MDT Drug Management

1
MDT Drug Management Logistics

• Health Secretaries Meeting
• on Leprosy Elimination
• Goa, 30th Sept 1st Oct. 2004

2

• Goal To provide uninterrupted MDT drugs to
  patients under treatment
• Strategy
• To maintain a 3-month buffer stock of each
  category of blister packs, at State, District and
  Block levels, according to the number of patients
  under treatment
• To wisely use available MDT drugs in order to
  avoid shortage, excess, or expired drugs

3
Current situation

• There is enough MDT stock in the country to meet
  the needs, but
• Lack of adequate distribution of MDT blister
  packs at district, block and health facility
  levels according to the number of patients
• Consequence Excess, shortage, or expired MDT
  drugs at PHCs/CHCs or districts stores

4
Examples

• Madhya Pradesh, Indore drug store
• - 11 190 PB-A expired in Nov. 2003 (US 22 380)
• - as on Jan 2004 14 700 MBA (Exp. 03/04), 28
  950 MBA (Exp 04/04)US 87300
• Orissa, July 2004 (in patient-months)
• Baragarh district 1.7 MBA, 0 MBC, 6.2 PBA, 0 PBC
• Gajapati district 8.9 MBA, 51.8 MBC, 21.1 PBA,
  35 PBC
• Uttar Pradesh, Sitapur district, August 04 (in
  patient-months)
• Pahla block 1 MBA, 0.5 MBC, 2.5 PBA, 9.5 PBC
• Sidhauli block 4.2 MBA, 10.6 MBC, 4.2 PBA, 43
  PBC
• Maharashtra, Wardha district, Bhidi hospital
• - large stock of MBA PBA expired in Nov. 2003
• Karnataka Mangalore district (in
  patient-months)
• 6 MBA (Exp.Oct 04), 20 MBC, 14 PBA, 28 PBC
• Madhya Pradesh, Jabalpur drug store Indent of 10
  000 MB-A 10 000 PB-A, received 44 000 of each
  category. Indent 5000 MB-C received 3000

5
Discrepancy () between MDT drug register and
actual availability of drugs in district stores
Source LEM 2004
6
The reasons

• MDT indents are arbitrary, not based on the needs
  (number of patients under treatment)
• Top-to-bottom process for indent instead of
  bottom-up (existing stock in the pipeline not
  accounted for)
• Responsibility of MDT supply/stock management not
  clearly defined at Health Facility District HQ
• Most of the DLOs, CMHOs, MOs/IC, pharmacists are
  not aware/using
• The BCP Patient-Months indicator
• The MDT indent form

7
The reasons (2)

• MDT drugs (stock expiry date) are not
  systematically reported in Monthly reports
• Govt. Of India guidelines on MDT not widely
  distributed/used at PHC/CHC level
• Buffer MDT stock (GoI guidelines)
• At State level 3 months
• At District level 3 months
• At Block level (PHC/CHC) 3 months
• At Health Sub-Centres 0 month (no buffer stock,
  only stock for patients under treatment at
  respective Health Sub-Centres)

8
Solutions

• To assess adequacy of stock, at any point of
  time,
• To regularly indent, according to the number of
  patients under treatment
• To change the top-to-bottom process to bottom-up
  (from PHC/CHC to district from district to
  State)
• To fill up the stock data, with expiry dates, on
  monthly reports
• To regularly monitor the MDT stock supply

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To assess adequacy of MDT stock

• Use of the BCP Patient-Months indicator

10
How to indent? - example
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Conclusions

• Currently, large stocks of MDT are available at
  district block levels
• Large quantity of expired MDT drugs is not
  acceptable, when shelf-life is about 3 years
• Despite some progress made in the past months,
  MDT stock management is still far from
  satisfactory
• Quality of MDT stock management is one of the
  components of the NLEP which needs drastic
  strengthening

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Recommendations

• Ensure collaborative efforts from all partners
  (Govt. staff, DTST, and WHO coordinators) in MDT
  stock management at state, district health
  facility levels
• Assign clear responsibility to designated
  individuals (pharmacists, MO/IC, etc.)
• Conduct on-the-job training at each health
  facility district HQ visited on BCP
  patient-months indicator and MDT indent form
• Ensure regular indent based on the number of
  patients, with a bottom-up process, by using the
  standard MDT indent form
• Include systematically MDT data (stock, expiry
  date) on Monthly report forms (LF04 LF05)

13
Recommendations (2)

• Update monthly the MDT drug register and
  double-check existing stock in store
• Always use the principle of First In First Out,
  using first blister packs with shortest expiry
  date
• Re-deploy excess of MDT drugs to other
  blocks/districts, at least 6 months before expiry
• Maintain proper storage (careful of rain heat)
  to avoid damaged blister packs
• Destroy expired MDT drugs according to standard
  procedures prescribed by Central and State Govt.