Last month, this picture put up by Anup Soans on his Facebook (FB) page elicited 215 ‘likes’, 361 ‘shares’ and 76 comments (as on Dec 2nd). The popularity of this post intrigued me not because it was something that had never happened earlier – Anup is quite popular on social media – but since it quickly assumed an accusatory tone and one of grievance.
Although I have no way to ascertain it, I am sure the cartoonist meant the picture to be something else before another creative person labeled the drummer as the ‘CEO’, the workers on the train cart as ‘head office managers’ and the lone person pulling the train cart with its heavy load of people as the ‘field managers’.
While the picture is a bit exaggerated, the way it was perceived on the FB post seemed to turn the entire concept of teamwork on its head. Despite a little prodding by the author, not one person looked at this as representing teamwork. It did not occur to anyone that the CEO seemed to be making an effort to keep the functions of the organization (if we assume the train cart to be one) in a smooth rhythm so that efficiency increases – a concept best demonstrated by the famous Kerala boat races. No one thought it was fantastic that all ‘head office managers’ worked as one team towards furthering the objectives of the organization without pushing individual agenda. The red-faced lone ‘field manager’ who pulled the cart didn’t seem to convey to anyone that while it was his job to further the organization towards its planned goal, it could well be a rotating assignment and when he pulled the cart up to a certain point – or goal – he could then hop on board the cart and begin to assist the other ‘head office managers’ with their work while someone on board took up the task of pulling the cart.
I found it very interesting that most people who commented seemed to do so in a pattern. The pattern was that sales and marketing are not two arms of the organization but are different silos. Marketing personnel know little about what sales personnel do and more often than not ‘force’ their ideas on them. A few other gentlemen, who tried to support the marketing function, did so either feebly or their arguments were quickly drowned out. I was reminded of the ongoing social media battle between supporters of two major political parties, which could be understood as that of opposing ideologies and goals. In this case however, sales and marketing people seemed to worry more about which function was better, more important or needed more effort and not on how the picture was a symbol of different functions within the organization working in tandem to help it attain its goal.
The ‘war’ between sales and marketing goes back a long time and spans across industries. However, it is also well documented that this lack of alignment ends up hurting organizational performance. Time and again, both groups stumble (and the organization suffers) because they don’t work together. There is no doubt that, when Sales and Marketing work well together, companies see substantial improvement on important performance metrics: Sales cycles are shorter, market-entry costs go down, and the cost of sales is lower.
As the Harvard Business Review says, the conflict between Sales and Marketing apart from being economic, is cultural in nature. This is true in part because the two functions attract different types of people. Marketers are deemed to have more formal education than salespeople. They are expected to be highly analytical, data oriented, and project focused, always thinking about building competitive advantage for the future. Sales teams do not appreciate it as much as they should because they perceive it to happen behind a desk in air-conditioned offices rather than out in the field. Salespeople, in contrast, spend their time talking to existing and potential customers. They’re skilled relationship builders; they’re expected to not only be savvy about customers’ willingness to buy but also intuitively know which products will fly and which will die. They want to keep moving. They’re used to rejection, and it doesn’t depress them. They live for closing a sale. It’s hardly surprising that these two groups of people find it difficult to work well together. Yet there is not a more opportune moment to harness the skills of both teams than the current one.
The pharmaceutical industry in India just hiccupped. From the customer facing side, new regulations such as the new pricing policy has just made medicines more affordable. However, a clamp-down on clinical trials has put the launch of new, innovative medicines on the back-burner for the moment. Also, there is no inflow of foreign capital into the sector putting capital expansion plans of companies on hold. Additionally, more and more Indian companies derive their real growth in earnings from serving overseas markets.
In such a scenario, the last thing a customer would appreciate is a chasm between internal departments in an organization that hamper his ability to provide services to his patients. Corporate equity is at potential risk if information flow on products is delayed because the marketing team does not respond to requests from the sales team or if crucial travel information of a KOL traveling to an international conference is withheld.
While I will not attempt to offer solutions or debate them here, I want to leave you with some thoughts. Why is it so difficult for colleagues within the same organization to work together? Isn’t everyone trying to do the same thing i.e. attain market leadership? How does it matter where you work or what you do? Aren’t you proud of what you are doing? Are we getting into the quicksand of wanting to do someone else’s role? At the risk of sounding preachy, I’d like to invoke the Bhagvad Gita here which extols us to merely do our duty and not worry about someone else. Just excelling at what we do helps us to create great value – tangible and otherwise. Cumulatively, this ever expanding pool of excellence is the fuel that propels organizations from being good to becoming great. So instead of worrying about why others fail, let us continue to focus on our own success.
If the red-faced man in the picture didn’t pull the train cart, how would it move forward? If the men on board didn’t tighten the bolts on the track and pat down the stones of the ballast, how would that section of the track become secure? If the CEO didn’t beat the drum to a rhythm, how would the overall efficiency of the team increase and progress be achieved?
Now if the red-faced man was constantly badgered by the ones on board, would he pull the cart? If he stopped pulling the cart, would the whole team (organization) move? Would the CEO then really matter?
As economic growth continues at its anemic pace, we’re all looking for ways to make our operations more productive. Bridging the sales-vs.-marketing divide is a way of achieving this. Let us change our perspective. It will make a positive impact on customers. We know well that customers these days are too mobile, too connected, and too informed to tolerate any gap between what one department says and another does. So, if we allow sales and marketing to operate in silos, at the end of the day, do you really think the customer cares? He would just move on to the next company.
Published in the December 2013 issue of MedicinMan
 ‘Ending the War between Sales and Marketing’: Philip Kotler, Neil Rackham, Suj Krishnaswamy; Harvard Business Review July-August 2006.
How did you feel when you read in the newspaper that two drug majors Ranbaxy and Wockhardt were pulled up by US regulators for impropriety in manufacturing practices and submitting false data about their products? Were you worried about the quality of medicines that you bought at the neighborhood pharmacy? Would you feel confident that the medicines your doctor prescribed to your child were of the best quality? Who can help you to answer these questions?
COMPLEXITY AND INADEQUACIES
India’s Drug Regulator or the Central Drug Standards Control Organization or CDSCO is charged with exactly that duty. It must lay the concerns of the Indian citizen to rest and ensure that the medicines available in the country are of the best quality, are affordable and are readily available.
Sadly, that is not always the case. A 2012 report from an Indian Parliamentary Committee exposed many failings such as inadequate infrastructure, shortage of drug inspectors and a lack of accurate data. In 2003, the R.A. Mashelkar Committee report estimated a requirement of more than 3,200 drug inspectors. Currently there are 1364 sanctioned posts, and around 864 are filled up.
The Drug Controller General of India (DCGI) recently told media that Rs 3,500 crore would be spent on expanding the regulatory agencies by 2017. The result of the lapse is that 3% to 20% of medicines made in India are spurious, depending on what data you look at. Your fear for the quality of medicine you buy for your child is not totally unfounded.
India has a complicated regulatory structure and a web of entities at the central and state levels tasked with monitoring the pharmaceutical industry. This complexity causes much to fall between the cracks. This becomes evident when the industry declares over 20,000 licensed manufacturing units and the DCGI estimates them at only 8000.
CREATIVITY IN GUJARAT
State governments are responsible for licensing, approvals, inspection and recalls of drugs manufactured in their jurisdiction. With the aforementioned challenges, the Food and Drug Administration in Gujarat stands out for its creative use of IT based services to ease up the entire pharmaceutical value chain – from manufacturing to dispensing medicines to patients.
With over 3000 manufacturing units, Gujarat accounts for nearly a third of India’s pharmaceutical manufacturers and about 28% of exports. To cut out inefficiencies such as travel time, paperwork and physical presence at drug regulator offices, the State Food and Drug Administration (FDA) digitized and crunched the process. Manufacturing licenses for new plants are issued in 15-20 days (inclusive of site inspection) which is far lesser than the mandated 30 days. The resultant cutting of red-tape has attracted companies based in neighboring Maharashtra to set up manufacturing bases in Gujarat.
SPEED ACROSS THE VALUE CHAIN
To improve the distribution of medicines across the state, 1300 officers across 25 district offices are empowered to issue retail pharmacy licenses online. In most cases when the application is genuine, the licenses are issued the same day. Technology has helped connect the entire state machinery and curtail malpractices like multiple licenses issued to the same pharmacist which was possible in the days of offline license allocations when district offices were not connected and one district officer had no way of checking if the applying pharmacist already had another license issued in a different district. As a result, avarice and corruption has been controlled to a great extent.
THE PATIENT BENEFITS
When a fake medicine is discovered or a medicine fails the quality test, the State FDA sends out the information through an SMS to the 30,000 retail pharmacies across the state almost. Patients benefit through the use of technology as they have easy access to information about failed, spurious and unapproved medicines on the FDA website A patient who earlier had no way of knowing about fake medicines feels tremendously empowered when he has the same information as the seller. The process is so popular that it has been adopted by other states like Maharashtra and Kerala amongst others.
While the use of technology is not a substitute for manpower (inspectors are still needed for physical inspection of manufacturing plants and retail pharmacies) it definitely speeds up the entire process and makes it easy for the manufacturer and the consumer alike. Wouldn’t you feel relieved when you know that your neighborhood pharmacy sells the best medicines that you can confidently buy for your child?
Published on 21/11/13 at Mera Bharosa here
A few days ago, the Union Health Ministry accepted the Prof. Ranjit Roy Chaudhury Expert Committee report on approval of new medicines, clinical trials & banning of medicines. One of the points in the Action Taken Report was that the Ministry decided to admit data from Phase I and Phase II trials done overseas for medicines that are being developed in India. This, they say, will reduce the time for new medicines to be launched in India.
Phase I trials study the effect of newly discovered medicine – which is either a chemical or a biological compound (new chemical/molecular entities or NCE/NMEs) – on the body of healthy volunteers. These studies determine the way the medicine behaves in the human body. The data is important to identify the dose at which the medicine has the best desired effect.
Once the dose is identified, Phase II studies are conducted to assess the efficacy and the safety of those medicines at the identified doses. Both these phases are essential first steps in the journey of drug discovery and provide confidence to both researchers and government regulators that the medicines are safe for mass commercialization. Phase III trials study the safety and efficacy of new medicines closer to availability in the market and Phase IV study them after the medicines are available on the market.
Before the Roy Choudhury Committee recommendation, the law did not allow the Central Drugs Standard Control Organization (CDSCO) – of which the Drugs Controller General of India (DCGI) is a part – to accept Phase I and II data of NCEs/NMEs that were conducted abroad. What confounded this rule was the fact that India does not have enough capacity in the first place, to deal with the requirements of Phase I and Phase II trials. This often delayed the process.
It is another story that these delays were inconsequential because very few NCE/NMEs are actually developed – and therefore need to be tested – in India. Almost all new medicines launched in India are discovered abroad and none of those innovator companies conduct Phase I or II studies here. This is because Phase I trials are completed in 4-8 weeks in the US and Europe while it takes at least 16 weeks to complete the first phase in India.
If the idea is to encourage drug discovery in India, it is an inconsequential one. As a study in 2012 by the Institute of Bioinformatics and Applied Biotechnology, found that the prospects for original drug discovery in India are poor. Improving drug discovery in India will need reforms at a much broader structural level. Merely allowing trials to be done abroad is hardly an incentive for companies to begin to invest in drug discovery – a process that involves hundreds of millions of dollars. So how does this development actually help the Indian patient?
To be fair, this maybe an attempt to reverse the damage created by the knee-jerk reactions plaguing the clinical trials industry in India. The rules currently allow parallel Phase II and Phase III Clinical trials in India for NCEs/NMEs undergoing clinical trials anywhere. This is an important step if the government is serious about making new drugs available faster to the Indian patient, since it is willing to approve medicines which have been studied in a sizeable sample of Indian subjects during Phase III. However, by clamping down on approvals of clinical trials, MNCs will continue to remain unclear on whether those parallel trials will ever take off in India.
Companies will also be forced to reconsider bringing to India even those medicines that have completed all trials (Phase I-IV) overseas. This could mean a delay of many years. To worsen this situation, the government wants to amend a rule that allowed the waiver of clinical trials in Indian subjects if the medicines had approval abroad. The government now intends to make it possible to waiver trials in Indian subjects only if there is a national emergency or an epidemic. This means a few more years of delay to the availability of new medicines in India. Add to this the ambiguity around India’s stand on IP laws and pricing of new medicines.
So will the changes make new medicines available in India faster than before? Are these changes going to be accepted independent of the other interlinking factors which often seem contradictory? At the moment, the hullabaloo around India’s health policy continues. Viewed macroscopically, it seems to be a misguided case of almost comical trials and judgmental errors.
A few days ago, the Vice President of the Indian National Congress party, Mr. Rahul Gandhi tweeted that his party would implement the free medicines scheme for the poor across India. Since the tweet coincided with Mr. Gandhi’s visit to Rajasthan, it can only be assumed that he was touting a relatively successful scheme that his party’s government runs in the state.
Sometime last year, India announced a $5.4 billion policy to provide free medicine to its people. This was the outcome of the report of the High Level Expert Group appointed by the Planning Commission in 2011 to look into the broader issue of Universal Health Coverage (UHC), a key requirement to improve social indices in India.
While the availability of free generics can be a decision that could change the lives of hundreds of millions of Indians, the proposal runs the risk of being overly simplistic and potentially dangerous. The underlying assumption here is that merely providing medicines free would help improve the health and the productivity of the nation. In isolation that is simply not true.
Health is a concept that far exceeds doctors, hospitals and medicines. You need these only when you have to treat a condition. The concept of keeping good health is to prevent anything from affecting you mentally, physically or spiritually. When the government decides that the first step towards UHC is free medicines, it is a step forward gone horribly wrong. It means that the government will do little to keep you in good health and will come up with hare-brained schemes even after you fall ill, leaving you to largely fend for yourself.
This is not to say that receiving free medicines is not a great idea. To the sick and the infirm, it will provide succor to millions who have to otherwise pay for it from their pockets. The problem is in its implementation. That Rajasthan did well with the scheme – as did a few other states – is well studied. However the fact that its nation-wide scale up was shelved demonstrates the government’s sheer lack of confidence. Here’s why.
Currently, less than 35% of India’s population has access to health care. This means approximately 2 out of 3 residents in India do not have a medical facility (clinic or primary health centre) to go to or a doctor to consult, much less be able to get a prescription and buy medicines. Even the 1 out of 3 residents, who have access to a medical facility, barely get to see a trained medical professional. This is because of an acute shortage of trained staff and chronic absenteeism – doctors get their salaries from the government anyway and prefer to spend more time at their private clinics where they can charge for their services. And if the patient is lucky to see a doctor and get a prescription, chances are that the medical stores will be out of stock. The medicines are either not purchased and delivered to the stores or sold into the private market for a hefty profit.
If this is the state of affairs when only 420 million people are anywhere close to accessing health care, imagine the sheer grit, determination and resources needed to scale this up to 1.2 billion Indian citizens and a few million other residents. Is it any wonder then that today 80% of doctors, 26% of nurses, 49% of beds, 78% of ambulatory services and 60% of in-patient care are provided by the private sector?
Providing free medicines is indeed a laudable idea but one that is fraught with impracticality. Mr. Gandhi must outline the measures he would put into place to prevent corruption in the tenders floated for the purchase of high quality medicines, create adequate storage facilities, tackle absenteeism of medical professionals in public hospitals and ensure constant supplies. These are just a few issues. And going by the way the Public Distribution System has shaped up over the last few decades, there is enough room for skepticism.
So, what is the alternative? Given that India vies for the title of “Pharmacy to the World”, it is safe to assume that there is no domestic shortage of production of medicines. The difficult part is to ensure that the medicines are of good quality. If the FDA can tighten the noose on Indian suppliers of generic medicines to the USA, there is no reason why the Indian regulatory agency cannot do it for its own residents. By ensuring the quality of medicines, the government can rely on the open market mechanism that influences the consumption of health care. The naysayers will do well to merely check on the systematic rot and neglect that public sector pharmaceutical companies have been put through by the government to understand why manufacturing has to be private-sector dependent.
The delivery system would also be efficient since it has to be competitive and competent. The huge saving thus accruing to the Government could be utilised to step up public investments in rural and urban health infrastructure and services, thereby generating employment and income opportunities — both directly and indirectly. For the genuinely needy, `medicine vouchers/stamps’ could be supplied through the Panchayat Raj or local government machinery that could be strengthened and empowered for the purpose. But all this services the sick and is a drain on the economy. Countries with the most efficient health care systems are those that prevent illness through early detection combined with community-based primary care to limit more costly upstream interventions.
India faces enormous challenges such as high disease prevalence, unregulated and fragmented health-care delivery system, non-availability of adequate skilled human resource and inadequate finances to name a few. To address these challenges there has to be a paradigm shift in health policies. While the planners of his government have realized that the central government is not ready to set up a scheme of this scale in the face of such challenges, it seems Mr. Gandhi is more optimistic about it.
Edited version published earlier at Mera Bharosa.
Earlier this month, a Parliamentary Standing Committee tabled its recommendations on Foreign Direct Investment (FDI) in the pharmaceuticals sector. Surprisingly for a country that recently prided itself for unshackling its economy and pushing pro-growth reforms, the Committee recommended a blanket ban on FDI in brownfield projects which means it doesn’t want foreign pharmaceutical companies to invest in existing Indian ones.
This is surprising since it comes from a legitimate body that is mandated to think rationally and rule in the best interests of the Indian people. The committee however seemed more driven by public perception and chose to value Bollywood actor Aamir Khan’s judgement over those of veteran economists!
The argument central is that FDI poses a direct threat to the access and affordability of medicines and threatens to elbow out our pharmaceutical industry. This is purely stupid and shows a complete lack of understanding of how the global pharmaceutical industry operates.
Foreign firms are not acquiring Indian generic companies to stop generic medicines. With a huge number of products going off-patent globally, pharmaceutical companies are building their capabilities to sell generic drugs. They are acquiring Indian companies for their strength in generics, not to obliterate them. Hence, the concern that India’s pharmaceutical industry will die if foreign companies invest here is silly. Why would Mylan – a global generic company spend $1.6 billion to kill Agila Technologies?
Another argument (more moral than rational) is that FDI in the sector will hamper Indian medicine exports. Currently, India exports drugs to more than 200 countries and vaccines and bio-pharma products to about 151 countries. The export growth rate is around 10 percent per annum. And the major chunk of exports relate to generic drugs.
A third argument is that prices of medicines will rise in India due to FDI inflows. This despite a recent study by India’s own Department of Pharmaceuticals that found domestic drug prices to be immune to acquisitions. It is also interesting to point out here that the largest critics of the recent Drugs Price Control Order (DPCO) were Indian companies and not foreign firms. Indian companies were also guilty of over-charging Indian patients, an accusation levied against foreign firms.
If anything, economic literature suggests that inefficient firms will lose market share due to foreign competition, which in the long run should increase the overall efficiency of the Indian economy. Either ways allowing FDI inflows is only beneficial for India and its citizens. Paying heed to sound economics is a much better way of deciding what is good for us rather than letting some fools destroy our country.
Health care policy in most developing countries has emphasized the development of government-owned health services, largely financed by tax revenues. Following the recommendations of the World Health Organization (WHO), many countries established systems consisting of peripheral clinics and health workers, integrated community health centers and a tiered system of public hospitals. As such systems became established, there was increasing attention given to how to obtain greater health impact from this service capacity.
Not in India. Here since Independence, the private health care sector has grown significantly. That its growth has profound implications for the general public is well understood but highly under-debated. Significantly, despite the problems resulting from the growth of the private sector, there has been little meaningful effort to establish market or regulatory mechanisms to ensure its appropriate growth. Instead of greater commitment to public spending towards health care, we see knee-jerk reactions like controlling prices of medicines that are already the cheapest in the world.
To be fair, since Independence, life expectancy at birth has doubled to 65 years. Yet, India is likely to fall short of deadline on most other Millennium Development Goals (MDGs) set by the WHO. It still accounts for 21% of the global disease burden and loses 6% to 12.5% of its GDP annually due to sickness.
It is therefore surprising that even in desperate times such as now; a glaring public need like universal and equitable health care fails to make it to the agenda of electoral politics. If good governance and its ensuing benefits are the main plank of the BJP, why then did its party President, Rajnath Singh simply talk of providing medical insurance to “even those living in villages and huts” and not pledge to deliver on the promise of Universal Health Care (UHC), a platform that the incumbent UPA fell woefully short on?
The popular adage ‘health is wealth’ has been turned on its head by successive governments that ruled India for the last 66 years. To the Indian citizen no wealth means no health. It is therefore, fervently hoped that an innocuous mention by the BJP will materialize into a strong electoral platform to provide much needed succor to the average Indian citizen.