A WHO team conducting a preliminary assessment of Afghanistan's pharmaceutical sector, in response to the humanitarian crisis, has found that the situation has deteriorated dramatically. Years of war have left the health infrastructure seriously weakened, with some buildings completely destroyed and many others badly damaged. Lack of essential drugs is very common in public health facilities, and the expensive brand-name medicines available in private pharmacies remain unaffordable for most Afghanis. In addition, there is widespread consumption of low-quality and ineffective medicines procured both in public and private facilities. However, the team found that recent events have resulted in a huge influx of drug donations to the country, temporarily alleviating shortages. And despite years of working under extreme conditions with very limited resources, the WHO team found their counterparts in the Ministry of Public Health still active and dedicated to improving the situation.

The WHO staff (from EDM and Emergency and Humanitarian Action in Geneva, and Essential Drugs and Biologicals, WHO Regional Office for the Eastern Mediterranean), visited key sites in Kabul, including the drug manufacturing plant, warehouses and the quality control laboratory. Meetings took place with senior government officials, including the Minister of Public Health, and representatives of other UN agencies and NGOs involved in the pharmaceutical sector.

A scene of devastation in Afghanistan, where WHO has a crucial role in the international effort to rebuild the health system

Photo: WHO

Long-term commitment

Major technical and financial assistance will be required to develop pharmaceutical systems that offer the level of services so urgently needed by the population. WHO has proposed a US$25 million budget to the international community for the first year. This would allow medical stores to be established at the central and provincial levels, supplying safe essential drugs to the Afghanis in Kabul, in the provinces, and also in remote areas where the majority of the population lives.

Several specific activities have been identified for immediate implementation. There were four main criteria for selecting an activity: its importance as a basis for sustainable development of the sector; whether it could serve to bring together key players under the overall guidance of the Ministry of Public Health; whether it could be initiated immediately, moving from assessment to action without undue delay; and finally if it was financially viable.

Areas identified for immediate action include:

• appointing an essential drugs focal point in the WHO Office in Kabul;
• developing national guidelines for drug donations;
• reviewing and updating the national list of essential drugs;
• training key staff;
• initiating the process of developing a national drug policy;
• establishing a mechanism for testing drug samples in the region.

Building up the pharmaceutical sector will take years, and will require long-term commitment from any partner involved in the country. WHO is committed to working closely with the Government of Afghanistan, and coordinating the efforts of other United Nations agencies and NGOs involved in developing the pharmaceutical sector.