S

ustainable development policy institute (SDPI)is an independent and non- profit

organization, which was formed with te recommendations of Pakistan conservation
strategy (NCS) in august 1992 to serve in the field of policy analysis and development,
policy advisory services and policy interventions towards sustainable development.

SDPI defines Sustainable development as the peace enhancement, social justice and well-being.
SDPI hatch the knowledge that can boost the government capacity to make wise policy decisions
and to engage CSOs on the issue of public interest. SDPI is performing two field functions: and
advisory role through systematic research, advocacy and policy advice and an assisting role
through providing resources, material and trainings to other individuals and organizations. SDPI
take responsibility to advocate on the issue of this hiked drug prices in Pakistan. In this report
SDPI shape their detailed advocacy strategy towards achieving their advocacy objectives.

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1. Advocacy Strategy for Hiked Drug Prices in Pakistan

1.2 BACKGROUND

The Sustainable Development Goal 3 presented by the UN emphasizes that there is an urgent need
to ensure that everyone has access to quality treatment at affordable costs. Therefore, among
several interventions, one method to control health-care costs is to make sure that medicines are
reasonably priced and affordable to the general population. However, affordability of medicines
seems to be of low importance to policymakers in Pakistan.

Half of Pakistan's population lived below the poverty line and they went to public hospitals for
medical treatment. The conditions in public hospitals are very poor. Instead improving the facilities
and providing the free medicines to all the patients coming to the government hospitals, Drug
Regulatory Authority of Pakistan through SRO 34(I)/2019 issued in January 2019 notified an
increase of 9% over and above maximum retail price (MRP) of medicines in hardship cases i.e.
drugs with cost of manufacturing exceeding market price; and 15% on all remaining medicines
(excluding medicines included in the former clause) registered with the authority. It is alleged that
a few pharmaceutical companies increased drug prices up to 24 per cent, as they considered both
15% as well as 9% increase under hardship cases applicable in their cases, whereas some went
overboard in taking undue advantage of the changing situation and hiked the prices at an
unbelievable rate, ranging from 40% to a whopping 100% and beyond. The price hike would
impact the rate of some 24,000 including lifesaving drugs such as medicines for heart ailments,
brain diseases, cancer, children's diseases, and post-surgical drugs, etc. medicines (Urdu Point
/ Pakistan Point News – 31st January, 2019). The sudden rise in drug prices caused great distress
and drew a lot of flak especially from low- and middle-class patients that were on regular
medication. People with budgets set for weekly/monthly medicine supplies are now distraught
over being unable to afford a basic necessity and human right ever since the exorbitant rise in drug
prices.

A major reason for this uncontrollable price hike is the devaluation of the rupee against the dollar
during the last one year, which in turn pushed up the cost of raw materials and packaging
materials. Similarly, increased in the gas and electricity tariffs also burdened the pharmaceutical
industry, along with additional duties and interest rate hike. Since some multinational companies
recently wrapped up their businesses, there has been a desperate shortage of life-saving drugs.

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Another major reason of this unacceptable hike in drug prices is the poor standard of the apex
drug regulator in the country, DRAP was currently at level three of World Health Organization
(WHO) standard certifications while other countries in the region were already on the seventh
level. Because of this unsatisfactory performance and poor control of the Drug Regulatory
Authority of Pakistan (DRAP), other pharmaceutical companies ignored DRAP's notification and
instead raised the prices higher than approved rates by confiscating their stocks. And the owners
of pharmaceutical companies are openly saying that they run businesses and are not doing charity
work.

In Pakistan and they need medicines, and these lifesaving medicines are not available in the market
(WHO 2017).The issue of rising medicine prices has been discussed for months but could not be
addressed. Considering all these stuff SDPI take initiative to advocate on this unjust act of
responsible bodies and Federal government to provide relief to this poor nation who are already
suffering from rapidly increased inflation.

1.2 AIM:

Sustainable development institute (SDPI) works inside and crossways the generations concerning
to the enrichment of peace, social justice, and well-being. So being aligned with the mission
statement of SDPI taking the initiative to advocate on the issue of this intolerable or unjustified
scramble in drug prices by the federal government and DRAP and also focus on development and
improvement of health sector.

The decisive aim of this SDPI’s advocacy strategy is “to encourage and influence primary key
decision makers to control the rambled prices of medicines in Pakistan and availability of quality
and efficacious medications at affordable and inexpensive cost. Besides this also ensured the
accessibility of new treatment opportunities for the population of Pakistan”.

1.3 OBJECTIVES:

As mentioned above, the goal of SDPI advocacy campaign is to get down the medicine prices in
Pakistan. Therefore following are some specific objectives have been identified to pursue this
advocacy campaign:

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  To recommend reforms in laws, regulations and operation of DRAP in order to improve
the system for effective monitoring of prices and the standard of medicines being sold in
the markets.
 To pressurized the federal government and relevant authorities to take stringent actions for
immediate reversal of price hike
 To raise public awareness on substitute cost-effective medicines
 To demand serious and immediate actions against those pharmaceutical companies who
illegally raised the prices of medicines by more than 100 per cent.

1.4 IDENTIFYING KEY DECISION-MAKING BODIES:

SDPI have identified some key decision makers and regulatory bodies who are responsible to
regulate the effective and affordable drug's mechanism in Pakistan. Their names and details are
given below.

 Drug Regulatory authority of Pakistan

 Drug pricing committee
 Ministry of national health services, Regulations, and coordination (NHSRC)
 Pakistan pharma bureau
 Pakistan pharmaceutical manufacturers association (PPMA)
 Senate standing committee on National Health
 Provencal Health department
 Senate standing committee on national health
 Competition commission of Pakistan
 National assembly standing committee on national health

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 1.5 PRIORITIZATION OF KEY DECISION MAKERS:
HIGH

Keep satisfied Manage closely

 Ministry of National Health Services,
Regulations, and Coordination
(NHSRC)
 National Assembly Standing
Committee on National Health
 Senate Standing Committee on
National Health
POWER
 Drug Regulatory Authority of
Pakistan (DRAP)
 Federal Government
 Drug Pricing Committee DPC
 Pakistan Pharma Bureau
 Provincial health departments

Monitor Keep informed

 Competition Commission of Pakistan
 SDPI advocacy department (CCP)
 Media channels  Pakistan Pharmaceutical
LOW

Manufacturers Association (PPMA)

LOW INTEREST HIGH

Drugs regulatory authority of Pakistan (DRAP) is responsible to regulate drugs in Pakistan, under
the drug act 1976 and works under the federal government. According to DRAP act 2012, after
the recommendation of DPC, Provincial government’s regulation includes sales, distribution and
shortage of drugs whereas enforcement matters like registration, manufacturing, pricing, import,
exports and drug monitoring comes under the sphere of federal government regulations.
Prices are fixed by the federal government. DPC consist on the members of provincial health
departments, consumer bodies, and finance ministry. This committee constituted the statutory
regulatory order in august 2103 regarding prices control. Particularly in perspective of Pakistani
government, DRAP and provincial health departments are responsible for regulating
accessibility, quality and availability of medicines in markets and has taken various steps in terms

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of these regulations. That’s why in the power interest grid DRAP, DPC and federal government
are considered to be manage closely.
Competition commission of Pakistan is the regulatory body in Pakistan which is maintain
competition within the markets of Pakistan and insuring to delivery of complete information to
consumers. Another primary and influential key decision making authority is Pakistan pharma
bureau, which represent the local industry and interface for dealing with government on drug
trade and production. In this unjustified hike of drug prices, pharmaceutical companies are playing
prominent role.
Another primary decision maker is The Pakistan Pharma Bureau represents the local industry
and forms an active interface for dealings with the government on drug production, pricing, and
trade. Ministry of National Health Services, Regulations, and Coordination (NHSRC) is
responsible for the Enforcement of Drugs Laws and Regulations in the country and Oversight for
regulatory bodies in the health sector and insured availability of equitable and affordable health
services to the general public.
Pakistan Pharmaceutical Manufacturers’ Association came into existence on January 26, 1961,
and the Government of Pakistan through the Ministry of Commerce registered PPMA as the only
Representative body of the Pharmaceutical Industry in the Country. The Government issued a
License to this effect under Section 26 of the Companies Act, 1913 on July 18, 1961 .and is the
responsible to improve the working conditions of pharmaceutical industries and facilitate effective
input for achievement of objects for which the Association has been established and follow the
orders of DRAP and to ensure people access to safe, quality and efficacious medicines at affordable
prices in the country.
These all identified key decision makers have an important authority to control this miserable
situations. So for an effective advocacy effort we will take on board all of them either they have
less of more power to influence.

1.6 STRATEGY TO INFLUENCE PRIMARY DECISION MAKERS:

SDPI advocates public issue through public awareness campaigns, community mobilization and
through research-based policy recommendation.

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Modes of Activities/ strategies Objectives Timeline
advocacy
Advocacy 1. Public Seminar 1. To hold and generate public 15th April
Events: 2. Public Conferences debate through engaging
decision makers, health
officials, independent experts
and media to enhance outreach
and on the public issue of price
hike of medicines.
Community 1. Campaign on Social 1. To mobilize citizens towards Side by side
mobilization : Media platforms (i.e. sustainable change Continued till
Twitter, Facebook, Spread awareness about usage objectives are
campaigns on alternative drugs achieved.
2. Creating a petition
Direct action: 1. Rallies, long march or 1. To influence the decisions of April last
protests responsible authorities. week.

Critical rhetoric 1. Talk shows, 1. To Questioning or criticizing Every

documentaries and short the legislators and regulatory weekend 8:45
video packages on SDTV. bodies their ineffectiveness PM
through partnering with
mainstream media
Lobbying 1. Holding briefings with 1. Direct lobbying with It’s Optional
parliamentarians. legislature for policy change when possible
Face to face meetings. Meetings with Key government or necessary.
functionaries to share key
recommendations.

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1. As stated already in SDPI advocacy strategy goals that its control hiked prices of drugs in
our country by influencing or persuading the crucial and key decision makers. So SDPI
decides to conduct different public involvement activities for advocacy of the issues,
activities regarding public seminar, media campaigns and community mobilization. The
SDPI steered a special seminar titled ‘hike in drugs prices in Pakistan; myths and realities
on 15th April 2019, where key decision makers, opinion leaders, general public and media
were invited. The panelists include:

In this regard, SDPI conducted a special seminar

o Mr. Asim Rauf, Chief Executive Officer, Drug Regulatory Authority of Pakistan DRAP.
o Senator Mian Muhammad Ateeq Shaikh, Chairperson, Senate Committee On National
Health Services Regulations And Coordinations
o Dr. Nisar Ahmed Cheema, Member National Assembly ( PML-N)
o Dr, Nausheen Hamid, Parliamentary Secretary, National Health Service, Regulations &
Coordinations
o Chaudhary Ansar Farooq, Chairman Pakistan Pharmaceutical Manufacturers
Associations ( PPMA)
o Ms. Vadiyya Khalil, Chairperson, Competition Commission of Pakistan

These all respectable guests or speakers including legislative bodies, opposition party
members and other responsible authorities discussed briefly about the current scenario or
issue of increasing prices of drugs in Pakistan. They people give some reasons behind this
concern and also suggest or recommend different ways or alternatives to overcome the issue
and control the prices of drugs in our country by effective means. Media channels
representatives were also part of this seminar and effective cross-questioning was seen
among worthy panelists, public and media.

2. Another strategy is usage of social media will be started a very next day to seminar. The
purpose of this social media campaign is to influence the relevant legislative bodies or
experts and mobilize general public. And also ensure public involvement through social
media by running the twitter trend “Adwiaat sasti karo”.
3. After media campaigning we will be approach towards electronic media to enrich our
campaign. More other tactics are used containing writing blogs or op-eds in leading dailies

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 and media advertisement through documentaries or short video packages on different
channels. These ways will be very obliging to create awareness and ability of critical
exploration regarding issue among citizens.
4. In mid of April, Online petition filed by mentioning Prime Minister Imran khan, titled
“Show misery to poor” via Mr. Asim Rauf, Chief Executive Officer, Drug Regulatory
Authority Of Pakistan DRAP. And other concerning bodies including national and
international unions will be helpful to seek the attention of key players.
5. In every year, Immunization Week is celebrated in last week of April around the world. So
we have decided to rallies will be arranged on last week of the month. The worldwide aim
of this week is to promote the use of vaccines to protect people against diseases. So a rally
will be organized by SDPI with coordination of relevant stakeholders for highlighting the
importance of the vaccines along with inaccessibility and hiked prices of these vaccines.
6. Lobbying with primary decision makers will be a great step towards achieving this goal.
SDPI senior advocacy team may arrange a persuasive advocacy team from outside or inside.
Although most of the time SDPI don’t involve in direct lobbying, but this is also an effective
advocacy strategy which can be prove very useful towards achieving this advocacy
campaigns objectives.

1.7 KEY MESSAGE

The intolerable increase in drugs prices creating more problems for deprived societies’ people who
are already affected by thrilling inflation. So there is a huge need of amendment in the relevant
agenda appended to the Drug and Pricing Act. The government should have to review prices
matter or to place stern policies on price control, and also actions to be taken in case of illegitimate
price scrambles.

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Narrative Summary Measurable Means Of Assumptions.
Indicators Verification
Goals 1. Audit of DRAP 1. Actions details 1. Local Community and relevant
have been conducted taken by federal bodies are accepting and
Ensure access of safe, quality by Federal government. appreciating this campaign.
and efficacious medicine at government.
affordable prices for the people 2. Change in 2. Cooperation from local
of Pakistan 2. Increase in DRAP regulations. community and relent departments.
awareness and
community
Objectives 1. Leaders are 1. Increase in 1. All stakeholders are fully
1. Decrease in drug prices in talking about this act awareness of cooperative.
Pakistan. of DRAP and federal general public and
government. mobilization of 2. Pharma companies are sealing by
2. Strict actions against government regulatory bodies.
pharmaceutical companies and 2. Relevant authorities.
Transformation in regulations responsible
and operation of DRAP authorities are taking
actions against
Pharma companies.
Output 1. Evaluation 1. Maintaining support of all
report of relevant departments and proper
Advocacy campaigns and 1. Number of implementation support for successful campaign
activities. e.g. advocacy campaign advocacy plan. execution.
 Seminars. activities.
 Rallies. 2. Campaign 2. DRAP and PPMA and other
 Petitions. completion report. bodies’ willingness to encourage
 Twitter trends. SDPI campaign for decrease in
3. Campaign rising prices of Drugs.
directors report.
Input Activities: 1. Campaign 1. Received appropriate support and
budget money on time
1. Develop advocacy plan and 1. Identify target 2. Official 2. Proper implementation of
campaign schedule. areas and decision Confirmation of campaign activities on time without
makers and Contact campaign Approval exclusions.
2. Meetings with advocacy with them. document 3. No political interference in
department members. 3. Meetings campaign activities.
circulars 4. Timely meetings with relevant
3. Assign duties to advocacy 4. On time work & authorities.
team for managing advocacy within budget. 5. No unforeseen activities on site
activities.

LOG FRAME ANALYSIS

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