STS: Supply Chain Management

Supply Chain Management (SCM) is the handing of flow of goods and material from point of origin to point of consumption, with the objective to ensure that the supplies are present for utilization without any interruption. It covers everything from procurement and sourcing of raw materials to delivery of final product to the consumer, along with the related logistics. It will also include the related information systems that enable monitoring and exchange of information.

Effective SCM ensures the following:

• Continuous availability of quality-assured medicines/ products at the right time and at all healthcare levels.
• Minimizes wastage by preventing expiry of drugs at all levels, maintenance of adequate stock levels and accurate records.
• Maximizes patient care by coordination in all departments and by minimizing human errors/ medication errors.
• Economically viable by minimizing monetary loss (e.g., through pilferage) and optimizing cost via bulk purchasing or according to consumption needs.

Robust supply chain management systems have two main components:

1. Physical flow: Involved the movement and storage of supplies
2. Information flow: Allows the various stakeholders to coordinate and control the flow of supplies

Resources

• NTEP Training Modules 1-4 for Programme Managers & Medical Officers, 2020.
• NTEP Training Modules 5-9 for Programme Managers & Medical Officers, 2020.
• Guidelines for Programmatic Management of Drug-resistant TB, 2021.

Assessment

Question​	Answer 1​	Answer 2​	Answer 3​	Answer 4​	Correct answer​	Correct explanation​	Page id​	Part of Pre-test​	Part of Post-test​
Which of the following statements are correct about supply chain management?	It is useful to ensure a continuous supply of good quality medicines.	It is an essential activity that must be undertaken by health programmes.	It helps reduce the cost burden on the healthcare system.	All of the above	4	Effective SCM is an essential activity that ensures a continuous supply of good quality medicines and cost optimization.	​

 

 

 

 

To ensure successful implementation, sustainability and quality services under the National TB Elimination Programme (NTEP), some guiding principles in Supply Chain Management (SCM) and drug logistics are to be ensured. These are showcased in the figure below.

 

Figure: Principles of SCM under NTEP

 

Important Points

• Timely procurement, uninterrupted supply and maintenance of stock and in-time distribution of anti-TB drugs and other consumables are essential for quality services.
• Monitoring of drug supply from the central to peripheral health institute level through web-based real-time software, Nikshay-Aushadhi, is crucial to avoid under-stocking (and delays in treatment initiation) and over-stocking (resulting in wastages).
• Maintaining appropriate storage and stacking norms i.e., different batches of drugs with different dates of manufacture and expiry are stored separately so as to facilitate First-expiry-first-out (FEFO) principles, viz., drug batches with the most recent expiry are issued first.

 

Under FEFO, the storekeeper at the drug store is responsible for:

• Installing appropriate tools to periodically monitor controls over the expiry position of drugs.
• Exercising prudence in the case of short-expiry drugs, wherein distribution is on a rational basis that considers the utilization pattern. This includes the following:
  • The storekeeper marks ‘Expiry Dates’ in Bold Letters 3” to 4” in size, on the drug cartons with a marker pen, for easy identification and control of drugs immediately on their arrival.
  • Routine monitoring of the stock position of all drugs.
  • Maintaining proper records.
  • Analyzing shelf-life analysis of drug stocks at all levels regularly.

 

 

Resources

• NTEP Training Modules 1-4 for Programme Managers & Medical Officers, 2020.
• NTEP Training Modules 5-9 for Programme Managers & Medical Officers, 2020.
• Guidelines for Programmatic Management of Drug-resistant TB, 2021.

Assessment

 

Question​	Answer 1​	Answer 2​	Answer 3​	Answer 4​	Correct answer​	Correct explanation​	Page id​	Part of Pre-test​	Part of Post-test​
What is FEFO?	FEFO is the division that manages drug receipts under NTEP.	FEFO is a supply chain principle that is used to forecast consumables that are required by the programme.	FEFO means First-expiry-first-out and it is a principle to be followed when issuing drugs/ consumables.	None of the above	3	FEFO means First-expiry-first-out and it is a principle to be followed when issuing drugs/ consumables.	​

 

 

Under the National TB Elimination Programme (NTEP), the anti-TB drugs are procured at the centre level by the Central TB Division (CTD), Ministry of Health and Family Welfare (MoHFW), and supplied to the central warehouses.

From the central level warehouses, the drugs are supplied to different State Drug Stores (SDS) and further distributed to District Drug Stores (DDS) and sub-district level (TB Unit (TU) Store and Peripheral Health Institute (PHI)).

This movement of drug flow is monitored in real-time through Ni-kshay Aushadhi.

 

Figure: Flowchart Showing the Overview of Distribution of Drugs

Abbr: CMSS: Central Medical Services Society; GDF: Global Drug Facility; CTD: Central TB Division; GMSD: Government Medical Store Depot; SDS: State Drug Store; DDS: District Drug Store; TU: TB Unit; PHC: Primary Health Centre; PHI: Peripheral Health Institute.

 

Resources

• Standard Operating Procedure Manual Procurement & Supply Chain Management, CTD, MoHFW, India, 2018.
• Procurement, Supply Chain Management & Preventive Maintenance, Module 6, CTD, MoHFW, India.

Regular, accurate information on consumption, drug stock and supplies at the Peripheral Health Institute (PHI), Tuberculosis Units (TUs), districts and state levels are essential for timely drug stock indenting and distribution at all levels.

The anti-TB drugs are mostly procured centrally, except for very few drugs, and supplied according to a stocking norm to various level stocking units, based on indenting.

These indentings are further dependent on the certain levels of stocks predefined for each level.

The overall idea is to ensure a working and a buffer stock at each level for ensuring uninterrupted drug delivery to the beneficiaries. 

 

Drug Distribution Process

Figure: Drug Distribution Process

Abbr: CTD: Central TB Division; GMSD: Government Medical Supplies Depot; CMSS: Central Medical Services Society; SDS: State Drug Store; DDS: District Drug Store; TU: TB Unit; PHC: Public Health Centre; PHI: Peripheral Health Institute.

 

Indenting

Indenting is a process in which the requisition for stocks is submitted by the sub-store to the parent store or to the supplier in order to initiate the process of drug supply from the parent store to the sub-store. 

The stock management up to the TU level, including transfer to PHI, is handled by Ni-kshay Aushadhi software, while PHI to the patient is handled by Ni-kshay.

Offline Indenting

• The PHIs submit their drug request to the TU through offline indenting modes such as email, phone, etc.
• On receipt of the offline indent, the respective TU releases drugs to the PHI through the TU login in Ni-kshay Aushadhi using "Dispatch without drug request”  under the Issue/ Dispatch module.​

Online Indenting

• Online indenting is the term used when the indent request is placed through the Ni-kshay Aushadhi software.
• The supply of drugs from the central to the state level and further to districts and TUs is facilitated through online indenting.

 

Resources

• Standard Operating Procedure Manual Procurement & Supply Chain Management, CTD, MoHFW, India, 2018.
• Procurement, Supply Chain Management & Preventive Maintenance, Module 6, CTD, MoHFW, India.

Assessment

Question​	Answer 1​	Answer 2​	Answer 3​	Answer 4​	Correct answer​	Correct explanation​	Page id​	Part of Pre-test​	Part of Post-test​
How is the online indenting process done?	Through Phone	Through e-mail	Through Physical visit	Through Ni-kshay Aushadhi	4	Online indenting is the term used when the indent request is placed through the Ni-kshay Aushadhi software.	​	Yes	Yes

 

 

'Logistics' is the process of planning and implementing the efficient transportation and storage of supplies (drugs, consumables and other related items) from the point of origin to the point of consumption through a systematic mechanism.

 

Figure: Flowchart depicting overview of  logistics under National TB Elimination Programme (NTEP)

Resources

• Standard Operating Procedure Manual - Procurement & Supply Chain Management, CTD, MoHFW, India, 2018.
• Procurement, Supply Chain Management & Preventive Maintenance, Module 6, CTD, MoHFW, India.

Assessment

Question	Answer 1	Answer 2	Answer 3	Answer 4	Correct answer	Correct explanation	Page id	Part of Pre-test	Part of Post-test
From where do the PHIs receive supplies?	GMSD	CMSS	SDS	TU	4	The PHIs receive the supplies from the TU.		Yes	Yes

Ni-kshay Aushadhi is a web-based portal that deals with the management of stocks (anti-TB drugs, consumables and other commodities) across all the stocking points across the National TB Elimination Programme (NTEP), i.e., Government Medical Store Depot (GMSD), Central Medical Services Society (CMSS) warehouses, State Drug Stores (SDS), District Drug Stores (DDS), TB Units (TUs) including Peripheral Health Institutes (PHIs).

Ni-kshay Aushadhi also helps in real-time management of stock position, providing expiry details of commodities, routine/ Additional Drug Request (ADR) Requirements, and patient-wise consumption of drugs at all levels.

Table 1: Nikshay Aushadhi Stakeholders

User	Services
Central TB Division (CTD)	1. Quantification 2. Purchase Order (PO) generation 3. Quality control 4. State warehouse Drug Transfer Advice (DTA) 5. Monitoring of nation-wide stock & expiry
CMSS warehouse	1. Quantification 2. Purchase request generation 3. Advance shipment details 4. Supplier delivery details 5. Release Order (RO) to SDS 6. Acknowledge desk 7. Transfer of drugs to other warehouses
GMSD	1. Quantification 2. Acknowledge desk 3. Advance shipment details 4. Transfer of drugs to other warehouses
Supplier	1. View Purchase Order (PO) and delivery schedule 2. Enter dispatch details 3. View receipt 4. Demand vs issue
SDS/ DDS/ Drug-resistant TB Centre (DR-TBC)/ TU	1. Routine/ ADR & dispatch to sub-stores 2. Acknowledge desk 3. Transfer of drugs to other warehouses 4. Issue voucher DTA 5. Box preparation, box modification, unpacking and box completion 6. Local purchase
PHI	1. Routine/ ADR  2. Acknowledge the receipt of drugs 3. Issue to patient 4. Return from patient

 

The Ni-kshay Aushadhi can be used for the following purposes:

• Quantification and forecasting
• Monitoring and distribution
• Data management and analysis
• Recording and reporting of the drugs related data
• Training and capacity building
• Quantification of drugs
• Issue/ dispatch
• Return of drugs
• Drug request management - Routine/ ADR
• Stock management (like drug inventory, Physical Stock Verification (PSV))
• Packaging/ repackaging
• Receive from store/ Acknowledge desk
• Quality control management

 

Figure: Supply chain management in NTEP through Ni-kshay Aushadhi; Source: Ni-kshay Aushadhi Manual

 

Resources

• Ni-kshay Aushadhi Portal.

 

Assessment

Question	Answer 1	Answer 2	Answer 3	Answer 4	Correct Answer	Correct Explanation	Page ID	Part of Pre-Test	Part of Post-Test
Ni-kshay Aushadhi can be used for the quantification and forecasting of drug stocks.	True	False			1	The Ni-kshay Aushadhi can be used for the following purposes: Quantification and forecasting Monitoring and distribution Data management and analysis Recording and reporting of the drugs-related data Training and capacity building Quantification of drugs Issue/ dispatch Return of drugs Drug request management - Routine/ ADR Stock management (like drug inventory, PSV) Packaging/ Repackaging Receive from store/ Acknowledge desk Quality control management Miscellaneous		Yes	Yes

Expiry management of supplies is crucial to avoid financial losses and harm to patients.

If any drug expires due to reasons beyond control, the write-off of expired drugs should be as per the guidelines given in NTEP National Strategic Plan. As per NSP, the State is allowed to write off up to 2% of the cost of the annual supply of drugs on implementation of Drug Sensitivity Testing (DST) guided treatment and 2% cost of rapid molecular test cartridges. The expired stock should be disposed-off as per the Bio-medical Waste (Management and Handling) guidelines of Govt. of India.

Disposal of Expired/Discarded Medicines

Colour of the bag to be used: Yellow

Figure 1: Disposal of expired supplies according to Bio-Medical Waste Management Rules 2016

Updating in Ni-kshay Aushadhi

To dispose of or remove the expired/rejected drugs from the online inventory, follow the steps below:

1. Go to the ‘Write-Off/Disposal’ process in Stock Management,
2. Click on the ‘Request’ button to generate the disposal request,
3. Select the ‘Expired or Rejected’ category, and the system will show the respective drugs
4. Select the drug with an expired batch and enter the quantity
5. Click on the ‘Save’ button.

Figure 2: Write-off/disposal register in Nikshay Aushadhi                         Source: Nikshay Aushadhi portal

 

Figure 3: Entering details of expired drugs in the write-off/disposal register in Nikshay Aushadhi   Source: Nikshay Aushadhi portal

 

Steps to follow

1. After saving, select the request and click on the ‘Write-off’ button,
2. Verify the drug details and select the type of write-off as ‘Burned/Buried’,
3. Enter the ‘Remarks’, and click on the ‘Save’ button,
4. System will generate the voucher, and the drug quantity will be deducted from the inventory.

Figure 3: Expired drug details in Nikshay Aushadhi   Source: Nikshay Aushadhi portal

 

 

Condemnation of laboratory supplies

Figure 4: Process of condemnation of laboratory supplies which are non-functional, obsolete, non-reparable equipment in NTEP’s laboratories

 

Information is required in below mentioned format to condemn the lab equipment:

Figure 5: Form GFR 10        Source: General Financial Rules 2017, Ministry of Finance, Department of Expenditure, GoI

 

The request for the replacement of the equipment condemned has to be submitted to State TB Officer (STO)/Central TB Division (CTD) in the below-mentioned format:

Figure 6: Annexure 4 for details of equipment for condemnation              Source: Guidelines for the condemnation and replacement of Tuberculosis (TB) laboratory equipment under the Revised National Tuberculosis Control Programme (RNTCP) 2019

 

Resources

1. Guidelines for Management of Healthcare Waste as per Biomedical Waste Management Rules, 2016

2. Guidelines for the condemnation and replacement of Tuberculosis (TB) laboratory equipment under the Revised National Tuberculosis Control Programme (RNTCP) 2019

 

Assessment:

Question​	Answer 1​	Answer 2​	Answer 3​	Answer 4​	Correct answer​	Correct explanation​	Page id​	Part of Pre-test​	Part of Post-test​
Disposal of expired supplies is done in which colour bag?	Yellow	Red	White	Blue	1	Discarded or expired medicine in yellow coloured non-chlorinated plastic bags

To preserve the quality of medicines, good storage practices should be in place at all levels, which requires that staff are appropriately trained and storage conditions adequate.

 

General Guidelines on Storage of Drugs

 

Mechanisms to improve TB stock management in central or peripheral drug stores are:

1. Stock rotation follows a First-expiry, First-out (FEFO) approach.
2. The cleanliness of the area is ensured.
3. The environment of the warehouse protects medicines from factors that could inhibit their effectiveness or use, such as sunlight, heat, cold, moisture, pests and theft.
4. The stock area is divided into zones for easy location of different products.
5. There is a designated area for second-line TB medicines.

 

Storage Guidelines under the National TB Elimination Programme (NTEP)

 

Under NTEP, space requirements change at the state, district and peripheral levels according to the NTEP stocking norms, but all other requirements remain the same as shown in the table below. The State TB Officer (STO)/ District TB Officer (DTO) must ensure that the pharmacist/ storekeeper adheres to the following guidelines on the proper storage of drugs.

 

Table: Guidelines for the Storage of Anti-TB Drugs in NTEP Drug Stores

Space Requirements at the State Drog Store (SDS)

For every ten lakh population, provision should be made for the storage of about 45 cartons (of 20 boxes each), of Patient-wise Boxes (PWBs) for new cases (PC-1) and PWBs for retreatment cases (PC-2) taken together. This is approximately equivalent to 6 months requirement of drugs. For this volume of drugs, the minimum space requirement may be approximated as 50 cubic feet. For loose drugs, space provision would be 10% of space allocated to PC-1 and PC-2 PWB cartons. These could alternatively be stored in cupboards/ almirahs where volumes are low and should be kept under lock and key. Do not stack drug cartons on the floor or on top of one another.

Room Requirements

The store should preferably comprise one large room. Where multiple rooms exist, these should be contiguous or proximate to each other. The ceiling must have a height of at least 5 metres. There should be a lockable door and at least one window with a grill and wire meshing. Properly lit with extra light points for plugging in the required office equipment. An even-level, ‘pukka’ floor.

Stacking Requirements

Ensure that different drug/ consumable items are clearly segregated and stacked on separate racks. Different batches of drugs with different dates of manufacture and expiry are stored separately to facilitate FEFO principles (drug batches with the most recent expiry are issued first) Mark ‘Expiry Dates’ in Bold Letters 3” to 4” in size, on the drug cartons with a marker pen, for easy identification and control of drugs immediately on their arrival. Separate and dispose of damaged or expired products without delay as soon as approval of the same has been received, according to the biomedical waste guidelines.

Temperature and Humidity Control

To keep humidity levels below the maximum 60% recommended for storage of drugs ensure appropriate ventilation and air circulation, and do not open cartons/ drug boxes unless necessary. Hydro thermometers are to be installed up to TB Unit (TU) drug store levels to monitor humidity and temperature regularly. Overhead exhaust fan required. Plastered walls and ceiling with whitewash without any kind of seepage in the room. The store should be clean, dry and well-ventilated. Ceiling and sidewalls should preferably be insulated, ensuring that the ambient temperature during peak summer does not result in damage to anti-TB drugs. The ambient temperature may be taken as 15-25°C or depending on climatic conditions, up to 30°C. PWBs/ cartons should be placed on shelves ensuring that there is sufficient space between shelves and walls of the storeroom. A regular power supply should be available for air conditioning.

Protection from Sunlight

Shade the windows or use curtains if they are in direct sunlight. Keep products in cartons/ drug boxes. Do not store or pack products in sunlight. Maintain trees around the premises of the drug store to help provide shade and cooling. Check their condition regularly to prevent any untoward incidents.

Fire Safety

Ensure that the fire safety equipment is available and accessible, and that personnel are trained to use it.

Others

Store medical supplies separately, away from rodents, insecticides, chemicals, old files, office supplies and other materials. Stores should not have any odour or indications of contamination and should be sanitised periodically including pest control measures.

 

Resources

• NTEP Training Modules (5-9) for Programme Managers & Medical Officers, 2020.
• Standard Operating Procedures Manual for State Drug Stores, NTEP, 2012.

 

Assessment

Question​	Answer 1​	Answer 2​	Answer 3​	Answer 4​	Correct answer​	Correct explanation​	Page id​	Part of Pre-test​	Part of Post-test​
Concerning storage of anti-TB drugs, which of the following is correct?	Stock rotation follows a First-expiry, First-out (FEFO) approach.	Store drugs away from direct sunlight.	Hydro thermometers are to be installed up to TU drug store levels to monitor humidity and temperature regularly.	All of the above	4	Appropriate anti-TB drug storage conditions include keeping drugs away from direct sunlight, maintaining appropriate temperature and humidity and following a FEFO approach.		Yes	Yes

 

 

An indent is an official order or requisition for medicine and supplies from a medical store and the process of requesting is called indenting.

Under National Tuberculosis Elimination Programme (NTEP), online indenting of drugs and consumables is done using the Ni-kshay Aushadhi web portal.

There are different types of requests raised through Ni-kshay Aushadhi:

1. Quarterly request
   1. From State to Central TB Division (CTD), District Drug Store (DDS) to State Drug Store (SDS) and Tuberculosis Unit (TU) to District Drug Store (DDS) on a quarterly basis.
   2. Quarterly replenishment of drug stocks with districts shall be based on the reports submitted by them in NI-kshay Aushadhi, providing complete details of opening and closing stocks, receipts, consumption and anticipated requirement.
2. Monthly request
   1. From Peripheral Health Institution (PHI) to DDS on a monthly basis.
3. Additional Drug Request (ADR)
   1. Supplies to District TB Centres (DTCs) against Additional Drug Requests (ADRs): There are likely to be occasions when the quarterly supply of drugs to DTCs as above, is insufficient to meet the needs of the district and additional drugs are required in advance of the next quarterly shipment. In such cases, the concerned DTC is required to prepare and submit an Additional Drug Request to the State TB Officer (STO), providing details in support of the supplementary requirement. 
   2. The need for an ADR arises only if the more patients put on treatment in the previous month in a quarter goes up, resulting in an insufficient stock in the store. To get the additional supply from CTD/ SDS/ DDS/ TU, an ADR for each item needs to be submitted by the SDS in charge/ District TB Officer (DTO)/ Medical Officer- Tuberculosis Control (MO-TC). Before sending the ADR, one should consider and track the drugs that have been already released and are being transported from central/ state/ district/ TU stores.

 

   Figure: Different Types of Drug Requests as Part of Indenting in NTEP through Ni-kshay Aushadhi Web Portal; Source: Ni-kshay Aushadhi Portal.

 

Resources

• Standard Operating Procedures Manual for State Drug Stores, Central TB Division, MoHFW, GoI, 2012.

 

Assessment

Question​	Answer 1​	Answer 2​	Answer 3​	Answer 4​	Correct answer​	Correct explanation​	Page id​	Part of Pre-test​	Part of Post-test​
What is the mode of indenting in NTEP?	Through phone call	Through Ni-kshay Aushadhi's web portal	Through letter	Through email	2	Under National Tuberculosis Elimination Programme (NTEP), online indenting of drugs and consumables is done using the Ni-kshay Aushadhi web portal.		Yes	Yes

 

The process of receipt of drugs is completed through the Ni-kshay Aushadhi application. Once a consignment is dispatched to the receiving unit, the system will display following three options:

1. Acknowledge Desk - For acknowledgment of drugs received against CTD-RO/ Issue Voucher
2. DTA Receipt - For acknowledgment of drugs received against CTD-DTA: This process is to be used to record receipt of drugs which are received against DTAs issued by CTD/ issued by parent store to correct stock imbalances in sub-stores.
3. Received from Third Party :This process is to be used when a store receives any drug or commodity from third party as donation.

• Receipt of  'complete' or 'partial' quantity of drugs can be acknowledged in Ni-kshay Aushadhi, as the case may be. When the user selects a particular consignment and clicks on the ‘Acknowledge’ option, the system shows a list of issued drugs/ items with the following details: Drug Name, Batch Number, Expiry Date, Requested Quantity, Issued Quantity, To be Acknowledged Quantity, Received Quantity, Damaged Quantity, Shortage Quantity.
• In instances where the quantity received is lesser than the issued quantity, the user should enter the same in the ‘Received qty’ column. As the request is partially acknowledged, the system will display it in the orange/ pink colour on the ‘acknowledge desk’. As and when the remaining quantity is received,  the user can acknowledge the same by selecting the previous partially acknowledged record and entering the remaining quantity that has been received.     

 

Resources

• Standard Operating Procedure Manual-Procurement & Supply Chain Management, CTD, MoHFW, India, 2018.

• Procurement, Supply Chain Management & Preventive Maintenance, Module 6, CTD, MoHFW, India.

• Receive and Acknowledge, Ni-kshay Aushadhi User Manual, CTD, MoHFW, India.

 

Assessment

Question	Answer 1	Answer 2	Answer 3	Answer 4	Correct answer	Correct explanation	Page id	Part of Pre-test	Part of Post-test
The partially acknowledged ‘receipt’ will be shown in which colour in the ‘acknowledge desk’ on Ni-kshay Aushadhi?	Yellow/ Blue	Orange/ Pink	Black/ White	Green/ Red	2	The partially acknowledged ‘receipt’ will be shown in orange/ pink colour in the ‘acknowledge desk’ on Ni-kshay Aushadhi.		Yes	Yes

Good storage conditions and safe custody of drugs is important to ensure quality of drugs. Temperature and humidity control systems should be appropriately designed, installed, qualified and maintained, to ensure that the required storage conditions are maintained.

The State TB Officer (STO)/ District TB Officer (DTO) must ensure that the pharmacist/ store-keeper adheres to the following guidelines on proper storage of drugs.

Temperature

• The storage temperature should be 25⁰C and maintained with an air conditioner wherever applicable.

Humidity

• Humidity levels should be below 60% and maintained with a dehumidifier, wherever required

Power Supply

• Regular power supply should be available for cooling devices (AC, ceiling fans etc) and dehumidifiers.

 

Drug Safety

Storage Room

• Should be cleaned and disinfected regularly, should be dry, well-lit and well-ventilated
• Should be free from any water penetration, rodent and pests
• Should have fire safety equipment in place
• The drugs should not be exposed to direct sunlight.

Stacking

• The shelves should be placed in such a way that there is sufficient space around for air circulation and free movement of personnel.
• Similar boxes should be stored adjacent to each other and stacked as per their expiry dates.
• The drugs expiring early should be placed closer to the ground and as those expiring late should be place at higher levels.
• Expired drugs should be segregated, sealed and stored in a separate part of the store so as to avoid issue to patients

 

Labelling

• The identification label, expiry date & manufacturing date of the anti-TB drugs should be marked with a bold marker pen on the visible side of the carton.

 

 

Resources

• WHO Technical Report Series, No. 908, 2003; Annex.9: Guide to Good Storage Practices for Pharmaceuticals.
• Procurement, Supply Chain Management & Preventive Maintenance, Module 6, CTD, MoHFW, India.
• Standard Operating Procedure Manual Procurement & Supply Chain Management, CTD, MoHFW, India, 2018.

 Assessment

Question	Answer 1	Answer 2	Answer 3	Answer 4	Correct answer	Correct explanation	Page id	Part of Pre-test	Part of Post-test
What is the maximum acceptable humidity levels in a drug store to maintain drug efficacy?	10%	25%	45%	60%	4	Humidity levels should be below 60% and maintained with a dehumidifier wherever required in order to ensure shelf life and efficacy of the drugs.		Yes	Yes

 

The Drug Dispensation Module in Ni-kshay web allows users to record details of products and the quality of the drugs issued to the patients. This module was launched to replace the existing Prescription Module and to add a variety of features that were missing in the Prescription Module. The user can access the dispensation for a particular patient from the Patient Details page, or directly from the navigation sidebar. 

 

Figure: Access to Drug Dispensation Module from the Navigation Bar or from the Patient Detail Page

 

The Drug Dispensation Module allows the users to perform the following different processes:

Process	Utility
Add Dispensation	This process allows users to record information on dispensation details, drug issuing facility, and product and refill details.
Print Dispensation	This process allows users to download and print a PDF containing all the information for a dispensation.
Return Dispensation	This process allows users to record events of dispensed drugs being returned back. To return a dispensation, the staff can select the drugs to be returned and add an appropriate reason for returning the drugs.
Copy Dispensation	This process allows users to create a copy of an existing dispensation for a patient thereby saving time by avoiding repetitive data entry.
Refill Due Task list	This process will show the list of patients who have a "Next Refill Due Date" in 2 days or less. It serves as a reminder so that the user can dispense the drugs on time.
Outcome assignment changes	This process automatically extends the “Treatment End Date” in the cases where the “Next Refill Due Date” is greater than the “Treatment End date”. A note for the same is also added.
Adherence linkage	This process allows users to switch on/off the linkage between dispensation and adherence. In case the link is switched on, no manual doses will be registered for the patient's adherence. Currently, the link is defaulted to "Yes" for Drug-sensitive TB (DS-TB) patients and "No" for Drug-resistant TB (DR-TB) patients.

                    

Resources

• Nikshay Training Materials.

 

Assessment

Question​	Answer 1​	Answer 2​	Answer 3​	Answer 4​	Correct answer​	Correct explanation​	Page id​	Part of Pre-test​	Part of Post-test​
Dispensation for a particular patient can be accessed from the patient details page only.	True	False			2	The user can access the dispensation for a particular patient from the Patient details page, or directly from the navigation sidebar.			YES