Background

1. Reporting Requirements and Indicators for Supply Chain Management of HIV Diagnostics & Medicines:Kenya and NigeriaYasmin Chandani,Coordinator for HIV/AIDS Technical InitiativesJSI/DELIVER

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

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

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

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

6. Comparison of PMTCT Indicators

7. Comparison of Other Preventive Area Indicators

8. Comparison of Palliative Care Indicators

9. Comparison of Lab Infrastructure Indicators

10. HIV/AIDS Treatment/ARV Drugs Indicators

11. Cross Cutting Indicators

12. GFATM Global SCM Indicators

13. Country Specific SCM Indicators for GFATM: Kenya & Nigeria • In Kenya, JSI consortium member to sub-recipient to MOF/GOK for a Global Fund grant in Round II • In Nigeria, JSI is not involved in any Global Fund activity (no JSI specific indicators). Also no supply chain indicators were discovered during the desk review of two GFATM grants for Nigeria.

14. SCM Indicators for GFATM Recipient in Kenya

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

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

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

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

19. Daily Activity Register for Antiretroviral drugs Monthly Facility LMIS Report for Antiretroviral drugs Counter Requisition & Issue Voucher Stock Card Monthly ART Patient Summary Sheet Daily Activity Register – Drugs for Opportunistic Infections Monthly Facility LMIS Report- Drugs for Opportunistic Infections LMIS Records & Reports for ARV Drugs in Kenya: Health Facilities

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

21. Stores Ledger Card Bin Card Stock Adjustment Card Counter Requisition & Issue Voucher Issue & Receipt Voucher Counter Receipt Voucher Summary Feedback Reports LMIS Records & Reports for ARV Drugs in Kenya: Central Warehouse

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

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

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

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

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

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

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