PENGANTAR MANAJEMEN LOGISTIKPERBEKALAN FARMASI

What is logistics? "Logistics means having the right thing, at the right place, at the right time."

Logistics - (business definition) Logistics is defined as a business planning framework for the management of material, service, information and capital flows. It includes the increasingly complex information, communication and control systems required in today's business environment. -- (Logistix Partners Oy, Helsinki, FI, 1996) Logistics - (military definition) The science of planning and carrying out the movement and maintenance of forces.... those aspects of military operations that deal with the design and development, acquisition, storage, movement, distribution, maintenance, evacuation and disposition of material; movement, evacuation, and hospitalization of personnel; acquisition of construction, maintenance, operation and disposition of facilities; and acquisition of furnishing of services. -- (JCS Pub 1-02 excerpt) Logistics - The procurement, maintenance, distribution, and replacement of personnel and materiel. -- (Websters Dictionary)

Lingkup material rumah sakitMedikSediaan farmasi , Alat kesehatan, Perbekalan kesehatan LinenSelimut, korden, baju operasiGiziBahan basah, bahan keringAlat Tulis KantorKertas, calculator, perforatorSparepartIC, tahananEmplasementSemen, tegel, gentengBarang umumTV, detergent, plastik sampah

LETS TRAVELING

No country is immune from the threat of counterfeit drugs. But, those with weakly regulated pharmaceuticals markets suffer most.Dr. Yasuhiro SuzukiWHOs Executive DirectorHealth Technology & Pharmaceuticals

Legal aspekUU NO 23 TENTANG KESEHATANUU NO 5 TENTANG NARKOTIKAUU NO 8 TENTANG PSIKOTROPIKAUU 8/1999 PERLINDUNGAN KONSUMENUU PRAKTEK KEDOKTERANKepmenkes 1197/Menkes/X/2004

StakeholdersPasien/keluargaSupplier/vendorPabrik obat/ drug companyRegulator (Dinas kesehatan)Pengawas (Badan POM, Kepolisian)Penulis resepDirekturAkuntansiKeuanganSDMInstalasi pengguna

Sediaan farmasiDefinisi (UU no 23 tentang Kesehatan):Obat, bahan obat, obat tradisional, kosmetikaUntuk diagnosa, terapi, rahabilitasiKlasifikasi hukumObat bebas, bebas terbatasObat kerasPsikotropikaNarkotika

INDIKASI-FARMAKOLOGIGASTRO-INTESTINAL SYSTEMCARDIOVASCULAR SYSTEMRESPIRATORY SYSTEMVENTRAL NERVOUS SYSTEMINFECTIONSANTIBACTERIAL DRUGSANTIFUNGALANTIVIRALANTIPROTOZOALANTHELMINTICSTHREADWORMS, ASCARCIDES, TAPEWORM, HOOKWORM, FILARICIDES, CUTANEOUS LARVA MIGRANS, STRONGYLOIDIASIS

Life savingVital : tidak bisa ditunda, untuk keselamatan manusiaEssential : banyak dibutuhkan karena morbiditas masyarakatNon essential : tidak prioritas

Sediaan farmasiBentuk sediaanTablet/kapletPulvis/pulveresCapsulSolutio/cairanUnguentum LinimentumSpraySuppositoria

PRODUKSIORIGINALADALATADALAT OROSME TOOCALCIANTA, CARVAS, CORDALAT (12)

GENERIK : NIFEDIPININDOFARMADEXA MEDICAKIMIA FARMAPHAPROSHEXAPHARM

PACKAGINGDOSISUNIT DOSE : AMPUL, SYRINGE-UNITMULTIDOSE : VIAL, TUBE, TURBOHALERDURASI REJIMEN : 7CAPSUL OMZISI : 1, 4, 25, 28, 60, 100, 250, 1000PENGEMAS : SACHET, BLISTER, BOTOL, DOS

DISTRIBUTORPENUNJUKAN UTAMAPT United Dico Citas (PT Takeda)MPI, Merapi Utama Pharma (PT Meiji)PENUNJUKAN TUNGGALPT Kimia Farma : Narkotika, ARVSUB DISTRIBUTORRETAIL : APOTEK/RS

PengadaanDroping : vaksin dasar, bantuan bencanaProduksi : pemuatan sendiri (OBH, Alkohol 70%)Pembelian :TenderLangsungnempilKhusus : narkotika, psikotropika, ARV

ReportingRegulatorNarkotika, Psikotropika, Generik, KBProgram khusus : vaksinasi polioManajemenRevenueBiaya operasionalPersediaanStok

ALAT KESEHATANHABIS PAKAISYRYNGENASO GASTRIC TUBETRACHEOSTOMI TUBEPERAWATANTENSI METERBENGKOK, POT SPUTUMTIMBANGAN BADANTermometer suhuAxialRectaltimpaniINVESTASISYRYNGE PUMPCT SCAN

BedahBenang bedahUnit, rolCut gutInplatPlat, screw, AMPUkuran : Reguler, miniTipe : lurus, bengkokGuntingAnatomis, klem

PEMBALUT- BANDAGEHYPAFIXFixomulPEMBALUT WANITAELASTIC VERBAN

FISIOTERAPICRUTCH : aluminium, kayuPAD ULTRASONOGRAPHYCORSET LUMBALCERVICAL COLLARBiasaBuatan sendiriBuatan pabrikKhusus : philadelphia

Distribution

Procurement

Use

Management Support

Organization

Financing

Information Management

Human Resources

Selection

Drug Management Cycle

SELEKSI OBATKepastian persediaanSistem mantapMengurangi biaya per unitMengurangi biaya kekosonganMinimal biaya pembelianMinimal biaya transportMencakup fluktuasi permintaan

List of common diseases & complaintsEssential medicines listAnd Formulary manualTraining andsupervisionFinancing andSupply of drugsImproved availabilityAnd use of medicinesTreatment guidelinesTreatment of choiceThe relationship between STGs and EMLs and how these affect respectively the use and the availability of medecines (WHO-MSH)

PENGADAAN-LINGKUPSPESIFIKASIKUANTITASSESUAIKAN BUDGETPILIH METODEPENGADAANTENTUKAN SUPPLIERSPESIFIKASIKONTRAK

MONITOR STATUS ORDERPENERIMAANCEKPEMBAYARANDISTRIBUSIPOLA KONSUMSI

TOTAL BIAYAKERUSAKAN KUALITASKOMISI-AGENTRANSPORTKETERLAMBATANPACKING CEPATRUSAK PENGIRIMANBIAYA KONTRAKHIDDENCOSTSVISIBLECOST

Kuantifikasi kebutuhanMajor optionConsumption methodMorbidity methodAdjusted consumption methodService-level projection of budget requirement

Consumption-based calculationQUANTITY TO ORDER

Qo = CA x (LT+PP)+SS-(S1+SO)

CA : average monthly consumptionLT: average lead time in monthsPP: procurement periodSS: quantity needed for safety stockS1: stock now in inventorySo: stock now in order

Comparation of QTY methods

METHODSUSESESSENTIAL DATALIMITATIONConsump-tion1st choice for procurement forecastMost reliable predictorReliable inventory records, supplier lead time, projected drug costsMust have accurate consumption dataCan perpetuate irrational useMorbidityEstimating need in new prog/disaster assistanceDev and justify budgetData on populationActual incidence of health problemMorbidity data not available for all diseasesStandard treatment may not be usedAdjusted consump-tionWhen other methods unreliableComparation area and system/capita data on consumption, px, service level, morbidityQuestionable comparability of patient populations, morbidity and treatment practiceService level projection of budget requirementEstimating budget needUtilization by service levels and facility typeVariable facility use, attendance, tx, supply syst efficiency

PROSES BISNISSUPLIERPENGADAANGUDANGUSERUSERUSERGUDANGUSER

INVENTORY MANAGEMENTorderrecievestoreissue

TUJUANUntuk menjaga persediaan selalu siap dlm penggunaan dengan biaya minimal baik dalam penyimpanan maupun pembelian

MANAGERMemastikan kebijakan/aturanSTOCK LEVEL (tingkat stok)REORDER FREQUENCY (frekwensi pembelian)REORDER QUANTITY (kuantitas pembeliaan)

FACTORS TO BE CONSIDEREDInventory management is the heart of the drug supply systemThe selection of item to stock, based on their value to public health, regularity, volume of consumptionIdeal : the optimal stock movement pattern, minimal inventory level, consumption pattern smooth, on time delivery Key issues : service level safety stock

sick inventory management systemSubjective/ad hoc decisions : order quantity & frequencyInaccurate stock records (count stock : anually, cyclic)Lack of systematic performance monitoringNo systematic proceduresNo rules to guide staff

Basic issues to be considered (7) Definition of the context (function)Determination of types of stock records and inventory reports neededSelection of items to be stockedMaintenance of proper balance between service levels vs stocked level Adoption of model for reordering frequencyImpelmentation of optimal reorder formulasIdentification and control of variable inventory management costs

DOKUMEN STOKKartu file vertikal: kartu yg tersimpan secara urut alfabet vertikal, tersimpan di lacikardexsystem : file yg tersimpan di pojok penyimpanan, lengkap dgn nama dan jumlah obatbin cart: tersimpan langsung bersama obatnyaLedger system : file yang lengkap seperti rekapitulasi Penghitungan stok secara fisik : cyclic counting (penghitungan terus-menerus)

LAPORAN DAN MONITORINGPosisi stok : kuantitatif per obatNilai awal dan akhir inventory/persediaanPerubahan nilai persediaan selama stokPola pemakaian obatTingkat pelayanan (distributor maupun farmasi)Status kadaluwarsaStok rusak

STOCK Berpengaruh Efisiensi dana dan Pelayanan pasienDipengaruhi Faktor : konsumsi dan waktu tunggu barang datang (Lead Time)

Working Stock = Quantity orderSafety Stock Obat emergency Formula = LT x

FREKWENSI PEMBELIAN ModelAnnual purchasingPendanaan, penyimpanan, stok, beban kerja administrasiSchedule purchasingManfaat lebih dari annualPerpetual purchasingFaktor distributor, regulasi keuangan, sistem informasiKombinasi : Annual dan perpetualObat yang sulit didapat, tapi fast movingObat slow moving, mudah didapat

KUANTITAS PEMESANAN KEMBALIFaktor manajemenBudgetAkses danaPacking vs minimal orderPerubahan pemakaianKenaikan hargaKenaikan biaya kirimDiscount vs kuantitasSlow moving, kehilangan (rusak, pencurian)

INVENTORY CONTROL

KUANTITAS PEMESANAN KEMBALI (standar, matematik)FAKTOR KALKULASI STANDARMINIMAL MAXIMAL STOCK LEVEL

Konsumsi rata-rataWaktu tunggu barang datangStok amanStok minimalStok maksimalStok sekarangPeriode pembelian

lanjutanCASE : Tetracycline Lead atime (LT) = 2 months, konsumsi (CA) 1000 caps/month, safety stock (SS) 2000 capsProcurement period (PP)= 6 monthsMinimal stock ; (LTxCa)+SS 4000Max stock = Smin + (PPxCA) 10000

lanjutanStock : 3000 caps, Dlm proses order 2000

Qo= (Smax+Sb)-(S1+So)= 10.000 (3000+2000)+0

lanjutan2. CONSUMPTION-BASED REORDERING FORMULASS=CAxLTSb : stock back orderQo=CAx(LT+PP)+SS+Sb-(S1+So)

Jika masih ada 2000 caps yg belum terpenuhi ? Qo = 1000x(2+6)+2000+2000-(0+3000)

Mathematical modelEconomic order quantity (EOQ)= V(2xUxO)+(HxC) U= annual use in unitsO=Incremental ordering costH=average holding cost (percentage of average inventory value)C=projected net acquisition cost

CASEPemakaian Dex 5% per tahun 25.000 btl Harga per botol $2Biaya pembelian :$70/beliBiaya simpan : 40% 2.091,65EOI = V(2xO)+(UxHxC) 0.08366 tahun

Forecasting ConsumptionMethodProjective past consumptionCausal external factors (market, epidemics, system size)Judgmental subjectivePatternBase rate stableTrend predictableSeasonality relatively predictableCyclic demand pasang surutRandom noise unexplaned variationsAVERAGE CONSUMPTIONSimple, seasonal, moving

Performance indicatorsNet sales to inventory (inventory turn over)Private company : 12Public drug supply : 6 (min)Inventory shrinksge Stok awal+pembelian-pengeluaran+ stok akhir = 0 (

Aplikasi rumah sakitPeta cost vs revenuePeta wilayah vs targetCase emergencySistem monitoringQuality assurance

DISTRIBUTIONPROCUREMENTPORT CLEARINGRECEIPT ANDINSPECTIONINVENTORYCONTROLSTORAGEREQUISITIONOF SUPPLIESDELIVERYDISPENSINGTO PATIENTCONSUMPTION REPORTING

Distribution networkSYSTEM DESIGN

Geographic/population coverageDegree of centralizationNumber of levelPush vs pull

SELECTION OF SITES

Facility designMaterial handling SystemsStock selection

DELIVERY

Collection vs deliverySelection/Acquisition of conveyancesMaintenance of vehiclesRouting of deliveriesScheduling of deliveriesINFORMATION SYSTEM

Inventory controlRequisition forms and ProcurementConsumption reportingInformation flow

STEPS FOR REDESIGNING SYSTEMDetermining the storage levels in systemDetermine the location of storage sitesDecide at which level of supply system decisions will be made concerning orderFix resupply intervals or frequency of placinf ordersSelect a method for distributing drugs to user unitsSelect an appropriate mode of transportDevelop a set of feasible and economical delivery schedule to service these routesEstimate operating costs and assess the cost effectiveness of contracting for storage and transport at one or more level

Storage The store should be devided into zones ( security, environment)Appropriate zone for each item to be storeStock should be store on pallets on the floor, shelvesGood housekeepingCleaning, inspection, disposal, damageThe management structure should be clearly definedQualified staff

MISMANAGEMENT LOGLOG FUNCTION RELATE TO CULTUREKPI : SPEED, COST, CONTROL, ACCURACY NO APPROPRIATE ANALYSISNO INSTANT OPTIMALIZATIONNO PROPER COST AND BENEFIT ANALYSISPOOR COMPETENCE AND POOR HUMAN RESOURCES DEV

QUALITY ASSURANCERECEIVINGPUT AWAYSTORAGEORDERPICKINGDISPENSING/DISPATCHDELIVERY

?Anggaran tahun 2006 terjadi kenaikan anggaran pembelian obat karena kunjungan meningkat 20% dan tingkat hunian naik 10%. Pada saat analisa ternyata kenaikan antibiotika menduduki porsi 40% dari seluruh belanja obat. Pengeluaran rata-rata perbulan obat ceftriaxone sebesar 150 box (per box 2 vial) @Rp. 13.800. Kedatangan distributor A setiap minggu dua kali (Selasa, Jumat) karena dari luar kota. Distributor B di kota yang sama juga menjual obat tersebut dengan harga lebih murah 10%. Jika dibandingkan keduanya hanya beda pada kepastian layanan distributor A dan penunjukan langsung dari pabrik. Jika stok yang ada masih 10 box, berapakan box yang harus dibeli dan ke distributor mana. Jelaskan pertimbangan anda.