4.2. Logistics and supplies
4.2.2. Management of emergency supplies
Emergency supplies include all materials and equipment required for disaster response. In health sector emergency interventions, two types of supplies can generally be distinguished:
- The products, equipment, and materials that health teams need for the sector’s specific tasks.
- The health-related equipment, and materials needed for use and consumption by the population, such as drugs, food, chlorination tablets, mosquito nets, food supplements, etc.
These supplies need to be mobilized and their quality preserved. They must be available in a timely manner and in a condition that allows for their immediate use. Specific procedures exist for these requirements.
1. Supply
The task here is to provide resources that have been requested to address identified or to provide necessary services. This requires procedures for seeking and sending resources to where they are needed and arranging for their receipt at the disaster site.
Seeking and obtaining supplies: Acquisition of the required supplies depends on arrangements and preparations made by the ministry of health, whether the needed items come from the ministry’s storerooms or are provided through pre-established procurement procedures. In the latter case, it is important to maintain lists of identified suppliers in order to contact them beforehand to ascertain the availability, characteristics, and condition of their products. Pre-established agreements specifying projected delivery time, credits, replacement parts, service, etc. in emergency situations are helpful.
Shipment of supplies to where they are needed: As general rule, supplies that have not been requested should not be shipped. Shipping standards and procedures include the following:
- Consider the quality and expiration dates of products that are sent.
- Sort, classify, and package supplies according to their type and characteristics.
- Take measures if special requirements are associated with the supplies. For example, some articles require refrigeration; some are particularly fragile, etc.
- Use suitable packaging to ensure supplies are protected and clearly identify the content of the packages.
- Inform recipients in advance of shipment details so that they can make proper arrangements for receiving the articles.
Receipt of supplies at the destination: Supplies can reach the emergency area either from the ministry of health central warehouses or from other suppliers. In either case, specific standards and procedures should be followed:
- Secure and prepare a site for receiving and storing the supplies, as well as for unloading and handling them
- Advise the sender when supplies have arrived and report any special condition or anomaly that is detected.
Chapters 6, 7, 8, and 9 of the PAHO publication Humanitarian supply management and logistics in the health sector explain the standards and procedures for this activity in detail.
2. Transportation
Transportation can face roadblocks in emergency situations such as a scarcity of vehicles, vehicles not suited to the conditions, or inaccessible roads. Planning for the rational use of transportation resources is necessary in these situations.
If local agencies at the disaster site face these challenges, it may be necessary to contract for commercial transportation. Although preferential treatment can sometimes be negotiated for humanitarian supplies, price commercial transportation is a business like any other. Price is not the only factor when contracting for these services; the company’s reliability and quality (speed, safety, commitment) must also be considered.
The logistician is responsible for conducting these negotiations and preparing a transportation plan that takes maximum advantage of the resources available, the ultimate purpose being to move people and provisions quickly and safely. Chapter 10 of the PAHO guide Humanitarian supply management and logistics in the health sector explains the standards and procedures necessary for this activity in detail.
3. Storage of drugs and other health supplies
Supplies must be protected and the quality standards of mediciens ensured by storing them under physical, hygienic, and infrastructure conditions that:
- Safeguard the therapeutic effectiveness of medicines until they are used.
- Prevent their deterioration or premature expiration.
The same general standards for storerooms apply to all facilities that store supplies and medicines for human use. However, storing pharmaceutical products, and indeed medical equipment in general, requires far more care. Consult the WHO information on the storage of essential drugs and other health supplies apply and must be followed.
Environmental factors to which products are exposed and which must be strictly controlled are:
- Light: Many drugs are photosensitive and their quality suffers if they are exposed to excessive light. They should be placed far from direct solar radiation or lamps. The packaging of individual drugs is of vital importance for their protection. It should guarantee their stability. Efforts should always be made to preserve original packaging, as it has been designed to extend the drugs’ shelf life.
- Moisture: A moist environment can encourage the growth of microorganisms such as fungi and bacteria and can precipitate chemical reactions such as oxidation of drug components. It can also render tablets soft.
- Temperature: If it is to retain its properties, each drug must be kept at a certain temperature. The temperature range is indicated on the product’s packaging. In the absence of an indication, extreme temperatures should be avoided. The principal effects of temperature on drugs are loss of potency or degeneration into toxic substances. Storage temperatures are categorized as follows:
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- Room temperature: 15-30oC
- Cool: 8-15oC
- Refrigeration: 2-8oC
- Always avoid temperatures below freezing (0oC) and above 30oC.
Vaccines and some drugs require a dependable cold chain. This requires refrigerators as well as thermometers to confirm inside temperatures. It is advisable to have a sheet with a table attached to refrigerator doors, or beside boxes, to record temperatures on a daily basis. Generators should be used to protect cold rooms, refrigerators, and freezers against power outages. If working refrigerators are not available, boxes with ice or dry ice can be used, but extreme care is needed in such cases to ensure that proper temperatures.
Some physical signs can indicate deterioration or degradation of drugs. Appropriate corrective measures should be ascertained and taken if they are present. The signs include:
- Spots on the tablets
- Hardening or softening of capsules
- Presence of undispersed particles in drugs that are in liquid form
- Cloudy solutions
- Altered color
- Bubbles in liquid drugs
- Inflated (bulging) containers
Chapters 9 and 12 of the PAHO publication Humanitarian supply management and logistics in the health sector explains in detail the standards and procedures needed for this activity.