Tuberculosis (TB) continues to be a critical problem in Central Asia. Tajikistan, with a population of almost 8.5 million, is a mountainous landlocked country bordered by China, Kyrgystan, Uzbekistan, and Afghanistan.  Like other former Soviet republics, it has inherited a centralized, government-supported health system. Tajikistan experiences alarmingly high rates of multidrug resistant TB (MDR-TB) and is one of the countries with the highest burden of TB with an incidence rate of 87 per 100,000 population; the rate of new MDR-TB cases is 14% and the retreatment rate is 77%.
High rates of MDR-TB likely result from a number of underlying causes, including improper prescribing practices, misuse of medicines, and inadequate quantification and supply planning resulting in stock-outs of anti-TB medicines. Decision making and managerial interventions aimed at overcoming these challenges are limited by a lack of reliable data, often due to weak information systems.
Increased capacity for TB pharmaceutical supply management and services
With support from SIAPS, as a part of human-resource capacity-building for the delivery of TB services, the Tajikistan MOH reformed the in-service curriculum for health care professionals on delivering anti-TB medicines. In addition to updating the curriculum, staff involved in TB pharmaceutical management were trained countrywide.
Improved use of information for decision making in TB control
The indicator-based assessment of TB pharmaceutical management systems in Tajikistan revealed a number of problems, including stock-outs of medicines at all levels of the health system. SIAPS facilitated a process of selecting priority interventions to strengthen the supply chain system for anti-TB medicines, including implementation of QuanTB for forecasting and quantification.
Improved pharmaceutical services and access to TB products to achieve goals
SIAPS supported setting up an early warning system for supply of anti-TB medicines.
- SIAPS provided dedicated TB pharmaceutical management in-service training for TB doctors and nurses.
- SIAPS assisted the National Tuberculosis Program (NTP) in optimizing the use of existing paper-based reporting and developing an automated tool to electronically monitor and manage Logistics Management Information System (LMIS) reporting. SIAPS further modified the LMIS to add functionality, allowing stock data to be distributed by batch expiration date and data to be imported to QuanTB. The new version of the LMIS was piloted in six districts.
- The mapping of the current TB Pharmaceutical Management Information System (PMIS) and gap analysis enhanced the development of the TB PMIS.
- SIAPS provided technical assistance to the NTP to develop the new National TB Control Strategic Plan for 2015-2017, particularly its pharmaceutical management section.
- After a successful pilot, QuanTB was implemented nationwide at the oblast level in all 4 regions and the capital city Dushanbe. Currently, information for early warning and quantification system (QuanTB) is collected on a quarterly basis throughout the country.
- SIAPS also supported the NTP in leading a drug management working group consisting of all international and national stakeholders.
SIAPS has played a crucial role in enhancing the coordination and management of pharmaceuticals at the national and oblast levels; strengthening the pharmaceutical system by achieving a sustainable supply of locally trained pharmaceutical personnel, leading to better stock monitoring of pharmaceuticals at health facilities; and better managing and using pharmaceutical information for decision making, which has reduced stock-outs in Tajikistan.