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

• Aziz Jafarov / Richard Laing

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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

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Population and health financing in Kazakhstan,
Kyrgyzstan, Tajikistan and Uzbekistan
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Method

• ?ompares 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.

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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.

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General resultsComparative table of EDLs of CAR
and WHO Model ListSUMMARY
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General results
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Forms and dosageErythromycin in WHO,
Kazakhstan, Kyrgyzstan and Uzbekistan EDLs.
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Forms and doses
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Forms and doses
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Form and doses
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Cardiovascular drugs
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Cardiovascular drugs
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Gastrointestinal drugs
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Drugs affecting the blood, blood products and
plasma
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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

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Recommendation

• Conduct seminars with medical professionals at
  primary, secondary and tertiary care

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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

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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

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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.

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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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• THANK YOU!