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 • • 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. – – – 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 District Distributors Regional Medical Store 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 District Distributors Regional Medical Store 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 District Distributors Regional Medical Store 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 District PUBLIC SECTOR Central Medical Store Primary Distributors Regional Medical Store 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 District Distributors Regional Medical Store District Medical Store Private Pharmacies Hospitals Health Centers Health Posts Community Key Product flow in traditional CMS System Users
Health System Supply Chain – Theory
The Complex Reality: Health Supply Chains in Kenya
Key Decisions • Key decisions include: – – – 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
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