Introduction to Drug Supply
Management
Presentation Outline
• Why Proper Supply System?
• Previous Supply System VS The Current
• Drug Supply Management Cycle
• Opportunities
• Selection
• Quantification
• Procurement
• Storage and distribution
Why Proper Supply System?
• Effectiveness of health programs depend on a
number of factors but largely on proper supply
management of inputs:
• Availability of the right commodities at the right time in the
right quantities at the right place that are used correctly.
• Inputs: supplies for preventive interventions,
diagnostic supplies, drugs and others.
• As the saying goes: “NO PRODUCT - NO
PROGRAM”.
The management process
Planning Implementing Controlling
Vision, mission Organizing Comparing
Setting goals & Staffing performance
objectives, targets
Operating with goals
Selecting tactics, (leading,
strategies, coordinating,
resources, motivating)
responsibilities
Feed back
Feed back
Supply System
• Previous: • PLMP/Current:
– Sources – Sources
• PHARMID (P+P) • PFSA/New PHARMID (Pu)
• Private importers (P+P) • Private importer/s (Pt)
• Local manufacturers (P+P) • Local manufacturers??
• FMOH/PSLD/RHB/ZHD/Wo • Distributors
HO (Pu)
• Public HFs (Only PFSA)
– Distributors • Private Sector (Expt PFSA)
• Public HFs (Expt Local ma.)
• Private Sector (Expt PSLD)
Drug Supply Management
Cycle
Selection
Use Management Procurement
Support
Distribution
Policy and Legal Framework
Drug Supply Management Cycle
• Opportunities
– National Health Policy
– National Drug Policy
– National PLMP
– Funding (FGOE, GFATM, UN-agencies, Government
Development Agencies…)
– National Diagnosis and Treatment Guidelines
– Partners’ interest in supply management
– Expanding public, private and other infrastructures
– Introduction of HEP/HEWs
– Better epidemiological data/HMIS
Selection
Definition
The process of deciding the type of
pharmaceuticals needed for successful
implementation of a program.
Why drug selection?
Too many drugs VS limited funds
Price advantage of bulk procurement of
fewer drugs
Prescribers can become familiar with a
smaller number of drugs
Procurement, storage and distribution are
simplified
Facilitates drug information and education
efforts
Advantages of selection
Brings changes or improvesprescribing,
dispensing and use behaviors
Reduces confusion
Improve drug availability
No irrational treatment alternatives available
The Essential Medicines
Target National list of
Registered medicines essential medicines
All the drugs
in the world
Levels of
use
S CHW S
dispensary
Health center Supplementary
Hospital specialist
Referral hospital medicines
Private sector
The process of medicines
selection
List of common diseases and
complaints
Treatment
choice
Essential medicines list
Treatment
/ National formulary
guidelines
Training and Financing and
Supervision Supply of drugs
Prevention
and care
Selection criteria
Inclusion of the drug in the national drug
list/Treatment Guideline
Proven quality, safety and efficacy/only from pre-
qualified suppliers and/or manufacturers by DACA
Preference for drugs that are well known and
possibilities for local manufacture
Ability of the drug to treat more than one disease
Availability of the drug in the market
The comparative price of the drug with other
alternative drugs
The health facility standard
Other considerations
Selection Committee- PT committee/DTC
Familiarization of the selected list to all
concerned parties.
Qualification level of the staff
Patient compliance
Existing treatment guideline, LIDE
Therapeutic efficacy evaluation to change
treatment guideline.
Quantification
Definition
Process of estimating the quantities
of specific drugs needed for the
next procurement period
Poor quantification symptoms
Poor quantification results in:
Frequent shortage of drugs
Excess stock due to overestimation
Wastage of resources
Unnecessary suffering and death
Inappropriate and ineffective prescribing
Prescribers shorten course of treatments to
stretch the inefficient supply
Substitute with inappropriate alternative drugs
Quantifications methods
1. Consumption method
2. Morbidity method
There is no single method best available
Each method has its own strengths and
weaknesses
The method used should be chosen
according to:
• actual and potential availability of data.
• the organization of the drug supply system
Comparison of quantification methods
1 Consumption method 2. Morbidity Method
Appropriate when the health This method is appropriate:
facility :
When available consumption
is adequately funded data are incomplete or
unreliable
has acceptable prescribing pattern
When we have reliable and
has adequate and uninterruptible complete epidemiological data
drug supply
When prescribing practices
Has good stock management are expensive and irrational
Complete and accurate When the budget is unlikely
consumption data and stock out to be sufficient to meet
information requirements
Has low level of wastage and When the facility is new or
losses expanding
Procurement
Definition: Procurement is the process of
acquiring goods and services (drugs, MS and
ME) through purchase, donation or manufacture .
Procurement …
Procurement Objectives
Plan to get the right drug (right quality and
quantity)
Acquire from the right source at the right price
Obtain at the right time
Make available at the right place
Procurement Key Principles
procure drugs by generic name
limit the procurement to a selected list
procure in bulk
order quantities based on reliable estimates of
the actual need
practice good financial management
apply transparent and written procedures
have a product quality assurance program
perform auditing and reporting regularly
The Processes of Procurement
It is a cyclic process that involves a
number of steps.
a. Correct quantification
b. Determine when to buy
c. Identify and select suppliers
e. Prepare the purchase order/requisition
f. Monitor the order status
g. Receive and inspect drugs
Methods of Procurement
Open tender(more appropriate method)
Request for proposal mainly for consultancy services)
(
Restricted tendering short listed Bidders)
(
Request for quotation (Performa invoices )
Single source procurement
Distribution
Definition
Distribution is a process of receiving,
storing, stock controlling, delivering,
record keeping and reporting.
Distribution …
it is cyclic process which begins when
supplier dispatches the drugs and ends when
drug consumption information is reported
back to the procurement unit
Pull Vs Push and quota systems
distribution encompasses a number of
processes but activities such as:
receipt and inspection
storage and inventory management
consumption reporting will be discussed.
Distribution System
• Pull: quantity determined by the facility;
can be collection and/or delivery
• Push: quantity determined by the next
higher level/supplier; can be collection
and/or delivery
• Push Vs Pull is all about decision
• Quota: Determining quantity by mere
proportion than actual need.
Inspection
When drugs and medical supplies arrive at the
facility store from the supplier, they should be
properly inspected.
This is done to ensure that the type, quality,
quantity, packaging, labeling and any other
information are as per the specifications.
If any discrepancy is observed, it has to be
communicated and verified.
Discrepancy Reporting using a form which at
least contains the following information.
Receiving
Items should be received by the store
manager using the Goods Receiving
Memo/Voucher
The receiving memo should contain
information on complete description of the
items (generic name, strength, unit and
pack size of the products), quantity
received, unit and total costs and space for
signatures.
Storage
The quality of drugs can be affected by heat,
moisture, sunlight, dirt and other extreme climatic
conditions
Drugs and medical supplies must be properly
stored in order to maintain their stability and
quality up to the expected shelf life
The store should be located in a place that is not
easily reached by flooding
It should be accessable to transport and secured
from theft and fire.
The store should have enough shelves and
pallets to allow the proper arrangement and stock
rotations of drugs and medical supplies.
Storage
Stock Rotation
First-In First Out (FIFO)method
it is generally true that the first-in drug should be
picked and issued first - Items arrived last should
be placed at the back.
Last-In-First Out (LIFO)/First Expiry First
Out: there is a case where the last in item can be
first out. This happens if the last in item has a
shorter shelf life.
Distribution
• Previously:
– Delivery is made from the federal level using distribution
plans or quotas.
– Collection could be made by the regions or FMOH deliver
the drugs to the RHBs
– Feedback or discrepancy report is expected form the RHB
– RHBs are expected to distribute the drugs to the Hospitals,
Zones or Woredas
– Zones or Woredas distribute the drugs to the HFs
• Currently/planned:
– Goods’ flow: PFSA to PFSA hubs to Health facilities
– Information flow: Health facilities to WoHO to RHB to
PSLD/FMOH OR Health facilities to PFSA hubs to PFSA
(central)
Inventory management
Inaccurate records produce inaccurate need
estimates
this is manifested with problems of stock-outs
and expiry
It is the sources of information used to calculate
needs
prevents shortage of drugs and medical supplies
Proper inventory control helps also to monitor
the expiry of drugs and the movements of stocks
Inventory management
Stock Levels
Minimum Stock Level: the minimum sock that
should be available in the store.
Maximum Stock Level: the maximum level of stocks
allowed to hold in store
Reorder Stock Level: This is the level of stocks at
which the new orders should be placed
Safety stock: this is the buffer stock kept in reserve to
prevent stock outs
Lead-time:
it is the time interval needed to complete the
procurement cycle
Inventory management
Stock record and Bin cards: these are very
important tools used to control the sock movement of
items in the store
Stock record card: this contains information:
about supplies and prices
about stock receipts, stock issues ,stock losses
and balances of each items
they are the primary source of information
one card is used for each product
it is usually kept in the office of the store manager.
Bin Card: keeps information about a single product. It is
usually displayed at the shelf where the lot is found
Stock Record card
Name of Health Institution ____________ Maximum Stock level _____
Name, Strength, and Dosage form of Item _______ Reorder Stock Level _____
___________________________ Minimum Stock Level_______ Unit
of Issue______ Location______ Average Monthly Consumption____
Date Document Issued to Quantity Unit Price Expiry Remark
No. (M 19 or Rece Issu Bala Birr Cents date
or M22 received ived ed nce
No.) from
BIN CARD
Name of Health Institution ____________________________________________
Name, Strength, and Dosage form of Item _______________________________
Unit of Issue______________________________________________________
Date Document Issued Quantity Expiry Remark
No. to or Received Issued Balance Date
(receiving or receive
issuing d from
form)
LMIS
The strong link in the distribution chain is
the flow of appropriate information
Reporting information on consumption to
the procuring section or any other relevant
and responsible party contributes towards
the efforts of ensuring the continuous
availability of essential drugs
It is necessary for health care facilities to
report and provide reliable information on
quantities received, distributed and
consumed on regular basis.
Consumption Reporting
A two-way information flow regarding drug consumption is
important:
for coordinating drug distribution
to project future drug needs
to revise budgets
to assess drug utilization etc.
In order to prepare a reliable consumption report, it is a
must to have proper inventory managements and correct
stock records
If these are available, the generation of data and
preparation of consumption reporting would be an easy
process
The sources of information are stock record cards, bin
cards, requisition forms, purchase invoices etc.
Thank You!
