Second Africa TB Regional Conference on Management of TB Medicines. Africa TB Conference 2012, Zanzibar December 5-7, 2012

Transcription

1 Second Africa TB Regional Conference on Management of TB Medicines Africa TB Conference 2012, Zanzibar December 5-7, 2012

2 Country experience in planning, quantification and supply of MDR- TB medicines in Kenya Dr Richard Muthoka DLTLD To render Kenya and its communities free of Leprosy, TB and Lung Disease

3 Objectives of Quantification and Procurement Planning To quantify the country s multidrug-resistant (MDR) TB medicines needs To highlight the challenges of MDR TB commodity security experienced in Kenya To describe the interventions laid down to address these challenges To share results and lessons learned

4 Background Information Case Notification Rate (CNR) in 2011 for all forms of TB is 298/100,000. Total cases 103,981 (CNR 83%) Policy on surveillance all retreatment cases WHO estimates (2003): Retreatment cases 1.7% 0.9% among the new cases 2003 to 2011, cumulative MDR-TB Patients diagnosed: 692 Treatment of MDR-TB Private sector in 2006 Public sector From April 2008, 389 patients on treatment 284 patients on treatment 101 patients cured Drug resistant (DR)-TB treatment sites 134

5 Trend of TB Cases:

6 Problem Statement Need to have uninterrupted supplies Need for focus on supply planning of second-line TB medicines Challenges in data for planning for scale-up of DR-TB Slow enrollment of cases leading to expiry of some drugs Changes of treatment protocols for DT-TB care and treatment Decentralization of MDR-TB treatment Short expiry dates of medicines Geographical diversity of country Different levels of understanding of needs by health care workers

7 Interventions Conduct a comprehensive quantification Develop a procurement plan Advocacy for Green Light Committee (GLC) to approve treatment of all DR-TB patients Form a commodity supply chain monitoring team Ensure a reliable supply of second-line medicines to support MDR-TB treatment and decentralization plan

8 Process of Implementation of Interventions Step 1 Decide composition of the commodity security subcommittee Identify key stakeholders (USAID, MSH, KAPTLD, World Bank, KEMSA, Kenyapharma/Phillips, WHO, KANCO, MSF, CDC and MOMS, IOM & NACC) Step 2 Bring together of all key stake holders for consensus building on key assumptions (1 day) Select a smaller team to then use the assumptions to generate the actual commodities requirements Actual F and Q and supply planning exercise (3 days) Step 3 Identify of key financial partners Plan for dissemination meeting

9 Process of Implementation of Interventions Step 4 Obtain funding commitment Step 5 Procurement Step 6 Monitoring of procurement process by the commodity security committee

10 Financial Gap Analysis and Commitment Total financial gap FY Total commitments Resultant Gap after commitment 1,555,663.9 (11.76%) 13,227, (100%) 11,671, (88.24%)

11 Results Immediate Quantification draft report completed Advocacy and identification of key partners and dissemination of the report Funding commitments obtained from government and donors to meet the financial obligation GoK officials, donors, and procurement agents committed to adhere to procurement plan

12 Results Item Description FINANCIAL GAP FOR TB COMMODITIES FOR THE YEAR Procurement requirements Available funds Financial Gap (USD) (USD) (USD) First and Second Line Anti-TB Medicines First Line anti-tb medicines 4,028, ,132, ,104, Second line anti-tb medicines 954, ,680, , Total Cost for 1st&2nd Line Medicines 4,983, ,813, ,830, PW&D fees 10% 498, , , Sub total 5,481, ,154, ,673, Laboratory Commodities AFB Microscopy & Equipments 1,559, ,042 1,142, Central Reference Laboratory 1,396, ,456 1,066, Gene-Xpert laboratory items 2,534, ,534, USAID, WHO Sub total 5,490, ,281, ,208, Stationery &LMIS Tools Requirement Stationery requirements 629, , , IEC Materials 1,625, , ,597, Sub total 2,254, , ,019, Grand totals 13,227, ,671, ,555, Funding Source, Bank & GFssf World Bank Gok GFssf GFssf CDC GFssf

13 Monitoring and Evaluation An all inclusive commodity security subcommittee in place which meets monthly to assess the stock-status situation and monitor the commodities pipelines The committee meets monthly to review the MDT-TB commodities stock situation and review procurement quantities or call downs from suppliers Feedback given to all stakeholders (2-page report detailing the stock status situation in the country)

14 Lessons Learned An all inclusive process is key for support and ownership Bringing together donors, government, and procurement agencies ensures effective coordination of commodity supply A comprehensive procurement plan acts as a good roadmap for the procurement process and is a vital tool for monitoring A well functioning mechanism for monitoring of commodity pipeline always provides early warnings thus ensuring uninterrupted access to medicines Timely planning on capacity building of staff to address knowledge gaps on both commodity management and rational use/pharmacovigilance of medicines

15 Strengths and Weaknesses of Interventions Strengths Support from the partners by providing skills and insight to the quantification and forecasting process Government commitment Support from the GLC for expansion of MDR-TB treatment 2011 annual case report provided morbidity data for quantification Weaknesses Missing data of previous procurements from KEMSA during quantification Insufficient data on average monthly consumption from the facilities to enable a consumption-based quantification method

16 Challenges Poor recording and reporting due to unavailability of hard M&E tools and treatment algorithms Inadequate commodity management at the facilities ordering, storage, inventory management, prescribing of SLMs, and handling of expired medicines Human resources knowledge gap on patient management in view of the decentralization Poor pharmacovigilance results in Poor quality care of patients as a result of decentralization Increased toxicities, morbidity, and mortality

17 Summary To assure uninterrupted supply of MDR-TB medicines Involve all relevant stakeholders in building assumptions Determine the requirements Develop a comprehensive procurement plan Obtain commitments from government, donors, and procurement agencies Put in place a well functioning mechanism for pipeline monitoring that provides regular and timely feedback Act promptly on the feedback

18 CSC - Group photo