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

Hugo A. VrakkingProcurement Officer

Royal Netherlands Tuberculosis Association

Country Case Studies on Effective TB Drug Management

by Stop TB Partnership & KNCV

sponsored by the World Bank

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

Country Case Studies on Effective TB Drug Management

By means of a Questionnaire

Questionnaires are available here and could be usedas an assessment tool for an NTP either

during this workshop or later.

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

Country Case Studies on Effective TB Drug Management

Completed questionnaires received from:

• Benin

• Nepal

StrengthsGeneral:

• No drug shortages in >15 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

StrengthsDrug 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

StrengthsDrug 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

StrengthsPersonnel 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.

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

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.

Recommendations

• Include physical drug stocks verification in supervision visits.

• Include drug management in every NTP review meeting at all levels.

Country Case Studies on Effective Drug Management

Next steps:

• Receive completed questionnaires (Brazil, China, Vietnam; others?)

• Evaluate answers and produce final study report (KNCV)

Country Case Studies on Effective Drug Management

Good drug management is both an indication and a consequence of a

well-run NTP!

(Benin)