LHW Systems Review - Oxford Policy Management

LHWP – Systems ReviewThe forecast for each year’s requirements of supplies is undertaken by the districts andsubmitted to the PPIUs/RPIUs and, subsequently, to the FPIU. 45 Economies of scale areachieved through bulk purchasing annually through a tender process. Economies of scale,keeping control over supply procedures, and lack of logistics management capability are themain reasons offered for centralised procurement. Provinces and districts have limited directprocurement authority. Procurement and distribution of drugs, medicines, and other suppliesis with the ‘active involvement of the Provincial governments and other related departmentsin the government i.e. the Ministry of Health and Finance’. 46Procurement is a high-risk area, and internal and external controls and timetables are veryimportant in managing this risk. The Procurement Committee is headed by the FederalDirector General of Health (Figure 6.1). The membership is deliberately large, for controlpurposes, and has the sole function of procurement. The committee is responsible forannually procuring drugs and non-drug items (including vehicles, contraceptives, and printedmaterials) according to procedures. 47 The process should be initiated in February, 18months in advance of the financial year for which the supplies are being procured. Tendersare reviewed in August/September, and supplies should start being delivered in January. Allsupplies, with the exception of condoms and injectable contraceptives, are to be procuredfrom within Pakistan.Distribution Successful bidders deliver supplies directly to the PPIU warehouses. Largequantities are supplied in three instalments, but most of the supplies are delivered biannually.48 The FPIU and PPIU logistics officers are responsible for monitoring thedistribution process from the PPIU to the districts. Physical distribution of supplies isundertaken by contracted transport from the PPIU to the DPIU on a quarterly basis.All supplies to the DPIU, and from the DPIU to the health facility, and thence to the LHWs (atthe monthly meeting at the health facility) are provided on a replenishment basis (institutedin 1998).45Refer to logistics manual: 14.46PC-1, LHWP: 41.47PC-1, LHWP: 47.48In 2007/08, paracetamol tablets, cotrimoxazole syrup, chloroquine tablets, vitamin B complex syrup, and ferrous fumarateand folic acid tablets were delivered in three instalments.30