Module 13 – March 2010
Management
of the Tuberculosis
Drug Supply
Project Partners
Funded by the Health Resources and Services Administration (HRSA)
Module Overview
 Determining
appropriate
quantities
 Ensuring
quality
 Financing and
procurement
 Distributing
and storing
Learning Objectives
At the end of this presentation, participants
will be able to:
 Describe the basic principles of TB drug
supply management
 Identify areas in the drug supply
management process that they can impact
Drug Supply
 Management of TB medicines is critical to
the success of a TB Program
 Interruptions in drug supply can result in
misuse, treatment default and the
development of drug resistance
 Nurses play an important role in ensuring
an uninterrupted supply of TB drugs by
monitoring stock supplies and advising
those in charge of ordering of the TB
medicine needs
Drug Supply (2)
 Selection, distribution and management of
the anti-TB drug supply is an important
responsibility of the NTP
 WHO and IUATLD recommend that use
of fixed-dose combinations be restricted
to combinations whose bioavailability has
been demonstrated by laboratories that
are independent from the manufacturers
Drug Quality
 National TB control programs should ensure
that anti-tuberculosis drugs are of good
quality by making sure that the drugs:
• Are produced following the good manufacturing
practices recommended by WHO
• Are imported with a PAHO/WHO certificate
• When bought by competitive tender, are ordered
with the appropriate specifications
• Are stored properly following good storage
practice and the first expiry, first out (FEFO)
principle
Appropriate Quantity: Stock Control
 Advantages of an effective stock control
system include:
• Ensures efficient use of financial resources
• Prevents under-stocking and “stock outs”
• Prevents overstocking and wastage
• Prevents shortages in case of delays in
delivery
• Keeps medicine stores going even when
there are staff shortages
• Allows identification of security problems
Medicine Distribution & Supply
 Keeping stock
records
up-to-date is
important for
real time
assessment of
available stock
 Steps include the ordering, receiving and
issuing of medications and related
supplies (includes the removal of expired
or damaged items from stock)
Ordering Principles
 Order at regular intervals
• Know when orders are to be placed and get order
in on time
 Anticipate changes in demand
• Quantity is directly related to number of TB
patients registered at the facility
 Be systematic
• Perform a physical stock count
• Decide whether or not an item needs to be ordered
• Complete order for items under the minimum stock
Terminology
 Order interval is the time between two
orders
 Minimum stock level is the level of an
item that is twice what is generally used
during an order interval
 Maximum usage is the average
consumption of an item during order cycle
x. This number should be documented on
the stock card
Terminology (2)
 Lead time is the time it takes between the
first step in the procurement process until
the supplies arrive in the country’s central
medical stores
 Both minimum and maximum stock
levels can change over time depending
on consumption. For TB medications,
these levels will change as the number of
TB patients change
Calculating Minimum Stock Level
Re-order when stock reaches
minimum stock level
Minimum
Stock Level
=
2 X Maximum
lead time in
months
X
Maximum
Usage
Minimum lead time = 1 time per month
Maximum Usage = 3 units per month
Minimum Stock Level = 3 units X 2 X 1 = 6 units of isoniazid
Receiving Supplies
 When supplies are received, the following
steps should be taken:
• Check that the number of items received
matches the number of items ordered
 Right item
 Right unit size
 Right quantity
Receiving Supplies (2)
 Check that all
boxes/containers
are sealed and
intact
 Check medicine
expiry dates
 Document and
report any
problems noted
Storage of TB Medications
 Good storage and management
procedures are particularly important for
medications
• Keep drugs safe – should be in a cabinet or
room that can be locked/secured when not in use
 Store high security/high value products in
appropriate security zones
• Temperature, light, and humidity should be kept
moderate in area where medications are stored
• No food, drink or smoking should be allowed in
the storage area
Storage of TB Medications (2)
 Place liquid products on the lower shelves
or bottom of stacks
 Separate damaged or expired products
from the usable stock without delay and
dispose of, using established disposal
procedures
 Arrange cartons so arrows point up and
identification labels, expiry dates, and
manufacturing dates are visible
Stock Records
 Product name/description
 Stock on hand/beginning stock balance
 Receipts
 Issues
 Losses/adjustments
 Closing/ending balance
 Transaction reference (e.g., issue
voucher number or name of supplier or
recipient)
Distribution of Supplies
 Each time supplies are issued/distributed,
it should be recorded on the _________
 Issuing supplies involves:
• Moving stock from shelf to dispensing areas,
treatment rooms, outreach teams
• Ensuring medications issued to peripheral
sites match the order sheet
• Removing stock of fast-moving items for prepackaging
• Removing expired supplies or damaged items
Methods to Avoid Stock Wastage
 FEFO Rule = First Expiry First Out
 Clearly mark containers with close expiry
dates (less than 12 months) and place at
the front of the shelf
 Return excess stock to hospital or
medical stores as soon as you are aware
of it
Summary
 Ensuring a secure, uninterrupted drug
supply is essential to an effective National
TB Control Program
 Staff at all levels can positively impact the
national drug supply through:
• Appropriate use of TB medications
• Trouble-shooting supply problems
• Ensuring that guidelines for management of
anti-TB drugs are fully implemented