CDI Module 14: Supply Chain Management
for CDI
©Jhpiego Corporation
The Johns Hopkins University
A Training Program on CommunityDirected Intervention (CDI) to Improve
Access to Essential Health Services
Module 14 Objectives
By the end of this module, learners will:
 Describe the process of anti-malarial drug procurement and
storage
 Explain how to estimate their community’s commodity
needs
 Outline the stock recording method and reporting format
 Describe the distribution process for anti-malarial
medicines and other malaria commodities (long-lasting
insecticide-treated nets [LLINs], rapid diagnostic tests
[RDTs])
 State how to monitor and report adverse drug reactions
(ADRs)
 Discuss the role of patent medicine vendors (PMVs) in
malaria commodity management
2
What Are Commodities?
3
Procurement and Supply Chain/Cycle
Clients
consume
stock
Supply system
information
management
Storage,
safety and
correct use
Forecasting
and ordering
Procurement
Distribution
to next level
Storage and
safety
Distribution to
first level
4
Commodities Flow from Suppliers to Central
Medical Stores, Then on to LGAs and Facilities
5
Flow of Commodities
 Health commodities for community-directed
intervention (CDI) and integrated community case
management (iCCM) can flow through both public
and private channels
 Each country is different, and in some cases:
 National, regional and district medical/pharmacy
stores order, procure and distribute
commodities/medicines
 Districts or community associations can use private
sector warehouses and suppliers to buy medicines
 In some countries, malaria commodities are
manufactured; in other countries, these commodities
are imported
6
Commodities Reach Consumers
 Ultimately, commodities like artemisinin-based
combination therapies (ACTs), RDTs, LLINs and
sulfadoxine-pyrimethamine (SP) need to reach
the frontline clinic, and from there, the
community-directed distributors (CDDs)
 Whatever the system, commodities must move
from point of manufacture to point of use
 (Present a chart that shows movement of
malaria and other iCCM commodities in your
country so that it finally reaches CDDs/villages)
7
Proper Estimation of Anti-Malarial
Commodities
 It is important to have estimates of eligible
clients/patients to determine anti-malarial commodity
requirements at all levels
 Accurate data are required to achieve these estimates
 Initial quantification of anti-malarial medicines (ACTs,
SP, quinine) needs to be done using population-at-risk
data, by episode, based on medicine consumption
 Lower level quantification can be done through
community “head counts” during community census
8
Malaria Tasks Have Different Schedules
(Forecasting)
 The first task is to conduct a community census to
determine numbers of people in need of services
 An insecticide-treated net (ITN) is needed as soon
as a woman knows she is pregnant
 Intermittent preventive treatment in pregnancy
(IPTp) occurs at least twice after quickening, at
monthly intervals
 Case management occurs whenever a community
member has malaria
 IPTp and ITNs may prevent most of the need for case
management
 Finally, health education is frequent
9
Identify and Coordinate Sources of
Supplies and Funding
LLINS
ACTs
SP
Global Fund
World Bank
USAID
UNICEF
Ministry
Present details from your own country
10
Sample Roadmap Country Summary
Need to 2010
Funded and
expected to be
distributed before
end 2010
Gap
LLINs
63 million LLINs
49 million
14 million
ACTs
129 million
doses
94 million
35 million
IRS
2.8 million
households
800,000
2 million
RDTs
59 million tests
34 million
25 million
IPTp
18 million
doses
18.3 million
0
11
Procurement and Supply
 It is recommended that drugs for home management
of malaria (HMM) be centrally procured
 Benefits of central procurement include bulk
purchasing, which can:
 Reduce cost of medicines and handling charges
 Ensure consistency and quality of supplies
 Simplify logistics
 These drugs should be World Health Organization
(WHO)-approved medicines
 Ultimately these should move in a well supervised
manner from national to sub-national to district to
health facility and then community
12
Companies Producing WHO Prequalified
Malaria Medicines as of August 2010
Amodiaquine + Artesunate
 Ipca Laboratories Limited
Dadra and Nagar Haveli (U.T.),
India
 Guilin Pharmaceutical Co. Ltd Guilin, Guangxi, China
 Cipla Ltd
Patalganga, India; Goa, India
 Sanofi-Aventis Group
MAPHAR Laboratories,
Casablanca, Morocco
Artemether + Lumefantrine
 Novartis Pharma
Beijing, China; Suffern, USA
 Ajanta Pharma Ltd
Paithan, Aurangabad,
Maharashtra, India
 Ipca Laboratories Ltd
Dadra and Nagar Haveli (U.T.),
India
 Cipla Ltd
Patalganga, India; Himachal
Pradesh, India
13
The Frontline Primary Health Care (PHC) Facility
Provides Commodity Link with CDDs
14
The Malaria Drug Supply Chain
 Community delivery of
malaria medicines
requires adequate
supplies at all levels
 Districts must monitor
frontline facilities to help
prevent stock-outs for
facilities and the CDDs
these facilities supervise
 CDDs collect stocks from
the nearest PHC facility
15
Forms Track the Use of
Anti-Malarial Medicines
 Forms are used at all levels of the health care
system to track the use of anti-malarial medicines
 States/municipalities use forms to track the drugs
they procure and distribute
 Facilities also use forms to track the drugs they
procure and distribute
 CDDs use forms to track the medicines they pick up
from their supervising facility and distribute within
the community
16
Why Use Anti-Malarial
Drug-Tracking Forms?
These forms collect data on:
 The consumption of different dosage packs
 The manufacture and expiry (expiration) dates of
medicines
These forms also include areas to record the
justification for any discrepancies in drug
consumption (e.g., partial medicine usage)
17
The Distribution Process for CDI
 Commodities reach the nearest health facility
 The community representative or CDD collects
initial supplies and materials from the health
facility
 The initial stock is based on a village census that
shows need
 On receipt of stocks, the CDD or community
representative signs an inventory register at the
health facility confirming collection of supplies
18
CDDs Need a Safe Place
to Store Their Own Medicines
19
Maintaining Stocks and Distribution
 The community is informed that commodities are
available from the CDD
 Women and caregivers seek these services,
when needed
 The CDD maintains distribution records and
summarizes these on a regular basis
 The community or the CDD submits summary
reports to the health facility on a regular basis
 Then they collect replenishment supplies
20
Community Preparation
 The community and the CDD announce to
community members that commodities are available
 The community decides on a distribution system for
commodities
 For ivermectin, people could go house-to-house or
distribute the drug from a central location
 For malaria commodities, people could go to the
CDD’s house, or the CDD could make home visits
 The community should decide on the most acceptable
processes
21
Storage
During training, CDI focal persons should sensitize
the CDDs to the following storage requirements:
 Keep medicines away from direct sunlight and
heat
 Ideally store SP, and ACTs in a cool, dry place—
temperature should not exceed 25°C
 Keep all medicines out of reach of children, at all
times
22
Keeping Medicines in the Community
 Keep community case management (CCM) kits
in dry, clean places in the house
 Medicines should be kept separate from the
other items in the house
 Medicines suspected to have come in contact
with water must not be used for treatment
 Damaged medicines should be returned to the
health center and a new stock collected
23
Medicines May Not Work as Expected
 CDDs should report dangerous or unexpected
effects of the drugs to their supervising health facility
 The supervising facility should report to the district
 This reporting is part of the pharmaco-vigilance
system
 Likewise, CDDs should take note of patients who do
not get well after taking ALL medicine correctly
 These patients should be reported and referred
 These steps help ensure quality of commodities
24
Getting New Stock for the Community
 A system of stock
collection is needed
 Monthly CDD meetings
at the frontline facility is
one way to accomplish
this:
 CDDs bring empty
medicine packets to
exchange for new
packets
 A system must be in
place to obtain stock
whenever it is needed
25
PMVs Are a Major Source of Medicines
for the Community
 Sometimes if CDD
stocks run out,
community members
may need medicines
quickly
 PMVs may be a
source
 We need to monitor
PMVs to ensure that
they provide quality
medicines
26
Procurement and PMVs
PMVs:
 Normally buy their stock from wholesalers
 Usually do not keep records and receipts
 Do know which medicines are popular
With the Affordable Medicines Facility for Malaria
(AMFm), PMVs:
 May now be receiving specially packed Coartem
from the health system
 Will need to learn how to manage stocks, check
expiration and report damages
27
PMV Associations Can Be Involved in Procurement and
Supply Chain Management (PSM) for the Private Sector
 Sometimes
communities
can re-stock
their medicine
box by buying
from a reliable
PMV shop
28
Summary and Conclusions
CDDs:
 Collect drugs from the health facility that provides
services to their community
 Ensure that drugs are stored appropriately
 Maintain an accurate account of drug use, damages
and stock at all times
 Report ADRs to the supervising health facility
 Attend monthly meetings and submit monthly
reports
PMV associations can also be involved in the supply
of approved malaria commodities
29