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[e-drug] Logistics systems in the less developed world (5)

E-DRUG: Logistics systems in the less developed world (5)
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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 
of stock.

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 
store.
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 
emergencies.)

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 
regularly.

*//*

*Beverley Snell*

Principal Fellow
Centre for International Health
Macfarlane Burnet Institute for Medical Research & Public Health
GPO Box 2284, Melbourne 8001 Australia
http://www.burnet.internationalhealth.edu.au
Telephone 613 9282 2115 / 9282 2275
Fax 61 3 9282 2144 or 9282 2100
Time zone: 11 hours ahead of GMT.
email<bev@burnet.edu.au>
Site: Alfred Medical Research & Education Precinct (AMREP),
85 Commercial Road, Prahran 3004


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