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Evaluating the Effectiveness of TB Medicine Supply Management Training in Western Cape, South Africa Fathima Fyzoo 1 ; Margaret von Zeil 2 1.Management Sciences for Health, SPS 2. Department of City Health, Western Cape ICIUM 2011 14-18 November 2011, Antalya, Turkey. Background.

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Background

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  1. Evaluating the Effectiveness of TB Medicine Supply Management Training in Western Cape, South Africa Fathima Fyzoo1; Margaret von Zeil2 1.Management Sciences for Health, SPS 2. Department of City Health, Western Cape ICIUM 2011 14-18 November 2011, Antalya, Turkey

  2. Background • South Africa (SA) has the second highest tuberculosis (TB) incidence in the world at 971 per 100,000 population (WHO Global TB report, 2009). • The SA National TB programme targets for 2011: cure rate of 85% and treatment success rate of >85% • An effective medicine supply management (MSM) system is essential • In SA, TB is managed mainly at a primary health care (PHC) level • MSM at most PHC facilities presents a huge challenge • SPS decided to provide support for MSM with a specific focus on TB

  3. Objectives • To determine the feasibility of using of TB medicine supply indicators for monitoring TB medicine management practices • To determine the effectiveness of TB MSM training for nurses at PHC facilities

  4. Design • Intervention with a pre-post assessment and no control group Setting • Intervention was undertaken at primary health care facilities within the public sector in the Western Cape province

  5. Intervention/Methods (1) A two day training workshop on TB MSM provided to 46 nurses from 28 PHC facilities

  6. Intervention/Methods (2) TB MSM Facility Assessment Tool

  7. Intervention/Methods (3)

  8. Results (1): Baseline & post training assessment at 3months p= 0.011 p=0.003 p=0.001

  9. Results (2): Baseline and post training assessment at 3 months

  10. Results (3) • No correlation was found between facility improvement and the number of nurses per facility trained • None of the facilities showed any relapse following improvement across all indicators over the 3 month assessment period • The ‘expired TB medicines’ & ‘correct average/reorder level’ indicators are more appropriate as a quarterly indicators rather than monthly indicators

  11. Summary • Use of TB MSM indicators was effective in measuring the outcome of training in a PHC setting. • Nurse training in TB medicine supply management resulted in improved TB stock management. • As a limitation, the evaluation did not follow-up on sustainability of good medicine management practices hence future evaluations should be designed as quarterly assessments over a longer period.

  12. Conclusions & Policy Implications • In the absence of pharmacists/pharmacist’s assistants at PHCs, training and capacity building of PHC nurses can ensure good MSM • Implementation of simple assessment tools and indicators for routine self monitoring can be effectively used to encourage good MSM practices at a PHC level • Ongoing M & E by PHC supervisors and district coordinators is essential to ensure sustainability of interventions

  13. Acknowledgements • District PHC supervisors/coordinators, Western Cape • Tiwonge Mkandiwire, SPS, MSH • P.C. Palli, Independent Research Statistician THANK YOU!

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