When a pharmacy (in a medical store or health facility) temporarily has no medicine on the shelf, it is known as a “stock-out”. It may affect one medicine or many medicines, or in the worst case, all medicines. A stock-out can be documented at one point-in-time or over a period of days, weeks or months. When there is good stock management systems in place, the stock-out duration will be minimal or, ideally, never.
The consequences of stock-outs for patients are grave:
- They have to travel to other health facilities or private sector which may be far away and often many times more expensive… or
- They may go without the medicines they need.
- They may get an alternative, appropriate or not, medicine.
- They lose confidence in the health facility to meet their needs.
The supply chain in developing countries:
Getting medicines to patients
- The government makes a “forecast” of how many medicines will be needed to manage and treat the population, based on the major public health challenges in the country.
- Orders and tenders are generated;
- Medicines are purchased and stored centrally;
- Medicines are distributed to regional stores and local health facilities;
- Medicines are dispensed to patients in health facility pharmacies.
In a push system, health facilities receive “kits” containing a set amount of medicines. The central and regional stores prepare and send these kits on a regular schedule.
In a pull system, the health facility decides the quantity of medicines needed and then they place orders for the medicines at the district, regional or central store.
Inefficiencies at any stage of the supply chain cause stock-outs.
- Inadequate funds for procurement of medicines
- Inaccurate and non-participatory forecasting
- Inadequate buffer stock of essential medicines at all levels of the supply chain
- Inefficient distribution systems at national and regional levels.
- Inadequate record-keeping
Is there information on stock-outs in my country?
WHO conducts surveys of countries’ pharmaceutical sectors to measure various aspects of the sector’s functioning, including the stock-out duration of medicines. This is done through retrospective analyses of stock-cards from the pharmacy records.
The graph shows the number of days a list of key essential medicines were out-of-stock in middle-level public health facilities in a year. The stock-out duration ranges from 25 to 89 days.
WHO and HAI monitor the availability (and price) of medicines in many African countries. This provides information on which medicines are, and which are not, on the shelves on the day of the survey. This gives useful information about the immediate availability situations, although it does not provide information about the duration which the medicine is off the shelves.
Taking action to eliminate stock-outs
- District health management teams should be participatory to encourage transparency and accountability in the supply chain
- Monitoring of availability of medicines at the health facilities
- Advocacy for 100% availability of essential medicines
- Advocacy for increased funding for essential medicines
1.WHO and HAI (2008). Measuring medicine prices, availability, affordability and price components http://haiweb.org/medicineprices/
2.Community Case Management (CCM) Essentials: A Guide for Program Managers http://www.coregroup.org/ccm/ccm_field.html
3.Using indicators to measure country pharmaceutical situations. Fact book on WHO level I and level II monitoring indicators; available from http://www.who.int/medicinedocs/index/assoc/s14101e/s14101e.pdf
4.WHO (2000). Promoting Rational Use of Medicines: Core components
5.WHO and MOH (2002). Baseline Survey of the Pharmaceutical sector in Tanzania
6.WHO, HAI, MOH (2002). Uganda Pharmaceutical sector Baseline Survey
7.WHO and MOH (2003). Assessment of the pharmaceutical sector in Ethiopia
8.WHO, HAI, MOH (2003). Assessment of the pharmaceutical sector in Ghana
9.WHO, HAI, MOH (2002). Assessment of the pharmaceutical situation in Kenya: a baseline survey
10.Gray, A (1998). Using stock cards to improve drug management http://www.hst.org.za/uploads/files/kwiksk13.pdf