157

Unit Four:

Purpose, Flow of information and

Products in IPLS
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4.1. Integrated pharmaceutical logistics systems (IPLS)

• 4.1.1 Introduction to IPLS
• The provision of complete health care necessitates the availability
of safe, effective and affordable drugs and related supplies of the
required quality, in adequate quantity at all times.
• Despite this fact, in the past, the pharmaceutical supply chain
management system of the country had several problems including
non-availability, unaffordability, poor storage and stock
management and irrational use.
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4.1.1 Introduction to IPLS…

• To solve these problems in public health facilities, Pharmaceuticals Fund
and Supply Agency (PFSA) was established in 2007 by Proclamation No.
553/2007 based on the Pharmaceuticals Logistics Master Plan (PLMP).
• Now currently this agency is named as Ethiopian Pharmaceutical Supply
Service (EPSS).
• The Agency is mandated to avail affordable and quality
pharmaceuticals sustainably to all public health facilities and ensure
their rational use.
• So as to execute its mandate in the area of pharmaceuticals supply in an
efficient and effective manner, integrated pharmaceuticals logistics
system (IPLS) has been developed and implemented since
2010.
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4.1.1 Introduction to IPLS…

• IPLS is the term applied to the single pharmaceuticals reporting
and distribution system based on the overall mandate and scope
of the EPSS.
• It aims to ensure that patients always get pharmaceuticals they
need.
• To be successful, the system must fulfill the six rights of supply
chain management by ensuring the right products, in the right
quantity, of the right quality, at the right place, at the right time and
for the right cost.
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4.1.1 Introduction to IPLS…

• The IPLS integrates the management of essential pharmaceuticals
including the following pharmaceuticals that were used to be managed
vertically: HIV/AIDS, Malaria, TB and Leprosy, EPI, MCH and
purchased essential drugs.
• It is the primary mechanism through which all public health facilities
obtain essential and vital pharmaceuticals.
• Products included on the National pharmaceuticals procurement List
(NPPL) are supplied and managed through the IPLS.
• One of the first concrete steps to move the integrated system from
concept to detailed implementation step was the development of the
Standard Operating Procedures (SOP) Manual for health facilities of
Ethiopia.
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4.1.2 Basic components of IPLS

Overview to Basic Components of IPLS at health facility:
A. Logistics Management Information System (LMIS) in IPLS
B. Inventory Control System in IPLS
C. Storage pharmaceutical in IPLS
D. Reports and records in IPLS
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A. Logistics Management Information System

(LMIS) in IPLS
• The primary function of the LMIS is to support the management of essential
pharmaceuticals.
• Three essential data items are required to run a logistics system and, therefore,
must be captured by the LMIS.
• These three essential data items are:
1. Stock on Hand: Quantities of usable stock available at a particular point in time.
2. Consumption Data: The quantity of pharmaceuticals used during the reporting period.
3. Losses/Adjustments: Losses are the quantities of products removed from your stock
for anything other than in the provision of services to patients or issuing to another
facility (e.g. expiry, lost, theft, or damage) and are recorded as negative (-) numbers.
Adjustments are quantities of a product received from any source other than EPSS, or
issued to anyone other than your health facility. An adjustment may also be a correction
due to an error in mathematics. An adjustment may be a negative (-) or positive (+)
number.
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• There are only three activities that happen to pharmaceuticals within a

logistics system: they are stored, moved between facilities, and used to
provide health services to patients.
• A well designed logistics management information system will include
records and forms that collect and report the three essential data items
as they relate to these three activities.
• Records and forms have been designed for the Integrated
Pharmaceuticals Logistics System LMIS and are included in this SOP
Manual along with step-by-step instructions on how to complete them.
• The roles and responsibilities of key personnel in the system were
highlighted in the previous section, and these same people are
responsible for completing these LMIS forms.
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B. Inventory Control System in IPLS:

• The purpose of an inventory control system is to inform personnel
when and how much of a pharmaceuticals to order and to
maintain an appropriate stock level to meet the needs of patients.
• A well designed and well operated inventory control system helps
to prevent shortages, oversupply, and expiry of pharmaceuticals
• To help maintain adequate stock levels, the maximum months of
stock, minimum months of stock and an emergency order point
have been established for each health facility in the system.
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• The maximum months of stock is the largest amount of each

pharmaceutical a facility should hold at any one time.
• If a facility has more than the maximum, it is overstocked and risks
having stocks expire before they are used.
• The minimum months of stock is the level of stock at which
actions to replenish inventory should occur under normal
conditions.
• The emergency order point is the level where the risk of stocking
out is likely, and an emergency order should be placed
immediately.
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• The inventory control system for the IPLS is a Forced Ordering

Maximum/Minimum inventory control system.
• This means that all facilities are required to report on a fixed schedule (monthly
at health posts, every other month at health centers and hospitals) for all
products.
• In addition, all products are re-supplied each time a report is completed.
• In emergencies, an emergency order can be placed.
• In practice, this means that:
• Health centers and hospitals are required to report and order every two months.
• Health centers and hospitals calculate their own order quantities, ordering sufficient
quantities of all pharmaceuticals to bring stock levels up to the maximum level.
• Health posts report data monthly to their affiliated Health Centre.
• The Health center calculates the re-supply quantities that are needed to bring health post
stocks up to the maximum level.
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• If the stock on hand for any product at a facility falls below a set
emergency order point before the end of the reporting period, an
emergency order should be placed.

Maximum Minimum Emergency Order

Level Review Period
Months of Stock Months of Stock Point

Health centers Every other 0.5 months (= 2

4 months 2 months
and Hospitals month weeks)
0.25 months
Health Posts Monthly 2 months 1 months
(= 1 week
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• Within hospitals and health centers, products will be managed

centrally in the Pharmacy Store.
• All products will be received into the pharmacy store and most of
the products will be stored there, until they are needed in the
various dispensing units within the facility.
• The pharmacy store manager and pharmacy head in collaboration
with staffs in dispensing units will establish a re-supply schedule
for the dispensing units.
• For example, each dispensing unit will have one day per week/per
2 weeks designated for re-supply.
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• On that day, dispensing unit staff will complete an Internal Facility

Report and Resupply Form; the Pharmacy Store manager will use the
information to determine the re-supply quantity needed to serve clients
until the next scheduled re-supply day.
• For example, every Monday (on a weekly or twice monthly basis), the
Mother and Child Health (MCH) service provider reports data to the
pharmacy store and receives enough product to serve clients during the
week or next 2 weeks.
• This system ensures that the dispensing units are not overworked with
pharmaceuticals management responsibilities and that the quantities
issued to the dispensing units from the pharmacy stores reflect actual
consumption by the clients.
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Quiz
• Fill the following information in IFRR form
• The OPD pharmacy wants to receive ciprofloxacilline 500mg tab from central pharmacy
store
• The reporting period is two weeks (9/11/2017-16/11/2017)
• The ending balance from the previous report were 500tab
• The quantity receive in the reporting period were 1000tab
• 100 tab were expire during the reporting period
• 200 tab were transferred out for IPD pharmacy during the reporting period
• The balance on 16/11/2017 were 200 tablets
• How much amount of the drug should be issued for the DU?
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C. Storage pharmaceutical in IPLS:

• Storing: is the safe keeping of pharmaceuticals to avoid damage,
expiry, and theft.
• Proper storage procedures help to ensure that storage facilities protect
the shelf life of products, and that there is little or no waste due to
damaged or expired products.
• If proper storage procedures are followed, customers can be assured
that they have received a high quality product.
• Storage conditions will affect the quality of the pharmaceuticals being
stored.
• Rooms that are too hot, stacks of cartons that are too high, and
other poor storage conditions can cause damage or cause a
reduction in shelf life.
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• A well-organized storeroom will simplify a facility's work; time

will not be wasted trying to find needed supplies.
• Properly stored pharmaceutical products delivered to each
dispensing units to keep the use of clients.
• Dispensing unit (DU): is any outlet in the hospital and health center
set up in which pharmaceuticals are dispensed out to clients.
• It includes high volume DUs such as outpatient pharmacy
dispensary and low volume DUs such as MCH (maternal and child
health) and TB clinics.
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D. Reports and records in IPLS

• Reporting and ordering form in IPLS is mechanism by which
health facilities (health centers and hospitals) communicate
information with their respective administrative offices and order
requests from their supplying EPSS hubs.
• Health Posts, however, only report the essential data items to their
supplying health centers.
• Hospitals and health centers use Request & Report Form (RRF)
and health posts use Health Post Monthly Report & Resupply Form
(HPMRR) for reporting.
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A. Reporting by Health Posts

• Health Posts complete one part of the Health Post Monthly Report
and Re-supply Form every month and carry the report to the health
center.
• The health center uses the information found on the Health Post
Monthly Report and Re-supply Form to complete the form and
calculate the quantity of pharmaceuticals needed by the health post.
• Each month, the health center will issue enough stock to bring the
health post up to its Maximum Stock Level of 2 months of stock
for each product.
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B. Reporting and Ordering by the Hospitals and Health

Centers
• This section of the manual addresses the process for reporting on
and ordering pharmaceuticals.
• Hospitals and Health Centers use the Report and Requisition Form
(RRF) to:
• Report on the quantities of pharmaceuticals used, lost or transferred, and the
quantities of stock available
• Order pharmaceuticals
• The actual RRF used by hospitals and health centers to report and
order pharmaceuticals are the same except the hospital RRF
includes larger number of pre-printed items on the form than the
health centers.
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• And also, to improve pharmaceuticals management by level, the

level specific RRFs will have 5 subgroups (pads) for program and
4 for Revolved Drug Fund (RDF) pharmaceuticals:
• RRF 1: Hospitals and ART Health Centers (Program Medicines)
• RRF 2: PMTCT Health Centers (Program medicines and laboratory Regents)
• RRF 3: Special Lab Monitoring Sites (Program Reagents, Supplies and
Diagnostics)
• RRF 4: Hospitals and Lab Monitoring Health Centers (Program Reagents,
Supplies and Diagnostics)
• RRF 5: Non Lab Monitoring ART Health Centers (Program Reagents,
Supplies and Diagnostics)
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• RRF 6: Hospitals (RDF Medicines)

• RRF 7: Health Centers (RDF Medicines)
• RRF 8: Hospitals (RDF Supplies and Diagnostic Reagents)
• RRF 9: Health Centers (RDF supplies and Diagnostic Reagents)
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• In preparing the order for pharmaceutical to be purchased, the facility

should complete; the cost analysis worksheet to know the monetary value
of products to be ordered.
• If the budget is insufficient to order all pharmaceuticals, the facility
should do VEN analysis and order all pharmaceuticals in Group V first,
the items in Group E second, and the Group N items last as funds allow.
• Additional funds from other sources can be used to supplement the
budget.
• Facilities that submit their RRF on time should always have sufficient
stocks of pharmaceuticals to serve their patients.
• Facilities should send their completed and approved RRF to EPSS until
the 10th day of the month following the end of the reporting period.
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• Health centers that are served through WoHO should submit the
original and one copy of RRF to WoHO until the 5th day of the
month.
• Woreda health offices will send the original RRF reports to
affiliated EPSS branch until the 10th day of the month on the
behalf of the health centers.
• For example, if the last month of the reporting period was Tikimt,
the RRF would be due at EPSS by Hidar 10th.
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Pharmaceuticals logistics data (RRF) acquisition options

• Completed RRFs at SDPs should reach to respective EPSS branches on time to
make resupply and other decisions.
• EPSS identified and proposed the following options of acquiring the data.
• All of these methods have their own advantages and limitations.
• Some of these options are designed solely to RRF data collection whereas; others
are designed to leverage the already existing system to serve the health system.
This section of the SOP addresses the definition of and the processes of each
option.
• Postal Service:
• Option 1. The health facilities will prepare their pharmaceutical logistics report and
requisition according to a prearranged timeline and may submit the report to the local post
office. The local post office will deliver the report to respective hubs.
• Option 2: EPSS may enter a contract with the postal service so the postal office may collect
the pharmaceutical logistics report from health facilities on a predetermined schedule and
deliver the reports to the respective hubs.
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Health Management Information System (HMIS) Route:

• Two copies of completed RRFs will be sent every other month to
respective management units (WoHO/ZHD/RHB) along with other
HMIS Reports.
• WoHOs/ZHDs/RHBs will keep one copy and sends the original to
respective EPSS branch.
• Fax: This option is recommended for facilities having a fax machine. If a
facility has a fax machine, the RRF should be faxed to EPSS and to the
appropriate management unit, and then the original copies would be sent
by post.
• Electronically (Email or any other means): If a facility has internet
access and a scanner, they may scan their competed RRFs and send it
electronically, then the original copies would be sent by post.
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• Data Processors: Trained professionals are assigned to collect

facility RRFs and provide onsite technical assistance on RRF
completion and data quality.
• Telephone: This method of pharmaceutical logistics data
acquisition is a means of getting pharmaceutical logistics report
from health facilities through the telephone.
• Other Delivery Means: The other delivery means is a way by
which health facilities deliver their pharmaceutical logistics report
and requisition, hand-carried to the nearby hub for resupply
decision.
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• The current experience of reporting in some regions of the country:

facilities sent to their woreda, woredas to zones and zones to the
supplying hubs.
• Each EPSS hub works closely with the ZHDs and RHBs of their
respective catchment area to map the data acquisition of all sites served
by the branches and it is communicated to the health facilities by the
RHBs/ ZHDs.
• The methods used in each site are documented by the branch and it is
periodically reviewed based on the situation of the health facilities.
• In addition to this, the performance of each health facility is monitored
and evaluated.
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4.2. Flow of information and products

• Program pharmaceuticals are reported and ordered every two months by
hospitals and health centers and delivered by EPSS to these facilities
directly or indirectly.
• Direct delivery sites are facilities that receive program pharmaceuticals
directly from EPSS hubs whereas non-direct delivery sites are health
centers that receive products from EPSS hubs through Woreda Health
Offices (WoHOs).
• Health posts report to health centers monthly and collect pharmaceuticals
from those health centers; the health centers use the data in the Health
Post report to calculate consumption and re- supply quantities.
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• For revolving drug fund (RDF) pharmaceuticals, health centers and

hospitals will complete RRF as per the facilities review period
which can be every two month, every quarter or every six months
and collect products from affiliated EPSS branch.
• The figure below illustrates the overall flow of program
pharmaceuticals and information in the IPLS.
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Figure 4.1: Flow of Pharmaceuticals and Information in the Integrated Pharmaceutical

Logistics System (IPLS)
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• Logistics information is collected and reported monthly by health posts

and every other month by health centers and hospitals on logistics
management information system (LMIS) forms.
• For direct delivery facilities a combined report and requisition form is
completed by health centers and hospitals and sent to EPSS hubs for
requisition processing; the health center order includes the
pharmaceuticals requirements of the health posts.
• For non-direct delivery facilities a combined report and requisition form
is completed by health centers and sent to EPSS branches through
WoHOs.
• For management and supervision purposes a copy of the health center
report and order and a copy of each health post report are sent to the
Woreda Health Office a copy of the hospital report and order is sent to the
RHB/ZHD.
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• The overall information system also includes a mechanism for providing

feedback to lower level facilities from upper level facilities.
• In the feedback reports, facilities will be able to see how they are
performing compared to other facilities in their area and will be able to
facilitate stock transfer.
• For instance, the Woreda or EPSS Hub may provide a short report to all
of the health centers showing the stock status of priority products (vital
pharmaceuticals), number of stock outs, reporting rate, and consumption
trends across health centers.
• The Woreda or EPSS might also provide specific feedbacks to health
centers pointing out timeliness, completeness and quality of their reports.
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4.3. Standard operating procedures of systems

• The manual is intended to simplify and standardize the work required for
the logistics management of pharmaceuticals used in public health
facilities.
• It also serves as a reference for service providers in facilities supplied by
EPSS and for the administrative units that provide management and
supervisory support.
• The SOP manual guides the staff in the completion of the following tasks:
 Recording and reporting on stock levels and usage of pharmaceuticals.
 Ordering pharmaceuticals from EPSS
 Receiving and storing pharmaceuticals
 Issuing pharmaceuticals between and within facilities
 Maintaining adequate amount of pharmaceuticals
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4.4. Roles & Responsibilities of the institutions in IPLS

• IPLS implementation requires collaborative efforts of different
officials and professionals working at all levels of the FMOH
system.
• The roles and responsibilities for organizations and personnel
involved in this system are listed below.
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A. Federal Ministry of Health (FMoH)

• The Federal Ministry of health has roles and responsibilities in the
IPLS.
• All the different directorates at the MoH has a stake in
implementing IPLS, however, the Pharmaceuticals and medical
service directorate through its Pharmaceutical and logistics
management unit is directly responsible for the IPLS.
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B. EPSS
• As an agency with a prime responsibility of managing the
pharmaceutical logistics system of the country, EPSS has
indispensable roles and responsibilities in the implementation of
the IPLS.
• Its responsibilities include forecasting, procurement, storage and
distribution of products and others.
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C. Regional Health Bureaus/Zonal Health Department

• Regional health bureaus have significant roles and responsibilities
in the implementation of the IPLS across health facilities found in
their respective regions.
• The major role of the bureaus is to monitor and evaluate the
implementation of the system.
• In addition, they have significant responsibilities in the area of
funding and other functions.
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D. Woreda Health Offices

• The Woreda health offices have major roles and responsibilities in
the implementation of IPLS in health centers directly reporting to
them.
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E. Hospitals
• Hospitals are health facilities which provide high level curative
health services.
• In order to ensure the provision of the health services expected
from the facilities, the hospitals have to perform a lot of activities
in the implementation of IPLS.
F. Health Centers
• Health centers are units of the supply chain of the country which
keeps products to dispense to the end users and to the health posts
managed by them.
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G. Health Posts
• As part of the primary health care unit, health posts manage
pharmaceuticals which are used at the community level.
• Store pharmaceuticals using appropriate storage procedures
• Maintain Bin Cards for all pharmaceuticals
• Complete a physical count of pharmaceuticals every month
• Complete the Completed by Health Post section of the Health Post Report and Re-
supply Form every month
• Arrange for transport and collect pharmaceuticals from health centers
• Dispense products to clients
• Issue products to community health workers or volunteers
• Visually inspect products when receiving, issuing and dispensing to clients