1. Procurement &supply chain management 5 th Joint International Monitoring Mission

2. Overall observations Increased funding for procurement of anti-TB drugs; No stock outs of anti-TB drugs & lab reagents; Availability and use of anti-TB fixed dosage combination drugs (FDCs) increased since 2007; Well established Pharmacovigilliance system; Ancillary drugs available for management of ADRs; Functioning drug distribution system; Good storage practices 5 th Joint International Monitoring Mission

3. Challenges Fragmented procurement: NHSO, SSO, CSMBS, BTB (GF), hospitals – higher cost, un-assured quality, frequent delays; Numerous formulations/strengths procured: complicates drug management, leads to errors, stock outs and oversupply; Still limited use of FDCs: poor treatment adherence and unfavorable outcomes; Lack of pediatric anti-TB formulations; OTC dispensing of anti-TB drugs: irrational use & amplification of resistance; Large amount of drugs issued to MDR TB patient at once: amplify resistance & cause serious toxicity 5 th Joint International Monitoring Mission

4. 1 MONTH MDR TB PATIENT TREATMENT

5. Recommendations Single & streamlined procurement of quality assured anti-TB medicines; Limit procurement of anti-TB medicines to essential formulations & strengths; Procure & promote use of fixed dosage combination drugs through all stakeholders & partners; Procure & avail nationwide child-friendly fixed dosage anti-TB formulations; Ban OTC dispensing of anti-TB medicines through legal sanctions; Ensure treatment enabler or observer for M/XDR TB patients 5 th Joint International Monitoring Mission