1

Development of Country-Specific Plans for TB Drug Selection and Use

Bangladesh, India, Kenya, Philippines, and Uzbekistan

2

TB Drug Selection: Bangladesh NTC needs consensus building for FDCs. Technical

assistance is required

STGs need to be revised

FDCs need to be added to the EDL and integrated into policy

Vertical TB drug selection committee is not required

3

TB Drug Selection: India No selection problems reported

There is a need to expand DOTS to the remaining non-RNTCP areas (50% of the country)

4

TB Drug Selection: Kenya NTP to be incorporated into National Therapeutic

Committee (responsible for compiling EDL)

STGs and Essential Drugs List, need to update new FDCs

Strengthen coordination between NTP and Kenya Medical Supplies Agency

5

TB Drug Selection: Philippines No problems reported at present.

Once FDCs are introduced, STGs will need to be updated and TB staff will need to be trained.

Ongoing efforts are promoting private sector use of government TB policy and guidelines.

6

TB Drug Use: Bangladesh Treatment monitoring system needs to be strengthened

The involvement of the private sector needs to incorporated into national policy

Private practitioners are not following STGs Implement incentives for private practitioners IEC activities: TB patient clubs (cured patients are in favor of DOTS) Identify funding sources for conducting private-sector research

7

TB Drug Use: India

Increase the involvement of the private sector in RNTCP

8

TB Drug Use: Kenya In the private sector, STGs for TB are not being followed

Need technical assistance to help train public- and private-sector providers

Explore incentives for providers and patients to promote rational drug use

Explore options for community-based TB care, especially in distant geographic areas

9

TB Drug Use: Philippines Revise GFATM proposal (related to drug use in the private sector) and resubmit to

the next round

Continue collaboration activities with the private sector to determine a common framework for TB (ongoing at present)

Destigmatization plan

MDR survey to be conducted in late 2002 to determine resistance status and patterns

Incentives for voluntary health workers exist at the community level

10

TB Drug Quantification: Bangladesh

Quantification based on reported cases

Centralized process

Need for capacity building

Need for strategic planning for drug needs

11

TB Drug Quantification: India

Decentralized process for loose drugs, centralized process for other drugs

Use morbidity and consumption data

Need for capacity building in quantification at the state level

12

TB Drug Quantification: Kenya

No problems reported

Primarily use morbidity data for quantification (stock data is also used), but do not reconcile the two

13

TB Drug Quantification: Philippines

No problems reported

Use both morbidity and consumption data for quantification

Highly decentralized

Manual system

14

TB Drug Quantification: Uzbekistan

No system of quantification at present—using morbidity only

No national TB program

DOTS pilot in ten areas

15

TB Drug Procurement: Bangladesh

Need for refresher training and capacity building for procurement staff

Procurement done by MOH, supported by TB specialist

Need readjustment and recalculation in terms of GDF support

16

TB Drug Procurement: India Refresher training for new World Bank procedures as

necessary, including prequalification

Due to recent delays in procurement, need to explore options for emergency supply mechanism (DFID and DANIDA previously supported such efforts). Possibility to use GDF in future?

17

TB Drug Procurement: Kenya Personnel is inexperienced in TB procurement and needs more

training

Lack of funds due to other competing priorities

Quality assurance is not utilized directly because, in Kenya, registration is required prior to bidding

Some procurement takes place through WB loan (with prequalification)

GTZ are the procurement agents

18

Procurement: Philippines Ensure that prequalification will be part of the World Bank bidding

process

Review and possibly incorporate WHO abbreviated protocol for bioequivalence for rifampicin

Explore the option of an emergency GDF grant

Under DOTS, the public-sector supplies select private providers with TB drugs. The only incentive to provide is the drugs themselves

Need for additional capacity building in procurement

19

Procurement: Uzbekistan There are three main bodies involved in procurement:

Donors, MOH, and local government authorities. There is a lack of coordination between them.

Recently received a grant from GDF

No experience in TB procurement

20

TB Drug Distribution: Bangladesh

Need for increased capacity building

Distribution system is presently in a state of flux. Strategic adjustments may be required.

Manual reporting system

21

TB Drug Distribution: India In the process of developing state TB-drug storage areas

(have completed 5 out of 35 states)

Transportation shortage to be addressed by hiring from the private sector

Logistics manager needs additional training

Need to improve stock-management training

Computerized MIS: quarterly reports received on both consumption and stock data

22

TB Drug Distribution: Kenya

No problems reported except for some pilferage. Mixed vertical and integrated system.

Have MIS manual-based system for stock-consumption reporting

Data reporting good

No buffer stocks due to shortages

23

TB Drug Distribution: Philippines Currently implementing a computerized system using

consumption and morbidity data

A private company has recently been contracted for one year to conduct distribution (payment will be performance-based).

Deliver to private providers in DOTS areas who receive drugs through the public sector

24

TB Drug Distribution: Uzbekistan

No system is in place for distribution and/or stock control

A system for distribution is in the planning phases with Project Hope assistance