Stop TB Partnership

Global Drug Facility Update: July


Mission in June: Niger
Upcoming missions in August
GDF Workshop at 2017 Union Africa Conference, Ghana

Mission in June: Niger

19-23 June, Niger: The participation of GDF at the TB program review of Niger has given opportunities to sensitize the Ministry of Public Health on the need to guarantee sufficient resources from the national budget to purchase first and second line tuberculosis medicines. Supply chain assessment was also conducted, and recommendations were made, particularly on the necessity to develop a drug management manual including the QuanTB software and to provide training for health agents on this manual and QuanTB.

The main results of the mission are:
  • Quantification of first and second line medicines and requirements for 2017/2018
  • Analysis of FLD stock level (inventory of 6 June 2017 at the central level) and for SLD (inventory of 10 June)
  • Analysis of the supply chain for TB medicines and identification of actions to strengthen the supply chain
Challenges:
  • Place an urgent order to cover the actual stock out. This urgent order can be funded by national resources and/or by donors (GFATM)
  • Finalize and validate the quantification carried out with the support of GDF in order to place an urgent order of FLDs
  • Secure availability of national budget (500 million CFA francs) for first-line drugs to ensure annual treatment of tuberculosis patients
  • Develop a TB drug management manual including management tools at different levels of the supply chain
  • Train all stakeholders/health agents on the drug management manual and on QuanTB
Next steps:
  • Promptly place an urgent order the week of 10 July 2017 for first line medicine needs which have been quantified during this mission. This urgent order can be funded by Global Fund or the National Budget
  • Contact GDF to apply for a Canadian grant for an urgent supply of first line pediatric medicines
  • Continue advocacy with the government to mobilize additional resources
  • Provide technical assistance for the development of TB drug management manual including management tools and training of stakeholders on this manual

Upcoming Missions in August

South Sudan: Stop TB Partnership's GDF mission will be conducted to South Sudan from 24 July to 2 August 2017. Its main objectives are to support the quantification and procurement planning for the Global Fund grant making, discuss PSM transition plans for new tools, review the current regulatory system and discuss procurement plans for transition from external funding to domestic funding among others.

DRC: The Global Fund requested Stop TB Partnership’s GDF support for the grant making of DRC. The consultant, Angelo Makpenon, who did the last 2 missions in DRC was asked to participate remotely to the strategic review related to PSM activities on July 6th and to join the GF team the first week of August (31 July to 5 August) to finalize the PSM plan and budget.

Madagascar: Stop TB Partnership’s GDF will participate to the Programme Review in Madagascar to cover the PSM part from 24 July to 4 August. In the following week from 7 to 11 August, GDF will support the Global Fund grant making for the PSM aspects.

GDF Workshop at 2017 Union Africa Conference, Ghana

Stop TB Partnership’s Global Drug Facility (GDF) workshop "Accelerated access to new TB medicines, regimens, and diagnostics: the supply management challenges and country experiences" attracted a massive audience during the 20th Union Africa Regional Conference in Accra, Ghana on Tuesday. More than 85 people attended the session requiring the organizers to bring extra chairs to the meeting room to accommodate all participants and the session even started with people standing.

In response to WHO recommendations, most countries are currently at different stages of adopting the new medicines, shorter DR-TB treatment regimen, new pediatric formulations and scaling up the use of new diagnostics. However, to successfully ensure access to these newer and better regimen and medicines, systems need to be in place to ensure transitions are done efficiently with minimum treatment interruption, proper supply chain planning, and coordination at all stages of pharmaceutical and supply management. In addition to reviewing treatment guidelines and adapting diagnostic algorithms to the new reality, countries need to develop transition plans for phasing in new regimens and phasing out others and estimate costs of potential wastage of “old” medicines in benefit of an earlier introduction of more effective and suitable regimens to treat patients. Complex calculations are required for quantification of multiple regimens, and optimized procurement with more frequent deliveries and analysis of finance gaps are critical to ensure patients have continuous access to appropriate TB treatments. Frequent forecasting and quantification, along with vigilant stock management, are vital to ensure the appropriate types and quantities of medicines are available to treat all patients.

During the workshop participants had opportunity to understand how the GDF has been supporting countries globally and particularly in Africa to accelerate the introduction and scale-up of the new TB tools, such as coordinating with global partners to advance policy, supplying new quality-assured medicines and diagnostics and providing ongoing technical assistance and capacity building for procurement and supply management. GDF invited four countries which had benefited from its support to share their real-life experiences and lessons learned during the workshop. Kenya discussed the use of a systematic quantification and early warning system (QuanTB) in planning for seamless transitioning to new pediatric TB formulations resulting improved prescribing and adherence with expected better treatment outcomes among children, savings over US$ 123,000 of government funds on potential wastage of old formulations and re-scheduling of deliveries of new pediatric formulations to minimize possible wastage worth US$ 214,000. Zimbabwe presented results of regional coordination efforts regarding cross-boarding transfer of medicines supported by GDF in 4 countries which averted stock-out and expiries of TB pediatric formulations and declared savings of more than US$ 3.3 million during the course of Global Fund grant implementation allowing reallocation of funds to activities that will enhance quality of care for patients with DR-TB, including NTP capacity to introduce the shorter MDR-TB treatment regimen. Swaziland discussed challenges faced on procurement of TB medicines due to increased demand and sub-optimal availability of adequate medicines and the lessons learned on the need for systematic review of data collection and validation tools, including logistic management information system, close monitoring of newly introduced medicines and regimens, and timely planning to prevent stock-outs in the future. Ethiopia discussed the use of systematic early warning system (QuanTB) to help preventing wastage of over US$ 1 million of second-line TB drugs (SLDs), including postponement of procurement, relocation of excess stocks to other countries and shipments likely to be overstocked were delayed and staggered to minimize the risk of expiries with support from GDF. These savings of SLDs were utilized to accelerate the procurement of new pediatric formulations and specific medicines for the shorter MDR-TB regimen. After each presentation there were fruitful discussions with presenters answering many relevant questions from the audience and thus providing valuable suggestions and recommendations to overcome common problems related to procurement and supply management of TB commodities in the region.

At the end of the workshop there was a live presentation of QuanTB, the freely downloadable digital health early warning system (EWS) for TB medicines. Participants had opportunity to learn through practical exercises how to use the tool, including for quantification of second-line and pediatric medicines. They also learned how to apply the EWS to predict variations on enrollment, consumption and costs, and take opportunistic corrective actions to prevent stock outs and expiries.