Quant Guid Quantification

Quantification Guidelines for Essential Medicines
ONTENTS
Acronyms .................................................................................................................................. iii

Glossary ...................................................................................................................................... v
Acknowledgments...................................................................................................................... 1
Foreword .................................................................................................................................... 2
Introduction ............................................................................................................................... 3
Objectives of Good Medicine Quantification ............................................................................ 5
Minimum Standards for Undertaking Medicines Quantification .............................................. 6
Systematic Approach to Quantification Planning ...................................................................... 7
Planning for Quantification .................................................................................................... 7
Quantification Structures ....................................................................................................... 7
Quantification Coordinator .................................................................................................... 8
Quantification Working Group ............................................................................................... 8
Roles and Responsibilities of the QWG .................................................................................. 9
Selecting a Quantification Methodology ................................................................................. 11
Consumption Method .............................................................................................................. 14
Morbidity Method ................................................................................................................... 19
Proxy Consumption Method .................................................................................................... 25
Service-Level Projection of Budget Requirements .................................................................. 27
VEN and ABC Analyses ............................................................................................................. 30
VEN Analysis ......................................................................................................................... 30
ABC Analysis ......................................................................................................................... 34
Combined VEN and ABC Analysis ......................................................................................... 40
Verification ........................................................................................................................... 42
Outcomes ............................................................................................................................. 43
References ............................................................................................................................... 46
Annex 1. BPHS Medicines List and Level of Facility ................................................................. 47
Annex 2. EPHS Medicines List and Level of Hospital ............................................................... 55
Annex 3. Indicators for Reporting on Quantification .............................................................. 67
ii
ACRONYMS
ABC classification by A, B, or C, according to the monetary value of usage

ACpy average per patient medicine cost per year
AIDS acquired immunodeficiency syndrome
AMC average monthly consumption
AMCa average monthly consumption adjusted
AMCp projected average monthly consumption
Au use adjustment
BPHS basic package of essential health services
BU basic unit
CPDS Coordinated Procurement and Distribution System
CSC Commodity Security Committee
Ct total consumption
Dcu basic unit per dose
Dos days out of stock
EML essential medicines list
EPHS essential package of hospital services
EPI Expanded Program on Immunization
GDPA General Directorate of Pharmaceutical Affairs
HIV human immunodeficiency virus
HMIS Health Management Information System
ICD International Classification of Diseases
IM intramuscular
INN international nonproprietary name
LD average number of days the dose is to be taken
LT lead time
Mb months of buffer stock
MoPH Ministry of Public Health
MU mega unit
ND average number of doses per day
NGO nongovernmental organization
Np number of patients
PS population served by the reference or standard facility
PT population served by the target facility
Qp quantity to procure
Qpa quantity to procure adjusted
Qps quantity to procure for reference or standard facility
Qpt quantity to procure for the target facility
Qr total quantity of each medicine required
Qtc quantity of each medicine needed for each treatment episode
QWG Quantification Working Group
Rm review period in months
Sh stock on hand
So stock on order
iii
SS safety stock
STG standard treatment guideline
TB tuberculosis
Te number of treatment episodes
Up unit price
VEN vital, essential, and nonessential
iv
GLOSSARY
ABC value analysis: A method by which medicines are classified as pareto category A, B, or C
according to the monetary value of their usage (unit cost multiplied by consumption). Class
A items have the highest value use and are often medicines with high unit cost or very high
consumption, typically 10–20% of items (for the EML, this equates to around 30 items).
Class A items account for 75–80% of the funds spent on essential medicines. Class B items
represent 10–20% of items and 15–20% of expenditures and have intermediate value usage.
Class C items are 60–80% of the items, but only about 5–10% of expenditures.
Average monthly consumption (AMC): The mean quantity of individual items used in one
month. The average is usually obtained by dividing the total quantity of medicine consumed
during a specific period of time by the number of months in that time period. In
Afghanistan, where there are four seasons, a 12-month consumption data is preferred to
accommodate varying seasonal morbidity patterns.
Consumption: The quantity at which items are dispensed to patients within a specific
period. This is usually measured in terms of units from an issuing store.
Consumption-based estimate: Prediction of future medicine requirements on the basis of

historical information on consumption.
Cumulative value: This is the sum of all the consecutive items occurring above the
Cumulative Value entry, if the items are listed in a sequence.1
Essential Medicines List (EML): Essential medicines are defined as effective, safe, and
quality drugs that fulfill most of the health requirements of the majority of the population.
The EML is a list of medicines approved for use in public health facilities in Afghanistan.
Expiry date: Established by the manufacturer in agreement with the medicine regulatory
authority, the date after which the manufacturer will not guarantee the potency, purity,
uniformity, or bioavailability of the product. Expiry dates appear on medicinal product
packaging. 2 1F
Inventory: The sum of all items held in stock, or the physical count of each single item in
stock.
Lead time: The time between when the need for new stock is recognized and when new
stock has arrived and is available for issue; the time interval needed to complete the
procurement cycle.
Metrics: Indicators for measurement of performance.

Morbidity: Frequency of common health problems.
1
http://support.microsoft.com/kb/301637
2
http://apps.who.int/medicinedocs/documents/s18675en/s18675en.pdf
v
Ordering: Requisitioning from a higher facility to a lower facility. Health facilities order from
district, provincial, or central stores.
Pipeline stock: Stock that is in transit at various stages of the procurement and distribution
cycles.
Procurement period: The time from placing one order to the date of the next order.
Quantification: A process that involves estimating how much of a specific item is needed for
the purpose of imminent procurement or ordering. Needs are estimated for a given context;
contextual factors to consider when quantifying needs include available budget, human
resources, storage space, and the capacity to deliver services. Forecasting is the term used
for longer-term estimates of requirements—typically multiyear—which will not be used for
immediate procurement.
Safety (buffer) stock: An amount of stock kept in reserve to protect against stock-outs and
cover for emergency needs and unforeseen circumstances.
Scaling up: An incremental increase or growth in the number of patients being treated over
a period of time.
Stock control/inventory management: The process of maintaining inventory data on the

quantity, location, and condition of supplies and equipment due-in, on-hand, and due-out,
to determine quantities of items available and/or required for issue and to facilitate
distribution and management of materiel.3
Stock on hand: The items stored in the warehouse or facility that are available for use. (It
does not include expired or damaged items or quarantined items.)
Stock-out time/days out of stock (Dos): The time between stocks becoming unavailable
(none on the shelf) until it is available again; this is usually measured in the number of days
that an item is out of stock.
Unusable stock/inventory: The sum of all the items that must still be held in the store
(pending investigation, certification, or write off), but which are not fit for use. This may
include expired goods, damaged goods, goods that have failed quality testing, or goods
under quarantine.4
VEN system: A system of setting purchasing and stock-keeping priorities in which medicines
are divided according to their health impact: V is vital, E is essential, and N is nonessential.
3
http://apps.who.int/medicinedocs/documents/s17396e/s17396e.pdf
4
http://policy.yale.edu/policy/4210-valuation-inventory
vi
ACKNOWLEDGMENTS
The development of these guidelines would not have been possible without the full support of
the Ministry of Public Health (MoPH)/General Directorate of Pharmaceutical Affairs (GDPA)
Leadership and the Technical Reviewer Committee. MoPH wishes to express its heartfelt
gratitude to the committee for its commitment and dedication in the review process and also
acknowledge their respective organizations, including MoPH (GDPA, General Directorate of Policy
and Planning [GDPP], National Medicine and Food Board [NMFB], Procurement Directorate,
Monitoring and Evaluation [M&E] Directorate, Central Medical Store [CMS], and Pharmaceutical
Enterprise [PE]), Kabul University/Faculty of Pharmacy, Health Net TPO (HN-TPO), Health
Partners International of Canada (HPIC), and the Bakhter Development Network (BDN). Special
thanks go to the Strengthening Pharmaceutical Systems (SPS) Program, funded by the US Agency
for International Development (USAID), for its technical and financial support throughout the
development of these important guidelines.
Quantification guidelines Technical Reviewer Committee members:
1. Pharmacist Fahima Habibi, General Manager of Medicine Resource, GDPA
2. Pharmacist Dawood Shah Waliyar, Registration and Licensing Dept, GDPA
3. Pharmacist Maria Feruz, Manager of Donated Medicines Department, GDPA
4. Pharmacist Jawid Ehsan, Supply Chain Development Program Manager, SPS
5. Pharmacist Sara Habibyar, Supply Chain Planning Advisor, SPS
6. Pharmacist Sohail Nazari, CPDS Officer, SPS
7. Pharmacist Khalid Banazada, CPDS Officer, SPS
8. Pharmacist Abdul Khalil Mohammadi, Quantification Officer, SPS
9. Dr. Ajmal Yadgari, CPDS Technical Coordinator, MoPH
10. Pharmacist Mohammad Nasim Yaqubi, Technical Member of the General Medical
Equipment Department, MoPH
11. Pharmacist Mahmood Nawabi, CMS, MoPH
12. Dr. Zekria Barakati, M&E Consultant, M&E Directorate, MoPH
13. Pharmacist Uzair Sekendari, General Manager of the Procurement Department, PE
14. Professor Gulalai Babak, Pharmacy Faculty Lecturer, Kabul University
15. Pharmacist Razia Nazari, Member of National Medicine and Food Board, NMFB
16. Pharmacist Najia Dehzad, Head of Pharmacy, HN-TPO
17. Dr. Friba Abedi, M&E Manager, HPIC
18. Dr. Zemarai Saleh, Pharmacy Officer, BDN
International technical advisory team:
• Andy Barraclough, Pharmaceutical Management Technical Adviser, SPS
• Paul Ickx, Senior Principal Technical Adviser, SPS
• Oliver Hazemba, Senior Technical Advisor, SPS
• Shiou-Chu (Judy) Wang, Senior Technical Adviser, SPS
Special thanks go to Pharmacist Abdul Hafiz Quraishi, GDPA General Director, and Pharmacist
Mohammad Zafar Omari, Chief of Party, SPS/Afghanistan, for directly supervising the
development of these guidelines and for facilitating a collaborative work environment.
With best regards,
Pharmacist Abdul Hafiz “Quraishi”

General Director of General Directorate of Medicine Affairs
1
FOREWORD
The Ministry of Public Health (MoPH) of the Islamic Republic of Afghanistan has the
responsibility for providing public health services and ensuring access to safe, effective, and
quality essential medicines for the people of Afghanistan. One of the strategies was to
establish the basic package of health services (BPHS) and the essential package of hospital
services (EPHS) throughout the country, in close collaboration with national and
international partners.
To understand the supply chain management situation in the pharmaceutical sector and to
identify possible solutions to address the challenges, a procurement, distribution, and
quantification assessment was conducted in 2012 (Khitab 2012). The review found that the
stakeholders’ existing systems do not operate uniformly enough to serve as a basis for
future coordinated system development. In addition, the qualities of the practices varied
among entities. Based on the assessment’s findings and recommendations, GDPA/MoPH, in
collaboration with CPDS, decided to develop guidelines for the procurement, distribution,
and quantification for essential medicines. The guidelines in this document are one of the
results of this initiative.
The key objectives of the quantification guidelines are to:
• Improve the process of estimating the right medicines, in the right quantities, for a
specific procurement period, in a timely and accurate manner
• Make rational decisions in response to service delivery and budgetary limitations
• Ensure uninterrupted availability of appropriate medicines
• Reduce stock outs and over stocking, and hence minimize wastage
• Improve cost-effectiveness and increase clients’ satisfaction
For the guidelines to be technically sound and appropriate to the local context, a Technical
Reviewer Committee of twelve experts from different national and international
organizations was established, with coordination and support of CPDS. The Technical
Reviewer Committee thoroughly reviewed the guidelines. MoPH wishes to express its
heartfelt gratitude to the committee members for its commitment and dedication to the
review process and is grateful to the technical and financial support of SPS, which is funded
by USAID. Implementation of the guidelines is anticipated to lead to good quantification
practices, effective use of resources, and good governance of medicines.
MoPH is committed to overseeing the implementation of these guidelines for all public
sector health service providers.
With best regards,
Dr. Ahmad Jan “Naeem”

Deputy Minister of Policy and Planning
Ministry of Public Health
2
INTRODUCTION
The Ministry of Public Health (MoPH) of the Islamic Republic of Afghanistan strives to ensure
access to safe, effective, and quality essential medicines for the people of Afghanistan. It
accepts the principle that availability of essential medicines not only improves the health of
patients, but also increases the peoples’ trust in health facilities and promotes their further
participation in health programs.
To fulfill its mandate, MoPH has received assistance from three major international
partners—the World Bank, European Union, and the US Agency for International
Development (USAID)—to provide essential medicines for the basic package of health
services (BPHS) and the essential package of hospital services (EPHS) throughout
Afghanistan over the past several years. USAID contracted SPS for procurement of
medicines from international suppliers; the World Bank and the European Union have
contracted with nongovernmental organizations (NGOs) as sub-recipients to procure
medicines primarily from the local market to supply health facilities.
The existence of the three drug financing and management systems among MoPH partners
has created several challenges in the management of pharmaceutical affairs and the current
highly fragmented and diverse medicine supply operations may not be providing the
optimal support possible. The Coordinated Procurement and Distribution System (CPDS),
which is reflective of good governance principles and oversight, facilitates the management
of partner contributions and in-country resources for essential medicines.
MoPH invited representatives of donors, NGOs, United Nations agencies, government

agencies, private sector representatives, and other agencies involved in drug procurement
and supply of medicines for the public sector to work together, and this has resulted in the
development of a CPDS governance framework.
The mission of CPDS is to promote good governance in pharmaceutical management for the
public health sector through clearly defined roles and responsibilities of each of the
different partners involved in procurement and distribution activities. The eventual goal is a
fully coordinated and uniform methodology of operation.
In 2012, the Advisory Committee for System Strengthening and Commodity Security
Committee of CPDS conducted a review of procurement, distribution, and quantification
activities and functions to assess the status of the different procurement and supply
systems in use. The purpose for the review was to:
• Form an overview of the existing pharmaceutical supply management situation

• Identify existing gaps, weakness, strengths, and opportunities of the current systems
• Determine the degree of similarity, uniformity, and commonality between the
different operating systems from which a coordinated system could be developed
The review reported that most stakeholders of the CPDS use a decentralized medicine
quantification system in support of the BPHS and EPHS. That means each stakeholder’s
3
responsible office or facility has ownership in compiling its own requirements based on the
national Essential Medicines List (EML). However, such decentralization can also result in
inefficiencies, unless each stakeholder adheres to specified standards and approaches.
The objective of these guidelines is to develop the practical competence of MoPH

stakeholders, either at the health facility or at the district, provincial, or national level in
estimating the quantities of essential medicines needed for the service areas. Additionally,
the guidelines are meant to promote reliability, consistency, and reproducibility in the
quantification of essential medicines. The guidelines facilitate processes and tasks that help
stakeholders carry out technical solutions that benefit the Afghan people. For instance, the
quantification guidelines help health care providers select the most appropriate method to
use, make informed decisions on the type of health problems to be treated, and provide an
opportunity to further develop the EML and standardize treatment schedules. The process
also gives an opportunity for the health staff to collect data on morbidity and drug use in
preparation for calculating future medicines needs. The guidelines also help stakeholders’
build competence in budget planning and reconciliation in estimating quantities to fit with
the availed funds from USAID, World Bank, European Union, or the Afghan Government.
Ultimately, the minimum requirements for essential medicines quantification guidelines

lead to improvements in availability of drugs at the point of use and minimize stock-outs,
overstock, waste, and errors. The guidelines bring increased productivity, efficiency, and
accountability and harmonize the processes involved in estimating medicine needs across
the diversity of stakeholders and health facilities that serve the Afghan people. The
minimum requirements guidelines for quantification provide stakeholders with a common
understanding of available methods used in quantification and estimating needs for
procurement. In the future, through the harmonization, these standardized practices will
also help provide a clear picture of national pharmaceutical needs and usage.
The guidelines also provide the basis for developing skills in monitoring and evaluating the
efficiency and effectiveness of the quantification processes to refine estimates for
successive periods.
4
OBJECTIVES OF GOOD MEDICINE QUANTIFICATION
• To improve the process of estimating the right pharmaceuticals, in the right quantities
for a specific procurement period, in a timely and accurate manner
• To make rational decisions in response to service delivery, budgetary, service providers’

competency, institutional capacities, and other attributes
• To ensure uninterrupted availability of appropriate medicines
• To decrease stock outs and over stocking, and hence minimize wastage
• To improve cost-effectiveness and increase clients’ satisfaction level
5
MINIMUM STANDARDS FOR UNDERTAKING MEDICINES QUANTIFICATION
1) Undertake medicines quantification only for those medicines approved for the health
programs—BPHS, EPHS, vertical programs, and specialist operations.
2) Produce a quantification plan with clear timelines and outcomes
3) Establish a quantification committee/team with clear responsibilities
4) Select appropriate quantification methods using evidence-based decisions
5) Undertake the quantification using the selected method
6) Verify the quantification results
7) Reconcile the cost estimates with the available budget; use only rational methods of
quantity adjustments (VEN/ABC) if insufficient budget is available
8) Produce a quantification report with details of all key assumptions and factors used
9) Measure the quantification indicators and publish the results at least annually
10) Measure the quantification accuracy against the real situation and use the results to
adjust assumptions and factors for the next quantification
6
Systematic Approach to Quantification Planning
SYSTEMATIC APPROACH TO QUANTIFICATION PLANNING
Planning for Quantification
Planning is the process of setting goals, developing strategies, and outlining tasks and
schedules to achieve a desired goal. When planning for quantification, step-by-step
activities should be taken with timeframes and resources to achieve an intended objective.
These steps require appropriate structures, systems, or mechanisms necessary for effective
implementation of the quantification plan. The plan should involve information review,
documentation, and retrieval so that the performance of the process can be measured in
terms of achieving the objectives.
Quantification Structures
The first step is to check whether appropriate structures to effectively manage the
quantification process exist at various levels of the health care service that will be
quantifying medicines required. Quantification could take place at MoPH, provincial public
health directorates, national hospitals, or the national or provincial offices of NGOs. If the
structures are not present, then they must be established. To adequately document that all
systems are in place, prepare an organogram showing positions, roles, responsibilities, and
their relationships to other units and departments in the organization.
Source: USAID | DELIVER
7
Figure 1. Typical quantification flow process

Quantification Coordinator
Once the need for quantification of pharmaceuticals has been identified, appoint a
coordinator to be in charge of the quantification process. This should be a task-oriented
position with a clear job description. In most cases, this will be one person, who fulfills this
function in addition to many other responsibilities. Normally, a person from the pharmacy,
clinic, or procurement department could manage the process.
The coordinator:
• Facilitates the appointment of the quantification working group (QWG)

• Facilitates the training of the QWG (if necessary) to make sure the members know
their tasks
• Serves as a secretariat for the QWG
• Obtains resources (computers, calculators, pens/pencils, papers, etc.) for the
quantification process
• Facilitates preparation of an action plan
• Develops a realistic and feasible time line or schedule, which may take months in
multilevel systems
• Assists in preparing quantification and/or data collection forms/datasheets
• Collaborates with the QWG to prepare a list of tasks and assign them to the
members
• Manages the QWG’s meetings and activities
• Coordinates integration and adoption of a procurement action plan
• Compiles/records all documents and takes all necessary actions based on the QWG’s
decisions
• Participates in any other relevant tasks
Quantification Working Group
To ensure accountability, transparency, and

efficiency, each stakeholder should be included in
the QWG, with specific roles and responsibilities.
The membership of this committee varies
depending on whether the system is decentralized
or centralized.
In decentralized systems, when quantification is

undertaken at the health-facility level and
pharmaceuticals are actually dispensed to patients,
the QWG could consist of representatives from the
pharmacy, clinical, nursing, and administration
(accounting, purchasing, health management
information) departments. It is not necessary that
Source: MDS-3, p. 20.14

8
Systematic Approach to Quantification Planning
all parties are involved, only that they be considered.

For centralized quantification, when
quantification is undertaken at a higher level, the
QWG could consist of representatives from the
central or provincial NGO office, Provincial Public
Health Office, MoPH/GDPA, health facilities
(prescribers, pharmacy staff, and clinical
managers), purchasing and information
departments, central medical store (or other
group handling pharmaceutical distribution), and
donors, as available. The QWG should choose a
chairperson. It is not necessary that all parties are
Members of a QWG (credit: SPS staff)
involved, only that they be considered.
Roles and Responsibilities of the QWG
• Define the scope of the quantification and specific objectives according to:
o Geographical area (region, district)

o Population
o Number and type of health facilities
o New programs, scaling up existing services
o National vertical programs (e.g., Expanded Program on Immunization [EPI], TB,
leprosy, malaria, leishmanises, HIV)
o Seasonal variation
o Forecasting period–drugs needed for 1 month, 1 quarter, 6 months, 1 year
o Programs for emergencies, such as outbreaks, strife, and earthquakes, and/or for
long-range forecasting; in an emergency, the group should liaise with the Emergency
National Group
• Examine the data from stock control, invoices, ledger books, Health Management
Information System (HMIS) or Tuberculosis Information System, and demographic
surveys and the population census (Government of Islamic Republic of Afghanistan,
Central Statistical Office, and EPI), which should include current stock level, morbidity
data, epidemiological data (HMIS and disease early warning system), consumption
(issues) over the review time period, number and length of time of any stock outs, and
expiry dates of goods in stock
• Define the data sources and sets required for an effective quantification of the selected
product(s)
• Determine the quantities of pharmaceuticals consumed by each or all health facilities,
either monthly or quarterly; if this information is not available, use total quantities
supplied to the facilities in the target areas
• Examine morbidity data to determine the range and number of incidences of diseases
encountered
• Examine the epidemiological data to determine incidence, distribution, and possible
control of diseases and other factors relating to health
9
• Perform the actual quantification in collaboration with key stakeholders
• Select the best quantification methods (consumption-based, morbidity, proxy-

adjusted consumption, or service-level budget projection) depending on the
availability and quality of existing data, human and financial resources, and
automated systems; after deciding the primary methodology to use, choose a
second method to be used for verification
• Explicitly document all assumptions and modifications or combinations of methods,

such as sources of data used, including the date at which the data was collected,
assumptions made for missing data, and each step in the quantification (i.e., a user
of these guidelines should be able to repeat the quantification without any problem,
at a different moment at any time)
• Monitor medicines that are on order before delivery (and document the
consumption trend) for better management of the forecasting process and any
adjustments as required during the forecasting period
• Write reports on the quantification processes and the final results for presentation
to management
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SELECTING A QUANTIFICATION METHODOLOGY
MoPH stakeholders use various rules and guidelines to estimate the medicines needs for
their facilities. Generally, four quantification methods are technically acceptable and may be
applied singularly or collectively by the stakeholders:
• Consumption
• Morbidity
• Proxy consumption
• Service-level budget projection method (for budget only)
Select a quantification method in a purposeful manner (table 1). The potential availability
and reliability of existing data and the type of supply system will be the primary criteria in
choosing the method. Hence, the first activity is to assess the availability and quality of the
following types of data:
• Demographic
• Morbidity
• Consumption
• Lead times
• Stock balance and pipeline
The most commonly applied quantification method used by MoPH stakeholders is the
consumption method. This method can be precise, if the data is complete, accurate, and
appropriately adjusted for stock outs and changes in demand and use. However, the
method does not respond to the appropriateness of past consumption patterns. Where
irrational use of medicines exists, consumption quantification perpetuates distorted data
that has no relevance to public health priorities and needs.
The morbidity quantification method is more complex and requires the use of well-defined
morbidity data. This method may be more appropriate when consumption data is
incomplete or unreliable, prescribing practices are not rational or do not follow standard
treatment guidelines (STGs), and new or rapidly changing health services occur. It can serve
as a first choice quantification method for well-defined vertical programs, such as universal
immunization (EPI), HIV and AIDS, TB, malaria, family planning (contraceptive supplies), and
special hospital-based interventions and new programs.
The proxy consumption method is generally used when suitable data for both consumption
and morbidity methods are not available. It extrapolates data from one set of facilities or
programs in another province or country to another set of facilities or programs that serves
a population within a similar setting, but for which no data is available.
The service-level budget projection method cannot be used to calculate medicine
quantities. It is used to estimate financial requirements for drug procurement based on
costs per patient treatment at various levels of the same health system or, with great
caution, based on data from another health system. It does not forecast needs for specific
drugs. It does serve as a very useful check or verification on the cost/financial estimates
produced by the other quantification methods. This method should ALWAYS be applied as a
quick check to every quantification.
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Table 1: QUANTIFICATION METHODS
Limitations to the
Meth Formula and
Usage Data required accuracy of the Remarks
ods Calculation steps
method
AMC: average monthly consumption
1. AMC = Ct/Rm
Ct: total quantity consumed
2. AMCa = Ct ÷ [Rm-
- Established Inventory records - Data may be Rm: number of months
(Dos ÷30.5)]
supply system of - Unit prices of the incomplete or AMCa: adjusted AMC for stock outs
3. AMCp = AMCa +
which logistic medicines* inaccurate; Dos: days of stock out
(AMCa x Au)
data is available - Lead time* - Inappropriate AMCp: projected AMC
Consumption
4. SS = AMCp X LT
- First choice if - Pipeline adjustment of Au: adjustment for use changes (if any)
5. Qp = AMCp x (LT +
reliable data is requirements* stock-outs SS: safety stock; LT: lead time
PP) + SS – (Si + So)
available * These data are also - Changes in Qp: quantity to procure for each
6. In case any loss:
- Most reliable used for procurement demand and use medicine
Qpa = Qp + (Qp X
predictor of for other including PP: procurement period
Al)
future quantification irrational use of Si: stock on hand; So: stock on order
7. Estimated cost =
consumption methods medicines Qpa: Qp adjusted for losses (if any)
∑Up X Qp or Qpa
Al: adjusted for losses
Up: unit price; ∑: sum
Qr: total quantity required
Qra: Adjusted Total Quantity Required
1. Qtc = Dcu x ND x LD
Qtc: quantity required for a treatment
- Number of 2. Qr= Qtc X Te course
patient 3. Qra = Qr + (Qr x
- New or vertical Rm: number of months of review period
attendance - Various Au)
programs AMRa = Adjusted Average Monthly
- Frequency of treatment
- New or rapidly
health problems protocols 4. AMRa = Qra/Rm Consumption
changing, scaling- 5. Qp= AMRa x Te: number of treatment episodes or
Morbidity
- Average - Inaccurate
up, health (LT+PP) +SS - cases for each identified health
treatment course patient
services (Si+So) problems of the reviewed period
- Standard attendance data
- When Qtc = quantity of each medicine needed
consumption data
treatments (idea, - Standard 6. In case any loss:
for each treatment episode
actual) treatments may Qpa = Qp + (Qp X
is incomplete or Dcu = Basic units per dose
- Projected not really use Al)
unreliable ND = Number of doses per day
pharmaceutical 7. Estimated cost = LD = length of treatments in day
prices ∑Up X Qp or Qpa Qp = quantity to procure for each
medicine
Qpa: Qp adjusted for losses (if any)
- Use known - Comparability of
consumption & facilities,
- Extrapolating
population data morbidity
facilities or 1. Calculate QpS for QpS: quantity to procure for the
from a reference patterns and
Proxy consumption
programs in a the standard facility reference or standard facility

facility to treatment
similar setting 2. QpT= QpS/PS X PT QpT: quantity to procure for the target
estimate practices
- When both 3. Qpta = Qpt + (Qpt x facility
medicine needs in between sites /
consumption and Au) PS: population served by the reference
a similar target countries
morbidity 4. Estimated cost = or standard facility
facility - Incomplete or
methods for a ∑Up X QpT PT: population served by the target
- Number of local inaccurate
target facility are facility
health facilities consumption
not applicable
- Estimate of local data from the
user population reference facility
- Attendance
Service level projection
treatment
- Average cost per
- Estimating pattern Estimating budget
requirements
patient ACpy: average treatment cost per

of budget
budget needs - Supply system needs for a health

attendance / year patient/year
- Check on efficiency condition + buffer =
- Use by service Np: number of patients
calculation by - It does not ACpy X Np (1+Mb/12)
levels and Facility Months of buffer: Mb
other methods forecast needs
type
for specific
medicines
12
Consumption Method
These methods are NOT exclusive, and the QWG should consider applying a combination of
the four methods because of challenges in obtaining reliable data in most health facilities.
At a minimum, one quantification method and the service-level projection method should
always be used. Note that the information on the four methods that follows is based on
MDS-3, chapter 20.
Figure 2. Publications that may be helpful when quantifying medicines
13
CONSUMPTION METHOD
1) Prepare a list of medicines to be quantified
There are various lists available from which quantification data can be drawn. These
include the EML, formularies and BPHS/EPHS list (annexes 1 and 2). The level of service,
such as BPHS or EPHS, determines the range of products. In addition, the level of
competence of the facility staff, infrastructure (internal environment of the warehouse,
shelves, availability of a cold chain system), and the resources available influence what
products will be ordered.
Depending on the system used, the department ordering the medicines should prepare
a draft list based on the background information available. Refer to table 2 for other
information that is required.
2) Obtain data and evaluate data quality and calculate the various types of consumption
a) For each health facility, collect total consumption (Ct) data for each medicine, taking
note of the days when the medicines were out of stock for the review period. At the
provincial or national level, the consumption data would be quantities issued.
The data can be collected from stock records (stock control cards, ledger books),
delivery invoices, monthly reports, and dispensing reports. The quantity and quality
of data is important for informed decision making. However, the relevance of the
data should be reviewed. For most MoPH stakeholders who receive funding annually
and know that Afghanistan has 4 clear climatic seasons that affect consumption and
morbidity figures, a 12-month consumption data review period should be used.
However, facilities quantifying for their monthly orders should use quarterly (3
months) consumption data. Where quantification is undertaken for more than one
health facility, it is common to find that some may have very good data while others
may have none. It is advisable to use the best data that is available.
b) From the collected data, calculate the average monthly consumption (AMC) and
adjust for stock-out time (if any; this will adjust the consumption to include the
consumption that would have occurred if the stock had been available).
• AMC = total consumption (Ct)/ review period in months (Rm)
• AMC = Ct/Rm
For example, acetylsalicylic acid 300 mg tablets over 12-month review period
AMC = 24,000 ÷ 12 months
= 2,000 per month
14
Consumption Method
c) Also calculate the adjusted average monthly consumption (AMCa), which takes into
account the number of days that the individual medicine was out of stock.
• AMCa = total consumption (Ct)/review period in months (Rm); from Rm is

subtracted the number of days an item was out of stock (Dos) during the review
period/30.5 days. The number 30.5 is an average number of days in a calendar
month over a period of 12 months.
• AMCa = Ct ÷ [Rm- (Dos ÷ 30.5)]
For example, acetylsalicylic acid 300 mg tablets were out of stock for 15 days in
the last 12 months
AMCa = 24,000 ÷ [12 – (15 ÷ 30.5)]
= 2,087
d) Once AMCa has been determined, calculate the projected average monthly
consumption (AMCp), which is the future consumption, adjusting for any expected
changes in consumption as a result of:
 Population movements due to war or floods

 Seasonal changes such as malaria, pneumonia, and diarrhea diseases
 Any other expected influence, such as expected population growth
For example, if the number of patients is expected to increase by 5%, adjust the
quantity by that amount.
• AMCp = adjusted average monthly consumption (AMCa) + adjusted average

monthly consumption (AMCa) × the use adjustment (Au).
• AMCp = AMCa + (AMCa × Au)
For example, acetylsalicylic acid 300 mg tablets with a 5% increased use

adjustment
AMCp = 2,087 + (2,087 × 0.05)
= 2,191
The Au factor is applied if there is an anticipated change in the consumption pattern.

This could be an increase or decrease expressed as a percentage. The rational for the
adjustments should be clearly known. If the adjustment is for specific conditions,
such as outbreaks of flu, cholera, or meningitis, it should be applied only to those
medicines used for those conditions. If the influencing factor is population based,
then the adjustment factor should be used for all medicines.
15
3) Calculate safety (buffer) stock (SS) needed for each medicine to avoid stock-out. The
preferred level of SS should be based on AMCa and the time it takes to replenish the
stock or lead time (LT). For MoPH stakeholder facilities that conduct quarterly orders,
the preferred SS should be at least three months. For central procurement agents
serving as central medical stores that conduct annual procurements requiring a longer
LT (12 months), a larger quantity SS is required, without holding unnecessary stocks in
danger of expiry. Some MoPH stakeholders conduct annual procurements from
international markets while others order from the local market. Their LTs differ.
• SS = projected average monthly consumption (AMCp) × lead time (LT; generally 3

months)
• SS = AMCp × LT
For example, acetylsalicylic acid 300 mg tablets

SS = 2,191 x 3
= 6,573
4) Calculate the quantity of medicines to procure (Qp) for the procurement period (often
the time between orders), taking into account AMCp, LT, SS, procurement period (PP;
number of months to be covered by the order), stock on hand (Sh), pipeline stock, and
unusable stock.
• Qp = projected average monthly consumption (AMCp) × by the sum of lead time (LT)
+ procurement period (PP); add to that SS, then subtract the sum of Sh and stock on
order (So).
• Qp = AMCp × (LT + PP) + SS – (Sh + So)

Qp = 2,191 × (3 + 12) + 6,573 – (2,000 + 1,000)
= 36,438
5) Calculate the quantity to procure adjusted for losses (Qpa), if any, that may occur
due to damage, spoilage, expiration, and theft. The adjustment factor should be
evidence-based from previous records. If the losses happen only to a specific set of
medicines, make the adjustment only to those medicines at risk (e.g., medicines with
a very short shelf life may have more expiry).
• Qpa = quantity to procure (Qp) + (quantity to procure [Qp] × loss adjustment

factor [Au]); loss adjustments are typically on the order of 5%
• Qpa = Qp + (Qp × Au)
16
Consumption Method

Qpa = 36,438 + (36,438 × 0.05)
= 38,259.9
6) The next step is to estimate the budget cost using the most current medicine prices.
Those MoPH stakeholders procuring from the local market estimate by using
previous prices and conducting a limited market survey on price changes for
medicines and use those values to determine the overall cost. The International Price
Indicator Guide can provide a good estimated international price for each medicine,
but remember to adjust for shipment costs to Afghanistan.
17
acid
factor
Name of
medicine
calculation
Acetylsalicylic
Strength
mg
300
Basic unit (BU)
tablet
Pack size
1000
Total con-sumption
(Ct)
24000
Table 2. Example of Past Consumption Data
15
Days out of stock

(Dos)
Average monthly
2000
consump-tion (AMC)
12 month
24,000/12
Average adjusted
Dos
2087
monthly consump-
tion (AMCa)
15 days
15/30.5)
24,000/(12-
18
Projected average
5%
2191
monthly con-
Consumption Method
sumption (AMCp)
patients
2,087*1.05
increase in
Stock on hand (Sh)

2000
Stock on order (So)

1000
Safety stock (SS)

6573
2191 *3
months
12
Quantity required
(Qp)
36438
months
Adjusted quantity to
5%
procure (Qpa)
*1.05
43,011
losses
38259.9
Cost per pack size

46
Order quantity
Value of proposed
order
MORBIDITY METHOD
The morbidity method uses data on patient use (attendances at health facilities) and
morbidity (the frequency of common health problems) to project the need for medicines
based on assumptions about how the problems will be treated.
1) Determine which health problems are a priority in the target area of service:
The Afghanistan health system (e.g., BPHS/EPHS, vertical programs) has listed the
common health problems at each level. Therefore, adapt the list of common health
problems from the BPHS/EPHS, vertical program, etc., and prioritize those common to
the area of service. The information can be accessed from the existing HMIS reports at
the health facilities. If there are no existing patient records, use the WHO International
Classification of Diseases
(ICD).
Figure 3. Flow diagram for the morbidity method
2) Decide which diseases or conditions are to be treated at the health facilities that are
being quantified
19
3) Collate the morbidity data for each identified health problem
4) Determine the list of medicines for the health conditions to be treated
The BPHS/EPHS and vertical programs have lists of medicines to be used for the
conditions at that level. Adapt the medicines and commodities list to treat the common
health problems for the target population. The EML, STGs, or previous procurement lists
can also be used. It may be necessary to develop an STG if one is not available.
5) Describe each product, including its generic name or international nonproprietary name
(INN), dosage form, strengths, basic unit, and packaging using the STGs, which provide
the following information:
• Health problem: malaria, pneumonia, hypertension
• Generic name, dosage form, and strength of the medicine: amoxicillin capsules, 250
mg
• Average dose, average number of doses per day, average number of days the
medicine is to be taken: 1 capsule 3 times a day for 5 days
When there is a choice between medicines given in the STGs, selection should be based
on efficacy, safety, quality, price, and availability.
6) Calculate the quantity of each medicine needed for each treatment episode (Qtc)
• Qtc = basic unit per dose (Dcu) × average number of doses per day (ND) × average
number of days the dose is to be taken (LD)
• Qtc = Dcu × ND × LD
• Qtc= 250 mg amoxacillin x 3 days x 5 = 15 capsules of amoxacillin 250 mg
• For chronic conditions, the total quantity given per prescription is used (e.g., one
month of treatment).
7) Calculate the total quantity of each medicine required (Qr) to treat each identified
health problem
• Qr = quantity of each medicine needed for each treatment episode (Qtc) × number
of treatment episodes of the health problem (Te)
• Qr = Qtc × Te
For example, amoxicillin 250 mg

Qr = 15 capsules × 525 cases
20
Morbidity Method
= 7,875 capsules
8) Combine the estimates for each of the identified health problems for the same
medicine into a master procurement list
9) Adjust the prepared list to cover other health problems that may not have been
addressed in the quantification. Use expert opinion or extrapolate requirements based
on data obtained from another health system for 20 or 30 commonly used medicines.
10) Adjust estimates as would be done if the consumption method (step 2d) were being
used
 Adjust for expected changes in consumption as a result of population movements,

seasonal changes, or other expected influences.
 projected quantity = total quantity + (total quantity x Au )

 Calculate the average Monthly Consumption
 Adjusted Average Monthly Quantitiy Requirement = Projected Quantity / Review
Period
 AMR = Qr/Rp
 Calculate quantity of medicines required for the procurement period (Qp). Take into
account LT, PP, SS, Sh,So, pipeline stock, and unusable stock. (See consumption
method, steps 3 and 4.)
 Qp = adjusted average monthly consumption (AMC) x (lead time [LT] +

procurement period [PP]) + safety stock (SS) – (stock on hand [Sh] + stock on
order [So])
 Qp = AMCp x (LT + PP) + SS – (Sh + So)

 Adjust for losses that may occur due to damage, spoilage, expiration, theft (see
consumption method, step 4)
 Qpa = Qp + (Qp x Au)
 Estimate the cost using the most current prices in Afghanistan for each medicine and
use the values to determine the overall cost. For international prices, refer to the
International Price Indicator Guide (see consumption method, step 5 )
 Compare for total costs with available budget and make rational adjustments based
on the funds available by applying the VEN system and ABC analysis.
21
Table 3. Example of Morbidity Data
Times a day
Amount per
adjusted by
Quantity to
quantity to
Number of
Number of
Quantities
quantities
Total cost
Unit price
treatment
course of
for buffer
episodes
Medicine
Adjusted
Adjusted
required
Disease
procure
procure
amount
Type of
patient
ICD #
Dose
Total
days
10%
Unit
($)
Adult 3 90 600 54,000 59,400
280 Anemia Ferrous sulfate 60 mg 30 Tab 0.00175
Child 1 30 400 1200 1,320
Procaiin Benzylpenicillin 3 MU
Pneumonia 3 MU 1 1 350 350 Vial 0.12100 127.6
Inj IM
Adult Phenoxymethyl penicillin 250
480- 1. Severity 1 2 tabs 4 5 40 350 14,000 0.02160 15,400
mg tab
6
Paracetamol 500 mg tab 2 tabs 4 1 8 350 2,800 Tab 0.00324 3,080
Pneumonia Amoxicillin 250 mg 1 tab 3 5 15 525 7,875 0.01034 8,662.5 4,331 25491 26,765 276.75
Child
1. Severity 1 Paracetamol 500 mg ½ tab 4 2 4 525 2,100 0.00324 2,310
22
Morbidity Method
Figure 4. Example of Morbidity data
23
Figure 5. Example of HMIS data
24
PROXY CONSUMPTION METHOD
1) Select the standard system for comparison and extrapolation.
This could be another region, province, district, or health facility that is similar to the
focus area. For example, health facility A is a new facility that has no consumption data.
However, health facility B is similar to facility A. Use the data from facility B data to
estimate the medicines need for facility A.
2) Develop the list of medicines as described under the consumption method.
3) Establish the period (number of months) under review (which could be 12 months as
discussed under the consumption method).
4) Review the available data from the selected standard system or facility.
5) Choose the comparison denominator (population or number of patient contacts).
Population factor (population served by target facility, PT, and population served by
reference or standard facility, PS) is much easier to find. However, if HMIS data is also
available for patient contacts, the latter is much more precise.
6) Determine the consumption rate in the standard system.
7) Extrapolate the standard system consumption rate to the target system.
8) Determine the quantity to procure (Qpt) for the target facility.
Qpt = Qps (quantity to procure for standard or reference facility)/PS × PT
a) Adjust for anticipated losses (see consumption method, step 5)
b) Estimated cost for each medicine = unit price (Up) × quantity to procure for target
facility
Estimated cost = Up × Qpt
c) Calculate total costs
d) Make adjustments based on the available budget (apply ABC/VEN analysis)
25
Table 4. Example of Proxy Consumption Method

Standard system consumption: 50,000 inhabitants, 32,500 Target system extrapolation: 80,000 inhabitant, unknown
outpatient contacts outpatient contacts
Total
usage Projected
in 6- Adj. avg. Adj. Usage Usage per requirement Value of
month Days monthly annual per 1,000 in BUs based Probable proposed
Pharmaceutical Basic period out of usage usage 1,000 outpatient on 80,000 Pack Order pack price order
product Strength unit (BU) stock (BU) (BU) pop. contacts inhabitants size qty. (USD) (USD)
Ampicillin 500 mg cap 59,500 20 11,137 133,644 2,673 4,112 213,831 1,000 214 46.50 9,951.00
400/
Co-trimoxazole tab 81,000 0 13,500 162,000 3,240 4,985 259,200 1,000 260 21.00 5,460.00
80 mg
Erythromycin 250 mg tab 80,500 0 13,417 161,000 3,220 4,954 257,600 500 516 14.50 7,482.00
200/
Ferrous salt/folic acid tab 353,000 0 58,833 706,000 14,120 21,723 1,129,600 1,000 1,130 2.30 2,599.00
.04 mg
Paracetamol 500 mg tab 319,000 15 57,927 695,128 13,903 21,389 1,112,204 100 1,021 3.90 3,981.90
Indomethacin 25 mg cap 167,000 0 27,833 334,000 6,680 10,277 534,400 1,000 535 3.30 1,765.50
Salbutamol liquid 150 125 mg/
bottle 1,063 0 177 2,126 43 65 3,402 1 3402 0.83 2,823.66
mL 5 mL
26
SERVICE-LEVEL PROJECTION OF BUDGET REQUIREMENTS
This method is used to estimate financial requirements, not specific medicine quantities, for
pharmaceutical procurement on the basis of costs per patient treated at various levels of
the same health system or, with great caution, data from other health systems. It does not
forecast needs for specific medicines, but provides a clear, logical, and simple means of
estimating or verifying pharmaceutical financing requirements.
The main requirement for this method is a fairly reliable estimate of average medicine cost
per patient attendance/treatment and average numbers of patient attendances at various
levels of the standard health system.
Example 1: ARVs
Anti-retro viral (ARV) treatments for patients living with HIV and AIDS can involve many
different treatment protocols with different medicine formulations. Quantification is
complex and requires accurate data on the relative ratios of patients on each of the
different treatment protocols.
However, a simple average medicine cost can be used to forecast potential future budget
requirements based on different rates of scale-up.
For first-line ARVs, a typical average per patient medicine cost per year (ACpy) in the US is
$130.
The calculation is then a simple matter of knowing the number of patients (Np) and
adjusting for months of buffer stock (Mb).
• Np = 1,000 patients on treatment forecasts
• ACpy = $130 per patient/year
• Cost for 1,000 patients for 1 year = 1,000 × $130 = $130,000
• Mb = 6 months = 1,000 × $130 × 6/12 = $65,000
• Total = $130,000 + $65,000 = $195,000
The following formula is another option:
Total = ACpy × Np (1 + Mb/12)
So, if the result of the quantification is in the millions of dollars, something went very wrong
with the math!
27
Example 2: TB Medicines
First-line TB treatment typically requires two phases: an intensive phase using four or more
medicines for two months and then a continuation phase using three or more medicines for
four months. Dosages are adjusted for body weight, and body weight can change during the
treatment—patients often gain back previously lost body weight as they start to recover
during the course of the treatment.
Again, this makes for complex calculations of the exact number of medicines required, but
for simple budgeting purposes, it is possible to use an average treatment price.
The Global Drug Facility produces a kit (figure 6) with all the medicines required for first-line
TB treatment in one box for an adult of average body weight. 5
Figure 6. Product information for a first-line TB treatment kit
Using a treatment price of $22.30 (FOB; i.e., no shipping costs included), it is then possible
to estimate budget costs for medicines based on the number of patients requiring
treatment.
Total = 10,000 patients × $22.30 = $223,000
5
http://www.stoptb.org/gdf/drugsupply/pc3.asp?PID=1
28
Service-Level Projection of Budget Requirements
Prioritization and Rational Adjustment of the Procurement List When Funds

are Limited
MoPH stakeholders often have limited budgets and cannot buy all the medicines they would
like. The QWG should compare the overall estimated cost of the quantification with the
available budget and make rational adjustments about what medicines to procure.
Minimum standard - A rational method of order quantity adjustment must be used when
there is insufficient budget.
The VEN and ABC analysis systems can be used to prioritize and make adjustments; when
possible, the two methods can be applied jointly.
29
VEN AND ABC ANALYSES
VEN Analysis
In most cases, the funds available for health services are limited. Meanwhile, there are
thousands of medicines available on the market to choose from. MoPH has minimized the
challenge and brought rational decision making to the medicines selection process by
producing an EML, BPHS/EPHS lists, and STGs to choose from for procurement and use.
When funds are limited, it is imperative that only medicines that have the greatest impact
on public health be procured. These guidelines describe the VEN and ABC systems for
selecting individual medicines that have the largest health impact from the quantified list.
VEN analysis is useful for assuring that procurement is in line with public health priorities.
Unit price and popularity of the medicine should always be a secondary consideration.
Health impact should be the top priority.
The abbreviations used are V for vital, E for essential, and N for nonessential (or necessary).
Criteria for VEN Classification
• Vital medicines are potentially lifesaving, have proven efficacy, have significant
withdrawal side effects (making continuous, reliable supply mandatory [e.g., ARVs, anti-
TB]), or are crucial to providing basic health services.
• Essential medicines are effective against less severe, but significant forms of illness, but
are not absolutely vital to providing basic health care.
• Nonessential medicines are used for minor or self-limited illnesses, are of questionable
efficacy, or have a comparatively high cost for a marginal therapeutic advantage.
Currently, medicines in the BPHS/EPHS, EML, and STGs are not classified according to the
VEN system. The National Drug and Therapeutic Committee (NDTC) will be reviewing the
BPHS/EPHS, EML, and STGs to assign each individual medicine a class as described above.
Where the NDTC has not yet undertaken the classification, the local Drug and Therapeutics
Committee should do so on behalf of the QWG to review the quantified medicines list for
that quantification cycle. They should designate each individual medicine as V, E, or N.
(Note: The WHO EML does list all medicines by VEN classification and this can be used as a
guideline.)
30
Service-Level Projection of Budget Requirements
How to Use VEN Classification to Prioritize Medicines for Procurement with

Limited Funds
1) Classify each individual item on the BPHS/EPHS/EML by V, E, or N.
2) Review the assumptions and formulas to ensure that proposed purchase quantities are
correctly adjusted for stock outs, future use and losses, buffer stock, etc.
3) Review the quantification costing and available budget for procurement and estimate
the value of saving required.
4) Remove any N items from the procurement list for which there is no clear therapeutic
need.
5) If a gap still exists, reduce quantities or eliminate other N items and reassess the
estimated procurement cost for the remaining items.
6) Limit therapeutic duplications (more than one medicine with a similar therapeutic
effect). Consider limiting medicines that are available in more than one strength and
make adjustments to quantities.
7) Reduce the quantities of items by using the “preferential weighting” approach (more
funds for V items, less funds for E items, remaining funds for N items).
31
VEN and ABC Analyses
Table 5. Examples of Medicines Classified by the VEN System

Vital Essential Nonessential
Criteria • Potentially lifesaving Effective against less severe, but • Used for minor or self-limited illnesses
• Significant withdrawal side effects nevertheless significant, forms of illness • Questionable efficacy
• Major public health importance • High cost for marginal therapeutic
advantage
Health • Phenobarbitone sodium tablet, 30 g • Lignocaine HCl injectable 1%, 25 mL vial • Lignocaine + adrenaline injectable, 1% +
center • Phenoxymethylpenicillin tablet, 250 mg • Praziquantel tablet, 600 mg 1/200,000
• Co-trimoxazole tablet, 480 mg • Gentian violet paint, aqueous 0.5%, 500 mL • Aspirin tablet, pediatric, 75 mg
• Nystatin pessaries, 100,000 units • Benzyl benzoate application, 25%, 100 mL • Suramin sodium injectable, 1 g vial, powder
• Artemether-lumefantrine tablet, 20 mg + 120 • Magnesium trisilicate complex tablet, for reconstitution
mg chewable • Nystatin tablet, 500,000 units
• Ferrous sulfate/folic acid tablet, 200 mg/0.5 • Chlorpromazine HCl tablet, 25 mg • Amodiaquine tablet, 200 mg base
mg • Aminophylline tablet, 100 mg • Migril tablet
• Adrenaline injectable, 1/1000, 1 mL ampoule • Vitamin B complex tablet • Ferrous sulfate tablet, 200 mg
• Oral rehydration salts (ORS) powder, 1 liter • Aluminum acetate eardrops, 13% • Propranolol HCl tablet, 10 mg
(WHO) • Zinc oxide ointment, 15% • Magenta paint, 20 mL
• Gentamicin injectable, 40 mg/mL, 2 mL vial • Mebendazole tablet, 200 mg • Anti-snakebite serum injectable, 10 mL amp
• Condoms with spermicide • Ferrous sulfate mixture, pediatric, 60 mg/5 • Ergometrine maleate tablet, 500 mcg
• Measles vaccine, live injectable, 10-dose (5 mL • Vitamins, multiple pediatric drops
mL) vial • Chlorpheniramine maleate tablet, 4 mg • Thymol mouthwash solution tablet
• Ergometrine maleate injectable, 500 • Lidocaine + adrenaline dental
mcg/mL, 1 mL ampoule cartridge 2% + 1/80,000
• Salbutamol sulfate tablet, 4 mg
• Vitamin A capsule, 200,000 IU
District • Diazepam injectable, 5 mg/mL, 2 mL • Diazepam tablet, 5 mg

hospital ampoule • Paracetamol tablet, 500 mg
• Atropine sulfate injectable, 600 mcg/mL, 1 • Codeine phosphate tablet, 15 mg
mL ampoule • Amoxicilline elixir, 125 mg/5 mL
• Nalidixic acid tablet, 500 mg • Erythromycin suspension, 125 mg/5 mL
• Isoniazid + thiacetazone tablet, (HT3) 300
mg/150 mg
• Digoxin tablet, 250 mcg
32
Source: Jamaican MOH 2008
Figure 7. Example of EML with VEN classification
Figure 8. Part of the Uganda essential medicines and health supplies list with
VEN classification
(Essential_Medicines_and_Health_Supplies_List_for_Uganda_2012_01.pdf 6)
6
http://ebookbrowsee.net/ministry-of-health-essential-medicines-and-health-supplies-list-for-uganda-2012-
01-pdf-d412485208
33
Table 6. Sample Guidelines for VEN Categories

Characteristic of drug or target condition Vital Essential Nonessential
Occurrence of target condition
• Persons affected (% of population)
Over 5% 1–5% Less than 1%
• Persons treated (number per day at average
health center)
Severity of target condition
• Life-threatening Yes Occasionally Rarely
• Disabling
Therapeutic effect of drug
• Prevent serious diseases • Yes • No • No
• Cures serious disease • Yes • Yes • No
• Treat minor, self-limited symptoms and • No • Possibly • Yes
conditions • Always • Usually • May or may not
• Has proven efficacy • Never • Rarely • May or may not
• Has unproven efficacy
ABC Analysis
Figure 9. ABC analysis

Experience in supply chain management has shown that a relatively small number of items
account for most of the monetary value of the annual consumption of medicines. The
34
analysis of this phenomenon is called ABC analysis (and more generally known as the Pareto
principle). The items used or required have different levels of monetary significance and
should be handled or controlled differently.
The goal of ABC analysis is to analyze the patterns and value of consumption or
procurement by classifying the medicines into three categories (A, B, and C) according to the
value of their usage or purchase (unit cost multiplied by total quantity). Class A items are
the few items that have the highest expenditure, typically 10–20% of items account for 75–
80% of the funds. They are often the medicines with the highest unit cost or consumption
rates. Class B items have intermediate usage rates (10–20% of items account for 15–20% of
the funds). Class C accounts for 60–80% of the items with low individual usage and low
monetary value (the total of which typically accounts for 5–10% of funds). Therefore, when
the budget is limited, class A items have the highest potential for savings, class B items may
have additional savings, and class C items have little or no potential for cost reduction.
ABC Analysis in Excel
1) Prepare an Excel spreadsheet listing each medicine and its Qpa, which is the last stage in
the quantification.
2) Rank the items in descending order by the total value, starting with the highest value
item at the top and the lowest value item at the bottom. Add all the total values
together to obtain a total value for all the medicines. This value will be used to calculate
the % total value for each individual medicine.
3) Add a new column labeled % of total value.
4) Calculate the %of total value represented by each item as follows: divide the value of
each item by the total value of all items at the bottom of the column and multiply by
100. The result obtained is each item’s cost as a percentage of the total cost.
% of total value = (value of each item/total value of all items) × 100
5) Add a new column labeled cumulative % of value.
6) The cumulative value for the first item is the same as the % of total value. For
example, in table 7, amoxicillin 500 mg is 11% for both % of total value and
cumulative % of value. For the next item, the cumulative % value is calculated
byadding the % total value of that itemto the % total values of the items above it. For
example, in table 7, the cumulative % value of oral rehydration salts is 23.74%, which
is the sum of the % of total value for amoxicillin 500 mg, amoxicillin 250 mg, and oral
rehydration salts (11.04% + 6.6% + 6.1%).
7) Choose cut-off points for A, B, and C categories of drugs (for example, A: 75–80% of
cumulative value, B: 95% and C: 100%)
8) Add a column labeled number of items and assign serial numbers (1, 2, 3, etc. ) for all
items. In table 7, this column is on the far right. The result indicates the number of
35
items that correspond to cumulative % of value (i.e., the number of items that
account for a certain percentage of total value). For the next step, use the last
number (total number of the items) as a as denominator.
9) Insert a column labeled % of items between cumulative % of value and number of

items (the ranking column on the far right; see table 7).
10) Calculate the percent using this formula: divide the ranking (far right column in table
7) by the total number of the items (in this case, 77), then multiply by 100. Each item
represents the cumulative percentage of the total items. The result indicates the
percentage of cumulative items that accounts for a certain percentage of cumulative
value.
% of items = each item number / total number of items × 100
11) The following is optional; it is recommended for the first time an ABC analysis is
conducted and should be repeated at regular intervals, but it is not necessary for
every quantification. If using spreadsheet software, select the cumulative % of value
column and make a line graph, which should be a curve (figure 10). The x-axis shows
rank of item in percentage and the y-axis shows the percentage of cumulative value
of the items. This graph shows the number of items that account for a percentage of
cumulative value.
12) The last step is to right click the axis, then select “data.” Under “horizontal (category)
axis label,” click edit; in the "axis data range," select the “% of items” column, click
OK, and click OK again. The graph showing percentage of items at the x-axis appears
(figure 10). This graph shows the percentage of items that account for certain
percentage of cumulative value.
13) Now combine the ABC approach with VEN methodology (table 8). Review class A
items with VEN classification. Removing any nonessential (N) medicines in classes A
and B will provide major savings for a limited budget.
36
Table 7. Example Medicine Order List of BHC Level for One Year (PCH Project)
(colored rows are category cut-off points)
Quantity % of
needed Total total Cumulative % of
No Item name Cost for 1 year cost ($) value % of value items No.
8 Amoxicillin 500 mg tab/cap 0.0420 4385431 184,363 11.04 11.04% 1% 1
7 Amoxicillin 250 mg/5 mL syrup 0.6340 175417 111,217 6.6 17.60% 3% 2
61 Oral rehydration salts 27 g for 1 0.0797 1293702 103,066 6.1 23.74% 4% 3
pack
6 Amoxicillin 250 mg tab/cap 0.0220 4385431 96,396 5.7 29.48% 5% 4
28 Co-trimoxazole (sulfmthx + tmp) 0.0110 7847730 86,619 5.2 34.64% 6% 5
480 mg tab
34 Ethinylestradiol 30 mcg + 0.2640 295685 78,061 4.6 39.29% 8% 6
levonorgestrel 150 mcg cycle
77 Zinc dispersible 20 mg blister of 10 0.2300 323426 74,388 4.4 43.72% 9% 7
tab
52 Metronidazol 125 mg/5 mL susp 0.4346 147409 64,059 3.8 47.53% 10% 8
100 mL
44 Levonorgestrel 0.03 mg tab, cycle 0.3000 185429 55,629 3.3 50.85% 12% 9
64 Paracetamol 500 mg tab 0.0066 7370473 48,645 2.9 53.74% 13% 10
69 Ringer lactate IV 1000 mL 0.6318 73705 46,569 2.8 56.52% 14% 11
53 Metronidazole 200 mg tab 0.0048 8770863 42,174 2.5 59.03% 16% 12
17 Cetrimide 15% + chlorhexidine 5.4900 6566 36,049 2.1 61.17% 17% 13
gluconate 1 L
73 Sodium chloride 0.9% isotonic IV 0.6857 51741 35,477 2.1 63.29% 18% 14
1000 mL
3 Aluminum hydroxide 120 mg + 0.0031 11055709 34,597 2.1 65.35% 19% 15
magnesium trisilicate 250 mg tab
35 Ferrous sulf 200 mg + folic acid 0.0020 15524427 31,583 2.1 67.23% 21% 16
0.25 mg tab
49 Methyldopa 250 mg tab (L) coated 0.0213 1418394 30,172 1.8 69.03% 22% 17
41 Ibuprofen 200 mg tab 0.0059 4912420 28,860 1.7 70.74% 23% 18
27 Co-trimoxazole (sulf mthx + tmp) 0.0037 7370473 27,179 1.6 72.36% 25% 19
120 mg tab
21 Chloramphenicol sod succ 1 g inj 0.3261 78418 25,570 1.5 73.89% 26% 20
26 Condoms w/without spermicide 0.0280 908136 25,397 1.5 75.40% 27% 21
66 Procaine benzylpenicillin 3 g (MIU) 0.2038 110557 22,526 1.3 76.74% 29% 22
inj
9 Ampicillin sod 1000 mg inj 0.1937 112033 21,704 1.3 78.03% 30% 23
20 Chloramphenicol 250 mg cap 0.0163 1308906 21,345 1.3 79.30% 31% 24
68 Retinol 200000 IU capsule 0.0241 854667 20,565 1.2 80.53% 32% 25
54 Multivitamin coated tab 0.0038 5287611 20,093 1.2 81.72% 34% 26
75 Tetracycline HCl 1% eye oint tube 0.1399 131563 18,405 1.1 82.82% 35% 27
5g
76 Water for injections 10 mL 0.0388 470811 18,279 1.1 83.91% 36% 28
63 Paracetamol 100 mg tab 0.0021 8597657 18,254 1.1 85.00% 38% 29
16 Benzoic acid 6% + salicylic acid 3% 0.4270 41385 17,671 1.1 86.05% 39% 30
oi/cr 40 g
42 Infusion giving set with airinlet + 0.1419 123312 17,499 1.0 87.09% 40% 31
needle
15 Benzathine benzylpenicillin 2.4 0.9236 18655 17,230 1.0 88.12% 42% 32
MIU/5 mL inj
37
Quantity % of
29 Dextrose 5% IV 500 mL btl with 0.4060 36852 14,962 0.9 89.01% 43% 33
nipple (no set)
10 Ampicillin sod 500 mg inj 0.0988 142651 14,087 0.8 89.85% 44% 34
39 Gentian violet powdered 25 g tin 1.7475 7370 12,880 0.8 90.61% 45% 35
14 Benzathine benzylpenicillin 1.2 0.6249 19257 12,034 0.7 91.33% 47% 36
MIU/5 mL inj
70 Salbutamol 100 mcg/dose aerosol 1.5800 7370 11,645 0.7 92.02% 48% 37
100 mL 200 doses
1 Acetylsalicylic acid 500 mg tab 0.0038 3038353 11,424 0.7 92.70% 49% 38
38 Gentamycin sulfate 80 mg/2 mL 0.0945 105287 9,950 0.6 93.30% 51% 39
inj
47 Mebendazole 100 mg tab 0.0058 1605289 9,351 0.6 93.85% 52% 40
37 Gentamycin sulfate 20 mg/2 mL 0.0884 105287 9,302 0.6 94.41% 53% 41
inj
19 Chloramphenicol 125 mg/5 mL 0.2244 40225 9,025 0.5 94.95% 55% 42
susp 100 mL
45 Lidocaine HCl (Lignocaine) 2% inj 1.0730 7370 7,909 0.5 95.42% 56% 43
20 mL
59 Nystatin 500,000 IU tab oral 0.0499 114013 5,684 0.3 95.75% 57% 44
coated
43 Intrauterine device copper coated 0.4900 10531 5,160 0.3 96.06% 58% 45
piece
60 Nystatin pessaries 100000 U 0.0158 313245 4,961 0.3 96.36% 60% 46
40 Hydrocortisone sodium suc 100 0.1560 29520 4,605 0.3 96.63% 61% 47
mg inj
65 Povidone-iodine 10% solution 500 1.1070 4135 4,578 0.3 96.90% 62% 48
mL
12 Artesunate 100 mg (6 tabs) + 1.0347 3685 3,813 0.2 97.13% 64% 49
sulfadoxine 500
mg/pyrimethamine 25 mg (3 tabs)
5 Aminophyllin 25 mg/mL inj 10 mL 0.4041 9428 3,810 0.2 97.36% 65% 50
13 Artesunate 50 mg (6 tabs) + 0.9911 3685 3,652 0.2 97.58% 66% 51
sulfadoxine 500
mg/pyrimethamine 25 mg (2 tabs)
36 Folate 5 mg tab 0.0021 1754173 3,636 0.2 97.79% 68% 52
58 Nystatin 100,000 IU tab oral non- 0.0174 182069 3,163 0.2 97.98% 69% 53
coated
71 Salbutamol 4 mg tab 0.0024 1257351 3,022 0.2 98.16% 70% 54
25 Chlorphenamine hydrogen 0.0021 1378143 2,915 0.2 98.33% 71% 55
maleate 4 mg tab
24 Chlorphenamine hydrogen 0.0733 36852 2,701 0.2 98.49% 73% 56
maleate 10 mg/1 mL inj
57 Nitrofurantoin 100 mg tab 0.0071 290084 2,056 0.1 98.62% 74% 57
33 Ergometrine 0.2 mg tab 0.0168 121780 2,042 0.1 98.74% 75% 58
11 Artemether 80 mg/mL inj 1 mL 1.0654 1843 1,963 0.1 98.86% 77% 59
62 Oxytocin 10 IU/mL inj 1 mL 0.0915 18426 1,686 0.1 98.96% 78% 60
23 Chloroquine phosphate 50 mg/5 0.4426 3685 1,631 0.1 99.05% 79% 61
mL syrup 60 mL
56 Nifedipine 20 mg Retard tab 0.0208 73705 1,529 0.1 99.14% 81% 62
2 Adrenalin 1 mg/mL inj 1 mL 0.2597 5723 1,486 0.1 99.23% 82% 63
38
Quantity % of
30 Diazepam 10 mg/2 mL inj 2 mL 0.0982 14165 1,391 0.1 99.32% 83% 64
22 Chloroquine phosphate 150 mg 0.0070 184262 1,291 0.1 99.39% 84% 65
(base) tab
72 Salbutamol 500 mcg/mL inj 1 mL 0.0840 14644 1,230 0.1 99.47% 86% 66
31 Diazepam 5 mg tab 0.0058 201799 1,166 0.1 99.54% 87% 67
46 Magnesium sulfate 50% inj 20 mL 0.8835 1216 1,074 0.1 99.60% 88% 68
4 Aminophyllin 100 mg tab 0.0056 184262 1,032 0.1 99.66% 90% 69
67 Quinine (bi)sulfate 300 mg tab 0.0541 18426 996 0.1 99.72% 91% 70
film-coated
18 Charcoal, activated powder 125 0.0135 73705 993 0.1 99.78% 92% 71
mg tab
55 Nifedipine 10 mg IR tab 0.0120 73705 884 0.1 99.83% 94% 72
51 Metoclopramide HCl 10 mg/2 mL 0.0757 11056 837 0.0 99.88% 95% 73
inj
74 Sulfadoxine 500 mg + 0.0259 27639 715 0.0 99.92% 96% 74
pyrimethamine 25 mg tab
32 Ergometrine 0.2 mg inj 1 mL 0.0884 7370 652 0.0 99.96% 97% 75
48 Medroxyprogesterone 150 mg/mL 0.0058 86000 501 0.0 99.99% 99% 76
depot inj 1 mL
50 Metoclopramide HCl 10 mg tab 0.0045 25797 116 0.0 100.00% 100% 77
120%
100%
Cumulative value/cost
80%
60%
40% A B C
20%
0%
1 4 7 10 13 16 19 22 25 28 31 34 37 40 43 46 49 52 55 58 61 64 67 70 73 76
Rank of item in percentage
Figure 10. ABC analysis
39
Combined VEN and ABC Analysis
Table 8. Example of Combined VEN and ABC Analysis

Price per Total
ABC Drug name, strength, Dosage package Quantity Total cost cost VEN
category package size form (USD) used (USD) (%) Cumulative (%) category Analysis
Inosine 200 mg N100 tab 20.00 800 16,000.00 16.5 16.5 N items but category
A; low health impact
N but high cost; reduce
Solcoseril 2 mL N25 20.12 700 14,084.00 14.5 31.0 quantity or remove
inj completely
Insulin HM 10 mL 40 V and A, keep
5.50 2000 11,000.00 11.3 42.3 V
IU/mL complete quantity
Drotaverine HCl 0.04 N and A, reduce or
tab 2.15 5000 10,750.00 11.1 53.4 N
A N100 remove
E and A keep, reduce
Isradipine 5 mg N30 caps 16.21 600 9,726.00 10.0 63.4 E only if very large
budget cut needed
Verapamil HCl 80 mg
tab 5.00 1200 6,000.00 6.2 69.6
N100 V V and A, keep
Cefotaxime sodium 1 g 2.40 2000 4,800.00 4.9 74.5
inj N and A, reduce or
Inosine 2% 5 mL N10 1.57 3000 4,710.00 4.8 79.4 N
remove
Ranitidine HCl 150 mg
tab 8.00 500 4,000.00 4.1 83.5 E E and B, keep
N100
Bendazol 0.5% 2 mL N and B, reduce if
0.50 5000 2,500.00 2.6 86.0 N
N10 budget
B inj
Prednisolone 30 mg
1.21 1900 2,299.00 2.4 88.4 V V and B, keep
N3
Nystatin 500,000 U
tab 0.73 3000 2,190.00 2.3 90.7 E E and B, keep
N25
40
Price per Total

ABC Drug name, strength, Dosage package Quantity Total cost cost VEN
category package size form (USD) used (USD) (%) Cumulative (%) category Analysis
Metoclopramide HCl
1.67 1200 2,004.00 2.1 92.7
10 mg N40
Ampicillin 250 mg N24 1.25 1500 1,875.00 1.9 94.7 V V and B, keep
Nandrolone decanoate
1.74 800 1,392.00 1.4 96.1 E E and B, keep
B 50 mg 1 mL
Cocarboxylase 50 mg 3 N and B, reduce if
inj 1.25 1000 1,250.00 1.3 97.4 N
mL N3 budget
Metamizole 50% 1 mL
0.30 2000 600.00 0.6 98.0 E E and B, keep
N10
Digoxin 0.25 mg N50 1.00 600 600.00 0.6 98.6 V V and B, keep
Allylestrenol 5 mg N20 1.63 300 489.00 0.5 99.1
C
Nitrofurantoin 100 mg tab 0.15 3000 450.00 0.5 99.6
N10 E E and C, keep
Chlordiazepoxide 10
0.56 800 448.00 0.5 100.0
mg N50
97,167.00 100.0
41
Verification
Before finalizing the quantification and preparing an order, it is essential that quantification
be verified.
The first step is a service-level projection quantification comparison. Although only a rough
indicator, it can be exceedingly useful in identifying major errors.
The service-level projection is a crude indicator of per capita medicine consumption cost
among the target population. For BPHS, this has been estimated at about $0.75 per capita in
2010 7 with an additional $0.06 for EPHS (for a total of $0.81).
Then, the catchment population is used to make a comparison between the total costs of
medicines required (not the order value) and the value needed (before any adjustments are
made for stock on hand, buffer stock, etc.), using either the consumption or morbidity
methods.
For example, for the USAID-supported provinces, the catchment population for BPHS in
2009 was 6,999,416 people.
So, the expected drug need for BPHS using the service-level projection is:
$0.75 × 6,999,416 = $5,249,562
The value calculated from a combination of consumption and morbidity was $5,500,000.
In general, if there is a difference of less than 20% between the two methodologies, then
the values are considered to be reasonably matched. If the difference is more than 20%,
some investigation and confirmation of base assumptions is recommended.
If the estimated total order is higher than 0.5 million AFN (according to the procurement law
of Afghanistan if the value exceed currently AFN 0.5 million, about $8600 then procurement
should go for open competitive bidding) ,so it is recommended the quantification process
and calculation should be checked by an independent party who was not part of the original
quantification team. This independent review will often shed light on the validity of the
assumptions and the accuracy of the calculation process, and greatly helps to assure donors
of the legitimacy of the order.
The independent party could be WHO or a UN agency, the GDPA, a provincial public health
directorate, one of the universities, or any other party with medicine quantification skills
that are not linked to any commercial pharmaceutical operations.
7
Clark, M., and A. Barraclough. 2010. Afghanistan Technical Report: Interim Findings and Conclusions of Drug
Financing.
42
Outcomes
Evaluate Quantification Process
The main objective of the quantification process is to ensure that needed essential
medicines are available in sufficient quantities. To achieve this objective, regular evaluations
of the effectiveness of the quantification process and the accuracy of the calculated
requirements are necessary. The QWG should use standard metrics to assess the
effectiveness of the process. Any problems encountered at each step should be identified
and a solution proposed.
On completion of the quantification process—
• The quantification coordinator, on behalf of the QWG, should provide feedback on

assumptions and modifications to stakeholders and health personnel through a
meeting, circular, newsletter, medicines bulletin, or any other means (or platform) of
communication.
The bulletin should provide information on any quantification reconciliation

decisions made as a result of budget cuts, adjustments in product range and
strengths, or any other reason.
• Evaluate (by an independent party) how well the quantification process went and
identify areas to improve for the next quantification. Before embarking on the
follow-up quantification cycle, review the accuracy of the previous quantification
estimates. This encompasses structural, processes followed, and outcomes as result
of the quantification strategy (e.g., objectives, planning, availability, stock-outs of a
few specific products or a wide range/coverage, cost, and utilization).
Indicators
Using standard indicators to monitor performance and program implementation

significantly improves quantification management—indeed, quantification can only improve
if there is clear feedback on its accuracy. Standard indicators allow comparison of actual
performance with targets, over time and among countries. It is not necessary to measure
every individual medicine. Some indicators use a standard list of 10–20 indicator medicines,
also called tracer medicines.
For some indicators, the current difficulties of measurement make it necessary to use proxy
indicators. These proxy indicators can be rates of stock outs or overstocks. Many factors can
contribute to out-of-stock situations, so it is not a perfect indicator for quantification;
however, if out-of-stock situations are occurring regularly, there is almost certainly a
quantification problem, so stock-outs should serve as a warning flag.
The quantification office should report on key quantification performance indicators at least
annually.
43
Indicators, such as actual consumption against forecast consumption and percentage of key
medicines out of stock, should be used to assess performance on a continuing basis.
The minimum set of indicators which should be used by stakeholders for reporting on
medicines quantification can be found in annex 3.
Indicator Development and Implementation
• Was a responsible person appointed for the quantification process? Y/N
• Was a QWG appointed and were the relevant members selected? Y/N
• Were resources available for the quantification process? Y/N
o Is the quantification plan documented? Y/N

o Is an identifiable, primary quantification method used?
o Is rationalization of resources using ABC and VEN analysis? Y/N
o Is the primary objective of estimating for quantities of essential medicine stated to
fit within the provided budget? Y/N
• Was the primary quantification method selected appropriate for the forecast problem
and data available? Y/N
• Does the methodology reflect the appropriate level of accuracy and detail that is needed
for the forecast? Y/N
The evaluation should assess the availability of necessary input (consumption data, stock
out data, morbidity/incidences data, population data resources) to conduct any
methods (consumption, morbidity, proxy, and service-level budget projection) or a
mixture of the methods for quantification. .
• Were the quantified medicines adequate to meet patient needs? Y/N
The evaluation should assess for stock outs using an indicator that measures the number
of medicine from a selected priority list of medicines available out of total number of
medicines (in the same list) in a sample of remote health facilities.
If the morbidity method was used, review whether the selected treatment schedules,
dosage forms, strengths, and dosing frequencies were well understood by the
prescribers and appropriate to the patients.
44
Source: Clark 2010

Figure 11. Example of an out-of-stock situation
This information can be ascertained by observing whether prescribers dispense

according to standard prescribing practices and adhere to treatment regimes, whether
patients comply, and changes in stock movements of some medications (i.e., percentage
of prescriptions adhering to the STG or selected treatment schedules from a total of
prescriptions selected from a sample of outpatient cards in remote health facilities).
If the adherence percentage is low, provide intense instruction to prescribers and

promote rational medicine use or consider changing the regimes.
• Were the data available, complete, reliable, and detailed enough? Y/N
If the answer to any of the above is no, then the QWG should ensure that appropriate
steps are taken to improve the quality of data through improved supervision, training,
data gathering, and availability of appropriate materials.
• Were the assumptions on which the calculations were made correct? Y/N
During the calculation phase, assumptions were made on the expected increase in
attendances and adjustments due to losses. Were the assumptions made appropriate in
terms of stock outs or increased stocks that may lead to miscalculation
• Were there any errors made in the calculations? Y/N
Review the calculations made in the previous quantification. If errors are found, then the
QWG members must be retrained.
• What impact did the rationalization of medicine quantities (to fit the available budget)
have on priority health problems? None/moderate (a few stock outs)/high (severe stock
outs/overstocking)
45
REFERENCES
Clark, M., and A. Barraclough. 2010. Afghanistan Technical Report: Interim Findings and
Conclusions of Drug Financing. Submitted to the US Agency for International Development
by the Strengthening Pharmaceutical Systems (SPS) Program. Arlington, VA: Management
Sciences for Health; http://pdf.usaid.gov/pdf_docs/pnaea596.pdf
Cochrane Reviews | The Cochrane Collaboration; www.cochrane.org/cochrane-reviews
Hazemba, O. , 2012. Coordinated Procurement and Distribution Systems: Minimum

Requirements for Quantification, Procurement, and Distribution. Submitted to the US
Agency for International Development by the Strengthening Pharmaceutical Systems (SPS)
Program. Arlington, VA: Management Sciences for Health.
International Narcotics Control Board and World Health Organization. 2012. Guide on
Estimating Requirements for Substances under International Control. United Nations.
Jamaican Ministry of Health and Environment. List of Vital Essential and Necessary (VEN)
Drugs and Medical Sundries for Public Health Institutions. 5th ed. 2008. Jamaica;
http://apps.who.int/medicinedocs/en/d/Js19469en/
Khitab, T., Hazemba, O., Ickx, P., et al. April 2012. Afghanistan: CPDS, CSC, and ACSS
Stakeholder Procurement, Distribution, and Quantification Activities and Functions Review.
Submitted to the US Agency for International Development (USAID) by the Strengthening
Pharmaceutical Systems (SPS) Program. Arlington, VA: Management Sciences for Health;
http://apps.who.int/medicinedocs/en/d/Js20275en/
Management Sciences for Health. 2011. MDS-3: Managing Access to Medicines and Health
Technologies. Sterling, Va.: Kumarian Press.
Sekhri, N., Chisholm, R., Longhi, A. et al. 2006. Principles for Forecasting Demand for Global
Health Products. Center for Global Development.
USAID | DELIVER PROJECT, Task Order 1. 2008. Quantification of Health Commodities: A

Guide to Forecasting and Supply Planning for Procurement. Arlington, Va.: USAID | DELIVER
PROJECT, Task Order 1. http://sc4ccm.jsi.com/files/2012/10/Quantification-of-
HealthCommodities.pdf
WHO Action Program on Essential Drugs. 1988. Estimating Drug Requirements: A Practical
Manual; http://apps.who.int/medicinedocs/en/d/Jh2931e/
46
Annex 1. BPHS Medicines List and Level of Facility
ANNEX 1. BPHS MEDICINES LIST AND LEVEL OF FACILITIES
From A Basic Package of Health Services for Afghanistan 2009/1388. Third Edition, The
Ministry of Public Health (MOPH) of the Islamic Republic of Afghanistan;
https://webgate.ec.europa.eu/europeaid/online-
services/index.cfm?ADSSChck=1336364738591&do=publi.getDoc&documentId=94459&pub
ID=128652
HP: health post

HS-C: health sub-center
BHC: basic health center
MHT: mobile health team
CHC: comprehensive health center
DH: district hospital
HP HS-C BHC MHT CHC DH

1. Anesthetics
1.1 General Anesthetics and Oxygen
Ketamine Injection 50gms (as hydrochloride)/ml in 10-
ml ampoule No No No No Yes Yes
Oxygen Inhalation (medical gas) No Yes Yes Yes Yes Yes
1.2 Local Anesthetics
Lidocaine injection solution 1% in vial No Yes Yes Yes Yes Yes
Lidocaine injection solution 2% in vial No Yes Yes Yes Yes Yes
Lidocaine Injection solution for spinal anesthesia 5% in
2-ml ampoule to be mixed with 7.5% glucose solution No No No No No Yes
Lidocaine Topical forms 2% (hydrochloride) No Yes Yes Yes Yes Yes
Lidocaine Topical forms 4% (hydrochloride) No Yes Yes Yes Yes Yes
Lidocaine + Adrenaline injection solution 1% +
epinephrine 1:200,000 in vial No No No Yes Yes Yes
Lidocaine + Adrenaline injection solution 2% +
epinephrine 1:200,000 in vial No No No Yes Yes Yes
2. Analgesics, Antipyretics, Non-steroidal Anti-
Inflammatory Drugs
2.1 Non-Opioid Analgesics/Antipyretics/ NSAID
Paracetamol (acetaminophen) Tablet 500 mg Yes Yes Yes Yes Yes Yes
Paracetamol (acetaminophen) Syrup 120 mg/5 ml No Yes Yes Yes Yes Yes
Paracetamol (acetaminophen) Tablet 100 mg Yes Yes Yes Yes Yes Yes
Acetyl Salicylic Acid Tablet 500 mg No Yes Yes Yes Yes Yes
Ibuprofen Tablet 200 mg No Yes Yes Yes Yes Yes
Diclofenac injection 25mg per ml in 3 ml ampoule No Yes Yes Yes Yes Yes
Tramadol injection 100 mg per 2 ml Ampoule No No No No Yes Yes
Morphine injection Morphine 10mg per ml in 2ml
ampoule No No No No No Yes
3. Anticonvulsants/Anti-Epileptics
Carbamazepine Tablet 200 mg No No No No Yes Yes
Diazepam injection 5 mg/ml in 2-ml ampoule No Yes Yes Yes Yes Yes
47

Magnesium Sulfate injection 500 mg/ml in 20-ml
ampoule No Yes Yes Yes Yes Yes
Phenobarbital Tablet 15 mg No No Yes Yes Yes Yes
Phenobarbital Tablet 100 mg No No Yes Yes Yes Yes
Sodium Valproate Tablet 200 mg No No No No No Yes
4. Antidotes
4.1 Nonspecific Antidotes
Activated charcoal Tablet 500 mg Yes Yes Yes Yes Yes Yes
Neostigmine Injection 0.5 mg per ml No No No No No Yes
Naloxone Hydrochloride Injection 0.4mg per ml No No No No No Yes
5. Antihistamines
5.1 H1-Receptor Antagonists
Chlorpheniramine Maleate (Chlorphenamine) Tablet 4
mg Yes Yes Yes Yes Yes Yes
Chlorpheniramine Maleate (Chlorphenamine) injection
10 mg/ml in 1-ml ampoule No Yes Yes Yes Yes Yes
6. Anti-infective Medicine
6.1 Anti-helminthics
Mebendazole chewable tablet 100 mg No Yes Yes Yes Yes Yes
6.2 Antibacterials
6.2.1 Beta Lactam Medicines
Amoxicillin capsules/tablet 500 mg (anhydrous) No Yes Yes Yes Yes Yes
Amoxicillin capsules/tablet 250 mg (anhydrous) No Yes Yes Yes Yes Yes
Amoxicillin powder for oral suspension 125 mg/5 ml
(anhydrous) No Yes Yes Yes Yes Yes
Ampicillin powder for injection 1g (as sodium salt) No Yes Yes Yes Yes Yes
Ampicillin powder for injection 500 mg (as sodium salt) No Yes Yes Yes Yes Yes
Benzathine Benzyl Penicillin powder for injection, 1.2
million IU in 5-ml vial No Yes Yes Yes Yes Yes
Benzathine Benzyl Penicillin powder for injection, 2.4
million IU in 5-ml vial No Yes Yes Yes Yes Yes
Phenoxy Methyl Penicillin (Penicillin V) Tablet 250 mg
(as potassium-salt) No Yes Yes Yes Yes Yes
Phenoxy Methyl Penicillin (Penicillin V) Tablet 500 mg
(as potassium-salt) No Yes Yes Yes Yes Yes
Phenoxy Methyl Penicillin (Penicillin V) powder for oral
suspension 250 mg/5 ml (as potassium salt) No Yes Yes Yes Yes Yes
Procaine Penicillin powder for injection 2 million IU No No Yes« Yes« Yes Yes
Procaine Penicillin powder for injection 4 million IU No No Yes« Yes« Yes Yes
Erythromycin(Ethyl succinate) Suspension 100 mg per
ml 100 ml bottles No Yes Yes Yes Yes Yes
Cloxacillin Injection 500 mg per vial No No No No No Yes
Cloxacillin Capsule 500 mg No No No No Yes Yes
6.2.2 Other Antibacterials
Silver sulfadiazine cream Cream Yes Yes Yes Yes Yes Yes
Chloramphenicol capsule/tablet 250 mg No Yes Yes Yes Yes Yes
Chloramphenicol powder for injection, 1-g vial No Yes Yes Yes Yes Yes
Chloramphenicol suspension 125 mg/5 ml No Yes Yes Yes Yes Yes
Doxycycline capsule/tablet 100 mg (hydrochloride) No Yes Yes Yes Yes Yes
48

Gentamicin injection 10 mg (as sulfate)/ml in 2-ml vial No Yes Yes Yes Yes Yes
Gentamicin injection 40 mg (as sulfate)/ml in 2-ml vial No Yes Yes Yes Yes Yes
Ciprofloxacin Tablet 250 mg No No No No Yes Yes
Ceftriaxone Injection 500 mg vial No No No No No Yes
6.2.3 Tuberculosis drugs
Ethambutol Tablet 400 mg No Yes Yes No Yes Yes
Ethambutol/Isoniazide (EH) Tablet 400/150mg No Yes Yes No Yes Yes
INH Tablet 100 mg No Yes Yes No Yes Yes
INH Tablet 300 mg No Yes Yes No Yes Yes
Isoniazide (H) Tablet 100 mg No Yes Yes No Yes Yes
Pyrazinamide(Z) Tablet 500 mg No Yes Yes No Yes Yes
Pyrazinamide (Z) Tablet 400mg No Yes Yes No Yes Yes
Rifampicin (Rifampin) capsule/tablet 150 mg No Yes Yes No Yes Yes
Rifampicin (Rifampin) capsule/tablet 300 mg No Yes Yes Yes Yes Yes
Rifampicin/Isoniazide (RH) Tablet 150/75mg No Yes Yes No Yes Yes
Rifampicin/Isoniazide (RH) Tablet 60/30mg (Child) No Yes Yes No Yes Yes
Rifampicin/Isoniazide/Ethambutol (RHE) Tablet
150/75/275mg No Yes Yes No Yes Yes
Rifampicin/Isoniazide/Pyrazinamide (RHZ) Tablet
60/30/150mg No Yes Yes No Yes Yes
Rifampicin/Isoniazide/Pyrazinamide/Ethambutol
(RHZE) Tablet 150/75/400/275mg No Yes Yes No Yes Yes
Streptomycin (S) powder for injection 1g (as sulfate) in
vial No Yes Yes Yes Yes Yes
6.3 Antifungal
Nystatin drop 100,000 IU/ml No Yes Yes Yes Yes Yes
Nystatin coated tablet 100,000 IU No Yes Yes Yes Yes Yes
Nystatin coated tablet 500,000 IU No Yes Yes Yes Yes Yes
6.4 Anti-protozoal Medicine
6.4.1 Anti-amoebic and Anti-giardiasis
Metronidazole Tablet 250 mg, 200mg No Yes Yes Yes Yes Yes
Metronidazole Tablet 400 mg, 500mg No Yes Yes Yes Yes Yes
Metronidazole injection 500 mg in 100 ml vial No No No No Yes Yes
Metronidazole oral suspension 200 mg (as benzoate)/5
ml No Yes Yes Yes Yes Yes
6.4.2 Antimalarial
Chloroquine Tablet 150 mg (as phosphate or sulfate) Yes Yes Yes Yes Yes Yes
Chloroquine Syrup 50 mg (as phosphate or sulfate)/5
ml Yes Yes Yes Yes Yes Yes
Primaquine Tablet 15mg No No No No Yes No
Pyrimethamine + Sulfadoxine (Fansidar) Tablet 25 mg +
500 mg Yes 1 Yes Yes Yes Yes Yes
Quinine Tablet 300 mg (as bisulfate or sulfate), No Yes 2 Yes 2 Yes Yes Yes
Quinine injection 300 mg (as dihydrochloride)/ml in 2-
ml ampoule No No No No Yes Yes
Artesunate + Sulfadoxine +Pyrimethamine3 Artesunate
100mg (6 tabs) + Sulfadoxine 500mg/Pyrimethamine
25mg (3 tabs) No Yes 4 Yes 4 Yes Yes Yes
Artesunate + Sulfadoxine +Pyrimethamine3 Artesunate No Yes 4 Yes 4 Yes Yes Yes
49

25mg (2 tabs)
Artesunate + Sulfadoxine +Pyrimethamine3 Artesunate
25mg (1 tabs) No Yes 4 Yes 4 Yes Yes Yes
Artemether for pre-referral treatment of suspected
and confirmed severe or complicated malaria Injection
20 & 80 mg in oil for intramuscular injection No Yes Yes Yes Yes Yes
(1) Presumptive treatment for unconfirmed malaria is
chloroquine and sulfadoxine / pyrimethamine, before
referral to CHC for confirmatory diagnosis
(2) Quinine – 2nd line treatment and treatment for
severe / complicated malaria require laboratory
confirmation
(3) Artemesinin combination therapy: Artesunate + SP
(fansidar) as first line treatment for laboratory
confirmed Falciparum malaria
(4) In BHCs where diagnostic services are available
6.4.3 Antileishmania
Sodium Stibogluconate Injection 100 mg per ml No No No No Yes 5 Yes 5
Meglumine antimonate Injection 85mg per ml No No No No Yes 5 Yes 5
(5) Either Stibogluconate or Meglumine antimonate to
be supplied
6.5 Sulfonamide/Related
Co-trimoxazole (Sulfamethoxazole + Trimethoprim)
Tablet 100 mg + 20 mg Yes Yes Yes Yes Yes Yes
Tablet 400 mg + 80 mg Yes Yes Yes Yes Yes Yes
suspension 200 mg + 40 mg/5 ml Yes Yes Yes Yes Yes Yes
Note: Co-trimoxazole is given to HIV-positive patients
at CHC and DH
6.6 Urinary Antiseptics
Nitrofurantoin Tablet 100 mg No No No Yes Yes Yes
7. Medicines affecting the Autonomic system
7.1 Sympathomimetics and |Anticholinergics
Adrenaline injection 1 mg (as hydrochloride or
hydrogen tartrate) in 1-ml ampoule No Yes Yes Yes Yes Yes
Salbutamol Tablet 4 mg (as sulfate) No Yes Yes Yes Yes Yes
Salbutamol Syrup 2 mg/5 ml (as sulfate) No Yes Yes Yes Yes Yes
Alcuronium Bromide Injection 5mg per ml in two ml
ampoule No No No No No Yes
Atropine Injection 1mg per ml No No No No Yes Yes
Trihexyphenidyl Tab 2 mg Tab 2 mg No No No No Yes Yes
8. Drugs Affecting the Blood
8.1 Drugs Used in Anemia
Ferrous Sulfate Tablet equivalent to 60 mg iron No Yes Yes Yes Yes Yes
Ferrous Sulfate oral solution equivalent 25 mg iron (as
sulfate)/ml No Yes Yes Yes Yes Yes
50

Ferrous Sulfate + Folic Acid Tablet equivalent to 60 mg
iron + 400 mcg folic acid Yes Yes Yes Yes Yes Yes
Folic Acid Tablet 5 mg No Yes Yes Yes Yes Yes
9. Cardiovascular medicines
9.1 Antihypertensive Agents
Atenolol Tablet 50 mg No No No Yes Yes Yes
Atenolol Tablet 100 mg No No No Yes Yes Yes
Methyl Dopa Tablet 250 mg No Yes Yes Yes Yes Yes
Nifedipine capsule/tablet 10 mg No No Yes« Yes« Yes Yes
Hydralazine Injection 20mg per ml No No No No No Yes
9.2 Antithrombotic Agent
Acetyl salicylic acid (Acetylsalicylic Acid) Tablet 100 mg No No Yes Yes Yes Yes
10. Dermatological Topical medicines
10.1 Anti-Infective, Topical
Gentian Violet (Methyl Rosanilinium Chloride) aqueous
solution 0.5% (or crystals) Yes Yes Yes Yes Yes Yes
Gentian Violet (Methyl Rosanilinium Chloride) aqueous
solution 1% (or crystals) Yes Yes Yes Yes Yes Yes
Silver Sulfadiazine Cream 1% No Yes Yes Yes Yes Yes
10.2 Antifungal, Topical
Benzoic Acid + Salicylic Acid cream or ointment 6% +
3% No Yes Yes Yes Yes Yes
Nystatin ointment 100,000 IU, vaginal No Yes Yes Yes Yes Yes
Nystatin tablet 100,000 IU, vaginal No Yes Yes Yes Yes Yes
10.3 Scabicides/Pediculocides
Lindane lotion 1% No Yes Yes Yes Yes Yes
11. Disinfectants and antiseptics
Chlorhexidine solution 5% (digluconate) for dilution Yes Yes Yes Yes Yes Yes
Chlorhexidine+Cetrimide solution chlorhexidine
gluconate 1.5% +Cetrimide 15% No Yes Yes Yes Yes Yes
Chlorine releasing comp., Powder for solution Yes Yes Yes Yes Yes Yes
12. Diuretics
Hydrochlorothiazide tablet 50 mg No Yes Yes Yes Yes Yes
Furosemide Tablet 20 mg No No No No Yes Yes
Furosemide Injection, 20 mg in 2-ml Ampoule No No No No No Yes
13. Gastro-intestinal medicines
13.1 Antacids
Aluminum Hydroxide tablet 500 mg No Yes Yes Yes Yes Yes
Aluminum Hydroxide + Magnesium Hydroxide
chewable tablet aluminum hydroxide 200 mg +
magnesium hydroxide 200 mg Yes Yes Yes Yes Yes Yes
Aluminum Hydroxide + Magnesium Hydroxide
suspension aluminum hydroxide 225 mg + magnesium
hydroxide 200 mg/5 ml No Yes Yes Yes Yes Yes
Ranitidine Tablet 150 mg No No No No Yes Yes
13.2 Anti-Emetics
Metoclopramide tablet 10 mg (hydrochloride) No Yes Yes Yes Yes Yes
Metoclopramide injection 5 mg (hydrochloride)/ml in
2-ml ampoule No Yes Yes Yes Yes Yes
51

13.3 Oral Rehydration Solution
Low Osmolarity ORS 20.5gr/liter Glucose anhydrous
13.5g, Sodium chloride 2.6g, Trisodium citrate
dihydrate 2.9 gm, Potasium chloride 1.5g for one liter Yes Yes Yes Yes Yes Yes
Note: Existing stocks of ORS 29.7gr/liter can be used till
depletion
14. Hormones, other endocrine and contraceptives
14.1 Adrenal Hormones and Synthetic Substitutes
Hydrocortisone powder for injection 100 mg (as
sodium succinate) in vial No Yes Yes Yes Yes Yes
Betamethasone + Neomycin Cream 1% + 0.5% No Yes Yes Yes Yes Yes
14.2 Contraceptives
Ethinylestradiol + Levonorgestrel tablet 30 microgram
+150 microgram Yes Yes Yes Yes Yes Yes
Ethinylestradiol + Levonorgestrel tablet 50 microgram
+ 250 microgram Yes Yes Yes Yes Yes Yes
Ethinylestradiol + Norgestrel tablet 30 microgram + 300
microgram Yes Yes Yes Yes Yes Yes
Ethinylestradiol + Norethisterone tablet 35 microgram
+ 1mg Yes Yes Yes Yes Yes Yes
Depot Medroxy Progestrone Acetate (DMPA) depot
injection 150 mg/ml in 1-ml vial Yes Yes Yes Yes Yes Yes
Progesterone Only Pills (POP) Tablet Norgestrel
75microgram Yes Yes Yes Yes Yes Yes
Progesterone Only Pills (POP) Pill Norethindrone 0.35
mg Yes Yes Yes Yes Yes Yes
Condoms Yes Yes Yes Yes Yes Yes
IUD No Yes Yes Yes Yes Yes
15. Immunologicals
15.1 Vaccines
BCG 0.05 ml given subcutaneously to children between
birth and 1 year old ( single dose ) No Yes Yes Yes Yes Yes
DPT (diphtheria, pertussis, tetanus) 0.5 ml given
intramuscularly to children between 6 weeks and 1-
year old No Yes Yes Yes Yes Yes
DPT/Hepatitis-B vaccine 0.5 ml given intramuscularly No Yes Yes Yes Yes Yes
Pentavalent DPTw-HB/Hib 0.5 ml given intramuscularly
to children between 6 weeks and 1 year old No Yes Yes Yes Yes Yes
Measles 0.5 ml given intramuscularly to children
between 9 months and 1 year old No Yes Yes Yes Yes Yes
OPV (oral polio vaccine) 2 drop PO for children under 1
year old, supplemental doses given to all children
under 5 years during NIDs No Yes Yes Yes Yes Yes
Tetanus Toxoid 0.5 ml given intramuscularly to women
15–45 years old No Yes Yes Yes Yes Yes
15.1 Antisera
Anti Tetanus Serum (ATS) Injection 1500 IU ampoule No No No No No Yes
16. Ophthalmological Preparations
16.1 Anti-Infective Topical
52

Tetracycline eye ointment 1% hydrochloride Yes Yes Yes Yes Yes Yes
Tetracaine Hydrochloride Eye drop 0.5% No No No No Yes Yes
Fluorescein No No No No No Yes
17. Oxytocics and anti-oxytocics
17.1 Oxytocics
Ergometrine tablet 200 microgram (hydrogen maleate) No Yes Yes Yes Yes Yes
Ergometrine injection 200 microgram (hydrogen
maleate) No Yes Yes No Yes Yes
Oxytocin injection 10 IU in 1-ml ampoule No Yes Yes Yes Yes Yes
17.2 Antioxytocics
Salbutamol tablet 4 mg (as sulfate) No Yes Yes Yes Yes Yes
Salbutamol injection 50 microgram (as sulfate)/ml in 5-
ml ampoule No Yes Yes No Yes Yes
18. Psychotherapeutic Medicines
18.1 Medicines Used in Psychotic Disorders
Chlorpromazine 100 mg tablet (hydrochloride) No No No No No Yes
Chlorpromazine injection 25 mg (hydrochloride)/ml in
2-ml ampoule No No No No No Yes
Haloperidol tablet 5 mg No No No No No Yes
Haloperidol injection 5 mg in 1-ml ampoule No No No No No Yes
Thioridazine tablet 25 mg No No No No No Yes
18.2 Medicines Used in Depressive Disorders
Amitriptyline tablet 25 mg (hydrochloride) No Yes Yes No Yes Yes
Fluoxetine Tablet 20 mg No No No No Yes Yes
18.3 Medicines Used in Generalized Anxiety and Sleep
Disorders
Diazepam tablet 5 mg No Yes Yes Yes Yes Yes
Diazepam tablet 10 mg No Yes Yes Yes Yes Yes
19. Medicines acting on the Respiratory tract
19.1 Anti-Asthmatic Medicines
Aminophylline injection 25 mg/ml in 10-ml ampoule No Yes Yes Yes Yes Yes
Aminophylline tablet 100 mg No Yes Yes Yes Yes Yes
Epinephrine (Adrenaline) injection 1 mg (as HCl or
hydrogen tartrate) in 1-ml ampoule No Yes« Yes« Yes« Yes Yes
Salbutamol tablet 4 mg No Yes Yes Yes Yes Yes
Salbutamol inhalation (aerosol) 100 microgram (as
sulfate) per dose No Yes Yes Yes Yes Yes
Salbutamol syrup 2 mg (as sulfate)/5 ml No Yes Yes Yes Yes Yes
Salbutamol respirator solution for use in nebulizers 5
mg (as sulfate)/ml No Yes Yes Yes Yes Yes
20. Solutions Correcting Water, Electrolyte and Acid-
base Disturbances
20.2 Parenteral
NaCl injectable solution 0.9% isotonic (equivalent to
Na+ 154mmol/1, Cl-154 mmol/1) No Yes Yes Yes Yes Yes
Compound solution of Sodium Lactate injectable
solution No Yes Yes Yes Yes Yes
Glucose injectable solution 10% isotonic 5% isotonic No Yes Yes Yes Yes Yes
Glucose injectable solution 50% hypertonic No No No No Yes Yes
53

Glucose with Sodium Chloride injectable solution 4%
glucose, 0.18% NaCl (equivalent to Na+, 30 mmol/l, Cl-,
30 mmol/l) No Yes Yes Yes Yes Yes
Potassium Chloride injectable solution 11.2% (112 mg)
in 20-ml ampoule (equivalent to K+, 1.5 mmol/ml, Cl-,
1.5 mmol/ml) No Yes« Yes« Yes Yes Yes
Sodium Hydrogen Carbonate (Sodium Bicarbonate)
injectable solution 8.4% (840 mg), in 10-ml ampoule,
equivalent to Na+, 1,000 mmol/l, HCO3 - 1,000 mmol/l) No No No Yes Yes Yes
Calcium Gluconate Injection 10% 10ml solution No Yes Yes Yes Yes Yes
20.3 Miscellaneous
Water for injection 5 ml Yes Yes Yes Yes Yes Yes
Water for injection 10 ml Yes Yes Yes Yes Yes Yes
21. Vitamins and Minerals
Iodine 0.57 ml (308 mg iodine) in dispenser bottle No Yes Yes Yes Yes Yes
Iodine capsule 200 mg No Yes Yes Yes Yes Yes
Retinol (vitamin A) sugarcoated tablet 100,000 IU (as
palmitate) (55 mg) Yes Yes Yes Yes Yes Yes
Retinol (vitamin A) capsule 200,000 IU (as palmitate)
(110mg) Yes Yes Yes Yes Yes Yes
Multi-micronutrients Yes Yes Yes Yes Yes Yes
Zinc Zinc Dispersable Tablet 20mg strip of ten Yes Yes Yes Yes Yes Yes
Vitamin K Injection 10mg per ml ampoule No Yes Yes Yes Yes Yes
54
ANNEX 2. EPHS MEDICINES LIST AND LEVEL OF HOSPITAL
From The Essential Package of Hospital Services for Afghanistan, The Ministry of Public
Health (MOPH) of the Islamic Republic of Afghanistan;
http://moph.gov.af/Content/Media/Documents/EPHS-2005-FINAL29122010164126629.pdf
DH: district hospital

PH: provincial hospital
RH: regional hospital
DH PH RH
1. Anesthetics and Oxygen
1.1 General Anesthetics and Oxygen
Halothane Cylinder X No No Yes
Ketamine Injection 50mg (as hydrochloride)/ml in 10-ml vial Yes Yes Yes
Sodium thiopental Powder for Injection, 0.5 g, 1 g (Sodium Salt) in Ampoule No No Yes
Oxygen Inhalation Yes Yes Yes
1.2 Local Anaesthetics
Lidocaine Injection 1%, 2 %( hydrochloride) in vial, Yes Yes Yes
Lidocaine Topical forms 2 % 4 % (hydrochloride) Yes Yes Yes
Lidocaine + Adrenaline Injection 1%-2% (hydrochloride) + epinephrine 1:200 Yes Yes Yes
000 in vial
Lidocaine dental Cartridge, 2%(hydrochloride) + Epinephrine 1:80 000 Yes Yes Yes
Bupivacain (not in EDL but critical for hospitals) Yes Yes Yes
2: Analgesics, Antipyretics, Non-Steroidal Anti-Inflammatory Drugs (NSAID)
Medicines Used to Treat Gout
2.1 Non-Opioid Analgesics / Antipyretics / NSAID
Acetaminophen Tablet 325mg, 500mg, Syrup 120mg/5ml Yes Yes Yes
Acetaminophen (Paracetamol) Suspension, drop 100 mg/ml Yes Yes Yes
Acetyl Salicylic Acid 500 mg Yes Yes Yes
Ibuprofen Tablet 200mg, 400mg Yes Yes Yes
2.2 Opioid Analgesics
Morphine Injection, 10mg (hydrochloride or sulfate) in 1-ml Ampoule Yes Yes Yes
Pethidine Injection, 50 mg (hydrochloride) in 1-ml Ampoule, Yes Yes Yes
Pethidine Tablet 50mg, 100mg No Yes Yes
2. 3 Medicines Used to Treat Gout
Allopurinol Tablet 100mg No No Yes
Colchicine Tablet 500 microgram No No Yes
3: Anti Convulsant /Anti epileptics DH PH RH
Carbamazepin Tablet 100mg, 200mg No No Yes
Diazepam Injection 5mg/ml in 2-ml Ampoule Yes Yes Yes
55
DH PH RH
Ethosuxamid capsule 250mg syrup 250mg/5ml No No Yes
Magnesium Sulphate Injection 500mg/ml in 2-ml Ampoule Yes Yes Yes
Phenobarbital Tablet 15mg 100mg ,Injection 200mg/ml Ampoule capsule or Yes Yes Yes
Tablet, 25mg, 50mg, 100mg
Phenobarbital (Sodium Salt) Injection 50mg (Sodium salt)/ml in 5-ml vial Yes Yes Yes
(Complementary)
Valproic acid enteric coated Tablet, 200mg, 500mg (Sodium Salt) No No Yes
4: Antidotes and Other Substances Used in Poisonings DH PH RH
4.1 Non-Specific Antidotes
Activated Charcoal powder /Tablet 500mg, 1gr Yes Yes Yes
4. 2 Specific Antidotes
Acetyl Cystein Injection, 200mg/ml in 10-ml Ampoule No No Yes
Atropine Sulphate Injection, 1mg (Sulfate) in 1ml Ampoule Yes Yes Yes
BAL (Dimercaprol) Injection in Oil 50mg/ml in 2-ml Amp. No No Yes
Deferoxamine Powder for Injection, 500 mg (mesilate) in vial X No No Yes
Diphenhydramine Injection [dosage], cap/tab 25mg & 50mg, syrup 5mg/5ml Yes Yes Yes
Methylen Blue (Methylthioninium) Injection 10 mg/ml in 10-ml Ampoule No No Yes
Naloxone Injection 400 microgram (Hydrochloride) in 1-ml Ampoule Yes Yes Yes
Calcium gluconate Injection 1 gram, 10% in 10 ml Ampoule Yes Yes Yes
Protamine Sulphate Injection 10mg/ml in 5-ml Ampoule (Complementary) No Yes Yes
Flumazenil Injection 100 micrograms/ml Ampoule Yes Yes Yes
5: Anti Histamines DH PH RH
5.1 H1 Receptor Antagonists
Chlorpheniramine Maleate Tablet 4mg, Injection 10mg/1ml Yes Yes Yes
Promethazine Tablet 25mg, Injection 25mg/ml No No Yes
Promethazine Hydrochloride Syrup 5mg/5ml No No Yes
5.2 H2 Receptor Antagonists
Ranitidine Tablet 150 mg, 300mg, Injection 50mg/2ml Ampule Yes Yes Yes
6: Anti Infective Medicines DH PH RH
6.1 Anthelmintics
6.1.1 Intestinal Anthelminthics
Mebendazole chewable Tablet 100mg (Complementary) Yes Yes Yes
Albendazol chewable Tablet, 200mg, 400mg Yes Yes Yes
6.1. 2 Antifilarials
Diethylcarbamazine Tablet 50mg, 100mg (dihydrogen citrate) Yes Yes Yes
6.2 Antibacterials
6.2.1 Beta Lactam Medicine
Amoxycillin Tablet 500mg and 250mg (anhydrous) Yes Yes Yes
Amoxycillin Powder for Oral suspension, 125mg (anhydrous)/5-ml, & 250 Yes Yes Yes
mg/5m
Ampicillin powder for Injection 1gram and 500mg (as sodium salt) in vial Yes Yes Yes
56
Annex 2. Quantification Guidelines for Essential Medicines
DH PH RH
Benzathine Benzyl Powder for Injection, 1,2 million IU & 2.4 million IU in 5-ml Yes Yes Yes
vial
Benzyl Penicillin G (Crystal) Powder for Injection 1 million IU & 5 million IU Yes Yes Yes
(Sodium or Potassium salt) in vial
Cloxacillin vial 500mg for Injection Yes Yes Yes
Cloxacillin Capsule / Tablet 500mg, 250mg (as sodium salt) Yes Yes Yes
Phenoxy Methyl Penicillin Tablet 250mg & 500mg (as potassium salt), Yes Yes Yes
Procaine Penicillin Powder for Injection, 2 million IU & 4 00.000 IU in vial Yes Yes Yes
(Complementary)
Amoxicillin + Clavulanic Acid (restricted indication) Tablet 500mg + 125 mg No No Yes
Amoxicillin + Clavulanic Acid (restricted indication) For oral suspension 125mg No No Yes
& 31.25mg/5ml
Ceftriaxone (restricted indication) vial 1 gram, 500mg No Yes Yes
6.2.2Other Antibacterial
Chloramphenicol capsule 250mg, Yes Yes Yes
Chloramphenicol Oral Suspension 125mg (as Palmitate)/5ml Yes Yes Yes
Chloramphenicol Powder for Injection 1 gram & 500 mg (Sodium succinate) in Yes Yes Yes
vial
Doxycycline capsule / Tablet 100mg (hydrochloride) Yes Yes Yes
Erythromycin Tablet 400mg/200mg (ethyl Succinate) Yes Yes Yes
Gentamicine Injection 20mg, 40mg & 80mg (as sulfate)/ml in 2-ml vial Yes Yes Yes
(Complementary)
Ciprofloxacin (restricted indication) Tablet 500 mg 250mg (as hydrochloride) No Yes Yes
Ciprofloxacin (restricted indication) Injection 2mg/ml, 50ml bottle No Yes Yes
6.2.3 Antileprosy medicines (in speciality facilities only)
Clofazimine Capsule 50mg, 100mg
Dapsone Tablet 25mg, 50mg, 100mg -
Rifampicin Capsule or Tablet 150mg, 300mg
6.2.4 Anti Tuberculosis medicines DH PH RH
Ethambutol Tablet 400mg Yes Yes Yes
INH Tablet 100mg & 300mg Yes Yes Yes
Pyrazinamid Tablet 500mg Yes Yes Yes
Rifampicin Capsule or Tablet 150mg, 300 mg Yes Yes Yes
Rifampicin Syrup 100mg/5ml No No Yes
Streptomycin Powder for Injection 1 G (as Sulfate) in vial Yes Yes Yes
(Complementary)
Thiacetazon +Isoniazid Tablet 50mg+100mg & 150mg+300mg No No Yes
6.3 Anti Fungal medicines
Benzoic acid+ Salicylic Cream or Ointment 6%+3% Yes Yes Yes
Griseofulvin capsule or Tablet 125mg, 250mg No Yes Yes
Ketoconazol Tablet 200 mg, topical cream 2% Yes Yes Yes
57
DH PH RH
Nystatin Tablet 100 000,500 000 IU Yes Yes Yes
Nystatin Vaginal Tablet 100 000 IU Yes Yes Yes
6.4 Antiviral Medicine
Aciclovir Opthalmic Ointment 3% No Yes Yes
6.5 Antiprotozoal medicines
6.5.1 Anti Amoebic and Anti Giardiasis medicines
Metronidazol Tablet 250mg, 400mg Yes Yes Yes
Metronidazol Injection 500mg in 100 – ml vial, Yes Yes Yes
Metronidazol Oral suspension, 200mg (as benzoate)/5 ml No No Yes
6.5.2 Anti-Leishmaniasis
Meglumine Antimonate Injection, 30%, equivalent to approx. 8.1% antimony in Yes Yes Yes
5-ml Ampoule
Stibogluconate Sodium Injection 100mg/ml Ampoule Yes Yes Yes
6.5.3 Anti Malarial
Chloroquine Tablet, base 150mg (as phosphate or sulfate), Yes Yes Yes
Chloroquine Syrup, base 50mg (as phosphate or sulfate) /5ml, Yes Yes Yes
Pyrimethamin + Sulfadoxine (Fansidar) Tablet 25mg+ 500mg Yes Yes Yes
Quinine Tablet 300mg (as bisulfate or sulfate), Yes Yes Yes
Quinine Injection, 300mg (as dihydrochloride)/ml in 2-ml Ampule. Yes Yes Yes
(Complementary)
Artesunate Tablet 50 mg (Note: Provided ony in malarial endemic areas) Yes Yes Yes
Artemether 80mg/ml 2ml Ampule (for IM only) Yes Yes Yes
6.6 Sulfonamide/Related
Co-Trimoxazole (Sulfamethoxazole+Trimeth oprime) suspension Yes Yes Yes
200mg+40mg/5ml,
Co-Trimoxazole (Sulfamethoxazole+Trimeth oprime) Tablet 100mg +20mg & Yes Yes Yes
400mg+80mg
6.7 Urinary & intestinal antiseptics
Nalidixic Acid Tablet 250mg 500mg, 250mg/5ml Syrup No No Yes
Nitrofurantoin Tablet 100mg Yes Yes Yes
Furazolidon Tablet 100mg, Syrup 125mg/5ml No No Yes
7: Antimigraine Medicines DH PH RH
Acetyl Salicylic Acid Tablet, 300mg 500mg Yes Yes Yes
Acetaminophen Tablet 325mg Yes Yes Yes
Ergotamine Tablet 1mg (tartrate) No No Yes
Propranolol Tablet 20mg 40mg (hydrochloride) Yes Yes Yes
8: Antiparkinsonism Medicines DH PH RH
Biperidin Tablet 2mg (hydrochloride) No No Yes
Biperidin Injection, 5mg (lactate) in 1-ml Ampoule No No Yes
Levodopa+Carbidopa Tablet 100mg+ 10mg No No Yes
Levodopa+Carbidopa 250mg+ 25mg No No Yes
58
DH PH RH
Trihexylphenidyl Tablet 2 mg No No Yes
9: Medicines Affecting the Autonomic System DH PH RH
9. 1 Parasympatomimetics
Pilocarpine Solution (eye drop), 2%, 4% (Hydrochloride or Nitrate) No No Yes
9. 2 Parasympatholytics
Atropine Solution (eye drop) 0,1%, 0,5%, 1% (sulfate), No No Yes
Atropine Tablet 1mg (sulfate), Injection 1mg (sulfate) in 1-ml Ampoule Yes Yes Yes
Hyoscine -N-butyl bromide Tablet 10mg, Injection 20mg/ml Yes Yes Yes
9. 3 Sympathomimetics
Adrenaline Injection 1mg (as hydrochloride or Hydrogen tartrate) in 1-ml Yes Yes Yes
Ampoule
Salbutamol Tablet 2mg, 4mg (as sulfate) Yes Yes Yes
Salbutamol Inhalation (aerosol), 100 microgram (as sulfate) per dose No Yes Yes
Salbutamol Respirator Solution for use in nebulizers 5mg (as sulfate)/ml Yes Yes Yes
Dopamine hydrochloride Injection, 40 mg/ml, 5 ml ampoule No No Yes
9. 4 Sympatholytics
Methyldopa Tablet 250mg Yes Yes Yes
Atenolol Tablet 50mg, 100mg No No Yes
Propranolol Tablet 10mg, 40mg Yes Yes Yes
Timolol Solution (eye drop), 0.25%, 0.5% (as maleate) No No Yes
9. 5 Muscle Relaxants (Peripherally acting) and Cholinesterase inhibitors
Alcuronium Injection, 5 mg/ml in 2 ml ampoule No No Yes
Suxamethonium (Succinyl Choline) Injection, 50mg (chloride)/ml in 2-ml Yes Yes Yes
Ampoule
9. 6 Autonomic Agents, Other
Bromocriptine Tablet 2.5 mg (as mesilate) No No Yes
10: Medicines Affecting the Blood DH PH RH
10.1 Drugs Used in Anemia
Ferrous Sulphate Tablet, equivalent to 60 mg iron, Oral Solution Yes Yes Yes
Folic Acid Tablet, 1mg and 5 mg/tablet Yes Yes Yes
Ferrous Sulphat+Folic Acid (Nutritional Supplement for use during pregnancy) Yes Yes Yes
Tablet, equivalent to 60 mg iron + 400 Microgram Folic acid
Hydroxocobalamine Injection, 1mg in 1-ml Ampoule No Yes Yes
(Complementary)
Iron Dextran Injection equivalent to 50mg iron/ml in 2-ml Ampoule No No Yes
10.2 Drugs Affecting Coagulation
Vit.K (Phytomenadione) Injection 10mg/ml Ampoule, Tablet, 10mg Yes Yes Yes
Sodium Heparine Injection 1000 iu/ml, 5 ml and 5000 iu/ml, 1 ml No Yes Yes
Enoxaprin (low molecular weight Heparine) restricted indication only for DVT Yes Yes Yes
sc injection
11: Blood Products and Plasma Substitutes DH PH RH
59
DH PH RH
Dextran 70 Injectable Solution 6% No No Yes
12: Cardiovascular Medications DH PH RH
12. 1 Anti Anginal Medicines
Atenolol Tablet, 50mg, 100mg No No Yes
Glyceryl trinitrate Tablet, (sublingual) 0.5 mg No No Yes
Isosorbide dinitrate Tablet, (sublingual) , 5mg , 10 mg Yes Yes Yes
Verapamil Tablet, 40 mg, 80 mg (hydrochloride) No No Yes
12. 2 Anti Arrhythmic Drugs
Atenolol Tablet 50mg, 100 mg No No Yes
Digoxin Tablet 0. 25 mg, Injection 0. 5 mg / 2ml Yes Yes Yes
Lidocaine Injection, 20 mg (hydrochloride) /ml in 5-ml Ampoule No No Yes
Procainamide Injection 1000 mg /10 ml, Cap/tab 250mg No No Yes
Verapamil tab 40mg, 80 mg, Injection, No No Yes
Verapamil 2.5mg (hydrochloride)/ml in 2-ml Ampoule No No Yes
12. 3 Anti Hypertensive Agents
Atenolol tab 50mg, 100mg No No Yes
Captopril Tablet 25mg No No Yes
Hydralazine Tablet 25mg, 50 mg (hydrochloride), powder No No Yes
Hydralazine For Injection, 20mg (hydrochloride) in Ampoule Yes Yes Yes
Methyl dopa Tablet 250 mg Yes Yes Yes
Nifedipine Capsule / Tablet 10mg Yes Yes Yes
12. 4 Cardiotonics
Digoxin Tablet 0.25mg, Injection 0. 5 mg / 2ml Yes Yes Yes
12. 5 Platelet Aggregation Inhibitors
Acetyl Salicylic Acid Tablet 100mg Yes Yes Yes
13: Dermatological Medicines (topical) DH PH RH
13.1 Anti infective, Topical
Methyl Rosanilinium Chloride (Gention Violet) aqueous Solution, 0. 5%, 1% Yes Yes Yes
Neomycine+Bacitracine Ointment, 5mg Neomycin Sulfate + 500IU Bacitracin Yes Yes Yes
zinc/G
Silver Sulfadiazine Cream 1%, in 500-gram Container Yes Yes Yes
13. 2 Anti Fungal, Topical
Benzoic Acid +Salicylic Acid Ointment or cream 6% + 3% Yes Yes Yes
Nystatine Ointment 100 000 U/Gram, Vaginal Tablet Yes Yes Yes
Nystatine 100 000 U, Drop 100 000 U/ml, Coated Tablet 500 000 U Yes Yes Yes
Tolnaftate Topical Cream 1%, Topical Solution 1% No No Yes
13. 3 Anti Inflammatory & Anti Pruritics, Topical
Calamine-lotion Lotion X X X Yes Yes Yes
Hydrocortisone Ointment or Cream, 1% (acetate) No No Yes
13. 4 Anti Infective/Anti-Inflammatory Combination, Topical
60
DH PH RH
Betamethasone-N Topical Cream /Ointment Betamethason (as Valerate) 0.1%+ Yes Yes Yes
Neomycin Sulfate0, 5%
13. 5 Sun Protectants/Screen
Zinc Oxide Topical Ointment 20%, powder Yes Yes Yes
13. 6 Keratolytics/Caustics
Benzoyl Peroxide lotion or cream, 5% No No Yes
Coal Tar Solution, 5% No No Yes
Fluorouracil Ointment, 5% No No Yes
Resorcinol-S Topical cream Resorcinol 2%+Sulphur 8% No No Yes
Salicylic Acid Solution, 5% Yes Yes Yes
13. 7 Scabicides/Pediculocides
Lindane Lotion 1% Yes Yes Yes
13. 8 Local Anesthetics, Topical
Lidocaine Gel 2 %, 4% Yes Yes Yes
14: Diagnostic Agents DH PH RH
14.1 Radio contrast Media
Barium sulfate aqueous suspension No No Yes
Meglumine Compound 76% Injection 20 ml, 100ml (Meglumine diatrizoate No No Yes
66%+ Sodiumdiatrizoate10%)
Meglumine Compound 76% Oral Solution (Meglumine diatrizoate 66%+ No No Yes
Sodium diatrizoate 10%)
15: Disinfectants and Antiseptics DH PH RH
Methanol Solution, 70 % (denatured) Yes Yes Yes
Chlorhexidine Solution, 5 % (digluconate) for dilution Yes Yes Yes
Chlorine releasing comp. Powder for solution, 1 gram per liter Yes Yes Yes
Hydrogenperoxid Solution 6 %( = approx.20 volume) Yes Yes Yes
Iodine Polyvidone Solution, 10% Yes Yes Yes
Gentian Violet Aqueous Solution 0, 5%, 1% Yes Yes Yes
Potassium Permanganate Aqueous Solution, 1:10 000 Yes Yes Yes
16: Diuretics DH PH RH
Furosemide Tablet 40 mg, Yes Yes Yes
Furosemide Injection, 10 mg/ml in 2-ml Ampoule Yes Yes Yes
Hydrochlorothiazid Tablet 25 mg 50mg Yes Yes Yes
Mannitol Injectable Solution, 10%, 20% No No Yes
Spironolactone Tablet 25 mg No No Yes
17: Gastrointestinal Medicines DH PH RH
17. 1 Antacids
Aluminum hydroxide + Magnesium Hydroxide Chewable Tablet Aluminum Yes Yes Yes
hydroxide 200mg +Magnesium hydroxide 200mg
17. 2 Laxatives
Bisacodyl Tablet 5mg Yes Yes Yes
61
DH PH RH
17. 3 Drugs Used in Peptic Ulcer
Histamine H2 Receptor Antagonist Ranitidine Tablet 150 mg, 300mg, Injection Yes Yes Yes
50mg/2ml
(Complementary)
Omeprazol capsule 20mg No Yes Yes
17. 4 Anti Emetics
Metoclopramid Tablet 10mg (hydrochloride), Yes Yes Yes
Metoclopramid Injection 5mg (Hydrochloride)/ml in 2-ml Ampoule Yes Yes Yes
17. 5 Anti Muscarinics/Anti Spasmodic
Atropine Injection 1 mg (Sulfate) in 1-ml Ampoule Yes Yes Yes
Hyoscine –N- Butyl Bromide Tablet, 10 mg, Yes Yes Yes
Hyoscine –N- Butyl Bromide Injection 4 mg/ml in 5-ml Ampoule Yes Yes Yes
17. 6 Anti Hemorrhoid Drugs
Anti-Inflammatory/Astringent/Local Anesthetic drugs Ointment or Suppository Yes Yes Yes
17.7 Oral Rehydration Salts (ORS)
Oral Rehydration Salt Powder, 27,9 g/l (for Glucose Electrolyte Solution) Yes Yes Yes
Sodium chloride (3.5 G/L), Trisodium citrate dihydrate (2.9 G/L), Potassium
chloride (1.5 G/L), Glucose (20 G/L); Trisodium Citrate
18: Hormones, other Endocrine medicines and Contraceptives DH PH RH
18.1. Adrenal Hormones and Synthetic Substitute
Hydrocortisone powder for Injection, Yes Yes Yes
Prednisolone Tablet 5mg Yes Yes Yes
18.3. Contraceptives
Hormonal Contraceptives
Ethinylestradiol + Levonorgestrol Tablet 30 microgram+150 microgram Yes Yes Yes
Ethinylestradiol + Levonorgestrol Tablet 50 microgram+250 microgram No No Yes
Ethinylestradiol + Norethisterone Tablet 35 microgram + 1.0mg No No Yes
(Complementary)
Medroxy Progesterone depot Injection, 150mg/ml in 1-ml vial Yes Yes Yes
18.4 Intrauterine Devices
Copper-containing device Yes Yes Yes
18.5 Barrier Methods
Condoms with or without spermicide (Nonoxinol) Yes Yes Yes
18.6 Estrogens
Ethinylestradiol Tablet 10 microgram, 50 microgram No No Yes
18.7 Progestines
18.8 Ovulation inducers
Clomiphene (Clomifen) Tablet 50 mg (Citrate) No No Yes
18.9 Insulin and Other Antidiabetic Agents
Glibenclamide Tablet 5mg No Yes Yes
Insulin Injection (Soluble) Injection, 40 IU /ml in 10 – ml vial No No Yes
62
DH PH RH
Insulin Injection (Soluble) 100 IU/ml in 10 – ml vial No Yes Yes
Intermediate-acting insulin Injection, 40 IU/ml in 10-ml vial
Intermediate-acting insulin 100 IU/ml in 10-ml vial (as compound insulin zinc No Yes Yes
suspension or Isophane insulin)
Metformine Tablet, 500mg (hydrochloride) No Yes Yes
18.9.1 Thyroid Hormones and Anti Thyroid Medicines
Levothyroxine Tablet, 50 microgram, 100 microgram (Sodium Salt) No No Yes
Potassium Iodide Tablet, 60mg No No Yes
Carbimazole Tablet, 5mg No No Yes
19: Immunologicals DH PH RH
19. 1 Diagnostic agents
Tuberculin, Purified Protein Derivative (PPD) Injection Yes Yes Yes
19. 2 Sera and Immunoglobulins
Anti –D immunoglobulin (Human) Injection, 250 microgram in single-dose vial No Yes Yes
Antitetanus immunoglobulin (Human) Injection, 500 IU, 1500 U, 3000 U Yes Yes Yes
Ampoule
Pertussis Antitoxin No No Yes
Diphtheria Antitoxin Injection, 10 000 IU, 20 000 IU in vial No Yes Yes
Rabies immunoglobulin Injection, 150 IU/ml in vial No Yes Yes
19. 3 Vaccines
BCG Yes Yes Yes
DPT Yes Yes Yes
Hepatitis –B Yes Yes Yes
Measles Yes Yes Yes
Poliomyelitis Yes Yes Yes
Tetanus Yes Yes Yes
19. 4 for Specific Group of Individuals DH PH RH
Mumps vaccine Yes Yes Yes
Rabies vaccine (inactivated: prepared in cell culture) Yes Yes Yes
Rubella Vaccine No No Yes
20: Ophthalmological Preparations and Drugs used in ENT DH PH RH
20. 1 Anti Glaucoma and Miotics
Acetazolamid Tablet, 250mg No No Yes
Pilocarpine Solution (eye drop), 2%, 4% (Hydrochloride or nitrate) No No Yes
Timolol Solution (eye drop), 0.25%, 0.5% (as maleate) No No Yes
20. 2 Anti Infective, Topical:
Aciclovir (Acyclovir) ophthalmic ointment 3% Yes Yes Yes
Chloramphenicol Solution (eye drop) 0.5% Yes Yes Yes
Gentamicine Solution (eye drop) 0.3 %(as Sulfate) No No Yes
Sulfacetamide Solution (eye drop) 10%, 20% No No Yes
63
DH PH RH
Silver Nitrate Solution (eye drop) 1% X No No Yes
Tetracycline Eye Ointment, 1% (hydrochloride) Yes Yes Yes
20. 3 Anti Inflammatory Topical agents
Prednisolone Solution (eye drop), 0.5% No No Yes
20. 4 Local Anaesthetics
Tetracaine Solution (eye drop), 0.5 %( hydrochloride) Yes Yes Yes
20. 5. Mydriatics
Atropine Solution (eye drop), 0.1%, 0.5%, 1 %( Sulfate) No No Yes
Tropicamide Solution (eye drop) 0.5%, 1% No No Yes
20. 6 Drugs Used in E.N.T
20.6.1 Decongestant
Naphazoline Solution (Nasal Drop) 0.05% Yes Yes Yes
20.6.2 Removal of Ear Wax
Glycerin Boric Solution 5% No No Yes
21: Oxytocics and Antioxytocics DH PH RH
21. 1 Oxytocics
Ergometrine Tablet 200 microgram (hydrogen maleate), Yes Yes Yes
Ergometrine Injection 200 microgram (hydrogen maleate) Yes Yes Yes
Oxytocin Injection, 10 IU in 1-ml Ampoule Yes Yes Yes
21. 2 Antioxytocics
Salbutamol Tablet 4mg (as Sulfate) Yes Yes Yes
Salbutamol Injection, 50 microgram (as sulfate)/ml in 5-ml Ampoule Yes Yes Yes
22: Psychotherapeutic Medicines DH PH RH
22. 1 Medicines Used in Psychotic Disorders
Chlorpromazine Tablet 100mg (hydrochloride), No No Yes
Chlorpromazine Syrup 25mg (hydrochloride)/5ml, No No Yes
Chlorpromazine Injection 25 mg (hydrochloride)/ml in 2-ml Ampoule No No Yes
Haloperidol Tablet 2mg, 5mg, Injection 5mg /1-ml Ampoule Yes Yes Yes
22.2 Medicines Used in Depressive Disorders
Amitriptyline Tablet, 25 mg (hydrochloride) No No Yes
Imipramine Tablet 10mg25mg X X X Yes Yes Yes
22. 3 Medicines Used in Generalized Anxiety and Sleep disorders
Diazepam Tablet 2mg, 5mg, 10mg, Injection 5mg/ml in 2-ml Ampoule Yes Yes Yes
(Complementary)
Oxazepam Tablet 10mg, 15mg No Yes Yes
22. 4 Medicines Used in vertigo
Dimenhydrinate Tablet 50mg No No Yes
23: Medicines acting on the Respiratory Tract DH PH RH
23. 1 Anti Asthmatic Medicines
Aminophylline Injection, 25mg/ml in 10-ml Ampoule Yes Yes Yes
64
DH PH RH
Aminophylline Tablet 100mg Yes Yes Yes
Beclometasone Inhalation (aerosol), 50 microgram, 250 microgram No No Yes
(dipropionate) per dose
Epinephrine (Adrenaline) Injection 1mg (as hydrochloride or Hydrogen Yes Yes Yes
tartrate) in 1-ml Ampoule
Salbutamol Tablet 2mg, 4mg (as sulfate) X X X Yes Yes Yes
Salbutamol Inhalation (aerosol), 100 microgram (as sulfate) per dose No No Yes
Salbutamol Syrup, 2mg (as sulfate)/5ml No No Yes
Salbutamol Injection, 50 microgram (as sulfate)/ml in 5-ml Ampoule No No Yes
Salbutamol Respirator Solution for use in nebulizers, 5mg (as sulfate)/ml Yes Yes Yes
24: Solutions Correcting Water, Electrolyte and Acid-base Disturbances DH
PH RH
24. 1 Oral
Oral Rehydration Salts (for Glucose-electrolyte Solution) for composition see Yes Yes Yes
section 18. 7
Potassium Chloride Powder for Solution X No No Yes
24. 2 Parenteral
Glucose Injectable Solution, 5% isotonic, 10%, 50% hypertonic Yes Yes Yes
Glucose with NaCl Injectable Solution, 4% glucose, 0.18% NaCl (Equivalent to No Yes Yes
Na+30mmol/l Cl-30mmol/l)
Potassium Chloride 11.2 % Solution in 20-ml Ampoule, (Equivalent to No No Yes
K+1.5mmol/ml, cl-1.5mmol/ml)
Sodium Chloride Injectable Solution, 0.9% isotonic (Equivalent to Na+154 Yes Yes Yes
mmol/l, Cl- 154 mmol/l)
Sodium Hydrogen Carbonate Injectable Solution 1.4% isotonic (Equivalent to No No Yes
Na+167mmol/l, HCO3- 167 mmol/l)
Sodium Hydrogen Carbonate 8.4% Solution in 10-ml Ampoule (Equivalent to No No Yes
Na+ 1000 mmol/l, HCO3-1000 mmol/l)
Compound Solution of Sodium Lactate (Ringer lactate) Injectable Solution Yes Yes Yes
24. 3 Miscellaneous
Water for Injection 5-ml, 10-ml Ampoule Yes Yes Yes
25: Vitamins and Minerals DH PH RH
Iodine iodized Oil, 1 ml (480mg iodine), No No Yes
Iodine 0.5 ml (240 mg iodine) in Ampoule (Oral or injectable) No No Yes
Iodine 0.57 ml,(308 mg iodine) in dispenser bottle No No Yes
Iodine Capsule, 200 mg No No Yes
Multimicronutrients Capsule Yes Yes Yes
Pyridoxine Tablets 25 and 40 mg, injection [dosage] Yes Yes Yes
Cholecalciferol Ampoule 600,000 iu/ml Yes Yes Yes
Phytomenadione (Vitamin K) Injection, 10mg/ml Ampoule, Yes Yes Yes
Phytomenadione (Vitamin K) Tablet, 10mg No No Yes
Retinol Sugarcoated Tablet, 10 000 IU (as palmitate)(5.5mg) Yes Yes Yes
65
DH PH RH
Retinol Capsule 200 000 IU (as palmitate)(110mg) Yes Yes Yes
Retinol oral oily Solution, 100 000 IU/ml in multidose dispenser (as palmitate), No No Yes
Retinol Injection, 100 000 IU (as palmitate) (55mg) in 2-ml Ampoule No No Yes
66
ANNEX 3. INDICATORS FOR REPORTING ON QUANTIFICATION
The following table lists the minimum set of indicators that stakeholders should use for reporting on forecasting to the central level (NGOs and
government agencies). These indicators are defined by WHO in Harmonized Monitoring and Evaluation Indicators for Procurement and Supply
Management Systems, which can be found at http://whqlibdoc.who.int/publications/2011/9789241500814_eng.pdf?ua=1.
These are core indicators—the list of indicators may be expanded over time as better data flows are established. The initial measurement
methods may have to use a limited tracer list (i.e., not all EDL/LDL items), but should be expanded to include more items as better data
collection methods are established.
Indicators for Reporting on Quantification

Quantification Target
Function Indicator Rationale Method Requires value
Proportion of quantities of Quantification must be grounded
• Value of public sector
products actually received in reality; if the medicines Divide total value of
medicines quantified
(procured plus donated) quantified are not being received medicines received in 100% ±
• Value of total public sector
during a defined period out (or over-supplied), quantification one year by total value 10%
medicines received
of total quantities planned must be adjusted (lead times, quantified as needed
(including donations)
Supplied volume for the same period financial levels, donations)
measurement Proportion of quantities of
products actually procured
(procured plus donated)
during a defined period out
of total quantities planned
for the same period
• Divide quantity • Quantities of each product
Percentage of quantities used
estimated in procured (donated) in a
out of total quantities available
quantification by defined period
Percentage by value of for consumption after deduction
Usage quantity actually • Opening balance of each 100% ±
medicines consumed by of buffer stock (opening balance
measurement consumed in 1 year product at the beginning of 20%
value quantified plus quantities procured plus
• Initially, start with just the defined period
quantities donated minus buffer
stock) during a defined period
10 tracer items • Buffer stock requirements
identified as “top ten” per product during the
67
Quantification Target
Function Indicator Rationale Method Requires value
by cost from ABC defined period
analysis • Quantities of each product
consumed during the same
defined period, as reported
by health facilities
Note: The following operational indicators are derived from MDS-3, page 20.29. Simple yes/no answers are adequate.
Formal workplan and Quantification requires major
Evidence of workplan and
schedule for quantification effort and must be properly
schedule
available resourced and planned
Does a quantification
committee exist with
representatives from health Wide scope of involvement is
Minutes of quantification
facilities (prescribers and required to achieve reliable
committee meetings
pharmacy staff), disease quantification
programs, logistics staff, and
independent body?
Are multiple quantification No method is perfect and should
methods used and be checked against other Details of calculations used
Quantification compared? available data Y/N Y
operation
Are records of stock outs
If there have been frequent stock
incorporated into the Stock records of stock outs
outs, accuracy will be reduced
calculations?
Must use a rational basis for
Are budget adjustments
adjusting medicines quantities to Details of calculations used
made using VEN system?
fit the available budget
Easy to make mistakes and
large monetary values are
Are quantification
involved; calculation should Verification report reviewed by
calculations verified by an
always be verified by a party not third party
independent party?
involved in the detailed
preparation
68
HMIS(EPHS) HMIS (BPHS)

Drug name Drug name
1 ACT Acetyl Salicylic
2 Atropine inj 1 Acid/Paracetamol
3 Benzyl Penicilline inj 2 Mebendazole/Albendazole
3 Amoxicillin/Ampicillin
4 Digoxine
4 INH
5 Ergometrine Inj 5 Rifampicin
6 Furosemide Inj 6 Amp. Diazepam
7 Gentamycine Inj 7 Inj. Lidocaine
8 Iodine Poluvidone 8 Metronidazole
9 Ketamine Inj 9 Co-trimoxazole
10 Lidocaine 5% Spinal Inj 10 Anti-hypertensives
11 Magnesium Sulphate 11 Oral contraceptive
12 Injectable contraceptive
12 Morphine inj
13 Condoms
13 Naloxone Inj
14 IUD
14 Hydralazine Inj 15 TT vaccine
15 Oxygen 16 PENTA vaccine
16 Pethidine inj 17 ORS
17 Phenobarbital Inj 18 Vitamin A
18 Quinine inj 19 Chloroquine
19 Ranitidine inj 20 Sulfadoxine + Pyrimethamin
20 Ringer Lactate IV 21 Ferrous Suplhate + folic acid
22 Oxytocin
21 Salbutamol Inj
23 Gloves
22 Sodium Chloride IV
24 Zinc Tablets
23 Arthesunate Inj 25 Artesunate + SP
26 Amitriptiline/Fluoxetine
27 Fluoxetine
69
This document is made possible by the generous support of the American people through the U.S.
Agency for International Development (USAID), under the terms of cooperative agreement number
306-A-00-11-00532-00. This document is developed with technical and financial support of
Managing Science for Health/ Strengthening Pharmaceutical System. The contents are the
responsibilities of General Directorate of Pharmaceutical Affaires, Ministry of Public Health and do
not necessarily reflect the views of USAID or the United States Government.

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Quantification Guidelines for Essential Medicines

Acronyms .................................................................................................................................. iii

ABC classification by A, B, or C, according to the monetary value of usage

Consumption-based estimate: Prediction of future medicine requirements on the basis of

Metrics: Indicators for measurement of performance.

Stock control/inventory management: The process of maintaining inventory data on the

Pharmacist Abdul Hafiz “Quraishi”

Dr. Ahmad Jan “Naeem”

MoPH invited representatives of donors, NGOs, United Nations agencies, government

• Form an overview of the existing pharmaceutical supply management situation

The objective of these guidelines is to develop the practical competence of MoPH

Ultimately, the minimum requirements for essential medicines quantification guidelines

• To make rational decisions in response to service delivery, budgetary, service providers’

• To ensure uninterrupted availability of appropriate medicines

• To improve cost-effectiveness and increase clients’ satisfaction level

2) Produce a quantification plan with clear timelines and outcomes

3) Establish a quantification committee/team with clear responsibilities

4) Select appropriate quantification methods using evidence-based decisions

5) Undertake the quantification using the selected method

6) Verify the quantification results

SYSTEMATIC APPROACH TO QUANTIFICATION PLANNING

Planning for Quantification

Source: USAID | DELIVER

Figure 1. Typical quantification flow process

• Facilitates the appointment of the quantification working group (QWG)

Quantification Working Group

To ensure accountability, transparency, and

In decentralized systems, when quantification is

Source: MDS-3, p. 20.14

all parties are involved, only that they be considered.

Roles and Responsibilities of the QWG

o Geographical area (region, district)

• Perform the actual quantification in collaboration with key stakeholders

• Select the best quantification methods (consumption-based, morbidity, proxy-

• Explicitly document all assumptions and modifications or combinations of methods,

Table 1: QUANTIFICATION METHODS

programs in a the standard facility reference or standard facility

patient ACpy: average treatment cost per

budget needs - Supply system needs for a health

Figure 2. Publications that may be helpful when quantifying medicines

1) Prepare a list of medicines to be quantified

• AMC = total consumption (Ct)/ review period in months (Rm)

• AMCa = total consumption (Ct)/review period in months (Rm); from Rm is

• AMCa = Ct ÷ [Rm- (Dos ÷ 30.5)]

 Population movements due to war or floods

• AMCp = adjusted average monthly consumption (AMCa) + adjusted average

• AMCp = AMCa + (AMCa × Au)

For example, acetylsalicylic acid 300 mg tablets with a 5% increased use

The Au factor is applied if there is an anticipated change in the consumption pattern.

• SS = projected average monthly consumption (AMCp) × lead time (LT; generally 3

For example, acetylsalicylic acid 300 mg tablets

• Qp = AMCp × (LT + PP) + SS – (Sh + So)

For example, acetylsalicylic acid 300 mg tablets

• Qpa = quantity to procure (Qp) + (quantity to procure [Qp] × loss adjustment

• Qpa = Qp + (Qp × Au)

For example, acetylsalicylic acid 300 mg tablets

Days out of stock

Stock on hand (Sh)

Stock on order (So)

Safety stock (SS)

Cost per pack size

Source: MDS-3, p. 20.19

Figure 3. Flow diagram for the morbidity method

3) Collate the morbidity data for each identified health problem