Healthcare

Healthcare System in Bangladesh

HIGHLIGHTS

Ministry of Health and Family Planning, GoB controls the health care system in Bangladesh in it’s total geography covering vast rural & urban areas. Back in 80s the rural healthcare facilities comprised sub-district health centers, family welfare centers and rural dispensaries which were poorly administered due to lack of infrastructures as well as ensuring availability of medical professionals. The situations have not changed till date to any significance. However, private/ non-government healthcare organization proliferated significantly over last two decades that largely meet healthcare needs of this 160 mio population country.

Stakeholders in Bangladesh Healthcare Market & their influence:
Stakeholders Expected changes / developments Implications /Actions
Payors  Private market, no reimbursement No influence on industry or service provider
Lack of market opportunity  Not viable option at given healthcare structure
Small market segment public hospital  
Wholesalers  Distributors for upcountry markets No influence on industry or service provider
Drives brands through discounting Manipulative trade channel for manufacturer
Shrinking business opportunity   
Pharmacists Dispenses according to prescription Single key role player in dispensing
Increased  focus by companies Trade campaigns, business partnering, substitution, retail chains
Strengthening of Association Influencing voice on the industry
General Physicians (GP) Continue as first line health service provider  & major prescriber pool High frequency of visits & reminders
Extension to rural population  Marginalize Rural Medical Practitioners
Values relationship and quality image of mfg.
Specialists Growing & KOL (Key Opinion Leader) segment  High frequency of visits & reminders
Drivers of disease management Shift of marketing focus from GPs
Shift of GP patient population Trend setters to disease mgt & KOLs for new launches 
Hospitals Geographical expansion  Shift of patient from doctors chamber
Enhancement of facility Price pressure, trade discounting & KAM implementation
Patients Growing awareness on quality & healthcare facility  Importance on quality 
Patient Advocacy Groups Patient clubs and health awareness programs

 

However, govt. healthcare support services extends from primary to tertiary level healthcare support system not equally distributed throughout the country. Capital city Dhaka and Port City Chittagong hosts most of the large govt. healthcare institutions. There are 15 Govt. Medical College hospitals (and growing) throughout the country providing quality medical education; some of them (DMC, CMC, RMC etc.)  approved by GMC, UK. However, some more new govt. medical college hospital already started Student admission recently. Besides, there are 48 private medical college running in different parts of the country for years, a few of them running for decades. For higher education, govt. approved 2 other Medical University (Chittagong & Rajshahi) apart from BSMMU.

 

 

 

Pharma

 

Pharma Market - Bangladesh

Bangladesh Pharmaceutical industry is the most technologically developed manufacturing sector and 3rd largest industry for contribution to government's revenue. This pharma industry contributes approx. 1% of the total GDP of the country. Out of many, about 250 pharmaceutical manufacturers are, although, around 40% companies are in operation and they produce >500 generic drugs. This market is highly concentrated as top 20 companies produce 85% of the revenue.

According to IMS, the retail market size is around BDT 118 billion as on 2014 where as it was around BDT 47 billion in 2008. It should be noted that IMS report points to the retail-level sales of pharmaceutical products not the institutional businesses (government and other organizational purchases) or export numbers.

Local pharmaceutical companies focus primarily on branded generics, mostly using imported APIs (Active Pharmaceuticals Ingredient). Unlike the international market, this generics constitute about 85% of the drugs sold in Bangladesh and 15% are patented drugs. Bangladesh produces as much as around 97% of it’s national consumption and thereby can be said to be self-sufficient in medicine production.

Presently, 15 Bangladeshi companies are involved in API (active pharmaceutical ingredients) production, The proposed API park is under development, in Munshiganj, about 40 kilometres from the capital. This park will accommodate 40 API industries with central effluent treatment plant and incinerator and other modern facilities. 

 

TRIPS Implications

Being LDC, Bangladesh will continue to enjoy patent-free production rights domestically until 2016 and limited exporting advantage. Having said that, as long as Bangladesh has to import APIs however, they will have to buy these from firms which are compliant with TRIPS laws and hence will have to incorporate the higher royalty patent price for these.

TRIPS also allow Bangladesh to export drugs patent free. The advantages that TRIPS does offer is somewhat offset by the pace and aggressiveness of the Indian and Chinese generic market, where companies can produce drugs, even including the patent costs, at an enormously competitive rate. As the days are counting, Bangladesh may export to any country if the drug is not under patent only until 2016. However, Least-developed country (LDC) members of the WTO will be allowed to maintain maximum flexibility in their approach to patenting pharmaceutical products until at least 2033, following a decision taken by the WTO’s Council for Trade-Related Aspects of Intellectual Property Rights (TRIPS) on 06 November '15 as published on WTO website.

 

Further reading: 

WTO members agree to extend drug patent exemption for poorest members.