1. University of Wisconsin Pain & Policy Studies Group World Health Organization Collaborating Center for Pain Policy and Palliative Care Cohort III International Pain Policy Fellows Opioid Availability Action Planning Worksheet Madison, Wisconsin, USA 6 – 10 August 2012

2. University of Wisconsin Pain & Policy Studies Group World Health Organization Collaborating Center for Pain Policy and Palliative Care CountryFellow(s)PPSG member(s) IEC member(s) AlbaniaKristo HutaJody Moen Snezana Bosnjak * Stephen Connor Bangladesh Rumana Dowla Farzana Khan Marty Skemp Brown Eric Krakauer India Priya Kulkarni Shalini Vallabhan Nandini Vallath David Joranson Frank Ferris M.R. Rajagopal KyrgyzstanTaalaigul SabyrbekovaMartha Maurer Henry Ddungu * Stephen Connor Sri Lanka Nadarajah Jeyakumaran Suraj Perera Jim ClearyBishnu Paudel UkraineNataliia DatsiukAsra Husain* Tom Lynch * IEC member who will not attend Training Program, but will provide follow-up technical assistance.

3. University of Wisconsin Pain & Policy Studies Group World Health Organization Collaborating Center for Pain Policy and Palliative Care Step 1 – Develop the Action Plan Section A: State the 3-5 problems that lead to inadequate patient access to opioid analgesics. Section B: State the objective(s) that would address the problem. (WHAT) Section C: List the action steps needed to achieve the objectives. (HOW) Section D: List those who have the authority/responsibility to take the necessary action. (WHO) Section E: Indicate an approximate timeline for completion of the action steps. (WHEN) Section F: State the assistance (technical, financial) that will be needed to achieve each objective. (HOW MUCH) Section G: Expected outputs, and how measured

4. University of Wisconsin Pain & Policy Studies Group World Health Organization Collaborating Center for Pain Policy and Palliative Care Medication Information Level 6. PATIENTS Level 1: International Narcotics Control Board Level 2: National Competent Authority Level 3. Importer/Manufacturers/Distributors Level 4. Hospitals/Pharmacies/Hospice/PC programs Level 5. Physicians/Pharmacists/Other Drug Distribution System Model

5. University of Wisconsin Pain & Policy Studies Group World Health Organization Collaborating Center for Pain Policy and Palliative Care Action Plan for: Kyrgyz Republic Prepared by: Taalaigul Sabyrbekova Martha Maurer Henry Ddungu Stephen Connor 10 August 2012

6. University of Wisconsin Pain & Policy Studies Group World Health Organization Collaborating Center for Pain Policy and Palliative Care 1: State the 3-5 problems that lead to inadequate patient access to opioid analgesics – Be as specific as you can Problem 1: Problem 2: Problem 3: Problem 4: Problem 5: POLICY Oral Morphine is not available No Palliative Care Educational Program No Clinical Guidelines, Clinical Protocols and SOP on PC and Pain Relief

7. University of Wisconsin Pain & Policy Studies Group World Health Organization Collaborating Center for Pain Policy and Palliative Care A: State the problem that leads to inadequate patient access to opioid analgesics (What?) – Be as specific as you can in stating one problem 1.POLICY 1.1. AIDS – Not allowed Morphine 1.2. Prescription form – 4 stamps, 2 signs 1.3. Law No 91 On Medicines uses “Addiction” 1.4. Add IR oral Morphine into the list of Government Resolution #2 (2011) 1.5. No National Palliative Care Standarts 1.5. Draft of National Cancer Control Program does not include pain relief opioids PROBLEM 1

8. University of Wisconsin Pain & Policy Studies Group World Health Organization Collaborating Center for Pain Policy and Palliative Care 1.To advocate to amend the policy 2.Remove of regulatory barriers to use of opioids. Problem 1. B: State the objective(s) that would address the problem. Which objectives are the top priorities? (What?)

9. University of Wisconsin Pain & Policy Studies Group World Health Organization Collaborating Center for Pain Policy and Palliative Care Problem 1 C: What action steps are needed to achieve the objectives? (How?) 1.National Drug Policy review 2. Organize meeting with Drug Committee 3. Provide with WHO Guidelines 4.Highlight the changes 5.Participation in preparation of the documents, highlighting the changes to Parliamentary Committee 6.Inclusion of PC and pain relief into the National Cancer Control Program 1.Public Fund “Voice of Freedom” 2.Anti drug Committee 3.MoH 4.Member of Parliament 5.WHO Country office 6.Ministry of Justice 7.Public Fund Ergene D: List those who have the authority and/or responsibility to take the necessary action; and with whom they should collaborate. (Who?)

10. University of Wisconsin Pain & Policy Studies Group World Health Organization Collaborating Center for Pain Policy and Palliative Care Problem 1 E: Timeline for completion of action steps. (When?) 1.National Drug Policy review and Highlight the changes – 2 months 2.Organize meeting with Drug Committee – on November 2012 2.Participation in preparation of the documents, highlighting the changes to Parliamentary Committee – November- March 2013 3.Present to the Parliament – March 2013 4.Getting approval from Parliament - ? 1.PPSG 2.Soros Foundation F: What assistance (technical, financial) will be needed to achieve each objective under part “B”? (How much?)

11. University of Wisconsin Pain & Policy Studies Group World Health Organization Collaborating Center for Pain Policy and Palliative Care 1.Policy amended 2.Presence of approved regulations 3.Policy reviewed Problem 1 G: Expected outputs, and how measured

12. University of Wisconsin Pain & Policy Studies Group World Health Organization Collaborating Center for Pain Policy and Palliative Care A: State the problem that leads to inadequate patient access to opioid analgesics (What?) – Be as specific as you can in stating one problem Oral Morphine is not available PROBLEM 2

13. University of Wisconsin Pain & Policy Studies Group World Health Organization Collaborating Center for Pain Policy and Palliative Care To make oral morphine available and accessible in sufficient amounts in Kyrgyzstan Problem 2. B: State the objective(s) that would address the problem. Which objectives are the top priorities? (What?)

14. University of Wisconsin Pain & Policy Studies Group World Health Organization Collaborating Center for Pain Policy and Palliative Care Problem 2. C: What action steps are needed to achieve the objectives? (How?) 1.Analysis of regulations for OM import 2.Prepare list of Pharmaceutical companies – morphine manufactures 3.Receive documents for registration 4.Analysis prices and quality 5.Estimate by WHO methods 6.Register of oral Morphine 7.Input OM into SGP 8.Starting using OM in Bishkek and Osh first than disseminate for all country 9.Data collection (research or M&E) 1.MoH, Pharmaceutical Department 2.State Agency for Drug Control 3.National Oncology Center 4.Oncology Center in Osh town 5.Family Medicine Centers 6.Family Doctors Associates 7.PPSG/WHO 8.Soros Fund D: List those who have the authority and/or responsibility to take the necessary action; and with whom they should collaborate. (Who?)

15. University of Wisconsin Pain & Policy Studies Group World Health Organization Collaborating Center for Pain Policy and Palliative Care Problem 2. E: Timeline for completion of action steps. (When?) 1.Analysis of regulations for CM import 2.Prepare list of Pharmaceutical companies – morphine manufactures 3.Receive documents for registration 4.Analysis prices and quality 1-4 September- November 2012 5.Estimate by WHO methods 6.Register of oral Morphine – October 2012 7.Starting using OM in Bishkek and Osh - October 2012 8.OM in throughout country - ? 1.PPSG 2.Soros Foundation F: What assistance (technical, financial) will be needed to achieve each objective under part “B”? (How much?)

16. University of Wisconsin Pain & Policy Studies Group World Health Organization Collaborating Center for Pain Policy and Palliative Care 1.Oral Morphine will available and accessible 1.1. OM registered 1.2. Quantity of OM consumed Problem 2 G: Expected outputs, and how measured

17. University of Wisconsin Pain & Policy Studies Group World Health Organization Collaborating Center for Pain Policy and Palliative Care A: State the problem that leads to inadequate patient access to opioid analgesics (What?) – Be as specific as you can in stating one problem No Clinical Guidelines, Clinical Protocols and SOP on PC and Pain Relief PROBLEM 3

18. University of Wisconsin Pain & Policy Studies Group World Health Organization Collaborating Center for Pain Policy and Palliative Care To ensure PC is understood and provided in streamlined way to guarantee quality service delivery at all Heath Care Levels in KR Problem 3. B: State the objective(s) that would address the problem. Which objectives are the top priorities? (What?)

19. University of Wisconsin Pain & Policy Studies Group World Health Organization Collaborating Center for Pain Policy and Palliative Care Problem 3. C: What action steps are needed to achieve the objectives? (How?) Develop Clinical Guidelines, Clinical Protocols and SOP on PC and Pain Relief - Identify the existing guidelines - Adapting to KR - Getting approval of MoH - Publishing - Implementation and dissemination among health care workers throughout country 1.KMSIP and CME 2.MoH 3.National Oncology Center 4.Oncology Center in Osh town 5.PPSG 6.FSK 7.Public Fund Ergene D: List those who have the authority and/or responsibility to take the necessary action; and with whom they should collaborate. (Who?)

20. University of Wisconsin Pain & Policy Studies Group World Health Organization Collaborating Center for Pain Policy and Palliative Care Problem 3. E: Timeline for completion of action steps. (When?) 1. Develop Clinical Guidelines – September 30, 2012 Clinical Protocols and SOP on PC and Pain Relief – December 15, 2012 - Identify the existing guidelines - Adapting to KR - Getting approval of MoH - Publishing -Implementation and dissemination among health care workers throughout country - Ongoing process 2. Develop PC National Standards - ? 1.Evidence based Center of the MoH 2.KSMIP and CME 3.National Oncology Center 4.PPSG 5.Soros Foundation F: What assistance (technical, financial) will be needed to achieve each objective under part “B”? (How much?)

21. University of Wisconsin Pain & Policy Studies Group World Health Organization Collaborating Center for Pain Policy and Palliative Care 1. Clinical Guidelines, Clinical Protocols and SOP on PC and Pain Relief will developed 2. PC National Standards will be developed Number of published CG, CP Number of educated health workers Problem 3 G: Expected outputs, and how measured

22. University of Wisconsin Pain & Policy Studies Group World Health Organization Collaborating Center for Pain Policy and Palliative Care A: State the problem that leads to inadequate patient access to opioid analgesics (What?) – Be as specific as you can in stating one problem No Palliative Care Educational Program: - for health workers -for population -for special group PROBLEM 4

23. University of Wisconsin Pain & Policy Studies Group World Health Organization Collaborating Center for Pain Policy and Palliative Care 1. Develop and implement educational programs into under and postgraduate medical institutions (Development of an academic program that prepares physicians and nurses to specialize in palliative care. Possibly a diploma program or fellowship and certification) 2. Develop and implement public awareness campaign on pain relief Problem 4. B: State the objective(s) that would address the problem. Which objectives are the top priorities? (What?)

24. University of Wisconsin Pain & Policy Studies Group World Health Organization Collaborating Center for Pain Policy and Palliative Care Problem 4. C: What action steps are needed to achieve the objectives? (How?) 1.Incorporation of palliative care issues into major pre-graduation curricula (KSMA, KRSU, medical faculty of Osh state University) and post-graduate curricula for upgrading qualification of doctors, nurses, social workers в (KSMI and CME) 2.Training of family members, development of patients schools, development of peer to peer education 3.Expansion of the role of public health in development and implementation of solutions of physical, psychological problems emerging in progression of an incurable disease 4.Development and incorporation of palliative care educational programs for social workers, members of patients’ families 5.Conducting of media campaigns on PC 1.MoH 2.Ministry of Education 3.Kyrgyz State Medical Academy 4.Kyrgyz Russian Slavonic University 5.Medical faculty of Osh state University 6.Kyrgyz State Medical Institute and CME 7.Social Workers Association 8.National TV and Radio 9.NGO and PP Union D: List those who have the authority and/or responsibility to take the necessary action; and with whom they should collaborate. (Who?)

25. University of Wisconsin Pain & Policy Studies Group World Health Organization Collaborating Center for Pain Policy and Palliative Care Problem 4. E: Timeline for completion of action steps. (When?) 1.Develop/adapt educational program – 6 months 2.Implement educational programs into under and postgraduate medical institutions – September 2013 3. Develop and implement public awareness campaign on pain relief - since September 2012 -? 1.KSMIP and CME 2.National Oncology Center 3.PPSG 4.Soros Foundation F: What assistance (technical, financial) will be needed to achieve each objective under part “B”? (How much?)

26. University of Wisconsin Pain & Policy Studies Group World Health Organization Collaborating Center for Pain Policy and Palliative Care 1.Curriculum will be included into medical school’s educational programs 2.Number of educated doctors, nurses, social workers, students Problem 4 G: Expected outputs, and how measured