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Development of Country-Specific Plans for TB Drug Selection and Use Bangladesh, India, Kenya, Philippines, and Uzbekistan. TB Drug Selection: Bangladesh. NTC needs consensus building for FDCs. Technical assistance is required STGs need to be revised
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Development of Country-Specific Plans for TB Drug Selection and Use Bangladesh, India, Kenya, Philippines, and Uzbekistan
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
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)
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
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.
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
TB Drug Use: India • Increase the involvement of the private sector in RNTCP
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
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
TB Drug Quantification: Bangladesh • Quantification based on reported cases • Centralized process • Need for capacity building • Need for strategic planning for drug needs
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
TB Drug Quantification: Kenya • No problems reported • Primarily use morbidity data for quantification (stock data is also used), but do not reconcile the two
TB Drug Quantification: Philippines • No problems reported • Use both morbidity and consumption data for quantification • Highly decentralized • Manual system
TB Drug Quantification: Uzbekistan • No system of quantification at present—using morbidity only • No national TB program • DOTS pilot in ten areas
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
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?
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
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
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
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
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
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
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
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