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OST IN SOUTH ASIA     Operational OST IN SOUTH ASIA     Operational

OST IN SOUTH ASIA Operational - PowerPoint Presentation

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OST IN SOUTH ASIA Operational - PPT Presentation

issues amp supply chain management Dr Ravindra Rao Contents of the presentation OST programme in SA region Current scenario Scaling up OST in SA region Supply chain management Contents of the presentation ID: 731697

chain ost outreach supply ost chain supply outreach clinic resource government management programme ngo services methadone region narcotics stock hospital medicine ngos

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Slide1

OST IN SOUTH ASIA

Operational issues & supply chain managementDr. Ravindra RaoSlide2

Contents of the presentationOST programme in SA region - Current scenarioScaling up OST in SA region

Supply chain managementSlide3

Contents of the presentationOST programme in SA region - Current scenario

Scaling up OST in SA region

Supply chain managementSlide4

OST in South Asia RegionSlide5

Existing OST models in SA regionDifferent modalities of implementationSetting (

Hospital / NGO / Hospital – NGO)Medications used (Methadone / Buprenorphine

)Activities/areas of OST implementationLinking clients to OST centre (outreach services)Assessment and dispensing (Clinic services)Psychosocial servicesSlide6
Slide7
Slide8
Slide9

Bangladesh OST ProgrammeInitiated in July 2010 in partnership with Ministry of Home through icddr,b

Methadone as OST medicine

One centre in DhakaClient load ~ 150Slide10

B

A

NGLADESH

OST clinic

Government hospital based clinic at the Drug treatment centre run by the

Deptt

of Narcotics Control,

MoH

Outreach, psychosocial and clinic services provided within one single setting

Human resource: one medical doctor, 2 nurses, one

counsellor

, 8 outreach workers, one co-

ordinator

, 2 guardsSlide11

India OST programme OST integrated in National AIDS Control Programme – Phase III

Three models operationalBuprenorphine

NGO based: 52 sites Government –NGO collaboration: 15 sitesMethadoneGovernment hospital based: 5 sites piloted by UNODCSlide12

NGO OST clinic

Run through NGOs implementing Harm reduction intervention

programmesClinic in the Drop-in-Centre located in the vicinity of the IDU hotspotsClient load: 50 – 200Human resource: Doctor, 2 nurses, one counsellor, 2 outreach workers

I

N

D

I

ASlide13

GO - NGO OST

OST clinic located in Government hospitalClient load: 50 – 200

Human resource: one doctor, 2 nurses, one counsellor, one data manager INDIA

NGO

Government hospital

Outreach and follow up services provided by NGOs implementing Harm Reduction TI

programmes

Human resource: One outreach worker, one

programme

managerSlide14

MMT clinic

Run through Government De-addiction

Centres, run by Ministry of HealthReferral of clients by NGOs working in the city/townClient load: 50 – 100Human resource: one Doctor (part time), 2 nurses, one counsellor

I

N

D

I

ASlide15

Nepal OST ProgrammeRe-initiated in the year 2007, as an emergency response

Pilots in partnership with Ministry of HomeOST medicine: Methadone, ? Buprenorphine

Currently operational through 3 unitsSlide16

OST clinic located in Government hospitalClient load: 100 – 150Human resource: one doctor, 3 nurses, one counsellor, one data manager, 3 Guards

NGO – SSU

Government hospital

Outreach, follow up and

counselling

services provided by Social Support Unit (SSU) managed by NGOs

Human resource: 5 – 7 staff

N

E

P

A

LSlide17

MaldivesInitiated in the year 2009Partnership with nodal drug agency with the Ministry of Health

OST medicine: Methadone

One centre operational in Male`Slide18

OST clinic located in Government premisesClient load: 70Human resource: one doctor, 2 nurses, 3 counsellors

NGOs

Government hospital

Outreach, follow up and part-

counselling

services provided by 3 NGOs

Human resource: 3 – 5 staff

M

A

L

D

I

V

E

SSlide19

Contents of the presentationOST

programme in SA region - Current scenario

Scaling up OST in SA regionSupply chain managementSlide20

Scale-up: ConsiderationsSetting the targetUniversal access to HIV prevention services40% of IDUs to be covered with OST (Target setting guidelines, UNODC, UNAIDS, WHO, 2008)

However…. Current coverage is < 3% in any country of SA regionDifferent countries are in different stages of IDU-HIV epidemic

Coverage is largely limited to IDUs, and not to opioid dependent drug usersSlide21

Following the epidemicEstimate IDU from major districts/provincesShortlist provinces with significant IDU estimatesIdentify provinces without OST services

Categorize provinces based on IDU estimates (high, medium and low priority) Prioritize provinces with moderate-high IDU-HIV prevalenceSlide22

Choosing OST centresSelect models, medications based on in-country & regional experienceShortlist potential centres

Conduct feasibility assessmentsAccessibility to the clientsInfrastructure

Safety measures for stock-keepingSlide23

Training and capacity buildingSensitisation meetings for policy makers (one day)Trainings Induction trainings for core staff (5 days)Exposure visits/study tours

Refresher trainings (3 days)Develop in-country capacities – capacity building institutions

Staff selectionDefining roles & responsibilitiesSlide24

Establish Quality assurance mechanismDevelop tools for standardisation of operation (Standard operating procedures, operational guidelines)Regular monitoring and evaluation of the programme

Success determined by registration and retention of clients into the programme

Factors influencing qualityDose of medicationDuration of treatmentStaff attitudeSatisfaction of clientsSlide25

CostingCurrent costing: range from 30000 USD – 180,000 USD

Start up cost

Sensitisation meetingTraining programmesFeasibility assessmentRefurbishment of centresImplementation costHuman resourceMedical doctorTwo nursesOne counsellor Two outreach staffOne data managerAccountantOther support staffRunning cost - travel, communication

Procurement cost

Medication

Buprenorphine: 37,000 USD

Methadone: 8,000 USD

Others:

Dispensers, water, etc.Slide26

Contents of the presentationOST

programme in SA region - Current scenario

Scaling up OST in SA regionSupply chain managementSlide27

International regulatory frameworkDifferent mechanism for narcotics /

psychotropicsMethadone

Covered under the 1961 conventionPrior quota and annual consumption reporting requiredBuprenorphineCovered under the 1971 conventionAnnual quota not required to be allocatedAnnual reporting for Buprenorphine (optional)Essential medicine list – WHO Methadone and buprenorphine in the listSlide28

Laws / policies of countriesDrawn in accordance to the conventionsMost of the countries support the use of narcotics / psychotropics for medicine and scientific purpose

India: use of opioids for OST (de-addiction) mentioned under NDPS act Nepal: harm reduction and OST endorsed in the National Drug policySlide29

Supply chain mechanismSlide30

Procurement procedures

Determining the medicine required Methadone: syrup in 5 or 10 mg/ml strengthsBuprenorphine tablets: 8 mg, 2 mg, 0.4 mg, 0.2 mg

Determining the quantityNo. of patients X no. of days X average dose per patient per dayRequest for QUOTARequired only for MethadoneNodal Ministry requests INCB for a quota for Methadone [Department of Narcotics Control (Bangladesh), Ministry of Home Affairs (Nepal), Central Bureau of Narcotics (India)]Slide31

Procuring agencyEach country has a nodal agency for procurement of goods and suppliesMaldives  State Trading OrganizationNepal

 ‘Sajha’ trust

Negotiate rates with procuring agency (management cost)Invitation for bidsInvite International Competitive bidsSlide32

Bidding agencyMust have a WHO-GMP certificate or equivalent certificateFor export, supplier would need “Certificate of Pharmaceutical Product”(COPP) as recommended by WHO

Manufacturers / DistributorsEvidence of its technical, financial and production capability

Finalise vendorTechnical and financial qualificationNegotiate RatesSlide33

Establishing a supply chain mechanism

SCENARIO A

SCENARIO BSlide34

Stock management

Licenses from relevant authorities for storage and transport

Central stocksStorage area of central stockResponsible officer for central stockSafe keeping: secure systemFlow of stocks from central to OST clinicChain of custodyClinic stocksStorage areaSecure systemStaff-in-charge?Slide35

Record maintenance for stock managementSlide36

Securing sustained supply: considerations

Clear understanding of the various Ministries/departments dealing with quota, licensing and procurement

Ensure clear commitment from the ministries – licensing, narcotics control / homeEnsure procurement is made well in-advancePrepare a standard supply chain protocol / guidelineSlide37

Securing sustained supply: considerations

Stock replenishment

Stock projectionRotate stocks with eye on expiry datesEstablish a strong supply chain mechanismIdentify officers responsible in-charge of the stock at every pointMaintain records strictlyCheck at regular intervalsSlide38

ConclusionOpioid dependence is a chronic medical condition and requires long term therapyDifferent modalities followed in different countries for operationalising MMT

Goal and objective of OST in each countryTreatment of opioid dependence Prevention of HIV among opioid users, especially injecting drug users

Urgent need to scale up OST in South Asia region Slide39

Advocacy for inclusion of narcotics / psychotropics

in the national essential medicine listRemoval of import duties

Use of computer based software for stock management (copy right issues, monopoly of pvt sector !)Robust supply chain an important part of scale up plan for OSTConclusionSlide40

THANK YOU