Distribution

and Inventory Management

of Anti-TBL pharmaceuticals
Medicines management cycle
 outline

• Objectives
• Distribution system
• Distribution of TB pharmaceuticals
• Exercise on SLDs ordering and refill
• LMIS forms for TB Pharmaceuticals
• Storage of pharmaceuticals
• Distribution of Anti Leprosy drugs
 Objectives

 To mention the basic elements of distribution system

 To describe TB pharmaceuticals reporting,requesting
& ordering
 To identify current distribution system of TB
Pharmaceuticals
 To list good storage practices
 To Identify current distribution system of anti leprosy
drugs
 To describe inventory control system
 Distribution system
An effective pharmaceutical distribution relies on well
established system design and management.

And results:
 A sustainable supply of pharmaceuticals

 Minimize loss of pharmaceuticals

 Accurate inventory records

 Promote good storage practice

 Efficient use of resources

 Reduce theft and fraud
 Distribution system
Basically four elements of distribution system
 System design
 Information system
 storage

 Delivery
 Distribution network (supply chain)
. local manufacturers
Local importers/whole
International suppliers sellers

PFSA Central

PFSA Hubs

Health centers

Private Private/NGO
Hospitals Health posts
hospitals clinics
 Distribution of TB pharmaceuticals

• The distribution of TB FLDs, cartridges and

falcon tube is as per the IPLS based on RRF

• The RLs prepare & distribute AFB reagents

to ZHD & then to HFs but further
decentralization is under process
 Distribution of TB laboratory reagents
AFB reagent
Components
Central PFSA Regional Laboratory

AFB reagent
Components Prepared AFB regents

EPHI Zonal Health department

Health Facilities (HFs)

 Distribution flow of SLDs

Every 6 months
FMOH Central PFSA

months
Every 6
RHB PFSA Hub

Every 2 months
TIC

Every 1- 2
Key:
months
Drug flow
TFC Resupply Request
Report & Request
Feedback
 Distribution flow of SLDs cont’

• TICs report until the 5th day of the reporting

period & send it along with RRF to PFSA hubs
• PFSA hubs deliver to respective TICs every 2
months or TICs will collect by themselves to
avoid any delay.
• The RHBs give feedback through email/telephone
to TICs on the number of new and existing MDR
TB patients. However this doesn’t mean that
PFSA hubs will wait for approval.
• PFSA hub resupply until the 10thth day of the
reporting period.
 Distribution flow of SLDs cont’
• TICs deliver SLDs to TFCs every one to three
months according to the situation

• TFCs must fill IFRR and submit the request to

the TIC based on agreed schedule & the drug
needs to be received and recorded by the
TFCs pharmacy store and then issued to the
TB clinic

• Delivery of SLDs shall be integrated with

routine IPLS schedule whenever possible
 Distribution system design…cont
Pull Vs Push

• Pull system (requisition system)

– Each level of the system determines types and
quantities to order e.g TB FLDs & SLDs…

• Push system (allocation)

– Supply sources at some level in the system determine
what type and quantities of commodities based on
sufficient evidence and data. e.g MDR TB ancillary
drugs
 Distribution system design…cont
Pull Vs. Push

• Most of Anti-TB drugs distribution is designed

by pull system

•Where HFs request their demand &

FMOH/PFSA approve supply based on their
request
 Distribution system design…cont
Delivery Vs collection

• Delivery
– when warehouse is responsible for delivering
supplies
• Collection
– Receiving facility takes responsibility of collecting
supplies from the warehouse
Previously, anti-TB SLDs were collected by TICs from central PFSA. New
system is delivery by PFSA hubs to TICs & TICs will continue delivering to
TFCs
LMIS forms for TB Pharmaceuticals
LMIS Recording Forms…..cont

Stock cards
Bin cards
Electronic records
from HCMIS
 Anti TB SLDs Excel request and report format For new patients
No. of
Ser. unit/d days/month drug Qty w(o)
No. Description ay will be taken unit/pt/Q % patient Qty Needed/Q 5% buffer Qty/pk Unit
Capreomycine 1gm
1 vial 1 24 48 100% - - - Vial
Cycloserine 250mg
2 tablet 3 28 168 100% - - - Pk of 100
Prothionamide
3 250mg tab 3 28 168 100% - - - Pk of 100
Levofloxacin 250mg
4 tablet 3 28 168 100% - - - Pk of 100
Pyrazinamide 400mg
5 tablet 4 28 224 100% - - - Pk of 672
Kanamycin 1gm vial
6 1 24 48 5% - -   Vial of 10
Moxifloxacine 400mg
7 tablet 1 28 56 5% - -   Pk of 5
PAS 4g sachet
8 2 28 112 5% - -   Pk of 25
Pyridoxine 50mg
9 tablet 3 28 168 100% - - - Pk of 1000
Augmentin
10 500/125mg tablet 3 28 168 5% - - - Pk of 20

Enter the number of patients to be enrolled into treatment (in the

coming quarter) in the yellow-shaded cell and request with the below
table.  
 SLDs request for Exixsting patients :To be used for calculating need (at health facility)
No. of No. of
Se days/ patients Qty Stock on
r. month taking Qty w(o) Hand
N unit/ drug will unit/ this Need 0% (Tablets Expiry Qty/p
o. Description day be taken pt/Q drug ed/Q buffer or Vials) date k Unit
Capreomycine
1 1gm vial 1 24 48   - -     - Vial
Cycloserine
2 250mg tablet 3 28 168   - -     - Pk of 100
Prothionamide
3 250mg tab 3 28 168   - -     - Pk of 100
Levofloxacin
4 250mg tablet 3 28 168   - -     - Pk of 100
Pyrazinamide
5 400mg tablet 4 28 224   - -     - Pk of 672
Kanamycin 1gm
6 vial 1 24 48   - -     - Vial of 10
Moxifloxacine
7 400mg tablet 1 28 56   - -     - Pk of 5
PAS 4g sachet
8 2 28 112   - -     - Pk of 25
Pyridoxine Pk of
9 50mg tablet 3 28 168   - -     - 1000
Augmentin
500/125mg
10 tablet 3 28 168   - -     - Pk of 20
 Ordering N95 mask
__________
__________ Number of in patients decidated for
Name of the center _______ DR-TB:___________
Number of
hours that Number of Allocated
Type of professionals
the staff is Respirator staffs in N95 for the Total Need in
working in the MDRTB
in close Need /wk the Period of pieces
ward of the TIC
contact with category request
patients/day
Consultant Less than 4 1
physicians, trainees, hrs
janitors, guards, data
clerks, social workers,
food servers   24 0
Ward physicians, 4 to 8 hrs 2
OPD nurses   48 0
Attendants, ward 8 to 16 hrs 3
nurses   72 0
Attendants of critically Longer 4
sick or terminally ill than 16 hrs
patients   96 0
Total N95 to be
requested         0
Pack of 20         0
 Exercise on ordering of SLDs
Exercise
• Mekele hospital has submitted the following data
on requesting SLDs

 No of patients planned to start SLDs during the

refill period= 15

 No of who already are on treatment mentioned in

the following table:
Calculate the total ordering and resupply quantity…
 Existing patients regimen data of Mekelle
Stock on
No. of patients taking Hand in
Description this drug small units EXPIRY DATE
Capreomycine 1gm vial
25 1,677 10/30/2020
Cycloserine 250mg tablet
80 8,600 3/30/2020
Prothionamide 250mg tab
80 52,100 12/30/2018
Levofloxacin 250mg tablet
80 23,000 12/30/2017
Pyrazinamide 400mg tablet
80 24,000 2/28/2018
Kanamycin 1gm vial
  65 10/30/2018
Moxifloxacine 400mg tablet
  - 10/30/2017
PAS 4g sachet 6/30/2017
1 510  
Pyridoxine 50mg tablet 8/30/2017
80 77,952  
Augmentin 500/125mg tablet  6/30/2017
   0
Supply chain management of Anti Leprosy drugs

• Anti Leprosy drugs are received from world

health organization (WHO) through donation
based on the morbidity pattern of the country

• The country submit the number of patients in

different category (MB & PB) and age (Adult &
Child) along with stock data and then quantity
to resupply is decided by WHO & shipped to
country
 Anti Leprosy drug distribution

• Though the distribution of leprosy drugs

follows IPLS ,since the drugs are in small
volume, it needs special consideration of the
distribution

• Distribution of the drugs should be based on

leprosy disease burden identified in national
leprosy mapping (high, medium and low
burden area)
 Anti Leprosy drug distribution cont’

• For high burden woredas the distribution will be

handled as per the IPLS based on their
consumption

• Medium leprosy burden woredas, refill will be

based on the request (RRF) from facilities or
woredas but needs cross checking the areas & the
patient number on the mapping result & refill will
be made based on the patient number (might not
need to reach the max )
 Anti Leprosy drug distribution cont’

• For low burden facilities; request and refill will

be made through the woreda (WoHO or cluster
HC) i.e some stock will be stored at woreda level
(WoHO or cluster HC) i.e as starter

• Leprosy free HFs report to their respective

woreda promptly when they encounter a case
and the woreda compiles (if any) & requests
PFSA for supply.
• Leprosy mapping by District in Ethiopia report t
o be final 1.docx
Storage of pharmaceuticals
 Storage – Maintain Quality
Inside the storage area …

…what can affect the quality of the medicines?

Cleanliness Temperature

Humidity Direct light

Source - MSH
Security
 GUIDELINES FOR PROPER STORAGE
1)Clean and disinfect storeroom regularly.
2)Store in a dry, well-lit, and well-ventilated storeroom, do not
store in direct sunlight.
3)Secure storeroom from water penetration.
4)Make Sure that fire safety equipment is available and accessible
and that employees are trained to use it.
5)Store latex products away from electric motors &fluorescent
lights.
6)Maintain cold storage, including a cold chain, for drugs require it.
7)Keep narcotics and other controlled substances in a locked place.
 GUIDELINES FOR PROPER STORAGE…
8) Store flammable products separately with appropriate safety
precautions.
9) Stack cartons at least 10 centimeters (4 inches) off the floor,30
centimeters (1 foot) away from the walls and other stacks, and no
more than 2.5 meters (8 feet) high.
10) Arrange cartons so that arrows point up and identification
labels, expiry dates, and manufacturing dates are visible.
11) Store health commodities in a manner that facilitates FEFO
stock management.
12) Store health commodities away from insecticides, hazardous
materials, old files, office supplies and equipment.
13) Separate damaged or expired health commodities without
delay, and dispose off them in accordance with established
procedures.
 Storage – Good Arrangement
How to Arrange the Storage Area

Photos by Gabriel Daniel, Management Sciences for Health, Rational

Pharmaceutical Management Plus Program
Storage: Good storage

Light
Storage – Good Arrangement….cont
 Storage – Proper disposal

Source - MSH
Storage – Good control and rotation
Management of Inventory
 Logistics: management of products in motion and at
rest
 There are only three activities that happen to
pharmaceuticals within a logistics system:
• Stored in inventory,---------inventory at rest
• Moved along different levels -----inventory in motion
• Moved to patients for provision of health services
-----inventory in motion
What is Inventory ?
 Idle resource with economic value waiting for future
usage, consumption, conversion or sale.
 Stock of items kept to meet future demand

Purpose of Inventory control system

 To determine when stock should be ordered/issued
 To determine how much stock should be
ordered/issued
 To maintain an appropriate stock level of all
products, avoiding shortages, expiry and
oversupply.
Why we keep inventory?
 Why we keep inventory..

To ensure availability (reduce the risk of stock

outs)
To maintain confidence in the system
To reduce the unit cost of drugs (bulk purchase)
 Inventory Management
• An Inventory Control Model includes such terms as:

 Lead time (time it takes to receive the items once you place your order
and ready for use)

 Safety stock - This is the additional buffer, or reserve stock kept on hand
to protect against stock outs caused by delayed deliveries, markedly
increased demand, or other unexpected events.

 Average inventory (average quantity of the items normally in stock over

the specified period)

 Working inventory (amount of stock in the storeroom minus the

specified safety stock)
 Maximum Level
Maximum Stock Level

STOCK LEVEL

Minimum Level
Minimum Stock Level

Buffer Stock Level

Buffer Stock Level

Q1 Q2 Q3 Q4
Table: Ethiopian Pharmaceuticals SCM, Max-Min Levels in
months

LEVEL MINIMUM MAXIMUM

Center 9 15
Hub 2 4
Health Facility 2 4
Total 13 23
Challenges of Anti-TB drugs inventory management& Distribution

 Quality of report from TICs is not good

 Limited capacity of health professionals in TICs, TFCs
about MDRTB drugs management
 TICs distribution to TFCs are not standard
 No bin cards and IFFR practiced at TB clinics where TB drugs
are dispensed
 TFCs do not order/report/no legal way of reporting
 Discussion points
 How do you manage TB drugs in your facility?
 How and How frequently do you deliver SLDs to TFCs?
• How do you deliver the drugs to TFCs
Thank you!!!!