Hospitals and clinics have long been considered as sanctuaries for patients. Whether you have a fractured rib or a terminal disease, once you place yourself in the care of a nurse or a doctor, you feel a sense of calm. You know that you have placed yourself in the hands of a qualified professional and that (s)he will do everything humanly possible to promote your physical and mental well-being.
Unfortunately, few can claim to enjoy such bliss when they walk into a hospital or clinic in Bangladesh. Whether the healthcare service provider is a run-down clinic in a remote locality or a sprawling multi-disciplinary specialized tertiary care hospital, one cannot help but be overcome by a brooding sense of doubt and concern when seeking medical services. Recent events have only sought to exacerbate the deepening crisis of confidence in medical services.
In March, the country’s leading private hospital, Apollo Hospital was raided by law enforcement agencies and representatives of the Drug Administration Directorate and the Health Ministry. Counterfeit drugs bearing the names of foreign manufacturers were found to have been sold for years from the hospital pharmacy. Expired reagents were found and seized from the hospital’s laboratory. Another raid at United Hospital’s pharmacy and laboratory in February earlier this year, found expired reagents and surgical thread in the hospital’s stock. Fines were slapped. Arrests were made.
But no one truly believes that we have seen an end to the supply of counterfeit drugs. In fact, such incidents greet us on a regular basis to remind us of the criminal proclivities of our fellow citizens. Less than six months ago, in November last year, students of Jahangir Nagar University set fire to expired medicine which were being sold by the University’s medical centre. The agitated students were pacified only after being assured that appropriate measures would be taken against the offenders. In February last year, pharmacies in the outskirts of the city were raided and their owners were sent to prison.
Yet notwithstanding the widely publicized raids, the business of selling expired medicine continues to flourish. None can however blame the regulatory framework for the booming industry of counterfeit drugs. For there is no dearth of laws for prosecuting suppliers of expired medicine. The Drugs Act, 1940, enacted in colonial times is a robust legislation which prohibits the manufacture, sale and distribution of drugs that are misbranded (which includes counterfeit drugs) and/or do not conform to a specified standard. The Act facilitates the punishment of the accused with upto three years imprisonment, a fine and also the confiscation of the drugs.
Four decades later, the Drugs Control Ordinance, 1982 was enacted making the manufacture, distribution and sale of adulterated and misbranded drugs punishable by imprisonment for up to ten years and a fine of Tk2,00,000. Furthermore, the Ordinance proscribes the manufacture and sale of sub-standard drugs, making it punishable by imprisonment for up to a term of five years and a fine of Tk1,00,000. The Act of 1940 and the Ordinance of 1982 have recently been supplemented by the enactment of the Consumer Rights Protection Act, 2009 which establishes a Directorate for National Consumer Rights Protection. The Act of 2009 not only proscribes the distribution of adulterated and expired medicine, but also empowers the Directorate to close down establishments which are engaged in manufacturing and selling adulterated or expired medicine.
Yet with all these weapons stacked in its armoury, the actions taken by the authorities to curb the supply of counterfeit drugs appear to be woefully inadequate. Sporadic drives and raids have brought to light the pervasive nature of the business, but have failed to stem the tide of counterfeit drugs supply. Pharmacy owners who are handed a fine for contravention of drugs legislations duly pay the fine, while those arrested are released on bail within a short period. And invariably, they all resume their business with renewed zeal.
A starting point for addressing this crisis would be to increase regulatory oversight of the retail pharmacies in the country. According to a Report of the Systems for Improved Access to Pharmaceuticals and Services Program (SIAPS) submitted to USAID in 2015, there are over 1,00,000 licensed retail pharmacies in the country and an almost equal number of unlicensed pharmacies dispensing drugs over the counter. The vast majority of the country’s retail pharmacies are manned by people who have no training in serving prescriptions for drugs, let alone being qualified as pharmacists under the Pharmacy Ordinance, 1976. The Ordinance prohibits the sale and distribution of drugs and medicine without a certificate of registration issued by the Pharmacy Council, but is rarely enforced, facilitating the unabated supply of counterfeit drugs.
While the adoption of stringent measures to shut down unlicensed drug stores is no doubt commendable, an abrupt and en masse closure of such drugstores is likely to be counter-productive as it is undeniable that these stores serve a useful purpose in facilitating easy access to medicine.
Rather, endeavours should be made towards bringing pharmacies across the country within the scope of the government’s regulatory regime. This could be done by bringing appropriate amendments to the governing law and offering training to existing dispensers as per the curriculum designed by the Pharmacy Council, simplifying the process of drug-licensing, and increasing the frequency of inspections by drug inspectors. The Pharmacists’ Code of Ethics, which has long fallen into disuse, should be incorporated into everyday practices of retail drug stores such that paramount consideration is given to the welfare of patients, with emphasis being placed on an assessment of the individual patient’s needs and the clinical appropriateness of medicines supplied to consumers.
It is also imperative that the government works closely with relevant stakeholders, including the Bangladesh Chemists and Druggists Association and the Consumers Association Bangladesh in order to combat the supply of adulterated drugs and to ensure the integrity and quality of products being supplied to patients.
Imran Siddiq is a lawyer practising in the Supreme Court of Bangladesh