Center for Climate Change

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EXPLORING THE INTERPLAY BETWEEN BUSINESS
REGULATION CORPORATE CONDUCT IN INDIA
(BRCC) MEETING AND PARTNERS WORKSHOP 26.06.12,
New Delhi

• Center for Climate Change
• Engineering Staff College of India (ESCI)
• Andhra Pradesh State Partner for BRCC Project

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OVERVIEW
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OVERVIEW PHARMACEUTICAL SECTOR

• Total Pharma Companies (Registered Units) in AP
  727
• - Small Medium Scale companies - 670
• - Large scale companies - Approx. 57

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OVERVIEW HEALTH CARE SECTOR

• Approx. 7000 Private Hospitals in AP
• 5400 are below 25 beds
• 1050 hospitals are above 25 beds
• 200 are 35 bedded hospitals
• 350 are above 100 beds

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METHODOLOGYField Work
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SURVEY FOR BRCC PROJECT

• Kakinada
• Vishakhapatnam
• Vijayawada
• Guntur
• Hyderabad
• Medak
• Ranga Reddy
• Mahaboob Nagar

Zone - I
Zone - II
Zone - III
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FIELD-WORK (PRIMARY RESEARCH)
The details of surveyors Zone wise Sri M.
Kameswara Rao (Visakhapatnam) Sri R.
Gopalakrishna (Kakinada)
Zone I Sri R. Sambasiva Rao (Vijayawada) Sri
C. Narayana Rao (Guntur) were allotted to do the
survey at respective places as the response was
not effective so the surveyors were changed. Sri
V. Venugopal and his Team Members (Vijayawada)
and Sri K. Sasidhar Reddy (Guntur)
Zone II Center for
Climate Change, ESCI members -- Zone - III
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DETAILS OF SURVEY COMPLETED
Zone - I
Zone - II
Sectors Number of samples collected
Pharmaceutical Companies --
Private Hospitals 34
Medical Representatives 20
Prescriptions 19
Sectors Number of samples collected
Pharmaceutical Companies 10
Private Hospitals 31
Medical Representatives 30
Prescriptions 33
Sectors Number of samples collected
Pharmaceutical Companies 30
Private Hospitals 09
Medical Representatives 13
Prescriptions 31
Zone - III
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FINDINGSPharma and Health Care Sector
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PHARMA COMPANIES STATED

• Environmental law should be implemented nation
  wide one state one law is unfair.
• Medicine should be affordable. This will happen
  when we encourage the local Pharma industries
  rather than going for imported medicine.
• To encourage local industries Government has to
  provide infrastructure. There is lot of gap
  between the present infrastructure facilities and
  the required facilities.
• NO isolated cluster for polluting industries.
  If all the Pharma industries are at one place
  then it is easy to mitigate pollution in cost
  effective manner. Solutions are there for
  pollution mitigation.
• Entrepreneurship in this sector had done very
  good job so that INDIAN PHARMA industry became
  world leader in 30 years. India started with 0
  now world leaders.
• Entrepreneurs done their part it is the
  responsibility of the government to provide
  necessary infrastructure and other things.
  Government failed in all aspects that not even
  provide infrastructure and not even working along
  with companies.

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INITIAL FINDINGS / SUGGESTIONS PHARMACEUTICAL
SECTOR

• Pharmaceutical companies should give the 25 -
  40 of production to the generic medicine shop,
  so that the medicine should be available at
  people at low cost
• Frequent auditing/third party inspection for
  the production and hazardous waste management
  should be mandatory and under the control of
  regulatory bodies.
• Non-licensed companies should be shut down as
  and when encountered.
• Strict rules for quality management and quality
  inspection should be prepared and controlled by
  government.
• Government has not deeply analyzed the cost of
  medicine/ inputs in pharma sector. This need to
  be done.
• Regulatory body should fix the cost of
  medicine.

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INITIAL FINDINGS / SUGGESTIONS HEALTHCARE SECTOR

• President, AP Nursing Home Association agreed
  that 90 of Doctors do NOT follow ethical
  practices.
• Also, that there is no Codes followed for
  diagnostics, prescription of medicines.
• No Corporate Hospital have any kind of CSR
  policy in place.
• Only 5 of hospitals are aware of NVG and
  Bio-Medical Waste Regulations.
• No hospital have defined charges for Diagnostics
  etc. They charge on the basis of opinion/ mood
  of doctor at the given time.
• Schemes like Arogyasri are more used for doing
  wrong diagnostics and non-required surgeries to
  get money from Govt. Moreover involvement of
  businessmen (as Hospital owner/ Chairman) make it
  more easy to extract money from Govt. due to
  network with politicians and higher officials.

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SuggestionsHealthcare Sector

• Universal Health Care plan is the best for
  country like India. In this CUBOID model, 100
  population is covered, with 100 financial
  coverage and payment is do e in advance i.e.
  prior to incidence of disease.
• Eg. In Europe that is Society based model where
  people pay the part of salary as tax, which is
  used for providing health care services. But its
  easy there as, their people work in organized
  sector.
• Whereas in India only 40 population work in
  organized
• sector, rest 60 approx.. live in rural area
  and work in
• unorganized sector.

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• For India, Eg. NAREGA- part payment can be
  cut and put into the pooled fund for health care
  of BPL / rural population.
• As OP is generally required by everyone once
  every year, 9 cases go for secondary treatment
  and only 1 go for tertiary treatment , this
  money can be used there, for achieving aim of
  Providing Health Services to All.
• National Level Committee need to work to
  establish the model for long term benefit of
  GOVT. HOSPITAL society. This will lead to
  reduction into Diversion of funds to Private
  Hospitals and will Improve Facilities, Infra
  and Work Environment of Govt Hospitals.
• Generally politicians come for 5 years and they
  see vote bank so they decide policies to give
  short term benefits. This is the reason that
  Arogyasri kind of scheme are focusing more on
  private and corporate hospitals rather than
  strengthening Govt. Hospitals (with doctors and
  facilities, equipments etc.) and local health
  care hospitals in rural areas.

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SOCIAL, ENVIRONMENTAL AND ECONOMIC IMPACTS OF
SUCH VIOLATIONS(AS GATHERED FROM SECONDARY/
PRIMARY RESEARCH)
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EVIDENCE- QUALITY OF WATER DUE TO POLLUTION FROM
PHARMA COMPANIES
Dirty water coming from the tap, due to Ground
Water Pollution caused by Pharma Companies. This
is used for day to day purposes in summer season.
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EVIDENCE SUGGESTING VIOLATION OF BUSINESS
RESPONSIBILITY IN THE BOTH SECTORS
1. There are many oral discussions with clients
and directors. 2. It was not mandatory to
collect the names of clients/ Directors
etc. PLAY VIDEO
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SECONDARY DATA COLLECTEDANDHRA PRADESH
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Eenadu dated 21 June 2012

• A report by a parliamentary committee has shown
  that the drug industry regulator, the Drug
  Controller General of India (DCGI), has been
  approving, on average, one new drug a month
  without conducting mandatory clinical trials or
  seeking expert medical opinionfindings that
  expose the deep flaws prevalent in Indias drug
  approval process.
• The committee has asked the health ministry to
  withdraw the discretionary powers given to the
  Central Drugs Standard Control Organization
  (CDSCO), which is headed by DCGI, to grant
  approvals to drug companies.

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Eenadu dated 21 June 2012

• The committee found that an overwhelming
  majority of the drugs were being approved on the
  basis of personal prescriptions and without any
  scientific evidence. The report concludes that
  there is adequate documentary evidence to show
  that (expert) opinions are written by the
  invisible hands of drug manufacturers and experts
  merely oblige by putting their signatures.
• The panel found sufficient evidence to
  establish a collusive nexus between medical
  experts, drug companies and CDSCO officials.

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DRIVERS/ FACTORS INFLUENCING BUSINESS
RESPONSIBILITY IN THE STATE
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• Political Constraints
• Desire of DOCTORS to earn money at any
• cost- may be organ trafficking or non-
• required surgery
• Corruption / Bribing
• Other factors like
• Absence of Planned cities / Industrial clusters
• Nexus
• Misuse of Government schemes like Aarogyasri
• Politicians looking for short term benefits
• 14 Licenses required by Pharma companies
• About 40 clearances required for establishing
• hospitals. No single window clearance to
  establish hospitals

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BRCC PROJECT IS SUPPORTED BY FOLLOWING
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SUPPORT FROM ANDHRA PRADESH POLLUTION CONTROL
BOARD (APPCB)
Meeting with Shri B.S.S. Prasad, Member
Secretary, Andhra Pradesh Pollution Control Board
(APPCB) for collecting data of Hazardous waste
and Bio-medical waste and to provide a letter
that is required to collect the data from
pharmaceutical and healthcare sectors. A letter
received from APPCB directing hospitals and
Pharma companies to provide certain data in the
prescribed format as a support of Business
Regulation and Corporate Conduct project.
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SUPPORT FROM ANDHRA PRADESH POLLUTION CONTROL
BOARD (APPCB)
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SUPPORT FROM ANDHRA PRADESH POLLUTION CONTROL
BOARD (APPCB)
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- COLLECTOR OFFICE, HYDERABAD- DMHO, HYDERABAD
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SURVEY OF ASSOCIATIONS
Dr. R.S. Saluja State President Andhra Pradesh
Private Hospitals Nursing Homes Associations,
Hyderabad - Details are furnished in the
prescribed format (Questionnaire)
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SURVEY OF ASSOCIATIONS
Dr. B. Bhaskar Rao MD, MS, DNB (CT
Surgery) Director, CEO, Chief Cardio Thoracic
Surgeon Krishna Institute of Medical Sciences
(KIMS) Hyderabad President, AP Corporate
Hospital Association - Details are furnished in
the prescribed format
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SURVEY OF ASSOCIATIONS
Shri A. Krishna Reddy Executive Director Bulk
Drug Manufacturers Association (India) Hyderabad
- Details provided are furnished in the
prescribed format (Questionnaire)
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SURVEY TOP OFFICIALS, PHARMA
Shri M. Narayana Reddy Managing Director Virchow
Laboratories Ltd Ex- President, BDMA Hyderabad
- Details provided will be furnished in the
report
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SURVEY TOP OFFICIAL, MEDICAL
Prof. K.S. Ratnakar MD., (Path-AIIMS), FICS,
FIMSA, FICP Director Global Medical Education
Research Centre Hyderabad - Details provided
will be furnished in the report
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SURVEY OF ACADEMICIANS, PHARMA
Dr. G. Krishna Mohan Member Pharmacy Council of
India, New Delhi Professor Head Centre for
Pharmaceutical Sciences Jawaharlal Nehru
Technological University Hyderabad - Details
provided will be furnished in the report
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SURVEY OF ACADEMICIANS, MEDICAL
Dr. G.V.S. Murthy Director Indian Institute of
Public Health (IIPH) Hyderabad - Details
provided will be furnished in the report
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MEETINGS WITH HIGHER GOVERNMENT OFFICIALS

• Sri Srikant Nagulapalli, IAS
• CEO
• Aarogyasri Health Care Trust
• Hyderabad
• Dr. E. Ravinder Reddy
• Managing Director Chairman
• State Medical Council, Andhra Pradesh
• Hyderabad

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SURVEY OF GOVERNMENT OFFICIALS
Shri K. Srinivasa Rao Inspector of
Factories Sangareddy Circle - 1 Hyderabad -
Details provided are furnished in the prescribed
format
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APPOINTMENTS WITH FORMER HIGHER GOVERNMENT
OFFICIALS

• Dr. Indra Shekar Rao
• Pediatrician
• Former Head of Niloufer Hospital
• Hyderabad

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• THANK YOU

Engineering Staff College of India HYDERABAD,
AP Email ccc.esci_at_gmail.com