E-DRUG: Logistics systems in the less developed world (5)
Logistics and Procurement and Supply Management in essential medicines
programs are widely recognised as needing attention.
I wish to make a few points based on my own experiences.
Efficient management of all parts of the procurement cycle is important
but I believe accurate quantification is the key to reliable maintenance
Stock-outs are common. Staff, communities and the media complain.
Stock-outs are blamed on long lead times (eg 6 months), poor supplier
performance, not enough money from finance or slow release of funds,
even corruption .......
I believe the problem is basic housekeeping - like working out much milk
you need to keep in the fridge.
Sometimes an allocation system that has been in place for a long time
has been partly responsible for the stock-outs - and for over stocks and
expiry. A standard allocation system can breed bad record keeping. In
some cases, at the national or program level there have been allocations
for procurement set in stone for years and the procurement people are
often not pharmacy people - they just look at and order numbers.
Staff working in remote and less remote clinics include nurses, pharmacy
assistants and other health workers. Medicines management is unlikely to
have been part of their formal training.
It has been found that staff in some cases had not previously thought
there could be a link between what is used and how records are kept and
their stock maintenance.
A reliable supply of essential medicines is possible.
How do you achieve that?
The use of an essential medicines list based on standard treatment
guidelines is not only the most efficient way to use the money that is
available and to provide safe and reliable treatment, it can also ensure
that appropriate medicines will always be available.
Well kept patient records and stock records are the basis of reliable
supply both to the individual health facilities and to the main medical
Adherence to the standard treatment guidelines and documentation of
patient's medication prescription provides important information on
which to base procurement of future supplies. Aggregation of the
information from health facilities can enable quanitification for a
whole program. (Of course buffers are needed for program expansion or
To be able to predict what will be used in the future it is imperative
that medicines are used according to standardised guidelines.If
prescribers continue to prescribe outside the guidelines it is
impossible to predict future needs.Procurement of reliable supplies
depends closely on predictable use of supplies.
If records are built up as explained, a fairly good estimate of typical
needs will develop.
One way is to calculate how much of each medicine was issued over the
last few months. As we explained before we need to ensure that medicines
are used appropriately and that good records are kept in the facilities
where the medicines are used.A second way is to have a regular stock
level of quantities to order but that stock level must have been
calculated from records of appropriate use and it must be reviewed
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