Comparative analysis of Lebanon development. Prospects for cooperation with the Russian Federation

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Abbreviations: GDP by PPP – gross domestic product by purchasing power parity per capita; VEM – Vital and essential medicines; CJSC – closed joint stock company; PM-pharmaceutical medicines; MF – medicinal form; INN –International non-patented; ОJSC – open joint stock company; UAE – United Arab Emirates; UN – United Nations; LLC – limited liability company; COR – certificate of registration; USA, Beirut-CIP – carriage and insurance paid to Beirut. Freight/transportation and insurance paid to Beirut.

INTRODUCTION

A significant growth in the population of Lebanon, due to the increased flow of refugees from the border country of Syria, since the outbreak of the civil war (March 2011), from 4,145.57 thousand people to 6,071.69 thousand people from 2009 to 2016, had revealed the need to eliminate the lack of knowledge regarding the processes currently occurring in the country’s health care, and the trends of its further development.^1,2,3

THE AIM of the work is to conduct a comparative analysis of the development of Lebanon on the basis of a number of demographic, economic and social indicators that characterize the health of Lebanon and to determine the prospects for cooperation with the Russian Federation in the pharmaceutical field.

MATERIALS AND METHODS

The research was conducted from 2009 to 2016. The objects were statistical data accumulated on the basis of the data from national institutions and international organizations, published annually in the reports of the Department of economic and social Affairs and the United Nations population Division⁴ for 11 countries in the Middle East: Bahrain, Jordan, Kuwait, Lebanon, Oman, Saudi Arabia (Asian countries), Egypt, Sudan, Tunisia (North African countries), Yemen. The research methods were: a comparative analysis, analytical grouping of data, ranking.

RESULTS AND DISCUSSION

One of the main demographic indicators is the population size in a certain period of time (Fig. 1).

 

Figure 1 – The total population of Lebanon in 2009-2016, thousand people

 

We found out that for the period of 2009–2016, the average population growth rate (relative to the base year of 2009) in Lebanon was 123.51% (Tab. 1).

 

Table 1 – Basic growth rates (relative to 2009) of demographic and socio-economic indicators in Lebanon

Year	Total population	Male mortality	Female mortality	Total mortality per 1,000 adults	Infant mortality per 1,000 live births	Birthrate	Life expectancy	GDP (PPP) per capita	Volume of health care expenditures per capita, Intern. dollar	Volume of expenditures on Medicines per capita, Intern. dollar	Share of drugs expenses in the structure of health care expenses, %	Number of doctors per 10,000 population	Number of pharmacists per 10,000 population
2009	100.00	100.00	100.00	100.00	100.00	100.00	100,00	100.00	100.00	100.00	100.00	100.00	100.00
2010	102.75	97.24	97.46	97.33	94.57	102.54	100.26	106.37	101.01	109.70	108.62	110.98	99.23
2011	107.69	94.47	94.93	94.66	90.22	105.92	100.64	104.53	99.67	117.18	117.58	108.11	101.19
2012	114.77	91.71	92.39	91.99	85.87	109.46	100.86	102.71	100.35	124.66	124.24	108.67	102.86
2013	123.16	89.84	90.79	90.23	82.61	112.59	101.09	99.65	95.72	139.12	145.36	111.02	104.81
2014	131.45	87.96	89.21	88.48	79.35	114.98	101.32	96.93	91.15	145.67	159.83	110.71	107.04
2015	138.25	86.08	87.61	86.71	77.17	116.49	101.53	94.09	96.01	152.42	158.77	103.01	102.37
2016	146.47	85.22	85.77	85.44	82.61	125.00	101.66	90.95	99.68	186.60	187.21	98.11	100.77
Average:	123.51	90.36	91.16	90.69	84.63	112.43	101.05	99.32	97.66	139.34	143.09	107.23	102.61

 

Previously, in 2004–2009 (relative to the base year of 2004), they were significantly lower: the average value was 104.73%. The analysis of the population growth rate in Lebanon relative to the previous period showed that the average value in 2009–2016 was 105.61% (Table 2). For comparison, in 2004–2009 it was 101.34%.

 

Table 2 – The growth rate of the chain (relative to the previous period) of demographic, socio-economic indicators in Lebanon

Year	Total population	Male mortality	Female mortality	Total mortality per 1,000 adults	Infant mortality per 1,000 live births	Birthrate	Life expectancy	GDP (PPP) per capita	Volume of health care expenditures per capita, Intern. dollar	Volume of expenditures on Medicines per capita, Intern. dollar	Share of health care expenses in the structure of health care expenses, %	Number of doctors per 10,000 population	Number of pharmacists per 10,000 population
2009	100.00	100.00	100.00	100.00	100.00	100.00	100.00	100.00	100.00	100.00	100.00	100.00	100.00
2010	102.75	97.24	97.46	97.33	94.57	102.54	100.26	106.37	101.01	109.70	108.62	110.98	99.23
2011	104.81	97.15	97.40	97.25	95.40	103.30	100.38	98.27	98.67	106.82	108.25	97.42	101.97
2012	106.58	97.08	97.33	97.18	95.18	103.34	100.22	98.26	100.68	106.38	105.66	100.52	101.65
2013	107.31	97.96	98.27	98.09	96.20	102.86	100.23	97.02	95.39	111.60	117.00	102.16	101.90
2014	106.74	97.91	98.26	98.06	96.05	102.12	100.23	97.27	95.23	104.71	109.95	99.72	102.13
2015	105.17	97.85	98.21	98.00	97.26	101.32	100.21	97.07	105.33	104.63	99.34	93.05	95.64
2016	105.94	99.00	97.90	98.54	107.04	107.30	100.13	96.66	103.82	122.43	117.91	95.24	98.43
Average:	105.61	97.74	97.83	97.78	97.39	103.25	100.24	98.70	100.02	109.47	109.53	99.87	100.14

 

Based on the United Nations data of the population, it was found out that among the 11 countries analyzed, the largest population (Rank 1) was in Egypt – 92519.54 thousand people (Table 3). It should be notified that Jordan had a close value to the population in Lebanon in the descending order of the indicator value in 2016 – 7734.38 thousand people (Rank 7). For all the countries analyzed in the region, there was a steady increase in the population, which is typical for the countries of the Middle East.

 

Table 3 – Ranks of demographic indicators for the Middle East countries in 2009–2016

Country	The ranks of values						Ranks of base growth rates						Ranks of chain growth rates
	Total population in 2016	Male mortality	Female mortality	Total mortality per 1,000 adults	Birthrate	Average life expectancy	Total population in 2016	Male mortality	Female mortality	Total mortality per 1,000 adults	Birthrate	Average life expectancy	Total population in 2016	Male mortality	Female mortality	Total mortality per 1,000 adults	Birthrate	Average life expectancy
Lebanon	8	1	1	3	10	1	2	1	1	3	1	5	2	1	1	8	1	6
UAE	6	3	2	2	11	2	4	5	4	5	11	8	4	2	2	4	11	9
Bahrain	11	2	4	1	9	4	6	6	6	11	8	10	6	6	4	1	7	10
Kuwait	10	4	3	4	8	6	3	11	8	6	10	9	3	11	7	3	10	8
Saudi Arabia	3	5	5	7	5	7	8	4	5	9	9	4	8	5	6	10	8	2
Oman	9	8	7.5	5	6	3	1	10	10	11	7	3	1	9.5	9.5	11	9	3
Tunisia	5	7	6	6	7	5	11	2	11	4	3	11	11	3	11	6	3	11
Jordan	7	6	7.5	8	3	8	5	9	10	8	4	7	5	9.5	9.5	7	4	5
Egypt	1	9	9	9	4	9	10	7	2	7	2	6	10	7	3	5	2	7
Yemen	4	10	10	10	2	10	7	8	7	2	6	2	7	8	8	2	6	4
Sudan	2	11	11	11	1	11	9	3	3	10	5	1	9	4	5	9	5	1

 

The interaction between the processes of renewal of new generations and the replacement of one generation by another ensures a continuous reproduction of the population. To characterize the social and demographic well-being of Lebanon and the degree of the development of its public health services, not only the basic and chain growth rates of the population were analyzed, the mortality rates of men, women, and infants separately as the indicators that more objectively reflect the level of development of the country’s health care, were also taken into account.

In the analysis of the mortality rates of men and women it was found out that in Lebanon they were the lowest among the analyzed countries in the region, both in absolute and relative values (Rank 1), in the ascending order of the indicator value. The absolute values of mortality rates for men and women in Lebanon by 2016 had decreased simultaneously by 14.78% and 14.23% compared to 2009. The similar dynamics of the negative growth was observed when analyzing the chain growth rates of mortality of men and women during the analyzed period: on average, minus 2.26% and minus 2.17%, respectively.

In Lebanon, the negative dynamics of the chain growth rate of male mortality from 2009 to 2012 was stable, and it was minus 2.84% per year at an average. However, in the period from 2013 to 2016, the opposite trend was observed: in 2016, relative to 2015, the chain growth rate of male mortality increased from minus 2.84% (2009–2012) to minus 1.00%.

In general, analyzing the basic growth rates of male mortality, it was found out that in all the 11 countries of the Middle East in the period of 2009–2016, the negative dynamics remained: at an average, the values of the basic growth rates of male mortality decreased by 5.28%.

In the Middle East, the mortality rates of women also tended to decrease during the analyzed period. According to this indicator, Lebanon had Rank 1 again. Rank 2 was assigned to the United Arab Emirates, where these indicators were higher than in Lebanon by 8% and 12% in 2009 and 2016, respectively.

An important result of the analysis of the chain growth rates of women’s mortality relative to the previous period is the following: as in the chain growth rates of men’s mortality, the opposite trend was observed in Lebanon, i.e. the negative vector showed its slowdown. Under these circumstances, in 2016, relative to 2015, the chain growth rate of mortality increased to minus 2.10% (Rank 2) from minus 2.50% in the period of 2009–2012.

It should be notified that in all the analyzed countries, there was a dynamic decrease in women’s mortality. The baseline rate of increase in women’s mortality was negative at an average (minus 5.82%), which indicates an improvement in women’s living conditions and advances in hygiene and health in the Arab countries in general.

Reduction in the children’s mortality, including the infant mortality, is one of the main goals of the Millennium Declaration adopted by the UN General Assembly on 08.09.2000. (Resolution No. A / RES/52 / 2)⁵. It was found out that there was a tendency to reduce the infant mortality in the analyzed countries by 12.86%. The rate of its changing was negative at an average. The analysis of the infant mortality showed that Lebanon had Rank 3 after Bahrain and the United Arab Emirates. For example, in Bahrain (Rank 1), the indicator was 7.60 and 5.10 in 2009 and 2016, respectively. In the UAE, the indicator of 7.60 in 2009 decreased to 5.70 in 2016. Lebanon (Rank 3) had the infant mortality rate of 9.20 in 2009 and 7.60 in 2016. Rank 3 of Lebanon in terms of the basic growth rate of the infant mortality reduction, corresponds to the average value for the analyzed period. In 2016, there was a slowdown in the decline in the negative values of the basic growth rate of the infant mortality, lowering the rating of Lebanon to Rank 8. According to the chain growth rate of the indicator, Lebanon also had Rank 8 out of the 11 countries analyzed.

The negative dynamics of the chain growth rates of men’s and women’s mortality since 2013 has slowed down, which is a signal of the presence of negative processes in the social sphere of Lebanon. This signal is also seen in infant mortality rates. The process of a slow decline in infant mortality rates reflected not only on the dynamics of the chain growth relative to the previous period, but also on the dynamics of the basic growth relative to 2009.

In terms of the birth rate, Lebanon experienced an 18.03% growth trend from 2009 to 2016. The base and chain growth rates of this indicator were significant: 25.00% and 3.25%, respectively. Our ranking, calculated in the descending order by birth rate, showed that Lebanon had Rank 10. Bahrain and the United Arab Emirates had similar ranks. It should be notified that, in contrast to Lebanon, the birth rate in these two countries tended to decrease.

When analyzing the basic rate of birth rate growth, it was found out that Lebanon (Rank 1) was the only country among the 11 analyzed countries that had a stable increase in the birth rate of the population: in 2016, compared to 2009, by +25.00%. For example, in Kuwait (Rank 10), it was minus 10.59%; in the United Arab Emirates (Rank 11), it was minus 12.40%. It should be emphasized that the average chain growth rate of fertility was positive only in two countries: Lebanon and Egypt (the average values of 103.25% and 100.34%, respectively).

All the other countries of the analyzed statistics population had negative chain growth rates in the birth rate of the population.

The study found out the following: having low absolute birth rates (Rank 10), Lebanon had Rank 1 in terms of basic and chain growth rates, which indicates the absence of a birth control policy. On the whole, the analyzed countries showed a general decline in the rate of birth rate growth. In terms of life expectancy, Lebanon had Rank 1, with an average life expectancy of 79.02 years in the analyzed period. For example, in the UAE it was 77.07 years (Rank 2). Life expectancy in Lebanon increased by 1.4 years from 78.30 years in 2009 up to 79.60 years in 2016, while in the UAE, this figure increased by less than 1 year.

Therefore, an analysis of the economic indicators has also been carried out. In particular, the gross domestic product by purchasing power parity per capita (GDP PPP) was considered6. It should be notified that this indicator has a multidirectional character in different countries. In most countries, the dynamics were positive. From 2009 to 2016, the negative dynamics were observed annually in only four countries: Lebanon, Kuwait, Oman and Yemen. The average decline was 17.36%. At the same time, in Oman, Kuwait and Yemen in 2016 compared to 2014 and 2015, there was stabilization in the decline of this indicator, while in Lebanon the slowdown in the growth rate of this indicator increased (Table 1). Thus, while in 2013 and 2014 the indicator of basic growth rates decreased by 0.35% and 3.07%, in 2015 and 2016 it decreased by 5.91% and 9.05%, respectively. A more complex situation in the dynamics of chain growth rates (Rank 9, Table 4) should be highlighted. While in 2013–2015, the GDP PPP indicator was relatively stable at minus 2.93% in Lebanon, in 2016 there was a decrease of 0.41% compared to 2015 and it amounted to minus 3.34%. The analysis of GDP PPP dynamics in 2009–2016, revealed the existence of problems in the economy of Lebanon, and their impact on the development of the health care system was considered on this basis. An important condition that determines a positive demographic situation is the development of the health sector in the country and training of specialists in the fields of medicine and pharmacy. An analysis of financial expenditure on health showed that in Lebanon, it had increased by 45.99% between 2009 and 2016.

 

Table 4 – Ranks of socio-economic indicators for the Middle East countries in 2009–2016

Country	Ranks of values						Ranks of base growth rates						Ranks of chain growth rates
	GDP (PPP), per capita	Health care expenditure, per capita	Expenditure on Medicines, per capita	Share of drugs expenses in the structure of health care expenses,	Number of doctors per 10,000 population	Number of pharmacists per 10,000 population	GDP (PPP), per capita	Health care expenditure, per capita	Expenditure on Medicines, per capita	Share of drugs expenses in the structure of health care expenses,per capita	Number of doctors per 10,000 population	Number of pharmacists per 10,000 population	GDP (PPP), per capita	Health care expenditure, per capita	Expenditure on Medicines, per capita	Share of drugs expenses in the structure of health care expenses,per capita	Number of doctors per 10,000 population	Number of pharmacists per 10,000 population
Lebanon	6	5	5	3	5	3	8	10	1	1	6	11	9	11	1	1	10	11
UAE	2	1	1	1	7	5	5	6	5	4	7	6	4	8	5	4	6	6
Bahrain	5	3	6	4	9	9	4	2	7	10	10	2	3	2	7	10	9	3
Kuwait	1	2	3	10	4	8	9	11	3	2	2	10	8	7	3	2	3	10
Saudi Arabia	3	4	4	6	2	6	1	1	6	11	4	8	1	1	6	11	4	8
Oman	4	6	2	11	6	4	10	4	2	8	9	9	10	4	2	9	7	4
Tunisia	8	8	7	8	8	7	3	5	11	9	3	1	5	9	11	7	2	2
Jordan	9	7	9	7	1	2	6	9	4	3	5	7	7	10	4	3	5	9
Egypt	7	9	8	2	3	1	2	3	10	7	11	4	2	3	10	5	11	7
Yemen	11	11	11	5	10	10	11	7	8	5	8	3	11	6	8	6	8	5
Sudan	10	10	10	9	11	11	7	8	9	6	1	5	6	5	9	8	1	1

 

While in 2013–2015, the GDP PPP indicator in Lebanon was relatively stable at minus 2.93%, in 2016 there was its decrease by 0.41% compared to 2015 and it amounted to minus 3.34%. The analysis of the dynamics of GDP PPP during 2009–2016 revealed the presence of problems in the economy of Lebanon, on the basis of which their impact on the development of the health care system was considered. An important condition that determines a positive demographic situation is the development of the health sector in the country and training of specialists in the fields of medicine and pharmacy. An analysis of financial expenditure on health showed that in Lebanon, it had increased by 45.99% between 2009 and 2016

It should be notified that the volume of health care expenditures per capita did not undergo any significant changes in 2016 compared to 2009 due to an increase in the population by 46.47% (Fig. 2).

 

Figure 2 – Financial expenditures on health per capita in Lebanon in 2009–2016

 

A comparative analysis of per capita health expenditures showed that Lebanon had Rank 5 (Tab.4). The volume of expenditures, while decreasing in 2013–2015, stabilized in 2016, slightly decreasing by 0.32% compared to 2009. The basic growth rate of health financing was stagnant (Rank 10). It is important to increase the volume of the expenditures on medicines per capita during the analyzed period (Fig. 3).

 

Figure 3 – Per capita expenditures on medicines in Lebanon in 2009–2016, in international dollars

 

When analyzing the structure of the expenditures in the health sector in Lebanon, significant changes were found out: the share of expenditures on health care increased from 32.14% in 2009 to 60.17% in 2016, thereby reducing the expenditures on general health items.

The conducted correlation analysis between this indicator and male, female and infant mortalities revealed a correlation, which, at first glance, is a contradictory situation: the decrease in health care funding had a positive impact on the reduction of male, female and infant mortalities: the correlation coefficient was 0.930.

However, at the stage of analyzing the chain growth rates of male, female and infant mortalities, there was no correlation: the correlation coefficient was minus 0.078. Accordingly, the inconsistency of the situation is explained by the difference in the rate of decline of the correlated parameters. The mechanism for reducing male, female and infant mortalities is more conservative, and the positive trends that had been laid down in the Lebanese health system in previous decades, continued to operate within the framework of the previously received inertia with reduced funding. The situation in which the chain growth rates in terms of mortality rates no longer correlated with funding indicators clearly showed a slowdown in the decline in mortality rates among the analyzed groups of the Lebanese population.

Further on, the hypothesis on the possibility of finding additional financial resources in the health care system by optimizing current expenses through the purchase of inexpensive medicines in the new for Lebanon dynamically developing pharmaceutical market of the Russian Federation was tested by the authors [7]. The imports of goods from the Pharmaceutical products group to Lebanon from the Russian Federation during the period of December 2017 – October 2018 amounted to 1.1 million US dollars, with a total weight of 14.6 tons.

The mainly imported products were the following: “human blood”; “animal blood”; “immune serums” (91%) and “Pharmaceutical products mentioned in Note 4 to this group” (9%), which include chemical contraceptives based on hormones, other compounds of the heading “Hormones, prostaglandins, thromboxane and leukotrienes, natural or synthesized; their derivatives and structural analogues, including chain modified polypeptides used mainly as hormones” or spermicides; contrast agents for x-ray examinations; diagnostic reagents intended for introduction to patients, and others.

In the structure of the exports of goods from the group “Pharmaceutical products” from the Russian Federation, Ukraine and Kazakhstan occupy the 1st (16%) and the 2^nd (16%) places. Lebanon is Russia’s partner number 42 with a 0.2% share of all MP supplies.

The cooperation between the Russian Federation and Lebanon has a significant potential [8–10]. The implementation of joint projects in the pharmaceutical industry and trade will expand the cooperation between the countries [11–19]. The interest of the Russian Federation in the export of the MP according to Strategy of the Pharmaceutical Provision of the Population of the Russian Federation for the Period Until 2025 is the key to this mutually beneficial cooperation and expanding economic ties between Russia and Lebanon.

To study the economic feasibility of introducing a mechanism for purchasing medicines from the Russian Federation, wholesale prices according to the reference and analytical publication of “Farm index” (for medical and pharmaceutical specialists) in the segment of vital and essential drugs were considered. The analysis was performed for 31 international non-proprietary names produced in the Russian Federation from Russian substances and imported by Lebanon from other countries. The comparative analysis of wholesale prices was based on the calculation of the cost of 1 gram of MPs under the terms of delivery of CIP Beirut (carriage and insurance paid to Beirut). The terms of delivery included: cargo packing, customs clearance, delivery to the port of loading, loading on the ship, sea transportation, unloading from the ship in the port of Beirut, delivery to the destination, insurance.

For a better visual representation, the VEDs nomenclature was presented in the form of 4 quartiles, depending on the price ratio (Lebanon/Russia): quartile I – 7.6–10.0 and higher ranked quartiles; quartile II-5.1-7.5; quartile III – 2.6–5.0; quartile IV-2.5 and lower ranked quartiles. The carried out ranking showed that at the time of the study, the current prices of Lebanon for all positions exceeded the book prices of the Russian Federation. The following was established: the highest rank, No. 1, when the ratio of prices amounted to 11, 21, was appointed to Olanzapine, 10 mg film-coated tablets (according to the Russian Commodity Nomenclature it is Olanzapine-TL, in Lebanon it is Zyprexa).

The lowest rank was 31, wherein the minimum ratio of the price index was 1.13. It was represented by Gemcitabine, 200 mg, in the form of lyophilisate for preparation of infusion solutions (according to the Russian Commodity Nomenclature it is Gemzar^®, in Lebanon it is Gemcitabine^TM).

A comparative analysis of the prices revealed that the MPs purchased in Lebanon in this segment, have an average of 4.54 times the price of MPs with the corresponding international non-proprietory name in the Russian Federation, taking into account the delivery to the port of Beirut.

At the same time, the calculations showed a high economic efficiency of importing 35.48% (11 nomenclature items) of medicinal products that had been included in quartiles I and II, from the Russian Federation, which showed the possibility of improving the drug supply in Lebanon by reducing the financial costs of purchasing medicinal products at the country level (Tab. 5).

 

Table 5 – Ranking of the ratio of wholesale prices for VEDs in the Russian Federation and Lebanon based on the cost of 1 gram of Medicines on the terms of CIP delivery to Beirut

RANK	INN	Trade name in Lebanon	Trade name in the Russian Federation	Manufacturer in Russia	Type of Dosage form	Dosage	Price ratio (Lebanon/ Russia)
Quartile I
1.	Olanzapine	Zyprexa TM	Olanzapine-TL	“Drugs technology”, Rabochaya St., Himki, Moscow region	Film-coated tablets	10 mg	11.21
2.	Ceftriaxone	Ceftriaxone Panpharma®	Ceftriaxon – АКОS	“Sintez Pharmaceuticals”, Kurgan	Powder for solution preparation for I.M. and I.V. administration	1g	9.88
3.	Olanzapine	Zyprexa TM	Olanzapine-TL	“Drugs technology”, Himki, Moscow region	Film-coated tablets	5 mg	9.22
4.	Ceftriaxone	Ceftriaxon LabatecB	Ceftriaxon – АКОS	“Sintez Pharmaceuticals”, Kurgan	Powder for solution preparation for I.M. and I.V. administration	2 g	8.98
5.	Levofloxacin	Levofloxaсin Hameln	Leflobact	“Sintez Pharmaceuticals”, Kurgan	Infusion solutions	5 mg/ml	8.63
			Levofloxabol	“Abolmed” Company, Novosibirsk
			Levofloxacin	JSC “Kraspharma”, Krasnoyarsk
Quartile II
6.	Bortezomib	Velcade®	Boramilan	“Nativa”, vil. Petrovo-Dal’neye, Moscow region 143422	Lyophilized for lyophilisate for preparation of I.V. and subcutaneous infusion solutions	3.5 mg	7.34
7.	Simvastatin	Simvastatin-Remedica®	Simvastatin	Valenta Pharm, Shchelkovo	Film-coated tablets	40 mg	7.23
			Simvastatin- SZ	“Severnaya Zvezda” CJSC, Vsevolozhsky district, the town of Kuzmolovsky, Leningrad region,
			Simvastatin	“Ozon”, Zhigulevsk (holder of reg. / UD. LLC «Atoll»)
8.	Cefotaxime	Cefotaxime	Cefosin	“Sintez Pharmaceuticals”, Kurgan	Powder for solution preparation for I.M. and I.V. administration	1 g	7.05
		Panpharma®	CEFOTAXIME	DEKO Company LLC, Tver region, p. Zelenogorsky
			Cefabol	Company «Abolmed», Novosibirsk
			Cefotaxime	CJSC «Pharmaceutical company «LECCO», The Vladimir region, p. Volginsky
9.	Gentamicin	Gentamicine Panpharma®	Gentamycine	JSC “MosChimPharmPreparaty” n.a. N.A. Semashko», Moscow	Solutions for for I.M. and I.V. administration	40 mg/ml	6.11
				“Atompharm”, Vashutinsk highway, Himki, Moscow region, Russia
10.	Metronidazole	Metronidazole®	Metronidazole – AKOS	“Sintez Pharmaceuticals”, Kurgan	Solution for infusions	5 mg/ml	5.49
			Metronidal	«Abolmed» Company, Novosibirsk
			Metronidazole	“Dalkhimpharm”, 22, Tashkent St, Khabarovsk,
11.	Cefazolin	Cefazolin Inj.	Cefazoline -АКОS	Sintez Pharmaceuticals, Kurgan	Powder for preparation of solution for intravenous and intramuscular administration	1 g	5.20
			Cefazoline	“Redkinsky Experimental Plant”, Zavodskaya St., vil. Redkino, Tver region.,
				“DEKO Company” LLC, Vil. Zelenogorsky, Tver region.
				“Biochimic”, Saransk
Quartile III
12.	Vancomycin	Vancomycin Hikma®	Vancorus	“Sintez Pharmaceuticals”, Kurgan	Lyophilisate for preparation of solutions for infusions and oral administration	500 mg	4.98
13.	Vancomycin	Vancomycin Hikma®	Vancorus	“Sintez Pharmaceuticals”, Kurgan	Lyophilisate for preparation of solutions for infusions and oral administration	1000 mg	4.50
14.	Tamoxifen	Tamoxifen Ebewe	Tamoxifen	“Ozon pharmaceutical”, Zhigulevsk	Tablets	10 mg	4.09
			Tamoxifen citrate	JSC” Obolenskoe – the pharmaceutical enterprise”
15.	Cefepime	Cefepime Panpharma®	Maxicef	“Prebend Production and Pharmaceutical company”, Novosibirsk	Powder for preparation of solution for I.M. and I.V. administration	1 g	4.02
16,5.	Tamoxifen	Tamoxifen Ebewe	Tamoxifen	“Ozon pharmaceuticals”, Zhigulevsk	Tablets	20 mg	3.25
16,5.	Ketolac	Ketolac®	Ketorolac	FSUE SPC “Parmzashchita” FMBA of Russia, Khimki	Powder for preparation of solutions for I.M. and I.V. administration	30 mg/ml	3.25
				“Ozon Pharmaceuticals”- Himki, Russia
				“Ellara”, Pokrov
				JSC «Biosynthesis», Penza
				JSC “MosChimPharmPreparaty” n.a. N.A. Semashko», Moscow
				JSC “Kurgan Joint-Stock company of medical preparations and products “Sintez”, Kurgan
			Dolomine	CJSC «FarmFirma “Sotex”, Moscow region, vil. Belikovo
			KETALGIN	JSC “Pharmstandard-Ufa VITA”, Ufa
18.	Paroxetin	Apo-Paroxetine®	Adepress	OJSC “Veropharm”, Belgorod	Film-coated tablets	20 mg	2.90
19.	Clarithromycin	Klacid RM®	Arvicin	JSC “Obolenskoye”, Obolensk, Moscow region,	Film-coated tablets	500 mg	2.84
			Clarithromycin	“Ozon pharmaceuticals”, Zhigulevsk
			Ecozitrin	JSC, Avva Rus, Kirov
20.	Acetylsalicylic acid	Aspirin Protect	Aspinat	JSC “Valenta Pharm”, Shchelkovo	Tablets	100 mg	2.80
			Aspicor	JSC “VERTEX”,St Petersburg	Tablets coated with an intestinal-soluble film coating
			Sanovasc	JSC “Irbit Chemical and Pharmaceutical Plant”, Irbit
Quartile IV
21.	Topiramate	Topamax®	Topiramate TL	LLC “Тechnology of Medicines”, Himki	Film-coated tablets	100 mg	2.52
22.	Ketorolac	Ketolac®	Ketolorac	JSC “TatСhemPharmPreparaty” Kazan	Film-coated tablets	10 mg	2.42
				JSC “Vertex”, St Petersburg
				“Sintez Pharmaceuticals”, Kurgan
				JSC “PFC “Update”, Novosibirsk
			Ketalgin	OJSC “Pharmstandard-Leksredstva”, Kursk
			Ketorolac-OBL	“Obolenskoye”, vil. Obolensk, Moscow region
23.	Irinotecan	Irinotecan Ebewe	Irinotecan	JSC “BIOCAD”, vil. Petrovo-Dal’neye	Concentrate for preparation of infusion solutions	20 mg/ml	2.03
24.	Leflunomide	Arava®	Ralef	OOO “Evofarm”, vil. Obolensk	Film-coated tablets	20 mg	1.96
			Leflaid	LLC “Тechnology of medicines”, Himki
25.	Cefuroxime	Cefuroxime –Panpharma®	Cefurus	“Sintez Pharmaceuticals”, Kurgan	Powder for preparation of solution for I.M. and I.V. administration	1500 mg	1.68
						750 mg	1.63
26.
27.	Topiramate	Topamax 25®	Topimate TL	LLC “Technology of medicines”, Himki	Film-coated tablets	25 mg	1.58
28.	Acetylsalicylic acid	Aspirine	Aspinat 300	JSC “Valenta Pharmaceuticals”, Shchelkovo	Tablets coated with an intestinal-soluble coating	300 mg	1.53
29.	Simvastatin	Simvastatin- Remedica®	Ovenkor	“Ozon pharmaceuticals”, Zhigulevsk	Film-coated tablets	20 mg	1.36
			Simvastatin SZ	“Severnaya Zvezda” CJSC, vil. Kuzmolovsky, Vsevolozhsky district, Leningrad region
			Simvastatin	JSC “Valenta Pharmaceuticals”, Shchelkovo
				CJSC «ALSI Pharma», Kirov
				JSC “Vertex”, St Petersburg
				JSC “AVVA RUS”, Kirov
30.	Allopurinol	Apo-Allopurinol®	Allopurinol	JSC “Organica”, Novokuznetsk	Tablets	100 mg	1.27
31.	Gemcitabine	Gemcitabine®	Gemcitare	JSC “BIOCAD”, Vil. Petrovo-Dal’neye	Lyophilisate for preparation of infusion solutions	200 mg	1.13
Average 4,54

 

CONCLUSION

A correlation analysis of demographic and economic indicators in Lebanon, revealed a satisfactory level of health financing (Rank 5) and making adequate decisions in the organization and management of the Lebanese health system which resulted in the low mortality rate and a high life expectancy. The positive trends that had been laid down in the Lebanese health system in previous decades continued to operate within the framework of the inertia received before, with reduced funding. It should be emphasized that the number of doctors and pharmaceutical specialists (on average 21.50 and 14.67 per 10,000 population, respectively) is fairly stable in Lebanon, which ensures the effectiveness and sustainability of the health system, especially in times of crises and wars. However, due to the limited financial resources of the country, the current situation in the health care system poses new challenges in finding management solutions in the field of organizational management. One of them is to optimize current expenses by purchasing low-cost medicines in new and dynamically developing pharmaceutical markets in Lebanon. Import of medicinal products from the Russian Federation will significantly reduce the cost of medical CARE for the population of Lebanon and migrants from the neighboring countries, which will increase the costs of providing medical care to the population.

FINANCIAL SUPPORT

This study did not have any financial support from third-party organizations.

AUTHOR’S CONTRIBUTION

El Moussawi MAEH – collection and processing of the materials, statistical data processing, text writing; Mironenkova Zh.V. – statistical data processing, text writing, editing; Umarov S.Z. – a research concept and design, editing; Knysh O.I. – a research concept and design, editing; Nemyatykh O.D. – text writing, editing.

CONFLICT OF INTEREST

The authors declare no conflict of interest.

¹ Naufal, Hala. Syrian Refugees in Lebanon: The humanitarian approach under political divisions / Hala Naufal // Migration Policy Centre Research Report. – 2012/13. – URL: http://www.migrationpolicycentre.eu (accessed: 2019 Apr 26).

² Rating of countries in the world by population // the United Nations Population Fund (UNFPA). – URL: http://www.un.org (date accessed: 2018 Feb 5).

³ National Health Statistics. Report in Lebanon. 2011. – URL: http://habitat3.org/wp-content/uploads/National-Report_LEBANON.pdf (accessed: 2019 Apr 24)

⁴ The Department of economic and social Affairs of the United Nations. – URL: https://esa.un.org (date accessed: 2019 Apr 26).

⁵ Millennium Declaration adopted by the UN General Assembly on 08.09.2000 (Resolution No. A / RES/52/2). – URL: http://www.un.org. (date accessed: 2019.Apr 26)

⁶ Global ranking of countries and territories of the world in terms of gross domestic product // Information and analytical portal “Humanitarian technologies and human development. URL: http://gtmarket.ru (date accessed:2019 Apr 24).

About the authors

Mohamad A. E. H. El Moussawi

Saint-Petersburg State Chemical and Pharmaceutical University; ”Mohammed” Pharmacy

Author for correspondence.
Email: drmohamadmoussawi@hotmail.com
ORCID iD: 0000-0001-5432-7680

candidate of the Department of medical and pharmaceutical commodity science; the head of the Pharmacy

Russian Federation, 14, Bld. A, Prof. Popov St., St Petersburg, 197376; 12, Hadath, Beirut, Lebanon 90201

Zhanna V. Mironenkova

Saint-Petersburg State Chemical and Pharmaceutical University

Email: shanna.mironenkova@pharminnotech.com
ORCID iD: 0000-0003-1029-093X

Doctor of Sciences (Pharmacy), Associate Professor, Professor of the Department of medical and pharmaceutical commodity science

Russian Federation, 14, Bld. A, Prof. Popov St., St Petersburg, 197376

Sergey Zakirdzhanovich Umarov

Saint-Petersburg State Chemical and Pharmaceutical University

Email: sergei.umarov@pharminnotech.com
ORCID iD: 0000-0003-0771-6143

Doctor of Sciences (Pharmacy), Professor, the Head of the Department of Medical and Pharmaceutical Commodity Science

Russian Federation, 14, Bld. A, Prof. Popov St., St Petersburg, 197376

Olga I. Knysh

Tyumen State Medical University

Email: knysho@mail.ru
ORCID iD: 0000-0001-6150-1683

Doctor of Sciences (Pharmacy), Professor, the Head of the Department of Pharmaceutical Disciplines

Russian Federation, 54, Odessa St., Tyumen, 625023

Oksana D. Nemyatykh

Saint-Petersburg State Chemical and Pharmaceutical University

Email: oksana.nemyatyh@pharminnotech.com
ORCID iD: 0000-0001-5933-2120

Doctor of Sciences (Pharmacy), Professor, Professor of the Department of Pharmacy Management and Economics

Russian Federation, 14, Bld. A, Prof. Popov St., St Petersburg, 197376

References

Supplementary files