Procurement In most countries, PEPFAR funding supports the procurement of ARVs in coordination with other donors and domestic resources, but the type of arrangement varies. In a few countries visited by the committee, the Global Fund procures first-line ARVs, and PEPFAR procures second-line ARVs or pediatric formulas, or both (240-5-PCGOV; 587-13-USG; 587-22-USG; 461-13-USACA). In most countries, the majority of ARVs are procured with Global Fund (116-11-PCGOV; 331-16-USG; 935-4-PCGOV) or PEPFAR (461-4-USG; 166-13-PCGOV; 396-4-PCGOV; 396-7-PCGOV) funding, but in some countries, the government has taken partial to complete responsibility for funding ARVs (636-4-PCGOV; 542-2-USG; 542-9-PCGOV; 272-1-USG; 196-10-PCGOV; 934-25-USPS).

In 2011, 71 percent of ARVs funded by PEPFAR were delivered by SCMS (SCMS, 2012). Interviewees from many countries mentioned that SCMS was responsible for the procurement of ARVs (240-5-PCGOV; 587-6-CCM; 166-6-USG; 166-8-USG; 461-13-USACA; 461-17-PCNGO; 396-4-PCGOV; 396-41-PCGOV; 934-12-CCM; 934-25-USPS). In several countries, PEPFAR was also supporting procurement of other commodities, such as diagnostic reagents, condoms (587-8-PCGOV; 196-6-USG; 934-10-PCGOV; 934-25-USPS; 116-19-PCACA; 166-11-USG), and drugs to treat tuberculosis (TB) and other opportunistic infections (166-6-USG; 396-7-PCGOV; 396-41-PCGOV; 934-12-CCM). In some countries, partner country governments have been unable to demonstrate adequate forecasting or quantification for the procurement of drugs (and other supply chain issues) (331-ES; 587-ES; 116-ES; 934-ES; 935-ES), so the Global Fund has refused to release funding (636-3-USG; NCV-11-USG). Interviewees from some countries described PEPFAR as a “safety net” for the government and gave examples of cases in which PEPFAR has provided buffer stocks or emergency procurement to address shortages or stock-outs (331-43-USG; 587-1-USG; 587-22-USG; 166-31-USG; 272-1-USG; 272-5-PCGOV; 272-22-USG; 934-5-USG; 116-2-USG; 935-14-USG). Shortages or stock-outs may be caused by partner country government financial crises (934-25-USPS); a failure to project needs, plan, or procure adequately (331-43-USG; 587-22-USG); temporary situations in which demand exceeds supply (272-1-USG); delays in disbursements from the Global Fund or other donors (196-6-USG; 116-2-USG; 934-5-USG; 587-22-USG); or transitions in support for procurement from one donor to another (934-5-USG). In some countries, PEPFAR-supported programs such as SCMS have set up procurement and supply chain systems outside of the partner country systems (166-22-USPS). In one country, interviewees noted that the supply chain for antiretroviral therapy must be separate and parallel to the national system in order for ARVs to reach treatment sites (116-18-PCNGO).

Partner country challenges Across partner countries, interviewees described common challenges with procurement and supply chain management (196-7-PCNGO; 196-26-USG; 331-43-USG; 636-9-USACA; 116-2-USG; 116-16-PCGOV; 166-6-USG; 166-31-USG; 461-17-PCNGO; 461-25-ML; 542-21-USNGO). In several countries, insufficient quantification and forecasting, often due to the unavailability of necessary data, had threatened the regular availability of drugs and commodities and resulted

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