Technical Bulletin 2

2. RECOMMENDATIONS TO ILEP MEMBER-ASSOCIATIONS FOR THE USE OF BLISTER CALENDAR PACKS IN LEPROSY CONTROL PROGRAMMES

2. Recommendations To Ilep Member-Associations For The Use Of Blister Calendar Packs In Leprosy Control Programmes

1. INTRODUCTION

ILEP Member Associations are quite frequently invited to supply Blister Calendar Packs to governments for their leprosy control programmes. The response to such a request is a very difficult decision, particularly when the extra cost is taken into account. A working group of the Leprosy Control Expert Discipline has reviewed the advantages and disadvantages of the Blister Calendar Packs and formulated some recommendations to help Member Associations make the best decision.

2. ADVANTAGES OF BLISTER CALENDAR PACKS

2.1 For the programme and the MDT implementors:

Blister Calendar Packs may help by:

Easier planning for drug needs. Drug supply calculations are simpler being made on a one patient one pack a month basis.
Avoidance of selection of drug resistant germs. All the drugs are available from the beginning of the treatment.
Better safeguard for rifampicin. The risk of rifampicin being diverted for other uses is reduced.
Faster and simpler dispensing of drugs. Safer dispensing by non health staff (village health leaders, teachers, etc.).
No need to count tablets.
No risk of giving the wrong drug or wrong dose.
Easier monitoring of patients’ compliance. The counting of pills, on the occasion of the home visit, is made simpler.
Assisting record keeping by numbering the Blister Calendar Packs before dispensing and requiring the patient to bring the Blister Calendar Packs to the clinic for exchange with a new one.
Helping patient identification. In lieu of identification card, clinical record or transfer slip, possession of a Blister Calendar Pack identifies the holder as a leprosy patient under MDT (provided that the name of the patient is written on the pack).

2.2 For the patients as well as the family members:

Blister Calendar Packs may help by:

Reminding the patient to take daily unsupervised doses. The risk of forgetting to take drug(s) or overtaking them is reduced Providing a reminder of the next clinic date.
Reducing the risk of losing any tablets/capsules.
Reducing the risk of spoilage. The drugs are protected from humidity, heat, insects, etc.
Ensuring that the patient is getting the correct monthly supervised dose.
The risk of a health worker giving him/her more or less than what he/she is due is reduced.
Having a psychological impact. The drugs look expensive thus patients may think them more effective.

3. DISADVANTAGES OF BLISTER CALENDAR PACKS

For the programme:

The bulk. The Blister Calendar Packs take up more space thus cost more for transport and storage.
Additional cost at purchasing. Currently the cost of Blister Calendar Packs supplied by one supplier is approximately 24 percent more expensive for MB treatment and 40 percent more expensive for PB treatment than when compared with the cost of loose drugs. However, it is extremely difficult to estimate the cost-effectiveness.

For the patients:

For some patients with insensitive fingers it is difficult to get the drugs out of the Blister Calendar Pack.

4. REMARKS

The Blister Calendar Packs provided by Ciba Geigy containing the WHO recommended multidrug therapy regimens are not the only presentations available to date. Smaller Blister Calendar Packs have been produced and are not as bulky for transportation and can be easily slipped into a patient’s pocket. Simple Blister Calendar Packs containing only one drug are less expensive and also protect against humidity and physical damage.

5. RECOMMENDATIONS

Blister Calendar Packs have administrative, operational and logistical advantages over loose drugs. However, given the much higher costs of Blister Calendar Packs, the majority of leprosy control programmes should use loose drugs.

There seems actually no justification for extending the use of Blister Calendar Packs to all Leprosy Control field programmes. Nevertheless it is clear that in special conditions, the use of Blister Calendar Packs is very beneficial and justified.

Patients who could benefit from Blister Calendar Packs are:

Those who cannot attend a clinic during part of the year, especially during the rainy season.
Those who live very far (e.g. more than 3 hours walk from a clinic), so that they do not need to travel long distances every month but can carry drugs for 3 or 4 months.
Very disabled or old patients, so that they have to travel less frequently to a clinic. Similarly for small children (with adapted Blister Calendar Packs), pregnant patients during the last few months of pregnancy and the first few months after delivery.
Nomads and people who, due to some obligation, cannot attend clinics regularly.
Patients followed in general health clinics with very few leprosy patients attending: Overstocking of loose drugs with the risk of their expiry date passing will be avoided. The risk of dispensing the wrong drugs, or in a wrong dose will be less with Blister Calendar Packs.