training module for medical officers primary health centre - NVBDCP

Of course, when blister packs would be used for all age groups, it will be more rational to estimate thenumber of the different types of blister-packs. The main determinant of requirement of RDT kits will bebased on the number of P. falciparum cases recorded and positivity rates in previous years.It is likely that the deployment of ACTs and RDTs will lead to increased demand for antimalarialtreatment from the government sector. Therefore, during the first year of implementation, it will beprudent to assume that the need will exceed the estimations based on morbidity data by about 25%.This assumption may lead to some wastage. That would be a lesser risk compared to not meeting thejustified expectations of the public after demand has been created.These simple methods of estimation may also be applied to other antimalarial medicines. Formedicines, used for the management of severe malaria, estimates are currently probably best basedprevious consumption data. Where parenteral artemisinin formulations have been introduced recently,the consumption of quinine ampoules can be used to estimate the requirements for injectableartemisinins. This requires conversion into equivalent amounts of parenteral treatment courses foradults.Since malaria transmission is seasonal, data for 3- or 6-month periods should be utilized to estimaterequirements for corresponding future 3- or 6- month periods.Estimate requirements on the basis of the number of subcentres and villages and safety stock ateach level.Adjust the quantity to be indented according to pack size and as well as the minimal demand sizeIn order to convert the estimated drug and RDT requirements into potential indents to coverconsumption between two cycles of demands, the amount of medicines that must be held in stockshould be calculated. As it is impossible to forecast demand with complete accuracy or to be absolutelycertain about the supply, a certain amount of stocks must be kept to absorb fluctuations in supply anddemand and to reduce the risk for stock outs. In districts prone to epidemics of malaria, an appropriateepidemic stock must be added to the quantities to be re-ordered. Because of the short shelf-life of RDTsand ACTs, the epidemic stock must be rotated with the routine stock to avoid the risk of expiration.ACTs may initially be distributed by a ‘push’ system, in which the central and State level determines thequantities of medicines to be delivered to lower levels. This is useful if peripheral staff at PHCs haslimited experience in assessing needs and managing inventories.The next step is to select an appropriate re-supply interval. Generally, deliveries are made at intervals of1–3 months, depending on availability, capacity and transport costs, as well as order size and storagecapacity at each level of the distribution system. Other factors, such as expiry dates, seasonality ofmalaria and the reliability of transport during the rainy season are also be taken into consideration. Inremote areas that are difficult to reach, adequate supplies of ACTs must be delivered and stored at least1 month before the start of the malaria season.LLINsPlanning87