“Quality is Everybody’s Responsibility”

A quality-assured laboratory system is now available in sub-Saharan Africa, World Health Organization (WHO) AFRO region, through the implementation of Stepwise Laboratory Improvement Process Towards Accreditation (SLIPTA) roll out from 2010, and the introduction of the Global Laboratory Initiative (GLI) TB tool for quality management system.

During the ”Ensured the Quality of TB laboratory Services” symposium on Thursday morning, Alaine Umubyeyi Nyaruhirira, a Senior Lab Advisor in the Center for Pharmaceutical Management at MSH Rwanda, and colleagues presented “Improving the quality of HIV and TB Laboratories: The Rwanda Experience“.

In this presentation, Nyaruhirira demonstrated how efforts to ensure the quality of HIV and TB laboratories services in five referral laboratories in Rwanda help to ensure clients satisfaction, recognition and visibility of the laboratories, and sustain the performance of a quality system.

”Quality is everybody’s responsibility, from laboratory staff to upper manager,” she said. In order for the system to be sustainable, the involvement of political leaders is more important than ever.

Transitioning to Sustainable Pharmaceutical Management Systems for TB

Today marked the 10th year the USAID-funded, MSH-led Systems for Improved Access to Pharmaceuticals and Services Program (SIAPS), in collaboration with The Global Drug Facility (GDF), an arm of the Stop TB partnership, conducted a pharmaceutical management systems workshop at the Union World Conference on Lung Health.

MSH/SIAPS and GDF shared experiences, strategies and tools for improving and sustaining pharmaceutical management systems from global, regional, national, facility, and patient perspectives (read workshop description).

The Global Perspective

Kaspars Lunte (GDF, Geneva) described 10 years of GDF experience with partnerships for increasing sustainable quality assured anti-TB medicines. If dedicated funding is available, GDF is positioned to double its number of patient treatments to 50,000 and deliver treatment for all global cases enrolled by 2015.

National Perspectives

  • Brazil: Margateth Dalcolmo (Director of the Helio Fraga Reference Center for TB, Fiocruz/Ministry of Health Brazil) reported on Brazil’s experience implementing SIAPS’s web-based tool for pharmaceutical management systems, e-TB Manager. With technical assistance from SIAPS during the pilot and implementation phases, the system is now maintained by Brazil’s TB program, thus working towards its long-term sustainability.
  • Rwanda: Alaine Nyaruhirira (MSH, Rwanda) outlined financing requirements needed to roll-out Xpert MTB/RIF under the extended National TB Control’s strategic plan. Attendants learned of the importance for TB programs to identify the connection between plans and budgets for treatment and diagnostics in determining financing requirements to sustain new interventions.

A Regional Perspective – Eastern Europe and Central Asia

Archil Salakaia (SIAPS, USA) presented challenges and lessons learned from developing partnership frameworks to improve TB information systems in Ukraine, Uzbekistan, Azerbaijan, Armenia, and Georgia. The presentation focused on lessons learned from the process of implementing e-TB Manager in the Eastern Europe and Central Asia region. New developments, for example the laboratory module for e-TB Manager, also were presented.

A Facility Perspective – Three Models for Public Private Mix (PPM)

  • Pakistan: Ayyaz Kiani (MOH, Pakistan) described the potential for 45,000 to 50,000 retail medicine outlets in Pakistan to facilitate early identification of clients with TB-like symptoms for referral to TB diagnostic centers for diagnosis and adequate treatment.
  • Tanzania: Salama Mwatawala (MSH, Tanzania) described how pharmacists and Accredited Drug Dispensing Outlet (ADDO) dispensers can contribute to current global and national initiatives which encourage the use of “public/private mix” approaches to increase TB case detection.
  • Kenya: Jerimiah Chakaya (Kenya Association for the Prevention of TB and Lung Disease – KAPTLD) described the highs and lows of 50 years engaging the private sector in Kenya’s TB control program.

Lessons learned from the three speakers’ presentations included the importance of training private practitioners in methods of TB case detection and referral, the importance of considering traditional healers as private practitioners, and to “Keep Calm, Carry On” – persistence and passion lead to success and sustainability.

The Patient Perspective

Antonia Kwiecien (SIAPS, USA) presented a tool developed by SIAPS to assist NTPs in developing a Drug Utilization Program for Second-line Drugs. Attendants learned that including a sustained Drug Utilization Review program in a National TB program can ensure patients receive appropriate drug therapy and optimal therapy outcome.

Looking Forward to The Post-2015 TB Strategy

Andre Zagorski (SIAPS, USA) summarized the workshop, emphasizing that we are all facing new challenges in terms of pharmaceutical systems management: scaling-up MDR-TB treatment, and developing new drugs and diagnostics. He thanked participants for their active engagement in the workshop.

Antonia Kwiecien, Senior Technical Advisor, SIAPS USA, contributed to this story.