Report on internship at

Ethiopian
pharmaceutical supply
service, Dire Dawa
branch

By Saron Alemayehu
Advisor Arebu Issa (Ass. Prof)

March, 2023
outline

• Introduction
• Findings
• Vistations
• Lesson learned
• Conclusion
• Recommendation
 Introduction
• Health experts in Ethiopia oversee the whole supply chain for the
healthcare system. Pharmacists make up a significant number of
their human resources for supply chain duties.
• To assume responsibilities, recent pharmacy graduates need
practical experience.
• Internship gives students the chance to familiarize themselves with
organizational cultures and current business processes as well as to
build a business network for potential future employment prospects.
 Introduction Four Regions

• Ethiopian Pharmaceuticals Supply service (EPSS), has nineteen

Four Zones
branches located throughout the country and anchored together by a
head office in the capital – Addis Ababa.
52 Woredas
• The 19 branches of EPSS are divided into 7 clusters. Among the EPPS
clusters, the Kebridehar Branch, Jigjiga Branch, and Dire Dawa Branch
are all part of the Eastern cluster.
• The Dire Dawa branch provides services to 1.1 million people.
Organogram of Ethiopian pharmacutical supply service , Dire
Dawa branch
 Findings
Core activities of supply chain sites
1.Warehouse and inventory management office (WIM)
• Officers are primarily in charge of
 Processing revolving drug fund (RDF) and Program repotring and request form
fund (RRF) from facilities in the office,
 Manage perpetual inventories and annual iventories,
 Reporting stock levels, and
 Tracking monthly key performance Indicator (KPIs) including order fill rates,
waste rates, and RRF quality measures.
• The office processes RRFs, monitors stock levels, and creates
reports using the health capital management information system
(HCMIS) (vitas).
 confirm
EPSS arrival
Dire Dawa by collecting
hub operations withmanagement
Pick list work
printedandprocess
by flow
Pick
data start
store and
list
entry
warehouse
inventory
submitted
by
model
maanger
control
- Health program
to
WIM 19
Recieve
Annual
Approval
STV
data
consumption
forecast
is
from
center of order
printed
facility End
WIMO
products
registers
Dispatching
Monthly
by
report
checksent
request
of
and
dispatcher
datatoquality
WIMO Center
RRF reporting quality

ZONE Reporting period Completeness Accuracy Legality Legibility Timeliness

1st RP 94% 37.31% 98.51% 100% 0%

West
Harargie
2nd RP 83.30% 25% 83% 85.40% 0%

1st RP 93.02% 55.81% 90.70% 100.00% 0%

East
Harargie
2nd RP 95.65% 54.35% 80.43% 95.65% 17.39%

1st RP 91.67% 50% 91.67% 91.67% 100%

Harari
2nd RP 66.67% 83.83% 100% 83.30% 83.30%
 Data quality dimentions of RRF
120%

100%

80%

60%

40%

20%

0%
1st RP 2nd RP 1st RP 2nd RP 1st RP 2nd RP
west hararge East Harerege Harari

Target Completness Accuracy

Legality Legiblity Timeliness
 Potential and wastage rate
Potential Wastage rate = Value of products that are with shelf life of less than 6
months) ÷ (Total value of products at the close of the month) x 100.
Wastage rate = Value of unusable stock of an item during a review period / Value
beginning stock plus quantity received of the items during a review period] * 100.
Product category Potential wastage rate Wastage rate

RDF 1.5 % 1.66 %

Program 1.2 % 0.0003%

Order fill rate and line fill rate

Order and line fill rate

85.00% 80.00%
83.29%
81.25% 63.04% 70.00%
68.08% 72.72% 64.11%
80.00% 62.83%
77.91% 77.86% 60.00%
76.25%
75.00%
53.90% 50.00%

40.00%
70.59%
70.00% 30.00%

20.00%
65.00%
10.00%

60.00% HFSUH Chiro Hospital Gelemso Hospital Sabiyan Hospital Dilchora Hospital Av fill rate
0.00%

Order Fill rate Line fill rate

USAID Warehouse Assessment Questionnaire Scoring Sheet Results.
SECTION KEY STRENGTHS KEY WEAKNESSES SCORE

Warehouse Ceiling, walls and floor are all in good There is power supply 13/14
Infrastructur condition.Warehouse is well ventilated.There is interruption.
e Planning functional temperature and humidity control
system.
B. Layout There separate and adequate receiving, staging There is no separately 7/9
Planning and and dispatch area.Aisle is clear of stored designated area for
operational commodities. damaged and expired
efficiency products.Storage unit of
flammable and hazardous
area is not separated from
the main building.
C. Warehouse Sufficient pallets and pallet racks and operable 8/8
Equipment fork truck.Adequate aisle space and clearance
for material handling equipment.Cartons are not
damaged and off the floor.
D. Special Storage The warehouse designated and There is no separate area for 8/10
operational cold chain facilities hazardous and flammable products
with sufficient away from the main building.The
capacity.Temperature is refrigerator runs on solar power.
monitored.There is back up
source of power.There is
separated locked area for high
value commodities.

E. Inventory There are electronic inventory 8/8

Management records updated for each receipt
and issue.Products are organized
according to FEFO.Physical
annual and perpetual inventory is
conducted.

F. Security and Safety The warehouse is well protected Personnel don’t wear protective 7/8
and guarded. equipment (gloves and boots.)
G. Human Resources Well-staffed 8/8
Warehouse assessment score of Dire Dawa EPSS hub

EPSS DD hub warehouse assessement Score

Human resources

Security and safety

Inventory management

special storage requirement

warehouse equipment
Layout planning
and operation efficiency
Warehouse infrustructure planning
10.00% 30.00% 50.00% 70.00% 90.00% 110.00%
Warehouse Layout warehouse special Inventory Security Human re-
infrustruc- planning equipment storage re- manage- and safety sources
ture plan- and operation quirement ment
ning efficiency

Score 0.928 0.777 1 0.8 1 0.875 1

Location utilization and inventory turuover rate

• An analysis of location utilization at the time of data

collection showed that there were 2032 total locations,
1338 of which were filled, leaving 694 empty spaces,
representing a utilization rate of 65.85%. Location
utilization for cold rooms 1 and 2 is 33.3% and 31.3%,
respectively.
• The inventory turn over rate of the warehouse was
calculated using a six month data of 2015 budget year
and found to be 2.89.
Order turn around time

ORDER TURN AROUND TIME

Days Target
1.60 1.52
1.40 1.30
1.18
1.20
1.00 0.97
1.00 0.87
0.80
0.60
0.40
0.20
0.00
sep oct Nov Dec Jan Feb
Picking accuracy

Picking accuracy, a 3 month report of 2014

100%
99%
98%
97%
96%
95%
94%
93%
92%
Sep oct nov
Accuracy level 0.99 0.94 0.978
 The cold room

• The cold room has a total area of 152 m2, and there are a total of three
cold rooms, of which two are currently functional. Moreover, there are
deep refrigerators and ultra-cold freezers or refrigerators.

• Cold Room One is specifically dedicated to vaccines.

• The cold room has a preventive maintenance schedule and tracking

sheet to follow, which includes cleaning the floor, roof, and gates of the
cold room, conducting deforestation if ice forms, checking the electrical
cable and wall socket, and cleaning the cold box.
• There is a temperature monitoring system that requires twice-daily
checking of the temperature of cold rooms and refrigerators.
cold room
• According to cold room assessment using good distribution
practice inspection, the status of the cold room
warehousing was found to be ;
• Premises and layout - full conformance
• Employee- partial conformace
• Storage- full conformance
• Picking- full conformace
Quantfiaction and market shaping

• It is the department's responsibility to create, update, and

distribute a quantification tool to healthcare facilities.
• Unlike to program medicines, whose quantification is
handled centrally, RDF pharmaceuticals are quantified in a
decentralized manner, with health facilities responsible for
determining their annual needs.
• These forecasts are submitted to the hubs, who assess their
accuracy.
 Quantfiaction and market shaping
• The individual EPSS hubs then aggregate these estimates. If
there is any service level pickup, the projections are modified.
• To calculate the national demand, the hub level's aggregated
requirements are further consolidated at the central EPSS
level.
• The consumption approach is the main quantification
technique used, and the quantification tool also supports it.
But other methods are also used accordingly such as
morbidity method for anticancer medicines, and others. The
department is also responsible to perform market shaping
analysis.
 Distribution and fleet management
• Depending on whether the facilities are covered by a direct or indirect
delivery system, the distribution is in charge of distributing goods to
woredas and facilities.
• Facilities and woredas can be found between 12 and 406 kilometers
from the hub.
• The Department uses five KPI to track its performance, including
1. Average delivery time,
2. Distribution cost,
3. % of stock returned incident,
4. On time delivery,
5. Dispatch confirmation rate and
6. Percentage of proof of delivery (POD) collection.
 Distribution and fleet management
• Depending on the type of product, the hub employs both a
delivery and a pick-up distribution system.
• Program medications are shipped, and facilities choose
RDF items.
• Based on how close together the facilities are, there are
ten routes that fall within the same zone.
• According to each zone's reporting period for program
medications, there is a scheduled delivery/refilling time.
• The distribution expert prepares the delivery schedule and
route plan, estimates the volume and weight of the
products requested, estimates vehicle requirements, and
notifies the distribution coordinator.
• The delivered vehicle will receive dispatched products and
conduct dispatch coordination;
• it will receive a vehicle pass; it will distribute products to health
facilities;
• it will collect proof of delivery (POD) accordingly; and it will
provide the collected POD to the data clerk.
Reason of return
Stock return Memo
Near expirey ;
80%
74%
70%

60%

50%

40%

30%
others ; 22%
20%

10% over stock; 4%

0%
Percentage
SWOT ANALYSIS
 Visitations - EPSS central
Quantification and market shaping
• Forecasts from hubs are sent to EPSS central and aggregated. The
Average monthly consumption is calculated and safety stock is added
after an annual demand is computed by multiplying the Average
monthly consumption (AMC) by 12. The supply plan considers shelf
life, products the pipeline and stock on hand. When there is budget
constraint prioritization is based on month of stock status of products.
The hub uses quantification tools like Quantimed for program drugs
however the RDF products are left to be dealt with Excel.
Procurement
• After the quantification process is finalized and the procurement
request is initiated, the tender management office evaluates the list
of items quantified and requested to be procured to see if it aligns
with the procurement plan list in terms of item and unit. There are 14
procurement process steps, starting with procurement budget
preparation and approval from the head of the public body to
ensure there is an adequate budget, after which the office starts
preparing bid documents, followed by bid advertisement, bid
document selling or issuing, bid clarification, bid offer
receiving, bid opening, bid evaluation, bid evaluation report
approval, awarding, handling complaints, the purchase order
process, the contract agreement, and finally documentation.
Addis Ababa city administration health bureau pharmaceutical
service and service directorate
• The city has a total of 101 Health centers, 6 regional hospitals, 7
federal hospitals, 29 private hospitals, 2,832 private health
facilities, 1319 drug vender & drug store and 1364 private clinics,
and a total of 12,541 health workers. The Population Vs HWs
Ratio is 3.25/1,000.
• Some of the challenges the team of supply chain is facing
includes shortage of storage space for bulk items, insufficient
warehouse and poor infrastructure, short shelf life of COVID-
19 Vaccines Global Access (COVAX) and test kits. The
measures taken to tackle such challenges were using push
system to collect timely and close monitoring and follow up
supporting to manage emergency supply separately.
 Mojo dry port
• EFDA is responsible for pre-port, on-port, and post-port regulations.
• On-port regulation starts when quality indicator documents
(certificate of compliance (COC)), import permits, registrations,
and analysis documents are subject to document evaluation by
EFDA at the port. Quality analysis can be done by the importer
through an accredited laboratory. EFDA conducts the analysis with
the sample number formula of √N + 1 and is the sample passes the
analysis the whole batch passes.
• Half (50%) of the imported containers are inspected, if there are
more than five containers carrying the same product with the same
batch number;otherwise, all containers are scrutinized.
• The sample is created using stratified and random sampling.
The product's documentation, packing material integrity,
arrangement, and organization within the container—
including whether the contents are palletized, labeled, or the
result of leak tests—are all compared. Products that don't pass
the inspection the product will either be returned or disposed at
the expense of the importer.
• Regarding shelf life if the product has self-life of > 2 years its
required for the product to have at least 60% if </= 2, 50 % of
remaining shelf life is required.
• The special temperature sensitive products are transported by
refrigerated containers.
DROGA Pharma

• Droga Pharma Pvt.Ltd.Co was established in April 2015 by a group of

healthcare professionals, who have rich business experience in the
pharmaceutical sector. Droga is working in the pharmaceuticals
import, wholesale and retail business, targeting the public as well as
the private health sector of Ethiopia.
• Droga selects its to-be-imported items mainly based on morbidity
data and market demand gaps. The company holds me to items that
are already available on the market, products that are scarce on the
market, and products solely developed by the company. Droga
supplies a huge section of orthopedic instruments in demand in the
country based on consumption data.
• The company uses a market survey to determine market demand.
• When there is supply demand market saturation and there is a
significant level of items, the company sells the products with there
cost price to minimize expiry related loss. Consignment is measure
which enables the company to sell near expiry products with lower
price and allow buyers to return the already expired or unsold items.
• There is an approach called placement where medical instrument is
given for free and free samples of reagents are given, and then
reagents are sold in the long run to customers.
• The major key performance indicator used is order turnaround time
and inventory accuracy. Inventory is conducted quarterly. Past
inventory accuracy was from 85-90% with previous inventory
management system.
 UNFPA- overview of procurement
• UNFPA is the United
Nations Agency for
Reproductive Health with
the vision of "delivering a
world where every
pregnancy is wanted,
every childbirth is safe,
and every young person’s
potential is fulfilled." Its
operations are guided by a
global strategic plan and
country-level "Country
Program Document.
Reception of commodities in the warehouse
 Lesson learned
• I spent the five weeks there studying how each supply chain site's supply chain
operates. I was able to view the forecast reports of facilities during my first week
of work with the department of quantification, assess their quality, and discover
how forecasts are combined at the hub level.
• The department of warehouse and inventory management was my 2nd stop
where I was able to learn how the department do stock status report and
measure key performance indicators.
• Last but not least, I was able to decide which topic of research I ought to
concentrate on.
• I gained knowledge of the procedures for receiving, putting away, picking up,
and replenishing. The cold room is clean and operates in accordance with
standards.
• In overall, the internship time was a crucial component of this master's class
because it enabled me to understand how the health care supply system
functions and to recognize its obstacles and weak points.
Contribution

• In addition to participating in to the daily routine activities

of the hub, I was able to work on some KPI analysis to
support the hub in identifying its status from different
sections of supply chain. The result of the analysis was
presented to the department team leaders and deputy
manager to communicate the finding and recommend
solutions to identified problems. The case study
conducted on forecast accuracy of facilities was shared
with facilities and the hub to indicate the gap identified.
Conclusion

• The Ethiopian pharmaceutical supply service (EPSS) and

its hub have a significant impact on the quality,
affordability, and accessibility of medicine in Ethiopia's
public health care sector. The Ethiopian health
transformation plan II identified weaknesses include
inadequate pharmaceutical supply chain management
system resulting in shortage of supplies, which raises the
interest to analyze the operation of the EPSS and
understand the problems.
Recommendation

• Health facilities
• Federal ministry of ministry of health (FMOH) and
regional health bureau and partner
• EPSS hub and central