Business Responsibility in the Pharmaceutical Private Healthcare

Business Responsibility in the Pharmaceutical & Private Healthcare Sectors in Himachal Pradesh Gunjan BRCC Project Organisaton for Community Development 1

Presentation lay out Basic information about the state Basic information about the project Pharmaceutical Industry Environmental aspect Marketing and distribution aspect Private Health care facility Environmental aspect Marketing and distribution aspect Concluding remarks 2

About Himachal from project perspective Industrilisation in Himachal initiated in and around 2000 -2001 Himachal is a fertile land to establish industry as there are no. of incentives to industries Tax incentives and exemptions Investment subsidies and other incentives Availability of finance at cost-effective terms Incentives foreign direct investment, (FDI) Profitability of the industry Physical and social infrastructure Condition of physical infrastructure such as power, water, roads, etc. Information infrastructure such as telecom, IT etc. Social infrastructure such as educational and medical facilities Most of the Pharma industries shifted from Gujrat to Himachal and around 200 pharma 3

Focused districts • Solan • Baddi • Barodiwala • Shimla • Kangra • Dharmsala • Palampur • Sirmaur 4

Sectoral Focus Pharmaceutical Sector Private Healthcare Sector 5

Pharma & Health care Infrastructure in project districts Pharmaceutical companies: District Bulk Drug Formulation Drug Solan 13 308 Sirmaur 02 86 Private Health care facilities: District No bed 1 -10 11 -20 21 -30 31 -40 41 -50 75 100 Solan 23 25 5 2 1 1 0 0 Shimla 8 14 6 0 2 0 0 0 Sirmour 4 4 5 0 0 1 Kangra 49 33 7 1 2 1 0 0 6

Sample size for the field work Particulars S. N. Sample Size First Phase 1. Pharmaceutical Firms 51 2. Private Hospitals 40 3. Medical Representatives 55 4. Prescription Collection 250 Second Phase 5. Medical Rep. Association, Chemist Association, Private Hospital Association, Pharmaceutical industry Association, Bio Medical Waste Entity Third Phase 6. Pollution Control Board, Department of Health and Family welfare, Food and Drug Controller, Community 7

Key stakeholders Firms: Pharmaceutical firms Private health care hospitals Sectoral Associations: Pharma association Private hospital Association MR association Chemist Association State level business chambers Regulators/Government Agencies: Government healthcare machinery State Pollution Control Board Municipal corporations Other: Consumers Communities 8

Pharmaceutical Industries 9

Impact on environment Industry: Though industries are aware that air, water and pollution through hazardous waste is being done by the industries and there are strict regulations for pollution control by Government, Industries are not self regulated. Many industries were penalized for not following the norms in last five years. Though 50% industries are outsourcing the job, only 30% out of those 50% are ensuring that outsourced industries are following pollution norms or not. None of the firms is aware about the National Voluntary Guidelines on Social Environmental and Economic Responsibilities of Business (NVGs) 10

Impact on environment …. Cont’d Association: Associations are not proactive and not even conducting meetings on related issues Firms expect handholding from the associations and government Government : Pollution Control board is proactive and initiated the process of establishing environment cell in large and medium scale industries. Board is conducting visits on regular basis and also trying to enhance the awareness level of staff on environment related issues Suggestions: Pharma collectives can play an important role to generate awareness and ensure adherence Strong environmental cell can establish innovative changes 11

Marketing & Distribution Industry: 80% firms sponsored events and 20% don’t have policy or don’t know about it. Benefit of sponsoring spreads the knowledge and products of the company which enhances the trade. Though gifts are being asked by doctors but it has not been accepted officially. Less than one third companies are aware about Code of Medical Ethics Regulations, 2002 (MCI) 75% industries are unaware about Uniform Code for Pharmaceutical Marketing Practices All companies employ MRs on incentives and are not ready to pay them fixed salary. 12

Marketing & Distribution cont’d…… 75% Industries acknowledge that there are certain ethical concerns relating to the ‘Incentive Structure' associated with the interplays among different actors involved with marketing and distribution chain of drugs Associations: Pharma Association: As per company’s representatives, Pharma association has not discussed or raised issues against the incentive process or thought about the alternative methods. There is no evident mechanisms within the association to monitor the marketing strategy of member firms. MR Association: Asking about the factors contributed to the present incentives regime in Pharmaceutical industry 66% voted for weak regulation and 33% for business strategy of pharma industry People are not comfortable with the existing chain of marketing and distributions of drugs and find responsible nexus of both for the same. Association has not met with any body for any issues: State Medical Council, State /Local Branch of Indian Medical Association, State Local Level Pharma Sectors Collective State /Local Level Industry Collective State/Local Drugs Control Administration 13

Private Hospitals 14

Impact on environment Private Hospitals Bio medical waste is being managed by the hired agencies but no one has verified or visited to verify the process. Only 12. 5% hospitals could tell the composition of the waste and 42% institution’s staff as taken any training BMW management. 55% hospitals send BMW management report to SPCB Training of the staff and the agency is required to improve bio waste management 15

Private Hospitals Impact on environment cont'd…. Associations: Associations are not proactive and has a base of 70 -75 members Though gap in BMW management is evident but association has not taken any step in this regard. Association has never conducted joint meeting of BMW agencies and members to resolve the issues faced by both. Association has never discussed environmental issues with members or any government agency. Association does not get any copy of the report sent to government from members on BMW 16

Private Hospitals Marketing and distribution Though 80% hospitals are aware about Code of Medical Ethics Regulations, 2002 but 72. 5% has no mechanism in place to ascertain if in-house and/or empanelled doctors abide by these Regulations More than 50% are not aware of the Uniform Code for Pharmaceutical Marketing Practices (UCPMP) 60% hospital don’t have guideline on Rational Use of Drugs. Though 60% hospital agreed on prescription audit but once it is started by our organisation, hospitals objected and did manhandling at two places. 80% hospitals either conduct diagnostic test in their own 17 labs or prescribe it to some specific diagnostic centre.

Private Hospitals Marketing and distribution cont'd…… 80% doctors denied to comment on some of the determinants of unethical behavior in private healthcare in the State. Associations: No one is aware on National Voluntary Guidelines on Social, Environmental and Economic Responsibilities of Business. No guidelines have been developed so far for the member hospitals to ensure responsible conduct from their part. Association never meet any of the agencies except once or twice with IMA and do not conduct regular meetings of the members. 18

Concluding remarks Sectoral associations in both pharma and health care is a weak link in the state. Regulatory bodies need to be proactive to address marketing and distribution related issues. There is lack of coordination with in the sector and with other agencies. There is an immense need of capacity building of all agencies on different rules and regulations and cross cutting issues. State Pollution Control Board has played a proactive role in the state. 19

Thanks……. 20