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

Laboratory Capacity
Others
• 16 states need private labs/NRL support to
attain lab targets, which will cost ~US$700k
for 2 years
• If state deficits not well managed, patient
enrollment could drop to 6,900 in 2011
• Delayed accreditation of labs will increase
private lab cost and/or reduce enrollment
further, e.g., a 6-month delay would cost
>US$2M over 2 years or limit patient
enrollment in 2011 to 5,200
• Aggressive plans to scale up established labs
and accredit new lab capacity is prone to
implementation delay
• Diagnostic policy changes could have indirect
negative impact on scale up. E.g., moving to
universal testing, levels of false positives may
become unacceptable
• Potential funding gap for GF drugs (US$5.5M)
could reduce GF enrollment by 2,600 by 2013
• Aggressive district appraisals and training
schedule could create implementation delays
• One key delay is the fact that states do not
yet have appropriate drug storage set up
• Bed capacity at some DOTS+ sites is insufficient
to initiate planned number of MDR TB cases
• HR vacancies at WHO, CTD and states limit
management support for MDR TB program
scale up
• Lack of integrated information systems and of
clarity around roles and project timelines
National Scale up Plan for Programmatic Management of DR TB 2011 - 2012
36
• Quickly set up effective contracting
relations with private labs (ensure enough
private lab capacity, budget for private
labs, set up MoUs, sample transport, etc)
• Consider use of NRL as fall-back plan
• Prioritize preparation of labs with more
urgent needs (e.g., Delhi, Rajasthan,
Gujarat)
• Revise schedule and resourcing of
accreditation process to reduce risk of
delay
• Analyze system-wide cost-benefit, e.g,
when does it become cost-effective to retest
DST positives and account for
increased lab capacity needs accordingly
• Negotiations with donors and/or
manufacturers
• Revise process and resourcing of plans for
district appraisals and training
• Need to track and ensure states
complete drug storage before appraisals
• Devise plan to increase bed capacity where
needed
• Aggressive hiring for key positions and
taking bandwidth limitations into account
• Communicate clear roles and timelines for
data systems, information sharing and
coordination processes
As part of the potential mitigation strategies, it is essential to have an ongoing tracking of key metrics
for early identification of any gross deviations from the planned course and to enable more effective
and timely corrections as described in the figure below: