medical shop mgt

8/12/2019 medical shop mgt

1/24

Medical stores management

Summary 44.244.1 Inormation or materials management 44.2

Manual versus computerized systems Procurementinformation Stock records Performance monitoring

and reporting Communications

44.2 Flow o stock and inormation 44.5Stock receipt Planning for space requirements Stockstorage Stock control using FIFO and FEFO Orderallocation Order picking Order assembly Order

dispatch and delivery Inventory taking

44.3 Zoning stock within the store 44.9Storage at uncontrolled room temperature Storageat controlled temperature and humidity Coldstorage Secure storage Flammables

44.4 Stock location within a zone 44.10Fixed location Fluid location Semiuid location

44.5 Stock classification 44.12Terapeutic or pharmacological category Alphabeticalorder Dosage form Random bin Commodity code

44.6 Stock storage and handling 44.13Packaging specications Shelving Floor

pallets Block-stacked pallets Pallet racking Load

handling

44.7 Housekeeping 44.15Cleaning and pest control Inspection Disposal of

expired or damaged stock Fire precautions Security

44.8 Human resources management in medical

stores 44.17Sta training and the medical stores proceduresmanual Sta supervision and discipline Career

development

44.9 Staff acilities 44.17Sanitary facilities Sta rest areas First aid

Reerences and urther readings 44.19

Assessment guide 44.20

Figure 44-1 Checking received goods 44.6Figure 44-2 Storage and load-handling equipment 44.14Figure 44-3 Good stores management 44.16Figure 44-4 Poor stores management 44.16Figure 44-5 Medical stores organizational chart 44.18

able 44-1 Inspection checklist or medicine receipts 44.7able 44-2 emperature and security zones 44.9able 44-3 ypical requirements or an effective cold

chain 44.11able 44-4 Contents o a procedures manual or a central

pharmaceutical supply system 44.19

Box 44-1 Examples o monitoring and evaluation targetsand indicators 44.5

CS 44-1 Central medical stores inventory control systemoperations in Namibia 44.3

Annex 44-1 Sample stock record card 44.21Annex 44-2 Sample bin/stock card 44.22Annex 44-3 Sample receiving report 44.23Annex 44-4 Sample requisition/issue voucher 44.23Annex 44-5 Sample delivery voucher 44.24Annex 44-6 Sample register o requisitions 44.24

Part I: Policy and economic issues Part II: Pharmaceutical management Part III: Management support systems

Planning and administration

Organization and management

43 Security management

44 Medical stores management

45 Hospital pharmacy management

46 Pharmaceutical management for health facilities

47 Laboratory services and medical supplies

Information management

Human resources management
http://www.msh.org/http://www.msh.org/http://www.msh.org/http://www.msh.org/


2/24

44.2 ORGANIZAION AND MANAGEMEN

44.1 Information for materials management

Te goals o medical stores management are to protectstored items rom loss, damage, thef, or wastage and to

manage the reliable movement o supplies rom source touser in the most economical and expeditious way. Effectivemanagement o inormation is the key to achieving thesegoals. Te integrated process is known as materials manage-ment. A ully developed system has three key components

1. Aninventory control system ensures that the rightgoods are acquired, in the correct quantities, monitorstheir quality, and minimizes the total variable cost ooperations (see Chapter 23).

2. Awarehouse management system monitors the physi-cal flow o goods within the system, such as receipts,storage, and issues.

3. Aperformance monitoring system checks that the sys-

tems are operating effectively.

Inormation is essential to management (see Chapter49). Collecting, processing, and disseminating inorma-tion may seem costly, but the cost o developing and main-taining an inormation system should be balanced againstthe costs o ineffective inventory control (see Chapter 23).Te design o the inormation system is important, but itssuccess depends primarily on well-trained, organized, andsupervised staff. Country Study 44-1 describes some o the

Tis chapter discusses medical stores management atcentral-level stores and at regional or district-level storesthat are independent rom health acilities. Tis supplymodel represents the traditional top-down system thatis operated by a governmental or parastatal entity or anongovernmental organization; however, a number ocountries have now decentralized many o their pharma-ceutical sector operations, including stores management.Chapter 8 discusses supply chain options, including thetrend toward decentralization. In addition, many supplysystems contract out certain operations to private-sectorcompanies. Managing contracts requires skills such asdefining and monitoring perormance indicators andnegotiating payment and service terms. See Chapter 39or more inormation on contracting. Te tenets o thischapter, thereore, apply to stores operating in either the

public (ofen called central medical stores) or nonpublicsectors.

Medical stores management should assist both the flowand reliability o supplies rom source to user as economi-cally and reliably as possible, and without significantwastage, loss o quality, or thef. Te primary purposeo a store is to receive, hold, and dispatch stock. Tismaterials management process is implemented throughinventory control and warehouse management systems,which may be manual or computer based. Te primarypurpose o inventory control is to manage stock andensure the smooth flow o goods by determining what,how much, and when to order stock. Consequently, itprovides essential inormation or procurement manage-ment. Warehouse management comprises the physicalmovement o stock into, through, and out o a medicalstore warehouse. Te systems should also be designed toprovide inormation or perormance monitoring.

Te ollowing are characteristics o a well-managedstores operation

Te store should be divided into zones that provide

a range o environmental conditions and degrees osecurity.

Tere should be an appropriate zone to suit everyitem to be stored.

Stock should be arranged within each zone accord-ing to some orderly system.

Stock should be stored off the floor on pallets, onpallet racks, or on shelves. Each o these systemsrequires specific types o handling equipment.

Good housekeepingcleaning and inspection, thedisposal o expired and damaged stock, recordingo stock movements, and the management o secu-rityshould be maintained.

Te management structure should be clearlydefined.

Staff should be appropriately qualified, trained, dis-ciplined, and rewarded.

Clearly written procedures and handbooks shouldbe available.

o promote efficiency, staff should have good work-ing conditions and acilities.

Stock should be verified regularly and periodicaudits should be conducted.

Although the essential characteristics o materials man-agement are the same or all systems, the level o sophis-

tication o medical stores varies widely, and each storeapproaches its system and documentation differently.Tereore, the basic eatures presented in this chapter areadaptable, depending on the complexity o the medicalstores management operation.

S U M M A R Y


3/24

44 / Medical stores management 44.3

inventory control system challenges to the central medicalstores in Namibia.

Manual versus computerized systems

Te inormation system must include data on products

entering and leaving the warehouse, products in stock,products on order, and ways to monitor the progress oorders in the supply pipeline. Key elements o the system arewell-designed orms, computerized inormation systems,and clearly defined procedures.

wo decades ago, most public supply systems reliedcompletely on manual stock records, but now, many pro-grams have changed to computerized systems. Even withcomputerization, however, many countries still maintaina manual system, such as bin cards, as a backup, espe-cially during the transition to computerization. Tere is awidely held belie that computerization solves the problemo inventory control. Tis belie is misguided. A computer

is not a substitute or trained staff; it is simply an addi-tional tool or staff to use (see Chapter 50). Both manualand computerized systems perorm the same undamentalinormation-processing tasks: data input, data storage, dataprocessing, data retrieval, and data dissemination. Te di-erence is that a computerized system enables some tasks

to be accomplished more rapidly, accurately, economically,and flexibly. Even with a computerized system, data mustbe entered, manipulated, and interpreted by skilled andknowledgeable staff.

Procurement information

Te procurement process (Chapters 1821) involves medi-cal stores input at all levels o the distribution system. Teseinputs are described below.

Procurement can be handled rom a department withinthe medical stores or rom an external unit. Te medicalstores unit provides the (internal or external) procurementunit with a list o the types and quantities o medicinesneeded or its operation. Afer a supplier is selected and apurchase order is placed, the procurement unit inorms themedical stores unit about suppliers, unit prices, the quanti-ties on order, the expected arrival dates o shipments, andother vital inormation.

Te procurement unit tracks inormation on inventorystatus, new shipments received and taken into stock, issuesmade to health acilities, expired medicines, damaged medi-cines, and audit data rom physical stock checks.

Te medical stores unit also tracks issues to individualhealth acilities, noting methods o transport, delivery

Namibia operates a classic central medical stores (CMS)

distribution system with a CMS and two regional medi-cal stores. Administratively, the regional stores do nothave any links with the CMSthe relationship betweenthem is one o customer and client. Te CMS distrib-utes medicines and supplies to the two regional medicalstores, all district hospitals, and local hospitals and clinicsin the surrounding regions, while the regional stores anddistrict hospitals are responsible or distributing to otheracilities within their geographic jurisdictions.

Facilities are expected to order products rom CMS everysix weeks, and it usually takes CMS about our weeksto process and deliver the order. An assessment o theCMS distribution showed, however, that stock recordswere not adequately maintained and physical inventorycounts did not correspond with either stock records orcomputerized records. Because the regional stores andhealth acilities had no effective systems or decidingwhen, what, or how much to order, most acilities endedup placing many emergency orders within the six-weekorder period, which stretched the capabilities o thealready overburdened CMS.

A computerized inventory control system had been

installed at the CMS several years earlier, but most o thestaff members who were initially trained to use it had lefthe public service; remaining staff members, thereore,were not using the system to its ull advantage. Manyunctions that could have been handled by the systemwere done manually or with spreadsheets. Moreover,management personnel reported that they did not haveenough time to acquire the additional skills that wouldhelp them use the system.

As a result o the CMS assessment, a number o recom-mendations to improve the inventory control systemwere made: conduct complete physical inventory countsat all levels and use the results to update or introducestock records; develop standard operating procedures orstore management; and train staff on how to maintainstock records and use the computerized inventory con-trol system to their best advantage.

Source: Management Sciences or Health/Rational PharmaceuticalManagement Plus Program.

Country Study 44-1

Central medical stores inventory control system operations in Namibia


4/24


times, and confirmation o receipts rom user units. Tistracking should generate inormation on the monthly andannual value o total issues, issue quantities, details o spe-cific products, and how budget allocations are used.

Afer an order has been placed, its progress should bemonitored until it is received at the central medical stores

(CMS). A good monitoring system makes it possible toestimate realistic delivery times and to decide whether anysupplementary or emergency orders are needed, well beorea stockout occurs.

Both manual and computerized systems should identiymilestones during the lead-time period to acilitate com-munication with suppliers and to prompt corrective actioni required. Important milestones o the procurement leadtime are

Order initiating date Date o award to supplier (or tenders) Letter o credit inormation

Shipment inormation and date Arrival at port Port-clearing date Date o issuing a receiving report

An effective supplier inormation system should includegeneral inormation on suppliers and products, lead times,merit ratings, value o purchases, product quality, paymentmethods, and prequalification based on good manuac-turing practices. Inormation about supplier perormanceshould be compiled throughout the procurement cycle toassist in choosing uture suppliers. Chapter 21 discussesthe eatures o a procurement inormation system in more

detail.

Stock records

Stock records contain inormation about suppliers, custom-ers, prices, stock receipts, stock issues, stock losses, and stockbalances. Tese data are essential or planning distribution.

A stock record (manual or computerized) must be main-tained or each item in the inventory. Te stock record docu-ments all transactions relating to an item. It may containinormation about reorder level, reorder interval, reorderquantity, lead time, stock on order, and estimated consump-

tion rate. Many stores also maintain bin cards or each prod-uct in each storage area to record inormation on issues,receipts, and stock balances. In some stores, this bin cardis the most current and accurate record o inventory move-ment.

Te design o stock cards and bin cards depends on thechoice o inventory control system. For details regardingthe design, selection, and use o different types o inventorycontrol systems, see Chapter 23; examples o a stock recordcard and a bin card are provided in Annexes 44-1 and 44-2.

When a shipment o medicines is received at the CMS, itis inspected to ensure that it meets the specifications in thesupply contract. I the shipment is satisactory, the receivingsection o the warehouse produces a receiving report (seeAnnex 44-3). Tis report brings the procurement lead-timeperiod to an end.

Individual health acilities are the end users o medi-cal supplies. Maintaining inormation rom health acili-ties is essential in order to monitor consumption, orecastpharmaceutical requirements, and make other manage-ment decisions. Many medical stores inormation systemsalso keep general inormation on acility location, acilitystatus, population served, method o distribution, deliveryschedule, value o issues, and extent o current budget uti-lization.

Performance monitoring and reporting

A store should monitor and evaluate its operations to

identiy problems in the system that need to be addressed.Record-keeping and reporting systems should be designedto make the collection o data or routine monitoring assimple as possible (see Chapter 48). Stock records are a

vital source o inormation on how effectively the dis-tribution system is being managed; thereore, maintain-ing these records accurately and keeping them up-to-dateis vital. Tey provide detailed evidence o how prod-ucts flow through the system and can be used to identiywhere problems are occurring so that corrective actioncan be taken. Operational indicators can track progressat two critical levels: rom the supplier to the store, orupstream, and rom the store to clients, or downstream.

Upstream inormation includes lead-time rom supplierto the store, number o medicines procured, and monthlystock status reports. At the downstream level, the storeshould collect routine lead-time inormation; distributioninormation by acility, district, and product; client sat-isaction and consumption data; and order-fill rate. Box44-1 shows a list o sample indicators. Te medical storesshould prepare regular reports on stock and order status,such as those described in Chapter 23, and send themto relevant parties such as the ministry o health, pub-lic health programs, donors, lower-level warehouses, andhealth acilities.

Communications

Te medical stores must maintain effective communica-tions with suppliers, with procurement and inventory con-trol units, with lower-level warehouses and health acilities,and with managers rom the ministry o health. Periodicmeetings with the staff members o client acilities can helpensure good communications and a more effective supplysystem.


5/24


44.2 Flow of stock and information

Stock, and the inormation that accompanies it, should flow

through the warehouse in an orderly manner. Tis processhas six stages

1. Receiving:Goods that arrive in the receiving room arequarantined, inspected, and i ound to be acceptable,entered into the stock-recording system. Receivingreports are prepared.

2. Storage:Accepted goods are moved to their allocatedstorage positions in the warehouse, where they arestored in first-in/first-out (FIFO) or first-expiry/first-out (FEFO) order. Records or stocks on hand and onorder are adjusted.

3. Allocation of stock: In most medical stores, the managerdetermines whether to allocate the complete quantitiesrequested when a requisition is received. Te deci-sion can be made in collaboration with the requestingacility but generally depends on stock status, a reviewo acility consumption patterns, and, in some cases,budget status.

4. Order picking: An order-picking list is prepared (thismay be the original requisition orm rather than aseparate list). Workers use this list to identiy and col-

lect the allocated items rom the warehouse.5. Order assembly: Individual orders are assembled and

checked in the packing area. Tey are then packed ordelivery. Delivery documentation is prepared.

6. Dispatch and delivery:Te packed goods are heldin designated secure areas pending shipment, then

loaded onto the transport and dispatched, accom-panied by the necessary documentation, including apacking list recording all items and quantities. Ideally,an invoice showing unit costs o medicines and total

value should accompany the shipment. Signed deliverynotes are checked when the vehicle returns. I errorsor damage have been reported, appropriate action istaken.

Formal and inormal physical stock counts shouldbe taken regularly to ensure that stock is being correctlyhandled and that losses and inaccuracies are properlyaccounted or.

Stock receipt

Importation and port clearing are described in Chapter 24.Te procedure outlined here assumes that those tasks arecarried out by an import unit attached to the CMS. Portclearing may, however, be contracted to a clearing agent ormade the responsibility o the supplier. In such cases, thegoods are delivered directly to the CMS or are collectedrom the agents warehouse. Final responsibility or inspec-tion remains with the CMS.

With the exception o locally purchased items, multiplecopies o the suppliers shipping documents and suppliers

invoice should be received by the CMS beore supplies arriveat the port o entry. Tis inormation is recorded on a man-ual or computerized orm to track each purchase order. Inaddition, the import unit should record the arrival inorma-tion. Tis advisory is clipped to the purchase order in thesuppliers file to await the arrival o the shipment.

When notice is received o a shipments arrival at the port,the necessary customs orms are completed. It is always nec-essary to visit the port to arrange or the release o the ship-ment.

Containers are inspected against the suppliers shippingdocument. Te first part o the receiving report is completed

(Annex 44-3). Any apparent damage and missing shippingcases are noted and reported to the port authorities, insur-ance agents, and customs officials.

When the shipment arrives at the warehouse receivingarea, contents should be quarantined until they have beenchecked (Figure 44-1). Te receiving clerks systematicallycheck the cases and their contents against the suppliersinvoice. Discrepancies, variations, and damage are notedon the invoice. A prompt and thorough inspection based onpredefined criteria is essential to quality assurance and as a

Number o sites to which medicines aredistributed

Quarterly report delivered on time Payment voucher processing time Number o patients receiving treatment Percentage o medicines that are wasted (as

a result o breakages, expiries, pilerage) as aproportion o overall stocks

ime elapsed rom order receipt by store untilshipment receipt by client

Order processing time within the store Lead time between the supplier and the store Lead time between the store and the client Forecast or store commodities completed

Percentage o commodities out o stock in servicedelivery sites Percentage o products tested or which a quality

problem was detected Percentage o shipments to service delivery sites

that are consolidated Percentage o cost savings as a result o price

negotiations

Box 44-1

Examples of monitoring and evaluation

targets and indicators


6/24


Figure 44-1 Checking received goods

QUARANTINEINCOMING GOODS

RELEASE INTO STOCK

REPORT INSPECT

ACCOUNTSREPORT

RECEIVINGREPORT

DISCREPANCYREPORT

CLAIMS

SAMPLE

CHECK DOCUMENTS

RECEIVINGDE

PT.

Procedurefo

r

receivinggoo

ds

andquarantin

e

INSPECTIONTEAM Interdepart-mentalcommunication Createreceivingreport

INSPECTIONTEAM

Endorse

receiving

reportorissue

discrepancy

report

Processclaim

formUpdaterecords

INSPECTIONTEAMCriteriaforchecking

tospecifica-tions? correctquantity usableordamaged?

QUALITYASSURANCE Protocolforsampletesting Samplerecords


7/24


precursor to any insurance claim. able 44-1 is a checklistwith sample inspection criteria.

Te annotated invoice is signed and dated by a senior staffmember. Observations are summarized on the second parto the receiving report.

One copy o the receiving report is filed according to the

purchase order number to which it corresponds. Te othercopy and the annotated suppliers invoice are passed to thestock control section. In some warehouses, a separate copygoes to the accounting department.

Te items are then entered on their respective stock recordcards (Annex 44-1). Te new stock on hand and on ordertotals are calculated, as well as the average cost per unit oreach item. I a computerized system is used, receipts areentered into the system as prescribed in the sofware manual.

Planning for space requirements

As mentioned in other chapters, the massive increase in

unding or pharmaceuticals rom global health initiativessuch as the Global Fund and the U.S. Presidents Emergency

Plan or AIDS Relie has increased the storage and distribu-tion volume needed in some countries by two- or threeold.In addition, managing these strategic stocks can be chal-lenging; or example, in the case o what to do with deadstock that never gets issued. Stores, thereore, need to workcareully with their clients to communicate about scale-up

o initiatives such as antiretroviral therapy and distribu-tion o bed nets to prevent malaria that will affect space anddistribution planning and to develop policies on managingstrategic stock.

Stock storage

Afer incoming stock has been checked and approved, it isormally released rom the receiving area and moved to thewarehouse to be stored in the appropriate zone. New stockmay be stored on floor pallets, pallet racks, or shelves. I afluid or semifluid location system is used (see Section 44.4),the exact location o each item must be recorded. I a bin

card system is in use, receipts should be entered on the bincard when the items are transerred to the storage area.

Table 44-1 Inspection checklist for medicine receipts

Product Notes Checklist

All shipments Compare the goods with the suppliers invoiceand original purchase order or contract. Notediscrepancies on the receiving report.

Take a sample for testing (if preacceptancesampling is a standard procedure).

Number of containers delivered is correct Number of packages in each container is correct Quantity in each package is correct Drug is correct (do not confuse generic name and brand name) Dosage form is correct (tablet, liquid, other) Strength is correct (milligrams, percentage concentration, other

measurement) Unique identifiers are present, if required (article code, ministry of

health stamp, other code) No visible evidence of damage (describe if present)

Tablets For each shipment, tablets of the same drugand dose should be consistent.

Tablets are identical in size Tablets are identical in shape Tablets are identical in color (shade of color may vary from batch

to batch) Tablet markings are identical (scoring, lettering, numbering) There are no defects (check for spots, pits, chips, breaks, uneven edges,

cracks, embedded or adherent foreign matter, stickiness) There is no odor when a sealed bottle is opened (except for flavored

tablets and those with active ingredients normally having acharacteristic odor)

There is no odor after tablets have been exposed to room air for 20 to30 minutes

Capsules For each shipment, capsules of the same drugand dose should be consistent.

Capsules are identical in size Capsules are identical in shape Capsules are identical in color (shade of color may vary from batch

to batch) Capsule markings are identical There are no defects (check for holes, pits, chips, breaks, uneven edges,

cracks, embedded or adherent foreign matter, stickiness) There are no empty capsules There are no open or broken capsules

Parenterals Parenterals are all products for injection(IV liquids, ampoules, dry solids forreconstitution, suspensions for injection).

Solutions are clear (solutions should be free from undissolved particles,within permitted limits)

Dry solids for use in injections are entirely free from visible foreignparticles

There are no leaking containers (bottles, ampoules)


8/24


Stock control using FIFO and FEFO

In order to avoid accumulation o expired and obsoletestock, items should be stored and issued on a FIFO or FEFObasis, according to the ollowing guidelines.

Te stock control system must record the expiry date and

the date o receipt. Stock must be stored so that earliest-expiring or first-delivered batches can be picked and issuedfirst. When small quantities are involved, this goal can beachieved by placing the newly received stock at the back othe shel behind the existing stock. When larger quantitiesare involvedor example, several pallet loadsthe newlyreceived items can be placed on the upper levels o the palletracking. Tey remain there until the older stock has beenissued. Te picking stock is kept in an accessible position,assuming that orders are picked by hand in relatively smallquantities. In warehouses where whole pallet loads arepicked or distribution to lower-level stores, accessibility isless o a concern because mechanical transporters are used.

Newly arrived stock sometimes has an earlier expiry datethan a previously received batch o the same item. I a FEFOsystem is used, this stock should be promoted so that it isissued beore later-expiring stock. Making this adjustmentis particularly important with products that have short shellives, such as vaccines.

Note that the system or stock rotation may be determinedby the scheme or price increases, i medicines are sold toclients. I pricing is done on a FIFO basis, this system shouldalso be used or stock management, except when newerstock will expire beore it can be used under a FIFO rotation.

Order allocation

Under a pull distribution system, lower-level stores andhealth acilities submit requests, or requisitions, or supplies.At most medical stores, a designated official is responsibleor reviewing requisitions and allocating stock based oninventory levels at the requesting acility and in the issuingwarehouse as well as on past consumption at the acility. Inmany countries, acilities use a set ormula or quantificationbased on their inventory control system to prevent over- orunderordering. Usually, the order quantity is rationed at thewarehouse level only i there are insufficient unds or stock.Te requesting acilities may have budgets that must be con-

sidered in making allocations. Afer the allocation has beenmade, the order can be picked.

Order picking

Te allocated quantities orm the order-picking list. Tislist is passed to the storekeeper. In a large storeespeciallyone that uses a fluid location system (see Section 44.4)thepicking list ofen needs to speciy the exact position o theitems to be selected. In a small store, the storekeeper prob-

ably knows where everything is. Te listed items are takenrom stock in strict FIFO or FEFO order and transported tothe packing area, where order assembly takes place.

In large stores, it is common to use separate zones orrooms or storing specific types o products, such as anti-retrovirals, which must be locked up. A specific storekeeper

is also assigned the responsibility o managing these prod-ucts. In such instances, it may be necessary to divide thepicking list or a given customer into several smaller pick-ing lists, according to the number o separate storerooms orareas in use. A similar approach would be needed when gen-erating goods received notes and transerring resh suppliesto individual storage areas.

I bin cards are used, the stock issued should be recordedon the bin card as it is pulled rom the storage area.

Order assembly

At a secured shipping location, the supplies are arranged

in the order in which they appear on the picking list orrequisition voucher. Te order is double checked by thestorekeeper or shipping clerk beore the items are packed,sealed, and labeled or delivery. Some items, such as vac-cines and controlled substances, require special packing andhandling.

Order dispatch and delivery

In the most commonly used in-house delivery system, sup-plies are generally distributed according to a fixed deliveryschedule. In some instances, a collection system may beused, whereby representatives rom health acilities col-

lect supplies rom the store. Te shipping clerk completes adelivery voucher (Annex 44-5). Te voucher lists the num-ber and type o shipped packages. Teir specific content isnot identified unless the items require special handling, suchas vaccines, loose items (such as bulk germicides), and med-ical gas tanks. Te voucher is signed by the driver, who takestwo copies with him, together with two copies o the invoiceor completed requisition orm. Te third copy o the deliv-ery voucher remains bound in the delivery vouchers book,which is maintained by the shipping clerk.

When the delivery arrives at the receiving acility, thedriver and the acilitys receiving officer count and inspect

the containers. Any apparent loss or damage is noted on thedelivery voucher. Te receiving officer and the driver signboth copies; each keeps one copy. Ideally, the received par-cels should be opened and verified against the requisitionorm in the presence o the driver. Because o time con-straints, however, immediate inspection is not always pos-sible.

Te signed delivery voucher certifies that the driver hassaely delivered the supplies. Te receiving store retains thetwo copies o the completed requisition orm. One is signed


9/24


and dated and returned to the delivering store. Any differ-ences between the contents o the delivery and the requi-sition orm are reported on the requisition orm, and aninvestigation takes place i there are discrepancies.

Te driver returns the signed copy o the delivery voucherto the inventory clerk, who signs and dates it and also signs

and dates the permanent copy in the delivery vouchers book.Tat copy (now bearing the signatures o the driver, thereceiving officer, and the inventory clerk, with the respectivedates) is placed with the file copy o the completed requisi-tion orm.

Some supply systems require that the receiving acil-ity send a written notification o receipt. In such cases, thereceiving acility should return a signed copy o the com-pleted requisition orm to the CMS beore the acilitys nextrequisition date. Te date o its return is entered in the reg-ister o requisitions (stores issues ledger; see Annex 44-6). Ithe receiving acility does not submit this certified receivedcopy, the supplying store may reuse to fill the next requisi-

tion. Te copy is filed in the individual requisitioners file bydate. I any discrepancies have been noted and subsequently

verified, all relevant records, including the inventory card,must be adjusted. Again, all these records can be computer-ized, with file copies maintained.

Inventory taking

Te bin card (Annex 44-2) and the stock record card (Annex44-1), the computer file, or both provide a continuousrecord o each supply item in stock. Te filed copies o thepurchase orders and the verified copies o suppliers invoicesare used to document additions to the inventory.

Te medical stores unit must regularly take physicalcounts o stock on hand to check that the stock balance onperpetual inventory records is correct. Te government orstores audit office should also periodically certiy that therecorded transactions and net totals are accurate. Te auditis carried out by examining procurements and requisitionsand is verified by a physical stock count. As discussed inChapter 23, the cyclic stock count is now preerred to thetraditional annual count. Te cyclic count is easier to man-age and is more likely to allow reconciliation o discrepan-cies between records and physical stock.

Both active and saety stock in all locations should be

counted as scheduled and compared with the numbers onthe respective cards (or computerized records). Inventoryverification, at every location where supplies are stocked,should be planned to

Enorce procedures and regulations designed to pre-vent loss and wastage

Ensure that security measures are adequate Provide an additional orm o evaluation that may

reveal deects in the warehousing system

Provide regular evaluation o storage conditions andthe adequacy o storage acilities, layout, and stockarrangement

Identiy surplus, expired, and obsolete stock

44.3 Zoning stock within the store

Medicines and essential medical supplies must be locatedin a part o the store with the correct combination o tem-perature and security. Tis initial zoning process is the mostbasic way in which supplies are arranged.

A zone can be a separate building or room, a locked cup-board, a rerigerator, a reezer, or a cold room. able 44-2indicates several possible combinations o temperature andsecurity and illustrates how to classiy items according totheir storage requirements. Tus, an item classified 2B inthis scheme would be stored at +15 to +2530C in a securestore.

Te product manuacturers storage instructions shouldbe ollowed to the extent possible. I these instructions can-not be ollowed, the product must be kept in the most suit-able conditions available and used as quickly as possible. Teproduct manuacturer should be consulted beore violatingrecommended storage conditions, to determine how longthe product will remain sae and effective under the actualstorage conditions.

I no specific storage instructions are given, normal stor-age conditions apply. Normal storage conditions or medi-cines have been defined as storage in dry, well-ventilatedpremises at temperatures o +15C to +25C, or, depend-ing upon climatic conditions, up to +30C (WHO 2003).

Each storage zone should have at least one thermometer,and temperatures should be recorded daily at the hottesttime o day.

Table 44-2 Temperature and security zones

Category

ANormalsecurity

BHigh

securityC

FlammableD

Corrosive

1: Uncontrolledtemperature

X X X X

2: +15 to +2530C (controlled

humidity)

X X

3: 0 to +8C X

4: 20C X

Notes:The +15 to +2530C zone is assumed to be air-conditioned and thereforehumidity controlled. In temperate climates, this temperature range can beachieved without air-conditioning, but humidity control may still be necessary.

Cells marked X are commonly required temperature and security zones. Othercombinations may be required for specific products. For example, zones3B and 4B may be needed for vaccines if the vaccines have a black-marketvaluefor instance, hepatitis Bor there is a particular problem with security forrefrigeration equipment.


10/24


11/24


Table 44-3 Typical requirements for an effective cold chain

Level and staff functions Management activities Supplies and equipment needed

National

Management National program coordination Epidemiology

Logistics Transport management Training Procurement Budget and finance Data analysis

Central store Storekeeping Delivery

Maintenance Equipment care and maintenance

Program planning Demographic/epidemiological data Administrative structures

Logistic systemsProgram monitoring Disease surveillance Immunization coverage Cold-chain and transport operations Supplies usage Program costs

Supplies management Procurement, storage, delivery Refrigeration monitoring Transport management

Also Independent evaluations Staff recruitment and training Supervision of operations

Cold-chain equipment +4C cold room: twin refrigeration units,

recording thermometer, alarm

20C freezer room equipped as above Ice packs and cold boxes unless refrigerated

vehicles are used Standby power supply

Working and safety stocks Vaccines and injection equipment Stationery and forms Cold-chain monitoring cards Cold-chain equipment and spare parts

Also Transport and fuel Special facilities Vaccine control laboratory (where feasible)

Regional/provincial

Management Regional program Epidemiology Logistics and transport Training Data analysis and reports

Regional store Storekeeping Delivery


Program monitoring Disease surveillance Immunization coverage Cold-chain and transport operations Supplies usage

Supplies management Requisitioning, storage, delivery Refrigeration monitoring Transport management

Also Staff recruitment and training Supervision of district operations

Cold-chain equipment +4C cold room or vaccine refrigerators,

thermometers, alarm Vaccine freezers, thermometers, alarm Ice packs and cold boxes unless refrigerated

transport is used Standby power supply

Working and safety stocks Vaccines and injection equipment Stationery and forms Spare parts

Also Transport and fuel

District

Management District program Data analysis and reports

District store Storekeeping Delivery


Program monitoring Disease reporting Immunization reporting Cold-chain and transport operations Supplies usage

Supplies management Requisitioning, storage, delivery Refrigeration monitoring Transport management

Also Supervision of health facilities

Cold-chain equipment Vaccine refrigerators, thermometers, alarm Vaccine freezers, thermometers, alarm Ice packs and cold boxes Standby power supply

Working and safety stocks Vaccines and injection equipment Stationery and forms Spare parts


Health facility

Giving immunizations Storekeeping Reporting Equipment care and maintenance

Supplies management Requisitioning and storage Refrigerator monitoring Transport management

Reporting of Disease incidence Immunizations given Refrigerator defects Transport mileage and defects Stock on hand

Cold-chain equipment Vaccine refrigerator with ice-making

compartment and thermometer Cold boxes for outreach sessions Vaccine carriers

Working and safety stocks Vaccines and injection equipment Stationery and forms



12/24


Fluid location

In a fluid location system, the store is divided into manydesignated locations. Each location is assigned a code.Individual items are stored wherever space is available atthe time o delivery. A fluid location system is like a hotel.

Rooms are assigned only when guests arrive.A fluid location system uses available space efficiently, but

it requires sophisticated stock administration. Experiencesuggests that a store using a fluid location system can be 20to 25 percent smaller than one using a fixed location system.

Te administration o a fluid location system works as ol-lows

Te procurement unit provides inormation on thetype, volume, and weight o goods arriving.

Te storekeeper assesses which locations will be emptywhen the new stock arrives and assigns an appropriatelocation. Tese data are recorded in the stock control

system. I insufficient space is available, other goods may be

moved to create more space. Te stock control location records are updated.

Fluid location systems require a classification system thatallocates a unique identifier code to each stock item and toeach location. Also, the stock record or each batch o eachitem must always indicate the physical location o the itemin the store. In a fluid location system, different batches oa particular item may be stored in several different places.For example, i item number 150-050-48 is 500 mg amoxi-cilline, 150-050-48: B1-B could be a batch o this product

stored in aisle B, bay 1, cell B, and 150-050-48: C2-B couldbe another batch o the same product stored in aisle C,bay 2, cell B.

Fluid location systems benefit immensely rom the useo a computerized bin location and storage system, whichimproves productivity and optimizes storage capacity. Suchsystems identiy not only locations o items, but also the bestlocation or storing an incoming consignment within stor-age areas.

Semifluid location

A semifluid location system is a combination o the fixedand fluid systems. It is like a hotel that has regular guests.Regular guests are always given the same room. Casualguests are given any room that is available.

In a semifluid location system, each item is assigned afixed space or picking stock. When an order is prepared, theorder-picking staff members know where to find each item.Te remainder o the store is filled on the fluid location prin-ciple. When the picking stock runs low, the fixed locationsare restocked using items rom the fluid locations.

A semifluid location system is not as space-efficient as afluid location system. However, picking stock is stored ata convenient height, eliminating the need or mechanicalhandling during order picking in stores that issue in rela-tively small quantities.

Another eature is that picking stock is always kept in the

same place. Unlike in a fixed location system, however, lessrisk exists that changing requirements will disrupt the sys-tem. I demand increases or a particular item, the pickingstock can be replenished more requently. As new productsare introduced, picking bays may be subdivided to providesufficient space.

44.5 Stock classification

Items should be clearly organized within each zone o thestore. Such organization makes it much easier or store per-sonnel to control stock, take periodic stock inventory, and

pick orders.In stores that use the fixed location principle, items can be

physically organized in one o several ways

Terapeutic or pharmacological category Alphabetical order Dosage orm Random bin Commodity code

In a fluid location system, clear organization and uniqueproduct identification are absolutely essential to the suc-cess o the system. Otherwise, items get lost. Coding by any

one o the first our methods is inappropriate or a fluidlocation system, because the position o a particular stockitem will vary over time. For example, i antipyretics arerandomly distributed about the store in a fluid location sys-tem, organizing the store on the basis o therapeutic classis not easible.

However, therapeutic or pharmacological class, alpha-betical order, and classifications may be used as ways oorganizing the stock records, whatever stock location sys-tem is used. One o the advantages o a computerizedstock control system is that records can be sorted in a

variety o ways or different management purposes; or

instance, according to therapeutic classes or in alphabeti-cal order.

Therapeutic or pharmacological category

Terapeutic or pharmacological classification may be aneffective way o organizing medicines in smaller stores andin the dispensaries o small clinical acilities where the store-keeper is also the dispenser. It is not an advantage in largerstores.


13/24


Alphabetical order

Alphabetical order (by generic name) is also attractivein peripheral stores that keep a small number o items.However, each change in the national (essential) medicineslist or in the level-o-use list requires reorganization o the

stores themselves and o the stock administration system.Tis method may not result in optimal use o available space.

Dosage form

A system based on dosage orm is commonly used in smallerwarehouses. ablets and capsules are stored together, withseparate areas or oral liquids, injections, creams and oint-ments, and topical liquids. Within each dosage-orm area,products may be stored in a fixed, fluid, or semifluid mannerand urther organized by any o the other systems describedin this section. Te main advantages are that the orms areeasy to recognize when receiving goods and this system

allows optimal use o space.

Random bin

Te random bin is a unique storage space identified by acode. For example, a shelving unit can be divided verticallyand horizontally into cells, each with a unique location code.A unit o shelving might be labeled B, its bays B1 andB2, and its shelves A, B, and C. A unique cell would beidentified, or example, as B1-B (see Figure 44-2). Tis cellis called a bin.

Te random bin storage method can combine the meth-ods previously described. For example, items are placed

alphabetically within therapeutic classifications. Genericnames are used throughout. I there is more than one brando the same generic drug preparation, all are stored in thebin or that type.

Commodity code

Commodity coding is an abstract organizational system. Itoffers maximum flexibility and can be used equally well insmall and large stores.

Tis system is based on a unique article code combinedwith a unique location code. Examples o article codes

include WHO technical specifications or UNICEF stockcodes. Article codes can be designed to speciy therapeuticclass, clinical indication, level o use, or any other relevantdata. In systems that use article coding and location coding,storekeeping staff do not need to have specific knowledge opharmaceutical names and therapeutic uses.

Changes in the national medicines list can easily be intro-duced by assigning unique article codes to new products.Article coding works well in a computerized system. endercontracts may require that only the article code be marked

on the bulk packaging as well as on the smaller units o sup-ply. Tis method increases security but still allows the goodsto be identified by those staff members who have access tothe coding key.

Te location code is totally independent o the articlecode and is similar to the random bin principle. Codes can

be designed to incorporate any number o characteristics,including

Correct storage temperature or the product Correct security level or the product Whether the product is flammable Te building where the product is located Pack size Pharmaceutical orm

44.6 Stock storage and handling

Within each temperature and security zone, products mustbe stored so that they are easily accessible and protectedagainst damage. Tere are our basic systems o storage:shelves, floor pallets, block-stacked pallets, and pallet racks.Direct storage o cartons on the warehouse floor should beavoided because their contents may be damaged by moisture.Te choice o system depends on the ollowing actors

otal quantity o products to be stored Average volume o each product Internal height o the storage building Local availability o mechanical handling equipment

and the skills to use and maintain it

Pallets are generally used at the national and regional lev-els, where products are stored in bulk. At the district leveland below, storage on shelves is most common. Te unda-mental rule or pallet storage is that each pallet should beused or only one product line. Pallets have the ollowingadvantages

Tey keep goods together and impose a disciplinedmethod o storage.

Large loads can be moved easily using mechanicalhandling equipment.

Pallets are easy to transship because they do notrequire any unpacking and repacking. Pallets isolate goods rom floors, which may be damp. I goods are supplied by the manuacturer on shrink-

wrapped pallets, it is easy to see when tampering hasoccurred.

Inspection or damage and or short shipments is easyto perorm.

When stock rearrangement is necessary, it is mucheasier to move pallets with mechanical handling


14/24


Figure 44-2 Storage and load-handling equipment

Heavy-Duty Storage Racks Shelf Unit B

Standard Pallet Hand Pallet Truck

Mechanical Hand-Lift Stacker Forklift

A

B

C

D

E

F

B1

B1-B

B2


15/24


equipment than it is to move a large volume o loosestock that has been placed on shelves.

Packaging specifications

Appropriate packaging specifications reduce the risk o

damage during handling. Floor pallets and pallet racks mustbe laid out to suit a selected pallet module. Pallets come ina range o sizes, and the size and weight o pallets affect thelayout o the store and the choice o mechanical handlingequipment. Although it may be difficult in practice due tothe range o pallets that may be available, whenever easible,a standard pallet size should be adopted throughout thedistribution system, and all contracts with suppliers shouldinclude this specification.

Shelving

Storage on shelves does not require mechanical handling

equipment and is a good choice when

Te volume and weight o individual items are toosmall to justiy pallets.

Te internal height o a building is not large enoughor multitier pallet racking, and shelving can be usedon its own or in combination with floor pallets or two-tier racking.

Manual goods handling is locally more reliable or eco-nomical than mechanical handling.

I shelving is used in a warehouse more than 4.5 metershigh, it may be possible to install an independent mezza-

nine flooring system supporting a second tier o shelving.Tis system can increase the available shelving volume byup to 100 percent, at the expense o some inconveniencein materials handling. Obviously, i a mezzanine is added,high-quality construction is critical to avoid injury to staffand damage to stored goods.

Floor pallets

Floor pallets are a good solution in warehouses with ceilingheights o less than 3 meters and in stores where the cost opallet racking and orklif trucks cannot be justified. Many

heavy or bulky items, such as rolls o cotton, medicine kits,or large hospital equipment, require floor locations. Floorsshould be marked to indicate pallet and aisle positions.

Block-stacked pallets

Pallets containing light goods may be stacked on top o oneanother in blocks. Block-stacked pallets should be used onlyor items without expiry dates or with very high turnover,because the first-in items are at the bottom o the stack.

Block stacking is a cheap and space-efficient method o stor-age, and no racking is required.

Pallet racking

Simple pallet racks generally have two or three tiers. wo

tiers o racking require a clear height o about 3 meters, andthree tiers require a clear height o about 4.5 meters. It is pos-sible to have several more tiers, but sophisticated mechani-cal handling equipment is then required.

Te benefits o shelving and pallet racking can be com-bined. Te bottom tier o racking may be used to store theworking stock. Tis tier is at a convenient height or manualorder picking. Alternatively, a special picking shel can beplaced immediately above the bottom tier o pallets. In bothcases, the upper tiers can be used to store saety stock.

Load handling

Each o the our storage systems described above requiressuitable handling equipment and appropriate organizationo stored goods. Appropriate handling equipment reducesthe risk o injury to workers and damage to goods. Careulstock organization on shelves and pallets reduces unneces-sary lifing and ensures easy access to goods during orderpicking.

Shelving. In order to reduce manual handling, goodsshould be transported to and rom the shelves on trolleycarts. Heavy items should be stored on the lower shelves.Whenever possible, other items should be organized so thatrequently picked items are at waist height. Saety stock maybe stored at a higher level.

Pallets. Loaded pallets can be moved only by usingmechanical equipment. Hand-operated hydraulic pallettrucks and pallet lifs are suitable or floor pallets and orpallet racking up to three tiers high. Operations that havepallets stored at higher levels or turn over large volumes ostock must use powered orklif trucks. Figure 44-2 illus-trates some typical storage and handling equipment.

44.7 Housekeeping

Housekeeping tasks or a store include cleaning and pest

control, a regular inspection system or issues such astemperature and roo leaks, disposal o stock, precautionsagainst fire, and strict security measures.

Cleaning and pest control

Te store should be kept tidy and should be cleaned atminimum two or three times a week; a busy store should becleaned once a day. Most warehouses have adequate person-nel available or scheduled cleanups, and adequate cleaning


16/24


equipment should be made available. Figures 44-3 and 44-4illustrate good and bad stores management.

Pest control can be difficult, but to avoid possible con-tamination and physical damage to stock, insects, mice, andother pests must be kept out o the storage area. I needed,pest control measures such as poison should be imple-

mented, with proper precautions. One o the chie reasonspests become a problem is the consumption o ood in stor-age areas; thereore, this practice should be strictly avoided.

Inspection

Senior staff should inspect the store regularly. Te chiestorekeeper must make sure that storeroom employeescheck the shelves and pallets daily or signs o thef, pests, orwater damage and or deterioration caused by climatic con-ditions. Storekeepers should open suspect containers andreport problems to managers.

Buildings and equipment need both emergency and rou-tine maintenance, but a regular building and equipmentinspection and maintenance program prevents major ail-ures and saves costs overall (see Chapter 42).

Disposal of expired or damaged stock

Damaged or expired stock should be placed in a designatedsalvage area to await authority or disposal. A written recordo all stock consigned to this area should be maintained. It

is recommended that each item be valued at its acquisitioncost. Te responsible authority should be inormed in writ-ing that stock is to be written off. Disposal may be delayedi a committee decision is required, and substantial stor-age space may be needed or junk stock. When destruc-tion is authorized, the inventory control clerk must adjust

the stock records. All medicines and other potentially toxicproducts should be disposed o in accordance with localregulations in a manner that does not pose a risk to publichealth.

Fire precautions

Flammable trash, such as cartons and boxes, must not beallowed to accumulate in the stores. Smoking must be strictlyorbidden, with No Smoking signs posted throughout thestore. Senior staff must obey the rule as strictly as juniorstaff, and penalties should be imposed on those who ignore

the rules. A smoking area outside the warehouse should bedesignated. Management must ensure that fire-detectionand firefighting equipment are regularly inspected and thatstaff members receive adequate training in firefighting tech-niques and emergency action. Regular fire drills should beheld to reinorce that training.

Staff should check requently or fire, but management isultimately responsible. Night watchmen can serve the dualpurpose o responding to fire alarms and protecting againstthef.

Figure 44-3 Good stores management Figure 44-4 Poor stores management


17/24


Security

Ideally, the chie storekeepers office should have windowsthat overlook the loading bay, the compound entrance, andthe store itsel. A storekeeper who sits behind a closed doorwith the curtains drawn cannot observe what is happening

at the site.No vehicles should be allowed into the store compound

unless they are authorized by the chie storekeeper oranother senior staff member. A list o authorized vehiclesshould be prepared or the compounds gatekeeper.

Pedestrian access to the storage buildings should bestrictly controlled. Visitors should report to the storekeepersoffice and should not be allowed into the store area except onbusiness. Visits by riends and amily o staff should be dis-couraged. Business visitors should always be accompaniedby a senior staff member. (See Chapter 43 or urther discus-sion o security measures.)

44.8 Human resources management inmedical stores

Te organization o a typical central medical store is illus-trated in Figure 44-5. Te organizational structure at anintermediate store is generally a compressed version o thisstructure.

Medical stores managers are encouraged to reviewChapters 51 and 52, which discuss human resources man-agement in more detail.

Staff training and the medical stores procedures

manual

Every worker should receive appropriate job training andreresher training, as appropriate. Most warehouse jobs arenontechnical, and in-service training and supervision ostaff are likely to be the most effective approach. A writtenmanual o standard operating procedures should cover theollowing

General management policy Management structure Job descriptions

Reporting procedures Stock control and other record-keeping procedures Operational procedures Health and saety procedures Security

Te manual should include visual aids that clariy opera-tions. Tese documents are normally used by the directorand section chies to train new staff and to settle proce-dural questions. able 44-4 gives a sample contents list.

Each work area should have a copy o the manual. Te con-tents o the document should be reviewed and explainedin group presentations. Te manual should be available toevery employee, and staff members should be encouragedto use it in perorming their duties. Te manual shouldalso be regularly reviewed and updated to reflect changes

in operations or the introduction o new systems or pro-cedures.

Staff supervision and discipline

Te supervisory hierarchy should be clearly described to allworkers. Personnel problems should be solved at the appro-priate level. Section heads who do not supervise their work-ers regularly and effectively should be replaced.

Positive eedback and encouragement are essential.Minor lapses in perormance should be kept in perspective.Major problems, such as proven cases o thef or recklessdriving, should be handled through established ministry or

organizational regulations. Regular staff meetings can helpmaintain a sense o shared purpose and ensure that all staffmembers understand their responsibilities.

Career development

Workers in the logistics system ofen have low status. Teyare requently badly paid, work under poor conditions, andare not motivated. Tese problems result in low levels o per-ormance.

An effective store relies on staff members who want toperorm their jobs correctly. When staff members perormwell, they should be rewarded and praised. Although it

is difficult to do in many government supply systems,improving salary grades and promoting staff who showability and commitment will help the organization retaingood staff. Staff members are also motivated by partici-pating in training programs and other opportunities orpersonal development. Frequent transers o personnelrom one site to another should be avoided, i possible.Chapter 51 discusses employee satisaction and motiva-tion.

I stores staff are treated badly by management, they willlook or other jobs, and their experience will be lost. A storesoperation that relies on casual labor is more likely to suffer

rom thef, breakages, and distribution errors.

44.9 Staff facilities

Good staff acilities encourage cleanliness, protect workersagainst occupational injuries, and contribute to good staffmorale. Just as medicines are susceptible to damage romexcessive heat or cold, staff perormance and motivation su-er in these conditions.


18/24


Minister

Permanent Secretary

Chief Medical Officer

Director

Central Pharmaceutical Stores

(Supplies Officer)

Asst. Dir. Inventory Control

(Chief Storekeeper)

Asst. Dir. Medicines

(Sr. Storekeeper: Medicines)

Asst. Dir. Medical Surgical

(Sr. Storekeeper: Med-Surg)

Secretarial Staff

Records Clerks

Assistant Directora

(Sr. Storekeeper)

Inventory Control ClerkInventory Clerk: Medicines

Storekeeper

Inventory Clerk: Med-Surg

Storekeeper

Laborers, Packers

Drivers

Messengers

Housekeepers

Receiving

Clerk

Issuing

ClerkReceiving

Clerk

Issuing

Clerk

Customs Clearance

Officer

aOther units as needed

Figure 44-5 Medical stores organizational chart


19/24


Sanitary facilities

Personal cleanliness is essential among workers who handlemedical supplies. Te store needs well-maintained sanitaryacilities or staff and visitors. Sanitary accommodationsshould be located on the perimeter o the building to allownatural ventilation and keep the drains outside the building.

Staff rest areas

A separate rest area, with a kitchen, toilet, and pantry orpreparing and storing ood, improves staff morale andreduces fire hazards and the risk o vermin inestation in thewarehouse. It also improves efficiency by segregating restingstaff rom working staff.

First aid

Adequately trained personnel with first-aid equipment and

dressings should be available to treat workers who sufferinjuries on the job. Emergency washing acilities should beprovided in case a staff member comes into contact witha corrosive or toxic agent. Installing emergency showersmay be necessary. Eye-washing sprays should also be pro-

vided. Local health and saety regulations should always beollowed. n

References and further readings

H= Key readings.

HBattersby, A., and A. Garnett. 1993. How to Estimate WarehouseSpace for Drugs. Geneva: World Health Organization.

Dalberg Global Development Advisors and the MI-Zaragoza

International Logistics Program. 2008. Te Private Sectors Rolein Health Supply Chains: Review of the Role and Potential forPrivate Sector Engagement in Developing Country Health SupplyChains.New York: Te Rockeeller Foundation.

Ghiani, G., G. Laporte, and R. Musmanno. 2004. Introduction toLogistics Systems Planning and Control.West Sussex, England: JohnWiley & Sons.

HJohn Snow Inc./DELIVER. 2005. Guidelines for Warehousing HealthCommodities.Arlington, Va.: John Snow, Inc./DELIVER, or theU.S. Agency or International Development.

HJohn Snow, Inc./DELIVER in collaboration with the World HealthOrganization. 2003. Guidelines for the Storage of Essential Medicines

and Other Health Commodities. Arlington, Va.: John Snow, Inc./DELIVER, or the U.S. Agency or International Development.

HMulcahy, D. 1994. Warehouse Distribution and Operations Hand-book. New York: McGraw-Hill Proessional.

WHO (World Health Organization). 2009. WHO Expert Committee onSpecications for Pharmaceutical Preparations. 43rd Report. Geneva:WHO.

Table 44-4 Contents of a procedures manual for a central pharmaceutical supply system

Content unit Typical structure

Statement of operational policy Central level

Organizational staffing pattern Regional level

District level

Community level

Lines of authority

Overview of sequence of tasks andactivities in supply management process(with discussion of objectives)

Job descriptions (all personnel by level, each level treated separately)

Logistics information system

Flow chart of central, regional, and district information

Supply operations forms (purchase order, receiving report, inventory card, requisition/issue form,issues ledger by item and facility, delivery voucher)

Accounting system and procedures

Inventory control system and procedures

Security system and regulations

Computerized information systems

Supply system administration

Operating budget (utilities, salaries, maintenance, supplies, miscellaneous)

Maintenance procedures (for buildings and equipment)

Special operating instructions Cold-chain storage procedures

Quality-control procedures

Shipping and packaging procedures
http://apps.who.int/medicinedocs/documents/s16323e/s16323e.pdfhttp://apps.who.int/medicinedocs/documents/s16323e/s16323e.pdfhttp://wileylogisticsbook.dii.unile.it/http://deliver.jsi.com/dlvr_content/resources/allpubs/guidelines/GuidWareHealComm.pdfhttp://deliver.jsi.com/dlvr_content/resources/allpubs/guidelines/GuidWareHealComm.pdfhttp://deliver.jsi.com/dlvr_content/resources/allpubs/guidelines/GuidWareHealComm.pdfhttp://deliver.jsi.com/dlvr_content/resources/allpubs/guidelines/GuidStorEsse_Pock.pdfhttp://deliver.jsi.com/dlvr_content/resources/allpubs/guidelines/GuidStorEsse_Pock.pdfhttp://www.who.int/medicines/publications/pharmprep/pdf_trs953.pdfhttp://www.who.int/medicines/publications/pharmprep/pdf_trs953.pdfhttp://www.who.int/medicines/publications/pharmprep/pdf_trs953.pdfhttp://www.who.int/medicines/publications/pharmprep/pdf_trs953.pdfhttp://deliver.jsi.com/dlvr_content/resources/allpubs/guidelines/GuidStorEsse_Pock.pdfhttp://deliver.jsi.com/dlvr_content/resources/allpubs/guidelines/GuidStorEsse_Pock.pdfhttp://deliver.jsi.com/dlvr_content/resources/allpubs/guidelines/GuidWareHealComm.pdfhttp://deliver.jsi.com/dlvr_content/resources/allpubs/guidelines/GuidWareHealComm.pdfhttp://deliver.jsi.com/dlvr_content/resources/allpubs/guidelines/GuidWareHealComm.pdfhttp://wileylogisticsbook.dii.unile.it/http://apps.who.int/medicinedocs/documents/s16323e/s16323e.pdfhttp://apps.who.int/medicinedocs/documents/s16323e/s16323e.pdf


20/24


General description

How are goods received, stored, and supplied? What acilities are served? How ofen is each sup-

plied? What methods o transport are used? Is adelivery, collection, or mixed system in use?

Stores management and staffing

Does an operations manual adequately describe cur-rent procedures and responsibilities?

Are staff positions described by category, listing thepositions approved to be filled and those that havebeen filled?

Receiving

Are procedures or receiving and checking medi-cines observed? Are standard checklists used?

What medicines were returned during the past year,and why?

How are complaints concerning product qualityhandled?

Communications and reporting

What reports are regularly issued rom medicalstores, or whom, and how ofen?

Stock control

What stock control system is used? Are random and periodic stock checks carried out?

Is a stock auditing system in place? What percentage o stock records (and bin cards)

corresponds with physical counts?

Stock management

Is stock location fixed, fluid, or semifluid? Are medicines issued by FIFO or FEFO?

What was the average stockout duration over the lastyear?

How many expired medicines are in stock? What istheir value?

What was the value o inventory at the beginningand end o the last fiscal year?

Storage conditions

Are medicines zoned in correct combinations otemperature, humidity, saety, and security?

How are medicines organized within each zone? Are vaccines stored and monitored in accordance

with the recommendations o the WHO ExpandedProgramme on Immunization?

Is the store neat, and are effective pest control proce-dures in place?

Buildings and equipment

Is storage space too small, adequate, or excessive? Are the loading bay, receiving area, packing area,

administrative area, staff rest area, and sanitaryacilities adequate?

What is the condition o roos, walls, floors, ceilings,firefighting equipment, windows, doors, locks, bur-glar bars, and water supply and drainage equipmentand inrastructure?

What storage systems are used (shelving, floor pal-lets, pallet racking)?

What are the conditions o mechanical handling

equipment, electricity supply, and telephones? What computer hardware and sofware systems are

employed and are they adequate to support inven-tory control needs?

Is there direct access to international communica-tions?

A S S E S S M E N T G U I D E

. 2007. WHO New Product Information Sheets (PIS) Since2000 Edition. Geneva: WHO.

H. 2003. Guide to Good Storage Practices or Pharmaceuticals.Annex 9 to the WHO Expert Committee on Specications forPharmaceutical Preparations. 37th Report. Geneva: WHO. < http://apps.who.int/medicinedocs/pd/s6156e/s6156e.pd>

. 2002. Guidelines for Establishing or Improving Primary andIntermediate Vaccine Stores. Geneva: WHO.

. 2000. WHO/UNICEF Product Information Sheets, 2000Edition.Geneva: WHO.

. No date. Perormance, Quality and Saety (PQS).

WHO/EPN (World Health Organization/Ecumenical PharmaceuticalNetwork). 2006. Multi-Country Study of Medicine Supply andDistribution Activities of Faith-Based Organizations in Sub-Saharan

African Countries. Geneva: WHO/EPN.
http://www.who.int/immunization_standards/vaccine_quality/new_sheets_intro/en/index.htmlhttp://www.who.int/immunization_standards/vaccine_quality/new_sheets_intro/en/index.htmlhttp://apps.who.int/medicinedocs/pdf/s6156e/s6156e.pdfhttp://apps.who.int/medicinedocs/pdf/s6156e/s6156e.pdfhttp://whqlibdoc.who.int/hq/2002/WHO_V&B_02.34.pdfhttp://whqlibdoc.who.int/hq/2002/WHO_V&B_02.34.pdfhttp://www.who.int/immunization_standards/vaccine_quality/pqs_prequalified_devices_e13/en/http://www.who.int/immunization_standards/vaccine_quality/pqs_prequalified_devices_e13/en/http://www.who.int/immunization_standards/vaccine_quality/pqs_prequalified_devices_e13/en/http://whqlibdoc.who.int/hq/2006/WHO_PSM_PAR_2006.2_eng.pdfhttp://whqlibdoc.who.int/hq/2006/WHO_PSM_PAR_2006.2_eng.pdfhttp://whqlibdoc.who.int/hq/2006/WHO_PSM_PAR_2006.2_eng.pdfhttp://whqlibdoc.who.int/hq/2006/WHO_PSM_PAR_2006.2_eng.pdfhttp://www.who.int/immunization_standards/vaccine_quality/pqs_prequalified_devices_e13/en/http://www.who.int/immunization_standards/vaccine_quality/pqs_prequalified_devices_e13/en/http://www.who.int/immunization_standards/vaccine_quality/pqs_prequalified_devices_e13/en/http://whqlibdoc.who.int/hq/2002/WHO_V&B_02.34.pdfhttp://whqlibdoc.who.int/hq/2002/WHO_V&B_02.34.pdfhttp://apps.who.int/medicinedocs/pdf/s6156e/s6156e.pdfhttp://apps.who.int/medicinedocs/pdf/s6156e/s6156e.pdfhttp://www.who.int/immunization_standards/vaccine_quality/new_sheets_intro/en/index.htmlhttp://www.who.int/immunization_standards/vaccine_quality/new_sheets_intro/en/index.html


21/24


Annex 44-1 Sample stock record card


22/24


Annex 44-2 Sample bin/stock card


23/24


Annex 44-3 Sample receiving report

Annex 44-4 Sample requisition/issue voucher


24/24


Annex 44-5 Sample delivery voucher

Annex 44-6 Sample register of requisitions

medical shop mgt

Documents