Dear Colleagues!  This is Asrar Qureshi’s Blog Post #600 for Pharma Veterans. Pharma Veterans welcome sharing of knowledge and wisdom by Veterans for the benefit of Community at large. Pharma Veterans Blog is published by Asrar Qureshi onWordPress, the top blog site. Please email to for publishing your contributions here.

Opening Note

February 2022 marks my completing 47 years of working in Pharma Industry. Allah be praised. I am still working. The first half of my working career was spent in Multinational companies, and the latter half in the Local Pharma, making me well-versed with both innovators and generics markets. I also had the opportunity to work in business as well as operations.

My journey of near half century is also the journey of Pharma Industry in Pakistan. Great changes have occurred in this time and a lot could be written about it. In my blogs, which were started about four and a half years ago, I have covered several topics rel ated to Pakistan Pharma Industry. This multi-part series shall do and review the SWOT – Strengths, Weaknesses, Opportunities, Threats – of the industry as a whole.

Stakeholders 6 – Patients

“Health is a human right, and all countries need to prioritize efficient, cost-effective primary healthcare as the path to achieving universal health coverage and the Sustainable Development Goals”, says WHO report. Human rights are often violated in Pakistan in many forms, and it is easy to understand what might happen to health human right. The holistic approach would be to protect the health first, and then provide healthcare to patients. The situation is that we take extremely unhealthy, substandard, adulterated, decaying food in routine. It is a wonder that we do not fall sick in much larger numbers, and we attribute it to our strong immunity.

We do have an elaborate infrastructure for public healthcare comprising of 4,144 Dispensaries, 4,616 BHUs, 482 RHCs, and 796 hospitals.  Basic Health Units – BHUs cater to 10,000-20,000 population; Rural Health Centers – RHCs serve 25,000-50,000 population; Tehsil Headquarters Hospitals – THQs serve 0.5 – 1.0 million; District Headquarters are for a district of several millions, and then there are tertiary care hospital located in larger cities. However, this rather large infrastructure and its additions have not kept pace with the fast rise in population. Corruption, misuse of funds, staff indiscipline, sifarish culture, absenteeism, lack of qualified healthcare staff, and wastages reduce the efficiency and effectiveness of public healthcare system further.

Another study shows that almost 80% of healthcare expense in a household is done from out-of-pocket expenses. This is a huge burden on the common people. Tertiary care is under heaviest pressure where the patients outnumber the healthcare providers and the facilities. The hospital attendants take bribes to do every small little thing. A wheelchair pusher expects money, a cleaner expects money, the female aayas expect money, and even the guards expect money and get it by force. Nurses are a clear exception even in these circumstances, at least I have not seen any female nurse asking for money directly or indirectly. Most of them still do their work diligently without expectation of reward, gratitude, or money.

Private hospitals are at once high-quality service providers and exploiters where patients are charged for necessary and unnecessary services. To maximize revenue per patient, private hospitals in connivance with the consultants engage in battery of expensive, unnecessary tests. The bills of these hospitals run into hundreds of thousands of rupees. Many private hospitals also do unnecessary procedures to extort more money from patients; Caesarian Section being most common in women who could deliver normally.

The sum up is that the patients are being fleeced by the healthcare providers, healthcare services, diagnostic labs, pharmacies, and the pharma companies. As mentioned earlier, patients cannot protect their rights because they do not have any platform which would raise their voice. Out of frustration, patients’ relatives sometimes resort to violence against healthcare providers, which ends up in more problems rather than solving any.

Bringing lawsuits against doctors and hospitals has never been successful. The professionals refuse to give evidence against their colleagues because they fear they may the next victims of legal action.

Stakeholders 7 – Pharmacies

In the original list, I had put up six stakeholders. Later, I realized that pharmacies are also a stakeholder, hence their addition.

Pharmacy business in Pakistan has grown at the same scale as the fashion brands. Many years ago, most pharmacies were small and open like any other shop. Due to new regulations, the pharmacies had to install air conditioners which meant they would have to close the front. They were also required to place refrigerators for cold chain products.

Pharmacy business was boosted by several factors. Many years ago, their association fought for and got 15% minimum profit fixed by law. Prior to this, it was 15% on local products and 10% on imported products. Their income increased. Secondly, the prices of medicines increased rapidly thereby increasing their revenue and profit. Thirdly, more and more high-priced drugs were introduced which again contributed to increase in revenue and profits. Fourthly, the number of prescribers, General Practitioners and Consultants increased manifold. More prescriptions were issued. Fifthly, prescriptions became heavier with multiple drugs thus further supporting pharmacy business. Sixthly, the number of patients increased due to population increase and greater access to healthcare. Seventhly, the paying capacity of patients increased. Eighthly, pharmacies also started keeping household medical devices, patient care products, and imported and local nutritional supplements.

To be Continued……

Disclaimer. Most pictures in these blogs are taken from Google Images which does not show anyone’s copyright claim. However, if any such claim is presented, we shall remove the image with suitable regrets.

Countries are spending more on health, but people are still paying too much out of their own pockets (

(PDF) Health Care System in Pakistan: A review (

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