Nigeria is the most populous country in Africa, with a population of 182 million and a life expectancy at birth of 52.4 years for males and 53.1 years for females.[1] The prevalence of TB is estimated at 330 per 100,000 population, with 91,354 TB cases reported annually.[2] The health system is tiered into primary, secondary, and tertiary levels.
Background
Beginning in 2013, SIAPS provided technical assistance to National TB Control Programs (NTPs) in 12 USAID-focus countries, including Nigeria, to strengthen the NTPs. Through regional and in-country technical advisors, the program supported NTPs to address challenges that result in uninterrupted access to TB medicines, including a lack of accurate and timely information to ensure an efficient TB commodity supply chain. The support included the use of QuanTB—an electronic forecasting tool and early warning system (EWS) that transforms complicated calculations into a user-friendly dashboard that displays key quantification and supply planning information and alerts on risks of stock-outs or expiries. Technical assistance was provided to improve quantification capacity and monitoring of TB programs.
Using a systems strengthening approach, QuanTB improved the quantification through institutional and individual capacity building.
Project Highlights
Project activities included:
- Improving quantification of TB medicines with support from the Global Fund
- Implementing QuanTB as an EWS to prevent stock-outs and wastage of TB medicines
- Strengthening information systems and improving case and stock data quality and reporting for informed decision making
- Supporting the development and implementation of the New Funding Model grant proposal plan for drug-susceptible TB and drug-resistant TB (DR-TB) for the NTP and partners
- Promoting and enhancing coordination and collaboration among the National TB and Leprosy Control Program (NTBLCP) and TB stakeholders and partners
- Supporting laboratory supply chain logistics activities
- Supporting the introduction of new TB medicines, including bedaquiline and delamanid, and setting up pharmacovigilance and adherence systems for new medicines
Results
- Institutionalized QuanTB as the national quantification tool
- Enhanced the NTBLCP’s quantification capacity and skills: The NTBLCP now conducts quarterly QuanTB exercises and generates data for forecasting and supply chain decision making. Other capacity-building activities included developing TB control procedures, guidelines, and tools (e.g., harmonization of TB standard operating procedures and DR-TB PSM guidelines, a TB pediatric desk reference, decision making during TB expert meetings, national Technical Working Group (TWG) presentations, guidelines, a handbook for field workers, training manuals, NTBLCP work plans, and action plans).
- Improved forecasting and supply planning: QuanTB forecasts, including updated data on the number of enrolled patients and stock on hand by expiry date, are reviewed quarterly and used to improve procurement, supply planning, and supply chain logistics management of TB commodities. The forecasts have been used to determine quantities of TB medicines and other commodities required for management and prevention activities for more than 500,000 Nigerians likely be infected with TB between July 2015 and December 2017. SIAPS technical assistance enabled the NTBLCP to quickly estimate medicine needs during the introduction of new medicines, such as pediatric formulations, bedaquiline, delamanid, and shorter regimen medicines.
- Supported the implementation of the EWS to prevent stock-outs and wastage of TB medicines and supported the MOH/NTBLCP PSM TWG for ongoing monitoring of the TB medicine supply pipeline.
- Strengthened information systems and improved data quality and reporting for informed decision making. The implementation of QuanTB has improved the TB logistics management information system and reporting.
- Strengthened overall pharmaceutical management of TB medicines in Nigeria.
- Improved coordination of activities and collaboration among NTBLCP and TB stakeholders and partners, including the NTBLCP PSM/Logistics Unit, donors, local TB partners, and other TB stakeholders.
- SIAPS TB technical assistance and QuanTB have improved TB medicines availability and TB control services.
Project Legacy
SIAPS support to the Nigeria Federal Ministry of Health and the NTBLCP has institutionalized the QuanTB EWS to improve forecasting, monitor stock, track expiries and stock-outs, make informed decisions, and take appropriate actions to close underlying pharmaceutical supply management gaps. Lessons learned include:
- Strong partnerships with in-country partners are key to leveraging resources and coordinating TB technical assistance and contribute significantly to the success of TB programs
- Regular monitoring of TB stock levels against patient enrollment is key to ensuring early identification of potential wastage or stock-outs of TB medicines
- Working with the NTP means providing support in all areas and requires excellent communication and interpersonal skills and a high level of patience and tolerance
Resources
- Implementing QuanTB to Improve Forecasting, Supply Planning, and Early Warning Systems for TB Medicines: Nigeria Report
- Pharmacovigilance Activities in HIV and AIDS Programs in Eight Sub-Saharan African Countries: Opportunities to Enhance Treatment Outcomes and Ensure Patient Safety
- Process of implementing e-TB Manager, 2008–2016: a summary of 10 countries
- QuanTB: Implementing an Early Warning System for TB Medicines
