Mission 12INI112: Short Term Technical Assistance of HIS and PSM Assessment for the National

Mission 12INI112: Short term technical assistance of HIS and PSM assessment for the National Aids Secretariat (NAS)

First mission summary: 16th February – 1st March 2012

Context

Given the difficulties encountered in the fight against HIV/Aids in the country and in view of the Phase 2 Round 9 negotiations with the Global Fund, the National Aids Secretariat (NAS) issued a request to the Initiative 5% in order to resort to Solthis technical assistance for the assessment of the HIV Information System (HIS) and Procurement and Supply Management system (PSM).

The following report summarizes the first mission of the two experts that took place between the 15th of February and the 1st of March:

-Sophie Ouvrard, on the PSM issues, from the 15th to the 29th of February

-Grégoire Lurton, on HIS issues, from the 20th of February to the 1st of March

Each mission started by a briefing with the National Aids Secretariat (NAS) and ended by a debriefing with the NAS and the National Aids Control Program (NACP).

1. Procurement and supply management (15th – 29th of February)

Two specific objectives have been assigned to Solthis:

-Assess the Procurement and Supply Chain Management situation at the central level and design a long-term capacity-building action plan

-Provide technical support on procurement issues during the Phase 2 Round 9 negotiations.

Sierra Leone has decided to submit the first draft of its request for the Phase 2 of the Round 9 to the Global Fund at the end of March. In order to respect this advanced deadline, most of this first mission was dedicated to prepare the PSM Plan including quantification issues for phase 2. The assessment was orientated towards the weaknesses and needs at each step of the PSM chain to identify possibilities of strengthening regarding the Phase 2.

The following activities were conducted:

-Meetings with the key actors of the Procurement and Supply Management System in order to assess the situation :

• National Aids Secretariat (NAS): Dr Kargbo (Director),Dr Veronica L. Deen (ART Pharmacist from the logistic unit) and Procurement unit
• National Aids Control Program (NACP): Dr Sesay (program manager) and Dr Conteh (ART manager)
• DHMT : HIV supervisor and logistic unit
• UNICEF: country representative
• WHO: HIV Aids adviser
• Board of pharmacy : Head Quality Control Laboratory &
• Principal Regulatory Officer

-Visit of Central store and district medical stores (Freetown only) to assess the situation onproducts storage and inventory stock management

-Visit of health facilities in order to discuss with their staff and assess their PSM-related reports (especially consumption report and patients on ART registers) and practices:

• ConnaughtHospital
• MurrayTownCommunityHealthCenter
• Ola During ChildrenHospital

In the context of phase 2 negotiations, the specific activities below were conducted:

-Review of the current products list. It appears that some crucial drugs were missing on the list, while some needed to be changed to suit the WHO recommendations. Thus, recommendations of rapid updates to the current guidelines (antiretroviral treatment, opportunistic infections) were issued in order to take into account the WHO recommendations.

-Review of the existing PSM plan and National guidelines related to PSM activities

-Data collection in order to elaborate quantification tools for ART and anti opportunistic infections (OI) drugs that suit Sierra Leone context

PSM next steps

Remote technical support will be provided for the following activities:

-Support national partners for the finalization of the rapid updates of national recommendations on ART/OI management

-Finalize Excel tools for quantifications (ART & OI drugs)

-Support NAS to quantify through the 2 methods (morbidity data and consumption data)

-Support the elaboration of PSM plan for phase 2 Round 9 and provide recommendations to strengthen PSM chain for HIV program.

The second mission (April) will focus on the whole system analysis, with a specific emphasis on health facilities to assess the needs of support especially for dispensing and inventory stock management. A mission to visit regional health facilities outside Freetown will be necessary in order to get a more accurate picture of the situation at the health facility level. At the end of the mission, a national workshop will take place to share the missions’ conclusions and design a long term capacity building plan to upgrade the PSM system.

2. HIV information system (from the 20th of February to the 1st of March)

The objective of the mission was to assess the needs of the information system to design a long term capacity building plan to upgrade the system

3 different elements had to be taken into consideration:

-Data needs: at the different level of health system, what are the information needed by Health System actors

-Review of data collection tools

-Coherence between assessed needs and tools

The following activities were conducted:

-Interviews of key Monitoring & Evaluation actors in order to assess the situation :

• NAS : Monitoring & Evaluation unit
• NACP : Dr Sesay (program manager) and Monitoring & Evaluation unit
• DHMT : HIV supervisor and Monitoring & Evaluation unit
• Unaids : Monitoring & Evaluation manager

-Visit of health facilities in order to discuss with their staff and assess their data collection tools (especially registers) and report practices :

• ConnaughtHospital
• MurrayTownCommunityHealthCenter
• Ola During ChildrenHospital

-Analysis of tools and reports collected throughout the mission

-Participation in meetings of M&E working group for the preparation of round 9 phase2, in charge of setting the working hypotheses to extrapolate the targets for the next phase.

So far, the following preliminary findings can be mentioned:

-Data need is well documented at the higher level. A new CSPro-based system has been developed, in order to integrate data circulation from district level to national level. NAS Data manager seems to be successfully leading this work.

-Most of data collecting tools at facility level appear to be appropriate, and properly used for data collection. There nonetheless seems to be a widespread misunderstanding about how to generate reports from these data collection tools. Most of all, loss to follow up seems to be not properly taken into account.

HIS next steps

The second mission will take place before the end of the second trimester in order to finish the HIS assessment and to organizea national workshop to share the missions’ conclusions and design a long term capacity building plan to upgrade the HIS system. As of now, a need to adapt the registries analysis methodology has been identified, as well as a need to work onPMTCTregistries.

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