Through improved coordination and use of the QuanTB quantification tool developed by SIAPS, the National Tuberculosis Program in Bangladesh strengthened pharmaceutical management of TB medicines. This averted medicine waste, ensured treatment coverage, and saved nearly $1 million by identifying and addressing potential stock outs and excess stock of both first-line and second-line TB medicines. Regular review of procurement data through the PSM platform now provides early warning of any issues to improve long-term availability of TB treatment.

1. October 2014
QuanTB Helps Ensure Medicines Availability,
Averts Waste, and Saves Money in Bangladesh
Through a new mechanism for improved coordination and use of the SIAPS-
developed QuanTB tool, the National Tuberculosis Program in Bangladesh improved
pharmaceutical management of tuberculosis medicines which averted medicines
waste, ensured treatment coverage, and saved nearly one million (US) dollars in
unnecessary medicines procurements.
Curbing the spread of tuberculosis (TB) requires that patients have uninterrupted
access to a full course of treatment, frequently a difficult task in developing country
settings considering that each regimen includes multiple medicines taken over the
span of several months which may need to be customized based on the type of TB
being treated and the patient’s reaction to the prescribed combination. The emergence
of multidrug- and extensively drug-resistant TB further complicates how TB
medicines are managed because patients with these types of TB require second-line
medicines, which have additional side effects compared to first-line medicines, and
need to be taken over a longer period of time. Additionally, while a full course of
treatment with first-line TB medicines costs approximately $20, second-line
treatments can cost up to $5,000 per regimen.1
Ensuring that TB medicines are available to use when and where they are needed
requires strong systems that promote effective medicines management. From
forecasting and procurement, to distribution and stock monitoring, these activities
often involve extensive planning, complex analyses, and close coordination between
health facilities, ministries of health, and suppliers like the Global Drug Facility. In
Bangladesh, SIAPS is working with the National Tuberculosis Program (NTP) to
strengthen the management of TB medicines, project future needs, and build capacity
to ensure that TB medicines are readily available to those in Bangladesh who need
them.
Partnering to Improve Supply Monitoring and Planning
Recognizing the importance of effective medicines management in decreasing TB
incidence, the NTP, with support from SIAPS, formed a national Procurement and
Supply Management (PSM) unit to ensure accurate forecasting, timely procurement,
and effective stock management of TB medicines across Bangladesh. The unit brings
together partners from the NTP, SIAPS, the World Health Organization, the TB Care
II project, the Damien Foundation, and BRAC to form a single platform for effective
collaboration for the multidisciplinary group.
1
World Health Organization. Drug-resistant tuberculosis now at record levels. 18 March 2010.
Accessed from:
http://www.who.int/mediacentre/news/releases/2010/drug_resistant_tb_20100318/en/

2. 2
In March 2014, the PSM unit began using the SIAPS-developed QuanTB tool to
quantify the projected amount of TB medicines that would be required for the
upcoming year. By capturing, collating, and analyzing multiple triangulated sources
of data, and by reassessing previous forecasting assumptions to ensure that the
number of current and projected cases were accurate, the forecasting exercise yielded
better estimates of the number of anticipated TB cases and how many medicines
would be required.
The first quantification
exercise conducted
using QuanTB indicated
two important findings.
The first was that
current stock levels for
first-line TB drugs were
at risk for a potential
stock out which could
have prevented
approximately 1,000
patients from receiving
their medicines. In
contrast, the second
finding indicated that
previous procurement assumptions and unanticipated variations in the number of
patients started on treatment had resulted in an overstock of medicines typically used
to treat extensively drug resistant TB. The exercise also indicated that several of the
overstocked medicines were set to expire in the coming months.
From Analysis to Action: Data driven decision making improves management of TB
medicines
With QuanTB acting as an early warning system signaling potential stock
management issues, the NTP, with technical support from SIAPS, was able to assess
these issues and take immediate steps to ensure continued availability of TB
medicines while eliminating unnecessary medicines waste.
To address the potential stock out of first-line TB medicines, the NTP was able to
work with the Global Drug Facility to expedite several previously placed orders to
ensure that shipments arrived in time to continue treatment for all current patients as
well as initiate treatment for any new cases.
QuanTB is an electronic forecasting, quantification, and early warning tool
designed to improve procurement processes, ordering, and planning for TB
treatment. QuanTB, a tool which can be downloaded to any desktop, can help
program managers quickly calculate forecasting needs and share key
information such as actual versus planned consumption, potential stock out
scenarios, and upcoming expiries through a user-friendly dashboard.
Sample dashboard generated using QuanTB, designed to
provide early warning information “at a glance”. Green
indicates months of stock on hand, yellow indicates stock
on order, and red indicates potential stock-outs.

3. 3
“Over 1.5 million
doses of
second-line TB
medicines were
cancelled and
over a million
doses were
reallocated to
other countries
in the region,
saving the NTP
$899,976 USD.”
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The NTP team was also able to minimize the extent of overstocked second-line
medicines by cancelling, deferring, and reallocating upcoming orders. Over 1.5
million doses of second-line TB medicines were cancelled and over a million doses
were reallocated to other countries in the region, saving the NTP $899,976 USD.
SIAPS was also able to assist the NTP in addressing the existing excess of second-
line TB medicines already in country by using a feature of QuanTB which allowed
for the development of several alternate treatment regimens within existing standard
treatment guidelines. By quickly carrying out complex dosing calculations, QuanTB
helped to determine that the second-line medicines, originally intended for treatment
of XDR-TB patients, could be used for MDR-TB patients which would allow the
NTP to use up the excess stock before it expires while also ensuring that enough
stock remains to treat current and expected XDR-TB patients.
Partnership and Planning for Stronger Pharmaceutical Management in the Long
Term
The NTP, along with relevant stakeholders and support from SIAPS, is now
reviewing the procurement data for TB medicines on a regular basis and addresses
any issues through the PSM platform. Through increased collaboration and use of
reliable data for informed decision making, the NTP in Bangladesh now has an early
warning mechanism in place that can monitor and track existing stock levels, alert
key stakeholders to potential stock outs and expiries, and improve the availability of
medicines for TB patients in Bangladesh.