Chapter 4 - Building Capacity: Partnerships for Sustainability
�The President�s Emergency Plan for AIDS Relief is a key example of effective foreign assistance and transformational diplomacy in action. Our approach is to empower every nation to take ownership of its own fight against HIV/AIDS through prevention, treatment, and care.�
Secretary of State Condoleezza Rice
The reality is that the fight against HIV/AIDS in hard-hit nations will have to continue for the long term. This fight will be sustainable only if it is owned by the people of each country. In many nations, this will require an increase in response of a magnitude that can best be described as a transformation. The primary responsibility for achieving such dramatic change ultimately rests with the leadership and citizens of developing nations themselves. The U.S. Government (USG) and other international partners can play a vital role, but outside resources for HIV/AIDS and other development efforts must be focused on transformational initiatives that are owned by host nations.
Governments and local civil society organizations � including non-governmental organizations (NGOs), faith-based organizations (FBOs), community-based organizations (CBOs), associations of health care workers, and the private sector � are crucial for this development, and are well-placed to identify the needs of their own countries and devise strategies for meeting them. In addition to working with governments, the Emergency Plan focuses on supporting local indigenous organizations, prioritizing funding to develop their capacity. A commitment to local ownership is the basis for the President�s Emergency Plan for AIDS Relief�s (Emergency Plan/PEPFAR�s) focus on working with host nations and supporting their strategies to bring comprehensive national responses to scale.
International NGOs are indispensable partners in PEPFAR implementation, and there will always be more work to do in resource-poor settings. Yet international partners must support the building of sustainable, country-owned programs. Therefore, new grant language for international NGO partners requires them to take steps to build local capacity. The Emergency Plan also now requires such partners to develop �exit strategies� � plans for reducing their own role and devolving responsibility to local people and organizations on a reasonable time frame.
Review of annual Country Operational Plans (COPs) includes an evaluation of efforts to increase the number of indigenous organizations partnering with the Emergency Plan. This emphasis has led to impressive results: In fiscal year 2006, approximately 1,532 partners, or 83 percent of Emergency Plan partners, were indigenous organizations (that is, organizations based in the host nations). Reliance on such local organizations, while challenging, is essential for PEPFAR to fulfill its promise to partner with host nations to develop sustainable responses. As another step in the direction of sustainability, COPs for fiscal year 2007 are required to devote no more than eight percent of funding to a single partner (with exceptions made for host government partners, commodity procurement, and �umbrella contractors� for smaller organizations). This requirement will help to expand and diversify PEPFAR�s base of partners and facilitate efforts to reach out to new partners, particularly local partners � a key to sustainability.
Alongside efforts to support community capacity-building, other crucial activities for sustainability include: enhancing the capacity of health systems and health care workers; strengthening quality assurance; improving financial management and accounting systems; building health infrastructure; and improving commodity distribution and control. The Emergency Plan is intensively supporting national strategies to strengthen these critical systems. Focus country partners reported that, in fiscal year 2006, approximately 25 percent of all activities had components that directly supported sustainable network development. Because building capacity goes hand-in-hand with expanding services, the previous chapters on Prevention, Treatment, and Care also summarize Emergency Plan efforts to ensure sustainability.
The capacity of host nations to finance HIV/AIDS and other health efforts on the scale required varies widely. While it is true that many deeply impoverished nations are years from being able to mount comprehensive programs with their own resources alone, it is essential that these countries appropriately prioritize HIV/AIDS and do what they can to fight the disease with locally available resources, including financial resources. A growing number are doing so. Many other nations do have significant resources, and are in a position to finance much of their own HIV/AIDS responses. The USG has urged African governments to meet their commitments from the Abuja Declaration, including their pledge to devote at least 15 percent of their budgets to health. Progress is being made by some countries, and a growing number of nations are investing in fighting HIV/AIDS on a scale commensurate with their financial capacity. In some cases, for example, host nations are procuring all or a portion of their own antiretroviral drugs (ARVs), while PEPFAR provides support for other aspects of quality treatment. Such developments within hard-hit nations build sustainability in each country�s fight against HIV/AIDS.
While HIV/AIDS is unmistakably the focus of PEPFAR, the initiative�s support for capacity-building has important spillover effects that support nations� broader efforts for sustainable development. Organizations whose capacity is expanded in order to meet USG fiduciary accountability requirements are also in an improved position to apply for funding for other activities or from other sources. Expanded health system capacity improves responses for diseases other than HIV/AIDS. Supply chain management capacity-building improves procurement for general health commodities. Improving the capacity to report on results fosters quality/systems improvement, and the resulting accountability helps to develop good governance and democracy. In a variety of ways, the Emergency Plan supports host nations in identifying their needs and in building the tools to address them in the future. (For further information please see PEPFAR�s 2006 Report on Workforce Capacity and HIV/AIDS located at http://www.PEPFAR.gov/progress/.)
Building Sustainable Institutional Capacity
The fiduciary accountability of local organizations is crucial to the Emergency Plan�s effort to build capacity, and the Emergency Plan has made a major effort to provide technical assistance to partners in this area. An impediment to working with many local groups is the limited technical expertise in accounting, managerial and administrative skills, auditing practices, and other activities required to receive funding directly from the USG. In fiscal year 2006, several focus countries used local �umbrella contractors,� including those that serve as local fiduciary agents for the Global Fund to Fight AIDS, Tuberculosis and Malaria.
The Emergency Plan also has begun to gather data on capacity-building via COPs and results reporting. USG partner agencies are instructed to review partner performance in strengthening indigenous organizations as part of portfolio reviews conducted in the field. As noted previously, in fiscal year 2007, country teams will devote no more than eight percent of resources to a single partner, unless one of several specified exceptions is satisfied, helping to broaden PEPFAR�s partner base.
Strengthening the institutional capacity of host governments and national systems is a fundamental strategy of the Emergency Plan. As a result, more than 19 percent of Emergency Plan partners in fiscal year 2006 were host government entities, including ministries of health (MoHs) and associated institutions, research organizations, and AIDS coordinating authorities. The Emergency Plan has supported the development of national policy and training in planning, budgeting, performance improvement, monitoring of activities and finances, and other management skills.
In several focus countries, U.S. personnel are located in, or detailed to, MoHs. In others, PEPFAR has supported MoH personnel retention schemes or contractual staffing arrangements, bolstering the number of health professionals working in the public sector and in rural areas. This supports national health system development in the face of the dramatic human resource crises these countries are facing. In Namibia, for example, the USG partners with Potentia, a private sector Namibian personnel agency, to support doctors, nurses, and pharmacists for public hospitals, at the same salaries as government workers, thus supporting needed staff positions in an equitable fashion. The Kenyan Medical Research Institute uses PEPFAR funds to actively train and support 260 healthcare workers, who provide such services as: technical assistance; personnel support to improve laboratory capacity; support for adherence to counseling; and assistance with monitoring and reporting on the progress of antiretroviral treatment (ART) regimens.
Local Civil Society Organizations
The Emergency Plan thus recognizes the value that faithbased organizations can add to HIV/AIDS efforts. In fiscal year 2006, approximately 23 percent of all Emergency Plan focus nation partners were faith-based.
In addition, local civil society organizations play a key role in organizing citizens to work in effective partnership with their governments. Organizations of PLWHA are among the key community-based groups that have been integrated into the Emergency Plan. PEPFAR also has launched pilot programs in multiple countries that allow groups to apply directly to Emergency Plan country teams for rapid approval of small grants, in order to get funds quickly to local organizations doing needed work on the ground. One example of PEPFAR�s impact comes from C�te d�Ivoire, where despite a fragile political environment, the Emergency Plan has worked with community leaders to create a local organization which has now become a PEPFAR partner, while also making grants to smaller community-based entities.
The New Partners Initiative
The Need for New Partners
New Partners Initiative Goals
How the New Partners Initiative Works
The Private Sector
PPPs bring outside resources to bear on areas of local need. PPPs contribute to the fight against HIV/AIDS by:
Potential private sector partners include a wide range of organizations, U.S. and non-U.S. private businesses, multinational corporations, small and medium-sized enterprises, business and trade associations, labor unions, foundations, and philanthropic leaders, including venture capitalists. PEPFAR engages the private sector in various ways and many countries are actively and creatively pursuing this objective.
The Emergency Plan works in partnership with a growing number of local industries, supporting their efforts to grow their capacity to meet the needs of their employees and their families, as well as the larger communities of which they are a part. In South Africa, for example, the large mining company Anglo American is a PEPFAR partner, reaching out to the community with effective programs and building the nation�s capacity to address HIV/AIDS.
The following examples illustrate the diversity of PEPFAR�s PPPs in support of HIV/AIDS prevention, treatment, and care programs:
Future Directions for Public-Private Partnerships
Goals for future PPPs include developing programs for training healthcare and ancillary workers, promoting treatment and care for orphans and vulnerable children (OVCs), providing resources for innovative workplace prevention programs and links to services, supporting laboratory systems, and developing information technology for clinical care and strategic information programs.
Building Human Resource Capacity
In fiscal year 2006, PEPFAR provided approximately $350 million in support of network development, human resources and local organizational capacity development, and training. However, systemic weaknesses in areas such as health networks and infrastructure are persistent obstacles to expanding health systems and building human resource capacity in many PEPFAR countries. The Emergency Plan, working with host countries, supports national strategies to strengthen these critical systems. In fiscal year 2006, partners reported that approximately 25 percent of all programmatic activities had components that directly supported development of networks, linkages and/ or referral systems. This focus on strengthening networks provides a base from which to build institutional and human resource capacity, in order to rapidly expand prevention, treatment, and care services.
The Emergency Plan recognizes that quality and sustainability in HIV/AIDS prevention, treatment, and care require skilled providers of health services. However, many PEPFAR countries lack the trained health workers necessary to respond to the need. With this in mind, the Emergency Plan and its host country partners support:
The Emergency Plan supports focused training for the development of human capacity to deliver HIV/AIDS services. In fiscal year 2006, the Emergency Plan supported training or retraining for more than 842,600 service providers (with some providers receiving multiple trainings). Approximately 428,600 individuals were trained or retrained in the prevention of sexual transmission; 32,600 in PMTCT; 58,700 in prevention of medical transmission; 52,000 to support antiretroviral treatment; 143,300 to care for OVCs; and 93,900 to provide care for PLWHA.
In addition to training existing health care workers, it is also essential to bring new workers into the health workforce. Policy change to allow task-shifting from more specialized to less specialized health workers is the one strategy that will have the most significant and immediate effect on increasing the pool of health workers to deliver HIV/AIDS services. The experience in Ethiopia, described in the accompanying text box, shows that changing national and local policies to support task-shifting can foster dramatic progress in expanding access to prevention, treatment, and care services. The Emergency Plan works with its host country partners to broaden national policies to allow trained members of the community � including people living with HIV/AIDS � to become part of clinical teams as community health workers.
Another challenge to providing high-quality HIV/AIDS treatment and care is the retention of skilled health workers such as physicians, nurses, pharmacists, and laboratory personnel. The Emergency Plan is supporting a number of innovative approaches to retaining health care workers. In a successful effort to prevent �brain drain� from Namibia, the MoH provides a package of benefits, including medical benefits, housing support, paid maternity leave, and competitive salaries. As part of a comprehensive strategy for strengthening human resources for health, the Malawi MoH provides free housing and support for educational scholarships to nursing tutors, who are critical to creating a larger pool of new health workers. Kenya, like many sub- Saharan countries, faces a human resources crisis due to lack of health care workers to deliver treatment and care in high need areas.
With PEPFAR support, the Capacity Project is working with the health sector on the Kenya Emergency Hiring Plan to take advantage of Kenya�s surplus of unemployed nurses, physicians, and other health professionals. The plan � approved and endorsed by the MoH � creates a non-governmental outsourcing mechanism to quickly hire, train, and deploy 800 providers in public-sector health centers. In Botswana, the Botswana Retired Nurses Society is expanding access to palliative care services for people living with HIV/AIDS through an innovative program using volunteer retired nurses. With PEPFAR support, the Society has recruited 25 retired nurses to provide comprehensive health and support services, including pain management, to 200 PLWHA. These trained health professionals are able to assess pain, advocate for the provision of appropriate pain relief medications including opiates, prescribe analgesics to minimize pain, and assist patients in adherence to their ARV regimen. This program has been so successful that the Society is planning to recruit, train and deploy 50 additional volunteer retired nurses in fiscal year 2007.
Twinning partnerships are another important tool to build local capacity. The resources of the PEPFAR-supported Twinning Center, described in the accompanying text box, are used to expand and strengthen local expertise in administrative as well as clinical capacity building.
MoHs throughout Africa are recognizing the importance of building their capacity in human resources management and human capacity development. The Emergency Plan, along with other international partners such as the Global Fund and the World Bank, is working with host governments to support these institutions, many of which suffer from severe shortages of staff. In the Rwanda MoH, the USG funds and mentors a specialist in human resources for health (HRH). Strong leadership has made a significant difference on several important HRH initiatives, such as:
This model of supporting the human resource planning and management functions within the MoH is currently being considered for other countries, as well.
In collaboration with WHO, PEPFAR has developed a PMTCT Generic Training Package, building provider capacity and collaborative partnerships within countries. The Emergency Plan has sought to anchor the training in advanced centers to ensure quality, while developing tools to assess the quality of the training. One example of a training assessment tool is the Instructional Design and Materials Evaluation Form. This research and evaluation tool evaluates and scores curricula in terms of instructional design elements, content review, and evaluation methodology. USG training efforts are directed not only at expanding clinical capacity, but at developing the pool of trained managerial personnel. The non-clinical staff is a key element of effective health networks, which fosters quality programs. The Emergency Plan has made on-the-job HIV/AIDS training for health care workers a priority in order to avoid the disruption in care that can occur with off-site training.
Strengthening Essential Health Care Systems
Clinical Quality Assurance
Quality assurance capacity-building activities include support for monitoring and evaluating programmatic indicators, on-site supervision systems, and district, national, and international reviews. The Emergency Plan supports programs to adapt quality improvement approaches to the needs of developing countries. For example, the Quality Assurance and Workforce Development Project, implemented by USAID, uses a collaborative approach in which teams of providers have documented improvements in the quality of prevention, treatment, and care services. These teams may bring counselors, clinicians, laboratory professionals, and pharmacists together to discuss difficult cases and recommend courses of action, such as helping to oversee changes to costly second line therapies. The providers work in tandem with community volunteers, who help people living with HIV/AIDS to access appropriate services and develop self care skills.
Innovative methods of managing clinical information to monitor and evaluate the quality of HIV care also receive PEPFAR support. The Emergency Plan supports the development, distribution, training and support of HIV clinical care data management software (CAREWare), originally developed by the U.S. Department of Health and Human Services/Health Resource and Services Administration (HHS/HRSA) for providers of care in the U.S. The software promotes quality care by providing a clear, customizable, user-friendly, and confidential platform for entering, collecting, and reporting demographic, service, and clinical information. The international version of CAREWare has been implemented with PEPFAR support in Nigeria, Russia, Uganda, Vietnam, and Zambia.
In fiscal year 2006, PEPFAR and the National Hospice and Palliative Care Association supported the development of a Guide to Supportive and Palliative Care for HIV/AIDS in Sub- Saharan Africa. This guide, written by African health care professionals, is now available on the web site of the Foundation for Hospices in Sub-Saharan Africa (http://www.fhssa.org).
The HIVQual software program is another tool currently in use in some PEPFAR host nations, such as in Uganda�s HIV care programs. To facilitate quality improvement, HIVQual enables participants to measure key indicators and use these measurements to benchmark and make progress on working toward objectives. The HIVQual software includes validated HIV clinical indicators for measurement of HIV clinical care (including ART management, opportunistic infection prophylaxis, tuberculosis screening and others), algorithm-based prompts to guide data entry, the ability to generate reports of performance data, and the capacity to analyze data by subgroups.
Health Care Network and Infrastructure Development
Common infrastructure obstacles to national responses include under-resourced facilities; unreliable electricity and water supplies, especially outside urban areas; outdated or broken equipment; and lack of information and communications technology for basic program planning and monitoring. Flexible, computer-based data systems enable host nations to classify, store, and analyze scientific information, allowing them to set national priorities, make important decisions on resource allocation, and monitor program activities.
In support of national strategies and Emergency Plan goals, PEPFAR is addressing these barriers by supporting such activities as the renovation of existing health facilities; procurement of equipment, supplies, furniture, and vehicles; improvement of information systems; and financing for expanded HIV/AIDS service delivery under the Emergency Plan. In South Africa, the Emergency Plan supports efforts at the Frere Hospital to enable health care professionals to improve their management skills (see text box on South Africa).
Emergency Plan staff have worked to strengthen the capacity of all focus countries to diagnose HIV and related infections. This allows growing numbers of people to learn their HIV infection status, and enables physicians to reliably determine which patients will benefit from treatment and monitor the success of that therapy. In Uganda, the Joint Clinical Research Center works to provide additional laboratory support to address gaps in the country�s overburdened health sector and to scale up HIV/AIDS treatment (see accompanying text box).
One priority is to support the use of rapid HIV tests. These tests, which require minimal equipment and can be reliably performed by lay counselors, can dramatically expand the capacity of countries that allow their use to perform HIV testing, as described in the Care chapter. Rapid HIV tests are especially important in peripheral testing sites, far from fully equipped laboratories. Emergency Plan personnel have prepared a training package on Rapid HIV Testing. They have participated in training programs for trainers and other staff, to ensure that trained manpower will be available for conducting such testing at PMTCT and other counseling and testing sites. Similar training packages for hematology, chemistry, CD4 testing, and for the diagnosis of HIV infection in infants are being prepared, which can be used by national personnel for future trainings.
To this end, the Emergency Plan has supported the development of a rapid HIV test training package and a plan for integration of HIV rapid testing in HIV prevention, treatment, and care programs. This training package has been customized by host nations and used to train hundreds of health care workers in Botswana, Kenya, Namibia, Tanzania, Uganda, and Zambia. Emergency Plan staff have been involved in supporting countries and collaborating agencies in the important task of evaluating rapid HIV test algorithms for use in-country. New rapid HIV tests are validated prior to their use in USG programs. This ensures that counseling and testing programs use the proper tests to identify people living with HIV/AIDS.
HIV incidence testing provides countries with the best data on where recent transmission has occurred. This information is essential for planning effective prevention programs and for measuring the success of programs in achieving the PEPFAR prevention goal. Emergency Plan teams have provided in-country/regional training on incidence testing in China, Ethiopia, Rwanda, South Africa, and Vietnam. Training in China and an Asia regional workshop are planned.
As discussed in the chapters on Children and Treatment, diagnosis of HIV infection in newborns is technically complicated and costly. Laboratories providing such testing are usually not located near PMTCT sites. In an effort to expand access to vital infant testing, Emergency Plan staff has trained local staff in the use of dried blood spots. This allows for the ready transport of specimens to central or provincial laboratories where testing is available. Training on the polymerase chain reaction (PCR) laboratory assay needed to detect HIV infection in infants has been provided to Ethiopia, Kenya, Mozambique, and Zambia and trainings in Nigeria and Tanzania are planned.
CD4 testing is very helpful for determining the level of immunosuppression in HIV infection. It also can be used as an important adjunct for determining when to initiate treatment and for monitoring response to treatment. Emergency Plan staff has been involved in the evaluation of lower cost and simpler assays for measuring CD4 cells. Training has been provided in conjunction with partners in C�te d�Ivoire, Ethiopia, Malawi, and Tanzania.
As more individuals are treated, the issue of resistance to ARVs will become more prominent. PEPFAR country teams are working with host nations to develop national or regional programs to conduct population-based resistance testing for monitoring resistance within a country. These also will use dried blood spots, which will be transported to laboratories for analysis. Training of laboratory staff to perform resistance genotyping testing has been provided to Ethiopia and Kenya.
Laboratory quality assurance is critical in assuring accurate diagnosis of HIV infection, determining when to start treatment, and monitoring patients while on treatment. The Emergency Plan has supported extensive training of in-county staff on building and sustaining high-quality laboratory systems. PEPFAR also supports the establishment of proficiency testing programs for laboratory testing in such areas as hematology, chemistry, CD4 testing, and infant diagnosis. This will build confidence in the ability of the laboratories to support the HIV programs, as well as sexually transmitted infection (STI) and TB programs. The USG also supports the development of laboratory certification programs in each country.
Key Components for Building Laboratory Capacity
Zambia: Project Supplies HIV Test Kits and ARVs, Conducts National Quantification of Lab Supplies
HIV test kits are in high demand, as more and more people are interested in knowing their HIV status. In response, with support from PEPFAR, the Supply Chain Management System (SCMS) project delivers HIV test kits to the Zambia Ministry of Health�s Central Medical Stores, for use at various testing sites throughout Zambia. By delivering kits in smaller shipments on a monthly basis, rather than in one bulk shipment, clients receive test kits with a longer shelf life, and space-constrained warehouses keep a smaller amount of inventory on hand. In addition, the first shipment of a large order of ARVs arrived in Zambia on November 17, 2006. These drugs will be provided to patients served by the Ministry of Health�s AIDS treatment program.
In September 2006, SCMS provided short-term technical assistance to the Zambia Ministry of Health�s laboratory staff and other partners, to conduct the national level laboratory quantification of lab commodities. This produced an estimate of the quantities needed to meet short- and long-term planning. Based on this exercise, the Ministry will produce a procurement plan for lab commodities, which will be supported by the Emergency Plan.
Building Laboratory Capacity and Supporting Quality Testing
With the rapid expansion of HIV treatment in resource-poor countries, and the accompanying need for HIV diagnosis and care that comes with it, there is a need to build capacity for high-quality laboratory services. This effort includes:
Commodity Procurement: Toward Sustainable Supply Chain Management
SCMS�s activities include supporting the purchase of lifesaving antiretroviral drugs, including low-cost generic ARVs; drugs for PLWHA care, including drugs for OIs such as tuberculosis; laboratory materials such as rapid test kits; and supplies including gowns, gloves, injection equipment, and cleaning and sterilization items.
To meet the need for a range of ARVs that are proven to be safe, effective, and of low cost, HHS/Food and Drug Administration (FDA) introduced in May 2004 an expedited process whereby ARVs from anywhere in the world, produced by any manufacturer, could be rapidly reviewed for purchase under PEPFAR. Approved or tentatively approved ARVs meet standards equal to those
|established for the U.S., ensuring that no drug purchased for use in PEPFAR programs abroad falls below standards for the U.S. market. Through January 7, 2007, 34 generic ARV formulations received approval or tentative approval from HHS/FDA under the expedited review, including eight pediatric formulations and eight fixed-dose combination (FDC) formulations containing at least two individual ARVs. FDCs are invaluable because they are easier to manage for patients, health workers, and program managers and can serve as an important bulwark against the development of HIV drug resistance. Three co-packaged triple drug combinations and two triple FDCs are now HHS/FDA tentatively approved and available for use by Emergency Plan partners and others.
SCMS and Emergency Plan partners have worked together to ensure that the lowest-priced, highest-quality drugs are available for ART. By late 2006, 14 focus countries had imported HHS/FDA-approved generics. Most FDA-approved products to date are widely used, standard first-line generic ARVs such as Triommune. In many countries, host governments also have requested USG support for more expensive second-line ARVs. As a side benefit, the process developed for PEPFAR also has expedited availability of generic versions of ARVs whose U.S. patent protection has expired.
SCMS supports delivery of essential lifesaving medicines to the front lines of Emergency Plan joint efforts with host nations. In its first year, SCMS established the infrastructure necessary to bring 17 organizations together to establish a global enterprise with the capability of procuring and delivering millions of dollars worth of life-saving HIV/AIDS drugs and supplies to those who need them. To date, approximately $94 million of focus country prevention, treatment, and care resources have been provided to the Partnership to support procurement of commodities such as ARVs, technical assistance, logistics and other aspects of supply chain management. Usage of SCMS is expected to increase significantly during its second full year of operation in fiscal year 2007. The project not just met but exceeded its goal of making initial country visits to all 15 of the Emergency Plan focus countries. Moreover, SCMS responded to in-country requests for long-term technical assistance by opening 10 country offices.
Since October 2005, SCMS has ensured an uninterrupted supply of ARVs, test kits, and other vital commodities to HIV/AIDS programs in Botswana, C�te d�Ivoire, Guyana, Haiti, Nigeria, Rwanda, Vietnam, and Zambia. SCMS has filled commodity orders on behalf of country programs that were frequently in danger of stockouts. (For more information, please see the Stockouts Averted section in the Treatment chapter.) Additionally, SCMS was enlisted to contribute to the coordination of significant donor-funded initiatives such as the World Health Organization (WHO)/Joint United Nations Programme on HIV/AIDS (UNAIDS) efforts to prepare a global ARV demand forecast, including active pharmaceutical ingredients, through 2008. As the technical secretariat of the Global Fund to Fight AIDS, Tuberculosis and Malaria, the World Bank, and PEPFAR�s joint procurement planning initiative, SCMS facilitates national procurement planning and supply chain management of HIV/AIDS commodities in six countries (Ethiopia, Guyana, Haiti, Mozambique, Rwanda, and Vietnam). For more information on SCMS and PEPFAR�s treatment programs, see the chapter on Treatment.
In collaboration with in-country and international partners, SCMS employs the following key strategies:
The implementing members of the Partnership for Supply Chain Management are:
Each partner offers unique capabilities to ensure that high-quality ARVs, HIV tests, and other supplies for diagnosing and treating HIV/AIDS are available to the people � patients, clinicians, laboratory technicians, and others � who need them.