The
Sri
Lanka
National Pharmaceuticals Policy was
established in the 1970s following the submission of a report by
Dr S.A. Wickremasinghe and Prof.
Seneka Bibile. It aimed at ensuring that
people get good quality
drugs at the
lowest possible price and that doctors would prescribe the minimum
required drugs to treat the patient's illness. It was a pioneer in
the field of rational
National pharmaceuticals
policy.
Background
At the time,
pharmaceutical
companies were making considerable money by selling drugs under
their
trade names, giving out biased
information about the
branded drugs as against
those named generically. Doctors often prescribed branded drugs,
which were far more expensive than
generic
drugs, which have the same efficacy.
The
United Front Government
of 1970 appointed the Wickremasinghe-Bibile commission of inquiry
into this issue and it recommended the establishment a national
policy and of a state body to regularise the trade.
In the 1970s Sri Lanka demonstrated that a state buying agency
linked to a national formulary was a viable and powerful instrument
for reducing drug costs without compromising quality, for saving
foreign exchange, for rationalising drug usage and for supplying
essential drugs at reasonable prices
to the whole community. This was made possible by the formulation
and implementation of an integrated
national pharmaceutical
policy.
A unique phenomenon about Sri Lanka's pharmaceuticals policy was
that the entire programme was conceived, formulated, developed and
implemented by Sri Lankan nationals without any form of external
aid or assistance.
National Formulary
A careful selection of drugs is an essential prerequisite of a
national pharmaceutical policy. In Sri Lanka, the Ministry of
Health requested Prof.
Seneka Bibile
to look into his matter and he prepared the
Ceylon Hospital Formulary (CHF) of
about 630 drugs under their
generic name. Subsequently
the Ministry of Health established a
National Formulary Committee
(NFC), consisting of representatives from the public and private
health sectors and the University Medical Schools, led by Bibile.
It published
Formulary Notes for doctors, keeping them
updated on developments.
State Buying Agency
Accordingly, in 1971 the
State
Pharmaceuticals Corporation of Sri Lanka (SPC) was established
with Bibile as Chairman. The SPC channelled all imports and
production of pharmaceuticals, calling for worldwide bulk
tenders which were limited to the approved drugs
listed in the CHF. The public and private health sectors had to
obtain all their requirements from the SPC.
Hence the stranglehold of the
Multinational corporations on the
drug trade was successfully broken and they were made to compete
with each other and with generic drug producers, enabling the
country to obtain drugs much cheaper. Branded drugs were replaced
by generic drugs in the prescription and sale of medicines.
In 1972 it imported 52 drugs at a third of their previous prices.
In 1973, the SPC itself bought the raw material necessary for 14
private processing laboratories established in the island. Some
drug prices dropped by half or two-thirds. The SPC bought from an
Indian company the raw material necessary for a widely used
tranquilliser at a much lower price than that charged by a Swiss
multinational.
Drug Information
It is essential that correct information on drugs and therapeutics
be given to all medical personnel. The promotional material
provided by the drugs manufacturers tends to be distorted in favour
of their own products and adds to the costs of supplying
drugs.
In Sri Lanka, drug information was provided from official sources.
The Prescriber, a quarterly publication edited by the NFC,
was published by the SPC and distributed to all medical personnel.
The extravagant promotional practices of drugs manufacturers were
stopped to remove the dangers and costs inherent in process.
International Experience
The Sri Lanka experience became a model for the rest of the world.
The policy was supported by
WHO and other
UN agencies with enormous benefit to Third World
countries. The
UNCTAD Secretariat examined
the Sri Lankan experience, concluding that an analysis of the Sri
Lankan model could give other developing countries an insight into
ways of formulating, developing and implementing integrated
national pharmaceutical policies. With Bibile’s assistance, it
published "Case Studies in the Transfer of Technology:
Pharmaceutical Policies in Sri Lanka".
[209489] This document has proved to be a very
valuable guideline for developing countries intending to initiate
pharmaceutical reforms. Translated into other languages, it may be
found with health planners of almost every Third World
country.
Reaction of Pharmaceutical Giants
The first response from the Multi-National Corporations came in May
1973.
Executives of the major pharmaceutical companies in the
United States met Sri Lanka's Ambassador
in Washington
DC
and handed him a letter addressed to the Prime
Minister of Sri Lanka from the President of the Pharmaceutical
Manufacturer's Association (PMA) of the US. The letter
concluded with a statement that the PMA believed that the proposed
actions would have most serious effects not only on the
pharmaceutical industry and on all private industry in Sri Lanka
but potentially for the health of its citizens.
The International Federation of Pharmaceutical Manufacturers
Associations (
IFPMA) issued a statement to
UNCTAD strongly criticising the UNCTAD report on the Sri Lankan
pharmaceutical policies.
Post-1977 Policy
This policy was watered down by the Multi-National-friendly
United National Party
Government of 1977. There was continued government control of the
types of drugs imported, but permission was given to the private
sector to import multiple brands. The SPC was never dissolved and
continued to supply affordable drugs, continuing to be responsible
for centralised procurement for the government health sector.
In 1987 the Pharmaceuticals Manufacturing Corporation was
established to import raw materials and manufacture generic drugs.
This has effectively withstood very strong pressures for
privatisation.
The earlier centrally controlled system enabled effective
monitoring. However, at present, because of decentralisation of
drug supply, while standard treatment guidelines are available,
there is no effective monitoring system for prescription practices
is in place; there is little quality assessment and no incentive
for rational use.
In 2005 the
United
People's Freedom Alliance Government promised to establish a
National Medicinal Drugs
Policy (NMPD) that would enable Sri Lankans significantly to
cut down on drug expenses and get quality drugs at affordable
prices while saving billions of
Rupees in
foreign exchange for the country. Implementation of the NMDP could
reduce the number of drugs imported, prescribed and sold in Sri
Lanka to about 350 varieties.
References
Dr. K Balasubramaniam , 'The neglected solution',
Daily News, 30 September 2002.
Dr. K. Balasubramanium, 'Drugs: David and Goliath', Daily
Mirror, 8 November 2002.
Include Medicinal Drugs Policy in Polls
Manifesto
Dr. Nihal Jayathilaka, Improving access to
affordable essential drugs: the experience of Sri Lanka
Prof. Tissa Vitarana, The Sri Lankan who
challenged global giants
Bibile, S, and Lall, S, 'The Political Economy of Controlling
Transnationals: The Pharmaceutical Industry in Sri Lanka
(1972-76)',
World Development, August 1977.
See also
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