Unethical promotion raises healthcare cost

Pharmaceutical companies of the country are engaged in aggressive promotional activities that are unethical and lead to significant increase in healthcare cost, health experts told a discussion yesterday.

Medical representatives, who are given annual drug sales targets, offer various gifts, from stationery items to sample drugs to air tickets for overseas trips, while using persuasion and supporting family members, even in times of personal emergencies, they added.

“In doing these, they pay little heed to the laws or ethics. The medical representatives try to develop an intimate relationship with the physicians which they exploit to achieve their "targets", said Senior Research Associate Dr Nahitun Naher of BRAC University.

Acceptance of these gifts, especially the expensive ones, obliges the physicians to return the favour by changing established prescription norms and increasing drug sales, said Nahitun of the James P Grant School of Public Health (JPGSPH), referring to a research of the university published last year.

Citing global studies, she said the pharmaceutical industries spend between 15 and 25 percent of their budget on promotional activities, which is even higher in third world countries where their activities are less regulated.

The issue is of great importance as out-of-pocket (OOP) expenditure, meaning what an individual spends, on healthcare in Bangladesh is 63 percent, which is too high and contributes to the impoverishment of millions of people every year, she said.

Of this 63 percent, 65 percent is spent in buying drugs, according to Bangladesh National Health Accounts.

Such practices go against the principle of Universal Health Coverage (UHC), which means all people will receive the quality healthcare they need without suffering financial hardship, said speakers at the discussion.

The JPGSPU in partnership with Bangladesh Health Reporters Forum (BHRF) organised the discussion at the Bangladesh Medical Association auditorium in the capital.

Ashadul Islam, director general of Health Economics Unit of the health ministry, said despite the significant progress made towards achieving the Millennium Development Goals, Bangladesh remains much behind in terms of achieving UHC.

There is a big gap between healthcare availed by the poor and the rich, he said, adding that improving healthcare quality still remains a question.

He said World Health Organization suggests the health budget be 8 to 10 percent of the national budget but it is now only 5.13 percent in Bangladesh.

Dr Malabika Sarket, director (research) at the JPGSPH, said as non-communicable diseases like cancer, heart and respiratory diseases were increasing, preventive approach of healthcare has become vital for Bangladesh.

She also observed that achieving UHC would not be possible without regulating the huge private healthcare sector that remains largely unregulated.

The Press Institute of Bangladesh Director General Shah Alamgir, JPGSPH Senior Research Fellow Nadia Ishrat Alamgir, JPGSPH Advocacy and Communications Manager Meher Niger Jerin and BHRF President Toufiq Maruf also spoke.