Overall Classification: ANSF Medical Logistics ANSF Medical Logistics Capt Josh Leslie, USAF UNCLASSIFIED

2 Last Updated: 21 Feb 2012 POC: CJ-SURG S-4, DSN: Agenda Introduction Afghan National Army (ANA) Afghan National Police (ANP) Forms Expectations Scenarios

3 UNCLASSIFIED Last Updated: 21 Feb 2012 POC: CJ-SURG S-4, DSN: Introduction Afghan’s MEDLOG system is not like ours –Depot system It is not perfect, but it works if done right Processes are established in official decrees (regulations) –ANA: Ministry of Defense (MoD) Decree 4.0 –ANP: Ministry of Interior (MoI) Decree 4.0 ANA & ANP systems are similar, but are distinctly separate entities ANA system is much more mature than ANP

4 UNCLASSIFIED Last Updated: 21 Feb 2012 POC: CJ-SURG S-4, DSN: Introduction Medical supplies are the only commodity fully transitioned and Afghan-led, coalition-funded Most internal hospital logistics is done by the pharmacy Why you should care –Afghans need supplies to run a medical system –Anyone advising Afghans in a medical facility will advise logistics –You cannot advise what you do not know

5 UNCLASSIFIED Last Updated: 21 Feb 2012 POC: CJ-SURG S-4, DSN: ANA MEDLOG System Requirements List (MEDCOM) Requirements -Based Procurement (AT&L) Requirements -Based Distribution (LOGCOM) Requirements -Based ASLs (FSDs) Usage Data (Med Units) MEDCOM Establishes requirements AT&L Procures requirements via contract with vendors LOGCOM Receives, stores, and distributes supplies National Supply Depot and regional Forward Support Depots Medical Units Report usage back to MEDCOM to develop requirements

6 UNCLASSIFIED Last Updated: 21 Feb 2012 POC: CJ-SURG S-4, DSN: LOG Structure ANA supply chain is based in Kabul, but each region maintains a Forward Support Depot (FSD) ATL Acquisition Agency LOGCOMMMCASC 1st FSD (Gardez) 2nd FSD (Kandahar) 3rd FSD (Herat) 4th FSD (MeS) CLVIII NSD Located in Kabul

7 UNCLASSIFIED Last Updated: 21 Feb 2012 POC: CJ-SURG S-4, DSN: Acquisition, Technology & Logistics (ATL): –Equips/sustains the military –Oversight of LOGCOM and Acquisition Agency –Establishes policies for logistics support systems –Creates and equips a sustaining base of supplies for the ANA Oversight agency for all logistics functions ATL Acquisition Agency LOGCOMMMCASC 1st FSD (Gardez) 2nd FSD (Kandahar) 3rd FSD (Herat) 4th FSD (MeS) CLVIII NSD Responsibilities – AT&L

8 UNCLASSIFIED Last Updated: 21 Feb 2012 POC: CJ-SURG S-4, DSN: Acquisition Agency: –MoD’s contracting authority –Provides contract & contract administration support for all classes of supply –Operates national codification system (assigns “NSN” to supplies) –Provides cost and pricing support to MoD Procures medical supplies for the ANA ATL Acquisition Agency LOGCOMMMCASC 1st FSD (Gardez) 2nd FSD (Kandahar) 3rd FSD (Herat) 4th FSD (MeS) CLVIII NSD Responsibilities – Acquisition Agency

9 UNCLASSIFIED Last Updated: 21 Feb 2012 POC: CJ-SURG S-4, DSN: Logistics Command (LOGCOM): –Responsible for storing and distributing all classes of supply –Oversight of National Depot and Forward Support Depots Stores and distributes medical supplies ATL Acquisition Agency LOGCOMMMCASC 1st FSD (Gardez) 2nd FSD (Kandahar) 3rd FSD (Herat) 4th FSD (MeS) CLVIII NSD Responsibilities – LOGCOM

10 UNCLASSIFIED Last Updated: 21 Feb 2012 POC: CJ-SURG S-4, DSN: Material Management Center (MMC): –Provides C2 over the supply chain –Reviews all MoD14 submissions for approval before forwarding to the depot to be filled Approves MoD14s based on requirements list generated by MEDCOM ATL Acquisition Agency LOGCOM MMC ASC 1st FSD (Gardez) 2nd FSD (Kandahar) 3rd FSD (Herat) 4th FSD (MeS) CLVIII NSD Responsibilities – MMC

11 UNCLASSIFIED Last Updated: 21 Feb 2012 POC: CJ-SURG S-4, DSN: Army Support Command (ASC): –Intermediary between the FSD and MMC –Headquarters for all FSDs –Does not approve or deny the contents of MoD14s, but does check for accuracy. If MoD14s are incomplete, they are returned to the FSDs. ASC Consolidates MoD14s and sends to MMC for approval ATL Acquisition Agency LOGCOM MMCASC 1st FSD (Gardez) 2nd FSD (Kandahar) 3rd FSD (Herat) 4th FSD (MeS) CLVIII NSD Responsibilities – ASC

12 UNCLASSIFIED Last Updated: 21 Feb 2012 POC: CJ-SURG S-4, DSN: CLVIII National Supply Depot (CLVIII NSD): –Responsible for storage of CLVIII (Medical) to support the entire ANA –Receives, stores, accounts and prepares CLVIII for shipment to the FSDs Manages CLVIII warehouse to support the entire ANA ATL Acquisition Agency LOGCOM MMC ASC 1st FSD (Gardez) 2nd FSD (Kandahar) 3rd FSD (Herat) 4th FSD (MeS) CLVIII NSD Responsibilities – CLVIII NSD

13 UNCLASSIFIED Last Updated: 21 Feb 2012 POC: CJ-SURG S-4, DSN: Forward Support Depots (FSDs): –Provides CLVIII support for all ANA units in region –Has CLVIII warehouse –Stores 25% of annual CLVIII requirements for regions –FSDs also in Shorabak and Gamberi, but there is no CLVIII warehouse Regional Depots provide CLVIII support to the region ATL Acquisition Agency LOGCOM MMC ASC 1st FSD (Gardez) 2nd FSD (Kandahar) 3rd FSD (Herat) 4th FSD (MeS) CLVIII NSD Responsibilities – FSD

14 UNCLASSIFIED Last Updated: 21 Feb 2012 POC: CJ-SURG S-4, DSN: Kabul ANA CLVIII Regional Depot System Gamberi FSD, No CLVIII Warehouse Hospital under construction AAF TMC Camp Shorabak (Helmand) FSD, No CLVIII Warehouse Garrison TMC X 3 Camp Shirzai (Kandahar) CLVIII Warehouse Hospital Garrison TMC X 3 AAF TMC Camp Zafar (Herat) CLVIII Warehouse Hospital Garrison TMC X 3 AAF TMC Camp Thunder (Gardez) CLVIII Warehouse Hospital Garrison TMC X 3 Camp Shaheen (MeZ) CLVIII Warehouse Hospital Garrison TMC X 3 AAF TMC Kabul National Supply Depot National Military Hospital TMC X 12

15 UNCLASSIFIED Last Updated: 21 Feb 2012 POC: CJ-SURG S-4, DSN: ANP CLVIII Regional Depot System ANP Regions/Zones Kabul Bamyan Konduz Nimroz HelmandKandahar Herat Farah Badghis Faryab Jowzjan Sar-I Pol Ghor Uruzgan Day Kundi Balkh Samangan Takhar Badakhshan Paktika Khowst Kunar Nangarhar Nuristan Parwan Wardak Spin Boldak Logar Panjshir Kapisa Laghman Ghazni Zabul Baghlan Paktya RC-Capital 101 Asmai (Kabul) RC-Central 202 Shamshad (Kabul) RC-North 303 Pamir (Mazar-e-Sharif) RC-South 404 Maiwand (Kandahar) RC-East 505 Spinghar (Gardez) RC-West 606 Ansar (Herat)

16 UNCLASSIFIED Last Updated: 21 Feb 2012 POC: CJ-SURG S-4, DSN: MoI National Logistics System ANP MoI National Logistics System Kabul Bamyan Konduz Nimroz HelmandKandahar Herat Farah Badghis Faryab Jowzjan Sar-I Pol Ghor Uruzgan Day Kundi Balkh Samangan Takhar Badakhshan Paktika Khowst Kunar Nangarhar Nuristan Parwan Wardak Spin Boldak Logar Panjshir Kapisa Laghman Ghazni Zabul Baghlan Paktya Northeast Route North Route Central Route (2 Options: Either via Wardak Province or via Parwan and Bamyan East Route South – West Route Southeast Route What We’re Developing: What We’re Developing: Existing Regional Logistics Centers Regional Logistics Centers (Projected

17 UNCLASSIFIED Last Updated: 21 Feb 2012 POC: CJ-SURG S-4, DSN: Important Forms MoD and MoI forms mirror each other –MoD/I Form 1 – Warehouse Receipt and Issue –MoD/I Form 2 – Stock Accounting Record –MoD/I Form 4 – Document Register –MoD/I Form 8 – Material Receiving Report –MoD/I Form 9 – Issue and Turn-In Document –MoD/I Form 14 – Request for Supplies ANA only: –MEDCOM Form 58 (Form 58) – In-patient Med Request –MEDCOM Form 59 (Form 59) – Monthly Usage Report These documents request, track and account for supplies throughout the supply chain

18 UNCLASSIFIED Last Updated: 21 Feb 2012 POC: CJ-SURG S-4, DSN: MoD 1 – Warehouse Receipt & Issue MoD 1 – Records all materiel that physically enters or leaves the warehouse or storeroom Who? Anyone who maintains stock. –National Supply Depot –Forward Support Depots –Hospital Storeroom –Pharmacy –Department Storerooms When? –When stocks increase or decrease –Pharmacy: Weekly/monthly adjustments based on usage tracking

19 UNCLASSIFIED Last Updated: 21 Feb 2012 POC: CJ-SURG S-4, DSN: MoD 2: Used to account for stock and collect demand data Who? Warehouses that support customers. –National Supply Depot –Forward Support Depots When? –When supplies are issued to a customer –When items are received from vendors or supply system MoD 2 – Stock Accounting Record

20 UNCLASSIFIED Last Updated: 21 Feb 2012 POC: CJ-SURG S-4, DSN: MoD 4: Used as a register of initiated supply actions (MoD14 requests, MoD9 issues, etc…) Who? Units with a stock record account. –FSD – maintained by customer service –Hospital – maintained by quartermaster When? –Unit submits a MoD 14 to next higher level –Unit receives supplies on a MoD 9 MoD 4 – Document Register

21 UNCLASSIFIED Last Updated: 21 Feb 2012 POC: CJ-SURG S-4, DSN: MoD 8: Records receiving of material from outside sources Who? Units that receive supplies from outside sources (donations, vendor deliveries). –National Supply Depot –Forward Support Depot –Hospitals When? –Unit receives a donation –Confiscated supplies are turned in –Delivery is received from vendor MoD 8 – Material Receiving Report

22 UNCLASSIFIED Last Updated: 21 Feb 2012 POC: CJ-SURG S-4, DSN: MoD 9: Document used to issue materiel from a supporting unit to a supported unit Who? Units that issue supplies to subordinate units. –National Supply Depot –Forward Support Depots –Hospital Storerooms –Pharmacy When? –Depot or storeroom issues supplies to a customer –Excludes meds covered by Rx or Form 58 MoD 9 – Issue and Turn-in Document

23 UNCLASSIFIED Last Updated: 21 Feb 2012 POC: CJ-SURG S-4, DSN: MoD 14: The basic form used to request items/supplies in the ANA Logistics System Who? Units that want supplies. –Forward Support Depots –Hospital Storerooms –Pharmacies –Department storerooms When? –User initiates a supply request MoD 14 – Request for Supplies Most commonly used form….know how to fill it out so you can advise the Afghans!

24 UNCLASSIFIED Last Updated: 21 Feb 2012 POC: CJ-SURG S-4, DSN: MEDCOM 58: Form used to track medication requests for hospitalized patients. Who? –Nursing ward When? –When medications are needed for in-patients MEDCOM Form 58 – In-patient Med Request

25 UNCLASSIFIED Last Updated: 21 Feb 2012 POC: CJ-SURG S-4, DSN: MEDCOM 59: Form used to track monthly usage of pharmaceuticals. Who? –Pharmacy When? –Once a month after consolidating daily usage MEDCOM Form 59 – Monthly Usage

26 UNCLASSIFIED Last Updated: 21 Feb 2012 POC: CJ-SURG S-4, DSN: ASC CC only signs MoD 14, does not approve/disapprove CLVIII Manager validates requirements, then either signs MoD14 and sends to CLVIII NSD or denies and returns to ASC RMH Generates MoD 14 FSD ASC FSD CC approves & signs, then issues items if on hand, or forwards to the ASC MMC Depot issues supplies/equipment on a MoD 9 based off approved MoD 14 CLVIII NSD NMH Everything in the supply chain starts with the end user and a MoD 14 MoD 14 Flow – ANA

27 UNCLASSIFIED Last Updated: 21 Feb 2012 POC: CJ-SURG S-4, DSN: ANP Projected Requisition Process Convoy RLC ANP Nat’l Warehouse Unit level end user “Pull” System MoI 14 – sent by end user MoI 9 – supply receipt Last Updated: 23 Feb 12 POC: Maj Patrick Barger, Requires trained, competent Afghan Logisticians at RLCs, PSPs, and unit end users Requires trained, competent Afghan Logisticians at RLCs, PSPs, and unit end users End user to RLC for supplies

28 UNCLASSIFIED Last Updated: 21 Feb 2012 POC: CJ-SURG S-4, DSN: Lifecycle of Meds/Supplies (ANA) We need X MEDCOM adds to requirements list Procured via AT&L Item delivered to NSD End User submits request for X FSD fills or forwards FSD Customer service forwards to ASC 4 ASC signs & forwards to MMC MMC validates & forwards to NSD NSD fills order Delivered to FSD 21 FSD fills order RMH receives item 14 Hospital storeroom issues to department 91 Prescribed to outpatient Issued to inpatient ward 58 Monthly usage report to MEDCOM 59 Expires – Destruction letter to MEDCOM or Item is a narcotic 57 Rx Hospital Only # = form updated or filled out

29 UNCLASSIFIED Last Updated: 21 Feb 2012 POC: CJ-SURG S-4, DSN: Lifecycle of Meds/Supplies (ANP) End user needs item End User submits request for item ANP Nat’l Warehouse fills or orders 9 Hospital end user receives item 1 Hospital pharmacy issues to department 91 Prescribed to outpatient Issued to inpatient ward Monthly usage report to OTSG Expires – Destruction letter to OSTG or Item is a narcotic Rx Hospital/Clinic Only # = form # completed/updated End user receives item 9

30 UNCLASSIFIED Last Updated: 21 Feb 2012 POC: CJ-SURG S-4, DSN: How You Can Help Build trust in the system Encourage Afghans to follow up with requests Advise department on MoD/I 1 & accountability Help department develop authorized stock list –Teaches them reorder points and reduces requests Do NOT fill out a MoD/I 14 for the Afghans –It is their system, let them do it Do not obtain supplies outside of the Afghan system

31 UNCLASSIFIED Last Updated: 21 Feb 2012 POC: CJ-SURG S-4, DSN: The Goal: Meds to beds, Afghan led…