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Shaukat Ali Jawaid
 

Ensuring availability
of Essential Drugs 

ShaukatJawaid

Ensuring availability of all the essential drugs at public and private healthcare facilities without any interruption should be the first choice and priority of the Government but it was rather amazing to listen to the representatives of the Pharma industry urging the authorities to take steps in this regard. This only shows the inefficiency, incompetence and ignorance of Health Managers of the present government or they are not being allowed to function independently taking decisions on merit by the too much interference of the omnipotent few selected Ministers who have surrounded Prime Minister   Nawaz Shareef. The result is that it is bringing lot of bad name to the Government besides making healthcare more expensive and beyond the reach of the population at large majority of which has to buy drugs from their own pocket.  It is so simple that if essential economical priced drugs will not be available, the patients will be forced to buy more expensive substitutes and that is what is now exactly happening.

While the government is not prepared to allow a reasonable and realistic increase in price of essential drugs, drug manufacturers are not inclined to produce them with ever eroding profitability. In fact, this suites the health bureaucrats, those in the drug control department as well as the medical profession because registration, production and availability of more expensive substitutes means there is much more money available to greeze  the palms of health officials besides bribing  the members of the medical profession through different ways which unfortunately goes on unchecked.

World Health Organization had come up with the idea of Essential Drugs to ensure that these medications which can take care of almost 90% of the diseases should be available at affordable prices which will ensure healthcare to the people. The WHO recommended Essential Drugs List has been adopted by a large number of the countries and it is regularly updated keeping in view their own requirements in view of the disease pattern in the respective countries. Even the Government of Bangladesh had set up a drug manufacturing plant in the public sector to produce essential drugs. Some steps were also taken in Pakistan in the past. On the initiative of Dr. A. H.Saeed, an eminent chest specialist who was Advisor to the Prime Minister Benazir Bhutto on Health, who worked in honorary capacity and was perhaps more loyal to the PPP than PPP leadership itself, Federal Health Ministry had prepared a Hospital Formulary which contained most of these essential drugs. To compile this, representatives from all the professional specialty organizations and medical organizations were invited to a meeting in Islamabad. After discussions and input from all the participants who represented all the disciplines of medicine, this Hospital Formulary which included all the essential drugs was compiled and later published. Director General Health, Government of Pakistan presented a copy of this Formulary at a WHO meeting in Geneva and got lot of applause for taking steps to implement WHO list of essential drugs. But what happened, it was never implemented for reasons which are not difficult to understand. This is exactly what happen and is the fate of many such useful documents which remain locked somewhere to gather dust and things in Pakistan keep on moving in their own routine way.

Pharma industry representatives say that they have tried their best to hold talks, enter into fruitful negotiations urging the government officials to opt for a realistic policy allowing rationalization of the drug prices so that essential drugs remain available but without any success. Even when they are convinced of our viewpoint, their usual response is that “we have orders to get the drug prices reduced”. How it is possible in view of the enormous increase in essential services like electricity, gas, water supply, fuel, manifold increase in wages, other commodities, devaluation of the Pakistani currency against major world currencies.  There has to be some method in this madness of harping on drug price reduction policy. Performance of the previous Nawaz Shareef Government was much better which helped the National Pharmaceutical industry to develop and grow which also paid rich dividends in many ways and the Pharma industry representatives do recognize and appreciate that. However, the present Nawaz Shareef Government it seems is totally cut off from the ground realities. Its incompetence and inefficiency is becoming more and more evident with the every passing day. The recent petrol crisis was a glaring example of its mismanagement but it appears Prime Minister Nawaz Shareef and his advisors have not learnt any lesson from that.  By saving the concerned ministers and making bureaucrats scapegoats won’t help the government, in fact it will discourage many bureaucrats to work and take any initiative.The government keeps on creating crisis itself one after the other and when it wakes up, situation has gone from bad to worse and then they start taking damage control measures leaving it with no time to take any initiative in other fields. Despite all efforts so far opposition has failed to create any real problem for the government but its own inefficiency and incompetence is enough to keep it struggling all the time.  If they did not wake up and continued with the same adhoc policies, the government will be eventually drowned so deep that Prime Minister Nawaz Shareef might find it extremely difficult to come up to the surface to survive. There is still some time and let it tackle the economic issues taking economic decisions rather than subjecting it to political decisions ignoring its own incompetence and inefficiency.

The performance of the Drug Regulatory Authority of Pakistan leaves much to be desired. Unethical practices in the health sector go on un-noticed and in the absence of any control, monitoring and accountability, it is the people who suffer. One hopes everyone in the health ministry will realize its duties and responsibilities and act before it is too late. Essential Drugs which at present is said to be available only at 4% of Government and 25% of private healthcare facilities is very depressing and disappointing. The situation needs to be rectified immediately by addressing the genuine grievances of the Pharma industry and solving their problems which is in the national interest.

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