An Overview in Iraqi Health Care System with Special Emphasis in Pharmaceutical Dr. Mustafa AL-Hiti

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Objectives Iraq Health country profile facts and challenges.

Iraq pharmaceutical country profile facts and challenges.

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Demographics and Socioeconomic Indicators

The total population of Iraq in 2018 was 38,000,000 with an annual population growth rate of 3.4%.

The annual GDP growth rate is 1.2%.

The GDP per capita was US$ 2036(at the current exchange rate).

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Health & Demographic Data

Mortality and Morbidity in IraqThe top 10 diseases causing Mortality (Causes

55% of Mortality) The top 10 diseases causing Morbidity

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Mortality and Causes of Death

Iraq- Health Expenditure

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Health Services

Total Population 2018 38,000,000

Total expenditure on health per capita (Intl $, 2015) 154<Egypt<Jorda<IranTotal expenditure on health as % of GDP (2014) 4.5%

Share of Total Pharmaceutical Expenditure As percentage of the Total Health Expenditure 2008. The THE in 2008 was 5,138,643 million IQD (US$ 4,392 million)

https://www.who.int/medicines/areas/coordination/Iraq_PSCPNarrativeQuestionnaire_01022012.pdf 6

Health Personnel and Infrastructure

7

22000 (1/1727)

10000 (1/3800)

<Jordan 34

< Syria 23

Health Center and Hospital Statistics

8

281

2765 We need 3000

11000

Questions to Discuss Which is the highest area of priority for HR development? Paramedics Are new medical or pharmacy schools opening? Yes What about pharmaceutical technician training? Poor Are there going to be more hospitals or primary care units constructed in future? Yes Are licensed pharmacies widely located or concentrated in the capital? Yes Are there any specific plans or policies to improve retention of nationally trained

healthcare workers? (is this an area of concern? No Which partners are working with Iraq or supporting initiatives in the above areas?

WHO. What projects are they involved in and how are they assisting or collaborating?

Policies.9

Policy Framework

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Policy Issues

An official National Medicine Policy document Exists & it was updated in 2008.

A national medical policy (NMP), implementation plan does not exist. Policies addressing pharmaceuticals exists. Pharmaceutical policy implementation is not regularly monitored/assessed.

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Policy Issues

National Medicine Policy

531 (Only 49 is available

- 3000 Selected Medicine/ National selection committe . - 1166 selected to be used in Health Institute. –Between 60%-70% of medicines in the Iraqi market are not under control

Medicines Trade and ProductionIntellectual property laws and medicines- Not available.

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Iraq Manufacturing Capabilities

Medicines Trade and Production / Iraq Manufacturing Capabilities

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Medicine Regulation

Regulatory Framework

In Iraq, there is no law or act that provides power and responsibilities to a Medicine Regulatory Authority (MRA).

There are ministerial orders, but no clear document that regulates the work of MRA.

The Directorate of Technical Affairs in the Ministry of Health in addition to that state owned public pharmaceutical procurement and distribution company (KIMADIA) and the Syndicate of Pharmacy play the role of a MRA.

Regulatory Activities

Controlled Medicines Yes

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Function of the national MRA

No

Legal Provision Activity

Local Entities Inspected for GMP Compliance

Import control Yes

Legal provisions pertaining to licensing Yes

Market Control and Quality Control Yes15

Regulatory Inspection

31 Factories

LicensingLegal provisions pertaining to GDP licensing/ Legal provision activity.

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Licensing

Reasons for Medicines Testing

Market Control & Quality Control

Yes

Legal Provision

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Advertising

Medicines advertising and promotion

Legal provision exists for prescription medicines

Legal provision does not exist for non-prescription medicines; only guidelines.

Legal Provision for Clinical Trials Clinical trials Yes

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Advertising/Legal Provision for Clinical Trials

Controlled MedicinesInternational conventions to which Iraq is signatory

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Controlled Medicines

Pharmacovigilance (pv)Regenerating pharmacovigilance law No

Pv guidelines specially for Iraq Yes

Training package Yes

Medicines FinancingPopulation groups provided with medicines free of charge

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Pharmacovigilance & Medicine Financing

Medications Provided Publicly at No Cost

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Medications Cost

Duties and TaxesA public health service, public health insurance, social insurance or other sickness fund does not provide at least partial medicines coverage. Private health insurance schemes do not provide medicines coverage. In Iraq, there is no private health insurance. All Iraqis receive health care and medicines either free of charge or for a very minimal (symbolic) fee.

Patient fees and co- payment No

Pricing regulation for private sector Yes

Prices availability and affordability of key medicines Not applicable

Price components and affordability Not conducted

Duties and taxes on pharmaceuticals (market) Yes 22

Duties and Taxes

Pharmaceutical Procurement and Distribution in The Public Sector

Public sector procurement Centralized and decentralized

Public sector distribution Yes

Private sector distribution Yes

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Procurement and Distributions

Selection and rational use of medicines

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Selection and rational use of medicines

National Structure

National Essential Medication List (EML) Yes

National Standard Treatment guideline (STGS) Yes

Prescribing

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Prescribing: Legal provisions exist to govern the licensing and prescribing

practices of prescribers. Legal provisions restricting dispensing by prescribers exist

No(Essential medicine list)

STGS: Standard Treatment Guidelines

Dispensing

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Dispensing:

Legal provisions in Iraq do not exist to govern dispensing practices of pharmaceutical personal.

The basic pharmacist training curriculum includes a spectrum of components.

Characteristics of Post-Conflict Health Systems• Health Status • Service Delivery

Indicators are worse– Than they should (historically)– Than non-conflict neighbors

Double burden of disease Additional needs

– Mental Health– Disability

Damaged infrastructure poor access in some areas

Reduced utilization/coverage Specific services for IDP, not

always easy to provide Poor quality

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Characteristics of Post-Conflict Health Systems• Health Financing • Human Resources Health is not a priority Low government funding Heavy reliance on OOP and

external funding Bias towards funding hospital

care

Brain-drain towards urban areas, abroad uneven availability

Discontinued training Multiple, ad hoc created categories reliance on lowly-trained cadres, use of CHW

Weak HRH management systems

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Characteristics of Post-Conflict Health Systems• Health Financing • Human Resources Health is not a priority Low government funding Heavy reliance on OOP and

external funding Bias towards funding hospital

care

Brain-drain towards urban areas, abroad uneven availability

Discontinued training Multiple, ad hoc created categories reliance on lowly-trained cadres, use of CHW

Weak HRH management systems

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Characteristics of Post-Conflict Health Systems• Health Information

Weak regulatory capacity Dependence on direct

importers (e.g. NGOs) Disrupted supply lines

vertical supply Push systems: kits not

requiring stock control skills Multiple informal drug sellers

Routine systems fragmented along vertical lines

Weak supervision Unreliable

• Pharmaceuticals

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Some Key Findings Access to medicines is shrinking Selection of medicines can improve Illegal medicines are being sold in the private sector Pharmaceutical regulation and management are very

fragmented and need to be drastically reformed Local production is facing serious difficulties Laws and regulations needs to be reviewed Inspectorate function needs to be enhanced Procurement of vaccines can be much more efficient

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Comprehensive Pharmaceutical

Sector Assessment

Pharmaceutical Manufacturing Development

New Directorate for

Pharmaceutical Regulation

Pharmaceutical Sector Needs to be Reformed

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National Medicine

Policy

Essential Medicines

List

National Regulatory Authorities

Supply Chain

Management

Pharmaceutical Production

Rational Use of Medicines

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CONTINUED……

Part of Right to Health

Integral Component of

UHC

Part of Health System

Framework

Access to quality assured (Essential) medicines that are Safe, Effective, Acceptable, and Affordable

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ConclusionMany challenges are facing the Iraqi health system, including the pharmaceutical sector, however, Iraq pharmaceuticals market will continue its healthy growth to meet all the demands.

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Thank You for Your Attention