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 SCs- over
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 client’s case.
 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 specialist’s 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 can’t 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 patient’s 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