title: Procurement and Supply Management System for MDR-TB in Nigeria: Are the Early Warning Targets for Drug Stock Outs and Over Stock of Drugs Being Achieved?
abstract: BACKGROUND
  The World Health Organisation (WHO) introduced the twelve early warning indicators for monitoring and evaluating drug Procurement and Supply management (PSM) systems, intended to prevent drug stock-outs and overstocking. Nigeria--one of the high Multi Drug Resistant Tuberculosis (MDR-TB) burden countries, scaled-up treatment in 2012 with the concurrent implementation of a PSM system.
  
  
  METHODS
  We evaluated how well this system functioned using the WHO indicators, including all seven MDR-TB treatment centres in the country that were functional throughout 2013.
  
  
  RESULTS
  The quantity of MDR-TB drugs ordered for 2013 matched the annual forecast and all central orders placed during the year were delivered in full and on time. Drug consumption was 81%-106% of the quantity allocated for routine consumption. Timely submission of complete inventory reports ranged from 86-100%, late submissions being 5-15 days late. Forty to 71% of treatment centres placed a drug order when stock was below the minimum level of three months. The proportion of drug orders received at the treatment centres in full and on time ranged from 29-80%, late orders being 1-19 days late.
  
  
  CONCLUSIONS
  The PSM was found to be performing well in terms of forecasting and procurement of MDR-TB drugs, but there were shortcomings in drug distribution, reporting at treatment centre level and in drug order placements. Despite these gaps, there were no stock outs. These findings indicate that where it matters most, namely ensuring that no drug stock outs affect patient management, the PSM system is effective. Addressing the observed shortcomings will help to strengthen the existing PSM system in anticipation of a growing MDR-TB case burden in the country.
authors.affiliation: Institute of Human Virology Nigeria, Abuja, Nigeria.
authors.forename: Bolajoko
authors.initials: B
authors.lastname: Jatau
authors.affiliation: Institute of Human Virology Nigeria, Abuja, Nigeria.
authors.forename: Yohanna
authors.initials: Y
authors.lastname: Avong
authors.affiliation: Special Program for research and Training in Tropical Disease, Geneva, Switzerland.
authors.forename: Olumide
authors.initials: O
authors.lastname: Ogundahunsi
authors.affiliation: Medecins Sans Frontieres (MSF), Operational Center Brussels, Operational Research Unit, MSF-Luxembourg, Luxembourg, Luxembourg.
authors.forename: Safieh
authors.initials: S
authors.lastname: Shah
authors.affiliation: Medecins Sans Frontieres (MSF), Operational Center Brussels, Operational Research Unit, MSF-Luxembourg, Luxembourg, Luxembourg.
authors.forename: Katherine
authors.initials: K
authors.lastname: Tayler Smith
authors.affiliation: Medecins Sans Frontieres (MSF), Operational Center Brussels, Operational Research Unit, MSF-Luxembourg, Luxembourg, Luxembourg.
authors.forename: Rafael
authors.initials: R
authors.lastname: Van den Bergh
authors.affiliation: Medecins Sans Frontieres (MSF), Operational Center Brussels, Operational Research Unit, MSF-Luxembourg, Luxembourg, Luxembourg.
authors.forename: Rony
authors.initials: R
authors.lastname: Zachariah
authors.affiliation: Institute of Tropical Medicine Antwerp, Antwerp, Belgium.
authors.forename: Johan
authors.initials: J
authors.lastname: van Griensven
authors.affiliation: Institute of Human Virology Nigeria, Abuja, Nigeria.
authors.forename: Ernest
authors.initials: E
authors.lastname: Ekong
authors.affiliation: Institute of Human Virology Nigeria, Abuja, Nigeria.
authors.forename: Patrick
authors.initials: P
authors.lastname: Dakum
mesh_terms: D000995:Antitubercular Agents / Q000600:supply & distribution* / Q000627:therapeutic use; D006801:Humans; D008421:Materials Management, Hospital; D009549:Nigeria; D004364:Pharmaceutical Preparations / Q000600:supply & distribution*; D010593:Pharmaceutical Services / Q000600:supply & distribution*; D018088:Tuberculosis, Multidrug-Resistant / Q000188:drug therapy*; D014944:World Health Organization
chemical_list: D000995:Antitubercular Agents; D004364:Pharmaceutical Preparations