TABLE 4.

Selected Facility-Level Practices/Behaviors, Existing Indicators, and Potential New Indicators for Future Testing and Piloting

Facility-Level Supply Chain Function Area	Practice/Behavior	Sample Measurable Indicators From Existing Research and Literature	Potential New Facility-Level Indicators
Forecasting and quantification	Order verification before submission to the central/regional level	Formal work plan and/or schedule for quantification²⁶ Average order entry time and order entry accuracy⁹	Orders are verified by staff prior to sending Second-stage order verification by staff member other than the person who filled the order
Warehousing and inventory management	Actions taken when stocks received from CMS/RMS	Average put-away accuracy and put-away time⁹	Immediate shelving of stock upon arrival by appropriate staff member Verification of stock arrival and shelving procedures Reported discrepancies between what was in the order placed and what was actually received
Prescribing and dispensing	Change in prescription	Perception of physician—If physicians are perceived to be professionally competent, pharmacy staff may model their behavior on physician prescribing patterns. Presence of some medical malpractice could also influence the pharmacy staff's behavior.¹⁴	Standardized procedure/formal communication among prescribers to adjust prescriptions during stock-outs followed Number of patients switched to another regimen due to stock-outs, then switched back to the old regimen or kept on the new regimen when the drug becomes available Changes in prescriptions recorded at the pharmacy
	Change in dispensing during stock-out	No existing indicators	Standardized procedure/formal communication among pharmacy staff regarding the amount to dispense during stock-outs followed Changes in dispensing recorded Discrepancies in what was prescribed and dispensed recorded Procedure established/followed when one of the medicines in a regimen is stocked out, and what happens to the other medicines (e.g., thrown out, given to someone else) Number of stock-outs for pediatric formulation affecting management of adult ARV stocks
	Action to ensure patient adherence	Regular pill counting²⁶ Percentage of patients with full adherence to ART (i.e., no doses missed in the 3-day recall period) Average percentage of days covered by ARVs dispensed for a sample of patients for a defined period (180 days) Percentage of patients who experienced a gap in ARV availability of more than 30 days in a row during the same defined period Percentage of patients who attend on or before the day of their appointment Percentage of patients who come within 3 days of their appointment	Pill counting conducted Changes in dispensed medicines recorded
Communication	Communication with higher-level supply chain management	No existing indicators	Perception of relationships between ARV manager/coordinator and regional offices Frequency of communication (times/month, times/year) Number of times the regional office “checks” on each pharmacy (times/month, times/year) Perception of relationships between pharmacy and central medical store Perception of support and good supervision the ARV manager thinks they receive from the regional pharmacist
	Communication with affiliated facilities	No existing indicators	Type of communications that occur between the facility and its affiliated facilities (e.g., outreach sites, baby clinics) Procedure for affiliated facilities placing orders followed Frequency that affiliated facilities place orders with the higher-level facility (times/month, times/year)

Abbreviations: ARV, antiretroviral drug; ART, antiretroviral therapy; CMS, central medical store; RMS, regional medical store.