In a strategic development, a Memorandum of Understanding (MoU) was signed between Central TB Division, IPA, AIOCD, SEARPharm Forum and Pharmacy Council of India (PCI) on April, 27 this year for inclusion of pharmacies in Revised National Tuberculosis Control Programme (RNTCP). Initially the model will be implemented in Orissa, Madhya Pradesh and Kerala and later will be adopted in the entire country in a phased manner.
A National Core Committee is being set up for the purpose and the Central TB Division will be adopting IPA’s training module for community pharmacists. It is touted to be a historic development for the pharmacy profession, as under RNTCP, though there have been several public-private partnerships (PPP's) to expand the provision of directly observed treatment, short course (DOTS), community pharmacists till now had remained a neglected link.
According to Manjiri Gharat, DOTS TB pharmacist project leader and vice-president and chairperson of the CPD IPA, this will be a milestone for pharmacy profession of India as it will set pharmacists' footprints in the national health programme. She said, “It is for the very first time the pharmacies are included in any such a programme and is a step towards recognition of the pharmacists’ work as health care professionals.”
Other high TB burden countries are in process of replicating the model. Pharmacists from Vietnam are visiting in first week of July to learn about this model and officials from Tanzania will be visiting later in the year.
India accounts for over one fifth of all tuberculosis (TB) cases worldwide. The first attempt to engage pharmacists in TB care and control was initiated by IPA community pharmacy division (IPA CPD) in the year 2004 with IPA/CPA/IPSF’s TB fact card project, Mumbai. This project focused on building awareness about TB in the community though retail pharmacies.
During this project, IPA realised that pharmacists should be roped in RNTCP and DOT services should be set up in pharmacies to increase outreach of free anti-TB medicines to improve case detection rate. All stakeholders, the pharmacists, chemist associations, government TB authorities were approached to explain and convince pharmacist centric model for DOTS provision.
Gharat informed, “After successful pilots between 2006-09, a scaled up collaborative programme, DOTS TB pharmacists project, was launched in Mumbai region in February 2010 which is still an ongoing project. Under this programme, pharmacists are trained by IPA and city-district TB officers for detecting chest symptomatic cases and referral to nearby designated microscopy centres. Apart from that they are also trained to do patient counselling and education, along with creating community awareness about TB and drug resistant TB. They also perform DOT medicine administration, give information on rational use of antibiotics etc.”
IPA is now working with seven city corporations in Maharashtra and around 270 pharmacists are engaged in the project. In Mumbai region, 70 pharmacists are at present delivering DOT services and more than 224 patients have got benefit from these services. Pharmacists are actively referring the TB suspects to nearby designated microscopy centres and case detection rate of finding positive TB cases among the referred cases is between 16 per cent to 30 per cent.
Considering the fact that there are approximately 750,000 pharmacies in India, this initiative, when scaled up nationally has huge potential to make significant impact in TB Control. The pilot evidenced increased trend in case detection and increased outreach of DOTS services for the community, encouraged with the success of this work in Mumbai region and realised the huge potential of pharmacists’ contribution in TB care and control.