Efficient monitoring enables you to:

• Notice when stocks need re-ordering.
• Check drug use against patient treatment.
• Become rapidly aware of discrepancies in drug treatment.

Discrepancies in drug usage are identified in the same way as discrepancies in equipment stocks. The amount of drug expected to be used is compared with the amount actually used. If there is a significant difference, this is a discrepancy.

Controlling life-saving drugs and fluids

Sometimes a patient's condition becomes severe or critical so suddenly that only the immediate use of certain drugs or fluids can save his or her life. It is very important that such supplies are always in stock. The absence of these supplies in an emergency may result in a patient dying. This is an unnecessary tragedy and a failure of health service management. To avoid this it is essential to:

• Make a list of life-saving drugs and fluids.
• Place them together on one shelf in the drugs cupboard or the refrigerator.
• Check the shelf frequently or whenever supplies are issued.
• Order a new supply when stocks are depleted by half.

An emergency supplies list for a rural Health Post managed by a Level-IV Health Extension Practitioner might include:

• Normal saline solution (given intravenously through a vein) for pre-referral treatment of severe dehydration or haemorrhage.
• Oxytocin (intramuscular injection) for pre-referral treatment of abnormal bleeding after delivery (postpartum haemorrhage).
• Rectal artesunate or intramuscular injection of artemether lumefantrine for pre-referral treatment of severe malaria.
• Amoxicillin or co-trimoxazole antibiotics for pre-referral treatment of severe pneumonia.
• Paracetamol for pre-referral treatment of severe pain.