PAHO Humanitarian Supply Management and Logistics in the Health Sector

Publication date: 2001

Emergency Preparedness and Disaster Relief Program Pan American Health Organization Washington, D.C., 2001 Department of Emergency and Humanitarian Action Sustainable Development and Healthy Environments World Health Organization Humanitarian Supply Management and Logistics in the Health Sector Cover photographs: PAHO/WHO PAHO Library Cataloguing in Publication Data: Pan American Health Organization Humanitarian supply management in logistics in the health sector Washington, D.C.: PAHO, © 2001 189 p. ISBN 92 75 12375 6 I. Title 1. DISASTERS 2. DISASTER PLANNING 3. DISASTER EMERGENCIES 4. EQUIPMENT AND SUPPLIES 5. INTERNATIONAL ASSISTANCE LC HV553.P187 2001 © Pan American Health Organization, 2001 A joint publication of the Emergency Preparedness and Disaster Relief Coordination Program of the Pan American Health Organization (PAHO) and the Department of Emergency and Humanitarian Action of the World Health Organization (WHO). The views expressed, the recommendations formulated, and the designations employed in this publication do not necessarily reflect the current policies or opin- ions of PAHO or WHO or of its Member States. The Pan American Health Organization and the World Health Organization welcome requests for permission to reproduce or translate, in part or in full this publication. Applications and inquiries should be addressed to the Emergency Preparedness and Disaster Relief Coordination Program, Pan American Health Organization, 525 Twenty-third Street, N.W., Washington, D.C. 20037, USA; fax: (202) 775-4578; e- mail: disaster@paho.org. This publication has been made possible through the financial support of the International Humanitarian Assistance Division of the Canadian International Development Agency (IHA/CIDA), the Office of Foreign Disaster Assistance of the U.S. Agency for International Development (OFDA/AID), the Department for International Development of the U.K. (DFID), the Swedish International Development Cooperation Agency (SIDA) and the Italian Ministry of Foreign Affairs. Acknowledgements.vii Preface .ix Introduction.xi Chapter 1 – The Context .1 Disasters – General Aspects .1 Main Effects of Disasters .3 Chapter 2 – Logistics.9 Logistics and Emergencies.9 Logistics Planning and Preparedness.9 Supply Chain Logistics .13 Chapter 3 – Assessing Logistical and Supply Needs .15 The Importance of Needs Assessment .15 Assessment of Local Capacity.17 Factors That May Restrict or Facilitate Relief Efforts .18 Social, Environmental and Cultural Features of the Affected Population and Region.19 Chapter 4 – Coordination .21 Coordination Structures .21 Cooperation Agreements .24 Requests for Humanitarian Assistance .25 Annex.30 Chapter 5 – Key Characteristics of Emergency Supplies .35 What Are Emergency Supplies? .35 Categories .35 Human Resources .37 The Standardization of Emergency Supplies .37 Hazardous Materials.38 Specialized Materials.39 Annex .40 Chapter 6 – Procurement .43 Sources and Procurement of Emergency Supplies .43 Requisitions .45 Sending Supplies .46 iii CONTENTS Page Annexes .52 Chapter 7 – Receiving Supplies.55 Arrival of Supplies .55 Receiving International Shipments .56 Receiving Local Shipments .62 Annexes .64 Chapter 8 – Record-Keeping, Control, and Monitoring of Supplies.69 Arrival and Recording of Supplies.69 Control, Monitoring, and Follow-up Systems .71 Dealing with Non-Priority Items and Other Supplies .76 Annex.78 Chapter 9 – Storage .83 Types of Warehouse .83 The Choice of Storage Site.84 Estimating Storage Needs and Capacity.85 Alternative Storage Sites .89 Staff Required .89 Equipment and Material Required in the Warehouse.90 Warehouse Sectors.91 Storage and Internal Distribution of the Supplies.94 Procedures for Arrival and Dispatch .96 Control and Monitoring Systems .98 Occupational Health and Safety in the Warehouse .99 Maintenance and Sanitation Measures .100 Hazardous Materials .101 Annexes .105 Chapter 10 – Transport .109 Types of Transport and Their Characteristics .109 Determining the Type of Transport Needed.114 Vehicle Control.115 Transporting Supplies.119 The Transport of Hazardous Materials .120 Convoys or Caravans .121 Management of Air Operations .124 Annexes .127 Humanitarian Supply Management and Logistics in the Health Sectoriv Chapter 11 – Distribution .131 Key Principles.131 Responsibilities and Criteria for Distribution .132 Distribution Systems .133 Monitoring and Control .137 Annexes .139 Chapter 12 – Managing Medical Supplies .143 Selection .143 Programming Acquisitions.146 Reception and Evaluation of Acquisitions.147 Donations .147 Storage Systems.150 Controlling and Monitoring Products in the Storage Centers .153 Distribution .154 Discarding Pharmaceutical Products .155 Annexes .156 Chapter 13 – Transparency and Information in Emergency Supply Management.159 Transparency.159 Information .159 Chapter 14 – Telecommunications .163 The Communication Strategy .163 Telecommunications Systems .164 Basic Procedures.167 Chapter 15 – The Application of New Technologies to Emergency Logistics.169 Bar Codes .170 AMS Laser Cards .172 Radio Frequency Identification Tags and Labels .173 References.175 vContents The Pan American Health Organization, Regional Office for theAmericas of the World Health Organization (PAHO/WHO) wouldlike to express their special gratitude to the chief author of this handbook, Gerardo Quirós Cuadra, an expert on the subject and a fre- quent collaborator of FUNDESUMA. We would also like to thank the out- standing support provided by FUNDESUMA and the technical contribu- tions it has made to the handbook. Other especially significant contributions came from Dr. María Margarita Restrepo, of the Faculty of Chemistry and Pharmacy of the University of Antioquia, Medellín; Gérard Gómez of the Latin American Emergency Relief Office of Médecins sans Frontières; Dr. Edgardo Acosta Nassar, Jerónimo Venegas and Víctor Martínez of FUNDESUMA; Glauco Quesada of the German Red Cross; Alvaro Montero, consultant for USAID/OFDA and FUNDESUMA; John Price II of the U.S. Defense Logistics Agency; and Sandra Salazar Vindas. Their suggestions, recom- mendations, documentary contributions and conceptual support have made it possible to offer a more comprehensive approach to the subjects covered in the book. The first draft of this work was widely disseminated among logistics and supply management organizations and experts around the world. Hundreds of comments were received and taken into account in the final version of the text. We wish to recognize all those individuals who, in a personal capacity or in the name of the organizations they work for, made valuable suggestions and comments that have enriched this effort. They include Katarina Toll, Isabelle Demuyser-Boucher, Gerhard Putnam-Cramer, and Hans Zimmerman of the U.N. Office for the Coordination of Humanitarian Affairs (OCHA); Rod McKinnon, of Emergency Management Australia; Gregorio Gutiérrez, Project Impact, the Dominican Republic; Luis Campos Cerda and Luis Felipe Puelma Calvo, Emergency and Disaster Program of Maule, Chile; G. Kipor, All- Russian Center for Disaster Medicine; Sonja Nieuwejaar of the U.S. Federal Emergency Management Agency (FEMA); Alfonso Vaca Perilla of Colombia’s Civil Defense; Luis Wintergest Toledo of Mexico’s Civil Protection Agency; Javier Olaya of the Colombian Red Cross; Steven De Vrient of PAHO/WHO Nicaragua; the Nicaraguan Red Cross; Alessandro Loretti of WHO; Martin E. Silverstein of the Uniformed Services University of Sciences; Peter Manfield of Cambridge University; Judith Acknowledgements vii Thimke of the World Food Program; Róger Barrios Chica of the Universidad Nacional Autónoma of León, Nicaragua; José Gómez Moncada; Tony Joe; Raúl Talavera Benavente and Vicente Bruneti. Many others enriched this text with their commentaries and recommen- dations. To all of them, our thanks. Humanitarian Supply Management and Logistics in the Health Sectorviii Emergencies and disasters place exceptional demands on the logis-tical and organizational skills of the affected country. This chal-lenge is felt with particular intensity in the health sector, where deficiencies in the flow of supplies may have dire consequences. The problem does not merely lie in the procurement of emergency goods and equipment. Special attention must also be paid to the management of those supplies already at hand or in the pipeline. Supplies may be piling up at the central level while acute shortages are painfully evident at the emergency site. Unsolicited—and often inappropriate—donations also compete for storage and transport facilities that may be in short supply. Humanitarian personnel may be unfamiliar with standard accounting and stock-control procedures. Alternatively, these procedures may be overlooked under the pressure of the emergency. Accountability and a thorough paper trail are likely to fail at exactly the moment when the mass media are most eager to find evidence of misappropriation of external assistance, and thus perpetuate the myth of local incompetence or, worse still, corruption. Since the publication in 1983 of PAHO’s handbook, Medical Supply Management after Natural Disasters, and particularly over the last decade, considerable progress has been made worldwide toward the effective management of humanitarian supplies, proper accountability, and greater transparency. The development by the Pan American Health Organization of the SUMA emergency supply management methodology has helped to place the effective and accountable control of the supply chain high on the list of priorities of both governments and nongovern- mental organizations. This handbook aims to present the most basic concepts of humanitarian supply management and logistics. Although the handling of medical and pharmaceutical supplies is given special attention, the logistics principles described here have multisectoral applications, not only in emergency situations, but also in the day-to-day operations that must be a part of disaster prevention and preparedness. ix Preface Humanitarian Supply Management and Logistics in the Health Sectorx Throughout this manual, a basic premise is maintained: that disaster management is primarily a national responsibility. While the massive inflow of donations may occasionally exceed the capacity of the affect- ed country to absorb them, the most effective and appropriate response by the international community and humanitarian organizations is to contribute to capacity building at the national level. This manual is directed at those who are locally responsible for managing the flow of supplies and ensuring the timely delivery of emergency supplies to dis- aster victims—from civil protection experts to custom officers, and from ministry of health and social security professionals to the dedicated vol- unteers of humanitarian organizations. It is our hope that this publication will contribute to greater effective- ness and accountability in the process of providing humanitarian assis- tance to the victims of disasters, and therefore to more equitable access to health by the affected population. Dr. Claude de Ville de Goyet Chief, Program on Emergency Preparedness and Disaster Relief, Pan American Health Organization Washington, D,C. xi Procurement, storage, mobilization, distribution—these and otheraspects of providing material assistance to people affected by dis-asters, and the handling of those supplies employed by relief organizations in their aid operations, require an organizational structure to ensure the efficient management and utilization of resources that in emergency situations, almost by definition, tend to be limited. This structure is provided by logistics, the art or strategy of achieving practical objectives as promptly and methodically as possible while mak- ing the most effective use of available resources. Two basic premises are addressed in this handbook: 1. Humanitarian supply logistics cannot be improvised at the time of the emergency. Countries and organizations must see it as a corner- stone of emergency planning and preparedness efforts. Employing resources appropriately, and being able to secure those that are not at hand, depends on first identifying their availability and location, as well as the sources for obtaining them. All those activities demanded by logistical deployment during an emergency—the mechanisms for standardizing the various processes and all the nec- essary documents for recording information and controlling, moni- toring and following up on the flow of supplies—must be prepared, understood, and tested in advance. 2. The various stages in the flow of supplies from their point of origin to the moment they reach their recipients—whether they be the organizations managing the emergency or the actual beneficiaries of the assistance—are a chain made up of very close links. How any one of these links is managed invariably affects the others. Supply man- agement must therefore be the focus of an integral approach that looks at all the links in the sequence and never loses sight of their interdependence. This is known as supply chain logistics. This handbook is intended as a guide to certain basic aspects of emer- gency supply logistics and as reference material for all those involved in Introduction the management of humanitarian supplies. It describes a series of proce- dures for the correct handling of supplies at each of the stages of the logistics chain. Some of these procedures reflect the standards of inter- national organizations involved in disaster response. Many others, how- ever, are the distillation of concrete experiences by those in the field. While no guidelines can be universally applicable, the techniques and procedures proposed here should be of some value in almost all circum- stances involving emergency operations. The manual is aimed at all those who work in emergency management, whether government officials or members of nongovernmental organi- zations; the procedures outlined should be applicable in both cases. The content has been organized in such a way that those who are already experts in the field can use it as reference material, while those who wish to learn about the subject will find a systematic presentation of the most relevant aspects of the logistics of managing humanitarian supplies. This is a new contribution by the Pan American Health Organization and the World Health Organization to national efforts to strengthen opera- tional capacity, particularly in those aspects related to the management of humanitarian assistance. It expands and updates information in PAHO/WHO’s Scientific Publication Medical Supply Management after Natural Disasters (1983). Humanitarian Supply Management and Logistics in the Health Sectorxii 1 The purpose of this chapter is to provide a general context for themost common scenarios that would call for an intervention byhumanitarian organizations, as well as for those recurring condi- tions in which these organizations must act to meet the needs of the vic- tims of disasters. Disasters – General Aspects The term “disaster” is usually applied to a breakdown in the normal functioning of a community that has a significant adverse impact on people, their works, and their environment, overwhelming local response capacity. This situation may be the result of a natural event—say, a hur- ricane or earthquake—or it may be the result of human activity. Some organizations make a distinction between “disasters”—the result of natural phenomena—and “complex emergencies” that are the product of armed conflicts or large-scale violence and often lead to massive dis- placements of people, famine, and outflows of refugees. Examples would include the Balkan crisis, the Ethiopian, Somali and Sudanese famines, the genocide in Rwanda and the violence in East Timor. Each disaster is unique—its effects not only have to do with the type of natural or man-made phenomenon, but also with the economic, health, and social conditions of the area. However, there are common features, and identifying them can help improve the management of humanitari- an assistance and the use of resources. The following aspects should be taken into account when considering the nature of a disaster (see also Table 1.1): 1. There is a correlation between the type of disaster and its impact on health, particularly the occurrence of injuries. For instance, earth- Chapter 1 The Context1 1 This chapter was originally written by Dr. Edgardo Acosta Nassar and partially modified to meet the needs of this handbook. Dr. Acosta is Executive Director of FUNDESUMA, a foundation dedicated to maintaining and disseminating the SUMA humanitarian supply management methodology. Dr. Acosta has extensive international experience in disaster preparedness and management. quakes cause many traumas that demand medical attention, while floods tend to produce relatively few injuries; 2. Some of a disaster’s effects do not have an immediate impact on public health, but pose a potential threat. Population displacements and environmental changes may increase the risk of a spread in communicable diseases. In general, though, epidemics are not caused by natural disasters; 3. Immediate and potential health hazards in the aftermath of a disas- ter seldom materialize simultaneously; they tend to strike at differ- ent times, and with variable intensity within the affected area. Thus, injuries tend to happen at the time and place of the impact, demand- ing immediate medical attention, while the risk of an increase in communicable diseases evolves more slowly and reaches maximum intensity with overcrowding and breakdowns in hygiene; 4. After a disaster, the need for food, clothing, shelter, and primary health care is rarely absolute; even the displaced often have the resources to satisfy some of their own basic needs. Moreover, it is common for the victims of a disaster to recover quickly from the ini- tial shock and participate spontaneously in search and rescue efforts and other relief initiatives, such as the storage and distribution of emergency supplies; 5. Wars and civil conflicts generate a particular set of health problems and operational obstacles. Overcoming them requires dealing with many political, social, ethnic and geographical issues. Effective humanitarian relief management is based on anticipating prob- lems and identifying them as they arise, and providing specific supplies at the right time where they are most needed. Humanitarian Supply Management and Logistics in the Health Sector2 Main Effects of Disasters The various effects of disasters on the population and its surroundings generate different kinds of needs and require different approaches to meet those needs. It is therefore important to have a general sense of what these effects are, and which systems are most commonly affected. However, experience shows that the effects in question cannot be taken as absolutes, since the impact and form a disaster takes depends on the specifics of the affected region. Bearing this in mind, the following is an overview of some basic characteristics of these effects. Social Reactions The behavior of disaster victims rarely explodes into general panic or sinks into stunned apathy. After the initial shock, people tend to start acting positively to meet well-defined personal goals, leading to an increase in individual activities that, in spite of being spontaneous, quickly self-organize into collective endeavors. Earthquake survivors, for instance, are usually the first to engage in search and rescue efforts, often within minutes of the impact; in a matter of hours, self-organized groups have already assigned themselves specific tasks that play a key role in relief and recovery. It is only in exceptional circumstances that actively antisocial behavior such as looting takes place. However, sometimes individuals’ sponta- neous reactions, while perfectly rational from the point of view of self- interest, can prove detrimental to the community as a whole, as when public utility employees do not show up at the workplace until they have taken steps to ensure the safety of their family and possessions. Since rumors abound after a disaster, especially concerning epidemics, the authorities may face tremendous pressure to adopt emergency meas- ures, such as massive vaccination campaigns against typhoid or cholera, without there being solid public health evidence for doing so. Moreover, many people are reluctant to apply the measures considered necessary by the authorities. After an early warning has been issued concerning a major risk, and even after a disaster has actually taken place, many are reluctant to be Chapter 1: The context 3 evacuated, although their homes may no longer be safe or, quite simply, may no longer exist. Communicable Diseases Natural disasters do not cause massive outbreaks of infectious diseases, although in some circumstances they may increase the odds of their spreading. In the short term, the increase in morbidity is frequently the result of fecal contamination of drinking water and food, causing gas- trointestinal diseases. The risk of epidemic outbreaks of communicable diseases is proportion- al to the density and displacement of the population, since these factors degrade living conditions and substantially increase the demand for drinking water and food, which tend to be scarce in such circumstances. In the immediate aftermath of a disaster, the risk of contamination grows—as in the case of refugee camps—as existing sanitation services such as water supply and sewerage systems break down and it becomes impossible to maintain or restore public health programs. In the case of complex disasters, malnutrition, overcrowding, and the lack of basic sanitary conditions are frequent. In such circumstances, outbreaks of cholera and other diseases have occurred. Population Displacements When large population displacements take place, whether spontaneous or organized, humanitarian assistance becomes crucial—and urgent. People tend to flock to urban areas, where public services do not have the capability to handle sudden, very large increases in the population served, leading to increased mortality and morbidity rates. If the disas- ter destroys most homes in a given area, large local “migrations” may take place within the same urban environment, as victims look for shel- ter in the homes of relatives and friends. In situations in which large numbers of the population flee their homes due to war or other forms of violence, and the threat to life is imminent, organized reactions are much less likely, since the chief priority of the Humanitarian Supply Management and Logistics in the Health Sector4 victims is to get away from the danger as quickly as possible. In these cases, the timely intervention of international aid organizations can still make the difference between life and death. Even so, these agencies may find among these populations attitudes of mutual assistance and organ- ized response that can maximize the effectiveness of the intervention. Exposure to the Elements Health hazards associated with exposure to the elements are not com- mon in temperate zones, even after a disaster, as long as the displaced are kept in dry places where they can remain sheltered from the wind and cold. However, in other climates with significant extremes in tem- perature, whether too hot or too cold, proper shelter can be vital. Hence, the need to provide emergency shelter should not be seen as a given, but depends instead, to a large extent, on local circumstances. Food and Nutrition Food shortages in the aftermath of a disaster are generally due to two causes. The first is the destruction of food stocks in the affected area, which combines with personal losses to reduce the immediate availabil- ity or affordability of food. The second is disorganized distribution sys- tems, which may contribute to shortages even if there is no absolute scarcity of food. After an earthquake, lack of food is rarely severe enough to cause mal- nutrition. River floods and unusually high tides causing coastal flooding may affect food stocks and ruin crops, as well as interfering with distri- bution. Efficient food distribution may be a key need in the short term, but large-scale imports or donations of food are seldom needed. One crucial exception must be mentioned. In the case of mass displace- ments of people, the victims do not carry much in the way of provisions, if they carry anything at all. All too frequently, supplies in the popula- tion centers that play host to them are insufficient and are quickly depleted. Chapter 1: The context 5 Water Supply and Sewerage Water supply and sewage systems are especially vulnerable to natural disasters. The interruption of such services leads to severe health risks. These systems are widely distributed, often poorly maintained or in dis- repair even before a disaster strikes, and exposed to a variety of hazards. Deficiencies in the quantity and quality of drinking water, or the safe disposal of fecal and other human waste, bring about a degradation of sanitary services, which in turn contributes to creating favorable condi- tions for the spread of water-borne diseases. Mental Health In the immediate aftermath of a disaster, anxiety, neurosis and depres- sion are not a major public health issue, and can generally be handled temporarily by other members of rural or traditional communities with- out external support. Confounding expectations, it is relief workers who may comprise a high-risk group. Whenever possible, all efforts must be made to preserve the social structure of families and communities. Likewise, the indiscriminate use of sedatives or tranquilizers during the relief stage of the disaster must be vigorously discouraged. In the industrialized or urbanized areas of developing countries, a sig- nificant increase in mental health problems often accompanies the long- term rehabilitation and reconstruction phase. Treatment must be pro- vided. Special reference must be made to the traumas that are the result of con- tact with the horrors of armed confrontation and other forms of extreme violence. The violent death, disappearance, or injury of relatives and friends aggravates the trauma, which generally calls for protracted ther- apy. Damage to Infrastructure Natural disasters frequently cause severe damage to key facilities, affect- ing the health of those sectors of the community that depend on the services provided. In the case of hospitals and health centers whose Humanitarian Supply Management and Logistics in the Health Sector6 structure is unsafe, natural disasters put its occupants at risk and limit institutional capacity to provide services to the victims. The 1985 Mexico City earthquake triggered the collapse of 13 hospitals. In three of them alone, 866 people died, including 100 hospital staffers; some 6,000 beds were lost. In 1998, Hurricane Mitch damaged or destroyed the water sup- ply systems of 23 hospitals in Honduras and affected 123 health centers. The disasters set off by the El Niño phenomenon in Peru between 1997 and 1998 affected almost 10% of the country’s health services. These destructive effects also have an impact on infrastructure, equip- ment, and other useful resources for managing the arrival, storage, and distribution of emergency supplies. Chapter 1: The context 7 Humanitarian Supply Management and Logistics in the Health Sector8 Ef fe ct D ea th sa Se ve re i nj ur ie s re qu ir in g ex te ns iv e tr ea tm en t In cr ea se d ri sk of c om m un ic ab le di se as es D am ag e to h ea lth fa ci lit ie s D am ag e to w at er su pp ly s ys te m s La ck o f fo od La rg e po pu la tio n di sp la ce m en ts Ea rt hq ua ke s M an y M an y Se ve re (s tr uc tu re a nd eq ui pm en t) Se ve re W in ds to rm s (w it ho ut f lo od in g) Fe w M od er at e Se ve re M in or Ts un am is an d su dd en f lo od s M an y Fe w Se ve re , bu t lo ca liz ed Se ve re Co m m on Sl ow -o ns et f lo od s Fe w Fe w Se ve re (e qu ip m en t on ly ) M in or Co m m on La nd sl id es M an y Fe w Se ve re , bu t lo ca liz ed Se ve re bu t lo ca liz ed In fr eq ue nt Vo lc an oe s an d m ud sl id es M an y Fe w Se ve re (s tr uc tu re a nd eq ui pm en t) Se ve re In fr eq ue nt Co m m on ( ge ne ra lly l im ite d) In fr eq ue nt ( ge ne ra lly c au se d by ec on om ic o r lo gi st ic al f ac to rs ) In fr eq ue nt ( te nd t o oc cu r in u rb an a re as th at h av e su ff er ed s ev er e da m ag e) Th is i s a po te nt ia l ha za rd a ft er a ny s ig ni fi ca nt n at ur al d is as te r. Th e po te nt ia l in cr ea se s in c lo se c or re la tio n w ith o ve rc ro w di ng a nd t he d eg ra da tio n of t he s an ita tio n si tu at io n. a In cl ud in g po te nt ia l l et ha l e ff ec ts in t he a bs en ce o f pr ev en tio n m ea su re s. Ta bl e 1. 1 Sh or t- te rm e ff ec ts o f m aj or d is as te rs Logistics and Emergencies Although the word "logistics" applied originally to the militaryprocedures for the procurement, maintenance, and transporta-tion of materiel, facilities, and personnel, it now has practical applications in civilian life. It generally refers to a system whose parts interact smoothly to help reach a goal promptly and effectively thanks to the optimized use of resources. While this is an immensely produc- tive approach, its downside is that the failure of even one of the com- ponents can affect the final result. Many commercial enterprises have a logistics department that coordi- nates, through a logical and sequential series of steps, all aspects relat- ed to procurement, transport, maintenance, stock management, and the flow of both material and intangible inputs—broadly speaking, all activ- ities considered auxiliary to the production and marketing process. In emergency relief operations, logistics are required to support the organization and implementation of response operations in order to ensure their timeliness and efficiency. Mobilizing the staff, equipment and goods of humanitarian assistance organizations, the evacuation of the injured or the resettlement of those directly affected by the disaster, requires a logistics system to maximize effectiveness. Logistics Planning and Preparedness2 It is beyond the scope of this section to explain in detail how to devel- op an emergency response logistics plan. However, it is feasible to pro- vide a few guidelines for developing such a plan, as well as to under- score the importance of planning as a key component of any disaster reduction effort. Chapter 2 Logistics 9 2 This section is based on Logistics, a module prepared by R.S. Stephenson, for the United Nations Development Programme, Disaster Management Training Program (Madison, University of Wisconsin, Disaster Management Center, 1991). Logistical activities have to be planned, since adequate preparations are essential to a smooth operation. It is indispensable to renounce the com- monly held notion that transport and other arrangements can be impro- vised, depending on circumstances “in the field” when disaster strikes. Planning is both necessary and practical, since it is generally possible to foresee the types of disasters that may affect a given location and the needs that such disasters will be likely to engender. In fact, logistics should be an active component of any national emer- gency response plan, as well as of the individual plans of disaster response organizations and key institutions such as schools and health establishments. Logistics must be closely linked to all other operational activities in the context of responding to a given emergency. The Plan Planning and anticipation are vital to an effective logistical system. The plan must be based, first of all, on a good working knowledge of the geo- graphical, social, political and physical characteristics of the area where the operations are to take place. Such a plan must not only be well thought out in advance, so that it can run smoothly—it must, above all, be clearly understood and accepted by all stakeholders in any future relief operation. The plan must provide clear answers to the following questions: � Which tasks must be carried out? How do they relate to all the other activities, and what are the correct sequences for carrying them out? � Who will be responsible for performing such tasks? (Rather than individuals, what must be identified here are organizations or departments.) � Who will be in charge of the overall coordination of the logistical system? � What resources are needed? How, when, and where can they be pro- cured? � What alternative actions can be implemented if the system is some- how disrupted? Humanitarian Supply Management and Logistics in the Health Sector10 Preparedness After these questions have been answered satisfactorily, we must draw up a list of preparatory activities. The more time and effort we invest in such activities, the greater the return in terms of our knowledge of the theater of operations, our weaknesses and those of our partners, eventu- al needs, and alternative solutions depending on different scenarios. These activities, which are described below, can be broken down by national regions, depending on the size of the country, beginning with those areas most at risk from natural disasters. Alternatively, organiza- tions may decide on which geographical areas they will focus their attention. Preparedness must also be based on the vulnerability and resource assessments normally carried out to develop a national or regional emergency response plan. We must never forget that logistics has to be a key component of any such plan. Preparatory activities must include the following: � Assessing the vulnerability of key infrastructure—The goal is to iden- tify the strengths and weaknesses of public works and strategic structures of the country or region—highways, water supply systems, schools, hospitals—as well as alternative actions that may be required should the infrastructure collapse. Specific actions would include: � Systematically mapping and evaluating national transport infrastructure (ports, airports, highways, railroads, and water- ways), taking into account the capacity and potential weak- nesses of strategic routes, possible bottlenecks (bridges, ferries), availability of communication resources, and risks to the infra- structure in the event of an emergency. It is essential to deter- mine the vulnerability of ports and airports to natural disasters. We must consider, for instance, the exposure of hangars and warehouses, or loading and fueling equipment, to the impact of a hurricane or an earthquake; � Analyzing the historical meteorological records of the country or region to determine the impact that severe weather might have on the capacity of the transport system at different times of the year; Chapter 2: Logistics 11 � Regularly monitoring major new construction or changes to existing structures that might cause bottlenecks or the tempo- rary need for rerouting, e.g., changes in a bridge’s weight or width restrictions, the closure of a route due to road repairs, and so on. � Determining the availability of strategic resources for logistical sup- port—These resources are constantly changing, so they must be reviewed frequently to keep the information as up-to-date as possi- ble. The review must also involve the private sector, the public sec- tor, and national and international nongovernmental organizations. � Taking stock at the national level of the location and sources of key supplies—including drugs and medical supplies, food, cloth- ing, fuel, and rescue equipment. This inventory must also deter- mine how long it would take for critical supplies to be delivered to their required destinations; � Analyzing the capacity of the transport system for moving peo- ple and supplies—assessing in detail the country’s transport capacity, such as the size of fleets, their type and capacity, loca- tion, costs, and availability; � Assessing potential sites for logistic bases, supply distribution centers, and fuel distribution points—including public and pri- vate facilities, large storage complexes, factories, and other facilities that might be adapted to these purposes; � Assessing the availability of spare parts and repair services— including private and public repair shops; � Determining the capacity of ports and airports to handle emer- gency supplies under different scenarios: Ports: Examining the capacity of port facilities to handle the arrival, storage, and flow of consignments, including repackag- ing and distribution. Reviewing with the port authorities the various procedures and formalities for the arrival of emergency consignments, and so on. Airports: Determining their capacity, which types of aircraft can land, which services are offered, availability of machinery and Humanitarian Supply Management and Logistics in the Health Sector12 equipment for unloading and loading, whether fuel supplies are available, and so on. Other transport options: Determining alternative routes and options, such as waterways, in the event of an emergency. � Reviewing government policies, plans, and preparations—It is very important for international agencies and nongovernmental organi- zations to know the government’s emergency response policies and plans. Since government disaster response agencies are the ones entrusted with coordinating relief efforts, it is crucial for the organ- izations that take part in these efforts to establish solid links with the local or national agencies. The contacts can also be used to negotiate mutual cooperation agreements for emergency situations, such as providing tax-exempt status to humanitarian supplies, pri- ority treatment at customs, and so on. All the information compiled and the activities carried out at the plan- ning and preparation stage should serve as the basis for the development of the logistics plan, which must spell out procedures, responsibilities, and timetables for implementation. Supply Chain Logistics This handbook will focus on supply chain logicstics in emergency situ- ations, the purpose of which is to "deliver the right supplies, in good condition and the quantities requested, in the right places and at the time they are needed”.3 The links in this logistics chain are not necessarily sequential or linear; indeed, they are often carried out in parallel. However, they must not be considered as separate activities but inte- grally, due to their complex interrelationships. Although a general coordinator must keep track of all the threads, no one could expect a single individual to micromanage the entire process. Accordingly, someone should be responsible for procurement, transport, storage, and distribution, as outlined below. Procurement The purpose of the procurement process is to make sure that the organ- izations involved in relief management have the resources needed to Chapter 2: Logistics 13 3 Ibid. meet identified needs. This in turn requires identifying the sources of those goods and services and the way in which they will be acquired. Transport Transport is the means whereby supplies reach the places where they are needed. A transport strategy must not only take into account the means of transport but also the actual possibilities of getting supplies from point A to B, as well as alternatives for the prompt, safe delivery of relief assistance. Storage The purpose of storage is to protect the emergency supplies in an organ- ized, systematic fashion until they can be delivered to their ultimate recipients. It must also take into account reserve supplies, or stockpiles, for future or unforeseen needs. Distribution The chief goal of the logistics chain in relief operations is delivering aid to the people affected by a disaster, or at least to the organizations entrusted with managing emergency supplies, in a way that is propor- tional to existing needs, fair, and properly controlled to prevent abuses or waste. Putting it all Together It is important to underscore the fact that all of the above components are closely linked. The failure or ineffective functioning of any of the links in the chain will affect overall performance. For instance, if the transport of a load of supplies has been organized correctly, but upon arrival it turns out that no provisions were made for storage, the effi- ciency of the transport effort will have been to no avail. Alternatively, if there are enough resources to cover the needs of an affected area, but no transport to take them where they are needed, the success of the other efforts will be, for all practical purposes, moot, because they were not properly synchronized with the transport component. One missing link is all that is needed for the chain to break. Humanitarian Supply Management and Logistics in the Health Sector14 The Importance of Needs Assessment Assessing logistical and supply needs is crucial to determine asaccurately as possible: � The needs of the population after a disaster; � Available local capacity and resources; � Complementary capabilities and resources required for meeting those needs. Such assessments should be fully integrated into the general needs- assessment process that is carried out in a disaster area to determine the type and severity of the damage and the most urgent intervention prior- ities. The quality of this assessment is very important, since requests for supplies will be based on the disaster situation as identified on the ground. It should be emphasized that the need for accurate assessments should not lead to paralysis. While assessments are the tool that enables relief man- agers to identify the affected sectors and the nature of the damage, and to quantify and qualify more precisely the type of assistance required, there is no need for them to be completed before the most pressing relief actions are undertaken. Needs assessments should make it possible to answer the following ques- tions: � What are the needs? a . What are the needs of the population? b . What are the operational needs? Chapter 3 Assessing Logistical and Supply Needs4 15 4 This chapter was written with the support of Alvaro Montero Sánchez. Mr. Montero is a consultant for USAID/OFDA and FUNDESUMA on emergency operations centers. � What is available capacity? a . What is the capacity of the local infrastructure? b . What resources (including human and information resources) are available locally? � What factors may hinder or facilitate relief efforts? � What are the social, cultural and environmental characteristics of the potential disaster area that may have a bearing on the effectiveness of the relief efforts? It is important to determine not just the needs of the affected population, but also of the organizations in charge of providing relief assistance. Some of the key questions that need to be answered are the following: � What is needed? � How much is needed? � When is it needed? (Is it urgent?) � Where is it needed? We also know that disasters are dynamic, changing processes. Accordingly, an assessment of this sort must not only help us to identify the current situation, but also to foresee likely needs in the future. Needs of the Population As we have seen, it is important not to stereotype disasters, since the needs they generate depend not only on the kind of event but also on the socioeconomic and other characteristics of the affected region or country. Nevertheless, experience shows that some aspects of everyday life are more likely to be affected by disasters, making it possible to foresee the most probable needs for survival. Such aspects include the following: � Health care: Most catastrophic events tend to affect public health to a greater or lesser extent, generating additional or urgent needs in this area. � Availability of water: It is common for drinking water supply sys- tems to suffer damage or fail to function. Humanitarian Supply Management and Logistics in the Health Sector16 � Availability of food: Not all events lead to dwindling stocks of food, but people who have lost their homes or belongings will likely require some temporary support in this regard. � Shelter: The impact of a disaster might force people to look for tem- porary shelter until they resolve their housing situation. � Sanitation: The generally sudden disruptions of the everyday func- tioning of a community, as well as the displacement or temporary resettlement of the victims, can cause environmental degradation and imperil health due to a rise in unsanitary conditions. Bearing in mind which kind of disaster we are facing, we can come to preliminary conclusions on what type of assistance will most likely be necessary, and launch an appropriate response in the field until more thorough assessments reveal to us in greater detail the needs that must be met. Operational Needs All too often, local organizations involved in emergency response do not have the resources to respond effectively to a disaster. It is therefore important to determine what resources an organization has (or is lacking), and what is required for relief operations to be carried out effectively. If logistical planning and preparations have taken place before the event, this will make it easier to determine which resources are available—and which are lacking and must be procured elsewhere. (See also the section on Logistics Planning and Preparedness in Chapter 2.) Assessment of Local Capacity By local capacity we mean not only the physical resources available at the site of an emergency, but any factors that may help emergency sup- ply management, such as local knowledge of the terrain or weather pat- terns, or social capital in the form of community organizations, formal and informal communications channels, and the like. Local Infrastructure Capacity Since disasters tend to affect lifelines, including roads and infrastructure in general, it is essential to carry out a quick inventory of their availabil- Chapter 3: Assessing logistical and supply needs 17 ity and operational capacity for the mobilization and reception of incom- ing supplies. From the point of view of infrastructure, the following issues must be dealt with: � The state of roads, waterways, and other transport infrastructure needed to guarantee the arrival of emergency supplies in the region or country that has been affected. Are there any restrictions on their effective use, such as the threat of landslides blocking access to a town, or a landing strip that may be unavailable in the event of flooding? Are any changes being contemplated, such as the digging of a tunnel? Is maintenance so deficient that the infrastructure is becoming increasingly vulnerable to the impact of an earthquake or hurricane? � The existence and availability of supply storage facilities; � The existence and availability of means of transport; � The state and capacity of points of arrival (airports, ports, borders, and so on). Are there any restrictions on their use? Are changes in the works, such as the expansion of a runway? Is maintenance a problem? Local Availability of Resources One can frequently find the necessary supplies locally, or at least not far from the emergency zone. Part of our assessment, then, must involve identifying the existence and location of such resources. Attention should not be paid only to commercially available goods that need to be pur- chased; there may also be public, and even private, resources that can eventually be put to use in relief efforts. This applies to resources for the affected population as well those required by relief organizations. Factors That May Restrict or Facilitate Relief Efforts Many factors may hinder or, alternatively, facilitate relief efforts. For instance, during a complex emergency, or in particular political contexts, national authorities may restrict humanitarian operations and supplies. A government may ban foreign-based relief organizations from entering the Humanitarian Supply Management and Logistics in the Health Sector18 disaster or conflict area, or even the country itself. Another may put for- ward religious, political, or health reasons for preventing the arrival of a given product or material. On the other hand, some governments may adopt exceptional measures to facilitate the efforts of relief organizations and the arrival of humani- tarian assistance into the country or the area where operations are underway. This would include offering priority treatment at customs, lowering or eliminating tariffs and taxes, or making government facilities available to humanitarian operations. The assessment report must mention the existence of any such measures, since they will have an impact on the supplies that may or may not be used and the movement of relief teams. Restrictions may have to be cir- cumvented, while favorable measures should be maximized. Other Relevant Issues Any other information that may affect supply availability, transport and distribution should also be recorded to assist in decision-making—weather forecasts, other events related to the event causing the emergency, or safe- ty and security considerations that must be taken into account regarding the movement and positioning of supplies. Social, Environmental and Cultural Features of the Affected Population and Region In order to provide the most appropriate and effective assistance to the affected population, it is imperative to identify and understand their social and cultural customs, as well as environmental characteristics of the area they occupy. This information must be taken into account when making decisions about the type of supplies needed, how they can best be distributed, and how they are likely to be used—in the case of clothing, housing, or house- hold items—or consumed, when it comes to water, food, and drink. The following are essential tasks: � Identifying the population’s dietary habits, including the types of food they will not consume for religious, cultural, or traditional rea- Chapter 3: Assessing logistical and supply needs 19 sons, the kitchen utensils they use for cooking, and any other rele- vant information that can help determine what kind of assistance to offer and what kind to avoid; � Identifying local and regional producers before asking for food assis- tance or negotiating the acquisition of food in other regions; � Finding out what type of clothes are used, and which ones are not worn due to cultural or environmental reasons; � Identifying the most common types of housing and construction materials, including the cultural or environmental reasons, if any, for such buildings and building practices; � Collecting information about the needs and type of assistance con- sidered a priority by the community itself; � Identifying ethnic or cultural minorities and their specific needs, in order to prevent any form of exclusion. Once again, a proper assessment will help to guide the decisions needed to provide appropriate and effective assistance. Defining the need for spe- cific supplies must be done as part of the overall assessment of the emer- gency. Humanitarian Supply Management and Logistics in the Health Sector20 The actors who intervene in relief operations are diverse, with dif-ferent mandates and working methods. Although they all sharethe desire to help, lack of coordination is common in emergency situations. Disputes between organizations, or the unwillingness to share information and work side by side, can delay the provision of care to disaster victims, lead to duplication of efforts, and waste valuable resources. To prevent this predicament, and to maximize available resources and expertise, relief efforts should be launched in a spirit of coordination. This will be possible to the extent that participating organizations know each other, share information, identify and acknowledge their respective strengths, and explore ways of collaborating and supporting each other. Coordination Structures The Actors5 Minor emergencies are generally handled by specialized national or local agencies, perhaps with the collaboration of international organizations present in the country. However, when an event is catastrophic, other sectors of the nation and the international community must often mobi- lize to provide relief. The increase in the arrival of emergency supplies and response personnel places an extra burden on the efforts to coordi- nate relief on the ground. It is crucial to establish effective working rela- tionships with the following stakeholders (see also Annex 4.1): � The local population: The residents of the affected area are the first to engage in search and rescue operations, and often among the first to share vital supplies such as food and water with victims of the disaster. � Neighboring communities or regions: It is also common for neigh- boring communities or even countries to respond quickly with dona- tions and the sending of volunteers. Chapter 4 Coordination 21 5 This section is partially based on J. Davis and R. Lambert, Engineering in Emergencies, Intermediate Technology Publications Ltd., 1995, London. � The national and local governments: A significant adverse event generally prompts the intervention, not only of the national disaster response agency, but of other government bodies as well. � Foreign governments: The governments of other nations intervene through their embassies and their bilateral cooperation agencies. This assistance, which occurs between the two governments, may include financial and in-kind donations, the financing of rehabilita- tion and reconstruction projects, or the sending of consultants and experts. (See Annex 4.1.) � Multilateral agencies: These are mostly intergovernmental agencies, such as those of the United Nations, whose mandate includes disas- ter reduction or humanitarian assistance. Generally, their support focuses on technical assistance related to their own field of expert- ise, sending consultants and experts, or supporting the allocation of resources to help the affected country in rehabilitation and recon- struction efforts. (See Annex 4.1.) � Nongovernmental organizations (NGOs): National and international, religious or social, their capabilities, experience and resources cover a wide spectrum. Some international NGOs specialize in emergency management, and their skills and resources are tailored for disaster situations. (See Annex 4.1.) � The private sector: National or transnational in scope, for-profit cor- porations can get involved at different levels, from donations to pro- viding specialized services in areas such as transportation, ware- house rentals, or the sale or in-kind donation of equipment, food and drugs. � Specialized institutions: These can provide highly valuable technical assistance in areas such as vulnerability assessments and risk reduc- tion, needs assessment, and more concrete efforts such as water purification or medical supply management. � Military institutions: A country’s armed forces have the experience and equipment to support logistical operations. They have their own means of transport, including sophisticated aircraft such as helicop- ters, highly flexible and deployable human resources, and essential skills in crucial fields such as rapid road repair and bridge construc- Humanitarian Supply Management and Logistics in the Health Sector22 tion. When the armed forces are taking active part in a conflict, however, their invovement in relief operations must be closely reviewed and might not be advisable for security reasons. Coordination Mechanisms It must be borne in mind that most countries have a national focal point—a National Emergency Commission, Civil Defense or Civil Protection—in charge of disaster response. It is generally a permanent structure, with its own budget and organizational structure. At times, however, governments establish temporary, ad hoc structures to respond to a particular disaster which will, at some point, transfer responsibility for their activities to permanent government agencies. Regardless of the arrangement involved, it makes sense, in order to discourage the dupli- cation of efforts, to try to channel all emergency assistance through such structures. The tasks of coordinating relief efforts must be viewed from a cross-sec- toral, inter-institutional, and interdisciplinary perspective. They should also, obviously, start long before an emergency takes place, and be rein- forced during a catastrophic event. Some of the key activities during these two crucial stages in the coordination process are the following: During the Preparedness Phase � Determine who is supposed to do what in the context of humanitar- ian intervention: which national, international, governmental, non- profit organizations are present in the country, and what are their specialties and fields of action; � Carry out frequent meetings and coordination activities to decide and even rehearse what is to be done before, during, and after an emergency; � Develop joint plans and seek collaborative agreements with the var- ious organizations for the stages before, during, and after an emer- gency; � Carry out inventories (national, regional, or institutional, as the case Chapter 4: Coordination 23 may be) of resources and contacts that would prove useful in the event of an emergency, and keep the inventories up to date; � Exchange information about resources that may be useful in the event of an emergency, whether the resources are in the hands of participating organizations or come from another source. During the Response Phase � Carry out joint assessments of the situation in the field. This can be extremely useful, since it allows for an interdisciplinary view of the emergency and makes it easier to identify areas for inter-agency col- laboration; � Maintain close and permanent contact between the various organi- zations involved; � Share among the organizations the results of any assessments and findings with a view to finding fields of action where the strengths of the various organizations can complement each other; � Share information about the activities undertaken and planned by each organization, to prevent duplication of efforts; � Promote the exchange of resources among the organizations, as well as the development and implementation of cooperation agreements; � In emergency situations that require a complex response, establish specialized working groups with representatives from all relevant organizations. Examples include a water and sanitation group, or a medical assistance group. Cooperation Agreements Disaster response organizations’ primary goal is to provide relief to those in need. Depending on its nature and history, each organization tends to specialize, to a greater or lesser extent, in a given work area. It is also evident that no agency, on its own, can handle all the logistical prob- lems attending a natural catastrophe. Humanitarian Supply Management and Logistics in the Health Sector24 The way in which international donors transfer resources for humani- tarian assistance has led to the emergence of many new relief organiza- tions and the entrance of existing institutions into this field, resulting in intense competition among these organizations for external resources. In spite of this competition, it is essential to develop mutual support and cooperation agreements, so that humanitarian assistance can be deliv- ered promptly and relief efforts can complement each other. These agreements must be both specific and feasible, so as not to create false expectations. Requests for Humanitarian Assistance Calls on the International Community When the impact of a disaster is such that it overwhelms national response capacity, a call for help soon goes out to the international com- munity. This is the responsibility of the national government, and the requests for assistance are usually channeled by embassies and the coun- try offices of the various UN bodies. The crucial point, again, is not to make such requests until needs have been assessed and it is clear that they cannot be met with local resources. Only then can international sol- idarity provide emergency relief that is truly useful. As part of disaster preparedness efforts, the foreign ministries of some countries—regrettably few—have issued guidelines to their diplomatic representatives abroad in the event of a disaster. These guidelines are meant to help the diplomats inform the authorities, potential donors, and the public about the impact of the event, the needs of the victims, and the type of assistance that would prove most valuable in the circum- stances, based on official reports issued by those responsible for disaster response. Ideally, this should help to identify and screen aid offers, reducing the number of inappropriate donations and helping to make sure that useful supplies arrive when and where they are most needed. Similarly, the country offices of international organizations may call on headquarters or other counterparts in the region to provide humanitari- an assistance. Normally, these organizations have their own procedures Chapter 4: Coordination 25 for mobilizing aid. It goes without saying that when calling for dona- tions, they should apply the same criteria outlined above. Information Exchange and Coordination with International Organizations International organizations, whether they have a country office or send delegations when a disaster occurs, are excellent vehicles for identifying sources of appropriate assistance, procuring the aid and channeling it to the victims. It is therefore vital to establish mechanisms to keep them informed of the evolution of the situation in the field of operations and the needs as they are identified. Instructions for Donors Guiding potential donors, not just about the type of assistance needed, but also about the most appropriate way to make it reach its destination, is extremely important. International organizations with ample experi- ence in disaster relief claim that there are some supplies and forms of assistance that should never be the subject of an open, massive appeal:6 � Used clothing and footwear: Generally, needs of this sort are met locally. In any case, for reasons of hygiene and convenience, it is best to obtain such items locally; � Pharmaceutical products: The arrival of drugs of every sort in all kinds of presentations, quantities, and packaging only serves to dis- tract already overstretched human and logistical resources, since the drugs need to be classified, labeled and, often, discarded or destroyed; � Food: The sending of food of any sort should not be encouraged, at least not as a given. In the event that food should be needed, donors should be advised to send non-perishable goods that can be adapt- ed to local consumption patterns and correctly labeled; � Blood and blood derivatives: Once again, local donations are usual- ly enough to satisfy local needs. Moreover, the arrival of such prod- Humanitarian Supply Management and Logistics in the Health Sector26 6 Adapted from Pan American Health Organization (PAHO), Humanitarian Assistance in Disaster Situations: A Guide for Effective Aid. Washington D.C., 1999. ucts from abroad causes more difficulties than benefits, from the health and logistical point of view; � Medical and paramedical personnel: Generally, national health serv- ices can cope with the need for medical care during an emergency. Should additional human resources be needed, it is always better for them to come from another part of the country than from abroad; � Other specialized personnel: Generally, national relief organizations have enough staff to meet the basic requirements of an emergency. Any need for specialized assistance should be handled directly through the relevant organizations, to prevent a rush of unneeded "experts"; � Field hospitals: These are not recommended; by the time they have been set up and are ready to operate, local health services and facil- ities will probably have been restored; � Medical equipment, new or old: Medical equipment is rarely needed or, if necessary, it is generally highly specific, to be dealt with by asking specialized organizations, not by broadcasting a general appeal; � Tents: New trends in disaster response discourage their use. Should they be needed, it is always better to exhaust the possibilities of local procurement, preventing the technical difficulties and cost of having them sent in from abroad. It should be stressed that in very specific cases it might be necessary to request some material or aid of the kind listed above. However, these cases should be addressed by asking a specialized institution and pro- viding all the specifications of the supplies needed. Such items should not be included in lists used for general appeals. The best approach is to ask the national and international community only for those supplies and assistance that will be unquestionably useful as determined by an assessment of real needs. Whenever possible, cash donations are preferable since they can be used to purchase supplies and services locally, saving the time and resources required for shipping and storing supplies. Chapter 4: Coordination 27 Another key consideration is how supplies are sent. Guidelines for donors should take into account the following: � Consignments should be sorted by product before they are dis- patched. Donors must be asked not to mix different products in the same package; � Consignments should be classified in advance, and packed accord- ing to standard categories (see section on Categories in Chapter 5); � Consignments should be labeled and identified, ideally in the local language, or else in a language that can be easily understood or translated at the disaster site; � Consignments should display the expiry dates of the products sent. Products with limited shelf life should not be sent if they will expire in less than one year or, in very special circumstances, six months at the shortest. The task of making international and national donors aware of the need for appropriate donations requires a permanent information and educa- tion effort as part of each country’s overall disaster preparedness strate- gy. The goal is to ensure that generosity goes beyond good intentions alone, and is of actual benefit to disaster victims. Following Up on Offers of Assistance Many governments and international organizations have become aware of the need for more targeted donations, and will not send any consign- ments until they have been notified of the needs that must be met. However, they might still offer assistance that could be useful later on, but not immediately. When an offer of this sort is made, an answer should be sent immedi- ately to the donor and a system must be in place to record such offers and follow up on them when they are finally needed. This approach also allows some time for evaluation and consultation when the offer includes unusual supplies whose usefulness is not imme- diately apparent. In such cases, specialized national organizations should be consulted. Humanitarian Supply Management and Logistics in the Health Sector28 One of the most awkward diplomatic tasks is to refuse an offer of aid outright. Sometimes, after consultations have been made, local decision- makers may determine that the supplies offered would be useless, drain- ing energy and resources away from the distribution of more effective assistance. Recipient countries should feel free to reject, with all due courtesy, such offers and to provide guidance to potential donors about the types of assistance that would be more appropriate in the circum- stances. In practice, every donation has a cost for the recipient since financial and human resources are required for storing the supplies, transporting them, and all too frequently discarding those that are in poor condition or are otherwise unusable. Chapter 4: Coordination 29 Annex 4.1 30 International Organizations that Intervene in Emergencies7 Any country can be a potential donor of humanitarian aid to another nation affected by a disaster or emergency. Bilateral assistance, from government to government, is probably the most significant overall source of foreign assistance, whether it involves human resources, humanitarian supplies, or both. In order to show the great variety of international organizations work- ing in the field of humanitarian aid, this annex lists some of the best- known among them. The list does not in any way pretend to be com- prehensive, and it leaves out many dedicated organizations with ample experience in providing emergency assistance. 1. United Nations Agencies United Nations Development Program (UNDP) The United Nations Development Program (UNDP) promotes and sup- ports disaster preparedness activities in member countries. In disaster sit- uations, the UNDP Country Office can help governments in areas such as channeling international assistance requests. The Country Office may also coordinate a Disaster Management Team (UN-DMT) comprising rep- resentatives of the various United Nations agencies, whose goal is to provide effective and coordinated assistance to governments in the wake of a disaster and during subsequent recovery and reconstruction efforts. Web site: http://www.UNDP.org United Nations Office for the Coordination of Humanitarian Affairs (OCHA) The United Nations Office for the Coordination of Humanitarian Affairs (OCHA), which in 1998 replaced the Department of Humanitarian Affairs, coordinates the response of the U.N. system to humanitarian emergencies. Its mission, in collaboration with other national and inter- national actors, is to mobilize and coordinate effective humanitarian actions aimed at relieving human suffering in disasters and emergencies. An advocate for the rights of disaster victims and other affected groups, it also promotes prevention and preparedness, and encourages sustain- able solutions to the problems posed by natural or manmade hazards. Web site: http://www.reliefweb.int/ocha_ol 7 More complete listings of disaster-related organizations can be found at http://www.reliefweb.int, http://www.colorado.edu/hazards/, and http://www.crid.or.cr. United Nations Disaster Assessment and Coordination (UNDAC) teams are groups of professionals who can be convened by the United Nations under the coordination of OCHA, at the request of an affected country, to carry out rapid assessment of priority needs and support the national authorities and the United Nations Resident Coordinator in the coordi- nation of international relief aid on the ground. These teams are appointed and funded by U.N. member governments and by OCHA, UNDP and operational humanitarian United Nations agencies such as WFP, UNICEF and WHO. Web site: http://www.reliefweb.int/undac World Food Program (WFP) The World Food Program (WFP) provides and coordinates food assis- tance and is frequently assigned the coordination of general logistics in large-scale emergencies. Its “Food for Work” program provides tempo- rary livelihoods to the affected population during the rehabilitation and reconstruction stage. Web site: http://www.wfp.org United Nations High Commissioner for Refugees (UNHCR) The mission of the United Nations High Commissioner for Refugees (UNHCR) is to protect refugees and search for sustainable solutions to their problems. It coordinates all assistance to refugees. Web site: http://www.unhcr.ch United Nations Children’s Fund (UNICEF) The main concerns of the United Nations Children’s Fund (UNICEF) are the health, education and welfare of women and children in developing countries. It has mechanisms in place to cover their needs during emer- gencies, including food, water, sanitation, health care, and social ser- vices. Web site: http://www.UNICEF.org World Health Organization (WHO) The World Health Organization (WHO) is in charge of coordinating international health action. The Pan American Health Organization (PAHO) and other regional WHO offices act as focal points for national health authorities and donors when disasters strike. WHO can provide technical cooperation aimed at assessing health needs, coordinating international health assistance, managing the stocks and distribution of supplies, carrying out epidemiological surveillance, establishing meas- ures for disease control, assessing environmental health, managing health services, and estimating the costs of assistance projects. WHO also promotes the implementation and use of the SUMA system for humani- tarian supply management. Web sites: http://www.who.org and http://www.paho.org Chapter 4: Coordination 31 2. Intergovernmental Agencies European Community Humanitarian Office (ECHO) The European Community Humanitarian Office (ECHO) works in collab- oration with nongovernmental organizations, specialized United Nations agencies, and other international organizations, providing food and other emergency assistance and helping refugees and displaced popula- tions. It also invests in projects aimed at disaster prevention in high-risk regions. Web site: http://www.europa.eu.int/comm/echo/ Organization of American States (OAS) The Organization of American States (OAS) is a regional body that sup- ports member states by assessing their vulnerability to natural hazards and implementing measures to mitigate the impact of disasters. It pro- vides technical assistance in development planning, the design of proj- ects, and training. It also manages the Inter-American Fund for Assistance in Emergency Situations (FONDEM). Web site: http://www. oas.org Caribbean Disaster and Emergency Response Agency (CDERA) CDERA is a regional organization established by the Caribbean Community; based in Barbados, it has 16 member states. Its chief func- tions are coordinating the response to any disaster affecting member countries and contributing to disaster reduction. Web site: http://www. cdera.org Coordination Center for the Prevention of Natural Disasters in Central America (CEPREDENAC) CEPREDENAC is an official organization within the Central American Integration System (SICA). It works with national scientific and opera- tions agencies to build local capacity for vulnerability reduction. Its objective is to promote disaster reduction in Central America through the exchange of experiences, technology and information, the joint analysis of common strategic problems, and channeling foreign cooperation. Web site: http://www.cepredenac.org 3. Nongovernmental Organizations The International Federation of Red Cross and Red Crescent Societies (IFRC) The IFRC is an international humanitarian organization bringing togeth- er national bodies from 175 countries. Its international secretariat is based in Geneva. It coordinates international humanitarian assistance Humanitarian Supply Management and Logistics in the Health Sector32 and intervenes in affected countries through its national societies or, should no national office exist, with the Federation’s own staff. Its great experience and flexibility, and its considerable resources, make the IFRC the most useful nongovernmental source of cooperation and support for the health sector. Web site: http://www.ifrc.org Médecins sans Frontières (MSF) MSF is a European organization comprised of several independent national bodies (MSF Spain, MSF France, MSF Holland, etc.). Its inter- ventions focus on medical assistance, but it also has great experience and capacity in logistics, water purification, sanitation, and the provi- sion of temporary shelter. Web site: http://www.msf.org Doctors of the World Doctors of the World is a humanitarian medical NGO that intervenes in emergencies and carries out medium- and long-term development proj- ects. Web site: http://www.doctorsoftheworld.org/ Cooperative for Assistance and Relief Everywhere (CARE) CARE International is a confederation of 10 national agencies from North America, Europe, Japan and Australia. Headquartered in Belgium, it manages development and aid projects in 62 countries in Africa, Asia, Latin America and Eastern Europe. CARE USA, based in Atlanta, over- sees CARE projects in Latin America and provides emergency assistance to communities affected by disasters. Web site: http://www.care.org World Vision International World Vision International is a Christian organization that intervenes in aid activities during disasters. It also provides development aid. Web site: http://www.wvi.org Caritas Internationalis Caritas Internationalis is an international confederation of 146 Roman Catholic agencies working in 194 countries and territories. It promotes, coordinates, and supports emergency aid and long-term rehabilitation activities. Web site: http://www.caritas.org OXFAM The Oxford Committee for Famine Relief (OXFAM), originally an English organization, is a network of 11 humanitarian groups from Australia, Belgium, Canada, Hong Kong, Ireland, the Netherlands, New Zealand, Spain, the United Kingdom and the United States. It provides funds and technical assistance for immediate and long-term aid in disaster situa- tions. Web site: http://www.oxfam.org Chapter 4: Coordination 33 Action Against Hunger Action Against Hunger is a European organization that focuses on food security and distribution and supports projects to rehabilitate agriculture and food production. U.S. Web site: http://www.aah-usa.org. U.K. Web site: http://www.aah-uk.org The Salvation Army The Salvation Army intervenes in more than 100 countries, providing social, medical, educational and other types of community assistance. In disaster situations, national affiliates provide health assistance and emergency supplies. Web site: http://www.salvationarmy.org World Council of Churches The Council is a coordinating body representing over 330 Christian and Orthodox denominations from 120 countries and territories worldwide. It supports disaster relief efforts through its member churches in various countries. Web site: http://www.wcc-coe.org/wcc/english.html Save the Children Save the Children intervenes in long-term development projects. In emergency situations, it provides humanitarian supplies and rehabilita- tion and reconstruction assistance. Web site: http://www.savethechil- dren.org/home.shtml International Red Cross Committee (ICRC) The International Committee of the Red Cross (ICRC) is a humanitarian Swiss organization, strictly private and neutral, that is based in Geneva. It protects and helps the victims of armed conflicts or civil disturbances and monitors the application of international humanitarian law. Web site: http://www.icrc.org/eng Voluntary Organizations in Cooperation in Emergencies (VOICE) Voluntary Organizations in Cooperation in Emergencies (VOICE) is a net- work of European nongovernmental organizations that provide emer- gency and rehabilitation assistance and contribute to disaster prepared- ness and conflict prevention. VOICE often collaborates with ECHO (see above). Web site: http://www.oneworld.org/voice Humanitarian Supply Management and Logistics in the Health Sector34 What Are Emergency Supplies? Humanitarian or emergency supplies are those goods, materials,and equipment used by organizations to provide relief in a dis-aster, particularly those required to meet the essential needs of the affected population. Such supplies cover an enormous spectrum, from food, drugs, and clothing to rescue equipment, electric generators, construction materials, and tools. As noted earlier, these supplies come from many different places. Some are procured or channeled by organizations in response to specific needs on the ground; most, however, are the result of the spontaneous solidar- ity of the national and international community. From the point of view of their origin, then, supplies can be of two kinds: 1. Those requested or acquired by organizations based on their inter- vention profiles—medical, economic, reconstructive—and on the needs of the affected population. Regardless of their relevance, they are generally managed by institutions that have asked for them, are aware of the contents of the shipments, and can assign a specific recipient for the aid. 2. Those supplies that are the result of the praiseworthy solidarity of the rest of the country or the world, but which do not necessarily meet the needs faced on the ground. They frequently do not have a specified recipient, and their management is the responsibility of national emergency authorities, who may have to start out by iden- tifying the goods, their characteristics and condition; the authorities must also assign a use—if any—for the supplies, select the recipients, and coordinate delivery. Categories Based on the experience of many humanitarian organizations around the world and the thousands of emergencies they have faced, it is generally Chapter 5 Key Characteristics of Emergency Supplies 35 possible to determine in advance which supplies are most likely to be needed. The World Health Organization (WHO), in consultation with other international organizations, has adopted a standard classification that places humanitarian supplies in 10 different categories. This form of identification is particularly useful for the sorting and recording of supplies. The SUMA system employs these categories for managing the data on incoming supplies. (See Annex 8.1 at the end of Chapter 8.) The categories are the following: 1. Medicines; 2. Water and environmental health; 3. Health supplies/Kits8; 4. Food; 5. Shelter/Electrical/Construction; 6. Logistics/Administration; 7. Personal needs/Education; 8. Human resources9; 9. Agriculture/Livestock; 10. Unclassified. The "unclassified" category is used for those supplies that may have expired, cannot be identified due to lack of labeling or any other reason, are useless in the circumstances, have spoiled, or were packed too hap- hazardly (different types of supplies in the same bags or boxes) for them to be effectively classified during the critical stage of the emergency. Every category is subdivided into subcategories, and the subcategories into items, as in the following example: Humanitarian Supply Management and Logistics in the Health Sector36 8 The “Medicines” category refers exclusively to pharmaceutical products. The “Health” category refers to those non-pharmaceutical supplies aimed at supporting health care activities; they include surgical instruments and materials, laboratory equipment, X-rays, and so on. 9 While “Human resources” are not considered supplies, it is useful to have a category to classify the expertise of volunteers or support personnel, particularly those from abroad, who offer assistance dur- ing an emergency. Category Water and environmental health Subcategory Water treatment Item Calcium hypochlorite Human Resources Obviously, the people who take part in relief activities should not be con- sidered, nor classified as, supplies, but their participation in humanitar- ian operations entails a series of needs and services, from their transport and mobilization to their feeding, lodging and health care, which must be taken into account in logistics planning. The teams on the ground should be as self-sufficient as possible, so as not to place an added bur- den on the already diminished resources of the affected country or region. The Standardization of Emergency Supplies The United Nations Development Program’s Inter-Agency Procurement Services Office (UNDP/IAPSO) has published a series of practical hand- books or catalogs on the availability, technical aspects, and use of stan- dardized equipment and materials that can be used for disaster response by humanitarian organizations. The Compendium of Generic Specifica- tions,10 contains information on emergency items for humanitarian relief such as the following: � Telecommunications equipment; � Shelter, housing, storage and kitchen equipment; � Water supply and distribution equipment; � Food; � Hygiene and sanitation goods and equipment; � Equipment for the handling of different materials; � Electrical power supply equipment. Chapter 5: Key characteristics of emergency supplies 37 10 United Nations Development Program (UNDP), Emergency Relief Items. Compendium of Generic Speci- fications, Volume 1, New York: UNDP, 1995. The Compendium of Basic Specifications,11 deals specifically with: � Medical supplies and equipment; � A select set of essential drugs; � Guidelines for donations of medicines. The purpose of these catalogs is to facilitate the procurement of appro- priate equipment and materials by organizations and donors from qual- ified suppliers in a timely fashion. Another useful tool is the Register of Emergency Stockpiles, a worldwide listing of various organizations’ emergency supply stockpiles in various regions.12 Hazardous Materials Hazardous materials are those that, though useful, have a chemical com- position that might be dangerous to people and their surroundings. Fuels, chlorinated products, cooking gas, oxygen, or laboratory reagents, which are used in everyday circumstances and are also needed during an emergency, require careful handling to prevent fires, explosions, poison- ing, pollution, and injuries. Hazardous materials fall into nine categories, based on their predomi- nant risk (radioactive, explosive, corrosive, flammable, poisonous, etc.) and, within these categories, according to other characteristics of the substances themselves and their chemical reactions. (See Annex 5.1.) International regulations set standards for labeling these products according to their characteristics and potential effects, the way they must be transported, and the precautions that must be taken when they are handled or stored. Those who participate in emergency supply transport and storage must have access to these guidelines, which also describe the composition of the products, their mutual incompatibilities, and procedures to follow in Humanitarian Supply Management and Logistics in the Health Sector38 11 United Nations Development Program (UNDP), Emergency Relief Items. Compendium of Generic Speci- fications, Volume 2, New York: UNDP, 1996. 12 For more information, please visit http://www.iapso.org, or contact: registry.iapso@iapso.org. the event of an accident. Knowledge of these standards ensures the prop- er handling of hazardous materials. One such set of guidelines, the 2000 Emergency Response Guidebook of the Canadian Transport Emergency Center (CANUTEC), can be found online at: http://www.tc.gc.ca/canutec/erg_gmu/erg2000_menu.htm. Another useful link, in Spanish, is: http://www.profepa.gob.mx/saa/ audita68.htm. It shows a listing of hazardous material emergency response centers with their Web addresses, and links to other sites of interest. Specialized Materials13 Frequently, a need arises for equipment or materials so specialized that no one can expect their arrival as part of the general donations. Instead, disaster response agencies must acquire them on their own or rely on international organizations that might have them available or can offer guidance on where and how to procure them. Organizations such as OXFAM, Médecins sans Frontières, the World Health Organization (WHO), or the Office of U.S. Foreign Disaster Assistance of the U.S. Agency for International Development (OFDA/ USAID), for instance, have assembled kits for water treatment, storage and distribution, or the building of shelters. Other kits focus on cholera prevention and treatment, lighting and power generation, pharmaceuti- cals, or essential medical equipment. These kits are generally donated or lent to relief agencies. The contents and characteristics of existing kits are described in detail in the catalogs of the respective organizations. Specialized equipment is often very costly. It is therefore essential to be certain that a real need exists for such supplies before asking for them. It is also important to have a clear picture of what is required (the spec- ifications), so that donors have the information necessary to respond effectively. Chapter 5: Key characteristics of emergency supplies 39 13 See also the section on “Standardization of Emergency Supplies,“ earlier in this chapter. Annex 5.1 40 Cl as s 1: E xp lo si ve s 1. 1. Ex pl os iv es t ha t ha ve a m as s ex pl os io n ha za rd . 1. 2. Ex pl os iv es t ha t ha ve a p ro je ct io n ha za rd . 1. 3. Ex pl os iv es t ha t ha ve a f ire h az ar d. 1. 4. Ex pl os iv es t ha t pr es en t a m in or b la st h az ar d. 1. 5. Bl as tin g ag en ts . V er y in se ns iti ve e xp lo si ve s. 1. 6. Ex pl os iv es . E xt re m el y in se ns iti ve d et on at in g de vi ce s. Cl as s 2: C om pr es se d Ga se s 2. 1. Fl am m ab le g as es . 2. 1. N on -f la m m ab le g as es . 2. 3. Po is on ou s ga se s. 2. 4. Co rr os iv e ga se s (C an ad a) . Cl as s 3: F la m m ab le li qu id s 3. 1. Fl as hp oi nt b el ow - 18 º C . 3. 2. Fl as hp oi nt b et w ee n -1 8º a nd 2 3º C . 3. 3. Fl as hp oi nt h ig he r th an 2 3º a nd lo w er t ha n 61 º C Cl as s 4: F la m m ab le s ol id s 4. 1. Fl am m ab le s ol id s. 4. 2. Sp on ta ne ou sl y co m bu st ib le m at er ia l. 4. 3. M at er ia ls t ha t ar e da ng er ou s w he n w et . Cl as s 5: O xi di ze rs a nd o rg an ic p er ox id es 5. 1. O xi di ze rs . 5. 2. O rg an ic p er ox id es . Cl as si fic at io n an d tr an sp or t pl ac ar ds f or h az ar do us m at er ia ls EX PL OS IVE S 1. 1* 1 EX PL OS IVE S 1. 2* 1 EX PL OS IVE S 1. 3* 1 EX PL OS IVE S 1. 4 * 1 FL AM MA BL E GA S 2 NO N-F LA MM AB LE GA S 2 OX YG EN 2 IN HA LA TIO N HA ZA RD 2 CO MB US TIB LE 3 FL AM MA BL E 3 FU EL OI L 3 FL AM MA BL E SO LID 4 SP ON TA NE OU SL Y CO MB US TIB LE 4 OX IDI ZE R 5. 1 OR GA NIC PE RO XID E 5. 2 DA NG ER OU S 4 WH EN WE T GA SO LIN E 3 BL AS TI NG AG EN TS 1. 5 D 1 EX PL OS IVE S 1. 6 N 1 Chapter 5: Key characteristics of emergency supplies 41 Cl as s 6: P oi so no us a nd t ox ic m at er ia ls 6. 1. Po is on ou s m at er ia ls . 6. 2. To xi c m at er ia ls . Cl as s 7: R ad io ac tiv e m at er ia ls Cl as s 8: C or ro si ve m at er ia ls Ác id s an d ba se s Cl as s 9: M is ce lla ne ou s H az ar do us M at er ia ls 9. 1. M is ce lla ne ou s ha za rd ou s m er ch an di se (C AN AD A) 9. 2. En vi ro nm en ta lly h az ar do us m at er ia ls (C AN AD A) 9. 3 H az ar do us w as te (C AN AD A) O th er h az ar do us m at er ia ls t ra ns po rt at io n pl ac ar ds Cl as si fic at io n an d tr an sp or t pl ac ar ds f or h az ar do us m at er ia ls (c on t.) PG II I 6 RA DIO AC TIV E 7 CO RR OS IVE 8 PO ISO N 6 IN HA LA TIO N HA ZA RD 6 TO XIC 6 So ur ce : D ep ar ta m en to d e Pr ot ec ci ón In te gr al , R ef in ad or a Co st ar ric en se d e Pe tr ól eo (R EC O PE ), Co st a Ri ca . Sources and Procurement of Emergency Supplies15 The supplies required to respond to an emergency come from dif-ferent sources, whether disaster relief organizations acquire themdirectly, receive them as donations from the national and inter- national community, or get them as loans. Normally, all these procurement methods will come into play in an emer- gency, and each has its advantages and disadvantages. Not only that, but we are seldom in a position to choose the most appropriate one in the circumstances. Whenever possible, however, the decision should be based on technical criteria and an unbiased assessment of the needs of the affected population. Purchasing Purchasing can be local or external. To choose one or the other, certain issues should be borne in mind. Local purchasing: The merits of local purchasing depend on several cri- teria, such as the local availability of the products needed, their quality and quantity, and how urgently they are needed. In any case, a cost/ben- efit analysis (including the key question of quality) must be made, and this may call for technical advice. Bulk purchases: Buying a specific product in large quantities may even- tually have an adverse effect on the local market, by upsetting the equi- librium of supply and demand and artificially raising prices. On the other hand, sensitive local purchasing can promote the economic recovery of the affected region. Chapter 6 Procurement14 43 14 This chapter has benefited from contributions by Médecins sans Frontières (MSF) and Gerard Gómez, of the MSF Regional Emergency Response Office for Latin America and the Caribbean. 15 See also the section on requesting international assistance in Chapter 4. Storage: Since space limitations are common when storing emergency supplies, it is sometimes possible to negotiate with local vendors so that the purchased goods can remain in their warehouses until needed by the end users. External purchases: Frequently, local availability of specific items is low or unpredictable, or the quantity and quality of locally available prod- ucts is not good enough to meet needs efficiently. In these cases, pro- curement from abroad or from another part of the country is an option, as long as delivery times are acceptable. Donations Donations may make up the bulk of the supplies received and handled during an emergency. When they comprise items that have not been requested, are not a priority, or do not meet the needs generated by the emergency, they often complicate unnecessarily the logistics of relief operations. However, donations are still very important. When appropriate, they can not only be of value to the affected population, but also provide budg- etary relief for the often cash-strapped disaster relief organizations. They also promote and strengthen solidarity. (See also Chapter 12 on stan- dards and guidelines for requesting and donating drugs and medical equipment.) Loans Some people, organizations, and private firms lend equipment or their services and expertise during a particular phase of the emergency. Although many of these loans are spontaneous, it is important to iden- tify potential lenders before disaster strikes and, if possible, establish agreements for these services during the planning stage. Table 6.1 shows some of the advantages and disadvantages of the vari- ous forms of supply procurement. Humanitarian Supply Management and Logistics in the Health Sector44 Requisitions The clearer and more specific our requests, the sooner the needed sup- plies will arrive and the more useful they will be. Misunderstandings can crop up when requesting emergency supplies, particularly when it comes to technical aspects. The following factors should be taken into consid- eration: Chapter 6: Procurement 45 Table 6.1 – Pros and cons of different kinds of acquisition. Form of acquisition Local purchase Imports Donations Loans Advantages � Prompt delivery � Lower transport costs � Support for local economy � Possible to obtain better quality, larger quantities � Can order according to specifications � Free or low-cost (bear in mind: every donation has a cost) � Promotes national and international solidarity � Sometimes, it is equipment or material that is hard to purchase � Lowers operation costs Disadvantages � Not always available in the quantity and quality needed � Can generate competition between organizations for the purchase of a product � Can cause shortages in the local market � Longer delivery time � Higher transportation costs � Do not support the local economy � Frequently, items have not been asked for � Supplies sent may not meet local needs � If unusable, their handling leads to a waste of time and resources � It is hard to reject them if they are useless � Depends on how long the items can be on loan � The loaned items must be cared for and must be replaced if damaged � It is hard to demand responsibility, quality, or the meeting of deadlines and other commitments � Requisition forms: Standardized documents should be used to request emergency supplies. The forms should be numbered, dated, and include carbon copies to help follow up on the response to each request. (See Annex 6.1.) � Assignment of responsibility: Only one clearly identified individual should be assigned responsibility for making requisitions. � Clarity: Requisitions should be clearly phrased, including all the details needed to identify the supplies wanted. The use of catalogs or any other kind of illustration, including drawings if needed, is always recommended to eliminate possible ambiguities. Once again, technical advice is called for when requesting supplies, especially in the case of unfamiliar products. � Priority: Every requisition should indicate clearly the priority of the supplies depending on identified needs, the volume of distribution, and stock control. � Frequency of requests: It depends on the needs of the affected pop- ulation, the volume to be distributed, and current stocks. However, one should not wait until the last minute before requesting new sup- plies, since a new shipment will take time to arrange, and to reach its destination. � Medicines and hazardous materials: It is necessary to know the national laws and regulations regarding the entry and handling of these goods, including the procedures to obtain authorization for their import. � Follow-up on requisition orders: When keeping track of requested supplies in transit, the number and date of the requisition must be mentioned. (See Annex 6.1.) Sending Supplies One way of easing the task of those who take delivery of emergency sup- plies in the field, sparing them additional complications, is to pack the supplies correctly following standardized procedures. Humanitarian Supply Management and Logistics in the Health Sector46 Another key principle of effective assistance is to send only those sup- plies that have been actually requested. It may occur that some product is likely to be needed, but has not been requested. In those cases, the best approach is to consult those responsible for operations in the field or suggest that the item be requested. A few basic measures can make a big difference in how supplies are mobilized and received. The following section will mention a few of them. Packing and Labeling the Loads Ideally, the supplies to be sent should first be classified and sorted. Items of different kinds—say, garments and drugs—should never be sent in the same package. In fact, to the extent possible, items should be packed separately. � In order to facilitate identifying the contents of the packages, they should be marked using the symbols and colors system that many international organizations currently use to identify the various cat- egories and items (see Annex 6.2): � Green for drugs and medical equipment; � Red for food; � Blue for clothing and household items; � Yellow for equipment and tools. � No supplies should ever be sent if there are any doubts about their quality or condition. Similarly, short-dated products should not be sent unless it is known that they will be distributed and used promptly. � Each package should be clearly labeled with the following informa- tion: � Contents (generic); � Destination; � Name, address, and telephone number of the recipient; Chapter 6: Procurement 47 � Name, address, and telephone number of the sender; � Any specific characteristic or care that must be taken with the package ("fragile", "needs refrigeration", "hazardous material"). � Labeling must be done with indelible ink; labels should not fall off easily. � Packages belonging to the same lot or batch should be numbered "x of y", where y is the total number of packages in the lot. For instance, in a lot of 100 packages, the first should be labeled 1/100, the second 2/100, all the way up to 100/100. This makes it easier to verify and follow up on the quantity of packages that arrive at a reception center. � When packing a consignment, it is important to bear in mind the kind of handling the packages will undergo. The durability of the packing material is important. � Depending on the means of transport (for instance, by air), efforts should be made to reduce "added weight", i.e., the weight of the packing material. � One of the packages should include a copy of the packing list and be labeled as the one carrying the list. The label should be placed inside a plastic envelope and attached to the exterior of the package to prevent it from getting wet or being torn. Volume, Weight, and Size of the Packages It is rare for reception points on the ground to have loading and offload- ing machinery such as forklift trucks. In principle, the size, weight, and shape of the packages should be such that each one can be handled by one individual without mechanical aid, as follows: � Weight: The packages should weigh between 25 kg and 50 kg; � Volume: The volume should be such that it can be handled manual- ly. Sometimes the weight may be all right but the size of the pack- age makes it hard to handle; � Shape: Packages should have the most symmetrical shape possible, Humanitarian Supply Management and Logistics in the Health Sector48 to make it easier to hold and lift them. Oddly shaped packages or shapeless packages should be discouraged. Consignment Notice Reception centers have to prepare for the arrival of new loads. They need to find storage space, arrange for transport if a transshipment needs to be made, and make sure there are enough employees or volunteers pres- ent to offload the shipment. It is therefore essential for officials at the point of origin to provide the reception center with as much advance information as possible about the consignment and the means of trans- portation to be used. The following information should be included. � Regarding the consignment: � Type of goods or equipment included in the consignment; � Quantity (number of packages, boxes, etc.); � Weight and volume; � Special care required (e.g., refrigeration); � Requisition number (if any). � About the means of transport: � Type and characteristics of the transport; � Shipping company (if any); � Person in charge of the transport. � Regarding the itinerary: � Estimated time of departure and likely route; � Estimated time of arrival (the reception point should be notified of any change as promptly as possible); � Exact destination (in an area where there might be several reception points). � Any other information considered relevant to facilitate reception. Chapter 6: Procurement 49 Consignment Documents � Local or national consignments Normally, local shipments require less documentation than interna- tional consignments. They must be accompanied by a cargo or load manifest describing the consignment and any other information about the supplies sent (see Annex 6.3), as well as by the packing list mentioned earlier. � International consignments In these cases, the shipment travels with a waybill or bill of lading and its respective load manifest, prepared by the carrier. It should be noted that the manifest prepared by the carrier on its own stationery is for the use of the company itself and customs purposes. It is advis- able for the organization that is sending the shipment to include its own manifest as well as a packing list outlining the contents of the load by package, to facilitate the internal controls of the organiza- tion. (See Annex 6.3.) Control and Monitoring Shipping operations, like any other link in the logistics chain, call for control and monitoring procedures that can track the emergency sup- plies from the time they are shipped until they arrive at their final des- tination. These controls help disaster managers, among other things, to: 1. Know the route taken by the supplies and thus be able to identify, for instance, where a consignment that has not reached its destina- tion might have been detained; 2. Identify all the people who have been responsible for the shipment, from its point of origin to its final destination; 3. Have the necessary documents to keep track of the shipping and reception of the supplies. In the case of consignments, these functions are made possible by the load manifest, which must be printed in standardized forms that include, as a minimum, the following information (see also Annex 6.3): Humanitarian Supply Management and Logistics in the Health Sector50 � Consignment number (consecutive); � Date of shipment; � Place of origin of the shipment; � Means of transport; � Name and signature of people responsible for the consignment, i.e. the sender, the carrier, and the recipient; � Description of the load; � Space for remarks. These forms should also have the following characteristics: � Be printed and bound in blocks; � Be consecutively numbered; � Provide copies for everyone involved in the process: sender, carrier, and recipient. Cargo Insurance When a shipment is sent through an authorized carrier, the insurance is generally part of the transport contract (see the section on “Incoterms” in chapter 7). Otherwise, it is necessary to find out what types of ship- ping insurance are available and what it is they cover. Clearly, one should not wait until the middle of an emergency to seek out this infor- mation. On the contrary, it is part of the preparations required for cor- rect emergency logistical planning. Chapter 6: Procurement 51 52 Annex 6.1 Sample – Consignment Requisition Form Request for Supplies Request 00/303/LIB-3 Place and date: Deliver at: Priority - URGENT - Normal Explain if necessary: Authorized Operator (name and signature): Requested Item Characteristics/Specifications Quantity REMARKS: 53 Annex 6.2 Selected symbols for supply identification (used by the International Federation of Red Cross and Red Crescent Societies) Basic symbols Men 15 years and older Women 15 years and older Boys 4-14 years Girls 4-14 years Infants 0-4 years Outerwear— men, women, and children Suits, jackets, slacks, shirts— men, women, and children Dresses, skirts and bouses— women Sweaters, jackets—men Shoes—men, women, chil- dren Undergar- ments, sleep- wear, socks— men, women, and children Blankets Labeling of bales Symbols stamped on this bale signify that it contains 25 overcoats for men. These symbols represent 120 undergar- ments for women. NOTE: These can be made with stencils, preferably metal. To label bales, they should be painted with aerosol paints, using the stencils as patterns. KEEP DRY 0001 Shipping Manifest Shipment N° Date of shipment Requisition N° Consignee: Origin of shipment: Exact delivery address: Means of transport: Agent/responsible party: Quantity Type of packaging Detailed list of contents Number of pieces Total weight (kg) Special instructions (handling, transport, storage) Remarks Dispatch: name, company, date Transport: name, company, date Recipient: name, company, date Annex 6.3 54 Sample Shipping Manifest Arrival of Supplies Emergency supplies—whether donations, loans or purchases—arrivefrom different points and by different means: land, sea, air. Inother words, consignment entry points can vary greatly, and so can reception points. Consignment Entry Points Generally, regardless of whether emergency supplies arrive from abroad or other parts of the affected country, they will go through maritime or river ports, airports, or across terrestrial borders. These are transit points for the supplies before they arrive at their ultimate destination. Since final recipients are often not identified as such by the senders, it is often the local or national government that takes over the handling of the emergency consignment from the entry point. It is at the entry point, ideally, that incoming supplies should be regis- tered based on the manifest (see Annex 6.3, Chapter 6), the bill of lad- ing, or any other shipping document that accompanies and describes the load. Registration can be made using the SUMA system, or any other method that can keep track of supplies from the point of arrival to their ultimate destination. As already noted, a reliable system must be in place, since the massive arrival of consignments can overwhelm the operational capacity of entry points, threatening to turn an orderly logistics chain into chaos. Reception Sites These are the collection sites installed by disaster relief agencies, private firms, or civil society groups to receive donations. They can also func- tion as transshipment points, places for preparing and packing consign- Chapter 7 Receiving Supplies 55 Humanitarian Supply Management and Logistics in the Health Sector56 ments, and central warehouses. They may be located in the affected region itself or elsewhere. Receiving International Shipments Customs Procedures and Shipping Papers It cannot be stressed too often: the planning stage of the logistics activ- ities requires careful preparations, since crucial aspects need to be coor- dinated in advance and preliminary agreements reached with the relevant authorities. During the planning phase, it is essential to establish contact with the customs authorities to learn their procedures and requirements and, if possible, negotiate special conditions, such as tax exemptions or priori- ty processing of humanitarian supplies. These agreements should be backed by signed documents, to prevent having to renegotiate condi- tions every time high-level customs officials are assigned to new posts. During an emergency, moreover, access to customs and other authorities might become more restricted, as many other organizations and individ- uals attempt to obtain preferential treatment in the handling of their imports. Some countries have ratified the Convention on the Privileges and Immunities of the United Nations, of 13 February 1946, which includes a series of measures to expedite the inflow and outflow of humanitarian supplies. Multilateral agreements among member states of regional pacts, such as the Central American Common Market or the South American Mercosur, have led to the inclusion, in their customs legisla- tion, of preferential treatment for such supplies. It is important to know about the applicability of such measures in individual countries. When emergency supplies arrive from abroad, it is generally more con- venient to hire a customs agency to handle all the formalities. However, this is not always possible. It is therefore important to know that all international shipments must include as a minimum the following doc- uments, which are required to clear the goods through customs: � Bill of Lading or Waybill. This is the shipping contract and proof that the shipment is on board. The document describes the load in 57 terms of number of packages, volume, weight, and any other useful information. Bills of lading (B/L) apply to maritime transport; way- bills refer to both land and air transport. (See Annexes 7.1 and 7.2.) � Manifest. This document indicates the type of products sent, their point of origin and their destination. It is for the use of customs offi- cials in the country receiving the goods. � Packing List: Ideally, the shipment should include this list, which identifies the load package by package, although the list is not required. This list is used in most cases when an organization is both sending and receiving the humanitarian supplies (for example, CARITAS in Argentina sends a shipment to CARITAS in Guatemala). Normally, the shipper sends these documents once the supplies have been handed to the carrier. If this has not happened, one should request that the documents be sent as soon as possible to proceed with the nec- essary arrangements. Other documents that may accompany the load, depending on specific situations, include the following: � Donation Certificates: They state that the shipment is a donation and therefore part of a non-profit effort. This is important to ensure that these supplies are not subject to import tariffs in the destination country. � Health Certificate: This has to be included whenever the shipment includes food of any kind, and certifies that the products have been tested and are fit for human consumption. In many countries, cus- toms and health authorities will not accept a shipment of food if it does not include this certificate. It is essential to bear in mind that the certificate, by itself, is not a full guarantee of the state of the food, since depending on the type of product, delays en route or conservation problems may mean that the shipment is no longer safe to eat. � Declaration of Hazardous Materials: This should be included when the shipment carries one or more chemical products that require spe- cial care, handling or testing, such as insecticides, laboratory reagents, or water purification products. (See Annex 7.3.) Chapter 7: Receiving supplies Humanitarian Supply Management and Logistics in the Health Sector58 International Commercial Terms (Incoterms) The international purchase, sale, and transport of goods are subject to International Trade Standards with a unified terminology, known as Incoterms (see Table 7.1). These terms specify the conditions that apply to the transaction and the responsibilities of the seller and buyer (or shipper and consignee) regarding costs and insurance risks, the place of delivery, and so on. When acquiring products abroad, it is important to have a clear idea of which Incoterm applies to the transaction. The first edition of the Incoterms was published in 1936; the newest of several additions and changes is Incoterms 2000, which reflects current trends in international trade. There are 13 Incoterms in all, of which the most common are the following: CIF: When the price paid by the buyer includes the cost of the merchan- dise itself, insurance to protect the shipment, and the price of the freight. This term is used exclusively for maritime and river transport. The equiv- alent term for other forms of transportation, by air, land, or a combina- tion of several modes is CIP, which stands for “Carriage, insurance, paid to.” When using CIF or CIP, the seller or shipper agrees to: 1. Deliver the shipment at a destination port specified by the buyer or consignee as stipulated in the documents, and secure and pay for the transport of the merchandise; 2. Pay for insurance to cover the shipment from the point of origin until the merchandise is unloaded; 3. Take charge of the customs paper work needed for the shipment to leave its country of origin and reach its final destination. The buyer or consignee must, in turn: 1. Assume all risks of loss or damage or any other costs incurred after the load is taken over by the carrier; 2. Deal with import formalities, as well as the offloading and addition- al transportation of the shipment upon arrival at the port. In the case of FOB, or free on board, the seller agrees to: 59 1. Place the products on board the carrier’s ship; 2. Deal with customs formalities both for export from the country of origin and import at its final destination. The buyer agrees to: 1. Hire the transport and pay for the insurance required for shipment to its final destination. 2. Deal with import formalities, as well as the offloading and addition- al handling of the shipment upon arrival. The term FOB is only used for maritime and river transport. The equiv- alent term for land, air, or multimodal transport is FCA, which stands for “free carrier.” With ExW, the price only covers the value of the merchandise at the sell- er’s facilities (Ex Works). The only responsibility of the seller is to sell the product. It is the buyer’s responsibility to arrange and pay for transportation and insurance from the point the shipment leaves the seller’s facilities until it reaches its final destination. It is also the buyer’s responsibility to com- plete customs formalities for export and import. The relevant type of Incoterm is noted in the Bill of Lading or Waybill, and the point of delivery must always be stipulated. For instance: CIF to Puerto Caldera; CIP to J. M. Córdova International Airport, Medellín; FOB to Puerto Armuellez. In the case of ExW, the papers must specify the factory or facility where the merchandise is to be picked up, when the seller has facilities in dif- ferent cities or countries. Chapter 7: Receiving supplies Humanitarian Supply Management and Logistics in the Health Sector60 In co te rm s Ex W - Ex W or ks FC A - Fr ee C ar rie r FA S Fr ee A lo ng si de Sh ip FO B Fr ee O n Bo ar d CF R Co st a nd F re ig ht CP T Ca rr ia ge P ai d To DE S De liv er ed E x Sh ip De sc rip tio n G oo ds a va ila bl e or d el iv er ed a t th e se lle r’s f ac ili tie s G oo d ar e pl ac ed o n bo ar d th e ag re ed t ra ns po rt G oo ds p la ce d al on gs id e th e sh ip a t th e ag re ed -u po n po rt o f de pa rt ur e G oo ds d el iv er ed a nd s to re d on b oa rd th e ag re ed v es se l G oo ds d el iv er ed a t th e ag re ed -u po n de liv er y po rt G oo ds d el iv er ed a t th e ag re ed -u po n de st in at io n G oo ds d el iv er ed a t th e ag re ed -u po n po rt o f ar riv al Re sp on si bi lit y of t he S el le r (E xp or te r) De liv er t he g oo ds t o th e bu ye r as s tip ul at ed in t he s al es c on tr ac t. Al l ot he r co st s m us t be a ss um ed b y th e bu ye r, in cl ud in g th e pr ep ar at io n an d pa ck in g fo r sh ip pi ng , u nl es s a di ff er en t ar ra ng em en t ha s be en a gr ee d to . Al l c os ts a nd c us to m s ex po rt f or m al iti es , u nt il th e go od s ar e pl ac ed un de r th e cu st od y of t he c ar rie r. Th e bu ye r pa ys f or t he t ra ns po rt at io n of t he g oo ds a nd a ll ne ce ss ar y in su ra nc e. Al l c os ts a nd c us to m s ex po rt fo rm al iti es u nt il th e go od s ar e de liv er ed al on gs id e th e sh ip o f t he c ar rie r d es ig na te d by t he b uy er . T he b uy er p ay s fo r th e lo ad in g an d tr an sp or ta tio n of t he g oo ds a nd a ny in su ra nc e re qu ire d. Al l c os ts a nd c us to m s ex po rt f or m al iti es u nt il th e go od s ar e lo ad ed o n bo ar d th e sh ip s el ec te d by t he b uy er , w ho m us t pa y fo r th e fr ei gh t an d in su ra nc e. Al l c os ts a nd c us to m s ex po rt f or m al iti es u nt il th e go od s an d bi ll of la di ng a re d el iv er ed b y th e ca rr ie r at t he a gr ee d- up on p or t of a rr iv al . Th e bu ye r pa ys f or in su ra nc e. Al l c os ts a nd c us to m s ex po rt f or m al iti es u nt il th e go od s ar e de liv er ed a t th e ag re ed u po n de st in at io n. T he b uy er is r es po ns ib le f or t he in su ra nc e. Al l c os ts a nd c us to m s ex po rt f or m al iti es u nt il th e go od s ar e de liv er ed a t th e ag re ed -u po n de st in at io n by t he c ar rie r’s v es se l. Th e bu ye r pa ys f or th e in su ra nc e, o ff lo ad in g co st s, an d ta xe s. Tr an sp or t An y An y O nl y m ar iti m e an d riv er O nl y m ar iti m e an d riv er O nl y m ar iti m e an d riv er An y O nl y m ar iti m e an d riv er Ta bl e 7. 1. In co te rm s – Co m m on ly u se d tr an sp or ta ti on t er m s So ur ce : A da pt ed f ro m In te rn at io na l F ed er at io n of R ed C ro ss a nd R ed C re sc en t So ci et ie s, H an db oo k fo r D el eg at es , a nd u pd at ed f ro m S er vi ci os A du an er os A vi m ay , I nc ot er m s 2 00 0 (S an Jo sé , C os ta R ic a, 20 00 ). 61Chapter 7: Receiving supplies In co te rm s DA F - De liv er ed a t Fr on tie r DE Q - De liv er ed E x Q ua y DD P - De liv er ed D ut y Pa id CI F - Co st , In su ra nc e, F re ig ht CI P - Ca rr ia ge a nd In su ra nc e Pa id t o DD U - De liv er ed D ut y U np ai d De sc rip tio n G oo ds d el iv er ed a t th e ag re ed u po n na tio na l b or de r, im po rt t ax es t o be pa id b y bu ye r Al l c os ts u nt il de liv er ed a t th e qu ay of t he d es tin at io n po rt G oo ds d el iv er ed a t th e ag re ed -u po n po in t w ith in t he d es tin at io n co un tr y; a ll ta xe s pa id G oo ds d el iv er ed a t th e ag re ed -u po n de st in at io n po rt ; a ll ch ar ge s pa id G oo ds d el iv er ed a t th e ag re ed u po n de st in at io n; a ll ch ar ge s pa id e xc ep t fo r ta xe s G oo ds d el iv er ed a t th e ag re ed -u po n po in t w ith in t he d es tin at io n co un tr y; n o ta xe s pa id Re sp on si bi lit y of t he S el le r Al l c os ts u nt il th e go od s ar e de liv er ed a t th e ag re ed -u po n bo rd er ch ec kp oi nt . Al l c os ts a nd c us to m s ex po rt f or m al iti es u nt il th e go od s ar e de liv er ed a t th e qu ay o f th e de st in at io n po rt , i nc lu di ng o ff lo ad in g co st s an d im po rt ta xe s. Al l c os ts a nd c us to m s ex po rt f or m al iti es u nt il th e go od s ar e de liv er ed a t an a gr ee d- up on p oi nt w ith in t he d es tin at io n co un tr y, in cl ud in g ta xe s. Al l c os ts a nd c us to m s ex po rt f or m al iti es u nt il th e go od s ar e de liv er ed a t th e de st in at io n po rt , i nc lu di ng m ar iti m e in su ra nc e. Sa m e as C PT , e xc ep t th at t he s el le r is a ls o re sp on si bl e fo r in su rin g th e go od s. Sa m e as D DP , e xc ep t th at t he b uy er m us t pa y th e im po rt t ax es . Tr an sp or t An y O nl y m ar iti m e an d riv er An y O nl y m ar iti m e an d riv er An y An y Ta bl e 7. 1. ( co nt in ue d) Humanitarian Supply Management and Logistics in the Health Sector62 Receiving Local Shipments Local shipments are generally less complicated than international ship- ments, since there is no need for the authorizations and other paperwork involved in moving goods across national borders. Nevertheless, prepa- rations are still required. These shipments are generally sent by land to their final destination in the field, for storage or distribution. They may arrive by commercial car- rier or in the transport vehicles available to the disaster relief organiza- tion. Offloading the Supplies Generally, final destination sites do not have access to hydraulic lifting equipment; instead, brawn and brain must come into play. It is impor- tant to know what type of vehicle will carry the load, and what the char- acteristics of the consignment are, in order to plan for its arrival. Factors to keep in mind when preparing to receive a shipment include: � A team should be available for offloading. It is also important to select carefully the precise spot where the consignment will be offloaded, preferably profiting from the topography of the ground by, for instance, improvising ramps or taking advantage of small irregularities so that the vehicle platform is even with the ground; � Car or truck tires (without the metal rim) can be used to cushion the fall of packages that cannot be unloaded by hand; � All possible safety measures must be taken for the protection of both the emergency supplies and the people offloading them. Regardless of the workload or the urgency with which the supplies may be needed, haste should not lead to accidents or damaged goods; � One person must be in charge of supervising and controlling the offloading process to prevent the inappropriate handling of the packages and to count the packages to make the sure the consign- ment is complete as indicated in the packing list. 63 Shipment Verification The content of the shipment must be verified at the point of reception and offloading. If this is postponed, it may never take place, or it may be done too late to identify anomalies and assign responsibilities. Verification must include as a minimum the following procedures: � Counting the packages and verifying the weight, which must corre- spond to the information on the shipping documents; � Verifying that the load does indeed contain the goods that were expected and identified in the shipping documents as well as the request order, if one was placed; � Checking the general condition of the load, both the packaging and the goods. It is important to watch out for leaks, torn packages, or items in poor condition; � Verifying if any items are missing. If there is evidence that some of the packages have been opened, it is important to find out whether any items have disappeared. Acknowledging Receipt of Goods Regardless of whether the shipment was international or national, the recipient must notify the sender of the arrival of the goods as soon as possible. After the verification process is complete, additional details should be sent concerning the condition and contents of the consignment. Controls The function of the shipping documents is to help verify that the ship- ment does indeed contain what was announced by the sender. It is always necessary to engage in double-checking by engaging in both documentary verification (what is stated in the papers) and visual or physical verification of the actual supplies received. The organization’s packing list should be the official document to guide the process. The sender or provider should be notified as soon as possible of any dis- crepancy or problem noted. These problems should be noted in the “Remarks” space of the packing list (see Annex 6.3, Chapter 6). A copy of the list must remain with the recipient, another copy is retained by the carrier as proof of delivery, and the third goes back to the sender. Chapter 7: Receiving supplies 64 Annex 7.1. Waybill 65 Explanation of Waybill16 1. Official Waybill Number. The first three digits are the International Air Transport Association’s (IATA) airline code. 2. Information on the shipper. 3. Information on the consignee. The provider must be asked to always include the consignee’s telephone number and exact address. 4. Issuing Carrier’s Agent information. The name and other details of the shipping agent or company that is handling the shipment. 5. Airport of departure. 6. These spaces are used if several airports will be involved in trans- shipment. 7. Currency of reference for calculating costs. 8. Depending on the Incoterms of the sales contract and invoice, this space indicates which charges are paid upon departure and which must be paid upon arrival. 9. This space must be filled in case the shipment has a declared value. 10. Airport of arrival. 11. Specifies the airline carrier (SN: Sabena; AF: Air France, and so on) plus the flight number. 12. Flight date. 13. Insured value assigned by the shipper. 14. Space for recording relevant information such as the documents that accompany the shipment, who must be notified upon arrival, etc. 15. Number of pieces. 16. Gross weight. 17. Chargeable weight. 18. Rate and charge (price per kg). 19. Nature and quantity of goods (including dimensions or volume). 20. A column specifying which charges have been prepaid and which must be collected from the consignee. 21. Other charges that must be paid. 22. Signature of issuing carrier or its agent upon the departure of the shipment (mandatory). Chapter 7: Receiving supplies 16 Source: Médecins sans Frontières, France. 66 Annex 7.2. Bill of Lading Explanation of Bill of Lading17 1. Official Bill of Lading Number. 2. Shipper. 3. Consignee. Not always the real or final recipient. The merchandise may be consigned to a shipping agent in case there is no represen- tative of the organization that owns the shipment at the place of delivery. In these cases the name and other information concerning the organization must be supplied followed by the phrase "care of" (c/o), authorizing the agent to handle the shipment. This is signifi- cant since the bill of lading, just like the waybill, are property titles. 4. Notify party – generally the organization as well as the agent. 5. Name of the ship and voyage number. 6. Port of loading. 7. Port of discharge. 8. The main body of the bill of lading, which contains, as required: � Number of container or quantity of pieces or pallets; � Customs seal number of the agent or shipper; � STC (Said To Contain): Declaration of the content; � Weight. 9. Total number of pieces or containers. 10. Details of prepaid charges and collect charges. 11. Number of original bills of lading. 12. Signature of the carrier’s agent upon delivery of the shipment (mandatory). 67Chapter 7: Receiving supplies 17 Ibid. 68 Annex 7.3. Declaration for Hazardous Materials Arrival and Recording of Supplies Procedures at Entry Points and Reception Centers Keeping records of which emergency supplies have arrived in eachconsignment is a key task—it is the first contact with incomingdonations, and effective record-keeping at this point will deter- mine to a large extent whether the rest of the system performs as it should. As noted in the previous chapter, supplies should be registered as soon as possible at the entry points and reception sites using a stan- dardized system that includes tools for control and follow-up. This requires the deployment of record-keeping and classification teams at each point, guided by a coordinator who can resolve disputes about sorting, classification, priorities and other issues concerning the dona- tions, their various categories, and other pre-established criteria. The SUMA methodology has produced positive results in countless emer- gencies and is a robust, well developed tool, which we recommend using. (See the SUMA System in Annex 8.1.) The most import record-keeping procedures at entry points are: � Using the standard definition of consignment employed in humani- tarian assistance operations, namely, a set of goods "that arrive at the same time, on the same means of transportation, from the same sender, and directed to the same recipient."18 � Making a record of each consignment upon arrival based on the shipping papers. Generally, entry points do not have the proper con- ditions (of space, for instance) to verify in detail that the shipment does indeed include all the items mentioned in the packing list; alternatively, the consignment may be addressed to recipients who must take the loads to their own warehouses. When recording incoming supplies, it is important to note as many details as possi- ble, such as: 69 Chapter 8 Record-Keeping, Control, and Monitoring of Supplies 18 Pan American Health Organization (PAHO), SUMA, User’s Manual, Washington D.C., PAHO: 1999. Humanitarian Supply Management and Logistics in the Health Sector70 � Consignee; � Point of departure; � Means of transportation; � Date and time of arrival; � Number of packages; � Weight (if possible, by category, e.g., 1,000 kg of food, 1 kg of drugs, and so on); � Contents and type of packing used; � Condition of the shipment upon arrival. � Sorting and labeling by priority. The organization in charge of han- dling the supplies should establish priorities for the different kinds of items based on the most urgent needs. For instance, in the event of an earthquake, medical supplies and equipment for treating injuries and fractures may be a priority, whereas during a flood it is food and water purification equipment that will require the most urgent distribution. Sorting by priority makes it possible to expedite the processing of the most urgently needed supplies, putting to one side those that can be sent later. All boxes and packages should be labeled clearly, indi- cating their priority, and grouped together in different sectors of the entry point or reception site. For instance, the SUMA system uses the following levels:19 Priority 1: Urgent—for immediate distribution. Identified by a red label. Priority 2: Non-urgent distribution. These are goods that are not immediately required but will be useful at a later stage of the emer- gency. Identified by a blue label. Priority 3: Non-priority goods—non-urgent distribution. Items that have been damaged, have expired, are unknown, useless, or of doubtful value. They are put to one side to be reexamined when time permits. Identified by a black label. 19 Ibid. Goods can also be labeled or marked to indicate that they need refrigeration or any other special treatment. � Incoming supplies should also be classified by categories and sub- categories, as mentioned in the “Categories” section of Chapter 5. Besides helping to identify the goods received, this helps to unify the classification, storage and inventory control processes. Control, Monitoring, and Follow-up Systems Emergency supplies will have to follow a route and a series of stages from the point of entry or reception until they are handed over to the end users, the affected population. To prevent losses or diversions, and ensure a more efficient use of resources, an instrument is required to cer- tify the progress of the supplies through the various stages and identify the next stage in the process. These controls should indicate what types of supplies have been mobilized, in what quantity, and in what condi- tion. They should also identify the parties that have intervened in the process. The documentary tools and the control and follow-up procedures should be agreed upon and designed during the preparation phase of logistics planning. The registration forms used should bear some kind of official stamp or logo, be consecutively numbered, and include copies for all the people responsible for the shipment at its various stages. The careful design of the documentation is important, since it should both confirm and com- plement the information gathered at the various stages of the consign- ment’s journey. It is also important to define clearly who will be responsible for control at each of those stages. When defining control procedures one faces the difficult task of finding a balance between the use of methods simple enough that they do not hinder the flow of supplies, and of methods suf- ficiently thorough to keep adequate track of the consignment’s move- ment, integrity, and condition as it goes through the various intermedi- ate points towards its final destination. A key issue is making sure that all the people in charge are familiar with the various types of documen- 71Chapter 8: Record-keeping, control, and monitoring of supplies Humanitarian Supply Management and Logistics in the Health Sector72 tation and procedures, and can supervise the various activities and human resources involved. The following aspects should be controlled at each stage of the move- ment of supplies within the affected country or region (see also Table 8.1): � Arrival of the donations and other supplies at the points of entry (ports, airports, borders) and the reception sites (collection centers, institutional warehouses, and so on) includes the following: � Arrival and registry of the goods; � Temporary storage; � Dispatch of the supplies (delivery to recipients for their use or distribution, delivery to authorized carriers for sending to other storage facilities). � Transport of the donations and other supplies to other storage facil- ities or their ultimate destination in the field includes: � Loading of the supplies; � Notification to the recipient of the delivery of the load; � Transport (including transshipments); � Offloading of the supplies. � Reception in the field or at secondary storage facilities requires: � Physical and documentary verification of the consignment (quantity, weight, quality); � Registration of incoming supplies; � Notification to recipient of the arrival of the load. � Storage of supplies includes these activities: � Record of the arrival of the supplies; � Inventory and stock control; � Sanitary and safety measures in the storage facility; 73 � Record of expiry dates and rotation of stocks; � Servicing and maintenance of equipment (e.g., water pumps, electrical generators, etc.); � Record and certification of the loss or destruction of items. � Record of the dispatch of the supplies to the final or intermedi- ate recipient. � Dispatch of the consignment from the storage site (deliveries for final use or for sending to distribution points) requires: � Loading the goods; � Notification of delivery to recipient; � Transportation (including transshipments); � Offloading supplies. � Distribution of the supplies includes: � Record of the supplies that arrive at the distribution points; � Storage; � Record and identification of beneficiaries; � Record of the delivery of the goods to the beneficiaries; � Inventory and stock control; � Daily distribution report. Chapter 8: Record-keeping, control, and monitoring of supplies Humanitarian Supply Management and Logistics in the Health Sector74 St ag e or s itu at io n Ar riv al in t he c ou nt ry o r th e em er ge nc y zo ne o f do na tio ns a nd o th er un so lic ite d hu m an ita ria n as si st an ce A sp ec ifi c re qu es t fr om th e fie ld is m ad e W he n do na tio ns a nd ot he r su pp lie s ar e se nt to t he f ie ld o r to de st in at io n ot he r th an st or ag e si te s Tr an sp or t of s up pl ie s Co nt ro l i ns tr um en t / pr oc ed ur es * - El ec tr on ic r ec or d (s uc h as t he SU M A sy st em ) - M an ua l r ec or d fo rm s - O ff ic ia l r eq ui si tio n fo rm w ith co ns ec ut iv e nu m be rin g - O ff ic ia l r eq ui si tio n fo rm , co ns ec ut iv el y nu m be re d - O ff ic ia l d el iv er y au th or iz at io n fo rm - O ff ic ia l d el iv er y au th or iz at io n fo rm - M an ife st o r pa ck in g lis t w ith co ns ec ut iv e nu m be rin g W ha t ne ed s to b e ve rif ie d - Co nt en ts b y ca te go rie s - Q ua nt ity a nd w ei gh t - Q ua lit y (c on di tio n of t he s up pl ie s) - Pl ac e of o rig in - Th at t he p er so n m ak in g th e re qu es t is a ut ho riz ed t o do so - Co nt en t of t he r eq ue st - Co ns ul t w ith p eo pl e in fi el d re ga rd in g do ub ts o r s ug ge st io ns - Th at t he p er so n m ak in g th e re qu es t is a ut ho riz ed t o do so - Si gn at ur es a nd s ta m ps f or d el iv er y au th or iz at io n - Th at t he lo ad t ha t is d el iv er ed c or re sp on ds (i n ty pe a nd qu an tit y) t o w ha t ap pe ar s on t he s hi pp in g do cu m en ts - De st in at io n of t he lo ad - Si gn at ur es a nd s ea ls a ut ho riz in g de liv er y - Th at t he lo ad c or re sp on ds t o w ha t ap pe ar s in s hi pp in g do cu m en ts (t yp e, q ua nt ity ) - De st in at io n Ve rif ic at io n si te - Po in ts o f en tr y (p or ts , ai rp or ts , b or de rs ) - Re ce pt io n ce nt er s an d ot he r c ol le ct io n fa ci lit ie s - Si te w he re r eq ue st is re ce iv ed - Te m po ra ry s to ra ge s ite - Du rin g th e lo ad in g of su pp lie s in to t he ag re ed -u po n ve hi cl e - Te m po ra ry s to ra ge fa ci lit y - Du rin g th e lo ad in g an d of flo ad in g of su pp lie s * A ll fo rm s m us t be c on se cu tiv el y nu m be re d an d in cl ud e ca rb on c op ie s fo r ea ch o f th e pe op le r es po ns ib le f or a ny s ta ge o f th e sh ip m en t. Ta bl e 8. 1. S up pl y m on it or in g an d co nt ro l m at rix 75Chapter 8: Record-keeping, control, and monitoring of supplies St ag e or s itu at io n Re ce pt io n of s up pl ie s at th e pl ac e w he re t he y w er e re qu es te d St or ag e of s up pl ie s Di st rib ut io n of s up pl ie s Co nt ro l i ns tr um en t / pr oc ed ur es * - M an ife st o r pa ck in g lis t w ith co ns ec ut iv e nu m be rin g - Fo rm t o re co rd t he a rr iv al o f th e lo ad a t th e re ce pt io n fa ci lit y - Re co rd o f su pp lie s ar riv in g at t he w ar eh ou se - Ph ys ic al a nd d oc um en ta ry in ve nt or y - Re co rd o f su pp lie s le av in g th e w ar eh ou se - Re co rd a nd c er tif ic at io n of lo ss o r de st ru ct io n of g oo ds , o r of de fe ct iv e, e xp ire d ite m s - Fo rm s ho w in g ar riv al o f su pp lie s at re ce pt io n ce nt er - Re gi st ra tio n an d id en tif ic at io n of co ns ig ne es - Di st rib ut io n ca rd s - Di st rib ut io n re po rt f or m - St oc k co nt ro l W ha t ne ed s to b e ve rif ie d - G en er al c on di tio n of t he lo ad - Th e co nt en ts , q ua nt ity a nd q ua lit y of t he g oo ds r ec ei ve d m us t co rr es po nd t o w ha t w as r eq ue st ed - Th e lo ad s ho ul d co rr es po nd t o w ha t is s ta te d in t he sh ip pi ng p ap er s - In ve nt or y co nt ro l - H yg ie ne a nd w ar eh ou se s ec ur ity m ea su re s - Co rr ec t ro ta tio n of s to ck s - Co m pl ia nc e w ith c rit er ia f or c ho os in g be ne fic ia rie s - Co rr ec t ap pl ic at io n of e st ab lis he d pr oc ed ur es a nd in st ru m en ts f or s up pl y di st rib ut io n - Re co nc ile d iff er en ce b et w ee n di st rib ut ed a nd r em ai ni ng su pp lie s Ve rif ic at io n si te - Re ce pt io n si te - Di st rib ut io n po in ts - St or ag e ce nt er s in di st rib ut io n ar ea s - Di st rib ut io n si te s - St or ag e ce nt er s in di st rib ut io n ar ea s * A ll fo rm s m us t be c on se cu tiv el y nu m be re d an d in cl ud e ca rb on c op ie s fo r ea ch o f th e pe op le r es po ns ib le f or a ny s ta ge o f th e sh ip m en t. Ta bl e 8. 1. ( co nt in ue d) Humanitarian Supply Management and Logistics in the Health Sector76 Dealing with Non-Priority Items and Other Supplies20 A significant proportion of incoming donations contain non-priority items or, simply, items that are useless or irrelevant. Both types of sup- plies increase the workload. However, it is important to make a distinc- tion between the two. Non-Priority Items As noted earlier in this chapter, some supplies may arrive that are not a priority but might prove useful at another stage of the emergency. Therefore, these products must be classified, labeled and stored until they are needed. Discarding Other Supplies Those items that are considered useless due to their condition (damaged, expired, totally inappropriate) should be discarded as soon as possible, particularly to make room for useful supplies. Regrettably, this is not an easy process, since quite often these supplies arrive by the ton, requiring their own logistics in terms of transport, tem- porary storage, and waste management. There is also a diplomatic or public relations difficulty, since the public— including the donors—are not pleased to see supplies discarded that in their opinion are needed to satisfy the needs of the affected population, although in reality they are not appropriate for human use or consump- tion. Discarding these items should be taken very seriously: they are not "sim- ply garbage". It is often more convenient to keep them in storage until they can be discarded safely, rather than discarding them where people may recover them or where they could constitute a public health hazard. These materials may be incinerated, buried, or otherwise disposed of. The 20 On the question of discarding drugs and other medical supplies, see Annexes 12.1 and 12.2 in Chapter 12, "Managing Medical Supplies". key is to have clear guidelines about the disposal process, so as to dis- courage improvisation. The situation is even more delicate when it comes to drugs or hazardous materials, which cannot be discarded with- out the participation of specialists, given the special handling and dis- posal they require. 77Chapter 8: Record-keeping, control, and monitoring of supplies 78 Annex 8.1 The SUMA System for Managing Humanitarian Assistance The Humanitarian Supply Management System (SUMA) was launched as a collective effort by the countries of Latin America and the Caribbean, with the technical support of the Pan American Health Organization (PAHO), the Regional Office for the Americas of the World Health Organization (WHO), and with the financial support of the government of the Netherlands, to improve the management of humanitarian sup- plies in disaster situations. Its objective is to help resolve the multiple problems involved in the mass arrival of assistance to a region or country affected by a disaster, whether supplies come from other cities or regions within the affected country, or have been provided by the international community. SUMA’s systematic approach, involving trained staff, sound classifica- tion procedures, and a user-friendly, flexible information technology mechanism, ensures that incoming supplies are properly sorted, invento- ried, prioritized, and stored at their point of entry. To attain this objective, all donations, regardless of their origin or ulti- mate recipient, are processed at the point of entry using the SUMA sys- tem before they are delivered. This requires that relief management organizations and institutions, whether governmental or nongovern- mental, cooperate closely to adopt operational policies and strategies before a disaster strikes. As countries gain experience in the use of SUMA, they often start imple- menting it to meet goals that were not included in the original SUMA project. A case in point is the use of SUMA to keep track of supplies pro- vided by local rather than international donors. Similarly, the system has been implemented at the local level to set up two field units at the same location, one to receive incoming donations and the other to manage their distribution. Regardless of how the system is adapted to local needs, it must be stressed that SUMA need not be used only for large-scale emergencies that require international support, but also can be used locally whenever the need arises to receive or mobilize supplies. 79 System Components The system has three levels: 1. SUMA CENTRAL 2. The SUMA Field Unit 3. Warehouse Management � SUMA CENTRAL is designed to operate at emergency management headquarters, i.e., the facilities where national authorities are man- aging a disaster or emergency. At this level, the main tasks are to: � Establish the criteria to be used by the Field Units, such as reception sites, consignment directories, definition of the main user, etc.; � Create Field Units; � Consolidate the information sent by the Field Units; � Respond to queries and prepare reports to support the decision- making process and promote inter-institutional coordination; � Maintain the program tables (lists). � FIELD UNITS are designed to work at the points of entry (e.g., bor- ders, ports), and at local collection centers where supplies arrive dur- ing an emergency, such as airports, collection sites, etc. The main tasks at this level are to: � Sort and identify incoming supplies and label them “URGENT – FOR IMMEDIATE DISTRIBUTION,” “NON-URGENT DISTRIBU- TION,” and “NON-PRIORITY ITEMS;” � Classify supplies by category and subcategory, and itemize them; � Reply to selective queries about available items; � Prepare reports on consignments that have arrived at that field unit; Chapter 8: Record-keeping, control, and monitoring of supplies Humanitarian Supply Management and Logistics in the Health Sector80 � Provide delivery receipts for recipients; � Consolidate all relevant data on diskettes to be sent to SUMA CENTRAL. The SUMA Field Unit team also uses paper forms in case the computers fail, or whenever the logistics of data collection requires their use. � The WAREHOUSE MANAGEMENT module is a tool that registers the arrival of supplies to storage centers or warehouses and their depar- ture for distribution. These warehouses receive supplies as well as electronic tracking information sent on diskette by the Field Units or SUMA CENTRAL. In this way, institutions can coordinate the inter- nal management of relief supplies or their distribution to other facil- ities or organizations involved in disaster relief efforts. The main tasks carried out at this level are: � Keeping track of the local inventory; � Preparing reports on existing stocks and deliveries, according to several criteria and categories; � Following up on the inventory in other warehouses, whether they are branches of the main warehouse or separate collection centers. The Consignment A consignment is the basic unit of reference for recording supplies using the SUMA system. It is a set of supplies that the same sender sends to the same recipient and that arrives at the same time by the same means of transport. The entire process of classifying and manipulating data on incoming supplies focuses on consignments. The point of entry is the place where consignments arrive: sea and river ports, airports, borders, customs offices, warehouses, etc. 81 Activities in the Supply Reception Facilities Before supplies can be delivered to their intended recipients, three steps must be taken: � Sorting; � Classifying; � Taking inventory. Sorting Supply management and distribution priorities are determined by the guidelines set forth by the emergency management agency or the SUMA Team Coordinator. These priorities depend on the type of disaster and the national or local needs. For instance, in the event of an earthquake, med- ical supplies for the treatment of wounds and fractures would be crucial; in the case of floods, priority items would include food and water. All incoming boxes and packages must be sorted and then labeled and color-coded so as to show clearly their level of priority. Moreover, health supplies must be identified with an additional green label. SUMA’s pri- ority levels and corresponding color codes are the following: Priority 1: URGENT – FOR IMMEDIATE DISTRIBUTION. These items must be distributed immediately at the site of the emergency. Label color: Red. Priority 2: NON-URGENT DISTRIBUTION. These items are not urgently needed during the critical phase of the emergency, but may be useful later, during the reconstruction or development phases. Label color: Blue. Priority 3: NON-PRIORITY ARTICLES. Some supplies may already have expired, or they have been damaged in transit. It may be impossible to identify them, or they will be useless in the context of the current emer- gency. Alternatively, they may have been packed together in such hap- hazard fashion that it would be impossible to sort them efficiently dur- ing the critical stage of the emergency. In these cases, recipients may classify these items later, when time and resources allow. Label color: Black. Chapter 8: Record-keeping, control, and monitoring of supplies Humanitarian Supply Management and Logistics in the Health Sector82 Classification Within the SUMA system, relief supplies fall into one of the following 10 technical categories: 1. Medicines; 2. Water and environmental health; 3. Health supplies/Kits; 4. Food; 5. Shelter/Electricial/Construction; 6. Logistics/Administration; 7. Personal needs/Education; 8. Human resources; 9. Agricultural/Livestock; 10. Unclassified. The basic recording unit in each consignment is the item. Examples include wheat, canned soups, aspirin and lidocaine. Each item can be identified by a series of characteristics such as its generic and brand names, its presentation and packaging unit (pills, kilograms, boxes or bags), and the total quantity received. Each item falls within a category and a subcategory. For instance, an ambulance would be an item that would fall within the "Health" catego- ry and the "Transport of patients" subcategory. The “Unclassified” category enables the staff at the point of entry to deal with expired items, items that are unidentifiable or unusable, or items that are to difficult to sort on the spot and must be classified eventual- ly by the recipient when time and resources allow, during or after the emergency. Inventory The inventory stage makes its possible for daily reports to be sent to the relevant national or local authorities on what supplies have been received and other relevant data, including the sender, the intended recipient, the categories of the supplies received, their quantity, and so on. Recipients can then make informed decisions on how to allocate these resources and otherwise manage the emergency. They can also notify donors directly of the arrival of their consignments. 83 Emergency supplies must be stored until they can be distributed orused. However, it is not simply a matter of finding a warehouselarge enough to accommodate the shipments. An organized sys- tem must be in place to keep track of the type and quantity of supplies and their location in the warehouse, including reserve stockpiles for future needs. The entire storage process is of crucial importance for pro- tecting emergency supplies until they can be handed over to their recip- ients. Organizing a warehouse so that it functions correctly means com- plying with current standards for protecting the quality and security of the products shipped. Some warehouses have been specially designed to facilitate storage, hav- ing the necessary space and characteristics for the safe loading, offload- ing, and handling of the merchandise. However, in most emergencies one has to settle for whichever spaces are available—and these are often schools, community centers, gyms, and the like, that were not designed for storage. While it may not be possible to apply the following warehouse manage- ment standards and procedures to the letter, they should guide the stor- age process regardless of whether the warehousing facilities were built for that purpose or improvised by adapting other available facilities. Types of Warehouse Ignoring for the moment their physical characteristics, warehouses tend to fall into four types depending on their function. In reality, however, they are seldom separate, but are often different sectors of the same building, depending on the type of supply handled, the size and duration of the operation and, above all, the availability of space. General Delivery Warehouse: This is a warehouse, often large, where products may be stored for a long time or just until they can be sent to Chapter 9 Storage21 21 This chapter would not have been possible without contributions by Médecins sans Frontières (MSF) and Gerard Gómez, delegate of the MSF Latin America and the Caribbean Regional Office for Emergencies. Humanitarian Supply Management and Logistics in the Health Sector84 secondary warehouses or distributed in the field. General delivery ware- houses are often located in the capital of the country or at strategic points of a given region. Slow Rotation Warehouse: A warehouse where non-urgent or reserve stockpiles are kept, including goods that are not in frequent demand, such as spare parts, equipment, tools, and so on. Quick Rotation Warehouse: A warehouse where emergency supplies tend to move quickly in and out, on a daily or at least fairly regular basis. Such warehouses are more common near the heart of the emer- gency zone, and tend to store goods that require prompt distribution among the affected population. Temporary Collection Sites: In the course of an emergency, it is com- mon to use any space available to stockpile incoming supplies until a more appropriate space can be found. The yards, offices, meeting rooms, and garages of disaster relief organizations quickly fill up with moun- tains of clothes, food, drugs, and other products. It is generally hard to set up an organized storage system in such places, particularly due to lack of space, and it is desirable to move the supplies to a proper ware- house as soon as possible. However, temporary collection sites can be used to sort and classify the donations, so as to send to the warehouses proper only those goods considered useful, already presorted by catego- ry. The Choice of Storage Site A special effort must be made to find an appropriate place for storing emergency supplies, even though choices are often few in an emergency zone. When selecting the site, however, certain basic issues must be borne in mind. Type of Supply To Be Stored Pharmaceutical products and foods require a well-ventilated, cool, dry place. Some of these products may even need temperature control. Other items, such as clothing or equipment, have more flexible requirements. Emergency supplies tend to include a bit of all these items, and quite often they have to be stored in the same warehouse. 85 Size and Access to the Site The size of the storage site is highly important. One must take into account not just its current capacity but also the potential for expansion of the storage area. It is always better to find a place that is larger than appears necessary. Access is another key issue, particularly by large vehicles. Location and distance in relation to the emergency zone are also important. � Internal conditions of the site (structural and nonstructural): Ideally, the warehouse should be a sturdy concrete building. Regardless of the construction materials employed, however, it should be in a good state of repair and maintenance, and not require major repairs to make it functional. It must be roofed and have doors; good lighting and ventilation are also necessary. Before the warehouse is used for the first time, it is important to check and repair the electrical installations, the water-supply and sanitation system, any leaks in the roof, and any cracks or holes in the walls or floors. � External site conditions (topography and social environment): The site should be checked for its vulnerability to natural hazards, such as the risk of flooding or landslides. Stagnant water, nearby waste disposal sites, overgrown weeds and other deficiencies should be avoided or remedied. The social environment must also be eval- uated to prevent any security problems that may arise. Estimating Storage Needs and Capacity22 The size of the warehouse needed depends on the quantity of supplies expected. However, in emergency operations it is generally hard to fore- see how many packages or bundles will come in, since most of the items sent are unsolicited. It is therefore best to choose the largest possible space, even if at first the quantity of supplies does not seem to justify such a course of action. Storage space is three-dimensional, i.e., it has width, height, and depth. Chapter 9: Storage 22 This segment is partly based on the United States Defense Logistics Agency’s (DLA) Stockpile Administration Handbook, elaborated by John Price II. Penn. (New Cumberland, Pennsylvania, U.S.A., 2000). Humanitarian Supply Management and Logistics in the Health Sector86 In order to determine the useful capacity of a site, some basic variables must be known (see table 9.1): � Gross space – Measured in square meters, it is the total dimensions of the warehouse (the space inside the walls) and is obtained by mul- tiplying the length of the space by the width. � Gross cubic meters – Looks at the entire vertical and horizontal space. It is obtained by multiplying the width by the depth by the height of the building. � Structural loss – It is the space that is "wasted" since it is occupied by pillars, columns, dividing walls, bathrooms, and any other struc- tural component within the building. � Support space – Offices, space to store warehousing equipment such as forklifts, and the operations area (classification, packing, etc.). � Net square meters – It is the actual storage space. To obtain this fig- ure, subtract from the gross space the structural loss, the support space, and any other area that cannot be used for storage. � Net cubic meters – This includes the entire vertical and horizontal space less the structural loss and overhead obstructions (lamps, pipes, beams, etc.). Table 9.1. Basic formulas for measuring storage space Width x depth = square meters (m2) Width x depth x height = cubic meters (m3) Total square meters of the space – (structural loss + support space) = net square meters (i.e., actual available storage space) 87 Moreover, it must be borne in mind that different supplies have differ- ent "storage volume" requirements. Table 9.2 shows examples of the esti- mated space needed to store a metric ton of different types of supplies. There are times in emergency operations when greater control over sup- plies is feasible. For instance, when food is distributed in a temporary shelter, the number of refugees may be well known, making it possible to predict the quantity of food supplies and the storage space needed. Table 9.3 illustrates how to estimate the space needed for a known quan- tity of supplies. Chapter 9: Storage 23 Taken from International Federation of Red Cross and Red Crescent Societies (IFRC), Handbook for Delegates, Geneva, 1997. Table 9.2. Space required to store metric ton of selected items23 Grains (rice, corn), flour, sugar in sacks 2m3 Powdered milk in sacks or boxes 3m3 Pharmaceuticals 3m3 Vegetable oil in cylinders or tins 1.5-2m3 Blankets in compressed packages (approx. 700) 4-5m3 Loose blankets 8-10m3 Clothes 7-10m3 Tents (approx. 25 family tents) 4-5m3 Kitchen utensils (between 35 and 40 boxes) 4-5m3 Another simple tool for estimating the area required is shown in Table 9.4. Table 9.4. Area estimate for 100 tons of rice with a storage height of two meters Humanitarian Supply Management and Logistics in the Health Sector88 Need to know Population to be served Intended distribution of supplies Frequency of distribution Estimated period of time during which these supplies will continue to be nee- ded Weight / Unit volume of goods Reserve supplies Examples Expected arrival of 30,000 people One tent per family (average of 6 people per family) Once Three months 1 metric ton = 25 tents = 5m3 10% Calculations Quantity of tents to store = 30,000/6 = 5,000 + 10% = 5,500 tents Volume of the tents = 5,500/25 x 5 m3 = 1,100 m3 For a height of 2 meters, floor area required = 1,100 m3 / 2 m = 550 m2 Load on the floor = 5,500 tents/25 tents per metric ton = 220 MT 220 MT / 550 m2 = 0.4 MT or 400 kg/m2 (acceptable) Estimate 550 m2 + 20% for access and ventilation = 600 m2 of floor space 24 Taken from UNHCR, Supplies and Food Aid Field Handbook, Geneva, June 1989. 25 Taken from International Federation of Red Cross and Red Crescent Societies (IFRC), Handbook for Delegates, Geneva, 1997. Table 9.3. Determining the storage capacity needed24 1 MT of rice = 2 m3 100 MT of rice = 200 m3 Area needed for the item: 200 m3 (2m = 100 m2) Total floor area required: 100m2 + 30% = 130 m2 Verification of real load capacity per m2 = 100 MT : 100 m2 = 1000 kg/m2 89Chapter 9: Storage Alternative Storage Sites There will be times when it is impossible to find an adequate structure to warehouse the goods, and it becomes necessary to explore alternatives for temporary storage. One option is to build a temporary structure out of timber and corrugat- ed iron, or using reinforced plastic, a procedure employed by Médecins sans Frontières or USAID/OFDA. Other alternatives include prefabricated structures for building hangars, which come with curved metal sheets that can be quickly assembled. Simpler but strictly short-term solutions include storing the supplies in shipping containers or in the trucks in which they arrived. This is not advisable in the case of drugs or food, which have little resistance to high temperatures. In any case, the decision of what type of structure should be built is directly related to the expected duration of the operation, as well as the possibility of finding a site with better conditions in the near future. If an alternative storage site is built, it must meet the same standards men- tioned in the section “Choice of Storage Site” of this chapter. Staff Required One individual must be in charge of managing the storage process, although he or she may of course have assistants depending on the vol- ume of operations. The key point is to prevent several people from hav- ing the same level of authority, since this causes confusion in the man- agement of the supplies, making it hard to determine who is responsible when problems arise. A team is required for maintenance and for handling the supplies in the warehouse area (offloading, loading, classification, moving items, and so on). This team can comprise relief personnel, volunteers from communi- ty organizations, or even the victims themselves. The use of local volunteers reduces operational costs. However, problems may arise regarding the security of the goods or the stability of the staff. Although the job does not involve highly specialized tasks, volunteers Humanitarian Supply Management and Logistics in the Health Sector90 must still receive basic training to do their job, and providing this train- ing can be a waste of resources if people keep dropping out of the effort. When disaster victims participate in storage management, a "food for work" arrangement can be a good way of providing payment in kind for the beneficiaries’ work. However, consultations should first be made with the donors of the food, since some organizations, such as the World Food Program (WFP), have restrictions in this regard. In any case, the coordinator must receive a salary, given the nature of his or her functions and responsibilities. It is also necessary to hire secu- rity personnel to guard the supplies and control the arrival of unautho- rized parties. To ensure that they perform their jobs as intended, all staff members must receive a written job description with clear instructions about their functions and duties. Equipment and Material Required in the Warehouse To ensure that the warehouse functions properly, some basic equipment and materials are required. The following are some examples: � A computer system should be in place with preinstalled software such as the SUMA applications, a spreadsheet program, or any other electronic method to record and keep track of supplies and their movements; � Forms and cards to control stocks and inflows and outflows of prod- ucts. Basic stationery, calculators, and other office supplies; � A metallic filing cabinet with a lock; � A first-aid cabinet and fire extinguishers of the ABC type; � An electric generator with its own maintenance material; � Refrigeration equipment; � Shelves and wooden pallets on which to stockpile products; � Tools for opening and closing crates and boxes, adhesive tape for packaging; 91 � Scales, metric measuring tape, ladders; � Cleaning materials and products; � Wheelbarrows and hydraulic loading and moving equipment; � Safety gear for the workers; � Weights and measures conversion tables. Warehouse Sectors Normally, 70% of the available space in a warehouse is used for storage, and the remaining 30% as working areas for handling and moving goods, packing, and access. To make a warehouse more functional and practical, it is necessary to identify its specific sectors. A basic space dis- tribution scheme can be summarized as follows: � Arrival zone:26 The place where supplies arrive and are offloaded. Supply reception, verification and control should take place here before the goods are stored; � Sorting, classification and recording zone: This is where supplies are sorted by priority (urgent, non-urgent, useless) and are classified by category and subcategory; � Packing and delivery preparation zone: This is where supplies are prepared for delivery to the next or final destination. Empty boxes and packing material can also be kept here in case some items need to be repackaged; � Storage area: This is the place to store the donations and other sup- plies that have not yet had a destination assigned to them. The area is divided according to the type of supply: food, clothing, personal needs, medical products, etc.; � Delivery zone: This is where supplies are kept when they are ready to be delivered. The supplies should be kept on separate pallets and labeled according to their destination; Chapter 9: Storage 26 The arrival zone and the delivery zone should coexist in facilities that have only one access door. In these cases, each side of the entrance (left or right) should be assigned permanently for one activity, either loading or offloading. Humanitarian Supply Management and Logistics in the Health Sector92 � Administrative sector: It can be a simple desk and filing cabinet (metallic, with a lock) for handling administrative matters. Figure 9.1 shows the plan of a warehouse with all the sectors described above. Planning the use of space and the internal distribution of the sectors should be carried out before the first supplies arrive. It is advisable to place marks on the floor to identify where the various types of supplies are to go. When the various sectors have been marked off, signs similar to those used in supermarket aisles can be hung to indicate where the different kinds of supplies can be found in each sector. 93Chapter 9: Storage Supplies stored by sector Supplies stored by sector Supplies in greatest demand Delivery zone Main transit corridor Arrival zone Supplies in greatest demand Packing and delivery preparation zone Supplies in greatest demand Reception, sorting and recording zone Administrative and services sector Storage area for supply handling equipment Area for storage and safekeeping of valuable items Supplies in greatest demand Supplies in greatest demand Supplies in greatest demand Figure 9.1. Warehouse sectors and movement zones Humanitarian Supply Management and Logistics in the Health Sector94 Storage and Internal Distribution of the Supplies The golden rule of warehouse management is never to mix products of a different sort on the same rack, pallet, or pile. In particular, hazardous materials (including powdered cement) should not be stored in the same place as food and other products for human consumption or use. Likewise, there are a series of factors that must be born in mind when planning how to use the space, for instance: � Similarity and quantity: Products of the same type should be stored together, not in multiple locations throughout the warehouse; � Demand: The goods that are in greater demand should be placed in the most accessible areas; � Measurements and weight: The larger and heavier the packages, the lower their stacks should be; � Characteristics: One must bear in mind the particular characteristics of the goods, such as whether they are hazardous to human health, fragile, sensitive to light or humidity, perishable, and so on. Other key issues are the following: � The place should be cleaned thoroughly before being used as a warehouse for emergency supplies, and it should be kept clean thereafter. Having the place sprayed for pests before any goods are stored is highly recommended. The floor should be clean and dry before any of the goods are stacked on it; � Supplies should be stored by sectors, depending on their type; � To prevent humidity and other problems, the products should not be in direct contact with the floor or walls. Pallets or other platforms should be used; they should be free of protruding nails or splinters that can tear the packages and bales; � If there are not enough pallets, they should be used primarily to sup- port those products that are less resistant to humidity or have been stored in sacks, paper bags, or cardboard boxes. Bottles and tins can 95 be stored directly on the floor, although not for long. Another tem- porary solution is to layer the floor with plastic sheets; � Floor strength should be borne in mind when piling packages of a given weight. Special precautions should be adopted when items are stored on an upper story; � The height of the stowage should be based on the resistance of the packing material or the instructions on the boxes or crates, if any. It is also important not to block the lighting or ventilation in the ware- house; � To prevent stacks from tipping over, it is wise to alternate the direc- tion of the boxes or bales on each layer; � Height should be kept to a minimum. Avoid high stacks of heavy boxes or packages. If working in an area at risk from seismic activ- ity, it may be necessary to add some external support to the stacks to reduce the danger of collapse; � There must be sufficient space between the stowage racks or shelves to allow for the free movement of the people engaged in the main- tenance, control, or handling of the goods. Room must also be made for the unencumbered movement of hydraulic lifting equipment if available, as well as to allow for air to circulate. The recommended distance is between 70 cm and 1 m, depending on the availability of space; � Special care must be taken to ensure that liquids, such as cooking oil or water, are stored upright in their containers to prevent leaks; � Torn packages should be repacked or distributed as soon as possible, as long as the damage to the packing does not entail a risk for the human consumption of the product; � Items for human use or consumption should never be repacked in containers whose previous content is unknown, since they could have contained hazardous products. Chapter 9: Storage Procedures for Arrival and Dispatch These procedures are carried out in the areas designated for arrival and dispatch of goods at the warehouse, using the appropriate forms. These procedures should be established in advance, be thoroughly understood by the people in charge, and used systematically. Forms should include spaces for the names and signatures of the people involved in the process. (See Annexes 9.1 and 9.2.) Arrivals The following are some of the standard procedures that should be applied when supplies arrive at the warehouse: � Every load that arrives should be checked to see if the quantity, weight, and quality correspond to the information contained in the shipping papers, by carrying out a physical examination of the load; � Once verification is made, goods should be recorded in the ware- house inventory. It is important to write down any special informa- tion about the supplies, such as whether a smaller quantity than expected was received, or the items were different from those men- tioned in the packing list. On these occasions, a file must be opened about each specific case, for future verification and reference when investigating the anomaly; � Sometimes all or part of some consignments may be returned to the warehouse, because they could not be distributed or were not needed. These should be recorded as returns, not as new arrivals; � By engaging in a physical examination of the load, it should be pos- sible to identify: � Bundles, crates, boxes, or sacks that are torn or wet; � Packages that show evidence of having been rifled; � Leaking containers; � Tins that are bulging, rusty or crushed, which might indicate that the contents are not suitable for human consumption; Humanitarian Supply Management and Logistics in the Health Sector96 � Tinned items without a label, with labels in an unknown lan- guage, or with expired dates. These products should not be dis- tributed, since it is impossible to guarantee the quality of their contents; � When food is received, say grains or cereals, it is important to ver- ify that there has been no contamination by insects. If insects are detected, the products should not be allowed into the warehouse to prevent infestation of the food already in storage. Any disinfectant treatment should be carried out by a specialist; � Powdered milk must be inspected to make sure it is not rancid; � In the case of corn, rice, beans or other grains, it must be determined upon arrival if they are meant for consumption or as seeds for sow- ing. Again, the inspection should be carried out by a person trained to make such distinctions. Dispatch The following are some of the standard procedures when dispatching supplies from the storage site: � Products should spend as little time as possible in storage; hence the rotation of the stocks on the basis of "first in, first out". The items that have been in the warehouse longest should be placed in the front rows of the stowage racks so they can be distributed first, and the items that come in later are to be placed at the back, rotating them to the front as deliveries are made; � The same principle applies to products with an expiry date: the first to be dispatched are those nearest their expiry date; � A dispatch can only be carried out with an official authorization document that has been signed by the person authorized to do so; � The same procedure of physical and documentary verification that was carried out when goods entered the warehouse must be carried out when they leave the warehouse, to make sure that the supplies that are being delivered correspond to the packing list or other iden- tification documents; 97Chapter 9: Storage Humanitarian Supply Management and Logistics in the Health Sector98 � Every dispatch must be recorded so it can be withdrawn from the inventory records. Control and Monitoring Systems It is part of the responsibility of warehouse managers to ensure that sup- plies are used by those who really need them, and prevent their loss or diversion. Pilferage or theft should be kept to a minimum. Similarly, the storage conditions must be such that they allow for the optimum con- servation of the supplies. Security of the Supplies � Only the authorized staff should have free access to the warehouse facilities. The presence of third parties should be discouraged as much as possible, and their access regulated and only allowed when in the company of an authorized official. � The storage area must be secured against break-ins and theft by means of locks, fences, external perimeter lighting, and so on. � Whenever possible, the most valuable goods and items must be kept under lock and key. � The use of the keys to the warehouse must also be strictly controlled. � Finally, guards must be available around the clock, seven days a week. Rotation of the Supplies � Minimum and maximum stock levels must be determined, as well as the point at which new supplies must be requested. The size of the stockpiles may differ depending on the type of supply and its rota- tion cycle. � The "first in, first out" principle must be applied strictly, which in turn requires an up-to-date list of the dates of arrival and expiry dates of the goods. Control and Monitoring � Clear and strict procedures must be in place to control the arrival and delivery of the supplies. � Each new arrival must be recorded in the inventory. Even those products that arrive in poor or unusable condition must be recorded as such. � A stock control card must be available for every type of product stored in the warehouse (see Annex 9.1). On the card, the dates and quantities that have arrived must be recorded; spaces must also be available on the card to register information about the delivery of the supplies. The current level of stocks of the same product must be recorded, as well as the sector of the warehouse where the product is kept. � Regular inventories should be performed; control cards, printed inventories, and the computer database (if one is in place) should be kept up to date. Inventories and delivery documents should corre- spond to the information recorded on the stock control cards. � Clear and up-to-date controls and records of losses and certification of expired or spoiled items must be kept. Normally, the destruction or discarding of expired or spoiled medicines must be carried out under the supervision of a specialist. � Individual forms are needed to record all warehouse activities, such as arrivals, deliveries, and requisitions. (See Annexes 9.2 and 9.3.) These forms should be numbered consecutively and must include the date and basic information about the people involved in the process. Occupational Health and Safety in the Warehouse The warehouse should be a safe place not only for the emergency sup- plies but also for the people who work with them. Occupational health and safety measures must therefore be designed in advance and imple- mented rigorously. � There should be no smoking in the warehouse; 99Chapter 9: Storage Humanitarian Supply Management and Logistics in the Health Sector100 � All the staff must be aware of existing hazards and security mea- sures to prevent accidents; � Maintenance staff must wear protective devices for their backs and hands handling shipments. Any other protection devices or toos required to carry out their tasks safely must be rigorously employed at all times; � Signs and labels alerting workers to any type of danger should be clearly visible; � Fire extinguishers and first-aid equipment should be clearly visible, located in an accessible place, and be in good working condition. The people who work in the warehouse should know how to use all such equipment. Maintenance and Sanitation Measures Maintenance Regular inspections should be carried out to determine the condition of the building, particularly its electrical installations, locks, roof, and structural integrity in general. Any necessary repairs must be carried out as soon as possible to prevent the damage from getting worse. Hygiene The warehouse and its environs should remain clean at all times. The uncontrolled accumulation of waste products such as empty cardboard boxes should be discouraged. It is important to get rid of stagnant water, overgrown weeds, or any other feature in the vicinity that may encour- age the proliferation of insects and rodents. A warehouse cleaning plan must be implemented, including both daily and periodic cleaning sessions. An inspection of the state of cleanliness of the stowage racks, corners, and sectors of the building must be car- ried out regularly. Similarly, a plan must be in place for managing and disposing of solid waste, whether spoiled supplies, packing material, or 101 empty containers. Warehouse inspections should be carried out at least once a week, in order to detect problems. These inspections must include, as a minimum, the following tasks:27 � Checking for and eliminating from the food piles insects, spider webs, or cocoons; � Detecting damage caused by rodents, birds or insects, or the careless extraction of samples from the grain and cereal sacks; � Looking for damage caused by water or humidity, such as mold, stains, discoloration, or hardening of the packages, bales and bun- dles; � Detecting leaks in containers and the loss of supplies due to tears in the packages; � Detecting tinned food cans that are bulging, leaking, or rusty; � Detecting signs of fermentation in cereals. Several layers of the stowage piles should be sampled, particularly the ones in the mid- dle. The inspection should cover all sides of the stowage piles. All corners and dark areas of the warehouse should be inspected to locate potential rodents’ nests or an accumulation of dust or waste. The most useful measure that can be taken to get rid of insect or rodent infestations is to prevent them in the first place. Domestic animals must not be allowed into the warehouse. Contaminated food should not be mixed with other products for human consumption. It is common to fumigate warehouses every so often. However, this should be undertaken by qualified exter- minators only. As a complement to these hygienic measures, Table 9.5 shows some con- ditions that must be met for the correct storage of certain supplies. Hazardous Materials Hazardous materials should not be stored in the same place as products meant for human consumption. The person in charge of the warehouse Chapter 9: Storage 27 Adapted from World Food Programme, Stockage des denrées alimentaires. Manuel des pratiques d’en- treposage. Rome, 1979. Humanitarian Supply Management and Logistics in the Health Sector102 must become familiar with the standards and regulations for identifying, handling, transporting and storing these substances. Products of this type should be identified with standard warning labels, and product compatibility should be checked before storing any types of hazardous materials together (see also the section on hazardous materials in Chapter 5 and Annex 5.1). 103Chapter 9: Storage Ty pe o f su pp ly G ra in c er ea ls Ce re al f lo ur Ca nn ed f oo d Po w de re d sk im m ilk (i n ba gs ) Po w de re d w ho le m ilk (i n ba gs ) De si re d co nd iti on Dr y, w ith ou t ge rm in at io n, w ith ou t im pu rit ie s. M ax im um 1 5% h um id ity . Dr y, no t to o tig ht ly s to w ed , s w ee tis h od or . M ax im um 1 5% h um id ity . N o ru st , n o sw el lin g, n o le ak s, ca rt on s in g oo d co nd iti on , e xp iry d at e O K, w ith la be ls id en tif yi ng c on te nt . Dr y, cl ea n od or , i vo ry c ol or . Dr y, cl ea n od or , i vo ry c ol or . St or ag e in h um id cl im at e Dr y, co ol , w el l v en til at ed pl ac e. O n pa lle ts . M ax im um 7 0% en vi ro nm en ta l h um id ity . Sa m e as g ra in c er ea ls . Pr ef er ab ly o n pa lle ts . Dr y pl ac e, c oo l, w el l ve nt ila te d, p re fe ra bl y in th e sh ad e. Dr y pl ac e, c oo l, w el l ve nt ila te d, p re fe ra bl y in th e sh ad e. Us ef ul L ife Ap pr ox . 6 m on th s Ap pr ox . 6 m on th s 6- 12 m on th s, de pe nd in g on ex pi ry d at e O ne y ea r. 8- 10 m on th s. Re m ar ks In sp ec t od or , h um id ity le ve l, ev id en ce o f pa ra si te s. Sa m e as g ra in c er ea l. De te ct d ef or m ed t in s. If w he n op en in g on e ga s co m es o ut , i t m ea ns t he c on te nt is s po ile d. Ca n ke ep b et w ee n 2- 3 ye ar s in t he d ar k at ab ou t 15 ° C. M ilk s om et im es h ar de ns ; t hi s do es n ot a lte r its v al ue , s o lo ng a s its o do r an d co lo r do n ot c ha ng e. Sa m e as s ki m m ilk . 28 A da pt ed f ro m I nt er na tio na l Fe de ra tio n of R ed C ro ss a nd R ed C re sc en t So ci et ie s, H an db oo k fo r D el eg at es , G en ev a, 1 99 7. Ta bl e 9. 5. S to rin g fo od a nd e qu ip m en t2 8 Humanitarian Supply Management and Logistics in the Health Sector104 Ty pe o f su pp ly Su ga r M ed ic in es Bl an ke ts Cl ot hi ng Te nt s De si re d co nd iti on Dr y, gr an ul at ed , w ith ou t lu m ps , s hi ny . Ex pi ry d at e O K. In o rig in al p ac ka gi ng . Pa ck s w ith ou t te ar s; n o ex po su re t o th e el em en ts . Pa ck ed . P re ve nt h um id ity . Pa ck ed , c le an . Pa ck ed . P re ve nt h um id ity . St or ag e in h um id cl im at e Dr y pl ac e, w el l- ve nt ila te d st ow ag e ra ck s. Dr y, co ol , w el l- ve nt ila te d pl ac e. O n pa lle ts . S om e re qu ire r ef rig er at io n Dr y pl ac e, w el l- ve nt ila te d st ow ag e ra ck s. Dr y pl ac e, w el l ve nt ila te d st ow ag e ra ck s. Dr y pl ac e, w el l- ve nt ila te d st ow ag e ra ck s ra is ed u p fr om t he f lo or . Us ef ul L ife Se ve ra l y ea rs De pe nd s on ex pi ry d at es Re m ar ks Ab so rb s hu m id ity v er y qu ic kl y. H ar d, h um id su ga r is s til l f it fo r hu m an c on su m pt io n. Co nt ro l t em pe ra tu re if p ro du ct s re qu ire re fr ig er at io n Da m p bl an ke ts s ho ul d be d rie d im m ed ia te ly . Be w ar e of f le as a nd m ot hs . W et c lo th in g sh ou ld b e dr ie d im m ed ia te ly . Be w ar e of f le as a nd m ot hs . Da m p te nt s sh ou ld b e dr ie d im m ed ia te ly . T he y w ill r ot q ui ck ly if s to re d w he n w et . Ta bl e 9. 5 (c on ti nu ed ) 105 Annex 9.1 Sample Stock Control Form Stock Control Form Warehouse:_________________________ Product/code______________________Batch No.__________Sector__________________ Date Arrivals Dispatch Destination Balance Name and signature of responsible party Remarks: 106 Annex 9.2 Sample Supply Arrival Form 0001 SUPPLY ARRIVAL RECORD Type and No. of transport document Date of arrival Date of entry Point of Origin: Consignee: Means of transport: Delivered by: Description of supplies Quantity Weight Expiration Type of date packaging Quantity of packages: Total Weight in Kg: Name, signature of recipient, place and date Remarks (report any difference between the type, weight and quantity of supplies recorded in the shipping documents and what is received): 107 Annex 9.3 Sample Form for Supply Dispatch 0001 SUPPLY DISPATCH RECORD Date of dispatch: Corresponds to request No. Name of requester: Delivery authorization No. Consignee: Means of transport: Supply description Quantity Weight Expiration Type of date shipment Total weight in kg Remarks Dispatch: name, Transport: name, Received by: name, signature, date signature, date signature, date 108 Annex 9.4 Sample Stock Report Form St oc k Re po rt W ar eh ou se :_ __ __ __ __ __ __ __ __ __ F ro m (d at e) :_ __ __ __ __ _ To (d at e) :_ __ __ __ __ _ Pr od uc t In iti al s to ck s Ar riv al s De liv er ie s Lo ss es (i f an y) Fi na l b al an ce Ex pi ra tio n da te Re qu ire m en ts (in cl ud e da te ) (in cl ud e da te ) of s to ck U ni ts kg U ni ts kg U ni ts kg U ni ts kg U ni ts kg U ni ts kg U ni ts kg U ni ts kg U ni ts kg U ni ts kg Ex pl an at io n of lo ss es : Re m ar ks : N am e an d si gn at ur e of r es po ns ib le p ar ty : Da te o f th e re po rt 109 Transport is the link in the logistics chain that makes it possible foremergency humanitarian assistance to reach its destination. Whendesigning an emergency supply transport strategy, it is not enough to consider in the abstract the best means of transport or the resources needed to mobilize supplies from A to B. Alternative means, methods, and routes should be considered as a matter of course. The challenge does not lie in eventually getting the supplies to their destination, regardless of when they may be needed—but in making sure that they arrive safely and on time. The movement of supplies within the country or area of operations is only one part of the process. The arrival of goods from abroad—donated by the international community, or acquired by a disaster relief organi- zation—also imposes its own logistical challenges. Getting emergency supplies from their point of origin to their final des- tination involves the combined use of different means of transport over air, land, or water. Types of Transport and Their Characteristics The various means of transport have advantages and disadvantages from the point of view of operational needs, ranging from their cost to their capacity and speed (see Table 10.1). When deciding which means of transport to use, we must think of two main issues: the needs on the ground, and feasible forms of transport. � The needs — How urgently are the supplies needed? What type of supplies are being shipped? How large and heavy is the shipment going to be? What is the destination? What distances must be tra- versed? � Feasible forms of transport — What means of transport are avail- Chapter 10 Transport29 29 This chapter has benefited from the contributions of Médecins sans Frontières (MSF) and Gerard Gómez of MSF’s Regional Emergency Response Department for Latin America and the Caribbean. Humanitarian Supply Management and Logistics in the Health Sector110 able? How much do they cost? How much can we afford? How hard is it to reach the intended destination, given the weather and the state of available routes? Enough resources will not always be available to pay for the ideal form of transportation and it may not always be available, in any case. Even if a particular means of transport is available, conditions in the field may rule out its use. Thus, it is not enough to determine what is needed; we must also know what is feasible. For every means of transport chosen there should be an alternative, should circumstances prevent its use. 111Chapter 10: Transport Ty pe o f tr an sp or t Ai r (A irp la ne s) Ai r (H el ic op te rs ) La nd (m ot or ve hi cl es ) La nd (r ai l) Ch ar ac te ris tic s U su al ly e m pl oy ed w he n su pp lie s ar e ne ed ed u rg en tly , o r w he n th er e is n o ot he r w ay t o re ac h th e af fe ct ed a re a. M uc h m or e ve rs at ile t ha n pl an es . U se d ep en ds m ai nl y on t he p hy si ca l an d sa fe ty c on di tio ns o f th e ac ce ss ro ut es t o th e de liv er y po in ts . U se , o bv io us ly , d ep en ds o n th e ex is te nc e an d ro ut e of t he r ai lro ad an d its c on di tio n Ad va nt ag es � Q ui ck a nd r el ia bl e. � Ca n re ac h fa r- aw ay a re as . � M ak es it p os si bl e to c om e cl os er to t he a re a of o pe ra tio ns . � Ca n la nd in d iff ic ul t ar ea s. � H ig hl y fle xi bl e. � In ex pe ns iv e an d re ad ily a va ila bl e (it is e as ie r to f in d ca rs a nd tr uc ks t ha n an y ot he r ve hi cl e) . � G iv en it s av ai la bi lit y, ca rg o ca pa ci ty in cr ea se s. � La rg e lo ad c ap ac ity . � O pe ra tin g co st s ar e ge ne ra lly qu ite lo w . Di sa dv an ta ge s � H ig h co st . � De pe nd in g on t he s iz e of t he p la ne , c ar go c ap ac ity m ay b e sm al l. � Su sc ep tib le t o m et eo ro lo gi ca l c on di tio ns . � Re qu ire s pl en ty o f sp ac e an d sa fe c on di tio ns f or la nd in g an d ta ke of f. � Re qu ire s sp ec ia l f ue ls , s uc h as J et A 1, w hi ch a lth ou gh co m m on a re n ot a lw ay s av ai la bl e in t he a re a of op er at io ns . � H as li m ite d ca rg o sp ac e. � Ro ut es m ig ht b e in b ad s ha pe , i m pa ss ab le , o r si m pl y no t ex is t. � La nd t ra ve l m ay b e da ng er ou s in c er ta in a re as , d ue t o th e th re at o f la nd sl id es , f lo od s, ea rt hq ua ke d am ag e, ar m ed c on fli ct , o r ba nd its . � Fr eq ue nt ly a w kw ar d to lo ad a nd o ff lo ad s up pl ie s in ra ilr oa d ya rd s or s ta tio ns . � N ee d to u se o th er t ra ns po rt t o ta ke t he s up pl ie s to th e w ar eh ou se o r op er at io ns c en te r. Ta bl e 10 .1 . C ha ra ct er is ti cs o f di ff er en t m ea ns o f tr an sp or t Humanitarian Supply Management and Logistics in the Health Sector112 Ty pe o f tr an sp or t M ar iti m e Ri ve r H um an a nd a ni m al Ch ar ac te ris tic s U se d m os tly f or t ra ns po rt in g su pp lie s fr om a br oa d. R eq ui re s ac ce ss t o a ha rb or o r pi er . U se fu l f or s up pl yi ng r iv er si de a nd ne ar by c om m un iti es w ith m od er at e am ou nt s of e m er ge nc y ai d, o r fo r m ov in g pe op le a nd s up pl ie s in t he ev en t of a f lo od . It is a s ol ut io n fo r sm al l l oa ds , ge ne ra lly in r em ot e ar ea s or p la ce s m ot or v eh ic le s ca nn ot r ea ch . Ad va nt ag es � La rg e lo ad c ap ac ity . � Ec on om ic al . � Lo w c os t of o pe ra tio ns . � Ac ce ss t o ar ea s ha rd t o re ac h by ot he r fo rm s of t ra ns po rt . � Lo w o pe ra tio na l c os ts . � Ac ce ss t o di ff ic ul t ar ea s. Di sa dv an ta ge s � Sl ow . � N ee d to u se o th er t ra ns po rt t o ta ke t he s up pl ie s to th e w ar eh ou se o r op er at io ns c en te r. � Sm al l l oa d ca pa ci ty , d ep en di ng o n th e si ze o f th e ve ss el . � U se d ep en ds o n th e si ze a nd o th er c ha ra ct er is tic s of th e riv er o r ot he r w at er w ay . � Li m ite d lo ad c ap ac ity . � Sl ow . Ta bl e 10 .1 ( co nt in ue d) Commercial vs. Non-commercial Transport Non-commercial or free transport, sometimes offered by other organiza- tions or volunteer groups, reduces the cost of the operation. In general, however, the owners of the transport do not assume responsibility for the safety of the goods. It makes sense to use such transport, and sometimes it is the only means available, but only if one is capable of taking spe- cial security measures to protect the load. With commercial carriers, special rates can sometimes be negotiated for humanitarian supplies. However, commercial transport is a for-profit business like any other. When hiring such transport, it is wise to bear in mind not only the price but also the reliability, safety, speed and quali- ty of the firm. Since it is a service contract for which we will have to pay, we are entitled to demand that the contract be fulfilled down to its smallest particulars. Different types of contracts have their own advantages and disadvan- tages. It is therefore essential to evaluate special requirements of the shipment, and review carefully what is included in the fare, e.g., loading and offloading, the driver’s fees, and so on. When planning to hire a firm’s transport services, it makes sense to bear in mind the issues out- lined in Table 10.2. 113Chapter 10: Transport Yype By the ton or ton/km Per vehicle per journey Per vehicle per day Advantages Client pays for the transport of the goods regardless of the time the trip takes, or whether the truck is full or not. The cost of the service is clearly agreed upon from the start. Client has exclusive use of the vehicle(s). Exclusive use of the vehicle. Usually the best option for short trips. Disadvantages - The carrier might include other clients’ loads in shipment, which may compromise safety of supplies. - The driver might use a less direct route to add kilometers to the bill. - The carrier might not be interested in filling each vehicle to its maximum capacity, thereby multiplying the number of trips. - The size of the vehicle might not correspond to the size of the load. - The carrier might choose to "take it easy" on each trip. - In the event the truck needs protracted repairs, the daily fee might still be applicable unless stipulated otherwise in the contract. Table 10.2. Types of transport contracts30 30 Adapted from International Federation of Red Cross and Red Crescent Societies (IFRC), Handbook for Delegates, Geneva, 1997. Humanitarian Supply Management and Logistics in the Health Sector114 Determining the Type of Transport Needed To determine the type and quantity of transport needed, certain aspects must be borne in mind: � The nature of the supplies to be transported; � The weight and volume of the load; � The destination: distance, form of access to the delivery point (by air, water, land), and the condition of the access routes; � The urgency of the delivery. Table 10.3 shows a simple procedure for estimating the number of vehi- cles needed, whether they be trucks, boats, or planes, to transport a load with a known weight and deadline for delivery. Annexes 10.1-10.3 show estimated load capacities for different means of transportation. This table is based on the weight of the load. However, one must also take into account the volume—that is, the space occupied by the pack- ages depending on their shape and size. 31 Taken from J. Davis and R. Lambert, Engineering in emergencies, London: Intermediate Technology Publication Ltd., 1995. Table 10.3. Formula for estimating the number of vehicles required31 Calculation procedure: • How many tons must be moved? By when? • How long will the vehicles take to take a load from the delivery point to the reception point and return? (Do not overestimate the speed, and include loading and unloading.) • What load capacity does the vehicle have? No. of possible trips per vehicle = Period Duration of round trip No. of loads = Total No. of tons Vehicle capacity No. of vehicles = No. of loads No. of possible trips / vehicles Add 25% extra time for contingencies. 115 If vehicles of different load capacity intervene in the operation, the esti- mate should be recalculated for each vehicle. Similarly, if the supplies are going to different destinations, each destination requires its own cal- culation. Vehicle Control When circumstances allow it, it is always better to hire a transport com- pany than to have to manage a fleet of vehicles, which is an extremely complex and delicate task. But the reality, in most emerge

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