PENGANTAR MANAJEMEN LOGISTIK

PERBEKALAN FARMASI

What is logistics?
"Logistics means having the right thing, at the right place, at the right time."
Logistics - (business definition) Logistics is defined as a business planning framework for the management of material, service, information and capital flows. It includes the increasingly complex information, communication and control systems required in today's business environment. -- (Logistix Partners Oy, Helsinki, FI, 1996) Logistics - (military definition) The science of planning and carrying out the movement and maintenance of forces.... those aspects of military operations that deal with the design and development, acquisition, storage, movement, distribution, maintenance, evacuation and disposition of material; movement, evacuation, and hospitalization of personnel; acquisition of construction, maintenance, operation and disposition of facilities; and acquisition of furnishing of services. -- (JCS Pub 1-02 excerpt) Logistics - The procurement, maintenance, distribution, and replacement of personnel and materiel. -- (Websters Dictionary)

Lingkup material rumah sakit

Medik
Sediaan farmasi , Alat kesehatan, Perbekalan kesehatan

Linen
Selimut, korden, baju operasi

Gizi
Bahan basah, bahan kering

Alat Tulis Kantor

Kertas, calculator, perforator

Sparepart
IC, tahanan

Emplasement
Semen, tegel, genteng

Barang umum
TV, detergent, plastik sampah

LETS TRAVELING

 No country is immune from the threat of counterfeit drugs. But, those with weakly regulated pharmaceuticals markets suffer most.

Dr. Yasuhiro Suzuki

WHOs Executive Director Health Technology & Pharmaceuticals

Legal aspek
UU NO 23 TENTANG KESEHATAN UU NO 5 TENTANG NARKOTIKA UU NO 8 TENTANG PSIKOTROPIKA UU 8/1999 PERLINDUNGAN KONSUMEN UU PRAKTEK KEDOKTERAN Kepmenkes 1197/Menkes/X/2004

Stakeholders
Pasien/keluarga Supplier/vendor Pabrik obat/ drug company Regulator (Dinas kesehatan) Pengawas (Badan POM, Kepolisian) Penulis resep Direktur Akuntansi Keuangan SDM Instalasi pengguna

Sediaan farmasi
Definisi (UU no 23 tentang Kesehatan):
Obat, bahan obat, obat tradisional, kosmetika Untuk diagnosa, terapi, rahabilitasi

Klasifikasi hukum
Obat bebas, bebas terbatas Obat keras Psikotropika Narkotika

INDIKASI-FARMAKOLOGI
GASTRO-INTESTINAL SYSTEM CARDIOVASCULAR SYSTEM RESPIRATORY SYSTEM VENTRAL NERVOUS SYSTEM INFECTIONS
ANTIBACTERIAL DRUGS ANTIFUNGAL ANTIVIRAL ANTIPROTOZOAL ANTHELMINTICS
THREADWORMS, ASCARCIDES, TAPEWORM, HOOKWORM, FILARICIDES, CUTANEOUS LARVA MIGRANS, STRONGYLOIDIASIS

Life saving
Vital : tidak bisa ditunda, untuk keselamatan manusia Essential : banyak dibutuhkan karena morbiditas masyarakat Non essential : tidak prioritas

Sediaan farmasi
Bentuk sediaan
Tablet/kaplet Pulvis/pulveres Capsul Solutio/cairan Unguentum Linimentum Spray Suppositoria

PRODUKSI
ORIGINAL ADALAT ADALAT OROS ME TOO CALCIANTA, CARVAS, CORDALAT (12) GENERIK : NIFEDIPIN INDOFARMA DEXA MEDICA KIMIA FARMA PHAPROS HEXAPHARM

PACKAGING
DOSIS
UNIT DOSE : AMPUL, SYRINGE-UNIT MULTIDOSE : VIAL, TUBE, TURBOHALER DURASI REJIMEN : 7CAPSUL OMZ

ISI : 1, 4, 25, 28, 60, 100, 250, 1000 PENGEMAS : SACHET, BLISTER, BOTOL, DOS

DISTRIBUTOR
PENUNJUKAN UTAMA
PT United Dico Citas (PT Takeda) MPI, Merapi Utama Pharma (PT Meiji)

PENUNJUKAN TUNGGAL
PT Kimia Farma : Narkotika, ARV

SUB DISTRIBUTOR RETAIL : APOTEK/RS

Pengadaan
Droping : vaksin dasar, bantuan bencana Produksi : pemuatan sendiri (OBH, Alkohol 70%) Pembelian :
Tender Langsung nempil Khusus : narkotika, psikotropika, ARV

Reporting
Regulator
Narkotika, Psikotropika, Generik, KB Program khusus : vaksinasi polio

Manajemen
Revenue Biaya operasional Persediaan Stok

ALAT KESEHATAN
HABIS PAKAI
SYRYNGE NASO GASTRIC TUBE TRACHEOSTOMI TUBE

PERAWATAN
TENSI METER BENGKOK, POT SPUTUM TIMBANGAN BADAN Termometer suhu
Axial Rectal timpani

INVESTASI
SYRYNGE PUMP CT SCAN

Bedah
Benang bedah
Unit, rol Cut gut

Inplat
Plat, screw, AMP Ukuran : Reguler, mini Tipe : lurus, bengkok

Gunting
Anatomis, klem

PEMBALUT- BANDAGE
HYPAFIX Fixomul PEMBALUT WANITA ELASTIC VERBAN

FISIOTERAPI
CRUTCH : aluminium, kayu PAD ULTRASONOGRAPHY CORSET LUMBAL CERVICAL COLLAR
Biasa
Buatan sendiri Buatan pabrik

Khusus : philadelphia

SELEKSI OBAT
Kepastian persediaan Sistem mantap Mengurangi biaya per unit Mengurangi biaya kekosongan Minimal biaya pembelian Minimal biaya transport Mencakup fluktuasi permintaan

The relationship between STGs and EMLs and how these affect respectively the use and the availability of medecines (WHO-MSH)
List of common diseases & complaints

Treatment of choice

Treatment guidelines

Essential medicines list And Formulary manual

Training and supervision

Financing and Supply of drugs

Improved availability And use of medicines

PENGADAAN-LINGKUP
SPESIFIKASI POLA KONSUMSI DISTRIBUSI PEMBAYARAN PENERIMAAN CEK MONITOR STATUS ORDER KUANTITAS SESUAIKAN BUDGET

PILIH METODE PENGADAAN

TENTUKAN SPESIFIKASI SUPPLIER KONTRAK

TOTAL BIAYA
KERUSAKAN KUALITAS

KOMISI-AGEN
TRANSPORT KETERLAMBATAN

HIDDEN COSTS

PACKING CEPAT
RUSAK PENGIRIMAN

BIAYA KONTRAK

VISIBLE COST

Kuantifikasi kebutuhan
Major option
Consumption method Morbidity method Adjusted consumption method Service-level projection of budget requirement

Consumption-based calculation
QUANTITY TO ORDER Qo = CA x (LT+PP)+SS-(S1+SO)
CA : average monthly consumption LT: average lead time in months PP: procurement period SS: quantity needed for safety stock S1: stock now in inventory So: stock now in order

Comparation of QTY methods

METHODS
Consumption

USES
1st choice for procurement forecast Most reliable predictor Estimating need in new prog/disaster assistance Dev and justify budget

ESSENTIAL DATA

LIMITATION

Reliable inventory Must have accurate records, supplier lead consumption data time, projected drug costs Can perpetuate irrational use Data on population Actual incidence of health problem Morbidity data not available for all diseases Standard treatment may not be used Questionable comparability of patient populations, morbidity and treatment practice Variable facility use, attendance, tx, supply syst efficiency

Morbidity

Adjusted consumption

When other methods unreliable

Comparation area and system/capita data on consumption, px, service level, morbidity Utilization by service levels and facility type

Service level projection of budget requirement

Estimating budget need

PROSES BISNIS
SUPLIER

PENGADAAN

GUDANG USER

GUDANG

USER USER

USER

INVENTORY MANAGEMENT

order issue

recieve

store

TUJUAN
Untuk menjaga persediaan selalu siap dlm penggunaan dengan biaya minimal baik dalam penyimpanan maupun pembelian

MANAGER Memastikan kebijakan/aturan

STOCK LEVEL (tingkat stok) REORDER FREQUENCY (frekwensi pembelian) REORDER QUANTITY (kuantitas pembeliaan)

FACTORS TO BE CONSIDERED
Inventory management is the heart of the drug supply system The selection of item to stock, based on their value to public health, regularity, volume of consumption Ideal : the optimal stock movement pattern, minimal inventory level, consumption pattern smooth, on time delivery Key issues : service level safety stock

sick inventory management system

Subjective/ad hoc decisions : order quantity & frequency Inaccurate stock records (count stock : anually, cyclic) Lack of systematic performance monitoring No systematic procedures No rules to guide staff

Basic issues to be considered (7)

1. Definition of the context (function) 2. Determination of types of stock records and inventory reports needed 3. Selection of items to be stocked 4. Maintenance of proper balance between service levels vs stocked level 5. Adoption of model for reordering frequency 6. Impelmentation of optimal reorder formulas 7. Identification and control of variable inventory management costs

DOKUMEN STOK
Kartu file vertikal: kartu yg tersimpan secara urut alfabet vertikal, tersimpan di laci kardexsystem : file yg tersimpan di pojok penyimpanan, lengkap dgn nama dan jumlah obat bin cart: tersimpan langsung bersama obatnya Ledger system : file yang lengkap seperti rekapitulasi Penghitungan stok secara fisik : cyclic counting (penghitungan terus-menerus)

LAPORAN DAN MONITORING

Posisi stok : kuantitatif per obat Nilai awal dan akhir inventory/persediaan Perubahan nilai persediaan selama stok Pola pemakaian obat Tingkat pelayanan (distributor maupun farmasi) Status kadaluwarsa Stok rusak

STOCK
Berpengaruh Efisiensi dana dan Pelayanan pasien Dipengaruhi Faktor : konsumsi dan waktu tunggu barang datang (Lead Time) Working Stock = Quantity order Safety Stock
Obat emergency Formula = LT x

FREKWENSI PEMBELIAN
Model
Annual purchasing
Pendanaan, penyimpanan, stok, beban kerja administrasi

Schedule purchasing
Manfaat lebih dari annual

Perpetual purchasing
Faktor distributor, regulasi keuangan, sistem informasi

Kombinasi : Annual dan perpetual

Obat yang sulit didapat, tapi fast moving Obat slow moving, mudah didapat

KUANTITAS PEMESANAN KEMBALI

Faktor manajemen Budget Akses dana Packing vs minimal order Perubahan pemakaian Kenaikan harga Kenaikan biaya kirim Discount vs kuantitas Slow moving, kehilangan (rusak, pencurian)

INVENTORY CONTROL

KUANTITAS PEMESANAN KEMBALI (standar, matematik)

FAKTOR KALKULASI STANDAR 1. MINIMAL MAXIMAL STOCK LEVEL
Konsumsi rata-rata Waktu tunggu barang datang Stok aman Stok minimal Stok maksimal Stok sekarang Periode pembelian

lanjutan
CASE : Tetracycline Lead atime (LT) = 2 months, konsumsi (CA) 1000 caps/month, safety stock (SS) 2000 caps Procurement period (PP)= 6 months
Minimal stock ; (LTxCa)+SS 4000 Max stock = Smin + (PPxCA) 10000

lanjutan
Stock : 3000 caps, Dlm proses order 2000 Qo= (Smax+Sb)-(S1+So)
= 10.000 (3000+2000)+0

lanjutan
2. CONSUMPTION-BASED REORDERING FORMULA SS=CAxLT Sb : stock back order Qo=CAx(LT+PP)+SS+Sb-(S1+So) Jika masih ada 2000 caps yg belum terpenuhi ? Qo = 1000x(2+6)+2000+2000-(0+3000)

Mathematical model
Economic order quantity (EOQ) = V(2xUxO)+(HxC) U= annual use in units O=Incremental ordering cost H=average holding cost (percentage of average inventory value) C=projected net acquisition cost

CASE
Pemakaian Dex 5% per tahun 25.000 btl Harga per botol $2 Biaya pembelian :$70/beli Biaya simpan : 40% 2.091,65 EOI = V(2xO)+(UxHxC) 0.08366 tahun

Forecasting Consumption
Method
Projective past consumption Causal external factors (market, epidemics, system size) Judgmental subjective

Pattern
Base rate stable Trend predictable Seasonality relatively predictable Cyclic demand pasang surut Random noise unexplaned variations

AVERAGE CONSUMPTION
Simple, seasonal, moving

Performance indicators
Net sales to inventory (inventory turn over)
Private company : 12 Public drug supply : 6 (min)

Inventory shrinksge
Stok awal+pembelian-pengeluaran+ stok akhir = 0 (<10%)

Expense ratio : total biaya/net sales Service level : persentase pemenuhan permintaan Average inventory holding cost : average inventory value ( 30-40%) Incremental ordering cost (each order)

Aplikasi rumah sakit

Peta cost vs revenue Peta wilayah vs target Case emergency Sistem monitoring Quality assurance

DISTRIBUTION
PROCUREMENT PORT CLEARING CONSUMPTION REPORTING RECEIPT AND INSPECTION INVENTORY CONTROL DELIVERY REQUISITION OF SUPPLIES STORAGE

DISPENSING TO PATIENT

Distribution network
SYSTEM DESIGN
Geographic/population coverage Degree of centralization Number of level Push vs pull

SELECTION OF SITES
Facility design Material handling Systems Stock selection

DELIVERY INFORMATION SYSTEM

Inventory control Requisition forms and Procurement Consumption reporting Information flow
Collection vs delivery Selection/Acquisition of conveyances Maintenance of vehicles Routing of deliveries Scheduling of deliveries

STEPS FOR REDESIGNING SYSTEM

Determining the storage levels in system Determine the location of storage sites Decide at which level of supply system decisions will be made concerning order Fix resupply intervals or frequency of placinf orders Select a method for distributing drugs to user units Select an appropriate mode of transport Develop a set of feasible and economical delivery schedule to service these routes Estimate operating costs and assess the cost effectiveness of contracting for storage and transport at one or more level

Storage
The store should be devided into zones ( security, environment) Appropriate zone for each item to be store Stock should be store on pallets on the floor, shelves Good housekeeping
Cleaning, inspection, disposal, damage

The management structure should be clearly defined Qualified staff

MISMANAGEMENT LOG
LOG FUNCTION RELATE TO CULTURE KPI : SPEED, COST, CONTROL, ACCURACY NO APPROPRIATE ANALYSIS NO INSTANT OPTIMALIZATION NO PROPER COST AND BENEFIT ANALYSIS POOR COMPETENCE AND POOR HUMAN RESOURCES DEV

QUALITY ASSURANCE
RECEIVING PUT AWAY STORAGE ORDER PICKING DISPENSING/ DISPATCH DELIVERY

?
Anggaran tahun 2006 terjadi kenaikan anggaran pembelian obat karena kunjungan meningkat 20% dan tingkat hunian naik 10%. Pada saat analisa ternyata kenaikan antibiotika menduduki porsi 40% dari seluruh belanja obat. Pengeluaran rata-rata perbulan obat ceftriaxone sebesar 150 box (per box 2 vial) @Rp. 13.800. Kedatangan distributor A setiap minggu dua kali (Selasa, Jumat) karena dari luar kota. Distributor B di kota yang sama juga menjual obat tersebut dengan harga lebih murah 10%. Jika dibandingkan keduanya hanya beda pada kepastian layanan distributor A dan penunjukan langsung dari pabrik. Jika stok yang ada masih 10 box, berapakan box yang harus dibeli dan ke distributor mana. Jelaskan pertimbangan anda.