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Medical Logistics Medical Logistics WFP Logistics, We Deliver
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Lesson Plan: Medical Logistics
LEARNING OBJECTIVES: By the end of the session, participants will be able to: Describe the scope of a Medical Supply Chain Describe the specific Supply Chain characteristics and features that are required for medical aid programmes Describe what medical items are used in medical aid programmes Structure Timing Activities Introduction 5 minutes Explain lesson objectives Humanitarian Medical Supply Chains 10 minutes Discuss the principles of medical humanitarian aid. Outline the scope of the supply chain in humanitarian medical aid (product characteristics and implications, overview of cold/cool chain, re-ordering (kits vs individual items), reverse logistics etc.). Medical Supply Procurement 15 minutes Outline the function and process of procurement, specific requirements/rules/regulations for procuring medical items, the right suppliers, product quality and GMP (Good Manufacturing Practice) Storage of Medical Items 20 minutes Outline the role of storage and storage requirements, cold chain and the role of pharmacy/inventory management Disposal of medical items Explain the importance of disposal of medical supply, the disposal process and methods and consequence of improper medical waste disposal Inventory management Explain minimum stock level system and reordering principles Exercise: Ordering Cycle 40 minutes Participants in groups calculate the monthly average consumption, minimum stock level and reorder point Lesson End/Plenary EVALUATION / RECAP QUESTIONS: The facilitator should ask the questions below, or similar questions to the class to recap the lesson to ensure participants have understood the lesson content. What the requirements for procurement in the Medical Supply Chain? What are the storage requirements for medical items? What are the methods to dispose of medical waste? Total Lesson Length 120 minutes This slide is for the facilitators reference only. This slide should be hidden from the workbook and from the class presentation DO NOT PRINT IN WORKBOOK DO NOT DISPLAY IN CLASS
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Lesson Objectives By the end of this lesson, you will be able to: 1 Describe the scope of a Medical Supply Chain 2 Describe the specific Supply Chain characteristics and features that are required for medical aid programmes 3 Describe what medical items are used in medical aid programmes
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Humanitarian Medical Aid
Medical Logistics Humanitarian Medical Aid Do No Harm Adherence to standards Quality - Certified Ordering - Technical specialist Cold Chain
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Characteristics of Medical Supply Chains
Medical Logistics Characteristics of Medical Supply Chains Donors International Supply of Items Warehouse International Movements Sea-port transit warehouse Airport transit warehouse Central Warehouse Domestic Supply of Items Regional Warehouse Hospitals Dispensaries Health Centres Community Health Workers Beneficiaries
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From Central Warehouse to Beneficiaries
Medical Logistics From Central Warehouse to Beneficiaries Beneficiaries Central Warehouse Regional Warehouse Health structures
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Product Characteristics and Supply Chain Implications
Medical Logistics Product Characteristics and Supply Chain Implications Temperature Sensitive Dangerous and Hazardous Goods Light Sensitive Weight, Volume, Physical state Humidity Sensitive Fragile Value Regulations and Documentation Shelf Life Complement and Dependent Kits
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Medical Logistics Indoors storage Medical items being unloaded inside a warehouse dock to avoid exposure to sun, light, rain
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Shift from kits to single/customized items
Medical Logistics Prioritization V O L U M E Food Other than Food Shift from kits to single/customized items 72hrs 2 wks 3-4wks 8wks
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Inter-Agencies Emergency Health Kit (IEHKK)
Medical Logistics Medical Kits Basic Health Care ERU Emergency Care and Triage Referral hospital ERU Rapid Deployment Emergency Hospital Inter-Agencies Emergency Health Kit (IEHKK) Surgical hospital, weapon wounded First-Aid Kits Medical Kits Cholera Kits Immunisation Kit Feeding & Nutrition Reproductive Kits
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Inter-Agency Emergency Health Kit
Medical Logistics Inter-Agency Emergency Health Kit IEHK – BASIC UNITS * BASIC * BASIC * BASIC * BASIC * BASIC IEHK – SUPPLIMENTARY UNIT 11*** MEDS 12 MEDS 13 MEDS * BASIC * BASIC * BASIC * BASIC * BASIC 14 INFS 15 INFS 16 INFS 17 INFS 18 INFS ** AM BASIC ** AM BASIC ** AM BASIC ** AM BASIC ** AM BASIC 19 RENW 20 RENW 21 RENW 22 RENW 23 RENW ** AM BASIC ** AM BASIC ** AM BASIC ** AM BASIC ** AM BASIC 24 EQPT 25 EQPT 26 EQPT COLD CHAIN * Basic Unit without Antimalarials ** Antimalarials for Basic Unit (can be left out if not required) *** Contains Antimalarials. Pt, Nt and/or PEP medicines, which can be left out if not required, see product list for details
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IEHK – SUPPLIMENTARY UNIT Inter-Agency Emergency Health Kit
IEHK – BASIC UNITS IEHK – SUPPLIMENTARY UNIT Medical Logistics Inter-Agency Emergency Health Kit 1.000 persons/3month, without malaria X 10 units 10.000pers/3m, w/o nar/psy/mal/PEP +
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Rapid Deployment Emergency Hospital
Medical Logistics Medical Set-Up Basic Health Unit Self contained modular (20 overnight) 1 month for up to 30,000 people Electricity Medical Store Pharmacy Administration Observation Maternity Morgue Water PRINT FULL PAGE IN WORKBOOK Rapid Deployment Emergency Hospital Waiting Showers OPD Toilets Admission Triage Electricity Administration Sterilization Kitchen Morgue Water Flexiward Pharmacy OPD OT Ships 24-48hrs / 8-10 delegates Safe surgery + OPD (50-100/10 days) Showers Toilets Staff Accommodation Admission Triage
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Procuring Medical Items:
Medical Logistics Procuring Medical Items: Need Immediate or forecasted Specify Quality, technical and functional specifications Source Types of suppliers, donation guidelines, GMP, LTA’s Method Qualification of suppliers Order PO, labelling/packaging, documentation, spares, complement items Delivery Delivery confirmation, quality/quantity inspection
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Medical Supply Donations
Medical Logistics Medical Supply Donations Does not correspond to the needs Not therapeutic according to the type of morbidities Language other than the local language Does not meet customs/importation requirements Label does not meet standard identification specifications Not of high enough quality No expiry dates, expired or spoiled goods
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Standard Storage Temperature
Medical Logistics Standard Storage Temperature Deep Freeze (DF) Below -15 degree Celsius E.g.: measles vaccine Refrigerator +2 to +8 degree Celsius E.g.: Tetanus vaccine Cooled +8 to +15 degree Celsius E.g.: Malaria Test Kit Room Temperature +15 to +25 degree Celsius E.g.: Tablets
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Medical Storage Layout
Medical Logistics Medical Storage Layout
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Medical Storage A clean, well lit, organised medical storage area
Medical Logistics Medical Storage A clean, well lit, organised medical storage area Items damaged through being stored on the floor or in contact with walls
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Organised, clean, well- lit Medical Warehouse
Medical Logistics Organised, clean, well- lit Medical Warehouse Items stored on pallets, shelves and racks
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Controlled substances Specific registration book
Medical Logistics Controlled substances Separate, secure and locked room WITH Specific registration book
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Cold room A cold room facility in a warehouse WITH Temperature control
Medical Logistics Cold room A cold room facility in a warehouse WITH Temperature control
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Cold Chain items Refrigerators, freezers, cold boxes and
Medical Logistics Cold Chain items Refrigerators, freezers, cold boxes and vaccine carriers stored in a clean, well lit warehouse
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Temperature Control Equipment
Medical Logistics Cold Chain Equipment Temperature Control Equipment Vaccine Carriers Cold box Freezer Refrigerator
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Equipment Throughout the Cold Chain
Medical Logistics Equipment Throughout the Cold Chain Vaccine Manufacturer Vaccine carrier or refrigerated truck/van 2° to 8° Primary Warehouse (State) WIC 2° to 8° WIF -15° to 25° Vaccine carrier or refrigerated truck/van 2° - 8° Secondary Warehouse (District) ILR 2° to 8° DF -15° to 25° Vaccination Site Vaccine Carrier 2° to 8° Health Centre ILR 2° to 8° Vaccine carrier or refrigerated truck/van 2° - 8°
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Transportation of Medical Items
Medical Logistics Transportation of Medical Items PRINT FULL PAGE IN WORKBOOK
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Disposal of Medical Waste
Medical Logistics Disposal of Medical Waste Incineration Encapsulation Return to Donor Inertization Landfill Sewer
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Incineration / Encapsulation / Inertization
Medical Logistics Reverse Logistics Supply Delivery Path Factory Supplier Warehouse Pharmacy Beneficiaries Reverse Logistics: Returning supplies from beneficiaries back to the supplier Supply Return Path Factory Supplier Warehouse Pharmacy Beneficiaries Incineration / Encapsulation / Inertization
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Inventory in Medical Supply Chains
Medical Logistics Inventory in Medical Supply Chains Stock Levels Stock Control Stock Count Stock Records
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Stocks - Definition + - Free Stock level is calculated as follows :
physical Stock on hand + Stock on order from suppliers Stock in transit - Stock allocated to consignments Stock reserved for special purposes
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Stocks - Definition LEAD TIME: time from order (from the pharmacy) to delivery (to the pharmacy) SAFETY STOCK: Stock that should be always present to avoid rupture. In general it is equalling the consumption for the reordering time. Take the example above: Lead Time 2 weeks, consumption 20 per week , meaning the Safety Stock will be: 2 weeks Stock+ 40 units Review Period = Ordering Cycle: depend of programs/organisations but in general it is 3 months. ORDERING QUANTITY = Safety + Average Order Cycle Consumption x Lead Time MINIMUM STOCK = Safety + Average Monthly Consumption x (Review Period+ Lead Time)
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Stocks - Calculation Medical Logistics a Minimum Stock Level is defined. At the Review Point, the Free Stock Level is compared with the Minimum Stock Level. If the Free Stock is less than the Minimum Stock Level, an order is placed. If the Free Stock is more than the Minimum Stock Level, no further action is taken. The diagram below illustrates the Periodic Review Minimum Stock system :
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Exercise: Reordering/Review Period
Medical Logistics Exercise: Reordering/Review Period In your groups, with a 3 month Ordering Cycle, calculate for each item that needs to be reordered: What is your Average Monthly Consumption? What is your minimum Stock Level? In considering that your free Stock = Stock Balance What would be the reordering quantity? 30 minutes to prepare 15 minutes to debrief DO NOT PRINT IN WORKBOOK
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Exercise: Stock Calculation Stock Balance (End Month 3)
Medical Logistics Exercise: Stock Calculation Ordering Cycle: Free stock = Stock Balance Average Order Cycle Consumption for the last 2 years = the consumption of month 3 Months Stock Balance (End Month 3) Consumption (Month 1) Consumption (Month 2) Consumption (Month 3) Safety Stock (1 month) Lead Time Average Consumption Minimum Stock Level Ordering Quantity Ketamine 100 50 30 40 0.5 Acetylsalicylat 30,000 8,000 10,000 12,000 1 Iodine povidone 200 60 Catheter 150 37 Infusion set 300 135 160 148 Compresse gauze 3,000 1,200 1,300 1,000 1,167 What is your Average Monthly Consumption? What should the minimum Stock level be? What should be your reordering quantity? DO NOT PRINT IN WORKBOOK
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Medical Logistics Answer: Consumption Average Monthly Consumption: Month 1 50 Month 2 30 Month 3 40 Example: Ketamine Avg Monthly Consumption 40 Number of Months 3 Minimum Stock: DO NOT PRINT IN WORKBOOK Safety Stock 40 Average Monthly Consumption 40 Review Period 3 Lead Time 0.5 Minimum Stock 180 Example: Ketamine Reorder Point: Safety Stock 40 Average Ordering Cycle Consumption 120 Lead Time 0.5 Reorder Point 100 Example: Ketamine
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Exercise: Stock Calculation - Answers Stock Balance (End Month 3)
Medical Logistics Exercise: Stock Calculation - Answers Ordering Cycle: 3 Months Stock Balance (End Month 3) Consumption (Month 1) Consumption (Month 2) Consumption (Month 3) Safety Stock (1 month) Lead Time Average Consumption Minimum Stock Level Ordering Quantity Ketamine 100 50 30 40 0.5 180 Acetylsalicylat 30,000 8,000 10,000 12,000 1 50,000 40,000 Iodine povidone 200 60 250 Catheter 150 37 165 92 Infusion set 300 135 160 148 668 371 Compresse gauze 3,000 1,200 1,300 1,000 1,167 5,833 4,667 What is your Average Monthly Consumption? What should the Minimum Stock Level be? MINIMUM STOCK = Safety + Average Monthly Consumption x (Review + Lead) What should be your Ordering Quantity? ORDING QUANTITY = Safety + Average Order Cycle Consumption x Lead Time DO NOT PRINT IN WORKBOOK
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DO NOT PRINT IN WORKBOOK
Lesson Recap Recap Lesson Questions: 1 What are the requirements for procurement in the medical supply chain? DO NOT PRINT IN WORKBOOK 2 What are the storage requirements for medical items? 3 What are the methods to dispose of medical waste?
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Medical Logistics Questions WFP Logistics, We Deliver
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