Interim activity report

IPF continuing fellowship 2005-2006

Project - “Promoting transparency and accountability as a factor of successful implementation of Pharmaceutical policy “

This Interim report covers activity implemented during the period of July 2005 – January 2006.

According to the timetable, literature review and Internet search were conducted during this period. Information was collected in order to receive data about changes which took place in the local situation since 2003, as well as related to the issues transparency and accountability, especially in the health care system and pharmaceutical sector.

Key informants were interviewed in order to study the current situation in the Armenian Pharmaceutical sector and to identify priority areas where providing transparency and accountability is the most important. Despite the fact that in the majority of publications the main areas of the pharmaceutical sector, where transparency is advised, are regulation, medicines selection, procurement, and distribution, the following areas were finally selected by me: legislation, national pharmaceutical policy, regulation, financing, selection of medicines, supply, distribution, use, and training. On the basis of publications review and analysis of the local situation a set of Core Indicators was developed (see attachment 1 in the draft of the Research paper). Indicators are worked out for each of the areas selected. Data for these indicators were collected by different methods: from official publications, not published reports, the State Statistical Service, interviewing key informants including local officials, etc.

In addition to activity planned a special study was implemented with objectives to estimate legal base for the activity connected to medicines, from the point of view of providing accountability and transparency; as well as to study and analyze opinion of public health experts concerning a present situation and importance of these strategies in the Armenian pharmaceutical sector. The contents of corresponding laws and under-legislation acts have been analyzed. Questionnaires for Health care professionals have been developed, in which respondents have been asked to estimate, using a five-point scale, the current situation (Table 1 of Questionnaire) and to determine importance of providing accountability and transparency (Table 2) on 13 main components in pharmaceutical management. The filled questionnaires have been received from 72 respondents. 136 professionals (72 – the same respondents and 74 additionally involved, in particular: 9 civil servants, 24 representatives of administration of the public medical enterprises, 20 heads of hospital pharmacies, 31 community pharmacists, 36 family physicians and 16 residents) were asked to respond to the question on necessity of a wide use of accountability and transparency for sphere of management and regulation of medicines.

Concrete mechanisms providing transparency and accountability in different areas of the pharmaceutical sector have been developed. The main recommendations are included in the draft of Policy paper (see IPF web page). Also suggestions related transparency and accountability have been written for the draft of a new Law “On medicines”. A draft circulated at the National Assembly does not include any requirement on transparency and accountability in the pharmaceutical sector.

The results of the above-mentioned study, as well as recommendations developed were presented to stakeholders during the seminar. Representatives of the Ministry of Health, local authorities, public medical establishments, private pharmaceutical organizations, National Institute of Health and so forth participated in the seminar. The representative of the Ministry of Health stressed actuality of transparency issue and asked for developing more specific recommendations for the draft of a new Law “On medicines”.

On the basis of information collected from literature review curricula for post-graduate education of pharmacists and in-service training for civil servants have been developed. A short in-service training was conducted for the staff of the Pharmacy Department at the National Institute of Health.

Work on creating a network on transparency and accountability in the pharmaceutical sector for NIS was started. Some information was collected from Internet and some data were received from contact points in other countries. Some work on developing a special web site also has been carried out.

On the basis of analysis of new data collected about the Pharmaceutical sector appropriate changes were added in a draft of the Pharma¬ceutical Policy document. Work was started on developing a draft of Pharma¬ceutical Policy Implementation plan (“Program on Essential Medicines”), covering also transparency and accountability mechanisms suggested for the pharmaceutical sector.

Presentation based on the first results was made at the Congress of International Pharmaceutical Federation in Cairo in September 2005. Abstract “Pharmaceutical expenditures in Armenia” was published in the Congress materials and is available at my IPF web page. Another abstract – “Providing accountability and transparency in the area of pharmaceutical management” (in Russian) covering the result of the study was presented for the Congress “Person and medicine” in Moscow. It also was accepted and published in Materials of the Congress. The WHO recommendations on the issue of transparency and accountability in the pharmaceutical sector were discussed at my meeting with representatives of the Regional Office for Europe of the World Health Organization during the trip in Copenhagen in November 2005.

The project is mainly implementing according to the Project proposal and Timetable approved.