Background

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!