Country Overview

In two years’ time, the number of clients on active treatment has tripled from 50,000 to 150,000, with a more than fourfold increase in the number of treatment sites, from 170 to 750.

In Ethiopia, 85 percent of the country’s 73.9 million people live in isolated rural areas, bringing significant challenges to HIV/AIDS testing and treatment programs. Yet despite these obstacles, the country has made significant strides. In two years’ time, the number of clients on active treatment has tripled from 50,000 to 150,000, with a more than fourfold increase in the number of treatment sites, from 170 to 750.

SCMS is one of several international partners working with the Ethiopian government to increase access to testing and treatment. It has operated in Ethiopia since November 2006, at the request of PEPFAR/USAID. The primary mandate of SCMS was to take over supply chain management activities and support from the RPM Plus (now SPS) project and to expand logistics services to PEPFAR-supported programs and the national HIV/AIDS program in Ethiopia overall. As per USAID’s deadline of September 2008, SCMS has effectively completed the transition of activities, and adequately staffed up to meet the new challenges and realities of the national program.

Key Objectives

• Support quantification, supply planning and procurement of required HIV/AIDS-related commodities.
• Develop and implement a commodity tracking system to monitor supplies of HIV/AIDS medicines, test kits, laboratory supplies and medicines for opportunistic infections, and provide data for quantification, supply planning and program management.
• Develop and implement a comprehensive logistics management system.
• Strengthen logistics management practices and technologies to improve procurement and distribution.
• Improve availability of essential laboratory ART testing supplies and strengthen logistics management systems for laboratory commodities to support comprehensive HIV/AIDS testing and treatment.

Activities and Impact

Value of commodities delivered as of December 2008: $25.2 million

Antiretroviral therapy (ART) program: SCMS has supported the scale-up of ART by graduating the ART supply chain from an informed “push” system to a “pull” system, implementing demand-driven logistics to minimize understocking or overstocking of commodities. The pull system was rolled out to all existing and newly initiated sites within a two-and-a-half month period, and training was provided to more than 1,000 pharmaceutical and facility store personnel. In addition, over $5 million of ARVs has been delivered on an emergency basis to avert national stockouts and shortages in late 2008. In the past two years, no single report of an ARV stockout has been recorded—a testament to successful logistics performance.

Supply chain capacity building: SCMS has designed and implemented supply chain systems for antiretrovirals (ARVs) and laboratory reagents and other commodities in Ethiopia, enabling a dramatic reduction in emergency orders at the facility level—with commensurate gains in distribution efficiency. Rather than working through a parallel system, we have supported the country’s Pharmaceutical Fund and Supply Agency (PFSA) in implementing the Pharmaceutical Logistics MasterPlan. We have furnished a cold room for the central main store with refrigeration paneling, procuring and delivering adjustable pallet racking; light, medium, heavy-duty and refrigerated vehicles; and material handling equipment for six regional stores in 2008. SCMS supported the design of future pharmaceutical-grade regional warehouses for PFSA by contracting the services of two architectural and engineering firms. We are also supporting emergency and transitional logistics at PFSA while warehousing and transport capacity are built.

Partner coordination: SCMS has coordinated with key partners, from the government of Ethiopia to donors and implementers, for commodity security throughout the supply chain continuum—from forecasting and quantification to procurement, financing, and delivery. We are the designated Secretariat for the national HIV/AIDS Commodities Supply Chain Management Advisory Committee (HCSMAC), working to raise understanding of the importance and role of sustainable and robust supply chain management system in responding to the HIV/AIDS program. We have worked closely with the Ministry of Health, HIV/AIDS Prevention and Control Office (HAPCO), and the Clinton Foundation HIV/AIDS Initiative (CHAI) in supply chain planning and monitoring to avert stockouts and critical shortages by responding with emergency orders of first- and second-line ARVs. We have also facilitated the quantification of over 300 program commodities through National Quantification Exercises, enabling resource mobilization, procurement, and distribution planning.