Improving access to quality essential medicines in Kyrgyzstan

WHO/Mihail Grigorev

In June 2017, Kyrgyzstan introduced 3 new laws focused on medicines and medical devices. National health authorities worked for several years on developing these strategic laws, and WHO actively contributed to the process and promoted their adoption.

The new laws on medicines allow the state to regulate the prices of essential medicines, making them more affordable to patients. Improving access to quality essential medicines for the population is a significant measure for strengthening a country’s health system. It is also an integral step forward on the path to universal health coverage, which Kyrgyzstan set out to achieve when it adopted the Sustainable Development Goals.

Referring to the process, Dr Kosmosbek Cholponbaev, Minister of Health of Kyrgyzstan said, “Technically and financially WHO helped a lot. Moreover, we have studied all the rules and practices that exist around the world and have developed our own drug pricing policy”.

Kyrgyzstan’s path to accessing essential medicines

In Kyrgyzstan, almost all citizens pay for medicines out of pocket and the state only pays for 10% of the cost. Medicines are the second-largest expenditure for most families after food. Recent studies have shown that essential medicines in Kyrgyzstan are among the most expensive in the world. The markups on the cost of medicines by pharmaceutical companies can reach as much as 130%.

Historically, during the early years of Kyrgyzstan’s independence, the government did not interfere with prices in the pharmaceutical market. Meanwhile, price controls were actively established and revised in many countries of the European Union. Many countries of the Commonwealth of Independent States – including Azerbaijan, Kazakhstan, the Republic of Moldova, the Russian Federation, Ukraine and Uzbekistan – have adopted laws on pricing regulation.

In August 2017, 3 new strategic laws on regulating medicines and health technologies came into effect in Kyrgyzstan. The laws were a major turning point in strengthening the Kyrgyz health-care sector overall.

Promoting new laws and strengthening collaboration

In 2018, national authorities, with WHO’s support, made bold steps towards the development of bylaws in different areas of medicines and medical devices regulation necessary to implement and fully enforce these new legal provisions.

To ensure correct interpretation, additional bylaws were also introduced to support medicine pricing regulation, enhancing overall regulation in this sector. In this context, WHO continues to provide specific technical assistance to Kyrgyzstan to achieve internationally recognized standards on:

  • the regulation of quality and circulation of medicines and medical devices
  • post-marketing control and monitoring of medicines and medical devices
  • the transparency, predictability and accountability of the pharmaceutical sector.

The state can now monitor the effectiveness and side effects of drugs that have already been allowed onto the market through post-marketing control measures. High-quality medical products will now enter the market more easily, because medicines that have already been tested by strong regulatory authorities – such as the United States Food and Drug Administration or the European Medicines Agency – or prequalified by WHO, will be given preference.

“Enforcement of the laws will have a positive impact on the availability of safe, effective and affordable medicines and medical devices in Kyrgyzstan, which is a key pillar of universal health coverage and the health-related Sustainable Development Goals,” said Dr Nazira Artykova, WHO Representative and Head of the WHO Country Office in Kyrgyzstan.

Strengthening capacity of the National Medicines Regulatory Agency

In order to implement the new laws effectively, the country must increase the capacity of governmental institutions and authorities responsible for the regulation of the pharmaceutical sector. WHO is assisting in this process by supporting the Kyrgyz National Medicines Regulatory Agency (NMRA) to conduct a self-assessment and produce an institutional development plan. The NMRA plays a key role, serving as a gatekeeper for medicines entering the national market.

The NMRA is currently assessing the maturity of its regulatory function, using a harmonized approach: the WHO Global Benchmarking Tool. WHO technical assistance will enable the identification of strengths and areas for improvement, as well as the elaboration of an institutional development plan. This plan will identify the technical and financial support needed for its implementation with continued monitoring of progress and impact.

To further promote health equity, Kyrgyzstan recently updated its national list of essential medicines. This document provides guidance on which medicines are considered most effective and safe, and meet the most important needs in the country’s health system, and should therefore be accessible and affordable for the population. The updated national list contains 85% of the medicines on the WHO Essential Medicines List, which recommends medicines with proven clinical efficacy and safety as well as comparative cost-effectiveness. The WHO Essential Medicines List is revised every 2 years, and is a guide for countries on the core medicines that a national health system needs.

Going forward, WHO will continue to work closely with the Ministry of Health in ensuring access to essential medicines. Effective regulatory systems are an essential component of health systems and contribute to better public health outcomes. WHO plays a pivotal role in supporting countries in strengthening their regulatory systems to ensure that all medicines brought onto the market are safe and effective.