18. Supply of Drugs, Laboratory Consumables and Documentation Materials

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Uninterrupted supply of adequate amounts of quality assured anti TB drugs and other consumables is mandatory for the smooth functioning of tuberculosis control activities across the country. Diagnosis of TB and the entire course of treatment for all registered TB patients are provided free of charge. The central level of NTP is responsible for planning, procurement and supply of anti-TB drugs, laboratory consumables and documentation materials (R&R formats and registers) to its implementing partners.

Estimates of the drugs and other items should be prepared taking the current and future requirements into account as well as the available stocks. Adequate buffer stocks are maintained at all levels to prevent stock outs due to unforeseen delays/disruption in supply as well unanticipated increase in number of patients. The entire process of drugs and logistics management has several interconnected components. The components of this management cycle are given below.

 

18.1 Selection and requirement of drugs

Selection of the drugs for procurement depends on regimens as well as categorization of patients. NTP follows global recommendation while selecting the optimum regimens or categorization of TB patients.

Quantification is based on the quantity of drugs required for treatment of different categories of patients (annex 4). Quantification of anti-TB drugs is usually carried out annually or as per requirement at the central level by the NTP managers with the technical assistance from partners. NTP uses GDF (Global Drug Facility) recommended tool, QuanTB, for quantification of TB drugs. This estimation of amounts of drugs required is based on the number of TB cases (category-wise) enrolled recently as well as estimated patients for the procurement period, treatment regimens to follow, amount of buffer stocks, stock-in-hand and stock on order (pipeline) at the time of the drug order.

Quantification of anti-TB drugs at the upazila, CDC or city level is usually done quarterly through drug requisition form or TB 08. This form has defined formula based on the number of patients (in different categories and regimens) diagnosed during the previous quarter, current stock and buffer.

The local health authorities, in collaboration with NGOs, will calculate the quantity of drugs required and fill in the requisition form for drugs (TB 08) at the end of every quarter. The form will be signed by the Upazila Health and Family Planning Officer (UH&FPO) or unit chief, countersigned by the Civil Surgeon (or supervisor for the unit) and forwarded to the central level, preferably within the first week of the following month. The concerned NGOs will collect the drugs from central level and deliver them to the respective indenting authority. Alternatively, the NTP may arrange for central supply of the drugs to the indenting authority. A tool for electronic indenting is in use in the program. The electronic indenting is connected to the Warehouse Inventory Management System (WIMS) used in Shyamoli Central TB Warehouse (CWH) for inventory as well as supply management. The electronic system follows the same calculation as the paper based TB08.

The NGOs will collect the required drugs from the designated UHC through an indent to the UH&FPO and will report consumption and balance of drugs and other delivered logistics/laboratory consumables to the respective UH&FPO (or unit chief).

The information about drug consumption and stock at the upazila level will be communicated quarterly to the central level along with the case finding and treatment outcome reports. It is the responsibility of the UH&FPO (or unit chief) to ensure that this information is sent on time to avoid delays of supplies and possible stock outs. The buffer stock of drugs and laboratory consumables for the peripheral stores will be for one quarter.

18.2 Requirement of Laboratory Consumables

All health facilities require an adequate supply of sputum containers to collect and transport sputum specimens to diagnostic sites e.g., microscopy centres, Xpert sites and C-DST Labs. In addition, the TB laboratories need to be provided with good quality binocular / LED microscopes and GeneXpert machines, regular supply of slides and Xpert cartridges and other Lab reagents. The "Laboratory Request Form" (Annex 5 and 6) explains the process of calculating the required quantities of the various consumables necessary for preparation of the stains and other supplies. Further details are given in the "Laboratory Manual on Smear Microscopy for Tuberculosis and its Quality Control in the NTP of Bangladesh" and “Operational Manual for GeneXpert testing”.

18.3 Requirement of Documentation Materials

Each registration unit needs a TB Register (one register will usually be sufficient for one year), TB treatment cards and patient identity cards based on the estimated number of patients. In addition, sputum request forms should be available in the TB diagnostic facilities. One sputum request form will be used for requesting (1) diagnostic examination of two sputum specimens from a Presumptive TB cases (2) diagnostic examination on GeneXpert and (3) for each follow-up examination during treatment. Depending on the number of suspects and follow-up cases examined, each laboratory will need one or more TB laboratory registers per year. On an annual basis, all registration units (UHC, CDC, urban clinic, medical college hospital, etc.) need 25 copies of the quarterly report forms on case finding, smear conversion, laboratory reporting form, IPT form and treatment outcome forms. All districts need 15 copies of the "Requisition Form for Drugs" and the" Laboratory Request Form". NTP will ensure procurement and indent-based supply of all necessary recording and reporting formats.

18.4 Inspection and Storage of Drugs and Supp

Upon receipt, all drugs and supplies should be inspected by a 'Survey Committee' constituted for the store. The committee will tally the supplies with the 'Invoice' and will report discrepancies or damages, if any.

Drugs and supplies should be stored under optimum conditions in a secured room and follow the good warehouse practices. The drugs and laboratory reagents should be monitored regularly for expiry date. The drugs with shorter expiry dates should be placed in front and those with longer expiry dates behind (FEFO or first expiry-first out). A stock ledger must be maintained and updated whenever drugs and other materials are received or dispensed. In addition, a stock card (bin card) should be maintained for each drug. The bin card must be updated whenever drugs are received or dispensed, so that the actual physical balance and the balance as per stock ledger always match.

The officer in charge of the store will ensure inspection of supplies, its optimum storage and proper recording as detailed in the "Standard Operating Procedures for Managing Drugs and Supplies".

18.5 Issuance of Drugs and Supplies

Drugs and other supplies will be issued quarterly based on completely and correctly filled form TB 8 "Requisition Form for Drugs form" and "Laboratory Request Form", according to the distribution schedule.

18.6 Monitoring and Supervision of Stores

Monitoring and supervision of drugs/supplies management must be done at all levels. Reports of case finding and drug stock status from the upazila received through indent form as well as quarterly stock status from the Central Store should be the basis for conducting systematic monitoring. Drug and other supply management (especially GDF drugs) should be included in the agenda of monitoring meetings at all levels.

Supervisory visits, including drug/other supply management, should be conducted using the checklist included in the general supervisory checklist. Reports of the supervisory visits should be analysed for monitoring and feedback.