Pharmacy management procedures

April 2005

Logistic Department

Nutrition Department Health Department

Introduction
This document defines the responsibilities and the procedure for the management of the central pharmacy on the missions. The document also describes the general organisation of medical supply. From an administrative point of view the pharmacy is a stock. It has therefore to respect the same principles and requirements than food and non-food items stock. Its essential to understand that the medical supplies purchased with the fund of an institutional donor are earmarked for pre-defined activities. Action contre la Faim has to respect this allocation. However due to the consequent number of products and the necessity to respect strictly the management per expiry date, Action contre la Faim has developed specific procedures and tools for the management of the pharmacies. When requesting funds to donors having specific requirement in terms of stock management the Logistics Coordinator has to include a request for a derogation within the proposal.

1 - Responsibilities regarding drugs and medical material

The Logistics Coordinator is responsible of: National purchases and SAE orders of drugs and medical materials Quality control for national purchases or in kind donations Clearing of incoming medical freight (including special authorisations for psychotrops or similar, example Valium) Implementation of logistic procedures for central pharmacy stock Monitoring of the correct application of logistic procedures for central pharmacy stock Control of the monthly stock reports of the central pharmacy Approval of the Release Orders for the central pharmacy in the absence of CMN Institutional donors reporting

The Medical and Nutrition Coordinator (CMN) is responsible of:

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Recruitment and supervision the Human Resources of the pharmacy (if required) Control of the physical storage practices Orders to replenish the central pharmacy, based on the stock reports Control of the program consumptions Validation of the field orders Preparation and approval of the Release Orders

+ Calculation of quantities for the elaboration of proposals + Forecast of the stock utilisation

2 - General organisation
Its essential to establish a clear organisation of the supply chain. The role of the central pharmacy is essential to guarantee the reporting to the various donors.

2.1 Central pharmacy

A central pharmacy has to be created in the Capital of the mission. This central pharmacy will supply directly the programs of the mission (in the Capital and on the bases). All the incoming supplies have to transit or be stored in the central pharmacy for registering. No direct deliveries to the bases or programmes One person has to be responsible of the management. This person can be a pharmacist if the volume of activity is important. For less consequent volume the CMN, the CMN assistant or an nurse employed on the capital can be in charge of the central pharmacy.

2.2 Pharmacies of the programmes

On a base the pharmacy has to be physically organised by programmes. One programme corresponds to one donor contract The CMN has to organise the ordering from the bases to the central pharmacy per programme
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Example: In case of one nutritional programme funded by OFDA and one health programme funded by ECHO on a base, there will be two separate pharmacy stock. These pharmacies can be located in Action contre la Faim premises but preferably on the programme themselves. Example: TFC drugs and materials, SFC drugs, Clinic etc. The total buffer stock of these pharmacies has to be minimal: One month consumption in general + Delivery time buffer + Reserve and anticipation buffer The total management of these pharmacies is under the responsibility of the relevant technical officer (nurse, doctor, nutritionist, etc.)

2.3 Pharmacy stock on the bases

Action contre la Faim recommends not having intermediary pharmacies on the bases. However when no other solutions are feasible the Logistics Coordinator and the CMN have to define precisely the responsibilities and procedures for this stock. Notes: To have an intermediary base pharmacy will oblige the consolidation of Stock reports and creates an additional workload for the teams. In addition experience has shown that intermediary pharmacies are the source of mismanagement.

3 - Physical and administrative organisation

3.1 Central Pharmacy
The products are defined by: Action contre la Faim Pharmacy management

The designation (molecule name) The concentration The packaging (presentation and manufacturer) The expiry date
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The funding contract (budget)

There is one Stock card per product. Within the central pharmacy the products are physically stored: Per designation Per expiry date Per budget

A mini Bin card has to identify the products on the pharmacy shelves. Example: MEDICAL Designation: Concentration: Packaging: Expiry date: Financial code: BIN CARD
AMOXICILLIN

250 mg Box 1000 cp June 2005 BU A1 M 78

Note: The batch N are not included in the stock management documents as Action contre la Faim do not split orders from a supplier between missions. Its possible to track the batch N with the invoices and shipping documents issued by the supplier.

3.2 Programme pharmacies

The management of the programme pharmacies is simplified compare to the central pharmacy: there is no consideration of the financial origin of the products. The products are defined by: The designation (molecule name) The concentration The packaging (presentation and manufacturer) The expiry date

There is one Stock card per product.

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Within the project pharmacies the products are physically stored: Per designation Per expiry date

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4 - Orders to the central pharmacy

4.1 Order frequency
The Logistics Coordinator and the Medical and Nutritional Coordinator have to determine an order frequency between the programmes and the central pharmacy. A regular frequency is essential for: - The organisation of the freights - To simplify the recording work within the central pharmacy Per default, the standard Action contre la Faim frequency for orders to the central pharmacy is one month.

4.2 Order per project

Orders from the various bases to the central pharmacy have to be detailed per programme. Therefore a base having several project mustnt consolidate the orders. This detail is necessary to record the exact destination of the deliveries.

4.3 Supply chain

1 Requester: Nurse or doctor responsible for the programme 2 Logistician of the base 3 Medical and Nutrition Coordinator 4 Pharmacist (or CMN or CMN assistant) 5 Logistics Coordinator or logistician in charge of the Pharmacy Order Register and forward Consumption and order verification Release Order Preparation of the order Delivery Note Organisation of the delivery

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Logistician of the base

Update the follow up and forward Delivery inspection, update or create stock cards

7 Requester

Note: For orders in the Capital the requester can forward the order directly to the CMN and the delivery will be organised directly to the requester. If required, the missions may add additional intermediary steps in the order chain.

5 Release Order and how to start a programme

5.1 Release Orders
When preparing the Release Order for the central pharmacy the CMN has to consider only the expiry date of the products. The respect of the closest expiry date OUT stock management principle is compulsory.

5.2 Beginning of a programme

When a new programme or new funding contract starts the CMN has to prepare immediately the order and forward it to the Logistics Coordinator. There are several alternatives to supply a new programme while waiting the delivery of the order: Use of a left overstock from another budget with the formal or implicit agreement of a donor Temporary loan from another programme.

6 - In and out procedures / Central pharmacy

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The pharmacist (or person in charge of the central pharmacy) must respect the following procedures and obey to the instructions received from the Logistics Coordinator for deliveries IN and delivery OUT of the central pharmacy.

6.1 Deliveries IN
All incoming products must have a Delivery Note or an equivalent documentation when delivered to the central pharmacy. If the pharmacist has doubts on the quality or faces a documentation problem he/she can refuse the items and call immediately the Logistics Coordinator or CMN. ACF Internal delivery (International procurement) The pharmacist has to: - Inspect the delivery: documentation, quantity and quality - Mention if any the observations or remarks before signing the Delivery Note - Archive the second sheet of the Delivery Note - Update or create the Stock cards (and Medical bin cards if needed) - Ask to the Logistics Coordinator the financial code - Store the products. Note: The quality inspection includes a meticulous verification of the expiry date of the products. ACF local purchase (The logistician or the purchaser delivers items recently purchased) The pharmacist has to: - Inspect the delivery: documentation, quantity and quality - Sign the appropriate cell in the Purchase Order - Archive the first sheet of the Purchase Order - Update or create the Stock cards (and bin cards if needed) - Store the products.* - When a supplier delivers articles to the pharmacy without the presence of the logistician or the purchaser, the supplier must have an External Order Form. The pharmacist will sign the waybill or debit note of the supplier and keep the 4th sheet of the EOF. The pharmacist has to call immediately the logistician if a supplier has no documentation. Note: The quality inspection includes a meticulous verification of the expiry date of the products. Delivery from other IO / NGO

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The pharmacist has to: - Inspect the delivery: documentation, quantity and quality - Mention if any the observations or remarks before signing the Delivery Note - Archive the Delivery Note (format depending on the organisation) - Ask to the Logistics Coordinator the financial code - Update or create the Stock cards (and bin cards if needed) - Store the products. Note: The quality inspection includes a meticulous verification of the expiry date of the products. Valorisation Action contre la Faim valorises the products in stock with the price of the last purchase and in the currency of purchase. The initial purchase price is mentioned on the header of the stock card. In case of stock replenishment the pharmacist indicates the new price in the Remarks column of the stock card.

6.2 Deliveries OUT

Only the CMN or in his/her absence the Logistics Coordinator is entitled to approve a release from the central pharmacy. The only document valid to allow a delivery is the Release Order. Note: Medical orders are usually long, however Action contre la Faim recommends to not create an additional form and to use the standard Release Order with a separate page listing the supplies. Without Release Order, the pharmacist has no authority to release a product. When receiving a Release Order the pharmacist has to: Prepare the Delivery Note Respect the expiry date of the products Prepare the delivery (departure zone) or load the vehicle. Update the Stock card, without forgetting the reference of the DN Update and indicate possible comments on the Release Order

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The pharmacist keeps the pending Delivery Note with the second sheet of the Release Order attached on it. The third sheet of the Release Order will go back to the CMN.

7 - Reminder on purchases
The standard processing time for an international order is two months. In addition Paris SAE will not accept a medical order funded by a contract ending within the next two months. Action contre la Faim recommends ordering the medical supplies in Kits. The processing time of a kit is quicker than a disparate order. Standard kits for drugs and materials are available for TFC programmes SFC programmes Health programmes

Note than to order one single article or a kit will require the same administrative procedures and the same processing time.

Local purchases
The local purchase of medical products has to be restricted to materials and products without expiry date. Action contre la Faim implemented this policy due to the difficulty to control the quality and the real chemical composition of the deliveries on the missions. Action contre la Faim recommends to work with international or regional (humanitarian) procurement centres specialised in medical supplies. Exceptionally the Headquarters can approve the local purchase of drugs to local suppliers. The Logistics Coordinator will have to submit all necessary information to verify the technical capacity and certification of the supplier.

8 - Stock report to the donors

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After the end of a contract, Action contre la Faim has to submit a stock declaration to the donor. In reason of the minimal stock on the project pharmacies and the ordering per project, Action contre la Faim will consider all deliveries from the central pharmacy as used for the project. Therefore the quantities in the programme pharmacies will not appear in the stock declarations submitted to the donor. The stock declaration will be:

Quantity purchased on the budget - total quantity of products used for the programme funded by this budget = quantity declared to the donor

The total quantity purchased on a specific contract is mentioned on the: Shipping documents and/or invoice Or in the Stock report (month of entry) The total quantity used for a project has to be calculated with the data from the Stock reports of the central pharmacy. The Logistics Coordinator will consolidate the deliveries to the programme during the funded period. In case of audit, these quantities can be justified with the Release Orders and the Delivery Notes. The format of the stock declaration is synthetic and will mention: designation, qty and unit. (No expiry date, no batch N) Action contre la Faim has to propose an utilisation of this leftover stock to the donor. Note: If the real quantity used by the programme is equal or exceed the quantity purchased by this budget Action contre la Faim will declare a stock equal to 0 for this product.

9 Reporting in the central pharmacy

The reporting period is from the 1st day of the month until the last day included.

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The central pharmacy report has to be submitted to the Logistics Coordinator before the 3rd of the next month. A total physical inventory has to be conducted at least every 6 month. Reminder: The differences found during a physical inventory have to be mentioned explicitly on the stock cards. (Date, extra or missing quantity, balance, inventory as remark and signature)

10 - Specific documentation
The Stock Card, Release Order, stock report and Delivery Notes to use for the pharmacy are the standard ACF forms. - Pharmacy report & order To be used only by the project pharmacies. This format combines a stock report and an order The CMN has to modify the format according to the drugs used on the mission. - Central pharmacy stock report To be used only for the central pharmacy - Mission consumption follow-up TFC To be used by the CMN to monitor the consumption of the TFC. The CMN has to adjust the file to the drugs used on the mission. The CMN can create files on this model for SFC, HC etc.

11 - Archiving
9.1 Filing in the pharmacy
Stock card files: Archived per budget and per category of products (DRUGSTABLETS, DRUGS-INJECTABLE, EXTERNAL USE, RENEWABLE SUPPLIES, MATERIALS) or more if needed, non-active stock cards (when the balance for an item reached 0) are kept in the same file. At least one file per budget

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Delivery Note files: The logistician decides the number of file to open according to the number of programs. At least, therere always two files: Delivery IN and Delivery OUT (with the release order). Delivery IN: Delivery OUT: Delivery Notes, or Purchase Order, External Order Form, and then chronologically Delivery Notes per destination and then chronologically

Specific files are needed for UN agencies. They provide Action Contre la Faim with in kind donations and Action contre la Faim has to submit regular reports. To archive their waybills in a separate file makes the work easier

9.2 Filing at the logistic department

Stock report file: Gift & loan file: The Stock reports from the central pharmacy on electronic files Gift certificate / temporary loans to other agencies + request from the agencies

9.3 Filing in the CMN office

Stock report file: central pharmacy Consumption report: Release Order file: Paper copies of the Stock reports from the Report from the various project All the RO per base/ program and per date.

12 - Annexes
Central pharmacy stock report Pharmacy report & order Mission consumption follow up TFC ACF list drugs TFC SFC ACF list drugs health centre

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