TB Fact Card Pilot Project – A Successful CPA/IPA Collaboration

TB Fact Card Pilot Project – A Successful CPA/IPA Collaboration

TB Fact Card Pilot Project

From TB Fact Card in Mumbai to DOTS TB Pharmacists across India:

A spectacular Journey of/for Indian Pharmacists

India has a large number of private retail (community) pharmacies (over 700 000) across the country and Community Pharmacists have been seen as a trader or as a shop-keeper rather than a healthcare professional. Pharmacists are hardly involved in any public health activities and the core focus of these pharmacies has always been the sale of medicines. In 2004, the Commonwealth Pharmacists Association (CPA) approached the Indian Pharmaceutical Association (IPA) to work on a collaborative project and it was decided to focus on Tuberculosis (TB). Keeping in mind the community pharmacy scenario that existed at that time, it was a bold and challenging project.

CPA had a very positive experience of the Malaria Fact Card Project in Africa and the Indian Project was named the TB Fact Card Project. It was in 2005 this project was implemented in the twin cities of Mumbai and Navi Mumbai and the project also had the support of the International Pharmaceutical Students’ Federation (IPSF). The project involved the development of the TB Fact Card in various languages and training the pharmacists and the pharmacy students. Trained pharmacists monitored the treatment of TB patients for adherence as well as worked to enhance community awareness of TB. The Fact Card project was quite successful and pharmacists worked with enthusiasm. They demonstrated the virtues of the pharmacists being more than just medicine sellers, which instilled confidence in the minds of the IPA leaders that pharmacists can play a vital role in public health. Nevertheless, the potential of pharmacies and pharmacists has not been utilized in any national health programme those days.  Fifty to sixty percent of TB patients sought treatment in private sector. During the Fact Card project, IPA realized that pharmacist is the missing link in the National TB Programme of India known as the Revised National TB Control Programme (RNTCP). RNTCP employed the DOTS strategy (Directly Observed Treatment, Short course), which offered free-of-cost diagnosis and anti-TB treatment at designated health care facilities.

Pharmacies, being the first point of contact for the people who are sick, which is open for long hours and located right in the community, were thought to be an ideal set up for delivering DOTS and for early case detection of TB. With this conviction and encouragement gained from the success of the TB Fact Card project, IPA took on the mission to engage pharmacists in RNTCP in 2006.

As one of the positive outcomes of the TB Fact Card project, IPA started piloting a public–private partnership project of engaging pharmacists in Mumbai ever since 2006. IPA appealed to the stakeholders such as the traders’ association, the Chemist and Druggist Association as well as the local TB programme managers. The drug regulatory authorities were approached to sort out the regulatory issues if any. IPA developed a training module and other practical tools. Training of pharmacists was conducted by the IPA and the RNTCP with cooperation from the Chemist and Druggist Association. The role of pharmacists included provision of DOTS through pharmacies, referral of TB symptomatics, patient counseling, community awareness activities and promotion of rational sale of anti-TB drugs. Though not all but some trained pharmacists started acting as DOT providers and referred the TB suspects, thus proving IPA’s conviction to be correct. Pharmacists started to voluntarily take on this socio-professional work without any monetary expectations or incentives. Reassured by these success stories even after a very humble beginning, IPA went on to scale up the work with support from the Eli Lilly MDR-TB Partnership in the year 2010. Under this initiative, in four Corporation areas, 150 pharmacists/pharmacy owners were trained. Overall, there was a 15–20% case detection rate among the cases referred by the pharmacists. More than 300 TB patients were reported to have been cured at pharmacies by mid-2012. Operations were then scaled up further to nine corporations in the state of Maharashtra. IPA organized a workshop “Pharmacies in RNTCP” in February 2012 at IPA headquarters in Mumbai with the support of the Central TB Division (CTD), Ministry of Health and Family Welfare, Government of India. Consistent advocacy seeking a role for pharmacists in TB control and the positive evidence from the work carried out by the IPA and a few other NGOs encouraged the CTD to sign a MoU in April 2012 with the IPA and other stakeholders to scale up engagement of pharmacies across the country. The pharmacists model is now being expanded to 6 States in the first phase and subsequently to the entire country.

A training manual developed by the IPA was reviewed by the Central TB Division, published as a joint publication and was uploaded on the TBC India website. Most of these training programmes were covered by the local and national newspapers as well as by the local TV channels in many cases. There has been a wide coverage about this work in pharma periodicals on a regular basis. This project work was presented at many international conferences.

This Pharmacists model received international recognition and many high TB burden countries sought help from the IPA for replication of the model in their countries. Thus, as one of the positive outcomes of TB Fact Card project, what IPA initiated in Mumbai in 2006,  has now reached national and international level to showcase pharmacists’ potential to play a significant and irrefutable role in TB care and control, which is now being explored and utilised for the benefit of the TB patients. Though compared to the total number of pharmacists in India, only a small number are engaged in the TB work, however, it remains to be a very encouraging and satisfying journey for the pharmacy profession and for IPA. The IPA will continue its efforts to reach the unexplored vast TB community through engaging the services of the pharmacists.

 

Case Study: Pharmacist Deepak Barai, Shreeji Medical, Dombivli, Maharashtra, India

Case Study: Pharmacist Deepak Barai, Shreeji Medical, Dombivli, Maharashtra, India

A young lady (age 20) was recurrently coming to the pharmacy to purchase medicines. Pharmacist Deepak Barai was observing the patient. She was coming back each time with a prescription from a different General Practitioner. But her condition was not improving and she continued to present with a cough or intermittent cough. None of the GPs suggested further investigations for TB. Pharmacist Deepak started counseling her and finally could convince that she should visit nearby DMC for sputum test. He guided her fully and followed her and ensured that she reached the DMC. She was diagnosed with Pulmonary TB. Her PWB was kept at Shreeji Medical where she completed the treatment and is now completely cured. Mr. Deepak Barai, who is working with IPA’s TB project since the last 7 years has been referring such cases regularly and has cured more than 70 patients to date.

  • DOT Provider Pharmacists, Maharashtra

    Vijay Ghatge, Navi Mumbai, Sagar Kulkarni,Kalyan, Abrar Khan, Nagpur

  • Deepak Barai, Dombivli, Vijay Jain, Kalyan