9.5 Management of the supply chain and storage conditions for pharmaceuticals

Management of the supply chain and storage conditions for pharmaceuticals should be reviewed to ensure that TB drug orders are made in good time and are correctly quantified to avoid overstocking or shortages. The NTP must ensure an uninterrupted supply of TB medicines through proper quantification, supply planning and rigorous quarterly monitoring, with a functional early warning system to avoid stock-outs and subsequent treatment interruptions. Similarly, other consumables (e.g. medicines for symptomatic relief and adverse reactions, syringes, diagnostic kits, medication for management of adverse effects, masks and N95 respirators) will be needed to ensure that the intervention is delivered as per internationally recommended standards (147). The principles for the quantification of medicines needed for the longer and shorter MDR-TB regimens are similar. The health care provider needs to have some basic details about how many patients will be treated and when they will start; the expected increment in caseload over successive years; the average body weight of the patients; whether children will also be enrolled; the expected losses (from interruptions, deaths and transfers to another regimen); and current stock on hand, including expiry dates and orders of medicines already in the pipeline and not yet delivered. It is best to split an order of medicines, the first part being for the patients expected to be started within 6 months, and the second part adjusted based on the actual enrolments. Technical assistance to strengthen the procurement and supply and to establish an early warning system for stock-outs can be accessed via the secretariats of the Global Drug Facility (GDF) and rGLC (which are housed in WHO regional offices) or via the WHO country offices. GDF provides support to many NTPs on the procurement and supply chain aspects of phase-in and phase-out plans of products or regimens and can procure child-friendly formulations. Childfriendly formulations allow more accurate paediatric dosing and are more acceptable to children and parents; they should be provided as the SoC wherever possible.

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