1. Calculation of TB patients' Drug Consumption using ENRS Amal Galal M&E, Surveillance officer NTP Egypt Dr. Samiha Baghdadi MO - EMRO WHO

2. Outlines What is ENRS What is the role of ENRS Historical background How ENRS can calculate the drug consumption of each TB patient. Applications on consumption using ENRS.  At Central level  At Provincial level  At District level Challenges facing the nationwide expansion

3. What is ENRS  It is a standalone system using available soft wares (Excel/Access), with local copy of the database.  It is the Electronic version of the main Registers in the TB recording reporting System, where Nominal data entry is done at TBMU level using Excel. Excel and Access  Nominal data are then processed to produce the routine reports in the NTP, and calculate indicators using Excel and Access.  Registers are linked using Access to produce patient profile and comprehensive data base

4. What is the role of ENRS Improve quality of TB surveillance accuracy, completeness and timeliness of reporting and indicators calculation in NTP (high quality) Facilitate supervision and increase it’s efficiency Facilitate locating patients per their residency not only their place of diagnosis. Capacity building of human resources Improve planning and budgeting for TB drug management.

5. Historical background Electronic Nominal Recording reporting System (ENRS) in Egypt, was applied at the district level since 2006, after piloting in two provinces. After two years of implementation, the system was updated to integrate the four recommended registers (suspect, lab, district, & contact) within the revised WHO recording reporting system aiming at upgrading data quality verification, plus data analysis and interpretation skills at the provincial & district levels. More than 600 data entry persons in 157 TBMUs were trained on data entry, cleaning and ensuring the parameters of quality verification. A handy data entry user guides were developed to help in a simple way, supported by pictures and instructions for each file to be as a reference in data entry and to facilitate the quality of work.

6. Confidentiality is ensured through developing a TB_ID number for each patient, consisted of his serial no., province letter code, TBMU no. code and file code. A supervision plan is applied with a detailed checklist to review the hard and soft formats, also for measuring the quality parameters of recording and reporting. Lastly, in 2009 Egypt has the whole set of ENRS package, four files from 154 TBMUs in 28 provinces were completed ( 45,000 records from suspects, 66,000 records from lab, 7300 records from district & 14,000 records from contacts were recorded and available)

7. How ENRS can calculate the drug consumption of each TB patient The sheet is supported with equations to calculate the actual number of treatment days, based on the date treatment started and the date on which treatment ended. Based on the number of treatment days the system can calculate the actual consumption of the drugs.

8. Applications on consumption using ENRS.

9. Calculation of consumption at Central level_1 The number of TB patients in 2009 and its breakdown by type & outcome. The actual number of treatment days by the same breakdown

10. Calculation of consumption at Central level_2 The consumption of Isoniazid in 2009. The consumption of Rifampin in 2009

11. Calculation of consumption at Central level_3 The consumption of Ethambutol in 2009. The consumption of Pyrazinamide in 2009

12. Calculation of consumption at Provincial level_1 The number of TB patients in 2009 and its breakdown by type & provinces.

13. Calculation of consumption at Provincial level_2 The number of treatment days in 2009 and its breakdown by type & provinces.

14. Calculation of consumption at Provincial level_3 The consumption of Isoniazid in 2009 at provinces and the amount needed with buffer stock for the next year quantification.

15. Calculation of consumption at Provincial level_5 The consumption of Rifampin in 2009 at provinces and the amount needed with buffer stock for the next year quantification.

16. Calculation of consumption at Provincial level_6 The consumption of Ethambutol in 2009 at provinces and the amount needed with buffer stock for the next year quantification.

17. Calculation of consumption at Provincial level_7 The consumption of Pyrazinamide in 2009 at provinces and the amount needed with buffer stock for the next year quantification.

18. Calculation of consumption at District level_1 The number of TB patients in 2009 at Alexandria and its breakdown by districts The number of treatment days at Alexandria and its breakdown by districts

19. Calculation of consumption at District level_2 The consumption of Isoniazid in 2009, and the amount needed with buffer stock for the next year quantification. The consumption of Rifampin 2009, and the amount with buffer stock for the next year management planning.

20. Calculation of consumption at District level_3 The consumption of Ethambutol in 2009, and the amount needed with buffer stock for the next year quantification. The consumption of Pyrazinamide 2009, and the amount with buffer stock for the next year management planning

21. Challenges facing nationwide expansion Expansion to other non NTP providers i.e. HIO, prisons, universities and others. Trained staff turn over which affect data quality Internet access not available in all TBMUs covered. Using national ID no. as a patient code to avoid duplication.

22. Thank you