LHW Systems Review - Oxford Policy Management

LHWP – Systems Review• Lack of logistics management expertise• Procurement requires dedicated and expert personnel. The long-standing LogisticsAdvisor (funded by external sources) left the Programme in July 2007. The LogisticsOfficer was also transferred, leaving no experienced staff in the Logistic Department.The salary package in Islamabad is unattractive to provincial logistics officers;• Lack of fundingo Lack of funding or delays in release of funds (e.g. stationery unavailable for newlyselected LHWs; modules not available for training);• Delays in supplyo Supplier delays: even though there are penalties for late delivery, these can bedifficult to apply;• Delays in distribution from the PPIU:o Quality control process delays; waiting for samples of batches to be tested by theone central laboratory;o Stock not available because it has failed the testing procedure (e.g. in 2007,stock-outs of paracetamol syrup and antiseptic lotion were reported to be due tothe products being declared sub-standard;o Not receiving the stock order from DPIU; and• Delays in distribution from the DPIU:o Administrators delaying distribution;o Lack of available vehicles (or POL); and• Staff being involved in health campaigns (e.g. Polio days resulting in either lack oftransport, lack of manpower, or both);• Not applying the replenishment system, leading to inaccurate assessment ofrequirements;• Under or over estimation of stocks required, resulting in either over-stocking orstock-outs:ooby the district, due to poor assessment of stock usage;difficulties in the time required by the forecasting process, sometimes up to oneyear in advance;• Inflexible distribution throughout the country, resulting in some areas being overstockedand other areas under-stocked, even though the total stock levels seemsufficient;• Storage facilities at the districts not always being suitable for warehousing supplies(e.g. Depo Provera). They might be too small, insecure, or too hot. There arereported problems with storing the larger quantities of stock required by theexpanded Programme; and• Expired stock Medicines with less than 85 percent shelf life are rejected at the timeof post-delivery inspection at the PPIU. However, if there are delays in transportationto the district, and from the DPIU to the health facility, then there is the risk of expiredmedicines.6.6 Findings1. The supply system for medicines is performing poorly The Programme did notsucceed in achieving its performance targets. There are a significant number ofLHWs who have been without various medicines for over two months. In addition,there is a shortage of non-drug items. The regular supply of drugs and contraceptives40