“Health care service in Nepal is moving in the right direction”
How has been the seven-year journey for Grande International Hospital? What types of health services has the hospital excelled at over these years?
Grande Hospital is a product of different thinking. It was not established with the objective of getting quick return on investment; it aims to create a long-term impact on human thinking. The journey has not been easy because of this long term thinking. However, throughout these years Grande has been able to bring a good impact on the health care sector by providing timely treatment. The earthquake was a bit challenging as we were facing a financial burden. Nevertheless, it gave us an opportunity to help the people. We conducted 122 major operations for free and treated more 1,500 outpatient cases for free. That was a very important social responsibility as an organisation. Despite the challenges we face financially, we have always been dedicated to being a socially responsible institution.
One of the most important jobs we have been doing is critical care. That critical care includes critical trauma care, medical critical care, surgical critical care, pediatric critical care, neo-natal critical care etc. In acute care, we have one of the best orthopedic departments where we do a joint replacement like spinal deformity correction scoliosis, spinal deformity trauma, pelvic injury, acitabular fracture, long bone fracture, and reconstructive surgery like joint replacement. We also have shoulder joint replacement so that we can treat the sports injury with the best ligament. If somebody’s shoulder gets dislocated, we can fix it. We have the best department for obstetric gynecology. We have children playroom at different places on the hospital premises. We also have the best neurosurgeons here. We have excellent laparoscopic and angioplasty surgeons. We also have one of the biggest departments in neurology. Grande has also become the center for renal transplantation in the private sector. We have more than 25 renal transplants done and up to now there is not a single complication. We also work on rehabilitation after surgery. We have physical and psychological rehabilitation centers. We also have dermatology, ophthalmology departments. We have a vascular surgery department for vessel and thoracic injuries. We have teams of doctors led by veteran doctors who fix breast cancer issues, thyroid issues. We have excellent services for head and neck surgery. We have not only the surgical treatment but also the best medical facilities. For Grande, prevention is more important than cure. In this regard, we have a separate ‘Wellness Clinic’ where the basic health checkups can be done for the prevention of diseases.
How does Grande ensure that the services it provides are in-line with the best global medical practices?
We have the education programme here. We have a strong academia and we organise trainings regularly so that all the medical professionals we have can update themselves on the global medical trends. We are very conscious about the patients' complaints. We are also trying to provide telemedicine by some of our best physicians who are of Nepali origin working in the United States. We also practice evidence based medicine and regularly send our doctors abroad to learn about the medical trends.
How has the hospital contributed to the growth of the Nepali healthcare sector?
We treat around 20,000-30,000 patients a month. Grande has been an able to bring a good impact on the health care sector by providing timely treatment. Everyday there are 4-5 helicopters landing at the hospital. Our doctors go to the remote places of the country and bring the patients from there and then provide them with the best possible care. Grande has been able to bring a change in the country by providing timely, good quality, compassionate health care in Nepal and aims to provide the best health care services in South Asia.
We are retaining almost 1.32 billion rupees a year that would have gone abroad in the absence of quality treatment services in Nepal. Patients coming here whether they are from well-to-do families, middle class or lower class families feel good about the services here.
What challenges has the hospital overcome in providing healthcare services to its patients?
The main challenge in the health sector is that people have to bear all the expenses of the health care in Nepal. Opening such a big institution definitely brings more patients and causes more stress. The patients are more stressed when they have to pay more than their potential. So, the government should help us in few areas including reducing the tax on the import of medical equipment. Running a hospital is not like selling a manufactured product which has a fixed price. This is a service oriented business and the level of skills among the medical persons is different. Also, the equipment are different and costly. So, we are not able to keep the same charge for our services. We are trying our best to provide quality service to the people. So, the government should support us by introducing policies like reduction in the tax or no tax on medical equipment. Another major important thing we need to do is we must make the people aware about health insurance.
What are the latest services introduced by Grande International Hospital? What new services is the hospital planning to start in the coming days?
With a lot of veteran doctors in the hospital, the best services we have been providing are the surgeries related to spinal deformity, renal transplant, endoscopic operation, joint replacement etc. We will also be promoting the bypass surgery and interventional cardiology. We want to go for in-vitro fertilisation very soon and we are also planning to expand the oncology department. We have started many services and now mostly we are in the process of refining those services.
How do you assess the present scenario of Nepal’s healthcare sector? What is the size of the domestic healthcare services market?
The health care service in Nepal is moving towards the right direction now. However, there is a lack of quality-based regulations. The institutions which fulfill regulatory requirements should be given incentives. Such an approach can help encourage the hospitals that are fulfilling the regulatory requirements. However, hospitals should not be opened haphazardly in every corner of the country because public health is a sensitive issue and quality must be the first priority. Government authorities or even international experts should monitor the hospitals without pre-information.
How do you view the increasing interest of private investors in the healthcare sector? How can the government facilitate private investments in healthcare in a more efficient way?
The increasing interest of the private sector in healthcare is good. However, again, the government should regulate the health sector properly. Healthcare has to be linked with education. To provide good service to the people, the doctors should be highly skilled. For this, every hospital has to update their medical professionals so that they can continuous to improve the quality of their services.
We should put private stakeholders, public stakeholders, government authorities and also some international experts together and work for improving as well as refining the health care services in the country. There is a huge possibility of medical tourism in Nepal.
Can you elaborate on the scope of medical tourism in Nepal?
There is a huge possibility of medical tourism in Nepal. The primary reason for this is Nepal's good weather. Nonetheless, along with improvement in health sector, there must be good roads, water supply and good hotels in Nepal. While undergoing treatment, the attendees can visit the local sites around the area where you have the hospital. The patients can also enjoy a different climate and environment after their treatment. Medical treatment can be packaged with sightseeing, yoga classes and observing the cultural side of Nepal. Nepali people are friendly and honest; so we have an opportunity to be associated with the other people in the world.
What are the problems being faced by Nepali private healthcare service providers?
The bank interest is high and paying a high interest and principle is one of the problems for the health sector entrepreneurs. The government and public think that the health sector has been making a lot of profit but our investors have not been getting profit at all. We are only able to cover the operational cost because we have lot of expenses including academia, equipment etc which are very high. Therefore, if the government helps us by reducing the tax on the import of equipment, we would be able to invest in academia and the quality improvement even more.
What type of policy level support Nepali private healthcare sector requires for serving the patients better?
The health professionals who are running hospitals and health care centers should be invited by the government for discussions from time to time. If our future has to be decided by someone who does not know our field properly, that is indeed not fair. The future of health care should be decided by the team who has been dedicated to the sector. Therefore, we should be engaged in those decision making process.
Security of doctors and other healthcare professionals has deteriorated over the last couple of years? How can such issues be addressed?
This is a serious issue. In Nepal, we see the patients are relatively very nice to doctors. Doctors are not gods and there are cases where even the doctors cannot do anything. However, the hospitals have to be safe and the learning should be advanced. Regarding the protests against doctors or hospitals, this is not a healthy approach to solve the problems. Whatever is taking place now, it is motivated by political forces. Doctors have to be protected because they don’t have bad intention towards their patients. There are weaknesses in all sectors and the health sector cannot be an exception here. The best method is to sit and resolve the issues through talks. There must be legal framework to address such problems officially.
“Norvic aims to become a referral centre of the country”
It’s been nearly two and a half decades since the establishment of Norvic International Hospital. What are major accomplishments of the hospital?
Norvic has completed 24 years in providing quality medical services to Nepalis. It has not only been serving the fellow countrymen, but also has been providing medical services to foreigners visiting and residing in Nepal.
Over the years, Norvic has accomplished 'many firsts' in the medical history of Nepal. We are the pioneers in pacemaker implants and Balloon Mitral Valvuloplasty (BMV) procedures in the country. We organised the first International Symposium entitled "Cardiac Surgery and Cardiology at the Dawn of New Millennium" here. We are the first hospital in Nepal to setup the state-of-the-art first OEC Digital Cath lab. Norvic’s establishment of the country's first catheterization lab in August, 2000 placed Nepal in the global net of definitive cardiac therapy. Similarly, the first Coronary Angiography (CAG) procedure took Norvic to the international club of definitive cardiac therapy.
The hospital successfully carried out the first Coronary Artery Bypass Grafting (CABG) procedure to pioneer in the Open-Heart Surgery in the beating heart state. Subsequently, procedures like the Coronary Artery Angioplasty (PTCA), Transoesophageal Echocardiography (TEE) were also carried out gradually by Norvic. The hospital is also the first in the country to launch "Mission Save Heart" programme with its Mobile CCU. Now, Norvic has a fleet of four mobile CCUs.
Similarly, Hospital services such as Peripheral, Cerebral, Renal and Carotid Angioplasties were also carried out in a great degree of successes. It was in Norvic where a surgery to open the Carotid Artery Blockade was conducted successfully for the first time in the country. Likewise, many diagnostics, therapeutic and rehabilitative measures with high-end technology have helped Norvic to be a most reliable critical care centre of the country with facilities of nuclear medicines. Now, Norvic has plans
to convert itself into a referral centre of Nepal.
How has the hospital contributed to the growth of the Nepali healthcare sector? What changes have you observed in the sector over the period?
Norvic from the very beginning has been instrumental for the positive change in healthcare domain of the country. The concept of compassionate patient care, implementation of internationally recognised world class treatment protocol, systematic group approach in diagnostics, therapeutic and curative mechanism and clean and hygienic environment are some of the hallmarks of Norvic’s treatment regime.
Norvic is first hospital in Nepal to introduced well trained and highly qualified nursing staff from Kerala, India for the professional patient care understanding the human sentiments. With the implementation of professional care of patient by Norvic, other hospitals in the country also started following professional care of patient. Until then the basic diagnostic facilities required for quality treatment were not available here and affluent Nepalis used to fly to neighboring countries and beyond for the treatment of simple ailments as well.
After two years of Norvic's establishment of the cath lab, the government also started the same kind of facility. All types of non-invasive and invasive cardiac procedures began in a great degree of success at par with European and American standards. Patients flying abroad gradually stared relying on Nepal's healthcare which also saved huge amount of money going out from the country and helped Nepali healthcare providers to be more competent, more conscious, more competitive and more professional.
Simultaneously, Norvic started revamping all technological aspects in modernsing medical and surgical departments gradually. The quality of diagnostics, therapeutic and rehabilitative measures got substantially improved and foreign patients also started trusting on the healthcare services provided by Norvic.
How Norvic ensures that its services are in-line with the best global medical practices?
Due to the internationally accepted treatment protocol, advanced diagnostics, therapeutic and curative method of treatments by professionals and group approach, engagement of multi-specialty medical experts, the majority of the treatments are accepted by the international medical fraternity. So, we can claim that Norvic's medical services are in-line with the best global medical practices.
The average standard for ballooning door as set by American Cardiac Association (ACA) (i.e. opening of artery blockage in the cath lab after heart attacks of the patient) is 90 minutes, whereas Norvic performs the surgery in 60 minutes only, and the success rate is similar to the American standard. Moreover, whatever new healthcare technology is launched in the western countries, the same is introduced (at least in the private sector hospitals) in Nepal within 30 to 60 days.
What are the latest services introduced by Norvic? What new services is the hospital planning to start in the upcoming days? What are the plans for expansion?
Norvic being a multi-specialty general hospital covers almost all faculties of health treatment. The hospital is soon going start a highly specialised mother and child care regime and IVF technology. Likewise, the dialysis services are also in pipeline.
Norvic plans to further upgrade the diagnostic services to a newer height to convert the hospital as an international class nuclear medicine centre. Furthermore, we have plans to increase the bed strength to over 350 by adding 200 more beds in the near future. With the expansion, there will be 20 emergency, nearly 100 general, 60 private and 50 critical care beds.
Furthermore, Norvic also plans to upgrade some of its super specialty centers such as Cardiology Centre, Digestive Disease Centre, Pulmonology Centre and Trauma Care Centre to greater heights. Five more modular operating suites will be added to the current three JCI standard modular operating suites. The total new built up area will cover 132,000 square feet and the new infrastructure will also have a helipad.
What type of government support Nepali private healthcare sector requires serving the patients better?
The customs duty structure needs to be more flexible on the import of high-end equipment and instruments. Second, the provision for importing such equipment from the country of origin should be reconsidered. For example, the country of origin of certain equipment is in Europe, but the same product is also available in the neighboring countries. Hence, the importer should be given the right to purchase the equipment from the neighboring countries so as to ensure timely delivery of the product. In absence of such practice, the importer and ultimately the patient has to suffer.
How do you see the scope of medical tourism in Nepal? And what is Norvic doing in this regard?
Given the geo-political situation, climate, friendliness of people and our culture of "Atithi Devo Bhawa", there is a tremendous possibility of medical tourism in Nepal. But we must be fully equipped in terms of healthcare technology. High investment is necessary to introduce high-end and the latest versions of medical, surgical and rehabilitative equipments. Apart from this, we need to upgrade ourselves in terms
of professional services. We must train our medical, paramedical and general manpower. Similarly, we must upgrade our infrastructures and most importantly we must be accessible in terms of easy, cost effective, safe and shorter route of transport. Likewise, our tour operators should be well versed and they should be fully aware on the specialised services in the country.
As far as Norvic is concerned, we are already into it. We have a separate International Emergency Care Unit (IECU) for foreign patients and a separate and an exclusive dedicated floor for foreign patients. The premium floor which consists of a separate business centre and a separate help desk has high bed-to-nurse ratio and the patients are exclusively offered better services. They are also provided with complementary breakfast.
To support the foreign patients better, Norvic also runs free emergency clinics both at international and domestic arrival lounge of the Tribhuvan International Airport (TIA). A dedicated mobile CCU is always on stand-by at the TIA clinic and if any untoward incident takes place the patients are immediately transferred to Norvic.
How is Norvic fulfilling its CSR obligations?
Norvic is guided by the philosophy that serving mankind is the best work of life. We have organised a number of CSR undertakings over the years. Some of these include a free two-day multi-specialty camp at Lukla at the height of 2,900 meters twice, free health camps along with distribution of relief materials worth Rs 5 milion to the victims the 2015 earthquake of nearly 40 rural destinations. The free camps organised in different part of the country and in the hospital premises also provided medical treatment and medicines worth over Rs 4 million to the patients. Similarly, several camps were also held for post-disaster outbreak control after the Sunkoshi flood in 2014 and the 2015 earthquake.
Meanwhile, we organised two weeks long specialised camps at Jajarkot district to combat swine flu epidemic just before the earthquake. We have also contributed Rs 500,000 to a two-day multi-disciplinary health camp at Namdu, Dolakha on the call of Himani Trust. Likewise, Norvic has provided full scholarship to the victim of the Dharahara tower collapse during the earthquake Prasamsa Shrestha for her B.Sc. Nursing programme. Earlier, she also received free surgical and medical treatment worth Rs 250,000 from the hospital. We have also been providing free consultations and treatment to the poor and needy through our sister charity hospital Shree Lunkaran Das Ganga Devi Chaudhary Charity Hospital located at Duhabi, Sunsari. Norvic strongly believes in the empowerment of women and has given opportunity to five trafficked girls to run the canteen of the Norvic Institute of Nursing Education.
“Samitivej hospitals are superior in terms of treatment and post-care services”
Tell us about the Samitivej Hospitals.
Samitivej hospital is one of the leading hospitals of Thailand. It was listed in world’s top 10 destinations for medical tourism in 2017. There are five hospitals in different locations of Thailand under the Samitivej Group of Hospitals. It is a Joint Commission International (JCI) accredited hospital. Our vision is to provide advanced health care with best medical service to people around the globe. We are currently known as one of the best destinations for medical tourists.
Samitivej Hospitals in Thailand have become prime institutions for many Nepalis to receive healthcare over the years. What are the reasons behind this attraction?
The access to the hospital is easy. Follow-up procedure like visa processing in Thailand is hassle-free in comparison to other countries. The hospitals use advanced medical technologies. Also, the team of specialists is another attraction for the people. The hospitals have more case studies archived so that the patients are ensured timely diagnosis. It is also popular for its post-care giving system which is considered admirable.
How are the medical services of Samitivej superior to other Thai hospitals?
The competition among medical institutions of Thailand exists, but talking about the part of communication, staffers of Samitivej Hospitals listen to patients and their families. Communication is the key to good service. The hospital has multilingual interpreters because of which people find it easier to present their problems, making communication effective. Language barrier is not a problem for patients who choose Samitivej Hospitals. Apart from it, the hospital obviously is superior in terms of treatments and the post-care it provides to patients.
What services do Nepali patients generally receive from the Samitivej Hospitals? Which category of Nepali patients do the hospitals generally serve?
People mostly go for whole body check-up that comes under our health package. There are different sections in whole body check-up categorized for male and female. Taking their age into consideration, we refer them to appropriate health package with required services. Samitivej Hospitals have been serving a majority of Nepali patients with gastro (stomach) related diseases. Cancer patients also visit the hospitals for treatment.
The hospitals have not categorized the group they serve but people who have not received proper treatment in Nepal and those who have to fly abroad for their treatment come to us, seeking help. The hospitals receive more businesspersons, politicians and expats than the general public.
Samitivej has also been partnering with Nepali hospitals in the recent years. How has the partnership benefitted the Nepali healthcare institutions?
We are working as the consulting partner and are more involved in hospital management. The services of our partners have definitely improved in comparison to when we were not involved. So, the partnership has benefitted the Nepali healthcare institutions in terms of hospital management.
What are the expansion plans of Samitivej Hospitals in Nepal?
We want to reach out to maximum people in Nepal. We are trying to make the service hassle-free by dealing with their queries, providing visa services and fixing appointment in the hospitals. We mostly have been serving patients who come to us through referrals of people who have already received our services. We are planning to intensify the use of advertisements in traditional media and adapting social media marketing to expand our services in Nepal.
How do you view the present scenario of Nepal’s healthcare sector?
The change in healthcare sector has been felt by everyone. Introduction of international level hospitals are evidences of the progress that the field is experiencing in the present context. The field has seen improvements with availability of competent doctors and caring system that hospitals guarantee. Though, we lack advanced technologies and expertise, the fact that the field has improved cannot be denied. The present scenario depicts continuous improvement in Nepal’s healthcare sector.
How do you view the increasing interest of the private investors in the healthcare sector? How can the government facilitate private investment in healthcare in a more efficient way?
I am positive about the private sector showing interest in investing in the healthcare sector. That way we can reach out to maximum number of patients. We cannot limit ourselves to government hospitals for healthcare services. Private investors who are coming forward should be appreciated. Investment of the private sector has increased the access to quality healthcare services in Nepal. The government should implement the right policies efficiently. It should not bind anyone; instead, the government should introduce appropriate policies and work on good governance.
What type of policy level support does the Nepali private healthcare sector require?
Good governance is a must. Timely supervision should be carried out by the government bodies concerned. The path to improvement is visible only if the policy is reviewed according to the need. Along with it, stability of government and economy of the country play a vital role. Until and unless the country acquires political and economic stability, good governance is a far cry. The policy should be private investment friendly so that the Nepali private health sector can serve the patients better.
How do you see the scope of medical tourism in Nepal?
Nepal is a country which has been witnessing the arrival of a decent number of tourists. The way international level hospitals are being opened in Nepal, it is possible that the country can be another medical tourism destination, just like Thailand. All it needs is proper and equal branding of both tourism and medical sector. If the government encourages the private sector, it will not be hard to introduce new and advanced technologies in Nepal’s healthcare sector. Nepal has a good chance for becoming a medical tourism destination.
“Mediciti has the potential to become one of the finest hospitals in South Asia”
Nepal Mediciti Hospital has recently come into operation. What services is the hospital providing to patients?
We have set an ambitious target of providing all kinds of treatment here in Nepal so that Nepalis do not have to go abroad for treatment. We are putting all our effort and using all available technologies and resources. Nepal Mediciti has the finest medical minds and advanced technologies to provide holistic treatment with a multi-disciplinary framework. We will provide a platform for practicing ‘safe and evidence based medicine’ driven by international guidelines and protocols. Nepal Mediciti is a private institution with a public purpose. This motto of ours has made Mediciti more affordable and accessible. We have the latest technologies in all departments. We will also foster research, education and a distinctive work culture that will set high ethical and social standards. Talking about the facilities and features, we have 60 OPDs, well-equipped modular operation theatres, best in class laboratory, diagnostic services, world class imaging and interventional radiology services, blood bank, among other modern features which are most probably new in Nepal. And we also have advanced technologies like 3T MRI – MagnetomSkyra 64 3T MRI, Cath Lab Cardio - 20-inch flat Panel Artis ZEE Floor (Siemens), among others latest equipment which help treat patients with more care.
Any plans for expansion? What are the strategies of the hospital?
Currently, the hospital has 300 beds which will be expanded to 550 within a year and to 750 within three years. We are focused on starting post-graduation within a year. Unless we start a post-graduation programme, we will not be able to fulfill the supply of high quality medical doctors. We will work with the insurance companies to make health service accessible to every Nepali. Currently, hardly two to three percent of the population has health insurance cover. We will work to make sure that patients are covered with some basic kind of health insurance. We will also organise different health awareness programmes. We will use different social media platforms like Whatsapp to inform patients about check-ups, medicines, among others. We also want to be a paperless hospital. We want to make this hospital extremely affordable.
How do you ensure that the services the hospital provides are in-line with the best global medical practices?
This is the first hospital in Nepal, and probably in South Asia, where all top doctors are available full time. In Nepal, doctors use to travel from one hospital to another for different shifts. And because of the traffic of the city, they are forced to spend more time on the roads. That leaves the patients waiting. Also, this prevents the doctors of different departments from working as a team. We have introduced the ‘one institute, one doctor’ principle. So, at least one senior doctor of every department will be present at the hospital anytime. This step will help the patients as they will be able to meet the best doctors of the hospital anytime. Here, we will have a multi-disciplinary care approach, in which every specialist doctor will focus on one patient so that it will be easier to diagnose the disease in a very short time.
We also want to collaborate with other small hospitals of the country, and send doctors there, or bring the patients here. If we collaborate with hospitals out of the capital having small bed capacity and limited resources, we will definitely be able to provide our kind of service in the rural parts of the country too. We are not here to compete with other hospitals. Rather, we want to work together to serve every patient.
Nepal Mediciti has targeted to serve both domestic and foreign patients. How will the hospital promote its healthcare services in Nepal and abroad?
We have targeted to serve every citizen of the country, and we have technologies and facilities which will surely attract foreign patients too. We are focusing on providing excellent medical service so that Nepalis need not go to foreign land for treatment paying hefty amount of money. An average Nepali while travelling overseas for treatment spends almost Rs 400,000 which is not a small amount. We want them to experience international standard health service in Nepal spending very less amount in comparison to the treatment cost of other countries. There are amazing and bright doctors here in this Himalayan country. We will not focus on bringing foreign doctors here, but we will have collaboration will other hospitals and universities of the world to work together to treat the patients. Providing quality service, we will prove that Nepal has one of the finest medical institutions in South Asia. We will work at such a pace that when someone talks about Nepal, they will say that it is the country with both natural beauty and Mediciti Hospital!
How do you evaluate the present condition of Nepali healthcare sector? How can the government facilitate private investment in healthcare in a more efficient way?
The number of Nepalis travelling abroad for proper treatment has been increasing every year. This means Nepalis spend billions of rupees abroad for treatment every year. Our vision and aim is to make every Nepali believe that getting quality health service is possible in Nepal as well. As our president Upendra Mahato has said, we have built this world class infrastructure to provide excellent medical services, and to retain the medical masterminds in the country. I think government must give health service more priority. Almost all pieces of medical equipment are imported here, and the customs process is a nightmare. The government should also work on providing power at low rates to the health sector as the price of electricity supplied to hospitals is comparable to that of cinema halls and malls. We are in a service sector; so, the government should work on supporting the health sector to reduce the financial burden.
The infrastructures of the hospital prove that it has massive investment. Will this hospital be affordable to the general public?
A total of almost Rs 8 billion has been invested to build this hospital. It doesn’t matter how big the infrastructure of the hospital is. We believe that every patient should get safe treatment and proper care. People should not think the infrastructure of the hospital is big so that the treatment in Mediciti will be costlier. We want everyone to get quality health service. So, the treatment cost at Mediciti is almost 10 percent cheaper than that at other private hospitals of the nation. Now the time has come for Nepal to make a drastic change in the health sector. We will also use technology to be in touch with patients. We aren’t focused on becoming the biggest hospital; rather we are focused on outcomes and becoming one of the finest medical institutions of the nation. We have the potential to be one of the finest institutions in South Asia. We are focused on providing quality service rather than focusing on serving a huge number of patients.
“Nepal will become self-reliant in medicine only when industry friendly laws are introduced”
You are the new president of APPON. What are your new plans and strategies?
Like industries in other areas of business, the pharmaceutical sector is also profit-oriented. Our main challenge is in supplying medicines at affordable rates to everyone in the country. As medicine is directly associated with the lives of people, we take our work very seriously. The policy formulated by the government some 22 years ago aimed to make Nepal self-sufficient by 80 percent in medicine. Sadly, this target has not been achieved so far. We have commissioned various studies and research in this regard and have analysed the situation of the pharmaceutical sectors in India, China and Bangladesh, among other countries. We submitted a report to the previous health minister Gagan Thapa regarding the pharmaceutical policy implemented in other countries. If the suggestions mentioned in the report are followed, then it will take no time for the pharmaceutical sector of the country to grow. If the government implements some of our suggestions, the Nepali medicine market is likely to grow by almost Rs 6 billion from its current size. If the market grows, it will be much easier for us to be self-reliant in pharmaceutical products.
Pharmaceutical entrepreneurs have been long demanding amendments in the Drugs Act, 2035. What provisions in the Act need to be amended?
The Nepal Drug Limited (formerly Royal Drug Limited) and a private drug company were the only medicine producers in the country when the Act was introduced some 40 years ago. No one had forseen that Nepal would become a house to many pharmaceutical industries when the law was introduced. Similarly, there are no provisions in the Act to cover veterinary, ayurvedic and homeopathic medicines. It seems that the Drugs Act, 2035 has only come to govern the import of medicines.
For a long time we have been urging the government to replace it with a new law. But the government has been saying it wants to amend the old law. The preamble of the Act itself has become irrelevant in the present context. The preamble of the Act is filled with phrases that give negative impressions such as ‘controlling of misleading promotion of medicines’ and ‘stopping wrongdoings in the medicine market’, among others. The preamble should incorporate phrases that give a positive message and boost the morale of producers. It is important to keep in mind that the formulation and implementation of laws are for aiding the development and growth of any sector. Healthcare has been addressed as a fundamental right of every citizen in the new constitution. So, the drugs act should be formulated according to the statute.
What other things are required for the growth of the pharmaceutical sector?
We have been stressing on the need for a new Act since 2003. Nepal will become self-reliant in medicine and the pharmaceutical sector will thrive only when business and industry friendly laws and policies are introduced. Ironically, we are so dependent that the responsibility of drafting a law is handed over to NGOs and INGOs. We should have the capability to formulate the required laws and policies on our own.
Similarly, APPON has been highlighting on the need to establish an integrated government body to regulate the pharmaceutical industry. We can establish the authority like in the United States where the Food and Drug Administration regulates the medicine and other markets. We should also develop an authority to look after pharmaceutical industries. There are separate laboratories for agro products and food items in the country operated by different government departments. This has led to problems in inter-ministerial and inter-departmental coordination causing difficulties for entrepreneurs like us.
We are very clear that high quality medicines should be available in the market at affordable rates. In this age of the open market economy, the government should allow the producers to determine the price of medicines. We should be allowed to make a profit from the pharmaceutical business according to the constitution which has ensured the right of citizens to engage in business and earn money lawfully. Isn’t it wrong for the government to fix the price of the pharmaceutical products that we produce? If someone is involved in illicit business practices, they can be punished accordingly. We have already presented our suggestions to the government on changing the provisions in the existing law.
Presently, the Nepali pharmaceutical market comprises of 48 percent domestic and 52 percent foreign medicines. Medicines produced in Nepal can be viable export products if the producers get the right kind of support. The government should work with our embassies in different countries to facilitate the export of pharmaceutical products.
How are Nepali producers producing medicines according to the WHO’s GMP guidelines at present?
The Good Manufacturing Practice (GMP) is a requirement set up by the World Health Organization (WTO) for the pharmaceutical companies to produce quality medicines. GMP is also a standard of quality for medicines worldwide. New companies in Nepal have also received GMP certifications. This shows Nepali producers have been producing high quality medicines. The Nepal government has also implemented the ‘Kushal Aausadi Samhita’ which is also like the GMP. The quality of medicines produced in Nepal is on par with foreign ones.