Procurement &supply chain management

5th Joint International Monitoring Mission

Overall observations • Increased funding for procurement of anti-TB

drugs;• No stock outs of anti-TB drugs & lab reagents; • Availability and use of anti-TB fixed dosage

combination drugs (FDCs) increased since 2007;• Well established Pharmacovigilliance system;• Ancillary drugs available for management of ADRs; • Functioning drug distribution system;• Good storage practices

5th Joint International Monitoring Mission

Challenges • Fragmented procurement: NHSO, SSO, CSMBS, BTB (GF),

hospitals – higher cost, un-assured quality, frequent delays; • Numerous formulations/strengths procured: complicates

drug management, leads to errors, stock outs and oversupply;• Still limited use of FDCs: poor treatment adherence and

unfavorable outcomes;• Lack of pediatric anti-TB formulations;• OTC dispensing of anti-TB drugs: irrational use &

amplification of resistance; • Large amount of drugs issued to MDR TB patient at once:

amplify resistance & cause serious toxicity

5th Joint International Monitoring Mission

5th Joint International Monitoring Mission

1 MONTH MDR TB PATIENT TREATMENT

Recommendations• Single & streamlined procurement of quality

assured anti-TB medicines; • Limit procurement of anti-TB medicines to essential

formulations & strengths;• Procure & promote use of fixed dosage combination

drugs through all stakeholders & partners;• Procure & avail nationwide child-friendly fixed

dosage anti-TB formulations;• Ban OTC dispensing of anti-TB medicines through

legal sanctions;• Ensure treatment enabler or observer for M/XDR TB

patients

5th Joint International Monitoring Mission