Public & Private Partnership
Strengthening Public Private Partnership (PPP) is one of the Health Sector Strategies to increase access to and quality of health care services in the country. The programme is also implementing PPP strategy as part of increasing TB case notification and strengthening DOT at service delivery level with support from grants the Global Fund Against AIDS, TB and Malaria (GFATM) round 6, CDC/PEPFAR and others. For example, with support from GFATM, seven regions of Tanzania namely; Kagera, Rukwa, Mara, Dodoma, Manyara, Kigoma and Dar es Salaam have scaled up PPP.
A total 70 out of 93 targeted PHF have been refurbished in 31 districts under GFR 6 to improve TB and TB/HIV control services. In addition, a total of 16 Olympus binocular microscopes were procured and distributed into two selected private health facilities (PHFs) in each of the 7 regions under GFR 6. Furthermore, a draft for the services agreement between MOHCDGEC through NTLP and PHF has been prepared and is in the final stages of approval. The grant also enables the programme to conduct sensitization meetings to owners, administrators and medical officers in charge of selected
PHFs in 7 regions under GFR 6 were done effectively. Similarly quarterly PPP stakeholders meetings were conducted routinely in 31 districts under GFR 6. Overall, 171 private health facilities have been supported and are now implementing TB/HIV services whereby a total of 3,126 TB cases were notified in 2010.
- Logistics Management System
Management of drugs, laboratory reagents, and other supplies: Proper drugs, laboratory reagents, and supplies management is an essential component of the program of work at the NTLP. It ensures continuous and uninterrupted availability of drugs, reagents, and supplies for TB and leprosy diagnosis and treatment. The management system should support the six rights (the right goods, in the right quantities and right condition, delivered to the right place, at the right time, at the right cost). Drugs, reagents, and supplies management involves procurement, distribution, storage, and rational use. The NTLP at the national, regional, district, and health facility levels should ensure regular availability of adequate drugs, reagents, and supplies so as to provide uninterrupted services.
• Procurement: Procurement of drugs, reagents, and supplies is carried out in line with national health policy and guidelines and in tandem with international guidelines on TB and leprosy diagnosis and treatment. The MOHCDGEC, through the NTLP, quantifies anti-TB/leprosy drugs, reagents, and supplies requirements biannually and submits its order to the Medical Stores Department (MSD), which procures the items and stocks them in its warehouse. Other procurements for specific items are done through the MOHCDGEC Procurement Management Unit and respective development partners. The requirements are calculated according to the number of patients notified during the respective biannual period (i.e., morbidity-based analysis and the available stocks in the country). The requirement estimation includes running and buffer stock for one year.
• Ordering of requirements: Health facilities, districts, and regions order drugs, reagents, and supplies based on the number of patients notified in the previous month/quarter and the amount of drugs available in their respective areas at the time when the order is made. Health facilities order requirements from districts every month, while districts order their requirements from the region quarterly. Subsequently, regions compile district requirements and submit orders to the MOHCDGEC/TLCU. The respective pharmacist or health facility in-charge (at health facility, district, and regional levels) orders drugs and supplies from the relevant level.
• Determining quantities to order: Health facility, district, and regional levels should ensure adequate availability of drugs, reagents, and supplies. Ordering steps include:
- Pharmacist or health facility in-charge aggregates stock position at that level (health facility, district, regional).
- Health focal person/health facility in-charge, DTLC, and RTLC compile the number of TB-notified patients by patient group and regimen enrolment.
- Pharmacist, in collaboration with health focal person/health facility in-charge, DTLC, and RTLC calculates drug running requirements using formulas in form TB 08.
- This requirement is multiplied by 2 to cover requirements for buffer stocks.
- The amount to order is determined by subtracting amounts of drugs remaining at the end of the previous month/quarter (in stock). At the district level, in-stock drugs includes amounts at district and health facility stores.
- Drugs, reagents, and supplies are ordered using the Combined Requisition and Issue Note Form.
Note: Combined Requisition and Issue Note Forms must be authorized by coordinators at all levels before drugs are issued to the requesting officer.
• Distribution: The MOHCDGEC/TLCU prepares distribution lists according to the regional requests, which are submitted to the Central MSD with copies to the regions. The Central MSD distributes the allocated medicines and supplies to regions through zonal MSD centers. In the regions, medicines and supplies are received and kept by regional pharmacists in the drugs stores. RTLCs, in collaboration with regional pharmacists, should acknowledge receipt of drugs and other supplies to the MOHCDGEC/TLCU using receipt notes. Regions distribute medicines to district stores, which subsequently distribute the consignments to health facilities.
Anti-TB/leprosy drugs, reagents, and supplies should be collected by districts from the regional pharmacy; otherwise, they can be sent to the districts during the RTLC/RHMT supervision. Districts should use the drug distribution routes and supervision visits to distribute anti-TB/leprosy drugs, reagents, and supplies.
• Storage of drugs, reagents, and supplies: Appropriate storage protects and maintains the quality of anti-TB/leprosy drugs and related supplies. Drugs and supplies are kept in health facility, district, and regional drug pharmacies, respectively, where they are managed by a pharmacy staff or designated responsible staff.
Drugs, reagents, and supplies should be kept in a dry, clean, and moisture-free room using pallets and cabinets. Drugs should not be kept under direct sunlight. Storage rooms should be kept at a moderate temperature with adequate light and air circulation, and free of pests and rats.
Drugs should be arranged by type according to first expiry, first out, and first in first out, meaning that drugs that expire soon and those which came first are arranged and kept in the front line(s) so that they can be distributed first. This will ensure that drugs about to expire are dispensed first.
• Adequate stocks maintained at each level: The national level maintains a one-year running stock and a one-year reserve stock of anti-TB/leprosy drugs, while at the regional level, a three-month running stock and three-month reserve stock are kept. At the district level, a three-month running stock and three-month reserve stock are kept, and at the health facility level, a two-month running supply and one-month reserve stock are kept.
Note: Anti-TB/leprosy drugs should only be used to treat TB/leprosy patients and not other conditions.
• Monitoring of drugs, reagents, and supplies: All steps for drug, reagent, and supplies management should be documented and reported using tools including Combined Requisition and Issue Note Forms, ledgers, bin cards, and stock position report forms. Monitoring of these items should be achieved through supervision as stipulated in the checklist, routine medicines, and other medical supplies reports and periodic audits. The reports include:
o Stock in hand: This should be reported by all levels at the end of the quarter.
o Consumption data: The quantity of commodities dispensed or used during a particular period of
o Data on losses and adjustments: This includes drugs damaged, expired, or stolen; transfers to or
from other facilities/districts/regions.
• Transport: The MOHCDGEC, in collaboration with partners, will provide transport for supervision at the regional and district levels. The RHMTs/CHMTs are responsible for covering fuel and maintenance costs for vehicles and motorcycles. The RTLCs and DTLCs are the custodians of vehicles/motorcycles at the regional and district levels respectively, including:
o Maintaining and updating vehicle logbooks regularly.
o Submitting quarterly vehicle/motorcycle reports.