RIFTYVALLEY UNIVERSITY

JIMMA CAMPUS
PHARMACY DEPARTMENT

Auditable Pharmaceuticals Transactions and Services (APTS)

learning guide for pharmacy level IV trainees

Auditable Pharmaceuticals Transactions and Services

Unit of Competence: -
(APTS)
Auditable Pharmaceuticals Transactions and Services
Module Title: -
(APTS)
TTLM Code: HLT PHS4 09 0218

Prepared by Yimer Mekonnen (B. Pharm., MSc)

May 2021

Jimma, Ethiopia

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Contents
CHAPTER ONE ......................................................................................................................................... 1
OVERVIEW OF APTS ............................................................................................................................ 1
Essential Elements .............................................................................................................................. 1
Benefits of APTS .............................................................................................................................. 5
CHAPTER TWO ....................................................................................................................................... 5
PRINCIPLES OF PHARMACY SERVICE AND ORGANIZATION ................................................................ 5
Organization of pharmaceutical service system ............................................................................. 5
Patient flow in APTS target service delivery ................................................................................... 8
CHAPTER THREE .................................................................................................................................... 11
PHARMACEUTICAL CODING .................................................................................................................. 11
Components of pharmaceutical coding ........................................................................................ 11
Purpose of pharmaceutical coding ............................................................................................... 12
Types of coding system ................................................................................................................. 12
CHAPTER FOUR ..................................................................................................................................... 23
SALES MANAGEMENT ....................................................................................................................... 23
Sales management of pharmaceuticals ............................................................................................ 23
Sales Ticket Pad Register............................................................................................................... 23
Cash Sales Ticket ........................................................................................................................... 23
Credit Sales Ticket/Credit Sales Dispensing Register .................................................................... 24
CHAPTER FIVE ....................................................................................................................................... 24
PHARMACEUTICAL STOCK AND CONSUMPTION ANALYSIS METHODS ................................................ 24
1. Stock Turnover Ratio (STR) ....................................................................................................... 25
2. Consumption to Stock Ratio (CSR) ............................................................................................ 26
3. Stock Status Analysis (SSA) ....................................................................................................... 26
CHAPTER SIX.......................................................................................................................................... 27
VEN AND ABC ANALYSIS, AND ABC-VEN RECONCILIATION .................................................................. 27
VEN Analysis ...................................................................................................................................... 27
ABC Analysis ...................................................................................................................................... 29
ABC/VEN Reconciliation and Interpretation of Findings .................................................................. 29
CHAPTER SEVEN .................................................................................................................................... 32
AUDITING FOR PRODUCT, FINANCE AND SERVICES ............................................................................. 32
Financial auditing .............................................................................................................................. 33
Service/Performance Auditing .......................................................................................................... 33
Product Auditing ............................................................................................................................... 34

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 CHAPTER ONE

OVERVIEW OF APTS

Essential Elements

APTS is a data driven package of interventions, with internationally proven methodologies,

used for pharmacy practices. It has five essential elements (result areas):

1. The Efficient Budget Utilization

2. Transparent and Accountable Transactions

3. Reliable Information for decision making

4. Pharmacy Service organization

5. Improved Customer Satisfaction

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1. Efficient utilization of medicines budget

Sales management: Establishing effective medicines sales management system: price

setting, daily sales summary as cash, credit and free

Product prioritization: Preparation of facility specific drug list prioritization as vital,

essential and non-essential (VEN).

Reconciliation: undertaking ABC/VEN analysis to identify and reconcile the most

needed medicines used to treat 20 top diseases in relation to budget consumption

(80% of budget) to address priority health problems of the catchment population by

the limited budget

Stock analysis: undertaking the three-analysis including consumption to stock ratio,

stock turnover and stock status analysis to identify the usable stocks versus obsolete

stocks, to get reliable financial and product information and increase sales.

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 Bin management: to identify slow moving items and reduce rate of expiry

2. Transparent and accountable pharmaceutical Transactions

 Tools - receiving and issuing vouchers, sales tickets, registers, daily summary and monthly

reporting forms in a way that can easily ensure transparency of transaction

 The pharmaceutical transactions and services should be supported by well-designed and upto-

date systems, software, proven methodologies used for prioritization, quantification, stock

analysis and tools used for recording and documentation.

 Coding of medicines: is a system which enables one to identify medicines using unique

identifiers (codes) so it would be easy for anyone to identify medicines and audit, make

transactions and services transparent.

 Conducting efficient and effective physical inventory

 Auditing of products, finance and service

 Legal framework: implement specific legal framework that is related to pharmacy service to

enforce accountability and equip managers the power to execute their duties.

3. Pharmacy renovation, reorganization, equipment/facilities, Workload analysis and

proper human resource deployment

 Dispensaries organized as Outpatient, Inpatient, Emergency and Chronic Care

Pharmacies to promote one-stop shopping service and effective medicines sales

 Reorganize pharmacy workflow best suited to improve medication use counseling

and patient convenience (dispensaries with two doors—entrance and exit), arranging

patient waiting area with shelter and chairs to sit.

 Rearranging the dispensing setup as Rx evaluatorbillercashier  counselor – all

in a line for patient convenience.

 Fulfilling the pharmaceutical services with adequate and secured storage spaces,

cashier cubicles in the dispensary, dispensing & counselling counters, patients’

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 waiting area, offices, rooms for extemporaneous preparation, provision of drug

information services and reference materials.

 Redefine roles of dispensers, pharmacy accountants and cashiers as per the workflow

 Deployment of adequate number of pharmacy professionals and other supportive staff

based on the workload in the health facility.

 Evaluation of performance based on quantity, quality and transparency of services

rendered using the daily summary, and auditing and onsite training based on the gap.

 Measuring level of effort, analyzing workload and deployment of adequate number

and mix of professionals for pharmacy services (pharmacist, pharmacy technicians,

accountants, cashiers, clerks, porters, cleaners and guards)

 Fulfilling essential equipment/facilities including refrigerators, shelves, lockable

cabinets, tablet counting trays, medicine envelopes, labeling stickers, wall/fridge

thermometers, air conditioning systems, and fire extinguishers hadn’t also been

supplied to meet the demands.

4. Information for decision making

 Generating timely, reliable and consistent information on product transacted, finance

and services rendered from daily summary and monthly reports for decision making.

 The information should be collected from vouchers, sales tickets, registers and

formats which have serially numbered references.

 This information should be timely reported to be used for decision making in health

facility, Woreda healthy office, Zonal Health department, regional and national levels.

5. Patient knowledge and satisfaction

 The patient satisfaction increases due to workflow arrangement, human power

adjustment, improving availability of prescribed medicines and better counseling

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  The patient knowledge and satisfaction can be measured by cross sectional study

through exit interview of patients

Benefits of APTS

The key benefits of APTS include:

 It enables efficient utilization of budget and helps to measure affordability

 It increases health facilities revenue by efficient sales management, reducing

wastages

 It enables making informed decision on product, finance and services

 It facilitates auditing (product, finance and services) by improving transparency and

accountability

 It enables to measure level of effort, human resource needs based on workload analysis.

 It increases patient knowledge on correct dosage and satisfaction on pharmacy services

 It supports the implementation of Balanced Score Card (BSC)

 It improves availability of essential medicines, supplies and reagents

CHAPTER TWO

PRINCIPLES OF PHARMACY SERVICE AND ORGANIZATION

Organization of pharmaceutical service system

The organization of pharmaceutical operations should be carried out in a way that enhances

the performance of professionals and patient convenience & satisfaction. The pharmacy

section in hospitals should be organized as:

Outpatient pharmacy service unit,

Inpatient pharmacy service unit

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 Emergency pharmacy service unit.

Pharmaceutical supply management unit

Drug information Service unit

Compounding pharmacy service unit and

Other units shall also be established depending on the hospital complexity and

demand.

Note: This standard is designed for hospital. For health centers, drug information and,

compounding may not be mandatory

The pharmacy organization should be designed to facilitate delivery of quality

pharmaceutical services and convenience for patients. Accordingly, the pharmacy operation

should be organized as follows

 Inpatient pharmacies: Depending on the bed size and patient load, there should be

one or more inpatient pharmacies. The inpatient pharmacies should be situated near to

each major ward to effectively monitor the use of pharmaceuticals in the respective

wards. The inpatient pharmacies should be conveniently designed to maintain the

quality of pharmaceuticals and facilitate the dispensing process. They should have

adequate space to effectively store most needed pharmaceuticals.

 OPD Pharmacy: Based on the arrangement of the OPD clinics and complexity of the

health facility, OPD pharmacies may be organized in multiple locations so as to

improve access and facilitate patient centered services (e.g. ART pharmacy, chronic

care pharmacy, pediatric 76 pharmacy, oncology pharmacy, etc.). The OPD

pharmacies should be carefully organized to create suitable workflow that ensures

appropriate level of care to patients. It should also be cognizant of the works

satisfaction of professionals.

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 Emergency pharmacy: It should be organized near Emergency clinic and provide 24

hour services. It should have adequate space, shelves and dispensing counter like the

other dispensing pharmacies. Since, the way of serving patients in emergency is

different, the accessibility of medicines for nurses, physicians should be based on

higher than other sections and they should take responsibility too. Example:

Medicines may be dispensed by oral prescription and documented latter

 Drug Supply management unit: to ensure uninterrupted supply of pharmaceuticals,

the health institution pharmacy should have drug supply management unit. The unit

has separate pharmaceutical stores for medicines and supplies (including consumable

medical

equipment’s and laboratory reagents). The overall operation of the unit (selection,

quantification, procurement, inventory management, warehousing and distribution)

should be coordinated by a dedicated pharmacist. Separate store managers should

manage the stores.

 Drug Information service unit: The hospital pharmacy should establish a drug

information center to serve as a source of information to patients, health care

providers and community.

 Extemporaneous compounding: In order to respond to specific patient needs the

health facility pharmacy should have compounding services with separate premises

and equipped with the necessary facilities.

 Rooms for dispensaries. All the dispensing room should be organized in such a way

to facilitate patient service and make life easy for professionals. There should be

enough space for prescription evaluators/ billers, cashiers and counselors. There also

should be waiting area with chairs for sit. In a waiting area, television, modeling films

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 for medicines use education will be a plus. Within a one dispensary the following rooms

or cubicles should be available:

Patient flow in APTS target service delivery

 Once the patient arrives at the dispensing unit with a prescription, he/she passes

through the following steps:

 Prescription (Rx) Evaluator: When patients arrived at the pharmacy with

prescription, they got prescription evaluator. The pharmacist validates the prescription

for completeness, legality and legibility. He/she should also make correctly interpret

any abbreviations. Then the Rx evaluator confirms the appropriateness of the drug

choice, dosage form, strength, dose, frequency quantity and duration of treatment with

the diagnosis. The Rx evaluator pharmacy professional is also required to identify

drug therapy problems.

 Biller for paying patients: Patients then will see the biller pharmacy professional
who makes calculations and tells the amount of money to them. If the patient has the

requested amount of money, the pharmacist writes the description of the medicines,

their quantities as well as respective price on the sales ticket. The sales ticket is given

to the cashier who sits next to the biller with the prescription. However, if the patient

cannot afford the payment for the prescription, the pharmacist will communicate with

prescriber and sort-out other best alternative medicines which patients can afford and

at the same that has the same curative value. By doing so, the pharmacy professional

will contribute rational medicines use in terms of dispensing affordable medicines to

clients.

Note: The Rx Evaluator can do the billing at the same time whenever the patient load

is minimal and if he/she is allocated to do both.

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 Cashier: The patient will see cashiers to pay on cash. The cashier will check the
horizontal and vertical calculations for retail and total prices and receive the amount

of charged. The cashier will reconcile the prescription with cash sales ticket by

signing and recording the serial number of sales tickets on the prescription. 87

 Credit/Free patients (sponsored patients): Patients who are not subjected to pay
will get their prescription evaluated, cost confirmed by biller and will be send to

delegated person to confirm sponsored patients and then to counselor for collecting

their medicines with information.

 Counselor: The patient will see counselor pharmacist and collect prescribed
medicines with appropriate information on correct dosage of each prescribed

medicines. The counselor will also conform whether the prescription received is

reconciled with either cash sales or credit/ free registers serial number. Then the

patient will be counseled appropriately and collect packed medicines with appropriate

information. If medicines prescribed are stocked out in the dispensary, patient will

collect copy of Rx prepared by the counselor to buy from other pharmacies. Note:

whenever, the counselor can check the picked medicines and take responsibility for

accuracy, a processer my assist.

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 CHAPTER THREE

PHARMACEUTICAL CODING

Components of pharmaceutical coding

 Coding is a system of assigning a unique identifier for a product. A code is used to

represent a product using letters, numbers, or their combinations to transfer messages

for identifying a product.

 Coding has two parts; the base code and detail codes.

 The detail codes include, batch codes, expiry dates, country of origin,

receiving date and internal price coding.

 The internal price coding refers to the process of assigning codes to

pharmaceutical products within the health facility to uniquely identify the

price. So, coding makes cost follow-ups of each medicine in a health facility

easier.

 What to code? Items like:

Medicines,

medical supplies,

laboratory reagents and raw chemicals,

raw materials for extemporaneous preparation,

radiology chemicals,

Sanitary chemicals (antiseptics and disinfectants) and consumable instruments

should be coded in health facilities.

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Purpose of pharmaceutical coding

 The purpose of this coding is to ensure traceability of medicines and

transactions at any point in the supply chain system and service delivery.

 It also makes all types of pharmaceutical transactions transparent,

understandable for non-health professionals and auditable.

 Unless medical products are coded, it would be very difficult to trace them, to

audit, especially by non-health professionals (auditors), loss and patient harm

due to adverse drug reactions i.e. it helps to uniquely identify products during

adverse drug events (ADE)

 Coding is also extremely important to summarize daily sales of dispensed

medicines manually, using cash registers or software.

 Computerization of medicine transactions is much easier when medicines have

codes. National control of medicines can also be greatly enhanced.

Types of coding system

 The type of characters majorly classifies coding systems they use for representing

pharmaceuticals.

 They can also be further sub classified by whether they are fixed or variable.

 Generally, there are two coding systems.

 Alpha-numeric coding system and

 Numeric coding system.

Alpha-numeric coding system

 This is a type of coding that uses letters and numbers.

 Alpha numeric code is constructed from 7 characters.

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  The first 4 are letters taken from the generic name of the product followed by

three digits.

 Therefore, we use the alpha-numeric coding system by using 4 letters and three-

digit numbers.

 Numbers are assigned based on the

Strength, dosage form and/or cost of the product.

Numbering starts from the smallest strength and continues to the highest.

The two numbers that come immediately after the letters refer to the

dosage form and strength of the product.

Alpha-numeric coding can be variable or fixed. In the variable coding

system, a third number is used to show the change in price.

This number varies according to the price of the product.

Numeric Coding System

 This is a coding system using numbers that starts from one and can increase until the

maximum number of items.

 Products with different strength and dosage form will have different codes. To give

codes using this system, arrange all the products (segregated by dosage form and

strength) in alphabetic order.

 Assign number 1to the first product in the list and continue numbering until the end.

 With this coding system, products of same strength and dosage form with varying

costs cannot be handled at the dispensary at the same time.

Note: The numeric coding system is very old model and becomes difficult to identify the

product using this code specially when there is a long list of products and if sources are

missed. Therefore, APTS recommends the use of alpha-numeric coding system

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Alpha-numeric variable coding and its application
 This is a type of coding that uses letters and numbers.

 As mentioned above, alpha numeric code is constructed from 7 characters.

 The first 4 are letters taken from the generic name of the product followed by three-digit

numbers (indicating dosage form, strength and price).

 Alphanumeric code possesses less burden of memorization on the pharmacy professionals

as the alpha components of the code gives clue about a medicine under question.

Four letters for codes

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15
 Two numbers for codes

 Next to the four letters, numbers that come immediately after the letters refer to the

dosage form and strength of the product.

 Numbering starts from the smallest strength and continues to the highest in

ascending order.

 The two numbers are assigned starting from 01 to 99 using the following agreements.

For chemicals, it is agreed to use 1 -01 to 4-09.

See the following table and refer the national code: -

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17
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Price code (the seventh characters-(number)

 For a drug having the same generic name, dosage form and strength but with different

cost, the codes vary by using variable coding system.

 The variable code is the last numerical digit of the code of the product; it varies

according to the cost of the product by increasing the last digit sequentially starting

from number 1 for the first price.

 Example: The code of Amoxicillin 250 mg capsule with a cost of 10 Birr is Amox-01-1. The

cost of Amoxicillin 250 mg capsule changes to 20 Birr, the code will be Amox-01-2

 In cases where we use fixed coding, the code remains the same irrespective of

variations of the cost.

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  In such situation, a product with a revised price cannot be shelved for dispensing prior

to finishing the already existing one.

 In addition, when the product with the old price is completed, announcement of cost

variation is mandatory before initiating of dispensing from the product with the

revised price.

 All dispensers should immediately note the change in price.

Using price code for price control sheet

 The price code is an additional number to be coded in a specific health facility per the

cost of the product whereas the base codes are prepared nationally.

 After the base code for a specific product is assigned, the price code is also assigned for

price controlling.

 Auditors use the price control sheet for auditing as a reference.

 The price code is assigned by store manager with pharmacy coordinator/dispensing head.

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 The copies of price control sheet should be available at all dispensing units, accountant

office, audit office and store.

 All shall sign at the price control sheet while receiving.

Advantages of coding system

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 CHAPTER FOUR

SALES MANAGEMENT

 Selling of medicines refer to the transactions between the client/patient and the service

provider at dispensing outlets and service delivery units.

 This transaction involves sales of medicines on cash or credit or free including

exempted health programs (e.g. TB, ART, Immunization, etc.)

 These transactions should be carried-out using the official forms and tools (sales ticket

pad register, cash sales tickets and credit sales tickets) used for cash and credit sales.

 Whereas, the credit/free registers will be used for credit or free sales. Note: credit sales

can be managed either using credit sales tickets or credit register.

Sales management of pharmaceuticals

Sales Ticket Pad Register
 It is a register with pages or serial number, used for controlling the movement of sales

ticket pads issued to and returned from dispensers.

 It identifies sales ticket pads by their serial numbers.

 The pharmacy accountant should distribute sales ticket pads to all dispensing outlets

and service units after recording all the details in the register (refer sales ticket pad

register).

Cash Sales Ticket

 Cash sales ticket is a receipt delivered to clients/patients in exchange of payment of cash.

 It is often a serially numbered triplicate copy consisting of 50 pages per pad, each bearing the

name and address of the health facility.

 It serves both as a sales ticket and a legal receipt of the health facility for medicine sales.

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Credit Sales Ticket/Credit Sales Dispensing Register
Credit Sales Ticket: Is a receipt delivered to clients/patients in exchange of presenting a

prescription paper, identification card and prior notification of credit sales agreement from

the sponsoring organization. It is the same as the cash sales ticket except the name

“Credit Sales Ticket”. It serves both as a credit sales ticket and a legal receipt of the health

facility for credit sales of medicines.

Credit Sales Dispensing Register: This register is a recording tool to keep track of clients

served by the pharmacy based on a credit agreement entered between the health facility and

sponsoring organizations, such as kebele/woreda and private institutions such as banks,

factories, etc., to which the beneficiary belongs. This register should be applied at the

outpatient pharmacy, inpatient pharmacy, emergency pharmacy, radiology, laboratory and

nursing stations.

Free Medicines Dispensing Register: This register is a recording tool to keep track of

clients served by the pharmacy for free of charge based on evidence of confirmation of being

beneficiaries of exempted programs. This register should be applied at the outpatient

pharmacy, inpatient pharmacy, emergency pharmacy, radiology, laboratory, and nursing

stations.

CHAPTER FIVE

PHARMACEUTICAL STOCK AND CONSUMPTION ANALYSIS METHODS

 Pharmaceutical stocks at the facility should be analyzed periodically to see whether the

stock is being sold or consumed at the expected levels.

 The results of the analyses help relevant professionals at health facilities to take

appropriate action on current stocks of medicines or on future procurements.

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 The stock is analyzed in terms of cost or volume of medicines sold/consumed during the

specific time-period using the following analysis methods:

1. Stock turnover ratio (STR)

2. Stock consumption ratio (SCR)

3. Stock status analysis (SSA)

 STR and SCR use aggregate data and are used as some general consumption

indicators whereas SSA indicates the movement of a specific product.

1. Stock Turnover Ratio (STR)

 Stock turnover ratio or inventory turnover ratio is a relationship between the cost of

medicines sold during a period and the cost of average inventory during that period.

 STR indicates the number of time the stock has been turned over during the period and

evaluates the efficiency with which the health facility can manage its stock of medicines.

 STR measures the rate of conversion of stock into sales (cash, credit, sales).

 In other words, it measures the number of times stock is sold or used during a specified

time.

 It indicates profitability of the business.

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2. Consumption to Stock Ratio (CSR)

 Consumption to stock ratio indicates the value of pharmaceuticals sold against the
stock available for sale.

 In other words, it is an indicator of the stock at hand versus stock sold during the
period.

 It simply measures the amount of dispensed medicines in relation to the stock

available for sale during the period.

 However, it doesn’t indicate that whether the stock movement is profitable or not.

3. Stock Status Analysis (SSA)

 Stock status analysis is a method used to analyze the consumption pattern of a product

in the past and predict utilization of available stock.

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  It identifies whether products are fast moving, slow moving, or non-moving.

 This information in APTS principle is used to get readiness, take action before

pharmaceuticals are near expiry, expired or stocked out ahead of time.

 The analysis allows evidence based decision making on utilization of current stock

and future procurements.

 This process enables the health facility to minimize wastages and ensure effective and

efficient utilization of budget and continuous availability of essential medicines.

 The main purpose of assessing stock status is to determine how long the

pharmaceuticals we have on hand will last and how much of it can be used.

 To conduct effective stock status analysis, pharmacy personnel in charge should

understand the concept of maximum stock level, reorder level, minimum stock level,

lead time, average monthly consumption, and safety stock (emergency order level)

and morbidity data.

CHAPTER SIX

VEN AND ABC ANALYSIS, AND ABC-VEN RECONCILIATION

VEN Analysis

 VEN analysis is a method that is used to classify medicines into

 Vital (V),

 Essential (E) or

 Nonessential/less essential (N) per their clinical importance.

 It is important that the health facility DTC should classify the pharmaceuticals list by

VEN.

 This categorization should guide the forecasting, procurement, and inventory

management decisions of the health facility.

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 Medicines can be categorized in to VEN according the catchment areas or disease

morbidity.

 Vital medicines are critically needed for the health facility to save lives

 The criteria for prioritization of medicines into VEN are as follows:

 Vital (V)

 Vital medicines are very essential medicines that fulfil one or more of the following

criteria:

o Potentially life-saving,

 without which it is impossible to save patient's life, and

 patient may die or may be harmed or disabled due to lack of these

medicines

o Crucial to provide basic health services, without which it is impossible to

deliver the basic services in the specific catchment area (in its absence service

may be discontinued).

o It is mandatory for these medicines to be available 24 hours of a day, 7 days of

a week, and 12 months of a year.

 Essential (E)

 Essential medicines are those that fulfil one or more of the following criteria:

o Effective against less severe but significant illnesses (it is between vital and less essential)

o Important to provide basic health services without which patients can face difficulty

o May be somehow substituted

o Essential to the service without which it is difficult to provide health service

o It is mandatory at least once a day, or at least once in a week, or at least once in a month

or once in a quarter of the year, but not as highly mandatory as vitals.

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  Nonessential (N)

 Non-essential medicines are less essential medicines that are:

o Effective for minor illnesses and have low therapeutic advantage
o Important to patients; however, patients will not die due to the absence of such
medicines

o Necessary to give the health service; however, health service delivery will not be
discontinued in the absence of these medicines

ABC Analysis

 ABC analysis is a method for determining and comparing pharmaceutical costs within

a health facility.

 It follows the Pareto principle “separating the vital few from the trivial many” in

terms of budget consumption/allocation.

 ABC Analysis can be explained in terms of budget consumed and number of

medicines in the budget list as follows:

ABC/VEN Reconciliation and Interpretation of Findings

 ABC/VEN reconciliation is made from ABC and VEN analyses.

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 It involves categorizing the class of medicines generated from ABC analysis by VEN

to identify if there is relatively high expenditure on low priority

medicines (N category items in Class “A”).

 Medicines in Class A should be further analyzed in relation to their importance in the

management of top ten diseases/conditions in the health facility.

 Follow the steps below to take the necessary action based on ABC-VEN

reconciliation:

o Present results of the reconciliation to DTC to discuss whether products in Class “A”

reflects public health problem of the area.

o Undertake drug use evaluation (DUE) on medicines suspected to be overused that fall

under class “A”.

o Determine the % of drugs purchased according to the medicines list of the facility

o Take appropriate measure on N items that fall in A class.

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 CHAPTER SEVEN

AUDITING FOR PRODUCT, FINANCE AND SERVICES

 Auditing is a systematic, independent examination and evaluation of data, statements,

records, a person, an organization, a system, a process, an enterprise, project or product

operations and performances.

 The inventory management, accounting, and information system must provide

comprehensive evidence on medicine transactions and service delivery for effective

auditing.

 Auditing provides reasonable assurance that reported statements of transactions and

services are free from error.

 In practice, because of lack of transparent system, auditing of the pharmacy transactions

and services in Ethiopia was found to be difficult.

 This is due to lack of clear responsibility and accountability, lack of documentation,

incomplete and unreliable information, and non-transparent transactions.

 The implementation of APTS facilitates the practice of effective auditing system in health

facilities.

 This is because, APTS institutes transparent transactions that enable the tracking of

information on items with their costs received to the health facility, items issued to

dispensing outlets and service units, items dispensed to end users/patients (with

appropriate counseling), losses and wastages.

 APTS provides three types of reliable information; financial, product and services

rendered in the health facilities.

 Auditing related to pharmaceuticals at health facilities covers both transactions and

services.

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 The auditing of pharmaceutical transactions and services may be performed in the form of

either random or scheduled auditing methods.

 There are three major types of auditing in APTS.

o They are financial,

o Service /performance auditing and

o Product

Financial auditing

 It is a formal examination, correction, and official endorsing of financial accounts,

especially those of a business, undertaken by an accountant.

 It is endorsing that the statement or report is true.

 In this regard, auditing pharmaceutical transactions with respect to finance is used to

check and endorse the daily and monthly financial transactions reports.

o The daily financial auditing includes; - the amount of cash collected, submitted to

main cashier /or deposited in bank, the cashier’s delivery note recording, the cash

sales ticket pad (ticket flow) etc.

o The monthly financial includes; - evaluation of the received items by vouchers with

costs, issued items with costs, dispensed items with prices

Service/Performance Auditing

 It is a systematic check or assessment, especially of the efficiency or effectiveness of an

organization, a process, an activity, or a person’s mission, when typically carried out by

an independent assessor.

 When service is audited, quality of service, performance of individuals and the health

facility will be evaluated.

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 Service auditing includes; measuring workload and analysis with the APTS standards, the

patient served, the number of counselling, the DTP identified etc.

Product Auditing

 It is a systematic, independent examination of data, statements and records of products in

quality and quantity.

 It is endorsing of the statement concerning the quality status and quantity of the physical

inventory of items is true by checking the actual items physically.

 The product auditing includes: checking of products received with expiry dates and batch

number, the number of expired items with records; the stock on hand, received, issued,

dispensed against the ending stock of specific products.

End of the module

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