Nyaya Health

Posted by Aram Harrow

Running a clinic or a hospital constantly requires large amounts of supplies, from medicine and syringes, to patient registration stationary and generator fuel. Managing these supplies is a crucial, but unglamorous, job. Since supplies of different types are used at very different rates, and often by more than one member of staff, the task of inventory management is difficult to perform without a computer. This post will describe some of the design criteria for inventory systems, the solutions we’ve adopted so far, and some ideas for improving them in the future.

Goals of an inventory system

• Any inventory system should be easy to operate by staff with varying levels of computer skills, and should be easy to maintain by administrators so that the system doesn’t depend on any one person.
• It should be able to summarize stock usage in ways that facilitate both reordering and audits (for example, breaking down costs of drugs by category, or disease category, or prescriber).
• There should be clear protocols and clearly delineated responsibilities for entering transactions into the system. In other words, an inventory system is not only a computer system, but also a management system.
• Where possible, the system should make it difficult to introduce errors, for example by linking inventory transactions to other data being entered.

Our approach
The inventory system we have been using so far (built mostly by volunteer Dr. Aditya Sharma) is for the pharmacy. It is a single Microsoft Access database containing several tables. The two main tables are Items, which contains the inventory, and Transactions, which contains a list of every prescription that has been issued. Some other supporting tables include lists of 1) patients, 2) staff who can issue prescriptions, 3) suppliers, and 4) drug names. These help prevent errors by forcing transactions, such as adding new stock or issuing prescriptions, to correspond to valid drug names, patient identifiers, and so on. Using Access, it is straightforward to automate useful queries, such as listing all of the expired drugs that need to be returned to the supplier, or estimating which drugs will run out in the next three months and need to be reordered.

Some of the entries in our pharmacy supply database.

An important part of keeping the database accurate is controlling who has access to it. Stock is only removed from the pharmacy after our pharmacist, Tara Man Kunwar, enters a transaction in the database. Even when supplies are delivered from the pharmacy to other parts of the hospital (e.g. out-patient department or delivery room), this is recorded as a prescription to the appropriate room. Having one person with primary responsibility helps the system run consistently, and means that not all staff need to be trained on the system.

The interface to the pharmacy inventory used by our pharmacist, Tara Man Kunwar.

Future goals
We plan to soon create similar inventory systems for other consumable supplies used in the laboratory (run by our lab personnel), and for office supplies (run by the hospital administrator). One complication of these systems is that supplies which come from Kathmandu or the U.S. will need to be reordered farther in advance. Also, we would like to link the lab inventory system to the database of lab tests, so that when it is appropriate, entering test results also prompts the user to indicate which lab supplies were consumed by the test.

As our services at Bayalpata Hospital expand, we plan to modify our inventory databases so they remain effective and user-friendly. Such inventory systems, when done well, are time-saving and can help reduce costs by allowing for easier monitoring of our supplies and usage.