Flow of DS-TB Drugs in NTEP

Drug-Susceptible Tuberculosis (DS-TB) drugs are available as Fixed Dose Combination. The treatment duration is generally 6-8 months. Weight-band-wise monthly strips are issued to the patient.

There is a significant difference between the flow of DS-TB drugs and Drug-Resistant Tuberculosis (DR-TB) drugs under the National TB Elimination Program (NTEP).  The process of DS-TB drug flow in NTEP is explained below:

• There is a centralised procurement mechanism under NTEP where the Central TB Division (CTD) procures drugs for all states at the central level and supplies the same to Central Medical Services Society (CMSS)/ Government Medical Stores Depots (GMSDs).
• The GMSDs/ CMSS then dispatch the DS-TB drugs to State Drug Stores (SDSs) or districts based on the quarterly reports submitted to CTD through Ni-kshay Aushadhi.
• The replenishment of DS-TB drugs from CTD to SDSs through Release Orders (RO) takes around 15-20 days.
• The districts transfer the drugs to the Tuberculosis Units (TUs), which in turn supply them to the Peripheral Health Institutes (PHIs), who then issue them to the patients.

Figure: Flowchart depicting the flow of DS-TB drugs

DS-TB Drug Distribution Management

• This whole process of drug distribution is carried out through a well-defined transportation mechanism/ Third-Party Logistics (3PL).
• In case of critical situations, provision to issue the drugs directly to the districts is also available.
• The SDS/ districts should follow up with the GMSDs/ CMSS in case of delay in receipt of drugs after receipt of the RO from the CTD.
• The SDSs should have at least a reserve stock of 3 months of consumption of DS-TB drugs in the state at the beginning of the quarter.
• To ensure sufficient stock of all drugs, as per stocking norms, at Peripheral Health Institution (PHI)/ Tuberculosis Unit (TU), District TB Centre (DTC) also need to have a reserve stock of three months of DS-TB drugs at the beginning of the quarter.
• Once SDS receives the reports from DTCs through Ni-kshay Aushadhi, it takes around 10 days for SDS to process the requirement (from all districts).

Resources

• Standard Operating Procedure Manual Procurement & Supply Chain Management; CTD, MoHFW,India,2018.
• Procurement, Supply Chain Management & Preventive Maintenance, Module 6; CTD, MoHFW, India.

Assessment