early warning stock-out system (ewss) · définitions •stock out in ewss : situation which occurs...
TRANSCRIPT
Early Warning Stock-out System
(EWSS)
Julien Deschamps Regional Support Officer
WHO/IST Libreville
GDF-StopTB partnership
Scope of presentation
• Causes of stock out
• Consequences/Implication in Public Health
• Early warning stock out system
– Objectives
– Expected outcomes
– Méthodology
– Data collection system
– Stakeholder and responsability
Définitions
•Stock out in EWSS : situation which occurs when there is no medicines
available at central (+ regional in some countries) that may lead to
treatment interruption
• Stock-out « risk » : is when a stock level drops below the established
minimum reorder level
Order 1 Delivery 1
Procurement cycle
1
Quantif 1
Rupture
Q2 O2
D2 D2
Reorder
level
Delivery
time
Procurement cycle
2
Reception Storage
Quality Control
Warehousing at central
level
Distribution
Warehousing at regional
level
Delivery to patient
Pharmaceutical Information system
Data :
Forecasting
• Selection
• Quantification
Procurement planning
Procurement process:
•Funding
•Purchase
•Réglementation (registration…)
•Préqualification
Coordination & information
Quality Assurance &
Monitoring & Evaluation
Causes of stock-out
– Funding (unsufficiant)
– Disbursement (delay)
– Custom-clearance
– Registration
– No procurement
planning
– Mistake in
Quantification
5
Countries with Stock-outs per
Primary Cause (%)
6
Percentage of Countries with Stock-
outs (2007 – 2013)
Implication in Public Health
•As consequences of stock-outs of anti-TB medicines :
–Treatment interruption, relapse, development of drug-resistant TB
–Patients have to purchase medicines in private sector at their own
expense and without any assurance of quality of the medicines
–Get an alternative medicines which is not appropriate
–Dysfunction of the national drug procurement and distribution system
to health center
National procurement/
distribution system
Warehouse at
central level
Warehouse at
régional level
Regional forecasting
(tools, training…)
Delivery Order
Health
center
Health center
forecasting (tools,
training…)
Distribution
planning
- Dysfunction
procurement/distrib
(order/delivery)
Risk/Stock-out
- No capacity building
/PSM at Regional &
Helath center level
• Efficient planning at country level and stakeholders
coordination should help aligning the different
processes for the supply chain
• Technical support on PSM and implement a good
management information system at the country level
to avoid stock outs.
• Early information sharing with stakeholders / in
country & with International partners are key to avoid
stock-outs
9
Avoid/reduce stock out
Early Warning System
• Initiative : GDF-Stop TB Partnership
• Implemented : WHO/GDF-Stop TB Partnership
• Implementation level :
Réception
Stockage
Contrôle
qualité
Gestion centrale
des stocks
Distribution
Gestion périph.
des stocks
Dispensation/
Utilisation
Système d'information
de gestion pharm.
Centralisation des données
Estimation des besoins
• Sélection
• Quantification
Planification des
approvisionnements
Processus d'approvisionn
ement
NTP
WHO/GDF
Global level
National level
Early Warning System
•Objectives : track country-level information on stock of anti-TB
drugs and take correctives actions
Identify early potential stock-outs risk
Alert relevant stakeholder of risk so that appropriate action can
be taken in a timely manner
Develop adequate capacity in procurement-supply and stock
management at country level
Strengthen the National procurement and distribution
system
Early Warning System
•Outcomes expected : decrease number of countries with stock
outs with appropriate Early warning and preventive action :
Availability of funding (National, Global Fund…) & accelerate
disbursement
« Anticipate » placing orders & accelerate « lead-time »
(supplier)
Inter-country loan of drug
Redeployment of stock available in the counrty
Provide (if required) technical assistance for forecasting of future
needs
Méthodology
•Reporting frequancy : Trimestrial
•Responsible of reporting: NTP
•Data to inform :
– Stock (central and régional)
– Number of patient/category of treatment
• Tools to learn :
– Annexe 1 : Stock and availability data
– Synthesis Report
• Responsible for analyses : NTP et WHO
• Responsible to collect : WHO (Country and IST team)
Annex 1 :Stocks & availability Stock situation and availability
Colonne en gris et jaune : Remplir les informations
Colonne en blanc : analyser les informations dans la note
trimestrielle
Drugs/produits
de laboratoire
Dosage, form
and
présentations
Monthly
Average
Consumption
(CMM)
"physical »
stock at
central level
"physical »
stock at
regional level
Total
"physical"
stock
« real »
availability
Pending
delivery
Delivery
date
"prévisionna»
stock
(physical
stock +
Delivery)
"prévisional »
availability
(with pending
delivery)
RHZE
Comprimés en
ADF boites de
672 :
(150/75/400/2
75) mg 205 1828 0 1828 9
1428+2229
(prêt
Cameroun) =
3657 3256 27
RHE
Compriés en
ADF :
(150/75/275)
mg 35 277 0 277 8
168+446
(prêt
Cameroun)=
614 891 25
RH
Comrpimés en
ADF : (150/75)
mg 368 2347 0 2347 6 1470 3817 10
Streptomycine
Boites de 100
flacons de 1
gramme 27 351 0 351 13 351 13
RHZ
Comprimés en
ADF :
(60/30/150)
mg 76 1666 0 1666 22 1666 22
RH
Comprimés en
ADF : (60/30)
mg 151 3338 0 3338 22 3338 22
Republic of Central Africa/July 2013)
Date analyses in Annex 1
• Quality of data : « previsional » Monthly Average
Consumption
– Use of épidémiologic data (WHOGlobal TB report or annual data from
NTP)
– Tools : GDF, Union, MSH…
• Early Warning Indicator : Availability of the stock
Number of month of consumption available on stock :
– <8 months of stock : red alert
– 8<stock/12 month : orange alert
– >12month of stock : green
preventive action
Warning Indicator
•Early Warning Indicator : Global level
•M & E Indicators for PSM (WHO) : National level
– 12 warning indicator to prevent stock out in PSM system
– Objective : Monitoring and surveillance "routine" key elements of a
program / project-based record keeping, and regular reports.
– Ex ; Availability : % of treatment sites AntiTB have experienced a stock-
out of one or more antiTB during a defined period
Complementary to
Synthesis report
•Objectives : assist countries to analyses the stock and
availability
•Méthod : completing with annex 1 + other data (ex,
pending delivery)
•Informations requested :
– Stocks and availability (Cf. Annexe 1)
– Procurement in process & pending delivery
– Availabaility at regional level
– Recommandation and action plan
See. « synthesis report»
Data collection system
NTP : Fill and transmit the
data
1st day of
trimester
WHO country (NPO): Collect and analyze
the data
WHO AFRO :
Transmsit the alert & discussion on corrective actions: - Mails - Téléconférence
Trimestrial Publication : (ex ; Bulletin Epidémiologic)
Correctives Action
GDF (HQ) : Collect, analyses and alert
WHO IST (RSO):
Collect/analyze the data
Transmit the alert
data
Stakeholder and Responsability
Stakeholder Responsability
OMS/GDF (EWSS manager) * Manage and develop the EWSS (tools, procédure…)
* Import the country data to the system
* Screen the alerts generated
* Transmit the alerts to the pertinent stakeholder
WHO/GDF Regional Support Officer & Medical Officer
* Validate and follow-up the country data with the respective NPO and NTPs
* Recommandation to NTPs of remedial action in the case of alert
WHO/NPO * Validate and follow-up the country data with GDF/WHO RSO and Medical Officer
* Recommandation to NTPs of remedial action in the case of alert
NTP manager * Submission of data to WHO (NPO/RSO)
* Overall coordination of remedial action in the case of alert
NTP focal point for stock management
*Provision of drug-stock information
* Provision of patient enrolment data
Technical partners * Technical Assistance to collect and transmit EWSS data
* Capacity building for national counterparts
Donors * Identifying of critical weakness for improved resource allocation
DISCUSSION