Assessments of the Supply Chain and Forecasting and Quantification of

Essential Medicines and Consumables for the MOHS, Sierra Leone, May 2009

PHYLLIS OCRANCONSULTANT

Agenda

Scope of Work and Objectives Capacity Building Assessments Essential Medicines and Medical

Consumables Quantification Training Proposal Logistics Cycle Challenges Recommendations

Scope of Work and Objectives

To assess the strengths and Limitations of the current Supply Chain and training needs of the health personnel involved with the supply chain at the districts and central levels.

Forecast the requirements of Essential Medicines and Medical Consumables needed to support the expansion of the Sierra Leone RCH/MOHS Program for the period 2009-2010

Capacity Building Exercise

Strengthening capacity within the MOHS in: Supply Chain Assessment using Tools Collection of Logistics and Morbidity data from

the field Reviewing the basic logistic concepts Data compilation, verification, validation,

aggregation, Inputting and analysis of the data Using forecasting methodologies Preparing the forecast Preparing reports on stock status, commodity

requirements and estimating Cost

Assessments

Strengths

Policy, Protocols and Guidelines have been established for key intervention areas in Health Systems-

Revised health services cost recovery policy guidelines

Guidelines for the donations of Medicines, Medical Supplies and equipment to Sierra Leone 2004

The Pharmacy and Drugs Act, 2001, Public Procurement Act 2004 Public Procurement Regulations 2006

Strengths Con’t

National Standard Treatment Guidelines Essential Medicines List etc., Existence of a National Drug Regulatory

Authority in Sierra Leone. Provision of technical assistance, essential

commodities and logistical support by Stakeholders, UN agencies and other NGO’s (UNICEF, World Bank, ADB, EU, UNFPA, MSF, GFATM and others).

Strengths Con’t

Some logistic records in the system-Stock cards-Daily activity registers-Store ledgers-Monthly drug consumption/issuing formClaim formsGeneral requisition/issue note (GRIN),

waybill)

Essential Medicines Distribution

Challenges

Lack of technical expertise on some district council’s procurement process. Often times most drugs procured by council on

behalf of the government when delivered has few months shelf life remaining, and this has resulted in a lot of expiries and wastage.

Large influx and availability of sub standard drugs

Lots of expiries because of unstandardized and unfavorable cost recovery mechanisms.

Challenges Con’t

Lots of stock outs throughout the Health Facilities –

Budgetary allocations for essential drugs are often times not adequate.

Drugs Procured inadequate to meet the needs of the general populace.

Challenges Con’t

There are different donors of drugs at the districts and each donor has its own reporting format This causes some facilities which are

the beneficiaries to be significantly overstocked, which can result in expiration, damage, and waste, whilst some facilities lack the medicines expiring elsewhere.

Challenges Con’t

Lack of trained personnel handling the essential medicines.

Low moral of some health workers who are working and are not yet on government payroll

Volunteers serving for long periods expected incentives which were not forthcoming

Challenges Con’t

Logistics management information system (LMIS) is nonexistent for the essential medicines Poor clinical recordings on patient

morbidity Lack of accurate record keeping and

good documentation Lack of reporting on drug usage

Stock Status Analysis as at May 2009

DISTRICTS KOINADUGU BOMBALI PORT LOKO

KAMBIA TONKOLILI KONO

S/N Drugs Months of Stock on

Hand

Months of Stock on

Hand

Months of Stock on

Hand

Months of Stock on

Hand

Months of Stock on

Hand

Months of Stock

on Hand

1 Lidocaine Injection (plain) 2% 1 0 8 1 1 0

2Lidocaine injection with

epinephrine 2%1 1 3 1 1 0

3 Paracetamol 125ml 1 1 1 1 1 0

4 Paracetamol 500mg 1 1 1 1 1 0

5 Aspirin 300mg 1 2 2 2 2 0

6 Diazepam tabs 10mg 2 0 12 1 0 0

7 Mebendazole 500mg 1 96 2 1 1 0

8 Albendazole 400mg 0 3 13 1 1 0

9 Mebendazole 100 mg 5 6 0 5 15 1

10 Amoxycillin 125mg/ml 0 1 1 1 1 0

11 Amoxycillin 250mg 1 2 0 1 1 0

12 Amoxycillin 500mg 0 0 0 0 0 0

13 Benzathine Benylpenicillin 2.4mu 1 1 2 1 1 0

14 chloramphenicol 250 mg caps 0 0 1 0 0 0

15 Ciprofloxacin 500mg/250 2 2 0 1 2 0

16 Ciprofloxacin 250mg 0 0 3 0 0 0

17 Co- trimoxazole 200+40mg/5ml 0 1 1 9 0 0

18 Co- trimoxazole 400 +80mg 1 1 0 1 1 0

19 Metronidazole 200mg 1 1 0 1 1 0

20 Metronidazole syrup 0 0 0 0 0 0

Quantification

Scope and Purpose

Forecast the requirements of essential medicines and medical consumables needed to support the expansion of the Sierra Leone RCH/MOHS Program for the period 2009-2010

For the morbidity method, the categories were:

-Pregnancy related conditions-Under fives presenting conditions-PHUs presenting conditions-Hospitals (in and out patient) presenting

conditions

Assumptions

Total Population of Sierra Leone = 5,400,000

Pregnancy related Conditions = 5% = 270,000 Under Fives = 17% = 918,000 PHUs and Hospitals (out patient and In

patients)adjusted for 60% reporting (DPI) STGs used

Forecasting Methodologies

Three forecasting methodologies were considered:

Consumption method (logistics data)

Morbidity method

(Demographic/morbidity/service data: no. of

patients with health conditions).

Adjusted Consumption method (Logistics data

adjusted)

Quantification Results

• Essential Medicines

• Medical Consumables

 Essential Medicines Quantity

requiredCost USD

1 Acyclovir 200mg 27,244 1,702.72

2 Albendazole 200mg 70,366 2,110.98

3 Albendazole 400mg 345 69.00

4 Aluminium hydroxide 500mg 690 2.69

5 Aminophilline 17,785 96.57

6 Aminophylline IV 12mg/kg 8 5.98

7 Amitryptyline 25mg 365 2.34

8 Amoxycillin 250mg 29,788 720.87

9 Amoxycillin 500mg 2,995 151.86

10 Amoxycillin /clavulanic acid 125/31mg 100ml 938 1,632.49

11 Amoxycillin/ Clavulanic acid 625mg 640 95.19

12 Ampicillin 1g, im/iv, powder for infection 31,348 3,235.12

13 Ampicilline 250 mg 24,420 602.19

14 Anti-hemorrhoidal Ointment 8,550 8,379.00

15 Anusol suppositories 8,795 953.34

16 Aspirin 300mg 178,559 537.46

17 Atenolol 50mg 11,349 55.38

Essential MedicinesQuantity required

Cost USD

18 Atenolol tabs 100 mg 16,964 115.19

19 Atropine 1mg/ml 800 76.43

20 Beclomethasone Inhaler 2 17.20

21 Bendrofluazide tabs 5mg 5,125 46.99

22 Benzathine Benzyl penicillin 1.2mu 1,421 497.52

23 Benzathine Pennicillin IM 2.4 1,840 1,473.18

24 Benzoic Acid ointment 6% 12,948 36,771.49

25 Benzyl Benzoate 25% 907 3,274.42

26 Benzyl Penicillin, 5mu, powder for infection 4,191 3,356.15

27 Benzyl Pennicillin IM 1MU 11,268 7,571.92

28 Bethametasone ointment 1% 1,080 742.86

29 Bisacodyl 5mg 18,499 183.33

30 Bruphen tabs 200 mg 483,410 5,269.17

31 Bruphen tabs 400 mg 236,921 2,084.91

32 Calamine lotion suspension BP formulation 6,689 26.82

33 Calcium gluconate 100mg/ml 9,419 2,332.13

34 Calcium lactate tabs 200mg 74,688 708.04

Medical ConsumablesQty Required Cost - USD

1 Crepe bandage 10 cm x 4 cm 853 2,208.50

2 Guaze bandage, N17, 7.5 cm x 5 m 888 7,968.45

3 Guaze Pads 10 x 10 cm, 12 ply, N17, non-sterile 1,292 93.25

4 Absorbent Cotton wool 500g 114 1,322.35

5 Adhesive Plaster 295 3,977.46

6 Zinc Oxide plaster 2.5 cm x 5 m 446 368.98

7 Needle and syringe 5ml 9,372 168,695.46

8 Folleys catheter 10, sterile, disposable 520 577.46

9 Folleys catheter 12, sterile, disposable 520 265.32

10 Folleys catheter 14, sterile, disposable 520 265.32

11 Folleys catheter 18, sterile, disposable 520 265.32

12 Surgical blade (Various sizes) box 1,508 66,234.10

13 Needle 19 G 3,226 59.36

14 Suction catheter, 08, sterile, disposable 72 15.75

15 Suction catheter, 10, sterile, disposable 72 15.75

16 Suction catheter, 14, sterile, disposable 72 10.03

17 Suction catheter, 16, sterile, disposable 72 12.17

18 Clinical Thermometer 111 896.97

Medical ConsumablesQty

Required Cost -USD

19 Assorted Sutures 1,056 13,156.51

20 Surgical spirit 100 ml 73 1,128.42

21 Absorbent Gauze 31 384.09

22 Medicine Bags 46 537.20

23 PVD Iodine 10% Solution 200 ml 62 62.54

24 Benzyl benzoate 25% application litre 93 1,443.34

25 Chlorhexidine di-gluconate 5% solution, litre 93 1,542.53

26 Rexoguard gallon 40 664.81

27

Cetrimide 15% litre, Chlorhexidine di-gluconate 5% solution, litre 46 767.09

28 Dissecting, spring-type, non-toothed, 11.5 cm, Forceps, 62 530.86

29 Artery Forceps 93 941.83

30 Operating Scissors 93 876.94

31 Gentian Violet Crystals 25g 46 41.25

32 Scalpel Holder 77 13,702.61

33 Needle Holder 93 1,243.11

34 Adult Scale 49 850.86

Cost Estimates for Commodities

$3,000,000 budget36% for freight and handling

Required Quantities Total Cost

Adjusted total Cost

Gap

Medicines $58,284,546.12 $1,799,749.35 $56,484,796.77

Consumables $11,739,817.06 $299,629.88 $11,440,187.18

Quantification Challenges

Absence of Logistics data in most health facilities

Inaccurate Logistics data in most health facilities

Poor reporting on most health conditions

Training Proposal

Two days sensitization workshop per group. The groups are:

District Council members especially the procurement Officers

District Medical Officers and Medical Superintendents

Hospital Administrators Monitoring and Evaluation Officers DHMT members Pharmacy Board

Training Proposal con’t

Three to five days training (# of trainings based on 25–30 participants) 10 people national level,1–2 pharmacist from District Hospitals, 1 Pharmacist from District medical Stores, 1 storekeeper from each District Store, 1 In charge of the CHP, MCHP,CHC per districts. 2 hospital midwives in charges.

Ten months of three to five day trainings of all staff throughout the system (919 RCH facilities and CMS, Pharmacy Board etc)

The Logistics Cycle

Recommendations

The MOHS should strive towards having a centralized system for procurement and drug distribution. It could be two agencies operating it on a not for profit basis, one of the agencies can be government owned and the other could be owned by civil society.

Recommendations Con’t

The MOHS should strengthen its procedures for management of essential medicines including procedures for issuing to health facilities, storage, distribution systems, procurement and a system for monitoring facility stock levels of the medicines.

Recommendations Con’t

The MOHS should seek technical assistance to design and implement a Logistics Management System for the Essential Medicines and train all Healthcare Workers managing the essential medicines throughout the supply chain. .

Recommendations Con’t

The MOHS should explore the options of having a scheduled delivery system for the essential drugs and medical consumables. The system would deliver directly from the Central level to the DMS and hospital stores and then to the PHU’s.

Recommendations Con’t

The MOHS should conduct a multi-year forecasts which will be reviewed biannually to enable medium term planning for financing and procuring essential medicines and medical consumables.

Looking across the horizon, the vision Looking across the horizon, the vision spreads so far away.spreads so far away.

Old saying……..Old saying……..A journey of thousand miles starts with the first A journey of thousand miles starts with the first step……step……

……The MOHS, Sierra Leone is past the second The MOHS, Sierra Leone is past the second stepstep

THANK YOUTHANK YOU