A new era for Indian Pharmacies in National TB Programe
Recently, a Memorandum of Understanding (MoU) was signed between Central TB Division & IPA, AIOCD, PCI & SEARPharm Forum, for inclusion of "Pharmacies in RNTCP (National TB Programme)". It is a historic development for the profession. The report here describes briefly IPA's journey in TB from year 2005 till signing of MoU.
India accounts for over one fifth of all Tuberculosis (TB) cases worldwide. National TB Programme known as Revised National Tuberculosis Control Program (RNTCP) provides free diagnosis & anti-TB medicines known as DOTS (Directly Observed Treatment, short course). Under the RNTCP, there have been several public-private partnerships to expand the provision of DOTS, but community pharmacists had remained neglected link.
IPA Community Pharmacy Division's (IPA CPD) journey in TB work started in year 2004 with IPA/CPA/IPSF's TB Fact Card Project, Mumbai. This was the first attempt to engage pharmacists in TB care & control. This project focused on building awareness about TB in the community though retail pharmacies. During this project, IPA realized that pharmacists should be roped in RNTCP & DOT services should be set up in pharmacies to increase outreach of free anti-TB medicines & to improve case detection rate. IPA was convinced to initiate this public- private partnership & began its attempts to establish it. All stakeholders, the pharmacists, chemist associations, Govt TB authorities were approached to explain & convince pharmacist centric model for DOTS provision.
After successful pilots between 2006-09, a scaled up collaborative programme DOTS TB pharmacists Project was launched in Mumbai region in Feb, 2010 & is still an ongoing project. The parterners of IPA are: FIP, SEARPharm Forum, Maharashtra State Chemist Association (MSCDA) and is supported by Lilly MDR TB partnership. State TB office’s permission was sought for the project & Maharashtra Food & Drug administration was informed & necessary permission was obtained.
Pharmacists are trained by IPA & City/District TB officers for following role:
- Detecting chest symptomatic cases & referral to nearby Designated Microscopy centers
- Patient counseling & education,
- Community awareness about TB & Drug Resistant TB
- DOT medicine administration
- Rational use of antibiotics
IPA is now working with seven City corporations in Maharashtra and around 270 pharmacists are engaged in the project.
In Mumbai region, 70 pharmacists are delivering DOT services & more than 224 patients have got benefit from these services. Pharmacists are actively referring the TB suspects to nearby designated microscopy centers & case detection rate (finding positive TB cases) among the referred cases is between 16% to 30%. RNTCP field staff regularly visits the pharmacies & pharmacists have developed excellent working relationship with them. No financial incentives are given to the pharmacists but they do get good amount of social-professional recognition & they are highly appreciated for their social work. Patient feedback also indicates the convenience of treatment & comfort of DOT at pharmacies due to friendly relations with pharmacy & proximity to the homes.
Considering the fact that there are approximately 750,000 pharmacies in India, this initiative, when scaled up nationally has huge potential to make significant impact in TB Control .The pilot evidenced increased trend in case detection & increased outreach of DOTS services for the community, encouraged with the success of this work in Mumbai region & realized the huge potential of pharmacists’ contribution in TB care & control. IPA felt it important that this model needs to be scaled up in the entire country. IPA organized 2 days workshop
"Pharmacies in RNTCP" with help of Central TB Division, Ministry of Health in Feb, 2012. IPA' evidence of pharmacists’ contribution was disseminated to the National TB Programme (NTP) managers. Similar experience by NGO PATH in Andhra Pradesh was also shared. IPA followed up consistently with the policy makers. On April, 27th 2012, Central TB Division signed a MoU with IPA, AIODC, SEARPharm Forum for inclusion of pharmacies in RNTCP pan India. Pharmacy Council of India has conveyed its intention and will be signing the MoU after necessary permissions. Initially the model will be implemented in Orissa, Madhya Pradesh and Kerala & later will be spread in the entire country in phased manner. National Core Committee is being set up for the purpose. Central TB Division is adopting IPA’s training module for Community Pharmacists.
This is a historic development & milestone for pharmacy profession of India as it will set pharmacists footprints in the National Health Programme. For it is for the very first time the pharmacies are included in any such national health programme. It is great recognition to the pharmacists' work as health care professionals. It is a beginning of the partnership for the human care & an opportunity for the pharmacists to be engaged in HIV/AIDS, Malaria, Leprosy Control programmes in near future.
This model is being replicated in high TB burden countries of Africa.
Thus, starting with 10 pharmacists in Mumbai in 2006, this model is spreading nationally & internationally & pharmacists are playing valuable role in fight against TB.
To sum up, capacity building and skill enhancement of pharmacists has helped in reorienting the role of community pharmacist from drug vendors to a skillful human health resource. Moreover, focused persistent advocacy efforts have influenced the national policy change. IPA CPD's work has served as
"Agent of CHANGE" benefiting the TB patients as well as enhancing the image of the pharmacists.
Click Here To View Signed MOU.