RPM Plus works to build human resources capacity in TB pharmaceutical management through—  | Formal Courses and Workshops Courses and workshops may be smaller, one- or two-day sessions held at international TB courses or weeklong events that include field visits to warehouses and treatment centers. Sessions feature presentations on components of the TB pharmaceutical management cycle and use self-guided questionnaires and practical group exercises as learning tools. Participants gain a better understanding of how to—
- Quantify medicine and commodity needs
- Procure these products in a cost-effective manner
- Assure quality from the time of ordering through storage, distribution, and administration to the patient
- Ensure rational use of the medicines by both provider and patient
Weeklong workshops also feature field visits to warehouses and treatment centers. These visits help "bring to life" the information exchanged during the workshop, preparing participants to make improvements in their home programs. The visits also help teach participants how to monitor the elements of TB medicines management using specific, rational indicators, for two purposes: 1) to bring together the information exchanged during the workshop for program improvement upon the participant's return home; and 2) to teach participants how to monitor each aspect of TB pharmaceutical management and the usage of specific, rational indicators. RPM Plus workshops are structured in modules that reflect the elements of the TB pharmaceutical management cycle, and consist of instructional materials and practical work tailored to specific groups. - Pharmaceutical Procurement for Tuberculosis
This weeklong course includes interactive presentations, practical exercises, and context-specific TB information presented by local health personnel. Partners in this course have included WHO, KNCV, PATH, and MSH's EQUITY project. The course is available in English, Romanian, Russian, and Spanish. It has been given in Indonesia, Kenya, Romania, South Africa, Uzbekistan, and Vietnam. - Pharmaceutical Management for Tuberculosis (first-line medicines)
RPM Plus expanded the content of the TB procurement course to include modules on pharmaceutical management information systems, inventory management, and monitoring and evaluation. The course has been conducted in Honduras (October 2003) and South Africa (April 2004). - Pharmaceutical Management for Multidrug-Resistant Tuberculosis (second-line medicines)
At the request of the Green Light Committee (GLC), RPM Plus adapted course modules from the Pharmaceutical Management for Tuberculosis course to address management of second-line TB drugs. Some of these new modules were field-tested in mid-2003 in Moscow and have since been used in Mexico, Romania, and Moldova. - Managing Medicines and Pharmaceutical Supplies for Tuberculosis
Using the materials from the two Pharmaceutical Management for TB courses discussed above, RPM Plus combined instructional materials, practical exercises, and field visits, addressing aspects of pharmaceutical management for both first-line and second-line TB medicines. The workshop was conducted in Tbilisi, Georgia (July 2004), and Cairo (May 2005). To learn more about RPM Plus workshops, contact us at rpmplus-tb@msh.org. To the top
Sector Analysis  RPM Plus's assessment manual Pharmaceutical Management for Tuberculosis can be used in-country to carry out TB sector analyses. The indicators and data collection tools provided in the manual serve as templates meant to be adapted to suit the specific TB infrastructure in the target country, in an assessment carried out by local stakeholders. For example, before conducting an assessment, country personnel need to develop an appropriate, country-specific tracer list of TB medicines and related commodities expected to be available in each type of health facility. When indicators and tools have been adapted, data collectors are provided with training in how to use data collection forms and how to approach staff in the surveyed health facilities. Finally, collected data are entered into a spreadsheet for analysis. An analysis of the TB sector can yield these positive results— - Stakeholders attain enhanced understanding of their TB pharmaceutical programs.
- Local capacity is built for repeating or expanding analyses in the future.
- Program managers can use assessment data as a basis for implementing changes in TB pharmaceutical management.
- Findings can be presented to partners to justify support in areas where program resources are lacking.
- Findings may suggest areas for operations research.
 Learn more about where the PMTB tool has been used in collaborative publication
Improving TB Drug Management [PDF - 1.4 MB].
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Operations Research  TB program operations research, like TB sector analysis, should be structured according to local context and needs. At the same time, it is important to document and share information on operations research efforts and results. This helps build an evidence base of both common challenges to and key elements of successful interventions—which can be used by national TB programs and a range of stakeholders to design and implement initiatives to improve TB control in their settings. Operations research on initiatives using incentives and enablers (I&E) has emerged as a topic of relevance to DOTS scale-up as well as to new strategies in TB control that adapt DOTS to reach more patients. Since 2001, RPM Plus has collaborated with the Stop TB Partnership and the World Bank to foster an expanded evidence base on I&E in TB control, examining the design, feasibility, effectiveness, and impact of I&Es. Another example of operations research is a Kenyan study on the impact of using patient packs on logistics management, training of personnel, rational use of medicines, treatment outcomes, and progress toward program indicator targets. Each pack represents complete treatment for one patient and is color-coded according to treatment regimen. Packs are composed of fixed-dose combination drugs (FDCs).
For more on FDCs, see WHO's Operational Guide for National TB Programmes on the Introduction and Use of Fixed-Dose Combination Drugs, developed with assistance from RPM Plus. Learn more about incentives and enablers. View Operational Guide for National TB Programmes on the Introduction and Use of Fixed-Dose Combination Drugs [PDF - 470 KB].
To the top | Modification of Tools for Local Context Tools modification frequently takes place during RPM Plus capacity-building activities and is specific to the needs of the local TB pharmaceutical program. Tools frequently modified are— - Quantification spreadsheets for calculation of commodity needs
- Spreadsheets for data analysis
- Presentations and practical exercises used in workshops
- Course materials used for basic training of storeroom personnel
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Launching of Stakeholder Working Groups Stakeholder working groups are often needed to effectively address cross-cutting issues. In TB pharmaceutical management, such issues include— - Human resources capacity of national TB programs
- Quality assurance of TB medicines and related commodities
- Effectiveness of the national essential medicines program
- Development of effective training programs for NTP staff and other stakeholders
- Effectiveness of national TB testing laboratory facilities
- Effectiveness of the national pharmaceutical regulatory agency
Although it is critical to address these issues, without external influence it is difficult to set up multidisciplinary working groups. RPM Plus has been successful in bringing stakeholder groups together because of its strong experience in cross-cutting pharmaceutical management issues. For example, RPM Plus has helped put together various stakeholder working groups in Brazil, which have been successful in— - Establishing TB medicine quality testing programs
- Developing a study protocol for evaluating a change in TB treatment to regimens using different fixed-dose combinations (FDCs)
- Conducting the studies
- Evaluating study results and making decisions on treatment change
- Monitoring the change to FDCs, including policy implementation, scale-up, clinical trials, bulk manufacturing, and distribution
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