Emlip Sop - Final

Republic of Zambia
MINISTRY OF HEALTH
STANDARD OPERATING
PROCEDURES MANUAL (SOP)
FOR
ESSENTIAL MEDICINES LOGISTICS

IMPROVEMENT PROGRAM (EMLIP HYBRID)
AUGUST, 2014
Edition
Facility Name: _________________________________________
Essential Medicines Logistics Improvement Programme
i
This standard operating procedures manual has been prepared as part of USAID | DELIVER
PROJECT, Task Order 4 Technical Assistance support to the Ministry of Health of the Republic of
Zambia to strengthen logistics management of essential Medicines.
USAID | DELIVER PROJECT, Task Order 4
The USAID | DELIVER PROJECT, Task Order 4, is funded by the U.S. Agency for International
Development (USAID) under contract number GPO-I-00-06-00007-00, order number AID-OAA-TO-
10-00064, beginning September 30, 2010. Task Order 4 is implemented by John Snow, Inc., in
collaboration with Asociación Benéfica PRISMA; Cargo Management Logistics; Crown Agents USA,
Inc.; Eastern and Southern African Management Institute; FHI 360; Futures Institute for Development,
LLC; LLamasoft, Inc; The Manoff Group, Inc.; OPS MEND, LLC; PATH; PHD International (a division
of the RTT Group); and Village Reach. The project improves essential health commodity supply
chains by strengthening logistics management information systems, streamlining distribution
systems, identifying financial resources for procurement and supply chain operation, and enhancing
forecasting and procurement planning. The project encourages policymakers and donors to support
logistics as a critical factor in the overall success of their healthcare mandates.
ii
ACRONYMS
AMI Average Monthly Issues

CIDRZ Centre for Infectious Disease Research in Zambia
CRS Catholic Relief Services
DCMO District Community Medical Office
EMLIP Essential Medicine Logistics Improvement Program
REMMS Report for Essential Medicines and Medical Supplies
FEFO First-to-expire, first-out
GRZ Government of the Republic of Zambia
HC Health Centre
JSI John Snow, Inc.
LMIS Logistics Management Information System
LMU Logistics Management Unit
MOH Ministry of Health
MSL Medical Stores Limited
NGO Non-governmental organization
OJT On-the-Job Training
PHO Provincial Health Office
PRA Pharmaceutical Regulatory Authority
SDP Service Delivery Point
SOP Standard Operating Procedure
USAID United States Agency for International Development
UTH University Teaching Hospital
ZPCT Zambia Prevention Care and Treatment Project (FHI)
iii
FOREWORD
Dear Colleagues,
The Ministry of Health (MoH) has the pleasure of providing you with this manual, which explains the
standard operating procedure for the management of the EMLIP Hybrid (EMLIP HYBRID)
The Ministry of Health through Medical Stores Limited with support from the USAID | DELIVER
PROJECT and the World Bank (WB) designed and implemented EMLIP HYBRID in 27 districts. As
part of an ongoing effort to continuously improve the supply chain for essential commodities, the
EMLIP HYBRID steering committee reviewed the system in its current format and made key
recommendations to align it with the logistics management information and inventory control
components for essential commodities whose focus is increasing efficiency in the re-supply of
commodities throughout the supply chain. This review also took into consideration the new MSL
mandates as announced by the honourable minister of health which includes rollout of distribution
strategy via hubs and staging posts.
This manual is the result of this participatory process which included representatives from all levels
of the Ministries of Health and Community Development Mother and Child Development, USAID |
DELIVER PROJECT, UNICEF, CHAZ, World Bank (WB) and Medical Stores Limited (MSL).By
following the procedures in the manual, we can ensure that the quality essential medicines will be
available at all times to the people who need them. Please refer to this manual when you have any
questions about how to order, store and record essential medicines.
The ministry of health would like to thank its cooperating partners USAID , the World Bank (WB)
Medical Stores Limited (MSL) and its implementing partner ; USAID | DELIVER PROJECT, John
Snow Inc for supporting the entire process with the Ministry of Health.
iv
ACKNOWLEDGEMENTS:
This SOP manual is a result of major effort by the Ministry of Health with support from its Cooperating
Partners to enhance the supply chain system for essential medicines and medical supplies in the
public sector. To this end, the EMLIP HYBRID steering committee chaired by the ministry decided on
important adaptations from current version of the logistics system to the EMLIP HYBRID. It is
expected that with these changes, the ministry will record improved logistics management information
system (LMIS) and inventory control system for essential medicines and medical supplies at all levels
of the supply chain. The following were the key partners who shared their valuable experience and
contributions to the system enhancement:
1. Chikuta Mbewe, MoH
2. Luke Alutuli, MoH
3. John Makumba, World Bank
4. Lameck Kachali, USAID
5. Dr. Fundafunda, MSL
6. Mark Kowalski, JSI: USAID | DELIVER PROJECT
7. Gamariel Simpungwe, JSI: USAID | DELIVER PROJECT
8. Kazuma Chipopa, MSL
9. John Ngosa, MSL
10. Jordan Mumba, MSL
11. Derrick Nyimbili, JSI: USAID | DELIVER PROJECT
12. Lastone Phiri, JSI: USAID | DELIVER PROJECT
13. Rabson Zyambo JSI: USAID | DELIVER PROJECT
14. Marlon Banda, CHAZ
15. Doreen Shampela, CHAZ
16. Caesar Mudondo,UNICEF
17. Wambuwa Nzioki,UNICEF
18. Meena Gandhi, DfID
The development of the EMLIP HYBRID and this SOP manual would not have been possible
without the support of the Ministry of Health, specifically, Permanent Secretary,
Dr. Chikamata Misheck Davy .
v
TABLE OF CONTENTS
TABLE OF CONTENTS ............................................................................................................... vi
I. INTRODUCTION .........................................................................................................................1
A. Purpose of the Manual ..................................................................................................................1
B. The Purpose of the EMLIP Hybrid in Zambia..............................................................................1
C. Key Features of the EMLIP Hybrid ..............................................................................................1
II. ROLES AND RESPONSIBILITIES ......................................................................................6
III. INTRODUCTION TO THE ZAMBIA EMLIP HYBRID .................................................11
A. Logistics Management Information System ................................................................................11
1. Forms Used in Managing Essential Medicines 12
2. Feedback Reports 13
B. The Zambia Essential Medicines Inventory Control System .......................................................14
IV. ASSESSING STOCK STATUS ............................................................................................16
JOB AID 1: Determining the Months of Stock on Hand for Essential Medicines ...........................18
JOB AID 2: Deciding What Actions to Take after Stock Status Has Been Determined 20
V. REPORTING FOR ESSENTIAL MEDICINES AND MEDICAL SUPPLIES ..............23
A. The Role of District level 1 hospitals, level 2 and 3 hospitals and Health Centres in Reporting23
Completing the Report for Essential Medicines and Medical Supplies for DCMOs, Level 1, 2 and 3
hospitals and health centres .....................................................................................................23
JOB AID 3: This job aid provides guidance for filling in the Report for Essential Medicines and
Medical Supplies at the Health Centre.....................................................................................24
Medical Supplies at the DCMO ...............................................................................................30
Medical Supplies at the Hospitals ............................................................................................35
B. The Role of the DCMO in reviewing the Report for Essential Medicines and Medical Supplies
for the Health Centre ................................................................................................................39
C. The Role of the DCMO in the Reporting and re-supplying Essential Medicines and Medical
Supplies to the Health Centre...................................................................................................40
JOB AID 6: Requisitioning Essential Medicines using the Supply voucher for Essential Medicines
and Medical supplies................................................................................................................40
D. The Role of the MOH Logistics Management Unit at MSL in Processing Orders ....................43
JOB AID 7: Demonstration on how order quantity for the DCMO, Hospitals and Health Centres is
calculated at LMU....................................................................................................................44
E. Placing Emergency Orders for the Health Centre or Hospital Level ..........................................46
JOB AID 8: Placing an Emergency Order at the Health Centre, DCMO or Hospital
Level ........................................................................................................................................ 47
VI. RECEIVING ESSENTIAL MEDICINES & MEDICAL SUPPLIES ..............................50
A. Receiving Essential Medicines & Medical Supplies at MSL HUB for the Health Facilities .....51
JOB AID 9: Receiving Essential Medicines & Medical Supplies at the MSL HUB for
the Health Facilities............................................................................................................... 51
B. Receiving Essential Medicines & Medical Supplies by the Health Facilities ............................53
C. Accounting for Stock Received and Stored ................................................................................56
JOB AID 11: Recording Transactions in the Essential Medicines & Medical Supplies Stock
Control Card.............................................................................................................................56
VII. STORING ESSENTIAL MEDICINES ................................................................................63
A. Storage Guidelines ......................................................................................................................63
B. Conducting a Physical Count ......................................................................................................65
JOB AID 12: Conducting a Physical Count 66
vi
C. Visual Inspection ........................................................................................................................69
D. Handling Damaged or Expired Stocks........................................................................................70
JOB AID 13: Handling of Damaged or Expired Products 70
JOB AID 14: Completing the MSL Returns Authorization Form 72
JOB AID 15: Completing the Report for Returning Products 74
E. Disposal Guidelines ....................................................................................................................76
VIII. MONITORING AND SUPERVISION ................................................................................76
A. Monitoring, Supervision and Providing Feedback .....................................................................76
B. Monitoring at the Provincial Level .............................................................................................77
C. Monitoring at the District Level .................................................................................................77
D. Using and Interpreting Feedback Reports...................................................................................77
E. Supervising the Health Centres ...................................................................................................82
F. Providing Feedback ....................................................................................................................83
G. Conducting a Supervisory Visit ..................................................................................................84
ANNEX: ...........................................................................................................................................87
A. Essential Medicines & Medical Supplies Stock Control Card ...................................................88
REPORT FOR ESSENTIAL MEDICINES AND MEDICAL SUPPLIES ........................ 89
E. SUPPLY VOUCHER FOR ESSENTIAL MEDICINES & MEDICAL SUPPLIES ..........109
F. Computer-generated Report and Requisition for Essential Medicines & Medical
Supplies ........................................................................................................................................111
G. MSL Despatch Note for Essential Medicines ............................................................................112
H. Returns Authorization Form for Essential Medicines...............................................................113
I. Report for Returning Products ....................................................................................................114
J. Beginning the Implementation of the EMLIP Hybrid, Preparing First Orders, including 1st, 2nd, and
3rd months...............................................................................................................................115
vii
I. INTRODUCTION
A. Purpose of the Manual
This SOP manual is intended to simplify and standardize the work required for Essential
Medicines logistics management to allow health care providers more time for client-focused
activities. Proper management of essential medicines will ensure a consistent supply of
products when and where they are needed to meet the needs of patients throughout
Zambia.
The SOP manual serves as a reference for health care staff in facilities operated by the
Zambian Ministry of Health and other Cooperating Partners. This SOP Manual guides
personnel in the completion of the following tasks related to essential medicines
management:
 Maintaining adequate supplies of essential medicines

 Ordering essential medicines from Medical Stores Limited (MSL)
 Receiving and storing essential medicines
 Recording and reporting issues of essential medicines
 Monitoring logistics activities throughout the system.
B. The Purpose of the EMLIP Hybrid in Zambia
The objective of the logistics system described in this SOP manual is to ensure that patients
always get the commodities they need. To be successful, the system must fulfil the Six
Rights of supply chain management. The system, and its staff, must ensure
 the Right Products for essential medicines

 in the Right Quantity
 of the Right Quality
are available
 at the Right Place
 at the Right Time
 for the Right Cost.
A logistics system addresses the concept, “No Product, No Program.” An essential

medicines program cannot operate successfully without a continuous, reliable supply of
medicines. Well-functioning supply chains are critical to achieving commodity security, which
exists when every person is able to obtain and use essential medicines whenever they are
needed.
C. Key Features of the EMLIP Hybrid

A summary of the most important features and enhancements of the EMLIP HYBRID
follows. NOTE: For NGOs and other Cooperating Partners, your specific involvement in the
EMLIP HYBRID may vary depending on your agreements with MOH and the level(s) at
which your organisation works.
1
Ministry of Health (MOH) – Logistics Management Unit (LMU)
 The Logistics Management Unit has been established in the Ministry of Health and
includes two to three pharmacists, a laboratory specialist and two to four Data Entry
Clerks.
 The MSL-LMU’s personnel are based at Medical Stores Limited (MSL) and are
responsible for reviewing and approving orders, managing the Supply Chain
Manager Software database that tracks reports and orders, coordinating supervision,
and monitoring the overall function of the logistics system.
 The MSL-LMU analyzes and interprets data in order to report logistics information,
including feedback reports to the Central, Provincial and District levels of the MOH
and its partners such as CIDRZ, ZPCT, and CRS/AIDSRELIEF; manages and
constantly monitors the national Pipeline database to ensure that appropriate and
prompt re-supply and commodity management actions are taken by the relevant
stakeholders.
 The MSL-LMU compiles data to be used to forecast and quantify the national needs
for essential Medicines, provides national level logistics system monitoring and
evaluation, and advises on troubleshooting and procurement planning.
 The MSL-LMU staff strives to meet the six rights for all patients.
Central MSL Warehouse
 In time, all essential medicines, including the stock for Cooperating Partners
programs and other international donors will be stored at MSL’s central warehouse.
 MOH and Cooperating Partners collaborate to ensure timely procurements of
commodities to refill Central MSL warehouse
 MSL warehouse staff work in close coordination with their colleagues at MSL-LMU to
ensure quick and accurate processing of all requisitions (orders) for each health
facility including DCMOs.
 All the pre-packaged orders for the health facilities (including pre-packaged orders of
top up or emergency commodities for the DCMOs) and Health centre Kits will be
shipped to the MSL Hub/staging post.
 Any service delivery point which fails to send the Report for Essential Medicines and
Medical Supplies will not be issued stock. “No report/order, No product, No program.”
 MSL staff strives to meet the six rights for all patients.
MSL Regional Hub/Staging Posts
 All essential medicines and medical supplies pre-packed for each health facility
including DCMO by Central MSL Warehouse will be sent directly to the MSL regional
Hub where they will be temporally stored before there last mile distribution.
 For Health facilities including DCMOs further away from the MSL regional Hub, they
will receive their supplies through the Hub staging posts close to them.
Provincial Health Office
 Receive quarterly feedback reports from the MSL-LMU on provincial essential

medicines logistics performance
 Provide technical support to DCMOs in the province
 Conduct supervision visits to the DCMOs and Level 2 and 3 Hospitals in the province
 Supervise DCMOs to address essential medicines logistics reporting and distribution
issues
2
Hospitals (District Level 1, and Level 2 and 3)
 Hospitals complete a Report for Essential Medicines and Medical Supplies at the end
of every calendar month and submit this form to the MSL-LMU. If the hospital does
not submit this form, commodities will not be issued to them from MSL. “No
report/order, No product, No programme.”
 Hospitals will receive their pre-packaged orders from MSL Central Warehouse via
the Hub and staging posts
 Hospital pharmacies maintain Essential Medicines & Medical Supplies Stock Control
Cards as well as issuing records.
 Hospital staff strives to meet the 6 rights for all patients.
District Community Medical Office (DCMO)

.
 The DCMO receives and review the Report for Essential Medicines and Medical
Supplies every month from each of its health centres
 Submit the completed REMMS for the health centre/NGO and district on top up or
emergency commodities to MSL- MU according to the MSL schedule.
 Receives and stores commodities from Central MSL via the MSL Hub/Staging post
to meet topping up or emergency needs of Health Centres served by the district
 Review essential medicines feedback reports received from MSL-LMU and takes
action as needed.
 DCMO makes supervisory visits to health centres based on the feedback reports
Health Centres
 Health Centres maintain Essential Medicines & Medical Supplies Stock Control
Cards.
 Health Centres generates and submit the Report for Essential Medicines and Medical
Supplies to the DCMO every month.
 Order commodities for topping up or emergency from the DCMO using a supply
voucher.
 Receives Health Centre Kit and pre-packaged orders from Central MSL via the MSL
Hub/Staging post.
 Health Centre staff strive to meet the six rights for all patients.
 Health Centres supply commodities to Community Health Workers and report these
issues to the DCMO along with their own.
Figure 1 illustrates the flow of commodities and information in the logistics system for
essential medicines. Commodities flow down from Central MSL to the hospitals, DCMO, and
health centres via the MSL regional Hubs. Commodities are dispensed to patients at service
delivery points which include health centres and District Level 1 Hospitals and Level 2 and
Level 3 Hospitals.
The information that is collected on the various forms used in the logistics management
information system flows up from the health centres, DCMO, and hospitals to the MSL-LMU
for processing. Feedback reports, including the completed, computer-generated Report and
Requisition form and reports from Supply Chain Manager software, are generated within the
MSL-LMU and sent to the MOH (Principal Pharmacist - Logistics), the Provincial Health
Office (Principal Pharmacist), DCMOs, hospitals, and health centres. Feedback reports are
used by central level MOH staff, the Principal Pharmacist, the District Pharmacists, and
NGO partners for supervision and feedback action.
3
Figure 1: Movement of Essential Medicines and Information
Essential Medicines National Pipeline

MOH
MSL
L MU
PH O
D CM O M SL H U B HOSPI TALS
L VL 1,2 & 3
Hu b
stagi n g
p o st
Com m odi t i es/ HC ki t s
LM I S Report i ng & O rderi ng

Feedback Repor t
Com m odi t i es/ - DCM O s H P/H C
LM I S Repor t i ng & O r der i ng
DCM O s
4
5
II. ROLES AND RESPONSIBILITIES
Many health staff play key roles in the operation of the EMLIP Hybrid. The roles and
responsibilities for personnel involved in this system are listed below. Depending on your job
or role within the system, this SOP manual will help you to complete these responsibilities in
a timely and effective manner.
 If you manage essential medicines, find your job title below or match your roles and
responsibilities with the appropriate title. This should help you understand your
responsibilities as they relate to the logistics system.
 If no one has been assigned one of the following personnel designations at your level or
facility, you must assign the responsibility to someone to ensure that the logistics system
operates and that adequate products are available for patients.
 If you supervise personnel who manage essential medicines, use these descriptions of
roles and responsibilities to ensure that the responsible staff member knows and is
performing his or her job.
 If you are an NGO or other Cooperating Partner, your specific roles and responsibilities
in the EMLIP HYBRID may vary depending on your agreements with MOH and the
level(s) at which your organisation works.
Level Personnel Roles and Responsibilities

 Review REMMS forms submitted by DCMOs (on behalf of health
centres) and hospitals
 Approve the computer-generated MSL Requisition/Issue Voucher
(PH 81-N) and give to MSL staff, along with the computer-
generated R&R, to package and ship approved essential
medicines orders to DCMOs and hospitals
 Processes emergency orders for the Hospitals and DCMOs on
Laboratory Specialist
behalf of the Health centres.

 Monitor stock levels in the system; periodically evaluate system
Pharmacists &
performance
 Communicate with the relevant procurement units and donor
partners for the procurement of essential medicines
 Report periodically to the Principal Pharmacist, other MOH units
and partners on medicines consumption, stock levels, and
reports regarding EMLIP HYBRID
 Enter the report and order information from the REMMS (from
Health centres through the DCMO) and Report for Essential
MSL – LMU
Medicines and Medical Supplies forms received from hospitals

Data Entry
into Supply Chain Manager software

 Generate Report and Requisition forms and feedback reports to
Clerk
send to provinces, DCMOs and service delivery points
6
 Supervise the management of essential medicines in the Central
Warehouse Manager
& Quality Assurance
MSL Warehouse and regional Hub
 Manage the stock levels of essential medicines and medical
supplies
Central MSL Warehouse
 Receive essential medicines various supplies


Manager
Issue pre-packed essential medicines / HC kits to the MSL Hub
(for distribution to the Health centres and hospitals)
 Report essential medicines stock levels and issues data to MSL -
LMU on a monthly basis
Assistant
Manager
Assuran
 Periodic checking of pre-packed orders / HC kits readiness for

Quality
dispatch to the MSL Hubs

ce
 Supervises and monitors the distribution schedule for essential

medicines orders for the SDPs received from Central MSL.
 Manage warehouse according to good storage practices
 Inspect pre – packaged orders/HC kits for health centre,
Hospitals NGOs received at the Hub and arrange them by
districts by region or route for smooth distribution to the
facilities
 Sign the MSL Dispatch Note for each health facility which
MSL Regional HUB
receive supplies, noting discrepancies in the number of carton

boxes / HC kits on the MSL Dispatch Note.
 Return signed copy of MSL Dispatch Note to Central MSL
MSL Hub Manager
driver
 File copy of MSL Dispatch Note received from Central MSL
and signed copy of Computer-generated R&R received from
the health centres when returned
 Fill out the discrepancy and damages section of the MSL
Dispatch Note in case of package damage or shortage
 Distributes pre-packaged orders/ HC Kits to the health

MSL Hub
facilities
Drivers
 Return signed copies of the computer generated R& R

from the health facilities
 Receive quarterly feedback reports from the MSL - LMU on

provincial essential medicines logistics performance
Health Office
 Provide technical support to DCMOs in the province

Pharmacist
Provincial
 Conduct supervision visits to the DCMO and Level 2 and 3

Principal
Hospitals in the province

 Supervise DCMOs to address essential medicines logistics
reporting and distribution issues
7
 Oversee all pharmaceutical services in the DCMO
 Work closely with District Pharmacist and stores keeper to
ensure smooth operation of the logistics system in the
district.
Overall Duties
 Supply commodities for topping up and emergency
requirements from district stores stocks to the Health
Centres
 Conduct physical count of essential medicines at end of
each reporting period for district stores stocks
 Receive and review the REMMS from the health centre and
NGOs
Pharmacy Technologist
 Generates REMMs for top up or emergency commodities

Pharmacy In-Charge
District Health Office
District Pharmacist /
kept at the DCMO.

 Submit the completed REMMS for the health centre/NGO
and district to LMU according to MSL schedule
 Review and approve requests for top up and emergency
Reporting
orders from health centres

 When need arises generate and submit an emergency
order to MSL-LMU for commodities kept at the DCMO.
 Receive pre-packaged essential medicines emergency
orders from Central MSL on behalf of the Health centres as
well as for the DCMO monthly orders or emergency
commodities
 Receive Reports for Returning Products forms from the
Receiving
health centres and NGOs. Submit products and forms as

required to the MSL-LMU
 Receive unusable, damaged or expired stocks from health
centres and NGOs
 Review essential medicines feedback reports received from
Monitoring &
Supervision
MSL-LMU and take action as needed

Pharmacy Technologist
 Monitor essential medicines management activities in the

Pharmacy In-Charge
District Health Office
district
District Pharmacist /
 Make supervisory visits to health centres based on

feedback reports
 Conduct OJT for HC staff in coordination with District
Pharmacy In-Charge
Training
 Conduct retraining and training of health centre staff in the

district in EMLIP HYBRID in conjunction with District
Pharmacy In-Charge
 Store essential medicines according to good storage
Hospitals: Level 1, 2 and
practices
Hospital Pharmacy In-

Issuing & Managing
Maintain stock in store room using Essential Medicines &

Medical Supplies Stock Control Cards for each essential
medicine.
 Complete a physical count of hospital essential medicines
stocks

Charge
Returns products to Central MSL that are usable and with a

minimum of 6 months shelf life (using Report for Returning
Products) via the MSL Hub.
3
8
Reporting &
 Complete and submit REMMS to MSL-LMU according
Ordering
MSL schedule
 Submit emergency orders of the pre-printed products to
MSL-LMU when necessary
 Conduct a visual inspection of the products received

Hospitals: Level 1, 2 and 3
 Sign the Computer-generated R&R on receipt of supply

Hospital Pharmacy In-
from MSL Hub

 Note discrepancies on Computer-generated R&R
 Update the Essential Medicines & Medical Supplies stock
Control Card with the receipts

Receiving
File copies of the Computer-generated R&R

 Return one copy of the Computer-generated R&R to MSL
Charge
Hub
 Receives emergency orders directly from Central MSL.
 Store essential medicines and medical supplies according
to good storage practices
 Maintain Essential Medicines & Medical Supplies Stock
Control Cards for all essential medicines held in storage
 Issue products to Community Health Workers
 Complete a physical count of essential medicines & stocks
every month
Managing

Issuing &
Return usable essential medicines and medical supplies

with a minimum 6 month shelf life to Central MSL using
the Report for Returning Products as well as to the DCMO
for redistribution within the district
Pharmacy In-Charge/Facility in-charge
 Ensure that the data from each of the Essential Medicines

& Medical Supplies Stock Control Cards is used to
complete the Report for Essential Medicines.
 Order commodities for top up and emergency from the
DCMO using the supply voucher.
 Compile issues to Community Health Workers and includes
Reporting & Ordering
these in monthly Report for Essential Medicines and

Medical Supplies.
 Authorize the REMMS and send to the DCMO for them to
Health Centres
review and subsequently send to MSL.

 For an emergency order for pre-printed products;
complete the REMMS and send to the DCMO to forward to
LMU.

9
 Receive products/ HC kits through the MSL Hub based
upon agreed schedule.
 Receives top up or emergency commodities from the
DCMO.
 Conduct a visual inspection of the products received
 Sign 2 copies of the computer-generated R&R for Essential
Medicines when receiving supplies from the MSL Hub
noting any discrepancies
 Update the Essential Medicines & Medical Stock Control
Receiving
Card with the receipts.
 File receipt copy of the computer-generated R&R for
Essential Medicines from the MSL Hub.


Community
Collect stock from health centre


Workers
Dispense medicines to patients in the community

Centres
Overall
Health
Health
Duties
 Keep stock records

 Orders stock from health centres
10
III. INTRODUCTION TO THE ZAMBIA EMLIP HYBRID
A. Logistics Management Information System
The purpose of a logistics management information system (LMIS) is to

collect, organize, and report information to other levels in the system in order
to make decisions that govern the logistics system and ensure that all six
rights are fulfilled for each client.
Only information which will support specific logistics decision-making should be collected.
Three essential data items are required to run a logistics system and, therefore, must be
captured by the LMIS. These three essential data items are:
1. Stock on Hand: Quantities of usable stock (essential medicines) available at a particular

point in time.
2. Consumption Data: The quantity of essential medicines dispensed to users during the
reporting period. (In the EMLIP HYBRID we will be using issues data in place of
consumption data which is stock issued from the storeroom).
3. Losses/Adjustments: Losses are the quantities of products removed from your stock for
anything other than dispensing to patients or issuing to another facility (e.g. expiry, lost,
theft, or damage) and are recorded as negative (-) numbers. Adjustments are quantities
of a product received from any source other than the DCMO or Central MSL or Hub, or
issued to anyone other than your facility’s patients. An adjustment may also be a
correction due to an error in mathematics. An adjustment may be a negative (-) or
positive (+) number.
There are only three activities that happen to essential medicines within a logistics system:
essential medicines are stored in inventory; essential medicines are moved between
facilities; and essential medicines are issued within the facility. A well designed logistics
management information system will include records and forms that collect and report the
three essential data items as they relate to these three activities.
Records and forms have been designed for the Zambia Essential Medicines LMIS and are
included in this SOP manual along with step-by-step instructions on how to fill them out.
The roles and responsibilities of key personnel in the system were highlighted in the
previous section, and these same people will be responsible for completing these LMIS
forms. By level, these key personnel include:
 Health Centre: Pharmacy In-Charge
 DCMO: District Pharmacist, District Pharmacy in-charge
 District Level 1 and Level 2 or 3 Hospital: District Pharmacist or Pharmacy In
Charge
11
1. Forms Used in Managing Essential Medicines
A detailed description of each type of form, its purpose, and its related activity are listed in
the table below. Copies of these forms can be found in the Annex of the SOP manual. Job
aids for completing the forms can also be found in this SOP manual.
Form Name Purpose Activity

Essential  To account for the quantity of  Issuing
Medicines & essential medicines &  Storing
Medical Supplies medical supplies in a  Receiving
Stock Control Card storeroom  Physical Inventory
Report for  To provide logistics data to  Reporting & Ordering
Essential the MSL-LMU
Medicines and  To provide a report on the
Medical Supplies stock status of essential
medicines at the Health
facility and DCMO
 To order essential medicines
at the Health facility and
DCMO
MSL Despatch  To account for receipt of  Receiving
Note products from Central MSL at  Issuing
MSL Hub/staging post or
DCMO (for the district and
HCs) and hospital during an
emergency order
MSL Returns  To receive authorization from  Returning
Authorization Form MSL to return unusable
products. (using the Report
for Returning Products)
Report for  To track products returned to  Reporting
Returning Products the central level from the
health facility via the
Hub/staging post
Supply Voucher for  To order Essential Medicines  Ordering
Essential and Medical Supplies at the
Medicines & health facility from the DCMO
Medical Supplies
12
2. Feedback Reports
Data reported to the MSL-LMU is aggregated, processed and analyzed to produce feedback
reports that are used by program and commodity managers to monitor the performance of
the EMLIP Hybrid. These same reports can be used by supervisors to help personnel
identify problems and take corrective actions.
The following are some of the expected feedback reports for the Zambia EMLIP Hybrid.
 Computer-generated R&R
 Facilities Stocked According to Plan
 Stock Imbalance Report by Facility
 Non Reporting Facilities
 Issues to User Graphs
Report Name Purpose Primary User

Computer-generated To indicate errors in the DCMO and SDP (hospital,
R&R, bolded entries completion of the Report for health centre) personnel
Essential Medicines and
Medical Supplies
Facilities Stocked To indicate facilities that are District Pharmacist, District

According to Plan stocked appropriately i.e. Pharmacy in-charge
where stocks fall between Principal Pharmacist, LMU
the set maximum level and staff, Central MOH staff
the Emergency Order Point. (program managers)
Stock Imbalances Report To report stock outs and District Pharmacist District
over stocks and products Pharmacy in-charge
below minimum by facility Principal Pharmacist, LMU
and by product staff, Central MOH staff
(program managers)
Non-Reporting Facilities To highlight non-reporting District Pharmacist,
facilities for a set reporting District Pharmacy in-charge
period. Principal Pharmacist, LMU
staff, Central MOH staff
(program managers)
Issues to User Graph To indicate monthly issues District Pharmacist,
of products over a period of District Pharmacy in-charge
time, by product, by facility Principal Pharmacist, LMU
or by administrative level staff, Central MOH staff
(programme managers)
Samples of these reports and instructions on their use can be found in Chapter VIII of this
SOP manual.
13
B. The Zambia Essential Medicines Inventory Control System
The purpose of an inventory control system is to inform personnel when and

how much of a commodity to order and to maintain an appropriate stock level
to meet the needs of patients. A well-designed and well-operated inventory
control system helps to prevent shortages, oversupply, and expiry of
Medicines.
The inventory control system designed for essential medicines in Zambia is a forced
ordering maximum-minimum inventory control system. This means that every hospital,
DCMO, and health centre in the system is required to report at the end of every month in
order to be resupplied essential medicines back up to the maximum level. The table below
describes the reporting and ordering required for each health facility:
At the end of every month…

Health Centres Report stock on hand,
receipts, issues, losses and
adjustments to the DCMO by
the 5th day of the month
following the reporting period
DCMOs After receiving the health DCMOs submit the REMMs to
centres’ Report for Essential LMU according to the dates
Medicines and Medical published in the MSL Delivery
Supplies, the DCMO reviews Schedule.
the reports including their
report that they generate and
submit to MSL-LMU who in
turn completes the order for
the health centre to bring stock
levels up to the maximum.
Hospitals: District Report stock on hand, issues, Hospitals submit their order to
Level 1 and Level 2 and losses/adjustments; Order MSL-LMU according to the
and 3 enough stock to bring stock dates published in the MSL
level up to the maximum Delivery Schedule
*If stock levels ever fall below 2 weeks (0.5 months) of stock before the end of the
month, an emergency order should be placed. See the Job Aid on Placing Emergency
Orders in Chapter V Section G.
To help you maintain adequate stocks, the maximum months of stock, minimum months of
stock, and an emergency order point have been established.
 The maximum months of stock is the level of stock above which inventory levels should
not rise under normal conditions. The maximum level is set as a number of months of
stock. The Maximum stock levels are fixed.
 The minimum months of stock is the level of stock at which actions to replenish inventory
should occur under normal conditions. As with the maximum, the minimum can be
expressed as a level (one month of stock). The Minimum stock level is fixed.
 The emergency order point is the level of stock that triggers an emergency order,
regardless of the timing within the review period.
The maximum months of stock, minimum months of stock and emergency order point for the
different levels of the EMLIP HYBRID are shown in the following table:
14
Maximum Months Minimum Months Emergency Order
Level of Stock
of Stock Point
Hospitals (District
2 weeks
Level 1, and Level 2 3 months 2 months
(0.5 months)
& 3)
2 weeks
Health Centres 4 months 3 months
(0.5 months)
DCMO (top up or
2 weeks
emergency 1 months 0.5 months
(0.5 months)
commodities)
15
IV. ASSESSING STOCK STATUS
A maximum/minimum inventory control system is a system designed to ensure that

quantities of stock fall within an established range – a maximum level and a minimum level.
In order to know if your stocks are within that range, you must assess your stock status.
When you review your stock status, you determine how much of each essential medicines
you have available at your facility and how long these stocks will last. You can review your
stock status by counting the stock available, as you do during a physical count. (See
Chapter VII Section B on how to conduct a physical count.) When you ﬁnish, you will have
an absolute quantity of stock available. But, it is much more important to know how long the
stocks will last and if you have enough stock available until you receive your next order.
We refer to this as months of stock.
Months of stock is the number of months essential medicines will last based on the present
issues rate. When you review your stock status, you need to determine how many months of
stock you have in your facility. Three months of stock means that your stock will last three
months, as long as issues remain at the current rate.
By reviewing your stock status you will be able to determine if your facility is understocked,
overstocked, or adequately stocked. If you are understocked and you know that a recently
ordered shipment is not on the way, you may need to place an emergency order. (See
Chapter V Section G for placing an emergency order.) If you are overstocked, you may
need to return stock to the higher facility for redistribution.
Determining Months of Stock

By calculating the months of stock, a facility can determine if the right quantities of essential
medicines are stocked. To determine how long stock will last, the following simple formula
can be used:
How much we have

(Stock on Hand) How long supplies will last
=
How much we have issued (Months of Stock on Hand)
(Average Monthly Issues)
Before calculating Months of Stock on Hand, you need to know two pieces of information:
Stock on Hand and Average Monthly Issues. To detemine Average Monthly Issues (AMI),
add the latest three months’ issues of a particular product, then divide by three.
Use the following formula to determine AMI:
Current month’s issues + previous two months’

issues = Average Monthly
3 Issues
Note: When you calculate average monthly issues, always round up to the nearest
whole number!!!
Previous months’ issues can be found on copies of the Report for Essential Medicines and
Medical Supplies for the last two months OR on the Essential Medicines & Medical Supplies
16
Stock Control Cards (for health centres and hospitals). For each medicines for which you
wish to assess stock status, retrieve the issues data for the last three complete months. If a
stock out has been experienced in any of those months, do not use that month’s data; use
the next most recent complete month issues for which there was no stock out. If you do not
have three months of data, use whatever data you have. Calculate the average monthly
issues.
Next, divide the Stock on Hand (determined from the physical count) by the AMI that you
calculated to obtain the Months of Stock on Hand. Use the following formula to determine
how many months the current quantity available for each product will last:
Stock on Hand Months of

=
Average Monthly Issues Stock on Hand
Note:When you determine months of stock, use only one number after the decimal point!
If the second number after the decimal is 4 or less, round down; if 5 or more, round up.
When to Assess Stock Status

The stock status for a facility should be assessed at any time you suspect that the stock
levels do not fall within the recommended maximum and minimum stock levels for your
facility. This may occur if there is a loss of supplies due to damage, expiry, or theft, or if there
is an unexpected increase or decrease in issues.
DCMOs should assess their stock status, and that of the health centres during supervisory
visits and as part of routine monitoring. When reviewing Report for Essential Medicines and
Medical Supplies, DCMO personnel should check the stock status:
 If they and there health centre are overstocked, then the stock status should be
assessed. Stocks may need to be returned if they will expire before they can be
issued .
 If their frequent errors on the report which the DCMO notices when reviewing their
report and that of a a particular health centre, then stock should be assesed to avert
either overstocking or under stocking which may lead to an emergency order.
 If they are submitting frequent emergency orders, work to identify the reason for the
emergency orders and take other action as required.
To review the stock status of any health facility, follow the procedures outlined below.
17
JOB AID 1: Determining the Months of Stock on Hand for Essential Medicines
Task: Determining the months of stock on hand
Completed by: District Pharmacist, , District Pharmacy in-charge, Hospital

Pharmacist, or Health Centre Pharmacy In-Charge/Facility In-
Charge
Purpose: To determine how long essential medicines stocks will last
When to Perform: When a stock imbalance is suspected

During routine monitoring and supervision
Can be done when completing the Report for Essential
Medicines and Medical Supplies for both the hospital; and
Report for Essential Medicines and Medical Supplies health
centres
Materials Needed: Report for Essential Medicines and Medical Supplies or Essential
Medicines & Medical Supplies Stock Control Cards for the most
recent 3 months, calculator and pen.
Step Action Notes

1 Determine the total issues If you are a hospital: Get the issues figures from
for three months: For each column E from the current Report for Essential
essential medicine, add the Medicines and Medical Supplies and the last two
issues for the most recent Reports for Essential Medicines and Medical
three completed months. Supplies
Then
If you are a health centre: Supply Chain Manager

(SCMgr) at LMU will determine the total issues
for three months by getting issues figures from
column E of the current Report for Essential
Medicines and Medical Supplies and the last two
computer-generated R&Rs
or
Using Essential Medicines & Medical Supplies

Stock Control Cards add up the last three months
issues.
Example: Paracetamol 500 mg tabs, Bottle of

1000 tabs
Total bottles issued for current month: 104
Total bottles issued last month: 92
Total bottles issued the month before last: 87
18
104 + 92 + 87 = 283 bottles
If there were any stock outs during one of the

three months, skip that month and use the issues
from the next previous month.
2. Calculate the Average
Monthly Issues: Divide the Example:
total issues for three months 283 ÷ 3 = 94.3 ≈ 95 bottles
by 3. AMI = 95 bottles
Always roundup to the nearest issuing unit.

Example:
37.2 ≈ 38 bottles
102.7 ≈ 103 bottle
3. Determine the current Example:

quantity of Stock on Hand: Physical count is 200 bottles.
Conduct a physical count or
obtain the physical count
from column H(DCMO and
Hospitals) or Column J for
HCs on the Report for
Essential Medicines and
Medical Supplies for both the
hospitals,
4. Calculate the Months of Months of Stock on Hand tells you how long your
Stock on Hand: Divide the current stock will last based on current issues. If
quantity of stock on hand for you have 2.5 months of stock, then your stock
the product by the Average will last 2.5 months.
Monthly Issues for that
product. Example:
200/95 = 2.1 months of stock
Always round off Months of Stock to the nearest

one decimal place.
Example:
3.22 ≈ 3.2 months of stock
1.88 ≈ 1.9 months of stock
5. Take action, if needed, See the Job Aid Deciding what Actions to Take
based on the months of after Stock Status has been Determined.
stock for the essential
medicines.
19
JOB AID 2: Deciding What Actions to Take after Stock Status Has Been
Determined
Task: Deciding what action to take after stock status has been determined
for essential medicines at a health facility
Completed by: District Pharmacist, , District Pharmacy in-charge Hospital

Pharmacist, or Health Centre Pharmacy In-Charge/Facility In-Charge
Purpose: To monitor the stock status in the health facilities

To correct any overstocking or understocking discovered after
determining stock status
To make an emergency order
When to perform: When a stock imbalance is suspected

During routine monitoring and supervision
When a Computer Generated Report and Requistion for Essential
Medicines is received
When completing the report at the Health facilities .
Note:
If communication is necessary regarding decisions about stock status, facilities should
contact the following levels.
 health centres should contact their DCMO.
 DCMOs should contact the MSL-LMU.
 hospitals should contact the MSL-LMU
For hospitals
Months of Stock Interpretation Decisions

Between 3 and 2 Stock status is adequate. No action required.
months
Greater than 3 The facility is overstocked Discuss the stock status of the product
months with this product. with your specified contact.
If some or all of the stock will expire in

the near future, you can transfer some
stock to another facility that may be
able to use it more quickly. The MSL
Hub/stagging posts can facilitate the
redistribution.
Between 2 The facility is understocked Continue to monitor stock levels until
months and 2 with that commodity, but the next delivery arrives, or until they
weeks stock levels have not yet reach the emergency order point.
(0.5 months) reached the emergency
order point.
20
Less than 2 The service delivery point is Discuss the stock status of the product
weeks understocked with this with your specified contact. An
(0.5 months) product. The stock level is emergency order for Pre-printed
below the emergency order products should be made! Complete
point of 2 weeks (0.5 the Report For Essential Medicine
months). and Medical Supplies and tick the EO
box with red.
Note: In order to assist staff with

identifying products which are at or
below the emergency order point, the
“New EOP” in quantities of products
will be listed on the Computer-
generated R&R that the facility receives
from MSL.
For DCMOs
months

stock to another District that may be
able to use it more quickly.The MSL
Hub/stagging posts can facilitate the
redistribution.
months and 2 with that commodity, but the next delivery arrives, or until they
weeks stock levels have not yet reach the emergency order point.
(0.5 months) reached the emergency
order point.
For health centres
months

stock to another facility that may be
able to use it more quickly.The DCMO
and MSL Hub/stagging post can
facilitate the redistribution
21
months and 2 with that commodity, but the next delivery arrives, or until the
weeks stock levels have not yet facility reaches the emergency order
(0.5 months) reached the emergency point.
order point.
Less than 2 The facility is understocked Discuss the stock status of the product
weeks with this product. The stock with your specified contact. An
(0.5 months) level is below the emergency emergency order for Pre-printed
order point of 2 weeks (0.5 products should be made!Complete
months). the Report for Essential Medicines
and Medical Supplies and tick the
EO box with red
Note: In order to assist staff with

identifying products which are at or
below the emergency order point, the
“New EOP” in quantities of products
will be listed on the Computer-
generated R&R that the facility receives
from MSL.
22
V. REPORTING FOR ESSENTIAL MEDICINES AND MEDICAL
SUPPLIES
This section of the manual will address the process for reporting on and ordering essential
medicines. It will also address the roles and responsibilities of the main actors in the
resupply process: the health centre, the DCMO, the hospitals, and the MSL-LMU. These
actors also represent the three levels of the EMLIP Hybrid.
A. The Role of District level 1 hospitals, level 2 and 3 hospitals and

Health Centres in Reporting
At the end of each calendar month the Pharmacy In-Charge at the level 1, 2 or 3 hospitals
and health centres complete the REMMS by using the Stock Control Cards for Essential
Medicines & Medical Supplies and the previous months’ completed Report for Essential
Medicines & Medical Supplies to fill in the required essential data. Such data include the
total stock of each essential medicine on hand at the health facility as determined by a
physical count; the beginning balance, receipts, and issues for the period; and the losses
and adjustments to the stock of each essential medicine that have occurred during the
month.
When these data points are compiled and recorded on the Report for Essential Medicines
and Medical Supplies, the health centres then sends the completed Report to the District
Pharmacist at the district level by no later than the 5th day following the reporting period for
review and approval. Thereafter the DCMO sends the report to LMU. The Hospital Levels 1,
2 and 3 review their reports and send them to LMU directly.
The following job aid provides detailed instructions for the Pharmacist In-Charge to complete
the Report for Essential Medicines and Medical Supplies.
Completing the Report for Essential Medicines and Medical Supplies for
DCMOs, Level 1, 2 and 3 hospitals and health centres
This job aid will guide you through the process of completing the Report for Essential
Medicines and Medical Supplies.
Please note that there are several pages to this form. Each page lists different essential
medicines.
HOSPITALS: When sending this form to LMU, it is very important that all pages are stapled
together as a single Report. It is also important that original copy of all pages is made during
the transfer of information. The pages are self-carbonized to make copies of each page. The
Pharmacy In-Charge at the hospital reviews and approves the Report for Essential
Medicines. The Report should be submitted to MSL-LMU according to the MSL schedule.
DCMO: When sending this form to LMU, it is very important that all pages are stapled
together as a single Report. It is also important that original copy of all pages is made during
the transfer of information. The pages are self-carbonized to make copies of each page. The
District pharmacy in charge reviews and approves the Report for Essential Medicines for the
DCMO and the health centres before submitting them to LMU according to the MSL
schedule.
23
HEALTH CENTRES: When sending this form to the DCMO, it is very important that all
pages are stapled together as a single Report. It is also important that 2 copies (original plus
2 duplicates) of all pages are made during the transfer of information. The pages are self-
carbonized to make copies of each page. The Pharmacy In-Charge/Facility in-charge at the
health centre completes the REMMS. The Report should be submitted to the DCMO
Pharmacy in charge no later than the 5th day of the month following the reporting period. The
District Pharmacist reviews and approves the REMMS before forwarding it to LMU.
JOB AID 3: This job aid provides guidance for filling in the Report for
Essential Medicines and Medical Supplies at the Health Centre
Task: Completing the Report for Essential Medicines & Medical Supplies at the
health Centre
Completed by: Pharmacy In-Charge/Facility in-charge at the Health Centre
Purpose: To report the number of essential medicines issued, the stock on hand,
and the losses/adjustments
When to perform: At the end of each reporting period
Materials needed: Essential Medicines & Medical Supplies Stock Control Card, Report for
Essential Medicines and Medical Supplies report for the previous month,
blank Report for Essential Medicines and Medical Supplies, pen and
calculator
Step Action Notes

1. Reporting Period: Write the day, The reporting period is a full month and this
month and year for the starting report should be completed at the end of each
date and ending date of the calendar month.
reporting period.
Example: 1 April 2009 – 30 April 2009
2. Facility Name: Write in the name
of the facility.
3. Province and District: Write in the
name of the province and district in
which the facility is located.
4. Date of last delivery of stock: This information can be obtained from the
Write in the date you received computer –generated R&R.
delivery of the last order.
5 Product Code (Column A): If the code is not pre-printed, write in the code
Product Codes are pre-printed. as listed in the MSL catalogue.
These codes are linked to the pack
sizes of the commodities.
24
6 Drug Product/Medical Supply If a pre-printed product of a different pack size
(Column B): Pre-printed. Full is received, it constitutes a different product
supply medicines and medical and for logistics purposes should be listed on
supplies have been pre-printed. a different line provided for on the REMMS.
Therefore the name, strength and form should
be written.
For example: Erythromycin 250 mg tabs,

packs of 500 needs to be on a different line
from Erythromycin 250 mg tabs, packs of
1000.
Note
In case of a health centre (l:e. urban health
centres) requesting a commodity besides
the already pre-printed they should write
name, strength and form of that particular
product in the blank space provided on the
REMMs. Ensure that the MSL code for this
product corresponds to the unit in the
follow on step.
7. Unit (Column C): Pre-printed. If If necessary, write in the total number of tabs,
the unit is not pre-printed, write the caps or mls packed per bottle for each
unit for the product. medicine that is not already on the form.
If the unit of issue is a bottle however, it is
important to identify the number of tabs, caps
or mls of the medicines contained in each
bottle.
Example: Bottle of 1000 tablets.
Note
The unit should always match the MSL
code in column A. A mismatch may lead to
wrong interpretation of data by SCMgr at
LMU that may eventually lead to wrong
order determination. This means a facility
may either be under supplied or
oversupplied.
8. Beginning Balance (Column D): This number should match the Physical Count
Write in the total balance of each at the end of the previous month (column J
product in the store room on the from the previous month’s Report for
starting date of the reporting Essential Medicines and Medical Supplies).
period. Refer to Column J of the previous Report for
Essential Medicines and Medical Supplies
If you do not manage this product at your

facility, draw a line through columns D – K;
fill in the Report for Essential Medicines
and Medical Supplies only for the products
that your facility manages.
25
9. Quantity Received during the This information comes from the “Received”
month From the Health Centre column on the Essential Medicines Stock
Kit (Column E): Add up and write Control Card.
in the total quantity of each product
that was received during the Top up or emergency commodities will only
reporting period from the health be received directly from MSL (via the
centre kit only Hub/staging post) through the Health Centre
Kits.
10 Quantity Received during the This information comes from the “Received”
month from bulk stock (Column column on the Essential Medicines Stock
F): Add up and write in the total Control Card.
quantity of each product that was
received during the reporting period Be sure to include any quantities received as
through the pre-packed orders from a part of a regular order (this excludes
MSL via the Hub/staging post or quantities contained in the HC Kit) or an
the top up or emergency emergency order received via the DCMO
commodities ordered through the
DCMO. Therefore whatever extra quantities they
request and receive from the DCMO should
be entered in this column
11 Total Quantity Received during This information comes from the “Received”
the month (E + F) (Column G): column on the Essential Medicines Stock
Add up and write in the total Control Card or column E and F on the
quantity of each product that was current REMMs
received during the reporting period
from both the Health Centre Kit and Make sure column G is equal to the sum of
bulk stock Column E and F before proceeding to column
H
Note.
SCMgr will calculate this automatically

once the data in column E and F is entered
in the software.
12 Total Quantity Issued for the The quantities issued come from the “Issued”
month (Column H): For each column on the Essential Medicines Stock
medicines issued during the Control Cards. Add up all issues for the month
reporting period, write the total
number of bottles issued.
13. Losses and Adjustments This information comes from the

(Column I): Calculate and write in “Losses/Adjustments” column of the Essential
the total losses/adjustments from Medicines Stock Control Card.
the start of the reporting period to
Adjustments are quantities of a product
the end of the reporting period.
received, from any source other than the
Central MSL/Hub, or issued to anyone other
than your facility’s patients (e.g. You received
5 bottles from a local NGO, which would be a
+5 adjustment or you loaned 5 bottles to
another facility, which would be a -5
26
adjustment. A local purchase by the Health
centres is a positive adjustment however
local purchases from the DCMOs should be
considered as Receipts by the Health
centres).
Losses are quantities removed from your
stock for anything other than dispensing to
patients or issuing to another facility (e.g.,
expired, lost, or damaged). Losses are
recorded as (-) negative numbers.
Write a plus (+) sign next to a positive
adjustment. Example: +3.
Write a minus (-) sign next to a negative
number. Example: -3.
Always indicate if the number is positive (+)
or negative (-).
14. Physical Count (Column J): Write The Physical Count should include all
in the quantities on hand for each essential medicines in the store room, and
Essential medicine and Medical should only include full, unopened packages
supplies on the last day of the or bottles. Do not include open, or partially
month. The quantities on hand used products in the Physical Count.
should be obtained by doing a
physical count regardless of See Job Aid: “Conducting a Physical Count,”
whether it came in the HC kit or for further instructions. Also see the Job Aid:
bulk stock “Completing the Essential Medicines &
Medical Supplies Stock Control Card”.
15
Number of days stocked out Calculations to obtain number of days the
(Column K): Write the number of facility was stocked out can be done using
days the facility was stocked out the Stock Control Card.
during the reporting month for each
product Example: You started the month with 5
bottles of 100mls Metronidazole Suspension
125mg/5ml and you did not receive anything
for that month. You issued the last of the 5
bottles of Metronidazole Suspension
125mg/5ml on the 7th of the month. To
Note calculate the number of days stocked out:
HCs can request top up or Subtract the number of days you issued the
emergency commodities should last of the 5 bottles from 30 days which is the
there be need from the DCMO number of days in a month
instead of waiting for their 30-7= 23 days stocked out
monthly routine orders to avoid
27
premature stock outs especially
for fast moving commodities If the facility did not experience any stock out
unless there is a central or during the reporting month; write “0”. Do not
DCMO stock out. leave this column blank.
16. Explanation for Losses & Include the product, the quantity, and the
Adjustments: Write an explanation reason for the loss or adjustment.
for any losses or adjustments on
the lines found at the bottom of the Example:
page. Erythromycin 250 mg tabs, packs of 500
expired
Paracetamol 500mg tabs, 10 packs loaned to
Ngori Health Centre
17. Discrepancies or Remarks: Discrepancies or remarks will be added as

Leave this space blank. needed when essential medicines are
received at the health centre.
18. Review your completed report and Items to check include:

make sure that you have filled in all Beginning balance on this report equals
of the columns with the correct Physical Count (column G) from the previous
information. report.
Cal. D + G -H+/- I = J
19. LOGISTICS MANAGEMENT INFORMATION SYSTEM (LMIS) FORMS
Make sure of ordering the forms pre-printed in the table should the facility run out to ensure
real time inventory management and reporting. ‘’Remember no reporting, no product and
no programme’’. Order a new form for reporting 3 months before the current one finishes
during your routine reporting to MSL-LMU.
If the REMMs is not been supplied to you by Central MSL request a copy from the DCMO that
will always keep extra copies in their reserves, however make sure you order your copies
during your routine reporting to avoid non reporting in cases where the DCMO has stocked
out of them.
20. Completed This form is in triplicate. Press hard enough

by/Signature/Date/Telephone: with your pen so that the name, signature and
Write your name, date, telephone date will appear on the bottom copy.
number and sign the form in the
spaces provided at the end of the Staffs that may complete include: Health
Report for Essential Medicines and Centre In-Charge, or Pharmacy In-Charge.
Medical Supplies.
21. Authorized by/Signature/Date: Staff who may be authorized includes: District

The Pharmacy In-Charge/Facility Pharmacist/Technologist
In-Charge at the Health Centre
completes the REMMS and
submits to the DCMO by the 5th
day of the month. The District
Pharmacist reviews and approves
the REMMS before forwarding it to
LMU according to MSL schedule.
28
22. Once the form is completed, tear The REMMS should be submitted to the
off the top 2 copies of each page of District Pharmacist no later than the 5th day
the Report for Essential Medicines of the month following the reporting period.
and Medical Supplies leaving the
bottom copy in the book. These
copies are then sent to the District
Pharmacist. Retain the bottom
copy for your records.
Once the Health Centre Report for Essential Medicines and Medical Supplies is
submitted to the District Pharmacist, he/she will review the report and send it on to the
MSL-LMU, it is reviewed and the order calculated. The order will be filled by Central
MSL and sent down to the MSL Hub for redistribution to the Health facilities. A
computer-generated version of the R&R will accompany the order to the facilities. This
copy should be compared to the original handwritten copy from the Health facility to
check on corrected errors, etc.
Task is complete when:

 The beginning and ending dates for the reporting period are filled in.
 The facility, district and province names are filled in.
 The beginning balance, quantity received, quantity issued, losses and adjustments, and
the results of the physical count are filled in.
 Any explanation for the losses and/or adjustments is filled in.
 The preparer’s name, telephone number, signature and date are filled in.
 An authorized person signs and dates the report.
 The Report for Essential Medicines and Medical Supplies is sent to the District
Pharmacist.
29
JOB AID 4: This job aid provides guidance for filling in the Report for
Essential Medicines and Medical Supplies at the DCMO
Task: Completing the Report for Essential Medicines & Medical Supplies at
the DCMO
Completed by: District Pharmacist, Pharmacy Technologist/District Pharmacy in-charge

at the DCMO
calculator
Step Action Notes

reporting period.
of the facility.
30
be written.

1000.
bottle.
Note
code in column A. A mismatch may lead to
oversupplied.
Write in the total balance of each at the end of the previous month (column J
period. Refer to Column J of the previous Report for
If you do not ‘order’ this product at the
DCMO, draw a line through columns D – I;
that managed.
9. Total Quantity Received during This information comes from the “Received”
the month (Column E): Add up column on the Essential Medicines Stock
and write in the total quantity of Control Card.
each product that was received
during the reporting period.
31

than your facility’s patients (e.g., You
received 5 bottles from a local NGO, which
would be a +5 adjustment or you loaned 5
bottles to another facility, which would be a -5
adjustment. Local purchases at the DCMOs
should be considered as positive adjustments
on the DCMO’s SCCs).
or negative (-).
in the quantities on hand for each Essential medicines and Medical supplies in
Essential medicine and Medical the store room, and should only include full,
supplies on the last day of the unopened packages or bottles. Do not
month include open, or partially used products in the
Physical Count.
See Job Aid: “Conducting a Physical Count,”

for further instructions. Also see the Job Aid:
“Completing the Essential Medicines &
32
15 Number of days stocked out Calculations to obtain number of days the
(Column K): Write the number of facility was stocked out can be done using
days the facility was stocked out the Stock Control Card.
calculate the number of days stocked out:
Subtract the number of days you issued the
last of the 5 bottles from 30 days which is the
number of days in a month
30-7= 23 days stocked out
If the facility did not experience any stock out

during the reporting month; write “0”. Do not
leave this column blank.
expired
Ngori Health Centre


Cal. D + E – F +/- G = H
Make sure you are ordering the forms pre-printed in the table for resupplying facilities that
may run out to ensure real time inventory management and reporting. Order these new forms
for various logistics systems being implemented by the health centres during your routine
reporting to MSL-LMU.DCMO should therefore be vigilant every month in ensuring that
every Health Centre has copies of these forms especially the ones for reporting and
ordering.
Do not forget to reserve copies for the districts as well especially that you are the sole source
of the top up or emergency commodities to the Health centres besides the monthly order
allocation from MSL . Stock out of the DCMO REMMs for instance will adversely affect stock
availability at the districts as they will not report to request a resupply from central MSL. This
may lead to health centres not being resupplied when they push in their orders at the DCMO
and eventually would stock out.
‘’Remember no reporting, no resupply = no product and no programme’’
33
20. Completed This form is in Duplicate. Press hard enough
by/Signature/Date/Telephone: with your pen so that the name, signature and
Write your name, date, telephone date will appear on the bottom copy.
spaces provided at the end of the Staffs that may complete include: or District
Report for Essential Medicines and Pharmacy In-Charge.
Medical Supplies.
21. Authorized by/Signature/Date: Staff who may be authorized includes: District

The Pharmacy In-charge at the Pharmacist/Technologist
DCMO reviews and approves the
REMMS and submits to LMU
according to MSL schedule.
The District Pharmacist reviews

and approves the REMMS before
forwarding it to LMU.
22. Once the form is completed, tear The REMMS should be submitted to MSL
off the first top copy of each page LMU according to the MSL delivery Schedule.
of the Report for Essential Retain the bottom copy for your records
Medicines and Medical Supplies
leaving the bottom copies for your
records. The first copy is what
should be submitted to MSL-LMU.
 The Report for Essential Medicines and Medical Supplies is sent to the MSL-LMU
34
JOB AID 5: This job aid provides guidance for filling in the Report for Essential
Medicines and Medical Supplies at the Hospitals
Task: Completing the Report for Essential Medicines & Medical Supplies at the
Hospital
Completed by: District Hospital Pharmacist, Hospital Pharmacist/Pharmacy

Technologist/Pharmacy in-charge at the Hospital
calculator
Step Action Notes

reporting period.
of the facility.
be written.

1000.
35
Step Action Notes
bottle.
Note
code in column A.A mismatch may lead to
oversupplied.
Write in the total balance of each at the end of the previous month (column H
period. Refer to Column H of the previous Report for
If you do not manage this product at your
facility, draw a line through columns D – I;
that managed.
9. Total Quantity Received during This information comes from the “Received”
the month (Column E): Add up column on the Essential Medicines Stock
and write in the total quantity of Control Card.
each product that was received
during the reporting period. Be sure to include any quantities received as
a part of a regular order or an emergency
order.

than your facility’s patients (e.g., You received
5 bottles from a local NGO, which would be a
+5 adjustment or you loaned 5 bottles to
36
another facility, which would be a -5
adjustment. Local purchases by the Hospitals
should be considered as positive adjustments
on the facility’s SCCs).
or negative (-).
in the quantities on hand for each Essential medicines and Medical supplies in
Essential medicine and Medical the store room, and should only include full,
supplies on the last day of the unopened packages or bottles. Do not include
month open, or partially used products in the
Physical Count.
See Job Aid: “Conducting a Physical Count,”

for further instructions. Also see the Job Aid:
“Completing the Essential Medicines &
15 Number of days stocked out Calculations to obtain number of days the

(Column K): Write the number of facility was stocked out can be done using the
days the facility was stocked out Stock Control Card.
calculate the number of days stocked out:
Subtract the number of days you issued the
last of the 5 bottles from 30 days which is the
number of days in a month
30-7= 23 days stocked out
If the facility did not experience any stock out

during the reporting month; write “0”. Do not
leave this column blank.
expired
37
Ngori Health Centre


Cal. D + E – F +/- G = H
38
Make sure you are ordering the forms pre-printed in the table should the facility run out to
ensure real time inventory management and reporting. Order a new form for reporting 3 months
before the current one finishes during your routine reporting to MSL-LMU.
‘’Remember no reporting, no product and no programme’’
20 Completed This form is in duplicate. Press hard enough with your

. by/Signature/Date/Telephone: pen so that the name, signature and date will appear
Write your name, date, telephone on the bottom copy.
spaces provided at the end of the Staffs that may complete include: or District Hospital or
Report for Essential Medicines Hospital Pharmacy In-Charge.
and Medical Supplies.
21 Authorized by/Signature/Date: Staff who may be authorized includes: District Hospital

. The Pharmacy In-charge at the Pharmacist/Technologist, Hospital
Hospital reviews and approves Pharmacist/Technologist
the REMMS and submits to LMU
according to MSL schedule.
REMMS are supposed to be

reviewed before forwarding to
MSL-LMU.
22 Once the form is completed, tear The REMMS should be submitted to MSL LMU
. off the first top copy of each page according to the MSL delivery Schedule. Retain the
of the Report for Essential bottom copy for your records
Medicines and Medical Supplies
leaving the bottom copies for
your records. The first copy is
what should be submitted to
MSL-LMU.
 The Report for Essential Medicines and Medical Supplies is sent to the MSL-LMU
B. The Role of the DCMO in reviewing the Report for Essential Medicines and Medical
Supplies for the Health Centre
No later than the 5th day of each calendar month, District Pharmacist, Pharmacy Technologist
or any person authorized to manage Essential Medicines & Medical Supplies at the District
Community Medical Office will receive 2 copies of the Report for Essential Medicines and Medical
Supplies from each of the Health Centres within its jurisdiction. The District Pharmacist (or any person
authorized) then takes responsibility of reviewing the reports from all the health centres in the district.
The data reported is reviewed for any possible errors by each health centre on the Report for Essential
Medicines and Medical Supplies.
39
C. The Role of the DCMO in the Reporting and re-supplying Essential Medicines and
Medical Supplies to the Health Centre
Some commodities will be available for resupply to the health centres via the DCMO requested bulk
stocks. This move is to ensure equity of distributing of commodities among the health centres through
their DCMOs. However health centres will still have direct access to these commodities through their
monthly allocated health centre kits and bulk requested stocks from the central level.
This means that the DCMO will report on all top up commodities to MSL-LMU and they will be
resupplied by central MSL via the MSL Hub/staging post. The health centre can therefore, still request
for extra commodities stored at the DCMO using the supply voucher for Essential Medicines and
Medical supplies as and when applicable. Note that the DCMO will only stock one month of stock of
what they will be requesting from MSL central
JOB AID 6: Requisitioning Essential Medicines using the Supply voucher for
Essential Medicines and Medical supplies
Task: Requisitioning essential medicines and medical supplies using the Supply
Voucher
Completed by: HC Pharmacy In-Charge, District Pharmacist, District Pharmacy

Technologist or any person trained and authorized to manage Essential
Medicines and Medical Supplies at the District Community Medical Office
Purpose: To request for essential medicines & medical supplies from the DCMO
To document the issue of essential medicines & medical supplies from the
DCMO and receipts at the health centre
To report the balance of health centre essential medicines and medical

supplies stored at the DCMO
When to perform: As agreed between the health centre and the DCMO
Materials needed: Supply Voucher, health centre Stock Control Card, health centre copy of
previous month’s Report for Essential Medicine & Medical Supplies, Stock
Control Cards of health centre stocks held at the DCMO, pen
Notes: The Supply Voucher for Essential Medicines & Medical Supplies, should have
3 copies (1 original and 2 copies) when initiated.
Step Action Notes

Steps 1 – 11 should be completed at the health centre
1. To (Name of district stores): Write the name
of the district that will receive this form.
2. From (Name of Centre/Unit/Dept): Write the
name of the health centre sending the form.
3. Requested by/Signature/Date: Print your
name, then sign and date the form.
40
4. Authorised by/Signature/Date: Leave this The In-Charge should not sign and date the
section blank until the product information has Supply Voucher for Essential Medicines &
been completed. Medical Supplies until Columns A, B, C, D
and E have been completed by the H.C.
Staff.
5. (A) Item Code: Enter the code number of the Example: EM0036
item as listed in the MSL catalogue.
6. (B) Description, Strength and Form: Write Example: Doxycycline, 100 mg tablet
the name of the essential medicines and
medical supplies, strength and form (e.g. tablet,
capsule, syrup)
7. (C) Unit: Write the individual unit of the As with the Report for Essential Medicines
essential medicines. Make sure the Unit and Medical Supplies and Stock Control
corresponds to the MSL code Cards, write the unit size (e.g.: bottle of 60
tabs, 240 ml bottle).
8. (D) Balance at Hand: Write the balance at Find the Balance at Hand for each essential
hand (in units) in the H.C. storeroom at the time medicine on the Essential Medicines &
of completing the Supply Voucher for Essential Medical Supplies Stock Control Card.
Medicines & Medical Supplies for each Ensure that the Essential Medicines Stock
Product. Control Card has been updated with the
most recent information.
9. (E) Quantity Requested: Write the total Quantity requested is determined by the
quantity of each essential medicines following formula:
requested.
Total quantity issued for the month (from
column E of the previous month’s Report)
minus Balance at Hand at the health
centre (column D of the Supply Voucher for
Essential Medicines & medical supplies).
The Pharmacy In-Charge/Facility in-charge

in consultation with the DCMO should
agree on the requested amount based
upon availability of products and transport
10. Authorised by/Signature/Date: The In- The Facility In-Charge should not sign and
Charge who must authorize the Supply date the Supply Voucher for Essential
Voucher for Essential Medicines & medical Medicines & Medical Supplies until
supplies prints his or her name, then sign and Columns A, B, C, D and E have been
date the form. completed.
11. Send original PLUS two copies of the Supply The health centre may also carry the copies
Voucher to the District Pharmacist, District of the Supply Voucher for Essential
Pharmacy Technologist or any person trained Medicines & Medical Supplies to the DCMO
and authorized to manage Essential Medicines and pick up the Medicines.
at the District Community Medical Office when
needed or according to agreed upon re-supply Note
schedule. Keep one copy for your files. The Health centres should take the
opportunity of collecting there stocks at
DCMO when they visit instead of waiting
for the DCMO to deliver which may take
longer thus leading their facility to or
prolonging the stock out
41
Steps 12 – 17 should be completed at the DCMO
12. (F) Quantity Supplied: Write in the quantity (in This quantity should equal the “Quantity
units) supplied to the health centre for each Requested” from Column E unless there
essential medicines. are stock shortages at the DCMO.
13. (G) Quantity Received: Leave this column The health centre will complete Column G
blank. after it receives the products.
14. (H) Remarks: Note any comments that pertain

to the quantities supplied.
15. Approved by/Date: The District Pharmacist,
Pharmacy Technologist or any person trained
and authorized to manage Essential Medicines
& Medical Supplies at the District Community
Medical Office should sign his/her name and
date the voucher after approval.
16. Issued by/Date: The District Pharmacist,
Pharmacy Technologist or any person trained
and authorized to manage Essential Medicines
at the District Community Medical Office
preparing the order should sign his/her name
and date the voucher after approval. Keep one
copy for DCMO files.
17. Despatch essential medicines to health
centre along with the original PLUS one
copy of Supply Voucher.
Steps 18 – 21 should be completed at the health centre upon delivery
18. Delivered by/Date: The truck driver should If the health centre comes to the DCMO to
sign his/her name and date the voucher after pick up supplies, leave this line blank.
delivering goods to the health centre.
19. (G) Quantity Received: Write the quantity of If a discrepancy is found between the
each essential medicine received. numbers in the “Quantity Supplied” column
and what was actually received, note this in
the Remarks Column (H) of the Supply
Voucher or at the bottom of the page.
20. Received by/Date: Sign your name and write
the date on which the products were received.
21. Health Centre keeps and files a copy of
completed Supply Voucher for Essential
Medicines & Medical Supplies and sends
the original to the DCMO.
The task is complete when:
42
 The health centre has completed columns A – E correctly and the appropriate individuals have
authorized and signed the voucher.
 The District Pharmacist has filled in the “Quantity Supplied” and “Balance on Hand at District”
columns and approved the voucher with his/her signature and the date.
 The supplies have been delivered to or picked up by the health centre and the delivery truck
driver and health centre Pharmacy In-Charge have signed and dated the voucher.
 The health centre has completed column G and the appropriate individuals have signed and
dated the voucher.
 The health centre has a copy of the fully completed Supply Voucher for Essential Medicines and
the DCMO has received the fully completed original.
D. The Role of the MOH Logistics Management Unit at MSL in Processing Orders
When the Report for Essential Medicines and Medical Supplies is received at the MOH Logistics
Management Unit (LMU) at MSL, the LMU reviews the report to make sure that the information is
complete and accurate. The report information is entered into the Supply Chain Manager software and
a computer-generated version of the R&R is produced. If there were math errors in the submitted
Report for Essential Medicines and Medical Supplies, the software will make the appropriate changes,
with the corrections shown in bold numbers. The LMU then approves the order and passes it to the
MSL Warehouse Manager with the computer-generated R&R and MSL Requisition/Issue Voucher (PH
81-N). Central MSL will pick the order, pack it and send it to the MSL Hub for onward distribution to the
health facilities
The information from the computer generated R&R is processed and used by central management for
procurement purposes. Feedback reports of processed information are sent to MOH Central, province,
and DCMO personnel for program planning, and monitoring and supervision purposes. Feedback
reports are also available to cooperating partners and NGOs to support their own reporting and
commodity management needs. Timely receipt and processing of the Report for Essential Medicines
and Medical Supplies is essential for ensuring that the system works well, that orders are received on
time, and that clients get the essential medicines they need.
Note:
Central MSL will pick product quantities to fulfil the orders through the HC Kit while other
quantities if not met from the kit including non kit products will be picked from the bulk,
otherwise if the quantities being sought are in the Kit, the product will not be supplied from the
bulk)
MSL-LMU will process the order for the DCMO top up or emergency commodities for resupply
as well as the HCs orders. If there is need for extra quantities, the HCs will request for the top
up from the DCMO.
43
JOB AID 7: Demonstration on how order quantity for the DCMO, Hospitals and
Health Centres is calculated at LMU
Task: Demonstration on how order quantity for the Hospitals and Health
Centres is calculated at LMU
Completed by: Data entry clerk, LMU technical officer
Purpose: To determine quantities needed to replenish the health facilities at the

end of the reporting period.
When to Perform: Whenever REMMS from the DCMOs, Hospitals and Health Centers
are received at LMU.
Materials Needed: Fully completed REMMS for the current month,SCMgr software
44
The steps below outline how SCMgr calculates order quantity in an event where there
was no stock out.
Steps Action Notes
1 AMI determination The AMI for a particular commodity is automatically

calculated by SCMgr. See notes on how AMI is calculated
on page 17
2 Determining the Maximum quantity at the Hospital:

maximum
quantity that a Maximum quantity at the hospital is calculated by multiplying
health facility can the AMI by 3.
keep Example: If the AMI for Paracetamol tablets is 1.
Then the maximum quantity will be 3 x 1 = 3.
Maximum quantity at the Health Centre:
Maximum quantity at the Health Centre is calculated by

multiplying the AMI by 4.
Example: If the AMI for Paracetamol tablets is 1.
Then the maximum quantity will be 1 x 4 = 4.
DCMO will have a max of one month of stock.
3 Determining the Order quantity = Maximum quantity – Stock on Hand

order quantity (physical count or closing balance at the end of the month)
If the SOH for Paracetamol for DCMO, Hospital and Health
Centre was 2 bottles, the order quantities at these facilities
will be calculated as follows;
Order Quantity for Health Centre: 4 – 2 = 2 Bottles
Order Quantity for Hospital: 3 – 2 = 1 Bottles
Order Quantity for DCMO: 1 – 2 = 0 Bottles (O/S by 1)
Note:
 Central MSL will pick some product quantities to fulfil

the orders for the HC Centres only through the HC
Kit while other quantities if not all of them especially
for non kit products will be picked from the bulk
otherwise if the quantities being sought are in the Kit,
the product will not be supplied from the bulk)
 Hospitals will never receive product through the

Health centre kits
The steps below outline how SCMgr calculates order quantity in an event where there
was a stock out.
45
4 Adjusted AMI Add the total number of issues for the current month and the
determination previous two months.
Example: 6 Bottles of Paracetamol tablets were issued in

January, 5 in February and 1 in March due to a stock out of
20 days.
Total issues is 6+5+1=12

4.
Cont... The adjusted AMI is calculated using the formula below:
Total Dispensed for 3 months

{( ) × 90}⁄3
90 – # of Days Stocked Out
12/(90-20) x 30
5.14 Bottles = 6 Bottles of Paracetamol
5 Determining the Maximum quantity at the Hospital:

maximum Adjusted AMI x Maximum stock level for the hospital
quantity that a
health facility can 6 x 3 = 18 bottles
keep
Maximum quantity at the DCMO:
Adjusted AMI x Maximum stock level for the DCMO
6 x 1 = 6 bottles
Maximum quantity at the Health Centre:

Adjusted AMI x Maximum stock level for the Health Centre
6 x 4 = 24 bottles
6 Determining the Refer to Step 3 above.

order quantity
Note: All the equations used step by step above were used
to derive one master equation which has been fitted in
SCMgr software. This means that all that is needed is an
accurately completed REMMS to generate the orders at
LMU.
E. Placing Emergency Orders for the Health Centre or Hospital Level
The EMLIP Hybrid is designed to prevent emergency orders. However, every system must have a
procedure for placing emergency orders. Emergency orders should only be for pre-printed products. If
stock levels are ever at or below 0.5 months (2 weeks), an emergency order should be placed. When
you receive the Computer-generated R&R, the new Emergency Order Point in actual amounts
will be printed for each product on the form. The following job aid describes the process for placing
an emergency order.
46
JOB AID 8: Placing an Emergency Order at the Health Centre, DCMO or Hospital Level
Task: Placing an Emergency Order for Pre-Printed Products ONLY
Completed by: Pharmacy In-Charge, District Pharmacist, Hospital Pharmacist/Pharmacy

Technologist/Facility In-Charge
Purpose: To order supplies when stock levels are at or below the 0.5 month (2 week)
emergency order point.
When to perform: Any time stock levels of essential medicines and medical supplies are at or
below the emergency order point.
Materials needed: Blank copy of REMMS; REMMS for previous months and a red pen.
Note: If the stock level of one product is at or below the Emergency Order Point, and
an MSL shipment is not expected in the next week, place an order for all Pre-
Printed essential medicines & medical supplies up to the Maximum Stock
Level.
Step Action Notes

1. Tick the “Emergency Order” box located on the top of Use a red pen to write Emergency
each page of the Report for Essential Medicines and Order across the top of each page.
Medical Supplies and write
“Emergency Order” across the top of each page of

the Report for Essential Medicines and Medical
Supplies.
2. IF…   THEN…
47
…you are a health Complete the Report for Be sure to tick the Emergency
centre Essential Medicines and Order box in top right corner of the
Medical Supplies for all Pre- form in red ink. Then follow Job Aid
Printed essential medicines for completing the Report for
and medical supplies you Essential Medicines and Medical
stock and send this form to Supplies found earlier in this
the DCMO. section.
The Reporting Period does not
have to be a full month. Write the
day, month and year for the starting
date of the month you are at or
below EOP of pre-printed products;
up to the day you place an
emergency order.
Please do not include non-Pre-

printed products on the
emergency order. Non Pre-
Printed products are ordered
only during the routine order and
there is no guarantee that you
will be supplied.
…DCMO will reviews Review and approve the SCMgr at LMU will calculate the
and approve its emergency Report for order quantities to bring the stock
REMMs and that of Essential Medicines and levels up to the maximum quantity
the health centres Medical Supplies form and of all Pre-printed products.(except
before submitting to fax it, or have it delivered, to for restricted commodities on HC
MSL-LMU during an the MSL-LMU. REMMs)
emergency order.
…you are a District Complete the Report for all SCMgr at LMU will calculate the
Level 1, or Level 2 or Pre-Printed essential order quantities to bring the stock
3 Hospital medicines & medical levels up to the maximum quantity
supplies you stock and have of all Pre-printed products.
it approved. Then send the
form or have it delivered to When you receive the Computer-
the MSL-LMU. generated R&R, the new
Emergency Order Point in actual
amounts will be printed for each
product on the form.
48
Step Action Notes
3. Hospitals and DCMOs with orders for HCs should
wait for order approval notification from MSL-LMU
and then go to MSL to pick up the order.
The Hospital and the DCMO signs the MSL Dispatch

Note and picks it up with Medicines along with the
computer-generated R&R.
4. Hospitals: Bring emergency order commodities back See Job Aid on “Completing the
to hospital and enter into Essential Medicines & Essential Medicines & Medical
Medical Supplies Stock Control Cards Supplies Stock Control Card.”
DCMOs after retrieving Emergency Order Follow routine receiving

commodities on behalf of the health Centres, should procedures for handling of the
send them to the facilities or alert health centres to MSL Dispatch Note and R&R for
pick up their supplies. emergency orders.
However if it is the Emergency order they have Quantities received as emergency

retrieved for restricted commodities, they should alert orders will be included in the next
health facilities that stocked out to request, otherwise month’s REMMs “Quantity
if they are already pending orders, they should Received during the month
process and deliver them to the facilities. from bulk stock” column.
This task is complete when:

 The Emergency Order box on the Report for Essential Medicines and Medical Supplies is
checked and “Emergency Order” is written across the top of the form.
 If you are a health centre, the Report for Essential Medicines and Medical Supplies has been
completed and sent to the DCMO
 If you are a DCMO, you have received the Report for Essential Medicines and Medical Supplies
from the health centre, have approved it after reviewing, and have faxed or delivered to the
MSL-LMU .
 Emergency orders for the hospitals are approved by the MSL-LMU; orders are picked up at MSL
by hospital staff.
 Emergency order commodity information has been entered in the Essential Medicines & Medical
Supplies Stock Control Cards at all levels.
 Health centre emergency order commodities have been issued to health centres according to
their storage needs and storage capacity.
49
VI. RECEIVING ESSENTIAL MEDICINES & MEDICAL
SUPPLIES
This section of the SOP manual addresses the process for receiving essential
medicines & medical supplies. It highlights the different actions at each level where
essential medicines & medical supplies are received i.e. the MSL Hub, the hospitals,
the health centres and Community Health Workers. Figure 2 below outlines the path of
essential medicines and medical supplies orders from MSL to their intended service
delivery point. Figure 2 also shows what forms accompany each order on its way down
the system.
FIGURE 2: ESSENTIAL MEDICINES & MEDICAL SUPPLIES DISTRIBUTION FLOW
MSL:
Essential Medicine & Medical Supplies
orders/HC kits are pre-packaged for HCs and
Hospitals.
Each order travels with the:

 Computer-generated copy of the
Report & Requisition for EMMs (2
copies)
 MSL Despatch Note (3 copies)
MSL HUB/Staging post:
Pre-packaged essential
medicine orders / HC Kits
from Central MSL arrive for
delivery to the Health
Centres, Hospitals, and DCMO:
NGOs etc. Pharmacy In-Charge at
the DCMO etc receives
Each order travels with the: Essential Medicines &
 Computer-generated copy of the Medical Supplies orders
Report & Requisition for EMMs (2 from the MSL Hub and
copies) manages stocks in store
 MSL Despatch Note (2 copies)
room according to good
storage practices.
Each order travels with the:

 Supply voucher for
EMMs (2 copies)
Hospitals:
Pharmacy In-Charge at the Health Centres:
Hospital etc receives Pharmacy In-Charge at the
Essential Medicines & Health Centre or Post, etc
Medical Supplies orders from receives Essential Medicines
the MSL Hub and manages & Medical Supplies orders
stocks in store room from the MSL Hub and
according to good storage manages stocks in store room
practices. according to good storage
practices.
50
A. Receiving Essential Medicines & Medical Supplies at MSL HUB for
the Health Facilities
If your DCMO submitted the Report for Essential Medicines & Medical Supplies on time
to the MSL-LMU, then the essential medicines order/HC kits (for HC only) for you will
arrive on MSL Hub trucks according to the MSL Essential Medicines & Medical
Supplies distribution schedule. Upon receipt, MSL Hub Manager should complete the
following steps to ensure a proper receipt of commodities:
JOB AID 9: Receiving Essential Medicines & Medical Supplies at the MSL HUB for the
Health Facilities
Task: Receiving essential medicines at the MSL Hub/staging post for the health facilities
Completed by: MSL Hub manager/logistics coordinator
Purpose: To inspect and account for essential medicines and HC kits received
To account for any discrepancies between documents and medicines received
When to perform: Every time essential medicines / HC kits are received
Materials needed: Essential Medicines & Medical Supplies Stock Control Cards for each essential
medicine (if storing medicines on behalf of health centre), pen, products and
documents received, Report for Essential Medicines and Medical Supplies submitted,
MSL Dispatch Note, Computer-generated R&R.
Note: The MSL Hub is not invoved in the distribution of emergency orders unless if the
cause for triggering such an order was caused by MSL (beyond Health facilities )
Each of these steps should be completed for each individual health facility
order. Do not combine health health facility orders or information.
Step Action Notes
1. Locate the There should be 2 copies of each document.
 Computer-generated R&R
 MSL Dispatch Note
The above two forms should always accompany the
order.
2. Conduct a visual inspection of the orders for The number of boxes/HC kits for each
packaging integrity and to ensure that the right health facility should be on the MSL
number of boxes for each health facility/HC kit has Despatch Note
been received. See Chapters VII Section C on Visual
Inspection
Quantities
3. If any discrepancies are noted between the number For example:
of carton boxes/HC kits delivered and those indicated If the number of cartons/HC kits delivered is
on the Dispatch Note, note the discrepancies on the not the same as those indicated on the MSL
MSL Dispatch Note. Dispatch Note, cross out the number and
write the quantity received on the MSL
Dispatch Note.
In every case, note the difference in quantity

and include an explanation on the MSL
Dispatch Note as to why the change was
made.
51
4. Sign the MSL Dispatch Note. There should be two (2) copies of MSL
Dispatch Note. Press hard when writing on
the forms so that the information and
signatures transfer to the second copy.
5. Return a signed copy of the MSL Dispatch Note to
the Central MSL driver.
6. Prepare and deliver orders to each DCMO, health Along with the products, each health facility
centre and hospitals should receive two copies of the computer-
generated R&R.
Note: The MSL Hub will store product in transit
according to good storage practise and
distribution to SDP will be according to the MSL
schedule.

 A visual inspection of the order has been conducted
 Any discrepancies are noted between what is stated on the MSL Dispatch Note and what was
actually received
 The MSL Dispatch Note is signed and returned with the Central MSL driver
52
B. Receiving Essential Medicines & Medical Supplies by the Health Facilities
If the DCMO submitted their last Report for Essential Medicines and Medical Supplies
on time to MSL-LMU, then the essential medicines order will arrive at the district
according to the agreed schedule through the MSL Hub for resupply the health centres.
If the health centres submitted their last Report for Essential Medicines and Medical
Supplies on time to MSL-LMU via DCMO, then the essential medicines order/HC kits
will arrive at the health centre according to the agreed schedule through the MSL Hub.
Health centres on the other hand will receive at the facility or at DCMO when they go to
pick up their requested order for top up or emergency commodities.
If the hospitals submitted their last Report for Essential Medicines and Medical Supplies
on time to MSL-LMU, then the essential medicines order will arrive at the health centre
according to the agreed schedule through the MSL Hub.
Upon receipt of the orders the health facilities pharmacy in charge should complete the
following steps to ensure proper receipt of commodities:
53
JOB AID 10: Receiving Essential Medicines & Medical Supplies by the Health Facility
Task: Receiving essential drugs by the health Facility
Completed by: Pharmacy In-Charge/Facility In-Charge
Purpose: To inspect and account for essential drugs received

To account for any discrepancies between documents and drugs received
To enter newly received essential drugs into Essential Medicines & Medical Supplies
Stock Control Card.
When to perform: Every time essential drugs/HC kits are received
Materials needed: Essential Medicines & Medical Supplies Stock Control Cards for each
essential medicines, pen, products and documents received, REMMS
Submitted for each order received, Computer-generated R&R.
Note:
The same procedures that are used for routine receipt of products should be
used for receipt of emergency orders.
HC kits are not captured on the computer generated R&R
If the health facility receives all of its products (DCMOs, health centre and Hospital), complete
Steps 1 to 7.
If health centre receiving requested top up or emergency commodities from DCMO, complete Steps
8 to 11.
STEP ACTION NOTES

1. Locate the Computer-generated R&R that One copy will be kept at the health centre; the
accompanied the order. other copy will be returned to the MSL Hub..
2. Conduct a visual inspection of the order for See Chapter VII Section C on Visual
product quality and to ensure that the right Inspection
quantities of the right products are Quantities supplied on the R&R should match
received. what you have received.
3. If any discrepancies are noted between The MSL Hub/staging post will have to contact
what was supplied and what was received, Central MSL to inform them that there has
note discrepancies under remarks on the been a discrepancy that should have been
Computer-generated R&R form. Cross out noted on the MSL Dispatch Note.
the incorrect quantity supplied on the R&R
and write the actual quantity received.
4. Next, note any differences between the The computer-generated R&R will include
Computer-generated R&R and the corrections to any mathematical mistakes that
handwritten REMMS submitted as the may have been on the hand-written REMMS.
order.
5. Sign both copies of the computer-
generated Report for Essential Medicines
and Medical Supplies and return one
signed copy to the MSL Hub/staging post.
6. Mark expiry dates clearly with large dark
numbers on each box or carton. Place and
reorganize products on shelves by FEFO.
54
STEP ACTION NOTES
7. Enter and update all stock information on See Job Aid Recording Transactions in the
the Essential Medicines & Medical Supplies Essential Medicines & Medical Supplies Stock
Stock Control Card for each essential drug Control Card found in Chapter VI Section D.
received.
health centre receiving requested top up or emergency commodities from DCMO,

8. Wait for the DCMO to inform you that your
order has been processed.
9. Depending upon the agreement with the Use the Supply Voucher for the first portion
DCMO either wait for them to deliver your received only to note Quantities Received.
supplies or go there and pick them up.
See the Job Aid Requisitioning Essential

Medicines Using the Supply Voucher.
10. Mark expiry dates clearly, with large, dark
numbers, on each box or carton. Place and
reorganize products on shelves by FEFO.
11. Enter and update all stock information on See Job Aid Recording Transaction in the
the Essential Medicines & Medical Supplies Essential Medicines & Medical Supplies Stock
Stock Control Card for each essential Control Card found in Chapter VI-Section D
medicines received. below.

 All supplies received have been inspected and checked against the R&R
 Any discrepancies between the R&R and what has been received are accounted for
 The appropriate signatures have been written on the receipt and copies filed by the Hospital and
the health Centre
 New inventory has been added to the appropriate Essential Medicines & Medical Supplies Stock
Control Cards
 Supplies are clearly marked with expiry date and stored according to FEFO
55
C. Accounting for Stock Received and Stored
Essential Medicines & Medical Supplies Stock Control Cards are used to account for
products held in storage, including their receipt and issue. The following job aid describes
the procedures for maintaining Essential Medicines & Medical Supplies Stock Control
Cards for essential medicines. The same procedures should be followed whether the
Medicines are stored at the health centre, DCMO or hospital.
JOB AID 11: Recording Transactions in the Essential Medicines & Medical Supplies
Stock Control Card
Task: Recording Transactions in the Essential Medicines & Medical
Supplies Stock Control Card.
Completed by: District or Hospital Pharmacist, Health Centre Pharmacy In-

Charge/Facility In-Charge or other staff authorized to complete
the Essential Medicines & Medical Supplies Stock Control Card;
witnessing staff member.
Purpose: To record supplies received.

To record supplies issued.
To record changes in stock balances.
To track supplies moved through non-routine methods (e.g., local
purchase by DCMOs or Hospitals, transfers).
To track losses/adjustments.
When To Perform: When supplies are received or issued.

When supplies are purchased locally.
When supplies are transferred to another facility.
When supplies are transferred in from another facility (Central
MSL or Hub).
When supplies are removed from the storage area for reasons
other than for issuing to clients (e.g., for demonstrations,
expiration, damage).
Materials Needed: Blank Essential Medicines & Medical Supplies Stock Control
Cards, red ink pen for receipts and physical inventories,
blue/black ink pen for issues; and green ink pen for audits.
56
Step Action Notes
1. Complete one Essential Medicines & For example, each of the following is a
Medical Supplies Stock Control Card for separate item and should have a separate
each essential medicine you store. Essential Medicines & Medical Supplies
Stock Control Card:
 Artemether Lumefantrine 120/20
mg tabs pack of 6 tabs



Note: There should be only one stock mg tabs pack of 24 tabs
control card for a given product
whether it is supplied through the HC
kit or received through the pre-packed
order.
2. Enter only one transaction on each line.
IF THEN
Opening a new Essential Medicines & Continue with Step 3.
Medical Supplies Stock Control Card
Entering a Transaction Skip to Step 9.
Steps 3-8: Opening a NEW Stock Control Card
3 In the space provided on the top of the
sheet write the:
a. Name of the Facility
b. Name of the District
4. Code: Enter the code number of the item Example: EM0036
as listed in the MSL catalogue.
5. Item Description: Enter the name and Example: Paracetamol tabs

form of the essential medicine or medical
supply
6. Strength: Enter the strength of the Example: 500 mg
essential medicine
57
Step Action Notes
7. Unit: Write the individual unit for the Example: bottle of 60 tabs, 240 ml bottle
particular essential medicine. Make that
the unit on the card corresponds to the Example:
MSL code on the same form to ensure
accurate transposing or picking of data 1. Coartem ( Artemether
during reporting. Lumefantrine 120/20 mg tabs)
pack of 6,12,18 and 24 tabs in
box of 30
The unit is the treatment course not the

box of 30 which is 6, 12, 18 and 24 tabs.
2. Microgynon/ Oralcon F
(Levonorgestrel/Ethinylestradiol
0.15/0.03mg tab) come in 28
tablets per cycle and usually in
a box of either 2 or 3 cycles
depending on the
manufacturer’s packaging
preference.
For this product a cycle of 28 tabs is the

unit as opposed to the number of cycles in
a particular box
For these two products a treatment

course/cycle is a default unit in SCMgr
software therefore to ensure a proper
order processing at MSL-LMU, facility
personnel should record this on the SCC
to ensure correct capturing of data for
subsequent transposing on the REMMs
during reporting.
8. Maximum Level: Maximum Level is the level above which

Write “3 Months of Stock” if you are a inventory should not exceed under normal
hospital conditions.
Write “4 Months of Stock” if you are a .

health centre
Note: Reorder Level is not used for the
management of Essential Medicines and
Medical Supplies.
STEPS 9 – 17: Recording Stock Transactions

9. Date: Enter the date of the transaction. Example: 27/11/09
10. Reference No: Enter the delivery note The number is on the MSL dispatch note
number of the item issued or received. accompanying the orders
58
Step Action Notes
11. Issued To or Received From:
 If this is the first line of a new Example: “Balance Brought Forward”.
Essential Medicines & Medical
Supplies Stock Control Card for an
existing product, write “Balance
Brought Forward” and continue with
Step 15 in this Job Aid. For recording a physical count, refer to the
 If this is the first line of a new stock Job Aid Conducting a Physical Count in
card for a new product, conduct and Chapter VII-B.
record a physical count.
 If an item is received, enter the Example: MSL or DCMO for local
name of the facility or source from purchases and top up or emergency
which the item was received. commodities or health centre kit
 If an item is issued, enter the name
of the facility to which the item was
issued.
 If you are entering a loss, write
“Loss”.
 If you are entering an adjustment,
write the facility from whom or to
whom the products were Example: Returned by…
transferred, or the nature of the Loaned to ….
adjustment. Local purchase
59
Step Action Notes
12. Received (+): Enter the exact amount of Stock returned from lower level facilities or
the product received on this date in red transferred from one facility to another or
ink. as a local purchase order from the DCMO
should be recorded as an adjustment (see
Step 14 for information on entering
adjustments). Therefore, the only
quantities entered in this column should
be those quantities received from Central
MSL or Hub
Note: Regardless of whether it is through

the HC kit or pre-packed order, the Health
centres should enter all the quantities
received for that product (s)
Example
1. Note Coartem ( Artemether

Lumefantrine 120/20 mg tabs)
strip of 6,12,18 and 24 tabs in
box of 30
For this product enter the exact number of

packs received
2. Microgynon/ Oralcon F
(Levonorgestrel/Ethinylestradiol
0.15/0.03mg tab) come in 28
tablets per cycle and usually in
a box of either 2 or 3 cycles
depending on the
manufacturer’s packaging
preference.
For this product enter the exact number of

cycles regardless of what may be
contained in the box
13. Issued (-): Enter the exact amount of the
product issued on this date in blue/black
ink.
60
Step Action Notes
14. Losses and Adjustments: Enter the Losses are quantities removed from your
exact amount of losses or adjustments to stock due to expiry, theft, or damages.
the inventory on this date. Losses are recorded as (-) negative
numbers.
Explain any losses or adjustments in the
“Remarks” column (See Step 18). Adjustments are quantities of a product
received from any source other than
Central MSL or Hub (e.g. donations,
DCMO or Hospital local purchases,
issues/receipts to/from another facility,
and loans to/from another facility). Always
use a (+) sign to indicate positive
adjustments, and a (-) sign to indicate
negative adjustments.
Adjustments may also be made to correct

mathematical mistakes previously made in
recording. Be sure to indicate if the
adjustment was negative or positive and
note the reason for the adjustment in the
“Remarks” column (see Step 18).
Note: Any error in entering quantity

received or issued or wrong interpretation
of the unit or wrong mathematical
calculation could give rise to these
adjustments in addition to lack of SCC
recording in real time.
15. Balance:
If recording the “Balance Brought

Forward” on a new Essential Medicines
& Medical Supplies Stock Control Card
for an existing product, write the last
recorded balance from the previous
stock control card in the Balance column.
If receiving products: Add the “Quantity

Received” to the Balance from the
previous row and then enter the new
balance.
If issuing products: Subtract the

“Quantity Issued” from the Balance from
the previous row and then enter the new
balance.
If recording a loss or adjustment: Add or

subtract the loss or adjustment quantity
to the Balance from the previous row and
then enter the new balance.
16. Unit Price: Leave this column blank.
61
Step Action Notes
17. Name/Signature: Print your name and
then put your signature.
18. Remarks: Provide a brief explanation for
any loss/adjustment or add any other
comments as needed.
When you have completed both the front and back sides of a stock control card for a
product, attach a new stock control card to the top of the old card. Follow steps 3-8
above and then write the date and the words “Balance Brought Forward” or “B/F” on
the first line. Write the quantity brought forward from the old card in the first
“Balance” space on the new card.
19. If your facility keeps a Stock Control .
Book, be sure to update this book with
the information on the Essential
Medicines & Medical Supplies Stock
Control Cards.
Keep the Essential Medicines &
Medical Supplies Stock Control Card
close to where products are being
stored and issued in the pharmacy.
NOTE: If you use an electronic version of this form ensure that it records all of the same
information as the hard copy Essential Medicines & Medical Supplies Stock Control Card.

 A separate Essential Medicines & Medical Supplies Stock Control Card has been
completed for each essential medicine managed in the store.
 The item description and stock levels have been written at the top of each Essential
Medicines & Medical Supplies Stock Control Card.
 Each transaction is recorded on the Essential Medicines & Medical Supplies Stock Control
Card as it occurs.
 The Essential Medicines & Medical Supplies Stock Control Card is kept close to where the
commodities are stored.
62
VII. STORING ESSENTIAL MEDICINES
Storing is the safe keeping of essential medicines to avoid damage, expiry, and theft. Proper storage
procedures help ensure that storage facilities protect the shelf life of products, that only high-quality
products are issued, and that there is little or no waste due to damaged or expired products. If proper
storage procedures are followed, customers can be assured that they have received a high quality
product.
Storage conditions will affect the quality of the essential medicines being stored. Rooms that are too
hot, stacks of cartons that are too high, and other poor storage conditions can cause damage to
essential medicines, or cause a reduction in shelf life. A well-organized storeroom will simplify a
facility’s work; time will not be wasted trying to find needed supplies
Each commodity has a shelf life which is Shelf life is the length of
specified by the manufacturer. When the time a product may be
medicine reaches the end of its shelf life it has stored without affecting
expired and should not be distributed to patients. the usability and safety
Some essential medicines have short shelf life. of the item.
Because of these short shelf life, it is important
that proper storage procedures are followed, so
that the shelf life is protected.
A. Storage Guidelines
In general, supplies should be protected from sun, heat, and water. Follow manufacturer
recommendations for storing supplies. This information is usually printed on the product carton and
boxes. The following are storage guidelines that should be followed at all facilities.
Storage Guidelines
1. Clean and disinfect the Pests are less attracted to the storeroom if it is regularly
storeroom regularly. cleaned and disinfected. If possible a regular schedule for
extermination will also help eliminate pests. Keep food and
drink out of the storeroom.
2. Store essential Extreme heat and exposure to direct sunlight can degrade
medicines in a dry, well- Essential Medicines and dramatically shorten shelf life.
lit, well- ventilated Temperatures in the storeroom should not exceed 25oC.
storeroom - out of direct Direct sunlight raises the temperature of the product and can
sunlight. reduce its shelf life. Essential Medicines should not be
opened to repackage them. Store supplies in their original
shipping cartons.
3. Protect storeroom from Water can destroy both supplies and their packaging. If the
water penetration. packaging is damaged, the product is still unacceptable to the
patient even when the essential medicine is not damaged.
Repair the storeroom so that water cannot enter. Stack
supplies off the floor on pallets at least 10 cm high and 30 cm
away from walls as moisture can seep through walls and
floors.
63
4. Keep fire safety Stopping a fire before it spreads can save millions of kwacha
equipment available, of supplies and the storage facility. The right equipment
accessible, and should be available; water is able to put out paper fires, but is
functional, and train ineffective on electrical and chemical fires. Place well-
employees to use it. maintained fire extinguishers at suitable positions in the
storeroom. If a fire extinguisher is not available, keep sand or
soil in a bucket nearby. Regardless of the method used, train
the staff in the use of the available fire safety equipment.
5. Store latex products Latex products can be damaged if they are directly exposed
away from electric to fluorescent lights and electric motors. Electric motors and
motors and fluorescent fluorescent lights create a chemical called ozone which can
lights. rapidly deteriorate latex products. Keep latex products in
paper boxes and cartons.
6. Maintain a cold storage, Cold storage (2 to 8 degrees Celsius; 36 to 46 degrees

including a cold chain, Fahrenheit) is essential for
as required. maintaining the shelf life of some essential medicines that
require it. These items are irrevocably damaged if the cold
chain is broken. If electricity is unreliable, the use of
cylindered gas or kerosene-powered refrigeration is
recommended.
7. Limit storage area To prevent theft and pilferage, lock the storeroom and/or limit
access to authorized access to personnel other than authorized staff, and track the
personnel and lock up movement of essential medicines. Access must not, however,
controlled substances. prevent appropriate distribution, thus a spare set of keys
should be kept in the office of the In-Charge. Physical counts
should be conducted on a regular basis to verify inventory
records.
8. Store cartons at least 10 Pallets keep the products off the floor so they are less
cm off the floor, 30 cm susceptible to pests, water and dirt damage. Stack pallets 30
away from the wall and cm away from the walls and each other to promote air
other stacks, and no circulation and to ease movement of stock, cleaning and
more than 2.5m high. inspection.
Do not stack cartons more than 2.5m as the weight of the

products may crush the cartons at the bottom. This will
reduce potential injury to warehouse personnel. If cartons
are particularly heavy, stack cartons less than 2.5m.
At health facilities, where the use of pallets is inappropriate,

shelving is used.
9. Store medical supplies Exposure to insecticides and other chemicals may affect the
away from insecticides, shelf life of medical supplies. Old files and office supplies may
chemicals, old files, get in the way and reduce space for medical supplies or
office supplies and other make them less accessible. Clean the storeroom regularly to
materials. avail more space for storage.
64
10. Store flammable Some medical procedures use flammable products, such as
products separately from alcohol, cylindered gas, or mineral spirits. Such products
other products. Take should be stored away from other products and near a fire
appropriate safety extinguisher.
precautions.
11. Store health FEFO (First-to-Expire, First Out) is a method of managing

commodities to facilitate essential medicines in a storage facility where the Medicines
FEFO procedures and are managed by their expiry date. Medicines that will expire
stock management. first are issued first, regardless of when they were received at
the health facility.
12. Arrange cartons with Identification labels make it easier to follow FEFO, and make
arrows pointing up, and it easier to select the right product. Items should be stored
with identification labels, according to manufacturer’s instructions on the cartons; this
expiry dates, and includes paying attention to the direction of the arrows.
manufacturing dates
clearly visible.
13. Separate damaged or Do not dispense expired medicines to the patients.

expired products from Designate a separate part of the storeroom for damaged and
usable commodities and expired goods. See Chapter VII Section D and Chapter VII
remove them from Section E for instructions on handling damaged or expired
inventory immediately products and return or disposal of Medicines.
and dispose of them
using established
procedures.
B. Conducting a Physical Count

A physical count is an actual count of the quantity of each essential medicine or other health commodity
at any given time. It is one of the most frequent activities in health facilities.
A physical count of essential Medicines should be conducted at the end of each

month and or when you suspect products have been tempered with/lost.
Physical count information comes from the quantities on the shelf in the storeroom which is then
recorded on the Essential Medicines & Medical Supplies Stock Control Card.
Opened bottles or packages whose seal is broken should not be included in a physical count. Count and
record only full bottles and packages
A physical count of the products in the storeroom is done to verify that the stock balance found on the
Essential Medicines & Medical Supplies Stock Control Card shows the correct number of usable
Medicines that are available in the storeroom. If the quantity on the Essential Medicines & Medical
Supplies Stock Control Card does not match the quantity on the shelf, the Essential Medicines &
Medical Supplies Stock Control Card should be updated and an adjustment entered. See Step 2i. of the
Job Aid below for information on entering adjustments on the Essential Medicines & Medical Supplies
Stock Control Card.
Instructions on how to complete a physical count are provided in the Job Aid below.
65
JOB AID 12: Conducting a Physical Count
Task: Conducting a Physical Count
Completed by: District or Hospital Pharmacist, Health Centre Pharmacy In-

Charge/Facility In-Charge
Purpose: To verify the stock level of a medicine in the store at the time of
physical count
To detect errors in medicine management records
To detect medicine loss in the store
When to perform: At the end of each calendar month, and any time you suspect that
products have been lost
Materials needed: Essential Medicines & Medical Supplies Stock Control Cards,
calculator, pencil, red ink pen, paper
Prior to a Physical Count, these tasks should be completed:
 Set a date at the end of the month for the physical count. Select the physical count
team. Participants should be selected from the facility. The Pharmacy In-charge at
DCMO, and Pharmacist should be members of the team.
 Do not issue Medicines during the physical count or count receipts on the day of the
physical count, except in an emergency. Receipts during the physical count will be
recorded on the Essential Medicines & Medical Supplies Stock Control Card the
following day and counted in the next physical count.
 Make sure that the Essential Medicines & Medical Supplies Stock Control Cards for the
Medicines are updated to the day of the physical count. If the Essential Medicines &
Medical Supplies Stock Control Cards are not completed, complete them.
 Prepare the store, making sure all cartons are neatly stacked and partial cartons are
clearly visible.
 Reorganize products by FEFO before counting. Mark expiry dates clearly, with large,
dark numbers, on each box or carton. This step should have been taken during routine
receipt and management of Medicines.
 Visually inspect the Medicines as you organize them for counting. See section on
Visual Inspection for more information.
 Separate any expired or damaged Medicines.
 Be sure to have the Essential Medicines & Medical Supplies Stock Control Cards for
the Medicines to be counted.
THE STORE ROOM IS NOW READY FOR THE PHYSICAL COUNT.
66
Step Action Notes
1. Count the usable Medicines. The units that should be used are bottles.
Make sure that you count units that have
A. Count unopened/complete cartons first. the same name, same dosage, same
Multiply the number of cartons by the formulation, and same pack size.
number of units of issue (i.e. bottles or
packs for Essential Medicines) in the carton. Example: Metronidazole 400 mg tabs
This will give you the total number of bottles bottle of 1000 tabs should be counted
or packs in the carton together.
A. Next count the boxes inside the open Example:

cartons. If an open carton contains I have 4 unopened cartons with each one
unopened boxes, count the boxes and containing 200 bottles.
multiply the number by the number of 4 x 200 = 800 total bottles in the
bottles in a box. This will give you the unopened cartons
total number of the bottles in the
unopened boxes. I also have 1 opened carton with 10
unopened boxes inside. Each unopened
B. Count all the units that are in open box contains 5 bottles.
boxes. 10 x 5 = 50 total bottles in the unopened
boxes.
C. Add up the total units from the unopened
cartons, unopened boxes, and in open I also have counted 19 bottles in an open
boxes in the storeroom. box/bottle on a shelf.
800 bottles from unopened cartons

50 bottles from unopened boxes
+ 19 bottles from opened boxes,
869 total bottles = Actual Quantity on
Hand.
2. Update the Essential Medicines & Use a red pen when completing these
Medical Supplies Stock Control Card by steps.
completing the following actions:
2a. Circle the last calculated Stock Balance. If Example: Circle “875”, which is the
this is the first entry on the Stock Control previous, calculated Stock Balance.
Card, skip to Step 2c.
2b. Draw a line under the row that shows the This will highlight the physical count
last calculated stock balance. information from the rest of the
information on the Essential Medicines &
Medical Supplies Stock Control Card.
2c. Date: Write the date of the physical count.
2d. Issued to or Received from: Write
“Physical Count”.
2e. Received (+) and Issued (-): Leave these
columns blank.
2f. Losses and Adjustments: Leave this Any losses and adjustments will be
column blank until after you complete Steps recorded after the physical quantity has
2g and 2h below. been recorded.
2g. Balance: Write in the result of the physical This is the actual quantity on hand in the
count. storeroom only.
67
Step Action Notes
2h. Compare the previously recorded stock
balance that you just circled to the
Physical Count balance.
If the previously recorded stock balance

(circled in the line above) matches the
physical count, skip to Step 3 below.
If the previously recorded stock balance

(circled in the line above) does not match
the physical count, continue with Step 2i
below.
2i. Determine your Loss or Adjustment. Example calculation:
Subtract the calculated Stock Balance
(previously circled) from the Actual Quantity 869 Actual Quantity on Hand
on Hand. - 875 Calculated Stock Balance
-6 Difference (Loss of 6 bottles)
If your result is a negative quantity you

have suffered a loss of the medicine.
If your result is a positive quantity, you

have more units of the medicine in
stock than you had recorded on the
Essential Medicines & Medical
Supplies Stock Control Card.
Sometimes the difference is due to a

mistake while counting during the
physical count or due to a mathematical
error in the Essential Medicines & Medical
Supplies Stock Control Card. Repeat the
physical count if you believe there was a
mistake in the counting, and check for
mathematical errors on the Essential
Medicines & Medical Supplies Stock
Control Card. If mistakes are not found,
the difference must be recorded on the
Essential Medicines & Medical Supplies
Stock Control Card.
2j. Record the Loss or Adjustment. On the Example;
Essential Medicines & Medical Supplies Losses/Adjustments -6
Stock Control Card. In the Losses and
Adjustments column, write the answer that If the adjustment is positive, write a plus
was calculated in step 2i. The (+) sign next to the number, example +3
loss/adjustment is documented in the same
row as the transaction of the physical count. If the adjustment is negative, write a
Write in red pen, the quantity of the negative (-) sign next to the number,
loss/adjustment. example –3
All Losses/Adjustments should be

documented, and the difference in stock
explained in the Remarks column
3. Unit Price: Leave this column blank.
68
Step Action Notes
4. Name/Signature: Print your name and write
your signature.
5. Remarks: Write any comments related to Examples:
losses/adjustments noted during the
physical count. Negative adjustments (losses): expiry,
damage, not found at physical count.
Positive adjustments: found at physical

count.
6. Draw a line under the row of the Essential This will complete the differentiation
Medicines & Medical Supplies Stock Control between the physical count information
Card where you recorded the physical and the rest of the information on the
count. card.
7. Make sure the stocks are arranged back
in their appropriate place according to
FEFO.
8. Keep each Stock Control Card with its
matching product in the storeroom.

 The Actual Quantity on Hand in units of the Medicines has been counted and
recorded in the Balance column on the Essential Medicines & Medical Supplies
Stock Control Card.
 Losses /Adjustments have been calculated and recorded in the Losses and
Adjustments column on the Essential Medicines & Medical Supplies Stock Control
Card. (If applicable)
 Losses/Adjustments have been documented and the difference in stock explained
in the Remarks column. (If applicable)
C. Visual Inspection
To protect the quality of Essential Medicines, it is important Visual inspection is the
to conduct visual inspections of the products. A visual process of examining
inspection should be completed each time products are products and their
handled: when receiving, issuing, or dispensing supplies, or packaging by eye to
when conducting a physical count. look for problems in
product quality.
When conducting a visual inspection, be sure to check the
following:
Package and product integrity: check for damage to packaging (tears, perforations, water
or oil) and products (broken or crumbled tablets, broken bottles).
Manufacturing defects: incomplete supply, missing or illegible identification information.
Labelling: Make sure that products are labelled with the date of manufacture or expiration,
lot number and manufacturer’s name.
For tablets and capsules, be sure that:
 Tablet/capsules are identical in size, shape and colour

 Tablet/capsule markings are identical (scoring, lettering, numbering)
 There are no defects such as spots, cracks, stickiness, etc.
69
 There is no unexpected odour when bottle is opened
 There are no broken tablets or no empty, open, or broken capsules.
D. Handling Damaged or Expired Stocks
Logistics systems try to minimize the amount of damaged or expired stocks. However, if expired or
damaged stocks are found at any time during a visual inspection or physical count (or upon receipt of a
consignment); these stocks should be removed from the inventory. These stocks should be moved to a
separate place, so that they cannot be issued or used. The following JOB AID explains how to handle
damaged or expired products.
JOB AID 13: Handling of Damaged or Expired Products
Task: Handling of damaged or expired products
Completed by: Pharmacy In-Charge, District Pharmacist, Hospital Pharmacist or other

authorized person
Purpose: To remove unusable products from storage so they are not distributed to
clients.
When to perform: Whenever damaged or expired products are known or discovered
Materials needed: Essential Medicines & Medical Supplies Stock Control Cards for the
damaged or expired products, calculator, pencil, and blue/black pen.
Step Action Notes
1. Store damaged or expired products separately from
usable stocks.
Step Action Notes
2. Write Damaged or Expired Stock on the box or

shelf.
3. IF  THEN
Damaged or  Record the quantity of See job aid “Completing the
expired products expired or damaged stock as Report for Returning Products”
were found a loss on the appropriate
during a visual Essential Medicines & Products may be returned to the
inspection or Medical Supplies Stock supplier (MSL, DCMO) when the
routine physical Control Card and subtracts driver brings the next order.
count. the quantity from the
Balance On Hand column.
 Complete the Report for
Returning Products.
70
Damaged or  Do not accept the products See job aid “Completing the
expired goods at your facility; return them Report for Returning Products”
were found upon with the driver
receipt of a  Complete the Report for
consignment Returning Products
4. If you are at a health centre, notify the DCMO.
If you are at a DCMO or hospital, notify MSL.

 Damaged or expired stock has been separated from usable stock.
 Essential Medicines Stock Control Cards have been updated.
 Appropriate authorities have been notified.
 Report for Returning Products has been completed (if necessary).
71
JOB AID 14: Completing the MSL Returns Authorization Form
Task: Completing the MSL Returns Authorization Form
Completed by: Pharmacy In-Charge, District or Hospital Pharmacist; and any other
person authorized to perform this task.
Purpose: To receive authorization to return unusable products to MSL in order

to proceed with the completion of the Report for Returning
Products form.
When to perform: Whenever there are surplus products with at least 6 months shelf life to
be returned to MSL for redistribution.
Materials needed: A blank MSL Returns Authorization Form calculator and pen.
Note: The MSL Returns Authorization Form must be submitted to and approved by MSL before
sending the products back to MSL. Once MSL approves the return of products by signing the
MSL Returns Authorization Form, then facilities can complete the Report for Returning Products
and send it along with products to be returned to MSL (See Job Aid below.)
If products are in surplus, contact your supervisor to determine if the products should be
returned to MSL for re-distribution to other facilities. Or you may be notified by MSL-LMU of
surplus quantities of product to be returned to MSL for redistribution.
Step Action Notes

1. Institution Name: Write the name of your
facility.
2. Name of Requesting Officer: Write the full
name of the officer requesting authorization
3. Designation: Write the title of the requesting
officer
4. Date: Write the full date day/month/year.
For each product being returned:

5 Product Detail: Enter information on the
product being returned.
No.: Enter the MSL catalogue number
72
Step Action Notes
5 Description: Write a description of the item
cont.... being returned, including name, form and
strength
Pack Size: Indicate the pack size of the
product
Qty: Indicate how many of each pack size of
a product is being returned.
Expiration Date(s): Write the expiration
date(s) of all commodities being returned.
Reason for return: Write a short
explanation identifying the reason for return.
6. Other comment from the customer: Enter
any other notes or comments to clarify the
return.
7. Submit the Returns Authorisation Form to Health centres should send the
the appropriate place. Returns Authorisation form to the
DCMO, who should submit the form to
MSL (by fax or mail).
DCMOs and hospitals must submit the
form directly to MSL
8. Await the arrival of the approved
authorization form before proceeding to
complete the Report for Returning
Products or returning any commodities to
MSL.
 The name of the facility and officer requesting authorisation for returning commodities is filled
in.
 The product detail for the product for which authorisation is sought is filled in.
 Any additional notes to clarify the request are indicated.
 The person filling out the report has written his/her name, signature and the date.
 For a health centre the form is sent to MSL via the DCMO. For a DCMO or hospital, the
form is sent directly to MSL
73
JOB AID 15: Completing the Report for Returning Products
Task: Completing the Report for Returning Products
Completed by: Pharmacy In-Charge, District Pharmacist,

or Hospital Pharmacist; the person transporting the returned products
Purpose: To track products returned to MSL from health facilities.
When to perform: Whenever products are damaged, expired, no longer in use or are in surplus
with at least 6 months shelf life, that needs to be returned to MSL
Materials needed: A blank Report for Returning Products, calculator and pen.
Note: This form has three copies (an original and two copies). Press hard on the top copy so that the
writing appears on all the carbonated copies clearly. Use a pen.
If products are in surplus, contact your supplier or supervisor to determine if the products
should be returned for re-distribution to other facilities.
IF THEN
YOU ARE A HEALTH CENTRE RETURNING SUPPLIES TO A
DCMO; OR YOU ARE A HOSPITAL RETURNING YOUR  COMPLETE STEPS 1-10
OWN SUPPLIES TO MSL
YOU ARE A DCMO RECEIVING SUPPLIES FROM A

HEALTH CENTRE  COMPLETE STEPS 11-12
YOU ARE A DCMO RETURNING SUPPLIES TO MSL

FROM ONE OR MORE HEALTH CENTRES IN YOUR  COMPLETE STEPS 13-14
DISTRICT
Step Action Notes

1. Sent to: Write the name of the facility to Health centres should return products to the
which the products are returned. DCMO.
DCMOs and hospitals should return supplies to

MSL, if necessary. Supplies do not have to be
returned to MSL if DCMOs and/or hospitals
have the ability and authority to reallocate the
products to another facility themselves.
2. Facility returning products: Write the
name of your facility.
For each product being returned:
3. Product Description: Write the name, Example: Paracetamol 500mg tablets
strength, and form of the product being
returned.
4. Quantity Returned: Write the quantity Example: 10 bottles of 1000 tabs
and unit of the product that you are
returning.
74
Step Action Notes
5. Expiry Date: Write the date of expiry of If there are multiple expiry dates for the same
the products. product, list each product with a different
expiration date separately.
Example:
 Paracetamol 500 mg tabs
Exp Date: 12 April 2009
Exp Date 27 May 2009
Exp Date 18 June 2009
6. Reason for Return: Write the reason for Example:
which you are returning the product(s). surplus, damaged, expired, etc.
7. Name of person returning products/
Date / Signature: Print your name, the
date and sign your name.
8. Name of Carrier / Date / Carrier’s
Signature: Ask the person who is
transporting the products from the
sending facility to the receiving facility to
print her/his name and date, and to sign
her/his name.
9. Comments: The person transporting the
products can write in any comments
related to the transaction.
10. Send the report (and products) to the Health centres should send the report and the
appropriate place. unusable products to the DCMO.
The facility originating the report should DCMOs and hospitals must return viable
retain the bottom copy. products to MSL.
WHEN RECEIVING RETURNED PRODUCTS, STEPS 11-12 SHOULD BE FOLLOWED
11. Receiver’s Name / Date / Receiver’s
Signature: The person who receives the
products at the receiving facility prints
her/his name and date, and signs her/his
name.
12. Comments: The receiver writes any
comments as appropriate.
WHEN A DCMO IS RETURNING UNUSABLE PRODUCTS RECEIVED
FROM HEALTH CENTRES IN THEIR DISTRICT TO MSL, STEPS 13-14 SHOULD BE FOLLOWED
13. Keep all products returned from various Keep these stocks separate from all other
health facilities until the MSL truck arrives inventory. If expired or damaged, these
for the next scheduled delivery. products should not be distributed to clients.
14. Name of Carrier / Date / Carrier’s When the MSL truck arrives, have the Carrier
Signature: Ask the person who is sign for each Report for Returning Products for
transporting the products from the each health centre.
sending facility to the receiving facility to
print her/his name and date, and to sign
her/his name.
Retain one copy of the Report for

Returning Products.
75
Step Action Notes
 The name of the facility to which products are being sent and the name of the facility returning
products are filled in.
 The description and quantity of products being returned, the expiry date and reason for non-use
are filled in.
 The person filling out the report has written his/her name, signature and the date.
 The person transporting the products has written his/her name, signature and the date.
 The person receiving the products has written his/her name, signature and the date.
 A copy of the form is kept at the facility where the form was completed and one copy is sent to
the appropriate party.
E. Disposal Guidelines
 Authorized hospitals and District Health Offices (DCMO) may dispose of unusable (expired
or damaged) essential medicines following Government of the Republic of Zambia
guidelines.
 Unusable essential medicines from health centres must be sent to authorized DCMOs and
hospitals for disposal.
 Refer to the Environment Council of Zambia (ECZ) Technical Guidelines on the Sound
Management of Health Care Waste.
VIII. MONITORING AND SUPERVISION

A. Monitoring, Supervision and Providing Feedback
Three of the most important responsibilities In-Charges at respective levels district-level

personnel carry out are monitoring of activities and systems, supervision of personnel, and
providing feedback to staff. These three responsibilities form the supportive backbone of an
effective logistics system. But what is it that makes a logistics system effective? In brief, we
know that an effective logistics system is one in which the right products, in the right quantities
and in the right condition are at the right place, at the right time and at the right cost. These
are the six rights of every Zambian. Health personnel responsible for the work of others are
therefore in a unique position to make sure that this “effectiveness” happens – and not just
once, but all of the time.
When it comes to the monitoring and supervision of the EMLIP Hybrid, there are several
reasons why personnel need to be supervised and logistics activities need to be monitored on
a regular basis:
 Essential Medicines can be expensive commodities and cannot be wasted.

 Information about the kinds and quantities of Medicines dispensed/issued is critical for
managing an uninterrupted supply of Medicines.
 EMLIP HYBRID has been designed to follow certain policies and procedures. For
example, DCMOs reviews the REMMS from health centres before submitting them to
MOH-LMU at MSL. Constant support and guidance from supervisors is therefore
needed to keep the system performing effectively.
 Staff might need in-service training to refresh or add to their knowledge and skills.
 Staff needs to know how the work they do contributes to Zambia’s overall efforts to
improve the quality of health care in Zambia.
In general, most logistics systems and activities can be monitored by reviewing reports. These
reviews can frequently be done from an office. For example, checking reports can determine if
a facility is maintaining stock balances between maximum and minimum levels, or if there are
76
unusual quantities of supplies expiring or lost. Likewise, a review of reports can reveal
whether demand for Essential Medicines is increasing or decreasing.
Effective supervision, on the other hand, can only take place in the presence of the facility
staff. Supervisors should plan to spend time supervising and providing on-the-job training
during each supervisory visit.
B. Monitoring at the Provincial Level

Principal Pharmacists supervise Districts and Level 2 and 3 Hospitals. They have the
responsibility to monitor the system at these levels. It is also the responsibility of the Principal
Pharmacist to provide OJT and ongoing training to the Districts and level 2 and 3 Hospitals.
The tools available to the Principal Pharmacist include feedback reports that DCMOs receive
from LMU.
C. Monitoring at the District Level
While monitoring the logistics system from the health centre Report for Essential Medicines
and Medical Supplies look for the following indicators:
 Timeliness of reports from the health centres: Did the reports arrive within the
designated time period? (i.e., in time so that the District Pharmacist is able to Review
them before sending them to LMU at MSL)
 Accuracy of the reports: Do the closing balances from previous month’s report equal
the beginning balances of the current report? Do the numbers reported make sense?
 Completeness of reports: Is all data required to calculate orders included in the
reports?
 Completeness of reporting: Are reports received from all the facilities that should
report?
 Stock outs: Do the reports indicate any stock outs of any supplies?
 Stocked between maximum and emergency order levels: Are the stock levels within
the designated maximum and reorder levels for that facility?
 Losses: Are there losses occurring at the facility-What type of loss e.g. (theft, damage,
expiry)
 Emergency Orders: Are health centres placing frequent emergency orders?
Problems that are found during routine reviews of reports received should be discussed during
the next supervisory visit to the facility concerned. Or at any time in contact with the facility in-
charge
D. Using and Interpreting Feedback Reports
Data that are reported to the MSL-LMU through the Report for Essential Medicines and
Medical Supplies and Report for Essential Medicines and Medical Supplies are entered into
the Supply Chain Manager Software. Several reports are generated from the database and
used for program management, procurement, monitoring and supervision. The following is a
sample of the feedback reports that may be disseminated to program managers and
implementers for monitoring and supervision. A brief description of how these reports may be
used is also included. Representative feedback reports include:
 Computer-generated R&R, errors Bolded

 Facilities Stocked According to Plan
 Stock Imbalances By Facility
 Facilities Stocked Out
77
 Non-Reporting Facilities
 Discrepancy between Quantity Supplied and Quantity Received
 Issues Graphs
When appropriately used, feedback reports can identify logistics system strengths and areas
for improvement. They can be used by supervisors to monitor the system in their district or
province, motivate staff who implements the system, and to identify areas where more effort is
needed to improve staff performance in managing the system.
Computer-generated R&R, errors Bolded

Bolded numbers on this R&R will reflect errors found by the Supply Chain Manager software
after inputting data from the submitted R&R. The bolded numbers tell the correct quantities
that should be ordered and what is supplied by MSL. The new computer generated EOP for
the coming reporting period is also found on this form which is expressed in actual quantities
of products. Comments at the bottom of the page will reflect additional findings worth noting
Facilities Stocked According to Plan
A sample of the Facilities Stocked According to Plan report can be found below. This report
summarizes, for each province or district, or the country as a whole, the number, percentage,
and names of facilities whose stock levels are within the accepted norms, being neither
stocked out nor overstocked at the time a report is submitted. Program managers, including
District Pharmacists, Principal Pharmacists, and MSL-LMU Staff, can use this report to see
how well facilities are able to maintain stock levels between the max/min levels for the EMLIP
Hybrid.
When appropriate stock status has been achieved, personnel should be congratulated on their
ability to effectively maintain sufficient inventories of products. If here are difficulties in
maintaining the appropriate stock levels, a number of potential weaknesses could be causing
the problem. These could include late or incorrect orders, long lead times in order processing
and delivery, or excessive damage or expiry of product. Program managers and supervisors
would investigate the potential causes of problems and take action to solve the problems
identified.
Facilities Stocked According to Plan

Period: January 2009-May 2009
Facility Type All
Reporting Group All
Total Facilities: 126

No. Stocked According to Plan: 98
Percent: 77.8%
Facility Facility
Code Facility Code Facility
Zambezi General
LUSA003 Lusaka Health Centre A ZAMB004 Hospital
St. Dorothy Health
LUSA006 Lusaka Level 1 Hospital SOLW001 Centre
Stock Imbalances by Facility
78
This report summarizes for each province or DCMO, or the country as a whole, the facilities
who reported a stock out, have product below their minimum or overstock as calculated from
their recent Report for Essential Medicines and Medical Supplies. Program managers,
including District Pharmacists, Principal Pharmacists, and LMU Staff, can use this report to
see at a glance how many facilities have experienced a stock out, an overstock or been below
minimum. Any facilities appearing on this report would be contacted or visited in order to
determine the cause of the stock imbalances. Depending on the cause of the stock imbalance,
the appropriate corrective measure(s) would be taken, in order to avoid stock imbalances in
the future.
Facilities Stocked Out
This report summarizes, for each province or district, or the country as a whole, the facilities
who reported a stock out on their recent Report for Essential Medicines and Medical Supplies.
Program managers, including District Pharmacists, Principal Pharmacists, and LMU Staff, can
use this report to see at a glance how many facilities have suffered a stock out. Any facilities
appearing on this report would be contacted or visited in order to determine the cause of the
stockout(s). Depending on the cause of the stock out, the appropriate corrective measure(s)
would be taken, in order to avoid stock outs in the future.
Facilities Stocked Out

Period: January 2009-May 2009
Facility Type All
Reporting Group All
Total
Facilities: 126
No. Stocked out: 20
Percent: 15.9%
Facility Facility
Code Facility Code Facility
LUSA003 Lusaka Health Centre A ZAMB004 Zambezi General Hospital
LUSA006 Lusaka Level 1 Hospital SOLW001 St. Dorothy Health Centre
NB: Facilities stocked out report based on indicator products.

Non-Reporting Facilities
The Non-Reporting Facilities report (below) indicates those facilities who had not submitted a
Report for Essential Medicines and Medical Supplies for the most recent reporting period.
Depending on the results as reported, corrective measures might be instituted at the health
centre (in the case of individual centres failing to submit R&Rs on time) or at the district level
(in the case of entire DCMOs not submitting the R&R on time).
79
Non-Reporting Facilities
Run Date: 03-Sep-09
Run Time 12:45 PM
Directorate of Planning
All Health Centre s Page: 1 of 1
Period: Aug 2009

Supplying Facility
Facility Type Location
Medical Stores Limited
Boma Health Centre HC Chomgwe
Chilubula Mission Health Centre HC Kasama
Kasama Rural Health Centre HC Kasama
Location Health Centre HC Kasama
Lukupa Health Centre HC Kasama
Mukunka Rural Heath Centre HC Kazungula
Kalulushi Health Centre HC Kitwe
Shimikanami Health Centre HC Kitwe
Chimwemwe Health Centre HC Kitwe DCMO
Ndeke Health Centre HC Kitwe DCMO
Kakoso Health Centre HC Lufwanyama
Lufwanyama Health Centre HC Lufwanyama
Bauleni Heath Centre HC Lusaka
Chelstone Heath Centre HC Lusaka
George Heath Centre HC Lusaka
Kalingalinga Health Centre HC Lusaka
Kamwala Heath Centre HC Lusaka
Kanyama Heath Centre HC Lusaka
Matero ref Heath Centre HC Lusaka
Mutendere Heath Centre HC Lusaka
UNZA Heath Centre HC Lusaka
Masaiti Boma Health Centre HC Masaiti
Masaiti Council Health Centre HC Masaiti
Mishikishi Health Centre HC Masaiti
Mpulungu Health Centre HC Mpulungu
Kamuchanga Health Centre HC Mufulira
Nakonde Rural Health Centre HC Nakonde
Non-Reporting Facilities 27
Active Supplied Facilities 159
Non-Reporting Percent 17%
Total Non-Reporting Facilities 27
Total Active Facilities 160
Total Non-Reporting Percent 17%
80
Discrepancy between Quantity Supplied and Quantity Received
The Discrepancy between Quantity Supplied and Quantity Received report highlights
differences between quantities reported as shipped by Central MSL and quantities reported
received by MSL Hub, hospitals and health centres. The same information is included in the
Computer-generated R&R, although in this format the discrepancies are highlighted. Using
this report, commodity managers can identify cases where losses are occurring during the
delivery process and take action as appropriate.
Reporting Period: June-09
Facility: Lusaka Health Centre A

Facility Code: 439023
Supplying Facility: MSL
Product Code Description Quantity Supplied Quantity Received

20045 Paracetamol 500 mg tabs; 1000 tabs 300 200
54309 Amoxycillin 250 mg tabs; 1000 tabs 400 380
Artemether Lumefantrine 20/120 mg tabs; 24
23435 X 30 160 200
86567 Ferrous Sulphate 200 mg tabs; 1000 tabs 30 25
Issues Graphs
Amoxycillin Caps
7000
6000
5000
4000
Amoxycillin Caps
3000
2000
1000
0
July August September October November
81
Amoxycillin Caps
7000
6000
5000
4000
Amoxycillin Caps
3000
2000
1000
0
July August September October November
E. Supervising the Health Centres
The following list provides suggestions for how to conduct logistics supervision during a
supervisory visit to health centres, so that the visit is useful for the person doing the
supervision and for the people who are receiving the visit as well.
1. These suggestions can be applied when the supervision is done from a higher level (like
the DCMO), or when it is done within the facility by the In-Charge:
 Conduct supervisory visits based on objective criteria such as standard operating
procedures, agreed-upon job descriptions, the work plan of a given unit, the objectives
of the supervisory visit, and the calendar of visits.
 Select the most important observations; organize observations into those that are
general observations and those that are specific to the person supervised; provide
feedback by giving specific examples of things that need changing and do this in a
non-threatening, supportive manner.
 Help the person being supervised to participate in the process: It is important to help
the person being supervised to participate because it lets him/her know that his/her
opinions are important, that he/she is part of the solution and can do something about
resolving the problem.
 Be ready to provide technical or other assistance when needed. Offer help without
removing responsibility for action. When you provide on the job training or coaching do
not take over the actual execution of the activity.
 Hold organized and productive meetings with an agenda that meets the needs of the
participants (health workers, District supervisors, etc.). Be conscious of workers’ needs
that can be responded to.
 Show interest in employees but give them independence and responsibility.
 Reinforce positive behaviour!
 Take appropriate measures to correct negative behaviour!
 Give feedback in a timely manner.
 If discipline is required, be specific and consistent with all employees.
82
 Ensure that all tasks that are appropriate for the removal of expired/damaged/excess
supplies are undertaken.
2. Logistics indicators at the facility that can be observed by the supervisor:

 Orderly arrangement in the stores and the dispensing area
 Proper record keeping
 Stores ledgers are up to date
 Dispensing registers in place
 Cleanliness of the stores
 Cleanliness of the staff
 Adequate storage space
F. Providing Feedback
The supervisor has two important functions: to get the work done through his/her staff and to
keep the team together so that everyone is doing his/her part to contribute to an effective
EMLIP Hybrid. These two functions require leadership, good communication with staff and
motivation of staff. One of the most important ways of accomplishing all three of these
responsibilities is through providing staff with appropriate feedback.
The purpose of providing feedback to staff is to support their capacity to do the right things
and to do them right. For example, a Health Centre In-Charge who never sees or hears from
his/her supervisor may simply never know whether he/she is making a difference or whether
he/she is doing the right things. On the other hand, a supervisor who is in touch with the
Health Centre In-Charge and praises him or her for getting the R&R in on time is supporting
the In-Charge to continue with the behaviour of getting the R&R in on time. We all need to
receive feedback that we are or aren’t on the right track and that we are valued as contributors
to the system. It’s motivating to be recognized and acknowledged.
For the supervisor of staff involved with logistics, there are different kinds of feedback that can
and should be used:
Analytical
 Health Centres, in addition to getting what they ordered, should receive feedback
about the overall national picture with respect to essential medicines, where their
district fits within this picture and where their health centre fits within the district. In
other words, they should be able to see how their health centre compares with the rest
of Zambia. The MSL-LMU will assist in providing such information to DCMOs to share
with their health centres.
 The District Pharmacist can aggregate data for the district for comparison with other
DCMOs, but can also summarize data per facility for comparison within the district.
Evaluative
 The District Pharmacist or other district-level authority can provide the health centres
with feedback that is more evaluative. That is, they can make a judgment about what
the health centre has done or not done and let the health centre know. The objective of
such feedback is to motivate and/or sustain good performance.
 The In-Charge of a health centre can let a staff member know that his/her performance
is great or is lacking, and discuss the reasons for both. Getting to the reasons for
performance that is lacking is critical for deciding how best to deal with poor
performance. Again, the objective is a supportive one. The supervisor is only
interested in giving the staff member all of the tools needed to do what is right and then
to do it the right way.
83
Probing/Understanding
 A supervisor at times just wants to have a better understanding of what’s going on.
He/she may have to ask questions and to probe a bit to get to the bottom of the issue.
Again, it’s not a matter of investigating, but more a matter of finding out how best to
support the staff member.
 This kind of feedback takes good listening skills. That is, the supervisor must be willing
to be quiet and listen to the staff member, ask questions for clarification, and ensure
complete understanding before saying anything. Just doing this can be a motivating
factor in itself.
Providing feedback is key to the success of a logistics system; and an effective EMLIP Hybrid
is key to whether a client lives or dies. Therefore, providing feedback is directly related to the
well being of the citizens of Zambia.
G. Conducting a Supervisory Visit

Supervision should be an integral part of the work at the district-level. As we have said,
however, it is not possible to supervise by reviewing reports. Visits to health centres are
required. However, they need to be planned and conducted systematically and not in a
haphazard way. Resources for supervision are scarce. It’s important to use them wisely and
for the purpose of supporting effective logistics systems. What follows is a checklist of
considerations for conducting a supervisory visit.
Supervision Checklist for Visit to Health Centres
District:
Health Centre Name:
Date of supervision visit:
Date of last supervision visit: _____________________
Name and title of the staff member(s) interviewed:
Name and title of the supervisor:
Preparation for the visit:
1. Prepare a schedule for the visits to the health centres

2. Develop an objective for each of the visits
3. Arrange for transport and allowances at least one week prior to visit.
4. Notify the health centres of your visits after you have confirmed transport.
5. Review the report from the last visit and the recommendations that were made.
6. Take along the SOPs for the EMLIP Hybrid, this checklist and a calculator.
Upon arriving at the facility:
1. Meet with the facility in-charge, make introductions, give your objective(s) for the visit,
and ask for permission to visit with the staff
2. Assemble the staff when appropriate.
3. Make any necessary introductions.
4. Explain the objective(s) of your visit.
5. Enquire and verify if the essential medicine SOPs are available in the facility and used.
84
PURPOSE: 1. To ensure that planned logistics activities are being carried out
properly and according to schedule;
2. To ensure that all records are correctly maintained and reports
are submitted in a timely manner;
3. To ensure that established logistics guidelines and procedures
are being followed;
4. To ensure that logistics personnel are doing their jobs properly,
and if not, why not.
5. To improve the performance of logistics personnel.
WHEN TO PERFORM: If possible, each logistics staff member should be visited quarterly. If
this is not possible, then visits should be done at least twice per year.
Item
Are logistics records being filled in completely and accurately? Are reports being
submitted in a timely manner and to the appropriate places?
1. _______
(If not, do personnel know how to fill in the forms? Do they know the procedures for
submitting records? If not, provide on-the-job training.)
Are Essential Medicines being ordered and issued according to established
policies?
2. _______
(If not, do personnel know the established policies regarding ordering and issuing? If
not, provide on-the-job training.)
Storage of Essential Medicines:
3. _______ a. Is storage area clean? _____
b. Is storage area safe from water damage?_____
c. Is storage area well lighted and well ventilated? _____
d. Is cold storage/chain maintained for Medicines that require it? _____
e. Are cartons/boxes stored off the floor? _____
f. Are cartons/boxes stacked away from walls?_____
g. Are cartons/boxes marked with expiry dates? _____
h. Are Essential Medicines stored in a manner to facilitate FEFO distribution?

_____
i. Are Essential Medicines stored separately from office supplies, insecticides, and
chemicals? _____
(If not, do personnel have the required knowledge/skills related to storage? If not,
identify knowledge/skill deficiencies and provide on-the-job training)
4. _______ Are Essential Medicines being issued according to the FEFO guideline (First-To-
Expire, First Out)?
(If not, do personnel understand the principle of FEFO? If not, explain the principle
and provide ideas on how Essential Medicines should be stored to facilitate FEFO
distribution.)
85
5. _______ Have procedures to dispose of expired or damaged Essential Medicines been
undertaken?
(If not, do personnel know the procedures? If not, review the procedures with them.)
6. _______ Are stock levels at each facility adequate (not above the maximum quantity; not at
an emergency order level)?
(If you think there is a problem, advise the facility personnel accordingly. Take the
necessary actions to correct the situation.)
7. _______ Check the Months of Stock on hand for each essential medicine. Use the formula:
BALANCE ON HAND = MONTHS OF STOCK ON HAND

AVERAGE MONTHLY ISSUES (AMI)
(If stocks are not within the recommended maximum and minimum levels, advise the
facility personnel accordingly; provide OJT for assessing stock status if needed, and
take the necessary actions to correct the situation.)
8. _______ Are physical inventories being conducted and properly recorded on the Essential
Medicine & Medical Supplies Stock Control Card?
(If not, do personnel know how to conduct a physical count and why it is important to
do so? If not, take a physical count of stock with the personnel and emphasize the
importance of conducting routine physical inventories. Demonstrate how to record a
physical count on the Essential Medicine & Medical Supplies Stock Control Card.)
86
ANNEX:
Sample Pages from the following forms
A. Essential Medicine & Medical Supplies Stock Control Card

B. Report for Essential Medicines and Medical Supplies (Health Centres only)
C. Report for Essential Medicines and Medical Supplies (Hospitals only)
D. Report for Essential Medicines and Medical Supplies (DCMO only)
E. Supply voucher for Essential Medicines and Medical Supplies
F. Report for Essential Medicines and Medical Supplies (computer-generated)

G. MSL Dispatch Note
H. List of Approved commodities to be kept at the Health Centres.
I. Returns Authorization Form
J. Report for Returning Products
Supplemental Information for Starting the EMLIP Hybrid
K. Beginning the Implementation of the EMLIP Hybrid.

1. Preparing First Orders
2. Completing the 2nd Report for Essential Medicines and Medical Supplies
3. Completing the 3rd Report for Essential Medicines and Medical Supplies
87
A. Essential Medicines & Medical Supplies Stock Control Card
Essential Medicines & Medical Supplies Stock Control Card
NAME OF FACILITY DISTRICT
CODE:
ITEM DESCRIPTION: STRENGTH:
UNIT:
MAXIMUM LEVEL: EOP: 0.5 MONTHS
ISSUED TO LOSSES
REF. RECEIVED ISSUED and
DATE OR BALANCE UNIT PRICE REMARKS NAME/ SIGNATURE
No. (+) (-) ADJUST-
RECEIVED FROM
MENTS
88
B. REPORT FOR ESSENTIAL MEDICINES AND MEDICAL SUPPLIES (Health Centre Only)
Emergency Order
REPORT FOR ESSENTIAL MEDICINES AND MEDICAL SUPPLIES
Maximum Stock
Reporting Period: From: to Province: Level: 4 Months
dd/mm/yyyy dd/mm/yyyy
Emergency Order
Facility: District: Point: 0.5 Months
Date of last delivery of stock:
dd/mm/yyyy
Physical
Total Total Count of
Quantity Quantity Quantity Quantity stocks in
Received Received Received Issued the
Beginning during the during the during from the storeroom Number
Balance of month From month the storeroom Losses at the end of Days
Product stock in the Health from bulk month during and of stocked
Code Drug Product Unit storeroom Centre Kit stock (E + F) the month Adjustments the month out
A B C D E F G H I J K
EM0006 Acetylsalicylic Acid, tablet 300mg 1000 Tablets

TBA Adhesive tape 7.5cm x 10m,ZOP Each
EM0020 Adrenaline Acid Tartrate, Injection, 1mg/ ml Ampoule

Aluminium hydroxide 120mg/Magnesium
EM0294 trisilicate 250mg,chewable tablets 1000 Tablets
Amoxicillin (Trihydrate), Dry powder for
EM0033 suspension 125mg/5ml 100ml Bottle
1000
EM0032 Amoxycillin 250mg capsules Capsules
MAL0001 Artemether/Lumefantrine, tablet 120/20mg 6 Tablets

Explanation for Losses/Adjustments: ________________________________________________________________
Discrepancies or Remarks: _________________________________________________________________________
89
Health Centres Only
REPORT FOR ESSENTIAL MEDICINES AND MEDICAL SUPPLIES Emergency Order

Maximum Stock
Emergency Order
dd/mm/yyyy
Quantity Quantity Total Physical

Received Received Quantity Total Count of
Beginning during the during the Received Quantity Issued stocks in the
Balance of month From the month during from the Losses storeroom Number
Product stock in Health Centre from bulk the month storeroom during and at the end of of Days
Code Drug Product Unit storeroom Kit stock (E + F) the month Adjustments the month stocked out
Artemether/Lumefantrine, tablet
MAL0004 120/20mg 24 Tablets
Benzathine Benzyl penicillin 2.4M
EM0595 20ml Ampoule
Benzyl penicillin Sodium, injection
EM0553 1MU Vial
TBA Biospot, NaDCC 2.5g effervescent tab 500

Catgut chromic 0; 75cm w/needle,
MS0098 30mm 12
Catgut chromic 2; 75cm w/needle,
MS0150 50mm 12
Chloramphenicol 0.5%, 5ml, eye
TBA drops Each
Chlorpheniramine maleate 4mg
EM0096 tablets 1000
EM0117 Clotrimazole 1%, 20g cream Each

Compress gauze 7.5x7.5cm, 12 ply,
MS0165 BP13 100
Explanation for Losses/Adjustments: _____________________________________________________________________________________
Discrepancies or Remarks: ______________________________________________________________________________________________

90
Health Centres Only
Maximum Stock
Emergency Order
dd/mm/yyyy

Balance of month From the month during from the Losses storeroom Number
Product stock in Health Centre from bulk the month storeroom during and at the end of of Days
Code Drug Product Unit storeroom Kit stock (E + F) the month Adjustments the month stocked out
RH0011 Condoms, lubricated 100

Cord clamp, umbilical, disposable
MS0117 sterile Each
Co-trimoxazole 120mg/5ml Oral
EM0477 suspension Each
EM0130 Co-trimoxazole 480mg tablets 1000
MS0040 Cotton wool, absorbent 500g Roll
RH0009 Depo Provera injection, 150mg/ml 25 Vials

1000
EM0178 Doxycycline 100mg as Hyclate tablets Tablets
EM0522 Dextrose 50%, 20ml Vial
EM0163 Diazepam 5mg/ml, 2ml injection Ampoule

Erythromycin 125mg/5ml Powder for
EM0191 Oral Suspension Each
Explanation for Losses/Adjustments: ______________________________________________________________________________________________________
Discrepancies or Remarks: _______________________________________________________________________________________________________________
91
Health Centres Only
Maximum Stock
Emergency Order
dd/mm/yyyy
Quantity Total Total Physical

Received Quantity Quantity Quantity Issued Count of
Beginning during the Received Received from the stocks in the Number
Balance of month From during the during storeroom Losses storeroom of Days
Product stock in the Health month from the month during and at the end of stocked
Code Drug Product Unit storeroom Centre Kit bulk stock (E + F) the month Adjustments the month out
EM0195 Erythromycin 250mg as stearate tablets 1000 Tablets

Ferrous sulphate 200mg sugar coated
EM0198 tablets 1000 Tablets
Ferrous sulphate 50mg sugar coated
EM0201 tablets 1000 Tablets
EM0213 Folic acid 5mg tablets 1000 Tablets
TBA Gauze bandage 5mx7.5cm BP13 25
MS0055 Gloves examination, latex, large, 6g 100
MS0055 Gloves examination, latex, medium, 6g 100
MS0058 Gloves surgical, size 7.5 50
TBA Hydrocortisone 1%, 15g Skin ointment Each

Hydrocortisone 100mg as sodium
EM0250 succinate, powder for injection Vial
MS0079 Infusion set, filter 150cm 21G 25
Explanation for Losses/Adjustments: ______________________________________________________________________________________________________
Discrepancies or Remarks: _______________________________________________________________________________________________________________
92
Health Centres Only
REPORT FOR ESSENTIAL MEDICINES AND MEDICAL SUPPLIESEmergency Order
Maximum Stock
Emergency Order
dd/mm/yyyy
Quantity Total Total Physical

Received Quantity Quantity Quantity Issued Count of
Beginning during the Received Received from the stocks in the Number
Balance of month From during the during storeroom Losses storeroom of Days
Product stock in the Health month from the month during and at the end of stocked
Code Drug Product Unit storeroom Centre Kit bulk stock (E + F) the month Adjustments the month out
MS0132 I.V cannulae 18G, w/port w/wings 100
MS0133 I.V cannulae 24G, w/port w/wings 100

Levonorgestrel/Ethinylestradiol
0.15/0.03mg (Oralcon F or Microgynon)
RH0004 tablet 28 Tablets
EM0598 Lidocaine 2%, 10ml Each
MAL0045 Malaria Rapid Diagnostics Tests 25 Tests
EM0501 Mebendazole 100mg tablets 100 Tablets
EM0316 Metronidazole 200mg tablets 1000 Tablets
TBA Minigrip bags, 75 x 110 x 0.025mm 1000
TBA Multivitamin, film coated tablets 1000 Tablets

Needle luer 21G x 1.5 (0.8 x 35mm)
MS0067 Disposable 100
Explanation for Losses/Adjustments: _____________________________________________________________________________________________________________________
Discrepancies or Remarks: ______________________________________________________________________________________________________________________________

93
Health Centres Only
Reporting Maximum Stock
Period: From: to Province: Level: 4 Months
Emergency Order
dd/mm/yyyy

Received Received Quantity Total Quantity Count of
Beginning during the during the Received Issued from the stocks in the Number
Balance of month From month during storeroom Losses storeroom of Days
Product stock in the Health from bulk the month during and at the end of stocked
Needle luer 23G x 1 (0.6 x 25mm)
MS0068 Disposable 100
100
TBA Nitrofurantoin 50mg tablets Tablets
EM0467 Nystatin 100,000 IU, pessaries 14 Pessaries
EM0334 Nystatin 100,000 IU/ml, 30ml, susp.liq Each
100
EM0338 Oral Rehydration Salts 20.5g, WHO mod Sachets
EM0341 Oxytocin 10 IU/ml, 1ml Ampoule
EM0348 Paracetamol 500mg tablets 1000
EM0345 Paracetamol 100mg tablets 1000
Paracetamol 125mg/5ml suspension, 2.5
EM0621 Ltrs Each
Penicillin benzathine benzyl, injection 2.4
EM0595 MU Each
1000
EM0367 Phenoxymethylpenicillin 250mg tablets Tablets
Explanation for Losses/Adjustments: _______________________________________________________________________________________________________________
Discrepancies or Remarks: _______________________________________________________________________________________________________________________

94
Health Centres Only
Emergency Order
Emergency Order
dd/mm/yyyy
Physical
Quantity Quantity Total Total Count of
Received Received Quantity Quantity Issued stocks in
Beginning during the during the Received from the the Number
Balance of month From month during storeroom Losses storeroom of Days
Product stock in the Health from bulk the month during and at the end of stocked
EM0387 Procaine penicillin 3M IU, powder for injection Ampoule
EM0391 Promethazine HCl 25mg/ml, 2ml injection Ampoule
MAL0010 Quinine sulphate 300mg film coated tablets 1000 Tablets
Safety box for used needles/syringes,
EQP0132 inflammable, 5L Each
EM0416 Salbutamol 2 mg tablets 1000 Tablets
MS0085 Scalpel blades, size 22, sterile disposable 100

MS0095 Silk 2/0 45cm w/needle 12
MS0094 Silk 3/0 45cm w/needle 12
TBA Silver sulfadiazine 1%, 20g cream Each
TBA Soap bar 100g Each

Sulfadoxine 500mg+pyrimethamine 25mg
MAL0013 tablets 1000
Explanation for Losses/Adjustments: ____________________________________________________________________________________________
Discrepancies or Remarks: _____________________________________________________________________________________________________
95
Health Centres Only
Emergency Order
Emergency Order
dd/mm/yyyy

Balance of month From month during from the Losses storeroom Number of
Product stock in the Health from bulk the month storeroom during and at the end of Days
Code Drug Product Unit storeroom Centre Kit stock (E + F) the month Adjustments the month stocked out
MS0103 Syringe disposal, 2ml 100
Tetracycline HCl 1%, 5g eye
EM0435 ointment Each
EM0462 Water for injection, 10ml 100
EM0465 Water for injection, 5ml 100
Zinc sulphate 20mg dispersible
NCEM0050 tablets 100
Explanation for Losses/Adjustments: _______________________________________________________________________________________________
Discrepancies or Remarks: _______________________________________________________________________________________________________
96
Health Centres Only
Emergency Order
Emergency Order
dd/mm/yyyy
Name of the LMIS Forms Unit Quantity Required Remarks

A B C D
Stock Control Card Each
Return Authorization Form Each
REMMS Each
Supply Voucher Each
Report for Returning Products Each
Completed by: Authorized by:

Signature: Signature:
Date: Date:
Cell phone: Cell phone:
97
C. REPORT FOR ESSENTIAL MEDICINES AND MEDICAL SUPPLIES (Hospital Only)
Reporting Period: From: to Province: Maximum Stock Level: 3 Months

Facility: District: Emergency Order Point: 0.5 Months
dd/mm/yyyy
Physical
Total Quantity Count of
Beginning Total Quantity Issued from the Losses stocks in the Number of
Balance of Received storeroom and storeroom Days
Product stock in during during Adjustment at the end stocked
Code Drug Product Unit storeroom the month the month s of the month out
A B C D E F G H I
EM0006 Acetylsalicylic Acid 300mg Tab 1000 Tablets
EM0015 Acyclovir 400mg Tab 100 Tablets
EM0020 Adrenaline Acid Tartrate, Injection, 1mg/ml Ampoule
EM0023 Aminophylline Injection 250mg/10ml Each
Amoxicillin (Trihydrate), Dry powder for
EM0033 suspension 125mg/5ml 100ml bottle
1000
EM0032 Amoxicillin (Trihydrate) Capsule 250mg Capsules
EM0052 Atropine 1mg/ml injection 100 Vials
MAL0001 Artemether/Lumefantrine, tablet 120/20mg,6 s 6 Tablets
Artemether/Lumefantrine, tablet 120/20mg,
MAL0002 12‘s 12 Tablets
Explanation for Losses/Adjustments: ____________________________________________________________________________
Discrepancies or Remarks: ________________________________________________________________________________________
98
Hospital Only
Maximum Stock
Emergency Order
dd/mm/yyyy
Physical
Count
Total Total Quantity of stocks in
Beginning Quantity Issued from the Losses the Number of
Product stock in during the during Adjustment at the end stocked
Code Drug Product Unit storeroom month the month s of the month out
A B C D E F G H I
100
EM0163 Diazepam 5mg/ml injection Ampoules
1000
EM0178 Doxycycline 100mg Capsule Capsules
Erythromycin ethyl succinate, pwdr oral
EM0191 suspension, 125mg/5ml 100ml
EM0195 Erythromycin Stearate 250mg tab 1000 Tablets
EM0198 Ferrous Sulphate 200mg tab 1000 Tablets
EM0213 Folic Acid 5mg Tablets 1000 Tablets
EM0219 Frusemide 40mg tablets 1000 Tablets
100
EM0216 Frusemide 10mg/ml injection Ampoules
100
EM0222 Gentamycin 40mg/ml injection Ampoules
Explanation for Losses/Adjustments: ____________________________________________________________________
Discrepancies or Remarks: _____________________________________________________________________________
99
Hospital Only
Emergency Order
Maximum Stock
Emergency Order
dd/mm/yyyy
Physical
Total Total Quantity Count of
Beginning Quantity Issued from the Losses stocks in the Number of
Product stock in during the during Adjustment at the end of stocked
Code Drug Product Unit storeroom month the month s the month out
A B C D E F G H I
EM0048 Gentamycin 0.5% eye drops Each

1000
EM0228 Glibenclamide 5mg tab Tablets
EM0250 Hydrocortisone 100mg Injection Vial
EM0470 Insulin, Soluble 100IU/ml injection 10

Insulin, Zinc suspension (Lente) 100IU/ml
EM0506 injection 10
EM0545 Ketamine 50mg/ml injection 10
RH0006 *Intra Uterine Device (IUD) Each
RH0005 *Jadelle 10
Levonorgestrel/Ethinylestradiol 0.15/0.03mg
RH0004 tab 28 Tablest
EM0598 Lidocaine 2% injection 10 Vials
Explanation for Losses/Adjustments: _____________________________________________________________________________
Discrepancies or Remarks: ______________________________________________________________________________________
100
Hospital Only
Emergency Order

dd/mm/yyyy
Physical
A B C D E F G H I
EM0501 Mebendazole 100mg tab 100 Tablets
EM0290 Magnesium Sulphate 500mg/ml 50 Vials

MAL001
5 Malaria Rapid Diagnostics Test 25 tests
EM0479 Metronidazole 5mg/ml injection Each
EM0316 Metronidazole, tablet 200mg 1000 Tablets
EM0328 Nifedipine Retard 20mg tablets 100 Tablets
EM334 Nystatin 100,000 IU/ml, 30ml Each
EM0338 Oral Rehydration Salt 27.9g 100 sachets

100
EM0341 Oxytocin 10IU/ml injection ampoules
EM0348 Paracetamol 500mg tab 1000 tablets
Explanation for Losses/Adjustments: ______________________________________________________________________________________________

101
Discrepancies or Remarks:
_______________________________________________________________________________________________________
REPORT FOR ESSENTIAL MEDICINES AND MEDICAL SUPPLIES Hospital Only

Emergency Order
dd/mm/yyyy
Physical
A B C D E F G H I
EM0342 Paracetamol 125mg/5ml suspension, 2.5 Ltrs Each
EM0748 Penicillin Benzathine benzyl, injection 2.4 MU 50 Vials
MAL007 Quinine Injection 600mg/2ml Ampoule

1000
MAL010 Quinine Sulphate 300mg tab Tablets
1000
EM0416 Salbutamol 2mg tab Tablets
1000
MAL015 Sulfadoxine/Pyrimethamine 500/25mg tab Tablets
Phytomenadione (Vitamin K1) 10mg/ml 100
EM0373 injection Ampoules
EM0408 Ringer's Lactate 1000ml solution 12
EM0468 Suxamethonium 20mg/Ml injection 10 vials
EM0424 Sodium Chloride 0.9% Solution 12
Explanation for Losses/Adjustments: ______________________________________________________________________________________________
102
Discrepancies or Remarks:
_______________________________________________________________________________________________________
Emergency Order
Maximum Stock
Emergency Order
dd/mm/yyyy
Physical
Count of
Beginning Total Total Quantity stocks in
Balance Quantity Issued from the Number
of Received the storeroom Losses storeroom of Days
Product stock in during the during and at the end of stocked
Code Drug Product Unit storeroom month the month Adjustments the month out
A B C D E F G H I
MS0133 Cannulae 24 g 100
MS0002 Cannulae 18G 100
MS0040 Cotton wool 500G Each
EM0276 Dental Needle Each
MS0055 Examination gloves medium 100

100
TBA Zinc Sulphate 20mg tab Tablets
Explanation for Losses/Adjustments: _______________________________________________________________________________________________
Discrepancies or Remarks: ________________________________________________________________________________________________________
103
Emergency Order
Maximum Stock
Emergency Order
dd/mm/yyyy
Name of the LMIS Quantity

Forms Unit Required Remarks
A B C D
Stock Control Card Each
Return Authorization Form Each
REMMS Each
Supply Voucher Each

Report for Returning
Products Each

Date: Date:
104
D. REPORT FOR ESSENTIAL MEDICINES AND MEDICAL SUPPLIES (DCMO Only)
Maximum Stock
Emergency Order 0.5
Facility: District: Point: Months
dd/mm/yyyy
Total Total Quantity Physical Count

Beginning quantity Issued from the of stocks in the Number
Balance of Received storeroom Losses storeroom of Days
Product stock in during the during and at the end stocked
Code Drug Product Unit storeroom month MSL the month Adjustments of the month out
A B C D E F G H I
EM0023 Aminophylline injection 25mg/ml Vial
EM0032 Amoxycillin Tablets 250mg 1000
MS0006 Bandage POP 15x3 10
EM0110 Ciprofloxacin 250mg Tablets 100
EM0522 Dextrose 50% Each
EM0163 Diazepam injection Each
EM0166 Diazepam tablet 1000
MS0055 Gloves examination, latex, large, 6g 100
MS0056 Gloves examination, latex, medium, 6g 100
Explanation for Losses/Adjustments: _____________________________________________________________________________
Discrepancies or Remarks: ______________________________________________________________________________________
105
DCMO Only
Emergency Order
Emergency Order 0.5
dd/mm/yyyy
Beginning Total Total Quantity Physical Count

Balance Quantity Issued from of stocks in the Number
of stock Received the storeroom Losses storeroom of Days
Product in during the during and at the end of stocked
Code Drug Product Unit storeroom month MSL the month Adjustments the month out
A B C D E F G H I
EM0222 Gentamicin injection 40mg/ml Ampoule
Halothane Inhalation 250ml
EM0238 Bottle Each
EM0250 Hydrocortisone injection Each
EM0506 Insulin lente 10
EM0470 Insulin soluble 10
EM0269 Ketamine injection 50
EM0275 Lidocaine dental cartridge 50
Explanation for Losses/Adjustments: _____________________________________________________________________________________________
Discrepancies or Remarks: ______________________________________________________________________________________________________
106
DCMO Only
Emergency Order 0.5
dd/mm/yyyy
Total Physical Count of

Beginning Quantity Total Quantity stocks in the
Balance of Received Issued from the Losses storeroom Number of
Product stock in during the storeroom during and at the end of Days
Code Drug Product Unit storeroom month MSL the month Adjustments the month stocked out
A B C D E F G H I
EM0341 Oxytocin 10 IU/ml Each
EM0857 Pancuronium injection Each
EM0348 Paracetamol 500mg tab 1000
EM0357 Pethidine injection 50mg/ml, 2ml 100
EM0363 Phenobarbital Tablet 30mg 1000
MS0079 Solution Giving Set 21G 25
MAL0013 Sulfadoxine+pyrimethamine 1000
MS0057 Surgical Gloves size 7.5 50pcs
MS0059 Surgical Gloves size 8 50pcs
Explanation for Losses/Adjustments: ________________________________________________________________________________________________________________
Discrepancies or Remarks: ________________________________________________________________________________________________________________________
107
DCMO Only
Maximum Stock
Emergency Order 0.5
dd/mm/yyyy
Name of the LMIS Forms Unit Quantity Required Remarks

A B C D
EM Stock Control Card Each
ARVs Stock Control Card Each
Laboratory Reagents Stock Control
Card Each
HIV Test Kit Stock Control Card Each
PMTCT Stock Control Card Each
PMTCT Report and Issue Voucher Each

REMMS (Health Centres only) Each
REMMS (DHO only) Each
ARVs R&R Each
Laboratory Usage Report Each
HIV Test Kit R & R Each

108
Date: Date:
E. SUPPLY VOUCHER FOR ESSENTIAL MEDICINES & MEDICAL SUPPLIES
To (Name of
DCMO): From (Name of Centre):
Requested
by: Authorised by:
Date: Date:
Product Balance at Quantity Quantity Quantity

Code Description, Strength, Form Unit Hand Requested Supplied Received Remarks
A B C D E F G H
Approved by: Issued by: Delivered by: Received by:

109
Signature: Signature: Signature: Signature:
Date: Date: Date: Date:
110
F. Computer-generated Report and Requisition for Essential Medicines & Medical Supplies
Report and Requisition for Essential Medicines
Report August, 2009 3.0 months

Period: Maximum Stock Level:
Facility: Mother Theresa Hospital Emergency Order Point: 0.5 months
Code: 8476352
Product Unit Beginning Total Total Adjust- Physical AMC New Order Quantity
Balance Quantity Quantity ments Count EOP Quantity Supplied
Received Issued
Bottle of
FDC004 Paracetamol 500 mg tabs
1000
0.00 200.00 150.00 50.00 100.00 150.00 75.00 350.00 350.00
AMOXYCILLIN 250 MG TABS Bottle of
FDC005 0.00 300.00 20.00 -100.00 180.00 20.00 10.00 0.00 0.00
1000
FD006 Artemether Lumefantrine 20/120 mg tabs; 24s Pack of 30 0.00 200.00 150.00 50.00 100.00 150.00 75.00 350.00 350.00
Comments:
Computer Generated Adjustment of –200
on 08-28-2006 at 22:51:16 for 0
Computer Generated Adjustment of –200
on 08-28-2006 at 22:51:25 for 0
Computer Generated Adjustment of 50
on 08-30-2006 at 16:22:48 for for Paracetamol 500 mg tabs
Computer Generated Adjustment of 50
on 08-30-2006 at 23:59:11 for Artemether Lumefantrine 20/120 mg tabs; 24s
LMU Technical Officer Signature & Name Date
Received by Signature & Name Date
111
G. MSL Despatch Note for Essential Medicines
Sample Despatch Note
SOU004
Ndola DCMO
P. O. Box 630063
DHMT
Sales Order 0014198
Despatch No. 00000898
Reference
Route/Drop G
Product Description Pack Ordered Expiry Despatched FC
Totals:
Facility Name: Driver’s Name:
Receiver’s Name: Vehicle Reg.:
Designation:
I.D.:
Date: Date: Time:
FC Legend 1-Not enough stock available

2-Rounding Up/Down to Full Cart
3-Restricted
4-Quantity Too Much for Facility
5-Product Picked More Than Once
6-No Stock Available
Customer Comments
112
H. Returns Authorization Form for Essential Medicines
MEDICAL STORES LIMITED
RETURNS AUTHORISATION FORM
1. Customer Details
Institution Name: _________________________________________________
Name of Requesting Officer: ________________________________________
Designation: ______________________________________________________
Date:_____________________________________________________________
2. Product Details
No. Description (Name, form, Pack Qty Exp Reason for Return
strength & size) Size date(s)
Other comments from the customer:
For MSL use only
RETURNS AUTHORISED BY:

Name: __________________________________________________________________________
Designation: _____________________________________________________________________
Date: ____________________________________________________________________________
Signature: ________________________________________________________________________
All items accepted for return? :_______________________________________________________
If no, which items will be accepted? :__________________________________________________
113
I. Report for Returning Products
Report for Returning Products
Sent to: ________________________________________________________________
Facility returning products: _________________________________________________
Quantity
Product Description Expiry Date Reason for Return
Returned
Name of person returning the products:___________________ Date: ___________20___

Signature of person returning the products:_________________________________
Carrier
I CERTIFY THAT the above quantities for return were received by me on _______(dd/mm/yy) except where
explained below.
Name of Carrier _________________________ Signature___________________________
Comments: _____________________________________________________________
Receiving Facility
explained below.
Receiver’s Name _________________________Signature____________________________
Comments: _____________________________________________________________
Carrier
explained below.
Name of Carrier _________________________ Signature___________________________
Comments: __________________________________________________________________________
Receiving Facility
explained below.
Receiver’s Name _________________________Signature____________________________
Comments: _________________________________________________________________
114
J. Beginning the Implementation of the EMLIP Hybrid, Preparing First Orders, including 1st, 2nd, and 3rd months
1. When completing the first 1st REMMS for the 1st report and order under the new system. (To be completed at the end of the month
during which you received your training!!!)
1A. Report for Essential Medicines and Medical Supplies for Health Centres and Hospitals
Total Quantity Losses Number

Beginning Physical Count of
Received and of Days
Balance of Total Quantity Issued for the month Store Room at the
during the Adjustme stocked
Store room end of the month
month nts out
Leave the Write in the total If you have Issues data for the entire reporting month: If you have Conduct a Physical Write zero
Beginning quantity of each  report that data in the Total Quantity Issued for the Month Losses and Count of the store “0” in this
Balance of product received column, and Adjustment room and write the column
Store room during the entire  add a “Remark” on each page saying “Actual issued data is s data for quantity for each
blank for this month. being reported” the product.
first R&R only. If you do not have Issues data for the entire reporting month, but you reporting
do have stock on hand data for the beginning and ending of the month, .
reporting month: write them
 calculate: on the
Estim REMMS.
quantity ated
received ending Total
beginning stock
+ during the – stock = Quant
balance
reporting balance ity
month Issue
d
 report the result as estimated Total Quantity Issued for the
Month quantity
 add a “Remark” on each page saying “Stock on hand data
was used to estimate actual issues”
For health centres and hospitals
115
If you have neither actual Issues data for the entire month, nor
stock on hand data for the reporting month:
 estimate the required quantity of each product based on the
number of patients visiting the facility with conditions that
require this product
 enter that quantity as estimated Total Quantity Issued for the
Month and
 add a “Remark” on each page saying “Patient data was used
to estimate actual issues”
Note: For new products that you are receiving for the first time
(e.g., patients are starting new Essential Medicines regimens
that your facility has never stocked in the past), follow the same
procedure using estimated issues data based on patient data.
Note: You do NOT need to overestimate your issues for the month if you do not have actual issues data; your monthly requirement will be
multiplied by 3 for hospitals and by 4 for health centres when determining order quantities. DO NOT OVERESTIMATE YOUR REQUIREMENTS
AS IT CAN LEAD TO OVERSTOCKS, WASTAGE AND EXPIRY and your facility and stock shortages at other facilities.
1B. Requisition for Hospitals
2. When completing the 2nd Report for Essential Medicines and Medical Supplies under the new system.
2A. Report Section for Health Centres and Hospitals
Number of
Beginning Total Quantity
Losses and Physical Count of Days
Balance of Received during Total Quantity Issued for the month
Adjustments Store Room Stocked
Store room the month
out
Write the Write in the total Fill in the actual issues for Total Quantity Issued for Record Losses and Conduct a Physical Write the
Beginning quantity of each the Month as collected on the Essential Medicines & Adjustments from Count of the store number of
Balance for the product received Medical Supplies Stock Control Card. the Essential room and write the days
start of the during the entire Medicines & Medical quantity for each stocked
reporting period; month. Supplies Stock product. out during
this should equal Control Card. the first
116
the Physical In the Remarks section of each page, write a note . reporting
Count of Store stating that “The Issues data represents actual issues month
Room at the end for the previous month”
of the month,
Column H, from
the previous
month’s R&R..
3. When completing the 3rd Report for Essential Medicines and Medical Supplies under the new system, follow the Job Aid in the
Standard Operating Procedures Manual; summarized below.
3A. Report Section for Health Centres and Hospitals
Beginning Total Quantity Total Quantity Issued for the month Losses and Physical Number Of
Balance of Store Received during Adjustments Count of Days
room the month Store Room stocked out
at the end of
the month
Write the Write in the total Fill in the actual issues for Total Quantity Issued for Record Losses and Conduct a Write the
Beginning quantity of each the Month as collected on the Essential Medicines & Adjustments from Physical Count number of
Balance for the product received Medical Supplies Stock Control Card for the previous the Essential of the store days stocked
start of the during the entire month. Medicines & room and write out during
reporting period; month. Medical Supplies the quantity for the second
this should equal Stock Control Card. each product. reporting
the Physical month.
Count of Store
Room at the end
of the month,
Column H, from
the previous
month’s R&R.
117
118

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Republic of Zambia

ESSENTIAL MEDICINES LOGISTICS

Facility Name: _________________________________________

Essential Medicines Logistics Improvement Programme

USAID | DELIVER PROJECT, Task Order 4

Essential Medicines Logistics Improvement Programme

AMI Average Monthly Issues

Essential Medicines Logistics Improvement Programme

Essential Medicines Logistics Improvement Programme

Essential Medicines Logistics Improvement Programme

Essential Medicines Logistics Improvement Programme

Essential Medicines Logistics Improvement Programme

 Maintaining adequate supplies of essential medicines

B. The Purpose of the EMLIP Hybrid in Zambia

 the Right Products for essential medicines

A logistics system addresses the concept, “No Product, No Program.” An essential

C. Key Features of the EMLIP Hybrid

Essential Medicines Logistics Improvement Programme

Central MSL Warehouse

MSL Regional Hub/Staging Posts

Provincial Health Office

 Receive quarterly feedback reports from the MSL-LMU on provincial essential

Essential Medicines Logistics Improvement Programme

District Community Medical Office (DCMO)

Essential Medicines Logistics Improvement Programme

Essential Medicines National Pipeline

LM I S Report i ng & O rderi ng

Essential Medicines Logistics Improvement Programme

Level Personnel Roles and Responsibilities

behalf of the Health centres.

Medicines and Medical Supplies forms received from hospitals

into Supply Chain Manager software

send to provinces, DCMOs and service delivery points

Essential Medicines Logistics Improvement Programme

 Receive essential medicines various supplies

 Periodic checking of pre-packed orders / HC kits readiness for

dispatch to the MSL Hubs

 Supervises and monitors the distribution schedule for essential

receive supplies, noting discrepancies in the number of carton

 Distributes pre-packaged orders/ HC Kits to the health

 Return signed copies of the computer generated R& R

 Receive quarterly feedback reports from the MSL - LMU on

 Provide technical support to DCMOs in the province

 Conduct supervision visits to the DCMO and Level 2 and 3

Hospitals in the province

Essential Medicines Logistics Improvement Programme

 Generates REMMs for top up or emergency commodities

kept at the DCMO.

orders from health centres

health centres and NGOs. Submit products and forms as

MSL-LMU and take action as needed

 Monitor essential medicines management activities in the

 Make supervisory visits to health centres based on

 Conduct retraining and training of health centre staff in the

Maintain stock in store room using Essential Medicines &

Returns products to Central MSL that are usable and with a

Essential Medicines Logistics Improvement Programme

 Conduct a visual inspection of the products received

 Sign the Computer-generated R&R on receipt of supply

from MSL Hub

File copies of the Computer-generated R&R

Return usable essential medicines and medical supplies