Early Warning Stock-out System (EWSS) · Définitions •Stock out in EWSS : situation which occurs when there is no medicines available at central (+ regional in some countries)

Early Warning Stock-out System

(EWSS)

Julien Deschamps Regional Support Officer

WHO/IST Libreville

GDF-StopTB partnership

Scope of presentation

• Causes of stock out

• Consequences/Implication in Public Health

• Early warning stock out system

– Objectives

– Expected outcomes

– Méthodology

– Data collection system

– Stakeholder and responsability

Définitions

•Stock out in EWSS : situation which occurs when there is no medicines

available at central (+ regional in some countries) that may lead to

treatment interruption

• Stock-out « risk » : is when a stock level drops below the established

minimum reorder level

Order 1 Delivery 1

Procurement cycle

1

Quantif 1

Rupture

Q2 O2

D2 D2

Reorder

level

Delivery

time

Procurement cycle

2

Reception Storage

Quality Control

Warehousing at central

level

Distribution

Warehousing at regional

level

Delivery to patient

Pharmaceutical Information system

Data :

Forecasting

• Selection

• Quantification

Procurement planning

Procurement process:

•Funding

•Purchase

•Réglementation (registration…)

•Préqualification

Coordination & information

Quality Assurance &

Monitoring & Evaluation

Causes of stock-out

– Funding (unsufficiant)

– Disbursement (delay)

– Custom-clearance

– Registration

– No procurement

planning

– Mistake in

Quantification

5

Countries with Stock-outs per

Primary Cause (%)

6

Percentage of Countries with Stock-

outs (2007 – 2013)

Implication in Public Health

•As consequences of stock-outs of anti-TB medicines :

–Treatment interruption, relapse, development of drug-resistant TB

–Patients have to purchase medicines in private sector at their own

expense and without any assurance of quality of the medicines

–Get an alternative medicines which is not appropriate

–Dysfunction of the national drug procurement and distribution system

to health center

National procurement/

distribution system

Warehouse at

central level

Warehouse at

régional level

Regional forecasting

(tools, training…)

Delivery Order

Health

center

Health center

forecasting (tools,

training…)

Distribution

planning

- Dysfunction

procurement/distrib

(order/delivery)

Risk/Stock-out

- No capacity building

/PSM at Regional &

Helath center level

• Efficient planning at country level and stakeholders

coordination should help aligning the different

processes for the supply chain

• Technical support on PSM and implement a good

management information system at the country level

to avoid stock outs.

• Early information sharing with stakeholders / in

country & with International partners are key to avoid

stock-outs

9

Avoid/reduce stock out

Early Warning System

• Initiative : GDF-Stop TB Partnership

• Implemented : WHO/GDF-Stop TB Partnership

• Implementation level :

Réception

Stockage

Contrôle

qualité

Gestion centrale

des stocks

Distribution

Gestion périph.

des stocks

Dispensation/

Utilisation

Système d'information

de gestion pharm.

Centralisation des données

Estimation des besoins

• Sélection

• Quantification

Planification des

approvisionnements

Processus d'approvisionn

ement

NTP

WHO/GDF

Global level

National level

Early Warning System

•Objectives : track country-level information on stock of anti-TB

drugs and take correctives actions

Identify early potential stock-outs risk

Alert relevant stakeholder of risk so that appropriate action can

be taken in a timely manner

Develop adequate capacity in procurement-supply and stock

management at country level

Strengthen the National procurement and distribution

system

Early Warning System

•Outcomes expected : decrease number of countries with stock

outs with appropriate Early warning and preventive action :

Availability of funding (National, Global Fund…) & accelerate

disbursement

« Anticipate » placing orders & accelerate « lead-time »

(supplier)

Inter-country loan of drug

Redeployment of stock available in the counrty

Provide (if required) technical assistance for forecasting of future

needs

Méthodology

•Reporting frequancy : Trimestrial

•Responsible of reporting: NTP

•Data to inform :

– Stock (central and régional)

– Number of patient/category of treatment

• Tools to learn :

– Annexe 1 : Stock and availability data

– Synthesis Report

• Responsible for analyses : NTP et WHO

• Responsible to collect : WHO (Country and IST team)

Annex 1 :Stocks & availability Stock situation and availability

Colonne en gris et jaune : Remplir les informations

Colonne en blanc : analyser les informations dans la note

trimestrielle

Drugs/produits

de laboratoire

Dosage, form

and

présentations

Monthly

Average

Consumption

(CMM)

"physical »

stock at

central level

"physical »

stock at

regional level

Total

"physical"

stock

« real »

availability

Pending

delivery

Delivery

date

"prévisionna»

stock

(physical

stock +

Delivery)

"prévisional »

availability

(with pending

delivery)

RHZE

Comprimés en

ADF boites de

672 :

(150/75/400/2

75) mg 205 1828 0 1828 9

1428+2229

(prêt

Cameroun) =

3657 3256 27

RHE

Compriés en

ADF :

(150/75/275)

mg 35 277 0 277 8

168+446

(prêt

Cameroun)=

614 891 25

RH

Comrpimés en

ADF : (150/75)

mg 368 2347 0 2347 6 1470 3817 10

Streptomycine

Boites de 100

flacons de 1

gramme 27 351 0 351 13 351 13

RHZ

Comprimés en

ADF :

(60/30/150)

mg 76 1666 0 1666 22 1666 22

RH

Comprimés en

ADF : (60/30)

mg 151 3338 0 3338 22 3338 22

Republic of Central Africa/July 2013)

Date analyses in Annex 1

• Quality of data : « previsional » Monthly Average

Consumption

– Use of épidémiologic data (WHOGlobal TB report or annual data from

NTP)

– Tools : GDF, Union, MSH…

• Early Warning Indicator : Availability of the stock

Number of month of consumption available on stock :

– <8 months of stock : red alert

– 8<stock/12 month : orange alert

– >12month of stock : green

preventive action

Warning Indicator

•Early Warning Indicator : Global level

•M & E Indicators for PSM (WHO) : National level

– 12 warning indicator to prevent stock out in PSM system

– Objective : Monitoring and surveillance "routine" key elements of a

program / project-based record keeping, and regular reports.

– Ex ; Availability : % of treatment sites AntiTB have experienced a stock-

out of one or more antiTB during a defined period

Complementary to

Synthesis report

•Objectives : assist countries to analyses the stock and

availability

•Méthod : completing with annex 1 + other data (ex,

pending delivery)

•Informations requested :

– Stocks and availability (Cf. Annexe 1)

– Procurement in process & pending delivery

– Availabaility at regional level

– Recommandation and action plan

See. « synthesis report»

Data collection system

NTP : Fill and transmit the

data

1st day of

trimester

WHO country (NPO): Collect and analyze

the data

WHO AFRO :

Transmsit the alert & discussion on corrective actions: - Mails - Téléconférence

Trimestrial Publication : (ex ; Bulletin Epidémiologic)

Correctives Action

GDF (HQ) : Collect, analyses and alert

WHO IST (RSO):

Collect/analyze the data

Transmit the alert

data

Stakeholder and Responsability

Stakeholder Responsability

OMS/GDF (EWSS manager) * Manage and develop the EWSS (tools, procédure…)

* Import the country data to the system

* Screen the alerts generated

* Transmit the alerts to the pertinent stakeholder

WHO/GDF Regional Support Officer & Medical Officer

* Validate and follow-up the country data with the respective NPO and NTPs

* Recommandation to NTPs of remedial action in the case of alert

WHO/NPO * Validate and follow-up the country data with GDF/WHO RSO and Medical Officer

* Recommandation to NTPs of remedial action in the case of alert

NTP manager * Submission of data to WHO (NPO/RSO)

* Overall coordination of remedial action in the case of alert

NTP focal point for stock management

*Provision of drug-stock information

* Provision of patient enrolment data

Technical partners * Technical Assistance to collect and transmit EWSS data

* Capacity building for national counterparts

Donors * Identifying of critical weakness for improved resource allocation

DISCUSSION