Zimbabwe MOHCW Male Circumcision Programme

1. Zimbabwe MOHCWMale Circumcision Programme Supply Chain Management Dr. O. Mugurungi, Director AIDS&TB Programme Ministry of Health and Child Welfare June 2010

2. OUTLINE(Logistics Cycle applied to MC commodities) • Background • Funding • Product Selection • Forecasting • Procurement • Storage and Distribution • Next Steps

3. 1. BACKGROUND 3 In 2009, overall adult HIV prevalence in Zimbabwe was 13.71% Approximately 10.3% of adult males reported to be circumcised (ZDHS 2005-2006) In 2009, MOHCW started actively promoting Male Circumcision (MC) as part of a comprehensive HIV prevention strategy MC pilot phase started May 09 with 5 sites represented different models of service delivery 2,805 procedures performed between May09 and Dec09 at 5 pilot sites (351/ month) 2258 MC procedures performed between Jan and April 2010 ( 567/month) 56,000 procedures planned over 12 months at approximately 22 sites

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

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

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

8. 5. PROCUREMENT • Programme Start up (Apr 2009- June 2010) • Kits, related commodities and equipments procured by PSI (USAID and UNFPA funding) • Programme Scale up (Jul 2010 – June 2015) • Kits, related commodities and equipments procured by SCMS (USAID Funding) • 5,000 kits to arrive in Zimbabwe in July/August 2010 • 23,900 kits, related commodities ordered and to arrive between Jul – Dec 2010 • Equipments procured by PSI (USAID) and UNFPA

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

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

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

12. THANK YOU! 12