Prof. Ilko Getov
, PhD, MSc Pharm, MHM, president of the Bulgarian Pharmaceutical Union (BPhU) provides a fascinating insight into the changes sweeping across the pharmaceutical industry in Bulgaria and reveals the country’s determination to modernize its offerings in line with the highest in Europe.
Could you please introduce yourself to our international audience as well as explaining the main activities and responsibilities of the Bulgarian Pharmaceutical Union (BPhU). How would you assess the evolution of the institution during its decade of history?
Just a quick background on myself; I devoted myself to pharmaceuticals at Sofia Medical University before furthering my own knowledge with a PhD from the same institution. I worked as a pharmaceutical specialist on projects in both Italy and Germany before returning to the field of academia eventually as a professor in the Faculty of Pharmacy. I am teaching students in the fields of social pharmacy, clinical pharmacy, pharmaceutical regulation and pharmacovigilance. I also have PhD students, eight of which have already finished their thesis and have very promising careers ahead of them.
In 2013, I became the president of the BPhU; a body created to establish professionalism in the pharmaceutical sector. Our members are pharmacists from all specific fields of the profession. Through a series of commissions and 28 regional chambers, the body focuses not only on distribution, supply and provision but the quality of pharmaceutical practice in Bulgaria. As of 2007, the body has had the same standing as the Doctors’ Medical Association and the Dentists’ Association. We participate in important meetings like the Parliamentary Health Commission as well as having representatives that liaise with the Ministry for Health and the Transparency Commission. Bulgaria is currently in the process of trying to make more medicine accessible to the public through the retail sector. This is my second term as president and it will expire at the end of 2019.
Until recently, trials to establish pharmaceutical associations were too far away for Bulgarian institutions to really take advantage of. Prior to the fall of the Iron Curtain, medical institutions were organised by trade associations meaning that medical experts were not always in control of medical organisations. Huge reforms did sweep across the country in 1989 but the primary focus was on doctors and medical professionals because the country had a greater number of pharmacists. In terms of size, currently, the Union has 6,466 members. Looking ahead, 2017 will be a very significant year for the Union not only because it is the 10th anniversary of the body but it is the 75th anniversary of pharmaceutical education in Bulgaria.
Putting the spotlight on yourself, what have been your main accomplishments since your appointment back in June 2013?
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It is important to distinguish between internal and external successes. I formulated the idea for the e-BPhU platform, which includes an electronic register of all our members thus allowing everyone to research each other and develop professional connections. The register is also available electronically to the public although with less detailed information. However, this is still useful for society and the patient as for instance we maintain the data and perform other vital functions. Through webinars and other pieces of educational material, individuals can complete distance-learning courses. In conclusion, the main accomplishment is the digitalization of the Union during my first mandate.
From an external point of view, we have a number of great projects. Our online platform mApteka provides a pharmacy map of Bulgaria with territorial information, distribution details and statistical data. This provides patients with the opportunity to check the services provided in each pharmacy and businesses can see which parts of the country would benefit from additional pharmacies. The institutions can also compare themselves with each other in terms of density and what treatments are most popular in other regions. Indeed, transparency is an outcome of digitalization and we have made the whole system very accessible and visible to the public. I believe national statistics are also very important. We have 3,960 pharmacies in Bulgaria; as a benchmark, while the European average for pharmacies per population is 1/4,000, in Bulgaria that figure is 1/1,000. This is a good statistic on a national level but when you examine these statistics further you see that the distribution on a provincial, rural and local level could be improved.
In Bulgaria, there is an uncontrolled expansion in the number of pharmacies in major cities concentrating only on economically attractive areas thus making medicines difficult to access in remote areas. As the president of the Bulgarian Pharmaceutical Union, what are your conclusions about this issue?
Obviously, we need to set up basic parameters that enable the population to have access to pharmacies because we have areas without pharmacies that also have contracts for national health insurance – some cities are also without 24-hour pharmacies. We would like to see strict regulations and stronger parameters that easily determine the capacities required to develop a new pharmacy or geographically expand existing pharmacies. Looking to our neighbouring countries, Hungary, Poland and Estonia are great examples in the last five years of how to regulate and support your pharmacy sector. The advancement of the Bulgarian Medicines Verifications Organisation (we are one of the five members) would really benefit the country because this organisation can really control the quality of the products available in the pharmacy sector. Additionally, in 2016, we propose to move up the monthly meetings of the Pharmaceutical Group of European Union /PGEU/ not only in Brussels but in the member states so high-profile meetings with pharmacists from other EU member states took place in Bulgaria.
One of the possible approaches is to set a geographical parameter in which a pharmacy has to be present. Another is to establish more pharmacies in the cities so that they are forced to search for business outside the city centres and in increasingly remote areas. The ideal is obviously to place GPs and various practices in remote areas and this could be achieved by increasing the pharmacy tax to 50 percent. Assisting the pharmacies with less rent costs in rural areas or providing transport for locals would also aid efforts in this regard – essentially medicines have to get closer to patients.
In 2015, the Bulgarian Government launched the Health Management Program 2020 with interesting initiatives such as eHealth and the National Pharmacy map, among others. What is your assessment of the said governmental healthcare programme and its advancements so far?
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This national health strategy is very significant for pharmacists and pharmacies because in addition to the introduction of e-health and e-prescription the whole pharmacy health service has become increasingly digitalized. The strategy also encourages decentralized responsibility with individual pharmacies playing a much greater role in the management of the care they provide to patients. Pharmacies will also be expected to undertake consultations, give advice and conduct patient monitoring. Thus, the final result of the therapy rests with the pharmacy. As a milestone, in hospitals, we already have a strong presence and as of January 1st 2019 every hospital with more than 400 beds must appoint a clinical pharmacist. Hospitalized and outpatients now fall under clinical pharmacy and pharmaceutical care in accordance with the 2020 strategy.
Obviously, there is the incentive to reduce costs behind these changes. With greater pharmacy presence, authorities are hoping that patients will spend less time in hospitals. I believe that authorities also expect greater patient compliance with treatments as a result of these changes. In fact, currently, medical doctors are overloaded and many people are waiting for consultations or various other services. The empowerment of pharmacists in the health system should provide strong assistance when tackling this problem. It is essentially a series of changes to deliver greater effectiveness.
From a human capital perspective, how would you assess the level of professionalism and quality of the Bulgarian healthcare professionals and pharmacists in particular?
For instance, the workload in the pharmaceutical industry is far from the leading nations in Western Europe. We have very good relationships with various faculties and the government in regards to the pharmaceutical student decision-making process; we will meet our selected target figure in 2025. Quality is a very interesting topic because in 2005 Bulgarian pharmaceutical education was harmonized to European standards, which means that we have individuals with different educational backgrounds. However, with the harmonization complete, Bulgarian pharmacists can work all over Europe without any requirement issues. In regards to quality, we can improve with continuous professional development and strong guidelines. In 2009, we put in place BPhU guidelines with the view to establishing Good pharmacy practice and I believe we can add to these firm foundations with pharmacists having to earn credit points for life-long learnings. Professional development through international events and additional materials is vital in order to continue the progress we have been making. This year, we had edition of our huge event Bulgarian Pharmaceutical Days in the city of Russe that promoted the quality of Bulgarian pharmacies.
What are the main objectives that you would like to accomplish in the upcoming years?
Firstly, I want to introduce an improved pharmacy map that coincides with stricter criteria when opening a pharmacy. Secondly, I want to totally integrate all pharmacies into the public health system. Thirdly, I want to personally lobby with politicians to establish a dialogue with the goal to creating a common European framework for pharmacy access within the EU. We believe the up-coming Bulgaria Presidency of the EU considers these matters very significant as it has made it into topics for discussion in first half of 2018. Improvements are still needed because a number of other services are still not harmonised to European standards.
Mr. Getov, you are considered a key opinion leader within the Bulgarian Healthcare community being a speaker in numerous scientific and practically oriented events for students, pharmacists, and other health professionals. What is your personal vision for the healthcare sector in Bulgaria in the next few years?
My mandate will finish at the end of 2019 and I do not wish to set the agenda for future residents. Personally, I feel that the Bulgarian Pharmaceutical Union needs to be put on the European map when dealing with medicines and healthcare system issues because currently we are poorly recognised and we need to address various issues in regards to the pricing of medicine. To make a big difference on issues like these you need to be recognised and in regular communication with the relevant parties.
