1. MC Kits – Considerations from a systems perspective May 20, 2009 Michael Stalker

2. Overview Examples from the field Public sector and the kit The role of the private sector

3. MCC in Nyanza, Kenya Research focused Commodities and supplies based on the RCT Commodities and supplies procured on a larger scale Kits assembled locally for local use

4. Minor Theatre Consumables ITEM PER 100 MCs Liquid soap (500ml)5 Disposable Hand Towels (serviettes)4 Hand rub4 Red bin liners200 Gloves 7.5" (packs of 50 pairs)4 Gloves 8" (packs of 50 pairs)4 Clean gloves (packs of 50 pairs)6 Gauze (non sterile) (packs of 100)20 Vaseline gauze (packs of 10)20 Sutures (3/0) (packs of 12)16 Sutures 4/0 (packs of 12)4 Surgical blades 10" (packs of 100)2 Elastic Bandage (roll of 25 mtrs)0.1 Face masks (3-ply) (packs of 50)4 Normal Saline100 Betadine 500 mls (30mls/procedure)20 Lignocaine 2% without epinephrine 30cc vials. (15mls/client)50 Syringes 20 cc (packs of 50)2 Needles G 21 (pack of 100)1 Needles G 23 (pack of 100)1 Water for injection (packs of 50)2 Alcohol spray (5l)0.2 Surgical spirit (5l)0.2 Spray gun0.5 Paracetemol Tabs (packs of 100)30 Dispensing envelopes100 Ziplock bags (25 pieces - last 2 times)2 Client Folders and Forms100 Diathermy tips (pack of 100)0.1

5. One negative element Substandard anesthesia – Providers using double the dosage – Suppliers replace the product – Packagers correct the kit contents locally Providers still using double the dosage

6. Considerations for the negative element Quality assurance systems for kit contents Good manufacturing practices Communication/training for providers

7. Public Sector Need endorsement from MOH supporting the kit approach Bulk purchasing discounts of commodities and supplies Integration of the kits into existing logistics systems Integrity of the kits at the facility level

8. Considerations for the Public Sector Assembly of the kits – national or sub-national level Lessons learned from ARV and CT services Evolution of the kits – after the “catch up” phase

9. Private sector Comprehensive HIV prevention programs Commodities and supplies from MOH Standardized services

10. Considerations for Private Sector National policy on the role of the private sector Starter kits and re-supply kits (for some supplies) QA on comprehensive MC services

11. Summary More questions than answers Advocacy with the MOH is essential Lessons learned from prior investments need to inform our strategies The private sector can be an important partner