1. A Synopsis of Strengths and Weaknesses Found in Country Case Studies on Effective TB Drug Management Hugo A. Vrakking Procurement Officer Royal Netherlands Tuberculosis Association

2. Country Case Studies on Effective TB Drug Management by Stop TB Partnership & KNCV sponsored by the World Bank

3. Country Case Studies on Effective TB Drug Management Objectives: Identify best practices in TB drug management in high-burden countries Share the elements that are relevant to other country settings

4. Country Case Studies on Effective TB Drug Management By means of a Questionnaire Questionnaires are available here and could be used as an assessment tool for an NTP either during this workshop or later.

5. Country Case Studies on Effective TB Drug Management Participating countries: BeninFacilitator: Dr. A. Trébucq, IUATLD Brazil Facilitator: Dr. D. Weil, WB ChinaFacilitator: Dr. P. Gondrie, KNCV NepalFacilitator: Dr. I. Smith, StopTB VietnamFacilitator: Dr. M. Bosman, KNCV

6. Country Case Studies on Effective TB Drug Management Completed questionnaires received from: Benin Nepal

7. Strengths General: No drug shortages in >15 years (It is possible!) Reserve fund in case of supply failure Strong professional commitment by the NTP team Support from a reliable and loyal external partner

8. Strengths Drug management system: Separate warehouse at central level directly managed by NTP Regular inventory of stocks at all levels Reliable estimates of requirements based on quarterly data on case findings

9. Strengths Drug management system: Buffer stock (4 months) at district level Reserve stock to replenish local drug stocks carried by supervisor Drug procurement: Prequalification of suppliers (LCB) Independent tender board

10. Strengths Personnel management: Regular review meetings are held at all levels, where demands are calculated and drug problems are reported. TB staff at all levels are trained and involved in management and calculation of TB drugs. Supervision includes drug stocks and drug management.

11. Challenges Dependence on international donors Donated drugs on Drug Regulatory Authority (DRA) clearance letter only Quality assurance by DRA: outside NTP Quality assurance based on information by suppliers only No WHO CPP required, bioavailability data for R not known

12. Recommendations Continue to lobby for and create separate budget line for TB drugs and lab supplies in budget of MoH. NTP managers should participate actively in every stage of (international) tendering.

13. Recommendations Include physical drug stocks verification in supervision visits. Include drug management in every NTP review meeting at all levels.

14. Country Case Studies on Effective Drug Management Next steps: Receive completed questionnaires (Brazil, China, Vietnam; others?) Evaluate answers and produce final study report (KNCV)

15. Country Case Studies on Effective Drug Management Good drug management is both an indication and a consequence of a well-run NTP! (Benin)