Pharmacist: Stocking NTEP drugs in Private sector

Stocking NTEP drugs in private sector-Overview and significance

Content

Overview of National TB Elimination Program (NTEP) Drug Logistics for Private Sector

The partnership option envisioned under NTEP should ensure an uninterrupted supply of anti-TB drugs at the state/ district/ sub-district and facility level for private sector facilities.

For private practitioners/ medical stores/ other partners registered as Peripheral Health Institute (PHI) under Ni-kshay, drugs will be issued from their concerned TB Units (TUs).
For non-registered private practitioners/ medical stores/ other partners under Ni-kshay, drugs will be issued as a third-party option and consumption of same should be recorded as ‘Misc. Consumption’ in Ni-kshay Aushadhi.
The drugs are to be supplied to the private sector not more than twice a month.

Significance of stocking drugs in the private sector

>40% of the patients in India attend private healthcare facilities initially for TB care and nearly 50% of the retreatment cases notified under NTEP are treated in the private sector before reaching NTEP. This data suggests inadequate TB treatment and could potentially develop drug resistance.
Additionally, gaps in TB care cascade and subsequent delays in treatment initiation have also been associated with private providers.

With the implementation of Universal Health Coverage (UHC), India has been working relentlessly to ensure that everyone receives healthcare services with minimum out-of-pocket expenditure.
With the same motive, the NTEP recommends that all TB patients who seek care in the private sector in India also come under the ambit of the programme and should have access to the same quality of diagnostics, drugs and community-based services as public-sector patients.
In a vast country like India, exploring partnerships with private sector service providers can strengthen supply chain management and ensure last-mile delivery of drugs.
Therefore, provision for availing correct TB treatment from the private sector should be a fundamental right of every TB patient and is an important consideration with respect to reducing the incidence of drug-resistant TB in India as well as bettering the TB treatment outcome. Hence, it is also essential to stock NTEP drugs in the private sector.

Resources

Assessment

Question	Answer 1	Answer 2	Answer 3	Answer 4	Correct answer	Correct explanation	Page id	Part of Pre-test	Part of Post-test
Which of the following options is incorrect with respect to stocking NTEP drugs in the private sector?	Reduces the gaps in TB care	Reduces treatment outcome	Reduces expenditure for patients	Ensures last mile delivery of anti-TB drugs.	2	Stocking NTEP drugs in the private sector could help reduce the gaps in the TB care cascade, may contribute to better treatment outcomes, helps reduce patient expenditure, and ensures last-mile delivery of anti-TB drugs.		Yes	Yes

Process of stocking drugs in Private Sector

Content

The private sector is the first point of care for nearly 50% of the patients with Tuberculosis (TB) and even then, the gaps in the TB care cascade and inadequate treatment are reported more in the private sector. The National Strategic Plan (NSP) 2017- 2025 has identified private sector engagement under the National TB Elimination Programme (NTEP) as a key priority in delivering quality ‘Standards for TB Care in India’ (STCI) services to the entire population. NTEP has implemented a policy of free drugs to all TB patients seeking treatment from public/private sectors.

Process of Stocking NTEP Drugs in the Private Sector

NTEP has utilized the partnership option of Patient-Provider Support Agencies (PPSA), where the private sector providers are contracted under the programme for effectively managing TB in the private sector.

The PPSA personnel are responsible for facilitating the process of stocking TB drugs in private sector.

Identifying the patient:

Once the patients are diagnosed of TB at the private health facilities (HF), they must be notified to the NTEP and registered through Nikshay on a real time basis.
Following registration, a drug dispensation module is created for each private notified patient on Nikshay by the PPSA user, where in all the details of the drug to be issued to the patient should be added.

Evaluating patient load:

The drugs are issued to the private sector stocking points based on the number of patients notified and started treatment in the private health facilities, as reported on Nikshay each month as well as the expected number of patients forecasted.
PPSA is responsible for ensuring real time notification as well as forecasting and regular supply of drugs to private health establishments and logistics management in co-ordination with NTEP.

Location

PPSA will facilitate identification of health facilities (HF) and chemists for Fixed Drug Combinations (FDC) management and dispensing activities who will then enter into a Letter of Arrangement (LOA) with district NTEP for FDC management and dispensing activities if medicines are stored there.
1-2 Chemist shop in each ward (need-based) where FDC could be dispensed should be identified , to ensure patients find it easier to collect medicines nearer to their house.
Alternately, the sputum collection point for private notified patients i.e., a Urban Primary Health Centre(UPHC) can be used to dispense FDCs to private TB patients.

Treatment regimen an drug requirement

Currently NTEP’s FDC for Drug Sensitive (DS) TB treatment are available at the private sector facilities free of cost to the patients.
Once DS TB diagnosis is established, the HF themselves may be encouraged to provide 1 strip of FDC or 3 days loose medicines (as applicable) to the patient.

For Drug Resistant (DR) TB, initiation of treatment for DR TB will preferably be at the District DR TB sites or NTEP engaged private sector DR-TB site with NTEP DR TB medicines and the PPSA will facilitate the entire process.

Stock availability and expiry management

PPSA will manage the FDC logistics from the respective Urban TU to the HF / empanelled chemists through Nikshay application which is integrated with the Nikshay Aushadhi through backend APIs (Application Programming Interface) and physical stock register.
Average of two months stocks with the chemists with monthly replenishment is desired.
PPSA should ensure that there is no expiry of FDC’s at the chemist. Coordinate with NTEP for forecasting and regular supply of drugs to private health establishments and logistics management.
PPSA should ensure sleeving the FDC strips with the appropriate 99 DOTS sleeves before delivering to the chemists.
Prescriptions containing NTEP FDC drugs will have to be honoured by the empanelled Chemists and all private sector consumption points must compulsorily fill the schedule H1 to prevent any indiscriminate use of anti TB drugs.

Resources

Assessment

Question

Answer 1

Answer 2

Answer 3

Answer 4

Correct answer

Correct explanation

Page id

Part of Pre-test

Part of Post-test

Fill in the blank

The credit/ debit of stock in the private sector is facilitated through ……

Private Provider

Treatment Supporter

Patient

Nikshay

4

The credit/ debit of stock in the private sector is facilitated through Nikshay

Yes

Monitoring and expiry management of drugs in Private sector

Content

Monitoring the supply chain of anti TB drugs and appropriate management of drug expiry is important:

to ensure an uninterrupted supply
to avoid delays in treatment initiation
to prevent drug stock imbalances.

Monitoring and Expiry Management of National TB Elimination Porgramme (NTEP) Drugs in the Private Sector

1) Personnel

The monitoring and expiry management of NTEP drug stocks in the private sector is managed by the Patient Provider Support Agency (PPSA) contracted under the NTEP.
The PPSA identifies the stocking points for the private sector based on their TB notification rate as well as the patient reach.
The PPSA will be responsible to ensure that sufficient stock is available at the private sector stocking unit and also to manage the transport of the drugs from the district to the empanelled chemists and other providers.

2) Assessment of stock requirement

The supply of drugs to private sector stocking points should only be undertaken based on the number of regimen-wise new patients initiated on treatment as notified on Nikshay and calculated number of future patients for a particular period.
Therefore, for smooth monitoring of private drug stocks, they must ensure that all the diagnosed TB patients in the private sector are notified on Nikshay.
The dispensation of drugs to private sector patients is fulfilled through Ni-kshay which is integrated with Ni-kshay Aushadhi via backend APIs (Application Programming Interface).

3) Stock availability and expiry management

Fixed Drug Combinations (FDCs) for DS TB treatment are stocked at the private sector health facilities and PPSA personnel should ensure the same.
Drug inventory records such as the FDC prescriptions/voucher invoice from the private sector stocking points should be reviewed by the PPSA personnel and also cross-checked with Nikshay records.
The drugs are to be supplied to the private sector stocking points for not more than twice a month.
The private sector chemist also needs to maintain a separate Schedule H1 register that includes the patient's identity, prescribing doctor's contact information, drug name and dispensed quantity, and date.
In any case of drugs being returned or drugs that are expiring, the same should be updated on Nikshay using the return dispensation module and should be transferred back to the parent store via the PPSA.
In no case, more than 60 days of FDC should be issued to a single patient at once.

Resources

Assessment

Question	Answer 1	Answer 2	Answer 3	Answer 4	Correct answer	Correct explanation	Page id	Part of Pre-test	Part of Post-test
How many times a month can the drugs be supplied to the private sector stocking points?	Only once	Maximum twice	Maximum three times	Maximum four times	2	The drugs are to be supplied to the stocking points for not more than twice a month.		Yes	Yes