Revised National TB Control Programme India

1
Revised National TB Control Programme India

• Dr. P.P.Mandal, MD
• Deputy Programme Manager
• Central TB Division, New Delhi

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India is the highest TB burden country globally
accounting for 1/5th of global incidence
Source WHO Geneva WHO Report 2005 Global
Tuberculosis Control Surveillance, Planning and
Financing
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TB in India

• 1114 million population
• 35 states and Union Territories
• Diverse socio-cultural and geographical
  characteristics
• Incidence 1.8 million new TB cases annually
• 0.8 million new infectious cases
• 75 new Smve cases/100,000/ year
• Prevalence 3.8 million bacteriologically
  positive cases (estimate for year 2000)
• Nearly 370,000 deaths due to TB each year
• gt1000 deaths a day gt2 deaths every 3 minutes

4
Milestones in TB control in India

• 1962 National TB Programe (NTP) launched
• 1992 NTP jointly reviewed by GOI, SIDA and WHO
• 1993 DOTS piloted in 5 sites
• 1997 Revised National TB Control Programme
  launched with credit from World Bank
• 2005 5.4 million TB cases put on DOTS since
  inception
• 1.3 million in 2005 alone (Success rate 86)
• 2006 Mar DOTS expanded to entire country

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Partners of RNTCP

• World Bank
• GFATM
• Projects in 3 rounds
• Total grant amount USD 64 Million
• Population of project areas 285 million
• DFID
• USAID
• GDF
• DANIDA
• WHO

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GFATM - Projects

• 1st round 56 million population in
  Chhattisgarh, Jharkhand Uttaranchal
• NGO REACH
• 2nd round 110 million populations in 56
  districts of
• Uttar Pradesh Bihar
• 4 NGOs
• 4th round 119 million populations in
• Andhra Pradesh and Orissa

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GFATM Funding in RNTCP
GFATM Round 1
GFATM Round 2
GFATM Round 4
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Procurement Supply Management

• Central Unit within the NTP, assisted by
• Procurement agency contracted at national level
• Logistics management agency
• Central level procurement done for
• Anti TB drugs in Patient Wise Boxes
• Peadiatric Patient Wise Boxes
• Binocular Microscopes (gt11,000 Microscopy
  Centres)
• Culture Sensitivity testing equipment
• 2nd Line anti TB drugs
• Services- Mass Media, Procurement, and Quality
  Control Laboratories

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PSM (Contd.)

• State and District TB units
• Standing Procurement Committee
• Decentralised procurement
• Lab consumables
• Non health products - civil works, office
  equipment, vehicles, etc
• Services- Human resource, ASCM, printed material
  etc

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Patient-wise drug boxes

• A unique feature of RNTCP are the patient-wise
  drug boxes (for adult and pediatric cases), which
  improve patient care, adherence, and drug supply
  and drug stock management

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Procurement procedures

• International Competitive bidding ( 1 Million
  for goods)
• National Competitive Bidding (gt 50,000)
• National Shopping (lt 50,000)
• GLC for GFATM funded 2nd Line drugs

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Strengths

• National supply management and procurement
  strategy and guidelines
• Unified procurement plan
• Enhanced capacity at Central level
• Quality assurance protocol functional at 4 levels
• Use of existing public drug storage and supply
  infrastructure
• Integrated Programme management information
  system with regular monitoring
• Delineated PSM responsibilities for each level

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Strengths (contd.)

• Procurement through dual mechanism
• Support of GDF procurement
• Services of contracted technically qualified
• Central Procurement agency
• Central logistics management agency
• Infrastructure inputs State, district and
  sub-district drug stores, essential manpower etc
• Training of key staff in Procurement Manual and
  SOP in drug management

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Challenges

• Magnitude of anti TB drug requirements
• Decentralised drug procurement
• Limited procurement capacity at peripheral level
• Maintaining an efficient supply logistics systems
  in the country
• World Bank procedures (ICB) has long lead time
• Ensuring accountability and transparency at all
  levels of procurement
• Maintaining highest quality of pharmaceuticals
  and non-pharmaceuticals

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Thank You

• www.tbcindia.org

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Drug Quality Assurance System

• Pre-shipment batch testing for all drug batches
  by the RNTCP procurement agent
• Routine sampling at GMSD for drug quality testing
• RNTCP random sampling of field drugs and testing
  at independent laboratory
• Additional State and Central Drug Inspectors take
  samples randomly or on specific complaints

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Procurement procedure for WB funding

• Steps of procurement
• Approval of Estimated quantities, Delivery
  schedule and Technical Specifications by an
  expert Technical Committee
• Administrative and Financial approval for
  quantities and provision for budget
• Preparation of Bid Document for Pre-
  qualification (PQ) of suppliers by Procurement
  Agency for the approved quantities
• Administrative and Financial approval of PQ Bid
  Documents

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Steps of procurement (Contd.)

• No Objection of World Bank on the PQ Bid
  Document
• Advertisement and Inviting Bids for PQ (Min. six
  weeks given to suppliers)
• Technical Evaluation of Bids
• Administrative approval of Technical Evaluation
  Report
• No Objection of World Bank on the Technical
  Evaluation Report
• Preparation of Bid Document, administrative
  financial approval and No Objection of WB on
  the same

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Steps of procurement (Contd.)

• Invitation of Financial Bids from Pre-qualified
  suppliers (Min. six weeks for submission)
• Technical (Repeat) Financial Evaluation of Bids
• Approval of Bid Evaluation Report by the High
  powered Integrated Purchase Committee (IPC)
• Administrative and Financial approval on the
  Recommendations of IPC (usually upto Minister)
• No Objection of World Bank on the
  recommendations for award of contracts

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Steps of procurement (Contd.)

• Award of Contracts and signing of Contract
  agreements (upto 4 weeks given to suppliers )
• Delivery of drugs in two tranches (First within 4
  months and Second within 9th Month of signing the
  Contract)
• Average Lead Time of about 14-16 months for
  delivery after starting procurement process