Shakeel Ahmad The Constitution 18th Amendment Act 2010 has omitted the Concurrent Legislative List. This list when it was part of the 1973 Constitution empowered both the federal and the provincial governments to promulgate new legislation or to carry out amendments in the existing laws and take measures to give effect to such legislation in respect of the subjects mentioned in it. In actual practice, the provincial governments generally refrained from exercising their authority under the Concurrent List and left it to the federal government to enact laws and to give effect to the approved legislation. So, the present Parliament decided to amend the Constitution by purging all impurities introduced by dictators Ziaul Haq and Pervez Musharraf. It was further decided that the issue of provincial autonomy should be settled and the Concurrent Legislative List, which was thought to impinge on provincial autonomy, should be omitted. However, the Parliamentary Committee refrained from analysing the consequences that would arise from the deletion of certain subjects mentioned in the said list. Mr Raza Rabbani, Chairman of the Committee, is a mature and experienced politician. He is also a much harried man. Drugs and medicines are a very serious subject and affect every citizen of the country. They are listed at serial number 20 of the Concurrent List and may have escaped notice of the Committee. As a result of the passage of the 18th Amendment, the registration of drugs and medicines, their pricing and quality control now falls in the domain of the four federating units. Subsequently, the realistic and sensible policies adopted by the federal government over the last three decades, the pharmaceutical industry of Pakistan has established more than 300 units, including 29 multinationals, which cater to 80 percent of the pharma requirements of the country. The remaining 20 percent are supplemented by imports. In order to attract further investment in raw material manufacturing, the Government of Pakistan has recently offered very attractive terms and concessions such as protective duties, duty-free import of plant and equipment, import of duty-free intermediates, and tax holiday for raw material manufactured in Pakistan. After meeting the domestic requirements, the drugs manufactured in Pakistan are being exported to Africa, Middle East, Central Asia, Bangladesh, Nepal, Sri Lanka, Afghanistan, Iran, etc. Pakistan manufactured drugs are competing with multinational products in foreign countries in their quality, efficacy, presentation and are being preferred in competition to the Indian products. The Drugs Act of 1976, which is the law to regulate their import, export, manufacture, storage, distribution and sale in Pakistan, gave the power to the federal government to regulate prices. Every pharmaceutical manufacturer is supposed to contribute one percent of his gross profit, before deduction of income tax, towards a Central Research Fund maintained by the federal government. An Expert Committee is responsible for allocating the fund to individuals and/or institutions, which are engaged in research in the field of pharmacy and medicine. After devolution, the prices will now be regulated by officials of the Provincial Health Departments, who neither have the expertise, nor the capability to handle the subject. The Ministry of Health was engaged in formulating a new drug pricing policy when it was overtaken by devolution. Unless the decision is reversed, the country will have four licensing boards, four drug registration boards, and a similar number of drug control organisations. The cost and confusion would be enormous. Patients will suffer throughout the country. The role of the two major bodies under the Ministry of Health will presumably be confined to Islamabad Capital Territory (ICT), Federally Administered Tribal Areas (FATA), Azad Jammu and Kashmir (AJK) and Gilgit Baltistan. The Health Ministry had proudly announced some months ago that the country would soon have a new drug pricing policy, which was being formulated in consultation with all the stakeholders, and would take into account the concerns of both the consumers and the manufacturing sector. But as a result of devolution, the Ministrys authority under the Drugs Act 1976 has been ousted. The four provinces will now be free to fix prices in accordance with whatever criteria they may evolve. So, the prices will necessarily not be uniform throughout the country. This has serious implications for the existing manufacturers and consumers. Moreover, there is little expertise available in the provinces for enforcing quality control. This is a very sensitive issue for the medical community, the manufacturers of drugs and consumers. Confronted by this very odd situation, most of the multinationals may decide to wind up their business and go home. There are further costs to be borne due to the devolution of drugs and medicines to the provinces. The import and export is a federal subject in accordance with the Constitution. The provinces will, therefore, be unable to grant any permit for the import of raw materials, or grant approval for the export of pharmaceuticals. The existing export orders will be jeopardised and future business will be lost. Then it will be difficult to recapture the lost markets. If a decision to review the devolution is not taken immediately, serious shortage of raw materials used for the manufacturing of drugs will take place. Besides this, the patients will encounter enormous sufferings. Already, many life saving drugs are in short supply. Every day there is an addition of new names to the drugs that are not being supplied by the manufacturers. Indeed, continued shortage of raw material will lead to the disappearance of various types of drugs from the market. At the same time, cross-border smuggling may become a prominent feature in the circumstances. The federal government has taken 40 years to develop the drug testing and registration mechanism. It is not possible to create a similar system in the provinces within a year. Similarly, licensing of new companies, renewal of contracts, marketing of finished goods, and fixation of drug prices could not be left to the District Coordination Officers or the Deputy Commissioners. It is the consumer who will suffer ultimately. In this situation, he may not care for provincial autonomy when the hospitals are without medicines. Even the affluent class to whom costs are immaterial will question the sanity of decisions that deny the availability of life saving drugs. A review of the devolution decision is urgently called for. The writer is a member of the former Civil Service of Pakistan.