based TB Case and Commodity Management Tool, Tbilisi, Georgia ...

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Regional Workshop on e-TB Manager–A Comprehensive Web-
based TB Case and Commodity Management Tool, Tbilisi, Georgia,
November 12–14, 2008

Evaluation of Georgia NTP needs for e-TB Manager, 17–19, 2008
Trip Report



Andrey Zagorskiy
Joel Keravec
Ricardo Memoria Lima

December 2008








_________________________________
Strengthening Pharmaceutical Systems
Center for Pharmaceutical Management
Management Sciences for Health
4301 North Fairfax Drive, Suite 400
Arlington, VA 22203 USA
Phone: 703.524.6575
Fax: 703.524.7898
E-mail: sps@msh.org

Regional Workshop on e-TB Manager – A Comprehensive Web-based TB Case and Commodity Management
Tool, Tbilisi, Georgia

i
i
This report is made possible by the generous support of the American people through the
U.S. Agency for International Development (USAID), under the terms of cooperative
agreement number GHN-A-00-07-00002-00. The contents are the responsibility of
Management Sciences for Health and do not necessarily reflect the views of USAID or the
United States Government.


About SPS

The Strengthening Pharmaceutical Systems (SPS) Program strives to build capacity within
developing countries to effectively manage all aspects of pharmaceutical systems and
services. SPS focuses on improving governance in the pharmaceutical sector, strengthening
pharmaceutical management systems and financing mechanisms, containing antimicrobial
resistance, and enhancing access to and appropriate use of medicines.


Abstract

SPS has developed a comprehensive web-based tool for programmatic management of TB
and drug-resistant TB called “E-TB Manager
©
.” The tool integrates all relevant aspects
required for national TB program management functions, including case management,
diagnosis, medicines and commodities. The tool is being adapted for the implementation in
the E&E region in selected countries.


Recommended Citation

This report may be reproduced if credit is given to SPS. Please use the following citation.

Zagorskiy, A; Keravec, J; Memoria, R. Regional Workshop on e-TB Manager – A
Comprehensive Web-based TB Case and Commodity Management Tool, Tbilisi, Georgia,
November 12 – 14, 2008. Evaluation of Georgia NTP needs for e-TB Manager, 17 – 19,
2008. Trip Report. Submitted to the U.S. Agency for International Development by the
Strengthening Pharmaceutical Systems (SPS) Program. Arlington, VA: Management
Sciences for Health.


Key Words

Tuberculosis, TB program management, electronic tools

Strengthening Pharmaceutical Systems
Center for Pharmaceutical Management
Management Sciences for Health
4301 North Fairfax Drive, Suite 400
Arlington, VA 22203 USA
Telephone: 703.524.6575
Fax: 703.524.7898
E-mail: sps@msh.org
Web: www.msh.org/sps


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CONTENTS


Acronyms ................................................................................................................................... v
 
Background ................................................................................................................................ 1
 
Purpose of Trip ...................................................................................................................... 1
 
Scope of Work ....................................................................................................................... 2
 
Activities .................................................................................................................................... 3
 
1.
 
Demonstration of e-TB Manager and Discussion .......................................................... 3
 
2.
 
Georgia context for e-TB Manager ................................................................................ 3
 
3.
 
Meeting at USAID/Georgia ........................................................................................... 4
 
4.
 
Adjustments to Planned Activities and/or Additional Activities ................................... 4
 
Next Steps .................................................................................................................................. 5
 
Immediate Follow-up Activities ............................................................................................ 5
 
Recommendations .................................................................................................................. 5
 
Important Upcoming Activities or Benchmarks in Program ................................................. 5
 
Annex 1. List of participants ...................................................................................................... 7
 
Annex 2. Agenda ....................................................................................................................... 9
 
Annex 3. Workshop Evaluation ............................................................................................... 11
 


Regional Workshop on e-TB Manager – A Comprehensive Web-based TB Case and Commodity Management
Tool, Tbilisi, Georgia

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v
ACRONYMS



MDR/XDR
M&E
MIS
Multi Drug Resistant / Extensively Drug Resistant
Monitoring and Evaluation
Management Information System
MOH Ministry of Health
MOU
MSF
NTP
PMDRT
RPM Plus
TB
SPS
SYMETA
USAID
WHO

Memorandum of Understanding
Médecins Sans Frontières (Doctors without Borders)
National Tuberculosis Program
Programmatic Management of Drug Resistant Tuberculosis
Rational Pharmaceutical Management Plus
Tuberculoses
Strengthening Pharmaceutical Management
Electronique Case Management System
United States Agency for International Development
World Health Organization















Regional Workshop on e-TB Manager – A Comprehensive Web-based TB Case and Commodity Management
Tool, Tbilisi, Georgia

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i



1

BACKGROUND


SPS has developed a comprehensive web-based tool for programmatic management of
tuberculosis (TB) and drug-resistant TB called “E-TB Manager
©
.” E-TB Manager integrates
all relevant aspects required for national TB program management functions at different
levels (e.g., cases, medicines, and other TB commodities) into a web-based tool and provides
key information consolidated for rapid decision making and epidemiological surveillance
where interventions are needed.
The tool has four electronic modules that captures data and generates reports as follows:

• Treatment and case management (online notification and follow-up, recording
clinical and laboratory results, tracking patient transfers in and out, providing data for
treatment adherence and patient contacts evaluation)
• First and second-line medicines (FLD and SLD)management at all levels:
medicine needs forecasting, ordering, distributing, dispensing, and recording of stock
movements
• Information and surveillance management: mapping of TB and multidrug-
resistant/extensively drug resistant (MDR/XDR) cases, epidemiological indicators,
co-morbidities, previous treatment history, World Health Organization (WHO)-type
surveillance reports, up-dated information with ready access online at central and
periphery levels
• Operational and clinical research: Data extraction tool for easy data analysis and
export to statistical interfaces

Currently, Moldova and Azerbaijan uses électronique case management system (SYMETA),
funded by Global Fund, and a MDR-TB, management system used in Georgia, funded by
MSF (Médecins Sans Frontières). However, no other system offers such a holistic
information management as e-TB Manager.

In 2006-2008, Moldova and Romania adopted the e-TB Manager, and Ukraine currently is in
its pilot stage. Other countries where the tool is being implemented include the Philippines,
Dominican Republic, and China. Consequently as the system is now offered in Russian and
could be easily translated into local languages, Kazakhstan, Azerbaijan, and Armenia have
expressed strong interest in the system.

In response to the interest from the Europe and Eurasia (E&E) region countries to adopt e-TB
Manager, a regional training workshop was scheduled for November 12 – 14, 2008 in Tbilisi,
Georgia. This was a three-day training to introduce the system, discuss the needs for
management information systems, identify adaptation requirements, and develop country-
specific plans. The workshop was followed by technical visits to Georgia and Azerbaijan to
determine country-specific needs for the adaption of e-TB Manager, and to Ukraine to
finalize the pilot version.


Purpose of Trip

The purpose of this visit was to introduce e-TB Manager and train users at the central level
from Armenia, Azerbaijan, Georgia, Kazakhstan, Ukraine, and Uzbekistan.
Regional Workshop on e-TB Manager – A Comprehensive Web-based TB Case and Commodity Management
Tool, Tbilisi, Georgia

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Scope of Work

1) Demonstrate the new generic version of e-TB Manager, discuss the needs for
management information systems, identify adaptation requirements, and develop country-
specific plans during a workshop November 12 – 14, 2008.

2) Collect information to specify the needs for changes to develop and adapt e-TB
Manager to meet the local requirements in Georgia context: case management and
treatment guidelines, drug management practices, information flows at all levels, required
system lay-out, required collection and presentation of data, required system
functionalities.

3) Identify all TB partners who might be involved in this project to further establish a
working group for project development, monitoring, follow-up, and evaluation.

4) Brief/debrief USAID mission as requested.



3
ACTIVITIES


1. Demonstration of e-TB Manager and Discussion

The workshop on e-TB Manager took place in Tbilisi, Georgia, during November 12 -14,
2008.

It was attended by 17 participants from Georgia, Armenia, Azerbaijan, Ukraine, and
Kazakhstan. Two participants from Uzbekistan cancelled their trip the last minute because of
emergency at their workplace in Tashkent, and one participant from Ukraine could not come
to Tbilisi. The list of participants is in Annex 1.

The workshop started with a plenary session on the general issues of monitoring and
evaluation (M&E) for tuberculosis followed by country presentations that described the TB
situation in each participating country and the tools – electronic and manual – that are used
by National Tuberculosis Program (NTP) for registering and monitoring TB cases, collecting
and reporting indicator data for treatment outcomes, and monitoring the supply of TB
medicines.

The main modules of e-TB Manager – case management, commodity management, and
administration were then discussed separately for DOTS programs and for programmatic
management of drug resistant tuberculosis (PMDRT). This was important for participants
because although the tool addresses the management all types of TB cases some countries
were planning to first implement the modules for PMDRT.

The workshop ended with an open discussion of the potential of e-TB Manager
implementation in each of the participating countries and identification of roles and
responsibilities at the central and periphery levels.

The workshop Agenda is in Annex 2, and the evaluation in Annex 3.


2. Georgia context for e-TB Manager

Following the workshop, SPS team had a series of meetings with Georgia NTP to better
understand the current monitoring and evaluation system in use, and to investigate the options
for e-TB Manager implementation.

Below are the findings:

Case Management

• The NTP has been using EpInfo (software) for 10 years to record TB cases;
• The EpInfo was recently adapted to record MDR cases, but they still use Microsoft DOS
based system (text-screen system) to record MDR-TB cases;
• Today a new WEB based case management for TB and MDR-TB is being implemented
in the TB Institute by the European Space Agency (in partnership with WHO) a project
called SAFE (program for applications of satellite communications for health) and hosted
in France. The decision to implement was made by the NTP in May 2008. It is expected,
Regional Workshop on e-TB Manager – A Comprehensive Web-based TB Case and Commodity Management
Tool, Tbilisi, Georgia

4
that the developed will complete the pilot version by January 2009. According to the
NTP, the new system does not cover all functionalities present in the current EpInfo DOS
system;

Drug Management

• The pharmacy at the NTP uses local systems (a local database) to register information
about medicine receiving and dispensing (developed in Visual FoxPro, with no support
since it was donated by Red Cross);
• 1
st
and 2
nd
line drugs are procured once a year, and 1
st
line drugs arrive in the country in
one single shipment, whereas 2
nd
line drugs come in 2 shipments annually;
• The drugs are stored in a central warehouse and distributed on a quarterly basis to 9
regional warehouses in the country. These regional warehouses are in charge of
distributing the drugs to TB Facilities;
• Drug procurement –2
nd
line medicines are procured through the GLC, and the MSF
(Medecins Sans Frontieres) assists the NTP in forecasting and quantification;
• Drug procurement –1
st
line drug procurement is made by the central level using the
following information sent by the regional level:
• Quarterly reports containing initial stock position, quantity received, quantity
issued and final stock position;
• Reports based on clinical forms and cases on treatment;
• Inventory Software – Local solution for inventory control;
• TB Facilities record every medicine transaction;
• TB Facilities generate reports using this software and send them (in paper format)
to the regional level;
• Two main reports are generated:
1. Quarterly reports containing initial stock position, quantity received, quantity
issued and final stock position;
2. Daily medicine transaction (by batch)
• The inventory system was developed in Borland Delphi programming language
and the author is unknown (i.e., no support is provided);

• The e-TB Manager will be evaluated and adapted for the implementation in Georgia;
• Since Georgia already has a software for TB/MDR-TB surveillance, the “Case
Management” component of e-TB Manager will not be implemented in the country;
• A demonstration version was established while in the country, and username/password
was provided to the NTP.


3. Meeting at USAID/Georgia

SPS team met with Dr Tamara Sirbiladze, USAID/Tbilisi, and provided information on e-TB
Manager and the potential for its implementation in Georgia.


4. Adjustments to Planned Activities and/or Additional Activities

No adjustments were required.



5
NEXT STEPS


Immediate Follow-up Activities

Contact the developers of the Georgia NTP case management software and initiate the dialog
re the development of an interface to connect the e-TB Manager Drug Management Module


Recommendations

It is advisable for USAID/Georgia to include support to electronic TB management tools into
its future plans of assistance


Important Upcoming Activities or Benchmarks in Program

• Technical visit to Azerbaijan to establish the needs for adaptation of e-TB Manager,
and identify sites and users (November 2008)
• Technical visit to Ukraine to finalize the pilot version of e-TB Manager (November
2008)
• Technical visit to Kazakhstan and possibly Uzbekistan (January 2009)

Regional Workshop on e-TB Manager – A Comprehensive Web-based TB Case and Commodity Management
Tool, Tbilisi, Georgia

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7
ANNEX 1. LIST OF PARTICIPANTS

Country Name Organization Title Contact
1 Kazakhstan Malik Adenov
National TB
Center Chief Doctor
Tel: +7 727 2918728
Fax: +7 727 2918658
Mobile: +7701 7122064
m.adenov@ncpt.kz
2 Kazakhstan
Gulnaz
Mussabekova
National TB
Center
Coordinator for
anti-TB drug
management
Tel: +7 727 2918652
Fax: +7 727 2918658
Mobile: +7 777 3884784
g.musabekova@ncpt.kz
3 Kazakhstan Olga Ivanko
National TB
Center
IT specialist of
department for
planning and
organization of
anti-TB
activities
Tel: +7 727 2938068
Fax: +7 727 2918658
Mobile: +7 777 3594000
o.ivanko@ncpt.kz
4 Armenia
Dr Arthur
Tadevosyan NTP/TCO
Head of the
National
tuberculosis
control office
(TCO)
5 Armenia
Dr Narine
Hovhannis
y
an NTP/TCO
Epidemiologist
, TCO
6 Armenia
Mr Hrachya
Sargsyan NTP/TCO
Data Base
Operator of
the GF project
of TCO
7 Azerbaijan
Mrs. Vafa
Shakhtakhtinska
ya
Scientific
Research Institute
of Lung Diseases,
NTP
Head of
Pharmaceutica
l department
Vafashaxtaxtinskaya@y
ahoo.com

8 Azerbaijan
Mr. Ilkham
Gasimov
Scientific
Research Institute
of Lung Diseases,
NTP
9 Azerbaijan
Dr Fuzuli
HUSEYNOV
Medical
Department of the
Ministry of Justice
TB
Programme
Coordinator
2, Bul-Bul Ave, Baku,
Azerbaijan
Tel. +994 12 598 05 13
e-mail
fuzulihuseynov@mail.ru
10 Azerbaijan
Dr Anar
HADJIYEV
Special Treatment
Institution for
Detainees
Head of MDR-
TB
Department
C/o Medical Department
of the Ministry of Justice
2, Bul-Bul Ave, Baku,
Azerbaijan
Tel. +994 12 493 31 46
11 Ukraine
Dr. Kirill
Chasovski NTP
Major
specialist,
department of
medical and
socialy
problems,
Commettee on
HIV/AIDS and
other socialy
Kiev, Grushevskogo St.,
7, 01021
+38044 221295
kirill_chasovski@mail.ru
Regional Workshop on e-TB Manager – A Comprehensive Web-based TB Case and Commodity Management
Tool, Tbilisi, Georgia

8
dangerous
deseases
control.
12 Ukraine
Dr. Oksana
Smetanina NTP
Head of
monitoring
department
Kiev, Amosova st. 10,
03680, Ukraine
+38044 275 40 11
13 Ukraine
Mykhaylo
Zlobynets
State Prison
Department
14 Uzbekistan
Dr. Ilhomjon
Butabekov
Republican DOTS
Center
Coordinator of
drug
management
of the Project
Implementatio
n Unit granted
by the GFATM
Work tel/fax: (998 71)
278-0730
mob: (998 71) 100-
6533
15 Uzbekistan
Dr. Dilrabo
Ulmasova
Republican DOTS
Center Director
Work tel/fax: (998 71)
278-0730
mob: (998 71) 101-7203
ilhom79@mail.ru
16 Georgia
Dr. Archil
Salakaia NTP
Executive
director
995 32 910252
asalakaia@yahoo.com
17 Georgia Medea Gegia NTP
MDR-TB
Clinical
Coordinator
Medeagegia@yahoo.co
m.au

18 Georgia Nino Lomtadze NTP
Operational
Rsearch
Coordinator
995 32 911621;
nlomtadze@gmail.com
19 Georgia
Veriko
Mirtskhulava NTP
Project
Coordinator
995 32 911621;
verikomir@gmail.com
20 Georgia Ucha Nanava NTP
Epidemiologist
, Data
Manager
995 32 911621;
alubali003@yahoo.com

Facilitator Joel Keravec MSH
Senior
Program
Associate Jkeravec@msh.org

Facilitator
Ricardo
Memoria Lima MSH Consultant
Rmemoria@terra.com.b
r

Facilitator
Andrey
Zagorskiy MSH
Program
Manager for
TB Azagorskiy@msh.org

















9

ANNEX 2. AGENDA



Workshop
“e-TB Manager”
Tbilisi - Georgia

November 12-114, 2008


AGENDA
November 12, 2008 –
8.30 See needed logistics and meeting venue
9:00


9:30


10:00
12:00
Welcome

Introduction of the participants
Objectives of the Workshop

Country presentations on current situation
regarding Information Systems in use for
Reporting and Recording / Case Management /
Drug Management (FLDs and SLDs)
(20 min / country)

Facilitator:
Ricardo Memoria, MSH/SPS Consultant

Joël Keravec, MSH/SPS Senior
Technical Advisor

Andrey Zargoskiy, MSH/SPS TB
Portfolio Manager

Attendees: to be completed
13:00
17:00
Introduction to the e-TB Manager “First Line and
(FLDs) Second Line Drugs (SLDs) Management
Module”.

Part I: Drug Management Module.
Detailed presentation and discussion on:
all current functionalities inserted in the DM
module for FLDS and SLDs
all variables required
structure of customized reports
Product of the day: clear understanding and
precise definitions of all functionalities, variables
and reports needed by the countries NTP for DM.
The list will be used as the reference basis for
system adaptation and to produce a first
contextualized version to be field tested in the
countries.

Facilitator:
Ricardo Memoria, MSH/SPS Consultant

Joël Keravec, MSH/SPS Senior
Technical Advisor

Andrey Zargoskiy, MSH/SPS TB
Portfolio Manager

Attendees: to be completed

November, 13 2008
8:30 See needed logistics and meeting venue
9:00-12:00
Part II. Introduction to the e-TB Manager “Case
Management Module for MDRTB”.
Detailed presentation and discussion on:
all current functionalities inserted in the Case
Management module
all variables required
structure of customized reports
Product of the day: clear understanding and
precise definitions of all functionalities, variables
and reports needed by the countries NTP for the

Facilitator:
Ricardo Memoria, MSH/SPS Consultant

Joël Keravec, MSH/SPS Senior
Technical Advisor

Andrey Zargoskiy, MSH/SPS TB
Portfolio Manager

Attendees: to be completed
Regional Workshop on e-TB Manager – A Comprehensive Web-based TB Case and Commodity Management
Tool, Tbilisi, Georgia

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case management module. The list will be used
as the reference basis for system adaptation and
to produce a first contextualized version to be
field tested in the countries.

13:00-15:30













15:30-17:00
Continuation of the discussion on the Part II.
Introduction to the e-TB Manager “Case
Management Module for MDRTB”.
Detailed presentation and discussion on:
all current functionalities inserted in the Case
Management module
all variables required
structure of customized reports
Product of the day: clear understanding and
precise definitions of all functionalities, variables
and reports needed by the countries NTP for the
case management module. The list will be used
as the reference basis for system adaptation and
to produce a first contextualized version to be
field tested in the countries.

Part III: Technical issues on the MIS
Infrastructure needed
Internet hosting
Work process for remote/distance technical
assistance during project’s implementation - Set
up of the version for the field test and training–
adaptation to the local contexts
Version testing and reporting bugs and changes
with RPROJ function

Facilitator:
Ricardo Memoria, MSH/SPS Consultant

Joël Keravec, MSH/SPS Senior
Technical Advisor

Andrey Zargoskiy, MSH/SPS TB
Portfolio Manager

Attendees: to be completed



19:00 Reception in "Tsiskvili" Restaurant
November, 14 2008

8.30 See needed logistics and meeting venue
9:00-10:00









10:00-12:00


12:00-13:00
Recap of day 1 and 2 – Part I, II, and III –
Synthesis and next steps
Review of the list of data and variables which will
be used as the reference basis for system
adaptation and to produce a first contextualized
version to be field tested in the countries
Harmonization of forms for data collection for a
common generic regional platform of the e-TB
Manager
Synthesis
Questions and answers
Next steps for the e-TB Manager implementation:
elaboration of summary country plans with a set
of activities to prepare e-TB Manager
implementation in each country

Workshop closing – Wrap-up

Facilitator:
Ricardo Memoria, MSH/SPS Consultant

Joël Keravec, MSH/SPS Senior
Technical Advisor

Andrey Zargoskiy, MSH/SPS TB
Portfolio Manager

Attendees: to be completed





11

ANNEX 3. WORKSHOP EVALUATION

Regional Workshop on e-TB Manager – A Comprehensive Web-based TB Case
and Commodity Management Tool, Tbilisi, Georgia, November 12 – 14, 2008

Workshop Evaluation

Did the workshop provide you with the understanding of e-TB manager and its functions, and
perspectives for the implementation in your country? Choose the rating that best describes your
answer according to the following scale.









Function:
Registration and Management of a TB Case
Yes, absolutely
5 4 3 2 1
No, needs much more
Average: 4.42



Function:
Management of Medicines and Commodities
Yes, absolutely 5 4 3 2 1 No, needs much more
Average: 4.71



Function:
Utilization of e-TB Manager for decision making (reports, data analysis, etc)
Yes, absolutely
5 4 3 2 1
No, needs much more
Average: 4.14



Function:
Possibility of adaptation for your country
Yes, absolutely
5 4 3 2 1
No, needs much more
Average: 4.21



Comments and suggestions
- Implementation is possible, and must be linked with the existing electronic system; the drug
management module is especially interesting
- Countries will need technical assistance (consultations)
- Demo version will provide the necessary practice with the program
- This is a good program because it gives an opportunity to react fast (on-line) to problems, and
thus avoid mistakes; would like to study it in more detail
- Three days were enough for basic understanding; more detailed practical studies are required
- It would be good to have more information on potential difficulties with the implementation so
that we could take precautions, better plan, and rapidly implement in the country
- Need more time for the in-depth study of e-TB Manager

Rating Definition
5 Yes, absolutel
y
4 Yes, mostly
3 Yes, minimally
2 No, left some doubts
1 No, needs much more