Upload
emery-shaw
View
273
Download
1
Tags:
Embed Size (px)
Citation preview
The Drug Management Cycle – Distribution
Butch Staley
Working Definitions
• Supply chain – The network of retailers, distributors, transporters, storage facilities, and suppliers that participate in the sale, delivery, and production of a product.
• Logistics – The overall management of the way resources are moved to the areas where they are required.
• Distribution – The delivery or giving out of an item or items to the intended recipients.
Elements of the Distribution System
Characteristics of Effective Distribution
• Constant supply• Maintained quality• Minimal loss/pilferage• Accurate and timely inventory and transaction
information• Proper storage• Efficient transport/delivery • Adequate geographic coverage
Supply System Models
• There are many models, ranging from fully public to fully private, each with relative advantages and disadvantages, depending on context.– Central Medical Stores model: South Africa, Tanzania– Autonomous supply agency: Uganda, Benin– Direct delivery: Caribbean– Primary distributor (prime vendor): USA– Fully private: Canada, Australia– Mixed models: Europe, Caribbean
LEVELSFULLY PRIVATE FULLY PUBLIC
International
National
Regional Regional Medical Store
District
Community
District Medical Store
HospitalsHealth CentersHealth Posts
Users Key
Product flow in traditional CMS System
PrivatePharmacies
International Suppliers
Local Wholesalers
Distributors
Local Manufacturers Central Medical Store
Pharmaceutical Distribution Models
Central Medical Store ModelLEVELS PRIVATE SECTOR PUBLIC SECTOR
International
National
Regional Regional Medical Store
District
Community
District Medical Store
HospitalsHealth CentersHealth Posts
Users Key
Product flow in traditional CMS System
Distributors
Shops, Pharmacies
Local Wholesalers
International Suppliers
Local Manufacturers Central Medical Store
Direct Delivery ModelLEVELS PRIVATE SECTOR PUBLIC SECTOR
International
National
Regional Regional Medical Store
District
Community
District Medical Store
HospitalsHealth CentersHealth Posts
Users Key
Product flow in traditional CMS System
Shops, Pharmacies
Central Medical Store
International Suppliers
Local Manufacturers
Local Wholesalers
Distributors
Primary Distributor ModelLEVELS PRIVATE SECTOR PUBLIC SECTOR
International
National
Regional Regional Medical Store
District
Community
District Medical Store
HospitalsHealth CentersHealth Posts
Users Key
Product flow in traditional CMS System
Shops, Pharmacies
Central Medical Store
International Suppliers
Local Manufacturers
Local Wholesalers
Distributors
Primary Distributor
LEVELS PRIVATE SECTOR PUBLIC SECTOR
International
National
Regional Regional Medical Store
District
Community
District Medical Store
HospitalsHealth CentersHealth Posts
Users Key
Product flow in traditional CMS System
PrivatePharmacies
Local Wholesalers
Distributors
Local Manufacturers Central Medical Store
Fully Private Model
International Suppliers
Health System Supply Chain – Theory
Government SupplyServices
LEVELS PRIVATE SECTOR PUBLIC SECTOR
International
National
Regional
District
Community
Multinational SuppliersInternational
Procurement Agencies
Local Wholesalers
DistributorsRegions
· Medical Stores· Hospitals
Retail Shops,Pharmacies
Districts· Medical Stores· Hospitals· Health Centers
Users
Community Health Workers
Key Drug flow in traditional CMS system Alternative drug flow (planned or unplanned) Information flow
PrivatePrescribers
NGO Health Facilities
· Insurers· Private Employers· Other Third Party
Programs
NGO Supply Services
Local Manufacturers
FamilyPlanning
(including somecondoms for STI/
HIV)
STIDrugs
EssentialDrugs
Vaccinesand
Vitamin A
TB/Leprosy
HIV/AIDStest kits
(&hepatitisB tests)
DFID(UK)
Kf
WUNICEF JICA
GOK,WB/IDA
Source offunds for
commodities
CommodityType
(colour coded)
MOHEquip-ment
(includinglaboratorysupplies)
Point of firstwarehousing
KEMSA Central Warehouse
KEMSARegionalDepots
Organizationresponsiblefor deliveryto district
levels
KEMSA, District Hospitals, DistrictStores (essential drugs kits, malaria drugs, lab
supplies, reagents, HIV/AIDS test kits)
ProcurementAgent/Body
CrownAgents
Governmentof Kenya
GOK
GTZ
DELIVER and LogisticsManagement Unit, Division of RH(MOH) (contraceptives, condoms, STI
kits, HIV/AIDS test kits)
Euro-pean
Union
Kf
W UNICEF
KEPI ColdStore
KEPI(vaccines
and vitaminA)
Malaria
SIDA (6 districts)
USAID
USAID
UNFPA
DANIDA (11 districts)
EUROPA
Condomsfor STI/HIV/
AIDSprevention
Belgian Gov (BTC) (2 districts)
CIDA World Bank DARE (8 districts)
UNFPA
European Union (20 districts)
District leveldecisions of
quantity, type andprocurement of
healthcommodities
De-centralization projects
USGov
CDC
WHO (3 districts)
NPHLS store
MEDSPrivate
DrugSources
GDF
DutchGov
Agent
Government
NGO/Private
Bilateral Donor
Multilateral Donor
World Bank Loan
Organization Key
JapanesePrivate
Company
JICA (5 districts)
WHO
GAVI
ADB (5 districts)
SIDA
NLTP(TB/
Leprosydrugs
The Complex Reality: Health Supply Chains in Kenya
Key Decisions
• Key decisions include:– Push versus pull– Centralized versus decentralized– Roles and responsibilities: public, private, NGO– Mix of in-house and contract services– Levels of distribution and stock requirements
Assessment/Option Analyses
• Understand context – functionality and current capacity of public, private, and NGO systems and institutions
• Consider variable costs with each option
• Consider capacity to manage and operate proposed system
• Define methods for monitoring and measuring performance
Summary
• Designing a system for storing and distributing pharmaceuticals is complex and important
• In some countries, private (or parastatal) distribution companies may provide cost-effective alternatives for storage and distribution of pharmaceuticals