The Drug Management Cycle – Distribution Butch Staley.

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


District

Community



Users Key


Distributors

Shops, Pharmacies

Local Wholesalers



Direct Delivery ModelLEVELS PRIVATE SECTOR PUBLIC SECTOR

International

National


District

Community



Users Key


Shops, Pharmacies

Central Medical Store


Local Manufacturers

Local Wholesalers

Distributors

Primary Distributor ModelLEVELS PRIVATE SECTOR PUBLIC SECTOR

International

National


District

Community



Users Key


Shops, Pharmacies

Central Medical Store


Local Manufacturers

Local Wholesalers

Distributors

Primary Distributor

LEVELS PRIVATE SECTOR PUBLIC SECTOR

International

National


District

Community



Users Key


PrivatePharmacies

Local Wholesalers

Distributors


Fully Private Model


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

The Drug Management Cycle – Distribution Butch Staley.

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