Page 71 - GHES-3-3

Global Health Economics and
Sustainability
Pharmaceutical system in Iraq

Health, 2019a). These practices have been enabled by the medicines, respectively, were reported missing. This was
ability of the private sector to outcompete the public sector mainly attributed to insufficient financial allocation and
in procurement. Thus, without enforceable government lengthy processes to acquire medications (Republic of Iraq
intervention, the market environment has made private Ministry of Health, 2019a).
distribution enterprises price-setters, often to the
detriment of healthcare equity and access. Moreover, the 5.2. Capabilities of the Ministry of Health
availability of unregistered and substandard/falsified (S/F) The MoH has limited expertise in health economics,
pharmaceutical products in the private market is a growing epidemiology, statistics, and public policy, which has
concern, exacerbated by poor control over points of entry resulted in suboptimal populational health outcomes
into the country (Al-Humadi & Liapi, 2019). (Republic of Iraq Ministry of Health, 2019a). It has been
reported that the link between the MoH’s economic policies
4.4. Quality assurance of medicines and national health priorities is poor, highlighting the lack
The DTA, through the National Centre for Drug Control of inter-departmental cooperation required to address

and Research, is responsible for testing all imported and modern systemic healthcare issues (Tawfik-Shukor &
domestically produced pharmaceutical products for Khoshnaw, 2010). These factors result in delayed responses
quality assurance (Figure 1). It adheres to the requirements to health crises, allowing the private sector to capitalize
of the US, United Kingdom, and European pharmacopeias on the delays, ultimately undermining health equity and
for compendial products and uses the manufacturers’ exacerbating populational health outcomes (Al-Jumaili
validated methods for non-compendial products. While et al., 2013; Republic of Iraq Ministry of Health, 2019a).
there is no established protocol for the routine testing of 5.3. Rational use of medicines
pharmaceutical products in the private sector, the National
Centre for Drug Control and Research is authorized to test The MoH, through the Department of Pharmacy/DTA,
any product that raises suspicions. Furthermore, products started a national program in 2008 to promote and
with valid registration from an accredited foreign regulatory monitor the rational use of medicines in public healthcare
agency are exempt from quality testing (Al-Mosawi, 2020; facilities. However, the MoH has reported no adherence
Republic of Iraq Ministry of Health, 2020). to guidelines for prescribing and dispensing medicines,
as well as poor management of antibiotics and biological
4.5. Pharmacovigilance medicines (such as those for diabetes, autoimmune
All adverse effects of medicines, biopharmaceuticals, diseases, chronic diseases, cancer, and rare diseases). This
vaccines, supplements, and herbal products are monitored non-compliance negatively affects medicine availability
by the National Pharmacovigilance Centre. The center and therapeutic outcomes in both the public and private
is also responsible for monitoring and reporting S/F sectors. Furthermore, the private sector remains largely
medicines found in both the public and private sectors. unregulated in this regard (Republic of Iraq Ministry of
Pharmaceutical companies and scientific bureaus are Health, 2019a).
legally obligated to monitor and report any identified S/F Notably, there is a lack of consistent awareness among
medicines to the National Pharmacovigilance Centre. physicians regarding generic and biosimilar medicines
Once reported, information is disseminated through the (Al-Kinani et al., 2020). There are no specific formulary
SIP and the Directorate of Inspections. The Directorate of or guidelines from regulatory authorities concerning the
Inspection has the authority to withdraw and confiscate quality, safety, and efficacy of these medicines. In addition,
any S/F products (Syndicate of Iraqi Pharmacists, 2021b). there has been poor awareness of generic medicine
In 2013, the MoH joined the Global Surveillance and prescribing and cost-effective prescribing due to the
Monitoring System, which is a global rapid warning system absence of relevant content in medical curricula (Sharrad
for S/F medicines (World Health Organization, 2013b). et al., 2008). A qualitative study has suggested that further
education and reassurance regarding the quality, safety,
5. Challenges in the pharmaceutical sector and efficacy of generic medicines are necessary in Iraq.
The study also found that some physicians are opposed to
5.1. Availability of medicine
involving pharmacists in therapeutic decisions, particularly
It is evident that the MoH, through KIMADIA, faces a in regard to brand substitution. This has been attributed
number of challenges in providing sufficient medications to a lack of trust between physicians and pharmacists,
and pharmaceutical products to fulfill public sector demand especially regarding the evaluation of therapeutic efficacy.
(Republic of Iraq Ministry of Health, 2019a; Sharrad et The World Health Organization (WHO) has suggested
al., 2008). In 2018 and 2019, 50% and 40% of essential that Iraq implement and enforce the rational use of

Volume 3 Issue 3 (2025) 63 https://doi.org/10.36922/GHES025110025