Pharmacist: Roles and responsibilities in SCM

The State Drug Store (SDS) pharmacist will perform the following activities:

1. Receipt of drugs: The state drug store may receive drugs from Government Medical Stores Depots (GMSDs) and Central Medical Store Services (CMSS) as a part of central supply, from drug stores of other states as a part of inter-state drug transfer and from district drug stores or other SDSs as a part of intra-state transfers. The pharmacist of the SDS will receive these drugs and maintain records relevant to this activity in Ni-kshay Aushadhi. 
2. Issues/ dispatches: The pharmacist of the SDS will issue and dispatch drugs under the following circumstances:

• Routine quarterly supplies to District Tuberculosis Centers (DTCs)
• Routine supplies to Nodal Drug-Resistant TB Centers (NDR-TBCs)
• Routine supply of cartridges and chips to the Nucleic Acid Amplification Testing (NAAT) labs
• Supplies to DTCs against Additional Drug Requests (ADR)
• Transfers to other SDS(s) in the same state
• Transfers to SDS(s) in other states

3. Prepare stock statements: The SDS pharmacist will prepare a Monthly Stock Statement (MSS) providing details of receipts, issues, and opening/ closing balance of drug items, on the last day of each calendar month. 
4. Data entry and record maintenance: The pharmacist of the SDS will maintain relevant records in the Bin Cards (BC) and record all the transactions in Ni-kshay Aushadhi. Stock Registers (SR) may also be used if real-time transactions are not recorded in the system.
5. Visits to DDS: The pharmacist of the SDS is also required to visit the DDSs, TB Units (TUs), and Peripheral Health Institutes (PHIs) and discuss the issues, and challenges and provide resolution and training support to the sub-level.
6. Monitoring: The SDS pharmacist will closely monitor the performance of the linked DDS, TUs and PHIs by periodically checking the records (both physical registers and online entries on N-ikshay Aushadhi). The SDS pharmacist is also required to perform physical stock verification of the DDS, TUs and PHIs and cross-check the same with the stock status in the stock register and other relevant records.
7. Analysis of reports: The SDS pharmacist will analyse the reports submitted by the DDSs to identify under/overstocked DDSs, and the DDSs with near-expiry drugs. The analysis of the reports will also help the pharmacist in forecasting the future requirement of these DDSs, TUs and PHIs.

Resources

• Standard Operating Procedure Manual Procurement and Supply Chain Management, Central TB Division, Ministry of Health and Family Welfare, Government of India. 

Assessment

The District Drug Store (DDS) pharmacist is responsible for managing the supply chain of all drugs and commodities at the district level under the National TB Elimination Programme (NTEP).

The DDS Pharmacist is involved in the following activities:

Figure: Role of District Drug Store (DDS) Pharmacist in National Tuberculosis Elimination Programme (NTEP)

1. Receipt of drugs: The DDS will receive drugs from the State Drug Store (SDS) as per the requirement. The pharmacist of the DDS will receive these drugs and maintain records relevant to this activity.  

2. Issues/ dispatches: The pharmacist of the DDS will issue and dispatch drugs under the following circumstances:

• Routine quarterly supplies to Peripheral Health Institutes (PHIs)

• Routine supplies to District Drug-resistant TB Centres (DDR-TBCs)

• Supplies to PHIs against Additional Drug Requests (ADR)

• Routine supply of Cartridge-based Nucleic Acid Amplification Testing (CBNAAT) cartridges and Truenat chips to the PHI stores

• Routine supplies to the private health facilities mapped with the district stores

3. Prepare stock statements: The DDS pharmacist will prepare a Monthly Stock Statement (MSS) providing details of receipts, issues, and opening/ closing balance of drug items, on the last day of each calendar month.

4. Data entry and record maintenance: The pharmacist of the DDS will maintain relevant records in the Bin Cards (BC) and record all the transactions in Ni-kshay Aushadhi. Stock Registers (SR) may also be used, if real-time transaction are not recorded in system.

5. Visits to TUs and PHIs: The pharmacist of the DDS is also required to visit the TUs and PHIs discuss the issues, challenges and provide resolution, training support to the sub-level.

6. Monitoring: The DDS pharmacist will closely monitor the performance of the linked TUs and PHIs by periodically checking the records (both physical registers and online entries on Ni-kshay Aushadhi). The DDS pharmacist is also required to perform physical stock verification of the TUs and PHIs and cross-check the same with the stock status in the stock register and other relevant records.

7. Analysis of reports: The DDS pharmacist will analyse the reports submitted by the linked TU to identify under/overstocked TUs, and the TUs with near-expiry drugs. The analysis of the reports will also help the pharmacist in forecasting the future requirement of these TUs.

Resources

• Standard Operating Procedure Manual Procurement & Supply Chain Management, Central TB Division, Ministry of Health and Family Welfare, Government of India. 

Assessment

Every Tuberculosis Unit (TU)/ Peripheral Health Institution (PHI) store has a pharmacist who ensures proper supply chain management of anti-TB drugs and other supplies at the TU and PHI level. TU/PHI pharmacist performs the following functions:

Image

Figure 1: Role of Tuberculosis Unit (TU)/Peripheral Health Institution (PHI) Pharmacist

1. Receipt of supplies: The pharmacist of the TU/PHI will receive supplies from District Drug Store (DDS) and maintain records relevant to this activity.  
2. Issues / dispatches by TU/PHI store: The pharmacist of the TU/PHI will issue supplies under the following circumstances:

• Routine monthly supplies to PHIs
• Supplies to PHIs against Additional Drug Requests (ADR)
• Routine supply of CBNAAT cartridges and Truenat chips to the NAAT labs.
• Routine supplies to the private health facilities mapped with the PHI stores
• Supply of medicines to the patients

3. Prepare stock statements: The TU/PHI Pharmacist will prepare a Monthly Stock Statement (MSS) at the last day of each calendar month. 

4. Data entry and record maintenance: The pharmacist of the TU/PHI will maintain records in the Bin cards (BC) and Stock registers (SR). The pharmacist will also make relevant entries in Ni-kshay Aushadhi.

Resources

Standard Operating Procedure Manual Procurement & Supply Chain Management, Central TB Division, Ministry of Health and Family Welfare; Government of India.

Assessment

Ensuring adherence to correct treatment is crucial in the outcome of tuberculosis and hence it is essential to develop a patient-centred approach to treatment administration.

• A Treatment Supporter (TS) who is acceptable and accessible to the patient as well as accountable to the health system should be identified in consultation with the patient during pre-treatment evaluation.
• The TS can either be a healthcare worker, community worker/ volunteer or private practitioner or family member.
• If a family member is identified as TS s/he should be trained to give medication under supervision at the residence, under close monitoring by Community Health Officer (CHO)/ Accredited Social Health Activist (ASHA)/ Auxilliary Nurse Midwife (ANM)/ Multipurpose Workers (MPW) with support from Tuberculosis Health Visitor (TBHV)/ Senior Treatment Supervisor (STS).

Role of TS in Supply Chain Management

• Whenever a patient is initiated on treatment, the monthly patient-wise boxes are issued to the TS of the patient.
• In the case of Bedaquiline (Bdq) since the treatment is initiated at the Nodal/ District DR-TB Centre (N/DDR-TBC), on discharge, the patient is issued the remaining bottle of Bdq drug, which is then handed over to the TS.
• In the case of Delamanid (Dlm), on discharge from the N/DDR TBC the remaining drugs for the rest of the first month are issued to the patient which is then handed over to the TS.
• In any case, TS is responsible for issuing the medicines to the patient on a daily basis until the end of the course, thereby ensuring Direct Observation of Treatment (DOT).
• The TS are also responsible for collecting/ receiving month-wise boxes throughout the treatment duration of the patient.
• The TS is assigned to the Ni-kshay database with respect to the particular patient and issued a Treatment Card to maintain a record of all drugs consumed by the patient.
• In case of death/ loss to follow-up/ discontinuation of treatment due to any reason or in case of change/ modification of the regimen, the TS is responsible for returning the issued patient wise box back to the treatment centre and also ensuring that the new/modified regimen box is issued to the patient.

Resources

1. Standard Operating Procedure Manual Procurement & Supply Chain Management, CTD, MoHFW, India, 2018.
2. Procurement, Supply Chain Management & Preventive Maintenance, Module 6, CTD, MoHFW, India.
3. Direct Benefi­t Transfer Manual for National Tuberculosis Elimination Programme, Central TB Division, Ministry of Health & Family Welfare, India, 2021.

Assessment