Transcript Pharmaceutical Distribution Models Central Medical Store Model

The Drug
Management
Cycle –
Distribution
Butch Staley
Working Definitions
• Supply chain – The network of retailers,
distributors, transporters, storage facilities, and
suppliers that participate in the sale, delivery,
and production of a product.
• Logistics – The overall management of the way
resources are moved to the areas where they
are required.
• Distribution – The delivery or giving out of an
item or items to the intended recipients.
Elements of the Distribution System
Receipt and
Inspection
Port
Clearance
Storage
Inventory
Control
Order
and Issue
Transport
Characteristics of Effective Distribution
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Constant supply
Maintained quality
Minimal loss/pilferage
Accurate and timely inventory and transaction
information
• Proper storage
• Efficient transport/delivery
• Adequate geographic coverage
Supply System Models
• There are many models, ranging from fully
public to fully private, each with relative
advantages and disadvantages, depending on
context.
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Central Medical Stores model: South Africa, Tanzania
Autonomous supply agency: Uganda, Benin
Direct delivery: Caribbean
Primary distributor (prime vendor): USA
Fully private: Canada, Australia
Mixed models: Europe, Caribbean
Pharmaceutical Distribution Models
LEVELS
International
National
FULLY PRIVATE
FULLY PUBLIC
International Suppliers
Local Manufacturers
Central Medical Store
Local Wholesalers
Regional
Distributors
Regional Medical Store
District
District Medical Store
Private
Pharmacies
Hospitals
Health Centers
Health Posts
Community
Key
Product flow in traditional
CMS System
Users
Central Medical Store Model
LEVELS
International
National
PRIVATE SECTOR
PUBLIC SECTOR
International Suppliers
Local Manufacturers
Central Medical Store
Local Wholesalers
Regional
Distributors
Regional Medical Store
District
District Medical Store
Shops,
Pharmacies
Hospitals
Health Centers
Health Posts
Community
Key
Product flow in traditional
CMS System
Users
Direct Delivery Model
LEVELS
International
National
PRIVATE SECTOR
PUBLIC SECTOR
International Suppliers
Local Manufacturers
Central Medical Store
Local Wholesalers
Regional
Distributors
Regional Medical Store
District
District Medical Store
Shops,
Pharmacies
Hospitals
Health Centers
Health Posts
Community
Key
Product flow in traditional
CMS System
Users
Primary Distributor Model
LEVELS
International
National
PRIVATE SECTOR
International Suppliers
Local Manufacturers
Local Wholesalers
Regional
PUBLIC SECTOR
Central Medical Store
Primary
Distributor
Distributors
Regional Medical Store
District
District Medical Store
Shops,
Pharmacies
Hospitals
Health Centers
Health Posts
Community
Key
Product flow in traditional
CMS System
Users
Fully Private Model
LEVELS
International
National
PRIVATE SECTOR
PUBLIC SECTOR
International Suppliers
Local Manufacturers
Central Medical Store
Local Wholesalers
Regional
Distributors
Regional Medical Store
District
District Medical Store
Private
Pharmacies
Hospitals
Health Centers
Health Posts
Community
Key
Product flow in traditional
CMS System
Users
Health System Supply Chain – Theory
LEVELS
PRIVATE SECTOR
International
National
International
Procurement Agencies
Multinational Suppliers
NGO Supply
Services
· Insurers
· Private Employers
· Other Third Party
Programs
PUBLIC SECTOR
Local
Manufacturers
Government Supply
Services
Local
Wholesalers
Regional
Distributors
Regions
· Medical Stores
· Hospitals
Private
Prescribers
District
NGO Health
Facilities
Districts
· Medical Stores
· Hospitals
· Health Centers
Retail Shops,
Pharmacies
Community
Health Workers
Community
Key
Drug flow in traditional CMS system
Alternative drug flow (planned or unplanned)
Information flow
Users
The Complex Reality:
Health Supply Chains in Kenya
Commodity
Type
Family
Planning
(colour coded)
STI
Drugs
(including some
condoms for STI/
HIV)
Vaccines
and
Vitamin A
Essential
Drugs
HIV/AIDS
test kits
(&
hepatitis
B tests)
TB/
Leprosy
Malaria
Condoms
for STI/HIV/
AIDS
prevention
MOH
Equipment
(including
laboratory
supplies)
Organization Key
Gove rnm ent
World Bank Loan
Bilateral Donor
Multilate ral Donor
NGO/Private
Source of
funds for
commodities
U
S
A
I
D
K
f
W
U
N
F
P
A
De-ce ntralization proje cts
DFID
(UK)
European
Union
S
I
D
A
W
H
O
GOK
G
A
V
I
C
I
D
A
UNICEF
JICA
G
D
F
GOK,
WB/IDA
US
Gov
DANIDA (11 dis tricts )
Europe an Union (20 dis tricts)
World Bank DARE (8 districts )
SIDA (6 districts )
Belgian Gov (BTC) (2 districts )
EUROPA
Procurement
Agent/Body
Point of first
warehousing
Organization
responsible
for delivery
to district
levels
U
S
A
I
D
K
f
W
U
N
F
P
A
KEMSA
Regional
Depots
NLTP
(TB/
Lepros y
drugs
WHO (3 districts )
Crown
Agents
Government
of Kenya
Dutch
Gov
Agent
UNICEF
KEMSA Central Warehouse
NPHLS store
KEMSA, District Hospitals, District
Stores (e ss e ntial drugs k its , m alaria drugs , lab
s upplie s , reagents , HIV/AIDS tes t kits )
Japanese
Private
Company
GTZ
C
D
C
k its , HIV/AIDS te st k its)
ADB (5 districts )
District level
decisions of
quantity, type and
procurement of
health
commodities
KEPI Cold
Store
DELIVER and Logistics
Management Unit, Division of RH
(MOH) (contrace ptive s, condom s , STI
JICA (5 districts )
KEPI
(vaccine s
and vitam in
A)
MEDS
Private
Drug
Sources
Key Decisions
• Key decisions include:
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Push versus pull
Centralized versus decentralized
Roles and responsibilities: public, private, NGO
Mix of in-house and contract services
Levels of distribution and stock requirements
Assessment/Option Analyses
• Understand context – functionality and current
capacity of public, private, and NGO systems
and institutions
• Consider variable costs with each option
• Consider capacity to manage and operate
proposed system
• Define methods for monitoring and measuring
performance
Summary
• Designing a system for storing and distributing
pharmaceuticals is complex and important
• In some countries, private (or parastatal)
distribution companies may provide costeffective alternatives for storage and distribution
of pharmaceuticals