January 2014, Volume 64, Issue 1

Letter to the Editor

Corruption in pharmaceutical sector in Pakistan

Mehran Qayum  ( Technical Advisor, FATA Development Program (FDP) Health, Deutsche Gesellschaft fuer Internationale Zusammenarbeit (GIZ) GmbH, Peshawar, Pakistan. )
Hassan Mehmood Khan  ( Technical Advisor, FATA Development Program (FDP) Health, Deutsche Gesellschaft fuer Internationale Zusammenarbeit (GIZ) GmbH, Peshawar, Pakistan. )
Shefa Haider Sawal  ( Technical Advisor, FATA Development Program (FDP) Health, Deutsche Gesellschaft fuer Internationale Zusammenarbeit (GIZ) GmbH, Peshawar, Pakistan. )

Madam, Pakistan has the worst economy in Asia-Pacific region ranking at 132 on Lagatum Prosperity Index and is missing out most of the Millennium Development Goals (MDGs).1,2 In Pakistan corruption subsists at all levels  and its dimensions are difficult to quantify.3 This occurs in the form of informal payments, financial leakages, embezzlement, pilferage, procurement frauds, clever book keeping, kickbacks, staff absenteeism, ghost workers and shaving of duty hours.3 Every year 4.1 trillion dollars are spent globally on provision of health services, however one half of this spending is lost in corruption.4 As per Transparency International report 2011 on global corruption, Pakistan ranked 134th out of 182 countries. "Medicines are only beneficial when they are safe, of high quality, and properly distributed and used by patients".5 The complex procedure of medicine supply chain provides a window of opportunity for corruption. In order to offer good quality, safe and effective medicines, it is essential that each stage of supply chain management should work at an optimum level.
According to World Health Organization 2006 report, registration of the drugs is one of the critical areas for corruption. A committee comprising of senior officials with clear responsibilities to assess the drug registration application should be in place. Transparency should be ensured at each and every step. The committee should be capable of undergoing periodic audits, monitoring and generating reports. WHO Model List of Essential Medicines is effective in selection of drugs to guarantee the cost effectiveness and appropriateness as it begins with the priority area and most common ailments.5,6 The technical competencies with unbiased decision makers and information sharing should be followed to avoid potential chances of corruption.  Theoretically in the procurement process contracts should be awarded to the bidders who are pre-qualified and can complete the contract. The information is not publicly available which is a point of concern and provides an ample chance to bribe tender committee for their vested interests. No appeal process for rejected tenders\' exists. Contract terms, model of distribution and criteria should be explicit. Open competitive procurement, oversight mechanisms, ongoing monitoring and supervision reduces corruption. Information flow mechanism should be clear and drugs should be well allocated and distributed to central and regional levels.
Similarly institutionalized corruption inculcated within the system is another big concern resulting in pilfering of medicines and selling them for private gains. This results in falsification of records and health system planning. Within the pharmaceutical unethical marketing strategies are practiced which has undermined the health system. The ultimate outcome is poor quality and shortage in supply of essential drugs.

References

1. Ghauri I. Millennium Development Goals: Pakistan to miss MDGs due to slow growth. The Express Tribune 2012 July 4.
2. Ali S. Pakistan has the worst economy in Asia-Pacific region: Report. The Express Tribune 2012 Nov 3.
3. Nishtar S. Pakistan\'s health sector. Does corruption lurk? Heartfile; 2007.
4. Organization WH. Medicines: corruption and pharmaceuticals. (Online) 2009 (Cited 2013 March 29). Available from URL: http://www.who.int/mediacentre/factsheets/fs335/en/.
5. Gutierrez D. WHO issues warning about corruption of pharmaceutical industry. (Online) 2010 (Cited 2013 March 29). Available from URL: http://www.naturalnews.com/028686_Big_Pharma_corruption.html.
6. Marshall IE. A survey of corruption issues in the mining and mineral sector, 2001. (Online) (Cited 2013 March 29). Available from URL: http://pubs.iied.org/pdfs/G00949.pdf.

Journal of the Pakistan Medical Association has agreed to receive and publish manuscripts in accordance with the principles of the following committees: