MANAGING

DRUG SUPPLY

Dra. Aziza Nuraini MM. Apt.

WHY WORRY ABOUT DRUGS ?

1. Drugs save lives and improve health

2. Drugs promote trust and participation in
health services
3. Drugs are costly
4. Drugs are different from other consumer products
5. Substantives improvements in the supply and
use of drugs , are possible
WASTE IN DRUG MANAGEMENT AND POTENTIAL FOR IMPROVEMENT

US$ 1,000,000 High prices

Continuing
Poor quality High prices
losses
Losses from
From Theft unaltered US$ 700,000
Problems problems Improved purchasing
With Improper storage
Drug Quality assurance
Expiration of drug
supply Security system
Irrational precribing Better storage
Reduction Careful inventory control
Lack of adherence In losses
Improved prescribing
By patients Through
Improved Public education
US$300,000 Manage-
ment

Original Allocation Therapeutic Benefit Therapeutic Benefit

US$ 1,000,000 With current Problems : With Improved Management :
US$ 300,000 US$ 700,000
 NATIONAL DRUG
POLICY – A TREE THAT
BEARS FRUIT
DRUG MANAGEMENT CYCLE

Selection

Management Support:
- Organization
Use - Financing Procurement
- Information Management
- Human Recources

Distribution

Policy and Legal Framework

 COMMON HEALTH PROBLEMS GUIDE SELECTION,
TRAINING, SUPPLY, AND DRUG USE

List of Common Health Problems

Choice of Standard Drug and

Nondrug Treatment

Drug List
List of Essential Drug Supply
Drugs • Procurement
• Donations
• Distribution Treatment
• Production Guidelines
Rational Drug Use
• Training
Formulary
• Supervision
• Monitoring
Drug Information

Greater Availability andMore Rational Use of Drugs

 PROCUREMENT CYCLE

DETERMINE QUANTITES
REVIEW DRUG SELECTION
NEEDED

COLLECT CONSUMPTION RECONCILE NEEDS

INFORMATION & FUNDS

CHOOSE PROCUREMENT
DISTRIBUTE DRUGS
METHOD

LOCATE AND SELECT

MAKE PAYMENT
SUPPLIERS

RECEIVE & CHECK DRUGS SPECIFY CONTRAST TERMS

MONITOR
ORDER STATUS
 COMPARISON OF QUANTIFICATION METHODS (1)
Methode Uses
First choice for procurement
forecasts, given reliable
Consumption data
Most reliable predictor of
future consumption
Estimating need in new
programs or disaster
assistance
Morbidity Comparing use with
theoritical needs
Developing and justifying
budgets
Essential Data Limitation
Reliable inventory
records Must have accurate
consumption data
Records of supplier lead
time Can perpetuate
irrational use
Projected drug costs
Data on population and
patient attendances Morbidity data not
Actual or prejected available for all
incidence of health diseases
problems Standard treatments
Standard treatments may not realy be used
(ideal, actual)
Projected drug costs
 COMPARISON OF QUANTIFICATION METHODS (2)

Methode Uses Essential Data Limitation

Adjusted Procurement forecasting Comparison area or
consumption when other methods system with good per
unreliable capita data on
consumption, patient
attendance, service levels,
and morbidity
Number of local health
facilities by category
Estimation of local user
population broken down
by age
Service-level Estimating budget needs Utilization by service
projection of levels and facility type
budget Average drug costs per
requirments attendance
Questionable
comparability of
patient populations,
morbidity, and
treatment practices
Variable facility use,
attendance patterns,
supply system
efficiency
SUCCESFUL DRUG QUANTIFICATION REQUIRES A TEAM EFFORT
AND A MIX OF METHODS
 MULTIPLE DEPARTMENT PHARMACY SYSTEM
Medical supplies coordinating unit

Issue and Receipt voucher (S 12)

Hospital bulk
Counter requisition and Drug store Counter requisition and
Issue voucher (S 11) Issue voucher (S 11)
Bin card (S 3)

Hospital Pharmacist

Outpatient Pharmacy
Inpatient Pharmacy
Drugs and Revenue Register
Hospital Pharmacy Bin Card
Hospital Pharmacy Bin Card
DDA Register for Pharmacy Counter requisition
and DDA Register for Pharmacy
Issue voucher (S 11) Oral Antibiotics/
Sulfonamides Register

Flow of
Wards Operating room Special Service OPD Injection Drug
Areas (e.g., X-ray) Room
Flow of
DDA : Dangerous Drugs Act request
INPATIENT DRUG DISTRIBUTION SYSTEM

1. BULK WARD STOCK REPLENISHMENT

2. INDIVIDUAL DRUG ORDER SYSTEM
3. UNIT-DOSE SYSTEM
OPTION FOR LAYOUT OF STORE AISLES
Very Frequent Access

Assembly Area Arrangement for

Frequent Access

Frequent Acces

Assembly Area Combined Arrangement for

Frequent Access Frequent and Infrequent
Access

Infrequent Access

Assembly Area Arrangement for

Infrequent Access

Infrequent Access Shelves

FACTORS INFLUENCING PRESCRIBING

PRESCRIBING
THE DISPENSING CYCLE

5. COUNSEL 1. RECEIVE
& &
SUPPLY CONFIRM

DISPENSING
4. RECORD CYCLE 2. INTERPRET
& &
ENDORSE VERIFY

3. PREPARE
& LABEL
THE MANAGEMENT CYCLE

PLANNING IMPLEMENTATION
• Situation analysis • Human recources
• Strategic planning, management
program planning, work • Financial management
planning • Information management

MONITORING & EVALUATION

• Monitoring of programs and
workplans
• Evaluation of organizational
effectiveness
LITERATURE

Management sciences for health & WHO,

Managing Drug Supply, 2nd ed, 1997,
Kumarian Press, USA