Anti malaria medicines and supplies Laboratory commodities NMS and JMS have high stock levels(>6 MOS) for Artesunate, AL 6*4, AL 6*2 , AL 6*3 and mRDTs. Issues of ACTs from the central warehouses are Lower than originally projected . Supply plans have been revised and shipments delayed to mitigate overstocks. MINISTRY OF HEALTH PHARMACY DIVISION STOCK STATUS REPORT AS AT 1st December 2018 A Publication of The Ministry of Health Uganda The purpose of this report is to inform the Ministry of Health and all stakeholders of the stock levels in the country as a tool that enables appropriate logistics decisions making . This report highlights stock status, real challenges, bottlenecks but also recommends potential solutions to mitigate stock outs and expiries of ARVs & HIV test kits, ACTs, Anti-TB medicines, Reproductive Health items, selected Laboratory commodities,Vaccines and selected medicines for treatment of Opportunistic Infections In the Repubic of Uganda This report serves to: - Act as an early warning indicator for potential stock outs and possible expiries of EMHS - Identify challenges and recommendations to avert supply interruptions - Encourage preparation and sharing of joint supply plans with stakeholders - Identify strategies for regularly reviewing supply plans for all the commodities - Encourage donors to honor their commitments in terms of quantities of products expected, timeliness of deliveries and flexibility. Summary of the stock status report as of 1st December 2018 Antiretroviral medicines This is a 1st December 2018 tock status report but updated with sock on hand data as of 31st December 2018. Warehouse data utilized includes information from NMS, JMS, MAUL, JCRC and UHMG . SD Bioline HIV test kits are adequately stocked (above 3 MOS) both at NMS and JMS however there are low stock levels of SD Bioline at MAUL. Stat-pak test kits are well stocked at NMS (> 3 mos) however there are low stock levels at JMS and MAUL at less than 3MOS. Determine test kits are well stocked (>3 MOS) at JMS and MAUL however there are low stock levels at NMS .Transfer of PEPFAR procured for HIV determine test kitsfrom JMS to NMS has been iniated (2.4 MOS). Shipments are expected from Global Fund for HIV test kits in 2019. Shipment for Stat-Pak is expected by end of January 2019 for JMS. Order needs to be placed for all HIV test kits for MAUL. Viral load testing kits and EID commodities (at UNHLS), TB sputum mugs and GeneXpert catridges (at NMS) have low stock levels of less than 3 MOS. TB LAM kits and Hepatitis B test kits are well stocked with more than 3 MOS. CD4+ reagents of BD FACS and Partec are stocked out at NMS, however shipments for all commodities are expected by end of January 2019. The PNFP sector: JMS is fairly well stocked with most of the commodities having over 3 months of stock except for LPV/r 200/50 mg,AZT/3TC/NVP 300/150/200, NVP 200 mg,NVP 50mg and NVP suspension with less than 3 MOS. MAUL is fairly stocked with ARVs having more than 3MOS except for TDF/3TC/EFV 300/300/600 mg,TDF/3TC 300/300 mg ,AZT/3TC 300/150 mg and DTG 50 mg with less than 3 Months of stock. The public sector: NMS has low stock levels of less than 3 MOS for a number of the ARV medicines except AZT/3TC/NVP 300/150/200 mg,TDF/3TC 300/300 mg,TDF/3TC/DTG 300/300/50 mg,NVP 200 mg ,LPV/r 200/50 mg ,AZT/3TC 60/30 mg ,EFV 200mg and LPV/r 100/5mg. Public sector stock under the PEPFAR $18.7m and $ 65m support is however available at JMS and MAUL to be transferred upon tranche requests from NMS. More shipments are expected from Global Fund , PEPFAR and GOU to ensure adequate stock availability through 2019.
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MINISTRY OF HEALTH PHARMACY DIVISION … SSR 1st...Lopinavir/Ritonavir 40/10mg (oral pellets) 1*120 caps 2,901 5,519 0.5 4.2 3.2 2.2 1.2 9.0 Min 3MOS, Max 6MOS Notes: NMS ARVs stock
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Anti malaria medicines and supplies
Laboratory commodities
NMS and JMS have high stock levels(>6 MOS) for Artesunate, AL 6*4, AL 6*2 , AL 6*3 and mRDTs. Issues of ACTs from the central warehouses are Lower than originally projected . Supply plans have been revised and shipments delayed to
mitigate overstocks.
MINISTRY OF HEALTH
PHARMACY DIVISION
STOCK STATUS REPORT AS AT 1st December 2018
A Publication of The Ministry of Health Uganda
The purpose of this report is to inform the Ministry of Health and all stakeholders of the stock levels in the country as a tool that enables appropriate logistics decisions making . This report highlights stock status, real challenges,
bottlenecks but also recommends potential solutions to mitigate stock outs and expiries of ARVs & HIV test kits, ACTs, Anti-TB medicines, Reproductive Health items, selected Laboratory commodities,Vaccines and selected medicines for
treatment of Opportunistic Infections In the Repubic of Uganda
This report serves to: - Act as an early warning indicator for potential stock outs and possible expiries of EMHS
- Identify challenges and recommendations to avert supply interruptions
- Encourage preparation and sharing of joint supply plans with stakeholders
- Identify strategies for regularly reviewing supply plans for all the commodities
- Encourage donors to honor their commitments in terms of quantities of products expected, timeliness of deliveries and flexibility.
Summary of the stock status report as of 1st December 2018
Antiretroviral medicines
This is a 1st December 2018 tock status report but updated with sock on hand data as of 31st December 2018. Warehouse data utilized includes information from NMS, JMS, MAUL, JCRC and UHMG .
SD Bioline HIV test kits are adequately stocked (above 3 MOS) both at NMS and JMS however there are low stock levels of SD Bioline at MAUL. Stat-pak test kits are well stocked at NMS (> 3 mos) however there are low stock levels at JMS
and MAUL at less than 3MOS. Determine test kits are well stocked (>3 MOS) at JMS and MAUL however there are low stock levels at NMS .Transfer of PEPFAR procured for HIV determine test kitsfrom JMS to NMS has been iniated (2.4
MOS). Shipments are expected from Global Fund for HIV test kits in 2019. Shipment for Stat-Pak is expected by end of January 2019 for JMS. Order needs to be placed for all HIV test kits for MAUL.
Viral load testing kits and EID commodities (at UNHLS), TB sputum mugs and GeneXpert catridges (at NMS) have low stock levels of less than 3 MOS. TB LAM kits and Hepatitis B test kits are well stocked with more than 3 MOS.
CD4+ reagents of BD FACS and Partec are stocked out at NMS, however shipments for all commodities are expected by end of January 2019.
The PNFP sector: JMS is fairly well stocked with most of the commodities having over 3 months of stock except for LPV/r 200/50 mg,AZT/3TC/NVP 300/150/200, NVP 200 mg,NVP 50mg and NVP suspension with less than 3 MOS. MAUL is
fairly stocked with ARVs having more than 3MOS except for TDF/3TC/EFV 300/300/600 mg,TDF/3TC 300/300 mg ,AZT/3TC 300/150 mg and DTG 50 mg with less than 3 Months of stock.
The public sector: NMS has low stock levels of less than 3 MOS for a number of the ARV medicines except AZT/3TC/NVP 300/150/200 mg,TDF/3TC 300/300 mg,TDF/3TC/DTG 300/300/50 mg,NVP 200 mg ,LPV/r 200/50 mg ,AZT/3TC 60/30
mg ,EFV 200mg and LPV/r 100/5mg. Public sector stock under the PEPFAR $18.7m and $ 65m support is however available at JMS and MAUL to be transferred upon tranche requests from NMS. More shipments are expected from Global
Fund , PEPFAR and GOU to ensure adequate stock availability through 2019.
Anti-Tuberculosis medicines
At NMS, Fluconazole formulations are fairly well stocked with more than 3 MOS. There are low stock levels of Cotrimoxazole 960mg; cotrimoxazole 120mg is well stocked with about 5.9 MOS at NMS.
JMS has sufficient stock of fluconazole suspension. There is an over stock of Fluconazole IV infusion and low stock levels of (< 3 MOS ) for Fluconazole 200mg tablets. Shipment for Fluconazole 200mg tablets is expected by the end of
January 2019. Transfer of fluconazole IV infusion from JMS to NMS is to be effected once the stock levels drop below minimum level at NMS. Cotrimoxazole 960mg is well stocked at JMS. There is however an over stock of Cotrimoxazole
120mg. Consumption of Cotrimoxazole 120mg at JMS is projected to increase with increased number of children as a result of rationalisation of USAID/CDC supported facilities.
MAUL is currently well stocked on both fluconazole and cotrimoxazole formulations however there are low stock levels of less than 3 MOS for Fluconazole IV infusion at MAUL. Shipment for Fluconazole IV infusion is expected by end of
January 2019.
First line and second line anti-TB medicines have low stock levels except for RHZ 75/50/150 mg, Capreomycin, Kanamycin and Cycloserine. There is a stock out of RHZE 150/75/400/275 mg. Shipments for RH mg 150/75 (4.2 MOS) and RHZE
150/75/400/275 mg (3.3 MOS) from GOU were received in December 2018. Additional 3.5 MOS for RH 150/75mg and 9.4 MOS for RHZE are expected in March and April 2019 from GOU.
Injectable Kanamycin and Capreomycin are to be phased out following WHO recommendation of exclusive use of oral MDR-TB regimens. The phase out is expected to start in July 2019.
Reproductive health commodities
Most reproductive health commodities are stocked out at NMS except Misoprostol and Combined Oral Contraceptives. Interwarehouse transfer from UHMG and JMS to NMS has been initiated for DPMA-IM and Combined oral
contraceptives.
There are low stock levels of RH commodties for the Alternative Distribution Channel (ADS) except for Combined oral Contraceptives, Implanon NXT, IUDs, DPMA-SC and DPMA-IM.
Shipments for male condoms, DPMA-IM, Levonorgestrel 75mg/rod, female condoms and IUDs are expected from USAID, GF and UNFPA.
Vaccines
Medicines for opportunistic infections
Vaccines are fairly stocked with 60% of the vaccines having more than 3MOS. Order needs to be placed for all vaccines.
A : National Medical Stores -Adult Formulations Stock Status
Product Name Unit of measure
Closing Bal at 31st
December 2018 AMC Nov 2018 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19 May-19
A detailed account is given below for selected commodities per warehouse.
Months of Stock at the end of the month
Antiretroviral Medicines
Adult first line formulations
Adult second line formulations
Adult ARV formulations have low stock levels of less than 3MOS except LPV/r 200/50 mg , NVP 200mg, TDF/3TC 300/300mg, AZT/3TC/NVP 300/150/200mg and TDF/3TC/DTG 300/300/50mg that are well stocked with more than 3
MOS. Stock is available in-country for ATV/r 300/100mg, EFV 600Mg,TDF/3TC/EFV 300/300/600mg and ABC/3TC 600/300mg. Stock levels are expected to improve with the transfer of PEPFAR stock at JMS to NMS. There is a stock out
of AZT/3TC 300/150mg caused by API challenges, hindering GOU supply that was meant to cover this period. Efforts are ongoing to expedite the PEPFAR shipment of 44,040 packs.
Notes: Adult ARVs at NMS
A:National Medical Stores -Pediatric Formulations Stock Status
Product Name Unit of measure
Closing Bal at 31st
December 2018 AMC Nov 2018 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19 May-19
Adult ARV medicines at JMS are well stocked with more than 3MOS except for AZT/3TC/NVP 300/150/200mg and LPV/r 200/50mg. Shipment for LPV/r 200/50mg is expected by end of January 2019.
There is a stock out of NVP 200mg. Interwarehouse transfer of NVP 200mg and AZT/3TC /NVP 300/150/200mg from NMS has been initiated.
B : Joint Medical Stores -Pediatric Formulations Stock Status
Product Name Unit of measure
Closing Bal at 31st
December 2018 AMC Nov 2018 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19 May-19
There is an overstock of EFV 200mg, ABC/3TC 120/60mg, AZT/3TC/NVP 60/30/50 mg and AZT/3TC 60/30 mg. NVP suspension and NVP 50mg tablets have low stock levels.
Close monitoring of consumption for EFV 200mg, ABC/3TC 120/60mg, AZT/3TC/NVP 60/30/50mg and AZT/3TC 60/30 mg is recommended to avoid wastage.
Shipments for NVP suspension and NVP 50 mg are expected by the end of January 2019.
C : Medical Access Uganda Limited-Adult Formulations Stock Status
Product Name Unit of measure
Closing Bal at 31st
December 2018 AMC Nov 2018 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19 May-19
ARV Adult formulations at MAUL are fairly stocked with more than 3 MOS except for TDF/3TC/EFV 300/300/600 mg, AZT/3TC 300/150 mg, DTG 50 mg and TDF/3TC 300/300 mg.
Shipments for AZT/3TC 300/150 mg and TDF/3TC 300/300 mg are expected by end of January 2019.
Order needs to be placed for DTG 50 mg tablets.
Adult second line formulations
Months of Stock at the end of the month
C : Medical Access Uganda Limited Pediatric Formulations Stock Status
Product Name Unit of measure
Closing Bal at 31st
December 2018 AMC Nov 2018 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19 May-19
Thirdline medicines are fairly stocked with more than 3 MOS except for Ritonavir 100mg and Darunavir 600mg. There is a stock out of Darunavir 150mg and Darunavir 75mg.
Stock for Etravirine 100mg (6.2 mos), Ritonavir 600mg (7.5 mos), Raltegravir 400 mg (5.7 MOS) and Darunavir 600mg (6.4 mos) are available in- country at MAUL.
Thirdline ARVs medicines are well stocked at NMS
NMS started distribution of Thirdline medicines to regional referral hospitals in January 2019.
A: National Medical Stores-Malaria Commodities Stock Status
Category Unit of measure (Pack)
Closing Bal at 31st
December 2018 AMC Nov 2018 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19 May-19
Artemether/ Lumefantrine (AL) 20/120mg formulations, Malaria RDTs and artesunate injection at NMS are over stocked except AL 6*1 MOS. Shipment for AL 6*1 is expected by end of January 2019.
Supply plan has been reviewed and some shipments delayed to avert overstocks.
There are 6.8 MOS of Sulfadoxine/Pyrimethamine 500/25mg available at NMS.
B: Joint Medical Stores-Malaria Commodities Stock Status
Category Unit of measure (Pack)
Closing Bal at 31st
December 2018 AMC Nov 2018 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19 May-19
There is an over stock of AL 6*2, AL 6*3, AL 6*4, Artesunate 60mg powder for injection and Malaria RDT test strips however there are low stock levels of AL 6*1.
Supply plan has been reviewed to delay shipments for malaria commodities that are over stocked. Shipment of AL 6*1 is expected by end of February 2019.
There are 12,000 doses (36*1000 tablets) of Sulfadoxine/Pyrimethamine 500/25mg available at JMS.
National Medical Stores /UNICEF-ICCM Commodities Stock Status
Product Name Unit of measure (Pack)
Closing Bal at 31st
December 2018 AMC Nov 2018 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19 May-19
All non- malarial medicines have low stock levels of less than 3 MOS. Shipments for Amoxicillin 10s and 20s are expected at the end of January 2019.
Non Malaria commodities
Malaria commodities
ICCM Program Stock status
Months of Stock at the end of the month
AL formulations and mRDTS have low stock levels
Safety boxes and Examination gloves have low stock levels of less than 3 MOS. Shipments for examination gloves and safety boxes are expected by January 2019.
iCCM supplies
ICCM supplies
Envelopes
Antimalaria commodities
Envelopes have low stock levels of less than 3 MOS.
Notes: ICCM commodities at NMS
A. CPHL Viral Load and EID Laboratory commodities Viral load commodities
Viral Load and EID commodities are well stocked. PSM and MUAL has placed orders for Q1, Q2 and Q3. MAUL is yet to confirm Q4 orders.
1,420 GeneXpert (GXP) kits are expected from PEPFAR under GDF and will be delivered in Feb 2019. Orders for GXP catridges funded by GF were placed, the order processing was delayed as the bundling MOU had not been signed. GF is
expediting the process with the supplier. Orders for TB LAM kits were also placed with GF. ZN reagents and Microscope slides are well stocked.
A: National Medical Stores Laboratory commodities PART AMonths of Stock at the end of the month
Category Unit of Measure
Closing Bal at 31st
December 2018 AMC Nov 2018 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19 May-19
There are low stocks of Determine, however 20,201 packs of Determine is available to be transfered to NMS from JMS. There is also pipeline for Determine from Global Fund expected in April 2019. Statpak, SD Bioline and Syphilis Duo
are well stocked. CD4 reagents in all platforms are stocked out but orders have been placed under Global Fund. Pipeline for Crag is expected at the end of January 2019.
A: NMS Laboratory Commodities PART B
Months of Stock at the end of the month
Other commodities
Blood collection tubes, syphilis testing devices and Hepatitis B antigen screening tests are well stocked with more than 3 MOS. There is a stock out of Vacutainer Needles. NMS is to make call offs for these commodities.
Category Unit of Measure Closing Bal at 31st
December 2018
AMC Nov 2018 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19 May-19
HIV Test kits are at risk of stocking out except SD Bioline and HIV determine. Shipments for Detemine and Sat-pak test kits are expected by end of January 2019. CD4 reagents are fairly stocked with more than 3 MOS except for Partec
with less than 3 MOS. Shipment for Partec is expected to be delivered by end of January 2019.
Months of Stock at the end of the month
Category Unit of Measure
Closing Bal at 31st
December 2018 AMC Nov 2018 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19 May-19
Cotrimoxazole 960mg at NMS is well stocked with more than 3 MOS however there is an overstock of Cotrimoxazole 120mg tablets.
Consumption of Cotrimoxazole 120 mg is being closely monitored following geographical rationalisation of CDC-USAID aided ART accredited facilities.
Months of Stock at the end of the month
Fluconazole formulation:
There is an over stock of Fluconazole IV infusion and low stock levels of Fluconazole 200 mg. Shipment for Fluconazole 200 mg is expected by end of January 2019
Cotrimoxazole formulations:
Medical Access Uganda Limited -Medicines for Opportunistic Infections Stock Status
Item description Unit of Measure
Closing Bal at 31st
December 2018 AMC Nov 2018 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19 May-19
Reproductive health commodties have low stock levels at NMS except Misoprostol 200mg and Combined Oral Cotraceptives with more than 3 MOS. Interwarhouse transfer has been initiated for Sayana press and Combined oral
contraceptives from UHMG and JMS to NMS.
Item Description Unit of Measure
Closing Bal at 31st
December 2018 AMC Nov 2018 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19 May-19
Reproductive health commodties have low stock levels of less than 3 MOS except Depo-provera, Sayana Press, Implanon NXT, IUDs and Combined oral contraceptives. There is a stock out of Female condoms. Shipment for Female
condoms is expected by end of January 2019.
There is a projected stock out of Misoprostol and Jadelle by end of January 2019 and February 2019 respectively
Order needs to be placed for Misoprostol, Jadelle, Emergency contraceptives and Microlut.
Notes: Reproductive health commodities at UHMG
Months of Stock at the end of the monthB: Alternative Distribution System (JMS and UHMG)-Reproductive Health Commodties Stock Status
A: National Medical Stores -First Line TB medicines Stock statusFirst Line TB Medicines
Item Description Pack size
Closing Bal at 31st
December 2018 AMC Nov 2018 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19 May-19
First Line TB medicines have low stock levels except for RHZ 75/50/150 mg and Ethambutol 100 mg . Shipments for RH mg 150/75 (4.2 MOS) and RHZE 150/75/400/275 mg (3.3 MOS) from GOU were received in December 2018.
Additional 3.5 MOS for RH 150/75mg and 9.4 MOS for RHZE are expected in March and April 2019 from GOU. Isoniazid
100mg is well stocked-252,969 packs of 100 (75,288 patient courses) ,however Isoniazid 300mg is low in stock-3203 packs of 672 (12,812 patient courses). A shipment of additional 177,000 adult patient doses (44,398 packs) arrived in-
country by end of December and hence delivery to the warehouse should be expedited.
Orders have been placed through GDF for all First Line TB medicines for CY 2019.
MDR TB Medicines Stock status
Item Description Pack size
Closing Bal at 31st
December 2018 AMC Nov 2018 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19 May-19
Min 9MOS, Max 15MOS Notes: MDR TB commodities at NMS
MDR TB Medicines are fairly stocked with more than 9 MOS except for Levofloxacin 250mg, Amikacin 500mg/2ml injection, Moxifloxacin 400mg and Ethambutol 400mg.
Order had been placed through GDF for Levofloxacin 250mg, Amikacin 500mg/2ml, Moxifloxacin 400mg and Ethambutol 400mg.
Injectable Kanamycin and Capreomycin are to be phased out following WHO recommendation of exclusive use of Oral MDR-TB regimens. The phaseout expected to start in July 2019.
Months of Stock at the end of the month
TB-XDR medicines stock status 7.429
Item Description Pack size
Closing Bal at 31st
December 2018 AMC Nov 2018 Dec-18 Jan-19 Feb-19 Mar-19 Apr-19 May-19
Clofazimine 100mg and Linezoli 600 mg are well stocked with more than 9 MOS, however there are low stock levels of Bedaquiline .Shipment for Bedaquiline (7.4 MOS) is expected to be delivered by end of March 2019.Additional 7.4
MDR TB medicines facility stock status as of 1st December 2018
Notes: MDR - TB medicines facility level stock statusMDR TB medicines are well stocked above 2.0 MOS. Pyrazinamide 400mg, Ethambutol 400mg, Kanamycin 1g inj, Moxifloxacin 400mg and Amikacin 500mg inj are overstocked. Redistributio of excess stock of these items is recommended to prevent wastage. Facility consumption of Kanamycin has declined with a slight increase in consumption of Capreomycin.