The Health Policy of PML-N (Part II)
By Dr Ghayur Ayub
After removal of Nawaz Sharif, the innovative activities of PML-N Health Policy pertaining to ‘Vision 2010’ were scraped. The key officers were removed and were replaced with officers who were either sidelined or removed by the previous government. One such officer who had close contacts with Gen Ghulam Ahmad was provided an office in Cabinet Secretariat headed by the general. He played active role derailing the policyand stopping the innovative programs.
To continue with anti-Nawaz policies, Musharaf’s military regime in 2001 announced a new Health Policy with 10 salient features labelling it‘concretising the Vision: Ten Specific Areas of Reforms’. Interestingly, the 10 salient features were selected from non-innovative and routine programs of PML-N, HP. Then in 2005, the civilian government of president Musharaf came up with another NHP, this time with ‘9 core programs’,again selected from PML-N, HP. Did any of the policy bring change in the healthcare of the public? Apparently not. As a matter of fact, in 2003, the donors did not extend an important activity of ‘SAPP II’ because the government met only 61 percent of its spending targets. The activity dealt with social service delivery of primary education, basic health care, population welfare and rural water supply and sanitation.
In 2008, the PPP government came up with another NHP. When I raised the point of it being an extension of PML-N HP in an article titled ‘Yet another health policy’ the health ministry rebutted it in newspapers stating“The new health policy would aim to strengthen the existing systems and create linkages between preventive and curative referrals”. Inadvertently the ministry confirmed my point of expostulation. In simple words, the non-innovative and routine programs of PML-N, HP became the basis of the three health policies announced by three successive governments in ten years.
So what were those innovative programs of PML-N, HP which if implemented could have brought revolutionary changes in ‘physical’ health, ‘mental’ uplift, ‘social’ well-being, and ‘spiritual’ awareness of the public?Some of the programs were;
Availability of basic medicine at the door step as part of National Drug Policy.
Poverty Alleviation Program.
National Health Care Schemes including National Health Insurance Scheme and National Health Card Systems.
Mosque and health program
Community Oriented Medical Education (COME).
Epidemic/Disaster Preparedness (DEWS), as part of Health Management Information System (HMIS)
Preparation of computerised database for; Structuring Pakistani society through disease demography and health details of population especially in tribal areas; Population census; Remapping of tribal belt through updated communication maps.
As one can see these activities covered ‘physical, mental, social, and spiritual’ aspects of health of the individuals. Let me briefly take up these programs one by one.
1)..Availability of basic medicine at the door step as part of National Drug Policy. The policy was introduced based on suggestions taken from the drug policies of France, Australia and South Africa. There was a background history to it. For example, a haphazard drug price hike hit the public in early 1990s, when the concept of ‘free economy’ was introduced in Pakistan. To solve the problem task was given to three successive committees led respectively by Tariq Sidiqui, A G N Kazi and Shahnaz Wazir Ali. They divided drugs into ‘controlled and decontrolled’ groups in 1994. Through a formula it was decided the government would keep its hold on prices of 25% of the drugs and the remaining 75% were left to the industry to adjust prices according to market flow. It meant the industry was allowed to fix prices of drugs wherever or whenever they deemed necessary. It was an ill-conceived step which resulted in rapid escalation of drug prices up to 1000% in some cases. When PML-N government took over in 1997 the mistake was recognized. By that time, most of the firms had made such huge profits that, according to some statisticians, they could remain in surplus up to 10 years without price rise.
Keeping such flaws in mind, a National Drug Policy based on Good Manufacturing Practices (GMP) was incorporated in NHP to; bring rationale in drug prices; make medicines accessible to the poor; improve the standards of drug manufacturing; upgrade the local pharmaceutical industry; and to introduce the concept of R&D in the local industry.
Local firms were given special permission to manufacture low priced essential drugs such as digoxin, thyroxin, mestinon, angasid etc. These drugs were manufactured only by the multinationals and were used as tool to pressurize government by bringing deliberate shortages. The aim of the government was to; come out of unnecessary pressures tactics of multi nationals; make the basic drugs available at the door steps of the poor. As a result of the policy, drug prices were not increased during PML-N government. Rather prices of 74 drugs were reduced between 10%-30% and the prices of 86 raw materials were reduced to the tune of Rs 1.15 billion. After removal of PML-N government in 1999, 8%-10% of price raise was given in 2000 and 3%-4% in 2001.
At provincial level, Shahbaz Sharif took the lead by; 1) forming a task force on spurious/substandard drugs to look into, working of medical stores and taking action against those who were violating drug laws, selling drug according to licensing policy, keeping drug prices in check, monitoring and supervising; testing of drug samples; controlling quackery; formation of drug courts. 2) removing all the drug inspectors with poor record. 3) freezing/banning new drug sale licenses. 4) providing funds to establish a new drug testing laboratory with modern facilities. 5) initiating mass media campaign to warn the deviant drug manufacturers, chemists, drug inspectors, quacks and other unscrupulous elements involved in the manufacture/sales of spurious/substandard drugs and to create awareness among the public on the issue. 6) establishing 3 extra drug courts at Multan, Rawalpindi and Faisalabad to reduce delays in handling the spurious/sub-standard drug cases.
This was just a small part of National Drug Policy implemented in Punjab and part of KPK (NWFP). If the policy was fully implemented in all parts of Pakistan, it would have brought revolutionary changes at the gross root level improving the ‘physical’ aspect of public health and cases like ‘ephedrine’ would not have taken place to improve the ‘social’ status of certain powerful individuals through unfair means. (To be continued)