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

Facility-Level Supply Chain Function AreaPractice/BehaviorSample Measurable Indicators From Existing Research and LiteraturePotential New Facility-Level Indicators
Forecasting and quantificationOrder 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 managementActions 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 dispensingChange 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

CommunicationCommunication 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.