Sri Lanka’s economic turmoil and the value of Senanka’s biblical drug policy – ​​The Island

Dr. Ajit Kumara
consultant doctor
President, All Ceylon Medical Officers Association

Professor Senaka Bibire is the greatest medical benefactor Sri Lanka has ever produced. During his school days, he was an all-rounder. He excelled in academic and extracurricular activities, including sports and arts. He completed his 1st, 2nd and final MB exams all with first class honors and won the coveted Janjishaw Gold Medal in Medicine with his Dadaboy Gold Medal and Lockwood Gold Medal in Surgery in the finals. Did.

Both his genius and his Marxist ideology motivated him to devote the rest of his life to the mission of developing medical education and implementing a national drug policy that was overwhelmingly supported by many countries and organizations around the world. rice field.

National drug policy background

The capitalist system is flawed by the nature of commodity production. After World War II, there was a temporary progression, followed soon after by the Great Depression, the OPEC oil crisis, the second British banking crisis of 1973-1975, the Latin American debt crisis, etc. recession followed.

Sri Lanka’s balance sheet has also steadily deteriorated since the 1960s, with economic growth gradually declining from 4.6% in the 1950s and 1960s to 2.6% in 1974. INR 33 million (INR 20 million for private sector, INR 13 million for imported goods in private medical stores). 24 million (14 million and 10 million rupees respectively). Regardless of population growth and steadily rising drug prices, these drastic cuts in health care costs have led to a significant reduction in per capita drug supply, jeopardizing health care across the country. Therefore, the Prime Minister has asked Professor Senaka Bivir to cut costs without compromising patient care.

By 1970, Sri Lanka, like most other countries, had no national health or drug policy, and drugs were distributed through private medical outlets and local agents of 134 foreign suppliers for the government and private sectors respectively. It was imported separately by the store. Both the government and the private sector were heavily influenced by the propaganda of multinational corporations (TNCs).

Key Recommendations in National Drug Policy

List of essential medicines

Professor Senaka Bibire started publishing the Ceylon Hospital Formulary from 1957 to identify essential medicines for hospitals and in 1958 introduced the concept of Essential Medicines List to Sri Lanka. It was new to the world and was later adopted by the WHO and other countries to ensure a continuous supply of essential medicines at the lowest possible cost.

When preparing the drug list, many counterfeit drugs that do not contribute to the therapeutic effect of specific drugs selected in consideration of economic efficiency, many fixed combination drugs, drugs with no clear therapeutic value, and highly toxic drugs are excluded. it was done. Drugs that differ slightly in structure from known drugs but have the same therapeutic effect (me-to-drugs) have also been removed. As such, he was able to minimize the drug list from approximately 4000 prescriptions to a reasonable number (approximately 600) without adversely affecting patient care.

Centralized purchase

The next major recommendation was to centralize the purchase of both finished medicines and pharmaceutical chemicals for local manufacturers according to a streamlined list. We have initiated this task of wholesale import of medicines and pharmaceutical raw materials and purchase of locally processed medicines. By the end of 1973, we were able to take over all imports.

We have saved a lot of money by shopping around the world and accepting bulk low-price bids instead of finished products. Certificates and independent quality certificates from reputable laboratories, agencies or public bodies should be produced.

He proposed the following formula to understand the price of a drug in order to reduce its price scientifically (see table).

CIF Value (Cost of Goods, Insurance and Freight) 100 Commission 05 Import Duty 25 Wholesaler Profit 35 Retailer Profit 35 Price to Consumer 200

By wholesale importing raw materials and bulk medicines at the most favorable prices (at the lowest possible CIF values), Prof. Bibire believes that pharmaceuticals can be obtained rather than fighting to limit the profits of wholesalers and retailers. I pointed out that it will be possible to sell at the lowest price.

ignore patent law

Another recommendation was to repeal the patent law. Until that time Sri Lanka could not purchase patented products from other manufacturers, even if the medicines were manufactured by a different process. You could not buy a cheap product made by a process. Therefore, only process patents apply, similar to how patent law operates in many countries such as Japan, Sweden, Denmark, Switzerland, and most socialist countries. proposed to amend the patent law so that product patents would not apply.

Drug distribution and advertising

The repackaging of medicines imported in bulk and the distribution of medicines to the government and private sectors should be carried out by national trade cooperation.

Pharmaceutical companies and their representatives should stop advertising medicines and educating doctors about medicines through brochures, and local manufacturers should also work together to promote their medicines.

nomenclature

The report strongly recommends using generic names of medicines instead of brand names in prescriptions.

state pharmaceutical industry

Manufacturing of medicines in the country should also be initiated under guidelines set by the government according to the list of essential medicines using state-imported materials, with advertising and distribution left to the state. If any manufacturer is found to be defiant, the government has the power to nationalize them. In 2015, it increased to 71 medicines, saving more than US$450,000 for the country.

Pharmaceutical quality control

It was proposed to set up a quality control laboratory with trained staff. Initially, he suggested acquiring a consultant for the Institute and training staff through WHO until a local counterpart could take over the function.

Pharmacies, pharmacists and their training

This has been one of the most neglected aspects of the healthcare system up to that point. He received support from his Dr J. Chilton at the University of Glasgow and his Pharmacoloy consultants at WHO to recommend the training of pharmacists and the establishment of model pharmacies in hospitals in Colombo. The pharmacology course was later upgraded to his two-year university diploma course, following his suggestion.

In addition to these, the report also covers research, monitoring, and continued development of human resources and infrastructure.

Therefore, when analyzing biblical policy, it is clear that it is not simply an attempt to control the price of drugs, but a very comprehensive national strategy of the pharmaceutical sector in the health care system..

national drug policy to the world

Professor Bibire was given the opportunity to present his novel drug policy model at the 1976 United Nations Conference on Trade and Development and was quickly endorsed by the World Health Organization (WHO) and other United Nations agencies. third world countries.

By 2000, more than 100 countries had national pharmacy policies, and 88 countries had introduced mandatory drug concepts into their medical and pharmacy curricula. In 1971, both Chile and Sri Lanka initiated centralized procurement, but Chile failed due to lack of pharmaceutical power and strong political will.

In the early 1980s, Bangladesh was the second poorest country in the world with an average per capita income of US$130. But they have succeeded in enacting national pharmacological policies through strong political commitment, and say that if there is a key element of political will and commitment, real progress is possible regardless of the power of the pharmaceutical giants. You have set a good example for the world.

Sri Lankan failure

In Sri Lanka, there were signs of failure from the beginning of policy implementation. In his 1976 report written by Professor Bibile and Dr. prevented the implementation of

Sri Lanka is currently facing a severe economic crisis, lacking foreign exchange and unable to provide basic requirements such as food, education and health of its citizens. Hospitals are running out of drugs, including life-saving drugs and surgical supplies.

Nevertheless, there are numerous combinations of different types of vitamins. A lot of unproven drugs, I am also a drug, and many counterfeit drugs on the market are wasting our foreign currency! About 30% of medical expenses are spent on medicines.

If Sri Lanka had implemented a biblical drug policy and imported medicines according to the essential medicine list, it would have been able to efficiently use its medical budget to purchase them and avoid wasting foreign currency on unnecessary medicines. I should have. It will be a quick solution to the current crisis in essential medicines. As previously planned, the start of pharmaceutical manufacturing would be an excellent way to earn much-needed foreign exchange in the long term. Therefore, implementing biblical drug policies is more important today than ever as a comprehensive approach to the health system crisis to ensure the availability of essential medicines.