Non-availability of Essential Drugs in Pakistan

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Non-availability of Essential
Drugs in Pakistan

Lt. Gen. (Retd) Prof. Mahmud Ahmad Akhtar

By definition essential drugs are important and day to day needed drugs which are effective, safe, affordable and fulfill the needs of a majority of people. Essential drug list has been complied by WHO expert committee long time ago –is reviewed periodically. Based on this, Pakistan had developed National Drug Formulary which was also updated periodically but hardly implemented ever. Recently press is abuzz with the news that the Government might increase the prices of drugs by 18 percent excluding the essential drugs.
This decision will be logical and meaningful only if the essential drugs are available in Pakistan. Unfortunately in Pakistan many of the essential drugs are either not available or are scarcely available –frequently disappearing from the market, while the markets are choked with irrational and harmful drugs. The aim behind the genesis of essential drugs list was to make these drugs within the reach of people at affordable prices thereby making medical treatment rational, safe and cost effective.
The Government of Pakistan is bound morally, ethically by its commitment to the international health agencies [WHO etc] and to the articles of constitution safe guarding the people’s basic fundamental rights-to make the essential drugs available everywhere and at all times. In fact the Government should provide essential drugs free of cost to the needy people as is done in other countries including SAARC ones. In reality the motive behind depriving the people of essential drugs is to provide space for expensive non essential and irrational drugs to earn hefty profits which are siphoned off by the companies to the countries of origin.
To illustrate the point –a few examples are narrated:
Iron deficiency anemia is a very common disorder in Pakistan, particularly in the vast lower socio- economic strata of population. For its treatment, ferrous sulphate tab which is most effective and costs a few paisa’s for per day treatment, is unavailable or sparsely available .Per force the patients are made to buy expensive non essential irrational combinations of iron preparations costing Rs four to seven for one day treatment which majority of people can not afford.
Antibiotics, first line lifesaving antibacterials drugs Penicillin V and Nitrofurantin contained in the WHO and Pakistan list are not available in Pakistan for decades. Erthromycin another first line anti- bacterial drugs disappeared from the market for a long period –has reappeared recently but not available at all places. Furadantin is sold in the black market at certain drug outlets at a cost 50 times of the official price, with the active connivance of the Government functionaries. Due to non availability of first line microbials, expensive 2nd and 3rd line antibiotics are used not only causing loss of finances but also creating bacterial –drug resistance, a very serious health hazard
Generic preparation of Vitamins and lifesaving anti-dotes needed to treat patients suffering from poisoning are not available. Likewise the list will go on expanding, needing much writing space. Another sinister way used is in pricing the drugs in Pakistan is that many drugs having same molecule and quantity are awarded prices 6-10 times of others, whereby companies pay kick backs to prescribing doctors.
In short essential drugs including many life saving ones are unavailable in Pakistan while the market is flooded with irrational including many harmful drugs not registered in other countries-robbing the people of their health causing iatrogenic diseases and the scarce financial resources of the country as well adversely affecting the country ‘s sinking economy. Without economic independence there cannot be a political independence. Irrational drugs should be de-registered.
There is dire need to make the essential drugs available as laid down in the 1976 Drug Act by which the Government and the pharmaceutical companies are legally bound to supply essential drugs to the public. Further some Pharma companies are aggressively promoting their irrational drugs-making false claims to boost their sales by advertisements with impunity in the print and digital media. According to the 1976 Drug Act, it is the duty of the Government to safe-guard people’s health by allowing ethical promotion of drugs ,which is not done.
Unfortunately there is elitism in the country whereby there is the rule of elites, for the elites and by the elites. In this equation people don’t matter. There are cartels of corruption led by the corrupt Government functionaries. The mega scams like ephedrine are just tip off the iceberg. To rectify this bleak situation, there is a need for major surgery. The so-called Regulatory Authorities (except few competent people) are composed generally of incompetent and corrupt individuals, responsible for the continuing pathetic drug scenario in Pakistan.”The old wine is placed in new bottles and the saga continues”. For over two decades these issues have been frequently raised from the platforms of organizations like ‘Network of rational use of drugs’, Network of consumer protection of Pakistan etc and by making representation to the govt./political parties, but without any cogent result. This is high time that effective measures are adopted to rectify the pathetic drug situation in Pakistan .If essential drug policies are working well in Bhutan, Nepal, Sri Lanka and even in Bangladesh, then there are all the reasons that these should work in Pakistan too. Pakistan was envisaged to be a welfare state by its founding fathers, therefore governing policies should be made pro- people and not anti- people .The Government should make people aware of the virtues of the use of essential drugs and hazards of misuse/abuse of irrational drugs. Rational use of drugs should be given due importance in the medical education curriculum. In the teaching hospitals there should be clinical units of clinical therapeutics and clinical pharmacology like units of cardiology, gastroenterology etc as recommended by WHO. These units promote rational use of drugs-impart education and training to doctors, pharmacists, nurses and paramedics and carry out research.