Speaking out for affordable medicines in Pakistan

As COVID-19 sweeps across the world, affordable medicine has never been more important. Yet in 2018, families in Pakistan needing to buy drugs had a shock. In pharmacies and health-care facilities, prices suddenly rocketed, making many medicines unaffordable for people in desperate need. And this was just the start.

The price rise proved to be the first in a series of staggering increases in the following years, hitting Pakistan’s poorest families and those needing regular medication the hardest. Unable to afford drugs despite careful budgeting, many people were forced to go without essential treatments and pain relief. Even middle-income families were hit hard.

Patients with illnesses including diabetes, cardiac disease, hepatitis and cancer had no choice but to pay extortionate prices for medicines or risk endangering their lives.

Life expectancy in Pakistan is 67 years old, six years lower than global life expectancy. There are many causes for this, but Pakistan’s high health-care costs are one. They are also a major financial burden on millions of households.

Many citizens believed that the sharp increases in medicine prices were happening under suspicious circumstances – officials had been arrested before for colluding with companies to illegally increase prices. Several contacted the Advocacy and Legal Advice Centre (ALAC) run by Transparency International Pakistan raising questions about undue influence from pharmaceutical companies.

Corruption has a strong grip on the health-care sector in Pakistan and neighbouring countries. According to the latest Global Corruption Barometer (GCB) – Asia, which surveyed more than 20,000 people in 17 nations about their day-to-day experiences of corruption, nearly one in five Asians who accesses basic services, such as health care, has to pay a bribe.

Following up on the citizens’ reports, the ALAC carried out detailed research into the official medicine pricing policy of the Drug Regulatory Authority of Pakistan (DRAP). It found that DRAP raised prices several times in 2018 and 2019, even revising the official pricing policy to permit the increases.

The price of all medicines was allowed to rise, while the price of almost 500 medicines rose up to 200 per cent - the highest increase in the past 40 years. Most households’ incomes were not enough to afford these new prices – with harmful or fatal consequences for countless people.

There was no justified explanation for these increases – making it possible that the price surges were linked to the undue influence of the pharmaceutical sector on drug industry regulators. With no monitoring mechanism to control illegally high drug costs and penalise policy violations, citizens feared that drug companies could simply pay officials to raise the prices of medicines.

To ensure that Pakistan’s regulators prioritised citizen’s needs over those of the pharmaceutical industry, the ALAC wrote to DRAP and the health ministry, highlighting the need for affordable medicines and demanding punishment of any officials found to be responsible for irregular prices rises.

It also urged the Senate Standing Committee on Health to conduct a fact-finding inquiry into the pricing issue, and notified other key authorities, including the National Accountability Bureau and the Supreme Court. To help keep the issue at the forefront of public and government attention, Transparency International Pakistan gave an interview to Pakistan’s leading news show.

As a result, in May 2019, Pakistan’s government finally imposed a 75 per cent cap on the increase in the price of drugs. This reduced the cost of many much-needed medicines – although others remain expensively high.

Transparency International Pakistan is working hard for full accountability in the country’s health sector, encouraging people to speak out when they face lack of integrity in medical care – and providing safe, accessible support through the ALAC. This has a ripple effect. Each time someone tackles an individual case, they’re also helping build a wider culture of trust and integrity.

Pakistanis will need to keep pushing for integrity – medicine prices recently went up again. Fortunately, the GCB shows that more than three out of five of people in Asia think ordinary citizens can help stop corruption. By speaking out against suspicious irregularities in drug pricing, Pakistan’s people have already shown that they can create change to make a difference – ending corrupt schemes and securing fairer prices.

Transparency International’s Advocacy and Legal Advice Centres (ALACs) provide free and confidential legal advice to witnesses and victims of corruption. With more than 100 offices in more than 60 countries, ALACs provide an accessible, effective way for people to report corrupt and demand action. Learn more.

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This article was written as part of the Global Corruption Barometer – Asia 2020, the largest, most detailed survey of citizens’ views on corruption and their direct experiences of bribery in Asia.