Introduction to Elements of InCountry

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Introduction to Elements of In-Country Drug
Management with Focus on TB Drugs Jim
Rankin Director, Center for Pharmaceutical
Management Management Sciences for Health
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Five Elements of DOTS

• Government commitment
• Case detection by sputum smear microscopy
• Standardized treatment regimen
• Regular uninterrupted supply of essential TB
  drugs
• Standardized recording and reporting system

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Supply Management Cycle
Selection
Management
Procurement
Use
Support
Distribution
Policy and Legal Framework
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Policy and Legal Framework

• National tuberculosis program
• Drug policy and legislation
• Product registration/licensing
• Product quality assurance policies and
  regulations
• Procurement policy
• Policies on use of drugs by health providers and
  consumers

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Selection of TB Drugs

• Morbidity, resistance patterns, utilization
  factors, Stop TB guidelines
• Standard treatments for country
• First-line drugs INH, rifampicin, ethambutol,
  pyrazinamide, streptomycin
• Second-line drugs capreomycin, cycloserine,
  aminoglycosides, quinolones
• Limited list
• Fixed-dose combinations versus individual
  products
• Packaging for optimal use

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Procurement

• Follow good procurement practices
• Base on accurate quantification
• Secure funding to meet needs
• Compare potential sources of supply
• Choose appropriate procurement method
• Select appropriate suppliers
• Assure drug quality
• Monitor supplier performance

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Distribution (Supply Chain Management)

• Develop plan to ensure effective/efficient supply
  chain
• Ensure efficient clearance, storage, transport,
  stock control
• Provide qualified staff to manage and operate
  system
• Use effective management information systems
• Monitor performance at all levels
• Consider public, NGO, and private-sector options

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Public-Private Supply Systems
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Typical Structure of Public-Private Dug
Distribution
PRIVATE SECTOR
LEVELS
PUBLIC SECTOR

International
International Manufacturers
International Procurement Agencies
Government/NGOSupply Services Central
Level Procurement Unit Finance Unit Medical
Stores
National
Local Manufacturers
Importer-Wholesalers
Local Wholesalers
Regions Medical Stores, Hospitals
Regional
Districts Medical Stores Hospitals Health Centers
District
Shops, Pharmacies
Community Health Workers
Community
Consumers
Key


Drug flow in formal system Alternative drug flow
(planned or unplanned)
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Rational Use (public or private)

• DOTs system for administering drugs
• Prescriber/dispenser/observer training
• Monitor prescribing and DOTs
• Patient and community education
• Incentives/enablers for providers and patients

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Management Support

• Political/senior manager commitment
• Effective planning
• Effective implementation and management
• Effective management information systems
• Monitoring and evaluation
• Constant vigilance to ensure continuous, unbroken
  cycle
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