Proposed switch to generic drugs would improve transparency of medical system, say doctors

A proposal currently under review would allow doctors to provide medication directly from health centers, bypassing the prescription process which often leads patients on a wild goose chase around Male’s pharmacies.

State Health Minister Ibrahim Waheed yesterday announced that the proposal is being discussed with health corporations, and that prescriptions could be ruled out by next June at the earliest.

He further suggested that a large pharmacy would be established in every atoll hospital, and would supply products to other health centers across the atolls.

Health Minister Aminath Jameel reportedly did not respond to most questions posed by MPs regarding health corporations at a committee meeting yesterday. Speaking to Minivan News today she said the proposal fell under the ministry’s remit but that she did not have the details and was unable to comment.

Other officials and offices at the Health Ministry had not responded to phone calls at time of press.

Generic drug-based systems which include hospital-centered distribution are commonly practiced in other countries, sources say.

The World Health Organisation supports the use of generic drugs, particularly in developing countries.

In a speech earlier this year, WHO Director General Dr. Margaret Chan said, “Generic products are considerably less expensive than originator products, and competition among generic manufacturers reduces prices even further. Generics serve the logic of the pocket. An affordable price encourages good patient compliance, which improves treatment outcome and also protects against the emergence of drug resistance.”

CEO of Indira Ghandi Memorial Hospital (IGMH) Cathy Waters said the hospital had not been officially informed of the proposal, but noted that pharmacies were generally not well-stocked and that there were multiple available brands.

Medical Director at Male’ Health Service Corporation Dr Robert Primhak said he “would welcome an improvement in pharmaceutical supply and prescribe system.”

According to Primhak, doctors currently prescribe drug brands rather than generic medications. Shifting to a generic drug-based system would mean that a list of nationally-approved drugs would be available for the first time in hospitals, clinics and pharmacies, a “major improvement” that would improve the medical system’s transparency.

However, such a shift would also require “robust quality control” and a centralised import and supply system, Primhak said.

These reforms could take the edge off of the medical import and supply business.

“There’s no business advantage in stocking medications that are not commonly used,” Primhak explained. “For example, a baby who is born with a heart problem needs a specific drug to keep a vessel open. We might get that case three times a year. But instead of stocking these specialised drugs which are only rarely used, the retailers prefer to stock common drugs and brands that will sell, because they know that they can get a turnover.

“The drugs that are imported are the ones they want to sell, not the ones we want to prescribe.”

MPs yesterday voiced concern that the proposed system would incur huge losses for pharmaceutical importers.

Minivan News asked Primhak if medical decisions in the Maldives were driven by business interests and ought to be re-directed towards serving the people. “Yes, to both points,” he said.

Chief Operating Officer at ADK Hospital and former head of the Center for Community Health and Disease Control (CCHDC), Ahmed Jamsheed, believes the proposed change would engender a stronger monitoring system by default.

“The new system would move towards generic drugs which would make it easier to monitor drug quality and standards, and bring down the price,” he said.

It would also improve patient convenience. “Now, a medication prescribed by a doctor in ADK may not be available in the hospital pharmacy, so the patient has to hop around to different pharmacies to get the prescription filled.”

Jamsheed believes the change would benefit the Maldives’ medical system but agrees that the focus should be on people, not corporations.

“Currently, there is a big network of pharmacies, most of which are privately owned. It is known that most pharmacies are poorly monitored, and the authorities are unable to control them. Many prescription-only drugs not meant for over-the-counter sale are actually available to anyone who asks. That carries a huge risk for the patient community.”

Usually, Jamsheed said, a small country like Maldives only needs one or two sources for importing the drugs. But he said the MPs have a point: standardised markets don’t foster high profit margins. “But at the end of the day, the government has to consider whether the system is best for the country and its people,” he observed.

Under the proposed 2012 state budget, Rf2 billion is allocated to the health sector; Rf638 million of that amount is to be used for developing mechanisms providing easy access to health care. Another Rf543 million is designated to developing atoll health centres under Public Private Partnership.

The budget also allots R720 million to the universal health insurance scheme, due to take effect in January 2012, while Rf100 million is to be spent on health corporations’ capital investments, which are made to improve their services.


6 thoughts on “Proposed switch to generic drugs would improve transparency of medical system, say doctors”

  1. The business regulators in Maldives do not realize that it is their legal responsibility to regulate this very unfair business. For ages, the the few pharmaceutical importers have monopolized and milked the Maldives market and fed them poor medicines.

    Hopefully the anti-corruption office will investigate business situations which allows consumers to be exploited due to failure to implement regulations.

  2. Introduction of Generic drugs would overall be a good move. However, what's worrying is whether the relevant authorities will be able to monitor the quality of the drugs and whether the hospitals will have the efficiency to educate each and every person, not just doctors, dealing with patients on how generic drugs work. People also need to be educated on the fact that Generic drugs are not low quality, which is the immediate assumption of a lot of people. And the MFDA needs to step up to ensure transparent regulations and policies are or will be in place to ensure that the generic drugs are sourced from reliable and reputable manufacturers. Last, but not least, the government should provide the private sector with adequate time to make the necessary changes to their imports, and enable everyone to compete on an equal footing. While pharmacies have to a large extent abused and misused the prescriptions needed by patients, with stringent laws and effective monitoring, there can be room for the private sector in importing and supplying reliable and good quality generic drugs.

  3. I think this takes us one step step backward.
    The problem with generic drugs is quality control. This facilitates every Tom, Dick and Harry to sell generic drugs cooked inside his own kitchen.
    Health Ministry should really know better.

    I am surprised that Aminath Jameel does not have enough information about this. She is the Heath MInister. If she does not know whats going on in the health sector, who does?

    No wonder out health system is complete chaos.

    Get rid of all the uneducated people in top level government positions who think they have bright ideas. Then this government can improve the health sector.

  4. @ Kareemuddin: Generic drugs manufacturers are subject to same standards as others, as far as manufacturing is concerned. They would also need approvals for the drugs. The difference is they dont have RnD facilities as such.

    Please dont blindly say stuff, ur ignorance is showing,

  5. I am a doctor and i have never prescribed generics to my parents....but in a third world resource limited poor country like Maldives we would have no choice but to use generics for the average patient..From my own experience I have strong reservations about generics from India and Pakistan, and not all drugs are available as generics.Generics from countries such as Malaysia and Thailand are of much better quality but a bit more expensive as well....The health ministry lacks the political will to monitor the situation and guarantee quality of medicine for our patients...I agree with @ Kareemuddin that health minister should be able to defend her position and basically give us more information on how this thing will work and that foreign supplier of all the medicine used in the Maldives will not be awarded to some unknown Indian company with dubious political contacts with Maldivian elite.

  6. @ SI

    Of course, you do not have the slightest information about the pharmaceutical industry. So better believe what I said.


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