Msd Report tz

8/13/2019 Msd Report tz

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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

2



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

5



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

5

8



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



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



*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

E



'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

mailto:[email protected]

mailto:[email protected]



&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

I



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

9



*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#

2@



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

22



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

25



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

28



$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#

2



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

2



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

2E



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

2

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