Tuesday, November 30, 2010

Medical Logistic For disaster

             In conjunction to the practical session about medical logistic for disaster I am going to have tomorow, I have done some reading on logistic management in the setting of disaster.

             First, lets clarify the key word "logistic". What is logistic? The word "logistics" comes originally from the military procedures for the procurement, maintenance, and transportation of materiel, facilities, and personnel. Generally, logistic refers to "a system whose parts interact smoothly to help reach a goal promptly and effectively thanks to the optimized use of resources". According to Pan American Health Organization-WHO,2001,  "logistics are required to support the organization and implementation of response operations in order to ensure their timeliness and efficiency in emergency relief operations."

           Besides, PAHO-WHO has classified the logistic items into ten classes as below.
1. Medicines;
2. Health supplies/Kits;
3. Water and environmental health;
4. Food;
5. Shelter/Electrical/Construction;
6. Logistics/Administration;
7. Personal needs/Education;
8. Human resources;
9. Agriculture/Livestock;
10. Unclassified. ( * supplies that may have expired, can't be identified due to poor  labelling,etc.,are useless, have spoiled or were packed too dangerously  to be sorted out.)

Basically,in the health sector, the logistic items are categorized into two main groups: - medical logistic and non-medical logistic. Medical logistic comprises of medicines and health supplies/kits. The rest are put under non-medical logistic. Ok, now back to the main topic I am going to talk about here.

            When a disaster strikes, loss of life or injury are events that are unavoidable. To preserve life or health of the disaster victims, it is essential for the drugs and medical equipments to be readily available in sufficient amount . Besides, the authority must optimize the use of all the resources, by storing and distributing the medical supplies in such a way that their quality are assured and that they are used rationally. In short, medical logistic is managed through the process of  selection, procurement, storage, and distribution. In fact, the support from organizations and regulations of work, human resources, information system and financing system is neccesary to run the management in a effective manner.

             Initially, a selection committee which comprises doctors, nurses, pharmacists, and representatives of the ministry of health will work together to develop a list of basic and critical medical supplies to be provided to the affected population. The selection criterias such as health care needs, the characteristics of the patients who require treatment, the availability of supplies and the capacity of the health system are taken into account. For instance, various countries will have their own list of basic drugs and medical products to respond to those health problems happen in the disaster. If no such list present, reference could be made from WHO- standard list of essential drugs and medical supplies for use in emergency situations.

Sample of basic drugs for Emergency Use ( by WHO) 

         Next, the drugs and other medical supplies is procured to ensure that the quantities are enough to meet the health care needs of the affected population. Besides, the quality of supplies is guaranteed and its availabilty at the time disaster happens is established. In order to anticipate or estimate the needs for supplies, a few methods or formula can be used. Below is one of the example of the formula.

             OPTIMAL STOCK = (WS + SO + LT + BS) - S
                                WS  = working stock
                                 SO  = stock out
                                 LT   = lead time
                                 BS  = buffer stock
                                  S   = stock in hand                                     ( DepKesRI, 2007)
           In addition, adequate storage conditions may make sure that health supplies retain their quality and effectiveness by creating the necessary physical, hygienic and infrastructural conditions. Besides, keeping track of stock level and monitoring regularly the expired dates of stored drugs could help in maintaining an optimal use of the available resources. Below is an example of approach for stock controlling.

                                      Fixed Order Quantity Approach: `Q' model

The above approach signifies that the order quantity can be fixed at a level depending on demand(D), value and inventory related costs. A stock level called Re Order Level (ROL) is fixed, which triggers ordering. ROL happens when safety stock/ buffer stock is sufficient to fulfill the demands rate during lead time . This approach order quantity is fixed by calculating Economic Order Quality(Q) and ROL is fixed by calculating lead-time consumption.

             Lastly, in disaster situations, a proper distribution of drugs and other medical supplies is done based on the demand for them and on the existing stock level. To ensure that the medical supplies are delivered at the right time and to the right person, the various organizations receiving supplies must coordinate their efforts, particularly with government agencies responsible for health care, such as the ministry of health. Few measures such as the availability of a reliable transport system to deliver the medical supplies, education to the patients about correct drug use and monitoring shall be carried out, the appropriateness of delivery schedules need to be considered for distribution to be conducted effectively. 

References:
1) Lecture Note by Dr Sulanto Saleh- Danu: Logistic( medical) and Disaster

                  


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