Medicine Supply Chain Research Articles

Qualitative exploration of issues of Indian generic medicine supply chain using ISM-MICMAC

Qualitative exploration of issues of Indian generic medicine supply chain using ISM-MICMAC

Analysis of issues of generic medicine supply chain using fuzzy AHP: a Pilot study of Indian public drug distribution scheme

PurposeIntegrated supply chain in pharmaceutical industry requires organized planning and modeling of each strategic element of pharmaceutical supply chain (PSC). The aim is to coordinate each activity of PSC and design a robust strategy to make the system hassle-free. Each activity of industry is interdependent and follows certain co-relations with each other. The paper focuses on the four most significant identified issues in PSC and analyses the weightages of these issues and their sub issues with respect to cost incurred and time taken to manage whole chain of supply.Design/methodology/approachFuzzy analytical hierarchy process methodology has been applied to rank the issues which consume maximum time and/or costs.FindingsThe derived result shows that warehouse design and management (WDM) consumes more than one third of the total time and around half of the total cost. Other than WDM, process of supplier selection for procurement is second most time and cost consuming issue. The derived results are discussed and provided to the field experts of the area. The analysis will be useful for decision makers to economize PSC.Research limitations/implicationsThe study is limited to PSC; hence, result may vary with other practical situations.Practical implicationsThis generated scope for further research on how to minimize the weightage of WDM for cost and time in PSC industry so that decision-makers can optimize the economic system of PSC.Originality/valueThe research is based on the field survey of India’s largest generic medicine distributing company in the government sector; hence, analysis has been performed on real situation.

Cost-effective subsidy policy for growers and biofuels-plants in closed-loop supply chain of herbs and herbal medicines: An interactive bi-objective optimization in T-environment

The purpose of present study is twofold. Firstly, this introduces a bi-objective closed-loop supply chain (CLSC) network by deliberating on farming of herbs and production plus distribution of associated herbal medicines in manufacturing-chain layer. Reverse-chain layer (RC-layer) recycles used substrates and unused herbs, thus producing biofuels and casing soil. Though majority of well-established CLSC models comprise sole pecuniary objective function, this aims to validates the economic self-reliance of RC-layer. Besides, Governments pay the subsidy to various entities, including the growers to encourage countrywide farming of herbs and the biofuels-plants for the extent of clean fuel produced. Thus, two different partners of same network earn subsidy without analysing trade-off. Secondly, this study develops an emended minmax method based interactive bi-objective optimization algorithm by employing absolute difference function and newly introduced semi-autonomized desired levels in real-life oriented T-environment. In pessimistic business scenario, whereas proposed model turns infeasible in classical interactive fuzzy multi-objective optimization algorithm, proposed algorithm determines corresponding Pareto optimal solution. In optimistic business scenario, optimal net profits to both layers of proposed model are more desirable than respective goals in proposed algorithm. Vulnerability analysis of twelve parameters to proposed model plus twelve subfigures pleads legislators to offer more subsidy to biofuels-plants and slightly lesser to growers; and to enact regulations to intensify the recycling of discarded substrates and herbs, thereby ensuring financial feasibility of RC-layer. Again, reduced subsidy to biofuels-plants and little more subsidy to growers, plus multi-angled modernization of all partners except landfills elevate the profitability of proposed network.

A Multi-objective Sustainable Medicine Supply Chain Network Design Using a Novel Hybrid Multi-objective Metaheuristic Algorithm

End-of-life products have a severe impact on the ecological system. Potential production policies and distribution strategies for the newly manufactured product have attracted significant attention to sustainable development. Sustainability in supply chain management has much importance to achieve eco-friendly goals. In this study, we have developed sustainable objectives in the supply chain optimization framework with different constraints. The trade-off between economic, environmental and social effects objectives have identified by ensuring the optimal allocation of different products among various levels. In this regard, a new sustainability multi-objective mixed-integer linear programming mathematical model in the medicine supply chain network is developed. Although the proposed model is an NP-hard problem, we develop a novel hybrid Particle Swarm Optimization and Genetic Algorithm to achieve Pareto solutions. Then, to adjust the important parameters of the algorithms and chose the optimum levels of the significant factors for more efficiency is employed the Taguchi method. The results show that the economic and environmental effects tend to be decreased and the social impacts tend to be increased in the medicine supply chain network which can exhibit the best sustainability performance. The various outcomes of numerical experiments indicate that the proposed solution algorithm is more reliable than other algorithms. The solution methods are complemented with several sensitivity analyses on the input parameters of the model.

Iranian\u2019s healthcare system challenges during natural disasters: the qualitative case study of Kermanshah earthquake

BackgroundIn order to the significance of lessons learned from the natural disasters for health care systems particularly in developing and under-developed countries, the main purpose of this study was to identify challenges and limitations in light of the earthquake experience in Kermanshah Province.MethodsThe present study was conducted in 2019 as a qualitative research using content analysis method. In this regard, 19 key informants were selected using snowball sampling. To enhance the accuracy of the study, the four validation criteria for qualitative studies in data coding developed by Guba and Lincoln including credibility, transferability, dependability and confirmability were used. Data was analyzed applying Graneheim and Lundman (2004) approach for analyzing the qualitative content of an interview text.ResultsAnalysis of the data led to the identification of 2 main themes, 5 sub- themes and 17 main categories. The first main theme was health system oriented challenges containing challenges of medication supply and preparation, structural challenges, challenges in crisis-scene management and challenges of service delivery and the second main theme was non-health system oriented challenges including social and psychosocial challenges.ConclusionAccording to the results, along with health system oriented challenges with the inter-sectoral or intra-sectoral nature, the non-health system oriented challenges the same as social, cultural and psychological factors can be considered as the major challenges of Iran’s healthcare system in the face of crises. This complicated context can shed the light to policy makers that not only attention to the medicine and medical equipment supply chain, manpower preparation and service delivery system can be considered as an emergency, but also careful attention to the structural challenges and crisis-scene management should be planned and considered as a priority. Besides, the policy makers and the local managers should try to plan and act in a contingent situation according to the social and cultural characteristics of the region and the psychological condition and the mental needs of the people.

Portable medicine chests and supply of medicines in Serbia from the 1830s to the mid-20th century: analysis of medicines list.

The first portable medicine chests appeared in Serbia immediately after liberation from Ottoman rule around 1830. The network of portable medicine chests grew very quickly and became the first effective public health method of supplying medicines and medical items to people living in cities without community pharmacies and to the rural population in villages. According to their purposes, three categories of portable medicine chests could be identified: Portable medicine chests owned by physicians or veterinarians in the cities, portable medicine chests established by the Department of Workers Health Insurance, and portable medicine chests of the Health Cooperatives that operated in the villages This paper analyzes all three types of portable medicine chests. We specifically examine the regulations concerning the management of portable medicine chests, their content, and supply chains of medicines from the third decade of the 19 th century through the first half of the 20th century. We conclude that portable medicine chests represent a specific type of pharmacy in the territory of Serbia that provided very effective medical service. The medicines in these pharmacies were handled and dispensed to patients by physicians not by pharmacists. Patent medicines, compounded medicines, sanitary items and bandage materials were dispensed as well. Future research is needed to ascertain if physicians who owned or worked with the portable medicine chests actually prepared and compounded simple preparations as they were specified in the laws.

Cost and cost drivers associated with setting-up a prime vendor system to complement the national medicines supply chain in Tanzania

IntroductionEconomic analysis of supply chain management interventions to improve the availability of healthcare commodities at healthcare facilities is important in generating evidence for decision-makers. The current study assesses the cost...

Medication utilization pattern among outpatients during the Hajj mass gathering

BackgroundThe Kingdom of Saudi Arabia (KSA) provides free healthcare, including medications, for the over 2 million Muslim pilgrims who attend Hajj every year. Information on drug utilization patterns at the Hajj is important to strengthen the supply chain for medicines, avert stock-outs, identify inappropriate use, and support public health planning for the event. MethodWe investigated drug utilization pattern among outpatients in eight seasonal Holy sites hospitals in Makkah, KSA, during the 2018 Hajj. Data on medication prescribed and dispensed were retrieved from the hospitals' electronic records. Data were also used to calculate six of the WHO indicators for drug use at these facilities. ResultsA total of 99,117 medications were prescribed for 37,367 outpatients during 37,933 encounters. Outpatients were mainly older males and originated from 134 countries. Twenty medications accounted for 72.8% of the 323 different medications prescribed. These were mainly nonsteroidal anti-inflammatory drugs, analgesics and antipyretics, and antibacterial medicines for systemic use. Outpatients were prescribed an average of 2.6 (SD = 1.2) drugs per consultation and polypharmacy (≥5 medications) was observed in 4.8% of the encounters. Antibiotics and an injection were prescribed in 46.9% and 6.5% of encounters, respectively. Nearly 90% of the prescribed drugs were actually dispensed. On average, medications were dispensed 16.4 (SD = 119.8) minutes from the time they were prescribed for the patient. All hospitals had a copy of the essential drugs list available and all of the prescribed drugs appeared on that list. ConclusionNonsteroidal anti-inflammatory drugs, analgesics and antibiotics are the most common medications prescribed to outpatient during Hajj. Our results, including the calculated WHO drug use indicators, can form a basis for further investigations into appropriate drug use at the Hajj and for planning purposes. These results could also guide the development of reference values for medications prescribing and use indicators at mass gatherings.

Acceptability of a Prime Vendor System in Public Healthcare Facilities in Tanzania.

Background: Pharmaceutical supply chain management in low- and middle-income countries has received substantial attention to address the shortage of medicines at peripheral facilities. The focus has been on health system interventions, including the establishment of public-private partnerships (PPPs). In 2014, the United Republic of Tanzania began implementing the Jazia prime vendor system (Jazia PVS) with a contracted private wholesale supplier to complement the national medicines supply chain in public facilities. Few studies have investigated the acceptability of such a prime vendor system. This study analyses factors that contributed to the acceptability of Jazia PVS introduced in Tanzania. We used qualitative analytical methods to study experiences of Jazia PVS implementers in 4 districts in mid-2018. Methods: Data were drawn from 14 focus group discussions (FGDs), 7 group discussions (GDs) and 30 in-depth interviews (IDIs) with a range of actors involved in Jazia PVS. The study analysed 7 acceptability dimensions as defined in the acceptability framework by Sekhon et al. Framework analysis was adopted to summarise the results using a deductive and an inductive approach. Results: The findings show that participants’ acceptability of Jazia PVS was influenced by the increased availability of essential medicines at the facilities, higher order fulfilment rates, and timely delivery of the consignment. Furthermore, acceptability was also influenced by the good reputation of the prime vendor, close collaboration with district managers, and participants’ understanding that the prime vendor was meant to complement the existing supply chain. Intervention coherence, experienced opportunity cost and intervention burden, affective attitude and self-efficacy were also important in explaining the acceptability of the Jazia PVS. Conclusion: In conclusion, the most critical factor contributing to the acceptability of the Jazia PVS was the perceived effectiveness of the system in achieving its intended purpose. Districts purchasing directly from the prime vendor have a policy based on the possibility to increase availability of essential medicines at peripheral facilities in a low income setting; however, it is crucial to select a reputable and competent vendor, as well as to abide by the contractual agreements.

A qualitative, patient-centered perspective toward plasma products supply chain network design with risk controlling

Motivated by a real issue in Iran blood transfusion organization and hemophilia community, this paper aims to design and plan an integrated plasma and plasma-derived medicines supply chain network to improve efficiency and timely access to high-quality services. This paper contributes to the existing literature by incorporating four factors, namely (1) quality, (2) efficiency, (3) type-differentiated demand, and (4) risk controlling into the model. To better manage the quality of plasma, we categorize fresh frozen plasma into two classes based on plasma freezing time interval. Moreover, since the number of available donors and centers accessibility affects the supply chain performance, the ideal candidate locations of plasma donation centers are evaluated through several pivotal criteria via a data envelopment analysis approach. We propose a mathematical model, based on a tactical-strategic decision in a real case. Furthermore, the robustness manages the inherent uncertainty in input data and controls the risk of probable disruption in the model, simultaneously. We consider a real case study according to hemophilia community issues in Tehran. The outcomes assist the practitioners in managing how plasma products should be manufactured to minimize the shortages and also control the robustness against uncertainty and disruption risks.

An Empirical Analysis of Demand-Supply Mismatches in Private Healthcare Facilities in Nairobi County

Universal health coverage (UHC) is an integral part of the United Nations’ sustainable development goals. The private sector plays a prominent role in achieving UHC, being the primary source of essential medicines for many people. However, many private healthcare facilities in low- and middle-income countries (LMICs) have insufficient stocks of essential medicines. At the same time, we find that these same facilities carry excessive quantities of certain drugs, leading to losses due to obsolescence. This suggests poor inventory control. To propose potential remedies, it is key to fully understand the underlying causes. In semi- structured interviews with facility managers from private healthcare facilities in Nairobi we asked them about their 1) inventory control systems, 2) inventory control skills, 3) time/human resource constraints, 4) budget constraints, 5) motivations for inventory control, and 6) suppliers. Our results show that the problems are strongly driven by resource limitations (budget and time/human resources), managerial issues (relating to skills and systems), and market mechanisms that limit overage and underage costs. Unavailability at the supplier level, and motivations for inventory control, are only minor issues. We argue that these key causes are strongly interlinked and stem from deeper issues in the market and regulatory environment. Our results challenge several prevalent beliefs about medicine supply chains in LMICs and lead to hypotheses that require further testing. We also discuss how such testing could improve our understanding of inventory management in private healthcare facilities and aid progress in achieving UHC.

Community pharmacists' perceptions, awareness and practices regarding counterfeit medicines: a cross-sectional survey in Alexandria, Egypt.

Counterfeit medicines are a threat to public health and the national economy in Egypt. The many community pharmacists in the country could help prevent counterfeit medicines reaching the patient. Information on community pharmacists' perceptions of counterfeit medicines is lacking. This study assessed the awareness, practices and perceptions of community pharmacists in Alexandria, Egypt with regard to counterfeit medicines. The aim was to identify gaps and inadequacies in pharmacy practice that might allow infiltration of counterfeit medicines in the legitimate medicine supply chain. A cross-sectional study was conducted of 175 community pharmacists in Alexandria in 2014-2015. A semi-structured interview questionnaire was used to assess their perceptions, awareness and practices. The chi-squared test was used to assess the relationships between selected pharmacists' characteristics and their awareness, purchasing practice and training related to counterfeit medicines. Most pharmacists thought medicine counterfeiting was widespread in Egypt and that they could contribute to combatting the problem. However, most also lacked a clear perception of counterfeit medicines, an awareness of their danger to patients or the legislation to reduce them. Their procurement practices and detection of counterfeit medicines and handling of incidents of counterfeit medicines were inadequate. Pharmacists who thought counterfeit medicines were widespread or a health threat were significantly more likely to purchase medicines from certified sources (P < 0.05). Pharmacists should be developed as a frontline resource to combat counterfeit medicines. To enhance their role, the pharmacy curriculum needs to be updated and continuing professional development activities mandated.

COVID-19: don't neglect antimicrobial stewardship principles!

COVID-19: don't neglect antimicrobial stewardship principles!

Medicines Value Chain Management Level in Cuban Health System

The value networks management in the pharmaceutical sector is fundamental to guide the work of health entities to the demands of patients. The Cuban health system is characterized by the full and free access of its citizens to these services. The medicines supply chain is of vital importance to complete health services, and in Cuba a specialized logistics operator manages it. This focuses on achieving the medicines availability according to the patients’ demands. This study presents the medicine supply chain and the evolution of its management level since 2015. The qualitative evaluation of its performance is carried out using the Value Network Reference Model as a methodological tool. The result shows that in 2018 the medicines chain reach a medium performance level and that, based on this diagnosis, the development projects are elaborated according to the needs identified. The Cuban medicines supply chain is a reference of the logistic support that sustains this health system and for other chains in Cuba, when it shows management levels above the national average of three points.

Mental health and psychosocial support services in primary health care in Nepal: perceived facilitating factors, barriers and strategies for improvement

BackgroundThe barriers and facilitating factors for integrating mental health into primary health care have been well documented in the literature, but little is known about the perspectives of primary health care workers (who provide integrated mental health care) on barriers and facilitating factors of the health system for scaling up mental health interventions in low and middle income countries. This study aimed to explore these perspectives of primary health care workers within the health system, and identify possible strategies to optimize the integration of mental health in primary health care.MethodsThe study was conducted in the Chitwan district of Nepal with 55 purposively selected primary health care workers representing prescribers (N = 35), non-prescribers (N = 12) and Female Community Health Volunteers (N = 8). Using a semi-structured interview guide, experienced qualitative researchers collected data between September 2016 and May 2017. The interviews were audio-taped, transcribed and then translated into English. The transcripts were coded using Nvivo 10 software and themes were generated for the thematic analysis.ResultsAccording to the health workers, the facilitating factors for scaling up mental health services in primary health care setting in Nepal included; (1) availability of guidelines, protocols and awareness raising materials, (2) provision of supervision, (3) referral systems being in place, (4) patient record keeping, (5) community sensitizations and home visits, and (6) provision of psychosocial counseling. The barriers identified included; (1) shortage of psychotropic medicines, (2) lack of private space for counseling, (3) workload and health workers’ grievances regarding incentives, and (4) perceived stigma causing dropouts.ConclusionsThe findings suggest that implementation of mental health services through primary health care workers in resource-poor setting is possible when health system level barriers are addressed and facilitating factors are strengthened. In order to address these barriers the health workers suggested a few strategies which included; ensuring dedicated staff available at health facility, allocating dedicated and confidential space for counseling, improving on incentives and motivational benefits to existing health staff, organizing policy level advocacy for mental health, improving medicine supply chain management and strengthening systems for supervision, referral and mental health information management.

Plan de mejoras al sistema de trazabilidad de medicamentos en Cuba

La trazabilidad consiste en asociar sistemáticamente un flujo de información a un flujo físico de mercancías, de manera que se pueda reencontrar en un instante determinado la información requerida relativa a los lotes o grupos de productos específicos. El sector de la salud, es por naturaleza un sector global que cuenta con cadenas de abastecimiento que cruzan fronteras, pero a la vez, el sector de la salud es muy local, razón por la cual la implementación de estándares globales, abiertos y probados permite sistemas de trazabilidad efectivos y eficientes alrededor del mundo. El estudio que se realiza es en el sector de la salud cubana, en la cadena de suministro de medicamentos, y tiene como objetivo general proponer un plan de trazabilidad que permita mejorar las deficiencias existentes en el Sistema de Trazabilidad de Medicamentos en Cuba. Se realiza el diagnóstico del sistema de trazabilidad y se realiza una propuesta de soluciones a través del diseño de un Plan de Trazabilidad. Se utilizaron técnicas y herramientas tales como el análisis bibliográfico, la entrevista, los diagramas Pareto, diagramas de flujo y otros. Fueron utilizados los softwares Minitab 16, Microsoft Excel y Visio.

Some aspects of state quality control of medicinal products at regional level

The aim of this article is the analysis of normative legal acts that characterize changes in the legislation on the quality control of medicines, regulations and orders of the State Medical Service of Ukraine regarding the prohibition of the implementation of medical devices in the last 5 years and the substantiation of the conclusions aimed at further improving the quality assurance medical products (m/p). Results. It was revealed that of the 41 supplier countries in Ukraine, the predominant number of m/p that were banned from marketing, was found in 9 countries (67.98 %). The largest number of m/p that fell under the ban falls to Ukraine (32.25 %), India (15.98 %) and Germany (15.68 %), the lowest number of such m/p is represented by Belgium (5.03 %) Under the prohibition on the implementation of m/p by the release forms, the most commonly burned m/p in tablet form (43.63 %). Anti-hypertensive agents (18.23 %), antiseptic and disinfectants (15.63 %), as well as hormonal (15.63 %) were the leaders among the m/p for the pharmacological groups that most often fell under the prohibition on implementation. Conclusions. The analysis of the orders and instructions of the State Service of Ukraine to ban the sale of drugs in 2015-2018 indicates a significant decrease in their number in 2018, which indicates the improvement of the state drug quality control system. The largest number of drugs that were banned were found in Ukraine, India and Germany; predominant drugs in pill and liquid forms; Most often, antihypertensive, antiseptic, disinfecting and hormonal agents were banned. The introduction of a unified system for monitoring drug trafficking by labeling medicines with control identification marks based on 2-D coding will allow you to track the entire supply chain of medicines from the manufacturer to the end user and, accordingly, strengthen control over the quality of medicines, their production and import, which will counteract the ingress to Ukraine counterfeit or counterfeit drugs.

Non-communicable diseases in the Western Area District, Sierra Leone, following the Ebola outbreak.

Background: Non-communicable diseases (NCDs) are the leading causes of morbidity and mortality in the world. During infectious disease outbreaks, such as the Ebola virus disease outbreak in West Africa from 2014-2015, the health system is often strained, and diagnosis, management and care of NCDs may be compromised. This study assessed numbers and distribution of NCDs in all health facilities in the Western-Area District, Sierra Leone, in the post-Ebola period (June-December 2015) comparing findings with the pre-Ebola (June-December 2013) and Ebola outbreak (June-December 2014) periods. Methods: This was a cross-sectional study using secondary data from routine records of aggregate monthly NCD reports. Data were analysed using Open EPI and comparisons were made between the post-Ebola and pre-Ebola/Ebola periods using the chi-square test. Results: There were 10,011 people reported with NCDs during the three six-month periods, with 6194 (62%) presenting at peripheral health units (PHU). Reported NCDs decreased during Ebola and increased post-Ebola, but did not recover to pre-Ebola levels. Hypertension cases remained fairly constant throughout being mainly managed at PHU. Numbers with diabetes mellitus generally stayed the same except for a significant post-Ebola increase in tertiary hospitals. Small numbers were reported with mental health disorders across all facilities in all time periods. Conclusion: NCD reporting is recovering in the immediate post-Ebola period. Decentralization of NCD care is welcome and is an effective strategy for management as evidenced by hypertension. To be successful, this must be supported by strengthening other elements of the health system such as training of health workers, robust information and referral systems and reliable medicine supply chains.

Non-communicable diseases in the Western Area District, Sierra Leone, following the Ebola outbreak

Background: Non-communicable diseases (NCDs) are the leading causes of morbidity and mortality in the world. During infectious disease outbreaks, such as the Ebola virus disease outbreak in West Africa from 2014-2015, the health system is often strained, and diagnosis, management and care of NCDs may be compromised. This study assessed numbers and distribution of NCDs in all health facilities in the Western-Area District, Sierra Leone, in the post-Ebola period (June–December 2015) comparing findings with the pre-Ebola (June–December 2013) and Ebola outbreak (June–December 2014) periods. Methods: This was a cross-sectional study using secondary data from routine records of aggregate monthly NCD reports. Data were analysed using Open EPI and comparisons were made between the post-Ebola and pre-Ebola/Ebola periods using the chi-square test. Results: There were 10,011 people reported with NCDs during the three six-month periods, with 6194 (62%) presenting at peripheral health units (PHU). Reported NCDs decreased during Ebola and increased post-Ebola, but did not recover to pre-Ebola levels. Hypertension cases remained fairly constant throughout being mainly managed at PHU. Numbers with diabetes mellitus generally stayed the same except for a significant post-Ebola increase in tertiary hospitals. Small numbers were reported with mental health disorders across all facilities in all time periods. Conclusion: NCD reporting is recovering in the immediate post-Ebola period. Decentralization of NCD care is welcome and is an effective strategy for management as evidenced by hypertension. To be successful, this must be supported by strengthening other elements of the health system such as training of health workers, robust information and referral systems and reliable medicine supply chains.

Eliminating medicine waste in a Finnish university hospital \u2014 a qualitative study

BackgroundMedicine waste in hospitals leads to severe economic loss. This waste emerges for a number of reasons. Medicines are often ordered in too large quantities, which leads to stock expiring without being dispensed. Wastage can also be a consequence of poor management practices. Technical aids, such as automatic dispensers, have been suggested to reduce waste, but they too have shortcomings. Information systems can arguably contribute to waste reduction, but this area has not been widely researched.In this exploratory case study, we scrutinized the management of medicines waste in a hospital from an information systems perspective and examined how information systems are used to manage the medicine supply chain and medicine waste. Our research case was a Finnish university hospital, its central pharmacy, and, more widely, the medicine supply chain within the hospital.MethodsThis is a qualitative case study, based on data gathered through interviews and a survey and a review of other information sources, including annual reports and other relevant collateral. The study participants included pharmacy staff members and other hospital staff involved in medicine supply. The interviews were conducted in two rounds, first capturing the main themes and then exploring them further in the later study stages.ResultsThe findings outline a picture of unfit technology and inconsistent and unreliable information. This is compensated for by manual practices and processes that cause an excessive administrative burden and ultimately increased wastage. An infrequent ordering process combined with the lack of recycling practices increase the wastage even more.ConclusionMedicine supply and waste management remain a manual administrative task. Inconsistent information and unfit information systems make this task challenging, and the process relies on the medicine supply staff’s experience and assumptions.