Logística/gestión de suministros

Intercambio MAC

16-1

Introduce the session by noting that, so far, we have emphasized the

need to bring clients to our door, and that once in the door, these clients
should have a well-informed, positive experience. But, if there are no
contraceptives, or the method chosen is not available, almost all of our
efforts become worthless.

16-1
 SI NO HAY
PRODUCTO,
NO HAY PROGRAMA

Logística/Gestión de suministros 16-2

The simple conclusion is: NO PRODUCT, NO PROGRAM. Note that

during this session we will discuss this simple and obvious conclusion,
in a context that helps inform us what we can do about ensuring that we
have the products we need.

Acknowledge that this assumption is somewhat naïve—certainly not all

clients require medication or contraceptives, but for the large majority of
them, the best counseling and access will not prevent an unwanted
pregnancy, prevent a sexually transmitted infection (STI), or improve
the outcome of a pregnancy if the products (e.g., iron supplements) are
not available. Logistics has too often been considered an ancillary
component of program management rather than a component that is
equal to IEC, counseling, and the other components of the “MAQ
Lotus.”

Note that the session will focus primarily on contraceptive supplies,

although the principles apply to any product—from suturing materials to
pads for writing prescriptions.

16-2
 El propósito de la logística:
los seis aspectos adecuados
Para maximizar el acceso de los clientes a
anticonceptivos de alta calidad, un sistema de
logística debe contar con lo siguiente:
u El producto ADECUADO
u En la cantidad ADECUADA
u En el estado ADECUADO
u En el lugar ADECUADO
u En el momento ADECUADO
u Por el costo ADECUADO

Logística/Gestión de suministros 16-3

Note that we have already looked at the example of a restaurant and

how it relates to our expectations for service. Ask participants to recall
some of these expectations (e.g., the staff is friendly and efficient, we
are offered a variety of choices, etc.)
Now ask participants to brainstorm ideas about what, other than
service, a restaurant has to get “right” in order to have a good customer
service experience. Note the answers on a flipchart. Reject only those
answers related to service. If participants are having a hard time
focusing on non-service issues, ask them to think about the food. What
about the food does the restaurant have to get right?
Summarize the brainstorm by relating it to the six rights on the slide.
After getting to the clinic, receiving counseling, and choosing the
appropriate method or treatment, the six rights should be fulfilled, just as
in a restaurant. Note how failure in even one of the six rights in a
reproductive (RH) program is a failure for that client. Unlike in a
restaurant where a customer might take chicken when fish is not
available, a client is unlikely to want to accept a contraceptive method
other than the one s/he has chosen with the advice of the provider.
Providers who are unable to prescribe the most appropriate, rational
treatment will likewise be frustrated. Conclude that the six rights define
the purpose of a logistics system in the eyes of the customer.

16-3
 La logística “da resultado”
en Kenia
Anticonceptivos como u Kenia gastó $4,5 millones
porcentaje del total en anticonceptivos en
de costos 1993
u La logística (19%) protege
la inversión en productos
u La logística protege el
81% restante de inversión

Fuente: National Council of Population and Development/Kenya, 1995.

Logística/Gestión de suministros 16-4

Ask participants if they believe that effort in logistics “pays off” for the
program? If so, how? Note that fulfilling the six rights has consequences
not only for the customer but also impacts the program as a whole.
Ask participants what percentage of a family planning (FP) program’s
total costs are spent on the contraceptives provided? Take a few
answers.

Note that in a report published in 1995, the National Council of

Population and Development in Kenya, estimated that in 1993 about
19% of total funds were spent on contraceptives. Note that we can look
at this in two ways. First, for Kenya in 1993, 19% of funds represented
$4.5 million. This represents a sizable investment in commodities (a
term we will use to mean the same thing as goods or supplies or
products). The impact to the program of losing even a portion of these
funds is considerable. So, if we improve the logistics to manage these
supplies, we will impact our program. We can also look at this from the
point of view that about 80% of our program is invested in people,
equipment, transport, IEC materials, buildings and the like. But because
we know that without quality supplies we jeopardize our investment in
other areas, we can look at improving logistics as improving our ability
to wisely spend the other approximately 80%.

16-4
 La logística contribuye al
EFECTO en Kenia

Logística/Gestión de suministros 16-5

Note that inputs to logistics do have impacts related to increasing

contraceptive prevalence. For Kenya, we can see an association
between lowering stockouts and increasing prevalence (CPR, the % of
women of reproductive age, generally 15-49 years, using a
contraceptive method). This was done by comparing the availability of
contraceptives from 1989 to 1998, and trends in prevalence of modern
contraceptive methods over the same period. If necessary, review what
we mean by a stockout—the unavailability of a product. Even though
another location may have the product, we have to fulfill all Six Rights.
Measuring stockouts is one simple method of evaluating the success of
a logistics system.
The assocation between stockouts and prevalence is undoubtedly
affected by other factors such as the success of better counseling, IEC
campaigns, and the like, but this graphic suggests that improvements in
logistics can assist in improving access to quality commodities.

(See also optional slide 22: Impact in Tanzania.)

16-5
 Organización de las actividades
de logística: El ciclo de logística

Logística/Gestión de suministros 16-6

Note that if we agree that logistics is important to our program’s success, we will need to determine what
activities are we talking about when we say “logistics?” Brainstorm a list of ideas without writing anything
down.
Note that over the years, logistics experts have organized these activities into the logistics cycle. This cycle
is used whether the product is essential drugs, contraceptives, Jeeps, or Coca-Cola. Note how similar it is
to the MAQ logo. Ask participants why this is so? Note that, like MAQ, the process is continuing and always
moving, hopefully in a positive direction. Note too the dependence of activities on one another. Note that in
the case of logistics, the cycle moves in one direction only—we cannot satisfy customers if we do not do
the other steps correctly. For the remainder of the session, we will explore these other steps in the context
of maximizing access and quality. Answer any questions about the logistics cycle. (If asked,
policy/adaptability represent the environment in which logistics rests and by which it is affected. For
example, a policy limiting brand proliferation will affect the number of products that are managed.
Adaptability refers to the ability of the system to respond to change. For example, how well can the logistics
system respond when it goes from an FP system to an RH system, with the new commodities it must
handle? The center box represents the management of the commodities. Primary among these tasks is the
management of information coming from all other activities. We use the term LMIS with the L for “logistics”
because we want to differentiate it from other management information systems (MISs), that may be
financial systems only, or health systems only (HMIS), that do not ROUTINELY collect the data needed to
make logistics decisions. Quality monitoring appears at all phases because it occurs at all four phases.
Customer perception of product quality should influence the selection of new products, the pre-
procurement process should be monitored for choosing quality items and specifying the expected quality in
the procurement process. Once received, products should be quality inspected, and as they are delivered
throughout the system, they should be monitored for quality.)

[Participants may ask about the difference between a “customer” and a “client.” We will use these terms
interchangeably to be the woman, man, or youth (anyone) who comes into any facility to receive
reproductive health information, counseling, testing, or products. Note that the logistics cycle is taken from
a business model, in which the emphasis is on “customers.” In health services, we generally use “client.”
Participants may also ask about “use” or “consumption” vs “serving customers.” For logistics, we are
concerned about the commodities given to customers, regardless of whether or not they are used because
they will still need to be re-supplied. For example, a customer receiving a cycle of pills for FP for the first
time may also receive condoms to use until the pills are effectively preventing pregnancy. The customer,
however, may not use them. In logistics, these condoms have still left the logistics system and are
therefore counted as “dispensed to user” (a term to be discussed further below)].

16-6
 Maximización del acceso
mediante la selección de productos
u Seleccionar métodos y productos
anticonceptivos basándose en la demanda de los
clientes (no como ocurre con los medicamentos)
u Ofrecer la más amplia variedad de opciones,
pero considerando la gestión de las cifras de
productos

Logística/Gestión de suministros 16-7

Ask participants how, looking at the Logistics Cycle, logistics helps

maximize access.

After listening to a few answers, note that we are really looking at

“product selection” and “forecasting and procurement” to assure that we
have a full-range of products that clients want.

Ask participants how we select the products to offer? Take a few

answers.

Note how selecting contraceptives is not quite like selecting other

medicines. For example, clients who are ill do not usually go to the
doctor to ask for a specific medicine. Rather, they ask the doctor to give
them the medicine that will help make them feel better. Doctors/medical
necessity, therefore, influence the selection of most drugs. With
contraceptives, the goal is to provide the client with the method the
customer desires.

16-7
 Maximizar el acceso
mediante la previsión
Primera visita u La previsión es un
ejercicio a nivel central
u Las previsiones pueden
prepararse empleando
diversas fuentes:
Re-visita − datos de población
− estadísticas de
servicios
− datos de logística

Logística/Gestión de suministros 16-8

Now turn to forecasting. Note that we have just concluded that the
primary determinant of product selection should be customer demand.
However, to decide how many of any item is needed, we need to be
able to quantify (forecast) needs into the future. How do we do this? We
can estimate consumption based on population data, data about the
number of visits or clients we have seen, or on the quantities actually
put in the hands of customers, which is called “dispensed-to-user” data.

(See also optional slides 23-25 for additional information about

forecasting.)

16-8
 Previsión usando
datos de logística
u Los datos de logística se
centran en el cliente
porque se basan en las
cantidades que en
realidad se distribuyen a
los usuarios
u Cuando no se dispone de
esos datos, se pueden
usar las cantidades
enviadas (despachadas)
del nivel más bajo
respecto al cual existen
datos
Logística/Gestión de suministros 16-9

We recommend a forecast prepared with logistics data—information

about the actual quantity of products dispensed to users. The result is a
real demand-driven forecast. The challenge is in collecting these data
from the customer service level (SDPs). Where this is not possible,
information from the lowest level of the system issuing supplies to the
next lowest level (called “issues data”) can be substituted.

16-9
 Previsión usando múltiples
fuentes de datos

Datos Estadísticas
Datos de
de de
logística
población servicios

Previsión
final

Logística/Gestión de suministros 16-10

Recommended: Those who want to select commodities to maximize access

should forecast needs based on real demand and then compare their forecasts to
forecasts using other data sources (like population and service statistics). Note
that for new programs, shipping data (issues) data may be the only logistics data
available.

Ask participants what we can conclude from this discussion. They should conclude
that:

• To select products and procure them, the client’s needs should drive the
process
• The selection of products should include considerations for method/ brand
preference and customer needs.
• The quantities to be procured should be based on dispensed-to-user data.
Forecasts based on population targets or service statistics will be
influenced by the assumptions that went into the forecast (i.e, dispensing
protocols).
• To determine dispensed-to-user data, it will be necessary to collect
information from the service delivery level (i.e., the lowest level of the
system).

Ask participants if they have any questions about maximizing access in a logistics
context.

16-10
 Actividad 1

¿QUÉ TAN CERCA ESTÁ LA GARANTÍA?

Se dice que un programa tiene garantía de

anticonceptivos cuando
u Puede calcular con exactitud los requisitos
u Puede controlar los recursos financieros
u Tiene la capacidad técnica de adquirir productos
u Puede distribuir productos a los clientes a medio
y largo plazo
Logística/Gestión de suministros 16-11

Tell participants that we want to generate some discussion from what we have
discussed so far. Using the information on the slide, define contraceptive security. Ask
participants to take 5 minutes to discuss with a partner how “close” or “far away” their
programs are from achieving contraceptive security. In other words, how close are
they to being confident they know where families in the future will obtain
contraceptives and condoms for HIV/AIDS prevention.
After 5 minutes, ask a few participants to share some of the information they have
heard. Some points may include:
ü Growing demand for contraceptives with no defined source
ü Growing demand for condoms for HIV/AIDS prevention with no defined source
ü Confusing array of many donors/sources with uncoordinated activities
ü Clearly defined projects with donors for support into the future
ü Beginning/ongoing discussion of phase-out for donor support
üChanging from one donor to another
üSecuring World Bank funds to pay for increased needs
üImprovements in the selection/forecasting/procurement areas to maximize use of
available resources
üComplete donor reliance
üLocal manufacture or international bidding by program’s own procurement unit.

Conclude that there are no right/wrong answers, only that countries must work to
ensure they know how their program is assuring its needs for supplies into the future.

16-11
 Maximización de la calidad
mediante buenas prácticas de
almacenamiento
u Cerciorarse de que se
puede maximizar la
calidad del producto al
maximizar la calidad del
almacenamiento
u Almacenar suficientes
productos para las
necesidades, prestando
atención a la fecha de
caducidad y al espacio
disponible
Logística/Gestión de suministros 16-12

Note that now we will discuss maximizing quality in a logistics context.

From what we have discussed so far, how do you think we would define
“quality” for a logistics system? In this case, we mean having a quality
product to offer the client.

If we look at the logistics cycle and think about the Six Rights, we can
see that to offer a quality product to the customer, we will have to have
good storage practices that maximize the shelf-life of the product. Note
that this slide shows some good and some poor storage practices.

Ask participants to brainstorm some rules for storage and listen to these
without writing them down.

Note how we can easily think of many rules for proper storage and that
most of them are common sense. Use the list on optional slides 26-28
to note several other rules if not already mentioned.

(See also optional slides 26-28: Rules for Good Storage Practices.)
Note that the rules for storage are available on thumbnail slides in the
Participant Handbook.

16-12
 Maximizar la calidad
mediante el control del inventario

Los sistemas de control del inventario permiten al personal saber

cuándo hacer pedidos habitualmente y cuánto deben pedir.
La meta es evitar el desabastecimiento

Logística/Gestión de suministros 16-13

Note that the main way we assure the availability of high-quality

products throughout the system is through inventory control,
specifically, max-min inventory control. Max-min systems help you
decide when to order and how much to order. Emphasize that this is for
routine ordering as compared to forecasting.

Ask participants if they are familiar with any max-min systems. Note that
they probably use such systems all the time at home without thinking
about it. For example, what is your inventory control system for rice (or
maize meal or any staple product) in the home? How often do you buy
rice? Is it only when you are running low? Is it every week, regardless of
how much you have? Note how it is not solely based on available
funds—because rice is probably an essential item in the home you
would always want to have some rice on hand. (If this example is
appropriate, note how fresh milk also requires inventory control and is a
better example because, like all drugs, it has an expiration date.)

16-13
 Max-Min
Cómo funciona
u Supone que hay suministros
completos de productos (no como
ocurre con muchos programas de
medicamentos)
u Tiene un nivel máximo, un nivel
mínimo y un punto de emergencia
que indica que deben hacerse
pedidos
u Incluye abastecimientos de
seguridad a fin de
− prepararse para cambios de la
demanda (estacionalidad)
− prepararse para lo imprevisto

Logística/Gestión de suministros 16-14

How does a max-min system work? First, it assumes that enough

supplies are available to meet all client needs. This system is different
from drug systems in which supplies are often in short supply or where
one item can be substituted for another. To be client-centered and fulfill
the Six Rights, programs must be prepared to meet the demand of all
clients.
The idea behind max-min is to maintain stock levels between a
maximum and minimum amount so that stockouts will not occur and so
that expiration is minimized. It is also important that storerooms not be
overwhelmed with supplies. In max-min, a certain amount of “slack” is
built into the system to strive to eliminate stockouts that we call the
“safety stock.” After all, a stockout may be a life or death situation for a
client. This means that we sometimes risk a small percentage of
expiration. We accept this risk in the hope that no client is denied
her/his method of choice. Ask participants what the max is for the fuel
gauge? The answer is “full.” And min is probably near the red mark,
where the safety stock is. “Empty” would be a stockout, and as with a
health program, the car will not move without fuel.

(See also optional slide 29: Max-Min for CBD Programs.)

16-14
 Maximizar la calidad mediante la
supervisión de los suministros

¿CUÁNTO DURARÁ EL SUMINISTRO DE ESTE

PRODUCTO?

Abastecimientos en reserva
÷
Consumo mensual promedio (CMP)
=
Meses de abastecimientos en reserva

Logística/Gestión de suministros 16-15

In an effective logistics system, we can maximize quality by monitoring supply

levels on a regular basis, by asking the simple question, “How long will our
supply of this item last?”
Note that most people assess stock status all the time in their daily work,
although they do it very informally. For instance, about how long will a full tank
of fuel last in your vehicle? A week? 10 days? Note that this measure of time
(“how long”) is much more useful than only knowing how many liters of fuel we
have.
To assess stock status, we divide the quantity of stock we have on hand by
the average monthly consumption. (Remind participants that “consumption”
comes from the SDPs.) This way, we know not how long we can keep
supplying our immediate customer (the next level down), but how long we can
continue to supply our ultimate customers—the clients who visit our clinics. In
our experience, using a simple average of the most recent 6 months of
consumption information to calculate the average is best when there is no
clear trend in consumption. When there is a trend, 3 months of data can be
used.
When an effective information reporting system is designed, supervisors can
monitor stock status at all levels of the system.
Conclude that inventory control helps ensure that the system has only the
stock it can use, minimizes expiration, minimizes the potential for stockouts,
creates simple rules for ordering, makes effective use of transportation, and
makes supervision easier. In these ways, inventory control helps maximize the
quality of the product that reaches the client.

16-15
 Información de logística
3 datos esenciales
u Abastecimientos en reserva
u Pérdidas/ajustes
u Tasa de consumo (CMP)

Logística/Gestión de suministros 16-16

Note that for logistics, information drives the system. We have implied
this throughout this session. What information do you think we need to
have an effective logistics system? Take a few answers.

Note that the message on this slide is the most important message of
the day. We have mentioned 2 data items already—these are
consumption data and stock on hand data. The third item is losses and
adjustments. To “close the loop” of what happened to the supplies, we
need to know what items were lost, missing, used for training, stolen, or
otherwise unaccounted for. In logistics, then, only 3 pieces of
information need to be collected from all facilities in order to run the
logistics system. This means that data collection should be
straightforward and uncomplicated. (Participant answers may include a
number of “service statistics” which measure numbers of people and
characteristics of people, like their age, parity, and the like. New and
continuing users are common service statistics. These are not logistics
data. Logistics data are about the supplies, not the clients, although one
can theoretically convert from one to the other using recommended
dispensing protocols. See the forecasting discussion above.)

16-16
 Recopilación de datos
esenciales: 3 tipos de registros

u Registro de consumo
u Registro de movimiento de suministros
u Registro de abastecimientos de suministros
almacenados
Logística/Gestión de suministros 16-17

Ask participants what can be done with a drug or contraceptive after it

has been manufactured. Note that there are only 3 things—you can
store it, you can transport it, or you can use it. Therefore, you need only
3 types of records—those that track consumption, movement of
supplies (transaction records), and that monitor stock levels in storage
(stock-keeping).

(See also optional slides 30-32 on collecting essential data.)

16-17
 Recopilación de datos
esenciales mediante informes
u Notificar todos los
datos esenciales al
siguiente nivel
u Este ejemplo también
incluye un pedido de
suministros
u En este ejemplo, un
formato sirve para
todos los niveles

Logística/Gestión de suministros 16-18

Note that data must travel from one level to another. Data travel on
reports. This slide shows an example of a report that includes the
request. Note that when reporting is tied to ordering, reporting levels are
generally higher. Note too, that this report could be used by a
supervisor to determine the reasonableness of the order. There are
ways of summarizing (aggregating) reports from lower levels that will
affect how much supervision can be done as a “desk exercise.” Note
how this report from Kenya also serves as a request for supplies.

Conclude that in order to help with product selection, forecasting and

procurement, and to monitor distribution, it is necessary to collect
information routinely. Unfortunately, most MISs are not designed to be
complete and therefore are not effective tools for logistics decision-
making. Therefore, an LMIS is often necessary. (If participants ask, one
big difference is the types of decisions that come out of the MIS that
make an LMIS important. An HMIS is generally designed to collect
disease and morbidity patterns, and the data are used to determine
things like staffing levels, program goals, and to analyze disease
patterns. It is not usually effective for routine activities like monthly
ordering. That is why we think an LMIS is a necessary function,
although it is possible to combine both systems.)

16-18
 Actividad 2

PUNTOS FUERTES Y PUNTOS DÉBILES

u ¿Cómo puede su programa mejorar el sistema

de logística para centrarse mejor en el cliente?
¿Cuál de los seis aspectos adecuados plantea
más retos en su logro?
u De las actividades del ciclo de logística, ¿en cuál
es usted más fuerte? ¿en cuál es más débil?
¿por qué? ¿qué puede hacer para mejorar?

Logística/Gestión de suministros 16-19

Ask participants to form pairs again and take 5 minutes to discuss the
questions in light of what we have just discussed.
After 5 minutes, ask a few participants to share their answers. Ask
other participants to share their advice.
Ask participants if they have any questions about logistics so far. Note
that, for further information, resources are listed on thumbnail slides in
the Participant Handbook.

16-19
 La logística tiene EFECTO

u Si no hay producto, no hay programa

u Satisfacer los seis aspectos adecuados para el éxito de la
logística
u Para maximizar el acceso
− Seleccionar/prever/adquirir según la demanda de los
clientes
u Para maximizar la calidad
− Aplicar medidas de almacenamiento apropiadas
− Evaluar el abastecimiento
− Aplicar el control del inventario
u Recopilar datos esenciales

Logística/Gestión de suministros 16-20

Conclusions
Remind participants of the following:
• No product, no program. Having a stockout of any item means that all efforts to
maximize access to service and deliver a quality service are lost because the client
cannot receive her/his method of choice.
• Maximizing access for logistics means fulfilling the Six Rights, then selecting the
best range of products to offer clients and then forecasting and procuring those
items.
• Maximizing quality for logistics means having high quality products. The best way
programs can do this is to ensure that products are properly stored, are stocked
according to a max-min inventory control system, and are monitored using stock
status assessments. A well-designed system includes a plan for supervision and
has built-in tools for supervision (like including information on reports that make
supervision easier).
• To work effectively, a logistics system must collect 3 essential data items from all
facilities: stock on hand, rate of consumption, and losses/adjustments. These are
often different from the data collected in HMISs or financial MISs, and therefore it
is usually necessary to collect these data separately for routine use in logistics.

Conclude that sound logistics management practices are a lever that impacts
program success directly. And, a small investment in logistics can have excellent
pay-offs, to both the program and the client.
(See also optional slides 33-36 on logistics resources.)
Answer any questions participants may have.

16-20
 Diapositivas opcionales

Logística/Gestión de suministros 16-21

The following are optional slides that may be used to supplement the
presentation.
IMPACT--Tanzania
Population Data
Service Statistics
Setting Realistic Expectations
Storage
Storage continued
Storage continued
CBD Max-Min
Consumption
Transaction
Stock-keeping
Logistics Resources
Logistics Resources continued
Logistics Resources continued
Logistics Resources continued

16-21
 La logística tiene EFECTO
en Tanzanía

Logística/Gestión de suministros 16-22

Here we have an example from Tanzania. This graph records trends in

availability and use. As stockouts decrease, prevalence increases.
Nepal and Bangladesh show similar results. We recognize that other
factors are at work, but believe that logistics does impact program
success.

16-22
 Previsión usando
datos de población

Número previsto de usuarios

x
factor PPA
=
Cantidad prevista necesaria

Logística/Gestión de suministros 16-23

When forecasting using population data, estimates are made of the

number of clients who will demand a particular product. The baseline
data are generally taken from census data. After calculating the number
of users of a particular product, you then have to convert the number of
users to the quantities they will use. This is done using estimates of
what the average couple will need to protect them against unintended
pregnancy for one year, known as the CYP (couple year protection)
factor. Because sexual behavior studies are not well-explored by
different areas of the world (or by country or within a country), it is
challenging to determine the quantities of supplies that will be needed
based on knowing the estimated number of users. The quantity of
supplies needed is, of course, the most important information for
running an effective logistics system.

Estimates using population data are popular in the absence of other

data sources, for new programs, and especially where Demographic
and Health Surveys (DHSs) have been recently conducted.

16-23
 Previsión usando
estadísticas de servicios
Retos:
u Definir visitas/revisitas o usuarios nuevos/que
continúan
u Convertir los usuarios en cantidades usando
protocolos estándar

Logística/Gestión de suministros 16-24

Service statistics are the information collected at service delivery points

(SDPs) where clients are served. They are usually information about
types of visits (first visit, re-visit) or about types of clients (new user,
continuing user, re-start, changing methods). The challenges to using
this data source are listed on the slide. Although we may have
dispensing protocols for determining how much of a product to give a
single client, these may not be adhered to well by providers. For better
customer service, we might give a client more than 3 cycles of oral pills
if, for example, she lives at a great distance from the clinic. Also non-
returning clients are not dropped off of the list of “continuing users.”

16-24
 Previsión Fijar
expectativas realistas
Índex Esfuerzo de programa
Por ejemplo, Indonesia, con
Fuerte Moderada Débil Muy débil una tasa de prevalencia de
Alta uso de anticonceptivos
Colombia Jamaica Costa Rica Iraq
(66%) (67%) (75%) (14%)
1.8 1.4 0.8 -0.1
(TPA) de 50% en el
Media Republica
momento del estudio, pudo
China Algeria Bolivia
-alta (83%)
Dominicana
(47%) (30%)
por lo menos en parte
(56%)
1.3 1.2 2.0 1.0 mediante esfuerzos
Media
Indonesia Egipto Ghana
programáticos fuertes,
-baja (50%) (46%) (13%) aumentar la TPA en 1,5
1.5 1.7 0.4
cada año.
Baja
India Bangladesh Haití Malawi
(43%) (40%) (10%) (13%)
1.3 2.1 -0.4 0.7 Clave: (XX%) = TPA en el momento
del estudio
X.X = aumento/año de la TPA

Logística/Gestión de suministros 16-25

What number of clients can be expected to accept FP each year? The

table on the slide lists a sampling of what expectations for increases in
contraceptive prevalence (CPR) would be realistic. Note that expected
increases in CPR of greater than 1% per year would represent an
extraordinary effort. This table represents a few countries and their
performance in increasing contraceptive prevalence rates (CPR)
relative to the efforts of the program to encourage contraception. The
number in parentheses represents their CPR at the time of the study
(early 1990s, source unknown). The other number is the annual amount
that the CPR increased.

16-25
 Reglas para buenas
prácticas de almacenamiento
1) Limpiar y desinfectar la bodega regularmente
2) Almacenar productos de salud en una bodega seca, bien
iluminada y bien ventilada —donde no reciba luz solar
directa
3) Proteger la bodega contra el agua
4) Cerciorarse de que hay equipo contra incendios y que éste
es accesible, y que el personal ha recibido capacitación
para usarlo
5) Almacenar productos de látex lejos de motores eléctricos y
luces fluorescentes

Logística/Gestión de suministros 16-26

Rationale for rules 1-5:

1) Clean and disinfect storeroom regularly. Rationale: Rodents and some insects (e.g., termites and
roaches) love to eat oral contraceptives. They also eat the shipping cartons and inner packaging. To
pest- proof your store means to stop the pests from getting in. If your store becomes infested with pests,
you must kill them. Appropriate pesticides and cats are effective against termites, rodents, roaches, etc.
Once you clear pests from the store, keep it clean. A clean store keeps pests away. Food and drinks in the
warehouse increase the risk of pests. Getting rid of some pests may be difficult and beyond the
storekeeper's means. Keeping the storeroom clean, however, should be easy.
2) Store health commodities in a dry, well-lit, and well-ventilated storeroom—out of direct sunlight.
Rationale: If the store gets hot, the heat may cause some of the supplies to spoil (i.e., decrease shelf life).
Point out that the shelf life of oral contraceptives and condoms is generally 4 to 5 years. However, this
period may be reduced if temperatures inside the warehouse rise above 104 degrees Fahrenheit (40
degrees C). For condoms, shelf life depends directly on storage conditions, and shelf life is likely to be
much shorter. Although air conditioning is ideal, it is expensive. Alternatives are ceiling fans and/or forced
ventilation. Direct exposure to sunlight can also reduce the shelf life of many products. Use roofing and
windows that shade the interior of the store from sunlight. Store supplies in their shipping cartons. Moving
supplies out of direct sunlight should be easy.
3) Secure storeroom from water penetration. Rationale: Water destroys either contraceptive supplies or
their packaging. If packaging is damaged, this makes the product unacceptable to the client even if the
contraceptive is undamaged. The obvious preventive measure for water damage is to repair the warehouse
so that water cannot enter. Other measures include stacking contraceptive supplies off the floor on pallets
(at least 4 inches or 10 cm off the floor and 1 foot or 30 cm away from walls) because moisture can seep
through walls and floors and into the contraceptive supplies.
4) Assure fire safety equipment is available and accessible, and that personnel are trained to use it.
Rationale: Being able to stop a fire before it spreads can save thousands of dollars of supplies, not to
mention the storage space itself. Keeping fire extinguishers accessible is easy, even if keeping them in
working order may be more difficult. Keeping one near the door is always a good idea, and keeping them
spread throughout the inside of larger warehouses is also important. Make sure the right equipment is
available--water works on wood and paper, but will not work in an electrical or chemical fire.
5) Store latex products away from electric motors and fluorescent lights. Rationale: Latex products,
especially condoms, can be damaged if they are directly exposed to the light of fluorescent lamps. These
lamps, and electric motors, create a chemical called ozone, which can rapidly deteriorate condoms.
Condoms in their paper boxes and cartons should not be affected, and should therefore be left in their
boxes. However, by simply moving condom boxes away from these sources, potential damage can be
eliminated.

16-26
 Reglas para buenas
prácticas de almacenamiento
(continuación)
6) Mantener almacenamiento frío, incluida una cadena de
frío, para los productos que lo requieren
7) Mantener los narcóticos y otras sustancias controladas en
un lugar bajo llave
8) Almacenar productos inflamables aparte, con
precauciones de seguridad apropiadas
9) Apilar las cajas de anticonceptivos por lo menos 10 cm
(4 pulgadas) por encima del suelo, 30 cm (1 pie)
separados de las paredes y otras pilas, y a una altura
máxima de 2,5 m (8 pies)

Logística/Gestión de suministros 16-27

Rationale for rules 6-9:

6) Maintain cold storage, including a cold chain, for commodities that require it. Rationale: Some products,
especially vaccines, require cool temperatures, while others require much colder temperatures. The cold
helps maintain the shelf life. Even a short-time exposure to temperatures outside the product’s range will
destroy its usefulness. In some cases, vaccines are distributed only at limited times each year because of
limited temperature-control equipment.

7) Keep narcotics and other controlled substances in a locked place. Rationale: Ensure that all stock
movement is authorized, by locking the storeroom, limiting access to persons other than storekeeper and
his/her assistants, and ensuring that both incoming and outgoing stock matches documentation. More than
one key to the storeroom should be available to ensure that the storeroom can always be accessed.
However, control of a second key should be maintained so that not everyone can access the storeroom.
One way to do this would be to have the key in a centrally located lock box, under the control of the
storekeeper's supervisor.

8) Store flammable products separately with appropriate safety precautions. Medical products may interact
poorly with each other, for example, alcohol with dry medications. Alcohol is also flammable and should be
kept separate.

9) Stack cartons at least 10 cm (4 in.) off the floor, 30 cm (1 ft) away from the walls and other stacks, and
no more than 2.5 m (8 ft.) high. Rationale: Pallets should be used to keep products off of floors, where they
will be less susceptible to pest, water and dirt damage. Pallets should be stacked away from walls and far
enough apart to allow one to walk completely around each pallet. This promotes air circulation and
facilitates movement of stock, cleaning, and inspection. Point out that the use of pallets is generally more
efficient than the use of shelving, particularly for bulk items. In general, pallets reduce the amount of
unpacking for storage and repackaging for delivery, facilitate shipment in lot sizes, are cheaper to construct,
hold more stock for the space they occupy. Point out that shelving will predominate over pallets at lower
levels of the program. Proper stacking of supplies will avoid crushing cartons at the bottom of a stack.
Cartons should be stacked no more than 8 feet (2.5 meters) high. Point out that this will also reduce
potential injury to warehouse personnel. Keeping contraceptives away from walls promotes circulation and
prevents cartons from moisture damage that may occur if water condenses or penetrates walls.

16-27
 Reglas para buenas
prácticas de almacenamiento
(continuación)
10) Disponer las cajas de modo que las flechas apunten hacia
arriba y se puedan ver las etiquetas de identificación,
fechas de caducidad y fechas de fabricación
11) Almacenar los anticonceptivos de manera que sean
accesibles para usar primero los que caducan primero,
para recuento y para gestión general
12) Almacenar productos de salud lejos de insecticidas,
materiales peligrosos, archivos viejos, suministros de
oficina y equipo
13) Separar productos dañados o caducados de inmediato y
desecharlos conforme a los procedimientos establecidos
Logística/Gestión de suministros 16-28

Rationale for rules 10-13:

10) Arrange cartons so that arrows point up, and so that identification labels, expiration dates and
manufacturing dates are visible. Rationale: Helps make it easier to follow FEFO, and makes it easier to
select the right product. Stress that if shipping cartons do not show either a date of manufacture or an
expiration date, the date of receipt of supplies at the receiving warehouse should be clearly marked on the
cartons and on bin cards. Write large, easy- to- read numbers with a marking crayon. Rewrite in large
numbers the manufacturing or expiration dates if the original markings are small or difficult to read. It is
important to store some products upright, such as Depo-Provera ®, because prolonged contact with the
rubber gasket has shown to affect the hormone over time.

11) Store health commodities in a manner accessible for FEFO, counting, and general management.
Rationale: Insure that the supply management principle of FIRST EXPIRY – FIRST OUT (FEFO) is
followed. Ask a participant to explain the difference between FEFO and First In, First Out (FIFO) policies.
Point out that supplies that have been recently received may sometimes be older than the stores' existing
stock. Either of these policies, however, is better than this one— First In, Still Here (FISH). This procedure
will most certainly lead to product expiration.

12) Store health commodities away from insecticides, chemicals, old files, office supplies, and other
materials. Rationale: Insecticides and other chemicals may affect the shelf lives of a number of products.
By keeping other supplies away from contraceptives, the contraceptives are easily accessed. Because
many products have a relatively short shelf life overall, they must move quickly to the end user. Storing old
junk that gets in the way may slow down access to products. While it should be easy to maintain separate
stocks in larger warehouses, it should be recognized that storekeepers may not have been given the option
of not storing some products in the same warehouse.

13) Separate damaged and expired health commodities without delay, and dispose of them in accordance
with established procedures. Rationale: Items that cannot be used occupy valuable warehouse space. It is
also important to make sure that these products are not distributed and cannot be distributed. Burning is
one common disposal method. Unfortunately, many programs lack a clear written policy for
disposal/destruction.

16-28
 Max-Min para programas de
distribución comunitaria

Un sistema de 2 cajones es fácil de usar:

2 cajones es max, 1 cajón es min

Logística/Gestión de suministros 16-29

A variation of max-min is effective for use in CBD programs, where the

goal is to minimize record-keeping while ensuring the availability of
supplies. This variation is called a continuous review-2 bin system. In
this system, the community-based distribution (CBD) worker is given 2
bins/bags/boxes of supplies. When the first bin is empty, an order is
placed for a new bin while the second bin continues to be used for
distribution. Choosing the size of the “bin” is the most important part of
designing such a system.

16-29
 Recopilación de datos
esenciales: Registro de consumo

u Registrar una “x” o un

número en cada recuadro
respecto a la cantidad de
cada método distribuido
u Recopila también algunos
datos de estadísticas de
servicios respecto a cada
cliente

Logística/Gestión de suministros 16-30

This is an example of a consumption record used in Ghana’s workplace

based program. Note that the idea was to create a simple form that
records dispensed-to-user data.

16-30
 Recopilación de
datos esenciales:
Registro de transacciones
u Registra información
relativa a productos
trasladados de un
lugar a otro
u Registra la
transacción completa
desde el pedido hasta
la confirmación de
recibo

Logística/Gestión de suministros 16-31

This is an example of a generic transaction record. Note how the dates

and signatures record the entire movement of supplies. The dates also
allow supervisors to monitor how quickly orders move, which we call the
“lead time.” These records are usually printed in 4 copies.

16-31
 Recopilación de
datos esenciales:Registro de
mantenimiento de abastecimientos
u Registra información
relativa a productos
recibidos, enviados,
perdidos/ajustados y el
remanente
u Incluye fechas y firmas
para verificación
u Debe mantenerse con
los productos
Logística/Gestión de suministros 16-32

This is an example of a generic stock-keeping record called a bin card,

because it is kept with the supplies. This one, in fact, was meant to be
tied with string to the shelf. It records issues and receipts of supplies, as
well as loss/adjustments and the result of physical inventory (counting
of stock to verify the numbers on the card).

16-32
 Recursos de logística

u Sitio en la Web: www.deliver.jsi.com

− Documentos
− Software
− Introducción a la capacitación mediante
computadora

Logística/Gestión de suministros 16-33

Tell participants that USAID’s Contraceptives and Logistics

Management Division manages a contract with John Snow, Inc., to
provide logistics technical assistance. The website and a very brief
description of what can be found there are listed on this optional slide.

16-33
 Recursos de logística
(continuación)

Texto: Programas que dan resultado: contribución

de la logística en la mejor salud en los países
en desarrollo

Se puede obtener mediante el Proyecto

DELIVER de John Snow, Inc. (Arlington, VA)

Logística/Gestión de suministros 16-34

This optional slide shows the title of a useful logistics publication and
how to obtain it.

16-34
 Recursos de logística
(continuación)

Texto: Manual de logística: Guía práctica para

proporcionar administradores en cadena en
programas de salud y planificación familiar

Se puede obtener mediante el Proyecto

DELIVER de John Snow, Inc. (Arlington, VA)

Logística/Gestión de suministros 16-35

This optional slide shows the title of another useful logistics publication
and how to obtain it.

16-35
 Recursos de logística
(continuación)

Para recibir asistencia técnica por favor

comuníquese con:
Director del Proyecto
Proyecto DELIVER
John Snow, Inc.
1616 N. Ft. Myer Drive,
Piso 11, Arlington, VA 22209 EE.UU.
Teléfono: 703-528-7474

Logística/Gestión de suministros 16-36

Contact information for obtaining technical assistance from the

DELIVER project is shown on this optional slide.

16-36