Access to medicines in treating bronchial asthma within the State Guarantee Benefit Programme

1. Access to medicines in treating bronchial asthma within the State Guarantee Benefit Programme N.N.Brimkulov, Lung health, Bishkek, Kyrgyz Republic October 2009 – February 2010

2. Introduction • Currently in KG the number of patients with bronchial asthma is approximately 10,000. • Within the framework of National Health Reform Program Manas Taalimi the following has been achieved: • Clinical protocols on asthma • Essential Drugs List • State Guarantee Benefit Programme (since 2006) • Outpatient Drug Benefit Package for insured citizens (since 2000) However, do all patients have access to medicines?

3. Survey Objective Availability and transparency survey of benefit medicine provision for the patients with bronchial asthma in the regions of KG

4. Coverage geography and survey materials and methods Survey of 100 patients and 203 health workers including: 89 – in FMC 89 – in hospitals 25 -pharmacists 151 medical сheck-lists were examined

5. Outcomes (1) • There are benefit medicine provision programs for patients with asthma in KG Butat the same time: • 16,3% of all interviewed health workers unaware of which diseases are included into SGP • 22,2% health workers in hospitals, 32%pharmacists and5,7%policlinic health workers have no awareness of SGBP • 84% interviewed patients with asthmaare informed of their privileges for medicines by their family physicians • 57,6%patients in oblasts haven’t seen the SGBP information at FMC stands

6. Outcomes (2) • 26% of interviewed patients don’t get refunded for prescriptions on SGBP as well as the physicians don’t offer, patients have no awareness • 48% ofinterviewed patients don’t purchase medicines by refunded prescriptions: pharmacies are out of stock, patients consider medicines expensive • Beclomethasone is available in pharmacies, patients almost don’t pay according to SGBP

7. Availability of inhalation glucocorticosteroids in oblasts

8. CONCLUSIONS and PROPOSALS (1) • 22,2% of hospital workers and 32% of pharmacists are not informed of SGBP • Because of patients unawareness: - 16% don’t know about their SGBP privileges, - 26% don’t get refunded prescriptions, - 48% don’t purchase medicines in pharmacy even having refunded prescription

9. CONCLUSIONS and PROPOSALS 2) • Training and study materials are required for patients • Joint trainings are required with participation of three parties: • Health Facility (state) 2. NGO (population) 3. Pharmacists • To include the issues of benefit medicines provision into continuous medical education program

10. CONCLUSIONS and PROPOSALS (3) • Control and accountability are needed: - norms of writing out refunded prescriptions Requires committment of physician and pharmacist - medicine realization on refunded prescriptions in pharmacies pharmacy get payment from Mandatory Health Insurance Fund for refunded prescriptions, but not for realized refunding medicines Control is needed over appropriate discloser of the information by pharmaceutical companies about medicines, alternatives in refundedprograms (for instance, a share “yellow card” to Ceretid «Glaxo Smith Kline»)

11. Pilot trainings held on the basis of taken results • Training for patients, health workers and pharmacists • Developing brochure “Does the government support patients with bronchial asthma? • Round Table after Survey was held with Stakeholders

12. “Does the government support patients with bronchial asthma?”

13. Thank you Nurlan Brimkulov CSC coalition Email: brimkulov@jet.kg Mobile number: +996 559 957777 Skype: Website: