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WHO
Collaborative Programme
National
Drugs Policies based on Essential Drugs
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Situation analysis
The issue of pharmaceuticals has surfaced in the year 2000 in Lebanon, to become a concern on the agenda of the parliamentary committee on health, supported by large part by the Prime Minister himself. This recent concern aims to reduce the national drug bill, and make drugs in Lebanon more affordable and accessible to those in need of them.
Upon the request of Prime Minister Hariri, the WHO became actively involved in the above parliamentary committee, which also included the stakeholders of the pharmaceutical sector in the country. The WHO consultants report titled" Comprehensive Analysis of the Pharmaceutical Sector in Lebanon, dated Nov 1999", and the recommendations of the IMCHR committee on drugs were submitted as working papers.
Areas receiving the most attention included strengthening and upgrading the MOH drug regulatory authority to include also quality assurance and public procurement practices, reviewing and updating the drug law and reviewing and changing the drug pricing practices.
The preliminary parliamentary recommendations were discussed in a public meeting at the house of parliament in September 2001. These recommendations once issued would serve as a blue print for a NDP. The recommendations would then be submitted through the Council of Ministers, to the Minister of Health for necessary actions.
In late 1999, a situation analysis of the pharmaceutical sector in the country was prepared by a team of WHO experts and the national program on drugs. The report included recommendation on the priorities to be tackled to upgrade this vital sector.
Regarding organization and management within the national DRA, during the previous biennium, the units on drug import/export and narcotics were rehabilitated and computerized. However, no upgrading was introduced to the remaining units, the administration and the inspection units.
The DRA administration handles licensure of pharmacists, pharmacies and drug related premises without computerization. The drug inspection unit as well remains understaffed and unprepared to deal with the comprehensive array of drug inspection activities. These units needs support with updated policies, with staff training, and with customized computerized system to improve their services and facilitate the communication channel with the other units within the DRA.
As for drug registration, the related MOH WHO collaborative project that aims at enforcing this system by computerizing the drug registration process, and creating complete dynamic files for all the drugs available on the Lebanese market is still being implemented. While collecting basic drug data, the MOH has chosen to review its existing archives rather than to request new data from drug providers. This has resulted in the accumulation of computerized drug files, some of which are complete while others are missing basic data, thus requiring verification, a step that is now in the process.
Once computerized files are created, a project to classify drugs therapeutically and to introduce drug-coding system should ensue.
Regarding public drug supply issues. In the 1999-2000 period, some of the public hospitals gained managerial autonomy, and no longer receive their drugs from the MOH CDW. The remaining public hospitals and the public HC centers and facilities as well as the Karantina public drug-dispensing center, are still dependent on the CDW as the sole source of their drug supply.
The CDW was enforced during the year 2001 with an upgraded computer hardware and software packages. Upon the request of the MOH, the WHO is supporting the center temporarily with one pharmacist and two store workers working under contract with the WHO.
Shortage in the supply of some essential drugs remain to be a problem due to the unpredictable timing of public procurement procedures, and to limited drug budgets which are further burdened by the un-discounted cost of short-orders obtained outside the tender cycle to compensate for drug stock outs.
Mid 2000, the MOH has collaborated with the WHO on a project to better manage the MOH public drug dispensing system through which the MOH distributes drugs for debilitating diseases for individual patients. The newly introduced system was enhanced with new management procedures, new layout, a customized drug dispensing software, and therapeutic guidelines for drug dispensing. The center is now able to serve efficiently almost twice the number of patients serviced previously, and is capable of generating timely reports on drug use history specific patients, physicians, areas of residence, disease states being treated, drug use patterns and other information needed for making sound managerial decisions. The center has introduced to the MOH a new information system to better manage a sector costing about 60-70% of the MOH total drug budget. Upon the request of the MOH, the WHO is temporarily supporting the center with 4 clinical pharmacists working under contract with the WHO
Public and official satisfaction with the performance of the center has prompted a MOH request to decentralize the services to the other Mohafazat in Lebanon. A project now pending funding.
The challenge to sustain the above services, and to reduce the hospitalization costs resulting as a consequence to drug stock outs, is to maintain a system for continuous drug supply, which would only be assured with proper policy-based budget planning, revision of the current time-consuming- procurement practices, and enforcement of MOH therapeutic guidelines in drug dispensing.
MOH public drug procurement, which due to the complexity of the public proceedings undergoes unplanned delays, deviated in 1999 from its traditional procedures and drugs were purchased through the army offices, using an open-bid procedure. This method had resulted in savings mounting up to 90% on the cost of some of the drugs. But in this process, only brand names were bided and local manufacturers were excluded from the bidding process. This triggered a political interest to consider analyzing current procurement practices
Public drug prices are set by the MOH based on a fixed markup formula, which applies to all drugs equally. This practice thou controls the drug costs, it allows huge markups on expensive drugs, and discourages the dispensing of the generic or the less expensive alternatives of the same drug at the pharmacy level.
The parliamentary committee on health took special interest this year in discussing the high FOB cost of drugs, especially the life saving expensive drugs, and the non-scaled local drug pricing formulas.
A review of worldwide prices of selective representative drugs, and a review of the drug pricing practices within the Middle Eastern Region and some of the industrialized countries, would assist in evaluating the current Lebanese practices in these areas.
As to the Lebanese essential drug list, the head of the pharmacy department reveals that the official decree needed to start the updating process is to be signed prior to the end of the year 2001. An updated list is expected to be printed and distributed in 2002.
The drug market in Lebanon is currently valued at US$ 400 million (Public price), which accounts for about 25% of the total health care bill.
At the general scene of the pharmaceutical sector, the political will to bring change is apparent thou not yet focused and refined. The usual resistance to change is obviously expressed from the sector's stakeholders.
Achievements:
Surfacing political interest in the drug sector rehabilitation in 2000
Analysis of the pharmaceutical sector in 1999
Upgrading of the MOH public drug dispensing system
Introduction of a new drug dispensing management software
Introduction of therapeutic guidelines for public drug dispensing
Upgrading the MOH CDW drug inventory management software
Exposure/ visit of the Lebanese DRA to the Tunisian DRA
A decree to update the Lebanese EDL
Challenges:
Stakeholders' resistance to change
The official endorsement of a NDP document
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