Good governance for medicines: measuring transparency and accountability in the public pharmaceutical sector of Malaysia / Siti Hadijah Shamsudin

The high value of pharmaceutical usage estimated at approximately USD600 billion per year has resulted in vulnerability to corruption. Inefficiencies in governments have led to a lack of transparency and accountability of the pharmaceutical system. This has created insufficient supply of medicines. The need to do continuous assessment and to identify areas for improvement in the function and structure of the pharmaceutical system is considered one of the crucial areas in healthcare system. The primary objective of the study is to measure the level of transparency and vulnerability to corruption in six functions of the pharmaceutical system (registration, inspection, promotion, selection, procurement and distribution of medicines) in Malaysia. The second objective is'to evaluate the perception and knowledge of consumers, healthcare professionals and pharmaceutical industry representatives about "availability and quality of medicines", "prescribing pattern and supplier-induced demand" and "knowledge of corrupt acts and practice of sanctions". The third objective is to evaluate the knowledge among public and private stakeholders of the vulnerability to corruption. A cross-sectional study, using structured questionnaires adapted from the World Health Organization assessment tools was used in semi-structured interview with stakeholders in the public and private pharmaceutical system. The responses to the questions were rated according to the criteria and then converted to scores on a numeral scale. The lower scores suggested greater vulnerability to corruption and the higher scores suggested lower vulnerability. The second part of the study is a self-administered survey used to evaluate the perception and knowledge of consumers, healthcare professionals and industry representatives, who were conveniently selected to answer three different types of questionnaires for the respective groups. Statistical analysis was conducted using SPSS Version 13. The overall score for Malaysia's pharmaceutical system was 6.2 out of 10, indicating a system that is marginally vulnerable to corruption. The weakest links were in the areas of medicine selection (4.6), followed by procurement (5.6) and registration (5.9). The consumer perception surveys reveal that consumers are confident of prescribing pattern, availability and quality of medicines but knowledge of corrupt acts and practice of sanctions is low. There is significant difference in knowledge of vulnerability to corruption among public and private stakeholders in registration, promotion, inspection and selection. Despite having a strong pharmaceutical system in place, the results showed that the pharmaceutical system in Malaysia is marginally to moderately vulnerable to corruption. The most glaring deficiency seems to be the absence of conflict of interest guidelines and the lack of publicly available documents for the selection process. The offer of material gifts and favoritism seems to be a common practice as well as a lack of guidelines. There were only slight inefficiencies in the distribution and utilization of pharmaceuticals in the system.