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

ZIMBABWE’S DELIVERY TEAM TOPPING UP SYSTEM: ADDING HIV TESTS AND NEVIRAPINE FOR PMTCT. David Alt, Country Director Naomi Printz, Technical Advisor. Background for DTTU. Started in late 2003 as the logistics system for condoms and contraceptives

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

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  1. ZIMBABWE’S DELIVERY TEAM TOPPING UP SYSTEM: ADDING HIV TESTS AND NEVIRAPINE FOR PMTCT David Alt, Country Director Naomi Printz, Technical Advisor

  2. 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

  3. 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)

  4. 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

  5. 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

  6. 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

  7. Objectives of the pilot To determine whether including HIV tests and NVP into DTTU would: • Make HIV RTKs and NVP widely available • Improve reporting rates for RTKs and NVP (Create a reliable LMIS)

  8. Delivery Coverage – Mash. Central

  9. Delivery Coverage – Mat South

  10. 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

  11. Reasons facility missed • Heaviest rainy season  flooded rivers • Drug rooms locked • Nurse away

  12. Stock Out Rates - Mash Central

  13. Stock Out rates – Mash Central

  14. Stock Out Rates Mat. South

  15. Stock Out Rates: Mat South

  16. 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

  17. Uptake of Maternal and Infant NVP Prophylaxis

  18. 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

  19. Results of the pilot • Rapid test kits and PMTCT NVP now widely available in the 2 provinces. • LMIS in the 2 provinces captures essential logistics data. • 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.

  20. 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

  21. 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

  22. Mazviita, Siyabonga, Thank you! Questions?????

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