Periodic Review ccm request template

Further details are available in the PSM plan, WCDOH Annex 2.

Quality Assurance: in order for the WC to meet the GF QAP requirements a budget of 5 % of the value forecast medicines has been included in the budget, WCDOH Annex 4 and PSM plan, WCDOH Annex 2. Either a national or provincial tender will be conducted to source a service provider to support development and implementation of a quality control plan.

In summary no significant challenges with respect to medicine supply are anticipated for years 7 to 10.

In the short term: to ensure that ART was continued the WCDOH utilized funds from the WCDOH’s conditional grant. Please note: This was a temporary solution and cannot continue further as it has restricted service delivery in other service delivery areas.

In the medium term: A WC limited bid tender allowed for the procurement of GF QAP compliant Tenofovir during the third quarter of 2012/13. GF QAP compliant products from Aspen [Lamivudine 150mg / Nevirapine 200mg / Zidovudine 300mg] and Cipla [Efavirenz 600mg / Lamivudine 300mg] on the tender RT71, as arranged by NDOH where delivered, although with a delay of between 6 and 18 months. The Abacavir syrup from Cipla arranged by NDOH has yet to be delivered.

In the long term: The recent ARV tender specifications included a 10% proportion of products to meet GF QAP requirements. The awarded tender [HP13 2013] caters for most of the products required for the GF ART Programme excepting the following line items: Didanosine 25mg / 50mg / 100mg / 400mg; Lamivudine 300mg; Stavudine 15mg; Zidovudine syrup and Zidovudine 300mg / Lamivudine 150mg combination tablet. Most of these products are not key cost drivers, with the exception of Lamivudine 300mg. However with the award of a Tenofovir / Emtricitabine / Efavirenz fixed dose combination meeting GF QAP requirements, the need for Lamivudine 300mg will be reduced.

During the continuation of funding period it is expected that the medicines will be available through the national tender as described above under the relevant activity.

Please refer to the Western Cape PSM Plan, WCDOH Annex 2, for further detail.

Quality Assurance: in order for the WC to meet the GF QAP requirements a budget of 5 % of the value forecast medicines has been included in the PSM plan, WCDOH Annex 2. Either a national or provincial tender will be conducted to source a service provider to implement the plan.

No significant challenges with respect to medicine supply are anticipated for years 7 to 10, which are the final years of the continuation of funding period.

6.2 Financial Proposal

6.2.1 Resources available to finance the grant/SSF after cut-off date

Table 33: Resources available to finance the grant/SSF after cut-off date

6.2.2 Summary funding request from cut-off date to end of next Phase/Implementation Period

Table 34: Summary funding request from cut-off date to end of next Phase/Implementation Period

6.2.3 CCM Budget Request for the next Phase/Implementation Period

The WCDOH budget is reflective of requirement needed to continue implementation of a successful grant. It takes into account the following:

1. 
   Planned Exit Strategy to ensure sustainability of the GF investment in the WC
   
2. 
   The decrease in number of objectives within the grant (from 4 to 3)
   
3. 
   The increase in access to GF QAP compliant medicines
   
4. 
   The decrease in costs of medicines available through the new national tender
   
5. 
   The decrease in laboratory protocol (move from bi-annual to annual testing of CD4 Count and Viral load)
   
6. 
   The WC GF grant is integrated into the WC District Health Care platform.
   

Thus there are no parallel processes created during its implementation. This ensures that the overall costs of the programme are minimized and the ability of the WC GF grant to Strengthen, Expand & Sustain the WC HIV/AIDS Prevention, Treatment and Care Programme is maximized.

Within the WC there is an increasing amount of evidence that the GF investment in the province is one of “Good value for money”. Furthermore impact is not only confined to the WC Province but extends across the country. Examples are as follows:

1. 
   The investment of the GF in the ART programme in Khayelitsha has meant that there has been an accelerated increase in the number of people who are able to access ART. Additionally, the development of the three tier reporting system (paper registered, Tier.net and eKapa) has enhanced the quality and accessibility of ART data within the WC. Noteworthy is that the WC three tier reporting system is currently being rolled out nationally.
   
2. 
   Tier.net is a stand-alone information system which is not directly linked to other facilities but from which information can be sent to a central point. eKapa is a linked / networked system, which allows patient ARV data to be tracked between facilities. eKapa has the added benefit of allowing medical personnel to establish whether a patient has been seen by a doctor or a nurse, where this visit took place as well as access to a patient’s test results carried out at alternative facilities. Thus, eKapa enables better patient care as well as decreasing possibility of duplication.
   
3. 
   The successful rolling out of the Tier.net and eKapa systems permitted the WC ART services to generate defaulter reports electronically and link those patients, on the reports, to the CCW (community care workers), for recall to the clinic, via the MDT (multi-disciplinary team) meetings. This has helped with ensuring that patients remain in care once treatment has been initiated.
   

The CBR objective’s Multi-Sectoral Action Teams (MSATS), relate directly to the mandate of Chapter 5 of the National Health Act: The establishment and support of the District Health Care System. This strengthening of the District Health Care system has helped to contribute towards a well-established, effective and operational District Health Care Platform.

The GF Peer Education WC Programme contributed to the framework and elements of the National Basic Education Department’s Peer Education Programme. It is expected that the material developed for use within the GF Peer Education will continue to be utilized within the WC both by the WCED and various Non-Profit Organisations (NPOs). Additionally the GF showcased the GF WC Peer Education Programme as having shown impact (and thereby value for money) in its 2010 GF publication: Stories of Innovation and Impact

Given the 9 year track record of the WC to successfully manage a well performing performance based grant, the impact of and continual evidence supporting the “value for money” of the GF grant in the WC can be expected to continue until the conclusion of the grant on 31 March 2016.

Furthermore, the exit strategy ensures that the continual effectiveness and impact made through the GF investment into the WC is sustained into the future. This is especially important given that the WC GF grant is a strategic intervention focused on those who are most at risk and vulnerable due to the prevalence and impact of the HIV/AIDs epidemic, where funding was not available to insure services where able to be implemented to address need.

The budget request submitted together with this request for funding falls within the specifications and budget envelope allowed to the Western Cape due to good programmatic and financial performance during the current grant period as well as the historical context. The capability of the WC to successfully run the GF performance based grant as well as to mitigate associated risks has been proven over the past 9 years (2004 – 2013). For the majority of this time the WC Grant has had an A1-A2 rating. Results, as reported over the WC GF Grant period, confirm that the Programme is both achieving its targets and has a demonstrable impact within the WC. One of the primary strengths of the grant is that it is fully integration into the WCDOH district health care platform / system. Thus parallel systems are not created but rather the grant strengthens and builds on existing systems, ensuring maximum impact and accountability at all levels within the WCDOH. Additionally, this fulfils the primary purpose of the WC GF grant which is to “Strengthen, Expand & Sustain the Western Cape HIV/AIDS Prevention, Treatment and Care Programme”.