Supply Chain Management, Monitoring and Reporting of Outpatient Therapeutic Care Programs. A Trainer s Manual

Transcription

1 Supply Chain Management, Monitoring and Reporting of Outpatient Therapeutic Care Programs A Trainer s Manual

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3 Supply Chain Management, Monitoring and Reporting of Outpatient Therapeutic Care Programs A Trainer s Manual

4 Financial support for this interim training manual was provided by USAID, Cooperative Agreement number 617-A The views expressed in this document do not necessarily reflect those of USAID. NuLife is implemented by University Research Co., LLC, (URC) in collaboration with Save the Children U.S.A. and ACDI/VOCA.

5 Table of Contents Preamble iii MODULE 1: Supply Chain Management 1 Session 1.1: Outpatient therapeutic care 3 Session 1.2: Stores Management 8 Session 1.3: Store Operation Policies/Procedures 17 Session 1.4: Store Records and Files for Commodity Inventory 36 Session 1.5: SOPs for Rodent Control 46 Session 1.6: The aspect of fire in store management 53 MODULE 2: MONITORING AND REPORTING 59 Session 2.1: Principles of monitoring, evaluation and reporting 65 Session 2.2: Individual client monitoring in Outpatient Therapeutic care 69 Session 2.3: OTC Program Monitoring 73 Session 2.4: Evaluating OTC program performance 75 Session 2.5 Monitoring and reporting Exercises 77 Session 2.6: Reporting System and mechanisms 81 Appendix 84 Supply chain and Monitoring and Reporting i

6 Preamble NuLife - Food and Nutrition Interventions for Uganda is a three-year program awarded to University Research Co., LLC (URC) by the United States Agency for International Development (USAID) designed to support the Ministry of Health (MOH) of Uganda and its development partners to expand nutrition and HIV programming. NuLife is being implemented by URC in partnership with ACDI/VOCA and Save the Children/US (SC-US). The major partnership objective between ACDI/VOCA and Nulife is the establishment of a supply chain system for effective delivery and distribution of RUTF to severely malnourished people living with or affected by HIV/AIDS which aspects forms Objective 3 of the program. It is from this back ground that the supply chain team did a facility assessment exercise to determine the storage conditions of all the phase one 32 sites, establish capacity gaps as well as determining storage capacities of these facilities. The same was replicated to phase II and III sites A number of issues were discovered during the assessment exercise and these included those related to capacity inadequacy with some people who were managing the store, store lay out and documentation inaccuracies among others It is from this back ground that training in stores management for persons charged with stores, dispensers and data clerks at health facilities is being organized so as to encourage them not to take store keeping for granted, but as a fundamental accounting component at health facilities. This training will be conducted with a perspective of introducing RUTF to all the selected implementing sites. ii Supply chain and Monitoring and Reporting

7 Training methodology The course employs a variety of training methods, including visual aids, demonstrations, practice, discussions, case studies, group discussion, recall situations, role plays, brainstorms etc. Participants also act as resource persons for each other Manual outline Each theme has several topics and each topic in its turn several sessions. Each topic of the manual outlines specific learning objectives, the contents showing the sessions it comprises with their time needed. In the individual sessions the following information is given: The session s objective(s) These should be shared with the participants on the beginning of each session to: -Stimulate participants interest and curiosity; -Present the subject usefulness and its importance; -Link the session to the preceding ones and to the training context. The session duration The estimated timing is given for each session considering the participant s experiences and their profile, very long sessions are avoided. The training methods For each session, the interactive techniques to be used are mentioned. The required materials For each session, the needed materials are mentioned. Examples are markers, flipchart (masking tape and flipchart stands are not mentioned but are indispensable), specific training aids [tracking tools, report formats], etc. The activities These are step-by-step instructions to the facilitator in order for him or her to carry out the session. The facilitators are asked to use these instructions with creativity, taking into consideration the participants experience and their skills. The preparation The training preparation starts as soon as one is selected for conducting the training. Each facilitator should: Refresh his or her knowledge of the training themes; Review his or her sessions; Get mentally ready; Ensure perfection of his or her technical skills for conducting demonstrations; Ascertain sufficiency of training aids such as flipcharts, masking tape, markers, manila paper, scissors, images, etc. Supply chain and Monitoring and Reporting iii

8 The co-facilitation Co-facilitation is an activity that involves several persons in conducting training. It allows co-facilitators to complement each other and to provide required guidance to participants. Training is more interesting, less stressful and more effective when it is conducted by more than one facilitator. If the training is conducted by a team, the team members need to prepare and clarify the following: Who is responsible for the overall training coordination? Who is responsible for which theme? Which of the co-facilitators will be responsible for logistics issues that arise? What does each facilitator expect from the others? Participants It s very important that the choice of participants is done according to the established criteria: people who are charged with the daily managing of the facility stores, the dispensers [and data clerks] It s also important for the facilitators to create and maintain a good training ambiance and relationship with the participants. This includes: Activities to create a good ambiance (e.g. start-up exercise); Utilization of humour (e.g. jokes, funny stories, energizers, ice breakers); Informal activities (e.g. chats with participants during breaks and meals); Good verbal and non-verbal communication. The facilitators should be interested in participants concerns and contribute to their problem solving. The facilitators meeting In order to ensure the quality of the training and to build a strong and efficient training team, the facilitators should support each other mutually, work together and have regular constructive feedbacks. At the end of each day, facilitators have a meeting to review the daily evaluations and to discuss the course of the day. Participants views are taken into consideration and strategies for the coming day are defined. Energizers Examples of How to Form Small Groups Depending on the number of participants (for example 20), and the number of groups to be formed (for example 5), ask participants to count off numbers from 1 to 5. Begin to count in a clockwise direction. On another occasion begin to count counter-clockwise. iv Supply chain and Monitoring and Reporting

9 Assessment of participants knowledge Participants knowledge evaluation is done at two different times: 1. In the beginning of the training, called the pre-assessment. This will give the facilitators an idea of the participants needs. 2. At the end of the training, called a post-assessment. If individuals are scoring badly on many of the questions, the facilitator should take time with those participants, find out what was not captured fully and go through the relevant information again. Daily Evaluations The following are descriptions of several daily evaluations that facilitators can select from at the end of each day (or topic) to assess the knowledge and skills that have been acquired and/ or to obtain feedback from participants. Form groups of 3 and ask participants to answer one, two, or all of the following questions in a group; 1. What did you learn today that will be useful in your work? 2. What was something that you liked? 3. Give a suggestion for improving today s sessions. If there were many neutral and frowning faces, facilitators should ask the group (the next day) what was less satisfying to them, and re-explain any sessions if necessary. If participants feel uncomfortable to be honest about certain issues, they can also write them on a piece of paper and put them in the parking lot. Training evaluation It is useful for the facilitators to have a feed-back on the training itself: the facilitators skills, the methodologies used, the logistics etc. Following exercise can be used to evaluate the training. Ask participants to form buzz groups of 3. Explain that their suggestions will be used to improve future trainings. Explain that questions will be asked and that each group should discuss among themselves what they think. Have one facilitator read the questions below, one by one, allowing groups to share their comments in the whole group in between. Another facilitator records the answers. What did you like about the teaching methods? What did you dislike about the teaching methods? How will you use the information provided? What suggestions do you have to improve the training? Do you have any other comments? Please share. Supply chain and Monitoring and Reporting v

10 Day 1 Session Content Methodology Activities Time 1 NuLife Profile Lecture N/A 30 Min 2 The concept of RUTF Interactive/ lecture Build on partcipants responses to give a vivid picture of what RUTF is. 30 Min Introduction to supply chain Management in the context of Storage management Brain storming Brainstorm with participants about the knowledge regarding storage related concepts. Encourage them to contextualize the concept to their own homes 30 Min Calculating storage capacity Lecture/ illustrative Calculating storage capacity of the training room 30 Min Selecting a suitable store Interactive Group work 30 Min 3 Key store staff Group discussion Group work 30 Min Cleaning and repairing stores Interactive 20 Min Stores equipment Group discussion Participants lists equipment found at the facilities 20 Min Store layout and floor plan Lecture/ illustrative Group activities 40 Min Stores Operation Procedures Group discussion 2 groups one to discuss rules for receiving and the other will look at those for dispatching. 30 Min The concept of Forecasting and Ordering Interactive/ illustrative Majorly group work 60 Min 4 Receiving and Dispatching Interactive/ illustrative Majorly group work 20 Min Distribution mechanism that will be used Informative 20 Min Delivery Mechanism that will be used in the positioning of RUTF Ideal Commodity handling procedures Informative 20 Min vi Supply chain and Monitoring and Reporting

11 Day 1 Session Content Methodology Activities Time Day 2 4 Store Inspection Interactive Field Visit 120 Min 5 Stores Records Interactive/Group work Group work (Entering data on the different forms) 60 Min 6 SOPs for rodents control Brain storming/informative Interactive discussion 30 Min 7 Basics of Fire fighting in the context of store management Brain storming/informative Interactive discussion 30 Min Activity work plan for the sites Mapping out work plans for the individual facilities. 40 Min Conclusion Closing remarks Supply chain and Monitoring and Reporting vii

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13 Module 1 Supply Chain Management Standard Operating Procedures for Ordering, Receiving, Storage, Dispatching and Tracking Ready to Use Therapeutic Food Supply chain and Monitoring and Reporting 1

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15 OUTPATIENT THERAPEUTIC CARE 1. 1 SESSION Duration: Method: Material: 30 minutes Lecture and participatory Flipchart and markers; samples of RUTF Activities: BRAINSTORM with participants about knowledge concerning outpatient therapeutic care. Using a flip chart note down their responses Build on what they know and thereafter define outpatient therapeutic care (OTC) Notes to the facilitator Contextualize the definition of OTC Components of OTC Purpose: To introduce participants to the basic concepts and protocols of the comprehensive outpatient therapeutic care for children, adults, pregnant and lactating women in the context of HIV/AIDS Learning objectives: By the end of this session, participants will be in position to define what outpatient Therapeutic Care is as well as knowing its components Activities Assess participants knowledge regarding OTC by way of asking questions like; what do you know about OTC or any one ever heard about OTC? WRITE partcipants responses down on the flipchart CORRECT or GIVE additional information Build on partcipants responses to give a vivid picture of what OTC is. Supply chain and Monitoring and Reporting 3

16 Introduction OTC provides home-based treatment and rehabilitation for clients who are severely, acutely malnourished but have appetite and are free of medical complications. This session will describe issues including criteria for entry and exit, activities in the OTC, link with other Care and planning and setting up OTC. Clients can come to outpatient therapeutic care OTC from different places: Referral from community Referral from home-based care teams Referral from child clinics, paediatric wards, counseling units and immunization points Referral from in-patient feeding programs or supplementary feeding programs if conditions improve or deteriorate. Referral from field partners (NGOs, faith based organizations, CBOs, orphanages). What is RUTF? RUTF (Ready to Use Therapeutic Food) is made of powdered ingredients embedded in a lipid rich paste, resulting in an energy dense food that resists microbial contamination. RUTF is a mixture of milk powder, vegetable oil, sugar, peanut butter, powdered vitamins and minerals. As the name implies, RUTF does not need to be prepared in any way prior to consumption, making it practical for use where cooking fuel and facilities are limiting constraints. RUTF has a very high energy density, about 23 kj/gm (5.5 kcal/g). RUTF has been shown to be a very effective therapeutic food in the rehabilitation of severely malnourished children, and facilitates home-based therapy of these children. A severely malnourished child can consume just a few spoonfuls of RUTF 5-7 times a day, and achieve sufficient nutrient intake for complete recovery. While RUTF must be consumed with water, no other foods are necessary for the rehabilitation of the malnourished child. RUTF has a very low water activity, thus it is impossible for significant bacterial growth to occur in these foods. This allows locally produced RUTF to be safely stored at ambient tropical conditions for 12 months [up to 24 months]. 4 Supply chain and Monitoring and Reporting

17 Benefits and composition of RUTF The quantity distributed to each client is easy to calculate based on the weight. One simply needs to open the sachet by cutting one corner and eat the paste. No preparation or cooking is necessary. Does not need to be diluted with water. This eliminates risk of contamination. Can be used at home with supervision from the health centre. Reduces on length of stay in hospital or Therapeutic Feeding Centre Reduces on number of staff necessary for preparation and distribution of therapeutic food. Has a faster recovery rate and higher acceptability than F100. Can be stored at room temperature for long periods of time. Has a long shelf life, even without refrigeration (24 months). Management Protocol for Outpatient Care (Generic) 1. Health and Nutrition education at the waiting area: On arrival, clients should be directed to the waiting area where the healthcare worker will provide health and nutrition education on how to prepare cheap, balanced and nutritious meals for the client. Care givers/ clients should also be counselled on HIV testing. Sick clients should be sent for medical check immediately. 2. Anthropometric measurements: Weight and Height and oedema checking should be taken during all visits. Based on the nutrition classification the client will be referred for enrollment or counseled. 3. Clinical assessment: Medical assessment should take place before appetite test to determine whether patient should be enrolled in OTC or referred for in-patient care. If a patient is moderately acutely malnourished (MAM) based on anthropometry, the MAM client s HIV status should be determined. If a MAM patient s HIV status is unknown, the patient should be referred immediately to a testing and counseling centre within the facility. Only MAM clients with HIV can be admitted into the program. If a client is MAM and HIV negative, nutritional counseling should be provided, and the patient can be referred to SFP, if available, but the client cannot be admitted into the OTC program. 4. Appetite test: The client s appetite should be assessed by giving a small amount of Plumpy Nut The client may refuse to eat the RUTF because he/she is in an unfamiliar or strange environment. In this case, the caregiver and healthcare worker should move the client to a comfortable setting and slowly encourage the client to try the RUTF. The client MUST be observed eating RUTF before the client can be accepted for outpatient care. Supply chain and Monitoring and Reporting 5

18 5. Registration in OTC: When a client fulfills the eligibility criteria, the register should: Explain what this means to the client and the caregiver (i.e. reasons for admission, type of treatment, rules to be followed, etc.). Fill out an OTC client card: allocate registration number, fill information on the client and caregiver and fill all required individual data. Fill out the OTC ration card to be given to the client or caregiver. Keep all OTC cards in the patient file which stays at the OTC site. 6. Counseling on RUTF administration: During the initial visit, the service provider should counsel on: How RUTF should only be used as medicine to treat the malnourished subjects How to administer the doses of RUTF (Plumpy Nut). The service provider should show the client or caregiver how the sachet should be cut at one corner and that the client eats the paste from the packet or on a spoon. GENERIC FLOW OF ACTIVITIES IN OTC TRIAGE Nutrition & Health Education Anthropometric measurements Clinical Assessment/ Immunization update Waiting Area Anthropometry Area Clinical Assessment Dispensing Medicine & RUTF Qualified persons Registered & Counselled on HIV Testing RUTF test amount served to client Fails if does not complete/passes if completes amount Dispensing Registration to OTC Appetite Test 6 Supply chain and Monitoring and Reporting

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20 1. 2 SESSION STORES MANAGEMENT Duration: 450 minutes Method Brain storming Lecturer method Group discussion Materials: Instructions for group work, flipcharts, markers Learning objectives To Introduce to participants the concept of supply chain Management in the context of Storage management To know how to calculating storage capacity Also participants should know the following; Selecting a suitable store Key store staff Cleaning and repairing stores Stores equipment Store layout and floor plan General rules for receiving and dispatching commodities Commodity storage and stacking Building stable stacks Store Inspection Stores records 8 Supply chain and Monitoring and Reporting

21 Key Activities: Introduce this session by telling participants that the concept of storage is not a new thing. Brainstorm with participants about the knowledge regarding storage related concepts. Encourage them to contextualize the concept to their own homes Write their responses on a flip chart upon which you will build your definition Project pictures of the different types and sizes of stores Demonstrate to participants how they would go about to calculating storage space. Divide participants into 4 groups and give them assignments related to space calculation Group presentations and plenary Divide participants into 4 groups and ask each group to discuss roles of the following people in store management. Medical Superintendent Store keeper/supplies officer Pharmacists/dispensers Medical officers/nurses Security guards Group presentations and plenary Supply chain and Monitoring and Reporting 9

22 Supply Chain Management Supply chain management (SCM) is the management of a network of interconnected businesses involved in the ultimate provision of product and service packages required by end customers. Supply Chain Management involves all movement and storage of raw materials, work-in-process inventory, and finished goods from point of origin to point of consumption. Store Management The store holds commodities entrusted to NuLife by the donors. Because food commodities are highly perishable, NuLife staff entrusted with the commodities must ensure their safekeeping. The store therefore needs to be a very safe place. What is a Store? A Store as a Bank Like a bank, which stores money that can be deposited and withdrawn, a store provides transit storage for food commodities that are received, stored, and dispatched. The storage period for a given food commodity is for short periods of time, frequently for less than three months and almost never for more than twelve months. The example below illustrates the bank analogy in another light, by calculating the actual value of commodities that are entrusted to us by donors in the form of cash. This example alludes to the Peanut-based Ready to Use Therapeutic Food received at ACDI/VOCA: Values in USD per MT FOB value Air Freight Inland Transport Warehousing costs Total Value per MT Total Food Value USD 89, , , , , The actual total cost of one MT of Peanut-based Ready To Use Therapeutic Food is USD $ 6, and the total cost of 25 MT is USD $ 165, The transport and associated handling expenses are such that the cost of the commodity, when it reaches a remote town, could be five times that at which it was originally purchased on the world market. Like a bank, storage security, accountability, inspection and documentation cannot be compromised; nor can storage policies, procedures and regulations. This chapter illustrates some best practices to enable NuLife staff to provide our stakeholders with the best possible Stores management. 10 Supply chain and Monitoring and Reporting

23 An ideal Store: Must be situated in a secure area to protect against theft; Must be easily accessible by road or rail. Must allow for easy commodity intake & dispatch Must have strong doors secure from theft and rodents Doors are best steel-framed, of a double-leaf sliding design, and clad with 0.8 mm galvanized steel or aluminium, giving a clear opening approximately 4 x 4 m. Two doors in each side wall are the minimum in a 1000 tone store. All doors should run outside the building and be supplied complete with all tracks and door gear, including locks, door flashings, etc. For a desired size and shape of store, give careful consideration to the number and location of doors. Bear in mind that, as well as admitting produce, doors are important for ventilation and lighting, but can also admit rodents and thieves Must have proper and adequate ventilation Control is crucial in areas that experience high relative humidity. Each ventilator opening should be covered by a flap-door which can be shut firmly when the outside air has a higher relative humidity than that inside the store. The most effective location for ventilators is high up on the walls, close underneath the eaves. Ventilators m high, top-hinged, running the full length of the building on the front and back sides should be satisfactory. They must be convenient to open and fasten from ground level outside the store. The openings should be covered with bird-proof wire mesh. Must have safe and intact roof to protect against rain Roof and awnings are generally covered with corrugated sheeting of galvanized steel or aluminium. The longitudinal lap minimum should be 0.2 m, side lap 0.15 m, and all laps sealed with mastic strip (or a layer of bitumen) to avoid leakage. Ideally there should be no transparent panels in the roof, but up to 5% of the total roof area as transparent panel is acceptable. Many transparent materials deteriorate rapidly in strong sunlight and hence have a short life. Overhanging roof extensions at eaves and gable ends are extremely important in shading both walls and ventilator openings from strong sunlight. Care should be taken in areas prone to high wind speeds. Any gaps between the top of the wall and adjoining roof sheets should be sealed, preferably with a flexible mastic substance which moves as the roof expands and contracts. The roof outside should ideally be painted white. Gutters on the roof can become inadequate, so it may be best to let rain runoff onto a wide concrete path, which slopes away from the wall, or onto a specially constructed drainage area. Must have a strong concrete floor or packed earth to protect against rodents burrowing under stacks Avoid filling the floor area with loose earth. Never use topsoil. If infill must be used, choose stones, rubble or broken bricks and consolidate these thoroughly in layers mm thick, using sand or fine gravel to fill gaps. Walls Sheet steel cladding and hollow or solid concrete blocks are suitable. Reinforcement should be included to enable walls to resist impact. A damp-proof course is important. Slate or engineering bricks or a course of waterproofed concrete, which will maintain strong adhesion to the blocks, are preferable to plastic or bitumen Supply chain and Monitoring and Reporting 11

24 Must have adequate drainage to avoid flooding Must have complete files and books for record keeping Calculating Storage Capacity Requirements Prior to procuring the most appropriate store to store incoming commodities for the food program, one must calculate the storage capacity requirements for the store. The amount of store space required is based on the total volume of food and the different types of food. General Guidelines for Determining Storage Space Allocate sufficient space for each type of food commodity as well as all non-food materials and supplies related to food programs. If necessary, use chalk to mark the stack location on the store floor. Allow sufficient space for easy access to the stacks for inspection, loading and unloading. Stacks should be one meter from the walls; allow for another meter between stacks. Allow space for storage of cleaning materials and supplies, which need to be stored separately from food commodities. Allocate store space for damaged food by shipment number. Allow sufficient space to repackage damaged food and place it in separate stacks by shipment numbers. Store/storage space is calculated as length times width times height up to the eaves. A general rule is that approximately half of the space in small stores or stores can be used as actual storage space and up to three-quarters (75%) of the space in large stores/store can accommodate commodities. However, the mix of commodities particularly if non-food materials and commodities must be stored together with food commodities determines the available storage space. For example, although a small store (store) may have a gross cubic volume of 150 cubic meters, the usable volume may only be 48 cubic meters after taking into consideration the space between stacks and walls and the space between the stack and the eaves. Office space and non-food items, which must be separated from food commodities, may displace fifteen to twenty percent of the usable space. Please refer to the following illustrations 12 Supply chain and Monitoring and Reporting

25 Gross volume = 10M x 20M = 200M 2 x 4M = 800M 3 Usable volume = 18M x 8M = 144M 2 x 3M = 432M 3 Once usable volume has been determined, the next step is to calculate how much food can actually be stored in the store in order to begin the search for a suitable store to adequately accommodate the quantities received. Use the following rules of thumb to estimate the usable space needed for different types of food: One metric ton of grain or pulses twenty 50-kg bags requires approximately two cubic meters of storage space, whether the twenty bags are end-to-end or stacked in layers. One metric ton of processed food, such as corn soya blend forty 25-kg bags requires slightly less storage space because the bags are less bulky. There is less air and the grains are ground up. One metric ton of RUTF 44 cartons holding 140 sachets requires approximately 1.4 cubic meters of storage space, whether the 44 cartons are laid out end to end or stacked in layers. Supply chain and Monitoring and Reporting 13

26 Exercise 1 Drawing from the illustration above, if the dimensions of a storage building are L-30; W-20; H-10mtr, what is its storage capacity? Selecting a suitable Store Now that the required store capacity is known, what are the available store options in the locality (Health facility, region, etc), what factors need to be taken into consideration when selecting a store to store the food commodities? Site Location & Access Where are the distribution points in relation to the store? Is the storage facility easily accessible to trucks? What is the condition of the roads approaching the store? Does the site appear secure? Is site acceptable to NuLife s partners? Site Compound & Space Is space sufficient for trucks to maneuver in the compound for a smooth loading and unloading operation? Is the store fenced in or is there some mechanism to control crowds & manage entry & exit of people? Is the store located on a higher ground than the surrounding area or are drainage ditches around it to prevent flooding? Is the yard clear of weeds & trash which invite rodents? Is the area free of contamination from industrial pollution? Store Buildings & Structure Is the roof in good condition and doesn t leak? Try to inspect the roof following a rainstorm. Is the floor concrete or if not, is the earth packed to prevent rodents from burrowing in under the sacks? Are the doors tight & secure against rodents and theft? Are windows sufficient to allow for ventilation & light? Are windows secured with bars or grating to prevent theft? Will other openings allow in rodents and birds? Are walls rodent-proof and all entry points sealed? Are the buildings hygienic or can they be properly cleaned? What repairs are needed? Store Equipment Are pallets available or do they need to be procured? What other handling equipment has already been provided? Capacity Is the store large enough to store the required food? Is it necessary to rent two or more stores? (One store is easier to control, manage, & supervise.) Financial & Human Resources Is the rent reasonable? Does the budget cover the projected store expenses? Who is in charge of site management? If NuLife is contracting out site management, storekeeping functions, store security guards, & loading/unloading functions, assess the quality of human resources. Is labor available for loading & offloading trucks & reconstituting commodities? 14 Supply chain and Monitoring and Reporting

27 Key Store Staff The number of store staff required to manage and implement store operations depends on the size of the store and the operation. A large operation, consisting of one or several stores requires a store manager and assistant store manager. A smaller store may only require the services of a storekeeper who supervises the operation and support staff. Specifically, the Stores manager Manages all aspects of the store operation that may include one or several stores in a locality or a region and supervises store storekeepers, assistant storekeepers, and all support staff. Storekeeper Oversees store activities in one store; Maintains stock cards and store inventory ledgers; Reconciles balances between the store inventory ledger and stack cards; Maintains copies of the waybills and distribution plans and initiates action where necessary on waybills; Usually reports to the store manager; Supervises the assistant storekeeper, if that position exists, as well as support staff; and Often occupies a small office attached to or inside the store; Stores tally clerk & bookkeeper may fulfill some of the functions outlined above under storekeeper, depending on the size of the operation. Temporary or casual laborers Load and offload commodities during food receipt and dispatch; Clean & maintain the store; Repackage damaged food; Should be trained in food handling & storage procedures; and Should be able to identify damaged packages & infestation. Supply chain and Monitoring and Reporting 15

28 Exercise 2 Store X has got an assortment of stock which includes 30 bags of beans of 100kgs each 20 cartons of vegetable oil (24.5 kgs each) 50 cartons of plumpy nut (weighing 13.8 kgs each) of which 25 cartons are due to expire in March 09 while 25 will be best used before May 09 Filing cabin 2 cans of kerosene (20ltrs each) Cleaning materials. Please note that the beans were received one month earlier than the plumpy nut which was received in Feb Determine how much storage space is required? Using flip charts, demonstrate how you would plan floor space Store Layout and Floor Plans Store preparation involves amalgamating all of the information about commodity arrivals by type and quantity as well as setting aside appropriate space to accommodate the equipment, materials, and supplies to design an appropriate store layout and floor plan. One example is illustrated below: 16 Supply chain and Monitoring and Reporting

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30 1. 3 SESSION STORE OPERATION POLICIES/PROCEDURES Duration: Method: Material: 80 minutes Brainstorm/Interactive Flipchart and markers Activities Contextualize the definition of SOPs BRAINSTORM with participants about guidelines used at their facilities related to store management. Using a flip chart note down their responses Purpose: To present the procedure on how to order, receive, store and deliver RUTF. This will be a check list that will be followed at all times. It is recommended that all health facilities staff who receive, store or dispatch stock items use this as reference when handling the RUTF Learning objectives: By the end of this session, participants will be in position to know the SOPs that are in line with: Forecasting Ordering Receiving Dispatching Distribution mechanism that will be used The Supply Chain Mechanism that will be used in the delivery of RUTF Ideal Commodity handling procedures Activities Assess participants knowledge regarding guidelines used at their individual facilities that are in line with management [thereafter contexualize their responses to store management] Write partcipants responses down on the flipchart Build on partcipants responses to systematically lay out the SOPs that will be followed in handling RUTF. Demonstration on how store should be layed out as well as stacking procedures 18 Supply chain and Monitoring and Reporting

31 Store Operation Policies/Procedures Every program involving a store food commodity operation should establish a store policy outlining store procedures, rules, and regulations, including handling store keys and clear expectations for store security guards. General rules for store operation: All commodities must be stacked on pallets. Stack commodities according to type and shipment number. Different commodity different stack. The same type of commodity with different shipment numbers must be stacked separately. All commodity stacks must have stack cards, which must be updated daily. Maintain a space of one meter between stacks and wall, stack and stack, stack and ceiling. Use the FIFO principle first in, first out for each commodity. Commodities arriving first must dispatched first except for reconstituted bags. Separate the loading and unloading area, if possible. Prepare sufficient space for reconstitution activities. Prepare a quarantine area where damaged bags of commodities will be stored. Try to build the same size of stacks to enable easy commodity counting, if possible. Build stacks according to the principles clearly outlined in the NuLife commodities manual. No chemicals, fuels or poisonous materials are allowed inside the food store. No smoking, eating, drinking, or throwing garbage in the store. Unused pallets must be stacked neatly in a designated location. The stack plan must be prepared before commodities arrive. Ordering Instructions (Ordering Process; General Procedure) Staff member of the requesting health facility. Contact the NuLife s Supply Chain Manager to complete and submit an order form. This may be done via by the designated deadline if additions or deletions to the direct delivery plan are desired. Identify quantities of each type of commodity required. Key information is required, including the physical delivery address of the facility/store and detailed contact information for final delivery. It is important to verify that adequate storage space is available. Supply Chain Team Verify the appropriateness of the amounts requested in light of health facility distribution plans. The supply chain manager will generate a Forwarding Notice (FN) and sends electronic copies to the ACDI/VOCA or Manufacturer. Identify transporter who will deliver the consignment Order and delivery process Order approval notification from NuLife. Pre-alert documents sent to Requesting Health detailing the status of consignment expected. Transport agent delivers to receiving address. Transport agent returns signed delivery note to the NuLife offices Receiving address receives verification of specific item quantity received by NuLife offices. Supply chain and Monitoring and Reporting 19

32 Order form completion instructions 1. Date requested by recipient: enter date when original requesting health facility made their request to NuLife 2. Date request submitted to: enter date form was completed and sent to logistics unit for approval. 3. Date approved : leave blank 4. Requesting health facility: enter principle user of commodities. Please include name, address, , and phone contact information. 5. NuLife contact: enter name, address, , and phone contact. 6. Delivery destination: enter the physical address that will receive consignment. Note: the address cannot be a P.O.Box #, or office address; it must be the delivery site. 7. Desired delivery date: enter the desired estimated arrival date for delivery. Note: this is a target date, not a guaranteed date. 8. Type of request: enter type of request (emergency, replenishment or preparedness) according to listed descriptions and criteria. note: emergency request requires chief of party clearance 9. Special instructions: indicate any special marking or handling requirements. 12. Quantity of commodity: enter the number of commodity required. 20 Supply chain and Monitoring and Reporting

33 Commodity Receipt Receive Waybill before offloading Inspect Truck before Offloading Offload commodities; ensure that commodities are handled properly; Count every bag as it is offloaded using tally sheet File all documents immediately in the right sequence. Never take waybills, store ledgers, or any other store documents out of the store without authorization Test weigh sampled bags to ensure that they the rite amount of quantity as stated. Update store ledger book & stack cards immediately after completing the waybill. Do physical count to ensure the accur acy. Ensure that quantity in waybill; stack card, stock control card and ledger tallies. Write information on waybill accurately. Clearly indicate all losses or damages. Write loss damage report and indicate who is responsible for the loss. The storekeeper can receive food commodities in several ways: 1. From the port, using a NuLife waybill, after NuLife has taken possession of the commodities at the port; 2. Using a through bill of lading for commodities; the shipping company is responsible for delivery directly to the NuLife stores. NuLife should try to negotiate use of the NuLife waybill from the port to the store to smoothly correspond to commodity accounting records. 3. Commodities returned to store after having earlier been dispatched because the truck was unable to make a delivery due to poor road conditions or inability of receiver to accept the food commodities. a. If all food commodities return on the same truck and were never delivered, note the food quantities and condition on the waybill. b. If some of the deliveries were made perhaps the truck was originally tasked to deliver commodities to two or more distribution centers, but some of the food was not delivered and was returned to the store, note the quantities in units returned, the condition of the food commodities, and the reasons for non-delivery on the waybill. c. If the truck reaches the delivery site or store but the receiver is unable or refuses to receive some or all of it either because the food is damaged or storage space is insufficient, the receiver should write information about the commodities received and returned in the original waybill and then prepare a new waybill to return the commodities to the original store, ensuring that the original waybill number is referenced on the new waybill. The receiver should file both waybills for reference by HC management. The new waybill should accompany the transporter back to the original dispatching store. Supply chain and Monitoring and Reporting 21

34 Exercise 3 Given that RUTF daily ration Size par category is indicated as below P/L Women CHILDREN [6mt 5yrs] CHILDREN [6yrs < 18yrs] ADULTS [18 and above] SAM MAM SAM MAM SAM MAM SAM MAM 3 sachets 1.5 sachets 3 sachets 1.5 sachets 4.5 sachets 2.25 sachets 3 sachets 1.5 sachets How much quantity will be required to for distribution for 2 months with a buffer stock for one month to the following? Category P/L Women CHILDREN [6mt 5yrs] CHILDREN [6yrs < 18yrs] ADULTS [18 and above] Nutrition status SAM MAM SAM MAM SAM MAM SAM MAM # of beneficiaries 50 clients 40 clients 14 clients 16 clients 14 clients 9 clients 8 clients 33 clients Commodity Dispatch Types of Commodity Dispatch: As noted above, the Store Manager or Storekeeper can dispatch food commodities for different purposes: 1. To distribution sites or secondary stores under designation or partner management, using recognized waybills. 2. Food repayment of a loan to another agency or project, using a recognized waybill. 3. Food commodity transfer to another primary or secondary store. 4. Food declared to be unfit for human consumption may be dispatched for sale as animal feed (after being certified by a recognized veterinary officer that the food in question will not harm the animals), or destroyed (after getting authorization/clearance from Nulife) using a recognized waybill. 22 Supply chain and Monitoring and Reporting

35 Distribution Plan Facility management must prepare a distribution plan prior to authorizing commodity dispatch from any store. The plan must have the following; Be based on the quarterly requirements and the stock balances in the stores or distribution centers; Serve as the basis for authorizing commodity dispatch from the store; Include a column identifying the store Provide the number of units & kg of each commodity type to dispatch Provide a time period for commodity dispatch; Provide columns listing the amount of commodities of different types programmed and actually delivered and another column indicating the difference; Include the names & signatures of the preparer & approver. Supply chain and Monitoring and Reporting 23

36 Exercise 4 Using details from the forecasting exercise, design a distribution Plan for facility X Dispatch Process & Procedures The commodity dispatch authorization must be prepared by the authorized person before dispatching commodities. No commodity dispatch without CDA. Ensure sufficient: food in store for dispatch; store workers for loading; trucks required for transport Inspect the truck. Ensure the trucks are in good condition to carry commodities Update store ledger according to the shipment number. Do not mix shipment entries in store LEDGER All documents must sing the same song..! Quantities & units listed in the store ledger, stack cards, & waybills must tally!! Prepare waybill after loading commodities: fill all required information; Clearly indicate shipment number, number of bags or other units, unit weight, net weight, date, and destination. Types & quantity of food indicated on waybill should match types & quantities loaded onto trucks. Delivery location on waybill should match that on distribution plan. Indicate any reconstituted bags on the waybill. Obtain signature of transporter taking the commodities from the store. Use FIFO principle first in first out dispatching food from the stacks holding the earliest received commodities. Inspect all food commodities loaded onto trucks, ensuring that no damaged food is dispatched. Use tally sheets to count every bag. Stack commodities systematically to enable easy verification of the units loaded onto the trucks. Update stack card corresponding to the commodity dispatched from the stack. Do not forget to sign the stock card after verifying the stock amount. 24 Supply chain and Monitoring and Reporting

37 Commodity Storage & Stacking (Storage Spacing & Commodity Separation) Plan the stack layout prior to arrival of commodities, calculating the floor space required for each commodity. Aisles between stacks must be sufficient for staff to move and work between stacks and loading and unloading operations are easily accommodated. Vegetable Oil Oil Maize (cereals) (Cereals) Maize (Flour) Plumpy Milk CSB Nut Plumpy Nut Beans Milk I meter Space between stacks and walls Stacks should be erected at least one meter between each other, the walls, and below the eaves of the store, allowing air to circulate and reducing the risk of infestations. Never store food commodities directly against walls, pipes, pillars, roof beams, or partitions, which increases stress on structures, renders stocks inaccessible, and increases the risks of dampness and infestation. Never obstruct ventilators. Vegetable Oil Nov Oil 08 Maize Maize (cereals) (Cereals) Oct 08 Maize Maize Flour (Flour) Oct 08 Milk Plumpy Nut CSB 25 Kg Jan 09 Dec 08 Jan 09 Plumpy Nut Beans Milk I meter Space between stacks and walls Place different commodities, different types of packaging and different consignments of new and old stocks in different stacks, which should be labeled according to their arrival dates. Food commodities should be separated from non-food items. Damaged commodities should always be separated from other food commodities; preferably repaired, repacked, and dispatched first if fit for human consumption. Chemicals, fuels, lubricants, and other hazardous materials should never be stored in the same store along with food commodities. Unless pallets absolutely cannot be obtained, such as at the beginning of an emergency operation, stack all food commodities on pallets to keep food commodities off the floor, protect food from dampness, allow for ventilation, and assist fumigation operations. Keep pallets clean, level, and free of projecting nails or splinters. If pallets are not available, try to place food commodities on wooden planks, woven mats or plastic sheeting. If pallets are insufficient to accommodate all commodities stored in the store, flour and blended food should be accommodated first. It is essential to keep food off the floor. Pallets should never project beyond the bottom of the stack. Supply chain and Monitoring and Reporting 25

38 Stacking on pallets Stacking food to eaves Commodity stocks received earliest should be dispatched at the earliest, a principle known as FIFO First in, first out. It becomes easy to apply this principle if the stacking sequence has been well-planned so that staff can easily access all food commodities in the store. FIFO should not be applied for food commodities which are fit to be consumed but will not store well, for example, commodities approaching the expiry date or reconstituted from damaged packages. It is better to issue such food without delay, even before dispatching older undamaged stock. New stock arriving in April can be stacked in the freed space after the area has been cleaned. Building Stable Stacks The most common stacking method, for rectangular bags and boxes, is to orient bags in different directions by cross-stacking bonded bags or boxes in each layer, which helps prevent stacks from falling over. The principle is to build stacks carefully to promote stability, maximize available space, and facilitate stocktaking, physical counts, cleaning, and inspection. Improperly erected stacks could collapse, injuring people or damaging commodities and store structures. Stacks should be positioned to benefit from available natural light to facilitate inspection and good ventilation to preserve food commodities longer in hot climates. It is important to limit stack heights to prevent potential damage to commodities stored at the bottom of stacks; bags could be split by compacting caused by excessive weight, which could also structurally damage the store. Do not stack cartons or tins or pails higher than ten layers or bags of grain and processed food more than twenty layers. If food is stacked higher, stacks can become unstable, especially as food is loaded on or offloaded. High stacks also become difficult to inspect and clean. 26 Supply chain and Monitoring and Reporting

39 Proper Stacking Sequence Bottom layer as seen from above Proper Stacking Sequence -- Top layer as seen from above Bonded or interlaced stack Staircase Stack Supply chain and Monitoring and Reporting 27

40 It is also acceptable to interlace stacks by laying the first layer lengthwise, the second layer crosswise, the next layer lengthwise and so forth. Stack layer patterns for two common types of stack Pallets should be constructed to suit the packages or sacks that will be stacked on them to ensure these do not sag through or fall 28 Supply chain and Monitoring and Reporting

41 Summary of Stacking Guidelines Ensure easy access to food that has been stored the longest so that it will be dispatched first. Store separate shipments of the same food commodity in separate stacks identified by stock cards. If this is not possible, place food remaining from a previous shipment on top of newly-arrived food so that it can be dispatched first. Place the first layer of the stack carefully on the pallets in order to maintain uniform stacks and avoid weakening the integrity of the stack, which could otherwise fall over. Bond or interlace layers of bags of grain or processed food to construct the stack. Line up bags or containers of food to the edge of a pallet. Place the same number of bags or containers on each level to make counting easy. Leave at least one meter between each stack and between stacks and walls to facilitate inspections, inventory counts, cleaning, and fumigation. Leave at least one meter of circulation space between the top of the stack and the eaves. Stack cartons or tins of oil in their upright position. Limit stack heights to avoid crushing food on the bottom and prevent excessive floor loading. Do not stack bags of grain or processed food higher than 20 layers or containers of oil higher than 10 layers. Lift bags, cartons and containers; do not throw them. Create separate stacks for food in original packages, damaged packages, repackaged food, food suspected and/or declared unfit, and sweepings. Conduct physical inventories by counting from the floor. Climb to the top to observe that the stack is whole and no food has been taken from the center. Store Inspections Store Managers should consistently and routinely inspect stores in order to: Promptly respond to improper commodity storage resulting in food commodity loss, deterioration or damage; Promote improved store management; and Guide programming planning. Weekly inspections should focus on cleanliness, structure maintenance, and proper storage and accounting practices. Findings should be clearly delineated in a Weekly Inspection Report. The following table provides basic guidelines what to include in store inspections. Supply chain and Monitoring and Reporting 29

42 Guidelines for Store Inspections Area to be inspected: Inspect for: Outside the store Store office area Inside the store Cleanliness & presence of debris or trash; Growth of vegetation; Evidence of rodent activity; Drainage & flood water disposal; Condition of drain pipes; Condition of roof, walls, and windows; Condition of lights & outdoor equipment; Condition of fences; Cleanliness; Adequate shelving; Adequate lighting; Condition of office equipment; Provision of cleaning equipment Sanitary conditions for staff; Condition and cleanliness of ceilings, floors, and walls; Doors well-fitting, secure, and sound; Windows & ventilation in good repair & screened to prevent access Placement of rodent baits & traps; Cleanliness of interior; Presence of hazardous substances such as chemicals and pesticides; Presence & expiry dates of fire extinguishing equipment; Food storage area Distance between stacks and between stacks and walls; Interlaced or bonded stacks; Pallets free of exposed nails or wooden splinters which may tear bags; Segregation of damaged food from regular stocks; Signs of insect infestations around pallets and bags; Signs of rodent or bird infestations around pallets and bags; Split or broken bags; Stale food which has been stored too long Leaking, stained or discolored containers, bulging, swelling or rusting cans, and caking of food within bags; Signs of germination of grain in sacks; Short-weight containers & other signs of theft; Commodity spillage & general hygienic conditions; Expiry dates on items with limited shelf-life; Flying insects, an indicator of infestation; Stack cards in position & maintained. 30 Supply chain and Monitoring and Reporting

43 During commodity stack inspections: Climb to the top and spot check bags or containers underneath top layer; Lift top bags and feel underneath for heating in the second layer, an indicator of germination or infestation; Carefully look in between bags or containers; Push up bags at corners to look for insects (without pushing over the stack); Look around the base of pallets or dunnage for signs of insects or rodents; Record the date of the inspection; Record findings in a Weekly Inspection Report and file the report; Take appropriate action in response to findings, particularly regarding damaged food. Inspection of Stacks Supply chain and Monitoring and Reporting 31