Comparative analysis of essential drug lists in four Central Asian Republics.

1. Comparative analysis of essential drug lists in four Central Asian Republics. Aziz Jafarov / Richard Laing

2. Countries • K a z a k h s t a n • K y r g y z s t a n • T a j i k i s t a n • U z b e k i s t a n

3. Population and health financing in Kazakhstan, Kyrgyzstan, Tajikistan and Uzbekistan

4. Method • Сompares the existing Essential Drug Lists of Kazakhstan, Kyrgyzstan, Uzbekistan, and Tajikistan with the WHO Model EDL List from 1999. • The 2002 WHO Model list is the same as the 1999 list, except for the additional Anti Retro Viral (ARVs) and anti malarial drugs. • For the purpose of this analysis, we have combined core and complementary drugs into a single master list. • For this paper a comparative table has been developed and the 1999 WHO Model EDL was taken as the standard.

5. Method Drugs on national EDLs were classified as being: • 1) on the WHO Model EDL • 2) From the same therapeutic group • 3) Not included on the WHO Model List. Based on the spreadsheet, summary tables were developed for all the EDLs and the WHO Model List and some of the therapeutic groups in order to compare with the national and the WHO list.

6. General resultsComparative table of EDLs of CAR and WHO Model ListSUMMARY

7. General results

8. Forms and dosageErythromycin in WHO, Kazakhstan, Kyrgyzstan and Uzbekistan EDLs.

9. Forms and doses

10. Forms and doses

11. Form and doses

12. Cardiovascular drugs

13. Cardiovascular drugs

14. Gastrointestinal drugs

15. Drugs affecting the blood, blood products and plasma

16. Recommendation • Design and conduct in-depth studies to evaluate the selection process in each country of the region and introduce and update the selection process according to the latest developments • Organize meetings at regional level on the EDL concept and selection process

17. Recommendation • Intensify collaboration with the WHO to select evidence-based medicines. WHO is the key organization in developing the EDL concept, and should continue to update countries on the changes made while revising the model EDL. • Reduce the number of forms and doses • Exclude the column of brand names as alternatives for generic names • Any information, which might possibly lead to misinterpretation, should be excluded from the list;

18. Recommendation • Assign the essential drugs by level of care: Primary, Secondary and Tertiary; • Create incentives for the private sector to import in generic essential drugs • Waive all duties for essential drugs and incentives for medical professionals to prescribe essential drugs • Assure registration of all the EDL drugs • Design brochures and regular newsletters on EDL and distribute them to medical professionals

19. Conclusion • There has been a significant effort by Kazakhstan, Kyrgyzstan, Tajikistan and Uzbekistan to implement the Essential Drug Concept. All of the four former Soviet Central Asian countries developed and revised their EDLs. • The total number of drugs included in the national lists is reasonable, except for the listing of brand names in Tajikistan and Kazakhstan EDLs. • Local institutions contributed to the process of the development and revision of the lists, and there is knowledge and interest in the ED concept.

20. Conclusion • The number of essential drugs among the four countries, the drugs selected for the national lists, and the excessive number of forms and doses for Kyrgyzstan and Uzbekistan make the lists controversial. • Inclusion of the brand names in a separate column in Kazakhstan and Tajikistan EDLs creates room for misinterpretation and for bad procurement practices. • The EDLs of Kazakhstan, Kyrgyzstan, Tajikistan and Uzbekistan are very different. At least some of their selected drugs and the selection process itself require radical revision.

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