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

1. Center for Climate Change Engineering Staff College of India (ESCI) Andhra Pradesh State Partner for BRCC Project EXPLORING THE INTERPLAY BETWEEN BUSINESS REGULATION & CORPORATE CONDUCT IN INDIA (BRCC) MEETING AND PARTNERS WORKSHOP 26.06.12, New Delhi

2. OVERVIEW

3. OVERVIEW PHARMACEUTICAL SECTOR Total Pharma Companies (Registered Units) in AP – 727 - Small & Medium Scale companies - 670 - Large scale companies - Approx. 57

4. 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

5. METHODOLOGYField Work

6. SURVEY FOR BRCC PROJECT • Kakinada • Vishakhapatnam • Vijayawada • Guntur • Hyderabad • Medak • Ranga Reddy • Mahaboob Nagar Zone - I Zone - II Zone - III

7. 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

8. DETAILS OF SURVEY COMPLETED Zone - I Zone - II Zone - III

9. FINDINGSPharma and Health Care Sector

10. 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.

11. 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.

12. 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.

13. 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.

14. 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, equipment’s etc.) and local health care hospitals in rural areas.

15. SOCIAL, ENVIRONMENTAL AND ECONOMIC IMPACTS OF SUCH VIOLATIONS(AS GATHERED FROM SECONDARY/ PRIMARY RESEARCH)

16. 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.

17. 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……………………

18. SECONDARY DATA COLLECTEDANDHRA PRADESH

23. 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 opinion—findings that expose the deep flaws prevalent in India’s 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.

24. 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.

25. DRIVERS/ FACTORS INFLUENCING BUSINESS RESPONSIBILITY IN THE STATE

26. 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

27. BRCC PROJECT IS SUPPORTED BY FOLLOWING

28. 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.

29. SUPPORT FROM ANDHRA PRADESH POLLUTION CONTROL BOARD (APPCB)

30. SUPPORT FROM ANDHRA PRADESH POLLUTION CONTROL BOARD (APPCB)

31. - COLLECTOR OFFICE, HYDERABAD- DM&HO, HYDERABAD

32. 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)

33. 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

34. SURVEY OF ASSOCIATIONS Shri A. Krishna Reddy Executive Director Bulk Drug Manufacturers Association (India) Hyderabad - Details provided are furnished in the prescribed format (Questionnaire)

35. 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

36. 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

37. 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

38. 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

39. 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

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

41. APPOINTMENTS WITH FORMER HIGHER GOVERNMENT OFFICIALS • Dr. Indra Shekar Rao • Pediatrician • Former Head of Niloufer Hospital • Hyderabad

42. THANK YOU Engineering Staff College of India HYDERABAD, AP Email: ccc.esci@gmail.com