Report

Regional Capacity Development Workshop on

Warehousing, Inventory Management and

Distribution

November 14 – 16, 2011 Bangkok, Thailand

A joint initiative of UNFPA – Asia Pacific Regional Office and the

International Council on Management of Population Programmes

(ICOMP)

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Executive Summary

Despite decades of focus on family planning, quite a significant proportion of the population in the

developing world still face a high unmet need for family planning and Reproductive Health. Progress has

been slow and inequities in FP and RH are pervasive, particularly among marginalized and displaced

women and girls. This despite the fact that countries have committed to meet the goals stipulated in the

MDGs, particularly MDG 5 on reducing maternal mortality and increasing the access to and use of

contraceptives.

One of the contributing factors for low contraceptive prevalence and high maternal mortality is a weak

health system. In the specific area of FP, a glaring consequence of such weak health system is the stock-

outs of contraceptives resulting in fewer FP acceptors and poor adherence to the regimen. The quality

of these contraceptive supplies may also be compromised given poor storage practices observed in

many of the developing countries. Given the said situation, there is a clarion call and a bandwagon of

support for governments to

assert more responsibility

towards their citizens.

Among which is to create,

fund, manage, regulate,

and supervise, a public

health care system that,

under optimum

circumstances, allows all

citizens equal access to

services and to products

which are safe and of high

quality.

With that as a backdrop,

UNFPA and ICOMP recently

organized a Regional Capacity Development Workshop on Warehousing, Inventory and Distribution in

Bangkok, Thailand on November 14-16, 2011, with the aim of strengthening the overall reproductive

health commodity supply chain management. The workshop focused more on effective warehouse

management to ensure quality medicines, supplies, devices and equipments are made available at

anytime and anywhere as needed. The workshop was guided by the Asia Pacific Regional Office of

UNFPA with a technical back up team from ICOMP, which included experienced resource persons. A

total of 35 participants from twelve (12) countries1 participated.

1 Afghanistan, Bangladesh, Pakistan, Bhuttan, Mongolia, Sri Lanka, Philippines, Indonesia, PDR Lao, Myanmar,

Vietnam, Papua New Guinea, and Mongolia

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The following are the lessons culled from the workshop:

1. It is vital to the success of warehouse management, inventory and distribution that all

practitioners embrace a universally recognized Code of Ethics.

2. Key threats to effective management of warehouses and supply chain are the following:

(a) inappropriate procurement policies and practices;

(b) unskilled and untrained personnel working in logistical operations;

(c) using medical warehouses as dumping grounds for obsolete equipment and expired drugs;

and

(d) lack of attention to temperature and humidity factors in handling drugs and supplies.

3. The absence of clear policies / guidelines on disposal of expired goods or unusable items results

in warehouses accumulating rubbish overtime, and thereby taking much needed space that is

required to properly store drugs and supplies.

4. In the design and construction of medical product warehouses, the opinion of a Health Care

Logistic Systems Expert must be sought.

5. Advocacy would need to take place to secure sustained, long – term funding from government

and/or donor(s) for improving storage infrastructure. As such, compelling economic evidence

needs to be developed and

presented.

6. There is a need to consider

issues regarding finance and

economics in operating

medical warehouses on a

daily basis in the context of

their vital role in the supply

chain.

7. Logistics and Health

Management Information

Systems go hand in hand, and

provide the critical dimensions with which to achieve the stated outcomes of health programs

vis a vis the supplies.

8. There is a need to ascertain the best logistic information system most appropriate to the

country.

9. When needed sufficient donor commitment and support should be available.

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10. There is a compelling need to integrate logistical systems of vertical programmes (i.e., MCH,

HIV/AIDS, FP and RH) with overlapping purposes and activities to save scarce resources by

avoiding unnecessary duplication and thereby making them more efficient.

11. Countries need to ensure accountability both in terms of the commercial value of the

commodities and the social value from their use.

12. To operate a successful pull system requires a broad knowledge and understanding of dynamics

of all program commodities, demands a degree of advocacy, and must be placed in a context of

a perpetual training program for all employees.

13. Political dynamics of countries, including status as decentralized or centralized form of

government, will impact on and shape the effectiveness and efficiency of the distribution

system.

On the basis of the various issues that emerged from the workshops and as a way of supporting

country plans, the following are the recommendations to take forward actions to strengthen and

improve warehousing, inventory management and distribution:

1. There is a compelling need for intensive guidance on warehouse organizational strengthening.

2. Continue to provide competency-based capacity building to improve and standardize the

practices on warehousing.

3. Develop or improve procedural manuals for the disposal of all kinds of expired drugs, outdated,

broken and derelict equipment and vehicles.

4. Support a regional logistics training institute.

5. Develop a ready to use, handy pocket book of standard guidelines and protocols for

warehousing that can be used by warehouse managers at different levels to guide them in their

routine work.

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The following are some actions plans identified by the countries:

Competency-based capacity building of warehouse staffs, including but not limited to

warehouse management, procurement and forecasting, distribution and reporting, LMIS and

Supply Chain Management

Assess the technical design and needs of warehouses as basis for the renovation and

improvement of warehouses.

Enhance the Logistic Management Information System of warehouses, and if possible such LMIS

from across warehouses are linked, and that information is available and accessed by the central

authority as basis for decision making.

Establish a regular coordinating mechanism by which government, donors, and private sectors

are talking and collaborating on various issues relevant to warehousing, procurement, inventory

management and distribution.

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1. Rationale

Global efforts are largely drawn towards achieving the Millineum Development Goals. Among the

MDG goals, it is acknowledged that MDG 5, Improving Maternal Health, is off-tracked in most

countries. In particular, Target 5b, Universal Access to Reproductive Health, encounters slow

progress specially so among resource-poor settings and countries.

Everyday, close to 1000 women die in childbirth and million more infected with any forms of Sexually

Transmitted Infections, including about 7000 cases of HIV. This situation could be prevented by

maximizing on cost-effective strategies and programs to prevent maternal death, including STI and

HIV. One of the recognized interventions, ensuring people’s access to contraceptives and supplies for

RH and safer maternal health and childbirth, is feasible and do-able in any setting.

Evolving good practices in the area of Reproductive Health Commodity Security (RHCS) has

documented success in increasing Contraceptive Prevalence Rate, making available mix of modern

methods of contraceptives in service delivery points, and reducing stock outs2.

There is groundswell of support, given the insidious stock outs in health centers, to take forward the

gains from initiatives to secure RH commodities and supplies. This requires that countries must build

the infrastructure that allows all individuals to obtain quality and affordable RH commodities to

communities either rich or poor, in urban or rural areas or to educated and less educated people,

including young couples.

More than increasing funding, the RHCS compels the improvement of the health systems and

infrastructure so the supplies may reach those who need them. Among others, it is measured, based

on agreed indicators, in the availability of contraceptive commodities and life-saving and essential

maternal health medicines in health facilities. Crucial in the chain of supply is warehouse

management, simply the storing of the products properly, ensuring, through an inventory system,

that sufficient stocks are available, and making optimal use of the warehouse spaces. In taking into

consideration these components, including distribution of RH supplies, will contribute to improved

access to supplies, but also in cutting costs through improved procurement processes.

By taking stock of good warehouse management, the quality of the medicines and supplies are

maintained, expiry drugs reduced to a minimum, de-clogged the warehouse with unusable materials,

and make available the commodities and supplies whenever needed. For example, by having good

warehouse management, Afghanistan was able to clean up its rubbish materials, which for years

have occupied their premises, and gained more space for storing medicines and supplies. And in

Nepal, it resulted in revenues from sales of more than $265,000 USD, which was added to the

government’s treasury.

2 The Global Programme to Enhance Reproductive Health Commodity Security, Annual Report 2010, UNFPA.

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It is also recognized fact that health care services, including maternal, child and reproductive care,

cannot be carried out effectively without equipment and commodities, including a range of essential

medicines, vaccines and family planning commodities. They also cannot be performed without a

team of dedicated skilled health practitioners i.e., physicians, birth attendants, nurses, pharmacists,

and logistics personnel. In addition, there is a need for a supply chain that includes warehouses and

storerooms equipped with temperature control capabilities, the means to transport commodities

and products, and ways to continuously monitor , track and account for them.

In fact, health products cannot and should not even enter the public supply chain unless they are

vetted and certified as safe by an authorized government body. In addition, it is also the principal

responsibility of the government and the public and private sectors to ensure that quality medicines,

vaccines and supplies are available when needed and accessible wherever people in need are

located. Without such products and supplies or whenever their quality are compromised, programs

will fail, and consequently resulting in poor health. Thus, one of the pillars of a good health system is

the availability of well designed and effectively managed warehouses.

2. The Workshop in Capsule

Advanced in the 2010 internal assessment on the status of warehousing conducted by the Asia

Pacific Regional Office of UNFPA (APRO), with participation from RHCS focal points in the countries of

the region, was that the warehousing in the region leaves much to be desired. Based from the

feedback and responses, the countries need support and guidance in warehouse management in

order to improve their practices with reference to this critical component of logistics management. It

was also realized that

although there are some

guidleines and protocols for

the design and layout of a

Model Warehouse, these are

not followed in routine, and

the staff at the grass roots

level does not have ready

access to these documents.

This emerged as an important

felt need of the countries.

As a follow up to these

findings, UNFPA and ICOMP

jointly organized the “Regional Capacity Development on Warehousing, Inventory Management and

Distribution” in Bangkok, Thailand, with the aim of strengthening the overall reproductive health

commodity supply chain management. The workshop focused mainly on effective warehouse

management to ensure adequate quality medicines, supplies, devices and equipments as needed

(Please see Annex 1: Workshop Programme). Specifically, the workshop was designed to enable the

participants to: (1) appreciate the international standards for effective warehousing, (2) recognize

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the importance of an organized and effective warehouse storage system, (3) appreciate the modern

trends in warehousing in order to provide fast and accurate reproductive health commodities

management, and (4) review warehousing situation in the participating countries.

To achieve the above-mentioned objectives, the workshop was divided into to several thematic

sessions: warehouse management system, good practices in warehouse management, logistics

management information system (LMIS), and development of supply chain management. In addition

to the practical aspects of warehousing, interactive sessions (e.g. group work and focus group

discussions) were conducted in order to learn from the vast field experience of the participants, and

to draw lessons as they sought to improve their warehousing practices. During the workshop, the

countries were also assisted to prepare a plan of action to take forward the strengthening of their

warehouses.

With guidance from UNFPA -

Asia Pacific Regional Office,

ICOMP conducted the workshop

with a team of experts, Mr. Philip

Brandt, logistics expert, along

with Mr. Javed Hafizi, Mr. Heem

S. Shakya, and Mr. Malik Ahmad

Khan. The selection of the

resource persons was made on

the basis of their past experience

on warehousing in countries like

Afghanistan, Nepal, Pakistan and

Lao PDR. The workshop was held

in Bangkok. A total of 35

delegates from twelve (12) countries3 participated. These participants represented the top level

leaders managing central and sub-national warehouses of their respective countries, including the

program officers responsible for RHCS in UNFPA country offices, and training institutions (Please See

Annex 2: List of Participants).

The workshop was officially inaugurated by Ms. Lubna Baqi, Deputy Regional Director, UNFPA-APRO,

Dr. Vinit Sharma, Regional Adviser, RH and RHCS, UNFPA APRO and Dr. Camilo Naraval, Senior

Programme Officer, the International Council on Management of Population Programmes.

3 Afghanistan, Bangladesh, Pakistan, Bhuttan, Mongolia, Sri Lanka, Philippines, Indonesia, PDR Lao, Myanmar,

Vietnam, Papua New Guinea, and Mongolia

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3. Lessons Learnt

3.1 It is vital to the success of warehouse management, inventory and distribution that all

practitioners embrace a universally recognized Code of Ethics, setting the standards on behavior

and practices of people involved in the organization.

As with most organizations, instilling and maintaining professionalism among the workforce is a

behavioral objective vital to the success of the effort. The manufacture, handling, , management

and distribution of medical products and pharmaceuticals are likewise governed by a Code of

Ethics. Setting the tone of the workshop was a presentation on the Code of Ethics for

pharmaceutical suppliers. The particulars of the British Association of Pharmaceutical Wholesalers

was chosen for this occasion as this document succinctly sums up the key ethical behaviors that all

purveyors of registered medicines and drugs in the United Kingdom are obliged to follow. This

presentation was anchored to several bibliographical references to WHO publications including

those having to do with Good Manufacturing Practices for Pharmaceutical Products and Good

Distribution Practices for Pharmaceutical Products.

3.2 Key threats to the effective management of warehouses and supply chain (distribution) practices

emerged during the discussions. Theseinclude: (1) inappropriate procurement policies and

practices, (2) unskilled and untrained personnel working in logistical operations, (3) using medical

warehouses as dumping grounds for obsolete equipment and expired drugs, and (4) lack of

attention to temperature and humidity factors pertaining to the handling, storage and

transportation of medical products.

Inappropriate Procurement Policies and Practices

It is vital to bear in mind the interests of the supply chain management, distribution tiers, and

consumers who are dependent upon the products. For example, ordering products with shelf lives

of sufficient duration to filter down to beneficiaries before their expiry; assuring receipt of full sets

of relevant documents in-country in advance of shipments’ arrival in-country; insisting on robust

packaging of products so as to withstand the rigors of in-country distribution; and taking into

consideration repacking and repackaging needs when breaking down bulk shipments for distribution

in-country.

In several occasions throughout the workshop, opportunities were availed to warn against issues

such as:

a) accepting donations from well-meaning givers in times of disaster or emergencies unless and

until warehouse and program managers have been consulted and have concurred;

b) confusing disaster assistance and emergency preparedness and response with the regular

functions of the public health care system, particularly among senior planning and budgeting

authorities, and home and foreign ministers;

c) accepting donated products in ordinary times as “gifts” from manufacturers; and

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d) not following exacting practices and protocols in preparing specifications for products to be

procured with a country’s own resources or those of its regular donors.

Unskilled and Untrained Personnel Working in Logistical Operations

The second risk factor was documented by recounting experiences from Bangladesh and PNG. Two

issues were emphasized:

(a) That in workforce planning for health care logistics systems, careful attention needs to be given

to the basic qualifications of personnel who will work in warehouses and stores, their pre-

service and in-service training and career development paths. This includes regular performance

evaluations followed by opportunities for obtaining professional insights such as exchange visits

to facilities either within their countries or abroad to broaden their understanding of

demonstrated best practices;

(b) That the authority’s policy is one of zero “0” tolerance for corruption and that corrupt practices,

including ‘short-cutting’ must not be tolerated nor rewarded. As an object lesson, a comparison

of a medical/drug warehouse with a bank and its vault was drawn.

The ‘agenda’ of advocacy for professionalism in the warehouse workspace is complex but essential.

There are many reasons to think carefully through the entire health care supply chain operations to

protect and preserve the value of the goods procured with funds, whether the people’s own or

those donated by well-meaning friends and donors, or both. Proper training of personnel is crucial

for preventing unintended effects that a poorly planned system might have on the health of those

who are engaged in the management of the system.

Warehouses as Dumping Grounds and Storage Centers of Unusable Equipment and Expired Drugs

To dramatize the third point, two presentations were made by co-facilitators, one featuring

Afghanistan’s central medical store in a before-after scenario, and the other featuring a long-term

effort made in Nepal to rid the warehouses, stores and grounds of derelict equipment and vehicles

and other unusable materials. Afghanistan’s exercise took place over a two-month period and

Nepal’s over a two-year period. Both were successful. By clearing the warehouse of unusable

materials, it created more space for storage. And in the case of Nepal, it resulted in revenues from

sales of more than $265,000 USD, which was deposited into the government’s treasury.

Inattention to Temperature and Humidity Factors

To give maximum attention to one of the threats to consumable medical products, a simple

thermometer was introduced in the classroom and throughout the three-day workshop,

temperature readings were taken, announced, and participants comfort levels monitored. If

conditions were too cold or too warm, immediate action was taken to adjust the ambient

temperature to achieve maximum comfort. That drugs and medical products are no different from

humans in their sensitiveness and tolerances, and their ability to work most effectively, was the

object lesson.

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3.3 The absence of clear policies / guidelines on disposal of expired goods or unusable items results

in warehouses accumulating rubbish, and thereby taking much needed space that is required to

properly store drugs and supplies.

Disposal of unusable materials varies from country to country across the region. In some parts of

the world, policies on disposal are either non-existent or too complex to handle. Several issues

surfaced with regard to the disposal of unusable materials, particularly expired medicines.

Specifically, on expired donations with no documentations as to the quantity and cost, warehouse

would have difficulty in disposing those since government procedures require costing of the expired

medicines. This brought to fore the issue on whether expired drugs are “valueless”, but given the

government regulations, the expired drugs need to be costed first before being written off from the

financial ledgers. Only then can these goods be disposed of appropriately. It is therefore important,

given government regulations, that these medicines must be costed.

The experiences from Afghanistan and Nepal showed that it was first necessary to rid the storage

facilities of accumulated rubbish and derelict materials before the true purpose of a medical supply

and distribution system could be brought out, and the priorities of the delivery of goods with

intrinsic value to the public emphasized. As the case of Bhutan, the disposal of expired drugs and

unusable good is centrally decided based upon recommendations from the warehouse. Thus, it is

essential that warehouses shall undertake to develop or improve their manuals on disposal of

expired drugs or unusable materials.

3.4 In the design and construction of medical product warehouses, the opinion of a Health Care

Logistics Systems Expert must be sought.

The participants learned about one such case in Afghanistan where UNFPA had funded a large

structure, constructed by the UN agency OPS, which was supposed to be a warehouse for

reproductive health products. Once built it was soon apparent it could not be used for that

purpose because of design flaws, among which the most glaring omission was proper insulation.

Three years after its construction, the building was subsequently successfully insulated sufficient

enough to withstand the extreme temperatures of Afghanistan’s hot summers and cold winters by

making use of locally available materials. But this was made possible only after a health logistics

supply chain expert had been brought in to assess the situation.

The absence of expert opinion, particularly in the design and construction of warehouses, has

resulted to poor planning of warehouses’ future storing capacity. What the lone participant from

Bangladesh made clear to the participants, was that the sub-district storage facilities, which had

been built in the 1980s and 1990s, were no longer considered adequate for the forthcoming

decade. In other words, additional investment in storage infrastructure is already critical to the

continuing operations of the health care system in that country. The co-facilitator from Nepal

recounted that country’s experience with finding a solution to good storage facilities at the district

level. Initially, the government elected to rent storage in the district capitals. This turned out to be

disadvantage and disastrous bottleneck. After a decade of inconvenience and untold amount of

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waste and mismanagement of valuable health supplies, new district warehouses were financed and

built throughout the country.

3.5 Advocacy would need to take place in order to secure sustained, long-term funding from

government or a donor for improving storage infrastructure. As such, compelling economic

evidence needs to be developed and presented.

Because resources are scarce and available funds are mostly used to buy essential drugs,

investment in storage infrastructure of appropriate quality is not high on a government’s priority

list. Obviously, a government would rather prefer that a donor agrees to fund the building of

storage facilities. However, it can be demonstrated that significant savings in terms of reduction in

wastage and from pilfering can be made thatmore than repays the investments over a period of

time, particularly if the facilities built are of appropriate design and high quality. Such line of

reasoning was used, in fact, to convince local government and donors in Pakistan of the need to

make commitments for proper medical storage.

Fundamental to the consideration of whether and what kind of storage facilities ought to be

constructed or acquired is the nature of the distribution system they are meant to serve. To put

this subject in context some time was devoted to discussing modern warehousing systems and

facilities in the context of each country’s peculiar environment.

An example from Pakistan was presented to the workshop. In this case, a donor invested in a

modestly sized warehouse in the port city of Karachi about 25 years ago. Recently the same donor

agreed to commit US$3 million to doubling the capacity of that warehouse. A major consideration

was that the original grounds and quality of construction of the original structure were adequate

for the renovation. One advocacy argument is that a considerable time horizon is required for the

life of any major storage facility such as a warehouse. That timeline could be as long as 25 years in

the future.

The key lesson learned is that in planning for construction of warehouse infrastructure a key factor

is appropriateness of location and size of the plot. A second factor is the quality of its construction

including foundation works. A key factor is to ascertain that any new storage facility that might be

designed or contemplated for renovation, is redesigned in such a manner that it is not used for

other purposes than that of warehousing and storage.

3.6 There is a need to consider issues regarding finance and economics in operating warehouses on a

daily basis in the context of their vital role in the supply chain.

Experience from around the region illustrates that Ministries of Health generally also do not

consider the cost implications of implementing good supply and distribution practices. Examples

abound from around the region: workers turning off fans and air-conditioners when they leave the

warehouses; non-disposal of waste from shipping, or by-products of shipping operations; lack of

security devices, or the presence of security personnel to guard warehouses; inattention to the

routine and regular maintenance of equipment such as fire extinguishers and lack of training in

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their use; non-provision of safety equipment and apparel for workers such as gloves, masks,

appropriate footwear and protective headgear, much less standard uniforms to be used while

working.

In some facilities there are no toilets or when available they are not fully functional. There is often

no provision for safe drinking water, no place for washing hands and face, nor even separate toilet

facilities for women employees.

3.7 Logistics and Health Management Information Systems go hand in hand, and provide the critical

dimensions with which to achieve the stated health outcomes vis a vis the supply.

The key advantage that the Nepal health commodity management information system enjoys is the

strong link with the health services output information service. The health management

information system reports on the results of services delivered, not simply on commodities

supplied as the LMIS does to enable and facilitate those services. This is an important context of

designed interventions (processes) and specific outputs anticipated when both systems are

communicating and sharing information. The results are then permitted to be observed by a regular

measurement of outcomes through the independent and periodic conduct of objective

demographic and health surveys.

3.8 There is a need to ascertain the best logistic information system most appropriate to the

country’s needs, weighing on the advantages and disadvantages of having a stand-alone or a

networked Logistic Management Information System.

Different countries’ experiences with commodity management information systems were also

shared. These included presentations from the Philippines, Sri Lanka and Pakistan (where a web-

based system is being trialed in one province). One of the key discussions was whether a

standalone commodity management information system is sufficient or whether a networked

system is preferable. Countries’ experiences with a software program prepared and offered by

UNFPA known as CHANNEL was recounted. CHANNEL is now used in more than 90 countries in

which UNFPA is active and has been used in different scenarios to demonstrate effective horizontal

and vertical linkages within the system. However, participants from the Philippines brought out the

fact that CHANNEL is useful within the context of a single or central medical store and that it does

not link to more than one warehouse. A systematic approach means that there must be linkages in

the information flow between storage levels on the same level and at lower levels throughout the

system. The degree to which these are integrated and monitored determines how effective overall

inventory management evolves over time.

In a situation where there are several major warehouses, such as in Bangladesh for example, it is

necessary to have a system that enables a central administrator to have access to commodity status

and transactions in all warehouses in the supply chain. The type of system is typically observed in

logistic operations such as employed by UPS and FedEx operations. As mentioned, Pakistan is

currently trying out such a system in its Punjab province whereby one central administrator has

been allocated full authority, and other regional or district system administrators have been

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permitted lesser levels of authority to observe and operate the supply chain. It is too early to

comment on whether this system will provide solutions to adequately meet general program

requirements but it is a step in the right direction. Early on in the Bangladesh case, networking was

first tried and tested by providing phone connections and fax machines to the three regional

warehouses so they could link to the central warehouse and send monthly inventory and

transaction statements which were compiled by central staff and distributed to program managers

and senior officials. Orders for movement of commodities could also be transmitted via these

devices.

In a perfect world, all facilities that store commodities ought to be visible to the central authority at

any time and all their transactions also ought to be visible and open to scrutiny by program

operatives throughout the supply chain. In Nepal this was achieved over the long term by fostering

a reporting expectation, through repeated training and monitoring processes, that is now email

based. Due to the expansion of internet connectivity throughout the country, reports on stock

status and transactions are submitted monthly by the District Health Offices as electronic

documents (attachments to emails).

These simple, spreadsheet-type reports are received by the central administrator at the

Department of Health Services’ commodity information management service. These are compiled

by a technical expert and are then presented to the program directors and the supply management

director in time for their monthly meetings. Composite summaries are also available for the semi-

annual meetings of MOH officials with their donor consortiums. This is how the system contributes

strategically to planning and budgeting for the vital public health programs.

Currently in Lao, the central medical warehouse and three newly built or refurbished regional

warehouses are not part of the information system, which remains controlled by the vertical

program manager (Maternal and Child Health Center). However, since 2009, the MOH has

instructed that its vertical programs integrate their logistics systems and progress towards creating

a unified commodity MIS is now ‘enabled’.

The reports of commodity status and transactions are also valuable “tools” for inventory

management at district, regional and central levels. For one, their interpretations allow managers

at these levels to determine whether stocks of each item at facilities are likely to be sufficient for

prescribed periods of time, whether there may be excess stocks in some and scarcity in others, and

whether stocks are likely to remain viable or to expire before expiration. Procedures for moving

excess stock of an item from one administrative area to another have been re-examined and

protocols revised to facilitate movement. Thus maximum utility of the costly investment in

inventory management has been strived for optimum efficiency and effectiveness.

3.9 When needed, sufficient donor commitment and support should be available.

The lessons learned from Nepal need to be applied to the Laotian scenario. First there has to be

vision, and the leadership has to commit to this vision. That vision has come to the Laotian

authorities. The Laotian commitment to achieving a result similar to that of Nepal has to be

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supported by donors, as it was in Nepal, for the early developmental period. That component has

been weak so far in Laos. Individual programs have their individual advocates such as UNICEF for

vaccinations and UNFPA for contraceptives and the Global Fund for T.B., Malaria and HIV/AIDS

(GFATM). Only recently have UNFPA and GFATM jointly supported the Medical Products Supply

Centre (MPSC) in its newly mandated role.

Earlier in the year, APRO had facilitated the organization of a scoping exercise (in collaboratuion

with the University of Canberra, Australia) whereby logisitics experts had come together to brain

strom on different models for integration / unification of the various logisitics management systems

in the country. The experts had demonstrated the efficiency and effectivenemss of a unified

logisitics management system and the substantial savings in terms of resources to the government

by conducting a pilot project in a province. Enthused by the result of the project, the government

has decided to upscale the model in more provinces.

More similar commitments are needed from other donors to the sector. While the necessary

capacity is being built, donor support, particularly for technical assistance and monitoring is vital. In

Laos, that support is flagging at the moment.

The commodity management information system now being built in Lao PDR is moderately

expensive but key investments have been made already in infrastructure by JICA as well as in IT

equipment by ADB, World Bank, WHO, JICA, GFATM, UNICEF and UNFPA. The future of the

development of the commodity management information system needs to be guaranteed for a

long-term, which requires coordination and collaboration by and between multi-lateral

organizations.

3.10 There is a compelling need to integrate logistical systems of vertical programmes (i.e., MCH,

HIV/AIDS, FP and RH) with overlapping purposes and activities to make them more efficient.

In most instances, health care delivery systems have been imposed on a country from the outside or

in collaboration with outsiders who represent larger vested interests. This has resulted in a

‘traditional way’ of doing business that is contrary to modern logistical principals and operations.

The prospect of integration of such individualized product specific systems into a unified modern

system is resisted by indigenous program managers who fear loss of autonomy and sometimes the

loss of perks that are offered to them by outsiders. Recognizing that change may not happen

overnight, but that it can happen if appropriate tact and pressure are applied smartly and

relentlessly to approach integration of several logistical systems that have overlapping and

complimentary activites and purposes.

Tact comes about by personal approach and persuasion through inclusiveness in such activities such

as in planning for desired change, and by developing an understanding of the benefits that may be

gained. Pressure can be brought to bear by presenting evidence that the present way of doing

business is, in fact, counterproductive either from a fiscal or economic point of view or from an

achievement (program) point of view. Since specific outsiders are often involved, it becomes

necessary to neutralize their influence, particularly by the higher authorities who may be the

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doorkeepers in the process of change. The most direct and effective way to motivate the authority

to consider change is to present a compelling argument that contains elements of both fiscal

responsibility and potential increments in program achievement.

A step by step process could be adopted, first by identifying challenges common to all program

warehouses, and agree on regular meetings to address key concerns and to share experiences. At

the very least, the aforementioned steps ought to take place if only for the warehouses to be

communicating with each other to make them more effective and efficient. Then another

collaborative effort that the vertical program warehouses could start is to develop standardized

systems and processes, including manuals.

3.11 Countries need to ensure accountability both in terms of the commercial value of the

commodities and the social value from their use.

With contraceptives, maternal and child supplements and vaccines meant for the prevention of

diseases, this value is measured, usually, in terms such as the contraceptive prevalence rate, the

number of unplanned pregnancies averted, the number of infant and children under 5 mortalities,

maternal deaths prevented etc.. With other key life-saving medicines (i.e., antibiotics, oxytocin,

ergometrine and magnesium sulfate), the social value is in mothers’ lives saved during child birth as

well as their babies. These are key indicators in the MDGs about which the community of nations is

vitally concerned.

The experiences and lessons learned disclosed in the previous discussion of commodity

management information systems have a large role to play in helping to keep accountability up-to-

date and transactions transparent. In terms of distribution itself, it matters little whether clients

received their program commodities through the public health care system, NGOs or commercial

vendors. What matters most is that they received good quality commodities, and they are fully

satisfied with the services they got.

3.12 To adopt a a push and/or pull system in requesting for, and delivering supplies must be weighed

in terms of their comparative advantages and disadvantages within the country and program

contexts.

In a push system, a typical and oft quoted example is that of vaccination campaigns whereby teams

of vaccinator-technicians make scheduled rounds to villages carrying stocks of vaccines and syringes

with them and vaccinate children as well as pregnant women against tetanus. On their scheduled

vaccination day, people show up at the appointed location with their children, receive not only

vaccinations, but often other program commodities such as iron tablets, de-worming medicines and

Vitamin A capsules. If someone fails to show up for any reason, they miss the opportunity and

either have to wait until the next vaccination round or make their way to a district hospital with

their children to request the service they missed.

In other scenarios, health program managers simply mandate that a certain quantity of medicines

be allocated to each official Service Delivery Point and then organize the distribution of quantities

17

thought sufficient for a period time, usually three to six months, to these outlets. This allocated

quantum of medicines may or may not be used up within the stipulated time since the

quantification equation employed is usually based on a notion of how much eligible population

resides in the catchment area and the prevalence of need for them among the catchment

population.

Such methodology gives rise to many observations about quantities of now expired items in the

cupboards of primary health centers for years together as demand for them was never either there

or was overestimated. On the other hand, perhaps clients had no idea that such medicines were

available should they need them as they seldom visit the outlets. Other stories abound about fresh

stocks of some commodities being exhausted within a few weeks and the cupboards being bare for

months until new allocations are made by the central authorities and eventually arrive at the SDPs.

Such push operations are very risky in terms of their accountability from both a traditional value

point of view as well as a social value standpoint. Without precise and regular reports on stocks

lying in storage feeding back to district health administrators, waste is bound to increase. It would

not be uncommon, for example, to find several years of stock confined to the medicine cabinet of a

rural SDP, all of which is expired.

In a pull system, the service providers request new supplies of essential medicines as they use up

their initial stocks. This type of system ought to work well provided service providers and logistics

personnel are conscientious in their monitoring of demand and stock levels in their stores. Since

some products are more popular than others, over time, providers learn to keep in stock supplies of

those which are more popular and tend to forget about those that are only occasionally in demand.

It is not uncommon to find outlets with very few of the more popular products on hand being

quickly replenished while stocks of unpopular products languish until they expire and are then

never reordered because of their perception that they are not in demand. A pull system also

requires a high degree of formality with reports on stock balances and consumption routinely

required at higher levels together with a requisition for additional stocks.

A pull system often suffers because authorities at higher levels in the supply chain arbitrarily

challenge orders coming from below. They do this for a variety of reasons some of which are inane

such as using the opportunity to demonstrate their authority and power.

Other reasons are due to their lack of comprehension of actual demand in the catchment area and

failure to order sufficient supplies from tertiary supply sources because providers or administrators

have not considered all the demand factors and nor consistently observed consumption history of

each product.

To operate successful pull system requires a broad knowledge and understanding of the dynamics

of all program commodities, demands a degree of advocacy, and must be placed in the context of

perpetual training program for all employees.

18

Often senior level managers are not aware of the nature and texture of demand and have not

prepared the ground sufficiently for procurement in terms of informing the financing entity of the

program’s needs. Thus stocks run out at the lowest level, buffer stocks are inadequate at

secondary storage levels, and reserve stocks at higher levels turn out to be insufficient to keep all

outlets adequately supplied, throughout the duration of a supply cycle.

3.13 Political dynamics of countries, including their status as to decentralized or centralized

government, shape the effectiveness and efficiency of the distribution system.

In Mongolia, a country that enjoys relative political stability, the MOH employs a private firm to

deliver products to districts of that country. As one participant noted, Mongolia is a socialist

republic and it is the duty of the state to accomplish the task of distribution of public health

commodities. In fact, her statement very well sums up the responsibilities of a government that is

truly concerned about the public’s health. However, the ground realities of carrying out the Mission

of Public Health in Mongolia include coping with extreme variations in climate as they do in

Afghanistan.

In Afghanistan, for example, the central government’s jurisdiction is limited to only a few provinces

where security of health staff can be guaranteed. In many provinces, services may only be provided

in ‘safe pockets’ of territory. In many of these, NGOs, financed by the major donors to the country,

provide services and commodities. At present there is no universal vision of a comprehensive public

health care service for that country, one that includes a formula for servicing all communities and

settlements with all necessary and desirable public health commodities.

In Pakistan, effective civil power has devolved to the provinces. The central ministry of health has

been dissolved. Currently public health supplies, if imported, are distributed from the central

medical store in Karachi by rail to those provincial health departments and district health offices. It

is not at all clear if there will be one singular system for assuring distribution takes place to all the

districts much less the sub-district service delivery points, under this de-centralized scenario.

In Nepal, the present political dynamic is reduced to how different administrative interests will share

power at the provincial and district levels and how essential health services are to be financed when

the new geo-political configuration of Nepal’s diverse landscape is finally worked out.

Will donors be able to contribute to provincial departments of health directly? Such programmatic

questions need to be answered as the political and socio-cultural dynamics play out. The

democratization processes are somewhat chaotic and excessively patchy in many countries. Besides

Afghanistan, Nepal and Pakistan, there are similar issues facing the people in Myanmar, Sri Lanka,

the Philippines and Indonesia.

19

4. Country Warehouse Status Self-Assessment and Country Plans

Taking stock of the lessons learned and the issues that emerged during the discussions and open forum,

the participants self-rated their country status and situation on the three areas of warehousing, such as

site selection, warehouse design and management, making use of the modified self-assessment tool on

warehousing inventory and distribution. The tool was adapted from the Management Science for Health

(MSH), and added some good practices and key country concerns, particularly on the management

aspect of warehousing (Please see Annex: Self-

Assessment on Warehouse Inventory and

Distribution). A score of 1, 2 or 3 is indicated by the

participants that best align or reflect their judgment

with regard to the status of their respective

warehouse on the set of criteria. A total of nine

countries assessed their warehouse management

and practices.

There were a total of seven (7) dimensions

pertaining to warehouse site selection. The median4

score on the dimensions of proximity to ports of

entry, security, and access to workplace is three (3), which is the ideal situation that a warehouse may

have. However, in all the other items, the median score was two (2) this being a reflection that for most

of the countries, there is seasonal interruption5 due to rains/floods affecting physical accessibility to

service delivery points. Then the warehouses suffer from water and electrical interruptions affecting

operations and most of the countries too have indicated that they experienced internet and telephone

interruptions from time to time. This has serious

implications in terms of responding to emergency

situations. Basing on the self-rating assessment,

drainage and sewage problems are experienced from

time to time, and they also experienced minimal

flooding.

With regard the warehouse design, the median score

of the nine countries is three (3) on the following

items: (a) easy movement of personnel, (b) secure

storage area for controlled substances and (c)

systematic arrangement of stocks. It means that in

the aforesaid practice areas, most countries have met the ideal set-up. However, the nine countries are

needing more work to improve further their air circulation, bulk storage pallets, maintenance, cold chain

4 Median is described as the numerical value separating the higher half of a sample, a population, or a probability

distribution, from the lower half. 5 Extreme weather / temperature

20

management, storage area for flammable materials and fire prevention measures. This shall require a

review of the warehouse design and protocols on storing medicines and supplies.

It is observed that among the three dimensions measured in the self-assessment tool, it is in the

leadership and management that the countries rated

a median score of two on all items: shared vision,

strategic directions, organizational structure,

staffing, staff capacity, systems and process and the

style of management. This graph illustrates that the

countries are nowhere close to good practices that

may likely usher them to organizational or warehouse

effectiveness. In terms of the vision, most of the

countries agreed that somehow a written vision and

strategies are in placed, however these were not

articulated. While the countries expressed some

clarity with regard the organizational structure, most

of them agreed that it needs review and revision to make it more practical and effective. This also holds

true with staffs’ job descriptions. They claimed that these are written down, but in most cases

performance evaluation based on the job descriptions is not carried out. Such could have been an

important modality to enhance skills, but the absence of feedback mechanism imperils on-the-job

mentoring, and the much needed skills strenghtening. Despite a weak performance evaluation and

feedback mechanism, most countries opined that their current staffs could perform and deliver basic

tasks, and that training needs are identified and are being followed-through. One of the most pressing

challenges expressed by the countries is the lack of standard operating procedures, country specific

guidelines and protocols, or if such documents are existing these are generally not understood or

practiced.

Based on the issues emerging from the workshops, and the self assessment of the status of warehouses

in each country, the following are some actions plans identified by the participants:

Competency-based capacity building of warehouse staffs, including but not limited to

warehouse management, procurement and forecasting, distribution and reporting, LMIS and

Supply Chain Management

Assess the technical design and needs of warehouses as basis for the renovation and

improvement of warehouses.

Enhance the Logistic Management Information System of warehouses, and if possible such LMIS

from across warehouses are linked, and that information is available and accessed by the central

authority as basis for decision making.

Establish a regular coordinating mechanism by which government, donors, and private sectors

are talking and collaborating on various issues relevant to warehousing, procurement, inventory

management and distribution.

21

Develop standard operating procedures and guidelines.

Strengthen the warehouse management particularly in the areas of articulating vision, aligning

vision with strategies, capacity building of the staff, organizational structure, management and

systems and processes.

5. Recommendations

5.1 Gleaning from the status of the countries on leading and managing warehouses, it appears that

there is a compelling need for intensive guidance on warehouse organizational strengthening.

5.2 Continue to provide competency-based capacity building to improve and standardize the practices

on warehousing, inventory management and distribution. The capacity building may take on various

training modalities, including workshops, mentoring, south-south exchange. It is also recommended

to identify, develop and pursue opportunities to involve workshop participants in appropriate

logistics system assessment missions together with leading logistics and health systems experts to

further improve their practices.

5.3 Procedural manuals for the disposal of all kinds of expired drugs, outdated, broken and derelict

equipment and vehicles had to be prepared and/or revised in order to make them relevant to the

needs of the health system.

5.4 Consider resource mobilization to support a regional logistics training institute. This could be a

mobile unit that consists of a few (two, three or four) master trainers and inducts three or four

relative knowledgeable but more general practitioners as co-presenters. Request specific host

governments to sponsor timebound courses for their own logistics personnel in their own

environments in order to address very specific needs (LMIS, commodity surcveys, warehouse and

storage assessments, distribution (transportation) planning, ethics and quality control, etc.) Such

needs could be codified into country specific Plans of Action. Countries such as Timor Leste, PNG,

Laos, Philippines, Vietnam, Myammar ought to be quite interested and this approach could be

repeated over several years with the Plans of Action serving as malleable roadmaps and incremental

progress as milestones. Arrange guided tours to select medical equipment and pharmaceutical

manufactuers to enable participants to observe and comprehend not only what the guides from

these industries are saying but learn to look for issues with a larger impact that pertain to their own

situations such as shelf lives of drugs, storage conditions of sensitive medicines, ways and means of

controlling storage environments, repair and disposal of damaged equipment and expired materials,

disposal of hazardous/toxic waste and other consumable materials such as packing and packaging by

products.

5.5 APRO should develop a ready to use, handy pocket book of standard guidelines and protocols for

warehousing that can be used by warehouse managers at different levels to guide them in their

routine work. Such a booklet needs to be compact and simple (with minimal technical jargon) to be

used for the designing and day to day activities of warehousing and storage of medicines.

22

ANNEX

Annex 1: Workshop Programme

DAY 1: 14 NOVEMBER 2011

08:30-09:00 Registration

09:00-09:30 Opening session

Welcome Remarks 1. Ms. Ms. Lubna Baqi, Deputy Regional Director, UNFPA-APRO 2. Dr. Vinit Sharma, Regional Adviser, RH and RHCS, UNFPA Asia & the Pacific Regional

Office 3. Dr. Camilo Naraval, Senior Programme Officer, ICOMP

INTRODUCTION

09:30-10:30 Topic 1: Introduction of Participants and Recitation of their Expectations Facilitator: Dr Jun Naraval Group work: Meta-card Expectation from the course, co-participants and facilitators Topic 2: Summation of Key Objectives of the Workshop Facilitator: Mr Jesse Brandt Introduction of Key Resource Materials on Warehousing Facilitator: Mr Jesse Brandt

10:30-11:00 Tea Break

SESSION 1: WAREHOUSE MANAGEMENT SYSTEM

11:00-12:30 Topic 1: Overview of the Logistic Cycle Facilitator Topic 2: Modern Trends of Warehouse Management Systems: Public vs. Private Facilitator: Mr Jesse Brandt

12:00-13:00 Lunch

SESSION 2: GOOD PRACTICES IN WAREHOUSE MANAGEMENT Objective: To bring out how various issues in warehouse management were contextualized and addressed.

13:00-15:30 Topic 1: Warehouse Physical Improvements and Organisation of Stocks: Lessons from Afghanistan Facilitator: Mr Javed Hafizi Topic 2: Clearance and Disposing of Unusable Items: Lessons from Nepal Facilitator: Dr Heem Shakya Topic 3: Commodity Management, Command and Control: Lessons from Lao PDR

23

Facilitator: Jessie Brandt 15:30-16:00 Tea Break

1600-1730 Group Work Topic 1: Managing integration of vertical program commodities Inventory management as essential part of efficiency in light of Good Warehouse and Supply principles and practices. Topic 2: Warehouse levels and systems within a country (central, port of entry, regional, provincial and district warehouse systems and operations) including safety stocks, pre-positioning, of emergency supplies and inventory control practices (i.e., standard operating procedures) Topic 3: Clearing and forwarding challenges, quality control issues pertaining to imported and locally manufactured goods, donated goods, and items of short expiry and recall Topic 4: Human resource management, and support systems for warehouse operations Topic 5: Training and capacity building of the staff Topic 6: Advocacy and Collaboration Plan under the development assistance framework 7 – 8 in a group Gallery walk Marker and meta-cards

1730 End of Day’s Proceedings

DAY 2: 15 NOVEMBER 2011

09:00-9:45 Recap Participatory using the cabbage paper By: Jesse Brandt/Jun Naraval

9:45-10:00 Tea Break

SESSION 3: LOGISTICS MANAGEMENT INFORMATION SYSTEM Objective:

12:00-13:00 Lunch

SESSION 4: DEVELOPMENT OF SUPPLY CHAIN MANAGEMENT Objective: How to measure progress and define success over time

13:00-15:00 Presentation of Group Work Comments / suggestions on the best practices/recommendations by facilitators and co-participants

24

15:00-15:30 Tea/coffee break

15:30-17:00 Group Work on Warehouse Work Plan Topic 1: Warehouse Work Plan Facilitators: Mr Javed Hafizi and Mr Malik Ahmad Khan

17:00 End of Day’s Proceedings

Day 3: 16 Nov 2011

09:00-9:45 Recap and reflection

9:45-10:30 Glimpses of an Ideal Warehouse Set-up Facilitator: Mr Javed Hafizi

10:30-10:45 Lunch Break

10:45-11:45 Taking Stock of Management Tools in Planning: SWOT Analysis Facilitator: Mr Malik Ahmad Khan

11:45-12:00 Finalization of the Checklist and Introduction of the Planning Matrix

12:00-13:00 Lunch

13:00-14:00 Country Level Planning: Country Action Plan

14:00-15:00 Market of Ideas (Countries may bounce back their plan or discuss with the resource persons)

15:00-15:30 Closing Ceremonies Presentation of Certificate Closing remarks from: UNFPA and ICOMP Words from Participants

End of the Day * Bon Voyage * Thank You

25

Annex 2: List of Participants

No. Name Title Organization Email Address

Afghanistan

1 Mr. Javed Hafizi National Programme Associate

UNFPA Afghanistan hafizi@unfpa.org

Bangladesh

2 Mr. Jawher Das Supply & Procurement Officer

UNFPA Bangladesh jawher@unfpa.org

3 Mr. MD Saiful Islam Additional Director (Drugs and Stores)

Directorate General of FP, Ministry of Health & Family Welfare

saifulfp@yahoo.com

Bhutan

4 Mr. Yeshi Dorji Assistant Procurement Officer

Ministry Of Health, Phuntsholing

yeshidorji@yahoo.com

5 Mr. Jayendra Sharma Planning Officer Planning and Policy Division, Ministry of Health

js@health.gov.bt

6 Ms. Pem Zam Programme Officer Ministry Of Health pemzam@health.gov.bt

7 Ms. Karma Tshering National Programme Officer

UNFPA Bhutan karma.tshering.fpa@unfpa.org

Indonesia

8 Mr. Mukhtar Bakti Head of International Training Division

BKKBN mbakti@bkkbn.go.id

9 Ms. Rizki Amaliah Staff at the Logistic Bureau

BKKBN rizki_amlh@yahoo.co.id

10 Ms. Popong W. Nuraeni

Head of FP office at Bandung City

BPPKB pong_aeni@gmail.com

Lao PDR

11 Ms. Oulayvahn Sayarath

Logistic Management UNFPA LAO Sayarath@unfpa.org

Mongolia

12 Ms. Choijoo Amarjargal

Officer of Pharmaceuticals and Medical Devices Division

Ministry of Health amarjargal_ch@yahoo.com

13 Mr. Munkhbat Sukhee Lecturer on Pharmaceutical Management and Economic

School of Pharmacy, HSUM

sumunkh@yahoo.com

Myanamr

14 Dr. Ni Ni Hlaing Assistant Director Central Medical Stores Depot, Yangon

demyohlaing@gmail.com

Papua New Guinea

26

No. Name Title Organization Email Address

15 Mr. Daphne Ghabu RHCS Technical Advisor

Department of Health dahpne_ghabu@health.gov.pg

16 Ms. Emma Powan Program Analyst UNFPA PNG powan@unfpa.org

Pakistan

17 Mr. Malik Ahmed Khan

Logistic Advisor UNFPA Pakistan malik.ahmad@un.org.pk

Philippines

18 Ms. Angelina A. Delmundo

Director III DoH panng31@hotmail.com

19 Ms. Ann Leal RHCS focal Point UNFPA Philippines leal@unfpa.org

Sri Lanka

20 Mr. Jaymini Seneviratne

Logistic Assistant UNFPA Sri Lanka seneviratne@unfpa.org

21 Mr. Stanley Gusthinga Wadu

Medical Supplies Officer

Family Health Bereau, Ministry of Health

msemage@gmail.com

22 Dr. Mudali Devage Krishantha Pushpakumara Peiris

Medical Officer Family Health Bereau, Ministry of Health

krishantha.fhb@gmail.com

Timor Leste

23 Ms. Maria Angela Bismark

Maternal Health Consultant

UNFPA Timor Leste bismark@unfpa.org

24 Ms. Ligia Parada RH Porgramme Associate

UNFPA Timor Leste parada@unfpa.org

25 Mr. Duarte Fonseca Procurement and Logistic Assistant

UNFPA Timor Leste fonseca@unfpa.org

Viet Nam

26 Dr. Hoang, Thanh Mai Viet Nam Drug Administration

Ministry of Health moicgld@gmail.com

27 Dr. Nguyen, Thi Ngoc Lan

General Office for Population and Family Planning

Ministry of Health nglannt@yahoo.com

28 Ms. Le, Thi Thiem General Office for Population and Family Planning

Ministry of Health lethithiem@yahoo.com

29 Dr. Pham, Nguyen Bang

RH Unit UNFPA Vietnam bang@unfpa.org

Resource Person(s)

30 Mr. Heem S. Shakya Team Leader, logistics Nepal Family Health Program, USAID Funded

hshakya@nfhp.org.np

31 Mr. Hairudin Masnin Programme Officer ICOMP hairudin@icomp.org.my

27

No. Name Title Organization Email Address

32 Mr. Philip Brandt Principal Trainer pmjbrandt@gmail.com

33 Dr. Jun Naraval Workshop Coordinator

ICOMP junnaraval@icomp.org.my

34 Ms. Lim Hwei Mian Officer ICOMP hweimian@icomp.org.my

35 Mr. Vinit Sharma Technical Advisor on RHCS

UNFPA APRO sharma@unfpa.org

28

Annex 3: Self-Assessment on Warehouse Inventory and Distribution

Checklist for Warehousing and Distribution This checklist cum self-rating exercise allows the organization to rate its status on the basis of the ideal set-up or practices on key variables relating to warehousing and distribution, including management. Please rate your organization / warehouse based on the criteria per variable. Country: ______________________________________________ Checklist for Warehouse Site Selection6

Scoring Criteria

Your Score

Variables 1 2 3

Physical accessibility to service delivery points

Poor access in most of the time.

Seasonal interruption7 due to rains/floods

Road is open the year round.

Utilities / Waste Management

Frequent interruption of water and electricity.

There is some interruption of water and electricity at the site.

Site is served by uninterrupted water and electricity.

Communications No telephone & internet, or frequently interrupted.

Interruption of telephone & internet service is experienced from time to time.

Reliable telephone & internet service.

Drainage & Sewage No drainage system/drainage system very poor

Minimal flooding is experienced.

Neither site nor surrounding area subject to flooding due to direct runoff or high water table.

Size: Access to workplace

Entry / exit is impaired. Some difficulty upon entry and exit of large vehicles.

Adequate entry and exit for large vehicles, ample parking.

Security Frequently experiences intrusions / vandalism.

There are some experience of intrusions / vandalism

Area not likely to invite intrusion or vandalism/very secured.

Proximity to ports of entry

Access is difficult. Access is okey/manageable

Good access to transport links, seaports, airports, railways, highways.

TOTAL

AVERAGE

6 Adopted and modified from Drug Supply Management, MSH

7 Extreme weather / temperature

29

Checklist for Warehouse Design8

Scoring Criteria

Your Score

Variables 1 2 3

Easy Movement of personnel

Difficult to move around Use one-floor layouts with poor partitioning.

Use one-floor layouts. Interior partitioning limits stock arrangement; if partitions are used, position walls and doors to promote movement.

Air Circulation

It is stuffy and usually dark

Some fans and some ventilation. Some space between shelves

Good fans and ventilation good working environment; Space between shelves / pallets

Bulk Storage Pallets

Few pallets, but if there are, these are of poor quality.

There are some but not adequate pallets in the store

Adequate pallets for the store and in good condition

Easy Maintenance

Poor floor drains Floor drainage works but needs improvements

Floors are graded and drains placed to catch runoff; provide well-spaced faucets.

Systematic Arrangement of Stock

Arrangement is random i.e., no system(not as per FEFO/FIFO)

Arrangements of stock for some commodities are okey but not throughout for all commodities

Good arrangements are by therapeutic/pharmacological class, clinical indications, level of service and alphabetic sequence. Array stock in the same order that products appear on standard requisition, as per FEFO/FIFO.

Cold Chain Maintained

Many of the cold chain equipment are not working and needs repair.

Need few more cold chain equipment (freezers, cold box…) and reliable power-backup needed

Adequate cold chain equipment and reliable power-backup system in place (Cold rooms, refrigerators, and freezers are protected from power cuts by backup generators)

Secure Storage Area for Controlled Substances

Narcotics are stored along with the other supplies.

Narcotics are stored separately but in the same store room

Narcotics are stored in areas with restricted access.

Protected Storage Area for Flammable Substances

Ether, alcohol and fuels are stored in the same store and not fire proof

Ether, alcohol and fuels are stored within the building premises, but not fireproof.

Ether, alcohol, and fuels are stored in out-buildings and storage room is sealed tightly, well ventilated, and insulated with fireproof material.

Fire Prevention Measures

Absence of smoke alarms, fire extinguishers and a night watchman.

Absence of any one or two of the following: smoke alarms, fire extinguishers and night watchman.

Do not allow trash to accumulate; provide smoke alarms, fire extinguishers, and a night watchman.

TOTAL

AVERAGE

8 Adapted and modified from Drug Supply Management, MSH

30

Checklist on Issues Pertaining to Management9

Scoring Criteria

Your Score

Variables 1 2 3

Shared vision of total logistics

Vision is not written; lack of understanding of institutional mandate.

Written vision, but not articulated within the organization;

Every head and staff shares the same understanding of its mandate as an institution, including the desired principles and values. Strong ownership of the vision.

Strategic Directions No written strategic directions or strategic directions not updated since the last three years.

Strategic directions not articulated within the organization.

Strategies to address key issues and achieve organizational objectives are outlined and agreed upon. Ownership to it by the staff is strong.

Structure of the Organization

No clarity in the organizational structure; overlapping of staff; no clear lines of communication and decision making.

There are some clarity but needs revision to make it more effective and efficient

Organizational structure is understood by everybody; staffing / office units are outlined; clear lines of communication and decision making, staff responsible for specific tasks (i.e. storage, distribution etc.) are authorized.

Staffing No clear written job descriptions.

Job descriptions are written down but no regular performance evaluation done.

Job descriptions are written and understood; there is regular performance evaluation on the basis of the job descriptions.

Staff Capacity Limited staff capacity affecting quality of work; requires intensive training.

Presence of basic capacity to deliver tasks; training needs are identified and implemented.

Right people in the right job; Identified training needs, and there is a training plan for the staff.

Systems and Process10

No written standard operating procedures.

There are some written standard operating procedures, but not understood or practiced.

Standard operating procedures are written and understood / practiced i.e., Human Resource, Good Distribution Practices, Good Storage Practices. Code of Ethics

Style of Management

Central decision making

Some consultation is taking place.

Participatory, inclusive, and able to deliver development results on time and on budget.

TOTAL

AVERAGE

9 Developed by ICOMP

10 Knowledge of concepts on logistics i.e. lead time, re-order levels