MINISTERIAL ORDER Nº 20/39 OF 29/01/2016 DETERMINING THE MEDICAL SERVICES PROVIDED AT EACH LEVEL OF HEALTH FACILITIES

Ingingo ya mbere: Ibikorwa by’ubuvuzi bitangwa kuri buri rwego rw’ibigo by’ubuvuzi Article One: Medical services provided at each level of health facilities Article premier: Prestations médicales dispensées à chaque niveau d’établissements de santé Ingingo ya mbere: bitangwa kuri buri rwego rw’ibigo by’ubuvuzi Article One: Medical services provided at each level of health facilities Urutonde rw‟ibikorwa by‟ubuvuzi n‟imiti bijyana bitangwa kuri buri rwego rw‟ibigo by‟ubuvuzi bifite amasezerano n‟ikigo cya Leta gifite ubwisungane mu kwivuza mu nshingano zacyo biri buri cyose ku mugereka wa I n‟uwa II y‟iri teka. The medical services and corresponding medicines provided at each level of health facilities that have a valid agreement with the public institution in charge of the community-based health insurance scheme are respectively in annex I and II of this Order. Article premier: Prestations médicales dispensées à chaque niveau d’établissement de santé Les prestations médicales et les médicaments correspondants dispensés à chaque niveau d‟établissement de santé ayant un contrat avec l‟établissement public en charge du régime des mutuelles de santé sont respectivement en annexe I et II du présent arrêté. 3

Ingingo ya 2: Ivugururwa ry’urutonde Article 2: Updating of the list Article 2 : Mise à jour de la liste Ingingo ya 2: Kuvugurura urutonde Article 2: Mise à jour de la liste Official Gazette nº06 of 08/02/2016 Article 2: Updating of the list by‟ubuvuzi rw‟ibikorwa Urutonde n‟imiti bivugwa mu ngingo ya mbere y‟iri teka rushobora guhinduka kuvugururwa kw‟ibikorwa by‟ubuvuzi cyangwa mu gihe habaye impinduka ku rutonde rw‟imiti y‟ibanze. hashingiwe ku The list of medical services and medicines provided for in Article One of this Order may be updated according to changes in the packages of medical services or changes in the essential medicines list. liste des La services médicaux et des médicaments prévus à l‟article premier du présent arrêté peut être mise à jour suite au changement du paquet des services médicaux et de médicaments essentiels. Ingingo zinyuranyije n’iri teka ya 3: Ivanwaho ry’ingingo

Ingingo ya 3: Ivanwaho ry’ingingoo zinyuranyije n’iri teka Article 3: Repealing provision Article 3 : Disposition abrogatoire Article 3: Disposition abrogatoire Article 3: Repealing provision Ingingo zose z‟amateka abanziriza zinyuranyije na ryo zivanyweho. iri kandi

Ingingo ya 4: Igihe iteka ritangiraa gukurikizwa Article 4: Commencement Article 4 : Entrée en vigueur 2 Official Gazette nº06 of 08/02/2016 29/01/2016 RIGENA ITEKA RYA MINISITIRI Nº20/39 RYO KU IBIKORWA WA BY’UBUVUZI BITANGWA KURI BURI RWEGO RW’IBIGO BY’UBUVUZI MINISTERIAL ORDER Nº20/39 OF 29/01/2016 DETERMINING THE MEDICAL SERVICES PROVIDED AT EACH LEVEL OF HEALTH FACILITIES ARRETE MINISTERIEL Nº20/39 DU LES 29/01/2016 PRESTATIONS MEDICALES DISPENSEES A CHAQUE NIVEAU D’ETABLISSEMENTS DE SANTE DETERMINANT Minisitiri w’Ubuzima; The Minister of Health; Le Ministre de la Santé; Ashingiye ku Itegeko Nshinga rya Repubulika y‟u Rwanda ryo mu 2003 ryavuguruwe mu 2015, cyane cyane mu ngingo zaryo, iya 121, iya 122 n‟iya 176; Ashingiye ku Itegeko n° 03/2015 ryo ku wa 02/03/2015 imitunganyirize y‟ubwisungane mu kwivuza, cyane cyane mu ngingo yaryo ya 9; rigenga Inama 03/11/2015 imaze kubisuzuma no kubyemeza; y‟Abaminisitiri yateranye ku wa Pursuant to the Constitution of the Republic of Rwanda of 2003 revised in 2015, especially in Articles 121, 122 and 176; Vu la Constitution de la République du Rwanda de 2003 révisée en 2015, spécialement en ses articles 121, 122 et 176 ; Pursuant to Law n° 03/2015 of 02/03/2015 governing the organization of the community-based health insurance scheme, especially in Article 9; Vu la Loi nº 03/2015 du 02/03/2015 portant organisation du régime des mutuelles de santé, spécialement dans son article 9; After consideration and approval by the Cabinet, in its session of 03/11/2015; Après examen et adoption par le Conseil des Ministres en sa séance du 03/11/2015; ATEGETSE: HEREBY ORDERS: ARRETE: Ibikorwa by’ubuvuzi Ingingo ya 4: Igihe iteka ritangira gukurikizwa teka ritangira gukurikizwa ku munsi Iri ritangarijweho mu Igazeti ya Leta ya Repubulika y‟u Rwanda. All prior provisions contrary to this Order are hereby repealed. Article 4: Commencement This Order shall come into force on the date of its publication in the Official Gazette of the Republic of Rwanda. Toutes les dispositions antérieures contraires au présent arrêté sont abrogées. Article 4: Entrée en vigueur Le présent arrêté entre en vigueur le jour de sa publication au Journal Officiel de la République du Rwanda. Kigali, ku wa 29/01/2016 Kigali, on 29/01/2016 Kigali, le 29/01/2016 (sé) Dr. BINAGWAHO Agnes Minisitiri w‟Ubuzima (sé) Dr. BINAGWAHO Agnes Minister of Health (sé) Dr. BINAGWAHO Agnes Ministre de la Santé Bibonywe kandi bishyizweho Ikirango cya Repubulika: (sé) BUSINGYE Johnston Minisitiri w‟Ubutabera/Intumwa Nkuru ya Leta Seen and sealed with the Seal of the Republic: Vu et scellé du Sceau de la République: (sé) BUSINGYE Johnston Minister of Justice/Attorney General (sé) BUSINGYE Johnston Ministre de la Justice/ Garde des Sceaux 4 ANNEXE I DE L’ARRETE MINISTERIEL Nº20/39 DU 29/01/2016 DETERMINANT LES DISPENSEES A CHAQUE NIVEAU D’ETABLISSEMENTS DE SANTE PRESTATIONS MEDICALES Official Gazette nº06 of 08/02/2016 UMUGEREKA WA I W’ITEKA RYA MINISITIRI Nº20/39 RYO KU WA 29/01/2016 RIGENA URUTONDE RW’IBIKORWA BY’UBUVUZI BITANGWA KURI BURI RWEGO RW’IBIGO BY’UBUVUZI ANNEX I TO MINISTERIAL ORDER Nº20/39 OF 29/01/2016 DETERMINING THE MEDICAL SERVICES PROVIDED AT EACH LEVEL OF HEALTH FACILITIES 5 Official Gazette nº06 of 15/02/2016 ANNEX I PART A. HEALTH SERVICE PACKAGES AT ALL LEVELS 1.1 HEALTH SERVICE PACKAGES AT HEALTH POST LEVEL Primary Health Care 1 Annual General checkups and screening1 2 Family planning (Condoms, Pills, Injection) 3 HIV voluntary counseling & testing (VCT) and Provider Initiated Testing (PIT) 4 Primary curative consultation by A2/A1 Nurse 5 Management of communicable and non-communicable diseases2 E.g. influenza, malaria, diarrhea, Clinical Integrated Management of Childhood Illnesses. 6 Wound care 7 Postnatal consultation(After 1 week of birth) 8 Follow up of malnutrition cases 9 Follow up of treatment initiated at upper level2. 10 Palliative Care and Pain management Laboratory/Rapid Test 1 Glycemia 2 Glucosuria 3 Rapid test for malaria 4 HIV Testing 5 Pregnancy test Pharmacy 1 Dispensing/Referring to the list of drugs authorized at HP level 2 Ambulance (par Km) 1.2. HEALTH SERVICE PACKAGES AT HEALTH CENTER EXTENSION FACILITY Primary Health Care 1 Annual General checkups and screening1 2 Vaccination/Immunization (newborns, children, pregnant women and others) 3 Antenatal Care (ANC) 4 Family planning (Condoms, Pills, Injection) 5 HIV voluntary counseling & testing (VCT) and Provider Initiated Testing (PIT) 6 Primary curative consultation by A2/A1 Nurse 7 Management of communicable and non-communicable diseases2 E.g. influenza, malaria, diarrhea, Clinical Integrated Management of Childhood Illnesses. 8 Wound care 9 Normal Delivery 10 Postnatal consultation (After 1 week of birth) 1 Follow up of malnutrition cases x x x x x x x x x x x x x x x x x x x x x x x x x x x x • 1 Reference to the package covered in Ministry of Health Instructions No.20/62 of 20th March 2014 on annual check up for Non-Communicable Diseases. Check list 6 Official Gazette nº06 of 08/02/2016 Primary Health Care 2 Follow up of treatment initiated at upper level. E.g. Direct Observed Treatment for Tuberculosis. Palliative Care and Pain management2 3 Laboratory3 1 Rapid Test(blood, urine, saliva) 2 Pharmacy 1 Dispensing/Ref list of drugs authorized at HC level 2 Hospitalization. (< 72h, longer stay should be motivated)2 3 Ambulance (per Km) Parasitology 1.3. HEALTH SERVICE PACKAGES AT HEALTH CENTER LEVEL Primary Health Care 1 Annual General checkups and screening1 2 Vaccination/Immunization (newborns, children, pregnant women and others) 3 Antenatal Care (ANC) Family planning 4 5 HIV voluntary counseling & testing (VCT), prevention of mother-to child transmission (PMTCT) and Provider Initiated Testing (PIT) Preventive treatment (e.g. opportunistic Infections) Post Exposure Prophylaxis 6 7 8 Management of SGBV cases 9 Primary curative consultation(A1 + A2 health professional) 10 Clinical psychology/counseling/mental health consultation 11 Management of communicable and non-communicable diseases 12 Therapeutic nutritional rehabilitation 13 Minor surgery with or without local anesthesia 14 Therapeutic Circumcision 15 Delivery 16 Basic Emergency Obstetric and Neonatal Care (BeONC-B) 17 Postnatal consultation 18 Follow up of non-communicable conditions 19 Traumatology. E.g. Pain management, wound care, immobilization Hospitalization. (< 72h, longer stay should be motivated)3 Ambulance (per Km) Laboratory 1 2 Hematology 3 Biochemistry 4 Parasitology 5 Microbiology Immuno-serology 2 Clear indication for extension for hospitalization 3 Clear indication for extension for hospitalization 7 x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Official Gazette nº06 of 08/02/2016 Pharmacy 1.4. HEALTH SERVICE PACKAGE AT DISTRICT HOSPITAL LEVEL Preventive Services 1 2 3 4 Vaccination/Immunization (newborns, children, pregnant women and others) Antenatal Care (ANC) Family planning HIV voluntary counseling & testing (VCT), prevention of mother-to child transmission (PMTCT) and Provider Initiated Testing (PIT) Preventive treatment (e.g. opportunistic Infections) Post Exposure Prophylaxis Provision of Orthotic and Prosthetic Appliances/disability Hospitalization Basic Emergency Obstetric and Neonatal Care (BeONC-B) Consultation by a Specialist Paramedical consultation (A0) Paramedical consultation (A1) Consultation by Nurse A1 5 6 Curative services 1 Medical consultation by a General Practionner 2 3 4 5 6 Management and follow up of non-communicable conditions2 7 Management and follow up visit for communicable diseases2 8 9 10 Comprehensive Emergency Obstetric and Neonatal Care (CeONC-C) 11 Minor surgery4 12 Major surgery6 13 14 Optometry 15 Hospitalization Accident and Emergencies 1 2 Anesthesia&Resuscitation 1 2 3 4 5 Medical Imaging 1 2 3 4 Pathology/ Medical Laboratory 1 2 Pre-anesthetic care Intra-operative care Post-anesthetic care (recovery) Resuscitation High dependency care General radiography General dental& intraoral x-ray Ultrasonography Fluoroscopy Pre-hospital emergency services Ambulance Immuno-serology Hematology 4 Ref to surgical procedures 8 x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Official Gazette nº06 of 08/02/2016 Dispensing/Ref list of drugs authorized at DH level Biochemistry Parasitology Virology 3 4 5 6 Mycobacteriology Pharmacy 1 Physiotherapy 1 2 3 4 Blood Bank 1 Medical Gas Production 1 Mortuary 1 Mortuary Oxygen Blood Transfusion Kit Hydrotherapy Electrotherapy Soft tissues mobilisation Neuro-developmental re-education 1.5. HEALTH SERVICE PACKAGE FOR PROVINCIAL HOSPITAL LEVEL Preventive Services 1 Vaccination/Immunization (newborns, children, pregnant women and others) 2 Antenatal Care (ANC) 3 Family planning 4 HIV voluntary counseling & testing (VCT), prevention of mother-to child transmission (PMTCT) and Provider Initiated Testing (PIT) Preventive treatment (e.g. opportunistic Infections) Post Exposure Prophylaxis Consultation by a General Practionner Consultation by a Specialist Paramedical consultation (A0) Paramedical consultation (A1) Consultation by Nurse A1 5 6 Curative Services 1 2 3 4 5 6 Management and follow up visit for non-communicable conditions. 7 Management and follow up visit for communicable diseases. 8 9 Minor/ Intermediate/ Major surgery. 10 Burn care 11 Hospitalization Physiotherapy 1 Hydrotherapy 2 3 4 Neuro-developmental re-education Electrotherapy Soft tissues mobilisation Comprehensive Emergency Obstetric and Neonatal Care (CeONC-C) 9 x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Official Gazette nº06 of 08/02/2016 Therapeutic nutrition rehabilitation Provision of Orthotic and Prothetic Appliances/disability Pre-hospital emergency care Rehabilitive Services 1 2 3 Optometry Accident and Emergencies 1 2 Ambulance Anesthesia and Resuscitation Pre-anesthetic care 1 Intra-operative care 2 Post anesthetic care (recovery) 3 Resuscitation 4 5 High dependency care Medical Imaging 1 General radiography 2 Dental intraoral x-ray or panoramic X-ray 3 CT-scanning 4 Ultrasonography 5 Fluoroscopy 6 Mammography Pathology/ Medical Laboratory 1 2 Hematology Biochemistry 3 Parasitology 4 5 Virology 6 Mycobacteriology 7 Medical Entomology 8 Cytology & histopathology 9 Molecular biology & genetics Pharmacy 1 Dispensing/Ref list of drugs authorized at PH level Blood Transfusion 1 Medical Gas Production 1 Oxygen Mortuary 1 Mortuary Blood Transfusion Kit Immuno-serology 1.6. HEALTH SERVICE PACKAGES FOR REFERRAL HOSPITAL LEVEL Preventive Services 1 Vaccination/Immunization (newborns, children, pregnant women and others) 2 Antenatal Care (ANC) Family planning 3 10 x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Official Gazette nº06 of 08/02/2016 4 HIV voluntary counseling & testing (VCT), prevention of mother-to child transmission (PMTCT) and Provider Initiated Testing (PIT) Preventive treatment2 Post Exposure Prophylaxis 5 6 Curative Services 1 2 3 4 5 6 Management and follow up visit for non-communicable conditions. 7 Management and follow up visit for communicable diseases. Consultation by a General Practioner Consultation by a Specialist Paramedical consultation (A0) Paramedical consultation (A1) Consultation by Nurse A0/A1 Comprehensive Emergency Obstetric and Neonatal Care (CeONC-C) Electrotherapy Soft tissues mobilisation Specialized physiotherapy (spine, neuro etc.) Speech &audiology Therapeutic nutrition rehabilitation Provision of Prosthetics & orthotics 8 Hospitalization (Annex with details) 9 10 Dialysis 11 Oncology 12 Surgery Physiotherapy 1 Hydrotherapy 2 3 4 Neuro-developmental re-education Rehabilitive Services 1 2 3 4 5 Optometry Accident and Emergencies 1 2 Ambulance Anesthesia&Resuscitation Pre-anesthetic care 1 Intra-operative care 2 Post anesthetic care (recovery) 3 4 Resuscitation 5 High dependency care Medical Imaging 1 General radiography 2 Dental intraoral x-ray or panoramic X-ray 3 CT-scanning 4 Ultrasonography Electroencephalography 5 Electrocardiography 6 Fluoroscopy 7 8 Mammography Pre-hospital emergency care 11 x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Official Gazette nº06 of 08/02/2016 Immuno-serology 9 Angiography 10 MRI scanning Pathology/ Medical Laboratory 1 2 Hematology Biochemistry 3 4 Parasitology 5 Virology 6 Mycobacteriology 7 Medical Entomology 8 Cytology & histopathology 9 Molecular biology & genetics Pharmacy 1 Dispensing/Ref list of drugs authorized at RH level Blood Transfusion 1 Blood or Blood Kits Medical Gas Production 1 Oxygen Mortuary 1 Mortuary x x x x x x x x x x x x x x x PART B. TYPES OF PROCEDURES AND INVESTIGATION DONE AT ALL LEVELS 2.1 INTERNAL MEDICINE PROCEDURES Specialty Service Area Internal Medicine Medical Condition Chronic Respiratory Diseases NRH/ UTH x P&R H x x x x x DH HC HP Comments x x x x x x x x GeneXpert is done at DH Type of Procedures Assessment & clinical staging Basic investigation General management (e.g: - bronchodilators and corticosteroids) Advanced investigations : -(E.g: ABG, pathology, microbiology, bronchoscopy, GeneXpert, etc) 12 Official Gazette nº06 of 08/02/2016 Specialty Service Area Medical Condition Respiratory Failure Gastrointestina l Diseases Type of Procedures Advanced management (- oxygenation and nebulization) Intubation, ventilator management Patient assessment Basic investigation (laboratory and imaging) Advanced investigation (pathology, endoscopy) Basic management (symptomatic management using drugs) Advanced management (drugs, endoscopic and surgical interventions) Genito-Urinary System- Upper and Lower Patient assessment Basic investigation (hematology, bacteriology, urine microscopy and dip stick & biochemistry) Advanced investigations (urine culture, ultrasound, cytology) DH HC HP Comments x x x x x x x x x x Highly specialized procedures such transplantation, reconstructive surgery etc…will be subject to guidelines guided by assessment prior its introduction. A specific authorization will be issued. x x x x x x NRH/ UTH x P&R H x x x x x x x x x x x x x x x x x x x 13 Official Gazette nº06 of 08/02/2016 Specialty Service Area Medical Condition Dermatology pathologies Cardiovascular diseases Type of Procedures Basic management ( symptomatic management using drugs) Advanced management (treatment guided by the culture and sensitivity results, surgical procedures, dialysis in acute phase: 6 weeks as per guidelines) Patient assessment Basic investigations (hematology, biochemistry) Advanced investigations (pathology) Basic management (symptomatic management using drugs) Advanced management (guided by specialized investigation results), Laser management Patient assessment Basic investigations (Laboratory and imaging) Advanced investigation (cardiac ultrasound, Holter monitor, stress test, cardiac enzymes, etc.) NRH/ UTH x P&R H x x x DH HC HP Comments x x x Highly specialized procedures such transplantatio, reconstructive surgery, dialysis, etc…will be subject to guidelines guided by assessment prior it introduction. A specific authorization will be issued. x x x x x x x x x x x x x x x x x x x x x x x x x x x 14 Official Gazette nº06 of 08/02/2016 Specialty Service Area Medical Condition Mental Health Oncology Type of Procedures Basic management (symptomatic management using drugs) Advanced management (guided by specialized investigation results); defibrillation, hemodynamic infusions and surgical procedures. Patient assessment Basic investigations (hematology, biochemistry) Advanced investigation (radiological scans and EEG) Basic management (symptomatic management using drugs) Advanced management (guided by specialized investigation results) Patient assessment: screening and early detection Basic investigation (hematology, biochemistry, bacteriology, biopsy procedures and processing for referral) NRH/ UTH x P&R H x DH HC HP Comments x x x Highly specialized procedures such valve replacement, pacemaker, catheterization etc…will be subject to guidelines guided by assessment prior it introduction. A specific authorization will be issued. x x x x x x x x x x x x x x x x x x x x e.g., palpation for breast cancer can be performed at all facilities x x x x x x x x 15 Official Gazette nº06 of 08/02/2016 Specialty Service Area Medical Condition Endocrinology /Metabolic Diseases, e.g. Diabetes Type of Procedures Advanced investigation (e.g., biopsy, x-rays, ultrasound, mammography, markers) Procedures(e.g.: cryotherapy and colposcopy) Advanced therapy: (e.g.: chemotherapy and surgery) Radiotherapy Patient assessment Basic investigation (hematology, biochemistry) Advanced investigation (e.g., fundoscopy, ECG, x-rays, ultrasound, HBA1C) Basic management (symptomatic treatment) Advanced management Infectious Diseases Patient Assessment Basic investigations (rapid tests) Advanced investigations DH HC HP Comments Mammography and scans only available at NRH Follow up for already initiated drugs by internists Highly specialized procedures/ treatment will be subject to guidelines guided by assessment prior it introduction. x x x x x x x x x x x x Management of Some endocrinology /metabolic diseases will be subject to guidelines guided by assessment prior it introduction. x x x x x x NRH/ UTH x P&R H x x x x x x x x x x x x x x x x x x x x x x 16 Official Gazette nº06 of 08/02/2016 Specialty Service Area Medical Condition Type of Procedures Basic management (e.g., antiretroviral, antibiotics, antimalarial and TB drugs) Advanced management DH HC HP Comments NRH/ UTH x P&R H x x x x Management of Some Infections diseases such as Hep C will be subject to guidelines guided by assessment prior it introduction. x x x 2.2. PEDIATRIC PROCEDURES Specialty Service Area Medical Conditions Type of Procedures NRH/ UTH P&R H DH HC HP Comments Neonatology Normal Normal care Newborn Care Prematurity Management of prematurity Low birth weight (<2500g) Warming/ Kangaroo Mother Care IV D10% Incubator Oxygen therapy Very low birth weight (<1500g) Extremely low birth weight (<1000g) Continuous positive airway pressure (CPAP) Mechanical ventilator support Surfactant IV antibiotics Respiratory Distress Syndrome Neonatal Infections : mild x x x x x x x x x x x x x x x x x x x x x x x x x x x x x 17 Premature neonates with extremely low birth weight (below 1kg) are to be referred to Provincial or Referral Hospitals for proper management. Babies requiring ventilator support for Respiratory Distress Syndrome are to be referred to Provincial or referral hospitals Official Gazette nº06 of 08/02/2016 Severe infection IV fluids Neonatal jaundice Oxygen therapy Mechanical ventilator support Phototherapy IV fluids Exchange transfusion Birth asphyxia Selective head cooling Convulsion management IV fluid restriction Non- pharmaceutical and pharmaceutical Resuscitation with IV replacement Endoscopic injection sclerotherapy Oral and IV fluids Oral and IV fluids Gastrointestinal Disorders Bleeding esophageal varices Acute gastroenteritis Persistent diarrhea Bloody diarrhea Non- pharmaceutical and pharmaceutical Non- pharmaceutical and pharmaceutical Non- pharmaceutical and pharmaceutical Specific antidotes Upper GI bleeding Peptic ulcer disease Poisoning Respiratory Diseases Respiratory distress Airway management Pneumonia Antibiotics Asthma Prophylaxis (avoidance of allergens) x x x x x x x x x x x x x x x x x x x x x 18 x x x x x x x x x x x x x x x x x x x x x x x x x x x x Assess and treat underlying causes; Use of IMCI guidelines Assess and treat specific poison x x x x Assess and treat x x x x x x underlying causes; IMCI guidelines x x Patient and family education Official Gazette nº06 of 08/02/2016 Pharmacological management : bronchodilators & corticosteroids Nebulizer therapy Oxygen therapy IV pharmacological therapy ENT conditions Pharmaceutical management, e.g. antibiotics Surgical procedures and devices Cardiovascular Diseases Rheumatic heart disease Congenital heart disease Dilated cardiomyopathy Antibiotics Surgery Cardiac catheterization Surgery Oxygen therapy Nutritional support Fluid management Cardiac medications x x x x Mild and moderate forms can be managed at DHs. x x x x x x x x x x Severe forms managed at P&RHs and RHs x ENT surgeons desirable at P&RHs. Management of ENT conditions requiring highly specialized procedures or devices etc..will be subject to guidelines guided by assessment prior it introduction. x x x x x x x x x CNS Disorders Pediatrics Seizure disorders Antiepileptic medications x x x x Coma Identify & treat cause: brain injury, diabetes, etc. x x x Endocrine Diseases 19 Not all seizures require medications; follow management of convulsions protocol. Cases of status epilepticus referred to higher levels Referral mainly for investigations (EEG, MRI or CT scan) Official Gazette nº06 of 08/02/2016 Diabetes Mellitus Lifestyle modification (nutrition & physical activity) x x x x x Insulin therapy x x x Mentorship at P&RHs and DHs from higher levels helpful for patients in rural settings Renal Diseases Urinary tract infections Acute renal failure Antibiotics Nutrition guidance Medication management Dialysis x x x x x x x x x x x x Refer cases of renal failure. Dialysis Only during the acute phase equivalent to the first 6 weeks. Acute glomerulonephr itis Medication management x x x Refer cases of renal failure. Renal Diseases Primary & secondary nephrotic syndrome Congenital nephrotic syndrome x x Immune system medications, diuretics, antibiotics Dialysis Kidney transplant x Pediatrics Cancer Requires multisystem management including management of HIV, diabetes, or lupus. Dialysis Only during the acute phase equivalent to the first 6 weeks. Cancer Suspected cancer x Refer to Butaro Hospital. Guidelines regulating Specialized Hospital as Butaro and their package with specifications considerations Infectious Diseases Malaria HIV Palliative care Antimalarial drugs Antiretroviral drugs Prophylaxis x x x x x x x x x x x x x x Refer complicated cases 20 Official Gazette nº06 of 08/02/2016 Antibiotics Sexually transmitted infections Tuberculosis Anti-tuberculosis Meningitis Hematological Conditions Sickle cell anemia Hemophilia drugs Antibiotics Medication management Simple or exchange transfusion Physical fitness, dental care, & vaccinations Prophylactic use of Blood or blood products x x x x x x x x x x x x x x x x x x x x x x x 2.3 SURGICAL PROCEDURES Abbreviations: Local anesthesia (LA), local regional anesthesia (LRA), and general anesthesia (GA), y t l a i c e p S a e r A e c i v r e S General principles and basic technique s n a g r O l a c i d e M n o i t i d n o C f o e p y T s e r u d e c o r P H T U / H R N H R & P f o e p y T a i s e h t s e n A DH HC x x x x General principles of resuscitation and life- saving procedures + common doses of sedatives and general anesthetics + Aseptic behavior + Handling instruments + Blood transfusion + Incision of an abscess + Suture technique + Hypovolemic- shock treatment + Bladder catheterization 21 s t n e m m o C Minor surgery at the HC= incision of a superficial abscess; bladder catheterization or supra-pubic puncture; suture of skin lesions;; emergency resuscitation with fluid infusion LA-RA-GA No Blood transfusion and assisted deliveries at health centers Official Gazette nº06 of 08/02/2016 f o e p y T s e r u d e c o r P H T U / H R N H R & P f o e p y T a i s e h t s e n A DH HC s t n e m m o C y t l a i c e p S a e r A e c i v r e S n a g r O l a c i d e M n o i t i d n o C Orthopedic Surgery Fractures, Dislocations and Amputations Lower and Upper Limbs Closed Fractures and Dislocati ons Splint x x x LRA, GA, sedation/ analgesics Lower and Upper Limbs Closed and Open Fractures Plaster technique x x x LRA, GA, sedation/ analgesics The patient transferred from a health facility to another should always be immobilized in a splint and transferred to an orthopedic surgeon. Cast with window in an open fracture. Definitive management to be done by an orthopedic surgeon. x x x LRA, GA Temporary Open fractures Lower and Upper Limbs Disinfection, debridement, plaster cast with window or tractions treatment waiting for external fixation to be provided by an orthopedic surgeon. Wound disinfected and dressed at the HC then transferred to an experienced surgeon for repair of a tendon at DH or PH. Patient should be transferred to an experienced health practitioner for Lower and upper limbs Tendon lesions Disinfection and dressing, x x x x LRA, LA- GA Primary suture Upper and lower limbs Traumati c amputati on of upper Hemostatic and Immobilizatio n x x x x GA, LRA, analgesics 22 Official Gazette nº06 of 08/02/2016 f o e p y T s e r u d e c o r P H T U / H R N H R & P f o e p y T a i s e h t s e n A DH HC Skin traction x x Pin traction x x x y t l a i c e p S a e r A e c i v r e S n a g r O Femur , Hip Femur , Hip, Tibia l a c i d e M n o i t i d n o C and lower limb Closed Fractures and Dislocati ons Closed Fractures and Dislocati ons Pelvis Fracture Hip Spica x x x and Dislocati on x x x x Foot Immobilizatio n in a back slab cast at 90˚ flexion of the foot Ligament and tendon injuries, fractures and dislocatio ns GA, LRA, sedation, analgesics GA, LRA, sedation, analgesics GA, LRA, analgesics Analgesic s, GA, LRA, sedation/a nalgesics s t n e m m o C amputation. Skin traction while admitted and a supportive cast/splint when transferred for orthopedic management. Conservative management is a definitive option. Open reduction and internal fixation and definitive conservative management must be performed in the P&RH by an orthopedic surgeon. Open reduction and internal fixation and definitive conservative management must be performed in the PH by an orthopedic surgeon. Health centers have provisional splints for fracture immobilization before transfer. As above Ankle Ligament and tendon injuries, Immobilizatio n in a back slab cast at 90˚ flexion of x x x x GA, LRA, sedation, analgesics 23 Official Gazette nº06 of 08/02/2016 H T U / H R N H R & P f o e p y T a i s e h t s e n A DH HC s t n e m m o C x x x x GA, LRA, sedation, analgesics Immobilization is mandatory before transfer. x x x x GA, LRA, sedation, analgesics Definitive treatment to be performed by an orthopedic surgeon. f o e p y T s e r u d e c o r P the foot Triangular sling for shoulder and humerus fracture (no casts) + Light U- slab. Apply cuff and collar in P&RHs and DHs after x- ray. The upper limb to be immobilized in a back slab at 90˚ y t l a i c e p S a e r A e c i v r e S n a g r O l a c i d e M n o i t i d n o C fractures and dislocatio ns. Fractures and Dislocati ons Clavic le, shoul der and humer us Elbow Head of radius, supra and inter- condylar, olecrano n fractures + dislocatio n Forear m Radius and ulnar fractures Upper elbow back slab + Suspended 90° long arm cast (arm to hand) x x x x GA, LRA, sedation, analgesics Wrist Distal radius, Below elbow Back slab x x x GA, LRA, sedation, 24 Open reduction and internal fixation and definitive conservative management must be performed in the PH by an orthopedic surgeon. Health centers have provisional splints for fracture immobilization before transfer. As above. y t l a i c e p S a e r A e c i v r e S n a g r O l a c i d e M n o i t i d n o C distal ulna, wrist bones, Hand Metacarp al and phalange bones Acute osteomye litis Bone Infections Upper and lower limbs Official Gazette nº06 of 08/02/2016 f o e p y T s e r u d e c o r P H T U / H R N H R & P f o e p y T a i s e h t s e n A DH HC s t n e m m o C analgesics Below elbow Back slab x x x As above GA, LRA, sedation, analgesics Immediate immobilizatio n with a plaster slab or a sling. x x x GA, LRA, sedation, analgesics IV antibiotics and immobilization are administered as soon as possible prior to transfer to an orthopedic surgeon. HCs have provisional splints for fracture immobilization before transfer. Perform before transfer to an orthopedic surgeon for definitive treatment. To be performed by a surgeon. Perform before transfer to an orthopedic surgeon for definitive treatment. To be performed by an experienced surgeon X x x x x x x GA, LRA, sedation, analgesics GA, LRA, sedation, analgesics x x x x Sedation/analg esics Chronic osteomye litis Chronic osteomye litis Arthritis Immobilizatio n with a plaster slab or a sling and/or dressing Extensive debridement, sequestrectom y, washing- drainage- pearls… Immobilizatio n with a plaster slab or a sling. Arthritis Needle x x x aspiration of the pus Sedation/analg esics Upper and lower limbs Upper and lower limbs Upper and Lower limb joints Lower and upper limb joints 25 Official Gazette nº06 of 08/02/2016 H R & P x H T U / H R N x x f o e p y T a i s e h t s e n A DH HC GA, LRA, sedation, analgesics LRA, sedation/analg esics GA, LRA, sedation, analgesics y t l a i c e p S a e r A e c i v r e S n a g r O l a c i d e M n o i t i d n o C f o e p y T s e r u d e c o r P Lower and upper limb joints Lower and upper limb Arthritis Arthrotomy Osteo- articular malforma tions with or without neurologi cal deficit s t n e m m o C To be performed by an orthopedic surgeon The surgery of these malformations is highly specialized and needs to be performed by an orthopedic surgeon. A lot of treatments of fractures and dislocations need traumatology experience. The level of treatment is thus dependent on the presence of competencies in plasters and slings application by an experienced nurse, but the indications for early mobilization of the fractured bones and joints are best decided by a specialist. All orthopedic cases in a provincial hospital are to be managed by a skilled surgeon. A lot of different types of fractures exist and can be consulted in the orthopedics/traumatology manuals5. An enumeration is thus not possible in this table. Only the main principles of treatment are mentioned. Generally, open reductions and fixations have to be performed by a skilled surgeon. Neurosurgery Head Skull scalp laceratio n Skull fracture, open Head injury Hydroce phalus Debridement x x x Hemostasis x x x x GA, LRA, sedation, analgesics Analgesics or sedation GA. Resuscitation and urgently refer the patient Refer the patient x x x x GA x x x GA Clean the wound to remove all foreign bodies and close the wound. Definitive management to be done by a neurosurgeon. Definitive treatment by a neurosurgeon. Definitive treatment by a competent surgeon. At the DHs, drainage 5 Cf. footnote 5 26 Official Gazette nº06 of 08/02/2016 y t l a i c e p S a e r A e c i v r e S n a g r O l a c i d e M n o i t i d n o C f o e p y T s e r u d e c o r P H T U / H R N H R & P f o e p y T a i s e h t s e n A DH HC s t n e m m o C Congenit al head abnormal ities Focal deficit Spine Spine trauma Thoracic and lumbar Spine pain Refer the patient according to the defined referral system Refer the patient according to the defined referral system Hard collar for cervical spine injuries + Hard board for thoracic and lumbar spine injuries and refer Proper assessment and management Spine pain with neurologi cal deficit Congenit al spine diseases Patient should be urgently referred to neurosurgical center Patient should be referred to the neurosurgeon x x x should be performed by a skilled surgeon. Definitive treatment by neurosurgeon GA, sedation/analg esics x x x x GA. x x x x x x x GA if intubation required. Analgesics x x x x GA, LRA, sedation, analgesics x x x x GA x x x x GA Definitive treatment by neurosurgeons Definitive treatment by spine surgeon Definitive treatment by spine surgeon At all levels, the health practitioner should seek advice and/or refer Definitive treatment by spine surgeon Definitive treatment by neurosurgeon Ear, Nose and Throat (ENT) Surgery Ear Foreign body Extraction of a foreign body x x x GA, sedation With hands on experience & appropriate equipment, this procedure can be done at HC. Cerumen Ear irrigation x x x GA, sedation As above 27 Official Gazette nº06 of 08/02/2016 y t l a i c e p S a e r A e c i v r e S n a g r O l a c i d e M n o i t i d n o C f o e p y T s e r u d e c o r P H T U / H R N H R & P f o e p y T a i s e h t s e n A DH HC s t n e m m o C impactio n Chronic/ recurrent otitis media Chronic/ recurrent otitis media Chronic/ recurrent otitis media External injuries Myringotomy x x GA, sedation Tympanoplast y x x Mastoidectom y x x ENT surgeon only GA GA Repair of external injuries Nose Epistaxis Stopping of epistaxis Extraction of a foreign body Repair of external injuries Incision of a peri-tonsil abscess Tonsillectomy and adenoidectom y Foreign body External injuries Peri- tonsil abscess Tonsilliti s and adenoidit is Throa t x x x x x x x x Goiter Thyroidectom y x x x LA, GA x x Compression is only applicable in the HC. x x GA, sedation With appropriate equipment can be done at HC x LA, GA GA GA GA Tonsillectomy and adenoidectomy done following the established criteria Thyroidectomy done following the established criteria Neck tumors Neck abscess Neck soft tissue injuries Tissue biopsy Incision of a neck abscess Repair of neck soft tissue injuries x x x x x LA, GA Sedation, GA LA, GA 28 y t l a i c e p S a e r A e c i v r e S n a g r O l a c i d e M n o i t i d n o C Dental Surgery Oral cavity Loose or diseased teeth Official Gazette nº06 of 08/02/2016 f o e p y T s e r u d e c o r P H T U / H R N H R & P f o e p y T a i s e h t s e n A DH HC x x x x LA, GA x x x Minor oral surgeries ( simple extraction, minor soft injury repair, freinectomy) Major oral surgeries ( Desimpaction , sequestrectom y, maxillar and mandibular fractures Cardiothoracic Surgery Airway Airway obstructi on Tracheostomy x x Crico- thyroidotomy x x x x x LA, GA LA, GA Effusion Thoracic effusion, Pneumot horax Thoracic drainage x x x x LA, GA Trauma Simple rib fracture Flail chest Conservative management of rib fracture Flail chest management x x x x Analgesics. GA, LRA GA, LRA Breast Breast abscess Incision of a breast abscess Breast mass Breast cancer Lumpectomy of breast tumor (benign) Mastectomy (malign tumor) x x x x GA GA, LRA x x GA, LRA 29 s t n e m m o C Only dental professionals should perform extraction. HC focuses on prevention Emergency to be taught at each level If it is tension pneumothorax, needle decompression should be performed at the HC. Refer to RHs, UTHs or national trauma center as needed Frequent complication of breast feeding P&RHs should perform diagnosis and if Official Gazette nº06 of 08/02/2016 y t l a i c e p S a e r A e c i v r e S n a g r O l a c i d e M n o i t i d n o C f o e p y T s e r u d e c o r P H T U / H R N H R & P f o e p y T a i s e h t s e n A DH HC General Surgery Abdo men Acute abdomen Laparotomy x x x GA x x GA x GA, LRA x x x x x x x x x x GA, LRA GA, LRA GA, LRA GA, LRA Abdomin al hernia Abdomin al trauma Abdominal hernia repair Inguinal hernia repair Strangulated hernia repair Umbilical hernia repair Abdominal incisional hernia repair Repair of traumatized abdominal wall and organs Stoma ch & duode num Urine retention Upper GI obstructi on Perforate d duodenal or gastric Insertion of a supra-pubic catheter Gastrostomy Simple repair of a perforation duodenal or x x GA, LRA GA, LRA x GA, LRA x x x x 30 s t n e m m o C cancer is conformed, refer to RHs, UTHs or national cancer center as needed Laparotomy is only indicated if the physician is able to treat bowel, liver, & spleen injuries. The most common technique is the Bassini repair. This repair is a major procedure. This repair is a major procedure. Emergency laparotomy is only indicated if unstable hemodynamic status & doctor is competent to manage bowel, liver, & spleen injuries. Emergency procedure in case or urine retention. Gastrostomy is performed for nutrition. The level of treatment is dependent on the skills of the Official Gazette nº06 of 08/02/2016 f o e p y T s e r u d e c o r P H T U / H R N H R & P f o e p y T a i s e h t s e n A DH HC x x x GA, LRA s t n e m m o C surgeon and skilled GP and on the benign or malignant nature of the ulcer. As above y t l a i c e p S a e r A e c i v r e S n a g r O l a c i d e M n o i t i d n o C ulcer Perforate d duodenal or gastric ulcer Gastric cancer Pyloric stenosis Hypertro phic pyloric stenosis Gallblad der stones, cancer, and infection s Intestinal perforati on Intestinal cancer Gallbl adder Small intesti ne gastric ulcer= excision of ulcer and closing suture Repair of a bleeding of a gastric or duodenal ulcer= Hemostatic suture, excision and closing suture Gastrectomy (subtotal or antrectomy) Pyloroplasty/ gastroenterost omy Pyloromytom y Cholecystecto my Suture of an intestinal perforation Intestinal resection and anastomosis x x x x x x x GA, LRA As above GA. LRA As above GA, LRA As above GA, LRA Cholecystectom y performed by a surgeon x x x GA, LRA x x x GA, LRA Procedure can also be done in a DH by a skilled physician. The symptoms of a small intestine disorder are very often a „high‟ obstruction. Procedure can also be done in a DH by a skilled physician. Appe ndix Appendic itis Appendectom y x x GA, LRA 31 Official Gazette nº06 of 08/02/2016 y t l a i c e p S a e r A e c i v r e S n a g r O l a c i d e M n o i t i d n o C f o e p y T s e r u d e c o r P H T U / H R N H R & P f o e p y T a i s e h t s e n A DH HC Colon Colon Colostomy x GA, LRA disorders Sigmoid volvulus Sigmoidecto my x x GA, LRA Rectu m Rectal prolapse Recto sigmoidectom y x GA, LRA Anus Hemorrh oids Anal fissure Anal fistula Ischio- rectal abscess x x x Hemorrhoidec tomy Anal fissure repair Anal fistula repair Incision of a ischio-rectal abscess x x x x x x GA, LRA GA, LRA GA, LRA GA, LRA Urology Surgery Bladd er Rupture of the bladder Repair of ruptured bladder x x GA, LRA Bladder stones Removal of bladder stones x x GA. LRA 32 s t n e m m o C The symptoms of a colon disorder are often a “low” obstruction. Before operating, soft introducing a rectal cannula can be tried-GA. Operation to be done by general surgeon HCs and DHs should perform manual reduction of rectal prolapse. Technique for a child and an adult differ! Operation to be done by general surgeon. Discuss with urologists. This type of abscess can be the consequence of a prostatic abscess. This rupture causes an uri- and hemoperitoneum . Operation to be done by general surgeon. Operation to be done by general surgeon. y t l a i c e p S a e r A e c i v r e S Official Gazette nº06 of 08/02/2016 n a g r O l a c i d e M n o i t i d n o C Urine retention Ureth ra Urine retention f o e p y T s e r u d e c o r P Cystostomy for urine retention due to urethral rupture Bladder catheterizatio n Dilation- bouginage Meatotomy Sleeve resection Paraphim osis Phimosis Dorsal slit Testis Undesce nded testis circumcision- phimosis Orchidopexy- undescended testis Torsion testis Tunica vaginalis - hydrocel e BPH Prost ate De-torsion and Orchidopexy or orchidectomy Eversion/exci sion of the tunica vaginalis- hydrocele Vasectomy Transvesical prostatectomy (modified Freyer) H T U / H R N x H R & P x f o e p y T a i s e h t s e n A DH HC x GA, LRA s t n e m m o C x x LA, GA x x x x x x x x x x GA, analgesics GA, LRA Sedation and LRA, GA LRA- GA x GA, LRA x x x GA, LRA x x x GA, LRA x x x x x LA, LRA, GA GA, LRA If the catheter cannot be inserted at the HC, refer immediately to the DH. To be done by medical officer Torsion can be managed at DH. In case of torsion, a bilateral orchidopexy is indicated. Operation to be done by urologist or skilled general surgeon Obstetric and Gynecological Surgery 33 Official Gazette nº06 of 08/02/2016 l a c i d e M n o i t i d n o C Retained placenta y t l a i c e p S a e r A e c i v r e S n a g r O Obstetrics Genital organs (uterus, ovaries, cervix, vagina) f o e p y T s e r u d e c o r P Manual removal of retained placenta H T U / H R N H R & P f o e p y T a i s e h t s e n A DH HC x x x Sedation, GA x x x LA-sedation (after delivery) x x LA-sedation (after delivery) x x LA-sedation (after delivery) x x SA-GA - Manual vacuum aspiration Assisted delivery (Vacuum) Cesarean section Laparotomy x x x x x x x x x x x SA- GA GA, LRA Acute first and second degree perineal tear Acute first and second degree perineal tear repair (delivery) Acute third degree perineal tear Acute third degree perineal tear repair Acute cervical and vaginal tear repair (delivery) Dilatation and curettage Acute cervical and vaginal tear Incomplete abortion Complicate d delivery Ectopic pregna ncy Ruptur ed uterus Conservative laparotomy, subtotal hysterectomy x x x GA 34 s t n e m m o C Procedure can be done, without sedation or GA, at HC provided there are experienced midwives. In HCs, repair is done by midwives or experienced nurses. Anal sphincter repair is to be a done specialist and under GA. by MvAcan be done at HCs if diagnosis can be made by a midwife and echography is available. If the GP of the DH is not skilled, resuscitation is initiated before transfer to the P&RH for GA. As above. Official Gazette nº06 of 08/02/2016 y t l a i c e p S a e r A e c i v r e S n a g r O l a c i d e M n o i t i d n o C Vesico- vaginal fistula f o e p y T s e r u d e c o r P H T U / H R N H R & P f o e p y T a i s e h t s e n A DH HC Vesico-vaginal fistula repair x x x GA, LRA Gynecology Investigatio ns Bartholin‟s cyst or abscess Biopsies-cervix, vulva, endometrial tissue Excision- incision of a Bartholin‟s cyst or abscess and marsupilisation. x x x x GA, LRA GA, LRA, sedation x x GA, LRA x x x GA, LRA Torsion of an ovarian cyst Oophorectomy for torsion of an ovarian cyst. Uterine prolapse + cystocele ( + rectocele) Management of a uterine prolapse + cystocele ( + rectocele) s t n e m m o C Some simple cases can be managed by urethral catheterization and repairs at DH by a trained person. The DH for sample collection in some cases An incomplete excision is a common cause of recurrences- GA. Abscess can be done at DH (but cystectomy at PH). The combined vaginal hysterectomy and colporrhaphy anterior and posterior is a complex procedure only to be performed by specialists.(insertio n of vaginal pessary) Family Planning Mini- laparotomy for sterilization (tubal ligation) x x x GA, LRA 35 Official Gazette nº06 of 08/02/2016 f o e p y T s e r u d e c o r P H T U / H R N H R & P f o e p y T a i s e h t s e n A DH HC s t n e m m o C x x x x LA, GA, LRA The physician y t l a i c e p S a e r A e c i v r e S n a g r O l a c i d e M n o i t i d n o C Vulvar and vaginal lesions Repair of vulvar and vaginal tears and lacerations should immediately contact the GBV center if the lesions are due to GBV. Early detection at all levels; Specialists and trained GP to do repair For DH it will be discussed with gynaecologists Cervical lacerations Repair x x x LA x x GA, LRA Uterine prolapse, fibroids endometri osis etc. Vaginal hysterectomy Abdominal hysterectomy 36 Official Gazette nº06 of 08/02/2016 2.4 TYPES OF SURGICAL PROCEDURES PROCEDURES Minor procedures Amputation of a finger 1 Ascites puncture 2 Bladder probe catheterization 3 Blepharorraphy 4 Chalazion incision and curettage procedure 5 Complicated dressing 6 Condyloma Cauterization 7 Cryo -thermo - coagulation 8 Curettage of molluscum contagiosum 9 10 Curo - pedal plaster 11 Deep or multiple sutures 12 Digital curage Ear syringing 13 Exeresis of small tumours (lipomatosis, cysts) 14 Extracting foreign material 15 Eyelid suture + paupo-tear way 16 Feet correcting plaster (Consumables are not included) 17 Foreign body extraction 18 19 Hymenectomy 20 Incision and drainage of deep abscess with local or general anesthesia 21 Incision and drainage of superficial abscess with or without local anesthesia Intra-articular injection IUD ablation IUD insertion Joint puncture Labia minora detachment Lumbar puncture 22 23 24 25 26 27 28 Male Circumcision 29 Norplan ablation 30 Norplan implantation 31 Organ Biopsy 32 33 34 Pelvic-pedal plaster Plaster (Consumables are not included) Plaster applied from hip to knee (Consumables are not included) 35 Plaster removal 37 CHU RH/PH DH HC x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Official Gazette nº06 of 08/02/2016 PROCEDURES Plaster splint 36 Plastered boots 37 Plastered corset (Consumables are not included) 38 Pleural puncture 39 Removal of ingrown nail 40 Removal of the stitches 41 Remove the stitches 42 Simple suture 43 Spillway curettage 44 Stomach tube 45 Strapping (elastic bandage) 46 Superficiel synovial cyst ablation 47 Surgical operation of cysts 48 Surgical operation of keloids 49 Surgical trimming 50 Tear duct probe 51 52 Thoracic drainage 53 Venous cut-downs 54 Wound Dressing Intermediate or Major procedures 1 Herniorrhaphy 2 Surgical operation of hemorrhoids 3 Skin graft 4 Hydrocele 5 Osseous curettage 6 Appendicectomy 7 Testicular torsion Isolated tubal ligation 8 9 Wound debridement 10 Cervical cerclage Laparotomy for ovarian cyst 11 12 Marsupialization (other etiology) 13 Cure of disembowelment 14 Varicectomy 15 External fixation 16 Dislocation reduction Capsulotomy 17 Cyst excision 18 Pterygium excision, pinguecula 19 Tumor excision Conjunctival 20 Pterygium excision, pinguecula 21 38 x x CHU RH/PH DH HC x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Official Gazette nº06 of 08/02/2016 Cure of vesical exstrophy Internal urethrotomy (other etiology) Prostate endoscopic resection Removal of a benign tumor of the esophagus Cure of diaphragmatic hernia Cure of hiatal hernia Cure of gastroesophageal reflux Cure of endo brachy-esophagus Excision of conjunctival tumor Esophageal perforation repair Resection and anastomosis of caustic injury of the esophagus Biopsy (superficial) Fasciotomy Endoscopic Third Ventriculostomy (ETV) Triple screw PROCEDURES 22 23 24 25 26 27 28 29 Osteotomy 30 31 32 33 34 35 36 37 38 Dilation of the esophagus 39 Oeso Cardio myotomy for megaesophagus (Heller procedure) 40 41 Oesogastrectomy for tumor of the cardia 42 43 Gastrostomy + Hemostasis on hemorrhagic ulcer 44 Gastrectomy on gastric ulcer or stomach cancer Extended gastrectomy on stomach cancer 45 46 Truncal vagotomy + pyloroplasty on duodenal ulcer (or other vagotomy without drainage) Esophagectomy for esophageal cancer Repair of a ruptured esophagus 47 A benign tumor ablation of the stomach 48 Gastrostomy on gastric diverticulum 49 Truncal vagotomy + gastro-entero-anastomosis stenosis of the pylorus Cure bleeding of duodenal ulcer 50 51 Unthrombosed hemorrhoid on Hemorroïdectomies 52 53 Cure of HIRSCHSPRUNG disease (Swenson-Dulamel, etc.) Posterior sagittal ano-recto plasty on ano-rectal malformation (ARM) Incision and drainage of amebic liver abscess Incision and drainage of liver abscess (other etiology) Cure of diaphragmatic hernia Cure of anal fissure Cure of anal fistula Laparoscopic surgery Enucleation of benign liver tumor Left or right hepatectomy of malignancy 54 55 56 57 58 59 60 61 39 x x CHU RH/PH DH HC x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Official Gazette nº06 of 08/02/2016 PROCEDURES 62 Debridement + hemostasis in liver trauma Excision of a metastatic liver tumor 63 Portocaval anastomosis on portal hypertension (or splenorenal) 64 Cholecystectomy on hydro cholecystitis 65 Cholecystectomy on pyocholecystite 66 Cholecystectomy + Exploration on cholelithiasis 67 Resection + anastomosis on stenosis of bile duct 68 Removal of choledochal cyst 69 Cholecystectomy + dissection of bladder cancer 70 Cure of cystocele 71 Cure of rectocele 72 Cure of vesical exstrophy 73 Cholecystectomy on perforation of the bladder 74 75 Pancreaticoduodenectomy 76 Gastroenterostomy (Gastro enteric anastomosis on antral tumor CHU RH/PH DH HC x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x 77 79 78 Enucleation of benign tumor of the pancreas Removal of blocked calculus stuck in VATER‟s bulb Pancreatectomy on the pancreas tumor or other) Cholecystectomy-jejunostomy + biliodigestive anastomosis on the fistula of bile ducts Cephalic duodeno-pancreatectomy on the cancer of the pancreatic head corporeal pancreatectomy in pancreas body cancer and pancreas tail cancer Cholecystectomy in cholecystitis 80 81 Debridement of necrosis of the pancreas 82 83 84 85 Drainage of the pancreatic abscess 86 87 88 89 Abdomino-perineal amputation in anal cancer 90 91 92 93 94 95 96 97 98 99 100 Lobectomy on lung tumor Cure of omphalocele-Gastroschisis Cure of CROHN disease Cure of myelomeningocele Cure spina bifida subtotal or total thyroidectomy on the goitre Cure of thyroglossal cyst Tracheotomy in case of dyspnea Biopsy of lymph node with a fine needle Biopsy on lymph nodules Lung decortication in case of encysted lung abscess Cholecystectomy on vesicular lithiasis Caudal splenopancreatectomy Splenorrhaphy on splenic abscess x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x 40 Official Gazette nº06 of 08/02/2016 Incision and drainage of an abscess PROCEDURES 101 Pneumonectomy on lung tumor 102 Cure of broncho-tracheal cyst 103 Cure of the branchial fistula 104 Debridement without anesthesia 105 Debridement under general anesthesia rib resection + Drainage of the emphysema 106 107 thoracic drainage of the pleural effusion 108 Thoracotomy + excision of mediastinal mass 109 Cancer cholecystectomy on the bile duct 110 Stripping of varicose veins on the leg 111 Pericardectomy of pericarditis 112 Vascular prosthesis on aneurysm 113 Cure of hygroma 114 115 Removal of a tumor/ Removal of a superficial foreign body 116 Denudation of dehydration 117 Amputation of the finger or toe 118 Amputation of the foot or hand 119 Amputation of the leg or forearm 120 Amputation of the thigh or arm 121 Disarticulation of the shoulder or hip 122 Removal of an ingrown nail 123 Resection of rectal polyp or colon polyps 124 Ventriculoperitoneal diversion of the hydrocephalus 125 Trepanation of extra dural or subdural hematoma 126 Drainage of the scalp hematoma 127 Pericardial drainage in case of pericardial effusion 128 Removal of a breast nodule 129 130 Mastectomy for Breast Cancer 131 Removal of a synovial cyst 132 Saphenous prosthesis on vessel wounds 133 Removal of a hemangioma 134 Skin graft of a clean wound 135 Cystostomy 136 Endoscopic removal of a urolithiasis 137 Endoscopic resection of the prostate for prostate adenoma 138 Endoscopic resection of a bladder polyp 139 Endoscopic electrocoagulation of posterior urethral valves 140 Resection of the bladder neck for cervical disease Internal urethrotomy for urethral stenosis 141 Incision and drainage of a breast abscess (mastitis) 41 x CHU RH/PH DH HC x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Official Gazette nº06 of 08/02/2016 PROCEDURES 142 Nephrectomy in renal calculus 143 Nephrectomy in renal cancer 144 Nephrectomy on Willims‟ tumor 145 Drainage of perinephric abscess 146 Cure of pyelo-ureteric junction syndrome 147 Nephrectomy on hydronephrosis 148 Ureterotomy on ureteric calculus 149 Cure of hydronephrosis on urethral stenosis 150 Ureteral Plasty of hydronephrosis on mega-ureter 151 Cystostomy of acute urinary retention 152 Cystostomy of the ruptured urethra 153 Cystotomy of bladder calculus 154 Bricaire operation on bladder cancer 155 Vascular Prosthesis on abdominal angina 156 Ureterotomy on urethral calculus 157 Repair of ruptured bladder 158 Adenomectomy on the prostate adenoma 159 Urethroplasty on urethral stenosis 160 Reimplantation of the ureter (ureterovesical) 161 Cure of epispadias or hypospadias 162 Removal of the urethral meatus tumor 163 Cure on persistent processus vaginalis of peritoneum 164 Cure of hydrocele 165 Cure of testicular ectopia 166 Removal of the cyst of the spermatic cord 167 Ligation of the spermatic vein in varicocele 168 Cure of testicular torsion 169 Cystoscopy + input of the ureteral catheter 170 Diagnostic Cystoscopy 171 Vesico-vaginal fistula, VVF Cure 172 Amputation of cancer of the penis 173 Reduction of the paraphymosis 174 Depressed fracture elevation 175 Exploratory trephination 176 Epidural hematoma evacuation 177 Acute sub-dural hematoma evacuation 178 Chronic sub-dural hematoma burrhole hematoma evacuation 179 Sub-dural hygroma burrhole evacuation 180 Intracerebral hematoma evacuation 181 Posterior fossa hematoma evacuation 182 Dural sinus repair 42 CHU RH/PH DH HC x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Official Gazette nº06 of 08/02/2016 PROCEDURES 183 Otorrhea or rhinnorrhea repair 184 Cranioplasty 185 Brain contusion/laceration debridement 186 Resection of supratentoral brain tumor 187 trans-sphenoidal pituitary adenoma resection 188 Transcranial resection of pituitary adenoma 189 Transphenoidal craniopharyngioma resection 190 transcranial resection of craniopharyngioma 191 Resection of convexity meningioma 192 Resection of parasagittal meningioma 193 Resection of falx meningioma 194 Resection of tentorial meningioma 195 Resection of lateral ventricle tumors 196 Resection of third ventricle tumors 197 Resection of cerebellar hemisphere tumors 198 Resection of cerebellar vermix tumors 199 Resection of fourth ventricle tumors 200 Acoustic neurinoma resection 201 Resection of cerebello-pontine angle meningioma 202 Resection of cerebello-pontine angle cholesteatoma 203 Resection of foramen magnum tumors 204 Resection of olfactory groove meningioma 205 Resection of suprasellar meningioma 206 Resection of sphenoidal ridge meningioma 207 Resection of clival tumor 208 Resection of cranial vault bone tumor 209 Resection of cranial base bone tumor 210 Evacuation of hypertensive supra-tentorial intracerebral hematoma Intraventricular hematoma drainage 211 Evacuation of hypertensive intracerebellar hematoma 212 213 Skull osteomyelitis resection 214 Subdural abcess drainage 215 Resection of epidural abcess 216 Drainage of brain abcess 217 Marsupialization of brain abcess 218 Resection of brain abcess 219 Removal of cysterci of fourth ventricle and basal cistern 220 Resection of skull cavernous hemangioma 221 Transcranial resection of optic nerve tumor 222 Repair of cranial bifida 223 Ventriculo-peritoneal shunt for hydrocephalus 43 CHU RH/PH DH HC x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Official Gazette nº06 of 08/02/2016 PROCEDURES 224 Ventriculo-atrial shunt for hydrocephalus 225 Resection of brain arachnoid cysts 226 Posterior fossa decompression 227 Resection of extradural tumor of spinal cord 228 Resection of subdural-extramedullary tumor 229 Resection of intrameduallary tumor 230 Resection and repair of spina bifida 231 Resection and repair of myelomeningocele 232 Resection of lumbosacral pilonidal sinus 233 Intracranial aneurism cliping 234 wrapping of intracranial aneurism 235 Giant intracranial aneurism aneurismoplasty 236 Resection of cerebral convexity arteriovenous malformation(AVM) 237 Resection of cerebral interhemisphere AVMs 238 Resection of intraventricular and periventricular AVMs 239 Resection of strio-capsulo-thalamic AVMs 240 Resection of hippocampo-lenticular AVMs 241 Resection of great Vein AVMs 242 Resection of infratentorial AVMs 243 Dural Arteriovenous fistulae operation 244 Carotid-cavernous fistula operation 245 Trapping of carotid-cavernous fistula 246 Carotid endarterectomy 247 Vertebral endarterectomy 248 Superficial temporal artery-MCA anastomosis 249 Removal of catheter cranial drainage 250 Trans-fontanel ventricular puncture 251 Trans-fontanel sub-dural hematoma drainage 252 Trans-fontanel ventricular CSF drainage 253 Skin graft of head 254 255 256 Transcranial ventricular CSF drainage (each side) 257 Plugging a base fractured 5th metatarsal 258 Reduction + plugging for interphalangeal dislocation 259 Reduction + plugging the metatarsal fracture 260 Reduction + plugging the phalanx fracture 261 Plugging the sternoclavicular dislocation 262 Sternoclavicular internal Cleidectomy 263 Screwing plate for a clavicle fracture 264 External fixation for fracture of the clavicle resection of scalp scar + plasty Intraventricular hematoma drainage(each side) 44 CHU RH/PH DH HC x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Official Gazette nº06 of 08/02/2016 PROCEDURES 265 Rush pine for a clavicle fracture 266 Plugging for acromioclavicular dislocation 267 Coracoid transfer for acromioclavicular dislocation 268 Open reduction for glenohumeral dislocation 269 Rush pine for a fractured humeral neck 270 T-plate for a fractured humeral neck 271 Hacketal for a fractured humeral neck 272 Plate console for a fracture of the distal radius 273 Screwing of trochiter fracture 274 Screwing plate for humeral shaft fracture 275 Plugging the Bennet fracture (1st meta) 276 Plugging the fracture of the metacarpals 277 Reduction + plugging the metacarpophalangeal dislocation 278 Plugging the fracture of the phalanges 279 Plugging the fracture of the radial head 280 Screwing plate for fracture of the radial shaft 281 Rush pin for radial shaft fracture 282 Screwing plate for pubic disjunction 283 Screw for fracture of the fibular head 284 Screwing plate for fracture ulnar shaft 285 Rush pin for fracture ulnar shaft 286 Screwing Plate to the fractured two forearm bones 287 Reduction + plugging the lower radio-ulnar dislocation 288 Plugging the lower extremity fracture of the radius 289 External fixator for fracture of the distal radius 290 Screwing the scaphoid fracture 291 Bone graft for scaphoid nonunion 292 Scaphoid nonunion for screwing 293 Reduction + plugging for dislocation interphalangeal 294 Reduction + traction for hip dislocation 295 Screw for femoral head fracture 296 Screwing of a fracture of the acetabulum 297 Screwing plate for fracture of the acetabulum 298 Reduction + screwed plate to a fracture of the acetabulum 299 Reduction + screwed plate to a hip fracture-dislocation 300 Suture for an Achilles tendon rupture 301 Tightening of the muscle plantaire for an Achilles tendon rupture 302 Reduction + plugging for ankle-subtalar dislocation 303 Screwing the talus fracture 304 Screwing of a fracture of the calcaneus 305 Screwing the broken scaphoid tarsal 45 CHU RH/PH DH HC x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Official Gazette nº06 of 08/02/2016 PROCEDURES 306 plugging + reduction for dislocation or subtalar 307 Reduction + plugging for dislocation midtarsal (Chopart) 308 Reduction + plugging for dislocation of tarsometatarsal CHU RH/PH DH HC x x x x x x (Lisfranc) 309 Hackethal for a fractured humeral shaft 310 Screwing the supra-condylar fracture 311 Plugging the supra-condylar fracture 312 Screw for fracture humeral condyle 313 Screwing for extra and intercondylar humerus fracture 314 Screwing the fractured capitellum 315 Plugging the fractured capitallum 316 Screwing of a fracture of epicondyle 317 Screw for fracture of the medial epicondyle 318 Plugging for epitrochlea fracture 319 Reduction for a dislocated elbow 320 Plugging the dislocated elbow 321 Bracing for a fracture of the olecranon 322 Screw for fracture coronoid 323 Plugging for fracture coronoid 324 Resection for a fracture of the radial head 325 Plated blade for a pertrochanteric fracture 326 Plugging for carpal fracture 327 Reduction + plugging the lunate dislocation 328 Reduction + plugging for perilunar dislocation of the carpus 329 Screwing the fracture Bennet (1st meta) 330 Suture + plaster to a wound of the flexor tendons 331 Suture + plaster to a wound of the extensor tendons 332 Suture + plaster to a wound of the nerves 333 Strapping + Post transplant for dens fracture 334 Strapping posterior for a fractured upper cervical spine 335 Screwing Plate to a fracture of the lower cervical spine 336 Graft for a posterior dislocation of the upper cervical spine 337 Graft for posterior dislocation of lower cervical spine 338 Graft for cervical dislocation fracture 339 Harrington-surgical fixation screw to fracture thoracolumbar spine 340 Reduction + Surgical fixation for thoracolumbar spine dislocation 341 Reduction + Surgical fixation for fracture thoracolumbar spine 342 Suture + plaster for a patellar tendon rupture 343 Reduction + plugging the metatarsophalangeal dislocation 344 Screwing plate for tibial pilon fracture 345 Screw for tibial pilon fracture 46 x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Official Gazette nº06 of 08/02/2016 PROCEDURES 346 Screwing a fracture of the medial malleolus 347 Screwing plate for fracture of the lateral malleolus 348 Rush pine for a fracture of the lateral malleolus 349 Screwing + screwed plate to a fracture bimalléolaire 350 Rush pin + screw for fracture bimalléolaire 351 Ankle fracture dislocation reduction + plaster 352 External fixation for the ankle fracture dislocation 353 Transplantar nail for ankle fracture dislocation 354 Surgical repair of a torn ankle ligament 355 External fixation for pubic disjunction 356 Traction + transplant for sacroiliac disjunction 357 Screwing of the femoral neck fracture 358 Hemi-prosthesis for femoral neck fracture 359 Surgical repair of a torn knee ligament + plaster 360 Plated screws for pertrochanteric fracture 361 Gamma nail for fracture pertrochanteric 362 Locked nail for trochanteric fracture 363 Plated blade for trochanteric fracture 364 Plated screw for trochanteric fracture 365 Fastening nail for femoral shaft fracture 366 Plated Screw for fracture of the femoral diaphysis 367 External fixator for fracture of the femoral diaphysis 368 Locked nail for a supra-condylar fracture of the femur 369 Plated blade to a supra-condylar fracture of the femur 370 Screwing + plated blade under and intercondylar fracture of the femur 371 Screwing for intercondylar fracture of the femur 372 Plated blade for epiphyseal abruption of the femur 373 Screwing a fractured tibial tuberosity 374 Spoiler Repair for patella luxation 375 Meniscectomy for a torn meniscus 376 Meniscal repair for a meniscus tear 377 Screwing Plate for fracture of tibial metaphyseal 378 Locked nail for fracture of the metaphysis of the tibia 379 External fixator for a lower epiphyseal abruption of the tibia 380 Plugging the lower epiphyseal abruption of the tibia 381 Staples to fix the epiphyseal abruption of the femur 382 Plugging for epiphyseal abruption of the femur 383 External fixator for epiphyseal abruption of the femur 384 Reduction + ligament repair + plaster for knee dislocation 385 Cerclage for a fracture of the kneecap 386 Plasty for a torn knee ligament 47 CHU RH/PH DH HC x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Official Gazette nº06 of 08/02/2016 PROCEDURES 387 Screw for tibial plateau fracture 388 Screwing plate for fracture of the tibial plateau 389 Fastening nail for the intramedullary fracture of the shaft of the CHU RH/PH DH HC x x x x x x x tibia Internal urethrotomy of urethral stenosis 390 Screwing plate for fracture of the shaft tibial 391 Screwing plate for fracture of the fibula diaphysis 392 Rush pine for a fracture of the shaft of the fibula 393 Bracing for a fracture of the knee cap 394 Suture + plaster to a ruptured quadriceps tendon 395 Ablation of osteosynthesis material under general anesthesia 396 Cystoscopy + biopsy of the bladder 397 Electrocoagulation of condylomata of the glans 398 Meatoplasty stenosis of the urethral meatus 399 Pulpectomy for prostate cancer 400 Scrotal abscess drainage of 401 Removal of urethral cyst 402 Cure of the kinking of the penis 403 Cure of varicocele 404 Nephrostomy 405 Urethrostomy 406 407 Cure of bladder diverticulum 408 Cure of ureterocele 409 Partial cystectomy 410 Radical cystectomy 411 Cystoplasty 412 Radical cystoprostatectomy 413 Nesbit operation (Lapeyronnie disease) 414 Endoscopic resection of prostate (ERP) (other etiology) 415 Endoscopic resection of bladder tumor (ERB) 416 Nephrolithotomy 417 Pyelolithotomy 418 Cure of VUR by mega ureter 419 Cure of a renal cyst 420 Cure of undescended testes (orchidopexy) 421 Sphincterotomy for anal fissure 422 Resection or dilatation of anal fissure 423 Cure of strangulated hernia 424 Diagnostic laparoscopy 425 Untwisting the sigmoid volvulus 426 Segmental colectomy / transverse 427 Cure + Herniorrhaphy on strangulated hernia 48 x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Official Gazette nº06 of 08/02/2016 Intestinal perforation cure Intestinal or colonic resection of intussusception PROCEDURES 428 429 Rectal prolapse 430 Cure perforated duodenal ulcer 431 Désinvagination (of intussusception) gut 432 433 Hemicolectomy right or left colon cancer 434 Laparotomy intestinal obstruction 435 Laparotomy on localized or generalized peritonitis 436 Laparotomy benign tumor of the intestine 437 Laparotomy for hemoperitoneum on anal fistula cure 438 Marsupialization for thoracic empyema 439 Resection (with or without cleaning) on tumor of the intestine 440 Colonic resection of tumor, volvulus or diverticulosis of the CHU RH/PH DH HC x x x x x x x x x x x x x x x x x x x x x x x x x x x colon 441 Resection of myocardial mesentery 442 Thoracotomy for empyema, decortication, etc ... 443 Therapeutic Laparoscopy 444 Fracture traction 445 Osteosynthesis 446 Baker's cyst removal (popliteal cyst) 447 Splenectomy 448 Thyroidectomy 449 Partial gastrectomy 450 Gastrointestinal enterotomy 451 Bowel resection 452 Removal of saphenous vein 453 Colostomy in case of bowel obstruction, Volvulus, peritonitis 454 Hysterectomy 455 Cesarean section 456 Caesarean and tubal ligation 457 Ectopic pregnancy 458 Amputation of a lower limb 459 Amputation of upper limb 460 Oophorectomy 461 Myomectomy 462 Salpingectomy 463 Sequestrectomy 464 Repair of cervical tears 465 Repair of perineal tear 466 Hysterorrhaphy 467 Vesico-vaginal fistula repair 468 Rectovaginal fistula repair x x x x x x x x x x x x x x x x x x x x x x x x x x x x 49 x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Official Gazette nº06 of 08/02/2016 PROCEDURES 469 Recto- vesico -vaginal fistula repair 470 Strapping rectal prolapse 471 Flattening anal fistula 472 Exploratory laparotomy 473 Tonsillectomy 474 Laminectomy 475 Trepanation 476 Nephrectomy (other etiology) 477 Hemicolectomy 478 Cholecystectomy 479 Cataract operation 480 Reduction of Finger / toe 481 Reduction of Ankle 482 Reduction of Wrist 483 Reduction of Forearm / elbow 484 Reduction of Shoulder 485 Reduction of Leg / Knee 486 Reduction of Hip 487 Reduction under fluoroscopy 488 Plaster of Paris 489 Synthetic Plaster CHU RH/PH DH HC x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x 2.5 PRE-HOSPITAL EMERGENCY PROCEDURES A. INJURIES 1. ROAD TRAFFIC ACCIDENTS  Any Road Traffic Accident is considered as pre-hospital emergency. 2. OTHER ACCIDENTS  Working place accidents: e.g: building collapsed, electrocution, etc  Home accidents: burns, electrocution, falling down, building collapsed all with life threatening conditions, poisoning, lightening  Assaults: Fight, gun shoot, etc B. MEDICAL EMERGENCIES 1. Coma status of any cause other than accident 2. Medical life threatening conditions: e.g: Asthma crisis, Diabetes crisis, Cardiac crisis, anaphylaxis of any cause, poisoning, PTSD (post traumatic stress disorder) 3. Shock of any cause C. GYNECO-OBSTETRIC & NEONATAL EMERGENCIES 1. Pre and post partum hemorrhage: Placenta praevia, Placenta retention, Abortion etc 2. Incomplete delivery out of health facility 3. Seizures during pregnancy of any cause e.g: pre-eclampsia and eclampsia 50 Official Gazette nº06 of 08/02/2016 4. Foetal distress of any cause e.g: Prolapsed cord, etc 5. Neonatal distress D. REFERRAL AND COUNTER-REFERRAL PROCEDURE 1. Referral: is done between 2 different health facilities with a referral note for further management or investigations 2. Counter-referral: is done between 2 different health facilities with a specialist counter- referral approval. e.g: for palliative care, to continue treatment etc. 2.6 INVESTIGATIONS A. MEDICAL IMAGING EXAMS I. RADIOGRAPHY UPPER LIMBS LOWER LIMBS CHEST SPINAL CORD ABDOMEN_Abdomen without preparation (Awp) SPECIAL EXAMS Lav. barium hysterosalpingography bronchography fistulography sialography Transit-oeso.-gastrointestinal duoden. cholecystography transit hail interventional colonoscopy intravenous urography Urethro-Cysto-Retrograde mammography (A breast) II. ECHOGRAPHY Abdominal ultrasound Abdominal pelvic ultrasound (Gyneco-obstetric) Electrocardiogram (ECG) Cardiac Doppler echography (or echocardiography) SPECIAL REVIEW biometrics And fluorescence angiography Other fundus Goldmann visual field Wallpaper glass eye contacts 51 UTH RH/PH DH HC x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Official Gazette nº06 of 08/02/2016 UTH x x x RH/PH x x x DH x x HC x x x x x x x x x x x x x x x x x x x x x x x x x x Test Lancaster Color vision / refractive Evisceration of the globe III. CT-SCAN HEAD NECK CHEST AND HEART ABDOMEN UPPER LIMBS LOWER LIMBS SPECIAL EXAMS / ENT audiometry bronchoscopy Electronystagmography impedancemetry evoked Potentials Sinuscopy MRI B. LABORATORY EXAMS 1. BIOCHEMISTRY 1.1 Glucose Metabolism Albuminua Glucosuria Blood sugar Fructosamine Ketone bodies Fructosamine Hemoglobin A1c 1.2 Renal Function & Nonprotein Nitrogen compounds Creatinine Urea Uric acid Ammonia Amino acids Acetylcholinesterase-s 1.3 Liver Function/Pancreas & Other enzymes SGOT – ASAT* RH/TH PH DH HC HP x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x 52 Official Gazette nº06 of 08/02/2016 SGPT –ALAT* Total Bilirubin* Direct Bilirubin * Blood sugar* Alcaline Phosphatase Amylase-Serum/urine Lipase Lactate dehydrogenase(LDH) Creatine phospho kinase(CPK) ACE (Angiotensine Converting Enzyme) Aldolase 1.4 Electrolytes/Blood Gas Na + (sodium) K + (potassium) Cl -(chlorure) Arteriol blood gas analysis(ABG) Ca + (total or calcium ionised) Phosphorus Magnesium Lithium Bicarbonate Lactates Osmolality 1.5 Proteins Total proteins (serum/urin/other body fluids) Albumin Globulines CRP (semiquantitative) CRP (Quantitative) Immunoglobulins (IgG,IgM,IgA, IgE) Serum Protein Electophoresis Isoenzymes Electrophoresis Immunoelectrophoresis/Immunofixation 1.6 Heart /Muscle CK-MB Myoglobin Troponin T/I Ultrasensitive CRP BNP/Pro BNP 1.7 Lipids Total Cholesterol Triglycerides HP HC x x x x DH x x x x x x x x x RH/TH PH x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x 53 Official Gazette nº06 of 08/02/2016 DH HC HP RH/TH PH x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x HDL-cholesterol LDL-cholesterol Lipoprotein a (Lp a) Apolipoproteins (ApoA-I & Apo B) 1.8 Anaemia Exploration Iron TIBC Transferrin/Siderophilline Soluble transferrin receptors Ferritine Folic acid Homocystein Vit B12 Haptoglobin 1.9 Hormones TSH x LH x FSH x Progesterone x TatalOestrogen x Oestriol x Oestradiol x Testosterone x Calcitonine x Prolactin x Cortisol x ACTH x Aldosterone x Androstenedione x DHEA-S x AFP [Alpha Foeto-Protein] x PSA [Prostatic Specific Antigen] Free x PSA [Prostatic Specific Antigen] Total x CA125 :cancer antigen 125[for ovarian cancer] x CA15-3 [for Breast cancer] x CA 19,9 [for gastro-intestinal tract cancer] x NeurospecificEnolase(NSE) [ for Bronchial Cancer] CEA ACE (Antigen Carcino Embryonic) ß2 Microglobulin-S 1.10 Hormones x x x x x 54 Official Gazette nº06 of 08/02/2016 Dosage of bêta-HCG T3 Free T3 Total T4 Free T4 Total TSH LH FSH Progesterone TatalOestrogen Oestriol Oestradiol Testosterone Calcitonine Prolactin Cortisol ACTH Aldosterone Androstenedione DHEA-S 1.11 Other Parameters Anti-thyroid autoantibodies Anti-thyroid peroxidase (anti-TPO) antibodies Antithyroglobulin antibody C peptide Procalcitonine Fecal Occult Blood Fecal Fat Test 2. HEMATOLOGY 2.1 Hemogram / Cell count Hb/Ht CD4 & CD8 count (PIMA ??) WBC and diferentiel count FBC Reticulocyte count Peripheral blood film Analysis 2.2. Other Analysis ESR Sickle cell test Direct Coombs test Indirect Coombs test G6PD DH HC HP RH/TH PH x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x 55 Official Gazette nº06 of 08/02/2016 RH/TH PH DH HC HP Pyruvate -Kinase Red cell osmotic fragility test The Kleihauer–Betke ("KB") test Cytogenetic investigations Immunophenotyping Hb Electrophoresis 2.3. Coagulation Tests Bleeding Time Clotting Time Fibrinogen Thrombine Time (TT) Reptilase Time (RT) Coagulation factors Prothrombine time/INR activated partial thromboplastin time (aPTT) D-Dimers fibrin degradation products Antithrombine (AT) Antiphospholipid antibodies (APLAs): anticardiolipin antibodies (ACAs) and lupus anticoagulant Homocystein Factor II G20210A Mutation Analysis Protein C(PC) Protein S (PS) Activated protein C resistance test Factor V Leiden 2.4. Blood Transfusion ABO/Rh grouping Cross matching 2.5. Bone Marrow Examination Bone marrow aspirate Bone marrow biopsy 2.6. Coagulation Tests Bleeding Time Clotting Time Coagulation factors Prothrombine time/INR activated partial thromboplastin time (aPTT) Fibrinogen Thrombine Time (TT) Reptilase Time (RT) x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x 56 x x x x x x x x x x x x x x x x x x Official Gazette nº06 of 08/02/2016 RH/TH PH DH HC HP D-Dimers Fibrin degradation products Antithrombine (AT) Antiphospholipid antibodies (APLAs): anticardiolipin antibodies (ACAs) and lupus anticoagulant Homocystein Factor II G20210A Mutation Analysis Protein C(PC) Protein S (PS) Activated protein C resistance test Factor V Leiden 3. MYCO - BACTERIOLOGY 3.1 Gram Stain Special Stain (gram stain) Methylene Blue Fresh microscopy Urin sediment other swab/fluid 3.2 Mycobacteriology Ziehl N / Kinyoun/ Auramine stain Gene-Xpert culture + sensitivity Aerobic & anaerobic/Isolation 3.3 Culture and Sensitivity test Hemoculture + AST Coproculture + AST culture of other fluid AST 3.4 MYCOLOGY Identification of Yeats/Molds Indian Ink stain KOH Germ tube test Culture Molecular tests 4. PARASITOLOGY 4.1 Stool Parasitology Wet smear Concentration Direct Wet Mount Examination after concentration x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x 57 x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Official Gazette nº06 of 08/02/2016 RH/TH PH DH HC HP x x x x x x 4.2 Blood Parasitology Blood smear Indian Ink stain Potassium Hydroxide (KOH) 4.3 Other specimen Special Staining Method Molecular tests 5. SEROLOGY 5.1 Viral Serology HIV 1 & 2 rapid testing HIV 1 & 2 Syphilis (RPR, VDRL) Pregnancy tests Dried Blood Spots (DBS) collection, storage and transportation for Polymerase Chain Reaction (PCR) and further testing Rapid Testing for Hepatitis B and C Hepatitis B and C viral load Hepatitis A Hepatitis B Hepatitis C Hepatitis D Hepatitis E 5.2 Bacterial serology Antistreptolysine O Salmonellosis Syphilis bacterial soluble Ag Antistaphylosine Antistreptodomase B Antistreptohyaluronidase Antistreptokinase Antistreptolysine O Brucellose Chlamydia trachomatis Listeriose Lyme disease Mycoplasma pneumoniae Rickettsioses 5.3 Parasitic serology Toxolpasmosis x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x 58 x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Official Gazette nº06 of 08/02/2016 Malaria Amibiasis Ascaridiosis Bilharziosis Candidosis Distomatosis Echinococcosis Filariosis Hydatisosis Leishmaniosis TESTS PER SERVICE Dried Blood Spots (DBS) collection, storage and transportation of for Polymerase Chain Reaction (PCR) and further testing Hepatitis A Hepatitis B Hepatitis C Hepatitis D Hepatitis E Adenovirus Cytomegalovirus(CMV) Herpes virus Miseals virus influenza virus virus ourlien Respiratory syncytial virus viral load 5.4 Auto-Immune Anti DNA antibody Ac.Ag soluble nuclear Ac. anti cardiolipin Ac. Anti gastric parietal cell Ac. anti centromere Ac. Anti cytoplasm of granulocytes Ac. Anti intrinsic factors Ac. anti glialidine Ac. anti histone Ac. Anti islet of Langerhans Ac. anti mitocondrie Ac. smooth Antimuscle Ac. antinuclear Complement DH x HC HP RH/TH PH x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x 59 DH HC HP Official Gazette nº06 of 08/02/2016 Circulating immune complexes rheumatoid factors 7. Toxicology Monitoring of drugs Diagnosis of drug abuse Toxins Drug toxicity 8. Genetics Cyto genetic Molecular biology RH/TH PH x x x x x x x x x x ANNEX 2.7: PSYCHOLOGIC/MENTAL HEALTHPROCEDURES Service Area Services Facilities NRH/UTH P&RH DH HC Clinical Psychology Social psychology: Personal and family relationship problems (e.g. family conflicts/violence/ intimate partner violence/child abuse and neglect, couple and marriage problems, etc.) Sexual dysfunctions and disorder Sexual orientation psychotherapies (for transgender, bisexual and homosexual) PTSD (post traumatic stress disorder, specificity of Rwanda in post genocide period) Anxiety and mood disorders Addictive behaviors, e.g. alcohol and drug addiction Mourning and grieving Palliative care in hospital and community for chronic disease Delinquency and adolescent deviant behaviors Children and adolescent psychological problems Adulthood and geriatric psychological disorders Professional and individual stress management Anxiety and depression Mental illness and psychiatrics diseases Eating and sleep disorders Learning and developmental disabilities 60 x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Facilities NRH/UTH P&RH DH HC x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x x Official Gazette nº06 of 08/02/2016 Service Area Services Psychology of handicapped persons Psychological assessment testing, and psychometrics (e.g.: intelligence, personality) Forensic and criminal psychology Behavioral medicine Working together with community health workers to identify and to report health problem including cases with mental health problems Participating in reintegration of people with mental health disabilities Assisting families with infertility problems Trauma & victimology Clinician‟s self-care 61 Comments If it is Only for Palliative Care services it is preferred to stabilize the patient and transfer him back to the lower level Official Gazette nº06 of 08/02/2016 ANNEX 2.8 PALLIATIVE CARE PACKAGE LEVELS National Referral Hospital Package Specialized services like :  Pain management using all steps of WHO ladder;  Chemo-palliative if needed and available Referral and Provincial Hospitals All services to improve quality of life of patients and families who are consulting or hospitalized for life threatening illnesses including:  Chemo-palliative if needed and available  Pain management using all 3 steps of WHO ladder including strong opioids  Nursing care ( Wound care, Mouth care etc)  Physiotherapy  Ongoing support counseling  End of life care District Hospital All services to improve quality of life of patients and families who are consulting or hospitalized for life threatening illnesses including:  Pain management using all 3 steps of WHO ladder including strong opioids  Nursing care ( Wound care, Mouth care etc)  Physiotherapy  Ongoing support counseling  End of life care Health Center All services to improve quality of life of patients and families who are consulting or hospitalized for life threatening illnesses including: The act can be done in OPD (Consultation) or in admission 1. Physical suffering: - Assessment of Pain and make appropriate referral Pain and symptoms management with drug administration including weak opioids (2 steps of WHO ladder) 2.Psychological Suffering: Initial and ongoing counseling 3. Social ( ex:will writing) and spiritual support: Bereavement support if patient died at the facility Health post Basic Nursing care ( wound -The health post has to organize the home visit 62 Official Gazette nº06 of 08/02/2016 LEVELS Package care, Mouth care drug administration) - Psychological consultation at least once a week per patient and family if needed - Rehabilitation though physiotherapy Community  Home based care services Including :  Basic Nursing  Rehabilitation through physiotherapy(ex. Massage, prevention of Bedsores)  Drug administration  Occupational Therapy (OT)  End of life care  Bereavement support 2.9 NUTRITION-DIETETIC PROCEDURES Comments and referral of Palliative Care patients in they catchment area( Transport and act done at home will need to be costed and paid by insurance) The act done at home by health providers( Nurse, social worker, psychologist, Spiritual workers) need to be considered in insurance Facilities DH HC HP x x PH R x x x x x x x x x x x x x x x x x x x x x x x x x Services NRH/ UTH Service Area Nutrition/Di etetic Nutritional assessment/screening (anthropometric measurements, interpretation of nutritional index, growth monitoring) Nutritional counseling Nutritional, rehabilitation of Protein Energy Malnutrition Diet recall (Anamnesis) and diet assessment Diet therapy: diabetes, hypertension, nephropathy, Protein Energy Malnutrition, Intensive Care Unit cases, before and after surgical procedure Meal planning 63 Official Gazette nº06 of 08/02/2016 Bibonywe ngo bishyirwe ku mugereka w’Iteka rya Minisitiri nº20/39 ryo ku wa 29/01/2016 rigena urutonde rw’ibikorwa by’ubuvuzi bitangwa kuri buri rwego rw’ibigo by’ubuvuzi Seen to be annexed to the Ministerial Order nº20/39 of 29/01/2016 determining medical services provided at each level of health facilities Vu pour être annexé à l’Arrêté Ministériel nº20/39 déterminant les prestations médicales dispensées à chaque niveau d’établissements de santé du 29/01/2016 Kigali, ku wa 29/01/2016 Kigali, on 29/01/2016 Kigali, le 29/01/2016 (sé) Dr. BINAGWAHO Agnes Minisitiri w‟Ubuzima (sé) Dr. BINAGWAHO Agnes Minister of Health (sé) Dr. BINAGWAHO Agnes Ministre de la Santé Bibonywe kandi bishyizweho Ikirango cya Repubulika: Seen and sealed with the Seal of the Republic: Vu et scellé du Sceau de la République : (sé) BUSINGYE Johnston Minisitiri w‟Ubutabera/Intumwa Nkuru ya Leta (sé) BUSINGYE Johnston Minister of Justice/Attorney General (sé) BUSINGYE Johnston Ministre de la Justice/ Garde des Sceaux 64 II W’ITEKA RYA UMUGEREKA WA RYO KU WA MINISITIRI Nº20/39 29/01/2016 URUTONDE RW’IBIKORWA BY’UBUVUZI BITANGWA RW’IBIGO KURI BY’UBUVUZI RIGENA RWEGO BURI ANNEXE II DE L’ARRETE MINISTERIEL Nº20/39 DU 29/01/2016 DETERMINANT LES DISPENSEES A CHAQUE NIVEAU D’ETABLISSEMENTS DE SANTE PRESTATIONS MEDICALES Official Gazette nº06 of 08/02/2016 29/01/2016 ANNEX II TO MINISTERIAL ORDER Nº20/39 OF DETERMINING THE MEDICAL SERVICES PROVIDED AT EACH LEVEL OF HEALTH FACILITIES 65 Official Gazette nº06 of 08/02/2016 ANNEX II PART A: ESSENTIAL MEDICINES FOR CHILDREN PH DH HC HP Co X X X X X X X X X X X X X X X X X X X RH X X X PH DH HC HP Co X X X X X X X X X X X X X X X X X X X X X X X X X 1. ANAESTHETICS 1.1. General anaesthetics and oxygen Product name Halothane Isoflurane Sevoflurane Nitrous oxide Propofol Ketamine Oxygen Thiopental Thiopental Dosage Form & Strength Inhalation Inhalation Inhalation Inhalation Injectable 20mg/ml Inj. 50 mg /ml inhalation (medical gas) powder for Inj. 1g powder for Inj. 0,5 g 1.2. Local anaesthetics RH X X X X X X X X X Product name Bupivacaine Bupivacaine Bupivacaine Lidocaine Lidocaine Lidocaine Lidocaine + Epinephrine Lidocaine + Epinephrine Ephedrine for Dosage form & Strength Inj., 0,25 % Inj., 0.5% Inj. anaesthesia: spinal Bupivacaine 0,5 % + 7.5% of Glucose inj., 2% Topical 2 to 4% Spray 10% 50ml inj., 2 % + 1/200000 Inj. 2 % + 1/ 80.000 (Dental cartridge) Inj. 30 mg/ml 66 Official Gazette nº06 of 08/02/2016 1.3. Preoperative medication and sedation for short-term procedures Product name Atropine Midazolam Midazolam Suxamethonium Neostigmine Vecuronium Cisatracurium Morphine Dosage form & Strength inj. 1 mg /ml Oral Liquid 2mg/ml Inj. 1mg/ml Inj. 50mg/ml Inj. 0.5mg/ml Powder for Inj Inj. 20mg/10ml Inj.: 10 mg/ml RH X X X X X X X X 2. MEDICINES FOR PAIN AND PALLIATIVE CARE X X X X X X PH DH HC HP Co X X X X X X X X X 2.1. Non-opioids and non-steroidal anti-inflammatory medicines X X X PH DH HC HP Co X X X X X X X X X X X X X X X X X X X X X X PH DH HC HP Co X X X X X X X X Product name Ibuprofen Paracetamol Paracetamol Paracetamol Diclofenac Diclofenac Ibuprofen6 Dosage form & Strength Tab. 200 mg syrup, 125 mg/5 ml Suppo. 125 mg and 250mg Inj. 1g Inj. 75mg/3ml Tab 50mg Susp. 100mg/5ml RH X X X X X X X 2.2. Opioid analgesics Product name Morphine Morphine Morphine Dosage form & Strength inj. 10 mg/ml Tab. 10 mg powder for oral sol RH X X X 6 Not in children less than 3 months 67 Official Gazette nº06 of 08/02/2016 2.3. Medicines for other symptoms common in palliative care Product name Amitriptyline Cyclizine Cyclizine Dexamethasone Dexamethasone Diazepam Diazepam Diazepam Diazepam Fluoxetine7 Docusate sodium Docusate sodium Hyoscine butylhybromide Hyoscine butylhybromide Lactulose Midazolam Dosage form & Strength Tab. 10 mg, 25 mg Inj. 50 mg/ml Tab. 50 mg Inj. 4 mg/ml Tab. 2 mg Inj. 5 mg/ml Oral liquid: 2 mg/5 ml Tab. 5 mg Tab. 10 mg. Tab. 20 mg Capsule: 100 mg Oral liquid. 50 mg/5 ml Inj. 400 µgr/ml or 600 µgr/ml Transdermal patches: 1 mg. Oral liquid: 3.1‐3.7 g/5 ml. Inj. 1 mg/ml; 5 mg/ml. RH X X X X X X X X X X X X X X X X 2.4. Antiallergics and medicines used in anaphylaxis PH DH HC HP Co X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X PH DH HC HP Co X X X X X X X X X X X X X Product name Dexamethasone Hydrocortisone Epinephrine (adrenaline) Chlorpheniramine Dosage form & Strength Inj. 4 mg/ml 1 ml Inj. 100mg Inj. 1mg/ ml 1 ml Susp. 2mg/5ml RH X X X X 7Not recommended for children under 8 years 68 Official Gazette nº06 of 08/02/2016 3. ANTIDOTES AND OTHER SUBSTANCES USED IN POISONINGS PH DH HC HP Co X X X X PH DH HC HP Co X X X X X X X X X X X X X X PH DH HC HP Co X X X X X X X X X X X X X X X X X X X X X X X X X X X X X 3.1. Non-specific Product name charcoal, activated Dosage form & Strength Tab. 125 mg or Powder RH X 3.2. Specific Product name Acetyl cysteine (N-) Atropine Naloxone Deferoxamine Sodium Bicarbonate Flumazenil Intralipid Pralidoxim Protamine Dosage form & Strength Inj. 200 mg/ml Inj. 1 mg/ml Inj. 400 µg/1ml Powder for inj. 500 mg Inj. 8.4% .10 ml Inj. 0,25mg/5ml Inj. 20% 100ml In. 20mg/ml Inj. 5000 IU/5ml 4. ANTICONVULSANTS/ANTIEPILEPTICS Product name Valproic acid (and Salts) Valproic acid (and Salts) Carbamazepine Carbamazepine Diazepam Diazepam Phenobarbital Dosage form & Strength Tab., 200 mg, 300mg Syrup 200mg/5ml Tab. 200 mg, Syrup 100mg/5ml Inj. 5 mg/ml.2 ml Tab. 5 mg Tab. 30 mg Phenobarbital Phenobarbital Phenytoin Phenytoin Levetiracetam Tab. 50 mg Inj. 100mg/ml 2ml Tab. 100 mg Inj. 250mg/5ml Susp. 100mg/ml RH X X X X X X X X X RH X X X X X X X X X X X X 69 Official Gazette nº06 of 08/02/2016 5. ANTI-INFECTIVE MEDICINES 5.1. Anthelminthics 5.1.1. Intestinal antihelminthics Product name Mebendazole Mebendazole Albendazole Albendazole Niclosamide Dosage form & Strength Tab. 100 mg or 500mg Susp. 100mg/5ml, Susp. 200mg/5ml Tab. 200mg; 400mg Tab. 500 mg 5.1.2. Antifilarials RH PH DH HC PH Co X X X X X X X X X X X X X X X X X X X X X X X X Product name Ivermectine Diethylcarbamazine Dosage form & Strength Tab. 6 mg Tab. 100 mg RH PH DH HC HP Co X X X X X X X X 5.1.3. Antischistosomals and other antitrematode medicines Product name Praziquantel Dosage form & Strength Tab. 150 mg, 600 mg RH PH DH HC HP Co X X X X 1. ANTIBACTERIALS 1.1. Beta Lactam medicines Product name Amoxicillin Amoxicillin Amoxicillin Amoxicillin/Clavulanic acid Amoxicillin/Clavulanic acid Ampicillin Ampicillin Benzathine benzylpenicillin Procaine Benzylpenicillin forte Benzylpenicillin Cephalexin Cephalexin Cefadroxyl Cloxacilline Cloxacilline Cloxacilline Phenoxymethylpenicilline Cefotaxime Ceftriaxone Dosage form & Strength Caps.250 mg, Tab. dispersible125mg Susp. 125 mg /5 ml, Susp. 125mg + 31,25 mg Tab. 500mg + 125mg Powder for inj. 500 mg, 1g Powder for inj.1g Powder for inj. 2,4 MIU, Powder for inj. 1 or 3 MIU Powder for inj. 5 MIU, Susp. 125 mg/5 ml Tab. 250 mg susp. 125 or 250 mg/5ml Caps. 250 mg Susp. 125mg Powder for inj.500 mg, Tab. 250 mg Powder for inj.1g, Powder for inj.1g, 70 RH PH DH HC HP Co X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X Official Gazette nº06 of 08/02/2016 Product name Ceftazidime Imipenem + cilastatin Dosage form & Strength Powder for inj.1g, Powder for Inj. 250/250 mg RH PH DH HC HP Co X X X X 1.1. Other antibacterial Product name Azithromycin Chloramphenicol Ciprofloxacin Ciprofloxacin Doxycycline Erythromycin Erythromycin Clarithromycin Gentamicin Metronidazole Metronidazole Metronidazole Nitrofurantoin Sulfamethoxazole/Trimethoprim Sulfamethoxazole/trimethoprim Sulfamethoxazole/trimethoprim Sulfamethoxazole/trimethoprim Clindamycin Clindamycin Vancomycin Dosage form & Strength Caps. 250 mg ; Oil susp.for inj., 0,5g/2 ml Tab. 250 mg Inj. 2mg/ml Tab. 100 mg Tab. 250 mg Oral susp.125 mg/5ml Tab. 250mg Inj. 40 mg /ml 2ml Tab. 250mg Inj. 500 mg /100ml Oral susp. 200mg/5ml Tab. 100 mg Tab., 100 mg + 20 mg Tab. 400 mg + 80 mg Oral susp 200mg + 40mg/5 ml Inj. 80 mg + 16 mg/ml, Tab. 150mg Inj. 150mg/ml Powder for inj.250 mg 2. ANTI TUBERCULOSIS MEDICINES X X X X X X X X X X X RH PH DH HC HP Co X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X Product name Ethambutol Isoniazide Pyrazinamide Rifampicine Rifampicine + isoniazide Rifampicine + isoniazide Rifampicine + isoniazide Rifampicine Pyrazinamide + Ethambutol Rifampicine Ethambutol Rifampicine Pyrazinamide Kanamycine Prothionamide Cycloserine Levofloxacin + + + Isoniazide Isoniazide Isoniazide Dosage Form &Strength Tab. 100 mg Tab. 100mg Tab. 400 mg Tab.,150 mg, 300 mg Tab. 150mg + 75mg Tab. 60mg + 60mg Tab. 60mg + 30mg Tab.150mg + 75mg + 400mg + 275mg Tab. 150mg + 75mg + 275mg RH PH X X X X X X X X X X X X X X X X X X Tab. 60mg + 30mg + 150mg X X X X Powder for inj. 1g X X Tab. 250 mg X X Tab. 250 mg X X Tab. 200 mg + + + 71 DH HC HP Co X X X X X X X X X X X X X X X X X X X X X X X X X X X X Official Gazette nº06 of 08/02/2016 Product name Capreomycin Para amino salicylic acid Moxifloxacin Clarithromycin Clofazimine Dosage Form &Strength Powder for inj. 1g Granules 4g Tab. 400mg Tab. 500mg Tab. 400mg RH PH X X X X X X X X X X DH HC HP Co X X X X X X X X X X 3. ANTIFUNGAL MEDICINES Product name Fluconazole Griseofulvin Nystatin Nystatin Amphotericin B Dosage form & Strength Susp. 50 mg/ml Tab., 125 mg Susp. 100.000 UI Tab. 500.000 UI Powder for inj. 50 mg 4. ANTIVIRALS 4.1. Antiherpetics Product name Aciclovir Aciclovir Aciclovir Dosage form & Strength Tab. 200 mg Inj. powder. 250 mg Cream 5% 4.2. ANTIRETROVIRALS RH PH DH HC HP Co X X X X X X X X X X X X X X X X X X X X X RH PH DH HC HP Co X X X X X X X X X X 4.2.1. Nucleoside/Nucleotide Reverse transcriptase inhibitors Product name Lamivudine (3TC) Zidovudine (AZT) Abacavir (ABC) Dosage form & Strength Oral solution, 10mg/ml, Oral solution,10mg/ml, Oral solution. 20mg/5ml RH PH DH HC HP Co X X X X X X X X X X X X 4.2.2. Non-nucleotide Reverse Transcriptase inhibitors Product name Efavirenz (EFV) Efavirenz (EFV) Nevirapine (NVP) Nevirapine (NVP) Etravirine (ETV) Dosage form & Strength Tab. 50mg Tab. 200mg Tab. 200 mg Oral suspension 10mg/ml, Tab. 25mg 4.2.3. Protease Inhibitors RH PH DH HC HP Co X X X X X X X X X X X X X X X X X X X X Product name Ritonavir + Lopinavir Ritonavir + Liponavir Atazanavir Dosage form & Strength Oral solution 80/20mg/ml Tab.100/25mg Tab, 200mg RH PH DH HC HP Co X X X X X X X X X X X X 72 Official Gazette nº06 of 08/02/2016 Atazanavir Atazanavir Darunavir Darunavir Tab, 150mg Tab, 100mg Tab. 150mg Tab.75mg X X X X X X X X X X X X X X X X 4.2.4. Fixed-Dose Combinations Product name Abacavir/Lamivudine Zidovudine/Lamivudine Zidovudine/Lamivudine/Nevirapine Dosage form & Strength RH X Tab, 60/30mg X Tab, 60/30mg X Tab, 60/30/50mg PH DH HC HP Co X X X X X X X X X 5. ANTIPROTOZOAL MEDICINES 5.1. Antiamoebic and Antigiardiasis Medicines Product name Metronidazole Metronidazole Metronidazole Dosage form & Strength Tab. 250 mg; Inj.500 mg Oral susp. 200 mg /5 ml RH X X X 5.2. Antimalarial medicines 5.2.1. Curative treatment medicines PH DH HC HP Co X X X X X X X X X X Product name Artemether + Lumefantrine Artesunate Artesunate Artesunate Quinine Quinine Dosage form & Strength Disp. 20 mg + 120mg Inj. 30mg Inj. 60mg Inj. 120mg Tab. 300 mg Inj. 300 mg/ml RH X X X X X X X PH DH HC HP Co X X X X X X X X X X X X X X X X X X X 5.2.2. Curative treatment medicines PH DH HC HP Co X X X X X X X X X X X X X X X Product name Long Lasting Insecticide Treated Nets Insecticides Larvicides Mosquito Repellents Dosage form & Strength RH X X X X 73 Official Gazette nº06 of 08/02/2016 6. ANTINEOPLASTICS AND IMMUNOSUPPRESSIVES 6.1. Cytotoxic and adjuvant medicines Product name Folinic acid Asparaginase Bleomycin Cyclophosphamide Cyclophosphamide Doxorubicin Methotrexate Methotrexate Vincristine Mercaptopurine Hydroxycarbamide Daunorubicin Dactinomycine Tamoxifene citrate Anastrozole Letrozole Cisplatin Imatinib Merfalan Thalidomide Trastuzumab Zoledronate Oxaliplatin Carboplatin Paclitaxel Ifosfomide Fluorouracil (5-FU) Fluorouracil (5-FU) Irinotecan Docetaxel Nitriximab Dosage form & Strength Tab. 15 mg Powder for inj. 10000IU Inj. 15 mg Tab. 25 mg Inj. 500 mg Powder for inj.10mg, 50 mg Tab. 2,5 mg Inj. 50 mg Powder for Inj. 1mg Tab. 50mg Capsule 500mg Inj. 50 mg Inj. 50 microgram Tab. 20mg Tab. 1mg Tab. 2.5mg Inj. 1mg/ml Tab. 100mg Tab. 2mg Tab. 200mg susp Powder 150mg IV Inj. 5mg/100ml Inj. 5mg/ml Inj. 10mg/ml Powder for Inj. 5mg/5ml Powder 100mg, Inj. 50mg/ml Cream 0.5%, 1% and 5% Inj. 20mg/ml, 15ml Inj. 20mg/ml, 1ml Susp.100mg/ml RH PH DH HC HP Co X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X 6.2. Immunosupressants Product name Dosage form & Strength RH PH DH HC HP Co Hydrocortizone Methylprednisolone Prednisolone Dexamethazone Interferons α-2a Interferons α-2b Inj. 100mg/ml Inj. 40mg/ml, 80mg/ml Tab. 5mg Inj. 4mg/ml Inj. 10000000IU/1,2ml Inj. 10000000IU/1,2ml X X X X X X X X X X X X X X X 74 Official Gazette nº06 of 08/02/2016 7. MEIDICINES AFFECTING THE BLOOD 7.1. Antianaemia medicines Product name Folic acid Hydroxocobalamin Ferrous salt Ferrous salt Ferrous salt + folic acid Phytomenadione Dosage form & Strength Tab. 5 mg Inj. 1mg/ml Tab. 60 mg Syrup 25mg/5ml Syrup 60mg + 400 µg Inj. 1mg/ml, 10mg/ml RH X X X X X X 7.2. Medicines affecting coagulation Product name Heparin sodium Protamine sulfate Enoxaparin Warfarin Warfarin Warfarin Warfarin Warfarin Hydroxocarbalamide Phytomenadione Phytomenadione Etamsylate Etamsylate Dosage form & Strength Inj. 5000 IU/ml Inj. 10 mg/ml Inj.10, 000IU Tab 1mg Tab 5mg Tab 0.5mg Tab 2mg Tab 10mg Inj. 1mg/ml Inj. 1mg/ml,10 mg/ml Tab. 10mg Tab. 250mg Inj. 250mg/2ml 8. CARDIOVASCULAR MEDICINES 8.1. Medicines used in heart failure RH X X X X X X X X X X X X X X PH DH HC HP Co X X X X X X X X X X X X X X X X X X X X X X PH DH HC HP Co X X X X X X X X X X X X X X X X X X X X X X X X X X X X Product name Digoxin Digoxin Digoxin Furosemide Carvedilol Dopamine Hydrochlorothiazide Dosage form & Strength Oral sol. 50 µg /ml Tab. 250 µg Inj. 250 µg /ml Inj. 10mg/ml Tab. 6.25mg; 12.5mg Inj. 40mg/ml Tab. 25mg RH X X X X X X X PH DH HC HP Co X X X X X X X X X X X X X X 8.2. Antihypertensive medicines Product name Nifedipine Amlodipine Amlodipine Furosemide Dosage form & Strength Tab. 10mg Tab. 5 mg Tab. 10mg Inj. 10mg/ml RH X X X X PH DH HC HP Co X X X X X X X X 75 Official Gazette nº06 of 08/02/2016 Atenolol Propranolol Hydralazine Hydralazine Captopril Tab 25mg Tab. 10 and 20mg Tab. 25mg Inj. 20mg/ml Tab. 25mg X X X X X X X X X X X X X X X 8.3. Anti arrhythmic Medicines Product name Adenosine Amiodarone Amiodarone Isoprenaline Digoxin Digoxin Digoxin Propranolol Captopril Dosage form & Strength Inj. 3mg/ml Inj150mg/3ml Tab. 100mg, 200mg Inj.0.2mg/ml Oral sol. 50 µg /ml Tab. 250 µg Inj. 250 µg /ml Tab. 10 and 20mg Tab. 25mg RH PH DH HC HP Co X X X X X X X X X X X X X X X X X X X X X X X 8.4. Diuretics Product name Furosemide Furosemide Furosemide Hydrochlorothiazide Mannitol Spironolactone Dosage form & Strength Inj. 10mg/ml Tab. 40mg Oral susp. 20mg/5ml Tab. scored, 25 mg Inj.10%, 20% Tab. 25mg 9. ANTIMIGRAINE MEDICINES 9.1. Medicines for treatment of acute attack Product name Paracetamol Ibuprofen Dosage form & Strength Tab. 500 mg Tab. 200 mg 9.2. Prophylaxis Product name Propranolol Cinnarizine Dosage form & Strength Tab.20 mg Tab. 25mg 10. DERMATOLOGICAL MEDICINES 10.1. Anti-fungal medicines Product name Miconazole Dosage form & Strength Cream or ointment 2% 76 RH PH DH HC HP Co X X X X X X X X X X X X X X X X X X X RH PH DH HC HP Co X X X X X X X X RH PH DH HC HP Co X X X X X X RH PH DH HC HP Co X X X X Official Gazette nº06 of 08/02/2016 Terbinafine Ketoconazole Silver nitrate Cream or ointment 1% Cream 2% Pencil X X X X X X X X X X X X 10.2. Anti-infective medicines Product name Potassium permanganate Silver sulfadiazine Dosage form & Strength Aqueous solution 1:10 000. Cream 1% RH PH DH HC HP Co X X X X X X X X 10.3. Anti-inflammatory and antipruritic medicines RH PH DH HC HP Co X X X X X X X X X X X X X X X X X Product name Betamethasone Calamine Hydrocortisone Diclofenac Dosage form & Strength Cream or ointment 0.1% Lotion Cream or ointment 1% Gel 3% 77 Official Gazette nº06 of 08/02/2016 10.4. Medicines affecting skin differentiation and proliferation Product name Benzoyl peroxide Podophyllum resin Salicylic acid urea Coal tar Dosage form & Strength Cream or lotion. 5%. Solution. 5%. Solution.10% to 25%. Solution. 5%. Sol. 5%. 10.5. SCABICIDE AND PEDICULICIDES Product name Benzyl benzoate8 Permethrin Metronidazole Dosage form & Strength Lotion: 25%. Cream: 5% or Lotion: 1%. Vaginal tab. 500mg 10.6. Antimicrobials Product name Neomycin + Bacitracin Gentamycin Tetracycline Fusidic acid Dosage form & Strength Cream 5 mg + 500 IU/g Ointment 0.1% Ointment 3% Cream 2% and ointment 10.7. Antivirals RH PH DH HC HP Co X X X X X X X X X X X X X X X X X X X X RH PH DH HC HP Co X X X X X X X X X X X X RH PH DH HC HP Co X X X X X X X X X X X X X X X Product name Dosage form & Strength RH PH DH HC HP Co Acyclovir Cream or ointment 5% X X X X 10.8. Keratolytics Product name Vaseline Lanoline Lanoline + Vaseline Zinc Oxyde Dosage form & Strength Ointment Ointment Ointment 50% + 50% Paste RH PH DH HC HP Co X X X X X X X X X X X X X X X X 10.9. Miscellaneous Product name Meladinine 5-Fluorouracyl Aluminium chloride Dosage form & Strength Sol. 0.1% or 0.75% Cream 5% Sol. 5% and 20% RH PH DH HC HP Co X X X X X X X X X 8Not recommended for children less than 2 years 78 Official Gazette nº06 of 08/02/2016 11. DIAGNOSTIC AGENTS 11.1. Ophthalmic Diagnostic Agents Product name Fluorescein Tropicamide Triptan blue Intra-occula Visco elastic Dosage form & Strength Eye drops: 1% Eye drops: 0.5%. Liquid 0.4% Inj. 40mg/ml 11.2. Radio contrast media RH PH DH HC HP Co X X X X X X X X X X X X Product name Barium sulfate. Amidotiozoate Dosage form & Strength Aqueous suspension Amp 20ml, 420mg of iodine/ml RH PH DH HC HP Co X X X X X 12. GASTROINTESTINAL MEDICINES 12.1. Antiulcer medicines Product name Ranitidine Ranitidine Omeprazole Cimetidine Aluminum/Magnesium Hydroxide Dosage form & Strength Inj. 25 mg/mL Tab., 150 mg Caps. 20mg Inj. 200mg Tab. 500mg 12.2. Antiemetic medicines RH PH DH HC HP Co X X X X X X X X X X X X X X X X X Product name Dexamethasone Dexamethasone Dexamethasone Metoclopramide Metoclopramide Metoclopramide Domperidone Dosage form & Strength Inj. 4 mg/ml Oral Sol 2mg/5ml, Tab. 4mg Syrup, 5 mg /5 ml Inj. 5 mg/ml Tab. 10mg Susp. 1mg/ml 12.3. Antireflux X RH PH DH HC HP Co X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X Product name Domperidone Alginate sodium Dosage form & Strength Suspension 1mg/ml Suspension 250mg/5ml RH PH DH HC HP Co X X X X X 12.4. Laxatives Product name Lactulose Paraffin oil Dosage form & Strength Oral liquid: 3.1‐3.7 g/5 ml. Bottle 250ml RH PH DH HC HP Co X X X X X X X X 79 Official Gazette nº06 of 08/02/2016 Glycerine Suppo. infant and child X X X X 12.5. Medicines Used In Diarrhoea 12.5.1. Oral Rehydration Product name Oral rehydration salts Resomal Dosage form & Strength Oral sol. 20.5g/l Oral sol. RH PH DH HC HP Co X X X X X X X X X X 12.5.2. Medicines for diarrhea in children Product name Zinc Sulfate Dosage form & Strength Tab. 10 mg, 20mg RH PH DH HC HP Co X X X X X X 13. HORMONES, OTHER ENDOCRINE MEDICINES AND CONTRACEPTIVES 13.1. Adrenal hormones and synthetic substitutes Product name Adrenal hormones and synthetic substitutes Adrenal hormones and synthetic substitutes Fludrocortisone hydrocortisone Dosage form & Strength Tab. 60 mg RH PH DH HC HP Co X X X Tab. 50 µg 100 µg X X X Tab. 100μg Tab. 5 mg; 10 mg; 20 mg. X X X X X 13.2. Medicines used for diabetes Product name Insulin Lente Insulin with intermediate action Insulin rapid action Dosage form & Strength Inj.100 IU/ml inj. 100 IU,/ml inj.100 IU/ml RH PH DH HC HP Co X X X X X X X X X X X X 13.3. Thyroid hormones Product name Levothyroxine Dosage form & Strength Tab 25 mcg, 50mcg, 100mcg RH PH DH HC HP Co X X X 80 Official Gazette nº06 of 08/02/2016 14. IMMUNOLOGICALS 14.1. Diagnostic agents Product name Tuberculin purified (PPT) Rapid Diagnostic Test (malaria) Rapid Diagnostic Test (HIV) Dosage form & Strength Inj. Kit Kit 14.2. Sera and immunoglobulins RH PH DH HC HP Co X X X X X X X X X X X X X Product name Diphtheria antitoxin Antirabies immunoglobulin Antitetanus immunoglobulin Human Immunoglobulin anti-D Antivenom immunoglobulin Dosage form & Strength Sol., 10000IU,20 000 IU Sol. inj. 150 IU/ml Sol. injectable, 500 IU Sol. Inj. 250 µgr Inj. RH PH DH HC HP Co X X X X X X X X X X X X X X X X X X X X 14.3. Vaccines administered at Health Centre level and in private facilities Currently Available Vaccines Vaccine BCG OPV DTP or DTP-HepB-Hib Measles9, Rubella TT (pregnant women) Pneumococcal Conjugate Vaccine HPV10 Total doses 1 4 3 2 2 3 3 Age and interval Birth Birth, 6, 10, 14 weeks 6, 10, 14 weeks 9 months, 15 months During pregnancy 6, 10, 14 weeks HPV for each cohort 10-14 years old girls Rotavirus vaccine11 3 6, 10, 14 weeks 14.4. General vaccines Product name Measles vaccine BCG vaccine Poliomyelitis vaccine Diphtheria vaccine DTP-Hep B + Hib Tetanus vaccine Dosage form & Strength 10 doses 20 doses Oral sol. 20dose RH PH DH HC HP Co X X X X X X X X X X X X X X X X 2 doses 10 doses X X X X 9Second dose of measles vaccine will be introduced starting in 2014 10 Human papilloma virus vaccine (HPV) will use a school based vaccination campaign approach 11 Rotavirus vaccine will be given in 3 doses, the first dose no later than 15 weeks of age and the last dose by 32 weeks of age 81 Official Gazette nº06 of 08/02/2016 14.5. Vaccines reserved to certain groups and materials Product name Meningococcal meningitis Rabies vaccine OPV Pneumococcal vaccine Tetanus vaccine BCG AD syringes AD Syringes Reconstitution Syringes Reconstitution Syringes Reconstitution Syringes Safety boxes Dosage form & Strength 10 et 50 doses 1 dose 20 doses 1 dose 10 doses 0.05 ml 0.5 ml 2ml 5ml 10ml RH PH DH HC HP Co X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X 15. MUSCLE RELAXANTS AND CHOLINESTERASE INHIBITORS Product name Neostigmine Neostigmine Suxamethonium Pyridostigmine Vecuronium Cisatracurium Dosage form & Strength Tab. 15 mg Inj. 2,5 mg/1 ml, 500 µg/1 ml, Inj. 50 mg/ml Inj.1 mg/1ml Inj.10 mg Inj. 2mg/ml RH PH DH HC HP Co X X X X X X X X X X X X X X X X X 16. OPHTALMOLOGICAL PREPARATIONS 16.1. Anti-infective agents Product name Aciclovir Azithromycin Gentamicin Ofloxacin Tetracycline Dosage form & Strength Ointment 3% Eye drops 1.5% Eye drops 0.3% Eye drops 0.3%. Eye ointment: 1% 16.2. Anti-Inflammatory agents RH PH DH HC HP Co X X X X X X X X X X X X X X X X X Product name Prednisolone Dosage form & Strength Eye drops 0.5 RH PH DH HC HP Co X X X 16.3. Local anaesthetics Product name Tetracaine Dosage form & Strength Eye drops 0.5% RH PH DH HC HP Co X X X 17. Peritoneal Dialysis Solution Product name Dosage form & Strength RH PH DH HC HP Co 82 Official Gazette nº06 of 08/02/2016 Parenteral solution intraperitoneal dialysis solution X X 18. MEDICINES FOR MENTAL AND BEHAVIOURAL DISORDERS 18.1. Medicines used in psychotic disorders X X X X X RH PH DH HC HP Co X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X RH PH DH HC HP Co X X X X X X X X X X X X X X X X RH PH DH HC HP Co X X X X X X X Product name Ziclopenthixol Chlorpromazine Chlorpromazine Chlorpromazine Levomepromazine Levomepromazine Haloperidol Haloperidol Haloperidol decanoate Fluopentixol Fluopentixol decanoate Olanzapine Risperidone Pipamperon Pipamperon Pimozide Silpiride Dosage form & Strength Inj. 50 mg Tab. 25mg or 100 mg Oral liquid 25 mg Inj.25 mg/ml Inj. 25mg/ml Tab. 25mg, 100mg Tab. 2 mg or 5 mg; Inj. 5 mg/1ml Inj. 50mg/ml Tab. 1mg or 0.5mg Inj. 20mg/ml Tab. 5mg Tab. 1mg Oral drop 40mg/ml Tab. 40mg Tab. 1mg Tab. 200mg 18.2. Medicines used in mood disorders 18.2.1. Medicines used in depressive disorders Product name Amitriptyline Fluoxetine Citalopram Clomipramine Clomipramine Trazodone Imipramine Dosage form & Strength Tab. 25 mg Tabs 20 mg Tab.20mg Tab. 25mg Inj. 25mg/ml Tab. 100mg Tab. 10mg, 25mg 18.2.2. Medicines used in bipolar disorders Product name Valproic acid (and salts) Carbamazepine Dosage form & Strength Tab. 200 mg; 300mg Tab. (scored): 100 mg; 200 mg. 83 Official Gazette nº06 of 08/02/2016 18.2.3. Medicines for anxiety disorders and Hypnotics Product name Diazepam Alprazolam Clorazepate Zolpidem Dosage form & Strength Tab. (scored): 5 mg. Tab. 0.5mg Cap.5mg Tab.10mg X X RH PH DH HC HP Co X X X X X X X X X 18.2.4. Medicines used for obsessive compulsive disorders Product name Clomipramine Clomipramine Dosage form & Strength Capsule: 10 mg; 25 mg Inj. 25 mg RH DH HC Co X X X X 18.2.5. Medicines used in vascular disturbances Product name Cinnarizine Piracetam Dosage form & Strength Tab. 25mg Tab. 800mg RH PH DH HC HP Co X X X X X 19. SOLUTIONS CORRECTING WATER, ELECTROLYTE AND ACID-BASE DISTURBANCES 19.1. Oral Product name Oral rehydration salts Potassium chloride Resomal 19.2. Parenterals Product name Calcium Gluconate Glucose with sodium chloride Potassium chloride Sodium chloride Glucose, Glucose Sodium lactate, compound Calcium chloride Hypertonic Saline Sodium Bicarbonate Dosage form & Strength Sachet, powder. 27,9g/l Powder for solution Powder for solution Dosage Form & Strength Inj.10%. 10ml Inj. 11,2 % 20 ml Inj. 7.5 % Inj. 0.9 % Inj. 50 % Inj. 5%, Inj. 0.9 % glucose Sol. Inj. Isotonic 0,9 % Sol. 3% Inj. 8.4% 10 ml NaCl + 5% RH PH DH HC HP Co X X X X X X X X X X X X X X RH PH DH HC HP Co X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X 19.3. Miscellaneous Product name Water for injection Dosage form & Strength Inj. 2 ml 5 ml or 10 ml 84 RH PH DH HC HP Co X X X X Official Gazette nº06 of 08/02/2016 20. VITAMINS AND MINERALS Product name Ascorbic acid Nicotinamide Cholecalciferol Pyridoxine Pyridoxine Retinol Thiamine Riboflavin Iodine Iodine Multivitamin Multivitamin Vitamine. B complex Dosage form & Strength Tab 50 mg; Tab., 50 mg Oral liquid: 400 IU/ml. Tab.400 IU; 1000 IU Tab. 25 mg and 50 mg Tab. 50 mg Caps. 200 000 IU; 100 000 IU Tab. 50 mg Tab. 5mg Caps. 200mg Oily sol. 240/ml or Inj. 308mg/0.57 ml Tab Syrup Tab RH PH DH HC HP Co X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X 21. EAR, NOSE AND THROAT MEDICINES IN CHILDREN Product name Acetic acid Topical: Ciprofloxacin Xylometazoline Chlorpheniramine Chlorpheniramine Sodium chloride Dosage form & Strength 2%, in alcohol. Ear drop 0.3% Nasal drops: 0.05%. Syrup 2ml/5ml Tabs. 2mg, 4mg Nasal drop 0.9% 10ml RH PH DH HC HP Co X X X X X X X X X X X X X X X X X X X X X X X X X X X X 22. MEDICINES ACTING ON THE RESPIRATORY TRACT Product name Beclometasone Beclometasone Epinephrine adrenaline Salbutamol Salbutamol Salbutamol Salbutamol Aminophylline Ipratropium bromide Hydrocortisone Budesonide Dosage form & Strength Aerosol sol., 50 µg /dose Aerosol sol., 250 µg /dose Inj. 1 mg/ml Inhalation Sol./aerosol 100µg Syrup 2 mg/5 ml Inj.50 µg /ml Sol. nebulizer, 5 mg /ml Inj. 25 mg/ml 10 ml 20 micrograms/metered dose Inj.100mg Nasal spray 100 µgr per dose. RH X X X X X X X X X X X 85 X X X X X X X X PH DH X X X X X X X X X X X X X HC Co X X X X X X X X Official Gazette nº06 of 08/02/2016 23. SPECIFIC MEDICINES FOR NEONATAL CARE 23.1. Medicines administered to the neonate Product name Caffeine Citrate Chlorhexidine Prostaglandin E Prostaglandin E 2: 1 Surfactant Dosage form & Strength Syrup 20 mg/ml Sol. or gel : 7.1% Inj. 0.5 mg/ml in alcohol 25 mg/ml or 80 mg/m mg/ml 25 mg/ml or 80 mg/ml. 24. MEDICINES FOR JOINT DISEASES X X RH PH DH HC HP Co X X X X X X X X X X X X 24.1. Disease modifying agents used in rheumatoid disorders Product name Hydroxychloroquine Methotrexate Dosage form & Strength Tab. 200 mg Tab. 2.5 mg RH PH DH HC HP X X X X X X Co 24.2. Juvenile joint diseases Product name Acetylsalicylic acid Acetylsalicylic acid Dosage form & Strength Suppository: 50 mg; 150 mg. Tab.: 75mg, 100 mg or 500 mg. RH X X PH DH HC HP Co X X X X X X 86 Official Gazette nº06 of 08/02/2016 PART B: ESSENTIAL MEDICINES FOR ADULTS 1. ANAESTHETICS 1.1 GENERAL ANAESTHETICS AND OXYGEN 1.1.1. Inhalational medicines Product name Isofluran Halothan Oxygen Nitrous oxide Dosage form & Strength Inhalation , Inhalation, Inhalation (medical gas ) Inhalation 1.1.2. Injectable medicines Product Name Ketamine Propofol Thiopental Dosage form & Strength Inj. 50 mg /1ml Inj. 20 mg/ml. Powder for inj. 500mg RH PH DH HC HP Co X X X X X X X X X X RH PH DH HC X X X X X X X X HP Co RH PH DH HC HP Co X X X X X X X X X X X X X X X Local anaesthetics 1.2 Product Name Bupivacaine Bupivacaine Lidocaine Lidocaine Lidocaine Lidocaine + epinephrine Dosage form & Strength Inj. 0,25 %, 0.5% Inj. for spinal anaesthesia: 0, 5 % to be mixed with 7.5% glucose Inj., 1% , 2% Inj. for spinal anaesthesia: 5% to be mixed with 7.5% glucose Topical forms: 2% to 4% Inj. 1%; 2% + Epinephrine 1:200 000 Lidocaine + Epinephrine Dental cartridge 2% + Epinephrine X X Ephedrine Lidocaine Lidocaine 1:80 000 Inj.30 mg ml. Spray: 10% Gel X X X X X X 1.3 Preoperative medication and sedation for short-term procedures X X X X X X X X Product Name Atropine Morphine Midazolam Neostigmine Suxamethonium Suxamethonium Vecuronium Cisatracurium Dosage form & Strength Inj. 0.5mg; 1 mg Inj. 10 mg/1ml Inj. 1 mg/ml. Inj. 500 μg/ml Inj.50 mg/ml Powder for inj. 50mg/ml, Powder for inj.10 mg Inj. 2mg/ml RH X X X X X X X X PH DH HC HP Co X X X X X X X X X X X X X X X 87 Official Gazette nº06 of 08/02/2016 2. ANALGESICS, ANTIPYRETICS, NON-STEROIDAL ANTI-INFLAMMATORY MEDICINES, (NSAIMS), ANTIGOUTS MEDICINES AND RHEUMATIC DISEASE MEDICINES THERAPY 2.1 Non-opioids, Antipyretics and non-steroidal Anti-Inflammatory medicines Product Name Acetylsalicylic acid Ibuprofen Paracetamol Paracetamol Paracetamol Diclofenac Diclofenac Diclofenac Indomethacin Indomethacin 2.2 Opioid analgesics Product Name Codeine Morphine Morphine Fentanyl Pentazocine Péthidine Tramadol hydrochloride Tramadol hydrochloride 2.3. Antigouts medicines Dosage form & Strength Tab. 500 mg Tab. 200 mg ;400mg Tab. 500 mg. Suppository. 250 mg. Inj.10mg/ml Inj.75 mg/3ml Tab. 50mg Suppository :100mg Caps: 25mg Suppository 100mg Dosage form & Strength Tab. 30 mg Inj.10 mg/ml Tab. 10 mg Inj.0,1 mg/ml Inj. 30mg/ml Inj. 50mg/ml Tab. 50 mg Inj. 50 mg/ml RH X X X X X X X X X X RH X X X X X X X X X X X X PH DH HC HP Co X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X PH X X X X X X X X DH HC HP Co X X X X X X X Product Name Colchicine Allopurinol Dosage form & Strength Tab, 300 mg Tab, 100 mg RH X X PH X X DH HC HP Co X X 3. ANTI-MIGRAINES MEDICINES 3.1 For treatment of acute attack Product Name Acetylsalicylic acid Ergotamine Paracetamol Sumatriptan succinate 3.2 For prophylaxis Dosage form & Strength Tab. 300 -500 mg Tab. 1 mg. Tab. 300-500 mg Tab. 50mg RH PH DH HC HP Co X X X X X X X X X X X X X X X X Product Name Propranolol Cinnarizine Dosage form & Strength Tab. 20 mg, 40 mg Tab. 25mg,75 mg RH PH DH HC HP Co X X X X X X 88 Official Gazette nº06 of 08/02/2016 4. ANTI-ALLERGIES AND MEDICINES USED IN ANAPHYLAXIS Product Name Chlorpheniramine Chlorpheniramine Dexamethasone Dexamethasone Epinephrine (adrenaline) Hydrocortisone Prednisolone Promethazine Promethazine Dosage form & Strength Tab. 4 mg Sol. 2 mg/5ml Inj. 4 mg/ml Tab. 0.5mg; 4mg Inj. 1 mg/1ml Powder for inj.100mg Tab. 5 mg, Inj. 25mg/ml Tab. 25 mg RH PH DH HC HP Co X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X ANTIDOTES AND OTHER SUBSTANCES USED IN POISONINGS 5. 5.1 Non-specific Product Name Charcoal, activated Dosage form & Strength Tab : 250 mg RH PH DH HC HP Co X X X X X 5.2 Specific Product Name Acetyl cysteine Atropine Calcium gluconate Naloxone Flumazenil Sodium bicarbonate Intralipid Protamine Vitamine K (Phytomedione) Pralidoxime Dosage form & Strength Inj. 200 mg/ml Inj.1 mg/ml Inj.100 mg/ml Inj. 400/ml Inj. 0.1mg/ml Inj. 8.4% Inj. 20% Inj. 5000UI/5ml Inj 10mg/ml Inj 20mg/ml RH PH DH HC HP Co X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X 6. ANTICONVULSANTS-ANTIEPILEPTICS Product Name Valproic acid and (Salts) Carbamazepine Diazepam Diazepam Phenobarbital Phenobarbital Phenytoin Phenytoin Magnesium Sulfate12 Clonazepam Levetiracetam Dosage form & Strength Tab. 200 mg; 300mg, 500 mg Tab. 200mg; 400mg Inj. 5 mg/ml Tab. 5 mg Tab. 100 mg Inj. 100mg/ml Tab. 100 mg Inj. 250mg/5ml Inj. 500 mg/ml Tab. 0,5 mg, 2mg Tab. 250mg; 500mg RH X X X X X X X X X X X 12Allowed to be used only in SONU health centers 89 X X X X X X X X X X X X X X X X PH DH HC HP Co X X X X X X X X X X X X Official Gazette nº06 of 08/02/2016 7. ANTI-PARKINSON MEDICINES Product Name Biperiden Biperiden Levodopa + Carbidopa Dosage form & Strength Tab: 2 mg Inj. 5 mg/ml Tab: 100 mg/10 mg; 250 mg/25 mg RH PH DH HC HP Co X X X X X X X X X 8. MEDICINES FOR MENTAL AND BEHAVIOURAL DISORDERS 8.1 Medicines used in psychotic disorders Product Name Zuclopenthixol acetate Zuclopenthixol acetate Chlorpromazine Chlorpromazine Levomepromazine Levomepromazine Haloperidol Haloperidol Haloperidol Flupentixol Flupentixol Olanzapine Risperidone Risperidone Pipamperon Pipamperon Dosage form & Strength Inj. 50 mg/ml, 200mg/ml Tab. 10mg, 25mg Tab. 25mg; 100 mg Inj. 25 mg/ml Inj. 25mg/ml Tab. 25mg, 100mg Tab.5 mg Inj. 5 mg/1ml; 50mg/ml Inj. 50mg/ml Tab. 0.5mg; 1mg Inj. 20mg/ml, 100mg/ml Tab. 5mg Tab. 2mg Inj. 25mg/ml Oral solution. 40mg/ml Tab. 40mg 8.2 Medicines Used In Mood Disorders 8.2.1 Medicines used in depressive disorders Product Name Amitriptyline Fluoxetine Citalopram Clomipramine Clomipramine Trazodone Imipramine Dosage form & Strength Tab. 25 mg Tab. 20 mg Tab. 20mg Tab. 25mg Inj. 25mg/ml Tab.100mg Tab. 10mg, 25mg 8.2.2 Medicines used in bipolar disorders Product Name Valproic acid (and salts) Carbamazepine Carbonate de lithium13 Dosage form & Strength Tab 200 mg; 300mg ;500 mg Tab 100 mg; 200 mg. Tab ou Tab, 250mg, 400mg 13Need a close monitoring due to its toxic effects; 90 X X X X X X X X X X RH PH DH HC HP Co X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X RH PH DH HC HP Co X X X X X X X X X X X X X X X X RH PH DH HC HP Co X X X X X X X X X Official Gazette nº06 of 08/02/2016 8.3 Medicines for anxiety disorders and Hypnotics Product Name Diazepam Alprazolam14 Clorazepate dipotassium Zolpidem Dosage form & Strength Tab. 5 mg. Tab. 0.5mg Caps. 5mg/10mg Tab. 10mg 8.4 Medicines used for obsessive compulsive disorders Product Name Clomipramine Clomipramine Dosage form & Strength Caps. 10 mg; 25 mg Inj. 25 mg 8.5 Medicines used in vascular disturbances X X RH PH DH HC HP Co X X X X X X X X X X RH PH DH HC HP Co X X X X X X Product Name Cinnarizine Piracetam Dosage form & Strength Tab:25mg or 75mg Tab:800mg RH X X PH DH HC HP Co X X X 9. CARDIOVASCULAR MEDICINES 9.1 Antianginal medicines Product Name Atenolol Isosorbide dinitrate Carvedilol Verapamil Dosage form & Strength Tab. 50 mg, 100 mg Sublingual tab. 5 mg; 20mg Tab. 6.25mg; 12.5mg, 25mg Tab. 40 mg 9.2 Antiarrhythmic medicines RH PH DH HC HP Co X X X X X X X X X X X ` Product Name Amiodarone Amiodarone Atenolol Digoxin Digoxin Digoxin Epinephrine (adrenaline) Propranolol Dosage form & Strength Inj. 50 mg/ml Tab. 200 mg Tab. 50 mg, 100mg Tab. 250 µg ; Oral liquid: 50 /ml. Inj. 250µg /ml Inj. 100 /ml Tab. 40mg RH X X X X X X X X PH DH HC HP X X X X X X X X X X X X X X Co 9.3 Antihypertensive medicines Product Name Spironolactone Captopril Lisinopril Atenolol Dosage form & Strength Tab. 25mg Tab. 12.5mg; 25 mg Tab. 5mg Tab. 25mg, 50 mg RH X X X X PH X X X X X X DH HC HP Co X X X X 14 Alternative of Diazepam in case of suspicion of dependence 91 Official Gazette nº06 of 08/02/2016 Carvedilol Hydrochlorothiazide Methyldopa15 Hydralazine Nifedipine Furosemide Furosemide Clonidine Amlodipine Losartan Losartan/Hydrochlorothiazide Tab. 6.25mg; 12.5mg Tab. 25 mg. Tab. 250 mg. Inj. 20mg/ml Tab. 10 mg; 20mg Inj.10mg/2ml Tab. 40mg Inj.100µg/ml Tab. 5mg; 10mg Tab. 50mg Tab. 50mg/12.5mg X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X 9.4 Medicines used in heart failure Product Name Hydrochlorothiazide Digoxin Digoxin Dopamine Spironolactone Atenolol Carvedilol Propranolol Furosemide Furosemide Captopril Lisinopril 9.5 Antithrombotic medicines and Lipid-lowering agents Dosage form & Strength Tab. 25 mg Tab.250µg Inj. 250μg/ml Inj. 40mg/ml Tab. 25mg Tab. 25 mg;50mg Tab. 6.25mg; 12.5mg Tab. 10mg or 40mg Inj.10mg/ml Tab. 20mg; 40mg Tab.12.5mg; 25 mg Tab. 5mg RH PH DH HC HP Co X X X X X X X X X X X X X X x X X X X X X X X X X X X X X X X X X X X X X X Product Name Acetylsalicylic acid Heparin sodium Enoxaparin Warfarin Clopidogrel Simvastatin 10. DIURETICS Product Name Furosemide Furosemide Hydrochlorothiazide Mannitol Dosage form & Strength Tab. 100 mg. Inj. 5000 IU/ml Inj.40mg/0.4ml Tab. 1mg; 5mg Tab. 75 mg; 300 mg Tab. 5 mg; 10 mg; 20 mg; 40 mg. RH PH DH HC HP Co X X X X X x X X X X X X X X X X X X Dosage form & Strength Inj.10 mg/ml Tab. 20mg; 40mg Tab. 25 mg. Inj. solution. 10%, 20%. RH PH DH HC HP Co X X X X X X X X X X X X X X X 15 Methyldopa is listed for use in the management of pregnancy‐induced hypertension if necessary. Its use in the treatment of essential hypertension is not recommended in view of the availability of more evidence of efficacy and safety of other medicines. 92 Official Gazette nº06 of 08/02/2016 Spironolactone Tab. 25 mg. X X X 11. MUSCLE RELAXANTS (PERIPHERALLY-ACTING) AND CHOLINESTERASE INHIBITORS Product Name Neostigmine Neostigmine Suxamethonium Suxamethonium Vecuronium bromide Cisatracurium Dosage form & Strength Tab. 15 mg Inj. 500 µg /ml; 2.5µg /ml; 2,5µg/ml Inj. 50 mg/ml Powder for inj. 50mg/ml Powder for inj. 10 mg Inj. 2mg/ml RH PH DH HC HP Co X X X X X X X X X X X X X X X X 12. ANTI-INFECTIVE MEDICINES 12.1 Anthelminthics 12.1.1 Intestinal anthelminthics Product Name Mebendazole Niclosamide Albendazole Dosage form & Strength Tab.100 mg; 500 mg Tab. 500 mg Tab. 400mg RH HP DH HC HP Co X X X X X X X X X X X X X 12.1.2 Antifilarials Product Name Ivermectin Diethylcarbamazine Dosage form & Strength Tab. 6 mg Tab. 100 mg RH PH DH HC HP Co X X X X X X X X 12.1.3 Antischistosomal medicines Product Name Praziquantel 12.2Antibacterials 12.2.1 Beta-lactam medicines Product Name Amoxicillin Amoxicillin Clavulanic acid Amoxicillin + Clavulanic acid Ampicillin Benzathine benzyl penicillin Benzyl penicillin Procaine benzyl penicillin Cloxacillin Cloxacillin Phenoxymethyl penicillin Cefotaxime Dosage form & Strength Tab 600 mg RH PH DH HC HP Co X X X X Dosage form & Strength Caps: 250 mg, 500mg Tab. 500mg/125mg Powder for inj. 1.2g. Powder for inj. 500mg, 1g Powder for inj. 2,4 MIU, Powder for inj. 5 MIU, Powder for inj. 4 MIU, Caps. 250 mg Powder for inj. 500 mg, Tab. 250 mg Powder for inj.1g 93 RH X X X X X X X X X X X X X PH DH HC HP Co X X X X X X X X X X X X X X X X X X X X X X X X X X X X Official Gazette nº06 of 08/02/2016 Ceftriaxone Ceftazidime Cefazolin16 Cefixime Imipenem + Cilastatin17 12.2.2 Other Antibacterials Powder for inj. 250mg, 1g Powder for inj. 1g Powder for inj. , 1g Capsules, 400 mg Powder for inj. 250mg + 500mg X X X X X X X X X X X X X Co Dosage form & Strength Tab. 500 mg; Oily susp. Inj. 0,5g/2 ml Tab. 250mg, 500 mg Tab. 100 mg Tab. 250 mg Inj. 40 mg /ml Tab. 250mg Inj. 500 mg/100ml Tab. 100 mg Powder for inj. 2g Product Name Azithromycine Chloramphenicol Ciprofloxacine Doxycycline Erythromycin Gentamycin Metronidazole Metronidazole Nitrofurantoin Spectinomycin Sulfamethoxazole/Trimethoprim Tab. 400 mg/80 mg Sulfamethoxazole/Trimethoprim Tab. 800 mg/160 mg Sulfamethoxazole/Trimethoprim Inj. 80 mg/16 mg Ciprofloxacine Clindamycin Clindamycin Vancomycin Claritromycine Inj. 200mg Tab.150mg Inj. 600mg Powder for inj. 500 mg Tab. 250 mg RH X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X PH DH HC HP X X X X X X X X X X X X X X X X X X X X X X X X 12.2.3 Antileprosy medicines Product Name Clofazimine Dapsone Rifampicin Dosage form & Strength Tab. 50 mg, 100 mg Tab. 50 mg, 100 mg Tab. 150 mg, 300 mg RH PH DH HC HP Co X X X X X X X X X X X X 12.2.4 Antituberculosis medicines Product Name Ethambutol Isoniazid Pyrazinamide Rifampicin Rifabutin18 Rifampicin/Isoniazid Rifampicin/Isoniazid Rifampicin/Isoniazid Dosage form & Strength Tab. 100, 400 mg Tab. 100mg, 300 mg Tab. 400 mg Tab. 150 mg, 300 mg Tab. 150mg Tab. 150mg/75mg Tab. 60mg/60mg Tab. 60mg/30mg RH PH DH HC HP Co X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X 16For surgical prophylaxis onlyX 17 Only for the treatment of life‐threatening infection due to suspected or proven multi drug resistant infection For use only in patients with HIV receiving protease inhibitors.X 18 94 Official Gazette nº06 of 08/02/2016 Rifampicin/Isoniazid/ Pyrazinamide/Ethambutol Rifampicin/Isoniazid/Ethambutol Rifampicin/Isoniazid/Pyrazinamide Streptomycin Kanamycin Ofloxacine Prothionamide Cycloserine p-Amino salicylic acid (PASER) p-Amino salicylic acid (PASER) Levofloxaxin Capreomycin Moxifloxacine Clarithromycin Clofazimine 12.3 Antifungal medicines Tab. 150mg75mg/400mg 275mg Tab. 150mg/75mg/275mg Tab. 60mg/30mg/150 Powder for inj. 1 g Inj. powder 1g Tab. 200 mg Tab. 250 mg Tab. 250 mg Tab. 500 mg Granules 4g in sachet Tab. 200 mg Powder for inj. 1g Tab. 400mg Tab. 500mg Tab. 400mg X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X Product Name Fluconazole Nystatin Amphotericin B Miconazole Nitrate Dosage form & Strength Tab. 200 mg Tab. 500 000UI Powder for inj. 50 mg Oral gel 40 g RH PH DH HC X X X X X X X X X X X X X X X HP Co 12.4 Antiviral Medicines 12.4.1Antiherpes Medicines Product Name Acyclovir Acyclovir Acyclovir 12.4.2 Antiretrovirals Dosage form & Strength Tab. 200 mg 400mg, 800mg Powder for inj. 250 mg Ointment RH PH DH HC HP Co X X X X X X X X X 12.4.2.1. Reverse-transcriptase inhibitors Product Name Tenofovir Dosage form & Strength Tab. 300mg 12.4.2.2 Non-nucleoside reverse transcriptase inhibitors RH PH DH HC HP Co X X X X Product Name Efavirenz Nevirapine Etravirine Dosage form & Strength Tab. 600mg Tab. 200 mg Tab.100mg RH PH DH HC HP Co X X X X X X X X X X X X 12.4.2.3 Protease inhibitors Product Name Atazanavir-Ritonavir Darunavir Dosage form & Strength Tab. 300/100mg Tab. 300mg RH PH DH HC HP Co X X X X X X X X 95 Official Gazette nº06 of 08/02/2016 Lopinavir/Ritonavir Ritonavir Tab. 200/50mg Tab.100mg X X X X X X X X 12.4.2.4 Integrase inhibitors Product Name Raltegravir Dosage form & Strength Tab. 400mg RH PH DH HC HP Co X X X X 12.4.2.5 Fixed-Dose combinations Product Name Abacavir/Lamivudine Zidovudine/Lamivudine/Nevirapine Zidovudine/Lamivudine Tenofovir/Lamivudine/Efavirenz Tenofovir/Lamivudine Dosage form & Strength Tab. 600/300mg Tab. 300/150/200mg Tab. 300/150mg Tab. 300/300/600mg Tab. 300/300mg RH PH DH HC HP Co X X X X X X X X X X X X X X X X X X X X 12.4.2.6 Booster Product Name Ritonavir Dosage form & Strength Tab.100mg RH PH DH HC HP Co X X X X 12.4.3. Anti-Hepatitis Medicines 12.4.3.1. Medicines for Hepatitis B Product Name Dosage form & Strength Tenofovir Entecavir Entecavir Lamivudine Tab. 300mg Oral liquid 0.05mg/ml Tab. 0.5mg; 1mg Tab.300mg 12.4.3.2. Medicines for Hepatitis C X X RH PH DH HC HP Co X X X X X X X X X X X X X X Product Name Adefovir Pegynterferon alfa-2a Simeprevir Sofosbuvir Ledipasvir Ribavirin Daclatasvir Ledipasvir/Sofosbuvir Dosage form & Strength Tab.10mg Inj. 180 µg Tab. 150mg Tab. 400mg Tab. 90mg Tab. 400mg, 600mg Tab. 60 mg Tab. 90 mg/400 mg. RH X X X X X X X X PH DH HC HP Co X X X X X X X X 96 Official Gazette nº06 of 08/02/2016 12.5 Antiprotozoal Medicines 12.5.1 Antiamoebic and antigiardiasis medicines Product Name Metronidazole Metronidazole Tinidazole Dosage form & Strength Tab. 250-500 mg; Inj.500 mg/ml Tab. 500mg 12.5.2 Antimalarial medicines 12.5.2.1 For curative treatment RH PH DH HC HP Co X X X X X X X X X X X X Product Name Dosage form & Strength RH PH DH HC HP Co Artemether /Lumefanthrine Artesunate Quinine Quinine Primaquin Tab. 20 mg/120mg Inj. 30mg; 60mg, 120mg Tab. 300 mg Inj. 300 mg/ml Tab. 7.5 mg; 15 mg X X X X X X X X X X X X X X X X X X X X 12.5.3.2 For malaria prevention Product Name Dosage form & Strength RH PH DH HC HP Co ITN has long-acting Polyester Insecticides Larvicides X X X X X X X X 12.5.4. Antipneumocystosis and Antitoxoplasmosis Medicines Product Name Sulphamethoxazole/Trimetoprim Dosage form & Strength Inj 80mg/16mg/ml RH PH DH HC HP Co X X X 13. DERMATOLOGICAL MEDICINES (TOPICAL) 13. 1. Anti-infective medicines 13.1.1. Antiseptics and disinfectants Product Name Povidone iodine Silver sulfadiazine Ethanol Eosin Potassium permanganate Chlorhexidine Hydrogen peroxide Chloramine Tri-enzyme liquid detergent Chlorhexidine + Cetrimide Dosage form & Strength Solution, 10% Cream, 1%, Denatured Solution. 70 % Powder Tab. 50mg, 100 mg Solution, 5% Sol 3% Tab. 500 mg 200 doses/25ml 1,5% + 15% RH X X X X X X X X X X PH X X X X X X X X X X 97 DH HC HP Co X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X Official Gazette nº06 of 08/02/2016 13.1.2 Antibacterials and Antiparasitics Product Name Bacitracin + Neomycin Tetracycline Fucidic acid Benzyl benzoate Permethrin Metronidazole Dosage form & Strength Ointment, 5 mg/500 IU/g Ointment Cream/ointment 2%, Lotion 25% Cream 5%;lotion 1% Vaginal tab. 500mg RH X X X X X X PH X X X X X X X X X DH HC HP Co X X X X X X X X 13.1.3. Antifungal medicines Product Name Ketoconazole Miconazole Nitrate Clotrimazole Clotrimazole Nystatin Dosage form & Strength Cream 2% Cream 2% Cream 1%; 10%. Vaginal tab. 100 mg; 500 mg. Vaginal Tab. 100000 IU RH X X X X X 13.2 Anti-inflammatory and antipruritic medicines 13.2.1 Steroid Anti-inflammatory medicines Product Name Betamethasone Valerate Betamethasone Valerate Hydrocortisone Calamine Miconazole/Hydrocortisone Bethamethasone/Salicylic acid Hydrocortisone/Oxytetracycline Betamethasone /Clotrimazole/Gentamycin Dosage form & Strength Cream/ Ointment 0.1% Lotion 0.1% Cream/ointment 1% Lotion Cream Ointment Ointment Ointment 13.2.2 Analgesics: Non-steroidal anti inflammatory PH DH HC HP Co X X X X X X X X X X X X X X X X X X X RH X X X X X X X X PH X X X X X X X X DH HC HP Co X X X X X X X X X X X X X X X X Product Name Diclofenac 13.3 Antivirals Product Name Acyclovir Dosage form & Strength Ointment 50 g RH PH DH HC HP Co X X X X X Dosage form & Strength Cream/ointment 5% RH PH DH HC HP Co X X X X 13.4 Medicines against acnea and rosacea 13.4.1 Medicines against acnea Product Name Benzoyl Peroxide Dosage form & Strength Gel/ Lotion 5 %, 10 % RH PH DH HC HP Co X X X X 13.4.2 Medicines against rosacea Product Name Metronidazole Dosage form & Strength Cream 0.75%, RH PH DH HC HP Co X X X X 98 Official Gazette nº06 of 08/02/2016 13.5. Medicines affecting skin differentiation and proliferation Product Name Salicylic acid Urea Salicylic acid Podophyllin Meladinine Fluorouracil Ditranol Dosage form & Strength Lotion, 5 % Ointment 5% - 30% Ointment 5% -30% Solution, 10-25 % Solution 0.1% 0.75% Cream 5% Ointment 0.05 % ; 1% RH PH DH HC HP Co X X X X X X X X X X X X X X X X X X X X X X X X X X X X 13.6. Protective or cicatrizing preparations Product Name Vaseline Zinc Oxide Dosage form & Strength Ointment Paste RH PH DH HC HP Co X X X X X X X X 99 Official Gazette nº06 of 08/02/2016 14. DERMATOLOGICAL MEDICINES (SYSTEMIC) Dosage form & Strength Tab. 10 mg Tab. 250mg, 500mg Product Name Meladinine Griseofulvin RH PH DH HC HP Co X X X X X X X X PREPARATIONS USED IN OPHTHALMOLOGY 15. 15.1 Anti-infective Agents Product Name Acyclovir Chloramphenicol Gentamicin Idoxuridine Fluoromethalone Idoxuridine Silver nitrate Tetracycline Norfloxacin Gentamycin Dosage form & Strength ophthalmic ointment 3 % Eye drops 0,5% Eye drops, 0,3 %, 1,5% Eye drops, 0,1 % ; Eye drops 0.1% Ointment ophthalmic, 0,2 % Sol, ophthalmic, 1 % Ointment ophthalmic, 1 % Eye drops 0.3% Ointment 15.2 Anti-inflammatory agents RH PH DH HC HP Co X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X Product Name Dexamethasone Hydrocortisone Prednisolone Dosage form & Strength Eye drops 1% Eye drops 1% Eye Drops 1% RH PH DH HC HP Co X X X X X X X X X 15.3. Anti-inflammatory and anti-infective combinations Product Name Dexamethasone/Gentamycin Dexamethasone/Neomycin Dosage form & Strength Eye drops 0.1% + 0.5% Eye drops RH PH DH HC HP Co X X X X X X 15.4 Local Anesthetics Product Name Tetracaine Proparacaine Oxybuprocaine Dosage form & Strength Eye drops, 0,5 % Eye Drops 0.5% Eye drops 0.4% RH PH DH HC HP Co X X X X X X X X X 15.5 Miotics and antiglaucoma medicines Product Name Acetazolamide Pilocarpine Timolol solution Latanoprost Dosage form & Strength Tab. 250 mg Eye drops. 2 %; 4 % Eye drops. 0,25 %; 0,5 % Eye drops 50μg/g RH PH DH HC HP Co X X X X X X X X X X X 100 Official Gazette nº06 of 08/02/2016 Dosage form & Strength Eye drops, 0,1 %, 0,5 %, 1 % Eye drops, 2 % Eye drops 0.5%, 1% Eye Drops 1% RH PH DH HC HP Co X X X X X X X X X X X X 15.6 Mydriatics Product Name Atropine solution Epinephrine/ Adrenaline Tropicamide Cyclopentolate 15.7 Antiallergic agents Product Name Sodium cromoglicate Methylcellulose Dosage form & Strength Eye drops, 0,1 %, 0,5 %, 1 % Eye drops, 1% RH PH DH HC HP Co X X X X X X X 16. MEDICINES USED IN GASTROENTEROLOGY 16.1 Antacid and other antiulcer medicines Product Name Aluminum hydroxid Aluminum hydroxide Magnesium hydroxide Ranitidine Cimetidine Cimetidine Omeprazole 16.2Antiemetic medicines Dosage form & Strength Tab. 500 mg Oral liquid, 320 mg/5 ml Oral liquid, 550 mg/10 ml Tab. 150mg, 300 mg Inj. 200g/2ml Tab. 200mg Caps 20 mg RH PH DH HC HP Co X X X X X X X X X X X X X X X X X X X X X X X X X X X X X Product Name Metoclopramide Promethazine Promethazine Metoclopramide Dosage form & Strength Inj., 5 mg Tab. 10 mg Inj. 25 mg 2 ml Tab. 10mg 16.3 Antihaemorrhoidal medicines RH PH DH HC HP Co X X X X X X X X X X X X X X X X X X local Product Name Anti-haemorrhoid: /astringent/anti-inflammatory Anti-haemorrhoid: /astringent/anti-inflammatory Daflon: diosmine 450mg/Hesperidin 50mg local anesthetic anesthetic Dosage form & Strength Suppository RH PH DH HC HP Co X X X X Ointment X X X X Tab 450mg + 50mg X X X X 16.4 Antispasmodic medicines Product Name Atropine Hyocine butylbromide Hyocine butylbromide Papaverine Dosage form & Strength Inj. 1mg/ml Tab. 10 mg Inj. 20 mg/1ml Inj. 20mg/ml RH PH DH HC HP Co X X X X X X X X X X X X X X X 101 Official Gazette nº06 of 08/02/2016 Papaverine Tab. 40mg X X X X 16.5 Laxative medicines Product Name Bisacodyl Lactulose Dosage form & Strength Tab. 5mg Syrup 3,33g/5ml RH PH DH HC HP Co X X X X X X X X X X 16.6 Medicines used in Diarrhoea 16.6.1 Oral Rehydration Product Name Oral rehydration salts Dosage form & Strength 2.5g/l sachets for dilution. RH PH DH HC HP Co X X X X X X 16.6.2 Medicines for diarrhoea Product Name Codeine Zinc Sulphate Loperamide Dosage form & Strength Tab 30 mg Tab 10 mg, 20mg Caps 2mg RH PH DH HC HP Co X X X X X X X X X X X X X X 17. MEDICINES ACTING ON THE RESPIRATORY TRACT Product Name Beclomethasone Epinephrine Salbutamol Salbutamol Salbutamol Aminophylline Aminophylline Ipratropium Dosage form & Strength Inhalation solution, 50 µg; 250 µg Inj. 1 mg/ml Inhalation solution 100µg/dose ; Inj.50 µg /ml; Nebuliser solution, 5 mg/ml Tab 100mg Inj. 25 mg/ml amp. 10 ml. 20 µg /metered dose 18. OXYTOCICS AND ANTIOXYTOCICS 18.1 Oxytocics X RH PH DH HC HP Co X X X X X X X X X X X X X X X X X X X X X X X X X X X Product Name Oxytocin Ergometrine Misoprostol Dosage form & Strength Inj. 10 IU/ml Inj. 200μg/ml Tab. 200 μg/ml RH PH DH HC HP Co X X X X X X X X X X X X 18.2 Anti-oxytocics (Tocolytics) Product Name Salbutamol Salbutamol Nifedipine 18. 3. Prostaglandins Dosage form & Strength Tab. 4 mg ; Inj, 50µg /ml Tab. 10mg RH PH DH HC HP Co X X X X X X X X X X Product Name Misoprostol Dosage form & Strength Tab. 200μg RH PH DH HC HP Co X X X X X 102 Official Gazette nº06 of 08/02/2016 19. ANTINEOPLASTIC, IMMUNOSUPPRESSIVE AND MEDICINES USED IN PALLIATIVE CARE 19.1 Anti-Cancer agents Product Name Folinic acid Bleomycin Cyclophosphamide Cyclophosphamide Doxorubicine Methotrexate Methotrexate Vincristine Mercaptopurine Hydroxycarbamide Tamoxifen Citrate Anastrozole Letrozole Cisplatin Imatinib mesylate Melphalan Trastuzumab Zoledronate Oxaliplatin Carboplatin Paclitaxel Ifosfomide Fluorouracil (5-fu) Fluorouracil (5-fu) Irinotecan Docetaxel Rituximab Cyclosporine Mycophenolate Dosage form & Strength Tab. 15 mg Inj. 15 mg Tab. 50 mg ; Inj. 500 mg Powder for inj.10mg; 50 mg Tab. 2,5 mg Inj. 50 mg Inj. 1mg/ml Tab. 50mg Caps. 200mg; 1g Tab. 20mg Tab. 1mg Tab. 2.5mg Inj. 1mg/ml Tab. 100mg Tab. 2mg Powder for inj. 150mg Inj. 5mg/100ml Inj. 5 mg/ml Inj. 10mg/ml Powder for inj. 6 mg/ ml. Powder for inj. 1000mg Inj. 50mg/ml Cream 0.5%, 1% and 5 % Inj. 20mg/ml Inj. 20mg/ml Powder for inj.100mg Tab. 25mg Tab 500mg RH X X X X X X X X X X X X X X X X X X X X X X X X X X X X X PH DH HC HP Co X X X X X X X X X X X X X X X X X X X X X X X X X X X X X 19.2. Medicines for Pain and Palliative Care 19.2.1 Non-opioids and non-steroidal Anti-Inflammatory medicines (NSAIMs) Product Name Acetylsalicylic acid Ibuprofen Paracetamol19 Dosage form & Strength Tab. 500 mg. Tab. 400 mg; Tab. 500 mg. RH PH DH HC HP Co X X X X X X X X X X X X X X X X 19Not recommended for anti‐inflammatory use due to lack of proven benefit to that effect 103 Official Gazette nº06 of 08/02/2016 19.2.2 Opioid analgesics Product Name Codeine Morphine Morphine Morphine Dosage form & Strength Tab. 30 mg Inj. 10 mg /ml Oral liquid. 10 mg/5 ml. Tab. 10 mg RH PH DH HC HP Co X X X X X X X X X X X X X 19.2.3 Medicines for other common symptoms in palliative care Product Name Amitriptyline Cyclizine Cyclizine Diazepam Diazepam Ondansetron Ondansetron Fluoxetine Hyoscine butylbromide Lactulose Loperamide Metoclopramide Metoclopramide Metoclopramide Dosage form & Strength Tab. 25 mg Inj. 50 mg/ml. Tab. 50 mg. Inj. 5 mg/ml. Tab. 5 mg. Inj. 2mg/ 2ml Tab. 8 mg. Tab. 20 mg Inj. 20 mg/ml. Oral liquid. 3,7 g/5 ml. Tab. 2 mg. Inj. 5 mg ml Oral liquid. 5 mg/5 ml. Tab. 10 mg 20. IMMUNODEPPRESSANTS X X X X RH PH DH HC HP Co X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X x X X X X X X X Product Name Hydrocortisone Predinisolone Dexamethazone Interferons α-2a Interferons α-2b Dosage form & Strength Inj. 100mg/ml Tab. 5mg Inj. 4mg/ml Inj. 10000000IU/1,2ml Inj. 10000000IU/1,2ml RH PH DH HC HP Co X X X X X X X X X X X X X 21. ANTIPARKINSONISM MEDICINES Product Name Biperiden Biperiden Levodopa/Carbidopa Dosage form & Strength Tab. 2 mg Inj. 5 mg/ml Tab. 100mg/10 mg; 250 mg/25 mg RH PH DH HC HP Co X X X X X X X X 22. MEDICINES AFFECTING THE BLOOD 22.1 Antianaemia medicines Product Name Folic Acid (Vit B9) Hydroxycobalamin (Vit B12) Fer salts Fer salts/Folic acid Dosage form & Strength Tab. 1 mg; 5mg Inj. 1 mg/ml Tab. 60 mg Tab. 60 mg/400 µg RH PH DH HC HP Co X X X X X X X X X X X X X X X X X X X 104 Official Gazette nº06 of 08/02/2016 22.2 Medicines affecting blood Coagulation Product Name Heparin Enoxaparin Warfarin Etamsylate Etamsylate Phytomenadione (Vit K) Protamine Dosage form & Strength Inj. 5000IU/ml Inj. 40mg/0.4ml Tab. 1mg, 5mg Tab. 250mg Inj.250 mg/2ml Inj. 10 mg/ml Inj. 10 mg/ml RH PH DH HC HP Co X X X X X X X X X X X X X X X X X X X X X X X 23. DERIVATIVES OF BLOOD AND PLASMA SUBSTITUTES 23.1 Plasma substitutes Product Name Gelatine (haemacel) Dextran 70 Dosage form & Strength Inj. 3,5% Injectable solution: 6% RH PH DH HC HP Co X X X X X 23.2 Blood and Blood components Product Name Red Blood Cells Platelets Fresh Frozen Plasma Human immunoglobulin (Anti D) Dosage form & Strength Unit, 250ml-300ml Unit, 50-70ml, 250-300ml Unit 200-250ml Vial of 300 micro-grams RH PH DH HC HP Co X X X X X X X X X X X X 24. DIAGNOSTIC PRODUCTS 24.1 In ophthalmology Product Name Fluorescein Tropicamid Dosage form & Strength Eye drops, 1 % Eye drops , 0,5 % RH PH DH HC HP Co X X X X X X 24.2 Diagnostic Products based on Immunological reactions Product Name Tuberculin, purified protein derivative (PPD) 24.3 Radiocontrast media Dosage form & Strength Injectable RH X PH X DH HC HP Co X X Product Name Amidotrizoate Iohexol Propyliodone Barium Sulfate Iotroxate meglumine Iopamidol Dosage form & Strength Inj. 140 to 420 mg of iodine/ml 140-350 mg of iodine /ml Oil suspension, 500-600 mg/ml Aqueous suspension Solution, 5-8 g Iodine 100-250 ml Inj. 300 mg/ml RH PH DH HC HP Co X X X X X X X X X X X X X 105 Official Gazette nº06 of 08/02/2016 25. HORMONES, OTHER ENDOCRINE MEDICINES AND CONTRACEPTIVES 25.1 Androgens Product Name Testosterone Dosage form & Strength Inj. 200 mg/ml RH X PH X DH HC HP Co X 25.2 Contraceptives 25.2.1 Hormonal contraceptives Product Name Levonorgestrel Medroxyprogesterone acetate Levonorgestrel Levonorgestrel Etonogestrel Norgestrel/Ethinyloestradiol Norethisterone enantate Ethinylestradiol + Levonorgestrel Ethinylestradiol + Norethisterone Ethinylestradiol + Gestodene Medroxyprogesterone acetate Mifepristone Dosage form & Strength Tab. 30mcg Inj. 150 mg Implant. 75mg Tab. 1.5mg Implant 68mg Tab. 300 µg, + 36mg Oily sol. 200 mg/ml Tab. 30 µg + 150 µg; Tab. 35 µg + 1,0 mg Tab. 30 µg, + 750 µg Inj. 150 mg/ml Tab. 200 mg RH X X X X X X X X X X X X X PH DH HC HP Co X X X X X X X X X X X X X X X X X X X X X X X X X X X X X XX X X X X X X X 25.3.2 Intrauterine devices Product Name Copper containing Device Levonorgestrel‐releasing intrauterine system Dosage form & Strength Intrauterine system with reservoir containing 52 mg of levonorestrel 25.3.3 Mechanical contraceptives RH PH DH HC HP X X X X X X X X Co Product Name Condoms Dosage form & Strength RH HP DH HC HP Co X X X X X X 25.4 Oestrogenic medicines Product Name Ethinylestradiol Oestrogen/Progesterone Oestrogen Progesterone Progesterone 25.5 Ovulation inducers Dosage form & Strength Tab.10 µg, 50 µg Tab. 0,625mg + 2,5mg Gel. 0.6mg/g, 80g Tab. 100 mg Pessaries 200mg RH PH DH HC X X X X X X X X X X X X X X X Co Product Name Clomifene Bromocriptine Dosage form & Strength Tab. 50mg Tab. 2,5 mg RH PH DH HC HP Co X X X X X 106 Official Gazette nº06 of 08/02/2016 25.6 Progestogens Product Name Norethisterone Medroxyprogesterone Dosage form & Strength Tab. 5 mg Tab. 5 mg RH PH DH HC HP Co X X X X X X X X 25.7. Insulins and other medicines used for diabetes Product Name Glibenclamide Gliclazide Long acting insulins Intermediate-acting insulins Rapid-acting insulins Metformin Dosage form & Strength Tab. 5 mg Tab. 30mg Inj.100 IU/ml Inj. 100 IU/ml Inj.100 IU/ml Tab. 500 mg, 850mg RH PH DH HC HP Co X X X X X X X X X X X X X X X X X X X X X X X 25.8 Thyroid hormone and antithyroid medicines Product Name Potassium iodide Levothyroxine Propylthiouracil Carbimazole Dosage form & Strength Tab. 60 mg Tab. 50 µg 100 µg Tab. 50mg Tab. 5mg RH PH DH HC HP Co X X X X X X X X X X X X 26. 26.1 IMMUNOLOGICAL PREPARATIONS Sera and immunoglobulins Product Name Diphtheria antitoxin Rabies immunoglobulin Tetanus human immunoglobulin Human anti-D immunoglobulin Snake Antivenoms Dosage form & Strength Inj. 10.000 IU, 20.000 IU Inj. 150 IU/ml Inj. 500IU Inj. 300 Inj. solution RH PH DH HC HP Co X X X X X X X X X X X X X X X X X X X X Dosage form & Strength 26.2 Vaccines 26.2.1 General Use Product Name Measles Vaccine BCG Vaccine Polio Vaccine DTP-HepB + Hib Tetanus (T ₁& T ₂) Yellow Fever20 Hepatitis B vaccine 20This vaccine is only administered at central level (RBC/VPDP) 107 RH PH DH HC HP Co X X X X X X X X X X X X X X X X X X X X X X X X X Official Gazette nº06 of 08/02/2016 26.2.2. Reserved for certain groups of subjects and materials Dosage form & Strength Product Name Meningococcal vaccine Rabies Vaccine Inactivated Oral Polio Vaccine (OPV) Pneumococcal Vaccine Antitetanic Vaccine Hepatitis B vaccine HPV vaccine RH PH DH HC HP Co X X X X X X X X X X X X X X X X X X X X X X X X X X X X 27. SOLUTIONS CORRECTING WATER, ELECTROLYTE AND ACID-BASE DISTURBANCES 27.1 Oral way and nutrients Product Name Oral rehydration salts Resomal Corn Soya Beans (CSB) Ready-To-Use-Therapeutic Food Therapeutic milk (F75, F100) Dosage form & Strength Powder. 20,5g/l Sachet powder Sachet powder Powder Sachet powder RH PH DH HC HP Co X X X X X X X X X X X X X X X X X X X X X X 27.2 Parenteral route Product Name Calcium gluconate Potassium Chloride Sodium Chloride Glucose Glucose Sodium Chloride Sodium bicarbonate Sodium lactate, solution Calcium chloride Sodium chloride Mannitol Gelatine (Haemecel) Parenteral nutrition Injectable micronutrients Enteral nutrition 27.3 Miscellaneous Dosage form & Strength Inj.10%, Solution 11,2 % Solution inj. Isotonic 0,9 % Solution inj. 5 %, 10%, 50% Solution inj. 4 % Inj. solution. isotonic 1,4 % solution inj. Solution inj. isotonic 0,9 % Inj. Solution 3 % Injectable Solution 20% Inj. 3.5% bottle 500ml Inj. Inj. Inj. Product Name Water for injections Dosage form & Strength Inj. Bottle of 2 ml, 5 ml, 10 ml 27.4 Peritoneal Dialysis Solution X X X X X X RH PH DH HC HP Co X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X RH PH DH HC HP Co X X X X Product Name Solution for peritoneal dialysis Dosage form & Strength Parenteral solution RH PH DH HC HP Co X X X 108 Official Gazette nº06 of 08/02/2016 28. VITAMINS AND MINERALS Product Name Ascorbic acid Nicotinamide Pyridoxine Retinol Thiamine Vitamin B complex Vitamin B complex Multivitamin Zinc Calcium + Vitamin D Calcium gluconate Cyano Cobalamine (Vitamin B12) Niacin (Vitamin B3) Potassium Chloride Iron and Folic Acid Potassium Phosphate Dosage form & Strength Tab. 50 mg Tab. 50 mg Tab. 25 mg Caps. 100,000; 200 000 IU Tab. 50 mg Inj. Tab. Tab. Tab. 10-20 mg Tab. 1000/880 mg Tab. 500mg Tab. Tab. Inj. 1g/10ml Tab Inj. 6g/10ml X X X X X X X X X RH PH DH HC HP Co X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X 29. ESSENTIAL MEDICAL SUPPLIES AND LABORATORY REAGENTS 29.1. Medical Consumables 29.1.1. Ligatures And Suture Materials And Surgicals Eye suture nylon Item description No 1 Bone wax 2 Catgut chromic, sutures 3 Colostomy bag 4 5 Nylon, sutures 6 7 8 9 10 Umbilical cord 11 Monofilamment non resorbable sutures 12 Resorbable sutures Staple suture 13 Polyglactin acid, sutures Silk sutures Staple suture Surgical absorbable haemostat RH PH X X X X X X X X X X X X X X X X X X X X X X X X X X DH HC HP Co X X X X X X X X X X X X X X X X X X X X X X X 29.1.2. Gloves Item description Examination gloves, latex, non-sterile No 1 2 Gynaecological gloves 3 Heavy duty gloves, household 4 Orthopaedics gloves RH PH X X X X X X X X 109 X DH HC HP Co X X X X X X X X X Official Gazette nº06 of 08/02/2016 5 Surgical gloves, sterile X X X X 29.1.3. Bandages And Dressings Item description Elastic bandage No 1 Adhesive tape 2 Bandage cotton 3 Bandage crepe, stretched 4 Bandage Plaster of paris (P.O.P) 5 6 Bandage triangular cotton 7 Absorbent Gauze 8 Gauze bandage 9 Gauze pads, sterile 10 Gauze swabs, Sterile 11 Abdominal gauze swabs sterile 12 Gauze, hydrophilic x-ray detectable 13 Paraffin Gauze 14 Plaster, adhesive elastic 15 Plaster, adhesive, zinc oxide 16 Wool, cotton RH X X X X X X X X X X X X X X X X X X X X PH DH HC HP Co X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X 29.1.4. Radiology And Other Imaging Supplies Item description ECG Gel EEG Gel, Lead apron 100 x 60cm H V No 1 2 3 4 Ultrasound gel 5 Ultrasound papers 6 Dosimeter machine 7 X-ray developer and replenisher 8 X-ray films 9 X-ray fixers RH PH X X X X X X X X X X X X X X X X X X X DH HC HP Co X X X X X X X X X 29.1.5. Administration Sets, Cannulas, Needles And Syringes Item description No 1 Air ring set, rubber with pump 2 Airway guedel 3 Blood collecting bags 4 Blood giving sets 5 Blood transfer bag 6 Cannula IV with injection port and stopper 7 Colostomy and ileostomy bag Immunization needles 8 Immunization syringes + needles 9 RH PH X X X X X X X X X X X X X X X X X X DH HC HP Co X X X X X X X X X X X 110 Official Gazette nº06 of 08/02/2016 10 Nasal oxygen cannulas 11 Dental Needle cartridge 12 Dental Needles 13 Needle for insulin device 14 Hypodermic, Needle, 15 Needles for lumbar puncture 16 17 Set of blood transfusion Infusion sets Syringe disposable, hypodermic, luer Insulin 18 20 Syringe with needle 21 Syringe, disposable Syringe, disposable, hypodermic with needle 22 23 Urine collecting bag 24 Alcohol hands crub 25 Central venous catheters 26 Safely boxes 27 Bottle for suction chest 28 Reconstitution Syringes 29.1.6. Catheters and Tubes Item description No 1 Catheter stopper for all sizes 2 Condom catheters Suction catheters 3 Endotracheal tubes 4 Feeding tubes 5 6 Gastroduodenal tubes 7 Nasogastric tube 8 Rectal tube 9 10 Tracheostomy tube 11 Urethral catheters Thoracic drainage tubes 29.1.7. Protectives Item description No 1 Apron plastified linen heavy duty 2 Apron protective, disposable 3 Bin linens different colors 4 Boots for theatre 5 Material for theatre gown 111 X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X RH PH X X X X X X X X X X X X X X X X X X X X X X RH PH X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X DH HC HP Co X X X X X X X X X X DH HC HP Co X X X X X Official Gazette nº06 of 08/02/2016 29.1.8. Ward And Theatre Supplies And Accesssories Item description Eye shield Single No 1 2 Oxygen mask with chamber nebulizer 3 Oxygen mask with connection tubes 4 Oxygen regulator, cylinder mounted 5 Resuscitator bags 6 Safe delivery (maternity) kit Standard RH PH DH HC HP Co X X X X X X X X X X X X X X X X X X X Safety box for syringes and needle disposal Safety glasses Safety pin assorted size 7 8 9 10 Shaver Single blade 11 Stopcocks 12 Circumcision devices and accessories 13 Cesarian section kits 14 Surgical brush (scrubbing) 15 Surgical mop 29.1.9. Blades And Blade Handles X X X X X X X X X X X X X X X X X X X X X X X X X X X X X Item description No 1 Blades scalpel 2 Scalpel handle for surgical blades RH PH DH HC HP Co X X X X X X X 29.1.10. Haemodialysis &Peritoneal Dialysis Item description No 1 Bicarbonate powder 2 Heamodialysis catheters 3 Dialysers, filters 4 Adapters and connectors Tenkhoff catheters 5 6 Y-line 7 Diaslysis collecting bag 29.1.11. Orthopaedic Supplies Item description No 1 Angled blade plate 2 AO femur nails 3 AO tibia nails 4 Austin Moore prosthesis 43mm diameter 5 Bipolar prosthesis 43mm diameter 6 Cancellous screw 7 Partially and fully threaded 112 Co RH PH DH HC HP X X X X X X X X X X X X X X X X X X X X X RH PH DH HC HP Co X X X X X X X X X X X X X X Official Gazette nº06 of 08/02/2016 8 Cancellous screws 9 Cortical compression screw 10 Diathermy cables and tips 11 Drill bits 12 Dynamic compression plates 13 Diameters 14 Dynamic compression, plates 15 Dynamic hip screw 16 External fixators Rods, single and double clamps and connecting rods 17 Ilizarov bars 18 Ilizarov bolts 19 20 Central hole Ilizarov wires 21 22 Kuntcher nails 23 K-wires 24 L plates 25 One-third tubular plates 26 Reconstruction plates 27 Rush rods 28 Schanz pins 29 Semi-tubular plates 30 Small external fixators 31 T plates 29.1.12. Dental and Ophtalmic supplies Item description No 1 Acrylic teeth, lower anterior Set 2 Dental needles 3 Dental plaster bag 4 Dental probes 5 Dental silver alloy 2 x 12g 6 Dental stone 1kg bag 7 Calcium hydroxide liquid and powder 8 Dental drill bits 9 Bite wing dental films 10 Arch bars, dental 11 Dental mirrors 12 Dental X-ray films 13 Silver point for root canal filling 14 Suction tubes (saliva ejectors) 15 Zinc phosphate cement powder 113 X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X RH PH DH HC HP Co X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X Official Gazette nº06 of 08/02/2016 16 Ethyl chloride spray 17 Eugenol liquid 18 Glass ionomer cement kit Polymethylmethacrylate (PMMA) intraocular lenses 19 X X X X X X X X X X X X 29.1.13. Miscellaneous Supplies Item description Face masks First aid kits No 1 Applicator stick with cotton tip 2 Autoclave tape 3 Bedpan, stainless steel Standard 4 Body bag 5 Condoms 6 Dispensing envelopes 7 8 9 Galliot, stainless steel 10 Mucus extractor 11 Pap smear kits 12 Tongue Depressor 13 Umbilical clamp 14 Undercast padding 15 Medical thermother 16 Blood pressure machine 18 Otoscope 19 Stockinet 20 Ambu bags 21 Oxygem masks 22 Protection glasses 18 Urine collecting bag 29.2. Laboratory Supplies and Reagents 29.2.1. Laboratory supplies Item description No 1 Alcohol swab 2 Blood lancet 3 Capillary tube, EDTA 4 CD4 stabilization tubes 5 Needle holders Pasteur pipette 6 Sharps container 7 8 Vacutainer tubes 9 Vacutainer needles 114 X X X X X X X X X X X X X RH PH DH HC HP Co X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X RH PH DH HC HP Co X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X Official Gazette nº06 of 08/02/2016 10 Vacutainer EDTA 11 Microscope slides 12 Filter papers 14 Cryotubes for serum 15 Conical tubes 16 Western Blot 17 Examination gloves 18 Masking tape 19 Pipettes stands 20 Vaginal swabs 21 Tips for Micro – pipettes 22 Syringes 23 Microscpe 24 Safety glasses 25 Mixer 26 Stool container 27 Urine container 28 Lamella 29 Needle Adaptators 30 Tips for micro pipettes 31 Glass tubes 32 Plastic tubes 33 Sampling containers 29.2.2. Testing kits including reagents IgM (tubex) Item description No 1 Blood glucose test strips 2 Brucella abortus Ag 3 Brucella melistensis Ag 4 Cryoptococcal latex antigen 5 HCG latex antigen 6 HCG pregnancy test 7 8 Malaria rapid diagnostics test (RDT) 9 RPR antigen 10 RPR test strips 11 Toxoplasma screening test 12 TPHA antigen 13 Treponema specific test 14 Biochemestry tests 15 Haematology Kits 16 Controls kits 17 CD4 counts kits and accessories 115 X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X RH PH DH HC HP Co X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X Official Gazette nº06 of 08/02/2016 18 HIV rapid tests 19 Viral load test kits 20 Urine test strips X X X X X X X X X X 29.2.3. Tuberculosis reagents kit Item description No 1 Methylene blue 2 Microscope slide 3 4 5 6 Strong carbol fuchsin Sulphuric acid Auramine-o stain Hydrochloride in ethanol 29.2.4. Malaria reagent kits No 1 2 3 4 5 6 7 Item description Cuvettes Cyanmethaemoglobin standard Giemsa stain Hemoglobin (Hb) calorimetry kit Phosphate buffer tablets Sodium chloride (saline) Sodium metabisulphite RH X X X X X X RH X X X X X X X X PH DH HC HP Co X X X X X X X X X X X X X X X X X X PH DH HC HP Co X X X X X X X X X X X X X X X X 29.2.5. Culture media and biochemical Reagents No Item description RH PH DH HC HP Co Alkaline peptone water agar,dehydrated powder 1 2 API-20E kit 3 Bile aesculin agar 500g Blood base agar, dehydrated powder 500g 4 5 Blood culture system (diphasic) Brain heart infusion dehydrated powder 500mg 6 Carry-Blair agar, dehydrated powder 500g 7 8 DCA agar, dehydrated powder 500g 9 GC base agar 500g Haemoglobin Agar, powder 500g 10 Haemophilus sensitivity agar, powder 500g 11 12 Kligler iron agar 500g 116 X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X Official Gazette nº06 of 08/02/2016 MacConkey agar, dehydrated powder 500g Maconkey sorbitol agar, dehydrated powder 500g 13 14 Muller Hinton agar, dehydrated powder 500g 15 16 Nutrient agar, dehydrated powder 500g 17 Phenyl alanine 500g 18 Saboraud dextrose agar 500g Selenite F broth, dehydrated powder 500g 19 20 SIM agar, dehydrated powder 500g 21 Skimmed milk 500g 22 TCBS agar, dehydrated powder 500g 23 Tryptone soya broth base 500g 24 TSI agar, dehydrated powder 500g 25 Urea agar, dehydrated powder 500g 26 XLD agar, dehydrated powder 500g 29.2.6. Antimicrobial densitivity discs kits X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X No Item description 1 Ampicillin 10μg 2 Bacitracin 3 Ceftrioxin μg 4 Chloramphenicol 10μg 5 Ciprofloxacin 1μg 6 Cotrimoxazole 25μg 7 Erythomycin 5μg 8 Gentamicin 100μg 9 Methicilin 10 Metronidazole 11 Nalidixic acid 30μg 12 Penicillin G 10μg 13 Tetracycline 10μg 29.2.7. Identification bio-chemicals Item description No E-strip test 100 strips 1 Factor V 50 pieces 2 Factor X 50 pieces 3 Factor X + V 50 pieces 4 Iso vitalex 10ml 5 6 Optochin 50 pieces HC HP Co RH X X X X X X X X X X X X X PH X X X X X X X X X X X X X DH X X X X X X X X X X X X X RH X X X X X X PH X X X X X X DH HC HC Co X X X X X X 117 Official Gazette nº06 of 08/02/2016 Pastorex rapid kit for meningitis Slidex latex rapid kit for cholera 7 8 9 Yersinia pestis rapid kit X X X X X X X X X 29.2.8. Typing sera Item description Salmonella monovalent Salmonella polyvalent Shigella boydii Shigella dysenteriae monovalent Shigella dysenteriae polyvalent No 1 Enteroinvasive escherichia coli 2 Escherichia coli polyvalent 3 Neisseria meningitidis monovalent 4 Neisseria meningitidis polyvalent 5 6 7 8 9 10 Shigella sonnei 11 Vibrio cholerae 12 Anti human globulin serum 13 Anti serum A 10ml 14 Anti serum AB 10ml 15 Anti serum B 10ml 16 Anti serum D (IgM + IgG) 10ml 17 Blood giving sets 18 Blood labels Capillary tubes 19 ELISA, Ag/Ab microplate 20 Ependorf tubes 1 BB E 21 Hepatitis B surface antigen strips 22 Hepatitis C antigen strips 23 Hydrochloric acid (concentrated) 24 Masking tape 25 Pipette stand 26 Single channel pipettes 27 Sulphuric acid (concentrated) 28 Bag holder, biohazard 29 Genotyping test kits 30 Bag, biohazard HC HP Co RH X X X X X X X X X X X X X X X X X X X X X X X X X X X X X X PH X X X X X X X X X X X X X X X X X X X X X X X X X X X X X DH X X X X X X X X X X X X X X X X X X X X X X X X X X X X X 118 Official Gazette nº06 of 08/02/2016 Bibonywe ngo bishyirwe ku mugereka w’Iteka rya Minisitiri nº20/39 ryo ku wa 29/01/2016 rigena urutonde rw’ibikorwa by’ubuvuzi bitangwa kuri buri rwego rw’ibigo by’ubuvuzi Seen to be annexed to the Ministerial Order nº20/39 of 29/01/2016 determining medical services provided at each level of health facilities Vu pour être annexé à l’Arrêté Ministériel nº20/39 les prestations médicales dispensées à chaque niveau d’établissements de santé du 29/01/2016 déterminant Kigali, ku wa 29/01/2016 Kigali, on 29/01/2016 Kigali, le 29/01/2016 (sé) Dr. BINAGWAHO Agnes Minisitiri w‟Ubuzima (sé) Dr. BINAGWAHO Agnes Minister of Health (sé) Dr. BINAGWAHO Agnes Ministre de la Santé Bibonywe kandi bishyizweho Ikirango cya Repubulika: Seen and sealed with the Seal of the Republic: Vu et scellé du Sceau de la République : (sé) BUSINGYE Johnston Minisitiri w‟Ubutabera/Intumwa Nkuru ya Leta (sé) BUSINGYE Johnston Minister of Justice/Attorney General (sé) BUSINGYE Johnston Ministre de la Justice/ Garde des Sceaux 119