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

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