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Evaluating the Effectiveness of TB Medicine Supply Management Training in Western Cape,
South Africa
Fathima Fyzoo1; Margaret von Zeil2
1.Management Sciences for Health, SPS
2. Department of City Health, Western Cape
ICIUM 2011 14-18 November 2011, Antalya, Turkey
Background South Africa (SA) has the second highest tuberculosis
(TB) incidence in the world at 971 per 100,000 population (WHO Global TB report, 2009).
The SA National TB programme targets for 2011: cure rate of 85% and treatment success rate of >85%
An effective medicine supply management (MSM) system is essential
In SA, TB is managed mainly at a primary health care (PHC) level
MSM at most PHC facilities presents a huge challenge SPS decided to provide support for MSM with a specific
focus on TB
Objectives
To determine the feasibility of using of TB medicine supply indicators for monitoring TB medicine management practices
To determine the effectiveness of TB MSM training for nurses at PHC facilities
Design
Intervention with a pre-post assessment and no control group
Setting Intervention was undertaken at primary
health care facilities within the public sector in the Western Cape province
Intervention/Methods (1)
A two day training workshop on TB MSM provided to 46 nurses from 28 PHC facilities
Intervention/Methods (2)
TB MEDICINE LISTTick if item is Stocked
Tick if item has a stock card
Stock Card balance
Shelf (physical stock) balance
Tot. Qty issued in 3 last months
Maximum (Re-order) level
Average stock level
Quantity expired (no. of packs)
1. Rif, INH, ETHAM & PZA 150/75/400/275 - Rifafour e-275 (28s) 2. RIF, INH, ETHAM & PZA 150/75/400/275 - Rifafour e-275 (56s) 3. RIF, INH, ETHAM & PZA 150/75/400/275 - Rifafour e-275 (84s) 4. RIF, INH, ETHAM & PZA 150/75/400/275 - Rifafour e-275 (112s) 5. RIF, INH, ETHAM & PZA 150/75/400/275 - Rifafour e-275 (140s) 6. RIF, INH, ETHAM & PZA 150/75/400/275 - Rifafour e-275 (100s) 7. Rifampicin and isoniazid 150/75 - RIFINAH (56s) 8. Rifampicin and isoniazid 150/75 - RIFINAH (84s) 9. Rifampicin and isoniazid 300/150 - RIFINAH/RIAZID (56s)
TB MSM Facility Assessment Tool
Intervention/Methods (3)
Facility TB MSM indicators1. % TB medicines with a stock card
2. % of TB stock cards updated3. % of TB medicines with correct average and re-order stock levels
4. % of TB medicines out of stock per month
5. % of TB medicines expired per month
Results (1): Baseline & post training assessment at 3months
p= 0.011 p=0.003 p=0.001
Results (2): Baseline and post training assessment at 3 months
Results (3) No correlation was found between facility
improvement and the number of nurses per facility trained
None of the facilities showed any relapse following improvement across all indicators over the 3 month assessment period
The ‘expired TB medicines’ & ‘correct average/reorder level’ indicators are more appropriate as a quarterly indicators rather than monthly indicators
Summary Use of TB MSM indicators was effective in
measuring the outcome of training in a PHC setting.
Nurse training in TB medicine supply management resulted in improved TB stock management.
As a limitation, the evaluation did not follow-up on sustainability of good medicine management practices hence future evaluations should be designed as quarterly assessments over a longer period.
Conclusions & Policy Implications In the absence of pharmacists/pharmacist’s
assistants at PHCs, training and capacity building of PHC nurses can ensure good MSM
Implementation of simple assessment tools and indicators for routine self monitoring can be effectively used to encourage good MSM practices at a PHC level
Ongoing M & E by PHC supervisors and district coordinators is essential to ensure sustainability of interventions
Acknowledgements
1. District PHC supervisors/coordinators, Western Cape
2. Tiwonge Mkandiwire, SPS, MSH
3. P.C. Palli, Independent Research Statistician
THANK YOU!
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