By Ata Garlyev
On 21 July President Gurbanguly Berdymukhammedov extended his greetings to healthcare practitioners in connection with their professional holiday.In his address to medical doctors the head of state boasted that Turkmenistan “had strengthened its position in the global arena as a powerful nation with highly-advanced medicine” and added that “all the necessary conditions have been created to extend life expectancy, prevent diseases and develop medical science”.
It appears that viewed from above, life in Turkmenistan does look so optimistic but the gold wrapping of this “candy” conceals a rather unpleasant filling.
A year ago the government provided the departments of in-patient medical facilities with free medications.The business unit of the medical association “Turkmenfarmatsia” was responsible for procuring medications both on the domestic market and overseas.
One half of the pharmaceuticals was used to supply hospitals whereas the second half was sent to in-house pharmacies of the association.
Since early 2018 free medications have no longer been supplied to hospitals. According to some sources, “Turkmenfarmatsia” faced constraints due to problems with foreign currency conversion. Patients now have to buy medications for a course of treatment in pharmacies at their own expense.
A short list of free medications has remained in emergency care departments these are I.V. solutions and a few Indian and Chinese antibiotics. At the same time, the emergency departments have issued a price list of medications which healthcare practitioners will use only if the patient can afford to pay for them.
Essential medications are available in pharmacies but patients prefer to pay for the drugs they need in the hospital there is no need to rush to pharmacies and there is no big difference in prices.
This is a real Klondike for local tycoons of the pharmaceuticals business since according to statistics it is in the in-patient medical facilities rather than out-patient clinics where the majority of prescriptions are made out.
Moreover, in this manner local pharmacies are excluded from the scheme of medications sale by “Turkmenfarmatsia” and for this reason suppliers and companies seek market entry to it.
In some cases expired medications are used to treat low-income patients who cannot afford to buy them.Yet, the number of such patients is increasing, which results in a deficit of medications.
At the same time, a constant price hike is recorded in pharmacies.
It should be emphasized that those diagnosed with tuberculosis, cancer or HIV positive patients do get some specific medications free of charge as these categories of patients are controlled by the WHO, otherwise this business would have been “shut down” long ago.
Yet, there have been some cases when healthcare practitioners tried to extort money for free medications to which the patients were entitled by law.
On the quality of medications
The bulk of the free medications list is made up of cheap drugs including Indian and Chinese pharmaceuticals, with the quality being related to the price.
It is noteworthy that a medical doctor is obliged initially to prescribe free medications available at the hospital department, which is included in the medication administration record, and only later, in case the patient’s medical condition does not improve, which happens in the majority of cases, may prescribe high quality efficient medications.
Despite the inefficiency of cheap generics and substitutes, “Turkmenfarmatsia” continues to procure them because high quality medications cost a lot and hit hard in the pockets of most residents and consequently it is impossible to sell such medications.
Furthermore, with inexpensive medications it is easier to add a mark-up for delivery, customs clearance and other “interests” of responsible officials.
For instance, the high quality and efficient European ceftriaxone (antibiotics) now costs 60 manats per bottle, whereas its Indian generic drug is sold at only 5-10 manats. The original European antimycotics cost 200-240 manats per capsule whereas its Indian generic is available at 3-5 manats per pill.
The quality of Chinese and Indian pharmaceuticals appears to be as low as the price.Not only are these drugs inefficient but they might occasionally be harmful.
For instance, many doctors complain that even original brand-name antibiotics are not efficient in some cases because at the preliminary stages of treatment cheap generics, the administration of which made infectious agents resistant to the drug, were prescribed to patients.
One might get the impression that the quality of imported medications is not thoroughly controlled.It is common to come across medications in Turkmenistan’s pharmacies which are not sold in the US, Europe and Russia as they are not certified.
Perhaps these countries have failed to come up to the development status where “all the necessary conditions have been created to extend life expectancy, prevent diseases and develop medical science”…