New Tool Reduces Anti-TB Drug Stock Outs in Ethiopia

{Photo credit: Warren Zelman}Photo credit: Warren Zelman

For over a decade, the Government of Ethiopia has been working to improve tuberculosis (TB) screening and has been greatly successful in increasing case detection. Unfortunately, as is too often the case, solving one problem created another: the nation now struggles to maintain an adequate supply of medicine to treat the newly diagnosed patients. Health facilities experience frequent stock outs of anti-TB medications, leaving many patients without treatment for weeks and even months. This service gap not only exacerbates many patients’ illness, but also contributes to TB transmission and development of drug-resistant TB strains. 

In 2011, to address this challenge, the US President’s Emergency Plan for AIDS Relief (PEPFAR)- and US Agency for International Development (USAID)-funded Help Ethiopia Address the Low TB Performance (HEAL TB) project began supporting the National TB Program in implementing an integrated pharmaceutical logistics system (IPLS) in Ethiopia. IPLS is a streamlined system that improves drug supply management by integrating drug requisition, distribution, and reporting information into a single mechanism. In addition to reduced paperwork, improved reporting consistency, and a simplified drug supply management system, IPLS includes a forced order delivery system that allows Ethiopia’s Pharmaceuticals Fund and Supply Agency (PFSA) to distribute drug supply quantities, based on health facilities’ monthly reports.

This feature allows health facilities to maintain drug supplies between a minimum and maximum level to avoid drug expiration and stock outs and ensures that all patients receive full treatment regimes.  

Led by Management Sciences for Health (MSH), HEAL TB started supporting the implementation of IPLS in the 10 zones of Amhara and Oromia Regions where 22 percent of health facilities had recorded anti-TB drug stock outs in 2011. In collaboration with the Amhara and Oromia Regional Health Bureaus and the PSFA, HEAL TB has:

  • trained 691 facility staff on IPLS operations;
  • provided IPLS recording and reporting tools,
  • distributed 355 lockable drug cabinets;
  • conducted quarterly supportive supervision visits to ensure staff are accurately implementing IPLS; and
  • held regular regional review meetings for implementers to share best practices and lessons learned.

At the end of an 18-month implementation period, the anti-TB drug stock out rate at the 691 facilities had declined to 0.2 percent (see figure 1). The Government of Ethiopia has been committed to scaling up the intervention to further improve TB and HIV drug supply management, and in turn, increase patient cure rates and reduce disease transmission.

Figure 1. Improved Drug Supplies and Management after IPLS Implementation (Amarah and Oromia zones, Ethiopia)

Indicator

Baseline
October-December, 2011

Endline
April-June, 2013

Stock out adult anti-TB medications

22%

0.2%

Up-to-date stock cards

25%

74%

Use of drug requisition and reporting forms

11%

75%

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