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
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