1. The Pharmaceutical Situational Analysis in Mongolia 1 Chimedtseren Munkhdelger 1 Sanjjav Tsetsegmaa 2, 1 Ministry of Health, 2 Pharmacy School, Health Sciences University Third International Conference For Improving Use of Medicines, November 14-18, 2011, Antalya, Turkey

2. Background General information about Mongolia –territory: 1.564,116 km 2 –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. 2 nd Pharmaceutical Sector Assessment was conducted in 2004. 2

3. Purpose of the study Identify strengths and weaknesses in the pharmaceutical sector of Mongolia and develop recommendations for future improvements and possible interventions. 3

4. 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. 4

5. Methods: Selecting the geographical areas & sampling Selected the geographical areas Number of Sampled facilitiesNumber of sampled patients Public health facilities Private pharmacy Whole saler Ulaanbaatar55130 Western region55130 Eastern region55130 Gobi region55130 Mountain region 55130 Central region55130 5

6. Results: Availability of key medicines (%) 6

7. Results: Affordability of treating moderate pneumonia (daily wage) Cost of treating moderate pneumonia Affordability= ------------------------------------------------------ Lowest daily salary of unskilled government worker 7

8. Results: Geographical accessibility to facilities 8

9. 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%). 9 Results:

10. 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. 10

11. 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. 11