Medical Representatives in rural Bangladesh: Who are They and What Is Their Role in the Drug Market?
Introduction Little is known about the role of medical representatives (MRs) in influencing the prescribing practices of informal and formal healthcare providers in developing countries. This study aims to describe the job characteristics of MRs, and the differences in promotional practices they apply to informal and formal healthcare providers.
Methods This study was conducted in 9 unions and 1 township of Chakaria, a rural sub-district of Bangladesh. Focus Group Discussions and In-depth Interviews were conducted among informal and formal healthcare providers and MRs, along with a quantitative survey including questions about demographics, education, and practice perceptions. Data analysis was performed using Grounded Theory for qualitative data and bivariate statistical tests for quantitative data.
Results Among medical representatives, 55.8% have a graduate degree and 41.9% have a post graduate degree. The duration of training varies by pharmaceutical company with an average duration of 41.5 days. Pharmaceutical companies offer MRs incentives such as bonuses, promotions, and travel opportunities based on their sales volume. MRs may offer purchasing discounts, free samples, extended credit lines, and gifts to doctors in order to increase sales. They share a more friendly relationship with informal providers and a more professional relationship with formal providers. The doctors who give out a greater number of prescriptions are favored for promotional activities. Some evidence suggests that medical representatives from more reputed (larger) companies may favor formal providers whereas informal health care providers may be more often targeted by smaller pharmaceuticals.
Conclusion The incentives offered by pharmaceutical companies to medical representatives encourage aggressive promotional practices that differ for informal versus formal providers. We suggest that MR may be an untapped ally in efforts to address undesirable prescribing practices in the informal sector of developing countries. Regulating incentives offered by pharmaceutical companies to MRs may encourage more ethical drug promotional practices in the informal sector.
Rahman, M.H.; Agarwal, S.; Tuddenham, S.; Peto, H.; Iqbal, M.; Bhuiya, A.; Peters, D. Medical Representatives in rural Bangladesh: Who are They and What Is Their Role in the Drug Market? Presented at 8th World Congress on Health Economics (iHEA), Toronto, Canada, 11 July 2011. (2011) 24 pp.