Distribution of medicines
A well managed distribution system focuses on measures that ensure product integrity and quality throughout the distribution channel of the medicines. WHO is focused on supporting countries to maintain a constant supply of medicines , keep medicines in good condition throughout the process, minimize medicines loss due to spoilage and expiry, maintain accurate inventory records, rationalize medicines storage points, use available transportation resources efficiently, and reduce theft and fraud. As discussed in the procurement step, national procurement and distribution systems have been assessed.
Types of distribution systems
Distribution from the main storage point to a lower level store or health facility may follow the push or pull system or a combination of both. The choice of a push or a pull system depends on the needs of the country
In the pull system medicines requests are sent from the lower level. Adequate human resources are required to calculate medicines needs to last for a certain defined period of distribution. In some countries, the central warehouse distributes products to all lower health facilities with its own transportation system. In other countries the responsibility of transporting the products from the central warehouse to the facilities is that of the individual health facilities .
The push system is used mainly in emergency situation where there is no adequate storage space or personnel to manage a range of products. In this case, a limited list of products is pushed from the higher level of warehouse to the health facilities during a defined time frame. This system is also used when starting a new medicines program where there are no previous consumption data.
A combination approach is used in some countries where the regional or district stores are subsidiary of the CMS. In this case, the push system may be used to supply these subsidiary stores and the pull systems is used to distribute stock to the health facilities.