Interplay between Interplay between business relations and business relations and corporate conduct in corporate conduct in

H.P.H.P.An update on An update on PharmaceuticalsPharmaceuticals  

and and Private HealthcarePrivate Healthcare sectors sectors

Study byStudy by

Gunjan Organisation Gunjan Organisation for for Community Community DevelopmentDevelopment

Dharmshala H.P.Dharmshala H.P.

Overview of the Overview of the PharmaceuticalsPharmaceuticals and  and Private Private HealthcareHealthcare sectors in the States sectors in the States

► There is concentration of pharmaceutical There is concentration of pharmaceutical manufacturing units in Solan and Sirmaur manufacturing units in Solan and Sirmaur district.district.

► Most of the units are small and medium Most of the units are small and medium (approximately 70% ) and rest are large units.(approximately 70% ) and rest are large units.

► Bulk drug pharma units are less in number and Bulk drug pharma units are less in number and most of the units are working on formulation.most of the units are working on formulation.

► Most of the hospitals in private set up are small Most of the hospitals in private set up are small units ranges 10 to 30 beds.units ranges 10 to 30 beds.

► Small units are developed to cater small Small units are developed to cater small clusters as population is scattered.clusters as population is scattered.

Focused districts

• Solan

• Baddi

• Barodiwala

• Shimla

• Kangra

• Dharmsala

• Palampur

• Sirmaur

Methodology for field-work Methodology for field-work

The following activities were undertaken during the FACT The following activities were undertaken during the FACT FINDING mission:FINDING mission:

►Qualitative interviews with relevant stakeholdersQualitative interviews with relevant stakeholders►Gathered relevant literature (academia, NGOs, other Gathered relevant literature (academia, NGOs, other

sources)/Govt. reports/newspaper reports)sources)/Govt. reports/newspaper reports)►Identifying sources of information needed for the Identifying sources of information needed for the

researchresearch►Identified ‘key stakeholders’ (govt. departments, Identified ‘key stakeholders’ (govt. departments,

regulators, associations, NGOs, individuals, etc.)regulators, associations, NGOs, individuals, etc.)►Identified institutions to seek support in research Identified institutions to seek support in research

activities like different departments of universities, activities like different departments of universities, research institutions and NGOs implementing health research institutions and NGOs implementing health projects.projects.

Methodology for field-work Methodology for field-work

►Primary advocacy was done during the Primary advocacy was done during the inception meeting in which representatives inception meeting in which representatives of stake holders were explained about the of stake holders were explained about the research goals, objectives and process.research goals, objectives and process.

► Introductory letter was sent to selected Introductory letter was sent to selected pharmaceutical companies and private pharmaceutical companies and private hospitals.hospitals.

►Team was trained on questionnaires and Team was trained on questionnaires and possible frequently asked questions were possible frequently asked questions were discussed during the orientationdiscussed during the orientation

Methodology for field-work Methodology for field-work

►Coordination office was established at Coordination office was established at organisation level and one staff was organisation level and one staff was engaged for the coordination between engaged for the coordination between teams working in the field and the Pharma teams working in the field and the Pharma units and Private hospitals to be visited units and Private hospitals to be visited

►Support from Government agencies like Support from Government agencies like Pollution Control Board, District Industry Pollution Control Board, District Industry Centre was also taken to take the Centre was also taken to take the appointment from the companies.appointment from the companies.

►Support from CII, federations were also Support from CII, federations were also sought though federations are not that sought though federations are not that effective in H.P.effective in H.P.

Status of field workStatus of field work

Sr. Sr. No.No. Particulars Particulars Sample Sample

SizeSizeSample Sample

achievedachieved %%

1.1. PharmaceuticPharmaceutical Firmsal Firms 4040 2020 50 %50 %

2.2. Private Private HospitalsHospitals 5050 2323 46 %46 %

3.3.Medical Medical RepresentativRepresentativeses

5050 5050 100 %100 %

4.4. Prescription Prescription CollectionCollection 250250 128128 51 %51 %

Challenges during the field-Challenges during the field-workwork

7 licenses of drug units 7 licenses of drug units suspendedsuspended  Ambika SharmaAmbika Sharma

Solan, May 15Solan, May 15With cases of substandard drugs With cases of substandard drugs involving violation of various involving violation of various manufacturing norms emerging in the manufacturing norms emerging in the Baddi-Barotiwala-Nalagarh (BBN) Baddi-Barotiwala-Nalagarh (BBN) industrial area every now and then, the industrial area every now and then, the regulatory mechanism seems to be regulatory mechanism seems to be insufficient to keep track of 600 insufficient to keep track of 600 manufacturing units in the state.manufacturing units in the state.

In the latest case, various ferrous In the latest case, various ferrous ascorbate and folic acid tablets ascorbate and folic acid tablets manufactured by two manufacturers of manufactured by two manufacturers of the BBN area have been found to have the BBN area have been found to have more than the prescribed limit of certain more than the prescribed limit of certain ferrous salts.ferrous salts.

• Most of the companies and

private hospitals are reluctant

to answer.

• This news has given the bad

impact as we had just started

the process in the field.

• Hot and humid weather was

a challenge for the field team

• Evidence on pollution sensitivity as this is the most Evidence on pollution sensitivity as this is the most sensitive issue for H.P.sensitive issue for H.P.• Pharma CompaniesPharma Companies

Private hospitals claim regarding Bio waste Private hospitals claim regarding Bio waste management but data shows that 78% are not aware management but data shows that 78% are not aware about the process of quality bio waste management and about the process of quality bio waste management and its proceduresits procedures

► Most of the firms are recognising GMP, if discussed Most of the firms are recognising GMP, if discussed about standard of procedures, knowledge level is almost about standard of procedures, knowledge level is almost negligible.negligible.

► 30% firms have faced regulatory action from SPCB. 30% firms have faced regulatory action from SPCB.

Evidence suggesting violation of Evidence suggesting violation of ‘Business Responsibility’ in the 2 sectors‘Business Responsibility’ in the 2 sectors

Disposal of sewage & Disposal of sewage & waste in conformity waste in conformity with requirement of with requirement of

SPCBSPCB

Standard operating Standard operating procedures for procedures for

sampling, inspecting sampling, inspecting and testing of raw and testing of raw

materialsmaterials

Verification of Verification of environmental environmental

procedures procedures

Filling products in Filling products in powder form exercised powder form exercised with special care so as with special care so as to avoid contamination to avoid contamination

of environmentof environment

All of these All of these

27%27% 27%27% 22%22% 16%16% 16%16%

►When asked “Do you think the When asked “Do you think the implementation of regulatory laws should be implementation of regulatory laws should be different on the basis of size of firms (Large different on the basis of size of firms (Large and SMEs)” 90% were not in favour of itand SMEs)” 90% were not in favour of it

► 80% of the firms said that they need 80% of the firms said that they need technical support and trainings from technical support and trainings from Government on environmental issuesGovernment on environmental issues

►Most of the firms and hospitals are investing Most of the firms and hospitals are investing funds in CSR for their image in the societyfunds in CSR for their image in the society

►Not a single firm and hospital is aware about Not a single firm and hospital is aware about National Voluntary Guidelines on Social, National Voluntary Guidelines on Social, Environmental and Economic Environmental and Economic Responsibilities of Business (NVGs)Responsibilities of Business (NVGs)

►Most of the marketing is being done Most of the marketing is being done through middlemen and MRsthrough middlemen and MRs

►80% firms sponsor events for the doctors80% firms sponsor events for the doctors►68% firms and 51% hospitals are not 68% firms and 51% hospitals are not

aware about “Code of Medical Ethics aware about “Code of Medical Ethics Regulations, 2002 - Medical Council of Regulations, 2002 - Medical Council of India”India”

►76% firms and 95% hospitals are unaware 76% firms and 95% hospitals are unaware about “UCPMP” Uniform Code for about “UCPMP” Uniform Code for Pharmaceutical Marketing PracticesPharmaceutical Marketing Practices

►There is no interaction of hospitals with There is no interaction of hospitals with state medical council and minimal with state medical council and minimal with other agenciesother agencies

►80%hospitals are not part of any 80%hospitals are not part of any associationassociation

►Almost 80% don’t have any guideline on Almost 80% don’t have any guideline on Rational Use of Drugs in the hospitalRational Use of Drugs in the hospital

►Though 90% hospitals agreed that Though 90% hospitals agreed that prescription audit should be mandatory prescription audit should be mandatory but when conducted by team they but when conducted by team they refused for the same.refused for the same.

► 60% hospital don’t agree for standard 60% hospital don’t agree for standard treatment protocols treatment protocols

►As far as quality assessment of Bio As far as quality assessment of Bio medical waste is concerned none of the medical waste is concerned none of the hospital has taken any steps on this hospital has taken any steps on this issueissue

SocialSocial

1.1. Social responsibilities are forgotten in Pharma Social responsibilities are forgotten in Pharma

firms as the budget which would be for CSR is firms as the budget which would be for CSR is

being spent for Marketingbeing spent for Marketing

2.2. Business values are changing, cuts & commission Business values are changing, cuts & commission

is well accepted trade practiceis well accepted trade practice

3.3. Self regulation is becoming second responsibility Self regulation is becoming second responsibility

for the sectorfor the sector

4.4. Doctor-patient relationship has lost its spirit, Doctor-patient relationship has lost its spirit,

patient has become a costumer for doctor.patient has become a costumer for doctor.

Drivers/Factors influencing Business Drivers/Factors influencing Business ResponsibilityResponsibility

►Subsidies provided by the government to Subsidies provided by the government to establish manufacturing unitsestablish manufacturing units

►Low cost labourLow cost labour►Non performance of enforcement agenciesNon performance of enforcement agencies►Overheads like commissions for the Overheads like commissions for the

marketing is giving impact on drug costmarketing is giving impact on drug cost►Patients are paying high cost of treatment Patients are paying high cost of treatment

for unnecessary tests and prescribed for unnecessary tests and prescribed medicinesmedicines