STS: Supply Chain Processes

An indent is an official order or requisition for medicine and supplies from a medical store and the process of requesting is called indenting.

Under National Tuberculosis Elimination Programme (NTEP), online indenting of drugs and consumables is done using the Ni-kshay Aushadhi web portal.

There are different types of requests raised through Ni-kshay Aushadhi:

1. Quarterly request
   1. From State to Central TB Division (CTD), District Drug Store (DDS) to State Drug Store (SDS) and Tuberculosis Unit (TU) to District Drug Store (DDS) on a quarterly basis.
   2. Quarterly replenishment of drug stocks with districts shall be based on the reports submitted by them in NI-kshay Aushadhi, providing complete details of opening and closing stocks, receipts, consumption and anticipated requirement.
2. Monthly request
   1. From Peripheral Health Institution (PHI) to DDS on a monthly basis.
3. Additional Drug Request (ADR)
   1. Supplies to District TB Centres (DTCs) against Additional Drug Requests (ADRs): There are likely to be occasions when the quarterly supply of drugs to DTCs as above, is insufficient to meet the needs of the district and additional drugs are required in advance of the next quarterly shipment. In such cases, the concerned DTC is required to prepare and submit an Additional Drug Request to the State TB Officer (STO), providing details in support of the supplementary requirement. 
   2. The need for an ADR arises only if the more patients put on treatment in the previous month in a quarter goes up, resulting in an insufficient stock in the store. To get the additional supply from CTD/ SDS/ DDS/ TU, an ADR for each item needs to be submitted by the SDS in charge/ District TB Officer (DTO)/ Medical Officer- Tuberculosis Control (MO-TC). Before sending the ADR, one should consider and track the drugs that have been already released and are being transported from central/ state/ district/ TU stores.

   Figure: Different Types of Drug Requests as Part of Indenting in NTEP through Ni-kshay Aushadhi Web Portal; Source: Ni-kshay Aushadhi Portal.

Resources

• Standard Operating Procedures Manual for State Drug Stores, Central TB Division, MoHFW, GoI, 2012.

Assessment

The process of receipt of drugs is completed through the Ni-kshay Aushadhi application. Once a consignment is dispatched to the receiving unit, the system will display following three options:

1. Acknowledge Desk - For acknowledgment of drugs received against CTD-RO/ Issue Voucher
2. DTA Receipt - For acknowledgment of drugs received against CTD-DTA: This process is to be used to record receipt of drugs which are received against DTAs issued by CTD/ issued by parent store to correct stock imbalances in sub-stores.
3. Received from Third Party :This process is to be used when a store receives any drug or commodity from third party as donation.

• Receipt of  'complete' or 'partial' quantity of drugs can be acknowledged in Ni-kshay Aushadhi, as the case may be. When the user selects a particular consignment and clicks on the ‘Acknowledge’ option, the system shows a list of issued drugs/ items with the following details: Drug Name, Batch Number, Expiry Date, Requested Quantity, Issued Quantity, To be Acknowledged Quantity, Received Quantity, Damaged Quantity, Shortage Quantity.
• In instances where the quantity received is lesser than the issued quantity, the user should enter the same in the ‘Received qty’ column. As the request is partially acknowledged, the system will display it in the orange/ pink colour on the ‘acknowledge desk’. As and when the remaining quantity is received,  the user can acknowledge the same by selecting the previous partially acknowledged record and entering the remaining quantity that has been received.     

Resources

• Standard Operating Procedure Manual-Procurement & Supply Chain Management, CTD, MoHFW, India, 2018.

• Procurement, Supply Chain Management & Preventive Maintenance, Module 6, CTD, MoHFW, India.

• Receive and Acknowledge, Ni-kshay Aushadhi User Manual, CTD, MoHFW, India.

Assessment

Good storage conditions and safe custody of drugs is important to ensure quality of drugs. Temperature and humidity control systems should be appropriately designed, installed, qualified and maintained, to ensure that the required storage conditions are maintained.

The State TB Officer (STO)/ District TB Officer (DTO) must ensure that the pharmacist/ store-keeper adheres to the following guidelines on proper storage of drugs.

Temperature

• The storage temperature should be 25⁰C and maintained with an air conditioner wherever applicable.

Humidity

• Humidity levels should be below 60% and maintained with a dehumidifier, wherever required

Power Supply

• Regular power supply should be available for cooling devices (AC, ceiling fans etc) and dehumidifiers.

Drug Safety

Storage Room

• Should be cleaned and disinfected regularly, should be dry, well-lit and well-ventilated
• Should be free from any water penetration, rodent and pests
• Should have fire safety equipment in place
• The drugs should not be exposed to direct sunlight.

Stacking

• The shelves should be placed in such a way that there is sufficient space around for air circulation and free movement of personnel.
• Similar boxes should be stored adjacent to each other and stacked as per their expiry dates.
• The drugs expiring early should be placed closer to the ground and as those expiring late should be place at higher levels.
• Expired drugs should be segregated, sealed and stored in a separate part of the store so as to avoid issue to patients

Labelling

• The identification label, expiry date & manufacturing date of the anti-TB drugs should be marked with a bold marker pen on the visible side of the carton.

Resources

• WHO Technical Report Series, No. 908, 2003; Annex.9: Guide to Good Storage Practices for Pharmaceuticals.
• Procurement, Supply Chain Management & Preventive Maintenance, Module 6, CTD, MoHFW, India.
• Standard Operating Procedure Manual Procurement & Supply Chain Management, CTD, MoHFW, India, 2018.

 Assessment