1. Strengthening HIV Responses through Private Sector Involvement in Supply Chain Management Medical Access Experience in Uganda Sowedi Muyingo 1, James Olweny 1, Morries Seru 2, Ashraf Kasujja 1, Lubega Basajasubi 1, Monica Dea 3, Pito Jjemba 3, Steven Wiersma 3 and Rashid Settaala 1 1 1.Medical Access Uganda Limited, Kampala, Uganda; 2.Ministry of Health, Uganda 3.The U.S. Centers for Disease Control and Prevention - Kampala, Uganda

2. Issues  1998 : ART Started under UNAIDS DAI  2002 & 2013 : Global Fund ; PEPFAR ; CHAI  Multiple, Parallel and uncoordinated supply chains 2

3. Supply Chain Challenges before PSSP 3 15 donor driven procurement and distribution systems Multiple procurement and distribution systems 5 LMIS tools were being used by donor supplies 67% of health facilities submitted bi-monthly orders Facility ARV Stock-out rate was 25%, HIV rapid test kits was 8% Multiple non- standardized LMIS tools at service delivery points ARV Cost = FOB Price + PSM costs + Mark up + Project management Cost markups on ARVs varied significantly 50% of health facilities had some expired medicines High HIV commodity wastage at facility level 70% of ARVs were generic products Rx not aligned to National Treatment guidelines Big number of ARV brands in various funded programs

4. 2003-2011: Uncoordinated Supply System 4  Inadequate Coordination from GoU and limited resource allocation

5. SCM Infrastructure to match ART scale-up 5  Patients on ART have grown from 280,904 in 2011 to 773,276 in 2015  Private sector contributes 50% of health service delivery in Uganda Health Sector Financing 2004/5 – 2014/15

6. 6 NMS Public GoU/GF JMS PNFP- PFP USAID MAUL PNFP CDC Description: SCM Rationalization Strategy in 2012 # of Sites1182304200  “One Supplier – One Facility” involves streamlining procurement, warehousing, distribution and data management to Public, PFP and PNFP health facilities  The SCR strategy is implemented by Ministry of Health Uganda

7. Description: PSSP Interventions 7 Consolidated procurements from 15 to 1 Benchmarking with international prices Centralized Procurement Procurement guided by National Standard Treatment Guidelines Procuring and manage a limited range of commodities Advocated and integrated 4 LMIS Tools into one national LMIS One national LMIS Integrated SCM and product portfolio Direct Delivery to health facility Product re-distribution strategy Warehousing and Direct Distribution using best practices Training Infrastructure enhancements for SCM Strengthening health facility capacity to manage commodities

8. Lessons Learned 8 261M savings from pooled economies and switch to Generic ARVs PSM costs consolidated Centralized procurements from 14 to 1 system Only FOB + PSM + Project management Savings of US$ 4,524,029 from ARV procurements, reaching 30,000 additional patients in 2012 No mark-ups added to ARV prices Rx habits and Procurement driven by NTGs Fewer regimens in line with the National Treatment Guidelines Standardized the regimens in use Zero stock outs at central level 0.05% of HIV commodities wasted over 4-year period Reduced stock outs – 17% in 2012 to 3% in 2014 Reduced HIV commodity wastage at facility level All sites use one National LMIS System (WAOS+) Over 240,000 patients on ART by Sept 2015 at 250 sites > 95% of commodities procured are generic ARVs One national LMIS & Direct Delivery Strategy Performance in logistics management improved at 215 SDPs Warehouse infrastructure improvements Strengthening Health Facility Capacity to Manage Commodities

9.  Doubled warehousing capacity to > 4,000 pallet positions in last 3 years  116m 3 space of cold chain capacity available  State of art SAP integrated System  Adherence to Good Warehousing & Distribution practices  ISO certification  Fleet expansion from 5 to 24 dedicated trucks  400,000 KM+ travelled to across Uganda  100% orders have been fulfilled on hand inventory  HIV commodities delivered to 215 health facilities  Providing ART to over 240,000 patients  215 PNFP Health facilities mentored and supported in HIV commodity management Private Sector Contribution 9 Storage Infrastructure Dedicated Medicine Transport Fleet Direct Delivery Model On-site Mentorship and Training Good Warehousing/ Distribution Practices

10. Reporting Rates for ARV Warehouses Oct.14-Jul.15 10 Ref: Uganda Ministry of Health | STD/AIDS Control Program Web-Based ARV Ordering and Reporting System (WAOS) Report June-July 2015 Warehouse 1 Warehouse 2  All 215 supported PNFP health facilities order and report to the national system on a bi-monthly re-supply schedule harmonized to MoH

11. Strengthened Capacity to manage HIV Commodities  Mentorship & on-Job Training  Improved health facility reporting to 100% 11  Strengthened performance of 215 health facilities’ to manage HIV related commodities

12. Next Steps  Expand investment in SCM infrastructure through strategic partnerships  Novel financing mechanisms for HIV commodities beyond PEPFAR  Promote & strengthen private public SCM partnerships as a strategy to attain the 90-90-90 12

13. 13 Acknowledgements  Ministry of Health  Centers for Disease Control and Prevention (CDC) - Uganda  All CDC supported Health Facilities & Implementing Partners  The management and staff of MAUL

14. From the field 14