The Pharmaceutical

1

• The Pharmaceutical
• Sector of the
• Republic of Tajikistan
• Presentation by Pascal Bernard, PSF CI, October
  2004

2
Legislation applicable to the pharmaceutical
sector in RT

• NPT/WHO elaborated Drug Policy of RT, which is
  approved by MOH
• According to this policy the set of standard acts
  on drug registration and quality control have
  been adopted
• The new WHO guideline on humanitarian donation
  was submitted and adopted by MOH
• Starting from 2005 procurement of some medicines
  will be free of VAT

3
Pharmaceutical production

• During the Soviet period, the domestic
  pharmaceutical plants produced only extracts and
  herbal products.
• Current domestic production of pharmaceuticals is
  almost absent.

4
Current Pharmaceutical production

• Anis
• Tajpharm Prom Invest
• Even if the standards of production do not comply
  with GMP, their production is of good quality and
  certified by MOH
• Total volume of output of both plants comes to
  1 of the pharmaceutical market

5
Procurement of medicines in RT

• According to SCDE
• 60 of procurement done by wholesalers, the rest
  by retailers
• 35 of procurement in the country is done by
  INGO.
• Only 13.21 of the total state budget allocated
  for health is intended for medicines.
• Hospitals and PHC procure medicines by themselves
  from private retailers or wholesaler.

6
A visual representation of Medicine procurement
in RT
7
Medicines Access

• According to the analysis done on medicine
  accessibility by NPT, expenses for medicines
  are covered as follows
• 7,5 by state budget
• 27,25 by INGO
• 65,25 by patients themselves

8
Medicines Access

• The prices of medicines in Tajikistan is higher
  than international prices by 15-30 (source NPT
  WHO)
• Low quality of pharmaceutical in the market
• Low level of registration of Essential Medical
  List

9
Rational use of medicines

• Prescribing indicators in Tajikistan
• Average ? of medicines per prescription 2,67
• of Generic drugs 60,0
• Prescriptions with 1 or more antibiotics 40,8
• Prescriptions with 1 or more injections 47,8
• Prescription of drugs figured in EML 65,8

10
Rational use of antibiotics
11
Pharmaceutical education

• Basic Pharmaceutical education is given at the
  medical university in Dushanbe.
• There is no postgraduate or refreshment courses
  for pharmacists and for the medical staff
  involved in distribution of medicines in health
  care facilities

12
Agencies involved in the pharmaceutical sector

• - Action against hunger
• Aga-khan foundation (AKF)
• CHAP
• Global partners
• IFRC
• Merlin
• Project HOPE (PH)
• PSF CI
• Save the children (US)
• UNFPA
• WHO
• UNICEF

13
Humanitarian medicines distribution

• 
  
  

14
Coverage of health structures in RT by
International Agencies

• Primary health care facilities including
  pharmacies and RHC AAH, AKF, IFRC, Project Hope
  (TB program), Sino project, Save the Children
  (US), UNFPA,PSF CI
• Secondary health care facilities CHAP, Merlin,
  Project Hope, UNFPA, PSF CI, AKF

15
Trainings in the pharmaceutical sector

• 1.Seminar on Rational use of antibiotics in
  primary and secondary health care in all
  regions. (PSF CI, IFRC, NPT WHO)
• 2.Seminar on Rational pharmaceutical
  management for pharmacists of private and state
  medical structures in all regions. (PSF,NPT WHO)

16
Pharmaceutical Sources of Information

• Elaboration of a National Formulary based on the
  WHO Essential List of Medicine by NPT and PSF CI
  
• Elaboration and publication of Standard
  treatment guideline for the primary health
  structures of RT by WHO NPT, Project Sino and
  WB
• Regular publication of Pharmaceutical Bulletin
  by WHO NPT
• ADB Health sector review 2004, including
  pharmaceutical sector review (ADB, SMEC, PSF CI)
• Creation of a Pharmaceutical information center
  ZdravPlus.

17
Creation of a National Medicines Procurement
Center

• PSF CI ADB Technical Assistance
• Establishment of a national strategy on
  procurement and distribution of medicines for the
  Republic of Tajikistan
• PSF CI ECHO
• Implementation of the MOH of RT strategy and
  transfer of the current Drug Procurement Center
  to MOH under ECHO fund