Strengths and Weaknesses

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Strengths and Weaknesses of TB Drug Management
Moldova, Nepal, Pakistan, Somalia, and Sudan
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Strengths (Selection)

• Existence of selection committees, closely
  related to procurement units

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Strengths (Procurement)

• Quality assurance system in place
• Quantification based on caseload reporting
• Central procurement
• Quality is assured through purchase from GDF
• Program managers are involved in the procurement
  process

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Strengths (Distribution)

• Buffer stocks have been established
• Supply system is regularly monitored and
  evaluated
• Samples are tested and inspected

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Strengths (Use)

• WHO Standard Treatment Guidelines

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Strengths (Management)

• Decentralized financing
• Universal training
• DOTS throughout NTP in most countries
• National quality assurance regulations and
  enforcement
• NGO network

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Weaknesses (Selection)

• Not using blister packaging
• Limited use of fixed dose combinations
• Decentralization of decision making

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Weaknesses (Procurement)

• Quantification at local (NGO) level
• Decentralized procurement leads to higher prices
• Bioequivalence analysis is not complete
• Lack of collaboration with procurement of medical
  supplies (e.g., sharp boxes and syringes)

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Weaknesses (Distribution)

• High distribution cost (e.g., air freighting
  consignments in Somalia and southern Sudan)
• TB drugs handled separately from other drugs and
  not integrated into national supply systems
• Inadequate storage conditions

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Weaknesses (Use)

• Difficulty implementing DOTS in an insecure
  situation
• Misuse of drugs in non-DOTS areas
• No antimicrobial resistance monitoring or
  training

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Weaknesses (Management)

• Donor dependence
• Dual programs (e.g., Ministry of Health and
  prison programs)
• Inadequate or lack of budget for TB drugs

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Weaknesses (Other)

• The influx of TB drugs to the private sector
  leads to irrational drug use which, in turn,
  increases multi-drug resistance
• Lack of enforcement by DRA
• Political instability
• Safe disposal of syringes

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In Conclusion

• In general, a lot of progress has been made in TB
  drug management. However, there are still several
  country-specific situations that need to be
  addressed.