logistic management system in Nepal

1. Logistic Management in Nepal
BPH , MPH
Binam Raj Shrestha
Former Child Health Technical Officer , Lifeline Nepal/UNICEF (2 years two months)
Source :DOHS annual report FY 2075/7

2. Outline
 Introduction
 Goal , objectives, strategies
 Major Logistics Activities to Strengthen Health Care Services
 Issues raised and action taken

3. Definition
 Supply Chain Management (SCM) is the process of planning, implementing
and controlling the operations of supply chain with the purpose to satisfy
customer requirements as efficiently as possible.
 Coordination of all supply activities of an organization from suppliers and
partners to customers.

4. Definition
 “Logistics management is the that part of supply chain management that plans,
implements, and controls the efficient, effective forwards and reverse flow and
storage of goods, services and related information between the point of origin
and the point of consumption in order to meet customers requirements.”-
CSCMP’s Definition of Logistics Management

5. Introduction
 An efficient management of logistics is crucial for an effective and efficient
delivery of health services as well as ensuring rights of citizen of having
quality of health care services.
 After the restructure of Nepal’s governance in federal structure, the logistic
management division was demolished and its functions are being carried out
through logistic management section under Management Division of
Department of Health Services(DOHS).

6.  The major function of LMD was to forecast, quantify, procure, store and
distribute health commodities for the health facilities of government of Nepal.
 It also involved repair and maintenance of bio-medical equipment, instruments
and the transportation vehicles.

7. Goal
 Quality health commodities available at health facilities and community level
round the year.

8. Overall Objective
 To plan and carry out the logistics activities for the uninterrupted supply of
essential medicines , vaccines, contraceptives, equipment, HMIS/LMIS forms
and allied commodities (including repair and maintenance of bio-medical
equipment) for the efficient delivery of healthcare services from the health
institutions of government of Nepal in the country.

9. Strategies
 Logistics planning for forecasting, quantification, procurement, storage and
distribution of health commodities.
 Introduce effective and efficient procurement mechanisms like e-Bidding, e
Submission.
 Use of LMIS information and real-time data in the decision making.

10.  Strengthen physical facilities at the central, regional, sub-regional and district
level for the storage and distribution of health commodities.
 Promote Online Inventory Management System and Non-
Expendable/Expendable Items Inventory System in Central, Regional and
Districts warehouses.

11.  Auctioning of non-functional cold chain equipments/furniture, vehicle etc.
 Repair and maintenance of bio-medical, cold chain equipments /instruments
and transportation vehicles.

12.  Capacity building of required human resources on logistics management
regarding public procurement, e-bidding, e-procurement, and online Inventory
Management System at Central, Regional and District levels.
 Implement effective Pull System for year-round availability of Essential Drugs
and other health commodities at all levels (Central, Regional, District and
Health Facilities).

13.  Improvement in procurement and supply chain of health commodities, working
on procurement reform and restructuring of federal, provincial and district
stores.
 Formation of Logistics Working Group at Central and provincial levels.

14. History
 Logistics Management Division (LMD) was established under the Department
of Health Services in 2050/51 (1993), with a network of central and five
regional medical stores as well as district level stores
 In order to systematize the management of logistics, the Logistics Management
Information System (LMIS) unit was established in LMD in 1994

15.  LMIS unit just started Online Inventory Management System in 2 Central
Warehouses, 5 Regional Warehouses and 75 District Warehouses in 2073/2074.

16. Major Functions of Logistic Management
 section are collection and analysis of quarterly (three monthly) LMIS reports
from all of the health facilities across the country; preparation, reporting and
dissemination of information to:
a) Forecast annual requirements of commodities for public health program
including family planning, maternal, neonatal and child health, HIV and AIDS
commodities, vaccines, and Essential Drugs;

17. b) Help to ensure demand and supply of drugs, vaccines, contraceptives, essential
medical and cold chain supplies at all levels;
c) Quarterly monitor the national pipeline and stock level of key health
commodities

18. Major Logistics Activities to Strengthen
Health Care Services
 Procurement
 Forecast and Quantification Workshop
 Quarterly National Pipeline Review Meetings
 Strengthen Storage Capacity
 Capacity Building in Logistics Management
 Formation and action taken of Logistics Working Group(LWG)

19. Procurement
 A district-wise breakdown list of essential drugs and quantities to be procured
at the district level, based on consensus forecast was developed by PHCRD
and LMD.
 The list and budget was sent to all districts by the Primary Health Care
Revitalization Division (PHCRD).
 Similarly, on the development of e-bidding software, the terms of
reference/guidelines was finalized and sent to prospective e-bidders for their
review and feedback.
 Training on public procurement for the Province and District level personnel
was provided with the financial support of UK AID/NHSSP and technical
support of GoN/PPMO.

20. Forecast and Quantification Workshop
 Every year, the working group forecasts for coming three year period with
periodic review.
 The group consists of representation from various divisions under
DOHS/MOH, districts, social marketing organizations and EDPs.
 The workshop convened on March 2017 and on March 2018 in the support of
USAID GHSC-PSM with participation from public sector, social marketing
sector and EDPs.

21.  The workshop developed a forecasting and quantification of Essential drugs,
RH/FP commodities, MNCH commodities, vaccines, syringes and HIV&
AIDS commodities.
 The forecast was based on scientific data, which included demographic data,
consumption pattern, morbidity issues and some special programmatic
considerations.

22. Quarterly National Pipeline Review
Meetings
 Pipeline monitoring of FP commodities was started since 1997/98.
 It now covers FP, MNCH, EPI Vaccines, Syringes, selected Essential Drugs
and HIV/AIDS commodities as well.
 National pipeline reports are now used to monitor the availability of the stock
at service delivery points (SDPs) and to monitor the procurement status of key
health commodities

23.  In each quarter, a national pipeline meeting takes place at the Logistic
management section to review, monitor, and evaluate the procurement,
shipment, distribution, transportation and stock status of family planning and
other health commodities.

24. Strengthen Storage Capacity
 Ideal storage conditions for essential drugs and commodities are required to
deliver quality health services to service delivery sites in order to ensure
optimal health service utilization by consumers.
 In the course of implementing the Logistics System Improvement Plan (LSIP)
of Ministry of Health and Population (MOH) jointly developed by MOH, a
massive clean-up and de-junking activities were carried out across the country
during the period of 1994-97.

25.  This effort resulted in freeing storage space and generating revenue for the
government (from de-junking and auctioning), which revealed that numerous
districts seriously lacked ideal storage space for handling health and other
allied commodities including vaccines.
 Effective Vaccine Management(EVM) is one of the cores working areas of
LMIS

26.  Effectiveness of vaccine management widely depends on the effectives and
proper storage of vaccine as well as cold chain and supply chain management.
 To ensure proper cold chain, LMS has mobilized mechanical engineers and
refrigerator technician for immediate repair of demerged refrigerators and
freezer to ensure effective vaccine management.

27. Inventory Management and Warehouse best practices
 Cleaning of the storage area
 Organizing of stores based on FEFO / FIFO and separation of non usable
health commodities from usable products;
 Performing physical count all health commodities in a store;

28.  Verifying and reconciling counted stock with stock registers;
 Signing and stamping reconciled quantities by relevant authority;
 Updating all inventory records and tools (registers and eLMIS)
 On-the job-training on inventory management and any relevant supply chain
management function.

29. Capacity Building in Logistics
Management
1. Real Time Inventory Management System (IMS)
 The Web-Based LMIS was introduced in 2008 replaced the quarterly paper
based reporting system to monthly,
 Logistic Management Section took an initiative to make real time inventory
management system up to the district level with customization of already in use
IMS software.

30.  This is being online system, gives real time information of stock status of
health commodities of at different level of stores. This allows to make supply
chain decision making.
 Training was provided to all provincial medical store and districts store
keepers with the financial supported by UNFPA/ADRA Nepal and Plan is to
implement this new system from next Fiscal Year.

31. 2. Manual Revision and Pull System Training
 LMS and National Health Training Center (NHTC) with support from
H4L,organizeda facility level pull system training to total fifty-nine
participants of HFs of Dailekh in February 19-24, 2016 and thirty-two
participants of HFs of Jumla on April 21-29, 2016. There were many new staff
who do not have idea on health logistics and many trained staffs were
transferred.

32.  The main aim of the training was to improve knowledge, skill and attitude of
the store keepers of health facilities so as to ensure the availability of adequate
supply of medicine and health commodities in health facilities via pull system
to provide effective health care service.

33. 3. Conduction of basic level logistics training.
 LMS conducted basic level logistics training was conducted with support from
UNFPA in Kapilvastu,Sindhuli and Rolpa. Similarly SAVE the Children also
supported in Dolakha. Procurement and supply chain management was also
conducted with support from USAID/GHSC-PSM in all districts.
4. Development of Basic Logistics Training Manual
 LMS has developed Trainers’ guide and participants hand book for Basic
Logistics Training.

34. 5. Conduction of eLMIS training:
 LMS conducted TOT and roll out training on eLMIS Online and Offline in 22
districts of province 5&6 and in 23 health facilities of Surkhet and Bardiya district.
 RDQA: LMS conducted routine data quality assessment as pilot project in
three districts at Kavre,Kaski and Makwanpur.
 The main objective of data quality assessment is to monitor quality of LMIS data at
facility level for data accuracy.

35. 6. Disposal of Unusable Health Equipment and Commodities
 Unusable and/or expired health commodities are a major problem for Nepal’s
health system. Safe storage conditions for essential drugs and commodities are
required to deliver quality health services to service delivery sites.
 In addition, “de-junking” of unusable commodities helps clear the way for
usable commodities. For example, a major de-junking drive in 1994-97 freed
up more than 125,000 square feet of free space and generated 25 million
Nepali Rupees (NRs.) for the Government of Nepal’s treasury.

36.  LMS started several actions to disposal of unused, unwanted or expired have
been carried out items.
 These activities include the provision of technical support in auctioning of
unusable commodities for the District for saving space to store valuable
lifesaving drugs.

37. Formation and action taken of Logistics
Working Group(LWG)
 An authentic Group was formation with 9 memberships chaired by Director of
Management Division with representation of Divisions, Centers and External
Development Partners at center level.
 The LWG addressed major issues regarding procurement and supply chain
management of health-related commodities.
 The LWG members will be extend on the basis of area and necessary and also
plan to extend the Regional level LWG.

38. Issues raised and action taken
Issues Action Taken Responsibility
Low Budget in Drug
Procurement and supply in local
level
Budget will be revised as
demand in next year.
MoHP/DoHS
Capacity building in
procurement, forecasting,
quantification and LMIS
LMS has planned to
conduct that training at all
provinces.
DoHS/MD/LMS
Not functioning of telemedicine
program in rural areas
LMS will coordinate to
start the well functioning of
telemedicine program
DoHS/MD/LMS

39. Management of Expired,
Wastage and unused
materials
LMS will collect those
materials from all provinces
and destroy or disposed as
process.
DoHS/MD/LMS
Inadequate of
HMIS/LMIS tools and
late supply
Tools will be supplied in time
and
adequately
DoHS/MD/LMS
High demand of required
equipments
LMS will demand budget for
equipment procurement.
DoHS/MD/LMS

40. Reference
 https://dohs.gov.np/wp-content/uploads/2020/11/DoHS-Annual-Report-FY-
075-76-.pdf