A Synopsis of Strengths and Weaknesses Found in Country Case Studies on Effective TB Drug Management

1
A Synopsis of Strengths and Weaknesses Found in
Country Case Studies on Effective TB Drug
Management Hugo A. Vrakking Procurement
Officer Royal Netherlands Tuberculosis
Association
2
Country Case Studies on Effective TB Drug
Management

• by Stop TB Partnership KNCV
• sponsored by the World Bank

3
Country Case Studies on Effective TB Drug
Management

• Objectives
• Identify best practices in TB drug management in
  high-burden countries
• Share the elements that are relevant to other
  country settings

4
Country Case Studies on Effective TB Drug
Management
By means of a Questionnaire Questionnaires are
available here and could be used as an assessment
tool for an NTP either during this workshop or
later.
5
Country Case Studies on Effective TB Drug
Management

• Participating countries
• Benin Facilitator Dr. A. Trébucq, IUATLD
• Brazil Facilitator Dr. D. Weil, WB
• China Facilitator Dr. P. Gondrie, KNCV
• Nepal Facilitator Dr. I. Smith, StopTB
• Vietnam Facilitator Dr. M. Bosman, KNCV

6
Country Case Studies on Effective TB Drug
Management

• Completed questionnaires received from
• Benin
• Nepal

7
Strengths

• General
• No drug shortages in gt15 years (It is possible!)
• Reserve fund in case of supply failure
• Strong professional commitment by the NTP team
• Support from a reliable and loyal external partner

8
Strengths

• Drug management system
• Separate warehouse at central level directly
  managed by NTP
• Regular inventory of stocks at all levels
• Reliable estimates of requirements based on
  quarterly data on case findings

9
Strengths

• Drug management system
• Buffer stock (4 months) at district level
• Reserve stock to replenish local drug stocks
  carried by supervisor
• Drug procurement
• Prequalification of suppliers (LCB)
• Independent tender board

10
Strengths

• Personnel management
• Regular review meetings are held at all levels,
  where demands are calculated and drug problems
  are reported.
• TB staff at all levels are trained and involved
  in management and calculation of TB drugs.
• Supervision includes drug stocks and drug
  management.

11
Challenges

• Dependence on international donors
• Donated drugs on Drug Regulatory Authority (DRA)
  clearance letter only
• Quality assurance by DRA outside NTP
• Quality assurance based on information by
  suppliers only
• No WHO CPP required, bioavailability data for R
  not known

12
Recommendations

• Continue to lobby for and create separate budget
  line for TB drugs and lab supplies in budget of
  MoH.
• NTP managers should participate actively in every
  stage of (international) tendering.

13
Recommendations

• Include physical drug stocks verification in
  supervision visits.
• Include drug management in every NTP review
  meeting at all levels.

14
Country Case Studies on Effective Drug Management

• Next steps
• Receive completed questionnaires (Brazil, China,
  Vietnam others?)
• Evaluate answers and produce final study report
  (KNCV)

15
Country Case Studies on Effective Drug Management
Good drug management is both an indication and a
consequence of a well-run NTP! (Benin)