Introduction to drug supply management

Outline of presentation

At the end of this session students will able to: -

• Essential Drug Concept, Alma-Ata, Bamako Initiative
• Defining drug and management
• Defining managing drug supply
• Why worry about drugs?
• Challenges for drug managements
• Drug management cycle
• The discovery of miracle (under )drugs
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 Essential Drug Concept

• The concept of essential medicines (EMs), developed

in 1977,
1st publication of ED model list
• It cleared that the scarce financial resources needed to
be cautiously used in order to contain the increasing
drug costs and ensure sustained availability and
accessibility of essential drugs.
• Such drugs are considered necessary and vital for the
health needs of the population;
– they should be available at all times, in the proper
dosage forms and at affordable costs.
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 Alma-Ata Declaration
• In 1978
• strongly reaffirms that health as a fundamental human right
and
– whose realization requires the action of many other social
and economic sectors in addition to the health sector.
• The existing gross inequality in the health status of the people
in developed and developing countries as well as within
countries is politically, socially and economically
unacceptable.
• The people have the right and duty to participate in the
planning and implementation of their health care.
• Health for all by 2000 where Primary health care is the key to
attaining this target

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 Bamako Initiative

• In 1987
• was launched to involve communities in financing
and managing their health care needs;
• The essential drug component became a core and
prominent issue of this initiative.
• The drugs, delivery system and service delivery must
be efficiently managed, supervised and monitored

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 What is a drug?
A drug can be given three possible operational definitions:
– A chemical substance that affects the processes of the
body or mind;
– Any chemical compound used on or administered to
humans or animals for the diagnosis, treatment or
prevention of disease, or other abnormal condition, for the
relief of pain or suffering, or to control or improve any
physiologic or pathologic state;
– A substance used recreationally for its effects on the CNS.

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 What is management?

• Management is the act or art of being responsible or in

charge and conducting or supervising
• Mgt is achieving results through people.

• It is a commitment to achieve objectives

• It is using resources efficiently.

• Generally it involves: Planning, organizing, Leading,

Coordinating and controlling the activities there to be
done.
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 Managing drug supply

• Most leading causes of death and disability in

developing countries can be prevented, treated or at
least alleviated with cost effective essential drugs
• Despite this fact, literally hundreds of millions of
people do not have regular access to ED
• Many of those who do have access are given the
wrong treatment, receive too little medicine for their
illness or do not use the drugs correctly
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Drug management supply is concerned with practical ways in which
gov’t policy makers, essential drugs program managers, NGOs,
donors and others can work to close:
– the huge gap between the need for essential drugs and public
access to them, and
– closing the gap between the availability of drugs and their
rational use
• Where the main aim is to ensure that high quality EDs are
available, affordable, and used rationally
• EDs are those drugs that meet the health needs of the majority of
the population(WHO,1975) 9
 Why worry about drugs?

 Accessible health services and qualified staff are necessary

components of any health care system, but drugs have
special importance for at least five reasons:
 Drugs save lives and improve health

 Drugs promote trust and participation in health services

 Drugs are costly

 Drugs are d/t from other consumer products

 Substantive improvements in the supply use of drugs are

possible 10
 Why manage drugs?
 Three reasons can be given to explain why drugs need to be
managed properly.
• Firstly, drugs are part of the link between the patient and
health services.
– Consequently, their availability or absence will contribute
to the positive or negative impact on health.
• Secondly, poor drug management, particularly in the public
sector of developing countries, is a critical issue,
– but major improvements are possible that can save money
and improve access. 11
• Finally, drugs are no longer the responsibility of health
workers only.
– Political, economic, financial and traditional
considerations have become so crucial in health care.
• All of these factors contribute to appropriate

financial expenditure, avoid wastage, increase access and

ensure that drugs are properly used
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 Challenges for drug managements

• Although much has been achieved, huge gaps remain between the need
for drugs and the supply of drugs, especially among poorer less
urbanized populations
• Major challenges for policy-makers and managers include:

– achieving financial sustainability,

– improving efficiency in public drug supply

– changing the behavior of providers, patients and public to promote

effective, safe and economical prescribing, dispensing and pts use
of drugs
– Reorienting the role of government
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– Regulating safety, efficacy and quality
 Challenges for drug managements cont’d

Achieving financial sustainability

• Financial sustainability is achieved only when expenditures
and financial resource balance are sufficient to support a
given level of demand.
• Health-sector reform is concerned with improving efficiency
through changes in the organization and allocation of health
care resources.
• It is also concerned with health care financing

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 Challenges for drug managements cont’d
Improving efficiency in public drug supply .

• Although many variation exist, there are five basic approaches for

organizing drug supply for government health services

1. CMS it is a conventional drug supply system, in which drugs are

procured and distributed by a centralized government unit

2. Autonomous supply agency is an alternative to CMS system, managed

by an autonomous or semi – autonomous drugs supply agency

3. Direct delivery system is a decentralized, non-CMS approach in which

drugs are delivered directly by suppliers to districts and major health

facilities.
 The government drug procurement office tenders to establish the supplier and 15
 Challenges for drug managements cont’d

4. Prime vendor system

– is another non-CMS system in the government drug procurement office

establishes a contract with a single prime vendor as well as separate

contracts with drug suppliers.

– The prime vendor is contracted to manage drug distribution by receiving

drugs from the suppliers and then storing and distributing them to districts

and major facilities

5. Fully private supply:

– in some countries drugs are provided by private pharmacies in or near

government health facilities.

– With such an approach, measures are required to ensure equity of access
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Changing behaviors of providers, patients, and public
– Major problems include prescribing and dispensing incorrect, harmful,
unnecessary drugs;
– failure by patients to use needed medications correctly and wasteful of
harmful self-medication practices.
Reorienting the role of government

• Access to health care, including essential drugs, is a fundamental

human right.
• The public health challenge is to work with the private sector and
NGOs to achieve universal access to essential drugs and rational use
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Regulation, safety, efficacy and quality

• Regulatory control is an indispensable foundation for ensuring the

safety, efficacy, and quality of drugs in a country.

• It is difficult to obtain effective regulatory capacity in developing

countries

• As such capacity requires a firm legislative basis, trained personnel;

specific technical resources, adequate funding, and perhaps most
import-public commitment to establishing and maintain basic
standards. 18
 Drug management cycle

• Drug Supply management involves four major functions:

- selection, procurement, distribution, & drug use.
• These are inter liked to each other & form a cyclic
process as shown below
• At the center the management support holds the drug
management cycle together in coordination.
• The entire cycle frame work of a policy & legal frame
work that establishes and supports the public
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 The discovery of miracle drugs(Assignment)

• Penicillin 1941
• Chloroquine 1943
• Streptomycin 1944
• TTC and CAF 1948
• Isoniazid 1951
• Erythromycin 1952
• CPZ 1952
• Sulfonylureas and nystatin1954
• OC in field trials 1955
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Thank you

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