Islamabad: Senior health leaders, regulators, parliamentarians and academics have called for urgent measures to eliminate unethical practices in Pakistan’s healthcare sector, warning that incentivised prescriptions, weak regulation and poor accountability are eroding public trust and driving costs to unbearable levels.
They stressed that reforms must prioritise transparency, ethical training and stronger oversight to ensure patient welfare, rather than profit, becomes the central concern. The call was made at the High-Level Forum on Good Governance and Ethical Practices in the Medical and Pharmaceutical Sector, organised by Transparency International Pakistan and Patients Not Profits.
The forum brought together officials from the Drug Regulatory Authority of Pakistan (DRAP), Pakistan Medical and Dental Council (PMDC), provincial health commissions, parliamentarians, pharmaceutical representatives and academics to review evidence of malpractice and propose reforms.
Prof. Shahzad Ali Khan, Vice Chancellor of the Health Services Academy, urged strict enforcement of laws to curb the pharma-physician nexus but said political raids on hospitals and public humiliation of doctors were counterproductive. “Accountability must target systemic flaws, not scapegoats,” he said.
He noted that free healthcare for all was unrealistic given Pakistan’s health spending of just 1.1 percent of GDP and $45 per capita, among the lowest in the region. Instead, he called for devolving authority to districts, strengthening public-private partnerships and granting autonomy to hospitals. “The government alone cannot deliver health services to 240 million people. The private sector must be part of the solution,” he added.
DRAP CEO Dr. Obaidullah acknowledged governance challenges that undermine effective regulation. He said DRAP’s role extended beyond licensing and quality assurance, stressing that “without ethical considerations, safe healthcare delivery is impossible,” but admitted limited capacity and human resources hindered performance.
A study presented by Prof. Mishal Khan of the London School of Hygiene and Tropical Medicine and Kashif Ali of TI Pakistan underscored the gravity of the problem. It revealed that 40 percent of doctors in Karachi were willing to accept payments from a fictitious pharmaceutical company without verifying its existence or the quality of its products. The findings showed how financial incentives, rather than patient needs, drive prescriptions, worsening out-of-pocket spending that already accounts for nearly 90 percent of healthcare costs.
Prof. Rizwan Taj, president of the PMDC, said aligning medical education with global standards, including bioethics, was a top priority. He announced that continuing medical education would soon be mandatory for the relicensing of more than 400,000 doctors.
“Relicensing will be linked with continuing education so physicians are trained to distinguish between ethical and unethical practices,” he said. Prof. Aamir Jafarey of SIUT urged PMDC to go further by establishing bioethics as a distinct discipline, warning that without structured training, young doctors would remain vulnerable to inducements.
Pakistan Pharmaceutical Manufacturers Association leader Dr. Osman Waheed noted that voluntary self-regulation had limits, since the association represented only 250 members while more than 650 firms operated nationwide. He said PPMA had set up an ethics committee to train members on responsible marketing but argued enforcement across the entire industry was essential.
Sindh Healthcare Commission official Dr. Zainab Hasan said most complaints they received related to quacks dominating the market rather than over-prescription, calling for stronger public awareness and a unified regulatory framework.
Ayesha Tammy Haq, executive director of the Pharma Bureau, said pharmaceutical companies were not philanthropists and required profits to survive but stressed profiteering at the expense of patients was indefensible. She urged uniform enforcement of the 10 percent cap on marketing expenditure across the sector.
Justice (retd) Zia Perwez, chairman of TI Pakistan, said healthcare reform cannot be state-led alone and must involve professionals and stakeholders across the system. His remarks opened a candid discussion on systemic corruption, governance failures and the need for genuine accountability.
National Assembly Standing Committee on Health Chairman Dr. Mahesh Kumar Malani pledged parliamentary support for reforms to strengthen accountability and ethical standards. He said the committee would advance the forum’s recommendations and review legislation to empower regulators and professional bodies. “Unless parliament, regulators, professionals and industry act collectively, there can be no meaningful change,” he said.
Policy proposals from the forum included mandatory disclosure of pharmaceutical marketing expenditure, ethical training for both doctors and pharma representatives, public reporting of regulatory actions against substandard drugs, improved oversight of nutraceuticals and stronger patient complaint systems. A working group under DRAP will carry forward the reform roadmap with defined roles for all stakeholders.
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