SlideShare a Scribd company logo

Drug Supply Management in Ethiopia

•Download as PPTX, PDF•
•
S
ShikurYasin

drug supply managment

Health & Medicine
1 of 385
Drug Supply Management By Dawit Teshome (M.Pharm) March 2019
1. Introduction 17/12/2022
1.1 Ethiopian Health care system • Pluralistic: traditional and modern – WHO estimate: TM 70 - 80% • The evaluation of modern health services could be divided into five periods. – Laying the Ground for Modern Medicine, Up to 1936 – The Italian interlude (1936-41) – The hospital/clinic based (reconstruction) period (1941- 1953) – The Basic Health Service period (1953-1974) – The Primary Health Care period (1974-1991) – The Sector Wide approach period (1991-2015) /HSDP period. – The Health sector transformation (1916-2020) 17/12/2022
1.2.1 Modern Medicine in Ethiopia • Introduced in 16th century in fragmented way: Emperor Libenedengel • Further progress in the introduction and development- reign of Emperor Menilek (1889 – 1913) • The first Government sponsored health facilities were established in Harar by Ras Mekonnen and Menelik II Hospital in Addis Ababa in 1909 • The Government formally assumed responsibility for the provision of health services with the establishment of the Health Department within the Ministry Interior in 1908. • Since then The Health Care System has been in constant change with socioeconomic and political changes. • 1935- health manpower training started by enrolling students for auxiliary medical training • Italian invasion – interrupt the activity 17/12/2022
• Modern medical care model (MMC) (The Reconstruction phase (1941-1953) – Earlier period of introduction of health services • Urban centered and Hospital based • Services were inaccessible to majority of rural population due to – geographical, economical and cultural barrier • It was mechanistic approach and not holistic – The health service coverage was estimated to be 25%. – Little attention was given to preventive health care in spite of the establishment of the Ministry of Public Health in 1947. 17/12/2022
Approach of Health care services • Basic Health Service Approach (BHSA) (1953-1974) • In 1952, the government officially proclaimed the basic health care policy. – Dominant theme in 50’s and 60’s – Criticism against mechanistic approach – Success stories utilizing large number of medical auxiliaries in China to provide service nearer to large population – Reframed and shifted utilization of medical auxiliary from medical facility to health center and health institution – Principle ” taking services where people live” through home visits, outreaches, prison heath serves by medical auxiliaries 17/12/2022
Approach of Health…..…….cont’d • The era of BHSA in Ethiopia – One of the success stories registered in health sector development • The organization and development of health services at that time can be considered as four tiered system: – Health station (with health assistant at grass root level) – Health center at Awraja level (health center team) – Regional referral Hospital (Tekelaygizat level) – Central referral hospital 17/12/2022
Approach of Health…..…….cont’d • Problem with BHSA – Constrained with respect to facility and manpower – Socio-cultural factor prevent population from using available sources – No mechanism for community participation that can ensure sustainability and culturally acceptable care • Primary health care (PHC) approach (1974-1991) – WHO and UNICEF re-examined their practice and this led to Alma-Ata declaration in 1978 17/12/2022
Approach of Health…..…….cont’d • Primary Health Care defined as – Essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and the country can afford to maintain at every stage of their development in the spirit of self- reliance and self-determination” 17/12/2022
Approach of Health…..…….cont’d • The five principles usually associated with the PHC strategy are: • Universal accessibility and coverage – Essential health services to all people • Community and individual involvement and self reliance – Individuals and communities have the right and responsibility to be active partners in making decisions about their health care and the health of their communities. 17/12/2022
Approach of Health…..…….cont’d • Appropriate technology and cost effectiveness – This includes methods of care, service delivery, procedures and equipment that are socially acceptable and affordable. • Intersectoral action for health – Commitment from all sectors (government, community and health) • Health promotion – Through the provision of affordable health services and community health education. 17/12/2022
Approach of Health…..…….cont’d • Component/element of PHC – Immunization – Food supply and proper nutrition – Water and sanitation – Appropriate treatment of common disease and injuries – Maternal child birth care including family planning – Providing essential drugs – Mental health 17/12/2022
Approach of Health…..…….cont’d – Education concerning the prevailing health problems and methods of preventing and controlling them – Provision and control of locally endemic – Dental health – Traditional medicine – Control of HIV/AIDS and STIs – Occupational health – As a member of WHO, Ethiopia signed the Almata charter – WHO internationally evaluated PHC strategy (1984 – 1985) 17/12/2022
Approach of Health…..…….cont’d • Problems observed: – Very limited intersectoral collaboration – Lack of community involvement due to lack of remuneration of trained CHWs; 85% were found to be non functional • Achievement: – Expansion of health services – Control of iodine deficiency disorder – Training in health education 17/12/2022
The HSDP period (1993-2015) • The transitional government issued a Health Policy in 1993. • The policy emphasizes equitable access of all people to decentralized preventive and promotive health oriented integrated PHC. • To achieve the objectives of the policy, the government identified and have been implementing the following strategies: 17/12/2022
Strategies • Strengthening preventive and promotive health services • Sustaining the existing essential curative services and encouraging rehabilitative services within the family and the private sectors • Provision of basic drugs at all health care units and encourage private sector participation in the procurement, distribution and production of drugs and medical supplies • Revitalizing the health information, documentation and processing system 17/12/2022
• Decentralizing and democratizing the management of the health care delivery system • Human resources development emphasizing front-line and mid-level health workers • Affordable and realistic research and development focusing on priority health problems and • Creating an enabling environment for community and private participation in health care financing as well as for efficient and effective utilization of the available limited resources. 17/12/2022
Health Sector Development Program I (HSDP I) (1997/98– 2001/02) • Prioritized disease prevention and decentralizing health services delivery. • HSDP I introduced a four tier system for health service delivery. – Primary health care unit (PHCU) (one HC and 5 HP health posts) ~ 25,000 people – District hospital ~ 250,000 – Zonal hospital ~ 1,000,000 – Specialized referral hospital. 17/12/2022
• In relation to Pharmaceutical sector, during HSDP I: – The Proclamation to the Drug Administration and Control Authority (DACA) have been issued & completed; – The National Drug List (NDL) of Ethiopia has been updated, printed, and was issued in July 2001; and – A federal Essential Drugs List has been prepared, listing priority drugs which should be available at all times, and structured by level of the health system. – Improvement in drug availability has been observed in the public and private sectors, partly through licensing of a large number of drug outlets of various levels to sell drugs (estimated at 311 pharmacies, 249 drug shops and 1917 rural drug vendors), and the establishment of several domestic manufacturers of drugs and medical supplies within the country. – There has been a significant increase in the supply of drug and medical supplies to the public center manifested by the marked increase in the drug budget from 20 million to 245 million birr. 17/12/2022
HSDP II (2002/03–2004/05) • Incorporates new initiatives like – the introduction of the Health Services Extension Programme (HSEP) – the accelerated Expansion of PHC – the development of the Essential Health Services Package (EHSP) – the elaboration of a Child Survival Strategy – the efforts to reach the Millennium Development Goals, – the new Plan for Accelerated and Sustained Development to End Poverty (PASDEP Oct 2005) – to seek improved alignment of donors and donor efforts of harmonization – establishment of Special Pharmacies (SP) has resulted in better drug availability and increased ability to cover recurrent costs. • Special and Budget Pharmacies were operating separately. 17/12/2022
HSDP III (2005/06–2009/10) • It stresses the need to increase national health spending, • Recognized the strategic role of NGOs as partners in achieving universal primary healthcare coverage • National Hygiene and Sanitation Strategy and National Protocol for Hygiene have been developed • Accelerated Expansion of Primary Health Service Coverage • Development and implementation of the National Nutrition Strategy and programme • In order to introduce efficiency in the supply chain of pharmaceuticals and medical supplies management system, PHARMID has been transformed into Pharmaceutical Fund and Supply Agency (PFSA) with the several measures taken to strengthen the capacity of the new agency 17/12/2022
HSDP IV (2010/11 – 2014/15) • Scaling up of Urban and Pastoralist HEP. • Maintaining coverage and improving the quality of HEP in rural areas. • HSDP IV will focus on a comprehensive and continuous quality monitoring mechanism • Enhancing the commitment of leadership at all levels of the system. • Building implementation capacity. • Scaling up of best practices. 17/12/2022
HSTP (2015/16 – 2019/20) • HSTP is the first phase of the 20-year health sector strategy called ‘Envisioning Ethiopia’s Path to Universal Health Care through strengthening of Primary Health Care’. • HSTP has three key features: quality and equity; universal health coverage and transformation. • Pillars of HSTP – 1. Excellence in health service delivery – 2. Excellence in quality improvement and assurance – 3. Excellence in leadership and governance – 4. Excellence in health system capacity 17/12/2022
HSTP (2015/16 – 2019/20) • Improve Supply Chain and Logistic Management is • Performance measures: – Increase availability of essential drugs for primary, secondary and tertiary healthcare to 100% – Reduce wastage rate to less than 2% – Increase proportion of essential drugs procured from local manufacturers from 25% to 60% – Reduce procurement lead-time from 240 days to 120 days 17/12/2022
Strategic Initiatives HSTP-Pharmaceutical • 1. Enhance efficiency in selection, quantification and procurement of essential medicines • 2. Optimize warehouse, inventory, fleet and distribution management systems • 3. Scale-up integrated information management system for pharmaceutical supply and services • 4. Scale-up auditable pharmaceutical transaction and services to all health facilities • 5. Scale-up community pharmacies • 6. Implement innovative strategies to shape the market in order to ensure affordability of essential drugs • 7. Strengthen supply chain modeling to analyze needs for management and scale-up of commodities • 8. Undertake measures to reduce drug wastage and integrated pharmaceutical waste • management • 9. Promote rational drug use • 10. Improve access to medicines through quality local production – implement the GMP (good manufacturing practice) Roadmap 17/12/2022
Approach of Health…..…….cont’d • Current health care delivery system : a three-tier • First level of a Woreda/District health system – Comprising a primary hospital • population coverage of 60,000-100,000 people), – Health centers (1/15,000-25,000 population) – Satellite Health Posts (1/3,000-5,000 population) • Connected to each other by a referral system 17/12/2022
Approach of Health…..…….cont’d – NB! Primary Hospital, Health center and health posts form a Primary health care unit (PHCU) with each health center having five satellite health posts. • Second level - General Hospital – Population coverage of 1-1.5 million people • Third level - a Specialized Hospital – Population of 3.5-5 million 17/12/2022
Three-tier health care delivery system in Ethiopia (currently used) 17/12/2022
Millennium Development Goals • In September 2000, leaders of 189 countries gathered at the United Nations headquarters and signed the historic Millennium Declaration, in which they committed to achieving a set of eight measurable goals that range from halving extreme poverty and hunger to promoting gender equality and reducing child mortality, by the target date of 2015. 17/12/2022
17/12/2022
The Global Consultation of Sustainable Development Goals • In July 2014, the UN General Assembly Open Working Group (OWG) proposed a document containing 17 goals to be put forward for the General Assembly’s approval in September 2015. This document set the ground for the new SDGs and the global development agenda spanning from 2015-2030. 17/12/2022
17/12/2022
17/12/2022
1.1 What is management? • A set of activities directed at the efficient and effective utilization of resources in the pursuit of one or more goals. • Working with human, financial, and physical resources to achieve organizational objectives by performing the planning, organizing, directing and controlling functions. • A problem solving process of the effectively achieving organizational objectives through the efficient use of scarce resources. 17/12/2022
• management is not a process, which is simply a method of doing something. • Managers are simply people who perform management activities. • While people whom we think of as “the boss” and those with administrative appointments within an organization certainly are managers, the fact is that anyone who has a task to accomplish or a goal to achieve is a manager as well 17/12/2022
• Leadership – It is a distinctly different skill from management. – Leadership involves the ability to inspire or direct others. – It is desirable that all managers also have leadership skills, they do not necessarily go hand in hand 17/12/2022
17/12/2022
Management……..cont’d • The Management Process – There are three dimensions of management: 1. Activities that managers perform 2. Resources that managers need 3. Levels at which managers make decisions – Every action taken by a manager involves at least one aspect of each of the three dimensions. 17/12/2022
The Management Process 17/12/2022
Classical Management Activities • Planning – Central functions of management – Determines the organizational direction – It is a rational systematic way of making decision today that will affect the future. – is predetermining a course of action based on one’s goals and objectives. 17/12/2022
Classical Management……..cont’d – Important for purpose of scarce resources – Effective planning incorporates the effects of both external and internal factors. – E.g. The chief pharmacist at a community pharmacy develop plans which drug products he wishes to carry • Organizing – Requires formal structures of authority and direction and flow of such authority. 17/12/2022
Classical Management……..cont’d • Organizing : concerned with – Identifying tasks that must be performed – Assigning tasks to personnel – Defining authority & responsibility of assigned personnel – Delegating such authority to employees – Establishing a relationship b/n authority & responsibility 17/12/2022
Classical Management……..cont’d – E.g. Once a pharmacist has decided which drug products he should offer, he needs to ask himself • what resources he needs to provide them • Who is responsible for procurement • how he will go about obtaining these resources • and then determine when he will need to obtain. • Leading or directing – bringing about purposeful action toward some desired outcome. 17/12/2022
Classical Management……..cont’d • Control or evaluation – Involves reviewing the progress that has been made toward the objectives that were set out in the plan. – Determining what actually happened and why it happened. – E.g. Pharmacists can ask themselves if the goods and services they offered met their goals (e.g. Did the goods and services result in high quality patient care or improved clinical outcomes?) 17/12/2022
Management activities cycle 17/12/2022
Management……..cont’d • Resources that are Managed – Managers, organizations and individuals must use resources to achieve their goals and objectives. – Resources are scarce • Money, People, Time • Material (E.g. drug products, equipment, and supplies) • Information 17/12/2022
Management……..cont’d • Levels of Management – Managers perform management activities at a number of level • Individual management – Self-management – occur much more frequently at lower levels. • Interpersonal management – between the manager and one other person – E.g. a pharmacist counselling a patient about a medication 17/12/2022
Management……..cont’d • Organizational management – Occurs less frequently – Involves actions that affect groups of people – E.g. deciding where to go for lunch – E.g. when a pharmacist needs to develop a policy or make a decision that may affect many people at the pharmacy 17/12/2022
What makes successful manager? • Politics, economy, human resources and infrastructure development contribute for success or failures. • But success lies – Managerial task – Managerial role – Managerial skill – Qualities of the manger 17/12/2022
Managerial tasks • Crisis management – e.g outbreak of meningitis and its management • Routine administration – e.g receiving report, managing staff, making decision • Long term program development – It is little time consuming – Failure to plan and implement needed change will increase the number of problems, makes routine administration less effective 17/12/2022
Managerial role • Role – is a set of expectation place on any one in a position of responsibility by the people around that person • Role of manager • Leader – Directing – motivating staff – maintaining liaison with other organization 17/12/2022
Managerial role • Communicator – maintaining networks of formal or informal) – Disseminating information – Serving as spokes person • Decision maker – Resource allocation – Program change and development – Problem solving – Negotiating 17/12/2022
Managerial skill • Technical skill – e.g. pharmacy, other skill related to specific jobs • Conceptual and analytical skill – ability to synthesize information – understand the prevailing circumstance – use planning program to move forward • Decision making skill – Identify and select option using analytical and technical skill – Decide 17/12/2022
Managerial skill • People skill – Understanding, motivating and directing people – Building team and improving effectiveness • Financial skill – Budgeting – Assessing value for money in people and projects • Negotiating – Adhering to budget – Coping with constraint • Communication and research skill – Listening , reading, writing, running meeting and making public presentation • Computer skill – Proficiency in different software 17/12/2022
Qualities of manger • Provide clear direction • Encourage open communication • Coaches and support people • Recognize staff for good performance • Follow up on important issues and provide feedback • Select the right of people for specific assignment • Understand the financial implication of decision • Encourage creativity and new ideas • Give staff clear cut decision when they are needed • Consistently demonstrate a high level of integrity 17/12/2022
2. Concepts of Essential Drugs And National Drug Policy 17/12/2022
2.1 Concept of Essential medicines/ Drugs • Health is a fundamental human right. • Access to health care includes access to essential drugs. • What is Access? – Physical availability • the type and quantity of product or service needed and provided – Affordability • users ability to pay for the products/services – Geographical accessibility • the location of the product/service and eventual user – Acceptability (satisfaction) • Users’ attitudes and expectation about products and services and the actual characteristics of products and services 17/12/2022
Concept of Essential …….cont’d • Essential medicines – are medicines that satisfy the priority health care needs of the population – should be available at all times, in adequate amounts in appropriate dosage forms and at a price the individual and the community can afford” 17/12/2022
Concept of Essential …….cont’d • Essential drugs concept – “a limited number of carefully selected drugs based on agreed clinical guidelines leads to more rational prescribing, to a better supply of drugs and to lower costs”. – It is a global concept that can be applied in any country, in the private and public sectors and at different levels of the health care system. 17/12/2022
The Essential Medicines Target S S All the drugs in the world Registered medicines National list of essential medicines Levels of use Supplementary specialist medicines CHW dispensary Health center Hospital Referral hospital Private sector 17/12/2022
2.2 The formulary process • The formulary process – consists of preparing, using and updating a • Formulary list or essential medicines list (EML) • Formulary manual • Standard treatment guidelines (STGs). 17/12/2022
The formulary list or Essential medicines list • The formulary list/ essential medicines – list of pharmaceutical products approved for use in specific health care setting • E.g National formulary list, provincial formulary list • Hospital list – Alphabetically and therapeutically arranged lists of drugs 17/12/2022
Formulary/essential medicines list • Selection criteria – Pattern of prevalent disease – Treatment facilities – Training and experience of available personnel – Financial resources – Genetic, demographic and environmental factor – Medicines which have sound, adequate data on efficacy and safety (clinical studies, evidence from general setting) – Adequate quality, including bioavailability, stability under anticipated conditions of storage and use 17/12/2022
Formulary/essential medicines list – Cost: Consider cost of the total treatment rather than the unit cost of the medicine • Use cost-effectiveness analysis result – Other factors: PK properties, availability of facilities for storage or manufacturers. – Essential medicines formulated as single compounds. – But fixed-ratio combination products are acceptable only when • The dosage of each ingredient meets the requirements of a defined population • The combination has a proven advantage over single compounds • Administered separately in therapeutic effect, safety or compliance. 17/12/2022
How STGs and EMLs lead to better prevention and care 17/12/2022
Formulary manual • Formulary manual – Is the summary information on medicines in the formulary list together in a manual. – Is drug centered – Handy reference that contains selected information relevant to prescriber, dispenser, nurse or other health worker • Drug information included in a comprehensive formulary • Introductory information – Acknowledgment, List of approved abbreviation – Introduction ( development of manual, intended user) – Formulary policies and procedures 17/12/2022
Formulary manual • Basic information about each medicine – Generic name – Dosage and strengths – Indications, CI and precautions – Side-effects – Dosage schedule – Instructions and warnings – Drug, food, laboratory interactions • Supplementary information for medicines – Price – Regulatory category – Storage guidelines – Patient counseling information – Labeling information – Brand names and synonyms 17/12/2022
Formulary manual • Prescribing and dispensing guidelines – Rational prescribing techniques – Principles of prescription writing – Guidelines for quantities to be dispensed – Controlled drug requirements – Adverse drug reaction reporting requirements – Dispensing guidelines – List of precautionary labels – Common drug interaction tables 17/12/2022
Advantages of essential medicines list • Prescribing – Training is more focused and simpler – More experience with fewer medicines – Non-availability of irrational treatment – Reduction of antimicrobial resistance – Focused drug information – Better recognition of ADR 17/12/2022
Advantages of essential medicines list • Supply – Easier procurement, storage and distribution – Lower stocks – Better quality assurance • Cost – Lower prices, more competition • Patient use – Focused education efforts – Reduced confusion and increased adherence to treatment – Improved medicine availability 17/12/2022
Standard Treatment Guidelines • STG: – Is also called Treatment Protocol or Clinical Guideline – Systematically developed statements that help practitioner or prescriber in deciding on appropriate treatments for specific clinical conditions. – It reflect consensus on the optimal treatment option within health facility or health system • It is disease centered – common disease and complaints, treatment alternatives – STG exist for various level of health care • E.g Hospital, health center, region, nation 17/12/2022
Standard Treatment Guidelines • Information on STG – Diagnostic criteria – Treatment of first choice – Cost of treatment – Important CI, SE – Important drug information, warnings and precautions – Referral criteria – index 17/12/2022
Standard Treatment Guidelines • For health officials – Identify cost effective treatments for common health problems – Provides a bases for assessing and comparing quality of care – Identifies most effective therapy in terms of quality – It helps to combats antimicrobial resistance – Provides information for practitioner to give to patients concerning the institutions standards of care – Is a vehicle for integrating special programs • control of diarrheal disease, acute respiratory tract infection, TB, Malaria at the point of primary health care provider 17/12/2022
Potential benefits of STG • For supply management staff – Identifies which medicines should be available for the most commonly treated problem – Facilitates pre packaging of course of therapy quantities of commonly prescribed items – Makes medicine demand more predictable, so forecasting is more reliable 17/12/2022
Potential benefits of STG • For health care providers – Provides expert consensus on most effective, economical treatment for specific setting – Gives provider the opportunity to concentrate on correct diagnosis – Sets a quality of care standard – Provide a basis for monitoring and supervision 17/12/2022
Potential benefits of STG • For patients – Encourage adherence to treatment through consistency among prescriber at all location within the health care system – Ensures most cost effective treatment are provided – Improves availability of medicines – improves treatment and outcomes 17/12/2022
Standard Treatment Guidelines • The problems associated with STGs include: – a development process • Difficult, time-consuming, • Requires human and financial resources – the need to update regularly to avoid STGs becoming obsolete – the danger of inaccurate or incomplete guidelines • providing wrong information to prescribers 17/12/2022
What is a national drug policy? • A political commitment to a goal and a guide for action. – It expresses and prioritizes the medium- to long-term goals set by the government for the pharmaceutical sector, and identifies the main strategies for attaining them. – It provides a framework within which the activities of the pharmaceutical sector can be coordinated. – It covers both the public and the private sectors, and involves all the main actors in the pharmaceutical field. 17/12/2022
Why is a national drug policy needed? • To present a formal record of values, aspirations, aims, decisions and medium- to long-term government commitments; • To define the national goals and objectives for the pharmaceutical sector, and set priorities; • To identify the strategies needed to meet those objectives, and identify the various actors responsible for implementing the main components of the policy; • To create a forum for national discussions on these issues. 17/12/2022
Objectives of a National Drug policy • The general health related objectives • To ensure: – Access: equitable availability and affordability of essential drugs – Quality: the quality, safety and efficacy of all medicines – Rational use: the promotion of therapeutically sound and cost-effective use of drugs by health professionals and consumers. 17/12/2022
National Drug policy • Other Goals of NDP – Economic related goals • To reduce foreign exchange for pharmaceutical import • To provide jobs (dispensing, pre-packaging, production of pharmaceuticals) – National development goal • Develop national pharmaceutical production • To take a stand on intellectual property rights 17/12/2022
National Drug policy • The specific goals and objectives of a NDP may vary from country to country depending on – Structure of health care system – Capacity of drug regulating authority – Pharmaceutical distribution system – The level of funding of pharmaceuticals – The country situation – The national health policy – Political priorities set by the government 17/12/2022
Example: Objectives of Ethiopian NDP • To meet the country’s demand for essential drugs and to systematize its supply, distribution and use. • To create conducive situations to make the prices of drugs compatible with the people’s purchasing power. • To ensure the safety, efficacy and quality of drugs. • To develop a domestic drug manufacturing capacity and gradual supply to the export market. • To expand the training of manpower and drugs research and development. • To devise ways and means for the utilization of traditional drugs in the regular health services after ensuring their safety and efficacy. 17/12/2022
Key components of a national drug policy 17/12/2022
Key components of ..……..cont’d • Selection of essential drugs – Adoption of the essential drugs concept – Selection criteria • Sound and adequate evidence, cost effectiveness) – Procedures to define and update the national list(s) of essential drugs; – Selection mechanisms for traditional and herbal medicines. 17/12/2022
Key components of ..……..cont’d • Affordability – For all drugs • Reduction of drug taxes, tariffs and distribution margins; pricing policy; – For multi-source products: • Promotion of competition • generic policies, generic substitution and good procurement practices; – For single-source products: • Price negotiations • Therapeutic substitution • TRIPS-compliant measures such as compulsory licensing, “early workings” of patented drugs for generic manufacturers and parallel imports. 17/12/2022
Key components of ..……..cont’d • Drug financing – commitment to measures to improve efficiency and reduce waste – increased government funding for priority diseases, and the poor and disadvantaged – promotion of drug reimbursement as part of public and private health insurance schemes – use and scope of user charges as a (temporary) drug financing option – use of and limits of development loans for drug financing – guidelines for drug donations 17/12/2022
Key components of ..……..cont’d • Supply systems – public–private mix in drug supply and distribution systems; – commitment to good pharmaceutical procurement practices in the public sector – publication of price information on raw materials and finished products – drug supply systems in acute emergencies – inventory control, and prevention of theft and waste – disposal of unwanted or expired drugs 17/12/2022
Key components of ..……..cont’d • Legislative and Regulatory framework – government commitment to drug regulation, including the need to ensure a sound legal basis and adequate human and financial resources; – independence and transparency of the drug regulatory agency; relations with the ministry of health (MoH) – Functioning drug regulatory authority – stepwise approach to drug evaluation and registration 17/12/2022
Key components of ..……..cont’d – Pharmaceutical quality assurance including inspection and enforcement – commitment to GMP, inspection and law enforcement – access to drug control facilities – commitment to regulation of drug promotion – regulation of traditional and herbal medicines – need and potential for systems of ADR monitoring – international exchange of information. 17/12/2022
Key components of ..……..cont’d • Rational use – development of evidence-based clinical guidelines, as the basis for training, prescribing, drug utilization review, drug supply and drug reimbursement; – establishment and support of drugs and therapeutics committees (DTC); – promotion of the concepts of essential drugs, rational drug use and generic prescribing in basic and in-service training of health professionals – the need and potential for training informal drug sellers; – continuing education of health care providers – independent, unbiased drug information 17/12/2022
Key components of ..……..cont’d – consumer education, and ways to deliver it; – financial incentives to promote rational drug use; – regulatory and managerial strategies to promote rational drug use. • Research – operational research in drug access, quality and rational use; – Pharmaceutical development and clinical research 17/12/2022
Key components of ..……..cont’d • Human resources (HR) development – government responsibility for planning and overseeing the development and training of the HR needed for the pharmaceutical sector; – define minimum education and training requirements for each category of staff; – career planning and team building in government service; – the need for external assistance (national and international). 17/12/2022
Key components of ..……..cont’d • Monitoring and evaluation – explicit government commitment to the principles of monitoring and evaluation; – monitoring of the pharmaceutical sector through regular indicator-based surveys; – independent external evaluation of the impact of the NDP on all sectors of the community and the economy. 17/12/2022
Strategic pathway for health commodity security (SPARCH) 17/12/2022 • Health commodity security exists when every person is able to choose, obtain, and use quality health products whenever s/he needs them.
Strategic pathway for health commodity security (SPARCH) 17/12/2022
Strategic pathway for health commodity security (SPARCH) 17/12/2022
Strategic pathway for health commodity security (SPARCH) 17/12/2022
Strategic pathway for health commodity security (SPARCH) 17/12/2022
Strategic pathway for health commodity security (SPARCH) 17/12/2022
Strategic pathway for health commodity security (SPARCH) 17/12/2022
Strategic pathway for health commodity security (SPARCH) 17/12/2022
Implementing a NDP/NMP • A policy without implementation is worthless • NDP needs – implementation plan or “master plan” – a detailed strategy and – specific action plans • Priorities for implementation – Priorities should be • based on the severity of the problems • on the potential for success in achieving the objective • making an impact with available resources. • Master plan and work plans – Implementation plan or master plan cover a 3–5-year period. 17/12/2022
Implementing a NDP/NMP – The master plan should be broken down into • annual action plans and work plans • specify in detail who is responsible, • listing the major tasks, • describing the target output, the detailed time frame and the exact budget • Responsibilities in implementation – the Ministry of Health or a separate unit within the ministry should oversee and coordinate all activities, and monitor the extent of implementation and the achievement of targets. 17/12/2022
Implementing a NDP/NMP • Creating a national consultative forum – To oversee policy implementation. – To maintain countrywide support for the policy – To ensure that the major stakeholders remain informed and involved. • Financial resources – Actively seeking funds and be able to secure regular funding from the government, international and local donors. – there should be no conflict of interest in accepting donor contributions 17/12/2022
2. Drug management cycle 17/12/2022
Drug Supply Management cycle 17/12/2022
Drug Supply Management cycle • Management support → core – Organization → functional orgn’l structure – Financing and sustainability → adequate – Information management → reliable – HR management → motivated staff • The entire framework relies on policies, laws and regulation 17/12/2022
Drug Supply Management cycle • NDP/NMP provides a sound foundation for managing pharmaceutical supply • Wise medicine selection underlies all other improvements • Effective management and good governance save money and improve performance • Rational medicine use requires more than just dissemination of information's • Systematic assessment and monitoring are essential 17/12/2022
The Logistics cycle 17/12/2022
The Logistics cycle • What Is Logistics? • “Supply chain management encompasses the planning and management of all activities involved in sourcing and procurement…and all logistics management activities. Importantly, it also includes coordination and collaboration with channel partners, which can be suppliers, intermediaries, third party service providers, and customers. • In essence, supply chain management integrates supply and demand management within and across companies.” 17/12/2022
The Logistics cycle • Logistics management as— – part of supply chain management that plans, implements, and controls the efficient, effective forward and reverses flow and storage of goods, services and related information between the point of origin and the point of consumption in order to meet customers’ requirement… 17/12/2022
17/12/2022 Introduction to Logistics & Supply Chain Management
Introduction…..cont’d • Different product • Different supply chain • Every product has story • Multiple supply chain – Rare to find a product created, manufactured, and consumed at the same time and place • Perishability – Banana vs. pumps • Source – Single source – Multiple source • Customer – Consumer e.g. women for shoes – B2C e.g. banana – Manufacturer – Construction company • Similarity in decision making – How much inventory – How do I forecast demand – Where to stock inventory – How do I move product from source to final destination • Difference – Value – Outcome 17/12/2022
• Supply chain – is a network of interconnected organizations or organizational entities developed with the goal of getting the right product to the right place at the right time – Two or more parties linked by a flow of resources – typically material, information, and money – that ultimately fulfill a customer request – SCM term coined 1980 – Before 1980, logistics, operations management terms were used 17/12/2022
17/12/2022
Simple chain or web 17/12/2022
Examples of supply chain 17/12/2022
17/12/2022
1-120 Supply Chain: Flows (2) Suppliers Manufacturers Distributors Customers After-sales support, Recycling, Order information, Payments Material, Information, Invoicing
Process View of Supply Chains • Four Primary Cycles – Customer Order Cycle – Replenishment cycle – Manufacturing Cycle – Procurement Cycle • Cycles Occur Between Stages – Interactions differ at each stage • Not every SC will have all 4 Cycles 17/12/2022
Macro Process (Software) Perspective 17/12/2022
Supply-Chain Operations Reference (SCOR) Model 17/12/2022
• SCM – Logistics management – Supplier relationship management – Customer relationship management 17/12/2022
Supply chain management • encompasses the planning and management of all activities involved in sourcing and procurement, conversion, and all logistics management activities. • Importantly, it also includes coordination and collaboration with channel partners, which can be suppliers, intermediaries, third party service providers, and customers. • In essence, supply chain management integrates supply and demand management within and across companies. 17/12/2022
• Logistics management – is that part of supply chain management that plans, implements, and controls the efficient, effective forward 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. 17/12/2022
• The pharmaceutical supply chain – is the management of product supply from raw material sourcing to active ingredient manufacturing through formulation, packaging and distribution to the patient. – It is the means through which medicines are delivered to patients. 17/12/2022
Pharmaceutical SCM in Ethiopia 17/12/2022 International/Local Source PUBLIC (PFSA Central) PFSA Hub Hospitals Health Centers Health Posts CLIENTS Wholesalers PRIVATE IMPORTERS Retailers (Pharmacy , drug store rural drug vendor) Hospitals, Clinics
The Logistics cycle • Why Logistics Matters • Well functioning supply chain benefit public health programs – increasing program impact • No product? No program! – enhancing quality of care – improving cost effectiveness and efficiency. 17/12/2022
Restaurant 17/12/2022
The Logistics cycle The PURPOSE of a logistics system is to get the RIGHT QUANTITIES of the RIGHT GOODS to the RIGHT PLACES at the RIGHT TIME in the RIGHT CONDITION at the RIGHT COST. 17/12/2022
Customer satisfaction 17/12/2022
Purpose of Product Selection or Advantages of limited list of Essential Medicines • Supply – Make the supply chain more manageable • Easier procurement, storage and distribution – Lower stocks – Better quality assurance • Prescribing – Training is more focused and therefore simpler – More experience with fewer medicines – Non availability of irrational treatment – Reduction of antimicrobial resistance – Focused drug information – Better recognition of ADR 17/12/2022
Purpose of Product Selection or Advantages of limited list of Essential Medicines • Cost – Lower prices, more competition • Patient use – Focused education efforts – Reduced confusion and increased adherence to treatment – Improved medicine availability 17/12/2022
Selection of Essential Medicines • Selection criteria – The national EML – Whether the product is registered in the country by the pharmaceutical regulatory authority – National STGs – Pattern of prevalent disease – Treatment facilities – Training and experience of available personnel – Financial resources – Genetic, demographic and environmental factor – Safe, efficacious, quality 17/12/2022
Selection of Essential Medicines – When two or more medicines appear to be similar • their relative efficacy, safety, quality, price and availability. • Cost – Consider the total cost of treatment rather than the unit cost of the medicine – The basis of a cost-effectiveness analysis. • Other factors such as – PK properties, availability of facilities for storage or manufacturers. 17/12/2022
3.2 Managing Procurement 17/12/2022
Definition of procurement • Procurement refers to obtaining goods, works, consultancy or other services through purchasing, hiring or obtaining by any other contractual means. • Procurement Management is defined as the process of acquisition of goods and non- consulting services and/or obtaining goods and services through grants, employment of contractors and consultants 12/17/2022 138 የኢትዮጵያኤሌክትሪክኃይል ETHIOPIANELECTRICPOWER
Definitions for different Types of Procurement • Goods mean – raw material, products and equipment and commodities in solid, liquid or gaseous form, marketable software and live animals as well as installation, transport, maintenance or similar obligations related to the supply of the goods if their value does not exceed that of the goods themselves. • Services mean – any object of procurement other than works, goods and consultancy services: such as maintenance, security, janitorial, electricity, telecommunication and water supply services. 12/17/2022 139
Cont… • Works mean – all work associated with the construction, reconstruction, up grading, demolition, repair or renovation of a building road, or structure, as well as services incidental to works, if the value of those services does not exceed that of the works themselves and includes build-own-operate, build- own-operate-transfer and build operate- transfer contracts. • Consultancy Service means – a service of an intellectual and advisory nature provided by consultants using their professional skills to study, design and organize specific projects, advice clients, conduct training and transfer knowledge. 12/17/2022 140
Procurement Vs Purchasing • Procurement deals with the sourcing activities, negotiation and strategic selection of goods and services that are usually of importance to an organization. • Purchasing can usually be described as the transactional function of procurement for goods or services. 12/17/2022 141
Basic Principles in Procurement 1) Best Value for Money  Economy  Efficiency  Effectiveness 2) Fairness 3) Transparency 4 ) Competitiveness 12/17/2022 142
Centralized and Decentralized Procurement Functions • What does centralized procurement function mean? • What does decentralized procurement function mean? 12/17/2022 143
Centralized vs Decentralized procurement structure • Pros of Centralized procurement structure are  Greater Specialization  Consolidation  Easier coordination and control  Effective planning and research work • Pros of Decentralized Procurement Structure are :  Easier coordinate on with operating departments  Speed of Operation  Effective Use of Local Sources  Plant Autonomy 12/17/2022 144
Factors affecting feasibility and desirability of centralization • Similarity of Materials Usage • Plant Department Size • Geographic Dispersion of plants 12/17/2022 145
Good Procurement Practice • Good Procurement Practice – Generic name – Limited to EML list or formulary list – Bulk purchases – Formal supplier qualification and monitoring – Competitive bidding process 17/12/2022
Good Procurement Practice – Commitment to a sole source – Order quantities based on reliable estimate of actual need – Reliable payment and good financial management – Transparency and written procedures – Separation of key functions – Product quality assurance program – Annual audit with published results – Regular reporting on performance 17/12/2022
17/12/2022
procurement process Program Planning • It is a collection of organizational resources that is geared to accomplish a certain major goal or set of goals. • It is like an organization , it is a system with inputs, processes, outputs (tangibles) and outcomes (impacts on customers)-with ongoing feedback among the parts. 12/17/2022 149 የኢትዮጵያኤሌክትሪክኃይል ETHIOPIANELECTRICPOWER
Program vs project • Project is temporary undertaking to create product or service. • A project has a defined start and end point and specific objectives that, when attained, signify completion. • A programme, on the other hand, is defined as a group of related projects managed in a coordinated way to obtain benefits not available from managing the projects individually. • A program is comprised of multiple projects and is created to obtain broad organizational or technical objectives. • There are many differences between a project and a programme including scope, benefits realization and time. 12/17/2022 150
2. Procurement planning • Basic Points 12/17/2022 151 Why How When What Who • To determine complete procurement requirements for project • Define packages • Define cost estimates / budget • Define procurement methods • Establish lead times • Determine procurement steps • Determine deadlines • Define specifications • Define quality standards • Project Manager • Procurement Unit • Control Units
Cont.. 3. Document Preparation • Specification • TOR • Drawing • Bidding Document • RFP 12/17/2022 152
Cont… 4.Bidding Period 5. Bid Submission and Opening 6. Bid Evaluation Process 7. Contract Administration 12/17/2022 153
• Procurement planning is the scheduling of stages involved in the procurement for goods, works, and services. • In this process, the following questions should be answered: – What goods and services will be procured? – Who will procure them? – How will they be procured ? – When will they be procured 12/17/2022 154 የኢትዮጵያኤሌክትሪክኃይል ETHIOPIANELECTRICPOWER
Basic Contents of Procurement Planning a) Description of goods or services b) The list of packages to be procured c) Estimated budget d) Method of procurement e) Review requirement f) Critical Stages of the bidding process 12/17/2022 155
Specific procurement methods 12/17/2022 156 LIB NCB Shopping Direct Contracting Force Account Same as ICB but no advertisement Used when:  Contract value is small  Number of suppliers is limited  Exceptional reasons exist Domestic preference not applicable National public procurement procedures are used Advertised in official gazette or local papers of nation-wide circulation National procedures must meet Bank criteria for transparency, efficiency, and economy Used when:  Goods or works that, by nature and scope, are unlikely to attract foreign competition  Contract value is small  Works are scattered geographically and over time  Goods are available locally at prices lower than international market  ICB is not cost- effective Quotations are sought from at least three suppliers. Request for quotations shall indicate description and quantity of the goods, as well as desired delivery time and place. International: at least three bids from two countries National: when goods are ordinarily available locally at competitive prices Offers received by fax and purchase orders issued contain the terms of the accepted offer Used when:  Contract value is low  Off the shelf goods and standard specification commodities of low value are being purchased Instead of shopping, IAPSO may be used as procurement agent for motor vehicles, information technology equipment, office equipment and supplies, and audio visual and communication equipment No competition; single source Used when:  Contract extensions when original contracts were awarded following Bank procedures  Standardization of equipment or spare parts is needed  Proprietary equipment is needed  Critical items must be purchased from one supplier as a condition of performance guarantee  Exceptional circumstances exist, such as natural disasters Borrower’s own personnel and equipment may be the only practical method for constructing some kind of works. Used when:  Quantities cannot be defined in advance  Works are small and scattered in remote locations  Risk of work interruption is better borne by the Borrower  Emergencies require prompt attention
Basic Points • Process Layout • Best Value for Money • Monitoring and Evaluation • Living Document • Lead-time • Backward Planning • Multidisciplinary 12/17/2022 157
Procurement Challenges • Accurate quantification and forecast data • Lengthy procurement process • Delays in funding allocation and release • Product quality assurance • Transparency 17/12/2022
Factors influencing pharmaceutical prices and total costs • Unit price – Competition among supplier • number of products and generic version – Rule of five • Gov’t policy – registration, licensing, prescribing, dispensing • Procurement method • Reorder frequency and the total cost of pharmaceutical purchasing – Total cost = Drug acquisition price + inventory holding cost + purchase operating cost + shortage cost 17/12/2022
Factors influencing pharmaceutical prices and total costs – Cost minimized by Reorder frequency • Interval b/n order (annual, scheduled, perpetual) • Safety stock target- lead time, consumption pattern, service level • Visible and hidden costs – Total cost= Hidden cost + visible cost 17/12/2022
17/12/2022
Key terms in health commodity procurement • Tender – The documentation and initiation of a process for soliciting bids; the specifications for the product/service desired and opening the contract to the bidding process. • Bid – A written offer for a quantity of goods, works, or services, at a stated price; based on technical specifications and other terms and conditions. 17/12/2022
Procurement methods • A procurement method is the technique that public body uses to acquire goods, works and services. • The method selected depends on a number of factors including: – the type of goods or service being procured – the value of the good or service being procured – the potential interest of foreign bidders – the cost of the procurement process itself. • Public bodies shall use open bidding as the preferred procedure of procurement except as otherwise provided in this Proclamation No. 649/2009. - 17/12/2022
• Public bodies may use a method other than open bidding only where conditions for use of such other method stipulated under this Proclamation are satisfied. • A procurement methods: – Open Bidding • International Competitive Bidding • National Competitive Bidding – Two Stage Bidding – Framework Approach – Limited Bidding – Request for Quotation – Direct Contracting. 17/12/2022
Procurement methods • Open Bidding/tender – Is a formal procedure by which quotations are invited from any suppliers on a local or worldwide basis, subjects to the terms and conditions specified in the tender invitation – all interested bidders are given adequate notification of contract requirements – all eligible bidders are given an equal opportunity to submit a tender – The Public body must give sufficient public notification of bidding opportunities to potential bidders to determine their interest and prepare bid documents. – the preferred procedure of procurement. – a method other than open bidding is used only where conditions for use of such other method stipulated under this proclamation are satisfied. 17/12/2022
• International Competitive Bidding (ICB) – is a procurement procedure where bidding is open to all local or international legal entities interested in submitting a tender – shall be used wherever in national open bidding an effective competition cannot be obtained unless foreign firms are invited to bid. – The objective of ICB is to provide all eligible prospective bidders with timely and adequate notification of purchasers' requirements and an equal opportunity to bid for the required goods and works. 17/12/2022
• National Competitive Bidding (NCB) – NCB is the procurement procedure where Invitation to Bid is restricted to the Federal Democratic Republic of Ethiopia. – NCB is preferred when • an effective competition can be obtained where both national and foreign firms are invited to bid. • There are circumstances where ICB would not be the most economic and efficient method of procurement, and where NCB is deemed more appropriate. • 17/12/2022
Procurement methods • Limited Bidding /RESTRICTED TENDERING – It includes both national and international. – Interested suppliers must be approved in advance (prequalification process) • conditions for RESTRICTED TENDERING – the required object of procurement is available only with limited suppliers; – the cost of procurement does not exceed the threshold specified – when the goods or services by reason of the highly complex or specialized nature – are only available from a limited number of suppliers. – he time and cost required to examine and evaluate a large number of bids would be disproportionate to the value of the goods or services to be procured. – This method is very similar to ICB/NCB using almost identical bidding documents. 17/12/2022
• Two Stage Bidding • Public bodies may engage in procurement by means of two-stage bidding: – when it is not feasible for the Public body to formulate detailed specifications for the goods or works and in the case of services, to identify their characteristics and, in order to obtain the most satisfactory solution to its procurement needs; – when the Public body seeks to enter into a contract for the purpose of research, experiment, study or development" except where the contract includes the production of goods in quantities sufficient to establish their commercial viability or to recover research and development costs; – where bid proceedings are initiated but no bids are submitted as a result of the nature of the object of procurement not being clearly described or where all bids are rejected due to failure; – Because of the technical character of the required goods or works, or because of the nature of the consultancy or other services it is necessary for the Public body to negotiate with the suppliers. 17/12/2022
Procurement methods • Request for Quotations – for the purchase of readily available goods for which there is an established market – the estimated value of the contract does not exceed an amount stated in the procurement directive to be issued by the Minister. – Request for quotation can be theoretically both from National and International suppliers or even a mixture. – In practice, it is usually only used for national due to the limitation of the threshold that would make it extremely unlikely, a response would be received from an International. This method only requires quotations to be solicited from at least three different suppliers. 17/12/2022
Procurement methods • Direct Procurement – is when the purchaser establishes direct contact with suppliers (without competition) or their representatives. – it can be applied both for domestic and foreign Contractors/ Suppliers/ Consultants. • Conditions for Direct Procurement – in absence of competitions (goods, works consultancy) or provided only by one candidate; – for additional deliveries of goods by the original supplier • replacement , installations or as the extension of existing supplies, – additional works, which have been not included in the initial contract – During emergency 17/12/2022
• General circumstances for direct contracting – Emergency – Urgency (very seldom seen in international best practice) – When a competitive bidding process has been conducted several times without satisfactory result – Procure or lease real estate property – Standardization – Established prices/rates – Existing contract (including contract variations & amendments) – Procuring based on a competitive bidding conducted within last e.g. 12 months – same item/prices – Professional services that cannot be objectively evaluated. – Situations, where formal solicitation will not give satisfactory result 17/12/2022
• Framework contracts – often a way to avoid emergency procurement – Establishing long term zero-contract framework contracts based a competitive process and with short notices for delivery is a common way to avoid ‘emergency’ and ‘urgency’ procurement. – If such zero-framework contracts are established for goods/services which have a history for falling under emergency/urgency, the products/services can be required with short notice – and still based on competitive tendering. – Whether or not the need comes up: the cost of having the zero framework contracts is zero. 17/12/2022
International Commercial Terms
3.1 INCOTERMS as stipulated by the ICC • INCOTERMS are a series of pre-defined commercial terms published by the International Chamber of Commerce widely used in international commercial transactions. • internationally accepted terms • Intended primarily to clearly communicate the tasks, costs and risks associated with the transportation and delivery of goods. • Accepted by governments, legal authorities and practitioners worldwide for the interpretation of most commonly used terms in IT. • Intended to reduce or remove altogether uncertainties arising from different interpretation of the rules in different countries. • First published in 1936, periodically updated, (1953, 1967, 1976, 1980, 1990, 2000) with the eighth version—INCOTERMS 2010— having been published on January 1, 2011.
• INCOTERMS – Define the responsibilities of exporters and importers in the arrangement of shipments and the transfer of liability involved at various stages of the transaction. – Do not cover ownership or the transfer of title of goods. – It will affect the costs and responsibilities involved in shipping, insurance and tariffs.
Cont…d • Appropriate term needs to be chosen • E.g., EXW – an exporter needs to make the goods available for pick up and provide any product information needed. – The importer's agent (freight forwarder) will arrange and pay for the pre-carriage, shipping, insurance and any additional costs from the exporter's door. • CIF – term requires the exporter to arrange and pay for the pre-carriage, shipping, and insurance to a named port of destination. – In this case, the sale price (invoice) includes the Cost of goods, Insurance and Freight costs that the importer pays the exporter.
Cont…d • The 2010 version consists 11 terms grouped into two • Rules for Sea and Inland Waterway Transport: • FAS - Free Alongside Ship – Risk passes to buyer, including payment of all transportation and insurance costs, once delivered alongside the ship (realistically at named port terminal) by the seller. The export clearance obligation rests with the seller. • FOB - Free On Board: – Risk passes to buyer, including payment of all transportation and insurance costs, once delivered on board the ship by the seller. • CFR - Cost and Freight – Seller delivers goods and risk passes to buyer when on board the vessel. – Seller arranges and pays cost and freight to the named destination port. A step further than FOB. • CIF - Cost, Insurance and Freight – Risk passes to buyer when delivered on board the ship. – Seller arranges and pays cost, freight and insurance to destination port. – Adds insurance costs to CFR.
Cont…d • Rules for Any Mode or Modes of Transportation: • EXW - Ex Works: – Seller delivers (without loading) the goods at disposal of buyer at seller's premises. – Long held as the most preferable term for those new-to-export because it represents the minimum liability to the seller. • FCA - Free Carrier: – Seller delivers the goods to the carrier and may be responsible for clearing the goods for export. More realistic than EXW because it includes loading at pick-up, which is commonly expected, and sellers are more concerned about export violations. • CPT - Carriage Paid To: – Seller delivers goods to the carrier at an agreed place, shifting risk to the buyer, but seller must pay cost of carriage to the named place of destination. • CIP - Carriage and Insurance Paid To: – Seller delivers goods to the carrier at an agreed place, shifting risk to the buyer, but seller pays carriage and insurance to the named place of destination.
Cont…d • DAT - Delivered at Terminal: – Seller bears cost, risk and responsibility until goods are unloaded (delivered) at named quay, warehouse, yard, or terminal at destination. – Demurrage or detention charges may apply to seller. – Seller clears goods for export, not import. • DAP - Delivered at Place: – Seller bears cost, risk and responsibility for goods until made available to buyer at named place of destination. Seller clears goods for export, not import. • DDP - Delivered Duty Paid: – Seller bears cost, risk and responsibility for cleared goods at named place of destination at buyers disposal. – Buyer is responsible for unloading. – Seller is responsible for import clearance, duties and taxes so buyer is not “importer of record”.
INCOTERMS 2010 Grou p Description Abb. Terms Detail Terms E The seller’s obligation is at its minimum: the seller has to do no more than place the goods at the disposal of the buyer at the agreed place - usually at the seller’s own premises. EXW EX Work (Named Place) F The seller to deliver the goods to a nominated carrier as instructed by the buyer. F stands for Free. FAS Free Alongside Ship (Name port of loading/shipment) FOB Free On Board (Named port of shipment) FCA Free Carrier (Named Place) C The seller to contract for carriage on usual terms at his own expense. Therefore, a point up to which he would have to pay transport costs must necessarily be indicated after the respective “C” term CFR Karachi. C stands for “Cost/Carriage”. CFR Cost of Freight (Named port of destination) CPT Carriage Paid To (Named place of destination) CIF Cost, Insurance & Freight (Named place of destination) CIP Carriage & Insurance Paid to (Named place of destination) D The seller bears all costs & risks related to the delivery of the goods DAF Delivered at Terminal DAP Delivered at Terminal 181
INCOTERMS 2000 – Risk Snapshot 182
Cont…d
Role of Banks (Commercial /National)  Banks provide services such as  advice on financial issues, IT processes, documentation, banking procedures and the potential risks involved.  Documentary requirements – Buyer - What documents does he needs? – Seller - With what documents will he be able to supply? – Country of export - what documents are required under the regulations of the exporting country? – Country of import - what documents are required under the regulations of the importing country? 184
Role of Banks (Commercial / National) • Wants/needs and problem of trading partners Partner Wants / Needs Problems Buyer Wants 1. Contract fulfillment. 2. Convenience. 3. Credit. 4. Advice and assistance 1. Am I going to get the goods? (in good condition / in time) 2. Does the settlement method safeguard these risks? 3. Before we pay—how to check the goods are exactly those ordered? 4. Any credit terms available Prefers to delay paying for the goods until they are sold. 5. From where can I get information on the exporter’s creditability Seller Needs 1. Contract fulfillment. 2. Convenience. 3. Prompt payment. 4. Advice and 1. Will I be paid? 2. When will I be paid? 3. How to minimize risk of non-payment? 4. How to maintain secrecy of our supplier? 185
Role of Banks (Commercial / National)  Basic agreement (International Trade – Sale Contract) 1. Preliminary Quotation & Commitment (Invoicing / order etc) 2. The Merchandise (goods to be imported / exported) 3. Packing (instructions regarding packing of imported / exported merchandise) 4. Method of Settlement 5. Shipping Instructions (trans shipment – partial shipment etc) 6. Price and its components (INCOTERMS 2010) 7. Delivery Mode ,Period, Place (Sea, Air, Road – place of shipment and last date of shipment) 8. Documents (Invoice, packing list, inspection report, certificate of origin, Bill of lading (B/L) and Airway bill (AWB) etc) 186
Making and Receiving Payment Internationally : International Payment Instruments • payment methods available in settling an international trade transaction. – Clean Payments – Documentary Collections – Letters of Credit
Clean Payments •Clean Payments are characterized by trust. • Either the Exporter sends the goods and trusts the Importer to pay once the goods have been received, or the Importer trusts the Exporter to send the goods after payment is effected. •In the case of Clean Payment transactions, all shipping documents, including title documents, are handled directly by the trading parties. The role of banks is limited to clearing funds as required. •There are two types of Clean Payments: Open Account & Payment in Advance. •Open Account. The Importer is trusted to pay the Exporter after receipt of the goods. •Payment in Advance. An arrangement whereby the Exporter is trusted to ship the goods after receiving payment from the Importer.
Clean Payments How does an Open Account transaction work? OPEN ACCOUNT: The Exporter ships the goods and the documents directly to the Importer and waits for the Importer to send payment. Exporter Importer 2 GOODS 1 PAYMENT
Clean Payments How does a Payment in Advance transaction work? PAYMENT IN ADVANCE: The Importer sends payment directly to the Exporter and waits for the Exporter to send the goods and documents. Exporter Importer 2 GOODS 1 PAYMENT
Risk Analysis: Clean Payments Advantages to Exporter: •Assumes no risks Disadvantages to Exporter: •None Advantages to Importer: •None - but could secure low cost! Disadvantages to Importer: •Assumes all risks •Opportunity cost of using company’s cash resources until goods are received. Open Account Payment in Advance Advantages to Exporter: •None - but could clinch the sale! Disadvantages to Exporter: •Assumes all risks Advantages to Importer: •Assumes no risks •Delays use of company’s cash resources. Disadvantages to Importer: •None
Documentary Collections What is a Documentary Collection? •A method of payment used in international trade whereby the Exporter entrusts the handling of commercial and often financial documents to banks and gives the banks instructions concerning the release of these documents to the Importer. •Banks involved do not provide any guarantee of payment. •Documents Against Payment (D/P) & Documents Against Acceptance (D/A) Documentary Collections may be carried out in two different ways: •Documents Against Payment. Documents are released to the Importer only against payment. Also known as a Sight Collection or Cash Against Documents (CAD). •Documents Against Acceptance. Documents are released to the Importer only against acceptance of a draft. Also known as a Term Collection.
Documentary Collections How does a Documentary Collection work? The mechanics of a Documentary Collection are easily understood when separated into the following three steps: » Flow of Goods » Flow of Documents » Flow of Payment
Documentary Collections: Flow of Documents After the goods are shipped, documents originating with the Exporter (e.g. commercial invoice) and the transport company (e.g. bill of lading) are delivered to a bank, called the Remitting Bank in the Collection process. The role of the Remitting Bank is to send these documents accompanied by a Collection Instruction giving complete and precise instructions to a bank in the Importer’s country, referred to as the Collecting/ Presenting Bank in the Collection process. The Collecting/ Presenting Bank acts in accordance with the instructions given in the Collection Instruction and releases the documents to the Importer against payment or acceptance, according to the Remitting Bank’s Collection instructions. Note: The Exporter’s Bank and the Remitting Bank need not be the same. Also, the Collecting Bank and Presenting Bank need not be the same. Each role could be performed by a different bank. Collecting/ Presenting Bank Importer/D rawee Remitting Bank 2 3 4 Exporter/D rawer GOODS 1 Documents Documents Documents
Documentary Collections: Flow of Payment Payment is forwarded to the Remitting Bank for the Exporter’s account. And the Importer can now present the transport document* to the carrier in exchange for the goods. Remitting Bank Presenting/ Collecting Bank 1 2 Exporter/D rawer Importer/D rawee Documents 4 3 *In this case, we are assuming that the transport document is a title document. GOODS
Risk Analysis: Documentary Collections Documentary Collections may be settled in two different ways. Documents Against Payment (D/P) refers to a Collection where the Importer receives the documents only in exchange for payment. With Documents Against Acceptance (D/A), the Importer may obtain the documents in exchange for the acceptance of the obligation to pay at a specified future date. These two methods of settlement carry different risks for both Importers and Exporters. Documents Against Payment (D/P) Documents Against Acceptance (D/A) Advantages to the Exporter: •Documents are not released to the Importer until payment has been effected. •Less costly than a Letter of Credit. Disadvantages to the Exporter: •Risk of refusal of payment. •Commercial and country risks not hedged. Advantages to the Importer: •Ability to examine documents before authorizing payment. •Unlike a Letter of Credit, a line of credit is not required, and fees are minimal. Disadvantages to the Importer: •In the case that transport documents carry title, cannot access goods until payment has been made. Advantages to the Exporter: •Less costly than a Letter of Credit. •May provide formal/legal means to collect unpaid obligation. Disadvantages to the Exporter: •Risk of non-acceptance of documents. •Commercial and country risks not hedged. •Although bill of exchange/draft is accepted by the Importer, there is no guarantee of payment by the banks involved. •Legal enforcement of unpaid obligation costly and time- consuming. Advantages to the Importer: •Will receive goods before having to make payment. Disadvantages to the Importer: •Dishonouring an accepted draft is a legal liability and may ruin business reputation.
Letters of Credit •A Letter of Credit is a written undertaking by the Importer’s bank, known as the Issuing Bank, on behalf of its customer, the Importer (Applicant), promising to effect payment in favor of the Exporter (Beneficiary) up to a stated sum of money, within a prescribed time limit and against stipulated documents. •A key principle underlying Letters of Credit is that banks deal only in documents and not in goods. •The decision to pay under a Letter of Credit will be based entirely on whether the documents presented to the bank appear on their face to be in accordance with the terms and conditions of the Letter of Credit. • It would be prohibitive for the banks to physically check whether all merchandise has been shipped exactly as per each letter of Credit. What is a Letter of Credit?
Letters of Credit • Letters of Credit are either Revocable or Irrevocable: – A Revocable Letter of Credit can be revoked without the consent of the Exporter, (it may be canceled or changed up to the time the documents are presented). – An Irrevocable Letter of Credit cannot be canceled or amended without the consent of all parties including the Exporter. Unless otherwise stipulated, all Letters of Credit are irrevocable. • Letters of Credit may be settled either by sight or by acceptance: – If payment is to be made at the time that documents are presented, this is referred to as a sight Letter of Credit. – If payment is to be made at a future fixed time from the presentation of documents, this is referred to as a term Letter of Credit Basic Facts: Revocable/Irrevocable & Sight/Term
Letters of Credit Confirmed Letter of Credit •Under a Confirmed Letter of Credit, a bank, called the Confirming Bank, adds its commitment to that of the Issuing Bank to pay the Exporter under the Letter of Credit provided all terms and conditions of the Letter of Credit are met. The Confirming Bank is usually located in the same country as the Exporter. •An Exporter would request a Confirmed Letter of Credit if it does not consider the financial strength of the Issuing Bank or the country in which it is located to be acceptable risks.
Letters of Credit How does a Letter of Credit work? The mechanics of a Letter of Credit are easily understood when separated into the following three steps: »Issuance »Flow of Goods »Flow of Documents & Payment
Letters of Credit: Issuance After the trading parties agree on a sale of goods where payment is made by Letter of Credit, the Importer requests that its bank (the Issuing Bank) issue a Letter of Credit in favour of the Exporter (Beneficiary). The Issuing Bank then sends the Letter of Credit to the Advising Bank. A request may be included for the Advising Bank to add its confirmation. The Advising Bank is usually located in the country where the Exporter does business and may be the Exporter’s bank, but does not have to be. Next, the Advising/Confirming Bank verifies the Letter of Credit for authenticity and sends it to the Exporter. 1 Importer applies for Letter of Credit. 3 Request to advise & possibly confirm the Letter of Credit Advice /Confirmation of the Letter of Credit. Advising/ Confirming Bank Issuing Bank 2 4 Exporter/ Beneficiary Importer/A pplicant Contract Negotiations
Letters of Credit: Flow of Goods Upon receipt of the Letter of Credit, the Exporter reviews the Letter of Credit to ensure that it corresponds to the terms and conditions in the purchase and sales agreement; that the documents stipulated in the Letter of Credit can be produced; and that the terms and conditions of the Letter of Credit can be fulfilled. Assuming the Exporter is in agreement with the above, it arranges for shipment of the goods. GOODS Exporter/Beneficiary Importer/Applicant
Letters of Credit: Flow of Documents & Payment After the goods are shipped, the Exporter presents the documents specified in the Letter of Credit to the Advising/ Confirming Bank. Once the documents are checked and found to comply with the Letter of Credit (i.e. without discrepancies), the Advising/ Confirming Bank forwards these documents to the Issuing Bank. The drawing is negotiated, paid or accepted as the case may be. Issuing Bank 2 4 Exporter/ Beneficiary Importer/A pplicant Documents 5 Documents 3 Advising/ Confirming Bank 1 GOODS
Letters of Credit: Flow of Documents & Payment In turn, the Issuing Bank examines the documents to ensure they comply with the Letter of Credit. If the documents are in order, the Issuing Bank will obtain payment from the Importer for payment already made to the Confirming Bank. Documents are delivered to the Importer to allow it to take possession of the goods. Issuing Bank 2 4 Exporter/ Beneficiary Importer/A pplicant Documents 6 5 Documents Documents 3 7 Advising/ Confirming Bank 1 GOODS
Risk Analysis: Letters of Credit Importer Exporter Advantages: •An undertaking from the Issuing Bank that you will receive payment under the Letter of Credit provided that you meet all terms and conditions of the Letter of Credit. •Shifts credit risk from the Importer to the Issuing bank. •Not obligated to ship against a Letter of Credit that is not issued as agreed. Disadvantages: •Documents must be prepared in strict compliance with the requirements stipulated in the Letter of Credit. Non- compliance leaves Exporter exposed to risk of non-payment. Advantages: •Importer is assured that, for the Exporter to be paid, all terms and conditions of the Letter of Credit must be met. •Ability to negotiate more favourable trade terms with the Exporter when payment by Letter of Credit is offered. Disadvantages: •A Letter of Credit assures correct documents but not necessarily correct goods. •Ties up line of credit.
INTERNATIONAL PAYMENTS RISK SPECTRUM Notice that Open Account and Payment in Advance sit at opposite ends of the Risk Spectrum. Documentary Collections offer more of a compromise in risk-taking between the Importer and the Exporter than Clean Payments. Whereas payment settled via Open Account and Payment in Advance represent a high degree of risk for one of the parties involved, both Documentary Collections and Letters of Credit offer a compromise in risks facing the Importer and the Exporter. LEAST RISK TO IMPORTER HIGHEST RISK TO IMPORTER HIGHEST RISK TO EXPORTER LEAST RISK TO EXPORTER •Open Account •Documentary Collections Documents Against Acceptance Documents Against Payment •Letters of Credit Unconfirmed Confirmed •Payment in Advance
Procurement and Purchasing - what's the difference? • Procurement – is the wider aspects related to the activities associated with the provisioning of equipment, products and services encompassing policy and strategy development and implementation, provisioning strategies and demand management etc. • Purchasing – is the procedural aspects related to competitive processes and the methods employed to actually purchase equipment, products and services. 17/12/2022
3.2.2. Quantification of drug requirements • Quantification- how much product is required for purchasing – Estimates the required finance • To estimate needs – Available funds – Storage space capacity – Human resource 17/12/2022
Logistics Terms • Lead Time: Lead time is the time interval between when new stock is ordered and when it is received and available for use. • Push System • Pull System • Dispensed-to-User Data • Issues Data • Inventory Control System
PIPELINE: The pipeline is the entire chain of storage facilities and transportation links through which supplies move from the manufacturer to the consumer, including the port facilities, central warehouse, regional warehouses, district warehouses, all service delivery points and transport vehicles.
PUSH vs. PULL SYSTEM PULL SYSTEM (REQUISITION) : Quantities to be issued are determined by personnel who receive the supplies. PUSH SYSTEM (ALLOCATION) : Quantities to be issued are determined by personnel who issue the supplies.
DISPENSED-TO-USER vs. ISSUES DATA DISPENSED-TO-USER DATA: Information about the quantity of goods actually put in the hands of clients. (Often shortened to “dispensed data.”) ISSUES DATA: Information about the quantity of goods shipped from one level of the system to another.
2018 Christian N. & Seid Y. 5. Demand Forecasting
2018 Christian N. & Seid Y. 17/12/2022 Type of products
2018 Christian N. & Seid Y. Quora: ”Demand forecasting is predicting future demand for the product. In other words, it refers to the prediction of probable demand for a product or a service on the basis of the past events and prevailing trends in the present.” What actually is demand forecasting ? Source: KLU T-T-T 2018
2018 Christian N. & Seid Y. Introduction…..cont’d  Different products  Different supply chain  Perishability  Banana vs. pumps  Source  Single source  Multiple source  Customer  Consumer e.g. women for shoes  B2C e.g. banana  Manufacturer  Construction company  Similarity in decision making  How much inventory  How do I forecast demand  Where to stock inventory  How do I move product from source to final destination  Difference  Value  Outcome 17/12/2022
2018 Christian N. & Seid Y.  An accurate forecast is crucial for almost all business decisions, e.g., production planning, capacity planning, inventory management, work force management, budget allocation, etc.  More accurate forecasts lead to better resource allocation and thus improved financial performance. WHY DO WE NEED DEMAND FORECASTING? Source: KLU T-T-T 2018
2018 Christian N. & Seid Y. Demand Process- Three key questions
2018 Christian N. & Seid Y. Forecasting levels
2018 Christian N. & Seid Y. Forecasting Truisms
2018 Christian N. & Seid Y. Forecasting quality 17/12/2022
2018 Christian N. & Seid Y. Forecast error increases with lead time Forecast error Lead time + -
2018 Christian N. & Seid Y. Marketing/ Logistic / sales 29% Operation/Prod uction 27% Forecasting Department 19% Finance 7% Strategic planning 6% Others 12% Place of Forecasters Source: Chaman Jain, “Benchmarking Forecasting Processes,” Journal of Business Forecasting 26, no. 4 (Winter 2007–08), p.12.
2018 Christian N. & Seid Y. Company Krispy Kreme Doughnuts GSK Phar Company Fiat Auto Data used • seasonal factors. • general population Growth • foot traffic • display locations Sales data GDP interest rate inflation rate raw-material prices Forecast method multiple forecasting system Quantitative methods and personal judgments Quantitative Use of forecast • to provide information related to production requirements • to provide financial forecast • To allocate resource for HR planning, for promotions & strategic planning • To set sales quotas. To estimate total sales of vehicles, engines, and gears
2018 Christian N. & Seid Y. Fundamental approaches to forecasting Forecasting methods Qualitative or judgemental Quantitative or statistical Projective • Projecting past patterns / trends into the future Causal • Examining external factors that affect demand to forecast demand
2018 Christian N. & Seid Y. Forecasting Methods
2018 Christian N. & Seid Y. Qualitative methods Qualitative forecasting techniques are: subjective, based on the opinion and judgment of consumers, experts appropriate when past data are not available. usually applied to intermediate- or long-range decisions. 17/12/2022
2018 Christian N. & Seid Y. Jury of executive opinion Appropriate managers within the organization assemble to discuss their opinions on what will happen to demand in the future. experienced guesses the resulting forecast is a blend of informed opinions. How to do the forecast? select people from different functional areas to get rich information Opinions can be collected in individual interviews or in a meeting Meeting Adv: an opportunity to discuss various points of view and deeper insights Dis-adv: people with strong personalities dominate the group, their opinions will become disproportionately important in the final consensus that is reached. 17/12/2022
2018 Christian N. & Seid Y. Delphi Method Delphi Method- gathers, evaluates, and summarizes expert opinions as the basis for a forecast, but the procedure is more formal than that for the jury of executive opinion method. Adv: takes the wisdom and insight of people who have considerable expertise about the area to be forecast. anonymity among the participants. The experts, perhaps five to seven in number Experts never meet to discuss their views none of them even knows who else is on the panel. 17/12/2022
2018 Christian N. & Seid Y. Delphi Method The Delphi Method has the following steps: STEP 1 – Participating panel members are selected. STEP 2. Questionnaires asking for opinions about the variables to be forecast are distributed to panel members. STEP 3. Results from panel members are collected, tabulated, and summarized. – Copies of summary are given to the individual experts with the request that they modify their original answers if they think it necessary. STEP 4 – Another summary is made of these modifications, and copies again are distributed to the experts. This time, however, expert opinions that deviate significantly from the norm must be justified in writing. STEP 5 – A third summary is made of the opinions and justifications, and copies are once again distributed to the experts. Justification in writing for all answers is now required. STEP 6 – The forecast is generated from all of the opinions and justifications that arise from step 5. 17/12/2022
2018 Christian N. & Seid Y. Sales force composite Sales force composite: Marketers have sales managers or representatives at different sales territories (districts/region) and marketers believe that sales managers know their territory better than anybody else. Managers ask respective sales manager to forecast expected sales in their own territories. The total of all these estimates basically gives company’s sales/demand forecast for next period. Advantage: getting information from sources who are very close to actual Buyers Disadvantage: if sales force are given quotas and bonus is considered based on the assigned performance 17/12/2022
2018 Christian N. & Seid Y. Consumer market survey Customer Survey and the General Population Marketers ask buyers about how many units that they would like to purchase from company’s products for coming period of time. Assumption: buyers plan their purchases and follow through with their plans more realistic for industrial sales than for sales to households and individuals. more realistic for big-ticket items than for convenience goods Example: Survey data concerning how people feel about the economy are sometimes used by forecasters to help predict certain buying behaviors 17/12/2022
2018 Christian N. & Seid Y. Advantages and Disadvantage of qualitative methods Advantages Do not require any particular mathematical background of the individuals involved Wide acceptance by user Disadvantages always biased they are not consistently accurate over time it takes years of experience for someone to learn how to convert intuitive judgment into good forecasts. 17/12/2022
2018 Christian N. & Seid Y. Quantitative Forecasting methods-Time Series Methods
2018 Christian N. & Seid Y. Time series methods are statistical techniques that make use of historical data accumulated over a period of time. Time series methods assume that what has occurred in the past will continue to occur in the future. These methods relate the forecast to only one factor time. Two types of time series methods: the moving average and exponential smoothing. Time Series Methods
2018 Christian N. & Seid Y. Demand Time Common patterns in time series Demand Time Demand Time Demand Time Seasonality Seasonality & Trend Constant series Trend
2018 Christian N. & Seid Y.  Simple average  Moving average  Exponential smoothing Projective forecasting methods
2018 Christian N. & Seid Y. Simple average: an average of the demand in the past  Easy to apply and good results when demand is constant  Inappropriate when seasonality is present  Past demand figures are equally weighted, i.e. the forecast does not respond quickly to changes in demand 𝐹𝑜𝑟𝑒𝑐𝑎𝑠𝑡 27 = (𝐷𝑚𝑑1 + 𝐷𝑚𝑑2 + … + 𝐷𝑚𝑑26) 26 𝐹𝑜𝑟𝑒𝑐𝑎𝑠𝑡 27 = (49+50+ …+48) 26 = 50 Simple average 40 44 48 52 56 60 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 Demand (units) Time (weeks) Simple average Sales If a simple average is projected into the future, it results in a flat line forecast
2018 Christian N. & Seid Y. Moving average: an average of n past periods  Forecast is based on more recent sales data (but still equally weighted)  n determines which periods to be included in the forecast  What value of n to choose?  Small number (n=3) results in responsive forecast, while high number (n=10) gives a less sensitive forecast  The moving average method is good for stable demand with no pronounced behavioral patterns. 𝐹𝑜𝑟𝑒𝑐𝑎𝑠𝑡 27 = (𝐷𝑚𝑑24 + 𝐷𝑚𝑑25 + 𝐷𝑚𝑑26) 3 𝐹𝑜𝑟𝑒𝑐𝑎𝑠𝑡 27 = (52+30+48) 3 = 43 Moving average 15 20 25 30 35 40 45 50 55 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 Demand (units) Time (weeks) Moving average (n=10) Moving average (n=3) Sales The moving average projected into the future Drawbacks of averages: • all historical values are given the same weight • the method only works well with relatively constant demand
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia
Drug Supply Management in Ethiopia

Recommended

INTRODUCTION OF CLINICAL PHARMACY
INTRODUCTION OF CLINICAL PHARMACYINTRODUCTION OF CLINICAL PHARMACY
INTRODUCTION OF CLINICAL PHARMACYVenkata subbareddy Bareddy
 
Define clinical pharmacy
Define clinical pharmacyDefine clinical pharmacy
Define clinical pharmacyRafi Bhat
 
Drug information center
Drug information centerDrug information center
Drug information centerPARUL UNIVERSITY
 
Patient counselling
Patient counsellingPatient counselling
Patient counsellingDr. Ramesh Bhandari
 
Pharmacy and Therapeutic committee
Pharmacy and Therapeutic committeePharmacy and Therapeutic committee
Pharmacy and Therapeutic committeeRx Mukul Sunil Tambe
 
Role of community pharmacist
Role of community pharmacistRole of community pharmacist
Role of community pharmacistMd. Mynul Hasan
 
Drug information centers
Drug information centersDrug information centers
Drug information centersNica Solis
 
Good Dispensing Practice
Good Dispensing PracticeGood Dispensing Practice
Good Dispensing PracticeJavis Von Onias
 

Recommended

INTRODUCTION OF CLINICAL PHARMACY
INTRODUCTION OF CLINICAL PHARMACYINTRODUCTION OF CLINICAL PHARMACY
INTRODUCTION OF CLINICAL PHARMACYVenkata subbareddy Bareddy
 
Define clinical pharmacy
Define clinical pharmacyDefine clinical pharmacy
Define clinical pharmacyRafi Bhat
 
Drug information center
Drug information centerDrug information center
Drug information centerPARUL UNIVERSITY
 
Patient counselling
Patient counsellingPatient counselling
Patient counsellingDr. Ramesh Bhandari
 
Pharmacy and Therapeutic committee
Pharmacy and Therapeutic committeePharmacy and Therapeutic committee
Pharmacy and Therapeutic committeeRx Mukul Sunil Tambe
 
Role of community pharmacist
Role of community pharmacistRole of community pharmacist
Role of community pharmacistMd. Mynul Hasan
 
Drug information centers
Drug information centersDrug information centers
Drug information centersNica Solis
 
Good Dispensing Practice
Good Dispensing PracticeGood Dispensing Practice
Good Dispensing PracticeJavis Von Onias
 
Opportunities for Pharmacy Practice Research in Community Setting
Opportunities for Pharmacy Practice Research in Community SettingOpportunities for Pharmacy Practice Research in Community Setting
Opportunities for Pharmacy Practice Research in Community SettingPharmCare Research Group USM
 
Good Dispensing Practice- ppt
Good Dispensing Practice- pptGood Dispensing Practice- ppt
Good Dispensing Practice- pptPhr. Shyam Kumar Adhikari
 
General Discussion on Clinical Pharmacy
General Discussion on Clinical Pharmacy General Discussion on Clinical Pharmacy
General Discussion on Clinical Pharmacy Jahangirnagar University
 
PHARMACY AND THERAPEUTIC COMMITTEE
PHARMACY AND THERAPEUTIC COMMITTEEPHARMACY AND THERAPEUTIC COMMITTEE
PHARMACY AND THERAPEUTIC COMMITTEERamesh Ganpisetti
 
Scope of community pharmacy
Scope of community pharmacyScope of community pharmacy
Scope of community pharmacyRamesh Ganpisetti
 
Good Dispensing Practice
Good Dispensing PracticeGood Dispensing Practice
Good Dispensing PracticeFoodanddrug Regionone
 
clinical pharmacy
clinical pharmacyclinical pharmacy
clinical pharmacySohan Patel
 
Otc drugs
Otc drugsOtc drugs
Otc drugsSiti Nurul Afiqah Johari
 
Drug Use Evaluation & Drug Utilisation Review (DUE & DUR)
Drug Use Evaluation & Drug Utilisation Review (DUE & DUR)Drug Use Evaluation & Drug Utilisation Review (DUE & DUR)
Drug Use Evaluation & Drug Utilisation Review (DUE & DUR)Anjali Rarichan
 
Concept of essential medicines and rational use of medicines
Concept of essential medicines and rational use of medicinesConcept of essential medicines and rational use of medicines
Concept of essential medicines and rational use of medicinesVivek Nayak
 
Pharmacy Practice: Managing Formularies
Pharmacy Practice: Managing FormulariesPharmacy Practice: Managing Formularies
Pharmacy Practice: Managing FormulariesAnas Bahnassi أنس البهنسي
 
DRUG UTILIZATION EVALUATION
DRUG UTILIZATION EVALUATIONDRUG UTILIZATION EVALUATION
DRUG UTILIZATION EVALUATIONaishuanju
 
RULES AND RESPONSIBILITIES OF COMMUNITY PHARMACY
RULES AND RESPONSIBILITIES OF COMMUNITY PHARMACYRULES AND RESPONSIBILITIES OF COMMUNITY PHARMACY
RULES AND RESPONSIBILITIES OF COMMUNITY PHARMACYRamesh Ganpisetti
 
Causality assessment,methods,pharmacovigilance
Causality assessment,methods,pharmacovigilanceCausality assessment,methods,pharmacovigilance
Causality assessment,methods,pharmacovigilanceGaurav Chhabra
 
Essential drug concept and rational use of medicines
Essential drug concept and rational use of medicinesEssential drug concept and rational use of medicines
Essential drug concept and rational use of medicinesPravin Prasad
 
Model of Drug Information Request Form
Model of Drug Information Request FormModel of Drug Information Request Form
Model of Drug Information Request FormMb Mahara
 
Pharmacoeconomics
PharmacoeconomicsPharmacoeconomics
PharmacoeconomicsSanthi Dasari
 
Pharmacy practice
Pharmacy practicePharmacy practice
Pharmacy practiceAsraful Islam Rayhan
 
Patient counselling
Patient counsellingPatient counselling
Patient counsellingRamesh Ganpisetti
 
Clinical pharmacy ppt
Clinical pharmacy pptClinical pharmacy ppt
Clinical pharmacy pptNabi Hasan
 
National Health Policy 1991 Review.pptx
National Health Policy 1991 Review.pptxNational Health Policy 1991 Review.pptx
National Health Policy 1991 Review.pptxmuskanpudasainee
 
National Health Policy
National Health Policy National Health Policy
National Health Policy DrGirishJHoogar
 

More Related Content

What's hot

Opportunities for Pharmacy Practice Research in Community Setting
Opportunities for Pharmacy Practice Research in Community SettingOpportunities for Pharmacy Practice Research in Community Setting
Opportunities for Pharmacy Practice Research in Community SettingPharmCare Research Group USM
 
PHARMACY AND THERAPEUTIC COMMITTEE
PHARMACY AND THERAPEUTIC COMMITTEEPHARMACY AND THERAPEUTIC COMMITTEE
PHARMACY AND THERAPEUTIC COMMITTEERamesh Ganpisetti
 
clinical pharmacy
clinical pharmacyclinical pharmacy
clinical pharmacySohan Patel
 
Drug Use Evaluation & Drug Utilisation Review (DUE & DUR)
Drug Use Evaluation & Drug Utilisation Review (DUE & DUR)Drug Use Evaluation & Drug Utilisation Review (DUE & DUR)
Drug Use Evaluation & Drug Utilisation Review (DUE & DUR)Anjali Rarichan
 
Concept of essential medicines and rational use of medicines
Concept of essential medicines and rational use of medicinesConcept of essential medicines and rational use of medicines
Concept of essential medicines and rational use of medicinesVivek Nayak
 
DRUG UTILIZATION EVALUATION
DRUG UTILIZATION EVALUATIONDRUG UTILIZATION EVALUATION
DRUG UTILIZATION EVALUATIONaishuanju
 
RULES AND RESPONSIBILITIES OF COMMUNITY PHARMACY
RULES AND RESPONSIBILITIES OF COMMUNITY PHARMACYRULES AND RESPONSIBILITIES OF COMMUNITY PHARMACY
RULES AND RESPONSIBILITIES OF COMMUNITY PHARMACYRamesh Ganpisetti
 
Causality assessment,methods,pharmacovigilance
Causality assessment,methods,pharmacovigilanceCausality assessment,methods,pharmacovigilance
Causality assessment,methods,pharmacovigilanceGaurav Chhabra
 
Essential drug concept and rational use of medicines
Essential drug concept and rational use of medicinesEssential drug concept and rational use of medicines
Essential drug concept and rational use of medicinesPravin Prasad
 
Model of Drug Information Request Form
Model of Drug Information Request FormModel of Drug Information Request Form
Model of Drug Information Request FormMb Mahara
 
Clinical pharmacy ppt
Clinical pharmacy pptClinical pharmacy ppt
Clinical pharmacy pptNabi Hasan
 

What's hot (20)

Opportunities for Pharmacy Practice Research in Community Setting
Opportunities for Pharmacy Practice Research in Community SettingOpportunities for Pharmacy Practice Research in Community Setting
Opportunities for Pharmacy Practice Research in Community Setting
 
Good Dispensing Practice- ppt
Good Dispensing Practice- pptGood Dispensing Practice- ppt
Good Dispensing Practice- ppt
 
General Discussion on Clinical Pharmacy
General Discussion on Clinical Pharmacy General Discussion on Clinical Pharmacy
General Discussion on Clinical Pharmacy
 
PHARMACY AND THERAPEUTIC COMMITTEE
PHARMACY AND THERAPEUTIC COMMITTEEPHARMACY AND THERAPEUTIC COMMITTEE
PHARMACY AND THERAPEUTIC COMMITTEE
 
Scope of community pharmacy
Scope of community pharmacyScope of community pharmacy
Scope of community pharmacy
 
Good Dispensing Practice
Good Dispensing PracticeGood Dispensing Practice
Good Dispensing Practice
 
clinical pharmacy
clinical pharmacyclinical pharmacy
clinical pharmacy
 
Otc drugs
Otc drugsOtc drugs
Otc drugs
 
Drug Use Evaluation & Drug Utilisation Review (DUE & DUR)
Drug Use Evaluation & Drug Utilisation Review (DUE & DUR)Drug Use Evaluation & Drug Utilisation Review (DUE & DUR)
Drug Use Evaluation & Drug Utilisation Review (DUE & DUR)
 
Concept of essential medicines and rational use of medicines
Concept of essential medicines and rational use of medicinesConcept of essential medicines and rational use of medicines
Concept of essential medicines and rational use of medicines
 
Pharmacy Practice: Managing Formularies
Pharmacy Practice: Managing FormulariesPharmacy Practice: Managing Formularies
Pharmacy Practice: Managing Formularies
 
DRUG UTILIZATION EVALUATION
DRUG UTILIZATION EVALUATIONDRUG UTILIZATION EVALUATION
DRUG UTILIZATION EVALUATION
 
RULES AND RESPONSIBILITIES OF COMMUNITY PHARMACY
RULES AND RESPONSIBILITIES OF COMMUNITY PHARMACYRULES AND RESPONSIBILITIES OF COMMUNITY PHARMACY
RULES AND RESPONSIBILITIES OF COMMUNITY PHARMACY
 
Causality assessment,methods,pharmacovigilance
Causality assessment,methods,pharmacovigilanceCausality assessment,methods,pharmacovigilance
Causality assessment,methods,pharmacovigilance
 
Essential drug concept and rational use of medicines
Essential drug concept and rational use of medicinesEssential drug concept and rational use of medicines
Essential drug concept and rational use of medicines
 
Model of Drug Information Request Form
Model of Drug Information Request FormModel of Drug Information Request Form
Model of Drug Information Request Form
 
Pharmacoeconomics
PharmacoeconomicsPharmacoeconomics
Pharmacoeconomics
 
Pharmacy practice
Pharmacy practicePharmacy practice
Pharmacy practice
 
Patient counselling
Patient counsellingPatient counselling
Patient counselling
 
Clinical pharmacy ppt
Clinical pharmacy pptClinical pharmacy ppt
Clinical pharmacy ppt
 

Similar to Drug Supply Management in Ethiopia

National Health Policy 1991 Review.pptx
National Health Policy 1991 Review.pptxNational Health Policy 1991 Review.pptx
National Health Policy 1991 Review.pptxmuskanpudasainee
 
National Health Policy of Nepal 2076 (ENGLISH)
National Health Policy of Nepal 2076 (ENGLISH)National Health Policy of Nepal 2076 (ENGLISH)
National Health Policy of Nepal 2076 (ENGLISH)BPKIHS
 
Universal health care
Universal health careUniversal health care
Universal health careSiva Mbbs
 
National Health Policies of India.pptx
National Health Policies of India.pptxNational Health Policies of India.pptx
National Health Policies of India.pptxSanjeevDavey1
 
oral health policy.pptx
oral health policy.pptxoral health policy.pptx
oral health policy.pptxRohma Yusuf
 
11 PRIMARY HEALTH CARE (PHC).pptx
11 PRIMARY HEALTH CARE (PHC).pptx11 PRIMARY HEALTH CARE (PHC).pptx
11 PRIMARY HEALTH CARE (PHC).pptxssuser541bb9
 
HSM, CH 4 Main functions of management-HDS.ppt
HSM, CH 4 Main functions of management-HDS.pptHSM, CH 4 Main functions of management-HDS.ppt
HSM, CH 4 Main functions of management-HDS.pptKhorBothPanom
 
Health sector reforms
Health sector reformsHealth sector reforms
Health sector reformsVikash Keshri
 
National health policy 2017
National health policy 2017National health policy 2017
National health policy 2017Saju Thomas
 
National Health Policy PPT.pptx
National Health Policy PPT.pptxNational Health Policy PPT.pptx
National Health Policy PPT.pptxVeereshDemashetti
 
2. PHC.pptx
2. PHC.pptx2. PHC.pptx
2. PHC.pptxjiregna5
 
Primary Health Care in Nepal.pptx
Primary Health Care in Nepal.pptxPrimary Health Care in Nepal.pptx
Primary Health Care in Nepal.pptxucghimire6
 
Primary Health Care in Nepal.pptx
Primary Health Care in Nepal.pptxPrimary Health Care in Nepal.pptx
Primary Health Care in Nepal.pptxucghimire6
 
Unit - 1 Health Services (BPH306.1 - HSMN) Part 1 & 2
Unit - 1 Health Services (BPH306.1 - HSMN) Part 1 & 2Unit - 1 Health Services (BPH306.1 - HSMN) Part 1 & 2
Unit - 1 Health Services (BPH306.1 - HSMN) Part 1 & 2Dipesh Tikhatri
 
National Health Policy and Plan
National Health Policy and PlanNational Health Policy and Plan
National Health Policy and Planlal bahadur Kunwar
 

Similar to Drug Supply Management in Ethiopia (20)

National Health Policy 1991 Review.pptx
National Health Policy 1991 Review.pptxNational Health Policy 1991 Review.pptx
National Health Policy 1991 Review.pptx
 
National Health Policy
National Health Policy National Health Policy
National Health Policy
 
National Health Policy of Nepal 2076 (ENGLISH)
National Health Policy of Nepal 2076 (ENGLISH)National Health Policy of Nepal 2076 (ENGLISH)
National Health Policy of Nepal 2076 (ENGLISH)
 
Universal health care
Universal health careUniversal health care
Universal health care
 
EHC & FHS
EHC & FHSEHC & FHS
EHC & FHS
 
National Health Policies of India.pptx
National Health Policies of India.pptxNational Health Policies of India.pptx
National Health Policies of India.pptx
 
oral health policy.pptx
oral health policy.pptxoral health policy.pptx
oral health policy.pptx
 
11 PRIMARY HEALTH CARE (PHC).pptx
11 PRIMARY HEALTH CARE (PHC).pptx11 PRIMARY HEALTH CARE (PHC).pptx
11 PRIMARY HEALTH CARE (PHC).pptx
 
Charles Hongoro, Human Sciences Research Council, South Africa
Charles Hongoro, Human Sciences Research Council, South AfricaCharles Hongoro, Human Sciences Research Council, South Africa
Charles Hongoro, Human Sciences Research Council, South Africa
 
HSM, CH 4 Main functions of management-HDS.ppt
HSM, CH 4 Main functions of management-HDS.pptHSM, CH 4 Main functions of management-HDS.ppt
HSM, CH 4 Main functions of management-HDS.ppt
 
Health sector reforms
Health sector reformsHealth sector reforms
Health sector reforms
 
National health policy 1991
National health policy 1991National health policy 1991
National health policy 1991
 
National health policy 2017
National health policy 2017National health policy 2017
National health policy 2017
 
National Health Policy PPT.pptx
National Health Policy PPT.pptxNational Health Policy PPT.pptx
National Health Policy PPT.pptx
 
National health policy 2002
National health policy 2002National health policy 2002
National health policy 2002
 
2. PHC.pptx
2. PHC.pptx2. PHC.pptx
2. PHC.pptx
 
Primary Health Care in Nepal.pptx
Primary Health Care in Nepal.pptxPrimary Health Care in Nepal.pptx
Primary Health Care in Nepal.pptx
 
Primary Health Care in Nepal.pptx
Primary Health Care in Nepal.pptxPrimary Health Care in Nepal.pptx
Primary Health Care in Nepal.pptx
 
Unit - 1 Health Services (BPH306.1 - HSMN) Part 1 & 2
Unit - 1 Health Services (BPH306.1 - HSMN) Part 1 & 2Unit - 1 Health Services (BPH306.1 - HSMN) Part 1 & 2
Unit - 1 Health Services (BPH306.1 - HSMN) Part 1 & 2
 
National Health Policy and Plan
National Health Policy and PlanNational Health Policy and Plan
National Health Policy and Plan
 

More from ShikurYasin

Therapeutic enzymes 2012.pptx
Therapeutic enzymes 2012.pptxTherapeutic enzymes 2012.pptx
Therapeutic enzymes 2012.pptxShikurYasin
 
Cytokines 2012.ppt
Cytokines 2012.pptCytokines 2012.ppt
Cytokines 2012.pptShikurYasin
 
4_5839321885057223185.pptx
4_5839321885057223185.pptx4_5839321885057223185.pptx
4_5839321885057223185.pptxShikurYasin
 
Infrared Spectrophotometry.ppt
Infrared Spectrophotometry.pptInfrared Spectrophotometry.ppt
Infrared Spectrophotometry.pptShikurYasin
 
Chromatography.pptx
Chromatography.pptxChromatography.pptx
Chromatography.pptxShikurYasin
 
Hospital practice Attachment portfolio (2).pptx
Hospital practice Attachment portfolio (2).pptxHospital practice Attachment portfolio (2).pptx
Hospital practice Attachment portfolio (2).pptxShikurYasin
 

More from ShikurYasin (14)

Therapeutic enzymes 2012.pptx
Therapeutic enzymes 2012.pptxTherapeutic enzymes 2012.pptx
Therapeutic enzymes 2012.pptx
 
Cytokines 2012.ppt
Cytokines 2012.pptCytokines 2012.ppt
Cytokines 2012.ppt
 
CH-1.pptx
CH-1.pptxCH-1.pptx
CH-1.pptx
 
4_5839321885057223185.pptx
4_5839321885057223185.pptx4_5839321885057223185.pptx
4_5839321885057223185.pptx
 
Infrared Spectrophotometry.ppt
Infrared Spectrophotometry.pptInfrared Spectrophotometry.ppt
Infrared Spectrophotometry.ppt
 
chapter -2.pptx
chapter -2.pptxchapter -2.pptx
chapter -2.pptx
 
chapter -1.pptx
chapter -1.pptxchapter -1.pptx
chapter -1.pptx
 
Chromatography.pptx
Chromatography.pptxChromatography.pptx
Chromatography.pptx
 
Hospital practice Attachment portfolio (2).pptx
Hospital practice Attachment portfolio (2).pptxHospital practice Attachment portfolio (2).pptx
Hospital practice Attachment portfolio (2).pptx
 
vitamin.pptx
vitamin.pptxvitamin.pptx
vitamin.pptx
 
ENA.pptx
ENA.pptxENA.pptx
ENA.pptx
 
TAME.pptx
TAME.pptxTAME.pptx
TAME.pptx
 
atachment.ppt
atachment.pptatachment.ppt
atachment.ppt
 
portfolio.pptx
portfolio.pptxportfolio.pptx
portfolio.pptx
 

Recently uploaded

VIP Call Girls Indore Kirti 💚😋 9256729539 🚀 Indore Escorts
VIP Call Girls Indore Kirti 💚😋 9256729539 🚀 Indore EscortsVIP Call Girls Indore Kirti 💚😋 9256729539 🚀 Indore Escorts
VIP Call Girls Indore Kirti 💚😋 9256729539 🚀 Indore Escortsaditipandeya
 
Call Girls In Andheri East Call 9920874524 Book Hot And Sexy Girls
Call Girls In Andheri East Call 9920874524 Book Hot And Sexy GirlsCall Girls In Andheri East Call 9920874524 Book Hot And Sexy Girls
Call Girls In Andheri East Call 9920874524 Book Hot And Sexy Girlsnehamumbai
 
Artifacts in Nuclear Medicine with Identifying and resolving artifacts.
Artifacts in Nuclear Medicine with Identifying and resolving artifacts.Artifacts in Nuclear Medicine with Identifying and resolving artifacts.
Artifacts in Nuclear Medicine with Identifying and resolving artifacts.MiadAlsulami
 
Call Girls Service In Shyam Nagar Whatsapp 8445551418 Independent Escort Service
Call Girls Service In Shyam Nagar Whatsapp 8445551418 Independent Escort ServiceCall Girls Service In Shyam Nagar Whatsapp 8445551418 Independent Escort Service
Call Girls Service In Shyam Nagar Whatsapp 8445551418 Independent Escort Serviceparulsinha
 
CALL ON ➥9907093804 🔝 Call Girls Baramati ( Pune) Girls Service
CALL ON ➥9907093804 🔝 Call Girls Baramati ( Pune) Girls ServiceCALL ON ➥9907093804 🔝 Call Girls Baramati ( Pune) Girls Service
CALL ON ➥9907093804 🔝 Call Girls Baramati ( Pune) Girls ServiceMiss joya
 
Call Girls Doddaballapur Road Just Call 7001305949 Top Class Call Girl Servic...
Call Girls Doddaballapur Road Just Call 7001305949 Top Class Call Girl Servic...Call Girls Doddaballapur Road Just Call 7001305949 Top Class Call Girl Servic...
Call Girls Doddaballapur Road Just Call 7001305949 Top Class Call Girl Servic...narwatsonia7
 
High Profile Call Girls Jaipur Vani 8445551418 Independent Escort Service Jaipur
High Profile Call Girls Jaipur Vani 8445551418 Independent Escort Service JaipurHigh Profile Call Girls Jaipur Vani 8445551418 Independent Escort Service Jaipur
High Profile Call Girls Jaipur Vani 8445551418 Independent Escort Service Jaipurparulsinha
 
Aspirin presentation slides by Dr. Rewas Ali
Aspirin presentation slides by Dr. Rewas AliAspirin presentation slides by Dr. Rewas Ali
Aspirin presentation slides by Dr. Rewas AliRewAs ALI
 
CALL ON ➥9907093804 🔝 Call Girls Hadapsar ( Pune) Girls Service
CALL ON ➥9907093804 🔝 Call Girls Hadapsar ( Pune) Girls ServiceCALL ON ➥9907093804 🔝 Call Girls Hadapsar ( Pune) Girls Service
CALL ON ➥9907093804 🔝 Call Girls Hadapsar ( Pune) Girls ServiceMiss joya
 
Kesar Bagh Call Girl Price 9548273370 , Lucknow Call Girls Service
Kesar Bagh Call Girl Price 9548273370 , Lucknow Call Girls ServiceKesar Bagh Call Girl Price 9548273370 , Lucknow Call Girls Service
Kesar Bagh Call Girl Price 9548273370 , Lucknow Call Girls Servicemakika9823
 
Call Girls Yelahanka Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Yelahanka Just Call 7001305949 Top Class Call Girl Service AvailableCall Girls Yelahanka Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Yelahanka Just Call 7001305949 Top Class Call Girl Service Availablenarwatsonia7
 
Housewife Call Girls Hoskote | 7001305949 At Low Cost Cash Payment Booking
Housewife Call Girls Hoskote | 7001305949 At Low Cost Cash Payment BookingHousewife Call Girls Hoskote | 7001305949 At Low Cost Cash Payment Booking
Housewife Call Girls Hoskote | 7001305949 At Low Cost Cash Payment Bookingnarwatsonia7
 
Call Girls Whitefield Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Whitefield Just Call 7001305949 Top Class Call Girl Service AvailableCall Girls Whitefield Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Whitefield Just Call 7001305949 Top Class Call Girl Service Availablenarwatsonia7
 
Russian Call Girls in Pune Tanvi 9907093804 Short 1500 Night 6000 Best call g...
Russian Call Girls in Pune Tanvi 9907093804 Short 1500 Night 6000 Best call g...Russian Call Girls in Pune Tanvi 9907093804 Short 1500 Night 6000 Best call g...
Russian Call Girls in Pune Tanvi 9907093804 Short 1500 Night 6000 Best call g...Miss joya
 
VIP Call Girls Pune Vrinda 9907093804 Short 1500 Night 6000 Best call girls S...
VIP Call Girls Pune Vrinda 9907093804 Short 1500 Night 6000 Best call girls S...VIP Call Girls Pune Vrinda 9907093804 Short 1500 Night 6000 Best call girls S...
VIP Call Girls Pune Vrinda 9907093804 Short 1500 Night 6000 Best call girls S...Miss joya
 
College Call Girls Pune Mira 9907093804 Short 1500 Night 6000 Best call girls...
College Call Girls Pune Mira 9907093804 Short 1500 Night 6000 Best call girls...College Call Girls Pune Mira 9907093804 Short 1500 Night 6000 Best call girls...
College Call Girls Pune Mira 9907093804 Short 1500 Night 6000 Best call girls...Miss joya
 
Vip Call Girls Anna Salai Chennai 👉 8250192130 ❣️💯 Top Class Girls Available
Vip Call Girls Anna Salai Chennai 👉 8250192130 ❣️💯 Top Class Girls AvailableVip Call Girls Anna Salai Chennai 👉 8250192130 ❣️💯 Top Class Girls Available
Vip Call Girls Anna Salai Chennai 👉 8250192130 ❣️💯 Top Class Girls AvailableNehru place Escorts
 
VIP Mumbai Call Girls Hiranandani Gardens Just Call 9920874524 with A/C Room ...
VIP Mumbai Call Girls Hiranandani Gardens Just Call 9920874524 with A/C Room ...VIP Mumbai Call Girls Hiranandani Gardens Just Call 9920874524 with A/C Room ...
VIP Mumbai Call Girls Hiranandani Gardens Just Call 9920874524 with A/C Room ...Garima Khatri
 
Hi,Fi Call Girl In Mysore Road - 7001305949 | 24x7 Service Available Near Me
Hi,Fi Call Girl In Mysore Road - 7001305949 | 24x7 Service Available Near MeHi,Fi Call Girl In Mysore Road - 7001305949 | 24x7 Service Available Near Me
Hi,Fi Call Girl In Mysore Road - 7001305949 | 24x7 Service Available Near Menarwatsonia7
 
Bangalore Call Girls Marathahalli 📞 9907093804 High Profile Service 100% Safe
Bangalore Call Girls Marathahalli 📞 9907093804 High Profile Service 100% SafeBangalore Call Girls Marathahalli 📞 9907093804 High Profile Service 100% Safe
Bangalore Call Girls Marathahalli 📞 9907093804 High Profile Service 100% Safenarwatsonia7
 

Recently uploaded (20)

VIP Call Girls Indore Kirti 💚😋 9256729539 🚀 Indore Escorts
VIP Call Girls Indore Kirti 💚😋 9256729539 🚀 Indore EscortsVIP Call Girls Indore Kirti 💚😋 9256729539 🚀 Indore Escorts
VIP Call Girls Indore Kirti 💚😋 9256729539 🚀 Indore Escorts
 
Call Girls In Andheri East Call 9920874524 Book Hot And Sexy Girls
Call Girls In Andheri East Call 9920874524 Book Hot And Sexy GirlsCall Girls In Andheri East Call 9920874524 Book Hot And Sexy Girls
Call Girls In Andheri East Call 9920874524 Book Hot And Sexy Girls
 
Artifacts in Nuclear Medicine with Identifying and resolving artifacts.
Artifacts in Nuclear Medicine with Identifying and resolving artifacts.Artifacts in Nuclear Medicine with Identifying and resolving artifacts.
Artifacts in Nuclear Medicine with Identifying and resolving artifacts.
 
Call Girls Service In Shyam Nagar Whatsapp 8445551418 Independent Escort Service
Call Girls Service In Shyam Nagar Whatsapp 8445551418 Independent Escort ServiceCall Girls Service In Shyam Nagar Whatsapp 8445551418 Independent Escort Service
Call Girls Service In Shyam Nagar Whatsapp 8445551418 Independent Escort Service
 
CALL ON ➥9907093804 🔝 Call Girls Baramati ( Pune) Girls Service
CALL ON ➥9907093804 🔝 Call Girls Baramati ( Pune) Girls ServiceCALL ON ➥9907093804 🔝 Call Girls Baramati ( Pune) Girls Service
CALL ON ➥9907093804 🔝 Call Girls Baramati ( Pune) Girls Service
 
Call Girls Doddaballapur Road Just Call 7001305949 Top Class Call Girl Servic...
Call Girls Doddaballapur Road Just Call 7001305949 Top Class Call Girl Servic...Call Girls Doddaballapur Road Just Call 7001305949 Top Class Call Girl Servic...
Call Girls Doddaballapur Road Just Call 7001305949 Top Class Call Girl Servic...
 
High Profile Call Girls Jaipur Vani 8445551418 Independent Escort Service Jaipur
High Profile Call Girls Jaipur Vani 8445551418 Independent Escort Service JaipurHigh Profile Call Girls Jaipur Vani 8445551418 Independent Escort Service Jaipur
High Profile Call Girls Jaipur Vani 8445551418 Independent Escort Service Jaipur
 
Aspirin presentation slides by Dr. Rewas Ali
Aspirin presentation slides by Dr. Rewas AliAspirin presentation slides by Dr. Rewas Ali
Aspirin presentation slides by Dr. Rewas Ali
 
CALL ON ➥9907093804 🔝 Call Girls Hadapsar ( Pune) Girls Service
CALL ON ➥9907093804 🔝 Call Girls Hadapsar ( Pune) Girls ServiceCALL ON ➥9907093804 🔝 Call Girls Hadapsar ( Pune) Girls Service
CALL ON ➥9907093804 🔝 Call Girls Hadapsar ( Pune) Girls Service
 
Kesar Bagh Call Girl Price 9548273370 , Lucknow Call Girls Service
Kesar Bagh Call Girl Price 9548273370 , Lucknow Call Girls ServiceKesar Bagh Call Girl Price 9548273370 , Lucknow Call Girls Service
Kesar Bagh Call Girl Price 9548273370 , Lucknow Call Girls Service
 
Call Girls Yelahanka Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Yelahanka Just Call 7001305949 Top Class Call Girl Service AvailableCall Girls Yelahanka Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Yelahanka Just Call 7001305949 Top Class Call Girl Service Available
 
Housewife Call Girls Hoskote | 7001305949 At Low Cost Cash Payment Booking
Housewife Call Girls Hoskote | 7001305949 At Low Cost Cash Payment BookingHousewife Call Girls Hoskote | 7001305949 At Low Cost Cash Payment Booking
Housewife Call Girls Hoskote | 7001305949 At Low Cost Cash Payment Booking
 
Call Girls Whitefield Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Whitefield Just Call 7001305949 Top Class Call Girl Service AvailableCall Girls Whitefield Just Call 7001305949 Top Class Call Girl Service Available
Call Girls Whitefield Just Call 7001305949 Top Class Call Girl Service Available
 
Russian Call Girls in Pune Tanvi 9907093804 Short 1500 Night 6000 Best call g...
Russian Call Girls in Pune Tanvi 9907093804 Short 1500 Night 6000 Best call g...Russian Call Girls in Pune Tanvi 9907093804 Short 1500 Night 6000 Best call g...
Russian Call Girls in Pune Tanvi 9907093804 Short 1500 Night 6000 Best call g...
 
VIP Call Girls Pune Vrinda 9907093804 Short 1500 Night 6000 Best call girls S...
VIP Call Girls Pune Vrinda 9907093804 Short 1500 Night 6000 Best call girls S...VIP Call Girls Pune Vrinda 9907093804 Short 1500 Night 6000 Best call girls S...
VIP Call Girls Pune Vrinda 9907093804 Short 1500 Night 6000 Best call girls S...
 
College Call Girls Pune Mira 9907093804 Short 1500 Night 6000 Best call girls...
College Call Girls Pune Mira 9907093804 Short 1500 Night 6000 Best call girls...College Call Girls Pune Mira 9907093804 Short 1500 Night 6000 Best call girls...
College Call Girls Pune Mira 9907093804 Short 1500 Night 6000 Best call girls...
 
Vip Call Girls Anna Salai Chennai 👉 8250192130 ❣️💯 Top Class Girls Available
Vip Call Girls Anna Salai Chennai 👉 8250192130 ❣️💯 Top Class Girls AvailableVip Call Girls Anna Salai Chennai 👉 8250192130 ❣️💯 Top Class Girls Available
Vip Call Girls Anna Salai Chennai 👉 8250192130 ❣️💯 Top Class Girls Available
 
VIP Mumbai Call Girls Hiranandani Gardens Just Call 9920874524 with A/C Room ...
VIP Mumbai Call Girls Hiranandani Gardens Just Call 9920874524 with A/C Room ...VIP Mumbai Call Girls Hiranandani Gardens Just Call 9920874524 with A/C Room ...
VIP Mumbai Call Girls Hiranandani Gardens Just Call 9920874524 with A/C Room ...
 
Hi,Fi Call Girl In Mysore Road - 7001305949 | 24x7 Service Available Near Me
Hi,Fi Call Girl In Mysore Road - 7001305949 | 24x7 Service Available Near MeHi,Fi Call Girl In Mysore Road - 7001305949 | 24x7 Service Available Near Me
Hi,Fi Call Girl In Mysore Road - 7001305949 | 24x7 Service Available Near Me
 
Bangalore Call Girls Marathahalli 📞 9907093804 High Profile Service 100% Safe
Bangalore Call Girls Marathahalli 📞 9907093804 High Profile Service 100% SafeBangalore Call Girls Marathahalli 📞 9907093804 High Profile Service 100% Safe
Bangalore Call Girls Marathahalli 📞 9907093804 High Profile Service 100% Safe
 

Drug Supply Management in Ethiopia

  • 1. Drug Supply Management By Dawit Teshome (M.Pharm) March 2019
  • 3. 1.1 Ethiopian Health care system • Pluralistic: traditional and modern – WHO estimate: TM 70 - 80% • The evaluation of modern health services could be divided into five periods. – Laying the Ground for Modern Medicine, Up to 1936 – The Italian interlude (1936-41) – The hospital/clinic based (reconstruction) period (1941- 1953) – The Basic Health Service period (1953-1974) – The Primary Health Care period (1974-1991) – The Sector Wide approach period (1991-2015) /HSDP period. – The Health sector transformation (1916-2020) 17/12/2022
  • 4. 1.2.1 Modern Medicine in Ethiopia • Introduced in 16th century in fragmented way: Emperor Libenedengel • Further progress in the introduction and development- reign of Emperor Menilek (1889 – 1913) • The first Government sponsored health facilities were established in Harar by Ras Mekonnen and Menelik II Hospital in Addis Ababa in 1909 • The Government formally assumed responsibility for the provision of health services with the establishment of the Health Department within the Ministry Interior in 1908. • Since then The Health Care System has been in constant change with socioeconomic and political changes. • 1935- health manpower training started by enrolling students for auxiliary medical training • Italian invasion – interrupt the activity 17/12/2022
  • 5. • Modern medical care model (MMC) (The Reconstruction phase (1941-1953) – Earlier period of introduction of health services • Urban centered and Hospital based • Services were inaccessible to majority of rural population due to – geographical, economical and cultural barrier • It was mechanistic approach and not holistic – The health service coverage was estimated to be 25%. – Little attention was given to preventive health care in spite of the establishment of the Ministry of Public Health in 1947. 17/12/2022
  • 6. Approach of Health care services • Basic Health Service Approach (BHSA) (1953-1974) • In 1952, the government officially proclaimed the basic health care policy. – Dominant theme in 50’s and 60’s – Criticism against mechanistic approach – Success stories utilizing large number of medical auxiliaries in China to provide service nearer to large population – Reframed and shifted utilization of medical auxiliary from medical facility to health center and health institution – Principle ” taking services where people live” through home visits, outreaches, prison heath serves by medical auxiliaries 17/12/2022
  • 7. Approach of Health…..…….cont’d • The era of BHSA in Ethiopia – One of the success stories registered in health sector development • The organization and development of health services at that time can be considered as four tiered system: – Health station (with health assistant at grass root level) – Health center at Awraja level (health center team) – Regional referral Hospital (Tekelaygizat level) – Central referral hospital 17/12/2022
  • 8. Approach of Health…..…….cont’d • Problem with BHSA – Constrained with respect to facility and manpower – Socio-cultural factor prevent population from using available sources – No mechanism for community participation that can ensure sustainability and culturally acceptable care • Primary health care (PHC) approach (1974-1991) – WHO and UNICEF re-examined their practice and this led to Alma-Ata declaration in 1978 17/12/2022
  • 9. Approach of Health…..…….cont’d • Primary Health Care defined as – Essential health care based on practical, scientifically sound and socially acceptable methods and technology made universally accessible to individuals and families in the community through their full participation and at a cost that the community and the country can afford to maintain at every stage of their development in the spirit of self- reliance and self-determination” 17/12/2022
  • 10. Approach of Health…..…….cont’d • The five principles usually associated with the PHC strategy are: • Universal accessibility and coverage – Essential health services to all people • Community and individual involvement and self reliance – Individuals and communities have the right and responsibility to be active partners in making decisions about their health care and the health of their communities. 17/12/2022
  • 11. Approach of Health…..…….cont’d • Appropriate technology and cost effectiveness – This includes methods of care, service delivery, procedures and equipment that are socially acceptable and affordable. • Intersectoral action for health – Commitment from all sectors (government, community and health) • Health promotion – Through the provision of affordable health services and community health education. 17/12/2022
  • 12. Approach of Health…..…….cont’d • Component/element of PHC – Immunization – Food supply and proper nutrition – Water and sanitation – Appropriate treatment of common disease and injuries – Maternal child birth care including family planning – Providing essential drugs – Mental health 17/12/2022
  • 13. Approach of Health…..…….cont’d – Education concerning the prevailing health problems and methods of preventing and controlling them – Provision and control of locally endemic – Dental health – Traditional medicine – Control of HIV/AIDS and STIs – Occupational health – As a member of WHO, Ethiopia signed the Almata charter – WHO internationally evaluated PHC strategy (1984 – 1985) 17/12/2022
  • 14. Approach of Health…..…….cont’d • Problems observed: – Very limited intersectoral collaboration – Lack of community involvement due to lack of remuneration of trained CHWs; 85% were found to be non functional • Achievement: – Expansion of health services – Control of iodine deficiency disorder – Training in health education 17/12/2022
  • 15. The HSDP period (1993-2015) • The transitional government issued a Health Policy in 1993. • The policy emphasizes equitable access of all people to decentralized preventive and promotive health oriented integrated PHC. • To achieve the objectives of the policy, the government identified and have been implementing the following strategies: 17/12/2022
  • 16. Strategies • Strengthening preventive and promotive health services • Sustaining the existing essential curative services and encouraging rehabilitative services within the family and the private sectors • Provision of basic drugs at all health care units and encourage private sector participation in the procurement, distribution and production of drugs and medical supplies • Revitalizing the health information, documentation and processing system 17/12/2022
  • 17. • Decentralizing and democratizing the management of the health care delivery system • Human resources development emphasizing front-line and mid-level health workers • Affordable and realistic research and development focusing on priority health problems and • Creating an enabling environment for community and private participation in health care financing as well as for efficient and effective utilization of the available limited resources. 17/12/2022
  • 18. Health Sector Development Program I (HSDP I) (1997/98– 2001/02) • Prioritized disease prevention and decentralizing health services delivery. • HSDP I introduced a four tier system for health service delivery. – Primary health care unit (PHCU) (one HC and 5 HP health posts) ~ 25,000 people – District hospital ~ 250,000 – Zonal hospital ~ 1,000,000 – Specialized referral hospital. 17/12/2022
  • 19. • In relation to Pharmaceutical sector, during HSDP I: – The Proclamation to the Drug Administration and Control Authority (DACA) have been issued & completed; – The National Drug List (NDL) of Ethiopia has been updated, printed, and was issued in July 2001; and – A federal Essential Drugs List has been prepared, listing priority drugs which should be available at all times, and structured by level of the health system. – Improvement in drug availability has been observed in the public and private sectors, partly through licensing of a large number of drug outlets of various levels to sell drugs (estimated at 311 pharmacies, 249 drug shops and 1917 rural drug vendors), and the establishment of several domestic manufacturers of drugs and medical supplies within the country. – There has been a significant increase in the supply of drug and medical supplies to the public center manifested by the marked increase in the drug budget from 20 million to 245 million birr. 17/12/2022
  • 20. HSDP II (2002/03–2004/05) • Incorporates new initiatives like – the introduction of the Health Services Extension Programme (HSEP) – the accelerated Expansion of PHC – the development of the Essential Health Services Package (EHSP) – the elaboration of a Child Survival Strategy – the efforts to reach the Millennium Development Goals, – the new Plan for Accelerated and Sustained Development to End Poverty (PASDEP Oct 2005) – to seek improved alignment of donors and donor efforts of harmonization – establishment of Special Pharmacies (SP) has resulted in better drug availability and increased ability to cover recurrent costs. • Special and Budget Pharmacies were operating separately. 17/12/2022
  • 21. HSDP III (2005/06–2009/10) • It stresses the need to increase national health spending, • Recognized the strategic role of NGOs as partners in achieving universal primary healthcare coverage • National Hygiene and Sanitation Strategy and National Protocol for Hygiene have been developed • Accelerated Expansion of Primary Health Service Coverage • Development and implementation of the National Nutrition Strategy and programme • In order to introduce efficiency in the supply chain of pharmaceuticals and medical supplies management system, PHARMID has been transformed into Pharmaceutical Fund and Supply Agency (PFSA) with the several measures taken to strengthen the capacity of the new agency 17/12/2022
  • 22. HSDP IV (2010/11 – 2014/15) • Scaling up of Urban and Pastoralist HEP. • Maintaining coverage and improving the quality of HEP in rural areas. • HSDP IV will focus on a comprehensive and continuous quality monitoring mechanism • Enhancing the commitment of leadership at all levels of the system. • Building implementation capacity. • Scaling up of best practices. 17/12/2022
  • 23. HSTP (2015/16 – 2019/20) • HSTP is the first phase of the 20-year health sector strategy called ‘Envisioning Ethiopia’s Path to Universal Health Care through strengthening of Primary Health Care’. • HSTP has three key features: quality and equity; universal health coverage and transformation. • Pillars of HSTP – 1. Excellence in health service delivery – 2. Excellence in quality improvement and assurance – 3. Excellence in leadership and governance – 4. Excellence in health system capacity 17/12/2022
  • 24. HSTP (2015/16 – 2019/20) • Improve Supply Chain and Logistic Management is • Performance measures: – Increase availability of essential drugs for primary, secondary and tertiary healthcare to 100% – Reduce wastage rate to less than 2% – Increase proportion of essential drugs procured from local manufacturers from 25% to 60% – Reduce procurement lead-time from 240 days to 120 days 17/12/2022
  • 25. Strategic Initiatives HSTP-Pharmaceutical • 1. Enhance efficiency in selection, quantification and procurement of essential medicines • 2. Optimize warehouse, inventory, fleet and distribution management systems • 3. Scale-up integrated information management system for pharmaceutical supply and services • 4. Scale-up auditable pharmaceutical transaction and services to all health facilities • 5. Scale-up community pharmacies • 6. Implement innovative strategies to shape the market in order to ensure affordability of essential drugs • 7. Strengthen supply chain modeling to analyze needs for management and scale-up of commodities • 8. Undertake measures to reduce drug wastage and integrated pharmaceutical waste • management • 9. Promote rational drug use • 10. Improve access to medicines through quality local production – implement the GMP (good manufacturing practice) Roadmap 17/12/2022
  • 26. Approach of Health…..…….cont’d • Current health care delivery system : a three-tier • First level of a Woreda/District health system – Comprising a primary hospital • population coverage of 60,000-100,000 people), – Health centers (1/15,000-25,000 population) – Satellite Health Posts (1/3,000-5,000 population) • Connected to each other by a referral system 17/12/2022
  • 27. Approach of Health…..…….cont’d – NB! Primary Hospital, Health center and health posts form a Primary health care unit (PHCU) with each health center having five satellite health posts. • Second level - General Hospital – Population coverage of 1-1.5 million people • Third level - a Specialized Hospital – Population of 3.5-5 million 17/12/2022
  • 28. Three-tier health care delivery system in Ethiopia (currently used) 17/12/2022
  • 29. Millennium Development Goals • In September 2000, leaders of 189 countries gathered at the United Nations headquarters and signed the historic Millennium Declaration, in which they committed to achieving a set of eight measurable goals that range from halving extreme poverty and hunger to promoting gender equality and reducing child mortality, by the target date of 2015. 17/12/2022
  • 31. The Global Consultation of Sustainable Development Goals • In July 2014, the UN General Assembly Open Working Group (OWG) proposed a document containing 17 goals to be put forward for the General Assembly’s approval in September 2015. This document set the ground for the new SDGs and the global development agenda spanning from 2015-2030. 17/12/2022
  • 34. 1.1 What is management? • A set of activities directed at the efficient and effective utilization of resources in the pursuit of one or more goals. • Working with human, financial, and physical resources to achieve organizational objectives by performing the planning, organizing, directing and controlling functions. • A problem solving process of the effectively achieving organizational objectives through the efficient use of scarce resources. 17/12/2022
  • 35. • management is not a process, which is simply a method of doing something. • Managers are simply people who perform management activities. • While people whom we think of as “the boss” and those with administrative appointments within an organization certainly are managers, the fact is that anyone who has a task to accomplish or a goal to achieve is a manager as well 17/12/2022
  • 36. • Leadership – It is a distinctly different skill from management. – Leadership involves the ability to inspire or direct others. – It is desirable that all managers also have leadership skills, they do not necessarily go hand in hand 17/12/2022
  • 38. Management……..cont’d • The Management Process – There are three dimensions of management: 1. Activities that managers perform 2. Resources that managers need 3. Levels at which managers make decisions – Every action taken by a manager involves at least one aspect of each of the three dimensions. 17/12/2022
  • 40. Classical Management Activities • Planning – Central functions of management – Determines the organizational direction – It is a rational systematic way of making decision today that will affect the future. – is predetermining a course of action based on one’s goals and objectives. 17/12/2022
  • 41. Classical Management……..cont’d – Important for purpose of scarce resources – Effective planning incorporates the effects of both external and internal factors. – E.g. The chief pharmacist at a community pharmacy develop plans which drug products he wishes to carry • Organizing – Requires formal structures of authority and direction and flow of such authority. 17/12/2022
  • 42. Classical Management……..cont’d • Organizing : concerned with – Identifying tasks that must be performed – Assigning tasks to personnel – Defining authority & responsibility of assigned personnel – Delegating such authority to employees – Establishing a relationship b/n authority & responsibility 17/12/2022
  • 43. Classical Management……..cont’d – E.g. Once a pharmacist has decided which drug products he should offer, he needs to ask himself • what resources he needs to provide them • Who is responsible for procurement • how he will go about obtaining these resources • and then determine when he will need to obtain. • Leading or directing – bringing about purposeful action toward some desired outcome. 17/12/2022
  • 44. Classical Management……..cont’d • Control or evaluation – Involves reviewing the progress that has been made toward the objectives that were set out in the plan. – Determining what actually happened and why it happened. – E.g. Pharmacists can ask themselves if the goods and services they offered met their goals (e.g. Did the goods and services result in high quality patient care or improved clinical outcomes?) 17/12/2022
  • 46. Management……..cont’d • Resources that are Managed – Managers, organizations and individuals must use resources to achieve their goals and objectives. – Resources are scarce • Money, People, Time • Material (E.g. drug products, equipment, and supplies) • Information 17/12/2022
  • 47. Management……..cont’d • Levels of Management – Managers perform management activities at a number of level • Individual management – Self-management – occur much more frequently at lower levels. • Interpersonal management – between the manager and one other person – E.g. a pharmacist counselling a patient about a medication 17/12/2022
  • 48. Management……..cont’d • Organizational management – Occurs less frequently – Involves actions that affect groups of people – E.g. deciding where to go for lunch – E.g. when a pharmacist needs to develop a policy or make a decision that may affect many people at the pharmacy 17/12/2022
  • 49. What makes successful manager? • Politics, economy, human resources and infrastructure development contribute for success or failures. • But success lies – Managerial task – Managerial role – Managerial skill – Qualities of the manger 17/12/2022
  • 50. Managerial tasks • Crisis management – e.g outbreak of meningitis and its management • Routine administration – e.g receiving report, managing staff, making decision • Long term program development – It is little time consuming – Failure to plan and implement needed change will increase the number of problems, makes routine administration less effective 17/12/2022
  • 51. Managerial role • Role – is a set of expectation place on any one in a position of responsibility by the people around that person • Role of manager • Leader – Directing – motivating staff – maintaining liaison with other organization 17/12/2022
  • 52. Managerial role • Communicator – maintaining networks of formal or informal) – Disseminating information – Serving as spokes person • Decision maker – Resource allocation – Program change and development – Problem solving – Negotiating 17/12/2022
  • 53. Managerial skill • Technical skill – e.g. pharmacy, other skill related to specific jobs • Conceptual and analytical skill – ability to synthesize information – understand the prevailing circumstance – use planning program to move forward • Decision making skill – Identify and select option using analytical and technical skill – Decide 17/12/2022
  • 54. Managerial skill • People skill – Understanding, motivating and directing people – Building team and improving effectiveness • Financial skill – Budgeting – Assessing value for money in people and projects • Negotiating – Adhering to budget – Coping with constraint • Communication and research skill – Listening , reading, writing, running meeting and making public presentation • Computer skill – Proficiency in different software 17/12/2022
  • 55. Qualities of manger • Provide clear direction • Encourage open communication • Coaches and support people • Recognize staff for good performance • Follow up on important issues and provide feedback • Select the right of people for specific assignment • Understand the financial implication of decision • Encourage creativity and new ideas • Give staff clear cut decision when they are needed • Consistently demonstrate a high level of integrity 17/12/2022
  • 56. 2. Concepts of Essential Drugs And National Drug Policy 17/12/2022
  • 57. 2.1 Concept of Essential medicines/ Drugs • Health is a fundamental human right. • Access to health care includes access to essential drugs. • What is Access? – Physical availability • the type and quantity of product or service needed and provided – Affordability • users ability to pay for the products/services – Geographical accessibility • the location of the product/service and eventual user – Acceptability (satisfaction) • Users’ attitudes and expectation about products and services and the actual characteristics of products and services 17/12/2022
  • 58. Concept of Essential …….cont’d • Essential medicines – are medicines that satisfy the priority health care needs of the population – should be available at all times, in adequate amounts in appropriate dosage forms and at a price the individual and the community can afford” 17/12/2022
  • 59. Concept of Essential …….cont’d • Essential drugs concept – “a limited number of carefully selected drugs based on agreed clinical guidelines leads to more rational prescribing, to a better supply of drugs and to lower costs”. – It is a global concept that can be applied in any country, in the private and public sectors and at different levels of the health care system. 17/12/2022
  • 60. The Essential Medicines Target S S All the drugs in the world Registered medicines National list of essential medicines Levels of use Supplementary specialist medicines CHW dispensary Health center Hospital Referral hospital Private sector 17/12/2022
  • 61. 2.2 The formulary process • The formulary process – consists of preparing, using and updating a • Formulary list or essential medicines list (EML) • Formulary manual • Standard treatment guidelines (STGs). 17/12/2022
  • 62. The formulary list or Essential medicines list • The formulary list/ essential medicines – list of pharmaceutical products approved for use in specific health care setting • E.g National formulary list, provincial formulary list • Hospital list – Alphabetically and therapeutically arranged lists of drugs 17/12/2022
  • 63. Formulary/essential medicines list • Selection criteria – Pattern of prevalent disease – Treatment facilities – Training and experience of available personnel – Financial resources – Genetic, demographic and environmental factor – Medicines which have sound, adequate data on efficacy and safety (clinical studies, evidence from general setting) – Adequate quality, including bioavailability, stability under anticipated conditions of storage and use 17/12/2022
  • 64. Formulary/essential medicines list – Cost: Consider cost of the total treatment rather than the unit cost of the medicine • Use cost-effectiveness analysis result – Other factors: PK properties, availability of facilities for storage or manufacturers. – Essential medicines formulated as single compounds. – But fixed-ratio combination products are acceptable only when • The dosage of each ingredient meets the requirements of a defined population • The combination has a proven advantage over single compounds • Administered separately in therapeutic effect, safety or compliance. 17/12/2022
  • 65. How STGs and EMLs lead to better prevention and care 17/12/2022
  • 66. Formulary manual • Formulary manual – Is the summary information on medicines in the formulary list together in a manual. – Is drug centered – Handy reference that contains selected information relevant to prescriber, dispenser, nurse or other health worker • Drug information included in a comprehensive formulary • Introductory information – Acknowledgment, List of approved abbreviation – Introduction ( development of manual, intended user) – Formulary policies and procedures 17/12/2022
  • 67. Formulary manual • Basic information about each medicine – Generic name – Dosage and strengths – Indications, CI and precautions – Side-effects – Dosage schedule – Instructions and warnings – Drug, food, laboratory interactions • Supplementary information for medicines – Price – Regulatory category – Storage guidelines – Patient counseling information – Labeling information – Brand names and synonyms 17/12/2022
  • 68. Formulary manual • Prescribing and dispensing guidelines – Rational prescribing techniques – Principles of prescription writing – Guidelines for quantities to be dispensed – Controlled drug requirements – Adverse drug reaction reporting requirements – Dispensing guidelines – List of precautionary labels – Common drug interaction tables 17/12/2022
  • 69. Advantages of essential medicines list • Prescribing – Training is more focused and simpler – More experience with fewer medicines – Non-availability of irrational treatment – Reduction of antimicrobial resistance – Focused drug information – Better recognition of ADR 17/12/2022
  • 70. Advantages of essential medicines list • Supply – Easier procurement, storage and distribution – Lower stocks – Better quality assurance • Cost – Lower prices, more competition • Patient use – Focused education efforts – Reduced confusion and increased adherence to treatment – Improved medicine availability 17/12/2022
  • 71. Standard Treatment Guidelines • STG: – Is also called Treatment Protocol or Clinical Guideline – Systematically developed statements that help practitioner or prescriber in deciding on appropriate treatments for specific clinical conditions. – It reflect consensus on the optimal treatment option within health facility or health system • It is disease centered – common disease and complaints, treatment alternatives – STG exist for various level of health care • E.g Hospital, health center, region, nation 17/12/2022
  • 72. Standard Treatment Guidelines • Information on STG – Diagnostic criteria – Treatment of first choice – Cost of treatment – Important CI, SE – Important drug information, warnings and precautions – Referral criteria – index 17/12/2022
  • 73. Standard Treatment Guidelines • For health officials – Identify cost effective treatments for common health problems – Provides a bases for assessing and comparing quality of care – Identifies most effective therapy in terms of quality – It helps to combats antimicrobial resistance – Provides information for practitioner to give to patients concerning the institutions standards of care – Is a vehicle for integrating special programs • control of diarrheal disease, acute respiratory tract infection, TB, Malaria at the point of primary health care provider 17/12/2022
  • 74. Potential benefits of STG • For supply management staff – Identifies which medicines should be available for the most commonly treated problem – Facilitates pre packaging of course of therapy quantities of commonly prescribed items – Makes medicine demand more predictable, so forecasting is more reliable 17/12/2022
  • 75. Potential benefits of STG • For health care providers – Provides expert consensus on most effective, economical treatment for specific setting – Gives provider the opportunity to concentrate on correct diagnosis – Sets a quality of care standard – Provide a basis for monitoring and supervision 17/12/2022
  • 76. Potential benefits of STG • For patients – Encourage adherence to treatment through consistency among prescriber at all location within the health care system – Ensures most cost effective treatment are provided – Improves availability of medicines – improves treatment and outcomes 17/12/2022
  • 77. Standard Treatment Guidelines • The problems associated with STGs include: – a development process • Difficult, time-consuming, • Requires human and financial resources – the need to update regularly to avoid STGs becoming obsolete – the danger of inaccurate or incomplete guidelines • providing wrong information to prescribers 17/12/2022
  • 78. What is a national drug policy? • A political commitment to a goal and a guide for action. – It expresses and prioritizes the medium- to long-term goals set by the government for the pharmaceutical sector, and identifies the main strategies for attaining them. – It provides a framework within which the activities of the pharmaceutical sector can be coordinated. – It covers both the public and the private sectors, and involves all the main actors in the pharmaceutical field. 17/12/2022
  • 79. Why is a national drug policy needed? • To present a formal record of values, aspirations, aims, decisions and medium- to long-term government commitments; • To define the national goals and objectives for the pharmaceutical sector, and set priorities; • To identify the strategies needed to meet those objectives, and identify the various actors responsible for implementing the main components of the policy; • To create a forum for national discussions on these issues. 17/12/2022
  • 80. Objectives of a National Drug policy • The general health related objectives • To ensure: – Access: equitable availability and affordability of essential drugs – Quality: the quality, safety and efficacy of all medicines – Rational use: the promotion of therapeutically sound and cost-effective use of drugs by health professionals and consumers. 17/12/2022
  • 81. National Drug policy • Other Goals of NDP – Economic related goals • To reduce foreign exchange for pharmaceutical import • To provide jobs (dispensing, pre-packaging, production of pharmaceuticals) – National development goal • Develop national pharmaceutical production • To take a stand on intellectual property rights 17/12/2022
  • 82. National Drug policy • The specific goals and objectives of a NDP may vary from country to country depending on – Structure of health care system – Capacity of drug regulating authority – Pharmaceutical distribution system – The level of funding of pharmaceuticals – The country situation – The national health policy – Political priorities set by the government 17/12/2022
  • 83. Example: Objectives of Ethiopian NDP • To meet the country’s demand for essential drugs and to systematize its supply, distribution and use. • To create conducive situations to make the prices of drugs compatible with the people’s purchasing power. • To ensure the safety, efficacy and quality of drugs. • To develop a domestic drug manufacturing capacity and gradual supply to the export market. • To expand the training of manpower and drugs research and development. • To devise ways and means for the utilization of traditional drugs in the regular health services after ensuring their safety and efficacy. 17/12/2022
  • 84. Key components of a national drug policy 17/12/2022
  • 85. Key components of ..……..cont’d • Selection of essential drugs – Adoption of the essential drugs concept – Selection criteria • Sound and adequate evidence, cost effectiveness) – Procedures to define and update the national list(s) of essential drugs; – Selection mechanisms for traditional and herbal medicines. 17/12/2022
  • 86. Key components of ..……..cont’d • Affordability – For all drugs • Reduction of drug taxes, tariffs and distribution margins; pricing policy; – For multi-source products: • Promotion of competition • generic policies, generic substitution and good procurement practices; – For single-source products: • Price negotiations • Therapeutic substitution • TRIPS-compliant measures such as compulsory licensing, “early workings” of patented drugs for generic manufacturers and parallel imports. 17/12/2022
  • 87. Key components of ..……..cont’d • Drug financing – commitment to measures to improve efficiency and reduce waste – increased government funding for priority diseases, and the poor and disadvantaged – promotion of drug reimbursement as part of public and private health insurance schemes – use and scope of user charges as a (temporary) drug financing option – use of and limits of development loans for drug financing – guidelines for drug donations 17/12/2022
  • 88. Key components of ..……..cont’d • Supply systems – public–private mix in drug supply and distribution systems; – commitment to good pharmaceutical procurement practices in the public sector – publication of price information on raw materials and finished products – drug supply systems in acute emergencies – inventory control, and prevention of theft and waste – disposal of unwanted or expired drugs 17/12/2022
  • 89. Key components of ..……..cont’d • Legislative and Regulatory framework – government commitment to drug regulation, including the need to ensure a sound legal basis and adequate human and financial resources; – independence and transparency of the drug regulatory agency; relations with the ministry of health (MoH) – Functioning drug regulatory authority – stepwise approach to drug evaluation and registration 17/12/2022
  • 90. Key components of ..……..cont’d – Pharmaceutical quality assurance including inspection and enforcement – commitment to GMP, inspection and law enforcement – access to drug control facilities – commitment to regulation of drug promotion – regulation of traditional and herbal medicines – need and potential for systems of ADR monitoring – international exchange of information. 17/12/2022
  • 91. Key components of ..……..cont’d • Rational use – development of evidence-based clinical guidelines, as the basis for training, prescribing, drug utilization review, drug supply and drug reimbursement; – establishment and support of drugs and therapeutics committees (DTC); – promotion of the concepts of essential drugs, rational drug use and generic prescribing in basic and in-service training of health professionals – the need and potential for training informal drug sellers; – continuing education of health care providers – independent, unbiased drug information 17/12/2022
  • 92. Key components of ..……..cont’d – consumer education, and ways to deliver it; – financial incentives to promote rational drug use; – regulatory and managerial strategies to promote rational drug use. • Research – operational research in drug access, quality and rational use; – Pharmaceutical development and clinical research 17/12/2022
  • 93. Key components of ..……..cont’d • Human resources (HR) development – government responsibility for planning and overseeing the development and training of the HR needed for the pharmaceutical sector; – define minimum education and training requirements for each category of staff; – career planning and team building in government service; – the need for external assistance (national and international). 17/12/2022
  • 94. Key components of ..……..cont’d • Monitoring and evaluation – explicit government commitment to the principles of monitoring and evaluation; – monitoring of the pharmaceutical sector through regular indicator-based surveys; – independent external evaluation of the impact of the NDP on all sectors of the community and the economy. 17/12/2022
  • 95. Strategic pathway for health commodity security (SPARCH) 17/12/2022 • Health commodity security exists when every person is able to choose, obtain, and use quality health products whenever s/he needs them.
  • 96. Strategic pathway for health commodity security (SPARCH) 17/12/2022
  • 97. Strategic pathway for health commodity security (SPARCH) 17/12/2022
  • 98. Strategic pathway for health commodity security (SPARCH) 17/12/2022
  • 99. Strategic pathway for health commodity security (SPARCH) 17/12/2022
  • 100. Strategic pathway for health commodity security (SPARCH) 17/12/2022
  • 101. Strategic pathway for health commodity security (SPARCH) 17/12/2022
  • 102. Strategic pathway for health commodity security (SPARCH) 17/12/2022
  • 103. Implementing a NDP/NMP • A policy without implementation is worthless • NDP needs – implementation plan or “master plan” – a detailed strategy and – specific action plans • Priorities for implementation – Priorities should be • based on the severity of the problems • on the potential for success in achieving the objective • making an impact with available resources. • Master plan and work plans – Implementation plan or master plan cover a 3–5-year period. 17/12/2022
  • 104. Implementing a NDP/NMP – The master plan should be broken down into • annual action plans and work plans • specify in detail who is responsible, • listing the major tasks, • describing the target output, the detailed time frame and the exact budget • Responsibilities in implementation – the Ministry of Health or a separate unit within the ministry should oversee and coordinate all activities, and monitor the extent of implementation and the achievement of targets. 17/12/2022
  • 105. Implementing a NDP/NMP • Creating a national consultative forum – To oversee policy implementation. – To maintain countrywide support for the policy – To ensure that the major stakeholders remain informed and involved. • Financial resources – Actively seeking funds and be able to secure regular funding from the government, international and local donors. – there should be no conflict of interest in accepting donor contributions 17/12/2022
  • 106. 2. Drug management cycle 17/12/2022
  • 107. Drug Supply Management cycle 17/12/2022
  • 108. Drug Supply Management cycle • Management support → core – Organization → functional orgn’l structure – Financing and sustainability → adequate – Information management → reliable – HR management → motivated staff • The entire framework relies on policies, laws and regulation 17/12/2022
  • 109. Drug Supply Management cycle • NDP/NMP provides a sound foundation for managing pharmaceutical supply • Wise medicine selection underlies all other improvements • Effective management and good governance save money and improve performance • Rational medicine use requires more than just dissemination of information's • Systematic assessment and monitoring are essential 17/12/2022
  • 111. The Logistics cycle • What Is Logistics? • “Supply chain management encompasses the planning and management of all activities involved in sourcing and procurement…and all logistics management activities. Importantly, it also includes coordination and collaboration with channel partners, which can be suppliers, intermediaries, third party service providers, and customers. • In essence, supply chain management integrates supply and demand management within and across companies.” 17/12/2022
  • 112. The Logistics cycle • Logistics management as— – part of supply chain management that plans, implements, and controls the efficient, effective forward and reverses flow and storage of goods, services and related information between the point of origin and the point of consumption in order to meet customers’ requirement… 17/12/2022
  • 113. 17/12/2022 Introduction to Logistics & Supply Chain Management
  • 114. Introduction…..cont’d • Different product • Different supply chain • Every product has story • Multiple supply chain – Rare to find a product created, manufactured, and consumed at the same time and place • Perishability – Banana vs. pumps • Source – Single source – Multiple source • Customer – Consumer e.g. women for shoes – B2C e.g. banana – Manufacturer – Construction company • Similarity in decision making – How much inventory – How do I forecast demand – Where to stock inventory – How do I move product from source to final destination • Difference – Value – Outcome 17/12/2022
  • 115. • Supply chain – is a network of interconnected organizations or organizational entities developed with the goal of getting the right product to the right place at the right time – Two or more parties linked by a flow of resources – typically material, information, and money – that ultimately fulfill a customer request – SCM term coined 1980 – Before 1980, logistics, operations management terms were used 17/12/2022
  • 117. Simple chain or web 17/12/2022
  • 118. Examples of supply chain 17/12/2022
  • 120. 1-120 Supply Chain: Flows (2) Suppliers Manufacturers Distributors Customers After-sales support, Recycling, Order information, Payments Material, Information, Invoicing
  • 121. Process View of Supply Chains • Four Primary Cycles – Customer Order Cycle – Replenishment cycle – Manufacturing Cycle – Procurement Cycle • Cycles Occur Between Stages – Interactions differ at each stage • Not every SC will have all 4 Cycles 17/12/2022
  • 122. Macro Process (Software) Perspective 17/12/2022
  • 124. • SCM – Logistics management – Supplier relationship management – Customer relationship management 17/12/2022
  • 125. Supply chain management • encompasses the planning and management of all activities involved in sourcing and procurement, conversion, and all logistics management activities. • Importantly, it also includes coordination and collaboration with channel partners, which can be suppliers, intermediaries, third party service providers, and customers. • In essence, supply chain management integrates supply and demand management within and across companies. 17/12/2022
  • 126. • Logistics management – is that part of supply chain management that plans, implements, and controls the efficient, effective forward 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. 17/12/2022
  • 127. • The pharmaceutical supply chain – is the management of product supply from raw material sourcing to active ingredient manufacturing through formulation, packaging and distribution to the patient. – It is the means through which medicines are delivered to patients. 17/12/2022
  • 128. Pharmaceutical SCM in Ethiopia 17/12/2022 International/Local Source PUBLIC (PFSA Central) PFSA Hub Hospitals Health Centers Health Posts CLIENTS Wholesalers PRIVATE IMPORTERS Retailers (Pharmacy , drug store rural drug vendor) Hospitals, Clinics
  • 129. The Logistics cycle • Why Logistics Matters • Well functioning supply chain benefit public health programs – increasing program impact • No product? No program! – enhancing quality of care – improving cost effectiveness and efficiency. 17/12/2022
  • 131. The Logistics cycle The PURPOSE of a logistics system is to get the RIGHT QUANTITIES of the RIGHT GOODS to the RIGHT PLACES at the RIGHT TIME in the RIGHT CONDITION at the RIGHT COST. 17/12/2022
  • 133. Purpose of Product Selection or Advantages of limited list of Essential Medicines • Supply – Make the supply chain more manageable • Easier procurement, storage and distribution – Lower stocks – Better quality assurance • Prescribing – Training is more focused and therefore simpler – More experience with fewer medicines – Non availability of irrational treatment – Reduction of antimicrobial resistance – Focused drug information – Better recognition of ADR 17/12/2022
  • 134. Purpose of Product Selection or Advantages of limited list of Essential Medicines • Cost – Lower prices, more competition • Patient use – Focused education efforts – Reduced confusion and increased adherence to treatment – Improved medicine availability 17/12/2022
  • 135. Selection of Essential Medicines • Selection criteria – The national EML – Whether the product is registered in the country by the pharmaceutical regulatory authority – National STGs – Pattern of prevalent disease – Treatment facilities – Training and experience of available personnel – Financial resources – Genetic, demographic and environmental factor – Safe, efficacious, quality 17/12/2022
  • 136. Selection of Essential Medicines – When two or more medicines appear to be similar • their relative efficacy, safety, quality, price and availability. • Cost – Consider the total cost of treatment rather than the unit cost of the medicine – The basis of a cost-effectiveness analysis. • Other factors such as – PK properties, availability of facilities for storage or manufacturers. 17/12/2022
  • 138. Definition of procurement • Procurement refers to obtaining goods, works, consultancy or other services through purchasing, hiring or obtaining by any other contractual means. • Procurement Management is defined as the process of acquisition of goods and non- consulting services and/or obtaining goods and services through grants, employment of contractors and consultants 12/17/2022 138 የኢትዮጵያኤሌክትሪክኃይል ETHIOPIANELECTRICPOWER
  • 139. Definitions for different Types of Procurement • Goods mean – raw material, products and equipment and commodities in solid, liquid or gaseous form, marketable software and live animals as well as installation, transport, maintenance or similar obligations related to the supply of the goods if their value does not exceed that of the goods themselves. • Services mean – any object of procurement other than works, goods and consultancy services: such as maintenance, security, janitorial, electricity, telecommunication and water supply services. 12/17/2022 139
  • 140. Cont… • Works mean – all work associated with the construction, reconstruction, up grading, demolition, repair or renovation of a building road, or structure, as well as services incidental to works, if the value of those services does not exceed that of the works themselves and includes build-own-operate, build- own-operate-transfer and build operate- transfer contracts. • Consultancy Service means – a service of an intellectual and advisory nature provided by consultants using their professional skills to study, design and organize specific projects, advice clients, conduct training and transfer knowledge. 12/17/2022 140
  • 141. Procurement Vs Purchasing • Procurement deals with the sourcing activities, negotiation and strategic selection of goods and services that are usually of importance to an organization. • Purchasing can usually be described as the transactional function of procurement for goods or services. 12/17/2022 141
  • 142. Basic Principles in Procurement 1) Best Value for Money  Economy  Efficiency  Effectiveness 2) Fairness 3) Transparency 4 ) Competitiveness 12/17/2022 142
  • 143. Centralized and Decentralized Procurement Functions • What does centralized procurement function mean? • What does decentralized procurement function mean? 12/17/2022 143
  • 144. Centralized vs Decentralized procurement structure • Pros of Centralized procurement structure are  Greater Specialization  Consolidation  Easier coordination and control  Effective planning and research work • Pros of Decentralized Procurement Structure are :  Easier coordinate on with operating departments  Speed of Operation  Effective Use of Local Sources  Plant Autonomy 12/17/2022 144
  • 145. Factors affecting feasibility and desirability of centralization • Similarity of Materials Usage • Plant Department Size • Geographic Dispersion of plants 12/17/2022 145
  • 146. Good Procurement Practice • Good Procurement Practice – Generic name – Limited to EML list or formulary list – Bulk purchases – Formal supplier qualification and monitoring – Competitive bidding process 17/12/2022
  • 147. Good Procurement Practice – Commitment to a sole source – Order quantities based on reliable estimate of actual need – Reliable payment and good financial management – Transparency and written procedures – Separation of key functions – Product quality assurance program – Annual audit with published results – Regular reporting on performance 17/12/2022
  • 149. procurement process Program Planning • It is a collection of organizational resources that is geared to accomplish a certain major goal or set of goals. • It is like an organization , it is a system with inputs, processes, outputs (tangibles) and outcomes (impacts on customers)-with ongoing feedback among the parts. 12/17/2022 149 የኢትዮጵያኤሌክትሪክኃይል ETHIOPIANELECTRICPOWER
  • 150. Program vs project • Project is temporary undertaking to create product or service. • A project has a defined start and end point and specific objectives that, when attained, signify completion. • A programme, on the other hand, is defined as a group of related projects managed in a coordinated way to obtain benefits not available from managing the projects individually. • A program is comprised of multiple projects and is created to obtain broad organizational or technical objectives. • There are many differences between a project and a programme including scope, benefits realization and time. 12/17/2022 150
  • 151. 2. Procurement planning • Basic Points 12/17/2022 151 Why How When What Who • To determine complete procurement requirements for project • Define packages • Define cost estimates / budget • Define procurement methods • Establish lead times • Determine procurement steps • Determine deadlines • Define specifications • Define quality standards • Project Manager • Procurement Unit • Control Units
  • 152. Cont.. 3. Document Preparation • Specification • TOR • Drawing • Bidding Document • RFP 12/17/2022 152
  • 153. Cont… 4.Bidding Period 5. Bid Submission and Opening 6. Bid Evaluation Process 7. Contract Administration 12/17/2022 153
  • 154. • Procurement planning is the scheduling of stages involved in the procurement for goods, works, and services. • In this process, the following questions should be answered: – What goods and services will be procured? – Who will procure them? – How will they be procured ? – When will they be procured 12/17/2022 154 የኢትዮጵያኤሌክትሪክኃይል ETHIOPIANELECTRICPOWER
  • 155. Basic Contents of Procurement Planning a) Description of goods or services b) The list of packages to be procured c) Estimated budget d) Method of procurement e) Review requirement f) Critical Stages of the bidding process 12/17/2022 155
  • 156. Specific procurement methods 12/17/2022 156 LIB NCB Shopping Direct Contracting Force Account Same as ICB but no advertisement Used when:  Contract value is small  Number of suppliers is limited  Exceptional reasons exist Domestic preference not applicable National public procurement procedures are used Advertised in official gazette or local papers of nation-wide circulation National procedures must meet Bank criteria for transparency, efficiency, and economy Used when:  Goods or works that, by nature and scope, are unlikely to attract foreign competition  Contract value is small  Works are scattered geographically and over time  Goods are available locally at prices lower than international market  ICB is not cost- effective Quotations are sought from at least three suppliers. Request for quotations shall indicate description and quantity of the goods, as well as desired delivery time and place. International: at least three bids from two countries National: when goods are ordinarily available locally at competitive prices Offers received by fax and purchase orders issued contain the terms of the accepted offer Used when:  Contract value is low  Off the shelf goods and standard specification commodities of low value are being purchased Instead of shopping, IAPSO may be used as procurement agent for motor vehicles, information technology equipment, office equipment and supplies, and audio visual and communication equipment No competition; single source Used when:  Contract extensions when original contracts were awarded following Bank procedures  Standardization of equipment or spare parts is needed  Proprietary equipment is needed  Critical items must be purchased from one supplier as a condition of performance guarantee  Exceptional circumstances exist, such as natural disasters Borrower’s own personnel and equipment may be the only practical method for constructing some kind of works. Used when:  Quantities cannot be defined in advance  Works are small and scattered in remote locations  Risk of work interruption is better borne by the Borrower  Emergencies require prompt attention
  • 157. Basic Points • Process Layout • Best Value for Money • Monitoring and Evaluation • Living Document • Lead-time • Backward Planning • Multidisciplinary 12/17/2022 157
  • 158. Procurement Challenges • Accurate quantification and forecast data • Lengthy procurement process • Delays in funding allocation and release • Product quality assurance • Transparency 17/12/2022
  • 159. Factors influencing pharmaceutical prices and total costs • Unit price – Competition among supplier • number of products and generic version – Rule of five • Gov’t policy – registration, licensing, prescribing, dispensing • Procurement method • Reorder frequency and the total cost of pharmaceutical purchasing – Total cost = Drug acquisition price + inventory holding cost + purchase operating cost + shortage cost 17/12/2022
  • 160. Factors influencing pharmaceutical prices and total costs – Cost minimized by Reorder frequency • Interval b/n order (annual, scheduled, perpetual) • Safety stock target- lead time, consumption pattern, service level • Visible and hidden costs – Total cost= Hidden cost + visible cost 17/12/2022
  • 162. Key terms in health commodity procurement • Tender – The documentation and initiation of a process for soliciting bids; the specifications for the product/service desired and opening the contract to the bidding process. • Bid – A written offer for a quantity of goods, works, or services, at a stated price; based on technical specifications and other terms and conditions. 17/12/2022
  • 163. Procurement methods • A procurement method is the technique that public body uses to acquire goods, works and services. • The method selected depends on a number of factors including: – the type of goods or service being procured – the value of the good or service being procured – the potential interest of foreign bidders – the cost of the procurement process itself. • Public bodies shall use open bidding as the preferred procedure of procurement except as otherwise provided in this Proclamation No. 649/2009. - 17/12/2022
  • 164. • Public bodies may use a method other than open bidding only where conditions for use of such other method stipulated under this Proclamation are satisfied. • A procurement methods: – Open Bidding • International Competitive Bidding • National Competitive Bidding – Two Stage Bidding – Framework Approach – Limited Bidding – Request for Quotation – Direct Contracting. 17/12/2022
  • 165. Procurement methods • Open Bidding/tender – Is a formal procedure by which quotations are invited from any suppliers on a local or worldwide basis, subjects to the terms and conditions specified in the tender invitation – all interested bidders are given adequate notification of contract requirements – all eligible bidders are given an equal opportunity to submit a tender – The Public body must give sufficient public notification of bidding opportunities to potential bidders to determine their interest and prepare bid documents. – the preferred procedure of procurement. – a method other than open bidding is used only where conditions for use of such other method stipulated under this proclamation are satisfied. 17/12/2022
  • 166. • International Competitive Bidding (ICB) – is a procurement procedure where bidding is open to all local or international legal entities interested in submitting a tender – shall be used wherever in national open bidding an effective competition cannot be obtained unless foreign firms are invited to bid. – The objective of ICB is to provide all eligible prospective bidders with timely and adequate notification of purchasers' requirements and an equal opportunity to bid for the required goods and works. 17/12/2022
  • 167. • National Competitive Bidding (NCB) – NCB is the procurement procedure where Invitation to Bid is restricted to the Federal Democratic Republic of Ethiopia. – NCB is preferred when • an effective competition can be obtained where both national and foreign firms are invited to bid. • There are circumstances where ICB would not be the most economic and efficient method of procurement, and where NCB is deemed more appropriate. • 17/12/2022
  • 168. Procurement methods • Limited Bidding /RESTRICTED TENDERING – It includes both national and international. – Interested suppliers must be approved in advance (prequalification process) • conditions for RESTRICTED TENDERING – the required object of procurement is available only with limited suppliers; – the cost of procurement does not exceed the threshold specified – when the goods or services by reason of the highly complex or specialized nature – are only available from a limited number of suppliers. – he time and cost required to examine and evaluate a large number of bids would be disproportionate to the value of the goods or services to be procured. – This method is very similar to ICB/NCB using almost identical bidding documents. 17/12/2022
  • 169. • Two Stage Bidding • Public bodies may engage in procurement by means of two-stage bidding: – when it is not feasible for the Public body to formulate detailed specifications for the goods or works and in the case of services, to identify their characteristics and, in order to obtain the most satisfactory solution to its procurement needs; – when the Public body seeks to enter into a contract for the purpose of research, experiment, study or development" except where the contract includes the production of goods in quantities sufficient to establish their commercial viability or to recover research and development costs; – where bid proceedings are initiated but no bids are submitted as a result of the nature of the object of procurement not being clearly described or where all bids are rejected due to failure; – Because of the technical character of the required goods or works, or because of the nature of the consultancy or other services it is necessary for the Public body to negotiate with the suppliers. 17/12/2022
  • 170. Procurement methods • Request for Quotations – for the purchase of readily available goods for which there is an established market – the estimated value of the contract does not exceed an amount stated in the procurement directive to be issued by the Minister. – Request for quotation can be theoretically both from National and International suppliers or even a mixture. – In practice, it is usually only used for national due to the limitation of the threshold that would make it extremely unlikely, a response would be received from an International. This method only requires quotations to be solicited from at least three different suppliers. 17/12/2022
  • 171. Procurement methods • Direct Procurement – is when the purchaser establishes direct contact with suppliers (without competition) or their representatives. – it can be applied both for domestic and foreign Contractors/ Suppliers/ Consultants. • Conditions for Direct Procurement – in absence of competitions (goods, works consultancy) or provided only by one candidate; – for additional deliveries of goods by the original supplier • replacement , installations or as the extension of existing supplies, – additional works, which have been not included in the initial contract – During emergency 17/12/2022
  • 172. • General circumstances for direct contracting – Emergency – Urgency (very seldom seen in international best practice) – When a competitive bidding process has been conducted several times without satisfactory result – Procure or lease real estate property – Standardization – Established prices/rates – Existing contract (including contract variations & amendments) – Procuring based on a competitive bidding conducted within last e.g. 12 months – same item/prices – Professional services that cannot be objectively evaluated. – Situations, where formal solicitation will not give satisfactory result 17/12/2022
  • 173. • Framework contracts – often a way to avoid emergency procurement – Establishing long term zero-contract framework contracts based a competitive process and with short notices for delivery is a common way to avoid ‘emergency’ and ‘urgency’ procurement. – If such zero-framework contracts are established for goods/services which have a history for falling under emergency/urgency, the products/services can be required with short notice – and still based on competitive tendering. – Whether or not the need comes up: the cost of having the zero framework contracts is zero. 17/12/2022
  • 175. 3.1 INCOTERMS as stipulated by the ICC • INCOTERMS are a series of pre-defined commercial terms published by the International Chamber of Commerce widely used in international commercial transactions. • internationally accepted terms • Intended primarily to clearly communicate the tasks, costs and risks associated with the transportation and delivery of goods. • Accepted by governments, legal authorities and practitioners worldwide for the interpretation of most commonly used terms in IT. • Intended to reduce or remove altogether uncertainties arising from different interpretation of the rules in different countries. • First published in 1936, periodically updated, (1953, 1967, 1976, 1980, 1990, 2000) with the eighth version—INCOTERMS 2010— having been published on January 1, 2011.
  • 176. • INCOTERMS – Define the responsibilities of exporters and importers in the arrangement of shipments and the transfer of liability involved at various stages of the transaction. – Do not cover ownership or the transfer of title of goods. – It will affect the costs and responsibilities involved in shipping, insurance and tariffs.
  • 177. Cont…d • Appropriate term needs to be chosen • E.g., EXW – an exporter needs to make the goods available for pick up and provide any product information needed. – The importer's agent (freight forwarder) will arrange and pay for the pre-carriage, shipping, insurance and any additional costs from the exporter's door. • CIF – term requires the exporter to arrange and pay for the pre-carriage, shipping, and insurance to a named port of destination. – In this case, the sale price (invoice) includes the Cost of goods, Insurance and Freight costs that the importer pays the exporter.
  • 178. Cont…d • The 2010 version consists 11 terms grouped into two • Rules for Sea and Inland Waterway Transport: • FAS - Free Alongside Ship – Risk passes to buyer, including payment of all transportation and insurance costs, once delivered alongside the ship (realistically at named port terminal) by the seller. The export clearance obligation rests with the seller. • FOB - Free On Board: – Risk passes to buyer, including payment of all transportation and insurance costs, once delivered on board the ship by the seller. • CFR - Cost and Freight – Seller delivers goods and risk passes to buyer when on board the vessel. – Seller arranges and pays cost and freight to the named destination port. A step further than FOB. • CIF - Cost, Insurance and Freight – Risk passes to buyer when delivered on board the ship. – Seller arranges and pays cost, freight and insurance to destination port. – Adds insurance costs to CFR.
  • 179. Cont…d • Rules for Any Mode or Modes of Transportation: • EXW - Ex Works: – Seller delivers (without loading) the goods at disposal of buyer at seller's premises. – Long held as the most preferable term for those new-to-export because it represents the minimum liability to the seller. • FCA - Free Carrier: – Seller delivers the goods to the carrier and may be responsible for clearing the goods for export. More realistic than EXW because it includes loading at pick-up, which is commonly expected, and sellers are more concerned about export violations. • CPT - Carriage Paid To: – Seller delivers goods to the carrier at an agreed place, shifting risk to the buyer, but seller must pay cost of carriage to the named place of destination. • CIP - Carriage and Insurance Paid To: – Seller delivers goods to the carrier at an agreed place, shifting risk to the buyer, but seller pays carriage and insurance to the named place of destination.
  • 180. Cont…d • DAT - Delivered at Terminal: – Seller bears cost, risk and responsibility until goods are unloaded (delivered) at named quay, warehouse, yard, or terminal at destination. – Demurrage or detention charges may apply to seller. – Seller clears goods for export, not import. • DAP - Delivered at Place: – Seller bears cost, risk and responsibility for goods until made available to buyer at named place of destination. Seller clears goods for export, not import. • DDP - Delivered Duty Paid: – Seller bears cost, risk and responsibility for cleared goods at named place of destination at buyers disposal. – Buyer is responsible for unloading. – Seller is responsible for import clearance, duties and taxes so buyer is not “importer of record”.
  • 181. INCOTERMS 2010 Grou p Description Abb. Terms Detail Terms E The seller’s obligation is at its minimum: the seller has to do no more than place the goods at the disposal of the buyer at the agreed place - usually at the seller’s own premises. EXW EX Work (Named Place) F The seller to deliver the goods to a nominated carrier as instructed by the buyer. F stands for Free. FAS Free Alongside Ship (Name port of loading/shipment) FOB Free On Board (Named port of shipment) FCA Free Carrier (Named Place) C The seller to contract for carriage on usual terms at his own expense. Therefore, a point up to which he would have to pay transport costs must necessarily be indicated after the respective “C” term CFR Karachi. C stands for “Cost/Carriage”. CFR Cost of Freight (Named port of destination) CPT Carriage Paid To (Named place of destination) CIF Cost, Insurance & Freight (Named place of destination) CIP Carriage & Insurance Paid to (Named place of destination) D The seller bears all costs & risks related to the delivery of the goods DAF Delivered at Terminal DAP Delivered at Terminal 181
  • 182. INCOTERMS 2000 – Risk Snapshot 182
  • 184. Role of Banks (Commercial /National)  Banks provide services such as  advice on financial issues, IT processes, documentation, banking procedures and the potential risks involved.  Documentary requirements – Buyer - What documents does he needs? – Seller - With what documents will he be able to supply? – Country of export - what documents are required under the regulations of the exporting country? – Country of import - what documents are required under the regulations of the importing country? 184
  • 185. Role of Banks (Commercial / National) • Wants/needs and problem of trading partners Partner Wants / Needs Problems Buyer Wants 1. Contract fulfillment. 2. Convenience. 3. Credit. 4. Advice and assistance 1. Am I going to get the goods? (in good condition / in time) 2. Does the settlement method safeguard these risks? 3. Before we pay—how to check the goods are exactly those ordered? 4. Any credit terms available Prefers to delay paying for the goods until they are sold. 5. From where can I get information on the exporter’s creditability Seller Needs 1. Contract fulfillment. 2. Convenience. 3. Prompt payment. 4. Advice and 1. Will I be paid? 2. When will I be paid? 3. How to minimize risk of non-payment? 4. How to maintain secrecy of our supplier? 185
  • 186. Role of Banks (Commercial / National)  Basic agreement (International Trade – Sale Contract) 1. Preliminary Quotation & Commitment (Invoicing / order etc) 2. The Merchandise (goods to be imported / exported) 3. Packing (instructions regarding packing of imported / exported merchandise) 4. Method of Settlement 5. Shipping Instructions (trans shipment – partial shipment etc) 6. Price and its components (INCOTERMS 2010) 7. Delivery Mode ,Period, Place (Sea, Air, Road – place of shipment and last date of shipment) 8. Documents (Invoice, packing list, inspection report, certificate of origin, Bill of lading (B/L) and Airway bill (AWB) etc) 186
  • 187. Making and Receiving Payment Internationally : International Payment Instruments • payment methods available in settling an international trade transaction. – Clean Payments – Documentary Collections – Letters of Credit
  • 188. Clean Payments •Clean Payments are characterized by trust. • Either the Exporter sends the goods and trusts the Importer to pay once the goods have been received, or the Importer trusts the Exporter to send the goods after payment is effected. •In the case of Clean Payment transactions, all shipping documents, including title documents, are handled directly by the trading parties. The role of banks is limited to clearing funds as required. •There are two types of Clean Payments: Open Account & Payment in Advance. •Open Account. The Importer is trusted to pay the Exporter after receipt of the goods. •Payment in Advance. An arrangement whereby the Exporter is trusted to ship the goods after receiving payment from the Importer.
  • 189. Clean Payments How does an Open Account transaction work? OPEN ACCOUNT: The Exporter ships the goods and the documents directly to the Importer and waits for the Importer to send payment. Exporter Importer 2 GOODS 1 PAYMENT
  • 190. Clean Payments How does a Payment in Advance transaction work? PAYMENT IN ADVANCE: The Importer sends payment directly to the Exporter and waits for the Exporter to send the goods and documents. Exporter Importer 2 GOODS 1 PAYMENT
  • 191. Risk Analysis: Clean Payments Advantages to Exporter: •Assumes no risks Disadvantages to Exporter: •None Advantages to Importer: •None - but could secure low cost! Disadvantages to Importer: •Assumes all risks •Opportunity cost of using company’s cash resources until goods are received. Open Account Payment in Advance Advantages to Exporter: •None - but could clinch the sale! Disadvantages to Exporter: •Assumes all risks Advantages to Importer: •Assumes no risks •Delays use of company’s cash resources. Disadvantages to Importer: •None
  • 192. Documentary Collections What is a Documentary Collection? •A method of payment used in international trade whereby the Exporter entrusts the handling of commercial and often financial documents to banks and gives the banks instructions concerning the release of these documents to the Importer. •Banks involved do not provide any guarantee of payment. •Documents Against Payment (D/P) & Documents Against Acceptance (D/A) Documentary Collections may be carried out in two different ways: •Documents Against Payment. Documents are released to the Importer only against payment. Also known as a Sight Collection or Cash Against Documents (CAD). •Documents Against Acceptance. Documents are released to the Importer only against acceptance of a draft. Also known as a Term Collection.
  • 193. Documentary Collections How does a Documentary Collection work? The mechanics of a Documentary Collection are easily understood when separated into the following three steps: » Flow of Goods » Flow of Documents » Flow of Payment
  • 194. Documentary Collections: Flow of Documents After the goods are shipped, documents originating with the Exporter (e.g. commercial invoice) and the transport company (e.g. bill of lading) are delivered to a bank, called the Remitting Bank in the Collection process. The role of the Remitting Bank is to send these documents accompanied by a Collection Instruction giving complete and precise instructions to a bank in the Importer’s country, referred to as the Collecting/ Presenting Bank in the Collection process. The Collecting/ Presenting Bank acts in accordance with the instructions given in the Collection Instruction and releases the documents to the Importer against payment or acceptance, according to the Remitting Bank’s Collection instructions. Note: The Exporter’s Bank and the Remitting Bank need not be the same. Also, the Collecting Bank and Presenting Bank need not be the same. Each role could be performed by a different bank. Collecting/ Presenting Bank Importer/D rawee Remitting Bank 2 3 4 Exporter/D rawer GOODS 1 Documents Documents Documents
  • 195. Documentary Collections: Flow of Payment Payment is forwarded to the Remitting Bank for the Exporter’s account. And the Importer can now present the transport document* to the carrier in exchange for the goods. Remitting Bank Presenting/ Collecting Bank 1 2 Exporter/D rawer Importer/D rawee Documents 4 3 *In this case, we are assuming that the transport document is a title document. GOODS
  • 196. Risk Analysis: Documentary Collections Documentary Collections may be settled in two different ways. Documents Against Payment (D/P) refers to a Collection where the Importer receives the documents only in exchange for payment. With Documents Against Acceptance (D/A), the Importer may obtain the documents in exchange for the acceptance of the obligation to pay at a specified future date. These two methods of settlement carry different risks for both Importers and Exporters. Documents Against Payment (D/P) Documents Against Acceptance (D/A) Advantages to the Exporter: •Documents are not released to the Importer until payment has been effected. •Less costly than a Letter of Credit. Disadvantages to the Exporter: •Risk of refusal of payment. •Commercial and country risks not hedged. Advantages to the Importer: •Ability to examine documents before authorizing payment. •Unlike a Letter of Credit, a line of credit is not required, and fees are minimal. Disadvantages to the Importer: •In the case that transport documents carry title, cannot access goods until payment has been made. Advantages to the Exporter: •Less costly than a Letter of Credit. •May provide formal/legal means to collect unpaid obligation. Disadvantages to the Exporter: •Risk of non-acceptance of documents. •Commercial and country risks not hedged. •Although bill of exchange/draft is accepted by the Importer, there is no guarantee of payment by the banks involved. •Legal enforcement of unpaid obligation costly and time- consuming. Advantages to the Importer: •Will receive goods before having to make payment. Disadvantages to the Importer: •Dishonouring an accepted draft is a legal liability and may ruin business reputation.
  • 197. Letters of Credit •A Letter of Credit is a written undertaking by the Importer’s bank, known as the Issuing Bank, on behalf of its customer, the Importer (Applicant), promising to effect payment in favor of the Exporter (Beneficiary) up to a stated sum of money, within a prescribed time limit and against stipulated documents. •A key principle underlying Letters of Credit is that banks deal only in documents and not in goods. •The decision to pay under a Letter of Credit will be based entirely on whether the documents presented to the bank appear on their face to be in accordance with the terms and conditions of the Letter of Credit. • It would be prohibitive for the banks to physically check whether all merchandise has been shipped exactly as per each letter of Credit. What is a Letter of Credit?
  • 198. Letters of Credit • Letters of Credit are either Revocable or Irrevocable: – A Revocable Letter of Credit can be revoked without the consent of the Exporter, (it may be canceled or changed up to the time the documents are presented). – An Irrevocable Letter of Credit cannot be canceled or amended without the consent of all parties including the Exporter. Unless otherwise stipulated, all Letters of Credit are irrevocable. • Letters of Credit may be settled either by sight or by acceptance: – If payment is to be made at the time that documents are presented, this is referred to as a sight Letter of Credit. – If payment is to be made at a future fixed time from the presentation of documents, this is referred to as a term Letter of Credit Basic Facts: Revocable/Irrevocable & Sight/Term
  • 199. Letters of Credit Confirmed Letter of Credit •Under a Confirmed Letter of Credit, a bank, called the Confirming Bank, adds its commitment to that of the Issuing Bank to pay the Exporter under the Letter of Credit provided all terms and conditions of the Letter of Credit are met. The Confirming Bank is usually located in the same country as the Exporter. •An Exporter would request a Confirmed Letter of Credit if it does not consider the financial strength of the Issuing Bank or the country in which it is located to be acceptable risks.
  • 200. Letters of Credit How does a Letter of Credit work? The mechanics of a Letter of Credit are easily understood when separated into the following three steps: »Issuance »Flow of Goods »Flow of Documents & Payment
  • 201. Letters of Credit: Issuance After the trading parties agree on a sale of goods where payment is made by Letter of Credit, the Importer requests that its bank (the Issuing Bank) issue a Letter of Credit in favour of the Exporter (Beneficiary). The Issuing Bank then sends the Letter of Credit to the Advising Bank. A request may be included for the Advising Bank to add its confirmation. The Advising Bank is usually located in the country where the Exporter does business and may be the Exporter’s bank, but does not have to be. Next, the Advising/Confirming Bank verifies the Letter of Credit for authenticity and sends it to the Exporter. 1 Importer applies for Letter of Credit. 3 Request to advise & possibly confirm the Letter of Credit Advice /Confirmation of the Letter of Credit. Advising/ Confirming Bank Issuing Bank 2 4 Exporter/ Beneficiary Importer/A pplicant Contract Negotiations
  • 202. Letters of Credit: Flow of Goods Upon receipt of the Letter of Credit, the Exporter reviews the Letter of Credit to ensure that it corresponds to the terms and conditions in the purchase and sales agreement; that the documents stipulated in the Letter of Credit can be produced; and that the terms and conditions of the Letter of Credit can be fulfilled. Assuming the Exporter is in agreement with the above, it arranges for shipment of the goods. GOODS Exporter/Beneficiary Importer/Applicant
  • 203. Letters of Credit: Flow of Documents & Payment After the goods are shipped, the Exporter presents the documents specified in the Letter of Credit to the Advising/ Confirming Bank. Once the documents are checked and found to comply with the Letter of Credit (i.e. without discrepancies), the Advising/ Confirming Bank forwards these documents to the Issuing Bank. The drawing is negotiated, paid or accepted as the case may be. Issuing Bank 2 4 Exporter/ Beneficiary Importer/A pplicant Documents 5 Documents 3 Advising/ Confirming Bank 1 GOODS
  • 204. Letters of Credit: Flow of Documents & Payment In turn, the Issuing Bank examines the documents to ensure they comply with the Letter of Credit. If the documents are in order, the Issuing Bank will obtain payment from the Importer for payment already made to the Confirming Bank. Documents are delivered to the Importer to allow it to take possession of the goods. Issuing Bank 2 4 Exporter/ Beneficiary Importer/A pplicant Documents 6 5 Documents Documents 3 7 Advising/ Confirming Bank 1 GOODS
  • 205. Risk Analysis: Letters of Credit Importer Exporter Advantages: •An undertaking from the Issuing Bank that you will receive payment under the Letter of Credit provided that you meet all terms and conditions of the Letter of Credit. •Shifts credit risk from the Importer to the Issuing bank. •Not obligated to ship against a Letter of Credit that is not issued as agreed. Disadvantages: •Documents must be prepared in strict compliance with the requirements stipulated in the Letter of Credit. Non- compliance leaves Exporter exposed to risk of non-payment. Advantages: •Importer is assured that, for the Exporter to be paid, all terms and conditions of the Letter of Credit must be met. •Ability to negotiate more favourable trade terms with the Exporter when payment by Letter of Credit is offered. Disadvantages: •A Letter of Credit assures correct documents but not necessarily correct goods. •Ties up line of credit.
  • 206. INTERNATIONAL PAYMENTS RISK SPECTRUM Notice that Open Account and Payment in Advance sit at opposite ends of the Risk Spectrum. Documentary Collections offer more of a compromise in risk-taking between the Importer and the Exporter than Clean Payments. Whereas payment settled via Open Account and Payment in Advance represent a high degree of risk for one of the parties involved, both Documentary Collections and Letters of Credit offer a compromise in risks facing the Importer and the Exporter. LEAST RISK TO IMPORTER HIGHEST RISK TO IMPORTER HIGHEST RISK TO EXPORTER LEAST RISK TO EXPORTER •Open Account •Documentary Collections Documents Against Acceptance Documents Against Payment •Letters of Credit Unconfirmed Confirmed •Payment in Advance
  • 207. Procurement and Purchasing - what's the difference? • Procurement – is the wider aspects related to the activities associated with the provisioning of equipment, products and services encompassing policy and strategy development and implementation, provisioning strategies and demand management etc. • Purchasing – is the procedural aspects related to competitive processes and the methods employed to actually purchase equipment, products and services. 17/12/2022
  • 208. 3.2.2. Quantification of drug requirements • Quantification- how much product is required for purchasing – Estimates the required finance • To estimate needs – Available funds – Storage space capacity – Human resource 17/12/2022
  • 209. Logistics Terms • Lead Time: Lead time is the time interval between when new stock is ordered and when it is received and available for use. • Push System • Pull System • Dispensed-to-User Data • Issues Data • Inventory Control System
  • 210. PIPELINE: The pipeline is the entire chain of storage facilities and transportation links through which supplies move from the manufacturer to the consumer, including the port facilities, central warehouse, regional warehouses, district warehouses, all service delivery points and transport vehicles.
  • 211. PUSH vs. PULL SYSTEM PULL SYSTEM (REQUISITION) : Quantities to be issued are determined by personnel who receive the supplies. PUSH SYSTEM (ALLOCATION) : Quantities to be issued are determined by personnel who issue the supplies.
  • 212. DISPENSED-TO-USER vs. ISSUES DATA DISPENSED-TO-USER DATA: Information about the quantity of goods actually put in the hands of clients. (Often shortened to “dispensed data.”) ISSUES DATA: Information about the quantity of goods shipped from one level of the system to another.
  • 213. 2018 Christian N. & Seid Y. 5. Demand Forecasting
  • 214. 2018 Christian N. & Seid Y. 17/12/2022 Type of products
  • 215. 2018 Christian N. & Seid Y. Quora: ”Demand forecasting is predicting future demand for the product. In other words, it refers to the prediction of probable demand for a product or a service on the basis of the past events and prevailing trends in the present.” What actually is demand forecasting ? Source: KLU T-T-T 2018
  • 216. 2018 Christian N. & Seid Y. Introduction…..cont’d  Different products  Different supply chain  Perishability  Banana vs. pumps  Source  Single source  Multiple source  Customer  Consumer e.g. women for shoes  B2C e.g. banana  Manufacturer  Construction company  Similarity in decision making  How much inventory  How do I forecast demand  Where to stock inventory  How do I move product from source to final destination  Difference  Value  Outcome 17/12/2022
  • 217. 2018 Christian N. & Seid Y.  An accurate forecast is crucial for almost all business decisions, e.g., production planning, capacity planning, inventory management, work force management, budget allocation, etc.  More accurate forecasts lead to better resource allocation and thus improved financial performance. WHY DO WE NEED DEMAND FORECASTING? Source: KLU T-T-T 2018
  • 218. 2018 Christian N. & Seid Y. Demand Process- Three key questions
  • 219. 2018 Christian N. & Seid Y. Forecasting levels
  • 220. 2018 Christian N. & Seid Y. Forecasting Truisms
  • 221. 2018 Christian N. & Seid Y. Forecasting quality 17/12/2022
  • 222. 2018 Christian N. & Seid Y. Forecast error increases with lead time Forecast error Lead time + -
  • 223. 2018 Christian N. & Seid Y. Marketing/ Logistic / sales 29% Operation/Prod uction 27% Forecasting Department 19% Finance 7% Strategic planning 6% Others 12% Place of Forecasters Source: Chaman Jain, “Benchmarking Forecasting Processes,” Journal of Business Forecasting 26, no. 4 (Winter 2007–08), p.12.
  • 224. 2018 Christian N. & Seid Y. Company Krispy Kreme Doughnuts GSK Phar Company Fiat Auto Data used • seasonal factors. • general population Growth • foot traffic • display locations Sales data GDP interest rate inflation rate raw-material prices Forecast method multiple forecasting system Quantitative methods and personal judgments Quantitative Use of forecast • to provide information related to production requirements • to provide financial forecast • To allocate resource for HR planning, for promotions & strategic planning • To set sales quotas. To estimate total sales of vehicles, engines, and gears
  • 225. 2018 Christian N. & Seid Y. Fundamental approaches to forecasting Forecasting methods Qualitative or judgemental Quantitative or statistical Projective • Projecting past patterns / trends into the future Causal • Examining external factors that affect demand to forecast demand
  • 226. 2018 Christian N. & Seid Y. Forecasting Methods
  • 227. 2018 Christian N. & Seid Y. Qualitative methods Qualitative forecasting techniques are: subjective, based on the opinion and judgment of consumers, experts appropriate when past data are not available. usually applied to intermediate- or long-range decisions. 17/12/2022
  • 228. 2018 Christian N. & Seid Y. Jury of executive opinion Appropriate managers within the organization assemble to discuss their opinions on what will happen to demand in the future. experienced guesses the resulting forecast is a blend of informed opinions. How to do the forecast? select people from different functional areas to get rich information Opinions can be collected in individual interviews or in a meeting Meeting Adv: an opportunity to discuss various points of view and deeper insights Dis-adv: people with strong personalities dominate the group, their opinions will become disproportionately important in the final consensus that is reached. 17/12/2022
  • 229. 2018 Christian N. & Seid Y. Delphi Method Delphi Method- gathers, evaluates, and summarizes expert opinions as the basis for a forecast, but the procedure is more formal than that for the jury of executive opinion method. Adv: takes the wisdom and insight of people who have considerable expertise about the area to be forecast. anonymity among the participants. The experts, perhaps five to seven in number Experts never meet to discuss their views none of them even knows who else is on the panel. 17/12/2022
  • 230. 2018 Christian N. & Seid Y. Delphi Method The Delphi Method has the following steps: STEP 1 – Participating panel members are selected. STEP 2. Questionnaires asking for opinions about the variables to be forecast are distributed to panel members. STEP 3. Results from panel members are collected, tabulated, and summarized. – Copies of summary are given to the individual experts with the request that they modify their original answers if they think it necessary. STEP 4 – Another summary is made of these modifications, and copies again are distributed to the experts. This time, however, expert opinions that deviate significantly from the norm must be justified in writing. STEP 5 – A third summary is made of the opinions and justifications, and copies are once again distributed to the experts. Justification in writing for all answers is now required. STEP 6 – The forecast is generated from all of the opinions and justifications that arise from step 5. 17/12/2022
  • 231. 2018 Christian N. & Seid Y. Sales force composite Sales force composite: Marketers have sales managers or representatives at different sales territories (districts/region) and marketers believe that sales managers know their territory better than anybody else. Managers ask respective sales manager to forecast expected sales in their own territories. The total of all these estimates basically gives company’s sales/demand forecast for next period. Advantage: getting information from sources who are very close to actual Buyers Disadvantage: if sales force are given quotas and bonus is considered based on the assigned performance 17/12/2022
  • 232. 2018 Christian N. & Seid Y. Consumer market survey Customer Survey and the General Population Marketers ask buyers about how many units that they would like to purchase from company’s products for coming period of time. Assumption: buyers plan their purchases and follow through with their plans more realistic for industrial sales than for sales to households and individuals. more realistic for big-ticket items than for convenience goods Example: Survey data concerning how people feel about the economy are sometimes used by forecasters to help predict certain buying behaviors 17/12/2022
  • 233. 2018 Christian N. & Seid Y. Advantages and Disadvantage of qualitative methods Advantages Do not require any particular mathematical background of the individuals involved Wide acceptance by user Disadvantages always biased they are not consistently accurate over time it takes years of experience for someone to learn how to convert intuitive judgment into good forecasts. 17/12/2022
  • 234. 2018 Christian N. & Seid Y. Quantitative Forecasting methods-Time Series Methods
  • 235. 2018 Christian N. & Seid Y. Time series methods are statistical techniques that make use of historical data accumulated over a period of time. Time series methods assume that what has occurred in the past will continue to occur in the future. These methods relate the forecast to only one factor time. Two types of time series methods: the moving average and exponential smoothing. Time Series Methods
  • 236. 2018 Christian N. & Seid Y. Demand Time Common patterns in time series Demand Time Demand Time Demand Time Seasonality Seasonality & Trend Constant series Trend
  • 237. 2018 Christian N. & Seid Y.  Simple average  Moving average  Exponential smoothing Projective forecasting methods
  • 238. 2018 Christian N. & Seid Y. Simple average: an average of the demand in the past  Easy to apply and good results when demand is constant  Inappropriate when seasonality is present  Past demand figures are equally weighted, i.e. the forecast does not respond quickly to changes in demand 𝐹𝑜𝑟𝑒𝑐𝑎𝑠𝑡 27 = (𝐷𝑚𝑑1 + 𝐷𝑚𝑑2 + … + 𝐷𝑚𝑑26) 26 𝐹𝑜𝑟𝑒𝑐𝑎𝑠𝑡 27 = (49+50+ …+48) 26 = 50 Simple average 40 44 48 52 56 60 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 Demand (units) Time (weeks) Simple average Sales If a simple average is projected into the future, it results in a flat line forecast
  • 239. 2018 Christian N. & Seid Y. Moving average: an average of n past periods  Forecast is based on more recent sales data (but still equally weighted)  n determines which periods to be included in the forecast  What value of n to choose?  Small number (n=3) results in responsive forecast, while high number (n=10) gives a less sensitive forecast  The moving average method is good for stable demand with no pronounced behavioral patterns. 𝐹𝑜𝑟𝑒𝑐𝑎𝑠𝑡 27 = (𝐷𝑚𝑑24 + 𝐷𝑚𝑑25 + 𝐷𝑚𝑑26) 3 𝐹𝑜𝑟𝑒𝑐𝑎𝑠𝑡 27 = (52+30+48) 3 = 43 Moving average 15 20 25 30 35 40 45 50 55 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 Demand (units) Time (weeks) Moving average (n=10) Moving average (n=3) Sales The moving average projected into the future Drawbacks of averages: • all historical values are given the same weight • the method only works well with relatively constant demand