Le Secteur De La Santé Publique

Le marché de la santé en Ouzbékistan

Présentation du marché

Le secteur de la santé publique:

Comprehensive measures taken by the government ensure sustainable economic growth in the country and contribute to dynamic advancement of sectors of the national economy.

Despite global financial downturn, annual GDP growth of Uzbekistan exceeds 8% over the last 10 years, which is one of the highest rates in the world. Over the past decade, the economy of Uzbekistan has doubled.

Uzbekistan is one of the largest Central Asian states and themostpopulous country exceeding31 million.

Healthcare in Uzbekistan is one of the foreground directions of the inclusive social policy implementation which experienced major reform over the past two decades.

Uzbekistan has a single statutory health care system, which includes public,private and other forms of non-public actors.

The share of national budget expenditures for healthcare is as high as 15.7 percent, and represents 4.1 percent of GDP.It is expected that the total health-care expenditures in the country would grow 3.8 times by 2020, and 8.7 times by 2030. This will result in the increase of the share of health-care expenditures in GDP to 9.8% in 2020 and 10.7% in 2030.

All kinds of primary health care are free of charge. On the same basis are being provided the emergency medical services and pediatric care, medical care for pregnant women to treat cancer, infectious and other socially significant diseases.

Today over 1,000 inpatient health institutions, 4,000 polyclinics and outpatient institutions, 501 rural outpatient posts, 2,606 rural health clinics (RHC) and other health institutions are providing qualified public health services.

The priorities of the Government of Uzbekistan, focused on comprehensive modernization of health system, continued gradual and targeted work on further reforming and developing of healthcare system. More attention is being paid to the protection of public health and strengthening of economic and technical base of medical institutions, as well as rendering high-quality medical services at modern requirements.

According to the Uzbek State Statistics Committee, the share of industry in total industrial production of Uzbekistan increased from 0.6% in 2014 to 0.7% in 2015. Medical industry of Uzbekistan produced goods for 674.6 billion soums in 2015.

In 2015, the large enterprises of the sector increased production of such products as: glass ampules for transportation or packing of goods (by 2.8 times), pro-vitamins, vitamins and their derivatives (2,3 times), medicaments, containing no hormones or antibiotics (1.3 times), etc.

The largest volume of industrial products was produced by enterprises of Tashkent city (56.4% of total industry) and Tashkent region (20.4%).

The small businesses of Uzbekistan increased production by 1.4 times year-on-year in 2015. Their share in the total volume of produced goods in the medical industry reached 64.3%.

Currently, Uzbekistan has 267 industrial enterprises in medical industry, of which 64 were created in 2015.

The country features high natural demographic growth rates, which total 1-1.5% per annum according to the projections. Approximately 615,000 newborns are expected annually in the next five years, whereas, 607,800 are expected annually in 2015-2020, and 596,700 annually in 2020-2025. Also absolute growth of the number of the elderly is expected thanks to the improvement of health services and better living standards.

These factors lead to higher demand for new technologies, modern equipment and high quality medications essential for treatment of pediatric diseases, mandatory vaccination of newborns and children, and treatment of diseases typical for the elderly – cardiovascular, oncologic, and neurological diseases.

Primary health care institutions are planned to reach international standards in the level of their equipment within the framework of “Health-3” project by the year 2018. This will promote improvement in the quality of medical services at rural health units, family policlinics, central district and municipal out-patient hospitals, as well as hospital care at municipal and district associations.

It has been envisaged to provide 517 medical establishments with modern medical equipment and equipment for utilization of wastes and furniture. The list has been determined on the basis of time sheet for fitting out medical establishments of the district and municipal levels. This will enable to create conditions for full coverage of rural and urban population with quality medical care at the level of primary out-patient and in-patient establishments.

It is planned to furnish medical institutions covered by the project, to the amount of $40 million. This will include X-ray equipment, dental equipment, vehicles for medical establishments located in remote and hard-to-reach areas. It is also planned to procure medical and laboratory furniture, sets of instruments, diagnostic and eye-care equipment and computers.

Oncology institutions are getting prepared for the installation of new equipment. New buildings are being built for Syrdarya and Jizzakh specialized clinics; those in other regions are under reconstruction. The first deliveries of equipment under the joint project of the Ministry of Health and the Islamic Development Bank are expected in the coming months.

Diagnostic service will be strengthened, as well. For the first time all cancer clinics will be provided with CT scanners, PCR analyzers, reagents and kits for immunohistochemical studies and identification of tumor markers, as well as mammography devices for screening centers for early detection of women breast cancer.

Modern radiotherapy equipment is to be installed in all cancer treatment institutions. The cancer service will be provided with dosimetry equipment, gamma-therapeutic devices for remote irradiation, devices and those for intracavitary gamma-therapy.

Besides, Uzbekistan will have two additional linear accelerators: one will be installed at the National Cancer Research Center, and the other - at the Tashkent Municipal Cancer Clinic.

This would raise the diagnostic accuracy and early detection of malignant tumors at times, and also develop a preventive service. Besides, it is projected to upgrade the stock of digital X-ray machines, ultrasonic scanners, laparoscopy, duadenofibroscopy, colonofibroscopy, bronchofibroscopy devices.

The package of projects of the Ministry of Health on to equipping outfit health facilities with modern equipment is fairly big as it includes both ongoing and projecting prospective ideas.

Jointly with KfW Bank, the Ministry is implementing a project on the provision to the Republican Specialized Center of Cardiology with high-tech equipment. The equipment hardware valued at $3.7 million to be delivered in the years to come.

Another project scheme is carried out in cooperation with the Saudi Development Fund. $20 million of loan funds will be used to purchase up-to-date equipment for the republican specialized centers of urology, eye microsurgery, surgery, dermatology and venereology, endocrinology, therapy and medical rehabilitation in 2014-2017. The list of health facilities will be likely expanded in the course of the implementation of the project.

Experts are currently working on the projectsschemes on to equipping regional diversified medical centers for adults that are regional medical institutions. A project on supply for urology departments of the artificial kidney devices was launched last year. There are several large-scale projects for creating ventures with foreign partners on complex equipping of all units of these institutions. For instance, under the joint project with KfW Bank, the Andijan medical center will be equipped this year.

Strengthening of the logistical capacities is also a part of the programs aimed at the development of psychiatric and tuberculosis institutions. New equipment will be delivered both to the republican and regional provincial medical institutions.

The Uzbek market for medical technology is almost entirely carried by imports.
Also due to the increasing importance of private medical services, the demand for industry products is growing.

Uzbek government approved projects to develop by 2017 of health care services in rural areas to a total value of 5.2 billion soms ($ 2.5 million at the exchange rate of the Central Bank of the country). In particular, organization on the basis of 228 rural health facilities of paid medical, dental services, phytobars and branch pharmacies of "Dori-Darmon" including therapeutic services.

The central government's investment program includes the construction of new andmodernization of existing medical objects.

The program of modernization, technical and technological re-tooling of pharmaceutical companies focused on consistent reduction of country’s dependenceon imports of medical drugs through more comprehensive use of own manufacturing capacity, inputs, scientific potential, and establishment of new pharmaceutical companies utilizing modern technologies.

Planned investment and loan projects of the Ministry of Health (2015-2018)

• Procurement of diagnostic and medical equipment in all regional multi-profile medical centers - Surkhandarya, Andijan, Bukhara, Navoi, Rep of Karakalpakstan (KfW) - 45,5 mill. US$

• Procurement of radiotherapy equipment for Oncological Service of Uzbekistan (Islamic Development Bank loan) – 37 mill US$

• Procurement of modern medical equipment for Republican Specialized Centers (source not identified) – 28 mill. US$

• Procurement of modern medical equipment for district and city health facilities (loan requested from Export-Import Bank of Korea) – 40 mill. US$

• Procurement of x-ray machines and fluorography devices for outpatient services of Tashkent City (loan requested from Export-Import Bank of Hungary)

• Procurement of equipment for Medical University Clinics and Republican Clinical Hospitals (source not identified) – 15 mill US$

• Procurement of laboratory equipment for Sanitary Inspection Centers (source not identified) – 30 mill US$

• Procurement of equipment for emergency ambulance services and emergency medical care (source not identified) – 6 mill. US$

Le secteur pharmaceutique:

Along with demographic growth, longer life expectancy, and increasing aging of population, and advancement of public health system, inter alia, thanks to the growth of health institutions, the need for medical drugs is increasing. Thus, the pharmaceutical sector has major development prospects.

At present time pharmaceutical market in Uzbekistan is one of the fast growing among CIS countries. In recent years several regulations have been adopted that clearly regulating this sphere of activity. In future it is expected to increase the volume of industrial production in three times and export - by 2.2 times.

Pharmaceutical market of Uzbekistan is about 80% dependent on imported drugs. At the present time imported pharmaceuticals currently provide from 60% to 95% of the market in various segments. It is expected that in the next 5 years import of medicines will increase each year by 20-22% roughly. Uzbekistan also exports drugs exclusively to CIS countries and every year export is also expected to increase by 20% yearly. In the currently existing growth of domestic demand for medicines pharmaceutical market should reach in coming years the mark of $ 1 billion.

Today, the pharmaceutical industry of Uzbekistan is represented by more than 561 wholesale companies licensed to pharmaceutical activities such as wholesale of medicines and medicinal products. There are 4932retail drugstores in Uzbekistan.

It should be noted that to date, 1447 medicines in 90 pharmacotherapeutic groups and 30 dosage forms, including antihypertensive agents, antispasmodics, vitamins, biostimulants, analgesics, anesthetics, antibiotics, anti-TB drugs, antiseptics, antiparasitic medicines, vaccines, serums and other drugs have been registered in the republic.

Generally Uzbekistan imports medicinal products from Ukraine, Russia, India, Hungary, China, Switzerland, France and Germany… In general, the products are imported from 57 countries.

Still foreign manufacturers dominate on the pharmaceutical market. Production of such companies as “Berlin Chemie/ Menarine Pharma” (Italy), «Novartis» (Switzerland), “Sanofi-Aventis” (France), etc. are in high demand.

The mostly imported drugs in Uzbekistan are antimicrobial medicines, antibiotics, antibiotics of cephalosporin, analgesics and antipyretics, anti-bacterial agents, expectorant drugs and other widely consumed drugs.

The most important pharmaceutical companies are interested in importing of consumables which could be used in medicine and dentistry. There is also a demand in technologic, laboratory equipment. Pharmaceutical companies are also looking for parapharmaceutical products, e.g. hygiene means, baby products.

Preventive health actions will have an impact on trends and composition of demand in the pharmaceuticalmarket. Inter alia, development of early diagnosis and diagnostics activities in general will increase the demandfor substances needed for laboratory tests and so on. Withthe emergenceof healthy lifestyle, consumption ofdrugs, which promote disease prevention, will be expanded.

Pharmaceutical sales in Uzbekistan will continue to expand, creating opportunitiesfordrugmakers. Meanwhile, the Uzbek government will continue toimprovethe domestic business environment through regulatory developments, privatisation and the promotion of foreign direct investment, which will benefit investments that enhance drug manufacturingand operationsin the country. However,the regional economic slowdownand a challenging operating environment will continue to weigh on Uzbekistan's pharmaceutical and healthcare sector growth potential, keeping a lid on its attractiveness to investors.

In general, in 2015-2018 foresees the implementation of 55 investment projects for the creation of large pharmaceutical enterprises in all regions.

Currently, the industry developed and implements a program of measures on attracting foreign investments to the projects, related to production of medicaments for TB, cancer, heart diseases, etc.
The capacities in pharmaceutical industry allows to produce medicaments on 30 forms and 96 pharmacotherapy groups of medicaments.

Most domestically manufactured medical drugs are generics, produced mostly from imported substances. More than 86% of domestic medical drugs are manufactured fully (14%) or mostly (72%) from imported substances, which currently makes domestic production of medications utterly dependant on imports, theirquality, and prices.

In spite of the relatively rapid growth of the pharmaceutical industry in Uzbekistan, further development of this sector is essential. Among the priorities is creation of medicines based on local raw materials. Uzbekistan is rich with many kinds of medicinal herbs. There are 138 families, 1023 genera and 4500 kinds of herbs (including 1150 medicinal). This allows producing original medicines and dietary supplements based on local raw materials.

Project of the SJSC Uzpharmsanoat for the production of medications based on medicinal herbs is meant for three years. It is planned to allocate 10 million hectares of land associated with forestry under the ownership of farms. Plantations will be created in each region of the country, and pharmaceutical companies start operating in the fields launched with the involvement of foreign investment. Production is scheduled for the end of this year and beginning of 2016. From 2015 to 2017 JSC“Dori-Darmon” plans to implement 65 projects for processing factories of medicinal plants and shops on their packaging. For these purposes it will be spent 12.2 million dollars.

“Dori-Darmon” JSC is a major state distributor, with extensive network of pharmacies nationwide. JSC “Dori-Darmon” and its subdivisions are the main suppliers of drugs in medical institutions of Ministry of Health, Ministry of Defense, Ministry of Internal Affairs, National Security Service and other medical institutions of the Republic(

The Company consists of 8 joint-stock companies and 10 subsidiaries with 17 warehouses, 15 analytical laboratories and 1328 pharmacies located in all regions of the country. More than 76% of retail outlets work in rural areas, including 718 branches working in rural medical stations.

Furthermore, there are mobile pharmacies – special vehicles withisothermalwagon with essential equipmentoperating in remote areas with the mandate to supply medications to the rural households in all oblasts ofUzbekistan.

All drugs imported to the country should be registered with the Pharmacological Committee of the Health Ministry be marketable in Uzbekistan.

Pharmaceuticals must meet the following requirements to be registered in Uzbekistan:

• All products must have a safety certificate from its country of origin
• All products must also have a registration certificate from the Pharmacological Committee of the Ministry of Public Health of Uzbekistan.
• There are special laboratories for pharmaceutical quality control which have been established by the customs department. These laboratories control pharmaceuticals which are being imported into the territory of the country and certify their compliance with proper quality standards.
• A sample of each type of pharmaceuticals which arrives at the customs warehouse must be sent to the central laboratory of control and analysis. The laboratory is operated by the State Joint-Stock Company "Dori-Darmon".

Exempt of VAT and custom duties:

• Import of raw materials for pharmaceutical production;
• Technologic equipment;
• Settled technologic equipment is exempt of property tax for 2 years.

Registration is a key point in the system of finished pharmaceutical products circulation.

Process of medicines registration in Uzbekistan:

1. Foreign manufacturing-firm that wants to register its production in Uzbekistan sends a letter – presentation in 2 copies to the Chief Board of medicines and medical equipment quality control.
2. Manufacturing-firm submits documents and samples depending on the medicine.
3. After documents and samples submission, the applying firm and State Center of medicines expertise and standardization conclude a contract.
4. Chief Directorate sends documents to Pharmacological Committee, Pharmacopoeia Committee, Drugs Control Committee, State Center of medicines expertise and standardization, medical, prophylactic and diagnostic devices and medical equipment registration Bureau.
5. After implementation of necessary procedures on documents and samples checking, the decision on medicine registration is made. It is decided by the expert board of Chief Directorate on medicines and medical equipment quality control.
6. After that Registration Bureau on the base of permission of the Directorate finalizes official registration certificate within 10 days.

Time period, required for registration, depends on many factors, first of all – on the medicine class, but on the average it takes about a year for generic registration, registration of original drug may last several years because it requires clinical trials organization.

Regulatory requirement in Uzbekistan is availability of medicine’s registration in other countries of the world excluding manufacturing country; otherwise clinical trials on the territory of Uzbekistan are assigned.
For medicine registration in Uzbekistan the following documents are required:
1. Letter of application.The following documents are attached to the letter:

• Registration application in standard form– 2 (or 3) copies;
• Registration dossier – 2 (or 3) copies;
• Samples of medicine, at sufficient amount for 3-fold analysis by methods, described in regulative documents, substances (active agents);
• Reference-standards, standards samples of medicines, foreign impurities, and specific chemical agents, necessary for the analysis.

2. Translated documents of the manufacturer (producer) in foreign languages shall be legalized according to the legislation of Side, in which state registration is implemented.
Registration process is very complex and it takes definite time. Registration is valid within 5 years; upon the expiry of it the medicine shall be re-registered.