off record
Shaukat Ali Jawaid

Health Bureaucrats
and a 
Combination of
Tableegh and Speech



There is a tendency to blame the Bureaucracy for all the ill the country is facing but we have seldom tried to look as if each one of us was performing our duties honesty. During my professional career of now over four decades I have come across a large number of honest, dedicated, devoted and God fearing kind heated bureaucrats who have always tried to uphold merit, transparency in their dealings and above all tried to help as many people as they could despite difficult circumstances. Since I work in a specialized area of health services, I can only talk about those bureaucrats whom I had a chance to meet and was impressed.  Mr. Pervez Masood Punjab Health Secretary who later became Chief Secretary was one of them. Again I was immensely impressed with Mr. Fawad Hassan Fawad whom I heard once and had a very brief meeting at a dinner reception. He served as Punjab Health Secretary for a brief period. Since he was too honest, he was not at all very popular with the medical profession which is constantly trying to avoid any monitoring and accountability. After the death of a young girl child at a Five Star private hospital at Lahore due to negligence, the Punjab Government formed the Punjab Healthcare Commission to improve the present state of affairs but the medical profession as usual was evading cooperating with the commission.

More recently I had a chance to listen to Mr. Ayub Sheikh Federal Secretary, Ministry of National Health Services, Regulation and Coordination who was the chief guest at a PPMA meeting where ways and means were discussed to promote drugs export from Pakistan. His speech on the occasion, which he myself termed as a combination of Tableegh and Takreer, was very much inspiring as every word he said, was coming from his heart. It also showed how serious and keen he was to improve the current state of affairs in the health sector. He highlighted the salient features of the Drug Pricing Policy which has been made transparent, no need to apply for increase in drug prices every year but the manufacturers can increase the price themselves based on the agreed formula of CPI and just inform the Ministry. What was more important was his message to the DRAP chief Dr. Mohammad Aslam not to be afraid of people with the vested interests.  While he praised the honest people working in the Drug Control Department, he also referred to the Mafia Group and urged that all of us should join hands against the Mafias to promote good practices. He also highlighted the way the Ministry is going to work in future dealing with the pharmaceutical trade and industry based on the recommendations and decisions made in the Drug Policy Board which fortunately has some very intelligent and competent people as its Members.

Federal Health Minister Ms.Saira Afzal enjoys a good reputation but unfortunately her performance so far is very much disappointing. I presented him a copy of the NBC Guidelines for Healthcare Professional interaction with the Pharma Trade and Industry during the psychiatric conference at Lahore over a year ago which were approved by the PM&DC as well as the Federal Government. However, as usual its implementation remains a far cry. I have my doubts whether Mr. Sara Afzal has looked at this document and read it with an intention to get it implemented.  A copy of these Guidelines was also sent to Mr. Ayub Sheikh and I sincerely hope that he will go through it.  If these Guidelines are implemented, over 80-90% unethical practices by healthcare professionals and unethical   marketing practices by the pharmaceutical trade and industry can be eliminated.  Billions of rupees are spent every year on lunches, dinners at Five Star Hotels during the so called medical conferences  many of which can be termed as Health Melas since the scientific contents and attendance in scientific sessions is very poor but at the time of lunch and dinner, there is great rush. All this is sponsored by the Pharma trade and industry which then passes it on to the poor patients thereby making the healthcare expensive. Drugs prices are beyond the reach of a large section of the society particularly the poor. What is more disturbing is the fact that some corrupt elements in the medical profession  are using it to make money by coercing the Pharma trade and industry to become Platinum, Gold and Silver sponsors for these events asking for  millions of rupees. A stall at the pharmaceutical exhibition which used to cost fifteen to twenty thousand rupees is now sold for millions of rupees.  It looks as if the corrupt elements in the medical profession and Pharma industry have joined hands to rob the poor patients in this country and there is no one to check this unethical practice. Of course there are some exceptions and a very few medical conferences have good scientific programme and they also attract audience. The CME Credit introduced by the PM&DC has also helped to bring in some participants to the scientific sessions who most often were seen gossiping outside or sitting at the Pharma company stalls. The ideal solution would be that the medical profession returns back to the lecture halls and auditoriums of medical institutions for such academic activities from the Banquet Halls of Five Star Hotels. It is also important to distinguish between genuine sponsorship for CME and other academic activities and outright bribing the medical profession through different ways.

Once, Mrs. Sara Afzal was invited to be the chief guest at a conference of Family Physicians, at a Five Star Hotel in Lahore. The topic of quackery and how to overcome this was highlighted by the conference organizers.  I wish Mrs. Sara Afzal had the courage to tell them that when they start holding their meetings at Five Star Hotels all sponsored by Pharma Trade and Industry and make the healthcare expensive, un-affording for the common man, how we can eliminate quackery? In fact the medical profession by such acts was promoting quackery rather than eliminating it. Conscious people like Prof. Khawaja Saadiq Hussain have often remarked that we must make healthcare accessible and affordable for the common man if we wish to eliminate quackery. It cannot be eliminated by Ordinances or legislations alone.

Ms. Sara Afzal was recently at the World Health Assembly at Geneva. She must have heard that WHO has published the New Model Essential Medicines List which was released on May 12, 2015. It includes ground breaking new treatments for Hepatitis-C, Breast Cancer, and Leukemia besides multidrug resistant tuberculosis. Governments and institutions around the world are using this WHO list to guide the development of their own Essential Medicines List (EML) because they know that every medicine listed has been vetted for efficacy, safety and quality. Not only that, but there has been a comparative cost evaluation with other alternatives in the same category of medicines. The objective of this EML is to provide guidance for the prioritization of medicines from a clinical and public health perspective. The hard work begins ensuring the availability of these drugs to the patients.

This WHO EML is revised every two years by an Experts Committee which consists of recognized specialists from academia, research, medical and pharmaceutical profession. Five new medicines directly acting oral antiviral preparations have recently been marketed transforming chronic Hepatitis-C from barely manageable to a curable condition. These drugs have very few side effects and much higher tolerance by the patients. All these five products including Sofosbuvir and Declatasvir have been included in this list. Cancer segment of the list has also been revised, fifty two products were reviewed and thirty treatments were confirmed with sixteen new anti-cancer preparations included in the list.  Five new anti TB drugs have been included in the Essential Drugs List, four of these including  Bedaquiline and Delamanid target multi drug resistant TB. The Experts Committee also reviewed Ranibizumab to treat eye disease macular degeneration. They looked at the price difference with Bevacizumab and preferred to retain Bevacizumab rejecting the application of Ranibizumab for inclusion as the price difference was too much. This shows how the Experts Committee works while reviewing the Essential Drugs List.

Mrs. Sara Afzal as well as Mr. Ayub Sheikh must try to find out why we do not have such a list of Essential Drugs and benefit from the vast experience of WHO experts like many other countries in the world? The problem with non-technical people looking after such technical subjects is that they lack any background information. They are not aware of the fact what has been going on in the country in the past and most often they are not keen either to listen and learn. For their information Federal Health Ministry had prepared such a list in the past and it was also published named as “National Hospital Formulary” with input from over seventy representatives of various professional specialty organizations. Lt. Gen.Mahmood Ahmad Akhtar former Surgeon General Pakistan Army had made significant contribution in this regard. This was published but never implemented even for a single day because of the corrupt elements in the drug control department, provincial health departments, healthcare facilities and the medical profession who all had their own vested interests.  It is not only the  Pharma industry  but the medical profession also has some very strong Mafia Groups  which needs to be tackled if we wish to make any headway in improving our health services, make primary healthcare available, accessible and affordable to the common man. When our neighboring country Iran can achieve this, why cannot we?  We just lack the will power and determination by the political leadership. Will it ever wake up? In the presence of people like Mr. Ayub Sheikh, we expect them to make some headway and at least initiate some measures which could bring a positive change in our healthcare set up.

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