Public Sector Logistics Management for Drug Selection, Procurement, and Distribution in Nepal

Introduction

The public sector logistics management system for pharmaceuticals in Nepal is critical for ensuring the availability of essential medicines across the country. The system operates under the Ministry of Health and Population (MoHP) and involves government agencies, Logistics Management Division (LMD), and various health service centers. The key processes in this system include drug selection, procurement, and distribution, which aim to provide quality-assured medicines to the public. However, several challenges persist, particularly in maintaining quality assurance throughout the supply chain.

1. Drug Selection Process

Key Features:

The selection of drugs for public sector procurement is based on the National List of Essential Medicines (NLEM) prepared by the MoHP.
The selection process prioritizes cost-effectiveness, therapeutic efficacy, and public health needs.
The Drug Consultative Council and Drug Advisory Committee provide technical inputs for drug selection.

Weaknesses in Quality Assurance:

Lack of regular updates in the essential medicines list to align with evolving disease patterns.
Inadequate representation of quality assurance experts in the selection process.
Limited evaluation of locally manufactured versus imported drugs concerning their efficacy and safety.

2. Drug Procurement System

Key Features:

Procurement is mainly handled by the Logistics Management Division (LMD) under the Department of Health Services (DoHS).
Procurement is conducted through public tendering processes to ensure transparency and cost-effectiveness.
Framework contracts and pooled procurement mechanisms help in bulk purchasing to reduce costs.
WHO Good Procurement Practices (GPP) guidelines are followed.

Weaknesses in Quality Assurance:

Delayed procurement processes due to bureaucratic inefficiencies, leading to stock shortages.
Lack of stringent prequalification of suppliers based on international quality standards.
Insufficient capacity for independent quality control testing before procurement finalization.
Weak enforcement of Good Manufacturing Practices (GMP) for locally sourced drugs.

3. Drug Distribution System

Key Features:

Centralized drug storage at the Central Medical Store (CMS) under the LMD.
Regional and provincial warehouses facilitate secondary distribution to hospitals, health posts, and community pharmacies.
Push and pull mechanisms are used to distribute drugs based on demand forecasting and stock levels.
Implementation of inventory management systems such as mSupply and LMIS (Logistics Management Information System).

Weaknesses in Quality Assurance:

Poor storage conditions at provincial and local levels, leading to drug deterioration.
Ineffective temperature and humidity control for sensitive pharmaceuticals (e.g., vaccines and biologics).
Lack of trained personnel in logistics and supply chain management at district and local levels.
Weak post-market surveillance to track substandard or counterfeit drugs after distribution.
Frequent stock imbalances, with some facilities facing drug shortages while others experience overstocking.

4. Recommendations for Quality Assurance Improvement

To enhance the quality assurance of pharmaceuticals in Nepal’s public sector logistics management, the following strategies should be implemented:

Strengthen Regulatory Oversight:
- Increase the capacity and resources of the Department of Drug Administration (DDA) to enforce quality standards.
- Conduct regular Good Distribution Practices (GDP) and Good Storage Practices (GSP) inspections.
Improve Supplier Prequalification & Quality Control:
- Implement rigorous quality screening for pharmaceutical suppliers before procurement contracts are awarded.
- Enhance in-country quality testing laboratories and enforce mandatory batch testing before drug distribution.
Enhance Inventory & Cold Chain Management:
- Upgrade storage facilities with temperature-controlled warehouses, especially for vaccines and biologics.
- Train personnel on inventory management systems to reduce stock imbalances.
Strengthen Monitoring & Post-Market Surveillance:
- Establish a national drug tracking system to monitor drug movement and prevent counterfeiting.
- Implement pharmacovigilance programs to track adverse drug reactions and recall substandard products.
Decentralize Procurement & Distribution:
- Empower provincial and local health authorities to manage procurement at their levels to reduce delays.
- Establish buffer stock systems at key distribution points to prevent shortages.

Conclusion

The public sector logistics management system for pharmaceuticals in Nepal plays a crucial role in ensuring drug availability and accessibility. However, weaknesses in quality assurance, procurement inefficiencies, poor storage conditions, and lack of robust monitoring pose significant challenges. Addressing these gaps through regulatory strengthening, improved supplier vetting, enhanced storage facilities, and better distribution mechanisms can significantly enhance the overall quality of drugs provided to the public.

By focusing on quality assurance at each stage of logistics management, Nepal can ensure safer, more effective, and uninterrupted access to essential medicines, ultimately improving public health outcomes.