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The Pharmaceutical Situational Analysis in

Mongolia

Chimedtseren Munkhdelger1 Sanjjav Tsetsegmaa2,

1Ministry of Health, 2Pharmacy School, Health Sciences

University

Third International Conference For Improving Use of Medicines, November 14-18, 2011, Antalya, Turkey

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Background• General information about Mongolia

– territory: 1.564,116 km2 – population: 2.78 million – provinces: 21( which are divided

into 329 counties) – capital city: Ulaanbaatar (9 districts)

• The National Medicine Policy of Mongolia (NMPM) was approved by the Parliament in 2002.

• The Law on Drugs and Medical Devices (1998) was amended twice and was revised by the Parliament in 2010.

• The EML was initially approved in 1991. Since then it has been revised every four years.

• 2nd Pharmaceutical Sector Assessment was conducted in 2004.

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Purpose of the study

Identify strengths and weaknesses in the pharmaceutical sector of Mongolia and develop recommendations for future improvements and possible interventions.

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Methods

• “WHO Operational package for assessing, monitoring and evaluating country pharmaceutical situations: Guide for coordinators and data collectors” was used.

• The study was conducted in 5 geographical areas and the capital city.

• The key medicines were chosen based on the disease pattern in Mongolia and several discussions held with health professionals.

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Methods: Selecting the geographical areas & sampling

Selected the geographical

areas

Number of Sampled facilities Number of

sampled patients

Public health

facilities

Private pharmacy

Whole saler

Ulaanbaatar 5 5 1 30Western region 5 5 1 30

Eastern region 5 5 1 30Gobi region 5 5 1 30Mountain region

5 5 1 30

Central region 5 5 1 30

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Results: Availability of key medicines (%)

Public

hea

lth fa

cilitie

s

Pivate

pha

rmac

ies

War

ehou

ses

Count

ry a

vera

ge

0102030405060708090 80 86.75 88.7

85.13

64.52

2009

2004

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Results: Affordability of treating moderate pneumonia (daily wage)

Public facility Private facility 0

0.20.40.60.8

11.21.41.61.8

1.71.8

0.9 0.9 Affordability of treatment for adultsAffordabilty of treatment children under 5 years of age

Cost of treating moderate pneumonia Affordability= ------------------------------------------------------ Lowest daily salary of unskilled government worker

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Results: Geographical accessibility to facilities

Public health facilities Private pharmacy0

1

2

3

4

5

6

7 6.7%

3.3%

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Rational use of medicine• The percentage of antibiotics per encounter increased

from 15% to 46.7% since the last assessment. • The average percentage of injections per encounter

decreased from 12% in 2004 to 6.70% in 2009. • The percentage of medicines prescribed by generic

name in public health facilities was 68.7% on average.

Quality• The best result for adequate conservation condition

and handling in storage rooms was observed in wholesaling companies (86%) followed by retail pharmacies (81.8%) and least in public health facilities (72.7%).

Results:

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Policy implications To improve the accessibility and availability of essential medicines:• Advance the medicine supply management skills of

health personnels at various levels,• Develop the medicine pricing policy and enhance the

transparency in it’s implementation procedures.

To improve medicine quality:• Improve the storage conditions of medicines in public

health facilities,• Ensure that the local manufacturers comply with GMP

requirements with proper certification,• Establish PMS for registered medicines.

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Policy implications

To improve rational use of medicine: • Improve the prescribing and dispensing practices by

organizing trainings and educational programs, i.e. rational medicine use with support of the Government,

• Investigate and develop interventions for the misuse of antibiotics to further decrease the number of patients receiving antibiotics.