Reproductive Health Commodity Security Strategic Plan 2007-2011

Publication date: 2007

[image: image6.png] June 2007 [image: image7.emf][image: image8.png] [image: image2.png] This document was produced with support from the U.S. Agency for International Development through the Action for West African Regional Health Project–Reproductive Health (AWARE–RH), and Deliver Project in collaboration with UNSRH/HIV/AIDSA. Foreword Sierra Leone has participated in a number of key conferences focusing on population and development, including the International Conference on Population and Development (ICPD) and ICPD+5. The ICPD Plan of Action adopted in 1994 establishes the right of women and men to be informed about their reproductive health choices and to have access to information and services to realize good health. Other international conferences include Mexico (1992); Rio de Janeiro (1992); Copenhagen (1995); Beijing (2000); and Johannesburg (2002). Also, sub-regional conferences on Repositioning Family Planning have been attended recently. Lessons learnt from these conferences marked the Government’s renewed commitment and support to Family Planning which is linked to the goal of the Reproductive Health Policy for Sierra Leone, “to improve the quality of reproductive and sexual health for all Sierra Leoneans with a bid to reducing poverty and achieving the Millennium Development Goals particularly those relating to reproductive and sexual health” and the current development plans of the country. My Ministry is aware that reproductive health commodity security and in particular contraceptive commodity security is a key strategy to achieving the above goals. It is an adjunct to the new programme on Reproductive and Child Health (RCH). Hence it is increasingly becoming a high priority for the Government of Sierra Leone, as well as for donors and stakeholders working in the country’s health sector to improve the contraceptive prevalence rate, reduce the total fertility rate, control HIV infections transmission rate, reduce maternal mortality and morbidity rates, increase the child survival rate and hence the quality of life of the citizenry. In preparing this strategic plan, the goals set for the ICPD were assessed and the present status of contraceptive commodity security evaluated. The information in this document should therefore assist Government and other development partners to plan for and develop meaningful programmes that will ensure contraceptive commodity security for users. Already, a significant financial and technical assistance for family planning has come from UNFPA and USAID. But to achieve and sustain reproductive health commodity security, other bilateral, multilateral organizations, NGOS, the private sector and the local business community, line ministries including Local Government are all expected to contribute to the implementation of this strategic plan. Any momentum gained now would serve as transition to attaining Reproductive Health Commodity Security. It is with joy and satisfaction therefore that my Ministry, in collaboration with development partners, presents this Reproductive Health Commodity Security Strategic Plan for 2007 to 2011. It is hoped that the implementation of this national strategy will assist Sierra Leone to progress towards sustained reproductive health commodity security and hence improve the reproductive well being of all living in Sierra Leone. [image: image9.png] Abator Thomas (Ms) Minister of Health & Sanitation June 2007 Acknowledgment The Ministry of Health and Sanitation acknowledges with gratitude the invaluable contributions, in financial and technical terms, of UNFPA, USAID, AWARE-RH and DELIVER PROJECT towards the development of the Reproductive Health Commodity Security Strategic Plan 2007-2011 for Sierra Leone. I am aware of the technical contributions made by, Dr. Meba Kagone of DELIVER PROJECT, Dr. Antoine Ndiaye and Simplice Kamdem of AWARE-RH, Dr Gifty Addico of UNFPA CST and Dr Adeoye Mustapha and Dr Peter S. Sikana of UNFPA Country Office. We thank them for helping us through the formulation of this important strategy implementation plan. I thank the Consultant, Mr. Moses L. J. Williams who conducted the assessment of Contraceptive Commodity Security in Sierra Leone; and also thank the multidisciplinary Contraceptive Commodity Security Committee members for their conscientious work towards the development of this document. I thank Dr Kechi Ogbuagu from UNFPA for complementing the various assessments of reproductive health commodity security situation in Sierra Leone carried out in the recent past. The findings and recommendations were used to fully reflect the wider RH commodity issues. Worthy of mention is the dynamic leadership of the Reproductive Health/Family Planning Programme towards the development of this document. Specific gratitude therefore goes to the Programme Manager, Alhaji Dr. K.S. Daoh, the Assistant Programme Manager, Dr. Francis Smart, and the FP Coordinator, Sister Isatu Jalloh, all of the Reproductive Health Division of the Ministry of Health and Sanitation for their tireless efforts towards the ongoing process of developing a contraceptive commodity security for this country. The Ministry acknowledges the contributions of all partners and stakeholders including individuals, communities and organizations or institutions towards the ongoing efforts to attain a reproductive health commodity security. I sincerely look forward to the continuing participation of all stakeholders in the implementation of this strategic plan. [image: image10.png] DR. ARTHUR C. WILLIAMS Chief Medical Officer ABBREVIATIONS AIDS Acquired Immunodeficiency Syndrome AWARE-RH Action for West African Region – Reproductive Health CBAs Community-Based Agents CCS Contraceptive Commodity Security CCSC Contraceptive Commodity Security Committee CEDAW Convention on the Elimination of Discrimination Against Women CLU Contraceptive Logistics Unit COC Combined Oral Contraceptives CPR Contraceptive Prevalence Rate CS Contraceptive Security CSOs Civil Society Organizations DACO Development Assistant Coordinating Office DHMT District Health Management Team DMPA Depo Medroxyl Progesterone Acetate EmONC Emergency Obstetric and Neonatal Care FP Family Planning GoSL Government of Sierra Leone HIV Human Immunodeficiency Virus ICPD International Conference on Population and Development IEC/BCC Information Education and Communication / Behaviour Change Communication IUCD Intra Uterine Contraceptive Device IUD Intra Uterine Device KAP Knowledge Attitude and Practice LIAT Logistics Indicators Assessment Tool LSAT Logistics System Assessment Tool LMIS Logistics Management Information System M&E Monitoring and Evaluation MIS Management Information System MOHS Ministry of Health and Sanitation MY&S Ministry of Youths and Sports NAS National AIDS Secretariat NGO Non Governmental Organization NPPU National Planning and Procurement Unit PAC Post-Abortion Care PHU Peripheral Health Unit PMCT Prevention of Mother to Child Transmission POP Progesterone Only Pills PRSP Poverty Reduction Strategy Plan RCH Reproductive and Child Health RH Reproductive Health RHCS Reproductive Health Commodity Security SPARHCS Strategic Pathway to Reproductive Health Commodity Security SRH Sexual and Reproductive Health STIs Sexually Transmissible Infections TFR Total Fertility Rate UNFPA United Nations Population Funds USAID United States Agency for International Development USD United States Dollar VHCs Village Health Committees VCT Voluntary Counselling Test Table Of Contents Outline Page Foreword ……………………………………………………………………………………………. .i Acknowledgement ………………………………………………………………………………. ….ii List of ABBREVIATIONS …………………………………………………………………………. .iii Table of Contents ………………………………………………………………….……………… iv Guide to terminology used in the Strategic plan…………………………….……………. …v Executive Summary ………….……………………………………………………………………….1 BACKGROUND …………………………………………………………………………………….3 1.1 Sierra Leone Context ………………………………………………………………………. 3 1.2 Contraceptive Security Situation Assessment ………………………………….…. ….5 Strategic Plan ………………………………………………………………………………….7 2.1 GOAL . ………………….…………………………………………………………………….7 2.2 Strategic Objectives per component………………………………………………………7 2.3 Specific Objectives And Activities Per Component…….………………………….8 2.3.1 Client Utilization and Demand ………………………………………………….8 2.3.2 Service Delivery ……………………………………………………………………10 2.3.3 Policy and Commitment ………………………………………………………….10 2.3.4 Capital ……………………………………………………………………………….11 2.3.5 Coordination and Partnership ……………………………………………….12 2.3.6 Logistics …………………………………………………………………………….12 2.3.7 Monitoring and Evaluation …………………………………………………….14 Action Plan ……………………………………………………………………………………15 3.1 Client Utilization and Demand …………………………………………………………. 15 3.2 Service Delivery…………………………………………………………………………. . 18 3.3 Commitment and Policy …………………………………………………………………. 21 3.4 Capital ………………….………………………………………………………………….24 3.5 Coordination and Partnership……………………………………………………. …….25 3.6 Logistics………………………………………………………………………………………27 3.7 Monitoring and Evaluation ……………………………………………………………. .31 Annexe 1: Estimated Total landed cost of contraceptives (USD) ………………………….33 Annexe 2: Estimated funding Requirements for Contraceptive Commodities, 2006–2011 ………….34 Annexe 3: Part duty and taxes in total cost of contraceptives …………………………….35 Annexe 3: Demographic, health, and development indicators for Sierra Leone ………….36 References and RESOURCES ……………………………………………………………………….37 List of tables, figures And boxes ………………………………………………………………. .38 Guide to Terminology Used in the Strategic Plan Each of the seven Components of the Strategic Plan is described in detail in this document. Every Component contains an overall Strategic Objective that describes the broad level of accomplishment expected within the component. Strategic Objectives are further broken down into a number of Specific Objectives that give details of the expected accomplishments for each component. RH commodity security vs. contraceptive security: In this plan, RH commodity security and contraceptive security are used in the sense that the primary goal of the reproductive health and family planning programme is to ensure that people can choose, obtain, and use a wide range of high-quality, affordable contraceptive methods and other reproductive health commodities. Referred to as RH commodity security, achieving this goal requires sustainable strategies that will ensure and maintain access to and the availability of reproductive health supplies. Issues Addressed: The specific problems or opportunities on which the objective focuses. Activities: A listing of the actions necessary to achieve the objectives. Coordinating Agency: For each component, the MOHS is the agency which coordinates the activities and sub-activities which will be undertaken. Coordination implies the harmonization, management, synchronization and direction of the activities undertaken by implementing agencies. The MOHS assumes overall responsibility for ensuring the accomplishment of all activities in the Strategic Plan. The specific office in the MOHS to assume this role is the RH Program. Implementing Agency: Each activity requires at least one organization to take responsibility for the accomplishment of the required actions. These implementing agencies will work under the coordination and direction of MOHS. Estimated Budget (USD): The estimated cost of implementing every activity and sub-activity. These figures should be considered as broad approximations until more detailed budgets are developed. Timing: The approximate time during which the activities and sub-activities are planned to be accomplished. Activities are marked as “done” where they have already been accomplished. Some activities are listed as “ongoing”, which indicates that implementation has begun, but is not yet completed. Output Indicators: Statements which describe the quantifiable products of the activities once implementation is completed. Outcome Indicators: A description of the measurable results which will be obtained once the outputs of the activities have been realized. Assumptions: A list of the preconditions, requirements and circumstances that must exist before and during the successful implementation of activities in the plan. Supply chain: Each of the four components of logistics management (storage and distribution, logistic management information system, forecasting, and procurement) represents a key function in the supply chain. An effective supply chain ensures the continuous supply of sufficient quantities of the high-quality contraceptives needed to achieve contraceptive security. Storage and distribution: This component includes managing storage capacity and conditions, standards for maintaining product quality, inventory control, stockouts, tracking system losses, and distribution and transportation systems. LMIS (Logistics Management Information Systems): This component includes managing reporting systems, the validation of data, information management and its use in decision-making. Forecasting: This component includes managing how estimates of product consumption are prepared, updated, validated, and incorporated into cost analysis and budgetary planning. Procurement: This component includes managing how forecasts are used to determine short-term procurement plans and the degree to which correct amounts of contraceptives are obtained in an appropriate timeframe. Unmet needs: This concept refers to the proportion of clients who desire to use family planning but are not currently doing so. The higher the percentage of women with unmet needs for contraception, the poorer the prospects for contraceptive security. Quality: It encompasses a range of programme elements/inputs that include maintaining standards for the procurement of reproductive health/contraceptive products and testing. This ensures compliance, improvement of acceptability, so that clients will be satisfied with the products and services being provided. This can be achieved through public awareness and correction of misinformation about RH/FP services and products. It requires improvement of the supply of basic RH/FP equipment at service delivery points, and providing a mix of products to cater for the various needs of clients. RHCS: is defined as ensuring a secure supply and choice of quality contraceptives and other reproductive health commodities to meet every person's needs at the right time and in the right place. Executive Summary In January 2006, the MOHS made the decision to develop a contraceptive security strategic plan for Sierra Leone. This high level policy decision came as a result of the estimation of the contraceptive requirements, which showed a financing gap to procure the needed products. The purpose of the strategic plan is to enable Government to adequately address the issue of reproductive health supply by putting together appropriate policy and advocacy mechanisms to ensure that the country meets the requirements for contraceptives and other supplies. The SPARHCS approach was adopted to develop the strategic plan and the SPARHCS guide adapted to the Sierra Leone context. The contraceptive security situation was assessed in July 2006 using the SPARHCS diagnostic guide. A Contraceptive Commodity Security Committee (CCSC) was formed to assist in the development of the strategic plan and oversee its implementation. Strengths and weaknesses identified during the RHCS assessments were used in the development of the strategic plan. In November 2006, a supplementary assessment was conduct by UNFPA, to complement the previous assessments of reproductive health commodity security situation in Sierra Leone carried out in the past and used the findings and recommendations to fully reflect the wider RH commodity issues. In February 2007, the Contraceptive Commodity Security (CCS) Strategic Plan was l In June 2007, the CCS Committee influenced by emerging issues, made the informed decision to expand the content of the Strategic Action Plan to include all relevant activities to ensue reproductive health commodity security and not just contraceptive security. The Goal of the strategic plan is as follows: Every woman/man in Sierra Leone will be able to choose, obtain and use quality reproductive health products including contraceptive methods whenever and wherever she or he needs them. The table below shows the strategic objective(s) for each component. Table 1: Strategic objectives per component Component Strategic Objective 1. Client Utilization and Demand Increase client demand and utilization for RH/FP services among adolescents, youth, women and men within reproductive age by 25% by 2011 Reduce the level of unmet need for RH/FP by 25% within 5years 2. Service Delivery Expand RH/FP services and improve quality to meet current and future demands 3. Policy and Commitment Endorse and Operationalize Reproductive Health Policy including other SRH/FP/HIV/AIDS Policy documents 4. Capital   Increase Government funding for RH/FP services Develop financial sustainability plan for RH/FP products/services 5. Coordination and Partnership Strengthen Coordination/Partnership for reproductive health including family planning services. 6. Logistics Achieve an effective and efficient RH/FP Logistic Management System in the country by the end of 2007 7. Monitoring and Evaluation Establish a functional monitoring and evaluation system to ensure that the strategic plan is well implemented. Budget Summary The budget provides estimates of costs for the implementation of the activities and the purchase of equipment and products during the 5 years of the plan. These costs do not include salaries for civil servants and partners’ interventions. The cost of contraceptives is presented in a separate table (see annexe1). Table 2: Estimated budget per component Component Cost (USD) Client Demand and Utilization 1,374,000 Service Delivery 3,649,000 Policy and Commitment 65,000 Capital 33,000 Coordination and Partnership 269,000 Logistics *1,718,500 Monitoring and Evaluation 248,000 Total 7,356,500 *Strategic Objective 2: Pharmacy Board = $840,000. Total:8,196,500 1. Background Sierra Leone Context Located on the west coast of Africa, Sierra Leone is a country with an area of about 72,000 square kilometres. It is bordered on the north and north-east by the Republic of Guinea and on the east and south-east by the Republic of Liberia and, by the west and south-west, the Atlantic Ocean. It gained independence in 1961. The official language is English with Krio being widely spoken. There are 16 ethnic groups in the country. The 2004 Population Census Report puts the country’s population at about 5 million persons with a sex ratio of 95 males to 100 females. About 48 percent of the population was aged between15 to 49 years. Women of childbearing age (15 -49) constitute about 25 percent of the total population of the country. The adult literacy rate is about 40%. The per capita income for the county is 273.01 USD with over 70 % of Sierra Leonean living below the poverty line of one USD per day. At the end of the ten-year rebel war (1991-2002) in the country, the rate of urbanization increased remarkably. About 37 percent of the population now lives in urban areas. However, the country still maintains its agrarian culture with about 63 percent of the people in agriculture. There is freedom of religious practice in the country. Data collected during the 2004 Population and Housing Census revealed that there were more Muslims than Christians in the country. Population Growth The population of Sierra Leone has grown over the years. In 1963 when the first census was held, the population was 2.2 million; it was 2.7 million in 1974 and 3.5 million in 1985. In 2004 when the last census was conducted Sierra Leone’s population was about 5 million. As can be seen from the table (annexe 4), the TFR which is 6.04, is among the highest in West Africa. The CPR is estimated at around 4 % which is the lowest in West Africa, comparable only to Mali 4.7% and Niger 4.4 %. By 2015, the population is expected to reach 6.5 million; a gradual increase but with potentials to create challenges for economic and social development. Health Profile The Maternal mortality ratio is 1,800 for 100,000 live births which is the highest in the sub region. The infant mortality rate is 115 per thousand live births . There is a correlation between the high maternal mortality ratio and the low CPR. Likewise, there is also a correlation between birth interval and infant mortality rate. The Lower the CPR, the higher the maternal mortality ratio. Over 62% of the country’s labour force lives in rural areas and this has created a challenge for ensuring that health services are accessible to them. The country’s health system has been decentralized and success in meeting the needs of the population is limited mainly by problems of access, service delivery, and quality of products. There is a shortage of health care personnel, especially in the districts. For example, on average, there were only 2 medical officers per district. [image: image11.png]Improving family planning services and access to commodities, for both fertility reduction, prevention of HIV/AIDS and reduction of maternal and child mortality, can contribute to the Government’s objectives of reducing poverty, improving population dynamics and achieving sustainable development (see annex 4). In January 2006, the Ministry of Health and Sanitation (MOHS) with assistance from USAID-funded projects: DELIVER and AWARE-RH and in collaboration with UNFPA country office, made an estimate of the contraceptive requirements for Sierra Leone for the next six years (2006-2011). During a Consultative meeting organized by the SRH/FP/HIV/AIDS (MOHS) for policy and decision makers, the contraceptives requirements assessment report was presented. The analysis showed some uncertainty regarding future funding for contraceptives for Sierra Leone as the financial contributions of the current donors are not enough to cover the requirements. A financial gap therefore existed that must be filled. During the same workshop participants were introduced to the Strategic Pathway to Reproductive Health Commodity Security (SPARHCS) Framework and subsequently discussed and adopted the SPARHCS diagnostic guide for the development of a contraceptive security strategic plan for the country. Major steps to be taken to develop the RHCS strategic plan included: formation of a RHCS committee, assessment of the contraceptive security situation using the SPARHCS diagnostic guide, and then development of the strategic plan. The SPARHCS diagnostic guide illustrated below provides the conceptual basis on which a RHCS strategic plan should be developed. Also, further steps involved in the development of the strategic plan are illustrated in the SPARHCS and the Program Cycle in figure 2. In the development of the RHCS strategic plan in Sierra Leone all the steps were taken. Figure 1: RHCS Framework Box 1. SPARHCS and the Programme Cycle Figure 2: SPARHRHCS and the Program Cycle [image: image3.emf] RH/CONTRACEPTIVE COMMODITY SECURITY ASSESSMENTS Information about the situation on contraceptive security in Sierra Leone was derived from an assessment carried out in July 2006 by a consultant using the SPARHCS diagnostic guide, which was adapted during a consultative workshop held in January 2006. The assessment was conducted with the following objectives in mind: To identify critical strengths, weaknesses, opportunities and threats (SWOT) in the area of Reproductive Health Commodity Security (RHCS), according to the components of the SPARHCS diagnostic guide To agree on consensus-based priority issues To present findings to key stakeholders and facilitate discussions that will initiate the development of a RHCS strategic plan The methodology for collecting data for the assessment included: The SPARHCS approach Some combination of extensive document review and report analysis Key informant interviews with stakeholders in sectors linked to the SPARHCS components Field visits The following components were retained: Client demand and utilization Service delivery Policy and commitment Capital Coordination and partnership Logistics Capacity is a crosscutting issue for the other components; therefore it is addressed in each of these components. Partnership has been added to Coordination. The following strengths and weaknesses by components were agreed upon, taken into consideration others assessments of reproductive health commodity needs. Table 3: Strengths and Weaknesses by Component Component Strengths Weaknesses Client Utilization & Demand On the whole, some information about family planning is provided, mostly in urban areas Availability of IEC/BCC materials Increased awareness about HIV/AIDS Expansion of condom promotion/ distribution activities in Urban areas. Availability of both essential and EmONC services in some districts Low Contraceptive Prevalence Rate (about 4 percent). Poor access to Information about family planning services and benefits Poor Information on SRH/FP/HIV/AIDS at service delivery points Limited male involvement in the use of RH services. Male dominance in decision making in the use of RH and contraceptive services Limited choice of methods for clients Negative traditional and religious beliefs; Low promotion and distribution of IUCDs Inadequate information for youths about RH services in general and contraceptives in particular Inadequate data on SRH commodities Limited target specific IEC/BCC materials. Low condom acceptance rate in rural areas Poor RH service delivery data Stigma and discrimination attached to HIV/AIDS Poor information on STI management and treatment Service Delivery Family planning services are offered in both urban and rural areas by public and private sectors as well as NGOs. There is expansion of social marketing activities of male condoms to rural and urban areas. Existence of institutionalized training of RH Counselors Existence of 90 PMTCT and 56 VCCT centres nationwide PMTCT are housed in the ANC facilities Midwifes are now trained as counselors EmONC services provided in six districts Availability of staff trained in syndromic management of STI STI services already integrated in PHCs Limited service delivery points offering FP/RH/HIV/AIDS services in the country, especially for STIs, FP, Post abortion care (PAC) and basic and essential obstetric care Most of the service delivery points are located in urban areas Poor quality of care Inadequate number of trained service providers and equipment. for RH service provision. Inadequate number of service providers with basic life saving skills Inadequate EmONC facilities Limited choice of FP methods for clients at service delivery points Limited provision of long term Family Planning methods, lack of implants Female condoms not promoted and distributed Limited provision of basic EmONC drugs and supplies Lack of Family Planning and STIs treatment Standards and Protocols Inadequate adolescent and youth friendly service delivery centres Low condom acceptance rate in rural areas Poor integration of FP/RH/HIV/AIDS services into Primary Health Care SRH/FP/HIV/AIDS service delivery system is poorly supervised and monitored Poor SRH/FP/HIV/AIDS service delivery data Minimal outreach services are offered by health personnel and community based workers. Limited condom programming within the private sector. Policy & Commitment Related Policies which have implications on RH have been developed e.g. National Health Policy, domestication of CEDAW, National HIV/AIDS Policy and National Youth Policy). Other policies such as Reproductive Health Policy have been developed. There is a budgetary provision in the government estimates for Reproductive Health. Family Planning and STI treatment products are on the list of essential drugs; The existence of Parliamentary Committee on Health and Social Services Existence of a condom distribution Committee at NAS RH/FP commodities are on the list of essential drugs; The Parliamentary Committee on Health and Social Services is represented on the RHCS committees No specific policies developed for Family Planning. No specific budget for Family Planning commodities in the government budgetary allocations Rules and regulations limit the procurement of family planning methods Customs duty is levied on RH products (purchased or donated) on arrival into the country. Long delays at Customs for release of family planning products No advocacy kit for advocacy activities. Lack of enforcement of rules and regulations regarding quality of products. PRSP does not address issues relating to RH and family planning commodity security Existing rules, regulations and traditional values limit the use of contraceptives. Inadequate dissemination and sensitization of Policies including HIV/AIDS. Not all policies have action plans Payment requested for quality control activities inadequate budget for RH Commodities in the government budgetary allocations Rules and regulations limit the procurement of certain RH commodities. Customs duty is levied on RH products (purchased or donated) on arrival into the country. Long delays at Customs for release of RH/FP commodities Capital Government in collaboration with development partners is involved in the procurement of contraceptives including condoms. There is a budget component in the government estimates for Reproductive Health. Existence of Local Governments (health budget, possibility of funding). NAS has a budget component for condoms Government and Donor funding have so far been inadequate. No budget line in the government estimates for RH commodities. . No financial sustainability plan for RH/FP commodities. No mechanism in place to deliver directly to local governments areas Coordination and Partnership Coordination is facilitated by the Health Task Force that meets once a month to discuss a wide range of issues Coordination is also facilitated by the RH Commodity Security Committee (RHCSC). Coordination is done by the RH/SRH/FP/HIV/AIDS program Existence of Partnership Forum at NAS Heath Task Force meetings do not address specific issues relating to family planning commodities No specific coordination mechanisms for RH/SRH/HIV/AIDS Poor coordination and information sharing with IP on availability of FP/RH products within the country Heath Task Force meetings do not address specific issues relating to Reproductive health commodity security No specific coordination mechanisms for RH/FP Limited coordination with the private sector Limited advocacy and resource mobilization roles of CSOs, NGOs, Private sector and professional bodies Weak Public / private partnership Logistics There is a Logistics Officer at the Reproductive Heath Division There is a procurement unit within the MOHS for the procurement of essential drugs and Reproductive Health/Family Planning products Logistics management information system is being developed Private Sector and NGOs contribute to the procurement and distribution of contraceptives. Existence of National Procurement Act Local Councils have Procurement Units Existence of Quality Control Laboratory Existence of Government and NGO distribution networks Technical expertise exist on Procurement Forecasting data exists Basic Inventory control system exists Existence of Registration and Quality Control Department within the Pharmacy Board No Logistics Unit in the Reproductive Health Division Lack of trained logistics officer in the RH Division Frequent stock outs of products at service delivery points Limited choice of Reproductive health commodities to users Delay in getting supply from national level to service delivery points Not all quality control is done in the country Forecasting: Inadequate capacity to forecast for needs of s Reproductive health commodities Procurement: Although Contraceptives are on the national essential drugs list, procurement unit in MOHS does not presently procure contraceptives. Distribution: There are problems relating to distribution of RH/FP commodities due to inadequate transportation and bad condition of roads. Storage: Inadequate storage facilities at national, regional and district levels. Logistics Management Information System: Limited logistics data is delivered to the national level Consumption data collected is incomplete. Frequent stock outs of SRH/FP/HIV/AIDS commodities occur at all levels Limited use of standard LMIS softwares Inventory Control System: No minimum or maximum stock level 2. Strategic Plan The Sierra Leone’s RH Commodity Security Strategic Plan is designed within the framework of the SPARHCS guide. It is a five year strategic plan: 2007-2011. It is expected that the interaction of all the components adopted by the RHCS Committee will make it possible to achieve RH commodity security. It addresses the issues identified in the assessments and builds on the strengths of the current systems to achieve the goal that Sierra Leoneans have set for their country in the domain of RH commodity security. 2.1 Goal The goal of this strategic plan is to ensure RHCS by achieving the continuous supply of high-quality RH/FP commodities in Sierra Leone by the end of 2011. The goal is specifically defined as: “Every woman/man in Sierra Leone will be able to choose, obtain and use quality reproductive health products including contraceptive methods whenever and wherever she or he needs them.” 2.2 Strategic Objectives by Component Each component has one or more strategic objective(s) that should be met. The consolidated results of all strategic objectives will help achieve RH/contraceptive commodity security in Sierra Leone. Table 4: Strategic objectives per Component Components Strategic objectives 1. Client Utilization and Demand To increase client demand and utilization for RH/FP services among adolescent, youth , women and men by 25% by 2011 To reduce the level of unmet need for RH/FP by 25% within 5 years 2. Service Delivery Expand RH services with emphasis on STIs, maternal and neonatal health care, PAC and family planning and improve quality to meet current and future demands Ensure availability of longer term FP methods 3. Policy and Commitment To endorse and operationalize RH/FP Policy documents 4. Capital To increase Government funding for RH/FP services To develop financial sustainability plan for RH/FP products/services Increase Government funding for RH services with emphasis on STIs, maternal and neonatal health care and family planning 5. Coordination and Partnership To strengthen Coordination/Partnership for RHFP services. Strengthen linkage between the RH programme and the Central Medical Stores supply chain to ensure RH commodity security by the end of 2008 6. Logistics To achieve an effective and efficient RH/FP Logistic Management Information System in the country by the end of 2008 Pharmacy Board to ensure that 100% of RH commodities imported for RH services meet the required standards of safety, efficacy and quality 7. Monitoring and Evaluation To establish a functional monitoring and evaluation system to ensure that the strategic plan is well implemented. 2.3 Specific Objectives And Activities Per Component 2.3.1 Client Utilization & Demand Strategic objective 1: To increase client demand and utilization for SRH/FP/HIV/AIDS services among adolescent, youth , women and men by 25% by 2011 Specific objective 1: To increase awareness by 50% among adolescent, youth, women and men on the availability and benefits of SRH/ FP/ HIV/AIDS In view of the low up take of SRH/FP/HIV/AIDS commodities, it is crucial that appropriate information about these services be given to the general population and to women of reproductive age in particular on the benefits and availability of RH services. At community level actions will be taken to enable community health agents to provide information on SRH/HIV/AIDS, and promote community based services utilization. Main activities: Organize one-day joint planning meeting for all stakeholders Conduct a national baseline KAP survey on availability and utilization of SRH/FP/HIV/AIDS services Develop/produce/adapt, launch and distribute target-specific and culturally appropriate IEC/BCC materials Produce jingles and folk drama and air them on at least one radio station in each district, three times a day for 52 weeks for five years Conduct peer educator training for adolescents, youth and adults on availability of services and benefits of family planning in the 14 districts. Conduct a mid-term evaluation on the impact of BCC messages on client demand and utilization of SRH/FP/HIV/AIDS services Conduct end-term impact evaluation of BCC messages on client demand and utilization of SRH/FP/HIV/AIDS services Specific objective 2: To strengthen the capacity of Village Heath Committees (VHCs), Community Based Agents and NGOs to participate in RH/FP/HIV/AIDS services promotion and delivery, by 2008 VHCs, Community Based Agents (CBAs) and NGOs will be involved in raising awareness about the availability of SRH and HIV/AIDS prevention services. As they are closer to the population their messages will be received by a large number of people including community leaders. Main activities: Train 360 CBAs/VHCs in SRH with emphasis on family planning, EmONC promotion and HIV/AIDS prevention and treatment in their communities VHCs/CBAs conduct sensitization activities to create awareness about the availability of SRH/FP/HIV/AIDS services Supervise awareness raising activities undertaken by VHCs/ CBAs in operational areas. Conduct SRH/FP/HIV/AIDS promotion activities Strategic objective 2: To reduce the level of unmet need for SRH/FP/HIV/AIDS by 25% within 5years Specific objective 1: To determine the national Contraceptive Prevalence Rate (CPR) and MMR and causes of SRH/FP//HIV/AIDS unmet needs by end 2008 Updated information on the national contraceptive prevalence is necessary in order to have the real figures of women using contraceptives in the country. A DHS is being planned for 2008 to determine the current CPR and MMR and also the level of unmet needs and their causes. Main activities: Conduct a nationwide survey to determine the CPR and causes of unmet needs for Family Planning Conduct a survey in 2011 at the end of this strategic plan to determine changes in CPR To train ANC service providers (Nurses, Midwives and other health personnel ) on joint SRH and HIV/AIDS issues Advocate the inclusion of module on MMR in the DHS Tool 2.3.2 Service Delivery Strategic objective 1: To upgrade existing FP programs to SRH including HIV/AIDS services and improve the quality to meet current and future demand Specific objective 1: To increase the number of SRH/FP/HIV/AIDS service delivery points in urban and rural areas by 50% by 2011 The 10 year civil war has caused a huge disruption of health service delivery management and particularly SRH/FP/HIV/AIDS services. It is essential to assess the situation of SRH/FP/HIV/AIDS service delivery and get accurate number of SRH/FP/HIV/AIDS services delivery points in the country. In order to further improve geographical access to SRH/FP/HIV/AIDS services, more contraceptive social marketing outlets will be created. Main activities: Conduct a country wide assessment to find out the number and status of SRH/FP/HIV/AIDS service delivery points in both rural and urban areas. (Data will be captured in KAP survey under 3.3.1) Integrate SRH/FP/HIV/AIDS services into health care facilities nationwide Conduct outreach activities for SRH/FP/HIV/AIDS services provision twice a month per PHU Establish 2,147 outlets nationwide for social marketing social marketing of condom and other RH commodities. To train ANC service providers (Nurses, Midwives and other health personnel) on SRH and HIV/AIDS issues. Provide a regular supply of RH commodities to both urban and rural health facilities in all 13 districts, especially for STIs, PAC, maternal and neonatal health care and family planning Provide the relevant Standards and Protocols for RH service provision in all service delivery points Specific objective 2: To strengthen SRH/FP/HIV/AIDS service delivery points in urban and rural areas Improvement of quality of SRH/FP/HIV/AIDS services is crucial in meeting the needs of clients. More specifically staff should be trained in adequate numbers; service delivery points should have appropriate equipment and quality products. Staff should be supervised to enable them to continuously improve their performance and quality of services. Special attention should be given to youth and specific services tailored to their needs and sensitivity should be developed. Main activities: Renovate and refurbish 150 PHUs (one PHU per chiefdom) to provide SRH/FP/HIV/AIDS services. Train 1,000 health staff in the provision of quality SRH/FP/HIV/AIDS services, especially for youth, in phases over 5 years (50 per quarter each year) Organize refresher training for 1,000 health staff in the provision of quality SRH/FP/HIV/AIDS services Provide appropriate equipment for SRH/FP/HIV/AIDS service provision to all PHUs. Provide supervision of clinics once a quarter to support trained service providers to provide SRH/FP/HIV/AIDS services. Integrate adolescent and youth friendly SRH/FP/HIV/AIDS services into all peripheral health units in each chiefdom. Strategic Objective 2: Improve availability of longer term FP methods Specific Objective 1: Increase the use of IUDs by 50% by the end of 2011 Main Activities: Assess barriers limiting the use of IUDs Develop/Adapt target specific IEC/BCC on IUDs Develop/update Guidelines for IUD Insertion and Removal Train service providers on the insertion and removal techniques Procure IUD insertion kits Initiate Social marketing of IUDs Specific Objective 2: Introduce implants in the package of RH/FP services by the end of 2008 Main Activities: Include implants in the Essential Drug List Conduct IEC/BCC interventions Train service providers on insertion and removal techniques Procure supplies of Implants Procure Implants Insertion and Removal kits Initiate Social marketing of implants Strategic objective 3: To increase the availability and utilisation of male and female condoms for dual protection by 50% Specific objective 1: To develop an integrated STI/HIV/FP through increase access to and use of male and female condoms at all levels. Main activities To Develop a joint plan/strategy Establish inter-agency task group on condoms programming Develop and launch national condom strategic plan Specific objective 2: To Design distribution system for male and female condoms Main activities: Conduct stakeholders logistics workshop to design the logistics system Establish condom social marketing activities in urban and rural areas Specific objective 3: To implement and monitor the strategy Main activities Review all existing IEC/BCC condom promotional materials Design and train staff on M&E systems Train providers Make available condoms at all FP/VCCT/PMCT centers Carry out joint condom procurement plan and stock management Reproduce and disseminate updated IEC/BCC materials targeting individuals, couples, social networks, community institutions, the private and public sectors and mass media. 2.3.3 Policy &Commitment Strategic Objective 1: To operationalize the RH Policy Specific objective 1: To create a specific budget line for RH products and services by end 2008 Government should develop or adopt favorable policies for RH and FP and demonstrate commitment by providing resources for SRH/FP products and services. The creation of this line item is very important in the eyes of donors who see this as Government’s commitment to funding its own program and purchasing the necessary family planning products in complement to partners support. Main activities: Organize a two-day advocacy and training workshop for RHCS National Committee members Train local health team to include SRH/HIV issues in their resource mobilization proposals. Develop a RH advocacy tool for all stakeholders Organize advocacy meetings with Parliamentarians, including relevant Policy Advisory Committees Specific objective 2: To advocate for duty and tax free concessions on RH/FP commodities by 2008 The current situation is one in which taxes are required in order to bring the products from the Port to the national or NGOs warehouses. This regulation which leads to product sitting at the Port for a long time and expiring or being damaged should be addressed so that duty free status is given to agencies importing RH/FP products into the country. Main activities: Organize a workshop to develop an eligibility criteria for importers of RH/FP commodities Launch an advocacy campaign to government, together with the commercial private sector, the Parliamentary Committee on Health and all stake holders, for duty and tax free concession on FP/EmONC commodities as listed Specific objective 3: To include SRH/FP/HIV/AIDS issues in the PRSP The Poverty Reduction Strategy Plan should include provision for RH/FP commodities. Main activities: To include SRH commodities to PRSP Preparation of a concept paper with relevant information on SRH/FP/HIV/AIDS issues to update PRSP for Directorate of Information and Planning (MOHS) Follow-up the inclusion of SRH/FP/HIV/AIDS issues in the PRSP Specific objective 4: To Develop SRH/FP/HIV/AIDS policy documents Main activities: Prepare and implement the national guidelines, standards and protocols for RH service delivery Prepare RH service delivery manual Upgrade existing FP delivery manual to SRH/HIV/AIDS.l Disseminate SRH/FP/HIV/AIDS policy documents, protocols and guidelines 2.3.4 Capital Financial resources are necessary to purchase SRH/FP/HIV/AIDS Commodities and to provide information and services. Government should strive to mobilize the required financial resources to meet the SRH/FP/HIV/AIDS Commodity requirements for the country. The MOHS, with assistance from partners will develop a financial sustainability plan which outlines clearly how the country is planning to meet the financial requirements to purchase SRH/FP/HIV/AIDS Commodities and how donor contributions will be supplemented. Strategic objective 1: To increase Government and Donor funding for SRH/FP/HIV/AIDS services provision Specific objective 1: To advocate with Government and Partners for increase of resources for SRH/FP/HIV/AIDS Commodities and Services, by end 2008 Main activities: Disseminate the RHCS strategic plan Map-out available resources and identify gaps Develop and implement harmonized resource mobilization plan Prepare financial sustainability plan for SRH/HIVAIDS Commodity Security Specific objective 2: To diversify sources of funding for SRH/FP/HIV/AIDS Commodities and Services, by end 2008 Main activities: Convene a donors conference for SRH/FP commodities Conduct Advocacy meeting with key stakeholders Expand RHCS Committee to include representation from private sector and corporate agencies Conduct willingness-to-pay and Ability-to-Pay studies for SRH/FP commodities and other services 2.3.5 Coordination & Partnership Coordination is a key strategy to make the best use of available resources and plan to leverage more resources. Efficient coordination leads to strengthened partnership. The MOHS will create functional coordination mechanism. Strategic objective 1: To strengthen Coordination/Partnership for RH and family planning services Specific objective 1: To make the RHCS Committee more functional by end of 2007 Main activities: Design the TOR of expanded RHCS Committee Monitor quarterly progress of implementation of RHCS strategic plan Provide program quarterly management update on implementation of RHCS strategic plan to RHCS Committee Conduct Bi-annual RHCS Strategic plan implementation review meetings. Specific objective 2: To support 13 DHMT, 19 Local Councils, 360 VHCs and CBAs to participate in SRH/FP/HIV/AIDS services management by end 2008 Community level coordination will be promoted to bring together all grass-root organizations that play an important role in family planning service delivery and promotion. Main activities: Train 13 DHMTs and 19 Local Councils in the area of RH management and coordination Train 360 VHCs/CBAs on SRH/FP/HIV/AIDS issues and coordination of activities at community level Conduct quarterly coordination meetings at community level Orient DHMTs and Local Councils on SRH/FP/HIV/AIDS programme Integration and linkages Specific Objective 3: Strengthen public-private sector partnership by the end of 2008 Main Activities: Establish advocacy networks of CSOs/NGOs/Private sector engaged in the provision RH & FP Commodities and Services Integrate Private sector LMIS into Public sector HIMS 2.3.6 Logistics SRH/FP/HIV/AIDS logistics have been disrupted by the long period of war and now the system should be redesigned, made functional and its performance increased. Particular attention should be drawn to the decentralization of the health system being implemented now and the districts should become key players in procurement, distribution and management of essential medicines, including contraceptives. A logistics unit should be created and made functional within the RH Division. This unit should be linked to the NPPU and must be competent to oversee the estimation of requirements and management of the contraceptives entering in the country. Strategic objective1: To achieve an effective and efficient SRH/FP/HIV/AIDS functional logistics Management Information System (LMIS) by the end 2008 Specific objective 1: To establish a functional logistics unit for the RH Division/CMS and the district health management levels by the end of 2008 Main activities: Integrate the SRH/FP/HIV/AIDS logistics at central and district levels Staff and equip the logistics unit at both central and district levels Specific objective 2: To build capacity for SRH/FP/HIV/AIDS logistics in Sierra Leone Main activities: Assess the present logistics system using the LSAT and LIAT Conduct a workshop to design RH commodity logistics system Develop a Logistics Manual including Standard Operating procedures Train staff of the logistics unit as well as those of the districts in logistics and on the use of LMIS Software Organize study tours for RH Program staff and Service Providers Specific objective 3: To develop and maintain a reliable forecasting mechanism, by end of 2007 Main activities: Establish a forecasting and quantification team Conduct a 5-day training workshop on forecasting and procurement planning for the forecasting team Conduct bi-annual forecasting sessions for procurement purposes Orient on the use of the various softwares (Pipeline, Quantimed, UNFPA CCM and CHANNEL) Specific Objective 4: Integrate RH Commodity supply pipeline into the CMS supply chain by the end of 2008 To avoid stock outs of products at all levels of the health system, a proper management of products in the warehouses should be put in place and maintained. Adequate means of distributing the products should be made available and managed properly. Main Activities: Build capacity to sustain RH Commodity supply chain in the CMS Conduct quality control analysis of RH commodities within the system Conduct joint inspection of the distribution channels of RH commodities Conduct post market surveillance of RH commodities. Monitor the use and adverse effect of the RH commodities Build capacity of staff at the national pharmaceutical quality control laboratory. Specific objective 5: To establish an effective Logistics Management Information System, by the end of 2008 Essential data in logistics must be collected on a regular basis and used to estimate the requirements of contraceptives. A functional logistics management information system is required to collect appropriate data from the appropriate level, at the right time, using the right forms that are channeled to the right levels. Main activities: Conduct four regional training workshops for DHMTs and other partners on LMIS Review and produce LMIS forms Distribute LMIS forms to all DHMTs, all stores and service delivery sites Cascade training for PHU staff at district level Strategic Objectives 2: Pharmacy Board to ensure that 100% 0f RH commodities imported for RH services are registered as outlined in the National Medicines Policy, 2004 and the Pharmacy and Drugs Act, 2001. Specific Objective 1: Pharmacy Board to ensure that 100% of RH commodities imported for RH services meet the required standards of safety, efficacy and quality Main Activities: Conduct quality control analysis on RH commodities within the system. Evaluate of dossiers to ensure compliance with Good Manufacturing Practices. Post market surveillance of RH commodities. Monitor the use and side effects of the RH commodities. Capacity building of staff for Registration, Quality Control Analysis and safety monitoring of RH products. 2.3.7 Monitoring & Evaluation Strategic objective 1: To establish a functional monitoring and evaluation system to ensure that the strategic plan is well implemented Specific objective 1: To develop and implement a comprehensive M&E plan for RHCS Strategy, by end of 2007, Main activities: Develop an M&E plan for RHCS strategy Adapt required data collection tools to monitor program implementation Train M&E officers across the country Train service providers to use appropriately M&E tools Provide quarterly feedback on M&E from central to district level Compile, collate and analyze M&E information on RH commodities on quarterly basis Work with Directorate of Planning and Information to harmonize data collection tools to capture RH information to monitor program implementation Produce and disseminate quarterly RH commodity M&E reports Specific objective 2: Monitor and evaluate the implementation of RHCS Strategic Plan Main activities Conduct mid-term and end of term evaluation of implementation of RHCS strategy Develop joint monitoring plan for SRH/HIV&AIDS Draft the 2012-2017 RHCS plan 3. Action Plan This section will provide information about the weaknesses addressed, key assumptions, strategic objectives, the specific objectives, activities, indicators, implementing agencies, the timing and the budget per component. Client Utilization and Demand Weaknesses addressed Low Contraceptive Prevalence Rate (about 4 percent). Poor access to Information about family planning services and benefits Poor Information on SRH/FP/HIV/AIDS at service delivery points Limited male involvement in the use of RH services. Male dominance in decision making in the use of RH and contraceptive services Limited choice of methods for clients Negative traditional and religious beliefs; Low promotion and distribution of IUCDs Inadequate information for youths about RH services in general and contraceptives in particular Inadequate data on SRH commodities Limited target specific IEC/BCC materials. Low condom acceptance rate in rural areas Poor RH service delivery data Stigma and discrimination attached to HIV/AIDS Poor information on STI management and treatment Assumptions: Commitment of GoSL, Partners and Stakeholders Timely availability and disbursement of funds Political stability Efficient and effective functioning of RHCS Committee Availability of adequate supply of SRH/FP/HIV/AIDS commodities at all times Availability of trained health personnel Demographic Health Survey conducted in 2007 Strategic Objective 1: To increase client demand and utilization for SRH/FP/HIV/AIDS services among adolescent, youth, women and men by 25% by 2011 Specific Objective 1: To increase awareness by 50% among adolescent, youth, women and men on the availability and benefits of SRH/ FP/ HIV/AIDS Activity Implementing partners Timing Budget (USD) Out put Indicators Outcome Indicators Organize one-day joint planning meeting for all stakeholders MOHS (SRH/FP/HIV/AIDS) Q4, 2007 2,000 Action Plan for the production of IEC/BCC materials available Joint work plan developed Awareness on the availability and benefits of SRH/FP/HIV/AIDS increased by 50% Conduct a national baseline KAP survey on availability and utilization of SRH/FP/HIV/AIDS services MOHS (RH/SRH/HIV/AIDS) Q1, 2008 69,000 National KAP survey conducted and report available 1.1.1.3 Develop/adapt/produce, launch and distribute IEC/BCC materials MOHS (RH/SRH/HIV/AIDS), H.Ed Unit, Local Councils, Partners Q3,2007 , ongoing 310,000 No. of IEC/BCC materials available Produce jingles and folk drama and air them on one radio station in each district, three times a day for 52 weeks for five years RH/SRH/FP/HIV/AIDS and Media Alliance, Local Drama Groups H.Ed Unit Q3,2007 , ongoing 122,000 No. of tools produces 1.1.1.5 Conduct a mid-term evaluation on the impact of BCC messages on client demand and utilization of SRH/FP/HIV/AIDS services RH/SRH/FP/HIV/AIDS and partners (Peer educators) Q3,2007 641,000 No. of peer educators trained 1.1.1.6 Conduct end-term impact evaluation of BCC messages on client demand and utilization of SRH/FP/HIV/AIDS services RHCS committee Q4, 2009 2,000 Evaluation report Specific Objective 2: To strengthen the capacity of Village Heath Committees (VHCs), Community Based Agents and NGOs to participate in SRH/FP/HIV/AIDS services promotion and delivery, by 2008 Activity Implementing partners Timing Budget (USD) Out put Indicators Outcome Indicators 1.1.2.1 Train 360 CBAs/VHCs in SRH with emphasis on family planning, EmONC promotion and HIV/AIDS prevention and treatment in their communities RH/DHMTs/ MOHS Q2-Q3 2008 75,000 No. of VHRHCS trained No of skilled trainings organized Capacity in SRH/FP/HIV/AIDS services promotion and delivery of Village Health Committees improved 1.1.2.2 VHCs/CBAs hold quarterly meetings to create awareness in communities about the availability of SRH/FP/HIV/AIDS services DHMT/VHCs/CBAs/CARE quarterly 10,000 No of meetings hold 1.1.2.3 Supervise awareness raising activities undertaken by VHCs/ CBAs in operational areas. DHMT/RH/ MOHS Q2, ONGOING 5,000 No of supervision report available 1.1.2.4 Conduct SRH/FP/HIV/AIDS promotion activities DHMTs, VHCs Q4 2008- 2011 17,000 No of sensitization activities conducted Strategic Objective 2: To reduce the level of unmet need for SRH/FP/HIV/AIDS by 25% within by end 2011 Specific Objective 1 : To determine the national Contraceptive Prevalence Rate (CPR) and MMR and causes of SRH/FP//HIV/AIDS unmet needs by end 2008 1.2.1.1 Conduct a nationwide survey to determine the CPR and causes of unmet needs for Family RHCS Committee MOHS, Local Council, Statistics Sierra Leone and other partners Q2,2007 69,000 Assessment report on CPR available RH data available 1.2.1.2 Conduct a survey in 2011 at the end of this strategic plan to determine changes in CPR RHCS Committee, MOHS, partners Q4, 2011 69,000 End of project assessment report available 1.2.1.3. To train ANC service providers (Nurses, Midwives and other health personnel ) on joint SRH and HIV/AIDS issues RHCS Committee, MOHS, partners Q4, 2007 10,000 Number or medical staff trained 1.2.1.4. Advocate the inclusion of module on MMR in the DHS survey Tool RHCS Committee ,MOHS, partners Q4, 2007 0 MMR include in DHS Tool 3.2 Service Delivery Weaknesses addressed Limited service delivery points offering FP/RH/HIV/AIDS services in the country, especially for STIs, FP, Post abortion care (PAC) and basic and essential obstetric care Most of the service delivery points are located in urban areas Poor quality of care Inadequate number of trained service providers and equipment. for RH service provision. Inadequate number of service providers with basic life saving skills Inadequate EmONC facilities Limited choice of FP methods for clients at service delivery points Limited provision of long term Family Planning methods, lack of implants Female condoms not promoted and distributed Limited provision of basic EmONC drugs and supplies Lack of Family Planning and STIs treatment Standards and Protocols Inadequate adolescent and youth friendly service delivery centres Low condom acceptance rate in rural areas Poor integration of FP/RH/HIV/AIDS services into Primary Health Care SRH/FP/HIV/AIDS service delivery system is poorly supervised and monitored Poor SRH/FP/HIV/AIDS service delivery data Minimal outreach services are offered by health personnel and community based workers. Limited condom programming within the private sector. Assumptions: Commitment of GoSL, Partners and Stakeholders Timely availability and disbursement of funds Political stability Efficient and effective functioning of RHCS Committee Availability of adequate supply of RH/FP commodities at all times Availability of trained health personnel Demographic Health Survey conducted in 2007 Improved human resource Strategic objective 1: To upgrade existing FP programs to SRH including HIV/AIDS services and improve the quality to meet current and future demand Specific Objective 1: To increase the number of SRH/FP/HIV/AIDS service delivery points in urban and rural areas by 50%, by 2011 Activity Implementing agency Timing Budget Out put Indicators Outcome Indicators 2.1.1.1 Conduct a countrywide facility assessment of SRH/FP/HIV/AIDS service delivery points in both urban and rural areas RH/SRH/HIV/AIDS Q2 2007 69,000 Assessment report available Increased access to quality and affordable SRH/FP/HIV/AIDS services 2.1.1.2 Integrate SRH/FP/HIV/AIDS services into health care facilities nationwide MOHS and Partners Start Q3 2007 69,000 No. of care facilities providing SRH/FP/HIV/AIDS services 2.1.1.3 Conduct monthly outreach activities for SRH/FP/HIV/AIDS service provision in PHUs DHMT/MOHS Start Q3 2007 178,000 N0.of outreach activities conducted 2.1.1.4 Establish 2,147 outlets nationwide for social marketing for specific RH commodities. MOHS, CARE/SL Start Q2 2007 0. 2,147 new outlets established 2.1.1.5 To train ANC service providers (Nurses, Midwives and other health personnel) on SRH and HIV/AIDS issues. MOHS/RH No. of medical personnel trained 2.1.1.6 Provide a regular supply of RH commodities to both urban and rural health facilities in all 13 districts, especially for STIs, PAC, maternal and neonatal health care and family planning MOHS, CMS, RHD, DHMT Q3 2007 0 RH Commodities are available 2.1.1.7 Provide the relevant Standards and Protocols for RH service provision in all service delivery points MOHS/MEST 2007/2008 Specific Objective 2: To strengthen SRH/FP/HIV/AIDS service delivery points in urban and rural areas Activity Implementing agency Timing Budget Out put Indicators Outcome Indicators 2.1.2.1 Renovate and refurbish 150 PHUs (one PHU per chiefdom) to provide SRH/FP/HIV/AIDS services. MOHS Q2 2007 310,000 No. of PHUs renovated and refurbished Increased access to quality SRH/FP/HIV/AIDS service provision 2.1.2.2 Train 1,000 health staff in the provision of quality SRH/FP/HIV/AIDS services, especially for youth, in phases over 5yrs (50 per quarter each year) RH/SRH/HIV/AIDS, MOHS Q3 2007 – Q3 2008 83,000 1000 health staff trained in the provision of SRH/FP/HIV/AIDS services, especially for youths 2.1.2.4 Organize refresher training for 1,000 health staff in the provision of quality SRH/FP/HIV/AIDS services MOHS/RH/SRH/HIV/AIDS Q2-Q4 2009 83,000 No. of health staff trained 2.1.2.5 Provide outreach and supervision allowances to SRH/FP/HIV/AIDS services providers RH/SRH/HIV/AIDS, MOHS Ongoing 830,000 No. of staff assigned to districts receiving allowances 2.1.2.6 Improve on storage facility for SRH/FP/HIV/AIDS products at service delivery points in 13 districts MOHS Q2-Q4 2007 0 Storage facilities at service centers improved 2.1.2.7 Provide appropriate equipment for SRH/FP/HIV/AIDS services provision to PHUs MOHS AND PARTNERS Q3 2007, ongoing 0 Appropriate equipment for SRH/FP/HIV/AIDS service delivery provided 2.1.2.8 Purchase and supply one motorbike per district (13) for staff to access hard to reach areas with SRH/FP/HIV/AIDS services MOHS, Partners Q3-Q4 2007 63,000 13 Motorbikes purchased and supplied to each district 2.1.2.9 Provide regular maintenance and running costs for 13 motorbikes over 5yrs MOHS, Partners On going 135,000 13 Motorbikes roadworthy over 5yrs 2.1.2.10 Provide 150 bicycles to chiefdoms for staff to access hard to reach areas with SRH/FP/HIV/AIDS services MOHS/DHMTs Q4, 2007 46,000 150 Bicycles purchased and supplied to chiefdoms 2.1.2.11 Conduct quarterly supervision of SRH/FP/HIV/AIDS services MOHS, DHMT Q2 2008 Ongoing 35,000 Number of supervisions conducted Strategic Objective 2: Improve availability of longer term FP methods Specific Objective 1: Increase the use of IUDs by 50% by the end of 2011 Activity Implementing agency Timing Budget Out put Indicators Outcome Indicators 2.2.1.1 Assess barriers limiting the use of IUDs MOHS Q2 2007 8,000 Assessment Report available Use of IUDs increased Develop/Adapt target specific IEC/BCC on IUDs RH/SRH/HIV/AIDS, MOHS Q1 2008 5,000 Specific IEC/BCC on IUDs adapted Develop/update Guidelines for IUD Insertion and Removal MOHS, Partners Q4,2007 5,000 Guidelines for IUD Insertion and Removal updated Train service providers on the IUD insertion and removal techniques MOHS, UNFPA, Partners 2008 10,000 No of service providers trained Procure 100 IUD Insertion/Removal kits MOHS, UNFPA, Partners Ongoing 10,000 No of IUD insertion/removal kits procured Initiate Social Marketing of IUDs MOHS, UNFPA, MSSSL, PPASL Q2-Q4 2007 5,000 IUDs Available in private sector Specific Objective 2: Introduce implants in the package of RH/FP services by the end of 2008 Include implants in the Essential Drug List MOHS, Pharmacy Board Q4-2007 0 Implants on EDL Implants offers among FP services Conduct IEC/BCC interventions MOHS, Partners Start Q1-2008 3,000 No of IEC/BCC intervention conducted Train service providers on Implants insertion and removal techniques MOHS, Partners 2008 10,000 No of Medical Staff trained Procure supplies of Implants MOHS, Partners Q1, 2008 - Quantity procured Procure Implants Insertion and Removal kits MOHS, Partners Q1,2008 30,000 No of Implant Insertion/removal kit procured Initiate Social marketing of implants MOHS, Partners Q1,2008 2,000 Social Marketing of implant carried out Strategic objective 3: To increase the availability and utilisation of male and female condoms for dual protection by 50% Specific objective 1: To develop an integrated STI/HIV/FP through increase access to and use of male and female condoms at all levels. Activity Implementing agency Timing Budget Out put Indicators Outcome Indicators 2.3.1.1 To Develop a joint plan/strategy MOHS Q3 2007 8,000 Document developed Increased access to quality SRH/FP/HIV/AIDS service provision 2.3.1.2 Establish inter-agency task group on condoms programming RH/SRH/HIV/AIDS, MOHS Q1 2008 1,000 Task group appointed Develop and launch national condom strategic plan MOHS, UNFPA, Partners 2008 1,000 National Condom Strategic plan launch Specific objective 2: To Design distribution system for male and female condoms 2.3.2.1 Conduct stakeholders logistics workshop to design the logistics system MOHS, NAS, CARE/SL, CMS, Pharmacy Board Q4 2007 2,000 Workshop Report Distribution System designed for Male and Female Condom 2.3.2.2 Establish condom social marketing activities in Urban and rural areas MOHS, CARE/SL, partners Q1,2008 No of activities carried out Specific objective 3: To implement and monitor the strategy 2.3.3.1 Review all existing IEC/BCC condom promotional materials MOHS, RHD, NAS, DMO, CARE/SL, MSSL, PPASL Q3 2007 See 1.1.1.3 Strategy is implemented and monitor Design M&E systems and train staff MOHS, RHD, NAS, DMO, CARE/SL, MSSL, PPASL Q4, 2007 10,000 No of staff trained Train providers MOHS, RHD, NAS, DMO, CARE/SL, Partners Q4,2007 10,000 No of staff trained Make available condoms at all FP/VCCT/PMCT centers MOHS, RHD, NAS, DMO, CARE/SL, MSSL, PPASL 2007 -2011 0 Quantity of Condom distributed Carry out joint condom procurement plan and stock management MOHS, RHD, NAS, DMO, CARE/SL, MSSL, PPASL, CMS, UNFPA Start Q1 2008, ongoing See Annual budget for commodities No of Joint procurement made Reproduce and disseminate updated IEC/BCC materials targeting individuals, couples, social networks, community institutions, the private and public sectors and mass media MOHS, RHD, NAS, DMO, CARE/SL, MSSL, PPASL Q 1 2008 5,000 Number of IEC/BCC materials disseminated 3.3 Policy and Commitment Weaknesses addressed: No specific policies developed for Family Planning. No specific budget for Family Planning commodities in the government budgetary allocations. Rules and regulations limit the procurement of family planning methods. Customs duty is levied on RH products (purchased or donated) on arrival into the country. Long delays at Customs for release of family planning products. No advocacy kits for advocacy activities. Lack of enforcement of rules and regulations regarding quality of products. PRSP does not address issues relating to RH and SRH/FP/HIV/AIDS commodity security Existing rules, regulations and traditional values limit the use of contraceptives. Inadequate dissemination and sensitization of Policies including HIV/AIDS. Not all policies have action plans Payment requested for quality control activities Assumptions: Adequate funding, Supportive environment, Adequate trained personnel Funds allocated and made available to RH Division Strategic Objective 1: To operationalize the RH Policy documents Specific Objective 1: To create a specific budget line for SRH/FP/HIV/AIDS products and services by end 2008 Activity Implementing agency Timing Budget Out put Indicators Outcome Indicators Organize a two-day advocacy and training workshop for the 30 members of the RHCS National Committee RHCS Committee, NEWMAP, MOHS Q4 2007 Q2 2009 10,000 30 CRHCSC members trained in advocacy A specific budget line for SRH/FP/HIV/AIDS commodities and services exists 3.1.1.2 Train local health team to include SRH/HIV issues in their resource mobilization proposals RH/FP/NAS/UNFPA/PMISU Q1, 2008 3.1.1.3 Develop a RH advocacy tool for all stakeholders RHCS Committee, MOHS Q4, 2007 10,000 No. of advocacy tools developed Organize advocacy meetings with Parliamentarians, including relevant Policy Advisory Committees RHCS Committee/RH Q4 2007 2,000 Number of advocacy meetings held Specific Objective 2: To advocate for duty and tax free concessions on RH/FP commodities by 2008 3.1.2.1 Prepare a list of RH/FP commodities and importers RH/SRH/HIV/AIDS/Pharmacy Board Q4 2007 0 A list of identified importers and SRH/FP/HIV/AIDS commodities available Concessions and other charges on SRH/FP/HIV/AIDS commodities approved 3.1.2.2 Organize a workshop to develop an eligibility criteria for importers of RH/FP commodities RHCS Committee, MOHS Q4 2007 2,000 eligibility criteria developed 3.1.2.3 Launch an advocacy campaign for duty and tax free concession on RH/FP commodities RH /RHCS Committee Q4 2007 4,000 No. of advocacy sessions carried out Specific objective 3:To include RH/SRH/FP/HIV/AIDS issues in the PRSP Activity Implementing agency Timing Budget Out put Indicators Outcome Indicators 3.1.3.1 Preparation of a concept paper with relevant information on SRH/FP/HIV/AIDS issues to update PRSP for Directorate of Information and Planning (DIP/ MOHS) MOHS/UNFPA/ Q2, 2007 0 Draft concept paper RH/SRH/FP/HIV/AIDS issues are included in PRSP 3.1.3.1 Follow-up the inclusion of SRH/FP/HIV/AIDS issues in the PRSP RH/RHCS Committee, MOHS Q3, 2007 1,000 Document included in the revised PRSP Specific objective 4:To Develop SRH/FP/HIV/AIDS policy documents 3.1.4.1 Prepare national guidelines for SRH/FP/HIV/AIDS services provision MOHS (RH/SRH/HIV/AIDS) Q4 2007 7,000 National SRH/FP/HIV/AIDS guidelines validated SRH/FP/HIV/AIDS policy documents disseminated 3.1.4.2 Prepare the SRH/FP/HIV/AIDS services delivery Protocols MOHS (RH/SRH/HIV/AIDS) Q4 2007 5,000 SRH/FP/HIV/AIDS service delivery protocols available 3.1.4.3 Upgrade existing FP delivery manual to SRH (FP, STIs/ Safe motherhood) including HIV/AIDS MOHS (RH/SRH/HIV/AIDS) Q4 2007 7,000 SRH/FP/HIV/AIDS service delivery manual revised 3.1.4.4 Launch the SRH/FP/HIV/AIDS policy documents MOHS (RH/SRH/HIV/AIDS) Q1 2008 4,000 Meeting held 3.1.4.5 Disseminate SRH/FP/HIV/AIDS policy documents, protocols and guidelines MOHS (RH/SRH/HIV/AIDS) Q1 2008 7,000 No. of SRH/FP/HIV/AIDS policies document documented 3.4 Capital Weaknesses addressed: Government and Donor funding have so far been inadequate No budget line in the government estimates for family planning products No financial sustainability plan for SRH/FP/HIV/AIDS commodities Assumptions: There is Government commitment Donor response is favorable Strategic objective 1: To increase Government funding for SRH/FP/HIV/AIDS services Specific objective 1: To ensure that Government mobilize adequate resources for SRH/FP/HIV/AIDS commodities and services, by end 2007 Activity Implementing agency Timing Budget Out put Indicators Outcome Indicators 4.1.1.1 Disseminate the RHCS strategic plan RHCS Committee/MOHS Q3 2007 9,000 RHCS strategic plan is disseminated Increased funding for SRH/HIV/AIDS/Commodities and services 4.1.1.2 Conduct a workshop to map-out available resources and identify gaps RHCS Committee/ MOHS Q3 2007 4,000 Report on resources mapping available 4.1.1.3 Develop and implement harmonized resource mobilization plan RH/SRH/FP/HIV/AIDS and partners Q2 2007 7,000 Financial sustainability plan produced 4.1.1.4 Prepare financial sustainability plan for RH/FP Commodity Security RHCS Committee/MOHS Start Q3 2007 ongoing 7,000 Financial sustainability plan produced Specific objective 2: To diversify sources of funding for contraceptives, by end 2008 Activity Implementing agency Timing Budget Out put Indicators Outcome Indicators 4.1.2.1 Convene a donors conference MOHS (RH/SRH/HIV/AIDS), NEWMAP Q4, 2007 2,000 Donors conference held Commitment from donors to support the implementation of RHCS plan 4.1.2.2 Conduct Advocacy meeting with key stakeholders RHCS Committee/MOHS On going 5,000 Advocacy meeting held Expand RHCS Committee to include representation from private sector and corporate agencies RHD, MOHS Q3, 2007 0 RHCS Committee is expanded Conduct willingness-to-pay and Ability-to-Pay studies for SRH/FP commodities and other services RHCS, MOHS, Partners Q1, 2008 10,000 Studies report available 3.5 Coordination and Partnership Weaknesses addressed: Heath Task Force meetings do not address specific issues relating to family planning commodities No specific coordination mechanisms for RH/SRH/FP/HIV/AIDS services Assumptions: Strategic plan is approved and funded Sustained Government commitment. Sustained Partners interest Continuing peace and stability. RH Program remains a priority in the country M&E tools available Relevant staff available Strategic objective 1: To strengthen Coordination/Partnership for RH and FP services Specific objective 1: To make the RHCS Committee more functional by end of 2007 Activity Implementing agency Timing Budget Out put Indicators Outcome Indicators 5.1.1.1 Design the TOR for RHCS Committee MOHS , RHCS committee, Partners Q3 2007 1,000 TOR designed RHCS Committee is efficient 5.1.1.2 Monitor quarterly progress of implementation of RHCS strategic plan RHCS Committee MOHS Quarterly 26,000 No. of reports available 5.1.1.3 Provide quarterly management update on implementation of RHCS strategic plan to RHCS Committee RHCS Committee, MOHS Quarterly 26,000 No. of reports available Conduct Bi-annual RHCS Strategic plan implementation review meetings RHCS Committee, MOHS Biannual 17,000 No. of reports available Specific objective 2: To support 13 DHMTs , 19 Local Councils and 360 VHCs to participate in SRH/FP/HIV/AIDS services management by end 2008 Activity Implementing agency Timing Budget Out put Indicators Outcome Indicators 5.1.2.1 Train 14 DHMTs and 19 Local Councils in the area of RH management and coordination RH/DHMTs/MOHS Q2, 2008 35,000 No. of members trained Better coordination of SRH/FP/HIV/AIDS services at community level 5.1.2.2 Train 360 VHCs on SRH/FP/HIV/AIDS issues and coordination of activities at community level RH/DHMTs/MOHS Q3, 2008 75,000 No. of VHRHCS members trained 5.1.2.3 Conduct quarterly coordination meeting at community level DHMT 2007-2008 90,000 No. of report available 5.1.2.4 Orient DHMTs and Local Councils on SRH/FP/HIV/AIDS programme Integration and linkages RHD, DHMT Q1,2008 13,000 Orientation Reports Specific objective 3: To Strengthen public-private sector partnership by the end of 2008 Activity Implementing agency Timing Budget Out put Indicators Outcome Indicators 5.1.3.1 Establish advocacy networks of CSOs/NGOs/Private sector engaged in the provision RH & FP Commodities and Services RH/DHMTs/MOHS, Partners Q2, 2008 3,000 Net work established Public-private sector partnership is strong 5.1.3.2 Integrate Private sector LMIS into Public sector HIMS RH/DHMTs/MOHS, partners Q2, 2008 7,000 Integrated public-private sector LMIS 4.6 Logistics Weaknesses addressed: No Logistics Unit in the Reproductive Health Division Lack of trained logistics officer in the RH Division Frequent stockouts of products at service delivery points Limited choice of commodities for users; Delay in getting supply from Central Medical Stores and from the districts to service delivery points Not all quality control tests are done in the country Forecasting: Inadequate capacity to forecast needs of contraceptives Procurement: Although Contraceptives are on the essential drugs list, Medical Stores does not procure contraceptives. Distribution: Inadequate transportation and bad conditions of roads Storage: Products are not stored according to stated standards. Inadequate storage facilities at national, regional and district levels. Logistics Management Information System: Limited logistics data is delivered to the national level. Consumption data collected are incomplete. Frequent stockouts of SRH/FP/HIV/AIDS commodities occur at all levels. Inventory Control System: No minimum or maximum stock level Assumptions Prompt implementation of the strategic plan Timely availability of funds Availability of personnel Effective partner involvement and participation Motivated personnel Timely procurement and delivery of office equipment Strategic objective1: To achieve an effective and efficient SRH/FP/HIV/AIDS functional logistics Management Information System(LMIS) by the end 2008 Specific objective 1: To establish a functional logistics unit for the RH Division/,CMS and the district health management levels by the end of 2008 Activity Implementing agency Timing Budget Out put Indicators Outcome Indicators 6.1.1.1 Integrate the SRH/FP/HIV/AIDS logistics at central and district levels MOHS/RHD Q4, 2007 5,000 Contraceptives fully integrated in the actual Essentials Drugs distribution system Fully functional Logistics/ RHCS unit within the RHD 6.1.1.2 Staff and equip the logistics unit at both central and district levels MOHS/RHD Q4, 2007 10,000 No of staff trained Specific objective 2: Build capacity for RH/FP logistics in Sierra Leone 6.1.2.1. Assess the present logistics system using the LSAT and LIAT Partners and MOHS (RH/SRH/HIV/AIDS) Q2 2007 20,000 Reports available Capacity for RH/SRH/FP/HIV/AIDS commodity built Conduct a workshop to design the RH commodity logistics system Partners and MOHS (RH/SRH/HIV/AIDS) Q2 2007 2,000 Contraceptive logistic system designed 6.1.2.3 Develop a Logistics Manual including Standard Operating procedures for RH commodities management MOHS (RH/SRH/HIV/AIDS) and partners Q3 2007 10,000 Workshop conduct and new design available 6.1.2.4 Train central level staff and District level personnel in logistics and on the use of LMIS software MOHS (RH/SRH/HIV/AIDS) and partners Q1 2008 20,000 No. of staff trained in logistics/RHCS 6.1.2.5 Organize study tours for RH Program staff and Service Providers MOHS (RH/SRH/HIV/AIDS) and partners 2007 Q4 30,000 Study tours conducted and lessons learned shared Specific objective 3: Develop and maintain a reliable forecasting mechanism, by end of 2007 Activity Implementing agency Timing Budget Out put Indicators Outcome Indicators Establish a forecasting team, and design the TOR RHD/CLU, MOHS, Partners Q4 2007 0 Team members appointed Stockouts reduced at all levels 6.1.3.2 Conduct a 5-day training workshop on forecasting and procurement planning for the forecasting team MOHS/RHD Q4, 2007 5,000 No of members trained Conduct bi-annual forecasting sessions annually for procurement purposes MOHS/RHD, Partners Q1 and Q4 20,000 No of forecasting sessions conducted Train 14 DHMTs staff in forecasting of RH commodities MOHS/ 2007 10,000 Number of District level staff trained Orient Central Level Staff on the use of various software (Pipeline/Quantimed/UNFPA CCM and Channel) MOHS, RDH, Partners Q4,2007 5,000 Orientation report available Specific Objective 4: Integrate RH Commodity supply pipeline into the CMS supply chain by the end of 2008 6.1.4.1 Build capacity to sustain RH Commodity supply chain in the CMS MOHS/RHD Q1-Q4 2007 150,000 SRH/FP/HIV/AIDS commodity warehouse constructed Maintain efficacy of products at above 95% Wastage reduced by at least 95% 6.1.4.2 Conduct quality control analysis of RH commodities within the system MOHS/RHD Annually 25,000 Insurance provided 6.1.4.3 Conduct joint inspection of the distribution channels of RH RHD 2007 – 2011 5,000 Inventory control tools provided 6.1.4.4 Conduct post market surveillance of RH commodities. MOHS/RHD On going - Report of post market surveillance activities 6.1.4.5 Monitor the use and adverse effect of the RH commodities MOHS/RHD Q2, 2008 - Report on monitoring 6.1.4.6 Build capacity of staff at the national pharmaceutical quality control laboratory MOHS, Pharmacy Board Q2, 2008 - No of staff trained Specific objective 5: To establish an effective Logistics Management Information System, by the end of 2007 Activity Implementing agency Timing Budget Out put Indicators Outcome Indicators 6.1.5.1 Conduct four regional training workshops for DHMTs and other partners on LMIS MOHS/RHD 2007 - 2011 15,000 No of persons trained on LMIS LMIS is operational 6.1.5.2 Review and produce LMIS forms MOHS/RHD Q2-Q3 2007 30,000 reviewed LMIS forms 6.1.5.3 Distribute LMIS forms to all DHMTs, all stores and service delivery sites MOHS/RHD Q2-Q3 2007 25,000 No of DHMTs with LMIS forms 6.1.5.4 Cascade training for PHU staff at district level RHD Ongoing 35,000 No of PHU Staff trained Strategic Objectives 2: Pharmacy Board to ensure that 100% 0f RH commodities imported for RH services are registered as outlined in the National Medicines Policy, 2004 and the Pharmacy and Drugs Act, 2001 Specific Objective: Pharmacy Board to ensure that 100% of RH commodities imported for RH services meet the required standards of safety, efficacy and purity. No. Activity Implementing Partners Timing Budget (USD) Output Indicator Outcome Indicators 6.1.6.1 Capacity building of staff in Product Registration, QC and drug safety monitoring PBSL 2008 Ongoing 240,000 No. of staff trained Training in drug registration QC and drug safety monitoring 6.1.6.2 Support Expert Committee on the evaluation of product registration requirements PBSL 2008-2011 15,000 No. of Expert Committee Meetings supported Products registration requirements monitored 6.1.6.3 Conduct joint inspection of distribution channels RH/FP PBSL 2008-2011 Quarterly 80,000 No. of distribution outlets inspection GSP and GDP Implemented Post market surveillance of RH commodities RH/FP PBSL 2008-2011 half yearly 80,000 No. of RH commodities sampled and identified for QC analysis Strengthened surveillance capacity for RH commodities 6.1.6.4 6.1.6.4.1 Quality Control Analysis of RH Commodities at the NPQCL Procurement of chemicals, reagents and reference standards for the laboratory PBSL 2008-2011 50,000 Chemicals reagents and reference standards procured for QC analysis of RH products Chemicals reagents and reference standards made available 6.1.6.4.2 Provision of fuel for the generator in the laboratory PBSL 2008-2011 60,000 Amount of fuel for the generator at the NPQCL Electricity provided for the NPQCL 6.1.6.4.3 Maintenance, repairs, standardization and validation of laboratory equipment PBSL 2008-2011 20,000 Capacity to maintain and validate equipment strengthened Equipment operational capacity maintained 6.1.6.5 Monitoring Use and Side Effects of RH commodities (Pharmacovigilance ) TOT for public and private sector health professionals on Drug Safety and Monitoring ( central, regional & district levels) PBSL 008-2011 Quarterly 40,000 No. of persons trained Strengthened capacity to implement training in drug safety monitoring 6.1.6.6 Print & distribute ADR forms and guidelines to health professionals RH/FP PBSL 2008-2011 Quarterly 40,000 No of ADR forms and guidelines produced ADR reporting forms & Guidelines made available 6.1.6.7 Follow-up inspection and supervision of ADR reporting RH/FP PBSL 2008-2011 Quarterly 40,000 No follow-up inspection and supervision made Follow-up inspections and guidelines conducted 6.1.6.8 6.1.6.8 (a) Advocacy and Community Sensitization on Appropriate Use of RH Commodities Develop and produce IEC/BBC materials RH/FP PBSL 2008-2011 Quarterly 50,000 No. of IEC materials made available Increased awareness on the availability and benefit of RH interventions and rational and safe use of RH commodities 6.1.6.8 (b) School Health Talks/Program PBSL 2008 10,000 No. of programs/talks conducted in schools “ 6.1.6.8 (c) TV Advert/Radio Advert PBSL 2008 10,000 No. of adverts conducted “ 6.1.6.8 (d) Bill Boards PBSL 2008 30,000 No. of Bill Boards “ 6.1.6.8 (e) University and other tertiary institutions talks/programs PBSL 2008 15,000 No. of programs/talks conducted in University or Tertiary Institution “ 6.1.8.9 Prescription and cohort event monitoring for RH commodities RH/FP PBSL 2008-2011 Quarterly 60,000 No. of prescriptions monitored Utilization and safety data on RH commodities acquired 3.7 Monitoring and Evaluation Assumptions: DHMTs have capacity to print data collection tools Availability of reliable data from DHMTs, private practitioners and NGOs M&E tools available Relevant staff available Strategic objective 1: To establish a functional monitoring and evaluation system to ensure that the strategic plan is well implemented Specific objective 1: To develop and implement a comprehensive M&E plan, by end of 2007, Activity Implementing agency Timing Budget Out put Indicators Outcome Indicators 7.1.1.1 Develop an M&E plan for RHCS strategy RH/MOHS/ RHCS committee, Partners Q2 2007 2,000 Existence of plan M&E/LMIS for SRH/FP/HIV/AIDS program is functional 7.1.1.2 Adapt required data collection tools to monitor program implementation RH/MOHS/ RHCS Committee, Partners Q2 2007 2,000 Availability of data collection tools 7.1.1.3 Train M&E officers across the country RH/MOHS/NAS Partners Q2 2008, Q3 2009 10,000 No. of M&E Officers trained 7.1.1.4 Train service providers to use appropriately M&E tools RH/MOHS/NAS Partners Q3 2008 75,000 No. of services providers trained 7.1.1.6 Provide quarterly feedback on plan implementation to lower levels. RH/DHMT/ RHCS Committee Q 4 2007- 2011 1,000 No of feedbacks meetings held 7.1.1.7 Compile, collate and analyze M&E information on RH commodities on quarterly basis RH/DHMT/ RHCS Committee Q3 2007, onwards 1,000 Availability of analysis reports 7.1.1.8 Work with Directorate of Planning and Information to harmonize data collection tools to capture RH information to monitor the program implementation RH/DHMT/ RHCS Committee Q3 2007, onwards 5,000 % of copies distributed 7.1.1.9 Procure two desk-top computers and one laptop and accessories RH/DHMT/ RHCS Committee Q2-Q3 2007 7,000 No of computers and accessories procured Specific objective 2: Monitor and evaluate the Implementation of RHCS plan Activity Implementing agency Timing Budget Out put Indicators Outcome Indicators 7.1.2.1 Conduct mid-term and end of term evaluation of implementation of RHCS strategy MOHS (RH), RHCS Committee Q4 ongoing 21,000 No. of Progress report available M&E plan implemented 7.1.2.2 Develop joint monitoring plan for SRH/HIV&AIDS MOHS (RH), RHCS Committee Q3 ongoing 42,000 Existence of evaluation report 7.1.2.4 Draft the 2012-2017 RHCS plan MOHS (RH/SRH/HIV/AIDS) RHCS Committee Q4 2011 3,000 Draft of RHCS plan available Annexe 1: Estimated Total landed cost of contraceptives (USD) Products 2006 2007 2008 2009 2010 2011 Total COC 74,192 89,355 105,230 121,843 139,220 157,390 687,231 POP 9,992 12,034 14,172 16,410 18,750 21,197 92,556 DMPA 85,886 103,439 121,815 141,046 161,163 182,197 795,546 Noristerat 10,870 13,091 15,417 17,851 20,397 23,059 100,686 IUCD 2,599 3,130 3,686 4,268 4,877 5,514 24,075 Implants 0 Will be updated after Contraceptives Procurement Table (CPTs) exercise Male Condom 24,679 25,454 26,254 27,078 27,929 28,806 160,199 TOTAL Commodity Cost 208,218 246,504 286,575 328,496 372,336 418,164 1,860,293 Import Duty 17.5% 30,985 36,682 42,645 48,883 55,407 62,227 276,829 VAT 5% 8,853 10,481 12,184 13,967 15,831 17,779 79,094 Total Cost w/taxes 248,055 293,666 341,404 391,347 443,574 498,169 2,216,216 Set for insertion and removal IUD ITEM DESCRIPTION UNIT QUANTITY 1 Disinfector instr. boiling type 320 x 170 x 100 mm fuel pc 1 2 Basin kidney 825 ml (28 oz) stainless steel pc 2 3 Cup solution 180 ml stainless steel pc 1 4 Gloves surgeon’s latex size 6-1/2, reusable pair 12 5 Gloves surgeon’s latex size 7, reusable pair 24 6 Gloves surgeon’s latex size 7-1/2, reusable pair 24 7 Gloves surgeon’s latex size 8, reusable pair 12 8 Flashlight pre-focused 2-cell right-angled head pc 1 9 Forceps hysterectomy straight Pean 220 mm SS pc 2 10 Forceps sponge-holding straight 200 mm pc 1 11 Forceps uterine tenaculum Duplay DBL-CVD 280 mm pc 1 12 Scissors uterine curved Sims 200 mm SS pc 1 13 Sound uterine Simpson 300 mm graduated in 20 mm pc 3 14 Speculum vaginal bi-valve Graves small SS pc 1 15 Speculum vaginal bi-valve Graves medium SS pc 2 16 Speculum vaginal bi-valve Graves large SS pc 1 17 Battery alkaline dry cell “D” type 1.5 V pc 2 The complete kit consists of: Total No of packages: 1 carton Total weight: 5 kgs Total volume: 0.026 m3 Total value: USD 100.-- Source: WHO Kits, 1998 Annexe 2: Sierra Leone Estimated funding Requirements for Contraceptive Commodities, 2006–2011 The figure below shows the estimated funding requirements for contraceptive commodities for 2006–2011. The estimates are inclusive of freight and procurement fees. Cost of Implants is not include. [image: image4.emf] Source: Estimate of the contraceptive requirements for Sierra Leone for the next six years (2007-2013), by Deliver and AWARE-RH Annexe 3: Part duty and taxes in total cost of contraceptives [image: image5.emf] Source: Estimate of the contraceptive requirements for Sierra Leone for the next six years (2007-2013), by Deliver and AWARE-RH (implants are not included into the estimates) Annexe 4: Demographic, health, and development indicators for Sierra Leone INDICATOR 10 Years Ago 5 Years Ago Current 5 Years from Now 10 Years from Now Total population 4.314M 4.834M 4.976M 5.607M 6.348M Percent of population that is urban N/A N/A 37.63% 36.611% 42.535% Percent of population that is rural N/A N/A 62.37% 63.39% 57.465% Population growth rate 2.1% 1.9% 1.8% N/A N/A Per capita income N/A $243.06 $273.01 N/A N/A Adult literacy rate N/A 30% 39% N/A N/A Number of women of reproductive age N/A N/A 1.249M N/A N/A Total fertility rate (TFR) N/A N/A 6.09 6.04 5.98 HIV prevalence 0.9% 1.5% 2.19 2.90 Infant mortality N/A N/A 115 107 98 Maternal mortality N/A 1,800 1,800 N/A N/A Average age at marriage for women and men N/A N/A 24 N/A N/A Average age at delivery of first child N/A N/A 20.0 20.0 21.0 Source: 2004 Population and Housing Census; National Accounts of Sierra Leone References and Resources Government of Sierra Leone (GOSL), November 2000: Survey Report on the Status of Women and Children in Sierra Leone at the end of the Decade (MIRHCS 2000) GOSL, January 2002: National HIV/AIDS Policy GOSL, August 2003: Sierra Leone Vision 2025 GOSL, March 2005: Poverty Reduction Strategy Paper (PRSP) GOSL, 2005: National Population – Based HIV Seroprevalence Rate GOSL, 2005: National Youth Policy GOSL, 2006: National Budget Allocation, Ministry of Finance GOSL, 2006: Draft National Reproductive Health Policy for Sierra Leone GOSL, 2004: Population and Housing Census Marie Stopes Society (SL): Summary of services delivered, 2001 -2004 Madagascar, 2003: SPARHCS Assessment Report MOHS, 2005: Reproductive Health Services Annual Report MOHS, July 2006, Contraceptives Commodity Security Assessment Report UN, 2005: The Millennium Development Goals Report UNDP, 2005: The Human Development Index Report UNFPA - CST, 2003: Report of the Qualitative Assessment of the RH Commodity Logistics System List of Tables, Figures And Boxes Tables Table 1: Strategic objectives per Component page 1 Table 2: Estimated budget per component page 2 Table 3: Strengths and Weaknesses by Component page 6 Table 4: Strategic objectives per Component page 8 Figures Figure 1: RHCS Framework page 4 Figure 2: SPARHCS and the Program Cycle Box Box 1: SPARHCS and the Programme Cycle page 5 Conduct a situation analysis Get consensus on priority areas Develop the RHCS plan Conduct advocacy to raise awareness and mobilize resources to fill the contraceptive gap Implement the RHCS plan and monitor and evaluate results All methods Modern methods � 2004 Population and Housing Census Report � In the Sierra Leone context, youth is 15 to 35 years � In the Sierra Leone context, youth is 15 to 35 years PAGE ii _1215987900.doc [image: image1.jpg]

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