Pharmaceutical Sciences Notes

NTA Level 5 • Semester 1 • PST05101 Procurement Methods Medicines and Medical Supplies Management • Source Session/Topic 10 Full source-text version: all educational wording from the extracted learning source is retained; only presenter/tutor metadata and web-layout noise are removed, while formatting is improved for readability. Session 10: Procurement Methods Total Session Time: 120 minutes Prerequisites • None Learning Tasks By the end of this session students are expected to be able to: • List methods for procurement of medicines and medical supplies • Identify criteria for selecting a procurement methods • Identify procurement models Resources Needed: • Flip charts, marker pens, and masking tape • Black/white board and chalk/whiteboard markers SESSION OVERVIEW |Step |Time |Activity/ |Content | | | |Method | | |1 |05 minutes |Presentation |Introduction, Learning Tasks | |2 |40 minutes |Presentation |Methods for Procurement of Medicines and| | | |Buzzing |medical supplies | |3 | |Presentation |Criteria for Selecting a Procurement | | |35 minutes |Small Group |Methods | | | |Discussion | | |4 |15 minutes |Presentation |Identify Procurement Models | | | |Buzzing | | |5 |15 minutes |Presentation |Key Points | |6 |10 minutes |Presentation |Evaluation | SESSION CONTENTS STEP 1: Presentation of Session Title and Learning Tasks (5 minutes) READ or ASK students to read the learning tasks and clarify ASK students if they have any questions before continuing. STEP 2: Methods for Procurement of Medicines and Medical Supplies (55 minutes) |Activity: Buzzing (5 minutes) | | | |ASK students to pair up and buzz on the following question for 3 | |minutes | | | |What are the methods for procurement of medicines and medical supplies?| | | |ALLOW few pairs to respond on the question and let other pairs add on | |points not mentioned WRITE their response on the flip chart/board | | | |CLARIFY and SUMMARIZE by using the content below | The following are the methods for procurement of medicines and medical supplies; Open tender • Open tendering is a formal procedure by which quotes are invited from any supplier’s representative on a local or worldwide basis, subject to the terms and conditions specified in the tender invitation. For example, International competitive bidding, as specified in World Bank (2000; 2004b) guidelines, is a tender open to all interested international manufacturers from World Bank member countries. Restricted tender • In a restricted tender, interested suppliers must be approved in advance, often through a formal prequalification process that considers adherence to good manufacturing practices, past supply performance, financial viability, and related factors. The prequalification process is often open to any supplier that wishes to apply. E-procurement and reverse auction • E-procurement is Internet-based tendering. In the reverse auction approach (which is a variation of restricted tenders), qualified bidders submit an initial offer; the lowest offer received is posted publicly without naming the bidder after the first round; and then qualified bidders are invited to offer lower prices than that posted low price. The process continues round-by-round until no more prices are submitted; then the lowest posted bid wins the contract. This approach has rarely been used for pharmaceutical procurement (with most experience in Latin America); however, it may gain traction as global Internet capacity and use increase. Pharmaceutical quality assurance requirements and related factors may limit the use of this model, at least in its current form. Competitive negotiation • In competitive negotiation, the buyer approaches a limited number of selected suppliers (typically at least three) for price quotations. Buyers may also bargain with these suppliers to achieve specific price or service arrangements. This procurement method is used primarily in the private sector, because public-sector procurement organizations are generally forbidden from negotiating or bargaining with suppliers. For example, global organizations such as UNICEF, the Clinton Foundation, and SCMS have successfully negotiated reduced prices of antiretroviral (ARV) medicines with manufacturers. International or local shopping • As with competitive negotiation, in international or local shopping, the buyer obtains at least three quotes from suppliers; however, bargaining or negotiation of any kind are generally not permitted. Direct procurement • The simplest, but usually most expensive, method of procurement is direct purchase from a single supplier, either at the quoted list price or at a negotiated standard discount off the list price. For single-source medicines (generally those under patent with no licensing agreements that allow other firms to manufacture the medicine), the buyer basically has three choices—negotiated procurement, direct procurement, or selection of an alternative drug product. STEP 3: Criteria for Selecting Procurement Methods (35 minutes) |Activity: Small Group Discussion ( 15 minutes) | | | |DIVIDE students into manageable groups | | | |ASK students to discuss in groups on the following question: | | | |What are the criteria for selecting a procurement methods? | | | |ALLOW students to discuss for 15 minutes | | | |ALLOW each groups to present | | | |CLARIFY and SUMMARIZE by using the contents below | The following are criteria for selecting procurement methods: • Funding sources(government and donors) • Reorder frequency models • Annual review • Scheduled review • Perpetual review • Cost of prized tender • Assured quality, efficacy and safety of the items STEP 4: Identification of Procurement Models (15 minutes) |Activity: Small Group Discussion ( 15 minutes) | | | |DIVIDE students into manageable groups | | | |ASK students to discuss in groups on the following question: | | | |What are the criteria for selecting a procurement methods? | | | |ALLOW students to discuss for 15 minutes | | | |ALLOW each groups to present | | | |CLARIFY and SUMMARIZE by using the contents below | The Procurement model commonly practices or used:- • Scheduled purchasing • Perpetual purchasing o Example : Impress system ▪ : Two bin system • Annual purchasing : Purchase once a year • Modified optional Replenishment: it is a combination of the above STEP 4: Key Points (15 minutes) • There are numerous mechanisms by which governments, non-governmental organizations

NTA Level 5 • Semester 1 • PST05101 Quality Assurance in Procurement of Medicines and Medical Medicines and Medical Supplies Management • Source Session/Topic 11 Full source-text version: all educational wording from the extracted learning source is retained; only presenter/tutor metadata and web-layout noise are removed, while formatting is improved for readability. Session 11: Quality Assurance in Procurement of Medicines and Medical Supplies Total Session Time: 120 minutes Prerequisites • None Learning Tasks By the end of this session students are expected to be able to: • List sources of medicines and medical supplies for procurement • Explain the quality assurance in procurement of medicines and medical supplies Resources Needed: • Flip charts, marker pens, and masking tape • Black/white board and chalk/whiteboard markers SESSION OVERVIEW |Step |Time |Activity/ |Content | | | |Method | | |1 |05 minutes |Presentation |Introduction, Learning Tasks | |2 | |Presentation |Sources of Medicines and Medical | | |35 minutes |Buzzing |Supplies for Procurement | |3 | |Presentation |Quality Assurance in Procurement of | | |40 minutes |Small Group |Medicines and Medical Supplies | | | |Discussion | | |4 |20 minutes |Presentation |Critical Elements in Quality Assurance | | | |Buzzing |for Pharmaceutical Procurement | |5 |10 minutes |Presentation |Key Points | |6 |10 minutes |Presentation |Evaluation | SESSION CONTENTS STEP 1: Presentation of Session Title and Learning Tasks (5 minutes) READ or ASK students to read the learning tasks and clarify ASK students if they have any questions before continuing. STEP 2: Sources of Medicines And Medical Supplies For Procurement (35 minutes) |Activity: Buzzing (5minutes) | | | |ASK students to pair up and buzz on the following question for 3 | |minutes | | | |What are the Sources of medicines and medical supplies for procurement?| | | |ALLOW few pairs to respond on the question and let other pairs add on | |points not mentioned WRITE their response on the flip chart/board | | | |CLARIFY and SUMMARIZE by using the content below | The following are the Sources of medicines and medical supplies for procurement: They could be primary or secondary sources: • Primary sources o Manufacturers o Industries • Secondary sources o Distributors o Agencies o Others eg individuals or private pharmacy These are examples of common Sources of medicines and medical supplies for procurement; • Medical Stores Department (MSD) • Private pharmacies • Donors (Non Governmental Organization-NGOs) ie Bilateral Aid programs eg. DANIDA,USAID, JICA • United Nation Organizations (United Nations International Children’s Emergency Fund-UNICEF, UNDP) • World Health Organization (WHO) • At the global level, United Nations agencies such as UNICEF, United Nations Population Fund, and United Nations Development Programme have long functioned as pooled procurement systems serving their country programs • In recent years, a number of new global procurement mechanisms have emerged, such as the Stop TB Global Drug Facility, the U.S. President’s Plan for Emergency AIDS Relief (PEPFAR)–funded Supply Chain Management System (SCMS), and the Global Fund to Fight AIDS, Tuberculosis and Malaria’s voluntary pooled procurement system STEP 3: Quality Assurance in Procurement of Medicines and Medical Supplies (40 minutes) |Activity: Small Group Discussion ( 15 minutes) | | | |DIVIDE students into manageable groups | | | |ASK students to discuss in groups on the following question: | | | |What is quality assurance in procurement of medicines and medical | |supplies? | | | |ALLOW students to discuss for 15 minutes | | | |ALLOW each groups to present | | | |CLARIFY and SUMMARIZE by using the contents below | Quality assurance in procurement of medicines and medical supplies: • The purpose of quality assurance in pharmaceutical supply systems is to help ensure that each medicine procured and that reach a patient is safe, effective, and of acceptable quality. • A comprehensive quality assurance program includes both technical and managerial activities, spanning the entire supply process from pharmaceutical selection to patient use. • For the purposes of primary health care, the most important characteristics of a pharmaceutical product are identity, purity, strength, potency, uniformity of dosage form, bioavailability, and stability. • Pharmaceutical quality is affected by starting materials, manufacturing process, packaging, transportation and storage conditions, and other factors; these influences may be cumulative. • If a pharmaceutical product does not meet established quality standards, passes its expiration date, or has been degraded by storage conditions, the possible consequences are; o Lack of therapeutic effect, leading to prolonged illness or death o Toxic and adverse reactions o Waste of limited financial resources o Loss of credibility of the health care delivery system • A comprehensive quality assurance program must ensure the following; o Pharmaceuticals selected have been shown to be safe and efficacious for their intended use, are presented in an appropriate dosage form, and have the longest possible shelf life o Suppliers with acceptable quality standards are selected o Pharmaceuticals received from commercial suppliers and donors meet specified quality standards at the time of delivery o Packaging meets contract and usage requirements o Repackaging activities and dispensing practices maintain quality o Storage and transportation conditions do not compromise product quality o Product quality concerns reported by prescribers, dispensers, and consumers are properly cataloged and addressed o Product recall procedures are implemented to remove defective products STEP 4: Critical Elements in Quality Assurance for Pharmaceutical Procurement (20 minutes) |Activity: Small Group Discussion ( 15 minutes) | | | |DIVIDE students into manageable groups | | | |ASK students to discuss in groups on the following question: | | | |What are the critical elements for quality assurance for pharmaceutical| |procurement? | | | |ALLOW students to discuss for 15 minutes | | | |ALLOW each groups to present | | | |CLARIFY and SUMMARIZE by using the contents below | • Product selection: products with longer shelf life (for example, powders for reconstitution rather than oral suspensions), avoidance of products with bioavailability problems, when possible • Product certification: supplier prequalification, recent GMP inspection reports from national drug authorities, formal supplier-monitoring system,

NTA Level 5 • Semester 1 • PST05101 Managing Drug Donations Medicines and Medical Supplies Management • Source Session/Topic 12 Full source-text version: all educational wording from the extracted learning source is retained; only presenter/tutor metadata and web-layout noise are removed, while formatting is improved for readability. Session 12: Managing Drug Donations Total Session Time: 120 minutes Prerequisites • None Learning Tasks By the end of this session students are expected to be able to: • Explain drug donation • List its associated benefits and problems • Explain the core principles in drug donation Resources Needed: • Flip charts, marker pens, and masking tape • Black/white board and chalk/whiteboard markers SESSION OVERVIEW |Step |Time |Activity/ |Content | | | |Method | | |1 |05 minutes |Presentation |Introduction, Learning Tasks | |2 |30 minutes |Presentation |Explanations of Drug Donation | | | |Buzzing | | |3 |20 minutes |Presentation |Identify the Core Principles in | | | |Buzzing |Pharmaceutical Donations | |4 | |Presentation |Benefits and Problems of Drug Donations | | |40 minutes |Small Group | | | | |Discussion | | |5 |15 minutes |Presentation |Key Points | |6 |10 minutes |Presentation |Evaluation | SESSION CONTENTS STEP 1: Presentation of Session Title and Learning Tasks (5 minutes) READ or ASK students to read the learning tasks and clarify ASK students if they have any questions before continuing. STEP 2: Explanations of Drug Donations (30 minutes) |Activity: Buzzing (5minutes) | | | |ASK students to pair up and buzz on the following question for 3 | |minutes | | | |What do you understand by drug donation? | | | |ALLOW few pairs to respond on the question and let other pairs add on | |points not mentioned WRITE their response on the flip chart/board | | | |CLARIFY and SUMMARIZE by using the content below | Drug Donations • Drug donations are usually given in response to acute emergencies, but they can also be part of development aid • Most pharmaceutical donations are given with the best of intentions but can nevertheless create problems at the receiving end. Often, donated pharmaceuticals are not relevant to the needs of the recipient, or they arrive unsorted or close to expiry. They may be labeled with a brand name or in a language that is not understood. Many pharmaceutical donations counteract government policies or violate national regulations of the recipient country and can be expensive for the country to store or destroy • Guidelines for pharmaceutical donations are needed for a number of reasons. Donors and recipients do not communicate on equal terms, and recipients often need assistance in formulating their needs. Many donors do not understand the potential difficulties at the receiving end and need guidance. Medicines require special regulations because they are different from other donated items. Pharmaceutical donations that occur without input from the recipient countries should be discouraged STEP 3: Core Principles for a Useful Pharmaceutical Donation. (20 minutes) |Activity: Buzzing (5minutes) | | | |ASK students to pair up and buzz on the following question for 3 | |minutes | | | |What are the core principles for useful donation of pharmaceuticals? | | | |ALLOW few pairs to respond on the question and let other pairs add on | |points not mentioned WRITE their response on the flip chart/board | | | |CLARIFY and SUMMARIZE by using the content below | • The four core principles for a useful pharmaceutical donation are; o A donation benefits the recipient to the maximum extent possible o A donation should be given with full respect for the wishes and authority of the recipient o Items that are not acceptable in the donor country for quality- related reasons are also not acceptable as donations: there should be no double standards in quality o Effective communication between the donor and recipient is necessary before any donation • These principles have been translated into a set of guidelines for pharmaceutical donations. First, recipients should review and adopt these guidelines and present them officially to the donor community. Only then can they be implemented and enforced. Second, recipients should develop and publish administrative procedures for pharmaceutical donations. Third, recipients should indicate to the donors, as clearly as possible, how they want to be helped, specifying the medicines they need, the quantities, and the priorities. Donors should inform the recipients well in advance which pharmaceutical donations are coming, and when. STEP 4: Benefits And Problems of Drug Donations (60 minutes) |Activity: Small Group Discussion ( 15 minutes) | | | |DIVIDE students into manageable groups | | | |ASK students to discuss in groups on the following question: | | | |What are the benefits and problems of drug donations? | | | |ALLOW students to discuss for 15 minutes | | | |ALLOW each groups to present | | | |CLARIFY and SUMMARIZE by using the contents below | Benefits of Drug Donations • Medicine donations can save lives and ease suffering when well- coordinated and managed. • In cases where recipient countries are not able to ensure adequate medicines access, donations can bring major benefits to those in need • They help to eradicate the situation of out of stock medicines • Medicine donations can become strategic benefits to recipient countries. They are often used to support the rebuilding of health systems or to ensure access of population to health products they otherwise wouldn’t have • Good donation practices may provide savings in development support budgets, enabling these resources to be used for other purposes • To donors there is a benefit of tax deduction • Builds good relationship between countries Problems of Drug Donations These are based on the following categories; Pharmaceutical donations in emergency situations • Donated pharmaceuticals are often not relevant for the emergency situation, for the disease pattern, or for the level of care that is a they available • Health workers and patients are not always familiar with the donated pharmaceuticals • The pharmaceuticals are often

NTA Level 5 • Semester 1 • PST05101 Procurement and Supply Agencies of Medicines and Medical Medicines and Medical Supplies Management • Source Session/Topic 13 Full source-text version: all educational wording from the extracted learning source is retained; only presenter/tutor metadata and web-layout noise are removed, while formatting is improved for readability. Session 13: Procurement and Supply Agencies of Medicines and Medical Supplies in Tanzania Total Session Time: 120 minutes Prerequisites • None Learning Tasks By the end of this session students are expected to be able to: • List major procurement agencies for medicines and medical supplies in Tanzania • Explain autonomous supply agencies for public and private procurement of medicines and medical supplies Resources Needed: • Flip charts, marker pens, and masking tape • Black/white board and chalk/whiteboard markers SESSION OVERVIEW |Step |Time |Activity/ |Content | | | |Method | | |1 |05 minutes |Presentation |Introduction, Learning Tasks | |2 |10 minutes |Presentation |Major Procurement Agencies for Medicines| | | |Brainstorming |and Medical Supplies in Tanzania | |3 | |Presentation |Explanations of Autonomous Supply | | |85 minutes |Small Group |Agencies for Public and Private | | | |Discussion |Procurement of Medicines and Medical | | | | |Supplies | |4 |10 minutes |Presentation |Key Points | |5 |10 minutes |Presentation |Evaluation | SESSION CONTENTS STEP 1: Presentation of Session Title and Learning Tasks (5 minutes) READ or ASK students to read the learning tasks and clarify ASK students if they have any questions before continuing. STEP 2: Major Procurement Agencies for Medicines and Medical Supplies in Tanzania (10 minutes) |Activity: Brainstorming (5 minutes) | | | |Ask students to brainstorm on the following question: | | | |What is are major procurement agencies for medicines and medical | |supplies in Tanzania? | | | |ALLOW few students to respond | | | |WRITE their responses on the flip chart/ board | | | |CLARIFY and SUMMARISE by using the content below | The following are major procurement agencies for medicines and medical supplies in Tanzania; • Medical Stores Department (MSD): It is intended to serve public and faith based hospitals, health centres and dispensaries • Autonomous agencies eg Action Medeor and Mission for Essential Medical Supplies (MEMS) serves faith based hospitals, health centres and dispensaries • Private wholesale pharmacies, intentionally they serve the private retail pharmacies, ,ADDO shop, private hospitals, health centres and dispensaries STEP 3: Explanations of Autonomous Supply Agencies for Public and Private Procurement of Medicines and Medical Supplies (85 minutes) |Activity: Small Group Discussion ( 15 minutes) | | | |DIVIDE students into manageable groups | | | |ASK students to discuss in groups on the following question: | | | |What Explanations can you give on autonomous supply agencies for public| |and private procurement of medicines and medical supplies in Tanzania? | | | |ALLOW students to discuss for 15 minutes | | | |ALLOW each groups to present | | | |CLARIFY and SUMMARIZE by using the contents below | The following are autonomous supply agencies for public and private procurement of medicines and medical supplies: • Action Medeor • Mission for Essential Medical Supplies (MEMS) Action Medeor • Action Medeor International Healthcare Tanzania provides essential medicines and medical supplies of assured high quality and affordable prices to healthcare partners in Tanzania • action medeor Tanzania is a subsidiary of action medeor e.V. in Germany. This charitable, non-governmental organization was founded in 1964 to improve the access to medicines for people in need in developing countries. It draws on years of experience and competences in various skill-oriented trainings, workshops and individual consultancy, transferring knowledge and practical experience in Good Manufacturing Practices, Good Distribution Practices and Good Regulatory Practices • action medeor is also engaged in disaster relief programmes and diverse health care projects • They started operating in 2004 in Dar es Salaam. Today, the head office with warehouse of action medeor Tanzania is still located there. Additionally, there are two additional warehouses in Masasi and Makambako to serve the south and south-west of Tanzania • They offer service to the non-commercial health sector and public institutions, the health sector of faith-based groups as well as of national and international non-governmental and charitable organizations in Tanzania • They offer the following; o Supply of essential medicines and medical equipment of assured high quality at affordable prices o Provision of good services and reliable information on medicines and equipment for customers o Assistance with technical advisory services and training in medicine management and rational medicine use • Action medeor Tanzania has adopted high standards of quality assurance ensuring our goal of safe, effective and good quality products. High quality is achieved by doing the following; o All supplying manufacturers or distributors have to comply with and be certified in Good Manufacturing Practices (GMP) o Regular on-site audits of the manufacturer’s production control full compliance with GMP o A random testing of products by certified and independent laboratories o All products are procured with a maximum shelf life o Ensuring that each batch of each product is accompanied with the certificate of analysis of the medicine as well as of the active pharmaceutical ingredients (API) o Well trained pharmacists supported by modern stock management system ensure Good Warehouse Practice • Most of products are purchased locally or within the region in line with the policy of action medeor to support local manufacturers, however, without compromising on quality • Products not available locally or regionally are procured from international manufacturers • They negotiate with suppliers for the lowest possible price due to bulk sourcing, thus benefiting from quantity discounts Mission for Essential Medical Supplies (MEMS) • [pic]An ecumenical non profit registered company owned by TEC and CCT mandated to supply essential medicines and supplies to faith based facilities and others of the same kind at compepetitive price and with certain in quality • Mission for MEMS is to “effectively and efficiently acquire, store and distribute essential medicines and medical supplies to health facilities in

NTA Level 5 • Semester 1 • PST05101 Structure and Functions of Medical Stores Department Medicines and Medical Supplies Management • Source Session/Topic 14 Full source-text version: all educational wording from the extracted learning source is retained; only presenter/tutor metadata and web-layout noise are removed, while formatting is improved for readability. Session 14: Structure and Functions of Medical Stores Department Total Session Time: 120 minutes Prerequisites • None Students Learning Tasks By the end of this session students are expected to be able to: • Describe the structure of Medical Stores Department • Describe the functions of Medical Stores Department Resources Needed: • Flip charts, marker pens, and masking tape • Black/white board and chalk/whiteboard markers SESSION OVERVIEW |Step |Time |Activity/ |Content | | | |Method | | |1 |05 minutes |Presentation |Introduction, Learning Tasks | |2 |35 minutes |Presentation |Structure of Medical Stores Department | | | |Buzzing | | |3 |55 minutes |Presentation |Functions of Medical Stores Department | | | |Small Group | | | | |Discussion | | |4 |15 minutes |Presentation |Key Points | |5 |10 minutes |Presentation |Evaluation | SESSION CONTENTS STEP 1: Presentation of Session Title and Learning Tasks (5 minutes) READ or ASK students to read the learning tasks and clarify ASK students if they have any questions before continuing. STEP 2: Structure of Medical Stores Department (35 minutes) |Activity: Buzzing (5minutes) | | | |ASK students to pair up and buzz on the following question for 3 | |minutes | | | |Describe the structure of Medical Stores Department? | | | |ALLOW few pairs to respond on the question and let other pairs add on | |points not mentioned WRITE their response on the flip chart/board | | | |CLARIFY and SUMMARIZE by using the content below | Introduction Medical Stores Department (MSD) was established by the Act of Parliament No.13 of 1993 as an autonomous department under the Ministry of Health, Community Development, Gender, Elderly and Children. Responsible for developing , maintaining and managing an efficient and cost effective system of procurement, storage and distribution of approved medicines and medical supplies required for use by the public health services Structure of MSD • This is an autonomous agency under the Ministry of Health and is governed by a board of trustees. Board of Trustees • The Board is composed of nine members appointed every three years. • The Chairman is appointed by the President of the United Republic of Tanzania • Eight members are appointed by the Minister responsible for health • The Board delegates the day to day management of the department operations to the Director General Executive Management Team (EMT) • All MSD administrative functions and operations are carried out and managed by and through the EMT • It consists of The Director General and six other Directors responsible for Human Resources and Administration, Finance and Planning, Logistics, Procurement, Information and Communication Technology as well as Customer Service and Zonal Operations • The Chief Legal Counsel serves as the Secretary • While the Director General is appointed by the President of the United Republic of Tanzania, the Board of Trustees appoints other Directors MSD Organisation Structure [pic] STEP 4: Functions of Medical Stores Department (55 minutes) |Activity: Small Group Discussion ( 15 minutes) | | | |DIVIDE students into manageable groups | | | |ASK students to discuss in groups on the following question: | | | |What are functions of Medical Stores Department? | | | |ALLOW students to discuss for 15 minutes | | | |ALLOW each groups to present | | | |CLARIFY and SUMMARIZE by using the contents below | Functions of MSD Medical Stores Department (MSD) has got three main functions which are: Procurement • MSD procures medicines, medical supplies and laboratory reagents on behalf of public health facilities, vertical programs as well as private health facilities approved by the ministry. MSD is the largest importer of which 80% of medicines, 90% of medical supplies and 100% laboratory supplies are imported from different countries across the world. • From 2017, MSD procures its medicines and medical supplies direct from manufacturers instead of suppliers to ensure the improvement of medicines availability as well as lowering the medicine prices by half and quarter to some medicines of which most prices were before. • In terms of quality, MSD procures medicines, medical supplies and laboratory reagent that have been approved or fully registered with Tanzania Food and Drug Authority (TFDA). Registration process involves evaluation of products for quality, safety and effectiveness. Each new product from the manufacturer or supplier has to be approved and registered by the TFDA. Products evaluation looks into all parameters necessary to ensure product’s quality, safety, efficacy and stability to ascertain prescribed shelf life. Packaging and labeling is another area that is critically evaluated. Storage • MSD stores medicines, medical supplies and laboratory reagents in its warehouses located strategically in different regions as zonal stores across the country. It has expanded its storage services to modern, computerized and technological warehouses with 10 warehouses across the country in different regions, this has increased storage capacity, service levels, accuracy as well as reduced stock losses. • To address the storage challenges in picking, receiving and dispatching items, MSD has adopted Barcode system. The initiative has allowed the capturing of items information through scanning and/or entering data via device keyboard. The implementation of warehousing activities by using Barcode system has reduced tremendous workload to the warehouse staff by having multiple options of transacting items within and out the warehouse to customers while maintaining data accuracy and speed. Distribution • MSD delivers essential medicines, medical supplies and Laboratory reagents direct to many health facilities (hospitals, Health centers and dispensaries) across the country. The system of Direct Delivery has registered tremendous improvements in terms of timely service delivery, order fill rate, quality and accurate documentation, which have in turn led to increased customer satisfaction. The distribution chain starts from MSD Headquarters Central Warehouse located in

NTA Level 5 • Semester 1 • PST05101 The Prime Vendor System Medicines and Medical Supplies Management • Source Session/Topic 15 Full source-text version: all educational wording from the extracted learning source is retained; only presenter/tutor metadata and web-layout noise are removed, while formatting is improved for readability. Session 15: The Prime Vendor System Total Session Time: 120 minutes Prerequisites • None Learning Tasks By the end of this session students are expected to be able to: • Explain the prime vendor system Resources Needed: • Flip charts, marker pens, and masking tape • Black/white board and chalk/whiteboard markers SESSION OVERVIEW |Step |Time |Activity/ |Content | | | |Method | | |1 |05 minutes |Presentation |Introduction, Learning Tasks | |2 |10 minutes |Presentation |Definitions of vendor, prime vendor | | | | |system | |3 |25 minutes |Buzzing |The need for Prime Vendor System | | | |Presentation | | |4 |25 minutes |Presentation |Financing for Prime Vendor System | |5 |35 minutes |Small Group |Strategy for Primary Vendor System | | | |Discussion | | | | |Presentation | | |6 |10 minutes |Presentation |Key Points | |7 |10 minutes |Presentation |Evaluation | SESSION CONTENTS STEP 1: Presentation of Session Title and Learning Tasks (5 minutes) READ or ASK students to read the learning tasks and clarify ASK students if they have any questions before continuing. STEP 2: Definitions of Vendor, Prime Vendor System (10 minutes) Vendor • Is a person or organization that vends or sells liable/ dependent labor or service • Specifically vendor can be an independent consultant, a consulting company or staffing company • Can also be called a supplier because they supply the labor or expertise Prime vendor system (PVS) • Is a contracting process that provides commercial products to customers from commercial distributors whereby customer typically receive material delivery through the vendor’s commercial distribution system STEP 3: The Need for Primary Vendor System (25 minutes) |Activity: Buzzing (5minutes) | | | |ASK students to pair up and buzz on the following question for 3 | |minutes | | | |Why do we the need for Primary Vendor System? | | | |ALLOW few pairs to respond on the question and let other pairs add on | |points not mentioned WRITE their response on the flip chart/board | | | |CLARIFY and SUMMARIZE by using the content below | • Stock-outs of medicines affect quality of care and discourage patients to enroll in the Community Health Fund (CHF) and other insurance schemes. Medical Stores Department (MSD) is the backbone for public medicines supply in Tanzania. But they face challenges in filling orders of health facilities • In the last few years, this supply gap has been growing and reached over 40% of orders. • Normally, health facilities fill this gap with purchases using complementary funds such as from community health fund (CHF), national health insurance fund (NHIF), user fees and donor basket funds. Procurement is done from multiple private sources within and outside their district and region; incurring in the process high opportunity costs (travel and fuel, per diems, high prices of medicines they purchase). The procedure is uneconomic, bureaucratic, in transparent, and lengthy and supplies are of questionable quality. The Jazia Primary Vendor System • The Jazia Primary Vendor System concept is described under the bilateral governmental agreement between the governments of Tanzania and Switzerland, signed by MoHCDGEC and PO-RALG • The Jazia PVS does not replace MSD but serves as a supplementary source for medicines and supplies out of stock or short supplied or not stocked by MSD • The Jazia PVS serves as a safety net to the region in case of stock falling-out at MSD and/or an unexpected spike in demand without compromising quality or price • . • The contracted Prime Vendor maintains sufficient stock level to meet supply shortfalls experienced from MSD. STEP 4: Financing for PVS (25 minutes) Financing • Health facilities (HF) have two main sources of funding for their supplies: o Direct funding deposited at MSD by the Ministry of Finance (MoF) through the MoHCDGEC and; o Supplementary funds collected by and/or residing at health facility level. These include: CHF, NHIF, cost sharing/user fees and donor health basket funds. At health facility level, complementary funds are managed by the Health Facility Governing Committee (HFGC). 67% of CHF revenue is dedicated to the purchase of supplementary medicines by health facilities. • Health facilities (HF) formerly used these funds to purchase from multiple private sources. However, now this supplementary source is used for purchases exclusively from the appointed Prime Vendor (PV) • Districts pool their demand for supplementary medicine at the regional level, benefitting from lower prices (economies of scale). Prices from the contracted PV are fixed and comparable to MSD prices • This allows health facilities to manage their own funds following standard operating procedures (SOP) hence enhancing fiscal decentralization. Funds are used for joint purchase from the PV, based on a public-private-partnership (PPP) framework contract. STEP 5: Strategy for PVS (35 minutes) |Activity: Small Group Discussion ( 15 minutes) | | | |DIVIDE students into manageable groups | | | |ASK students to discuss in groups on the following question: | | | |What is the strategy for PVS? | | | |ALLOW students to discuss for 15 minutes | | | |ALLOW each groups to present | | | |CLARIFY and SUMMARIZE by using the contents below | Strategy of appointing primary vendor • Medical Stores Department (MSD) is the backbone for public medicines supply in Tanzania. But they face challenges in filling orders of health facilities. The supply gap of more than 40% stemming from the out-of-stock situation and low order fulfillment rates for supplies by MSD needs to be complemented by medicines from other sources • Districts may purchase from private suppliers in case of stock-out at MSD upon its approval. However, this procedure is lacking consistency and transparency, The current procedure is bureaucratic and uneconomic, and it prolongs lead-time for delivery

NTA Level 5 • Semester 1 • PST05101 Objectives and Purpose of LMIS in the Context of Tanzania Medicines and Medical Supplies Management • Source Session/Topic 16 Full source-text version: all educational wording from the extracted learning source is retained; only presenter/tutor metadata and web-layout noise are removed, while formatting is improved for readability. Session 16: Objectives and Purpose of LMIS in the Context of Tanzania Total Session Time: 120 minutes Prerequisites • None Learning Tasks By the end of this session students are expected to be able to: • Explain the objectives and purpose of Logistics Management Information System (LMIS) in the context of Tanzania. Resources Needed: • Flip charts, marker pens, and masking tape • Black/white board and chalk/whiteboard markers SESSION OVERVIEW |Step |Time |Activity/ |Content | | | |Method | | |1 |05 minutes |Presentation |Introduction, Learning Tasks | |2 |10 minutes |Presentation |Definition of Logistics Management | | | | |Information System (LMIS) | |3 |60 minutes |Buzzing |The purpose of Logistics Management | | | |Presentation |Information System (LMIS) | |4 |25 minutes |Small Group |The objectives of Logistics Management | | | |Discussion |Information System (LMIS) | | | |Presentation | | |5 |10 minutes |Presentation |Key Points | |6 |10 minutes |Presentation |Evaluation | SESSION CONTENTS STEP 1: Presentation of Session Title and Learning Tasks (5 minutes) READ or ASK students to read the learning tasks and clarify ASK students if they have any questions before continuing. STEP 2: Definition of Logistics Management Information System (LMIS) (10 minutes) • A logistics management information system (LMIS) is a system of records and reports whether paper-based or electronic used to aggregate , analyze ,validate and display data (from all levels of the logistic system ) that can be used to make logistics decisions and manage the supply chain • Logisticians added the word logistics to management information system (MIS) to create logistics management information system (LMIS). They wanted to make it clear that the collection of data for logistics is a separate activity from the collection of data for other information systems, including health management information systems (HMISs). Logisticians emphasize the use of logistics data for making decisions about activities within the logistics cycle • Among the tool used in LMIS is R&R (Request and Requisition) forms STEP 3: The Objectives of Logistics Management Information System (LMIS) (25 minutes) |Activity: Small Group Discussion ( 15 minutes) | | | |DIVIDE students into manageable groups | | | |ASK students to discuss in groups on the following question: | | | |What are the objectives of LMIS? | | | |ALLOW students to discuss for 15 minutes | | | |ALLOW each groups to present | | | |CLARIFY and SUMMARIZE by using the contents below | The objectives of LMIS • The following are the objectives of LMIS are to obtain: o The right data (the essential data items), o at the right time (in time to take action), o at the right place (the information must be where the decisions are made), o and in the right quantity (having all essential data from all facilities), o the data must be of the right quality (we have to believe that the data are correct) o at the right cost (we should not spend more to collect information than we spend on supplies!) STEP 4: The Purpose of Logistics Management Information System (LMIS) (60 minutes) |Activity: Buzzing (5minutes) | | | |ASK students to pair up and buzz on the following question for 3 | |minutes | | | |What is the purpose of LMIS? | | | |ALLOW few pairs to respond on the question and let other pairs add on | |points not mentioned WRITE their response on the flip chart/board | | | |CLARIFY and SUMMARIZE by using the content below | The purpose of LMIS • The purpose of a logistics management information system is to collect, organize, and report data that will be used to make decisions • The collected information should be able to be used to make decisions. The information gathered is used to improve customer service by improving the quality of management decisions. LMISs enable logisticians to collect the information needed to make informed choices. If information which is not going to be used to make decisions, it should not be collected. • Information is the motor that drives the logistics cycle. Without information, the logistics system would not be able to run smoothly. Managers gather information about each activity in the system and analyse that information to coordinate future actions. For example, information about inventory levels and consumption must be gathered to ensure that a manager knows how much more of a product to procure • Essential Data for Decision Making: o If data are to be collected for decision making, you need to know how much data and what data to collect. To decide what data to collect, look at the decisions you will need to make. Think about the questions a logistics manager might ask. What information would he or she need to answer those questions and make informed decisions? o The questions might include the following: ▪ How long will current supplies last by calculating months stock? ▪ Do we need to order more supplies now? ▪ Where are our supplies in the pipeline? ▪ Do we need to move supplies from higher to lower levels? ▪ Where is consumption the highest? ▪ Do those facilities need more resources? ▪ Are we experiencing losses from the system that require us to take action? ▪ Are supplies flowing regularly through the pipeline? ▪ Do we need to adjust our pipeline to account for bottlenecks in the system? ▪ Are there products about to expire? Should we take them out of the pipeline? ▪ Can we distribute them before they expire? • Although we may make good use of other data items in logistics, these three data items are absolutely required to run a logistics

NTA Level 5 • Semester 1 • PST05101 The Integrated Logistics System (ILS) Medicines and Medical Supplies Management • Source Session/Topic 17 Full source-text version: all educational wording from the extracted learning source is retained; only presenter/tutor metadata and web-layout noise are removed, while formatting is improved for readability. Session 17: The Integrated Logistics System (ILS) Total Session Time: 60 minutes Prerequisites • None Learning Tasks By the end of this session students are expected to be able to: • Define Integrated Logistics System (ILS) • List key features of the ILS system Resources Needed: • Flip charts, marker pens, and masking tape • Black/white board and chalk/whiteboard markers SESSION OVERVIEW |Step |Time |Activity/ |Content | | | |Method | | |1 |05 minutes |Presentation |Introduction, Learning Tasks | |2 |10 minutes |Presentation |Definition of Integrated Logistic | | | |Buzzing |System | |3 |30 minutes |Presentation |Key features of Integrated Logistic | | | |Small Group |System | | | |Discussion | | |4 |05 minutes |Presentation |Key Points | |5 |10 minutes |Presentation |Evaluation | SESSION CONTENTS STEP 1: Presentation of Session Title and Learning Tasks (5 minutes) READ or ASK students to read the learning tasks and clarify ASK students if they have any questions before continuing. STEP 2: Definition of Integrated Logistic System (10 minutes) |Activity: Buzzing (5minutes) | | | |ASK students to pair up and buzz on the following question for 3 | |minutes | | | |What is the definition of Integrated Logistic System? | | | |ALLOW few pairs to respond on the question and let other pairs add on | |points not mentioned WRITE their response on the flip chart/board | | | |CLARIFY and SUMMARIZE by using the content below | Integrated Logistic System (ILS) • ILS is a system that optimizes functional support, leverages existing resources, and guides the system process to quantify and lower life cycle cost and decrease the logistics footprint (demand for logistics), making the system easier to support • ILS is an integration and demand oriented ordering that offers to the health facilities a complete (integrated) range of medicines and medical supplies STEP 3: Key Features of Integrated Logistic System (30 minutes) |Activity: Small Group Discussion ( 15 minutes) | | | |DIVIDE students into manageable groups | | | |ASK students to discuss in groups on the following question: | | | |What are the key features of Integrated Logistic System? | | | |ALLOW students to discuss for 15 minutes | | | |ALLOW each groups to present | | | |CLARIFY and SUMMARIZE by using the contents below | The following are key features of Integrated Logistics System: • Allows each facility to determine its own needs of medicines and medical supplies • Assists the facility staff in managing medicines and medical supplies finances • Reduces the number of forms that are often used in vertical programs • Enhances by reinforcing stock and financial record keeping is all health facilities • Provide tolls and indicators for facilitates supervision • Promotes a more rational use of medicines and rational utilization of transportation • Provide tools to enables data collection for planning and budgeting • Minimizes wastage and pilferage of medicines and medical supplies STEP 5: Key Points (5 minutes) • ILS is a system that optimizes functional support, leverages existing resources, and guides the system process to quantify and lower life cycle cost and decrease the logistics footprint (demand for logistics), making the system easier to support • The key features of ILS includes the following; Allows each facility to determine its own needs, Assists in managing medicines and medical supplies finances, Reduces the number of forms that are often used in vertical programs, Enhances record keeping, Facilitates supervision, Promotes a more rational use of medicines and transportation, Enables data collection for planning and budgeting, Minimizes wastage and pilferage STEP 6: Evaluation (10 minutes) • What is Integrated Logistics System? • What are the key features of the Integrated Logistic System? References MSH and WHO (2012) Managing Access to Medicines and Health Technology, 3rd Edition. Kumarian Press World Health Organization (WHO), Regional Office for Africa Brazzaville 2004, Management of Drugs at Health Centre Level Training Manual. United Republic of Tanzania Ministry of Health and Social Welfare, Strategy for Development and Implementation of an Integrated Logistics System for Essential Health Commodities: Government Printers, Dar es Salaam ← Previous TopicNext Topic →View all Medicines and Medical Supplies Management topicsOpen Complete Full Notes PDF / OFFLINE NOTES Unataka kutumiwa notes hizi kupitia WhatsApp?Kwa notes zilizopangiliwa vizuri kwa kusoma offline au PDF, bonyeza kitufe hapa chini. Ujumbe wenye Level, Semester, Module na Topic utaandaliwa moja kwa moja.TUMIWA NOTES WHATSAPP WhatsApp: 255620339260

NTA Level 5 • Semester 1 • PST05101 The LMIS Tools and How to Complete Them Medicines and Medical Supplies Management • Source Session/Topic 18 Full source-text version: all educational wording from the extracted learning source is retained; only presenter/tutor metadata and web-layout noise are removed, while formatting is improved for readability. Session 18: The LMIS Tools and How to Complete Them Total Session Time: 120 minutes Prerequisites • None Learning Tasks By the end of this session students are expected to be able to: • List LMIS tools • Explain the objects of LMIS • Complete R and R forms Resources Needed: • Flip charts, marker pens, and masking tape • Black/white board and chalk/whiteboard markers SESSION OVERVIEW |Step |Time |Activity/ |Content | | | |Method | | |1 |05 minutes |Presentation |Introduction, Learning Tasks | |2 |15 minutes |Buzzing | LMIS Tools | | | |Presentation | | |3 |15 minutes |Buzzing |The Objectives of LMIS | | | |Presentation | | |4 |65 minutes |Small Group |Completing R and R Forms | | | |Discussion | | | | |Presentation | | |5 |10 minutes |Presentation |Key Points | |6 |10 minutes |Presentation |Evaluation | SESSION CONTENTS STEP 1: Presentation of Session Title and Learning Tasks (5 minutes) READ or ASK students to read the learning tasks and clarify ASK students if they have any questions before continuing. STEP 2: LMIS tools (15 minutes) |Activity: Buzzing (5minutes) | | | |ASK students to pair up and buzz on the following question for 3 | |minutes | | | |What are theLMIS tools? | | | |ALLOW few pairs to respond on the question and let other pairs add on | |points not mentioned WRITE their response on the flip chart/board | | | |CLARIFY and SUMMARIZE by using the content below | The following are LMIS tools: • Forms and worksheets in the ILS, comprises a serials of management tools used to collect information vital for management decision making. The tools in the ILS include number form and sheets primary used to account for medicines in the logistic cycle. Different forms order and account for priority medicines, and related supplies, from MSD in the dispensaries, health centres and hospitals • Forms in the ILS, information will be collected using a series of management tools. The tools in the ILS are the following: o Form 1: Prescription Form prescribed and dispensed Dispenser to patients o Form 2A, Dispensary or Health Centre Report & Request for Priority Medicines and Related Medical Supplies and Equipment o Form 2B, Hospital Report & Request for Priority Medicines and Related Medical Supplies and o Form 2C, Blank Report & Request for Additional Medicines and Related Medical Supplies and Equipment To order additional medicines and related medical supplies not printed on Forms 2A & 2B. o Form 3: Order Compilation o Form 4: MSD Sales Invoice o Form 5: Customer Statement of Account o Form 6: Goods Received Note (GRN) o Form 7: Verification and Claims form • In addition to forms, the ILS also includes several worksheets and registers. • Worksheets are intended to be tools that assist in making decisions. The use of worksheets is not required but is encouraged. Worksheets are not pre-printed o Worksheets 1 Assigning Delivery facilities to a delivery Groups schedule DMO o Worksheets 2 ILS Supervision Checklist To use during supervisory visits DMO, District Pharmacist and other CHMT Supervisors • Registers In the ILS, there are a number of registers that are used. Registers are management tools that are used in information management. Registers are used to collect, organize and maintain data on transactions that occur in the ILS. They collect data or information that is generated as day to-day . ILS registers document all transactions from the receipt of commodities until they are dispensed or issued out of the facility. Different registers are used at different points in the logistics system. o Stores Ledger: stored in storerooms. or Pharmacy used to account for supplies o Patients register: To collect patient data and diagnosis Prescriber o Dispensing register: To collect data on drugs dispensed Dispenser o Injection register: To collect data on injections STEP 3: Completing R and R forms (80 minutes) • The LMIS tools includes R and R forms,… • In order to complete or fill the R and R forms the following are the things to do using Job Aid F:; • Completing Form 2 (R&R) : Dispensary or Health Center Report & Request (R&R) for Priority Medicines and Related Supplies and Equipment, Form 2B: Hospital Report & Request for Priority Medicines and Related Supplies and Equipment, and Form 2C: Blank Report & Request for Additional Medicines and Related Supplies and Equipment at the Dispensary or Health Center, or Hospital • :Completing Form 2A-C: Report & Request for Medicines and Related Supplies and Equipment at the Dispensary, Health Center or Hospital Dispensary or Health Center In-charges or Pharmacy in-charge of Hospital • Before ordering you have:- o To report on the quantities of supplies received and dispensed during the quarter o To determine order quantities for each supply o To provide MOH with data and information on supply usage and stock levels Quarterly • Form 2A: Dispensary Report & Request for Priority Medicines and Supplies and Equipment or Form 2B: Hospital Report & Request for Priority Medicines and Supplies and Equipment, • Too to be used o The Stores Ledger book(s) for all storage areas, the most recent Form 5: Facility Statement of Account, pen, calculator. Form 2C: Blank Report & Request for Additional Medicines and Related Supplies and Equipment may also be needed. • All dispensaries and health centers are expected to complete Form 2A: R&R first, by ordering up to their maximum stock level all priority supplies. • All hospitals are expected to complete Form 2B: R&R first, by ordering up to their maximum stock level all priority supplies. 2 3 Facilities can order Additional Supplies using Form 2C: Blank R&R,

NTA Level 5 • Semester 1 • PST05101 The Pull and Push Systems Medicines and Medical Supplies Management • Source Session/Topic 19 Full source-text version: all educational wording from the extracted learning source is retained; only presenter/tutor metadata and web-layout noise are removed, while formatting is improved for readability. Session 19: The Pull and Push Systems Total Session Time: 120 minutes Prerequisites • None Students Learning Tasks By the end of this session students are expected to be able to: • Explain background change from kits supply system integrated logistic supply system • Differentiate between pull and push systems • Explain the advantages and disadvantages of Pull supply system • Explain the advantages and disadvantages of Push supply system Resources Needed: • Flip charts, marker pens, and masking tape • Black/white board and chalk/whiteboard markers SESSION OVERVIEW |Step |Time |Activity/ |Content | | | |Method | | |1 |05 minutes |Presentation |Introduction, Learning Tasks | |2 |10 minutes |Presentation |Definitions of Pull and Push Systems | | | |Brainstorming | | |3 |20 minutes |Presentation |Explanations of the Pull System ,its | | | |Buzzing |Advantages and Disadvantages | |4 |20 minutes |Presentation |Explanations of the Push System, its | | | |Small Group |Advantages and Disadvantages | | | |Discussion | | |5 |45 minutes |Presentation |Differences Between Pull and Push | | | | |systems | |6 |10 minutes |Presentation |Key Points | |7 |10 minutes |Presentation |Evaluation | SESSION CONTENTS STEP 1: Presentation of Session Title and Learning Tasks (5 minutes) READ or ASK students to read the learning tasks and clarify ASK students if they have any questions before continuing. STEP 2: Definitions of Pull and Push Systems (10 minutes) |Activity: Brainstorming (5 minutes) | | | |Ask students to brainstorm on the following question: | | | |What is the meaning of the pull and push system? | | | |ALLOW few students to respond | | | |WRITE their responses on the flip chart/ board | | | |CLARIFY and SUMMARISE by using the content below | Pull System • This is defined as a logistics system where by the quantity to be ordered is determined by the person placing the order. Also known as requisition system Push System • This is defined as a logistics system where by the quantity to be ordered is determined by the person who fulfills the order. Also known as allocation system STEP 3: Explanations of the Pull System (35 minutes) |Activity: Buzzing (5minutes) | | | |ASK students to pair up and buzz on the following question for 3 | |minutes | | | |What explanations can you give about the pull system? | | | |ALLOW few pairs to respond on the question and let other pairs add on | |points not mentioned WRITE their response on the flip chart/board | | | |CLARIFY and SUMMARIZE by using the content below | Pull system • The customer determines their own needs depending on the demand. • It is demand driven supply • Customer has the control over the products Advantage o Minimizes overstocking or understocking o Customer gets what they need o Lower inventory holding costs o Minimum wastage due to expiry o Less space required o Guarantee high quality o Better communication Disadvantage o Long lead time because supply is based on demand o Expensive o Requires professional to forecast demand STEP 4: Explanations of the Push System (45 minutes) |Activity: Small Group Discussion ( 15 minutes) | | | |DIVIDE students into manageable groups | | | |ASK students to discuss in groups on the following question: | | | |What explanations can you give about the push system? | | | |ALLOW students to discuss for 15 minutes | | | |ALLOW each groups to present | | | |CLARIFY and SUMMARIZE by using the contents below | Push system: • Supplier determines what to supply to the customer • Supplier driven supply • Supplier has the control over the market demand Advantage o Shorter lead time o Lower distribution costs Disadvantage o It may lead into overstocking or understocking o May lead into expiry of commodities o Requires professionals to master optimum flow of commodities o It may lead into more wastage due to expiry o High inventory carrying costs o Poor communication STEP 5: Differentiation between Pull and Push systems (45 minutes) The following are the comparison of pull and push system [pic] STEP 5: Key Points (5 minutes) • The pull system is a logistics system where by the quantity to be ordered is determined by the person placing the order. Also known as requisition system • The push system is a logistics system where by the quantity to be ordered is determined by the person who fulfills the order. Also known as allocation system • There are several differences regarding these two systems and they are based on the advantages and disadvantages of the two systems. In a nutshell; if supplies of products are limited, a pull system is not appropriate, because not enough supplies are available to fill all orders. In this case, a push system is the only choice. In a push system, the higher level tracks the needs of all lower levels and determines the best way to distribute the limited quantity of supplies. STEP 6: Evaluation (5 minutes) • What is the definitions of the following; o Pull system? o Push system? • What are the differences between the pull and push systems? References MSH and WHO (2012) Managing Access to Medicines and Health Technology, 3rd Edition. Kumarian Press World Health Organization (WHO), Regional Office for Africa Brazzaville 2004, Management of Drugs at Health Centre Level Training Manual. United Republic of Tanzania Ministry of Health and Social Welfare, Strategy for Development and Implementation of an Integrated Logistics System for Essential Health Commodities: Government Printers, Dar es Salaam USAID | DELIVER PROJECT, Task Order 1. 2011. Tanzania: 2020 Supply Chain Modeling—Forecasting Demand from 2020–2024. Arlington,