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Business_Responsibility_in_the_Pharmaceutical_and_Private_Healthcare_sectors_in_HP Powered By Docstoc
Organisation for
Goal: To stimulate better business to
      achieve sustainable development
      objectives in India
     Motivate firms to adopt ‘responsible’
      corporate conduct.
     Evolve a policy discourse between
      business community and policymakers to
      facilitate a policy environment that
      promotes business development in a
      sustainable manner.
     Address the regulatory and operational
      constraints faced by businesses in India.
Pharmaceutical  Sector
Private Healthcare Sector
A.   Environment
 What is the level of adverse environmental
   impact (especially in terms of pollution) from
   Pharmaceutical companies in the state?
 Why have the available regulatory safeguards
   not worked in places where impacts were found
   to be significant?
 What should be done to make these regulations
   work, so that there are no such adverse
   environmental impacts in future?
B.   Marketing & Distribution
    What is the current status of incentives
     (cuts/commissions) provided by Pharmaceutical
     companies to Doctors and Chemists in the state?
    What impact does it have on ‘Rational Use of
    Why have these incentives continued to be
     provided by the companies, in spite of regulatory
     safeguards being in place?
    What can be done to ensure that companies
     undertake their marketing activities keeping in
     view the principle of ‘Rational Use of Drugs’
A. Environment
   What is the current status of bio-medical waste
    management practices being followed by hospitals
    and diagnostic service providers in the state? If the
    situation is problematic, why is it so – in spite of
    regulatory safeguards?
   How can the situation be corrected?
   What have been the steps taken up by the hospital
    associations/industry bodies to deal with the
   What are the good practices?
   What are the drivers of good practices and how can
    these be scaled up or replicated?
B. Marketing         & Distribution
 How prevalent is the act of ‘cuts/commissions to
   doctors (individuals/in hospitals)’ among
   diagnostic service providers in the state?
 Why have these cuts/commissions to doctors
   existed in spite of regulatory safeguards in place?
 How to combat the situation? What have been the
   efforts of hospital associations and other such
   collectives to deal with the problem? What are
   the regulatory barriers, if any?
 Pharmaceutical firms
 Private health care hospitals
Sectoral Associations:
 Pharma association
 Private hospital Association
 MR association
 Chemist Association
 State level business chambers
Regulators/Government Agencies:
 Government healthcare machinery
 State Pollution Control Board
 Municipal corporations
 Consumers
 Communities
   Fact finding visit was undertaken and on the basis of that
    institutions were identified to seek support in research
   Primary advocacy was done during the inception meeting in
    which representatives of stake holders were explained about
    the research goals, objectives and process.
   Research study is being conducted in three phases:
    First phase: Questionnaires were filled with
     Pharma firms
     Private hospitals
     prescription audit
    Second phase: Questionnaires were filled with
     Pharma associations
     Medical Rep associations
     Chemist associations
     BMW agency
     Hospital associations
    Third phase:
       State level government agencies like food and drug controller,
        SPCB, Environment, Health and family welfare
   All the production units are following GMP and they
    think that GMP ensures quality products that give
    goodwill to the firms and facilitate in getting Govt.
   All the large industries, 56% medium scale and 36%
    small scale industries have dedicated Environmental
    Management department.
   Most of the small and medium scale industries (77%)
    don’t have CSR policies while around 70% large
    industries have CSR policy in place.
   None of the firms is aware about the National
    Voluntary Guidelines on Social Environmental and
    Economic Responsibilities of Business (NVGs).
 Around 83% large and medium scale firms
  sponsors events (meeting, workshop, seminar,
  etc.) for the doctors.
 Though asking whether doctors ask for gift
  most of the organisations said no but talking
  informally they said this is part of the business.
 Asking about the Code of Medical Ethics
  Regulations, 2002 - Medical Council of India
  formulated by Medical Council of India (MCI)
  around 66% are not aware about it.
 Hospital association has been initiated with
 the objective to create a forum for the
 members to discuss technical and
 administrative issues and to protect the
 rights riteria c and update the knowledge.
 Currently Private Hospital Association of
 district Shimla (……) has a base of 70-75
 members and any set up run by the
 allopathic doctor can be the member of the
 Criteria to be a member of hospital association is
  not well defined and only criteria which has come
  up during discussions that any Hospital managed by
  allopathic doctors can be the member of the
 No guidelines have been developed so far for the
  member hospitals to ensure responsible conduct
  from their part.
 Clinical establishment act formulated by GoI and
  state government was discussed during the last
   The Clinical Establishment (Registration and Regulation) Act 2010,
    which will be implemented soon in the state, is likely to make life
    difficult for private practitioners here as the state has already
    given ascent for its implementation.
   Private practitioners thinks that
       Act had been framed keeping in mind corporate hospitals and health insurance
        schemes at the cost of poor patients and doctors doing private practice.
       Act prescribed minimum standards for up to 10 bed clinics and
        hospitals. If the minimum standards for buildings, equipments and
        trained manpower as prescribed in the Act were implemented, the cost
        of running 10 bed hospitals would go up to about Rs 3.5 lakh per
      The Act also prohibits examination, diagnosis and treatment of
      patients at unregistered places which will restrict free medical
      camps, eye camps or first aid posts, especially in rural areas.
     Even home deliveries would be illegal.
   Heavy penalties proposed in the Act. As it says registration of a
    medical establishment can be cancelled if convicted under the
    Act and there is no provision for revocation of cancellation.
 Patient’s satisfaction record is being
  maintained by the hospitals, but it was not
  very clear to the surveyors, how this was
  being done [‘Bell’ story]
 Members of the association are not aware
  about the National Voluntary Guidelines on
  Social, Environment and Economic
  Responsibilities of Business
 There is no interaction with any of the
  entities except IMA in last one year.
 Doctors and nurses are working on hybrid
  model (Salary + per case payment)
 Doctors  agree that the idea of standard
  treatment code will set the framework of
 None is aware about Uniform code for
  pharmaceutical Marketing Practices(UCPMP)
 No policy or guidelines have been developed for
  the members to ensure rational use of drugs.
 No prescription audit is envisaged so far but
  preliminary discussion has been initiated for the
 Association has not taken action against any
  member so far.
 No response was given to identify the factors
  which have contributed to the emergence of
  unethical behaviour in private health care.
 Association never tried to bring together different
  stakeholders (chemist, pharma industries etc.) to
  discuss health care related issues like standard
  procedure protocols, rational use of drugs and
  incentive structures.
 Association  is aware about BMW rules 1998 and
  think there is scope for improvement as it is
  not being managed professionally and need
  capacity building of BMW agencies.
 Irregular services by the agency creates a lot
  of problems.
 Encouraging Private agencies might resolve the
  challenges faced for the disposal of the bio-
 Association is not aware on National
  Voluntary Guidelines on Social,
  Environmental and Economic Responsibilities
  of Business that have recently been issued by
  the Ministry of Corporate Affairs,
  Government of India.
 Association interact with State Pollution
  Control board as and when any issue comes
  otherwise send reports timely to the board.
 Incentives by Pharma firms and Weak
  regulatory framework/institutions dealing with
  marketing and distribution factors have
  contributed to the present “incentive regime
  "in the pharmaceutical industry
 No mechanisms within the association to
  monitor the marketing strategy has been
  developed so far.
 Marketing spurious medicines, Neglecting the
  licensing requirements and Regulatory
  adherence are to be considered as major
 Association  is aware of Code of Medical Ethics
  Regulations, 2002 formulated by Medical Council
  of India (MCI) and is satisfied with its present form
  but not aware of the UCPMP (Uniform Code for
  Pharmaceutical Marketing Practices).
 As far as level of awareness among the member
  firms about regulation and regulatory authorities
  related to pharmaceutical industry is concerned,
  only few of the bigger firms keep themselves
  aware of regulations pertaining to pharmaceutical
 Sectoral associations in both pharma and
  health care is a weak link in the state.
 There is lack of information about relevant
  regulation among the players of both the
 State Pollution Control Board has played a
  proactive role in the state.

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