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

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

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 was performed during 2011–2012, with the purpose of providing the Ministry of Health with comprehensive evidence regarding access to essential medicines of good quality. This report presents the results, based on a secondary analysis of evidence collected during a series of assessments conducted by the World Health Organization Regional Office for Europe in collaboration with the Ministry of Health of the Republic of Moldova, the Medicines Agency, Nicolae Testemitanu Republic of Moldova State Medical and Pharmaceutical University, and Health Action International. The assessments covered the areas of: public procurement; main regulatory functions; availability, affordability, prices and price components of essential medicines; and an evaluation of the essential list of medicines, prescribing practices and pricing policies. The main recommendations of the report provide insights into ways of improving regulatory and procurement practices, along with the best methods to constrain 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

ASSESSMENT OF THE COMMUNITY PHARMACY PRACTICE IN THE REPUBLIC OF MACEDONIA- BUILDING PLATFORM FOR IMPLEMENTATION OF GOOD PHARMACY PRACTICE

The objective of the study was to evaluate the actual status of the community pharmacy practice and quality of services and to identify the gaps and barriers to implement the best pharmacy practice and care. Cross-sectional descriptive survey was conducted for the pharmacies/pharmacists where pre-coded multiple choice closed questions were used with response format: activity fully applied, partially applied, applicable or not applicable. Set of 155 indicators was developed covering five essential components: pharmacy structure and practice; patient safety; manufacture practice; staff workflow and competences and quality assurance. The actual score was 64 out of 100. Pharmacy services related to manufacture practice and quality assurance were identified as the areas of highest priority for improvement, followed by the services related to patient safety. Priorities for intervention by key stakeholders (national authorities, academia, professional associations and pharmacists) and recommendations for introducing new and improving the existing roles of the pharmacists were defined. Key words: community pharmacy practice, services, standards, Republic of Macedoni