Author: Augustine Omodieke, Health Strategy and Delivery Foundation

Over the past years, Liberia’s John F. Kennedy Medical Centre (JFKMC) has experienced stock out of essential drugs due to poor inventory management and demand forecasting. As a result, patients were forced to purchase drugs from private drug stores. Stacks of commodities (mostly donated products) arrived at the hospital’s warehouse already expired or close to expiration; thus, impeding adequate storage and visibility of available commodities. The Accelerator is working with leadership from JFKMC to organize and implement interventions to ensure adequate stock of pharmaceuticals and medical supplies to eliminate stock out of essential commodities, expirations, and waste.

A Material Management Department was established to centralize warehousing and oversee all of the facility’s assets, including pharmaceuticals, medical, and laboratory supplies. Supply chain management policies and guidelines were formulated, including a Procurement Policy to better align the hospital’s procurement processes with the Liberian Public Procurement and Concessions Commission’s Act; Drugs and Medical Supplies Donations Policy, which seeks to protect the facility from receiving harmful donations from donors and vertical programs.  The Warehousing and Inventory Management Guidelines were also created to optimize warehousing activities and practices and enforce the implementation of FEFO/FIFO (First Expire First Out/First In First Out) stock rotation mechanism for inventory management to eliminate expiration/wastages of essential drugs and supplies.

In addition, the Accelerator coordinated with the Pharmacy and Material Management departments to reorganize the pharmacy warehouse. This exercise involved sorting and removing expired stock (to free up useful space in the storage areas), identifying and assigning unique codes to products, and allocating specific bins on shelves for unique products. Other activities included tagging all bins on shelves with product identification codes and bin cards and rearranging products alphabetically and according to product categories. Following this exercise, all products will be immediately unboxed and organized on dedicated bins on shelves to facilitate the FEFO protocol as part of strategies to mitigate risks of expiration and accumulation of expired products.

Unorganized products in pharmacy warehouse (before Accelerator’s intervention)
Unorganized products in pharmacy warehouse (before Accelerator’s intervention). Photo credit: HSDF
Appropriately arranged injectables section of the pharmacy warehouse (following Accelerator’s ongoing intervention)
Appropriately arranged injectables section of the pharmacy warehouse (following Accelerator’s ongoing intervention). Photo credit: HSDF

Moreover, the Accelerator supported the hospital in adapting the Combined Report, Requisition, Issue, and Receipt Form (CRRIRF) to standardize its paper-based logistics management information system (LMIS). The CRRIRF summarizes consumption, the quantity of stock received within the review period, and stock on hand, amongst other data elements. It will provide a structure that collates, analyses, and presents LMIS data in a usable format for decision-making. It will lead to the availability of logistics data repository, improvement in LMIS data quality, progress monitoring, a valuable source of data for demand/supply planning and forecasting assumptions, and an improvement in LMIS data management for the facility. Plans to pilot the form in the pharmacy department are being finalized with the leadership of JFKMC.

The Accelerator will collaborate with the pharmacy and material management team to conduct an ABC analysis for pharmaceuticals using consumption and demand data in the coming weeks. This analysis will help the facility’s management make evidence-based decisions regarding prioritizing specific essential commodities and maximizing scarce resources to ensure uninterrupted delivery of quality healthcare services.

The organization and rigorous management of a pharmacy are vital in all health structures, particularly in resource-constrained settings. A well-organized pharmacy will help JFKMC (like other health facilities with limited resources) maintain a sufficient stock of drugs and appropriate medical supplies; and reduce the costs associated with the purchase, management, and wastage.