NATIONAL DRUG POLICY AND STRATEGY TRAINERS’ GUIDES
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- Title
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NATIONAL DRUG POLICY AND STRATEGY
TRAINERS’ GUIDES
- extracted text
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WORLD HEALTH ORGANIZATION
DISTR.: LIMITED
ORGANISATION MONDIALE DE LA SANTE
DAP/86.2
DRAFT
NATIONAL DRUG POLICY AND STRATEGY
TRAINERS’ GUIDES
S WUSSENJMz 0
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50
I I
WORLD HEALTH ORGANIZATION
DISTR. : LIMITED
DISTR. : LIMITEE
ORGANISATION MONDIALE DE LA SANTE
DAP/86.2
DRAFT
NATIONAL DRUG POLICY AND STRATEGY
TRAINERS’ GUIDES
1
X ^tSSENI/4/ A
MEDICW^5
1
This document can be used in conjunction with DAP/86.3 - a series of nine session guides:
(1) Introduction to a INational Drug Policy, (2) Supply System Organization, (3) Selection
of Drugs, (4) Planning Drug Requirements, (5) Procurement Strategies, (6) Systematic Cost
Reduction, (7) Financing The Drug Supply, (8) Quality Assurance, (9) Introduction to
Proper Drug Use.
This document is not issued to the general public, and
all rights are reserved by the World Health Organization
(WHO). The document may not be reviewed, abstracted,
quoted, reproduced or translated, in part or in whole,
without the prior written permission of WHO. No part
of this document may be stored in a retrieval system or
transmitted in any form or by any means - electronic,
mechanical or other without the prior written permission
of WHO.
Ce document n'est pas destine a etre distribue au grand public
et tous les droits y afferents sont reserves par ^Organisation
mondiale de la Sante (QMS). 11 ne peut etre commente, resume,
cite, reproduit ou traduit, partiellement ou en totalite, sans
une autorisation prealable ecrite de I'OMS. Aucune partie
ne doit etre chargee dans un systeme de recherche documentaire ou diffusee sous quelque forme ou par quelque moyen
que ce soit - electronique, mecanique, ou autre - sans une auto
risation prealable ecrite de I'OMS.
The views expressed in documents by named authors are
solely the responsibility of those authors.
Les opinions exprimees dans les documents par des auteurs
cites nommement n'engagent que lesdits auteurs.
INTRODUCTION TO A NATIONAL DRUG POLICY
DURATION:
PREPARATION
AND MATERIALS:
2-3 hours
A. Read: 1. The Session Notes,*
2. MPS, Chapter I.B., pp. 7-21.
B.
C.
Prepare the following Visual Aids:
VA 1:
Goals for a national drug policy
VA 2:
Activity areas of a pharmaceutical policy
VA 3:
Policy
VA 4:
The Policy Circle
and Impact Analysis Worksheet
Obtain for use during the session either:
1.
A blackboard with chalk
2.
Flipcharts with markers (newsprint)
3.
Overhead projector with transparencies and markers
NOTE: The session plan assumes that flipchart or newsprint is
available.
Background (READING)
Activity & Time
Plan
Background
Prior to beginning this session,
participants should have completed
the Basic Reading listed in their
notes. However, the introductory
Trainer Presentation review most
of the essential material and this
unit can be taught without
participants having completed the
Basic reading.
Introduction
30-45 minutes
1. Present the rationale for the
unit:
Notes
- National drug policies form
the context and background for
any public and private drug
supply.
(C)
Management Sciences for Health 1986. This training unit has been adapted by the
World Health Organization from material produced by Management Sciences for Health.
DAP/86.2
page 2
Activity & Time
Plan
Notes
- Drug policies involve many
different government agencies
and are often not clearly
stated in a comprehensive way;
therefore, it may take
systematic effort on the part
of a Minister of Health or
other official to understand
his or her country’s policies
- Drug policies arise from a
complex combination of healthrelated, cultural, economic,
and political factors;
understanding of and sensitivity
to these factors is essential in
planning a successful program.
- While few officials have control
over the entire range of drugrelated policies, all of them
can still exert an important
influence if they understand the
various goals, the range of
potential implementation
activities, and the manner in
which various arms of government
cooperate or compete in issues
of drug policy.
- Summary: This unit is intended
to help participants think
systematically about national drug
policies — policies both within
and outside their control — in
order to plan activities with a
high likelihood of success and to
implement a comprehensive national
policy.
2. Goals for National Drug Policy
Point out that there are three main
areas in which national drug policies
can have an impact:
- Health-related Goals
- Economic Goals
- National Development Goals
Lead a discussion on what specific
goals might be cited under each of
these three areas.
VA 1
Mark up on newsprint
DAP/86.2
page 3
Activity & Time
Plan
Notes
3. Activities Areas for National Drug
Policies
Describe in brief the three main
areas for implementation activities:
(1) Supply of drugs.
(2) Regulation of the Pharmaceutical
Sector.
(3) Promotion of Local Production
VA 2
May want to use
newsprint to mark up
additions to the
list of activities
Ask participants to suggest other
possible activities in each area.
Individual Activity
30 minutes
4.Policy and Impact Analysis
The purpose of this activity
is to get participants to begin
to apply the above terms and
concepts to their own countries.
Participants should have
completed worksheets in their
own Guides in preparation for
this session. If they have not,
allow twenty minutes at the
beginning of this activity for
participants to fill at least
the first two columns (Policy
Area and Current Policy) of
their worksheets.
The columns on the worksheet
refer to the following:
Policy Area - This simply
refers to the issue or
topic addressed by a specific
policy, law, or piece of
legislation. For example
"drug patents", "Import
controls," "use of generic
names".
Current Policy - A brief
(3-8 word) statement of
the content of the current
policy. For example,
"generic names required for
all public procurements".
Encl. 1 is an example
from a country (for
your own use)
VA 3
DAP/86.2
page 4
Activity & Time
Plan
Notes
Responsible Government or
Private Agency - Who
initiated and/or implements
the policy? In compiling
the list of policies,
participants should try to
include related policies from
a range of government and
private agencies.
Impact - This should be a
rough, qualitative indicator
of whether the policy has a
favorable (+), unfavorable (-),
or neutral (o) effect on public
health, the economy, and
national development.
Presentation of
individual work
20 minutes
5. Once participants have completed
their own Impact Analysis
worksheets, one or two
participants should be asked to
present their worksheets. A
newsprint worksheet should be
completed as the participant
describes his or her policies
and their impact.
Prepare double-side
newsprint in advance to
accommodate the content
of one participant
The trainer may wish to limit
the number of Policy Areas
included on the newsprint
worksheet. The aim is to
demonstrate the variety of
policy areas, responsible
agencies, impacts involved.
Group Activity
6. The Policy Circle
The purpose of this activity
is to have participants think
systematically about the way
in which policies interact
with each other.
Two policies may be:
- Reinforcing - both help to
achieve the same purpose.
- Independent - each aimed at
unrelated objectives.
- Competing - two policies are
aimed at achieving opposite
ends, at least have that
effect.
VA 4
DAP/86.2
page 5
Activity & Time
Plan
For this activity take the
Policy Areas listed on the
newsprint worksheet from the
previous step and arrange
them around a circle,
preferably grouped by the
major three activity areas
listed in VA 2.
After drawing the circle and
entering the policies, lead
a discussion of the major
policy interactions.
As the discussion proceeds,
draw in the major policy
interactions and mark them
as reinforcing (+),
independent (o) or
competing (-).
The group may realise from
this that part of their
frustration as executives
and managers is that
different government and
private agencies seem to
work at cross purposes.
Summary
7. Recapitulate the main
findings of the session
and print out with examples
based on the Policy and
Impact Analysis worksheets:
- the necessity of better
understanding all the
policies related to the
drug sector;
- the possibilities of
improving the supply
and use of drugs.
Notes
DAP/86.2
page 6
DAP/86.2
page 7
Introduction to a National Drug Policy
VA 1
GOALS FREQUENTLY CITED FOR NATIONAL DRUG POLICY
The major health-related, economic and national development goals which might be
achieved through the formulation and enactment of a broad-based national drug policy are the
following:
Health Related Goals
Make essential drugs available to the entire population.
Increase attendance at health clinics by increasing the credibility and acceptance
of village health workers.
Assure the safety and efficacy of medicines provided to the public.
Improve dispensing conditions, including labeling, packaging, and instructions to
patients.
Rationalize the prescribing of pharmaceuticals.
Promote correct use of medications by patients.
Economic Goals
Lower the cost of drugs to the government and the public.
Reduce foreign exchange drain for drug imports through wiser purchasing.
Provide jobs in areas such as dispensing, prepackaging of drugs,and supply
management.
National Development Goals
Increase manpower skills in management, pharmacy, and medicine.
Improve internal transportation and communication systems.
Establish a starting place for the evolution of industrial competence in
packaging, chemical processing, and other production areas.
DAP/86.2
page 8
DAP/86.2
page 9
Introduction to a National Drug Policy VA 2
Activity Areas for Comprehensive National Drug Policies
Regulation of the Pharmaceutical Sector
Supply of Drugs
/- Identification of therapeutic needs
/- Selection of drugs
- Estimation of drug requirements
- Procurement of drugs
j
(importation/local
production)
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r
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r ___ f
j
- Distribution (private/public sector) '!
- Proper use of drugs by prescribers
and patients
\
- Drug registration
- Control of importation
- Regulation on quality assurance
- Regulation of local manufacturing
- Patent laws
- Price controls
- Prescribing laws
- Generic prescribing
- Licensing of pharmacies and
other retail shops
- Control of marketing practices
Promotion of Local Production
- Investment incentives
- Transfer of technology
- Import incentives/dis incentives
- Government participation
/
//
DAP/86.2
page 10
DAP/86.2
page 11
Introduction to a National Drug Policy VA 3
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DAP/86.2
page 12
POLICY AND IMPACT ANALYSIS
Impact
Reaponaiblo Government:
Policy Area
Accessibility
Nat.drug list
Nomenclature
Brand-names
Generic
prescribing
Importation
Registration
Registrat ion
of outlets
QC of drugs
Local
production
QC of
manufacturing
■Patent laws
Technology
Transfer
Import duties
Current Policy
Drugs available no charge pubrSecto:
minimal fee in vol. agencies
Compliance with nat.drug list in
public sector
Drugs listed and procured under INN
for public sector
or Private Agency
Economic
National
Development
(+ for recipients)
MOH
MOH
0/+
0
MOH
0
£
Discouraged during training
MOH
General guidance in favour
Limited to MOH, NAPCO,
donations to vol, agencies
Every new drug(since 1979) must
be registered____
All wholesale and retail outlets
must be registered_
MOH
MOH, Min.Trade, Min.Fin.
0
O/ +
0
0
3
MOH
0
MOH
MOH/Min. of Ind.
Patent rights 8-16 years
Min. of Ind. + Trade
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MOH
Curren11 y no policy______
Production of essential drugs
increase self-reliance
Factories inspected once a year
and licenses issued
Develop local production
Duties waived on ethicals + raw
materials
Public
Health
0
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MOH
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+ (?)
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MOH/Min. Trade^Planning
Min. Finance
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Sales of drugs
Marketing
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Regulated by Act
MOH
Discouraged
MOH
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DAP/86.2
page 14
*
DAP/86.2
page 15
Introduction to a National Drug Policy
VA4
Drug Policies
Activity 2
Th« Policy Circle
WORKSHEET
SUPPLY OF
DRUGS
regulation
LOCAL PRODUCTION
Sample Completed Policy Ci
Generic Drug Lav
Public Drug Procurement
Primary health care
essential drugs
/
policy
Import Fees
4*
SUIyLY OF
DRUGS
REGULATION
Dispenser
training
school
Price Controls
©
t
State Manufacturing
Company
Restrictive
Marketing Lava
©
LOCAL
IDUI
ON
Tax break*
Local Private
Industry Lava
DAP/86.2
page 16
DAP/86.2
page 17
SUPPLY SYSTEM ORGANIZATION
DURATION:
2 hours
PREPARATION
AND MATERIALS:
A. Read: Managing Drug Supply, Chapter I.B.
B. Prepare the following Visual Aids:
Activity & Time
Introduction
10 minutes
Discussion
20 minutes
VA 1:
Problems in Drug Supply and Potential for Improvements
VA 2:
The Drug Supply Cycle
VA 3:
The Dimensions of Pharmaceutical Supply
VA 4:
Functional Analysis Matrix
VA 5:
Problem Matrix
Plan
Notes
1. Give a short presentation to:
explain the rationale for
this unit;
discuss what improvements
are possible in the supply
system;
VA 1
describe the supply system.
VA 2
2. For each function ask the
participants what activities
are needed to carry it out.
Try to elicit the activities
shown on the Functional
Analysis Matrix.
3. Discuss the resources needed
to carry out the activities
4. Discuss the relationship
between functions (activities),
resources and levels.
VA 3
DAP/86.2
page 18
Activity & Time
Plan
Individual Activity
30 minutes
5. Introduce the Functional
Analysis Matrix activity.
Assist the participants as
needed.
Presentation of
individual work
30 minutes
6. Ask each participant on a
rotating basis to report
on the activities. Let the
other participants comment.
Use an empty VA 4 to write
the results on.
Group Activity
40 minutes
7. Divide the participants into
groups of four and explain the
problem matrix. Assign each
group a different function to
work on. Break the activity
after 40 minutes even if all
the groups have not finished.
Presentation of
Group Work
30 minutes
8. Ask each group to present the
results of their work and
discuss the extent to which a
specific problem affects the
cost, availability, quality and
proper use of drugs. Use an
empty VA 5 to write results on.
Summary
10 minutes
9. Review the activities during
the session and point out with
examples:
- the necessity to know how
the system functions;
- the possibilities to contain
costs by selective improvements
in the supply system.
Notes
VA 4
VA 5
DAP/86.2
page 19
Supply System Organization
VA 1
Problems in Drug Supply and Potential for Improvement
—(U.S. $1.000.006)—
1
-I
L_ Poor quality
-I
I
I
Theft
I
I
1--------------------- J
High prices
Losses
from
problems
with drug
supply
1
Improper storage
I
|-------------------------------- 1
j Expiration of drugs
■ Irr.-.tional prescribing
'
I______________ I
I1 Misuse
I,
Misuseof
of drugs
drugs
Continuing
losses
from
unaltered
problems
I
I
I
I
1
> z-------------------- \ !
r-(_u.s. $700.000 )—
_ Improved purchasing _
_ " Quality assurance__
Reduction
in losses
through
improved
management
Security systems
2 22 Setter storage
2
CarefyHn^ntary-EPDiroL
Altered prescribing habits
Effective dispensing
Practices
—( U.S. $300,000J—
ORIGINAL
ALLOCATION:
U.S. $1,000,000
Source:
THERAPEUTIC
BENEFIT WITH
CURRENT
PROBLEMS
U.S. $300,000
Managing Drug Supply, page 17.
THERAPEUTIC
BENEFIT WITH
IMPROVED
MANAGEMENT
U.S. $700,000
DAP/86.2
page 20
*
1
DAP/86.2
page 21
Supply System Organization
The Drug Supply Cycle
1.
SELECTION
2.
PROCUREMENT
USE
3.
DISTRIBUTION
VA 2
DAP/86.2
page 22
*
DAP/86.2
page 23
Supply System Organization
THE DIMENSIONS OF PHARMACEUTICAL SUPPLY
RESOURCES
Administration
Information System
Personnel
Facilities
Supplies, Equipment
Finances
I
National
Regional
District
Health center/
dispensary
/
LEVELS
4>
Source:
Managing Drug Supply, page 19.
VA 3
DAP/86.2
page 24
DAP/86.2
page 25
Supply System Organization VA 4
FUNCTIONAL ANALYSIS MATRIX
Function
Activity
Selection of drugs
Selection
Quantification
Budgeting
Financing
Procurement
Purchasing
Quality assurance
Decision to produce
drugs locally or import
Customs clearance
Storage
Distribution
Inventory control
Delivery
Promoting rational
drug prescribing
Use
Establishing good
dispensing practices
Encouraging patient
education/compliance
Who is responsible?
When is it done?
DAP/86.2
page 26
PROBLEM MATRIX
Function
Activity
Problem
Policies/
Procedures
Organizational
Structure
Information
System
Personnel
Facilities
Equipment
F inances
S
E
L
Selection
of drugs
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Quanti
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N
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Budgeting
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Quality
Assurance
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Local
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DAP/86.2
page 28
PROBLEM MATRIX
Function
Activity
Problem
Policies/
Procedures
Organizational
Structure
Information
Personnel
Facilities
Equipment
Finances
System
D
I
Customs
Clearance
S
T
Storage
R
I
Inventory
Control
B
U
Delivery
T
I
Quality
Assurance
0
cn
C
N
‘C
U
S
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Prescribing
Practices
Dispensing
Practices
Patient
Education/
Compliance
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DAP/86.2
page 30
DAP/86.2
page 31
SELECTION OF DRUGS
DURATION:
2-3 hours
PREPARATION
AND MATERIALS:
A.
Read:
B.
Ask the participants to read the session notes before
the session.
C.
Prepare the following Visual Aids:
1.
2.
3.
VA 1:
Worksheet 1:
How are Drugs Selected for
your Formulary/Drug List?
VA 2:
Worksheet 2:
Interest Group Support and
Opposition and Actions to
Gain Acceptance of a Drug
List.
Activity & Time
Discussion
60 minutes
The Session Notes.
Managing Drug Supply (chapter 11 B).
The Use of Essential Drugs (WHO TRS No.
722, 1985).
Plan
1.
2.
Start by asking the group why
it is necessary to worry about
drug selection.
Review the rationale for the
unit presented in the session
notes. Point out that
selection offers:
therapeutic benefits
economic and
administrative benefits.
Discuss the possible
disadvantages of selection
by asking the group its
experience in this area.
According to the country,
include in the discussions
the problems of selection
related to the private
sector.
3.
Continue with a review and
discussion of the use of
generic names for drugs.
Review terminology.
Notes
VA 1
DAP/86.2
page 32
Plan
Activity & Time
Discussion
45 minutes
4.
Discuss the drug selection
process. Use Worksheet 1
as a basis for your discussion.
Allow the participants 15
minutes to complete the
worksheet before the
discussion.
Discussion
45 minutes
5.
Review the other sub-topics
in the Session with appropriate
input of participants including
completion of Worksheet 2.
Summary
15 minutes
6.
Summarize the main activities
and issues raised during the
session stressing the advantages
of a selective drug list
organized according to generic
names.
Notes
DAP/86.2
page 33
Potential Benefits of Selective Drug Lists
THERAPEUTIC BENEFITS
eliminate ineffective or unsafe drugs and thereby increase drugs with demonstrated
efficacy and safety;
with fewer drugs, it is easier to provide drug information to doctors and other
health workers and easier for health workers to be informed about each drug they
use;
with fewer drugs, monitoring of drug utilization is more feasible;
allows more uniform prescribing practices, which reduces confusion for patients,
and dispensing and prescribing errors;
quality assurance at all levels is easier with fewer items.
ECONOMIC AND ADMINISTRATIVE BENEFITS
lower purchase prices through bulk discounts and wiser purchasing (with few drugs
procurement staff can concentrate on locating the least expensive source for each
item);
reduced inventory costs;
fewer items makes stock-keeping easier and stockouts less likely;
fewer items facilitates paperwork of all types (ordering, stock records, etc.)
stimulate local production.
Possible Arguments Against a Selective List
restrict the freedom of choice of the doctors;
quality of generic products less guaranteed than brand names;
no funds generated for research;
usefulness of some drugs as placebos.
DAP/86.2
page 34
DAP/86.2
page 35
Selection of Drugs
WORKSHEET 1:
How Are Drugs Selected for your Drug List?
1.
Who are the organizations and people involved in making drug selections? ( List
organizations and positions of the people involved.)
2.
What are the criteria used by those making the drug selections? (List the major
considerations involved in choosing individual drugs.)
VA 1
DAP/86.2
page 36
4
DAP/86.2
page 37
How are Drugs Selected — Options and Considerations
1.
PEOPLE:
a.
Who should be involved in making drug selections?
Consider representation from governmental and non-governmental agencies.
Ministry of Health senior official(s) - senior administrative physician.
Directors of primary health programs, maternal and child health programs. etc.
Professors from local medical schools or major hospitals.
Practicing physicians and auxiliary medical workers from government health
programs.
Chief hospital pharmacist(s) of major general hospital(s).
Drug and Therapeutics Committee(s) of major hospital(s).
Medical Staff Committee(s) of major hospital(s).
Teachers from auxiliary medical worker training programs.
Practicing general practitioner nominated by Medical Association.
Practicing private pharmacist nominated by Pharmacists’ Association.
b.
Consider the skills to be represented in the above drug selection committee, or
whose particular expertise can be called upon:
medical: general and specialties;
clinical pharmacology;
legal;
economics and business administration;
local drug industry, importers and distributors;
aid program officials: WHO, UNICEF, USAID, CIDA, DANIDA, etc.
2.
PROCESS:
How are drugs selected?
Is there a standard list or formulary?
If more than one, what are they?
Is there a formalized selection process or is it informal?
Are drugs selected by the individual practitioner, local health districts,
hospital pharmacists or therapeutics committees, a procurement clerk at the
national level, a national committee?
Are selections periodically reviewed?
DAP/86.2
page 38
What forms should be used? (i.e., should there be an individual written
application for each drug considered for purchase and/or inclusion in a standard
formulary?)
What time-frame should be used?
every year? every two years?
3.
CRITERIA:
Should selections be reviewed every six months?
What criteria should be used in making individual drug selections?
What information should be used and where can it be obtained?
Should there be a preference for locally produced products?
Should cost be a consideration?
Should drugs be selected or assigned by level-of-care categories?
Should generic names be used?
Should combination drugs be considered?
Should local traditional remedies be considered?
Are local disease patterns known and considered?
DAP/86.2
page 39
Groups with a Potential Special Interest in a Selective Drug List
Ministry of Health officials
Officials from other ministries and government agencies
Practicing government doctors
Private doctors
Other government medical and health care practitioners
Government pharmacists
Private Pharmacies
Donor Agencies (UNICEF, WHO, USAID, DANIDA, etc.)
Multinational drug suppliers
Local Manufacturers
Importers and wholesalers
Others:
Drug Salesmen
Consumer groups: General and specific (e.g. Diabetes Association)
Politicians
DAP/86.2
page 40
DAP/86.2
page 41
Selection of Drugs VA 2
WORKSHEET 2:
Individuals and
Groups with a
Special Interest
in a Selective
Drug List
Interest Group Support and Opposition
Potential Points of
Support
Potential Points of
Opposition
DAP/86.2
page 42
DAP/86.2
page 43
PLANNING DRUG REQUIREMENTS
DURATION:
2 hours
PREPARATION
AND MATERIALS:
A.
Read the Session Notes and Managing Drug Supply, chapter II B.
B.
Prepare the following visual aids:
Activity & Time
VA 1;
ABC analysis of large MOH supply system.
VA 2:
Therapeutic alternative analysis.
VA 3:
Epidemiology model for estimating drug requirements.
VA 4:
Health problem profile
VA 5:
Standard treatment
VA 6:
Summary of drug requirements.
Plan
Trainer presentation
10 minutes
1. What is meant by "planning drug
requirements"
Discussion
15 minutes
2. Participants* current methods
Trainer presentation
30 minutes
3. Consumption Method
Notes
Group Discussion
a. Data Collection
- sources of data
- format
- examples (Kojast
consumption records
could be used as an
example)
b. Data Analysis
(Utilization Review)
- ABC value analysis
- therapeutic alternatives
analysis
- anticipating program
growth
Annex 1
DAP/86.2
page 44
Activity & Time
Trainer presentation
30 minutes
Plan
4. Epidemiologic Method
a. Population Coverage
b. Health Problem Profile
c. Standard Treatments
d. Calculation of Quantities
Required
Summary
15 minutes
5. Uses for Drug Estimates, Ask
the participants for
suggestions. The responses
should include the following:
- determining order quantities
for existing programs;
- determining order quantities
for new or rapidly growing
programs;
- planning a budget;
- promoting cost-effective
drug utilization;
- negotiating foreign exchange
requirements;
- seeking donor funding;
- assessing the need for
specific items which may
have been offered as gifts.
Notes
DAP/86.2
page 45
VA 1
Planning Drug Requirements
ABC Value Analysis
!
I CODE
I
fear;
Drug Product rescript ion
Rank
Oroer
fcHO
Ess.
List
I
!
{
VEM
Cat.
1953
X at
Total
Cost
Total
Cost
(LC)
Cufiulative X !
of Totai Cost 1
!
I
loo.oox :
- 431 ITEMS
56.040,448
CLASS ’A4 - 37 ITEMS
CLASS "B- - 69 ITEMS
CLASS ‘C3 - 375 ITEMS
39,166.166
11.216,647
5.657,635
69.39X
20.02X
10.10X
69.89X i
89.91X :
100.007. ;
3,363,300
4,640.000
3.726.250
3,333,080
1,639,078
1.172.979
1,161.203
1,143.:;?
1,053/7"
1.016.1-:
785,I.783.2?..636,7-2
626,327
532,40v
553,318
14.92Z
8.28X
14.92X
23.20X
29.85X
75.SOX
7b.73X
40.82X
42.3‘?X
44.9ZX ?
ifi.aix
4S.62X
50.OCX
51.39X
52.57X
57.647.
54.34X
TOTAL
100.OCX
I
!
!
59111 1
74060 :
581o2 I
53051 !
33061 :
68023 ;
’0x4 :
29172 i
33072 ;
5910! !
75117 ;
59050 ;
53260 !
58040 :
58280 ;
59090
31080 .
58163 .
12091 i
55140 i
■33032 ;
68021 :
42050 i
746bU i
•33* L !
59040 :
46061 :
68033 !
74670 i
33024 .
54066 :
58420 ;
58132 ;
I
1 Straptcsvcxne Sulfate :-3uare i q®.
2 Distilled water 10CX
3 reniciiline 5 IM unit Ini.
4 CMartetracYchne 17.
5 Si-case Pert. Isctoniqje
6 I-'suli.no Retard I r Z 40 u
i
I
•: Y
;
t
• .Y
!
v
v
v
E
i
' Asciri-.e 500 ag
a Peniciliine itrer.icill.SFro I-*' unit
9 Scdius Crlarure Per/ Isatcrir^a
10 FifaapiCine 150 si.
11 Ar.ti-Svisacdiques (2=Bara.3=Avai
12 Ethior.aaide 25C ;c.
13 Sul ;agja--131.-!9
i2gi
14 Chiora'onenicol 250 aa.
15 Sul fisstnox ••DvridaSine
16 Pvrazinaaide 550 jg.
17 Caraa’cchrzae
18 Reni-::!line 5 5 M Jmt Inj.
•9 Frucnenezine 9s?arc Inject. 25 i-i
20 Cwt st reeve line 250 ®q.
21 Fotassiua Chlorure 250 aq.
22 Insulins 40 U
23 Broeure Butyl d’Hvosine 20 ng,
24 Anti-Infectieux Pul»!onaire En+ant
25 Sadiua Bicarbonate 14X
26 Etna-Xiutel 500 ag.
27 .it. B/6 iPyr--3Gx.Lf.»:r. Inj. > 25C:g
28 51 vtuta.il•;= 500 ig.
2? An-.i-Zfectieux rulfftnairs
30 Calciua Gluccnats Inject. 1<X
31 HvarQrCrt jscpe Inject as is ICO -ng.
32 Triiui/mdes iulraiflia:. ? itnis:. i
v
■j
r
E
N
r
c
fi
Y
N
Y
N
N
V
V
V
E
315.664
51-1.77.S
/
Y
E
495.43t
459.:4d
459,100
y
N
V
471,40’
!4
453,075
413.562
I
33 Benzatn.-e reniciliine evO.OOO J
34 CnicrDrcjazina* iCO sg
53431 : 35 Benzatnire Pen:/ reniciilirs !.2ml4oi3G : 36 vitaaine r.l I.-.jectaole 20 eg.
7537.) ; 37 Antiacide
12013 ■
3j6.16-6
E
N
N
*<
N
N
Y
i
t
Y
I
1
}
v
E
353,290
352,755
347.728
343.550
3-O.?:5
324,223
30’.,=74
290,2'4
285/80
287,320
279/63
276.006
.‘J.65X
5.95X
2.927.
2.09Z
2.077.
2.C4X
1.337.
1.31X
1.40X
1.36X
1.14X
1.12X
1.007.
0.99Z
C.92Z
0.92X
0.3'7.
•:>.37X
0.377.
C.34X
0.817.
' 0.747.
i;.6iX
O.oTX
•:.63Z
O.o'X
O.ilX
O.ciX
. 534
0.54X
0.52X
0.52X
0.51X
0.50X
0.49X
u5. 2.’X
5o.55Z
57.47X
:8.ToX
5v.::x
oO.HX
60.95X
61.7tX
52. ^X
c3.13X
67.76;
64.’97.
35.0IX
6:.-32X
66.27X
66.31X
67.75X
c7.87X
08.73'4
o3J0X
67.40X
«7.39I
!
DAP/86.2
page 46
VA 2 Planning Drug Requirements
SAHPLE DATA CNL!
Theraoeutics Alternatives Analysis
Year: 1983
Frzauct
}
CODE
Drag Product Description
! Consuaption 1984
Route
VEN :
Cate.l
Total
Cost
Cost per
Treatsent
Episode
Nuiber ot ;
Treatment !
Episodes I
<
rtAvGR TRANGuILlZEFS
AVERAGE 2CST .
TOTAL COST ■
PERCENT OF TOTAL EXPENDITURES
12(-91
12100
12015
12092
12033
12073
' 2'"’2”
12102
12013
12031
12030
120o2
4
J
12010
120:0
12090
Flupnenacine Retard Inject. 25 sq !
Pipat:azine (Esthers) I’-.* 100 sq ;
Chl-srproffiazine Inject. 25 eg
^liccnar.azi-e Decanoate Lu. 2: s;
Levoaeprcaazine Inject.
Tri’iuocerazir.s 100 sg
HaiGr-endcl Inject.
Piaoti’Zine (Estners/ Inj. 100 ng
Chlcrprueazine* 100 ag
i.ev.:aecr-:aazne 100 ag
Levusepronazine 25 ag
Tniqrisazir.e ;0 iiq
Thiorioazr-e 50 eg
2-‘icr:-r-3?3:irle 25 .ug
r--bjpr-:serizi-:a 10 ag
►iup-enazin? 257 jg
7.24
1,855.374.94
3.31X
IV
IV
■IV
N
N
N
•v
.1
IV
IV
M
•v
IV
pj
{
N
N
N
E
P0
PG
N
p:j
N
:u
ru
fl
PC
1
fl
fl
493.486.00
209.4ol.50
158,858.00
151,383.00
41.091.60
22,784.)0
14,369.14
14.544.
288,97?. :•
199.790.: •
89,682. J.
83.628..:
81.547,40
66.627.35
9.151.20
8.464.50
30.12
2.S2
5.8S
34.13
4.70
2.56
6.24
2.91
0.43
1.82
0.70
0.53
1.17
0.08
1.49
1.98
16.550 ;
74,167 !
27,017 :
4.445 !
8,733 1
а, 9co :
2,383 ;
5,000 !
607,100 :
109,775 :
128.825 ;
145,188 :
69.433 :
856,333 i
б. 150 !
4.275 !
DAP/86.2
page 47
Planning Drug Requirements
VA 3
EPIDEMIOLOGY MODEL FOR ESTIMATING DRUG REQUIREMENTS — CONCEPTUAL FRAMEWORK
Population
★
Population
Coverage
I Benefits
I
of
III Treatment
I ---- 1 - -
Population
to be
Served
I
I
I
I
I
Health
Problem
Profile
Impact
on
Health
Health
Problems
Treated
I
Cost/Effective
Drug Procurements
•k
Cost
of
Drugs
Drug
Quantities
Required
Standard
Treatments
*
★
Available
Drug
Stocks
Unit
Prices
of
Drugs
*Points of Medical, Pharmacy, or Management Decision or Influence
= Information and relationships which are difficult or impossible
to measure at present.
5
3
3
3'
00
Health Problen Profile
Year:
SAMPLE DATA ONLY
Number of Patient Contacts Last Year:
Children Under Age 5 as I of Contacts:
1905
o
3,123,409
20.007.
3
OO
?o
(D
£>
3
Hi-t
I
Health Problet
! Treatment Episodes
! per 1000 Contacts
s’"
I Code
Na«e of
Health Problem
j
1
1 Age
!_______
I •
I
i.ii :
: 14.12 :
Acute diarrhea
Bacterial shn infections
I
9.11 :
Conjunctivitis
: 15.40 :
low bad pain
: '5
: :=5
: :5
: >=5
:
5
: =5
:
5
■
:
0.11 :
Headache
:
4.32 :
Heartburn, gastritis
1
1
: 10.12 :
5.21 :
Otitis aedia
Comaon cold,upper resp.infect.
I
5.22 : Acuti frlJUltls
>=5
: ,=5
: ^5
: >=5
: <5
: >=5
<5
! >=5
I <5
: >=5
Adjusted Number of
Treatment Episodes
n>
3
I
(B
3
! 17. adiust-I
' lent I
;
I
Paraaed i cal 1
Medical
fa--T,gjKa. ,
w
Medic<1
Paramedical I
I
I
1
: Expected i
! Change !
I
!Group :
!
! Medical
I
! Number of Treatment
! Episodes Last Year
220.0 :
75.0 :
95.0 :
15.5 :
30.4 :
24.0 1
2.5 :
36.0 1
21.0 :
55.4 1
14.0 I
46.0 :
45.6 :
15.6 1
146.0 :
50.0 :
36.0 :
19.5
I
I
1
1
HIO
J
£ » u.1
50.0 :
125.4 :
73.6 I
22.6 1
14.6 :
o.e i
19.4 :
16.9 :
62.0 :
13.2 :
30.0 ;
60.6 :
15.7 ;
166.9 :
74.0 :
36.0 :
15.5 1
t
171,797
50,564 I
74,181 !
12,105 :
23,730 1
19,740 1
1,952 !
29,in :
16,398 !
43.259 '
10,932 •
36,544 J
35,607 i
10,620 :
114,004 :
39,047 1
28,111 5
14,446 5
I
I
1
I
I
652,160 1
117,128 :
293,757 1
172,412 1
52,942
34,201 :
c:
45,446 !
39,589 !
145,238 J
30,922 !
70,277 i
141,959 !
36,776 I
390,973
173,349 I
84,332 1
36,510 1
i
:•
i
!
TS U
fb »>
OQ ►TJ
(B
00
Cs
00 •
N5
DAP/86.2
page 49
Planning Drug Requirements VA 5
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Year: 1785
Suanary of Drug Reauireaents
3
n>
!
: Drug
: Code
!
Drug
Product
Description
7012 : ASP IP i Nt 500 ff.g tab
7013 IhSFIRIHE 125 ac sipp
50183 IBENZATMIHE FEHi 1.2«l
57240 INEON/CIN CREAM
50051 .’CliLORTETRACYClINE I 7. oshthol
41992 INAALOI
50172 IPENI G < PRO FEHI l.i
59173 IPENI G»PENI PPG 400u
76999 ’.ORAL REHYDPfiUON SALTS
59260 ;SULFAGUAN1DINE
I
Total Heeds
Purchase
PacHge
Size
Pasi:
IBottle of 1000 tabs
IBo' of !2 supocsitones
.’Box a< 50 5-nl a?.ps
IBo:: of 25 15-gn tubes
.'Box of 50 5-ok tubes
it.ox of 21 120-al bottles
Bo: of lOv 5-<il asps
!
1 Box of 100 5-«l amps
IBcx cf 4C sachets
:Box of 40 bottles of 1(00 tabs!
184710
•0104 :
24125 !
R3222 !
1’426
2027-7 !
29419 :
23’S8 :
224106 !
150416 ;
Total
Cost
:’:.:rrhase
Jnits
185 :
6515 i
483 ’
372° !
349 !
943 ;
2S4 :
294 ;
5603 :
3 :
i
1 Percent
! if Total
:E;.f enditi res:
IE.4'0.?p :
ic,83’..26 !
54,452.91 !
7,3:7.16 !
31,318.89 :
40.4’4.-8 I
61,549.72 !
50,275.77 !
652,080.00 !
2i.-‘85.3O !
0.317.;
o.iex:
0.947.!
o.isz:
0.527.;
0.671;
1.031!
0.841;
10.871!
0.431!
!
976.35\00 5
TOTAL
IS. 207.1
i
I
3
n>
3
OT
TJ Q
P p>
OQ hj
(D
CO
tn O'
O •
NJ
DAP/86.2
page 51
Kojast Consuaption Records — 1983-1994
GENERIC NAME
UNIT
STRENGTH FORM COST
RECEIPTS
83/84
USAGE
83/84
TOTAL COST
MONTHLY MONTHS MONTHS OF
CONSUMP ON HAND STOCKOUT
30/6/84 (Est.) Consumption Receipts
$188,491.09 1165,318.02
TOTAL
3300
0
tab 0.0510
250 (iq
acetazolaaide
tab 0.0060 100000 206000
300 aq
acetylsalicylic acid
43500
40000
tab 0.0036
acetylsalicylic acid snluble 75 «q
23750
12000
acetylsalicylic acid/codeine 300/8 aq tab 0.0320
0
1273
1 ag/Al inj 0.1000
adrenaline
6000
0
tab 0.1200
100 aq
allopurinol
37900
0
tab 0.0120
100 sq
aainophylline
0
45000
tab 0.0270
25 aq
amitrvpt11ine
55
0
10 aq/al inj 6.6700
aaobarbitone (2.5 al)
0
0
0.0000
50
i&q
inj
amphotericin 8
0
5000
tab 0.4330
250 ®q
arphotericine 8
734
2721
125 &q/5al suso 1.6200
ampicillin
3220
1400
inj 0.5630
500 aq
aapicillin
108500
165000
cap
0.0810
250
ffiQ
ampicillin
36000
3000
tab 0.0032
50 sig
ascorbic acid
8085
1800
500 acg/al inj 0.0890
atropine sulphate
0
0
47.0600
50
aq/0.Salinj
aurc-thicaaiate sodiua
0
0
tab 0.0000
100 ap
azathioprir.e
1300
200
tab 0.5300
50 aq
azathioprtne
20000 150500
tab 0.0067
5 ag
bendrqfluazide
1850
2000
0.6220
inj
1.2
MU
benzathine oenicillin
3379
2628
0.6800
2.4 MU
inj
benzathine penicillin
0
0
tab 0.0120
5 aq
tenzhexol
29000
24000
0.0100
tab
2 aq
’ienzhexol
0
0
tab 0.0000
2 aq
benztrcoir.e
282
0
1 iiq/B»l
ini 13.4400
ben:tropine sesylate (2 <al)
1.6 MU
2440
50
inj 0.0500
benzylpenicillin
1000
10000
tab 0.0520
beonenium hydroxynaphthoate 500 ipq
7.5’7.
18
0
inj 2.9600
Bicarbonate scdiusi 50 al
0
0
tab 0.7300
2 mg
busuiohan
0
0
500 acq
tab 0.0000
busulonan
0
0
1.3000
20 Z
inj
calciui chloride (10 al)
0
0
1.1060
10 X
inj
calciuB chloride (10 nl)
o
3500
0.0140
tab
300 t-q
calcium gluconate
150
0
inj 1.8200
10 X
•zalciua gluconate (10 al)
3000
0
tab 0.0065
300 (aq
calciua lactate
100
500
tab 0.4300
200 aq
caroaaazepine
4400
4000
0.0090
tab
5
Tip
carbimazole
2000
0
tab 0.0210
300 sg
cascara saqrada
10900
0
tab 0.0130
25 a>q
cb 1 corona: me
58600
0
tao 0.0430
100 nq
chi opr or,az me
0
500
2 aq
tab 0.5700
chlorambucil
237
150
6.7000
inj
chloramohenicoi
1 9
17700
2000
cap 0.0300
250 mg
chlcraaohenicol
0
0
DGMd 0.0000
chlor-sphemcol
317
17167
3625
1979
106
500
3158
3750
5
0
0
61
268
9042
667
6’4
0
0
108
12542
154
282
0
2417
0
24
203
83
2
0
0
0
0
292
13
250
3
3a 7
167
908
4333
0
20
1475
0
32.2
5.9
13.8
0.4
29.2
4.2
0.0
12.8
15.3
ERR
ERR
32.6
0.9
6.5
42.0
I. 0
ERR
ERR
0.0
1.0
II. 7
5.8
ERR
4.6
ERR
2.0
37.7
108.0
302.0
ERR
ERR
ERR ■
ERR
20.6
130.0
156.0
43.0
0.0
96.0
0.0
3.7
ERR
5.2
3.1
ERR
$0.00
0.0
$193.80
$600.00
0.0 $1,236.00
$144.00
0.0
$156.60
$384.00
$760.00
0.0
$0.00
$127.30
0.0
$0.00
$720.00
0.0
$0.00
$454.80
0.0
$0.00
0.0 $1,215.00
$0.00
$366.85
0.0
$0.00
$0.00
12.0
$2,415.00
$0.00
10.5
$4,408.02
3.0 $1,189.03
$788.20
0.0 $1,812.36
2.0 $8,788.50 $13,365.00
$295.20
$65.60
4.5
$180.20
$719.57
2.5
$0.00
$0.00
0.0
$0.00
$0.00
12.0
$106.00
$689.00
1.5
$134.00
0.0 $1,003.35
$1,244.00
0.0 $1,150.70
$1,787.04
0.0 $2,297.72
$0.00
$0.00
12.0
$240.00
$290.00
0.0
$0.00
$0.00
12.0
$0.00
0.0 $3,790.08
$2.50
$122.00
0.0
$520.00
$52.00
7.5
$0.00
$53.28
0.0
$0.00
$0.00
0.0
$0.00
$0.00
12.0
$0.00
$0.00
0.0
$0.00
$0.00
0.0
$0.00
$49.00
0.0
$0.00
$273.00
0.0
$0.00
$19.50
0.0
$240.00
$48.00
. 4-5
' 4.5
$36.00
$39.60
$0.00
$42.00
0.0
$0.00
$141.70
3.0
$0.00
0.0 $2,519.30
$335.00
$0.00
4.5
$1,005.00
1.0 $1,587.90
$a0.00
$531.00
0.0
$0.00
$0.00
12.0
1
1
Ar
05854
*
-—
J
DAP/86.2
page 52
chloraaphenicol
chlordiazepoxide
chlordiazeooxide
chloroquine pnosphate
chloroheniraaine
chlcrpneniraaine
chlorpromazine
chlorpropaaide
dinitest
clofazimne
dcxacillin
cloxacillin
cloxadllin
co-triaoxazole
colchicine
corticotrophin
cortisone
cortisone acetate
cyclcpnosohaaide
cyclophosphaside
cydophosohaaiae
daosone
dexamethasone
dextrose in water '.20 ml/
dextrostix
diazepa#
diazepa.!
diazeoai
diethyicarbaaazine
digoxin
digoxin
diaenhydrate
diaenrvdrate
dipyridamole
edropnomuii
emetine Hcl
ephedrine Hcl
ephedrine Hcl
ergasetnoe
ergometrine
ergo-Tietrine
ergometrine ox vtoc i n
ervthroavcin
ervthroavcin estolate
e r v t n r •: s v c i n e t n v 1 s u c c i a t e
ethambctol
etraaoutoi
ethosuximide
ferrous sulphate
ferrous sulonate
fibrinogene
fludrocortisone acetate
fluonenazine cecar-oate
folic acid
125 ag/5®l susp 16.3000
tab 0.0130
10 aq
tab 0.0270
25 ag
150 «g
tab 0.3400
inj 0.2400
10 ag
4 ag
tab 0.0040
50 iig/al inj 0.3700
tab 0.0260
250 mq
stri 2.8500
100 sq
cap 0.0000
cap 0.1030
250 aq
500 mg
inj 0.6200
125 aq/5al susp 6.0100
4S0 ag
tab 0.0510
500 acg
tab 0.0150
40 U/ai
inj 0.0000
25 ag
tab 0.1300
25 ag/ai inj 0.0000
200 ag
inj 13.0660
50 ag
tab 1.1400
25 ag
tab 0.3400
100 mg
tab 0.0082
5 aq/al
inj 0.3200
50 X
inj 2.2330
25's
stri 21.0500
2 ag
tab 0.0654
5 ag/al
inj 9.1380
5 ag
tap 0,9965
50 ag
tab 9.0976
256 r‘cg/'il inj 3.3100
250 fig*
tab O.vlOO
59 sg/fil inj 6.5309
50 aq
tab 6.0250
25 ag
tab 0.3700
10 sq/al
in j
1.0900
oO ag/al
inj 0.0000
30 aq
tab 9.0050
69 ag
tab 0.6900
250 acg
tab 9.0099
500 acg/d ini
1.3700
tab 0.0399
500 acg
mi 0.3000
250 mg
tat 6.2660
125 ag/jal susp 34.3379
200 ■’■•3
SUSP
400 .no
tab 0.0900
tao O.0000
tab 0.3400
tab 0.0030
tab 0.0*40
inj 124. ?£:)0
tab 0.1400
inj 84.2200
tab 0.0030
lOO
250 sq
200 nq
300 »q
1 0
ICO flCQ
25
5 2q
6.3600
0
1000
0
0
500
1950
398
83000
0
0 .
6450
300
300
14OO0
0
0
0
0
25
3000
0
5000
0
280
96
2000
0
v
0
0
120
0
0
0
0
0
0
0
0
1000
651
0
75
0
0
0
0
75000
3G0000
:)
600
360
60660
12
14200
2500
250
605
32000
3673
83000
8
0
11750
705
178
30000
0
0
500
0
34
0
1800
1000
50
100
135
37200
2945
77500
21
77
39000
224
6500
600
0
0
1900
0
0
2395
13400
766
31500
73
102
6850
0
500
0
264000
0
100
231
103250
1
1183
208
21
50
2667
307
6917
I
0
979
59
15
2500
0
0
42
0
3
0
150
83
4
8
11
3100
245
6453
2
6
3250
19
542
50
0
0
153
0
0
200
1117
□4
i.'jL. J
6
9
571
f>
42
0
22000
0
3
19
6604
10.0
48.0
64.8
62.4
3.0
18.5
11.3
2.6
0.0
ERR
1.0
0.0
14.7
0.4
ERR
ERR
216.0
ERR
9.5
ERR
1.3
156.0
30.0
21.6
2.8
25.0
4.1
0.2
2845.1
4.7
21.8
0.1
46.6
0.0
ERR
ERR
107.4
ERR
ERR
1.6
44.3
0.0
0.0
6.9
4.9
26.5
ERR
70.8
ERR
1.6
ERR
oO.O
3.3
3.0
0.0
$195.60
$134.60
0.0
$67.50
0.0
0.0
$85.00
0.0
$145.20
0.0
$123.00
0.0 $1,360.86
3.0 $2,158.00
11.0
$22.30
$0.00
12.0
0.0 $1,210.25
4.0
$437.10
0.0 $1,069.78
I. 5 $1,530.00
12.0
$0.00
12.0
$0.00
0.0
$65.00
12.0
$0.00
$444.24
0.0
4.5
$0.00
O.O $1,512.00
0.0
$8.20
0.0
$16.00
$223.30
8.5
0.0 $2,841.75
0.6
$200.38
0.0
$406.41
0.0
$503.75
0.0
$0.16
0.0
$25i.37
$390.00
0.0
2
$1,462.72
0.0
$162.50
4.5
$222.00
0.0
$0.00
12.0
$0.00
0.0
$9.50
12.0
$0.00
$0.00
12.0
0.0 $3,231.15
6.0
$402.00
2.0
$612.80
2.0 $6,300.00
O.O $2,510.25
0.0
$643.72
0.0
$616.50
$0.00
■ 12.0
$1’0.00
0.0
7.5
$0.00
0.0 $3,696.00
$0.00
0.0
$14.00
II. 0
0.2 119,454.32
O.O
$309.75
I
2
$0.00
$13.00
$0.00
$0.00
$120.00
$7.80
$332.26
$2,158.00
$0.00
$0.00
$664.35
$186.00
$1,303.00
$714.00
$0.00
$0.00
$0.00
$0.00
$326.65
$3,420.00
$0.00
’ $41.00
$0.00
$625.24
$2,020.80
$10.80
$338.79
$0.00
10.00
$0.00
$0.00
$733.60
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$30.00
$520.80
$0.00
$2,579.03
$0.00
$0.00
$0.00
IC.vO
$225.00
$4,200.00
$0.00
$64.00
$25,266.00
$15). 00
DAP/86.2
page 53
furoseaide
40 aq
tab 0.0130
furqseiide
40 mq/ml in j 0.1490
qentanycin
40 mq/al inj 0.5700
glyceryl trinitrate
500 ®q
tab 0.0450
qriseofulvin
500 mg
tab 0.2200
griseofulvin
125 aq
tab 0.0630
guanethidine
tab 0.0500
25 aq
haloperidol
tab 0.0400
5 nq
5000 ij/ml inj 5.7200
heparin aodiua
hydralazine
20 aq/al inj 1.2100
hydral1 azine
25 mg
tab 0.0560
hydrochlorothiazide
50 aq
tab 0.0140
hydrocortisone
100 ag/amo inj 2.3500
1000 mcq/mlinj 0.2240
hydroxycobalaoine
aydroxyprogesterone
250 acg
inj 11.6800
ieipraair.e Hcl
25 mg
tab 0.0249
indoaethacme
25 ag
tab 0.0090
300 rag
isoniazid
tab 0.0000
100 rag
tab 0.0075
isoniazid
isoniazid + P.aminosalicylate
tab 0.0000
100/50 ag tab 0.0033
isoniazid/thiacetazone
tab 0.0140
isoprenalir.e sulphate
20 rag
ketaaine hcl
50 rag/al inj 16.5100
stri 7.7120
ketostix
50's
1 ag/iil inj
konakian
1.5000
5Z plain inj 1.4500
lignocaine hcl
lignocaine hcl
2Z plain inj 0.6034
1Z plain inj 0.5135
lignocaine hcl
lithiua carbonate
250 ag
tab 0.0900
magnesium sulphate
10X/10 ml inj 1.2700
aaqnesiua trisilicate
tao 0.0060
250 aq
mebendazole
100 aq
tab 0.0240
aecnloretha.aine hcl
10 ag
inj 23.6400
aelonalan
2 aq
tab 0.9000
aercaatopurine
50 siq
tab 0.0820
aetforaine
500 ».q
tab 0.0970
methotrexate
5 iig
inj 18.8500
methotrexate
25 aq
tab 0.9300
methotrexate
50 aq
inj 0.0000
methvldopa
250 ng
tab 0.0750
aetodooraaide
10 aq
tab 0.2100
50 aq
tab 0.4500
metoprolol
200 mg
tab 0.0170
metronidazole
tab 0.0056
multivitamins
nalidixic acid
500 mg
tab 0.2900
.4 mq/nil inj 0.0000
naloxone
naloxone
.02 ag/ml inj 0.0000
neonycin sulphate
250 ’iq
tab 0.5140
neostiqaine bromide
15 ag
tao 0.0600
neostigmine methyl sulphate
.5 aq/>l ir.j 0.3700
nikethamide
250 mg/al inj 0.0000
nitrazepam
5 aq
tab 0.0185
nitrofurantoin
50 ag
tao 0.0080
nitrofurantoin
100 ag
tab 0.0110
6000
0
1200
0
0
0
0
0
0
600
96000
0
0
0
20
500
20000
0
5000
0
0
0
10
60
0
10
0
21
0
100
80000
8000
0
0
0
36000
0
200
0
254000
0
5000
30000
0
1800
0
0
10000
5500
151
0
0
6000
0
93250
890
335
4500
7500
1000
56500
4400
67
452
103200
17000
970
200
3
1000
8750
0
10700
0
1500
0
26
0
290
50
484
676
0
100
131150
41000
0
0
25
57500
9
0
0
149350
2000
0
63750
53000
0
0
0
0
4900
471
177
10900
3500
8000
8188
74
28
375
625
33
4703
367
6
38
8600
1417
81
17
0
83
729
0
892
0
125
0
2
0
24
4
40
56
0
8
10929
3417
0
0
2
4792
I
0
0
12446
167
0
5729
4417
0
0
0
i)
403
39
15
908
292
667
0.6
4.0
31.5
2.7
50.4
78.0
0.1
0.0
9.0
14.6
1.5
38.8
14.8
150.0
128.0
54.0
15.8
ERR
21.3
ERR
200.0
ERR
15.7
ERR
0.4
45.6
10.8
1.3
ERR
0.0
0.9
4.4
ERR
ERR
130.0
2.9
0.0
ERR
ERR
14.5
0.0
ERR
2
34.3
ERR
ERR
ERR
ERR
5.1
0.0
14.o
27.7
B.o
2.3
0.0 $1,277.25
0.0
$132.61
8.0
$190.95
0.0
$202.50
0.0 $1,650.00
0.0
$63.00
0.0 $2,325.00
1.5
$176.00
0.0
$383.24
0.0
$546.92
0.0 $5,779.20
0.0
$238.00
0.0 $2,279.50
0.0
$44.80
0.0
$35.04
0.0
$24.90
6.5
$78.75
12.0
$0.00
0.0
$30.25
$0.00
12.0
0.0
$12.45
0.0
$0.00
$429.26
0.0
8.5
$0.00
0.0
$435.00
$72.50
0.0
0.0
$292.05
0.0
$347.13
0.0
$0.00
8.0
$127.00
0.0
$786.90
0.0
$984.00
0.0
$0.00
0.0
$0.00
0.0
$2.05
1.5 $5,577.50
1.0
$169.65
0.0
$0.00
12.0
$0.00
0.0 $11,201.25
2.0
$420.00
4.5
$0.00
0.0 $1,168.75
0.0
$296.80
0.0
$0.00
12.0
$0.00
'12.0
$0.00
10.5
$0.00
1.0
$294.00
$174.27
1.0
0.0
$0.00
0.0
$201.65
$23.00
8.5
0.0
$88.00
I
3
$78.00
$0.00
$634.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$726.00
$5,376.00
$0.00
$0.00
$0.00
$233.60
$12.45
$180.00
$0.00
$37.50
$0.00
$0.00
■
$0.00
$165.10
$462.72
$0.00
$14.50
$0.00
$10.78
$0.00
$127.00
$430.00
$192.00
$0.00
$0.00
$0.00
$3,492.00
$0.00
$196.00
$0.00
$19,050.00
$0.00
$2,250.00
$510.00
$0.00
$522.00
$0.00
$0.00
$5,140.00
$330.00
$55.87
$0.00
$0.00
$48.00
$0.00
DAP/86.2
page 54
norethisterone
5 eg
tab 0.5400
nystatin
.1 MU
susp 6.2200
nystatin
.5 MU
tab 0.1920
oxytocin
100 al
inj 0.1400
para-aaino-salicylate
500 sg
tab 0.0000
paracetamol
500 aq
tab 0.0110
paraldehyde
inj 1.5000
penicillamine
250 itg
cap 0.8900
penicillin V
250 mg
tab 0.0400
penicillin V
125 9g/5.11 SUSP 1.8100
pentaerythritol
80 <ig
tab 0.2800
pethidine
50 mg
tab 0.0000
phenindione
50 ig
tab 0.0000
phenobarbitone
200 wg/al inj 0.9100
phenobarbitone
30 ag
tab 0.0030
phenobarbitone
60 mg
tab 0.0070
phentolaoine
10 mg/«l inj 0.0000
phenylalanme/nitrogen austard 2 mg
tab 0.0000
phenylbutazone
100 ag
tab 0.0080
phenytoin sodium
100 ng
tab 0.0110
phytoaenadione
10 mg/al inj 0.2700
potassium chloride
20 mg/lO ainj 2.9400
potassium chloride
600 ag
tab 0.0270
preonisolor.e
5 mq
tab 0.0240
priaagume
75 ag
tab 0.0000
priaidone
250 sg
tab 0.1400
probenecid
500 ag
tab 0.2200
procainamide
250 ag
tab 0.1740
procaine penicillin
4.0 Mil
ini 0.8400
procarbazine
50 mg
tab 0.0550
prochlorperazine
25 ig
mj 1.4400
prochlorperazine
5 ag
tab 0.0130
prochlorperazine
25 ag
tab 0.0000
progesterone
10 aq/il inj 7.7000
promazine
50 ag
inj 0.0000
proaethazine
50 ag/2 ml inj 0.0030
proaetnazine
25 ag/il inj 1.0500
propanolol
80 aq
tab 0.0067
prooanolol
40 ag
tab 0.0200
propantheline
15 ag
tab 0.0120
protamine
10 Jig/al inj 11.2000
pyridostigmine
60 mg
tab 0.0000
pvncoxine
50 mg
tab 0.0000
quinidine sulphate
200 ag
tab 0.1550
reserpine
250 ag
inj 0.6100
250 acg
reserpine
tab 0.0040
nfaspicin
150 Ag
tab 0.0000
rifampicin
300 ag
cap 0.4900
salazoovnne
500 mg
tab 0.0000
salbutamol
4 ng
tab 0.1400
aq
spironolactone
tab 0.0375
stilboestrol
500 •icq
tab 0.1300
streptomycin
inj 0.3500
1
sulphaoiaidine
500 ag
tab 0.0200
0
300
5000
2550
0
83000
0
0
36000
0
0
0
0
0
50000
10000
0
0
90000
20000
0
0
50500
20000
0
0
0
0
0
0
0
0
0
0
0
110
0
15000
187000
5000
18
0
0
0
50
30500
0
5000
0
5000
10000
o
100
0
2400
151
6700
2020
0
120000
373
700
50000
1305
1900
0
0
300
73500
4000
0
0
57750
54500
nr.r
40J
175
49500
31500
0
3100
3200
100
3087
0
40
10000
0
3
0
110
665
15000
101350
15500
39
0
A
500
25
51200
0
11100
0
looGU
6500
9800
5840
1000
200
13
553
168
0
10000
31
58
4167
109
158
0
0
25
6125
333
0
0
4813
4542
24
15
4125
2625
0
nen
uo
267
8
257
0
3
833
0
0
0
9
55
1250
8446
1292
3
0
0
42
-
4267
0
925
0
1567
542
817
487
83
3.0
13.7
9.1
9.1
ERR
1.3
0.0
1.7
1.7
0.5
281.1
ERR
ERR
23.6
1.6
18.0
ERR
ERR
13.7
0.4
64.0
0.0
1.6
6.9
ERR
0.0
14.6
228.0
24.7
ERR
9.0
10.8
ERR
36.0
ERR
429.6
2.7
0.0
11.7
0.4
5.5
ERR
ERR
52.8
12.0
.1
T
1 •i
ERR
1.4
ERR
0.0
6.5
16.2
83.6
156.0
0.0
3.0
0.0
0.0
12.0
4.5
2.0
0.0
2.0
0.0
0.0
12.0
12.0
0.0
1.5
7.5
12.0
12.0
0.0
0.0
0.0
3.0
0.0
0.0
12.0
8.0
0.0
0.0
0.0
0.0
0.0
0.0
12.0
0.0
12.0
0.0
0.0
7.0
1.5
0.0
0.0
12.0
12.0
0.0
4.8
0.0
• 12.0
0.0
12.0
3.0
6.5
0.0
0.0
0.0
$1,296.00
$939.22
$1,286.40
$282.80
$0.00
$1,320.00
$559.50
$623.00
$2,000.00
$2,362.05
$532.00
$0.00
$0.00
$273.00
$220.50
$28.00
$0.00
$0.00
$462.00
$599.50
$76.95
$514.50
$1,336.50
$756.00
$0.00
$434.00
$704.00
$17.40
$2,593.08
$0.00
$57.60
$130.00
$0.00
$23.10
$0.00
$0.88
$698.25
$101.10
$2,027.00
$136.00
$436.60
$0.00
$0.00
$77.50
$15.25
$204.80
$0.00
$5,439.00
$0.00
$2,632.00
$243.75
$1,274.00
$2,044.00
$20.00
i
4
10.00
$1,366.00
$960.00
$357.00
$0.00
$913.00
$0.00
$0.00
$1,440.00
$0.00
$0.00
$0.00
$0.00
$0.00
$150.00
$70.00
$0.00
$0.00
$720.00
$220.00
$0.00
■
$0.00
$1,363.50
$430.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.00
$0.63
$0.00
$101.10
$3,740.00
$60.00
$201.60
$0.00
$0.00
$0.00
$30.50
$122.00
$0.00
$2,450.00
$0.00
$700.00
$375.00
$0.00
$35.00
$0.00
DAP/86.2
page 55
tetracycline Hcl
theophylline
theophyl1ine/ephedrine
thiabendazole
thiaaine Hcl
thiaaine hcl
thiooentone scdiua
thiopentone scdiua
thyroxine sodiuii
trifluoperazine
trifluoperazine
triaethadione
uristix
vincristine sulphate
vitaain b coiolex
warfarin
warfarin
water pro injection
water oro injection
water pro injection
xylocaine ♦ epineohnne 21
250 ag
cap 0.0230
250 aq/10 amj 0.1630
120/24 ag tab 0.0160
500 ffig
tab 0.0390
50 «g
tab 0.0200
100 aq/aI in j 0.2030
5 gzvial inj 4.3300
1 g/vial inj 1.0800
50 acg
tan 0.0039
1 ag/al inj 0.0000
5 ag
tab 0.0260
300 ag
tab 0.0000
50's’
stri 13.7200
1 ag
inj 55.9800
tab 0.0040
5 ag
tab 0.0810
tab 0.0300
3 oq
5 al
inj 0.1C36
10 ail
inj 0.1620
ICO al
inj 0.7900
inj 0.7300
142000
0
50000
25000
20000
100
0
1500
0
0
0
0
1304
PA
JV
0
0
0
6100
0
0
6200
63400
790
38000
8900
0
10
0
1290
3500
0
9000
0
808
12
74500
0
1000
2800
5630
91
12000
5283
66
3167
742
0
1
0
108
292
0
750
0
67
1
6208
0
83
233
469
3
1000
21.7
14.6
15.2
23.1
ERR
108.0
ERR
10.7
5.1
ERR
24.0
ERR
10.5
59.0
9.4
ERR
6.0
19.7
4.3
0.0
2.2
3.0 11,775.20
0.0
$128.77
$603.00
0.0
0.0
$347.10
7.5
$0.00
7.8
$2.03
0.0
$0.00
0.0 $1,393.20
0.0
$31.15
12.0
$0.00
0.0
$234.00
12.0
$0.00
0.5 $11,085.76
0.0
$671.76
0.0
$293.00
12.0
$0.00
0.0
$80.00
0.0
$304.08
$912.06
0.0
$71.39
11.5
O.O $8,760.00
$3,976.00
$0.00
$800.00
$975.00
$400.00
$20.30
$0.00
$1,620.00
$0.00
$0.00
$0.00
$0.00
$17,390.33
$2,799.00
$0.00
$0.00
$0.00
$662.46
$0.00
$0.00
$4,526.00
DAP/86.2
page 56
DAP/86.2
page 57
PROCUREMENT STRATEGIES
DURATION:
2-3 hours
PREPARATION
AND MATERIALS:
A.
Read the Session Notes and Managing Drug Supply, chapter III A.
B.
Prepare the following visual aids:
VA 1:
The supply cycle.
VA 2:
The procurement cycle.
VA 3:
Impact of hidden costs on total costs.
VA 4:
Action alternatives for reducing lead time.
Activity & Time
Plan
Notes
Introduction/
Discussion
15 minutes
1. Review the supply cycle
(VA 1) and introduce and
discuss the procurement
cycle (VA 2)
VA 1
2. Review:
VA 3
VA 4
a. purchasing methods
b. lead time analysis
c. monitoring order status
d. role of donations in
drug supply
e. local production
Group Activity One
20 minutes
Introduce activity one and divide
the participants according to
the number of purchasing agencies
in the country.
Discussion
30 minutes
Ask each group to report on their
findings in order for everybody
to share a common understanding
of the present situation.
Group Activity Two
60 minutes
Introduce activity two and ask
the same groups as above to work
on the 3 questions:
A.
Best procurement system
B.
Comparison of prices
C.
Local production
VA 2
DAP/86.2
page 58
Activity & Time
Discussion
60 minutes
Plan
Ask one group to report on
"Best Procurement System".
Comments from the other groups.
Ask each group to report on
"Comparison of Prices".
Write down on a transparency
(Prepared ahead).
Ask one group to report on
"Local Production". Comments
from the other groups.
Notes
DAP/86.2
page 59
Procurement Strategies VA 1
THE SUPPLY CYCLE
1.
SELECTION
2.
USE
PROCUREMENT
3.
DISTRIBUTION
DAP/86.2
page 60
DAP/86.2
page 61
VA 2
Procurement Strategies
The Drug Procurement Cycle
I.
Reconcile Drug
Requirements
and Funds
7.
2.
MAKE
CHOOSE
PROCUREMENT
METHOD
PAYMENT
6.
3.
RECEIVE AND
CHECK
DRUGS
SELECT
SUPPLIERS
5.
MONITOR
ORDER
STATUS
4.
. SPECIFY
CONTRACT
TERMS
DAP/86.2
page 62
DAP/86.2
page 63
Procurement Strategies VA 3
Impact of Hidden Costs on Total Cost
Hidden
Costs
Short-packing
Contract Price
Visible
Cost
linn i n
Supplier A
Supplier B
Total Cost = Visible Cost + Hidden Cost
Source:
Managing Drug Supply, page 117.
DAP/86.2
page 64
DAP/86.2
page 65
Procurement Strategies
VA 4
ACTION ALTERNATIVES FOR REDUCING LEAD TIME
Procurement
Activity
Time interval (weeks)
Observed
Desired
Action Alternatives for
Reducing Lead Time
- no vacations for procurement staff
in July;
- stop single annual purchasing and do
perpetual purchasing;
- obtain a computer to identify drugs
needing to be ordered and their
order quantities.
Need to Order
6
2-3
Call for Offers
4
4
(four weeks is a reasonable open per
iod for a tender; should probably not
be shortened).
— organize procurement office more
efficiently;
— use summary tables to facilitate
price comparison;
— use a computer to schedule world
wide tenders and present results on
a summary sheet to be evaluated by
the Tender Board.
Closing Date
3
2
4
2-3
Contracts Awarded
Letter of Credit
Established
13
4-8
9
4-8
Goods Shipped
Gords Received in Port
4
1-2
Goods Clear Customs
4
2
47
20-32
- work with Finance to speed the credit
process.
- monitor supplier performance; let
suppliers know you expect prompt
delivery;
- drop suppliers who are habitually
late.
- provide new suppliers with informa
tion on fastest shipping routes.
use order status system to keep in
formed of expected arrival dates;
assign several staff to port
clearing .
- obtain legislation which expedites
drug clearance;
- more warehouse staff;
- improve supervision of warehouse
staff.
Goods Received and Ready
at Warehouse
TOTAL
i
DAP/86.2
page 66
DAP/86.2
page 67
SYSTEMATIC COST REDUCTION
DURATION:
3 hours
PREPARATION
AND MATERIALS
A.
Read: All materials listed in the Participant’s Guide, In
particular, read the study Managing Drug Supply, Chapter VI.B., pp.
493 - 512.
"“2. In addition, you should be very familiar with Chapters
III.A., I1I.B., and III.C. on various aspects of procurement, as
well as Chapters IV.A., IV.B., and IV.C. on specific aspects of
distribution and inventory control. CConcepts in
‘ these
’
six chapters
are necessary background for applying the cost reduction techniques
discussed in this unit.
B.
Prepare: the following visual aids:
VA 1:
Sample ABC Curve
VA 2:
Worksheet One, Activity One (Blank)
VA 3:
Worksheet Two, Activity One (Blank)
VA 4;
Worksheet Three, Activity One (Blank)
VA 5:
Worksheet One, Activity One (Complete)
VA 6:
Worksheet Two, Activity One (Complete)
VA 7:
Worksheet Three, Activity One (Complete)
VA 8:
Typical ABC Analysis for Two Drug Supply Programs
VA 9:
ABC Inventory Analysis, Country I
VA 10:
ABC Inventory Analysis, Country II
VA 11:
Procurement Patterns Based on ABC Analysis
VA 12:
Examples of VEN Classifications, Sri Lanka
VA 13:
Sample Guidelines for VEN Categories
DAP/86.2
page 68
Activity & Time
Trainer Presentation
15 minutes
Notes
Plan
1. Introduction
Review the rationale for the
unit presented in the Session
Guide. Point out that:
- Cost reduction can and
should occur throughout the
system by way of:
. careful selection
. wise procurement
. efficient distribution
. rational use
. sound management of each
step in the process.
- In addition, there are some
specific analytic techniques
which come from the field of
management science (or
operations research) which
can be extremely useful in
realizing further savings.
Among these techniques:
. ABC Value Analysis
. VEN System for Setting
Priorities
- Use of these techniques
requires certain prerequisites,
the most important of which
are:
an information system capable
of providing data on drug
prices, consumption, supplies,
etc.;
. willingness and capability
to make changes in procure
ment and distribution
processes;
. resources to do the
calculations: clerks, adding
machines, computers who can
and will do the necessary
calculations.
List:
1. Information System
2. Willingness to make
change
3. Resources for
calculations
DAP/86.2
page 69
Activity & Time
Trainer Presentation
15 minutes
Plan
Notes
2. ABC Value Analysis
a. Basic Concept
Present the basic concept of
ABC analysis.
It is a well-known observation
in inventory management and
procurement that the majority
of funds (dollars, pesos, etc.)
are spent on a relatively small
number of items.
This observation can be used
to divide drugs into three
categories:
Class A — 10-20% of items
accounting for
70-80% of funds
spent.
Class B — intermediate usage
rates.
Class C — vast majority of
low usage items
which account for
less than 20-25%
of funds spent.
Known as ABC Value Analysis OR
the 80/20 Rule
The basic concept is familiar:
Pharmacists know that 80% of
illness is due to a small
number of conditions (colds,
diarrhea, etc.).
Accountants know that 80% of
funds are spent in a small
number of budget categories
e.g., salary and benefits).
Everyone knows that 80% of
complaints come from the
vocal minority.
Present Visual Aid 1, sample
ABC curve.
Individual Activity One
30-45 minutes
VA 1
b. Performing an ABC Analysis
Talk through the worksheets
for Activity 1, showing them
on the overhead projector, or
holding them up.
VA 2
VA 3
VA 4
DAP/86.2
page 70
Activity & Time
Plan
Notes
Point out each term used:
- Units consumed per year
("Annual Consumption")
- Unit Cost
- Annual Usage (value of
annual usage or value of
annual consumption)
- Rank order of annual usage
- Cumulative Value of Annual
Usage
- ABC Curve
Ask for questions, then break
discussion to allow each
participant to complete the
ABC analysis in Activity One
When all participants have
completed the analysis, ask
one to present his or her
results.
Have several blank ABC curves
available (Worksheet 3) for
participant presenters to
trace their own curves.
Finally, present Visual Aid 7
as the final result if
participants have not presented
the correct curve. Keep Visual
Aid 5 and 6 ready, if needed.
Trainer Presentation
15 minutes
VA 7
VA 5 & 6
c. Examples of ABC Curves from
Asia and South America
Present Visual Aid 8, Typical
ABC Analysis for Two Drug
Supply Programmes
Country I: Central Asia,
20 million people
Country II: South America,
16.6 million people
(Further background details
appear on p.43 of J. Quick,
"Applying Management Science
in Developing Countries" which
is listed under Supplemental
Reading.)
VA 8
Briefly present Visual Aid 9
and 10 and discuss how these
illustrate the numbers of drugs
and values involved in a typical
ABC analysis.
VA 9
VA 10
DAP/86.2
page 71
Plan
Activity & Time
Trainer presentation
Notes
3. VEN System for Setting
Priorities
a. Basic Concept
Begin by asking participants
how they decide what to buy
when funds are short.
(Most programmes have some
form of unstated or implicit
priority system.)
List responses
Ask who decides and how
they decide. Then comment
that these ’’informal”
priority systems have been
formalized in the VEN system.
VEN first applied to national
pharmaceutical programme in
Sri Lanka. Based on dividing
drugs into 3 categories:
Vital — potentially life
saving, necessary for basic
primary health (e.g., vaccines),
or have significant withdrawal
problems.
Essential — drugs effective
against less severe, but
nevertheless significant forms
of illness.
Non-essential — or Normal usage
— drugs for minor, self-limited
illness, drugs of questionable
efficacy, drugs with high cost
for marginal therapeutic
advantage (example: newer
antibiotics, newer beta-blocker
heart drugs).
VEN Examples from Sri Lanka;
Visual Aid 12
Vital
Tetracycline capsules;
Aspirin tablets;
Ampicillin capsules - 250 mgs;
Chloroquine phosphate.
Essential
Vitamins A & D soft capsules;
Ampicillin capsules - 125 mgs;
Kaolin compound poultice;
Indomethacin capsules.
VA 12
(optional, depending on
audience)
DAP/86.2
page 72
Plan
Activity & Time
Notes
Non-essential
Calcium lactate;
Magnesium trisilicate;
Vasaka compound syrup;
Aspirin ethopheptazine tabs.
Point out that in Sri Lanka,
division of drugs into VEN
categories was done by a
physician, a Clinical
Pharmacologist.
Limited experience indicates that
drug lists will be divided in
proportions of 40:40:20 for
V:E:N groups.
Visual Aid 13 illustrates some
sample guidelines which might
be used to set VEN categories.
Ask each group to categorize
the first 50 drugs in the
pharmaceutical list of the
Central Medical Store into
the VEN system. Let this
be followed by each group
presenting a V, E and N drug.
Group Work
b.
Group Activity Two
30 minutes
Ask each group to discuss activity
two. Ask each group on a rotating
basis for suggestions. Supply
with answers from the other group.
Summary
Summarize the session by asking
the participants to suggest ways
in which ABC analysis and VEN
categories might be used to
reduce costs while maintaining
important services. List these
as they are mentioned.
The responses should include the
suggestions mentioned on p.73-74.
VA 13
DAP/86.2
page 73
ABC VALUE ANALYSIS
SELECTION
(1)
Lower Cost Alternatives — Review of Class A drugs may uncover high usage items for
which lower cost alternatives are available, e.g. substitution of brand with generic or
a product with a similar therapeutic effect.
PROCUREMENT
(1)
Order Quantities & Intervals — order quantity influences supply activities in at least
six ways:
determine average inventory (higher order quantity means higher inventory levels);
joint procurement might mean lower drug prices (economies of scale);
determine procurement workload (higher order quantity means less frequent ordering
and vice-versa);
determine safety stock (less frequent ordering means inventory less often low and
less safety stock);
influence bulk prices (larger orders mean more bulk rates);
affect storage capacity for drugs;
affect shelf life of dated products.
Ordering A items more often and C items less often reduces workload and inventory
costs. This is illustrated by Visual Aid 11, which is based on Country I. (Further details
on this appear in the supplemental reading by J. Quick, "Applying Management Science in
Developing Countries").
(2)
Price Reduction Activities — procurement office should concentrate on getting lower
unit prices for A items by:
looking for cheaper dosage forms;
seeking cheaper suppliers (and testing samples of their products, if needed).
(3)
Monitoring Order Status — if orders of class A items are late, it usually means air
freighting an expensive quantity of goods. Therefore A items should be monitored
carefully to be sure shipments are not late.
(4)
Monitoring Shelf Life — Could minimize waste due to drugs exceeding their shelf lives
by carefully monitoring shelf lives of Class A drugs.
DISTRIBUTION
(1)
Delivery schedules — even if all drugs are ordered only once a year, the inventory
reductions shown in Visual Aid 12 can still be achieved by requiring divided deliveries
for high usage (A) items. (Show Visual Aid 12 again).
(2)
Stock-Taking — it may be difficult to do a formal stock-take on all items every 6 to
12 months. However, A items should probably be reviewed regularly, since they account
for the largest value.
(3)
Storage — improves control for issue and storage of Class A drugs at user points such
as hospitals and health centres, etc., to minimize waste, pilferage, and organized
theft of drugs.
DAP/86.2
page 74
USE
(1)
Monitor drug use — review of high usage items by health officials, practicing
physicians, and other health workers may suggest areas of overuse and underuse.
VEN SYSTEM ANALYSIS
SELECTION
(1)
Delete non-essential drugs from national drug formulary.
PROCUREMENT
(1)
Order Quantities — if funds are short during a particular period of time, VEN system
should be used to assure that Vital and Essential drugs are bought first. Point out
that once VEN categories are established, clerks can implement them. If used
correctly, they can decrease the impact of ’’influence’' on purchasing, since there is an
official system of setting priorities.
(2)
Supplier Selection — only reliable suppliers should be used for Vital and Essential
drugs. Quality and service for new and unknown suppliers can more safely be tested by
awarding them contracts for Non-essential drugs.
DISTRIBUTION
(1)
Safety stock — safety stocks should be high for vital and essential items,
savings can be realized by reducing safety stocks of non-essential items.
Inventory
USE
(1)
Monitor Drug Use — review of usage by VEN categories may suggest underuse or overuse.
DAP/86.2
page 75
Systematic Cost Reduction VA 1
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DAP/86.2
page 76
*
DAP/86.2
page 77
Systematic Cost Reduction VA 2
Worksheet One: Calculation of Annual Usage
Name of Drug
(1)
Units Consumed
per year
(2)
Unit Cost
(US $ )
(3)
A
400,000
0.50
B
100,000
1.25
c
500,000
0.10
D
300,000
0.10
E
10,000
1.90
F
10,000
1.80
G
20,000
0.84
H
5,000
3.16
I
500
29.60
J
10,000
0.14
K
10,000
1.30
L
10,000
1.26
M
1,000
13.20
N
10,000
1.44
0
3,000
5.00
P
20,000
0.81
Q
300,000
1.00
R
10,000
7.50
S
20,000
1.00
T
10,000
1.72
Value of Annual
Usage ($)
(col.2 x col.3)
(4)
Rank Order of
Annual Usage
(5)
DAP/86.2
page 78
«»
DAP/86.2
page 79
Systematic Cost Reduction
VA 3
Worksheet Two: Rank Ordering of Drugs by Annual Usage
Rank Order of
Annual Usage
(1)
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
Total Value
Name of
Drug
(2)
Value of
Annual Usage
(3)
Cumulative
Value of
Annual Usage
(4)
Cumulative
Value as
% of total
(5)
DAP/86.2
page 80
DAP/86.2
page 81
Systematic Cost Reduction
VA 4
Worksheet Three: ABC Curve
100
1,000,000
90
900,000
80
800,000
70
700,000
60
600,000
50
500,000
40
400,000
30
300,000
20
200,000
10
100,000
Number of Items
percent of all
items:
1
2
10
3
4
20
5
6
30
7
8
40
9 10 11 12 13 14 15 16 17 18 19 20
50
60
70
80
90
100
DAP/86.2
page 82
DAP/86.2
page 83
Systematic Cost Reduction VA 5
Worksheet One: Calculation of Annual Usage
Name of Drug
(1)
Units Consumed
per year
(2)
Unit Cost
(US S )
(3)
Value of Annual
Usage ($)
(col.2 x col.3)
(4)
Rank Order of
Annual Usage
(5)
A
400,000
0.50
3
100,000
1.25
C
500,000
0.10
D
300,000
0.10
E
10,000
1.90
F
10,000
1.80
G
20,000
0.84
H
5,000
3.16
I
500
29.60
J
10,000
1.40
K
10,000
1.30
!\0 0O
1^
L
10,000
1.26
IT., (,0O
70
M
1 ,000
13.20
60
18
N
10,000
1.44
1 % L/o°
/4
0
3,000
5.00
P
20,000
0.81
Q
300,000
1 .00
R
10,000
7.50
7
7
S
20,000
1 .00
JO; ODO
7
T
10,000
1.72
/ 7, ^-0(0
10
} 00o
3
ro, ODO
DOO
6
1% 0^°
1%, 000
/)
/<
,3
/r
iclj
OOP
JOO
/A
3 too, OdO
/
/____
DAP/86.2
page 84
«
♦
DAP/86.2
page 85
Systematic Cost Reduction VA 6
Worksheet Two: Rank Ordering of Drugs by Annual Usage
Rank Order of
Annual Usage
(1)
Name of
Drug
(2)
1
2
3
4
60.
£
12O-/ QOO
6 2^, 000
62.
7rz^
odO
r7OO/ DOO
160, OOD
3<0,000
? go, oo o
7o.
7F7^.
3)0, ODO
loo, 00o
£
15
16
17
v
^31, OPP
13,200
^S~7, 2.00
^.1
H/ goo
S') I 1 ODD
_£
/d, 2DO
Qg ?,200
S7.Z
7
//
16/ 300
30 3 003
o
/5'/ POD
ooo
^32 ? goo
I
2L-
/%
H, ^ 0'0
7 ,200
/7, oao
OOP
7^4 2DO
177} loo
13 7.
12, 6oo
/, 000/ QDD
18
19
20
Total Value
£A1
11/0 00
13,000
11
14
3Q.
600, OQO
9
13
(5)
^.OO^OOO
7
12
Cumulat ive
Value as
7, of total
A
6
10
Cumulat ive
Value of
Annual Usage
(4)
30a,00Q
5
8
Value of
Annual Usage
(3)
73.3
77.7
U- !
/D O. o
DAP/86.2
page 86
-
DAP/86.2
page 87
Systematic Cost Reduction VA 7
Worksheet Three: ABC Curve
100
1,000,000
90
900,000
80
800,000
70
700,000
60
600,000
50
500,000
40
400,000
30
300,000
20
200,000
10
100,000
Cumulative
Value of
Drugs
I
V
Number of Items
percent of all
items:
1
2
10
3
4
20
5
6
30
7
8
40
9 10 11 12 13 14 15 16 17 18 19 20
50
60
70
80
90
100
DAP/86.2
page 88
DAP/86.2
page 89
Systematic Cost Reduction
Typical ABC Analysis for Two Drug Supply Programs
Country I
©
100
2o
90
3
s
Ci
'I
80
i
I
m --------A, ?Zt
70
S
60
<D
CT
Z)
D
C
c
<
I ;
7
/ / Aj ; i
:
i
1
:
'■
I :
I :
I :
I :
I :
I !
i;
I :
I :
40
a
CO
i
Ba
/i/h
:
50
I
<D
>
0)
>
Country II
Bi
10-1
I
I
I
I
I
I
I
I
I
I
i
i
I
I
I
I
I i
I '
10
i
20
i
i
i
30
40
50
60
70
80
90
25
o
Percentage of Total Range of Drug Items
«
Source:
Managing Drug Supply, page 501.
N. = 344, N> = 220
100
VA 8
DAP/86.2
page 90
DAP/86.2
page 91
Systematic Cost Reduction VA 9
ABC INVENTORY ANALYSIS, COUNTRY I
ABC Category
DRUG LIST CHARACTERISTIC
A
B
C
TOTAL
Number of Items
25
34
285
344
Percent of Al’. Items
7.3
9.9
82.8
100.0
1,438,274
$14,787,144
14.9
9.7
100.0
275,844,000
97,990,000
148,678,725
522,512,725
11,033,760
2,882,058
521,680
1,518,932
$ 11,151,270
$ 2,197,600
Percent of Total Annual
Consumption
75.4
Number of Units of Stock
Mean Number of Units per Item
Value of Annual Consumption
(US $)
«
Source:
Managing Drug Supply, page 501.
$
DAP/86.2
page 92
DAP/86.2
page 93
Systematic Cost Reduction VA 10
ABC INVENTORY ANALYSIS, COUNTRY II
ABC Category
DRUG LIST CHARACTERISTIC
A
B
C
TOTAL
Number of Items
34
35
151
220
Percent of All Items
15.5
15.9
68.6
100.0
6,401,593
$ 1,415,641
69.4
15.4
Value of Annual Consumption
(US $)
Percent of Total Annual
Consumption
Number of Units of Stock
Mean Number of Units per Item
Source:
$
$
1,401,088
15.2
$ 9,218,122
100.0
1,103,858,000
70,511,250
89,063,088
263,432,330
33,054,647
2,014,607
589,822
1,197,420
Managing Drug Supply, page 501.
DAP/86.2
page 94
DAP/86.2
page 95
Systematic Cost Reduction
PROCUREMENT PATTERNS BASED ON ABC ANALYSIS, COUNTRY I
Pattern
I
II
III
IV
Average Inventory Value
(000's of dollars)
ABC
Category
Order Quantity
in Months
Orders
per Year
A
B
C
12
12
12
334
9,730
A
B
C
6
12
12
369
7,750
A
B
C
4'
6
12
428
6.882
A
B
C
4
4
4
1032
6,471
*Assumes safety stock for 98% service level (2% stockout rate).
Source:
Managing Drug Supply, page 501.
VA 11
DAP/86.2
page 96
DAP/86.2
page 97
Systematic Cost Reduction VA 12
EXAMPLES OF VEN CLASSIFICATION, SRI LANKA
VITAL
TETRACYCLINE CAPSULES
ASPIRIN TABLETS
/WICILLIN CAPSULES - 250 mgs.
CHLOROQUINE PHOSPHATE
ESSENTIAL
VIT/WNS A & D SOFT CAPSULES
/WICILLIN CAPSULES - 125 mgs.
KAOLIN COMPOUND POULTICE
INDOMETHACIN CAPSULES
NON-ESSEMTIAL
CALCIUM LACTATE
MAGNESIUM TRISILICATE
VASAKA COMPOUND SYRUP
ASPIRIN ETHOPHEPTAZINE TABLETS
DAP/86.2
page 98
DAP/86.2
page 99
Systematic Cost Reduction
VA 13
SAMPLE GUIDELINES FOR VEN CATEGORIES
Non-Essent ial
Characteristic of Individual
Drug or Target Condition
Vital
Persons Affected (Z of pop.)
over 5Z
1-5Z
less than 1Z
Persons Treated (number per
day at average health center)
over 5
1-5
less than 1
Target Condition Life Threatening
yes
occasionally
rarely
Target Condition Disabling
yes
occas ionally
rarely
Drug Prevents Serious Disease
yes
no
no
Drug Cures Serious Disease
yes
yes
no
Drug Treats Minor, Self-limited
Symptoms and Conditions
no
possibly
yes
Drug has Proven Efficacy
always
usually
may or may not
Drug has Unproven Efficacy
never
rarely
may or may not
Essent ial
DAP/86.2
page 100
DAP/86.2
page 101
FINANCING THE DRUG SUPPLY
DURATION:
3 hours
PREPARATION
AND MATERIALS:
A.
Read: the Session Notes and further readings.
B.
Prepare the following visual aids:
Activity & Time
Discussion
30 minutes
VA 1:
Drug costs
VA 2;
Operating Costs
VA 3:
Development costs
VA 4:
Funding alternatives matrix
VA 5:
Alternative financing mechanism
Notes
Plan
1. Introduce the session and
discuss the different types
of costs:
VA 1
VA 2
VA 3
. drug costs
. operating costs
. development costs
2. Then discuss the differences
between operating (recurring)
and development (capital) costs.
Ask the participants to provide
examples of each one. Include
a discussion of the relation
ship between the two types of
costs.
Group Activity One
45 minutes
3. Divide the participants into
groups of 5-6 persons and
ask each group to work on
activity one.
Presentation of
Group Work
30 minutes
4. Ask each group on a rotating
basis of the effect of the drug
supply system of each funding
source. Check the conclusions
with the other groups.
f
Group Activity Two
30 minutes
5. Same groups as before. Ask
the groups to work on activity
two.
8585 4
I
k ooC'
VA 3
DAP/86.2
page 102
Activity & Time
Plan
Presentation of
Group Work
30 minutes
6. Ask one group for their
suggestions and supply with
answers from the other groups.
Discussion
10 minutes
(optional)
7. Present alternative financing
mechanisms introduced in other
countries.
Summary
10 minutes
8. Summarize the activities of
the session and stress the
following points:
- there are three broad
categories of costs;
- development costs usually
lead to an increase in
operating costs;
- there are many different
funding alternatives, each
with its own advantages
and disadvantages.
Notes
VA 5
DAP/86.2
page 103
Financing the Drug Supply VA 1
DRUG COSTS
fWUFACTURER'S PRICE
+
FREIGHT
+
INSURANCE
+
DEMURRAGE FEES
+
CUSTOMS
+
PORT CHARGES
+
TRANSPORT TO WAREHOUSE
+
QUALITY ASSURANCE EXPEHDITURES
TOTAL DRUG COSTS
DAP/86.2
page 104
<
DAP/86.2
page 105
Financing the Drug Supply VA 2
DRUG SUPPLY SYSTEM OPERATING BUDGET
BUDGET
CATEGORY
LINE ITEM
Personnel
Salaries
AMOUNT
BUDGETED
FOREIGN EXCHANGE
REQUIRED?
Special Allowances
Insurance
Services
Telephone/Telex
Water & Electricity
Rental of Land or Buildings
Building Maintenance
Vehicle Maintenance
yes
Equipment Maintenance
yes
Domestic Travel &
Subsistence
Materials
Foreign travel &
Subsistence
yes
Freight & Handling Charges
yes
Packaging Supplies
yes
Office Supplies
yes
Forms Including Printing
Costs
Technical Literature
yes
Fuel & Lubricants
Building Materials
yes
Vehicle Spare Parts
yes
Equipment Spare Parts
DAP/86.2
page 106
DAP/86.2
page 107
Financing the Drug Supply VA 3
DEVELOPMENT BUDGET FOR DRUG SUPPLY SYSTEM
Budget Category
Line Item
Development
Expenditure
Annual Operating Cost Implication
Foreign Exchange
% Development
Requirement
Amount
Cost Required
Building
Construction
5%
Small (*)
Vehicles
20%
Large
Furniture
5%
Nil
Office Equipment
10%
Small
Warehouse
10%
Small
Refrigeration
(Equipment
20%
Large
[Packaging
[Equipment
20%
Large
i
10%
Large
(**)
Large
I_____
[Equipment
Garage Equipment
Personnel
Training
DAP/86.2
page 108
t
■
DAP/86.2
page 109
Financing the Drug Supply VA 4
Funding Alternative Matrix
FUNDING
SOURCES
fes/No
Equity
Efficiency
Flexibility
Stability
= ==== ==== = = = ::
Impact
External
Funding
Non-governmental
organizations
MOH
Budget
Regional
Budgets
Local
Budgets
Community
Contribution
Insurance
Individual
Consumer
Expenditure
0 = Neutral effect
+ = Favourable effect
- = Unfavourable effect
+/- = Favourable and unfavourable effect
Feasibility!
DAP/86.2
page 110
DAP/86.2
page 111
Financing the Drug Supply VA 5
ALTERNATIVE FINANCING MECHANISMS
COMMUNITY FINANCING
- Fund-raising special events (cultural^ athletic, health fairs).
Taxation at village level.
Insurance (Health Book).
Lotteries.
Donations - from individuals, cooperatives, or local organizations
FEE FOR SERVICE
Standard fee.
Variable - by type of service or population group.
Donation.
FEE FOR DRUGS
Standard fee per prescription
Variable - by cost or quantity of drug, type of drug, population group.
Donation.
DAP/86.2
page 112
DAP/86.2
page 113
QUALITY ASSURANCE
DURATION:
2-3 hours
PREPARATION
AND MATERIALS:
A.
Read: all materials listed in the Participant's Guide, in
particular, read and study Managing Drug Supply, Chapter III.D.,
pgs. 181-206.
B.
Prepare the attached visual aids on poster board, newsprint, or
transparencies.
VA 1: Determinants of Drug Quality
VA 2: Elements of Comprehensive Quality Assurance Program
VA 3: Procedures to assess Drug Quality
C.
D.
Activity t Time
Trainer Presentation
10 minutes
Obtain a blackboard with chalk, flipcharts, or newsprint with
’ . Be sure to have
markers, or overhead projector with transparencies,
blank
transparencies
and
appropriate
markers for
enough newsprint or 1--each group in Activity One.
Assure that all participants have the complete participant guide and
review with them the reading assignment.
Plan
1. Review the rationale for the
unit presented in the
Participant’s Guide.
Emphasize that quality
assurance has two primary
functions:
a) Assure safe, effective,
acceptable drug products
(including vaccines) for
patients.
b) Maintain credibility of
the health program by
maintaining an image of
high quality.
Group Task
20 minutes
2. What is "Drug Quality"?
(NOTE: In this and the next
steps, keep in mind who the
pharmacists are in the group,
if any. Call on their
expertise to supplement your
presentation, but do not
neglect non-pharmacists or
leave any basic questions
unanswered).
Notes
DAP/86.2
page 114
Activity & Time
Plan
Ask the group to list the
characteristics which define
drug quality.
These should include:
Notes
List responses on black
board, newsprint, or
transparency.
- Identity
- Purity
~ Potency
- Uniformity
- Bioavailability
Be sure to clarify any
questions participants
might have about the
meaning of these terms.
Trainer Presentation
20 minutes
3. What determines the quality
of drugs reaching the patient?
(NOTE: Much of the material in
this step will be familiar to
participants who are pharmacists
and to some nurses and physicians.
This material is really back
ground material to help
participants understand the
reasons for considering quality
assurance a comprehensive
function, rather than simply a
laboratory analysis function.
Show the participants Visual
Aid 1, Determinants of Drug
Quality and slowly talk through
each part of the diagram.
Define terms as you go along.
Bear in mind that the small
terms in the figure cannot be
seen from a distance.
Group Task
10 minutes
4. Why worry about drug quality?
Ask the group to list the
reasons for being concerned
about drug quality. These
reasons fall under "healthrelated" and "programrelated" categories. The
health-related reasons are
discussed in the Session Notes
and Managing Drug Supply.
The program-related reasons
are largely common sense.
VA 1
DAP/86.2
page 115
Activity & Time
Plan
The list should look something
like this when complete:
Notes
List responses on black
board, newsprint or
transparency
Health-Related Concerns
- Loss of potency;
- Medication errors;
- Toxic degradation;
- Contamination.
Program-Related Concerns
- Credibility with patients;
- Credibility with health
workers;
- Cost (poor quality drugs or
packaging leads to losses);
- Credibility with donor groups.
Group Task
30 minutes
Activity 1, part 1
5. Participants' Quality Assurance
Issues and Concerns
In this step, participants will
be divided into two (or three)
groups of six to eight people,
depending upon the number of
participants. Ask the groups
to prepare a list of the
quality assurance activities
which are carried out in their
country at each level and of
the main problems encountered.
As they mention their issues
and concerns, list them under
the following headings:
- Sources Quality Issues
(i.e., problems with the
quality of drugs being
supplied to them by
commercial sources,
government production, or
donors)
- Supply System Issues
(i.e., problems with quality
assurance at central ware
house, in transit, at local
facilities, etc.).
— Examples of Poor Quality
(i.e., anecdotes which
illustrate poor quality, but
which do not clearly fit
under the above headings).
Activity 1 to be
prepared on a
transparency
List responses under
three headings on black
board, newsprint or
transparency.
DAP/86.2
page 116
Plan
Activity & Time
Notes
If the above discussion of
participants quality assurance
concerns is slow, you might ask:
- Are you satisfied with the
quality of the drugs you receive?
- Is quality maintained throughout
your distribution network?
- Are there any complaints of poor
quality by health workers,
patients or other groups?
- Does anyone have a particular
quality assurance issue which
he or she had wanted help with?
Activity 1, part 2
30-45 minutes
6. Design of a Quality Assurance
System
Each group will then be
responsible for developing a
quality assurance plan for a
country. Each plan will then
be presented to the entire
group and discussed.
Discussion of
Group Work
30-45 minutes
Try to have the group point out
the strengths and weaknesses of
each of the plans they present.
Point out additional strengths
and weaknesses yourself.
Raise implementation issues which
stem from:
- cost factors;
- feasibility questions;
- manpower (availability, numbers,
training);
- local technology or lack thereof;
- political constraints.
Ask questions such as.
- could you really establish such
a program?
- would it work?
- is it worth the cost and effort?
- what if drugs "go bad" at health
centers? (How do you know about
it?)
Group Task
15 minutes
7. Summary
Have the group list what they
now consider to be the essential
elements in a quality assurance
system. The list should look
something like Visual Aid 3
VA 2 - 3
DAP/86.2
page 117
Quality Assurance
Determinants of Drug Quality
/ Drug Production
11
Plant Environment
•temperature / Tl
•humidity
.
J |||
r Manufacturing----Equipment
&
r----—
;
•
c,eanl,ness
Inactive
6^ V Process
O
Maintenance; ^Active
Ingredients^
(01
J
II
Drug^A^fe
*1—Diluents
<L Colors
<L. Flavors
Solvents
<1 Emulsifiers
J Coatings
^Disintegrators
j— Bindings
Quality^ Formulation
Control
Immediate^
Packaging! B
External i Packaging
Shipping
Conditions
Port
Conditions
- ■ -i yr
Transportation
Conditions
)
Warehouse! Conditions
I
Storage
Conditions
|
E
Dispensing
Conditions
1 ’T
J)
/ '
■
Re-packaging:
^1 •materials
’UX^Viipi
equipment
I
>■. — . _ , ; 1 ’
I IQI II
r y
•procedures
■/i
Patient
Handling
IS!
/
: a "
.11
Source:
<■
Managing Drug Supply, page 185.
9
>
\J
VA 1
DAP/86.2
page 118
DAP/86.2
page 119
Quality Assurance VA 2
Elements of a Comprehensive Quality Assurance Program
Key
Flow of Drugs
Levels
Private Sector
Inter
national
Multinational
Manufacturers
National
Local Man
ufacturers
Public Sector
International
Assistance Agencies
j—
V
Government
Supply Services
I
Local
Wholesalers
• Procurement Unit
• Import Unit
• Inventory Control Unit
• Finance Unit
• Medical Stores
[_
|
T
Regional
(^Distributors )--------------
• Gather accurate information
about reliability of new
supplie rs.
• Maintain supplier file on past
performance.
• Request and test samples from
selected prospective suppliers.
PORT CLEARANCE
• Monitor storage conditions to
assure that proper temperature,
light, cleanliness, and
humidity are maintained.
• Ensure that required Certifi
cates of Quality are presen
ted with import documents.
SHIPMENT ACCEPTANCE
---------------- —
Regions
REPACKAGING
• Medical Stores
• Hospitals
X
District
• Participate in selection of
repackaging systems to assure
that they are suitable to the
local environment.
• Monitor packaging equipment,
materials, and techniques to
assure that adequate enclosure
is maintained.
Districts
STORAGE
• Medical Stores
• Hospitals
• Monitor conditions to assure
that acceptable storage'envi
ronments are maintained.
• Health Centers
Shops,
Pharmacies
A
V
Community
Health
^Workers
Community
rn
Source:
SUPPLIER SELECTION
• Inspect shipment contents to
assure adherance to contract
spec i fications.
• Test samples, either routinely
or for suspect products.
T
c
Information Flow
V
Users
Managing Drug Supply, page 187.
1
/
TRANSPORTATION
• Review transportation modes,
routes, and schedules to pre
vent serious lapses in cold chain
or other storage requirements.
DISPENSING
• Assure adequacy of storage con
ditions at dispensing points.
• Review selections of bottles,
envelopes, papers, and other
dispensing materials.
• Maintain a system to verify
quality of drugs at the final
dispensing points.
DAP/86.2
page 120
DAP/86.2
page 121
Quality Assurance
PROCEDURES TO ASSESS DRUG QUALITY
A.
Restricted Supplier Selection
1. International known firms only.
2. Certificate of Origin and Certificate of Free Sale required.
3. Lowest price suppliers omitted.
B.
Inspection for Good Manufacturing Practices (GMP)
1. GMP report by manufacturer's drug regulatory authority.
2. GMP report from reliable procurement program or national drug
regulatory agency outside country of manufacturer.
3. Purchaser performs GMP inspection.
C.
Physical Inspection of Each Shipment
1. Inspection by independent agent in exporting country.
2. Inspection by purchaser's own port and/or warehouse inspectors.
D.
Laboratory Analysis
1. Manufacturer's quality control batch testing report.
2. Independent laboratory batch analysis report.
3. Testing by manufacturer's national drug regulatory agency. ./
4. Pre-purchase sampling by purchaser.
5. Pre-acceptance sampling by purchaser.
6. Testing by exception.
7. Post-acceptance testing.
8. Local stability testing.
VA 3
DAP/86.2
page 122
DAP/86.2
page 123
INTRODUCTION TO PROPER DRUG USE
DURATION:
2 hours
PREPARATION
AND MATERIALS:
A.
Read MPS, Chapter V.A., pp. 401-406
Chapter V.B., pp. 429-442
Chapter V.C., pp. 447-457
B.
Review the Session Notes
C.
Prepare the following visual aids;
VA 1: Elements in proper drug use.
VA 2: Types of irrational drug use
(From Managing Drug Supply, p. 403).
VA 3: Potential barriers to appropriate drug use.
VA 4: Options for promoting appropriate drug use.
D.
Obtain examples of efforts to improve drug use:
- copies of Sri Lanka’s The Prescriber;
- copies of PNG manuals;
- essential drugs packagings in Kenya;
- Gambia symbolic labels.
Activity & Time
Introductory Presentation
15 minutes
Plan
1. Present the rationale for this
unit and introduce the key
elements in promoting rational
drug use.
15 minutes
2. Ask the participants to
identify barriers to proper
drug use in general.
20 minutes
3. Divide the participants into
groups and ask them to fill
up worksheet 1.
40 minutes
4. Continue with a discussion of
the problems they listed and
of available options for
improving prescribing,
dispensing, packaging or
patient use. Encourage a
discussion of options they
may have tried in their
countries.
Notes
VA 1-2
VA 3-4
DAP/86.2
page 124
Activity & Time
Plan
Demonstration
15 minutes
5. Provide and discuss specific
examples of efforts to improve
drug use.
Session Summary
15 minutes
6. Review the different problems
and solutions which have been
presented in the session.
Discuss shortly what factors
have to be considered when
choosing between different
options.
Notes
Prepare transparency
with Speight's or other
bar graphs.
DAP/86.2
page 125
Introduction to Proper Drug Use VA 1
PROPER DRUG USE
The Drug Use Process
J
Diagnosis
Prescribing
Dispensing
Packaging & Labelling
Pati
Compliance
DAP/86.2
page 126
J
DAP/86.2
page 127
Introduction to Proper Drug Use VA 2
Types of Irrational Drug Use*
Type of Irrational
Drug Use
Extravagant
Prescribing
Occurs if a drug is prescribed when:
• a less expensive drug would provide comparable
efficacy,and safety
♦ symptomatic treatment of mild conditions diverts
funds from treating serious illness
• a brand name is used where less expensive equiva
lents are available
Over
prescribing
• the drug is not needed
• the dase is too large
• the treatment period is too long
• the quantity dispensed is too great for the
current course of treatment
Incorrect
Presc r ibing
• the drug is given for an incorrect diagnosis
• the wrong drug is selected for the indication
• the prescription is prepared improperly
• adjustments are not made for co-existing medical,
genetic, environmental, or other factors
Multiple
Prescribing
• two or more medications are used when one or two
would achieve virtually the same effect
• several related conditions are treated when, treat
ment of the primary condition will improve or
cure the other conditions
Underpre scr i b ing
• needed medications are not prescribed
• dosage is inadequate
• length of treatment is too brief
*
Adapted from Working Party, Council of Europe, 1976.
i
Source:
Managing Drug Supply, page 403.
DAP/86.2
page 128
DAP/86.2
page 129
Introduction to Proper Drug Use VA 3
POTENTIAL BARRIERS-TO PROPER DRUG USE
Potential Barrier or Pitfall
Element
1.
Ac curate Diagnosis
- practitioners lack skill or conscientiousness
- too few practitioners
- practitioners overworked
- laboratory and x-ray tests lacking
- inadequate supervision of practitioners
- diseases or problems too complex
- unlicensed practitioners
2.
Rational Prescribing,
- inadequate pharmacology training
lack of continuing education
- inappropriate "prestige overprescribing"
- drug company influences
- practitioner overworked
- pressure from patients
- fear-induced prescribing
- incorrect generj. 1 ization from experience
- poor patient-doctor communication
3.
Correct Dispensing
- inability to re.:! or interpret prescription
- inadequately trainin'' dispensers
- too few dispensers
- lack of equipment or f-’.c i 1 i t ies
- overworked dispensers
- poor attitude about dispensing
4.
Suitable Packaging
- no packaging materials
- adequate packaging thought to be too costly
- poor attitude about packaging
5.
Proper Use
-
no labeling
labels patient cannot understand
inadequate verbal instructions
patients misunderstand drugs and their use
cultural values conflict with therapy
lack of patient trust
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DAP/86.2
page 130
J
DAP/86.2
page 131
Introduction to Proper Drug Use VA 4
OPTIONS FOR PROMOTING PROPER DRUG USE
1. .Improve Prescribing Habits
- limit drugs to those which are truly needed
- provide good pharmacology training at medical schools and
medical auxiliary training schools
- provide regulary supervision of medical auxiliaries which
inc hides a review of their prescribing practices
institute a drug information newsletter or other means of
providing regulary, unbiased information of drugs
- place controls on drug company representatives to avoid
nisinfornation
- restrict prescribing by level-of-care categories
2.
Improve Disnens_ing Practices
- recruit and train competent dispensers
recruit a sufficient number of quality phar:-.‘.cists to
supervise the supply system
organize facilities appropriately (space should he
organized efficiently and easily cleaned ant; secured)
- provide adequate equipment in the form of measuring vials,
counting trays, >etc.
2
Provide Suitable Packaging
- acceptable forms of bottles, plastic bags :in<: other containers
should be available for hand-dispensing of drugs
- consider pre-packaging drugs by course-of-tberapy quantities
- be sure that dispensers, pharmacists and other health, workers
understand the importance of suitable packaging
4.
Encourage Proper Us?
- effective labeling (written or syrnbo lie)
- patient education by doctors, auxiliary health workers, community
health workers, and community health education activities
- analyze and help health workers to understand local beliefs
and customs which influence the use of medications
(
DAP/86.2
page 132
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