Storing&Managing
Overall guidelines:
2003 WHO's Guide to Good Storage Practices for Pharmaceuticals. WHO Technical Report Series, Annex 9
2014 WHO's Assessment tool based on the model quality assurance system for procurement agencies: aide-memoire for inspection, Module IV: Receiving and storage and further
2014 JSI/DELIVER Guidelines for Warehousing Health Commodities and short version
Guidelines related to specific supplies:
2005 UNFPA/WHO/PATH Condom Programming for Hiv Prevention : A Manual for Service Providers page 9
2011 WHO's Model guidance for the storage and transport of time- and temperature–sensitive pharmaceutical products
2015 WHO's Model guidance for the storage and transport of time- and temperature–sensitive pharmaceutical products
Step 1. Transporting from customs to central/regional warehouse
a. Because of the supplies require medical and health grades, transportation should be performed by adequately trained staff (handling boxes with care, preventing pocking, crashing and squeezing, limiting dust and dirt).
b. Vehicle should be adequate in size (to minimize the number of trips), in conditions (clean and not open to dust), and able to maintain room temperature between 15 to 25°C). Supplies cannot transported with non-medical and health grade supplies to prevent these products being contaminated.
c. To minimize cost, transportation can be outsourced to a transportation company if they meet the above requirements.
Note : Sometimes, it makes sense to distribute directly to regional warehouses and bypass the central warehouse.
Step 2. Inspecting and applying Quality Assurance upon receiving
Note : This step might be coordinated with/performed by the National Regulatory Agency.
a. Ensure that all conditions, requirements, quantities and specifications in the Purchase Order are met.
b. Make sure that the Certificate of Conformity is conform and produced by a certified agency.
c. Controlling that the temperature recording device has not experienced any temperature excursion during transportation. If any, contact the supplier and agree with next steps.
d. Making sure that the Quality Assurance plan is applied with random Quality Control testing such as:
i. Conformity test
ii. Sterility test on the individual sterile paraphernalia (syringes and needles individually blistered)
iii. Etc.
Note: Following 2011 UNFPA's Post-Shipment Testing of Male Condoms can be of help for applying Quality Assurance upon receiving.
Step 3. Required conditions of central, regional warehouse, and points-of-care's storing rooms
a. The warehousing/storing place, the equipment, and the staff are adequate, efficient and effective for the task (large quantities for warehousing, smaller quantities for local storing). They have been trained to, and follow the Guidelines for Management of Stock, Warehouses/Storerooms, Cabinets, Fridges and Freezer with references to the international guidance above.
b. Security with locked doors and secured windows and sufficient electricity.
c. Cleanliness and absence of opening to outside (to limit vermin, dust, and dirt). Mopping and cleaning with detergent are performed monthly.
d. Heating and air conditioning (+ generator if needed) to maintain room temperature (between 15 to 25°C), and professional temperature and humidity recording devices (to ensure compliance 24/7 - medical grade pharmaceutical products must be stored at room temperature, with no more than 60% humidity ; condoms/latex cannot reach freezing temperature or be above 35°C).
e. Professional metal shelving for small quantities and palettes installed on the floor before staking big/bulky boxes.
f. Individual stock cards attached next to each supply type with lot number, expiration date, last stock movements in/out, current stock-on-hand, minimum safety stock to maintain.
g. Registry for recording stock movements with beneficiary, lot number, expiration date, remaining stock-on-hand.
h. One designated area for quarantine with a clear sign reading "quarantined, do not use". One designated area for expired product with a sign reading "expired, do not use".
i. A receiving/packing table.
j. A fire extinguisher placed at the entrance of the room.
k. Trained and experienced staff with detailed job description and clear chain of command, equipped with clear written guidelines.
l. Supplies should be stored in an orderly fashion or with a methodology.
Step 4. Warehousing and point-of-care's storing, managing stock
a. Receiving
i. Control quicky products received against Purchase Order's quantity and specifications, open and control randomly 1 box.
ii. Inspect quickly outer boxes for product damages. If any, consider refusing the shipment.
iii. Sign receipt.
iv. Control and inspect more thoroughly. In case of doubt, place on quarantine, liaise with manufacturer, request QC test, release from quarantine only if it is certain there are no risks for clients.
v. Wipe boxes to make sure they are clean from dust and dirt.
b. Puting away on shelve or stack
i. Arrange on the shelve/stacking pallet as First Expired/First out. Refrain from opening box and carton. Make sure that at least 40cm stay between stacks and walls.
ii. Update individual stock cards with a new entry.
iii. Update stock movement registry or software.
c. Counting physical stock
i. Perform monthly cyclic and/or random physical stock count.
ii. Check expiration date and remove expired products and place them in the designated area for expired products.
iii. Ensure that root causes of discrepancies are found and acted upon to prevent them from happening again.
d. Dispensing supplies
i. To increase efficiency, try to batch stock replenishment request processing on certain hours of day/day of the week.
ii. Always issue supplies that are expiring first. Try to issue an entire carton/box to keep intact outer carton and ease.
iii. Update individual stock cards and verify the stock level is above the safety stock. If not, reorder.
iv. Update stock movement registry (or software) including beneficiary name, supply specification, quantity, and lot number (in case of a recall).
v. Pack and label adequately supplies to be distributed to sub-beneficiary. Make sure they will be kept at room temperature during the transportation.
vi. Prepare two copies of the Stock Replenishment Requests to be signed by the beneficiary. 1 copy should be kept for record.
e. Maintaining stock level
i. Monthly check stock level (on the stock card) for each product types.
ii. Every year reevaluate safety stock level (as a generally agreed practice : 6 months-of-usage-on-hand for central warehouse, 1 to 3 month for regional warehouse and local storing room depending on distribution frequency).
f. Following monthly Key Performance Indicators (monthly and cumulated), evaluating variance, investigating root causes, and acting upon them
i. (central and regional warehouses) Total lead time between stock replenishment request date and reception date at the storing room.
ii. (central and regional warehouses) Number of mistakes in fulfilling stock replenishment requests.
iii. (warehouse and storing room) Total space used vs. available.
iv. (warehouse and storing room) Number of outer cartons received and distributed that have been mishandled and damaged.
v. (warehouse and storing room) Number of product types reaching safety stock level, number of products out-of-stock.
vi. (warehouse and storing room) Number of products expiring (< 1 month) and number of products expired.
vii. Number of type of products recalled
viii. Etc.
For more details : 2006 USAID's Indicators for Monitoring Performance of Logistics Systems
Step 5. Transporting central warehouse to regional warehouse/points-of-care's storing rooms
Similar to step 1.
Step 6. Managing defective supply at point-of-care and returns to the central warehouse
Note : A communication system between program management, the central warehouse/storing, and points-of-care should be in place (by email, phone call, etc.), Standard Operating Procedure for defective products and returns should be developed, and staff appropriatly trained.
a. Collect information about the defective product, its specifications, quantity, lot number, especially with digital pictures. Make a decision whether it is a truly defective product.
b. If yes, request the entire quantity of the defective products be removed from the shelves, from consultation room, and outreach workers' bags, etc. and be placed under quarantine at the point-of-care's storing room with the sign "under quarantine, do not use".
c. Inquire whether the defective product is widespread across other points-of-care and all warehouses. Act upon information and recall the entire lot within the country if needed.
d. Organize the defective supplies to be shipped back to the central warehouse. The cheapest solution is a delivery vehicle on its way back.
e. Place under quarantine in the central warehouse. Evaluate with a QA/QC expert (from the Regulatory Agency if possible) how big is the issue. Report to the Regulatory Authority.
f. Liaise with the manufacturer/distributor to have the shipment replaced as soon as possible, a temporary solution (rush delivery), the defective products destroyed at zero cost.
g. Downgrade this manufacturer within the procurement records.
Note : Example of a one-page procedure for managing defective supplies
Stock management softwares/tools
- OpenLMIS from VillageReach, USA http://openlmis.org/
Purpose: Country wide system, central/local stock management and distribution, not specific to harm reduction supplies, good for integration with other health programs
Specifications: Free of charge, web-based, easy to use, configurable, interoperable, English/Portugese/French versions
Features: Centralized reporting exportable on MS Excel, automated replenishment quantities
Contract type : Open source, customization requires investment
- eLMIS from JSI/DELIVER/USAID, USA
Purpose : Country wide system, central/local stock management and distribution, not specific to harm reduction paraphernalia
Specifications : Free of charge, web-based, easy to use, configurable, interoperable, not specific to harm reduction supplies, English only
Contract type : Open source, customization requires investment
- SupplyChainManager from USAID/DELIVER, USA
Downloadable : Email at http://deliver.jsi.com/dhome/resources/tools/supplychainmanager to request a copy
User's Manual : http://deliver.jsi.com/dlvr_content/resources/allpubs/softwaremanuals/SC...
Purpose: Country wide system, central/local stock management and distribution, not specific to harm reduction supplies.
Specifications: Free of charge, MS Access based, computer-based, easy to use, configurable, english only
Contract type : Proprietary
- cStock from JSI, USA
User's manual: http://cstock.jsi.com/static/malawi/doc/User%20Manual%20cStock.pdf
Purpose: cStock is a RapidSMS based, open-source, automated logistics management information system for reporting, calculating resupply, and managing and monitoring community-level essential medicines that includes transmission of logistics information via SMS to a computer application that responds with information for product resupply, displays product information on a web-based dashboard, and produces reports that can be used to monitor availability of community health products and the overall performance of the districts. Not specific to harm reduction supplies
Features: Inventory tracking, order management, transmission via SMS
Contract type : Open source, customization requires investment
- mSupply from mSupply, Nepal/New Zealand http://msupply.org.nz/
User's manual : http://docs.msupply.org.nz/
Purpose: Quantify, purchase, manage and distribute supplies
Specifications: Free of charge for 1 user. For more than 1, fee per user
Features: Central/local, quantification, inventory tracking, issuing goods, tender management, include price, English/French versions
Contract type : Proprietry, customization requires investment
- Logistimo from Logistimo, India
Purpose: Country wide system, central/local stock management and distribution, not specific to harm reduction paraphernalia
Specifications: Usage for a fee, web based, usable via smart phone, configurable, english only
Features: Inventory tracking, order management, credit management, vehicle tracking, workforce behavior monitoring, workflow handling, demand forecasting, replenishment optimization, quality monitoring, network expansion, routing & scheduling, usable via smart phone
Contract type : Proprietry, customization requires investment
- CommCare from Dimagi, USA
Purpose: Country wide system reporting stock, case management, and service provision via SMS, not specific to harm reduction paraphernalia
Specifications: Usage for a fee, web-based at central, local uses smart phone, configurable, english only
Features: Inventory tracking, order management, workflow handling, local stock management and stock replenishment requesting, usable via smart phone.
Contract type : Proprietry, customization requires investment
Tools specialised in managing service provison to clients/patients
- SyrEX from International AIDS Alliance in Ukraine, Ukraine
Purpose : Clients registration; recording commodities and services provided
Specifications : Free of charge
Contract type : Proprietry, customization requires investment
- Nebula from Orion, Uk
Purpose : Clients registration and case management including HIV, hepatitis, saliva and tetanus; recording commodities and services provided;stock management and returns, specific to harm reduction supplies and services
Specifications : For a fee
Contract type : Proprietry, customization requires investment
- NEXmanager from webstar-health, Uk
Purpose : Secure, web-based NSP service administration system for pharmacies and harm reduction programs
Specifications : Providers enter data directly, Real time data availability, Convenient web-based interface, Automated invoice and payment schedules
Features : Central/local visibility
Contract type : Proprietry, customization requires investment