While the tugrug exchange rate against the United States dollar went over 1900 last week, another incident took place and shocked the society.. Sixteen babies up to three months old were poisoned by excessive dosages of phenobarbitalmistakenly provided by a Monos pharmacy.Although Monos did not produce this drug, they still are the biggest pharmaceutical chain of Mongolia and it was one of their employeeswho acted in an irresponsible way that produced such consequences. What can we expect from other pharmacies supplied by private dealers when such incident is caused by Monos, our leading pharmaceutical manufacturer?
Mongolia has a population of less than three million, but our pharmaceutical industry has 32 manufacturers, 1283 pharmacies, and 120 suppliers. Half of our population as well as two-thirds of all pharmacies in Mongolia are located in Ulaanbaatar. There are over 3000 different drugs registered in the national directory and most of the drugs are imported from Russia, China, Slovakia, India, and Germany. In comparison, Finland, which has a population of five million, has 24 hospital pharmacies, 224 medicine centers, and 800 private pharmacies. It is reported that 88 percent of their population are content with the health services they receive.
Supply and use of drugs is one component of our healthcare system. When you look more deeply into it and analyze the serious deviations from the standard, it can be seen that our healthcare system needs to be changed fundamentally.
DEVIATION IN USE
Mongolians today are consuming drugs so carelessly as if they are eating bread and butter. People are having aspirin when they have a headache, ftalazol for stomachache, antibiotics for flu, and injections for exhaustion. When someone is not feeling well, a family member comes up with a diagnosis and purchases drugs from the nearest pharmacy without any prescription.Just like developed countries have coffee shops on every street, we have kiosks with the name of ‘pharmacy’ almost in every apartment building. Mongolians are spending about 170 billion tugrugs on drugs annually.
Normally, if someone finds out that his health is not in a good condition, he should go to a hospital, have medical examinations, receive a diagnosis, get a prescription, and do what the doctor says rather than rush off to a pharmacy straightaway.People could tend to buy drugs immediately due to lack of availability of doctors, family health centers, and health service, especially in soums and baghs. It is also said that Mongolian doctors are not beingvery enthusiastic when writing prescriptionsthat their handwriting is almost unreadable.On the other hand, all pharmacies have been privatized, so hospital pharmacies stopped serving the general population. Therefore, drug sales have fully become market-oriented.
It has become common for Mongolians to self-medicate or take whatever drugs that are suggested by a random pharmacist. Some people forcefully purchase medications that are supposed to be given only when there is prescription. It produces a wide range of negative consequences including people poisoning themselves over many years and getting chronic diseases. In contrast, a person who was treated in Korea says that Korean doctors gave him a medication for regulating blood pressure along with two others that mitigate the side effects and prevent the stomach from getting a shock.
Initially, pharmaceutical drugs were a very profitable business in Mongolia, which is why many individuals used to bring drugs from abroad just like they did with food productsand asked pharmacies they befriended to sell them.However, it should be noted that such activities have been reduced lately as the competition is getting fiercer. As more urbanization is coming our way, we increasingly need to improve our knowledge on health and keep ourselves healthy by exercising rather than taking drugs.
DEVIATION IN SUPPLY
Approximately 30 domestic companies are producing many pharmaceutical drugs, both that are officially registered and unregistered, while we import more than 1300 different drugs from over 120 foreign companies. Also, individuals are bringing hundreds of drugs in their handbags and luggage when they are coming back to Mongolia. Those drugs are then distributed to the general population regardless of whether there is a prescription or not. These are all happening in Mongolia and it is being allowed to happen.The government organization in charge of quality, production, supply, and distribution of drugs is not the Ministry of Health, but the State Specialized Inspection Agency. It is quite clear that the 150 employees that the agency has in total would be nowhere sufficient enoughto cover every industry and every services sector.
The law states that drugs that are to be consumed by Mongolians must be registered and permitted regardless of whether they were produced domestically or imported. However, half of drugs sold by pharmacies todayare not registered. It is because a drug can be registered only after two years since being included in the pharmacopeia, a book containing the names of drugs and information about production and use. The chairman of the ‘pharmacopeia committee’, which has the authority to sign off the final approval for drug registration, has been linked to a corruption case and is being investigated by court. As a result, the committee had a chance to convene a meeting only a few times and about 10 different drugs are approved on one meeting. Therefore, there are many drugs that are still not registered.However, those drugs have been produced since the socialist era, which means that there is a traditional demand in the market and the drugs are still being sold despite the registration issue.
The drugs being sold in pharmacies can be registered or not registered. But, it does not necessarily mean that they are permitted or not permitted. Also, it turns out that hospital pharmacies do not have the permit to serve the general population; they can only prescribe medication to their patients.
CHANGE IN SYSTEM AND ATTITUDE
It is time to change not only the drug supply system, but also the attitude towards pharmacies. As other countries do, we should start seeing pharmacies as a station that distributes pharmaceutical drugs and a part of the wider health care system.
In order to bring better organization in pharmaceuticals supply, validate their quality, and have pharmacies become fully compliant and stop purchasing drugs from individuals, we need to introduce risk management and start demanding the insurance of the responsibilities before others. In a market economy, insurance organizations regulate issues related to safety and responsibility. Some of the health quality responsibilities of the State Specialized Inspection Agency could be transferred to other organizations such as health insurance companies or other insurance companies.
It is time for us to demand construction companies, pharmaceutical manufacturers, pharmacies and other specialized organizations to insure the responsibilities they have before others. Insurance organizations receive a small amount of payment for insuring those organizations for their responsibilities before the society. Therefore,insurance companies make regular assessments on their safety, professional skills, risk management, and others. If there are more risks, they increase the payment they receive, which becomes an economic leverage for those organizations to improve their risk management. If there are continuous issues of risks, they cannot find an insurance company to serve them and go out of business.
When providing compensation for health services payments, the health insurance authority of Mongolia needs to check whether diagnosis and treatment were right just like they do in developed countries.When getting medical treatment in Seoul, Mongolians are regarded as the most ‘profitable’ clients because we make all payments for any treatment right away as there is no insurance provided by insurance companies with professional medical practitioners.
Let us first reform the impaired health system!