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Working Towards a Healthy Pakistan

Published in Mar-Apr 2021

Assessing the challenges faced by Pakistan’s healthcare system.

The government calls the Pakistani pharmaceutical sector the ‘Sunshine Industry’, but we are not sure how bright the sun is shining. The policies that have proved successful in the region should be modelled, formulated and implemented in Pakistan. While concerns in this sector were prevalent long before, Covid-19 highlighted some alarming systemic issues that need to be addressed as a priority. Major upgrades are required at the state level to bring our pharmaceutical sector at par with the rest of the world. This includes boosting regional trade, reassessing the tax and governance system, focusing on primary healthcare, establishing quality control mechanisms and being environmentally conscious, among many others. It is high time we are prepared for locally manufacturing biologicals, as although the virus has been kind to our genes, we must not take any pandemic lightly or expect that another pandemic will not strike again.

API Vs Local Production – The Right Fit for Pakistan

Active Pharmaceutical Ingredients (API) is a capital, energy and technology intensive process. It requires downstream channels and industry, chemicals and engineering, an area where Pakistan is weak. Therefore, the government’s support in setting up vaccine manufacturing, oncology and biological plants will add value while contributing to reducing imports, as well as contributing to exports. Pakistan’s pharmaceutical industry can benefit from importing APIs and investing in local production of the finished product, as opposed to directly importing the finished product, as this would drive the costs higher and ultimately prices. In Pakistan, the pharma industry manufactures 90% of medicines locally, employing millions of people, which if imported, would be very expensive. Also, given the current constraints the pharma industry faces, it is more financially feasible to continue importing APIs instead of opting for an approach to manufacture them locally. Many would argue that producing APIs locally can resolve the pricing issue; however, this is a half-baked notion. It can take up to 21 reactions to produce APIs with highly sophisticated machinery and solvents that are also imported, making the entire process very costly.

Tax and Governance System

Pakistan has one of the highest tax rates in the world and no provision of services to back it – with 37% Corporate Tax and 17% General Sales Tax (GST). The Tax to GDP ratio and the Tax Per Capita is the lowest in the region which has huge implications on health, industry, science, and technology.

Low Percentage of GDP Spent

Pakistan spends less than half of what the World Health Organization recommends nations should spend on healthcare. We also spend less than half of what most middle-income countries spend on health as a percentage of the GDP. The government must increase the percentage of GDP spending on health from the current 2.6% to six percent. They must also implement import substitution to increase manufacturing as a percentage of GDP from the current 13.5% to 25%. This might not be possible to achieve until and unless we increase the tax to GDP and tax to population ratios to match other countries. Pakistan can only improve its healthcare sector if it improves its Gross National Income and education, and has bilateral trade within the region. If we look at Pakistan’s GDP as a share of India’s GDP, we see a major decline from 14% in 2006 to nine percent in 2020.

Environmentally Unfriendliness

Since time immemorial, we have been draining natural resources and not giving anything back. Covid-19 has made us realise this more than ever. We now know that there is a limit to how much we can extract from the earth and how total depletion will thrust the planet into further turmoil with increased food insecurity, flooding, wildfires, famine and extensive human displacement. As we enter the post-Covid-19 era, we need to think about paying back to the system and investing in the prevention of disease rather than just the cure, starting with an investment in primary healthcare. Leaders from a broad spectrum have opined on this matter – from the Pope to esteemed scholars like Noam Chomsky – and have been warning us that climate change is the single biggest danger to mankind. In this regard, corporate leaders, corporations and governments must lead from the front and implement the legislation already on the books to ensure that all the effluents produced in offices, factories and homes are treated and turned into clean water before they are released into the city water system. There are only a handful of companies in Pakistan that have been designed in compliance with the globally recognised Leadership in Energy and Environmental Design (LEED) certification that is supervised, audited and granted by the Green Building Certification Institute (GBCI) in the USA. Pharmaceutical manufacturers need to invest in environmentally friendly practices to lower carbon emissions.

Poor Primary Healthcare System

Covid-19 has made us revisit our approach towards investment in primary healthcare and channel resources towards primary healthcare systems. We need to focus on disease prevention and disease surveillance rather than disease treatment, so that we can control the disease before it turns into an outbreak. We must invest and improve primary health, which is rated very low compared to the rest of the region. Meanwhile, tertiary health is bursting due to a poor primary health system. This pandemic has taught us that disease does not discriminate between anyone and knows no boundaries or geographical borders. Hence, the only way to tackle health crises of such a scale in the future is to increase funding on healthcare, both at a country level and globally, with a special emphasis on supporting the most vulnerable sections of the population. The solution lies in making primary healthcare more robust through awareness about improving lifestyle and consumption patterns.

Dr Wajiha Javed is Head of Public Health and Research, Getz Pharma.

Wajiha Farooq is Management Trainee, Getz Pharma.

Muhammad Ahsan Arif is Executive, Digital Communications, Getz Pharma.