MINISTRY OF HEALTH

The Participant’s Manual

Community-Based SupplyChain

Management System

For Injectable Contraceptives

Community-Based Injectable ContraceptivesLogistics Management System

Training for Community-Based Distributors

INTRODUCTION

  • Training Goals
  • Training Objectives

CONTENT

SESSION 1:

  • Overview of the Community-Based Logistics Management System

SESSION 2:

  • Responsibilities in the Injectable Contraceptives Logistics System

SESSION 3:

  • Storing Injectable Contraceptives and related supplies

SESSION 4:

  • Logistics Record Keeping and Reporting

SESSION 5:

  • Conducting Physical Inventory

SESSION 6:

  • Reviewing Stock Status

SESSION 7:

  • Monitoring and Supervision

INTRODUCTION

Training Objectives

Overall Objective

Equip Health Surveillance Assistants with the knowledge and skills required to effectively manage the community-based Injectable Contraceptives logistics management system to ensure continued availability of Injectable Contraceptives at community level.

Specific Objectives

  • Describe purpose and components of the community-based Injectable Contraceptives logistics management system.
  • Identify individual responsibilities and describe them in relation to those of others at different levels in the system
  • Strengthen skills to store and issue Injectable Contraceptives according to guidelines
  • Strengthen skills to maintain records and report consumption, losses and adjustments, stock on hand and other logistics data
  • Acquire skills to assess stock status at the community-based service delivery point.

Session 1:Overview of the Community-Based Logistics Management System

Objectives

  • Describe a logistics system
  • Describe the purpose of a logistics system
  • Outline the flow of supplies in the community-based logistics management system

Logistics System

This is the MoH’s medical supply system of inventory management, record keeping and reporting for contraceptives and other medical commodities supplied through the community-based logistics system.

Purpose of a logistics System

To ensure that all Malawians at the community level receive quality service when they visit the community-based provider by ensuring that:

the right product

in the right quantity

in the right condition

is delivered to the right place

at the right time

for the right cost

Flow of commodities in the community-based logistics system

Regional Medical Stores

Health Centre

Health Surveillance Assistant (HSA)

Client

Session 2:Responsibilities in the Injectable Contraceptives Logistics System

Objectives

  • Identify the responsibilities of all personnel that are managing the community-based logistics system for Injectable Contraceptives

The personnel involved in the system are the Family Planning Focal Person at Health Facility level and the HSA at community level.

Family Planning Focal Person

Meets with all HSAs during the first three days of the month at a designatedlocation

Review the CBD Monthly Injectable Contraceptives Work Sheet

Calculates the quantity of injectable contraceptivesand related medical supplies to issue to each HSA and issues

Completes the CBD Supervision Monthly Contraceptive Summary Form (LMIS-01J)

Provide supportive supervision to the HSAs

Provide feedback and on-the-job training to the HSA

HSA

Receive and store injectable contraceptives and related medical supplies following storage guidelines

Provide injectable contraceptives to clients in units according to set standards

Record the quantities of injectables given to clients on the CBD Client & Contraceptive Tally Sheet (LMIS-01G)

Aggregate information in the CBD Client & Contraceptives Tally Sheet and compile the CBD Monthly DMPA Worksheet (LMIS-01K).

Prepare the CBD Supervision Monthly Summary Form(LMIS-01J) together with the Family Planning focal person

Transfer the Sharps Box back to the health facility

Attend Feedback meetings on commodity management.

Session 3:Storing Injectable Contraceptives and related medical supplies

Objectives

  • Describe the purpose of storage
  • Describe shelf life
  • List proper storage guidelines

Purpose of Storage

Appropriate storage protects the quality of the contraceptives and other supplies.

It also preserves the integrity of the packaging while, at the same time, makes them available for use.

Shelf Life

Shelf life is the length of time a product may be stored under ideal

conditions without affecting its usability, safety, purity, or potency.

If a product is not stored correctly, the shelf life may be shortened

Proper Storage Guidelines

  • Store contraceptives in container supplied by the CBD Injectable Contraceptives Programme only
  • Clean storage area regularly.Take precautions to prevent harmful insects and rodents from entering the storage area.

  • Store health commodities in a dry area away from water, direct sunlight and fire.

  • Lock up contraceptives in the box to ensure they are inaccessible to unauthorized people.

  • Store contraceptives to facilitate FEFOprocedures of stockmanagement.

  • Separate damaged andexpired contraceptives in different compartments from usable ones.

  • Store Injectable Contraceptives vials in an upright position all the time

  • Store sharp objects away from other medical supplies

  • Store flammable supplies away from heat and fire. e.g. spirit

Disposal of Sharps and other Waste

Description of sharps and waste

  • Syringes and needles
  • Broken and empty vials
  • Used swabs

Handling of Sharps and Waste

  • All sharps and waste from the community-based Injectable Contraceptives should be deposited in the Sharps Boxes that will be provided by the program
  • The Sharps Box should be kept out of the reach of children and domesticated animals (where possible it is recommended to hang the box on a nail above the children’s reach)
  • When three quarters full, the sharps box should be carefully closed or sealed and taken to the Health Centre by the HSA.
  • The Family Planning Focal Person at the HC will be responsible for taking the sharps box for disposal
  • Anothersharps box will be given .

Session 4: Logistics Record Keeping and Reporting

Objectives

  • Define LMIS
  • Describe purpose of record keeping and reporting
  • Identify the different records and reports used in the community-based logistics management of Injectable Contraceptives and related supplies.
  • Practice to fill in all logistics records and reports completely and accurately

LMIS (Logistics Management Information System)

  • LMIS consists of records and reports that are used to collect and transmit information about contraceptives and other related medical supplies dispensed to customers.

Purpose of record keeping and reporting

  • To collect and report information to other levels of the system in order to make decisions regarding the quantity and time to distribute contraceptives and related supplies.

Records and Reports Used in the Community-Based Logistics System

Name of Record/Report / LMIS Number / Who Completes / When Completed
CBD Client & Contraceptive Tally Sheet / LMIS-01G / HSA / During the month
CBD Monthly DMPA Worksheet / LMIS-01K / HSA / Within the first 3
days of the month
CBD Supervision Monthly Contraceptive Summary / LMIS-01J / Family Planning Focal Person together with HSA / Within the first 3 days of the month

How to Complete Logistics Data in the CBD Client & Contraceptive Tally Sheet

Use the following instructions to fill logistics data in the CBD Client & Contraceptives Tally Sheet.

  • NJIRA ZOPEREKEDWA: Draw a diagonal line through the circle to indicate the number of each contraceptive given out to a client. For Injectable Contraceptives, one diagonal line equals to 1 vial. Each client is given 1 vial.

  • CHIWERENGERO CHA MWEZI ONSE CHA NJIRA: Add the number of diagonal lines for each of the contraceptive methods given to both new and continuing clients and write the total

  • chiwerengero CHA ZOTSALA POTHA PA MWEZI: Count the quantity of each contraceptive remaining at the end of the month and write the total

How to Complete the CBD Monthly DMPA Worksheet

After filling in the Name of HSA, Product and Health Centre Affiliation, Complete columns A–G.
  • Column A – Beginning Balance: Write the amount of injectable contraceptive available with the HSA at the beginning of the reporting period

  • Column B - Quantity Dispensed: The amount of injectable contraceptive the HSA gave to clients during the reporting period. Get this from the “CBD Client & Contraceptive Tally Sheet”

  • Column C – Losses/Adjustment: The amount of contraceptive the HSA reports as a loss (-) or
Addition (+).
  • Column D - Quantity on Hand: The total amount of injectable contraceptive available for use on thelast day of the reporting period which should be the same asthe physical inventory you conducted before completing this report.

  • Column E – Quantity Received: The amount of injectable contraceptive the Family Planning focal
person issued to HSA.
  • Column F – New Quantity on Hand:The new amount after adding quantity received from the
Family Planning focal personand the old quantity on hand.
  • Column G - Remarks:Brief sentence explaining the reason for the loss or adjustment.

Session 5: Conducting Physical Inventory

Objectives

  • Define physical inventory
  • Describe the purpose of conducting physical inventory
  • List steps in conducting physical inventory

Physical Inventory Definition

  • A physical inventory is the process of counting by hand the total number of each health commodity in your store or health facility, at any given time.

Purpose of Physical Inventory

  1. To verify the quantity of usable stock available for distribution/Issue to clients.
  2. To identify discrepancies between actual supplies and the stock balance on the stock card and other logistics records and reports.
  3. To detect damaged or expired items.
  4. To provide an opportunity for storage reorganisation.

Steps in Conducting Physical Inventory

  • Separate and count any expired or damaged injectable contraceptives & related medical supplies.

  • Count every usable injectable contraceptive & related medical supplyby hand.
  • Count unopened/complete packing boxes first. Multiply the number of boxes by the number of units in the carton to determine the total number of commodity units in the carton.
  • Count all the units that are in open boxesand add them together.
  • Add the total units from unopened boxes, opened boxes. This will give you the total number of units of the commodity available in your store (Quantity on Hand).

  • Mark the expiry date clearly with large, dark numbers on each box or carton.

  • Reorganise products according to expiry dates to comply with FEFO distribution.

Session 6: Reviewing Stock Status

Objectives

  • Describe the purpose of reviewing stock status
  • Describe months of stock
  • Describe how to determine months of stock
  • Describe how to review stock status
  • Describe actions to take after reviewing stock status
  • Describe how to place emergency orders

Purpose of reviewing stock status

  • The purpose of reviewing stock status is to determine how much of usable contraceptive and related medical supplies you have available at your facility.

Months of stock

  • Months of stock is the number of months Contraceptives & other commodities will last based on the present consumption rate.
  • Three months of stock means that your stock will last three months, as long as consumption remains at the current rate.

How to review stock status and determine months of stock

The allowed levels of stock the HSA can keep in the big box are:

Maximum – 1 month of stock

Minimum – 1 month of stock

Emergency Order Point – 0.5 months of stock

  • To determine how many months each product will last, add the latest two months’ usage of a particular product, then divide by two to determine your Average Monthly Consumption (AMC).
  • Use the following formula to determine AMC:

Current month’s usage + previous one months’ usage = Average Monthly Consumption
2

Next, divide the stock on hand by the AMC to obtain the Months of Stock on Hand.

Use the following formula to determine how many months the current quantity available for each product will last:

Stock on Hand = Months of Stock
Average Monthly Consumption

You must remember one rule when you determine months of stock—use only one number after the decimal point— round up or down all numbers after that number

Example

Total DMPA dispensed for the current month is 50 vials and last month 20 vials.

The AMC is

50 + 20 = 70

70/2 = 35

(AMC = 35)

Assuming Physical Count for DMPAin the box is 100 vials

The months of stock is

100/35 = 2.8

This means the stock you have will last 2.8 months.

Actions to take after reviewing stock status

Situation / Interpretation / Decisions
At CBD Point, if Months of stock is 1 month / Stock status is adequate / No action required
Months of stock is 2.8 months at CBD Point / The HSA is over stocked / Contact the HC and discuss the stock status of the product.
Months of stock is less than 1 month but more than 0.5 months / The HSA is under stocked but the stock levels have not yet reached the emergency order point. / Place an order and continue to monitor stock levels until the next delivery arrives, or until they reach the emergency order point.
The number of months of stock is 0.5 months for the CBD point / The HSA is under stocked. The stock level is below the emergency order point. / Place an emergency order.

How to place emergency orders

1. / Complete a CBD Monthly DMPA Worksheet
2. / Write the words EMERGENCY ORDER in red ink at the top of the form.
3. / Take the completedCBD Monthly DMPA Worksheet to the Family
Planning Focal Person

Session 7:Monitoring and Supervision

Objectives

  • Define Monitoring
  • Describe purpose of monitoring
  • Define Supervision
  • Describe purpose of supervision
  • Describe guidelines for logistics monitoring and supervision

Monitoring

  • Monitoring is checking on a regular basis to ensure that assigned activities are being carried out

Purpose of Monitoring

  • To ensure that clients are getting the services they want when they need them
  • To ensure that planned logistics activities are being carried out according to schedule
  • To ensure that all records are correctly maintained and reports are submitted on time
  • To determine the quantity of supplies to order or issue

Supervision

  • The process of ensuring that personnel have the knowledge and skills required to carry out their responsibilities effectively and to provide immediate on-the-job training as needed.

Purpose of Supervision

  • To ensure they have the knowledge and skills they need to effectively manage the logistics system.
  • To identify weaknesses in performance and to improve performance by providing immediate on-the-job training.

Annexe

A1-CBD Client & Contraceptive Tally Sheet

A2-CBD Monthly DMPA Worksheet

A3-CBD Supervision Monthly Contraceptive Summary

1