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Description : Check out this medical PowerPoint presentation titled "DRUG SUPPLY MANAGEMENT".

This medical PowerPoint presentation is about drug supply management, the process of ensuring that medications are properly stored, distributed, and used to meet the needs of patients. It involves the effective planning, procurement, storage, and distribution of medicines, as well as monitoring their use and disposal.

The objective of drug supply management is to make sure that the right drugs are available at the right time, in the right quantity, and at an affordable cost. This requires effective coordination among various stakeholders, including healthcare providers, pharmaceutical companies, regulatory agencies, and patients.

Effective drug supply management involves several key activities, such as forecasting the demand for drugs, selecting and procuring the appropriate drugs, ensuring proper storage and handling, managing inventory levels, distributing drugs to healthcare facilities, monitoring drug use and adherence, and properly disposing of expired or unused drugs.

A well-functioning drug supply management system is critical for ensuring access to essential medicines, improving health outcomes, and preventing medication-related problems such as drug shortages, stockouts, counterfeit drugs, and medication errors.

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DRUG SUPPLY MANAGEMENT 24-Jun-23 Drug Supply Management 1
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CHAPTER ONE INTRODUCTION 24-Jun-23 Drug Supply Management 2
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Objective Explain the importance of drug supply management Explain the need to worry about drugs and their management 24-Jun-23 Drug Supply Management 3
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Why drug supply management (DSM)? Lack of access to medication Irrational drug use DSM is needed as it is concerned with practical ways in which high quality essential drugs are available, affordable and used rationally. 24-Jun-23 Drug Supply Management 4
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Why worry about drugs and their management? Drugs save lives and improve health. Drugs promote trust and participation in health services. Drugs are costly for individuals, households, government health institutions, country. Drugs are different from other consumer products. Substantive improvements in the supply and use of drugs are possible. 24-Jun-23 Drug Supply Management 5
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Important lessons in drug management National drug policy provides a sound foundation for managing drug supply Wise drug selection underlies all other improvements Effective management saves money and improve performance Rational drug use requires more than drug information Systematic assessment and monitoring are essential 24-Jun-23 Drug Supply Management 6
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Challenges for drug management Achieving financial sustainability Improving efficiency in public drug supply Changing the perceptions and behaviors of providers, patients and the public Reorienting the role of government Regulating safety, efficacy and quality 24-Jun-23 Drug Supply Management 7
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CHAPTER TWO ESSENTIAL MEDICINE CONCEPT 24-Jun-23 Drug Supply Management 8
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Objective Explain essential medicine concept 24-Jun-23 Drug Supply Management 9
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2.1. Historical Background During and soon after WWII “Miracle” However, the miracles were for the minority there was gap in access to drugs Series of drug-induced disasters Some of the complaints in the early nineteen seventies were: No links between drugs and health needs No access to most needed drugs Rising costs of pharmaceuticals Uneven rural-urban distribution Protests against industry marketing practice 24-Jun-23 Drug Supply Management 10
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WHO adopted the concept with the view that essential medicines should be given priority. In 1975- WHO defined essential medicines In 1977, WHO published the first model list of essential drugs List is revised every 2-3 years by WHO expert committee In 1978, historic goal of ‘health for all by 2000’ essential medicines were recognized as one of the eight elements of primary health care. Against this background: Birth of essential drug concept 24-Jun-23 Drug Supply Management 11
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2.2. Essential medicine concept and its principles Concept: A limited range of carefully selected medicines leads to better health care, better drug management and lower costs. Principles: The vast majority of health problems can be treated with a small, carefully selected number of drugs. Most practitioners routinely use fewer than 200 drugs. Supply activities can be carried out most efficiently for a limited number of pharmaceutical products. Patients can be better informed when confronted with limited drugs. 24-Jun-23 Drug Supply Management 12
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24-Jun-23 Drug Supply Management 13
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24-Jun-23 Drug Supply Management 14
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CHAPTER THREE DRUG MANAGEMENT CYCLE 24-Jun-23 Drug Supply Management 15
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Objectives Discuss components of drug management cycle (selection, quantification, procurement, distribution and drug use) 24-Jun-23 Drug Supply Management 16
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3.1. Overview Managing drug supply is organized around the following basic functions: Selection Quantification Procurement Distribution and Use 24-Jun-23 Drug Supply Management 17
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24-Jun-23 Drug Supply Management 18
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3.2. Drug Selection is a process of deciding the type of needed drug products. Enforcing reasons for drug selection: Up to 70% of pharmaceuticals in the world market are duplicate and non-essential Availability of so many drugs is confusing for professionals and leads to inconsistency in practice Large number of non-essential drugs decrease purchasing power 24-Jun-23 Drug Supply Management 19
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Drug selection can lead to: Better supply More rational prescribing and dispensing Lower cost More rational patient use So careful selection of drugs has: Cost implications Clinical implications 24-Jun-23 Drug Supply Management 20
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Criteria for drug selection Relevance to the pattern of prevalent diseases Facilities (diagnostic facilities, treatment facilities, physical facilities for distribution and facilities) Training and experience of available personnel Drug products only for which sound and adequate scientific data on efficacy, safety, quality, bioavailability and stability are available; 24-Jun-23 Drug Supply Management 21
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Possibilities of easy and prompt procurement and local manufacture Drug products with widest possible coverage for the prevailing diseases Drugs with affordable cost by considering total cost of treatment not only the unit cost of drug(s) Single ingredient drug products When two or more drugs seem similar in the above respects selection can be based on: The most thoroughly investigated drug Drug(s) which offers better patient compliance Drug(s) which are locally available 24-Jun-23 Drug Supply Management 22
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Basic steps in drug selection Establish Drug Selection Committee Determine the prevalent health problems and patient characteristics Decide which health problems may be treated at the level of drug selection Choose the drugs to be used for the health problems Structure the list Introducing the list of drugs to health professionals of institution and other concerned bodies Updating the list of drugs 24-Jun-23 Drug Supply Management 23
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Very important: Paralleling preparation of drug list with development of formulary and standard treatment guideline 24-Jun-23 Drug Supply Management 24
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Source of drug information Primary Secondary Tertiary 24-Jun-23 Drug Supply Management 25
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3.3. DRUG QUANTIFICATION 24-Jun-23 26 Drug Supply Management
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It is the process of determining the amount of drug products needed for the purpose of procurement. Appropriate drug quantification can avoid: Shortage of (out of stock) of drugs as well as Overstock of drugs. 24-Jun-23 27 Drug Supply Management
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Indicators of poor quantification: Shortage of drugs Overstocking of drugs Irrational prescribing Inefficient budget use Suppression or distortion of demand 24-Jun-23 28 Drug Supply Management
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Quantification Methods The four general methods for quantification are: Consumption method Morbidity method Proxy consumption/adjusted consumption method Service level projection of budget requirements 24-Jun-23 29 Drug Supply Management
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Selection of the appropriate quantification method requires considering: Advantages and disadvantages The conditions under which each method can be applied The sets of data required The organization of the drug supply system Additional purposes 24-Jun-23 30 Drug Supply Management
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A. Consumption method Involves using records of past consumption on individual medicines It can be used under the following conditions: Adequate fund Acceptable pattern of prescribing Adequate and uninterrupted drug supply Good stock management Low level of wastages and loses 24-Jun-23 31 Drug Supply Management
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Data sets needed: Consumption data Drug list Pharmaceutical budget 24-Jun-23 32 Drug Supply Management
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Steps in quantification: Prepare/review a list of drugs with order pack size and price data 2. Select the period 3. Determine consumption of each drugs Recorded consumption = (opening stock + drug received)- (closing stock) 24-Jun-23 33 Drug Supply Management
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4. Adjust consumption for different reasons For stock out: Other reasons: wastages/losses, expected changes in consumption pattern, …. 5. Compile decentralized quantification (if applicable) 6. Convert the quantity obtained to the required pack size 24-Jun-23 34 Drug Supply Management
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7. Estimate the cost of drug quantities required 8. Finalize cost needed 9. Compare cost needed (demand) with budget allocated and make adjustment (reconciliation) Approaches to make rational adjustment are: VEN analysis ABC analysis Therapeutic category analysis 24-Jun-23 35 Drug Supply Management
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Additional points Consumption method Alternatively drug quantity can be calculated by using average monthly consumption, lead time and safety stock Quantity to order= average monthly consumption x (lead time + procurement period) + safety stock Considering Stock on hand and Stock on order Quantity to order= average monthly consumption x (lead time + procurement period) + safety stock – (stock on hand + stock on order) Always consider adjustment for different reasons Expected changes, losses…….. 24-Jun-23 36 Drug Supply Management
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Advantages: First choice for quantification, given reliable data Requires less detailed calculation Useful for facilities where health problems are numerous and drug treatment is complex Identifies stock management problems and encourages improvement No morbidity data and treatment schedule needed 24-Jun-23 37 Drug Supply Management
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Disadvantages: Reliable consumption data may not be found Can perpetuate irrational use May not be helpful for reviewing prescribing/drug use Less appropriate if there have been long stockouts/ high drug wastages or loses Doesn’t encourage good morbidity recording 24-Jun-23 38 Drug Supply Management
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B. Morbidity method Estimates the need for specific medicines based on: expected number of attendances, the incidence of common diseases and standard treatment patterns for the diseases considered. Assumption: service providers will adhere to established treatment guidelines. 24-Jun-23 39 Drug Supply Management
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Conditions: Available consumption data are incomplete or unreliable Prescribing patterns are inappropriate The budget is insufficient The health facilities or services concerned are new, or expanding or contracting rapidly. 24-Jun-23 40 Drug Supply Management
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Data sets needed: Drug list with pack size and price data Complete patient morbidity profile Standard drug treatment schedules Pharmaceutical budget 24-Jun-23 41 Drug Supply Management
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Steps for quantification: Specify the list of health problems 2. Establish the list of drugs to be quantified with pack size and price data 3. Establish standard or average drug treatment schedule for each health problems 4. Select the period to review morbidity data 24-Jun-23 42 Drug Supply Management
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5. Determine the number of treatment episodes for each health problems Treatment episode is a patient contact which a standard contact for which a standard course of drug treatment is required. Steps: Obtain the total number of patient contact by the health problems defined in the average treatment schedule Within the health problems, breakdown the number of patient contacts by age, sex, weight and severity if treatment varies with this variables Determine contacts for which a standard treatment schedule is required 24-Jun-23 43 Drug Supply Management
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6. Calculate the quantity of drugs needed for each health problem 7. Combine the estimates for each drug for various health problems into a master procurement list 8. Adjust quantities to cover for other health problems, for wastages/loses, filling the pipeline, stock order…. 24-Jun-23 44 Drug Supply Management
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9. Convert quantities in to order pack size 10. Estimate cost of the drug quantities required 11. Finalize the cost 12. Reconcile need with budget 24-Jun-23 45 Drug Supply Management
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Morbidity method- additional tip Always make adjustment for different reasons 24-Jun-23 46 Drug Supply Management
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Advantages: Does not require consumption data Can be used for review of drug use and prescribing Can be used for estimating need in new and scaling-up programs or disaster assistance Motivates reliable morbidity recording 24-Jun-23 47 Drug Supply Management
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Disadvantages: Detailed morbidity data and standard treatment schedule may both present difficulty Require detailed calculation Standard treatment may not really be used 24-Jun-23 48 Drug Supply Management
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C. Proxy/adjusted consumption method It uses known consumption data from one system called the standard, to estimate the drug needs in a similar or expanded system known as the target. It can be used when neither consumption method nor morbidity method are feasible. The adjustment can be based on: Population coverage- drug use per 1000 population Service-level to be provided- drug use per specified patient case or inpatient admission. 24-Jun-23 49 Drug Supply Management
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Steps in quantification: 1. Select the standard system for comparison and extrapolation 2. Develop the drug list 3. Establish the time period to be covered in review 4. Review records from the standard system to compile contact or population data 5. Establish the denominator for extrapolation 24-Jun-23 50 Drug Supply Management
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6. Determine the consumption rate in the standard system 7. Extrapolate the standard system’s consumption rate to the target system Target consumption = (Standard consumption rate) x (Number of thousands of contact or inhabitants) 24-Jun-23 51 Drug Supply Management
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8. Adjust for expected losses 9. Estimate costs for each drug and total costs and make adjustments 24-Jun-23 52 Drug Supply Management
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D. Service-level projection of budget requirements It uses the average drug procurement cost per attendance or bed-day in different types of health facilities in a standard system to project drug costs in similar types of facilities in the target system. This method does not estimate quantities of individual medicines rather it is used to estimate financial requirements. 24-Jun-23 53 Drug Supply Management
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Steps in quantification Establish the categories of facilities and determine the number in each category Determine the patient contact denominators for each type of facility and compile or estimate the average number of patient contacts of each type at each category of facility 24-Jun-23 54 Drug Supply Management
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Calculate the average cost per contact Calculate the total projected drug costs Multiply the average number of patient contact for each facility by the number of facility and average drug cost. 24-Jun-23 55 Drug Supply Management
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Methods of reconciliation of demand with budget VEN analysis It is an approach in which drugs are divided according to their health impact in to: Vital, Essential and Non-essential/normal-use categories 24-Jun-23 56 Drug Supply Management
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V (Vital drugs): Potentially lifesaving have significant withdrawal effect Crucial to providing basic health services E (Essential drugs): Effective against less severe but nevertheless significant forms of illness Not absolutely vital to providing basic health services N (Nonessential drugs): Used for minor or self-limiting illnesses 24-Jun-23 57 Drug Supply Management
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Steps in conducting VEN analysis: Classify all drugs on the list as V, E, or N Analyze N items. Where possible, reduce quantities to purchase or eliminate purchases entirely. Identify and limit therapeutic duplications, if any Reconsider proposed purchased quantities Find additional funds if needed or possible 24-Jun-23 58 Drug Supply Management
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b. ABC analysis ABC analysis is the method for determining and comparing drug cost. It identifies three useful tiers for analysis: Class A items: highest annual usage ( high volume or high cost) Usually accounts for 10-20 percent of items ordered and 70 to 80 percent of funds. 24-Jun-23 59 Drug Supply Management
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Class B items: moderate annual usage Accounts 10 to 20 percent of items ordered and 15 to 20 percent of funds. Class C items: Lowest annual usage Accounts for 60-80 percent of items ordered and 5-10 percent of funds. 24-Jun-23 60 Drug Supply Management
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Steps to perform ABC analysis: List all items purchased or consumed and enter the unit cost Enter consumption quantities over a defined period of time Calculate the value of consumption (utilize acquisition cost) Calculate the percentage of total value represented by each item. 24-Jun-23 61 Drug Supply Management
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Rearrange the list. Rank items with descending order by total value, staring at the top with the highest value. Calculate the cumulative percentage of the total value for each item Choose cutoff points or boundaries for A, B, and C drugs 24-Jun-23 62 Drug Supply Management
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C. Therapeutic category analysis Its applications are the same as those of ABC analysis. The focus is on cost-control efforts on the therapeutic categories that show the highest consumption and greatest expenditures. In this approach, therapeutic categories having the consecutive highest expenditures will be looked for possible interventions. 24-Jun-23 63 Drug Supply Management
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Example 1: The following table shows stock movement of doxycycline 100mg tablet as obtained from a bin card and stock out recording form in health center “X” for one year (consumption is in tablet). 24-Jun-23 64 Drug Supply Management
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Example 2: Drug “X” is available in tablet formulation of 500mg strength. It is used for the treatment of three diseases (A, B and C). The average amount of the drug needed per course of treatment was 20 tablets for disease “A”, 20 tablets for disease “B” and 10 tablets for disease “C” (assume the average treatment schedule is the same for all group of patients). The total number of treatment episodes (number of cases who need drug treatment) per year in a given hospital were 500 (disease “A”), 2000 (disease “B”) and 1000 (disease “C”). If one box contains 100 strips of 10 tablets, calculate: The total quantity of the drug needed in box unit (consider 5% allowance). 24-Jun-23 65 Drug Supply Management
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3.4. Drug Procurement 24-Jun-23 66 Drug Supply Management
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Procurement is the process of acquiring drug product through purchase, manufacture or donation. It is a major determinant of drug availability and the total health cost. An effective procurement process should: Procure the right drug in the right time Obtain the lowest possible purchase price Ensures that all drugs procured meet recognized standard quality Arrange timely delivery to avoid shortage and stock out Achieve the lowest total cost 24-Jun-23 67 Drug Supply Management
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Procurement cycle: 24-Jun-23 68 Drug Supply Management
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Operational Principles of Good Pharmaceutical Procurement There are operational principles for good pharmaceutical procurement clustered in to four: Efficient and transparent management Financing and competition Drug selection and quantification Supplier selection and quality assurance 24-Jun-23 69 Drug Supply Management
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Efficient and transparent management Separation of key procurement functions and responsibilities Transparency, written procedures and using explicit criteria to award contracts. Planning procurement and monitoring procurement performance 24-Jun-23 70 Drug Supply Management
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Drug Selection and Quantification Procurement limited to an essential drugs list or national/local formulary list Procurement by generic name Order quantities based on a reliable estimate of actual need 24-Jun-23 71 Drug Supply Management
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Financing and Competition Reliable financing for procurement Procurement in bulk Competitive procurement methods, except for very small or emergency orders Sole-source commitment 24-Jun-23 72 Drug Supply Management
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Supplier Selection and Quality Assurance Prospective suppliers should be pre-qualified, and selected suppliers should be monitored Criteria: Price and quality of products Delivery times Regulations Reliability Reputation Guaranties Product quality assurance program 24-Jun-23 73 Drug Supply Management
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Procurement Mechanisms Based on the responsible body for procurement and distribution: Central store system Autonomous supply agency system Direct delivery system Prime vendor system Fully private supply 24-Jun-23 74 Drug Supply Management
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b. Based on the level demand is determined Push system (allocation/ration system) Supply sources at some level determine what type and quantities of drugs will be delivered to the lower levels. Conditions: Lower staff-not competent Demand greatly exceeds supply (ration necessary) Limited number of products are being handled Disaster relief is needed 24-Jun-23 75 Drug Supply Management
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Pull system (independent demand/ requisition system Each level of the system determines what types and quantities are needed and place orders with the supply source. Conditions: Lower level staff-competent Sufficient supply is available Large range of products are managed There is regular supervision and performance monitoring 24-Jun-23 76 Drug Supply Management
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Procurement Methods All pharmaceutical procurement methods fall into one of the following four basic categories: Open tender Restricted tender Competitive negotiation Direct procurement 24-Jun-23 77 Drug Supply Management
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Table: Advantages and disadvantages of different procurement methods 24-Jun-23 78 Drug Supply Management
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Purchasing Models Procurement may proceed under different models: Annual purchasing Scheduled purchasing Perpetual purchasing 24-Jun-23 79 Drug Supply Management
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Common Procurement Challenges Absence of a comprehensive procurement policy Inadequate rules, regulations, and structures Public sector staff with little experience and training to respond to market situations 24-Jun-23 80 Drug Supply Management
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Government funding that is insufficient and/or released at irregular intervals Donor agencies with conflicting procurement regulations Fragmented drug procurement at provincial or district level Lack of unbiased market information Corruption and lack of transparency 24-Jun-23 81 Drug Supply Management
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3.5. DRUG DISTRIBUTION 24-Jun-23 82 Drug Supply Management
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Drug distribution is a continuous process of receiving drugs from the supplier and moving them safely/securely, expeditiously to the many point in the health care system at which the drugs will be dispensed to patients. A well-run distribution system should: Maintain a constant supply of drugs Keep drugs in good condition 24-Jun-23 83 Drug Supply Management
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Minimize drug loses due to spoilage and expiry Rationalize drug storage costs Use available transport as efficiently as possible Reduce theft and fraud Provide information for forecasting drug needs 24-Jun-23 84 Drug Supply Management
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The distribution cycle 24-Jun-23 85 Drug Supply Management
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A. Visual inspection Visual inspection is the process of examining products and their packaging to look for obvious problems with product quality. When to conduct visual inspection Visual inspection can be conducted during the following circumstances: Receiving products Issuing products from one level to another Dispensing products to patients Storage 24-Jun-23 86 Drug Supply Management
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Visual inspection… Conducting physical inventory Receiving complaints from lower levels or customers Products are to expire Products show signs of damage Products have been kept under improper storage conditions 24-Jun-23 87 Drug Supply Management
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Visual inspection… What to look for in a visual inspection Mechanical damage Chemical damage Packaging Labeling (product identity, expiry date, lot number…..) Quantity of products 24-Jun-23 88 Drug Supply Management
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B. Stock management (storage, handling, arrangement….) Storage of pharmaceuticals Proper storage practice is the safe keeping of products until ultimately reaches the consumer Generally pharmaceuticals should be protected from: Moisture Heat Sunlight Physical damage Dirt…. 24-Jun-23 89 Drug Supply Management
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Characteristics of a well managed stores operation and good storage guidelines Clearly defined management structure Staffs appropriately qualified, trained, disciplined and rewarded Store divided into zones Stocks arranged within each zone in some order system Stocks stored on pallets on the floor or pallet racks or on shelves Store products based on manufacturer’ specification 24-Jun-23 90 Drug Supply Management
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Good housekeeping- regular cleaning and inspection Store pharmaceuticals in a dry, well-lit, well-ventilated store room-out of direct sun light Protect storeroom from water penetration Keep fire safety equipment available, accessible, and functional, and train employees to use it Store latex products away from electric motors and fluorescent lights Maintain cold storage, including a cold chain, as required 24-Jun-23 91 Storage…. Drug Supply Management
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Storage…. Limit storage area access to authorized personnel and lock up controlled substances Stack cartons at least 10 cm off the floor and, 30cm away from the wall and other stacks, and no more than 2.5m high Store medical supplies away from insecticides, chemicals, old files, office supplies and other materials Arrange cartons with arrows pointing up, and identification labels, expiry dates, and manufacturing dates clearly visible 24-Jun-23 92 Drug Supply Management
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Liquid and heavy products kept at the lower shelves Products arranged to facilitate first expiry first out Damaged/expired products stored separately Store flammable products separately from other products Report products with near expiry 24-Jun-23 93 Storage…. Drug Supply Management
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Location and design of store Location Design Size Height of the wall Roof 24-Jun-23 94 Drug Supply Management
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Storage conditions There are two main types of storage conditions: Normal storage condition Special storage condition Cold storage condition Separate storage 24-Jun-23 95 Drug Supply Management
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Storage temperature and environment Dry place ……………………. <5% relative humidity Protect from heat ……………. not >30oC At room temperature ………… 15oC – 30oC Cool place …………………… 8oC – 15oC Cold place (refrigeration)-not >8oC (usually 2-8 oC) In deep freezer ………………. -20oC – 0oC 24-Jun-23 96 Drug Supply Management
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Arrangement of drugs Arranging drugs properly enables to control shelf life and simplify accessibility. Types: Pharmaco-therapeutic Alphabetic Pharmaceutic order/dosage form 24-Jun-23 97 Drug Supply Management
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Stock rotation First Expiry First Out (FEFO): Involves arranging drugs with the earliest expiration date in front/on top and drugs with the latest expiration date in the back/below so that drugs with near expiry will be issued and/or dispensed first. Other approaches: First In First Out(FIFO), Last In First Out (LIFO) 24-Jun-23 98 Drug Supply Management
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Inventory is the stock on hand at any given time. Inventory control is the process of maintaining of stock properly at all times. It is a process of assuring that the right volume and movement are secured in order to ensure that the obtained drugs have reached to the final consumer correctly. 24-Jun-23 99 C. Inventory Control and Logistic Management Information System( LMIS) Drug Supply Management
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Inventory control helps to: Maintain appropriate stock Avoid over-stocking Monitor shortage of drugs Check the movement of stocks Prevent expiry of drug before being used Balance the merits and demerits of inventory keeping 24-Jun-23 100 Inventory control system…… Drug Supply Management
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An inventory control system informs personnel when to order or issue, how much to order or issue and how to maintain an appropriate stock level to meet the needs of patients. The most important inventory control systems for health commodities are max-min inventory control systems. 24-Jun-23 101 Inventory control system…… Drug Supply Management
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Key terms: Maximum Stock Level: is the level of stock above which inventory levels should not rise, under normal condition. Minimum Stock Level: is the level of stock at which actions to replenish inventory occur under normal condition. It can also be considered as reorder stock level. Review Period: this is the interval of time between assessments of stock levels to determine if additional stock is needed. 24-Jun-23 102 Inventory control system…… Drug Supply Management
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Safety/reserve stock level: is the additional buffer or reserve kept on hand to protect against stockouts caused by delayed deliveries, markedly increased demand, or other unexpected events. Lead time: is the time between ordering a supply up to receiving and availing it for use. Lead time stock level: is the level of stock used within the lead time period Emergency order point (EOP): this is the level of stock that triggers an emergency order. The EOP must be less than the min. 24-Jun-23 103 Inventory control system…… Drug Supply Management
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There are three types of a max-min inventory control systems that are applicable to health commodity logistic system: Forced ordering system Continuous review system Standard system 24-Jun-23 104 Inventory control system…… Drug Supply Management
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No matter which inventory control system is used, the formula for calculating the order or issue quantity is the same. i.e order/issue quantity= (Maximum stock level/quantity)- (stock on hand) if there is stock on order which is not yet received: order/issue quantity= (Maximum stock level/quantity)- (stock on order)-(stock on hand The difference between the above three inventory control systems is the trigger for placing an order or issuing resupply. 24-Jun-23 105 Inventory control system…… Drug Supply Management
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1. Forced ordering system: Decision rule: the review period is the trigger for ordering. emergency order point is used to place an emergency order Advantage: Decision rule is simple Transportation can be scheduled for specific times Unless there is potential for stock out, assessing stock status constantly is not needed Every facility orders or is resupplied at the end of every review period Disadvantage: Orders for some items may be for small quantities 24-Jun-23 106 Inventory control system…… Drug Supply Management
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Forced-ordering delivery truck system: it is one variation of forced ordering system. It is sometimes called a topping up or bread truck system. In this system, a truck is loaded with supplies at the end of the review period. The truck and delivery team travel to each facility, assess the stock, and leave (top up) an amount of each product that is sufficient to bring stock levels up to the maximum at that location. 24-Jun-23 107 Inventory control system…… Drug Supply Management
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2. Continuous review system Decision rule: the trigger for ordering products is the minimum stock level. Advantage: Decision rule is simple It is more responsive and flexible Small orders are eliminated Disadvantage Transportation resources are harder to schedule The workload on the store keeper is high 24-Jun-23 108 Inventory control system…… Drug Supply Management
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Two bin system: it is one variation of continuous review system. Two equal-sized bins (containers, boxes….) will be prepared for each product. When the first bin is empty, the min has been reached and hence an order will be placed 24-Jun-23 109 Inventory control system…… Drug Supply Management
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3. Standard max-min system Decision rule: It combines the decision rules of both forced-ordering and continuous review. The decision when to make an order or issue new stock is based on the min stock level and the review period. Review all stock levels at the end of each review period and order quantities up to the maximum level for products that are at or have fallen below the min. EOP will be needed to ensure that a stockout does not occur between review periods. 24-Jun-23 110 Inventory control system…… Drug Supply Management
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Advantage: Small orders are eliminated There is no need to assess stock status continuously Reduce the number of calculations as only products that are at or have fallen below the min will be ordered Transportation can be scheduled Disadvantage: The min stock level is higher (higher likelihood of expiry, require more storage capacity and increased cost) Decision rule is complex 24-Jun-23 111 Inventory control system…… Drug Supply Management
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The decision to choose an appropriate max-min system depends on following factors: Number of items managed Type of products managed Transport availability Level of staff training Level of reporting Whether push or pull system is used Supervision system Storage space 24-Jun-23 112 Inventory control system…… Drug Supply Management
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Setting stock levels One of the tasks in inventory control system is setting different stock levels. The most important stock levels are emergency order point, safety stock level, minimum stock level and maximum stock level. Considering lead time and review period is mandatory to determine the stock levels. 24-Jun-23 113 Inventory control system…… Drug Supply Management
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Determine lead time Lead times are variable. One could calculate the lead time stock level to equal the average of the lead time levels for the past two or three review periods, for the average facility. Set the review period The routine interval of time between assessments of stock levels and subsequent order of products should be set. It shouldn’t be too short, nor as infrequent as once a year. 24-Jun-23 114 Inventory control system…… Drug Supply Management
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Set the safety stock It depends on the extent of uncertainty of demand and how well the logistic system is functioning. As a general guideline, the safety stock level should equal at least half of the review period. 24-Jun-23 115 Inventory control system…… Drug Supply Management
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Set the minimum stock level 24-Jun-23 116 Inventory control system…… Drug Supply Management
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Set the maximum stock level Set the emergency order point EOP could be as high as the lead time stock level if urgent orders take as long to process as routine order. 24-Jun-23 117 Inventory control system…… Drug Supply Management
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Pharmaceutical stock and consumption analysis There are three methods of stock or consumption analysis: Stock turnover ratio (STR) Consumption to stock ratio (CSR) Stock status analysis 24-Jun-23 118 Inventory control system…… Drug Supply Management
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LMIS and its linkage with inventory control: An LMIS and the inventory control system have a close relationship: the LMIS provides the data required to maintain the inventory control system. 24-Jun-23 119 Inventory control system…… Drug Supply Management
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Inventory control system…… Logistics systems for all commodities should include at least three essential data items Stock on hand: The quantities of usable stock available Consumption: The quantity of stock dispensed to users or used during a particular time period Losses/adjustments 24-Jun-23 120 Drug Supply Management
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Inventory control system…… There are three types of logistics records to track products. 1. Stock keeping records: Holds information about products in storage. Example: bin card, stock card, inventory control card, stores ledger 2. Transaction records: Holds information about products being moved. Example: Issue and receipt vouchers 3. Consumption records: Holds information about products being consumed or used. Example: daily dispensing registers 24-Jun-23 121 Drug Supply Management
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Inventory/logistics records Stock records and reports form the foundation of an effective inventory management and overall drug supply management. Information to be included product name/description including the form and strength beginning stock balance receipts issues losses/adjustments closing/ending balance transaction reference (e.g., issue voucher number or name of supplier or recipient). 24-Jun-23 122 Drug Supply Management
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special storage conditions unit prices lot numbers/bin locations item codes expiry dates calculated data items: average monthly consumption (AMC), lead times for ordering/requisition, maximum and minimum stock levels, emergency order point 24-Jun-23 123 Drug Supply Management
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Standard forms used for inventory control: Stock cards Bin cards Requisition/issue vouchers Expired stock disposal forms Physical inventory forms list of approved medicines and prices 24-Jun-23 124 Drug Supply Management
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Stock cards: Can be used: As the base for requisition and issuing of products To know fluctuation of price of drugs To control shelf life Bin cards Remain with each item in the store Filled by the store keeper Are used as an easy reference on stock levels and expiry dates 24-Jun-23 125 Drug Supply Management
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Physical inventory It is the process of counting by hand the number of each type of product in a store at any given time It is used to: Know whether the actual quantity on hand balances the recorded stock on the stock keeping records Identify surplus, expired and obsolete (outdated) stock Promote periodic evaluation of storage conditions and the adequacy of storage facilities, layout and stock management. 24-Jun-23 126 Drug Supply Management
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There are two kinds of physical inventory: Complete physical inventory: All products are counted at the same time. A complete inventory should be taken at least once a year. More frequent inventory (quarterly or monthly) is recommended. For large warehouses, this may require closing the storage facility for a day or longer. It is easier to conduct regularly at facilities that manage smaller quantities of products. 24-Jun-23 127 Drug Supply Management
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Cyclic or random physical inventory: Selected products are counted and checked against the stock keeping records on a rotating or regular basis throughout the year. It is usually appropriate at facilities that manage larger quantities of products. 24-Jun-23 128 Drug Supply Management
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3.6. DRUG USE 24-Jun-23 129 Drug Supply Management
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Drug use is the process of: Prescribing Dispensing Patient use 24-Jun-23 130 Drug Supply Management
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The rational use of drugs requires that patients receive: medications appropriate to their clinical needs, in doses that meet their own individual requirements, for an adequate period of time, and at the lowest cost to them and to their community 24-Jun-23 131 Drug Supply Management
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Rational drug use involves: Appropriate indication Appropriate drug Appropriate dosage regimen Appropriate patient Correct dispensing Patient adherence 24-Jun-23 132 Drug Supply Management
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a. Rational Prescribing Requires: Making accurate diagnosis Deciding whether or not the diagnosis requires drug treatment Selecting the best drug among available Prescribing in accordance with the standard course of treatment Following correct prescription writing Counseling the patient 24-Jun-23 133 Drug Supply Management
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What roles can you play as a pharmacist to promote rational prescribing? 24-Jun-23 134 Drug Supply Management
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b. Rational dispensing Dispensing: refers to the process of preparing drugs and distributing them to their users with provision of appropriate information. It may be based on a prescription or an oral request of users (patients or care providers) depending on the type of drugs to be dispensed 24-Jun-23 135 Drug Supply Management
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Dispensing a prescription Receiving and validation of a prescription Interpreting a prescription Preparing medication/s to be dispensed Issuing medication/s with the provision of appropriate and complete instruction 24-Jun-23 136 Drug Supply Management
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Dispensing a prescription…. A label must contain the following information: Patient name Generic name, strength, and dosage form of medicine Dosage regimen information (dose, frequency and duration of treatment) quantity dispensed How to administer medicine Storage condition Date dispensed Name of dispenser 24-Jun-23 Drug Supply Management 137
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2. Dispensing OTC medications/responding to symptoms The following information are relevant before dispensing Age, sex, pregnancy status if female, history of allergic reaction, history of renal or hepatic disease and any history of other disease Nature, site and severity of symptom/s For how long the symptom/s persist Whether the patient is taking any medication to relief from the existing complication or for any other purpose 24-Jun-23 138 Drug Supply Management
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Based on the above information decide whether the symptom/s are minor or are indication of major illness Decide whether the patient need non-drug management, OTC drug or referring If the decision is to give OTC drug/s select an appropriate OTC drug considering the above relevant information 24-Jun-23 139 Drug Supply Management
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c. Appropriate patient use Proper handling of medications Adherence to treatment 24-Jun-23 140 Drug Supply Management
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Irrational drug use Common types?????? 24-Jun-23 141 Drug Supply Management
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Impact of irrational drug use ??????? 24-Jun-23 142 Drug Supply Management
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Factors underlying irrational drug use a. Health care provider (prescriber and dispenser) Inadequate pre-service training Lack of continuing education Financial interest Lack of role models who practice rationally Patient load and pressure on treatment choice Unethical promotional activities by pharmaceutical companies 24-Jun-23 143 Drug Supply Management
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b. Health system Pharmaceutical supply system and availability of facilities Poor quantification and forecasting Inadequate inventory management Unreliable supplies Inadequate distribution system Inefficient management of procurement process Lack of adequate laboratory facilities Lack of facilities for dispensing 24-Jun-23 144 Drug Supply Management
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Legal and regulatory framework Non-formal prescribers/dispensers Out of date or no-existent standard treatment guideline (STG), drug list, formulary… No drug and therapeutics committee (DTC) encouragement No pharmacovigilance program Inadequate medicine registration and quality assurance system 24-Jun-23 145 Drug Supply Management
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Lack of system for continuing medical education Lack of financing and reimbursement mechanisms Lack of regulation on drug promotion Even in the presence of regulations, there may be lack of enforcement 24-Jun-23 146 Drug Supply Management
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c. Patient/client and community Perceived need for medicines Perceived need for consulting health workers Ideas about efficacy and safety Uncertainty resulting in polytherapy Cost of medicines Absence of social support 24-Jun-23 147 Drug Supply Management
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Inability to take time off work Low literacy level Medicine use culture Medicine supply system Quality of prescribing and dispensing Therapy related factors 24-Jun-23 148 Drug Supply Management
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Stepwise approach for promotion of rational drug use Assess current patterns of drug use, identify any problem and recognize the need for action Identify underlying causes and motivating factors List possible interventions Assess resources available for action Choose and carryout interventions Monitor the impact and restructure the intervention 24-Jun-23 149 Drug Supply Management
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24-Jun-23 150 Drug Supply Management
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Interventions/strategies to improve drug use They can be classified in to three major strategies: Educational Regulatory Managerial Educational: Is intended to persuade individuals by providing information It may include training, provision of printed materials and education 24-Jun-23 151 Drug Supply Management
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Managerial: Is used to guide action (decision making) Example: Drug list, STG Drug utilization review and feedback Regulatory: Aimed to enforce decisions Example: Drug registration regulation Generic policy Prescribing and dispensing restrictions Level of use restrictions 24-Jun-23 152 Drug Supply Management
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Characteristics of effective interventions: Identify key influence factors Target individuals or groups with the worst practice Use credible information sources Use credible communication channels Use personal contact whenever possible Limit the number of messages using different media Provide better alternatives 24-Jun-23 153 Drug Supply Management
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CHAPTER FOURINVESTIGATING DRUG USE 24-Jun-23 154 Drug Supply Management
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objectives Explain the need to investigate drug use Describe methods of investigating drug use 24-Jun-23 Drug Supply Management 155
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Outline The need for investigating medicine use Quantitative methods: WHO drug use indicators Drug use studies based on aggregate data (DDD, ABC, VEN) Other drug use studies Qualitative methods: Focused Group Discussion (FGD) In-depth Interview Structured Observation 24-Jun-23 156 Drug Supply Management
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Major reasons for investigating drug use: To describe current patterns of drug use To identify drug use problems and underlying problems To monitor drug use over time Methods for assessing drug use Quantitative methods Qualitative methods 24-Jun-23 157 Drug Supply Management
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A. Quantitative Methods Are used to describe how often certain drug use practices occur 24-Jun-23 158 Drug Supply Management
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1. WHO drug use indicators A. Core drug use indicators (12) I. Prescribing indicators II. Patient-care indicators III. Health facility indicators B. Complementary drug use indicators (7) 24-Jun-23 159 Drug Supply Management
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A. Core drug use indicators (12) I. Prescribing indicators (5) Average number of drugs per encounter % of drugs prescribed by generic name % of encounters with an antibiotic prescribed % of encounters with an injection prescribed % of drugs prescribed from drug list/formulary 24-Jun-23 Drug Supply Management 160
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II. Patient-care indicators (5) Average consultation time Average dispensing time % of drugs actually dispensed % of drugs adequately labelled Patients’ knowledge of correct dosage 24-Jun-23 Drug Supply Management 161
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III. Facility indicators Availability of copy of essential drug list or formulary Availability of key drugs 24-Jun-23 Drug Supply Management 162
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B. Complementary drug use indicators (7) % of patients treated without drugs Average drug cost per encounter % of drug cost spent on antibiotics % of drug cost spent on injections Prescription in accordance with treatment guidelines % of patients satisfied with the care they received % of health facilities with access to impartial drug information 24-Jun-23 Drug Supply Management 163
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2. Aggregate data Defined Daily Dose (DDD) methodology ABC analysis VEN analysis 24-Jun-23 164 Drug Supply Management
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1. Defined Daily Dose (DDD) methodology Defined daily dose: Is the assumed average daily maintenance dose for the medication’s main indication (adults). It converts and standardizes readily available product quantity data such as packages, tablets, injections vials etc in to number of daily doses. It is used to directly compare consumption of drugs irrespective of price and type of formulation 24-Jun-23 Drug Supply Management 165
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DDD… Consumption report expressions: DDDs/1000inhabitant/day DDDs/inhabitant/year DDDs/100 bed/day 24-Jun-23 Drug Supply Management 166
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DDD… Example: interpretations: 4 DDDs/1000 inhabitants/day (DDD of the drug is 1 gm) 2 DDDs/100 bed-days (DDD of the drug is 250 mg) 2. A district hospital and health centers use 25,000 tablets yearly of methyldopa 250mg and 3, 000 tablets yearly of methyldopa 500mg. This drug usage is for a total population of 2,000,000 people. Calculate consumption in DDD/inhabitant/year 24-Jun-23 Drug Supply Management 167
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DDD… 2. In a region where 50 million people are said to live, it was reported that 400 million 10 mg tablets of drug A were sold in the past fiscal year. If on the average 4.38% of the people will be using DDD per day, then what is the DDD of drug A? 24-Jun-23 Drug Supply Management 168
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3. Other drug use studies Health-problem based Drug-specific studies 24-Jun-23 169 Drug Supply Management
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B. Qualitative Methods Used to determine why things are the way they are or why people behave as they do Used to find out more about People’s ideas The reasons why problems occur What people see as possible solutions and constrains 24-Jun-23 170 Drug Supply Management
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The methods include: FGD (Focused Group Discussion) In-depth interview Structured observation 24-Jun-23 171 Drug Supply Management
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CHAPTER FIVE NATIONAL DRUG POLICY 24-Jun-23 Drug Supply Management 172
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Learning Objectives At the end of this chapter, students will be able to: Define national drug policy Narrate the core objectives and key strategies of a National Drug Policy Discuss the process of National Drug Policy development identify components of a national drug policy Review national drug policy of Ethiopia 24-Jun-23 173 Drug Supply Management
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5.1. Rationale Health is a fundamental human right. Access to health care, which includes access to essential drugs, is a prerequisite for realizing that right. Despite the obvious medical and economic importance of drugs there are still widespread lack of access, poor quality, irrational use and waste. 24-Jun-23 174 Drug Supply Management
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Rationale 1. Lack of access to essential drugs WHO has estimated that at least one-third of the world’s population lacks access to essential drugs; in poorer areas of Asia and Africa this figure may be as high as one-half 2 Millions of children and adults die each year from diseases that could have been prevented or treated with cost-effective and inexpensive essential drugs. 24-Jun-23 175 Drug Supply Management
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Rationale 2. Poor quality inadequate drug quality assurance systems substandard and counterfeit products inappropriate handling, storage and distribution can alter the quality of drugs. 24-Jun-23 176 Drug Supply Management
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Rationale 3. Irrational use of drugs No right medicine in the right dosage when needed Many people buy, or are prescribed and dispensed, drugs that are not appropriate for their needs. use several drugs (poly pharmacy) use drugs that carry unnecessary risks. The irrational use of drugs may unnecessarily prolong or even cause ill-health and suffering, and results in a waste of limited resources. 24-Jun-23 177 Drug Supply Management
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Rationale A national drug policy as a common framework to solve problems in pharmaceuticals A common framework to address the sectors problems comprehensively 24-Jun-23 178 Drug Supply Management
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5.2. what is a national drug policy A commitment to a goal and a guide for action: It expresses and prioritizes the medium- to long-term goals set by the government for the pharmaceutical sector, and identifies the main strategies for attaining them. It provides a framework within which the activities of the pharmaceutical sector can be coordinated. It covers both the public and the private sectors, and involves all the main actors in the pharmaceutical field. 24-Jun-23 179 Drug Supply Management
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A national drug policy is an essential part of health policy It must fit within the framework of a particular health care system, a national health policy and, perhaps, a programme of health sector reform. The goals of the national drug policy should be consistent with broader health objectives, and policy implementation should help to achieve those broader objectives. It is very difficult to implement a health policy without a drug policy(why?) 24-Jun-23 180 Drug Supply Management
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5.3. Objectives of a national drug policy The general objectives of a national drug policy are to ensure: ■ Access: equitable availability and affordability of essential drugs ■ Quality: the quality, safety and efficacy of all medicines ■ Rational use: the promotion of therapeutically sound and cost-effective use of drugs by health professionals and consumers. The more specific goals and objectives of a national policy will depend upon the country situation, the national health policy, and political priorities set by the government. In addition to health-related goals there may be others, such as economic goals. 24-Jun-23 181 Drug Supply Management
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5.4. national drug policy development process Steps of formulating NDP Step 1: Organize the policy process: The ministry of health take the lead role in formulating a national drug policy decide how to organize the development process that will identify the structure of the policy, major objectives and priority components. identify all the interested parties that need to be involved, the necessary resources, and how these can be obtained 24-Jun-23 182 Drug Supply Management
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national drug policy development process Throughout the policy process there should be consultation, dialogue and negotiations with all interested groups and stakeholders. These include: other ministries (higher education, trade, industry), doctors, pharmacists and nurses, local and international pharmaceutical industries, drug sellers, academia, nongovernmental organizations (NGOs), professional associations and consumer groups, provincial and district medical and administrative personnel, traditional and herbal medicine practitioners, drug regulatory agency, the media etc… In general it can be said that the more the existing pharmaceutical system needs to be improved, the more important it is to involve all interested parties in discussing the necessary reforms.(why?) 24-Jun-23 183 Drug Supply Management
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national drug policy development process Step 2: Identify the main problem There are various ways of carrying out an initial situation analysis. small team of experts from the ministry of health and other disciplines examine the situation systematically, to identify the main problems, make recommendations. their recommendations, discussed at one or more multidisciplinary workshops, in order to formulate consolidated advice to the government. 24-Jun-23 184 Drug Supply Management
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national drug policy development process Step 3: Make a detailed situation analysis Further analyse the source of the problems, in order to identify potential solutions, choose the most appropriate strategies, set priorities, and serve as a baseline for future systems of monitoring and evaluation. Step 4: Set goals and objectives for a NDP Once the main problems have been defined, goals can be set and priority objectives identified Broad consultation and careful consideration of conflicting interests and structural constraints are necessary to set achievable objectives 24-Jun-23 185 Drug Supply Management
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national drug policy development process Step 5: Draft the text of the policy Once a thorough analysis of the situation and an outline of the main goals, objectives and approaches have been completed, a draft text of the national drug policy should be prepared It should set out the general and specific objectives of the policy. Step 6: Circulate and revise the draft policy circulated for comments, first within the ministry of health, then in other government, NGOs & to relevant institutions. 24-Jun-23 186 Drug Supply Management
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national drug policy development process Step 7: Secure formal endorsement(permission) of the policy Step 8: Launch the national drug policy 24-Jun-23 187 Drug Supply Management
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5.5. Key components of a national drug policy A national drug policy is a comprehensive framework in which each component plays an important role in achieving one or more of the general objectives of the policy The policy should balance the various goals and objectives, creating a complete and consistent entity. For example, access to essential drugs can only be achieved through rational selection, affordable prices, sustainable financing and reliable health and supply systems. 24-Jun-23 188 Drug Supply Management
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Key components of a national drug policy Selection of essential drugs Affordability Drug financing Supply systems Drug regulation Rational use of drugs Research Human resource development Monitoring and evaluation 24-Jun-23 189 Drug Supply Management
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Image source: Jad Davenport 24-Jun-23 190 Drug Supply Management
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191 24-Jun-23 5.6. Ethiopian National Drug Policy 1993 and its implementation Objectives To meet the country’s Demand of essential drugs/ and ensure access To ensure safety, efficacy and quality To develop domestic manufacturing capacity directed to export To expand human resource training, Resaerch&Development To devise ways and means to utilize traditional medicine Drug Supply Management
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192 24-Jun-23 Ethiopian National Drug Policy 1993 and its implementation Create favourable conditions for local manufacturers, importer/distributors Establish an effective system of drug regulation Establish system of rational use of drugs Devise a program for the training of professionals Conduct a coordinated research on traditional medicine Create favourable condition for technology transfer Create favourable condition for export Drug Supply Management
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193 24-Jun-23 Ethiopian National Drug Policy and its implementation 1993 Strategies 1.Selection of drugs Based on the country’s health problems, trained HR, Financial resources and infrastructure National Drug List (Human and Veterinary) Categorized list/Zonal/district/health centre health post Essential Drug List Establishment of a National Drug Advisory Committee Drug Supply Management
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194 24-Jun-23 Drug Supply Management
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195 24-Jun-23 Ethiopian National Drug Policy and its implementation 1993 2. Drug Supply Favourable conditions for manufacturers- Government shall establish a drug procurement and distribution enterprise/PFSA Domestic Drug procurement and distribution shall be carried out by networks established at regional level/PFSA Drug Supply Management
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196 24-Jun-23 Ethiopian National Drug Policy and its implementation 1993 3.Drug administration and control -FMHACA Registration certificate issuance (veterinary drugs registration guidelines)* veterinary drugs registered till to-date Quality standards setting Drug information Inspectors assignment Registration, classification and licensing to be carried out by responsible body Drug Supply Management
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197 24-Jun-23 Ethiopian National Drug Policy and its implementation 1993 4. Human Resource training Formal pharmacy training/more than 10 Universities Strategy for upgrading/Diploma to Degree in different Universities On job training and continuation education- Continuing Professional Development Guideline 5. Drug information and promotion Monitoring of the content and distribution of DI to professionals and the public/Drug advertisement and promotion directives/ Current and accurate information and reference materials on drugs shall be produced and distributed to practitioners in the field/DICs, Drug information bulletin/Zena Medhanit Drug Supply Management
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198 24-Jun-23 Drug Supply Management
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199 24-Jun-23 Ethiopian National Drug Policy and its implementation 1993 Drug promotion shall be carried out by trained professionals/Licensing of Medical representatives Mass media promotion shall\be controlled/Electronics and print media regulation (Cosmetics and medical equipment assisted services) Drug Supply Management
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200 24-Jun-23 Ethiopian National Drug Policy and its implementation 1993 7. Drug Use List OTC drugs Standard prescription Generic prescribing encouraged Generic substitutions for Brand drugs by pharmacists Public awareness on drug use/Radio/ Tv STGs ( Both Human &Vet STG in use) Formularies (Both Human &Vet in use) Drug Supply Management
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201 24-Jun-23 Drug Supply Management
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202 24-Jun-23 Ethiopian National Drug Policy and its implementation 1993 8. Traditional Medicine Research and development/Universities, EHNRI,EARI) Favourable condition to be created for the application of safe and effective TM/Licensing of TM practitioners, Registration of TD, ADR-TM monitoring 9. Research and development Introduction of appropriate technology and knowledge to vitalize the sector.\The government shall provide incentives and support/Clinical trial guidelines, licenses issued. Drug Supply Management
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203 24-Jun-23 Ethiopian NDP revision: the need The country is still overwhelmingly dependent on importation of drugs The number and distribution outlets shows mismatch to the needs. Enforcement capacity is its lowest level to fight illegal drug trade and encourage expansion of legal activities. Shortage of qualified and experienced management and technical personnel in public health facilities and industry. Drug Supply Management
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204 24-Jun-23 Ethiopian NDP revision: the need… Unsuitable and insufficient distribution and storage facilities. Inadequate systematic and continuing education coupled with inadequate reference and learning materials. Drug Supply Management
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205 24-Jun-23 Ethiopian NDP revision: the need… Trade-Related Aspects of Intellectual Property Rights/World Trade Organization (TRIPS/WTO) agreement Shifting in health financing strategies from out of pocket expenditure by patients to health insurance schemes. Drug Supply Management
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206 24-Jun-23 Ethiopian NDP revision: the need… Therefore: The draft revised policy includes new areas that were not covered by the previous policy further elaborates some strategies which were not adequately addressed pays particular attention to specific items included in the drug definition. Drug Supply Management
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207 24-Jun-23 Contents of the Draft Revised NDP SECTIONS Goal General Objectives of the Policy Components and Strategies Selection of Drugs Production and Supply of Drugs Production Procurement and Distribution *Stock Management (correction not Component 3 as it is in the document) 3. Drug Administration and Control 4. Drug Information and Promotion 5. Monitoring Safety of Drugs Drug Supply Management
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208 24-Jun-23 Contents of the Draft Revised NDP 6. Rational Drug Use 7. Traditional Drugs 8. Research and Development 9. Affordability and Financing of Drugs 10. National, Regional and International Relations 11. Human Resource Planning, Development and Retention 12. Policy Enforcement and Implementation of the National Drug Policy Drug Supply Management
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CHAPTER SIX PHARMACEUTICAL SUPPLY AND SERVICE REFORMS IN ETHIOPIA 24-Jun-23 209 Drug Supply Management
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Objectives After completion of this section students will be able to: Explain Auditable Pharmaceutical Transaction and Services (APTS) Explain Integrated Pharmaceutical Logistics System (IPLS) 24-Jun-23 210 Drug Supply Management
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1. Auditable Pharmaceutical Transaction and Services 24-Jun-23 211 Drug Supply Management
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The Evolution of APTS FMOH has been leading sector wide reform to improve the quality and accessibility of health services Accordingly Ethiopian Hospital Reform Implementation Guideline (EHRIG) was issued in 2010 to implement the reform EHRIG in the Pharmacy Chapter stated 12 operational standards The 4th standard: “All drug transactions and patient medication-related information should be recorded and documented” 24-Jun-23 212 Drug Supply Management
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Evolution of APTS … However, there were different challenges to the expected standards of pharmacy services Lack of transparent systems and tools for medicines transactions and sales management and difficult to audit Lack of efficient utilization of medicines budgets (high expiry and high stock out at the same time) Poor pharmacy organization, pharmaceutical management, poor infrastructure & chaotic work flow Improper human resource mix, number, & deployment Irrational dispensing practice became a tradition Absence of legal instruments to enforce good practice 24-Jun-23 213 Drug Supply Management
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Evolution of APTS … Debremarkos Referral Hospital took the initiative to implement transparent and accountable and transparent system Experience taken from community pharmacies and other hospitals The name “Auditable Pharmaceutical Transactions and Services, APTS” coined The system scaled-up to other hospitals in Amhara Region and backed by regulation Recognizing the benefits, other regions and FMOH are adapting the system 24-Jun-23 214 Drug Supply Management
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Essential Elements of APTS The essential elements of APTS are: Preparing tools Redesigning and using proven methodologies Pharmacy renovation, reorganization to suit work flow Workload analysis Physical inventory and auditing Prescription evaluation, counseling and dispensing Legal instruments development and enactment 24-Jun-23 215 Drug Supply Management
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Essential Elements … 1. Preparing tools that ensure transparency and accountability. receiving and issuing vouchers, sales tickets, dispensing registers, daily summary and monthly reporting forms Analysis forms 2. Methodologies for Efficient utilization of budgets : Establish effective medicines sales management system: price setting, daily sales summary as cash, credit and free Generating reliable information on product, finance and pharmaceutical service rendered. Bin ownership at dispensary to ensure accessibility of medicines and increase work efficiency 24-Jun-23 216 Drug Supply Management
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Essential elements … 2. Methodologies… Facility specific drug list segregated as vital, essential and non essential (VEN) ABC/VEN reconciliation Threesome analyses (Consumption to stock, stock turnover and stock status analysis) Registering medicines and supplies with unique identifier codes 24-Jun-23 217 Drug Supply Management
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Essential Elements … 3. Pharmacy renovation, reorganization, Equipment/Facilities and making suitable work flow Reorganizing dispensaries Rearranging the workflow Redefining roles of dispensers, accountants and cashiers 24-Jun-23 218 Drug Supply Management
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Organization and workflow at dispensaries 24-Jun-23 219 Drug Supply Management
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Essential elements … 4. . Workload analysis and proper human resource deployment, performance evaluation and training Deployment of proper number of pharmacists based on workload Evaluation of performance based on quantity, quality and transparency of services rendered 5. Regular physical inventory and auditing to ensure transparency and accountability 6. Prescription evaluation & medicines use counseling to attain proper use of medicines Training of professionals on dispensing steps, patients handling and counseling to increase patients knowledge on prescribed medicines’ use to improve adherence 7. Legal instruments supporting the implementation APTS implementation requires legal backup 24-Jun-23 220 Drug Supply Management
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Benefits of implementing APTS Several benefits in improving access to pharmaceuticals and quality of services Efficient budget utilization through SSA, ABC/VEN reconciliation Informed decision-making Increase hospital revenue, minimize wastage Improve availability and affordability of medicines Identify and prevent loss, theft, pilferage 24-Jun-23 221 Drug Supply Management
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Benefits … Enables allocation of pharmacy workforce based on workload Creates transparent, accountable and auditable system Enables transparent performance evaluation (BSC) Improves patient satisfaction through improved service quality, improved work flow and product availability Facilitates the implementation of EHRIG Pharmacy Chapter Operational Standards 24-Jun-23 222 Drug Supply Management
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Benefits of APTS … Key result areas of APTS 24-Jun-23 223 Drug Supply Management
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APTS practical experience APTS is showing improvement in pharmacy workforce allocation, improved drug availability, budget utilization and patient satisfaction, and reduced wastage. Specific cases of some hospitals that are implementing APTS are presented below 24-Jun-23 224 Drug Supply Management
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Improved Patient Satisfaction: 24-Jun-23 225 Drug Supply Management
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Reduced wastage rate 24-Jun-23 226 Drug Supply Management
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24-Jun-23 227 Drug Supply Management
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2. Integrated Pharmaceutical Logistic System (IPLS) 24-Jun-23 228 Drug Supply Management
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IPLS…. Pharmaceuticals Fund and Supply Agency (PFSA) was established in 2007 by Proclamation No. 553/2007 based on the Pharmaceuticals Logistics Master Plan (PLMP). The Agency is mandated to avail affordable and quality pharmaceuticals sustainably to all public health facilities and ensure their rational use. So as to execute its mandate in the area of pharmaceuticals supply in an efficient and effective manner, integrated pharmaceuticals logistics system (IPLS) has been developed and implemented since 2010. 24-Jun-23 229 Drug Supply Management
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IPLS…. IPLS is the term applied to the single pharmaceuticals reporting and distribution system based on the overall mandate and scope of the PFSA. It aims to ensure that patients always get pharmaceuticals they need. The IPLS integrates the management of essential pharmaceuticals including the following pharmaceuticals that were used to be managed vertically: HIV/AIDS, Malaria, TB and Leprosy, EPI, MCH and purchased essential drugs 24-Jun-23 230 Drug Supply Management
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IPLS It is the primary mechanism through which all public health facilities obtain essential and vital pharmaceuticals. Products included on the National pharmaceuticals procurement List (NPPL) are supplied and managed through the IPLS. 24-Jun-23 231 Drug Supply Management
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Information flow in IPLS hospitals and health centres order Program pharmaceuticals every two months by and delivered by PFSA to these facilities directly or indirectly. Direct delivery sites are facilities that receive program pharmaceuticals directly from PFSA hubs whereas non-direct delivery sites are health centres that receive products from PFSA hubs through Woreda Health Offices (WoHOs). Health posts report to health centres monthly and collect pharmaceuticals from those health centres; the health centres use the data in the Health Post report to calculate consumption and re-supply quantities. 24-Jun-23 232 Drug Supply Management
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Information flow in IPLS For revolving drug fund (RDF) pharmaceuticals, health centres and hospitals will complete Report and Re-supply form (RRF) as per the facilities review period which can be every two month, every quarter or every six months and collect products from affiliated PFSA branch. 24-Jun-23 233 Drug Supply Management
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Information flow in IPLS 24-Jun-23 234 Drug Supply Management
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Stock levels in IPLS 24-Jun-23 235 Drug Supply Management
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Logistic records in IPLS Bin Card (BC) Stock Record Card (SRC) Health Post Monthly Report and Re-supply Form (HPMRR) Internal Facility Report and Resupply Form (IFRR) Report and Requisition Form (RRF) for Program Drugs Report and Requisition Form (RRF) for RDF Drugs 24-Jun-23 236 Drug Supply Management
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Thank You!!! 24-Jun-23 237 Drug Supply Management