Zimbabwe, a low-income country in Southern Africa, has a population of 15 million. The country has one of the highest burdens of tuberculosis (TB), TB-HIV, and drug-resistant TB, although the prevalence of HIV/AIDS declined from 29.7% in 1997 to 18.1% in 2006, and there is a TB prevalence rate of 292/100,000.[1] Reducing the HIV, AIDS, TB, malaria, and neglected tropical diseases burden is one of the country’s strategic priorities. The health system is organized into central, provincial, and district levels and is funded by the government with contributions from the private sector, bilateral and multilateral donor agencies, nongovernmental organizations, and patients.
SIAPS, with support from USAID, has implemented activities in Zimbabwe through short-term technical assistance visits in coordination with in-country and regional partners and stakeholders.
Project Highlights
A mismatch between consumption-based quantification and notification trends, long procurement lead times, and overstocks and expiry of TB medicines led to the request for technical assistance for an early warning system (EWS) and for implementing QuanTB. QuanTB is now updated bimonthly, and results are used to track TB medicine stock, plan shipments, and determine actions to avoid stock-outs and wastage.
[Click to enlarge]SIAPS supported the national TB control program (NTP) to quantify TB medicine needs for its annual procurement and reviewed the quantification figures that the country submitted for the Global Fund new funding model.
SIAPS trained staff from the NTP’s National Quantification Technical Committee in the quantification of TB medicines in Harare in May 2015. It also trained staff from the Global Fund, the World Health Organization, and partner organizations on QuanTB. Using the data from this tool, multicountry (Tanzania, Uganda, Kenya, Bangladesh, Zimbabwe, Zambia, and Ethiopia) web-based dashboards were developed to display EWS data to prevent stock-outs and minimize TB medicine expiries.
The capacity of the Ecumenical Pharmaceutical Network (EPN)—a global network of faith-based organizations involved in strengthening pharmaceutical services in church health systems—increased.
Results
[Click to enlarge]Zimbabwe has adopted and institutionalized QuanTB and the EWS, which have enhanced the quantification capacity and skills of the NTP. More than USD 10 million was saved in Ethiopia, Nigeria, Tanzania, Kenya, and Zimbabwe between December 2014 and June 2016 as a result of the SIAPS technical assistance to the NTP.
Between January 2014 and December 2015, the TB medicine stock-out rate decreased from 13% to 0% for second-line medicines and from 6% to 0% for first-line medicines.
With technical assistance from SIAPS, the Zimbabwe Association of Church-related Hospitals, an EPN member, developed and conducted a training of trainers program on antimicrobial resistance (AMR), and 23 journalists have been trained. SIAPS followed up with each participant to establish a plan of action and tracked the publication of 23 articles related to AMR.
SIAPS supported the development and implementation of annual plans to accompany the Global Drug Facility mission.
Project Legacy
With assistance from SIAPS, Zimbabwe has fully adopted the QuanTB EWS to strengthen the information system and improve data quality, reporting, and decision making. The tool links patient and stock data to facilitate the early detection of potential over- and understocks. There is now better coordination among the NTP and other TB stakeholders.
The in-country partnerships can be further strengthened. Regular monitoring of TB stock levels against patient enrollment will ensure the early identification of potential wastage or stock-outs of TB medicines. Building in-country IT capacity through regular refresher trainings will help to address QuanTB software problems as they arise.
