Component 2 of the Zambia ARV public supply chain

1. ARV Supply Chain
Component 2
IH722
February 10, 2015
Katie Broecker
Bethany Bryant
Jennifer Johnson
Liz Nerad

2. Medical Stores Limited (MSL)
MOH Logistics
Management Unit (LMU)
Clients
District Community
Medical Office (DCMO)
Health Centers
NGO Health
Facilities
Provincial
Health
Office
District Hospital
Level 1,2,3
Overview of ARV Pipeline in Zambia
Within Zambia’s ARV supply system, there are
approximately 40 types of ARVs (including
Nucleoside reverse transcriptase inhibitors, Non-
nucleoside Transcreptase inhibitors, Protease
Inhibitors in Triple fixed dose, single dose and
pediatric solutions; very few 3rd line ARVs
available). ARV procurement for the public health
system is limited to those listed on the Essential
Medicines List.
Each level of the supply chain is a PULL system.
The review period at each level is 1 month. ARVs
are provided for free at public facilities.
• Tier 1 consists of the MSL central warehouse
and the LMU
• Tier 2 consists of the DCMO and district level 1
hospital
• Tier 3 consists of service delivery points
including level 2, 3 hospitals, health centers
and NGO health facilities
Zambia is currently rolling out a new design, which
includes regional hubs and docking at DCMO.

3. Supply Chain Information Flow
Medical Stores Limited (MSL)
MOH Logistics
Management Unit (LMU)
Clients
District Community
Medical Office (DCMO)
Health Centers
NGO Health
Facilities
Provincial
Health
Office
District Hospital
Level 1,2,3
Forms Form Movements
SCC
Stock Control
Card
 Stays in facility
DAR
Daily Activity
Reports
 Stays in facility
FR
Feedback
Reports
 Sent to lower levels (DCMO, Hospitals,
Health Centers)
 Sent to Provincial Medical Office (PMO)
R&R
Request and
Requisition
Report
 Sent to higher levels from lower level
facilities
CR&R
Computerized
Copy of Request
and Requisition
Report
 Sent to lower levels where it is then
signed and returned to higher level
 Copy of signed C-R&R is kept at the
receiving facility
RFRP
Reports for
Returning
Products
 Sent to higher levels from lower level
facilities
SV Supply Voucher
 Signed and returned upon receipt of
product
**IF product is held at DCMO, take SV
with you to get your product
MDN
MSL Dispatch
Note
 Sent with products to the DCMO and
Hospitals.
 Signed and copy is sent back to MSL
 Copy of signed MSL is filed at
Hospitals/DCMO
RFRP
R&R
SV
DAR SCC
CR&R
RFRP
MDN
CR&R
MDN R&R SCC
DAR SCC R&R
CR&R
PH81-
N
FR
CR&R
MDN
FR
FR
CR&R
RFRP
R&R
FR
R&R
RFRP
SV
R&R
RFRP

4. Medical Stores Limited (MSL)
MOH Logistics
Management Unit (LMU)
Clients
District Community
Medical Office (DCMO)
Health Centers
NGO Health
Facilities
Provincial
Health
Office
District Hospital
Level 1,2,3
Inventory Control System
The ARV supply chain operates as a PULL system at each level. The review
period is 1 month. If stock levels ever fall below 2 weeks (0.5 months) of
stock before the end of the month, an emergency order should be placed.
Tier 1
SDP
Tier 2
At the end of the month, health centers should: Report stock on
hand, consumption, and losses and adjustments. As this is a forced
ordering system, facilities should order enough stock to bring stock
level up to the maximum (3 months) and submit the order to the
District by the 5th day of the following month. The minimum stock
level is 2 months, the EOP is 0.5 months. Hospitals submit their
order to the MSL LMU by the dates published in the MSL Delivery
Schedule.
At the end of the month, districts submit the orders for their Health
Centers to the MSL LMU by the dates published in the MSL Delivery
Schedule. The district reviews and approves the health center
orders. The DCMO operates as a cross docking station and only
stores stock for health centers without the space or capacity.
Information about the max/min/EOP ordering protocol at the MSL
level is unavailable at this time. MSL procures and supplies 40
different types of ARVs including:
● Nucleoside reverse transcriptase inhibitors (NRTI)
● Non-nucleoside Transcriptase inhibitors (NNTIs)
● Protease Inhibitors
3 months MAX
2 months MIN
0.5 months EOP
Cross-
docking
Station

5. • DELIVER, JSI, USAID. Standard Operating Procedures Manual for the Management of the National ARV Logistics System.
Republic of Zambia Ministry of Health; 2013.
• Ministry of Health, Zambia National Formulary Committee. 2008. Standard Treatment Guidelines, Essential Medicines List,
Essential Laboratory Supplies for Zambia. 2nd ed Lusaka, Zambia: Zambia Ministry of health.
http://apps.who.int/medicinedocs/documents/s19280en/s19280en.pdf
• Nicodemus W. Interviewed by: Nerad L. 22 Jan 2015.
• Yadav, Prashant. 2007. Appendix E: Analysis of the public private, and mission sector supply chains for essential drugs in
Zambia. A study conducted for DFID Health Resource Center under the Aegis of the META Project.
• Zambia National Formulary Committee (2011) 2011-2013 Zambia National Formulary http://www.moh.gov.zm/docs/znf.pdf
References