Facility Level Supply Chain - Ordering Process

Health centers and facilities in Tanzania have different processes for tracking and distributing various groups of products. Most medicines and supplies are managed through the Integrated Logistic System (ILS), a “pull” system that requires health facilities to order according to their needs.  In 2002, the ILS was integrated to include ordering processes for the Essential Drugs Program (EDP), which included supplies for family planning, sexually transmitted diseases, malaria, laboratory and diagnostics, and twelve additional vertical programs.  TB, HIV/AIDS and vaccines were not integrated into ILS and are managed by dedicated program officers, often based on a “push” system, which relies upon a calculation of need for the medication based upon burden of disease and population in the particular area.

Of the approximately 5,000 health centers and facilities in Tanzania, the majority place orders using the Request and Requisition Form (R&R), which includes 120 essential drugs. In each district, the facilities are divided into three groups: A, B, and C. Each month, MSD would deliver the supplies for one of these three groups to its District Medical Office (DMO), which was projected to result in four deliveries to each facility each year. The system was designed so that facilities should have a maximum buffer stock of seven months and a minimum of four months’ supply. 

Challenges

Despite this design, lengthy stock outs remained common, as explained in the excerpt from a USAID report:1.

“Overall, the data collection teams observed that districts are often not fulfilling their designated ILS roles. Districts did not seem to be consistently ensuring that facilities order on time and follow the delivery group schedule. They also did not seem to be consistently reviewing R&R forms from the facilities for completeness and accuracy. In addition, districts are charged with ensuring that the amount of supplies requested from MSD does not exceed a facility’s budget, yet this does not appear to be happening consistently.”

Example of Health Facility Challenges in Filling the R&R Form

The photograph (left) is taken from the storage facility in a health dispensary in Tanga Region, July 2011.  The staff explained that its facility had no shelves, so medicines were kept in their boxes, making it difficult for staff both to find the proper medications to dispense, and to count the number of medicines and other supplies currently available in the facility.  Thus, since the first step in filling out forms is to calculate the 'Beginning Balance' through a physical count, filling out the forms accurately proved a significant challenge for staff in the health facilities. 

 

 

 

 

  • 1.   Chimnani, Jaya, Joy Kamunyori, Emily Bancroft, Natalia Nazarewicz, Noela Kisoka and Josephine Mahamba.2010. Tanzania: Review of the Health Facility Report and Request Forms at MSD Zonal Stores. Arlington, Va.: USAID | DELIVER PROJECT, Task Orders 1 and 3




 Background Resources

ILS Procedures Manual by the Ministry of Health and Social Welfare, September 2008. 

For more information read sections:

V. Ordering
VI. Issuing Supplies by MSD to Districts
 

Tanzania: Review of the Health Facility Report and Request Forms at MSD Zonal Stores by USAID, August 2010.

Read about challenges in the ordering process due to incorrect filling and delays receiving the R&R form.  The report also includes stock outs for essential and vertical programs by zone.

Filled Request and Requisition (R&R) Form from Tanga Region 2011

Please click image above to enlarge.