Interplay between business relations and corporate conduct in H.P. An update on Pharmaceuticals and Private Healthcare sectors Study by Gunjan Organisation for Community Development Dharmshala H.P.

Overview of the Pharmaceuticals and Private Healthcare sectors in the States ► There is concentration of pharmaceutical manufacturing units in Solan and Sirmaur district. ► Most of the units are small and medium (approximately 70% ) and rest are large units. ► Bulk drug pharma units are less in number and most of the units are working on formulation. ► Most of the hospitals in private set up are small units ranges 10 to 30 beds. ► Small units are developed to cater small clusters as population is scattered.

Focused districts Solan Baddi Barodiwala Shimla Kangra Dharmsala Palampur Sirmaur

Methodology for field-work The following activities were undertaken during the FACT FINDING mission: ► Qualitative interviews with relevant stakeholders ► Gathered relevant literature (academia, NGOs, other sources)/Govt. reports/newspaper reports) ► Identifying sources of information needed for the research ► Identified ‘key stakeholders’ (govt. departments, regulators, associations, NGOs, individuals, etc.) ► Identified institutions to seek support in research activities like different departments of universities, research institutions and NGOs implementing health projects.

Methodology for field-work ► Primary advocacy was done during the inception meeting in which representatives of stake holders were explained about the research goals, objectives and process. ► Introductory letter was sent to selected pharmaceutical companies and private hospitals. ► Team was trained on questionnaires and possible frequently asked questions were discussed during the orientation

Methodology for field-work ► Coordination office was established at organisation level and one staff was engaged for the coordination between teams working in the field and the Pharma units and Private hospitals to be visited ► Support from Government agencies like Pollution Control Board, District Industry Centre was also taken to take the appointment from the companies. ► Support from CII, federations were also sought though federations are not that effective in H.P.

Status of field work Sr. No. Particulars Sample Size Sample achieved % 1. Pharmaceutical Firms % 2. Private Hospitals % 3. Medical Representatives % 4. Prescription Collection %

Challenges during the field-work 7 licenses of drug units suspended Ambika Sharma Solan, May 15 With cases of substandard drugs involving violation of various manufacturing norms emerging in the Baddi-Barotiwala-Nalagarh (BBN) industrial area every now and then, the regulatory mechanism seems to be insufficient to keep track of 600 manufacturing units in the state. In the latest case, various ferrous ascorbate and folic acid tablets manufactured by two manufacturers of the BBN area have been found to have more than the prescribed limit of certain ferrous salts. Most of the companies and private hospitals are reluctant to answer. This news has given the bad impact as we had just started the process in the field. Hot and humid weather was a challenge for the field team

Evidence on pollution sensitivity as this is the most sensitive issue for H.P. Evidence on pollution sensitivity as this is the most sensitive issue for H.P. Pharma CompaniesPharma Companies  Private hospitals claim regarding Bio waste management but data shows that 78% are not aware about the process of quality bio waste management and its procedures ► Most of the firms are recognising GMP, if discussed about standard of procedures, knowledge level is almost negligible. ► 30% firms have faced regulatory action from SPCB. Evidence suggesting violation of ‘Business Responsibility’ in the 2 sectors Disposal of sewage & waste 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 All of these 27%27%22%16%16%

► When asked “Do you think the implementation of regulatory laws should be different on the basis of size of firms (Large and SMEs)” 90% were not in favour of it ► 80% of the firms said that they need technical support and trainings from Government on environmental issues ► Most of the firms and hospitals are investing funds in CSR for their image in the society ► Not a single firm and hospital is aware about National Voluntary Guidelines on Social, Environmental and Economic Responsibilities of Business (NVGs)

► Most of the marketing is being done through middlemen and MRs ► 80% firms sponsor events for the doctors ► 68% firms and 51% hospitals are not aware about “Code of Medical Ethics Regulations, Medical Council of India” ► 76% firms and 95% hospitals are unaware about “UCPMP” Uniform Code for Pharmaceutical Marketing Practices ► There is no interaction of hospitals with state medical council and minimal with other agencies ► 80%hospitals are not part of any association

► Almost 80% don’t have any guideline on Rational Use of Drugs in the hospital ► Though 90% hospitals agreed that prescription audit should be mandatory but when conducted by team they refused for the same. ► 60% hospital don’t agree for standard treatment protocols ► As far as quality assessment of Bio medical waste is concerned none of the hospital has taken any steps on this issue

Social 1. Social responsibilities are forgotten in Pharma firms as the budget which would be for CSR is being spent for Marketing 2. Business values are changing, cuts & commission is well accepted trade practice 3. Self regulation is becoming second responsibility for the sector 4. Doctor-patient relationship has lost its spirit, patient has become a costumer for doctor.

Drivers/Factors influencing Business Responsibility ► Subsidies provided by the government to establish manufacturing units ► Low cost labour ► Non performance of enforcement agencies ► Overheads like commissions for the marketing is giving impact on drug cost ► Patients are paying high cost of treatment for unnecessary tests and prescribed medicines