Trainers' Guide for Pharmacists (SDS & DDS)

Introduction

The purpose of this document is to provide the course coordinators and trainers for the “Course for Pharmacists and storekeepers in NTEP” guidance for planning and executing the training. The targeted trainees for this course would be:

State Drug Stores Pharmacists cum storekeepers
District Drug Stores Pharmacists
TU/PHI Drug Store Pharmacist

This training may be provided by utilizing the blended approach where a mix of training methods and modes will be used to deliver content. This would include either in-person/ virtual training or facilitator led/ Self learning/ demonstrations/ practical exercises. Training sessions which require hands-on training will be conducted only in a physical setting. Keeping in mind the aforesaid best practices of the Modernised Training System, each State Office may decide to choose the approach which is most suitable for their State.

For virtual sessions, the trainees will be going through the online content, and attempt quizzes after each chapter. An instructor-led session will also be conducted for each module. This will help the trainees for better clarification of contents and to address the queries and doubts of the training participants.

For the training areas which require handholding of trainees like demonstration of processes- like filling of forms, verification of supplies, stacking, etc. in-person training sessions need to be conducted.

Training curriculum / Agenda

Sr.	Module	Chapters	Training Modality	Duration (Hrs)
1	Basics of TB and NTEP	TB & TB Epidemiology NTEP Diagnostic Technologies Approaches to TB Case Finding TB Case Finding in NTEP	Virtual	3 hrs
2	TB Treatment	General concepts in TB Treatment DS-TB Treatment and care DR-TB Treatment and care Shorter Oral Bedaquiline containing MDR/RR-TB Regimen Longer Oral M/XDR-TB Regimen Isoniazid (H) Mono/Poly DR-TB Regimen TB Infection treatment and care Newer anti-TB Drugs in NTEP TB-Comorbidities and special situations General Concepts in Adherence Management	Virtual	3 hrs
3	General concepts and Principles of SCM in NTEP	Key Concepts and Principles in SCM Drugs and consumables in NTEP Stores in NTEP Patient-wise Boxes Information Systems in NTEP SCM Roles and responsibilities in SCM	Virtual	3 hrs (Includes 1 hr of Demonstration)
4	Inventory Management in NTEP	Overview of Inventory management in NTEP Indenting and receipt Issue and consumption Reporting of Stocks Expiry Management Stocking NTEP drugs in Private sector	Physical	6 hrs (Includes 3 hrs of Demonstration)
5	Procurement in NTEP	Key concepts in Procurement Procurement Processes Government e-Marketplace [GeM]	Physical	2 hrs (Includes 1 hr of Demonstration)
6	Logistics and Distribution of Drugs and consumables	Flow of Supplies Packaging Return and Reconstitution Transportation	Physical	4 hrs (Includes 2 hr of Demonstration)
7	Supervision, Monitoring and Evaluation and QA	Quality Assurance of Drugs Monitoring of sub-stores Store Visits Physical Verification Evaluation of Stores and Stocks	Physical	3 hrs (Includes 2 hr of Demonstration)

Trainers

For this course, following personnel may be appointed as the trainers

SDS Pharmacists
DDS Pharmacists (select)
DTO (select)
MO - STDC
MO - STC
WHO-consultants

Eligibility -

Trainers are selected based on their ability to conduct training in an interactive and interesting manner. They must possess strong knowledge about Supply Chain Management and related processes in NTEP. The Trainers should have completed the ‘Course for Pharmacists’. The Trainers should be well versed with the IT systems such as, Zoom (for video conferencing), Swasthya-eGurukul (Learning Management System), Nikshay and Nikshay Aushadhi. The Trainers need to go through the Chapter- wise Training Guide for this Course.

The training of pharmacists of District and TU level to be conducted at state level.

It is recommended that the trainers are appointed from all regions of the State, so that subsequent refresher training can be conducted locally by these trainers.

Chapter wise detailed instructions for Trainers

The aim of providing chapter-wise detailed instructions provides the Trainers with the following:

Module-wise and Chapter-wise, modality that may be adopted ( virtual/ Physical/ In-person)
The estimated time to complete the content
The key messages that a trainer should emphasise upon, while delivering the training
The activities which should be conducted at the end of each chapter / session to ensure learning effectiveness. This may include asking specific questions, demonstrating processes, discussing various forms and equipment. If any Module specific physical visits are required to be conducted, such details are also provided here.

This guiding document will also aid in bringing uniformity with respect to the content and quality of training conducted across the entire state and nation.

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
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
Chapter 1.5	TB Case Finding in NTEP	Virtual Session (7 min)
Emphasis Points
Post Session Activity
Module 3: General concepts and Principles of SCM in NTEP Virtual Session (114 min)
Chapter 2.1	Key Concepts and Principles in SCM	Virtual Session (33 min)
Emphasis Points	Explain the flow of supplies through different tiers in SCM various stock types with special emphasis on Minimum & Maximum stock, Buffer stock and its significance. May be explained by giving suitable examples from the local context and stories. Identification of short expiry drugs and broad principles of management of Short expiry drugs. 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) Explain the importance of Pharmacists in NTEP giving emphasis on SCM, stock-keeping, and expiry management and use of Ni-kshay Aushadhi
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 The different types of stocks may be asked with examples Different Drugs and consumables may be shown over camera/physically
Chapter 2.2	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	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 2.3	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 2.4	Patient-wise Boxes	Virtual Session (29 min)
Emphasis Points
Post Session Activity
Chapter 2.5	Information Systems in NTEP SCM	Virtual Session (10 min)
Emphasis Points	Nikshay Aushadhi and its significance,
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
Chapter 2.6	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
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) << Note>>
Chapter 3.1	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	Situational questions may be asked to participants- (eg
Chapter 3.2	Indenting and receipt	Physical Session (24 min)
Emphasis Points	The different process involved in Indenting of supplies should be explained in detail giving eg of drugs or any other supplies, 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
Post Session Activity	Demonstration of the indenting in Nikshay Aushadhi, The processes of requesting supplies in Nikshay Aushadhi. The recording of receipt of supplies from different stores should be demonstrated in Nikshay 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 Nikshay Aushadhi (recording and reporting) for the said supplies.
Chapter 3.3	Issue and consumption	Physical Session (48 min)
Emphasis Points
Post Session Activity	Demonstration of the issuing of supplies in Nikshay Aushadhi, The processes of issuing supplies in Nikshay Aushadhi. The recording of issue of supplies to different stores should be demonstrated in Nikshay 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 Nikshay 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 3.4	Reporting of Stocks	Physical Session (13 min)
Emphasis Points	importance of forecasting and follow-up actions following forecasting. 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
Chapter 3.5	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 3.6	Stocking NTEP drugs in Private sector	Physical Session (13 min)
Emphasis Points
Post Session Activity
Module 6: Logistics and Distribution of Drugs and consumables Physical Session (89 min)
Chapter 4.1	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 4.2	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 PWB 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 4.3	Return and Reconstitution	Physical Session (18 min)
Emphasis Points	The overview of the process and importance of it.
Post Session Activity	Demonstrate the entire process in Nikshay Aushadhi Participants may be asked about the circumstances when return and reconstitution is carried out 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 4.4	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 5	Procurement in NTEP	Physical Session (39 min)
Chapter 5.1	Key concepts in Procurement	Physical Session (13 min)
Emphasis Points
Post Session Activity
Chapter 5.2	Procurement Processes	Physical Session (8 min)
Emphasis Points
Post Session Activity
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.
Module 7	Supervision, Monitoring and Evaluation and QA	Physical Session (76 min)
Chapter 6.1	Quality Assurance of Drugs	Physical Session (33 min)
Emphasis Points
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.
Chapter 6.2	Monitoring of sub-stores	Physical Session (10 min)
Emphasis Points
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 6.3	Store Visits and Physical Verification	Physical Session (15 min)
Emphasis Points
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. An Audit Trail may also be undertaken.
Chapter 6.4	Physical Verification	Physical Session (13 min)
Emphasis Points
Post Session Activity	The site may be visited and the different
Chapter 6.5	Evaluation of Stores and Stocks	Physical Session (5 min)
Emphasis Points
Post Session Activity
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 7.2	DS-TB Treatment and care	Virtual Session (10 min)
Emphasis Points
Post Session Activity
Chapter 7.3	DR-TB Treatment and care	Virtual Session (31 min)
Emphasis Points
Post Session Activity
Chapter 7.4	Shorter Oral Bedaquiline-containing MDR/RR-TB Regimen	Virtual Session (14 min)
Emphasis Points	The regimen may be shown to the participants- over the camera
Post Session Activity	The composition of regimen and duration may be asked
Chapter 7.5	Longer Oral M/XDR-TB Regimen	Virtual Session (10 min)
Emphasis Points	The regimen may be shown to the participants- over the camera.
Post Session Activity	The composition of regimen and duration may be asked
Chapter 7.6	Isoniazid (H) Mono/Poly DR-TB Regimen	Virtual Session (5 min)
Emphasis Points	The regimen may be shown to the participants- over the camera.
Post Session Activity	The composition of regimen and duration may be asked
Chapter 7.7	TB Infection treatment and care	Virtual Session (14 min)
Emphasis Points	The regimen may be shown to the participants- over the camera.
Post Session Activity	The composition of regimen and duration may be asked.
Chapter 7.8	TB-Comorbidities and special situations	Virtual Session (26 min)
Emphasis Points	The details of the facilities for alcohol cessation and tobacco cessation may be shared with the participants.
Post Session Activity
Chapter 7.9	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 Nikshay by TS, STS), How to assign TS and role of TS
Post Session Activity	Demonstration of the following at the end of the session: TB Arogya Sathi app and adherence recording Nikshay and adherence recording

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Trainers' Guide for Pharmacists (SDS & DDS)