National PMDT Scale-up Plan - India - 2011-12 - TBC India

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National Scale up Plan for Programmatic Management of DR TB 2011 - 2012 Table 15: Overview of Appraisals, Supervision, Monitoring and Evaluation Strategy for PMDT Stage Preparatory States / Districts Implementing States / Districts Supervision � Supervisory checklists for various levels (DP Site, District, TU, DMC, and Patient) – NEW Monitoring � Quarterly status report on Preparatory activities for PMDT scale-up – State & District (NEW) � Monitoring indicators on PMDT Coverage introduced (NEW) Evaluation � PMDT Appraisal Protocol – State & Central level (UPDATED) � IE formats to include 1 page for preparatory states / districts (UPDATED) 34 � DOTS Plus Quarterly Report � CF, 6m Int, 12m CC, TO � Quarterly Lab Reports � Monitoring indicators on DOTS implementation introduced (NEW) � Lab Monitoring Indicators � IE formats to include section for implementing states / districts with assess progress on scale up plan, visits to DP Sites, C-DST Lab, Drug Stores, Patients interview etc. (UPDATED) The following Job Aides for PMDT services have also been developed by CTD that will be pilot tested in 4 states in June 2011: 1. Patient Clinical Information Booklet – DOT Plus Site 2. Standard Counseling Tool for MDR TB Patients 3. MDRTB suspect line list – DMC, TU, DTC 4. Flow Charts - Diagnosis, Treatment, Ambulatory DOT, Recording, Reporting 5. Supervisory checklist for MDR TB - DOTS Plus Site, District, TU, DMC, and Patient Interview 6. Monitoring and management of Adverse Drug Reactions A set of monitoring indicators were introduced in the RNTCP Annual Status Report – TB India 2011 (Annexure 8) and will be regularly published in all quarterly and annual performance report. These indicators are divided into 5 sub-sets as follows: 1. Coverage indicators on population with access to DOTS Plus services and geographical coverage 2. Case finding activities 3. 6 month interim outcomes 4. 12 month culture conversion and interim outcomes 5. Final treatment outcomes These indicators will be used for reviewing the status with the states during the RNTCP Bi-annual STO Consultant’s Meeting to be held in future.
National Scale up Plan for Programmatic Management of DR TB 2011 - 2012 10. Summary of Key Risks and Potential Mitigation Strategies for Scale up of PMDT in India: The Pinch-point analysis of the scale up of RNTCP’s MDR TB program was undertaken by CHAI (with DFID and WHO support) sought to validate this plan, and in that process was able to identify potential ‘pinchpoints’ of the current scale up plan for MDR TB that may cause actual patient enrollment to fall short of stated targets over the coming years. The following table summarizes the key risks and potential mitigation strategies the emerged from the pinch point analysis: Overall Drug Supply Drug Procurement Table 16: Summary of Key Risks and Potential Mitigation Strategies for the scale up of PMDT. (Mitigation strategies have been in part incorporated into this plan.) Key risks to MDR TB program scale up Potential mitigation strategies • PMDT micro-planning was a critical first step to align resources and timelines, but there are still key planning and execution challenges to deal with • If program enrolls fewer than 4,800 patients in 2011, significant drug expiries will occur • Cs drug expiry will happen in GDF states under current enrollment plan, unless drugs get relocated to GoI states • Despite supply and demand challenges, confirmed deliveries can support enrollment plans until Q1 2012 without nationally stocking out • Without state-to-state drug transfers, enrollments could be limited to 4,400 in 2011, and stock-outs occur in some states as soon as Feb 2011 • There is little margin for error in drug supply management to avoid stock outs or expiries • Poor storage conditions at periphery put Cs drug quality at risk • Inflexible technical specs and sub-optimal tender design and execution make procurement error-prone • Long and unpredictable lead times complicate supply planning and reduce procurement reactivity 35 • Overall need to ensure feasibility of planning, track key metrics on ongoing basis, and have mitigation strategies for high-risk aspects • If needed, allow performing states to go over target to compensate for underenrollment in lagging states • A decision on accepting or not emergency relocations of drugs between GoI and GDF streams is necessary to optimize stock utilization • 2010/11 orders from GDF and WB need to arrive by Q4 2011 and account for backfill • Systematic and urgent reallocations between states needed to optimize use of limited drug supply • Build capacity at center for systematic drug management (process and tools) to proactively manage supply and transfers, e.g., operating on notion of patient months, transferring models for expiries and reallocations to SAMS • Install day-time AC at district level • Actively manage tender execution, e.g., organize pre-tender meeting • Harmonize RNTCP’s and GDF’s tech specs where feasible • Control and reduce lead time jointly with procurement agent, donors, and suppliers
Page 1 and 2: National Scale up Plan for Programm
Page 3 and 4: Acknowledgements National Scale up
Page 11 and 12: 4. RNTCP Vision and Plans for PMDT
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Page 21 and 22: # of Patients per Quarter 70000 600
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State Profile: State Arunachal Prad
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Tripura : Enrollment Plan of MDR TB
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National PMDT Scale-up Plan - India - 2011-12 - TBC India

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