Tanzania, with a population of 56 million, has a HIV/TB mortality rate of 48/100,000 population. Approximately 65,000 TB cases were reported in 2016, and there was 40% coverage for TB treatment.[1] While the National Tuberculosis Program (NTP) offers free diagnosis and treatment for TB, many people first seek care from other providers, such as physicians in the private sector, pharmacists, or informal drug sellers. Pharmacists and pharmacy associations have only recently been recognized as key players in these partnerships. The USAID-funded SIAPS Program provided technical assistance to the Ministry of Health, Community Development, and Gender, Elderly and Children (MOHCDGEC) Tanzania, and specifically the National Tuberculosis and Leprosy Control Program (NTLCP), to address challenges in ensuring uninterrupted access to TB medicines. Challenges included inadequate technical skills and tools to forecast and plan for the supply of required TB medicines; no monitoring system for stock status and pipeline management; and no early warning system (EWS) to prevent stock-outs, overstock, or expiries. These challenges resulted in under or overestimation of TB medicines.
Project Highlights
The NTLCP adopted and institutionalized QuanTB as the national quantification tool and EWS for TB medicines
Developed training materials and trained 30 people to quantify TB medicines using QuanTB, including NTLCP staff; TB supply chain subcommittee members; and other national-level stakeholders from key institutions (MSD, Tanzania Food and Drug Administration, MOHCDGEC/Pharmacy Unit, LMU staff and partners (SCMS), and other stakeholders)
Technical Assistance to the Public-Private Mix for TB Case Management in Tanzania: Workshop, May 2012 [Click to enlarge]Supported forecasting, supply planning, and biannual quantification review meetings with the TB subcommittee
MOHCDGEC staff participated in regional workshops for the Global TB Supply Chain meetings in Zanzibar, Tanzania, and Bangkok
The MOHCDGEC developed the procurement and supply management component of of the National Tuberculosis Strategic Plan for 2015–2019, which focuses on improving pharmaceutical supply management for TB
Supported setting up a structured system for referring presumptive TB cases from private drug outlets (which are used by almost 40% of people as the first point of contact when seeking health care services in Tanzania) to TB diagnostic centers
Conducted a knowledge and practice survey related to TB among drug dispensers in Tanzania that involved 250 private drug outlets
Developed training materials, trained private drug dispensers, and provided assistance in the design of referral tools
Coordinated sensitization meetings with 466 health workers from 98 TB diagnostic centers on the new public-private mix (PPM) intervention, established a team of 32 trainers to support training of dispensers on TB case finding as part of the PPM approach, and enhanced the capacity of 737 dispensers to support the identification of TB cases
Results
Percentage of stock-outs of TB medicines [Click to enlarge]The use of QuanTB has provided more timely, accurate, and reliable data than were previously available. The tool also helped to review trends in actual enrollment of TB cases and necessary steps taken to minimize the risk of stock-outs or overstock of certain medicines when the number of TB cases increased or decreased.
Stock-outs of first-line medicines decreased from 29% to 11% and of second-line medicines from 17% to 9% from January 2014 to April 2016.
The country was able to borrow 1,000 packs of RHZE from Malawi and 2,000 from Zimbabwe (consignments valued at USD 115,000) to prevent a stock-out while awaiting GDF delivery. A shipment of overstocked second-line TB medicines from the GDF worth USD 326,934 was postponed in response to slow enrollment of multidrug-resistant TB patients, and future shipments were staggered.
An evaluation to assess the impact of involving private drug outlets in improving TB case detection showed that 587 TB presumptive cases were identified by private drug sellers and were referred for TB diagnosis; 43% of these were confirmed as TB patients.
