Progress in increasing affordability of medicines for non-communicable diseases since the introduction of mandatory health insurance in the Republic of Moldova.

BACKGROUND: To assess progress in improving affordability of medicines since the introduction of mandatory health insurance in the Republic of Moldova. METHOD: Using data from national health insurance, we estimate affordability of partially reimbursed medicines for the treatment of non-communicable diseases, and analyse which factors contributed to changes in affordability. RESULTS: Affordability of subsidized medicines improved over time. In 2013, it took a median of 0.84 days of income for the lowest income quintile (ranging from 0 to 3.32 days) to purchase 1 month of treatment for cardiovascular conditions in comparison to 1.85 days in 2006. This improvement however was mainly driven by higher incomes rather than deeper coverage through the reimbursement list. CONCLUSION: If mandatory health insurance is to improve affordability of medicines for the Moldovan population, more funds need to be (re-)allocated to enable higher percentage coverage of essential medicines and efficiencies need to be generated within the health system. These should include a budget reallocation between secondary and primary care, strengthening primary care to manage chronic conditions and raise population awareness, implementation of evidence-based selection and quality use of medicines in both outpatient and inpatient settings, improving monitoring and regulation of prices and the supply chain; and alignment of national treatment guidelines and clinical practice with international best practices and evidence-based medicine.

Better noncommunicable disease outcomes: challenges and opportunities for health systems: Tajikistan country assessment

Cardiovascular diseases are the predominant cause of death in Tajikistan, with a growing burden of ischaemic heart disease, strokes and cirrhosis between 1990 and 2010. Considering this, this report focuses on cardiovascular diseases and their risk factors, such as hypertension and poor nutrition; it is estimated that 40% of the Tajik population is overweight and 9% is obese. Other risk factors such as diabetes and tobacco use are also analysed. While Tajikistan has made some progress in implementing anti-smoking policies and reducing the harmful use of alcohol, opportunities such as better enforcement and monitoring of legislation exist. Significant challenges also remain for coverage of core individual services, especially in the effective diagnosis and management of key cardiovascular disease conditions, such as hypertension and diabetes. This report identifies key health system challenges that prevent greater coverage of core noncommunicable diseases interventions and services, and proposes three strategic recommendations to accelerate gains in cardiovascular diseases outcomes.

Antibiotic use in eastern Europe: a cross-national database study in coordination with the WHO Regional Office for Europe.

BACKGROUND: There are no reliable data on antibiotic use in non-European Union (EU) southern and eastern European countries and newly independent states. We aimed to collect valid, representative, comparable data on systemic antimicrobial use in these non-EU countries of the WHO European region. METHODS: Validated 2011 total national wholesale antibiotic-use data of six southern and eastern European countries and regions and seven newly independent states were analysed in accordance with the WHO anatomical therapeutic chemical (ATC)/defined daily doses (DDD) method and expressed in DDD/1000 inhabitants per day (DID). FINDINGS: Total (outpatients and hospital care) antibiotic use ranged from 15·3 DID for Armenia to 42·3 DID for Turkey. Co-amoxiclav was mainly used in Georgia (42·9% of total antibiotic use) and Turkey (30·7%). Newly independent states used substantial quantities of ampicillin and amoxicillin (up to 55·9% of total antibiotic use in Azerbaijan). Montenegro and Serbia were the highest consumers of macrolides (15·8% and 19·5% of total antibiotic use, respectively), mainly azithromycin. Parenteral antibiotic treatment is common practice: 46·4% of total antibiotic use in Azerbaijan (mainly ampicillin; 5·3 DID) and 31·1% of total antibiotic use in Tajikistan (mainly ceftriaxone; 4·7 DID). INTERPRETATION: This study provides publicly available total antibiotic-use data for 13 non-EU countries and areas of the WHO European region. These data will raise awareness of inappropriate antibiotic use and stimulate policy makers to develop action plans. The established surveillance system provides a method to develop quality indicators of antibiotic use and to assess the effect of policy and regulatory actions. FUNDING: Netherlands Ministry of Health, Welfare, and Sport, and EU.

An in-depth analysis of pharmaceutical regulation in the Republic of Moldova.

OBJECTIVE: Regulation of the pharmaceutical system is a crucial, yet often neglected, component in ensuring access to safe and effective medicines. The aim of this study was to provide an in-depth analysis of the existing pharmaceutical regulation, including recent changes, in the Republic of Moldova. METHODS: Data from field work conducted by the World Health Organization (WHO) together with a review of policy documents and quantitative secondary data analysis was used to achieve this aim. RESULTS: This analysis identified several ways in which pharmaceutical regulation affects availability of quality medicines in the Republic of Moldova. These include lack of full implementation bioequivalence requirements for generics registration, incomplete implementation of good manufacturing practices and no implementation of good distribution practices, use of quality control instead of quality assurance as a method to ensure quality of medicines, frequent change of power within the Medicines and Medical Devices Agency (MMDA) leading to lack of long-term strategy and plans, conflict of interest between the different functions of the MMDA, the lack of sufficient funding for the MMDA to conduct its activities and to invest in continuous training of its staff (particularly inspectors) and very weak post-marketing control. Notably, several improvements have been recently introduced, including a roadmap for change for the MMDA, the introduction of good manufacturing practices and the drafting of a quality manual for the Agency. CONCLUSION: Based on these findings the authors propose a set of priority actions to address existing gaps and draw lessons learned from other countries.

Better noncommunicable disease outcomes: challenges and opportunities for health systems: Kyrgyzstan country assessment: focus on cardiovascular disease

Cardiovascular mortality in Kyrgyzstan has decreased over the past seven years in part due to impressive health system reforms. However, moving towards the 25 by 25 targets and addressing the sizeable gender gap in premature mortality present a significant challenge. While Kyrgyzstan has made some strides in implementing anti-smoking policies, reducing the harmful effects of alcohol and strengthening nutrition policies, there are still great opportunities through better enforcement and monitoring of legislation. Significant challenges also remain for coverage of core individual services especially in the effective diagnosis and management of key cardiovascular disease (CVD) conditions, such as hypertension and diabetes. The report identifies key health system challenges that prevent greater coverage of core noncommunicable disease interventions and services, and proposes three strategic directions to accelerate gains in CVD outcomes.

Better noncommunicable disease outcomes: challenges and opportunities for health systems: Tajikistan country assessment: focus on cardiovascular disease

Cardiovascular diseases are the predominant cause of death in Tajikistan, with a growing burden of ischaemic heart disease, strokes and cirrhosis between 1990 and 2010. Considering this, this report focuses on cardiovascular diseases and their risk factors, such as hypertension and poor nutrition; it is estimated that 40% of the Tajik population is overweight and 9% is obese. Other risk factors such as diabetes and tobacco use are also analysed. While Tajikistan has made some progress in implementing anti-smoking policies and reducing the harmful use of alcohol, opportunities such as better enforcement and monitoring of legislation exist. Significant challenges also remain for coverage of core individual services, especially in the effective diagnosis and management of key cardiovascular disease conditions, such as hypertension and diabetes. This report identifies key health system challenges that prevent greater coverage of core noncommunicable diseases interventions and services, and proposes three strategic recommendations to accelerate gains in cardiovascular diseases outcomes.

Availability and affordability of medicines and assessment of quality systems for prescription of medicines in the Republic of Moldova: final report

An overall assessment of the pharmaceutical sector in the Republic of Moldova wasperformed during 2011–2012, with the purpose of providing the Ministry of Healthwith comprehensive evidence regarding access to essential medicines of goodquality. This report presents the results, based on a secondary analysis of evidencecollected during a series of assessments conducted by the World Health OrganizationRegional Office for Europe in collaboration with the Ministry of Health of the Republicof Moldova, the Medicines Agency, Nicolae Testemitanu Republic of MoldovaState Medical and Pharmaceutical University, and Health Action International. Theassessments covered the areas of: public procurement; main regulatory functions;availability, affordability, prices and price components of essential medicines; andan evaluation of the essential list of medicines, prescribing practices and pricingpolicies. The main recommendations of the report provide insights into ways ofimproving regulatory and procurement practices, along with the best methods toconstrain the costs of medicines.

An assessment of community pharmacists’ attitudes towards professional practice in the Republic of Moldova

Pharmacy in Moldova is undergoing a period of transition. The professional practice is adjusting to a market-oriented economy from the previous Soviet system. The pharmaceutical sector has been liberalised giving rise to a significant increase in the number of community pharmacies. This has led to some adverse effects on the profession of pharmacy with pharmacists having considerable difficulties fulfilling their professional aspirations and possibly losing confidence in further developing their professional role. Objective: To assess community pharmacists’ attitudes towards their professional practice and to determine their perceived competence in various pharmaceutical activities. Methods: A questionnaire which addressed managerial activities, dispensing activities, pharmaceutical care activities, inter-professional relationships, public health and competence was mailed to 600 community pharmacists who were asked to score the importance and perceived competence for each activity on a scale ranging from 0-5. In the case of pharmaceutical care activities, pharmacists were asked to score their degree of agreement or disagreement as to whether it is the responsibility of the pharmacist to engage in specific pharmaceutical care activities. Results: A total of 370 valid questionnaires were returned giving a response rate of 61.7%. Managerial and dispensing activities were scored the highest both in terms of perceived importance and competence. The more innovative pharmaceutical care activities scored relatively low. Overall scores relating to the importance of pharmacists engaging in public health activities appear to be the lowest of the entire questionnaire. Younger pharmacists between the ages of 22-30 obtained significantly higher scores with regards to the perceived pharmacist’s responsibility in engaging in various pharmaceutical care activities. Respondents who practiced in an accredited pharmacy scored higher in the majority of questions. Conclusion: Pharmacists in Moldova appear to be deeply rooted in the traditional approach to the practice of pharmacy pertaining mainly to distributive practice model and are somewhat distant from the other models of practice such as pharmaceutical care, drug information and self-care (AU)

La farmacia en Moldova está sufriendo un periodo de transición. El ejercicio profesional se está ajustando a una economía de mercado desde el anterior sistema soviético. El sector farmacéutico se ha liberalizado dando lugar a un significativo incremento en el número de farmacias comunitarias. Esto ha producido algunos efectos adversos sobre la profesión farmacéutica que tiene dificultades de cumplir sus aspiraciones profesionales y posiblemente perdiendo confianza en el futuro desarrollo de su papel profesional. Objetivo: Evaluar las actitudes de los farmacéuticos comunitarios hacia su ejercicio profesional y determinar su percepción de competencia en varias actividades farmacéuticas. Métodos: Se envió un cuestionario a 600 farmacéuticos comunitarios a los que se pedía que puntuasen la importancia y la competencia percibida con valores de 0-5 para cada una de las actividades: gestión, dispensación, atención farmacéutica, relaciones inter-profesionales, y salud pública. En las actividades de atención farmacéutica, se pidió a los farmacéuticos que puntuasen su grado de acuerdo o desacuerdo sobre si es responsabilidad del farmacéutico involucrarse en actividades específicas de atención farmacéutica. Resultados: Se recibieron 370 cuestionarios válidos con una tasa de respuesta del 61%. Las actividades de gestión y de dispensación fueron puntuadas las más altas tanto en términos de importancia percibida como de competencia. Las más innovadoras actividades de atención farmacéutica puntuaron relativamente bajas. Las puntuaciones totales relativas a la importancia de que los farmacéuticos se involucren en actividades de salud pública aparecieron en el lugar más bajo del cuestionario. Los farmacéuticos jóvenes, entre 22-30 años, obtuvieron puntuaciones significativamente más altas sobre la percepción de la responsabilidad del farmacéutico de involucrarse en varias actividades de atención farmacéutica. Los respondentes que ejercían en una farmacia acreditada puntuaron más alta en la mayoría de las preguntas. Conclusión: Los farmacéuticos de Moldova parecían estar profundamente enraizados en la aproximación tradicional del ejercicio de la farmacia, perteneciendo principalmente al modelo de ejercicio distributivo y, de algún modo, distantes de otros modelos de ejercicio como la atención farmacéutica, la información sobre medicamentos y el auto-cuidado (AU)

An assessment of community pharmacists' attitudes towards professional practice in the Republic of Moldova.

UNLABELLED: Pharmacy in Moldova is undergoing a period of transition. The professional practice is adjusting to a market-oriented economy from the previous Soviet system. The pharmaceutical sector has been liberalised giving rise to a significant increase in the number of community pharmacies. This has led to some adverse effects on the profession of pharmacy with pharmacists having considerable difficulties fulfilling their professional aspirations and possibly losing confidence in further developing their professional role. OBJECTIVE: To assess community pharmacists' attitudes towards their professional practice and to determine their perceived competence in various pharmaceutical activities. METHODS: A questionnaire which addressed managerial activities, dispensing activities, pharmaceutical care activities, inter-professional relationships, public health and competence was mailed to 600 community pharmacists who were asked to score the importance and perceived competence for each activity on a scale ranging from 0-5. In the case of pharmaceutical care activities, pharmacists were asked to score their degree of agreement or disagreement as to whether it is the responsibility of the pharmacist to engage in specific pharmaceutical care activities. RESULTS: A total of 370 valid questionnaires were returned giving a response rate of 61.7%. Managerial and dispensing activities were scored the highest both in terms of perceived importance and competence. The more innovative pharmaceutical care activities scored relatively low. Overall scores relating to the importance of pharmacists engaging in public health activities appear to be the lowest of the entire questionnaire. Younger pharmacists between the ages of 22-30 obtained significantly higher scores with regards to the perceived pharmacist's responsibility in engaging in various pharmaceutical care activities. Respondents who practiced in an accredited pharmacy scored higher in the majority of questions. CONCLUSION: Pharmacists in Moldova appear to be deeply rooted in the traditional approach to the practice of pharmacy pertaining mainly to distributive practice model and are somewhat distant from the other models of practice such as pharmaceutical care, drug information and self-care.