Pharmacy stock and expiry control in Ethiopian hospitals

Ask a hospital pharmacist in Ethiopia about stock and you will often hear two complaints in the same breath: a medicine they could not dispense last week because it had run out, and a carton of something else they have just found, expired, at the back of the store. Stock-outs and expiry seem like opposite problems. In practice they usually have the same cause: the pharmacy does not know, batch by batch and day by day, what it has, where it is, and when it expires.

Medicines are among the largest costs a hospital carries, and supply is often irregular. Public facilities receive much of their stock through the national pharmaceutical supply system and buy the rest; private facilities buy from wholesalers and importers whose availability changes. When supply is uncertain, every carton that expires on the shelf is money lost and, often, a medicine a patient could not get.

Why medicines expire on the shelf

• First in, first out instead of first expiry, first out. The carton nearest the front is dispensed, regardless of which batch expires soonest. A later delivery with a shorter shelf life sits behind it until it expires.
• Expiry dates are not recorded at receipt. The bin card shows quantities but not batches, so nobody can list what is expiring in the next three months.
• Stock is only counted once or twice a year, so slow-moving items are not noticed until the count.
• Large consignments arrive without consumption data to show whether the quantity can be used before it expires.
• Stock is split between the main store and several dispensing points, and nobody sees the total.

Why stock runs out

• Reorder decisions are made when the shelf is empty, not when stock falls below a level that allows time for resupply.
• Consumption is not measured, so the reorder quantity is a guess.
• Dispensing is not recorded against stock in real time, so the stock figure on paper is always behind reality.
• Stock exists in one dispensing point while another runs out.

What good stock control looks like

The fix, whether on paper or in software, is the same set of disciplines. Software makes them practical at hospital scale.

1. Receive by batch. Every delivery is recorded with its batch number, expiry date, quantity and unit cost. From that moment the hospital knows exactly what it holds and when each batch expires.
2. Dispense first-expiry, first-out. When a medicine is dispensed, stock is taken from the batch that expires soonest. In CareLink's pharmacy module, this happens automatically: each dispense decrements stock from the earliest-expiring batch at the patient's facility.
3. Record every movement. Receipts, issues from the store to dispensing points, dispenses, returns and write-offs are each recorded in a stock ledger, so the stock figure is always current and every change can be traced.
4. Refuse what does not exist. A dispense larger than usable stock should be refused, not recorded as negative stock to be sorted out later. This keeps the figures honest.
5. Warn early. An expiry warning ninety days ahead gives the pharmacy time to use, transfer or return stock before it expires. A reorder-level alert for each item gives time to resupply before running out.
6. Count often, and small. Cycle counts of a few items each week find discrepancies while they can still be explained.

Linking stock to the patient and the bill

When dispensing is part of the same system as prescribing and billing, three useful things happen. The pharmacist dispenses exactly what the clinician prescribed, with no retyping. Each dispense raises a charge on the patient's bill automatically, so medicines dispensed are medicines billed — or claimed, for CBHI and insured patients. And management can see consumption per item over time, which is the basis for sensible reorder levels and quantities.

This is the design behind CareLink's pharmacy and inventory modules: receipts by batch with expiry and unit cost, issues to dispensing with a stock movement ledger, dispensing from the earliest-expiring batch, expiry warnings at ninety days and reorder-level alerts per item.

The reports that matter

With batches, movements and dispenses recorded, a handful of reports do most of the work. The pharmacist in charge should look at them on a fixed schedule rather than when a problem appears:

• Items expiring in the next ninety days, by batch and location — weekly. This is the list to act on: use first, transfer to a ward or another facility that will use it, or return where the supplier allows.
• Items at or below reorder level — weekly, or daily for essential medicines.
• Consumption per item per month — monthly. This is what reorder levels and order quantities should be based on, and what to show a supplier or the supply agency when arguing for a different allocation.
• Write-offs and adjustments by reason — monthly. A rising number of unexplained adjustments is an early sign of a control problem.
• Dispensed versus billed — monthly. Every dispense should have a matching charge; a gap means revenue is being lost.

None of these reports is new. What changes with software is that they are available at any moment, from data that is already being recorded, rather than produced from bin cards once a quarter.

What software cannot do

Software does not make medicines arrive. If a supplier cannot deliver, a reorder alert only tells you sooner. Nor does it replace the pharmacist's judgement about substitutions, rationing during shortages, or which slow-moving items are still clinically necessary. What it does is remove the uncertainty: the pharmacy always knows what it holds, what is about to expire, and what is about to run out, and can act while there is still time.

Getting started

• Before go-live, do a full count by batch and expiry. This is the opening balance, and it is worth doing carefully.
• Set reorder levels for the items that matter most first — the essential medicines your hospital cannot be without — and refine them as consumption data builds up.
• Decide who may record write-offs and returns, and review them monthly.
• Review the expiry report every week, not every quarter.

Related reading: CBHI claims and how digital claims cut rejections, since medicines dispensed to members must be claimed accurately. To see batch tracking and expiry warnings on our demo hospital, ask us for a walkthrough.