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Logistics

 

4.1 Logistics – General

 

These general requirements apply to all consumables, medical equipment, pharmaceuticals, and other medical donations. 

4.1.1 General – Packaging

Packaging can be one of the most complicated aspects of medical donations. Access to high-quality medical products can be compromised when proper packaging procedures are not followed.

 

4.1.1.1 Prior to making a donation, MSROs should work with recipients to ensure that packaging, labeling, maintenance, and operating instructions (when applicable) are able to be understood by the recipient organization.

 

4.1.1.2 MSROs should take account of the mode of transportation when protective packaging is chosen (i.e. glass syringes and bottles must be packed to avoid breakage).

 

Guidance & Resources

 

Building and maintaining strong relationships with in-country recipients as well as Ministry of Health and other government officials will ensure products arrive safely at their destination. Using a medical translation service is a good option for recipients who don’t have fluency in the packaging language. When planning a donation process, the MSRO should ensure the recipient or transportation service has the appropriate transport mode available to transport product to the final destination safely.

 

UPS: Preparing Your Package

This resource provides general information regarding preparing a package for shipping.

(Source: UPS)

 

UPS: How to Prepare Freight Shipments

This resource provides general information regarding preparing shipping containers and palletizing shipments.

(Source: UPS)

4.1.2 General – Storage Access

 

High quality medical products can be compromised when proper storage is not available, or when procedures are not followed. A strong in-country partner relationship is integral to ensuring that products are stored properly.

 

4.1.2.1 Prior to a donation being made, MSROs should ensure that recipients can demonstrate the ability to provide the adequate storage capacity to accommodate necessary supplies and maintenance parts relative to the equipment being donated.

Guidance & Resources

 

MSROs should identify whether or not the recipient has adequate storage facilities during the needs assessment process.

 

Guidelines for the Storage of Essential Medicines and Other Health Commodities 

These guidelines were created by the World Health Organization. Some of the sections included are: Receiving and Arranging Commodities; Keeping Track of Products in Your Storeroom; Maintaining the Quality of Your Products; Setting up Your Medical Store; and Waste Management.

(Source: John Snow Institute. The World Health Organization)

 

Storage, Distribution, and Dispensing of Medical Supplies

These guidelines lay out the proper way to store, distribute, and dispense medical supplies. This is an excellent resource for an MSRO wishing to learn more about proper medical supply storage.

(Source: Belson D. Storage, distribution, and dispensing or medical supplies. Center for Risk and Economic Analysis of Terrorism Events. University of Southern California. Los Angeles, California. April. 2005.)

4.1.3 General – Transportation

 

 MSROs should consider the following when transporting a donation.

4.1.3.1 MSROs should ensure that the means of travel are appropriate to the circumstances of the donation.

 

4.1.3.2 MSROs should ensure that shipping documents are clear and contain all the essential information.

 

4.1.3.3 MSROS should confirm that arrangements for necessary storage are made prior to shipping.

 

4.1.3.4 MSROs should confirm that the recipient or their designee is able to provide transportation from the point of entry to the final destination.

 

Guidance & Resources

 

MSROs should have an open and ongoing communication process with the recipient regarding transportation throughout the donation process. MSROs should create and use a transportation checklist for each country and/or recipient to ensure important transportation requirements are not overlooked. In addition, it is often a good idea for an MSRO to work with a freight forwarding company when planning international shipments.

 

How to Plan Your Shipment

This How-to-Guide was created by Missionary Expediters. It explains how to properly plan a shipment for transport. It also provides advice on everything from preparing cargo to choosing a departure port.

(Source: Missionary Expediters)

 

How to Choose a Freight Forwarder 

These guidelines were developed by the South Florida District Export Council. They describe how to choose a freight forwarder for international shipping. This is an excellent resource for any MSRO wishing to learn more about selecting and working with freight forwarding companies.

(Source: South Florida District Export Council)

4.1.4 General – Staging and Loading

 

 When staging and loading a shipment, MSROs should take the following factors into account.

4.1.4.1 MSROS should take into account and properly handle product shipment with regard to the mode of transport, product volume, and product type.

 

4.1.4.2 MSROs should ensure that proper loading of donations (donations should be palletized, shrink wrapped, and include an accompanying packing list) occurs in order to ensure stability (size and weight distribution, strapping) and ease and safety of offloading.

 

Guidance & Resources

 

Staging and loading is an important aspect of logistics that is often overlooked. MSROs should work with the recipient in order to determine the appropriate volume of the donation. While it may seem beneficial and easy to fill a 40ft container for each shipment, if the recipient lacks adequate storage and capacity for the donation it may cause unintended harm and unnecessary burden to the recipient facility. Before a product is added to a shipment to fill container space, MSROs need to ask the recipient if they are able to receive and use the product in question.

 

 It is crucial that all containers are loaded professionally, according to pre-determined practices and procedures, and by experienced staff. It is a good idea for MSROs to develop internal practices regarding the frequency in which items are tied down in the container and the order in which they are loaded. In addition, it may be necessary to pack and load some items in crates, as opposed to only being wrapped. Finally, it is recommended that each pallet be accompanied by its own packing list. This will make customs clearance, unloading, and distribution easier for the entire shipment.  

 

WHO Procurement and Management of Supplies and Equipment 

This document was created by the WHO and provides information on the proper procurement and management of supplies and equipment.

(Source: The World Health Organization)

 

Medical Stores Management

This document was created by the Management Sciences for Health. It provides information regarding the proper management of inventory and stock flow. This is an excellent resource for a recipient wishing to learn more about proper inventory management and ordering.

(Source: Management Sciences for Health)

 

Container Handbook: Loading and Load Securing

These guidelines were created by the German Marine Insurers as part of a larger Container Handbook. This section addresses areas including packaging and marking, packing and stowage, and load securing. This is an excellent resource for an MSRO that wants to learn how to properly load and secure a container.

(Source: German Marine Insurers Container Handbook)

OSHA Loading and Unloading

This resource provides safety information for workers loading and unloading trucks and trailers.

(Source: United States Department of Labor Occupational Safety and Health Administration)

 

Container Packing 

These guidelines were put together by Hapag-Lloyd. They outline proper procedures for packing a container. Some of the sections covered include possible stresses during transport, preparing the container for transport, protection against climatic influences, and materials for securing cargo. This is an excellent resource for any MSRO wishing to learn more about how to properly pack a container.

(Source: Hapag-Lloyd)

 

4.1.5 General – Customs Clearance

 

4.1.5.1 MSROs should confirm that the recipient has access to human resources with the capacity to receive the shipment of donated medical resources and the necessary clearance documents to move it through customs in a timely manner.

 

4.1.5.2 MSROs should confirm that, unless otherwise arranged, the recipient is able to provide transportation from the point of entry to the final destination.

 

Guidance & Resources

 

MSROs should work with the recipient organization to determine whether or not they have access to the appropriate human resources to properly receive the shipment. This includes whether or not they will be able to successfully obtain customs clearance documents. Prior to making a shipment, MSROs should also have written assurance from the recipient that there will be adequate transportation waiting for the shipment upon arrival.

FDA Export Certificate Guidance

This resource has information regarding exportation of vaccines, biologics, and other medical products. It also contains templates and contact information regarding export.

(Source: Food and Drug Administration)

 

FedEx International Shipping Guide Customs and Shipping Tools 

This website provides links to various customs tools created by FedEx to assist customers with preparing international shipments including: FedEx Document Preparation Centre; Regulatory News & Information; FedEx Global Trade Manager; FedEx Electronic Trade Documents; Guide to Customs Forms; international Shipping Resources; Ancillary Clearance Services; and Import Shipping and Recipient Information. This is an excellent resource for any MSRO wishing to learn more about proper customs clearance procedures.

(Source: FedEx)

 

US Export: Export Licenses, Standards and Economic Sanctions

This website is hosted by Export.gov. It provides up-to-date information regarding US exports laws and regulations.

(Source: Export.gov)

What Can't Ship Internationally

This website lists items from the United States that are typically restricted for import in other countries.

(Source: MyUS.com)

 

4.1.6 General – Security

4.1.6.1 MSROs should use a high security bolt seal that meets C-TPAT and ISO standards (i.e. TydenBrooks Intermodal II Seal). The seal number should be recorded for internal tracking and on shipping documents.

 

Guidance & Resources

 

MSROs should check to ensure that all shipments comply with international safety standards and requirements.

 

Supply Chain Security Best Practices Catalog

This document was created by the Customs-Trade Partnership Against Terrorism (C-TPAT) and provides information on maintaining shipment security in the supply chain. One section of the document discusses container seals. This information would help helpful for an MSRO wishing to learn more about international shipment security.

(Source: Milgram; U.S. Customs and Border Protection, Customs-Trade Partnership Against Terrorism (C-TPAT))

 

Bolt Seals: How They Keep The World Held Together

This website provides information on the different Bolt Seals produced by TydenBrooks. This is an excellent resource for any MSRO wishing to learn more about different security seal options for international shipments.

(Source: TydenBrooks)

 

Customs-Trade Partnership Against Terrorism: Security Seal Standards for C-TPAT

This document describes the C-TPAT Security Seal Standards. This is an excellent resource for any MSRO wishing to learn more about international shipping security standards.

(Source: Stoffel; Customs-Trade Partnership Against Terrorism (C-TPAT))

 

4.2 Logistics – Consumables

4.2.1 Consumables – Packaging

 

4.2.1.1 MSROs should ensure that expiry dates are clearly labeled on all packaging.

 

4.2.1.2 MSROs should ensure that consumables are packed in boxes that protect the integrity of the product and are suitable for transportation.

 

4.2.1.3 MSROs should ensure that packaging is sealed securely to prevent opening in transit and tampering.

 

Guidance & Resources

 

Consumables should be packaged in boxes that are appropriate for the size and type of product. The smallest box possible should always be used, in order to avoid empty space that might endanger the integrity of the package. All boxes should be properly sealed and secured within the container.

 

Packaging for Medical Devices and Pharmaceuticals

This article discusses protective packaging for medical devices and pharmaceuticals.

(Source: Enright, Cicely. Packaging for Medical Devices and Pharmaceuticals. 2009. ASTM International, Standardization News.)

 

UPS: Preparing Your Package

This resource provides general information regarding preparing a package for shipping.

(Source: UPS)

 

4.2.2 Consumables – Storage

 

4.2.2.1 Prior to shipping, MSROs should determine that recipients can provide the adequate storage capacity to accommodate the consumables to be donated.

Guidance & Resources

 

The needs assessment process should include storage capacity. Part of this process should be a discussion of whether or not the recipient has adequate storage facilities for the product being donated.

 

Guidelines for the Storage of Essential Medicines and Other Health Commodities 

These guidelines were created by the World Health Organization; some of the sections included are: Receiving and Arranging Commodities; Keeping Track of Products in Your Storeroom; Maintaining the Quality of Your Products; Setting up Your Medical Store, and Waste Management.

(Source: John Snow Institute. The World Health Organization)

Solving storage challenges in the Amhara region 

This case study provides an example of a recipient warehouse that was improved by reorganizing their storage facility.

(Source: John Snow Inc. JSI Research and Training Institute)

4.2.3 Consumables – Transportation

 

4.2.3.1 MSROs should ensure that the means of transportation is appropriate to the circumstances of the donation.

 

4.2.3.2 MSROs should ensure that shipping documents are clear and that they contain all necessary information.

4.2.3.3 MSROs should ensure that all consumables are palletized and shrink wrapped with an accompanying packing list.  

Guidance & Resources

 

MSROs should have an open and ongoing communication process with the recipient regarding transportation throughout the donation process. MSROs should create and use a transportation checklist for each country and/or recipient to ensure important transportation requirements are not overlooked. In addition, it is often a good idea for an MSRO to work with a freight forwarding when planning international shipments.

 

Sample Packing List 

This is a sample packing list created by KKFreight. It provides an excellent example of packing lists that should accompany a shipment.

(Source: KKFreight)

 

How to Choose a Freight Forwarder

These guidelines were developed by the South Florida District Export Council. They describe how to choose a freight forwarder for international shipping. This is an excellent resource for any MSRO wishing to learn more about selecting and working with freight forwarding companies.

(Source: South Florida District Export Council)

How to Plan Your Shipment

This How-to-Guide was created by Missionary Expediters. It explains how to properly plan a shipment for transport. It also provides advice on everything from preparing cargo to choosing a departure port.

(Source: Missionary Expediters)

 

4.2.4 Consumables – Staging and Loading

 

When staging and loading a shipment of consumables, MSROs should take the following factors into account.

 

4.2.4.1 MSROS should take into account and properly handle product shipment with regard to the mode of transport, product volume, and product type.

 

4.2.4.2 MSROs should ensure that proper loading of donations (donations should be palletized, shrink wrapped, and include an accompanying packing list) occurs in order to ensure stability (size and weight distribution, strapping) and ease and safety of offloading.

 

Guidance & Resources

 

Volume is an important aspect of logistics that is often overlooked. It is important for MSROs to work with the recipient in order to determine the appropriate volume of the donation. While it may seem beneficial and easy to fill a 40ft container for each shipment, if the recipient lacks adequate storage and capacity for the donation it may cause unintended harm and unnecessary burden to the recipient facility. Before a product is added to a shipment to fill container space, MSROs need to ask the recipient if they are able to receive and use the product in question.

 

When loading, it is crucial that all containers are loaded professionally, according to pre-determined practices and procedures, and by experienced staff. It is a good idea for MSROs to develop internal practices regarding the frequency in which items are tied down in the container and the order in which they are loaded. In addition, it may be necessary to pack and load some items in crates, as opposed to only being wrapped. It is recommended that each pallet be accompanied by its own packing list, in order to make customs clearance, unloading, and distribution easier for the entire shipment.

 

OSHA Loading and Unloading

This resource provides safety information for workers loading and unloading trucks and trailers.

(Source: United States Department of Labor Occupational Safety and Health Administration)

 

Container Packing

These guidelines were put together by Hapag-Lloyd and outline proper procedures for packing a container. Some of the sections covered include possible stresses during transport, preparing the container for transport, protection against climatic influences, and materials for securing cargo.

(Source: Hapag-Lloyd)

 

Container Handbook: Loading and Load Securing

These guidelines were created by the German Marine Insurer as part of a larger Container Handbook. This section addresses areas including packaging and marking, packing and stowage, and load securing. This is an excellent resource for an MSRO that wants to learn how to properly load and secure a container.

(Source: German Marine Insurers. Container Handbook: 4)

4.2.5 Consumables – Customs Clearance

 

4.2.5.1 MSROs should ensure that recipients have access to human resources with the capacity to receive the shipment and the necessary clearance documents to move it through customs in a timely manner.

 

4.2.5.2 MSROs should ensure the recipient is able to provide transportation from the point of entry to the final destination.

 

Guidance & Resources

 

Having a trusted in-country partner or expert on staff is integral to successful customs clearance, as well as for ensuring the donation arrives at the final destination safely.

 

FedEx International Shipping Guide Customs and Shipping Tools

This website provides links to various customs tools created by FedEx to assist customers with preparing international shipments. The website provides links to the following tools: FedEx Document Preparation Centre; Regulatory News & Information; FedEx Global Trade Manager; FedEx Electronic Trade Documents; Guide to Customs Forms; International Shipping Resources; Ancillary Clearance Services; Import Shipping; and Recipient Information. This is an excellent resource for any MSRO wishing to learn more about proper customs clearance procedures.

(Source: Fedex)

 

FDA Export Certificate Guidance

This FDA resource has information regarding exportation of vaccines, biologics, and other medical products. It also contains templates and contact information for questions regarding export.

(Source: Food and Drug Administration)

Guidelines for Quality Medical Product Donations 2018

This resource provides detailed guidelines and information regarding medical product donations generally, including customs documents and customs clearance.

(Source: Partnership for Quality Medical Donations)

4.3 Logistics – Medical Equipment

 

4.3.1 Medical Equipment – Packaging 

 

4.3.1.1 MSROs will ensure that donated equipment is created and/or packed to minimize damage during shipment.

 

4.3.1.2 MSROs will ensure that the necessary components referred to in the installation instructions are included, packaged together, and shipped with the equipment.

 

4.3.1.3 MSROs will ensure that installation (when applicable), operating, and maintenance instructions are included for all equipment. If instructions are not available, MSROs will work with the recipient to confirm that they have the capacity to appropriate operate and utilize the donation.

 

Guidance & Resources

 

When packaging and shipping medical equipment, MSROs need to work closely with the recipient. There should be open communication regarding package size and composition, in order to ensure that the recipient will be able to unload the equipment upon arrival. In addition, prior to shipping a piece of equipment MSROs need to understand the recipient’s capacity to properly install the item. MSROs need to make sure all necessary manuals and instructions are included that are required for installation.

 

Resource Library for Medical Device Professionals

This website provides important information regarding medical device guidelines in many different countries.

(Source: Emergo Group)

4.4 Logistics – Pharmaceuticals

4.4.1 Pharmaceuticals – Packaging

When packaging pharmaceuticals for donation, MSROs should take into account the following factors.

 

4.4.1.1 MSROs should ensure that pharmaceuticals are packaged properly with regard to the climatic conditions in the recipient

country.

 

4.4.1.2 MSROs should ensure that the necessary steps are taken and the necessary materials are used in the packaging process to avoid breakage.

 

4.4.1.3 MSROs should ensure that products requiring maintenance of cold-chain are properly labeled and contain control thermometers.

 

4.4.1.4 MSROs should ensure that shipping documents include the product's generic name and other relevant information (i.e. quantity, expiration date, lot and control numbers, and storage/temperature requirements).

 

4.4.1.5 MSROs should ensure that prescribing information is in a language that will be understood by a staff member at the recipient institution.

Guidance & Resources

 

MSROs should confirm pharmaceuticals will arrive at the recipient location with at least 6-10 months left before expiry. Recipients should be informed of expiry dating and agree to take the product prior to any pharmaceutical being shipped.

IEC 60601-1: Medical Device Marking and Labeling

This resource includes common symbols used in medical equipment labeling. This includes symbols for sterilization, units, instruction, cleaning, maintenance, environmental information, technical description, transport, storage, and collateral information.

(Source: MDDI/Qmed)

 

Vaccine Cold Chain Guidelines

These guidelines outline what is involved in a proper cold chain process. In addition, information is provided on monitoring the shipment to ensure that cold chain was properly maintained.

(Source: Government of Western Australian Department of Health)

 

4.4.2 Pharmaceuticals – Transportation

 

4.4.2.1 MSROs should use only qualified, licensed, and reliable transport companies when shipping pharmaceuticals.

 

4.2.2.2 MSROs should take into account and properly address the duration of time that a shipment will spend on transport when determining the appropriate means of transportation for items requiring refrigeration.

 

Guidance & Resources

 

When determining the proper transportation method for pharmaceuticals, MSROs need to carefully consider the item’s expiry date and storage temperature requirements. For example, if a particular vaccine being shipped requires the maintenance of cold chain, MSROs must choose an appropriate mode of transportation.  

 

Handbook for Vaccine & Cold Chain Handlers

UNICEF developed this handbook with a thorough framework and importance of the cold chain process. It includes information on cold chain systems, equipment, temperature monitoring, equipment maintenance, storage and distribution, and responsibilities of personnel.

(Sources: Ministry of Health and Family Welfare, Government of India; UNICEF; WHO/NPSP; MCHIP; NIHFW)

 

USAID Cold Chain and Logistics Management: An Essential Part of Safe and Effective Vaccination Programs

This resource provides information regarding the necessity of and proper strategies for proper logistics management of vaccine transportation.

(Source: United States Agency for International Development, Immunization Basics Snap Shots)

 

WHO Good Distribution Practices for Pharmaceutical Products

This document was created by the World Health Organization and outlines good distribution practices for pharmaceutical products. Some of the sections in this document address warehousing and storage, vehicles, equipment, and transportation and products in transit.

(Source: The World Health Organization, WHO Technical Report Series, Essential medicines and health products, No. 957, 2010)

 

Cold Chain Management and the Use of TempTale Technology 

This article describes how to properly use a TempTale to determine if cold chain has been properly maintained.

(Source: Colonel Mitchell E. Brew, Major Michael Ronn, and Petty Officer First Class Summer Webb, USN. Professional Bulletin of United States Army Sustainment. PB 700-10-05 Volume 42, Issue 5.)

 

Key Performance Indicators in Humanitarian Logistics

This academic resource provides input on its findings that identify key performance indicators of high-quality humanitarian logistics. It uses a “scorecard” to evaluate logistics procedures and identifies improvement strategies.

(Source: The Fritz Institute, Anne Leslie Davidson, 2006)