Pharmaceutical Management

Careful management of pharmaceuticals is directly related to a country’s ability to address public health concerns. Even so, many health systems and programs run into difficulty achieving their goals because they have not addressed how the medicines essential to saving lives and improving health will be managed, supplied, and used. Pharmaceuticals can be expensive to purchase and distribute, but shortages of essential medicines, improper use of medicines, and spending on unnecessary or low-quality medicines also have a high cost—wasted resources and preventable illness and death.

Because medicines are so important and resources so limited, ways have been developed to
improve the supply and use of medicines while minimizing costs. Pharmaceutical management
represents the whole set of activities aimed at ensuring the timely availability and appropriate use of safe, effective quality medicines and related products and services in any health care setting.

The following terms are used in pharmaceutical management.

• Bid: A bid is document prepared in response to an expression of procurement needs (also known as a tender).
• Cold chain: The distribution system used for the storage and transport of pharmaceuticals that require refrigeration (e.g., certain vaccines) is called a cold chain. In some countries a formal cold chain is also managed through a vertical program such as an immunization program (e.g., Expanded Programme on Immunization [EPI]).
• Essential medicines: The World Health Organization (WHO) defines essential medicines as the limited number of medicines that satisfy the needs of the majority of the population and that should be available at all times. Countries often publish a national essential medicines list (NEML) that identifies the medicines considered to be most important and relevant for the public health needs of that population.
• Kits: Kits are standardized packages of essential medicines and supplies that are delivered to the facility. Type and quantities of contents are determined by expected utilization rates for predefined services. Kits are generally part of a push distribution system that does not use requisitions.
• Lead time: The time needed to prepare bids, the time required to make an award and place an order, the time required to receive the delivery, and the time between receipt and payment are all defined as lead time.
• Pharmaceuticals: The term pharmaceuticals encompasses medicinal products, vaccines, contraceptives, diagnostics, and medical supplies.
• Push/pull systems: Push and pull are two types of distribution systems. In push systems, quantities of supplies and the schedule for their delivery to facilities are determined at a higher (usually central) level with little to no input from lower levels. In pull systems, facilities provide information on actual consumption and needs estimates to higher levels.
• Rational medicine use: Rational medicine use occurs when clients/patients are prescribed and dispensed the full amount of the appropriate, quality medicines at the lowest cost to them, to their communities, and to the system, and when clients/patients take the medicines correctly and without interruption.
• Standard treatment guidelines (STGs): STGs are disease-oriented guidelines that reflect a consensus on the treatments of choice for common medical conditions. They help practitioners make decisions about appropriate treatments and help to minimize variation in treatments offered by practitioners in the health care system.
• Tracer products: Approximately 20 pharmaceuticals or commodities that are selected to evaluate availability of essential products. The items to be selected for a tracer list should be relevant for public health priorities and should be expected to be available able at all times in the level of facilities of interest (e.g., clinics or hospitals). They are, therefore, likely to be on the NEML.
• Tender: Same as bid.

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