Editor in Chief: Moh. Reza Huwaida Sunday, October 25th, 2020

The Pharmaceutical Challenges in Afghanistan

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The Pharmaceutical Challenges in Afghanistan

Yesterday, it was coincided with world pharmacists’ day. Ahmad Jawad Osmani, the acting minister of public health, speaking  in a related ceremony, as local report quoted, said that around $400 to $600 million dollars is spent annually to import medicine to Afghanistan. According to experts, this extreme dependency is  not only a major blow to the local economy but also a blow to public health due to low quality medicine which specially produced for Afghanistan. Although the government made some good efforts in last two decades to pave ground for drug production inside the country, we have not been to produce enough medicine inside the country. As a result, a huge amount of money is poured to the packet of regional producers, importers and smugglers who import or produced the lowest quality medicine for Afghanistan. Therefore, a large number of Afghan people undertake a long and  uneasy trip expenses to neighboring countries for treatment as a result of low quality health service inside the country while a large part of problem is rooted in low quality medicine imported through smuggling or other corrupt channels.
Undeniably, the corruption is the first important factor which has challenged everything including health sector. The corruption issue not only pave the ground for smuggling but also override almost every step of the importation process, including quality control checkpoints at the border, importing pharmaceuticals beyond those listed permitted by the health officials. Corruption can also play role in getting licenses illegally and producing low quality medicine inside and outside the country. Corruption can ensures companies produce the drugs are not evaluated for the quality of their products or followed proper storage and cold chain maintenance procedures before and during transport. During the summer, pharmaceutical are often transported through areas that reach 40 centigrade, ensuring the many medications will be spoiled, but sold to consumers anyway. In addition, pharmaceutical transport to and through Afghanistan is exposed to many of the same vulnerabilities found in Afghanistan’s notoriously corrupt border management system.
Seemingly, the rules, regulations and mechanisms that govern pharmaceutical imports in Afghanistan need to be significantly revised, as there are procedures that, if followed, could mitigate the importation of poor quality pharmaceuticals. Thus, the Licensed National Pharmaceutical List that allow which products can be imported, produced, and distributed need to be regularly updated. The Pharmaceutical Law deals with selection, production, importation, distribution and consumption of pharmaceutical products in the country but if It was enacted in past different circumstances it must be revised. In the other world, given the dramatic increase in the volume of low quality pharmaceutical imports, these law and mechanism is not functional therefore need of substantial change. Aside from the highly permissive environment the Pharmaceutical Law provides importers, it is blamed for deficient in addressing conflict of interest issues that are easily exploited by government staff. It is said that many MoPH staff members have direct or indirect business relationships with pharmaceutical companies.
In other word, It seems that the entire medicine importation process is highly vulnerable to corruption, from registration of pharmaceutical companies to laboratory-based quality control. Enormous financial incentives to engage in illicit importation of pharmaceuticals has led to an increase in smuggling, as well as the creation of an entire industry dedicated to producing and importing low quality pharmaceuticals into Afghanistan. For example, it is estimated a large amount of pharmaceuticals imported into Afghanistan are produced, in neighboring countries, specifically for the Afghanistan market. It is widely believed that the dramatic increase in the number of pharmaceutical companies in certain neighboring countries is due to the ease with which low quality medicines can be produced and imported with relatively little oversight or quality control. Many of these companies are not allowed to sell their products in their own market, but are permitted to export their products to Afghanistan. As a result, enormous profits can be made particularly since the producing companies do not even need to meet their local quality control standards as long as the pharmaceuticals are produced for export to Afghanistan only. This raises serious concerns over Afghanistan’s importation standards, even relative to the region.
In addition to corruption and low quality issue in pharmaceutical industry, there is imbalanced medicine price in the country. Some of the so-called doctors have secret link with the pharmacists writing prescription in a surreptitious way so that the patients cannot provide the medicine from other pharmacists. Misusing from their job they impose high priced medicine on the poor and suffering people. In fact, these types of misuses are more dangerous than street attacks by robbers or house burglars because they suck the blood of poor and suffering patients while the street robbers or house burglars do not attack on poor patients. Unfortunately, the ministry of public health has no serious mechanism to control such hidden oppression in the country while in other countries the retail price of medicine is written on the medicine pack so as to prevent from misuses. Therefore it is expected from the health officials to take the same measures so as to end such pestiferous behavior in the country.
In short, there is a serious need to limit the volume of low quality pharmaceutical products entering Afghanistan through a range of reforms to the registration and licensing process, retail price, as well as broader regulatory reforms. On the other hand, promoting technical surveillance and monitoring capacity is important to ensure that production and import companies are adequately vetted, and that pharmaceuticals entering the country are subjected to rigorous quality control. It is one of the important government duty to minimize the effect of low quality pharmaceuticals undermine the human rights of citizens to quality health goods and services.

Mohammad Zahir Akbari is the permanent writer of the Daily Outlook Afghanistan. He can be reached at mohammadzahirakbari@gmail.com

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