At odds with its neighbor, Afghanistan has banned all imports of Pakistani medicines, determined to develop its pharmaceutical industry to improve product quality, while also collaborating more closely with India. But the pill of change is sometimes hard to swallow.
Last November, a month after deadly clashes, Taliban authorities announced that they planned to quickly end Afghanistan's historical dependence on Pakistani medicines.
The long border between the two countries has been closed for about four months.
In February, the hammer fell on medicines with the effective ban on their importation.
"The Ministry of Finance is once again urging all businessmen to import medicines through legal sources other than Pakistan," the minister's spokesman, Abdul Qayoom Naseer, told AFP.
The challenge is immense for a country that imported more than half of its medicines from Pakistan.
"The price of some Pakistani medicines has increased, for others there is a shortage, it creates a lot of problems for people," notes Mujeebullah Afzali, a pharmacist in Kabul.
Even the supply of medicines manufactured in India has been impacted by the border closure. Previously, they transited through the Pakistani city of Karachi.
"Now we have to bring them in through Islam Qala (the border crossing with Iran, editor's note), which has increased transport prices from 10 to 15%," because the journey is longer, explains this 31-year-old pharmacist.
Previously, transport costs represented 6 to 7% of the wholesale purchase price of a drug, but now this proportion is between 20 and 30%, a source in the pharmaceutical sector, speaking on condition of anonymity for security reasons, told AFP.
According to this source, the numerous difficulties in obtaining supplies have cost drug dealers millions of dollars.
– “Illegal supplies” –
"Before, if a medicine was out of stock, we would call Pakistan and the delivery would be made in two or three days, legally or illegally," she adds.
It is precisely these illegal supply channels that motivated the Taliban government to decide to no longer depend on Pakistan, explains the Afghan Ministry of Health.
"The biggest problem with Pakistani medicines is that we receive counterfeit ones, mainly through illegal supply channels," ministry spokesman Sharafat Zaman told AFP.
He acknowledges that it will take some time to change the face of the market, even though the authorities are actively working with India, Iran, Bangladesh, Uzbekistan, Turkey, China and Belarus.
"India was the second largest supplier, which means we can now compensate with Indian medicines," the spokesman said.
At the same time, he argues, the production of 600 types of medicines in Afghanistan "has largely solved the problems of patients."
The Afghan company Milli Shifa Pharmaceutical, for example, produces 100,000 bottles of serum per day and "can double this production" depending on market demand, its CEO Nasar Ahmad Taraki told AFP. Among the medications produced are antibiotics and paracetamol.
– “Higher costs” –
Even though the country of more than 45 million inhabitants has developed its pharmaceutical industry in recent years, it "struggles to meet the full range of needs of the health sector", underlines a report by the United Nations Development Programme (UNDP).
The cost of energy, inadequate infrastructure and the need to import some of the basic substances make it difficult to achieve self-sufficiency, explains the source in the pharmaceutical sector.
Some locally produced medicines are therefore more expensive than those imported from Pakistan.
Patients are also reluctant to change their habits. "They believe that by using Pakistani medicines, they will be well treated and that this will not be the case with products from India or other countries," the same source notes.
In hospitals or clinics, doctors are also encountering difficulties in replacing medicines from Pakistan.
"They need to find alternative solutions and spend more time adjusting treatments," a source within a facility in Kabul emphasized, speaking on condition of anonymity for security reasons.
She adds that patients are also affected, with "drugs out of stock, numerous prescription changes and sometimes higher costs".
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