Reporting Requirements and Indicators for Supply Chain

Management of HIV Diagnostics & Medicines:

Kenya and Nigeria

Yasmin Chandani,Coordinator for HIV/AIDS Technical Initiatives

JSI/DELIVER

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

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

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.

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)

Kenya NigeriaNumber of sites where HIV tests are available

Number of PMTCT sites with continuous full supply of centrally procured HIV test kits and prophylactic ARVs (no stockouts)

Number of sites where Nevirapine is in stock

Number of PMTCT sites following proper storage and inventory management of HIV test kits and prophylactic ARVs

Reporting rate (for LMIS reports)

Number of PMTCT site pharmacists and service providers trained in logistics management

Number of supervisors trained in PMTCT logistics system supportive supervision and provided with supervisory tools

Semi-annual reviews of quantification of and procurement plans for HIV test kits and ARVs required for PMTCT sites

Comparison of PMTCT Indicators

Kenya NigeriaNumber of condoms distributed Number of ART and PMTCT sites with

continuous full supply of condoms (no stockouts)

Number of GON and NGO facilities following proper storage of and inventory management of condoms

Comparison of Other Preventive Area Indicators

Kenya NigeriaNumber of kits distributed

Number of DOTS implementing sites with continuous full supply of TB drugs (no stockouts)

Number of DOTS implementing sites following proper storage and inventory management of TB drugs

Re-designed logistics management system for the national TB program

Number of TB program zonal, state, LGA TB coordinators and service providers trained in logistics management

Number of supervisors trained in TB program logistics system supportive supervision and provided with supervisory tools

Comparison of Palliative Care Indicators

Kenya NigeriaNo. of labs fully equipped for HIV testing/ARV ass

Number of ARV program laboratories with continuous full supply of HIV of selected laboratory supplies (no stockouts)

Number of ARV program laboratories sites following proper storage of and inventory management of HIV and TB testing products

Number of ARV program laboratory technicians trained in logistics management

Comparison of Lab Infrastructure Indicators

NigeriaNumber of expansion ART sites assessed for ART service provision readiness

Number of ART sites with continuous full supply of ARVs (no stockouts)

Number of ART sites observed to be following proper storage and inventory management of ARVs

Number of ART site pharmacists and storekeepers trained in logistics management

Number of supervisors trained in ART logistics system supportive supervision and provided with supervisory tools

HIV/AIDS Treatment/ARV Drugs Indicators

KenyaInformation and tracking system in place - % reporting

Stockout rates of HIV tests

Cross Cutting Indicators

GFATM Global SCM IndicatorsThe proportion of randomly selected retail outlets and service delivery points that have condoms in stock at the time of a survey, or all retail outlets and service delivery points selected for survey

% of drug distribution nodes reporting on stock status (repletion, shortage, consumption, quality, losses) on a monthly basis.

Treatment guidelines and utilization manuals developed and available at service sites

Number or % of districts or other administrative unit with at least one drug distribution center

% of drug distribution nodes/facilities reporting no drug shortage

% of project service delivery points with sufficient drug supplies

Unit cost(s) of project drug(s) and commodities

Number of project services deliverers trained in procurement and supply management

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.

SCM Indicators for GFATM Recipient in Kenya

Time and length of procurement

Cost, number and type of items procured

Number of items delivered

Supply Chain efficiency including warehousing and storage conditions

Stockout of commodities

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

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

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

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

LMIS Records & Reports for ARV Drugs in Kenya: Health Facilities

• 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: Districts

• 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: Central Warehouse

• Stores Ledger Card

• Bin Card• Stock Adjustment

Card• Counter

Requisition & Issue Voucher

• Issue & Receipt Voucher

• Counter Receipt Voucher

• Summary Feedback Reports

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

Monitoring Indicators used by JSI/DELIVER

• 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

• 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

• 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

• 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

• 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

Questions?

Thank you for your

attention

Thanks To:

Jaya Chimnani, M&E Advisor, JSI/DELIVER

Elizabeth Bunde, M&E Advisor, JSI/DELIVER