USAID PROGRAM FOR ACCELERATED CONTROL ON TB IN KARAMOJA (PACT)

INFECTIOUS DISEASES INSTITUTE

COLLEGE OF HEALTH SCIENCES

MAKERERE UNIVERSITY

QUARTERLY PERFORMANCE & ACTIVITY REPORT

Section: Pharmacy & Logistics

Period: July – September 2022

Compiled by: James Otema Oroma and Raymond Akena

Date of Compilation: 15th October 2022

Introduction: Karamoja region is working towards increasing tuberculosis (TB) case detection and treatment
success rates to meet the national targets for reducing the burden. The USAID/IDI/PACT Karamoja project
aims to increase TB case detection and treatment success rates through health systems strengthening in all
districts of North Eastern sub-region of Uganda. In collaboration with development partners, the region
proactively institute measures to control the occurrence and spread of TB to foster health equity and nurture a
healthy and productive population. Although treatment outcomes are suboptimal, a lot of gains have been
made in key TB control indicators to the extent that case detection is above national target in some districts.
For TB therapy programs to be successful, anti-TB medicines and other supplies need to be available 100% of
the time. The availability of enough quantities of these viable commodities is dependent upon achieving an
effective network of Logistics & Supply Chain Management (SCM) system. Therefore, pharmacy department
under PACT Karamoja supports the logistics management systems at facility and district level & offers
technical support and guidance to ensure that safe, efficacious, and quality medicines and medical supplies are
available in enough quantities whenever they are required.
 Activities Planned for the reporting Quarter (July – September 2022):
 Activity 1.3: Conduct integrated coaching to improve Laboratory processes and commodity
management in supported facilities
 Activity 2.8: Facilitate MMS’ to support facilities to complete and timely send NMS bi-monthly TB
commodity orders and reports using TWOS and to do order verification
 Activity 2.9: Use SMS reminder system to enhance timely submission of TB commodity orders at the
health facilities to National Medical Stores (NMS)
 Activity 3.1: Mentor HCWs on screening and initiation of eligible populations on TPT including how to
manage TPT commodity stocks and TB infection control

KEY TB LOGISTICS & SUPPLY CHAIN ACTIVITIES IMPLEMENTED DURING THE QUARTER

The following narrative describes the activities that were conducted during the quarter of July to September
2022 to achieve the above goals:

NMS+ CSSP Ordering & Reporting for NMS cycle 1 & 2 FY 2022/2023:
To ensure constant commodity availability during the quarter, 1 RRH, 3 District General Hospitals i.e, Abim
(1), Kaabong (1), Kotido (1) and 4 Health Centre IV i.e Karenga (1), Amudat (1), Nakapiripirit (1) and
Nabilatuk (1) were support to compile and submit their orders through the NMS+ CSSP system.
Furthermore, 46 lower facilities (HC IIIs and HC IIs) i.e (North 19 and south 27) that report and order from
National Medical Stores (NMS) for TB medicines and supplies were supported in the compilation and
submission of orders and reports during NMS cycle 1&2 (FY 2022/2023). Most HC IIs were unable to placed
TB medicines orders during cycle 1 because their data were not uploaded in to the system. Therefore, their
orders were merge with others facilities that had data in their NMS+ CSSP accounts.
Through coordination with the NMS regional and central team, data for all HC IIs data were uploaded in to
the system and they were able to place their orders through NMS+ CSSP during the NMS cycle 2 ordering.
100% order timeliness and reporting were achieved in all the supported districts in the region to ensure
availability of TB supplies at the diagnostic treatment units (DTUs) as well as treatment units (TUs).

TB Web-based Ordering & Reporting (TWOS) for JMS cycle 4 & 5 FY 2022/2023:
To ensure constant commodity availability during the quarter 14 PNFPs in the region that order and report
from JMS for TB medicines and supplies were supported in the compilation and submission of orders and
reports during JMS cycle 3 & 4.
The table below shows ordering & reporting rates for the two warehouses. 100% order timeliness and
reporting was achieved in all the supported districts in the region.
3 PNFPs health Facility without TWOS entry account were also supported to make their orders which were
merged with other facilities that have TWOS DHIS2 account for ordering & reporting to ensure availability of
TB supplies at all diagnostic treatment units (DTUs) as well as treatment units (TUs).
Figure 1.

NMS+ CSSP ORDERING & REPORTING RATES

120%

100% 100% 100% 100% 100% 100% 100% 100%

100%
% of Order Submission Timeliness

80%

59%
60%

40%

20%

0%
Feb - Mar 20 June 2020- Jun - Jul 21 Aug - Sept Oct - Nov 21 Dec 20 - Jan Feb - Mar 22 Apr-May 22 Jun-Jul 22
May 2021 21 21
NMS cycle 6 FY 20/21 NMS cycle 2 NMS cycle 3 NMS cycle 4 NMS cycle 5 NMS cycle 6 NMS cycle 1 NMS cycle 2
FY 19/20 FY 21/22 FY 21/22 FY 21/22 FY 21/22 FY 21/22 FY 22/23 FY 22/23

NMS Bimonthly Ordering & Reporting Cycles

Figure 2.
 mission Timeliness PACT TWOS ORDERING & REPORTING RATES
% of Order Sub-

120%
100%
80%
60%
100% 100% 100% 100% 100%
40%
20%
0%
JMS cycle 1 FY JMS cycle 2 FY JMS cycle 3 FY JMS cycle 4 FY JMS cycle 5 FY
21/22 21/22 21/22 22/23 22/23

JMS Bimonthly Ordering & Reporting Cycles

From the graph above (Figure 1&2), PACT Karamoja worked together with the DHTs (DHOs, MMS’ and
district logistics focal persons DLFPs) to achieve and maintain the 100% order submission timeliness and
completeness for NMS cycle 1&2 FY 2022/2023 and JMS cycle 4&5 during the quarter.
Technical support provided was inform of coaching & mentorship to 66 health facilities (35 in the south & 31
from the north), (58 government facilities and 8 PNFPs) and 135 (71 in the south & 64 in the north) healthcare
workers on extraction of data from primary data sources during ordering and reporting, facilitation, and
engagement of MMS’, DLFPs, continuous SMS & phone call reminders and technical guidance including
entry of orders into NMS+ CSSP and TB Web-based Ordering System (TWOS) hosted on DHIS 2.
Figure 3 below shows the number of health facilities supported to complete NMS & JMS bimonthly ordering
& reporting by level of care (Regional referrals-2, District hospitals-3, HC IVs-4, HC IIIs-39 & HC IIs-18).

Health facilities supported by level of care during NMS cycle 5 & JMS Cycle 2 FY
21/22 Ordering & reporting
HC II 18
HC III 39
HC IV 4
District Hospital 3
Regional Referral hospital 2

TB MDR ordering & reporting: During the quarter, two (2) regional referral hospitals i.e., Moroto RRH
(government) and Matany Hospital (PNFP) were supported in ordering and reporting for MDR TB medicines.
The orders were submitted on time.

Use of SMS reminder system to enhance timely submission of TB commodity orders at the health
facilities to national medical stores:
During NMS cycle 1&2 and JMS cycle 4&5 FY 2022/23 ordering & reporting, a total of 5 bulk SMS
messages were sent out targeting 254 facilities, district & IDI staff as a reminder to ensure timely submission
of NMS orders/reports (Abim-20, Karenga-15, Kaabong-22, Kotido-36, Amudat-19, Moroto-47, Napak-35,
Nabilatuk-21, Nakapiripirit-33, and IDI PACT staff-6). As a result, 100% timely reporting rates achieved per
district for NMS cycle 1 & 2 and JMS cycle 4 & 5 FY 2022/23.

Commodity Verification (NMS Cycle 1 & JMS cycle 4 deliveries):

During the quarter, IDI PACT Karamoja Pharmacy team in collaboration with district logistics focal persons
(DLFPs) & the Medicines Management Supervisors (MMS’) supported verification of NMS cycle 1 & JMS
cycle 4 deliveries in the 66 (35 south & 31 in the north) facilities that order for Anti TB drugs from NMS i.e.
Abim (9), Kaabong (9), Karenga (4), Kotido (9), Moroto (11), Amudat (5), Napak (8), Nakapiripirit (6) and
Nabilatuk (5). It was noted that RHZE 150/75/275/400mg, RH 150/75mg and INH 300mg had 100% order
fulfilment rate, RH 75/50mg, ethambutol 100mg, & Pyridoxine 25mg had 75% order fulfilment rate &
INH100mg & RHZ 75/50/150mg had 45% order fulfilment rate. This is as shown in the graph below:
DR-TB second line drugs had fulfilment rates of 78%.
The figure 4 below shows PACT order fulfilment rates for NMS cycle 1 & JMS cycle 4 FY 22/23 deliveries:

PACT Order fulfilment rate (%) for NMS cycle 1 & JMS cycle 4
120 deliveries
100 100 100
100
Order Fulfilment Rate (%)

80 75 75 75

60
45 45
40

20

0
RHZE RH 150/75mg Isonaizid (INH) RHZ RH 75/50mg Isonaizid (INH) Ethambutol Pyridoxine
150/75/375/4 300mg 75/50/150mg 100mg 100mg 25mg
00mg

TB Medicine Regimens

Several redistributions were done to ensure continuity in patient care and appropriate support and technical
assistance in NMS cycle 1&2 and JMS cycle 4&5 FY 22/23 ordering to cater for commodities which had less
than 100% order fulfilment rates in NMS cycle 1 FY 22/23 & JMS cycle 3 deliveries.
TB Commodities availability (July-September 2022) and Regional TB stock status summary (As of
September 2022)
USAID-PACT Pharmacy & logistics team analyzed weekly RASS data and collect stock status from facilities
that does not have RASS accounts for submission of weekly stock status to determine stock levels in the
different facilities across the region. During the quarter, the region was overstocked with INH 300mg and
there was low stock level of INH 100mg, Pyridoxine 25mg, Ethambutol 100mg, RHZ 75/50/150mg and RH
150/75mg in about 15%,17%, 14%, 11% and 16% of the facilities in the region respectively. These were
mainly facilities that does not order TB commodities and they rely on redistribution from other facilities that
order for TB supplies and increase in consumption during the CAST TB campaign. The graph below
summarizes TB medicines availability during the quarter.

100% 3% 1%
8% 6%
12%
90%
28%
80% 37% 34% 39%
27%
36%
70% 37%
67%
60%

50%
35%
56%
40% 49% 46%
49%
47%
30% 42%

20% 25%
28%
10% 16% 15% 17%
11% 14%
8% 9%
0% 0% 0%
RHZE RH INH (300mg) RHZ RH (75/50mg) Ethambutol INH (100mg) Pyridoxine
(150/75/275/4 (150/75mg) (75/50/150mg) (100mg) (25mg)
00mg)

Zero month <2 month 2-4 Month >4 Month

Regional TB stock status summary as of September 2022:

At the end of the July – September 2022 quarter, we obtained real time TB medicine stock statuses to mitigate
any stock outs. This was done by analyzing the average monthly consumption (AMC) and stock at hand to
obtain months of stock (MOS) as shown below:
 REGIONAL TB MEDICINES STOCK STATUS FOR FIRST LINE
FIRST LINE ANTI - TB MEDICINES STOCK STATUS
S/N REGIMMEN PACK SIZE STOCK AT HAND AMC MOS Comments
1 RHZE 150/75/275/400mg 24 blisters of 28 tabs 10250 2525 4.06 Adequately stocked
2 RH 150/75mg 24 blisters of 28 tabs 9858 2855 3.45 Moderately stocked
3 INH 300mg 24 blisters of 28 tabs 30000 4035 7.43 Overstocked

4 RHZ 75/50/150mg 3 blisters of 28 tabs 1800 852 2.11 Slightly understocked

5 RH 75/50mg 3 blisters of 28 tabs 3980 1250 3.18 Moderately stocked

6 Ethambutol 100mg 10 blisters of 10 tabs 3500 1320 2.65 Slightly understocked

7 INH 100mg 10 blisters of 10 tabs 6250 3000 2.08 Slightly understocked

8 Pyridoxine 25mg A Tin of 1000 tabs 500 82 6.10 Overstocked

From the figure 5 above, it can be observed that the region is slightly understocked stocked with RHZ
75/50/150mg, Ethambutol, INH 100mg due to low order fulfilment rate and increased consumption during the
CAST TB campaign. Adjustments in order quantities were made during cycle 2 ordering and emergency
orders was placed to cater for low stock levels
RASS reporting rates in Karamoja region
Ministry of health with support from implementing partners is implementing the Real time ARV, TB, Test kit
stock status reporting systems (RATSS) formerly called RASS where facility report stock status for the
commodities at the facility on weekly basis using phone through SMS platform which is sent to 6767.
The RATTSS uptake is ongoing and due to the benefit associated with RATTSS, PACT Karamoja has been
following up to ensure facilities submit their weekly stock status.
The table below shows a summary of RASS reporting rates per district for the July to September 2022 quarter.
 RASS REPORTING RATES AND TIMELINESS
120%

100%
100% 100% 100% 100% 100%
98%
95% 97% 92% 97%
94% 92%
92% 89%
92% 94%
92%
90%
89% 87% 89% 88%
80% 85% 86% 84% 84%
80% 77%
77% 78%
74%
71% 72%
72% 68%
69%
60% 61%
56%

48%
45%
40%

20%

0%
Abim Amudat Kaabong Karenga Kotido Moroto Nabilatuk Nakapiripirit Napak Regional

Jan-Mar 2022 Apr-Jun 2022 Jul-Sep 2022 Timeliness

15/10/2022 Source https://dhis.mets.or.ug

From the graph above, it can be noted that all the districts of Karamoja are above 90% reporting rates with
Amudat and Karenga achieving over 100% during the quarter and 97% as the region. However, the timeliness
was at 68%. We worked collaboratively with USAID Strengthening Supply Chain System (USAID SSCS) to
create accounts for online reporting using smart phones/computers instead of the SMS submission. This was
more convenient to the facility staff and promote accuracy when entering the data in to the system. Weekly
SMS, phone call reminders and physical follow up were also done during the quarter that ensured continued
improvement in the reporting rates from the previous quarters and more weekly SMS, phone call reminders
and physical follow up would be done to ensure improvement in the reporting rates and timeliness in the
coming quarter.

HMIS 105 section 6 Reporting.

As part of the logistics information management system, facilities compile and to submit HMIS 105 section 6
that consists of 41 (2 anti-TB drugs) tracer medicines. These medicines are classified in to baskets depending
on the facility level (HC II 15, HC III 34, HC IV 38 and Hospital 41). MoH and Implementing partners
analyze these data for decision-making. Below is the reporting rates and timeliness from January to September
2022.

HMIS 105 SECTION 6 REPORTING

120%

97% 97% 99% 98% 98%

100% 95% 95% 95%

83%
80%

60%
53%
48%
44%
40%
35% 32%
30%
20%
18%
9%
6%
0%
Jan-22 Feb-22 Mar-22 Apr-22 May-22 Jun-22 Jul-22 Aug-22 Sep-22

National Target HMIS 105 section 6 repporting rates

National Target HMIS 105 section 6 completeness

14/10/2022 Source DHIS 2

The reporting rate for the region is above the national target 90%. We are showing significant improvement in
completeness and we exceeded the target in August 2022. Data for September 2022 are still being entered in
to DHIS 2 and we hope to achieve the target for reporting rates and completeness. Facility staff were
mentored how to compile the report, District biostatistician, HMIS focal persons and project M&E team were
mentored on how to enter the report in to the system to completeness.

Medicines Redistribution
To minimize stock outs resulting from low fulfilment rates of orders by the NMS and poor quantification by
some health facilities as well as a mechanism to avoid expiries, twenty nine (29) medicines redistributions
were conducted with support from the district health teams (DHTs) and Medicines management supervisors
(MMS’) with (20) inter-district redistributions, (9) intra-district and (0) inter-region redistributions. More
redistribution was conducted compared to last quarter (20) due to increased consumption during the Cast TB
campaign.
Support provided was in the form of physical transportation of commodities to and from the various health
facilities within the region. Some of the commodities that were redistributed include: RHZE
150/75/400/275mg, RH 150/75mg, Pyridoxine, RHZ 75/50/150mg, Ethambutol 100mg, RH 75/50mg,
INH100mg, Disposal gloves, disposal face masks, sputum mugs and Gene Expert Cartridges. All
redistributions were performed in accordance with the national policies (MoH guidelines on redistribution)
with support from DHOs, DTLS, DLFPs and MMS’.

Mentorship on committing INH for IPT, general stock management, RASS reporting and
Pharmacovigilance
During the quarter, 42 mentorships was conducted in the region. The mentorship themes mainly focused on
principles of committing IPT commodities to eligible clients, general stock management, and use of stock
book, proper quantification during ordering & reporting for anti-TBs and accurate documentation in the LMIS
tools particularly stock cards and stock books, accurate reporting into RASS system and pharmacovigilance
(detecting, assessing, managing and reporting suspected adverse drugs reactions)
1200 Adverse drug reactions (ADR) screening tools 80 ADR/PV report forms were distributed to 11 sites to
facilitate monitoring and filling the reports.

Health facility electronic Logistics information Management System (Health facility eLMIS)
MoH in collaboration with USAID SSCS conducted a one-week training on health facility eLMIS during the
quarter. The logistics team attended the training and learned how to installed Rx solution, synchronize stock
status data in to Pharmaceutical Information Portal (PIP), extract and analyze data from PIP (synchronization
status, SPARS progress and stock status) and DHIS2 (RASS, TWOS, stock status and HMIS 105 reporting).
Moroto regional referral hospital and Kotido hospital were supported to synchronize stock status for August
2022.

CAST TB campaign support.

MoH in collaboration with implementing partners organized the second CAST TB campaign. USAID PACT
supported implementation of the activity in the region. The project logistics arm supported in compiling TB
commodities stock status, receiving and redistributing the CAST emergency supplies to the respective
facilities. Items delivered includes facemask, surgical gloves, sputum containers, gene Xpert Cartridges and
TB drugs.
We also made an emergency for Nabilatuk HC IV to cater for the increase in consumption during the CAST
TB campaign.

Key Achievements from Activities Implemented during the quarter (April – June 2022):
 Ordering & Reporting – 100% timely submission to warehouses (NMS & JMS) was achieved for
NMS cycle 1&2 and JMS cycle 4 & 5.
 TB supplies in 66 facilities in the region with 35 in the south and 31 in the north NMS cycle 1 &
JMS cycle 4 deliveries were verified
 Improvement in RASS reporting rate from 84% to 97%
 Improvement in 105 section 6 reporting and completion rate.

Challenges encountered during the Quarter (July-September 2022):

 INH 100mg & RHZ 75/50/150mg had low fulfilment rates for both NMS and JMS deliveries
 Inadequate stock cards, requisition, RASS and order booklet in some facilities
 Network and systems upgrade affected order submission and RASS reporting.
 Knowledge gap in accurate and complete ordering & reporting, TPT implementation due to transfers
of experience workers
 The new NMS CSSP+ system was unstable which made order submission difficult but later on it was
resolved.
 Warehouse rationalization for PNFPs affected ordering of gene Xpert Cartridges.
 Inadequate infrastructures to support order submission.

Way forward to address the Challenges:

 TB dispensing logbook and order booklet have been delivered by NMS during cycle 5 delivery.
 Need for continuous mentorships for all DTUs that order & report
 Continuous mentorships and coaching to all the DTUs on TPT implementation
 Coordinate with NMS during order submission using the NMS CSSP+ system.

Planned Activities for the next quarter (October-December 2022):

 Activity IR 2: Facilitate MMS to support facilities to complete and timely send NMS bi-monthly TB
commodity orders and reports using TWOS and to do order verification
 Activity IR 1: Conduct integrated CQI coaching by District mentors to improve clinical diagnosis,
retention, and TPT initiation among U5, Laboratory processes and commodity management