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Continued from Previous…… This series is based on a report compiled by Jilian Clare Cohen1, Monique Mrazek2, and Loraine Hawkins3 for the World Bank.
Our long discourse on corruption in pharmaceuticals now comes to an end. In this part we shall conclude with some recommendations.
The six decision points identified by the authors of the report for the World Bank are certainly the most critical steps. There are following additional factors which let the corruption continue and/or further flourish. These factors are more relevant to developing countries like Pakistan.
We have been alternating between civilian rule and military rule since Pakistan came into being. Though some semblance of democracy has been prevailing since last 10-12 years, but the sword of uncertainty keeps hanging over the heads. Experience tells us that mostly short-term measures are taken during military rule because their tenure is not predetermined, though it may last longer than civilian rule. The civil governments on the other hand are mired in political struggles, and backdoor wheeling and dealing. This leaves no time for doing serious work to bring long-term reforms.
Medicines are a public issue and have high political volatility. Successive governments have declined to do concrete work in this area due to its high political explosiveness potential.
Political Will is a critical factor if corruption in pharmaceuticals is to be curbed.
Weak Regulatory Infrastructure
The strength of regulatory infrastructure is another factor which determines the present and future of corruption.
In 2012, DRAP – Drug Regulatory Authority was established with the explicit purpose of bringing regulatory structure in line with the new recommendations. The change had the same fate that earlier EPB – Export Promotion Bureau had after it was converted to TDAP – Trade Development Authority Pakistan. While the fees and costs increased manifold, the service went down to unprecedented levels. There is continuous internal strife between old government employees on lower pay scales, and new contractual employees on higher pay scales. All senior positions are being run on adhoc/ additional charge basis which is renewed every 3 months. In such uncertain situation, nothing worthwhile can be expected.
Health was divulged to provinces after 18th Amendment, which have not been able to formulate business rules to handle this responsibility. The health infrastructure has been split into primary, secondary and tertiary levels, which has frayed the structure further.
Effective control of corruption will be possible when fatal flaws from regulatory and control infrastructure are removed.
Quality of Regulators
Not too long ago, the regulators worked without any training at all. Then with the support of WHO, several training courses were conducted in Pakistan and abroad. It must have made them more skillful, but the practical benefit is not accruing the way it was probably envisaged.
Regulators have two functions; they ensure control as per rules, and they advise the industry on how to upgrade. It is policing and consulting combined into one role.
Our regulators are mostly busy in policing, while consultative work is ignored. Policing also appear to give more authority, which we all love. Like all government functionaries, corruption works as part of the rules of business.
Quality, efficacy and maturity of regulators is desired to keep corruption at bay.
Lukewarm Attitude of Pharmaceutical Business Owners
The business owners pay little attention to improvement measures which may be advised from time to time. Even after many years, the HVAC system is neither fully installed nor fully functional in all Pharma manufacturing units. The business owners look at it from commercial angle and do not see any return on this investment.
The business owners find it easy to spend money on inspectors rather than on structural improvements. Profit is the supreme consideration, everything else may be ‘managed’.
Active participation of pharmaceutical industry is required to tackle corruption.
Lack of Technology
The use of technology is limited to using computers as typewriters and calculators. The digitization effort at the cost of millions of rupees was limited to scanning the old files and storing these. Scanning of maybe several million pages and storing these as isolated files does not help in doing analysis.
In a large country of over 200 million people, customized, if not custom-designed, software is necessary to doing analysis, making strategies, and following the implementation of strategies. Keeping control on the progress is well-nigh impossible with rudimentary techniques.
Technology can offer critical support for curbing corruption.
These are the major areas where reforms shall bring tangible reduction in corruption.
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- Jilian Clare Cohen – Toronto, Canada
- Monique Mrazek – Latin America
- Loraine Hawkins – London