MeTA Kyrgyzstan

Medicines Transparency Alliance21/04/23 1

MeTA Kyrgyzstan

Country OverviewPublic SectorCivil Society


Country overview

Mariam Djankorozova

MeTA Country coordinator


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

Medicines Transparency Alliance

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

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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

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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

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Thank you

Mariam Djankorozova

MeTA Country coordinator Email: [email protected]

Mobile number: +996 555 92 94 12

Skype: mariamdjan1

Website: www.metakg.org


Djusupova Djanyl

Deputy director of NDRA of KG

Public SectorExpertise of current Legislation

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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

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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

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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

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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 patient’s 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


Challenges with legislative features

1. 1. Contradictions in certain normative documents including differences in terminology

2. 2. It is necessary to improve the regulatory framework (conflict of interests of NDRA and exclusion of obsolete rules)

3. 3. Medicines included in the scope of the Law "On the basis of technical regulation in the Kyrgyz Republic”

4. 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. 5. Inadequacy of certain legislation (complication of pharmaceutical inspection, law enforcement pressure on pharmacies)

6. 6. The lack of legislative mechanisms to ensure transparency and accountability in the pharmaceutical sector


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)


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


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


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

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Thank you

Djusupova Djanyl

Deputy director of NDRA of KG Email: [email protected]

Mobile number: +996 770 221 055

Skype:

Website: www.pharm.med.kg

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MeTA Kyrgyzstan

Burul MakenbaevaCSO Coordinator, Kyrgyzstan


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 informedAnd a high level of mistrust between the sectors, the myths and stereotypes from all partiesThe lack of communication between NGOs and the public sector: only letters - ineffective communicationEverything was a thick and gray clouds!


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

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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

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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

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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

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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 children’s 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.

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Documents

MeTA Kyrgyzstan