UNIVERSITY OF GONDAR COLLEGE OF MEDICNE AND HEALTH SCINCE

DEPARTMENT OF SOCAIL AND ADMINSTRATIVE PHARMACY

SCHOOL OF PHARMACY
SOCIAL AND ADMINISTRATIVE PHARMACY DEPARTMENT

SUBMITTED BY: BINIYAM TADELE

EMAIL: biniyamtadele54@gmail.com

PRINCIPAL ADVISOR: Alem Endeshaw (Assistance Professor)

TO ASSESs PHARMACEUTICAL LOGISTICS MANAGMENT ACTIVITES IN TIBEBE

GIYON HOSPITAL USING SWOT ANALYSIS MATRIX.
Acknowledgements
I would like to express my deep gratitude to the colleagues at Tibebe Giyon hospital for their
invaluable support, guidance, and encouragement in creating this mini-SWOT based logistics
assessment.

I would like to express my gratitude to the faculty of the College of Medicine and Health
Science and specifically the Pharmaceutical Supply Chain Management Department at Gondar
University. They have given me the opportunity to oversee the utilization of a logistics
management information system (LMIS) and its associated factors at Tibebe Giyon Hospital.

i
 Acronyms

LMIS----------------------------------Logistics Management information system

IPLS----------------------------------Integrated Pharmaceutical information system

HIV ADIS--------------------------Human acquired immune deficiency Virus.

TB Tuberculosis

FMOH------------------------------Federal Ministry of health

JSI Jhon snow Inc.

RRF---------------------------------Reporting and resupplying format

HPMRR---------------------------Health post monthly reporting and resupplying

IFRR------------------------------Internal reporting and resupplying format

DTC-------------------------------Drug and Therapeutic committee

SWOT----------------------------Strength, Weakness, Opportunity, and Threat

LIAT-----------------------------Logistics indicator Assessment Tool

TGSH------------------------------------Tibebe giyon specializes compressive hospital

DIC……………………………..drug information center

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 Table of Contents

Contents
Acknowledgements.............................................................................................................................................1
Acronyms............................................................................................................................................................2
Table of Figure................................................................................................................................................5
List of Table....................................................................................................................................................5
Chapter one.........................................................................................................................................................1
1. Introduction...................................................................................................................................................1
1.1 Background of the study...............................................................................................................................1
Figure 1 The Logistics Cycle (From Logistics Handbook: JSI/DELIVER, 2009 page 5)............................4
1.2 Statement of the problem..............................................................................................................................5
Objectives............................................................................................................................................................7
1.3. Objectives of the study.........................................................................................................................7
1.3.1. General Objective:................................................................................................................................7
1.3.2. Specific Objectives:..............................................................................................................................7
Chapter Two............................................................................................................................................................................................. 8
2. Literature Review...................................................................................................................................................................... 8
Chapter Three....................................................................................................................................................................................... 14
3. Study Methods.......................................................................................................................................................................... 14
3.1. Study area............................................................................................................................................14
Study Design and Period...................................................................................................................................14
3.3 Population of the study...............................................................................................................................14
3.4 Sample Size and sampling technique..........................................................................................................14
3.5 Instruments..................................................................................................................................................15
3.5.1 Quantitative.........................................................................................................................................15
3.6 Data collection procedures..........................................................................................................................15
3.7 Pre-testing of questionnaire.......................................................................................................................15
3.8 Data processing and analysis......................................................................................................................15
3.9 Ethical consideration...................................................................................................................................15

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 3.10 Dissemination of the result.................................................................................................................16
3.1.1 Operational Definitions.......................................................................................................................16
4. Time Schedule.......................................................................................................................................................................... 18
5. Budget Schedule...................................................................................................................................................................... 19
Table 2: costs to be used in the study..........................................................................................................19
Product Selection..........................................................................................................................................20
Weakness......................................................................................................................................................20
Opportunities.................................................................................................................................................20
Hospital Warehousing...................................................................................................................................21
Inventory Management.................................................................................................................................23
Procurement..................................................................................................................................................27
Strength................................................................................................................................................................................................... 29
Threat...........................................................................................................................................................29
Fleet Management of the hospital................................................................................................................................................ 30
Weakness.....................................................................................................................................................30
Discussion.............................................................................................................................................................................................. 31
Conclusion....................................................................................................................................................31
Recommendations.........................................................................................................................................32
References.............................................................................................................................................................................................. 33
Section II 1: Background and Characteristics of the Respondent....................................................................36

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Table of Figure

Figure 1 The Logistics Cycle (From Logistics Handbook: JSI/DELIVER, 2009 page 5).............3
Figure 2 : factors affecting Logistics management information system performance adapted from

List of Table

Table 1 : Activities time schedule..................................................................................................16

Table 2: costs to be used in the study...........................................................................................17

Section I: 1 services and Infrastructure..........................................................................................33

Section II 1: Background and Characteristics of the Respondent.................................................34

Find Result 1................................................................................................................................................28

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 Chapter one
1. Introduction
1.1 Background of the study
Logistics involves the integration of inventory, warehousing, material handling, packaging and
transportation of products along with security. The era of globalization has driven attention to global
systems of supplier relationships and the expansion of supply chains over national boundaries and
into other continents. The Indian pharmaceutical industry is ready to become globally competitive
with a potential to reach $ 57 billion by 2012. Supply chain is very critical as it maintains the complex
network relationship between drug manufacturers, trading partners, wholesalers and retailers.
Pharmaceutical products need temperature controlled storage and distribution under strict regulatory
control in a manner ensuring no adverse effect on product quality. Although the storage conditions
are maintained relatively constant, the distribution environment can vary greatly, especially when a
drug product is shipped between various climatic zones in different countries challenging the quality
and stability of product. “WHO good distribution practices for pharmaceutical products” guideline
assists in ensuring the quality and identity of pharmaceutical products during all aspects of the
distribution process. Evolution of new comprehensive supply chain dissolving the intermediation of
wholesalers and distributors reduce the cost by developing lower- cost-service channel. Particular
attention should be paid to products containing potentially toxic, hazardous, inflammable or narcotic
products. Vehicles and equipment used to distribute pharmaceutical products should be suitable to
prevent contamination and appropriately equipped to prevent exposure to conditions adversely
effecting stability and packaging integrity. Successful adoption of SCM practices allows the
companies to gain a bargaining power and reduce prices by five to ten percent (1).

Logistics is process of planning, implementing, and controlling efficient flow of raw materials, in
process inventory, finished goods and related information from point of origin to point of
consumption, for the purpose of conforming to customer requirements in the least possible time
(2).
Supply chains of the Pharmaceutical are more complex, and more immature compared to other
industries especially in developing country. This can be explained by different reasons. First,
supply chain management has an impact on human health requiring adequate amount and
accurate type of pharmaceuticals conforming to the patients’ needs. If drugs and medical
supplies are stocked out, distributed to the wrong patient or are prepared inadequately, patients
may suffer adverse events, and sometimes may cause of death (3).
Logistics information in pharmaceutical area is very crucial and the motor that drives the
pharmaceutical logistics. Information has to be gathered and analyzed about each activity in the
1
cycle to coordinate subsequent actions. Thus, there is a need to manage the information system
for other activities of the logistics to function properly. 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
are fulfilled for each client (4).
Logistics Management Information System (LMIS) is important for all public health commodity
distribution systems. It is especially critical for Human Immunodeficiency Virus/Acquired
Immunodeficiency Syndrome (HIV/AIDS) commodities that have high value and requires special
handling procedures (5). Without LMIS implementation, programs will inevitably waste valuable
resources through prolonged and frequent stock outs, overstocks and losses (6).
Pharmaceutical logistics data are collected, processed, and reported through a LMIS which
maintained an adequate supply of all HIV/AIDS and tuberculosis (TB) commodities for all
facilities (7). LMIS is an essential tool for supply chain managers and policy makers to make
sound decisions, ranging from routine resupply decisions at the local level to long-term
forecasting and procurement decisions at the national level.

2
The Ethiopian Pharmaceutical LMIS is weak, consistently being hampered by several systemic
challenges that caused frequent stock outs of critical commodities, thus impeding continuous and
quality service for patients (8). Currently, the country has designed integrated pharmaceutical
logistics systems (IPLS) for all public health commodities including essential drugs, family
planning, malaria, laboratory services, nutrition, TB-leprosy and HIV/AIDS commodities (9).
Pharmaceutical logistics management information system that manages RVI and TB drugs and
other commodities in any setting (public or private sector) and at any level (local, regional or
national) follows a well-recognized system that can be viewed as a cycle of selection,
quantification and procurement, distribution and use. At the center of the cycle is management
support that includes financing, information management, staffing, monitoring and evaluation
(10).
A good supply chain is a customer driven and all logistics functions within the supply chain must
work effectively to ensure commodity availability. Logistics information available through the
LMIS drives all decisions in the supply chain and enables managers to operate supply chain
functions including forecasting, quantification, and inventory management (11).

3
 Policy
Serving Customers

Inventory
management Product Selection
 Storage LMIS
 1 . Distribution

Forecasting and
Procurement
Adaptability
Figure 1 The Logistics Cycle (From Logistics Handbook: JSI/DELIVER, 2009 page 5)

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A logistics system provides quality customer service by fulfilling six rights: ensuring that the
right information on the right laboratory commodity in the right quantities at the right time and
right place for making the right decisions on what, when and how much to order. If the
laboratory LMIS is not functioning well, service delivery points (SDPs) will be forced to
experience either stock outs or excess stocks finally leading to dissatisfaction of clients or
wastage of commodities (12).
The essential logistics data to be collected, processed, and utilized for decision making are stock
on hand, consumption, losses, and adjustments (13). These data need to be collected, processed,
and analyzed at all levels of service delivery points (hospitals and health centers) and
warehouses at different levels (PFSA and SDPs) for decision making.
This study focuses only on the facilities that providing ART and TB treatments under East
Gojjam and Bahir Dar City administrative zones. This is because the public sector is the major
provider of HIV related and tuberculosis laboratory diagnosis, monitoring and treatment
services.

1.2Statement of the problem

In resource limited countries Supply chain management of pharmaceuticals are challenging
unless the required innovative approach which are built on the sound of logistics principle (14).
Ethiopian Ministry of health developed national pharmaceutical logistics master plan, establish a
responsible firm to perform pharmaceuticals supply chain management activities and develop
standard operating procedure manual for uniform Integrated Pharmaceutical Logistics System
(IPLS) implementation in health facilities all over the nation.

Among the activities of IPLS the one which drives others pillar is Logistics Management
Information System (LMIS). Thus, poor LMIS implementation has created many problems at
SDP such as stock out, shortage and wastage of products (10). Logistics records serve as the
backbone of every logistics system. They are designed to capture critical logistics data at each
level of the health system. The data captured on logistics records are then brought together to
form logistics reports used for crucial decision making about resupply quantities, forecasting and
procurement.

The proper implementation of LMIS is the most important technical intervention in supply chain
management system. Without accurate and timely logistics data, HIV/AIDS and TB program

5
managers/ Suppliers will not have sufficient information to make re-supply decisions or to
operate efficient and effectively the logistics system (15).

The Ethiopia nationally designed integrated pharmaceutical logistics management system

directed to operate the system in all public health facilities to manage its inventory control
system in the way of forced ordering min/max inventory control system, use and updating stock
keeping and recording tools and generate reports from it for re-supplying decision making. PFSA
is responsible for quantification, procurement, storage and distribution of pharmaceuticals to
public health facilities (16). Health centers and hospitals are required to prepare and send reports
through LMIS (RRFs) used for decision making on inventory level flow from health facilities
store to PFSA in every other month, as per IPLS SOP manual, public hospitals and health centers
establish their maximum level stock, minimum level stock and emergency order point as
consumption for 4 months, 2 months and 0.5 month respectively.

The designed pharmaceutical logistics management information system plays an important role
on the distribution of commodities, decrease emergency order, decrease stock out rates and
minimize expiry of products. However, there are many challenges such as; inadequate
availability of products, lack of information for forecasting, quantification and procurement,
inconsistencies on implementation of logistics management information system that leads
unavailability of needed pharmaceuticals and service interruption in the facilities (17).

In Kenya, the utilization of bin cards to manage pharmaceuticals in health facilities store is very
much to low (13%) even if the card is available as more as enough (18). Due to the
implementation of integrated pharmaceutical supply chain management system in Ethiopia, it has
an improvement in availability of pharmaceuticals but still there are many challenges like
improper controlling system of inventories, failing to use stock recording formats, generating
poor quality supply report data, lack of providing regular and continuous supportive supervision
for respected Service Delivery points (SDPs). Skill problem, loss and low management
ownership, lack of professionals are also the factors for poor implementation of LMIS in Health
facilities (19).

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Several studies and assessments have been conducted to see the status of logistics management
information system and supply chain system for ART and rapid test kit for HIV. Besides, there is
limited information in Ethiopia in general. Therefore, this study designed to analyze
determinants for inconsistent utilization and implementation of LMIS for HIV/AIDS and TB
treatment drugs and its consequence at Tibebe Gyon Hospital which gives the services found
under north Gondar zone administration.

Objectives
1.3. Objectives of the study

1.3.1. General Objective:

To identify availability and utilization of pharmaceutical logistics management information

system formats and factors associated with in Tibebe giyon Hospital.

1.3.2. Specific Objectives:

 To analyze the current structure and functionality of the Logistic Management Information System
(LMIS) employed at Tibebe Giyon Hospital.
 To identify utilization of LMIS formats in Tibebe giyon hospital for system improvement.
 To identify the strengths and weaknesses of the LMIS in supporting inventory management,
procurement,.
 To evaluate the integration of the LMIS with other hospital information systems and its
impact on overall operational efficiency.

7
Literature Review

Chapter Two
2. Literature Review
The pharmaceutical logistics industry also needs to meet the dual expectations of the medical
manufacturers and the downstream marketing channel suppliers. To gain favor among customers
and pharmaceutical manufacturers and to ensure competitive advantage, pharmaceutical
companies must attempt to continuously improve their services, taking service quality into
account. However, the cost of the input needs to be considered because, once the quality reaches
a certain level, more investment may not always bring the same profit. We therefore investigate
how pharmaceutical companies can better understand the needs of customers to obtain an
advantage over their competitors and provide services that consider the customers’ requirements
to increase the quality of services.

In recent years, various service industries have placed increasing value on customer satisfaction.
“Customer satisfaction” requires service providers to know how to penetrate the hearts of
customers and meet the customers' needs, while “customer value” requires service providers to
think from the perspective of empathy and the interests of customers, know how to solve
problems for customers, and add more intimate and convenient services based on the
perspectives of customers to gain customer attention and improve customer satisfaction. To
ensure customer satisfaction, we need to identify the customers’ thoughts and opinions on
service quality, obtain a thorough understanding of the characteristics or levels that customers
use to appraise the quality of products or services, and strengthen the service provided according
to the quality factors of most concern to the customers. The quality of the service provided is the
most appropriate approach. In addition to making the best use of limited resources, it is essential
to respond quickly to the changing needs of customers to improve service quality and raise
customer satisfaction.

As well as controlling costs by applying convenient, fast distribution logistics, the appearance of
outsourcing of pharmaceutical medical materials logistics is likely to be beneficial for the
healthcare industry through its mixture of logistics, automated connection and information

8
management. Integration trims unnecessary operating costs, and boosts profit, and reduces the
costs of obtaining a small number of diversified medical materials and drugs, which improves the
healthcare industry supply chain's the overall logistics performance (20).
To be effective, LIMS should be effective when the facility is equipped with adequately trained
staff, formats, equipment, and facilities. However, some studies showed that there is a problem
in this regard (21).
LMIS is an important tool in inventory management, therefore accurate record keeping is
essential. A study in Tanzania reported 8% and 72% recorded balance that was less and greater
than the physical count (Kagashe & Massawe 2012). Another study done in Tanzania showed
that often neither minimum nor maximum levels were defined (21). To the worst, in South
Sudan, only 27% of the assessed health facilities were reported to fill forms accurately (22).
The current Ethiopian health care system is guided by a National Health Policy which was issued
in 1993 following changes of government in 1991 (23). The policy was the first of its kind in the
Ethiopia in a sense that it incorporates elements of democratization, decentralization, inter-
sectorial collaboration, collaboration with neighboring countries, and promotion of the
participation of the private sector in health care. The policy also calls for the promotion of
occupational health and safety, environmental health, and the extension of health services to
pastoralists and other rural populations, the urban poor and victims of manmade and natural
disasters (24).

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In response to high burden of ill health and high rate of mortality in the country because of poor
access to health services and complex health system, the Ethiopian government has sought to
reform the health service system into a cost-effective and efficient system for past several years.
Accordingly, a twenty-year health development implementation strategy, known as Health
Sector Development Program (HSDP) with a series of five-year investment programs was
launched in 1998 which is aligned with the wider frame works of Plan for Accelerated
Development to End Poverty and Millennium Development Goals. Currently the country is
implementing the fifth year of HSTP V (25).
Regarding the health delivery system, Ethiopia implemented a three-tier health service delivery
system characterized by a first level of a Woreda/District health system comprising a health
center (40,000 population) in urban areas, and primary hospital (with population coverage of
60,000-100,000 people), health centers (1/15,000-25,000 population) and their satellite health
posts (1/3,000-5,000 population) in rural areas that are connected to each other by a referral
system. A primary hospital, health center and health posts form a primary health care unit with
each health center having five satellite health posts. The second level in the tier is a General
Hospital with population coverage of 1-1.5 million people; and the third a Specialized Hospital
that covers population of 3.5-5 million (25).
As part of the health care reform, Business Process Reengineering (BPR) was employed in
Ethiopian Fiscal Year 2001 with key principle of bringing a significant improvement in the
quality of health services through the institutionalization of accountability and transparency. One
mechanism of achieving this was to seriously consider the separation of purchaser, provider and
regulator in the health system (25). As part of this important endeavor, the former Drug
Administration and Control Authority (DACA) has undergone an institutional transformation to
a new agency called Food, Medicine and Health Care Administration and Control Authority (26).
The mandate of the new agency is to undertake inspection and quality control of health and
health related products; premises, professionals, and health delivery processes in an integrated
manner (27).
The National Drug Policy of 1993 which is part and parcel of the health policy has served as an
umbrella for pharmaceutical services in Ethiopia (MOH, 1993). Since the start of HSDP I, the
government of Ethiopia was committed to ensuring community’s access to the essential
medicines that are safe, effective and of assured quality including rational drug prescription and

10
use. Moreover, since HSDP III a number of reforms have been employed that have significant
impact on quality of pharmaceutical service.
One of the reforms is the Pharmaceutical Logistics Master Plan (PLMP) which was introduced in
2009 with the aim of ensuring the uninterrupted supply of essential, quality, and cost-effective
pharmaceuticals at all health facilities (26). To achieve this, the Pharmaceutical Fund and Supply
Agency (PFSA) was created with mandates: to supply the entire country with both Program and
Essential pharmaceuticals, as well as serve as the distribution entity for vaccines, other health
facility supplies, and laboratory equipment (28). So as to execute its mandate in the area of
pharmaceuticals supply in an efficient and effective manner, PFSA developed the integrated
pharmaceuticals logistics system that integrates the drug requisition, distribution, and reporting
of essential pharmaceuticals that used to be managed vertically into a single mechanism (25).
PFSA’s objectives include:
 Improve availability of program and non-program pharmaceuticals nationwide to100%
 Reduce wastage rate less than 2%
 Reduce cycle time (forecasting, procurement, storage, and delivery to public health
facilities) to 120 days.
 Establish a quality complaint system and ensure rational use of pharmaceuticals.
 Improve customer satisfaction in terms of availability and quality of service at public
health facilities from 51% to 100%
The end goal is for PFSA to be the sole distributor of health-related materials to all public
facilities within the country (25). In 2009, the USAID aided DELIVER project introduced an
automated health commodity management information system (HCMIS) that can significantly
improve health facilities’ ability to manage supplies in their stores. The HCMIS is a locally
developed, user-friendly software package that helps health facilities manages all EDs, as well as
medical and laboratory supplies. The HCMIS automatically receives, and issues reports and
orders, manages inventory, and produces a variety of commodity reports for store managers,
pharmacists, and facility heads. Since the program began, the project has implemented the
system in 205 selected health facilities throughout Ethiopia as of 2011 (29).
Moreover, National Minimum Standards for Health Centers were also developed

11
Protect the public from sub-standard services and promote quality of health service.

The standard includes minimum standards for pharmaceutical services which include standards
for medicine and supply management, and medicine waste management (26).
Over the past few years, pharmaceutical waste management has received more attention in
Ethiopia. Accordingly, FMHACA developed a directive on medicines waste management and
disposal in 2011 in order to ensure safe pharmaceutical waste management and disposal practice,
and hence to protect the public and the environment from health risks and hazards of
pharmaceutical waste (26).

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Conceptual framework

Management Ownership on the Socio – demographic Factors

System Educational status and year of
- System follow experience

- Availability of LMIS Formats

 Budgeting

Performance in implementation
Supportive Supervision
of Pharmaceutical LMIS

Skill of staffs
-Professional qualification
Dependent Variables
- Work experience on LMIS

- Training

Independent Variables
Figure 2 : factors affecting Logistics management information system performance
adapted from Samuel Getachew, 2014.

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Chapter Three
3. Study Methods
This chapter describes the procedures that were used in carrying out this research. It deals with
research design, population of the study, sample and sampling techniques, research instruments,
data collection procedure, data processing and analysis, finally operational definition for
measuring variables.

3.1. Study area

TGSH is a University hospital, and one of the 43 governmental hospitals in Amhara region. The hospital serves
more than five million people in the catchment area. This teaching hospital has more than 500 beds, and 2000
patients per day in both inpatient and outpatient services. The Department of orthopedic surgery has both
inpatient and outpatient services. There are 66 beds in the inpatient, a total of 14 orthopedic surgeons (2 of
them are on fellowship), and 40 orthopedic specializing residents. Operations are done 4 days a week as
elective cases and daily for emergency cases. The department has its own major operation room with three
operating tables.

Study Design and Period

A facility based cross-sectional descriptive study has been done conduct from Dec 1 – Jan 2024,
on LMIS formats usage practiced for drugs used drugs for ARV, FH and TB. Quantitative data
collection methods will have used. Interviewing persons will be professionals which are
responsible for managing program drugs used for HIV treatment, FH products and TB drugs
separately or generally.

3.3 Population of the study

The study was conducted t in Amhara region of North Gondar zonal Administration

3.4 Sample Size and sampling technique

The study sample has included one general hospital in north Gondar zone administration.

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3.5 Instruments

3.5.1 Quantitative

A structured questionnaire which is originally developed by USAID/DELIVER Logistics

Assessment indicator tool (LIAT) will be customize/adapt to in the context of this study to collect
quantitative information from health facility’s store, Chronic ART clinic, Family planning
Dispensing unit and TB clinic in the health facilities.

3.6 Data collection procedures

The investigator was responsible about data collection and instruments. The data collectors
administer face to face interview based on the tools for professionals managing pharmaceuticals.
Besides the information is collected through interview, physical counts of selected
pharmaceuticals for the program will be done for the comparison of recorded on LMIS formats
to actual stock.

3.7 Pre-testing of questionnaire

Testing of questionnaire carried out to confirm the reliability and validity for the intended
purpose. It also helps to redesigning better and estimates the amount of time required to collect
and process the data effectively.

3.8 Data processing and analysis

After collection of data, it will be edit, coded, tabulated, and analyzed. The collected data will
have analyzed using statistical package for social science (SPSS) version 20 by binary logistics
regression analysis method.

3.9 Ethical consideration

The assessment started after getting ethical clearance from university of Gondar department of
PSCM. Verbal and written informed consent will be obtained from all the study participants after
explaining the purpose, and potential risk and benefits of the study.

Confidentiality will be ensured, and unauthorized persons don’t have access to the data. Only
principal investigator, Statistician who will support data analysis and supervisors of the principal
investigator will have access to the data.

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3.10 Dissemination of the result

The report of the study will be submitted to University of Gondar Department of Pharmaceutical
supply chain, Regional Health bureau, and to the hospital. The findings will be communicated to
the regional Health Bureau, zonal health Department and the respective health institutions.

3.1.1 Operational Definitions

The following operational definitions were used in the study to define important words and
measure variables of the study. Pharmaceuticals inventory control system is the dependent
variable and Socio demographic factors, management system ownership (support), health facility
service volume level and skill of professionals who are involved in managing of pharmaceuticals
are the independent variables.
Tracer drugs: these are drugs selected by the federal ministry health of Ethiopia to be available
in all government health institutions in all the time, 24 hours a day and 365 days in a year.
Management ownership on the system (support): is the level of the management on system
follow up and considered acceptable if management of health facilities fulfilled at least seven
from the following ten criteria (System implementation supportive supervision check list of
Ethiopia)
1. Health facility management or DTC meets and discuss on the system implementations at least
every other month.
2. District health office or higher health structure support on the system at least every quarter
3. Inclusion of system implementations in BSC and number of points on measures given,
4. Conducting logistics review meeting at least once a year per district health office and/or zonal
health department
5. Availability of require pharmacy professionals as per the BPR
6. Holding budget for deployment of pharmacy professionals
7. Receiving of stock status report
8. Allocating budget for printing of recording and reporting formats
9. Provision of feed backs, signing on resupply report
10. Continues skill transfer from trained to untrained profession during release/transfer of trained
professionals

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Skills of the staff: the ability to do the inventory control system well and requires placement of
required professionals (pharmacy) and training on the system. For the study facilities fulfilling at
least 7 from the ten following considered acceptable.
1. Pharmaceuticals storage being run with IPLS trained professionals
2. Pharmaceuticals storage being run by pharmacy professionals
3. Regularly preparing and sending the supply report timely
4. Orienting and Establishing Max-min ICS for the DUs of the health facility
5. Conducting pharmaceuticals inventory at least annually
6. Proper storage of pharmaceuticals
7. Able of updating recording formats,
8. Properly transposing data from recording formats for preparing supply report
9. Regular supporting the dispensing units and health posts on recording, reporting and drugs
supply management.
10. Generating valid and accurate supply report.

17
 4. Time Schedule
Table 1 : Activities time schedule
Activities Time schedule /2016 E.C
March
Day
1-2 3-5 6-9 10-12 13-14 15

Ethical Clearance from Department of

PSCM

Material preparation and Data collection

Report Writing for information and

Action

Result Presentation to the evaluator

Submission of final assessment

Result presentation

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 5. Budget Schedule
Table 2: Stationery, Per Diem, Transport, and related costs to be used in the study

Unit price
Item Unit Amount required Total cost (ETB)
(ETB)

Transport cost Two 70.00 3trips 210

rounds

Mobile service card Pcs 100 1 100

Refreshment EA 500 1 300

Other copy and print EA 100 1 100

Total 710

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 Result (Overall PSCM practice, SWOT)

Product Selection

Strengths

 Availability of DTC structure

 Selection of product is being conduct by the hospital DTC.
 Qualified Staff: Tibebe Giyon Hospital likely has pharmacists and pharmacy technicians who are
well-trained and qualified to handle various pharmaceutical activities.
 Quality Products: The hospital likely procures pharmaceuticals from reputable suppliers, ensuring
the quality and efficacy of medications provided to patients.
 Regulatory Compliance: Compliance with local and national regulations ensures that
pharmaceutical activities adhere to standards, promoting patient safety and trust.
 Technological Integration: Integration of technology, such as pharmacy management systems, can
streamline operations, improve inventory management, and enhance patient care.

Weakness

 Selection data lacks proper documentation.

 Unable to done Clinical audit.
 Data Quality problems and not used to decision.
 Limited Resources: The hospital may face limitations in terms of budget, infrastructure, and
staffing, potentially impacting the efficiency of pharmaceutical activities.
 Inventory Management Challenges: Poor inventory management practices could lead to issues
such as stock outs or expired medications, affecting patient care and operational efficiency.
 Lack of Specialized Services: The hospital might lack specialized pharmaceutical services or
expertise in certain areas, limiting the scope of care provided to patients.
 Dependency on Suppliers: Dependency on a limited number of suppliers can pose risks such as
supply chain disruptions or price fluctuations.

Opportunities

 Expansion of Services: Tibebe Giyon Hospital could explore expanding its pharmaceutical
services, such as offering clinical pharmacy services or specialty medication management.

 Community Outreach Programs: Engaging in community outreach programs, such as health

education campaigns or medication management workshops, can enhance the hospital's
20
 reputation and reach.

 DIC Services: Implementing this services can extend the reach of pharmaceutical care to
patients and other staffs.

 Research and Development: Investing in research and development initiatives can lead to the
discovery of new drugs or the improvement of existing pharmaceutical practices, enhancing
patient outcomes.

 Presence of Health partners

 Health care financing
 Supporting of MOH, RHB APHI AND ZHD
 Presence of hospital Reforms
Threats
 Competitive Landscape: Competition from other healthcare providers or pharmacies in the area can pose a threat to Tibebe
Giyon Hospital's pharmaceutical activities.

 Regulatory Changes: Changes in regulations related to pharmaceuticals or healthcare can require adjustments in

Processes and may increase compliance costs.

 Healthcare Fraud and Counterfeiting: The presence of counterfeit medications or fraudulent practices in the

Pharmaceutical supply chain poses risks to patient safety and the hospital's reputation.

 Economic Factors: Economic downturns or fluctuations in currency exchange rates can impact the affordability

And availability of pharmaceuticals, affecting both the hospital and its patients.

 Interruption of supporting budget

 Shortage of drugs, medical supply and medical equipment

 Shortage of infrastructure

 Laboratory፣ Maternal and Child Health Profession ፣Dermatologist ፣Pathologist Neurologist

 covid 19 pandemic

Hospital Warehousing
Strengths:

 Wide Product Range: Offering a wide range of pharmaceutical products can attract a diverse customer base and increase
21
 revenue streams.

 Strong Supplier Relationships: Building strong relationships with pharmaceutical suppliers can ensure timely deliveries
and potentially negotiate better pricing, enhancing the competitiveness of the warehouse.

 Advanced Technology: Utilizing advanced inventory management systems and technology can optimize warehouse
operations, minimize errors, and improve overall efficiency

22
Weakness
 Dependence on Suppliers: If the warehouse heavily relies on a limited number of suppliers, it can be vulnerable to supply
chain disruptions, shortages, or price fluctuations
 Regulatory Compliance: Compliance with pharmaceutical regulations and quality standards can be complex and expensive.
Non-compliance could lead to legal issues or loss of licenses.
 High Initial Investment: Setting up and maintaining a pharmaceutical warehouse requires significant initial investment in
infrastructure, technology, and skilled personnel.
 Market Saturation: In a highly competitive market with numerous pharmaceutical warehouses, it may be challenging to
differentiate Tibebe Giyon Pharmaceutical Warehouse from competitors.
 Delay to resupply the dispensing units.
 Poor biosafety measure in the warehouse (Fire safety equipment's are not functional) No commodity arrangement in all
types of warehouses. (No palatalization)
 Presence of Expired item inside the warehouse and over stock

Opportunity:

 Presence of Partners (ICRC, JSI, rarely UN according to the storekeeper), Health care financing
policy.

 Partnerships and Alliances: Forming strategic partnerships with pharmaceutical manufacturers,

distributors, or healthcare facilities can provide access to new resources, markets, and
technologies.

Threat:
 Regulatory Changes: Changes in pharmaceutical regulations or healthcare policies can impact operations and
require costly adaptations to remain compliant.
 Competitive Pressure: Intense competition from existing pharmaceutical warehouses or new entrants can erode
market share and pressure pricing.
 Supply Chain Disruptions: Disruptions in the supply chain due to natural disasters, geopolitical tensions, or
pandemics can lead to inventory shortages or delays, affecting customer satisfaction and revenue.

Inventory Management

Top 20 item spot checking were done daily taken to test the stock.

23
24
25
26
 Procurement

Several times in some tasks. Workload was mentioned for not moving the file to the next steps.

Strength
 Established relationships with pharmaceutical suppliers: long-standing relationships with reliable pharmaceutical suppliers,
it can leverage these to negotiate favorable terms and ensure a stable supply chain.
 Efficient procurement processes: Streamlined procurement processes can minimize delays and ensure that medications are
readily available when needed, optimizing patient care.
 Trained procurement staff: Having a team of skilled professionals who understand the intricacies of pharmaceutical
procurement can help in making informed decisions and avoiding errors.
 Inventory management system: A robust inventory management system can help in monitoring stock levels, reducing
wastage, and ensuring that essential medications are always in stock.
 Local market knowledge: Being a local institution, Tibeb Giyon Hospital likely has a good understanding of the local
pharmaceutical market, allowing them to identify reputable suppliers and quality medications.
 Integration with healthcare services: The hospital's procurement process may be closely integrated with its
healthcare services, ensuring timely availability of medications to meet patient needs.

Weakness

Limited budget: Like many healthcare facilities, Tibeb Giyon Hospital may face budget
constraints that limit their ability to procure a wide range of pharmaceuticals or invest in
bulk purchasing for

-No structured supplier data base for the hospital procurement (Medical and non-medical
purchase where huge budget is being spent.

-No Bench mark price from regional health burea,Finance bureau and EPSS.

One can purchase with any threshold.

-No sense of Electronics procurement (eGp). Electronics government procurement.

No specification for vehicle spare part purchase. Purchaser can buy what is considering good
quality not the requester or the management.

27
28
Strength
NTR
Weakness
No supply chain officer.
No agreed lead time for warehouse to dispensing unit and procurement of goods.
No excel file to follow up where they are in terms of procurement order.
No forecast and quantification Plan.
Opportunity: The hospital can assign one supply chain officer from among the team to
follow up orders from the beginning to the end till items reach to customer.
Threat
Compliance, Fraud, delayed lead time, high prevalence mortality and morbidity.

29
 Fleet Management of the hospital
It was hard to get an overview of hospital fleet information (Ambulance and other vehicles
of the hospital. They need to be more serious in terms of Ambulance where huge need is
available.
Strength
Good Parking lot.
Weakness
No fleet stock management (I cloud not see Bincard and Mini store for fleet stock.
No Daily checkup check List (Cleanness, oil, coolant, fuel, steering, air filter, first aid kit and
Battery situation.

Find Result

S.No Pilar Log. Area No of indicators Achievement Result in %

1 Warehousing 10 6 60%

2 Procurement 5 3 60%

3 Supply chain 4 2 50%

4 Fleet Management 6 3 50%

Total performance 25 14 56%

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 Discussion
• The availability of smart and functional LM structure has crucial impact on the
implementation of medical supply chain program where resource limitation is a
growing concern in medical market.

• In this assessment method almost all types of LM practice activity indicators were
included. The assessment was focused on assessing the level of LM practice in Tibebe
giyon Better to refresh or oriented to have understand strength, weakness, opportunity, and
ositatreats.
Better tray to do all department heads strength, weakness, opportunity and treats in
budget year.
In the present assessment the overall performance on LM system practice found to be
60%, ,60% ,50% and 50% respectively.
This shows that there are limitations on the overall LM practice implementation which
can affect the pharmaceutical supply chain system performance of the hospital.
In regarding to Warehousing: The total achievement of Leadership practice in the
organization was 60% which require more work to improve internal situational analysis,
Prioritizing and inspiring employees.
Regarding to Procurement: (60%) Planning and organizing practice are encouraging
however implementation and controlling still needs more work to take corrective actions.
In regarding to Supply chain (50%) engaging stake holder and shared directions are well
exercised. But assigning focal person to SCM and resource stewardship are still the area
that the hospital desires to be improved.
Regarding Fleet:50% still needs to implement all fleet procedures.

Conclusion
There is low performance of LM practice 56%) in Tibebe giyon hospital. From the assessment
we concluded that the hospital Logistics management practice needs more intensive work to
improve organizational performance through using IPLS practice as an instrument of supply
chain activity implementation for the coming strategic plan implementation period of the
hospital.

Generally, the availability of LM training, implementation and evaluation had been found
significant factors with their all over Logistics management practice.

31
Recommendations
 Logistics Management training should be given for Pharmacy and CEO.

 Rewarding and motivational mechanisms should available since there is staff turnover.

 Pharmaceutical Monitoring and evaluation system should be in practice.

 Availability should be improved by enhancing proper warehouse activities.

 Internal situational analysis should be done.

 Employees Performance should be measured.

 Job description should be available and Supply chain officer should be allowed
for hospitals.

 Supplier list should be developed in all health facility of the country.

 Benchmark price for procurement should be a trend for the country.

32
 References

1. https://www.researchgate.net/publication/259702275_Pharmaceutical_Supply_Chain_Management
2. https://www.researchgate.net/publication/297369572_Logistics_and_Supply_Chain_Management
3. https://www.techtarget.com/searcherp/definition/logistics
4. (IPLS SOP 2015).
5. Deliver, 2004
6. Richard, C & Warner T. 2003
7. USAID/DELIVER project, 2009
8. Nigatu A. et al, 2009
9. FMOH/PFSA, 2015
10. USAID/DELIVER, 2008
11. USAID/Deliver project, 2008
12. Chandani, Y. et al, 2006
13. Raja, S. and Mohammed, N. 2005
14. WHO, 2001
15. Mwench, A. 2009
16. Abdellah, H. 2009
17. Pharasi, B. 2007
18. Mugwe, E. 2014
19. ANRSHB, 2015
20. https://www.sciencedirect.com/science/article/abs/pii/S0969698920303428
21. MOHSW, 2008; GH Tech, 2011
22. GH Tech, 2011
23. MOH, 1993a
24. Kloos H. 1997
25. FMOH, 2015
26. FMHACA
27. HPR of FDRE, 2010
28. The World Bank, 2009
29. John Snow Inc. /DELIVER, 2011

33
Annex (Data Collection Tool- Quantitative and qualitative part) (give due emphasis to prepare a
good data collection tool which covers all important PSCM activities in health facilities)

Introduction
My name is Biniyam Tadele I am working in research team of University of Gondar, the team
will conduct studies on assessment of practices and challenges of pharmaceutical humanitarian
logistics in the case of selected refugee camps Amhara region Ethiopia. The study will benefit
the beneficiary of the project and the humanitarian agency by suggesting important intervention
point to better serving to community. Before that we are engaging data collection process and
now, I am requesting you your kind voluntariness on providing information according to the
developed questionnaires for this purpose.
Thank you, the questions are not as such difficult to answer and I hereby assure you that your
name will not be recorded in the formats and never be requested in connection with any of the
information you are going to provide for me. You are not also obliged to respond any question/s
you do not want to answer, and you may interrupt this interview at any time you think it imposed
inconvenience; however, providing honesty response for the questions will contribute generating
quality and factual outcome for the study which enables us to come up with pertinent
intervention point at the end.
Thank you again and appreciate your help on participating in our job, interview by the way will
not take more time, not more than an hour.

34
Date………………………………………………………………
01:-Questionnaire number………….
02:-Are you willing to participate in the study? 1. Yes
2.No 03:-Study area,
Zone: -……………………, District:-……………………..
Name of Facility………………………. Facility phone no………………….
Section I: 1 services and Infrastructure

Information about Interview

Date: Date:

Interviewer/s Name:

Signature

Checked by: Suprvisors Name……………………. Signature…………………..

No Question Code Classification Go To/Comments

01 Name of the organization

02 Region

03 Zone

04 Woreda

05 City/Town

35
06 Supplying Hub

07 Organization Code

08 Type of organization 1. developmental

2. humanitarian
09 Is organization provide the following services
1. health Service 1. Yes
2. No
2. Economic security program 1. Yes
2. No
3. Water and sanitation program 1. Yes
2. No

Section II 1: Background and Characteristics of the Respondent

1) Skills related questions in Store and Dispensing units.

a) Store

No Questions Code Classification Go To

101 Your profession and educational level 1. Business

graduate
2. Pharmacy

technician
3. Others

36
102 Number of years and months’ work experience 1. 0- 1 year
2. 1 – 2 years
3. 2- 3 years
4. 3- 4 years
5. Above 4 years
103 Are you the primary person responsible for managing 1. Yes
procurement at this organization 2. No
104 Do you train on electronics procurement 1. Yes
2. No
105 PMIS formats Availability

a. Purchase requestions 1. Yes

2. No
b. Supply request 1. Yes
2. No
c. Request for quotation /proposal 1. Yes
2. No
d. SOP for procurement management 1. Yes
2. No
106 Do you use supply request for all procurement 1. Yes (>80%)
(Check at least 10 different procurement service from 2. No (<80%)
the programs). 3. Specify in %.....
107 Do you use update always approved Purchase order 1. Yes (>80%)
2. No (<80%)
3. Specify in %.....
108 Do you have supplier list for various procurement 1. Yes
category approved by the management 2. No
109 Do you prepare and send RFQ using email address of 1. Yes

the registered suppliers using blind copy 2. No

(Check the past 3 RFQs)

37
b) RFQ management 1
No Questions Code Classification Go To

110

Do you use standard RFQ format Yes

No

Do the RFQ has opening date and closing date 1. Yes

2. No
Do you have supplier follow up format after floating 1. Yes
of the RFQ 2. No
111 PMIS Formats Availability

ART Dispensing unit

Supply request 1. Yes

2. No
RFQ 1. Yes
2. No
TB dispensing unit
RFQ follow up formats 1. Yes
2. No
Purchase order 1. Yes
2. No
Requester
Supply request 1. Yes
2. No
Purchase order 1. Yes
2. No
112 Do you trained/ take orientation about electronics Procurement management
information system (PMIS) in or out of the the organization?

38
 WFP 1. Yes
2. No
IOM 1. Yes
2. No
UNHCR 1. Yes
2. No
UNICEF 1. Yes

2. No

2) Management ownership
No Questions Code Classification Go To

201 Does the organization fulfil the required 1. Yes

procurement professionals as per the UN standard 2. No
202 Do the available logistics professionals sufficient 1. Yes
to perform and support procurement for recording 2. No

and reporting regularly?

203 Do you have budget for recruiting procurement 1. Yes
professional to fulfill gaps? 2. No
204 Do you have functional logistics division 1. Yes
2. No
205 Do the management give weekly base remote 1. Yes
skype call to support the procurement activities 2. No
206 Do procurement implementation included in 1. Yes
Performance management and development tools 2. No
for all professionals to measure their performance?

39
207 Do you take e-procurement Orientation training? 1. Yes
2. No
208 Has the facility allocated budget for printing LMIS 1. Yes
formats? 2. No
209 Do you follow, support, and enforce on the 1. Yes
implementation of e procurement system (use and 2. No
210 Do you Follow and support task and skill transfer 1. Yes
about e procurement implementation during 2. No
resigning, transferring and shifting of professionals
with in and out of the facility?

3) Supportive Supervision
No Questions Code Classification Go To

301 Do country logistics department provide scheduled

supportive supervision at least in two months for
field level procurement?
Contract Management 1. Yes
2. No
Frame Agreement for bulk and long-term purchase 1. Yes

40
 2. No
For hand to mouth purchase 1. Yes
2. No
302 Have you got a supportive supervision from partners.

4) Performance of implementation of ePMIS

List of electronics Total number in Managed Send to Delayed Supplier Contribution
procurement service the last 3 electronically at upstream due to response green logistic
months this organization? level? some
Y/N Y/N reason
Electronics supply
Request

Electronics RFQ

Purchase order validation

Supplier list
Product availability
Bulk Purchase and Bench
mark price.

41