Thailand - Stop TB Partnership

Distribution
In addition to manufacturing drugs, the GPO also oversees drug distribution. The Regional
Office of Disease Prevention and Control directly distributes TB drugs to 19 zonal TB control
centers, which in turn supply the provincial and district hospitals. District health workers
then collect TB drugs from district hospitals, and supervise distribution by local health
workers to patients.
A case study in southern Thailand revealed drug shortages and overstocking at
the local level, beyond the provincial and district hospitals’ control. According to the study,
rifampicin was overstocked most frequently (five times the recommended amount) and
shortages of ethambutol were most common. 137 Local solutions to these problems include
extra purchasing, requesting additional drug supplies to cover shortages, and sending surplus
drugs to other institutes. In 1999, approximately 555,000 baht ($14,681) worth of TB
drugs expired due to overstocking. 138 A more centralized system of drug management and
distribution would help eliminate or decrease such inefficiencies.
Education and research
The MoPH has supported a range of operational research projects on issues related to TB
control. Thai TB experts emphasize the importance of prioritizing research that can be
translated into policy, and of relating research priorities to the most pressing issues in the
field, such as TB/HIV, the impact of health reforms on TB control, and the existence of
subepidemics and inadequate access to services among vulnerable groups.
To date, the NTP has prioritized operational research on DOTS, with a focus on
evaluating DOTS implementation, the behavioral factors associated with adherence to TB
treatment, and the cost effectiveness of the TB control strategy. In addition, funding agencies
such as the Thailand Research Fund and the Health System Research Institute have
hosted meetings to brainstorm on TB research priorities. Regional and district-level research
has reflected regional priorities such as TB/HIV (in the northern region) and the impact of
decentralization on TB control activities (in Yala province, southern Thailand).
The government should commit financial resources to conduct research on the
following:
• further standardization of TB diagnostic and treatment services to minimize the
risk of MDR-TB
• the effects of sociocultural factors on TB adherence
• techniques for diagnosing TB among HIV patients
• the effect of health system reform on NTP implementation
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TB POLICY IN THAILAND