ANSF Medical Logistics Capt Josh Leslie, USAF

1. ANSF Medical LogisticsCapt Josh Leslie, USAF UNCLASSIFIED

2. Agenda • Introduction • Afghan National Army (ANA) • Afghan National Police (ANP) • Forms • Expectations • Scenarios

3. Introduction • Afghan’s MEDLOG system is not like ours • Depot system • It is not perfect, but it works if done right • Processes are established in official decrees (regulations) • ANA: Ministry of Defense (MoD) Decree 4.0 • ANP: Ministry of Interior (MoI) Decree 4.0 • ANA & ANP systems are similar, but are distinctly separate entities • ANA system is much more mature than ANP

4. Introduction • Medical supplies are the only commodity fully transitioned and Afghan-led, coalition-funded • Most internal hospital logistics is done by the pharmacy • Why you should care • Afghans need supplies to run a medical system • Anyone advising Afghans in a medical facility will advise logistics • You cannot advise what you do not know

5. ANA MEDLOG System • MEDCOM • Establishes requirements • AT&L • Procures requirements via contract with vendors • LOGCOM • Receives, stores, and distributes supplies • National Supply Depot and regional Forward Support Depots • Medical Units • Report usage back to MEDCOM to develop requirements

6. LOG Structure Located in Kabul ANA supply chain is based in Kabul, but each region maintains a Forward Support Depot (FSD)

7. Responsibilities – AT&L Acquisition, Technology & Logistics (ATL): • Equips/sustains the military • Oversight of LOGCOM and Acquisition Agency • Establishes policies for logistics support systems • Creates and equips a sustaining base of supplies for the ANA Oversight agency for all logistics functions

8. Responsibilities – Acquisition Agency Acquisition Agency: • MoD’s contracting authority • Provides contract & contract administration support for all classes of supply • Operates national codification system (assigns “NSN” to supplies) • Provides cost and pricing support to MoD Procures medical supplies for the ANA

9. Responsibilities – LOGCOM Logistics Command (LOGCOM): • Responsible for storing and distributing all classes of supply • Oversight of National Depot and Forward Support Depots Stores and distributes medical supplies

10. Responsibilities – MMC Material Management Center (MMC): • Provides C2 over the supply chain • Reviews all MoD14 submissions for approval before forwarding to the depot to be filled Approves MoD14s based on requirements list generated by MEDCOM

11. Responsibilities – ASC Army Support Command (ASC): • Intermediary between the FSD and MMC • Headquarters for all FSDs • Does not approve or deny the contents of MoD14s, but does check for accuracy. If MoD14s are incomplete, they are returned to the FSDs. ASC Consolidates MoD14s and sends to MMC for approval

12. Responsibilities – CLVIII NSD CLVIII National Supply Depot (CLVIII NSD): • Responsible for storage of CLVIII (Medical) to support the entire ANA • Receives, stores, accounts and prepares CLVIII for shipment to the FSDs Manages CLVIII warehouse to support the entire ANA

13. Responsibilities – FSD Forward Support Depots (FSDs): • Provides CLVIII support for all ANA units in region • Has CLVIII warehouse • Stores 25% of annual CLVIII requirements for regions • FSDs also in Shorabak and Gamberi, but there is no CLVIII warehouse Regional Depots provide CLVIII support to the region

14. ANA CLVIII Regional Depot System Camp Shaheen (MeZ) CLVIII Warehouse Hospital Garrison TMC X 3 AAF TMC Camp Zafar (Herat) CLVIII Warehouse Hospital Garrison TMC X 3 AAF TMC Kabul National Supply Depot National Military Hospital TMC X 12 Gamberi FSD, No CLVIII Warehouse Hospital under construction AAF TMC Kabul Camp Thunder (Gardez) CLVIII Warehouse Hospital Garrison TMC X 3 Camp Shirzai (Kandahar) CLVIII Warehouse Hospital Garrison TMC X 3 AAF TMC Camp Shorabak (Helmand) FSD, No CLVIII Warehouse Garrison TMC X 3

15. ANP CLVIII Regional Depot System ANP Regions/Zones Badakhshan Jowzjan Balkh Konduz Takhar Samangan Faryab Baghlan RC-Capital 101 Asmai (Kabul) Panjshir Sar-I Pol Nuristan Badghis RC-Central 202 Shamshad (Kabul) Kapisa Parwan Kunar Laghman Herat Kabul Bamyan RC-North 303 Pamir (Mazar-e-Sharif) Wardak Nangarhar Day Kundi Logar Ghor RC-South 404 Maiwand (Kandahar) Paktya Khowst Ghazni RC-East 505 Spinghar (Gardez) Uruzgan Zabul Farah Paktika RC-West 606 Ansar (Herat) Spin Boldak Nimroz Helmand Kandahar

16. ANP MoI National Logistics System What We’re Developing: Badakhshan Jowzjan Balkh Konduz Takhar Samangan Faryab Baghlan Northeast Route Panjshir Nuristan Sar-I Pol Badghis Parwan Kapisa North Route Kunar Laghman Herat Central Route (2 Options: Either via Wardak Province or via Parwan and Bamyan Kabul Bamyan Wardak Nangarhar Day Kundi Logar Ghor Paktya East Route Khowst Ghazni South – West Route Uruzgan Zabul Farah Paktika Southeast Route Existing Regional Logistics Centers Spin Boldak Regional Logistics Centers (Projected 2012-2014 Nimroz Helmand Kandahar

17. Important Forms • MoD and MoI forms mirror each other • MoD/I Form 1 – Warehouse Receipt and Issue • MoD/I Form 2 – Stock Accounting Record • MoD/I Form 4 – Document Register • MoD/I Form 8 – Material Receiving Report • MoD/I Form 9 – Issue and Turn-In Document • MoD/I Form 14 – Request for Supplies • ANA only: • MEDCOM Form 58 (Form 58) – In-patient Med Request • MEDCOM Form 59 (Form 59) – Monthly Usage Report These documents request, track and account for supplies throughout the supply chain

18. MoD 1 – Warehouse Receipt & Issue • MoD 1 – Records all materiel that physically enters or leaves the warehouse or storeroom • Who? Anyone who maintains stock. • National Supply Depot • Forward Support Depots • Hospital Storeroom • Pharmacy • Department Storerooms • When? • When stocks increase or decrease • Pharmacy: Weekly/monthly adjustments based on usage tracking

19. MoD 2 – Stock Accounting Record • MoD 2: Used to account for stock and collect demand data • Who? Warehouses that support customers. • National Supply Depot • Forward Support Depots • When? • When supplies are issued to a customer • When items are received from vendors or supply system

20. MoD 4 – Document Register • MoD 4: Used as a register of initiated supply actions (MoD14 requests, MoD9 issues, etc…) • Who? Units with a stock record account. • FSD – maintained by customer service • Hospital – maintained by quartermaster • When? • Unit submits a MoD 14 to next higher level • Unit receives supplies on a MoD 9

21. MoD 8 – Material Receiving Report • MoD 8: Records receiving of material from outside sources • Who? Units that receive supplies from outside sources (donations, vendor deliveries). • National Supply Depot • Forward Support Depot • Hospitals • When? • Unit receives a donation • Confiscated supplies are turned in • Delivery is received from vendor

22. MoD 9 – Issue and Turn-in Document • MoD 9: Document used to issue materiel from a supporting unit to a supported unit • Who? Units that issue supplies to subordinate units. • National Supply Depot • Forward Support Depots • Hospital Storerooms • Pharmacy • When? • Depot or storeroom issues supplies to a customer • Excludes meds covered by Rx or Form 58

23. MoD 14 – Request for Supplies • MoD 14: The basic form used to request items/supplies in the ANA Logistics System • Who? Units that want supplies. • Forward Support Depots • Hospital Storerooms • Pharmacies • Department storerooms • When? • User initiates a supply request Most commonly used form….know how to fill it out so you can advise the Afghans!

24. MEDCOM Form 58 – In-patient Med Request • MEDCOM 58: Form used to track medication requests for hospitalized patients. • Who? • Nursing ward • When? • When medications are needed for in-patients

25. MEDCOM Form 59 – Monthly Usage • MEDCOM 59: Form used to track monthly usage of pharmaceuticals. • Who? • Pharmacy • When? • Once a month after consolidating daily usage

26. MoD 14 Flow – ANA CLVIII NSD MMC ASC FSD RMH Depot issues supplies/equipment on a MoD 9 based off approved MoD 14 CLVIII Manager validates requirements, then either signs MoD14 and sends to CLVIII NSD or denies and returns to ASC ASC CC only signs MoD 14, does not approve/disapprove FSD CC approves & signs, then issues items if on hand, or forwards to the ASC NMH Generates MoD 14 Everything in the supply chain starts with the end user and a MoD 14

27. ANP Projected Requisition Process “Pull” System RLC MoI 14 – sent by end user MoI 9 – supply receipt Convoy End user to RLC for supplies ANP Nat’l Warehouse Unit level end user Requires trained, competent Afghan Logisticians at RLCs, PSPs, and unit end users Last Updated: 23 Feb 12 POC: Maj Patrick Barger, 237-3971

28. Lifecycle of Meds/Supplies (ANA) We need X MEDCOM adds to requirements list Procured via AT&L Item delivered to NSD # = form updated or filled out 1 2 8 End User submits request for X FSD fills or forwards FSD Customer service forwards to ASC ASC signs & forwards to MMC MMC validates & forwards to NSD NSD fills order 14 4 4 9 1384 1 2 Hospital storeroom issues to department Hospital Only 1 9 Delivered to FSD FSD fills order RMH receives item Monthly usage report to MEDCOM Expires – Destruction letter to MEDCOM Prescribed to outpatient or 1 2 1 2 1 4 9 4 59 Rx Item is a narcotic Issued to inpatient ward 57 58

29. Lifecycle of Meds/Supplies (ANP) End user needs item # = form # completed/updated End User submits request for item ANP Nat’l Warehouse fills or orders End user receives item 14 9 1 9 2 Hospital pharmacy issues to department Hospital/Clinic Only 1 9 Hospital end user receives item Monthly usage report to OTSG Expires – Destruction letter to OSTG Prescribed to outpatient or 1 Rx Item is a narcotic Issued to inpatient ward

30. How You Can Help • Build trust in the system • Encourage Afghans to follow up with requests • Advise department on MoD/I 1 & accountability • Help department develop authorized stock list • Teaches them reorder points and reduces requests • Do NOT fill out a MoD/I 14 for the Afghans • It is their system, let them do it • Do not obtain supplies outside of the Afghan system

31. The Goal: Meds to beds, Afghan led…