Scenario of Bangladesh
A leading pharmaceutical company recently started marketing Dexamethasone eye drop with Tk. 24 only for 5 ml while "Lowest price and good quality" was their slogan. Within two months, they put two stickers revising the price, one on another on original price print respectively Tk. 34 and Tk. 50. At the same time, some other companies are marketing the same drug at a cost of Tk. 50, Tk. 27.80 and Tk. 34 only. Surprisingly the same drug is marketed produced locally by Tk.

90 by another company.

Locally produced Diclofenac eye drop costs Tk. 40 while at the same time there are Diclofenac preparations in the market by other companies at Tk. 70 and even at Tk. 200.

A senior consultant and professor of a reputed eye health care institute at Dhaka recently told that the laser instrument of his institution is out of order for a couple of months as because the local agency could not replace a damaged cord. He mentioned that ‘after sale service’ in the respective field has fallen to a very poor level in our country. Further he told that others are also running in great hardship.

Buyers become prisoners to the agency for particular instrument. While buying a A-scan Biometry, local agency of a reputed USA company supplied me a used probe claiming brand new. They surrendered while I challenged and replaced me a new one immediately.

They also beg pardon and requested not to tell to others.

These are two examples of poor ‘after sales service and dishonestly of instrument supplies in our country. Ophthalmic instruments are sold by particular agencies or dealers for particular company. So it is not possible to know the original price of the products in most cases. And we do not know how much we are paying including value added taxes to the company. We see gulf of differences of pricing of ophthalmic products including drugs with neighboring country.

Feeling of ophthalmologists
These are the very usual issues in mind of many sensible ophthalmologists of the country and discussed very often. But yet no one came forward to raise this very important public health issue.

We know that all the drugs are approved by Drug Administration Authority for its standard quality, quantity and price before being marketed; all companies claim that they procure raw material from best possible origin; and all claim that they do never compromise with quality of product. Then naturally it comes in our mind that why this difference of price of a same product produced in Bangladesh.

We have to prescribe medicine for treatment leaving no choice for the patients. If all the companies fix the price of Dexamethasone around Tk. 90 and Diclofenac around Tk. 200 as it remains in market already, then what will happen to the poor patients, especially in the rural areas? But we can not stop prescribing those drugs because we have to write for the treatment of patients.

Pharmaceuticals companies should come forward with their justified arguments to satisfy us in this regard. In our country we have a peculiar attitude about pricing since people use to pay or buy whatever the price may be. Besides it is for the treatment and cure of the disease. As a result, patients have no choice left behind. But physicians may have some choice considering the quality, quantity, costing and availability keeping in mind for overall welfare of the patients.

What we can do?
Ophthalmological Society of Bangladesh (OSB) along with BMA (Bangladesh Medical Association), can play a vital role in this respect. Seminars could be arranged, including the pharmaceutical companies and importers of ophthalmic instruments to share the views.

To consider all aspect, OSB can setup a sub committee or existing Member Protection Sub Committee to deal with following aims and objectives --

1. To advise and inform members regarding quality and pricing of products.
2. To advise and inform members regarding honesty and competence of suppliers.
3. To take up complains of users against manufacturers/suppliers for investigation and redress.
4. To take up complains of suppliers/manufactures against users and work out solution fair to all concerned.
5. To act and/or recommend action to ensure the above objectives.
6. All related should be made aware that the OSB is concerned about quality, pricing and standards in ophthalmic health care delivery.

Conclusion
Health service facilities getting modernised day by day. Among other criteria of modernisation, easy availability, low cost and high quality are most important. To minimise the cost of health service facilities which are already very high, drug manufacturers, instrument importers and related all others should come forward to do their best for the poor people of our country.

Now a days we see a competition of fixing higher prices of eye drugs, surprisingly newer producer starting with higher price, claiming their medicine is of higher quality. It is very pity that around 20 leading pharmaceutical companies are making a syndicate, fixing high prices for commonly used drugs, compelling poor patients paying more. But they could do reverse to reduce price to serve the humanity while they have the capability to do that. We all hope that the concerned organisations like OSB, BMA and the pharmaceutical companies will play role to overcome the problem for a healthy life and sight.

Dr A K Khan (DOMS) is a Senior Assistant Professor of Gono Bishowbiddaloy SV Medical College, Savar, Dhaka and Director of: "Dristisheba O Goveshona" Jamalpur. [Dristisheba@hotmail.com]