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Resources Management & Entrepreneurship Notes Za Wizara Cmt Nta 4 Clinical Medicine First Year

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Major issues in drug management:

Medicine selection defined

is a process of deciding type of drugs and medical supplies needed for a diagnosis, prevention and treatment of prevalent diseases.




The importance of selection of essential drugs and medical supplies is to get better supply of lower costs but effective items.


Medicine selection:

A. Preparing Standard Drug Lists

i. Each district should constantly work on standard drug lists and standard treatment guidelines.

ii. National guidelines exist but local conditions may differ.  Standard drug lists for districts may therefore differ.


Deciding Between Drugs to be included in the List

i. The important questions to be asked when working on a standard drug list are:

ii. What diseases and conditions are common in the district/health facility?

iii. Which drugs are available; or can be used for these conditions?

iv. What are the effectiveness, convenience, toxicity and costs of these drugs?


The choice of  drugs depends on many factors, such as

i. the pattern of prevalent diseases;

ii. the treatment facilities;

iii. the training and experience of the available personnel;

iv. the financial resources;

v. genetic, demographic and environmental factors


In developing countries like Tanzania medicine are largely selected through an experience-based process rather than scientific- based approach that are recommended by WHO

a. Selection of drugs must always be based on valid scientific evidence.

b. Only those drugs should be selected for which sound and adequate data on efficacy and safety are available from clinical studies.

c. Where two or more drugs appear to be similar in the above respects, the choice between them should be made on the basis of a careful evaluation of their relative efficacy, safety, quality, price and availability.

In cost comparisons between drugs, the cost of the total treatment, and not only the unit cost of the drug, must be considered.


Drug procurement ,quantification and ordering.


is a process of determining the amount of drugs and medical supplies needed in the health facilities.


Why quantification 

i. To ensure that health facilities never run out of essential drugs and other supplies.

ii. To avoid overstocking or wastage.

iii. To use limited funds in the most efficient way.


Types of quantification

A. The Consumption Based Method

This method is based on the actual consumption of drugs/medical supplies at the facility.


When using this method differentiate between drugs which have actually been used through dispensing to the "real" patients and those drugs dispensed without any record e.g. through thefts, have expired or been spoiled while in the store, were out of stock for more than 15 days during any time of the year

B. Stock Level and Quantities of each Drug

The amount of drugs stored by the time you are preparing the order or doing the quantification.



C. Average Monthly or Quarterly Consumption

How much on average is each drug used in a month or during a three months period?


D. Order Quantity

The quantity of drugs used at your facility during one supply cycle (three months).


Another method of quantification is to find from the records how much of each drug was needed in the past, and then assumes that the same amounts are needed this time.


The disadvantage of this method is that wrong choices that were made in the past will be repeated.

A much better method is to look at the attendance records and estimate how many patients are likely to attend with particular conditions in the coming season.

With the use of the standard treatments for these conditions it is possible to calculate the drugs needed.


If on average ten adults are treated for pneumonia daily and the standard treatment for pneumonia for an adult is a total of 20 tablets of Cotrimoxazole 480mg, each then the total amount needed for one month (30 days) will be 20 x 10 x (30 x 1) = 6,000 tabs), 1 tin = 1,000 tabs.


Drug Ordering

In a decentralized procurement distribution system one could have zonal stores or regional/district stores which make bulky drugs procurement before selling them to public or other institutions.  

For example, the Medical Stores Department (MSD).

With free market distribution, an individual organization is allowed to procure drugs and selling them to institutions and the public.



Ordering is a process of requesting. In health facility ordering is the process of requesting drugs, medical supplies, equipments and other supplies used in the health facility.


Ordering process:

Under the new ordering and distribution system in the capitalization Program, the facility pharmacy in charge is responsible for ordering drugs and medical supplies mainly from Medical Store Department on Cash

The facility pharmacy in charge is responsible for determining what to order and in what quantity.

He/She will raise Combined Requisition and Issue Note (CRIN) and submit to medical officer in-charge for endorsement.

He/She will raise Combined Requisition and Issue Note (CRIN) and submit to medical officer in-charge for endorsement.

Health facilities are required to order based on their requirement and budget allocation.

The district headquarters at the DMO's office is responsible for receiving the supplies from the central or zonal medical


It is important that DMOs office should have;

i. Adequate storage facilities

ii. Good communication

iii. Clear requisition and reporting system

iv. Effective delivery and transport systems

v. Systems for locating and transferring dormant items


Drug utilization:

Rational Drug Use

Rational drug use emphasizes that patients receive treatments appropriate to their correct diagnosis, in the right dose, for the right length of time, right route and a drug of the lowest cost, but equally effective and safe .


Irrational Drug Use

Irrational drug use occurs with:


a. too many drugs are prescribed unnecessarily

b. Use of wrong or ineffective drug for a diagnosis

c. Under use or Over use

d. Incorrect use of an effective drug

e. Prescribing drugs under brand names


Drug utilization:

Drugs and medical supplies should be properly managed to ensure availability when and where needed.

Management is further necessary to promote correct use of drugs through training, supervision of health workers, and giving education to the public and patients.

All staff including accountants, drivers, and storekeepers should be educated on the importance of drugs and the way to handle them.

This can be done through clinical meetings.

The national treatment guidelines should be available in every prescriber's office.


Drug Quality Assurance :

Aims at ensuring that, a drug supply system provides safety to patients, effectiveness and acceptable standards of drugs.

The use of sub-standard drugs may lead to some of the following shortfalls,

i. Drugs not killing the organisms leading to - prolonged illness and/or death

ii. Toxic and adverse reactions

iii. Loss of meager financial resources

iv. Loss of credibility of the health care delivery systems


Drug quality assurance:

Note: Drugs ordered in the health facilities should met the required standards.  

Therefore Quality assurance should be considered in every step of drug management.

During ordering facilities will be required to request their needs following the indent system which advocates - team work in determining the needs according to the catchment area.


The indent system is a demand driven supply system different from the push standard kit supply system.

The staff has to plan and analyze data that period.

 Depending on the financial resources available, which can help to set their priorities for that period.



Stocking and Storage of Drugs :

Store drugs in an orderly manner and record them in a stock ledger or bin cards.

Drugs should be kept in a cupboard, dry, cool and away from light.

Keep tablets in airtight tins or jars and clearly label each container.

Clearly mark all drugs containers with their expiry dates.

When storing and issuing drugs remember FIFO and FEFO principles.

FIFO = First in First Out (first use the drug that first went in the cupboard) for drugs with the same expiry dates.

FEFO = First Expired First Out (first use the drug that will expire first).





Issuing of Drugs
Record issuing of drugs on the bin cards and stock ledger as required. Calculate the remaining balance and check against what remains on the shelf.

In this way one can;

a. Notice when you need to order new stocks.

b. Check drug use against patient treatment requirements.

c. Be aware of discrepancies and changes in drug use.

d. Drugs on the "dangerous drugs list" are controlled by special laws.

e. They should be kept in a separate locked cupboard and are only issued on prescription for individual patients.


Stock Control System
The use of stock management/operational tools as previously mentioned e.g. prescriptions forms, stock /bin cards, ledger books, patient record books, dispensers books, patient injection registers, will help to determine quantities required for consumption monthly, quarterly or yearly.

A simple drug stock control system is the A/B or double shelf system.

When new drugs arrive divide them into two portions: portion A and portion B.

If possible, put portion B in plastic bags, in any case, place portion A and portion B on different shelves


i. Start using the drugs on shelf A.

ii. Place your order as soon as the drugs on shelf A are finished.

iii. Meanwhile use the drugs on shelf B to bridge the time for the new order to arrive.

iv. Sometimes the time between ordering and receiving new drugs is very long.

v. To make the double shelf system work, ensure that the amount of drugs on shelf B are sufficient to bridge the time between the ordering and receiving of new drugs

vi. Use the double shelf system at least for the life saving drugs.

vii. Taking care of delays that might occur from time to time with medical suppliers, it is advisable to calculate a minimum stock for each item.

viii. This is the amount of each item required over a period of three months.

ix. When the minimum stock is ordered, there are hardly any supplies problems if the deliveries are constant.

x. On receiving the orders, all the items are entered in the stock cards and the FIFO and/or FEFO rules applied.


Disposal of expired and unused drugs:

i. Expired and unused drugs have to be destroyed.

ii. Follow Government Financial Order Part III and Stores regulations.

iii. Board of survey has to be used.

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