDA to finalize both ADDO Implementation Manual and review of ADDO regulations. The implementation manual will guide ADDO roll out scale-up by local government and other implementing partner. The review of ADDO regulations intends to further delegate TFDA regulatory responsibilities on ADDOs and other medicines related issues to local councils.

• Conducted supportive supervision for ADDOs in Ulanga and Kilombero Districts, from 7th to 27th September 2007.

Next steps

• Finalize key reports and other documents on inspection, supervision and training.

• Finalize the dispensers’ training for Mvomero and Morogoro rural districts.

• Finalize plan for the selection of distributor in Morogoro for HBC kits distribution with FHI/Tunajali part of ADDO-HIV/AIDS palliative care link in Morogoro.

• Start planning for the ADDO accreditation activities in Morogoro urban. However, funding constraint may not allow immediate implementation.

Country Programs 72 RPM Plus Activities and Products Status Report

TANZANIA—PMI Overview

USAID/Tanzania, in March 2006, asked the Rational Pharmaceutical Management Plus (RPM Plus) Program to provide technical support for the implementation of the President’s Malaria Initiative (PMI) in Tanzania. In the context of the national policies, the RPM Plus/PMI program activities continue to support ACT policy implementation through private sector distribution of subsidized ACT using the Accredited Drug Dispensing Outlet (ADDO) program. RPM Plus also supports TFDA to strengthen Pharmacovigilance systems in the country with regards to monitoring possible Adverse Drug Reaction (ADR) including that due to ACTs.

Major Activities This Quarter

• Completed labeling ACT packages (113,280 treatment doses) with ADDO stickers. 48,960 treatment doses have been sent to Songea and Morogoro regions for distributing to ADDOs. • Developed, printed and distributed management tools for tracking ACT consumption and distribution, SOPs for ACTs distribution and price indicator guides for distributors and ADDOs. • Re worked the overall ADDO supportive supervision checklist to incorporating information related to tracking ACT distribution and use. The guide was used in September during supportive supervision visits in Songea and Morogoro. RPM Plus in collaboration with TDFA and NMCP supported the CHMTs to conduct the visits. • Adapted ACTs treatment charts from the National Guidelines for Malaria Diagnosis and Treatment (NMCP 2006). The charts were printed and distributed to all ADDOs receiving subsidized ACTs. • Held joint meetings with JSI/DELIVER to discuss procurement of the next ACT consignment from Novartis. • Continued to support PV activities through participating in PV working group meetings, providing support in planning supportive supervision and working with PV focal persons to reinforce ADR reporting in districts • RPM Plus participated in the NMCP-PMI partners meeting and presented the status of implementation of the planned activities and shared the next steps • RPM Plus also presented its experience and lessons learned in distributing ACTs through the private sector (ADDO) to the workshop for the development of a strategic plan to improve access of ACTs to the private sector in Uganda. • In supporting the NMCP in ACT policy implementation, RPM Plus coordinated and participated in the ACT Management Working Group Meeting where various issues on ACT procurement, storage, distribution, use, QA and management information systems were discussed and way forward agreed by key stakeholders.

Country Programs 73 RPM Plus Activities and Products Status Report

UGANDA - PMI Overview

RPM Plus is an implementing partner under USAID Uganda’s President’s Malaria Initiative (PMI) year two Country Action Plan. Within the FY07 scope of work, RPM Plus is supporting the distribution of insecticide-treated bed nets procured with GFATM funds to children under five years old, pregnant women, and other vulnerable populations, such as, people living with HIV/AIDS. In addition, RPM Plus is providing support to overcome the challenges in the pharmaceutical management system necessary to roll-out Artemisinin based combination therapy (ACTs) under the direction of the National Malaria Control Program (NMCP). Whilst providing technical assistance to the roll-out process, additional RPM Plus support is aimed at ensuring the rational use of the selected national first-line treatments.

RPM Plus activities under the Uganda PMI country program focus the following technical objectives: 1) To strengthen the existing malaria medicines pharmaceutical management system to ensure the constant availability of malaria medicines at health facilities and supporting the National Medical Stores’ handling and distribution of PMI-procured treatment doses of ACTs.

2) To provide technical support to the National Malaria control Program of the Ministry of Health, Uganda to scale up its malaria control activities, with an emphasis on malaria treatment activities, particularly the roll-out and rational use of ACTs.

Major Activities This Quarter

• Identified trainees, adapted materials and conducted a 5 days TOT workshop on medicines management for the district stores persons and Health sub-district in-charges. Also, organized and conducted a training workshop (using MTP approach) on malaria medicines management for 75 health workers from the districts of Moyo and Adjumani. RPM Plus trained 10 health workers in monitoring, problem solving and evaluation of pharmaceutical management for malaria medicines • Supported aggregation of district order for a special distribution of Coartem to those that had missed due to a stock out at NMS. • Operationalized the Job Aid that is aimed at supporting the NMS in assessing the rationality of Coartem orders and provided TA to staff coordinating orders with districts. As a result of this support, 75% of orders have been received at the NMS and NMS is enclosing supply discrepancy report forms with consignments being dispatched. • Verified stock position in NMS to ensure sufficiency for both health facility distribution and HBMF roll out • During this quarter, RPM Plus facilitated the redistribution of Coartem at risk of expiry within Pader and Kanungu districts. Similarly, 6,300 doses of yellow Coartem at the risk of expiry were sent to Mulago referral hospital. RPM Plus also facilitated the distribution of Coartem to Jinja district that had run out of stock and coordinated the distribution of Coartem to flood affected victims.

Country Programs 74 RPM Plus Activities and Products Status Report

• Provided TA for quantification of national first line anti-malaria medicines needs for 2007 - 2010 in the GFATM round 4 phase two planning. • Contacted district health officers to establish the stock position of Coartem within the districts, districts had at least 50% of health facilities with more than a month’s stock. • RPM Plus participated in meetings and workshops including the monthly medicines supply chain committee meeting, a joint MSH/ RPM Plus-SCMS meeting to guide SCMS review the NMS supply chain, a 3 day best practices workshop for NMCPs in Nairobi Kenya and MOH task force meeting to plan for the MMV stakeholders workshop scheduled for October 2007 • Support was provided to the National survey to establish availability of anti-malaria medicines in Uganda through assisting in the planning process, training data collectors and writing the survey report • Work is ongoing to finalize guidelines for phase out of mono therapies • Provided TA to the NMCP in gathering information for developing a strategic plan document for improving access to ACTs for the community through the Private sector. RPM plus organized a one day workshop for stakeholders to gather views on the approach to the development of the strategic plan. Following this workshop, a two days retreat was organized to guide the development of the Strategic plan. A preliminary report for the retreat has been disseminated, the strategic plan will be written by RPM Plus provided consultant. • Plans for piloting ACTs in the private sector in selected districts by MMV are underway, RPM Plus is participating in the process • Finalized draft monitoring and reporting plan (MRP) and submitted to USAID/Uganda for review and approval. Subsequently, the Uganda PMI monitoring and reporting system to track results linked to specific activities and output indicators was established. • Began preparations for PMI program audit

Country Programs 75 RPM Plus Activities and Products Status Report

FINANCIAL INFORMATION

On September 28, 2000, Management Sciences for Health was awarded the RPM Plus cooperative agreement, the follow-on to the Rational Pharmaceutical Management Project. The RPM Plus current ceiling increase is US$162,035,912 as a result of receiving a 3 year extension and ceiling increase in September 2003 and a subsequent ceiling increase in June 2005. The cumulative obligation for RPM Plus currently stands at US$155,614,800.

MSH tracks and reports expenditures by source of funding (Global or Core and Field Support, by Bureau, Region, and Country). MSH further subdivides Global or Core expenditures based on the various Strategic Support Objectives designated by USAID when funding is received (e.g., SO1-Population, SO4-HIV/AIDS, SO5-Infectious Diseases).

The Fiscal Data chart shows the Year 1 through Year 8 obligations, cumulative funds obligated, quarter three expenditures, in addition to the cumulative to-date (October 1, 2000 to September 30, 2007) expenditures of US$139,585,711 by funding source.

The RPM Plus cooperative agreement stipulates that MSH should cost-share an amount not less than US$21,000,000 over the life of the program. As of September 30, 2007, RPM Plus to date has surpassed this cost-share requirement, generating over the required US$21,000,000 in non-Federal funding, within the technical scope of work for RPM Plus.

Country Programs 76 RPM Plus Activities and Products Status Report Funding Total Total Total Total Total Total Total Total Cummulative Q4 Grand Total Grand Total Funding Source Typ e Obli gated Obli gated Obli gated Obli gated Obli gated Obli gated Obli gated Obli gated Obli gated Ex penditures Spent Remainin g Year 1 Year 2 Year 3 Year 4 Year 5 Year 6 Year 7 Year 8 30-Sep-07 Jul-Sep 2007 30-Sep-07 30-Sep-07 Core SO1: POP $ 100,000 $ 250,000 $ 350,000 $ - $ 393,686 ($43,686) SO2: Mat ernal Health Core $ 275,840 $ 354,000 $ 230,000 $ 200,000 $ 230,000 $ 349,450 $ 315,000 $1,954,290$ 96,970 $ 1,629,121 $325,169 SO3: Chi ld Survival Core $ 269,440 $ 587,000 $ 573,280 $ 745,000 $ 725,000 $ 292,100 $ 950,000 $ 4,141,820 $ 282,451 $ 3,732,160 $409,660 SO4: Sub Total $ 200,000 $ 650,000 $ 900,000 $ 1,300,000 $ 800,000 $ 500,000 $ 1,120,000 $ - $ 5,470,000 $ 127,216 $ 4,990,122 $479,878 SO5: Sub Total $ 984,720 $ 2,405,000 $ 3,730,000 $ 3,600,000 $ 5,174,725 $ 4,169,450 $ 2,120,000 $ - $ 22,183,895 $ 780,497 $ 21,467,979 $715,916 Comm on Agenda Core $ 800,000 $ 1,030,538 $ 1,650,000 $ 973,000 $ 773,000 $ 800,000 $ 773,940 $6,800,478$ 263,248 $ 6,764,969 $35,509 Mains treaming Core $ 135,000 $ 62,510 $ 123,500 $321,010$ 16,008 $ 183,114 $137,896 Core$ 2,630,000 $ 5,026,538 $ 7,083,280 $ 6,818,000 $ 8,087,725 $ 6,173,510 $ 5,402,440 $ - $ 41,221,493 $ 1,566,390 $ 39,161,151 $2,060,342 Burea u/Field Support Funds LAC/SPO-PM TCT FS $ 1,200,000 $1,200,000 $ 905 $ 1,121,188 $78,812 Africa B ureau Sub Total $ 290,000 $ 700,000 $ 250,000 $ 650,000 $ 250,000 $ 70,000 $ - $ - $ 2,210,000 $ 252,779 $ 2,150,101 $59,899 Asia/Nea r East Bureau/ID FS $ 200,000 $ 150,000 $ 590,000 $ 400,000 $ 200,000 $ 200,000 $1,740,000$ 159,014 $ 2,208,703 ($468,703) RDM/A Su b Total $ - $ - $ - $ - $ 780,000 $ 600,000 $ 600,000 $ - $ 1,980,000 $ - $ 165,570 $1,814,430 G/PHN NG Os/OFDA FS $ 50,000 $ 120,000 $170,000 $ 9,825 $ 142,375 $27,625 E and E Bureau FS $ 235,000 $ 935,000 $ 505,000 $ 215,000 $ 50,000 $1,940,000$ 76,463 $ 1,730,099 $209,901 REDS O Sub Total $ 300,000 $ 315,000 $ 320,000 $ 800,000 $ 725,000 $ 340,000 $ 357,000 $ - $ 3,157,000 $ 26,338 $ 3,225,758 ($68,758) WARP Sub Total $ - $ - $ - $ 250,000 $ 340,000 $ 500,000 $ 150,000 $ - $ 1,240,000 $ 35,456 $ 1,189,339 $50,661 LAC Bur eau Sub Total $ 195,000 $ 101,571 $ 510,000 $ 780,000 $ 660,000 $ 650,000 $ 600,000 $ - $ 3,496,571 $ 267,525 $ 2,808,917 $687,654 Bureau$ 1,035,000 $ 1,501,571 $ 2,605,000 $ 3,385,000 $ 4,370,000 $ 2,410,000 $ 1,827,000 $ - $ 17,133,571 $ 828,305 $ 14,742,051 $2,391,520 Region al Mission Funds MAC Mis sion Funding Sub Total $ - $ - $ 498,750 $ 334,500 $ 1,116,250 $ 1,025,000 $ - $ - $ 2,974,500 $ 24,103 $ 2,855,357 $119,143 Albania FS $ 300,000 $ 100,000 $400,000 $ 9,668 $ 302,153 $97,847 Armenia FS $ 500,000 $ 1,000,000 $1,500,000$ 181,612 $ 1,122,808 $377,192 Centra l Asia Regional FS $ 100,000 $100,000 $ 773 $ 95,798 $4,202 Kazak hstan FS $ 50,000 $50,000 $ - $ 53,629 ($3,629) Kyrgys tan FS $ 50,000 $ 50,000 $100,000 $ 7,546 $ 92,627 $7,373 Tajikis tan FS $ 50,000 $50,000 $ 1,356 $ 42,758 $7,242 Turkm enistan FS $ 91,208 $91,208 $ - $ 81,551 $9,657 Uzbek istan FS $ 108,792 $ 100,000 $ 100,000 $308,792 $ 5,459 $ 301,100 $7,692 Brazil FS $ 798,000 $ 350,000 $ 250,000 $ 400,000 $1,798,000$ 120,522 $ 1,618,499 $179,501 Domini can Republic MAARD $ 103,389 $ 100,000 $ 100,000 $ 100,000 $ 30,000 $433,389$ 17,017 $ 406,246 $27,143 Haiti S ub Total $ - $ 110,000 $ 100,000 $ 1,390,000 $ 1,950,000 $ 3,750,000 $ - $ - $ 7,300,000 $ 537 $ 6,775,137 $524,863 Hondur as Mission FS $ 30,000 $ 50,000 $80,000 $ 6,521 $ 65,031 $14,969 Mexico MAARD $ 49,957 $49,957 $ - $ 49,871 $86 Nicaragua FS $ 100,000 $ 150,000 $ 394,581 $ 90,000 $ 50,000 $784,581$ 14,506 $ 740,585 $43,996 Peru Mis sion FS $ 100,000 $100,000 $ - $ 107,017 ($7,017) Banglades h Mission FS $ 100,000 $100,000 $ - $ 65,235 $34,765 Cambod ia FS $ 150,000 $ 100,000 $ 150,000 $400,000 $ - $ 407,778 ($7,778) India FS $ 276,000 $276,000 $ - $ - $276,000 Nepal FS $ 413,000 $ 300,000 $713,000 $ - $ 704,070 $8,930 Vietnam FS $ 1,000,000 $ 2,847,000 $ 181,990 $4,028,990 $ 1,744 $ 3,967,352 $61,638 Angola P MI FS $ 100,000 $ 500,000 $600,000$ 33,438 $ 381,848 $218,152 Malawi FS $ 200,000 $200,000$ 80,739 $ 210,605 ($10,605) Benin MAARD $ 50,000 $50,000 $ - $ 49,888 $112 Benin- Malaria MAARD $ 30,000 $30,000 $ - $ 34,826 ($4,826) Ethiopi a Sub Total $ - $ - $ - $ 3,500,000 $ 3,000,000 $ 22,300,000 $ 7,586,000 $ - $ 36,386,000 $ 818,736 $ 29,272,454 $7,113,546 Kenya Sub Total $ - $ - $ - $ 1,737,000 $ - $ 2,194,850 $ 4,496,000 $ - $ 8,427,850 $ 1,254,956 $ 8,247,776 $180,074 Namibia S ub Total $ - $ - $ - $ 835,000 $ 1,177,000 $ 1,742,100 $ 1,970,795 $ 600,000 $ 6,324,895 $ 275,995 $ 6,317,628 $7,267 Rwanda Sub Total $ - $ - $ - $ 1,600,000 $ 665,000 $ 1,938,109 $ 2,809,465 $ 300,000 $ 7,312,574 $ 537,897 $ 7,301,685 $10,889 Senegal S ub Total $ - $ - $ - $ 150,000 $ 150,000 $ - $ - $ 75,000 $ 375,000 $ 25,653 $ 376,880 ($1,880) South Afr ica Sub Total $ - $ - $ - $ 1,000,000 $ 1,400,000 $ 2,550,000 $ 3,600,000 $ - $ 8,550,000 $ 612,504 $ 6,931,466 $1,618,534 Sudan $600,000 $600,000$ 145,748 $ 346,024 $253,976 Tanzania Sub Total $ - $ - $ - $ - $ - $ 1,150,000 $ 1,440,000 $ 150,000 $ 2,740,000 $ 119,500 $ 2,672,185 $67,815 Uganda Sub Total $ - $ - $ - $ - $ - $ - $ 500,000 $ 500,000 $ 1,000,000 $ 209,970 $ 661,911 $338,089 Zambi a Sub Total $ 100,000 $ 280,000 $ 780,000 $ 1,865,000 $ - $ - $ - $ - $ 3,025,000 $ - $ 3,022,733 $2,267 Mission$ 330,000 $ 1,456,389 $ 2,078,750 $ 13,909,500 $ 11,678,831 $ 40,667,059 $ 24,632,217 $ 2,506,990 $ 97,259,736 $ 4,506,502 $ 85,682,509 $11,577,227

ACF Su rplus/(Deficit) ($0) otal $ 3,995,000 $ 7,984,498 $ 11,767,030 $ 24,112,500 $ 24,136,556 $ 49,250,569 $ 31,861,657 $ 2,506,990 $ 155,614,800 $ 6,901,196 $ 139,585,711 Grand T $16,029,089

Country Programs 77 RPM Plus Activities and Products Status Report

Rational Pharmaceutical Management Plus Financial Status Overview Cumulative Expenditure activity through September 30, 2007

Total Funding Received to date: $155,614,800

Total Amount Spent to date: $139,585,711

Pipeline: $16,029,089

Percent of Funds Spent: 89.70%

Cost-Share Earned to Date: +$21,000,000 Target Cost-Share Amount: $21,000,000

Percent of Cost-Share Realized: 100%+

$162,036 $165,000

$160,000 $155,615 $155,615

$155,000

$150,000

$145,000 $139,586

(US$ in 1,000s) $140,000

$135,000

$130,000

$125,000 Current Obligations/Expenditures Current Obligation/Ceiling

Country Programs 78 RPM Plus Activities and Products Status Report

Rational Pharmaceutical Management Plus Program Expenditures through September 30, 2007

RPM Plus Expenditures by Quarter by Fiscal Year

FY06 $9,325 $7,243 $8,659 $6,901 (Oct'06-Sep'07)

FY05 $10,185 $8,334 $8,465 $7,938 (Oct'05-Sep'06)

FY04 $5,948 $6,366 $11,700 $11,650 (Oct'04-Sep'05)

FY03 $3,458 $3,573 $5,454 $4,996 (Oct'03-Sep'04)

$2,251 FY02 $2,130 (Oct'02-Sep'03) $2,155 $2,643 FY01 Quarter 1 (Oct'01-Sep'02) Quarter 2 Quarter 3 FY00 Quarter 4 (Oct'00-Sep'01)

$- $5,000 $10,000 $15,000 $20,000 $25,000 $30,000 $35,000 $40,000

Financial Information RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Global Fund Bottleneck-HIV Year 06 Activity Title Peru - Provide TA to GF primary recipient and assess TB and ARV pharmaceutical and procurement systems.

Activity Manager Citysoft Admin Activity # 3 Task: A1WW06GFH Sub-Task: 60CXH3 Activity Description To facilitate compliance with the identified precedent conditions established by the Global Fund, the requested technical support for the efficient implementation of Global Fund projects in Peru aims to improve the logistics and procurement processes used at MINSA, for selection and procurement of HIV/AIDS and TB health products. As a result of this technical assistance, it is expected that having standardized ART and TB regimens as well as the needed technical pharmaceutical files the procurement system will work more efficiently reducing length of time for acquiring health products from 6 months to 15 working days at the most. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project First trip was conducted January 15 – The stakeholders in country Report of the trip and Year 7 Q4 February 2nd. Terms of Reference for desired an expansion of the recommendation to be this trip were slightly modified based on SoW. Activities requested were finalized by March 30th. communication and feedback from the outside the intentions of this TA MoH. mechanism and not included in the initial budget. Last Updated: 04/10/2007

Thursday, December 20, 2007 3:55 PM Page 1 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Global Fund Bottleneck-HIV Year 06 Activity Title Vietnam - enhance the quality of TB pharmaceutical procurement and management.

Activity Manager Citysoft Admin Activity # 5 Task: A1WW06GFH Sub-Task: 60CXH5 Activity Description Activity 1: Standardize TB procurement process and build capacity and skills of procurement team

MSH/RPM Plus will: -Review existing bidding documents for procurement -Revise biding documents for procurement according to international recommendations and Vietnam national regulation. -Develop training materials to build capacity and skills on procurement including tender process and management, supplier selection, negotiations, contracting, quality assurance etc -Train procurement staff using training materials. Training to include second line TB drugs procurement requirements

Activity 2: Develop standard operating procedures drug distribution, distribution planning and build capacity and skills of TB staff

MSH/RPM Plus will: -Investigate and explore feasibility of rationalizing buffer stock levels -Investigate feasibility of introducing a second inventory records at stores -Develop SOPs for drug distribution processes. Content of SOPs will include; procedures for receiving supplies, inventory management, etc -Review distribution planning guidelines and processes for TB drugs and materials for central, regional, provincial and district levels -Investigate consumption and use of TB materials and equipment -Revise distribution planning guidelines for central, regional, provincial and district levels based on current/planned treatment regimens -Train TB staff on distribution planning process

Activity 3: Strengthen monitoring and evaluation of TB drug management through supervisory visits

MSH/RPM Plus will: -Review M&E process and supervisory checklist at all levels -Revise/include drug management component to M&E for supervisory checklist -Train TB officers to improve M&E for drug management through supervisory checklists Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products

Thursday, December 20, 2007 3:55 PM Page 2 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Global Fund Bottleneck-HIV Year 06 Activity Title Vietnam - enhance the quality of TB pharmaceutical procurement and management.

Project RPM plus conducted a training on TB Another visit to Vietnam in Year 7 Q4 commodity procurement and processes October to develop an to build capacity and skills of NTP and implementation plan for the MOH staff working involved in TB SOPs with NTP and make procurement. Workshop also focused final changes. A workshop on the revised bidding documents on quantification and M&E prepared for TB commodity is also planned in October procurement. This concludes the to build capacity of NTP procurement activity in Vietnam. staff responsible for this activity. RPM plus finalized and translated the guide “TB commodity distribution planning, monitoring and Evaluation: National Tuberculosis Program Guide” which provides stepwise instructions on quantification and distribution planning for TB medicines and laboratory consumables for different service levels in the country. An Excel based estimation tool was also developed to complement the guide. Documents are presently been reviewed by NTP.

Thursday, December 20, 2007 3:55 PM Page 3 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Global Fund Bottleneck-Malaria Year 06 Activity Title Senegal- Assess the pharmaceutical MIS for ACTs and make recommendations

Activity Manager Citysoft Admin Activity # 3 Task: A1WW06GFM Sub-Task: 60C3A3 Activity Description RPM Plus will provide support to the GFATM PR in malaria pharmaceutical malaria management focusing on case management and the tracking of ACT distribution at the health facility and community levels. The initial assessment will be combined with the development and validation of products and measures to improve the ACT tracking system. These activities will be performed by a RPM Plus two person team combined with the WHO team representative(s) and selected representatives from the MOH and partners. Activities will include the following elements:

- Hold working sessions with USAID and the central services of the Ministry of Health (specifically with the PNA - the National Drug Supply Office, SNIGS – National Health Information System and the NMCP) involved in the drug use monitoring system; - Make field visits to selected regions (PRA –Regional Drug Supply Office) and districts (health centers, posts and huts); - Hold a working session with the NMCP to identify next tasks to be accomplished to implement recommendations - Prepare the workshop to share assessment results and validate recommendations. - Hold a sharing workshop with stakeholders; - Prepare an assessment report with the recommendations Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products

Thursday, December 20, 2007 3:55 PM Page 4 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Global Fund Bottleneck-Malaria Year 06 Activity Title Senegal- Assess the pharmaceutical MIS for ACTs and make recommendations

Project RPm Plus provided assistance in None Assess the training needs in Year 7 Q4 developing the SOPs manual on the districts and discuss pharmaceutical management and the with the NMCP on sharing training manual on inventory and stock the training costs. Schedule management. The training manual was training sessions. developed based on the previously developed Community health workers training module. The manuals were validated by the National Committee overseeing the implementation of the GF mission’s recommendations.RPM Plus also supported the NMCP to train/orient the Regional and district teams of Kolda, Ziguinchor and Tambacounda on the SOPs Manual. The meetings provided an opportunity to identify training needs for districts’ pharmacy dispensers.• RPM Plus supported the NMCP to draft TORs for the Long lasting Insecticides nets (LLINs) management workshop intended to define strategies to sustain the availability of LLINs, secure distribution channel and identify data collection mechanisms at the operational level. Last Updated: 10/11/2007

Thursday, December 20, 2007 3:55 PM Page 5 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Global Fund Bottleneck-Malaria Year 06 Activity Title Senegal-Assist in implementing recommendations

Activity Manager Citysoft Admin Activity # 4 Task: A1WW06GFM Sub-Task: 60C3H4 Activity Description This subsequent phase will depend on the identified recommendations (from the pharmaceutical MIS assessment) and level/type of support that will be needed from MAC partners for the implementation. They may include the following elements:

- develop/review the data collection tools for the ACT tracking system, - develop the training materials for the ACT tracking system, - train the trainers using the modules - support the initial training implemented by trainers - provide the necessary technical assistance for data analysis and sharing - assess the functionality of the system once initiated.

Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project Continued to refine the pharmaceutical Traininf on pharmaceutical Year 7 Q4 inventory management guidelines for inventory management heath centers and posts. Represented guidelines for health centers RPM Plus in a workshop to discuss the and posts findings of feasibility studies on RDT use in the health system by the Dakar University. The study supports the use of RDTs in the health system to diagnose malaria Last Updated: 10/11/2007

Thursday, December 20, 2007 3:55 PM Page 6 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Global Fund Bottleneck-Malaria Year 06 Activity Title DRC-Strengthen selected sentinel sites, antimalarial supply management and develop M&E plan.

Activity Manager Citysoft Admin Activity # 5 Task: A1WW06GFM Sub-Task: 60CXH5 Activity Description The full success of the grant requires improvement of the Health System, capacity building and of the PNLP and central, intermediate and local levels, and the strengthening of the M&E system. This activity aims to- 1. Undertake an initial diagnostic for problems analysis with a focus on organizational development and strategic vision of the CCM, the NMCP and its implementing partners.

2. Provide guidelines to set up the surveillance sentinel sites and to improve the existing sites.

3. Help develop strategy to get the private sector involved in the process.

4. Help strengthen the drug (ACTs) and supply management system

5. Help develop a Monitoring and Evaluation Plan with a data base system Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project During this quarter, RPM Plus assisted TA to quantification training Year 7 Q4 the PNLP and the Drug regulatory for GFATM supported authority to organize a workshop for the zones. private sector involvement in ACT policy implementation and monotherapy ban Technical meeting with the workshop report including private sector to recommendations was finalized. The communicate the deadline division of pharmacy, medicines and for monotherapies use medical plants was assisted to organize meeting to communicate the interdiction of the monotherapy drug use against uncomplicated malaria. Assistance was also provided to the PNLP to develop training materials on quantification for GFATM supported Health zones and to plan for the training Last Updated: 10/11/2007

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Workplan: Global Fund Bottleneck-Malaria Year 06 Activity Title Mali- Provide TA to Global Fund recipients and Sub-Recipient to develop management and procurement plans for malaria

Activity Manager Citysoft Admin Activity # 6 Task: A1WW06GFM Sub-Task: 60C2H6 Activity Description RPm Plus will provide TA to Global Fund recipients and Sub-Recipient to develop management and procurement plans for malaria commodities Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project RPM Plus supported the PPM to plan None Develop invitations to tender Year 7 Q4 for ACT and RDT procurement using GF round 6 phase 1 malaria grants. In addition to discussing with the PPM team, RPM Plus collected useful information needed for quantification of ACTs and RDT Last Updated: 10/11/2007

Thursday, December 20, 2007 3:55 PM Page 8 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Mainstreaming Initiative Year 06 Activity Title Develop training materials based on the Health System Assessment approach tool.

Activity Manager Citysoft Admin Activity # 3 Task: A1WW06MNS Sub-Task: 60AXE3 Activity Description Training materials will be developed based on the HSA mnaual. Among the potential formats are e-learning courses and face-to-face training. The materials will be developed in collaboration with HS 20/20. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project Draft has been submitted for review by Revision and finalization of Year 7 Q4 USAID and HS 20/20. A draft has also current draft will be done be critiqued by the E-Learning program. after receiving comments from reviewers. After final review, materials will be submmitted to USAID E- learning progam for uploading. Last Updated: 10/04/2007

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Workplan: Maternal Health Year 05 Activity Title Provide technical assistance on pharmaceutical management components of the POPPHI Global Survey.

Activity Manager McCollum, Jennifer Activity # 3 Task: A1WW05RPH Sub-Task: 60F5H3 Activity Description Continuing collaboration with POPPHI partners, RPM Plus will continue to support the POPPHI Global Survey of current AMTSL practices in West Africa. Through this process, RPM Plus will identify potential areas for technical assistance to improve the availability and management of uterotonics. This activity will take place throughout the year. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project Data collection for the AMTSL Study Year 7 Q4 was completed in July. The process of data cleaning and analysis has begun. The Study Coordinator will be collaborating with the Benin Study Coordinator and the Global AMTSL Study Principal Investigator to conduct a complete audit and analysis of data in October. Last Updated: 09/28/2007

Thursday, December 20, 2007 3:55 PM Page 10 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Maternal Health Year 05 Activity Title Working with local government and professional institutions to provide technical assistance in pharmaceutical management of

Activity Manager Leopold, Jennifer Activity # 4 Task: A1WW05RPH Sub-Task: 60F5A4 Activity Description RPM Plus will work with national MoH, USAID and partners to facilitate a national dissemination of study findings. In coordination with POPPHI partner intervention initiatives, RPM Plus will identify needs for technical assistance in proper management of uterotonics necessary for AMTSL.

Assistance may include workshops for health providers in commodity management of uterotonics; the development and distribution of job aids, for the storage and use of uterotonics in addition to other activities to improve the availability and use of high-quality medicines to prevent postpartum hemorrhage.

This will be a mid-term activity. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project On July 18, RPM Plus in coordination Awaiting DSF validation of Year 7 Q4 with PATH/POPPHI, USAID Benin and the Stakeholder's the MoH/Division of Family Health (DSF) recommendations for presented AMTSL study findings to in 39 improved practice of stakeholders working to promote AMTSL AMTSL. In coordination with in Benin, including international POPPHI and PISAF, RPM organizations and MoH representatives. Plus is also planning to A number of recommendations were disseminate study findings agreed upon and are yet to be validated to health care providers - by the Director of the DSF. getting their input to key cause for gaps identified. During this visit, RPM Plus and POPPHI Tentative dates proposed also met individually with a number of for mid November. key partners working in Benin including, MoH/DSF and CAME (Central Medical Stores), PSI, WHO, UNICEF, UNFPA, URC/QAP and URC/PISAF.

The Benin Study Report has been finalized and will be translated into English. Last Updated: 09/28/2007

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Workplan: Maternal Health Year 06 Activity Title Support implementation of interventions in two to four selected countries to improve the management of uterotonics in support of

Activity Manager Leopold, Jennifer Activity # 2 Task: A1WW06RPH Sub-Task: 60F5H2 Activity Description In addressing these challenges, RPM Plus will work with the MoHs and partner agencies currently working to expand AMTSL to support their current efforts. This may include working at the national and/or the facility level, with the central medical stores to improve storage practices and estimation of needs, providing assistance with facility-level quantification and training, and incorporating pharmaceutical management issues in pre- and in-service training of care providers. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project July 22-27, RPM Plus visited Mali to RPM Plus will continue to Year 7 Q4 follow up on previous discussions give support to DSR in surrounding how to address gaps coordination with other identified in the management of partners, in the following uterotonics. While in Mali, RPM Plus areas: met with the MOH (DPM, PPM, and 1.development of protocols Division of Reproductive Health) and for storage and use of with partners IntraHealth, PATH, ATN, uterotonics in the delivery and CARE. room, 2.quantification of the needs on uterotonics as the program will expand, and 3.development of training materials and training of health workers on uterotonics management. Last Updated: 09/12/2007

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Workplan: Child Survival Year 01 Activity Title Revision of the DMCI Tool.

Activity Manager Adeya, Grace Activity # 2 Task: A1WW01CHS Sub-Task: 60F6K2 Activity Description RPM Plus has planned to develop a more simplified DMCI tool for use at district level. The national DMCI assessment tool needs some revising to make it easier to follow and apply. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project This quarter, the revisions on the district RPM Plus will finalize the Year 7 Q4 DMCI are almost complete. Final revisions to the D-DMCI and revisions and editing are underway. DMCI tools. Last Updated: 09/28/2007

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Workplan: Child Survival Year 03 Activity Title Developing interventions guide to improve child survival drug management at community level

Activity Manager Adeya, Grace Activity # 3 Task: A1WW03CHS Sub-Task: 60F6K3 Activity Description A guide to interventions is being developed in order to orient district managers as well as policy makers, in the selection and development of interventions to improve availability and use of medicines in the community. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project This quarter, the final draft version of the The guide will be finalized Year 7 Q4 Interventions Guide was completed by after incorporation of RPM Plus and Harvard and sent to comments from the World World Health Organization staff for a Health Organization review. final review. Additionally, the draft will be reviewed by field staff to incorporate perspectives from the field. Last Updated: 09/28/2007

Thursday, December 20, 2007 3:55 PM Page 14 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Child Survival Year 03 Activity Title Implement community drug management interventions in the LAC region

Activity Manager Adeya, Grace Activity # 7 Task: A1WW03CHS Sub-Task: 60F6H7 Activity Description RPM Plus will follow up on the C-DMCI assessment conducted in Peru in 2003 with a strategy planning workshop to assist program planners in the country to select and develop appropriate interventions to improve community drug management for childhood illnesses. After the selection of appropriate interventions, RPM Plus will continue to work with partners in country and provide technical assistance to guide the development, planning and implementation of the interventions, through, for example, the provision of training materials and sharing of tools and experiences from other countries.

RPM Plus has been requested by PAHO to provide technical assistance to their program of PMTCT/IMCI integrated activities in Latin America. In collaboration with PAHO, specific activities will be determined from these proposals and technical assistance provided by RPM Plus where necessary. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project This quarter, the English version of the The Spanish version of the Year 7 Q4 Peru C-DMCI report was completed. Peru C-DMCI report has This budget line is now closed. already been disseminated to partners and stakeholders. RPM Plus will follow up in country as necessary to see if results from the C-DMCI assessment have been applied to guide intervention development. This budget line is now closed. Last Updated: 10/04/2007

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Workplan: Child Survival Year 04 Activity Title Develop drug management training in support of IMCI

Activity Manager Adeya, Grace Activity # 4 Task: A1WW04CHS Sub-Task: 60F6M4 Activity Description Improve availability and use of drugs for child health in areas where IMCI is implemented. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project This quarter, RPM Plus contributed to The district DMCI tool will Year 7 Q4 collaborate with the World Health be completed and RPM Organization, commenting on draft Plus will continue to follow materials and sharing training materials up with WHO specific to pharmaceutical management. representatives on ongoing RPM Plus staff reviewed and provided collaborative activities. feedback on the draft training material to Refer to A1 AB04CHS assist child health program managers 60F6H3 for additional being developed by the World Health information on collaborative Organization. activities with WHO AFRO. The store management module developed by RPM Plus that was added onto the IMCI training in Senegal was shared with WHO to use as a reference as WHO revises the IMCI training. In addition, revisions advanced on the district DMCI tool. For more info on RPM Plus collaboration with WHO AFRO please refer to A1 AB04CHS 60F6H3. Last Updated: 09/28/2007

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Workplan: Child Survival Year 05 Activity Title Private sector initiates - Tanzania

Activity Manager Adeya, Grace Activity # 2 Task: A1WW05CHS Sub-Task: 60A2H2 Activity Description RPM Plus will work with partners to implement a package of interventions focused on child health as part of the Accredited Drug Dispensing Outlet (ADDO) program in Tanzania. The package consists of community demand creation, capacity building to improve quality of care provided at outlets, oversight and regulation and monitoring and evaluation. RPM Plus will work with the BASICS project on the implementation of this package. The child health package (IMCI in the ADDOs), once it has been developed and evaluated, will be incorporated into the national ADDO program. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project This budget line is now closed. Refer to A1WW06CHS Year 7 Q4 Continuing private sector activities in 60C5H2, “Support for Tanzania are reported under ADDO program in A1WW06CHS 60C5H2, “Support for Tanzania” for ongoing ADDO program in Tanzania”. activities. This budget line is now closed. Last Updated: 10/05/2007

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Workplan: Child Survival Year 05 Activity Title Assist BASICS in the roll-out of zinc in Madagascar

Activity Manager Adeya, Grace Activity # 7 Task: A1WW05CHS Sub-Task: 60BXH7 Activity Description As Madagascar is planning on implementing a community case management program for diarrhea (including zinc treatment) as well as ARI and malaria, a baseline survey is proposed, using an adapted version of the C-DMCI, to collect information on current drug use practices of facilities and the community, leveraging funds from BASICS & the RPM Plus malaria portfolio. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project This quarter, the trip report for the This budget line is closed. Year 7 Q4 Madagascar visit to estimate the For continuing activities requirements for pharmaceutical involving zinc refer to products used for the management of A1WW06CHS 60BXH6, “TA malaria and other childhood illnesses to roll-out zinc”. conducted in February 2007 was completed and shared (refer to A1 MG05MAC 60F4H1 for more information and to see the trip report). This budget line is now closed. For continuing activities related to zinc roll out refer to A1WW06CHS 60BXH6, “TA to roll-out zinc”. Last Updated: 10/02/2007

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Workplan: Child Survival Year 06 Activity Title Technical Activity coordination and monitoring

Activity Manager Adeya, Grace Activity # 1 Task: A1WW06CHS Sub-Task: 97XXY1 Activity Description This activity includes technical activity coordination, workplan development, budget monitoring, progress monitoring, reporting, meetings, and communications with partners and collaborators. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project This quarter, standard reporting RPM Plus will ensure all Year 7 Q4 continued. A review of products was products are cited in the conducted to ensure that all products Strategic Monitoring System are cited on the network drive and in the and labeled properly on the Strategic Monitoring System. In addition, network drive. In addition, the RPM Plus annual meeting was held. the FY 07 workplan will be During the meeting technical staff finalized. involved with child health activities met to discuss current activities and progress and to plan next steps in the context of RPM Plus completion and the beginning of the follow-on SPS program. Meetings were held with the maternal and child health team within RPM Plus to begin discussions on the implication of merging the maternal and child health portfolios under the SPS program. Last Updated: 10/04/2007

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Workplan: Child Survival Year 06 Activity Title Support for ADDO program in Tanzania

Activity Manager Adeya, Grace Activity # 2 Task: A1WW06CHS Sub-Task: 60C5H2 Activity Description RPM Plus will continue to support TFDA and other stakeholders in developing an implementation model for the ADDO program that is capable of nation-wide implementation. Specifically this year, there will be a focus on integrating the ADDO child survival training module into the ADDO training for roll-out, but also on catch up training on those regions where ADDO has been implemented without the child survival component (expected to be Morogoro,district). In conjunction with BASICS, RPM Plus will ensure the use of appropriate job aids by the dispensers and support information, education and communication (IEC) interventions at community level to promote use of the ADDOs. A follow-up evaluation (a repeat of the quantitative baseline conducted in September 2006) will be required to evaluate the child survival package. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products

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Workplan: Child Survival Year 06 Activity Title Support for ADDO program in Tanzania

Project This quarter, activities progressed in RPM Plus will technically Year 7 Q4 Tanzania related to the integration of the review the English version child health component into the ADDO of the child health training program. A total of 642 ADDO materials and complete the dispensers, 21 regional Council Health entire package of ADDO Management Team (CHMT) members materials in English for and 3 national representatives were dissemination to partners trained in 5 districts of the Morogoro interested in private sector region. In three of these districts, the interventions. In child health training was conducted coordination with BASICS, alone, because the dispensers had schedule the next round of previously received the core ADDO radio media workshops training. In two districts, RPM Plus focused on key child health supported the Ministry of Health and messages related to acute Social Welfare to conduct an integrated respiratory infections and training which included the child health diarrhea management. session as the sixth module of the complete ADDO training package. The ADDO curriculum will now be taught with the integrated child health session for all subsequent roll out activities. During the trainings, patient referral forms were distributed for use as well as educational materials (fliers and posters) focusing on key child health messages. The current version of the child health session has been translated into English for final review of technical content by RPM Plus staff. The baseline quantitative report on the ADDO program has been completed, and extensive comments were submitted to BASICS for completion of the qualitative report. A report has been drafted and revised detailing the process of integration for the child health component into the ADDO program. Supervision visits to ADDOs began in two regions (Ruvuma and Morogoro) using a revised supervision form. Supervision teams are composed of members from RPM Plus and the Ministry of Health and Social Welfare. Eight radio spots focusing on key

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Workplan: Child Survival Year 06 Activity Title Support for ADDO program in Tanzania

malaria messages related to child health that had been developed last quarter as part of the radio media workshop began being aired to a regional audience in Ruvuma. In addition to country level activities, RPM Plus developed and submitted a proposal outline titled “Training a new class of private-sector health care providers to improve pharmaceutical services in underserved areas: the ADDO experience in Tanzania” for consideration for the WHO and the journals Education for Health and Human Resources for Health. Reviewer comments were received and a revised outline has been resubmitted for consideration. Last Updated: 10/05/2007

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Workplan: Child Survival Year 06 Activity Title Support for Private Sector Initiatives in Cambodia

Activity Manager Adeya, Grace Activity # 3 Task: A1WW06CHS Sub-Task: 60C5H3 Activity Description The SO3 funding will be used for the adaptation of the materials and approaches used in Tanzania and Senegal to the Cambodia setting and the initial implementation of these materials and approaches in priority regions in Cambodia, as agreed with the Mission. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project At the request of the USAID Mission in The USAID Mission in Cambodia RPM Plus will follow up with Year 7 Q4 Cambodia, current activities continue to has put a hold on current USAID on the status of the be on hold until an internal review is activities until an internal review internal review before completed of activities underway in is completed. progressing with activities. Cambodia. Last Updated: 10/02/2007

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Workplan: Child Survival Year 06 Activity Title Other Private Sector Initiatives

Activity Manager Adeya, Grace Activity # 4 Task: A1WW06CHS Sub-Task: 60A2H4 Activity Description In Senegal, RPM Plus will continue to support the MoH and syndicate of pharmacists to set up and establish a regular supervision mechanism to monitor the performance of the sales assistants in private pharmacies. The intervention package of training and follow-up will be evaluated.

In addition, RPM Plus will continue to build from initial assessment trips and the evaluation of home based management of malaria in Rwanda. In collaboration with partners (particularly BASICS), RPM Plus will further investigate and develop a private sector strategy to improve child health services in the private sector, where appropriate. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project This quarter, planning advanced to In Senegal, key partners involved In Senegal, the consultant Year 7 Q4 continue private sector activities in in private sector activities have will lead private sector Senegal. The final report of the private been unavailable to discuss ways activities to investigate sector counter assistant’s trainings was forward due to conflicting progress and impact of the completed. A consultant who had been priorities, changing of key staff, trainings provided to 290 involved in the private sector trainings and busy workloads. In addition, private sector counter was contacted and agreed to lead the the desired consultant was assistants. In Rwanda, private sector follow-on work to solicited for activities with another RPM Plus will continue to investigate progress and track the organization. monitor in country needs impact of the training which was related to private sector provided to 290 private sector counter interventions. In addition, assistants. A scope of work and budget the systematic review of are under development to cover two private sector interventions teams of surveyors that will be will be finalized. evaluating selected pharmacies in the regions where the training occurred.

In Rwanda, RPM Plus continued discussions with in country staff on potential development of private sector interventions as part of the President’s Malaria Initiative (PMI) activities. Currently, private sector interventions are not a priority in country and there is not interest to move forward. Last Updated: 10/04/2007

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Workplan: Child Survival Year 06 Activity Title Community Case Management of ARI, malaria and diarrhea

Activity Manager Adeya, Grace Activity # 5 Task: A1WW06CHS Sub-Task: 60EXH5 Activity Description Technical assistance will be focused on the development of programs targeted in specific countries and training materials for community agents, pharmaceutical distribution systems, and ongoing monitoring, supervision and evaluation mechanisms. Where possible, the new WHO recommendation will be applied into practice emphasizing that a three day course of antibiotics is sufficient, minimizes cost and facilitates compliance. Collaboration will continue with partners to accelerate the CCM global agenda and scale-up of CCM activities including support to CORE group initiatives as appropriate. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project This quarter, RPM Plus continued RPM Plus will finalize the Year 7 Q4 involvement with the CORE group in the management of medicines development of the Community Case chapter for the Community Management (CCM) Essentials Guide. Case Management (CCM) Drafts of each chapter, including the Essentials Guide. For more management of medicines chapter information on CCM developed by RPM Plus have been activities in DRC please posted for authors to access and review. refer to A1 AB03CHS RPM Plus will review the drafts and 60E3H5, “Support to CCM submit necessary changes before the in DRC”. draft chapters are shared with the field for testing and feedback before finalization. For more information on CCM activities in DRC please refer to A1 AB03CHS 60E3H5, “Support to CCM in DRC”. Last Updated: 10/05/2007

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Workplan: Child Survival Year 06 Activity Title TA to roll-out zinc treatment

Activity Manager Adeya, Grace Activity # 6 Task: A1WW06CHS Sub-Task: 60BXH6 Activity Description Technical assistance will be provided as needed in developing, reviewing and revising treatment guidelines, assessment tools, and supervision and evaluation mechanisms to facilitate the implementation and sustainability of zinc treatment for diarrhea management at the global and national levels. This TA will be targeted at focus countries as indicated by USAID, the Zinc Task force or other partners in the implementation of zinc roll-out such as BASICS and A2Z.

At the country level, RPM Plus will continue to collaborate with partners in DRC, to provide technical assistance in the form of reviewing national job aids, training, advocacy and dissemination materials, and developing standardized assessment, supervision, evaluation and monitoring tools to evaluate the feasibility and track the introduction of zinc in country. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products

Thursday, December 20, 2007 3:55 PM Page 26 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Child Survival Year 06 Activity Title TA to roll-out zinc treatment

Project This quarter, barriers to zinc registration RPM Plus will continue to Year 7 Q4 which have been identified as the main provide support to cause of delay in implementation advancing zinc treatment activities were discussed in meetings roll-out in appropriate with USAID Washington and countries including Benin, representatives from Benin, Ethiopia, Ethiopia, Uganda, Nepal, Uganda, Nepal, Tanzania and DRC. A Tanzania and DRC. In meeting with Nutriset, the main global addition to working with supplier of zinc has been scheduled in specific countries, RPM France with USAID and RPM Plus for Plus will continue early next quarter to discuss some of the discussions with Nutriset registration challenges. At the regional regarding registration level, USAID and RPM Plus agreed to issues. hold a workshop in Eastern Africa to bring together medicine regulatory authorities of interested countries to discuss developing common criteria for zinc registration. At the country level, in DRC forms were developed and reviewed for reporting adverse effects and to monitor the use of zinc treatment within health facilities. RPM Plus provided technical input to develop materials for health workers in the community and at the facility level for training on zinc treatment as part of diarrheal disease case management. A series of technical meetings were held to discuss the review of the national Essentials Medicine List, which will consider inclusion of zinc treatment and the new formula ORS. In Tanzania, RPM Plus participated in a meeting of the national zinc task force. Items discussed included: reviewing the progress of the country plan for national adoption of zinc treatment, reviewing results of formative research conducted in country, sharing experiences with zinc introduction in other countries, and strategizing next steps towards scale up of zinc treatment. Last Updated: 10/05/2007

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Workplan: Child Survival Year 06 Activity Title Commodity tracking tool

Activity Manager Adeya, Grace Activity # 7 Task: A1WW06CHS Sub-Task: 60CXJ7 Activity Description RPM Plus will continue to work the PMNCH as needed, and specifically within the Monitoring and Evaluation working group, to investigate the most appropriate methodology to measure and monitor progress in child health at the country level. If necessary, RPM Plus will revise the current commodity tracking tool to be used at the country level. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project This quarter, RPM Plus continued to RPM Plus will continue to Year 7 Q4 follow up regarding the applicability of explore the applicability of the commodity tracking tool. It appears the commodity tracking tool that commodity tracking may not be a for resource tracking priority for USAID Child Health funds. purposes. Last Updated: 10/05/2007

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Workplan: Child Survival Year 06 Activity Title Mainstreaming pharmaceutical management into the global child survival agenda

Activity Manager Adeya, Grace Activity # 8 Task: A1WW06CHS Sub-Task: 60F6H8 Activity Description RPM Plus will continue to work in coordination with WHO (HQ and AFRO) and UNICEF to integrate aspects of pharmaceutical management into the revisions of the IMCI package and training materials, and the monitoring and evaluation tools. RPM Plus will also work with BASICS, the CORE group and PVOs to assure the soundness of the pharmaceutical management aspects of their activities. Advocacy will continue with WHO Geneva using evidence and experience from RPM Plus’ collaborative work with WHO AFRO to push for incorporation of pharmaceutical management as a standard component in IMCI trainings and surveys across the board, in all countries. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products

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Workplan: Child Survival Year 06 Activity Title Mainstreaming pharmaceutical management into the global child survival agenda

Project This quarter RPM Plus continued to RPM Plus will continue to Year 7 Q4 increase involvement with the advocate for inclusion of Partnership for Maternal, Newborn and pharmaceutical Child Health (PMNCH). RPM Plus joined management in key child the general membership of the Country health strategies, Support Working Group and also documents, and programs. nominated a MSH candidate for an open At the international level, seat on the PMNCH Board for an NGO RPM Plus will continue to representative. RPM Plus participated actively investigate how to during a PMNCH Update meeting (July contribute towards the 20, 2007) in Washington DC to learn Partnership for Maternal about the current status of working Child and Newborn Health groups and activities and discuss the (PMNCH) working groups. possible role of RPM Plus within the Country Support Working Group. In addition to activities related to the PMNCH, RPM Plus staffed reviewed and provided feedback on the World Health Organization’s first draft of a model list of essential medicines for children as well as providing input to USAID for them to provide feedback on the WHO proposed list of research priorities related to child health medicines. RPM Plus continued to collect key child health journal articles and technical documents for dissemination of the monthly child health update as well as update the RPM Plus website as appropriate. A poster was drafted for the annual APHA conference (for more information refer to A1 AB03CHS 60F6F4) for presentation early next quarter. Last Updated: 10/05/2007

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Workplan: HIV/AIDS Year 05 Activity Title Update the VCT Planning Guide

Activity Manager Walkowiak, Helena Activity # 10 Task: A1WW05HIV Sub-Task: 60EXE0 Activity Description Originally planned using FY03 funding, the review and update of the document is now being done in FY05. The aim of the document is to provide practical guidance on commodity management issues related to establishing, managing and scaling up testing and counseling programs.The document will be completed and disseminated. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project The second draft of the document was Our partners FHI have been Our partners FHI, will Year 7 Q4 prepared and submitted to FHI for their extremely busy with travel this forward their updated review and contributions at the end of quarter. sections and comments at April 2007. RPM Plus and FHI met to the begining of October review comments from FHI and identify 2007. The updated changes needed to complete the document should be document in July 2007 finalized by the end of 2007. Last Updated: 09/28/2007

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Workplan: HIV/AIDS Year 05 Activity Title Work with USAID, the World Bank, the World Health Organisation, the Global Fund for AIDS, TB and Malaria (GFATM) and other

Activity Manager Ndyanabangi, Bannet Activity # 4 Task: A1WW05HIV Sub-Task: 60F2H4 Activity Description RPM Plus will continue to work with USAID/OHA in collaborating with international agencies including UNAIDS WHO,GFATM, the World Bank and other donors and organizations to exchange information related to HIV/AIDS health commodity management and to identify opportunities for collaboration to address health commodity management issues. These may include collaborating on assessments, follow-on health commodity management technical assistance and training and assisting countries to scale-up activities. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products

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Workplan: HIV/AIDS Year 05 Activity Title Work with USAID, the World Bank, the World Health Organisation, the Global Fund for AIDS, TB and Malaria (GFATM) and other

Project RPM Plus continued to contribute to the In the next quarter, RPM Year 7 Q4 development of an “Operations Manual Plus will continue to work for Delivery of HIV Prevention, Care and with the WHO-USG expert Treatment at Primary Health Centres in committee on Supply High Prevalence, Resource Constrained Management to finalize the Settings” and accompanying country document. RPM Plus will “Adaptation Guide” as part of a WHO- also assist UNICEF in USG collaboration around the scale-up finalizing the WHO/UNICEF of HIV services in resource-constrained publication “Programming settings of high HIV prevalence. Framework to Scale up Activities in this quarter include Pediatric Care, Support and reviewing and commenting on the drafts Treatment in Resource- of all ten chapters of the Operations Constrained Settings” and Manual and the second draft of the provide input into Supply Management chapter of developing a document that Adaptation guide and sharing tools and looks at scaling up access approaches developed by RPM Plus to to Cotrimoxazole Preventive support PEPFAR-funded programs. Therapy (CPT) in HIV Exposed and Infected Also in this quarter RPM Plus continued Infants and Children to work with UNICEF to assist in finalizing the WHO/UNICEF publication “Programming Framework to Scale up Pediatric Care, Support and Treatment in Resource-Constrained Settings.” RPM Plus was invited to join a new working group formed to provide input in and direction to the “Interagency Task Team (IATT) on the Prevention of HIV Transmission to Pregnant Women, Mothers, and their Children” on issues specific to essential health services for children, including access to HIV care and treatment. A two-day meeting was held at the end of July to agree the terms of reference for the group and the first task was to review the programming framework. RPM Plus revised the section on Supply Management, one of the six strategic components of the document to incorporate feedback from the group.

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Workplan: HIV/AIDS Year 05 Activity Title Work with USAID, the World Bank, the World Health Organisation, the Global Fund for AIDS, TB and Malaria (GFATM) and other

Last Updated: 09/28/2007

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Workplan: Antimicrobial Resistance Year 06 Activity Title Technical Activity Montioring and Coordination

Activity Manager Joshi, Mohan Activity # 1 Task: A1WW06AMR Sub-Task: 97XXY1 Activity Description This activity includes technical activity coordination, work plan development, budget monitoring, progress monitoring, meetings, and communications with partners and collaborators. It will also include updating of the RPM Plus Strategic Monitoring System (SMS) with quarterly progress reports and the MSH/RPM Plus AMR website. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products

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Workplan: Antimicrobial Resistance Year 06 Activity Title Technical Activity Montioring and Coordination

Project - AMR website further updated None - Further update the AMR Year 7 Q4 - Communications with in-country section of the MSH/RPM partners in Swaziland, Zambia, Plus website in order to Tanzania, South Africa and Namibia make it as complete as continued to support progess on various possible before the RPM activities. Plus project comes to an - Coordination with Links Media and end. APUA was maintained for journalist - Finalize all tools and training on AMR in Ethiopia in early documents, pass them October. through the CPM Editorial - AMR Portfolio increased link with SAIDI Team, and activity by participating in the SAIDI archive/disseminate before Steering Committee Meeting in RPM Plus closing. September. - During this quarter the AMR portfolio did technical reviews of and provided feedback on several documents in response to ad hoc requests from USAID. - Based on suggestions from RPM Plus CTO, the RPM Plus AMR team developed a draft write-up on "economic consequences of antimicrobial resistance on health systems." The draft is undergoing further revision and will soon be submitted to the CTO. - RPM Plus's AMR budget tracking was carefully maintained as the project is approaching its closing period. - In order to prepare for RPM Plus closing, efforts were intensified towards finalizing all tools and documents developed by the AMR Portfolio under this project. Last Updated: 10/02/2007

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Workplan: Antimicrobial Resistance Year 06 Activity Title Finalize the manual “How to Investigate Antimicrobial Drug Use in Hospitals”

Activity Manager Green, Terry Activity # 10 Task: A1WW06AMR Sub-Task: 60F1E0 Activity Description A team of investigators led by local experts (potentially including those who have attended past DTC courses) will carry out research on antimicrobial use in hospital settings in at least two countries using the manual “How to Investigate Antimicrobial Use in Hospitals: Selected Indicators,” developed by RPM Plus. From the findings, hospitals can investigate causes and design cost effective interventions using the tool to monitor progress and evaluate the interventions. Field test of the draft manual in more hospitals will also allow further revision and finalization of the tool. Once finalized the tool will be widely disseminated. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project Contracting with Dr. Dumba for the field Identifying a high quality - Monitor field test progress Year 7 Q4 test has been completed and an investigator who has the time to in Uganda. advance has been sent to him for initial manage the field test has been a - Continue search for a services and expenses. Dr Ddumba challenge from the beginning of second investigator to field has completed the hiring of a team for this project. The search for a test the manual. the Uganda field test of the manual and second investigator continues. indicators. Final plans have been developed and the field test has started at Mulago Hospital in Kampala. Two other hospitals will also be included in the next month. Last Updated: 10/01/2007

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Workplan: Antimicrobial Resistance Year 06 Activity Title Support SAIDI to advance AMR advocacy and containment

Activity Manager Yeager, Beth Activity # 11 Task: A1WW05AMR Sub-Task: 60F1H6 Activity Description The AMR Portfolio will consolidate the RPM Plus contribution to SAIDI by leveraging further support for APUA to expand and build on FY05 activities. APUA Headquarter will continue to use existing APUA country chapters to work with SAIDI working groups to disseminate AMR information. All three SAIDI countries currently have APUA chapters whose representatives are part of the local SAIDI stakeholder group. Through the AMR Portfolio’s support, APUA will continue to work and strategize with stakeholders and opinion leaders to strengthen local SAIDI groups. In collaboration with selected SAIDI international and national partners, APUA will provide technical assistance in surveillance, assessment and development of country specific AMR plans as well as provide training on Risk Perception and Communication in AMR alert. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products

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Workplan: Antimicrobial Resistance Year 06 Activity Title Support SAIDI to advance AMR advocacy and containment

Project This quarter APUA-HQ technical staff National chapters have been slow The specific Year 7 Q4 (Anibal Sosa) worked with APUA in submitting adequately detailed recommendations for Chapters in Peru, Paraguay and Bolivia work plans and budgets for the national chapters discussed to develop workplans for activities that proposed activities. Since the during the SAIDI steering would contribute to overall SAIDI national chapters are not legal committee meeting will be activities in each of the three countries. entities, getting funding for the shared with Chapter leaders In Peru, APUA Chapter members planned activities to chapter so they can submit new assisted SAIDI national partners in members has been a challenge. workplans. Dr. Sosa will reviewing standard treatment guidelines travel to Peru in mid- for respiratory infections in children October to work with the under 5, for use in the Callao Health local chapter and participate Directorate. In Paraguay, APUA in a communications Chapter members worked with the SAIDI planning meeting led by communications team to identify Links Media. opportunities for collaboration. In Bolivia, APUA Chapter leadership met with national stakeholders to collect information and identify opportunities for information sharing. In addition, Dr. Sosa represented SAIDI international partners in August at the IX Congress of South American Pharmacists in Asuncion, Paraguay. SAIDI national partners from Peru and Paraguay also presented on SAIDI progress to date. Dr. Sosa also participated in the SAIDI steering committee meeting held in Arlington, VA on September 27 – 28, 2007. Last Updated: 10/01/2007

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Workplan: Antimicrobial Resistance Year 06 Activity Title Develop a training session on AMR for USAID’s global health E-learning Center

Activity Manager Citysoft Admin Activity # 12 Task: A1WW06AMR Sub-Task: 60F1MB Activity Description RPM Plus will develop a module for the USAID Global Health E-Learning Center. For this, relevant background information will be collected and analyzed and priority AMR-related topics identified as key elements to be included in the sessions. Based on these materials the CPM Training Unit will develop the session. The session will then be reviewed internally for content and technical accuracy before finally submitting to USAID. Utilization of this internet-based resource is expected to improve awareness and understanding of AMR amongst USAID PHN officers in missions and staff at USAID/Washington, its Cooperating Agencies (CAs), and others. The activity will also contribute to the much needed global attention and advocacy for AMR Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project A Draft of AMR Module 1 was submitted Multiple e-learning projects - Complete graphic search Year 7 Q4 to USAID and was approved by Jim compete with the priorities of the for Module 2. Shelton, Science Advisor for the Bureau RPM Plus training staff. - Draft pre and post test of Global Health and then forwarded to questions. the E-learning website developers. An - Submit Module 2 draft for initial discussion was held with Chris USAID review. Davis, the USAID Global E-learning - Complete uploading of Center Coordinator to plan next steps for Module 1 into the online getting the module on the web. A further template, user test, and training session was scheduled and submit for review. work has begun in putting the content into the online template. Module 2 continues to be edited and graphics are being sought. Last Updated: 10/02/2007

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Workplan: Antimicrobial Resistance Year 06 Activity Title Compile and Disseminate Lessons Learned from RPM Plus AMR Portfolio Activities

Activity Manager Joshi, Mohan Activity # 13 Task: A1WW06AMR Sub-Task: 60F1FC Activity Description RPM Plus will produce a lessons learned report that will be submitted to USAID. The report will serve as a comprehensive documentation of lessons learned from RPM Plus’ AMR containment efforts. It will inform relevant global, regional and in-country AMR stakeholders about the key progresses made, challenges encountered, and practical lessons understood to guide potential future work, thus supporting the much required international advocacy and coordination on AMR. The report will also form a basis for recommendations to USAID for potential future support of high priority AMR areas. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project - This activity was initiated in the this None - Revise and expand the Year 7 Q4 (last) quarter of FY06 in order to capture draft including more recent the progress made in the current fiscal accomplishments. year as well. - Finalize document and - A framework for the lessons learned disseminate. document was developed. Activity leads drafted and submitted lessons for each activity area. These were compiled along with overview and background material developed from a review of the literature. A lessons learned matrix was then developed to identify common themes among activities in order to come up with over all lessons learned for the AMR portfolio. Putting all these pieces together, a preliminary draft subsequently prepared. Last Updated: 10/02/2007

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Workplan: Antimicrobial Resistance Year 06 Activity Title Implement a country-level AMR advocacy and containment program

Activity Manager Goredema, Wonder Activity # 2 Task: A1WW06AMR Sub-Task: 60AXP2 Activity Description In FY06 activities in Zambia will be further advanced. In Ethiopia, recommendations generated at the November 2006 Call to Action Workshop in Adama will be utilized to strategize further AMR containment and advocacy activities. Drawing from the ongoing experiences in Zambia and Ethiopia, the approach will be initiated in a third country. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products

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Workplan: Antimicrobial Resistance Year 06 Activity Title Implement a country-level AMR advocacy and containment program

Project Progress was made during this quarter Competing in-country priorities in • In Zambia, RPM Plus will Year 7 Q4 towards finalizing RPM Plus tools Ethiopia have caused some delay continue collaboration with developed to complement the country- in progress towards the AWG and other in-country level AMR approach: (1) The AMR establishment the national AMR partners to advance the on- Operational Guide for Building local advocacy coalition. going medical curriculum Support for Containing Drug Resistance review process at UNZA was finalized [see activity # ]. (2) A and finalization and technical consultant with experience dissemination of reviewed working at USAID mission was engaged STGs. for a final review of the “AMR Field • In Ethiopia, continue TA Guide for USAID Missions”. The guide support to the National AMR will soon be finalized after incorporating Advocacy Coalition in her suggestions. (3) The pre- and in- Ethiopia as needed. service curriculum review guidelines • Begin the CPM editorial designed to help address AMR topics process for the AMR were given to RPM Plus senior Operational Guide for management for a final review. Building Local Support for IN ZAMBIA: Containing Drug Resistance During this quarter RPM Plus and the Antimicrobial Advocacy Working Group (AWG) worked with MOH to conduct a peer-review and final editing of the updated STGs. A second meeting was held July 13-15 to plan next steps for finalizing and disseminating the updated STGs. The activity was reported in the Times of Zambia on July 17, 2007. RPM Plus continued to collaborate with the AWG, the Ministry of Health and other in- country partners in Zambia to develop, produce and broadcast television programs on AMR advocacy and awareness in July 2007. The programs were aired several times and well received by the public. IN ETHIOPIA: RPM Plus staff continued collaboration with Links Media, APUA and in-country partners for a media training course on AMR to be conducted in Ethiopia in October. The couse will be mainly facilitated by Links Media with APUA with RPM Plus support. The training will

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Workplan: Antimicrobial Resistance Year 06 Activity Title Implement a country-level AMR advocacy and containment program

include training for the media, AMR spokespersons, and a session on advocacy and resource mobilization for the National Committee for AMR Containment. Additionally, there will be an opportunity to network the spokespersons with the media to facilitate effective information flow through these relationships. Additionally, RPM Plus AMR portfolio developed a draft questionnaire for a facility-based survey on AMR issues. RPM Plus/Ethiopia has provided the draft to in- country partners for review. The survey seeks to identify specific problems relating to AMR at facilities and get feedback from facility respondents on feasible solutions to those problems. Last Updated: 10/01/2007

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Workplan: Antimicrobial Resistance Year 06 Activity Title Finalize and distribute AMR country-level approach workbook

Activity Manager Joshi, Mohan Activity # 3 Task: A1WW05AMR Sub-Task: 60F1F3 Activity Description The planning and implementation experiences in Zambia and Ethiopia are yielding several lessons that will be of much practical value to add to the workbook. So the plan is to further revise the workbook incorporating experiences and lessons learned in Zambia and Ethiopia as work continues in those countries. Under this workplan the workbook will be revised and finalized by RPM Plus in collaboration with country partners and made available for guidance in initiating the approach by additional interested countries. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project The comments of the internal and None - Submit the final draft to Year 7 Q4 external (Links Media) reviews were editorial for final editing, incorporated and significant progress formatting and publication. was made on the document. One key - Make strategic plan for change was on the title of the document dissemination of the guide. to better reflect its content. The new agreed title was---Building Local Support for Containing Drug Resistance: an Operational Guide. The techncial contents of the guide are now finalized. Last Updated: 10/02/2007

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Workplan: Antimicrobial Resistance Year 06 Activity Title Prevent resistance to antiretrovirals through ART adherence measurement and support

Activity Manager Steel, Gavin Activity # 4 Task: A1WW05AMR Sub-Task: 60EXA3 Activity Description In FY06 a nationwide ART adherence assessment and support pilot will be launched after a national consultative meeting. The pilot program will include one or two sites from each of the nine provinces in the country. RPM Plus will also collaborate with in-country stakeholders to initiate a similar ART adherence program in Namibia. The implementation of these adherence measurement and support activities will result in the availability of national data on ART adherence and current adherence support practices, availability of national standards for measuring adherence and strategies for improving adherence. The experiences in South Africa and Namibia will form the base for a generic ART adherence measurement and support guideline for resource-limited countries. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products

Thursday, December 20, 2007 3:55 PM Page 46 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Antimicrobial Resistance Year 06 Activity Title Prevent resistance to antiretrovirals through ART adherence measurement and support

Project IN SOUTH AFRICA: SOUTH AFRICA: This activity IN SOUTH AFRICA: Year 7 Q4 - Held follow up meeting with the has introduced new provincial Finalize implementation Department of Health (DOH) on the 5th counterparts; traditionally RPM plan with each province. July 07 to present project plan. has only interacted with Provide initial training to - Training agenda, PowerPoint slides pharmaceutical services in the identified sites of each and role play scripts were prepared to province. Here the SPA has to province on the use of the assist the RPM Plus/South Africa senior develop contact with the tool. Then provide ongoing program associates (SPAs) in their provincial HIV coordinator and TA to each site on provincial training sessions. hence the development of this adherence assessment and - DOH disseminated a letter to provincial relationship is taking longer than support measures. counterparts introducing the RPM Plus usual. In a few instances the IN NAMIBIA: Respond to tool and the implementation program. counter part has resigned and we any questions MOH may - Technical report on the ART adhernece have to wait until a new have and check again for tool development and pilot was finalized incumbent person is in position. approval. and disseminated. NAMIBIA: Approval for survey - SPAs have made contact with 4 of the has still not been obtained. 9 provinces and implementation strategies are currently being negotiated in – FS, NC, Gauteng & WC. - Participants of the RPM Plus HIV and AIDs Pharmaceutical Management Training Course have been exposed to the adherence tool – 5 sessions and about 100 participants. Early experience seems to indicate that the tool will be readily accepted by pharmacy personnel. IN NAMIBIA: - Held meetings with the M&E Subdivision of the DSP, MoHSS to discuss the way forward in obtaining approval for the survey - Held meetings with the Health Research Unit of MoHSS to determine the survey approval status - Made presentations on adherence measurement to the HIV Clinicians Society - Held meetings with the Technical Advisory Committee for HIV/AIDS and the HIV Clinicians Society for the implementation of the adherence measurement tool in Namibia

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Workplan: Antimicrobial Resistance Year 06 Activity Title Prevent resistance to antiretrovirals through ART adherence measurement and support

Last Updated: 10/02/2007

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Workplan: Antimicrobial Resistance Year 06 Activity Title Strengthen hospital drug and therapeutics committees through locally-led DTC-TOT training courses

Activity Manager Green, Terry Activity # 5 Task: A1WW06AMR Sub-Task: 60B4M5 Activity Description FY06 funds will support a locally-led DTC-TOT course in one region in Africa led by individuals identified from previous DTC-TOT courses who would provide primary technical assistance and follow-up to participants after training. Although RPM Plus will leverage support and assistance, the implementation will be handled mainly by a local organization in collaboration with the Regional Technical Collaboration (RTRC) network currently active in East Africa. RPM Plus will also collaborate with WHO China and WPRO Offices to support the second DTC-TOT course in China. Additionally, efforts will be made to finalize versions of the DTC and TOT materials for wide dissemination. The materials will then be translated into Spanish and French. With this effort, DTC capabilities will be enhanced, DTCs in hospitals will be strengthened, and evidence-based interventions will be implemented, resulting in the improved used of drugs, including antimicrobials. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products

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Workplan: Antimicrobial Resistance Year 06 Activity Title Strengthen hospital drug and therapeutics committees through locally-led DTC-TOT training courses

Project LOCALLY-LED DTC TRAINING None UGANDA – Increase Year 7 Q4 COURSE – Makerere University publicity to recruit more continues it is planning and advertising participants for the training for the Uganda DTC Training Course. A course. second e-drug advertisement has been CHINA – Continue to sent out and many correspondences maintain communicate with have been sent to MSH and WHO the key local counterpart Dr. offices about the course. Enrollment for Xiao Yonghong to explore the course is quite low at this time and possibilities for a national will require an aggressive campaign to DTC course next year. identify enough participants to have the ARMENIA – Where course. A contract for the Secretariat possible, provide follow-up has been completed and sent to assistance for Makerere University and an advance has advocacy/technical support also been sent. MSH/Uganda has been to help implement the contacted about the course to request training materials into support as needed for this Makerere led academia and other training activity. Saul Kiddie plans to meet programs. directly with USAID to inform them of the activity. CHINA DTC TRAINING COURSE – The China DTC training course was conducted on July 23-27 in Jinan, Shandong Province, PRC. This training was accomplished in partnership with WHO and the Ministry of Health. RPM Plus participation in the course included facilitation and shared management of the training course sessions. Two facilitators were sent to the course. A brief field study was also included during the course. Follow-up plans are not immediately known, but another national level course is anticipated for next year. ARMENIA RDU/DTC TRAINING – This training course was conducted in Yerevan on July 16-25, 2007. Training materials were adapted for the Armenia context and translated to Armenian. The training was conducted over a 5-day period. Simultaneous translation was provided which stimulated very active participation and added to the learning

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Workplan: Antimicrobial Resistance Year 06 Activity Title Strengthen hospital drug and therapeutics committees through locally-led DTC-TOT training courses

process significantly. Where possible, follow-up assistance for advocacy/technical support will be provided to help implement the training materials into academia and other training programs. Last Updated: 10/01/2007

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Workplan: Antimicrobial Resistance Year 06 Activity Title Provide sustained follow-up technical support to DTC-TOT participants to enable them to implement their work plans

Activity Manager Konduri, Niranjan Activity # 6 Task: A1WW06AMR Sub-Task: 60B4H6 Activity Description In FY06, RPM Plus will continue and intensify provision of follow-up assistance to the DTC-TOT participants from past and future courses by continued relationship building and technical assistance through email, conference call for participants to share experiences, documenting success of the participants on the DTC website, gathering lessons learned, use of a continuously updated matrix of participants’ progress, and provision of small grants to participants who develop viable DTC- and training-related proposals. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project - Technical Support was provided to None Upload Sital Shah’s FIP Year 7 Q4 Sital Shah in Kenya for developing her presentation to the AMR presentation at the FIP annual meeting section of the MSH/RPM in Beijing, China. Plus website. - Feedback was provided to RPM Plus Rwanda country office in the design and scope of activities for the upcoming National DTC-TOT training course. Upon request by the country office, adapted training materials were reviewed. Last Updated: 10/02/2007

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Workplan: Antimicrobial Resistance Year 06 Activity Title Help strengthen quality assurance of selected antimicrobials through a regional approach

Activity Manager Tran, Dat Activity # 7 Task: A1WW05AMR Sub-Task: 69DXH7 Activity Description The process of validating level two TLC/densitometry as a methodology to effectively assess the quality of additional antimicrobials, particularly antiretrovirals (ARVs) which was initiated in Tanzania in FY05 will be completed in FY06. Also, the program initiated in Zambia to roll out the Tanzania model of Level One Drug Inspection and Minilab testing will be further advanced. In addition to focusing on product quality, the AMR portfolio of RPM Plus will also explore opportunities to further collaborate with PMI to strengthen pharmacovigilance of antimalarials in Tanzania to support a broader QA system. The AMR and malaria portfolios will also collaborate to organize a regional consultative meeting on the quality of antimalarials with the goal of forging a practical regional approach to assist all countries improve their quality assurance systems for antimalarials and antimicrobials at large. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products

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Workplan: Antimicrobial Resistance Year 06 Activity Title Help strengthen quality assurance of selected antimicrobials through a regional approach

Project IN ZAMBIA: None • RPM Plus will continue to Year 7 Q4 • RPM Plus technical staff visited provide technical assistance Zambia from Aug 24 to Sep 2, 2007 to to PRA and CHAZ to follow up the inspection training and monitor the critical early provided technical assistance to the stages of implementing new Pharmaceutical Regulatory Authority inspection and product (PRA) in reviewing and documenting testing at key ports of entry. progress of QA implementation. RPM Key among this is the need Plus also reviewed inspection data to define a flexible and collected thus far by PRA at the key port workable sampling plan that of entry, Lusaka International Airport best meets the need and (LIA) and by the Churches Health resources available. Association of Zambia (CHAZ) at their • RPM Plus will develop a central warehouse. In addition, RPM guidance document, clearly Plus provided on-site training to outlining lessons learned in additional inspection staff on the use of Zambia and a general Minilab to test the quality pharmaceutical model to help other drug products. regulatory authorities • PRA has made substantial strengthen pharmaceutical improvements in its inspection quality assurance system processes, including: Developed clear guidelines for all pharmaceutical importers to get pro forma invoice (PI) approved, ensuring that only registered products can enter the country. This process is enhanced by better collaboration between PRA and custom officers from the Zambia Revenue Authority (ZRA), resulting in greater than 90% of all pharmaceutical consignments being subjected to inspection at LIA. At least 2 consignments failed inspection and were detained due to improper registration. Documentation and visual inspection of all products are now carried out according to established SOPs. Records indicated that 145 batches of different products were inspected between July and August. IN TANZANIA: • During this quarter, RPM Plus, along with TFDA, conducted a joint supervisory visit to public and private

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Workplan: Antimicrobial Resistance Year 06 Activity Title Help strengthen quality assurance of selected antimicrobials through a regional approach

health facilities, including accredited drug dispensing outlets (ADDOs), to monitor indicators of key areas: dispensing practices, malaria, integrated management of childhood illness (IMCI), and adverse event reporting in Kilombero and Ulanga districts (Morogoro region). The increased awareness in adverse event reporting is reflected in 3 adverse event reports collected from a health center. Other private facilities such as ADDOs have also reported “complaints” from patients to the council of health management team (CHMT) of the district. Among key observations made during the supervision is that many prescribers and dispensers at public health facilities have taken upon themselves to train other staff in their facilities. Last Updated: 10/01/2007

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Workplan: Antimicrobial Resistance Year 06 Activity Title Disseminate customized information on antimicrobial resistance in HIV/AIDS, malaria, and TB and other priority diseases in

Activity Manager Green, Terry Activity # 8 Task: A1WW05AMR Sub-Task: 60G2H8 Activity Description In FY06 RPM Plus and APUA will provide further technical assistance to VOA reporters and also directly to in-country media professionals to develop stories in Africa and Asia about the dangers of AMR in order to effectively deal with AMR and improve antimicrobial delivery and its effectiveness in HIV, Malaria, TB and other prevalent infectious diseases. RPM Plus, in collaboration with VOA and APUA, will engage, inform and train health reporters on AMR issues in Africa and Asia and conduct a 3-day training program in East Africa. The partnership will ensure active and accurate AMR reporting by maintaining follow-up with training participants via email. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project In this quarter attempts to move forward Issues around training content USAID, RPM plus, VOA, Year 7 Q4 the delayed India training program (due and methodologies for the India and APUA will work to issues around course content and training program has delayed collaboratively to finalize training methodology) was attempted implementation of the India as content and methodology through communciations with USAID well as the Africa training, which for this training. and APUA. was being planned to be implemented based on India experience. Last Updated: 10/02/2007

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Workplan: Antimicrobial Resistance Year 06 Activity Title Provide technical assistance for country-level implementation of infection control tools

Activity Manager Goredema, Wonder Activity # 9 Task: A1WW05AMR Sub-Task: 60E3H0 Activity Description Building on the communication and tool dissemination process started in South Africa and Swaziland under last year’s workplan, RPM Plus will leverage technical assistance for initial tool utilization, training and follow up activities for rapid cycle quality improvement (RCQI) at selected hospitals in these two countries. The finalized CD materials will also be translated into Spanish and piloted in selected hospitals in Paraguay and Peru with leveraging of FY06 SO5/AMR fund and the remaining LAC funding from previous years for infection control. African and LAC experiences will form the basis for an updated version of the CD and a self-learning tool suitable for availability on the MSH/RPM Plus website. This task will be initiated in FY06 and completed in FY07. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products

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Workplan: Antimicrobial Resistance Year 06 Activity Title Provide technical assistance for country-level implementation of infection control tools

Project RPM Plus continued to coordinate with The earlier plan to collaborate • Hold the planned infection Year 7 Q4 in-country partners in Swaziland and with stakeholders in Paraguay to control review workshop in South Africa to provide follow up introduce the infection control Manzini, Swaziland in early technical support for implementation of assessment tool and help October. the approach and tool at pilot sites. organize an initial workshop did • Provide TA to NDOH in IN SWAZILAND: not materialize due to lack of conducting a national train RPM Plus conducted support visits to all adequate response from the trainer workshop in pilot sites–– Dvokolwako Health Center incountry partners. South Africa. (DHC), Sithobela Health Center (SHC), • Finalize Spanish RFM hospital and Mbabane Government translation of the tool and Hospital (MGH) July 13-19 and August initiate implementation of 24, 2007. Accomplishments at the sites the tool in Latin America. included: Discussions are currently • SHC adapted and finalized a hand going on with in-country hygiene policy from infection control (IC) stakeholders in Guatemala CD-ROM resources in July 2007 for potential uptake of the • DHC made good progress with their tool by hospitals and hand hygiene project. They completed ministry for their infection their baseline survey and submitted a control work. progress report to RPM Plus in July 2007 • RFM hosptial completed the construction of a new incinerator and initiated a second project on improving hand hygiene. • The National Infection Control Coordinator for Swaziland recently used the ICAT to assess IC practices at MGH and has agreed that the ICAT should become a national tool. • Preparations were finalized for the review workshop that will be held in Manzini October 8-9, 2007. IN SOUTH AFRICA: RPM Plus and the NDOH conducted support visits to Kimberley Hospital Complex (KHC) and Kuruman District Hospital (KDH) July-11 and August 21- 22 and to Rustenburg Provincial Hospital (RPH) on September 13, 2007. Accomplishments at the sites included–– • About two thirds of the employees at KDH have been trained on infection control and waste management. The

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Workplan: Antimicrobial Resistance Year 06 Activity Title Provide technical assistance for country-level implementation of infection control tools

hospital completed but has yet to officially launch a hospital waste management policy. • KHC’s wound management project is progressing well. Hospital management are planning to assign a medical doctor on the infection control committee. • The planned hand hygiene awareness campaign at RPH–previously postponed because of an industrial action–was finally implemented September 10-14.. Activities of the week included a competition on developing creative hand hygiene awareness materials, such as posters, hand hygiene awareness and education sessions for hospital employees, an infection control exhibition for private companies and taking random microbiological swabs. • A review workshop was held from September 26-28 in Kimberley with representatives of infection control teams from the pilot hospitals and quality assurance managers from the National and Provincial Departments of Health. Last Updated: 10/01/2007

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Workplan: Roll Back Malaria (RBM) Year 04 Activity Title Support for the RBM Partnership: technical review of documents for RBM Partners

Activity Manager Lee, Evan Activity # 3 Task: A1WW04MAL Sub-Task: 60G3H7 Activity Description In order to help partners keep informed of issues related to and affecting the rapidly changing scene in malaria prevention and treatment, RPM Plus will support the RBM Partners by providing technical reviews of documents and assist with dissemination of critical information to partners. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project Reviewed the Global ACT subsidy Year 7 Q4 proposal Last Updated: 10/04/2007

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Workplan: Roll Back Malaria (RBM) Year 05 Activity Title Support to RBM PSM working group

Activity Manager Citysoft Admin Activity # 10 Task: A1WW05MAL Sub-Task: 60CXHA Activity Description RPM Plus will provide TA to the PSM WG to address Procurement and Supply Chain issues related to malaria control Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project Support to the PSMWG began in the last Year 7 Q4 quarter. In this quarter, RPM Plus hosted the RBM PSM working group meeting in Arlington offices, during this meeting, RPM Plus staff, Ms Rima Shretta was elected to be one of the co chairs of the working group. RPM Plus continues to provide technical assistance in developing workplan and budgets for the working group Last Updated: 10/04/2007

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Workplan: Roll Back Malaria (RBM) Year 05 Activity Title Support the updating of the Sources and Prices Guide

Activity Manager Citysoft Admin Activity # 2 Task: A1WW05MAL Sub-Task: 60C2F2 Activity Description The “Sources and Prices of Selected Products for the Prevention, Diagnosis, and Treatment of Malaria” was first issued in September 2004. With the increased number of manufacturers of anti-malarial drugs,; nets—including LLINs; and RDTs, program managers and procurement units with countries whoa re responsible for purchasing these commodities are faced with a bewildering choice of suppliers and products. To assist the procurement process, and to ensure that countries have access to high-quality products, MMSS is in the process of producing a second version of the Sources and Prices Guide for 2006. RPM Plus proposes to assist MMSS with the production of this guide. Activities will include revising the questionnaires that will be sent to manufacturers; writing and reviewing the procurement information that will be included; and analyzing the data that is returned by manufacturers. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project Discussed with RBM on hiring a Funding Discuss with project Year 7 Q4 consultant who would develop manager on funding deliverables and finalize the sources and prices guide Last Updated: 10/04/2007

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Workplan: Roll Back Malaria (RBM) Year 05 Activity Title Production of updates on the situation of taxes and tariffs that are pertinent to the production and procurement of antimalarial drugs,

Activity Manager Lee, Evan Activity # 8 Task: A1WW05MAL Sub-Task: 60CXF8 Activity Description As the scale-up of malaria-related interventions accelerates, these efforts are confronted by the issue of taxes and tariffs. In many countries taxes and tariffs can represent 25% or more to the cost of an ITN, thus limiting the potential coverage of many programs. For malaria treatment, given that patients are predominantly utilizing the private healthcare, taxes and tariffs limit ACT access to these patients. African countries have expressed a strong desire for local production of essential anti-malarial commodities, yet high taxes and tariffs on inputs for manufacturing, such as excipients for drugs, or polyester thread for nets, can make locally produced products more expensive than the imported product, and thus ineligible for purchase through funds from donors such as The Global Fund or the World Bank. The Malaria Medicines and Supplies Service (MMSS) receives many requests for information on taxes and tariffs, yet there is no database or reference source where the answers to the issues posed above can be readily found. RPM Plus proposes to support MMSS through a series of written briefs to clarify and explain the different tax and tariff regimes that are applicable to drugs, nets, and RDTs. Additionally, the development of a database containing tax and tariff information for the different types of malaria prevention and control interventions could be considered. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project Work is ongoing to compile data and None Compile data and complete Year 7 Q4 complete report on the multi-county report study to assess the Taxes and Tariffs of Malaria commodities. Last Updated: 10/04/2007

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Workplan: Tuberculosis Year 05 Activity Title Develop a guidance document on effective commodity management to complement WHO TB/HIV guidelines

Activity Manager Owunna, Chinwe Activity # 8 Task: A1WW05TBX Sub-Task: 60CXE8 Activity Description In collaboration with StopTB TB/HIV working group and UNAIDS, RPM Plus will finalize the two-phased activity. A guidance document based on the study findings will be developed. It will highlight different pharmaceutical management considerations of TB/HIV programs to address policy and organizational development, pharmaceutical management of collaborative interventions requiring pharmaceuticals, information management and monitoring. The document will provide guidance for TB and HIV program collaboration in commodity management; it will complement the WHO TB/HIV interim policy and guidance to decrease the co-infection rate. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project The finalized document “Managing Findings from this study will Year 7 Q4 Pharmaceuticals for TB/HIV disseminated during the Collaboration: Lessons Learned from a upcoming Union congress Five-Country Study in East Africa” has meeting in Cape Town, been sent to the RPM Plus editorial South Africa. review team for finalization and printing. Last Updated: 10/04/2007

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Workplan: Tuberculosis Year 06 Activity Title Provide technical leadership to the GLC in expediting response to DOTS strengthening and addressing MDR/XDR TB

Activity Manager Citysoft Admin Activity # 2 Task: A1WW06TBX Sub-Task: 60F3H5 Activity Description •Provide technical leadership and assistance to the GLC as requested through RPM Plus staff permanently based in Geneva. (ongoing) •Participate in the GLC survey missions, and assist in the development of tools and survey mechanisms to ensure that DOTS Plus recipient programs have good pharmaceutical management mechanisms in place (new) •Provide short-term TA to recipient countries where urgent problems have been identified and where donor support for TA is not available (new) Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project RPM Plus Senior Program Associate The partners group of The Year 7 Q4 facilitated two sessions during The Stop Stop TB Working Group TB Working Group on MDR-TB in Tbilisi, wants to establish a Georgia. The objective of this working subgroup drug management group was to find a way to speed up the committee and MSH to a prequalification of suppliers of second part of it. line drugs, to understand the size of the global market, to find additional second line drug suppliers and others. The two sessions RPM Plus facilitated were on working group on drug management and on recording & reporting. RPM Plus also worked with GLC on updating PSM plans for 2nd line drugs management. Last Updated: 10/04/2007

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Workplan: Tuberculosis Year 06 Activity Title Provide technical leadership to WHO, StopTB Working Groups and partners, and other global initiatives to ensure that

Activity Manager Citysoft Admin Activity # 3 Task: A1WW06TBX Sub-Task: 60CXH3 Activity Description RPM will conduct the following activities: a.Participate in technical meetings of the WHO and StopTB Working Groups meeting (DOTS Expansion WG, DOTS Plus, TB/HIV WG) (ongoing) b.Conduct a drug management workshop at IUATLD Congress Building Capacity in Pharmaceutical Management for TB, MDR-TB and TB/HIV. The workshop will be conducted in collaboration with the GDF/GLC (ongoing) c.Finalize paper on New Technologies for TB Control: A Guide for their Adoption, Introduction, and Implementation Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project There has been an on-going preparation Year 7 Q4 for IUATLD Congress to take place in Cape Town in November 2007. RPM Plus developed presentations for the full- day workshop at the UNION Congress on management of TB pharmaceuticals and commodities. Last Updated: 10/04/2007

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Workplan: Tuberculosis Year 06 Activity Title Finalize paper on New Technologies for TB Control: A Guide for their Adoption, Introduction, and Implementation

Activity Manager Citysoft Admin Activity # 3 Task: A1WW06TBX Sub-Task: 60F3F4 Activity Description RPM plus will provide technical leadership to StopTB partners in revising major TB tools, such as the WHO TB Handbook, and preparing for re-tooling in light of new TB products expected in future. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project During this quarter, Second and Third Year 7 Q4 draft of Stakeholder Engagement document, a follow on to the retooling guide, was presented to the Retooling Task Force. Appropriate case studies were developed through literature search and interviews for the purpose of document. Checklist of key actions for ‘Liquid Culture- Drug Susceptibility Testing System’ was refined through interviews and feedback. RPM Plus also participated in two conference calls with Task Force members to report on progress of assignment and seek guidance on how best to move forward. Last Updated: 10/04/2007

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Workplan: Tuberculosis Year 06 Activity Title Strengthen human capacity for TB pharmaceutical management at Global and NTP level

Activity Manager Citysoft Admin Activity # 4 Task: A1WW06TBX Sub-Task: 60F3M7 Activity Description With FY06 funding, RPM Plus will: a.Conduct a regional Course on Pharmaceutical Management for TB in collaboration with the GDF and WHO regional offices; region to be defined (ongoing) b.Conduct targeted regional training of DOTS Plus programs with the focus on quantification, ordering, and monitoring the use of second-line medicines; the course will be conducted in conjunction with the GLC (ongoing) c.Facilitate sessions on pharmaceutical management for TB at four WHO courses for international TB and TB/HIV consultants (Sondalo), and at the annual WHO/KNCV Course for NTP Managers in Warsaw; (ongoing) d.Field-test and finalize TB drug management capacity-building tool for lower level facilities and providers (PHC). Potential field test in Pakistan (new) e.Develop training modules on management of TB laboratory commodities, patient kits, and pediatric TB medicines for the GDF consultants to address new products on the GDF list (new activity). Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project RPM Plus TB portfolio manager Year 7 Q4 conducted sessions on integrated TB/HIV management for WHO course for TB consultants in Sondalo, Italy. RPM Plus Principal Program Associate prepared workshop materials for MDR- TB workshop with WHO WPRO Region to take place in November 2007. Another two workshops have been planned for the next quarter, totaling in three: Sondalo, Warsaw, and Manila. Last Updated: 10/04/2007

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Workplan: Tuberculosis Year 06 Activity Title Disseminate RPM Plus Pharmaceutical Management for TB tools and materials

Activity Manager Citysoft Admin Activity # 6 Task: A1WW06TBX Sub-Task: 60G2D9 Activity Description In FY07 RPM Plus will: a.Maintain RPM Plus Pharmaceutical Management for TB website (ongoing) b.Translate RPM Plus guidelines for PHC level into French for use in francophone Africa (continued) As a result, organizations working in TB control will have access to a wide range of resources related to best practices in pharmaceutical management for TB. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project The RPM Plus TB website has been Year 7 Q4 updated on a regular basis, while various TB tools continue to be in demand. The “Managing of TB Medicines at Primary Level” guide has been finalized and 100 copies have been printed for dissemination. Last Updated: 10/04/2007

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Workplan: Africa Bureau/Child Survival Year 03 Activity Title Offer assistance to IRC to conduct a Community DMCI assessment in Rwanda

Activity Manager Briggs, Jane Activity # 3 Task: A1WW03CHS Sub-Task: 60EXA3 Activity Description Many PVOs are implementing community child health activities and several have already approached RPM Plus for technical assistance to improve drug management at community level. The International Rescue Committee in Rwanda is one such PVO project interested. It is proposed that RPM Plus will provide technical assistance to IRC in Rwanda to conduct a community DMCI assessment and to develop appropriate interventions to improve the availability and use of drugs in the community. This activity will link well with the RPM Plus activities in the area of HIV/AIDS and PMTCT, demonstrating RPM Plus’ commitment to strengthening child health services alongside implementation of PMTCT, as well as being supportive of the work of the RPM Plus malaria portfolio in home-based management of malaria. It is expected that additional finances will be leveraged from the Mission and the IRC project for this activity. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project This quarter, no further assistance was RPM Plus will continue to Year 7 Q4 required from RPM Plus. work with PVO stakeholders to support their implementation plans in Rwanda under the Expanded Impact Child Survival project. Last Updated: 10/10/2007

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Workplan: Africa Bureau/Child Survival Year 03 Activity Title Technical Papers

Activity Manager Briggs, Jane Activity # 4 Task: A1AB03CHS Sub-Task: 60F6F4 Activity Description RPM Plus will document the experiences of the use of the DMCI and C-DMCI assessment tools in the countries in which they have been used. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project This quarter, a poster was drafted for RPM Plus will complete Year 7 Q4 presentation at the Annual American papers on the DMCI and C- Public Health Association Conference DMCI experience. In (November 2007). The poster is titled addition, the poster based “Improving child health through informed on the Senegal C-DMCI policy decisions and targeted experience will be interventions to strengthen medicine presented during the annual management in the community: the APHA meeting (November example of Senegal”. Draft text was 2007) and the cover sheet developed for an article based on the and abstracts for a panel DMCI experience was reviewed presentation will be internally. In addition, RPM Plus initiated submitted for consideration contact with three other organizations to for the Annual GHC coordinate a panel submission on Conference 2008. community case management for the Annual Global Health Council Conference in 2008. Last Updated: 10/10/2007

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Workplan: Africa Bureau/Child Survival Year 03 Activity Title Support to Community Case Management in DRC

Activity Manager Briggs, Jane Activity # 5 Task: A1AB03CHS Sub-Task: 60E3H5 Activity Description Based on the lessons learned from monitoring, supervision, and evaluation activities in pilot areas where CCM was implemented in DRC, RPM Plus will work with partners to support the national roll out of CCM into other districts, adapting tools and training materials as necessary. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project This quarter, partners agreed on the final RPM Plus will continue to Year 7 Q4 version of the community case support the roll-out of CCM management implementation guide, and and provide technical RPM Plus printed the first copies for assistance to other partners to use. A session on diarrheal implementing partners disease case management including the where necessary. The treatment of zinc was developed for the community case training of community health workers. management workshop is RPM Plus provided technical assistance scheduled for early next to organize the community case quarter. Katie Senauer and management review workshop Serigne Diagne of RPM scheduled for Oct 22-27, 2007. In Plus will attend the addition, data collection began to workshop during which they monitor availability of key medicines at will share the community community sites (an indicator that has case management been a challenge to collect during experiences in Senegal with regular reporting). An abstract was the DRC team, and will plan drafted based on the DRC CCM next steps and future experience for submission to the Global activities with the RPM Plus Health Council (refer to A1 AB03CHS team in DRC. 60F6F4 for further information). Last Updated: 10/10/2007

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Workplan: Africa Bureau/Child Survival Year 03 Activity Title Support to CCM in Senegal

Activity Manager Adeya, Grace Activity # 6 Task: A1AB03CHS Sub-Task: 60E3H6 Activity Description Based on the lessons learned from monitoring, supervision, and evaluation activities in pilot areas where CCM was implemented in Senegal, RPM Plus will work with partners to support the national roll out of CCM into other districts, adapting tools and training materials as necessary. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project This quarter, discussions began with RPM Plus will support the Year 7 Q4 RPM Plus staff in Senegal to explore roll-out of CCM and provide options for supporting CCM activities technical assistance to including reviewing the supervision other implementing partners mechanism to ensure inclusion of where necessary in elements of pharmaceutical Senegal. Activity plans for management and supporting the providing technical appropriate use of ACTs at the assistance will be finalized. community level. Last Updated: 10/10/2007

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Workplan: Africa Bureau/Child Survival Year 03 Activity Title Finalize the C-DMCI database

Activity Manager Briggs, Jane Activity # 7 Task: A1AB03CHS Sub-Task: 60F6J7 Activity Description An Access-based data analysis package is being developed to generate the standard indicators of the C-DMCI survey in three languages (English, Spanish and French). Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project This quarter, revisions continued on the RPM Plus will test and Year 7 Q4 C-DMCI database. A revised user finalize the revised manual which incorporated changes database and the user based on the updated version of the manual of the C-DMCI database was shared for internal review. analysis software. In addition, translations began to develop a Spanish and French version of the database. Last Updated: 10/10/2007

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Workplan: Africa Bureau/Child Survival Year 04 Activity Title Technical activity coordination and monitoring

Activity Manager Briggs, Jane Activity # 1 Task: A1AB04CHS Sub-Task: 97XXY1 Activity Description n/a Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project This quarter, standardized reporting Year 7 Q4 continued. Last Updated: 10/10/2007

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Workplan: Africa Bureau/Child Survival Year 04 Activity Title Continued collaboration with AFRO

Activity Manager Briggs, Jane Activity # 3 Task: A1AB04CHS Sub-Task: 60F6H3 Activity Description Promote and plan pharmaceutical management by regional AFRO and the country offices. RPM Plus will provide specific technical assistance to the AFRO team to integrate drug management into the child survival programs in the region. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project This quarter, the data analysis sheets for RPM Plus will continue to Year 7 Q4 the IMCI Health Facility survey drug follow up with the WHO management components were finalized focal people regarding in English, French and Spanish and incorporation of shared with WHO. Discussions pharmaceutical continued regarding incorporating the management components drug management component (including into standard trainings, the analysis spreadsheets) into the guidelines and surveys standard IMCI Health Facility survey including incorporating the package. In addition, RPM Plus pharmaceutical reviewed and commented on the draft management component training material to assist child health into the standard IMCI program managers being developed by Health Facility survey and WHO. revising standard trainings to include pharmaceutical management components. Last Updated: 10/10/2007

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Workplan: Asia Near East Bureau Year 02 Activity Title Provide TA to ACTMalaria to incorporate pharmaceutical management concepts into regional malaria courses

Activity Manager Lynders, Marion Activity # 17 Task: A1RN02IDX Sub-Task: 60F4HK Activity Description Explore the needs in developing pharmaceutical management skills, and incorporate these into a regional malaria pharmaceutical management course. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project In collaboration with ACT Malaria and None RPM Plus will coordinate Year 7 Q4 with the support of RDM/A, RPM Plus with ACT Malaria and other will conduct an Asia regional course on partners to finalize the pharmaceutical management of malaria, course schedule, technical with special focus on quantification in objectives, participant list, Hanoi, Vietnam in late November to course materials, and December 2007. In keeping with the requirements for pre-course practical focus of the course, participant preparation for participants will be challenged to the course. evaluate country-specific needs, based on their own country data, and to modify their PSM plans for Global Fund grants, or to develop improvement plans that can be implemented after their return. Last Updated: 10/12/2007

Thursday, December 20, 2007 3:55 PM Page 77 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Asia Near East Bureau Year 04 Activity Title Provide TA in pharmaceutical management for HIV/AIDS as agreed with RDM/A

Activity Manager Duzey, Olya Activity # 13 Task: A!RN04IDX Sub-Task: 60F2H0 Activity Description RPM Plus will provide TA to identify key programmatic issues in HIV/AIDS-related pharmaceutical management and help develop recommendations for the application of specific approaches and initiatives to address such issues. These activities could include reviews and studies in the areas of enhancers and monitoring tools for patient adherence to ART and HIV/TB commodity management integration. Other potential activities could address commodity management issues related to HIV/AIDS pediatric treatment, or the integration of PMTCT and child survival pharmaceutical management systems.

This activity will take place in 3rd and 4th quarters of RPM Plus Year 5. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project In June 2007, RPM Plus staff, in RPM Plus was invited to RPM Plus will hold a one- Year 7 Q4 collaboration with the World Health participate in a work planning day meeting in collaboration Organization (WHO) and the Chinese meeting in Yunnan and Guangxi with the WHO and the national HIV/AIDS program, conducted provinces in October to learn NCAIDS to discuss initial an exploratory visit to several HIV/AIDS about partner activities in findings and facilities in Yunnan Province to learn HIV/AIDS prevention, diagnosis, recommendations for about current ARV and opportunistic and treatment, and to participate Yunnan Province. Staff will infections (OI) medicines supply system in work plan discussions. It is not also plan a visit to Guangxi operations. RPM Plus reported details certain that RPM Plus staff will be Province to review the of the visit and subsequent able to participate, as this management of ARVs and recommendations to WHO and coincides with planned work on other commodities for USAID/RDMA; these will serve as the TB pharmaceutical management. HIV/AIDS. basis for a one day workshop featuring discussions on strengthening pharmaceutical management of ARVs and other HIV/AIDS commodities in October 2007.

Last Updated: 10/12/2007

Thursday, December 20, 2007 3:55 PM Page 78 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Asia Near East Bureau Year 04 Activity Title Explore feasibility of private sector engagement to increase access to medicines

Activity Manager Duzey, Olya Activity # 14 Task: A!RN04IDX Sub-Task: 60A3HH Activity Description The private sector in the ANE region continues to be a major source of pharmaceuticals for populations in need of medicine. Experience under SEAM indicates that, while implementing innovated strategies to engage the private sector, there is also a need to concurrently strengthen the capacity of the public sector to regulate and work with the private sector. Based on findings from previous pharmaceutical management surveys, appropriate incentives and disincentives need to be put in place for private practitioners to follow national treatment guidelines. RPM Plus will provide TA to counterparts, in one ANE country to explore feasible intervention strategies which are targeted towards enhancing access to essential medicines in the private sector while continuing to improve quality and access to care in the public sector.

This activity will take place in 3rd and 4th quarters of RPM Plus Year 5. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project No progress on this activity. Although RPM Plus has explored Year 7 Q4 various options for potential activities to engage the private sector, it will be most useful to revisit next steps, following adoption of a new systems strengthening strategy for pharmaceutical management in the region, and review of work planning for TB and malaria in the region. Last Updated: 10/12/2007

Thursday, December 20, 2007 3:55 PM Page 79 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Asia Near East Bureau Year 04 Activity Title Provide technical assistance to develop training materials for TB pharmaceutical management SOP scale up in China.

Activity Manager Dias, Vimal Activity # 16 Task: A1RN04IDX Sub-Task: 60F3EC Activity Description RPM Plus will develop training materials for the implementation of TB pharmaceutical management SOPs in selected facilities and/provinces, as agreed with WHO and the NCTB. These materials will include facilitator and use guides, plus practical exercises. Counterparts will be involved in all phases of development, and the materials will be translated into Chinese prior to their application. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project RPM Plus provides technical assistance None RPM Plus will review and Year 7 Q4 to the Chinese National Center for refine the training materials Tuberculosis Control and Prevention during a visit to China in (NCTB) in scaling-up use of standard late October, and provide operating procedures (SOP) for TB technical assistance in pharmaceutical management. Chinese conducting training in counterparts have decided to scale up implementation of the SOPs implementation of the SOPs not only in in November or early Henan Province, but 5 additional December 2007. provinces, and requested RPM Plus technical assistance in developing participant and facilitator training guides on topics including general pharmaceutical management, receiving medicines, storekeeping, dispensing and quantification to facilitate the scale-up of SOP use. Last Updated: 10/12/2007

Thursday, December 20, 2007 3:55 PM Page 80 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Asia Near East Bureau Year 04 Activity Title Provide TA in transition planning and support for management of medicines for HIV/AIDS in Laos

Activity Manager Duzey, Olya Activity # 17 Task: A1RN04IDX Sub-Task: 60F2HD Activity Description RPM Plus will provide TA in planning for pharmaceutical management aspects of the transition of management of the HIV/AIDS program from MSF to MOH by September 2008. In addition, RPM Plus will provide technical assistance during this transition, as agreed with the RDMA and country counterparts. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products

Thursday, December 20, 2007 3:55 PM Page 81 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Asia Near East Bureau Year 04 Activity Title Provide TA in transition planning and support for management of medicines for HIV/AIDS in Laos

Project In June 2007, RPM Plus met with None to-date. However, it will be At the request of the MOH, Year 7 Q4 governmental, INGO, Global Fund, and necessary to begin the process RPM Plus will develop and other counterparts in Laos to learn about for developing an MOU with the submit a proposal outlining current and planned activities for Government of the Lao PDR, in priority activities in Laos for implementation of antiretroviral therapy order to undertake technical pharmaceutical (ART) under Global Fund Round 6, assistance activities there. It is management of ARVs and current management of ACTs and TB uncertain how long this process other commodities for medicines, and visited a provincial site, may take. HIV/AIDS. At the end of the where Médecins Sans Frontières (MSF) visit, RPM Plus will discuss has been managing a program for the potential involvement in the prevention, diagnosis and treatment of process with the US HIV/AIDS since 2001. RPM Plus Embassy in Laos and the recommendations for immediate action RDMA, and discuss and included planning with all key obtain concurrence with stakeholders for transition of proposed next steps. management of antiretroviral (ARV) medicines from MSF to MOH, identifying technical assistance and resource needs for existing and planned scale up facilities, and conducting an options analysis for improving medicines distribution and other commodities under Global Fund grants.

In September 2007, RPM Plus participated with key stakeholders in a round table discussion in Savannakhet, Laos, regarding the transition of ARV operations from MSF to the MOH. RPM Plus worked with counterparts to evaluate potential options for the distribution of ARVs and other commodities, procured through the Global Fund. Last Updated: 10/12/2007

Thursday, December 20, 2007 3:55 PM Page 82 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Asia Near East Bureau Year 04 Activity Title Conduct a mapping of capacity in the ANE to conduct drug management TA

Activity Manager Duzey, Olya Activity # 6 Task: A1RN04IDX Sub-Task: 60CXAD Activity Description In the ANE region there is a great need for pharmaceutical management technical assistance in various areas, including community pharmaceutical management. One means for meeting this need is the development of South to South capacity. In the ANE, a first step in the process is to map existing pharmaceutical management capacity, so that strengths and gaps can be identified. This activity will take place in 3rd and 4th quarters of RPM Plus Year 5. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project One challenge of implementing Given the recent award of the RPM Plus will discuss the Year 7 Q4 strategies and activities to improve new Strengthening new SPS strategy with the pharmaceutical management in Pharmaceutical Systems (SPS) Mission and partners, and Southeast Asia is the lack of human Program to MSH, RPM Plus will then determine next steps. resource capacity at the professional continue this work in the context These may include and pre-professional levels. In July, a new strategy for strengthening ascertaining funding levels RPM Plus met with representatives from human resource capacity in the and sources, and collecting Mahidol and Chulalongkorn Universities region, once it is agreed upon information necessary for in Thailand to discuss options for with the Mission. developing a regional capacity development pharmaceutical activities. There was agreement that the management capacity is a need for a regional pharmaceutical strengthening framework management capacity strengthening and implementation plan. forum including, but that this might take various forms. One potential option might be pairing institutions, such as between Laos and Thailand, to allow development of capacity, while working on practical solutions to priority issues. RPM Plus also discussed with partners potential organizations in the region that may serve as models or centers for strengthening capacity. Last Updated: 10/12/2007

Thursday, December 20, 2007 3:55 PM Page 83 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Europe and Eurasia Bureau Year 02 Activity Title Provide TBCTA Follow-up TA in TB Drug Management in NIS.

Activity Manager Zagorskiy, Andrey Activity # 9 Task: A1RI02XXX Sub-Task: 60F3HA Activity Description During the surveys RPM Plus identified gaps in TB drug management of the programs that need to be addressed. The full report of the TB CTA is due by December 2002. The activities for concrete technical assistance and countries will be identified based on the surveys findings. RPM Plus will then provide targeted technical assistance to selected country TB programs using funds specifically earmarked by the E&E Bureau to RPM Plus TB drug management activities in NIS. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products

Thursday, December 20, 2007 3:55 PM Page 84 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Europe and Eurasia Bureau Year 02 Activity Title Provide TBCTA Follow-up TA in TB Drug Management in NIS.

Project On August 29, 2007, RPM Plus hosted a Upon return to Kazakhstan Year 7 Q4 meeting with seven high-level medical and discussion with other professionals and officials responsible MOH officials, the visiting for TB control in Kazakhstan. The group team will contact RPM Plus was on a three-week State Department- CAR activity manager to sponsored International Visitor discuss specific technical Leadership Program, entitled "Multi-Drug assistance needs for further Resistant Tuberculosis,” during which activities with regard to drug they visited health facilities, NGOs, management information private sector entities, and state and systems and Minilabs. local government offices to learn about tuberculosis control efforts in the United States. During the one-day meeting hosted at the MSH Arlington office, RPM Plus presented sessions and facilitated discussions on pharmaceutical management for MDR-TB, including procurement options and the importance of drug quality assurance programs in preventing the development and spread of resistant strains of tuberculosis. The discussions were built around the findings of a joint TB assessment conducted in Kazakhstan by WHO, RPM Plus and partners in the field in May 2007; and from a global market research of second-line TB medicines conducted by RPM Plus jointly with the Green Light Committee. The session on drug quality assurance programs included discussion concerning Minilabs as an element of Drug Quality Assurance program, results of Minilab implementation in Kazakhstan, and next steps to be planned by the MOH and TB Institute to ensure effective use of Minilabs in the country. RPM Plus also discussed new technologies in TB control, the Stop TB framework for adoption, introduction and implementation of new technologies for TB control, and lessons learned from other health and disease programs. In addition, RPM Plus made a presentation

Thursday, December 20, 2007 3:55 PM Page 85 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Europe and Eurasia Bureau Year 02 Activity Title Provide TBCTA Follow-up TA in TB Drug Management in NIS.

of its latest web-based TB Case and Commodity Management tool for Multi- drug Resistant Tuberculosis (MDR-TB). The tool is currently adopted in Brazil, Romania, and Moldova, and is used by national TB programs to ensure proper registration of cases, prescription, adherence to treatment, patient follow- up, and timely quantification and supply of TB medicines. The visiting team requested an access to a test version of the tool, specifically its pharmaceutical management part, to analyze possible integration of this tool into the locally developed solutions. Last Updated: 10/15/2007

Thursday, December 20, 2007 3:55 PM Page 86 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Latin America Caribbean Amazon Ma Year 06 Activity Title Provide follow-up technical assistance to five Initiative countries to plan and implement activities that will strengthen the availability

Activity Manager Thumm, Melissa Activity # 2 Task: A1LN06MAL Sub-Task: 60CXH2 Activity Description In FY06, all eight of the countries have at least one activity aimed at strengthening pharmaceutical management in their work plans, for which they have requested assistance from RPM Plus. The activities include assessments (in the two countries that have not yet conducted them); implementation of policies and strategies to address the problems of availability and use identified through assessments in FY04 and FY05; and, the application of additional RPM Plus tools and methods for assessing and strengthening drug management, particularly around implementation of the new drug policies and quantification of malaria medicines. Based on their preparedness and on-going work in the area, Bolivia, Ecuador, Guyana, Peru and Suriname have been tentatively selected to receive in-country technical assistance from RPM Plus in FY06. Assistance to the remaining three countries will be available via email. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project RPM Plus began a technical review of None. Continue to coordinate with Year 7 Q4 Ecuador’s “Good Storage Practices” Ecuador MoH and the manual based on information gathered consultant reviewing at RPM Plus’ pharmaceutical technical manual. management workshops. RPM Plus made arrangements for a Peruvian consultant to review and provide comments to the Ecuador MoH. Last Updated: 10/16/2007

Thursday, December 20, 2007 3:55 PM Page 87 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Latin America Caribbean Amazon Ma Year 06 Activity Title Develop and translate training materials and conduct a regional workshop on supply chain management for malaria medicines and

Activity Manager Thumm, Melissa Activity # 3 Task: A1LN06MAL Sub-Task: 60CXM3 Activity Description To begin addressing the variety of problems that the countries are facing in this area, RPM Plus will develop training materials on the different aspects of supply chain management and use them to conduct a regional workshop with participants from all eight of the Initiative countries. The key elements of supply chain have been introduced and briefly discussed at previous workshops; this training, however, will focus exclusively on the topic, examining storage, distribution, and inventory management in much greater depth. Participants will be asked to bring specific information on the present situation in their countries. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project The regional supply chain management None. Continue planning for Year 7 Q4 workshop, which had been tentatively supply chain management scheduled for September 20-22, 2007 in workshop. Lima, Peru was postponed to align the contents and timing with the reviewed strategic plan of AMI. The work shop is tentatively scheduled for the first quarter of 2008. Last Updated: 10/16/2007

Thursday, December 20, 2007 3:55 PM Page 88 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Latin America Caribbean Amazon Ma Year 06 Activity Title Collaborate with other Initiative partners on activities related to pharmaceutical management

Activity Manager Barillas, Edgar Activity # 4 Task: A1LN06MAL Sub-Task: 60F4H4 Activity Description RPM Plus will continue to collaborate with the other Initiative partners on activities that include a pharmaceutical management component. At present, these activities include facilitating a session at a regional workshop on drug quality assurance organized by USP (tentatively scheduled for June in Lima, Peru) and working with PAHO to develop, pilot and implement a simple monitoring tool for routine use in primary health care facilities that diagnose and treat malaria. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project RPM Plus and USP-DQI continued to None. Continue working with AMI Year 7 Q4 collaborate on developing materials and partners to coordinate the an agenda for a regional drug quality drug quality workshop. assurance workshop scheduled for September 17-19, 2007 in Lima, Peru. The workshop was postponed until early 2008 to allow PAHO to add its expertise in drug quality in Latin America, and to align the contents and timing with the reviewed strategic plan of AMI. Last Updated: 10/16/2007

Thursday, December 20, 2007 3:55 PM Page 89 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Latin America Caribbean Amazon Ma Year 06 Activity Title Participate in annual steering committee and other regional meetings with initiative countries and technical partners

Activity Manager Barillas, Edgar Activity # 5 Task: A1LN06MAL Sub-Task: 60F4N5 Activity Description RPM Plus will participate in the annual meeting as well as the semi-annual steering committee meeting, tentatively scheduled to take place back-to-back in Brazil in March 2007. RPM Plus will also attend the second steering committee meeting in Washington, DC in September 2007 and any other AMI meetings at which RPM Plus’ attendance is requested. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project In September 2007, RPM Plus None. Meet with AMI coordinator Year 7 Q4 participated in the AMI Steering and finalize workplan for Committee meeting in Washington, DC. upcoming year. Continue to At this meeting, participants reviewed work with AMI partners to technical partners’ and initiative draft access and use countries’ workplans for the upcoming proposal. year. The SC decided to draft a 4 year strategic work plan, to align all countries and partners future activities to shared “end-points”. RPM Plus, PAHO and the USP will draft a proposal for the “drug access and use” thematic area. It is expected this document will be completed in October 2007.

Thursday, December 20, 2007 3:55 PM Page 90 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Latin America Caribbean Amazon Ma Year 06 Activity Title Document and disseminate AMI results, experiences, and lessons learned (including external evaluation)

Activity Manager Barillas, Edgar Activity # 6 Task: A1LN06MAL Sub-Task: 60F4D6 Activity Description Documenting the Initiative’s results, experiences and lessons learned and disseminating the information to a wide audience are top priorities in FY06 for all of the international and national partners. RPM Plus will produce documents in collaboration with its partners on all malaria-related drug management activities in the region, maintain up to date information about its involvement in AMI activities on the RPM Plus program website (www.msh.org/rpmplus), and contribute to coordinated efforts to disseminate information at conferences and meetings, as well as through publications. As part of this process, RPM Plus will work with its partners to create a comprehensive portfolio of documents and presentations to submit to an external evaluation team, which is expected to evaluate AMI in FY06. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project RPM Plus presented the AMI strategic None. Follow up on Year 7 Q4 framework and activities at the SPS communication and Project Launch; attendees included RPM dissemination activities Plus/SPS staff and SPS partners and described in AMI associates. communications plan.

The RPM Plus AMI webpage is in the process of being edited and approved before being posted online. Last Updated: 10/16/2007

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Workplan: Latin America Caribbean IDI for AMR Year 03 Activity Title Implementation of Hospital Infection Control Assessment Tool in LAC

Activity Manager Yeager, Beth Activity # 10 Task: A1LN03AMR Sub-Task: 60E3H9 Activity Description The English version of the tool will be translated into Spanish. RPM Plus will work with national partners in Guatemala to organize an initial workshop in December 2007. Participating hospitals will then have approximately six months to implement the tool. A second, follow-up workshop will then be conducted to review results and discuss next steps. Based on the results, the tool will be revised and distributed to other hospitals in Guatemala. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project The translation of the Infection Control None RPM Plus Senior Program Year 7 Q4 Assessment Tool, workshop materials Associate has been in and presentations and other supporting contact with consultants in documents and materials continued Guatemala who will assist during this quarter. with this activity. Meetings are scheduled with authorties from the Ministry of Health to present the ICAT and assess the MoH's interest in implementing this activity. If MoH approval is granted, the initial workshop will be programmed for early December, with the participation of 3 - 4 pilot hospitals. Last Updated: 10/11/2007

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Workplan: Latin America Caribbean SAIDI Year 06 Activity Title Support the implementation of AMR containment strategies by awarding small grants to national SAIDI partners

Activity Manager Yeager, Beth Activity # 2 Task: a1ln06amr Sub-Task: 60axh2 Activity Description Some of the activities contained in these actions plans will be supported through grants from RPM Plus to local implementing partners Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project In Peru, RPM Plus continued to support Due to the earthquake that PERU: Finalize and print Year 7 Q4 SAIDI activities described in the Peru occurred in Peru in August, the STGs and begin logical framework : Standard Treatment MoH was on "red alert" and implementation; Initiate Guidelines for Respiratory Infections in therefore many activities were implementation of IC Children under 5 were reviewed by postponed or delayed. improvement plans in members of the local APUA chapter and Fires in Paraguay caused some selected hospitals; Initiate presented to the DISA for distribution; delay in activities; problems with paperwork for accrediation local hospitals’ plans to improve wire transfers for of Callao warehouse; infection control practices were communications activities Continue virtual course in presented and reviewed by DISA-Callao Peru and Paraguay; and VIGIA and work to improve the Continue communications regional warehouse continued. activities; Work with Regionally, RPM Plus supported the national partners to begin participation of 60 Peruvian and implementation of local Paraguayan pharmacists in a virtual AMR surveillance network; course on pharmaceutical Coordinate activities to management. AIS, the organization increase number of administering funds for SAIDI Peru inspections of private communications activities, received their pharmacies in Callao second payment and continued working PARAGUAY: Continue with the SAIDI communications group to work on communication develop materials and plan for the activities official project launch. In Paraguay, SAIDI communications activities continued; RPM Plus supported these activities by providing two computers and printers to hospitals in order to create a regional network to promote rational pharmaceutical management and monitor antimicrobial resistance in Paraguay. Last Updated: 10/12/2007

Thursday, December 20, 2007 3:55 PM Page 93 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Latin America Caribbean SAIDI Year 06 Activity Title Strengthen pharmaceutical management of antimicrobials in selected hospitals in Asuncion, Paraguay

Activity Manager Yeager, Beth Activity # 3 Task: a1ln06amr Sub-Task: 60e3h3 Activity Description RPM Plus will contribute by providing technical assistance selection, storage and dispensing of antimicrobials, and by strengthening the hospitals’ drug and therapeutic committees. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project In Paraguay, RPM Plus continued After the visit in late August, the Expand the Good Storage Year 7 Q4 support of DIC-coordinated trainings in MoH has not provided the Practices trainings to two basic pharmaceutical management (with requested information to more regions; Provide an emphasis on good storage practices) continue. necessary materials to with pharmacists and facility managers strengthen pharmaceutical in three regions; these trainings will be management at local level; expanded in the coming quarters. RPM Develop Pharmaceutical Plus Senior Program Associate Edgar Care trainings; Follow up Barillas conducted a rapid evaluation of with MoH the national procurement system at the request of the Ministry of Health; recommendations and next steps were discussed with government authorities. Last Updated: 10/12/2007

Thursday, December 20, 2007 3:55 PM Page 94 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Latin America Caribbean SAIDI Year 06 Activity Title Strengthen Drug Information Centers in Paraguay and Peru

Activity Manager Yeager, Beth Activity # 4 Task: a1ln06amr Sub-Task: 60gxh4 Activity Description In Asuncion, the only available information center is operated by the National University of Asuncion. Working with other SAIDI international partners, in particular Links Media, RPM Plus will provide technical assistance and reference materials to the information center and support its development as a platform for other communication activities.

In Peru, in collaboration with Links Media and national partners, RPM Plus will provide technical assistance and reference materials to the local information center in the DISA Callao. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project In Peru, DIC personnel were trained and None Cochrane course planned Year 7 Q4 additional support materials/equipment for October; PERU: were provided. RPM Plus continued to operational documents to coordinate the Cochrane course on be prepared; PARAGUAY: critical analysis. Identify opportunities for South-South collaboration with Peru Last Updated: 10/12/2007

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Workplan: Latin America Caribbean SAIDI Year 06 Activity Title Provide technical assistance to the national TB control programs in all three initiative countries

Activity Manager Yeager, Beth Activity # 5 Task: a1ln06amr Sub-Task: 60f3h5 Activity Description One of the targeted activities this yearb will be an evaluation of how the TB program in Callao, Peru, manages their medicines, in particular second-line drugs. Based on the results of this evaluation, RPM Plus will provide recommendations and follow-up support for implementation. RPM Plus will conduct similar activities in Bolivia this year. Other activities in support of the national TB control programs may be considered. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products

Thursday, December 20, 2007 3:55 PM Page 96 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Latin America Caribbean SAIDI Year 06 Activity Title Provide technical assistance to the national TB control programs in all three initiative countries

Project In Peru, a local RPM Plus consultant None PERU: Finalize guidelines Year 7 Q4 developed guidelines for the and distribute in Callao; pharmaceutical management of MDR- Work with national partners TB medicines and shared a draft of to define strategies to these guidelines with the National TB address TB meds in private Program. The results of the study on pharmacies; BOLIVIA: the availability of TB medicines in private Monitor process of pharmacies were also discussed with implemenation of TB kits; the National TB Program and other local PARAGUAY: Finalize SAIDI partners. assessment report and provide recommendations In Paraguay, RPM Plus Program to NTP Associate Silas Holland (with a Bolivian consultant) traveled to Paraguay to follow up on SAIDI activities and carry out an assessment of the implementation of individualized TB treatment kits. RPM Plus met with the National TB Program and surveyed 41 regional health centers; a formal report will be developed in October 2007.

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Workplan: Latin America Caribbean SAIDI Year 06 Activity Title Dissemination of SAIDI activities and results in all three initiative countries and internationally

Activity Manager Yeager, Beth Activity # 6 Task: a1ln06amr Sub-Task: 60g2d6 Activity Description RPM Plus will work with the national partners involved in all three countries to identify appropriate ways to make information about SAIDI available to other groups in country. This may include the preparation of presentations, articles for publication in local journals or other types of printed material, or web-based publications.

RPM Plus will also work with international partners in the development and implementation of an international dissemination plan that includes printed documents, presentations at scientific conferences and meetings and web- based publication. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project RPM Plus also collected SAIDI products None Compile products to date; Year 7 Q4 from partners and participated in the work with Links Media Steering Committee Meeting in August identify other opportunities 2007; partners shared their workplans for dissemination for the upcoming year and discussed SAIDI short-, mid-, and long-term goals/objectives. Last Updated: 10/12/2007

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Workplan: Latin America Caribbean IDI for TB Year 04 Activity Title Technical assistance to follow up on specific country requirements

Activity Manager Barillas, Edgar Activity # 3 Task: A1LN04TBX Sub-Task: 60F2H3 Activity Description This work plan includes resources to cover technical assistance missions to two countries in the form of country visits for a period of 10 days each on average. If an in-depth assessment or further technical assistance is needed, RPM Plus will explore with the USAID local mission, or other partners, the availability of financial resources to support the more intense activities in the country. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project As September 2007 just USD 2,000 The regional TB meeting was The TB regional meeting Year 7 Q4 were remaining from FY04 resources. postponed because of the was re-scheduled for These resources were planed to be used earthquake in Pisco, Peru. December 2007. to support RPM Plus participation in the Regional TB Managers Meeting (Lima, Peru August 22 – 25). The meeting was re-scheduled to December 2007 because of the earthquake Pisco, Peru. Last Updated: 09/26/2007

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Workplan: Malaria (MAC) Core Year 03 Activity Title Global fund case study

Activity Manager Shretta, Rima Activity # 20 Task: A1WW03MAC Sub-Task: 60F4GJ Activity Description Three countries, Ghana, Nigeria and Guinea Bissau will be used as case studies to document the process of implementation of TGF malaria grant. Each case study will focus on tracing key events of the implementation process from the development of Procurement Supply and Management (PSM) plans to the receipt of funds to mobilization of key stakeholders for the procurement process and ultimately distribution to health facilities. The study will be descriptive and document the process of implementation of ACTs, challenges faced and the actions taken to alleviate these challenges.

Specifically the Scope of Work addresses the following elements:

1. Develop and elaborate a framework with specific research questions for the study 2. Develop the methodology and tools to assist in data collection in the three countries 3. Conduct a desk-based document review to document the processes at the global level regarding the implementation of ACTs 4. Conduct interviews with key stakeholders in-country to identify the various challenges and bottlenecks that they have been faced with regarding the procurement and distribution processes for ACTs as part of the malaria grant. 5. Identify the mechanisms and the processes undertaken to address any challenges/bottlenecks. 6. Document key lessons learned that can be shared with other countries

The focus of this work will be limited to ACTs which are the first line treatment for malaria case management in all three countries. This study will be a collaborative effort between RPM Plus/MSH, TGF and the RBM Partnership. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project Finalized and disseminated the TGF Discuss with GF funding for Year 7 Q4 case studies reports including a requested training course synthesis of the case studies, a summary report, individual country reports and a discussion paper for the GFATM to consider in their dialogue with recipient countries. RPM Plus traveled to Geneva to discuss the studies with the GF Last Updated: 10/12/2007

Thursday, December 20, 2007 3:55 PM Page 100 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Malaria (MAC) Core Year 06 Activity Title Technical activity coordination of MAC activities

Activity Manager Citysoft Admin Activity # 1 Task: A1WW06MAC Sub-Task: 97XXY1 Activity Description The RPM Plus Malaria Program Manager will direct this activity and partly work with a Program Associate and an Administrative Coordinator to insure appropriate programmatic, administrative and financial coordination of MAC core and field activities. They will be based in the Arlington RPM Plus office for this purpose Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project Continued to support MAC partner Year 7 Q4 coordination through conference calls and sharing of documents produced by partners Last Updated: 10/12/2007

Thursday, December 20, 2007 3:55 PM Page 101 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Malaria (MAC) Core Year 06 Activity Title Implementation of the ACT monitoring and evaluation tool in Senegal, DRC and Kenya

Activity Manager Citysoft Admin Activity # 2 Task: A1WW06MAC Sub-Task: 60F4J2 Activity Description The tool will be utilized in the proposed countries to assess ACT pharmaceutical management in its implementation process and outcomes. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project Continued with developing of the M&E Finalize document and field Year 7 Q4 guide for pharmaceutical management test in at least one country aspects of ACT policy implementation. The documents will be field tested in one country in the coming year Last Updated: 10/12/2007

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Workplan: Malaria (MAC) Core Year 06 Activity Title RPM Plus/MAC final report dissemination.

Activity Manager Citysoft Admin Activity # 3 Task: A1WW06MAC Sub-Task: 60F4F3 Activity Description Under this activity, RPM Plus will compile and disseminate achievements and lessons learned into the global malaria community, sharing the tools and documentation developed under MAC will help to support the efforts of other RBM partners as they move forward with their own efforts to combat malaria. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project A draft of the MAC ( 2002-2007) final Incorporate comments and Year 7 Q4 report was developed and sent to finalize the report partners for inputs and comments Last Updated: 10/12/2007

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Workplan: Malaria (MAC) Core Year 06 Activity Title Support to the RBM working group

Activity Manager Citysoft Admin Activity # 5 Task: A1WW06MAC Sub-Task: 60F4H5 Activity Description RPM Plus will support the PSMWG activities Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project As a co chair of the PSMWG, RPM Plus None Plan for the upcoming Year 7 Q4 participated in RBM Work plan PSMWG meeting harmonization meeting in Geneva. RPM Plus also participated in the ACT subsidy task force meeting and presented at the implementers meeting in Geneva. RPM Plus continues to support the PSMWG. Last Updated: 10/12/2007

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Workplan: Malaria (MAC) Core Year 06 Activity Title Support to PMI in improving severe malaria case management

Activity Manager Citysoft Admin Activity # 6 Task: A1WW06MAC Sub-Task: 60F4H6 Activity Description RPM Plus will provide technical support on severe malaria medicines quantification for PMI countries Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project RPM Plus organized with the PMI team Year 7 Q4 a technical meeting in Washington on severe malaria medicine quantification, including the review of product specifications, quantification methods and available data and studies for the adoption of consistent quantification approaches among PMI countries Last Updated: 10/12/2007

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Workplan: Malaria (MAC) Core Year 06 Activity Title MAC Management

Activity Manager Citysoft Admin Activity # 7 Task: A1WW06MAC Sub-Task: 97XXYX Activity Description RPM Plus will continue to coordinate management of the MAC partners including organizing meetings and conference calls, reporting and communicating with USAID on behalf of the MAC partnership Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project Year 7 Q4 Continued witn managind MAC activites including, coordinating conference calls and reporting monthly malaria activites Last Updated: 11/08/2007

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Workplan: Regional Development Mission/Asia Year 05 Activity Title Provide TA to counterparts in one country to utilize the ACT Implementation guide to develop an implementation strategy and identify

Activity Manager Duzey, Olya Activity # 4 Task: A1RN05IDX Sub-Task: 60F4H4 Activity Description RPM Plus will identify, together with the RDM/A and the appropriate Mission, a country, where there is a need to develop an implementation plan, and provide technical assistance throughout the process. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project In June, the RPM Plus Director meet The Mission is developing a RPM Plus will communicate Year 7 Q4 with the PHN Director, USAID/Cambodia country strategy to appropriately with the Mission to learn to discuss Mission priorities, determine prioritize country activities. about any changes in how RPM Plus can best support Mission Current and future RPM Plus pharmaceutical strategy, and to orient new Mission staff activities, including the policy management issues, and to the purpose and rationale of RPM change implementation for propose a strategy for Plus activities in Cambodia. RDM/A and antimalarial medicines, must strengthening USAID/Washington continue to demonstrate consistency with the pharmaceutical emphasize the need for pharmaceutical stated priorities in order to management for malaria. management of malaria and are working receive Mission concurrence. RPM Plus will also track with the Mission to determine what role additional developments in RPM Plus will play in pharmaceutical the malaria program, and management strengthening activities in maintain dialogue with Cambodia. malaria and child survival partners. An RPM Plus consultant continues to track developments on the management of antimalarials and RDTs, and to provide inputs in the development of the survey instrument that will be used by the CNM to the GF Round 2 evaluation. Last Updated: 10/12/2007

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Workplan: Regional Development Mission/Asia Year 05 Activity Title Provide TA to scale up standard operating procedures (SOPs) for TB pharmaceutical management in one or more Chinese provinces

Activity Manager Dias, Vimal Activity # 6 Task: A1RN05IDX Sub-Task: 60F3H6 Activity Description During FY05, a plan for refinement of drug management systems will be developed with counterparts, and in collaboration with WHO/China. Interventions may include the development of more detailed standard operating procedures and an SOP manual. RPM Plus will also work with counterparts to prioritize problems in DMIS and develop recommendations for improvements. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project RPM Plus continue to develop None Once the materials are Year 7 Q4 participant training materials continue reviewed by Chinese which will be used by Chinese counterparts and refined, counterparts to facilitate scale-up in the RPM Plus will plan another use of standard operating procedures visit for the purpose of (SOP) for TB medicines. implementing the training.

The actual costs of further development of training materials is reported under FY04 activity 16. Last Updated: 10/12/2007

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Workplan: Regional Development Mission/Asia Year 06 Activity Title Technical activity coordination and monitoring

Activity Manager Duzey, Olya Activity # 1 Task: A1-RN06IDX Sub-Task: 97XXY1 Activity Description This activity includes technical activity coordination, work plan development, budget monitoring, progress monitoring, reporting, meetings, and communications with partners and collaborators. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project One of the key issues discussed in the None RPM Plus will submit the Year 7 Q4 Mekong is the need for coordination of draft work plan to the RDMA partner activities in malaria according to for review, and present it at an overall coherent strategy, similar to the partners meeting. the process used in the Amazon region. The RDM/A will host a biannual malaria partners meeting in late October. During the meeting, partners will discuss progress during the last fiscal year and work plans, such that they form a cohesive strategy for addressing malaria priority issues in the region. Approximately six months later, a second meeting will be held to discuss the progress of those work plans. Last Updated: 10/12/2007

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Workplan: Regional Development Mission/Asia Year 06 Activity Title Participate in meetings with partners and donors on pharmaceutical management issues in the ANE region

Activity Manager Duzey, Olya Activity # 2 Task: A1RN06IDX Sub-Task: 60EXN2 Activity Description In this fiscal year, RPM Plus will participate in meetings in the ANE region and in the Washington, DC, along with other partners to address pharmaceutical management strengthening needs in malaria, TB, HIV/AIDS, or other areas. It is also anticipated that, during this fiscal year, new RDMA regional strategies will be developed in TB and malaria. RPM Plus will participate in those discussions and planning and review meetings.

This activity will take place throughout this fiscal year. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project The Director, RPM Plus traveled to the None RPM Plus, with other invited Year 7 Q4 region In June/July 2007 to meet with partners, will participate in the Cambodia Mission, RDM/A and the annual malaria partners other partners to discuss pharmaceutical work plan meeting in management issues and approaches for Thailand in late October strengthening. 2007. Last Updated: 10/12/2007

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Workplan: Regional Development Mission/Asia Year 06 Activity Title Provide support for one regional training on pharmaceutical management of second line TB medicines

Activity Manager Moore, Thomas Activity # 7 Task: A1RN06IDX Sub-Task: 60F3M7 Activity Description RPM Plus is collaborating with the WHO/WPRO, WHO/Geneva, Green Light Committee, and the GDF, plus the RPM Plus core SO5 tuberculosis portfolio to tailor a workshop to the needs of the region, and to conduct a workshop in late 2007. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project Planning for the regional workshop on None Participant invitations will be Year 7 Q4 the management of second line anti- sent out, along with tubercular medicines continues. The requirements for data that course is being co-sponsored by they will be utilizing during WHO/WPRO, WHO/Geneva, GDF, and course exercises. Logistical the RPM Plus core TB portfolio. The arrangements will be course will be held in Manila, the finalized together with the Philippines from November 19-23, 2007. WHO/WPRO office. The agenda has been finalized, and participant selection is under way. It is anticipated that participants from five countries will take part: Cambodia, China, Mongolia, the Philippines, and Vietnam.. Last Updated: 10/12/2007

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Workplan: REDSO MAC Year 05 Activity Title Document and disseminate lessons learned on ACT implementation

Activity Manager Citysoft Admin Activity # 1 Task: A1RD05MAC Sub-Task: 60F4D1 Activity Description RPM Plus will work to document lessons learned in a number of countries in the REDSO region including Kenya, Tanzania, Zanzibar, Ethiopia, Zambia and Rwanda. These lessons will be disseminated to all countries in the region.

Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products

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Workplan: REDSO MAC Year 05 Activity Title Document and disseminate lessons learned on ACT implementation

Project RPM Plus has provided intensive Continue participation in Year 7 Q4 support to the EARN through assisting in EARN delibarations and workplan development. Through this NMCP workshops support, RPM Plus Nairobi office hosted the EARN 3rd Quarter Meeting. The meeting was attended by WHO/AFRO, RBM Secretariat (Geneva), PSI, Uganda Country Partnership. The group received RBM updates and successfully achieved a detailed review of our work plan activities/budgets. In addition, detailed activities for the upcoming quarter were agreed upon including the recruitment of a temporary focal point for 3 months, tentative agenda and venue for the EARN Annual Coordination Meeting for Implementation Support and the operationalization of the proposed USG support to RBM. As a coordinating member of the EARN , RPM Plus participated in RBM Work plan harmonization meeting in Geneva.Supported the preparation and chaired the NMCP Best Practice Sharing Workshop held in Kenya. 17 African countries implementing artemether- lumefantrine as first line ACT were represented. Aside from sharing best practices, countries developed a checklist for ensuring efficient distribution, inventory management and ACT tracking. RPM Plus strategies and achievements were acknowledged at the meeting, as part of country strategies and achievements. Last Updated: 10/12/2007

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Workplan: East.Africa /RLI Year 06 Activity Title Provide technical assistance to the Regional Pharmaceutical Forum (RPF) for the dissemination and country adaptation of

Activity Manager Thuo, Michael Activity # 2 Task: A1RD06XX Sub-Task: 60AXH2 Activity Description In FY 06, RPM Plus, will provide technical assistance to the RPF/ECSA HC and other regional collaborating partners, such as East African Community, to undertake dissemination and advocacy activities at regional level. The TA may include development of materials for advocacy and dissemination at regional health fora including the ECSA Health Ministers Meeting. At country level, dissemination activities will target the Division of Pharmacy in health ministries and disease specific programs e.g. National AIDS Control Programs, Divisions of Malaria and TB control. Specifically, a generic strategic plan for the implementation of the Medicines Policy by countries will be drafted and technical support provided to 2-3 member states that need to review national medicines policies. Also, technical assistance will be given to countries to institutionalize the periodic application of the Tool for regular performance assessment of the pharmaceutical management systems. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products

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Workplan: East.Africa /RLI Year 06 Activity Title Provide technical assistance to the Regional Pharmaceutical Forum (RPF) for the dissemination and country adaptation of

Project • As a roll-out of CIB, the situational • Funding from USAID/EA is Within the limited funding: Year 7 Q4 analysis and feasibility study for pooled very limited. The RPF, through • Disseminate the ready procurement of Essential Medicines for ECSA HC Secretariat, is documents widely and East African Community (EAC) was exploring possibilities of involving advocate for their completed. The report was presented to other development partners adaptation and adoption by medicines experts from EAC at a working in the region. (The ministries of health of ECSA Workshop on Medicines Pricing Policy Clinton Foundation co-funded the member states and disease and Pooled Procurement. Based on the meeting on strengthening the specific programs, as evidence provided by the study and the capacity for national Drug appropriate. participants’ experience, the Group Regulatory Authorities held in • Provide TA in the Contracting model was chosen (and a Arusha). developments of strategies select list of items) as the most suitable for Group Contracting of model and recommendations made to selected essential the Council of Health Ministers, EAC, on medicines for EAC partner how to implement it. These states recommendations and the Report are to • Provide TA for member be presented to the Council for approval states to adapt and apply by mid- September. the Generic Medicines • Dissemination activities continued and Policy Implementation Plan. presentations were made at different forums including the EAC Meeting of chief/principal pharmacists, CEOs of Drug Regulatory Authorities and Procurement Agencies; at the 2007 DJCC and 1st Forum on Best Practices in Health; • The Draft ‘Generic Medicines Policy Implementation Plan’ is ready for presentation, discussion and endorsement by the Regional Pharmaceutical Forum at the 4th RPF Meeting to be held from 30th September, 2007.

Last Updated: 09/28/2007

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Workplan: East.Africa /RLI Year 06 Activity Title Advocate and provide technical support for inclusion of a Pharmaceutical Management Module into the Pre-service Curricula of

Activity Manager Thuo, Michael Activity # 3 Task: A1RD06XXX Sub-Task: 60GXH3 Activity Description In FY 06 RPM Plus will provide similar TA and support to an additional 2-3 health institutions and universities in the region. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project • Discussed and planned for a • Limited funding for regional • Plan the implementation Year 7 Q4 workshop on implementation of the Pre- activities. Workshop for Malawi with service Curriculum at the College of funding through bilateral Health Sciences, Malawi, i.e. for nurses agreements. and pharmacy technicians. For the University of Malawi, implementation will be more relevant in 2008 when the B. Pharm students enter the 3rdYear.

Last Updated: 09/28/2007

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Workplan: East.Africa /RLI Year 06 Activity Title Provide support to ANECCA’s pediatric cohort study sites and selected PMTCT programs to improve commodity management.

Activity Manager Thuo, Michael Activity # 4 Task: A1RD06XXX Sub-Task: 60CXH4 Activity Description In FY06 RPM Plus will support this international collaboration by providing technical assistance to strengthen commodity management at 2-4 selected project sites in the region. Site strengthening will involve the inclusion of commodity management and pharmacovigilance modules in the in-service training curriculum developed by ANECCA. In addition, installation of computers for dispensing and application of proven inventory control tools such as the electronic ART dispensing tool, will be supported. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project • Response to a questionnaire sent to • Lack of responsiveness from • NA Year 7 Q4 the medical officer in charge of the the unit. Association Nationale de Soutien aux Séropositifs (ANSS) – Bujumbura, Burundi has not been received. The questionnaire was intended to obtain a description of the unit to establish the kind of assistance in pharmaceutical management needed to strengthen it.

Last Updated: 09/28/2007

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Workplan: East.Africa /RLI Year 06 Activity Title Provide support to “Learning Sites” to disseminate better practices instituted for improving HIV/AIDS Commodity Management

Activity Manager Thuo, Michael Activity # 5 Task: A1RD06XXX Sub-Task: 60F2H5 Activity Description In FY 06, RPM Plus will assist the learning sites to disseminate better practices learned and instituted over the previous two years to other ECSA countries. The aim of this dissemination is to give opportunity to 3-4 additional sites to learn quickly and practically how to strengthen commodity management in resource constrained settings. Examples of these better practices with the relevant proven tools include; SOPs for the Pharmacy, monitoring and evaluation using a simple access based electronic dispensing tool, strengthening of pharmacy and therapeutics committees and adapting patient medicines information leaflets for country use.

Further, dissemination and support for adaptation of the ‘Model Formulary for HIV/AIDS, TB and Malaria for ECSA Countries’ will be undertaken. The methodology to disseminate these better practices may include training of staff from targeted sites using case studies from the three previously strengthened sites. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project • This activity was not implemented. • Shortage of funds to engage • NA. Year 7 Q4 consultants to follow-up and write the case studies. Last Updated: 09/28/2007

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Workplan: Albania Year 03 Activity Title Coordination and Assessment Visit

Activity Manager Citysoft Admin Activity # 2 Task: A1AL03XXX Sub-Task: 60EXA2 Activity Description -Conduct an exploratory visit to Albania to assess options to collaborate with URC/PRO Shendetit to improve health in the community by improving rational medicine use at PHC level. This should include an overview of the current training curricula for nurses and particular how far their training covers community work and medicine use; an investigation of what is known about problems with medicine use in the community; an overview of the current supervisory system for community nurses; and a visit to a health institution supported by URC/PRO Shendetit -Develop the plan for the RPM Plus activity in the promotion of rational medicine use -Support and coordinate the implementation of the activity according to the activity plan -Maintain close communication and collaboration with the partner (PRO Shendetit) in Albania Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products

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Workplan: Albania Year 03 Activity Title Coordination and Assessment Visit

Project In July 2007 a MSH consultant visited The next step is for RPM Year 7 Q4 Albania to explore how MSH could Plus to contract a lecturer collaborate with URC/PRO Shëndetit to from the Tirana Faculty of improve the rational use of medicines in Nursing to prepare CME the community while focussing on the training materials according capacity of nurses. This exploratory trip to the session outline was conducted from July 1-6, 2007, and prepared by MSH. at the end the RPM Plus consultant, URC/PRO Shëndetit, and USAID, Albania, agreed, that RPM Plus work should support the development of training sessions for the Continuing Medical Education of nurses working at Primary Health Care level in the five prefectures supported by the URC/PRO Shëndetit program with USAID funding.

MSH has drafted a session outline for all five selected CME sessions which shall be used to develop the respective training materials. Last Updated: 10/04/2007

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Workplan: Angola (PMI) Year 07 Activity Title Technical Activity Coordination and Monitoring

Activity Manager Citysoft Admin Activity # 1 Task: A1AO07PMI Sub-Task: 97XXY1 Activity Description RPM Plus will support PMI activities in Angola through a local staff member supported by short term technical assistance provided by the RPM Plus staff based in the region as well as in RPM Plus headquarters from Arlington, Virginia, USA. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project Provided inputs to the PMI / Angola Year 7 Q4 news letter prepared by the Centers for Disease Control ( CDC) Last Updated: 10/04/2007

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Workplan: Angola (PMI) Year 07 Activity Title Training of the health agents in Coartem Management in support of the appropriate use and availability of ACTs and other essential

Activity Manager Citysoft Admin Activity # 3 Task: A1AO07PMI Sub-Task: 60CXM3 Activity Description The target audience includes the health agents prescribing and managing ACTs in health centers as well as the personnel that are managing the provincial warehouse and supervising the health facilities. Training activities will start with a training of trainers activity followed by provincial level trainings to be implemented by PMI partners.

RPM Plus will work with the EDP and NMCP to finalize the training materials. RPM Plus will also coordinate with other USAID PMI partners, in particular MENTOR, and the bilateral project EHSP for implementation of the training activities. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project During this quarter, a consultant Dr Year 7 Q4 Gustavo Bastos traveled to Angola to provide technical assistance to National Essential Medicine Program (PNME) training on essential medicine procedures. He provided inputs to facilitators to ensure that the training materials are appropriately used and that correct and consistent messages on pharmaceutical management are given to participant attending the trainings through out the country. He also visited three health centers where staffs were trained on the ACT management procedures to verify if the National Malaria Control Program (PNCM) and PNME information management forms and procedures are being followed as presented during previous trainings.Following his visit, work is ongoing to revise training materials on the kit system procedures for the European Union and the PNME Last Updated: 10/04/2007

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Workplan: Angola (PMI) Year 07 Activity Title Coordination and planning of ACT procurement and distribution including quantification for scale-up of PMI

Activity Manager Citysoft Admin Activity # 6 Task: A1AO07PMI Sub-Task: 60CXH6 Activity Description Under this workplan, RPM Plus will support this effort by contributing to the collection and dissemination of information on the status of ACTs among partners and its use to adjust ACT distribution and procurement efforts. RPM Plus will help to organize and conduct a quantification exercise based on the MOH guidelines for health facility inclusion (hospitals, health centers, health units and community levels), geographic scale up (full coverage of the 9 focus provinces followed by the inclusion of the remaining ones) and requirements for biological diagnosis (microscopy and/or rapid diagnostic tests). Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project RPM Plus consultant collaborated with Year 7 Q4 PMI, PNMC, and PNME, WHO, UNDP and partners to update the ACT quantities needed for all targeted health facilities Last Updated: 10/04/2007

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Workplan: Brazil Year 06 Activity Title Monitor national study to re-evaluate appropriate drug regimen for TB failures

Activity Manager Keravec, Joel Activity # 2 Task: A1BR06XXX Sub-Task: 60E3H2 Activity Description RPM Plus provided technical assistance and management support to Helio Fraga TB Center and an expert working group to develop a study protocol and methodology for testing resistance in the population to currently used TB medicines, and for testing appropriate regimens to remove the drug ethionamide which is not recommended by WHO due to potential serious adverse reactions. The study protocol was approved by local TB experts, the national TB program (NTP) and the national ethical committee. RPM Plus plans to continue this support in FY06 by monitoring the initiation and carrying out of the study. RPM Plus will hire a consultant with study monitoring experience to train cohort center personnel, set up data collection sites, and coordinate the analysis of study data. Because of the slowness in adding patients to the cohort, the study will likely require three years to complete. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products

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Workplan: Brazil Year 06 Activity Title Monitor national study to re-evaluate appropriate drug regimen for TB failures

Project TB and MDR-TB experts met in Next steps are: Year 7 Q4 September in São Paulo with the • To monitor progress on Brazilian Society of Pneumology and the definition of the drugs Tysiology to discuss the agenda for which will be incorporated to defining the needed up-dates of the the new R3 scheme and to national TB guidelines (called TB redefine a protocol with the consensus) and to harmonize the edition committee according to final of these guidelines with official norms of decisions to be taken by the the MoH for TB. The issue of the needed program changes in the re-treatment scheme was • To monitor approval addressed and there is a consensus process of the updated reached on suppression of the first R1 re- study protocol from the treatment regimen (2RHZE/4RHE). Final ethics committees of the decisions on the composition of the R3 federal government scheme (the second re-treatment scheme, which would later become the unique re-treatment scheme) to update the previously approved study protocol were still not made to date by the MDRTB experts committee. A new team has been nominated at the head of the TB program and RPM Plus met with the new NTP coordinators: the next workplan for FY07 was approved, with a special emphasis on the need for the TB program to address the re- treatment regimens changes as a priority.

• Report of evidence to support regimen change — completed • Report on recommendations and experts meeting for regimen change — completed • Plan of specific activities — continuing to review based on informational meeting with investigators • Meeting recall to update study protocol -- completed • Monitoring and supervision system -- ongoing • Approved study protocol — original protocol completed and approved by

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Workplan: Brazil Year 06 Activity Title Monitor national study to re-evaluate appropriate drug regimen for TB failures

ethics committee; however, because of new MDR-TB evidence the study protocol has to be updated • Interim reports of accomplishments — ongoing • Training materials for monitors — final orientations need to be formalized by NTP before definition of these materials Last Updated: 10/11/2007

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Workplan: Brazil Year 06 Activity Title Support national study to re-formulate first line TB drugs to fixed-dose combination (FDC) products

Activity Manager Keravec, Joel Activity # 3 Task: A1BR06XXX Sub-Task: 60E3G3 Activity Description RPM Plus during the last two years has mobilized a stakeholders group representing all necessary MoH agencies for FDC introduction (manufacturers, FDA, NTP, Pharmacy Department). A working plan with shared responsibilities was developed and RPM Plus is providing technical and managerial assistance through local and international experts. The largest government manufacturing laboratory Farmanguinhos, acquired new equipment in its facility which is dedicated to TB drugs production (FDCs and pediatric sachets). The following products are either in stability testing phase or are ready for production by the national laboratories.

• Moved from 2 products in 1-product FDCs in tablet form (was capsules) for better stability of the products • Developing formulations for three products in one and four products in one FDCs (3-FDC, 4-FDC) in tablet forms • Developed pediatric formulations including sachets which are in advanced stability testing

Using the stakeholder’s working group approach which included the highest level personnel possible from the MoH has led to better integration of Brazil manufacturing potential and procurement strategy and gave Brazil a chance to better understand strategies of the international partners such as WHO’s Global TB Drug Facility and Green Light Committee. It is interesting to note that the national Malaria program has copied the RPM Plus approach, apparently with similar results. Another important outcome is the visibility Brazil has gained in the Latin America-Caribbean (LAC) region as a potential provider of TB medicines.

In FY06 RPM Plus plans to support a South-to-South approach for further developing and implementing FDCs in Brazil. Dr. Bernard Fourie developer of the FDC four products-in-one for the WHO and who is familiar with the Brazil system would provide technical expertise during the implementation. This technical assistance began at the Second National Conference for Tuberculosis held in São Paulo, Brazil 19-22 July 2006 when Dr. Fourie presented on the transition process of South Africa for switching to FDCs and also had several meetings with Brazilian producers, the quality assurance program and the national TB program. All are on-board for his expert assistance as Brazil moves to the 3- FDC product. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products

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Workplan: Brazil Year 06 Activity Title Support national study to re-formulate first line TB drugs to fixed-dose combination (FDC) products

Project • South to South Cooperation: • Continue to monitor on- Year 7 Q4 • RPM Plus met with the technical decision process involving three going stability studies for expert group in charge of developing a countries is slow, and the FDCs scope of South-to-South collaboration cooperation process is led by the • Provide assistance for between Brazil, South Africa and India in Ministries of Science and developing bioequivalence TB area for pharmaceutical related Technology whose agendas are and bioavailability studies issues like production of FDCs or not always 100% aligned with the necessary to register the MDRTB monitoring. Final report from the agendas of Ministries of Health new formulations of 2 in 1 TB meeting held in October 2006 in for disease control. FDC (R+H , tablet) with South Africa was officially endorsed by • FDCs: a major difficulty to be ANVISA through the Center the three participating countries. A solved and barrier to the for Research of meeting on MDRTB has been proposed development process of FDC has IPEC/Fiocruz in October/November 2007 to transfer been the timeframe and • Hire TB experts to the experience acquired in Brazil with procedures to procure quality provide technical assistance recording and reporting systems for assured rifampicin salts with the in conducting studies as MDRTB case management and second adequate characterization for the appropriate line medicines management. needed formulation. • Farmanguinhos has been in a • After an extensive work on raw process of transferring its material characterization, production lines from Fiocruz site Farmanguinhos acquired quality assured to the new plant of Jacarepagua, rifampicin salts from a certified supplier and needed to follow the legal to initiate fabrication of the pilot batch of process with Anvisa (NRA) to get 2 in 1 tablets FDC of rifampicin and approval for the new production isoniazid. This batch will be used to site and new equipment initiate the bio-equivalence study (study acquired. protocol is already developed and approved and should be carried out at the IPEC/Fiocruz) • Farmanguinhos developed a new formulation on sachets for the 3 in 1 FDC –adult form (rifampicin, isoniazid, and pyrazinamid). Further technical definitions need to be conducted on packaging before this formulation can enter in an advanced stability testing process. • RPM Plus provided technical assistance to TB experts on request of NTP and MoH / SVS to evaluate potential use of sachets for adults TB treatment (including best formulation according to current schemes and doses

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Workplan: Brazil Year 06 Activity Title Support national study to re-formulate first line TB drugs to fixed-dose combination (FDC) products

used in Brazil, quality assurance and programmatic issues) and documentation sent by suppliers to MoH • RPM Plus provided some support for the implementation of capillary electrophoresis methodology at Farmanguinhos and INCQS to allow expanded testing of drug samples. o Equipment qualification and calibration were finalized and first tests performed on isoniazid and rifampicin tablets (FDCs 2 in 1): first analytical curves realized and evaluated, tests on solution stability within the range of tests requirements realized. o Training of a technician in a course for Gaz Chromatography • FDCs production for TB were earmarked again as a priority demand from the NTP in a meeting held at the MoH early October between the ¨Pharmacy Department, the Health surveillance Department, Farmanguinhos and the NTP Last Updated: 10/11/2007

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Workplan: Brazil Year 06 Activity Title Coordinate decentralization of the quality control system for TB pharmaceutical management

Activity Manager Keravec, Joel Activity # 4 Task: A1BR06XXX Sub-Task: 60DXH4 Activity Description During the past two years RPM Plus used the stakeholder’s working group approach and established a sustainable system at the MoH for testing 1st and 2nd line TB drugs, the first testing program in Brazil of its kind. The working group highly mobilized persons from cross cutting agencies and stakeholder organizations to assure procurement, distribution, quality control and rational use of TB drugs. This is the first time such a group of stakeholders has taken a holistic, comprehensive approach to improve the quality of drugs all the way from national selection of medicines to their final use by health workers and patients in treatment settings. One of RPM Plus’ main partners, INCQS was instrumental in supporting this work and RPM Plus has been the main catalyst in making this activity successful.

Another important success factor has been the LabMOST a new tool for Quality Systems Implementation in Drugs Quality Testing Labs introduced by RPM Plus over the last two years. The LabMost is helping to move reference labs to ISO accreditation (norm ISO/IEC 17025) by providing a comprehensive set of management tools for strengthening lab capacity. The LabMost tool is currently being adapted for minimum quality systems implementation in labs performing in limited resource settings. As a result of the previous successes the national product quality working group decided that 11 additional laboratories located throughout the country will be involved in the ISO accreditation process which will in effect decentralize capacity of product testing closer to where the products are being manufactured. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products

Thursday, December 20, 2007 3:55 PM Page 130 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Brazil Year 06 Activity Title Coordinate decentralization of the quality control system for TB pharmaceutical management

Project . RPM Plus consultant with a specialty . For reference laboratory Year 7 Q4 in laboratories continues to work with the at Helio Fraga: new reference laboratory at Helio Fraga - Continue training of and National Institute for Quality Control personnel on SOPS; update with the following accomplishments this SOPs as needed quarter: - Continue capacity - Finalizing process of development of building of the technicians technical SOPs for the Quality Manual for conducting internal (meets reference laboratory ISO audits of the physical standards 15189.2003) laboratory, procedures, - Preparing a personnel training in document and training and biosafety issues follow-up of tests conducted - Assisting laboratory during process of . Support meeting with an external audit ANVISA to expand quality . A training course on ISO IEC 17025 control testing of field Norm for drug quality testing was held in samples August 2007 at the Public Health Laboratory of Amapa state, in partnership with INCQS . Quality control testing program for TB drugs is awaiting further definition from Anvisa to start a new round (organizational and financial issues to support program were raised by Lacens) . NTP requests assistance to RPM Plus for testing the new batches of first line TB drugs recently procured: information on how to carry out the process and interaction with INCQS was provided Last Updated: 10/11/2007

Thursday, December 20, 2007 3:55 PM Page 131 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Brazil Year 06 Activity Title Expand DMIS surveillance system for managing MDR-TB patients

Activity Manager Keravec, Joel Activity # 5 Task: A1BR06XXX Sub-Task: 60G4H5 Activity Description During the past two years RPM Plus has worked with one of its main partners CRPHF to develop DMIS surveillance system for managing MDR-TB patients: Created a model for decentralization •Developed course methodology and educational materials for training of MDR-TB reference center personnel•Is web-based for data entry facilitating use by local and national level MoH personnel•Created a procedural guide for both: –use of the web-based system, and –training plan so that reference centers can train additional personnel•Has been institutionalized whereby the computer server and system are managed by CRPHF (MoH organization operating at the national level)•Implemented in 27 states•Is a capacity building program where 450 health professionals in 61 MDRTB reference centers have been trained and are currently using the system•Increased case detection rate of MDR-TB significantly increased 2nd year after the project started.Plans for FY06 are to expand the surveillance model to include all re-treatment cases under the DOTS program to optimize monitoring and prevent risks of MDRTB. An evaluation will be done to determine the correct usage of the system one year after implementation. Based on this evaluation the system will be modified if needed. RPM Plus and its partners also plan to expand the MDRTB model to underserved populations including community programs, indigenous areas and states/country prison system as much as possible. Considerable interest about the MDR-TB surveillance model has been expressed outside Brazil. Dr. Joel Keravec, RPM Plus/Brazil technical coordinator and Dr. Miguel A.Hijjar, Director of CRPHF traveled to Atlanta at the request of PAHO to participate in the GLC partners’ summit in May 2006. Then in July 2006 Dr. Keravec and Dr. Margareth Dalcolmo CRPHF Director of outpatient treatment traveled to Mexico City at the request of PAHO and the TB UNION to demonstrate the MDR-TB surveillance model and to facilitate sessions on appropriate use of the web-based tool including steps in the implementation process. Brazil MOH and Ministry of Foreign Affairs have asked that RPM Plus become part of a forum to share this experience in a South-to- South technical cooperation project they are planning to implement among countries such as India, China, South Africa and Brazil. Also, two countries in the NIS region, Moldova and Romania have expressed interest in using the model in their countries using RPM Plus support as well. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products

Thursday, December 20, 2007 3:55 PM Page 132 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Brazil Year 06 Activity Title Expand DMIS surveillance system for managing MDR-TB patients

Project 1)Review and update of data in the Limitations in human resources • Data extraction of the Year 7 Q4 database for the DMIS system during at CRPHF to manage the DMIS MDR-TB surveillance this quarter: - RPMPlus consultants at have slowed down the transfer system will lead to a regular CRPHF level, central Unit for MDRTB process, which needs man power epidemiological surveillance surveillance, validated 790forms to definitions to be consolidated; bulletin complete the MDRTB data base (68new DMIS users need more trainings • Stock and 2nd line drugs notification, 243new Patient follow-up and the process of permanent distribution control through and 33Post-Cure were edited at central learning is still slow to incorporate DMIS implementation will level)- Consultants contributed to the culture of information sharing allow CRPHF to define new validate data entered electronically to between different TB procedures for a better the DMIS from state MDR-TB reference management levels. trade off between 2nd line centers (RC) level (throughout Brazil: medicines providing and Case notification forms:84;Patient follow- information receiving up forms:231;Post-Cure forms:69) - Total data currently available from the MDR-TB surveillance data base to date is as follows: Case notification forms:3007; Patient follow-up forms:7152; Post-Cure forms:1043) 2)RPM Plus consultants did: All modules of the MDR-TB case management system have been validated, some new functionalities recently developed for data analysis and drug management are still on a validation process. 3)Consultants extracted data from the electronic DMIS database and contributed to format a MDRTB surveillance boletim which has to be further revised and edited by CRPHF according to its institutional mandate as head of MDRTB surveillance. The current validated functions of DMIS are being used to extract epidemiological informations to be employed in trainings, and also to be further used by the MoH for MDRTB surveillance and further published in national scientific bulletins. 4)The consultants are working in developing strategies with CRPHF to scale up the access and use of the DMIS throughout the country where electronic data transfer use is still low for

Thursday, December 20, 2007 3:55 PM Page 133 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Brazil Year 06 Activity Title Expand DMIS surveillance system for managing MDR-TB patients

notification and follow-up. A training was conducted in Bahia State MDRTB RC to review to increase capacity building on system procedures and flows, and to review the MDRTB medical charts in order to update the patient information and available data in the DMIS database. New trainings are being planned for Nov and Dec07 to cover all the country using the same methodology. 5)The System User Manual has been updated and the case control module was retested and validated during the pilot training carried out in Bahia State. 6)Transferring the System Management from RPMPlus to CRPHF. The consultants have been assisting the firm contracted by CRPHF which scope of work is to develop a specific web site to host the DMIS. Technical and managerial steps have been defined to ensure a full functional transfer during the coming months; MOU for intellectual rights and property have been updated at this occasion. Last Updated: 10/11/2007

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Workplan: Dominican Republic Year 05 Activity Title Training of trainers on the use of FDC

Activity Manager Barillas, Edgar Activity # 2 Task: A1DO05XXX Sub-Task: 60F3M2 Activity Description The ToT workshop will include strategies to reproduce the training during supervision visits to all health facilities, to monitor the implementation process and to include corrective actions during the supervision visits. RPM Plus will program resources for the ToT on FDC (tentatively scheduled for the second quarter FY05) and for the reproduction of materials, but not for supervision visits and additional training activities. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project RPM Plus visited Dominican Republic No contraints Activity is closed Year 7 Q4 from July 16th to 20th to facilitate a training workshop on the management and use of fixed dose combinations medicines. Thirty seven managers from 19 provinces, and the central level participated in the workshop that was held in the V Centenario Hotel on July 18th. The modality used was a training of trainers, so the participants were instructed in strategies to replicate the training and provided with educational materials. Last Updated: 09/26/2007

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Workplan: Dominican Republic Year 05 Activity Title Conduct FDC needs estimation

Activity Manager Barillas, Edgar Activity # 3 Task: A1DO05XXX Sub-Task: 60F3A3 Activity Description The estimation of needs of FDC to treat all cases in the country will be conducted with the participation of NTP managers. Results will be used to complete the application to the GDF, and the elaboration of a plan for discontinuing the use of loose medicines without wastage. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project RPM Plus estimated the availability of No contraints Activity is completed Year 7 Q4 TB medicines, based on information produced by the Drug Management Information System and data collected from the central medical store. For all medicines, with the exception of Rifampicin, there is enough working and security stock for more than 12 months. The next procurement to the GDF should be planned early next year. RPM Plus will assist the NTP in the estimation of needs.

The second shipment of FDC, to cover 50% of the cases, arrived on the third week of July; immediately after the workshop. Last Updated: 09/26/2007

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Workplan: Dominican Republic Year 05 Activity Title Technical assistance for internal and external evaluations

Activity Manager Barillas, Edgar Activity # 6 Task: A1DO05XXX Sub-Task: 60F3H6 Activity Description RPM Plus will participate in three internal / external evaluations of the programa during FY05 Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project No evaluations were planned for this No contraints Activity was completed Year 7 Q4 quarter Last Updated: 09/26/2007

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Workplan: Dominican Republic Year 05 Activity Title Support for the analysis of the information produced by the PMIS

Activity Manager Barillas, Edgar Activity # 7 Task: A1DO05XXX Sub-Task: 60G4H7 Activity Description The PMIS is starting to produce data on availability and consumption of medicines in all levels of the logistical network. RPM Plus will support central level technicians on the analysis of this information and its use for annual quantification exercises and periodical ordering. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project RPM Plus estimated the availability of No contraints Activity was completed Year 7 Q4 TB medicines, based on information produced by the Drug Management Information System and data collected from the central medical store. For all medicines, with the exception of Rifampicin, there is enough working and security stock for more than 12 months. The next procurement to the GDF should be planned early next year. RPM Plus will assist the NTP in the estimation of needs.

The second shipment of FDC, to cover 50% of the cases, arrived on the third week of July; immediately after the workshop. Last Updated: 09/26/2007

Thursday, December 20, 2007 3:55 PM Page 138 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Dominican Republic Year 06 Activity Title Technical assistance for the scale up of the use of FDC

Activity Manager Barillas, Edgar Activity # 2 Task: A1DO06XXX Sub-Task: 60F3H2 Activity Description The progressive scale up on the use of FDC will take 12 months, to ensure a programmed phase out of the loose medicines. FY06 resources will contribute to the estimation of needs of FDC, and technical assistance to consolidate the administrative procedures for upcoming applications to the GDF. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project Still using FY05 resources, RPM Plus No contraints A visit is scheduled for Year 7 Q4 visited Dominican Republic from July November 2007 to review 16th to 20th to facilitate a training the progress in the scale up workshop on the management and use of fixed dose combinantions. of fixed dose combinations medicines. Thirty seven managers from 19 provinces, and the central level participated in the workshop that was held in the V Centenario Hotel on July 18th. The modality used was a training of trainers, so the participants were instructed in strategies to replicate the training and provided with educational materials. Last Updated: 09/26/2007

Thursday, December 20, 2007 3:55 PM Page 139 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Dominican Republic Year 06 Activity Title Support for the analysis of the information produced by the PMIS

Activity Manager Barillas, Edgar Activity # 3 Task: A1DO06XXX Sub-Task: 60G4H3 Activity Description The PMIS is starting to produce data on availability and consumption of medicines in all levels of the logistical network. FY06 resources will support central level technicians on the analysis of this information and its use for annual quantification exercises and periodical ordering. Unused FY02 resources (USD, 20,000.00, originally assigned to software adjustment, as described above) will be reprogrammed to support this activity. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project During a visit to Dominican Republic on No contraints. During the next visit to Year 7 Q4 July 2007, and still using FY05 Dominican Republic, resources, RPM Plus estimated the tentatively scheduled for availability of TB medicines, based on November 2007, RPM Plus information produced by the Drug will analyze the information Management Information System and produced by the DMIS to data collected from the central medical estimate the consumption store. For all medicines, with the and availability of fixed dose exception of Rifampicin, there is enough combinations. working and security stock for more than 12 months. The next procurement to the GDF should be planned early next year. RPM Plus will assist the NTP in the estimation of needs.

The second shipment of FDC, to cover 50% of the cases, arrived on the third week of July; immediately after the workshop.

Last Updated: 09/26/2007

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Workplan: Dominican Republic Year 06 Activity Title Participation in external and internal evaluations of the NTP

Activity Manager Barillas, Edgar Activity # 4 Task: A1DO06XXX Sub-Task: 60F3A4 Activity Description In addition to the follow up activities, the USAID mission requested the participation of RPM Plus in national evaluations of the NTP, and as part of external evaluation teams. FY06 resources will finance the participation in one evaluation visit. Unused FY05 resources will also support this activity. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project No activities were planned for this No contraints. During next visit to Year 7 Q4 quarter. Dominican Republic on November 2007, RPM Plus will discuss the tentative dates for internal and external evaluations to plan accordingly. Last Updated: 09/26/2007

Thursday, December 20, 2007 3:55 PM Page 141 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Ethiopia COP Year 07 Activity Title Renovation/Infrastructure

Activity Manager Daniel, Gabriel Activity # Q3 Task: A1ET05HIP Sub-Task: 60A2H4 Activity Description Renovate and upgrade pharmacy and laboratory infrastructures as required for secure and safe storage for drugs, supplies and records. (shelving/ lockable cabinets, refrigerators) and provide improved confidential dispensing and counseling booths and incinerators for damaged drug disposal Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project Renovation and upgrading of structures Price fluctuations Assigning selected Year 7 Q4 (dispensing pharmacy, drug store, contractors counseling rooms, laboratory, incinerator and dispensing booths.) at 17 sites has been completed and handed over to the Health Facilities Renovation and upgrading of structures at 29 sites is in good progress and near completion Dr. Negussu Mekonnen, COP RPM Plus/MSH officially handed over the renovated sections of the pharmacy to the health facility at Mekele Tigray, on June 21, 2007 Renovation work at Harar Police Hospital and Hirna HC, which is almost finalized, was supervised. Handover is expected to take place in the near future Last Updated: 07/11/2007

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Workplan: Honduras Year 01 Activity Title Technical assistance and follow-up visit.

Activity Manager Paredes, Patricia Activity # 3 Task: A1HN01XXX Sub-Task: 60F3H3 Activity Description Follow-up of country activities will be done in coordination with the national TB managers. RPM Plus will communicate through telephone and electronic mail, providing technical assistance to country managers during the stages of monitoring activities. A report will be prepared after this second workshop to assess the need for further technical assistance by RPM Plus and the areas where this assistance might have more impact. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project RPM Plus visited Tegucigalpa to analyze No contraints. With remaining resources Year 7 Q4 and discuss with local counterparts the RPM Plus will provide TA in situation of TB pharmaceutical any of the areas management, the feasibility of the recomended in the trip introduction of fixed dose combinations report. Not follow up visit and the implementation of alternative has been scheduled at this mechanisms to procure TB point. pharmaceuticals and commodities. A draft version of the trip report was sent to the TB manager and staff. Last Updated: 09/26/2007

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Workplan: Kenya COP Year 06 Activity Title Plan, coordinate, and inform health commodity procurement and distribution by working collaboratively with MEDS and USG PEPFAR

Activity Manager Thuo, Michael Activity # 2 Task: A1KE06HIP Sub-Task: 60CXH2 Activity Description Under COP 2006, RPM Plus will continue coordinating ART commodity supply and distribution efforts on behalf of the USG team. MSH/RPM Plus will continue playing its role as the source of data and information for ARV drug usage by the ART sites. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products

Thursday, December 20, 2007 3:55 PM Page 144 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Kenya COP Year 06 Activity Title Plan, coordinate, and inform health commodity procurement and distribution by working collaboratively with MEDS and USG PEPFAR

Project 1. Procurement of ARVs 1. Procurement of ARVs 1. Work collaboratively Year 7 Q4 RPM Plus continued to work closely with • Long lead times by suppliers in with USG team, MEDS and the USG team and MEDS to monitor the delivering some ARV drugs to NASCOP in the timely rate of delivery of the procured ARV MEDS e.g. Abacavir solution. quantification and drugs into MEDS. Delivery of the drugs • Inadequate supply of drugs for forecasting of ARVs and into MEDS was in accordance to a opportunistic infections, mainly procurement from approved delivery schedule modified according to due to lack of clear guidance on suppliers. the program expansion rate. The their procurement hence their not 2. Working with USG procured ARVs are used for supporting being budgeted for in this team, MEDS and NASCOP both the ART and PMTCT programs. procurement period. in ensuring that appropriate RPM Plus provided information crucial to drugs in fixed dose additional procurement of pediatric 2. Distribution of ARVs to health combinations are procured ARVs from Clinton Foundation through facilities for use by sites. This would MEDS. • Slow uptake of paediatric significantly lessen some of RPM Plus supported a national formulations at sites hence the constraints due to single quantification exercise for procurement leading to expiries in some sites. dose formulations. of ARV drugs by Clinton Foundation • Some sites were still not able 3. Work closely with through MEDS. to place their orders in a timely NASCOP to coordinate and manner. This was due to various streamline the dual supply 2. Distribution of ARVs and other OI reasons e.g. excessive workload, of ARVs to ART sites drugs responsible persons for placing including paediatric RPM Plus worked collaboratively with orders being absent etc. formulations. NASCOP, MEDS and the USG team in • Delays in getting paediatric re- 4. Continue providing distributing ARV drugs to approved ART supply orders from NASCOP for technical assistance to sites and PMTCT sites using a demand driven various ART sites. to improve their system. By the end of September, a management of data and total of 283 ART sites from 8 provinces 3. Data collection and collation subsequent reporting on supporting over 82,000 ART patients on ARV drug utilization ARV drug utilization. This were receiving ARVs from MEDS for • Lack of tools to track includes the use of tried and their ART program with the assistance of commodity utilization and patient tested manual tools RPM Plus (i.e. 197 in public sector; 56 service statistics at the points of developed by RPM Plus FBO; 14 community based; 9 private; service. and others for commodity and 6 NGO-based facilities). • Some sites had a very high management. For those patient load and their use of sites that are able to afford RPM Plus continued to support the manual data collection tools computers, they will be PMTCT program, by coordinating the made the process of reporting provided with the computer ARV drug distribution to various PMTCT slow and cumbersome. based ART Dispensing Tool sites. By end September 2007, a total of • Some sites do not have skilled and Inventory Tracking 301 PMTCT sites from 8 provinces were staff to manage their data in Tool, both developed by receiving ARV drugs with RPM Plus order to prepare accurate reports RPM Plus to assist in support (i.e. 238 in public sector; 46 on drug utilization. managing data for both the FBO; 3 community based; 9 private • Late reporting by sites, patients receiving drugs, sector; and 5 NGO-based facilities). especially some of the high and the stocks within the

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Workplan: Kenya COP Year 06 Activity Title Plan, coordinate, and inform health commodity procurement and distribution by working collaboratively with MEDS and USG PEPFAR

volume sites that were initially pharmacy. RPM Plus continued to provide routine submitting their reports regularly. 5. Work closely with the commodity utilization reports to • For the PMTCT program, the PMTCT group in ensuring NASCOP on behalf of the Kenya data collection has been a big that the system for ordering PEPFAR program. challenge as many sites do not ARVs by sites and reporting have the primary data capture on utilization is 3. Monitoring utilization of ARVs by sites tools, and the requisite skills to strengthened. RPM Plus continued to work with the properly manage PMTCT 6. Plan to train staff from USG team and NASCOP to monitor the commodities. various PMTCT sites on usage of ARVs at sites. A monthly commodity management, in summary report was used to collect collaboration with other information on ART & PMTCT implementing partners. commodity status/utilization as well as on patient service statistics. Follow ups were made by RPM Plus to the sites to discuss the status of their ARVs and advise on issues related to utilization and scale up. Site feedback was useful to inform the USG team, MEDS, NASCOP and partners on effective and efficient planning for timely commodity acquisition and distribution to sites.

Status of products: – Quantification tables – available with USG team – Workshop proceedings on quantification – draft report available – Monthly commodity usage reports to NASCOP – available (NASCOP) – Minutes for meetings on supply chain coordination – available Last Updated: 10/03/2007

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Workplan: Kenya COP Year 06 Activity Title Provide technical assistance to build the capacity of MEDS to support the scale up of access to and rational use of ART in Kenya

Activity Manager Thuo, Michael Activity # 3 Task: A1KE06HIP Sub-Task: 60EXH3 Activity Description Activities will include; • Technical assistance to strengthen MEDS staff in quantification and inventory management techniques. • Technical assistance to strengthen MEDS Management Information Systems (MIS) and client service, • Improving the HR Capacity for commodity management through training and mentoring, and regional study tours • Strengthening the Training, Supervision and M&E initiatives. • Strengthening MEDS capability to support both the public and private ART sites through appropriate linkages and synergies • Strengthen current MEDS ART commodity management training initiatives Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products

Thursday, December 20, 2007 3:55 PM Page 147 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Kenya COP Year 06 Activity Title Provide technical assistance to build the capacity of MEDS to support the scale up of access to and rational use of ART in Kenya

Project 1. TA to strengthen MEDS staff in • The rapid scale up of the 1. Continue working Year 7 Q4 quantification and inventory program has put a lot of strain on closely with MEDS and management techniques. the normal operations of MEDS. facility staff on MEDS have continued to receive The staff at MEDS have limited strengthening their ability to technical support during quantification of time to develop or improve their quantify, conduct M&E and ARV and OI drugs in support of the USG skills in specific areas of improve various strategy for Kenya. During this period, commodity management e.g. components in their MIS. RPM Plus worked collaboratively with quantification, management 2. Continue supporting staff from NASCOP, MEDS, Clinton information systems, monitoring MEDS’ initiatives to train Foundation, and the USG team in and evaluation etc. As the more facility staff in quantifying ARV needs for PEPFAR year program expands, there is an commodity management 4. increased need to get more staff 3. Continue supporting skilled in specific areas of MEDS’ initiatives on 2. Technical Assistance to strengthen commodity management, strengthening linkages with MEDS Management Information System including the use more innovative other organizations that are and client service approaches, to support the supporting the HIV/AIDS RPM Plus has continuously supported supply chain activities. Programs MEDS’ efforts in strengthening their management information systems in order to improve their client service. In so doing, RPM Plus has worked closely with MEDS to maintain a robust demand driven system for ordering ARVs and OI drugs through MEDS. RPM Plus continued to coordinate the ordering by sites, and facilitate collection and collation of information from sites so that the information captured by MEDS is ready for inputting into the MEDS information system. This support has allowed MEDS to be able to be responsive to their clients, and be able to generate various types of commodity management reports, despite the increasing number of sites (both ART and PMTCT).

3. Strengthening the training, supervision and M&E Initiatives • RPM Plus assisted MEDS in tracking commodities from suppliers into MEDS and between MEDS and the PEPFAR- assisted sites.

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Workplan: Kenya COP Year 06 Activity Title Provide technical assistance to build the capacity of MEDS to support the scale up of access to and rational use of ART in Kenya

• RPM Plus also continued providing support to MEDS in monitoring the utilization of ARV drugs by sites. This helps to ensure that the delivery schedules for key ART commodities were adjusted accordingly with the consumption pattern.

4. Strengthening MEDS capability to support both the public and private ART sites through appropriate linkages and synergies With the continued scaling up of the program to more sites, RPM Plus supported MEDS in being able to service all sites including those in the public, FBO, community and private sectors. Some of these included sharing of information on commodity access and use for PLWHA. RPM Plus continued to support MEDS in expanding the paediatric ART services through Clinton Foundation support. Specifically, RPM Plus supported MEDS in coordinating distribution of Clinton Foundation-procured paediatric ARV drugs to sites, and in the quantification for procurement of additional paediatric ARV drugs. Last Updated: 10/03/2007

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Workplan: Kenya COP Year 06 Activity Title Provide technical assistance to build the capacity of MOH/NASCOP to support access to , and rational use of, quality pharmaceutical

Activity Manager Thuo, Michael Activity # 4 Task: A1KE06HIP Sub-Task: 60AXH4 Activity Description Activities will include: ? Support to the MOH/NASCOP centrally by: 1. Involvement in MOH/NASCOP Drug sub-committee activities; 2. Involvement in MOH/NASCOP Training sub-committee activities ; 3. Involvement in MOH/NASCOP Planning & Operations sub-committee activities. 4. Involvement in Paediatric and PMTCT commodity management activities 5. Involvement in MOH bilateral and multilateral commodity management activities undertaken through the National AIDS Control Council (NACC). ? Support to the MOH/NASCOP commodity management support supervision activities ? Develop ART Commodity Management job aids ? Support NASCOP training efforts by continuing the existing joint RPM Plus/NASCOP commodity management training efforts in the following areas in which RPM Plus has designed in-service training curricula: o Inventory Management for ART Drugs & Medical Supplies o ART Commodity Management for Health workers in Primary Health Care Settings o Implementing the use of an electronic tool for ART dispensing o Quantification training for central level pharmacists working in KEMSA, MEDS and NASCOP o Promoting Rational Use Of Medicines (PRDU) international training to central staff working in NASCOP,KEMSA, Teaching& Referral sites, PGHs and other high volume sites o Training Of Trainers (TOT) for Regional based Commodity Management training teams o Training of Pharmacy staff at ART sites on ART drug consumption data handling

? Implementation of Commodity management tools and approaches to support the national programme in areas of: o Quantification and Forecasting of ARV needs (Quantimed Tool) o Dispensing and commodity patient usage tracking at points of use ( MSH- ART Dispensing Tool) o Manual Quantification Tools ( MSH Quantification Workbooks) o Supply and inventory management tools ( forms and registers) ? Support workshops to develop training curricula on specific areas in ART commodity management; ? Support efforts to develop/updating ART standard treatment guidelines, ? Support efforts to develop/update MIS and M&E commodity management indicators and instruments, ? Support efforts to develop patient medication counseling materials and methodologies. ? Implementation of the MTP (Monitoring, Planning, Training) Approach to training ? Support NASCOP ART Adherence and ADR monitoring efforts

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Workplan: Kenya COP Year 06 Activity Title Provide technical assistance to build the capacity of MOH/NASCOP to support access to , and rational use of, quality pharmaceutical

Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products

Thursday, December 20, 2007 3:55 PM Page 151 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Kenya COP Year 06 Activity Title Provide technical assistance to build the capacity of MOH/NASCOP to support access to , and rational use of, quality pharmaceutical

Project Activity Progress: None • Continue to participate Year 7 Q4 1.Support to MoH/NASCOP Centrally and contribute to various • ART Task Force meeting. Major National ART Task Force issues;-Pediatric RRI scale up; subcommittees decentralization of ART; training of • Continue to support HCWs for scale up national training efforts by • Pediatric ART Subcommittee: Review liaising with ART partners to of Media campaign materials leverage training workshops • ART Training Subcommittee. • Continue to develop Participated in 3 meetings. Review of training materials to ongoing IMAI Training, Development of address identified gaps in higher level IMAI Training curriculum, various areas of commodity strategies for beyond training management • Commodity Working Group meetings: • Continue to support • Updates on commodity status at both National efforts to put MEDS and KEMSA; test kits; OI drugs electronic systems in place • Facilitated the quantification meeting in support of for both paed and 2nd line ARVs to be decentralization efforts procured by Clinton Foundation. • Continue to work with • Assisted NASCOP in deriving NASCOP to develop assumptions to quantify for procurement strategies and approaches through the Global Fund, for strengthening • Assisted NASCOP in compiling pharmaceutical services in national regimen data to review the support of ART percentage of patients (both adults and • Work with NASCOP paeds) who are on 2nd line regimens. central staff to strengthen The data was submitted to WHO. leadership and 2. Support in training management skills • Commodity Management: 56 staff • Work with NASCOP from 34 ART sites central staff to identify and • ToT: 28 staff from 24 sites strengthen technical skills • Supportive Supervision: 21 staff from needed to plan and co- 13 ART sites ordinate ART commodity • ART Dispensing Tool: 17 ART sites management at National were trained and implemented use of the Level ART dispensing tool 3. Development of Training Materials and job aids • Nine ART commodity management job aids reviewed and adapted nationally. Printing started • National ART commodity management SOPs reviewed and 12

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Workplan: Kenya COP Year 06 Activity Title Provide technical assistance to build the capacity of MOH/NASCOP to support access to , and rational use of, quality pharmaceutical

adopted nationally. Final review in quarter 1. • Support Supervision: Draft of training curriculum and a Manual of Tools developed, reviewed, printed and presented to NASCOP • Mentorship: Training curriculum and mentorship program reviewed, developed and presented to NASCOP. Final review in quarter 1 3. Dissemination/Implementation of Commodity management tools and approaches • Job aids disseminated to 47 ART sites • ART commodity management training materials provided for 2 regional trainings

Progress On Products • Mentorship: Training Curriculum and Program description available • Supportive Supervision: Training curriculum and Tools available • Supportive Supervision: Training report- in Progress • ARV Dispensing Tool: Training report- in Progress • National ART Commodity Management Job Aids Available • Draft National SOPs Available Last Updated: 10/03/2007

Thursday, December 20, 2007 3:55 PM Page 153 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Kenya COP Year 06 Activity Title Conduct assessments in potential ART service delivery points to determine their readiness for the provision of Pharmaceutical

Activity Manager Thuo, Michael Activity # 5 Task: A1KE06HIP Sub-Task: 60CXA5 Activity Description The rapid assessments (usually lasting for a duration of one day), are also intended to provide information on commodity management gaps existing at the sites, and to guide ART commodity management system strengthening efforts. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products

Thursday, December 20, 2007 3:55 PM Page 154 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Kenya COP Year 06 Activity Title Conduct assessments in potential ART service delivery points to determine their readiness for the provision of Pharmaceutical

Project 1.1 A) Assessments were done in ? Chronic staff shortage and ? Share assessment Year 7 Q4 September in 3 health centers offering transfer of focal pharmaceutical findings and lessons PMTCT (prevention mother to child staff has been a major constraint learned from MTP transmission) services. The three health in implementation the MTP implementation with centers (Westlands, Makadara and approach. National AIDS and STD Langata) are Ministry of Health facilities. ? Increased workload Control Program 1.2 Assessments were done to associated with implementing ? Convene a workshop understand supply chain management MTP. with ART partners and staff issues for prevention mother to child from sites involved in MTP transmission (PMTCT) health related approach to share findings commodities. The assessments focused & plan MTP scale-up on DASCOs (District AIDS and STI nationwide coordinators), facility PMTCT coordinators and the district pharmacists. The following was assessed: Human resource capacity (numbers, cadres and training status), Sources of PMTCT commodities, Inventory management of PMTCT commodities, Status and use of Pharmaceutical management information systems in support of PMTCT commodity management, Dispensing of PMTCT commodities and the records used, Challenges in PMTCT commodity availability. Findings showed weak pharmaceutical management information systems (PMIS). There were no inventory management records and no tools for collecting or reporting PMTCT antiretroviral drug utilization.

B. Program evaluation data from 10 Ministry of Health facilities involved in Monitoring Training and Planning (MTP) Operational Research was analyzed. The facilities were 5 pilot facilities (Rift Valley PGH, Machakos DH, Nyeri PGH, Kiambu DH, and Muranga DH) and 5 control facilities (Nyanza PGH, Thika DH, Embu PGH, Mbagathi DH and Naivasha DH).

Thursday, December 20, 2007 3:55 PM Page 155 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Kenya COP Year 06 Activity Title Conduct assessments in potential ART service delivery points to determine their readiness for the provision of Pharmaceutical

Data analysis showed that the 5 pilot sites had successfully implemented the MTP approach. They all had updated bin cards, tablet counters, ADR monitoring& tracking system and standard operating procedures for physical stock count, quantities received, quantities consumed per month, reporting stock-outs and reporting expired stocks.

1.3. Stipulation of recommendations/interventions to address the identified gaps and challenges was done in the 3 health centers.

1.4 Preliminary assessment findings from the final program evaluation of sites involved in Monitoring Training and Planning (MTP) Operational Research were shared at the MSH/RPM Plus annual retreat.

1.5. Progress on products ? 3 site assessments reports available. ? Draft report on MTP final program evaluation ? Power point presentation given during the MSH/RPM Plus retreat available. Last Updated: 10/03/2007

Thursday, December 20, 2007 3:55 PM Page 156 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Kenya COP Year 06 Activity Title Provide technical assistance to national efforts in strengthening pharmaceutical services at site level in support of ART scale up

Activity Manager Thuo, Michael Activity # 6 Task: A1KE06HIP Sub-Task: 60CXH6 Activity Description Technical assistance activities will include: Initiating and strengthening commodity management activities at ART sites in support of program scale up:- o Commodity management training to address human resource needs at sites; o assist in setting up site based ART commodity management structures (eg, Drugs & Therapeutic Committees); o developing site-based commodity management implementation plans, where necessary o providing strategic ART policy, professional and operational information / material as needed by the sites Initiating commodity management plans of action collaboratively with site staff to address:- o Development and /or adaptation of SOPs and forms ; o use of inventory management tools o patient medication counseling for adherence, o commodity management monitoring and evaluation systems, including ART Drug Utilization Reviews (DUR) o the design and implementation of robust ART Drug Management Information Systems o on going training and monitoring for performance improvement at site level—this may employ the MTP methodology Supporting ART treatment partners by assisting in : o training of clinical service providers in commodity management for ART, o monitoring and development of strategies to promote rational drug use for ART Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products

Thursday, December 20, 2007 3:55 PM Page 157 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Kenya COP Year 06 Activity Title Provide technical assistance to national efforts in strengthening pharmaceutical services at site level in support of ART scale up

Project Activity Progress • Limitations in ability to assist • Continue responding to Year 7 Q4 1.0 Initiating and strengthening sites with infrastructure and requests for training in ART commodity management activities at equipment needs which is a commodity management by ART sites in support of program scale up major constraint to program scale ART partners nationwide • i) Implementation of ART Dispensing up • Continue to disseminate Tool. • Staff turnover and shortage of ART commodity • Assessed capacity of 10 Imperative pharmaceutical cadres management tools ART sites supported by APHIA-II nationwide continues to hamper nationwide Western for implementation of ART efforts to develop human • Continue to work with Dispensing Tool and made resource capacity at site level sites to build robust ART recommendations drug management • Supported 3 day OJT Training for 5 of information systems in these ART sites support of ART using • ii). MIS available electronic or • TA to AMPATH by On the Job manual tools Training for 24 staff at 17 AMPATH ART sites. • Mentored 1 pharmaceutical technologist and 1 IT staff at MTRH to provide ongoing support to AMPATH peripheral sites • Reviewed ART dispensing register and provided final template to AMPATH program pharmacist for printing • Ongoing support to 5 public sector ART central sites in implementation of Inventory Tracking Tool • Met with Acting Provincial Pharmacist- Nairobi to plan for strengthening MIS in support of supply chain for ART sites in Nairobi Province for next quarter • iii) Job Aids and Tools o Dissemination of ART commodity Management Job Aids to sites supported by ICAP, APHIA-II Nairobi, APHIA-II Western, APHIA-II Eastern o Dissemination of ART commodity management support supervision tools to sites supported by APHIA-II Eastern iv). SOPs • Ongoing TA on request to COGRI ART Sites in development of SOPs and plan for review of SOPs in quarter 1.

Thursday, December 20, 2007 3:55 PM Page 158 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Kenya COP Year 06 Activity Title Provide technical assistance to national efforts in strengthening pharmaceutical services at site level in support of ART scale up

2.0 Initiating commodity management plans of action collaboratively with site staff to address:- • i). Support Supervision implementation (short term action plan):- 13 ART sites in Eastern Province North 3.0. Support to ART treatment partners • ART Dispensing Tool Training and Implementation: APHIA-II Western (5 sites), KEMRI (1 site), AMREF(1 site) • Commodity Management Training: APHIA-II Nairobi (28 staff from 17 sites), APHIA-II Western (27 staff from 17 sites ) • Support Supervision Training: APHIA- II Eastern-(21 staff from 13 sites) • ToT-Commodity Management: AMPATH (14 staff from 11 sites) • Job Aids: APHIA-II Western (17), APHIA-II Eastern (13), APHIA-II Nairobi (17) Progress On Products • TA trip report to AMPATH available • Training report on TOT for ART commodity management available • Training report on Support supervision training on ART commodity management: In progress • List of ART commodity management support supervision job aids disseminated available • TA summary report on ART dispensing tool Implementation, On the Job Training Assessments and recommendations for APHIA-II available Last Updated: 10/03/2007

Thursday, December 20, 2007 3:55 PM Page 159 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Kenya COP Year 06 Activity Title Provide technical assistance to the Department of Pharmaceutical Services to strengthen ART policy, practice, and regulatory

Activity Manager Thuo, Michael Activity # 7 Task: A1KE06HIP Sub-Task: 60AXH7 Activity Description Activities will include: Review of the National Medicines Policy to include components supportive of the provision of effective ART commodity management services Preparation of the National Medicines Strategic plan to guide the pharmaceutical sub-sector Support stakeholders in the development and dissemination of various ART policy guidelines Encourage and advocate for linkages between the Department of Pharmaceutical Services, NASCOP, PPB , NQCL in cross-cutting issues such pharmacovigilance, ART drug procurement and Quality Assurance, ART medicine adherence and ADR monitoring work. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products

Thursday, December 20, 2007 3:55 PM Page 160 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Kenya COP Year 06 Activity Title Provide technical assistance to the Department of Pharmaceutical Services to strengthen ART policy, practice, and regulatory

Project This quarter RPM plus along with other Delays in the implementation of 1. Finalization of the Kenya Year 7 Q4 stakeholders continued to provide TA to national ADR tools and National Pharmaceutical the Division of Pharmacy / MOH in the completion of the revised NDP Policy document and following areas: due to competing priorities ratification by the MOH. 2. TA for the development 1. Continued to participate and of Pharmaceutical Policy contribute to the on-going revision of the Implementation Plan for the national drug policy. Comments from the revised Policy stakeholders meeting held on 2nd 3. Support for August were incorporated into the implementation of national document. One meeting to chart the pharmacovigilance frame implementation process is due before work the document is handed over for 4. Continued support for ratification. training of community based pharmacists to improve 2. Developed materials for a 1 day rational use and training for Healthcare workers in private management of ART drugs & community based settings on: • ART Treatment guidelines and review of antiretroviral drugs • Rational Use of medicines • Side effects and ADR management, monitoring & reporting • Pharmacotherapy of HIV related diseases • Pediatric ART • Medication use counseling • Drafts available, to be reviewed by technical experts in the coming quarter

3. Conducted a 2nd session of Practice based training for HIV/AIDS Practitioners in private and community settings on Rational Drug use, in Mombasa. The training was held on 8th July 2007 and a total of 54 participants (doctors, pharmacists, nurses, clinical officers and pharmaceutical technologists) attended.

Last Updated: 10/03/2007

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Workplan: Kenya COP Year 06 Activity Title Provide technical assistance to National Public Health Laboratory Services ( NPHLS ) in strengthening laboratory services in support

Activity Manager Thuo, Michael Activity # 8 Task: A1KE06HIP Sub-Task: 60DXH8 Activity Description Technical assistance will include: ? Support to National Level Laboratory activities: o Support to the ART commodity management activities of the various working sub-committees of the laboratory interagency coordinating committee. o Support to national level efforts to implement the national laboratory policy jointly with MOH/NPHLS and partners o Support to national level efforts to implement a national laboratory policy strategic plan jointly with MOH/NPHLS and partners o Support national level activities aimed at improving institutional capacity by adopting and disseminating laboratory SOPs. o Support the national efforts to improve existing laboratory MIS.o Provide support to NPHLS in capacity building to strengthen the management and coordination of the laboratory network; o Contribute to the development and implementation of in-service laboratory training curriculum and materials; o Strengthen the national efforts to implement external quality assurance procedures

? Supporting NPHLS activities aimed at strengthening and scaling up laboratory activities at priority ART sites o Train laboratory staff to address human resource knowledge and skills for ART; o Train laboratory staff on implementation of SOPs, for quality and efficiency of laboratory services. o Assist in improving existing laboratory record keeping and MIS o Train laboratory staff on good laboratory practices. o provide strategic ART policy, professional and operational information /materials as needed o Develop SOPs on equipment maintenance o Strengthen sites to implement internal and external quality assurance procedures

o Provide support to laboratory supervisors and strengthen their managerial skills.

? Implementing good laboratory practices in support of ART at the site level o Adapt and disseminate laboratory guidelines and standard operating procedures o Institutionalize laboratory quality assurance procedures including performance of internal QCs and calibration of equipment o Strengthen inventory management systems to reduce outages of reagents and procedures to maintain equipment to reduce breakdown episodes. o Provide on going training for performance improvement.

Thursday, December 20, 2007 3:55 PM Page 162 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Kenya COP Year 06 Activity Title Provide technical assistance to National Public Health Laboratory Services ( NPHLS ) in strengthening laboratory services in support o Provide on going training on the use of laboratory MIS, M&E tools and the use of routine laboratory data. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products

Thursday, December 20, 2007 3:55 PM Page 163 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Kenya COP Year 06 Activity Title Provide technical assistance to National Public Health Laboratory Services ( NPHLS ) in strengthening laboratory services in support

Project Support to NPHLS HR capacity The MTP approach is hampered Support to Lab ICC: Year 7 Q4 strengthening and selected ART sites: by unplanned transfer out of staff • Continue to serve as • Trained 21 personnel from NPHLS especially those who have secretariat for Lab ICC and and 6 ART sites and 1 warehouse on already learned applied new convener for Lab sub- commodity management practices knowledge and have become committee on systems including: how to use the S12- Issue and champions of good commodity strengthening Receipts Voucher order form . management practices • Participate jointly with • Continued to support the NPHLS other partners in on-going follow-up and supportive supervision of Lab ICC plans for official 6 selected ART sites in implementing launch of MOH documents commodity/inventory management for in Nov. 2007. lab supplies in support of ART. • Present progress report • Continued to track and document on Systems sub committee lessons regularly on the Lab MTP to the ICC as may be strategy from 6 facility and 1 required. warehouse teams. • Participate in other sub- • In collaboration with NPHLS, KEMRI, committee meetings as UoN, and BD, trained 29 laboratory required. technologists on CD4 Enumeration from 21 ART sites and the Kenya Support to activities for Medical Research Institute HIV and ART strengthening capacity of labs NPHLS : • Finalize the editing the T.A. support to Institutional Capacity NPHLS Test and strengthening efforts for NPHLS: Commodity tracking tools • Provided T.A .and guidance to a team • Provide technical of 28 senior laboratory staff from both leadership to NPHLS in field NPHLS reference and field laboratories testing of the tools and and representing all 8 Kenya provinces implement the field testing to develop second draft (2) of generic work plan ( including OJT lab registers, test request and referral module for orientation of forms, and commodity management site staff) forms & register • Complete development of • Provided T.A to 11 NPHLS Expert the 3 additional Job Aids Review Team in the final review of the identified as priority draft laboratory test data registers and • Finalize and post the commodity management forms report on the findings of a • 11- Draft test registers( 8) and rapid assessment of request, referral and reporting forms(3) laboratories in selected , and corresponding SOPs on use facilities in Nairobi reviewed and finalized for field testing • Collaborate with NPHLS, • 11- Draft commodity forms/cards or and UON as needed to train registers and corresponding SOPs on 30 hands on lab

Thursday, December 20, 2007 3:55 PM Page 164 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Kenya COP Year 06 Activity Title Provide technical assistance to National Public Health Laboratory Services ( NPHLS ) in strengthening laboratory services in support

use of the manual tools reviewed and technologists on Viral Load finalized for field testing testing for 3 days. • Developed a draft work plan for field • Collaborate with KEMRI testing the 22 tools to develop a curriculum, pretest it, and train 30 T.A. support to institutional capacity hands on DBS strengthening of NPHLS and selected technologists for 3 days ART sites • Compile a QA toolkit for • Continued to support ( 2 facilities) - use in QA training Mbagathi District Hospital and EDARP • Compile draft of a in pilot- testing the use of the Lab customized Lab Electronic tool Commodity Management T.A. Support to National Efforts through Curriculum participation in the Lab ICC • Draft components of the • Supported NPHLS convene the LAB supervision manual for ICC meeting review by NPHLS • Participated and collaborated with the T.A. and stakeholders partners to Support to NPHLS and conduct a Lab ICC resulting in setting selected sites : dates for the official launch of MOH • Continue to track and Policy and standards documents. document lessons on the MTP for lab from the 6 facility teams on regular basis. • Continue to implement the MTP approach in 6 ART facilities to improve quality of laboratory service offered. • Continue to field test the electronic lab commodity tool at Mbagathi District Hospital and EDARP. • Train the lab staff from Mbagathi District Hospital and EDARP further on the use of lab tool. Last Updated: 10/03/2007

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Workplan: Kenya MAC Year 06 Activity Title Technical Activity Coordination and Monitoring

Activity Manager Tetteh, Gladys Activity # 1 Task: A1KE06RPM Sub-Task: 9XXY1 Activity Description This activity includes technical activity coordination, workplan development, budget monitoring, progress monitoring, reporting, meetings, and communications with partners and collaborators.

This is expected to occur throughout the year. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project Developed a draft RPM Plus/SPS Kenya Workplan draft submitted Year 7 Q4 Malaria FY 07 work plan, in close for internal review after consultation with the Kenya DOMC and which will be submitted to USAID/Kenya. Continued with weekly the mission for final approval and biweekly coordination meetings Continued technical activity coordination and monitoring Last Updated: 10/12/2007

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Workplan: Kenya MAC Year 06 Activity Title Participate in appropriate meetings and working groups

Activity Manager Tetteh, Gladys Activity # 2 Task: A1KE06RPM Sub-Task: XXXXXX Activity Description To strengthen national level collaboration in support of Kenya’s national malaria strategy, RPM Plus will participate and contribute to meetings concerned with malaria treatment and prevention and policies.

RPM Plus will participate in these Drug Policy Technical Working Group meetings to strengthen policy dialogue and to support the development of appropriate tools and interventions that promote the effective case management of malaria. RPM Plus will offer drug management expertise to discussions.

This is expected to occur throughout the year. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products

Thursday, December 20, 2007 3:55 PM Page 167 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Kenya MAC Year 06 Activity Title Participate in appropriate meetings and working groups

Project Provided financial and technical support Continue to partcipate in Year 7 Q4 in special Malaria Inter-agency appropriate meetings Coordination Committee (MICC) Continue to support th meetings where the Malaria Business execution of follow up Plan was finalized and revised versions meetings for the Reserch of the plan under different themes were technical working group consolidated. RPM Plus also supported Provide inputs to the the Research Technical Working Group writting of the Malaria meeting to discuss on establishing sites indicator survey report for monitoring insecticide resistance and efficacy of first and second-line antimalarial drugs. In this quarter RPM Plus participated in several meetings including; the interim Report Meeting on the Malaria Indicator Survey where preliminary results were presented and pharmacovigilance meetings. In addition to participating in a community access meeting,RPM Plus was asked to contribute to developing the indicators related to medicines availability and management at non-facility outlets such as general retail shops. RPM Plus supported the DOMC in launching the Malaria Interventions Impact report by developing a policy brief, Power Point presentations and the drafting of a press release. The report was launched by the Minister for Health; USAID was represented by Dr. Mike Strong who acknowledged MSH’s efforts. Finally, the Kenya malaria team held discussions with Kathy Webb on developing a guide and tools for monitoring progress in ACT policy implementation Last Updated: 10/12/2007

Thursday, December 20, 2007 3:55 PM Page 168 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Kenya MAC Year 06 Activity Title Strengthen the Division of Malaria Control’s Monitoring and Evaluation System

Activity Manager Tetteh, Gladys Activity # 3 Task: A1KE06RPM Sub-Task: XXXXXX Activity Description RPM plus will continue to support the DOMC by implementing the developed M&E system. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products

Thursday, December 20, 2007 3:55 PM Page 169 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Kenya MAC Year 06 Activity Title Strengthen the Division of Malaria Control’s Monitoring and Evaluation System

Project RPM Plus supported the research Collecting contexual data needed Continue to support DOMC Year 7 Q4 technical working group meeting to to make better sense of Al IT/M&E activities. finalize/harmonize the pre-IRS reports availability survey findings has Continued participation and and to draft proposals for post IRS delayed the report writting and funding of appropriate evaluation in the eight districts chosen finalization meetings. for the exercise. In this quarter, data Support data analysis and entry for the AL availability survey was report writting of MIS completed and report writing is ongoing. Assisted the DOMC in developing its website in close collaboration with website design partners. A demo website was developed for feedback on changes that need to be made on website content and style. The website is expected to be launched in October. Participated in internal DOMC M&E meetings to discuss global fund reporting, MIS survey, MIAS and monitoring of distribution of nets in the new ITN distribution campaign. The interim MIAS system will be used to provide feedback in preparing the requirements of the main MIAS system. In addition, new database reporting formats were created to enable further reporting required for GF Round 4 Phase 1. To support the development of the 2006 Annual Report for Kenya’s malaria program, RPM Plus facilitated data collection from the various DOMC departments for collation and report writing by the consultant. RPM Plus facilitated the transfer of DOMC’s Internet and Email access services from Internet Service Providers UUNET to the new providers, Access Kenya. Supported the creation of linkages between the Pharmacy & Poisons Board (PPB), DOMC and international agencies to better combat fake antimalarial drugs in the market. RPM Plus also provided a DVD for the DOMC

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Workplan: Kenya MAC Year 06 Activity Title Strengthen the Division of Malaria Control’s Monitoring and Evaluation System

head to provide background information in meetings with the press. RPM Plus supported the DOMC in the collation of national malaria control data requested by the WHO’s Global Malaria Programme. Participated in the Afrihealth 2007 Conference together with one DOMC staff. The conference was the first on ICT in Health to be held in Kenya. Last Updated: 10/12/2007

Thursday, December 20, 2007 3:55 PM Page 171 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Kenya MAC Year 06 Activity Title Develop the M&E capacity of DOMC and it’s partners

Activity Manager Tetteh, Gladys Activity # 4 Task: A1KE06RPM Sub-Task: XXXXXX Activity Description RPM Plus will support a technical training program for DOMC staff and partners to strengthen the overall capacity at DOMC for performing M&E activities Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project Conducted refresher training for DOMC None Finalize collecting data for Year 7 Q4 staffs in Microsoft Office applications as malaria partners database well as in the use of the interim system. Continue support DOMC Designed a questionnaire that will be used to collect data for developing a database containing information on all the DOMC’s partners in the fight against malaria. In addition, two research assistants were recruited to collect data.Hosted a quantification workshop to determine antimalarial drug quantities for the 2nd year of ACT policy implementation. Attended Antimalarial Survey Meeting held to discuss progress on report writing for this activity. During this meeting, RPM Plus recommended data to be re-entered and also developed dummy tables to be used in the analysis and final write upevelopment Last Updated: 10/12/2007

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Workplan: Kenya - KEMSA Public Sector Comm Year 06 Activity Title To provide administrative, operational, and technical support for TB activities undertaken by the National TB & Leprosy (NTLP)

Activity Manager Thuo, Michael Activity # 3 Task: A1KE06XXX Sub-Task: 60F3H3 Activity Description RPM Plus proposes to continue supporting Central NTLP and peripheral NTLP activities and at the same time, develop plans to capacitate NTLP to assume key administrative and operational activities. RPM Plus activities will include: o Supporting NTLP central office operational costs ( eg, office running, fuel, communication, internet, stationary and supplies, printing/photocopying, key province level M&E meetings) o Supporting implementation of PTLC and DTLC work plans that have been approved by the Director of NTLP. o Supporting NTLP Commodity management activities; e.g; quantification, drug requirements planning, TB drug usage reporting o Supporting PTLC and DTLC TB monitoring and evaluation activities. o Supporting TB/HIV activities and meetings o Supporting NTLP central office technical activities e.g. M&E, DOTS expansion and case detection, policy implementation. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products

Thursday, December 20, 2007 3:55 PM Page 173 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Kenya - KEMSA Public Sector Comm Year 06 Activity Title To provide administrative, operational, and technical support for TB activities undertaken by the National TB & Leprosy (NTLP)

Project Jointly with NLTP conduct Year 7 Q4 Activity Progress Delay in sending technical and DTLCs and PTLCs financial reports meetings to strategise on (1) Continued to support DTLD Central how to implement Unit activities by: workplans and submission • Supporting DTLD IT capabilities by of technical and financial providing : reports a) Wireless communication services to Central Unit and PTLCs and training PTLCs in all provinces b) Maintenance of computers in DTLD Central Unit office.(Total cost Kes 751,002) • Supporting Supplies of laboratory reagents to CRL (Total cost Kes 335,060/=)

(2) Continued to support Peripheral PTLCs and DTLCs activities through: • Provision of funds to support supervision activities (Total cost Kes 4,234,310/=) • Provision of funds to support DTLCs quarterly meetings in 10 Provinces and one Mid-year PTLC meeting held at Utalii Hotel (Kes 2,400,000/=)

(3) Regular meetings with DTLD administration

(4) Other field activities supported include: • Fueling DTLD vehicles (Total Kes.712,310/=) • Repairing DTLD vehicles costing (Total cost Kes.448,631/=) • Repairs of DTLCs motorcycles ( Total cost Kes 251,375/= • Fueling of DTLCs motorcycles costing ( Total cost Kes 1,033,194/=) • Airtime for PTLCs and DTLCs (Total cost Kes 810,265)

Thursday, December 20, 2007 3:55 PM Page 174 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Kenya - KEMSA Public Sector Comm Year 06 Activity Title To provide administrative, operational, and technical support for TB activities undertaken by the National TB & Leprosy (NTLP)

Progress on Products • Financial Procedures and tracking tools • Approved financial requests from Head of DTLD Last Updated: 10/03/2007

Thursday, December 20, 2007 3:55 PM Page 175 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Kenya - KEMSA Public Sector Comm Year 06 Activity Title Provide focused / targeted Technical assistance to strengthen the institutional and human resource capacity for effective commodity

Activity Manager Thuo, Michael Activity # 4 Task: A1KE06XXX Sub-Task: 60CXH4 Activity Description RPM Plus will work collaboratively with KEMSA and MOH divisions to provide commodity management training and tools. Typical sub-activities will include: o Training KEMSA/MOH central training of trainers (CToT) team in quantification, forecasting, and other key aspects of commodity management (e.g. rational use) so that they can in turn support further training for regional and district based teams. o Providing KEMSA with tried and tested manual and electronic tools for quantification and tracking of product use at the central warehouse, depots and facilities. o Conduct focused commodity management trainings in support of staff working in various KEMSA departments, depots and MOH divisions. This may include hands on trainings in commodity management aspects such as quantification, SOPs o Design and distribute commodity management job aids for use by KEMSA staff, its depots and sites o Conduct a training in commodity quantification using quantimed software o Provide KEMSA with essential tools and equipment to support commodity management o Provide KEMSA with support to improve telecommunication/electronic communication o Assist KEMSA to implement a plan for strengthening the pharmaceutical logistics management information system o Assist KEMSA and MOH divisions to implement a harmonized commodity management M&E tool o Assist KEMSA to develop QA/QC procedures for products and services o Assist KEMSA and MOH divisions develop Standard Operating Procedures for crucial commodity management services o Assist KEMSA and MOH divisions to implement commodity tracking tools at depots and large ordering points o Work collaboratively with KEMSA and MOH divisions to provide manual and electronic tools for collecting and maintaining commodity utilization information Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products

Thursday, December 20, 2007 3:55 PM Page 176 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Kenya - KEMSA Public Sector Comm Year 06 Activity Title Provide focused / targeted Technical assistance to strengthen the institutional and human resource capacity for effective commodity

Project Activity Progress • None. • Pre-testing of the draft Year 7 Q4 • Training of KEMSA / MoH central Quantification job aid for Training of Trainers team in commodity program level staff management • Pre-testing of the draft o 13 MoH staff from Rift Valley, DRH Commodity Western and Nyanza ART sites were Management Trainer’s trained as ToTs in commodity manual management • Finalization and • Provide MoH divisions and KEMSA dissemination of the DRH with essential tools and equipment to Trainer’s manual to the support commodity management Family Planning Working o Support to improve Group telecommunication/electronic communication provided to Division of Reproductive Health ? Continued to provide DRH with mobile airtime to improve telecommunication and reporting between DRH field facilities and the LMU o Continued to provide MoH divisions with courier service account for transmission of commodity consumption reports to LMU • Design and distribute commodity management job aids for use in KEMSA and MoH sites o Development and adaptation of Job aids to support Decentralization of ART commodity management is ongoing • Commodity management training curriculum development o Draft Integrated Commodity Management Curriculum was developed o Internal peer review of this curriculum conducted. o Integrated Commodity Management Curriculum was finalized. • Development of a DRH Commodity Management Trainer’s manual o Conducted structured interviews of stakeholders to collect views to be incorporated in the DRH Trainer’s manual

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Workplan: Kenya - KEMSA Public Sector Comm Year 06 Activity Title Provide focused / targeted Technical assistance to strengthen the institutional and human resource capacity for effective commodity

o Workshop held to develop draft of the manual o Draft manual disseminated to stakeholders for comments which will be followed by review of the manual. • Development of guidelines on ART commodity decentralization o Work collaboratively with NASCOP to develop toolkit in support of Decentralization of ART commodity management ? Held 2 meetings with NASCOP counterparts to develop Guidelines on Decentralization Last Updated: 10/03/2007

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Workplan: Kenya - KEMSA Public Sector Comm Year 06 Activity Title Provide focused / targeted Technical assistance to strengthen the institutional and human resource capacity for effective commodity

Project Activity Progress • Availability of key MoH and • Dissemination of DRH Year 7 Q4 • Collaborative development of a KEMSA personnel for the Commodity Management commodity management M&E collaborative development of a data collection tools and Framework commodity management M&E training of RH staff through o Meeting held with NASCOP ART framework was affected by regional workshops counterparts to initiate development of scheduling of other competing • Finalization and printing commodity M&E indicators activities. of Condom commodity • Collaborative development and management reporting tools implementation of manual and electronic • Provide TA to PMTCT tools for commodity usage data capture logistics committee to o DRH commodity management tools: review the draft PMTCT • DRH data reporting tools are printed commodity management and ready for dissemination tools and commodity flow • Held planning meetings for regional system. dissemination of the data reporting tools • Development of draft o Participated in meetings to review commodity management draft Condom commodity management M&E indicators data collection and reporting tools. o Draft Condom commodity management data collection and reporting tools pre-tested in selected sites o Development of PMTCT commodity management reporting tools and system is ongoing o 3 meetings were held to finalize the reviewed ART commodity management reporting tools for District stores/Central sites and for service delivery points. o Printing of ART Commodity reporting tools for NASCOP is ongoing o Review of reporting tools for MoH division ordering points is a continuous process as the programs grow. • Support of rapid targeted commodity management M&E type assessments to diagnose suspected problems and develop intervention measures o Disseminated findings of Baseline Assessment of ART Central sites to the NASCOP staff and made recommendations for improvement of commodity management.

Thursday, December 20, 2007 3:55 PM Page 179 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Kenya - KEMSA Public Sector Comm Year 06 Activity Title Provide focused / targeted Technical assistance to strengthen the institutional and human resource capacity for effective commodity

o Ongoing technical assistance to DRH to undertake a Service delivery point / Health facilities assessment with use of the reports to update the data in the PLMIS database. o Prepared DRH commodity stock report showing stock receipts, distribution, stock status and consumption of RH commodities. o Ongoing assessment of the availability of MoH divisional reporting tools at KEMSA with a view to ensuring sustained availability. Progress on products • DRH commodity management data collection tools printed and available for dissemination • Draft Condom commodity management data collection tools available • Draft PMTCT commodity management data collection tools available • Final Decentralization workshop proceedings report available • Final report on Baseline assessment of Central ART sites available. Last Updated: 10/03/2007

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Workplan: Kenya - KEMSA Public Sector Comm Year 06 Activity Title Support to the review and updating of the KEMSA’s

Activity Manager Thuo, Michael Activity # 6 Task: A1KE06XXX Sub-Task: 60AXH6 Activity Description RPM Plus will assist KEMSA to update the Strategic plan and amend its Business Plan to reflect those prevailing realities.

Typical activities include: o Review KEMSA’s business and strategic plans o Support meetings/workshops to develop and update the strategic/business plan. o Development of strategic options to implement the new business plan Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products

Thursday, December 20, 2007 3:55 PM Page 181 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Kenya - KEMSA Public Sector Comm Year 06 Activity Title Support to the review and updating of the KEMSA’s

Project Activity Progress • Availability of KEMSA Board to • Presentation of ratified Year 7 Q4 • Review KEMSA’s business and review and ratify the Business KEMSA Business Plan strategic plans Plan draft was affected by 2007-2010 to other o Presented the draft KEMSA Business scheduling of other competing stakeholders plan 2007-2010 in Quarter 3. activities. • Formalization of MSH o Awaiting feedback from the KEMSA • Support and cooperation of the technical assistance to Board of directors and management KEMSA Board and management KEMSA by the Ministry of team. was affected by inadequate Health o Two formal requests for Technical understanding of MSH • Prioritization of Technical assistance prioritization and planning involvement in the provision of Assistance areas outlined in meetings made by MSH to KEMSA on technical assistance to KEMSA. the Business plan and 3rd April and 8th May 2007. Feedback response to requests for is awaited. Technical Assistance • Development of strategic options to implement the new business plan o Held a meeting with KEMSA management team to chart the way forward in the provision of technical assistance to KEMSA. o Facilitated several meetings between SCMS and other key stakeholders in preparation for implementation of MCA activities. ? Introduced SCMS to KEMSA management team to prompt planning for implementation of MCA activities. o Prepared a summary of MSH/ RPM Plus technical support activities to various programs and Ministry of Health to inform decisions on key MCA areas to be implemented by MSH.

Last Updated: 10/03/2007

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Workplan: Kenya - KEMSA Public Sector Comm Year 06 Activity Title To support KEMSA to develop and implement effective distribution planning systems

Activity Manager Thuo, Michael Activity # 7 Task: A1KE06XXX Sub-Task: 97XXYX Activity Description RPM Plus will work with KEMSA to develop a more efficient commodity distribution policy and master plan. The master plan will assist in the further implementation of medicine supply schedules in line with MOH Divisions’ needs. Typical activities with RPM Plus TA support will include: o development and implementation of commodity distribution policy; o distribution resource master plan; o Standard Operating Procedures (SOPs) for drug distribution; o Development of transport information management systems (TIMS) and , o formulation of commodity distribution options for different levels of care..

Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project • Development and implementation of • Implementation of the planned • Following the ratification Year 7 Q4 commodity distribution policy activities is highly dependent on of the KEMSA Business o Strengthening and streamlining of the ratification of the KEMSA Plan, a workshop will be divisional commodity pipelines and Business Plan which has not convened between vertical distribution schedules is ongoing with a been achieved to date. programs of the MoH view of future integration of divisional divisions and KEMSA to distribution agree on modalities for ? Ongoing assistance to DRH and integration of commodity NASCOP to streamline their commodity distribution. pipelines and distribution schedules by defining commodity and information flows and development of tools to facilitate the process. ? Strengthened the NASCOP commodity pipeline to support decentralization of ART commodity management efforts. • Formulation of commodity distribution options for different levels of care o Advised and assisted MoH staff in NASCOP ART program in undertaking national ART quantification to ensure Commodity security. Last Updated: 10/03/2007

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Workplan: Lesotho Year 06 Activity Title Technical Activity Coordination

Activity Manager Sallet, Jean-Pierre Activity # 1 Task: A1SL06XXX Sub-Task: 97XXY1 Activity Description This includes technical activity coordination, work plan development and implementiona monitoring, budget and progress monitoring, reporting, meetings and communications Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project M & E training for Lesotho was attended Year 7 Q4 on August 8th and 10th. The Lesotho USG Partners meeting was attended on August 27, 2007.

A PEPFAR Partners’ meeting with the Ministry of Health & Social Welfare (MOHSW) was attended in Maseru on September 5,2007. Work plans were shared and a presentation on RPM Plus activities in Lesotho was made. It was indicated to the Ministry officials that an RPM Plus office would be established in Lesotho.

A USG Target Setting Meeting for COP08 was attended on September 19 , whereafter work commenced on the preparation of COP08 for Lesotho.

Interviews were conducted with prospective candidates for the SPA/Lesotho post.

Various meetings and teleconferences were held regarding the upcoming RPM Plus/SCMS supply management assessment in Lesotho. It is anticipated that this assessment will be carried out in Lesotho from October 22 to November 2,2007.

Last Updated: 10/15/2007

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Workplan: Lesotho Year 06 Activity Title Strengthening pharmaceutical services at the facility level

Activity Manager Pharasi, Bada Activity # 2 Task: A1SL06XXX Sub-Task: 60E3H2 Activity Description RPM Plus will work with the MOHSW and in collaboration with WHO to review legislation relating to the supply of medicine. Strengthening of legislation will help to ensure that standards for pharmaceutical services are appropriately developed and supportive of the provision of quality pharmaceutical services. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project The completed questionnaires for the It was found that the Year 7 Q4 baseline assessment were collected questionnaires for most of the from the counterpart as no progress had CHAL sites in the Butha Buthe been made with the capturing of data. District and for QEII Hospital are Capturing on the database has missing. commenced. Last Updated: 10/15/2007

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Workplan: Lesotho Year 06 Activity Title Strengthening NDSO information system operations and provide TA

Activity Manager Sallet, Jean-Pierre Activity # 3 Task: A1SL06XXX Sub-Task: 60GXH3 Activity Description The strategic plan of the NDSO ended in 2006. Upon request of the NDSO, RPM Plus will provide technical assistance in collaboration with the Southern African Human Capacity Development Coalition (SAHCD) partner for the development of the new strategic plan. Also because of previous poor performance in the implementation of the previous strategic plan, it was agreed that RPM Plus will assist in the development of a performance management system that will help in monitoring the implementation of the strategic plan. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project A request was received from the Problems were experienced in A request was received for Year 7 Q4 National Drug Services Organisation getting management reports for additional TA with regard to (NDSO) to provide TA with the ORION@MSH. determining the fees levied development of a Strategic Plan and by the NDSO for Performance Management System for procurement, storage and the NDSO. This activity was undertaken distribution of ARVs and in collaboration with Southern African related commodities. Human Capacity Development Coalition (SAHDC). A three day HRM and Strategic Planning workshop subsequently took place in Mafeteng on July 18th – 20th. A strategic and human resources plan was developed. The Performance Management System is still to follow.

The quantification tool in use in Lesotho was updated, and now includes quantification for pregnant women. Last Updated: 10/15/2007

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Workplan: Lesotho Year 06 Activity Title Provide training to pharmacists, pharmacy technicians and health care professionals at all levels

Activity Manager Sallet, Jean-Pierre Activity # 4 Task: A1SL06XXX Sub-Task: 60CXM4 Activity Description Basic skills in medicine supply management of HIV/AIDS and related diseases such as TB are also required to manage the medicine supply chain for key essential commodities. Under COP05, appropriate training materials were adopted for this purpose. RPM Plus will use these materials to train pharmacists, pharmacy technicians, nurses, and other relevant health care workers. The key objective is to build adequate skills around procurement, storage, distribution and dispensing of medicines, thereby ensuring availability of ARVs and related medicines and commodities at all times. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project Training on quantification was conducted Year 7 Q4 by the counterpart on July 19, 2007 using the quantification tool developed by RPM Plus (30 people trained). The person who conducted the training was trained previously at a workshop conducted by RPM Plus.

HIV/AIDS Training was conducted from 13th-16th of August 2007 (33 people trained).

Quantification training took place on 21st of August (32 people trained).

DSM Training took place on 22nd-23rd of August 2007 (31 people trained)

Last Updated: 10/15/2007

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Workplan: Lesotho Year 06 Activity Title Implement and support MIPC and PTCs

Activity Manager Steel, Gavin Activity # 5 Task: A1LS06XXX Sub-Task: 60AXH5 Activity Description RPM Plus will use FY06 to continue to train and provide continuing technical assistance to these PTCs. These committees will play a key role in promoting standard treatment guidelines (e.g. HIV and AIDS regimens) and reviewing medicine use practices thus promoting rational medicine use at all levels. In response to the need for information on ARV products both to the health care providers and patients and also the need to monitor adverse drug events (ADE), RPM Plus will explore with the Lesotho MOHSW the opportunity to set up a National Medicine Information and Pharmacovigilance Center. This activity will address the structure, manpower and resources needed for the establishment of this center Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project A PTC workshop was held in the Berea No commitment has been Year 7 Q4 district from 11th-13th of July 2007. The received from the Directorate to workshop was attended by six people on follow up on activities agreed the 11th and seven people on the 12th. upon in the work plan. A work plan was developed. A report of the workshop is available. Last Updated: 10/15/2007

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Workplan: Lesotho Year 06 Activity Title Rx Solution roll-out in target sites

Activity Manager Sallet, Jean-Pierre Activity # 6 Task: A1LS06XXX Sub-Task: 60CXJ6 Activity Description Using FY06 funds, RPM Plus will ensure that the tool is continuing to function appropriately at these sites and will be rolled-out to the remaining public ART sites. Special focus will be given to the generation of adequate and timely reports and their submission to the national level for program planning and monitoring. In addition, RPM Plus will explore with the MOHSW the opportunity to roll-out the system in other CHAL facilities. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project A RxSolution training workshop was held Visiting the sites will require more Year 7 Q4 in Maseru for 32 users on 20th of time due to distances. August. Rx Solution was installed on 20 computers with users being given the Unavailability and/or transfer of opportunity to familiarize themselves pharmacy technicians from sites. with the program before the new version is rolled out. Tentative plans have been Challenges with support developed for roll-out by district. personnel not reporting problems with the system timeously. Site visits were made to Berea ARV clinic, Mafeteng ARV clinic, Leribe Main Pharmacy & ARV clinic and HAHPCO.

The Lesotho National Product List was obtained from NDSO. The list will be used as a product file for all Lesotho installations. Last Updated: 10/15/2007

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Workplan: Lesotho Year 06 Activity Title Provide TA in pharmaceutical management in support to national,district and/or facility level

Activity Manager Steel, Gavin Activity # 7 Task: A1LS06XXX Sub-Task: 60CXH7 Activity Description RPM Plus will use FY06to continue to train and provided continuing technical assistance to these PTCs. These committees will play a key role in promoting standard treatment guidelines (e.g HIV and AIDS regimens) and reviewing medicine use practices thus promoting rational medicine use at all levels Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project No activities were reported during this Year 7 Q4 quarter. Last Updated: 10/16/2007

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Workplan: Lesotho Year 06 Activity Title Documentation of lessons learned and dissemination of best practices

Activity Manager Sallet, Jean-Pierre Activity # 8 Task: A1LS06XXX Sub-Task: 60GXH8 Activity Description The activity also aims at documenting the different lessons learned from the implementation of the Emergency Plan interventions as applied in the pharmaceutical sector. It will document workable solutions and strategies. The program will identify success stories and ensure their documentation. The program will work with the USG team and other partners to identify opportunities for the presentation and dissemination of lessons learned locally, regionally and internationally Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project No activities were reported during this Year 7 Q4 quarter. Last Updated: 10/16/2007

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Workplan: Madagascar MAC Year 05 Activity Title Technical Assistance for ACT policy change and implementation

Activity Manager Adeya, Grace Activity # 1 Task: A1MG05MAC Sub-Task: 60F4H1 Activity Description MAC through RPM Plus is providing technical assistance to the MoH to change the antimalarials treatment policy and develop an implementation plan for the new policy. RPM Plus and WHO/AFRO will continue to support this implementation process. The specific activities will be determined once the ACT implementation plan is finalized and validated by the MoH and its RBM partners. This activity will occur throughout the year Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project Traveled to Madagascar to work with Non availability of NMCP staff to Write trip report and share Year 7 Q4 NMCP on pharmaceutical management meet and work on with USAID and health information system and to meet with pharmaceutical management commodity working group. recently established health commodity reporting form for ACTs and RDTs Develop scope of work for management working group to see how local consultant to work with RPM Plus can support with remaining NMCP on ACT and RDT MAC FS funds pharmaceutical management reporting tool, test and dissemination of tool. Last Updated: 10/12/2007

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Workplan: Namibia COP Year 07 Activity Title Support the production of middle level pharmaceutical officers and CPDs

Activity Manager Nwokike, Jude Activity # 0 Task: A1NA07HIP Sub-Task: 60AXH0 Activity Description This activity aims at increasing the production of middle level pharmacy staffs Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project In the quarter under review, RPM plus There is need to expand the To conduct a national Year 7 Q4 successfully advocated for and physical infrastructural capacity stakeholders workshop to supported the doubling of enrollment of (number of classes rooms) at review and update the draft students for the PA course at NHTC. NHTC to accommodate the revised curriculum in Consequently, the number of students doubled enrollment of students October 2007 enrolled for the 2008 training has and the increased number of To motivate for and finance doubled to 20. Through targeted tutors for the PA course infrastructural renovations advocacy and technical assistance, required to accommodate RPM plus succeeded in convincing key the increased number of stakeholders on the need for reviewing students and tutors and updating of the PA training Continue to provide curriculum. A draft revised curriculum technical assistance in has been produced and circulated to implementation of revised stakeholders for comments. RPM plus training curriculum contacted and held two meetings with the secretary of the Pharmaceutical Society of Namibia to enlist the societies support in training of PA’s and in development of CPD materials for pharmacist. Last Updated: 10/09/2007

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Workplan: Namibia COP Year 07 Activity Title Strengthen Medicines Control Council

Activity Manager Nwokike, Jude Activity # 2 Task: A1NA07HIP Sub-Task: 60BXH2 Activity Description This activity addresses issues related to improving the regulatory system for the assurance of quality, safety and efficacy of medicines Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project During this quarter, RPM Plus conducted Delays in MoHSS confirmation of Procure the services of Year 7 Q4 a desk review of the desirability and preferences vendors for the set up of the requirements for the establishment of a web site and the domain website for the Medicines Control name registration Council (MCC). Reviewed materials Collaborate with MoHSS for included the findings of the study; Pilot the launch of the site study on drug regulatory websites: current status and future challenges, the WHO model web site and the web sites of numerous drug regulatory authorities in Africa. RPM Plus subsequently obtained sketches of dummy sites and presented to MCC. MCC requested that RPM Plus support should include the web site and domain registration. Last Updated: 10/09/2007

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Workplan: Namibia COP Year 07 Activity Title Provide TA for Therapeutics Information and Pharmacovigilance Center (TIPC)

Activity Manager Nwokike, Jude Activity # 3 Task: A1NA07HIP Sub-Task: 60B2H3 Activity Description This activity will provide for a system for the provision of unbiased information on medicines and the tracking of adverse events Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project In the quarter under review, RPM plus Delays in the public procurement To conduct a national Year 7 Q4 continued to provide technical and process that is retarding the pace training on material support towards the of procurement of services for pharmacovigilance and establishment, running and launch of the development of the MCC/TIPC medicines information for TIPC. In July 2007, RPM plus and website health workers in Namibia in MoHSS trained 13 healthcare workers November 2007 as trainers in pharmacovigilance (ToT). To have the TIPC officially RPM plus donated 16 assorted and launched by end of relevant reference books to the TIPC, November 2007 developed and presented draft To recruit a suitable medicines safety reporting form, technical staff to strengthen therapeutics information request form, delivery of TIPC services TIPC advocacy materials (a flyer, poster and pamphlet) which were reviewed by the TIPC implementing working group (IWG), and followed up on the registration for the use of the online Vigiflow tool of the Uppsala Monitoring Center. RPM plus provided on going technical guidance on the operation of the centre, the creating of the MCC/TIPC website and planning for the official launch of the center. Last Updated: 10/09/2007

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Workplan: Namibia COP Year 07 Activity Title Support Treatment guidelines committees

Activity Manager Nwokike, Jude Activity # 4 Task: A1NA07HIP Sub-Task: 60BXH4 Activity Description Activity will provide capacity to committees charged with developing and updating treatment guidelines Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project No activity this quarter None Support committee with Year 7 Q4 journals and literature Conduct trainings on critical appriasal skills and pharmacoeconomics Last Updated: 10/09/2007

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Workplan: Namibia COP Year 07 Activity Title Provide TA for selection of medicines for palliative care and HBC Kits

Activity Manager Nwokike, Jude Activity # 5 Task: A1NA07HIP Sub-Task: 60B4H5 Activity Description This activity will result in improved access to palliative care medicines Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project Conducted preliminary desk review on None Meet with MoHSS and Year 7 Q4 current practices on medicines lsited in make presentations on the palliative care essential medicines current practices in other list. Initiated advocacy for the possibility countries and proposed list of a workshop or forum for discussions of essential medicines on review of the medicines lists for required for palliative care palliative care and home-based care and home-based care needs. Last Updated: 10/09/2007

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Workplan: Namibia COP Year 07 Activity Title Provide TA for the update of the NMP Master Plan

Activity Manager Nwokike, Jude Activity # 6 Task: A1NA07HIP Sub-Task: 60BXH6 Activity Description This activity will provide support for the update of the National Medicines Policy implementation master plan Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project No activity this quarter None Advocacy for the initiation of Year 7 Q4 preliminary discussions on the update of the NMP master plan Last Updated: 10/09/2007

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Workplan: Namibia COP Year 07 Activity Title Provide TA for the update and dissemination of EML

Activity Manager Nwokike, Jude Activity # 7 Task: A1NA07HIP Sub-Task: 60B4H7 Activity Description This activity will support the update of the NEMList Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project During this quarter technical assistance Many of the applications are - Finalize the review and Year 7 Q4 was provided to Pharmaceutical incomplete, necessitating further prepare the submissions to Services in reviewing applications for follow-up and consultation. This be considered by the changes to the NEMList that have been has greatly slowed the review NEMList committee. submitted to the NEMList secretariat by process. In addition, the - Support retreat for the various health workers in the country. secretariat does not have EML committee for the This involved reviewing the applications adequate manpower which has review of the proposed for completeness, reviewing the further slowed the process. changes in October accompanying motivations and obtaining - Submit the changes additional supporting document in order recommended/ approved by to prepare the submissions to be the EML committee to the considered by the essential medicines MoHSS Policy Management list committee. This process is still in and Development Review progress and is expected to be Committee for ratification. completed in October 2007. - Print and distribute During this period, the activity lead and updated EML the Chief Pharmacist, Sub-division: National Medicines Policy Co-ordination, the secretariat of the NEMList Committee visited the RPM Plus offices in South Africa to familiarize themselves and consider possible adoption of an electronic tool that can be used for managing the formulary/EML process. The recommendations from this visit have been submitted to the MoHSS for consideration. Last Updated: 10/09/2007

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Workplan: Namibia COP Year 07 Activity Title Support Pharmacy Management Information System (PMIS)

Activity Manager Nwokike, Jude Activity # 8 Task: A1NA07HIP Sub-Task: 60B1H8 Activity Description This activity will support the actual implementation of the PMIS Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project In this quarter, RPM Plus supported the Due to a number of concurrent In the coming quarter RPM Year 7 Q4 PMIS task force in finalizing and printing activities at both the national and Plus will support the regions of the PMIS user manuals, data regional level, some regions are in the implementation of the collection tools and training materials yet to finalize with the regional system at the regional revel and in the subsequent launch and trainings which had been planned and specifically the data national training held in early July. to conclude by the end of collection and reporting. RPM Plus also provided computers and September 2007. The RPM Plus will also support related hardware to all the regions to development and rollout of the regional pharmacists to facilitate data collection and reporting in PMIS database is behind perform PMIS supportive the regions by the regional pharmacists schedule and the first set of supervisory visits at facilities All the 13 regions were also supported in reports will have to be processed to support implementation conducting regional PMIS trainings for and transmitted manually. at this level pharmacy personnel and other facility A software developer has and regional office personnel in been engaged to develop preparation for the data collection database to facilitate data activities due to start in October 2007. capture, analysis and reporting both at national level and at the regions. This should be ready and installed at the regions by the end of October 2007. Last Updated: 10/09/2007

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Workplan: Namibia COP Year 07 Activity Title Provide 11 pharmacists, 5 PhAss, and 5 pharmacy technologists

Activity Manager Nwokike, Jude Activity # 9 Task: A1NA07HIP Sub-Task: 60AXH9 Activity Description This activity will improve local capacity of Pharmacy staffs Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project RPM Plus supported 6 Pharmacists and - The recruitment process is - In the October to Year 7 Q4 5 newly qualified Pharmacist Assistants significantly prolonged by December Quarter, 3-4 with salaries. This funding will continue immigration procedures. On Pharmacists and 3 until the MoHSS is able to absorb them. some occasions, it has taken interviewed will be recruited In this quarter, the MoHSS/MSH re- more than four (4) months to get and posted to the evaluated the human resource gaps and a technical staff into the country. respective departments and identified facilities and position in the This is a major constraint. facilities. MoHSS that urgently needed staff. As - The unpredictable absorption - One IT technical staff will an intervention, 4 Pharmacists and 5 of staff renders it difficult for RPM be recruited for the MoHSS Pharmacists assistants were interviewed Plus/MSH to plan in time for - All HR support will of which 3 new pharmacists, and 3 replacement. continue through Potentia Pharmacists will be recruited in the Namibia October to December 2007 quarter. - RPM Plus/MSH will work with the MoHSS to review the adequacy of human resources in the delivery of pharmaceutical care in Namibia Last Updated: 10/09/2007

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Workplan: Namibia COP Year 07 Activity Title Support health care workers participation in local and international conferences

Activity Manager Nwokike, Jude Activity # A Task: A1NA07HIP Sub-Task: 60AXBA Activity Description This activity will support participation in conferences Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project Sponsored the presentation of a poster None Continue to seek Year 7 Q4 on adherence at the South Africa opportunities and provide HIV/AIDS conference in Durban. RPM sponsorship for staff and Plus supported participation of some partners in conferences and staff to the MSH/RPM Plus annual workshops with theme or retreat. Also supported participation at related issues to HIV/AIDS the 23rd International Conference on and Pharmaceutical Pharmacoepidemiology and Therapeutic management Risk Management held in Quebec City from 18 - 22 Aug, 2007 Last Updated: 10/09/2007

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Workplan: Namibia COP Year 07 Activity Title Dissemination of results of RPM Plus pharmaceutical management initiatives in Namibia

Activity Manager Nwokike, Jude Activity # B Task: A1NA07HIP Sub-Task: 60G2DB Activity Description This activity provides for the RPM Plus Namibia project dissemination Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project None None Compile a listing of the Year 7 Q4 products of the project. Hold meetings for the purposes of determining the requirements for the event Last Updated: 10/09/2007

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Workplan: Namibia COP Year 07 Activity Title Provide support to the implementation of SOPs

Activity Manager Nwokike, Jude Activity # C Task: A1NA07HIP Sub-Task: 60CXHC Activity Description This activity supports the implementation of SOPs Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project None None Develop first draft of the Year 7 Q4 comprehensive SOPs for review by MoHSS and partners Last Updated: 10/09/2007

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Workplan: Namibia COP Year 07 Activity Title Support the roll-out of the ART Commodity Tracking System (ACTS)

Activity Manager Nwokike, Jude Activity # D Task: A1NA07HIP Sub-Task: 60G4JD Activity Description This activity supports the use of the ADT Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project With the roll-out of the ADT to cover 24 Delays in developing and • Finalize ADT version 2 Year 7 Q4 facilities and the positive benefits of the completing the contract. This • Roll-out ADT to the system reported by users came also the process took over about a month remaining 11 facilities need to update the ADT in order to meet to complete. • Set up the national the current realities in Namibia and also database include other functionalities that were previously not taken care of by the ADT such as adherence monitoring and quantification at facility level. In this quarter, RPM Plus together with end users reviewed the functionalities of the ADT and identified areas that need improvement. A contract with HAADER was secured and works on updating the ADT started. The new reporting tool in line with the MoHSS requirements was completed and tested at all 24 sites. Last Updated: 10/09/2007

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Workplan: Namibia COP Year 07 Activity Title Support to monitoring and supervision of pharmaceutical management at the site level

Activity Manager Nwokike, Jude Activity # E Task: A1NA07HIP Sub-Task: 60CXHE Activity Description This activity supports supportive supervisory roles of regional health managers particularly pharmacists Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project During this quarter, RPM Plus Waiting and following up with the a) Provide support to each Year 7 Q4 supported pharmaceutical services regional pharmacists for their regional pharmacist division in strengthening supervisory plans according to their activity support visits by regional pharmacists by plan taking the lead in developing a comprehensive supervisory support checklist/tool and also in taking the lead in facilitating the development of Supportive Supervision Activity Plans by each regional pharmacist. Last Updated: 10/09/2007

Thursday, December 20, 2007 3:55 PM Page 206 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Namibia COP Year 07 Activity Title Training in pharmaceutical management for treatment facilities sites in 7 regions

Activity Manager Nwokike, Jude Activity # F Task: A1NA07HIP Sub-Task: 60CXMF Activity Description This activity supports training on HIV/AIDS Pharmaceutical management Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project In the quarter under review, the PMTC None Although the 7 targeted Year 7 Q4 material was reviewed and updated to regions have been covered, the current Namibia situation. A core only half of the pharmacy training team was formed and the NHTC staff in the regions could be was also adopted into the core training trained during this time. team. Training for the seven North west Two additional trainings and North Eastern regions of Namibia have been planned for Feb was conducted in August 2007. A total and march 2008 to cover of 21 pharmacist’s assistants were half of the staff that were trained including 2 from the NDF not trained in all regions (Namibia Defense Forces). During this and also any new staff that training, the pool of trainers was have entered the system increased by involving regional after the August 2007 pharmacists, hospital pharmacists and training. the NHTC tutor – an addition of 5 new trainers to the pool. Advocacy was also provided to ensure that the PMTC is included in the PA training Course curriculum Last Updated: 10/09/2007

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Workplan: Namibia COP Year 07 Activity Title Support MoHSS decentralization plan for ART at 13 health centers and clinics

Activity Manager Nwokike, Jude Activity # G Task: A1NA07HIP Sub-Task: 60AXHG Activity Description This activity supports MoHSS decentralization of ART services Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project None None Collaborate with DSP in Year 7 Q4 performing rapid assessment of the identified sites to determine site readiness and requirements Last Updated: 10/09/2007

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Workplan: Namibia COP Year 07 Activity Title TA for strengthening Therapeutics Committees

Activity Manager Nwokike, Jude Activity # I Task: A1NA07HIP Sub-Task: 60BXHI Activity Description This activity supports efforts at strengthening Therapeutics Committees at the regional and facility levels Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products

Thursday, December 20, 2007 3:55 PM Page 209 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Namibia COP Year 07 Activity Title TA for strengthening Therapeutics Committees

Project During this quarter, five regional Lack of time for TC members to In the next quarter, Year 7 Q4 therapeutics committees were supported actively participate in TC technical assistance and in various activities. Erongo region was activities has been a major support will be provided to supported in conducting two regional TC constraint in this activity. Most of the four regions developing meetings in July and September. the TC members have other a joint formulary/ treatment Similarly, Oshikoto region was also administrative or clinical duties at guidelines. A formulary tool, supported in holding its August regional their facilities and this has been developed by RPM Plus, meeting. an impediment to carrying out will be shared with the Two TC projects are currently being planned TC activities in some formulary committee and supported. Four regional TCs, Oshikoto, instances. This is aggravated by possibly used in the Omusati, Ohangwena and Oshana are staff shortages in some facilities. regional formulary currently being supported to develop In addition bringing together TC development process. joint regional formulary and treatment members from different districts The Erongo TC will be guidelines and the inaugural formulary to meet or participate in regional supported in conducting a committee meeting was held in August TC activities has also been a second inventory 2007. RPM Plus is also currently problem due to logistical issues management training supporting the Erongo Regional TC in especially for the vast regions targeting nurses in charge implementing interventions to improve of pharmaceuticals and inventory management practices in the related supplies at region. peripheral clinics and health centers. The regional pharmacist will also be supported in conducting supervisory visits to the districts to support and provide on the job training on stores and inventory management to Pharmacist’s Assistants and nurses at various facilities. Omahake and Caprivi regional therepeutics committees have requested for support in conducting TCs activities. This will be provided to these committees starting from the next quarter. Last Updated: 10/09/2007

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Workplan: Namibia COP Year 07 Activity Title TA for development and implementation of adherence monitoring and measurement

Activity Manager Nwokike, Jude Activity # J Task: A1NA07HIP Sub-Task: 60EXHJ Activity Description This activity supports strategies aimed at improving adherence to ART Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project No progress with the approval of the Delays in approvals from MoHSS Collaborate with Year 7 Q4 adherence survey. Treatment facilities Therapeutics Committees have continued to request assistance and treatment facilities for with the implementation of interventions the implementation of to improve adherence. interventions to improve adherence Last Updated: 10/09/2007

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Workplan: Namibia COP Year 07 Activity Title Provide TA and support for the development and printing of medicines Formulary

Activity Manager Nwokike, Jude Activity # K Task: A1NA07HIP Sub-Task: 60B4HK Activity Description This activity will support Formulary development Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project In the quarter under review, RPM plus There is need to build consensus To conduct a national Year 7 Q4 held two meetings with potential experts by key stakeholders at the stakeholders meeting to to assess their technical capacity to National level obtain consensus on need develop a national formulary and revise of a National formulary the treatment manual for clinics. In To engage a consultancy to addition, 1 SPA from RPM plus, together develop a draft for with the Ag Director: Division of discussion Pharmaceutical Services, MoHSS visited South Africa to assess the feasibility of utilizing formulary development and maintenance tools in Namibia. Last Updated: 10/09/2007

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Workplan: Namibia COP Year 07 Activity Title Provide TA and support to reduce cost of ART treatment at the private sector

Activity Manager Nwokike, Jude Activity # L Task: A1NA07HIP Sub-Task: 60C5HL Activity Description This activity will support efforts at improving ART services in the private sector Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project In this quarter RPM Plus worked with the - Delayed approval of the - Revision of the draft Year 7 Q4 Office of the Prime Minister, PSEMAS protocol by the Ministry of protocol suited with private (Public Sector Medical Scheme) and Finance and the Office of the schemes and MedScheme to explore ways of carrying Prime Minister. implementation of the pout a baseline survey and thereafter baseline survey of the Cost design appropriate interventions. A draft of ART in the Private sector protocol for the determination of factors in Namibia that influence ARV use in the private sector has been developed. Last Updated: 10/09/2007

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Workplan: Nicaragua Year 05 Activity Title Standardization of procedures and forms used by the VSM quality assurance program

Activity Manager Barillas, Edgar Activity # 3 Task: A1NI05XXX Sub-Task: 60DXH3 Activity Description The Ventas Sociales de Medicamentos networks have already developed components of a comprehensive QA program. RPM Plus will provide TA to standardize the procedures among the different networks, develop an indicator base system to monitor the QA program, and to document the experience. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project Local RPM Plus consultant finished and There were delays, though, in the The Minilab ® is already in Year 7 Q4 presented the baseline studies before introduction of the Minilab ® Nicaragua and RPM Plus the implementation of the Quality because of difficulties in has programmed a training Assurance Manual.The implementation international shipping and port workshop on October 23rd of the Quality Assurance Manual is in an clearance. – 25th. advances stage. Last Updated: 09/26/2007

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Workplan: Nicaragua Year 05 Activity Title Technical assistance for the implementation of the standardized quality assurance program of the VSM

Activity Manager Barillas, Edgar Activity # 4 Task: A1NI05XXX Sub-Task: 60DXH4 Activity Description The quality assurance program manual was completed and validated by all the VMS networks on August 2006. During FY06 RPM Plus will provide technical assistance for the systematic application of the norms and procedures, develop an indicator base system to monitor the QA program, and implement an assessment of the impact in the quality of the medicines dispensed by the VSM. A local consultant will be hired to support this activity. The USAID Mission in Nicaragua agreed that unused resources from FY05 (USD 20,000.00 approximately), for the Strengthening of MoH Pharmaceutical and Therapeutic Committees, as mentioned before) will also be used to support this activity, including the purchase of a MiniLab® set and technical assistance on its use. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project Local RPM Plus consultant finished and There were delays, though, in the The Minilab ® is already in Year 7 Q4 presented the baseline studies before introduction of the Minilab ® Nicaragua and RPM Plus the implementation of the Quality because of difficulties in has programmed a training Assurance Manual. The implementation international shipping and port workshop on October 23rd of the Quality Assurance Manual is in an clearance. – 25th. This activity will advances stage. continue using FY06 (year 7) resources. Last Updated: 10/18/2007

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Workplan: Nicaragua Year 06 Activity Title Technical assistance for the implementation of the standardized quality assurance program of the VSM

Activity Manager Barillas, Edgar Activity # 2 Task: A1NI06XXX Sub-Task: 60DXH2 Activity Description The quality assurance program manual was completed and validated by all the VMS networks on August 2006. During FY06 RPM Plus will provide technical assistance for the systematic application of the norms and procedures, develop an indicator base system to monitor the QA program, and implement an assessment of the impact in the quality of the medicines dispensed by the VSM. A local consultant will be hired to support this activity. The USAID Mission in Nicaragua agreed that unused resources from FY05 (USD 20,000.00 approximately), for the Strengthening of MoH Pharmaceutical and Therapeutic Committees, as mentioned before) will also be used to support this activity, including the purchase of a MiniLab® set and technical assistance on its use Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project Still using FY05 resources, local RPM There were delays, though, in the The Minilab ® is already in Year 7 Q4 Plus consultant finished and presented introduction of the Minilab ® Nicaragua and RPM Plus the baseline studies before the because of difficulties in has programmed a training implementation of the Quality Assurance international shipping and port workshop on October 23rd Manual and the Standardized Manual for clearance. – 25th. the Training of Dispensers. The implementation of the Quality Assurance Manual is in an advances stage. Last Updated: 09/26/2007

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Workplan: Nicaragua Year 06 Activity Title Technical assistance for assessing the impact of the application of the standardized manual for the training of VSM dispensers

Activity Manager Barillas, Edgar Activity # 3 Task: A1NI06XXX Sub-Task: 60G3H3 Activity Description This training manual was completed and validated by all the VSM networks on August 2006. RPM Plus will provide technical assistance to develop an indicator base system to monitor the training process, and implement an assessment on the knowledge, practice and attitudes of the participants. A local consultant will be hired to support this activity. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project Local RPM Plus consultant finished and No contraints The completion of the Year 7 Q4 presented the baseline studies before training for AMC dispensers the implementation of the Standardized will take place before the Manual for the Training of Dispensers. end of 2008.

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Workplan: Rwanda PMI Year 07 Activity Title Technical Activity Coordination and Monitoring

Activity Manager Kabuya-Mutshipayi, Willy Activity # 1 Task: A1RW07PMI Sub-Task: 97XXY1 Activity Description The technical activity coordination includes work plan development, budget monitoring, progress monitoring and reporting as well as meetings, and communications with partners and collaborators. Quarterly meetings will also be scheduled with partners involved in the PMI under the leadership of USAID. Moderation and location of these meetings will rotate among partners.

RPM Plus is initially hiring one senior staff (Senior Program Associate) in Rwanda who will collaborate closely with the other PMI partners including USAID, CDC, PNILP, Global Fund Malaria, UPDC/MOH, PSI, CAMERWA, PTF/MINISAN, RAMA, ARPHA, BTC, NRL UNICEF, WHO and others at the national, and the district levels as appropriate. RPM Plus/Rwanda will receive technical and administrative support from RPM Plus Regional malaria technical advisors based in Nairobi as well as from the RPM Plus malaria team based in Arlington, Virginia. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project Participated in a 10 days technical Year 7 Q4 meeting with the USAID PMI/HQ team and CDC to review work plans in preparation of next FY’s MOP08. Also participated in several meetings to discuss issues related to pharmacovigilance (PV), private sector approach, harmonizing commodities management (between PNILP, RPM Plus and DELIVER) and Commodities in the HBM. The new Senior Program Associate began working in July, after her orientation an introductory period plan was developed Last Updated: 10/12/2007

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Workplan: Rwanda PMI Year 07 Activity Title Strengthen distribution mechanisms and inventory management of malaria related commodities

Activity Manager Kabuya-Mutshipayi, Willy Activity # 3 Task: A1RW07PMI Sub-Task: 60C4H3 Activity Description RPM Plus will provide TA to CAMERWA to coordinate with implementing partners managers of health facilities to distribute ACTs and LLINs to the health facilities. Timely information will be given to health facilities on delivery at district pharmacy, to prepare them for reception and transport to their respective facilities.

RPM Plus will support CAMERWA to develop a strategic distribution plan to undertake an active distribution. In collaboration with other projects and partners, RPM Plus will participate in the transition from a pick-up distribution system to an active distribution system, according to an agreed strategic plan to ensure readiness and smooth transition at both national and peripheral levels. RPM Plus will review the performance of any existing drug inventories, logistics, management information system and corresponding tools within the public sector and recommend adjustments needed to improve performance monitoring. RPM Plus will support CAMERWA and PNILP to identify all existing stocks of old drugs and remove them while distributing the new treatments (ACTs) and will support PNILP to improve existing drug management information tools and reinforce their utilization, particularly the daily consumption registration and the monthly report tools. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products

Thursday, December 20, 2007 3:55 PM Page 219 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Rwanda PMI Year 07 Activity Title Strengthen distribution mechanisms and inventory management of malaria related commodities

Project During this quarter, discussions were PNILP and PTF agreement on Assist the PNILP and HBM Year 7 Q4 held with the PNILP on data to be the training plan implementing partners to reported by district pharmacies and monitor ACT compliance( needed modifications in the drafted develop tools,data reporting tools. RPM Plus requested the collection and analysis) PNILP for copies of third quarter data reported by District Pharmacies.With Final exchanges with the regards to training of CHWs on home PNILP and PTF technical based management of malaria (HBM), team. RPM Plus reviewed the drug management section of the training Printing and reproduction of manual and provided technical advice on the tools the TOT methodology and critical Job Aids to be used. RPM Plus also Training at the district and supervised the trainings in Kirehe, FOSA levels Nyanza and Gasabo. Supervision report and recommendations has been shared with HBM implementing partners and PNILP. In order to monitor ACT compliance in HBM, RPM Plus met with EIP to talk about developing HBM monitoring tool that would include elements of compliance monitoring. Also during this quarter, the PNILP’s comments to the malaria reporting tools were incorporated into the initial draft and subsequently, a draft plan for introducing the reporting tools at the district and FOSA levels was developed. Both the revised reporting tools and the draft plan were submitted to the PNILP.In efforts to develop a coordinated procurement and distribution system, RPM Plus assessed the system, a preliminary report is being developed for internal discussions Last Updated: 10/12/2007

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Workplan: Rwanda COP Year 06 Activity Title To assist the districts and the sites with the implementation of adequate electronic and manual tools for improving stock management

Activity Manager Citysoft Admin Activity # 10 Task: A1RW06HIP Sub-Task: 60C3H0 Activity Description During COP06 RPM Plus will implement SOPs and inventory management tools in all district pharmacies, and will update the SOPs of the ART sites according to the changes in the distribution system. The pharmaceutical MIS will be expanded to include at least ARVs, OIs and Rapid Test Kits, and the electronic version of the ARV Dispensing Tools will be implemented in at least 20 new sites, after individual assessment of its appropriateness. In regard to the District Pharmacies, the ART Tracking Tool will be tested to be used for inventory management of all essential medicines. The potential advantage of using this tool versus other inventory management tools is the possibility of tracking the quantities consumed at facility level versus the quantities distributed, as well as the possibility of customizing reports as required Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products

Thursday, December 20, 2007 3:55 PM Page 221 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Rwanda COP Year 06 Activity Title To assist the districts and the sites with the implementation of adequate electronic and manual tools for improving stock management

Project The use of the tool was also *High turnover of health facility Continue to reach out to Year 7 Q4 consolidated in 27 health facilities where staff and frequent inoperation of supporting programs to it is already operational. DMIS specialist computers often leads to lack of seek assistance in providing worked with the sites to respond to use or installation of the DT tool. computers for health resolve their technical maintenance *The ability of PTF, UDPC, & facilities to ensure the problems. Efforts to effective scale up CAMERWA to appropriately continuous use of the DT; the installation of the tool have been coordinate the efforts in a timely continue to provide TA and hampered by the lack of availability of fashion to ensure that the support to FOSA re training computers in many of the health training, printing of to ensure continuous facilities. Under COP07 RPM Plus will tool/instructions, and utilization of the DT.RPM continue to install the tool at health implementation plans are Plus will discuss the status facilities that have the necessary appropriately in place of the situation with the resources to allow for the installation of CPDS Coordinator and the tool. The progressive integration of assist with exploring the ARVs, OIs, and Test Kits through the possible ways to move the districts is part of the work plan that process forward. each of the 8 disticts developed in December 2006. However, the full implementation of this activiy will depend upon CAMERWA readiness to move to active distribution. It is expected that the active distribution will be launched in phases, starting with the districts that are ready to assume this new role. A condition for the district pharmacies to act as distribution centers, is that their capacity to manage as well the reporting system. RPM Plus is providing support to both CAMERWA and the districts in ensuring readiness and coordination at both central an peripheral levels. The ART Tracking Tool was installed in eight district pharmacies during the reporting period and training provided to district pharmacists. RPM Plus continue to schedule installation of the tracking tool and provide training for the staff of district pharmacies as the need arise. RPM Plus will continue to provide technical assistance to the new CPDS Coordinator move this activity forward under COP07.

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Workplan: Rwanda COP Year 06 Activity Title To assist the districts and the sites with the implementation of adequate electronic and manual tools for improving stock management

Last Updated: 10/06/2007

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Workplan: Rwanda COP Year 06 Activity Title To promote through the District Health Directors the implementation of Drug and Therapeutics Committees in 8 ART hospitals, in

Activity Manager Gatera, Antoine Activity # 11 Task: A1RW06HIP Sub-Task: 60BXHA Activity Description RPM Plus aims to establish DTC in at least eight district hospitals where RPM Plus has allocated a district pharmacist, which will also serve to test the implementation process for future scaling up. Following the activities of COP05, a second training in DTC might be necessary for those district health authorities, pharmacy staff and other health staff involved who did not participate in the previous training. Priority activities to be conducted through the committees will be defined after having conducted key pharmaceutical assessments such as ABC / VEN analysis, and gathered indicators on prescription habits and drug utilization. RPM Plus will continue the support to the MOH for the finalization of the Standard Treatment Guidelines and National Formulary, which whose utilization will be monitored through the DTC implemented. In order to harmonize the DTCs and in view of future expansion to other districts, RPM Plus anticipate the need of creating a National Drug and Therapeutics Committee, chaired by the MOH with the participation of representatives of the DTCs . Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products

Thursday, December 20, 2007 3:55 PM Page 224 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Rwanda COP Year 06 Activity Title To promote through the District Health Directors the implementation of Drug and Therapeutics Committees in 8 ART hospitals, in

Project During the second quarter of COP06 The availability and commitment RPM Plus will continue to Year 7 Q4 RPM Plus in collaboration with PTF & of directors of hospitals to take work with PTF and perhaps WHO organized a consensus workshop the implementation of DTCs as seek support at a higher for the finalisation of the National extremely important and urgent level of the MOH for the Standards Teatment Guidelines (STG) implementation of DTCs and the National Formulary (NF) . The throughout Rwanda STG and NF documents currently being reviewed for approval and dissemination by the MOH. It is hoped that the documents will be approved and disseminated by the end of September 2007. RPM Plus staff continues to provide TA in the area of DTC 8 health facilities. During the second quarter the TA provided resulted in the occurrence of the first DTC meeting in two sites (Ruhengeri & Muhima Hospitals); RPM Plus provided orientation to the new members of the newly established DTC. RPM Plus' support of the establishment and strengthening of DTCs in the 8 sites continues on a weekly basis. An assesment to identify problems and barriers to the functioning of CHUK DTC was conducted and results are currently under review by RPM Plus staff who will provide feedback and assistance with determining next steps. Needed TA and support was provided to KFH in the development of an ADR and Medical errors reporting system which will be implemented within the hospital in the next few months. RPM Plus continues to provide technical support to all 8 health facilities as they continue the process of establishing new DTCs or strengthening existing DTCs in their respective health facilities. During the third quarter of COP06 RPM Plus provided TA for the development of a 5 day DTC training of new DTC members for 4 hospitals. The training is scheduled to occur in the 1st quarter of COP07. The support to the 8

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Workplan: Rwanda COP Year 06 Activity Title To promote through the District Health Directors the implementation of Drug and Therapeutics Committees in 8 ART hospitals, in

hospital will continue under COP07. Last Updated: 10/06/2007

Thursday, December 20, 2007 3:55 PM Page 226 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Rwanda COP Year 06 Activity Title To develop and implement formative pharmacy supervision tools in the districts, integrated with other aspects of health care

Activity Manager Hitayezu, Felix Activity # 12 Task: A1RW06HIP Sub-Task: 60AXJB Activity Description During COP06 RPM Plus and PBF will continue their mutual collaboration for putting in place an integrative supervision system, where the pharmacy component will be harmonized with the rest of the supervision requirements. Supervision tools will be finalized and implemented, and will integrate the specificities required for the management of products used by the programs (such as ARVs, antiTB and antimalarials) with the management of other essential medicines. The strategy also anticipates the training of supervisors as well as a TOT for supervision. The pharmaceutical component will be tested in the districts that have been staffed with RPM Plus pharmacists, before expanding the initiative to other districts. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project After the workshop on development or The delays of the availability of Contact MOH to know the Year 7 Q4 adaptation of the tools of the Integrated standards from MOH status of the development Supportive Supervision the MOH ask us of norms activity; plan the to wait for the developments of the adaptation of the tools for standards for all the levels of health Integrated Supportive structures of Rwanda. Since then we Supervision (ISS), have continued the discussions with development of the ISS PBF and produced a draft that RPM Plus manual, and organisation of and PBF will propose to partners. Once a TOT in supervision the standards are available, RPM Plus followed. will finalize the draft produced .RPM plus will follow up on the plan and strategy for the next steps adopted during the workshop. This includes finalization of the tools for Integrated Supportive Supervision (ISS), development of the ISS manual, organisation of a TOT in supervision followed by the training of district supervisors on ISS, then regular follow up. This activity will continue under COP07. Last Updated: 10/06/2007

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Workplan: Rwanda COP Year 06 Activity Title To coordinate other USG partners in activities related to improving the district pharmacies.

Activity Manager Ntumba, Georges Activity # 13 Task: A1RW06HIP Sub-Task: 60A2HD Activity Description The coordination role of RPM Plus for supporting the activities at the district pharmacies include to share with other CAs referral materials developed by RPM Plus such as the Minimal Norms for the Pharmacy by level of helath care, tools and SOPs for pharmaceutical management, and training materials. RPM Plus will also support all CAs that have funds for pharmacy renovation, by accompanying the CAs in the field visits, providing TA for the type of renovations needed, and sharing lessons learned. RPM Plus will facilitate effective communication with other CAs through meetings and emails Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project During the previous reporting periods None noted Continue to make staff Year 7 Q4 MSH/RPM Plus met with both FHI, available to render any Intrahealth, and EGPAH to discuss needed assistance to MSH/RPM Plus' approach for pharmacy partners rehabilitation. With regards to FHI, RPM Plus accompanied FHI staff to Gakenke and Muhanga Districts to explore with them the process necessary to effectively rehabilitate pharmacies. RPM Plus provided FHI with norms for district pharmacies, as well as plans indicating the specifications for an ideal pharmacy. MSH/RPM Plus will continue to meet with USG Clinical Partners to discuss activities related to pharmaceutical management and assist them in any way possible with exploring appropriate approaches for rehabilitating pharmacies. While this activity is not continued under COP07, RPM Plus will continue to make its staff available to provide any information, tools, or recommendations that is required by USG and non USG partners. Last Updated: 10/06/2007

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Workplan: Rwanda COP Year 06 Activity Title To provide technical assistance to the MOH and the Resource Management Commission for the consolidation of the CPDS.

Activity Manager Citysoft Admin Activity # 2 Task: A1RW06HIP Sub-Task: 60CXH2 Activity Description In close collaboration with different representatives of the MOH and CAMERWA, RPM Plus will recruit, train, and second to the MOH a senior local staff to coordinate the activities and members of the CPDS. The coordinator of the CPDS will oversee the good performance of the technical committees and its members according to performance plans, indicators and reports. The coordinator will also play a central role facilitating meetings and communications between the members of the technical committees, the donors, and the MOH. The coordinator of the CPDS will be the focal point at the MOH for ensuring that multiple donor procurement initiatives are adequately coordinated within the system. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products

Thursday, December 20, 2007 3:55 PM Page 229 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Rwanda COP Year 06 Activity Title To provide technical assistance to the MOH and the Resource Management Commission for the consolidation of the CPDS.

Project During this reporting period MSH/RPM The ability of PTF, UDPC, NRL & *Provide orientation on the Year 7 Q4 Plus advertised the position of CPDS CAMERWA to appropriately CPDS, establish immediate Coordinator in several different outlets. coordinate the efforts in a timely scope of work, and provide The recruitment process led to the fashion to ensure that the on going technical identification of three candidates. On training, printing of assistance. the 25th of May, a panel comprised of tool/instructions, and *For the CPDS Coordinator representatives of PS, MOH, TRAC, implementation plans are to follow up on the status of CAMERWA, PTF, CNLS, SCMS, and appropriately in place the implementation/trainings RPM Plus conducted interviews for all for both tools and three candidates. At the end of coordinate the appropriate interviews one candidate was selected meetings; RPM Plus is by the panel as the recommended available and willing to candidate for the position. On the 25th assist in any way possible of June, the PS approved the selection to push the agenda. of the candidate recommended by the panel. The newly hired CPDS Coordinator is schedule to begin work on the 1st of October 07. Under COP07 RPM Plus will provide technical support to this position. MSH/RPM Plus developed a draft of an integrated reporting template/instructions to be used for OIs and test kits. While the tool for OIs was approved for implementation, training on the tool was only provided to district managers and not yet to the staff of the health facilities. There is a need at this point in time to bring the stakeholders together to elaborate a plan for training the health facility staff on the tool, as well as to develop a comprehensive plan for monitoring the implementation and use of the tool. The newly installed CPDS Coordinator will follow up and facilitate the process to ensure that a proper implementation plan is in place. The OIs tool will be printed by RPM Plus. Once the tool for test kits was developed through the Quantification Committee it was provided to the National Reference Lab for final approval, scheduling of printing of the tool, training, and

Thursday, December 20, 2007 3:55 PM Page 230 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Rwanda COP Year 06 Activity Title To provide technical assistance to the MOH and the Resource Management Commission for the consolidation of the CPDS.

implementation. The CPDS Coordinator will also be following up on the status of this matter. Aforementioned matters will be finalized under COP07. Last Updated: 10/06/2007

Thursday, December 20, 2007 3:55 PM Page 231 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Rwanda COP Year 06 Activity Title To upgrade skills and knowledge of the members of the technical committees of the CPDS.

Activity Manager Buki, Gege Activity # 3 Task: A1RW06HIP Sub-Task: 60CXM3 Activity Description During COP 06 RPM Plus will focus the assistance to the technical members of the CPDS in two major interventions. The first intervention aims to integrate in the CPDS the management of other products, including HIV/AIDS rapid test kits, and drugs for preventing and treating opportunistic infections. RPM Plus also aims to apply the experience and lessons learned in coordinating donors and resources for the management of ARVs under the HIV/AIDS initiatives to the coordination of the multiple donors operating under the malaria agenda. The RPM Plus team in Kigali will therefore facilitate the collaboration between PEPFAR and PMI in all aspects related to procurement and distribution of HIV/AIDS and malaria related commodities. The second important intervention is to implement the monitoring and reporting system as stated in the CPDS Governance Document. Although the Quantification Committee produces comprehensive reports every procurement period on achievements and projections of scaling up rates and budgets, the planned quarterly reports on inventory management and ARV consumption have not been yet systematically implemented, and will need to be applied to any other product managed through the CPDS. RPM Plus will use all the functionalities of the ART Tracking Tool in combination with CAMERWA’s management software (Exact) in order to ensure adequate control of the drugs. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products

Thursday, December 20, 2007 3:55 PM Page 232 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Rwanda COP Year 06 Activity Title To upgrade skills and knowledge of the members of the technical committees of the CPDS.

Project As OIs, Lab reagents and Tests Kits *SCMS' readiness to take on the *RPM Plus will in Year 7 Q4 procurement were integrated in the technical support and collaboration with the MOH CPDS during the previous reporting responsibilities RPM Plus has and other partners quarter, an integrated training on traditionally provided to the coordinate and implement quantification of ARVs, OIs, lab reagents CPDS. the comprehensive and tests kits will be organized and *Ensuring that the supervision quantification training that is conducted by RPM Plus in collaboration report is finalized by TRAC and scheduled for November 07; with MOH from 5th to 9th of November. appropriately disseminated in a schedule a series of This comprehensive quantification timely fashion to all interested meeting with SCMS, TRAC, training as per the request of the MOH stakeholders; inability to ensure and the CPDS Coordinator will cover not only ARVs, but also TB, the availability of PTF staff to to define and determine the Malaria, and other commodities. Under conduct joint field visits with the process that will be used to COP07 RPM Plus will transition its staff of RPM Plus transition responsibilities technical responsibilities in support of *In spite of ongoing training to the from RPM Plus to SCMS. the quantification process & the CPDS staff of CAMERWA on how to *Request from TRAC status to SCMS. conduct appropriate analysis of update for the finalization of Fields are ongoing and will result in requistions from site in relation to supervision report and action plans for each pharmacy; action appropriate distribution of drugs, dissemination date; plans are developed in collaboration with the staff continues experience continue to work closely the staff of each pharmacy and will be difficulties with adhering with PTF to coordinate followed by staff of RPM Plus on a effectively to established systems efforts to ensure that joint monthly basis. This activity will continue and procedures field visits are carried out to under COP07. *CAMERWA's lack of district and health facility RPM Plus continues to assist consistency with appropriate pharmacies by PTFand CAMERWA with the monitoring of stock collection, documentation, and RPM Plus levels for ARVs, OIs, and test kits on an reporting of data in spite of *Continue to follow up with ongoing basis to avoid stock outs.Under ongoing support from RPM Plus; the appropriate staff of COP07 RPM Plus will continue to render staff does not always CAMERWA to ensure that technical support to the Implemation appropriately grasp the appropriate analysis of drug Committee chaired by CAMERWA. importantance of maintaining and requests are being During the previous reporting period adhering to procedures and conducted in relation to RPM Plus provide TA and oversight to systems that are in place to good distribution practices CAMERWA for the development of the assist with better data *Continue to support first quarterly report for CPDS for 2007. management CAMERWA in its effort to This report was recently finalized and *The ability of the donors to come produce the quarterly disseminated by CAMERWA. The ART to an agreement on the level of reports on a timely basis; Tracking Tool was used for the contribution that they will each continue to encourage development and production of both need to make to ensure that the CAMERWA to ensure that reports; CAMERWA is in the process of lab commodities are procurred on appropriate data or completing and finalizing the production time appropriately available for of the Q2 report for the CPDS. Under entering into the ITT to COP07 RPM Plus will continue to render allow for proper utilization technical support and assistance to and exploitation of data

Thursday, December 20, 2007 3:55 PM Page 233 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Rwanda COP Year 06 Activity Title To upgrade skills and knowledge of the members of the technical committees of the CPDS.

ensure the maintenance of the systems from the tool that are currently in place. *For the CPDS Coordinator With technical support to the to follow up with the NRL Quantification Committee (QC) of the and lab commodities donors CPDS, RPM Plus assisted with the to ascertain their concerns quantification of both OIs and labs. and bring the matter to a Procurement for 6 months was already final conclusion resulting in completed for the OIs at the completion the timely procurement of of the quantification process. While the lab commodities quantification of the labs was already completed through the QC, the procurement was not yet completed as there is still remains ongoing discussions with the various donors with respect to the level of contribution that is required by each of them. The CPDS Coordinator with technical support from RPM Plus will follow up this matter to ensure that the process is moved forward. RPM Plus will continue to render technical support to the process under COP07. Last Updated: 10/08/2007

Thursday, December 20, 2007 3:55 PM Page 234 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Rwanda COP Year 06 Activity Title To establish an effective communication system between CAMERWA and the district pharmacies.

Activity Manager Ntumba, Georges Activity # 4 Task: A1RW06HIP Sub-Task: 60CXH4 Activity Description During COP06 RPM Plus will assist CAMERWA and the Districts in the creation of the adequate procedures and tools that will ensure an effective exchange of data and information between CAMERWA and the Districts for monitoring and planning at both national and peripheral levels. The system will ensure that data on drug distribution, stock on hand at the districts and CAMERWA, as well as national pipelines of vital drugs will be routinely gathered, processed, analyzed and reported. This communication and reporting system will be a necessary step for other strategic activities such as the implementation of an active distribution system (activity 5) and the progressive integration of the vertical programs into the same pharmaceutical management system. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products

Thursday, December 20, 2007 3:55 PM Page 235 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Rwanda COP Year 06 Activity Title To establish an effective communication system between CAMERWA and the district pharmacies.

Project An effective communication system none at this time RPM Plus will continue to Year 7 Q4 between CAMERWA and 8 selected render technical support to district pharmacies for exchange of the process to ensure that information and ensuring the once CAMERWA is ready performance of the supply chain for Active Distribution that between the central level and the the districts will have districts was developed during the month already implemented the of May 2007 by a team comprised of reporting tools and RPM Plus, CAMERWA, and PTF. A communication system reporting system to link the central level, based upon the testing of districts, and health facilities was the tools at the 8 districts developed and technically reviewed by where seconded district representatives of PTF, CAMERWA, pharmacists are located. and RPM Plus on the 22nd of June. Revisions to the reporting system (tools and instructions) were made following the technical review meeting. In July 07 PTF agreed to allow for the testing of the reporting to be done in 8 districts where seconded district pharmacists are located. In addition in August 07 RPM Plus assisted with the facilitation on training of district pharmacy managers on the utilization of the tools developed and/or revised by team comprised of RPM Plus, CAMERWA, and PTF. As CAMERWA continues the process of finalizing its strategic plan for the implementation of active distribution, the goal is to have the reporting system tested and ready at the appointed time when CAMERWA effectively implements active distribution. RPM Plus under COP07 will continue to render any needed technical assistance required for the implementation of the reporting tools and communication system in general. Last Updated: 10/06/2007

Thursday, December 20, 2007 3:55 PM Page 236 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Rwanda COP Year 06 Activity Title To provide technical assistance and equipment to CAMERWA for the development and implementation of an active distribution

Activity Manager Ntumba, Georges Activity # 5 Task: A1RW06HIP Sub-Task: 60C4H5 Activity Description RPM Plus will assist CAMERWA to develop an strategic plan for the transition into an active distribution from an ad hoc delivery system where orders were processed as received without any schedule or plan. Some of the activities that RPM Plus will support in collaboration with SCMS will be to supervise the adequacy of the physical spaces and equipment for storage, preparing and packing orders, to update the internal management procedures and tools according to the new functions and staffing, to develop and implement the strategy for rolling out the active distribution from a defined list of products and districts to the whole country, and to develop a monitoring and evaluation system. RPM Plus will also assist the district pharmacies to ensure their readiness for acting as focal point between the facilities and CAMERWA (See also activity 8) Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products

Thursday, December 20, 2007 3:55 PM Page 237 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Rwanda COP Year 06 Activity Title To provide technical assistance and equipment to CAMERWA for the development and implementation of an active distribution

Project RPM Plus attempted to collaborate with *SCMS is working closely with *RPM Plus will continue to Year 7 Q4 CAMERWA to further develop a CAMERWA; however lack of reach out to CAMERWA in comprehensive strategic plan for active frequent technical meetings to an effort to render sound distribution. To this end, RPM Plus allow for open understanding technical advice, drafted and provided to CAMERWA a where the process is, what is recommendation, and comprehensive outline of the strategic needed at this point in time, and assistance in relation to and operational plan. RPM Plus and to determine how partners such Active Distribution. SCMS have worked very closely to as RPM Plus may be of *Under COP07 RPM Plus identify the appropriate assistance assistance in the process. will render any needed required by CAMERWA to develop the *CAMERWA's internal appropriate support on this plan, as well as implementation of the restructuring process activity if requested by active distribution. It was determined by *Unfortunately several of the CAMERWA and SCMS CAMERWA that SCMS would take the needed equipment are not readily *RPM Plus will make lead in rendering technical support to available in Rwanda; a tendering purchase once the CAMERWA with the development of process is required to ensure that tendering process is plans and procedures for active the equipments can be concluded. distribution. Unfortunately, several purchased at the lowest price and months later CAMERWA remains with the highest quality without a comprehensive strategic plan for active distriction and is in fact considerably late with starting active distribution in Rwanda. RPM Plus has made its staff available to participate in all meetings related to active distribution; however, the meetings on the subject have not been called in months by CAMERWA or SCMS. RPM Plus has provided several agreed upon equipments to support CAMERWA's readiness for Active Distribution, as well as is currently in the process of procuring a few additional equipments. Under COP07 RPM Plus will complete the procurement of equipments, as well as continue to make staff available to participate in any discussion on Active Distribution. This activity was behind schedule because of different changes in the activity scheduling by CAMERWA. MSH/RPM Plus consultant was on duty in CAMERWA, but was unable to start the process of developing the QA plan before the end of the restructuring

Thursday, December 20, 2007 3:55 PM Page 238 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Rwanda COP Year 06 Activity Title To provide technical assistance and equipment to CAMERWA for the development and implementation of an active distribution

process. In addition, once SCMS arrived in Rwanda it was determined by CAMERWA that this particular activity would be carried out by SCMS in the context of assisting CAMERWA with making itself ready for Active Distribution. This matter is still pending as CAMERWA has not yet completed its restructuring process. This activity was abandoned as it will be carried out in the future by SCMS. RPM Plus will still make itself available to assist any way necessary (if needed) under COP07. Additional equipments to be purchased are currently going through a tendering process; purchasing of equipments will be finalized during the 1st quarter of COP07. Last Updated: 10/06/2007

Thursday, December 20, 2007 3:55 PM Page 239 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Rwanda COP Year 06 Activity Title To support CAMERWA in the interventions recommended in the Human Capacity Development Assessment conducted in COP05 for

Activity Manager Ntumba, Georges Activity # 6 Task: A1RW06HIP Sub-Task: 60CXM6 Activity Description During COP06 RPM Plus will assist CAMERWA in the implementation of some of the recommendations of the plan, including the training of a core group of staff in Leadership and eventually other strategic training according to the plan developed. It is also expected that the facilitators of the assessment will conduct a follow-up visit in order to evaluate and review the implementation of the plan in view of the expansion and changes of the organization. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project MSH/RPM Plus has sponsored the None noted RPM Plus will continue to Year 7 Q4 enrollment of senior managers of follow up on the attendance CAMERWA in a Management and and progress of the staff of Leadership course with CRESTCOM - CAMERWA relative to their Rwanda. CAMERWA's senior completion of the course managers including the head of CAMERWA are in various stages of completion of the one year training. Several individuals have already completed the training. It is anticipated that all individuals would have completed the training by the end of the 1st quarter of COP07. Last Updated: 10/06/2007

Thursday, December 20, 2007 3:55 PM Page 240 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Rwanda COP Year 06 Activity Title To recruit eight district pharmacists to be seconded to the MOH in support to the decentralization policy

Activity Manager Ntumba, Georges Activity # 7 Task: A1RW06HIP Sub-Task: 60A2H7 Activity Description Under the terms of an MOU between the MOH and RPM Plus, RPM Plus will recruit eight district pharmacists who will be assigned to eight districts selected by the MOH. RPM Plus will provide an introductory training of one month to all pharmacist and will provide technical guidance for the planning and implementation of the activities in the district. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project All the 8 districts pharmacists seconded Lack of willingness on the parts Joint field visits by Year 7 Q4 to MOH by MSH are on duty in their of district authorities to PTF/RPM Plus to each assigned districts. The official launching appropriately integrate the district district where district of the district pharmacies and pharmacists into existing district pharmacists are assigned pharmacists occurred in Ruhango administrations and appropriately as already begun and will District on the 30th of January 07. The support the work of the continue to ensure that event was attended by the Minister of pharmacists; inability of PTF to each district pharmacist is Health, representatives of USAID, and effectively grasp the importance appropriately integrated into other local and international partners. and need to support the their respective assigned Ongoing support to the district integration of the pharmacists districts. pharmacies and pharmacists is provided into their assigned districts by MSH/RPM Plus and PTF. Under COP07 RPM Plus will continue to provide technical supervision, assistance, and support to all 8 district pharmacists. Last Updated: 10/08/2007

Thursday, December 20, 2007 3:55 PM Page 241 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Rwanda COP Year 06 Activity Title To improve the skills and capacity of the pharmacy staff at the districts and facility sites in quantification, procurement, distribution,

Activity Manager Hitayezu, Felix Activity # 8 Task: A1RW06HIP Sub-Task: 60CXM8 Activity Description For COP06 RPM Plus aims that the pharmacy staff of all existing and new ART sites receive adequate training in store management, good dispensing practices and rational drug use. In addition, RPM Plus also aims to collaboratively work with the MOH in order to build the capacity of the district pharmacies to perform their tasks as pharmacy administrators, supervisors and trainers according to the new roles and responsibilities of the district pharmacies. Since most probably not all the district pharmacies will have the same capacity in terms of human resources and infrastructure RPM Plus will adapt the training curriculums according to priorities and needs. RPM Plus will continue providing direct training to pharmacy staff of facilities when the district pharmacies are not yet ready to assume that function, with especial attention to those facilities that start to implement ART services. Finally, RPM Plus will assess the possibility of implementing the approach Monitoring-Training-Planning (MTP) in the districts that have adequate human resources. This approach that has been already tested and used by RPM Plus in other countries aims to empower the staff of the facilities to resolve their own routine problems through the delimitation and analysis of problems and the monitoring and planning of actions to be taken in a timeframe. Training might be a component of this approach when lack of training is perceived as a problem needing intervention.

Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products

Thursday, December 20, 2007 3:55 PM Page 242 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Rwanda COP Year 06 Activity Title To improve the skills and capacity of the pharmacy staff at the districts and facility sites in quantification, procurement, distribution,

Project The SOPs for facilities and district *High turnover of health facility *Implementation of the use Year 7 Q4 pharmacies are still under technical staff, which requires on going of the tools and instructions; revision,the final product will be ready by training at the health facility level. dissemination of the the end of 1st quarter of COP07. *High turnover of FOSA staff and supervision report by TRAC; frequent inoperation of computers and finalization of SOPs for MSH/RPM Plus has actively organized often leads to lack of use of the health facilities and district and conducted training of district and DT and continued use of other pharmacies. There is FOSA pharmacy staff during joint field tools as well ongoing need for training visits conducted with PTF in several *High turnover of staff at the around the proper utilization districts during the course of COP06 district and health facility levels. of tools in the field. The utilizing the SOPs, reporting tools, *Delays in identification of new aforementioned issue will problem solving oriented supervision, ART sites, as well as be addressed during routine and pharmaceutical MIS (including the identification of staff of existing joint field visits that are use of dispensing tool). Under COP07 ART sites that are in need of being done in by RPM Plus RPM Plus staff with PTF staff will refresher training or training due in collaboration with PTF. continue conduct on going joint field to the loss of the previously *To conduct the same filed visits (training and supervsion) in all trained staff visits in collaboration with districts throughout Rwanda. The PTF under COP07; Inventory Tracking Tool (ITT) is currently continue to reach out to installed and working in 8 districts where supporting programs to where district pharmacists were hired seek assistance in providing seconded to the MOH by RPM Plus. computers for FOSA to The district pharmacists were trained on ensure the continuous use the application and use of the tool. In of the DT; continue to addition, the Dispensing Tool (DT) has provide TA and support to been installed in a tool of 27 FOSAs FOSA re training to ensure throughout Rwanda. RPM Plus continuous utilization of the continues to provide technical DT adn other tools assistance and support to the sites were *To continue to work with the tools are installed. PTF under COP07 to provide on going trainings and supervision to all pharmacies at both district During ongoing joint field visits during and health facility levels. the second, third, and fourth quarters of *Work with TRAC and the COP06 individuals from district and supporting program to have FOSA pharmacies were trained on early identification of new various aspects of pharmaceutical ART sites to allow for timely management utilizing the new approach planning for training of the of problem solving oriented supervision staff which included quantification. The eight district pharmacists hired and seconded to the MOH by RPM Plus received TOT

Thursday, December 20, 2007 3:55 PM Page 243 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Rwanda COP Year 06 Activity Title To improve the skills and capacity of the pharmacy staff at the districts and facility sites in quantification, procurement, distribution,

during the period 2nd to 6th of July 07 to render them capable of providing appropriate and effective TA and support to FOSAs in their respective districts. A total of 337 individuals were trained in all aspects of pharmaceutical management during COP06!

During the reporting period a total of four provincial trainings were conducted by RPM Plus in collaboration with PTF. The trainings occurred from the 17th to 28th of September 07. The trainings covered all aspects of basic pharmaceutical management. Participants included staff from all new ART sites, as well as new staff of existing ART sites. A total of 169 individuals were trained during the four provincial training. This figure is in addition to the on going joint field trainings that are conducted by RPM Plus in collaboration with PTF throughout the year. RPM Plus under COP07 will continue in collaboration with PTF to provide training to staff of existing and newly established ART sites. Last Updated: 10/08/2007

Thursday, December 20, 2007 3:55 PM Page 244 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Rwanda COP Year 06 Activity Title In collaboration with the districts, to upgrade 15 new pharmacies (district pharmacies and ART sites) to standard minimal

Activity Manager Ntumba, Georges Activity # 9 Task: A1RW06HIP Sub-Task: 60CXH9 Activity Description During COP06 RPM plus will continue the upgrade of other district pharmacies and pharmacies at facility site, up to maximum of 15 pharmacies. The activities involved include to assess the adequacy of the pharmacy spaces and equipment in regard to the functions of the pharmacy and the flow of the drugs in the facility, to develop the terms of reference of the renovations required with the assistance of an independent consultant, to open the bid for competition of constructors within the district as required by local regulations, to evaluate the tenders and make the contract with the winner, and to monitor the renovation according to plans. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project While it was the plan of RPM Plus to Agreement with PTF/MOH on the In collaboration with PTF Year 7 Q4 upgrade an additional 15 pharmacies number of pharmacies to be contact each district to under COP06 it was difficult to agree rehabilitated and the districts begin the process of upon a final list with the MOH/PTF. where the pharmacies to be planning for the During the final quarter of COP06 RPM rehabilitated are located. rehabilitations Plus was finally able to gain the approval of the PTF/MOH on the number of additional district pharmacies to be rehabilitated and the districts. It was decided that under COP07 a total of 10 district pharmacies will be rehabilitated and equipped by RPM Plus. Last Updated: 10/06/2007

Thursday, December 20, 2007 3:55 PM Page 245 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Southern Sudan Year 06 Activity Title Support MOH to establish/strengthen public sector ITN provision within the context of IVM

Activity Manager Azairwe, Robert Activity # 2 Task: A1SD06MAL Sub-Task: 60F4H2 Activity Description RPM Plus will support MOH/NMCP to develop a proposal to seek additional funding to support public sector provision of ITNs/LLINs. Based on the proposal, MOH/NMCP will be supported to organize a partner’s meeting to mobilize resources for public sector ITN provision. RPM Plus will also support NMCP/MOH to better track ITN distributions by different partners. In addition, RPM Plus will provide technical input to WHO and NMCP to support the ongoing process of developing a national Integrated Vector Management (IVM) strategy. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project MOH/NMCP was supported to review None Continue to support MOH to Year 7 Q4 the PSI-led strategy for distribution of design ITNs distribution 1.0 million LLINs that are being procured systems under the MDTF/MOH Program. Last Updated: 10/09/2007

Thursday, December 20, 2007 3:55 PM Page 246 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Southern Sudan Year 06 Activity Title Support MOH to build capacity of health workers to provide appropriate malaria treatment

Activity Manager Azairwe, Robert Activity # 3 Task: A1SD05MAC Sub-Task: 60E3H3 Activity Description RPM Plus will support the MOH/NMCP to embark on the process of training health workers nationwide. In terms of funding, the support will focus on the two states of Central and Eastern Equatoria, which were the first to have a training of trainers TOT course. Because of the long period since the TOTs, a one day meeting will be held in each State to re- orient and update the trainers and prepare for training of the health workers. A facilitator will be hired to coordinate and document the initial training courses in the 2 States. The skills of the trained health workers will be reinforced through regular support supervision visits Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project RPM Plus facilitated the sensitization of Lack of enough staff to continue to support training Year 7 Q4 30 health workers in Eastern Equatoria coordinate multiple trainings of other health workers state on the new malaria treatment policy. In the same state, 20 health workers including doctors, clinical officers and senior nurses were trained in the management of both uncomplicated and severe malaria. This high cadre of trained staff will help to coordinate training of other health workers. An additional 20 health workers in were also trained in the management and prevention of malaria in Central Equatoria State Last Updated: 10/09/2007

Thursday, December 20, 2007 3:55 PM Page 247 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Southern Sudan Year 06 Activity Title Support MOH to strengthen Pharmaceutical Management Systems for antimalarial medicines

Activity Manager Azairwe, Robert Activity # 4 Task: A1SD06MAL Sub-Task: 60F4H5 Activity Description RPM Plus will work with the NMS and Medical Supplies Departments for Central and Eastern Equatoria States (and other partners) to develop a plan of action to improve availability distribution, use and reporting of ACTs at public and private treatment outlets. The activity will include quantification of drug requirements at different levels and establishing inventory management systems. In addition two training workshops will be organized to orient personal at private drug outlets on key issues regarding the new national malaria treatment policy.

To manage this new area of work, an additional Pharmacist will be hired to offer direct support to NMS and the State Medical Supply Departments. In addition, the medical stores will be facilitated trough procurement of two trucks for drug distribution. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products

Thursday, December 20, 2007 3:55 PM Page 248 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Southern Sudan Year 06 Activity Title Support MOH to strengthen Pharmaceutical Management Systems for antimalarial medicines

Project RPM Plus supported the Directorate of None Continue to support Year 7 Q4 Pharmaceutical Services (DPS) to development of appropriate restructure its organogram, describe its policies and strategies key functions, and outline TOR for the Director General of Pharmaceutical Services. In addition, support was provided to summarize the Pharmacy Policy for presentation to the Parliament by the Minister of Health. Support was provided to the DPS to draft a three-year Pharmaceutical Master Plan (2007-2010 Short/Mid-term Work Plan). The master plan was presented to Cabinet by the Minister for Health. The DPS was also supported to organize a capacity building workshop on HIV and AIDS care, prevention and treatment. The three day workshop conducted by Howard University Continuing Education (HUCE) through USAID-funding for the ROADS Project, was attended by 40 participants mainly pharmacists from all the 10 states. RPM Plus facilitated discussions and made 3 technical presentations on managing medicines supply and training the adult learner. Two of these presentations were adaptations of MSH materials Last Updated: 10/09/2007

Thursday, December 20, 2007 3:55 PM Page 249 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Southern Sudan Year 06 Activity Title Provide technical assistance in developing malaria M&E systems including surveillance for malaria epidemics

Activity Manager Azairwe, Robert Activity # 6 Task: A1SD06MAL Sub-Task: 60GXH6 Activity Description RPM Plus will support NMCP to carry out support supervision visits to all the states on a bi-annual basis. Central and Eastern Equatoria States will be supported to operationalize the full support supervision cascade.Eastern Equatoria, a focus State for FY07 has some malaria epidemic prone areas on its South Eastern border with Kenya. Support will be provided to establish epidemic thresholds and chart “normal channels” for at least two health facilities in the epidemic prone areas. The facilities will serve as sentinel sites for malaria surveillance to facilitate early detection of any malaria epidemics. In addition, the State will be supported to develop appropriate malaria epidemic preparedness and response plans. A Consultant will be hired to support setting up of the malaria epidemic surveillance system Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project MOH/NMCP was facilitated to undertake Developing an overall health Continue to refine the Year 7 Q4 support supervision visits to Unity and sector M&E plan can take a long malaria M&E plan within the Upper Nile States time overall sector M&E plan Last Updated: 10/09/2007

Thursday, December 20, 2007 3:55 PM Page 250 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Sudan MAC Year 05 Activity Title Support NMCP to finalize and disseminate the National Malaria Control Strategic Plan (NMSP)

Activity Manager Azairwe, Robert Activity # 2 Task: A1SD05MAC Sub-Task: 60AXH2 Activity Description This activity will include following up the finalization, submission and endorsement of the plan, printing the final plan, launching and orienting of State and County Health Officials on the strategic plan Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project Support was provided to the MOH to Endorserment by the parliament Year 7 Q4 review the “Laws of Southern Sudan takes long time Malaria control and Treatment Bill, 2007” which was drawn from the malaria strategic plan Last Updated: 10/09/2007

Thursday, December 20, 2007 3:55 PM Page 251 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Sudan MAC Year 05 Activity Title Support NMCP to develop key malaria technical guidelines and training manuals

Activity Manager Azairwe, Robert Activity # 3 Task: A1SD05MAC Sub-Task: 60F4F3 Activity Description RPM Plus will support the NMCP and partners to put in place the key technical guidelines necessary for successful implementation of the new RBM strategic plan. This will include support to printing of the malaria case management guidelines, harmonizing ITN distribution guidelines, printing and orienting partners on the ITN guidelines, support to NMCP and partners to develop SOW for, and undertake the IRS feasibility study and development of the IVM guidelines. Support will also be provided in developing a national communication strategy for effective promotion of malaria control activities. This will include hiring consultants to work with the national resource persons. In addition to technical support, RPM Plus will co-fund the above activities in case funding already earmarked by other partners is not available or is not sufficient Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project Supportedthe MOH to proof-read the Long endorsement process Finalization of IVM strategic Year 7 Q4 first print out of the “Guidelines for plan; development of a Management of Malaria in Southern communication strategy Sudan.The final document will be printed by a partner.In collaboration with key partners, a guideline for distributing ITNs through the public sector was developed. The guideline will be utilized in the planned distribution of over 1 million ITNs in the next quarter Last Updated: 10/09/2007

Thursday, December 20, 2007 3:55 PM Page 252 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Sudan MAC Year 05 Activity Title Support MOH to strengthen the capacity of NMCP (human, equipment and infrastructure)

Activity Manager Azairwe, Robert Activity # 4 Task: A1SD05MAC Sub-Task: 60F4X4 Activity Description RPM will support MOH to; develop a concept/proposal of the long term structure and functioning of NMCP; recruit national technical officers, acquire office space and basic equipment for NMCP.

NMCP will also be supported to establish a team of malaria trainers and supervisors, hold quarterly technical seminars, participate in technical meetings and undertake selected study tours. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project An office manager was recruited and None None Year 7 Q4 orinted. she will help to ensure smooth running of the National Malaria Control Program (NMCP) and safeguard RPM Plus assets. Also,RPM Plus supported MOH/NMCP and other programs within the Directorate of Preventive Medicine in the development of 2007/8 health sector plans Last Updated: 10/09/2007

Thursday, December 20, 2007 3:55 PM Page 253 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Sudan MAC Year 05 Activity Title Support MOH and NMCP to strengthen coordination of RBM partners

Activity Manager Azairwe, Robert Activity # 5 Task: A1SD05MAC Sub-Task: 60F4N5 Activity Description Under this activity, technical support will be provided to NMCP to map ongoing RBM projects indicating the partners, staffing levels, interventions provided and level of coverage, amount and source of funding, present and planned activities, etc for each project. An appropriate tool will be designed to collect the required information.

NMCP will also be supported to update the SOW and develop an activity plan for the malaria Technical Working Group, call for and hold monthly meetings for the group. In addition, NMCP will be supported to hold biannual meetings with the state malaria coordinators as a forum for providing technical updates and reviewing progress of planned activities.

To enhance awareness on status of malaria control activities among partners and stakeholders, NMCP will be supported to publish a malaria newsletter, initially on an annual basis. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project RPM Plus supported MOH and the None Continue to support NMCP Year 7 Q4 malaria Technical Working group (TWG) to hold regular TWG to finalize and submit a malaria proposal meetings in response to round 7 GFATM call for grant applications. Subsequently, the CCM Southern Sudan was facilitated to respond to clarifications from GFATM and evaluate the proposal development process. Additionally, in this quarter, RPM Plus made a presentation on “Home Management of Malaria (HMM) - key considerations in implementation” to the malaria TWG meeting. Subsequently, RPM supported MOH to develop Terms of Reference (TORs) for a Task Force to design the HMM strategy. The TORs were discussed and agreed upon within the malaria TWG Last Updated: 10/09/2007

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Workplan: Senegal (PMI) Year 07 Activity Title Technical activity coordination and monitoring

Activity Manager Ndoye, Thidiane Activity # 1 Task: A1SN07PMI Sub-Task: 97XXY1 Activity Description RPM Plus will implement RPM Plus/PMI activities in Senegal through its staff based in Dakar with support provided by RPM Plus headquarters from Arlington, Virginia, USA. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project Participated in the planning meeting for Year 7 Q4 MOP year 2 of PMI.Also participated in NMCP organized quarterly review meeting. Participants included district health officials, regional medical team, PNLP, PNA and partners. Presentations and discussions focused on malaria treatment, IPT, ITN distribution and ACT management. An official report of the meeting addressing issues related to ACTs that are about to expire, RDT training, ADR reporting and data collection and analysis in health facilities is being done. Last Updated: 10/11/2007

Thursday, December 20, 2007 3:55 PM Page 255 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Senegal (PMI) Year 07 Activity Title Support the PNLP and the PNA in developing and implementing supervision guide for health agents at the regional, district and

Activity Manager Ndoye, Thidiane Activity # 4 Task: A1SN07PMI Sub-Task: 60F4F2 Activity Description Sub-activities include:

Support the PNLP and the PNA in developing the national pharmaceutical management supervision guide and piloting the tools and approach in USAID supported regions.

Contribute to the national training of trainers’ session for nationwide scale up and support the dissemination of the pharmaceutical management supervision guide.

Monitor the use and appropriateness of the pharmaceutical management supervision guide and participate in implementation in selected locations for potential improvement of the approach and the tool. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products

Thursday, December 20, 2007 3:55 PM Page 256 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Senegal (PMI) Year 07 Activity Title Support the PNLP and the PNA in developing and implementing supervision guide for health agents at the regional, district and

Project Provided technical assistance to the Follow up with the PNA to Year 7 Q4 NMCP in conducting formative facilitate organisation of the supervision visits in Thies region. RPM two days workshop to Plus oversaw the pharmaceutical finalize the guide. management aspects in the districts Once finalized, the guide depots and health centers. Presented to will be tested in selected the National Management Information districts. System (NMIS) a draft of the formative Train supervisors. supervision guide on pharmaceutical management. The supervision guide was also shared with the MOH and other NGOs. The PNA assigned its technical person to organize a two days workshop to finalize the document. The PNA is advocated to lead and coordinate future supervisions. With the available tools, the PNA can plan a countrywide supervision and solicit other partners to participate. The NMCP hired external providers (18 providers and 3 supervisors) in order to strengthen supervision in the private sector and at the district level. RPM Plus provided support in developing Terms of Reference (TORs), candidate selection and in recruitment process. Participated in the antimalarial quality surveillance coordination committee meeting of the ministry of health. The meeting was held in response to reports regarding of stock levels Adolescents ACT/12 in many PRA and at the central medical store Last Updated: 10/11/2007

Thursday, December 20, 2007 3:55 PM Page 257 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Tanzania (PMI) Year 06 Activity Title Technical Activity Coordination and Monitoring

Activity Manager Rutta, Edmund Activity # 1 Task: A1TZ06PMI Sub-Task: 97XXXY1 Activity Description This activity includes technical activity coordination, workplan development, budget monitoring, progress monitoring, reporting, meetings, and communications with partners and collaborators.

Implementation of the listed workplan activities will be through the MSH/RPM Plus office in Tanzania. RPM Plus is hiring a Senior Program Associate in Tanzania who will work closely and coordinate with the President’s Malaria Initiative team, NMCP, TFDA, and other partners at the national level, and stakeholders at the district level including councils, district medical officers, ward and village executive officers in Ruvuma and Morogoro regions. RPM Plus will coordinate activities with Ifakara Health Research and Development Center (IHRDC). The RPM Plus Tanzania team will be supported by the regional technical malaria team based in Nairobi, and the RPM Plus malaria team based in Arlington, Virginia. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project RPM Plus participated in the NMCP-PMI None Year 7 Q4 partners meeting and presented the status of implementation of the planned activities and shared the next steps. RPM Plus also presented its experience and lessons learned in distributing ACTs through the private sector (ADDO) to the workshop for the development of a strategic plan to improve access of ACTs to the private sector in Uganda. In supporting the NMCP in ACT policy implementation, RPM Plus coordinated and participated in the ACT Management Working Group Meeting where various issues on ACT procurement, storage, distribution, use, QA and management information systems were discussed and way forward agreed by key stakeholders. Last Updated: 10/09/2007

Thursday, December 20, 2007 3:55 PM Page 258 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Tanzania (PMI) Year 06 Activity Title Private sector distribution of subsidized ACT through the Accredited Drug Dispensing Outlet (ADDO) program

Activity Manager Rutta, Edmund Activity # 2 Task: A1TZ06PMI Sub-Task: 60C4H2 Activity Description It is planned that under current USAID Tanzania funding for PMI activities, $ 300,000 worth of ACT treatment (Artemether-Lumefantrine) will be procured from Novartis for ADDOs. RPM Plus will support the implementation of this strategy through the following sub-activities:

Sub-activities planned:

2.1. Quantification of ACT consumption and morbidity data in Ruvuma and Morogoro regions to be used in quantification of ACTs for ADDOs. Share the estimated quantities with PMI team and Private whole seller for procurement purpose.

2.2. Assist MOHSW/NMCP, donors and other stakeholders to develop a model/mechanism for determining pricing for ACTs as a basis for pricing policy decisions within the private sector.

2.3. Develop distribution plan and map out all distributors for ACTs for ADDO. Conduct meetings with selected ACTs distributors for Ruvuma and Morogoro region to discuss the, distribution, storage, record keeping, pricing and incentives.

2.4. Develop and implement commodity tracking for ACTs consumption within the overall ADDO monitoring system. In particular, monitoring for leakage and discouraging the sale of subsidized products intended for rural ADDOs at urban pharmacies or through other illegal channels.

2.4. Strengthen the ADDOs’ capacities to implement the new malaria policy related to artemether-lumefantrine storage, inventory control, and reporting [trainings and orientation of owners, dispensers and inspectors on the new ACT policy].

2.5. Strengthen the ADDO supportive supervision and monitoring system to track artemether-lumefantrine distribution, quality, distributor’s performance and rational use in collaboration with NMCP, TFDA, and district authorities.

2.6. Implement NMCP communication strategy to promote the access of Artemether-lumefantrine through ADDOs in Ruvuma and Morogoro regions Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products

Thursday, December 20, 2007 3:55 PM Page 259 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Tanzania (PMI) Year 06 Activity Title Private sector distribution of subsidized ACT through the Accredited Drug Dispensing Outlet (ADDO) program

Project In this quarter, labeling ACT packages None Support the preparation for Year 7 Q4 (113,280 treatment doses) with ADDO launching ACTs in ADDO. stickers was completed and 48,960 treatment doses have been sent to Continue to collaborate with Songea and Morogoro regions for JSI/DELIVER to plan for the distributing to ADDOs. Aslo, next procurement. management tools for tracking ACT consumption and distribution, SOPs for Continue to follow up with ACTs distribution and price indicator distributors and district drug guides for distributors and ADDOs were technical committee on developed and distributed. Together with ACT distribution in ADDO these tools, ACTs treatment charts adapted from the National Guidelines for Support implementation of Malaria Diagnosis and Treatment communication strategy to (NMCP 2006) were also distributed. promote ACT access Re worked the overall ADDO supportive through ADDO. supervision checklist to incorporating information related to tracking ACT distribution and use. The guide was used in September during supportive supervision visits in Songea and Morogoro. RPM Plus in collaboration with TDFA and NMCP supported the CHMTs to conduct the visits.Lastly, RPM Plus held joint meetings with JSI/DELIVER to discuss procurement of the next ACT consignment from Novartis Last Updated: 10/09/2007

Thursday, December 20, 2007 3:55 PM Page 260 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Tanzania (PMI) Year 06 Activity Title Support to TFDA to undertake adverse drug reaction (ADR) monitoring and also to establish systems to detect unintentional exposure

Activity Manager Citysoft Admin Activity # 4 Task: A1TZ06PMI Sub-Task: 60EXH4 Activity Description The TFDA pharmacovigilance system will be used to monitor the safety profile of the drug. However; the big challenge with the existing ADR monitoring system is that only a few reports are being received from the zonal centers and health facilities. In order to revitalize the ADR monitoring system, RPM Plus will work with TFDA on the following: Conduct two days consultative PV meeting to share experiences and lessons learned from ADR monitoring of antimalarials in pregnant women in Ghana and Mozambique. Identify gaps in ADR monitoring system of ACTs in Tanzania.

4.2. Develop and discuss PV implementation plan with NMCP, TFDA and CDC/IHRDC.

4.3. Develop strategies to improve surveillance methods and ADR reporting structure at the district level where ADR reports are expected to be generated.

4.4. Develop guidelines and SOPs for distribution and collection of ADR reporting forms. Provide training at district level to raise ADR awareness as drug safety issue. Use of SOPs for distribution and collection ADR reporting system.

4.5. Monitoring and evaluation of pilots districts PV-intervention. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project Continued to support PV activities None Continue working with PV Year 7 Q4 through participating in PV working focal persons group meetings, providing support in planning supportive supervision and working with PV focal persons to reinforce ADR reporting in districts Last Updated: 10/09/2007

Thursday, December 20, 2007 3:55 PM Page 261 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Uganda (PMI) Year 07 Activity Title Provide financial and technical support to National Medical Stores (NMS) for storage and distribution of ACTs procured under the PMI

Activity Manager Kidde, Saul Activity # 2 Task: AIUG07PMI Sub-Task: 60CXH2 Activity Description RPM Plus will continue to pay handling fees on behalf of USAID, for the ACTs funded by PMI in the coming year, using funds advanced by USAID . In addition RPM Plus will continue to support the NMS in ensuring regular ordering of ACTs, to ensure their availability at the district level. Review of the problems facing the regularity of ordering has revealed that districts are not conversant with the NMS system of ordering and some do not have trained personnel to coordinate the soliciting and rationalization of orders to meet the facility needs. RPM Plus through the support to NMS and in collaboration with DELIVER and SCMS will carry out training for all district logistics officer to bring them to a level where they can effectively make timely orders. NMS will support the district logisticians through periodical support supervision visits for continuous improvement Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products

Thursday, December 20, 2007 3:55 PM Page 262 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: Uganda (PMI) Year 07 Activity Title Provide financial and technical support to National Medical Stores (NMS) for storage and distribution of ACTs procured under the PMI

Project • Identified trainees, adapted materials Developed SOPs for receiving Monitoring and evaluation Year 7 Q4 and conducted a 5 days TOT workshop and sales order processing have of training impact in the two on medicines management for the never been operationalized districts district stores persons and Health sub- because of lack of an individual district in-charges. Also, organized and to coordinate within NMS Training based on the MTP conducted a training workshop (using approach in 3 more MTP approach) on malaria medicines districts. management for 75 health workers from the districts of Moyo and Adjumani. RPM Plus trained 10 health workers in monitoring, problem solving and evaluation of pharmaceutical management for malaria medicines • Supported aggregation of district order for a special distribution of Coartem to those that had missed due to a stock out at NMS. • Operationalized the Job Aid that is aimed at supporting the NMS in assessing the rationality of Coartem orders and provided TA to staff coordinating orders with districts. As a result of this support, 75% of orders have been received at the NMS and NMS is enclosing supply discrepancy report forms with consignments being dispatched. • Verified stock position in NMS to ensure sufficiency for both health facility distribution and HBMF roll out Last Updated: 10/11/2007

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Workplan: Uganda (PMI) Year 07 Activity Title Support the coordination of a National Malaria Commodities and Medicines Supply Chain Committee

Activity Manager Kidde, Saul Activity # 3 Task: A1UG07PMI Sub-Task: 60C4H3 Activity Description This committee’s work will be augmented by RPM Plus’s Senior Program Associate who will spend substantial amounts of time with NMS to stream line the order acquisition and processing of malaria medicines orders from the health facilities. The committee will occasionally carry out field visits to facilities to ascertain the impact of its interventions but also to carry out support supervision for systems improvement at health facilities. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project During this quarter, RPM Plus facilitated Year 7 Q4 the redistribution of Coartem at risk of expiry within Pader and Kanungu districts. Similarly, 6,300 doses of yellow Coartem at the risk of expiry were sent to Mulago referral hospital. RPM Plus also facilitated the distribution of Coartem to Jinja district that had run out of stock and coordinated the distribution of Coartem to flood affected victims. RPM Plus provided TA for quantification of national first line anti-malaria medicines needs for 2007 -2010 in the GFATM round 4 phase two planning. Contacted district health officers to establish the stock position of Coartem within the districts, districts had at least 50% of health facilities with more than a month’s stock. RPM Plus participated in meetings and workshops including the monthly medicines supply chain committee meeting, a joint MSH/ RPM Plus-SCMS meeting to guide SCMS review the NMS supply chain, a 3 day best practices workshop for NMCPs in Nairobi Kenya and MOH task force meeting to plan for the MMV stakeholders workshop scheduled for October 2007 Last Updated: 10/11/2007

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Workplan: Uganda (PMI) Year 07 Activity Title Support NMS in restructuring its report generation system to enhance the efficiency of order processing and forecasting of malaria

Activity Manager Kidde, Saul Activity # 4 Task: A1UG07PMI Sub-Task: 60G4H4 Activity Description RPM Plus proposes to support NMS in implementing a database that will form a repository for all data currently stored in the various databases of the organization.This intervention will not only benefit Malaria medicine supply chain but also all essential medicines handled by NMS. RPM Plus is collaborating with the SCMS project for joint activities, these will include joint systems analysis, monitoring and evaluation of performance and support supervision to beneficially units to assess impact Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project Finalized draft monitoring and reporting None RPM Plus/SPS Uganda Year 7 Q4 plan (MRP) and submitted to staff to monitor monthly and USAID/Uganda for review and approval. quarterly activity progress Subsequently, the Uganda PMI and file supporting monitoring and reporting system to track documentation and reports results linked to specific activities and as required output indicators was established Last Updated: 10/11/2007

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Workplan: Uganda (PMI) Year 07 Activity Title Work with NMCP and Pharmacy Department to establish a Malaria Commodities Information Acquisition System

Activity Manager Kidde, Saul Activity # 5 Task: A1UG07PMI Sub-Task: 60CXJ5 Activity Description The MIAS will be used as a vehicle to provide accurate, reliable and timely information on use and availability of malaria medicines that can inform interventions at the district, national, regional and global levels.This system will be implemented in conjunction with the Health Management Information System (HMIS) to ensure that there is no duplication of information collection. The system will be pre-tested in two or more districts (the number and location of the districts will be decided by NMCP), and then scaled up to other districts depending on national data needs.District health record officers and pharmaceutical personnel will be trained in the collection, processing and use of the data to manage the medicines (ACTs) and prevent stock-outs Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project None This activity has been Investigate the possibility of Year 7 Q4 rescheduled to SPS FY07 work collaboration with SCMS plan that awaits mission approval and DELIVER for joint because the scope when implementation in selected discussed with MOH widened sites beyond what was planned. Last Updated: 10/11/2007

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Workplan: Uganda (PMI) Year 07 Activity Title Work with NMCP, NMS and NDA to implement the phasing out of CQ/SP as first line for malaria case management and other mono-

Activity Manager Kidde, Saul Activity # 6 Task: A1UG07PMI Sub-Task: 60E3H6 Activity Description This activity will involve taking stock of the current available monotherapies in circulation in the country and setting targets for implementation of the phase out plan. The phase out plan will involve 1. Stakeholders Dissemination workshop 2. Survey to determine the quantities of anti-malaria medicines at government and private sector facilities and raw materials in manufacturing plants. 3. Establishment of availability of ACTs in public and private sector health facilities country wide 4. Monitoring the importation and availability of ACTs 5. Publication of Malaria drug indicator Prices

Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project Support was provided to the National Quantification data is unreliable Disseminate findings of the Year 7 Q4 survey to establish availability of anti- survey and determine malaria medicines in Uganda through phase out timeline assisting in the planning process, training data collectors and writing the survey report. Work is ongoing to finalize guidelines for phase out of mono therapies Last Updated: 10/11/2007

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Workplan: Uganda (PMI) Year 07 Activity Title Support the improvement of access to ACTs in rural health communities using private sector distribution outlets (drug shops).

Activity Manager Kidde, Saul Activity # 7 Task: A1UG07PMI Sub-Task: 60C5H7 Activity Description RPM Plus is proposing to improve access to anti-malarial medicines including ACTs and monitor the services provided by the private sector drug outlets through strengthening government accreditation and regulation.The activity will be implemented in collaboration with other partners, in a phased manner starting with three selected districts.RPM Plus will train the service providers and prepare the outlets for accreditation Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project Provided TA to the NMCP in gathering None Engage a consultant to Year 7 Q4 information for developing a strategic write the strategic plan plan document for improving access to ACTs for the community through the Private sector. RPM plus organized a one day workshop for stakeholders to gather views on the approach to the development of the strategic plan. Following this workshop, a two days retreat was organized to guide the development of the Strategic plan. A preliminary report for the retreat has been disseminated, the strategic plan will be written by RPM Plus provided consultant.Plans for piloting ACTs in the private sector in selected districts by MMV are underway, RPM Plus is participating in the process Last Updated: 10/11/2007

Thursday, December 20, 2007 3:55 PM Page 268 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: South Africa PEP and RHAP Year 06 Activity Title Technical Activity Coordination

Activity Manager Sallet, Jean-Pierre Activity # 1 Task: A1ZA06HIP Sub-Task: 97XXY1 Activity Description This activity include technical activity coordination, workplan development and implementation monitoring, routine M&E activities, budget and progress monitoring, reporting, meetings, and communications with Emergency Plan partners and collaborators. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products

Thursday, December 20, 2007 3:55 PM Page 269 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: South Africa PEP and RHAP Year 06 Activity Title Technical Activity Coordination

Project During this reporting period staff Year 7 Q4 meetings were held on 27 July and 14- 15 September. The meeting held in September was used to do strategic planning for the project in South Africa, Swaziland and Lesotho in the light of the awarding of the SPS contract.

The submission for COP08 for South Africa was finalised.

One meetings of the ICC which took place on 26 September was attended. It was agreed at the meeting that one of the main themes of the next SCC meeting to be held later in the year would be infection control. RPM Plus was requested to do a presentation at the meeting on work done on the Infection Control Assessment Tool (ICAT).

Two new members of staff took up their positions and were orientated.

The RPM Plus Retreat and SPS Launch held in Arlington, USA from 6 – 15 August 2007 was attended by JP Sallet, B Pharasi, S Banoo and S Putter. Presentations were made on pharmacovigilance, M & E experiences, Rx Solution and RPM Plus activities in South Africa, Swaziland and Lesotho.

The Strategic Planning conference for Free State Pharmaceutical Services was attended on 28-29 September 2007. A coordinating mechanism for integrating the RPM Plus work plan for the Free State with the sub directorate’s business plan was developed to ensure that activities in the province are coordinated and planned properly.

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Workplan: South Africa PEP and RHAP Year 06 Activity Title Technical Activity Coordination

Last Updated: 10/15/2007

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Workplan: South Africa PEP and RHAP Year 06 Activity Title Support the Pharmacy and Therapeutic Committees (PTCs) and strengthen evidence-based principles for the selection of medicines

Activity Manager Sallet, Jean-Pierre Activity # 10 Task: A1ZA06HIP Sub-Task: 60BXH0 Activity Description RPM Plus will use FY06 funding to assist the Department of Health in promoting these new STGs through provincial workshops on rational drug use; strengthening provincial, district and institutional Drug and Therapeutic Committees (DTCs); train staff in basic principles of pharmacy-economics and the use of evidence-based principles for drug selection. Since 2004, more than 200 individuals have been trained; an additional 250 service providers will be reached during FY06. RPM Plus will also provided TA to different PTCs in areas such as formulary development and use, rational medicine use, medicine safety and pharmacovigilance and PTC oversight of clinical trials. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products

Thursday, December 20, 2007 3:55 PM Page 272 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: South Africa PEP and RHAP Year 06 Activity Title Support the Pharmacy and Therapeutic Committees (PTCs) and strengthen evidence-based principles for the selection of medicines

Project TA was provided to a meeting of the PTC training is planned to Year 7 Q4 Free State ProvincialPTC on 1August.A take place in the Free State report of an ABC Analysis for the from 15 – 17 October 2007. province was prepared and presented.Recommendations made were accepted.TA and support continued tobe provided inthe Northern Cape tothe provincial PTC and the PTC of the Kimberley Hospital Complex.PTC meetings continued totake place monthly andwere well attended.The ICAT National project plan ison track. During this quarter TA regarding the ICAT was provided ata national level aswellas atthe pilot sites at Kimberley, Kuruman and Rustenburg. An ICAT Review workshop was held inKimberley.Itwas attended by 20participants from pilot sites aswell asfrom two other provinces. New scale up plans were developed and the National Plan adjusted.ICAT was presented to the Gauteng Provincial Infection Control Committee. The tool waswell accepted.A poster relating to hand hygiene was finalised and a questionnaire relating tohand hygiene practices was prepared and field tested.The quarterly ICAT report was prepared and submitted to the Arlington office.TrainingMaterial was received from the South African Pharmacy Council regarding the submission for approval of the PTC course,the PTC training material was amended to address issues identified in the evaluation.The resubmission was finalised and sent tothe SAPC.Namibia Ministry of HealthPharmacovigilance(PV)training was conducted in Namibia 11- 12July.This training was organized by RPM Plus Namibia, asTOT for a core

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Workplan: South Africa PEP and RHAP Year 06 Activity Title Support the Pharmacy and Therapeutic Committees (PTCs) and strengthen evidence-based principles for the selection of medicines

group of individuals who are expected to serve as trainers in future PVtraining.Participants were drawn from directorates involved in activities likely to benefit from a strengthened PVsystem in the country aswellas from healthfacilities.Training covered all aspects of the implementation of a PV system and exposed participants toa wide rangeof topicsin pharmacovigilance.It provided a forum forthe exchangeof ideas onthe functioning ofthe Namibian Therapeutic Information andPharmacovigilance Centre and how the center’s activities canbe expanded to involve ADR monitoring and reporting.It's recommended that this initiative be supported so asto deliver the required results which will be critical in ensuring that PVis entrenched asa necessary service inthe country’s health system.In addition,itis important that the PV program develops partnerships with regional and international PV programs(e.g. SA)to build capacity andto share information.Afurther PV training course aimed at MOH staff is planned for November2007. Last Updated: 10/15/2007

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Workplan: South Africa PEP and RHAP Year 06 Activity Title Implement Medicine Information Center (MIC) and document best practices

Activity Manager Sallet, Jean-Pierre Activity # 11 Task: A1ZA06HIP Sub-Task: 60GXHA Activity Description During FY06, RPM Plus will enter into a Memorandum of Understanding for the establishment of this Center. Experience from the application of the model in the Eastern Cape will be documented and lessons learned will be incorporated into a model that can be further replicated in other regions of the country. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project A suitable candidate for the post at the Year 7 Q4 MIC at Rhodes University was identified and arrangements made for an interview to be held. Last Updated: 10/15/2007

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Workplan: South Africa PEP and RHAP Year 06 Activity Title Monitoring and Dissemination of results and lessons learned from the implementation of Emergency Plan pharmaceutical services

Activity Manager Sallet, Jean-Pierre Activity # 12 Task: A1ZA06HIP Sub-Task: 60F8DB Activity Description This activity also aims at documenting the different lessons learned from the implementation of the Emergency Plan interventions as applied in the pharmaceutical sector. It will document workable solutions and strategies. The program will identify success stories and ensure their documentation. The Program will work with the USG team and other partners to identify opportunities for the presentation and dissemination of lessons learned locally, regionally and internationally. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project Reporting Year 7 Q4 Figures for reporting for Q3 were finalised and loaded on the PEPFAR data warehouse. Work continued on the revision of the South African MERP. The SMS activity reports were prepared and submitted to the Washington office. A presentation on the use of the MERP in South Africa was made at the RPM Plus Retreat. The presentation has subsequently been provided to the PMI project for use in Uganda on explaining the development and use of a MERP as a management tool. Last Updated: 10/15/2007

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Workplan: South Africa PEP and RHAP Year 06 Activity Title Facilitate the compliance of the New Medicines and Pharmacy Act and the Comprehensive Plan accreditation requirements

Activity Manager Sallet, Jean-Pierre Activity # 2 Task: A1ZA06HIP Sub-Task: 60A5H2 Activity Description With FY06 funding, RPM Plus will continue to assist provinces and facilities in monitoring progress towards compliance with legislative requirements in terms of the delivery of pharmaceutical services hence facilitating the process leading to the accreditation of the health institutions to provide ART. This will address issues related to infrastructure, human resources, equipment and systems. The activity also includes the development of a monitoring system and the periodic review with provincial counterparts in the provinces. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products

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Workplan: South Africa PEP and RHAP Year 06 Activity Title Facilitate the compliance of the New Medicines and Pharmacy Act and the Comprehensive Plan accreditation requirements

Project Legislative compliance Finalise the report on the Year 7 Q4 A meeting was held on 2 July 2007 with compliance workshop the Acting Chief Director: Pharmaceutical Policy and Planning Ms Mandisa Hela to report on the National Compliance Workshop held with the provinces at the end of June, and to discuss the way forward following the workshop. Work commenced on the drafting of the report following the workshop.

The questionnaire for the auditing of the main pharmacy in an institution was amended and supplied to the Department of Correctional Services and to the Eastern Cape province. Re- auditing of facilities in the Eastern Cape for legislative compliance commenced during this period.

Three legislation workshops were held in the Northern Cape. One workshop was held in Upington on 18 July 2007with 18 participants and two workshops were held in Kimberley on 19 July with a total of 47 participants.

A presentation relating to the Role of Pharmacist’s Assistants was made at the first conference for pharmacist’s assistants organised by Metro District Health Services of the Western Cape.

Assistance with queries relating to the legislation

Assistance was provided on an ongoing basis with queries relating to the legislation impacting on the provision of pharmaceutical services. Last Updated: 10/15/2007

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Workplan: South Africa PEP and RHAP Year 06 Activity Title Strengthen pharmaceutical policy and provide TA to key national stakeholders

Activity Manager Sallet, Jean-Pierre Activity # 3 Task: A1ZA06HIP Sub-Task: 60AXH3 Activity Description In addition, RPM Plus will continue to provide support to relevant national committees and entities including the national Essential Drug List (EDL) committee, the Medicines Control Council and its subcommittees, as well as the Pricing Committee. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products

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Workplan: South Africa PEP and RHAP Year 06 Activity Title Strengthen pharmaceutical policy and provide TA to key national stakeholders

Project TheSPAs responsibleattended Year 7 Q4 therelevant meetings ofthe MedicinesControlCouncil,Clinical TrialsCommittee and MCCSchedulingCommittee5September. EssentialDrug ListCommittee andPricingCommitteeThe SPA responsible attended therelevant meetings ofthe EDL committee andthe PricingCommitteeoftheNationalDepartme ntofHealth.A meeting which took place on3August andwas convened jointly by the DepartmentofHealth and thePharmacy Council wasfacilitated. The objective ofthe meeting wasto discussthe developmentof midlevel workersin pharmacy, includingtheir scopeof practice withthe various stake holders.This isan ongoing project inwhich RPM Plus isproviding technical assistance.Assistance continued to be provided withthe drafting ofthe NationalHuman Resourcesplanforpharmacy.Researchand Development Task Team ofthe South African Pharmacy CouncilWork continued onthe research project underway todetermine theactivity times forthe procedures which maybe performed by pharmacists, todetermine the tariff of fees payableto apharmacist inrespect ofprofessional services andto determine staffing norms for all categories ofpharmaceutical personnel.Ameeting held on12September whichwas attended bythe HeadsofPharmaceuticalServices,the NationalDepartmentofHealth,membersoft he SAPC was facilitated by the SPA responsible forthis activity. Further assistance was provided in the drafting of the data collection instrument to be

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Workplan: South Africa PEP and RHAP Year 06 Activity Title Strengthen pharmaceutical policy and provide TA to key national stakeholders

used in Phase2 of the research, thefinal reportof Phase1 andthe research protocolfor Phase2 ofthe project.TheRPM Plus workplan was presented tothenewHeadof PharmaceuticalServicesinthe Northern Cape.An invitation was extendedto RPM Plusto attend the strategic planning session forthe provincein Upington on17&18October and makea presentation on the DrugSupplyManagementCycle.The Mpumalanga Pharmacists’AnnualConferencewas attended. Presentationswere made regarding pharmacist’s assistants and RxSolution.The annualconference of PharmaceuticalServices in theEasternCape was attended on28/29SeptemberPresentation wasmade on therole of pharmacist’s assistants.Discussions were held with Gauteng Health’s Pharmaceutical Services following arequest for RPM Plus tobecome involved ina teamof pharmacists thathasbeen tasked withpreparing Gauteng’spharmaceuticalservices for the 2010SoccerWorldCup.Alecture wasgiven tothirdyear graduate medicalstudents atthe UniversityofWitwatersrand. Last Updated: 10/15/2007

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Workplan: South Africa PEP and RHAP Year 06 Activity Title Strengthen the capacity of pharmacy personnel and training institutions in the area of HIV/AIDS pharmaceutical services in response

Activity Manager Sallet, Jean-Pierre Activity # 4 Task: A1ZA06HIP Sub-Task: 60CXH4 Activity Description With FY06 funding, further provincial workshops will be conducted for pharmacy personnel attached to ARV accredited sites and referral centers (e.g. community health centers) to improve patient care at dispensing counters. Pharmacists using computerized dispensing system will be trained to assess ARV prescribing practices, compliance with National Standard Treatment Guidelines (STGs) and reporting on treatment failure. Overall 1,000 individuals are targeted for training in the next twelve months. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products

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Workplan: South Africa PEP and RHAP Year 06 Activity Title Strengthen the capacity of pharmacy personnel and training institutions in the area of HIV/AIDS pharmaceutical services in response

Project During this quarter the following training Many participants were of the Revise the training material Year 7 Q4 in HIV/AIDS Pharmaceutical opinion that the HIV/AIDS course and approach as agreed in Management was conducted was too short and needed five the review workshop. Limpopo10–13July,Mpumalanga16–19 days to really get to grips with it. July,North West20–23August,Western There was also some criticism of Further HIV/AIDS training is Cape27–30 August,Western the training material. These planned for the Free State, Cape10–13September.Participants issues were addressed in the Western Cape and Kwazulu- trained were pharmacists, pharmacy review workshop. Natal. Pharmacovigilance interns, pharmacists doing community training is planned for service and pharmacist’s assistants Both attendance and participation Kwazulu Natal. employed at ART treatment sites as well at the Free State MTP follow up as in some cases managers.The MTP session was disappointing. Follow up for the Free State training took place on 23July. The MTP follow up for the Limpopo training took place on 7August. The provincial Head of Pharmaceutical Services attended the session.The HOPS made notes on the condition of some of the ARV pharmacies where inadequacies were highlighted by the facility questionnaire.The MTP followup for the Mpumalanga training was held on 23August.A workshop was held on 20–21September to review the HIV/AIDS Training Material and training approach. The objective of the workshop was to review the training and to introduce the training materials.Amendments were made to the training material after feedback had been received from the South African Pharmacy Council.Western Cape project for the provision of ARVs by pharmacist’s assistants at PHCclinics.Work continued on this project to supplement the nurse driven doctor supported model for the provision of ARVs at PHC clinics in the Western Cape by using pharmacist’s assistants to dispense ARVs. Work continued in accordance with the project plan developed. Progress was made on a

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Workplan: South Africa PEP and RHAP Year 06 Activity Title Strengthen the capacity of pharmacy personnel and training institutions in the area of HIV/AIDS pharmaceutical services in response

document detailing the legislative requirements, check lists and standard operating procedures for dispensing and counselling of patients by PAs and supervisory visits to the PHC clinics by pharmacists for monitoring purposes.Technical assistance was provided to Rustenburg Provincial Hospital in the North West. Assistance was provided for implementation of ARV dispensing and information management systems for new and down-referred ART patients, planning for training of ARV site personnel on dispensing, counselling, adherence and monitoring of patients on ART and implementation of a pharmacovigilance system for monitoring, identification, management and reporting of ART-related adverse events.A plenary lecture on HIV/AIDS Pharmacovigilance waspresented at the Adverse Drug Reaction and Lipodystrophy Workshop.The presentation focused on implementation of cohort event monitoring systems inHIV/AIDSprograms with particular reference to resource limited settings. Last Updated: 10/15/2007

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Workplan: South Africa PEP and RHAP Year 06 Activity Title Strengthen the capacity of pharmacy personnel and training institutions in the area of HIV/AIDS pharmaceutical services in response

Thursday, December 20, 2007 3:55 PM Page 285 of 297 RPM Plus Activity and Product Status Report Selection Criteria: Reporting Year = Project Year 7 AND Reporting Quarter = Q4

Workplan: South Africa PEP and RHAP Year 06 Activity Title Strengthen the capacity of pharmacy personnel and training institutions in the area of HIV/AIDS pharmaceutical services in response

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Workplan: South Africa PEP and RHAP Year 06 Activity Title Develop and test ARV adherence tools and facilitate the implementation of best practices

Activity Manager Steel, Gavin Activity # 5 Task: A1ZA06HIP Sub-Task: 60EXJ5 Activity Description During the current workplan, results from the pilot will be shared with the national level. “Best practices” will be piloted and implemented on a larger scale. Clinical staff (doctors, nurses and pharmacists) will be trained in providing: patient education on HIV/AIDS and ART; psychological and social screening of patients to assess readiness for treatment; and support services aimed at relieving barriers to adherence. Decision makers will be able to use the information for national health policy and planning. These efforts will also contribute to the overall strengthening of the health system as medication adherence monitoring and support measures are generic tools that may be applied to settings providing treatment for other chronic diseases. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products

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Workplan: South Africa PEP and RHAP Year 06 Activity Title Develop and test ARV adherence tools and facilitate the implementation of best practices

Project The adherence tool was presented at Year 7 Q4 the CCMT meeting held in May 2007 in Limpopo. It was agreed to roll the tool out in all 9 provinces. Some adjustments were made to the tool and the tool was provided to the provincial co-ordinators. Provincial coordinators were requested to meet with the provincial contact person in the ARV Directorate in each province. Designated initial roll out sites are to be identified in each province and a provincial training workshop held.

In the Free State and the Western Cape the adherence tool and manual were provided to the CCMT Provincial coordinator and ARV Manager In the Free State district coordinators met to discuss implementation in their districts.

In Gauteng meetings were held with the Gauteng CCMT Manager and HIV/AIDS Program Medical Director regarding implementation of the tool at selected sites in the province. Training will be provided to care teams (doctor, pharmacist, nurse and counsellor) from the selected sites. A 1-day training session is planned for 29 November 2007 and will be followed by TA at the sites to support implementation.

In the North West contact has been made with the CCMT Manager in the province. A follow-up meeting has been planned once CCMT Program coordinators in the regions have identified sites and personnel to be trained.

This matter is being followed up in the

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Workplan: South Africa PEP and RHAP Year 06 Activity Title Develop and test ARV adherence tools and facilitate the implementation of best practices

other provinces. Last Updated: 10/15/2007

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Workplan: South Africa PEP and RHAP Year 06 Activity Title Assess PMTCT pharmaceutical services

Activity Manager Sallet, Jean-Pierre Activity # 6 Task: A1ZA06HIP Sub-Task: 60F8A6 Activity Description FY06 funds will be used to apply the tool at facilities with PMTCT services and to provide technical assistance aimed at strengthening their pharmaceutical management capacity. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project Planned Pilot of the PMTCT Year 7 Q4 Assessment Tool at facilities in the Ekurhuleni Metro.

As a result of the recent public sector wage dispute, the PMTCT assessments could not be completed on the planned dates (25-29 June) and had to be rescheduled. During this quarter meetings were held with the HAST coordinator in the Ekurhuleni Metro regarding the rescheduling of the PMTCT assessments and to meet new HAST staff appointed. Despite the delays the Metro continues to be extremely supportive and enthusiastic about the need for the assessments.

The PMTCT assessment questionnaire was finalised. The pilot will now be conducted at all antenatal clinic sites in the Southern region where PMTCT services are provided (27 in total). Plans were finalised for the pilot to be conducted from 8 – 12 October 2007. Assistance will be provided by lay counsellors from ANC sites in the Metro. Training of lay counsellors in the use of the assessment questionnaire is planned for the end of September. Last Updated: 10/15/2007

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Workplan: South Africa PEP and RHAP Year 06 Activity Title Strengthen the capacity of facilities in quantification practices for ART, TB, STIs and other essential medicines

Activity Manager Sallet, Jean-Pierre Activity # 7 Task: A1ZA06HIP Sub-Task: 60C1H7 Activity Description RPM Plus, in collaboration with the National and Provincial Departments of Heath, will conduct further national and provincial workshops during which national and provincial pharmacists and managers responsible for the procurement of ARVs will be trained on the use of the quantification tool and to estimate medicine requirements. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products Project National Quantification Forum Some provinces did not attend Visits will be paid to some Year 7 Q4 the Quantification Forum. of the provinces to assist The National Forum was postponed due with quantification. RPM to the heavy workload in the National Plus has offered to assist Department of Health but subsequently the Department with the took place on 25-26 September in verification of the estimates Pretoria. The meeting was attended by submitted by provinces. Drs Kalombo and Ntangula from the HIV & AIDS & HAST units in the NDoH. Dr Kalombo provided detailed input to the meeting. The list of medicines for tender was discussed and the Department requested to send an addendum with details of any additional items as well as the latest guidelines. Concerns around the implementation of the new continuous regimen for TB were also discussed as it is not yet clear how this will be phased in. Last Updated: 10/15/2007

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Workplan: South Africa PEP and RHAP Year 06 Activity Title Strengthen the capacity of pharmacy personnel in the area of medicine supply management

Activity Manager Sallet, Jean-Pierre Activity # 7 Task: A1ZA06HIP Sub-Task: 60CXH8 Activity Description A series of national and provincial workshops are planned under COP06. These will focus on building the capacity of pharmacy personnel in this area and also in using data and information to ensure that the increasing demand for drugs required for the care and treatment of HIV and AIDS, TB and other related programs is met. This will also provide an opportunity to strengthen the working relationship between pharmacists and other program managers. Over 100 individuals from the Provincial Pharmaceutical Services and from the National Pharmaceutical Policy and Planning cluster will be targeted. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products

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Workplan: South Africa PEP and RHAP Year 06 Activity Title Strengthen the capacity of pharmacy personnel in the area of medicine supply management

Project Chronic dispensing project in KZN Finalise the revision of the Year 7 Q4 MSM manual for Monthly meetings of the task team in submission to the SAPC for KZN which is tasked to set up a facility approval of the course. for the dispensing of all chronic Continue support in the prescriptions in the province continued KZN project. to be held. TA was provided in the application of the detailed project plan developed using MS project. Work continued on the activities identified with RPM Plus providing technical assistance. These included the development and finalization of criteria for the approval of private community pharmacies to participate in the project, the development of SOPs and checklists and the costing of the pilot project.

Updating of Medicine Supply Management Training Material

The DSM manual has been revised and is being reviewed by members of the RPM Plus team in South Africa. Further improvements are being made to the DSM for TB course. Currently appropriate text is being written for each module of the course.

Technical Assistance

On 12 September a presentation was made to the North West Pharmacists’ Annual Conference on medical waste disposal.

Ongoing technical assistance was provided in the Northern Cape at the Medical Depot, the Kimberley Hospital Complex and the Kuruman District Hospital to strengthen drug supply management principles. Computerised and manual systems are in use in these

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facilities. Last Updated: 10/15/2007

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Workplan: South Africa PEP and RHAP Year 06 Activity Title Implement Drug Management computerized systems at facility level and strengthen capacity for the use of pharmaceutical information

Activity Manager Sallet, Jean-Pierre Activity # 9 Task: A1ZA06HIP Sub-Task: 60G4H9 Activity Description During FY06, the system (RxSuite) will be implemented in at least 3 additional provinces in over 80 provincial and local government sites (including 30 ARV accredited sites). A minimum of two staff will be trained at each site. RPM Plus will assist the provinces to develop contractual agreements with private IT service contractors to provide support and maintenance to these site. Activity Progress Barriers to Progress Next Steps Products Planned Progress on Products

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Workplan: South Africa PEP and RHAP Year 06 Activity Title Implement Drug Management computerized systems at facility level and strengthen capacity for the use of pharmaceutical information

Project Rx Solution Implementation • Version control remains a • In the Eastern Cape Year 7 Q4 challenge. All sites must be training on the new version Free State province running the same version. of RxSolution is planned for • Difficulties in Mpumalanga with 2 people per facility. A An implementation plan has been the private service provider which users meeting is planned to developed for the deployment of was contracted to do installation, take place in the eastern RxSolution at 39 sites in the Free State training and implementation (lack half of the province. province. During this quarter four training of expertise). • Need to upgrade all sites workshops on RxSolution were held in • In Mpumalanga, computers are with the latest version which Bloemfontein in July. A total of 47 connected via a wireless network is not yet finalized people were trained. Support continued and loss of signal occurs to be provided to the DSM/IT Pharmacist regularly. Loss of connectivity appointed at the Head Office by the results in the loss of transactions. province as well as to various sites. A This has been a particular request was received from the Province challenge at Ermelo Hospital. and approval obtained to purchase 20 • Users requiring ongoing computers and 20 printers. adaptations to the program • Need for dedicated attention to Mpumalanga RxSolution programming requirements In Mpumalanga, Ermelo Hospital is • Training is best done on a one being used as the RxSolution Pilot site to one basis with follow up for the province. The Paab interface was training where the procedures of deployed and is operational. A stock- specific hospitals/clinics are taking procedure was developed and put discussed. This is very time into place. Assistance was provided in a consuming and labour intensive stock-take which was done on but is necessary to ensure that pharmaceuticals during the period 17 to the system supports the 20 September 2007. institutions workflow and processes optimally. Eastern Cape

A users meting was held in Umthatha on 22 August 2007. It was attended by 15 participants. The opportunity was provided for users to share their experiences and receive training and support. Agreement was reached regarding further support to the province.

Two new computers were set up at the Dorah Nginza Hospital in Port Elizabeth. Support was provided to Jose’ Pearson

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Workplan: South Africa PEP and RHAP Year 06 Activity Title Implement Drug Management computerized systems at facility level and strengthen capacity for the use of pharmaceutical information

TB hospital. Maclear Hospital was upgraded from RxStore to RxSolution. At Frontier Hospital logging problems were corrected and an additional networked computer was installed at the OPD pharmacy. Various problems were addressed at St Barnabas, All Saints Hospital and Rietvlei Hospital.

Gauteng

Six members of staff at Baragwanath Hospital were trained on the dispensing module.

Development

The RxSolution manual was finalised. Work continued on the upgrade of RxSolution (September Edition)

Last Updated: 10/15/2007

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