Material management in

PHC, CHC and SC

Definition
It is concerned with providing the
drug supplies and equipment needed
by health personnel to deliver health
services.

Aims
To maximize the availability of
material of right quality at right time
at the right place for accomplishing
the objectives of an organization.

Components
Material planning and estimation of right
quantity.
Procurement of estimated demand for
material
Storage of the material
Issue from store for use
Maintenance
Disposal
Accounting and information system

Material planning
The demand estimation to be
prepared at SC and PHC level based
on identified service needs and
submitted to the district level for
supply main/ central store
Regular supply to chc, phc and sc
-- on quaterly basis.

Required items at PHC level

Drugs and vaccines
Medical supplies and family planning
supplies
Non-medical supplies
Equipment and instruments
Should be procured by the medical
officer

Procurement
Based on total requirement need for
phc medical officer submits the list to
the district medical officer.
Lead time: the time lag between the
placement of an order and getting
supply of the same order.
Supplies may be received in four
instalments on quarterly basis.

Storage
Materials after being inspected and received,
stored in store room till its consumption.
At particular temperature
Arrange the supplies on racks with both front
and backsides are open, so that one can fill
this rack from back side and take out from
front side.
This will help in maintaining the principles of
first-in-first out to avoid getting material old,
stale, and even expired

Methods for inventory

control
Two-bin method
Buffer stock

Two-bin method
Entire stock is separated in two boxes.
One - main stock, other sub stock -holds
quantity required during the lead time.
As soon as the main box gets empty,
another order should be placed for
replenishment
In CHC and PHC sub stock issued for a
week or month from the main stock to the
pharmacist who maintains the daily
consumption

BUFFER STOCK
EMERGENCY STOCK for meeting demand
during unforeseen situations resulting from
either sudden increase in consumption of a
particular material/drug or under extension
of lead time i.e., failure of timely supply
10 % of total requirements- very crucial
items for providing services
5% of the local stock is adequate as buffer
stock

Issue from store for use

Medical officer will provide supplies to
all the sub-centres on quaterly basis
under his/her control after receiving the
supplies from the district level officer.
Always ensure that there is always
stock for one or two months at each SCs
If large quantity available at any SCsover indenting, non-performance or
under utilization of services.

Storage
Material is stored in 2 places
Main store and at place of use
Main stock or reserve stock- idle
items (items waiting to be used)

 Receiving of new equipment:

Items are purchased at the district level and
some of the items at centre and state level,
then supplied to the PHC through district
level authority.
In the PHC- verify the right type of equipment
Its functional condition
Enter it in stock book or ledger with date of
receipt of item, reference no. of item,
quantity of item received

Controlling and maintaining

equipment
Consumable items must be used economically
to avoid wastage to the possible extent
Detecting and interpreting discrepancies:
discrepancy means difference between what
is expected to be there and what is actually
there?
difference between the amount of
consumable items used and the amount
normally is expected to be use must be
detected and reasons identified for taking
appropriate actions.

Maintenance of some important

equipment
At phc level, Equipment for cold
chain- ice line refrigerator
Deep freezer
Cold box
At sc, only vaccine carrier and day
carrier

Referral system
A referral can be defined as a
process in which a health worker at a
one level of the health system,
having insufficient resources (drugs,
equipment, skills) to manage a
clinical condition, seeks the
assistance of a better or differently
resourced facility at the same or
higher level to assist in, or take over
the management of, the clients

Referral system
Purpose:
to seek expert opinion regarding the client
to seek additional or different services for the client
to seek admission and management of the client
to seek use of diagnostic and therapeutic tools
Providing specialists services to the patient
Propagating the purposes of referral system among
health workers.
Teaching the nursing personnel for reviewing of
patients, sent for referral.
Preventing further complications and for appropriate
treatment
Sending the patient comfortably to the referral institute.

Selection for referral

First group or final patients.
Second group or serious patients.
Third group or general patients.

First group or final patients.

Patient cant survive despite the best
treatment made available to them.
Provide appropriate treatment at
health centre itself with available
resources.
It is essential for the relatives of the
patient to understand that it will not
be beneficial to send the patient for
referral

Second group or serious patients.

Condition of such patients is
considered serious but immediate
treatment can save their lives,
Before referral reduce the
seriousness of the condition

Third group or general patients.

Though the diseases may be serious in
such patients still the condition of the
patients are found to be normal
Immediately sent for referral
On the basis of patients condition, type
of disease, objectives of treatment and
the latest technique of treatment or
need of diagnosis, the patient can be
prepared for the referral system.

Levels of referral system

Village level primary level
Sub Centre level
Primary health Centre
Community health Centre secondary level
District hospitals
Teaching or specialty hospitals tertiary level

Inter-displinary referral
system
Referring the patient for another type
of therapy for needful.
Eg: Allopathy to AYUSH

Elements of referral system

Urgent referral

Hyperpyrexia
Severe pain in any body part(>3 days)
Tetanus
Convulsions(more than one attack)
Haematemesis
Complicated deliveries
Coma
Severe diarrhoea
Chest pain in heart patients
Fracture
Poisonous conditions

Role of nurse
Knowledge of referral system
Aware of limitations in referral
system
In case of emergency attempt should
be made to save the life of the
patient
Entries in referral form.
Life saving equipment and medicines
should be arranged for serious
patients