MeTA Kyrgyzstan

1
MeTA Kyrgyzstan

• Country Overview
• Public Sector
• Civil Society

2
Country overview

• Mariam Djankorozova
• MeTA Country coordinator

3
Multi-stakeholder process

• Situation analysis of multi-stakeholders in the
  Country
• Organization of MeTA Council in Kyrgyzstan
• Regular meetings engaging multi-stakeholders
• Formation of MeTA CSOs Coalition
• Private sector from remote regions of KG more
  interested in MeTA than central regions
• CSOs was active in dialogues with private and
  government sectors
• Procurement and availability of medicines is the
  main issues for CS and private sectors
• Implementation of CS observers in tenders (Gov
  bodies are inviting)
• Private sector suggested to implement
  E-procurement system in hospitals

4
Major achievements and successes

• Common forum for discussion on pharmaceutical
  issues
• Availed platform for Problem solving on
  significant issues in the sector, including
  WEB-site (has launched, content in the process of
  filling)
• Conduct inter sectoral collaboration via design
  of activities allowing data gathering and
  information
• Improved communication and awareness of different
  sectors
• MoH KG
• Private sector initiated to organise small active
  group on Legislation issues and regular meetings.
• Capacity building of the CSO Coalition is
  considered as the major success in Kyrgyzstan

5
Overall challenges

• Current political situation with constrained
  government management (poor transparency and
  accountability)
• Private sector involvement limited due to
  inadequate information on how to engage in MeTA
  process
• How to show the benefit of MeTA to every sector
• Poor leadership of MeTA Council due to conflict
  of interest (Director of DRA is chairman of MeTA
  Council)
• Overcoming conflict of Interest and engagement
  between sectors (better understanding of each
  other role of each sector in the country)
• Active promotion of MeTA was not possible
  because of political situation

6
Lessons Learned

• Different background of MeTA Council Member
  complicate the dialogue
• Development of Criteria for management of MeTA
  Council requires wider consideration than
  sectoral interest
• Engagement of Multi stakeholder is a Process and
  takes time
• Requires skills to engage and manage the
  different sectors (particularly to listen to the
  other sector and increase awareness)
• MSP requires good facilitation and these skills
  need to be development and learnt
• Power in numbers (when we are many we are
  stronger)
• Benefit is important Private sector wants to be
  involved more active in Legislation issues.
• Media strategy for promoting MeTA it must be at
  the beginning of process

7
Thank you

• Mariam Djankorozova
• MeTA Country coordinator
• Email mariamkad_at_gmail.com
• Mobile number 996 555 92 94 12
• Skype mariamdjan1
• Website www.metakg.org

8
Public SectorExpertise of current
Legislation

• Djusupova Djanyl
• Deputy director of NDRA of KG

9
Summary Analysis at start of MeTA

• Since gaining independence of KG when the
  pharmaceutical sector privatized the legal
  framework corresponding new function requirements
  in drug provision has been established
• NDRA KG has been established
• However, regulatory tools lacked to ensure
  transparency and accountability in the
  pharmaceutical sector if basic legislation was
  available
• Survey objective
• Analysis of legislation, with emphasis on
  mechanisms of transparency and accountability,
  including an assessment of the law in practice
  and existing contradictions

10
Summary Analysis at start of MeTA

• The new policy reforms aimed at improving the
  business environment by removing administrative
  barriers to business and investment has led to
• A reduction of 30 of licenses and permissions
  for business activities.
• Changing the system of control and inspection of
  business.
• Reduction to 30 of the bodies monitoring
  business.
• A significant impact on regulation of
  pharmaceutical sector
• According to advisory group of BEI project
  medicines were considered as an ordinary product
  without regard to their characteristics. The
  adoption of some recommendations could lead to
  deregulation in pharmaceutical sector
• Activities of wholesalers and manufacturers of
  medicines and pharmacies (except pharmacies
  produced medicines extempore) is no longer
  licensed
• MoH standards would be voluntary implemented in
  pharmaceutical sector
• the declaration of compliance with medicines is
  introducing instead of mandatory certification of
  medicines
• Unilateral recognition of medicine registration
• Pharmaceutical Inspection has no rights to have
  unexpected visit , even there are public
  complaints

11
Major milestones

• META initiated a dialogue with the USAID BEI
  project involving private sector, NGOs,
  government and WHO to prevent an imbalance in the
  regulation of the pharmaceutical sector under an
  authoritarian approach and non-transparency of
  the policy
• Expert group on legislation analysis conducted
  meetings with representatives of different
  sectors
• - Public sector MoH, MoF, NDRA
• - CSOs sector
• - Private sector
• Identified issues and contraventions in
  legislation were discussed at the Round Table by
  all parties participated
• E- group involving all stakeholders was created
  to discuss legislation issues

12
Areas of survey

• 1. The main normative documents governing the
  drug provision in KG
• 1.1. Effectiveness of legal documents to ensure
  transparency of drug provision in KG
• 1.2. Legal and regulatory shortcomings and
  contradictions
• 2. The patients rights on the drug provision
  and their protection
• 2.1. Information public support on medicine
  issues
• 2.2. Services on the drug provision
• 2.3. The possibility of appeal by patients of
  their rights on the drug provision
• 3. State regulation
• 3.1. Regulation of licensing issues concerning
  the drug provision
• 3.2. Bodies authorized to control the drug
  provision
• 3.3. The system of state control efficiency and
  drug safety
• 4. Responsibility for the public health

13
Challenges with legislative features

• 1. Contradictions in certain normative documents
  including differences in terminology
• 2. It is necessary to improve the regulatory
  framework (conflict of interests of NDRA and
  exclusion of obsolete rules)
• 3. Medicines included in the scope of the Law "On
  the basis of technical regulation in the Kyrgyz
  Republic
• 4. New rules of establishment of regulation
  status may lead to the fact that regulations of
  the drug provision will cease to be binding
• 5. Inadequacy of certain legislation
  (complication of pharmaceutical inspection, law
  enforcement pressure on pharmacies)
• 6. The lack of legislative mechanisms to ensure
  transparency and accountability in the
  pharmaceutical sector

14
Challenges with executive features

• 1. Procurement
• The inaccessibility of information on procurement
  of medicines, except for procurement announcement
• Violation of procurement procedures
• 2. Licensing system
• No transparency in issue of licenses
• There is no public information on licensed
  pharmacies
• Lack of information management system in the
  pharmaceutical sector
• 3. Disciplinary-executive
• - Competence of documentation requirement by
  certain control agencies (prosecution or other
  fiscal bodies)

15
Recommendations of Stakeholders (1)

• Increasing the responsibility of officials
  (administrative, criminal, disciplinary)
• Obligatory support information of patients
  including information on ADR
• To introduce standards for the number of
  pharmacies in a particular area To attract the
  local government to monitor the activities of
  pharmacies
• Promotion of ethic code of pharmacist
• To introduce bar code for medicines
• To ensure timely review of list of medicines
  reimbursed

16
Recommendations of Stakeholders (2)

• Tender
• to implement e-procurement (legalize the flow of
  documents in electronic format).
• to introduce ethic standards for the members of
  tender commission
• to introduce criteria for medicine procurement to
  procure quality medicines (price should not be
  sole criterion)
• Information
• Increasing public awareness
• Information on the DRA website
• Licensed pharmacies ,
• Certified products,
• Registered medicines
• To introduce provisional regulations on period of
  medicine certification

17
Lessons Learned

• Working with different sectors revealed a
  significant lack of information in the
  pharmaceutical sector (indicated by all parties)
• Private sector and NGOs are ready to participate
  in development and enhancement of legislation
  through
• Establishing working group involving all sectors
  to address specific laws
• Establishing groups to lobby for promotion of
  certain laws
• The system of regular meetings, newsletters,
  online forums
• Involvement of all stakeholders enhances the
  process of improving the legislation and its
  implementation
• Activities META promote confidence-building
  between the sectors

18
Thank you

• Djusupova Djanyl
• Deputy director of NDRA of KG
• Email ddjanyl_at_gmail.com
• Mobile number 996 770 221 055
• Skype
• Website www.pharm.med.kg

19
MeTA Kyrgyzstan

• Burul Makenbaeva
• CSO Coordinator, Kyrgyzstan

20
Summary Analysis at start of MeTA

• What were the needs and issues in your specific
  sector at the start of MeTA?
• Mission of Mental Health and Society is the
  return of people with mental disorders into the
  community of closed psychiatric institutions.
  Access to medicines in the community is a main
  matter.
• Since 2006 Drug Package of SGP for patients with
  mental disorders has been implemented at the
  primary health care level but patients were not
  informed
• And a high level of mistrust between the sectors,
  the myths and stereotypes from all parties
• The lack of communication between NGOs and the
  public sector only letters - ineffective
  communicationEverything was a thick and gray
  clouds!

21
Major milestones

• What milestones have been achieved during the
  MeTA pilot phase?
• Establishment of CSO Coalition, trainings and
  small grants surveys
• Studies have begun sowing clouds, the picture
  became more clear, what works and how, and why if
  not working
• The regular communication is created
• Building trust and respect

22
Successes

• What were the successes for your sector during
  the MeTA pilot phase?
• NGOs participate in public procurement process at
  the national level
• The initiative of NGO inclusion comes from
  government
• All Coalition members have full access to
  information
• Building trust with the public media, local
  authorities, local community

23
Challenges

• What challenges has your sector endured during
  the MeTA pilot phase?
• Lack of capacity and knowledge on drug
  circulation and lack of legal capacity
• The diversity of interests and different ideas of
  how to act in coalition
•  Discussion took a long time and it was a risk to
  lose interest
• Change Leadership

24
Lessons Learned

• What are the lessons that your sector has learned
  from MeTA?
• Identification of interests and motivations
• Maintaining a balance of interests to develop a
  unified strategy
• Solidarity and broad cooperation including the
  International MeTA
• The necessity to react quickly to unforeseen
  difficulties
• Flexibility
• Full involvement of stakeholders from the
  beginning

25
Lessons Learned

• Topics
• Availability of psychotropic medicine under the
  State Guarantee Program in Bishkek and Osh
  Cities. (PF Public Health in partnership with PF
  New View on Mental Health).
• Availability of medicine under the State
  Guarantee Program in rural areas based on the
  example of Kochkor District, Naryn Province (PF
  Harmony Plus in partnership with Village Health
  Committee (Kochkor District, Naryn Province), PF
  Etiyat (Issyk-Kul Province) and NGO Door Eli
  (Bishkek).
• Availability of vitally important medicines in
  childrens residential institutions (League of
  Child Rights Defenders)
• Study of State Procurement Practice at the
  National Cancer Center (PF People Living with
  Chronic Myeloleukemia)
• Rationality of medicine use at Bishkek hospitals
  based on the example of Hospitals 1 and 6 (NGO
  For Safe and Rational Use of Medicine)
• Availability of diabetes medicine in Chui
  Province.

30/10/2013
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30/10/2013
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