Country Overview

Increasing donor commitments have resulted in continuous program scale-up from 70,000 patients under treatment in 2007 to 120,000 in 2008 and 180,000 in 2009.

Despite a highly severe and unstable economic environment, the Government of Zimbabwe is making significant progress in reducing infection rates and scaling up treatment for people living with HIV/AIDS. Since 2001, HIV infection rates for people aged 15-49 have dropped over 17 percent, from 33 percent to about 15.6 percent in 2009.  By 2009 the annual death toll from AIDS had fallen to 84,000 compared to 169,000 in 2005 as more AIDS patients were placed on ART.

SCMS provides first-line antiretroviral medicines (ARVs) for 59,000 patients (24 percent) of the 247,000 adult patients estimated to be on treatment in Zimbabwe as of June 2010. SCMS also provides Prevention of Mother-to-Child Transmission (PMTCT) ARV treatment for 4,200 mother/babies, Male Circumcision Kits (MC) and related commodities for 28,900 procedures, CD4 point of care machines and reagent for 25,000 tests, and supplies HIV test kits to perform more than 900,000 HIV tests in 2010.

Key Objectives

• Provide first line and PMTCT ARVs, HIV Rapid Test Kits, MC kits and CD4 Point of Care machines and reagents and other supplies to support the Government of Zimbabwe HIV and AIDS program
• Build capacity in quantification and supply chain management among Ministry of Health & Child Welfare partners
• Operate and continually improve sustainable National HIV and AIDS commodities logistics systems
• Enhance current central warehousing and distribution capabilities

Activities and Impact

Value of commodities delivered as of June 2010: $20 million

Procurement: SCMS supported the Logistics Sub-Unit (LSU) of the Ministry of Health and Child Welfare (MOHCW) and National Pharmaceutical Company of Zimbabwe (NatPharm) in the distribution of ARVs and Fluconazole to 69 ART sites in the Southern region.  In spite of ongoing economic challenges, partners continue to achieve full availability of ARV regimens at all treatment sites countrywide.  

WHO and UNAIDS have reported that male circumcision (MC) can reduce the risk of HIV transmission by 50 percent or more.  Zimbabwe has pioneered the procurement of MC supplies as the first SCMS-supported country to place a large scale order for MC kits.  In Zimbabwe, PEPFAR has committed $1.5 million in core funding for SCMS to procure the kits. These additional funds will allow SCMS together with Population Services International (PSI) to significantly expand the MOHCW MC Program that started in 2009. In collaboration with the MOHCW and PSI, SCMS completed product selection and forecasts for MC commodities to be procured with the funding to support approximately 28,000 MC procedures. Other commodities to be procured include: MC surgical instrument kits, consumable sterile kits, surgical procedure bulk items, infection prevention, waste disposal items, and emergency toolkits. The first shipment of MC kits arrived in Zimbabwe in August 2010 for the start of the MC Program.

Forecasting and demand planning: Zimbabwe is the first PEPFAR country to fully manage its own forecasting and demand planning process. Since November 2007, the LSU of the  MOHCW has led and managed quarterly updates to forecasts and supply plans for ARVs, HIV test kits, opportunistic infection (OI) drugs, and TB drugs, with limited SCMS guidance. The quantification results are presented to partners during monthly meetings of  Procurement and Logistics Subcommittee (PLS) of the National ART Partnership Forum, a program of the MOHCW.  Effective quantification for adult and pediatric ARVs, HIV rapid test kits, Fluconazole, Cotrimoxazole for OI, and TB drugs—including 24-month forecasts, 12-month supply plans and quarterly review of both—is helping to reduce the incidence of stockouts, lowering the price of purchased commodities and helping donors coordinate funding.

Logistics: SCMS works with the MOHCW to design, implement, and support a strong ARV ordering and distribution system based on a manual and a computerized logistics management information system (LMIS). The LMIS has been operating for more than a year, with encouraging results.

Distribution: In spite of Zimbabwe’s challenging economic environment, SCMS continues to maintain and operate a fleet of three ARV delivery trucks. These vehicles deliver ARVs to 115 initiating and follow-up sites in all provinces and 55 out of the 62 districts in Zimbabwe, helping to avoid stockouts and treatment interruptions. Beginning in 2004 SCMS began using a new distribution model, Delivery Team Topping Up (DTTU), in conjunction with the USAID | DELIVER PROJECT to ensure availability of products. DTTU is an inventory control and physical distribution system that is based on an informed-push logistics system for condoms, contraceptives, HIV and syphilis RTKs, nevarapine and the more efficacious tegimens for PMTCT.

Partner coordination:  SCMS provides key support to the PLS to coordinate the efforts of government agencies with donor and partner organizations such as the Clinton Foundation, DFID, Elizabeth Glaser Pediatric AIDS Foundation (EGPAF), the European Union, the Global Fund, Médecins Sans Frontières, and UNICEF.