Title: Assessment survey of TB drug management
1Assessment survey of TB drug management in
Cambodia Uchiyama Y, Chay S, Kousoum M, Leng C,
Kien S, Nou C, Chhom C
CENAT/JICA National TB Control Project, Cambodia
2Drug supply management system in Cambodia
- Selection/Procurement
- National Essential Drug List
- Public procurement (centralized system)
- Yearly drug requests from ODs/NHs to MOH
- Quantity adjustment, pricing open tender by MOH
- Distribution
- Flow of drug delivery requests
- CMS ? ODs/NHs quarterly
- ODs ? RHs/HCs monthly
- Inventory store management, following MOH
guidelines - Use
- Management is various among national programmes
3NTP TBDM
- Selection
- Criteria National/WHO Model List authorized TB
guides - Procurement (source other than NB)
- Donation of GDF-standard TB drugs from Japan
through the JICAs Grant Program (2004-2006) - Distribution
- Safety stocks (ODs/NHs 3M, RHs/HCs 1M)
- Use
- 8M treatment regimen
- (C1 2RHZE/6EH, C2 2RHZES/1RHZE/5RHE, C3
2RHZ/6EH) - DOTS approach hospitalization, ambulatory
home delivery - DOTS expansion to HCs 780/942 HCs (March 2004)
- Two TB staff in each health facility with TB
service
4Examples of findings obtained from the
National Workshop on TBDM
- Selection/Procurement
- Qty. of TB drugs per bottle delivered ? qty.
indicated on the label - Shelf life of TB drugs delivered is not long
enough to use up - Distribution
- Stock records ? physical counts
- Poor quality of loose tablets (color change,
moisture) - No measure to verify the validity of TB drug
consumption - Use
- TB patients poor adherence to TB treatment
poor knowledge of TB/TB treatment among TB staff - Management support
- TBDM has not been a priority for supervision
- Policy and legal framework
- Private practitioners do not follow the TB
treatment guidelines - TB drugs are available in pvt. pharmacies without
prescription
5Survey methods
- Design/Setting
- Treatment record review, structured interview
inventory check - 107 public TB health facilities (cover 40 of all
the TB cases) in 14 TB high-burden ODs (14
provinces) out of 75 ODs (24 provinces),
including a problematic OD in TBDM reported 66
pvt. pharmacies - Intervention (7 investigators)
- Preparation (Oct-Nov 03), data collection (Nov
03-Feb 04) data analysis (Feb-Mar 04) - Outcome measures ()
- New ss TB patients who received correct TB drugs
in correct dosage - TB staff/new ss TB outpatients who had correct
knowledge of TB - Drug stores where stock records corresponded with
physical counts - Expired stocks for TB drugs
- Drug stores where stock-out for TB drugs was
observed - Treatment cost per new ss TB patient
-
- (Design outcome measures were referred to in
the Drug Management for Tuberculosis Manual, MSH)
6Survey results 1 of new ss TB patients who
received correct TB drugs in correct dosage
7Survey results 2 of TB service providers who
had correct knowledge of TB/TB treatment
8Survey results 3 of new ss TB outpatients
who had correct knowledge of TB treatment
9 Survey results 4 of drug stores where stock
records corresponded with physical counts of
expired stocks for TB drugs of drug stores
where stock-out for TB drugs was observed
- S 1000 vials were stored in 27 out of
51 facilities. - Physical countsexpired stocks is
regarded as stock-out
10Survey results 5
Treatment cost per new ss TB patient (8M,
35-49Kg)
- Quoted from the International Drug
Price Indicator Guide, MSH. - Added 15 for shipping and insurance
costs to FOB prices
11Conclusions recommendations
- Further attention should be paid to treatment for
TB patients weighing gt50Kg. - Periodic training on DOTS is needed for
peripheral TB staff. - TB outpatients answers are affected by
interviewers position character (central NTP
staff in charge of IEC/supervision activities are
eligible). - DOT rate among CF patients can be increased with
expansion of community DOT. - Periodic training on stock management is needed
for pharmacists store keepers. - More pharmacists are needed to reduce workload,
or incentives should be considered for them.
12Conclusions recommendations (contd.)
- TB drugs procured should be of high quality the
cheapest price. GDF-standard TB drugs are
preferable. - An indicator-based TBDM assessment survey can be
utilized for - identifying both strengths weaknesses in TBDM
- monitoring changes in TBDM practices quality of
DOTS - developing specific action plans for the
improvement of TBDM - providing health education to TB patients
- Close cooperation with the MOH is important to
address DM issues that are beyond the scope of
NTP.