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Final Activity Report

Final Policy Paper

Final Research Paper

“comparative policy analysis occupies 
a middle ground between ‘pure research’ 
of theoretical nature and ‘applied science’ 
directed towards the nuts and bolts 
of detailed problem solving” 
Heidenheimer et al.

   Since1992 Armenia formulated own national health and pharmaceutical policy. However, the rapid pace of socioeconomic change, and the changes in the Health and Pharmaceutical services have had negative repercussions on the development of pharmaceutical policy in the NIS countries. This was in part the result of the implementation of reforms, which were not based on a thorough comprehensive analysis of new realities. At present many patients still do not access to proper health and pharmaceutical services. Public spending on pharmaceuticals is very low. Calculation of public pharmaceutical expenditures approved by the Armenian Law on the State Budget for 2001 allows to see that public expenditures are less than 2 USD per capita per year. In addition, there is no state health insurance system and people have to pay for themselves. Drug prices are high and are often unaffordable for the majority of population. According to our calculation, cost of one 20-days course of Hypertension treatment amounts to 25 USD what is about 64% of an average monthly salary in Armenia. There is no pricing policy for pharmaceuticals in place. Introducing VAT for medicines since 1st January 2001 has lead to further prices increase. 

   Thus, there is an evident need in reform of the current pharmaceutical system. Developing a new pharmaceutical policy document seems to be an essential task. To be effective this document has to be based on a comprehensive assessment of the pharmaceutical service. 

   The purpose of this study is comprehensive assessment of the pharmaceutical service in Armenia and further developing project of a national pharmaceutical policy document. 

Objectives of the research: 

1. investigating the pharmaceutical service in Armenia, diagnosing problems in the system and defining on-going trends and affecting factors, 
2. comparative assessing different options and designing appropriate evidence-based strategies, 
3. designing the main principles of national pharmaceutical policy, as well as principles of for each separate component, and following discussing them with the main actors of the pharmaceutical system in Armenia, 
4. developing a project of national pharmaceutical policy document for Armenia, based on the results of the study. 

   The methods of obtaining necessary information will be: document review, key informants interviews, collection of data from existing records. Data targeted will be collected in the form of performance indicators. Two existing sets of performance indicators (“Rapid Pharmaceutical Management Assessment: An Indicator-based Approach” developed by the Management Science for Health and “Indicators for Monitoring national drug policies” developed by the World Health Organization), as well as indicators designed specially for this research project will be defined. 

   The main areas covered by assessment will be the following: Policy, Legislation, Regulation; Formulary System; Ministry of Health Budget and Procurement; Financing, Reimbursement and Cost Containment of pharmaceuticals; Private Sector Activity; Drug Information; Patient Access and Drug Utilization. 

   Pharmaceutical policy document will be designed on the basis of the results of research implemented, as well as analysis of publications available and experience of other countries. It will include goal and objectives, the main principles of pharmaceutical policy, principles of pharmaceutical policy for individual components (Legislation and regulation, choice of drugs, supply, rational use, economic strategies, human resorces development, monitoring and evaluation), strategies for each component. 

Stages of planned investigation: 
1. Literature review. Study design and preparation. 
2. Data gathering. 
3. Evaluation of competing alternatives. 
4. Developing policy principles and discussing them with all main actors of the pharmaceutical system interested in. 
5. Developing national pharmaceutical policy document project and presenting it for further discussion. 

   In order a project of pharmaceutical policy document developed might be applied in practice in Armenia, this document will be discussed in-depth among the members of the NGO “Drug Utilization Research Group” having among others tasks an objective to formulate recommendations for policy-makers in the area of pharmaceutical policy. Then document will be circulated for comments within the Ministry of Health, other government establishments and organizations. Principles of pharmaceutical policy, which will be developed as the result of project implementation, could be used by other countries developing their pharmaceutical policy as well.