Consultant: CMS Pharmaceutical Stock Management Training

Consultant: CMS Pharmaceutical Stock Management Training Terms of Reference Capacity Building and Access to Medicines (CBAM) Afghanistan DEADLINE FOR COMPLETE PROPOSALS (Including workplan and budget): DECEMBER 16, 2011 to Julia Wight at jwight@hpicafghanistan.ca

Technical Activity: Providing training in pharmaceutical stock management and fire safety for the CMS

Timeframe: January 15 – February 29, 2012 Location: Kabul, Afghanistan Amount of Contract: Negotiable

A. Introduction

Health Partners International of Canada (HPIC) is a humanitarian not-for-profit relief and development organization dedicated to improving access to medicine and enhancing health in the developing world. HPIC contributes to well-being by providing donations of essential medicines, supplies and vaccines, building national health sector capacities, and responding to emergencies and health threats. We partner with a network of ministries of health, non-governmental organizations (NGOs) and healthcare professionals, with healthcare product companies, and with Canadian government departments; and we count on the financial support of individual donors, foundations and corporations. Currently HPIC is conducting a project to build the capacity of the national health sector in Afghanistan through the Capacity Building and Access to Medicine (CBAM) project.

The goal of the CBAM project is to support the Ministry of Public Health (MoPH) in Afghanistan to effectively ensure greater and more equitable access to priority pharmaceuticals and medical supplies for all Afghans with a specific emphasis on women and children. HPIC is the implementing partner in the CBAM project, and as part of the project, has agreed to provide capacity building and training to the Central Medical Stores (CMS). The CMS, operating under the MoPH General Directorate of Administrative Affairs (GDAA), is the national warehouse storing and managing pharmaceuticals and medical supplies for public health facilities, and is an integral part of the pharmaceutical distribution system in Afghanistan. It is a complex storage and distribution facility that requires a pharmaceutical stock management system that meets international best practice standards in-order to effectively and efficiently coordinate the supply of pharmaceuticals and medical supplies throughout Afghanistan.

Such a system requires a knowledgeable and well-trained staff to ensure that best practice standards are followed on a daily basis.

The CMS Pharmaceutical Stock Management Training will provide the CMS management and staff with training in sound pharmaceutical stock management practices, as well as hands on experience implementing these practices. There needs to be a special focus on providing refresher training to training provided in November 2010 in general stock management, medicine stock management, and physical inventory. To complement this training, the CMS management and staff also require training in the proper completion of forms and documents, especially those used for documenting CMS receiving, storage and distribution process. Further training is also needed in fire safety and prevention to increase the overall safety of the CMS facilities. The training will require close collaboration with the CMS management and staff. The entire CMS Pharmaceutical Stock Management Training is to begin in January 2012 and be concluded by the end of February 2012. This includes preparation, conducting the training, providing a post-training assessment of participants, and a summary report of training activities, lessons learned and recommendations.

B. Background / Rationale for Assignment

During current efforts to rebuild Afghanistan it has been vital to address the provision of quality healthcare, especially for women and children. Crucial to this has been ensuring that Afghan health facilities are supplied with sufficient quality pharmaceuticals and medical supplies. The CMS acts as the direct link between health facilities and the rest of the national pharmaceutical and medical supply chain. However after decades of war, it’s capacity to act as this link has degraded through neglect and the daily realities of limited resources and complex management systems. In a 2008 report, the European Commission commented that the CMS is “highly disorganized, unprofessionally managed and far removed from exhibiting good storage practices.” To address this concern, HPIC is working to improve the CMS’ management system, with special attention to providing the CMS staff with a regular series of training in pharmaceutical and stock management best practices.

In February 2010, HPIC conducted an assessment study of the CMS to identify the infrastructure and capacity needs of the CMS. This assessment was to help determine the role of the CBAM project in working with the CMS to improve its pharmaceutical management system as a means of improving logistics and pharmaceutical supply chain management at the national level. As a major finding, it found that there was no regular or uniform pharmaceutical or stock management training at the CMS. Following the recommendations of the assessment a training needs checklist was developed to document the kind of training that CMS employees had previously had, and to determine the type of training that CMS employees were interested in obtaining. The training areas that received the highest preference were: general stock management, medicine stock management, and physical inventory. In November 2010, a 10 half-day training session was facilitated by HPIC that provided 40 CMS employees with training in the above topics. As follow-up to this training, HPIC has been conducting monthly reviews of the CMS to determine if the training provided has been, and continues to be, implemented. As of September 2011, of the three CMS stock rooms checked, the CMS employees were achieving a level of over 87% compliance.

Though the CMS has reached a high level of compliance, HPIC has determined that it is important to ensure that the benefits gained from the November 2010 training are not lost, and are built upon to ensure the sustainable use of pharmaceutical and stock management best practices at the CMS, and to further increase the level of compliance. Providing follow-up training will allow CMS employees to gain refreshment training in the topics previously covered, as well as to obtain new information and knowledge in the most up-to-date approaches to those topics. In addition, to further the capacity building of the CMS employees, HPIC has also determined that providing complementary training in topics that received less preference from CMS employees in the training needs checklist would be of great value. For this consultancy, those topics will be the importance of proper preparation and completion of forms and documents, and the provision of proper safety training, which, in the case of this consultancy, will involve fire safety and prevention.

Responsible for the receiving, storage and distribution of all hospital supplies provided by the Afghan federal government to Afghan public hospitals, the CMS is also responsible for ensuring that these supplies are well documented and continuously accounted for. The use of proper documents is vital for ensuring a high level of accountability and transparency on the part of the CMS, as well as the Afghan government. Currently the CMS makes use of several forms and documents to track all hospital supplies from their arrival at the CMS, to their distribution to Afghan hospitals, including: receiving cards, storage registration cards, stock cards, return item forms, and distribution forms. Though these documents are currently being utilized and filled out at the CMS, it has been found that there is a lack of understanding on the part of many CMS employees as to the overall purpose and importance of this documentation. At times it has been given a low priority when CMS employees are completing tasks, and may be neglected for unacceptable periods. To increase the effectiveness and relevance of documentation and to provide an underlying reasoning behind the importance of these documents, training discussing the importance of properly completing CMS documents is required.

In the past year, HPIC has worked to build the capacity of the CMS by donating needed equipment including some fire fighting and prevention equipment, such as several fire extinguishers. Proper understanding and a thorough practical knowledge of how this equipment is used, and how fires can be prevented, will be of great value to the CMS. Fire safety and prevention is needed to ensure the safety of the facility and all of its personnel. Several items stored at the CMS contain flammable materials, as do several items used at the CMS, including chemicals, propane and construction material. In addition, the CMS, being mostly without computers, is also highly reliant on paper, and stores all paper files on site. Though fires at the CMS are rare, a staff that is properly trained in both the means of preventing fires, as well knowing what to do when a fire occurs, would be invaluable for creating a greater sense of safety at the CMS. CMS employees require a full understanding of methods to prevent fires in a warehouse environment, as well as practical drills and exercises that they can implement in preparation of a future fire.

Goal and Objectives

The GOAL of the CMS Pharmaceutical Stock Management Training consultancy is to provide pharmaceutical stock management training to the staff and management of the CMS based on international best practices for warehouse and pharmaceutical stock management, in order to increase the capacity of the CMS staff and management to operate the CMS in an organized, effective, efficient and safe manner.

Objectives 1. Research, develop and author training material in the following areas: a. General stock management; b. Medicine stock management; c. Physical inventory; d. Importance of completing CMS stock management forms and documents; and e. Fire safety and prevention.

All training will follow the applicable international best practices and standards, with particular attention given to those by the World Health Organization (WHO). It should also be noted that the CMS follows the guidelines provided by Management Sciences for Health (MSH) in Managing Drug Supply, 2nd Edition; these should also be followed

1. Deliver a 10 half-day, hands-on training session for the CMS staff. The training session will have three purposes.
   a. To provide the CMS staff with refresher training for general stock management, medicine stock management and physical inventory, which they were previously trained on in 2010, along with any up-to-date techniques or methods that are deemed useful; b. To provide new training on the importance of proper preparation and completion of stock management forms and documents; and
   c. To provide new training in fire safety and prevention techniques.

2. Conduct post-training assessments to determine if the CMS employees have a proper comprehension of the training.

3. Provide a post-training report to summarize the activities used, content provided in the training as well as lessons learned and recommendations for future training sessions.

C. Methodology/Approach

1. Parties Involved During the assignment, work and collaboration will occur between the following actors: a. Training Consultant: HPIC anticipates engaging an individual that should be an expert in the following areas: i. Pharmaceutical stock management ii. Warehouse fire safety It would be preferably if the consultant is knowledgeable in any of the following: i. Adult education/training ii. Gender equity

The training will occur mostly in Dari. The documentation process will occur fully in English.

b. Stakeholders and Participants i. The CMS Management will have a participatory role and will be involved in providing insight, access to necessary documents, employees and facilities; they will also participate in the training. The CMS Employees will participate in the training. ii. Other stakeholders and participants as identified and required.

1. Meetings: Before, during and after the assignment, the following meetings, and contact between the commissioning organization and the consultant are planned: a. The consultant will provide HPIC Canada staff with the pharmaceutical stock management training material at least two weeks before training is to commence for review, comments and finalizations. b. The consultant will meet with HPIC Kabul staff to present the pharmaceutical stock management training material at least one week before training is to commence to ensure all training material presented represents the purpose of this TOR and that all necessary preparations are made.

2. Training Methods a. A variety of methods can be used for development of training material. These include, but are not limited to. i. Document Review ii. Key Informant Interviews b. A variety of training activities can be carried out. These include, but are not limited to. i. Hands on training ii. Group discussions iii. Case studies iv. Individual tasks v. Seminar/workshop style classes

3. Resources Available: During the assignment, the consultant will have access to the following resources: a. The consultant will have access to an office space at HPIC Kabul b. HPIC Kabul can arrange necessary research aids (CMS meetings/tours, interviews, etc.) c. HPIC Kabul can arrange necessary teaching aids (projectors, white boards, etc.) as needed to conduct the pharmaceutical stock management training. d. HPIC Kabul will provide printed documents as necessary.

D. Specific Tasks and Deliverables List of tasks to be accomplished (eg. Review of existing information, provide training, etc.) and the desired deliverables mentioning deadlines and reporting requirements. 1. Tasks: a. Preparation i. Review the 2010 CMS Pharmacy Stock Management Training Material, the book Managing Drug Supply 2nd Edition, and relevant WHO documents ii. Prepare material for training iii. Harmonize and finalize training material with HPIC staff b. Conducting training i. Hold daily training for CMS employees for 10 half-days ii. Ensure all trainees are engaged and involved iii. Record attendance daily (disaggregated by sex) c. Training Assessment i. Conduct post-training assessments of training participants (disaggregated by sex) d. Post-Training Report i. Provide a post-training report summarizing the training activities and lessons learned and providing recommendations for follow-up or complementary training 2. Deliverables: a. Training materials (in English and Dari) b. Daily attendance records (disaggregated by sex) c. Post-training assessments and their compiled results (disaggregated by sex) (in English) d. Post-training summary report detailing training activities, results, lessons learned and recommendations (in English) 3. Timeframes/Level of effort a. Preparation is to take 2 weeks beginning in mid-January 2012 b. CMS training to take 10 half-days in total, to begin in early February 2012 c. Presentation of training assessment results to take 1 week after completion of training d. Presentation of post-training summary report to take 2 weeks, beginning in mid-February 2012 4. Deadlines: Due dates for various activity components a. Preparation to begin on January 15, 2012 and to be finished by January 26, 2012 b. CMS training to begin on February 5, 2012 and to be completed by February 16, 2012 c. Training assessment results and post-training summary report to be produced by February 29, 2012 5. Reporting Procedures and Supervision. a. Consultant will consult with the HPIC Canada staff in the design and finalization of all training material; the HPIC Senior Director will provide final approval of the training material. b.Consultant will report to the HPIC Project Director and the Logistics Manager when the training course material is completed. c. Consultant will report to the HPIC Logistics Manager during the training component. d. At the conclusion, the consultant will report again to the Project Director and Logistics Manger with training assessment results.

E. Remuneration and Terms of Payment 1. 50% of the agreed costs will be paid upon signing of contract, 25% at the conclusion of the training and 25% upon the submission and approval of the post-training summary report. 2. If consultant is from outside of Kabul, HPIC will negotiate accommodations, travel arrangements and other associated costs.

F. Other Other information the consultant may need or other information specific to the assignment. 1. List of Reference Documents a. Managing Drug Supply 2nd Edition by Management Sciences for Health b. WHO Guidelines for Safe Disposal of Unwanted Pharmaceuticals in and around Emergencies c. 2010 CMS Pharmacy Stock Management Training Material

How to apply:

DEADLINE FOR COMPLETE PROPOSALS (Including workplan and budget): DECEMBER 16, 2011 to Julia Wight atjwight@hpicafghanistan.ca