Process of stocking drugs in Private Sector

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

• National Strategic Plan for Tuberculosis Elimination 2017–2025, CTD, MoHFW, India.
• Procurement, Supply Chain Management & Preventive Maintenance, Module 6, CTD, MoHFW, India.
• The Number of Privately-treated Tuberculosis Cases in India: An Estimation from Drug Sales Data, Lancet Infectious Diseases, 2016, pii: S1473-309930259-6.

• Nikshay Dispensation Module v2.1, CTD, MoHFW, India, 2022

Assessment