Abstract
ObjectiveTo characterize the impact of widespread inventory management policies on stock-outs of essential drugs in Zambia’s health clinics and develop related recommendations.MethodsDaily clinic storeroom stock levels of artemether-lumefantrine (AL) products in 2009–2010 were captured in 145 facilities through photography and manual transcription of paper forms, then used to determine historical stock-out levels and estimate demand patterns. Delivery lead-times and estimates of monthly facility accessibility were obtained through worker surveys. A simulation model was constructed and validated for predictive accuracy against historical stock-outs, then used to evaluate various changes potentially affecting product availability.FindingsWhile almost no stock-outs of AL products were observed during Q4 2009 consistent with primary analysis, up to 30% of surveyed facilities stocked out of some AL product during Q1 2010 despite ample inventory being simultaneously available at the national warehouse. Simulation experiments closely reproduced these results and linked them to the use of average past monthly issues and failure to capture lead-time variability in current inventory control policies. Several inventory policy enhancements currently recommended by USAID | DELIVER were found to have limited impact on product availability.ConclusionsInventory control policies widely recommended and used for distributing medicines in sub-Saharan Africa directly account for a substantial fraction of stock-outs observed in common situations involving demand seasonality and facility access interruptions. Developing central capabilities in peripheral demand forecasting and inventory control is critical. More rigorous independent peer-reviewed research on pharmaceutical supply chain management in low-income countries is needed.
Highlights
BackgroundStock-outs of essential medicines at the clinic level are an important and widely acknowledged public health problem in sub-Saharan Africa (SSA) with a recognized negative impact on morbidity, mortality and disease epidemiology [1,2]
Inventory control policies widely recommended and used for distributing medicines in subSaharan Africa directly account for a substantial fraction of stock-outs observed in common situations involving demand seasonality and facility access interruptions
This study seeks to characterize the specific impact of inventory management policies currently used in many low-income countries, leveraging the recent intervention in Zambia's public pharmaceutical supply chain described by Vledder et al and further discussed below [9]
Summary
BackgroundStock-outs of essential medicines at the clinic level are an important and widely acknowledged public health problem in sub-Saharan Africa (SSA) with a recognized negative impact on morbidity, mortality and disease epidemiology [1,2]. This study seeks to characterize the specific impact of inventory management policies currently used in many low-income countries, leveraging the recent intervention in Zambia's public pharmaceutical supply chain described by Vledder et al and further discussed below (the 2009/10 pilot) [9]. Zambia's public pharmaceutical supply chain and the max-min inventory policy. Inventory management follows guidelines currently recommended by the USAID|DELIVER project, which are applied in many low-income countries [12]. They involve a periodic review base-stock policy [13] known as max-min inventory control, and the monthly completion and upstream communication by every facility of request and requisition forms (Fig 1B). For products with demand seasonality such as anti-malarials, USAID|DELIVER recently recommended other methods for calculating replenishment targets [14,15]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
