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GLOBAL HEALTH SUPPLY CHAIN TECHNICAL ASSISTANCE - FRANCOPHONE TASK ORDER:

April 2017 – September 2018 Work Plan - Haiti

Contract number: AID-OAA-TO-17-00006

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CONTENTS

FRANCOPHONE TA TASK ORDER BACKGROUND 2

FRANCOPHONE TA TASK ORDER OVERALL STRATEGIC APPROACH 3 PROJECT GOAL 3 RESULTS FRAMEWORK 4

PROPOSED HAITI TECHNICAL ASSISTANCE PROGRAM: 5 TECHNICAL ACTIVITY IMPLEMENTATION, COORDINATION & MONITORING 18 OPERATIONS MANAGEMENT 18

MONITORING & EVALUATION 19 BASELINES AND TARGETS, DATA COLLECTION 19 DATA ANALYSIS, QUALITY AND REPORTING 19

REPORTING PLAN 19

HAITI BUDGET 20

ANNEX 1: HAITI – DRAFT GANTT CHART 21

ANNEX 2: HAITI – BUDGET BREAKDOWN 23

ANNEX 3: SUPPORT STTA/CONSULTANT 24

ANNEX 4: INTERNATIONAL TRAVELS 24

FRANCOPHONE TO: HAITI COUNTRY WORKPLAN | 2

FRANCOPHONE TA TASK ORDER BACKGROUND USAID’s investments in Francophone countries of West Africa and Haiti have significantly improved availability of HIV/AIDS, malaria, and maternal and child health, and family planning (FP) commodities to the region. To usher in the next phase in the evolution of health commodity security, a paradigm shift is needed to empower country leaders so that they may effectively address systemic barriers with decreasing levels of external assistance over time. We have crafted our approach in alignment with the goal of building sustainable in-country supply chain systems while ensuring the reliable delivery of USG-provided health commodities.

USAID’s Global Health Supply Chain (GHSC) Program includes a portfolio of projects that focus on health commodity procurement, system strengthening, and technical assistance related to supply chain management and commodity security. GHSC is a continuation of USAID’s work and investment in strengthening supply chains in various countries, to serve many of the world most vulnerable and difficult-to-reach communities. The GHSC-Technical Assistance (TA) Francophone task order provides specialized supply chain expertise to designated countries to improve the efficiency of national supply chains, improve national and regional collaboration with supply chain stakeholders, and improve sustainability of supply chain systems. Chemonics' partner organizations under this Task Order for technical assistance include IntraHealth International (IntraHealth), McKinsey&Company (McKinsey), and University Research Co., LLC (URC).

Strengthening health supply chains in Francophone West Africa and Haiti requires a nuanced understanding of each country and tailored approaches to fit country contexts. The focus countries of this Task Order (TO) vary considerably in the functionality and sustainability of their nationally run supply chains. Benin and Senegal are edging closer to building sustainable supply systems, whereas the Democratic Republic of Congo (DRC) and Haiti remain reliant on donor-managed supply chains for essential health products. Common challenges to delivering health commodities stem from poor logistics systems design and inadequate data visibility, storage capacity, commodity financing, and human resources.

To strengthen supply chain and instill country ownership we will engage local stakeholders to shape the agenda through use of structured tools such as supply chain maturity models. We will also improve data visibility and logistics systems by capturing and reporting data across supply chains, creating more efficient logistics systems for transport and distribution to remote areas. We will enable local partners to address such challenges by implementing cost-effective tools that draw on technology including data entry via SMS or tablet software with on/offline modes, data dashboards to view real-time stock data, and data scanning kits.

Given the complexity of health supply chain systems, promoting in-country and regional coordination is paramount for success. As some countries are pursuing decentralization strategies endowing provinces with more responsibility in supply chain operations, we will take these dynamics into account in organizing coordination and technical assistance. We will establish clear roles and responsibilities MOUs with partners and seek avenues for collaborating with the European Union, World Health Organization (WHO), U.N. agencies, CHAI, and the Gates Foundation on joint initiatives.

Chemonics will leverage the experience of partner McKinsey as we engage multi-sectoral stakeholders in select GHSA developing countries in Africa and enable them to be better prepared to provide commodities needed to manage disease outbreaks with pandemic potential. McKinsey is ideally suited to lead this effort as they have significant experience establishing Emergency Operations Centers

FRANCOPHONE TO: HAITI COUNTRY WORKPLAN 3

(EOCs) in Nigeria and Senegal and in providing strategy and coordination of national responses to Ebola, Zika virus, swine flu, MERS and Polio.

Chemonics GHSC-TA team has engaged in technical calls with USAID missions to establish priorities for the Task Order activities in each country. Startup teams have established office space, clarified registration and financial banking systems, and begun recruitment. These teams met with the respective USAID Activity Managers, members of the USAID Health Team, and local stakeholders to gather initial information to inform this work plan. In anticipation of technical work planning, USAID has shared information, recommendations, and priorities. This information has been combined with technical activities from our program design as the starting point for country specific work plan development.

FRANCOPHONE TA TASK ORDER OVERALL STRATEGIC APPROACH

PROJECT GOAL

The GHSC-TA TO mission “Strengthen Supply Chain Systems in West Africa Francophone Countries and Haiti to Ensure Timely Access to Quality Essential Health Products and services, Improve In-Country and Regional Collaboration and Coordination, and support the Global Health Security Agenda” is supported by three objectives. These objectives are below as well as a brief description of possible areas of intervention:

Objective 1. Countries Supply Chain Systems Strengthened: governance, coordination, strategic plan development, quantification and forecasting, procurement, logistics and warehousing, LMIS and data visibility and monitoring, and capacity building are the overarching areas that will be addressed. This should apply to all levels of the countries supply chain, including last mile when required. Biomedical and medical equipment maintenance, and pharmaceutical waste management will be supported in selected countries.

Objective 2. Strengthen Collaboration and Regional Organizations to Improve Commodity Security: focuses on building on the accomplishments of other USG supported programs, such as USAID | DELIVER and SIAPS, to empower regional actors to strengthen health systems, and to foster the collaboration and coordination between all relevant regional (e.g. the Ouagadougou Partnership Association) and global (e.g. 90/90/90 Initiative) initiatives. The supply chain for Family Planning and Reproductive Health, together with the one for HIV/AIDS commodities, have been identified as priority areas. The project may also work on supporting technical activities such as in-country logistics, quantification, and supply chain optimization. Enhancing data sharing and visibility will also be supported through the implementation of regional dashboard(s).

Objective 3. Global Health Security Agenda (GHSA) and Emergency Preparedness Strategies Supported by Countries Supply Chain: includes the development of an essential competencies framework for supply chain management to respond to public health emergencies efficiently. Once developed, this framework will be tested and customized for 5 selected GHSA countries. Stakeholder engagement and coordination will also be key to ensure that the adequate resources are available and responsibilities clearly defined to ensure that country supply chains are fully equipped to respond in the most efficient fashion to public health emergencies.


RESULTS FRAMEWORK

The three objectives described in the previous paragraph are the pillars of the project and are supported by their respective Intermediate Results (IRs) as outlined in Figure 1. This framework also shows the link between the project, the USG initiatives and strategies, and Global Goals, initiatives and Partnerships.

Figure 1. Francophone TA Task Order Results Framework

Global Goals, Initiatives and Partnerships Post-2015 Development Agenda Commission on Life Saving Commodities

Roll Back Malaria A Promise Renewed AIDS Free Generation 90-90-90 Initiative

Family Planning 2020 Women Deliver

U.S Government Initiatives and Strategies Global Health Initiative USAID Forward

President's Emergency Plan for AIDS Relief

President's Malaria Initiative

USAID Global Health Strategic Framework

GHSC-FTO Goal: Strengthen Supply Chain Systems in West Africa Francophone Countries and Haiti to Ensure Timely Access to Quality Essential Health Products and Services, Improve In-Country and Regional Collaboration and Coordination, and support the Global Health Security

Agenda (GHSA)

Objective 1: Systems strengthening technical assistance - strengthen in-country supply systems

Objective 2: Strengthen collaboration and regional organizations for improved commodity security

Objective 3: Building countries’ supply chain management capacity in the context of GHS and emergency preparedness

IR 1.1: Improved Policy, Governance, Strategy, Coordination

IR 2.1: Build Regional Capacity to Improve Logistics Management and Commodity Security

IR 3.1: National Supply Chain Systems for Public Health Emergency Preparedness and Response Developed

IR 1.2: Optimized Forecasting and Procurement process are implemented

IR 2.2: Strengthen National/Regional LMIS Platforms

IR 3.2: Stakeholder Engagement and Coordination Improved

IR 1.3: Best Practices for Distribution, Warehousing, Logistics Implemented

IR 1.4: Data Visibility and Stock Monitoring Enhanced

IR 1.5: Improved Rational Use of Medical and Laboratory Equipment & Commodities, and Pharmaceutical Waste Management done according to International Standards

These IRs are expected to be the results of selected focused technical interventions that will be developed and conducted by the project in, and across, selected countries of the West Africa region and in Haiti over the life of the project.


PROPOSED HAITI TECHNICAL ASSISTANCE PROGRAM: BACKGROUND

Health services in Haiti have chronically suffered from a range of management and operational problems, including frequent stock-outs, inadequate provider knowledge, poorly managed infrastructure and equipment, poor quality of care, and limited availability and access to health services due to uneven distribution of services throughout the country. USAID/Haiti works to expand national access to essential health, nutrition, and family planning services to underserved Haitians, including women, children, and people living with HIV/AIDS. While domestic health investments remain limited, the Ministry of Health (MSPP1) has demonstrated its commitment to strengthen management and oversight of the health sector. Haiti lacks a national supply chain system, supply chain management for pharmaceuticals and related commodities is being done by PROMESS/PAHO and GHSC-PSM/USAID. Moreover, a reverse logistics system to ensure the regular removal and disposal of pharmaceutical products from health institutions when they are expired, obsolete or unusable is not in place. After the 2010 earthquake, Haiti faced additional challenges managing its pharmaceutical waste. Health care facilities accumulated this waste at a rate that affected their operational capacity, and occupied valuable storage space allocated to pharmaceutical commodities. Unsafe storage and inappropriate disposal methods created risks that pharmaceutical waste might spread through heavy rains with devastating consequences on the environment (water, agriculture, fauna, flora), endangering public health. Some progress has been achieved by the Medicine and Pharmacy Directorate (DMP/MT2) in collaboration with the Health Promotion and Environment Protection Directorate (DPSPE3) with the support provided by projects such as SCMS and SIAPS, and now GHSC-PSM, but much needs to be done to have a pharmaceutical waste management system and procedures in place. The lack of a system for management and maintenance of medical equipment within the public health sector has also been recognized as a challenge for Haiti. An excessive amount of unused equipment (e.g. hospital beds, incubators, etc.) clutters storage areas and open fields at health facilities. Much equipment is inoperable due to disrepair, lack of spare parts and/or supplies. Increasing the availability of operational medical equipment in the public health system and disposing of the non-functioning equipment are among the priorities of the Directorate of Health Services Organization (DOSS4) - the technical entity of the MSPP that is responsible for medical equipment. The DOSS faces a critical shortage of biomedical engineers to routinely manage the situation. In the past five years, Haiti has made progress in automating laboratory testing to reinforce quality of laboratory results and standardization of equipment in country which are managed by the National Public Health Laboratory (LNSP5). With the support of PEPFAR, decentralization of CD4, chemistry, and hematology testing was achieved with the procurement and installation of equipment such as PIMA, FACSCount, Sysmex, Reflotron, and GeneXpert. Despite a decrease in

1 Ministère de la Santé Publique et de la Population 2 Département de la Pharmacie, du Médicament et de la Médicine Traditionnelle 3 Département de la Promotion de la Santé et de la Protection de l’Environnement 4 Direction de l'Organisation des services de Santé 5 Laboratoire National de Santé Publique


PEPFAR funding, Haiti remains committed to ensuring a sustainable management system for the repair and maintenance of laboratory equipment in order to continue to provide quality laboratory services to patients. FOCUS The GHSC-TA project work in Haiti will focus on interventions to strengthen the national management of pharmaceutical waste, the maintenance of laboratory (for PEPFAR-supported sites) and medical equipment (in northern sites supported by the Services de Santé de Qualité pour Haïti [SSQH] project managed by JHPIEGO). At this time the Francophone TA TO in Haiti is expected to be funded for 2 years. The project proposes to implement a series of technical activities at the central level and in the provinces as per USAID guidelines. Consistent with our 4Es approach to our work (Figure 2), each of these activities will include a strong capacity building component in order to hand over these tasks to the Government of Haiti (GoH) staff in a timely manner throughout the project lifetime.

Figure 2. GHSC-TA Conceptual Framework

The project will work in very close collaboration with the GHSC-PSM project as it is the key partner responsible for procurement and distribution of health products for USG supported sites. Areas of work were identified in the response to the USAID RFP. They are:

• Development of a master plan to establish a national system for the management of pharmaceutical waste

• Strengthening of national systems for the maintenance and repair of: o Medical equipment used to provide maternal-child health services at SSQH sites o PEPFAR supported laboratories

Therefore, unlike any other country programs supported by the project, most of the proposed activities to address USAID-Haiti mission’s requests for technical assistance fit under IR 1.5 Improved Rational Use of Medical and Laboratory Equipment & Commodities, and Pharmaceutical Waste Management done according to International Standards. The cross-cutting nature of these activities also contribute to IR 1.1. Improved Policy, Governance, Strategy, Coordination of the relevant GoH directorates (DPM/MT/DPSPE, NLSP, DOSS), and IR 1.4. Data Visibility and Stock Monitoring Enhanced by improving current system use to monitor the status of biomedical and medical equipment. A 3 day consultative workshop was held with all relevant stakeholders in July 2017 in Port-Au-Prince. The following activities are a reflection of the discussions and recommendations that were made and agreed upon during this workshop.


OBJECTIVE 1 Systems Strengthening Technical Assistance - Strengthen In-Country Supply Systems IR 1.1. Improved Policy, Governance, Strategy, Coordination

• Activity 1.1.1. Strengthen the capacity of the MSPP, DOSS, DPM/MT/DPSPE and the NLSP in supporting their respective programs: from the start of the project implementation, the MSPP, DOSS, DPM/MT/DPSPE and the NLSP will be involved in the development and implementation of the methodology, and tools, to assess and monitor the status of the laboratory and medical equipment installed at selected sites supported by USAID, and the development of the national master plan to manage pharmaceutical waste. This will be done through the creation of a technical working group (TWG) for each of the relevant technical areas that will be responsible to oversee the implementation of the project technical activities. At the beginning of the project these TWGs will meet monthly and will be spearheaded by the relevant GoH lead with the support from the project’s relevant technical leads (environment and waste management specialist, medical equipment management specialist, laboratory coordinator). Moreover, the project capacity and training coordinator will also provide governance guidance and support to all directorates at both national and provincial levels and ensure coordination of activities.

IR 1.4. Data Visibility and Stock Monitoring Enhanced

• Activity 1.4.1. Implementation of a computerized maintenance management system (CMMS) to manage laboratory and medical equipment, monitor and report on their status: led by the country project director, in collaboration with the medical equipment management specialist and the laboratory coordinator, this activity will be conducted in 3 phases:

o Identify the various functions that need to be managed by the system (e.g. equipment and spare part inventories, maintenance request, work orders, etc…) and confirm the data elements to be captured. This will be done through a series of consultative sessions with managers and potential users to develop user requirements.

o Conduct a review of existing CMMS that can be implemented and supported in a resource limited environment like Haiti. Short listed systems will be presented to the laboratory and medical equipment TWGs for approval.

o Implement selected system and build capacity of the DOSS and NLSP staff at both national and departmental levels.

o Identify and train super users, selected among MoH staff, that will be responsible for providing user support and maintenance, and monitor the proper use of the system.

Criteria for selection of the CMMS will include ease of use, configurability, and licensing cost and its ability to be used for both laboratory and medical equipment. In addition of the DOSS and NLSP, this activity be done in collaboration with the project REPARE and the Haiti based United Nation Operation for Project Services (UNOPS) as they are involved in similar activities.

IR 1.5. Improved Rational Use of Medical and Laboratory Equipment & Commodities and Pharmaceutical Waste Management done according to International Standards

• Activity 1.5.1. Development of a national pharmaceutical waste management strategic master plan to support the creation of a pharmaceutical waste treatment facility: work with GHSC-PSM, DPM/MT, DPSPE, and other relevant ministries and stakeholders (WHO, EPA, EU) to establish a technical working group (TWG) that will develop a strategy for the implementation of a national health-care pharmaceutical waste management (HCPWM) plan, and associated SOPs and guidelines, to safely and sustainably treat and dispose of pharmaceutical waste in accordance with accepted national and international standards. The plan will be informed by


a comprehensive assessment of the existing HCPWM landscape in Haiti that will be led by the waste management unit of the project in collaboration with the TWG. Relevant guidelines and SOPs will be developed to support the national strategy plan implementation and training in their use will be conducted during the following workplan period. Key activities to be conducted during this workplan period will include:

o Presentation of this activity to all Departmental Directions of Health o Conduct an environmental and Social Impact Study for the selected HCPWM plant

site (performed by a locally hired consultant with appropriate expertise). o Identify and hire a consultant to identify technology, equipment, fleet and human

resource requirements. o Develop a strategic plan and seek approval from the MoH o Work with the MoH with the review of MSPP Norms and SOPs for the

management of pharmaceutical waste and seek approval. o Develop a pharmaceutical waste management training program for the relevant

health personnel informed by the revised MSPP norms and regulations.

The following Gantt Chart for this activity highlights the overall objective and sub-objectives and related sub-activities that have been programmed over the life of the project, however it is important to note that the budget which is presented in Annexe 2 reflect the budget required to support to-date activities up to September 2018.


ACTIVITY 1.5.1. WASTE MANAGEMENT GANTT CHART

Sub-Activities Lead Staff Partners

FY17 FY18 FY19

Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

Overall Objective: Contribute to the development and implementation of the National Strategy for Pharmaceutical Waste Management Sub-Objective 1: Develop a Strategic Master Plan for the implementation of the National Treatment and Disposal Plant (NTDP)

a. Present Project to all Departmental Directions of Health

Environment and Waste

Management Specialist (EWMS)

DDH

b. Implementation of a Technical Working Group (TWG) EWMS

DPM, DPSPE, DOSS, LNSP, DCVA, PAHO,

USAID, GHSC-PSM,

OHMASS

c. Conduct Environmental & Social Impact Study Consultant

BNEE, DPM/MT,

DPSPE

d. Identification of technology, fleet and human resources requirements

EWMS & Consultant

DPM/MT, DPSPE, DRH,

DOSS

e. Presentation of Strategic Plan to the MoH for approval EWMS TWG

Sub-Objective 2: Build capacity of the MoH to manage pharmaceutical waste at all levels of the health system

a.

Assist with the Development of Norms and SOPs of the MOH for the Management of Pharmaceutical Waste at health site level

EWMS DPM/MT

b. Approval of Norms and SOPs by the MoH (incl. printing, publication & dissemination)

EWMS DPM/MT

c. Develop a Curriculum and a Training Program with a focus on site level CBTC DPM/MT



FY17 FY18 FY19

Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

Overall Objective: Contribute to the development and implementation of the National Strategy for Pharmaceutical Waste Management

d. Approval of curriculum and training program by MoH CBTC DPM/MT

e. Conduct Training Program CBTC DPM/MT


Activity 1.5.2. Assist MSPP with managing maintenance and repairs of selected medical equipment from SSQH sites: this will be informed by an assessment of SSQH sites’ medical equipment and local capacity, including private sector providers, to repair, transport, and dispose of equipment in accordance with health, safety, and environmental measures. Although SSQH is supporting 164 sites, the assessment will be relevant to about half of these sites, as they are the ones using the equipment which will be supported by the project. This assessment will be conducted by the medical equipment management specialist together with the MSPP and the SSQH staff. Design and implement comprehensive training programs to build national and provincial staff capacity to maintain selected equipment, taking into consideration lessons learned from existing programs like the REPARE project. Strengthen the capacity of the DOSS to draft, implement and monitor service contracts to outsource the repair of these equipment when required. Key sub-activities to be conducted during this work plan period will include:

o Presentation of this activity to all Departmental Directions of Health o Develop EMMP for submission to the mission for approval o Develop a medical equipment assessment tool o Conduct a comprehensive assessment of medical equipment from selected SSQH

sites that will result in detailed inventory of available and usable equipment. The assessment report will be submitted for approval

o Develop a spare part catalog to facilitate procurement coordination with GHSC-PSM o Develop repair fact sheets, repair protocols and SOPs o Identify opportunities to strengthen or implement central and departmental repair

workshops and equip them with basic repair tool kits o Establish a DOSS hotline for equipment failure and repair requests o Develop a plan for the disposal of obsolete or unusable equipment in compliance with

local regulations o Identify existing, or new staff, to provide medical equipment maintenance and assess

their training needs o Support CMMS implementation (see activity 1.4.1.) o Review training programs available (e.g. REPARE training workshops) and develop a

training curriculum adapted to the type of equipment and the level of maintenance required

o Develop training calendar and start the training in selected departments. All 10 departments will be covered by the end of the following work plan period.

This implementation of the CMMS will play a key role in supporting the monitoring and reporting on progress for this activity.



ACTIVITY 1.5.2. MEDICAL EQUIPEMENT MAINTENANCE AND REPAIR GANTT CHART


FY17 FY18 FY19

Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

Overall Objective: Support the MSPP and the DOSS by building capacity to maintain PEPFAR-funded medical equipment Sub-Objective 1: Document status of medical equipment and strengthen their maintenance

a. Present the project to all departmental directions of health (DSH)

GHSC-TA FTO Managers DDH

b. Implementation of a Technical Working Group (TWG)

Medical Equipment

Management Specialist (MEMS)

DOSS, DPSPE, Haiti

Recycling, SSQH, DSF,

DCVA, PAHO, USAID,

GHSC-PSM

c. Develop EMMP for approval by mission EWMS USAID

d. Develop Assessment Tool DOSS

e. Conduct Assessment of medical equipment at selected SSQH sites MEMS

SSQH, DOSS, DDS, CSCCA, GHSC-PSM

f. Develop a comprehensive list of equipment to maintain, and a catalog of their associated spare parts

MEMS DOSS, SSQH

g. Approval of assessment report and list of equipment MEMS DOSS, TWG

h. Develop repair fact sheets, routine maintenance and repair protocols and SOPs

MEMS DOSS,SSQH

i.

Identify opportunities to strengthen or implement central and departmental repair workshops and equip them with basic repair tool kits

MEMS DOSS, IPs



FY17 FY18 FY19

Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

j. Initiate the procurement of required equipment and/or spare part in collaboration with GHSC-PSM

MEMS GHSC-PSM

k. Support CMMS implementation (see activity 1.4.1.) MEMS DOSS, IS,

REPARE

l. Strengthen communication channels (HOTLINE) to report equipment failures

MEMS DOSS

m. Submit Monthly Report to all relevant stakeholders MEMS DOSS, IS

n. Develop a plan for disposal of obsolete equipment and identify opportunities to recycle spare parts MEMS

DOSS,GHSC-PSM, HAITI RECYCLING,

REPARE

Sub-Objective 2: Strengthen capacity of MSPP staff at all levels of the health network to maintain medical equipment

a. Develop a curriculum for medical equipment maintenance CBTC DOSS,

REPARE,DSF

b. Train MSPP biomedical technicians CBTC DOSS,

REPARE,DSF, SSQH

c. Develop training calendar and conduct training of technicians in the departments

CBTC DOSS,

REPARE,DSF, SSQH

d. Conduct evaluation of the training program CBTC DOSS, DSF,

SSQH


Activity1.5.3. Support the MSPP and the LNSP by building capacity to maintain PEPFAR-funded laboratory equipment: a TWG which will include members of the Comité d'Approvisionnement et Gestion des Intrants de Laboratoire (CAGIL), MSPP and LNSP will be created to support this activity. In collaboration with the MSPP, Direction Départementale Sanitaire (DDS) and the LNSP, conduct a comprehensive assessment of the laboratory equipment used at PEPFAR supported sites, and make recommendations for their repair, upgrade, disposal or harmonization to leverage USG investments. Identify qualified technicians to certify biosafety cabinets. Build capacity of a cadre of biomedical technicians (25 have been identified by the LNSP) in PEPFAR-funded equipment maintenance using the SLIPTA checklist in line with ISO 15189. Review service contracts with local service providers and explore opportunities for cost savings approach such as using reagent rental contracts. Using a similar approach to activity 1.5.2, key sub-activities to be conducted and led by the laboratory coordinator during this workplan period will include:

o Presentation of this activity to all Departmental Directions of Health o Develop a laboratory equipment assessment tool o Conduct a comprehensive assessment of laboratory equipment from PEPFAR

supported sites o Develop a laboratory equipment spare part catalog which procurement will be

coordinated in collaboration with GHSC-PSM o Review maintenance contracts offered by vendors o Develop a routine maintenance calendar tailored to comply with manufacturers

recommendation for each type of equipment that will be supported by repair fact sheets, repair protocols and SOPS that will be distributed

o Initiate the procurement of required equipment and/or spare parts in collaboration with GHSC-PSM

o Support CMMS implementation (see activity 1.4.1.) o Establish a hotline at the LNSP for users to report equipment failure and repair

requests o Develop a plan for the disposal of obsolete or unusable equipment and make

recommendations for their harmonization o Dispose of obsolete equipment o Identify training needs for biomedical technicians o Develop a training program for lab equipment and start its implementation in all 10

departments

This implementation of the CMMS will play a key role in supporting the monitoring and reporting on progress for this activity.



ACTIVITY 1.5.3. LABORATORY EQUIPEMENT MAINTENANCE AND REPAIR GANTT CHART Sub-Activities Lead Staff Partners FY17 FY18 FY18

Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

Overall Objective: Support the MSPP and the LNSP by building capacity to maintain PEPFAR-funded laboratory equipment Sub-Objective 1: Document status of laboratory equipment and strengthen their maintenance

a. Present the project to all departmental directions of health (DSH)

GHSC-TA FTO Managers DDH

b. Implementation of a Technical Working Group (TWG)

Laboratory Coordinator

(LC)

LNSP, MSPP, DOSS, CAGIL,

GHSC-PSM, IPs

c. Develop Assessment Tool LC LNSP, DOSS

d. Conduct Assessment of laboratory equipment at PEPFAR supported sites LC

LNSP, DOSS

e.

Develop a comprehensive list of diagnostic laboratory equipment, spare parts and other related products (e.g. centrifuge)

LC LNSP, GHSC-PSM, SSQH, OHMASS, DDSTD, IS

f. Review supplier maintenance contracts LC

GHSC-PSM, LNSP,

OHMASS

g. Develop maintenance schedule according to manufacturer recommendations

LC GHSC-PSM,

LNSP, OHMASS

h. Develop repair fact sheets, routine maintenance and repair protocols and SOPs and ensure its distribution

LC LNSP,PAHO, GHSC-PSM

i. Initiate the procurement of required equipment and/or spare part in collaboration with GHSC-PSM

LC LNSP, GHSC-PSM

j. Support CMMS implementation (see activity 1.4.1.) LC LNSP


Sub-Activities Lead Staff Partners FY17 FY18 FY18

Q3 Q4 Q1 Q2 Q3 Q4 Q1 Q2 Q3 Q4

k. Strengthen communication channels (HOTLINE) to report equipment failures

LC DOSS

l. Submit Monthly Report to all relevant stakeholders LC LNSP

m. Develop a plan for disposal of obsolete equipment in compliance with Haitian regulations

LC

DD, Departement

Juridique, Cours

Superieure des Comptes,

DAB

n. Dispose of obsolete equipment in compliance with Haitian regulations LC LNSP, IPs

Sub-Objective 2: Strengthen capacity of LNSP staff at all levels of the health network to maintain laboratory equipment

a. Develop a curriculum for laboratory equipment maintenance CBTC

LNSP, SSQH, OHMAS,

UNOPS, UNIQ

b. Train LNSP biomedical technicians CBTC LNSP

c. Develop training calendar and conduct training of biomedical technicians in the 10 departments

CBTC LNSP,DDS,IS


PROGRAM MANAGEMENT Under the Francophone Task Order, project implementation is managed by three groups: 1) under the technical leadership of the Country Director, the country team implements activities that are in line with the project’s strategies and that are adapted for the local country context. 2) the HQ staff located in Crystal City develop the global strategic vision for the project , provide technical leadership, oversee field-staff managers and country directors, support monitoring and evaluation, and ensure communication and knowledge sharing between country offices, and 3) the project management unit ensures contract, USG, and Chemonics rules and regulations are followed. These three teams are mutually reinforcing and ensure continuity of operations, consistency of technical initiatives, and clarity of technical and financial reporting and management across all of the task order countries.

Figure 3 shows the proposed staffing structure for the Haiti country office. At the request of the mission the technical staff is expected to be located on the compound of the Ministry of Health. For this purpose, a prefabricated building will be erected and handed-over to the relevant counterparts by the end of the project. The waste environment and waste management specialist of GHSC-PSM will share 25% of its time supporting the GHSC-TA Francophone Task Order Project. He will be supported by a full time technical advisor for waste management that will be hired by the project, however the possibility of having such position embedded within the GoH and funded by OHMaSS is currently under consideration. Procurement, finance management and M&E will be also supported by GHSC-PSM staff that will be shared as required.. A MOU will developed with GHSC-PSM for that purpose.

Figure 3. Proposed GHSC-TA Haiti Organogram


TECHNICAL ACTIVITY IMPLEMENTATION, COORDINATION & MONITORING Implementation. Technical implementation, coordination, and monitoring will occur at the activity level, country level, and task order level by the Francophone TO’s field teams as well as the HQ staff. In-county and regional activities will be directed by each country’s approved work plan, as well as the overarching TO work plan. In particular, Task Order Director Rachel Hampshire, and her HQ based team, will work directly with Country Directors to develop an implementation strategy for annual work plans, and regularly monitor progress against annual targets and goals. Country Directors will have day-to-day managerial responsibility for in-country activities, suggesting new approaches or initiatives to meet the changing needs of in-country implementation, and serve as the main point of contact with USAID mission personnel. Field team technical experts, and administrative staff, will design and implement technical assistance activities based on annual work plans, direction from USAID, and host-country government needs. Recruitment of international and local experts will be a coordinated effort between the field and HQ teams.

Coordination. To ensure coordination between the HQ and field offices, as well as across all countries operating under this task order, the HQ team will establish weekly calls with field offices to discuss progress, upcoming activities, and plan additional or alternative initiatives as needed. Calls will include HQ staff, including the Field Programs Manager, Technical Manager, and the Task Order Director. In addition to weekly country team calls, the HQ staff will establish quarterly virtual regional management meetings with Country Directors to identify opportunities for cross border cooperation and information sharing. Finally, the HQ team and the project management unit will establish regular meetings with the GHSC-PSM teams for Haiti and non-presence countries (DRC, Benin and Senegal) to bolster communications and cooperation between the projects, and HQ backstops.

Monitoring. Each country team will have dedicated monitoring and evaluation expertise on the project, reporting to the country director, and responsible for making sure data obtained by the project is reliable and valid. In-country M&E experts will be supported by the HQ M&E manager who will conduct data quality assessments, as well as compile M&E data across all five countries of operation for periodic reporting.

OPERATIONS MANAGEMENT

Project operations will be managed in each field office, primarily by an office manager, operations manager, or a combination of positions, with support provided by HQ staff and the Francophone TO’s project management unit. Operations teams will have access to numerous Chemonics manuals, key manuals in French, to support in-country operations, such as our field accounting and compliance manual, procurement manual, global quality management system for up-to-date templates in line with USG and Chemonics procedures, as well as country-specific human resource policy manuals approved by local counsel. Field operations teams will also have regular communication with the HQ project management unit through bi-weekly check-ins, and ad hoc communications as needed.


MONITORING & EVALUATION

The Haiti Performance Monitoring Plan (PMP) will serve as a tool for gauging progress against planned activities and will capture data on in-country supply chain, project performance, and sustainability. The PMP will also be designed to serve as a tool to support continuous learning.

The project’s results framework shows the relationships between the broader project goals, objectives and intermediate results. Illustrative indicators to measure the quality and impact of the broader project’s interventions are being reviewed by USAID/W. In Haiti, the project interventions are focused on objective 1 and the indicators used to monitor performance will be in alignment with those relevant for agreed upon activities.

BASELINES AND TARGETS, DATA COLLECTION

The program will rely on existing data to formulate baselines. We will conduct focused baseline assessments only where current data is inaccurate or incomplete. Target setting will be done in collaboration with local partners and in consultation with USAID to ensure that targets are realistic, yet ambitious given baseline data and planned activities.

Data collection may be done through a variety of methods including accessing LMIS systems, partner project records/reports, routine monthly/quarterly data collection, beneficiary and counterpart surveys, interviews, and observations.

DATA ANALYSIS, QUALITY AND REPORTING

M&E advisors in country offices along with M&E counterparts within government stakeholder institutions or partner organizations will regularly analyze and interpret data to identify any notable trends and/or any quality improvement needs. Data-based results may be communicated to counterparts, beneficiaries, and USAID in user-friendly formats and any other required reporting formats. The HQ M&E Manager will work with each country team to foster sharing of data and results that other countries and the region could learn from under this global project.

Ensuring data integrity will routinely be done by our M&E teams with support from our M&E Manager. With the understanding that data use for decision-making at the central and decentralized level is essential for achieving program results, our country-level M&E staff will continuously coach, when appropriate, government counterparts on interpretation of data for decision making. Our indicators will capture outcomes at a variety of levels and we will provide M&E technical assistance to promote continuous data flow.

REPORTING PLAN Throughout implementation the project team will submit periodic performance, financial, and monitoring reports in line with the task order. The Haiti field team, in cooperation with the HQ billable team, will develop and update an annual performance monitoring plan, quarterly progress reports, annual reports on technical implementation and milestones achieved, as well as other ad hoc reports such as supply chain assessments, technical findings reports, and project specific communications tools. Additionally, monthly financial reports will show to-date expenditures, remaining pipeline estimates, as well as future plans and accruals to ensure programmatic activities are in line with mission priorities and obligated budgets. Reports will be submitted to activity managers and project CORs, and will be constantly adapted to ensure the information remains useful and relevant for local and regional counterparts and stakeholders.


HAITI BUDGET The Francophone TO is expecting to spend $2,924,282 through Fiscal Year (FY) 2018 under its programmatic operations that support the Haiti work plan. The period of FY 2017 includes costs from February 2017, when the contract was signed, and startup activities started, purchase and installation of a prefab office building, through costs of field staff and activities through September 30, 2018. Our overall anticipated spend is in line with both the current Haiti total obligation, as well as the health sector funding streams to date. A more detailed breakdown of anticipated costs, including costs per activity, can be found in annex 2. Anticipated STTA and international travels that have been also included in the budget are listed in annex 3 and 4 respectively.


ANNEX 1: HAITI – DRAFT GANTT CHART

Activities

(National Strategies) Technical Area(s)

Lead Technical Staff

Partners and Collaborators

Year 1 Year 2

Q2 Q3 Q4 Q1 Q2 Q3 Q4

Country Program Start-up Activities

Set-up Office (include erection of prefab structure)

Project Management/Operations

PMU Director

Recruit Staff Project Management/Operations

Project Managers

Review SOW Project Management Project Director

Draft Workplan Project Management Project Director

Finalize Workplan Project Management Project Director

Objective 1: System Strengthening Technical Assistance – Strengthen In-Country Supply Systems

IR 1.1. Improved Policy, Governance, Strategy, Coordination

Activity 1.1.1. Strengthen the capacity of the MSPP, DOSS, DPM/MT and the NLSP in supporting their respective programs

Governance Capacity Building and Training Coordinator

DOSS, MSPP, LNSP


Activities

(National Strategies) Technical Area(s)

Lead Technical Staff

Partners and Collaborators

Year 1 Year 2

Q2 Q3 Q4 Q1 Q2 Q3 Q4

1.4. Data Visibility and Stock Monitoring Enhanced

Activity 1.4.1. Implementation of a computerized maintenance management system (CCMS) to manage laboratory and medical equipment, monitor and report on their status

Monitoring Country Director DOSS, MSPP. LNSP

1.5. Improved Rational Use of Medical and Laboratory Equipment & Commodities and Pharmaceutical Waste Management Done According to International Standards

Activity 1.5.1. Development of a national pharmaceutical waste management master plan to support the creation of a pharmaceutical waste treatment facility

Waste Environment and Waste

Management Specialist

MSPP, DPM/MT DPSPE

Activity 1.5.2. Assist MSPP with managing maintenance and repairs of selected medical equipment from SSQH sites

Medical Equipment Medical Equipment

Management Specialist

MSPP, DOSS, SSQH, REPARE

Activity 1.5.3. Support the MSPP and the LNSP by building capacity to maintain PEPFAR-funded laboratory equipment

Biomedical Equipment Laboratory Coordinator

MSPP, LNSP, EU


ANNEX 2: HAITI – BUDGET BREAKDOWN

ACTIVITIES MNCH PEPFAR TOTAL Office Operations $ 77,287 $ 344,670 $ 421,956 Project Management $ 56,135 $ 250,340 $ 306,474 1.1.1 Strengthen the capacity of the MSPP, DOSS, DPM/MT and the NLSP in supporting their

respective programs $ 13,717 $ 61,174 $ 74,891

1.4.1 Implementation of a computerized maintenance management system (CMMS) to manage laboratory and medical equipment, monitor and report on their status

$ 16,804 $ 74,937 $ 91,741

1.5.1 Development of a national pharmaceutical waste management master plan to support the creation of a pharmaceutical waste treatment facility

$ 222,369 $ 991,681 $ 1,214,050

1.5.2 Assist MSPP with managing maintenance and repairs of selected medical equipment from SSQH sites

$ 409.963 $ 409.963

1.5.3 Support the MSPP and the LNSP by building capacity to maintain PEPFAR-funded laboratory equipment

$ 405,207 $ 405,207

Total $ 796,274 $ 2,128,008

$ 2,924,282


ANNEX 3: SUPPORT STTA/CONSULTANT

# Technical Areas Task Estimated LOE Source of Funding

1 Waste Management Conduct Environmental and Social Impact Study 6 months MCH/HIV/AIDS

2 Waste Management Pharmaceutical Waste Management Strategic Plan Development

1 month (another month scheduled for next work plan) MCH/HIV/AIDS

3 Medical Equipment Medical Equipment Assessment 1 month MCH

ANNEX 4: INTERNATIONAL TRAVELS #

Trips Technical Areas Suggested Travelers Travel Dates Origin/Destination LOE in days Expected Deliverables Source of Funding

1 Start-up Visit Jean-Pierre Sallet April 2017

(completed) Washington DC/Haiti 10 Trip report MCH/HIV/AIDS

1 Work plan Development Jean-Pierre Sallet July 2017

(completed) Haiti/Washington DC 10 Trip report/Work

plan MCH/HIV/AIDS

3 Project Management Support Jean-Pierre Sallet/TBD Q1, Q2, Q3 Washington DC/Haiti 10 Trip report MCH/HIV/AIDS

1 Work plan Development Jean-Pierre Sallet July 2018 Washington DC/Haiti 10 Trip report/Work

plan MCH/HIV/AIDS

1 Project Director Orientation Lauramare A. Val November 2017 Haiti/Washington DC 7 Trip Report MCH/HIV/AIDS

1 Office Operations TBD TBD Washington DC/Haiti 10 Trip report MCH/HIV/AIDS 1 Financial Management Job Diarra TBD Washington DC/Haiti 10 Trip report MCH/HIV/AIDS

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