“We had people working for 20 or 25 years on inventory management who had no idea how to manage stock.”
– CMS Director, Dr. Waahidi
The National Central Medical Stores (CMS) is the warehouse facility responsible for the storage and management of all medicines used in Kabul’s medical hospitals and clinics. The CBAM project has worked with the CMS to help them receive and manage pharmaceuticals and supplies more efficiently, as well as to improve their gender sensitive policies and environmentally sound procedures. The partnership also works to increase staff’s ability to track and control all shipments and deliveries going in and out of the warehouse.
When the CBAM team arrived in 2010 to conduct an appraisal of the CMS, a few important issues were brought to light immediately. The area around the main storage building was littered with debris that had accumulated over years, the warehouse was in disrepair, and there were no standardized inventory systems in place. Further, there was no temperature control system or ventilation in the storage facility and inefficient storage conditions resulted in the loss of medicines through waste or expiration. Finally, the CMS lacked the methods to properly dispose of these types of expired or unusable medicines.
A priority at the start of the project was to clear the CMS property and storage facilities so that the space could be used more efficiently and appropriately. The parking lot was paved to reduce the amount of atmospheric dust and a shelter was built along the back of the medicine storage building in order to protect the stocks from water. Maintenance was also made a priority and three large industrial vacuum cleaners and a basic tool kit were provided for the staff’s use.
The workspaces for staff were improved as well. The two existing bathrooms were completely renovated and two more were built, along with a washing station and a kitchen area for the staff to use. These efforts have been made to increase the quality of life for staff, namely with regards to hygiene and nutrition.
The CBAM project is also supporting the construction of a new storage building at the CMS to provide staff with more room to conduct safe disposals of medicines, as well as to store more pharmaceuticals and supplies. The clearing of the land for the construction took place in the spring and the structural work has begun. The stock room is expected to be completed in the coming months.
Improved Safety and Security
When the CBAM project began working with the CMS, the staff was working in a facility without access to protective or safety gear. The CBAM project has since provided equipment such as protective clothing, a trolley for the transfer of waste, and a carton packing machine. A new front gate was also installed and barbed wire was strung around the front walls so as to deter any breaches in security.
“There have been important changes in safety in the CMS. Firstly there are changes in the way we store medicines and there are also improved safety standards for the staff. We have better equipment, safety gear and uniforms and all these things are helping.” – CMS Director, Dr. Waahidi
Another important initiative for the CMS has been the ongoing development of Standard Operating Procedures (SOPs). Currently, 166 have been written and are pending Ministry approval before being translated into Dari. These SOPs provide staff with standardized work procedures they can refer to, ensuring continuity in their quality of work and assisting the organization in operating up to international standards. According to Dr. Waahidi, these SOPs are a priority for the CMS, “The SOPs are a very important addition to our work. It is contributing to the long term sustainability of the CMS and as guidelines for standardized operation.”
Perhaps the most significant work being done at the CMS has been the provision of training to staff, many of whom have been working at the facility for years without regularly scheduled or standardized training sessions. According to CMS management, the training provided to staff to date has had a significant impact on their quality of work. “The most important activity that has happened is the trainings. We had people working for 20 or 25 years on inventory management who had no idea how to manage stock.” The training has led to a significant decrease in delays when processing orders. Managers have also noted a real improvement in staff attitudes since the facility renovations and trainings have begun. “Staff members used to come to work and were focused on their paycheck more than anything. Now they are more focused on their jobs; they are more invested in their work,” he explained while citing an example of a staff initiative to renovate part of the CMS.
A series of trainings have been provided to CMS staff with CBAM support. These include a 10-day-training session on Medicines and Stock Management for staff from the CMS, the QC Lab, as well as Ministry and hospital staff. The project also provided training in Warehouse Operations and Management, which was conducted in the United Arab Emirates for five CMS staff. The training in the UAE was specially formatted for those who participated to also be able to train others upon their return. Finally, CMS staff joined four participants from provincial health directorates in Jalalabad and Kandahar for three days of training in Dubai on Warehouse Operations/ Management. These participants were able to present the topics covered to their colleagues who had stayed in Kabul.
Upcoming trainings planned for staff include a pharmaceutical waste disposal training for the provinces in September and a gender awareness training for CMS staff in later in the Fall.
Another important aspect of CBAM’s contribution to Afghanistan’s storage and distribution of pharmaceuticals is the creation and implementation of a new and much needed database. “The development of the database is a fundamental need for us as well,” the CMS director told HPIC staff with regards to the ongoing work on implementing the new system.
The CMS staff, in collaboration with CBAM, identified the need for a functional computerized database system for the daily management of stock within the warehouse. Prior to this development, the inventory had been tracked through a paper-based system. This computerized database would allow CMS staff to track expiry dating and locate stock more efficiently. The database could be accessed by staff across various departments within the CMS in order to allow for the effective monitoring of stock throughout the warehouse. It would also facilitate timely reporting with a fast and efficient way to generate required government forms and reports. It is also anticipated that the database will, in coming years, be expanded and linked through the internet to similar databases running in other MoPH departments. This will allow for improved coordination and information sharing regarding pharmaceutical supply and needs forecasting.