Quantification of Public Health Emergency Commodities Supply

1. Novel Coronavirus (COVID-19)
Emergency Commodity Supply &
Quantification
11th March ,2020
Ethiopia
1
Negese Sewagegn Semie
Director of Pharmaceutical & Medical Equipment
Amhara Public Health Institute
Bahir Dar, Ethiopia

2. Selection of Products
• WHO technical guidance
1. COVID-19 Disease Commodity Package (DCP)
2. Patient kit reserves, and other essential supplies
2

3. COVID-19 Disease Commodity Package
• Products for
– Surveillance,
– Prevention & Control, and
– Case Management are undergoing rapid and continuous
development and refinement.
3

4. COVID-19 outbreak control activities
considered for material supply
• Supportive treatment (oxygen, antibiotics,
hydration & fever/pain relief) to reduce mortality
• Personal Protective Equipment and material for the
establishment of IPC measures at health care level to
reduce transmission
4

5. Surveillance
– Sample Collection
• Triple packaging boxes
• Viral Transport Medium
• Sharps container boxes
5

6. Surveillance…
• Diagnostics
– Criteria for selection of specific diagnostic tests may include
historical efficacy, adherence to any existing Target Product
Profiles, ease of use, necessary throughput, distribution and
logistics requirements, and manufacturer production capacity.
– For some pathogens, consideration may need to be given to the
presence of mutations in targeted gene sequences or proteins.
– WHO can advise on the selection of tests on a case by case basis
as determined by a specific event.
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7. Triage / Screening
• PPE
– Mask, surgical- Healthcare worker
– Mask, surgical- patient
7

8. Clinical Management
• Supportive Treatment
– Oxygen concentrators
– (Oxygen concentrator) Flow splitter
– Oxygen prongs, nasal, non-sterile, single use
– Oxygen tube, extension
– Portable ventilator
– Pulse Oximeter
8

9. Clinical Management…
• Supportive Treatment…
– Laryngoscope
– Set of stainless steel depressors
– Endotracheal tube, without cuff
– Endotracheal tube, with cuff
– Carbon dioxide detector
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10. Clinical Management…
• Supportive Treatment…
– Portable ultrasound scanner
– Portable ultrasound probes, included with scanner
– Resuscitator, adult
– Resuscitator, child
– Airway, Guedel, sterile, single use (range of sizes)
10

11. Clinical Management…
• Supportive Treatment…
– Compound Sodium Lactate Solution
• (Ringer's lactate), injection solution, w/o IV set and needle,
1000ml
– Infusion giving set
– Antibiotics---- according to national guidelines and
clinical presentation
– Paracetamol 500mg, tablets
11

12. Clinical Management
• PPE Health Care Facilities
– Gloves, examination-nitrile, powder-free, non-sterile.
– Gloves, surgical, length to forearm large (longer than
examination gloves)-nitrile, powder-free, single use.
– Face shield
12

13. Clinical Management…
• PPE Health Care Facilities…
– Fit Test Kit-To evaluate effectiveness of seal for tight
fitting respiratory protection devices
– Particulate respirator, grade N95 or higher-Minimum
"N95" respirator according to FDA Class II.
– Mask, surgical-health care worker--Type II or above
– Mask, surgical- patient-- Type I
13

14. Clinical Management…
• PPE Health Care Facilities…
– Scrubs, tops---Tunic/tops, worn underneath the coveralls
or gown.
– Scrubs, pants---Trouser/pants, worn underneath the
coveralls or gown.
– Apron, heavy duty
– Gown--Single use, disposable, length mid-calf.
– Goggles, protective
14

15. Clinical Management…
• PPE Health Care Facilities…
– Alcohol-based hand rub ------Bottle of 100ml & 500ml
– Bio-hazardous bag---disposal bag for bio-hazardous waste,
30x50cm,
– Safety Box--- needles/syringes for incineration
– Soap---Liquid (preferred), powder and bar
– Gloves, Cleaning--Puncture resistant, FDA compliant
– Hand drying tissue---50 to 100m roll
– Chlorine
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16. Pillar 8: Operational support and
logistics
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17. Logistics, procurement and supply
management
• Logistical arrangements to support incident
management and operations (prevention and control
measures for COVD-19) should be reviewed.
• Expedited procedures may be required in all key areas
anticipated (e.g. surge staff deployments, procurement
of essential supplies, staff payments).
17

18. Recommended Actions
• Implement supply chain control, security, transport, management
system for storage and distribution of COVID-19 DCP, patient kit
reserves, and other essential supplies in country.
• Conduct regular review of supplies based on DCP and COVID-19
patient kit; develop a central stock reserve for case management of
COVID-19.
• Disease commodity package
– Lists critical supplies, with descriptions and technical specifications per
WHO guidelines for responding to an outbreak of COVID-19.
18

19. Step1
• Action to be taken:
1. Map available resources and supply systems in
health and other sectors;
2. Conduct in-country inventory review of supplies
based on WHO’s
a) Disease Commodity Package (DCP) and
b) COVID-19 patient kit, and develop a central stock reserve
for COVID-19 case management.
19

20. Step 2
• Action to be taken:
1. Review supply chain control and management system (stockpiling,
storage, security, transportation and distribution arrangements) for
medical and other essential supplies, including COVID-19 DCP
and patient kit reserve in-country †
2. Review procurement processes (including importation and
customs) for medical and other essential supplies, and encourage
local sourcing to ensure sustainability
20

21. Step 2…
• Action to be taken: …
3. †Assess the capacity of local market to meet increased demand for medical and
other essential supplies, and
4. Coordinate international request of supplies through regional and global
procurement mechanisms
5. †Prepare staff surge capacity and deployment mechanisms; health advisories
(guidelines and SOPs); pre- and post-deployment package (briefings,
recommended/mandatory vaccinations, enhanced medical travel kits,
psychosocial and psychological support, including peer support groups) to
ensure staff well-being
21

22. Step 3
• Action to be taken:
1. Identify and support critical functions that must continue
during a widespread outbreak of COVID-19, examples
– water and sanitation;
– fuel and energy;
– food;
– telecommunications/internet;
– finance;
– law and order;
– education;
– transportation),
– necessary resources, and
– essential workforce
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23. Overview of quantification emergency
needs for disaster reliefs and epidemics
23

24. Quantification
• Methods of quantification
 Consumption method
 Morbidity method
 Adjusted consumption method
 Service-level projection of budget requirements
• The quantification method selected must be chosen in
light of the resources and information available
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25. Morbidity method
• Forecasts the theoretical quantity needed for the treatment of
specific diseases.
• Requires reliable data on morbidity(the incidence of diseases) and
patient attendances (visits to health facilities) and uses standard
treatment guidelines to project drug needs.
• The most complex and time-consuming method, and there can be
major discrepancies between projections and subsequent utilization.
• Still, often useful and may be the most convincing approach for
justifying a budget request.
25

26. Morbidity Method
26

27. The patient morbidity-standard
treatment method
• This method starts from two sets of data
a) the number of episodes of each health problem treated by
the type or types of facilities for which drug requirements are
to be estimated;
b) average standard treatment schedules agreed for each
health problem defined.
• The quantity of drugs given as a standard treatment for each health
problem, multiplied by the number of treatment episodes of that
problem, gives the total quantity of drugs required for it. 27

28. Calculation
= 𝑻𝒐𝒕𝒂𝒍 𝒒𝒖𝒂𝒏𝒕𝒊𝒕𝒚 𝒐𝒇 𝒂 𝒅𝒓𝒖𝒈 𝒓𝒆𝒒𝒖𝒊𝒓𝒆𝒅
𝒇𝒐𝒓 𝒂 𝒈𝒊𝒗𝒆𝒏 𝒉𝒆𝒂𝒍𝒕𝒉 𝒑𝒓𝒐𝒃𝒍𝒆𝒎
Quantity of the drug
specified for a standard
course of treatment
𝑵𝒖𝒎𝒃𝒆𝒓𝒐𝒇 𝒕𝒓𝒆𝒂𝒎𝒆𝒏𝒕
𝒆𝒑𝒊𝒔𝒐𝒅𝒆𝒔 𝒐𝒇 𝒕𝒉𝒆 𝒉𝒆𝒂𝒍𝒕𝒉
𝒑𝒓𝒐𝒃𝒍𝒆𝒎
×
28

29. Estimating treatment episodes from national
level patient morbidity statistics
• A treatment episode is a patient contact for which a standard course of
drug treatment is required
• Average standard treatment is specified within a health problem, according
to the patient’s
– age group, (child/adult), or
– the severity of the disease (mild/sever) or both,
– the number of patient contact for each one must be established.
• Estimate the relative proportions of child and adult contacts, for each the
health problem where standard treatment is specified for children and adults.
29

30. Scenarios in different settings
Exam
ple
Setting Type Population
at risk
Attack
rate
Estimated cases
Total Severe
cases
(10%)
Mild
cases
(90%)
1 Open
setting
Rural xxxxx 0.5% xxxx
2 Urban
setting
City/Town xxxx 1% xxx
3 Closed
setting
China
camps
xxx 2% xx
4 Transient
setting
Air port xx 3% x
30

31. Worksheet for calculating t/t episodes
31
COVID-19
Mild
Sever
Total Total
1
2
3
4
5
Number of treatment episodes
SN Total AllHealth problem Children Adults

32. Illustrative standard treatment for quantification of
drug requirements based on average doses
32
SN Indication Drugs Dose
Times per
day
Number of
days
Amount per
course of
treatment
1 COVID-19
Pneumonia
Adults Ceftriaxone 1g 1vial x2 x10 20vials
Children Ceftriaxone 500mg 1vial x2 x10 20vials
Adults Paracetamol 500mg 2tabs x4 x1 8tabs
Children Paracetamol 500mg 1/2tab x4 x2 4tabs

33. Worksheet for calculating drug
quantities by health problem
33
SN Health Problem
Standard treatment
drug generic name,
dosage form and
strength
Quantity per
standard
treatment
Number of
treatment
episodes
Total
quantity
Order
pack size
(number
of units
per pack)
Number of
packs
required
(rounded to
the nearest
whole
number)
Price
per pack
($/Birr)
Total
cost
Percent
of total
cost
1 COVID-19 A B C D=B*C E= F=D/E G H=F*G
Severe-adults Paracetamole 500mg 16tabs 100 1600 100tabs 16pk 200 3200 A=V
Severe-children Paracetamole 500mg 8tabs 50 400 100tabs 8pk 200 1600 B=E
Mild-adults Paracetamole 500mg 8tabs 1000 8000 100tabs 8pk 200 1600 C=N
Mild-children Paracetamole 500mg 4tabs 500 2000 100tabs 4pk 200 800
RL1000ml
Ceftriaxone 1g
Mask N95
Glove 7.5

34. What we are going to do right now for
response (national, regional, zonal levels)
• Assigning logistics & supply focal point for supply forecasting
• Mapping available resources and supply systems in health and other sectors
– Establishing product and information flow for emergency supply chain
management
• Ensuring procurement mechanism in place, budget as well
• Presence of sufficient storage capacity
• Availability of stock management system
• Availability of transport & distribution system
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35. Thank you
35