The government has planned to build a pharmacy network aimed at making medicine easily accessible to people with initially opening pharmacies at 700 hospitals across the country. The government also emphasised manufacturing of more essential drugs. Experts think treatment costs will decrease once these two measures are in place.
According to the senior officials at the health ministry, these pharmacies will be attached to 429 upazila hospitals, 59 district or Sadar hospitals, 35 government medical college hospitals and 21 specialised hospitals.
Besides, pharmacies will be operated on lease at other government health institutions and big cities. These pharmacies will remain open round-the-clock. Besides those, private pharmacies will also continue to operate, increasing availability of drugs.
The health ministry already held several meetings with Bangladesh Association of Pharmaceutical Industries (BAPI), civil organisations and various government agencies about the matter. Some issues were even raised at the advisory council’s meeting.
The Health Affairs Reform Commission also recommended setting up a nationwide pharmacy network, updating the list of essential drugs and increasing supply of medicines at public hospitals.
Bangladesh is one of the countries with higher personal spending on healthcare. People in Bangladesh spend 70 per cent of personal spending on healthcare, with 65 out of the 70 per cent going on drugs.
Experts said if it becomes possible to reduce cost on drugs, healthcare expenses will also decrease.
Special assistant to the chief adviser of the interim government (with the status of state minister at health ministry) Professor Md Sayedur Rahman told Prothom Alo, “Many hospitals already have pharmacies, which will be expanded or modernised as much as necessary. Pharmacies will be built at the hospitals that have none. Initially, we will start with building a network of 700 pharmacies.”
State of pharmacy
The Health Affairs Reform Commission said in its last draft report that each government hospital and primary health complex must have a pharmacy with all essential drugs. Trained degree-holder registered pharmacists will run these pharmacies, and these pharmacists will provide drugs, counsel patients and ensure the rational usages of medicines.
Pharmacies will remain open round-the-clock to avail drugs to hospital patients, as well as outsiders. The reform commission said hospital patients must be provided with all essential drugs free of cost from these pharmacies where digital systems or surveillance on drug distribution will be maintained to forecast drug usage, prevent theft and reduce waste.
There will be three categories of drugs; one will be for free, another will be subsidised drugs and the remaining will be available at a competitive market price.
The health commission said in its draft report that personal treatment costs dropped in Sri Lanka because of the state-run pharmacy network while Thailand has added the government drug supply system to the hospital pharmacies under universal health protection scheme. Access to drugs, as well as standards of medicines increased in both countries.
Regarding this, Health Affairs Reform Commission member Ahmed Ahsanur Rahman told Prothom Alo that drugs should be accessible. It is a part of the rights to basic healthcare. The government will introduce a 24/7 pharmacy network.
It is a measure to come out of the thoughts to sell drugs at groceries. If drugs cannot be found when necessary, universal healthcare protection is not possible, he added.
Increase of essential drug list
The lone state-run drug manufacturer Essential Drugs Company Limited (UDCL) operates factories and various faculties in Dhaka, Bogura, Gopalganj, Khulna and Tangail’s Madhupur. Drugs manufactured by UDCL are supplied to people free of cost at state-run hospitals. Besides this, birth control products manufactured by UDCL are distributed to eligible couples through family planning field workers.
The commission said UDCL must be transformed to make the company self-sufficient in drug manufacturing, as well as made short-term (1-2 years), medium-term (3-5 years) and long-term (10 years) recommendations. Short-term activities include increase in capital investment to modernise the factories, enhancing the drug quality ensuring method and bringing the production system to international standard.
The government already changed UDCL’s top officials including the managing director and started laying off additional human resources. A decision has been taken to stop manufacturing drugs at other companies. Besides, the process started to purchase new machinery.
The reform commission also recommended updating the list of essential drugs considering the prevalence, type and trend of disease. Lastly, the list of essential drugs that include 285 medicines was updated in 2016. No company manufactures several drugs from the list.
Special assistant to chief adviser Sayedur Rahman told Prothom Alo that work is underway to update the list of essential drugs with the help of the World Bank. Several meetings were held, and a new list would be finalised soon.
A source said many old drugs will be left out, as well as many new drugs including medicines for cancer, diabetics, high blood pressure and several expensive drugs will be added to the new list containing over 300 types of medicines.
The health commission also made further recommendations on the health sector. If Physicians write the generic name of drugs so that patients will be able purchase medicine relatively at lower prices. The commission recommended using generic names for 20 per cent of the expensive drugs, as well as reducing campaign and packaging cost to lower drug prices.
People from the drug industry said the commission had made conservative recommendations that are hindrance to the growth of industry, and it might harm the reputation of the capacity of Bangladesh’s drug industry to the world. About 200,000 pharmacists work across the country and it is not possible to do this work by 700 pharmacies.
BAPI secretary general Zakir Hossain appreciated the initiatives to modernise and strengthen UDCL.
He told Prothom Alo the government should take no step that may pose risk to the success of Bangladesh’s medicine industry. Anything overregulated will harm the industry. Besides, it should not be a problem for the government to update the list of essential drugs with the opinions of all parties.
Emphasis on API
Local drug manufacturers import raw materials known as API (active pharmaceutical ingredient), mainly from India and China. Only 5 per cent of API is manufactured in the country.
The reform commission recommended providing government assistance and incentives to increase manufacturing of more API in the country.
Experts said security of Bangladesh’s drug industry will not be ensured unless the country becomes self-sufficient in manufacturing API.
Bangladesh API and Intermediaries Manufacturers Association president SM Saifur Rahman told Prothom Alo, “We want assistance and facilities similar to the policy support and incentives that China and India provided in their countries to flourish their API industries. We spoke to various ministries and government agencies including Bangladesh Bank and National Board of Revenue, and we received a positive response.”
* This report appeared in the print and online editions of Prothom Alo and has been rewritten in English by Hasanul Banna