Tuberculosis
TB Medicines Management in Ethiopia
Ethiopia has one of the highest TB burdens in the world—it ranks seventh in estimated number of cases. In addition, TB is an opportunistic infection that causes the majority of deaths in people infected with HIV.
In 2004, using the Pharmaceutical Management for Tuberculosis tool (PDF - 140KB), MSH's RPM Plus Program assessed Ethiopia's TB pharmaceutical management system (PDF - 250KB) to evaluate TB medicine availability and use.
The countrywide assessment covered 33 health facilities, encompassing medical stores in six regional states and two administrative states. To gain a comprehensive overview of the system, RPM Plus used—
- Standard indicators to collect data on TB medicine availability and use
- Interviews with key informants to help create an overall picture of the country's health care system
- Interviews with TB patients to evaluate how well they understood how to take their medicines
Assessment results showed that inventory management of TB pharmaceuticals was weak—inventory records were not regularly updated, resulting in discrepancies between stock records and actual stock counts. Some facilities had no inventory records.
The country's standard treatment guidelines differed slightly on first-line treatment from the recommendations of the World Health Organization (WHO). For example, the Ethiopian national TB guidelines for Category I patients included injections rather than tablets, even though injections cost more and are more invasive.
Data from patient registers showed that health care providers had given incorrect prescriptions as often as 10 percent of the time; a correct prescription indicates the medicine name, strength, dosage frequency, and number of tablets according to what is appropriate for the patient's age and weight.
| I recall a story an old friend and professional colleague told me. "When I see many patients in a long queue," he said, "I know the anti-TB drugs have arrived." This was not too long ago, but we have taken a number of steps so that we can now say: that kind of experience is a thing of the past. —Zerihun Tadesse, M.D.,
M.P.H.
Manager, TB and Leprosy
Prevention and Control
Program, Ethiopia |
In addition, the assessment showed poor compliance with WHO's Directly Observed Treatment, Short-Course (DOTS) strategy that requires, among other things, that health care workers watch patients take their medicines during the initial treatment phase—only 76 percent of patients interviewed said they were observed. Only 32 percent of patients had adequate knowledge about how to take their medicines, defined as knowing the medicine's name or color, how many tablets to take each day and when, and how long the course of treatment should last. Since the assessment, Ethiopia's TB and Leprosy Prevention and Control Program has taken specific measures to address some of these problems. The program recruited a logistics officer to oversee the details of TB medicines and supplies management, and information on logistics management has been incorporated into the newest national TB program manual. Pharmacy staff now receive training on how to manage TB medicines and commodities as well as supportive supervision to reinforce their training.
Pharmacists and pharmacy technicians are using new methods to record and report on the consumption of TB medicines and their stock status, which helps guarantee that enough stock is available at all times and that a patient's treatment is not interrupted. Pharmaceutical supply management assessments held throughout the year monitor progress and identify areas that still need improvement. The program has also revised its standard treatment guidelines to be in line with WHO recommendations. 
Patients diagnosed with TB are referred to public TB clinics, where health care personnel are now required to attend a weeklong training that emphasizes proper treatment regimens as well as prescribing, patient support, and treatment adherence. In addition, most treatment regimens use fixed-dose combinations (FDCs) of medicines that are blister-packaged rather than supplied as loose tablets. FDCs and blister packs simplify stock management, reduce the number of tablets taken by the patient, and make it easier for patients to keep track of their doses.
Dr. Zerihun, manager of the TB and Leprosy Prevention and Control Program, reports that these new measures are significantly improving TB medicines management in Ethiopia. With the program's progress in effectively managing pharmaceuticals, the country's TB patients can be assured that they will receive high-quality TB medicines at the right dose and when they need them.
Related Information
» Latest RPM Plus activities
» More on RPM Plus' work in TB
