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WELCOME RDC/ CUTS/ BRCC-Gujarat : 11-9-2012 1 Promoting Responsible Business in Pharmaceuticals and Private Healthcare Sector STATE LEVEL STAKEHOLDER DIALOGUE

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Page 1: WELCOME RDC/ CUTS/ BRCC-Gujarat : 11-9-2012 1 Promoting Responsible Business in Pharmaceuticals and Private Healthcare Sector STATE LEVEL STAKEHOLDER DIALOGUE

1

WELCOME

RDC/ CUTS/ BRCC-Gujarat : 11-9-2012

Promoting Responsible Business in Pharmaceuticals and Private Healthcare

Sector

STATE LEVEL STAKEHOLDER DIALOGUE

Page 2: WELCOME RDC/ CUTS/ BRCC-Gujarat : 11-9-2012 1 Promoting Responsible Business in Pharmaceuticals and Private Healthcare Sector STATE LEVEL STAKEHOLDER DIALOGUE

PRESENTATION ON KEY FINDINGS: BRCC PROJECT- GUJARAT

11th September, 2012

CUTS INTERNATIONAL – RAMAN DEVELOPMENT CONSULTANTS PVT. LTD.

Page 3: WELCOME RDC/ CUTS/ BRCC-Gujarat : 11-9-2012 1 Promoting Responsible Business in Pharmaceuticals and Private Healthcare Sector STATE LEVEL STAKEHOLDER DIALOGUE

Presentation Points

RDC/ CUTS/ BRCC-Gujarat : 11-9-2012

3

A brief introduction to the project A brief introduction to the Approach & methodology Key Stakeholders Findings of Pharma Sector – Environment Related

Inquiry Findings of Pharma Sector – Marketing &

Distribution Related Inquiry Findings of Private health care sector – Environment

Related Inquiry Findings of Private health care Sector – Marketing &

Distribution Related Inquiry

Page 4: WELCOME RDC/ CUTS/ BRCC-Gujarat : 11-9-2012 1 Promoting Responsible Business in Pharmaceuticals and Private Healthcare Sector STATE LEVEL STAKEHOLDER DIALOGUE

BRCC Project Overview

4

Business Regulation and Corporate Conduct - BRCC

Implementers:

Consumer Unity & Trust Society (CUTS International)

Norwegian Institute of International Affairs (NUPI)

Raman Development Consultants Pvt. Ltd. (RDC) – Gujarat State Partner

Duration: April 2011 to December 2012

Page 5: WELCOME RDC/ CUTS/ BRCC-Gujarat : 11-9-2012 1 Promoting Responsible Business in Pharmaceuticals and Private Healthcare Sector STATE LEVEL STAKEHOLDER DIALOGUE

BRCC Project

Sectoral Focus : Pharmaceutical Sector Private Healthcare Sector

Geographical Focus : Andhra Pradesh Gujarat Himachal Pradesh West Bengal

Page 6: WELCOME RDC/ CUTS/ BRCC-Gujarat : 11-9-2012 1 Promoting Responsible Business in Pharmaceuticals and Private Healthcare Sector STATE LEVEL STAKEHOLDER DIALOGUE

Policy & Regulatory Framework

Business Development

OptimalPractica

lFacilitat

ing

Responsible

EthicalSociety friendly

Environment

friendly

InclusiveSustaina

ble

Page 7: WELCOME RDC/ CUTS/ BRCC-Gujarat : 11-9-2012 1 Promoting Responsible Business in Pharmaceuticals and Private Healthcare Sector STATE LEVEL STAKEHOLDER DIALOGUE

Business Regulation & Corporate Conduct

Regulation

Mandatory

Guiding

Benchmarks

Conduct

Government

Society

Environment

Page 8: WELCOME RDC/ CUTS/ BRCC-Gujarat : 11-9-2012 1 Promoting Responsible Business in Pharmaceuticals and Private Healthcare Sector STATE LEVEL STAKEHOLDER DIALOGUE

Objectives of the Project

Address the regulatory and operational constraints faced by businesses in India.

Motivate firms to adopt ‘Responsible Corporate Conduct’. Evolve a policy discourse between business community

and policymakers to facilitate a policy environment that promotes business development in a sustainable manner.

Thrust: Encouraging responsible corporate conduct and building optimal regulatory framework through focused, informed and continuous discourse among government, business and stakeholders

Page 9: WELCOME RDC/ CUTS/ BRCC-Gujarat : 11-9-2012 1 Promoting Responsible Business in Pharmaceuticals and Private Healthcare Sector STATE LEVEL STAKEHOLDER DIALOGUE

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Key Areas of Inquiry

Current Situation and gaps Why have the regulatory safeguards not

effective in addressing the gaps? What should be done to make the

regulatory safe guards work? What role is expected from the industry

collectives?

RDC/ CUTS/ BRCC-Gujarat : 11-9-2012

Page 10: WELCOME RDC/ CUTS/ BRCC-Gujarat : 11-9-2012 1 Promoting Responsible Business in Pharmaceuticals and Private Healthcare Sector STATE LEVEL STAKEHOLDER DIALOGUE

Critical Issues in Pharmaceutical Sector

Environment Problem :• Current level of adverse environmental Impact• Why have the regulatory safeguards not worked where there are

significant impacts ?• What should be done to make these regulation work, so that such

adverse impacts can be minimized?

Marketing & Distribution Problem :• Current status of incentives provided by companies to doctors and

chemist• Its impact on ‘Rational Use of Drugs’• Why have these incentives continued despite regulations?• What can be done to ensure companies undertake their marketing

supporting rational use of drugs?• Presence of expired drugs in the market? Reasons of presence in spite of

regulations• What should be done to make betterment in the drug supply chain?

Page 11: WELCOME RDC/ CUTS/ BRCC-Gujarat : 11-9-2012 1 Promoting Responsible Business in Pharmaceuticals and Private Healthcare Sector STATE LEVEL STAKEHOLDER DIALOGUE

Critical Issues in Private Healthcare Sector

Environment Problem :• Current status of bio-medical waste management practices by hospitals and diagostic

service providers • If situation is problematic, explore why it is so despite regulations• How the situation can be corrected• Steps taken by hospital associations/industry bodies• What are the good practices? Drivers of good practices

Marketing & Distribution Problem:• Prevalence of ‘cuts/commission to doctors by diagnostic service providers• Why ‘cut/commissions’ exist in spite of regulatory safeguards?• How the situation can be corrected• Steps taken by hospital associations/other associations• What are the regulatory barriers?• Extent to which Standard Treatment Protocol are followed• Reasons for deviation and other non compliances• How it can be ensured hospitals promote alignment with Standard Treatment Protocols• Adequate measures by HCPs to respect and address diagnosis & treatment related

queries of clients?• Any other self regulatory mechanisms in place?

Page 12: WELCOME RDC/ CUTS/ BRCC-Gujarat : 11-9-2012 1 Promoting Responsible Business in Pharmaceuticals and Private Healthcare Sector STATE LEVEL STAKEHOLDER DIALOGUE

Stakeholders for Pharma Sector

Government Department Health and Family Welfare Department Gujarat Pollution Control Board Food and Drug Control Administration Commissioner of Industries

Associations of Pharmaceutical Industry including Small, Medium and Large Scale Manufacturers (Formulation and Bulk drug Industries) & Other related stakeholders IDMA Indian Pharmaceutical Association Pharma Export Council Ahmedabad Chemist Association Gujarat State Medical Representatives Association

Page 13: WELCOME RDC/ CUTS/ BRCC-Gujarat : 11-9-2012 1 Promoting Responsible Business in Pharmaceuticals and Private Healthcare Sector STATE LEVEL STAKEHOLDER DIALOGUE

Stakeholders for Pharma Sector

Industrial Associations Gujarat Chamber of Commerce and Industry Associated Chambers of Commerce and Industry of India (ACCII) FICCI ASSOCHAM Local GIDC Associations District Level Industrial Associations

Academic Institutions Individual Pharmaceutical Firms Civil Society Organizations Media Community residing in proximity of Pharma Units

Page 14: WELCOME RDC/ CUTS/ BRCC-Gujarat : 11-9-2012 1 Promoting Responsible Business in Pharmaceuticals and Private Healthcare Sector STATE LEVEL STAKEHOLDER DIALOGUE

Stakeholders for Private Healthcare Sector

Government Department Health and Family Welfare Department Gujarat Pollution Control Board

Medical Associations Gujarat Medical Council Indian Medical Association Ahmedabad Medical Association

Private Hospitals Biomedical waste management units Academic Institutions Civil Society Organization Media Consumers availing services of private hospitals

Page 15: WELCOME RDC/ CUTS/ BRCC-Gujarat : 11-9-2012 1 Promoting Responsible Business in Pharmaceuticals and Private Healthcare Sector STATE LEVEL STAKEHOLDER DIALOGUE

Approach and Methodology

RDC/ CUTS/ BRCC-Gujarat : 11-9-2012

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Respondent Data collection tool Approach

Pharmaceutical firm- Manager/ Director/ CEO/ Accountant

Semi-structured questionnaire & collect best practices documents

Scheduled interview with prior consent on tele-talk/ eMail/ personal visit

Private Hospital- RMO/ Manager/ CEO/ Accountant

Semi-structured questionnaire & collect best practices documents

Scheduled interview with prior consent on tele-talk/ eMail/ personal visit

Medical Representative

Semi-structured questionnaire

Snow balling

Prescription Analysis

Prescription of OPD Patients

Xerox/ Digital photo with consent

Associations Semi-structured questionnaire

Scheduled interview with prior consent on tele-talk/ eMail/ personal visit

Page 16: WELCOME RDC/ CUTS/ BRCC-Gujarat : 11-9-2012 1 Promoting Responsible Business in Pharmaceuticals and Private Healthcare Sector STATE LEVEL STAKEHOLDER DIALOGUE

Status of Field Work

Particulars Ahmed

abadVadoda

raBharuc

hValsad Total

Pharmaceutical Firms

40 10 12 13 75

Private Hospitals

50 10 8 7 75

Medical Representatives

25 10 - - 35

Prescription Collection

135 - 10 - 145

Associations 7 - - - 7

16

RDC/ CUTS/ BRCC-Gujarat : 11-9-2012

Page 17: WELCOME RDC/ CUTS/ BRCC-Gujarat : 11-9-2012 1 Promoting Responsible Business in Pharmaceuticals and Private Healthcare Sector STATE LEVEL STAKEHOLDER DIALOGUE

Findings of Pharma Sector – Environment Related Inquiry

RDC/ CUTS/ BRCC-Gujarat : 11-9-2012

17

Page 18: WELCOME RDC/ CUTS/ BRCC-Gujarat : 11-9-2012 1 Promoting Responsible Business in Pharmaceuticals and Private Healthcare Sector STATE LEVEL STAKEHOLDER DIALOGUE

Findings of Phase I: Pharma Firms

RDC/ CUTS/ BRCC-Gujarat : 11-9-2012

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Good Manufacturing Process (GMP) 93.33 % firms are aware, 83.08 % respondents all

elements of GMP as below: Disposal of sewage & wastes in conformity with

requirement of SPCB, Standard operating procedures for sampling,

Inspecting and testing of raw materials, Verification of environmental procedures, Filling products in powder form exercised with special

care so as to avoid contamination of environment Filter installed to retain dust and protect the local

environment

Page 19: WELCOME RDC/ CUTS/ BRCC-Gujarat : 11-9-2012 1 Promoting Responsible Business in Pharmaceuticals and Private Healthcare Sector STATE LEVEL STAKEHOLDER DIALOGUE

Difficulties and Expectations of Pharma firms to follow GMP

RDC/ CUTS/ BRCC-Gujarat : 11-9-2012

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Difficulties % Expectations from Government & Associations

%

Financial constrains 37.96 Financial support (Govt)40.51

Too tough Rules & regulations

14.81 Awareness programme (Govt)

27.85Lack of Government support

12.96 Regular Interaction with Govt

48.39

Lack of awareness among firms/association

6.48 Updating firms on recent development related to technology, Policies, Regulations (Associations)

29.03

No difficulty 22.22

Page 20: WELCOME RDC/ CUTS/ BRCC-Gujarat : 11-9-2012 1 Promoting Responsible Business in Pharmaceuticals and Private Healthcare Sector STATE LEVEL STAKEHOLDER DIALOGUE

Contribution of the Pharma industry to the environmental impacts

RDC/ CUTS/ BRCC-Gujarat : 11-9-2012

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Type of pollution 1-5 scale (%) 6-10 scale (%)

Air 59.1 40.92

Water 54.85 45.17

Land 76.47 23.52

Hazardous Waster 60.00 40.00

Health problems in community

61.53 38.45

Occupational health 57.89 42.1

• 33.33 firms discuss it in board room meeting• 86.48 % ensure compliance to env. Practice even in outsourcing through contract or

encouragement

Page 21: WELCOME RDC/ CUTS/ BRCC-Gujarat : 11-9-2012 1 Promoting Responsible Business in Pharmaceuticals and Private Healthcare Sector STATE LEVEL STAKEHOLDER DIALOGUE

Contribution of the Pharma industry to the environmental impacts

RDC/ CUTS/ BRCC-Gujarat : 11-9-2012

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82.86% respondents expects different regulatory laws and implementation according to nature of the unit and size of firms

65.33 % firms does not have dedicated Environment Management Department

98.48 % did not receive any assistance from government

Page 22: WELCOME RDC/ CUTS/ BRCC-Gujarat : 11-9-2012 1 Promoting Responsible Business in Pharmaceuticals and Private Healthcare Sector STATE LEVEL STAKEHOLDER DIALOGUE

Social responsibility of Pharma firms

RDC/ CUTS/ BRCC-Gujarat : 11-9-2012

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81.43 % firms covered under survey does not have CSR policy

Out of the firms which reported doing some CSR activities, half of them reported doing it out of individual philanthropic sentiments

91.78 % reported being Unaware of NVGs

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Pharma Associations..

RDC/ CUTS/ BRCC-Gujarat : 11-9-2012

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India Drug Manufacture’s Association (IDMA)

Large and medium firms highly adhere regulatory compliance of the different segments of the pharma sector in the state while small firms adhere at medium level.

Lack of awareness among firms/ association and financial constraints reported as among major difficulties to adhere regulatory requirements of GMP by firms

Government should consider providing financial support and should keep firms interest also in mind while formulating such regulations

IDMA does interact with government and other stakeholders on different issues of pharma

Page 24: WELCOME RDC/ CUTS/ BRCC-Gujarat : 11-9-2012 1 Promoting Responsible Business in Pharmaceuticals and Private Healthcare Sector STATE LEVEL STAKEHOLDER DIALOGUE

Findings of Pharma Sector – Marketing & Distribution Related Inquiry

RDC/ CUTS/ BRCC-Gujarat : 11-9-2012

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Page 25: WELCOME RDC/ CUTS/ BRCC-Gujarat : 11-9-2012 1 Promoting Responsible Business in Pharmaceuticals and Private Healthcare Sector STATE LEVEL STAKEHOLDER DIALOGUE

Marketing & Distribution

RDC/ CUTS/ BRCC-Gujarat : 11-9-2012

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Use of Medical Representatives was reported as a major strategy for M&D by 73.24 % firms

68.42 firms reported awareness on Code of Medical Ethics Regulations, 2002

57.50% of firms reported awareness on Uniform Code for Pharmaceutical Marketing Practices

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Marketing & Distribution

RDC/ CUTS/ BRCC-Gujarat : 11-9-2012

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41.18 % firms reported sponsoring events for doctors

77.42 % of firms reported that Doctors ask MRs for gifts during their visits

68.57% firms reported considering it as bad conduct to ask for gifts

40% firms reported indulging into distribution of gifts/incentives in order to maximize profit and gain new markets, while 24.44 % think that it is ‘essential to survive’

Page 27: WELCOME RDC/ CUTS/ BRCC-Gujarat : 11-9-2012 1 Promoting Responsible Business in Pharmaceuticals and Private Healthcare Sector STATE LEVEL STAKEHOLDER DIALOGUE

Findings from MR study

RDC/ CUTS/ BRCC-Gujarat : 11-9-2012

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80% of MR reported that that meeting with the doctors is primarily a part of marketing strategy

Based on the responses, the value addition through the meetings by MRs can be classified as follows: Information related to new drugs in market

(60%) Information on latest development in

pharma industry (37.14%) Building good relationship between Doctors

and pharmaceutical firms (48.17%)

Page 28: WELCOME RDC/ CUTS/ BRCC-Gujarat : 11-9-2012 1 Promoting Responsible Business in Pharmaceuticals and Private Healthcare Sector STATE LEVEL STAKEHOLDER DIALOGUE

Findings from MR study

RDC/ CUTS/ BRCC-Gujarat : 11-9-2012

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85.7% MRs reported being asked by Doctors for any kind of gifts/incentives during their visit

Reporting about the motive of asking for gifts/incentives, major reasons reported were: To promote product (54.28%) Giving time to MR to meet (28.51%).

40% MRs reported that it is a regular practice to give gifts to doctors, while 60 % reported that gifts are distributed only on special occasions

54.28 % MRs reported awareness about UCPMP

Page 29: WELCOME RDC/ CUTS/ BRCC-Gujarat : 11-9-2012 1 Promoting Responsible Business in Pharmaceuticals and Private Healthcare Sector STATE LEVEL STAKEHOLDER DIALOGUE

Findings from Pharma Association..

RDC/ CUTS/ BRCC-Gujarat : 11-9-2012

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India Drug Manufacture’s Association (IDMA) &

& Associated Chambers of Commerce and Industry of India (ACCII)

Both association do not have specific mechanism to monitor marketing strategy of member firms.

Both are aware of Code of Medical Ethics Regulations, 2002 and also were in favor of it

Both association are unaware of Uniform Code for Pharmaceutical Marketing Practices.

Page 30: WELCOME RDC/ CUTS/ BRCC-Gujarat : 11-9-2012 1 Promoting Responsible Business in Pharmaceuticals and Private Healthcare Sector STATE LEVEL STAKEHOLDER DIALOGUE

Findings from Pharma Association..

RDC/ CUTS/ BRCC-Gujarat : 11-9-2012

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Ahmedabad Chemist Association Incentive regime – reasons are commercial motivation of

doctors and weak regulatory framework Increasing number of companies and number of products is the

main challenge faced by ACA MR's working with different pharmaceutical firms often create

pressure on chemists to increase sale of their products Chemists often sell over the counter (OTC) drugs without

prescription Prescriptions often contain expensive medicines in spite of the

availability of cheaper generic version Aware about Medical Ethics Regulations, (Professional conduct,

Etiquette and Ethics) 2002 formulated by Medical Council of India (MCI) and The Uniform Code of Pharmaceuticals Marketing Practices

Page 31: WELCOME RDC/ CUTS/ BRCC-Gujarat : 11-9-2012 1 Promoting Responsible Business in Pharmaceuticals and Private Healthcare Sector STATE LEVEL STAKEHOLDER DIALOGUE

Findings from Pharma Association..

RDC/ CUTS/ BRCC-Gujarat : 11-9-2012

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Medical Representative Association Gifts are distributed on regular basis not on only some special occasion. Such gifts are booked by pharma firm under “Gratification” head

Aware about Medical Ethics Regulations & The Uniform Code of Pharmaceuticals Marketing Practices

Incentive regime” in pharma industry is contributed mainly by business strategy of pharma industry, commercial motivation of doctors, and weak regulatory framework

Fix remuneration would be more stable option for MRs Regulatory set-up is not sufficient and optimal enough to ensure responsible and ethical corporate conduct on the part of Pharmaceutical Firms

GSMRA never had interaction with any other body

Page 32: WELCOME RDC/ CUTS/ BRCC-Gujarat : 11-9-2012 1 Promoting Responsible Business in Pharmaceuticals and Private Healthcare Sector STATE LEVEL STAKEHOLDER DIALOGUE

Findings of Private Health care sector – Environment Related Inquiry

RDC/ CUTS/ BRCC-Gujarat : 11-9-2012

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Page 33: WELCOME RDC/ CUTS/ BRCC-Gujarat : 11-9-2012 1 Promoting Responsible Business in Pharmaceuticals and Private Healthcare Sector STATE LEVEL STAKEHOLDER DIALOGUE

Private Hospital study results

RDC/ CUTS/ BRCC-Gujarat : 11-9-2012

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Coverage of private hospitals under study

69.33 % of private hospitals reported following some guidelines/code of conduct for providing optimal healthcare service to the patients

79.73% reported maintaining patient satisfaction record and want it be mandatory. Same % of respondents mentioned it to be mandatory.

Capacity of bed %

10-30 26

31-60 40

61-90 20

>91 14

Page 34: WELCOME RDC/ CUTS/ BRCC-Gujarat : 11-9-2012 1 Promoting Responsible Business in Pharmaceuticals and Private Healthcare Sector STATE LEVEL STAKEHOLDER DIALOGUE

Private Hospital study results

RDC/ CUTS/ BRCC-Gujarat : 11-9-2012

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In term of interactions with SPCB, 53.52% found it as “OK, the way it is”, while 32.39 felt there is a “need for improvement”

In terms of interactions with state health administration and 40.91 % find it as “OK, the way it is” while 33% reported that there is a “need for improvement”

80.82% private hospitals reported that they are not part of any association of hospitals

Page 35: WELCOME RDC/ CUTS/ BRCC-Gujarat : 11-9-2012 1 Promoting Responsible Business in Pharmaceuticals and Private Healthcare Sector STATE LEVEL STAKEHOLDER DIALOGUE

Private Hospital study results: BMW

RDC/ CUTS/ BRCC-Gujarat : 11-9-2012

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98.65 % private hospitals are aware of BMW rule 1998

Various mode through which the Hospitals manage BMW were found reported as follows: Through private BMW service provider –

78.21 % Though common BMW treatment facility –

17.95 % Stand alone facility in hospital- 1.28 %

33.33% reported that there is a need for improvement in BMW rules

Page 36: WELCOME RDC/ CUTS/ BRCC-Gujarat : 11-9-2012 1 Promoting Responsible Business in Pharmaceuticals and Private Healthcare Sector STATE LEVEL STAKEHOLDER DIALOGUE

Private Hospital study results: BMW

RDC/ CUTS/ BRCC-Gujarat : 11-9-2012

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Almost all (>99%) the hospitals reported that their staff has undergone the training on BMW. About half of these (50%) reported undergoing process oriented training

82.43% private hospitals reported having some specific mechanism in place to carry out quality assessment of BMW

71.62% hospitals reported submitting periodic reports on BMW management, mainly to SPCB

Page 37: WELCOME RDC/ CUTS/ BRCC-Gujarat : 11-9-2012 1 Promoting Responsible Business in Pharmaceuticals and Private Healthcare Sector STATE LEVEL STAKEHOLDER DIALOGUE

Private Hospital: BMW: Difficulties & Expectations

RDC/ CUTS/ BRCC-Gujarat : 11-9-2012

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Challenges % Expectations from Government

%

Lack of awareness and training

24.55 Training by SPCB & private hospitals

57.14

High cost charged by BMW service provider/ irregularity

20.00 Modernization of BMW systems

13.10

Difficulties in segregation & Storage

10.91

Page 38: WELCOME RDC/ CUTS/ BRCC-Gujarat : 11-9-2012 1 Promoting Responsible Business in Pharmaceuticals and Private Healthcare Sector STATE LEVEL STAKEHOLDER DIALOGUE

Private Hospital study results

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65.75 % hospitals reported having a CSR policy in place

89.04% private hospitals reported providing free of cost/concessional treatment to BPL or poor patients

83.10 % hospitals reported no awareness about NVGs

Page 39: WELCOME RDC/ CUTS/ BRCC-Gujarat : 11-9-2012 1 Promoting Responsible Business in Pharmaceuticals and Private Healthcare Sector STATE LEVEL STAKEHOLDER DIALOGUE

Findings from Private Health care Association

RDC/ CUTS/ BRCC-Gujarat : 11-9-2012

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Associated Chambers of Commerce and Industry of India (ACCII): Challenges relating to the Private Healthcare and

Pharmaceutical Sector were reported as mainly - Nexus between private health care and pharma sector, Increasing cases related to unethical practices from the part of

private health care system Profit oriented approach of private health care sector Lack of regulatory framework to ensure responsible conduct from

private health care sector Aware about NVG and BMW rules For Long term solution of BMW issues Consistent and better

informed government regulations, strict enforcement of regulations and self regulations are key strategies

Page 40: WELCOME RDC/ CUTS/ BRCC-Gujarat : 11-9-2012 1 Promoting Responsible Business in Pharmaceuticals and Private Healthcare Sector STATE LEVEL STAKEHOLDER DIALOGUE

Findings from BMW Service Providers

RDC/ CUTS/ BRCC-Gujarat : 11-9-2012

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Large hospitals perform “fair” for BMW management while medium and small hospitals perform “poor’

Less willingness of hospitals to manage BMW

Waste received from hospitals are segregated properly

SPCB performance was described as ‘good’

Page 41: WELCOME RDC/ CUTS/ BRCC-Gujarat : 11-9-2012 1 Promoting Responsible Business in Pharmaceuticals and Private Healthcare Sector STATE LEVEL STAKEHOLDER DIALOGUE

Findings of Private Health Care Sector – Marketing & Distribution Related Inquiry

RDC/ CUTS/ BRCC-Gujarat : 11-9-2012

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Private Hospital study results:

RDC/ CUTS/ BRCC-Gujarat : 11-9-2012

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75. 68 % hospitals reported no awareness about UCPMP

77.03 % reported being aware of Medical Ethics Regulations, 2002

45.71 % hospitals reported having mechanisms in place to ascertain their in-house and/or empanelled doctors follow such guidelines

64.38 % hospitals are in favor of support mandatory prescription audit while 32.88 % are not in favor of it.

83.78 % hospitals reported not having any specific instrument to guide doctors on medicine prescriptions and allowed doctors to prescribe medicine at their discretion

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Private Hospital study results:

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60.27 % private hospitals does not have any in-house guideline on Rational Use of Drugs in the hospitals

49.32% hospitals favored mandatory STP for private hospitals while 50.68% did not favor it

75% hospitals reported existence of a nexus between hospitals and pharma industry, necessary for two interdependent business entities.

On questioning hospitals about what they consider as determinants of unethical behavior in private healthcare in state, following major responses were reported: 25.23 % - weak regulatory framework 23.42 % - incentives by pharma firms 22.52 % - commercial motivation of doctors

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Private Healthcare Association..

RDC/ CUTS/ BRCC-Gujarat : 11-9-2012

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Ahmedabad Medical Association: The AMA does neither have any state/locality-specific regulatory

instruments (code/manual/guidelines etc.) put in place for the private healthcare providers/doctors to follow nor does they have any monitoring mechanisms to ascertain its compliance

Unaware of NVG and UCPMP, aware of Medical Ethics Regulations, 2002

Lack of communication between government and private hospitals is the key issue faced by Private health sector

AMA does not developed any specific instrument (policy/code/manual/guideline etc.) for its member doctors on medicine prescriptions nor on rational use of drugs

STP should be mandatory for doctors/ private hospitals State health/local health administration should do prescription

audit, and private healthcare sector should disease registry

Page 45: WELCOME RDC/ CUTS/ BRCC-Gujarat : 11-9-2012 1 Promoting Responsible Business in Pharmaceuticals and Private Healthcare Sector STATE LEVEL STAKEHOLDER DIALOGUE

Findings from Prescription Analysis

RDC/ CUTS/ BRCC-Gujarat : 11-9-2012

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Coverage: 145 prescriptions from different hospitals in Ahmedabad

In Subscription part: Gender and age of patient were mentioned in 13.8% prescriptions Address of the patient was not mentioned in any the prescription T for tablet and Inj for injection mentioned in all Dose of drug was not completely written in 75.8% of prescription Duration of treatment were not mentioned in 84.13% of

prescription Direction of use of drug was not properly mentioned in

77.24%case In all 81.37% prescription were illegible

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Findings from Prescription Analysis

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In 37.24 % prescriptions 1-2 drugs were prescribed

In 42.07 % prescriptions 3-4 drugs were prescribed

In 20.69 % prescriptions 5 or >5 drugs were prescribed

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Findings from Prescription Analysis

RDC/ CUTS/ BRCC-Gujarat : 11-9-2012

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WHO prescribing indicators Prescription analysisPercentage of drugs prescribed by generic name

8.97%

Percentage of encounters with an antibiotic prescribed

42.75%

Percentage of encounters with an injection prescribed

28.96 %

Percentage of drugs prescribed from essential medicines list

58.33%

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Emerging Messages

RDC/ CUTS/ BRCC-Gujarat : 11-9-2012

48

Stricter monitoring and effective implementation of rules and regulation by regulators

More, systematic and mandatory efforts for Capacity building of all stakeholders and leadership by state

Systematic efforts to promote increased self regulation with associated sizeable incentives

Industry collectives to take up a more proactive role in effective implementation of regulations

Increased inter-sectoral dialogues for environmental issues due to pharma and private health care firms

Mechanism to curb unethical practices in the sectorCombination of negative and positive incentives for firms

for compliances to rules and regulations

Page 49: WELCOME RDC/ CUTS/ BRCC-Gujarat : 11-9-2012 1 Promoting Responsible Business in Pharmaceuticals and Private Healthcare Sector STATE LEVEL STAKEHOLDER DIALOGUE

Thank You

RDC/ CUTS/ BRCC-Gujarat : 11-9-2012

49

Page 50: WELCOME RDC/ CUTS/ BRCC-Gujarat : 11-9-2012 1 Promoting Responsible Business in Pharmaceuticals and Private Healthcare Sector STATE LEVEL STAKEHOLDER DIALOGUE

Respondents

Total Contacte

d (Phone/E

mail)

Not Interest

ed to talk

Interested/

Visited

Not Answered

after Appointm

ent

Gate Out

Pharma 300+ 200 100 15 10

P. Hospitals 300+ 150 150 50+ 5

MRs 60+ 20 40 3 0

Hosp. for Prescription

50+ 30 20 7 10

Associations 9 0 7 2 0

Status of Field Work