Trainers' Guide for Pharmacists (SDS & DDS)

Module 1: Basics of TB and NTEP                                                 Virtual Session (90 min)

Chapter 1.1

TB & TB Epidemiology

Virtual Session (26 min)

Emphasis Points

Post Session Activity

• The participants may be asked to raise their doubts/questions. 
• The participants may be asked to unmute themselves and may be asked to enumerate the various determinants of TB, difference between TB Infection and TB Disease etc.

Chapter 1.2

NTEP

Virtual Session (34 min)

Emphasis Points

• Different institutions may be explained and discussed with respect to its coverage geographically, its organogram, the functions that particular institution is carrying out.

Post Session Activity

• The institution from which participants have come may be explained in detail and its relationship with other institutions. (e.g. District level functionaries may be asked about their relation with the state level and TU level institutions)
• The stages in TB patient’s care cycle may be elaborated as a story with special emphasis on long term post-treatment follow-up

Chapter 1.3

Diagnostic Technologies

Virtual Session (16 min)

Emphasis Points

• Names of different tests, their significance in Diagnostic algorithm

Post Session Activity

• The consumables required for different diagnostic technologies may also be mentioned here briefly to make it more relevant for the trainees

Chapter 1.4

Approaches to TB Case Finding

Virtual Session (6 min)

Emphasis Points

• The three approaches may be discussed by giving suitable egs to fit into the three scenarios
• The different case definition may be mentioned.

Post Session Activity

• The participants may be given the scenarios like visit to HIV Clinic, ANC Clinic, Covid clinic, OPD visit to a tertiary hospital, etc

Module 2

 TB Treatment

Virtual Session (203 min)

Chapter 7.1

General concepts in TB Treatment

Virtual Session (45 min)

Emphasis Points

• The other formats like Tb Treatment Card and NTEP ID card may also be shown and the different fields along with the significance may be discussed
• The transfer of patients on Ni-kshay also demonstrated and the impact of this transfer on the patients on the trainees may be asked first and discussed in detail
• The importance of monitoring the transfer of the patient should also be explained

Post Session Activity

• The FDCs may be shown to the trainees over camera, (Various regimens and packaging should also be shown to them on their physical visits for training)
• The wrongly filled treatment cards may also be shown and discussed.

Chapter 2.2

DS-TB Treatment and care

Virtual Session (10 min)

Emphasis Points

• Explain the basis of categorization of regimen i.e. age and weigt
• Explain the significance of weight measurement of patient on every follow-up visit
• Explain the importance of weight change and changes in regimen required.
• The weight bands may be explained and subsequent increase in dosage required.
• The importance should be given on the fact that weight change of the patient requires change in drug dosages and hence the practice of one time dispensation of medicines for the complete course or the complete phase should be discouraged
• The ADRs due to DS-TB treatment may be explained and when should one seek medical attention. It should be explained to the participants that not each patient will develop ADRs and tolerance develops for the drugs with due course of treatment and when should patient seek medical care.

Post Session Activity

• The participants may be asked to enumerate the ADRs and when to seek medical care
• Some participants may also be asked – how to counsel the patient about the ADRs 

Chapter 2.3

DR-TB Treatment and care

Virtual Session (20 min)

Emphasis Points

• The meaning of DR-TB should be explained emphasizing on the fact that that once a patient develops DR-TB, he’ll be transmitting the DR-TB to the community. 
• The different factors that lead to development of drug resistance should be explained. The role of incomplete and inadequate treatment should be emphasized connecting it to the importance of monthly follow-up and weight monitoring. It should again be emphasized that the practice of one-time dispensation of DS-TB drug to be discouraged.
• The different types of drug resistance may be explained with the different regimens available.
• The need for creation of different PWBs should be explained here.
• The MERM and its importance should be explained.

Post Session Activity

Chapter 2.4

Shorter Oral Bedaquiline-containing MDR/RR-TB Regimen

Virtual Session (14 min)

Emphasis Points

• The salient features of regimen, its composition, the weight bands, the duration and some common ADRs of the regimen may be explained.
• The action to be followed after ADRs identification, whom to contact need to be explained.

Post Session Activity

• The regimen may be shown to the participants- over the camera
• The composition of regimen and duration may be asked

Chapter 2.5

Longer Oral M/XDR-TB Regimen

Virtual Session (10 min)

Emphasis Points

• The salient features of regimen, its composition, the weight bands, the duration and some common ADRs of the regimen may be explained.
• The action to be followed after ADRs identification, whom to contact need to be explained.

Post Session Activity

• The regimen may be shown to the participants- over the camera
• The composition of regimen and duration may be asked

Chapter 2.6

Isoniazid (H) Mono/Poly DR-TB Regimen

Virtual Session (5 min)

Emphasis Points

• The salient features of regimen, its composition, the weight bands, the duration and some common ADRs of the regimen may be explained.
• The action to be followed after ADRs identification, whom to contact need to be explained.

Post Session Activity

• The regimen may be shown to the participants- over the camera
• The composition of regimen and duration may be asked

Chapter 2.7

TB Infection treatment and care

Virtual Session (14 min)

Emphasis Points

• The TB infection may be explained here. The different tests available for TB infection testing may be mentioned here. 
• The two regimens should be explained.

Post Session Activity

• The regimen may be shown to the participants- over the camera.
• The composition of regimen and duration may be asked.

Chapter 2.8

TB-Comorbidities and special situations

Virtual Session (26 min)

Emphasis Points

• Various Comorbidities and special situations like Pregnancy and lactation may be enlisted. The significance and impact of having these comorbidities to a TB patient should be explained.
• Bidirectional screening and its importance for HIV, Diabetes, COVID should be explained.

Post Session Activity

• The details of the facilities for alcohol cessation and tobacco cessation may be shared with the participants.

Chapter 2.9

General Concepts in Adherence Management

Virtual Session (48 min)

Emphasis Points

• What is adherence, importance of adherence, their role in adherence management, different ways of recording adherence- 3 ways(on Treatment Card by TS/STS, Self-reporting (99DOTS, MERM, TB Arogya Sathi), in Ni-kshay by TS, STS), 
• How to assign TS and role of TS

Post Session Activity

• Demonstration of the following at the end of the session:

1. TB Arogya Sathi app and adherence recording
2. Ni-kshay and adherence recording

Module 3: General concepts and Principles of SCM in NTEP             Virtual Session (114 min)

Chapter 3.1

Key Concepts and Principles in SCM

Virtual Session (33 min)

Emphasis Points

• Explain the flow of supplies through different tiers in SCM
• various types of drugs with emphasis on Minimum & Maximum stock, Buffer stock and its significance. May be explained by giving suitable examples from the local context and stories.
• Situational examples and past experiences to be shared, explain the various stocks like lost in transit, quarantine, substandard etc.
• The drug distribution flow and Stock types may be explained through a storyline (i.e. Some quantity of stock was transferred to State- in the transit some got damaged, some was quarantined for testing, and so on
• Identification of short expiry drugs and broad principles of management of Short expiry drugs. Outline the principle of FEFO and its scenario-based usage
• Indicating the various stocking points along with the purpose of respective stores.

Post Session Activity

• The participants may be asked about the significance of SCM in their own words to check their understanding and their role clearly in the SCM
• To ask what will happen if SCM is not maintained efficiently
• Situational based examples for different types of stocks may be asked 

Chapter 3.2

Drugs and consumables in NTEP

Virtual Session (14 min)

Emphasis Points

• The different drugs and consumables handled by different stores may be shown over the camera or the images of the commodities may be flashed
• These supplies should be arranged beforehand by the trainer and should be present on the demonstration table
• The lab consumables handled by the respective store (by the trainees) and the importance of maintaining the efficient supplies of lab consumables
• The consequences of poor SCM of lab consumables should also be explained

Post Session Activity

• Different Drugs and consumables may be shown over camera/physically
• The participants may be asked to identify the different supplies by asking them to unmute themselves
• Various registers and forms may also be displayed and brief intro about it may also be mentioned.

Chapter 3.3

Stores in NTEP

Virtual Session (14 min)

Emphasis Points

• Different stores at State, district, TB, PHI may be explained ( Covering its geographical coverage, the infrastructure requirements, HRs posted there and the functions carried out by the respective stores.

Post Session Activity

• The trainees may be asked about the existing gaps in stores with respect to stores infra, and the gaps in functioning of stores which are under their jurisdiction

Chapter 3.4

Patient-wise Boxes

Virtual Session (29 min)

Emphasis Points

Post Session Activity

Chapter 3.5

Information Systems in NTEP SCM

Virtual Session (10 min)

Emphasis Points

• Ni-kshay Aushadhi and its significance,
• Detailed discussion on the Dashboard and various reports available in the Ni-kshay Aushadhi

Post Session Activity

• Demonstration of the demo version of the portal and the navigation through it to discuss the different dashboard and its significance, generation of different reports
• Data to be fetched from Dashboard / various reports of Ni-kshay  to be shown and participants may be asked to give their observation

Chapter 3.6

Roles and responsibilities in SCM

Virtual Session (14 min)

Emphasis Points

• Explain the roles and responsibilities of different HR involved associating it with the functions of the stores
• Explain the importance and role of Pharmacists in NTEP emphasis on SCM, stock-keeping, and expiry management and use of Ni-kshay Aushadhi

Post Session Activity

• Some of the participants may be asked to enumerate the roles of the position they are holding

Module 4: Inventory Management in NTEP                      Physical Session (125 min)

Chapter 4.1

Overview of Inventory management in NTEP

Physical Session (8 min)

Emphasis Points

• Explain about the concept and the significance of it. discuss the process involved therein and significance of each step and also associate it with their role (trainees role in inventory management)
  discuss the different stocking norms at different levels and importance of it (norms at a particular level and why)

Post Session Activity

• Different scenarios from daily life may asked to shared
• Essentials for Robust Supply Chain
• Situational questions may be asked to participants

Chapter 4.2

Indenting and receipt

Physical Session (24 min)

Emphasis Points

• Types of method to be explained (Quarterly/ ADR along with its significance
• The different process involved in Indenting of supplies should be explained in detail giving example of drugs or any other supplies.
• Various sources of receipt to be indicated along with the purpose of them
• Steps to be followed physically to be explained 
• The storytelling methodology may be adopted - where to request supply, supplies come from where, what to do in receipt of supplies and how to record the process in Nikshay Aushadhi
• Step wise procedure in Ni-kshay Aushadhi for receipt to be shown

Post Session Activity

• Demonstration of the indenting in Ni-kshay Aushadhi, The processes of requesting supplies in Ni-kshay Aushadhi.
  The recording of receipt of supplies from different stores should be demonstrated in Ni-kshay Aushadhi.
• After the Module all the process should be demonstrated to the participants on live supplies- like checking for documents, inspection, check for damaged stocks, acknowledgement , followed by documenting in Ni-kshay Aushadhi (recording and reporting) for the said supplies.

Chapter 4.3

Issue and consumption

Physical Session (48 min)

Emphasis Points

• Various sources to explained 
• Essential steps  required to be taken up by the Pharmacist upon the issue of
• Various methods for issue of drugs to be explained, with emphasis on the scenarios where these methods to be used

Post Session Activity

• Demonstration of the issuing of supplies in Ni-kshay Aushadhi, The processes of issuing supplies in Ni-kshay Aushadhi.
• The recording of issue of supplies to different stores should be demonstrated in Ni-kshay Aushadhi.
• After the Module all the process should be demonstrated to the participants on live supplies- like checking for documents, inspection, check for damaged stocks, acknowledgement, followed by documenting in Ni-kshay Aushadhi (recording and reporting) for the said supplies. The same demonstrations to be made for issue of supplies as well.
• The drug dispensation module may be demonstrated to the participants (in real-time while dispensing the medicines to the patient at the PHI)

Chapter 4.4

Reporting of Stocks

Physical Session (13 min)

Emphasis Points

• Importance of forecasting and follow-up actions following forecasting.
• Data for forecasting to be discussed with focus on the which data and from which date to be considered 
• the need of forecasting may also be emphasized by giving the national perspective like that will happen if forecasting goes wrong and how to different levels forecast the supplies of different commodities and the factors affecting it.

Post Session Activity

• Explain the participant about the consequences of not forecasting and doing it incorrectly. The participants should have clarity about the process and their role in making the process efficient
• Hypothetically situation (excess stock, shortage and short expiry) to be created and data of stock, expiry, consumption to be given and participant may be asked to forecast the requirement for 12moths. 

Chapter 4.5

Expiry Management

Physical Session (19 min)

Emphasis Points

• The end to end process- like what's expiry, how to identify expiry supplies, shelf-life of different supplies, forecasting of expiry drugs, reporting it and the follow-up actions to forecasting of expiry drugs including the scientific disposal of expiry drugs may be explained.

Post Session Activity

• the participants may be asked to enumerate the different steps and the consequences if any of the step is not done efficiently.
• Demonstration of whole process in Nikshay Aushadhi

Chapter 4.6

Stocking NTEP drugs in Private sector

Physical Session (13 min)

Emphasis Points

• Importance of stocking drugs in private sector to be explained

Post Session Activity

• Participants may be sked to share their methods currently being sued for stocking and recording of drugs in private sector

Module 5: Procurement in NTEP                                                     Physical Session (39 min)

Chapter 5.1

Key concepts in Procurement

Physical Session (13 min)

Emphasis Points

• Procurement – Goods, Works and Services
• Types of Procurement

Post Session Activity

• Participants to be asked to explain procurement of goods, works and services with examples 
• clearly set out the differences between them 

Chapter 5.2

Procurement Processes

Physical Session (8 min)

Emphasis Points

• Type and Process of procurement to be explained 

Post Session Activity

• Following the types of procurements (direct, tender, single source / sole etc, situation to be provided and participants may be asked which process to be followed and also asked to indicate the process from end to end.

Chapter 5.3

Government e-Marketplace [GeM]

Physical Session (18 min)

Emphasis Points

• the GeM, its significance and the processes involved

Post Session Activity

• Demonstration of GeM and the different processes involved for the supplies at the participants level if any.
• Participants may be asked to explain upon the methods of evaluation, custom bids, various different options available under the GEM

Module 6: Logistics and Distribution of Drugs and consumables 

Physical Session (89 min)

Chapter 6.1

Flow of Supplies

Physical Session (23 min)

Emphasis Points

• Explain the difference in flow of DS-TB drugs and flow of DR-TB Drugs, flow of Bdq and Dlm need to be explained separately. Flow of supplies of CBNAAT cartridges and Truenat chips may be explained in state-specific context.

Post Session Activity

• The participants may be asked to discuss the issues they are facing in the supplies and solutions may be suggested.

Chapter 6.2

Packaging

Physical Session (35 min)

Emphasis Points

• The importance of packaging, specifications, labelling requirement, packaging instructions, preparation of PWB for different regimens and its recording in Nikshay Aushadhi should come out clearly. 

Post Session Activity

• The different PWBs (physically) may be shown to the participants along with the constituents (with attention on the details of specification of boxes, labelling of boxes).
• The recording of the whole process in Nikshay Aushadhi (PWB prep in real-time may also be demonstrated)

Chapter 6.3

Return and Reconstitution

Physical Session (18 min)

Emphasis Points

• The overview of the process and importance of it.

Post Session Activity

• Participants may be asked about the circumstances when return and reconstitution is carried out
• Demonstrate the entire process in Nikshay Aushadhi
• Situational Questions may be asked about Bdq and Dlm return and reconstitution.( Eg 10 Bdq tablets need to be returned- the process of return and reconstitution may be discussed)
• Some participants may share their experiences with respect to this process, the challenges they have faced and solutions may be suggested.

Chapter 6.4

Transportation

Physical Session (13 min)

Emphasis Points

Post Session Activity

• The transportation facility available at the store may be demonstrated and the best practices may be discussed with the participants

Module 7

Supervision, Monitoring and Evaluation and QA

Physical Session (76 min)

Chapter 7.1

Quality Assurance of Drugs

Physical Session (33 min)

Emphasis Points

•  Type of Quality Assurance (Pre Dispatch / Post dispatch)
• Step to be followed for collection of sample for testing and in case of repeat testing
• Explain the process of recording the sample collection in Ni-kshay Aushadhi

Post Session Activity

• The drug collection process for testing may be demonstrated to the participants. ( One batch of any drug and take out 10 strips for testing and packing. The remaining drugs need to be put in quarantine. 
• Demo on Ni-kshay Aushadhi  to record the transaction

Chapter 7.2

Monitoring of sub-stores

Physical Session (10 min)

Emphasis Points

• Explain the significance of Monitoring and why it is reuired
• Different types of Monitoring methods to be explained with examples 

Post Session Activity

• Different groups may be formed, and the groups may be asked to do analysis of the reports, performance of sub-stores through Nikshay Aushadhi. 
• The sample reports will be provided by the facilitator. The reports prepared may be reviewed jointly and follow-up actions may be discussed.

Chapter 7.3

Store Visits and Physical Verification

Physical Session (15 min)

Emphasis Points

• Key points to be considered while visiting a store
• Post Visit, what steps to be taken
• What steps to be followed for conducting Physical verification and at what Intervals
• Importance of recording of physical verification

Post Session Activity

• For store visit and Physical verification, the two demonstrations may be clubbed as a single exercise. The batch may be divided into subgroups (not more than 5) and may visit different stores (SDS, DDS, TU, PHI). The participants may be asked to fill the checklist. After the visit, the checklists filled by different trainees may be evaluated and discussed. Team to propose recommendation 
• An Audit Trail may also be undertaken by the team, one batch to be selected from SDS (preferably issued to district almost 5-6 months back). Team to visit said district and to check upon the date of receipt, documentation and to check in which district it was issued. Then team to visit said TU and again take out the trail of same batch and figure out the PHI. Similarly visit said PHI and check. Afteward, team to enlist the observations and propose recommendation if required

Chapter 7.4

Physical Verification[SS1] 

Physical   Session (13 min)

Emphasis Points

•   What steps to be followed for conducting Physical verification and at what Intervals
• Importance of recording of physical verification

Post Session Activity

• The site may be visited and the different processes may be explained.

Chapter 7.5

Evaluation of Stores and Stocks[SS2] 

Physical Session (5 min)

Emphasis Points

Post Session Activity