logistics manual for health ctr

Department of Drug, Food and Cosmetics - Ministry of Health

RACHA-1999 (Health Center Manual) 1

LOGISTICS MANAGEMENT MANUALFOR HEALTH CENTER

A Procedures Manual – August 1999



Introduction

WHO IS THIS MANUAL WRITTEN FOR?

This manual was written for you and other personnel who manage essential drugs andcontraceptive supplies. It is your job to order, issue, distribute, and store these commodities.You are the official designated Health Center Drugstore keeper.This manual is also provided to your Chief of Health Center as reference document for theHealth Center and also a guide for him to help you if you have problems.

WHY WAS THIS MANUAL WRITTEN FOR YOU?

This manual was written to provide standardized procedures and guidelines for the managementof essential drugs and contraceptive supplies. The manual will assist you to do the followingactivities:

• Determine supply needs

• Order, receive and store supplies properly

• Maintain adequate supplies

• Record and report accurate information about quantities of supplies dispensed

These procedures will help you manage your store effectively. By following them, you will then,be able to provide quality service to clients visiting your Health Center.



HOW SHOULD YOU USE THIS MANUAL?

This manual will assist you in doing your job. Take the time to look over the whole manual andbecome familiar with its contents. Then refer to it as you carry out yourresponsibilities.

Each chapter of the manual describes a specific logistics management activity, including:

• The purpose of the logistics management activity,• When the activity should be carried out,• Instructions on how to complete the activity, and• Examples illustrating the activity.

You will find a list of acronyms (abbreviations) and a glossary of logistics terms at the end of themanual. There are also annexes, which include copies of all recording and reporting forms youshould have to use to carry out your logistics responsibilities.

The following summary provides information on the contents of each chapter:

I. An Overview of the Cambodian Essential Drugs and Birth Spacing CommoditiesDistribution and Logistics Management Information System

This chapter describes the purpose and structure of the Essential Drugs andcontraceptives distribution and information system.

II. Logistics Management Responsibilities

This chapter describes and lists your responsibilities and the OD Pharmacist whosupervise you.

III. Storing Commodities

This chapter provides guidelines for receiving, storing, and maintaining the quality of thevarious commodities.

IV. Conducting A Physical InventoryThis chapter describes how and when you should conduct physical inventories of yourstocks.



V. Recording and Reporting

This chapter describes how to record consumption data and what to report using standardMoH forms.

VI. Reviewing Stock Status

This chapter describes how to calculate how many months of stock you have in yourfacility. It helps you determine if your facility is overstocked, under-stocked, or properlystocked, and what actions to take, if necessary.

VII. Calculating How Much to Order

This chapter describes how to calculate the quantity of commodities to order.

VIII. Monitoring and Supervision

This chapter describes Monitoring and Supervision activities in Logistics Management.

APPENDICES

Appendices include glossary of terms, acronyms, packaging symbols and all the variousMinistry of health standard forms you will be using during the workshop and at your workstation. It also contains the various exercises which you will be referring to during the workshop.



ITHE CAMBODIAN ESSENTIALDRUGS& OTHER COMMODITIESSUPPLY SYSTEM

How does it work?

MOH + DONORS

Essential Drugs Bureau Central Medical Store (EDB) (CMS) (Generate National demand) (National Supplier)

Distribution toRHs, FDHs and

HCsOperational

District Pharmacists Provincial need

The ideal Solution isAppropriate Demand =Appropriate Supply

Referral Hospitals , Former DistrictHospitals & Health Centers

Requestingthe RIGHT GOODS

in the RIGHTQUANTITIES

in the RIGHTCONDITION

to the RIGHT PLACE

at the RIGHT TIME

at the RIGHT COST.

Supplyingthe RIGHT GOODS

in the RIGHTQUANTITIES

in the RIGHTCONDITION

to the RIGHTPLACE

at the RIGHT TIME

at the RIGHTCOST.



Logistics Management helps you to understand how a system of inventory management works. Itwill also help you how to record your consumption and monitor the flow of commodities withinyour facility. The overall objective can be described as the Six Rights.

THE SIX RIGHTS

the RIGHT GOODS

in the RIGHT QUANTITIES

in the RIGHT CONDITION

to the RIGHT PLACE

at the RIGHT TIME

at the RIGHT COST.

HOW DO COMMODITIES GET TO YOU?

Essential Drugs and Contraceptives are moved from the Central Medical Stores to theOperational District Stores. According to the "New Health Coverage Plan", the Ministry ofHealth has divided the country up into entities called Operational Districts (OD).The Operational District will then redistribute to Referral Hospitals, Former Districts Hospitals,Health Centres and to Khum Clinics.

TO WHOM SHOULD YOU SEND INFORMATION?

You should send all relevant information to your Operational District Pharmacist who willforward them to the Provincial Drugs Dpt. who will then send all the reports to the EssentialDrugs Bureau (EDB). Based on this information, EDB and Central Medical Stores (CMS) willdecide to supply you the commodities at the appropriate time in the appropriate quantities.



WHO ARE INVOLVED ?

The following table briefly outlines the personnel within the structure of the Ministry of Healthwho are involved in the logistics management and distribution of essential drugs and birthspacing commodities to your health center.

Who Responsibilities WhenPerformed

* Dispense drugs and other commodities to patients andcompletes the Monthly Consumption Report

DailyHealthCentreStorekeeper

* Work out your total consumption and request re supply using“Drugs and Consumables Consumption report”

Monthlyor

QuarterlyProvincialPharmacist * Coordinate distribution of commodities

* Solve stock status irregularities including expired anddamaged drugs.

Operational

DistrictPharmacist.

* Process requests from all Referral Hospitals, Former DistrictHospitals, Health Centers and Khum clinics (with BirthSpacing Program).

* Calculate supply needs for OD and submit request to EDB.* Receive supplies from CMS and distributes them to Referral

Hospitals, Former District Hospitals, Health Centers andKhum Clinics.

Monthly

orQuarterly

orSix

monthly

* Screen and decide on quantities to be supplied to Ods

Send ODs requests to CMS

Quarterlyand Sixmonthly

E D B

* Estimate and advise on procurement process Yearly

• Process ODs requests

• Dispatch drugs and other commodities to ODs

Quarterly

orSix

monthly

CMS

* Procurement clearance Ongoing



IILogistics ManagementResponsibilities

As a Health Center Storekeeper, in matters related to logistics Management your dutiescan be defined as follow:(responsibilities of OD Pharmacist are also outlined for your information only as he/she isyour direct line of communication)

HEALTH CENTRE STORE KEEPER

1. Store Essential Drugs and Birth Spacing Commodities in the health centre storeroom inaccordance with MoH recommended storage guidelines.

2. Record all issues and receipts of stocks on Stock Cards.

3. Issue commodities according to “first expiry, first out” distribution.

4. Conduct a physical inventory of commodities monthly.

5. Complete the Drugs and Consumables Consumption Report and send it to the ODPharmacist.

6. Perform other tasks as appropriate.



OPERATIONAL DISTRICT PHARMACIST

1. Store Essential Drugs and Birth Spacing Commodities in the OD storeroom inaccordance with MoH recommended storage guidelines (if storeroom exists).

2. Record all issues and receipts of stocks on Stock Cards (if storeroom exists).

3. Store and issue commodities according to “first expiry, first out” distribution (ifstoreroom exists).

4. Conduct a physical inventory of commodities monthly (if storeroom exists).

5. Process "Drugs and Consumables Consumption Report" received from ReferralHospitals, Former District Hospitals and health Centers under jurisdiction.

6. Calculate supply needs for the OD and submit request to EDB via Provincial DrugsDpt.

7. Receive supplies from CMS and coordinate distribution of these supplies toReferral Hospitals, Former District Hospitals, Health Centers and Khum Clinics asappropriate.

8. React to Emergency Requests as appropriate.

9. Perform other tasks as required.



III

StorageGuidelines

WHAT IS THE PURPOSE OF STORAGE?

The purpose of storage is to protect the quality of commodities and package integrity so as toensure that drugs and other commodities reach clients in the best condition. If not storedproperly the shelf life of commodities may be shortened.

WHAT IS SHELF LIFE?

The shelf life is the length of time a product may be stored under idealconditions without affecting its usability, safety, purity, or potency.



Each commodity has a shelf life determined by the manufacturer. When the product reaches theend of its shelf life, it has expired and should not be distributed. You should be familiar with theshelf life of commonly used drugs.

COMMODITIES SHELF LIFE

Amoxycilline (250gr) 4 years

Cotrimoxazole (100+ 20mg) 4 years

DMPA 3 years (US manufacture)5 years (European manufacture)

O RS 3 years

Paracemtamol (100gr) 5 years

Penicilline G IM/IV (1 Mui) 4 years

Condoms 5 years



Generally, both the manufacturing and expiry dates are printed on drugs and birth spacingcommodities. However, some condoms may in some cases only have manufacturing dates.Always check for the expiry dates before dispensing commodities and do not dispensecommodities that have already expired unless authorized in writing (MoH Circular or MoHDirectives) by the Ministry of Health.

HOW DO YOU DETERMINE THE EXPIRY DATE?

TASK: Determining expiry date

COMPLETED BY: Health Centre Storekeeper or Designated Personnel

PURPOSE: To determine if a commodity has or has not expired

WHEN TO PERFORM: Whenever you are receiving, dispensing and storingcommodities

ACTIONS EXAMPLES

IF THEN

Manufacturing date isprinted on product or itspackaging (No expirydate given)

Add the number of years of theshelf life to the manufacturing dateto get the expiry date.

If you receive condomswith a manufacturing date of2/00, add the shelf life (5years) to this date. Theexpiry date will be 2/05.

No manufacturing dateis printed on the productor its packaging

Find the printed expiry date on thecarton, box or unit.

If you receive Paracetamol(tab. 100mg), there is nomanufacturing date on thecontainer, but there is anexpiry date.



WHAT ARE PROPER STORAGE GUIDELINES?

NO YES



HEALTH CENTRE STORES

TASK: Storing commodities

COMPLETED BY: Health Centre storekeeper or designated person.

PURPOSE: To protect commodity quality and package integrity while at thesame time making them available for use

WHEN TO PERFORM: When commodities are being stored

STORAGE GUIDELINES NOTES

(1) Clean and maintain store regularly. • Use disinfectant to clean the store.

• Use insecticide to eliminate insects andmouse traps to eliminate mice.

(2) Store commodities in a dry, well litand well ventilated storeroom – outof direct sunlight.

• Must have ventilation to let air circulatewell.

(must have exhaust area with grill or windowwith bars)

• Excessive heat and ultra violet radiationfrom sunlight reduces shelf life of certaincommodities.

(3) Secure storeroom from waterpenetration

Ensure security of store.

• Water can destroy commodities and soiltheir packaging.

• Always lock the store after duty hours.

(4) Assure fire safety device ( ormethod) is available and accessibleand that personnel are trained to useit.

• Do not allow smoking in the storeroom.

• A fire extinguisher is recommended butfailing that please ensure availability of apale of dirt and a spade.

(5) Store latex products (i.e. condoms)from electric motors and fluorescent

• Running electric motors produce chemicalthat destroys latex products.



HEALTH CENTRE STORES

lights.

(6) Store essential drugs separatelyfrom special programmescommodities and organise them intoalphabetical order.

• Store items for each national programmeseparately.

• Attach labels for each item torack/cabinets.

• Label plain container with commodityname (missing or erased original label).

(7) Store commodities in a manneraccessible for FEFO distribution,counting, and general management.

• FEFO or “first expiry, first out” is amodern distribution procedure wherecommodities which are older or which willexpire soonest are issued to other facilitiesor dispensed to users before newercommodities.

(8) Store heavy items on pallet.Ensure light and bulky items are storedon top shelf.

• No item should ever be on the floor.• No item should be piled higher than 2.5

mtrs off the floor (follow instructions onbox if stacking is required)

(9) Separate damaged or expiredcommodities.

• Damaged or expired must be listed andkept in a separate area within the store.

(10) Follow packaging symbols • Fragile commodities must be handled withcare.

( 11) All commodities MUST be storedwithin the storeroom (not in clinical units) • Commodities stored in different locations

lead to unaccounted losses.



WHAT IS “FEFO” AND HOW DO YOU FOLLOW IT?

FEFO means FIRST EXPIRY, FIRST OUT. Always issue commodities that will expire first.Never follow FIFO, First In, First Out unless shelf life is unknown.

TASK: Dispensing according to FEFO

COMPLETED BY: Health Centre store keeper or designated person.

PURPOSE: To ensure that commodities are distributed before they expire

WHEN TO PERFORM: Whenever commodities are issued

STEPS ACTIONS

1 Write expiry dates on outside of containers in large letters if necessary.

2 Arrange containers such a way that stocks to expire are stacked in front or on top ofstocks that will expire later.

3 Issue stocks from front to back or top to bottom so older stocks are issued first.



WHAT DO YOU DO WITH DAMAGED AND EXPIRED STOCK?

TASK: Handling of damaged or expired commodities

COMPLETED BY: Health Center Storekeeper or designated person

PURPOSE: To separate unusable from useable commodities from storage sothey are not distributed to clients

WHEN TO PERFORM: Whenever damaged or expired commodities are discovered

STEPS ACTIONS

1 • Keep damaged or expired commodities separately from usable stocks but stillwithin the store.

2• Note the quantity of expired or damaged stock as an adjustment on the

appropriate Stock Card and subtract the quantity from the "Balance".

• Write “expired or damaged” in the “Observations” column in red ink.

• Get the Health Center Chief to countersign.

3 • Every 6 months, fill in “Report of expired drug” and submit to OD on 30th Juneand 31st December.



WHAT DO YOU DO WHEN YOU RECEIVE COMMODITIES?

TASK: Receiving Commodities

COMPLETED BY: Health Centre Storekeeper/designated person

PURPOSE: To ensure that the right commodities are received in the correctquantity, in the right quality and that they are recorded in theappropriate manner.

WHEN TO PERFORM: Each time commodities are received

STEPS ACTIONS

1 Ensure that there is sufficient storage space.

2 Prepare and clean space to receive and store the supplies.

Go to the OD store to collect your supplies on the designated day.

IF THEN

Commodities arenot damaged orexpired

At the OD pick up point:1. Count the number of containers, boxes, or units

received.2. Check date, expiry date and quantity received

against quantity on invoices.3. Note any discrepancies on “Observation” column

of your invoice.4. Get OD Pharmacist and OD Chief to countersign

on the invoice.On arrival at your Health Centre1. Clear Admin. receipt form2. Arrange commodities in storage area to facilitate

FEFO distribution3. Enter the date and quantity received in Stock Card.

3

Commodities aredamaged or expired

1. Separate damaged or expired stock from usablestock.

2. If damaged or expired commodities are discoveredwhile receiving delivery from OD store, get ODPharmacist to acknowledge by countersigning.

3. If damaged or expired commodities are discoveredwhen goods have already reached your store,follow procedures for handling damaged or expiredstock.



HOW DO YOU DISPENSE COMMODITIES?

TASK: Dispensing Commodities

COMPLETED BY: Health Centre Storekeeper/designated person

PURPOSE: To ensure that a standard practice is adopted to dispensecommodities

WHEN TO PERFORM: Each time commodities are issued to end users.

STEPS ACTIONS

1 Check the prescription or request from other clinical units.

• ensure that the prescription bears a # and that is appropriate for the age, sexand weight of the patient

2 Dispensing

• Find the required commodity, check the expiry date

• Count the quantity required and put away extra tablets back into thecontainer immediately.

• Use dispensing plastic bags to package commodities

• Teach the patient how to use the drug (when to take it, how much to take it,how often to take it). Also ask the patient to repeat back what you have justsaid to verify comprehension.

• Tell the patient to keep all drugs in a safe place at home and out of the reachof children

3 Recording

• Fill up the "Monthly consumption report"

• Cross check total quantity dispensed matches up with quantity issued fromyour store.



IVConductingA Physical Inventory

WHAT IS A PHYSICAL INVENTORY?

Physical inventory is the process of counting by hand the total number of each commodityheld in your store at any given time.

When you count and record commodities, they should always be counted in single units and notby boxes or cases.



HOW DO YOU CONDUCT A PHYSICAL INVENTORY?

TASK: Conducting a physical inventory

COMPLETED BY: Health Centre Storekeeper or designated person.

PURPOSE: 1. To verify the quantity of usable stock available fordistribution2. To identify discrepancies between actual supplies and theStock Card3. To detect expired items4. To provide opportunity for store re-organization

WHEN TO PERFORM: 1. When you are ordering your re supply (monthly or quarterlyand on 31st December2. Any time you think there may be discrepancies in the amountsof usable stocks available.

STEPS ACTIONS NOTES

1 Separate and count any expired ordamaged commodities.

To avoid counting them as useablestock.

2 Count every useable commodity byhand.

Be sure to include stock held instorerooms.

3 On the Stock Card, record the date of thephysical inventory, the words “PhysicalInventory,” any losses or adjustments,and the quantities counted in red ink.

Record any adjustments in“observation” column of the Stock Card,indicate reason if known .

Record the useable quantity counted inthe “Balance” Column.

4Re-organize all commodities accordingto expiry dates to comply with FEFO(first expiry, first out) distribution.

Follow FEFO during routine receipt andmanagement of commodities.

Any losses and adjustments should be written on the Stock Card before the entry for thephysical inventory. After recording a physical inventory on the Stock Card, skip a line, leaving itblank, and begin recording the next month transactions on the next line.



VRecording andReporting

WHY RECORD?

Recording stock movements are very important tasks as this will enable you to monitorconsumption as well as enabling you to determine your Health Center's needs.

The following table lists what you need to record, which forms you need to record data on andwhen and whom you should send the information to:

Level Designation Records and Reports When ?

Stock Card During theMonth

Monthly Consumption Report Daily

Drugs and Consumables Consumption Report(MPA)

Monthly orQuarterly

Invoice (from OD) Monthly orQuarterly

Report on Expired Drugs Six monthly

HealthCentre

Storekeeper

Yearly Data Collection Form Yearly



HOW DO YOU FILL IN THE FORMS?

Below you will find detailed instructions for completing the various forms. .Please refer to theseinstructions when completing the forms.



A. Stock Card

TASK:

COMPLETED BY:

PURPOSE:

WHEN TO PERFORM:

Filling in the Stock Card

Store keeper/designated personnel

1. To maintain a continuous record of all commodities transactions.2. To record results of a physical inventory

Each time you:1. Receive and issue commodities

2. Update biweekly stock adjustment3. Record stock loss or stock loss or stock adjustment

4. Conduct a physical inventory5. Whenever there is a change of store keeper

STEPS ACTIONS NOTES EXAMPLES

Always start the top of each page of the Stock Card with the words “Balance Forward” and thequantity brought forward for the last entry of the previous Stock Card.

1 Commodity name, dose,form: Enter the particularsof the item as listed in theEDB standard description.

Acetyl salicylic acid

AA01 tab (500mg.)

2 Date: Enter the date of thetransaction.

At end of month the dateentry should be from…to

01/04/00 to 31/04/00

3 Invoice #: Enter deliverynote number of the itemreceived or issued.

For received goods only Invoice #: 0039

4 Supplier/Destination:Indicate where you got thecommodity from or whereyou dispense it to.

Delivery from OD

5 Incoming: Enter the exactamount of the productreceived on this date orperiod.

Stock returned from othersources or transferred fromone facility to another shouldbe recorded as a receipt.

Donation from MSF



6 Outgoing: Enter the exactamount of the productissued on this date.

Do not record "expired ordamaged" quantities

7 Balance: Add any receiptsor adjustments and subtractany issues or losses fromthe existing “balance” todetermine the new“balance.”

Write this figure in the“balance” for this date.

This column should alwaysrepresent the amount of thisitem presently in your store.

When conducting a physicalinventory, always record theexact amount counted. If thephysical count does not matchthe amount recorded in thiscolumn, review the issues andreceipts against the deliverynotes, check the math, notethe reason of adjustment inthe "Observation" column andupdate the figure in the“Balance” column.

Condoms quantity onHand = 143,000

Physical Inventory =143,000

(- 300) (damagedstock)

8 Expiry Date: RecordExpiry Date in the Expirydate column.

For receipt only 02/05

9 Observations: Clarifyentry

enter amount and explanationsuch as "damaged", "expired"or dispensed for specialpurpose.

(100) Damaged

After recording a physical inventory on the Stock Card, skip a line, leaving it blank, and beginrecording the next month transactions on the next line.

When you have completed a stock card for a product, attach a new stock card to the top of theold card and write the words “Balance Forward” on the line and the quantity brought forwardfrom the old card in the first “Balance” space on the new card.

On first of January of each year: Conduct a Physical Inventory count and record quantity foundin the "Balance" column and write across "balance brought froward" from last year.



B. Monthly Consumption Report

This Monthly Consumption Report is intended to be used as a draft document in whichconsumption data will be summarily transferred onto the Drugs and Consumables ConsumptionReport at the end of the month or quarter.

TASK: Filling Monthly Consumption Report

COMPLETED BY: Health Centre Store keeper or designated person.

PURPOSE: To record daily consumption of each commodity dispensed bythe Health Centre.

WHEN TO PERFORM: Daily.

MATERIALS NEEDED: All daily prescriptions, requests from clinical departments.

STEPS ACTION NOTES EXAMPLE

1 Date: Enter the date coveringperiod the consumption took place

From...... to.........

2 Daily task: list date and quantitydispensed for each commodity.

10/02/00ORS: 100

3 Biweekly task: add total amountdispensed for each commodity overthe past 2 weeks and enter it into"TOT" column.

10+12+11+8+22+10+15+25+19=

ORS: 123

4 Monthly: Aggregate all sub totalsand Enter the amount in the lastcolumn (G. Tot)

This is the monthlyconsumption for eachcommodity.

231+329=325

Data transfer and filing

Transfer data at the end of each month and update the stock card, from column (G.Tot) to "Outgoing column" of the Drugs and Comsumables Consumption Report.

Some health centres keep a separate manual Dispensing Register, you may do so if this practiceis helping you but it is not a requirement. This form is to be kept ate the health center for yourrecord, you are not required to send it to the OD.



C. Drugs and Consumables Consumption Report

The Drugs and Consumables Consumption Report is the form used by Health Centre to recordinformation on stock level and the volume of commodities received or dispensed. Based on thesedata, the Health Centre can then determine the quantities of commodities to be ordered for thenext period.

TASK: Filling Drugs and Consumables Consumption Report


PURPOSE: To report monthly consumption, stock level and quantityrequired for the next period ,of each commodity by the healthcentre, .

WHEN TO PERFORM: Monthly or quarterly (on day designated by OD)

MATERIALS NEEDED: Completed Monthly Consumption Report, updated stock cardsand applicable calculation formula .


1 Particulars: Enter the name of yourfacility and its location

This confirm theidentity of yourfacility

Health Dpt:Siemreap.OD: Kralanh.Facility: PreyChrouk HealthCentre.

2 # of OPD: Enter the Total # of outpatients for the review period.

This reflects yourlevel of activity foryour review period

# of OPD: 350

3 Month: Enter the month (or quarter) forwhich data are being reported.

Month: JuneQuarter: Jan-Mar.

4 Year: Enter the year for which data arebeing reported.

Year: 2000



5 Initial Stock: Enter amount as shown onstock card.

This must be aPhysical Stockcount of all locationswhere the commoditymay be stocked.

ORS : 10

6 Incoming: Enter total amount receivedfrom OD or any other source duringreview period (adhoc donations)

Ensure that thisamount matches upwith details ofincoming as shown inStock card

ORS : 41

7 Total: Add “Initial Stock” with“ Incoming”

The stock card recordmust be revealing thesame total

ORS10+41 = 51

8 Outgoing: Transfer data from column(G.Tot. ) of “Monthly ConsumptionReport.a) If monthly supplied then use only

one

monthly Totalb) If quarterly supplied then use Total of

3 months

Double check foraccuracy.Verify on Stock card.Ensure that the # ofOPD is alsotransferred.

G.Tot. column ofMonthlyConsumptionReport =Outgoing Columnof Drugs andConsumablesConsumptionReport.

9 Balance: Conduct Physical Inventoryand enter the quantity found.

Verify stock card anddelivery note if indoubt.

10 Request Qty: Request Qty based onappropriate formula.

See How to Ordersection

11 Observation : Utilise this column toindicate any relevant information whichyou may want to inform the ODPharmacist.

Amount listed in thecolumn are excludedfrom amount listed inthe "Balance" column

Damaged Expiredor donations tothird parties.

12 Signature/Date: Write your signatureand enter the date when the form wascompleted and get your Health CenterChief to coutersign.

So SovannStore Keeper,9 Feb.00Tep Bunla HealthCenter Chief9 Feb. 00

Note: This document must be done in duplicate, one copy is to be sent to the OD and the secondcopy is to kept at the Health Center for archives.



D. Invoice

This document is used as formal detailed receipt from the OD to the Health Centre. It lists thequantity of each commodities supplied following submission of your request.

TASK: Receiving (collecting ) supplies from OD store

COMPLETED BY: Health Centre Storekeeper or designated Person

PURPOSE: To acknowledge receipt of stock from OD.

WHEN TO PERFORM: Whenever you are collecting or (receiving) stock from OD.

STEPS

ACTIONS NOTES EXAMPLES

1 Particulars: Must check toensure it is your HealthCentre.

HC may have similarname

OD: Mongkol BoreyHealth Centre: Poipet 1

2 Supply Quantities: Conductmanual count for eachcommodity.

Ensure that quantity listedagrees with manual count

Multivitamines

Qty. on Invoice = 4500Manual count = 4500

3 Observations: If stock isdamaged, use this column toindicate the amendedquantity and get ODPharmacist to countersign.

Amount must be enteredin words and in number inthis column

Paracetamol 100gr

Qty on invoice : 5000Amended qty : 500-4500.

4 Signature/date: Ensurelogistics personnel presentcountersign your invoice.

Note: When receiving stock conduct quality spot check by opening a few boxes to ensure that youreceive useable and un-expired commodities.



E. Report on Expired Drugs

TASK: Completing Report on Expired Drugs

COMPLETED BY: Store keeper or designated person

PURPOSE: To report to OD about volume of “damaged andexpired drugs commodities”.

WHEN TO PERFORM: Send report and stock to OD (Twice a year :June 1st

and Dec 1st of each year)

STEPS ACTIONS

1 Add up and list all "Expired and Damaged" commodities during the past 6 monthsand verify amount deducted from the Stock Cards.

2 Fill in and send report to OD on 1st June and 1st December

(The report must be in triplicate :One copy for the Health Centre, second copy forthe OD third copy to be lodged in the box contained the “damaged and expireddrugs”).

Note:- You are not to destroy or issue these "damaged or expired"commodities.- Damaged or Expired Drugs of National Programme must be compiled separately.



F. Yearly Data Collection Form

The Yearly Data Collection Form is to be submitted to OD no LATER THAN 31 January ofeach year. It is your end of year Physical Inventory for your store. It is very important thatEVERY commodity is accurately counted and reported. If wrong quantities are reported EDBwill not be able to accurately supply your facility according to your consumption level.

TASK: Filling Yearly Data Collection Form

COMPLETED BY: Health Centre Store-keeper or designated person.

PURPOSE: To conduct a year-end physical inventory.

WHEN TO PERFORM: Between Dec 31st - Jan. 31st of each year.

MATERIALS NEEDED: Records from the following forms from 1st Jan to 31 dec. for theyear:

a) Stock Cardsb) Drugs and Consumables Consumption Reportsc) Invoicesd) Report on expired drugs


1 Particulars : Enter the nameyour facility and its location

Fill in as appropriate Health Dpt: Pailin CityOD: Pailin

Facility: Sala Krau

2 Data age: 12 months cycle 01/01/00 – 31/12/00

3 Service Statistics:a) Yearly total # of Out patients

served

by the Facilityb) Yearly total # of In Patients

served by the facility.

This figure can beobtained by addingthe # of OPD (onTop Right handcorner of each Drugsand ConsumablesReport.

Total Number of OPD for2000

3380 Patients



4Data Source : where do you getthe Data from

q Stock Card

q Drugs and Cosummablesconsumption Reportq Monthly Consumption

Report

5 "Dispensed in 2000": This isyour facility yearly consumptionfor each commodity

This figure can beobtained by addingthe qty . dispensedfor each commoditylisted for the 12months period asrecorded on theStock Card

.

Acetyl Salicylic Acid(Tab. 500 gr.)Jan. issued : 5000Feb. issued: 7500

March issued: 9000--------issued: 10800

Dec. issued : 4500________________

Total

for 2000 : 36800

6 Filling "Lost/other in....."ColumnThis is the yearly total qty lost,damaged for each commodity.

This figure isobtained from

-Stock card records-Report on expireddrugs

Diazepam (Tab. 5mg.)Feb. 2000

Damaged : 350

July 2000Lost : 158

Total lostfor 2000 : 508

7 Filling "Stock on hand – Lastday of ....."column: This is amanual Physical count for eachcommodity on the last day ofyear 2000.

You MUST COUNTEACHCOMMODITY:1- accurately and

manually

2- count stock in alllocations

Mebendazole (Tab.100mg)

587

Note:- Stock Card of new year must start with PI count of the previious year.- This form must be completed in duplicate, one copy to be sent to the OD Pharmacist and onecopy to be kept for archives.



VIReview StockStatus

1. WHAT IS YOUR STOCK STATUS?

When you review your stock status you are determining how much of each commodity you haveavailable at your facility. You can review your stock status by simply counting the stockavailable, such as in a physical inventory. (See Chapter IV for procedures for conducting aphysical inventory.) This gives you an absolute quantity of stock available. But it is much moreuseful to know how long the stocks will last and if you have enough stock available until youreceive your next order. We usually refer to this as months of stock (MOS).

2. WHAT IS MONTHS OF STOCK?

Months of stock is the number of months a commodity will last based on the presentconsumption rate. When you review your stock status, you need to determine how many monthsof stock you have in your facility.By reviewing your stock status you will be able to know if your facility is under-stocked,overstocked or adequately stocked. If you are under-stocked, you may have to place anemergency order. (See Chapter VII for procedures for placing an additional order.) If you areoverstocked, it may be necessary to inform your OD Pharmacist.

To assist you in maintaining adequate stocks, a maximum month of stock.

3. HOW DO YOU DETERMINE MONTHS OF STOCK?The following formula illustrates how to determine how many months of stock of each item isavailable at the facility.

STOCK ON HAND MONTHS OFAVERAGE MONTHLY CONSUMPTION RATE = STOCK

“CHECK YOUR STOCK STATUS REGULARLY”

For facilities receiving monthly delivery, the maximum MoS is 2and

For those receiving quarterly delivery the Maximum MoS is 6



TASK: Determining months of stock (MOS)


PURPOSE: To determine if the health centre is adequately stocked to meetthe needs of your patients.

WHEN TO PERFORM: At the end of each month when you submit request to your OD.


1 Add the Total QuantitiesDispensed to Users from thecurrent month and the twomost recent months for eachcommodity.

These figurescome from themonthly totalsfound the “Drugsand ConsumablesConsumptionReport”.

Total ORS dispensed by theKonpomg Thkov HealthCentre:January 12,345February 12,452March 12,532

37,329

Total ORS dispensed is 37,329.

2 Divide the total by 3 to getthe average monthlyconsumption rate.

37,329 ÷ 3 = 12,443 averagemonthly consumption for ORSin kompong Thkov Healthcentre.

3 Divide the Stock on Handfor the commodity by theaverage monthlyconsumption rate for thiscommodity.

Get the Stock onHand from the“balance”columnof the StockCard..

Balance at end of March is60,900 pieces.60,900 ÷ 12,443 = 4.8 monthsof stock

Once you know how many months this commodity last you, then you need to determine whatactions to take. Use the following guidelines to help you decide if any action is needed.



TASK: Determining what actions to take once stock status has beendetermined for each commodity.

COMPLETED BY: Health Centre Store keeper or designated person

PURPOSE: To correct any overstocking or under-stocking discovered afterdetermining stock status

WHEN TO PERFORM: At the end of each month (or quarterly)

SITUATION INTERPRETATION DECISIONS

For monthly :MOS =between 1-2

For quarterly :

MOS= between 3-6

Stock status is adequate Monthly supplied:Re order to replenish stocklevel.

Quarterly supplied:Re order to replenish at endof cycle.

Monthly:Months of stock is greaterthan 2 months.Quarterly:

Months of stock is greaterthan 6 months.

The health centre is overstocked withthis commodity.

If some or all stock willexpire in the next fewmonths, notify your ODPharmacist who may want totransfer some stock to anotherdistrict that may be able todistribute it sooner.

Do not order any morestock of these commodities.

Monthly: MOS is 1 or less

Quarterly:

MOS is 3 or less

The health centre is under-stocked. Consult with Health CenterChief and investigate theincrease in consumption andtake appropriate action toreplenish stock level.



VIICalculatingHow muchTo Order

1. HOW TO ORDER COMMODITIES?

The Ministry of health through EDB and CMS is responsible for supplying Essential Drugs,Medical consumables and birth spacing commodities to OD and they in turn distribute to otherperipheral health facilities. Determining how much of each commodity to order and issue is acritical element in the logistics management.

Ø Each month, the OD Pharmacist determines how much stock each health centre, Referralhospital and Former District Hospital should receive based on the information sent in theirmonthly report.

Ø The OD Pharmacist determines how much to order for the district and submits the order to theEDB.

Ø The EDB review the orders (amend them as appropriate) and then passes them to CMS toprocess the delivery of these commodities to the OD stores.

Ø The OD Pharmacist then informs peripheral facilities to collect their orders.

The ordering and issuing of essential drugs and birth spacing commodities is integrally linked tothe reporting system. If the OD Pharmacist does not receive the “, Drugs and ConsumablesReport” from you, she can not determine how much stock your health centre needs. It alsomakes it more difficult for him/her to determine how much the OD should order. It is veryimportant that reports are submitted on time to ensure a consistent supply of commodities.

Currently, the Ministry guidelines for requesting commodities are based on formulas usingmonthly consumption criteria ( CMM – Consommation Moyenne Mensuelle or AMC – AverageMonthly Consumption)



There are 2 types of AMC :

a) AMC (Real) which can be defined as “Average monthly consumption” of an item based on theaverage monthly issuance during the most recent review (3 months). Therefore you mustcalculate AMC (Real) first before determining your request.

b) AMC (Standard) which can be defined as “Average Monthly consumption” as set by the EDB.

Currently the EDB has established the following quota:

Note: Buffer Stock and Security Stock and allocated on the one off basis only.

Total Quantity dispensed during last 3 monthsAMC (Real)=

3

Health Center Stock QuotaMonthly Supplied:

* 1 Month Supply (1AMC)* 2 Weeks Buffer Stock (0.5 AMC)* 2 Weeks Security Stock (0.5 AMC)

Quarterly Supplied:* 3 Months Supply (3 AMCS)* 6 Months buffer Supply (1.5 AMCs)* 6Weeks Security Stock (1.5 AMCs)



HOW DO YOU CALCULATE HOW MUCH TO ORDER FOR YOUR HEALTH CENTRE?

TASK: Calculating the quantity for each commodity to replenish yourstock level.


PURPOSE: To determine the quantity of each commodity to be requestedfrom the OD store.

WHEN TO PERFORM: Every month (or quarterly).

MATERIALS NEEDED: Completed Drugs and Consummables Consumption Report for thelast 3 months period (quarterly supplied) or last month (monthlysupplied).Updated stock cards


1 Calculating the AMC (Real). Aggregate amount listedfor each commodity incolumn “Grand Total”of the “MonthyConsumption Report” .

The totals dispensed tousers for ORS:

April 4,200May 4,600June 5,200

The 3 month total is14,000 sachets.The AMC is :

14,000: 3 = 4,667sachets



IF THEN

2 a)

Your AMC(Real) is lessthan or equalto the AMC(Standard)

b)

Your AMC(Real) isGreater thanthe AMC(St.).

c)

Special Case

Use the AMC(Real) tocalculate theamount to berequested.

You MUST usethe AMC (St.)

review periodand submitrequest basedon that.

Monthly supplied:Request = AMC(Real)x 2 –balance

Quarterly supplied:Request =AMC(Real)x 6 – balance

Monthly supplied:

Request = AMC (St.) x 2 – balance

Quarterly supplied:Request =AMC (St.) x 6 – balance

Breast feedingCampaign requiringhigh consumption ofIron tables.

AMC (Real) = 4,667AMC (St.) = 4,980Use AMC (Real)1. Monthly request:{4,667 x 2}- 2,975 = 6,3592. Quarterly request:{{4,667 x 6}- 2,975 = 2,5027

AMC (Real) = 4,667AMC (St.) = 4,980Use AMC (St.)1. Monthly request:{4,980 x 2}- 2,975 = 14,5852. Quarterly request:{{4,980 x 6}- 2,975 = 49,705

Target:Women patients: 400

Campaign will call fora need of: 2tabs/days/patient for 30days, therefore therequested quantityshould be:

400 x 2 x 90 days =

72,000



HOW DOES THE HEALTH CENTRE PLACE AN ADDITIONAL ORDER?

When the stock status at the health centre is at or below the emergency order point, the healthcentre staff should place an emergency order using the following procedure.

TASK: Placing an additional order

COMPLETED BY: Store-Keeper or designated person.

PURPOSE: To order supplies when stock levels are at or below theemergency order point.

WHEN TO PERFORM: Any time the stock level falls below the emergency order point.

STEPS ACTIONS

1 Write formally to the OD Pharmacist who will review the request and decide onquantity to supply

2 Write the words “ADDITIONAL ORDER” as letter’s subject.

3 List all the items you are requesting emergency supply, state your current stock onhand.

4 Include all the factors which lead you to request emergency supply:

-Increase of activities.-Health promotion activities.

-Responding to epidemic outbreaks/ natural disaster situations.



VIIILogistics Monitoringand Supervision

INTRODUCTION

Two of the most important responsibilities logistics personnel carry out are monitoring andsupervision. Monitoring and supervision are the backbone of an effective logistics system.Without continuous monitoring of logistics activities and supervision of the personnel who carryout these responsibilities, overall quality of the logistics system may weaken, which in turn mayjeopardize the quality of service provided to users. This section does not apply directly to youbut is useful to you as a guideline to ensure that you know what to expect from a Supervisionvisit.

WHAT IS "MONITORING"?

Monitoring is checking on a regular basis to ensure that assignedactivities are carried out.

WHY MONITOR LOGISTICS ACTIVITIES?

There are several reasons why logistics activities should be monitored on a regular basis:

Ø To ensure that clients are getting the commodities appropriately.

Ø To ensure that planned logistics activities are being carried out according to schedule;

Ø To ensure that all records are correctly maintained and reports are submitted timely;

Ø To ensure the right quantity of supplies are ordered.



WHAT IS "SUPERVISION"?

Supervision is the process of ensuring that personnel have the knowledgeand skills required to carry out their responsibilities effectively, andproviding immediate on-the-job training as needed.

WHY SUPERVISE LOGISTICS PERSONNEL?

There are several reasons logistics personnel should be supervised:

Ø To ensure they have the knowledge and skills they need to effectively manage the logisticssystem;Ø To identify performance weaknesses and to improve performance by providing immediate on-

the-job training as needed.

Ø To ensure that established logistics guidelines and procedures are being followed.

Most supervisors agree that if they are to be truly effective supervisors they must have the sameknowledge and skills as the people they supervise. In the logistics system this means thatsupervisors must be able to effectively carry out all of the responsibilities of the personnel at thelevel below them. The following are issues which require your attention in ensuring a successfulsupervision visit:• Ensure your records and reports are regularly updated.• Ensure that the store is clean and well maintained according to the storage guidelines.• Ensure that commodities are stored according to the guidelines.• Ensure that you are following the correct guidelines for ordering your stock

WHAT QUESTIONS DO GET ASKED BY THE SUPERVISOR?

1. Are logistics records being filled in completely and accurately? Are reports being submittedtimely and to the appropriate places?

(If not, do personnel know the how to fill in forms? Do they know the procedures forsubmitting records? If not, provide on-the-job training.)

2. Are commodities being ordered and issued according to established policies?

(If not, do personnel know the established policies regarding ordering and issuing? If not,provide on-the-job training.



3. Storage :a. Is storage area clean?b. Is storage area safe from water damage, mice or termite ?c. Is storage area well lighted and well-ventilated?d. Are condoms stored away from electric motors and florescent lights?e. Are cartons/boxes stored off the floor?f. Are cartons/boxes stacked away from walls?g. Are cartons/boxes marked with expiry dates?h. Are commodities stored in a manner to facilitate FEFO distribution?

(If not, do personnel have the required knowledge/skills related to storage? If not, identifyknowledge/skill deficiencies and provide on-the-job training.)

4. Are commodities being issued according to FEFO guideline (FIRST EXPIRY, FIRST OUT)?

(If not, do personnel understand principle of FEFO? If not, explain the principle of FEFOand provide ideas on how commodities should be stored to facilitate FEFO distribution.)

5. Have procedures to dispose of expired or damaged commodities been undertaken?

(If not, do personnel know the procedures? If not, review the procedures.)

6. Are stock levels at each facility adequate (not above the maximum quantity; not at anemergency order level)?

(If you think there is a problem, contact the OD Pharmacist who will take the necessaryactions to correct the situation.)

7. Check the Months of Stock understanding.Use the formula:

CALCULATING MONTHS OF STOCK

BALANCE ON HAND------------------------------------------------------ = MONTHS OF STOCK ON HANDAVERAGE MONTHLY CONSUMPTION



8. Are personnel correctly understand AMC values (Real and Standard )?

(If not, identify the knowledge/skill deficiency and provide on-the-job training.)

9. Are physical inventories being conducted and properly recorded in the Stock Card?

(If not, do personnel know how to conduct a physical inventory and why it is important todo so? If not, take a physical count of stock with the personnel and emphasize theimportance of conducting routine physical inventories. Demonstrate how to recordphysical inventory in the Stock Card.)

logistics manual for health ctr

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