I am really impressed by the paper shared by Dr. William Wells,
One of the strategies to address unstandardized practice which may lead to MDR-TB and/or XDR-TB is promoting Public-Private Mix as repeatedly mentioned in the document.
Ethiopia has a promising practice with this regard since 2006 and currently there are more than 200 private service delivery points which are providing TB treatment service as per the national tuberculosis treatment standards for first line regimens.The drugs are supplied for free from the public sector including laboratory reagents and the patients are not expected to pay for the drugs.The USAID funded private health sector program which is implemented by Abt associates Inc.is giving technical assistance for the facilities.So there are are many experiences to be shared from this approach.
Coming to my specific points,
1. Most of the private sectors may use the black market for both first line and second line drugs which may not be addressed in the IMS database
2.Fluoroquinolones are being prescribed left and right for other ailments(ciprofloxacin is common in Ethiopian market including Moxifloxacin which is recommended by WHO for tuberculosis treatment) and cross resistance is inevitable.
I think this two points are potential areas for investigation to help further address issue of drug resistant tuberculosis
With Best Regards,
Seyfu Abebe(BPharm,MPH candidate)
Pharmaceutical logistics coordinator
USAID/Private Health Sector Program