Central Asian Republics

The central Asian republics—Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan and Uzbekistan—face daunting challenges toward improving their national health systems due to changes in economic status and restructuring of governments since the dissolution of the Soviet Union. Since gaining independence, poverty in Turkmenistan, Kyrgyzstan, and Tajikistan has risen significantly and, with it, the burden of disease. Due to severe shortages of equipment and drugs and a lack of trained physicians, the quality of overall healthcare has deteriorated drastically.

Despite a slight decrease in rates, tuberculosis still threatens public health in the Eastern European region. Seventy-five percent of reported TB patients reside in the Central Asia Republics and, according to data, cases in this area are also more likely to be multidrug-resistant TB (MDR-TB) than in the rest of the world. The rise in the number of instances of HIV/AIDS in the vicinity presents additional hardship.

The Central Asia Republics in general, and Kyrgyzstan and Uzbekistan in particular, have made efforts to improve the implementation of national tuberculosis control programs by introducing or expanding the internationally known directly-observed treatment short-course (DOTS) strategy and applying to the Global Fund to Fight HIV/AIDS, Tuberculosis and Malaria. Yet despite having all essential TB drugs available and following the treatment protocols, MDR-TB rates in the region remain high.

Because drug quality may play a role in this occurrence, USP DQI joined Rational Pharmaceutical Management Plus (RPM Plus) in an activity targeting the quality of drugs being procured by the Central Asian countries. Based on results of drug sampling and testing performed in four regions of Kazakhstan, USP DQI and RPM Plus conducted workshops on drug quality issues in Kazakhstan. The two programs followed up those awareness-raising activities by providing Minilab kits—portable, easy-to-use self-contained laboratories—and training for Kazakhstan, Kyrgyzstan, Tajikistan, and Uzbekistan to assist them in detecting counterfeit and substandard medicines.

Kazakhstan

The largest and wealthiest of the republics created by the break-up of the Soviet Union, Kazakhstan has made significant economic progress but more than 30% of the population still lives below poverty level. The transition wreaked havoc on the country's public health systems as well which deteriorated from providing basic care even in remote areas to no longer allowing private treatment of cancer, tuberculosis, venereal disease, pregnancy, and infectious diseases. During the 1990s, the lack of medicine and facilities generated outbreaks of several potentially epidemic diseases, including tuberculosis (TB). The situation has improved since the Kazakh president called for wide-ranging reforms, doubled the health budget, and passed significant legislation to improve the overall health system and establish a drug quality control laboratory in each of the 14 oblasts.

Kazakhstan is making an effort to improve the implementation of national tuberculosis control programs by introducing and expanding an internationally known regimen, the directly observed treatment short-course (DOTS) strategy. In 1998, DOTS population coverage reached 100%. Despite this achievement, however, the country was identified in the WHO Third Global Report as one of the hot spots for multi-drug resistance tuberculosis (MDR-TB) with a prevalence of over 10%. In order to reach the global target of detecting 70% of new-smear positive patients and curing 85% of them, the quality of DOTS implementation still needs to be improved.

Proper drug management has been one of the hurdles in TB control efforts. Since 2001, the Rational Pharmaceutical Management Plus (RPM Plus) Project has been assisting Kazakhstan to improve the anti-TB drug decentralized procurement mechanism. As part of this activity, USP DQI collaborated with USAID and international partners in 2003 to collect samples of selected anti-TB drugs from four regions of the country to be tested for quality in two local laboratories. Based on results of this testing—all anti-TB drugs were found to be of good quality—a training workshop on drug quality issues in Kazakhstan followed, conducted in cooperation with other international organizations and local partners. Most recently, USP DQI and RPM Plus conducted a five-day training workshop on how to use a Minilab kit—a portable, easy-to-use self-contained laboratory for the detection of counterfeits and substandard pharmaceuticals—for representatives of the Drug Regulatory Agencies and National Quality Control Laboratories of Kazakhstan, Kyrgyzstan, Tajikistan, and Uzbekistan. The regional focus encourages communication and shared experiences among local counterparts.