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CDI Module 14: Supply Chain Management for CDI
©Jhpiego Corporation
The Johns Hopkins UniversityA Training Program on Community- Directed Intervention (CDI) to Improve Access to Essential Health Services
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Module 14 Objectives
By the end of this module, learners will: Describe the process of anti-malarial drug procurement and
storage Explain how to estimate their community’s commodity
needs Outline the stock recording method and reporting format Describe the distribution process for anti-malarial medicines
and other malaria commodities (long-lasting insecticide-treated nets [LLINs], rapid diagnostic tests [RDTs])
State how to monitor and report adverse drug reactions (ADRs)
Discuss the role of patent medicine vendors (PMVs) in malaria commodity management
What Are Commodities?
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Procurement and Supply Chain/Cycle
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Clients consume
stock
Supply system information
managementForecasting and ordering
Procurement
Distribution to first level
Storage, safety and correct use
Distribution to next level
Storage and safety
Commodities Flow from Suppliers to Central Medical Stores, Then on to LGAs and Facilities
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Flow of Commodities
Health commodities for community-directed intervention (CDI) and integrated community case management (iCCM) can flow through both public and private channels
Each country is different, and in some cases: National, regional and district medical/pharmacy stores
order, procure and distribute commodities/medicines Districts or community associations can use private
sector warehouses and suppliers to buy medicines In some countries, malaria commodities are
manufactured; in other countries, these commodities are imported
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Commodities Reach Consumers
Ultimately, commodities like artemisinin-based combination therapies (ACTs), RDTs, LLINs and sulfadoxine-pyrimethamine (SP) need to reach the frontline clinic, and from there, the community-directed distributors (CDDs)
Whatever the system, commodities must move from point of manufacture to point of use
(Present a chart that shows movement of malaria and other iCCM commodities in your country so that it finally reaches CDDs/villages)
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Proper Estimation of Anti-Malarial Commodities
It is important to have estimates of eligible clients/patients to determine anti-malarial commodity requirements at all levels
Accurate data are required to achieve these estimates Initial quantification of anti-malarial medicines (ACTs, SP,
quinine) needs to be done using population-at-risk data, by episode, based on medicine consumption
Lower level quantification can be done through community “head counts” during community census
Malaria Tasks Have Different Schedules (Forecasting)
The first task is to conduct a community census to determine numbers of people in need of services
An insecticide-treated net (ITN) is needed as soon as a woman knows she is pregnant
Intermittent preventive treatment in pregnancy (IPTp) occurs at least twice after quickening, at monthly intervals
Case management occurs whenever a community member has malaria IPTp and ITNs may prevent most of the need for case
management
Finally, health education is frequent
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Identify and Coordinate Sources of Supplies and Funding
LLINS ACTs SP
Global Fund
World Bank
USAID
UNICEF
Ministry
10Present details from your own country
Sample Roadmap Country Summary
Need to 2010 Funded and expected to be
distributed before end 2010
Gap
LLINs 63 million LLINs 49 million 14 million
ACTs 129 million doses
94 million 35 million
IRS 2.8 million households
800,000 2 million
RDTs 59 million tests 34 million 25 million
IPTp 18 million doses
18.3 million 0
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Procurement and Supply
It is recommended that drugs for home management of malaria (HMM) be centrally procured
Benefits of central procurement include bulk purchasing, which can: Reduce cost of medicines and handling charges Ensure consistency and quality of supplies Simplify logistics
These drugs should be World Health Organization (WHO)-approved medicines
Ultimately these should move in a well supervised manner from national to sub-national to district to health facility and then community
Companies Producing WHO Prequalified Malaria Medicines as of August 2010
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Amodiaquine + Artesunate Ipca Laboratories Limited Dadra and Nagar Haveli (U.T.),
India Guilin Pharmaceutical Co. Ltd Guilin, Guangxi, China Cipla Ltd Patalganga, India; Goa, India Sanofi-Aventis Group MAPHAR Laboratories,
Casablanca, MoroccoArtemether + Lumefantrine Novartis Pharma Beijing, China; Suffern, USA Ajanta Pharma Ltd Paithan, Aurangabad,
Maharashtra, India Ipca Laboratories Ltd Dadra and Nagar Haveli (U.T.),
India Cipla Ltd Patalganga, India; Himachal
Pradesh, India
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The Frontline Primary Health Care (PHC) Facility Provides Commodity Link with CDDs
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The Malaria Drug Supply Chain
Community delivery of malaria medicines requires adequate supplies at all levels
Districts must monitor frontline facilities to help prevent stock-outs for facilities and the CDDs these facilities supervise
CDDs collect stocks from the nearest PHC facility
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Forms Track the Use ofAnti-Malarial Medicines
Forms are used at all levels of the health care system to track the use of anti-malarial medicines
States/municipalities use forms to track the drugs they procure and distribute
Facilities also use forms to track the drugs they procure and distribute
CDDs use forms to track the medicines they pick up from their supervising facility and distribute within the community
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Why Use Anti-MalarialDrug-Tracking Forms?
These forms collect data on: The consumption of different dosage packs The manufacture and expiry (expiration) dates of
medicines
These forms also include areas to record the justification for any discrepancies in drug consumption (e.g., partial medicine usage)
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The Distribution Process for CDI
Commodities reach the nearest health facility The community representative or CDD collects
initial supplies and materials from the health facility The initial stock is based on a village census that
shows need On receipt of stocks, the CDD or community
representative signs an inventory register at the health facility confirming collection of supplies
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CDDs Need a Safe Placeto Store Their Own Medicines
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Maintaining Stocks and Distribution
The community is informed that commodities are available from the CDD
Women and caregivers seek these services, when needed
The CDD maintains distribution records and summarizes these on a regular basis
The community or the CDD submits summary reports to the health facility on a regular basis
Then they collect replenishment supplies
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Community Preparation
The community and the CDD announce to community members that commodities are available
The community decides on a distribution system for commodities For ivermectin, people could go house-to-house or
distribute the drug from a central location For malaria commodities, people could go to the
CDD’s house, or the CDD could make home visits The community should decide on the most acceptable
processes
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Storage
During training, CDI focal persons should sensitize the CDDs to the following storage requirements: Keep medicines away from direct sunlight and
heat Ideally store SP, and ACTs in a cool, dry place—
temperature should not exceed 25°C Keep all medicines out of reach of children, at all
times
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Keeping Medicines in the Community
Keep community case management (CCM) kits in dry, clean places in the house
Medicines should be kept separate from the other items in the house
Medicines suspected to have come in contact with water must not be used for treatment
Damaged medicines should be returned to the health center and a new stock collected
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Medicines May Not Work as Expected
CDDs should report dangerous or unexpected effects of the drugs to their supervising health facility
The supervising facility should report to the district This reporting is part of the pharmaco-vigilance
system Likewise, CDDs should take note of patients who do
not get well after taking ALL medicine correctly These patients should be reported and referred
These steps help ensure quality of commodities
Getting New Stock for the Community
A system of stock collection is needed
Monthly CDD meetings at the frontline facility is one way to accomplish this: CDDs bring empty
medicine packets to exchange for new packets
A system must be in place to obtain stock whenever it is needed
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PMVs Are a Major Source of Medicines for the Community
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Sometimes if CDD stocks run out, community members may need medicines quickly
PMVs may be a source
We need to monitor PMVs to ensure that they provide quality medicines
Procurement and PMVs
PMVs: Normally buy their stock from wholesalers Usually do not keep records and receipts Do know which medicines are popular
With the Affordable Medicines Facility for Malaria (AMFm), PMVs: May now be receiving specially packed Coartem
from the health system Will need to learn how to manage stocks, check
expiration and report damages
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PMV Associations Can Be Involved in Procurement and Supply Chain Management (PSM) for the Private Sector
Sometimes communities can re-stock their medicine box by buying from a reliable PMV shop
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Summary and Conclusions
CDDs: Collect drugs from the health facility that provides
services to their community Ensure that drugs are stored appropriately Maintain an accurate account of drug use, damages and
stock at all times Report ADRs to the supervising health facility Attend monthly meetings and submit monthly reports
PMV associations can also be involved in the supply of approved malaria commodities