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ABBREVIATIONS
PSU Pharmaceutical Supply Unit
MSD Medical Store Department
NGO’s Non Governmental Organisation
BBO Budget Based Ordering
HF Health Facilities
MOHS Ministry o! Health and Social ell Fair
"P# "$panded Programme !or #mmuni%ation
UN#&"F 'he United Nations &hildren(s Fund
S'G Standard 'reatment Guideline
N"M)#' National "ssential Medicine )ist
N*&P National *ids &ontrol Programme
H#+ Human immunode!iciency virus
*#DS *c,uired immunode!iciency syndrome
N')P National 'u-erculosis and )eprosy
.&HS .eproductive and &hild Health
NM&P National Malaria &ontrol Programme
#)S #ntergrated )ogistic System
HO orld Health Organisation'FD* 'an%ania Food and Drug *uthrority
UDSM University o! Dar es Salaam
B#&O 'he -ureau !or standard corporation
'BS 'an%ania Bureau o! Standare
MNH Muhim-ili National Hospital
MO# Muhim-ili Orthopaedic #nstitute
GMP Good Manu!acturing Practice
/S# /ohn Sno0 #nc1
S&MS Supply &hain Management System
*.+ *ntiretroviral drugs
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ACKNOWLEDGEMENTS
'he Muhim-ili University &ollege o! Health and *llied Science especially School o!
Pharmacy 0ould li3e to e$press its gratitude to the Medical Store Department !or ma3ing
it possi-le to conduct this practical 0or31
#n particular # 0ould li3e to mention 'he O!!ice o! Procurement and 'echnical services
especially Mr1 Mchunga !or their *dministrative support they o!!ered to us during the all
period and 0hile preparing this report1
*lso the support !rom the general entire management team o! MSD and individual sta!! is
highly appreciated1
Finally the School o! Pharmacy especially 'he Head o! Pharmaceutical Department Dr1
G1 4agashe !or coordinating this programme1
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Introduction
'he Medical Stores Department 6MSD7 is an autonomous government department under
the Ministry o! Health and Social el!are1 MSD 0as esta-lished -y an *ct o! Parliament
No1 28 o! 2998 to ta3e over the !unctions o! the !ormer: &entral Medical Store 6&MS71
'he core !unctions o! MSD are procurement, stor !e nd distri"ution#
DG ; Director General
D$A ; Directorate o! Finance < *dmin
DIS ; Directorate o! #n!ormation SystemDC%O ; Directorate o! &ustomer Servcices and =onal Operations
DL ; Directorate o! )ogistics
D&TS ; Directorate o! Procurement and 'echnical services
Organizational Structure
BOARD OF TRUSTEES
DG
DFA DIS DCZO DL DPTS
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MSD VISION
'o provide ,uality medical services closer to people1
MSD MISSION STATEMENT
'o ma3e availa-le at all times essential drugs and medical supplies o! accepta-le ,uality
at cost>e!!ective to the populatin through government and approved non>government and
privat health !acilities1
MSD'S OVERALL OB(ECTIVE
'o develop maintain and manage an e!!icient and cost>e!!ective system o! procurement:
storage and distri-ution o! approved essential drugs and other medical supplies re,uired
!or use 0ith the country at all times1
KE) DE$INITION TERMS
Lo!istic
'he part o! supply chain management that plans: implements: and controls the e!!icient:
e!!ective !or0ard and reverses !lo0 and storage o! goods: services and related
in!ormation -et0een the point o! origin and the point o! consumption in order to meet
customers’ re,uirement1
Lo!istics m n !ement
#t is an integrating !unction: 0hich coordinates and optimi%es all logistics activities: as
0ell as integrates logistics activities 0ith other !unctions including mar3eting: sales
manu!acturing: !inance: and in!ormation technology1? 6&S&MP 5@227
&us* s+s+tem A
* central authority orders drugs !rom suppliers and determines the ,uantities that 0ill -e
shipped to operating unit -ased on the annual distri-ution plan and on in!ormation
transmitted to the 0arehouse a-out need at the operating unit
&u s+stem-
Operating units order drugs !rom 0arehouse or supplies according to local determination
o! need1
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MSD SERVICES
Norm order#
'hese 0ere the orders re,uested -ased MSD catalogue items1 * customer !ills !orm
6&.#N’s7 0hich is availa-le at MSD1 'he !illed>in !orm must signed -y *uthorised
o!!icer !rom the health !acility1 Government hospitals utilised !unds allocated to MSD -y
Government1 For NGO’s hospital and others goods are sold against direct payment
e$amples -an3ers che,ue or cash1
S&ECIAL &ROC.REMENT ORDER#
'hese 0ere items re,uired -y customer -ut not !all under MSD catalogue1 'he customer
re,uired to 0rite a letter to MSD: and indicate clear speci!ication o! hisCher re,uirements1
MSD o!!ice may assist in developing speci!ications i! re,uired to do so on -ehal! o! thecustomer
*lso a!ter receipts o! the speci!ication: MSD 0ill communicate 0ith suppliers and
determined all the costs associate 0ith procurement o! the items and !inally noti!y the
customer1 #! customer accepts the costs: heCshe 0ill -e re,uire either to pay in advance or
commit himsel!Chersel! that he 0ill pay the said costs -e!ore MSD con!irm the orders1
'he order 0ill -e processed and upon arrival o! the items: the customer 0ill -e noti!ied to
collect the same at the nearest MSD distri-utin %aonal store1
EMERGENC) &ROC.REMENTS
'hese are items o! 0hich their demand e$ceed normal MSD !orecasted re,uirement
during the -usiness period due to une$pected increase in usage1 MSD orders the products
under the emergency terms and customers 0ill -e in!ormed o! the status o! the item
ordered
C.STOMER IDENTI$ICATION CARDS#
*n institution su-mits a !orm o! t0o signatories authorises to approve e$penditure1 *n
institution also nominates and su-mits pictures o! a minimum o! t0o persons 0ho are
authorise to collect drug and medical supplies !rom MSD1
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*n institution in!orms MSD on change o! signatories or collecting personnel i! it happens
-e!ore the elapse o! three yeas1 No drugs or medical supplies 0ill -e issued to a person
0ithout MSD proper identi!ication
BACK ORDERS#
'hese are orders either partly supplied or 0ith missed items to the customers1 #! this
occur MSD systematically in!orm customers on the status o! all -ac3 orders -ecause o!
out o! stoc3 conditions and advice them to recon!irm orders and collect 0hen the items
arrive d
B.DGET BASE ORDERING S)STEM /BBO0
BBO system is a commitment o! MSD on !uture provision o! services upon understandig
o! the !uture demand o! every Health Facility 6HF7 especialty those supported -y the
governments1
'he -ene!it o! using this system MSD 1ere-
Customer ser2ices e2e is impro2ed
Incre sed in s es 2o ume is !ener + impro2ed
Impro2ed stor !e 3 ctor, s on + dem nded items 1i "e *e d in stoc4
A so t*is *e p MSD to reduce 1 st !e o3 supp ies /c used "+ o"so escence nd
e5pir+0 s stoc4 e2e s 1i "e !e red to1 rds meetin! dem nd
COM&LAINTS'hese are complaints related to the customer’s dissatis!action !or the service and the 0ay
0e e$ecute our activities and any other matter that the customer 0ould li3e to -e
addressed -y MSD1
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'hose Health !acilities 0ith pro-lem they 0ill contact nearest %onal o!!ice !or !urther
clari!ication and solution or i! they are not satis!ied 0ith service they have to contact
&ustomer Services Manager or MSD management1 'his can -e also done via email
address in!o msd1or1t%
67 DA)S &RIOR ORDERING#
Most o! the customers 0ere encourage su-mitting their orders 2 days prior to
purchasing day so that MSD can have ade,uate time to plan !or their needs1
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&ROC.REMENT
CENTRAL MEDICAL STORE
*t the &entral Medical Store procurement o! essential medicines and all other category o!
product are procured -y the MSD 'ender Board1 'he tender -oard mem-ership is
comprised o! people 0ith di!!erent ,uali!ications including: Pharmacists: Financial
e$pert: Material Management sta!! and )ogisticians1 So this may result into the central
-uying unit manages the purchase on -ehal! o! mem-er1 Most essential medicines and
supplies stoc3ed at MSD are procured -y tender through #nternational &ompetitive
Bidding 6commonly used7: National competitive -idding: Negotiated tender: selective
-idding: direct procurement and shopping 0ere also used1 So the &entral Medical Store
has the duties o! to procure and distri-ute to all health !acilities in 'an%ania1
*t MSD procurement process 0as mainly 0ith essenti medicine nd supp ies and !or
2ertic pro!r m items#
&rocurement o3 essenti medicines nd supp ies
'he centrali%ed procurement system is in place 0here-y the 0hole re,uirements o! all
levels o! health !acilities in 'an%ania are purchased -y a single agency: 'he Medical
Stores Department1 'he MSD 'ender Board is in place and is the legal entity under
'an%ania Pu-lic Procurement *ct 5@@ and .egulations 5@@ that is empo0ered to
advertise: receive: evaluate and a0ards success!ul -idders1 Price and ,uality o! product
are given e,ual consideration 0hen determining !actor !or a0arding tender1
Pu-lic health !acilities dra0 their re,uirements !rom MSD either through their respective
!unds deposited at MSD direct -y MOHS or -y direct purchase using their o0n !unds
!rom other sources including government -as3et !unds1
&rocurement o3 Vertic pro!r m items
'hese are mostly non MSD catalogue items 6only a-out are on MSD list o! products7
and are procured only under special re,uest -y the respective programs1 MOHS and the
programs mo-ili%e enough !unds !rom the government or development partners or -oth
and deposit the same to MSD 0hich in turn advertise tenders1 #n some incidences
development partners donate direct goods to the programs1
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On the other hand the MOHS utili%e the technical e$pertise o! some multilateral
partners to procure speciali%ed goods1 For instance vaccines !or "P# are solely procured
-y UN#&"Funder special arrangements1
Se ection o3 t*e !ener essenti medicines
#n 'an%ania selection o! the essential medicines is done at the national level -y the
N tion Medicine nd T*er peutic Committee 0hich has the overall responsi-ility o!
ma3ing appropriate selection: supervising ade,uate procurement and rational
management and use o! essential medicines to pu-lic health !acilities 0ithin the availa-le
-udge limitation1 #t ensures that only e!!icacious: sa!e: cost e!!ective and good ,uality
medicines are used1 'he committee not only develops and guides implementation o! an
e!!icient cost e!!ective National Medicine Formularly and Standard 'reatment Guidelines6S'G7 -ut also develops and pu-lishes the National "ssential Medicine )ist !or 'an%ania
6N"M)#'71 *ll these three are periodically updated in order to address ne0 diseases or
medical challenges that re,uire ne0 or alternative interventions and or treatment
protocols1
Se ection o3 medicines 3or Vertic &ro!r ms
'he various +ertic 6+accines7: .&HS6.eproductive and &hild Health7: NM&P 6Malaria7:
B'S6sa!e -lood7 3eep a list o! medicines: la-oratory reagents and medical supplies
appropriate to their programs plan and need1 'his selection is done -y the MOHS in
colla-oration 0ith the program managers1 'reatment protocols are developed and
implemented -y the programs1 National advisory su->committee !or the respective
programs are in place1 'hese committees play great roles in monitoring the per!ormance
o! the programs1 Program managers maintain and regularly update list o! their respective
medicines and or medical supplies1
$ORECASTING AND 8.ANTI$ICATION
*t the &entral Medical Store there is a special committee responsi-le !or !orecasting and
,uanti!ication o! essential medicines1 Other category o! products such as H#+C*#DS
medicines: anti>malarias etc1 are !orecasted and ,uanti!ied -y their respective vertical
programs1
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*lso at MSD: procurement plans are -ased on re,uirement estimates derived
mathematically !rom the !ollo0ing dataA
6i7 !orecasts: 6ii7 stoc3 on hands at all levels o! distri-ution system: 6iii7 previous
procurement ,uantities ordered or deliveries e$pected: 6iv7 losses e$pected to occur dueto damage or e$piry: 6v7 direct donations !rom development partners 6vi7 desired stoc3 at
the end o! each planning period 6including sa!ety stoc3s and 0or3ing stoc3s at all levels71
'he estimated ,uantity o! medicine re,uired in a successive planning period: usually an
year: is calculated asA
8.ANTITIES RE8.IRED 9 STOCK ON :AND ; 8.ANTITIES ALREAD)
ORDERED ; DIRECT DONATIONS E<&ECTED $ROM AN) OT:ER SO.RCE
= ESTIMATED CONS.M&TION $OR T:E &ERIOD = LOSSES = DESIREDSTOCK AT T:E END O$ &ERIOD#
hen the net supply re,uirement is ne! ti2e num"er, the ,uantity e,uivalent to the
integer must -e o-tained to maintain the desired stoc3 level1 #! the num-er is positi2e,
there is a possi-le over supply o! stoc3 and no order is re,uired to -e placed1 Order
deliveries are planned in a staggered manner to ena-le not only proper utili%ation o!
0arehouse space -ut also ena-ling good cash !lo0 -y not holding unnecessary e$cessstoc3s at any time1
T*e VEN 6vital: essential and non>essential7 analysis: therapeutic category analysis and
*B& analysis techni,ues are utili%ed at MSD to select priorities and reduce the ,uantities
o! less cost>e!!ective medicines1 #tems pulled -y primary healthcare !acilities under the
ne0ly introduced #ntegrated )ogistics Systems 6#)S7 are another priority area1
$orec stin! nd >u nti3ic tion 3or Vertic pro!r ms
'his is per!ormed -y all programs1 #t is ho0ever: conducted once each year as the -ase
!or determining annual needs1 Programs 0or3 closely 0ith partners 69@ 7 to determine
the ,uantities and generate a procurement plan1 /S# and S&MS have played a great role in
!orecasting and ,uanti!ication !or *.+s: )a-oratory reagents and H#+ test 3its: *nti>
malarials: Products !or .&HS: &ondoms: and sa!ety syringes1 On the other hand "P#
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program manager 0or3s very closely to .egional and District vaccine cold chain
coordinators together 0ith partners at UN#&"Fto generate the annual procurement plan
!or vaccines1
& cement o3 orders ? contr ct m n !ement
'he MOHS ministerial tender -oard and MSD a0ard contract to success!ul -idders and
initiate contract management activities !or each a0ard1 hereas most o! MOHS
tenders and a0ards are -ased on )ots: at MSD: tenders and a0ards are on individual item
-asis1 'he later strives to get the lo0est or competitive price o! individual items: 0here as
the !ormer -ene!it on managing !e0er contracts at a time1 'his practice has ena-led MSD
to get prices o! medicines and supplies at lo0 rate than the respective international price
indicators1
8.ALIT) CONTROL
Juality assurance unit is the 'echnical 0ing o! MSD1 #t consist o! 'echnical sta!! 0ho
have the o-Kective o! maintaining the Juality *ssurance Policy o! MSD 0ith a goal o!
ma3ing certain that: each drug and medical supply reaching a patient is sa!e: e!!ective and
o! standard ,uality
ROLES O$ 8.ALIT) ASS.RANCE-
O2er
#t 0as the responsi-ility o! Juality *ssurance unit to assure the ,uality o! the entire
product coming into MSD1
Speci3ic
'he tas3 and activities o! the unit are divided into routine and non>routine1 #t include
'echnical and Managerial activities
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ACTIVITIES COND.CTED
8u it+ ssur nce
'an%ania Food and Drugs *uthority 6'FD*7 is the National Medicine and Medical
Devices .egulatory *uthority: under this result all medicines has to -e registered or
approved -y 'FD* -e!ore are allo0ed to circulate on 'an%ania mar3et and MSD adhere
to this1
*ll medical devices are to -e approved -y 'FD* -e!ore allo0ed to circulate on 'an%ania
mar3et and this is the area 0here the registration o! medical devices has started1 here
need -e: other ,uality assurance -odies and or e$perts are employed to veri!y on the
,uality o! devices imported -y MSD: include 'BS: UDSM 6B#&&O7: "$pert Users6MNH: MO#71
*ll devices has to meet re,uired manu!acturing standards #SO: &"N: &" *ll medicines
has to -e HO GMP compliant
8u it+ Contro
*ll incoming consignments are inspected !or ,uality satis!action -e!ore -eing accepted to
store that is random samples are pic3ed and send to 'FD* !or testing11 MSD has in place
J* Section reporting direct to DG also MSD has a min la- !or conducting simple tests1
*ll consignments that do not meet prescri-ed standards are reKected1 'he J* section also
conducts mar3et surveillance1 .ecall SOPs are !ollo0ed during 0ithdra0 o! item !rom
the mar3et1
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LOGISTICS
MSD has one the most complete logistic net0or3s in 'an%ania1 'he net0or3 consists o! I
%onal stores and a central o!!ice and 0arehouses in Dar es Salaam1
T*e net1or4 is c* r cterisin! "+-
Fleet o! modern truc3s: capa-ility to store cold chain items: monthly vaccine delivery to
all %ones: three month delivery to all indents customers and !ull Management #n!ormation
System 6M#S7 supplying up to date in!ormation on all aspect o! logistics: order status:
inventory and deliveries1
#t 0as sho0n that MSD delivers goods at the same price nation0ide: 0hether in Dar es
Salaam or M0an%a the delivery price remaining the same due to its volume operations
and highly competitive -idding it can provide the least costly transportation solutions tocustomers1
&us* nd &u s+stem
Pull system is employed and not push system1 SM*.' push is employed in every rare
cases on the instruction o! MOHS 0hen there is de!icit in medicineS and supplies in
most areas o! Health Facilities11 #ntergrated )ogistic System 6#)S7 is -eing practice1 But
no0 MSD has started Direct Delivery to primary health center !acilities in 'anga:
Shinyang: DSM and &oast .egions1 But !or very district hospital CDDH is reaching
Medical Store Department 0ithin a day1
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$i!ure 6# No1 MSD * s @ on distri"ution centers o2er T n ni #
T " e 6# List o3 *e t* 3 ci ities 3or distri"ution *e t* !oods
C te!or+ o3 :e t* $ ci it+ Num"er
2 National Hospital 25 MaKor .e!erral Hospitals 8
8 Speciali%ed Hospitals
.egional Hospitals 5@
District < DDH Hospitals 28I
E Other Hospitals approved -y MOHS
6Faith Based: *rmy: &orporate < NGOs7 and
=an%i-ar
25
Health &enters 59
I Dispensaries 8:92
'otal :@@@
WARE:O.SE STORAGE#
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Good storage practice 0as !ollo0ed at MSD1 Goods are stored according to prescri-ed
conditions: cold rooms: chilled room and room temperature1 Sa!ety and cleanliness is
ensured1 MSD use so!t 0are ".P !or inventory management is in place: O.#ON no0 0as
replaced -y "P#&O.1 .eal time data capture and reporting is in place1 'his system 0as
used to identi!y any stoc3 status o! di!!erent %ones in 'an%ania and can -e easy !or them
to reallocate the items to another place 0ere there is a de!iciency1
C:ALLENGES
The following are still being challenges in the provision of
health services by MSD
1. Still medicines and medical supplies were being stock outs
2. Long procurement lead time3. Communication gaps
4. Non maintenance of good quality of supplies
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Conc usion
MSD is the conventional supply system 0here-y medicines and medical supplies
procured and distri-uted -y centralised government unit 6MSD71 'his system has
advantageous o! -eing easily to monitor and involvement o! Government to control over
entire system1 *lso MSD no0 it tries to ma3e an e!!ort on improving customer care and
communication: to maintain good ,uality o! medicine and supplies and to cut do0n the
long lead times1
&urrently the system su!!er !rom a lot o! shortcoming li3e having high capital cost !or
o!!ice: storage: transport !acilities1 "$isting o! recurrent cost o! sta!!: transport and other
operational cost1 )imited incentive !or e!!iciency1 *lso open to political and other
inter!erence1
Recommendations
PSUC MOHS to avail a certain percentage o! the hospitals’ medicines -udget 65@ >
8@ 7 to -e managed -y the Hospital administration !or procurement o! medicines !rom
either MSD or othersources1
Health 'raining #nstitutions should incorporate the "M) < S'G concept their training
curricula to create a0areness to students and inculcate a culture o! rational use during
their practices1'o put into practice other approach !or organi%ing medicine and health goods supply !or
government health service li3e prime vendor system: !ull private supply: direct delivery
system and autonomous system depending on the condition e$ist1
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Re3erence-
Class review notes/handouts
Management Science for health. Managing drug supply; the selection,
procurement, distribution and use of Pharmaceuticals. umarian Press, !"",
Second edition, revised and e#panded
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