Chapter 15: Managing

Medicines and Health

Products
MOHAMMED H (MPH/HSM)
WOLLO UNIVERSITY

Chapter objectives

After completion of this chapter, students will be

able to:

Describe the pharmaceutical management cycle

analyze the contribution of management and

governance for better performance of the
pharmaceutical cycle

Describe the principles of organizing medicines

and supplies in the storage area

Discuss how to keep good records of all the

medicines and related supplies

Identify the factors to be considered in

ordering
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Introduction

most leading causes of death and disability in

developing countries can be prevented, treated,
or alleviated with cost-effective essential
medicines
however, hundreds of millions of people do not
have access to essential medicines
for those who do have access, incorrect use of
medicines limits their effectiveness
even when we invest large amounts of money in
medicines, we often do not make the best use of
that resource
poor leadership and management can result in
wastage in all its forms from expired medicines
to damaged stock to medicines that are never
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used

Introduction

medicines also serve to generate trust and

participation in health services
a health center without medicines to dispense, no
matter how well staffed and maintained, soon
loses its credibility in the community
improved supply management can bring dramatic
improvements in the availability of medicines and
the cost-effectiveness of their provision
in a typical supply system, up to 70 percent of the
funding invested in essential medicines can be
lost or wasted
with only basic management improvements, it is
possible to make a significant change
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Introduction.

What does access to medicines means?

1.

2.

3.

4.

Four dimensions of access relevant to essential

medicines, vaccines and other commodities
Availability: the relationship between the type and
quantity of products or services needed and the type
and quantity of products or services provided
Accessibility: the location of the products or services
and the location of product or service users
Affordability: the relationship between the price of
product or services and the users ability to pay for
them
Acceptability (satisfaction): the relationship between the
users attitude and expectations about the products and
services and the actual characteristics of products and
services
A cross-cutting characteristics of access is quality of
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products and services: more applies to safety, efficacy

Introduction

Essential medicines have been defined by WHO

as those that are indispensable and necessary to
satisfy the health care needs of the majority of
the population.

they should therefore be available and accessible

at all times, in the appropriate dosage forms and
at prices affordable to all

this definition does not in any way diminish the

usefulness of any medicine that may not be on
any given essential medicine list

it is a conscious attempt to utilize available

resources on the most important medicines of
benefit to the majority of the population
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Why we worry about

medicines

Medicines have special importance for at

least five reasons

Medicines save lives and improve health

Medicines promote trust and participation in

health services

Medicines are costly

Medicines are different from other consumer

products

Substantive improvements in the supply and

use of medicines are possible
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The pharmaceutical management

cycle

Pharmaceutical management comprises four

basic functions:

Selection: involves reviewing the

prevalent health problems, identifying
treatments of choice, choosing individual
medicines and dosage forms, and deciding
which medicines will be available at each
level of the health system.

Procurement: includes quantifying

medicine requirements, selecting
procurement methods, managing tenders,
establishing contract terms, and ensuring
pharmaceutical quality adherence to
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contract terms.

The pharmaceutical management

cycle

Distribution: includes clearing

customs, stock control, store
management, and delivery to depots,
pharmacies, and health facilities.

Use: includes diagnosing, prescribing,

dispensing, and proper consumption
by the patient.

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The pharmaceutical management

cycle

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The pharmaceutical management

cycle

In the pharmaceutical management cycle, each

major function builds on the previous function and
leads logically to the next

Selection should be based on actual experience with

health needs and medicine use; procurement
requirements follow from selection decisions,

Supply management does not operate in isolation

At the centre of the pharmaceutical management

cycle is a set of core management practices and
systems:
planning and organization of services,
financing and financial management,
information management, and
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human resource management.

The pharmaceutical management

cycle
These management support systems hold the

pharmaceutical management cycle together

individual parts of the cycle may function
independently for a short time; but the whole cycle
soon cease if there is lack of:
effective leadership,
a functional organizational structure,
adequate and sustainable financing,
reliable management information, and motivated
staff
Effective management and good governance save
money and improve performance
Finally, the entire cycle rests on a policy and legal
framework that establishes and supports
the public
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commitment to essential medicine supply

Managing the storage of

medicines and health
products
At the district level, the most relevant elements of the
pharmaceutical management cycle are distribution,
including storage and stock management, and use

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Organizing supplies in the storage

Managing medicines and related supplies needs a
area

team effort, involving all types and levels of staff

Choosing a secured room to serve as a store
Keeping your store in good condition
storage areas must be clean, properly arranged
& secured
the temperature must be controlled and the area
well-ventilated but not exposed to dust
one rule of thumb is that if you feel too hot in
the storeroom, the products are also being
exposed to high temperatures
extreme temperatures, light, or humidity may
cause medicines to deteriorate
all products need to be kept in their original
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packaging, containers, or boxes

Organizing supplies

Maintaining and using refrigerators and freezers

keep refrigerator or freezer in good working
condition: Record the temperature inside the
refrigerator or freezer daily.
Store similar items together:
Store medicines in the following groups:
externals, internals, and injectables.
Shelve tablets and capsules together.
Shelve liquids and ointments together.
Shelve other health products and supplies
together.
Organizing each group of items in alphabetical
order often improves store organization and
simplifies stock management.
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Organizing supplies

If there are three or more shelves in your store,

organize your supplies as follows:
Top shelves: Store dry medicines (tablets,
capsules, oral rehydration packets).

Middle shelves: Store liquids, including

injectables and ointments.

If the top shelf is near the ceiling or out of your reach,

use that shelf to store items that are not sensitive to
heat and not used regularly.

Do not put dry medicines below them.

If liquids leak, the dry medicines may spoil.

Bottom shelves: Store other supplies, such as

surgical items, laboratory supplies
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Organizing supplies

Group products by expiry date:

The first expiry, first out (FEFO) method of

inventory management involves issuing
products with the earliest expiry date first,
regardless of the order in which they are
received.

This method helps prevent expiration of valuable

pharmaceuticals.

It is usually a combination of physical placement

the earliest-expiring stock is placed at the
front of the shelf so that will be picked firstand
good record control, which tracks the expiry
dates of all items in stock.
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Organizing supplies

1.

2.

store medical supplies and other commodities

without expiry dates using first in, first out (FIFO)
procedures.
products must be systematically arranged.
there are three common classification systems for
smaller stores and dispensaries:
in alphabetical order by generic name
this classification is found in both large and
small facilities
by dosage form
similar dosage forms (for example, tablets,
injectable, oral liquids, ointments, etc.) can be
stored together
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products are sorted alphabetically within each

Organizing supplies

by therapeutic category
you can store products with the same
therapeutic properties together,
for example, all antibiotics, all antihypertensive
medicines can be stored together, and so on
products are then sorted alphabetically within
each category

once a classification method is chosen, use the

FEFO or FIFO method

Arrange and label the supplies,

Identify the products generic names.

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Organizing supplies

Controlled access:
Some products need storage in an environment
with controlled access.
It is important to identify products that are at risk of
theft or abuse, have the potential for addiction, or
have legal or regulatory requirements; be sure to
provide increased security
Medicines which are scarce, expensive, and in high
demand and short supply need to be kept in secure
storage
Narcotics, opioids and strong analgesics, and
psychotropic medicines require special attention.
Security measures include storing the products in a
separate locked room or cabinet.

High demand or have the potential for resale on the black market
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Principles of good storage: for all types of

storage

Follow the manufacturer directions when stacking,

Place liquid products on the lower shelves or on the
bottom of stacks
Store products that require cold storage in appropriate
temperature-controlled zones.
Store high-security and high-value products in
appropriate security zones
Separate damaged or expired products from usable
stock without delay, and dispose of them using
established disposal procedures.
Store all commodities in a manner that facilitates FEFO
policy for stock management.
Arrange cartons so arrows point up and identification
labels, expiry dates, and manufacturing dates are
visible. If this is not possible, write the product name
and expiry date clearly on the visible side.22

Receiving and arrangement of

stock

Seven things to do when receiving supplies

1. Receive the supplies in person.
All supplies should be received by at least one
staff member at the time of delivery.
2. Check the outside of the boxes for any signs of
damage or opening that could indicate theft
3. Keep a record of deliveries
4. Check the supplies received against the items
ordered and items identified as delivered on the
delivery note
5. Check the expiry dates of all items
6. Check the basic quality of all items in the delivery.
7. Document all discrepancies and report
immediately-documenting discrepancies
protects
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Waste management

It is important to dispose of pharmaceuticals

properly because there can be serious negative
consequences from improper disposal
Improper disposal can result in:

environmental impacts, which may include

contaminated water supplies, damage to flora
(plants) and fauna (wildlife), and increases in
antimicrobial resistance to medicines
the diversion and resale of expired or inactive
medicines;
air pollution from improperly incinerated products.

Always follow your facilitys procedures for

handling damaged or expired medicines
damaged or expired products are immediately
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separated from usable stock and disposed
of

Inventory management and stock

control

Benefits of maintaining a sufficient stock of items

Patients receive medicines promptly, and stockouts can be prevented even when deliveries to
the store are delayed

Patients have confidence in the facility

an effective inventory control system keeps track

of and guarantees accountability for supplies

Stock cards are the inventory management tool

used to monitor stock level and consumption of
medicines and health supplies

By monitoring the rate of consumption, the staff

responsible for managing stocks can forecast future
requirements with accuracy
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Problems arising from poor stock

control
When inventory control fails

a patients condition may worsen because of a

delay in treatment, or antimicrobial resistance
may develop because a course of treatment was
not completed
a patient die if a lifesaving medicine is out of
stock
if medicines are not available in rural facilities,
patients may have to make long and expensive
journeys to obtain treatment
if the availability of medicines at the secondary
level is better than at the primary level, the
community will lose confidence in primary health
care and seek hospital treatment instead
frequent stock-outs may establish or reinforce
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Cost of maintaining stock

Poor inventory control leads to wastage or

increased costs for holding stock

For example:

Overstocking of certain items may tie up a

substantial portion of the pharmaceutical
budget, leaving insufficient funds for other
important, perhaps lifesaving, medicines.

Overstocked medicines often expire

Poor stock records and poor security make theft

easier

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Using stock records for ordering

stock

The amount of supplies to be ordered should be

based on the amount that is used or their past
consumption

It is important to keep good records of all the

medicines and related supplies you have in stock

This helps you understand the flow of supplies

into and out of your health care facility

It will also help you know:

what items are available in stock

how much is available of each item in stock

how much stock is used on a regular basis

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Using stock records

In addition, keeping records serves as the basis

for the information needed for deciding

what to order,

when to order, and

the quantities to order

There should be a stock card for each item in

your store

In small stores, keep the stock card with the item

on the shelf

Use the stock card to track the movement of the

item.
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Ordering new stock

Estimate future needs

two methods commonly used to estimate

product needs for a procurement system:

the consumption method, which uses historical

consumption data, and

the morbidity method, which is based on the

number of cases of each major prevalent
disease or health condition

The two methods are not exclusive, and each

has strengths and weaknesses
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Consumption method

The consumption method is the simplest, and

often most accurate, way for you to calculate
medicine requirements, because you have the
information on medicines dispensed readily
available on stock cards

Nevertheless, it is important to realize that other

factors, such as stock-outs, seasonal variations,
short shelf life, and storage space, can affect the
accuracy of consumption data

Formulary changes can also affect the accuracy

of consumption data, for example, if new
medicines are added or older ones removed
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Morbidity method

takes into consideration the prevalence of

various diseases in the community and the
number and ages of patients to be treated

pharmaceutical requirements are then

estimated using standard treatment
guidelines

can be useful, especially when you are

planning new programs or scaling up
programs, but it requires data that are
generally not readily available to district
and health facility staf
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Morbidity method

data analysis can be difficult, since a larger

data set is required to accurately assess
disease patterns in a particular country

its accuracy also depends on prescribers

following standard treatment guidelines,
which is often not the case and is beyond
the control of supply managers

morbidity analysis is useful, however, when

no consumption records are available, as

a check on the accuracy of the
consumption data, or

you are assessing whether prescription of

medicines is being done in accordance
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with standard treatment guidelines

Comparison of the consumption and morbidity

Consumption
Morbidity
methods
Uses

First choice for

procurement forecasts if
reliable data are available
Most reliable predictor
when consumption pattern
remains unchanged
Essential Reliable inventory records
Records of supplier lead
data
time
Projected medicine costs

Limitatio Must have accurate

ns
consumption data
Can perpetuate irrational
use

Estimating needs in new and

scaling-up programs or for
disaster assistance
Comparing use with theoretical
needs
Developing and justifying budgets
Data on population and patient
attendance
Actual or projected incidence of
health problems
Standard treatments (ideal,
actual)
Records of supplier lead times
Projected medicine costs
Morbidity data not available for all
diseases
Accurate attendance data not
available

Standard treatments may not

really be used

Factors that influence order

quantity

Constant factors: do not vary too much from

month to month; their values are reasonably
predictable and can be easily calculated from
historical data
Average monthly consumption: the average
quantity used per month;
Supplier lead time: the length of time that
elapses between the time the order is
placed and the time the order is received at
your store or facility;
Stock balance: the balance in stock at the
time of the order
Procurement period/order frequency: the
length of time between two orders
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Factors that influence order

quantity
Variable factors: These vary regularly or
cannot be anticipated
Health campaigns: consumption increase
during the campaign;
Disease outbreaks: If there is an outbreak
of a disease, consumption expected to
increase;
Seasonal factors: Some diseases are more
frequent during a particular period of a
year
New prescribers: you can expect some
changes in the use of certain products;
Budget allocations: When products are
purchased within a limited facility
budget,
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health workers have to make choices,

Good dispensing practices

The aim of all pharmaceutical management

systems is to deliver the correct medicine to the
patient

A critical component of rational use is correct

dispensing of medication, including providing
patients with appropriate information about their
medication

Good dispensing practices ensure that an

effective form of the correct medicine is delivered
to the right patient, in the prescribed dosage and
quantity, with clear instructions, and in a package
that maintains the medicines potency
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Rational prescription and use of

medicines

The goal of good pharmaceutical management

practices is having the correct medicines
prescribed for and used by the patient
the rational use of medicines requires that
patients receive medications appropriate to
their clinical needs,
in doses that meet their own individual
requirements,
for an adequate period of time, and
at the lowest cost to them and their
community (WHO 1987)
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Rational use of medicines

Many factors influence rational use, and it is

essential to formulate an overall policy for
rational use of medicines and detailed procedures
to address each of the component areas
factors for irrational medicine use
prescriber's knowledge and experience
the dispensing process,
the patient or community,
the health system itself

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Rational use of medicines

Criteria to any policy on rational prescribing and

use:
correct medicine;
appropriate indication: the reason for prescribing
is based on sound medical considerations;
appropriate medicine, considering efficacy,
safety, suitability for the patient, and cost;
appropriate dosage, administration, and duration
of treatment;
appropriate patient: no contraindications exist,
and the likelihood of adverse reactions to the
medicine is minimal;
correct dispensing, including appropriate
information for the patients about the
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