Thesis

Addis Ababa University
College of Business and Economics

School of Commerce
Department of Logistics and Supply Chain
Management
An assessment on the Role of Integrated Pharmaceutical

Logistics System (IPLS) on Drug Supply Management,
Hospitals under
Addis Ababa City Administration Health Bureau
A Thesis Submitted in Partial Fulfillment of the Requirements for the Master of Art
Degree in Logistics and Supply Chain Management
By: GETACHEW KASSA

ADVISOR: Dr. ABEBE EJIGU, Associate Prof.
May, 2015
Addis Ababa
ADDIS ABABA UNIVERSITY
FACULTY OF BUSINESS AND ECONOMICS
SCHOOL OF COMMERCE
DEPARTMENT OF LOGISTICS AND SUPPLY CHAIN
MANAGMENT
“An Assessment on The Role of Integrated Pharmaceutical Logistics

System (IPLS) on Drug Supply Management, Hospitals under Addis
Ababa City Administration Health Bureau”
In Partial Fulfillment of the Requirements for MA Degree,
By: GETACHEW KASSA
Approved by Board of examiners

Dr. Abebe Ejigu _____________ __________
Advisor Signature Date
Name _________________________ ___________ __________
Internal Examiner Signature Date
Name ________________________ ___________ __________
External Examiner Signature Date
Declaration
I, Getachew Kassa declare that this paper is a result of my independent research work on the
topic entitled “An Assessment on The Role of Integrated Pharmaceutical Logistics System
(IPLS) on Drug Supply Management, Hospitals under Addis Ababa City Administration
Health Bureau” in partial fulfillment of the requirements for the Degree of Masters of Art in
Logistics and Supply Chain Management at Addis Ababa University, school of Commerce.
This work has not been submitted for a degree to any other university. All the references are also
duly acknowledged.
Getachew Kassa
Signature_____________________
Date_____________________
Confirmation
This is to certify that Getachew Kassa has carried out this research work on the topic entitled
“An Assessment on The Role of Integrated Pharmaceutical Logistics System (IPLS) on Drug
Supply Management, Hospitals under Addis Ababa City Administration Health Bureau”
under my supervision. This work is original in nature and has not been presented for a degree in
any University and it can be submitted for the partial fulfillment of the requirements for the
award of the degree of Masters of Art in Logistics and Supply Chain Management.
Abebe Ejigu (PhD)
Signature______________________
Date__________________
Acknowledgement
First, I am very indebted to the Almighty God.
I thank Dr. Abebe Ejigu, Associate Prof. for his corrections and guidance in ensuring successful
completion of this study. His support, supervision and constructive criticism contributed in
diverse ways in ensuring the fruitful accomplishment of this work.
I heartily thank all who helped and cooperated in giving relevant information, especially
pharmacy staffs in all hospitals under Addis Ababa City Administration Health Bureau. I also
express my gratitude to other members, particularly department of procurement and supply
management and other people I have met along the way for their support and encouragement.
I am also very grateful and would like to extend my appreciation to Addis Ababa University,
School of Commerce staffs.
My final appreciation, very special and enormous thanks goes to Feven Abera and Marta Kassa
for their invaluable support during the writing of this thesis. I say God richly bless you.
Abbreviations
AIDS Acquired Immune Deficiency Syndrome
AACDHB Addis Ababa City Administration Health Bureau
DSM Drug Supply Management
DU Dispensing Unit
EDL Essential Drug List
FDRE Federal Democratic Republic of Ethiopia
5
FMHACA Food, Medicine and Healthcare Administration Control Authority
EPI Expanded program on immunization
HIV Human Immune Deficiency Virus
IFRR Internal Facility Report and Resupply Form
LMIS Logistics Management Information System
IPLS Integrated pharmaceutical logistic system
NPPL National Pharmaceuticals Procurement List
PFSA Pharmaceutical Fund and Supply Agency
RHB Regional Health Bureau
SCM Supply Chain Management
TB Tuberculosis
WHO World health Organization
Table of Contents
6
List of tables
Table 4.1 Level of Education, hospitals under AARHB, May 2015………….............................22

Table 4.2 Experience of pharmacy staffs in the hospitals under AACAHB, May
2015................................................................................................................................................22
Table 4.3 Distribution of pharmacy staffs available in each hospital under AACAHB, May
2015………………………………………………………………..……………......................…24
Table 4.4 List of top ten diseases of hospitals under AACAHB with their key drugs, May
2015…………………………………………………………………………....................………36
List of figures
Graph 4.1 Distribution of pharmacy staffs by gender in each hospital under AACAHB, May
2015………………………………………………………......................………………………..21
Graph 4.2 Sum of qualification of pharmacy staffs available in each hospital under AACAHB,
May 2015…………………………………………………………….......................……………23
Graph 4.3 Pharmacy staffs who took IPLS training and who didn’t, hospitals under AACAHB,
May 2015……………………………….......................…………………………………………28
Graph 4.4 Pharmacy staffs confidence level to perform IPLS tasks, hospitals under AACAHB,
May 2015…………….......................................…………………………………………………29
Graph 4.5 Disadvantages mentioned about IPLS, hospitals under AACAHB, May
2015………………………………………………………………………………………............30
Graph 4.6 Essential data that are required to run logistics system and must be captured by LMIS,
hospitals under AACAHB, May 2015………………………………...........................................33
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Abstract
Supply chain management practices correctly applied in Public Health institutions can contribute
greatly in maintaining the availability of essential drugs. The aim of this qualitative study design
was to assess the role of Integrated Pharmaceutical Logistics System (IPLS) on drug supply
management in hospitals under Addis Ababa City Administration Health Bureau. This
descriptive research depicted that pharmacy department of all hospitals under bureau hadn’t their
own mission, vision and objectives. IPLS integrates the management of essential
pharmaceuticals; however among the respondents 39.1% don’t have the procedural manual. Of
all the participants only 56.4% had taken IPLS training, while about 41.8% felt very confident to
confident to perform their tasks in the IPLS. The hospitals had a non-functional DTC. Most of
them have very narrow and not of the standard store and the dispensary area except that of the
ART pharmacy which is of standard and suitable. Majority of the respondents were not satisfied
with their job and the quality of service they provide. Though pharmacy department is doing its
best provided that there are infrastructure and facility gaps; applying IPLS properly, a functional
DTC, and developing own drug list can contribute a lot while it further improves the service.
Key Words: Pharmacy service, IPLS procedure, FMHACA hospital requirements.
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CHAPTER ONE
INTRODUCTION
1.1. Background of the study
Pharmaceutical services are central components in the provision of health care services required
by a community. To ensure or improve the quality of pharmaceutical care one must address both
the resources and activities carried out in the provision of care. However in many cases quality
of pharmacy services can be improved by making changes to the health care system or pharmacy
system without necessarily increasing resources. This is also supported by the fact that
improving the process of pharmacy practice not only creates better outcomes but also reduces
cost. With this regard pharmaceutical logistics system is the recommended concept of practice in
that it alters the care and services that pharmacists provide to the public.
Pharmacy inventory management system facilitates to manage the inventory of the pharmacy on
a day to day basis for taking care of the pharmacy accurately and efficiently. The system keeps
track of purchases, stock, reorder level, supplies, issues, returns, billing and expiry. The various
kinds of reports generated help to make timely decisions and appropriate actions towards smooth
operation of pharmacy leading to customer satisfaction. (Wiedenmayer et al., 2008) The
Integrated Logistics System (ILS), a system for reporting about use of drugs and related medical
supplies and for requesting resupply, was designed to move beyond the current indent system by
integrating the drugs and supplies for numerous vertical programs. Each program previously had
its own method for resupply, with varying degrees of effectiveness in ensuring appropriate
supplies in health facilities.
The major aims of hospital inventory management and healthcare supply chains research is to
reduce healthcare cost without sacrificing the quality of service to the patient by improving
efficiency and productivity of healthcare system. Inventory management has a significant role in
the supply chain. Among various SCM issues, inventory management is a greater extent relevant
to the entire supply chain. Inventory management has been recognized as one of the most
important functions that has huge impact on their overall performance. Supply chain inventory
management is focused on end-customer demand and aims at improving customer service while
lowering relevant cost. (Ilma et al. 2013)
In Ethiopia, there is a system governing the logistics and inventory management of
pharmaceuticals namely, Integrated Pharmaceutical Logistics System (IPLS). The objective of
IPLS is to ensure that patients always get the health services they need. To ensure these facilities
must have the commodities to provide health services. 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 system
addresses the six rights of supply chain management by ensuring the right products, in the right
quantity, of the right quality, at the right place, at the right time and for the right cost. 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, FP, MCH
and purchased essential drugs. It is the primary mechanism through which all public health
facilities obtain essential and vital pharmaceuticals. Products included on the National
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pharmaceuticals procurement List (NPPL) are supplied and managed through the IPLS. (FDRE,
2010)
Some of the reasons of focusing on Pharmaceutical Systems are; drugs are specialised health
commodities, pharmaceuticals are the second highest public health budget expenditure in most
countries, drug expenditure accounts for 50-90% of non-personnel health system cost, access to
affordable high quality health commodities is central to health care systems, drug availability
promotes confidence in health systems and management of pharmaceutical systems is complex.
While some of the roles/ advantages of pharmaceutical systems like IPLS include; facility
controls quantity ordered, facility controls how funds are spent, one formula for all systems,
clearer documentation of procedures, helps to decide how much to order, eliminate separate
orders for FP, STI, Malaria, uninterrupted availability and affordability of pharmaceuticals,
ensuring that safe and efficacious drugs are available in the correct form and condition for the
correct indication and at an affordable cost whenever client needs them, iimproved inventory
management / record keeping, centralized and integrated forecasting of pharmaceuticals, and
improved communication between PFSA and health facilities, leading to more effective
management of emergency orders.
1.2. Back ground of the organization

Ethiopia has been enjoying consecutive economic growth for the last 10 years, with an
average annual growth rate of 10.7 percent. The country targets by the year 2025 to be a
middle income country (World Bank, 2014). Health service provision is one of the most
priority service the government has pledged areas for the population. At present, health
service providers in Addis Ababa are Federal Government Agencies, Addis Ababa Health
Bureau, Non-Governmental Organizations (NGOs), factories, and the private entrepreneurs.
The health service coverage and quality is improving in the city from time to time. However,
health service supply is still below the standards established by the Ministry of Health.
According to the standard set by the Ministry of Health; one district hospital is for 250,000
people, one regional hospital for 1,000,000 people and one specialized hospital for 5,000,000
million people.
Hospitals in Addis Ababa are not limited to providing services for the people residing in the
city only. As the city is the center of the country in many socio-economic aspects of peoples’
life and due to the expectations that better health services are available in Addis Ababa than in
other regional centers, health facilities in Addis Ababa provide service to significant number
of population in the surrounding areas outside the city and other regional states. As a result,
practically high shortage of hospital services is observed.
The Addis Ababa Health Bureau has a mandate to administer the six hospitals namely Gandi
Memorial, Millik II, Zewditu Memorial, Ras Desta Memorial, Yekatit 12 and Tirunesh-
Beijing hospital. The bureau has the following vision, mission and goal.
Vision- Aspire to see one of the best cities in health service delivery system in Africa where
there is no disability and death from preventable and curable disease.
Mission-To provide quality and equitable, preventive and curative health services to the
inhabitants of Addis Ababa and thereby reducing morbidity and mortality due to
communicable diseases and other health problems through active participation of the
community and all partners.
Goal-To improve the health status of the residents of Addis Ababa by providing quality and
comprehensive health service.
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1.3. Statement of Problem
All effective supply chains are driven by accurate and timely logistics data that is related to
demand, inventory, and pipeline information. Without quality logistics data, supply systems
are more likely to have problems, such as stock outs, which make the system unresponsive to
health facility and patient needs; and imbalances, which undermine facility services to patients
and the supply system accountability. (DELIVER. 2003. Malawi)
The provision of complete health care necessitates the availability of safe, effective and
affordable drugs and related supplies of the required quality, in adequate quantity at all times.
Despite this fact, in the past, the pharmaceutical supply chain management system of Ethiopia
had several problems including non-availability, un-affordability, poor storage and stock
management and irrational use.
PFSA 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) was developed and implemented. The purpose of an inventory control
system is inform personnel when and how much of the commodity to order and to maintain an
appropriate stock level to meet the needs of customers. A well designed and well operated
inventory control system helps to prevent shortages, oversupply, and obsolescence of
commodities. (FMHACA, 2011)
Being a developing country and due to the curriculum in Ethiopia; the pharmacy personnel
found in almost all institutions are all drug oriented. The pharmacist by definition has many
roles, for instance the pharmacy personnel is believed to have adequate training for the
management of drug supply chain but in Ethiopia they usually fail to act in accordance. This
may be attributed due to lack of motivation, inadequate training, financial constraints and
unfavorable working environment.
On the other hand, failure to manage pharmaceutical inventory has both economical and
health related problems. Pharmaceutical inventory management is the corner stone of the
health care system. Most health facilities have their own store to keep drugs and related
supplies. However, there are also significant risks involved in pharmaceutical supply
management as a whole; not only could scarce resources be wasted but poor quality products
may potentially cause severe damage to the health and well-being of those affected by the
diseases.
Before integration, both PFSA and the RHB vertically managed supply chains for different
program commodities. PFSA handled HIV and AIDS supplies, including commodities for
opportunistic infections, while the RHB managed TB, malaria, and family planning
commodities. This created inefficiencies, duplication of effort, and confusion about
responsibilities. To operationalize integration, PFSA hub management and the RHB discussed
the new commodity management roles and responsibilities for different program units of the
RHB, woreda (district) health offices, and service delivery points (SDPs).
1.4. Objectives of the study

The main objective of the study was to assess the Role of Integrated Pharmaceutical Logistics
System (IPLS) on drug supply management in hospitals under Addis Ababa City Administration
Health Bureau.
The specific objectives of the study were:
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 To investigate the proper storage practice of drugs and medical supplies
 To explore inventory management practice and infrastructure alignment with standards
 To explain handling of expired and damaged products
 To evaluate the proper recording of inventories
 To evaluate the general practice of the hospitals on IPLS
1.5. Research Questions

In order to provide answers to the research objectives, the following questions were posed for
investigation:
o How storage of drugs and medical supplies are made?
o Does the inventory management practice align with standards set by the Pharmaceutical
Fund and Supply Agency (FDRE, 2010)?
o How are the recordings of inventories undertaken?
o How are expired and damaged products handled?
o How IPLS practice helped the respective hospitals in drug management?
1.6. Significance of Study

IPLS is supposed to improve drug supply chain by integrating drug requisition, distribution, and
reporting into a single mechanism. Since 2010, health facilities have been implementing the
IPLS in a phased approach. With this consideration, the study will define various types of
logistics activities handled by the respective hospitals. The role of the new automated system on;
easy access to information on issues, orders, existing stock levels, and expiry date of
commodities, in stock outs, wastage, and expiry of drugs, with a special focus on drug supply
management.
Ethiopia is continuously improving its health care systems and therefore, the findings will help
hospitals in other regions to adopt some of the practices, like use of information technology as
competitive factors that can improve the service and reduce the cost of operation. The study will
figure out the contribution of IPLS in reducing drug stock outs in the selected hospitals. It will
provide clue to policy makers and stakeholders. It will identify gaps in drug supply management
and come up with profound recommendations. Further, the study will serve as to enrich the
knowledge of reader on the topic and as a spring board for other researchers who would like to
study the same issue in a wider.
1.7. Limitation of Study

The study was done in the six hospitals under Addis Ababa City Administration Health Bureau,
while the focus of the study was to assess the role of IPLS on drug supply management. The
emphasis was made on the practice of the system and didn't look at stock out rate, transportation
and availability of specialty items where the researcher suggests these require specialized survey.
The sample size included in this particular study was purposively determined and are relatively
small as compared to the total size of health facilities in the city. All hospitals under the study are
administered by one bureau, therefore it may not be a representative which is enough for
generalization.
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1.8. Ethical consideration
An official written letter was taken from Addis Ababa University School of commerce,
Department of Logistics and Supply Chain Management to the respective hospital’s Medical
director/ chief executive officer of the hospital. During data collection, each respondent was told
the purpose, scope and expected outcome and all data are anonymous.
1.9. Organization of the Study

The thesis is structured into five chapters:
Chapter one gives a brief description of the research and highlights salient discussions on the
role of integrated pharmaceutical logistics system on drug supply management. The chapter also
presents a statement of the problem, objectives of the study, research questions, and significance
of the study.
Chapter two describes pharmaceutical logistics system and drug supply management from
different perspective, the concept of pharmaceutical inventory management based on the
literature from numerous writers.
Chapter three presents the methodological perspectives of this study. The strategies adopted in
the study are fully discussed in this chapter. The strategies included sample/sampling procedures
and data collecting tools employed.
Chapter four presents the analysis and a brief discusses of the results of the study.
Chapter five presents major findings and recommendations for improving pharmaceutical
logistics in the respective hospitals.
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CHAPTER TWO
LITERATURE REVIEW
2.1. Why to integrate supply chains?
Supply chain management practices correctly applied in Public Health Institutions can contribute
greatly in maintaining the availability of essential drugs. A number of studies have been carried
out in the field of supply chain management targeting different industries but no studies have
focused on the availability of drugs in public health institutions in general or in particular in
Ethiopia sub county region.
Efficient public health supply chain performance is essential for assuring access to health
supplies, and thus for positive health outcomes. This is particularly important in most countries,
particularly in sub- Saharan Africa where large proportion of the population is served by the
public and mission health sectors. The public/mission health supply chain manager therefore has
an essential role in the realization of global public health goals, for improving maternal health,
reducing child mortality, and combating HIV/AIDS, malaria and other diseases. Rapidly
increasing health assistance from multilateral and bilateral donors has significantly benefited
health programs, but has also resulted in huge increases in the quantity and value of commodities
flowing through public health supply chains — a trend that will continue as newly developed
products (many with demanding supply chain requirements) continue to be introduced into
developing countries health systems.
Stock control, otherwise known as inventory control, is used to show how much stock one has at
any one time, and how to keep track of it. It applies to every item used to produce a product or
service from raw material to finished goods. It covers stock at every state of the production
process, from purchase and delivery to using and reordering the stock. Efficient stock control
allows one to have the right amount of stock in the right place at the right time. (Lamichhane JR,
Shakya HS, 2008)
Lyson and Farrington (2006) points out that supply chain management can be summarized to
mean the management of all activities, information, knowledge and financial resources
associated with the flow and transformation of goods and services up from raw-materials
suppliers, components suppliers, and other suppliers in such a way that the expectation of the
users and the organizations are met or surpassed.
Vertically managed disease control programs operate separately from the primary health care
supply system, which is managed by the central pharmaceutical and medical stores. Each
disease-specific program owns the physical infrastructure for storing and transporting health
products within the health system. Although disease-specific health programs and their vertical
supply systems have been an efficient way to meet disease control priorities and objectives,
many, like the TB and immunization programs, are under increasing pressures to manage larger
volumes of higher-value products from the national to service-delivery levels. Recent analyses in
more than 50 low- and middle-income countries discovered that none had logistics systems that
met the internationally recognized World Health Organization (WHO) criteria of effective
logistics management (WHO unpublished data, 2013). This research further highlights chronic
and enduring challenge of stock management, pharmaceuticals distribution, and overall
inefficiencies of supply chain and logistics systems. Separate research has suggested that without
addressing these challenges, pharmaceuticals supply chain systems will be a bottleneck to the
health sector in general.
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Supply chain integration is a major structural undertaking that can be very difficult but also very
effective in the long term. By moving from vertically managed programs toward horizontally
integrated systems, public health programs may be able to improve both efficiency and
effectiveness as long as the right steps to integrate are taken. Depending on where, when, and
how it takes place, the following benefits may accrue from increased horizontal integration when
successfully implemented:
 Increased economies of scale using infrastructure, equipment, and human resources at
full capacity and selling or relocating unneeded warehousing facilities, and vehicles
elsewhere in the health system.
 Increased flexibility and adaptability to enable expansion of products and growth of
the network through a clear, segmented framework of operations.
 Improved efficiency through better use of existing resources, streamlined delivery
routes, and specialization of supply chain professionals.
 Improved performance of supply chains and disease control programs. (Allain L,
Goentzel J, Bates J, and Durgavich J.)
2.2. General overview of IPLS

All effective supply chains are driven by accurate and timely logistics data that is related to
demand, inventory, and pipeline information. Without quality logistics data, supply systems are
more likely to have problems, such as stock outs, which make the system unresponsive to health
facility and patient needs; and imbalances, which undermine facility services to patients and the
supply system accountability. (USAID | DELIVER PROJECT, 2011)
Pharmaceuticals Fund and Supply Agency (PFSA) is coordinating sector wide effort aimed at
significantly improving sustainable availability of quality assured pharmaceuticals at an
affordable price to the public. The agency is also working to reduce national pharmaceutical
wastage and improve distribution of pharmaceuticals to service delivery points. As part of this
effort, the Agency has developed and further revised standard operating procedures (SOP) for
Integrated Pharmaceuticals Logistics System (IPLS).
IPLS strengthens institutional capacity to more efficiently manage, store, and distribute
commodities using a single system under the management of one entity, the PFSA.
Pharmaceuticals are ordered every two months by hospitals and health centers from the agency
and delivered to facilities. Health posts report to health centers monthly and collect
pharmaceuticals from those health centers; the health centers use the data in the Health Post
report to calculate consumption and re-supply quantities. Health centers and hospitals manage
their own budgets for the purchase of pharmaceuticals.
Logistics information is collected and reported monthly by health posts and every other month
by health centers and hospitals on logistics management information system (LMIS) forms.
 A combined report and order form is completed by health centers and hospitals and sent
to PFSA Hubs for order processing; the health center order includes the pharmaceuticals
requirements of the health posts.
 A copy of the health center report and order and a copy of each health post report are sent
to the Woreda Health Office for management and supervision purposes; Standard
Operating Procedures for the Integrated Pharmaceutical Logistics System 4 copy of the
hospital report and order is sent to the Regional Health Bureau for management and
supervision purposes.
 The Woreda Health Office aggregate logistics data from the health centers and send
aggregated reports of logistics data to the regional and zonal departments.
15
The overall information system also includes a mechanism for providing “feedback” to lower
level facilities from upper level facilities. In the feedback reports, facilities will be able to see
how they are performing compared to other facilities in their geographical area. For instance, the
Woreda or PFSA Hub may provide a short report to all of the health centers in the Woreda/ Hub
showing the stock status of priority products (key pharmaceuticals) in the various health centers,
the number of stock outs, the reporting rate or increases/decreases in consumption. The IPLS
integrates the management of commodities of essential drugs, family planning, Nutrition, MCH,
EPI, TB and leprosy, malaria, HIV/AIDS, other infectious diseases, laboratory services, and
environmental health and sanitation. The IPLS is the primary mechanism through which all
public health facilities obtain essential and vital health commodities. ( FMHACA, 2011)
As part of the health care system the pharmacy department has its own input in delivering health
care and also attaining the ‘health’ definition set by WHO. Some of the pharmacists’ role would
be to ensure patient safety with regard to drugs, take part in the activity of clinical pharmacy,
provide medicine information, ensure availability of medicine, compounding of medicine,
communicate with patients and physicians, drug use evaluation, keeping a register of controlled
drugs for legal and stock control purpose, etc. are required from a pharmacist to achieve the
desired out come from a health service (Fiscella. K, 2003).
A. Stock Levels
Inventory management is influenced by the nature of demand including whether demand is
derived or independent. Inventory levels are affected by customer service expectations, demand
uncertainty, and the flexibility of the supply chain (Ballou, 2004). For products characterized by
erratic demand, a short life cycle or product proliferation, a more responsive supply chain and
larger buffer inventories may be needed to meet a desired customer service level.
Inventory costs fall into three classes: carrying costs of regular inventory and safety stock,
ordering or set up costs, and stock- out costs. Inventory control systems balance the cost of
carrying inventory against the cost associated with ordering or shortfalls. Service level goals can
differ by the value placed on stock- outs and indirectly carrying costs. A high cost of stock- out
valuation will result in higher inventories and higher service levels. A constant availability of
stock provides a continuous uninterrupted customer service.
Stock levels should be maintained to minimum level so as not to incur unnecessary stock holding
cost but always available for continuous service to customers. Careful analysis can identify an
economic order quantity (EOQ), being the quantity of an item that should be regularly ordered so
as to minimize total cost of ordering and holding cost.
B. Essential Drugs
World Health Organization defines essential drugs (medicines) as those that meet the priority
health care needs of the population, carefully and systematically selected using evidence based
process. Regard is given to public health relevance, clear evidence on efficiency and safety and
comparative cost effectiveness. These drugs are meant to be always available in a functioning
health care system in adequate amounts, appropriate dosage forms with assured quality and
adequate information. (Ballou, 2004)
2.2.1. Overview to basic components of IPLS at health facility

FDRE, 2010 clearly states that IPLS at facility level includes the following basic logistics
functions:
A. Logistics Management Information System (LMIS) in IPLS
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The purpose of a Logistics Management Information System (LMIS) is to collect, organize, and
report information to other levels in the system in order to make decisions that govern the
logistics system and ensure that all six rights.
The primary function of the LMIS is to support the management of essential pharmaceuticals.
Three essential data items are required to run a logistics system and, therefore, must be captured
by the LMIS. These three essential data items are:
1. Stock on Hand: Quantities of usable stock available at a particular point in time.
2. Consumption Data: The quantity of pharmaceuticals used during the reporting period.
3. Losses/Adjustments: Losses are the quantities of products removed from your stock for
anything other than in the provision of services to patients or issuing to another facility
(e.g. expiry, lost, theft, or damage) and are recorded as negative (-) numbers. Adjustments
are quantities of a product received from any source other than PFSA, or issued to anyone
other than your health facility. An adjustment may also be a correction due to an error in
mathematics. An adjustment may be a negative (-) or positive (+) number.
There are only three activities that happen to pharmaceuticals within a logistics system: they are
stored in inventory, moved between facilities, and used to provide health services to patients. A
well-designed logistics management information system will include records and forms that
collect and report the three essential data items as they relate to these three activities.
B. Inventory Control System in IPLS
The purpose of an inventory control system is to inform personnel when and how much of a
pharmaceuticals to order and to maintain an appropriate stock level to meet the needs of patients.
A well designed and well operated inventory control system helps to prevent shortages,
oversupply, and expiry of pharmaceuticals.
To help maintain adequate stock levels, the maximum months of stock, minimum months of stock
and an emergency order point have been established for each health facility in the system.
 The maximum months of stock is the largest amount of each pharmaceutical a facility
should hold at any one time. If a facility has more than the maximum, it is overstocked
and risks having stocks expire before they are used.
 The minimum months of stock is the level of stock at which actions to replenish
inventory should occur under normal conditions.
 The emergency order point is the level where the risk of stocking out is likely, and an
emergency order should be placed immediately.
The inventory control system for the IPLS is a Forced Ordering Maximum/Minimum inventory
control system. This means that all facilities are required to report on a fixed schedule (monthly
at health posts, every other month at health centers and hospitals) for all products. In addition, all
products are re-supplied each time a report is completed. In emergencies, an emergency order
can be placed.
C. Storage of Pharmaceuticals in the IPLS
Storing is the safe keeping of pharmaceuticals to avoid damage, expiry, and theft. Proper storage
procedures help to ensure that storage facilities protect the shelf life of products, that only high-
quality products are issued, and that there is little or no waste due to damaged or expired
products. If proper storage procedures are followed, customers can be assured that they have
received a high quality product.
Storage conditions will affect the quality of the pharmaceuticals being stored. Rooms that are too
hot, stacks of cartons that are too high, and other poor storage conditions can cause damage or
cause a reduction in shelf life. A well-organized storeroom will simplify a facility’s work; time
will not be wasted trying to find needed supplies.
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D. Placing Emergency Orders
A maximum/minimum inventory control system is designed so that facilities always have enough
stock to serve their clients and to prevent emergency orders. However, every system must have a
procedure for placing emergency orders if they are ever needed. An emergency order would be
needed to avoid reaching a stock out before the end of the review period. At the Health Centers
and Hospitals an emergency order is needed if the stock level falls below 2 weeks of stock (0.5
months of stock) before the end of the review period. At the Health Posts an emergency order is
needed if the stock level falls below 1 week of stock (0.25 months of stock) before the end of the
review period.
2.2.2. Recording system in IPLS

Cards and Stock Record Cards are used to account for products held in storage, including their
receipt and issue. In the IPLS valuable information used to make re-supply decisions is recorded
on the Bin Card and Stock Record Card; data from these records are used in reporting,
calculating reorder quantities and for monitoring stock levels.
It is essential that personnel responsible for the management of pharmaceuticals maintain up to-
date and accurate Bin Cards and Stock Record Cards for each product and individual units of
issues for products having more than one units of issue.
2.2.3. When to Assess Stock Status

It’s believed that one should assess his/ her stock status at any time you think that your current
stock on hand will not last until the end of the current review period. This may occur if there is a
loss of supplies due to damage, expiry, or theft, or if there is an unexpected increase in
consumption.
2.2.4. Issuing pharmaceuticals

Pharmaceuticals used by a facility should be stored in the pharmacy storeroom. When
pharmaceuticals are issued from the storeroom to dispensing unit (DU), the dispensing unit (DU)
staff will provide essential logistics data on the Internal Facility Report and Resupply Form
(IFRR). After completing the report section of the form, the health worker will take the IFRR to
the pharmacy to obtain the needed pharmaceuticals. The store manager will use the information
in the report section to determine re-supply quantities and issue the pharmaceuticals.
When issuing the pharmaceuticals both the person receiving the pharmaceuticals and the
pharmacist or pharmacy store manager sign the Internal Facility Report and Resupply Form
(IFRR). After issuing the pharmaceuticals, pharmacy store manager updates the Bin Card and the
pharmacy head updates the Stock Record Card and files the Internal Facility Report and
Resupply Form (IFRR).
2.2.5. Issuing Pharmaceuticals within Health Centers and Hospitals

In order to maintain the quality of the pharmaceuticals, and to better manage the pharmaceuticals
in a Health Centre or Hospital, most of the commodities should be stored in the Health Centre or
Hospital pharmacy store. Pharmaceuticals should be issued to the service providers (nurses,
clinicians, out-patient pharmacies etc.) referred in this document as dispensing units (D.U.s) at
their work area (in the ward, in a clinic, in the dispensary) in small quantities once or more
during the month.
It is recommended that service providers hold enough pharmaceuticals at their work area to serve
clients for one, two or four weeks. This means that the service providers will come to the Health
Centre or Hospital pharmacy/store between 2 and 4 times a month for re-supply.
18
When issuing pharmaceuticals to a unit within a Health Centre or Hospital, the Internal Facility
Report and Resupply Form (IFRR) is used to maintain a record of the products that are issued
and received. The Internal Facility Report and Resupply Form (IFRR) should be kept in the
respective Dispensing Units and completed when a service provider is scheduled to come for re-
supply.
2.2.6. Receiving pharmaceuticals from PFSA

PFSA delivers pharmaceuticals to Hospitals and Health Centers which have submitted a
completed and approved RRF on time. Hospitals and Health Centers receive pharmaceuticals
every other month. At the time of delivery, PFSA trucks will wait while products are counted and
verified, to take note of any discrepancies, to obtain proof of delivery (Model 19), to collect
signed and sealed PFSA Delivery for the pharmaceuticals shipment. Pharmaceuticals are
delivered with two copies of PFSA Delivery Invoices. But, the facility will use the RRF copy in
the facility to check if they are receiving the quantity Ordered. (FMHACA, 2011)
CHAPTER THREE
METHODOLOGY
This chapter involves presenting the choice of method of collecting and analyzing data and
presents research design, describes the research methods, sampling techniques and the
instruments employed in the data gathering.
3.1. Population
The study was carried out in the pharmacy department found in six hospitals under Addis Ababa
City Administration Health Bureau. Source of population was pharmacists and druggists of the
respective hospitals. It was conducted from March 15-May 30, 2015.
3.2. Study Design

In order to achieve the stated objectives above, the study adopted qualitative strategy. A
descriptive study using a semi–structured interview, and observation check list was employed
among hospitals during the specified study period.
3.3. Sampling methods

Convenient sampling technique was employed so that the sampling unit of the study included
employees of the respective hospitals who were readily available pharmacy department staffs.
The researcher select this method because it bears low cost, it consumes less time to perform and
helps to select easiest population members and who are also good prospects for accurate
information.
3.4. Data Collection Tools and Procedures

The study made use of primary and secondary data sources in order to gather relevant
information for the study. The primary data were collected from the selected respondents of the
hospitals understudy. The study employed mainly semi-structured interview and observation in
collecting the primary data and the analysis was substantially based on primary data. The
secondary data which were collected from existing literature formed the literature review of this
study.
19
Observation was used as a means to assess the techniques used in documentation and system of
operation as well as the existing facilities of the hospitals. Important documents of the respective
hospitals such as Bin Card, Stock Card, RRF, and inspection to stores have been also used to
perform qualitative analysis. The interview was developed in order to gain important
information regarding the existing pharmaceutical inventory management and IPLS practice. It
was developed aiming for responders ‘of educational level of diploma and above.
3.5. Data analysis and presentation

The data collected was analyzed using a data processing tool, Statistical Package for Social
Sciences (SPSS) and were presented in the form of tables, percentage, graphs. A descriptive
approach were followed on the analyzed data and figures and possible recommendations made.
20
CHAPTER FOUR
DATA PRESENTATION, ANALYSIS AND DISCUSSIONS
4.1. DATA PRESENTATION AND ANALYSIS
This chapter gives a summary of key findings of the study presented according to the objectives
of the study. The result is mainly from the responses of the interview made to the staffs and the
observation of the six hospitals which are under the Addis Ababa Regional Health Bureau.
Statistical Package for Social Scientists (SPSS) was used to perform the analysis and Microsoft
Excel 2007 was used to generate the chart to explain the results. The questionnaire was
administered to a total of 113 respondents who were pharmacists or druggists in profession and
who were currently working during the study period. The questionnaire was fist standardized
and corrected through pilot study. Of the entire 113 questionnaire administered, 110 were
obtained, checked for completeness and were valid for analysis while three were discarded as a
result of improper and incomplete responses. The valid questionnaires which formed the analysis
yielded 97% response rate.
4.1.1. General organization of Hospitals under Addis Ababa City Administration

Health Bureau (AACAHB)
AACAB was established in 1985 E.C pursuant to the proclamation number 311/95 Addis Ababa
City proclamation of municipality service No.2/1995. The bureau is authorized to organize, Co-
ordinate and regulate public health activities in the city. The bureau has a mandate to administer
the following six hospitals;
1. Gandi Memorial Hospital
2. Millik II Hospital
3. Zewditu Memorial Hospital
4. Ras Desta Memorial Hospital
5. Yekatit 12 Hospital
6. Tirunesh-Beijing hospital
4.1.2. Pharmaceutical supplies

The Ethiopian Pharmaceutical Fund Supplies Agency (PFSA) is the sole supplier of all
pharmaceuticals and other medical products for the all facilities in the public health sector in the
country. The provision of complete health care necessitates the availability of safe, effective and
affordable drugs and related supplies of the required quality, in adequate quantity at all times.
Despite this fact, in the past, the pharmaceutical supply chain management system of the country
had several problems including non-availability, un-affordability, poor storage and stock
management and irrational use.
To solve these problems in public health facilities, 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) was developed and is underutilized.
21
4.1.3. Socio-Demographic Characteristics
There were a total of 110 pharmacists of which 24 were druggists. They accounted 76 male
respondents representing 69.1% and the remaining 34 of respondents which accounted 30.9%
were female. This is illustrated in figure 4.1 below. The pharmacist/ druggist by definition has
many roles, for instance the pharmacy personnel is believed to have adequate training for the
management of drug supply chain but in Ethiopia they usually fail to act in accordance due to the
curriculum; where pharmacy personnel found in almost all institution are all drug oriented. This
may be attributed due to lack of motivation, inadequate training, financial constraints and
unfavorable working environment. The age of the participants ranges from 24 to 48 years.
Graph 4.1-Distribution of pharmacy staffs by gender in each hospital under AACAHB, May
2015
Source: Survey of May, 2015
78.2% of educational level of the hospital staffs was degree and the rest 21.8% was diploma.
The study included all pharmacy personnel staffs that were available during the study period.
They were currently working at pharmacy store, supply store, outpatient pharmacy, ART
pharmacy, inpatient pharmacy, pediatric pharmacy and emergency pharmacy but all the staffs got
the chance of visiting the other pharmacy, i.e. there is a job rotation every 6 month period.
Almost all had been participated in one of job related trainings given such as basic ART training,
Drug Supply and Management, Procurement of Laboratory reagents and instruments, Food by
Prescription, IPLS, Challenges faced on adherence to ARV’s, Syndromatic approach to STI’s,
22
Logistic management system, Laboratory commodity, Standard based management (SBM) and
medical instrument maintenance and short courses on HAART.
23
Table 4.1 Level of Education, hospitals under AACAHB, May 2015
Levels of Education Frequency Percent Cumulative Percent
Degree 86 78.2 78.2
Diploma 24 21.8 100.0
Total 110 100.0
Majority of the respondents had been working in the hospitals at different positions, 39.2% has
an experience more than five years, while only 28.2% worked less than two years and the rest
has been working between two to five years.
Table 4.2 Experience of pharmacy staffs in the hospitals under AACAHB, May 2015
Experience in the hospital Frequency Percent Cumulative Percent
Less than 2 Years 31 28.2 28.2
2 to 5 Years 36 32.7 60.9
More than 5
43 39.1 100.0
Years
Total 110 100.0

The clinical services given in the hospitals include outpatient service, inpatient service,
emergency, dental service, radiology service, pathology service, ophthalmology, ENT,
researches, teaching, VCT, ART, TB clinic, Family planning, EPI delivery, pharmacy, laboratory
service, injection and wound care. The hospitals do have staffs comprised of specialist doctors,
general practitioners, nurses, health officers, pharmacists, druggists and other supporting staffs.
The study was particularly done in the pharmacy departments consisting of pharmacy team,
which has addressed a total of 110 staffs. Of the respondents 78.2% are degree holder while
21.8% have diploma, i.e out of which 86 are pharmacists, 24 druggists, and Zewditu Memorial
hospital being with the highest number. Except Gandhi memorial hospital, and Tirunesh
Beinjing hospital; with no private pharmacy; all hospitals have 5 pharmacies: Out-patient
pharmacy, In-patient pharmacy, Private pharmacy, Emergency pharmacy and ART pharmacy.
The qualification of the head pharmacist, procurement section and store manager are pharmacist,
in all of the hospitals.
24
Graph 4.2 Sum of qualification of pharmacy staffs available in each hospital under AACAHB,
May 2015
Table 4.3 Distribution of pharmacy staffs available in each hospital under the AACAHB, May
2015
Name of the Hospital Frequency Percent Cumulative

Of Pharmacy Percent
personnel
Gandhi Memorial
13 11.8 11.8
Hospital
Minilik II Hospital 20 18.2 30.0
Ras Deseta Hospital 16 14.5 44.5
25
Tirunesh Beinjing
17 15.5 60.0
Hospital
Yekatit 12 Hospital 21 19.1 79.1
Zewditu Memorial
23 20.9 100.0
Hospital
Total 110 100.0
4.1.4. Pharmaceutical Inventory Management

The Ethiopian Pharmaceutical Fund Supplies Agency (PFSA) is the sole supplier of all
pharmaceuticals and other medical products for the all facilities in the public health sector in the
country. Supply chain management practices correctly applied in public Health Institutions can
contribute greatly in maintaining the availability of essential drugs in public health institutions.
Efficient public health supply chain performance is essential for assuring access to health
supplies, and thus for positive health outcomes. This is particularly important in most countries
in sub- Saharan Africa where large proportion of the population is served by the public and
mission health sectors.
Hospitals under AACAHB claimed that on average they do provide service to about 350 to 500
patients per day. On the other hand, of the hospitals’ 2014 annual budget, about 15 to 20 percent
was allocated to pharmacy department which was only for the purchase of drugs and medical
supplies. Lyson and Farrington (2006) points out that supply chain management can be
summarized to mean the management of all activities, information, knowledge and financial
resources associated with the flow and transformation of goods and services up from raw-
materials suppliers, components suppliers, and other suppliers in such a way that the expectation
of the users and the organizations are met or surpassed.
The Practice of Purchasing in all hospitals is in line with the procedure manual of Government
proclamation No. 277/1994 to organize and control the purchase process. This Procurement
Procedure Manual has at its heart, the nationally and internationally accepted principles of
economy, quality, efficiency, fairness, transparency and accountability.
Even though there are different procurement methods stated and shall be employed in the
procurement of goods and services as may be appropriate, all hospital generally acquires supplies
and/or services purchased from local suppliers who are legal and capable of providing the
required supplies or services by the company. This is again possible only while the different
pharmaceuticals are first requested from PFSA, and if not available and approved by PFSA;
hospitals look for other suppliers. Much of the purchase is made using of pro-forma purchase for
least valued and repeatedly used items. It’s sated that stock items are purchased by means of
open tender every quarter or half a year as the case may be.
Hospitals under the study replied that quantification of pharmaceuticals and supplies is based on
consumption method, accounted 86.4%, and 13.6% of them said its combination. They
mentioned (84.5%) procurement is predominantly based on periodic technique and 15.5% of the
respondents claimed perpetual. Of the respondents who said periodic, 80.9% said every two
month, while 10.9% replied monthly, the rest 7.3% said any time when there is need. Direct
procurement is the main method followed by all hospitals, 88.2% as all are sourcing medications
and supplies from a sole provider of the country, a governmental agency called PFSA. However
there are times when items are not available and this time they said open tender is followed
which accounted for 11.8% of the response.
26
The purpose of an inventory control system is to inform personnel when and how much of a
pharmaceuticals to order and to maintain an appropriate stock level to meet the needs of patients.
A well designed and well operated inventory control system helps to prevent shortages,
oversupply, and expiry.
The inventory control system for the IPLS is a Forced Ordering Maximum/Minimum inventory
control system. This means that all facilities are required to report on a fixed schedule (monthly
at health posts, every other month at health centers and hospitals) for all products. About one
fourth of the respondents failed to put their minimum and maximum stock, while 82.5%
responded as; maximum months of stock is a four months and the minimum months of stock is
the level of stock at which actions to replenish inventory should occur under normal conditions
(two months).
Procurement is done primarily from pharmaceutical fund and supply agency (PFSA) using
Report and Requisition Form and also from other importer when not found and got approved
from PFSA. They all use direct procurement, 88.2% and open tender, 11.8%. Almost all
pharmacy departments claimed that the total budget allocated to them accounted about 15% to
20% of the total budget of the hospitals. But this budget according to the participants 81.8% was
not enough to fulfill the demand. These again resulted in frequent stock outs for many of the
drugs. Observation made during the study period showed that there were run of some essential
drugs from each category. Besides the procurement made, the hospitals also receive
pharmaceuticals and supplies donations through PFSA but initially the sources were Clinton
Foundation and USAID, and the usual supplies of donation included TB, ART and family
planning.
Generally, the SOP of IPLS states that the pharmacy store manager and pharmacy head in
collaboration with staffs in dispensing units will establish a re-supply schedule for the dispensing
units. For example, each dispensing unit will have one day per week/per 2 weeks designated for
re-supply. On that day, dispensing unit staff will complete an Internal Facility Report and
Resupply Form; the Pharmacy Store manager will use the information to determine the re-supply
quantity needed to serve clients until the next scheduled re-supply day. For example, every
Monday (on a weekly or twice monthly basis), the MCH service provider reports data to the
pharmacy store and receives enough product to serve clients during the week or next 2 weeks.
Though this system is supposed to ensures that the dispensing units are not overworked with
pharmaceuticals management responsibilities and that the quantities issued to the dispensing
units from the pharmacy stores reflect actual consumption by the clients, the researcher had
observed pharmaceutical items which were not available in dispensary while it exists in the store.
These were witnessed in three hospitals Ras Deseta, Yekatit 12 and Gandhi Memorial hospital.
4.1.5. IPLS Practice

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. To be successful, the system must fulfill the six rights of supply chain
management by ensuring the right products, in the right quantity, of the right quality, at the right
place, at the right time and for the right cost.
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. 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.
27
Different job related trainings were given to pharmacy staffs; about 82.7% but indicated that
43% of them didn’t take IPLS training. Among the respondents who took IPLS training, 52%
don’t believe that the training is sufficient to perform their IPLS tasks. Among the participants
60.9% of them had the procedure manual, while 39.1% don’t have it. The manual is intended to
simplify and standardize the work required for the logistics management of pharmaceuticals used
in public health facilities. It also serves as a reference for pharmacy and program staff and
service providers in facilities supplied by PFSA and for the administrative units that provide
management and supervisory support. The manual guides the staff in the completion of the
following tasks:
o Recording and reporting on stock levels and usage of pharmaceuticals.
o Ordering pharmaceuticals from PFSA
o Receiving and storing pharmaceuticals
o Issuing pharmaceuticals between and within facilities
o Maintaining adequate amount of pharmaceuticals
At all times each pharmacy had 2 pharmacists and 1 or 2 druggists giving service as per the
national guideline. Data clerk is only available to the sub department, ART pharmacy and all
don’t have. Practitioner students do also have roles in assisting pharmacy staffs while they
practice in the hospital pharmacies. The Addis Ababa health bureau states that the hospital’s
pharmacy department has a mission of giving fast and full services to their patients while the
vision of the pharmacy department is to establish a strong and active DTC and DIC for the
hospital and aspire to change the dispensary units to a standard type. However among the
respondents 34.5% don’t know whether the pharmacy department has its own mission and
vision.
28
Graph 4.3 Pharmacy staffs who took IPLS training and who didn’t, hospitals under AACAHB,
May 2015
All hospitals established DTC but mentioned that it isn’t functional. Among the participants 94%
don’t have EDL at hand, however replied that selection of pharmaceuticals are limited to EDL.
The drug selection is done by the purchaser based on the request made from the store. All
hospitals reflected that they use the EDL and the consumption data to select and quantify drugs.
However the application of IPLS is not given a due consideration in all hospitals, 13.5% of the
respondents don’t know that IPLS is an important tool in pharmaceutical quantification, while 15
participants said that selection, quantification and procurement of pharmaceuticals is need based.
In all hospitals most of the medications are generic products, but still found to contain few brand
too. Of all the respondents only 56.4% had taken IPLS training, while 38% read the manual and
the rest 9.1% were assisted by a colleague. However, only 22.7% felt very confident, 19.1%
confident to perform their tasks in the IPLS, while 32.7% were somehow confident and about
25.4% were not at all confident.
29
Graph 4.4 Pharmacy staffs confidence level to perform IPLS tasks, hospitals under AACAHB,
May 2015
Among the choices given, participants mentioned different advantages of IPLS of which74%
facility controls quantity ordered, 63% facility controls how funds are spent, 47% one formula
for all systems, 59% clearer documentation of procedures, 87% helps to decide how much to
order, 48% eliminate separate orders for FP, STI, Malaria, etc. However majority of the
participants were also responded more than two of the disadvantages, as shown in the following
graph.
30
Graph 4.5 Disadvantages mentioned about IPLS, hospitals under Addis AACAHB, May 2015
They all indicated that they weren’t provided with any written job description but enumerate
their responsibilities to be;
 Dispensing
 ART dispensing and counseling
 Maintain patient confidentiality
 Managing expired and damaged products
 Make sure medical products are stored appropriately and securely to ensure freshness and
potency
 Controlling incoming and outgoing drugs
 Extemporaneous compounding of medications
 Undertaking procurement of drugs
 Respond to medication related queries from physicians
 Patient oriented pharmacy practice
 Assisting hospital members with their request, good quality assurance and drug supply
management
Since they all have rotations every 6 month they have all at some time practiced the above
mentioned. They mainly interacted with the prescribers on issues related to dose adjustment,
31
inappropriate drug administration that needs change to different drug, drug concomitant
administration and drug-drug interaction issues. Most of them are not all aware of the
pharmacies vision, mission and objective, which comprised of 34.5%. They all indicated that,
there is lack of enough staff, lack of dispensing area, and the large amount of patient flow,
shortage of medication and salary is not attractive. And they all shared some recommendations
for the betterment of the pharmaceutical service provided in their hospital. These include,
 A better pharmacy dispensing stores, enlarge the store and the dispensing area
 Better software technologies and room temperature monitor
 Capacity building of health professionals
 Increasing the supply of drugs to the hospital
 Giving trainings regularly for pharmacy professionals
 Active DTC Committee
 Increase the one-to-one interaction of patient with health care professional and also
between professionals
 Increase the number of pharmacy personnel
 Create incentives for the pharmacy personnel such as increasing the salary scale
 Increase the budget allocated to the pharmacy sector
 Help the society increase awareness on health issues
4.1.6. Recording and Storage of Pharmaceuticals in the IPLS

Storing is the safe keeping of pharmaceuticals to avoid damage, expiry, and theft. Proper storage
procedures help to ensure that storage facilities protect the shelf life of products, that only high-
quality products are issued, and that there is little or no waste due to damaged or expired
products. If proper storage procedures are followed, customers can be assured that they have
received a high quality product.
Stock control, otherwise known as inventory control, is used to show how much stock one has at
any one time, and how to keep track of it. It applies to every item used to produce a product or
service from raw material to finished goods. It covers stock at every state of the production
process, from purchase and delivery to using and reordering the stock. Efficient stock control
allows one to have the right amount of stock in the right place at the right time.
There are only three activities that happen to pharmaceuticals within a logistics system: they are
stored in inventory, moved between facilities, and used to provide health services to patients. A
well-designed logistics management information system will include records and forms that
collect and report the three essential data items as they relate to these three activities. Of the
participants who were asked to choose among the essential data items that is required to run the
logistic system and which must be captured by LMIS, only 39.1% said all, while 15.4% stock on
hand, 29.1% consumption data, and the remaining 16.4% losses/ adjustments.
32
Graph 4.6 Essential data that are required to run logistics system and must be captured by LMIS,
hospitals under AACAHB, 2015
Inventory management is influenced by the nature of demand including whether demand is

derived or independent. Inventory levels are affected by customer service expectations, demand
uncertainty, and the flexibility of the supply chain (Ballou,2004).
All except Tirunesh Beinging, hospital have two stores, a main store for pharmaceuticals and
another store for supplies. Both stores are separated from the dispensary areas. No one of the
hospitals treat expired drugs, supplies and useless medical equipment separately. Storage
conditions will affect the quality of the pharmaceuticals being stored. Rooms that are too hot,
stacks of cartons that are too high, and other poor storage conditions can cause damage or cause
a reduction in shelf life. A well-organized storeroom will simplify a facility’s work; time will not
be wasted trying to find needed supplies.
Facility pharmacy Store improvement is among the major IPLS related pharmaceuticals
management improvement initiatives. Major steps involved are de junking, logical organization
and arrangement following “good pharmaceutical storage practices” and “overall
pharmaceuticals management efficiency”.
Here, Zewditu Memorial hospital and Ras Desta Damtew hospital have established a store which
is large enough to keep all the supplies in good condition. On the other hand, all hospitals’
33
pharmacy store, showed that the door of the store have a lock and are kept locked at all times
when not in use. Regarding the structure of the store, only the two hospitals mentioned above are
in good condition, there are no cracks, holes or signs of water drainage. The windows are painted
white, have curtains, are secured and have grills. The store also has a ceiling in good condition
even though the height is not as specified in the standard. Air moves freely, it is well ventilated.
In all the hospitals, the researcher has observed that’s shelves are dusted, floors are swept, walls
are clean and supplies are stored neatly on the shelves. The store has no pests. Shelves and boxes
are raised off the floor, on pallets. Narcotic and Psychotropic drugs are locked within the store in
a separate shelf. The hospitals in general have a backup generator.
Tirunesh Beinjing hospital is the only hospital with one store where within the main store there
are three separated rooms, for ART drugs, drips and dressing materials and a room for laboratory
reagents and toxic chemicals. All hospitals’ pharmacy showed that items in the store are stored in
groups (internals, externals and injectable). Supplies however are not arranged in alphabetical
order by generic name. Items are ordered using FEFO, items with shorter expiry are placed in
front and supplies with no expiry are stored in the order received. Expired items are kept in a
separated room; however, stores in the three hospitals, Gandhi Memorial, Yekatit 12, and Minilik
II hospital are found stored expired items in the same room. For some items, all hospitals got
overstock and even there were items stocked for a long period of time, more than 5 years. The
researcher noticed that, almost all of the pharmacies didn’t use IPLS. There was workload and
didn’t give prescribers the supplementary information when the drugs are about to expire, and
there is no consumption follow up. On the other hand, each of the hospitals is well following
IPLS procedure particularly in ART supplies and medication. They all have a supporting clerk to
this particular sub department and that’s because of the funds gotten from NGO. And this is also
the major obstacle stated by respondents to exercise IPLS. This has resulted in a gap with the
management of supplies and medications, forecasting system and under stock or overstock of
some items.
On the other hand, the supplies store relatively is not given attention as compared to the drug;
this was particularly noticed in Gandhi Memorial hospital, Yekatit 12 and Minilik II hospital.
Their store is not enough to accommodate all supplies and beside this it is not well ventilated and
clean. The items are placed one on top of the other. No order is followed; everything is just kept
as suitable. Zewditu Memorial and Yekatit 12 hospital, specifically have supply store with no
window, have no ventilation and not painted white. Pests are there.
Bin Cards and Stock Record Cards are used to account for products held in storage, including
their receipt and issue. In the IPLS valuable information used to make re-supply decisions is
recorded on the Bin Card and Stock Record Card; data from these records are used in reporting,
calculating reorder quantities and for monitoring stock levels. All hospitals observed had an
updated Bin Cards and Stock Record Cards, with the exception of Gandhi Memorial hospital
where it was not up to dated.
4.1.7. Dispensing area and procedures

On average, at all dispensing units of each hospital at least 2 pharmacists and a druggist were on
duty. To the dispensing units, drugs and supplies are brought to each pharmacy every week.
Expired drugs were not stored at the dispensing units. During the study, EDL and a formulary
manual were not available at three hospitals, Gandhi Memorial, Tirunesh Beinjing and Yekatit
12. Relatively the dispensers check the appropriateness of the prescription for the patient. The
dispensers label the packages with date, name of item, quantity dispensed and written
instructions for the patient but didn’t label the patient name. The dispenser before dispensing
34
opens the container and checks quality and puts the right amount of the quantity prescribed. The
dispenser shows or tells the patient how to prepare and take the dose but failed to tell the name of
the medication, the use of the medication and failed to inform the patient to keep the drug out of
reach of children.
Drugs in all pharmacies are pharmacologically ordered. Pharmacy rooms except ART pharmacy,
in all the hospitals are not to the standard. ART pharmacy is different from others in that it is well
managed and where IPLS is practically showed. The pharmacy is separated from the other
pharmacy, and it is very wide, not crowded, very clean and well ventilated. It is very comfortable
for counseling. On the other hand, emergency pharmacy found in all hospitals is very narrow and
is run by single pharmacy personnel (whoever is on duty). All the drugs are just placed, no order
is followed.
4.1.8. Key Drugs availability

World Health Organization defines essential drugs (medicines) as those that meet the priority
health care needs of the population, carefully and systematically selected using evidence based
process. Regard is given to public health relevance, clear evidence on efficiency and safety and
comparative cost effectiveness. These drugs are meant to be always available in a functioning
health care system in adequate amounts, appropriate dosage forms with assured quality and
adequate information. The provision of complete health care necessitates the availability of safe,
effective and affordable drugs and related supplies of the required quality, in adequate quantity at
all times. Despite this fact, in the past, the pharmaceutical supply chain management system of
the country had several problems including non-availability, un-affordability, poor storage and
stock management and irrational use. No one of the hospitals had its own drug list, however
among the hospitals all had identified having the listed key drugs, and 100% were available
during the visit with some drugs missed in the category.
Table 4.4 List of top ten diseases of hospitals under AACAHB with their key drugs
Types of diseases Key drugs to treat the important disease
Other diseases of the urinary system Norfloxacin, Ciprofloxacin
Other acute upper respiratory infections Amoxacillin,Doxycyclin, Augmentin
Other diseases of the musculoskeletal system Methylsalicillate, Diclofenac, Ibuprofen,
and connective tissue Tramadol
Diabetes mellitus Metformin, Glibenclamide, Insulin Injection
Typhoid and paratyphoid Ciprofloxacin, Doxycycline
Rheumatoid arthritis and other inflammatory Ibuprofen, Diclofenac, Indomethacin
poly-arthropathies
Gastritis and duodenal ulcer Omperazole
Other intestinal infectious diseases Tinidazole, Albendazole, Mebendazole
Essential(primary) hypertension Enalapril,
Pain, (mild to moderate) Tramadol, Diclofenac, Pethidine
Source: www.moh.gov.et
4.2. Discussion
Addis Ababa Regional Health Bureau is responsible to administer and watch the six hospitals
being the owner in the regional administration. Though all hospitals had informed that they own
35
DTC, it was found to be non-active and due to this drug selection, quantification and
procurement are dealt by the head pharmacist and the purchaser pharmacist. This practice may
result in excess or shortage of some products. The involvement of the DTC could help tackle this
problem. For many developing countries 30 – 40% of the total hospitals budget is allocated to
the pharmacy department. In average, hospitals under Addis Ababa Regional Health Bureau,
allocated about 15% to 20 % of 2014 budget for the purchase of pharmaceuticals and supplies,
which didn’t include the purchase of medical equipment. All pharmacies emphasized that the
budget is not enough for the provision of all the patients demand and procure all drug and
supplies needed by the hospitals. Here it’s clear that the involvement of the DTC and the use of
the hospitals EDL could help in using the budget allocated wisely and efficiently to at least try to
serve the patients need with the available resource. The findings of the study indicated that all
workers tremendously prefer the IPLS to the former vertical system. Only 3 of 110 respondents
did not prefer the IPLS. Nearly 41.8% of the respondents additionally noted that they felt
confident in their ability to implement their IPLS duties. The rest responded, however, that they
faced some challenges in completing the report and request (R&R) form.
The supply stores were not of the standard, except Zewditu Memorial hospital and Ras Deseta
Dametew hospital. The dispensary areas except ART pharmacy, all were not of the standard type.
They were narrow; there were no enough shelves available, not well ventilated and hadn't
enough windows for service. The standard set by FMHACA is that the area of the dispensaries is
to be a minimum of 25 sq. meters (FMHACA, 2001). On the other hand, dispensing area of ART
pharmacy is well ventilated and is also comfortable for counseling and/or maintaining
confidentiality. Hospitals can consider the ART pharmacy as the bench mark and plan to build
the others dispensing areas in the same way. All hospitals had high patient load and not enough
windows for service and so this affects their counseling or dispensing practice. On the other
hand, respondents in all hospitals are hoping to give the standard service with a standard
infrastructure while the new building starts functioning. The researcher has noticed that all
hospitals are under expansion by building new rooms to a seven stair building.
All hospital except Tirunesh Beinjing has two stores, a main store and supply store. Gandhi
Memorial hospital’s store which provides accommodations to supplies is very narrow, there are
no enough shelves to keep the medicine and some of the drugs were kept in the floor with-out
pallet, not well ventilated, the window was not painted. Both the stores of Gandhi Memorial
hospital and Minilik hospital were not of the standards set by the FMHACA where the required
height of the wall to be 3 meters. Laboratory reagents, chemical and toxic substance were not
separated in Gandhi Memorial, Ras Desta Damtew and Tirunesh Beinjing hospitals. The
refrigerators were all working and temperature regulated. Controlled substances where kept in a
locked cabinet as stated clearly by WHO. The minimum and maximum stock level for the
hospitals is 2 and 4 months respectively for the items received from PFSA. However, all
hospitals showed up with overstocks, stocks handled for a long period of time and out of stocks.
All the drugs dispensed to the patient had the drug name, this was because majority of the drugs
were pre packed and for the rest, they packed with plastic bags in the dispensary, the pharmacy
personnel always labeled it with the drug name, 100%. Again 100% of them labeled with full
dosage schedule and none of the drug packs were labeled with patient name even if the WHO
and FMHACA minimum standard for hospital suggest patient name as one requirement of
labeling
None of the hospitals had its own drug list; however, all of the drugs identified as key drugs were
available at the store during the study period. The WHO recommended value for the availability
36
of EDL and key drugs are 100%, which is indicating that all hospitals are in line with the WHO
recommended value.
Most of the pharmacy personnel were not satisfied by the service they provide due to the
unfavorable work condition, patient load and lack of incentive. They were not provided with
written job description and some were not even aware of the pharmacies mission and vision.
Despite this they were all dedicated and hardworking. Providing job description and creating
incentives would further initiate their pharmacy staffs.
CHAPTER FIVE
MAJOR FINDINGS AND RECOMMENDATIONS

5.1. Major Findings
With regard to pharmaceuticals and supply management, PFSA has set a system called IPLS
which helps to have good cordial working relations with the agency. Findings from this study
indicate that the respondents generally agreed on the role of IPLS as inevitable. However there
had been knowledge gap on how to practice the system. They all hadn’t taken trainings regarding
the system or taken refreshment on how to exercise the system. The system evolve e-
procurement to change the cost of preparation and transmission of paper purchase requests and
invoices and thus eliminating costly, time consuming errors from manual data entry. On the other
hand the absence of data clerk in pharmacy department of all hospitals had imposed an obstacle
in data capturing process and input to IPLS. This was well comprehended and demonstrated in
the ART pharmacy where there is a data clerk hired and accountable to NGO, partner institutions.
All pharmacy departments had not own mission, vision and objective and or otherwise were not
aware of. The hospitals also hadn’t their own EDL and there were at least two pharmacists
working in collaboration with a druggist at a time as recommended by the BPR. Despite the fact
that all hospitals claimed to have DTC, none was active. IPLS is somehow implemented to the
hospitals though the training given was not enough.
The stock-out rate under the IPLS is supposed to be good enough than that of the vertical system
for each program. The agency claimed that the system provides direct delivery of
pharmaceuticals from PFSA to hospitals by which minimizing the lead time and hence the stock-
out rate at health facilities. However on the day of the visit, for some items stock-out was
observed in each hospital. One advantage of the system mentioned by the participants was given
that the IPLS transfers responsibility for ordering to the facility (moving from a push to a pull
system for at least essential drugs), this result is an excellent achievement in terms of IPLS
performance. Quantification is made based on consumption while purchase of medications and
supplies is made every two months. Majority of the pharmacy personnel are dissatisfied with the
service they provide. There is high patient overload which is not balanced with the pharmacy
personnel available and this has resulted in dissatisfaction of the service they provide to their
patients. Another major area that has resulted in dissatisfaction of their job is the narrow
dispensing area which resulted in suffocation in the room.
37
5.2. Recommendations
Based on the analysis and the findings, the following are recommended to help improve
pharmaceutical inventory management and IPLS practice of the respective hospitals. The
pharmacy department shall follow the SOP on IPLS and give attention on supervision of IPLS
practice, capacity building, including refreshment trainings in collaboration with other partners
like PFSA. Dispensing procedure shall be in accordance with standard to promote rational use of
drugs to patients. On the other hand to reduce the number of stock keeping units (SKUs) on
LMIS reports, and to guide procurement decisions that are based on funds availability; prioritize
essential medicines, based on criteria such as vital, essential, non-essential (VEN) analysis, and
ABC (most valuable or fast moving versus least valuable or slow moving) categorization. The
DTC should be reorganized and strengthened to start playing its role like drug selection. The
pharmacy department shall communicate with other responsible departments like finance and
management to address the issue regarding budget, pharmacy staff as per the BPR. The
department shall expedite items which have been stored for a long period of time and improve in
the forecasting system, propose an urgent solution to items which has been in the store more than
5 years; properly use, transfer to other hospitals or seek other means to avoid it. To streamline
management of the hundreds of different health commodities, pharmacists must be supported
with data clerk to capture the appropriate inventory parameters as it witnessed in ART pharmacy
REFERENCES
Wiedenmayer K, Summers RS, Mackie CA, Gous AG, Everard M (2008). Developing Pharmacy
Practice: A focus on Patient Care. World Health Organization and International Pharmaceutical
Federation, Switzerland.
Ilma Nurul Rachmania*, Mursyid Hasan Basri, 2013, Pharmaceutical Inventory Management
Issues in Hospital Supply Chains, Bandung, Indonesia
The Federal Democratic Republic of Ethiopia Pharmaceuticals Fund and Supply Agency, March
2013, Standard Operating Procedures Manual for Pharmaceuticals Logistics System, Addis
Ababa
Food, medicine and healthcare administration and control authority of Ethiopia. “Medicines
Waste Management and Disposal Directive No. 2/2011”.2011.
38
Lysons K. and Farrington B. (2006): Purchasing and Supply Chain Management, Pearson
Educational Limited (Allain L, Goentzel J, Bates J, Durgavich J. Reengineering Public
Health Supply Chains for Improved Performance: Guide for Applying Supply Chain
Segmentation Framework. Arlington: USAID | DELIVER PROJECT, Task Order 1; 2010.
Fiscella K (2003). Assessing Health Care Quality for Minority and Other Disparity
Populations.Agency for Healthcare Research and Quality Rockville, Maryland.
USAID | DELIVER PROJECT.The Logistics Handbook: A Practical Guide for the Supply Chain
Management of Health Commodities. Second Edition.Arlington; 2011.
Ballou, R. A. (2004). Business Logistics Management. NJ: Prentice-Hall, Englewood Cliffs.
Lamichhane JR, Shakya HS. Nepal: Scaling Up an Integrated Health Logistics System (Case
Study). Boston: John Snow, Inc; 2008.
DELIVER. 2003. Malawi: Health Commodities Logistics Management System Procedures

Manual. Arlington, Va.: John Snow, Inc./DELIVER, for the U.S. Agency for International
Development.
Asante, F., and Aikins, M.(2008). Does the NHIS cover the poor? Institute of Statistical Social
and Economic Research and School of Public Health at the University of Ghana, with support
from the Danida Health Sector Support Office
Malawi Ministry of Health. 2013. LMIS Reporting Scorecard – December 2012. Lilongwe:
Malawi Ministry of Health.
Beyene W, Jira C, Sudhakar M. Assessment of Quality of Health Care in Jimma Zone, Southwest
Ethiopia. Ethiop J Health Sci. 2011 August; 21(Suppl 1): 49-58.
Aronovich, D, Marie T, Ethan C, Adriano S and Linda A.( 2010). Measuring Supply Chain
Performance: A Guide to Key Performance Indicators for Public Health Managers. Arlington,
Va.: USAID |DELIVER PROJECT,
39
APPENDICES
40
Annex I
Questionnaires
ADDIS ABABA UNIVERSITY
COLLEGE OF BUSINESS AND ECONOMICS
SCHOOL OF COMMERCE
DEPARTMENT OF LOGISTICS AND SUPPLY CHAIN MANAGEMENT
Dear respondents,
In partial fulfillment of requirements for the degree of Masters of Arts (Logistics and Supply
Chain Management), at AAUSC, I am carrying out a study which aims at assessing the role of
Integrated Pharmaceutical Logistics System (IPLS) on Drug Supply Management in hospitals
under Addis Ababa Regional Health Bureau.
The study is entirely academic and the information provided shall be treated with utmost
confidentiality and all your answers will be anonymous. You are therefore requested a kind
cooperation in answering the questions as truthfully as possible. I would like to appreciate your
assistance and support in this particular research endeavor.
For other questions pertaining to this study, please contact Addis Ababa University, college of
business and economics; school of commerce.
Thank you very much for your cooperation.

Part I. General information
1. Name of the hospital ______________________________
2. Are you, Pharmacist ______ druggist ___________
3. Level of education
a. Postgraduate b. Degree holder
c. Diploma holder c. certificate
4. Your experience in the hospital?
a. Less than 2 years b.2 to 5 years c. More than 5 years
5. Qualification of head pharmacist? ______________________________
6. Qualification of the store keeper? ______________________________
7. Qualification of the procurement section? _______________________
8. Does the pharmacy department have its own DATA clerk and other supporting staffs?
Yes _________NO___________
9. Does the pharmacy department have its own mission, vision and objectives?
Yes___________ No________
10. Do you think budget to the pharmacy department it is sufficient?
Yes___________ No________
No Part II: socio demographic characteristics

1 Gender M F
2 Age ________
3 Experience in the hospital (year)______________
41
4 What is the Highest Education Level you completed? _________________________
5 Job position/Title at Current Job: ____________________________________________
Part III: professional information

3.1 Which sub-department in the pharmacy are you currently working?
_______________________________
3.2 Job related trainings you have taken till?

__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
_________________________________________________________________________
3.3 Have you provided with written job description in the hospital? Yes No
3.4 Do you think these roles and responsibilities are exhaustive Yes No If no go
(enough)? to #3.5
3.5 If no, what additional roles and responsibilities can be included?

-
-
-
-
-
-
-
3.6 Did you perform all roles and responsibilities stated in your job Yes No If no go
description? to 3.7
3.7 If no, which roles you are not performing? Why?

__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
_________________________________________________________________________
3.8 If your answer for number 3.6 is no what roles and responsibilities are you performing at the
facility?
-
-
-
-
-
3.9 How often do you check the appropriateness of prescription for drug indication, dose, and
duration of therapy and drug interactions?
42
□Always
□ Sometimes
□ Never
Which of the following interventions do you routinely perform through interacting with
prescribers?
□ Dose adjustment
□ Change dosage form
□ Inappropriate drug for the condition that needs change to a different drug
□Others[PleaseSpecify]
__________________________________________________________________________
__________________________________________________________________________
□None
3.10 How often do you counsel all patients coming to your pharmacy?
□Always
□Sometimes
□ Never
3.11 If your answer for question no. 3.10 is Always or Sometimes, where do you counsel them?
□Special counseling area
□ Pharmacy counter (or window)
□ Others [Please Specify] __________________________________
3.12 Do you have good professional relationship with the prescribers and Yes No
other health personnel? If no why and what are the barriers?
______________________________________________________
______________________________________________________
________________________________________
3.13 For which of the following do the prescribers contact you routinely regarding information?
□Dosage form □Dose Strength
□Dosage interval □Duration of use
□Drug interaction □Adverse drug reactions
□ Contraindications □Never contacted
3.14 Are you satisfied with the quality of service you provide to patients? Yes No
3.15 Are you satisfied with your job? Yes No
3.16 If your answer to question no.3.14 and 3.15 is No, what is/are the reason/s for your
dissatisfaction?
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
3.16 What is your recommendation to improve the quality of pharmaceutical care in your hospital
and generally in all health settings?
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
43
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
44
A. Selection, Quantification and Procurement of pharmaceuticals
No Questions Yes No I don’t know

1. Were you trained in IPLS?
2. If Yes, was the training sufficient to allow you to perform your IPLS
tasks?
3. Do you have a copy of the IPLS procedures manual?
4. Do you prefer IPLS to the former vertical system for each program?
5. Does the hospital have DTC?
6. Do you have Ethiopian essential drug list at hand?
7. Do you have the “sales invoice” for the most recent orders?
8. Is selection of pharmaceuticals limited to EDL?
9. Is the procurement done by generic name?
10 Is there established procedure for placing emergency/ interim orders?

.
11 Are there any stock keeping (bin card/ stock card/ stock register or
. inventory control card)?
12 Is IPLS an important tool in pharmaceutical quantification?

.
13 Selection, Quantification and Procurement of pharmaceuticals is need

. based and the role of IPLS is not clear.
B. Storage
1. How many stores do you have? _____________
2. Do you do physical count for inventory control? (if no go to No 4)
Yes _______ No _______
3. Is physical count made at regular intervals?
Yes _____ No______
4. When do you do the count?
__________________________________________________________________
5. What is your minimum stock and maximum stock?
__________________________________________________________________
C. Dispensing
45
1. Do you have formulary or EDL at hand?
Yes__________ No__________
2. Did you have training on rational drug use?
Yes ___________ No ____________
3. On average how many patients do you serve per day?
_________________
4. Do you label the drug when you dispense to your patient?
Yes ________ No __________
5. If the answer for No 4 is no, what do you do?
_____________________________________________________________________
_____________________________________________________________________
_____________________________________________________________________
6. Do you store expired and damaged drug in the dispensary?
Yes _________ No_________
7. If the answer to No 6 is no where do you put the expired drug?
________________________________________________________________
D. Knowledge
a.i.1. What do you think are the advantages of the IPLS? (You can choose more than one)
a. Facility controls quantity ordered
b. Facility controls how funds are spent
c. One formula for all systems
d. Clearer documentation of procedures
e. Helps to decide how much to order
f. Eliminate separate orders for FP, STI, Malaria, etc
g. Other, specify ____________________________________________________
____________________________________________________
a.i.2. What do you think are the disadvantages of the IPLS?
a. Too much work for facility staffs
b. Time table too rigid
c. No buffer stock kept
d. More costly than previous system
e. Too much paper work
f. More stock-outs
g. Other, specify ____________________________________________________
____________________________________________________
a.i.3. How did you primarily learn how to do the activities in the IPLS?
a.i.3.a. Read the manual on my own
a.i.3.b. Other trained person (still here) from this facility trained me
a.i.3.c. Other trained person ( not still here) from this facility trained me
a.i.3.d. Supervisor
a.i.3.e. No I don’t know it
a.i.3.f. Other
a.i.4. How confident do you feel that you can perform your tasks in the IPLS?
a.i.4.a. Very confident
a.i.4.b. Confident
46
a.i.4.c. Somehow confident
a.i.4.d. Not at all confident
a.i.4.e. No I don’t know it
a.i.5. Which of the following essential data is required to run logistic system and must be
captured by LMIS?
a. Stock on hand
b. Consumption data
c. Losses/ Adjustment
d. All
a.i.6. On what basis do you quantify drugs (method used)?
a. Consumption method b. Morbidity method
c. Adjusted Consumption method d. Combination e. Other
a.i.7. Which procurement technique do you follow?
a. Periodic b. Perpetual c. Alternative d. Other
a.i.8. If periodic, at what interval?
a. Monthly b. Quarterly c. Annually d. Other
a.i.9. Which procurement method is used for most of the drug products?
a. Open tender b. Restricted tender
c. Competitive negotiation d. Direct procurement e. Combination
E. Dispensing Procedures
How are supplies dispensed at your health care facility? Tick (√) the YES box if the statement is
true. If not, tick NO.
No Storage procedure Yes No I don’t know

1 At the beginning of the day or session, a pharmacist/druggist
. issues all items needed from the store to the appropriate
dispensing area.
The dispenser checks that the prescription is appropriate for the
patient.
The dispenser collects a container of the prescribed item and
checks its expiry date.
The dispenser labels the package with the patient's name, date,
name of the item, quantity dispensed, and written instructions
for the patient.
The dispenser opens the container and checks the quality of its
contents.
Controlled substances are kept separate in a double-locked
storage space.
The dispenser puts the correct amount of the medicine in the
package.
The dispenser gives the package to the patient and tells him/her
the name of the medicine, what the medicine is for, and dosage.
47
The dispenser shows or tells the patient how to prepare and take
the dose.
The dispenser asks the patient to repeat the instructions.
The dispenser tells the patient to keep all medicine and medical
supplies in a safe place at home, and out of the reach of
children.
Thank you!
Observation Check list

A. Storage Practice
1.Name of the hospital ______________________________
2.Total No. of pharmacy personnel ________________
3.What is the total budget of the hospital and to the pharmacy department?
_______________________ and _______________________
No Physical conditions Yes No
1 Is the store separated from the dispensary; medicines are not dispensed to
patients from the store?
2 Is the store large enough to keep all of the supplies?
3 The door to the store has lock
4 The store is kept locked at all times when not in use.
5 The store structure is in good condition; there are no cracks, holes or signs
of water damage.
6 There is a ceiling in the store; the ceiling is in good condition.
7 Air moves freely in the store; fans and screens are in good condition.
8 The windows are painted white or have curtains; windows are secured and
have grills.
9 The store is free of pests; there are no signs of pest infestations.
10 The store is tidy; shelves are dusted, floor is swept, and walls are clean.
11 Supplies are stored neatly on shelves or in boxes.
12 Shelves and boxes are raised off the floor, on pallets or on boards and
bricks.
13 The refrigerator is in good condition; there is no staff food in the
refrigerator
14 If the electric system discontinued, do you have any backup system for
storage of cold chain product?
15 Store for toxic chemicals, diagnostic, reagents and inflammable products
is separated
B. Storage Procedures
No Storage procedure Yes No
48
1 They use stock keeping records, (bin card/ stock card/ stock register or
inventory control card).
2 Stock keeping records are up-to-date.
3 Supplies are shelved in groups: externals, internals and injectable
4 Tablets, capsules and other dry medicines (such as ORS packets) are
stored in airtight containers on the upper shelves
5 Liquids, ointments and injectable are stored on the middle shelves.
6 Supplies, such as surgical items, condoms and labels, are stored on the
bottom shelves.
7 Cold-chain items are stored in the refrigerator
8 Controlled substances are kept separate in a double-locked storage
space.
9 Supplies are arranged on the shelves in alphabetical order by generic
name.
10 Items are grouped in amounts that are easy to count
11 There are no expired items in the store
12 Items with shorter expiry dates are placed in front of those with later
expiry dates.
13 For items with the same expiry date, newly received items are placed
behind those already on the shelves.
14 Supplies with no expiry or manufacture date are stored in the order
received.
15 Supplies with no expiry date but with a manufacture date are placed
with
later dates behind shorter dates
16 There are no overstocked or no longer used items on the shelves
17 There is a record of the removal of items; the record includes date,
time, witness and reason of removal.
C. Key drugs availability
No Types of diseases Key drugs to treat the important In the stock

disease (0/1)*
1 Other diseases of the urinary Norfloxacin, Ciprofloxacin
system
2 Other acute upper respiratory Amoxacillin, Doxycyclin, Augmentin
infections
3 Other diseases of the Methylsalicillate, Diclofenac,
musculoskeletal system and Ibuprofen, Tramadol
connective tissue
4 Diabetes mellitus Metformin, Glibenclamide, Insulin
Injection
5 Typhoid and paratyphoid Ciprofloxacin, Doxycycline
6 Rheumatoid arthritis and other Ibuprofen, Diclofenac, Indomethacin
inflammatory poly-arthropathies
7 Gastritis and duodenal ulcer Omperazole,
49
8 Other intestinal infectious Tinidazole, Albendazole, Mebendazole
diseases
9 Essential(primary) hypertension Enalapril,
10 Pain, (mild to moderate) Tramadol, Diclofenac, Pethidine
* 0=No 1=Yes
Percentage of key drugs available= ____________________________
% of key drugs available = # of key drugs available at store X 100
Total number of key drugs
Thank you!!
50

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Addis Ababa University

College of Business and Economics

An assessment on the Role of Integrated Pharmaceutical

By: GETACHEW KASSA

“An Assessment on The Role of Integrated Pharmaceutical Logistics

In Partial Fulfillment of the Requirements for MA Degree,

By: GETACHEW KASSA

Approved by Board of examiners

Abebe Ejigu (PhD)

Table 4.1 Level of Education, hospitals under AARHB, May 2015………….............................22

Key Words: Pharmacy service, IPLS procedure, FMHACA hospital requirements.

1.2. Back ground of the organization

1.4. Objectives of the study

1.5. Research Questions

1.6. Significance of Study

1.7. Limitation of Study

1.9. Organization of the Study

2.2. General overview of IPLS

2.2.1. Overview to basic components of IPLS at health facility

2.2.2. Recording system in IPLS

2.2.3. When to Assess Stock Status

2.2.4. Issuing pharmaceuticals

2.2.5. Issuing Pharmaceuticals within Health Centers and Hospitals

2.2.6. Receiving pharmaceuticals from PFSA

3.2. Study Design

3.3. Sampling methods

3.4. Data Collection Tools and Procedures

3.5. Data analysis and presentation

4.1.1. General organization of Hospitals under Addis Ababa City Administration

4.1.2. Pharmaceutical supplies

Source: Survey of May, 2015

Name of the Hospital Frequency Percent Cumulative

4.1.4. Pharmaceutical Inventory Management

4.1.5. IPLS Practice

4.1.6. Recording and Storage of Pharmaceuticals in the IPLS

Inventory management is influenced by the nature of demand including whether demand is

4.1.7. Dispensing area and procedures

4.1.8. Key Drugs availability

MAJOR FINDINGS AND RECOMMENDATIONS

Ballou, R. A. (2004). Business Logistics Management. NJ: Prentice-Hall, Englewood Cliffs.

DELIVER. 2003. Malawi: Health Commodities Logistics Management System Procedures

Thank you very much for your cooperation.

No Part II: socio demographic characteristics

3 Experience in the hospital (year)______________

5 Job position/Title at Current Job: ____________________________________________

Part III: professional information

3.2 Job related trainings you have taken till?

3.5 If no, what additional roles and responsibilities can be included?

3.7 If no, which roles you are not performing? Why?

No Questions Yes No I don’t know

5. Does the hospital have DTC?

6. Do you have Ethiopian essential drug list at hand?

8. Is selection of pharmaceuticals limited to EDL?

9. Is the procurement done by generic name?

10 Is there established procedure for placing emergency/ interim orders?

12 Is IPLS an important tool in pharmaceutical quantification?

13 Selection, Quantification and Procurement of pharmaceuticals is need

No Storage procedure Yes No I don’t know

Observation Check list

No Storage procedure Yes No

No Types of diseases Key drugs to treat the important In the stock

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