Supply Chain Management, Monitoring and Reporting of Outpatient ...

A Trainer’s Manual

Supply Chain Management, Monitoring and Reporting of Outpatient Therapeutic Care Programs


Supply Chain Management, Monitoring and Reporting of Outpatient Therapeutic Care Programs

Financial support for this interim training manual was provided by USAID, Cooperative Agreement number 617-A-00-08-00006-00. 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.

Supply chain and Monitoring and Reporting | i

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

ii | Supply chain and Monitoring and Reporting

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.

Preamble

Supply chain and Monitoring and Reporting | iii

Training methodologyThe 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 outlineEach 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 durationThe estimated timing is given for each session considering the participant’s experiences and their profile, very long sessions are avoided.

The training methodsFor each session, the interactive techniques to be used are mentioned.

The required materialsFor 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 activitiesThese 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 preparationThe 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.

iv | Supply chain and Monitoring and Reporting

The co-facilitationCo-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?•

ParticipantsIt’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’ meetingIn 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 GroupsDepending 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.

Supply chain and Monitoring and Reporting | v

Assessment of participants’ knowledgeParticipants’ 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 EvaluationsThe 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 evaluationIt 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.•

vi | Supply chain and Monitoring and Reporting

Day 1

Session Content Methodology Activities Time

1 NuLife Profile Lecture N/A 30 Min

2 The concept of RUTFInteractive/lecture

Build on partcipants’ responses to give a vivid picture of what RUTF is.

30 Min

3

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 capacityLecture/illustrative

Calculating storage capacity of the training room

30 Min

Selecting a suitable store Interactive Group work 30 Min

Key store staffGroup discussion

Group work 30 Min

Cleaning and repairing stores Interactive 20 Min

Stores equipmentGroup discussion

Participants lists equipment found at the facilities

20 Min

Store layout and floor planLecture/illustrative

Group activities 40 Min

4

Stores Operation ProceduresGroup 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

Receiving and DispatchingInteractive/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

Supply chain and Monitoring and Reporting | vii

Day 1

Session Content Methodology Activities Time

Day 2

4 Store Inspection Interactive Field Visit120 Min

5 Stores Records Interactive/Group workGroup work (Entering data on the different forms)

60 Min

6 SOPs for rodents’ control Brain storming/Informative Interactive discussion 30 Min

7Basics of Fire fighting in the context of store management

Brain storming/Informative Interactive discussion 30 Min

Activity work plan for the sitesMapping out work plans for the individual facilities.

40 Min

Conclusion Closing remarks

viii | Supply chain and Monitoring and Reporting

Supply chain and Monitoring and Reporting | 1

Supply Chain Management

Module 1

Standard Operating Procedures for Ordering, Receiving, Storage, Dispatching and Tracking Ready to Use Therapeutic Food

2 | Supply chain and Monitoring and Reporting


Duration: 30 minutes

Method: Lecture and participatory

Material: 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

ActivitiesAssess 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. •

OUTPATIENT THERAPEUTIC CARE

SESSION

1. 1


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].


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.


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.

Anthropometry Area Waiting Area

Anthropometric measurements

Clinical Assessment/ Immunization update

Qualified persons Registered & Counselled on HIV Testing

Dispensing Medicine & RUTF

GENERIC FLOW OF ACTIVITIES IN OTC

TRIAGE Nutrition & Health Education

Clinical Assessment

RUTF test amount served to client Fails if does not complete/Passes if completes amount

Registration to OTC Dispensing Appetite Test



Method Brain storming•Lecturer method•Group discussion•

Materials: Instructions for group work, flipcharts, markers

Learning objectivesTo Introduce to participants the concept of supply chain Management in the context of Storage •managementTo 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•

STORES MANAGEMENT

SESSION

1. 2


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 homesWrite 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 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 BankLike 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 FoodValue USD

89,624.67 68,725.64 7,362.00 102.40 6,632.57 165,814.35

The actual total cost of one MT of Peanut-based Ready To Use Therapeutic Food is USD $ 6,632.57 and the total cost of 25 MT is USD $ 165,814.35. 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.


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 rodentsDoors 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 ventilationControl 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 0.6–1 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 rainRoof 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 stacksAvoid 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 150–300 mm thick, using sand or fine gravel to fill gaps.

WallsSheet 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


Must have adequate drainage to avoid flooding

Must have complete files and books for record keeping

Calculating Storage Capacity RequirementsPrior 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


Gross volume = 10M x 20M = 200M2 x 4M = 800M3

Usable volume= 18M x 8M = 144M2 x 3M = 432M3

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.


Exercise 1Drawing 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 StoreNow 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 • Wherearethedistributionpointsinrelationtothestore?• Isthestoragefacilityeasilyaccessibletotrucks?• Whatistheconditionoftheroadsapproachingthestore?• Doesthesiteappearsecure?• IssiteacceptabletoNuLife’s partners?

Site Compound & Space

• Isspacesufficientfortruckstomaneuverinthecompoundforasmoothloading

and unloading operation?• Isthestorefencedinoristheresomemechanismtocontrolcrowds&manage

entry&exitofpeople?• Isthestorelocatedonahighergroundthanthesurroundingareaoraredrainage

ditches around it to prevent flooding?• Istheyardclearofweeds&trashwhichinviterodents?• Istheareafreeofcontaminationfromindustrialpollution?

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?Arethedoorstight&secureagainstrodentsandtheft?•Arewindowssufficienttoallowforventilation&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 • Arepalletsavailableordotheyneedtobeprocured?• Whatotherhandlingequipmenthasalreadybeenprovided?

Capacity • Isthestorelargeenoughtostoretherequiredfood?• Isitnecessarytorenttwoormorestores?(Onestoreiseasiertocontrol,manage,

&supervise.)

Financial & Human Resources

• Istherentreasonable?• Doesthebudgetcovertheprojectedstoreexpenses?• Whoisinchargeofsitemanagement?• If NuLife is contracting out site management, storekeeping functions, store

security guards, & loading/unloading functions, assess the quality of humanresources.

• Islaboravailableforloading&offloadingtrucks&reconstitutingcommodities?


Key Store StaffThe 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&maintainthestore;•Repackage damaged food; •Shouldbetrainedinfoodhandling&storageprocedures;and•Shouldbeabletoidentifydamagedpackages&infestation.•


Exercise 2Store 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 09Filing 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 09.

Determine how much storage space is required?1. Using flip charts, demonstrate how you would plan floor space2.

Store Layout and Floor PlansStore 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:



Method: Brainstorm/Interactive

Material: 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•

ActivitiesAssess 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•

STORE OPERATION POLICIES/PROCEDURES

SESSION

1. 3


Store Operation Policies/ProceduresEvery 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 email 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.


Order form completion instructions1. 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, email, and phone contact information.

5. NuLife contact: enter name, address, email, 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.


Commodity Receipt

Test weigh sampled bags to ensure that they the rite amount of quantity as stated.

Write information on waybill accurately. Clearly indicate all losses or damages. Write loss damage report and indicate who is responsible for the loss.

Updatestoreledgerbook&stackcardsimmediately 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.

File all documents immediately in the right sequence. Never take waybills, store ledgers, or any other store documents out of the store without authorization

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

The storekeeper can receive food commodities in several ways:From the port, using a 1. NuLife waybill, after NuLife has taken possession of the commodities at the port;Using a through bill of lading for commodities; the shipping company is responsible for 2.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.Commodities returned to store after having earlier been dispatched because the truck was 3.unable to make a delivery due to poor road conditions or inability of receiver to accept the food commodities. If all food commodities return on the same truck and were never delivered, note the food a.quantities and condition on the waybill.If some of the deliveries were made – perhaps the truck was originally tasked to deliver b.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. If the truck reaches the delivery site or store but the receiver is unable or refuses to receive c.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.


Exercise 3Given 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:

To distribution sites or secondary stores under designation or partner management, using 1. recognized waybills.Food repayment of a loan to another agency or project, using a recognized waybill.2. Food commodity transfer to another primary or secondary store.3. Food declared to be unfit for human consumption may be dispatched for sale as animal 4. 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.


Distribution PlanFacility 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•Providethenumberofunits&kgofeachcommoditytypetodispatch•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;Includethenames&signaturesofthepreparer&approver.•


Exercise 4Using details from the forecasting exercise, design a distribution Plan for facility X

DispatchProcess&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

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&quantityoffood indicated on waybill shouldmatchtypes&quantitiesloadedontotrucks.

• 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.

Update stack card corresponding to the commodity dispatched from the stack. Do not forget to sign the stock card after verifying the stock amount.

• 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.

All documents must sing the same song..!Quantities&unitslistedinthestoreledger, stack cards,&waybills must tally!!

Update store ledger according to the shipment number. Do not mix shipment entries in store LEDGER


CommodityStorage&Stacking

(StorageSpacing&CommoditySeparation)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.

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.

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.

Vegetable Oil

Maize (Cereals)

Plumpy Nut Beans Milk

Maize (Flour)

Vegetable Oil

Milk

Maize (cereals)

Plumpy Nut

CSB

Maize Flour

I meter Space between stacks and walls

Vegetable Oil

Maize (Cereals)

Plumpy Nut Beans Milk

Maize (Flour)

Veg Oil Nov 08

Milk Jan 09

Maize (cereals) Oct 08

Plumpy Nut Dec 08

CSB 25 Kg Jan 09

Maize Flour Oct 08

I meter Space between stacks and walls


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 StacksThe 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.


Proper Stacking Sequence – Bottom layer as seen from above

Proper Stacking Sequence -- Top layer as seen from above

Bonded or interlaced stack

Staircase Stack


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


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 InspectionsStore 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.


Guidelines for Store Inspections

Area to be inspected: Inspect for:

Outside the store

Cleanliness&presenceofdebrisortrash;•Growth of vegetation;•Evidence of rodent activity;•Drainage&floodwaterdisposal;•Condition of drain pipes;•Condition of roof, walls, and windows;•Conditionoflights&outdoorequipment;•Condition of fences;•

Store office area

Cleanliness;•Adequate shelving;•Adequate lighting;•Condition of office equipment;•Provision of cleaning equipment•Sanitary conditions for staff;•

Inside the store

Condition and cleanliness of ceilings, floors, and walls;•Doors well-fitting, secure, and sound;•Windows & ventilation in good repair & screened to prevent•accessPlacementofrodentbaits&traps;•Cleanliness of interior;•Presence of hazardous substances such as chemicals and •pesticides;Presence&expirydatesoffireextinguishingequipment;•

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-weightcontainers&othersignsoftheft;•Commodityspillage&generalhygienicconditions;•Expiry dates on items with limited shelf-life;•Flying insects, an indicator of infestation;•Stackcardsinposition&maintained.•


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


MinimizingDamages&LossesintheStore

Based on the inspection process, store storekeepers and manager should internalize appropriate responses and actions to minimize food damages and losses. Store inspections should be undertaken routinely every week. In addition, the Store Manager or Commodity Officer should prepare a Store Inspection Report at least once a month, outlining recommendations and follow-up actions in response to the recommendations. The report should be filed in the store as well as in the regional office.

The following table provides guidance for action and responses based on different types of scenarios relating to food losses and damages:

Type of damage

Evidence of Damage

Methods of Control

Action Required

Short-weight containers

Bags appear slack.

Containers are not as heavy as normal when lifted.

Weighing a random sample of bags and containers indicates short-weight units.

If loss appears in bulk shipments, increase vigilance of bagging operation at port.

Increase security in storage areas and during transport.

Repackage or assign a new weight to the containers. Prepare Loss and Adjustment Reports and enter transactions on stack cards and in store inventory ledgers.Place empty containers in separate storeaftercleaningbags&fittinglidsoncontainers.

Leaking, broken or torn bags or containers

Spilled food in transport vehicle.

Food spills from containers during unloading.

Torn bags and dented or crumpled containers.

Handle properly: Do not throw bags, stack commodities too high or use hooks on bags.

Contact donor if packaging material or container appears inadequate.

Repackage food fit for human consumption. Inspect sweepings and either reconstitute or dispose of sweepings declared unfit for human consumption. Prepare Loss and Adjustment Reports and enter transactions on stack cards and in store inventory ledgers.

Wet, stained or moldy bags or containers

Containers are wet to the touch or dripping.

Containers are discolored

Unusual smell (moldy or chemical)

Food Caking.

Ship food in waterproof holds or in adequately sealed cargo containers.

Keep food under cover when stored outside.Transport using tarpaulins.

Insure adequate air circulation.

Do not store past expiration date on container. Refer to USAID Commodity Reference Manual and other donor guidelines onstorage&expiryperiods for food.

Inspect and reconstitute food fit for human consumption. Dispose of food declared unfit for human consumption after certified by competent authority.

Dry & reconstitute food dampened by rain.Prepare Loss and Adjustment Reports and enter transactions on stack cards and in store inventory ledgers.


Type of damage

Evidence of Damage

Methods of Control

Action Required

Bulging or rusted tins

Rust on outside of container, especially near seams and lids.

Shape of container is bulging and distorted.

Rancid smell of vegetable oil.

Do not store in direct sunlight.

Do not store past expiration date on container or, if possible, longer than four months.

Inspect and reconstitute food fit for human consumption. Dispose of food declared unfit for human consumption after certified by competent authority.

Prepare Loss and Adjustment Reports and enter transactions on stack cards and in store inventory ledgers.

Rodent or bird infestation

Rodents or birds in the store.

Excrement on the floor or stacks.

Gnawed bags or containers.

Footprints in dust.

Bird nests.

Cleanliness and maintenance are critical to preventing infestations.

Maintain cleanliness outside and inside of the storage facility and free of debris.

Close holes or openings in walls, floors and ceilings.

Place screens over windows and ventilation openings if possible.

Cats are effective in controlling rodents.

Traps can be set along the interior walls of the store, at each side of every outside door, and in rafters.

Do not leave poisons or traps accessible to the cats.

Inspect and reconstitute food fit for human consumption.

Dispose of food declared unfit for human consumption after certified by competent authority.


Insect or moth infestation

Flying insects in store.

Live or dead insects or larvae on the floor.

Traces of insects or larva in dust.

Grain bags have small holes and excessive dust.

Noise heard inside the bag.Irregular holes in the grain or beans

Strong odor

Cleanliness is critical to prevent insect infestations.

Maintain cleanliness outside and inside of the storage facility and free of dust and debris.

Inspect and fumigate. Dispose of food declared unfit for human consumption.



Type of damage

Evidence of Damage

Methods of Control

Action Required

Sweepings

Loose food from slack or torn bags on store floors.

Loose food on store floors after reconstitution

Do not allow rough handling of food.

Do not move food commodities often.

Instruct laborers to avoid as much spillage as possible during the reconstitution of food.

Sweep floors frequently to maintain cleanliness.Reconstitute all food that may be fit for human consumption.Contact competent authority to determine if sweepings are unfit for human consumption.Dispose of food declared unfit for human consumption.Prepare Loss and Adjustment Reports and enter transactions on stack cards and in store inventory ledgers.



Method: Brainstorm/Interactive

Material: Flipchart and markers; samples of tracking tools [waybills, stock cards, inventory sheets, RUTF status reports, loss reports, distribution register and the ordering /request form

Purpose:The purpose of this session is to navigate together with partcipants through the reporting tools/forms that will be used in handling and tracking [usage] of RUTF.

Learning objectives:By the end of this session, participants will be in position:

To differentiate between different reporting forms and tools, purposes [uses] of each •individual tool/formAble navigate as well as enter the required data into the tools with ease.•

Activities: BRAINSTORM with participants, asking them what documents they use in managing •supplies. Using a flip chart note down their responses•Build on what they know and thereafter contextualize the definition as well as the use of the •documents/forms mentioned:

STORE RECORDS AND FILES FOR COMMODITY INVENTORY

SESSION

1. 4


Store inventory and accounting documentation and reporting allow store managers, storekeepers, and other store staff to:

Track units of food, such as bags of grain or cartons of oil by maintaining accurate records •of commodities received or dispatched from the store;Maintain an accurate record of commodity stocks in the store;•Update key files regularly – daily;•Maintain effective control of non-commodity supplies, such as empty bags or containers, •pallets, and weighing scales;Inform management of commodity store inventory balances, which is critical information •for effective and efficient food programming and planning.

The Waybill (What is the Waybill)Should be understood as the same as a bank cheque used to withdraw money from a •bank – or commodities from a store – and deposit money into an account – or transport commodities to be loaded into stores;Should be understood as a type of contract, a legal agreement between organisation and •the transporter documenting the commodity dispatch and receipt in condition agreed to and signed by both the receiving and dispatching parties;Should be completely filled out and signed by store managers or storekeepers as well as •transporters dispatching and receiving the food commodities;Should only be signed upon carefully counting and examining the condition of the food •commodities received from the transporter;Should clearly document all losses and damages on each of the five copies to enable •organisation to initiate claims against the transporter, if necessary; andShould be filed in numerical order in the dispatching store, the receiving store, the central •office, and the regional office, and kept securely under lock and key.A waybill is like a BANK CHEQUE. Just like the bank cheque authorizes the release of •MONEY from a bank account so does a waybill authorize the release the COMMODITIES from the store. A waybill is like a CONTRACT therefore it is a LEGAL document. The contractual •agreement between organisation and a transporter for example is legally strengthened by a waybill to prove that the work is done. It helps to solve disputes because it carries and breaks down all the facts and details

Waybill Procedures

Safekeeping: Blank unused waybills in five color-coded copies should be kept in a safe secure location only accessible by the person authorized to prepare the waybill. Waybills are printed up in pre-printed, pre-numbered order. The logistics office is responsible for keeping track of the waybills and the numerical sequence sent out to each store, or port officer, or clearing agent. The logistics office usually does this by coding the waybills sent out to offices or stores.


Waybill Authorization: The Facility management should delegate one staff member – usually a store manager or storekeeper to take responsibility for:

Completing the information on the waybill;•Ensuring that the types and quantities of food commodities loaded onto the truck •matches the waybill information which in turn matches the distribution plan for the food project;Verifying that the waybill destination matches that of the project distribution plan;•Obtaining the signature of the transporter or truck driver.•

Dispatching: The transporter and store manager or storekeeper should sign waybills in 5 copies documenting the number of units of food commodities loaded onto the truck. Use official waybills issued by the central Logistics office. If the transporters-contractors insist on using their own waybills, ensure that all of the information (see below) required on the waybill is included on the waybill.

Receiving: Upon receipt at the store, the store manager or storekeeper must sign the waybill to signify receipt of food commodities, but only after carefully counting and examining the condition of the commodities. All losses and damages must be noted clearly on all copies of the waybill. This information will later be used toward possible claims against the transporter, if any of the commodities are missing or damaged.

Filing: After completing the transport operation, signing the waybill, and documenting any irregularities requiring further action, the five color-coded copies of the waybills should be filed in secure locations as such:

White: in the office;•Pink: Transporter copy;•Yellow: at the receiving destination office;•Blue: in the dispatching store or port office;•Green: at the regional office.•

Waybill InformationStandard waybills should include the following information:

Date of dispatch;•Origin&destinationofdispatch;•Transporter;•Waybill number;•Vehicle plate number;•Shipment number by commodity;•Standard weight of unit of food commodities;•Types&amountofcommodities;•Totalnet&grossweightofeachcommodity;•Signatureofstoremanager&transportdrivercertifyingloading;•Signatureofstorekeeper&drivercertifyingcommodityoffloading;•Totalunits&netweightofeachcommodity:•

Received in good condition;•Received in damaged condition; •Missing;•


Remarks about any missing or damaged food commodities.•

Monthly Receipt SummaryThe Monthly Commodity Receipt Summary encapsulates all shipments of commodities received in the store during the month. Commodity Managers cannot complete the monthly status reports without having first completed the Monthly Receipt Summary, which lists all the trucks and accompanying waybills for each commodity by:

Date received;•Truck-trailer&waybillnumbers;•Commodity units per waybill;•Excesses or shortages;•Total receipts; and•Balance for each commodity received•

Monthly Dispatch SummaryA companion document to the Monthly Receipt Summary, the Monthly Commodity Dispatch Report summarizes all commodities dispatched from the store during the month. This document is also necessary for completion of the monthly status reports. The Monthly Dispatch Summary lists all waybills for each commodity dispatched from the store by:

Date;•Waybill number;•Destination&intendedrecipients;•Number of units shipped and actually received intact;•Number of damaged units; and•Status of waybill signature returned.•

Store Ledger Effective store inventory documentation relies on continual daily maintenance and updating of the store ledger, which records all transactions of individual shipments of commodities for each type of food commodity received into, stored in, and dispatched from the store. Together with the waybill and stack card, the store ledger is the essential inventory accounting instrument documenting commodity status in the store.

Register commodities entering and leaving the store immediately in the ledger, which •should be updated DAILY, as soon as a waybill has been issued or received. Reconcile the ledger daily with the respective stack card in order to easily detect losses •and know stock balances for each commodity.Maintain separate ledgers for each commodity type and unit and shipment.•Maintain separate ledgers for food suspected or declared to be unfit for human •consumption (which should be separated from good food commodities), which allows for easier reconciliation between store ledgers, stack cards, and physical counts.Record entries in whole units (for example, instead of writing 1 ½ bags of 50 kg, write 1 •bag, 25 kg).Close ledgers at the end of each month in coordination with country office commodity •accounting team.Document in the store ledger the receipt or dispatch and balance of each commodity •and shipment number by date, waybill and truck numbers. Carry forward the opening balance from the previous month’s ending balance. •Enter any returns of dispatches to stores as a negative number in the dispatch column.•Fill out a Loss/Damage Report in conjunction with updating the store ledger upon •


discovering any loss or excess, after reconstituting food into new bags or containers and subsequently describing the nature and extent of the loss or damage.The store ledger and other records and stock should be inspected on a regular and a •random basis.Repeated errors will lead to immediate dismissal or in some cases criminal prosecution •(by the donor/facility management)

Stack CardsEach stack of food commodities MUST have a stack card, normally having the consistency of cardboard paper or a large card, on which daily commodity movement in and out of the stack is immediately recorded at the time of the transaction. Stack card preparation should include the following:

Sign&datethestackcardafterrecordingatransaction.•Stack cards should always display the current stock level, based on balances after •recording receipts and dispatches.Stack cards should record units – # of bags or cartons – and not weight.•Maintain separate stack cards on separate stacks for each type of commodity and each •shipment number. If, on rare occasions, space is an extreme constraint, stack food of the same type from an earlier shipment on top of food from a later shipment, divide the stack card in half, and list both shipments.Maintain separate stack cards on separate stacks for each shipment of:•

Damaged food awaiting reconstitution;•Repackaged food; and•Food unfit for human consumption.•

Conduct periodic physical counts and reconcile counts with the balance on the stack •card, investigating any discrepancies.Compare stack card balances, physical counts, and store ledger quantities, investigating •and reporting discrepancies. Prepare appropriate Loss/Damage reports, if necessary.Repeated errors in updating the stack card should be investigated.•

Physical InventoryCommodity managers or storekeepers should periodically and systematically undertake physical inventories – physical counts – of store commodity stacks in order to monitor potential losses and reconcile store records – stack cards and store ledgers – with actual amounts. The principle of physical inventories is that food commodities actually counted in the store represent the true balance, irrespective of balances recorded on the stack cards and the store ledgers.

Depending on the amount and intensity of store activities, prepare physical inventory •schedules to regularly conduct physical counts, weekly, bi-weekly, or at the very least, once per month in order to know the actual commodity counts in the store and reconcile differences documented.Physical inventories should be conducted by individuals independent of the store staff, •such as Finance, CTS, and Administration staff in order to ensure accountability and accuracy. Rotate the Physical Inventory Auditors on a regular basis to further ensure accountability.Complete the physical inventory worksheet or tally sheet at the time of the inventory, •allowing the user to document any differences in the physical count and the quantity listed in the store ledger and on each stack card, as well as comment on the physical


condition of the food commodities.Any differences discovered during the physical inventory must be documented in a Loss/•Balance report. Only after the report is investigated and approved can the Store Manager or Storekeeper record the difference as a loss or excess in the store ledger.Differences between physical counts and stack card balances should also be noted on •the stock card, signed, and dated.Physical Inventory Worksheets should be filed.•The Store Manager, Storekeeper, or whoever is responsible for the store should •understand that they could be found liable for the value of any differences that are not reconciled between physical counts, stack cards, and ledgers with a valid explanation.

Loss/Damage ReportTheLoss&DamageReportshouldbefilledoutfor:

Losses discovered in stores during the physical inventory or other occasions;•Losses during transit for food dispatched from or received into the store;•Food declared unfit for human consumption by a public health official or the equivalent;•Commodity units damaged in the store or during transit for food dispatched or received.•

The report allows the Store Manager, Storekeeper staff to document:The background – date, place, and type – of commodity loss or damage;•Amountsdamaged,recovered,ormissingbynumberofunits&KGs;•Nature and circumstances of the loss, damage or misuse;•Responsibility for the loss or damages;•Actions to recover or reconstitute losses or damages; and•Actions to avoid further losses or damages.•

After filling out the Loss/Damage Report,Submit the report to the Senior authorities (MS) to investigate and/or approve the report, •andEnter the quantity of losses into the appropriate loss column of the store ledger.•

Store Commodity Status Report (CSR)Commodity Status Reports provide management with a critically important planning and management tool based on information about monthly receipts, dispatches, losses, and physical inventories of commodities from every store in the country. For that reason, Store Managers and Storekeepers in every store are obliged to prepare a CSR at the end of each month. This report must be reconciled with all relevant store supporting documents before it is submitted to the CTS coordinator for verification.

Regional or district in-country offices in turn verify and amalgamate store CSRs into a regional CSR, which is then sent on to the Logistics Manager in the country headquarters, who aggregates the district or regional CSRs into a county-wide CSR. The CSR format has been adapted from the required CSR format of USAID’s Food for Peace Title II programs.


Guidelines for Preparing the CSR

List the commodity type & shipment number for all food in the store.

AFill in the inventory at the beginning of the month for all commodities, based on physical counts (A).

BAdd in all receipts during the month, totaling everything received (B5) including waybill quantities (B1) + loans from other agencies (B3) + commodities brought back to inventory (B4).

C Total of beginning inventory (A4) + receipts during the month (B5).

DTotal all dispatches for distributions during the month for (D1) Food for Development project activities, (D2) Emergency Programming, (D3) General Relief programming, and (D4) Monetization (not generally recorded in the stores.

E Report the balance according to documentation, including store ledgers and waybills.

FReport the physical inventory, based on the physical count in the store, at the end of the month.

GReport the difference between physical inventory (F) and the balance according to documentation (E). The total difference (G7) is based on losses recorded during the month, loans issued or repaid, and adjustments out.

H Report total difference accounted for (H).

IReport any food commodity unaccounted for. (H) + (G) should generally equal F, but may not, pending an ongoing investigation. The Store Manager must provide explanations for any unaccounted differences.

Store Inspection ReportThe Store Inspection Report is completed during every inspection exercise and then filed in the store files as well as the district or regional logistics office files. This report includes information about:

Structural condition of the store and staffing patterns (A);•Storage and stacking conditions and quality of food commodities (B);•Insect and rodent control measures (C); •Store records (D) – are they all there and up-to-date? Are store documents reconciled •with physical inventory?Comments or discrepancies.•


Truck Inspection ReportThe organisation closely monitors the performance of transporters carrying food commodities to the site for distribution to project participants or beneficiaries. The Truck Inspection Report allows facility (field) staff, including Store Managers, to promptly report transport discrepancies or improper procedures during loading or unloading, including the following information:

Location;•Shipmentnumber&donor;•Waybillnumbersandplacesofdispatch&receipt;•Transporter&store;•Truck&trailernumbers;•Commodityquantitiesbyunit&numberofunitsverified;•Conditionoftrucks&provisionsforinclementweather;•Quality of commodities, including any damaged commodities;•Condition of documents, including waybill;•Check for other unauthorised commodities carried with food commodities;•Othercomments&descriptionofpotentialproblems.•


Exercise 550 cartons of plumpy nut were dispatched from ACDI/VOCA warehouse to Hoima regional referral hospital, on 17th Nov 2008, on Way bill # 200023. 45 cartons were received at the destined site. On Dec 17th 2008, 26.3 Cartons were distributed to 250 malnourished PLWHAs. Enter the provided details (above) onto the respective records/ documents.

OtherUsefulStoreDocuments&FormatsOther useful store documents and records include:

Certificate of Destruction of Commodity Unfit for Human Consumption;•Stock Control sheet;•Loading Authorization;•Fumigation records;•List of casual staff; and•Store expense report.•

Supply Chain flow

•Waybill

•Transporter’s contract

•Authorized Agency documentation (MOU)

•ACDI/VOCA warehouse dispatch food to Health

Facilities (Short term)

Actual Distribution•Beneficiary certification for eligibility.•Releasing food•RUTF Monitoring

•Health Facility personnel (Store Keeper)• Offloading•Random spot weigh•Physical count•Signing waybill (acknowledgement of receipt)•Storage / Stacking

•Waybill

•Truck Insp. Report

•Inventory mechanism

•Local manufacturer of RUTF

(Producing according to certified specifications)

Preparation of &Submission of Distribution Plan

•RUTF Forecasting•Call Forwards

•Loss Status Report

•Commodity Status Report

•Recipient Status Report

Report Preparation

•Ration card•Master Ben. distribution List (certified)•Loss/damage report


Duration: 30 min

Purpose of this sessionPeople can successfully control rodents through a variety of means. This session provides information about preventing, identifying, and treating rodent infestations. It also addresses regulation of rodent-control products and safe pesticide use.

Learning Objective: Each year, rodents cause significant damage to property and food supplies across the world. In addition to damaging property, rodents may also spread diseases, posing a serious risk to public health. Rodent-borne diseases can be transferred directly to humans through bite wounds or consumption of contaminated food and/or water, or indirectly by way of ticks, mites, and fleas that transmit the infection to humans after feeding on infected rodents.

The objective of this session is to therefore highlight the things that one can do to prevent or treat rodent problems, even without the use of chemical rodenticides. Another underlying specific objective is for participants to learn more about rodent control, safe use and regulation of rodenticides.

SOPS FOR RODENT CONTROL

SESSION

1. 5


Food commodities in stores are vulnerable to attack by rodents such as rats and mice. Apart from food eaten, spoiled or contaminated, there are additional losses such as costs incurred to replace or repair packaging materials. Rodents are capable of transmitting diseases to people either directly by bites or handling of rodent carcases, or indirectly through contact with food contaminated with rodent droppings and urine or by infected blood sucking arthropods (Fleas). Rats and mice gnaw inedible materials including electrical wiring. Hence their presence in a building can constitute a fire hazard.

RodentsRodents make up about half the living species of mammals, and include rats, mice, beavers, squirrels, lemmings, shrews, and hamsters.

General features: All rodents possess one pair of upper and one of lower incisors, growing throughout life, with the enamel restricted to a band on the front side of the teeth. Behind this is a large gap (diastema) followed by two to five cheek teeth. The jaw articulation is so arranged that when the cheek teeth are in use, the incisors do not meet, and vice versa. The incisors grow continuously, and must be worn off equally fast, or the whole gnawing mechanism is ruined. Because of the necessity to abrade these incisors, rodents spend a considerable amount of time gnawing hard objects.

Rodents are of major economic importance, primarily as consumers of the grains that are the basic foodstuff for man. It has been estimated that rats and mice destroy up to one-third of grain crops under conditions of heavy infestation. Burrowing rodents may damage root crops. The muskrat (Ondatra zibethica) and nutria (Myocastor coypus), introduced into Europe as fur sources, have escaped and spread over much of Europe between the Baltic and the Alps. Their burrows, particularly in canal banks, have been a major source of damage to the drainage system, most especially in The Netherlands. A number of rodents serve as reservoirs for human diseases, such as bubonic plague, tularemia, scrub typhus, and others. The plague that ravaged Europe during the mid-14th century was transmitted by fleas from rats to humans.

Types of insects found on stored commoditiesBeetles of the genus a. Sitophilus are important primary pests of whole cereal grains and are called weevils. Three species are pests of stored grain:

Sitophilus zeamais b. (maize weevil), Sitophilus oryzae (rice weevil) and Sitophilus granarius (granary weevil). The common names are misleading because they suggest the pest is restricted to particular grains, which is not the case. The adults of all three species are small, active insects with a narrow snout that carries the mouthparts. The body colour ranges from light to dark brown, and both S. zeamais and S. oryzae often have four large, reddish-orange spots on their wing cases

Rhyzopertha dominica c. and Prostephanus truncatus belong to the family Bostrichidae. They thrive in stored products such as cereals and dried cassava roots, and are important primary pests. Adult R. dominica are small (about 2.0–3.0 mm long) and P. truncatus are somewhat larger (about 3.0–4.5 mm long), both are cylindrical brown beetles Rhyzopertha dominica


(left life-size, 2–3 mm long) and Prostephanus truncatus (right life-size, 3–4.5 mm long)Acanthoscelides obtectus d. is a common pest of Phaseolus beans. It sometimes attacks other legumes, but it is seldom a serious pest on these. The adult is a robust, active beetle, the body colours of which are greys, browns and reddish-browns forming vague and indistinct patterns. The wing cases do not completely cover the abdomen

Rodents Control Rodent proofing: Blocking all unnecessary openings that are accessible to rodents with materials that are proof against gnawing (e.g. Sheet metal and concrete).

Acute rodenticides (zinc phosphide)These are an obvious choice for rodents found to be resistant to the available anticoagulants. Acute rodenticides may also be needed in situations where speed rather than maximum effectiveness is required. In buildings where inattention to rodent control has led to the build-up of large populations attacking stored food, further damage will be halted most quickly by using acute rodenticides. However, any advantage gained may very soon be lost if the acute treatment is not rapidly followed by one using anticoagulants for the survivors.

Acute rodenticides, like anticoagulants, are usually mixed with bait, but they differ from anticoagulants in that best results are generally obtained if unpoisoned baits are laid for 4–8 days before placing poisoned baits. This technique, called pre-baiting, allows the rodents to get used to feeding at a particular place on particular bait, so that when rodenticides are added they are likely to feed on it readily and rapidly. Rapid feeding can also be encouraged by using moistened bait and avoiding all disturbances in the treatment area. Of the acute rodenticides, zinc phosphide is probably the most widely used. Sodium fluoroacetate and fluoroacetamide are among the most effective of the acute poisons but are more hazardous than the others and should only be used by experts. There is no advantage in making acute rodenticides available to rodents for long periods; one or two nights is generally sufficient, particularly after pre-baiting. After it has been removed, a few days should be allowed for any rodents that have taken a sub lethal dose to become active again, and the area should then be surveyed and unpoisoned baits of a different type laid. When the new bait is being taken, poisoned bait should be laid using a different rodenticide, and this process of prebaiting and poisoning should go on until full control is achieved. Mice are sometimes more difficult than other rodents to eradicate. Mice can survive for some time in the absence of drinking water, so the use of poisoned water may not be effective. Control is most often successful when a large number of baiting points are used, because mice prefer to eat from many different sources.

FumigationRats and mice are more susceptible than insects to fumigants, and treatments with phosphine which are designed to control insect pests will also kill rats and mice. Fumigation of bag stacks under gas-proof sheets will control rodents, but is usually not cost-effective if used solely for that purpose. Rodents living in burrows outside food stores may be controlled using solid preparations of aluminium phosphide which liberate phosphine in the burrow. Not more than 2 g phosphine (two tablets) should be used in each burrow because of the risk of explosion if the soil is very wet. Each hole should be blocked with soil after application of the fumigant. Any holes reopened by rodents should be blocked and re-fumigated, this process being repeated until no further re-opening occurs.


A bag stack placed under gas-tight sheets ready for fumigation to begin

How to fumigate bag stacks with phosphineFumigation of a bag stack may be divided into eight key stages:

Initial preparations1. Sheeting the stack2. Spraying store surfaces with insecticide3. Applying the fumigant and sealing the stack4. Monitoring the fumigation5. Aeration6. Disposal of the residue7. Inspection of fumigation performance.8.

Initial preparationsMeasure up the store for fumigation/spraying and determine required dosages with •reference to current standing instructions. If the fumigation includes any empty space, the dosage rate must be calculated on a volume rather than a tonnage basis.The current recommended dosage rate for phosphine is 2 g gas/tonne or 1.5 g gas/m3. •Small increases in dosage rate may be acceptable if the target gas concentration on day 5 is difficult to achieve (see below), although this should not normally be necessary.Confirm there are no human habitations within 100 m of the planned fumigation; if •there are, check that arrangements can be made for people to be relocated during the treatment.Check that the surfaces of floor, walls and bag stacks are clean and free of food residues.•Check on the availability of essential safety equipment such as respirators and canisters, •gloves, dust masks and protective overalls, detector tubes/monitoring equipment, warning signs, etc.Consider the needs for prophylactic pest control such as spraying of the store structure •and stack surfaces with a residual insecticide.

Sheeting the stackBefore sheets are placed on a stack, secure two nylon gas-sampling lines, a long one that •comes from the top of the stack close to the middle, and a short one from the side of the stack just above ground level.Place any store residues or sweepings in a sack by the bag stack so that they will be •included in the fumigation.Unroll the sheet to cover that part of the stack.•

Spraying the store surfaces with insecticideThe floor and internal walls of the store should now be sprayed with an approved •residual insecticide at the manufacturer’s recommended dosage. Although the surface of the bag stack cannot be treated in this situation, such a treatment is, in any case, not recommended.Insecticide application to walls should be until run-off, that is, sufficient spray is applied •to the surface to the point where it just starts to run down the wall. The floor is sprayed


until there is a slight excess of liquid. To achieve this typically requires the application of between 3 and 5 l insecticide diluted in water for every 100 m2 to be treated; more porous surfaces require the larger volumes.Spraying should always start at the highest point on the walls. The area for treatment •should be divided visually into bands 2–3 m wide and, starting at the top, the spray should come down in a zig-zag pattern to the floor.

Applying the fumigant and sealing the stackDecide on each person’s responsibility.•If using phosphide tablets, lay out trays around the stack; remove the sand snakes that •hold down the sheets next to the trays.Place warning signs on the warehouse doors and on the sides of the stacks being •fumigated

Monitoring the fumigationOn the fifth or seventh day of fumigation, a member of the pest control team, wearing a •gas mask fitted with the appropriate phosphine filter, should enter the store to measure the concentration of phosphine from the two gas-sampling lines. As a safety precaution, a second member of the team should stand at the door to watch the one who is measuring the phosphine concentration. The phosphine concentration may be measured with an electronic phosphine meter or gas-detector tubes.The fumigator should record the gas measurements and submit them as evidence that •the job has been completed successfully.

AerationCareful planning is especially important at this stage to minimize dangers.

Fumigation team members should open all doors and ventilators. •They should enter the store wearing gas masks fitted with the appropriate phosphine •filters, and should remove all sand snakes. Pull back the sheeting from about one-third of the stack. Pull the corners of the sheet up •onto the top of the stack using a rope. This should be done by two people climbing to the top of the stack, while a third person remains at the base. Fumigation team members should then leave the store for at least 2 h; ideally the store •should be left overnight. After this time they may return wearing gas masks to check that the phosphine concentration is at or below 0.3 ppm. At this stage the use of gas-detector tubes is required for the verification of safe conditions in the warehouse, as these enable the accurate measurement of very low phosphine concentrations. Once safe conditions have been verified, gas masks may be removed and other staff allowed entering the store.


Disposal of the residueAll phosphide residues, which are a fine grey dust, or used sachets must be removed from •the store and disposed of safely, for example, buried to a depth of at least 500 mm. Dig a hole at a place away from public access and then fill in firmly.

Inspection of fumigation performanceInspect stacks immediately after fumigation for signs of control failure.•

Safety Precaution Protection against diseases

Live or dead rodents should not be handled unless gloves are worn•All scratches and abrasions need to be treated and kept covered until healed•Immunization against particular diseases. •

Protection against rodenticidesBaits containing zinc phosphide that give rise to phosphine gas, should be mixed in open •air.Gloves should be worn when handling rodenticides•There should be no smoking or eating in places where rodenticides are prepared or •stored.


Duration: 30 min

Purpose of the sessionThis session explores the current state-of-knowledge regarding the role of institutions in helping their department implement the mandate of guarding against fire outbreaks. An example of such mandate is to institute a pre-fire management scheme. Pre-fire management is any treatment put in place prior to a fire that reduces risk, hazard, or exposure of a value to loss. The expected result of pre-fire programs is a reduction in costs and damages associated with fires.

Learning ObjectiveParticipants should know that Fire prevention aims to reduce the incidence and extent of fires by preventing them from occurring.

THE ASPECT OF FIRE IN STORE MANAGEMENT

SESSION

1. 6


Fire is an aspect that can destroy property worth millions. As a precaution, it is advised that functional fire extinguishers be kept at accessible points of the store. Fire extinguishers are divided into four categories, based on different types of fires. Each fire extinguisher also has a numerical rating that serves as a guide for the amount of fire the extinguisher can handle. The higher the number, the more the fire-fighting power.

The following is a quick guide to help choose the right type of extinguisher.

Class A fire: Extinguishers are for ordinary combustible materials such as paper, wood, cardboard, and most plastics. The numerical rating on these types of extinguishers indicates the amount of water it holds and the amount of fire it can extinguish.

Class B fires: Involve flammable or combustible liquids such as gasoline, kerosene, grease and oil. The numerical rating for class B extinguishers indicates the approximate number of square feet of fire it can extinguish.

Class C fires: Involve electrical equipment, such as appliances, wiring, circuit breakers and outlets. Never use water to extinguish class C fires - the risk of electrical shock is far too great! Class C extinguishers do not have a numerical rating. The C classification means the extinguishing agent is non-conductive.

Class D fire: Extinguishers are commonly found in a chemical laboratory. They are for fires that involve combustible metals, such as magnesium, titanium, potassium and sodium. These types of extinguishers also have no numerical rating, nor are they given a multi-purpose rating - they are designed for class D fires only.

Some fires may involve a combination of these classifications. Your fire extinguishers should have ABC ratings on them.

Here are the most common types of fire extinguishers:


Water extinguishers or APW extinguishers (air-pressurized water) are suitable for class A fires only. Never use a water extinguisher on grease fires electrical fires or class D fires - the flames will spread and make the fire bigger! Water extinguishers are filled with water and pressurized with oxygen. Again - water extinguishers can be very dangerous in the wrong type of situation. Only fight the fire if you’re certain it contains ordinary combustible materials only.

Dry chemical extinguishers come in a variety of types and are suitable for a combination of class A, B and C fires. These are filled with foam or powder and pressurized with nitrogen.

BC -• This is the regular type of dry chemical extinguisher. It is filled with sodium bicarbonate or potassium bicarbonate. The BC variety leaves a mildly corrosive residue which must be cleaned immediately to prevent any damage to materials.

ABC • - This is the multipurpose dry chemical extinguisher. The ABC type is filled with mono-ammonium phosphate, a yellow powder that leaves a sticky residue that may be damaging to electrical appliances such as a computer

Dry chemical extinguishers have an advantage over CO2 extinguishers since they leave a non-flammable substance on the extinguished material, reducing the likelihood of re-ignition.

Carbon Dioxide (CO2) extinguishers are used for class B and C fires. CO2 extinguishers contain carbon dioxide, a non-flammable gas, and are highly pressurized. The pressure is so great that it is not uncommon for bits of dry ice to shoot out the nozzle. They don’t work very well on class A fires because they may not be able to displace enough oxygen to put the fire out, causing it to re-ignite.

CO2 extinguishers have an advantage over dry chemical extinguishers since they don’t leave a harmful residue - a good choice for an electrical fire on a computer or other favorite electronic device such as a stereo or TV. It is vital to know what type of extinguisher you are using. Using the wrong type of extinguisher for the wrong type of fire can be life-threatening. Before using your fire extinguisher, be sure to read the instructions before it’s too late. Although there are many different types of fire extinguishers, all of them operate in a similar manner.

Use this acronym as a quick reference (it is a good idea to print this reference and pin it next to your fire extinguisher):

PASSPull the Pin at the top of the extinguisher. The pin releases a locking mechanism and will allow you to discharge the extinguisher.

Aim at the base of the fire, not the flames. This is important - in order to put out the fire, you must extinguish the fuel.

Squeeze the lever slowly. This will release the extinguishing agent in the extinguisher. If the handle is released, the discharge will stop.

Sweep from side to side. Using a sweeping motion, move the fire extinguisher back and forth until the fire is completely out. Operate the extinguisher from a safe distance, several feet away, and then move towards the fire once it starts to diminish. Be sure to read the instructions on your fire extinguisher - different fire extinguishers recommend operating them from different distances. Remember: Aim at the base of the fire, not at the flames!!!!


Care and Maintenance: Inspect fire extinguishers at least once a month (more often in severe environments). Fire extinguisher maintenance is important for everyone’s safety. You must ensure that the extinguisher is not blocked by equipment, coats or other objects that could interfere with access in an emergency.

The pressure is at the recommended level. On extinguishers equipped with a gauge •(such as that shown on the right), the needle should be in the green zone - not too high and not too low. The nozzle or other parts are not hindered in any way. •The pin and tamper seal (if it has one) are intact. •There are no dents, leaks, rust, chemical deposits and/or other signs of abuse/wear. Wipe •off any corrosive chemicals, oil, gunk etc. that may have deposited on the extinguisher.

Some manufacturers recommend shaking your dry chemical extinguishers once a month to prevent the powder from settling/packing. Fire extinguishers should be pressure tested (a process called hydrostatic testing) after a number of years to ensure that the cylinder is safe to use. Consult your owner’s manual, extinguisher label or the manufacturer to see when yours may need such testing.

COLOUR CODINGZONE COLOUR EXTINGUISHER TYPE

RED WATER

CREAM FORM

BLUE POWDER

BLACK CARBON DIOXIDE

CANARY YELLOW WET CHEMICALS

IMPORTANT: Recharge all extinguishers immediately after use regardless of how much they were used.


Exercise 8What is the difference between a fire extinguisher inspection and fire extinguisher maintenance?


Monitoring and Reporting

Module 2


Purpose:This session introduces participants to the basic principles of monitoring and reporting on outpatient therapeutic care for PLHIV with acute malnutrition receiving nutrition comprehensive care and support. The session further describes how individual PLHIVs are tracked and monitored and how monitoring information and data are collected and reported for the service/program as a whole.

Learning objectives:At the end of the session participants will be able to:

Describe the principles and concept of a Monitoring and reporting system for OTC in the •context of HIV Gain basic skills on how to track and monitor individual clients receiving nutrition care and •support through the programGain basic skills on how to complete reporting tools for the OTC program including the •revised HIV care/ART card that integrates nutrition indicators Gain knowledge of computing the basic indicators for an OTC program •

Duration

Content Methodology Activities Time (min)

Session 2.1

The principles and concept of a Monitoring and reporting system for OTC in the context of HIV including concepts for monitoring and evaluation

Key program indicators

Participatory lecture with examples

Power point presentation and plenary session for participants

60 min

Session 2.2

Individual client monitoring including data collection tools

The ration card •The HIV/ART care card•The OTC client card •The referral form (facility •and community)

Participatory lecture and group activity and plenary discussion

Distribute each reporting tool to the participants

Ask participants to review the tools independently

Explain each tool to the participants starting with the ration card. For each tool, explain the rationale for the tool, the information it collects and how to complete information into the tool.

5 min

5 min

40 min

Monitoring and Reporting



Session 2.3

Program Monitoring

• The OTC register • The monthly reporting

form

Participatory lecture and group activity and plenary discussion

Distribute the OTC monthly report and the OTC register to the participants

Ask participants to review the tools independently

For each tool, explain the rationale for the tool, the information it collects and how to complete information into the tool.

5 min

5 min

40 min

Session 2.4

Evaluating program performance

Program outcome •indicatorsProgram supervision •

Participatory lecture and plenary discussion

Power point presentation and plenary session for participants

30 min

Session 2.5

Exercise set Completing the data collection tools and computing basic OTC indicators (Number on RUTF with SAM, MAM, default rate, cure rate, and death rate).

Group work activity and plenary discussion

Form groups of 2 people, using the case studies, ask them to complete:

The HIV care card1.The OTC register using 2.the case study3. Compute indicators on 3.clients receiving RUTF by category and patient outcome indicators

4. Ask them to present in plenary and discuss results

90mins



Session 2.6

Reporting mechanism Group work and plenary

Form four groups of 6 people each.

In groups, let them discuss desired reporting mechanisms to the program to include timelines, responsible person, methods of delivery to the program etc

Let them present in plenary findings from the group work

5 min

30 min

20 min

Wrap up and closure 10 min

Total time 345 min


PRINCIPLES OF MONITORING, EVALUATION AND REPORTING

SESSION

2. 1

Monitoring and Evaluation: When considering nutrition interventions it is essential that good monitoring systems are established, in order to save lives and maintain nutrition status of the affected population making the best use of the scare resources available, i.e. the best use of personnel, time, available space and inputs. Well designed monitoring systems can identify, for example, problems with treatment regimes, and inefficiencies in the systems established. Monitoring systems also provide information for on-going needs assessment. Monitoring and evaluation (M&E) information can be used to inform and improve program design, management andsupervision; to report results (outcomes and impacts) of food and nutrition interventions in order to provide accountability to government, donors and meet reporting requirements; and to advocate for support and expansion of effective approaches.

Monitoring: Monitoring is the periodic oversight of the implementation of an activity which seeks to establish the extent to which input deliveries, work schedules, other required actions and targeted outputs are proceeding according to plan, so that timely action can be taken to correct deficiencies detected. “Monitoring” is also useful for the systematic checking on a condition or set of conditions, such as following the situation of women and children.

Evaluation: Evaluation is a process which attempts to determine as systematically and objectively as possible the relevance, effectiveness, efficiency and impact of activities in the light of specified objectives. It is a learning and action-oriented management tool and organizational process for improving current activities and future planning, programming and decision-making.

Types of monitoring There are guidelines for the monitoring and evaluation of each of the main nutrition related interventions in emergencies, namely general food distribution, therapeutic care, supplementary feeding, infant and young child feeding and for livelihoods interventions. These are covered in the relevant modules in this training package.


There are broadly two types of monitoring; process and impact monitoring.

Process monitoring is about monitoring programme delivery. For example, in the •case of general food distribution key process indicators are food pipeline flows, food management, and coverage. Impact monitoring assesses how food security, nutrition status, mortality rates and •micro-nutrient deficiencies have changed as a result of the intervention at population level. For example, in the case of therapeutic care, the numbers of children treated and cured, numbers defaulting and dying are monitored.

Key Program Indicators

Key aspects of monitoring and reporting in Outpatient Therapeutic Care?

To monitor an OTC program effectively, you will need to:Monitor the individual client•Monitor and report on the effectiveness of the service as a whole•Supervise and support the health care providers•

Indicator 1a 1. Number of HIV positive individuals receiving ART with evidence of severe

malnutrition receiving food and nutrition supplementation. (PEPFAR)

Indicator 1b 2. Number of HIV positive individuals receiving food and nutrition

supplementation.

Indicator 1.13. Percent of HIV positive individuals receiving nutritional assessment utilizing

MUAC during HIV Clinic visits

Indicator 1.2 4. Percent of HIV positive individuals receiving nutritional counseling according

to national guidelines.

Indicator 1.35. Number of HIV positive pregnant or lactating women receiving food and

nutrition supplementation in a PMTCT setting (PEPFAR)

Indicator 1.46. Number of OVC receiving food and nutritional supplementation through

OVC programs (PEPFAR)

Indicator 1.3.1:7. Number of healthcare providers trained in HIV and nutrition.

Indicator 1.4.1:8. Number of acutely malnourished individuals assessed by community

health workers and referred to sites providing comprehensive nutrition care

Indicator 1.4.2: 9. Percent of trained community volunteers who are actively referring clients

for nutritional interventions.

Indicator 3.1.1: 10. Number of metric tons of RUTF distributed to health facilities

Indicator 3.2.211. Percentage loss of the RUTF distributed to NuLife supported facilities


Why do we monitor OTC services?

Monitoring helps to identify what is working well (strengths), what is not working and where

there might be gaps (weaknesses). With this information, weaknesses and gaps can be

addressed.

In OTC, the individual client is monitored to ensure that clients are treated appropriately and

effectively, which helps to continually improve the services received.


INDIVIDUAL CLIENT MONITORING IN OUTPATIENT THERAPEUTIC CARE

SESSION

2. 2

Client monitoring is an important part of high quality client care. Monitoring involves documenting all client encounters by keeping regular and accurate records of key aspects of nutrition care and support that is offered. This makes it possible to capture the history of a client over time while the client is receiving treatment as well as to collect data for reporting on and evaluating client care at regular intervals. Over the course of management for acute malnutrition, clients are transferred between different types of care (e.g. OTC, In-client sites, Supplementary Feeding Program and other clinics) as their condition improves or deteriorates. It is crucial to be able to track clients between the different types of care and in between clinics. Therefore, these links must be well managed. Key elements include:

A clear numbering system.•The routine collection of medical, nutritional, and follow-up client data clearly •documented on cards and maintained in an efficient filing system.Program monitoring and reporting•

Registration and numbering system: Given this program is mainly targeting HIV positive individuals receiving HIV care and treatment for nutrition care and support, two numbering systems are recommended to track individuals entering and receiving RUTF in the program; the HIV client ID number and the OTC unique registration number. These two numbers will both be recorded on the OTC ration card, the OTC register and the HIV/ART care card. To ensure effective tracking and follow up, all records concerning the client should follow the same numbering system. This includes the OTC register, ration card, referral slips and other records. It is important that other registration numbers assigned to the client in other clinics (HIV counseling and testing, PMTCT clinic, OPD, child clinic and ART sites etc) are recorded on the clients’ forms for purposes of easy tracking. In case of transfers, healthcare workers must ensure that the registration number appears on referral slips that accompany the clients. Returning defaulters should retain the same number and card as they are still suffering from the same episode of malnutrition, while readmissions(Clients who meet admission criteria again after being discharged cured, i.e., they relapsed) should receive a new number and card since they are suffering from a different episode of acute malnutrition.


Registration numbering system proposed for OTC• Each Client receives a registration number when she/he is first admitted to outpatient

care, inpatient care or supplementary feeding. Each registration number has three parts: the health facility’s name or code, the client’s individual serial number and the service code indicating where the Client started treatment (inpatient care, outpatient care or supplementary feeding) for malnutrition.

• The code for each facility must be established before services at that facility start, must be unique for that facility and must be used consistently by all staff to avoid confusion as to which facility a client is receiving services. The facility code should be three or four letters and should be easily understood by all staff at the facility.

• In Uganda, there is a standard numbering system as part of the health management information system (HMIS). The numbering system for IMAM can be adapted to take this into account. In adapting the HMIS numbering system, ensure that the facility where each client entered OTC and his/her initial IMAM service are included. We will follow the national IMAM guidelines as and when they are finalized.

Table Client numbering system

Standard IMAM numbering system

HFA/001/OTC

HFA: Health Facility code name or number

001: Individual serial number allocated to each client

OTC: Service where the client started treatment

HMIS numbering system

77/88/999/MMYY/OTC

77: District code

88: Health facility code

999: Patient’s number

MMYY: month and year of admission

OTC: Service where the client started treatment

Routine data collection tools There are three forms that will be used to monitor individual clients receiving comprehensive nutrition care and support within the program; the RUTF ration card, the client OTC card for some facilities and the HIV care/ART Card


OTC client card: Individual treatment of clients with acute malnutrition is monitored on an OTC client card which is kept by the health worker at the HIV care clinic where the client is being treated for acute malnutrition. In some facilities where no HIV services are offered, each client admitted with SAM and MAM will have an OTC client card for purposes of proper monitoring. The client’s OTC registration number and other numbers are recorded on the OTC client card. The OTC number will be the client’s identifying number throughout his/her stay in the program. The OTC card is kept on the file in the HIV care clinic as part of other records for the client receiving HIV care at the facility.

Key steps for filling out the OTC client card: At admission the health care worker should fill all client and caregiver information using •the OTC client card. A unique OTC number should be assigned to the client at the initial visit as described •above. The HIV status, ART status, counseling information of the client needs to be recorded at •admission and adjusted accordingly if test takes place after admission.The weight, height, MUAC, W/H Z-scores, BMI Z-scores and BMI depending on the age •group of the client should be recorded at admission. At discharge, use weight gain if MUAC was used for admission, else uses the above •parameters. Fill out data required on page 2 of the card according (opportunistic infections, other •treatments received and RUTF ration at each visit.When a client exits the OTC program the category in which he/she exits should be •recorded (e.g. cured, not responding, transfer, died etc).

The number of cards in the file represents the number of clients currently in the program.

For recording purposes, monitoring progress and quantifying the numbers of clients on nutrition care and support, all clients that exit the OTC, the cards need to be labeled and stored in folders according to the different categories as follows:

Cured: The cards of clients who have recovered are usually kept separately. It is useful to have these at the site to check any relapses.

Non-recovered: This applies to clients who are not responding to the treatment at four months. If the client is readmitted, monitoring continues on a new client card, but he/she keeps different registration number.

Transfers: Ensures that transfers are not overlooked and that follow-up takes place if they do not return. If the client returns, monitoring continues on a new client card, but he/she keeps the same registration number.

Defaulter cards awaiting return: On return, monitoring can continue on the same card or when the client returns, monitoring continues on a new client card, but he/she keeps the same registration number.

Deaths: Complete and file card.


Activities for the Closure of the Day:The registrar should take the register and record the following information:

Record the clients who did not show up for their scheduled visits (absentees and 1.defaulters)Register the number and types of admissions (return from transfer or defaulting, new cases), 2.number and types of discharges (cured, defaulter, death, non-respondent) and transfersCount and record the total number of clients enrolled in the program3.

The registrar should then identify clients who have defaulted and organize outreach visits.

The Ration card: The RUTF ration card is provided to the client and/or care giver and provides a record of the client’s progress and RUTF received at each client visit and follow on sessions. Health workers should give caretakers a ration card to take home at the client’s initial visit. These cards contain key information about the client in addition to basic information on their progress (i.e. weight, target weight, RUTF ration received, MUAC and date of next visit). These cards are the caregiver’s record of the client’s progress in the program. The cards should be presented at each clinic visit as they are required to collect the client’s next ration. Upon discharge, the RUTF ration card is returned to the health facility to be attached to outpatient care treatment card or other patient forms.

HIV care/ART card: The Ministry of Health revised the HIV care/ART monitoring tools including the HIV care card so as to include nutrition related indicators. The HIV Care/ART Card puts in one place a summary of the client’s chronic HIV care and ART information. It helps the clinical team keep track both of the individual patient and all patients receiving chronic HIV care. This card will aid in reducing on the number of forms required to be completed by health workers for clients concurrently receiving chronic HIV care and comprehensive nutrition care. In addition to HIV care information, the card collects information on the weight, height, MUAC, nutritional supplements given, infant feeding and counseling, and nutritional support received by the client. When all HIV positive individuals are enrolled, they should be counseled and assessed for nutritional status and if they qualify for RUTF, they should be enrolled for RUTF and information recorded on the HIV care card.

Referral slips: To allow tracking of clients moving between program components and sites, exchange of information is crucial. Information has to flow with the client between the different components in the facility, between facilities and the community. Existing referral slips (HMIS 032) should be used for clients being referred. The referral slip collects information on History and Symptoms, investigations done, diagnosis, treatment given and reasons for referral for the patients. If referring for nutritional support and care use of this very form is recommended. This card also helps health workers for whom the patient has been referred to avoid having the same medication being given twice. The form is attached in the appendix.


OTC PROGRAM MONITORING

SESSION

2. 3

At the core of program monitoring is the collection, management, compilation, and utilization of key information for a group of clients receiving care within the facility as well as describing the outcome of the OTC program. Proper program monitoring and reporting is essential to allow health workers at the site, health managers at national and district level to assess the effectiveness of the OTC program. Program monitoring will involve completing registers and monthly reporting forms which are described in the following sub-sections.

OTC Register: The purpose of the register is to collect in a single location (the register) the same information (a column) about an entire group of clients enrolled into the OTC program. All the information that ends up on the OTC register comes originally from individual OTC client card, the ration card, the HIV care card and other forms that collect information on OTC services received from the facility. Whereas the information on the individual client cards allows you to monitor what is happening with each individual client, the information collected on the register allows you to monitor what is happening with your whole group of clients and the OTC program as a whole. Registers should be completed at the end of each clinic day, and register data from each site is compiled to form monthly facility reports.

Monthly OTC report:Accurate reporting using the registers and monthly reports is essential, since the analysis of these enables health providers and supervisors ensure that proper treatment for acute malnutrition is given to the individual. Regular reports also give important information about the performance of the health facilities and the nutrition program as a whole. Routine monitoring data is usually collected and reported into monthly reporting formats from all of the sites implementing the OTC program. All the data collected during the month should be summarized in the monthly report format to provide the total numbers seen for the month. The monthly report will also include the number that are continuing in the program from the previous month and the number of clients who will be continuing in the program in the following month. Information for completing the monthly OTC report primarily comes from the OTC registers.


Routine service data that are collected include:

The total number of individuals under treatment at the Start of month-is the number of clients who were in the program at the end of the previous month.

Total new admissions by admission category are either: SAM with oedema, SAM without oedema, and MAM. This data will also be disaggregated by gender and patient category.

The number of Total Discharges by discharge category: - Cured: individuals who reached the discharge criteria after treatment, Died: individuals who died while in treatment, Defaulted: individuals who left the program before reaching the discharge criteria, individuals who were absent for 2 consecutive visits

Non-recovered• : Clients who do not meet the discharge criteria after four months in treatment(after medical investigation done) and other exit categoryTransfers to: • Clients who left the site temporarily because they were referred to in-patient, young child clinic for medical investigation.


EVALUATING OTC PROGRAM PERFORMANCE

SESSION

2. 4

Performance indicators for OTC:Performance indicators measure whether the IMAM program achieves its objectives and planned outcomes. These indicators will be calculated through monthly reports for each individual site to monitor site performance and take corrective action when needed. Within the monthly reports, the following performance and/or outcome indicators are collected:

• Cure rate: the number of clients successfully discharged ‘cured’ during the reporting month as a proportion of the total number of clients discharged during the reporting month.

• Death rate: the number of clients who died after admission to the OTC in the reporting month as a percentage of the total number of clients discharged during the reporting month.

• Default rate: the number of clients who dropped out of the OTC program (i.e. did not attend for two consecutive sessions) as a proportion of the total number of clients discharged during the reporting month.

• Non-response rate: the number of clients discharged as non-responders (are in the OTC program for more than 4 months and did not reached the discharge criteria) as a proportion of the total number of clients discharged during the reporting month.

These data may also be calculated by facility, district or at national level to evaluate the overall performance of the out-patient management of acute malnutrition. Results can be compared with international minimum standards for therapeutic feeding programs in emergency settings, established by the Sphere Project, although the reliability of these standards is not yet clear in non-emergency contexts. Program outcome indicators should meet the criteria below:

Cure rate >75%

Death Rate <10%

Default rate <15%

Non response rate <10%


Program supervision: Supervisors should use supervisor checklists or coaching guidelines to assist in monitoring the implementation of the program at facility level. Supervisors must ensure that admissions and discharges are made according to IMAM guidelines and that routine and supplemental medicines are given correctly. Supervisors should review the registers, the OTC treatment cards and particularly those clients who have defaulted, died, or are not responding to treatment. This should ensure that weaknesses in the management of individual clients or in the delivery of the program are identified so that corrections can be made. Details will be covered in the coaching guides.

Supervisors and clinicians should review:Proper completion of the treatment, ration cards, and health passports•Proper use of medical protocols•Progress of individual children, checking for consistent weight gain•Proper community follow-up or referral according to protocols•Proper completion of registers and report forms•Proper completion of stock records of medicines and RUTF•Other procedures according to the supervision checklist•


Exercise 1

Completing the HIV care and ration cards.

For this exercise, use a blank HIV care card, OTC register and ration card to transfer this informationforthecasestudiesA,B&C.

Case Part A:

Today is the 23rd January 2009. Patient’s name is Mary Turyamureba. Mary is a 15 year-old girl. Upon further questions, you determine that she lives in Rugarama village, in Kebsoni Sub county, Rukungiri district. She comes to the clinic for the first time by herself. She shows you written confirmation of her HIV test, which indicates that she is HIV positive. She comes today with her caretaker because she has experienced weight loss for over a month, with episodes of diarrhea for the last one week with 4-5 stools per day, but with no vomiting, cough and fever. Upon further interrogation, she tells you that she has been on ART at this facility for two months. On conducting a rapid pregnancy test, you find that she is not pregnant.

The nurse at the waiting area takes her weight and height which is recoded as 34.5kgs and 152cms respectively. The health worker also takes her MUAC which is recorded as 155mm (Red). Upon conducting an appetite test, she successfully takes 75% of required daily sachets of RUTF.

During this visit, she is given cotrimoxazole by the Clinical Officer and you provided her with vitamin A capsules because she was vitamin A deficient. She is also provided with the correct ration of RUTF that will last her one week.

Question: How would you fill out this information on the HIV care card and ration card for this visit? Compute her target weight.

MONITORING AND REPORTING EXERCISES

SESSION

2. 5


Case Part B:

Mary and her caretaker returns one week later (30th January 2009) as scheduled and the caretaker tells you that her diarrhea has improved with 1-3 stools per day. She tells you that she has been taking the cotrimoxazole and RUTF everyday and has not missed one dose on any day. You take her weight and it has slightly improved to 34.8 kgs. Upon conducting an appetite test, she successfully takes 75% of the daily recommended sachets of RUTF. During this visit, she is not given cotrimoxazole and vitamin A capsules. She is also provided with the correct ration of RUTF that will last her another two weeks.

Question: How would you fill out this visit?

Case Part C:

On the fourth week, Mary returns as scheduled for follow-up, because she had developed a cough and fever for the last 1 week. On her clinical review besides the cough and fever the diarrhea has subsided. Her weight is now 34 kg and the MUAC was 159mm. Right now she is unable to do most of the housework and rests for most part of the day. She has not missed any doses of the cotrimoxazole and RUTF, slightly passes the appetite test when she takes 5 sachet of the RUTF. On this day, you advice her to start on treatment for the cough and fever and takes her RUTF ration of 32 sachets for the next one week.

Questions:How would you fill out this visit?

Provide any recommendations for management of her current problem and follow-up?


Exercise 2Completing the Monthly reporting formats

Hand outs OTC registers with sample data

Empty OTC monthly report format

Instructions

1. Divide into pairs

2. Review data in the OTC registers provided which contain data extracted from Mwanamugimu nutrition unit for the months of January 2009.

3. Transfer this data to the empty monthly report form provided into the appropriate columns and rows and in the different tables. Assume that you are reporting for the month of January 2009 and that no clients were in the program during the last month.

4. How many patients have SAM and MAM by ART status?

5. Comment on the process of completing the monthly report format.

6. In plenary, present the completed set of information (Due to time limitation, not all the groups will present in plenary)


What is Reporting?A report is a compilation of descriptive and quantitative information. It is a communication tool to present monitoring results by presenting raw data and information as knowledge in form of periodic reports. It is also an opportunity for facility level implementers and other staff to inform themselves and others (stakeholders, government, partners, donors, etc.) on the progress, problems, difficulties encountered, successes, and lessons learned during a given reporting period.

Why is Reporting Essential?There is not much point to collecting monitoring data unless you know how and by whom that data will be used. Your challenge is to turn raw data and information into useful knowledge and then report your results to the different OTC program audiences (e.g., donors, MOH, National programs, district) in a way that will be useful both to them and your facility.

Reporting enables the assessment of progress and achievements and helps focus •audiences on the results of activities, enabling the improvement of subsequent OTC programs in other facilities and countries. Reporting helps form the basis for decision-making and learning at all levels including •facility, community, district, national and program level. Reporting communicates how effectively and efficiently the program is meeting its •objectives.

Group exercise- reporting mechanisms This will differ for each facility. But for each aspect of monitoring, it is important to determine in advance who specifically is responsible for collecting and documenting the data and who specifically is responsible for reporting. You will discuss the reporting mechanisms in groups and present in plenary

REPORTING SYSTEM AND MECHANISMS

SESSION

2. 6


Guiding Questions for group work Who will be responsible for reporting at the facility level?-Discuss the appropriate timeline (deadline) for submission of monthly reports? -What support (logistical and technical) will be required for efficient reporting? -What levels should we report to and who should we report to?-

Now that the steps of monitoring and evaluation have been covered, it is important that each person know his/her role in the process. The flow chart below describes the reporting system of the data for this program:

NuLife/Ministry of Health

Should compile the data from each individual site into a

summary report

The MoH/NuLife should send this summary report to: partners

and donors.

Nutrition Focal person Cross-checks the

Monthly Reports After checking, sends

Monthly Reports to the NuLife,

Ministry of HealthShould also send food

request form

Service Provider:

Fill in Client Cards, registers and

Monthly Report form Send the Monthly Report to the nutrition focal person or person in-charge of the site.


REFFERENCE TOOLS

Appendix


_

FOOD AND NUTRITION INTERVENTION ROGRAM

LOSS/DAMAGE REPORT

Facility: ______________________ District: ___________________________

Location: ______________________ Donor ID No.: ________________________

Commodity: _____________________Shipment No: ________________________

1. Detail TIME, PLACE AND TYPE of loss or damage_____________________________

______________________________________________________________

2. Describe amount lost below:

Number of Units [cartons]

1. Unit damaged (potential loss) [A]

2. Quantity Recovered [B] (A-C-D-E)

3.Loss by Damage (Rodents, water,

expiry) [C]

4.Loss by Damage (Clinical - apetite

test)[D]

5. Missing entirely [E]

TOTAL LOST (C+D+E)

Prepared by_____________________ Approved by____________________

Title _________________________ Title__________________________

Signature and Date_________________ Signature and Date__________________

FOOD AND NUTRITION INTERVENTION PROGRAMLOSS/DAMAGE REPORT


MO

NTH

LY R

EPO

RT

FOR

OU

TPA

TIEN

T TH

ERA

PEU

TIC

CA

RE

(OTC

)

Nam

e o

f Fac

ility

:

Nu

trit

ion

Fo

cal P

erso

n:

Dis

tric

t:

Co

nta

ct P

ho

ne

# :

C

on

tact

Em

ail :

Rep

ort

ing

mo

nth

:

Sub

mis

sio

n D

ate:

AD

MIS

SIO

N A

ND

DIS

CH

AR

GE

DA

TA

Clie

nt

Cat

ego

ry

TOTA

L in

p

rog

ram

en

d o

f la

st m

on

th

(A)

Ad

mis

sio

ns

Tota

l Ad

mis

sio

ns

(

E) =

B

+ C

+ D

Exit

s

Tota

l Exi

ts (M

) =

F+G

+H

+I+

J+K

+L

TOTA

L in

p

rog

ram

en

d o

f m

on

th

(N

) = A

+

E - M

SAM

MA

M

Dis

char

ged

as:

Tran

sfer

red

to

:

Wit

h

Oed

ema

(B)

Wit

ho

ut

Oed

ema

(C)

Tota

l M

ale

Fem

ale

Cu

red

(

F)N

on

-re

spo

nse

(G

)

Def

ault

(H

)D

eath

(I

)IT

C

(J

)

Oth

er

OTC

(K)

Med

ical

(L

)

6mth

s - <

6yrs

6- <

15 y

ears

15- <

18 y

ears

18 y

ears

an

d a

bov

e

Preg

. an

d

lact

atin

g w

om

en

No

n la

ctat

ing

w

om

en w

ith

ch

ild<

6 m

on

th

TOTA

L

Cur

e ra

te =

F / (

F +

G +

H +

I)

Nu

mb

er o

f Rel

apse

s (r

ead

mis

sio

ns

afte

r d

isch

arg

e cu

red

): __

____

____

____

Targ

et>

75%

<10

%<

10%

<15

%N

on-r

espo

nse

rate

= G

/ (F

+ G

+ H

+ I)


Nu

mb

er o

f Ret

urn

ed D

efau

lter

s: _

____

____

____

_D

efau

lt ra

te =

H/ (

F +

G +

H +

I)

Dea

th ra

te =

I/ (F

+ G

+ H

+ I)

AD

DIT

ION

AL

PATI

ENT

DA

TA (f

or a

dm

issi

on

s o

nly

)

Clie

nt

Cat

ego

ry

H

IV s

tatu

s

HIV

+H

IV-

Ref

use

d

Test

ing

Test

ed a

fter

A

dm

issi

on

On

AR

T

SAM

MA

M

Tota

lM

FM

F

6mth

s - <

6yrs

6- <

15 y

ears

15- <

18 y

ears

18 y

ears

an

d a

bov

e

Preg

. an

d la

ctat

ing

wo

men

No

n la

ctat

ing

wo

men

wit

h c

hild

< 6

mo

nth


Category RUTF (Sachets/Cartons)

A. Opening Balance

Total Available for Distribution

SAM

MAM

SAM

MAM

SAM

MAM

SAM

MAM

Total Distributed

Prepared by …………………………………………………………………

Title:___________________________________________________

Signature:_______________________________________________

Balance

D. Loss at distribution point as per loss

report.

Adults (18 and above)

FOOD AND NUTRITION INTERVENTION ROGRAM

MONTHLY DISTRIBUTION REPORT

NAME OF FACILITY ……………………… ……………Reporting Date………………………………

B. Quantity received from NuLife per way

bill No.

Nutrition Status Number of Beneficiaries

C. Quantity distributed

Preg/Lactating/mother with child

less than 6 months

Children (6mths -<5 yrs)

MONTH OF DISTRIBUTION REPORT_______________YEAR______________

Children (6yrs- <18 yrs)


D

IST

RIB

UT

ION

RE

GIS

TE

R

Reg

ion_

____

____

____

____

____

____

____

___

Mon

th__

____

____

____

____

__

Dis

tric

t___

____

____

____

____

____

____

____

Y

ear_

____

____

____

____

____

_

Hea

lth

Fac

ility

____

____

____

____

____

___

Rep

orti

ng D

ate_

____

____

____

____

Dat

e R

egis

trat

ion

Num

ber

Ben

efic

iary

Nam

e Se

x (M

/F

Age

(in

ye

ars

unle

ss

indi

cate

d)

Cat

egor

y of

Ben

efic

iary

N

utri

tion

Sta

tus

Num

ber

of

RU

TF

Sa

chet

s di

stri

bute

d

Sign

atur

e of

D

istr

ibut

or

Sign

atur

e/T

hum

b P

rint

of

reci

pien

t C

hild

ren

(6m

ths

- <6

yrs)

Chi

ldre

n (6

yrs

-

<18

yrs)

Pre

g/L

acta

ting

/mot

her

wit

h ch

ild le

ss t

han

6 m

onth

s

A

dult

s

(1

8 an

d ab

ove)

MA

M

SAM


Monthly Physical Inventory Report

Name of Facility: ___________________ District: _________________

Year__________ Month__________

Shipment #________________Date of Inventory__________________

Units Net (Kgs).

Opening Physical Inventory. [A]

Arrivals at Warehouse as per W/B [B1]

Transport losses [B2]

Total received at Warehouse (B1-B2 ) [C]

TOTAL AVAILABLE FOR DISTRIBUTION (A+C3)[D]

Distribution [E]

Losses (Detailed on Loss Reports) [F]

Closing Balance (D-E-F)[G]

Actual Closing Physical Balance

State the Expiry date of the RUTF currently in stock

Explain Difference_______________________________

Prepared by_____________ Approved by__________________

Title __________________ Title_________________________

Signature and Date_________ Signature and Date___________


REFERRAL NOTE

Date of Referral________________________________________________________________________

TO: _________________________________________________________________________________

FROM: Health Unit_________________________________ Referral number______________________

REFERENCE: Patient name___________________________ Patient number______________________

Age _______ Sex ________ Date of first visit_____________________________________

Please attend the above person who we are referring to your health unit for further action.

History and Symptoms:

Investigations done:

Diagnosis:

Treatment given:

Reason for referral:

Please complete this note on discharge and send it back to our unit

Name of clinician______________________________ Signature________________________________

-------------------------------------------To be completed at the referral site-----------------------------------

Date of arrival________________________ Date of discharge __________________________________

Further investigations done

Diagnosis:

Treatment given:

Treatment or surveillance to be continued:

Remarks:

Name of clinician ________________________________ Signature _____________________________

Supply Chain Management, Monitoring and Reporting of Outpatient ...

Documents

Transcript of Supply Chain Management, Monitoring and Reporting of Outpatient ...