MOH ARV SOPs

Republic of Zambia
MINISTRY OF HEALTH
STANDARD OPERATING
PROCEDURES MANUAL
FOR
THE MANAGEMENT OF
THE NATIONAL
ARV LOGISTICS SYSTEM
AUGUST 2017
(Edition)
This Standard Operating Procedures Manual has been prepared as part of DELIVER Technical
Assistance support to the Ministry of Health of the Republic of Zambia to strengthen logistics
management of ARV Drugs.
DELIVER, a six-year worldwide technical assistance support contract funded by the U.S. Agency for
International Development (USAID) and the US President’s Emergency Plan for AIDS Relief
(PEPFAR).
Implemented by John Snow, Inc. (JSI), (contract no. HRN-C-00-00-00010-00) and subcontractors (Man
off Group, Program for Appropriate Technology in Health [PATH], and Social Sectors Development
Strategies, Inc.), DELIVER strengthens the supply chains of health and family planning programs in
developing countries to ensure the availability of critical health products for customers. DELIVER also
provides technical management of USAID’s central contraceptive management information system.
ACRONYMS
AIDS Acquired Immunodeficiency Syndrome

AMC Average Monthly Consumption
ART Antiretroviral Therapy
ARV Antiretroviral (drug)
CIDRZ Centre for Infectious Disease Research in Zambia
CRS Catholic Relief Services
DAR Daily Activity Register
DHO District Health Office
GRZ Government of the Republic of Zambia
JSI John Snow, Inc.
LMIS Logistics Management Information System
CSC Commodity Security Centre
MOH Ministry of Health
MSL Medical Stores Limited
OQ Order Quantity
PHO Provincial Health Office
PRA Pharmaceutical Regulatory Authority
R&R Report and Requisition for Antiretroviral Drugs
SDP Service Delivery Point
USAID United States Agency for International Development
UTH University Teaching Hospital
ZDF Zambia Defence Forces
ZPCT Zambia Prevention Care and Treatment Project (FHI)
Republic of Zambia: Management of the National ARV Logistics System i

LETTER FROM THE PERMANENT SECRETARY
Republic of Zambia: Management of the National ARV Logistics System ii

ACKNOWLEDGEMENTS/FOREWORD
This SOP Manual is the result of the major effort by the Ministry of Health and Cooperating Partners
to enhance the supply chain system for ARV Drugs in Zambia. As part of this effort, an ARV Drug
logistics system design workshop was held from May 14 – May 20, 2006, to review and enhance the
current logistics management information system (LMIS) and the inventory control system for ARV
Drugs. The following individuals, representing every MOH level, and NGO and donor partners, and a
representative from the Zambian Defence Forces participated in this workshop and brought valuable
experience and contributions to the system design:
Mr. Lupiya Banda, Mtendere Mission Hospital Mr. Morgan Musongole, MOH
Mr. Wezi Banda, Ndola DHO Dr. Albert Mwango, MOH
Mrs. Mika Bwembya, JSI/DELIVER Miss Iris Mwanza, CIDRZ
Mr. Enock Chikatula, UTH Mr. Billy Mweetwa, CIDRZ
Mrs. Beatrice Chikotola, USAID/Zambia Mr. Davy Nanduba, MOH- PHO
Miss Violet Kabwe, HSSP Mr. Cornelius Nkaka, MOH-PHO
Mr. Lameck Kachali, CRS-AIDS Relief Mr. Farai Nyoni, Ndola Central Hospital, MOH
Miss Loyce Lishimpi, WHO Mr. Walter Proper, JSI/DELIVER
Mr. Shadreck Malupenga, CHAZ Mrs. Rose Sichalwe, MSL
Mrs. Hyde Moonga Mapulanga, MOH Mr. John Sikasote, JSI/DELIVER
Mrs. Fredah Masafwa, Ndola DHO Mr. Gamariel Simpungwe, JSI/DELIVER
Mrs. Cecilia Moono, ART Nurse, MOH Mr. Revocatus Suzah, JSI/DELIVER
Mr. Simon Mukuka, Lusaka DHO Mrs. Angela Taylor, CIDRZ
Mrs. Mildred Mulenga, Lusaka DHO Mr. Azion Tonga, MOH
Mr. Derrick Muneene, CDC Ms. Caroline Yeta, MOH
Miss Mumbi Musonda, ZPCT Major Robson Zulu, Defence Force Med. Services
We must also commend and recognize the efforts of our colleagues who developed the “Pharmacy
Antiretroviral Therapy Standard Operating Procedures Manual” in January 2005. This “Logistics
Standard Operating Procedures Manual” should be used in conjunction with that manual. Some forms
from that manual can also be found in this SOP Manual as these have forms directly used in the ARV
Logistics System.
The development of the ARV Logistics System and this SOP Manual would not have been possible
without the support of the Ministry of Health, specifically, Dr. Simon K. Miti, Permanent Secretary; Dr.
Velepi Mtonga, Director of Technical Support; and Dr. James Simpungwe, Director of Clinical Care
and Diagnostic Services.
Republic of Zambia: Management of the National ARV Logistics System iii

TABLE OF CONTENTS
ACRONYMS……………………………………………………………………………………….i
LETTER FROM THE PERMANENT SECRETARY…………………………………………ii
TABLE OF CONTENTS…………………………………………………………………………iv
I. INTRODUCTION………………………………………………………………………………1
A. Purpose of the Manual ......………………………………………………………………………1
B. The Purpose of the ARV Logistics System in Zambia .................................................................1
C. Key Features of the ARV Logistics System .................................................................................1
II. ROLES AND RESPONSIBILITIES………………………………………………………….4
III. INTRODUCTION TO THE ZAMBIA ARV LOGISTICS SYSTEM……………………..9
A. Logistics Management Information System ..................................................................................9
1. Forms Used in Managing ARV Drugs………………………………………………………….10
2. Feedback Reports………………………………………………………………………………..10
B. The Zambia ARV Drug Inventory Control System .....................................................................11
IV. DISPENSING ARV DRUGS…………………………………………………………………13
JOB AID: Completing the ART Daily Activity Register ………………………………………….13
V. ASSESSING STOCK STATUS………………………………………………………………16
JOB AID: Determining the Months of Stock on Hand for ARVs………………………………..18
JOB AID: Deciding What Actions to Take after Stock Status Has Been Determined ……….20
VI. REPORTING & ORDERING ARV DRUGS………………………………………………21
A. The Role of Health Centres and Satellites in Reporting .............................................................21
JOB AID: Completing the Report and Requisition for ARVs Drugs……………………………21
B. The Role of the DHO in Reporting and Ordering for the Health Centre ....................................26
JOB AID: District Reviewing the Report and Requisition for ARVs for Health Centres ……..27
C. Using the Supply Voucher to Resupply ARV Drugs from the District ......................................30
JOB AID: Requisitioning ARV Drugs Using the Supply Voucher………………………………30
D. The Role of Hospitals in Reporting & Ordering .........................................................................33
JOB AID: Completing the Report and Requisition for ARVs – District Level 1 Hospitals, and
Level 2 and 3 Hospitals …………………………………………………………………………….33
E. The Role of the Commodity Security Centre in Processing Orders ...........................................38
F. Placing Emergency Orders .........................................................................................................38
JOB AID: Placing an Emergency Order ………………………………………………………….39
VII. RECEIVING ARV DRUGS………………………………………………………………...41
A. Receiving ARV Drugs at a Hospital ...........................................................................................42
JOB AID: Receiving ARV Drugs at a Hospital …………………………………………………42
B. Receiving ARV Drugs at a District for the Health Centre..........................................................44
JOB AID: Receiving ARV Drugs at the District…………………………………………………..44
C. Receiving/Collecting ARV Drugs by the Health Centre ............................................................46
JOB AID: Receiving/Collecting ARV Drugs by the Health Centre……………………………..47
D. Accounting for Stock Received and Stored ................................................................................48
VIII. STORING ARV DRUGS…………………………………………………………………..54
A. Storage Guidelines ......................................................................................................................54
B. Conducting a Physical Count ......................................................................................................57
JOB AID: Conducting a Physical Count…………………………………………………………..58
C. Visual Inspection ........................................................................................................................61
D. Handling Damaged or Expired Stocks........................................................................................62
JOB AID: Handling of Damaged or Expired Products …………………………………………..62
JOB AID: Completing the MSL Returns Authorisation Form…………………………………...64
E. Disposal Guidelines ....................................................................................................................68
IX. MONITORING AND SUPERVISION……………………………………………………...69
A. Monitoring, Supervision and Providing Feedback .....................................................................69
Republic of Zambia: Management of the National ARV Logistics System iv

B. Monitoring at the District Level .................................................................................................70
C. Using and Interpreting Feedback Reports...................................................................................70
D. Supervising the Health Centres ...................................................................................................74
E. Providing Feedback ....................................................................................................................74
F. Conducting a Supervisory Visit ..................................................................................................76
Supervision Checklist for Visit to Health Centres 76
ANNEX:…………………………………………………………………………………………...79
A. ARV Drug Stock Control Card………………………………………………...……………….80
B. ART Daily Activity Register ……………………………………………………………..81
C. Report and Requisition for Antiretroviral Drugs ....................................... Error! Bookmark not
defined.………………………………………………82
D. Supply Voucher (Health Centre) for ARV Drugs .......................................................................85
E. Sample Despatch Note .................................................................................................................86
F. Computer-generated Report and Requisition for Antiretroviral Drugs ........................................87
G. MSL Returns Authorisation form ...............................................................................................88
H. Report for Returning Products ....................................................................................................89
I. Beginning the Implementation of the ARV Logistics System, Preparing First Orders, including 1st,
2nd, and 3rd months .................................................................................................................91
Republic of Zambia: Management of the National ARV Logistics System v

I. INTRODUCTION
A. Purpose of the Manual
This SOP Manual is intended to simplify and standardize the work required for antiretroviral
(ARV) drug logistics management to allow health care providers more time for client-focused
activities. Proper management of ARV Drugs will ensure a consistent supply of products
when and where they are needed to meet the needs of patients enrolled in the Antiretroviral
Therapy (ART) Program.
The SOP Manual serves as a reference for ART health care staff in facilities operated by the
Zambian Ministry of Health and other Cooperating Partners. This SOP Manual guides ART
personnel in the completion of the following tasks related to ARV Drug management:
• Maintaining adequate supplies of ARV Drugs
• Ordering ARV Drugs from Medical Stores Limited (MSL)
• Receiving and storing ARV Drugs
• Recording and reporting consumption of ARV Drugs
• Monitoring logistics activities throughout the system.
B. The Purpose of the ARV Logistics System in Zambia

The objective of the logistics system described in this SOP Manual is to ensure that patients
always get the commodities they need. To be successful, the system must fulfil the Six
Rights of supply chain management. The system, and its staff, must ensure
• the Right Products for ART
• in the Right Quantity
• of the Right Quality
are available
• at the Right Place
• at the Right Time
• for the Right Cost.
A logistics system addresses the concept, “No Report” “No Product, No Program.” An ART
program cannot operate successfully without a continuous, reliable supply of ARV Drugs.
Well-functioning supply chains are critical to achieving HIV/AIDS commodity security, which
exists when every person is able to obtain and use ARV Drugs whenever they are needed.
C. Key Features of the ARV Logistics System

A summary of the most important features and enhancements of the ARV logistics system
follows. NOTE: For NGOs and other Cooperating Partners, your specific involvement in the
ARV LS may vary depending on your agreements with MOH and the level(s) at which your
organisation works.
Medical Stores Limited (MSL) – Commodity Security Centre (CSC)

• The Commodity Security Centre (MSL- CSC) was established to manage supply
chain processes at the central level. The unit has many players ranging from
pharmacists, a laboratory specialist, Logistics officials and data entry clerks.
• The MSL CSC’s personnel as stated are based at Medical Stores Limited (MSL) and
are responsible for reviewing and approving orders, managing the Supply Chain
Manager Software database that tracks reports and orders, coordinating supervision,
and monitoring the overall function of the logistics system.
• The MSL CSC analyzes and interprets data in order to report logistics information,
including feedback reports to the Central, Provincial and District levels and its
partners such as CIDRZ, ZPCT, and CRS/AIDSRELIEF; manages and constantly
Republic of Zambia: Management of the National ARV Logistics System 1

monitors the national PipeLine1 database to ensure that appropriate and prompt re-
supply and commodity management actions are taken by the relevant stakeholders.
• The MSL CSC compiles data to be used to forecast and quantify the national needs
for ARV Drugs, provides national level logistics system monitoring and evaluation,
and advises on troubleshooting and procurement planning.
• The MSL CSC staff strive to meet the six rights for all ART patients.
Central Medical Stores

• In time, all ARV Drugs, including the stock of Cooperating Partner programs and
other international donors will be stored at MSL’s central warehouse. The MOH and
Cooperating Partners collaborate to ensure timely and secure distribution to all
service delivery points.
• MSL staff work in close coordination with the MSL CSC to quickly and accurately
process all reports and requisitions (orders). Any service delivery point which fails to
send the Report and Requisition form will not be issued stock. “No report/order, No
product, No program.”
• ARV orders for Hospitals are shipped along with the Hospital Essential Drug orders
according to the MSL delivery schedule.
• All Health Centre ARV Drug orders are pre-packaged at MSL, separate from
individual District orders, but sent at the same time. These pre-packaged products
are delivered to the District from where they are sent to or picked up by the
appropriate Health Centre. Health Centre pre-packaged stock always remains
separated from other District stock.
• MSL staff strive to meet the six rights for all ART patients.
MSL Regional Hub/Staging Posts

• All essential medicines, ARV drugs and other medical supplies pre-packed for each
health facility by Central MSL Warehouse will be sent directly to the MSL regional
Hub where they will be temporally stored before there last mile distribution.
• For Health facilities including DHOs further away from the MSL regional Hub, they
will receive their supplies through the Hub staging posts close to them.
Hospitals (District Level 1, and Level 2 and 3)

• Hospital ART Programs complete a Report and Requisition form at the end of every
calendar month and submit this form to the MSL CSC. If the hospital does not submit
this form, commodities will not be issued to them from MSL. “No report/order, No
product, No program.”
• Hospital pharmacies maintain Stock Control Cards for ARV Drugs as well as
dispensing records.
• Hospital ART staff strive to meet the 6 rights for all ART patients.
District Health Office (DHO)

• Districts receive reports each month from each of its Health Centres that have ART
programs.
• The Districts review the R&Rs and submit the reports to the MSL CSC on behalf of
the Health Centres. If the DHO does not submit these forms, commodities will not be
issued for the Health Centres. “No report/order, No product, No program.”
• The Districts receive pre-packaged orders for the Health Centres from MSL and
distribute these orders as quickly as possible.
• DHO ART staff strive to meet the 6 rights for all ART patients.
1
The Pipeline Monitoring and Procurement Planning (PipeLine) system is a software tool that helps
program managers gather critical forecasting information, ensure that products arrive on time,
maintain consistent stock levels at the program or national level, and prevent stockouts.

Health Centres and Satellites
• Health Centres with ART programs report consumption and stock data on the Report
and Requisition form to the DHO every month. Satellite sites also report their data to
the Parent Health Centre. If the Health Centre/Satellite does not submit this
information, then commodities will not be issued to them via the District from MSL.
“No report/order, No product, No program.”
• Health Centres and satellites maintain Stock Control Cards for ARV Drugs as well as
dispensing records.
• Health Centre and satellite ART staff strive to meet the six rights for all ART patients.
Figure 1 illustrates the flow of commodities and information in the logistics system for ARV
Drugs. Commodities flow down from MSL to the Hospitals, Districts, and Health Centres.
Commodities are dispensed to clients at service delivery points. Service delivery points
include Health Centres and District Level 1 Hospitals and Level 2 and Level 3 Hospitals.
The information that is collected on the various forms used in the Logistics Management
Information System flows up from the Health Centres, Districts, and Hospitals to the MSL
CSC for processing. Feedback reports, including the completed, computer-generated Report
and Requisition form and reports from Supply Chain Manager Software, are generated
within the MSL CSC and sent to the Pharmacy Specialist, the ART Programme Managers at
the Central Ministry levels, the Provincial Health Office (Principal Pharmacist), Districts,
Hospitals, and Health Centres. Feedback reports are used by central level officials, the
Principal Pharmacists, the District Pharmacists, and NGO partners for supervision and
feedback action.
FIGURE 1: Movement of ARV Drugs and Information
ARV National Pipeline

(Movement of Commodities and Facility Reports)
CHAZ
WAREHOUS
MOH MSL Commodity
Security Centre
E
Commodities Provincial
Health Office
LMIS Reporting
and Ordering
DHO CHAZ
MSL HUBs to Level 1,2 and 3 SUPPORTED
deliver to Hospitals SITES
facilities
NGO Health
Health Facility
Centres
Satellite
Sites

Clients
II. ROLES AND RESPONSIBILITIES
Many health staff play key roles in the operation of the ARV logistics system. The roles and
responsibilities for personnel involved in this system are listed below. Depending on your job
or role within the system, this SOP Manual will help you to complete these responsibilities in
a timely and effective manner.
 If you manage ARV Drugs, find your job title below or match your roles and
responsibilities with the appropriate title. This should help you understand your
responsibilities as they relate to the logistics system.
 If no one has been assigned one of the following personnel designations at your level or
facility, you must assign the responsibility to someone to ensure that the logistics system
operates and that adequate products are available for clients.
 If you supervise personnel who manage ARV Drugs, use these descriptions of roles and
responsibilities to ensure that the responsible staff member knows and is performing his
or her job.
 If you are an NGO or other Cooperating Partners, your specific roles and responsibilities
in the ARV LS may vary depending on your agreements with MOH and the level(s) at
which your organisation works.
Level Personnel Roles and Responsibilities

• Review and approve Report and Requisition for Antiretroviral Drugs
(R&R) forms submitted by Districts (on behalf of Health Centres)
and Hospitals
• Approve the computer-generated R&R, to package and ship
approved ARV orders to Districts and Hospitals
Pharmacis
• Monitor stock levels in the system; periodically evaluate system
ts &
performance
Laboratory
• Communicate with the relevant procurement units and donor
MSL -CSC
Specialist
partners for the procurement of ARV Drugs
• Report periodically to the Pharmacy Specialist, ART Programme
Coordinator, other Ministry units and partners on drug consumption,
stock levels, and reports regarding the ARV Drug logistics
management system
• Enter the report and order information from the Report and
Requisition for Antiretroviral Drugs forms by facility received from
Data Entry Districts and Hospitals into Supply Chain Manager Software
Clerk • Generate Computer - generated Report and Requisition forms and
feedback reports to send to Provinces, Districts and service delivery
points
•
Warehous
Supervise the management of ARV Drugs in the MSL central store

Central
B MSL
• Manage the stock levels of ARV Drugs

e
• Receive ARV Drugs

• Issue ARV Drugs to Hospitals and Districts (for distribution to
Warehouse Manager,
Health Centres)
Logistics Directors &

other Technical staff
• Report ARV stock levels and issues data to MSL CSC on a monthly
basis
• To ensure Stock Control software are updated every time ARV
Drugs are issued or received
• Adhere to quality standards for storing ARV Drugs
• Coordinate distribution of ARV Drugs according to the MSL
Schedule and ensure secure delivery
•
• Supervises and monitors the distribution schedule for essential
medicines orders for the SDPs received from Central MSL.
• Manage warehouse according to good storage practices
• Inspect pre – packaged orders/HC kits for health centre, Hospitals
NGOs received at the Hub and arrange them by districts by region
or route for smooth distribution to the facilities
MSL Regional HUB
• Sign the MSL Dispatch Note for each health facility which receive
supplies, noting discrepancies in the number of carton boxes / HC
MSL Hub Manager
kits on the MSL Dispatch Note.

• Return signed copy of MSL Dispatch Note to Central MSL driver
• File copy of MSL Dispatch Note received from Central MSL and
signed copy of Computer-generated R&R received from the health
centres when returned
• Fill out the discrepancy and damages section of the MSL Dispatch
Note in case of package damage or shortage
• Distributes pre-packaged orders/ HC Kits to the health facilities
Drivers
• Return signed copies of the computer generated R& R from the

MSL
Hub
health facilities
• Receive quarterly feedback reports from the MSL CSC on
Provincial
provincial ARV logistics performance

Medical
Principal
Office
• Conduct supervision visits to the DHOs and Level 2 and 3 Hospitals

Pharmacis
in the province
t
• Supervise DHOs to address ARV logistics reporting and distribution
issues
Ordering & Reporting
District Health Office
DISTRICT LEVEL 1
• Receive the Report and Requisition for ARV Drugs from

FOR HEALTH
CENTRE AND
ACTIVITIES
Health Centres with both the report and requisition section

HOSPITAL
District completed. Check for errors

Pharmacis • Review the Report and Requisition for ARV Drugs and submit
t to the MSL CSC when sending in MSL essential drug orders
• If necessary, approve an Emergency Order for the Health
Centre and send immediately to the MSL CSC

• Receive pre-packaged ARV orders for each Health Centre
providing ART in your District.
• Inspect Health Centre orders received at District and sign the
MSL Despatch Note for each Health Centre for which you
District
Receiving
receive supplies, noting discrepancies on the Despatch Note
Pharmacy and Computer - generated R&R, as needed
Technolog • Return signed copies of MSL Despatch Note to MSL driver
ist • File signed copies of MSL Despatch Note received from MSL
and signed copies of Computer - generated R&R received
from the Health Centres
• Notify Health Centres for which the District stores drugs that
the order has been received
• Issue Health Centre orders, along with the Computer -
generated R&R, to Health Centres as soon as possible after
receipt.
• For Health Centres who are unable to store all
Issuing & Managing
commodities in their facility at one time:

- Store ARV Drugs at the DHO according to good storage
practices
- Issue ARV Drugs to Health Centres upon receipt of
Supply Voucher from the Health Centre
- Complete Supply Voucher sent from the Health Centre
- Track all receipts and issues for Health Centre
commodities on separate Stock Control Cards.
• Receive Reports for Returning Products forms from the Health
Centres. Submit products and forms as required to the MSL
CSC.
Monitoring &
Supervision
• Review ARV Drug feedback reports received from MSL CSC

and take action as needed
• Monitor ARV Drug management activities in the District
• Make quarterly supervision visits to Health Centres
• Fill in the ART Daily Activity Register every time ARV Drugs
Hospitals: District Level 1, and Level 2 and 3
Dispensing & Managing
are dispensed
• Store ARV Drugs according to good storage practices
• Maintain Stock Control Cards for all ARV Drugs held in
Pharmacis storage
ts • Complete a physical count of Hospital ARV stock every
month and enter it on the Stock Control Card and in the
Report and Requisition Form.
• Return unusable ARV Drugs to MSL after filling out the
Report for Returning Products
Hospital
Pharmacis • Compile the data from all of the ART Daily Activity Registers
t in and Stock Control Cards every month, and complete the
Reporting &
Ordering
Charge Report and Requisition for ARV Drugs

• Authorize Report and Requisition for ARV Drugs and send to
the MSL CSC when sending the MSL essential drug orders
• Complete a Report and Requisition for ARV Drugs to place
an emergency order to MSL, if necessary

• Conduct a visual inspection of the products received
• Sign the MSL Despatch Note on receipt of supply from MSL.
Receiving
Note any discrepancies on Despatch Note.
• Update the Stock Control Card with the receipts.
• File copies of the Computer - generated R&R and MSL
Despatch Note.
• Return one copy of the MSL Despatch Note to MSL.
Dispensing & Managing • Fill in the ART Daily Activity Register every time ARV Drugs
are dispensed
• Maintain Stock Control Cards for all ARV Drugs held in
storage
• Complete a physical count of ARV stock every month and
enter it on the Stock Control Card and in the Report and
Requisition for ARV Drugs
• Send unusable ARV Drugs to the District after filling out the
• Compile the data from all of the ART Daily Activity Registers
ART and Stock Control Cards every month and complete both
Reporting & Ordering
Pharmacy
sections of the Report and Requisition for ARV Drugs
In-Charge
Health Centre

the District for review and onward submission to MSL
• Complete the report and requisition section of the Report and
Requisition for ARV Drugs and send to the District to place
the emergency order to MSL, if necessary
ART Focal • For those Health Centres that store ARV Drugs at the
Person District: Complete the Supply Voucher weekly or as agreed
and submit to the District.
• Sign the computer-generated Report & Requisition for ARV
Drugs upon receipt of supply from the District; note any
Receiving
discrepancies
• Return copy of signed R&R to District and file a copy of the
computer-generated R&R
• If storing drugs at District: When notified of receipt of order
at District, go to District and conduct receiving procedures as
above; bring Supply Voucher and pick up weekly order
• Fill in the ART Daily Activity Register every time ARV Drugs
ART are dispensed
Dispensing & Managing
Pharmacy
In-Charge
•
Satellite Sites
Maintain Stock Control Cards for all ARV Drugs held in

storage
• Complete a physical count of ARV stock every month and
enter it on the Stock Control Card and in the Report and
• Send unusable ARV Drugs to the Parent Health Centre after
filling out the Report for Returning Products

ART Focal • Compile the data from all of the ART Daily Activity Registers
Person and Stock Control Cards every month and complete both
Reporting &
sections of the Report and Requisition for ARV Drugs.
Ordering
the Parent Health Centre
• Complete a Report and Requisition for ARV Drugs for
emergency order and send to the Parent Health Centre if
necessary
• Sign the ‘supply voucher’ used upon receipt of supply from the
Receiving
Parent Health Centre note any discrepancies

• Return copy of signed R&R to the Parent Health Centre and
file a copy

III. INTRODUCTION TO THE ZAMBIA ARV LOGISTICS SYSTEM
A. Logistics Management Information System
The purpose of a logistics management information system (LMIS) is to

collect, organize, 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.
Only information which will support specific logistics decision-making should be collected.
Three essential data items are required to run a logistics system and, therefore, must be
captured by the LMIS. These three essential data items are:
1. Stock on Hand: Quantities of usable stock (ARV Drugs) available at a particular point in
time.
2. Consumption Data: The quantity of ARV Drugs dispensed to users during the reporting
period (one month).
3. Losses/Adjustments: Losses are the quantities of products removed from your stock
for anything other than dispensing to patients or issuing to another facility (e.g. expiry,
lost, theft, or damage) and are recorded as negative (-) numbers. Adjustments are
quantities of a product received from any source other than the District or MSL, or issued
to anyone other than your facility’s patients. An adjustment may also be a correction due
to an error in mathematics. An adjustment may be a negative (-) or positive (+) number.
There are only three activities that happen to ARV Drugs within a logistics system:
ARV Drugs are stored in inventory; ARV Drugs are moved between facilities; and ARV
Drugs are dispensed to users. A well designed logistics management information system will
include records and forms that collect and report the three essential data items as they relate
to these three activities.
Records and forms have been designed for the Zambia ARV LMIS and are included in this
SOP Manual along with step-by-step instructions on how to fill them out. In addition, the
forms in this SOP Manual marked with an asterisk (*) can also be found in the “Pharmacy
Antiretroviral Therapy Standard Operating Procedures Manual” (January 2005).
The roles and responsibilities of key personnel in the system were highlighted in the
previous section, and these same people will be responsible for completing these LMIS
forms. By level, these key personnel include:
• Health Centre: ART Pharmacy In-Charge or ART Focal Person
• DHO: District Pharmacist or Pharmacy Assistant
• District Level 1 and Level 2 or 3 Hospital: District Pharmacist or Pharmacist

1. Forms Used in Managing ARV Drugs
A detailed description of each type of form, its purpose, and its related activity are listed in
the table below. Copies of these forms can be found in the Annex of the SOP Manual. Job
aids for completing the forms can also be found in this SOP Manual. Forms marked with an
asterisk (*) are taken from the Pharmacy Antiretroviral Therapy Standard Operating
Procedures Manual, and thus, can also be found in that manual.
Form Name Purpose Activity

Stock Control • To account for the quantity of • Issuing
Card* ARV Drugs in a storeroom • Storing
• Receiving
• Reporting & Ordering
• Physical Inventory
ART Daily Activity • To record and track the • Dispensing
Register number of ARV Drugs • Reporting & Ordering
dispensed to patients
Report and • To provide logistics data to • Reporting & Ordering
Requisition for the MSL CSC
Antiretroviral Drugs • To provide a report on the
stock status of ARV Drugs at
the facility
• To order ARV Drugs
Supply Voucher for • To request ARV Drugs from • Ordering
ARV Drugs the District • Issuing
(Health Centres) • To account for receipt of • Receiving
For Health products at the Health
Centres that store Centre from the District
drugs at the • To note any discrepancies
District …
MSL Despatch • To account for receipt of • Receiving
Note products from MSL at the • Issuing
District or Hospital
Report for • To track products returned to • Storing
Returning Products the central level from the
health facility level
Stock Control Books may also be used. While instructions for using the Stock Control Book
are not found in this SOP Manual, they may be found in the Pharmacy Antiretroviral Therapy
Standard Operating Procedures Manual.
2. Feedback Reports
Data reported to the MSL CSC is aggregated, processed and analysed to produce feedback
reports that are used by program and commodity managers to monitor the performance of
the ARV logistics system. These same reports can be used by supervisors to help personnel
identify problems and take corrective actions.

The following are some of the expected feedback reports for the Zambia ARV Drug logistics
system.
Report Name Purpose Primary User

Supply Status by Facility To report product stock District Pharmacist,
Report levels (actual quantity and Principal Pharmacist, CSC
months of stock) by facility, Staff
average monthly
consumption and maximum
stock
Stock Imbalances Report To report stock outs and District Pharmacist,
over stocks by facility and Principal Pharmacist, CSC
by product Staff
Computer - generated To indicate errors in the District and SDP (Hospital,
R&R, bolded entries completion of the Report Health Centre) personnel
and Requisition for ARV
Drugs, by R&R completed
Dispensed to User Graph To indicate monthly District Pharmacist,
consumption of products Principal Pharmacist, CSC
over a period of time, by Staff
product, by facility or by
administrative level
Samples of these reports and their use can be found in Section IX-C of this SOP Manual.
B. The Zambia ARV Drug Inventory Control System
The purpose of an inventory control system is to inform personnel when and

how much of a commodity to order and to maintain an appropriate stock level
to meet the needs of patients. A well designed and well operated inventory
control system helps to prevents shortages, oversupply, and expiry of drugs.
The inventory control system designed for ARV Drugs is a Forced Ordering
Maximum/Minimum inventory control system. In the Zambia system, this means that every
service delivery point (SDP) in the system is required to report at the end of every month and
order all ARV Drugs back up to the maximum level. The table below describes the reporting
and ordering required for each service delivery point:
At the end of every month…

Health Centres Report stock on hand,
consumption, and losses and
adjustments; Order enough
stock to bring stock level up to
the maximum and. Submit the
order to the District by the 5th
day of the following month.
Districts with ART Reviews and approves the Districts submit the orders for
Sites at Health health centre orders their Health Centres to the MSL
Centres CSC by the dates published in
the MSL Delivery Schedule.

Hospitals: District Report stock on hand, Hospitals submit their order to
Level 1 and Level 2 consumption, and losses and the MSL CSC by the dates
and 3 adjustments; Order enough published in the MSL Delivery
stock to bring stock level up to Schedule.
the maximum.
*If stock levels ever fall below 2 weeks (0.5 months) of stock before the end of the
month, an emergency order should be placed. See the Job Aid on Placing Emergency
Orders in Section VI-F.
To help you maintain adequate stocks, the maximum months of stock and an emergency
order point have been established.
• The maximum months of stock is the largest amount of each ARV Drug a facility should
hold at any one time. If a facility has more than the maximum, it is overstocked and risks
having stocks expire before they are used.
• The emergency order point is the level where the risk of stocking out is likely, and an
emergency order should be placed immediately.
The maximum months of stock and emergency order points for the different levels of the
ARV logistics system are shown in the following table:
Maximum Months Emergency Order

Level
of Stock Point
Hospitals (District
2 weeks
Level 1, and Level 2 3 months
(= 0.5 months)
& 3)
2 weeks
Health Centres 3 months
( =0.5 months)

IV. DISPENSING ARV DRUGS
Dispensing is a process of supplying ARV Drugs to the patients enrolled in the ART
program. The pharmacist or pharmacy technician dispenses ARV Drugs to patients. Careful
dispensing is an important component in managing drug supplies because it is the last step
which ensures that the patient has received the right ARV Drugs.
All Hospitals and Health Centres should follow the steps below when dispensing:
1) Approach patient cordially

2) Receive and validate the Prescription Form from the client
3) Calculate quantities to be dispensed
4) Dispense right quantity
5) Record the quantities dispensed to each client in the ART Daily Activity Register
and/or, where applicable, update the ART software
6) Retain prescription for records The recording and
reporting of these
The DAR is kept at the dispensing areas, where the drugs are dispensed-to-user data
dispensed to patients. When ARV Drugs are dispensed, these are critical to the
quantities are recorded in the ART Daily Activity Register. These functioning of the ARV
data are aggregated at the end of the month and the total quantities logistics system.
dispensed for the month are reported on the Report and Requisition
for ARV Drugs.
The following job aid describes how to complete the ART Daily Activity Register.
JOB AID: Completing the ART Daily Activity Register
Task: Completing the ART Daily Activity Register
Completed by: Pharmacist, pharmacy technician, or other staff trained and

authorized to dispense ARV Drugs
Purpose: To record and track the number of ARV Drugs dispensed to

patients
When to perform: Each time an ARV Drug is dispensed to a patient

When calculating the totals per register page
When calculating the total of ARV Drugs dispensed during the
month
Materials needed: ART Daily Activity Register, calculator, and pen; Pharmacy ART
SOP Manual
Note: For each patient, verify the prescription before dispensing

ARVs. See SOP 014 in the “Pharmacy ART Standard Operating
Procedures Manual" on pg 42-44 on how to validate a patient’s
prescription before dispensing

Step Action Notes
1. Select the appropriate action:
IF THEN
STARTING A NEW BOOK CONTINUE TO STEP NUMBER 2
BEGINNING A NEW MONTH SKIP TO STEP NUMBER 3
STARTING A NEW PAGE SKIP TO STEP NUMBER 3
DISPENSING DRUGS SKIP TO STEP NUMBER 5
FILLING THE LAST LINE ON A PAGE SKIP TO STEP NUMBER 10
ENDING A MONTH SKIP TO STEP NUMBER 9
When starting a new book or ledger
2. ART Daily Activity Register Book Note that this data would also be
Cover: On the cover sheet write the: captured using the eLMIS once
a. Name of the Facility piloted and rolled out
b. Name of the District
Continue with step number 3.

When starting a new page and when dispensing drugs
3. Facility: Write the name of your health
facility.
4. District: Write the name of the District
that the facility is in.
5. Date: Write in the date.
6. Patient Name/Number: Write the name This can be the patient’s ART
and/or number assigned to the patient to number.
whom you will give ARV Drugs.
7. Fixed Dose Combinations and/or Examples of units of issue:
Single Drug Formulations: For each 1 bottle of 30 tablets – write 1
patient, enter in the appropriate column 1 pack of 60 – write 1
the quantities of each drug dispensed by ¼ of a bottle- write 0.25
unit of issue.
If you are dispensing any ARVs
which are not pre-printed on the
form, write them in the blank
columns. When writing in an ARV
that is not pre-printed on the form,
write the name of the drug, the
strength, form, and unit size.
Example: Nevirapine, 200 mg
tablets, bottle of 60 tabs
8. Dispenser’s Initials: The person
dispensing the drugs should sign with
his/her initials.
At the end of the month:
9. Close out the page by crossing out any Continue with Step 10.
unused lines on the page.
When a page is filled or at the end of the month:

Step Action Notes
10. Total Quantity Dispensed: Write the Do this addition each time you
total quantity of each ARV Drug complete one page or at the end of
dispensed by adding the quantities the month.
entered for each patient listed on the
page. If there are products that have not
been dispensed, write “0” in the
spaces on the row for “totals.” Do
not leave the spaces blank.
11. Quantity Dispensed for Month (running If there are products that have not
total): Add the Total Quantity Dispensed been dispensed, write “0” in the
listed on this page to the running total spaces on the row for “totals.” Do
from the previous page. This will give you not leave the spaces blank.
the total quantities of each product that
you have dispensed during the entire You will round up the total to the
month. nearest full unit (e.g., bottle) and
transfer this total quantity to column
E of the Report and Requisition for
Antiretroviral Drugs when reporting.
Example: 4.25 bottles dispensed 

5 bottles
When starting to see patients in

a new month, the running total at
the bottom of each page should
be started afresh for that new
month.
12. Check your calculations twice. Be sure you have not erroneously
put page totals for one drug item
with the totals for another drug
item. Any error in the quantities
dispensed means that you will not
report (and get re-supplied with)
the correct amount.
The task is complete when:
 The facility and District names are filled in.
 Date, patient name and/or number and quantities of drugs dispensed to each patient
are entered.
 Dispenser has signed with his/her initials each time drugs are dispensed.
 The quantities of drugs recorded on each row of the page are totalled by column to
get the total quantity dispensed for each drug.
 The total quantity dispensed for each drug is added to the running total quantity
dispensed from the previous page to get the running total for the month of the
quantities dispensed.
 Monthly total for each drug dispensed is calculated.

V. ASSESSING STOCK STATUS
A maximum/minimum inventory control system is a system designed to ensure that quantities

of stock fall within an established range – a maximum level and a minimum level. In order to
know if your stocks are within that range, you must assess your stock status.
When you review your stock status, you determine how much of each ARV Drug you have
available at your facility and how long these stocks will last. You can review your stock status
by counting the stock available, as you do during a physical count. (See Section VIII-B on how
to conduct a physical count.) When you ﬁnish, you will have an absolute quantity of stock
available. But, it is much more important to know how long the stocks will last and if you
have enough stock available until you receive your next order. We refer to this as months of
stock.
Months of stock is the number of months ARV Drugs will last based on the present
consumption rate. When you review your stock status, you need to determine how many
months of stock you have in your facility. Three months of stock means that your stock will
last three months, as long as consumption remains at the current rate.
By reviewing your stock status you will be able to determine if your facility is understocked,
overstocked, or adequately stocked. If you are understocked and you know that a recently
ordered shipment is not on the way, you may need to place an emergency order. (See Section
VI-F for placing an emergency order.) If you are overstocked, you may need to return stock to
the higher facility for redistribution.
Determining Months of Stock

By calculating the months of stock, a facility can determine if the right quantities of ARV
Drugs are stocked. To determine how long stock will last, the following simple formula can
be used:
How much we have

(Stock on Hand) How long supplies will last
=
How much we have used (Months of Stock on Hand)
(Average Monthly Consumption)
Before calculating Months of Stock on Hand, you need to know two pieces of information:
Stock on Hand and Average Monthly Consumption. To detemine Average Monthly
Consumption (AMC), add the latest three months’ consumption of a particular product, then
divide by three.
Use the following formula to determine AMC:
Current month’s usage + previous two months’ usage Average Monthly

=
3 Consumption
Note: When you calculate average monthly consumption, always round up to the nearest
whole number!!!
Previous months’ usage can be found on copies of the Report and Requisition for ARV Drugs

for the last two months OR on the ART Daily Activity Register (for Health Centres and
Hospitals). For each drug for which you wish to assess stock status, retrieve the usage data
(consumption) for the last three complete months. If a stock out has been experienced in any
of those months, do not use that month’s data; use the next most recent complete month
consumption for which there was no stock out. If you do not have three months of data, use
whatever data you have. Calculate the average monthly consumption.
Next, divide the Stock on Hand (determined from the physical count) by the AMC that you
calculated to obtain the Months of Stock on Hand. Use the following formula to determine how
many months the current quantity available for each product will last:
Stock on Hand Months of

=
Average Monthly Consumption Stock on Hand
Note: When you determine months of stock, use only one number after the decimal point!
If the second number after the decimal is 4 or less, round down; if 5 or more, round up.
When to Assess Stock Status

The stock status for a facility should be assessed at any time you suspect that the stock
levels do not fall within the recommended maximum and minimum stock levels for your
facility. This may occur if there is a loss of supplies due to damage, expiry, or theft, or if there
is an unexpected increase or decrease in consumption.
Districts should assess the stock status of Health Centres during supervisory visits and as
part of routine monitoring. When completing the requisition section of the Report &
Requisition, District personnel should check the stock status of the Health Centres:
• If the order quantity is a negative number, then the Health Centre is overstocked and
the stock status should be assessed. Stocks may need to be returned if they will
expire before they can be dispensed.
• If a larger than normal order quantity is required, then the Health Centre may be
understocked and should be advised to monitor and assess its stocks more
frequently to avoid the need for an emergency order.
• If a facility is submitting frequent emergency orders, work to identify the reason for
the emergency orders and take other action as required.
To review the stock status of any health facility, follow the procedures outlined below.

JOB AID: Determining the Months of Stock on Hand for ARVs
Task: Determining the months of stock on hand
Completed by: ART Focal Person (varies depending on location); District

Pharmacist
Purpose: To determine how long ARV Drug stocks will last
When to Perform: When a stock imbalance is suspected

During routine monitoring and supervision
Can be done when completing the Report and Requisition
Materials Needed: Report and Requisition for ARV Drugs for the most recent 3
months, calculator and pen.
Step Action Notes

1. Determine the total Get the consumption figures from column E on
consumption for three the Report and Requisition for ARV Drugs or end
months: For each ARV of month “Quantity Dispensed for Month” row of
Drug, add the consumption the ART Daily Activity Register.
for the most recent three
completed months. Example: Tenofovir/Lamivudine/Efavirenz
300/300/600 mg Tabs, Bottle of 60 Tabs
Total bottles dispensed for current month: 104
Total bottles dispensed last month: 92
Total bottles dispensed the month before last: 87
104 + 92 + 87 = 283 bottles
If there were any stock outs during one of the

three months, skip that month and use the
consumption from the next previous month.
2. Calculate the Average Example:
Monthly Consumption: 283 ÷ 3 = 94.3 ≈ 95 bottles
Divide the total consumption AMC = 95 bottles
for three months by 3.
Always round up to the nearest dispensing unit.
Example:
37.2 ≈ 38 bottles
102.7 ≈ 103 bottles
If assessing stock when completing a Report and

Requisition form at the end of the month, write
the AMC you have calculated in column H of the
R&R.

Step Action Notes
3. Determine the current Example:
quantity of Stock on Hand: Physical count is 200 bottles.
Conduct a physical count or
obtain the physical count
from column G on the Report
and Requisition for ARV
Drugs.
4. Calculate the Months of Months of Stock on Hand tells you how long your
Stock on Hand: Divide the current stock will last based on current
quantity of stock on hand for consumption. If you have 2.5 months of stock,
the product by the Average then your stock will last 2.5 months.
Monthly Consumption for
that product. Example:
200/95 = 2.1 months of stock
Always round Months of Stock to the nearest one

decimal place.
Example:
3.22 ≈ 3.2 months of stock
1.88 ≈ 1.9 months of stock
5. Take action, if needed, See the Job Aid Deciding what Actions to Take
based on the Months of after Stock Status has been Determined.
Stock for the ARV Drug.

JOB AID: Deciding What Actions to Take after Stock Status Has Been Determined
Task: Deciding what action to take after stock status has been determined
for ARVs at a health facility
Completed by: ART Focal Person (varies by location); District Pharmacist
Purpose: To monitor the stock status in the health facilities

To correct any overstocking or understocking discovered after
determining stock status
When to perform: When a stock imbalance is suspected

During routine monitoring and supervision
When a Report and Requistion for ARV Drugs is received and/or
completed.
Note:
If communication is necessary regarding decisions about stock status, facilities should
contact the following levels.
• Health Centres should contact their District.
• Hospitals should contact the CSC.
• Districts who manage stock for a Health Centre should contact the Health
Centre and then contact the CSC.
Months of Stock Interpretation Decisions

Between 3 and 2 Stock status is adequate. No action required.
months
Greater than 3 The facility is overstocked Discuss the stock status of the product
months with this product. with your specified contact.
If some or all of the stock will expire in

the near future, you can transfer some
stock to another facility that may be
able to use it more quickly.
Between 2 The facility is understocked Continue to monitor stock levels until
months and 2 with that commodity, but the next delivery arrives, or until they
weeks stock levels have not yet reach the emergency order point.
(0.5 months) reached the emergency
order point.
Less than 2 The service delivery point is Discuss the stock status of the product
weeks understocked with this with your specified contact. An
(0.5 months) product. The stock level is emergency order should be made!
below the emergency order
point of 2 weeks (0.5 Note: In order to assist staff with
months). identifying products which are at or
below the emergency order point, the
“New EOP” in quantities of products
will be listed on the Computer -
generated R&R that the facility receives
from MSL.

VI. REPORTING & ORDERING ARV DRUGS
This section of the Manual will address the process for reporting on and ordering ARV Drugs.
It will also address the roles and responsibilities of the main actors in the resupply process:
the Health Centre, the District, the Hospitals, and the MSL CSC. These actors also represent
the three levels of the ARV Logistics System.
A. The Role of Health Centres and Satellites in Reporting
At the end of each calendar month, the ART Focal Person or Pharmacist In-Charge at the
Health Centre completes the Report and Requisition for ARV Drugs (R&R) form. Both the
Health Centre and satellites completes both sections of this form. The ART Focal Person or
Pharmacist In-Charge uses the Stock Control Cards for ARV Drugs, the ART Daily Activity
Register, and the previous months’ completed R&R to fill in essential data. Such data include
the total stock of each ARV on hand at the Health Centre or satellite as determined by a
physical count; the beginning balance and receipts for the period; the losses and adjustments
to the stock of each ARV that have occurred during the month; and the total quantity of each
ARV Drug that was dispensed during the month.
When these data are compiled and recorded on the R&R, the Health Centre then sends the
completed R&R to the District Pharmacist at the District level by no later than the 5th day
following the reporting period. The satellite sites will send the completed R&R with both
sections completed to the parent ART site.
The following job aid provides detailed instructions for the Health Centre ART Focal Person
or Pharmacist In-Charge to complete the R&R.
JOB AID: Completing the Report and Requisition for ARVs Drugs
This job aid will guide you through the process of completing the Report section of the Report
and Requisition for Antiretroviral Drugs (R&R). There are two sections to the R&R. Columns
A through G comprise the Report Section. Columns H through J comprise the Requisition
Section.
Please note that there are several pages to this form. Each page lists different ARV Drugs.
When sending this form to the District it is very important that all pages are stapled together
as a single Report and Requisition. It is also important that 3 copies (original and 2 copies) of
all pages are made during the transfer of information. The pages are self-carbonized to make
copies of each page.
The ART Focal Person or Pharmacist in Charge at the Health Centre completes the Report
and requisition section of the form. The R&R should be submitted to the District Pharmacist
no later than the 5th day of the month following the reporting period
Note: Facilities with eLMIS, once the report is completed and submitted, it will appear
in the central edition and the district will review and approve.

This job aid provides guidance on how to complete the form.
Task: Completing the Report and Requisition Section of the Report and
Requisition for ARVs at the Health Centre or satellite site
Completed by: ART Focal Person or Pharmacy In-Charge at the Health Centre
Purpose: To report the number of ARV Drugs dispensed, the stock on hand,
the losses/adjustments and Order enough stock to bring stock level
up to the maximum.
When to perform: At the end of each calendar month
Materials needed: Stock Control Card, ART Daily Activity Register, Blank Report and
Requisition for ARV Drugs, the completed R&Rs from the two
previous months, calculator and pen
Step Action Notes

1. Reporting Period: Write the day, The reporting period is a full month and
month and year for the starting date this report should be completed at the
and ending date of the reporting end of each calendar month.
period.
Example: 1 April 2017 – 30 April 2017
2. Facility Name: Write in the name of
the facility.
3. Province and District: Write in the
name of the Province and District in
which the facility is located.

Step Action Notes
4. Drug Product (Column A): Pre- If any of the drugs you are recording are
printed. If the product name is not missing from the pre-printed list, write in
pre-printed, write the name, strength the names of any fixed dose
and form of the product. combinations that were dispensed during
the reporting period that do not appear on
the form. Then write in the names of any
single drug formulations that do not
appear on the form.
Write the name of the drug, the strength,

and form. For example: Nevirapine, 200
mg tablets. Be sure to write the drugs on
the appropriate row on the form.
Note that the same product in different

pack sizes constitutes a different product
for logistics purposes and so should be
listed on different lines of the R&R.
For example: Zidovudine 300 mg tablets,

bottles of 100 needs to be on a different
line from Zidovudine 300 mg tablets,
bottles of 30.
5. Unit (Column B): Pre-printed. If If necessary, write in the total number of

the unit is not pre-printed, write the tabs, caps or mls packed per bottle for
unit for the product. each drug that is not already on the form.
The unit of issue is a bottle. However, it is
important to identify the number of tabs,
caps or mls of the drug contained in each
bottle.
6. Beginning Balance (Column C): This number should match the Physical
Write in the total balance of each Count at the end of the previous month
product in the store room and the (column G from the previous month’s
dispensary on the starting date of R&R). Refer to Column G of the previous
the reporting period. R&R.
If you do not manage this product at
your facility, draw a line through
columns C – J; fill in the R&R only for
the products that your facility
manages.
7. Total Quantity Received during This information comes from the
the month (Column D): Add up “Received” column on the Stock Control
and write in the total quantity of Card.
each product that was received
during the reporting period. Be sure to include any quantities
received as a part of a regular order or an
emergency order.

Step Action Notes
8. Total Quantity Dispensed for the The quantities dispensed come from the
month (Column E): For each drug ART Daily Activity Register “Quantity
dispensed during the reporting Dispensed for Month”.
period, write the total number of
bottles dispensed. See Job Aid: Completing the ART Daily
Activity Register for completing the row
labelled “Quantity Dispensed for Month.”
9. Losses and Adjustments (Column This information comes from the
F): Calculate and write in the total “Losses/Adjustments” column of the
for the losses/adjustments from the Stock Control Card.
start of the reporting period to the
Adjustments are quantities of a product
end of the reporting period.
received, from any source other than the
District or MSL, or issued to anyone other
than your facility’s patients (e.g., You
received 5 bottles from a local NGO,
which would be a +5 adjustment or you
loaned 5 bottles to another facility, which
would be a -5 adjustment).
Losses are quantities removed from your
stock for anything other than dispensing
to patients or issuing to another facility
(e.g., expired, lost, or damaged). Losses
are recorded as (-) negative numbers.
Write a plus (+) sign next to a positive
adjustment. Example: +3.
Write a minus (-) sign next to a negative
number. Example: -3.
Always indicate if the number is positive
(+) or negative (-).
10. Physical Count (Column G): Write The Physical Count should include all
in the quantities on hand for each ARV Drugs at the facility, including stocks
ARV Drug on the last day of the in the store and dispensary, dispensing
month. The quantities on hand area, and anywhere else ARV Drugs may
should be obtained by doing a be stored, and should only include full
physical count. unopened bottles. Do not include open,
partially used bottles in the Physical
Count.
If the Health Centre stores stock at the

District, they must also add the “Balance
on Hand at the District” from the most
recent Supply Voucher for ARV Drugs to
the quantity stored at the Health Centre.
See Job Aid: “Conducting a Physical

Count,” for further instructions. Also see
the Job Aid: “Completing the Stock
Control Card”.

Step Action Notes
11. Explanation for Losses & Include the product, the quantity, and the
Adjustments: Explain any losses or reason for the loss or adjustment.
adjustments.
Example:
Stavudine/Lamivudine 30/150mg tabs, 5
bottles expired
Nevirapine 200mg tabs, 10 bottles loaned
to Lubuto Health Centre
12. Review your completed report and Items to check include:
make sure that you have filled in all Beginning balance on this report equals
of the columns with the correct Physical Count (column G) from the
information. previous report.
Col. C + D – E +/- F = G
13 AMC (Average Monthly For example:
Consumption) (Column H): For
each Health Centre report, Total quantity of Stavudine/Lamivudine
determine the AMC for each ARV by 30/150mg tabs dispensed for the current
(1) taking the total quantity month (March) is 35 bottles (Column E).
dispensed for the current month
from column E and (2) adding it to Quantity of Stavudine/Lamivudine
the total quantity dispensed during 30/150mg tabs dispensed for the last two
the last two months (which can be months: January = 30, February = 25.
found in column E on the previous
months’ R&R’s). Then, (3) dividing Total dispensed for current and last two
this 3-month total by three. months =
35 + 30 + 25 = 90 bottles
The AMC = 90 ÷ 3 = 30 bottles
Round AMC up to the nearest whole

dispensing unit.
Example: 84.3 ≈ 85 bottles
If the Health Centre experienced stock

outs during the month, do not use that
month’s consumption to determine AMC;
use the next previous month’s
consumption.
14 Maximum Quantity (Column I): Example: 30 x 3 = 90 bottles
Multiply the AMC from Column H by
three. This indicates the maximum quantity of
each ARV to have on hand at the Health
Centre.
15 Order Quantity (Column J): Use the formula: J = I – G
Subtract the physical count of each
ARV listed in Column G from the
maximum quantity for each ARV
noted in Column I.
16 Remarks: Write any remarks or
comments that may be necessary
related to the Requisition Section.

Step Action Notes
17 Completed by/Signature/Date: Press hard enough with your pen so that
Write your name, and sign and date name, signature and date transfer to the
the form. bottom page.
Staff who may be authorized includes:
ART Focal Person, Health Centre In-
Charge, or Pharmacist In-Charge.
18. Ordered by: Print your name and Staff who may be authorized includes:
sign and date the form. ART Focal Person, Health Centre In-
Charge, or Pharmacist In-Charge
19. Authorized by/Signature/Date: If you are not authorized to approve the
Leave this part to be completed Requisition before sending it to MSL let
by the respective District authorized person print his/her name,
authorized staff who will write sign and date.
his/her name, signature and date
the R&R The District Health Officer, District
Pharmacist, or other designated
For satellite sites this R&R goes to Pharmacy staff may be authorized to sign
the Parent Health Center where a the R&R.
review will also be done before
consolidating data by the Parent site
20. Once the form is completed, tear off The R&R should be submitted to the
the top two pages of each page of District Pharmacist no later than the 5th
the R&R leaving the bottom copy in day of the month following the reporting
the book. Then send the top two period.
sheets of each page to the District
Pharmacist. Retain the bottom copy
for your records.
Once the Health Centre Report and Requisition for ARV Drugs is submitted to the District
Pharmacist, he/she will review the R&R and send it on to the MSL CSC. The order will be
delivered through the supply pipeline and a Computer - generated version of the R&R will
accompany the order. This copy should be compared to the original handwritten copy to
check on corrected errors, etc.
Note that satellite sites will submit the form to respective Parent Health Centre and
not the District by the 2nd day following the reporting period so that the Parent site
can consolidate the data.
Task is complete when:

 The beginning and ending dates for the reporting period are filled in
 The facility, District and Province names are filled in
 The beginning balance, quantity received, quantity dispensed, losses and
adjustments, and the results of the physical count are filled in
 Any explanation for losses and/or adjustments are filled in
 The AMC, Maximum quantity and Order quantity have been filled
 The preparer’s and ordering staff name, signature and date are filled in.
 The R&R is sent to the District Pharmacist
B. The Role of the DHO in Reporting and Ordering for the Health Centre
No later than the 5th day of each calendar month, the District Pharmacist will receive 2 copies
of the report section of the R&R from each of the Health Centres within its jurisdiction that

manages an ART program. The District Pharmacist (or delegate) then takes responsibility for
reviewing the reports submitted by each Health Centre on the R&R.
Note: Facilities with eLMIS, once the report is completed and submitted, it will appear
in the central edition and the district will review and approve.
The first task for the District Pharmacist is to verify data accuracy including ARV Drugs
dispensed during the reporting period. Another task the District Pharmacist will have to do as
they review the R&RS will be ascertaining order quantities entered. This will be done by the
simple formula of subtracting the quantity found during the physical count from the maximum
quantity will result in how much to order. The District Pharmacist or designate uses this formula
for each Health Centre order and then submits the orders to the MSL CSC.
In cases where the District may be storing a supply of ARV Drugs for a Health Centre that
does not have sufficient storage space, the Health Centre will have added the quantity of
stock stored at the District to the physical count at the Health Centre as reported in the most
recent Supply Voucher.
Physical Count at Health Centre

Quantity to (3 x Average Monthly
= – (plus stock stored at District
Order Consumption)
where applicable)
JOB AID: District Reviewing the Report and Requisition for ARVs for Health Centres
This job aid will guide you through the process of reviewing R&Rs for Antiretroviral Drugs
(R&R). There are two sections to the R&R. Columns A through G comprise the Report Section
and Columns H through J comprise the Requisition Section both of which are completed by
the Heath Centers.
Note that the satellite site will complete both sections as well..
Each page of the R&R lists different ARV Drugs. When sending this form to the MSL CSC it
is very important that all pages are sent together as a single Report and Requisition. It is also
important that 2 copies of all pages are made during the transfer of report and order
information. The pages are self-carbonized to make copies of each page.
This job aid provides guidance for Reviewing the Report and Requisition.

Task: Reviewing the Report and Requisition for Antiretroviral Drugs for
Health Centres
Completed by: District Pharmacist, Pharmacy Technologist, or any other person

trained and authorized to manage ARV Drugs at the District level
Purpose: To review the Report and Requisition for Antiretroviral Drugs for each
Health Centre in the District providing a monthly report
When to perform: At the end of the report period (each month)
Materials needed: The current month’s completed Report Sections from each ART site in
the District, the completed R&Rs from the two previous months,
calculator and pen
Step Action Notes

1. Review the Report and Requisition for Items to check include:
ARV Drugs received from each of the Beginning balance on this report equals
ART sites in the District. Ensure that Physical Count (column G) from the
each of the Report and order Sections previous report.
is completed properly. Col. C + D – E +/- F = G
2. AMC (Average Monthly For example:
Consumption) (Column H): For each
Health Centre report, Check for AMC Total quantity of Stavudine/Lamivudine
accuracy for each ARV by (1) taking 30/150mg tabs dispensed for the current
the total quantity dispensed for the month (March) is 35 bottles (Column E).
current month from column E and (2)
adding it to the total quantity dispensed Quantity of Stavudine/Lamivudine
during the last two months (which can 30/150mg tabs dispensed for the last two
be found in column E on the previous months: January = 30, February = 25.
months’ R&R’s). Then, (3) dividing this
3-month total by three. Total dispensed for current and last two
months =
35 + 30 + 25 = 90 bottles

dispensing unit.
If the Health Centre experienced

stockouts during the month, do not use
that month’s consumption to determine
AMC; use the next previous month’s
consumption.
3. Maximum Quantity (Column I): Example: 30 x 3 = 90 bottles
Check accuracy of this column by
Multiplying the AMC from Column H by This indicates the maximum quantity of
three. each ARV to have on hand at the Health
Centre.

Step Action Notes
4. Order Quantity (Column J): Subtract Use the formula: J = I – G
the physical count of each ARV listed
in Column G from the maximum
quantity for each ARV noted in
Column I.
5. Remarks: Check for any remarks or Could it be an emergency order or
comments that that may have been situation of potential stock outs, expiries
included on the R&R etc which will require District intervention
6. Authorized by: Write your name and If you are not authorized to approve the
sign and date the form. Requisition before sending it to MSL let
authorized person print his/her name,
sign and date.
The District Health Officer, District

Pharmacist, or other designated
Pharmacy staff may be authorized to sign
the R&R.
7. Tear off and keep the bottom copy of
each page of the completed form for
your records. Then send the top copy
to the MSL CSC by the date indicated
in the published MSL Delivery
Schedule.
The MSL CSC will review the R&R and make sure that the calculations are correct. It will
then pass on the order to MSL staff that will pick the Health Centre’s order, pack it and send
it to the District or through the Hub to the respective sites. The CSC computer will also
generate a new version of the R&R with the information received. This computer-generated
R&R will accompany the Health Centre’s order. Refer to instructions for receiving ARV Drugs
in Chapter VII.
✓ The Report Section of the Form is completed properly.

✓ The Physical Count (Column G) includes any Health Facility Stock that is being stored
at the District facility where applicable.
✓ The AMC is calculated correctly.
✓ The Maximum Quantity for the Health Centre to have on hand is calculated.
✓ The Order Quantity is checked for accuracy
✓ The name, signature and date of the person who completes and orders are filled in.
✓ An authorized person signs and dates the requisition.
✓ The requisition is sent to the MSL CSC.

C. Using the Supply Voucher to Resupply ARV Drugs from the District
As referenced above, it is possible that some Health Centres do not have the sufficient storage
space in their facility to accommodate the maximum quantity of ARV Drugs. It is therefore
necessary for the District Pharmacist to hold some inventory at the District Store on behalf of
these Health Centres. Therefore, when the Health Centre monthly order arrives at the District;
the District stores the order, and re-supplies the Health Centre weekly throughout the month.
The Health Centres uses the Supply Voucher each week to requisition a portion of their
monthly stock received at the District.
JOB AID: Requisitioning ARV Drugs Using the Supply Voucher
Task: Requisitioning ARV Drugs Using the Supply Voucher
Completed by: Health Centre ART Pharmacy In Charge for Health Centres who
store ARVs at the District, District Pharmacist
Purpose: To request ARV Drugs from the District

To report the balance of Health Centre ARV Drugs stored at the
District
To document the issue of ARV Drugs from the District and
receipts at the Health Centre
When to perform: At the end of each week or as agreed between the Health
Centre and the District
Materials needed: Supply Voucher, Health Centre Stock Control Card, Health
Centre copy of previous month’s R&R, District Stock Control
Cards of Health Centre stocks, pen
Notes: The Supply Voucher should have 4 copies (1 original and 3

copies) when initiated.
Step Action Notes

Steps 1 – 11 should be completed at the Health Centre
1. To (Name of District Stores): Write the
name of the District that will receive this
form.
2. From (Name of Centre/Unit/Dept): Write
the name of the Health Centre sending
the form.
3. Requested by/Signature/Date: Print
your name, then sign and date the form.
4. Authorised by/Signature/Date: Leave The In-Charge should not sign and
this section blank until the product date the Supply Voucher until
information has been completed. Columns A, B, C, D and E have
been completed by the H.C. Staff.

Step Action Notes
5. (A) Item Code: Enter the code number of Example: LM0036
the item as listed in the MSL catalogue. If
a facility uses its own codes, these codes
should apply.
6. (B) Description, Strength and Form: Example: Nevirapine, 200 mg tablet
Write the name of the ARV Drug, strength
and form (e.g. tablet, capsule, syrup)
7. (C) Unit: Write the individual unit of the As with the Report and Requisition
ARV Drug Form and Stock Control Cards,
write the unit size (e.g.: bottle of 60
tabs, 240 ml bottle).
8. (D) Balance at Hand: Write the balance Find the Balance at Hand for each
at hand (in units) in the H.C. storeroom at ARV Drug on the Stock Control
the time of completing the Supply Card. Ensure that the Stock Control
Voucher for each ARV Drug. Card has been updated with the
most recent information.
9. (E) Quantity Requested: Write the total The quantity requested is
quantity of each ARV Drug requested. determined by the following formula:
Total quantity dispensed for the
month (from column E of the
previous month’s R&R) minus
Balance at Hand at the Health
Centre (column D of the Supply
Voucher).
If the Health Centre and the District

have agreed to re-supply on a
different (not weekly) schedule,
determine the Quantity Requested
based on your re-supply schedule.
10. Authorised by/Signature/Date: The in- The In-Charge should not sign and
charge who must authorize the Supply date the Supply Voucher until
Voucher prints his or her name, then sign Columns A, B, C, D and E have
and date the form. been completed.
11. Send original and two copies of the The Health Centre may also carry
Supply Voucher to District Pharmacist the copies of the Supply Voucher to
at the end of every week. Keep one the District and pick up the drugs.
copy for your files.
If the Health Centre and the District
have agreed to re-supply on a
different (not weekly) schedule,
submit the Supply Voucher based
on your re-supply schedule.

Step Action Notes
Steps 12 – 18 should be completed at the District
12. (F) Quantity Supplied: Write in the This quantity should equal the
quantity (in units) supplied to the Health “Quantity Requested” from column
Centre for each ARV Drug and update E unless there are Health Centre
the Stock Control Card for that product. stock shortages at the District.
13. (G) Quantity Received: Leave this The Health Centre will complete
column blank. Column G after it receives the
products.
14. (H) Balance on Hand at District: Write
in the balance in units of Health Centre
stock still on hand after the District
supplies the quantity listed on the Supply
Voucher.
15. (I) Remarks: Note any comments that
pertain to the quantities supplied.
16. Approved by/Date: The District
Pharmacist should sign his/her name and
date the voucher after approval.
17. Issued by/Date: The District Pharmacist
or other authorized person preparing the
order should sign his/her name and date
the voucher after approval. Keep one
copy for District files.
18. Dispatch ARV Drugs to Health Centre
along with the original and one copy of
Supply Voucher.
Steps 19 – 22 should be completed at the Health Centre upon delivery
19. Delivered by/Date: The truck driver If the Health Centre comes to the
should sign his/her name and date the District to pick up supplies, leave
voucher after delivering goods to the this line blank.
Health Centre.
20. (G) Quantity Received: Write the If a discrepancy is found between
quantity of each ARV Drug received. the numbers in the “Quantity
Supplied” column and what was
actually received, note this in the
Remarks (I) column of the Supply
Voucher or at the bottom of the
page.
21. Received by/Date: Sign your name and
write the date on which the products were
received.
22. Health Centre keeps and files one
copy of completed Supply Voucher
and gives the original copy to the
District.

 The Health Centre has completed columns A – E and the appropriate individuals
have authorized and signed the voucher.
 The District Pharmacist has filled in the “Quantity Supplied” and “Balance on Hand
at District” columns and approved the voucher with his/her signature and the date.
 The supplies have been delivered to or picked up by the Health Centre and the
delivery truck driver and Health Centre ART Pharmacy In-Charge have signed and
dated the voucher.
 The Health Centre has completed column G and the appropriate individuals have
signed and dated the voucher.
 The Health Centre has a copy of the fully completed Supply Voucher and the District
has received the original.
D. The Role of Hospitals in Reporting & Ordering
Like Health Centres, District Level 1 Hospitals and Level 2 and 3 Hospitals report essential
logistics data at the end of each calendar month. Unlike Health Centres, however, they
calculate their own orders and submit them directly to CSC. Therefore, Hospitals have a
responsibility to report and to order, filling out the entire Report and Requisition form.
If the District Pharmacist who is completing the Health Centre orders is also the pharmacist
for the District Level 1 Hospital, then the District Pharmacist must complete the orders for the
Health Centres and the R&R for the District Hospital.
JOB AID: Completing the Report and Requisition for ARVs – District Level 1
Hospitals, and Level 2 and 3 Hospitals
This job aid will guide you through the process of completing the Report and Requisition for
Antiretroviral Drugs (R&R). There are two sections to the R&R. One section is comprised of
columns A through G and is referred to as the Report Section. The other section is
comprised of columns H through J called the Requisition Section.
The ART Focal Person or Pharmacist in Charge at the District Level 1 Hospital or Level 2 or
Level 3 Hospital completes the R&R.

Task: Completing the Report and Requisition for ARV Drugs – District
Level 1 Hospitals and Level 2 and 3 Hospitals
Completed by: District Pharmacist, ART Focal Person or Hospital Pharmacist in

Charge
Purpose: To report the number of ARV Drugs dispensed, the stock on hand,
and the losses/adjustments and
To calculate and order the appropriate order quantity of ARVs each
month
When to perform: At the end of each calendar month
Materials needed: The completed Stock Control Cards, Stock Control Book (if used),
ART Daily Activity Register, Blank Report and Requisition for ARVs,
R&Rs from the previous two months, calculator and pen
Step Action Notes

1. Reporting Period: Write the day, The reporting period is a full month. The
month and year for the starting R&R should be completed at the end of
date and ending date of the each calendar month.
reporting period.
Example: 1 April 2017 – 30 April 2017
2. Facility Name: Write in the name e.g. Livingstone District Hospital
of the facility.
3. Province and District: Write in
the name of the Province and
District in which the facility is
located.
4. Drug Product (Column A): Pre- If any of the drugs you are recording are
printed. If the product name is not missing from the pre-printed list, write in the
pre-printed, write the name, names of any fixed dose combinations that
strength and form of the product. were dispensed during the reporting period
that do not appear on the form. Then write
in the names of any single drug
formulations that do not appear on the form.
When writing in an ARV that is not pre-
printed on the form, write the name of the
drug, the strength, and form. For example:
Nevirapine, 200 mg tablets.
Note that the same product in different pack
sizes constitutes a different product for
logistics purposes and so should be listed
on different lines of the R&R. For example:
Zidovudine 300 mg tablets, bottles of 100
needs to be on a different line from
Zidovudine 300 mg tablets, bottles of 30.

Step Action Notes
5. Unit (Column B): Pre-printed. If If necessary, write in the total number of
the unit is not pre-printed, write tabs, caps or mls. per bottle for each drug
the unit for the product. dispensed that is not on the form.
The unit of issue is a bottle. However, it is

important to identify the number of tabs,
caps or mls of the drug contained in each
bottle. Example: Bottle of 60 tabs.
For example, the triple fixed dose

combination of Tenofovir, Lamivudine and
Efavirenz comes in a bottle of 30 tablets.
6. Beginning Balance (Column C): This number should match the Physical
Write in the total balance of each Count, column G, from the previous report
product in the store room and the period. Please refer to Column G of the
dispensary on the starting date of previous month’s R&R.
the reporting period.
If you do not manage this product at
your facility, draw a line through
columns C – J; fill in the R&R only for
the products that your facility manages.
7. Total Quantity Received during This information comes from the “Received”
the month (Column D): Add up column on the Stock Control Card.
and write in the total quantity of
each product that was received Be sure to include any quantities received
during the reporting period. as a part of a regular order or an
emergency order.
8. Total Quantity Dispensed for The quantities dispensed come from the
the month (Column E): For each ART Daily Activity Register “Quantity
drug dispensed during the Dispensed for Month”.
reporting period, write the total
number of bottles dispensed. See Job Aid: Completing the ART Daily
Activity Register for completing the row
Labelled “Quantity Dispensed for Month”.

Step Action Notes
9. Losses/Adjustments (Column This information comes from the
F): Calculate and write in the total “Losses/Adjustments” column of the Stock
for the losses/adjustments from Control Card.
the start of the reporting period to
the end of the reporting period. Adjustments are quantities of a product
received, from any source other than the
District or MSL, or issued to anyone other
than your facility’s patients (e.g. You
received 5 bottles from a local NGO, which
would be a +5 adjustment or you loaned 5
bottles to another facility, which would be a
-5 adjustment).
Losses are quantities removed from your

stock for anything other than dispensing to
patients or issuing to another facility (e.g.,
expired, lost, or damaged). Losses are
recorded as (-) negative numbers.
Write a plus (+) sign next to a positive

number. Example: +3.
Write a negative (-) sign next to a negative

number. Example: -3.
Always indicate if the number is positive (+)

or negative (-).
10. Physical Count (Column G): The Physical Count should include all ARV
Write in the quantities on hand for Drugs at the facility, including stocks in the
each ARV Drug on the last day of store and dispensary, dispensing area, and
the month. The quantities on hand anywhere else ARV Drugs may be stored,
should be obtained by doing a and should only include full unopened
physical count. bottles. Do not include open, partially used
bottles in the Physical Count.
See Job Aid: “Conducting a Physical

Count,” for further instructions. Also see the
Job Aid: “Completing the Stock Control
Card”.
11. Explanation for Losses & Include the product, the quantity, and the
Adjustments: Explain any losses reason for the loss or adjustment.
or adjustments.
Example:
Stavudine/Lamivudine 30/150mg tabs, 5
bottles expired
Nevirapine 200mg tabs, 10 bottles loaned
to Lubuto Health Centre
12. Review the completed report Items to check include:
section and make sure that you Beginning balance on this report equals
have filled in all of the columns Physical Count (column G) from the
with the correct information. previous report.
Col. C + D – E +/- F = G

Step Action Notes
13. AMC (Average Monthly For example:
Consumption) (Column H):,
determine the AMC for each ARV Total quantity of Stavudine/Lamivudine
by (1) taking the total quantity 30/150mg tabs dispensed for the current
dispensed for the current month month (March) is 35 bottles (Column E).
from column E and (2) adding it to
the total quantity dispensed during Quantity of Stavudine/Lamivudine
the last two months (which can be 30/150mg tabs dispensed for the last two
found in column E on the previous months: January = 30, February = 25.
months’ R&R’s). Then, (3) dividing
this 3-month total by three. Total dispensed for current and last two
months =
35 + 30 + 25 = 90 bottles

dispensing unit.
If the Hospital experienced stockouts during

the month, do not use that month’s
consumption to determine AMC; use the
next previous month’s consumption.
14. Maximum Quantity (Column I): Example: 30 x 3 = 90 bottles
Multiply the AMC from Column H
by three. This indicates the maximum quantity of
each ARV to have on hand at the Health
Centre.
15. Order Quantity (Column J): Use the formula: J = I – G
Subtract the physical count of
each ARV listed in Column G from
the maximum quantity for each
ARV noted in Column I.
16. Ordered by: Print your name and Be sure to press hard enough with your pen
sign and date the form. so that name, signature and date transfer to
the bottom page.
17. Authorized by: Write your name If you are not authorized to approve the
and sign and date the form. Requisition before sending it to MSL, get
the signature and date from an authorized
person. The authorized person should print
his/her name, sign and date.
The Hospital Pharmacist In-Charge,

Hospital ART Focal Person or the Hospital
Superintendent may be authorized to sign
the R&R.

Step Action Notes
18. Tear off the top copy of each page
of the R&R (keeping the bottom
copy in the book for your records).
Then send the top copy to the
MSL CSC by the date indicated
on the published MSL Delivery
Schedule.

 The beginning and ending dates for the reporting period are filled in
 The facility, Province and District names are filled in
 The beginning balance, quantity received, quantity dispensed, losses and
adjustments, and the results of the physical count are filled in
 Any explanation for losses and/or adjustments are filled in
 The Report Section of the Form is completed properly
 The AMC is calculated
 The Maximum Quantity for the hospital to have on hand is calculated
 The Order Quantity is calculated.
 The name, signature and date of the person are filled in.
 An authorized person signs and dates the requisition
 The facility tears off the bottom copy and sends the two remaining to MSL with copies
of each page stapled to each other.
E. The Role of the Commodity Security Centre in Processing Orders
When the R&R is received at the Commodity Security Centre (CSC) at MSL, the CSC
reviews the R&R to make sure that the information is complete. The R&R information is
entered into the Supply Chain Manager Software and a computer-generated version of the
R&R is produced. If there were math errors in the submitted R&R, the software will make the
appropriate changes, with the corrections shown in bold numbers. The CSC then approves
the order and passes it to the Warehouse section with the computer-generated R&R and
MSL Despatch Note. The Warehouse staff will pick the order, pack it and send it to the
District for onward distribution to the Health Centres. Hospital orders are sent directly from
MSL to the Hospital.
The information from the R&R is processed and used by central management for
procurement purposes. Feedback reports of processed information are sent to MOH,
MCDMCH Central, Province, and District personnel for program planning, and monitoring
and supervision purposes. Feedback reports are also available to cooperating partners and
NGOs to support their own reporting and commodity management needs. Timely receipt and
processing of the R&Rs is essential for ensuring that the system works well, that orders are
received on time, and that clients get the ARV Drugs they need.
F. Placing Emergency Orders

The ARV logistics system is designed to prevent emergency orders. However, every system
must have a procedure for placing emergency orders. As mentioned above, if stock levels
are ever at or below 0.5 months (2 weeks), an emergency order should be placed. When
you receive the Computer - generated R&R, the new Emergency Order in actual
amounts will be printed for each product on the form. The following job aid describes the
process for placing an emergency order.
Note that satellite sites will only send emergency orders to the Parent Health Centre
for drugs at or below EOP

JOB AID: Placing an Emergency Order
Task: Placing an Emergency Order
Completed by: ART Focal Person, District Pharmacist, Hospital Pharmacist In-Charge
Purpose: To order supplies when stock levels are at or below the 0.5 month (2
week) emergency order point.
When to perform: Any time stock levels of ARV Drugs are at or below the emergency order
point.
Materials needed: Blank Report and Requisition for ARV Drugs, previous month’s R&R, and
a red pen.
Note: If the stock level of one product is at or below the Emergency Order
Point, and an MSL delivery is not expected in the next week, place an
order for ARV Drugs that are at or below EOP up to the Maximum Stock
Level.
Step Action Notes

1. Check the “Emergency Order” box located on the top of Use a red pen to write
each page of the Report and Requisition for ARV Drugs Emergency Order across
and write “Emergency Order” across the top of each the top of each page.
page of the Report and Requisition for ARV Drugs.
2. IF…   THEN…
…you are a Health Centre Complete the Report and See Job Aid for completing
Requisition sections for the Report and Requisition
ARV Drugs that are at or form.
below EOP and send this The Reporting Period does
form to the District. not have to be a full
month. Write the day,
month and year for the
starting date of the month
you are at or below EOP
of ARV Drugs; up to the
day you place an
emergency order.
Please do not include all

ARV drugs on the
emergency order.
Include only ARV Drugs
that are at or below EOP.
… you are a District Review and approve the
emergency Report and
form and fax it or have it
delivered to the MSL CSC.

Step Action Notes
…you are a District Level Complete the Report and
1, or Level 2 or 3 Hospital Requisition for ARV Drugs When you receive the
and have the Report & Computer - generated
Requisition approved for R&R, the new
ARV Drugs that are at or Emergency Order Point
below EOP, and fax the in actual amounts will be
form or have it delivered to printed for each product
the MSL CSC.. on the form.
3. Wait until the CSC notifies the you of the order approval.
Then go to MSL to pick up the order.
The District signs the MSL Despatch Note and picks that
up with drugs along with the computer-generated R&R.
4. Hospitals: Bring Emergency Order commodities back to See Job Aid on
hospital and enter into Stock Control Cards “Completing the Stock
Control Card.”
Districts retrieving Emergency Order commodities for
Health Centres: Follow routine receiving
• If Health Centres can store entire shipment, send procedures for handling of
products down to Health Centres or alert Health the MSL Despatch Note
Centres to pick up their supplies. and R&R for emergency
orders.
• If Health Centre cannot store entire shipment,
District should enter commodity information on
Stock Control Cards for the Health Centre stock Quantities received as
stored at the District and inform Health Centre to emergency orders will be
submit a Supply Voucher to receive a portion of included in the next
the order received. month’s R&R “Quantity
Received” column.
This task is complete when:

 The Emergency Order box on the Report and Requisition for ARV Drugs is checked and
“Emergency Order” is written across the top of the form.
 If you are a Health Centre, the Report and Requisition sections for ARV Drugs has been
completed and sent to the District.
 If you are a District, you have received the R&R from the Health Centre, have approved it,
and have faxed or delivered to the MSL CSC.
 If you are a Hospital, the Report and Requisition sections for ARV Drugs form has been
completed and faxed or delivered to the MSL CSC.
 After Emergency Orders are approved by the CSC; orders are picked up at MSL by District
and Hospital staff.
 Emergency Order commodity information has been entered in the Stock Control Cards.
 Health Centre Emergency Order commodities have been issued to Health Centres
according to their storage needs.

VII. RECEIVING ARV DRUGS
This section of the SOP Manual addresses the process for receiving ARV Drugs. It highlights
the different actions at each level where ARV Drugs are received including the District, the
Hospitals and the Health Centres. Figure 2 below outlines the path of ARV Drug orders from
MSL to their intended service delivery point. Figure 2 also shows what forms accompany
each order on its way down the system.
FIGURE 2: ARV DRUG DISTRIBUTION FLOW
MSL:
ARV Drug orders are pre-
packaged for Health Centres;
ARV Drug orders for Hospitals
are included with Hospital
Essential Drug Orders
Each order travels with the:

• Computer-generated copy of
the Report & Requisition for
ARV Drugs (2 copies)
• Computer-generated MSL
Despatch Note (2 copies)
DISTRICT: or MSL Hubs HOSPITALS:

Pre-packaged ARV Drug orders for ARV Drug orders for the
the Health Centres arrive with the Hospitals arrive with the
aggregated Essential Drug orders Essential Drug orders.
for the Districts.
Each order travels with the:

• Computer-generated copy of the Report &
Requisition for ARV Drugs (2 copies)
• Supply Voucher (for those Health Centres
that store drugs at the District) (2 copies)
HEALTH CENTRE:
Pre-packaged ARV Drug
orders for the Health Centres
arrive with the Essential Drug
orders or are picked up at the
District by the Health Centre.

A. Receiving ARV Drugs at a Hospital
If the Hospital submitted its last Report and Requisition for ARV Drugs on time to the MSL
CSC, then the pre-packaged ARV Drug order will arrive on MSL trucks according to the MSL
Essential Drug Distribution schedule. Upon receipt, the Hospital Pharmacist In-Charge
should complete the following steps to ensure a proper receipt of commodities:
JOB AID: Receiving ARV Drugs at a Hospital
Task: Receiving ARV Drugs at the Hospital
Completed by: Hospital Pharmacist In-Charge
Purpose: To inspect and account for ARV Drugs received

To account for any discrepancies between documents and drugs
received
To enter newly received ARV Drugs into inventory
When to perform: Any time ARV Drugs are received
Materials needed: Stock Control Cards for each ARV Drug, pen, products and
documents received, R&R submitted for the order received, MSL
Despatch Note, Computer - generated R&R.
Note: The same procedures that are used for routine receipt of products
should be used for receipt of emergency orders.
Step Action Notes

1. Locate the following documents that
should accompany the order:
• R&R
• MSL Despatch Note
2. Conduct a visual inspection of the See Section VIII-C on Visual Inspection.
order for product quality and to
ensure that the right quantities of
the right products were received.
3. If any discrepancies are noted For example:
between what was supplied If the quantity received is not the same as
according to Despatch Note and the quantity shipped, cross out the
what was received, note number and write the quantity received.
discrepancies on the form.
If any damaged or expired products are
received, cross out the number shipped
and write the quantity of usable product
received.
In every case, include an explanation on

the Despatch Note as to why the change
was made and the difference in quantity.
4. Sign the MSL Despatch Note. There should be two copies of each.
Press hard when writing on the forms so
that the information and signatures
transfer to the second copy.

Step Action Notes
5. Return a signed copy of the MSL
Despatch Note to the MSL driver.
6. Note any differences between the The computer-generated R&R will
computer-generated R&R and the include, in bold print, corrections to any
handwritten R&R submitted as the mathematical mistakes that may have
order. been on the hand-written R&R completed
for ordering.
7. File the copy of the computer-
generated Report and Requisition
for ARV Drugs and the Despatch
Note
8. Enter and update all stock See Job Aid Recording Transactions in
information on the Stock Control the Stock Control Card found in Section
Card for each ARV Drug received. VII-C below.
9. Mark expiry dates clearly, with large,
dark numbers, on each box or
carton. Place and reorganize
products on shelves by FEFO.

B. Receiving ARV Drugs at a District for the Health Centre
If your District submitted the last Report and Requisition for ARV Drugs for its Health Centres
on time to the MSL CSC, then the pre-packaged ARV Drug orders for your Health Centres will
arrive on MSL trucks according to the MSL Essential Drug Distribution schedule. Upon receipt,
the District Pharmacist should complete the following steps to ensure a proper receipt of
commodities:
JOB AID: Receiving ARV Drugs at the District
Task: Receiving ARV Drugs at the District for the Health Centre
Completed by: District Pharmacist

received
To enter newly received ARV Drugs into inventory (if stored on
behalf of the Health Centre)
Materials needed: Stock cards for each ARV Drug (if storing drugs on behalf of
Health Centre), pen, products and documents received, R&R
submitted for each order received, MSL Despatch Note, Computer
- generated R&R.
Each of these steps should be completed for each individual

Health Centre order. Do not combine Health Centre orders or
information.
Step Action Notes

1. Locate the There should be two copies of each
• Computer - generated R&R document.
• MSL Despatch Note
that should accompany the order:
2. Conduct a visual inspection of the See Section VIII-C on Visual Inspection
order for product quality and to
ensure that the right quantities of

Step Action Notes
3. If any discrepancies are noted For example:
between what was supplied If the quantity received is not the same as
according to Despatch Note and the quantity shipped, cross out the
what was received, note number and write the quantity received.
discrepancies on the Despatch
Note, and correct the Computer - If any damaged or expired products are
generated R&R showing the actual received, cross out the quantity shipped
amount received. and write the quantity of usable product
received.
In every case, note the difference in

quantity and include an explanation on
the Despatch Note as to why the change
was made.
4. Sign the MSL Despatch Note. The Health Centre will sign the computer
generated R&R form
There should be two copies of PH81-N.

Press hard when writing on the forms so
that the information and signatures
transfer to the second copy.
5. Return a signed copy of the MSL
Despatch Note to the MSL driver.
computer-generated R&R and the include corrections to any mathematical
handwritten R&R submitted as the mistakes that may have been on the
order. hand-written R&R completed for ordering.
Example corrections:
If the Beginning Balance did not match
the previous month’s ending balance, the
computer will correct the entry so that the
two balances match. The corrected
Beginning Balance will be shown in bold,
and an adjustment, also in bold, will be
included.
If the AMC was calculated incorrectly, the

computer will put the correct amount in
bold and correct the order quantity as
needed, and show the new order quantity
in bold.
7. Prepare and deliver orders to each Along with the products, each Health
Health Centre. Centre should receive two copies of the
computer-generated R&R.
8. After delivery of the order to the
Health Centre, obtain and file copy
of the computer-generated R&R
signed by the Health Centre.

Step Action Notes
If the District stores drugs on behalf of a Health Centre…
9. Enter and update all stock A separate set of Stock Control Cards
information on the Stock Control should be maintained for each Health
Cards for each specific Health Centre’s stock.
Centre for each ARV Drug received.
See Job Aid Recording Transactions in
the Stock Control Card found in Section
VII-C.
11. Inform the Health Centre that the The Health Centre staff should sign the
order has been received. Request Supply Voucher for the order while at the
the Health Centre staff to bring the District.
next Supply Voucher to the District.
The first time that the Health Centre
receives the weekly supply for that
month, they should receive a copy of the
computer-generated R&R.
C. Receiving/Collecting ARV Drugs by the Health Centre
If the Health Centres submitted their last Report and Requisition for ARV Drugs on time to
District, and if the District submitted them on time to the MSL CSC, then pre-packaged ARV
Drug order will arrive at the District on MSL trucks according to the MSL Essential Drug
Distribution schedule.
All Health Centres receive their supplies from their District. Some Health Centres will receive
their entire pre-packaged order from the District at once, but those Health Centres with limited
storage space will receive a portion of their order weekly. Those Health Centres who receive
ARV Drugs weekly from the District must submit the Supply Voucher to request their weekly
order. See Section VI-C.
Whether whole or incremental orders are delivered or collected by the Health Centres, upon
receipt, the ART In-Charge or ART Focal Person should complete the following steps to
ensure a proper receipt of commodities:
The satellites will received their drugs from the Parent Health Centre after sending their R&R
according to the arrangement with the HC.

JOB AID: Receiving/Collecting ARV Drugs by the Health Centre
Task: Receiving ARV Drugs by the Health Centre
Completed by: ART In-Charge or ART Focal Person

received
To enter newly received ARV Drugs into inventory
Materials needed: Stock cards for each ARV Drug, pen, products and documents
received, R&R submitted for each order received, Computer -
generated R&R.
If the Health Centre receives all of its products, complete Steps 1 to 7.

If the Health Centre stores products at the District, complete Steps 8 to 11.
STEP ACTION NOTES

1. Locate the Computer - generated One copy will be kept at the Health
R&R that accompanies the order. Centre; the other copy will be returned to
the District.
2. Conduct a visual inspection of the See Section VIII-C on Visual Inspection
order for product quality and to Quantities supplied on the R&R should
ensure that the right quantities of match what you have received.
3. If any discrepancies are noted The District will have to contact MSL to
between what was supplied and inform them that there has been a
what was received, note discrepancy that should have been noted
discrepancies under remarks on the on the Despatch Note
R&R form: cross out the incorrect
quantity supplied on the R&R and
write the actual quantity received.
computer-generated R&R and the include corrections to any mathematical
handwritten R&R submitted as the mistakes that may have been on the
order. hand-written R&R.
5. Return one signed copy of the
computer-generated Report and
Requisition for Antiretroviral Drugs
and return one signed copy to the
District.
6. Enter and update all stock See Job Aid Recording Transactions in
information on the Stock Control the Stock Control Card found in Section
Card for each ARV Drug received. VII-C.

STEP ACTION NOTES
If your Health Centre stores ARV Drugs at the District…
8. Wait for the District to inform you
that your order has been received at
the District.
9. Go to the District to receive your The first time that your Health Centre
weekly drug supply and sign the receives the weekly supply for that
Supply Voucher for your ARV Drugs month, you will also receive a copy of the
when you receive them. computer generated R&R form. Use the
R&R to verify the information that you
submitted on the original R&R. However,
since you are not receiving all of the
quantities listed as supplied, you will not
sign for the full quantities on the
computer-generated R&R. Use the
Supply Voucher only to note Quantities
Received.
See the Job Aid Requisitioning ARV

Drugs Using the Supply Voucher.
10. Enter and update all stock See Job Aid Recording Transaction in the
information on the Stock Control Stock Control Card found in Section VII-C
Card for each ARV Drug received below.
D. Accounting for Stock Received and Stored
Stock Control Cards are used to account for products held in storage, including their receipt
and issue. The following job aid describes the procedures for maintaining Stock Control Cards
for ARV Drugs. The same procedures should be followed whether the drugs are stored at the
Health Centre, Hospital or at the District on behalf of the Health Centre. In the case where the
District stores ARV Drugs for Health Centres in the District, separate sets of Stock Control
Cards should be kept for each Health Centre with one Stock Control Card for each brand,
pack size, form or dosage of each ARV.

JOB AID: Recording Transactions in the Stock Control Card
Task: Recording Transactions in the Stock Control Card
Completed by: Pharmacist, Pharmacy Technician or other staff in charge of ARVs

authorized to complete the Stock Control Card; witnessing staff
member
Purpose: To record supplies received
To record supplies issued
To record changes in stock balances
To track supplies moved through non-routine methods (e.g., local
purchase, transfers)
To track losses/adjustments
When To Perform: When supplies are received or issued

When supplies are purchased locally
When supplies are transferred to another facility
When supplies are transferred in from another facility (not the
District or MSL)
When supplies are removed from the storage area for reasons
other than for issuing to clients (e.g., for demonstrations,
expiration, damage)
Materials Needed: Blank Stock Control Cards, red ink pen for receipts and physical
inventories, blue/black ink pen for issues; and green ink pen for
audits.
Step Action Notes

1. Complete one Stock Control Card for For example, each of the following
each ARV Drug you store. should have a separate Stock
Control Card:
• Efavirenz 200mg Tablets, bottle

of 90 caps
• Efavirenz 600mg tablets, bottle of
30 tabs
2. Enter only one transaction on each line.

If Opening a new Stock Control Card Continue with Step 3.
If Entering a Transaction Skip to Step 8.
Steps 3-7: Opening a NEW Stock Control Card
3. Code: Enter the code number of the Example: LM0036
item as listed in the MSL catalogue.
If a facility uses its own codes, these
codes should apply.

Step Action Notes
4. Item Description: Enter the name and Example: Nevirapine Tabs
form of the ARV Drug.
5. Strength: Enter the strength of the ARV Example: 200 mg
Drug.
6. Unit: Write the individual unit for the Example: bottle of 60 tabs, 240 ml
particular ARV Drug. bottle
7. Maximum Level: Write “3 Months of Maximum Level is the level above
Stock”. which inventory should not exceed
under normal conditions.
Minimum Level is the level below

Minimum Level: Write “2 Months of which inventory should not fall under
Stock”. normal circumstances.
All Health Centres and Hospitals

have the same Max and Min levels
for all ARV Drugs:
Maximum level: 3 months

Minimum level: 2 months
Note: Reorder Level is not used for

the management of ARV Drugs.
STEPS 8 – 17: Recording Stock Transactions
8. Date: Enter the date of the transaction. Example: 27/11/06
9. Reference No: Enter the delivery note Found on the MSL Despatch Note or
number of the item issued or received. Supply Voucher that accompanies
the item.

Step Action Notes
10. Issued To or Received From:
• If this is the first line of a new stock Example: “Balance Brought
card for an existing product, write Forward”.
“Balance Brought Forward” and
continue with Step 14 in this Job
Aid.
• If this is the first line of a new stock
card for a new product, conduct For recording a physical count, refer
and record a physical count. to the Job Aid Conducting a Physical
• If an item is received, enter the Count in Chapter VIII-B. Page 60
name of the facility from which the
item was received. Example: MSL
• If an item is issued, enter the
name of the facility to which the
item was issued.
• If you are entering a loss, write
“Loss”.
• If you are entering an adjustment,
write the facility from whom or to
whom the products were
transferred, or the nature of the
adjustment.
11. Received (+): Enter the exact amount Stock returned from lower level
of the product received on this date in facilities or transferred from one
red ink. facility to another should be
recorded as an adjustment (see
Step 13 for information on entering
adjustments). Therefore, the only
quantities entered in this column
should be those quantities received
from MSL or CHAZ for those CHAZ
supported sites respectively.
12. Issued (-): Enter the exact amount of
the product issued on this date in
blue/black ink.

Step Action Notes
13. Losses and Adjustments: Enter the Losses are quantities removed from
exact amount of losses or adjustments your stock for anything other than
to the inventory on this date. dispensing to patients or issuing to
another facility (e.g. expired, lost,
Explain any losses or adjustments in stolen, or damaged). Losses are
the “Remarks” column (See Step 17). recorded as (-) negative numbers.
Adjustments are quantities of a

product received from any source
other than the District or MSL, or
issued to anyone other than your
facility’s patients (e.g., you received
5 bottles from a local NGO, which
would be a +5 adjustment or you
loaned 5 bottles to another facility,
which would be a -5 adjustment).
Always use a (+) sign to indicate
positive adjustments, and a (-) sign
to indicate negative adjustments.
Adjustments may also be made to

correct mathematical mistakes
previously made in recording. Be
sure to indicate if the adjustment
was negative or positive and note
the reason for the adjustment in the
“Remarks” column.
14. Balance:
If receiving products: Add the “Quantity

Received” to the Balance from the
previous row and then enter the new
balance.
If issuing products: Subtract the

“Quantity Issued” from the Balance from
the previous row and then enter the
new balance.
If recording a loss or adjustment: Add or

subtract the loss or adjustment quantity
to the Balance from the previous row
and then enter the new balance.
15. Unit Price: Leave this column blank. At this time, Unit Price is not listed
on the MSL Despatch Note and will
not be used for the day-to-day
management of ARV Drugs.
16. Name/Signature: Print your name and
then put your signature.

Step Action Notes
17. Remarks: Provide a brief explanation
for any loss/adjustment or add any
other comments as needed.
When you have completed both the front and back sides of a stock control
card for a product, attach a new stock control card to the top of the old card.
Follow steps 3-7 above and then write the date and the words “Balance
Brought Forward” or “B/F” on the first line. Write the quantity brought forward
from the old card in the first “Balance” space on the new card.
18. If your facility keeps a Stock Control Additional information can be found
Book, be sure to update this book with in the Pharmacy Antiretroviral
the information on the Stock Control Therapy Standard Operating
Cards. Procedures Manual (January 2005)
on pages 10-14: SOP 004 Inventory
Control in the Bulk Store.
Keep the Stock Control Card close to
where products are being stored and
issued in the pharmacy.
NOTE: If you use an electronic version of this form or enter this data in ART software,
ensure that all the electronic versions record all of the same information as the hard copy
Stock Control Card.

 A separate Stock Control Card has been completed for each ARV Drug managed in the
store.
 The item description and stock levels have been written at the top of each Stock Control
Card.
 Each transaction is recorded on the Stock Control Card as it occurs.
 The Stock Control Card is kept close to where the commodities are stored.

VIII. STORING ARV DRUGS
Storing is the safe keeping of ARV Drugs to avoid damage, expiry, and theft. Proper storage
procedures help ensure that storage facilities protect the shelf life of products, that only high-
quality products are issued, and that there is little or no waste due to damaged or expired
products. If proper storage procedures are followed, customers can be assured that they have
received a high quality product.
Storage conditions will affect the quality of the ARV Drugs being stored. Rooms that are too
hot, stacks of cartons that are too high, and other poor storage conditions can cause damage
to ARV Drugs, or cause a reduction in shelf life. A well-organized storeroom will simplify a
facility’s work; time will not be wasted trying to find needed supplies.
Each commodity has a shelf life which is specified by the Shelf life is the length of
manufacturer. When the drug reaches the end of its shelf, time a product may be
it has expired and should not be distributed to patients. stored without affecting
ARV Drugs have short shelf lives, ranging from six to 24 the usability and safety
months. Because of these short shelf lives, it is important of the item.
that proper storage procedures are followed, so that the
shelf life is protected.
A. Storage Guidelines
In general, supplies should be protected from sun, heat, and water. Follow manufacturer
recommendations for storing supplies. This information is usually printed on the product
carton and boxes. The following are storage guidelines that should be followed at all
facilities.
Storage Guidelines
1. Clean and disinfect the Pests are less attracted to the storeroom if it is
storeroom regularly. regularly cleaned and disinfected. If possible a
regular schedule for extermination will also help
eliminate pests. Keep food and drink out of the
storeroom.
2. Store ARV Drugs in a Extreme heat and exposure to direct sunlight can
dry, well-lit, well- degrade ARV Drugs and dramatically shorten shelf
ventilated storeroom - life. Temperatures in the storeroom should not
out of direct sunlight. exceed 27oC. Direct sunlight raises the temperature
of the product and can reduce its shelf life. ARV
Drugs should not be opened to repackage them.
Store supplies in their original shipping cartons.
3. Protect storeroom from Water can destroy both supplies and their
water penetration. packaging. If the packaging is damaged, the product
is still unacceptable to the patient even when the
ARV Drug is not damaged. Repair the storeroom so
that water can not enter. Stack supplies off the floor
on pallets at least 10 cm high and 30 cm away from
walls as moisture can seep through walls and floors.
ARV Drugs are particularly sensitive to moisture.

4. Keep fire safety Stopping a fire before it spreads can save millions of
equipment available, kwacha of supplies and the storage facility. The right
accessible, and equipment should be available; water is able to put
functional, and train out paper fires, but is ineffective on electrical and
employees to use it. chemical fires. Place well-maintained fire
extinguishers at suitable positions in the storeroom.
If a fire extinguisher is not available, keep sand or
soil in a bucket nearby. Regardless of the method
used, train the staff in the use of the available fire
safety equipment.
5. Store latex products Latex products can be damaged if they are directly
away from electric exposed to fluorescent lights and electric motors.
motors and fluorescent Electric motors and fluorescent lights create a
lights. Not related to chemical called ozone which can rapidly deteriorate
ARVs, but… latex products. Keep latex products in paper boxes
and cartons.
6. Maintain a cold storage, Cold storage (2 to 8 degrees Celsius; 36 to 46

including a cold chain, degrees Fahrenheit) is essential for maintaining the
as required. shelf life of ARV Drugs that require it. These items
are irrevocably damaged if the cold chain is broken.
If electricity is unreliable, the use of cylindered gas or
kerosene-powered refrigeration is recommended.
Most ARV Drugs require storage below 25 oC. Some
of those that require refrigeration, that is storage
between 2- 8 oC, include lopinavir/ritonavir capsules
and Stavudine oral suspension after reconstitution.
7. Limit storage area To prevent theft and pilferage, lock the storeroom
access to authorized and/or limit access to personnel other than
personnel and lock up authorized staff, and track the movement of ARV
controlled substances. Drugs. Access must not, however, prevent
appropriate distribution, thus a spare set of keys
should be kept in the office of the In-Charge.
Physical counts should be conducted on a regular
basis to verify inventory records.
8. Stack cartons at least 10 Pallets keep the products off the floor so they are
cm off the floor, 30 cm less susceptible to pests, water and dirt damage.
away from the wall and Stack pallets 30 cm away from the walls and each
other stacks, and no other to promote air circulation and to ease
more than 2.5m high. movement of stock, cleaning and inspection.
Do not stack cartons more than 2.5m as the weight

of the products may crush the cartons at the bottom.
This will reduce potential injury to warehouse
personnel. If cartons are particularly heavy, stack
cartons less than 2.5m.
At health facilities, where the use of pallets is

inappropriate, shelving is used.

9. Store medical supplies Exposure to insecticides and other chemicals may
away from insecticides, affect the shelf life of medical supplies. Old files and
chemicals, old files, office supplies may get in the way and reduce space
office supplies and other for medical supplies or make them less accessible.
materials. “Dejunk” the storeroom regularly to avail more space
for storage.
10. Store flammable Some medical procedures use flammable products,

products separately from such as alcohol, cylindered gas, or mineral spirits.
other products. Take Such products should be stored away from other
appropriate safety products and near a fire extinguisher.
precautions.
11. Store health FEFO (First Expired, First Out) is a method of

commodities to facilitate managing ARV Drugs in a storage facility where the
FEFO procedures and drugs are managed by their expiry date. Drugs that
stock management. will expire first are issued first, regardless of when
they were received at the health facility.
12. Arrange cartons with Identification labels make it easier to follow FEFO,
arrows pointing up, and and make it easier to select the right product. Items
with identification labels, should be stored according to manufacturer’s
expiry dates, and instructions on the cartons; this includes paying
manufacturing dates attention to the direction of the arrows.
clearly visible.
13. Separate from usable Do not dispense expired drugs to the patients.
commodities and Designate a separate part of the storeroom for
dispose of damaged or damaged and expired goods. See Section VIII-D
expired products, and VIII-E for instructions on handling damaged or
Remove them from expired products and return or disposal of drugs.
inventory immediately
and dispose of them
using established
procedures.
NOTE: District Level 1 Hospitals that store Health Centre stock should also
store this stock according to the guidelines; however, the Health Centre
stock must be kept separate from the District Hospital’s own stocks of ARV
Drugs and separate Stock Control Cards maintained. A separate section of
the storeroom should be allocated for the storage of Health Centre stock.

B. Conducting a Physical Count
A physical count is an actual count of the quantity of each supply at any given time. It is one
of the most frequent activities in health facilities.
A physical count of ARVs should be conducted at the end of each month.
Physical count information comes from two locations in any facility:
(1) The quantities on the shelf in the storeroom, which are recorded on the Stock
Control Card; and
(2) The quantities kept by the dispensers in the facility, which are added to the
quantities in the storeroom and reported on the R&R. Note: Health Centres that store
products at the District must also add the quantities being held at the District to the
Physical Count amounts they enter on the R&R.
For example, when conducting a count of Nevirapine

200 mg tablets, 60 tablets per bottle, if there are 10 When taking physical count
bottles on the shelf in the storeroom, and 2 bottles and completing the Report
held at the dispensing site, the total physical count and Requisition for ARV
for the facility is 12 bottles. The 10 bottles on the Drugs, all stock, including
shelf in the storeroom are noted on the Stock Control what is remaining in the
Card; the total of 12 bottles is noted on the R&R. dispensary after dispensing
to the client, should be
Opened bottles or bottles in the dispensary or store counted.
whose seal is broken should not be included in a
physical count. Count and record only full bottles.
A physical count of the products in the storeroom is done to verify that the stock balance
found on the Stock Control Card shows the correct number of usable drugs that are
available in the storeroom. If the quantity on the Stock Control Card does not match the
quantity on the shelf, the Stock Control Card should be updated and an adjustment entered.
See Step 2i. of the Job Aid below for information on entering adjustments on the Stock
Control Card.
Instructions on how to complete a physical count are provided in the Job Aid below.

JOB AID: Conducting a Physical Count
Task: Conducting a Physical Count
Completed by: Storekeeper
Purpose: To verify the stock level of a drug in the store at the time of
physical count
To detect errors in drug management records
To detect drug loss in the store
When to perform: At the end of each calendar month, and any time you suspect
that products have been lost
Materials needed: Stock Control Cards, calculator, pencil, red ink pen, paper
Prior to a Physical Count, these tasks should be completed:
 Set a date at the end of the month for the physical count. Select the physical count
team. Participants should be selected from the facility. The storekeeper, dispenser
and pharmacist should be members of the team.
 Do not issue drugs during the physical count or count receipts on the day of the
physical count, except in an emergency. Receipts during the physical count will be
recorded on the Stock Control Card the following day and counted in the next
physical count.
 Make sure that the Stock Control Cards for the drugs are updated to the day of the
physical count. If the Stock Control Cards are not completed, complete them.
 Prepare the store, making sure all cartons are neatly stacked and partial cartons
are clearly visible.
 Reorganize products by FEFO before counting. Mark expiry dates clearly, with
large, dark numbers, on each box or carton. This step should have been taken
during routine receipt and management of drugs.
 Visually inspect the drugs as you organize them for counting. See section on Visual
Inspection for more information.
 Separate any expired or damaged drugs.
 Be sure to have the Stock Control Cards for the drugs to be counted.
THE STORE IS NOW READY FOR THE PHYSICAL COUNT.

Conducting a Physical Count
Step Action Notes

1. Count the usable drugs. The units that should be used are
bottles. Make sure that you count units
A. Count unopened/complete that have the same name, same
cartons first. Multiply the dosage, same formulation, and same
number of cartons by the pack size.
number of unit Management
Units (bottles or blister packs, Example: all “Zidovudine/Lamivudine
for co-packaged ARV Drugs) 300/150 mg tablets, bottles of 60
in the carton. This will give you tablets” should be counted together.
the total number of bottles in
the carton. Example:
I have 4 unopened cartons with each
B. Next count the boxes inside one containing 200 bottles.
the open cartons. If an open 4 x 200 = 800 total bottles in the
carton contains unopened unopened cartons
boxes, count the boxes and
multiply the number by the I also have 1 opened carton with 10
number of bottles in a box. unopened boxes inside. Each unopened
This will give you the total box contains 5 bottles.
number of the bottles in the 10 x 5 = 50 total bottles in the unopened
unopened boxes. boxes.
C. Count all the units that are in I also have counted 19 bottles in an
open boxes. open box/bottle on a shelf.
D. Add up the total units from the 800 bottles from unopened cartons
unopened cartons, unopened 50 bottles from unopened boxes
boxes, and in open boxes in + 19 bottles from opened boxes,
the storeroom. 869 total bottles = Actual Quantity on
Hand.
2. Update the Stock Control Card Use a red pen when completing these
by completing the following steps.
actions:
2a. Circle the last calculated Stock Example: Circle “875”, which is the
Balance. If this is the first entry on previous, calculated Stock Balance.
the Stock Control Card, skip to
Step 2c.
2b. Draw a line under the row that This will highlight the physical count
shows the last calculated stock information from the rest of the
balance. information on the Stock Control Card.
2c. Date: Write the date of the
physical count.
2d. Issued to or Received from:
Write “Physical Count”.
2e. Received (+) and Issued (-):
Leave these columns blank.
2f. Losses and Adjustments: Leave Any losses and adjustments will be
this column blank until after you recorded after the physical quantity has
complete Steps 2g and 2h below. been recorded.

Step Action Notes
2g. Balance: Write in the result of the This is the actual quantity on hand in the
physical count. storeroom only.
2h. Compare the previously
recorded stock balance that you
just circled to the Physical
Count balance.
If the previously recorded stock

balance (circled in the line above)
matches the physical count, skip
to Step 3 below.
If the previously recorded stock

balance (circled in the line above)
does not match the physical
count, continue with Step 2i
below.
2i. Determine your Loss or Example calculation:
Adjustment. Subtract the
calculated Stock Balance 869 Actual Quantity on Hand
(previously circled) from the Actual - 875 Calculated Stock Balance
Quantity on Hand. -6 Difference (Loss of 6 bottles)
➢If your result is a negative quantity

you have suffered a loss of the drug.
➢If your result is a positive quantity,

you have more units of the drug in
stock than you had recorded on the
Stock Control Card.
Sometimes the difference is due to a

mistake while counting during the
physical count or due to a mathematical
error in the Stock Control Card. Repeat
the physical count if you believe there
was a mistake in the counting, and
check for mathematical errors on the
Stock Control Card. If mistakes are not
found, the difference must be recorded
on the Stock Control Card.

Step Action Notes
2j. Record the Loss or Adjustment. Example;
On the Stock Control Card. In the Losses/Adjustments -6
Losses and Adjustments
column, write the answer that was If the adjustment is positive, write a plus
calculated in step 2i. The (+) sign next to the number, example +3
loss/adjustment is documented in
the same row as the transaction of If the adjustment is negative, write a
the physical count. Write in red negative (-) sign next to the number,
pen, the quantity of the example –3
loss/adjustment.
All Losses/Adjustments should be
documented, and the difference in stock
explained in the Remarks column
3. Unit Price: Leave this column This will not be used for the day-to-day
blank. management of ARV Drugs.
4. Name/Signature: Print your name
and write your signature.
5. Remarks: Write any comments Examples:
related to losses/adjustments
noted during the physical count. Negative adjustments (losses): expiry,
damage, not found at physical count.
Positive adjustments: found at physical

count.
6. Draw a line under the row of the This will complete the differentiation
Stock Control Card where you between the physical count information
recorded the physical count. and the rest of the information on the
card.
7. Make sure the stocks are
arranged back in their appropriate
place according to FEFO.
8. Keep each Stock Control Card
with its matching product in the
storeroom.

 The Actual Quantity on Hand in units of the drugs has been counted and recorded
in the Balance column on the Stock Control Card.
 Losses /Adjustments have been calculated and recorded in the Losses and
Adjustments column on the Stock Control Card. (If applicable)
 Losses/Adjustments have been documented and the difference in stock explained
in the Remarks column. (If applicable)
C. Visual Inspection
To protect the quality of ARVs, it is important to conduct Visual inspection is the
visual inspections of the products. A visual inspection should process of examining
be completed each time products are handled: when products and their
receiving, issuing, or dispensing supplies, or when packaging by eye to
conducting a physical count. look for problems in
product quality.

When conducting a visual inspection, be sure to check the following:
Package and product integrity: check for damage to packaging

(tears, perforations, water or oil) and products (broken or crumbled
tablets, broken bottles).
Manufacturing defects: incomplete supply, missing or illegible

identification information.
Labelling: make sure that products are labelled with the date of
manufacture or expiration, lot number and manufacturer’s name.
For tablets and capsules, be sure that:

• Tablet/capsules are identical in size, shape and colour
• Tablet/capsule markings are identical (scoring, lettering, numbering)
• There are no defects such as spots, cracks, stickiness, etc.
• There is no unexpected odour when bottle is opened
• There are no broken tablets or no empty, open, or broken capsules.
D. Handling Damaged or Expired Stocks

Logistics systems try to minimize the amount of damaged or expired stocks. However, if
expired or damaged stocks are found at any time during a visual inspection or physical count
(or upon receipt of a consignment), these stocks should be removed from the inventory.
These stocks should be moved to a separate place, so that they cannot be dispensed or
used. The following JOB AID explains how to handle damaged or expired products.
JOB AID: Handling of Damaged or Expired Products

Task: Handling of damaged or expired products
Completed by: ART Pharmacy in-charge countersigned by overall ART in-

charge, Hospital Pharmacist or other authorized person
Purpose: To remove unusable products from storage so they are not

distributed to clients.
When to perform: Whenever damaged or expired products are known or discovered
Materials needed: Stock Cards for damaged or expired products
Step Action Notes

1. Stack damaged or expired products separately from
usable stocks; keep them in an unused box or on an
unused shelf.
2. Write Damaged or Expired Stock on the box or shelf.

Step Action Notes
3. IF  THEN
Damaged or • Record the quantity of expired See job aid
expired products or damaged stock as a loss on “Completing the
were found during the appropriate Stock Control Report for
a visual inspection Card and subtract the quantity Returning
or routine physical from the Balance On Hand Products”
count. column.
• Complete the Report for Products may be
Returning Products. returned to the
supplier (MSL,
District) when the
driver brings the
next order.
Damaged or • Do not accept the products at See job aid
expired goods your facility; return them with “Completing the
were found upon the driver Report for
receipt of a • Complete the Report for Returning
consignment Returning Products Products”
4. If you are at a Health Centre, notify the District.
If you are at a District or Hospital, notify MSL.

 Damaged or expired stock has been separated from usable stock.
 Stock Control Cards have been updated.
 Appropriate authorities have been notified.
 Report for Returning Products has been completed (if necessary).

JOB AID: Completing the MSL Returns Authorisation Form
Task: Completing the MSL Returns Authorisation Form
Completed by: ART Focal Person or Pharmacy In-Charge at the Health Centre,
District Pharmacist, ART Focal Person or Hospital Pharmacist in
Charge
Purpose: To obtain authorisation to return unusable products to MSL from

health facilities.
When to perform: Whenever there are surplus or unusable products that need to be
returned to MSL.
Materials needed: A blank MSL Returns Authorisation form and a pen.
Note: You must first determine if products are in excessive surplus. If so, contact
your supplier or supervisor to determine if the products should be returned for re-
distribution to other facilities before seeking authorisation to return the products to
MSL.
Step Action Notes

Client Details
1. Institution Name: Write the name of
the facility from which the products are
returned.
2. Name of Requesting
Officer/Designation/Date: : Print your
name, designation and date of request.
Product Details
3. Product Description/Pack Size: Write Example: Nevirapine 200 mg tablets,
the name, strength, and form of the Pack size: 60 tablets
product being returned and the pack
size
4. Quantity to be Returned: Write the Example: 10 bottles
quantity in units of the product that you
requesting to be returned.
5. Expiry Date: Write the date of expiry of If there are multiple expiry dates for the
the products. same product, list each product with a
different expiration date separately.
Example:
• Nevirapine 200 mg tabs
Exp Date: 12 April 2006
Exp Date 27 May 2006
Exp Date 18 June 2006

Step Action Notes
6. Reason for Return: Write the reason Example:
for which you are returning the Damaged, expired, unusable etc.
product(s).
7. Other comments from the customer: e.g. valid but no longer in use at the
Write any supporting information that is facility etc
necessary in authorising the return of
the products.
8. Send the MSL Authorisation form to Health Centres should send the form to
the appropriate place. the District who after review will send
the form to CSC.
Hospitals will send the form directly to

CSC and await their response.
9 Authorisation: Refer to Job Aid: Completing Report for

Once MSL has authorised the return of Returning product(s) form below.
the products, the facility will be informed
to hand over the product with the
accompanying completed Report for
Returning product(s) form to the MSL
driver.

JOB AID: Completing the Report for Returning Products
Task: Completing the Report for Returning Products
Completed by: ART Pharmacy-In-Charge, District Pharmacist, or Hospital

Pharmacist; the person transporting the returned products
Purpose: To track products returned to MSL from health facilities.
When to perform: Whenever there are surplus or unusable products that need to be
returned to MSL.
Materials needed: A blank Report for Returning Products, calculator and pen.
Note: The Report for Returning products form has three copies (an original and two
copies). Press hard on the top copy so that the writing appears on all the carbonated
copies clearly. Use a pen.
Determine if products are in excessive surplus; contact your supplier or supervisor

to determine if the products should be return
d for r
-distributi
n to other facilities.
IF THEN
YOU ARE A HEALTH CENTRE RETURNING SUPPLIES
TO A DISTRICT; OR YOU ARE A HOSPITAL  COMPLETE STEPS 1-10
RETURNING YOUR OWN SUPPLIES TO MSL
YOU ARE A DISTRICT RECEIVING SUPPLIES FROM A

HEALTH CENTRE  COMPLETE STEPS 11-12
YOU ARE A DISTRICT RETURNING SUPPLIES TO MSL

FROM ONE OR MORE HEALTH CENTRES IN YOUR  COMPLETE STEPS 13-14
DISTRICT
YOU ARE A DISTRICT RETURNING SUPPLIES TO MSL
FROM YOUR OWN FACILITY  COMPLETE STEPS 1-10
Step Action Notes

1. Sent to: Write the name of the facility to Health Centres should return products
which the products are returned. to the District.
Districts and Hospitals should return

supplies to MSL, if necessary. Supplies
do not have to be returned to MSL if
Districts and/or Hospitals have the
ability and authority to dispose of
products themselves.
2. Facility returning products: Write the
name of your facility.
For each product being returned:

Step Action Notes
3. Product Description: Write the name, Example: Nevirapine 200 mg tablets
strength, and form of the product being
returned.
4. Quantity Returned: Write the quantity Example: 10 bottles of 90
and unit of the product that you are
returning.
5. Expiry Date: Write the date of expiry of If there are multiple expiry dates for the
the products. same product, list each product with a
different expiration date separately.
Example:
Exp Date: 12 April 2006
Exp Date 27 May 2006
Exp Date 18 June 2006
6. Reason for Return: Write the reason Example:
for which you are returning the Damaged, expired, etc.
product(s).
7. Name of person returning products/
Date / Signature: Print your name, put
the date and sign your name.
8. Name of Carrier / Date / Carrier’s
Signature: Ask the person who is
transporting the products from the
sending facility to the receiving facility to
print her/his name and date, and to sign
her/his name.
9. Comments: The person transporting Normally, there should be no additional
the products can write in any comments comments required.
related to the transaction.
10. Send the report (and products) to the Health Centres should send the report
appropriate place. and the unusable products to the
District.
The facility originating the report should
retain the bottom copy. Unusable products should be placed
on the District/ MSL truck the next time
the District/ MSL truck comes to the
facility.
Districts and Hospitals must return

viable products to MSL. It is not
necessary to return products to MSL if
the District or Hospital has the ability
and authority to dispose of expired or
damaged products themselves.
WHEN RECEIVING RETURNED PRODUCTS, STEPS 11-12 SHOULD BE FOLLOWED
11. Receiver’s Name / Date / Receiver’s
Signature: The person who receives
the products at the receiving facility
prints her/his name and date, and signs
her/his name.

Step Action Notes
12. Comments: The receiver writes any
comments as appropriate.
WHEN A DISTRICT IS RETURNING UNUSABLE PRODUCTS RECEIVED
FROM HEALTH CENTRES IN THEIR DISTRICT TO MSL, STEPS 13-14 SHOULD BE FOLLOWED
13. Keep all products returned from various Keep these stocks separate from all
health facilities until the MSL truck other inventory. If expired or damaged,
arrives for the next scheduled delivery. these products should not be
distributed to clients.
14. Name of Carrier / Date / Carrier’s When the MSL truck arrives, have the
Signature: Ask the person who is Carrier sign for each Report for
transporting the products from the Returning Products for each Health
sending facility to the receiving facility to Centre.
print her/his name and date, and to sign
her/his name.
Retain one copy of the Report for

Returning Products.

 The name of the facility to which products are being sent and the name of the facility
returning products are filled in.
 The description and quantity of products being returned, the expiry date and reason for
non-use are filled in.
 The person filling out the report has written his/her name, signature and the date.
 The person transporting the products has written his/her name, signature and the date.
 The person receiving the products has written his/her name, signature and the date.
 A copy of the form is kept at the facility where the form was completed and one copy is
sent to the appropriate party.
E. Disposal Guidelines
If authorized, DHOs and Hospitals may dispose of unusable drugs following Government of
Zambia guidelines. Additional information can be found in the Pharmacy Antiretroviral
Therapy Standard Operating Procedures Manual (January 2005) on pages 38-40: “SOP 013
Disposal of ARVs.”

IX. MONITORING AND SUPERVISION
A. Monitoring, Supervision and Providing Feedback
Three of the most important responsibilities In-Charges and District-level personnel carry out
are monitoring of activities and systems, supervision of personnel, and providing feedback to
staff. These three responsibilities form the supportive backbone of an effective logistics
system. But what is it that makes a logistics system effective? In brief, we know that an
effective logistics system is one in which the right products, in the right quantities and in the
right condition are at the right place, at the right time and at the right cost. These are the six
rights of every Zambian. Health personnel responsible for the work of others are therefore in
a unique position to make sure that this “effectiveness” happens – and not just once, but all of
the time.
When it comes to the monitoring and supervision of the ARV logistics system, there are
several reasons why personnel need to be supervised and logistics activities need to be
monitored on a regular basis:
• ARVs are expensive commodities and most have relatively short shelf lives. They
cannot be wasted.
• Clients on ART must not miss their scheduled treatment regimens or they could
develop resistance to the drugs;
• Most regimens are a combination of drugs so whether they are in individual or
combined formulations, they must be available to the client for the rest of his/her life;
• Information about the kinds and quantities of drugs dispensed is critical for managing
an uninterrupted supply of drugs;
• The ARV logistics system has been designed to follow certain policies and
procedures. For example, Districts calculate the orders for Health Centres based on
the Health Centres’ reports. Constant support and guidance from supervisors is
therefore needed to keep
the system performing
effectively.
• Staff might need in- MOH MSL
service training to refresh CSC
their knowledge and skills
or perhaps to add to their
knowledge and skills; Provincial
Health Office
• Staff need to know how
the work they do
contributes to Zambia’s Level 2 and 3 District Level 1 DHO
Hospitals Hospitals
overall battle against
AIDS. Feedback
Report
Health Centres
In general, most logistics
systems and activities can be Feedback
Action
monitored by reviewing reports.
These reviews can frequently be
done from an office. For example, checking reports can determine if a facility is maintaining
stock balances between maximum and reorder levels, or if there are unusual quantities of
supplies expiring or lost. Likewise, a review of reports can reveal whether demand for ART is
increasing or decreasing.

Effective supervision, on the other hand, can only take place in the presence of the facility
staff. Supervisors should plan to spend time supervising and providing on-the-job training
during each supervisory visit.
B. Monitoring at the District Level
While monitoring the logistics system from the Health Centre R&R, look for the following
indicators:
• Timeliness of reports from the Health Centres: Did the reports arrive within the
designated time period? (i.e., in time so that the District Pharmacist is able to
calculate the orders?)
• Accuracy of the reports: Do the ending balances from one report equal the beginning
balances of the following report? Do the numbers reported make sense?
• Completeness of reports: Is all information required to calculate orders included in
the reports?
• Completeness of reporting: Are reports received from all the facilities that should
report?
• Stockouts: Do the reports indicate any stockouts of any supplies?
• Stocked according to maximum and reorder levels: Are the stock levels within the
designated maximum and reorder levels for that facility?
• Losses: What quantities of stock were lost due to theft, damage or expiry?
Problems that are found during routine reviews of reports received should be discussed
during the next supervisory visit to the facility concerned.
C. Using and Interpreting Feedback Reports
Data that are reported to the CSC through the Report and Requisition for Antiretroviral Drugs
are entered into the Supply Chain Management Software. Several reports are generated from
the database and used for program management, procurement, monitoring and supervision.
The following is a sample of the feedback reports that may be disseminated to program
managers and implementers for monitoring and supervision. A brief description of how these
reports may be used is also included. Representative feedback reports include:
• Facilities Stocked According to Plan

• Facilities Stocked Out
• Non-Reporting Facilities
• Summary Consumption Comparison by Product
• Discrepancy between Quantity Supplied and Quantity Received
When appropriately used, feedback reports can identify logistics system strengths and areas
for improvement. They can be used by supervisors to monitor the system in their District or
province, motivate staff who implement the system, and to identify areas where more effort
is needed to improve staff performance in managing the system.
Facilities Stocked According to Plan
A sample of the Facilities Stocked According to Plan report can be found on the following
page. This report summarizes, for each Province or District, or the country as a whole, the
number, percentage, and names of facilities whose stock levels are within the accepted norms,
being neither under-stocked nor overstocked at the time a report is submitted. Program
managers, including District Pharmacists, Principal Pharmacists, and CSC Staff, can use this

report to see how well facilities are able to maintain stock levels between the 3 month
maximum and 2 month minimum level for the National ARV Logistics System.
When appropriate stock status has been achieved, personnel should be congratulated on their
ability to effectively maintain sufficient inventories of products. If here are difficulties in
maintaining the appropriate stock levels, a number of potential weaknesses could be causing
the problem. These could include late or incorrect orders, long lead times in order processing
and delivery, or excessive damage or expiry of product. Program managers and supervisors
would investigate the potential causes of problems and take action to solve the problems
identified.
Facilities Stocked According to Plan

Period: January 2006-May 2006
Facility Type all
Reporting Group all
Total Facilities: 126

No. Stocked According to Plan: 98
Percent: 77.8%
Facility Facility
Code Facility Code Facility
Zambezi General
LUSA003 Lusaka Health Center A ZAMB004 Hospital
St. Dorothy Health
LUSA006 Lusaka Level 1 Hospital SOLW001 Center
Facilities Stocked Out
The Facilities Stocked Out report summarizes, for each Province or District, or the country as
a whole, the facilities who reported a stockout on their recent Report and Requisition for ARV
Drugs. Program managers, including District Pharmacists, Principal Pharmacists, and CSC
Staff, can use this report to see at a glance how many facilities have suffered a stockout. Any
facilities appearing on this report would be contacted or visited in order to determine the cause
of the stockout(s). Depending on the cause of the stockout, the appropriate corrective
measure(s) would be taken, in order to avoid stockouts in the future.
Facilities Stocked Out

Facility Type all
Reporting Group all
Total Facilities: 126

No. Stocked out: 20
Percent: 15.9%
Facility Code Facility Facility Code Facility

LUSA003 Lusaka Health Center A ZAMB004 Zambezi General Hospital
LUSA006 Lusaka Level 1 Hospital SOLW001 St. Dorothy Health Center

Non-Reporting Facilities
The Non-Reporting Facilities report (below) indicates those facilities who had not submitted
a Report and Requisition for ARV Drugs for the most recent reporting period. Depending on
the results as reported, corrective measures might be instituted at the Health Centre (in the
case of individual centres failing to submit R&Rs on time) or at the District level (in the case
of entire Districts not submitting the R&R on time).
Non-Reporting Facilities
Run Date: 03-Sep-06
Run Time 12:45 PM
Directorate of Planning
All Health Centers Page: 1 of 1
Period: Aug 2006

Supplying Facility
Facility Type Location
Medical Stores Limited
Boma health Center HC Chomgwe
Chilubula Mission Health Center HC Kasama
Kasama Rural Health Center HC Kasama
Location Health Center HC Kasama
Lukupa Health Center HC Kasama
Mukunka Rural Heath Center HC Kazungula
Kalulushi Health Center HC Kitwe
Shimikanami Health Center HC Kitwe
Chimwemwe Health Center HC Kitwe DHO
Ndeke Health Center HC Kitwe DHO
Kakoso Health Center HC Lufwanyama
Lufwanyama Health Center HC Lufwanyama
Bauleni Heath Center HC Lusaka
Chelstone Heath Center HC Lusaka
George Heath Center HC Lusaka
Kalingalinga Health Center HC Lusaka
Kamwala Heath Center HC Lusaka
Kanyama Heath Center HC Lusaka
Matero ref Heath Center HC Lusaka
Mutendere Heath Center HC Lusaka
UNZA Heath Center HC Lusaka
Masaiti Boma Health Center HC Masaiti
Masaiti Council Health Center HC Masaiti
Mishikishi Health Center HC Masaiti
Mpulungu Health Center HC Mpulungu
Kamuchanga Health Center HC Mufulira
Nakonde Rural Health Center HC Nakonde
Non-Reporting Facilities 27
Active Supplied Facilities 159
Non-Reporting Percent 17%
Total Non-Reporting Facilities 27
Total Active Facilities 160
Total Non-Reporting Percent 17%

Summary Consumption Comparison by Product
The Summary Consumption Comparison by Product shows, for each product, what
percentages of each product are consumed at the lower levels. The sample report below
shows the percentage of each product accounted for by District compared to the country as a
whole, though the report might also show Provinces/country, Districts/Province, or Health
Centres/District. The report can be used for general monitoring of the level of ART activity in
each Province or District, and can also be used for program planning purposes.
Summary Consumption Comparison by Product

Facility Type All Districts
Reporting Group all
Stavudine/Lamivudine/Nevirapine
AR12175B 30/150/200mg Tablets
District Consumption % of Total
District A 43290 20%
District B 54892 25%
District C 59930 28%
District D 58493 27%
Total 216605
AR12210A Abacavir/Lamivudin 60/30mg Capsules

District Consumption % of Total
District A 8898 10%
District B 67865 73%
District C 7896 8%
District D 8905 10%
Total 93564
Discrepancy between Quantity Supplied and Quantity Received
The Discrepancy between Quantity Supplied and Quantity Received report highlights
differences between quantities reported as shipped by MSL and quantities reported received
by Districts, Hospitals and Health Centres. The same information is included in the Computer
- generated R&R, although in this format the discrepancies are highlighted. Using this report,
commodity managers can identify cases where losses are occurring during the delivery
process and take action as appropriate.
Discrepancy between Quantity Supplied and Quantity Received

Reporting Period: June-06
Facility: Lusaka Health Center A

Facility Code: 439023
Supplying Facility: MSL
Product Code Description Quantity Supplied Quantity Received

Stavudine/Lamivudine/Nevirapine
20045 30/150/200mg Tablets 300 200
Zidovudine/Lamivudine + Efavirenz 300/150
54309 + 600mg Tablets 400 380
23435 Zidovudine 100mg Capsules 160 200
86567 Abacavir 300mg Tablets 30 25

D. Supervising the Health Centres
The following list provides suggestions for how to conduct logistics supervision during a
supervisory visit to Health Centres, so that the visit is useful for the person doing the
supervision and for the people who are receiving the visit as well.
1. These suggestions can be applied when the supervision is done from a higher level (like
the District), or when it is done within the facility by the In-Charge:
• Conduct supervisory visits based on objective criteria such as standard operating

procedures, agreed-upon job descriptions, the work plan of a given unit, the
objectives of the supervisory visit, and the calendar of visits.
• Select the most important observations; organize observations into those that are
general observations and those that are specific to the person supervised; provide
feedback by giving specific examples of things that need changing and do this in a
non-threatening, supportive manner.
• Help the person being supervised to participate in the process: It is important to help
the person being supervised to participate because it lets him/her know that his/her
opinions are important, that he/she is part of the solution and can do something
about resolving the problem.
• Be ready to provide technical or other assistance when needed. Offer help without
removing responsibility for action. When you provide on the job training or coaching
do not take over the actual execution of the activity.
• Hold organized and productive meetings with an agenda that meets the needs of the
participants (health workers, District supervisors, etc.). Be conscious of workers’
needs that can be responded to.
• Show interest in employees but give them independence and responsibility.
• Reinforce positive behaviour!
• Take appropriate measures to correct negative behaviour!
• Give feedback in a timely manner.
• If discipline is required, be specific and consistent with all employees.
• Ensure that all tasks that are appropriate for the removal of expired/damaged/excess
supplies are undertaken.
2. Logistics indicators at the facility that can be observed by the supervisor:

• Orderly arrangement in the stores and the dispensing area
• Proper record keeping
• Stores ledgers are up to date
• Dispensing registers in place
• Cleanliness of the stores
• Cleanliness of the staff
• Adequate storage space
E. Providing Feedback
The supervisor has two important functions: to get the work done through his/her staff and to
keep the team together so that everyone is doing his/her part to contribute to an effective ARV
logistics system. These two functions require leadership, good communication with staff and
motivation of staff. One of the most important ways of accomplishing all three of these
responsibilities is through providing staff with appropriate feedback.

The purpose of providing feedback to staff is to support their capacity to do the right things
and to do them right. For example, a Health Centre In-Charge who never sees or hears from
his/her supervisor may simply never know whether he/she is making a difference or whether
he/she is doing the right things. On the other hand, a supervisor who is in touch with the Health
Centre In-Charge and praises him or her for getting the R&R in on time, for example, is
supporting the In-Charge to continue with the behaviour of getting the R&R in on time. We all
need to receive feedback that we are or aren’t on the right track and that we are valued as
contributors to the system. It’s motivating to be recognized and acknowledged.
For the supervisor of staff involved with logistics, there are different kinds of feedback that can
and should be used:
Analytical
• Health Centres, in addition to getting what they ordered, should receive feedback
about the overall national picture with respect to ART, where their District fits within
this picture and where their Health Centre fits within the District. In other words, they
should be able to see how their Health Centre compares with the rest of Zambia. The
MSL CSC will assist in providing such information to Districts to share with their
Health Centres.
• The District Pharmacist can aggregate data for the District for comparison with other
Districts, but can also summarize data per facility for comparison within the District.
Evaluative
• The District Pharmacist or other District-level authority can provide the Health
Centres with feedback that is more evaluative. That is, they can make a judgment
about what the Health Centre has done or not done and let the Health Centre know.
The objective of such feedback is to motivate and/or sustain good performance.
• The In-Charge of a Health Centre can let a staff member know that his/her
performance is great or is lacking and discuss the reasons for both. Getting to the
reasons for performance that is lacking is critical for deciding how best to deal with
poor performance. Again, the objective is a supportive one. The supervisor is only
interested in giving the staff member all of the tools needed to do what is right and
then to do it the right way.
Probing/Understanding
• A supervisor at times just wants to have a better understanding of what’s going on.
He/she may have to ask questions and to probe a bit to get to the bottom of the
issue. Again, it’s not a matter of investigating, but more a matter of finding out how
best to support the staff member.
• This kind of feedback takes good listening skills. That is, the supervisor must be
willing to be quiet and listen to the staff member, ask questions for clarification, and
ensure complete understanding before saying anything. Just doing this can be a
motivating factor in itself.
Providing feedback is key to the success of a logistics system; and an effective ARV logistics
system is key to whether a client lives or dies. Therefore, providing feedback is directly
related to the success or failure of ART.

F. Conducting a Supervisory Visit
Supervision should be an integral part of the work at the District-level. As we have said,
however, it is not possible to supervise by reviewing reports. Visits to Health Centres are
required. However, they need to be planned and conducted systematically and not in a
haphazard way. Resources for supervision are scarce. It’s important to use them wisely and
for the purpose of supporting effective logistics systems. What follows is a checklist of
considerations for conducting a supervisory visit.
Supervision Checklist for Visit to Health Centres
District:
Health Centre Name:
Date of supervision visit:
Date of last supervision visit: _____________________
Name and title of the staff member(s) interviewed:
Name and title of the supervisor:
Preparation for the visit:
1. Prepare a schedule for the visits to the Health Centres

2. Develop an objective for each of the visits
3. Arrange for transport and allowances at least one week prior to visit.
4. Notify the Health Centres of your visits after you have confirmed transport.
5. Review the report from the last visit and the recommendations that were made.
6. Take along the SOPs for the ARV Logistics System, this checklist and a calculator.
Upon arriving at the facility:
1. Meet with the facility in-charge, make introductions, give your objective(s) for the
visit, and ask for permission to visit with the staff
2. Assemble the staff when appropriate.
3. Make any necessary introductions.
4. Explain the objective(s) of your visit.
5. Enquire and verify if the ARV SOPs are available in the facility and used.

PURPOSE: 1. To ensure that planned logistics activities are being
carried out properly and according to schedule;
2. To ensure that all records are correctly maintained
and reports are submitted in a timely manner;
3. To ensure that established logistics guidelines and
procedures are being followed;
4. To ensure that logistics personnel are doing their
jobs properly, and if not, why not.
5. To improve the performance of logistics personnel.
WHEN TO PERFORM: If possible, each logistics staff member should be visited

quarterly. If this is not possible, then visits should be
done at least twice per year.
Item
✓
1. _______ Are logistics records being filled in completely and accurately? Are
reports being submitted in a timely manner and to the appropriate
places?
(If not, do personnel know how to fill in the forms? Do they know the
procedures for submitting records? If not, provide on-the-job training.)
2. _______ Are ARVs being ordered and issued according to established policies?
(If not, do personnel know the established policies regarding ordering
and issuing? If not, provide on-the-job training.)
3. _______ Storage of ARVs:

a. Is storage area clean? _____
b. Is storage area safe from water damage?_____
c. Is storage area well lighted and well ventilated? _____
d. Is cold storage/chain maintained for drugs that require it? _____
e. Are cartons/boxes stored off the floor? _____
f. Are cartons/boxes stacked away from walls?_____
g. Are cartons/boxes marked with expiry dates? _____
h. Are ARV Drugs stored in a manner to facilitate FEFO distribution?
_____
i. Are ARV Drugs stored separately from medical supplies, office
supplies, insecticides, and chemicals? _____
(If not, do personnel have the required knowledge/skills related to

storage? If not, identify knowledge/skill deficiencies and provide on-the-
job training)

Item
✓
4. _______ Are ARVs being issued according to the FEFO guideline (FIRST
EXPIRY, FIRST OUT)?
(If not, do personnel understand the principle of FEFO? If not, explain
the principle and provide ideas on how ARV Drugs should be stored to
facilitate FEFO distribution.)
5. _______ Have procedures to dispose of expired or damaged ARVs been

undertaken?
(If not, do personnel know the procedures? If not, review the
procedures with them.)
6. _______ Are stock levels at each facility adequate (not above the maximum
quantity; not at an emergency order level)?
(If you think there is a problem, advise the facility personnel
accordingly. Take the necessary actions to correct the situation.)
7. _______ Check the Months of Stock on hand for each brand of ARV. Use the
formula:
BALANCE ON HAND = MONTHS OF STOCK ON HAND

AVERAGE MONTHLY CONSUMPTION (AMC)
(If stocks are not within the recommended maximum and minimum
levels, advise the facility personnel accordingly; provide OJT for
assessing stock status if needed, and take the necessary actions to
correct the situation.)
8. _______ Are physical inventories being conducted and properly recorded on the
ARV Drug Stock Control Card?
(If not, do personnel know how to conduct a physical count and why it is
important to do so? If not, take a physical count of stock with the
personnel and emphasize the importance of conducting routine
physical inventories. Demonstrate how to record a physical count on
the ARV Drug Stock Control Card.)

ANNEX:
Sample Pages from the following forms
A. ARV Drug Stock Control Card

B. ART Daily Activity Register
C. Report and Requisition for Antiretroviral Drugs
D. Supply Voucher (Health Centre) for ARV Drugs
E. MSL Despatch Note
F. Report and Requisition for Antiretroviral Drugs (computer-generated)
G. MSL Authorisation form for Returning Products
H. Report for Returning Products
Supplemental Information for Starting the ARV Logistics System
H. Beginning the Implementation of the ARV Logistics System

ARV Drug Stock Control Card
ARV Drug Stock Control Card

CODE:
ITEM DESCRIPTION: STRENGTH:
UNIT:
MAXIMUM LEVEL: MINIMUM LEVEL: (Reorder Level)
ISSUED TO LOSSES
REF. RECEIVED ISSUED and
DATE OR BALANCE UNIT PRICE NAME/ SIGNATURE REMARKS
No. (+) (-) ADJUST-
RECEIVED FROM
MENTS

Date
(running total):
Total Quantity Dispensed
Quantity Dispensed for Month
Patient Name/Number
Facility: ___________________
District: ___________________
Abacavir/Lamivudine 60/30mg
Bottle of 60Tabs
Bottle of 60 Tabs
Stavudine/Lamivudine 30/150mg
Bottle of 60
30/150mg Tabs
Bottle of 60 Tabs
Tenofovir/Lamivudine 300/300mg
tablets Bottle of 30 tablets
Tenofovir/Lamivudine/Efavirenz
300/300/400mg Bottle of 30Tab
Tenofovir/Emitricitabine/Efaviren
z 300/300/600mg Bottle of 30Tab
Tenofovir/Lamuvidine 300/300mg
Bottle of 30Tab
Zidovudine/Lamivudine
300/150mg Bottle of 60Tab
Zidovudine/Lamivudine 30/60mg
Fixed Dose Combinations
Bottle of 60Tab
B. ART Daily Activity Register
Abacavir 300mg Tablets Bottle of

60 Tabs
300mg Tabs
Bottle of 60
Efavirenz Tabs Bottle of 90
200mg
Tabs
200mg Caps
Bottle of 90 Caps
Efavirenz 600mg Bottle of 30

Bottle of 30 Caps
Lamuvidine 150mg Bottle of 60
Tabs
600mg Tabs
Bottle of 30 Tabs
Lopinavir/Ritonavir 200/50mg
Bottle of 120 Tabs
Republic of Zambia: Management of the National ARV Logistics System

100mg Tabs
MINISTRY OF HEALTH
Bottle of 30 Tabs
Nevirapine 200mg Bottle of 60

ART DAILY ACTIVITY REGISTER
Tabs
Zidovudine 300mg Bottle of 60
Tabs
200mg Tabs
Bottle of 60 Tabs
Atazanavir/Ritonavir 300/ 100mg
Quantities Dispensed
Bottle of 30 Tabs
200mg Tabs
Single Drug Formulations
Bottle of 60 Tabs
Tenofovir 300mg Bottle of 30 tabs
Lopinovir/Retonovir Pellets
40/10ml Bottle of 120 pellet
Raltegravir 100mg Bottle of 60

Tabs
Lopinavir/Ritonavir
20mg/80mg/ml Bottle of 60 ml
100mg Tabs
Bottle Tabs
of 30oral
Nevirapine suspension
10mg/ml Bottle of 100ml
20mg/80mg/ml
60ml bottle
Liquid/Powder Formulations
Dispenser's Initials
81
Emergency Order
REPORT AND REQUISITION FOR ANTIRETROVIRAL DRUGS
Reportin Period: From to Province: Maximum Stock Level: 3 Months

dd/mm/yyyy dd/mm/yyyy
Facility: District: Emergency Order Point: 0.5 Months
AMC =
Beginning Total Quantity Losses Physical Count of
Total Quantity (E + previous
Balance of Received and Store Room + Maximum Order
Drug Product Unit Dispensed for 2 months
Store room + during the Adjustmen Dispensary at the Quantity Quantity
the month consumption)
Dispensary month ts end of the month
÷ 3
A B C D E F G H I = (H X 3) J = (I–G)
Fixed Dose Combinations
Abacavir/Lamivudine 60/30mg Bottle of
Tablets 60Tablets
Stavudine/Lamivudine 30/150mg Bottle of 60
Tablets Tablets
Tenofovir/ Lamivudine 300/300 mg Bottle of 30
Tablets Tablets
Tenofovir/ Lamivudine /Efavirenz Bottle of 30
300/300/400 mg Tablets Tablets
Tenofovir/Lamivudine /Efavirenz Bottle of
300/300/600 mg Tablets 30 Tablets
Tenofovir/Lamivudine 300/300mg Bottle of
Tablets 30 Tablets
Zidovudine/Lamivudine Bottle of
300/150mg Tablets 60Tablets
Zidovudine/Lamivudine Bottle of
30/60mg Tablets 60Tablets
Explanation for Losses/Adjustments:___________________________________________________________________________________________

Remarks:___________________________________________________________________________________________________________________

REPORT AND REQUISITION FOR ANTIRETROVIRAL DRUGS
Emergency Order
Reporting Period: From to Province: Maximum Stock Level: 3 Months

AMC =
Beginning Total Quantity Total Quantity Losses and Physical Count of (E + previous
Balance of Received during Dispensed for Adjustments Store Room + 2 months Maximum Order
Drug Product Unit Store room + the month the month Dispensary at the consumption) Quantity Quantity
Dispensary end of the month ÷ 3
A B C D E F G H I=(H X 3) J=(I-G)
Single Drug Formulations
Abacavir 300mg Tablets Bottle of 60
Efavirenz 200mg Tablets Bottle of 90
Efavirenz 600mg Tablets Bottle of 30
Lamivudine 150mg Tablets Bottle of 60
Lopinavir/Ritonavir 200/50mg Bottle of 120

Tablets
Nevirapine 200mg Tablets Bottle of 60
Zidovudine 300mg Tablets Bottle of 60

Tablets
Atazanavir/Ritonavir 300/100mg Bottle of 30
tablets
Tenofovir 150mg Tablets Bottle of 30
tablets
tablets
tablets
Lopinavir/Retonavir Pellets Bottle of 120
40/10ml pellet
Raltegravir 100mg Tabs Bottle of 60
tablets
Explanation for Losses/Adjustments: ___________________________________________________________________________________________

Remarks:___________________________________________________________________________________________________________________
REPORT AND REQUISITION FOR ANTIRETROVIRAL DRUGS Emergency Order
Reporting Period: From to Province: Maximum Stock Level: 3 Months

Beginning Total Quantity Total Quantity Physical Count of AMC =

Losses and (E + previous
Balance of Received Dispensed for Adjustments Store Room +
Drug Product Unit Store room + during the Dispensary at the 2 months Maximum Order
the month
Dispensary month end of the month consumption) ÷ 3 Quantity Quantity
A B C D E F G H I = (H X 3) J = (I–G)
Liquid/Powder Formulations
Lopinavir/ritonavir 20mg/80mg/ml 60ml Bottle
Nevirapine oral suspension 10mg/ml 100ml Bottle
Co-trimoxazole for Prophylaxis of Bacterial Infections

Container of
Co-trimoxazole 80+400mg Tablet
1000 tablets
Co-trimoxazole 240/5ml Suspension 100ml Bottle
Explanation for Losses/Adjustments: __________________________________________________________________________________________

Remarks: _________________________________________________________________________________________________________________
Completed by: Authorized by: Ordered by: Authorized by:

Signature: Signature: Signature: Signature:
Date: Date: Date: Date:

D. Supply Voucher (Health Centre) for ARV Drugs
SUPPLY VOUCHER (Health Centre) for ARV Drugs
To (Name of District Stores): From (Name of Centre/Unit/Dept):
____________________________________________ ____________________________________________
Requested by: _____________ Signature: _____________ Date: _________
Authorised by: _____________ Signature: Date: _________

(A) (B) (C) (D) (E) (F) (G) (H) Balance (I)
Item Description, Strength, Unit Balance at Quantity Quantity Quantity on Hand at Remarks
Code Form Hand Requested Supplied Received District
Approved by:_____________ Issued by:_______________ Delivered by:_____________ Received by:______________
Date: ___________________ Date: __________________ Date: ___________________ Date: ___________________

E. Sample Dispatch Note
SOU004
Ndola DHO
P. O. Box 630063
DHMT
Sales Order 0014198
Dispatch No. 00000898
Reference
Route/Drop G
Product Description Pack Ordered Expiry Dispatched FC
Totals:
Facility Name: Driver’s Name:
Receiver’s Name: Vehicle Reg.:
Designation:
I.D.:
Signature: Signature:
Date: Date: Time:
FC Legend 1-Not enough stock available

2-Rounding Up/Down to Full Cart
3-Restricted
4-Quantity Too Much for Facility
5-Product Picked More Than Once
6-No Stock Available
Customer Comments

F. Computer-generated Report and Requisition for Antiretroviral Drugs
Report and Requisition for Antiretroviral Drugs
Report Period: August, 2017 Maximum Stock Level: 3.0 months

Facility: Mother Theresa Hospital Emergency Order Point: 0.5 months
Code: 8476352
Product Unit Beginning Total Total Adjust- Physical AMC New Order Quantity
Balance Quantity Quantity ments Count EOP Quantity Supplied
Received Dispensed
FDC004 Abacavir 300mg Tablets Bottle of 60 0.00 200.00 150.00 50.00 100.00 150.00 75.00 350.00 350.00
FDC005 Zidovudine/Lamivudine 300/150mg Tablets Bottle of 60 0.00 300.00 20.00 -100.00 180.00 20.00 10.00 0.00 0.00
Tenofivir/ Lamivudine /Efavirenz 300/200/600mg
FD006
Tablets
Bottle of 30 0.00 200.00 150.00 50.00 100.00 150.00 75.00 350.00 350.00
SDF001 Efavirenz 200mg Tablets Bottle of 90 0.00 200.00 150.00 50.00 100.00 150.00 75.00 350.00 350.00
Comments:
Computer Generated Adjustment of –200
on 08-28-2006 at 22:51:16 for 0
Computer Generated Adjustment of –200
on 08-28-2006 at 22:51:25 for 0
Computer Generated Adjustment of 50
on 08-30-2006 at 16:22:48 for for Stavudine/Lamivudine 30/150mg Tablets
on 08-30-2006 at 23:59:11 for Tenofivir/Emitricitabine 300/200mg Tablets
on 08-31-2006 at 00:32:07 for Efavirenz 200mg Tablets
CSC Technical Officer Signature & Name Date
Received by Signature & Name Date

G. MSL Returns Authorisation form
MEDICAL STORES LIMITED
RETURNS AUTHORISATION FORM

1. Customer Details
Institution Name: __________________________________________
Name of Requesting Officer: __________________________________________
Designation: __________________________________________
Date: __________________________________________
2. Product Details:
No. Description (Name, form, strength & size) Pack Size Qty Exp dates (s) Reason for Return
Other comments from the customer:
For MSL use only

RETURN AUTHORISED BY:
Name
Designation
Date
Signature
All items accepted for return?
If no, which items will not be accepted?

H. Report for Returning Products
Sent to: ________________________________________________________________
Facility returning products: _________________________________________________
Quantity
Product Description Expiry Date Reason for Return
Returned
Name of person returning the products:______________________________ Date: ___________20___

Signature of person returning the products:_________________________________________________
Carrier
I CERTIFY THAT the above quantities for return were received by me on _______(dd/mm/yy) except where
explained below.
Name of Carrier ____________________________________ Signature___________________________
Comments: ___________________________________________________________________________
Receiving Facility
explained below.
Receiver’s Name _________________________Signature_______________________________________
Comments: ____________________________________________________________________________
Carrier
explained below.
Name of Carrier _________________________ Signature___________________________
Comments: __________________________________________________________________________
Receiving Facility
explained below.
Receiver’s Name _________________________Signature_______________________________________
Comments: ____________________________________________________________________________

I. Beginning the Implementation of the ARV Logistics System, Preparing First Orders, including 1st, 2nd, and 3rd months
1. When completing the first 1st R&R for the 1st report and order under the new system. (To be completed at the end of the month during which you
received your training!!!)
1A. Report Section for Health Centres and Hospitals
Beginning Balance Total Quantity Physical Count of Store
Losses and
of Store room + Received during Total Quantity Dispensed for the month Room + Dispensary at
Adjustments
Dispensary the month the end of the month
Leave the Write in the total If you have Dispensed to User data for the entire reporting month: If you have Losses Conduct a Physical
Beginning Balance quantity of each • report that data in the Total Quantity Dispensed for the Month column, and Adjustments Count of the store room
of Store room + product received and data for the and dispensary and
Dispensary blank during the entire • add a “Remark” on each page saying “Actual dispensed to user data is reporting month, write the quantity for
for this first R&R month. being reported” write them on the each product.
only. If you do not have Dispensed to User data for the entire reporting month, but R&R.
you do have stock on hand data for the beginning and ending of the reporting
month:
• calculate:
quantity received Estimated Total
beginning stock ending stock
+ during the – = Quantity
balance balance
reporting month Dispensed
• report the result as estimated Total Quantity Dispensed for the Month
quantity
• add a “Remark” on each page saying “Stock on hand data was used to
estimate actual consumption”
If you have neither actual dispensed to user data for the entire month, nor
stock on hand data for the reporting month:
• estimate the required quantity of each product based on the number of
patients who received ART from your facility during the reporting
month or a similar catchment facility quantities,
• enter that quantity as estimated Total Quantity Dispensed for the
Month and
• add a “Remark” on each page saying “Patient data was used to
estimate actual consumption”
Note: For new products that you are receiving for the first time (e.g.,
patients are starting new ART regimens that your facility has not
dispensed in the past), follow the same procedure using estimated
consumption based on patient data.
Note: You do NOT need to overestimate your consumption for the month if you do not have actual dispensed to user data; your monthly requirement will be multiplied by 3 when
determining order quantities. DO NOT OVERESTIMATE YOUR REQUIREMENTS AS IT CAN LEAD TO OVERSTOCKS, WASTAGE AND EXPIRY and your facility and stock shortages at
other facilities.

1B. Requisition Section for Districts and Hospitals
AMC Maximum Quantity Order Quantity

Write in the quantity reported as Total Multiply the quantity reported as Average Calculate the Order Quantity as usual:
Quantity Dispensed for Month. Monthly Consumption by 3. Subtract the Physical Count Store Room +
Dispensary at the end of the month from the
Maximum Quantity
2. When completing the 2nd R&R under the new system.
Physical Count of
Beginning Balance of Total Quantity
Losses and Store Room +
Store room + Received during the Total Quantity Dispensed for the month
Adjustments Dispensary at the end
Dispensary month
of the month
Write the Beginning Write in the total Fill in the actual consumption for Total Quantity Dispensed for the Month Record Losses and Conduct a Physical
Balance for the start of quantity of each as collected on the Daily Activity Register. Adjustments from the Count of the store room
the reporting period; product received Stock Control Card. and dispensary and
this should equal the during the entire In the Remarks section of each page, write a note stating that “The write the quantity for
Physical Count of month. Dispensed to User data represents actual consumption for the previous each product.
Store Room + month”
Dispensary at the end
of the month, Column
G, from the previous
month’s R&R.

Add this month’s consumption to the previous Multiply the quantity reported as Average Calculate the Order Quantity as usual:
month’s reported consumption (actual or Monthly Consumption by 3. Subtract the Physical Count Store Room +
estimate, from the previous R&R) and divide Dispensary at the end of the month from the
by 2. Maximum Quantity
If the first actual consumption is quite different

from the original estimate, make a note in the
remarks section so that the current order can
be adjusted by CSC.

3. When completing the 3rd R&R under the new system, follow the Job Aid in the Standard Operating Procedures Manual; summarized below.
Beginning Balance of Total Quantity Total Quantity Dispensed for the month Losses and Physical Count of
Store room + Received during the Adjustments Store Room +
Dispensary month Dispensary at the end
of the month
Write the Beginning Write in the total Fill in the actual consumption for Total Quantity Dispensed for the Month Record Losses and Conduct a Physical
Balance for the start of quantity of each as collected on the Daily Activity Register for the previous month. Adjustments from the Count of the store room
the reporting period; product received Stock Control Card. and dispensary and
this should equal the during the entire write the quantity for
Physical Count of month. each product.
Store Room +
Dispensary at the end
of the month, Column
G, from the previous
month’s R&R.

Add this month’s actual consumption to the Multiply the quantity reported as Average Calculate the Order Quantity as usual:
previous two month’s reported consumption Monthly Consumption by 3. Subtract the Physical Count Store Room +
(actual or estimate, from the previous R&R) Dispensary at the end of the month from the
and divide by 3. Maximum Quantity

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Republic of Zambia

AIDS Acquired Immunodeficiency Syndrome

Republic of Zambia: Management of the National ARV Logistics System i

Republic of Zambia: Management of the National ARV Logistics System ii

Republic of Zambia: Management of the National ARV Logistics System iii

Republic of Zambia: Management of the National ARV Logistics System iv

Republic of Zambia: Management of the National ARV Logistics System v

B. The Purpose of the ARV Logistics System in Zambia

C. Key Features of the ARV Logistics System

Medical Stores Limited (MSL) – Commodity Security Centre (CSC)

Republic of Zambia: Management of the National ARV Logistics System 1

Central Medical Stores

MSL Regional Hub/Staging Posts

Hospitals (District Level 1, and Level 2 and 3)

District Health Office (DHO)

Republic of Zambia: Management of the National ARV Logistics System 2

FIGURE 1: Movement of ARV Drugs and Information

ARV National Pipeline

Republic of Zambia: Management of the National ARV Logistics System 3

Level Personnel Roles and Responsibilities

Supervise the management of ARV Drugs in the MSL central store

• Manage the stock levels of ARV Drugs

• Receive ARV Drugs

Republic of Zambia: Management of the National ARV Logistics System 4

• Issue ARV Drugs to Hospitals and Districts (for distribution to

Logistics Directors &

kits on the MSL Dispatch Note.

• Return signed copies of the computer generated R& R from the

provincial ARV logistics performance

• Conduct supervision visits to the DHOs and Level 2 and 3 Hospitals

• Receive the Report and Requisition for ARV Drugs from

Health Centres with both the report and requisition section

District completed. Check for errors

Republic of Zambia: Management of the National ARV Logistics System 5

commodities in their facility at one time:

• Review ARV Drug feedback reports received from MSL CSC

Dispensing & Managing

Charge Report and Requisition for ARV Drugs

Republic of Zambia: Management of the National ARV Logistics System 6

• Authorize Report and Requisition for ARV Drugs and send to

Maintain Stock Control Cards for all ARV Drugs held in

Republic of Zambia: Management of the National ARV Logistics System 7

Parent Health Centre note any discrepancies

Republic of Zambia: Management of the National ARV Logistics System 8

A. Logistics Management Information System

The purpose of a logistics management information system (LMIS) is to

Republic of Zambia: Management of the National ARV Logistics System 9

Form Name Purpose Activity

Republic of Zambia: Management of the National ARV Logistics System 10

Report Name Purpose Primary User

B. The Zambia ARV Drug Inventory Control System

The purpose of an inventory control system is to inform personnel when and

At the end of every month…

Republic of Zambia: Management of the National ARV Logistics System 11

Maximum Months Emergency Order

Republic of Zambia: Management of the National ARV Logistics System 12

1) Approach patient cordially

JOB AID: Completing the ART Daily Activity Register