2. Objectives:
At the end of this session participants will be able:
• To describe the current pharmaceutical transactions
and services
• To discuss limitations of the current practices and
their consequences
• To list causes of the problems in current practices
• To identify potential interventions to rectify the
existing problems
3. Outline:
• Current practices on pharmaceutical service and
transactions
• Limitations of existing practice
• Causes and consequences of the problems in
current practices
• Potential interventions
4. 1. Current Practices
• Process
• Pharmaceutical Transactions
• Pharmaceutical Services
• Limitations
• Pharmaceutical Transactions
• Pharmaceutical Services
5. Receiving Pharmaceutical Products
• Pharmaceuticals are received at the store of the
hospital
• Receiving takes place using Model 19 which has 3
copies
• The store manager crosschecks products with the
delivery invoice,
• Updates the bin card
6. Storage and Handling of Products
• The store manager with support of porters places
medicines on shelves or pallets or floor
• Checks stock status by looking at the bin cards,
physical count
• Arranges store in a systematized order
• Monitors expiry dates of products and report those
with expiry date of less than 6 months
• Segregate expired medicines from usable stock and
stock it in a separate place
7. Storage and Handling …
• Corrosive and flammable products are stored
pharmaceuticals together with other products
• Storage spaces are cleaned randomly once in a month
or two months or more
8. Physical Inventory
• Physical count is carried out irregularly only in few
facilities
• The purpose of the physical count is either :
• to meet reporting requirements (in rare cases) or
• to facilitate handing over of responsibilities during
staff exchange (all the time)
9. Physical Inventory …
• The occasional physical count is conducted without
taking into account the full description of the
product and cost of medicine
• In most cases, physical count is carried out in the
presence of store manager, pharmacy head and
experts from finance/audit
• No registration and arrangement of prior to the
physical count
• The physical count is neither reported nor reconciled
with beginning/ending balance and consumption
10. Issuing Pharmaceuticals:
• The store manager receives an approved request (using
both IFRR and Model 20) from dispensaries and other
units
• The store manager checks for availability of requested
products in the stated quantities
11. Issuing Pharmaceuticals…
• The store manager transcribe the requested items
into Model 22 (issuing voucher) in 3 copies
• Signatories of issuing voucher are only two
individuals i.e. store manager and the receiver
• Updates the bin card
12. Storage and Handling of Medicines at DUs
• Products are shelved systematically
• Products are not shelved immediately after they are
received from the store.
• Expiry dates are not monitored on a routine basis
• Retail prices not labeled on packages
• Physical count is not conducted at all
• Actual consumption is not determined all the time
• Request is not based on actual consumption
• No system to control loss and pilferage
13. Dispensing Medicines to Patients at Pharmacies
• Medicines are dispensed to clients based on
prescriptions
• Prescriptions are filed without registering what has
actually been dispensed to clients
• Cashiers are usually located far from pharmacies
• No adequate labeling of medicines
14. Dispensing Medicines to Patients at
Pharmacies…
• No adequate counseling or inappropriate counseling
environment
• No appropriate tools for medicine transactions as:
o cash register,
o standard sales ticket,
o dispensing register, etc
• Medicines dispensed to free or insured patients are
not recorded
15. Administering to Patients or Issuing to Health
care Providers at Wards, Laboratory Units and
Outpatient Clinics
• Authorized persons (heads) from different departments
receive and store products
• Authorized persons issue products to health care
providers for conducting various procedures without
any recording and documentation
16. Administering to Patients …
• A physician/specialist prescribes medicine and issues
the prescription to the patient
• The care giver or the nurse collects the prescribed
medications and stores them into the patient’s
bedside cabinet.
• A nurse administers medicine as per the order of an
authorized prescriber
17. Planning, Budgeting and Monitoring:
• The pharmacy unit prepares list of medicines with
budget estimate
• The pharmacy unit prepares supply plan based on
the approved budget
• Selection of medicines is carried out based on past
experience of the pharmacy unit
• Quantification of medicines is carried out based on
incomplete data and information
18. Planning, Budgeting and Monitoring…
• Prioritization of medicines is not based on standard
methodologies and services provided
• No reconciliation of need and budget
• The pharmaceutical services rendered by the health
facility is not properly monitored
19. Auditing of Pharmacy Transactions
• Physical count is carried out irregularly or during staff
handover
• Transactions are difficult to audit
20. Human Resource Development and
Deployment
• Pharmacy services are being managed by pharmacy
personnel
• The performance of practitioners is evaluated
regularly
• In-service training is provided
• Pharmacy staff employment is carried out by the
regional health bureau
21. 2. Limitations of Existing Practices
• Models 19 and 22 lacks essential product information
and extra copy to update stock control cards
• Bin cards and stock cards are not recorded and
updated on regular basis
• Absence of appropriate storage places and facilities for
storage of medicines and undertaking pharmaceutical
activities
• Difficult to carry out physical count effectively and
within short period of time
• Results of physical count are not analyzed
appropriately in such a way that appropriate action
can be taken
22. Limitations …
• No system to rotate stock according to the first-expire-
first out principle
• No means to identify overstock and under stocks
• No practice to monitor storage temperature, moisture,
sunlight, and protect them from unnecessary damage
• There is a possibility of damage and loss due to storing
corrosives and flammables with other products
23. Limitations …
• There is not system to identify wastage, theft,
pilferages, etc… timely
• It is difficult to identify or trace specific products
(with specific batch, brand, expiry date and cost)
• Irrational requests of medicines (type and quantity)
from different units may be approved and issued
• The facility may fail to respond to emergency
situations in cases of limited stock levels
• Medicines may unnecessarily expire at service
delivery units
24. Limitations …
• No system to ensure accountability at dispensaries
and other service delivery points (responsibility is not
shared among all dispensers)
• Retail prices are not clearly understood by all
dispensers
• Average monthly consumption of a specific product is
difficult to calculate
• The system is liable to overage and shortage of sales
25. Limitations …
• Dispensaries are not appropriately organized and
staffed to provide quality pharmaceutical services to
patients
• The information entered by the cashiers in the receipt
is not descriptive of what is actually dispensed
• The receipt/sales ticket given to patients is not
appropriate for medicine transactions
• The system is exposed to high level of pilferage,
especially of medicines given free of charge
• Patients do not have adequate knowledge of their
medications
26. Limitations…
• The health facility does not have propor system to
collect account receivables from sponsors of free and
insured patients.
• The system is not favorable to implement revenue
retention and income generation activities
• For inpatients, lack of price and consumption records
makes it difficult to summarize total expense at the time
of discharge
• The lack of appropriate recording and documentation
leads to pilferage, theft and loss of valuable medicines
27. Limitations …
• The system in place does not ensure accountability
• Wastage of resources due to expiry
• Shortages and stock out of essential medicines may
occur due to poor prioritization
• Shortage of budget to avail vital medicines leading to
compromised services and patient suffering or death
• Poor satisfaction of clients/patients
28. Limitations…
• Compromised treatment outcomes due to poor
patient knowledge and treatment adherence
• Development of AMR due to poor prescribing
/dispensing practice and patient use of antimicrobials
• Clients lack of trust and credibility on the health
institution and health care providers
29. Limitations …
• Pharmacy transactions cannot be audited due to lack
of appropriate records and documentation
• Lack of accountability due to absence of transparency
• Identification of products during ADE or product
defects is almost impossible due to absence of
standard documentations
• Innocent professionals are being accused due to lack
of transparency and documentation in the system
30. Limitations …
• Lack of commitment, responsibility and
professionalism
• High attrition rate of experienced staff due to
dissatisfaction
• Compromised efficiency and effectiveness of
pharmacy services due to absence of adequate
support staff
• Pharmacy workforce allocation doesn’t take into
account the actual work load and quality of work
needed
31. Limitations…
• Pharmacy personnel are assigned to a specific job
without having proper orientation and clearly defined
job description
• Performance evaluation of pharmacy staff is not based
on objective criteria and accomplishments of defined
tasks
• The pharmacy staff do not have appropriate schemes
of remuneration/incentives and professional
development plan
32. 3. Causes and Consequences Problems in
the existing practice
• Problems are the results of multifaceted factors
• Organization and Management
• Human Resource Development and Deployment
• Work Flow
• Absence of Systems and/or Tools
• Accountability and Transparency
• Efficient Utilization of Limited Budget
• Infrastructure and Equipment/Facilities
• Protection of Financial and Other Risk Liabilities
• Legal Instruments and Enforcement
33. Causes and Consequences …
• The aforementioned problems have resulted in:
• Shortage of essential medicines
• Wastage
• Inefficient budget utilization
• Irrational use of medicines leading to AMR, morbidity
and mortality
34. 4. Potential Interventions
• Various interventions tried to improve supply
management and use of medicines
• IPLS
• DTC
• DIS
• Clinical pharmacy
• APTS addresses gaps that were difficult to resolve
by other interventions
• Transaction at dispensing units
• Dispensing and counseling
• Liking pharmaceuticals transactions with finance
35. 4. Potential Interventions
• APTS addresses gaps that were difficult to resolve
by other interventions
• Transaction at dispensing units
• Dispensing and counseling
• Liking pharmaceuticals transactions with finance
unit
36. Summary
• The current pharmaceutical service practices have
many limitations and resulted in problems:
• No relevant vouchers for pharmaceuticals products
and transactions
• There is no extra copy of receiving and issuing
vouchers to be given to the stock card clerk to
update the stock status in the stock
• No regular updating of stock
• Inadequate storage facilities
37. Summary…
• High rate of wastage and pilferage
• Inadequate pharmacy staff to deliver quality service
• No accountable and transparent system to recover
values from insured and credit patients
• Pharmacy transactions are not auditable
APTS is an interventions designed and proved to be
effective to resolve these problems
