Session 15: Supply Chain Management
In this session, you will learn about supply chain management systems and the flow of commodities and information in those systems.
Learning Objectives
By the end of this session, you will be able to:
- Describe the purpose and key features of ZAPS and ZADS.
- Identify the flow of commodities and information in both systems.
Learning Activities
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Introduction (5 min)
An ART programme cannot operate successfully without a continuous, reliable supply of ARV medicines and fluconazole. A logistics system addresses the concept “no product, no programme.” Well-functioning supply chains are critical to HIV & AIDS commodity security, which is achieved when every person can obtain and use HIV and AIDS commodities whenever they are needed.
The purpose of a logistics management information system is to collect, organise and report information to other levels in the system in order to make decisions that govern the logistics system and ensure that all Six Rights are fulfilled for each client:
- The Right Product
- In the Right Quantity
- In the Right Condition/Quality
- Is delivered to the Right Place
- At the Right Time
- For the Right Cost
Currently, there are six different logistics systems managing different health commodities in Zimbabwe. These are traditional Essential Medicines Pull System (tEMPS), Zimbabwe Anti-retroviral Distribution System (ZADS), Delivery Team Topping Up System (DTTU), Zimbabwe Informed Push System/Primary Health Care Packages (ZIP/PHCP), Voluntary Medical Male Circumcision (VMMC) Commodity Logistics System, and Zimbabwe Laboratory Commodities Distribution System (ZiLaCoDs).
Goal of supply chain management
The Zimbabwe ARVs Distribution System, known as ZADS, was developed in 2006 for recording, reporting, and distribution of ARVs and fluconazole targeted to all hospitals.
Another system, known as ZAPS, was developed for reporting and distribution of selected commodities including ARVs to primary level facilities. These two systems aim to prepare health facility staff to complete necessary tools during the ordering and receiving commodities managed under ZADS and ZAPS for ARVs, condoms and contraceptives, TB, malaria, nutrition, diagnostics, and other essential medicines and medical supplies at both clinics and hospitals.
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ZADS (5 min)
A logistics sub-unit (LU) has been established within the MoHCC. The staff complement of the LU includes a unit manager, an upstream logistics coordinator, a senior logistics officer, logistics officers, a management information systems officer, and data encoder/administrator.
How the system works
Facilities record patient and dispensing information in the ARVs/Fluconazole Dispensing Registers. At the end of the quarter facilities aggregate and report patient regimen data and medicines consumption/ adjustments/ stock on hand using the CR Form.
The LU processes orders and NatPharm picks, packs, and delivers commodities. The LU compiles data to be used to forecast and quantify the national needs for ARV medicines and fluconazole, provides national-level logistics system monitoring and evaluation, and advises on troubleshooting and procurement planning. When possible, essential medicine and medical supply orders are delivered with the ARV medicine and fluconazole orders.
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ZAPS (5 min)
The Ministry of Health and Child Care (MoHCC), in collaboration with cooperating partners, designed an assisted pull system for all health commodities at primary care levels and selected commodities at the hospital level, known as Zimbabwe Assisted Pull System (ZAPS). The aim was to come up with a system that is more effective, efficient, and sustainable in the medium to long term.
What is ZAPS?
The ZAPS is an inventory control system which comprises of an ordering team (pharmacy person and driver) traveling to all health facilities in their respective districts to assist facility staff collect essential logistics data and order all health commodities managed under the system. The team sends the facility orders to NatPharm, which is responsible for picking, packing, and delivering the orders to all facilities.
The ZAPS is designed to ensure that all health facilities and community-based distributors (CBD) or faith-based organizations (FBO) are able to receive the health commodities they need, whenever they require them. The system harmonizes the previous distribution systems that include ZADS, ZIP, and Delivery Team Topping Up (DTTU) at the primary care level. The “assisted pull” is a step towards a full pull system for all commodities.
The purpose of the ZAPS is to ensure that all health commodities managed under ZAPS are continuously available. In order to be successful, the system and its staff must be able to meet the Six Rights for all ART patients.
The products managed under ZAPS include:
- HIV prevention and treatment commodities - HIV and syphilis rapid test kits (RTKs), ARVs for the prevention of mother-to-child transmission (PMTCT), early infant diagnosis, and point of care reagents and consumables.
- Family planning commodities - condoms and contraceptives
- Malaria commodities - medicines for complicated, uncomplicated malaria and rapid diagnostic test kits
- Tuberculosis commodities - medicines for first line TB, streptomycin
- Nutrition commodities - therapeutic feeds
- Other essential medicines - medicines used at C level
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Flow of Commodities and Information (10 min)
The ZAPS is two tiered and consists of NatPharm and health facilities. Health facilities place orders and are re-supplied every three months.
As commodities move down to health facilities through the ZAPS, information moves up from health facilities to NatPharm, the directorates of pharmacy and laboratory services, ZNFPC, district medical offices (DMOs), and provincial medical directorate (PMD) offices. This information is used to make decisions on ordering and issuing of ZAPS commodities at the right time and in the right quantities.
This graphic shows the flow of information and commodities to and from different levels of the system.
Roles and responsibilities
Many health care staff play key roles in the operation of ZAPS. The roles and responsibilities for personnel involved in this system are listed in the Standard Operating Procedures Manual for the Management of the ZAPS, also known as the SOPs manual (see resources).
The purpose of the SOP manual is to simplify and standardize the work required for the functioning of the ZAPS distribution system. This SOP manual gives the steps one should follow to appropriately complete a specific task. These tasks include placing orders, receiving orders, storing commodities, and conducting physical counts.
Depending on your job or role within the system, the SOP manual will help you to complete these responsibilities in a timely and effective manner. Refer and become familiar with it as you perform your job of managing ZAPS commodities. It guides you to do your work following the procedures consistently outlined to achieve top performance.
When necessary, use this SOP when providing on-the-job training. Each chapter in the manual describes various specific activities in managing the system, including:
- Purpose of the activity
- When the activities should be carried out
- Instructions on how to complete the activities (job aids)
- Examples that illustrate the activity
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Knowledge Check (5 min)
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Key Points (5 min)
- ZAPS helps to prepare health facility staff to complete necessary tools during the ordering and receiving commodities managed in this system for ARVs, condoms and contraceptives, TB, malaria, nutrition, diagnostics, and other essential medicines and medical supplies.
- ZADS assists facilities in ordering the right quantities of ARVs /fluconazole and report patient and logistics data for decision making.