ZIMBABWE’S DELIVERY TEAM TOPPING UP SYSTEM: ADDING HIV TESTS AND NEVIRAPINE FOR PMTCT

David Alt, Country Director

Naomi Printz, Technical Advisor

2PEPFAR

Implementing Partner

Background for DTTU

• Started in late 2003 as the logistics system for condoms and contraceptives

• Run by Zimbabwe National Family Planning Council

• Funded by USAID through USAID | DELIVER PROJECT and DfID through Crown Agents

• Forced ordering delivery truck inventory control system

• Delivery truck loaded with commodities drives to all facilities (1600+ total) once in 4 months

• Facilities do not place orders

3PEPFAR

Implementing Partner

How a DTTU delivery works

• Delivery team arrives at facility and:• Questions SDP staff about losses and

adjustments and days out of stock• Carries out physical counts of commodities• Calculates the average monthly consumption• Calculates maximum quantity for the facility• Tops up the facility to maximum quantity level

• Facility Staff sign for the stock delivered• All calculations and receipts recorded on

Delivery/Receipt Voucher (DRV)

4PEPFAR

Implementing Partner

DTTU Achievements

• 97% Coverage (3% facilities not delivered to)

• More than 95% availability for condoms and contraceptives

• Reliable Logistics Management Information System (LMIS) with data on stock on hand, consumption, and losses & adjustments

5PEPFAR

Implementing Partner

Background to HIV test kit and NVP management

• Managed under the AIDS & TB Unit of the Ministry of Health and Child Welfare

• No national logistics data available reporting rates less than 30%

• No delivery system in place sites had to travel to central warehouse to collect stocks

• Reports of stockouts and overstocks• HIV test kits and NVP for PMTCT are FULL

SUPPLY commodities

6PEPFAR

Implementing Partner

Pilot for Adding HIV RTKS & NVP to DTTU

• MOHCW AND ZNFPC decided to pilot the addition of HIV RTKs and NVP- Jul to Dec 2007

• In 2 provinces: Matebeleland South and Mashonaland Central

7PEPFAR

Implementing Partner

Objectives of the pilot

To determine whether including HIV tests and NVP into DTTU would:

1. Make HIV RTKs and NVP widely available2. Improve reporting rates for RTKs and NVP

(Create a reliable LMIS)

8PEPFAR

Implementing Partner

Delivery Coverage – Mash. Central

DeliveryRun

Total Facilities

Received Deliveries

% Delivery Coverage

1 66 66 100

2 87 86 99

3 87 66 75

9PEPFAR

Implementing Partner

Delivery Coverage – Mat South

DeliveryRun

Total Facilities

Received Deliveries

% Delivery Coverage

1 52 52 100

2 54 50 93

3 56 52 93

10PEPFAR

Implementing Partner

Delivery coverage – new facilities

• Total of 30 new facilities in Mash Central• Total of 25 new facilities in Mat South• 38% of total coverage = new facilities

11PEPFAR

Implementing Partner

Reasons facility missed

• Heaviest rainy season flooded rivers• Drug rooms locked• Nurse away

12PEPFAR

Implementing Partner

Stock Out Rates - Mash Central

Product Run 1 Run 2 Run 3

Chase Buffer 33 37 2

Determine 11 5 2

SD Bioline 19 5 2

Oraquick 77 83 100

Infant Nev. 39 9 2

Matern. Nev 33 15 2

13PEPFAR

Implementing Partner

Stock Out rates – Mash Central

14PEPFAR

Implementing Partner

Stock Out Rates Mat. South

Product Run 1 Run 2 Run 3

Chase Buffer 65 25 16

Determine 0 4 6

SD Bioline 3 4 6

Oraquick 68 100 100

Infant Nev. 39 2 2

Matern. Nev 39 2 2

15PEPFAR

Implementing Partner

Stock Out Rates: Mat South

16PEPFAR

Implementing Partner

Linking logistics data and service statistics

• Elizabeth Glaser Paediatric AIDS Foundation (EGPAF) supporting PMTCT activities in Zimbabwe

• In conjunction with EGPAF, wanted to determine whether improved commodity availability led to an increase in clients served

17PEPFAR

Implementing Partner

Uptake of Maternal and Infant NVP Prophylaxis

Percentage Women and Infants Dispensed with sdNVP 12 Sites from Matabeleland South Jan-Dec 2007

66%61%

88%

66%

82% 83%

55% 55%

0%

20%

40%

60%

80%

100%

Jan - Mar Apr - Jun Jul - Sep Oct - Dec

Quarter - 2007

% Women Dispensed w ith sdNVP % Infants Dispensed sdNVP

18PEPFAR

Implementing Partner

Issues highlighted in the pilot

• Chase buffer use & unit of recording• Shelf Life of Oraquick new tiebreaker

has been identified• Packaging of nevirapine syrup• New PMTCT regimens

19PEPFAR

Implementing Partner

Results of the pilot

1. Rapid test kits and PMTCT NVP now widely available in the 2 provinces.

2. LMIS in the 2 provinces captures essential logistics data.

3. Reporting rate in the 2 provinces improved from 30% to 97% after only 3 deliveries.

It was recommended that HIV test kits and NVP to be added to the DTTU system and rolled out nationally as soon as possible.

20PEPFAR

Implementing Partner

Changes made to DTTU

• Number of commodities increased from 5 to 11

• Deliveries were changed from every 4 months to every 2 months

• Maximum stock reduced from 8 months to 4 months

• Standard operating procedures developed (along with new forms)

• All team leaders trained

21PEPFAR

Implementing Partner

Now….

• Integrated deliveries are being incrementally implemented throughout the country

• By end July, every facility in the country will be receiving integrated deliveries

• Pilot to automate the completion of the Delivery/Receipt Voucher has been started

22PEPFAR

Implementing Partner

Mazviita, Siyabonga,

Thank you!

Questions?????