Role of the tunisian central pharmacy in the import of radio-pharmaceutical products

In Tunisia the centralized organization of the medicine sector has a strategic and economic importance. It presents particular characteristics concerning the importation and the control of drugs. Tcp has a monopoly on the importation of drugs for the country, which enters in the state policy for the control of drug purchasing costs, their availability in different region of the country and their guarantee and quality. The Tcp has a crucial role in the availability of drugs and in the holding safety stock and strategic reserve of the imported pharmaceutical products, either for the public or private sector. The Tcp has to stock up medicaments, chemical and pharmaceutical products, objects of bandages, instruments, accessory tools and other supplies necessary for the human and veterinary medicine. The Tcp packages any specialized or not medicament and all other products or supplies. The Tcp provides medicaments and products entering within the framework of its task to different health groups and hospitals. The Tcp provides distributors, laboratories and pharmacies over the country. In Tunisia the import of radioisotopes used in the medical domain is attributed to the Tcp. The objective is to centralize purchases and to guarantee: the security, the availability as well as the traceability. The Tcp supply radiopharmaceutical products for diagnostic and therapy purposes according to an authorization delivered annually by the National Center of Radiation Protection (NCRP). An authorization of removal used at the customs allows the clearance of products at the level of the air freights by the transit service of the Tcp. Regarding the evolution of purchases of radio-pharmaceutical products, their importation remained stable during the last three years. Indeed, it is approximately around 1MDT annually (954 121 DT in 2010, 939 956 in 2011 and 1047 967 in 2012). Sources of supply are divided between 4 suppliers: International IBA-CISBIO (49.9 pour cent), COVIDIEN EX (TYCO HEALTHCARE GROUP AG) (28 pour cent), GE HEALTHCARE LIMITED (15.3 pour cent) and BEBIG (6.8 pour cent). Analysis of radioactive products showed that: 24 products on 155 imported products (15,48 pour cent), represent 80 pour cent of the global value of the imported products. Regarding the consumption of the 4 main customers, the analysis shows that SALAH AZAIZ institute used (47.2 pour cent), HABIB BOURGUIBA Sfax hospital (21.4 pour cent), SAHLOUL hospital, Sousse (9.9 pour cent), and the military hospital of Tunis (7.9 pour cent). These four institutions correspond to 80 pour cent of the sales. The distribution of the sales by category of customer (public - private) is rather stable for the last three years and is around 88 pour cent for public and of 12 pour cent for the private. Among problems encountered by the Tcp associated with the provision of radiopharmaceuticals products we can mention: a direct agreement between the customer and the supplier, a withdrawal of the customer for certain scheduled deliveries and so times totally or partially received products, a reception of radiopharmaceuticals products having a low activity with respect to that required, recorded delays in the receipt of purchase orders from customers, PCT clears radiopharmaceuticals products urgently on the basis of a proforma invoice. Any delays in the submission of final invoices from the supplier involve penalties. To conclude, the Tcp plays an intermediate role between the supplier of radioisotopes and the users. Therefore it needs an accredited laboratory of quality control to accomplish its mission which requires the recruitment of at least a radio pharmacist. It is important to draw attention to the necessity of providing training in radio-protection to the staff involved in the handling, storage, and transport of radioisotopes. (Author)