ISLAMABAD: Though essential medicines are updated all over the world on regular basis, Pakistan is one of the few countries where the matter is not taken seriously.

There is a need to encourage the pharmaceutical industry and boost its confidence so that it can invest in the sector. Top 50 companies should be asked to take responsibility for manufacturing three to five essential drugs each that are currently not available in the country.

Moreover, concerns of the industry, such as pricing and registration, should be addressed by implementing the pricing policy.

Ombudsman committee in a report says there is a need to ensure availability of 400 medicines

These observations were made by Imtiaz Inayat Elahi, a member of the Federal Ombudsman’s Committee on “Availability of essential drugs of high standards, efficacy, safety, quality at affordable prices for all and check on fake drugs.”

Mr Elahi was commenting on a report which the committee submitted to President Mamnoon Hussain.

According to the report, the office of the federal ombudsman received complaints about maladministration on part of agencies concerned regarding the unavailability of essential medicines, quality, safety and efficacy of drugs at affordable prices. The report claimed that Pakistan was among countries with highest death toll due to the unavailability of proper medicines.

The process to update the National Essential Medicine List, which is the requirement for a country to enlist minimum medicine needs for the healthcare system, was completed in early 2016. In the meanwhile, however, a number of questions arose about quality and availability of drugs.

In February 2016, the committee, headed by Mahmud Ahmad Akhtar, a former surgeon general of the Pakistan Army, was formed to investigate the complaints.

Mr Elahi, a former secretary of the ministries of National Health Services (NHS) and Capital Administration and Development Division (CADD), told Dawn that there were around 400 drugs mostly required by patients.

“There is a need to ensure availability of these medicines. Moreover, the quality and efficacy of drugs should be ensured.

Members of the committee held meetings with all stakeholders to address the issue. The pharmaceutical industry had concerns that some of the medicines were not viable to manufacture because of high rates of the raw material. However, we were of the opinion that manufacturing of essential drugs cannot be stopped,” he said.

“Moreover, companies had complaints that the Drug Regulatory Authority of Pakistan (Drap) was delaying the registration of new drugs. They also suggested addressing the issue of corruption. The industry representatives said they were ready to make investments but should be facilitated. On the other hand, Drap promised that all the issues would be addressed,” Mr Elahi said.

“In the report, we have recommended that there should be laboratories to check quality of medicines. There is a need to establish the US Food and Drug Administration (FDA) approved factories in Pakistan so that the quality of drugs is acceptable at the international market,” he said.

According to the recommendations, the drug laws should be implemented in letter and spirit. The technical members of the drug courts should be fulltime members for quick disposal of cases. Laboratories needed an upgradation and a monitory board should be constituted to put a check on doctors who travel abroad at the expense of pharmaceutical companies. An external audit system should also be designed to ensure the quality of drugs and check corrupt practices.

Drug inspectors should have a list of all the registered drugs so that they can check the unregistered ones. A stability test of drugs should also be held to know their shelf-life or expiry dates. Drugs which have become obsolete need to be deregistered, the report added.

It suggested that top 50 manufacturers should be invited and given responsibility to produce three to five essential drugs which are not currently available in the country.

It was further recommended that the drug inspectors should be trained through the World Health Organisation (WHO) and the government laboratories be prequalified with the UN agency. The labs should maintain their status by reviewing the process after every three years.

The Pakistan Medical and Dental Council (PMDC) should introduce courses on the continued medical education programme at graduate and postgraduate level. Pharmacists should be appointed in all hospitals at the ratio of one pharmacist for every 50 beds.

An essential drug pricing policy should be formulated to ensure the availability of safe and efficacious drugs at affordable prices.

The ministry of NHS has been advised to start a dialogue with pharmaceutical companies willing to accept the rationalisation of prices of essential drugs. Such steps will encourage companies to have out-of court settlements because currently the citizens are suffering and paying more because of court cases and higher prices.

Published in Dawn, March 26th, 2017