The document discusses issues observed in the medication supply chain management process in Morocco. Key issues identified include a lack of computerization leading to deviations in prescription fulfillment, manual consolidation of medication needs, inflexible public procurement processes, challenges in supplier management including late deliveries, risks during receiving and inventory management due to lack of dedicated space and systems, and mismatched delivery schedules to customer needs. The impacts of these issues are delays, stockouts, wasted resources, and risks to quality and safety.

1. Traduction
Synthesis of observation :
1. Elaboration on the needs:
Observations
 The needs are expressed depending on the direction of the concept note,
allocated budgets, schedules and target prices (the estimated price is
based on past orders).
 The needs are expressed on the basis of previous consumption adjusted
for population data (demographics, age, job insecurity, location...).
 The needs do not take into account unmet prescriptions, the number of
admitted patients and supply disruptions.
 The review of nomenclatures is not systematic and many drugs are
renewed year by year.
Impact
 The lack of computerized medication circuit generates deviations
(untracked) between the prescription and the
dispensation/administration of medications and therefore in the
estimated management of needs.
 Renew drugs with low therapeutic impact.
 Renew drugs whose packaging, dosage or any other aspect has been
modified.
2. Consolidation of the needs:
Observations
 The formulation of needs is achieved on Excel and centrally consolidated
after being validated.
 Important deadlines for consistency checks (Not exceeding credit,
compliance with schedules and prices, volumes) due to being managed
manually in Excel
 The final control is established by taking into account the needs to
deliver to hospitals and delegations the available stock and the rest to be
delivered by suppliers trough the replenishment of safety stocks.
Impact
 Significant mobilization of resources from the DA on tasks of control and
reliability
 Delay in making the final order
3. Management of the Market
Observations
 The procurement procedures of the public market are not adapted to the
supply chain management of the medicines and the regulatory
constraints associated with it.
 The time between notification and the auction are sometimes long.

2.  The refusal to respond to certain monopoly drug suppliers (estimated
price, lot size).
 The management of the contracting process is manual and generates a
lot of bureaucracy and administrative delays.
 The lack of suitable IT tools makes it difficult to produce real-time
market history statistics.
Impact
 Pressure on delays of production/import generated DLE shortcuts.
 Inability of suppliers to deliver on time (very important volumes)
generating penalties on delays and stockouts on the downstream
channel.
 Risk of rejection when receiving the medicine due to the regulations on
expiration dates.
 Risk of unsuccessful batches for medicine in monopoly and inventory
shortages in central and within health points.
 Delay of management of the bidding process.
 Lack of capitalization on past contracts
4. Management of supplier
Observations
 Deliveries must be 50% complete within 4 months and 50% within the
next 6 months.
 Management of supplier’s appointments is made by email and managed
on Excel.
 Suppliers deliver large volumes at the end of the year to be free of late
fees.
 The quantitative and qualitative receipts (validation of the analysis
report) are made concurrently.
 The weak stocking capacity on consumer points reduces receptor
capabilities in central and increases the number of supplier deliveries.
Impact
 Significant congestion in warehouses for the suppliers at certain times of
the year.
 Lengthening of the period of receival from supplier
 Refusal of receival and return of supplier’s truck at a later date( J+1)
 Delay unloading supplier’s trucks and mobilization of vehicle all day.
 Elevated security risk linked to the intersection of human flows and
goods.
5. Unloading products and receiving controls
Observations
 Mandatory presence of a laboatory representative on site of the health
ministry to watch the progress of the reception.
 Double handling during the palletization of products on the dock.

3.  The format and dimensions of the delivered articles will vary depending
on the laboratories.
 The saturation of the reception area do not facilitate the quantitative
control operation.
Impact
 Time of palletization is important.
 Elevated security risk linked to the intersection of human flows and
goods.
 Risk of damaged product
 Risk of work accidents
 Risk of error count and seizure
 Hefty management of documents
 Elevated delay of product transit in the receiving zone
6. Quarantine management
Observations
 The products received in quarantine are sometimes put directly in the
rack with free products waiting for picking and delivery.
 Absence of a dedicated zone for quarantine
 Significant delay of release or recovery of non-compliant products by the
supplier.
Impact
 Occupied stocking space waiting for corrective action.
 Risk of loss of traceability of non-compliant items.
7. Inventory management
Observations
 The entry of incoming inventory is done manually based on the physical
inventory status of empty slots.
 In the absence of SI, several checks and corrections are made to ensure
inventory reliability.
Impact
 Risk of inventory discrepancies.
 Crucial mobilization of resources.
 Loss of productivity.
8. Order preparation
Observations
 Good prints are distributed by a group. Each group is responsible for an
area or product category.
 Lack of methods to prepare for bulk orders. Preparation on the floor.
 Prepared orders are placed in a congested shipping area.
 Several forklifts are out of service. ( Ex: Berrechid: 5/10 Out of service).
Impact

4.  Decreased productivity
 Delay in order preparation
 Risk of lack of products.
9. Order control
Observations
 The control of prepared order is done in an unidentified shipping area.
 Orders to the same region are laid on the dock without identification.
Ventilation is guaranteed solely by preparers.
 Double order commands to avoid gaps and items errors.
Impact
 Risk of mixing orders with products.
 Delay of control and very high validation.
Management of loads
Observations
 Bottleneck at the shipping door.
 Lack of space to control shipments
 The control of an order is done jointly by the carrier and the Ministry of
Health agent.
 Manual control of shipments extends the loading time.
 The boxes containing bulk orders are identified via a label or the total
amount is handwritten.
 Bulk boxes are sometimes poorly closed or do not support the weight and
amount of loading.
 The grouping of orders by region or destination enables transport
optimization.
 The current shipping rate by region causes significant reclaim rate with
an emergency delivery management system.
 The driver makes a second control inside his vehicle.
 The BL is jointly covered by the carrier and the controller with a second
copy to be signed by the final recipient and to be given back to bring by
the driver.
Impact
 Risk of mixing orders and recipient’s errors
 Non-compliance with the load order
 Risk of double handling by the carrier to the consignee
 Substantial management of logging pallet with the carrier and recipient.
 Extension of loading time
 Risk of loss or damage of bulk products during transport
 Delay of BL returns signed by the consignee
 Increasing the stockout rate
 Subtantial management of urgent deliveries

5. 11. Customer Delivery Management (DR/Hospitals)
Observations
 Deliveries are made to the regions according to a tour plan prepared by
the central pharmacy.
 The delivery schedules are not correlated to a schedule approved by the
recipient’s needs.
 The customers are sometimes forced to come to source for emergency
needs on their own.
 The thermolabile products are delivered according to a consumption plan
not exceeding two months in view of the breakdown of the cold chain and
random storage conditions in health issues.
 The deliveries can spread over several years (2011item are still being
delivered).
 Health points often lack storage facilities suitable for quality conservation
and safety of medicines based on the delivered volumes (corridors, damp
room, place lent by the municipalities...).
 The medicine’s deliveries are insured by an external carrier except for
thermolabile products.
Impact
 Absence of a computerized management system of medicine inventory at
points of use generates a lack of visibility of inventory turns by the
Central Pharmacy,which induces stockouts.
 Risk of phase shift between the delivery period and the medicine’s use
can lead to obsolescence.
 Risk of theft or diversion of the drug because of the difficulty of counting
the points of delivery.
 Security risk in drug use by inappropriate storage conditions on health
issues.