The Drug Management Cycle

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The Drug Management Cycle Distribution

• Butch Staley

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Working Definitions

• Supply chain The network of retailers,
  distributors, transporters, storage facilities,
  and suppliers that participate in the sale,
  delivery, and production of a product.
• Logistics The overall management of the way
  resources are moved to the areas where they are
  required.
• Distribution The delivery or giving out of an
  item or items to the intended recipients.

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Elements of the Distribution System
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Characteristics of Effective Distribution

• Constant supply
• Maintained quality
• Minimal loss/pilferage
• Accurate and timely inventory and transaction
  information
• Proper storage
• Efficient transport/delivery
• Adequate geographic coverage

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Supply System Models

• There are many models, ranging from fully public
  to fully private, each with relative advantages
  and disadvantages, depending on context.
• Central Medical Stores model South Africa,
  Tanzania
• Autonomous supply agency Uganda, Benin
• Direct delivery Caribbean
• Primary distributor (prime vendor) USA
• Fully private Canada, Australia
• Mixed models Europe, Caribbean

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Pharmaceutical Distribution Models
FULLY PRIVATE
FULLY PUBLIC
LEVELS
International
International Suppliers
National
Local Manufacturers
Central Medical Store
Local Wholesalers
Regional Medical Store
Distributors
Regional
District
District Medical Store
Private Pharmacies
Hospitals Health Centers Health Posts
Community
Users
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Central Medical Store Model
LEVELS
PRIVATE SECTOR
PUBLIC SECTOR
International
International Suppliers
National
Local Manufacturers
Central Medical Store
Local Wholesalers
Regional Medical Store
Distributors
Regional
District
District Medical Store
Shops, Pharmacies
Hospitals Health Centers Health Posts
Community
Users
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Direct Delivery Model
LEVELS
PRIVATE SECTOR
PUBLIC SECTOR
International
International Suppliers
National
Local Manufacturers
Central Medical Store
Local Wholesalers
Regional Medical Store
Distributors
Regional
District
District Medical Store
Shops, Pharmacies
Hospitals Health Centers Health Posts
Community
Users
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Primary Distributor Model
LEVELS
PRIVATE SECTOR
PUBLIC SECTOR
International
International Suppliers
National
Local Manufacturers
Central Medical Store
Primary Distributor
Local Wholesalers
Regional Medical Store
Distributors
Regional
District
District Medical Store
Shops, Pharmacies
Hospitals Health Centers Health Posts
Community
Users
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Fully Private Model
LEVELS
PRIVATE SECTOR
PUBLIC SECTOR
International
International Suppliers
National
Local Manufacturers
Central Medical Store
Local Wholesalers
Regional Medical Store
Distributors
Regional
District
District Medical Store
Private Pharmacies
Hospitals Health Centers Health Posts
Community
Users
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Health System Supply Chain Theory
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The Complex Reality Health Supply Chains in
Kenya
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Key Decisions

• Key decisions include
• Push versus pull
• Centralized versus decentralized
• Roles and responsibilities public, private, NGO
• Mix of in-house and contract services
• Levels of distribution and stock requirements

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Assessment/Option Analyses

• Understand context functionality and current
  capacity of public, private, and NGO systems and
  institutions
• Consider variable costs with each option
• Consider capacity to manage and operate proposed
  system
• Define methods for monitoring and measuring
  performance

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Summary

• Designing a system for storing and distributing
  pharmaceuticals is complex and important
• In some countries, private (or parastatal)
  distribution companies may provide cost-effective
  alternatives for storage and distribution of
  pharmaceuticals