The Coordinated Procurement and Distribution System (CPDS) optimizes the purchasing power of multiple donors by centralizing the supply of quality antiretrovirals (ARVs). Today CPDS is a model of collaboration among the Government of Rwanda, donors, national institutions, and international organizations. CPDS has proven that despite the urgency and difficulties of managing ARVs in low-income countries, in-country coordination initiatives among stakeholders can empower local institutions without compromising the efficiency of the supply chain. RPM Plus has supported CPDS since its inception in 2005 by providing technical support in several areas, including—
System Design
Decision making related to ARV management in Rwanda had been fragmented across many departments in the Ministry of Health. The new coordinated procurement system would be sustainable only as long as it was embedded in the existing health system—and more specifically—within the institutions involved in ARV decision making and management. The effectiveness of the system required not only that national and international stakeholders agree on roles and responsibilities, but also that they define procurement and distribution procedures and implement a monitoring and reporting system to ensure system integrity. RPM Plus helped develop the CPDS governance framework in collaboration with all CPDS members. The framework describes the CPDS objectives, organization, functioning principles, and roles of its members. Under this framework, the CPDS has two primary components— - Resource Management Commission (RMC), which is chaired by the Permanent Secretary of the Ministry of Health and responsible for political, strategic, and financing decisions
- Technical committees responsible for pharmaceutical procurement, distribution, and monitoring processes
Both components are linked by a coordinator, who was recruited by RPM Plus to work in the Ministry of Health to provide technical advice to the Permanent Secretary and coordinate the work of the technical committees.
 Quantification
Rwanda first tested and used the electronic quantification tool, Quantimed, which RPM Plus developed, for the quantification conducted in June 2005. Since then, Quantimed has been used for all national ARV quantifications. Although RPM Plus estimated the quantification for the first procurement, the members of the Quantification Committee have since been properly trained and coached to take on that responsibility, ensuring that the expertise is in local hands. RPM Plus has also supported the national quantification of HIV/AIDS rapid test kits and medicines for treating opportunistic infections, because those products will soon be integrated into the Coordinated Procurement and Distribution System.
| Procurement
The RPM Plus Program worked with partners to reach consensus on the procurement procedures in the CPDS governance framework. RPM Plus has also provided technical assistance during the implementation process by— - Estimating each donor’s financial contribution according to the number of patients on treatment and expected new patients
- Assessing and defining tendering evaluation criteria and participating on the tender evaluation committee
- Helping members of the CPDS—in exceptional situations—obtain government waivers that allow them to import ARVs that are not prequalified by the Ministry of Health (for example, during the international shortages of stavudine in 2005).
Distribution and Stock Management RPM Plus has worked both at the national and the facility level to simplify distribution and stock management practices. CAMERWA, the government’s central medical store, is responsible for procuring and distributing Rwanda’s pharmaceuticals, and it is the only local supplier allowed to import ARVs into Rwanda. RPM Plus has worked with CAMERWA to implement a scheduled system for distributing ARVs to a growing number of ART sites. The Quantimed tool also helps CAMERWA monitor distribution and inventory of ARVs. In addition, RPM Plus developed simple tools to help validate the requisition orders from the facilities. To the top
Strengthening of the Pharmaceutical System in Support to CPDS The CPDS has helped accelerate efforts to strengthen other areas of the pharmaceutical sector that were needed to support the coordination system. Consequently, pharmaceutical procedures and tools have been standardized in the country, and pharmacy staff have been trained in how to manage essential medicines, including quantification, procurement, storage, dispensing, and use of ARVs. RPM has helped strengthen the pharmaceutical sector by— - Providing training to pharmacy staff at 130 ART sites in pharmaceutical management, use of standard operating procedures, and quantification of medicine needs
- Facilitating a system to supervise pharmacy staff on reporting requirements and quarterly requisitions for ARVs
- Assisting an implementing partner, Treatment and Research AIDS Center (TRAC), in field supervision visits to ensure data quality and regular reporting
- Working with the Ministry of Health and CAMERWA to develop new reporting tools for rapid test kits, medicines for opportunistic infections, and other essential medicines
Monitoring, Reporting, and Evaluation
Tools used for monitoring, reporting, and evaluation have been developed and adapted to facilitate in the quantification process and inventory management. Specifically, RPM Plus has— - Helped TRAC develop quantification reports at the end of each quantification process
- Assisted CAMERWA in completing its 2006 ARV inventory management report
- Worked with CAMERWA to develop a system of quarterly reporting to the members of the CPDS
- Customized the electronic tool, SIMPLE 1 (Systeme d'Information pour le Monitoring des Produits Pharmaceutiques pour la lutte contre les Endemies/Epidemies), for CAMERWA’s use and staffed CAMERWA with a data manager
- Established a filing system and introduced an electronic management tool to monitor treatment sites’ compliance with the reporting system
- Helped design monitoring and reporting tools and procedures for other pharmaceuticals that will soon be integrated into CPDS
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