Health sector experts said the government has a huge role to play in alleviating the health crisis in Pakistan – from keeping a check on spurious drugs, crafting an enabling policy for the pharmaceutical industry, and allocating an appropriate amount of budget for the health sector.
In a moot organised at the Al-Nimrah College of Nursing and Health Sciences over the weekend, Mohammad Aslam Khan, Director Al-Nimrah College of Nursing and Health Sciences, Dr Aftab Ahmed, Honorary General Secretary Pakistan Medical Association, Tauqeer Ul Haq, former chairman Pakistan Pharmaceutical Manufacturers Association (PPMA), and GM Business Development Essa Lab Dr Nayyar Jabeen spoke on the health sector crisis in Pakistan.
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Tauqeer Ul Haq said the pharmaceutical industry in Pakistan has always worked amid crisis in the country, let it be war, floods or the pandemic.
He said political uncertainty, unprecedented inflation at about 40%, and rupee depreciation severely affected the pharmaceutical sector as well.
“We have to import around 90% of the raw material imports but since the prices are regulated, companies are unable to pass them on. When the cost is higher than the price, companies cease to make products. This is the reason behind the shortage,” he said, referring to the drug shortage that has become common in Pakistan.
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He added the pharma industry has sent hardship cases for 262 essential medicines where cost of production has increased so much there is no incentive for companies to make it anymore.
He said that the government's Drug Regulatory Authority of Pakistan (DRAP) has approved it and sent it to the government.
“However, 11 months have passed and the government has yet to issue a notification,” he said.
“There’s no heprin, which is a critical medicine for heart patients. There’s a shortage of TB, cancer medicines and other lifesaving and critical medicines.”
He added that the crisis will continue to happen if the government doesn’t approve the price recommended by its own department.
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Dr Aftab Ahmed said that there’s a need for collaborative effort between DRAP, government, doctors association and pharma companies to resolve the health crisis in Pakistan.
Ahmed added that PMA wants the government to have flexibility to resolve issues that are severely hurting patients.
Dr Aftab said PMA stands with pharma companies and wants their genuine issues resolved.
However, he also criticised pharma companies for sending doctors on foreign tours, raising ethical concerns as well.
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Tauqeer Ul Haq said this is happening but added that PPMA discourages its member companies from doing this.
“There are 462 registered companies with PPMA. There are a total of 700 companies. It is certainly happening but it’s being done by a very small number of companies. Big responsible companies don't do this.”
Haq said the pharma sector is over-regulated.
“Government doesn’t control prices anywhere in the world. Take examples of India and Bangladesh. India has only 376 essential drugs list while Bangladesh only has 150 drugs on the list as essential. All the rest of the medicines are left for market forces to decide. Competition eventually stabilises prices.”
Haq added that the presence of multinational companies is important because they bring new research and molecules to a market.
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He added that 95% of the manufacturing is happening locally but still local companies are downsizing because they aren’t able to operate at their capacity because of price regulation.
“If we start working today, then we will be able to produce an API (basic ingredient, raw material) in 10 years. You need investment in that but you don’t give a price despite prices of everything such as electricity and gas going up. How will investment come?”
He said that India exports $28 billion worth of medicines while Pakistan only exports only $300 million worth of drugs annually.
“We need a stable policy to embark on long-term goals. But we need to handle the immediate crisis first. We need to make medicines available. The most expensive medicines are those which are not available."
Meanwhile, he said it’s very difficult for common people to differentiate between fake and original medicines. It’s the work of DRAP to stop spurious drug availability in the market.
“If (legitimate) medicines availability has been ensured, there will be no premium for mafias to get into making fake medicines or bringing smuggled drugs to the market.”
He said DRAP has initiated a barcode system to verify if a drug is spurious or legitimate. It is expected to be fully implemented in the next few years so that spurious drugs could be eliminated from the market.
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He again cited the example of Heprin. He said that its price is Rs1,285 but after shortage, it is being smuggled from Turkey and is being sold for Rs3,000 and Rs4,000.
"If chemists have stock, they are also selling it at a high price."
Haq said that the government has to play a role in providing quality medicines to the poor people.
“Unlike other developed countries, Pakistan’s health budget is miniscule. We provide medicines to government hospitals at a price as low as its costs. Government has a role to play in making health facilities accessible to poor people. But the government has no focus on education and health sectors.”
GM Business Development Essa Lab Dr Nayeer Jabeen said diagnostics has also been affected as a part of the complete health sector.
“We need regents and several other things. Import has been stopped. The shipment that used to cost Rs20 million is being received for Rs40 million and that too, after a long wait."
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She added big diagnostics were keeping their quality but the smaller ones who need to generate revenues are compromising on quality.
“When diagnostic industry is affected, it will definitely impact the health care system. Screening is important, but it is now the least priority. As tests have become expensive, people aren’t going for it.”
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