World Health Organization
 Collaborating Center on
 Pharmaceutical Policy

    Improving Access to and Use of Essential Medicines



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Central Asia Projects

ZdravPlus Central Asia Health Reform Project

The 5-year USAID ZdravPlus Project provides resources to help the governments of Central Asia to improve the financial sustainability, efficiency, and quality of their health care while preserving equitable access. Implemented by US-based consulting firm Abt Associates and partners, the ZdravPlus Quality Public Health and Primary Health Care in Central Asia Project operates in Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan and Uzbekistan. Partners include John Snow Inc. (JSI), Boston University School of Public Health Center for International Health and Development led by Brenda Waning, Scientific Technology and Language Institute (STLI), CitiHope International, Morehouse School of Medicine, Institute for Sustainable Communities, and Socium Consult (Kyrgyzstan). The role of Boston University, as a sub-contractor to Abt Associates, is to set the technical agenda, provide technical assistance, build local capacity, conduct research, monitor and evaluate interventions, engage in policy dialogue and promote collaboration among local and international counterparts on pharmaceutical issues as they relate to evolving health reforms.

The primary emphasis of the group is on drafting, revising, implementing, and evaluating pharmaceutical policies to support the health reforms. The emphasis in Kyrgyzstan and Kazakhstan is focused around the establishment, maintenance and expansion of health insurance systems for medicines. Other regional and country level work has addressed medicine quality, decentralization of medicine procurement, medicine prices, human resource shortages, and evidence-based medicine, including selection and standard treatment guidelines and rational use of medicines. The Boston CCPP, in conjunction with WHO Euro and WHO Geneva co-facilitated a National Drug Policy launch and implementation meeting in Dushanbe, Tajikistan.


CAPACITY Central Asia HIV/AIDS Project

The Central Asian Program on AIDS Control in Vulnerable Populations (CAPACITY) Project is a 5-year HIV-prevention project funded by the US Agency for International Development (USAID) and implemented in the five Central Asian countries of Kazakhstan, Kyrgyzstan, Tajikistan, Turkmenistan and Uzbekistan. The purpose of the CAPACITY Project is to provide technical support and assistance to the countries of Central Asia in their efforts to launch large-scale and urgent responses to HIV/AIDS epidemics among vulnerable populations. The CAPACITY Project is managed by JSI Research and Training Institute, Inc. in partnership with Abt Associates Inc, Brenda Waning of Boston University, Howard University, the International HIV/AIDS Alliance, and Population Services International.

The role of Boston University is to set the technical agenda, provide technical assistance, build local capacity, conduct research, monitor and evaluate interventions, engage in policy dialogue and promote collaboration among local and international counterparts on pharmaceutical issues as they relate to provision of anti-retroviral therapy (ART) services, including anti-retroviral (ARV) adherence and integration of AIDS services.


USAID Project to Increase Access to Medicines in Rural Kyrgyzstan

Under the USAID/Central Asian Program on AIDS Control in Vulnerable Populations (CAPACITY) Project, qualitative research conducted by Brenda Waning, Paul Bolton and Judy Bass examined barriers to antiretroviral therapy (ART) uptake and adherence in Temirtau, Kazakhstan where the regional HIV/AIDS epidemic is concentrated and most prevalent among intravenous drug users (IVDU) and substitution therapy for IVDU is illegal. Free list and key informant interviews suggested barriers to uptake and adherence to ART include:  widespread discrimination and stigma with regards to both HIV/AIDS and IVDU; adherence information as provided by health professionals instills fear such that patients feel they are better off to never begin ART than to begin ART and miss a few doses and fear that side effects will be more uncomfortable than disease progression; no community experience of successful outcomes with ART and a resultant disbelief in ART efficacy; feelings of being guinea pigs for US research; distrust in free generic medicines; single and centralized/vertical delivery system with limited hours of operation; difficulty in keeping track of IVDU patients as they travel through detoxification, rehabilitation, and prison systems. Follow-on work includes the design, implementation and evaluation of interventions to address some of these barriers.

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Information from the Third International Conference for Improving Use of Medicines, ICIUM2011