Produce a report focused on the evidence on the comparative advantages and disadvantages of “push” and “pull” mechanisms in pharmaceutical management
In pharmaceutical management, distribution schemes for medicines can be defined as “push” or “pull” systems. In a pull system, each level of the system determines the types and quantities of medicines needed and place orders with the supply source. In a push system, supply sources determine the types and quantities of medicines to be delivered to lower levels. This helpdesk report examines the advantages and disadvantages of these “push” and “pull” mechanisms. Advantages of pull systems include that they are responsive to health facilities’ medication requirements, so there is more flexibility in selecting medicines for specific health problems in particular regions or types of health units. Their flexibility can result in less shortages or surpluses of items and less wastage caused by expiry of medications. Push systems are less flexible and responsive but they can be useful in particular situations. They can provide essential medicines with a simplified system of budgeting, procurement, storage, transport and supply management. They are widely used in disaster relief. Some countries use push systems for routine supply of essential medicines to rural health facilities. This report includes case studies of countries in transition from “push” to “pull” systems; countries that use a mix of “push” and “pull” mechanisms and examples of other approaches such as “top-up” or informed push systems.