Prevention and Care- Role of Pharmacists. Prafull Sheth, FIP Vice President

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1 Challenges in TB Prevention and Care- Role of Pharmacists Prafull Sheth, FIP Vice President

2 Tuberculosis- Global Facts Disease of poverty, Contagious and Air borne Among the top ten causes of deaths 1.7 Million People died from TB in Million new TB cases in % People successfully treated in Million saved through DOTS and Stop TB strategy in 2009 Multidrug Resistant (MDR) and Extensively drug resistant TB (XDR) are difficult and expensive to treat India suffers more TB cases than any other country in the world The 1.9 million incident cases in 2009 represented one fifth of the global l burden

3 ARE PHARMACISTS UNTAPPED POTENTIAL IN TB CARE AND CONTROL IN INDIA?

4 Are Pharmacists untapped potential in TB care and control in India? National TB Programmes (NTPs) in several countries ti have made significant ifi progress in involving diverse public, private, voluntary and corporate care providers in TB care and control. However the involvement of pharmacists was distinctly lacking in India

5 TB CARE AND CONTROL: JOINT COMMITMENT

6 THE INTENT The World Health Organization (WHO) and the International Pharmaceutical Federation (FIP) intend to intensify their collaboration towards care and control of TB and MDR-TB globally.

7 JOINT STATEMENT: JOINT ACTION

8 JOINT STATEMENT: EIGHT COLLABORATIVE ACTIONS Through these collaborative actions, WHO and FIP urge NTPs and NPAs to develop and implement plans to engage pharmacists in the fight against TB within the context of the national health systems and services.

9 EIGHT COLLABORATIVE ACTIONS 1. Joint Stewardship 2. Oi Orientation i and dtraining i 3. Creating Awareness 4. Quality of Prescribed Medicines 5. TB Management Practices 6. Partnership for TB Care and Control 7. Role of NPAs 8. Making a Beginning

10 ACTION PLAN WHAT SHOULD STAKEHOLDERS DO TO UTILISE PHARMACISTS IN TB CARE AND CONTROL IN INDIA? 10

11 1. Joint Stewardship Statement: Provide joint stewardship between NTPs and NPAs for policy guidance and mobilizing i resources to engage pharmacists in TB care and control. A Pan India Working Group of IPA in close collaboration with AIOCD, PCI and RNTCP to develop national strategy to engage pharmacists in RNTCP program objective

12 2. Orientation and Training Statement: Undertake orientation and training of pharmacists on the specific tasks that t they can contribute to TB care and control taking local context and needs into account. PCI to lead the process for review and update of pharmacy curriculum in India with a specific focus on the role of pharmacists in TB care and control and public health in general.

13 3. Creating Awareness Statement: Increasing awareness about TB among the people by facilitating ti effective contribution ti of pharmacists to specific areas related to TB care and control. Prepare a research model on remuneration fee-for- service provided by pharmacists and explore non cash incentives and other key drivers for success.

14 4. Quality of Prescribed Medicines Statement: In promoting rational use of anti-tb medicines, i efforts should be made to ensure that t quality-assured medicines are procured and supplied and WHO recommended FDCs are used. Prepare and distribute guidelines to address rational prescribing of anti-tb medicines and regimens in local languages. Estimation of the proportion of sale of anti TB medicines in private pharmacies.

15 5. TB Management Practices Statement: Contribute to rationalize and strengthen TB management practices of prescribers by maintaining a continuous dialogue with HCPs. IPA and IMA should work together to discourage dispening of anti-tb medicines without prescription.

16 6. Partnership for TB Care and Control Statement: Engage pharmacists and their associations to be a part of the Stop TB partnership efforts at global, national and local level. For resource mobilisation, conduct mapping of public funds for TB and Tap into these funds.

17 7. Role of NPAs Statement: Develop and implement a system to monitor, evaluate and improve collaboration between NTPs and NPAs. IPA to establish a working relationship with RNTCP, AIOCD and PCI to support National TB Programmes.

18 8. Making a Beginning Use this statement as a stimulus for initiating partnerships between NTPs and NPAs. The Pan India working group should begin documentation and sharing of experiences and lessons learnt in order to establish an evidence base on the role of pharmacists in TB care and control and also help to identify and scale up best practice models.

19 Is there any evidence of pharmacists' work in TB care and control in India.

20 Lilly MDR-TB Partnership In 2010, SEARPharm Forum and Indian Pharmaceutical Association (IPA) strengthened the public-private private mix (PPM) model in India with the Lilly MDR-TB Partnership to deliver a pilot project. The project achieved a 15-fold scaling up in the training of pharmacists in the DOTS protocol with a focus on improving case detection & referral, medication management, counselling and overall monitoring of the treatment in selected areas of Mumbai. These efforts are now being taken up to scale involving 1000 pharmacists in four to five major cities of India.

21 DOTS TB Pharmacist Project Year FIP Indian Pharmaceutical Association 2 Year Project Lilly MDR TB Partnership SEARPharm Forum Government TB Offices Chemist Association Multi-stakeholders : Scaling of this pharmacist centric public-private mix activity

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23 Areas of Intervention Contained in FIP/WHO Joint Statement Early identification of suspects and referral activities to increase case detection. Support delivery of DOTS treatment for cutting the disease transmission. Improving rational use of anti TB medicines and contributing to preventing emergence of drug resistance. Public education and communication campaigns on TB and Public education and communication campaigns on TB and MDR TB awareness

24 FIP Challenge on TB Round 1 India Represents 1/5 th of the global TB/MDR-TB burden. RNTCP needs support of private sector for universal access to TB treatment. Trained pharmacists can supplement early detection, DOTS Provisions. Evidence base need to be established for strengthening the role of pharmacists. Pharmacists can contribute significantly to different tasks essential to quality TB care and control.

25 Expected Scope Development of a reference document of pharmacists innovative approaches. Establish evidence base by collecting state wise case studies in community, hospital and other practice settings. Reference paper would essentially make a case based on evidence that pharmacists can make a difference Establish partnership of IPA with other HCPs and engage IPA in National Policy in the implementation of RNTCP plans.

26 Step Wise Approach to Work Plan Objective Activity Quantitative and verifiable outcome Timeline Development of National Working group Identification and setting up of pan India working group Meeting of the working group Terms of reference scope and structure of the reference document Approaches to be used for this document 30 Nov, 2011 India s National Situation (state wise) Demographic data State wise breakup of prevailing situation June, 2012 PublicPrivateMix activities Database June, 2012 Early identification of TB suspects and Prevailing methods for TB diagnosis Guidelines for Early detection June, 2012 referral activities for diagnosis thereby Recent Trends and innovation in TB Guidelines for use of novel methods for early June, 2012 reducing delays in diagnosis, saving costs diagnosis detection of care and contributing to increasing case Collection of references and case Evidence of Pharmacist role in Early detection of TB in January, detection. studies of pharmacists work. community, hospital and other practice settings Support effective medication therapy including DOTS treatment focusing on training of pharmacists and patients on adherence, so as to enhance treatment Collection of references and case studies of pharmacists work. Evidence of Pharmacist role in effective medication therapy management in community, hospital and other practice settings. success, reducing defaults and contributing to cutting the disease transmission. Improving rational use of anti TB Collection of references and case Evidence of Pharmacist role in promoting rational use medicines and contributing to preventing studies of pharmacists work in of anti TB medicines in community, hospital and other emergence of drug resistance. promoting rational use of anti TB practice settings. medicines Public education and communication Collection of references and case Evidence of Pharmacist role in patient education and campaigns on TB and MDR TB awareness. studies of pharmacists work in improving pharmacists professional performance in Public education and community, hospital and other practice settings. communication campaigns on TB Role of professional organizations in patient and MDR TB awareness education and contributing to improving effectiveness of healthcare system and Public health January, 2012 January, 2012 January, 2012 Preparation of the final report and database e database August, 2012

27 Stakeholders Prafull D. Sheth (Vice-President, FIP) C. G. K. Murty (President, IPA) Raj Vaidya (Vice-President, IPA-CPD) Manjiri Gharat (IPA-CPD) R N Gupta (IPA-Hospital Pharmacy) Subhash Mandal (IPA-Regulatory) M Ahmed Khan (SEARPharm Forum) Alok Ghosh (Lupin) Kapil M Khambolja (Novartis) B. Suresh (PCI) J. S. Shinde (AIOCD) R. Parmeshwar (DSPRUD) G. P. Mohanta (Annamalai University) it N K Gurbani (IIHMR) M Mitra (Forumer Deputy Drug Controller) Shibu Vijayan (RNTCP) E. R. Babu (The Union) Kathleen Holloway (EDM, WHO-SEARO) Deepesh Reddy(WHO-CO, India) Satish Kaipilyawar (PATH) Nalini Krishnan (REACH)

28 Pharmacists in RNTCP: A New Beginning-2012 MEMORANDUM OF UNDERSTANDING This agreement is made by and between the following to set out the policy of engaging community pharmacies in Revised National Tuberculosis Control Programme (RNTCP ) Government of India, Ministry of Health & Family Welfare, The Central TB Division i i Indian Pharmaceutical Association (IPA) All India Organisation of Chemists & Druggists, PCI, and SEARPharm Forum

29 THANK YOU