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OPERATIONS

Report by: Saeed Bashir Uthman


5 July 2016
TABLE OF CONTENTS
1. PREAMBLE .......................................................................................................................................................3
2. INFRASTRUCTURE.........................................................................................................................................5
3. PROCUREMENT OF HEALTH COMMODITIES ...........................................................................................5
4. STOCK RECEPTION ......................................................................................................................................6
5. ORDERS FROM OUR HEALTH FACILITIES ...........................................................................................7
6. PHYSICAL INVENTORY COUNT .................................................................................................................8
7. REPORTING ....................................................................................................................................................9
8. FEEDBACK ..................................................................................................................................................... 12
9. TYPICAL WAREHOUSE CALENDAR .......................................................................................................... 14
10. NEEDS ............................................................................................................................................................ 18
11. APPENDIX ..................................................................................................................................................... 20

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1. PREAMBLE

1.1. ESTABLISHMENT
Kgalagadi South DHMT Warehouse was established in November 2012. This
was in response to the Savingram dated 27 September 2012 Reference No:
DCS 5/1 XVII (66) regarding the Implementation of the New Medicines
Supply Chain Management Guidelines. Guideline No. 6 indicated that
with effect from October 2012, CMS would only deliver supplies to
DHMTs.

In response, the DHMT acquired and handed over to the Pharmacy


Department, a warehouse to be used for the purpose. The warehouse in
question originally belonged to the defunct Department of Supplies,
Ministry of Finance and Development Planning.

1.2. LOCATION
The DHMT Warehouse is currently housed in the biggest warehousing
facility located at the Supplies Depot in Tsabong Village.

1.3. MANPOWER
The warehouse is currently manned by the following personnel:
a) 1Principal Pharmacy Technician
b) 1Health Care Assistant
c) 3Security Guards (Temporary)

1.4. CLIENTELE
The Warehouse was established to manage the reliable distribution of
Health Commodities from the Suppliers to the Kgalagadi South DHMT
Service Delivery Points (SDPs). Our SDPs include 1 Hospital, 5 Clinics
with Maternity, 1 Clinic without Maternity and 15 Health Posts.

1.5. AREA GEOGRAPHY


Kokotsha village in the North of the district which is located 35km
away from Werda is the entry point to the Kgalagadi South District.
The village is exactly 185km away from Tsabong village, the DHMT
Headquarters. A 55km gravel road leads to Hereford village which is
located to the East of Werda village. Werda Clinic is the Mother
Clinic for the Werda Cluster. Werda Cluster comprises the following
facilities:

a) Hereford Clinic d) Draihoek Health Post


b) Makopong Clinic e) Kokotsha Health Post
c) Werda Clinic

Tsabong Clinic is the Mother Clinic for the Tsabong Cluster. Tsabong
Cluster comprises the following facilities:

a) Tsabong Clinic d) Maralaleng Health Post


b) Khisa Health Post e) Maubelo Health Post
c) Maleshe Health Post f) Omaweneno Health Post

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100km South of Tsabong and situated along the Border with the Republic
of South Africa is Middlepits village. Khawa village, famous for the
Annual Sand-Dune Festivals is accessible via a gravel road 77km West
of Khuis village which is located 7km to the South of Middlepits.
Middlepits Clinic is the Mother Clinic for the Middlepits Cluster.
Middlepits Cluster comprises the following facilities:

a) Middlepits Clinic d) Khawa Health Post


b) Bogogobo Health Post e) Khuis Health Post
c) Gakhibane Health Post f) Kolonkwaneng Health Post

Bokspits, Botswanas southernmost village is exactly 257km from


Tsabong and also 1km from the Border with the Republic of South
Africa. Struizendam, the last village and also near the Border with
the Republic of South Africa is linked to Bokspits via a 35km-long
gravel road. Bokspits Clinic is the Mother Clinic for the Bokspits
Cluster (BORAVAST). Bokspits Cluster comprises the following
facilities:

a) Bokspits Clinic c) Struizendam Health Post


b) Rappelspan Health Post d) Vaalhoek Health Post

1.6. POPULATION DYNAMICS


NO. NAME OF VILLAGE POPULATION (2011 CENSUS)

Bokspits village 649


Hereford village 1, 041
Makopong village 1, 853
Middlepits village 1, 136
Tsabong village 9, 471
Werda village 3, 428
Bogogobo village 360
Draihoek / Phepheng village 994
Gakhibane village 986
Khawa village 840
Khisa village 458
Khuis village 1, 049
Kokotsha village 1, 488
Kolonkwaneng village 706
Maleshe village 532
Maralaleng village 609
Maubelo village 514
Rappelspan village 404
Struizendam village 510
Omaweneno village 994
Vaalhoek village 355

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2. INFRASTRUCTURE

2.1. STRUCTURAL ANALYSIS


Since the warehouse was not originally intended for the storage of
medical supplies, it required structural modifications and
improvements to suit the new purpose. Communication regarding this
matter between the DHMT and MOH happened several times and the
Ministry is aware of this matter. A comprehensive report, a copy of
which was sent to MOH, CMS and Botswana Couriers and Logistics; is
attached (Situational Analysis/Requirements), please see Appendix.

2.2. THE COLD CHAIN


The vaccines and medicines that require refrigeration are kept in 3
Chest fridges. 2 of them have got freezing compartments where ice-
packs are kept. The fridge temperature charting is done twice every
day using the Fridge-tag 2 technology.

2.3. SECURITY
The warehouse is guarded by 3 temporary security guards. 2 of them
cover the night shift whereas the other one covers the day shift. The
day shift security guard is stationed at the gate to open for our
customers.

2.4. INFORMATION TECHNOLOGY


The warehouse is equipped with the following IT equipment:
a) Direct telephone line (6540889)
b) Telephone extension line (6540267) from Supplies Administration.
c) Fax line (6540894)
d) WIFIenabled modem for BTC Broadband internet connection

3. PROCUREMENT OF HEALTH COMMODITIES

3.1. GENERAL PROCUREMENT


Central Medical Stores is the primary source of all our health care
commodities. Our orders are submitted to Botswana Couriers for
processing according to their ordering schedule.

3.2. ORDERING AND RECEIVING

3.2.1. Main Orders


Kgalagadi South District places 2 main orders every month (the 2nd and
4th Monday) before 1000am.

3.2.2. Emergency Orders


Emergency orders are placed to CMS depending on the need. Below are
the circumstances under which emergency orders are often placed:
When CMS receives a commodity that has been out of stock
When a commodity is under-stocked, that is, stock level is at or
below the emergency order point.
For national campaigns.

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3.2.3. The Ordering Process
The process of ordering consists of the following steps:
Assessing Stock Status
Generating the Quantity to Order Report
Compiling the Order and Signing all Requisition Forms
Faxing the order to Botswana Couriers and Logistics

3.3. MICRO-PROCUREMENT
This is often our last resort when commodities can neither be obtained
from CMS nor from any other facilities around the Country. The Micro-
procurement vote was re-introduced during the 2015/2016 financial year
to assist us to address the Stock-Outs situation that had become
rampant at CMS.

3.3.1. The Process of Micro-Procurement


Micro-procurement involves the purchasing of commodities from the
private sector. This involves the following Steps:
Confirming the unavailability of particular commodities at CMS
Sending Requests for Quotations to Suppliers
Evaluating Quotations and awarding tenders
Receiving commodities and processing payment
Reporting the micro-procurement activities

3.4. STOCK FROM OUR SERVICE DELIVERY POINTS


The return of stock from the health facilities to the warehouse is an
ongoing process. This mainly affects:
Excessively stocked commodities
Commodities with a short shelf-life
Slow-moving/unused commodities

4. STOCK RECEPTION
The process of receiving consists of the following critical steps:
Confirming that the particulars of the delivered cartons of
commodities correspond with the details on the Form Gen 12.
Acknowledging receipt
Visual inspection while noting package integrity and product
quality
Confirming that the particulars of the delivered products match
the information on the packing lists.
Capturing the receipts data on Stock Cards and in the e-inventory
system (CHANNEL)
Generating the Stock-reception Report.

4.1. STOCK RECEIVED FROM CMS WITH DISCREPANCIES


This happens each time a received consignment of health commodities
has quality, quantity and/or identity problems that are inconsistent
with what was ordered/is being delivered. CMS allows a period of up to
7 days from the date of receipt to return the affected commodities.

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4.1.1. The Process of Returning Stock with Discrepancies
The following steps are involved:
Identifying received commodities with discrepancies
Filling the Discrepancy Form (MH3057)
Faxing the Form MH 3057 along with the relevant documentation to
CMS

5. ORDERS FROM OUR HEALTH FACILITIES


Three different kinds of facility orders are handled at the warehouse:
Main Orders
Emergency Orders
Vaccine Orders
Facilities place their main orders according to our schedule. Orders
are placed once a month. Emergency and vaccine orders are placed
whenever necessary.

5.1. REPORTING AND REQUISITION (R&R)


This tool was introduced in 2014. It was meant to ease the ordering
process for facilities. It has a comprehensive list of commodities. It
only requires Stock on Hand and Expiry data. Uses of the R&R:
Tool for stock-taking
Advice on the stock-status, that is, it indicates:
o Stock-outs
o Excessively stocked commodities
o Slow moving/unused commodities
o Commodities to replenish

5.2. PROCESSING FACILITY ORDERS

5.2.1. Capturing the R&R


Data on the R&R is captured on the eR&R Spreadsheet as soon as they
are received from the facilities. The Spreadsheet calculates the
quantity to issue using the R&R data.

5.2.2. Vetting the Facility Orders


The following activities are carried out during vetting:
o Facility Average Monthly Consumption (AMC)data is updated
o Quantity to issue is determined basing on the Stock-on-Hand
and AMC data.
o Issuing slip is printed advising on:
Quantity issued
Adjusted quantities for certain commodities
Issued alternatives in case of stock-out commodities
Pre-packaged commodities
Stock-out commodities

5.2.3. Issuing Facility Orders


CHANNEL software is used for issuing. Commodities in the CHANNEL
database are arranged by default according to CLASS as indicated in
the CMS Catalogue. Issuing is done using the advice slip. A picking

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list is generated and 2 copies of the invoice are printed. At this
point, the issued order is ready for picking.

5.2.4. Picking Facility Orders


The CHANNEL Invoice is used for picking. Issued commodities are
arranged on the invoice by default according to Class and so is the
arrangement of our commodities in their respective storage areas. A
tick is placed against each commodity picked. Each facility has a
steel cage for holding the picked commodities.

The word Fridge is written in bold at the top of the front page if
keep-cool commodities were issued. Keep-cool commodities are only
picked at the time of dispatch.

5.2.5. Dispatching Facility Orders


The collecting Officer cross-checks the picked commodities against the
invoice and any noticeable discrepancies are rectified prior to
loading.

For cluster collections, one facility is cleared at a time; the


cartons for each facility are clearly labeled and numbered using a
permanent marker (e.g. Khawa, 1 of 7) to ease delivery.

5.2.5.1. Emergency Orders from Facilities


Vaccines and Emergency Orders are issued and picked whenever they are
received at the warehouse. Issued Vaccine Orders are picked only when
the collecting officers are ready to depart from Tsabong.

6. PHYSICAL INVENTORY COUNT


A physical count exercise involves an actual count of the quantity of
each commodity in stock which is conducted after every two weeks at
the warehouse. There are three reasons for this:
Facility Orders from 2 clusters are issued during the first two
weeks of the month, thus it facilitates the compilation of our
Cycle-1 Main Order to CMS to replenish stock.
Month-end Stock Take concludes the activities of the reporting
period and thus facilitates the compilation of our Cycle-2 Main
Order to CMS as well as the compilation of reports.
Owing to a large volume of facility orders processed each month,
frequent Stock-takes enable us to easily identify the causes of
most of the stock discrepancies.
Facilitates the assessment of stock status and to take prompt
action.

6.1. CONDUCTING PHYSICAL INVENTORY COUNT


A physical count exercise involves the following activities:
Preparing for the count (a day before the count)
Printing the Current Stock Report and counting the stock (day
of stock take)
Updating the stock inventory.

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Analyzing Stock Status

6.2. ASSESSING STOCK STATUS


This is done to determine if the warehouse is understocked,
overstocked or adequately stocked.

6.2.1. Actions taken after Determining Stock Status


Greater The product is Application for the return of Surplus
than 2 overstocked. Stock is generated and sent to CMS if
months the commodity has a shelf-life in
excess of 1 year.
An advert for excess stock is e-
mailed to the National Forum and
faxed to all Hospitals and DHMT
Warehouses. Adverts are also done
telephonically.
At or Stock status is No action required, however, if the
above 1 adequate. assessment is done following stock take,
month a main order is placed accordingly.
Below 1 The product is Stock monitoring is continued until:
month and understocked but The arrival of the next delivery or,
above 0.5 stock levels have Stock level reaches the emergency
month. not yet reached order point.
the emergency
order point.
At or The product is Place an emergency order to CMS
below 0.5 under-stocked, immediately.
month. stock level is at
or below the
emergency order
point.

7. REPORTING
Facilities generate certain reports every month. These reports are
consolidated at the warehouse and escalated to the higher levels. At
the same time, faculties receive feedback on their reporting. LMU
also provides feedback on our VEN LMIS Report.

7.1. QUARTERLY PACK


The quarterly pack is dispatched to
facilities before the beginning of every
quarter that comprises the following:
R&R for Clinics.
R&R for H/Posts.
Emergency Tray Replenishment Form.
Drug Availability Report Form.
Ordering Schedule for New Quarter.
Expired Drugs Report form.
Vaccine Consumption Report form.
Temperature Log.

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This initiative was instituted to ensure constant availability of all
Reporting Forms and to promote timely reporting.

7.2. REPORTS FROM FACILITIES


Two of the reports from the facilities are processed at the warehouse:

7.2.1. Reporting and Requisition (R&R)


Each cluster was allocated a week during which their R&R is received
at the warehouse and processed.

7.2.2. Vaccines Consumption Report


The vaccine utilization and wastage report is received at the
warehouse from the facilities from the beginning of the month until
the 14th day to submit their report.

7.3. REPORTS TO HIGHER LEVELS


The following reports are generated at the warehouse for higher
levels:
Friday Morning Pharmacy Briefing Report
Weekly Drug Availability Report
Stock-Outs Report
Monthly Drug Availability Report
VEN LMIS Report
Stock Take Report, it reports on;
o Audit Queries
o Drug Expiries
o Losses and Adjustments
Vaccines Utilization and Wastage Report

7.3.1. Friday Morning Pharmacy Briefing Report


Every Thursday, the report covering all activities that transpired
since Friday the previous week as well as the current stock situation
at the warehouse is compiled for the Pharmacy Departmental briefing
held every Friday morning at the Hospital.

7.3.2. Weekly Drug Availability Report


Every Friday before 1630hours, the report on the availability of
Vital, Essential and Necessary Drugs and Non-drug c commodities is
compiled. This report is e-mailed on Monday the following week to the
following:
a) MOH (Deputy CS-Clinical Services , Chief Pharmacist and Chief
Pharmacist-BEDAP)
b) DHMT (PHS, CMO, CHO, Matron, Senior Pharmacist and CPT)
c) Department (Stock Manager-TPH, Cluster Pharmacy Technicians)

7.3.3. Stock-Outs Report


The list of commodities that are out of stock, comments from CMS
regarding their procurement status and our alternative procurement

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efforts accompanies the Weekly Drug Availability Report every Monday
to the same addressees mentioned in 4.3.2 above.

7.3.4. Monthly Availability Report


This report gives the availability picture for Vital, Essential and
Necessary Drugs and Non-drug commodities at the warehouse over a
period of 1 month. Monthly availability is determined by computing the
average of the weekly availabilities for that particular month and is
reported together with the last Weekly Drug Availability Report to the
same addressees mentioned in 4.3.2 above.

7.3.5. VEN LMIS Report


This report was established by the LMU in September 2013. Since then,
this report has been compiled at the warehouse following the Month-end
Physical Stock-Take and sent to the LMU on or before the 10th day of
the following month. The purpose of this report is to provide the LMU
with logistics data for the management of the logistics system. The
LMIS Report is completed using the month-end physical count data
together with either:
The Monthly Close-Out data from the Stock/Bin Cards (totals of
Qty received, Qty issued, Losses and Adjustments) or
Quantity Balance Report from CHANNEL

7.3.6. Stock Take Report


The stock take report is generated within 3 days of concluding the
physical inventory count and submitted to the Senior Pharmacist and
CMO. The report guides us on which actions to take for particular
issues that may be associated with certain commodities. It also
advises Management on the detailed stock situation at the warehouse.
The report contains the following details:

7.3.6.1. Expiries
Report 99001 from CHANNEL (Inventory Losses due to Expiry) shows a
list of commodities that expired at the end of the reporting period,
their quantities and their monitory value.

7.3.6.2. Losses
Report 10389007 from CHANNEL (Inventory Loss due to Picking Error)
shows a list of commodities (with their quantities and monitory value)
that were wrongly picked (that is, wrong item or wrong dosage form or
wrong strength).

Report 10389006 from CHANNEL (Inventory Loss due to Oversupply) shows


a list of commodities (with their quantities and monitory value) that
were oversupplied.

7.3.6.3. Adjustments
Report 111 from CHANNEL (Stock Reception) shows a list of commodities
(with their quantities and monitory value) that were either
undersupplied or not supplied at all.

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7.3.6.4. Audit Queries

This is the rate of occurrence of discrepancies in stock on hand which


is calculated thus:
Number of
discrepancies
Stock-on-Hand = X 100%
Total number of
commodities

During the last financial year, we were able to maintain it below 6%


but our target is to reach 0%. However, this target is difficult to
achieve owing to human error which is compounded by the pressure of a
heavy workload being executed by one or two individuals at a time.

7.3.7. Vaccines Utilization and Wastage Report


This report is aimed at monitoring vaccine usage to help in the
national quantification and procurement. The report is processed at
the warehouse basing on the facility reports submitted by the 14th. The
report is submitted on the 15th day to:
a) MOH EPI unit (Mr. M. Gaolaolwe and Mrs. N.J. Monyatsi)
b) DHMT (PHS, CMO, CHO, Matron, Senior Pharmacist and CPT)
c) Cluster Pharmacy Technicians

8. FEEDBACK

8.1. ANALYSIS OF VEN LMIS FEEDBACK


As soon as our VEN LMIS Report reaches the Logistics Management Unit
(LMU), it is processed and a feedback is e-mailed to us thereafter.
This normally takes 1 to 2 weeks. Upon receipt of their feedback, we
scrutinize and respond to it and take the necessary actions within a
week. It is sent to:
CMS (CMS Manager, Logistics Management Unit)
DHMT (PHS, CMO, CHO, Matron, Senior Pharmacist and CPT)
The feedback comprises such data as:
o Accuracy of the LMIS Report feedback
o Corrections
o Recommendations

8.2. MAIN ORDER STOCK RECEPTION FEEDBACK


The received main order is always analyzed within a week and feedback
is sent to:
MOH (Deputy CS-Clinical Services , Chief Pharmacist and Chief
Pharmacist-BEDAP)
CMS (CMS Manager, QA Manager-Botswana Couriers and Logistics)
DHMT (PHS, CMO, CHO, Matron, Senior Pharmacist and CPT)
The feedback comprises such data as:
o Overall Order Fill Rate (OFR).
o OFRs for drugs and for Non-drugs
o OFR according to Class
o Discrepancies

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8.3. VACCINES CONSUMPTION REPORTING FEEDBACK
This provides feedback to facilities on their pattern and accuracy of
reporting vaccine consumption. It is often compiled in the third week
and is sent to:
DHMT (PHS, CMO, CHO, Matron, Senior Pharmacist and CPT)
Pharmacy Department (Area Pharmacy Technicians)
Cluster Matrons
Heads of Clinics and Health Posts
The feedback comprises such data as:
o The rate of facility reporting
o Accuracy of reporting
o Appropriateness of used reporting forms
o Timeliness of report submission

8.4. FACILITY MAIN ORDER PROCESSING FEEDBACK


Facilities and DHMT Management are advised through this report on
their reporting/ordering behaviour. Below are the recipients of this
feedback:
DHMT (PHS, CMO, CHO, Matron, Senior Pharmacist and CPT)
Pharmacy Department (Area Pharmacy Technicians)
Cluster Matrons
Heads of Clinics and Health Posts
The feedback comprises the following data:
o The rate of facility reporting
o Completeness of the reports
o Appropriateness of used reporting forms
o Timeliness of report submission

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9. TYPICAL WAREHOUSE CALENDAR
9.1. WEEK 1
DATE DAY ACTIVITY
1 Monday Submitting Weekly and Monthly Drug Availability and
Stock-Outs Reports
Receiving R&Rs from Werda Cluster
Making Stock Adjustments following last Month-end Stock-
take
2 Tuesday Vetting R&Rs from Werda Cluster
Issuing main orders for Werda Cluster
Compiling and submitting the Stock-take Report
Compiling and advertising the list of Excessive/Slow
moving/Short-dated commodities
Faxing request for Stock-Out commodities to Hospitals and
other DHMT Warehouses
3 Wednesday Picking main orders for Werda Cluster Facility 1 and 2
Dispatching Facility Orders
Raising list of commodities for Micro-procurement
Attending Monthly Pharmacy Departmental Meeting
4 Thursday Picking main orders for Werda Cluster Facility 3 and 4
Dispatching Facility Orders
Making emergency order to CMS(in response to Weekly CMS
Availability Report)
Compiling and submitting Weekly Departmental Report to
HOD
Raising Internal Requisition for Micro-procurement
5 Friday Picking main orders for Werda Cluster Facility 5
Dispatching Facility Orders
Compiling Main Order
Compiling Weekly Drug Availability Report
Compiling Stock-Outs Report
Compiling Requests for Quotation and faxing to
pharmaceutical distributors
Writing-off expired drugs for the last quarter (done ONLY
in 1st month of new Quarter)
6 Saturday
7 Sunday

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9.2. WEEK 2
8 Monday Receiving R&Rs from Tsabong Cluster
Faxing Main Order to CMS
Submitting Weekly Drug Availability and Stock-Outs
Reports
Sending the Main Order Processing Feedback to Werda
Cluster
1st day of Receiving Quotations
9 Tuesday Receiving Emergency Order from CMS
Arranging received Emergency Order in the storage areas
Vetting R&Rs from Tsabong Cluster
Issuing main orders for Tsabong Cluster
2nd day of Receiving Quotations
10 Wednesday Picking main orders for Tsabong ClusterFacility 1 and 2
Dispatching Facility Orders
Receiving Main Order from CMS
Arranging received Main Order in the storage areas
Compiling and submitting Main Order Stock Reception
Feedback
Compiling and submitting the VEN LMIS Report
Requesting Supplies Officer to oversee destruction of
Expired Drugs
Requesting the use of the landfill and incinerator for
the destruction of Expired Drugs
3rd day of Receiving Quotations
11 Thursday Arranging received Main Order in the storage areas
Picking main orders for Tsabong ClusterFacility 3 and 4
Dispatching Facility Orders
Making emergency order (in response to Weekly CMS
Availability Report)
Compiling Weekly Departmental Report
4th day of Receiving Quotations
12 Friday Attending Friday Pharmacy Departmental Briefing
Picking main orders for Tsabong Cluster 5 and 6
Dispatching Facility Orders
Compiling Weekly Drug Availability Report
Compiling Stock-Outs Report
Last day of Receiving Quotations
13 Saturday Mid-Month Stock Take
14 Sunday

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9.3. WEEK 3
15 Monday Receiving R&Rs from Middlepits Cluster
Making Stock Adjustments following Mid-month Stock-take
Compiling and submitting the Vaccine Utilization and
Wastage Report
Sending the Main Order Processing Feedback to Tsabong
Cluster
16 Tuesday Receiving Emergency Order from CMS
Arranging received Emergency Order in the storage areas
Vetting R&Rs from Middlepits Cluster
Issuing main orders for Middlepits Cluster
Compiling and submitting the Stock-take Report
17 Wednesday Evaluating Quotations for Micro-procurement
Re-arranging stock according to FEFO
Picking main orders for Middlepits ClusterFacility 1 & 2
Dispatching Facility Orders
Analyzing LMU VEN LMIS Report Feedback
18 Thursday Picking main orders for Middlepits ClusterFacility 3 & 4
Dispatching Facility Orders
Making emergency order (in response to Weekly CMS
Availability Report)
Faxing GPOs to the Pharmaceutical Distributors
Compiling Weekly Departmental Report
19 Friday Attending Friday Pharmacy Departmental Briefing
Receiving Micro-procured commodities
Picking main orders for Middlepits ClusterFacility 5 & 6
Dispatching Facility Orders
Compiling Main Order to CMS
Compiling Weekly Drug Availability Report
Compiling Stock-Outs Report
Conducting the destruction of Expired Drugs
20 Saturday
21 Sunday

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9.4. WEEK 4
22 Monday Receiving Micro-procured commodities
Receiving R&Rs from Bokspits Cluster
Faxing Main Order to CMS
Receiving Emergency Order from CMS
Submitting Weekly Drug Availability and Stock-Outs
Reports
Sending the Main Order Processing Feedback to Middlepits
Cluster
23 Tuesday Receiving Micro-procured commodities
Vetting R&Rs from Bokspits Cluster
Issuing main orders for Bokspits Cluster
Assembling the Quarterly Pack (done ONLY in final Month
of the Quarter)
24 Wednesday Receiving Main Order from CMS
Arranging received Main Order in the storage areas
Dispatching the Quarterly Pack (done ONLY in final Month
of the Quarter)
25 Thursday Arranging received Main Order in the storage areas
Compiling and submitting Main Order Stock Reception
Feedback for Main Order 2.
Picking main orders for Bokspits ClusterFacility 1 and 2
Dispatching Facility Orders
Making emergency order (in response to Weekly CMS
Availability Report)
Compiling Weekly Departmental Report
Dispatching the Quarterly Pack (done ONLY in final Month
of the Quarter)
26 Friday Attending Friday Pharmacy Departmental Briefing
Picking main orders for Bokspits ClusterFacility 3 and 4
Dispatching Facility Orders
Compiling Weekly Drug Availability Report
Compiling Stock-Outs Report
Dispatching the Quarterly Pack (done ONLY in final Month
of the Quarter)
27 Saturday Month-end Stock Take
28 Sunday

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9.5. WEEK 5
29 Monday Submitting Weekly and Monthly Drug Availability and
Stock-Outs Reports
Making Stock Adjustments following Month-end Stock-take
Dispatching the Quarterly Pack (done ONLY in final Month
of the Quarter)
Compiling and submitting Micro-procurement Report
Sending the Main Order Processing Feedback to Bokspits
Cluster
30 Tuesday Receiving Emergency Order from CMS
Compiling and submitting the Stock-take Report
Compiling and advertising the list of Excessive/Slow
moving/Short-dated commodities
Faxing request for Stock-Outs to Hospitals and other DHMT
Warehouses
Dispatching the Quarterly Pack (done ONLY in final Month
of the Quarter)
31 Wednesday Compiling and submitting the VEN LMIS Report
Sending the Vaccine Reporting Feedback to facilities
Isolating and registering Expired drugs
Making follow-up with facilities to confirm receipt of
quarterly pack
Emergency and vaccine orders are received, processed and dispatched the same
day. On average three vaccine/Emergency orders are processed daily.

10. NEEDS
For the warehouse to function efficiently, the following should be put
in place:
a) Structural improvement
b) Personnel
c) Equipment
d) Oxygen shade
e) Security
f) Transport

Structural improvement
Since the warehouse was not originally intended for the storage of
medical supplies, it required structural modifications and
improvements to suit the new purpose. This requires:
i. Partitioning,
ii. Installation of air conditioning and
iii. Installation of alarm security system

Personnel
The warehouse requires the following additional staff:
i. 1Pharmacist or Chief Pharmacy Technician
ii. 1Senior Pharmacy Technician

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iii. 1Junior Pharmacy Technician
iv. 2Store Keepers
v. 2Casual Laborers
vi. 4Cleaners
vii. 1Extra Security Guard

Equipment
The following equipments are needed to improve working conditions at
the warehouse:
i. Ablution facilities
ii. Mini-kitchen
iii. Compounding area/library
iv. Cold room
v. Vault for ARVs and HFDs
vi. Hand wash basins

Oxygen shade
Most of our facilities lack oxygen cylinders. The few cylinders
available in the district are not well managed. A shade for oxygen
cylinders will ensure proper management and distribution.

Security
To ensure the safety of our drugs, we need in addition to permanent
security guards, installation of an Alarm Security System.

Transport
A twin cab truck is required to ensure timely distribution of medical
supplies and for support supervisory visits.

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11. APPENDIX

KGALAGADI SOUTH DHMT


The Pharmacy Warehouse Modification

SITUATIONAL ANALYSIS/REQUIREMENTS

Drug storage conditions at the warehouse


Storage conditions are only regulated in 2 tiny offices used as
temporary storage facilities for consumable supplies. Class 800 and
Infusion fluids are kept in an unregulated area. Unfortunately,
temperatures go to extremes in this part of the country. This grossly
compromises the quality and efficacy of the medications.

Below are the dimensions of the whole structure:


Length: 48.6metres
Breadth: 35.2metres

According to the inspection report of DBES following their site visit


of the facility on 16th November 2012, the cost of the structural
modification of the entire building could run into millions of pula.

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However, only half of the entire area is required for drug storage
leaving partitioning as the only plausible option.

Two options were suggested:


In case of temporary partitioning, the dimensions of the area to be
air-conditioned are 18.6metres by 17.85metres.

This is a framework of
steel shelves located
in the central portion
of the warehouse.
According to DBES, it
would need a material
similar to the one
used for building
Porta-Cabins, a
material that can only
be imported.

In case of permanent partitioning, the warehouse would be divided into


two using bricks. One half would serve as the drug storage whereas the
other half would be utilized by the DHMT for other storage purposes.
It would need:
Bricks for partitioning;
Ply wood for the ceiling;
Evaporative coolers; and
Painting.

Other modifications and installations required will


include:
Sealing-off of the air vents:
There are two air vents that need to be sealed off for purposes
of security as well as to keep out dust:
o One is located at the roof top on either side of the apex
running from one end to the other.
o The other one is located between the roof and the wall and
running all the way around the building.

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Removing the louvers
There are quite a
number of louvre
windows which were
meant for
ventilation. They
need to be removed
as they also admit
dust and pests.

Reducing the number of windows


In addition to the
louvre windows,
there are a quite
a number of
circular shutter-
less windows meant
for additional
illumination that
are not relevant
on a drug storage
facility. They too
need to be
removed.

Ablution facilities
The only accessible ablution facilities are located by the main
gate to the complex. Time and again they malfunction leaving us
with no option to drive home when nature calls. Apart from that,
the distance also does not favour us especially when there is
only one officer on duty or during rainy weather.

Mini-kitchen

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The facility is located very far away from the shopping centers.
A mini-kitchen equipped with a microwave oven and a domestic
fridge would be very helpful as well as a water dispenser for our
customers.

Compounding area/library
Bulks of commodities are pre-packaged at the warehouse before
being issued to our facilities. Therefore, a production area is
required to ease the task. In this area we need a weighing scale
and a tablet counting machine. This area will also double as a
mini-library where our reference materials, policy documents and
guidelines will be kept.

Cold room
A cold room will be needed for storage of all pharmaceuticals
that need to be maintained at cold room conditions.

Vault
Currently, our Habit-forming drugs are kept at the hospital. Our
clinics order their ARV supplies directly from CMS. If a vault is
incorporated in the design, facilities will be able to receive
their ARV as well as HFD supplies from the warehouse.

Hand wash basins


The design should incorporate hand wash basins in the production
area, mini-kitchen and at dispatch.

Security
To ensure the safety of our drugs, we need
Permanent security guards to provide 24 hour security services;
during the day, we need two guards such that as one mans the main
gate the other one keeps an eye on the activities within the
warehouse.
Alarm system installation

Oxygen shade
Our facilities struggle a lot when it comes to oxygen therapy. Most of
them lack oxygen cylinders. The few cylinders available in the
district are not well managed. For proper management and distribution,
a shade for our oxygen cylinders needs to be erected adjacent to the
warehouse.

Transport
Delivery and re-distribution of pharmaceutical supplies in the
district is very difficult. A truck is required to ensure timely
distribution to all facilities.

We are under performing in the area of supervision of our facilities.


It is not easy to acquire transport to go for support visits. If the

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pharmacy department obtains a Van, it will be used for support
supervisory visits and smaller distribution errands.

Manpower
Current Staff at the Warehouse includes;
1 X Principal Pharmacy Technicians
1 X Health Care Assistant.

The temporary staffs include;


3 X Casual Labourers,
3 X Security Guards.

For us to function properly, we need extra staff as suggested below;


1 X Pharmacist,
1 X Chief Pharmacy Technician,
2 X Storekeepers,
2 X Cleaners and
2 X Drivers.

Summary
From the above information, it is very clear that the warehouse is
underutilized but occupancy in the two storerooms is 100%. A Loading
area exists but is not raised. The floor is not tiled but thoroughly
cemented. Air conditioning is available in the two storerooms. There
is no cold room.

Compiled by: Saeed Bashir Uthman


Principal Pharmacy Technician
Kgalagadi South DHMT

08 February 2016

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