GLOBAL HEALTH SUPPLY CHAIN TECHNICAL ASSISTANCE

1

GLOBAL HEALTH SUPPLY CHAIN

TECHNICAL ASSISTANCE - TANZANIA

Quarterly Report

April to June 2019

LMS All Hands Meeting held from 24th to 26th April at St. Gasper Conference Centre-Dodoma

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TABLE OF CONTENTS

Project Goal and Objectives 3

Key Accomplishments this Quarter 4

Workstream Accomplishments 5

Implementation Challenges, Risks, and

Mitigation Measures21

Project Monitoring Plan Report 26

Annexes 31

Acronyms 32

Root Cause Analysis for selected PMP

Indicators37

Travel and Training Report 56Dr. Zainab Chaula, Permanent Secretary of the MoHCDGEC

addressing the participants at a meeting introducing new MoHCDGEC staff to implementing partners in Dodoma.

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GHSC TA-TZ PROJECT GOALS & OBJECTIVES

Key stakeholders (in addition to USAID and CDC): Ministry of Health, Community Development, Gender, Elderly and Children (MoHCDGEC)–specifically the Pharmaceutical Services Unit (PSU), Diagnostics Service Section (DSS), Information, Communication and Technology (ICT) directorate, and

vertical programs – including National AIDS Control Program (NACP), National Malaria Control Program (NMCP), Reproductive and Child Health Services

(RCHS) Program, and National Tuberculosis and Leprosy Program (NTLP), Medical Stores Department (MSD) - central and 10 zones; President’s Office of Regional Administration and Local Governments (PO-RALG) (comprised of 186 councils, 168 districts, and 26 regions), Zanzibar Ministry of Health, Zanzibar Central Medical Stores, Zanzibar Vertical Programs, and other implementing partners.

Timeframe – June 2016 – June 2021

(3 year base and 2 option years)

Geographic focus – Mainland Tanzania. Zanzibar

(Approximately 7,000 public health facilities)

Assist leadership to

operationalize strategic

plans

Provide strategic

planning and

implementation

assistance

1

Support supply chain costing

and financing strategies

Strengthen supply chain MIS

Strengthen laboratory

supply chains

Increase skills of key

counterparts

Increase data use and

improve data quality

Support MoHCDGEC in

implementing and

improving RBF scheme

Establish a culture of

collaboration and

information sharing

Improve delivery of

health commodities

in service sites2

Obje

ctiv

esIn

terv

enti

ons

Broaden stakeholder

understanding and

engagement of the

supply chain system

3Strengthen enabling

environments to

improve supply chain

performance

4

Support the transition of

LMS/LMU to GoT and GoZ

structure(s)

Strengthen governance and

accountability

Goal: Support the development of agile, robust, and sustainable health supply chains that will contribute towards improving medicines availability and the health status of Tanzanians

Improve supply chain

performance against key

indicators

Strengthen and streamline

quantification

4

Objective 1: Provide Strategic

Planning and

Implementation

Assistance

Emergency Supply Chain PreparednessConducted a table top simulation training on ESC in Mwanza as part

of strengthening the MoHCDGEC’s capacity to prepare for and

respond to unfolding emergencies. Using the Tanzania Emergency

Supply Chain Operations Guideline (TESCOG), participants practiced

decision-making through Ebola and Cholera case study scenarios.

LMS Transition Supported the transition of LMS through a series of consultations with

Director of Administrative and Human Resource (DAHRM) of

MoHCDGEC to support their switch from USAID to Global Fund

funding. Conducted a series of capacity building workshops for the

newly recruited and continuing LMS staff.

Objective 2: Improve

Delivery of

Health

Commodities in

Service Sites

Integration of Info Systems Facilitated information exchange among

various health information systems, including

visibility of funding (options of funds for

facilities to use to pay for health

commodities) and proof of delivery.

ARV Quantification and Analysis Following the national ARV quantification,

conducted several analyses utilizing stock

status and upcoming shipments to inform

orders to be made, assist in determining

timing of certain shifts (for example, shifts to

pediatric LPV/r formulations), and to identify

options for using alternative regimens and

consequences of each option. The project

also helped NACP plan for TLD transition,

including the phasing in and out of different

pack sizes of TLD, along with switches to

alternate regimens.

System RedesignWorked closely with LMS staff of Mwanza

zone to prepare monthly progress updates

with quantitative indicators, as well as

document challenges and solutions of the

rollout of the redesigned logistics system in

Mwanza. These monthly updates are

circulated to key stakeholders. GoTHOMIS ReviewParticipated in a comprehensive review of

GoTHOMIS, which includes a re-architecture

of the entire system.

National KPIs Obtained approval on the National KPI

Reference manual.

Ongoing System SupportProvided ongoing eLMIS user support for

facilities in the redesigned system as well as

the current system.

Laboratory OptimizationPresented results and recommendations from

the laboratory network optimization activity,

which were accepted and taken for action.

Objective 3: Broaden

Stakeholders’

Understanding

and Engagement

with the Supply

Chain System

IMPACT TeamsIncreased the use of supply chain data for decision making

by scaling up implementation of IMPACT teams, which

provide a structured approach for commodity managers

(such as R/CHMTs) to use data to identify challenges and

create action plans. In collaboration with PO-RALG,

EGPAF, THPS, and inSupply, IMPACT teams were rolled

out in Geita, Kagera, Simiyu, and Tabora this quarter.

Objective 4: Strengthen

Enabling

Environment to

Improve Supply

Chain Performance

Support to RBFConducted a process evaluation for the MSD supply

chain component of RBF.

GovernanceDeveloped recommendations for strengthening PO-

RALG oversight of health supply chain implementation.

KEY ACCOMPLISHMENTS THIS QUARTER

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WORK STREAM

ACCOMPLISHMENTS

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Objective 1: Strategic Planning 2 3 4

Overview In Year 3, the project began supporting a new set of activities under the Global Health Security Agenda (GHSA), focused on adapting an

emergency supply chain (ESC) framework for the Tanzania context.

Activities

and

Impact

Related

KPIs

N/A

GHSC TA-TZ, in collaboration MoHCDGEC, conducted an ESC table top simulation

in Mwanza to strengthen Tanzania’s capacity to prepare for and respond to unfolding

public health emergencies (PHEs). The simulation was officiated by MoHCDGEC’S

Acting Director from the Emergency, Preparedness and Response Unit (EPRU), who

highlighted the link between the simulation training and recommendations from the

Joint External Evaluation (JEE) conducted in 2016.

The simulation and training was timely given the high risk posed by the Ebola

outbreak in neighboring countries. Participants included representatives from

MoHCDGEC, PO-RALG, selected members Kigoma and Kagera RHMTs, selected

members of Ngara and Kasulu CHMTs, MSD, and Development Partners (DPs).

Using the Tanzania Emergency Supply Chain Operations Guidelines (TESCOG)

developed by project personnel, participants practiced decision-making during

simulated Ebola and Cholera outbreaks. These simulated scenarios provided

participants a low-stakes environment in which to learn and apply leading practices in

communication and coordination.

SUPPORT TO STRENGTHENING EMERGENCY SUPPLY CHAINS AS PART OF

THE GLOBAL HEALTH SECURITY AGENDA

Participants from MoHCDGEC, PORALG, DPs, selected RHMT members (from Kagera and Kigoma region), CHMT

(from Kasulu and Ngara), DP, MSD practice table top

decision-making using Ebola and Cholera scenarios.

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Overview The project promotes deliberate and routine integration of costing and financing components into supply chain interventions, and alignment of

stakeholders around the cost of the supply chain and available funding sources.

Activities

and

Impact

This quarter, GHSC TA-TZ and an external consultant worked to align the health commodity revolving fund guidelines with government

standards. The guidelines aim to ensure the sustainability of financing of medicines and medical supplies at health facility level by tapping into

complementary funds available, and retaining revenues generated by facilities through health commodities sales. The guidelines will be used by

facilities to improve:

• Collection of revenue for health services provided by health facilities

• Management of revenue collected

• Expenditure of revenue on health commodities

The project also kicked-off an activity to investigate the potential implications of Direct Health Facility Financing (DHFF), particularly on

product availability at the facility level. This study is expected to provide detailed analysis on the impact of a DHFF model for financing of

health commodities, and provide recommendations for ensuring that DHFF is leveraged effectively to improve the quality of health services

and availability of health commodities.

Related

KPIs1.1.1 Percentage of activities carried out in accordance with Costed Implementation Plan: N/A (reported semi-annually)

1.2.2 Percentage of health commodity needs budgeted to be covered by MoHCDGEC: N/A (reported annually)

1.2.3 Percentage of MoHCDGEC budgeted amount which is actually disbursed: N/A (reported annually)

SUPPORT SUPPLY CHAIN COSTING AND FINANCING STRATEGIES

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Overview The Tanzania mainland Logistics Management Services (LMS) was established by the GoT, with support from USAID and the Global Fund, to

coordinate supply chain activities of different MoHCDGEC programs under one unit. GHSC TA-TZ, in addition to providing technical assistance

to the central level LMS, has supported LMS operations at the zonal level with project staff based at MSD zonal warehouses, MSD Central, and in

Dar es Salaam. As of June 30 2019, GHSC TA-TZ no longer provides operational support or staffing to the LMS.

Activities

and

Impact

The project supported the transition of LMS staff from GHSC TA-TZ

structures to the MoHCDGEC by collaborating with the office of

Director of Administrative and Human Resource (DAHRM) of

MoHCDGEC. Numerous consultations and information sharing sessions

with USAID-funded LMS staff were provided to DHARM to facilitate

and smooth and timely transition from USAID to the GF funding

mechanism. The project supported the transfer process of assets

including vehicles, working tools and office furniture from USAID to

GoT ownership.

The project also conducted two phases of capacity building of LMS staff,

focusing on the newly recruited staff:

• Phase I: All Hands Meeting aimed to orient LMS staff to GoT

administrative processes. All LMS staff were in attendance, as were

external facilitators from MOH, PORALG, GFCU, RSSH, HIV Grant,

LFA, and GHSC TA-TZ.

• Phase II: Technical Training intended to build capacity of LMS

staff on Basic Logistics and Supply Chain Management; this involved

LMS staff and external facilitation from MoHCDGEC Programs and

Sections, MSD and GHSC TA-TZ.

Related

KPIs1.2.1 Percentage of LMS operational cost paid by GoT: N/A (reported annually)

SUPPORT THE TRANSITION OF LMS TO GoT STRUCTURES

LMS All Hands Meeting held from 24th to 26th April

at St. Gasper Conference

Centre-Dodoma

Participants in session during the LMS Basic Logistics and Supply Chain Management Training held at Edema Conference

Centre - Morogoro from 13th to 31st May 2019

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Overview In Zanzibar, the Logistics Management Unit (LMU) has been successfully integrated under the Chief Pharmacist Office (CPO) and is

responsible for organizing, monitoring, and supporting Zanzibar’s supply chain activities and logistics systems. The Zanzibar Supply Chain

Strategic Plan of 2017-2020 (and the related Zanzibar Supply Chain Costed Action Plan), dictates LMU-ZNZ’s activities and associated annual

work plans. Four GHSC TA-TZ staff currently provide operational and technical support to LMU-ZNZ, and will continue to do so until June

2020.

Activities

and

Impact

Quantification: The LMU completed a number of quantification exercises, including around ARVs, life-saving commodities, and essential

commodities. The ARV quantification exercise, including PipeLine training, was supported by TA from mainland project staff.

Fleet Management: The project, in collaboration with MSD, assisted the LMU and CMS in developing a Vehicle Use policy and SOPs for

fleet management. The project also provided an orientation to drivers on the policy and SOPs.

Data Use and Quality: The LMU updated the performance monitoring plan, and conducted quarterly supply chain performance review

meetings. Additionally, the LMU participated in the National Medicine Therapeutic Committee.

Increasing Data Visibility: With funding from the Global Fund, the LMU supported the rollout of the eLMIS facility edition (FE) at 5 facilities

as a pilot project.

Supportive Supervision: The LMU conducted supportive supervision, incorporating data quality assessment (DQA) protocols, and offered

on-the-job training (OJT) to support and strengthen the performance of facility staff.

Related

KPIsN/A

SUPPORT THE LOGISTICS MANAGEMENT UNIT: ZANZIBAR

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1 Objective 2: In-Country Logistics 3 4

Overview GHSC TA-TZ supports the implementation of the electronic logistics management information system (eLMIS) to improve data visibility, quality (via

automated data validation), and use. In addition to supporting eLMIS, the project also contributes to the broader Health Information System (HIS)

architecture, facilitating eLMIS integration with other HISs including Epicor9, DHIS2, the Government of Tanzania Hospital Management Information

System (GoTHOMIS), and the Health Information Mediator (HIM) and Muungano Gateway (interoperability layers).

Activities

and

Impact

Related

KPIs

2.1.1 Percentage of eLMIS issues reported and resolved with agreed SLA: 86%; 2.1.2 Percentage of eLMIS hosting/operational cost supported by GoT: N/A

(reported annually); 2.3.5 Percentage of health facilities submitting timely R&R: 96%

STRENGTHEN SUPPLY CHAIN MANAGEMENT INFORMATION SYSTEMS

systems resulting in significantly improved supply chain visibility.

• Options for “other sources of funds” from which to pay for health

commodities are now available.

• Health facility fulfillment data is now obtained from the Proof of

Delivery MSD mobile application. As MSD rolls out the application,

fulfillment data will be available in eLMIS and MSD portal shown at

right.

Enhancing GoTHOMIS: Following MoHCDGEC & PO-RALG joint guidance to stakeholders in the health sector to support the

improvement of GoTHOMIS as a system of choice by the government, GHSC TA-TZ worked the GoT and IPs on an initial review of

existing GoTHOMIS functionality and requirements as well opportunities for integration with similar initiatives. The objective of the current

improvement plan is to reuse and leverage existing efforts and best practices and to come up with an improved system to support service

delivery at the last mile.

eLMIS Transition: As part of the eLMIS transition where in-country/government staff will maintain, support, and own the system, two

working sessions were conducted to build the capacity in nine government software developers from both MoHCDGEC and PO-RALG to

learn the eLMIS code base. The project continued to provide routine eLMIS support through Helpdesk service, for those in Mwanza and

the other zones.

Increasing Data Availability: The eLMIS was reconfigured per system redesign parameters, and monthly stock-on-hand data is now

available for facilities in Mwanza zone, helping facilitate more accurate monitoring of the TLD transition. Other activities included:

• Health information exchange layers (Muungano Gateway & Health Information Mediator - HIM) bridged previous gaps between information

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Overview GHSC TA-TZ provides technical assistance and capacity building around quantification within MoHCDGEC (in mainland Tanzania and Zanzibar), to

increase ownership and sustainability of quantification for vertical programs and essential health commodities. In addition, the project broadly aims

to improve forecast accuracy and reduce stock imbalances throughout the public health supply chain.

Activities

and

Impact

Related

KPIs2.2.1 Level of country counterpart ownership in quantification and supply planning: N/A (reported annually)

2.2.2 Forecast accuracy: N/A (reported annually)

STRENGTHEN AND STREAMLINE QUANTIFICATION

ARV quantification debriefing in Dar es Salaam (May 2019)

TDF/3TC/DTG,

0%

54%

85% TDF/3TC/DTG,

85%

TDF /3TC/EFV,

77%

30%

10%

TDF /3TC/EFV,

10%

ABC/3TC+DTG,

5%0%

20%

40%

60%

80%

100%

Pre Jul-19 J19-J20 J20-J21 J21-J22

Transition of Adult 1l TDF/3TC/DTG

TDF /3TC/EFV

ABC/3TC+DTG

AZT/3TC + EFV

AZT/3TC/NVP

ABC/3TC+EFV

TDF/FTC/EFV

ABC+3TC+DTG,

20%

37%ABC+3TC+DTG,

37%

TDF+3TC+DTG,

15%

36% TDF+3TC+DTG,

36%

TDF+3TC+EFV(A),

10%

20% TDF+3TC+EFV(A),

20%

AZT+3TC+LPV/r,

5%

4%AZT+3TC+LPV/r,

4%0%

20%

40%

J19-J20 J20-J21 J21-J22

Transition of Pediatric 1l ABC+3TC+DTG

TDF+3TC+DTG

TDF+3TC+EFV(A)

AZT+3TC+LPV/r

ABC+3TC+ATV/r (A)

AZT+3TC+NVP (P)

AZT+3TC + EFV (P)

ABC+3TC + EFV (P)

ABC+3TC + EFV (P)

Scale enlarged to show detail

The project also supported RCHS and NMCP in updating the PipeLine databases, and submitted all supply plans to PSM.

In addition, project personnel participated in the IPT medicines (Isoniazid 100mg and 300mg) quantification exercise in June 2019. Exercise

attendees included representatives from IPS (AMREF, AGPAHI, THPS, MDH, KNCV), NTLP, NACP, RCHMTs and PORALG central.

The project supported the ARV quantification exercise from April 25 – May 7 which

modeled significant changes to adult and pediatric ARV regimens. Following the

quantification, the project conducted several analyses using stock status and upcoming

shipments to inform orders to be made, help determine timing of certain shifts (e.g.,

shifts to pediatric LPV/r formulations), and to identify options and associated

consequences for using alternative regimens. The project also helped NACP plan for

TLD transition, including the phasing in and out of different pack sizes of TLD. During

this transition period, stocks of ARVs will be closely monitored and the project will

work with NACP to highlight any stock imbalances.

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Overview One of the prioritized recommendations from the Holistic Supply Chain Review (HSCR) was to increase the frequency of ordering and resupply

for the in-country supply chains (including ILS, HIV/AIDS and TB supply chains). GHSC TA-TZ provides technical guidance on design decisions,

helps build consensus on those decisions, and works to align stakeholders on the process and approach to rollout the system. The project also

works to institutionalize the collection, review, and use of key performance indicators of the national health supply chain, across all stakeholders.

Activities

and

Impact

System Redesign: During Q2, the project supported the rollout of a redesigned logistics system in Mwanza. This quarter, the project continued

working closely with MSD and LMS staff of Mwanza zone to prepare monthly progress updates on quantitative indicators, challenges and solutions

for key stakeholders. The project participated in a consensus meeting with MoHCDGEC (PSU), PO-RALG, Global Fund and PEPFAR to discuss

the rollout of the redesigned logistics system. After the meeting, the project supported preparation of a joint implementation plan leveraging the

lessons learned from Mwanza to facilitate the improvement and scaling up of the redesigned system in the remaining 19 regions.

The MoHCDGEC has decided not to conduct a formal evaluation of the Mwanza pilot, per the original plan, but instead to document performance

on a monthly basis. A system redesign oversight committee was formed, comprised of MoHCDGEC, PORALG, GF, USAID, WHO & GHSC-TA-

TZ; TORs will be developed as soon as possible. The project also followed up on recommendations from the MSD Mwanza assessment,

highlighting actions that should be taken in order for MSD to comply with redesigned logistics system parameters.

KPI Reference Manual: During this quarter, the KPI Reference Manual was approved by MoHCDGEC. The manual contains a total of 16 KPIs,

and documents the parameters and stakeholders responsible for each indicator. Training on the manual and dissemination to key stakeholders is

scheduled for August 2019. The project continued to work with stakeholders to determine baselines and targets for five of the seven pending

KPIs. The remaining two MSD-owned KPIs are dependent on the completion of the ongoing rollout of a proof-of-delivery mobile app across all

zones. The rollout will facilitate reporting MSD item fill rate and on-time delivery.

Management of MDR TB Medicines: The project supported the rapid assessment of multi drug resistant (MDR) TB medicines supply and

management practices. This was in response to an NTLP request to explore potential areas for streamlining management of MDR TB medicines,

as limited focus was given to these medicines during the system redesign initiative. The project provided technical input in developing the rapid

assessment plan and tools, facilitated the orientation of a data collection workshop and participated in data collection. A total of 14 health facilities

were visited between the 7th and 10th May, 2019.

Related

KPIs

2.3.1: Stockout rates for tracer commodities (see PMP); 2.3.2: Inventory turns (see PMP); 2.3.3: Cycle times (see PMP); 2.3.4: Percent of

shipments delivered on time and complete within agreed window (see PMP); 2.3.6 ACT, SP, mRDTS Purchased & Distributed with USG funds:

N/A (reported annually); 2.3.7: Stocked according to plan (see PMP).

IMPROVE SUPPLY CHAIN PERFORMANCE AGAINST KEY INDICATORS

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Overview GHSC TA-TZ, in collaboration with MoHCDGEC, PO-RALG, USG and IPs, provides technical assistance to strengthen the in-country laboratory

supply chain, focusing on the quantification of laboratory commodities, the implementation of lab-related recommendations from the HSCR, and

the optimization of the laboratory network.

Activities

and

Impact

Laboratory HIV Quantification: The project provided technical assistance on the laboratory HIV quantification exercise throughout all stages

of the process, from data gathering through assumption building, forecasting, supply planning (using PipeLine), and documentation of results for

debriefing meetings. The scope included rapid test kits (RTKs), HIV Viral Load (HVL), HIV Early Infant Diagnosis (EID), hematology, chemistry,

microbiology, and general consumables; during this exercise, hematology and chemistry were not included due to the pending completion of

standardized equipment lists. Following the quantification, the project collected and analyzed data on HVL and HEID machines to determine the

current machine availability and their percentage split among platforms. Results showed that Roche has 75% coverage while Abbot has 25%.

Laboratory Pipeline Monitoring: As part of ongoing efforts to strengthen supply planning, the project provided technical assistance to

MoHCDGEC/NACP on laboratory pipeline monitoring, wherein actual consumption rates from facilities were aggregated from eLMIS, analyzed

and entered to PipeLine database, along with stocks on hand. The project worked with new employees at NACP to build skills in PipeLine

database management, and outputs from PipeLine were shared with relevant stakeholders.

Laboratory Network Optimization: Following the laboratory network optimization activity from last quarter, the project presented the

results and recommendations at the laboratory supply chain meeting and at the laboratory HVL and HEID technical working group. Results were

accepted and recommendations taken for implementation.

Stakeholder Engagement: The project facilitated HVL and EID supply chain discussions through ECHO with stakeholders on HVL/EID

milestones, storage, distribution and inventory levels. The project also conducted a meeting with supply chain stakeholders at MSD to discuss

challenges including Abbot reagents transportation and reagent quality.

Related

KPIsN/A

STRENGTHEN LABORATORY SUPPLY CHAINS

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1 2 Objective 3: Capacity Building 4

ESTABLISH A CULTURE OF COLLABORATION AND INFORMATION SHARING

Overview Collaboration with in-country stakeholders is central to the project’s approach to supply chain strengthening, decision-making, and management.

Coordination groups (such as commodity security meetings and technical working groups) provide a mechanism to share supply chain data, align

objectives, and facilitate the effective management of commodity-related resources. The project provides quantitative and qualitative data on

supply chain performance to these groups to promote information sharing and the use of data for decision making.

Activities

and

Impact

HIV Supply Chain: The project participated in a series of meetings for HIV supply chains, including the HIV commodities subcommittees

meeting in Dodoma on 28th and 29th May 2019, and the HIV supply chain stakeholders' meetings in Dar from June 20-21st. The project provided

analysis on the stock status of ARVs and highlighted actions that need to be taken. Progress on TLD transition was also discussed, along with

various scenarios for pediatric ART.

information on supply chain activities and collaboratively develop solutions to those challenges.

HSCS’19: Building on the success from the first Tanzania Health Supply Chain Summit (HSCS), the project has begun preparations for the

second summit, to be held in October in Dar es Salaam.

Additional Collaboration Forums: The project continued participation in routine forums for information sharing, including the GHSA

partners coordination meeting, the JPPM in Zanzibar, the GoTHOMIS steering committee, and the Health Commodities and Technologies

Technical Working Group (TWG).

Related

KPIs

3.1.1 Number of information sharing technical forums supported by providing data for decision making: 16

3.1.2 Number of program reports produced and disseminated with other supply chain stakeholders: 10

Delegation from Mali during LMU study tour sessions at MSD Central and MSD Dar zone

LMU Task Force- Mali: In late April, GHSC TA-TZ

received a delegation from Mali (LMU Task Force) who

intend to establish an LMU in Mali. The project shared

our experiences and lessons learned in establishing and

supporting the LMU, and facilitated meetings with MSD,

LMU zonal offices and the head of LMS.

Supply Chain Partners Discussion Forum: The

project is revitalizing the supply chain partners discussion

forum, an informal forum for partners to share

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INCREASE DATA USE AND IMPROVE DATA QUALITY

Overview GHSC TA-TZ aims to improve supply chain performance by using supply chain data to inform decisions by key stakeholders at all levels of the

supply chain. The IMPACT team approach is establishing a sustainable structure encouraging commodity managers and other stakeholders (such as

R/CHMTs) to use data to check progress against key KPIs, conduct root cause analyses, and develop action plans for improvement.

Activities

and

Impact

The project continues to collaborate with stakeholders to implement IMPACT teams. IMPACT team members are trained in using data for

improved supply chain decision making. All IMPACT teams develop primary supply chain indicators to monitor; over time, they work to improve

these indicators through the development and implementation of action plans. From April – June 2019, the project, in collaboration with PO-

RALG, EGPAF, InSupply and MDH, coordinated and led IMPACT team orientation trainings in Geita, Kagera, Simiyu, and Tabora regions.

The framework is expected to be used by the PO-RALG central IMPACT team (once trained) in performance monitoring. PO-RALG requested

assistance to conduct an assessment of the implementation of IMPACT teams approach, scheduled for September. The project developed a

methodology for the assessment, which will utilize the developed M&E framework. The assessment will inform PO-RALG and other stakeholders

on areas to improve for greater efficiency and effectiveness of IMPACT teams.

Related

KPIs3.2.1 Number of national/subnational TWG meetings utilizing eLMIS reports for evidence-based decision making: 6

3.2.2 Number of unique eLMIS logins: 4,008

Q3 IMPACT Teams Rollouts

Regions TeamsTeam

Members

Collaborating

Partner

Geita 9 (1RHMT + 6

Councils + 2HMT)

72 MDH

Kagera 10 (1RHMT + 8

Councils + 1HMT)

96 MDH

Simiyu 9 (1RHMT + 6

Councils + 2HMT)

79 inSupply

Health

Tabora 13 (1RHMT + 6

Councils + 2HMT)

111 EGPAF

For the teams that have already been rolled out in Njombe, Singida, Pwani,

and Kigoma, follow-up support was provided for the ongoing IMPACT team

meetings. Implementing partners covered training costs while GHSC TA-TZ

developed training materials and provided technical support staff.

The project is focused on monitoring the performance of the supply chain in

IMPACT team implementing regions, and performance of the teams

themselves. GHSC TA-TZ supported PO-RALG to develop an M&E

framework, which includes KPIs for supply chain performance and

implementation progress. In collaboration with PO-RALG, the project set

performance benchmarks and criteria for ranking performance of the

IMPACT team implementing regions.

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INCREASE DATA USE AND IMPROVE DATA QUALITY THROUGH LMS/U

Overview LMS (Mainland Tanzania) and LMU (Zanzibar) are continually working to improve the visibility of logistics data across all levels of the public health

supply chain. Specifically, LMS/U has been advocating to accelerate the availability of quality data and promote a culture of using data for

performance improvement and decision making.

Activities

and

Impact

For the April – June 2019 quarter, the zonal LMS continued review of the Report and Request (R&Rs) forms submitted by the health facilities to

improve data quality before they are converted to orders for MSD processing and delivery. A total of 9,917 R&Rs were reviewed and approved

out of expected 5,582. Through the review process, 15% (1,441) of R&Rs were rejected due to data quality issues. The below table summarized

key statistics on R&Rs for this reporting quarter:

Notes: Due to its revised scope, LMS will not be reviewing, approving and rejecting R&Rs—that task has been shifted back to the councils.

Also, the above data do not include Mwanza, as the zone began implementing the redesigned system in Feb 2019.

Related

KPIs3.2.3 Percent of R&Rs passing data quality checks: 86%

STATISTICS ON R&R FORMS FOR APRIL – JUNE 2019

Months

# of R&Rs

Expected to be submitted

to MSD zones

Total # of

R&Rs Reviewed

and Approved

Total # of

Regular R&Rs

Total # of

Emergency R&Rs

Total # of

R&Rs Rejected

April-19 2,161 3,370 2,131 1,239 578

May-19 1,989 3,945 1,945 2,000 497

June-19 1,432 2,602 1,263 1,338 366

Total 5,582 9,917 5,339 4,557 1,441

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INCREASE SKILLS OF KEY COUNTERPARTS

Overview A focus on capacity building is integrated through most GHSC TA-TZ activities, and is intended to enhance the knowledge and skills of key

heath supply chain stakeholders within GoT. Stakeholders include GoT staff from all levels, as well as implementing partner staff and the larger

supply chain community. The project is working with key GoT stakeholders to support the development of an eLearning platform for the

health supply chain, which will serve as a foundation for all online learning efforts within the Tanzania health supply chain ecosystem.

Activities

and

Impact

eLearning Platform Development: In support of the eLearning platform, the project conducted an evaluation of proposals from potential

bidders in response to the RFP that was advertised by the project to secure additional technical expertise for the platform’s development,

content curation, and integration within existing GoT virtual learning efforts. The evaluation team consisted of staff from the project, PO-

RALG, PSU, MoHCDGEC’s Directorate of Human Resources and Training and Directorate of ICT. Seven bids were reviewed in the technical

evaluation process to find one successful proposal. The project has initiated communication with the successful bidder to begin planning for

our collaboration.

Supportive Supervision Harmonization: This quarter, the project participated in the supportive supervision harmonization activity that

was organized by the MoHCDGEC in Morogoro. The activity involved reviewing the supportive supervision tools of MoHCDGEC, PO-RALG

and partners and driving the development of one harmonized tool.

DQA Protocol Finalization: During the quarter, the project continued to work with PSU to finalize the data quality assurance (DQA)

protocols, which provide guidance on conducting DQA for health commodities at all levels of the supply chain. The protocol standardizes the

DQA exercise, including methodology for conducting a DQA, with the overall goal of improving data collection, analysis, management, and

reporting at the respective reporting levels for appropriate decision making.

Related

KPIsN/A

18


Overview Part of the LMS mandate is to help build capacity at the R/CHMT level through supportive supervision visits. These visits blend on-the-job

training (OJT) with mentoring, knowledge sharing, and discussion to help build the skills and knowledge of R/CHMT members in logistics and

commodity management. The LMS also works with implementing partners and other GoT stakeholders to identify and respond to supply chain

challenges.

Activities

and

Impact

For this reporting quarter, a total of 29 councils were visited by the zonal teams; supportive supervision was conducted in 20 councils, district

mentorship in 6 councils, and eLMIS training in 3 councils. A total of 103 health facilities were visited during the supportive supervision activities,

and OJT was conducted on key logistics areas and eLMIS for 259 and 309 healthcare workers, respectively. Most HCWs trained on eLMIS

received either district mentorship or training sessions conducted at the council level. The district mentorship (through IPs) is used as a strategy

to improve data quality before submitting R&Rs into the system.

Related

KPIs3.1.3 Number of joint supportive supervision field trips/reports made: 29

expiry. Finally, personnel provided inputs on how to best start Phase III considering challenges identified during Phase I and II distribution

process.

INCREASE SKILLS OF KEY COUNTERPARTS THROUGH LMS/U

During supervision activities, R/CHMT personnel learn to use eLMIS

data to make decisions. A total of 35 members from R/CHMTs were

trained on conducting OJT and applying data-driven supervision of

lower level health facilities. In addition, 44 personnel were trained on

using eLMIS to analyze supply chain performance and make

appropriate operational decisions to avoid stock imbalances.

Through LMS staff seconded at MSD central, the project supported

distribution of TLD & DTG to 231 Phase I and II Health facilities. LMS

worked with NACP to help ensure that hospitals supposed to start

using TLD received and began dispensing to eligible clients and that

that ARV stock status was closely monitored during TLD transition.

Throughout, LMS supported data analyses and redistribution of other

regimens to facilities not immediately implementing TLD to avoid

719

33

95

5

39

214

6

227

25

57

0

50

100

150

200

250

April '19 May '19 June '19

Q3 Supportive Supervision and Capacity Building

Total # of councils visited for SS and Capacity Building

Total # of HFs visited

Total # of HCWs provided with OJT on key logistics areas

Total # HCWs provided with OJT - eLMIS

19

1 2 3 Objective 4: Enabling Environment

Overview The MoHCDGEC, in collaboration with PORALG, is implementing a Results-based Financing (RBF) scheme to improve the quality and

utilization of health services in primary care facilities. Tanzania’s RBF model links payment of cash upon verification of predetermined

performance indicators. Currently, the scheme is being implemented in eight regions and the MSD zones supporting these regions in Tanzania

mainland. GHSC TA-TZ has been supporting the implementation of RBF MSD’s central and zonal Strategic Business Units (SBUs), namely

central headquarters, central vertical program, transport, Mwanza, Tabora and Dar SBUs.

Activities

and

Impact

This quarter, the project has finalized data transcription, coding, analysis and report writing for the MSD supply chain component RBF process

evaluation. The report has been shared with MoHCDGEC for review. Key findings included the following:

The MoHCDGEC will resume SBU performance verification exercises in July 2019; the project has previously supported development of the

tools and approach to be used during the exercise.

Related

KPIs4.1.1 Percent of RBF performance incentives received by MSD SBUs: N/A (Due to the ongoing restricting of the RBF scheme, the project was

unable to report on the percentage of performance incentives received by SBUs.)

SUPPORT THE IMPLEMENTATION OF RESULTS BASED FINANCING SCHEME

• Total financial incentive received across SBUs over time as of

Oct-Dec 2017 quarter was TZS 578,504,195 out of total

ceiling budget of TZS 1,181,790,000 (43.2%). On average,

22% of total incentives received were not spent.

• There is a need to establish a link between the MSD supply

chain component and the health facility level, particularly on

order fill rate. In the MSD supply chain component, order fill

rate is calculated for all commodities ordered and not based

on the selected commodities (tracers) at the health facilities

implementing RBF.

• Commodity availability of a group of 10 tracer items across

SBU-served health facilities from 2015 – 2018 is shown at

right. In 2018, commodity availability dropped across SBUs

implementing RBF, with the exception of Tabora.

57%

72%66%64%

72% 74%80%

85% 83% 86%83% 81% 80%73%

0%

20%

40%

60%

80%

100%

Tabora Mwanza Muleba Sales Point Dar es Salaam

Commodity Availability by SBU

2015 2016 2017 2018

20

1 2 3 Objective 4: Enabling Environment

Overview With a range of stakeholders involved in supply chain strengthening activities, GHSC TA-TZ works to align PO-RALG and the MoHCDGEC on

supply chain priorities and clarify roles and responsibilities. The project works to help institutionalize these roles and responsibilities, and to

strengthen the oversight of supply chain implementation, particularly at PO-RALG.

Activities

and

Impact

Related

KPIs4.2.1 Overall health facility satisfaction rating for supply chain services: N/A (Due to the ongoing restricting of the RBF scheme, the project was

unable to report on the percentage of performance incentives received by SBUs.)

STRENGTHEN GOVERNANCE AND ACCOUNTABILITY

October 2018

Supported PO-RALG to survey alignment of

existing supply chain IPs

March 2019

Reviewed findings from PO-RALG survey and decided on developing

guidelines

May 2019

Supported MoHCDGEC and PO-RALG in

development of GoT-Partners alignment

guidelines

July 2019

Planning to review draft guidelines with other IPs

and DPs towards finalization

Partner Alignment Guidelines: GHSC TA-TZ has continued to support MoHCDGEC and PO-RALG in aligning

the activities of supply chain partners. This quarter, project personnel formed a task team to draft guidelines for

GoT and partner alignment. The guidelines account for the number of partners supporting different commodity

groups, ranging from 14 partners supporting HIV to 3 working on emergency outbreaks shown in the chart below.

Over the next quarter, the project will review the draft guidelines with IPs, DPs, and other stakeholders to gather

feedback and support.

Roles and Responsibilities Guidelines:

The Guidelines for Roles and

Responsibilities in the Health Commodity

Supply Chain is awaiting signature from the

MoHCDGEC.

Strengthened PO-RALG Oversight:

The project developed recommendations

for strengthening PO-RALG oversight of

health supply chain implementation, based

on governance-related GoT policies. These

recommendations are expected to support

PO-RALG in strengthening their oversight

of health supply chain in wake of the

LMS/LMU transition to GoT.

14

12

11

11

10

10

9

5

4

3

3

HIV

Laboratory

Malaria

Reproductive health

Essential medicines

Tuberculosis

Maternal and child health

Nutrition

Vaccines/immunizations

Neglected tropical…

Emergency outbreaks

Number of Partners Supporting Different

Commodity Groups

21

QUARTERLY IMPLEMENTATION

CHALLENGES, RISKS, AND MITIGATION

MEASURES

22

IMPLEMENTATION CHALLENGES, RISKS, AND MITIGATION MEASURES

Risks and Challenges Mitigation

The project’s financial and operational support for the LMS ended June 30, 2019. As of June 30th, the

remaining staff (22) had not received contracts to continue their employment through Global Fund

support. Additionally, there were existing vacancies in the Global Fund supported staff. There has

been very limited communication by PSU to stakeholders on the LMS transition, as described in the

LMS Charter, and the LMS Steering Committee has not met on schedule.

• Continue to follow up on the status of contracts, push for

LMS Steering Committee meetings, and advocate for

increased communication to stakeholders.

From a project perspective, once we are no longer supporting LMU staff, we will not have routine

access to all data sources (some of which are included in the PMP). Further, the project will not be

able to respond to requests from USAID on specific commodity or supply chain issues at different

facilities or MSD zones.

• Recruit the two LMS Advisors, who will be able to facilitate

information sharing between the LMU/S and the project.

The MoHCDGEC has decided not to do an evaluation of the phase 1 implementation of the revised

logistics system in Mwanza. At the same time, there are some challenges which need to be addressed

prior to broader rollout of the system.

• Comprehensively document the challenges from Phase 1

implementation, and circulate to the Steering Committee.

• Actively participate in the Steering Committee that has

been established to ensure a sound rollout of the system.

Several challenges emerged around quantification. In our role as advisor, the project provides

technical input and guidance throughout the activity, though the process is owned and managed by

the government. At times, this input may not be incorporated or agreed to. The project continues to

struggle with the need to update PipeLine more frequently while the GoT guidance is to update it

quarterly.

• Continue to conduct analyses, outlining pros/cons of

various decisions that are made, and highlight actions to be

taken.

• Advocate for more frequent PipeLine updates.

A range of activities competing for attention and buy-in from GoT counterparts, coupled with the

need to cultivate ownership and facilitate sustainability means delay in timelines of implementation.

This is compounded by suboptimal communication across supply chain actors (MSD, PO-RALG, and

PSU).

• Share project workplan with PORALG, PSU, and other key

stakeholders, and collaboratively develop timelines for

completion.

• Hold routine meetings reviewing activity progress.

• Facilitate the implementation of stronger supply chain

oversight mechanism.

23

IMPLEMENTATION CHALLENGES, RISKS, AND MITIGATION MEASURES,

CONT.Risks and Challenges Mitigation

Delays in TEC approval have made it difficult for the project to commit specific support to GOT

beyond September 2019, as we must work under the assumption of a limited budget. As Year 4

workplanning approaches in August 2019, the risks of not committing specific support increase. As

the project awaits TEC approval, USAID has recommended prioritizing remaining project funds for

Y4 activities, potentially leaving Y5 drastically underfunded. If the TEC increase is not approved, the

project may be forced to close prior to completing intended activities and achieving desired

outcomes.

The project as engaged in constant communication with USAID

to emphasize the risks associated with delayed TEC approval,

however, a detailed risk analysis may be required.

Some emerging support from KOICA, UNICEF, and GF overlaps with support currently being

provided by the project. Insufficient coordination and alignment of stakeholders with scopes

overlapping with GHSC TA-TZ may make it difficult for the project to (a) influence MoH decisions

regarding the optimal technical approach; and (b) schedule project activities (i.e., redesigned system

rollout, MIS activities, etc.).

The project will continue to coordinate with emerging

implementing partners and advocate for alignment regarding

technical interventions. The project is also advocating for a

supply chain partners alignment guideline to guide all partners

supporting the country’s supply chain activities.

26

Q2 PROJECT MONITORING

PLAN REPORT

27

PROJECT MONITORING PLAN: Objective 1

OBJECTIVE MEASURE TARGET REPORTING

FREQUENCY

DIRECT OR

INDIRECT

Q4 JULY – SEP

2018

Q1 OCT – DEC

2018

Q2 JAN – MAR

2019

Q3 APR – JUNE

2019

1) Provide

Strategic Planning

and

Implementation

Assistance

1.1.1 Percent of activities

carried out in accordance with

Costed Implementation Plan

(CIP) from HSCR

recommendations

100% of CIP

activities carried

out by GoT by

2019

Semi Annual

(starting Year

2)

Indirect 73% 39%

1.2.1 Percentage of LMU

operational costs paid for by

the GoT

100% by 2019

will be paid by

GoT

Annual

(starting Year

2)

Indirect 2.5%

1.2.2 Percentage of health

commodity needs budgeted to

be covered by MoHCDGEC

Positive trend in

GOT funding for

health

commodities

Annual Indirect

ARVs 0%

RTKs 0%

RH 11%

Malaria 1%

EM 75%

1.2.3 Percentage of

MoHCDGEC budgeted

amount which is actually

disbursed

Positive trend in

GOT

disbursement for

health

commodities

Annual Indirect

ARVs 0%

RTKs 0%

RH 7%

Malaria 1%

EM 89%

28


FREQUENCY

DIRECT OR

INDIRECT

Q4 JULY – SEP

2018

Q1 OCT – DEC

2018

Q2 JAN – MAR

2019

Q3 APR – JUN

2019

2) Improve

Delivery of Health

Commodities in

Service Sites

2.1.1 Percent of eLMIS issues reported

and resolved within 24 SLA defined

performance period

80% Quarterly Direct 78% 89% 87% 86%

2.1.2 Percentage of e-LMIS

hosting/operational cost supported by

GoT

Positive trend

in GoT funding Annual Indirect 0%

2.2.1 Level of country counterpart

ownership in quantification and supply

planning

75% Annual Direct 81.8%

2.2.2 Percent forecast accuracy

(by commodity group)70% Annual Direct

ARVs 83%

RTKs 79%

RH 70%

Malaria 70%

mRDT 87%

2.3.1(a) Stock-out rate for tracer

commodities< 5% Quarterly Indirect

ARVs 6%

RTKs 8%

FP 20%

Malaria 20%

EM 14%

TB 7%

ARVs 7%

RTKs 5%

FP 18 %

Malaria 12%

EM 16 %

TB 9%

ARVs 6%

RTKs 20%

FP 19%

Malaria 10%

EM 20%

TB 6%

ARVs 11%

RTKs 12%

FP 22%

Malaria 12%

EM 19%

TB 7%

2.3.1(b) Stock-out rate for tracer

commodities (Mwanza Zone)< 5% Quarterly Indirect

ARVs 7%

RTKs 7%

FP 11%

Malaria 8%

EM 17%

TB -

ARVs 14%

RTKs 10%

FP 13%

Malaria 15%

EM 22%

TB 11%

2.3.2 Inventory turns (at MSD central) 2 Quarterly Indirect

ARVs 1

FP 1.4

Malaria 0.49

RTK 3

ARVs 2

FP 1.2

Malaria 2.1

RTKs 2

TB 1.3

ARVs 4

FP 0.9

Malaria 2

RTKs 3

TB 1

ARVs 1

FP 1.4

Malaria 2

RTKs 1

TB 2


29



FREQUENCY

DIRECT OR

INDIRECT

Q4 JULY – SEP

2018

Q1 OCT – DEC

2018

Q2 JAN – MAR

2019

Q3 APR – JUN

2019

2) Improve

Delivery of Health

Commodities in

Service Sites

2.3.3 Cycle Time (average) 14 days Quarterly Indirect 14 days 9.1 days 8.98 days 15.2 days

2.3.4 Percent of shipments delivered on time

and complete within an agreed upon window

(Central to Zonal level only)

80% Quarterly Indirect

ARVs 73%

RTKS 41%

FP 54%

Malaria 55%

TB 67%

ARVs 75%

RTKS 54%

FP 76%

Malaria 55%

TB 75%

ARVs 87%

RTKS 80%

FP 65%

Malaria 73%

TB 92%

ARVs 53%

RTKS 33%

FP 50%

Malaria 73%

TB 43%

2.3.5 Percent of facilities sending timely and

complete LMIS reports to the central level 80% Quarterly Indirect 96% 99% 98% 96%

2.3.6 Number of Artemisinin based

combination therapy (ACT), SP and mRDTs

treatments purchased in any fiscal year with

USG funds that were distributed in this fiscal

year

N/A Annual Indirect

ALU P/3 = 215,640

SP = 63562

MRDT = 307,607

2.3.7(a) PEPFAR commodities stocked

according to planN/A Quarterly Indirect

ARV 23%,

RTKs 23%,

Cotri susp: 21%

Cotri tablet: 22%

Male condom 17%

ARV 25%,

RTKs 17%

Cotri susp 20%,

Cotri tab 21%,

Male condom 12%

ARV 32%,

RTKs 13%

Cotri susp 19%,

Cotri tab 21%,

Male condom 15%

ARV 18%,

RTKs18 %

Cotri susp 14%,

Cotri tab 20%,

Male condom 13%

2.3.7(b) PEPFAR commodities stocked

according to plan (Mwanza Zone)N/A Quarterly Indirect

ARV 21%,

RTKs 25%

Cotri susp 19%,

Cotri tab 20%,

Male condom 25%

ARV 28%,

RTKs 21%

Cotri susp 24%,

Cotri tab 21%,

Male condom 15%

30


FREQUENCY

DIRECT OR

INDIRECT

Q4 JULY – SEP

2018

Q1 OCT – DEC

2018

Q2 JAN – MAR

2019Q3 APR – JUN 2019

3) Broaden

Stakeholders'

Understanding and

Engagement of the

Supply Chain

System

3.1.1 Number of information

sharing technical forums where the

project provided data for decision

making

N/A Quarterly Direct 17 28 44 16

3.1.2 Number of project reports

produced and disseminate with

other supply chain stakeholders


3.1.3 Number of joint supportive

supervisions conducted

72 supervision

annual Quarterly Direct 13 95 20 29

3.2.1 Number of

national/subnational TWG

meetings utilizing e-LMIS reports

for evidence-based decision

making


3.2.2 Number of people logging-in

into e-LMIS N/A Quarterly Indirect 2678 3245 3,663 4,008

3.2.3 Percentage of R&R passing

data quality check in specific

period.

N/A Quarterly Indirect 82% 84% 84% 86%

4) Strengthening

Enabling

Environments to

Improve Supply

Chain Performance

4.1.1 Percent of RBF performance

incentives received by MSD SBUs

over a specified period

Positive trend on

percentage

received of the

RBF performance

Quarterly Indirect

Central SBU 19.2%

Central VP 51.4%

Transport SBU 0%

Mwanza 49.6%

Dar 21%,

Tabora 59.6%,

Muleba 77.4%

N/A N/A N/A

4.2.1 Overall health facility

satisfaction rating for supply chain

services

N/A Semi-annual Indirect

Very Good 6%

Good 60%,

Neutral 29%,

Poor 4%,

Very Poor 1%

N/A

PROJECT MONITORING PLAN: Objectives 3 & 4

31

ANNEXES

32

ACRONYMS

33

ACRONYM LIST (A-F)

ACT Artemisinin-based Combination Therapy

ART Antiretroviral Therapy

ARV Antiretroviral

CHMT Council Health Management Team

CIP Costed Implementation Plan

CMS Central Medical Store

CP Chief Pharmacist

DHIS2 District Health Information System

DMO District Medical Officer

DPP Directorate Of Prevention And Planning

DQA Data Quality Assessment

DRF Drug Revolving Fund

EID Early Infant Diagnosis

eLMIS Electronic Logistics Management Information System

EM Essential Medicines

ESP Emergency Supply Chain

FEFO First Expiry First Out

FP Family Planning

34

ACRONYM LIST (G-M)

GHSC TA-TZ Global Health Supply Chain Technical Assistance – Tanzania

GOTHOMIS Government of Tanzania Hospital Management Information System

GOZ Government of Zanzibar

HCWs Health Care Workers

HF Health Facility

HIM Health Information Mediator

HIS Health Information System

HIV Human Immunodeficiency Virus

HSCR Holistic Supply Chain Review

HVL HIV Viral Load

ILS Integrated Logistics System

IMPACT Information Mobilized for Performance Analysis and Continuous Transformation

IP Implementing Partner

KPI Key performance indicator

LMU Logistics Management Unit

MOH Ministry of Health (Zanzibar)

MoHCDGEC Ministry of Health, Community Development, Gender, Elderly and Children

MRDT Malaria Rapidly Test Kits

MSD Medical Store Department

35

NACP National AIDS Control Program

NMCP National Malaria Control Program

NPAP National Pharmaceutical Action Plan

NTLP National Tuberculosis And Leprosy Program

OIG Office Of Inspector General

PMTCT Prevention Of Mother To Child Transmission (Of HIV)

PO-RALG President’s Office Of Regional Administration And Local Governments

PS Permanent Secretary

PSM Procurement And Supply Management

PSU Pharmaceutical Services Unit

QA Quality Assessment

R&R Report And Request

R/CHMTs Regional Council Health Management Team

RCHS Reproductive And Child Health Services

RUM Rational Use Of Medicine

SBU Strategic Business Unit

SCMT Supply Chain Monitoring Team

SOP Standard Operating Procedure

ACRONYM LIST (N-S)

36

STTA Short Term Technical Assistance

SWOT Strength, Weakness, Opportunity And Threat

TA Technical Assistance

TFDA Tanzania Food And Drug Authority

TOR Terms Of Reference

TOT Training Of Trainers

UNICEF United Nations Children Emergency Fund

USAID United States Agency For International Development

WHO World Health Organization

ZNZ Zanzibar

ZSCAP Zanzibar Supply Chain

ZSCCAP Zanzibar Supply Chain Costed Action Plan

ACRONYM LIST (T-Z)

37

ROOT CAUSE ANALYSIS FOR

SELECTED PMP INDICATORS

Legend for PMP Indicator Graphs

Previous quarter metric

Q3 metric, did not meet target

Q3 metric, met/exceeded target

38

Performance

Trends and

Description

This quarter saw fewer issues reported to the eLMIS helpdesk compared to previous quarter. Between Apr – Jun 2019, reported

issues/tickets were 96 compared to 135 tickets the previous quarter. Of the 96 tickets, 82 (86%) were resolved with the agreed

SLA target of 24 hours, indicating that we’ve exceeded the target metric of 80% SLA adherence. The decrease in tickets is in part

due to personnel associated with the Mwanza system redesign becoming more familiar and more proficient with eLMIS, compared

to the first three months of the redesign as reported in the previous quarter.

2.1.1 PERCENTAGE OF eLMIS ISSUES REPORTED AND RESOLVED WITH SLA

77%

89%

93%

40%

50%

60%

70%

80%

90%

100%

Apr-19 May-19 Jun-19

% S

LA

Adhere

nce

SLA Adherence Apr - Jun 2019

39

Performance

Trends and

Description

The overall RTK stock out rate and stocked according to plan were 12% and 18%, respectively. Data shown in Q3 do not include

Mwanza zone facilities. The RTK stock out target of <5% was not achieved. However, out of the two types of RTKs monitored, SD

Bioline was able to meet the target.

Root Cause

Analysis • The overall stock out rate dropped to 12%, a decrease from last quarter when the stock out rate was 20%. Similarly, stocked

according to plan improved from 13% to 18%. The stockout rate affected by non-availability of Unigold. Following the January 2019

expiry of Unigold reported by most zones, a 2 MOS consignment of Unigold expiring in February 2020 was distributed. Shortages of

Unigold have been reported at MSD central in April 2019, which have contributed to facility level stockouts.

• Some zones have Unigiold that expires in July 2019 (Dar zone 598 kits and Tanga sales point 2 kits). Mbeya zone has 160 kits of

Unigold expiring in August 2019.

• In April 2019, zonal average fill rates of NACP laboratory commodities was 36% of which Unigold contributed significantly. Similarly,

in May 2019 the average including RTKs was 28%.

Notes on stocked according to plan: Stocked according to plan intends to show the stocks that are reported between established minimum and maximum stock levels (ILS: max = 6, min = 4; redesigned system: max = 4; min =2). These data are obtained from the most recent R&Rs submitted, which are submitted at the end of the review period, when resupply is requested. At this time, facilities may be below the minimum, but are not necessarily at risk of stocking out (a facility could have more than 3 months stock or more at the time of reporting, and still not be “stocked according to plan”.

2.3.1 STOCK OUT RATE: RTKs and 2.3.7 STOCKED ACCORDING TO PLAN: RTKs

8% 5%

20%12%

0%

20%

40%

60%

80%

100%

FY18 Q4 FY19 Q1 FY19 Q2 FY19 Q3

Stock Out Rate: RTKs

23%17% 13%

18%

0%

20%

40%

60%

80%

100%

FY18 Q4 FY19 Q1 FY19 Q2 FY19 Q3

Stocked According to

Plan: RTKs

5%

19%

0%

20%

40%

60%

80%

100%

SD Bioline Unigold

Q3 RTKs Stock Out Rate by

Product

40

Performance

trends and

description

The Q3 Mwanza RTK stock out rate was 10%, with stocked according to plan at 28%. The stock out target of <5% was not

achieved although for individual RTK types, SD Bioline attained the target of <5%

Root Cause

Analysis

• The overall stock out rate in Mwanza zone was 10%, an increase from the previous quarter. The overall stock out rate in other

zones was 12%. As in other zones, Unigold was the primary contributor to the stockout rates, with some stocks expiring in January

2019 and the depletion of the consignment from Global fund that expires in February 2020.

• As of June 2019, Mwanza zone and Muleba sales point were completely stocked out of Unigold.

• With regard to stocked according to plan, 28% of facilities stocked RTKs within the 2-4 months stock levels which are the established

minimum and maximum stock levels in regions undergoing system redesign.

2.3.1 STOCK OUT RATE: RTKs and 2.3.7 STOCKED ACCORDING TO PLAN: RTKs -

MWANZA

7% 10%

0%

20%

40%

60%

80%

100%

FY19 Q2 FY19 Q3

Stock Out Rate: RTKs

(Mwanza)

25% 28%

0%

20%

40%

60%

80%

100%

FY19 Q2 FY19 Q3

Stocked According to Plan:

RTKs (Mwanza)

5%

15%

0%

20%

40%

60%

80%

100%

SD Bioline Unigold

Q3 RTKs Stock Out Rates by

Produce (Mwanza)

41

Performance

trends and

description

Q3 ARV stock out rate and stocked according to plan were 11% and 18% respectively. Of note, the ARV list has been revised to

accommodate DTG based regimens which are recommended for first line treatment of HIV. In addition, two additional pediatric formulations

have been added. These changes have resulted in removal of some ARVs and replacement of new ones leading to 10 tracked ARVs in Q3

compared to nine in Q2. Out of the 10 ARVs for which stock-out data was collected, one exceeded the target.

Root Cause

Analysis

• The overall stockout rate was 11% this quarter, attributed to stock outs at MSD central: especially the Lopinavir-based pediatric formulations,

Lopinavir/ritonavir 200/50mg for adults, and Atazanavir/ritonavir 300/100mg. Low fill rates were reported in April and May 2019. For

Lopinavir/ritonavir adults, reported stock outs have also been attributed to expiry date of May 2019. Facilities stocked according to plan also

dropped from 32% last quarter to 18% this quarter.

• The stock out of Lopinavir/ritonavir 100/25mg has affected the availability of Lopinavir/ritonavir 80/20mg/ml at MSD, which was available prior

to the increase in consumption which resulted in shortages.

• With the newly introduced medicines (TLD and DTG), a plan was created whereby facilities were divided into three phases for transition.

Phase 1 included Regional and Referral Hospitals, and Phase II includes District and other hospitals. Dispensaries and health centers are

included in Phase III. Some challenges have been reported with TLD transition. Currently, the resupply of ARVs is based on past consumption

data; with the shift to TLD, resupply of other ARVs should be adjusted to account for anticipated lower consumption. As facilities begin

transition to TLD, there is a concern that other ARVs (such as TLE) will not be ordered.

• With the TLD transition, the project has supported the distribution of Phase I and Phase II of TLD and DTG, conducted analyses for ARVs in

critical state, and advised the program on how to embark on Phase III distribution following challenges in Phase I and II.

2.3.1 STOCK OUT RATE: ARVs and 2.3.7 STOCKED ACCORDING TO PLAN: ARVs

6% 7% 6%13%

0%

20%

40%

60%

80%

100%

FY18 Q4 FY19 Q1 FY19 Q2 FY19 Q3

Stock Out Rate: ARVs

23% 25%32%

17%

0%

20%

40%

60%

80%

100%

FY18 Q4 FY19 Q1 FY19 Q2 FY19 Q3

Stocked According to Plan: ARVs

28%19% 19% 19% 18%

13% 13% 11% 10% 8% 4%

0%

20%

40%

60%

80%

100%

Q3 ARVs Stock Out Rate by Product

42

Performance

trends and

description

Mwanza Q3 ARV overall stock out rate and stocked according to plan were 14% and 21%, respectively. However, changes were made to the

list of tracers to include the new first line ARV regimens for adults as well as additional pediatric formulations.

Root Cause

Analysis

• The overall stock out rate of ARVs in Mwanza zone was 14% compared to 11% in the other zones. The stock out rate is attributed to stock

outs of Lopinavir/ritonavir 100/25mg at national level. In addition, Lopinavir/ritonavir 80/20mg/ml availability shifted from being consistently

available in previous quarters to experiencing severe shortages as due to increased consumption from patients formerly receiving

Lopinavir/ritonavir 100/25mg.

• As reported in other zones, Mwanza reported stock outs of Atazanavir/ritonavir 300/100mg in April 2019.

• To mitigate stock outs of ARVs in the future, the project has began monthly supply plan monitoring, reviewed our business processes with

PSM to ensure alignment, and strengthened coordination with GF. The project will continue to collaborate with NACP and Implementing

partners to ensure smooth TLD transition and disseminate appropriate information to service delivery points without affecting reporting and

requesting of other regimens /formulations

2.3.1 STOCK OUT RATE: ARVs and 2.3.7 STOCKED ACCORDING TO PLAN: ARVs -

MWANZA

7%12%

0%

20%

40%

60%

80%

100%

FY19 Q2 FY19 Q3

Stock Out Rate: ARVs

21% 22%

0%

20%

40%

60%

80%

100%

FY19 Q2 FY19 Q3


ARVs

30%26%

20% 20%12% 9% 9% 7% 6%

0% 0%0%

20%

40%

60%

80%

100%Q3 ARV Stock Out Rate by Product

43

Performance

trends and

description

Q3 Malaria commodities had overall stock out and stocked according to plan rates of 12% and 17%. Data shown in quarter two do not include

Mwanza zone facilities. The target of <5% has not yet been achieved.

Root Cause

Analysis

• The overall stock out rate for malaria was 12%, an increase from 10% the previous quarter. Similarly, stocked according to plan dropped from

23% in the previous quarter to 17% for this quarter.

• The average zonal fill rates for malaria commodities in this quarter were 73% for malaria products.

• The stock out rate has been attributed to stock outs of Quinine tablets and ALU presentations. Quinine tablets are a normal MSD saleable

commodities whose availability is subject to availability of funds. For ALU, zones reported that some facilities do not manage all four

presentations. In April 2019, it was reported that Chief pharmacist had submitted a draft minute sheet to PS that proposed to standardize

UOM across ALU packs

2.3.1 STOCK OUT RATE: MALARIA and 2.3.7 STOCKED ACCORDING TO PLAN:

MALARIA

13% 12% 10% 12%

0%

20%

40%

60%

80%

100%

FY18 Q4 FY19 Q1 FY19 Q2 FY19 Q3

Stock Out Rate: Malaria

20% 20% 23%17%

0%

20%

40%

60%

80%

100%

FY18 Q4 FY19 Q1 FY19 Q2 FY19 Q3


Malaria

36%

18% 15% 15% 14% 13%8% 7% 6%

0%

20%

40%

60%

80%

100%

Q3 Malaria Stock Out Rate by Product

44

Performance

trends and

description

Mwanza Q3 Malaria stock out and stocked according to plan were 15% and 19% respectively. Two of the reported products, Sulphadoxine

and Pyrimethamine (SP) and mRDT met the stock out rate target of < 5%

Root Cause

Analysis

• During quarter three, the overall stock out rate of malaria commodities in Mwanza zone was 15% compared to the 12% reported for

other zones. As in other zones, the products most frequently stocked out were quinine tablets and ALU presentations

• Muleba sales point reported through ZPR of May 2019 shortages of malaria commodities at both central and sales point especially ALU 4

(0.2MOS)

• For Mwanza zone, 19% of malaria commodities were stocked adequately compared to 17% in other zones.

2.3.1 STOCK OUT RATE: MALARIA and 2.3.7 STOCKED ACCORDING TO PLAN:

MALARIA - MWANZA

8%15%

0%

20%

40%

60%

80%

100%

FY19 Q2 FY19 Q3

Stock Out Rate: Malaria

(Mwanza)

21% 19%

0%

20%

40%

60%

80%

100%

FY19 Q2 FY19 Q3


Malaria (Mwanza)

37%

27% 26%21% 19% 16%

6% 4% 3%

0%

20%

40%

60%

80%

100%

Q3 Malaria Stock Out Rate by Product (Mwanza)

45

Performance

trends and

description

Q3 TB commodity stock out and stocked according to plan rates were 7% and 14% respectively. A new product was added to the list of TB

medicines to be monitored - Isoniazid 100mg for pediatrics. Two of the four products, RHZE and RH, achieved the target of <5%.

Root Cause

Analysis

• The overall stock out rate for TB products was 7% compared to 6% the previous quarter. TB stocked according to plan was at 14%, down

from 19% in the previous quarter. Both Isoniazid100mg and Isoniazid 300mg contributed to the higher stock out rate.

• As of April 2019, all MSD zones experienced stock outs of Isoniazid 100mg at (0.6 MOS). Shipment is expected in September 2019

• Average zonal fill rates for April and May were 39% and 36% as a result of shortages of Isoniazid, RHZE, RHZ and RH.

• In both April and May 2019, Tanga sales point had the highest fill rate of 61%.

• Isoniazid 100mg and 300mg are the main contributors to the high stock out rate due to scale up of IPT which has increased the demand

significantly. Clinical service delivery partners especially those focusing on HIV care and treatment services have targets for IPT hence the

shortages. In rectifying these challenges in availability of TB medicines, GHSC-TA-TZ has supported NTLP in the quantification of INH and

provided technical advice. In addition, the project through LMU collaborated with MSD to carry out interzonal transfers and interfacility

redistributions.

2.3.1 STOCK OUT RATE: TB and 2.3.7 STOCKED ACCORDING TO PLAN: TB

7% 9% 6% 7%

0%

20%

40%

60%

80%

100%

FY18 Q4 FY19 Q1 FY19 Q2 FY19 Q3

Stock Out Rate: TB

22% 22% 19%14%

0%

20%

40%

60%

80%

100%

FY18 Q4 FY19 Q1 FY19 Q2 FY19 Q3

Stocked According to Plan: TB

17%8%

3% 2%

0%

20%

40%

60%

80%

100%

Isoniazid BPTablet 100

mg

Isoniazid300mg tabs

RHZE RH

Q3 TB Stock Out Rate by Product

46

Performance

trends and

description

Mwanza Q2 TB Commodity overall stock out rate and stocked according to plan were 11% and 25% respectively. Note that, in the previous

quarter, data on stock out rate for TB medicines could not be obtained. Also, Isoniazid 100mg has been added to the list of TB medicines

to be monitored. Out of the four products, only Isoniazid 100mg did not achieve the target of <5%.

Root Cause

Analysis

• The overall stockout rate for TB products was 11% for this quarter which is higher than the 7% stock out rate in other zones. As in other

zones with Isoniazid 100mg, which is the main contributor to the high stock out rates in Mwanza zone. The scale up of IPT increased the

demand significantly. TB stocked according to plan was at 25%.

• Average zonal fill rates have been as low as 26% in April 2019 where Muleba sales point had the lowest fill rate of 19%.

• In May 2019, Mwanza zone and Muleba sales point had fill rates of 50% and 34% respectively. The average zonal fill rate was 36%.

2.3.1 STOCK OUT RATE: TB and 2.3.7 STOCKED ACCORDING TO PLAN: TB-

MWANZA

11%

0%

20%

40%

60%

80%

100%

FY19 Q3

Stock Out Rate: TB

(Mwanza)

25%

0%

20%

40%

60%

80%

100%

FY19 Q3


TB (Mwanza)

27%

5% 2%0%

0%

20%

40%

60%

80%

100%

IsoniazideBP Tablet100 mg

Isoniazid300mg tabs

RHZE RH

TB Stock Out Rate by Product

(Mwanza)

47

Performance

trends and

description

Q3 essential medicines stock out rate was 19%. Data shown is for all zones excluding Mwanza. Like in the previous quarters, the target of

<5% has not yet been achieved.

Root Cause

Analysis

• The overall stock out rate of essential medicines was 19% for this quarter, a slight decline from the 20% of the previous quarter. The

main contributors include Cotrimoxazole suspension, Paracetamol and Albendazole. These are normal, saleable items at MSD that

facilities must pay for. With limited budgets, these products are not always prioritized by facilities to purchase. In addition, Amoxicillin

DT was also reported by several zones to have been stocked out. These include Moshi zone in April 2019 ZPR, Mtwara, Mbeya and

Iringa zones in May 2019 ZPR. As of May 31st 2019, there were 3MOS of stock of Amoxicillin DT.

• The project has supported FFARS integration with eLMIS. From July 2019, it is expected that FFARs will start collecting "Other Sources

of Fund" data from facilities which will facilitate purchases of commodities from MSD by health facilities using the other sources of funds.

2.3.1 STOCK OUT RATE: ESSENTIAL MEDICINES

14% 16%20% 19%

0%

20%

40%

60%

80%

100%

FY18 Q4 FY19 Q1 FY19 Q2 FY19 Q3

Stock Out Rate: Essential Medicines

33%27% 26% 26%

19%15% 15% 14% 12% 12%

0%

20%

40%

60%

80%

100%

Q3 Essential Medicines Stock Out Rate by Product

48

Performance

trends and

description

Mwanza Q3 essential medicines stock out rate was 22%. No single commodity has achieved the target of <5%.

Root Cause

Analysis

• During quarter three, the overall stock out rate of essential medicines in Mwanza zone was 22%, higher than the 19% in other zones.

• In Mwanza zone, the high stock out rate was mainly attributed to Amoxicillin DT. Muleba sales point in the April 2019 ZPR reported stock

outs of the commodity whereas Mwanza zone in the May ZPR also reported stock outs of Amoxicillin DT resulting in a spill over effect at

the service delivery points which were also stocked out.

• As of 31st May 2019, there were 3MOS of Amoxicillin DT at National level.

• Stock outs of FEFOL have also been reported by several zones. This is because FEFOL is a normal saleable commodity whose availability at

health facility level is subject to funding .

2.3.1 STOCK OUT RATE: ESSENTIAL MEDICINES - MWANZA

17%22%

0%

20%

40%

60%

80%

100%

FY19 Q2 FY19 Q3

Stock Out Rate: Essential Medicines

(Mwanza)

37%31% 30%

21% 20% 20% 18% 18%11% 8%

0%

20%

40%

60%

80%

100%

Q3 Essential Medicines Stock Out Rate by Product

(Mwanza)

49

Performance

trends and

description

Q3 RMNCH commodity overall stock out rate was 22% (not including Mwanza zone). The target of <5% has not yet been achieved.

Root Cause

Analysis

• The overall stock out rate of RNMCH commodities has increased from 19% in quarter two to 22% this quarter. Although data show high

stock out rate of emergency contraceptives, there are overstocks of emergency contraceptives at national level (13 MOS as of April 2019).

The main reason for the apparent high stock out rate of EC is that most of the facilities neither report on the item nor use it. The same

applies to Female condoms contributing to its higher stock out rate.

• Although male condom stock out rates decreased in Q3, stock outs have continue due to delays in distributing the 9 million condoms

received in March to 7000+ facilities (i.e., the March and April distribution). Stock outs of male condoms in part resulted from multiple part

numbers--one part number was out of stock so facilities ordering solely using that part number were more likely to experience stock outs.

• In addition, Tanga zone reported stock outs of Oxytocin, Depo-Provera and Magnesium sulphate and male condoms during the April 2019

ZPR in part due to the multiple part number issue. Other zones such as Dar, Iringa and Moshi, reported stock outs of male condoms at zonal

level in May 2019. Dar and Moshi zones and Tanga SP reported stock outs of Microgynon in April and May.

• As of May 2019, there were 7 MOS of male condoms, 1 MOS of oxytocin 10IU/ml and I MOS of Magnesium sulphate injection.

• GHSC-TA-TZ will collaborate with RCHS to raise awareness of and improve reporting on ECs and Female condoms in addition to working

with MSD sales officers to communicate part numbers to health facilities at zonal and regional levels via platforms such as WhatsApp groups

2.3.1 STOCK OUT RATE: RMNCH

20% 18% 19% 22%

0%

20%

40%

60%

80%

100%

FY18 Q4 FY19 Q1 FY19 Q2 FY19 Q3

Stock Out Rate: RMNCH

45%39% 37% 36% 31% 28% 26% 24% 21% 18% 15% 14% 14% 13%

0%

20%

40%

60%

80%

100%

Q3 RMNCH Stock Out Rate by Product

50

2.3.1 STOCK OUT RATE: RMNCH - MWANZA

Performance

trends and

description

Mwanza Q3 RMNCH commodity overall stock out rate was 13%. Out of the monitored RMNCH commodities, Cooper T IUD and

Misoprostol 20mcg achieved the <5% target.

Root Cause

Analysis

● During quarter three, the overall stock out rate of RMNCH commodities in Mwanza zone was 13%, lower than the 22%

stockout rate of other zones but higher than Mwanza’s Q2 rate of 11%. As in other zones, the high stock out rate was mainly

attributed to commodities such as Microgynon which were reported stocked out in the April 2019 ZPR.

● Additionally, Mwanza reported male condoms as stocked out in both April and May 2019.

● Mwanza zone experienced “false” stock outs of Emergency contraceptives and Female condoms due to personnel not reporting

on either commodity. RCHS will work to raise awareness about both commodities and promote better compliance with

inventory reporting procedures.

● GHSC-TA-TZ will continue to collaborate and work with the RCHS program to support the redesign.

11% 13%

0%

20%

40%

60%

80%

100%

FY19 Q2 FY19 Q3

Stock Out Rate: RMNCAH (Mwanza)

26% 25%21%

15% 15% 14% 13% 11% 10% 9% 9%6% 4%

0%0%

20%

40%

60%

80%

100%Q3 RMNCAH Stock Out Rate by Product (Mwanza)

51

Performance

Trends and

Description

96% of facilities submitted R&R submissions in a timely fashion compared to 98% last quarter. The chart on the right focuses on Mwanza

zone system redesign implementation which features only two reporting groups (A & B). R&R submissions for facilities reporting bi-

monthly was 99%.

Root Cause

Analysis

● Many councils submitted R&R on time. For the ILS program, Kibiti improved from making timely R&R submissions 50% of the time

last quarter to 67% this quarter. The improvement is due to close follow up of R/CHMT together with LMS to support the new

District pharmacist and help encourage health facilities to report on time.

● Other councils with timely reporting below 80% for ILS include Kilombero (61%) and Simanjiro (76%). The lowest performing

councils for this period include: Mpimwa council in Katavi (33% for ARVs) and for LAB, both Mbinga (33%) and Nyasa councils

(50%).

● Following the transition of LMS, the least performing councils should be monitored closely by the R/CHMTs together with LMS.

2.3.5 PERCENTAGE OF HEALTH FACILITIES SUBMITTING TIMELY R&R

99 99 99 9996100 100 100100

95100 98

0

20

40

60

80

100

B A B Average

% T

imel

ines

s

Reporting Groups

Timely Submission of R&R (Bi-Monthly)

RedILS RedLAB RedTB

93% 94% 97% 95%96% 99% 98% 98%93% 91%

95% 93%98% 100% 100% 99%

0%

20%

40%

60%

80%

100%

A B C Average

% T

imel

ines

s

Reporting Groups

Timely Submission of R&R (Quarterly)

ILS ARV LAB TB

52

Performance

trends and

description

In Q3, Cotrimoxazole suspension and Cotrimoxazole tablets were stocked according to plan at 14% and 20% respectively.

Root Cause

Analysis

• Note: Both Cotrimoxazole suspension and tablets are normal saleable commodities. Due to limited budgets at the facility level, these

products are not always prioritized for procurement.

• The project continues to advocate through R/CHMT for the procurement of CTX suspension and tablets via other sources of funds. An

added feature in eLMIS associated with the ongoing system redesign work, allows health facilities to state the source of funds while

procuring essential medicines can help ensure facilities order the saleable products.

2.3.7 STOCKED ACCORDING TO PLAN: COTRIMOXAZOLE TABLETS AND

SUSPENSION

21% 20% 19%14%

0%

20%

40%

60%

80%

100%

FY18 Q4 FY19 Q1 FY19 Q2 FY19 Q3

Stocked According to Plan: CTX Suspension

22% 21% 19% 20%

0%

20%

40%

60%

80%

100%

FY18 Q4 FY19 Q1 FY19 Q2 FY19 Q3

Stocked According to Plan: CTX Tablets

53

Performance

trends and

description

In Q3, Mwanza Cotrimoxazole suspension and Cotrimoxazole tablets were stocked according to plan at 24% and 21%

respectively.

Root Cause

Analysis

• Note: Both Cotrimoxazole suspension and tablets are normal saleable commodities. Due to limited budgets at the facility level,

these products are not always prioritized for procurement

• In Mwanza zone, CTX suspension was more frequently stocked according to plan compared to CTX tablets.

• The availability of these commodities is subject to funding and prioritization at facility level.

2.3.7 STOCKED ACCORDING TO PLAN: COTRIMOXAZOLE TABLETS AND

SUSPENSION - MWANZA

22% 24%

0%

20%

40%

60%

80%

100%

FY19 Q2 FY19 Q3

Stocked According to Plan: CTX Suspension

(Mwanza)

20% 21%

0%

20%

40%

60%

80%

100%

FY19 Q2 FY19 Q3

Stocked According to Plan: CTX Tablets

(Mwanza)

54

Performance

trends and

description

In Q3, male condoms were stocked according to plan at a rate of 13% (not including Mwanza).

Root Cause

Analysis

• Male condom stocked according to plan declined from 15% in Q2 to 13% in Q3 despite improved system-wide availability. Multiple part

numbers, data quality issues, and distribution delays contributed to the drop in adequate stocking.

• The project continued to collaborate with MSD in inter-zonal transfers and inter-facility redistributions as a temporary remedial action

but pushed for distribution of received consignment in March to facilities that had been critically stocked out.

2.3.7 STOCKED ACCORDING TO PLAN: MALE CONDOMS

17%12% 15% 13%

0%

20%

40%

60%

80%

100%

FY18 Q4 FY19 Q1 FY19 Q2 FY19 Q3

Stocked According to Plan: Male Condoms

55

Performance

trends and

description

In Q3, male condoms stocked according to plan was 15%, compared to 20% the previous quarter.

Root Cause

Analysis

• In quarter three, stocked according to plan for male condoms was 15% compared to 20% the previous quarter. As in other zones, this

was due to multiple part numbers, data quality issues, and distribution delays.

2.3.7 STOCKED ACCORDING TO PLAN: MALE CONDOMS - MWANZA

20%15%

0%

20%

40%

60%

80%

100%

FY19 Q2 FY19 Q3

Stocked According to Plan: Male Condoms

(Mwanza)

56

TRAINING AND TRAVEL REPORT

(JANUARY – MARCH 2019)

57

Dates Purpose Responsible GHSC staff

April 1, 2019 Health Commodities Health Technologies Technical Working Group meeting Naomi Printz

April 1 – 2, 2019 EGPAF’s Biannual Supply Chain Meeting in Singida with the theme “Improving Logistics Data Use

for Decision Making”

Peace Nyankojo

Ondo Baraka

April 1 – 2, 2019 Shinyanga Regional Quarterly Experience Sharing Supply Chain Meeting organized by AGPAHI LMS Mwanza

April 8, 2019 Consensus meeting and roadmap development for development of SC KPI Dashboard. Hussein Hassan

Michael Kishiwa

April 8 – 12, 2019 Harmonization of Supportive Supervision Tools workshop; the aim of the workshop was to

harmonize and standardize supply chain supportive supervision tools across diseases programs

and IPs

Peace Nyankojo

Nabila Hemed

Juma Ikombola

April 8 – 12, 2019Capacity building training for eLMIS code base skills transfer to government software developers

in MoHCDGEC and PORALG.

Ian Manyama

Hussein Hassan

Alfred Mchau

April 15 – 17, 2019

April 16, 2019

Roll out of IMPACT team in Tabora region

NACP’s Advisors and recruitment and selection - Dodoma

Eddom Silabi

Ondo Baraka

Mavere Tukai

April 24 – 26, 2019

April 26, 2019

LMS staff All Hands Meeting

National Laboratory Advisory meeting - Dodoma

LMS staffs

Edna Edward

Peter Sangu

John Obonyo

Mavere Tukai

April 29 – May 9, 2019 Bagamoyo - ARVs quantification exercise

Nabila Hemed

Chediel Mbonea

Narsis Makori

Mavere Tukai

Q3 TRAINING AND TRAVEL REPORT

58


April 29 – May 7, 2019

May 6 – 8, 2019

Zanzibar – ARV quantification and PipeLine training

HCRF Guideline Development – Morogoro

Anneth Massawe

Naomi Printz

Mavere Tukai

May 7 – 9, 2019 Roll out of IMPACT team in Simiyu region Eddom Silabi

Ondo Baraka

May 7 – 10, 2019 Conduct a rapid assessment on MDR TB medicines management practices Vicent Manyilizu

Sharon Shayo

May 9, 2019 Debriefing meeting following ARVs quantification results Peace Nyankojo

Chediel Mbonea

May 13 – 31 , 2019 LMS Basic Logistics and Supply Chain Management training LMS Staff

Ian Manyama

Michael John

May 4 – 5, 2019 eLMIS Training to Moshi Mc HCWs Loius Nicas

Saad Hussein

May 6 – 7, 2019

Nairobi, Kenya

OpenLMIS community conducted a two-day workshop to orient the community developers on

the new reporting tool capabilities which comes with latest releases of OpenLMIS.

Ian Manyama

Hussein Hassan

May 10, 2019

Stakeholders alignment meeting called for by MoHCDGEC & PORALG jointly. The meeting

announced the Government decision to have invest and focus on One Platform solution at health

facility, hence directed DP & IP to support to achieve the goal

Mavere Tukai

Alfred Mchau

May 11 – 22, 2019

May 17, 2019

June 24, 2019

Provide technical assistance on HIV laboratory quantification exercise

Improved GoTHOMIS kick off meeting – Dodoma

GoTHOMIS Steering Committee Meeting – Dodoma

Joseph Lubenga (STTA)

Mavere Tukai

Mavere Tukai

Q3 TRAINING AND TRAVEL REPORT, CONT.

59


May 14 – 22, 2019HIV laboratory quantification exercise which covered HIV commodities for RTK, HVL, HEID,

Microbiology, Consumables. Albertho Chengula

May 23 – 31, 2019

Morogoro

GoTHOMIS requirement review and merging with other initiatives requirement for Improvement.

A PORALG and MoHCDGEC led activity

Alfred Mchau,

Ian Manyama

Hussein Hassan

May 25-27, 2019 Dodoma – Adhoc HIV clinical sub-committee Nabila Hemed

Mavere Tukai

May 28 – 29, 2019 Participated in the HIV commodities subcommittees meeting in Dodoma Vicent Manyilizu

May 28 – 31, 2019

Morogoro

Finalizing and testing integration of eLMIS, FFARS and MSD Epicor through Muungano gateway

and HIMHussein Hassan

May 28, 2019

To present GHSC TA-TZ project accomplishments during a Joint USAID Joint Planning and

Programming Meeting (JPPM) hosted by Zanzibar Malaria Elimination Program (ZAMEP) in

Zanzibar

Hubert Assenga

Abdul Mzale

May – June 2019 Zonal Supportive Supervision through GF funding Zonal SCMAs

June 8 – 10 , 2019 eLMIS Training to Mwanga Dc HCWs Gipson Mathias

Cosmas Kulaya

June 17 – 21 2019 Roll out of IMPACT team in Geita and Kagera regions Michael Deleli

Yusuf Mdogwa

Eddom Silabi

Ondo Baraka


60


June 10 – 14, 2019Capacity building training for eLMIS code base skills transfer to government software developers

in MoHCDGEC and PORALG

Ian Manyama

Hussein Hassan

Alfred Mchau

June 13, 2019

Attended the annual laboratory stakeholders meeting coordinated by MoHCDGEC supported by

THPS. Through the meeting the laboratory Diagnostic network optimization and respective

recommendations were shared.

Albertho Chengula

Chediel Mbonea

Godfrey Odinga

June 13 – 21, 2019 Support Emergency supply chain preparedness activities Emily Magurno (STTA)

June 14 - 20, 2019To support to MoHCDGEC to strengthen capacity in emergency supply chains preparedness in

responding to public health hazards in line with Global Health Security Agenda (GHSA) in Mwanza

Michael Kishiwa

Hubert Assenga

June 15 – 19, 2019

Dodoma

GoTHOMIS requirement review and merging with other initiatives requirement for Improvement.

A PORALG and MoHCDGEC led activity

Hussein Hassan

Ian Manyama

Alfred Mchau

June 17 – July 3, 2019 Support LMU closeout Bethany Saad (STTA)

June 24 – 28, 2019 Participated in the quantification exercise for IPT medicines (Isoniazid 100mg and Isoniazid 300mg)

in Tanga

Vicent Manyilizu

June 25 – 28, 2019 MOCDGEC Health financing meeting and Single National Health Insurance(SNHI) Fund where I

shared the status of HCRF and how it link with other cost sharing guidelines for Monitoring and

Evaluation. Also, discussed the possibility of link the health commodities Fund and SNHI

Regina Ndakidemi

June 27, 2019 Zanzibar Logistics Technical Working Group meeting Ondo Baraka

Naomi Printz


GLOBAL HEALTH SUPPLY CHAIN TECHNICAL ASSISTANCE

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