Waste 0means 0the 0item 0which 0is 0not 0used 0by 0people, 0the 0item 0which 0has 0been

0discarded 0and 0people 0get 0rid 0of 0that 0item.

In 0our 0daily 0activity 0different 0waste 0occur 0from 0different 0sources 0.the 0waste 0can 0be
0from 0household, 0commercial, 0industrial, 0agricultural, 0etc. 0with 0such 0vast 0quantities 0of
0waste 0it 0should 0be 0managed 0in 0such 0a 0way 0that 0it 0should 0not 0harm 0the 0human
0health 0and 0the 0environment 0.
The 0treatment 0and 0management 0of 0waste 0which 0prevent, 0minimize, 0reuse, 0recycle,
0disposable 0is 0called 0as 0the 0waste 0management.
Pharmaceutical 0waste:
The 0waste 0is 0generated 0through 0wide 0variety 0of 0health 0care 0facilities 0.it 0includes:
 Expired 0drug 0
 Syringe
 Patient 0discarded 0personal 0medications 0
 Waste 0material 0containing 0chemotherapy 0drug 0residue 0(syringes, 0vials, 0tubing 0etc.)
 Open 0containers 0
 Drugs 0that 0are 0discarded 0
 Contaminated 0garments, 0absorbent 0and 0spill 0containers 0or 0cleanup 0materials.
 Pharmaceutical 0waste 0can 0be 0divided 0into 0three:
 Hazardous 0waste 0
 Nonhazardous 0waste 0
 Chemo 0waste 0

Here 0are 0some 0example 0that 0are 0affecting 0the 0human 0being 0and 0animal 0by 0improper
0disposal
 Evidences 0from 0rodent 0and 0fish 0study 0suggest 0that 0there 0is 0some 0endocrine
0disrupting 0compound 0which 0has 0synthetic 0hormone 0and 0is 0leading 0to 0tumor
0formation 0in 0human 0beings.
 Antibiotics 0in 0the 0sewage 0promote 0the 0transfer 0of 0resistance 0genes 0from
0harmless 0environment 0microbes 0into 0deadly 0pathogen, 0which 0leads 0to 0emergence
0of 0deadly 0drug 0resistance 0microorganism.
 Anti-neoplastic 0and 0cytotoxic 0drugs 0must 0be 0handled 0with 0care 0because 0they
0have 0the 0ability 0to 0kill 0and 0stop 0growth 0of 0living 0cells 0and 0can 0interfere 0with
0the 0reproductive 0processes 0in 0various 0life 0forms.
  The 0immune 0deficiency 0virus 0and 0hepatitis 0virus 0b 0and 0c 0are 0the 0strong
0evidence 0of 0transmission 0via 0health 0care 0waste 0as 0the 0virus 0generally
0transmitted 0through 0injuries 0from 0syringe 0needles 0contaminated 0by 0human
0blood.
 Concentrated 0cultures 0of 0pathogens 0and 0contaminated 0sharps 0are 0probably 0the
0waste 0items 0that 0represent 0the 0acute 0health 0hazard.
 Obsolete 0pesticides 0stored 0in 0leaking 0drums 0or 0torn 0bags 0can 0directly 0or
0indirectly 0affect 0the 0health 0of 0anyone 0who 0comes 0in 0contact.
 Chemical 0residues 0discharged 0into 0the 0sewerage 0system 0may 0have 0adverse 0effects
0on 0the 0operation 0of 0biological 0sewage 0treatment 0plants 0or 0toxic 0effects 0on 0the
0natural 0ecosystem.
 Cytotoxic 0drugs 0are 0extremely 0irritant 0and 0have 0harmful 0effects 0after 0direct
0contact 0with 0skin 0or 0eyes.
 Radioactive 0waste 0can 0lead 0to 0headache, 0dizziness, 0vomiting 0and 0other 0serious
0problems.
00
CASE 0STUDY 0
Mumbai 0Metropolitan 0Region 0(MMR), 0spread 0over 04,355sq. 0km 0is 0home 0to 0seven 0civil
0enterprises. 0Every 0Municipal 0Corporation 0in 0India 0are 0commanded 0to 0investigate 0strong
0waste 0administration 0in 0their 0useful 0areas 0under 0the 074th 0Constitutional 0Amendment.
0At 0present, 0all 0the 0seven 0city 0companies 0rely 0on 0unified 0methods 0for 0overseeing
0waste 0which 0is 0dumped 0at 0doled 0out 0landfills 0post 0gathering. 0Aside 0from 0the
0enterprise, 0there 0are 0various 0players 0who 0assume 0a 0pivotal 0job 0in 0dealing 0with 0the
0waste. 0A 0lot 0of 0this 0is 0overseen 0by 0casual 0part 0and 0now 0rising 0recyclers 0who 0are
0setting 0up 0procedures 0for 0decentralized 0waste 0administration. 0
0Many 0people 0are 0unfit 0to 0accomplish 0100% 0decentralized 0administration 0because 0of
0absence 0of 0proper 0channels 0for 0overseeing 0rejects 0and 0clean 0waste. 0 0Significantly, 0it
0is 0basic 0to 0comprehend 0the 0disappointment 0and 0confinements 0of 0the 0city 0partnership
0since 0they 0are 0monetarily 0subject 0to 0the 0inside 0and 0state 0for 0their 0working. 0In 0any
0case, 0in 0spite 0of 0each 0one 0of 0those 0requirements, 0it 0bodes 0well 0to 0check 0vitality 0and
0material 0recuperation 0possibilities 0and 0connect 0to 0metropolitan 0waste 0administration. 0By
0methods 0for 0various 0models 0and 0an 0innovation 0supplier 0for 0bio-medical 0waste, 0we 0can
0have 0an 0effect 0towards 0making 0greener, 0and 0clean 0environment.
Pharmaceutical 0waste 0treatment 0and 0disposal 0technologies 0specified 0in 0India’s
0pharmaceutical 0waste 0rule:
 Incineration:
The 0solid 0organic 0waste 0are 0subjected 0to 0combustion 0so 0to 0convert 0them 0into 0gaseous
0products. 0It 0is 0also 0known 0as 0thermal 0treatment.it 0is 0high 0investment 0and 0requires
0highly 0skilled 0operating 0personnel.
 Autoclaving:
The 0saturated 0steam 0and 0the 0temperature 0requires 0to 0kill 0the 0pathogens 0.it 0requires
0qualified 0technicians 0and 0medium 0investment 0and 0operating 0cost.
 Microwaving:
The 0electromagnetic 0field 0provokes 0the 0liquid 0in 0the 0waste 0to 0oscillate 0and 0heat 0up
0destroying 0the 0infectious 0components 0by 0induction.
This 0technology 0requires 0medium 0investment 0and 0operating 0cost.
 Deep 0burial:
It 0should 0be 0prepared 0by 0digging 0the 0pit 0or 0trench 0that 0is 0not 0prone 0to 0flooding 0or
0erosion 0and 0where 0soil 0is 0impermeable.
 Encapsulation:
Immobilization 0of 0the 0pharmaceuticals 0in 0a 0solid 0block 0within 0a 0plastic 0or 0steel 0drum.
0
 Inertization:
Removing 0the 0packing 0materials, 0paper, 0cardboard, 0and 0plastics 0from 0the
0pharmaceuticals. 0The 0process 0is 0inexpensive.
 Sewer:
Some 0liquids 0pharmaceutical 0can 0be 0flushed 0into 0sewer 0without 0serious 0public 0health 0or
0environmental 0health.

Strategies 0for 0the 0waste 0management

Prevention 0of 0waste 0material 0leads 0to 0waste 0reduction 0.it 0includes 0money 0methods 0such
0as
 Reuse:
Use 0of 0product 0more 0than 0one 0time 0for 0the 0same 0purpose 0or 0for 0the 0different
0purpose 0without 0any 0reprocessing. 0Example 0: 0using 0an 0empty 0glass 0jar 0for 0storing.
0Help 0the 0save 0on 0energy 0and 0material 0usage.

 Recycling:
Treatment 0or 0reprocessing 0of 0a 0discarded 0waste 0material 0to 0make 0it 0subsequent 0re 0use
0either 0for 0its 0original 0form 0or 0other 0purpose 0example 0: 0paper 0recycling.
 Energy 0recovery:

Steps 0to 0follow 0waste 0management:

 Establishment 0of 0pharmacy 0management 0plan
 Identification 0of 0hazardous 0and 0nonhazardous 0wastes 0
 Implementation 0of 0best 0management 0practices
 Determination 0of 0waste 0generator 0status 0
 Complying 0guidelines 0for 0transport 0and 0disposal

CASE 0STUDY
ITC 0has 0expanded 0its 0renewable 0energy 0portfolio 0with 038% 0of 0its 0energy 0consumption
0being 0met 0from 0renewable 0sources 0ITC 0‘s 0strategy 0of 0Waste 0Management:- 0Often
0considered 0to 0be 0only 0an 0urban 0phenomenon, 0inadequate 0waste 0management 0today
0threatens 0the 0quality 0of 0life 0throughout 0India. 0Heaps 0of 0unattended 0waste 0has 0become
0a 0common 0sight 0in 0both 0urban 0and 0rural 0areas 0of 0the 0country
a] 0Reduction 0of 0waste:- 0All 0ITC 0units 0are 0mandated 0to 0reduce 0specific 0waste 0generation
0through 0construct, 0monitoring 0and 0improvement 0of 0efficiency 0in 0material 0utilization.
0b] 0Segregation 0at 0source 0All 0ITC 0units 0are 0required 0to 0ensure 0that 0all 0wastes 0are
0segregated 0at 0source 0in 0accordance 0with 0company 0defined 0guidelines. 0This 0ensures
0maximum 0reuse 0and 0recycling 0of 0waste.
0c] 0Effluent 0Discharge: 0- 0ITC 0is 0committed 0to 0achieve 0zero 0effluent 0discharge 0through
0treating 0and 0recycling 0of 0waste 0water 0and 0harvesting 0of 0rain 0water 0on 0its 0properties.
0This 0not 0only 0reduces 0fresh 0water 0intake 0but 0also 0maintains 0groundwater 0recharge
Over 0the 0past 0few 0years 0ITC 0has 0become 0environmental 0conscious 0and 0sensitive
0towards 0the 0climate 0change 0and 0global 0warming. 0It 0has 0adopted 0and 0sustained 0green
0practices 0successfully.
There 0will 0be 0also 0intangible 0benefits 0like 0conservation 0of 0the 0environment, 0motivated
0employees 0that 0experience 0pride 0at 0work, 0enhanced 0customer 0loyalty, 0stronger
0relationships 0with 0communities 0and 0regulatory 0bodies 0and 0a 0trusted 0brand 0image

 Pharmacist 0play 0important 0role 0in 0wellbeing 0and 0health 0care 0system 0to 0make
0the 0environment 0free 0from 0pollution 0
 The 0pharmaceutical 0industry 0is 0strengthening 0and 0progressing 0the 0techniques 0to
0treat 0the 0waste 0product 0and 0implying 0the 0minimization 0of 0use 0dangerous
0product 0and 0adopt 0the 0green 0management.
 So 0the 0knowledge 0of 0method 0of 0disposal 0of 0unused 0medicines 0should 0equally
0be 0mandatory 0similar 0to 0the 0knowledge 0of 0consumption 0of 0medicines 0and
0medical 0devices, 0equipment’s.
 Pharmacist 0is 0involved 0with 0the 0entire 0process 0of 0prescribing, 0advising,
0dispensing, 0pharmaceutical 0care, 0disposal 0of 0expired 0medicines 0and 0ultimately
0reduction 0in 0metabolic 0waste 0discharge 0into 0the 0environment.
 Awarding 0people 0about 0the 0use 0and 0misuse 0of 0medicines 0and 0the 0way 0of
0disposing 0it 0and 0as 0a 0result, 0it 0would 0decrease 0the 0risk 0to 0the 0environment
0and 0well-being. 0
 Pharmacists 0are 0the 0medication 0experts 0and 0the 0most 0knowledgeable 0health 0care
0professionals, 0which 0can 0provide 0valuable 0education 0to 0people 0on 0how 0to
0dispose 0the 0unwanted 0waste 0in 0an 0effective 0manner
 0Adopting 0the 0green 0purchasing 0strategies 0as 0they 0ask 0the 0suppliers 0if 0they
0have 0the 0certification 0in 0environmental 0compliance.
 Drug 0disposal 0programs 0and 0pharmaceutical 0collection 0events 0serve 0not 0only 0as
0resources 0to 0the 0community 0for 0safely 0disposing 0of 0unused 0or 0unwanted
0medications, 0but 0also 0as 0platforms 0for 0examining 0the 0causes 0of 0medication
0waste.
 Examination 0of 0pharmacy’s 0energy 0and 0the 0use 0and 0adopt 0of 0the 0energy 0saving
0heating 0like 0cooling, 0ventilation, 0water, 0and 0lighting 0practices.
There 0are 0some 0regulations 0which 0comply 0with 0local 0and 0national 0environmental
0regulations 0to 0manage 0the 0waste. 0
Regulations 0are:
 Do 0not 0mix 0waste 0pharmaceuticals 0with 0other 0medical 0waste.
 Document 0destruction 0of 0hazardous 0waste 0
  Reverse 0distribution 0
 Refusing 0the 0samples
 Encouraging 0the 0employees 0for 0the 0recycling 0programs 0
 Replacing 0the 0older 0equipment’s 0and 0devices 0with 0more 0energy 0efficient 0options
0
 Communicate 0with 0patients 0about 0the 0proper 0medication 0disposal.
“COSUME 0LESS” 0“EMIT 0LESS” 0“CONSERVE 0MORE” 0and 0protect 0our 0environment.

CASE 0STUDY 01:

NTPC 0
 The 0power 0generating 0company 0in 0India, 0there 0core 0business 0is 0the 0engineering,
0construction, 0and 0operation 0of 0power 0generating 0plants.
 The 0backbone 0of 0NTPC 0is 0human 0resource, 0they 0believe 0in 0achieving
0organizational 0excellence 0through 0its 0human 0
 It 0was 0also 0ranked 0the 0third 0best 0employer 0for 0the 0second 0consecutive 0year.
They 0have 0formulated 0strategy 0which 0rests 0on 0four 0building 0block 0of 0HR: 0
 Competence 0building 0
 Commitment 0building 0
 Culture 0building 0
 System 0building 0
The 0objectives 0are:
 Enhancing 0the 0organizational 0performance 0
 Develop 0business 0by 0implementing 0a 0career 0development 0system 0
 Enhancing 0the 0commitment 0of 0employee 0
 Building 0and 0sustaining 0learning 0organization 0
 Creating 0core 0values 0and 0culture 0
 Trade 0union 0act 0a 0mechanism 0to 0give 0voice 0to 0employee 0grievance 0and 0problem
0before 0management 0and 0they 0are 0improving 0the 0quality 0of 0work 0life.
 Meetings 0held 0time 0to 0time 0in 0which 0management 0and 0union 0representative
0discuss 0and 0try 0to 0resolve 0several 0issues, 0the 0primary 0ones 0pertaining 0to 0labor
0welfare.

In 0Maruti 0Suzuki 0Manesar 0IMT 0plant 0the 0workers 0applied 0for 0the 0new 0registration 0of
0union 0but 0the 0management 0forced 0and 0threatened 0workers 0to 0sign 0on 0a 0blank 0sheet
0allegedly 0to 0state 0they 0will 0not 0join 0the 0new 0union 0so 0the 0worker 0protest 0against
0the 0management 0as 0the 0worker 0started 0a 0sit 0in 0strike 0demanding 0recognition 0of 0newly
0form 0Maruti 0Suzuki 0implies 0union. 0So 0the 0pressure 0on 0worker 0was 0put 0as 0the
0management 0dismissed 011 0workers 0including 0MSEU 0office 0bearer 0for 0allegedly 0insisting
0worker 0to 0go 0on 0strike. 0The 0management 0of 0the 0Manesar 0plant 0did 0not 0allow 0to
0have 0independent 0union 0but 0they 0can 0became 0a 0part 0of 0MUKU 0union.
0Both 0the 0parties 0agreed 0to 0cooperate 0with 0each 0other.
CONCLUSION:
 Set 0up 0grievance 0redressal 0committee.
 Formation 0of 0labor 0welfare 0committee. 0

One 0of 0the 0most 0important 0roles 0that 0labor 0unions 0perform 0is 0that 0when 0there 0is 0a
0dispute 0in 0the 0workplace, 0the 0union 0acts 0as 0an 0intermediary 0between 0employers 0and
0business 0owners. 0Labor 0union 0leaders 0are 0experienced 0at 0solving 0problems 0through
0formal 0arbitration 0and 0grievance 0procedures. 0Instead 0of 0viewing 0this 0process 0as
0contentious, 0business 0owners 0should 0welcome 0the 0involvement 0of 0a 0union
0representative, 0because 0it 0can 0expedite 0the 0resolution. 0When 0issues 0arise 0at 0the
0workplace 0between 0you 0and 0your 0employee, 0the 0goal 0is 0to 0secure 0a 0“win-win” 0in
0which 0both 0sides 0feel 0as 0if 0they 0each 0attained 0something 0from 0the 0deal.
Mangers 0must 0be 0cautious 0about 0their 0own 0frames 0of 0mind 0and 0attitude. 0If 0they
0demonstrate 0a 0negative 0attitude 0toward 0their 0workers, 0their 0impact 0can 0be
0tremendously 0negative 0for 0the 0organization. 0That's 0because 0poor 0management 0attitudes
0negatively 0affect 0their 0employees' 0motivation 0to 0work. 0 0Along 0these 0lines, 0they 0should
0screen 0their 0own 0correspondences 0with 0representatives, 0even 0messages 0and 0telephone
0calls, 0and 0look 0for 0input 0from 0workers 0on 0how 0they 0are 0seen 0as 0supervisors. 0Input
0causes 0administrators 0to 0pinpoint 0issue 0zones 0in 0which 0they 0should 0improve, 0Managers
0can 0also 0take 0action 0by 0working 0to 0eliminate 0the 0negative 0interactions 0that 0employees
0experience 0at 0work. 0
Great 0connections 0among 0boss 0and 0representative 0don't 0simply 0occur. 0They 0are 0the
0result 0of 0a 0strategy 0and 0activities 0that 0employee 0relations 0managers 0design 0to 0improve
0communication 0between 0employees 0and 0management. 0
A trade union (or a labor union in the U.S.) is an association of workers forming a legal unit or legal
personhood, usually called a "bargaining unit", which acts as bargaining agent and legal representative
for a unit of employees in all matters of law or right arising from or in the administration of a collective
agreement. Labour unions typically fund the formal organization, head office, and legal team functions
of the labour union through regular fees or union dues.
Best 0practices 0consolidate 0work 0and 0business 0laws, 0genius 0and 0human 0asset 0ability 0in
0creating 0rehearses 0that 0improve 0working 0connections. 0
Successful 0work 0the 0executives 0connections 0are 0pull 0in 0regard 0for 0the 0law. 0The
0government 0law 0that 0oversees 0the 0connections 0between 0worker's 0organizations 0and
0businesses 0is 0central 0to 0accomplishing 0a 0gainful 0association 0workplace. 0 0 0 0 0 0 0 0 0 0
Morale
Morale 0is 0governed 0by 0the 0way 0managers 0treat 0employees, 0the 0way 0managers 0motivate
0employees 0and 0the 0goals 0managers 0ask 0employees 0to 0accomplish. 0 0Managers 0who
0converse 0with 0employees 0in 0a 0friendly 0manner, 0push 0them 0to 0accomplish 0reachable
0goals 0and 0motivate 0them 0with 0rewards 0cause 0employees 0to 0feel 0motivated 0to 0come
0to 0work 0every 0day. 0Managers 0who 0don’t 0care 0about 0employees, 0shrug 0them 0off 0as
0mere 0subordinates 0and 0tell 0them 0to 0accomplish 0goals 0that 0aren’t 0possible 0cultivate 0a
0sense 0of 0helplessness 0in 0those 0employees.
Performance
Managers 0who 0make 0it 0a 0point 0to 0perform 0at 0a 0high 0level 0each 0day 0and 0complete
0their 0tasks 0to 0the 0best 0of 0their 0ability 0typically 0infuse 0the 0workplace 0with 0the 0same
0mindset. 0Because 0people 0learn 0from 0an 0early 0age 0to 0pay 0attention 0to 0the 0way 0their
0superiors 0act, 0many 0employees, 0whether 0they’re 0naturally 0hardworking 0or 0lack 0work
0ethic, 0subconsciously 0incorporate 0a 0manager’s 0work 0ethic 0into 0their 0own 0ways. 0Take
0for 0example 0a 0manager 0at 0a 0pizza 0shop. 0When 0he 0ensures 0that 0each 0task 0he
0completes, 0from 0cleaning 0the 0ovens 0to 0serving 0customers, 0is 0completed 0to 0the 0best
0of 0his 0ability, 0his 0assistant 0managers 0and 0crew 0can’t 0help 0but 0notice 0the 0effort 0he
0puts 0into 0everything 0he 0does.
A trade union (or a labor union in the U.S.) is an association of workers forming a legal unit or legal
personhood, usually called a "bargaining unit", which acts as bargaining agent and legal representative
for a unit of employees in all matters of law or right arising from or in the administration of a collective
agreement. Labour unions typically fund the formal organization, head office, and legal team functions
of the labour union through regular fees or union dues.

Attitude
A 0company 0consists 0of 0employees 0with 0primarily 0negative 0or 0positive 0attitudes. 0An
0employee’s 0attitude 0often 0reflects 0the 0attitude 0of 0his 0superiors. 0Managers 0who 0take 0a
0negative 0outlook 0on 0everything 0usually 0cause 0employees 0to 0do 0the 0same. 0Negative
0attitudes 0cause 0employees 0to 0become 0cynical 0about 0their 0work, 0leading 0to 0carelessness.
0Negative 0managers 0also 0prevent 0employees 0from 0growing 0and 0improving, 0because 0their
0management 0style 0doesn’t 0promote 0positive 0thinking 0and 0encouragement. 0Managers
0who 0take 0on 0a 0negative 0attitude 0usually 0do 0so 0without 0realizing 0that 0it 0adversely
0affects 0the 0workplace.
Collective 0Bargaining
The 0act 0states 0that 0employers 0and 0labor 0unions 0must 0engage 0in 0a 0collective 0bargaining
0process 0that 0will 0result 0in 0a 0labor 0union 0contract 0to 0which 0both 0parties, 0plus 0union
0members, 0can 0agree.
Grievance 0Handling
A 0collective 0bargaining 0agreement, 0or 0labor 0union 0contract, 0typically 0contains 0a 0grievance
0process, 0which 0is 0key 0to 0maintaining 0an 0effective 0labor-management 0relationship. 0In 0a
0unionized 0work 0environment, 0employees 0who 0dispute 0their 0supervisors' 0decisions 0must
0file 0a 0grievance.
Perception
0Best 0practices 0implement 0and 0support 0activities 0that 0improve 0the 0perception 0of 0human
0resources 0from 0an 0administrative-based 0department 0to 0one 0that 0acts 0in 0the 0best
0interest 0of 0the 0organization, 0its 0workforce 0and 0individual 0employees. 0Treating 0employees
0as 0internal 0customers 0is 0a 0big 0step 0in 0moving 0toward 0positive 0interaction 0with
0employees.
Communication
Maintaining 0an 0open 0line 0of 0communication 0with 0upper 0management 0is 0an 0essential
0step 0in 0improving 0the 0employer-employee 0relationship. 0Employee 0relations 0managers
0engage 0in 0periodic 0exchanges 0with 0managers. 0
Employee 0Satisfaction
Managers 0who 0focus 0on 0employee 0relations 0devote 0a 0significant 0amount 0of 0their 0time
0to 0measuring 0and 0ensuring 0job 0satisfaction. 0They 0use 0tools 0such 0as 0employee 0focus
0groups, 0surveys, 0one-on-one 0conferences 0with 0supervisors, 0managers 0and 0exit 0interviews
0to 0determine 0the 0causes 0of 0low 0employee 0morale. 0The 0most 0effective 0task 0employee
0relations 0managers 0have 0is 0identifying 0what 0underlies 0employee 0satisfaction 0and
0resolving 0matters 0that 0cause 0dissatisfaction 0in 0the 0workplace.
Impact:
 To 0govern 0the 0uptake 0of 0new 0devices.
 Healthcare 0expenditure 0
 Collection 0of 0primary 0data 0through 0national 0survey 0by 0the 0public 0hospitals 0
 Adoption 0of 0costly 0devices 0unlike 0hospital 0based 0HTA 0
 Centralized 0regional 0procurement 0yields 0lower 0medical 0device 0unit 0prices.
 To 0maintain 0an 0appropriate 0balance 0between 0the 0patient 0access 0to 0modern 0care
0and 0the 0economic 0sustainability 0of 0healthcare 0system.

CASE 0STUDY 01: 0

Singapore 0 0
Singapore 0has 0strong 0and 0healthy 0t 0health 0care 0system 0that 0is 0well 0known 0for
0providing 0the 0good 0health 0outcomes 0.in 0public 0health 0care 0sector 0subsidies 0and
0financial 0assistance 0are 0provided 0for 0drug 0listed 0on 0the 0standard 0drug 0list 0and
0medication 0assistance 0fund.
It 0is 0always 0available 0to 0provide 0the 0support 0for 0patient 0in 0need.
With 0the 0new 0technology 0entering 0in 0the 0market 0at 0high 0cost 0, 0the 0HTA 0plays 0a
0important 0role 0to 0inform 0the 0value 0and 0determine 0how 0best 0to 0allocate 0finite 0health
0care 0resources 0to 0ensure 0long 0term 0sustainability 0of 0the 0health 0care 0system 0.
Role:
 They 0are 0currently 0focusing 0on 0the 0subsidy 0decision 0making 0and 0improving
0patient 0access 0to 0cost 0effective 0drugs.
 Recommending 0public 0funding 0of 0drug.
 To 0ensure 0and 0evaluate 0the 0strong 0and 0healthy 0health 0care 0system.
 Value 0based 0pricing 0has 0led 0to 0more 0cost 0effective 0prices 0being 0negotiated 0with
0companies 0to 0improve 0affordability 0for 0patient 0and 0in 0public 0health 0care 0system
0.

Conclusion:
  To 0achieve 0the 0great 0impact 0
 They 0need 0to 0expand 0the 0HTA 0capacity 0beyond 0subsidy 0decision 0making 0and
0drive 0appropriate 0care 0in 0a 0suitable 0manner 0for 0future 0generation 0.

CASE 0STUDY 02:

Spain 0
Objective:
To 0compare 0the 0HTA 0as 0a 0support 0pricing 0and 0reimbursement 0of 0new 0medicines 0in
0Spain 0with 0other 0countries 0(England, 0Sweden, 0France 0and 0Germany)
For 0each 0country 0the 0literature 0used 0to 0identify 0the 0purpose 0and 0timing 0and 0HTA
0decision 0making 0procedure 0used 0to 0generate 0the 0evidences 0and 0the 0criteria 0to 0make
0the 0decisions.
Results: 0comparisons 0are 0made 0between 0the 0Spain 0and 0the 0other 0countries 0
Conclusion:
 HTA 0might 0develop 0in 0Spain:
 To 0improve 0the 0governance 0and 0efficiency 0
 Still 0falls 0short 0of 0the 0international 0standards 0in 0terms 0of 0independence 0of 0the
0HTA 0agencies 0and 0decision 0making 0committee 0from 0political 0influence 0and
0industrial 0policy 0
 The 0setting 0of 0prices 0of 0medicinal 0in 0relation 0to 0health 0gain.
 Improve 0the 0transparency 0of 0the 0process.
 To 0evaluate 0and 0to 0promote 0the 0participation 0of 0stakeholder 0
 To 0coordinate 0effort 0across 0the 0various 0agencies 0strengthen 0technical 0staff 0and
0to 0ensure 0the 0access 0to 0medicines 0between 0regions.

HTA 0studies 0the 0medical, 0social, 0ethical, 0and 0economic 0implications 0of 0development,
0diffusion, 0and 0use 0of 0health 0technology
The 0information 0provided 0by 0HTA 0can 0be 0used 0to 0optimize 0the 0prioritization 0of
0resources 0in 0healthcare: 0good 0value 0for 0money 0investments 0take 0precedent 0over 0poor
0value 0for 0money 0investments.
Within 0HTA 0there 0are 0several 0types 0of 0economic 0analysis 0which 0are 0commonly 0used: 0
 Cost 0benefit 0analysis 0(CBA), 0
  Cost-effectiveness 0analysis 0(CEA), 0
 Cost-utility 0analysis 0(CUA), 0and 0
 Cost-minimization 0analysis 0(CMA). 0
0CBA: 0An 0economic 0analysis 0that 0considers 0both 0the 0costs 0and 0benefits 0of 0investing 0in
0a 0particular 0health 0technology 0compared 0with 0an 0alternative 0strategy. 0Costs 0and
0benefits 0are 0typically 0measured 0in 0present 0value 0monetary 0terms. 0
0CEA: 0A 0form 0of 0analysis 0that 0considers 0both 0the 0costs 0and 0effectiveness 0of 0investing
0in 0a 0particular 0health 0technology. 0Effectiveness 0can 0be 0measured 0in 0a 0variety 0of 0ways
0such 0as 0number 0of 0falls, 0number 0of 0hospital 0visits, 0length 0of 0recovery 0time 0or 0an
0improvement 0of 0quality 0of 0life 0for 0instance. 0CEA 0returns 0a 0result 0in 0the 0form 0of 0cost
0per 0outcome.
0CUA: 0A 0sub-form 0of 0CEA 0that 0takes 0into 0account 0the 0incremental 0costs 0versus
0incremental 0utility 0provided 0of 0a 0new 0health 0technology. 0Utility 0gain 0is 0a 0measure 0of
0quality 0of 0life 0improvement 0that 0uses 0quality 0adjusted 0life 0years 0(QALYs) 0as 0units.
0CMA: 0The 0health 0technology 0under 0consideration 0has 0been 0deemed 0equivalent 0in
0efficacy 0to 0that 0of 0current 0practice 0and 0as 0such 0only 0the 0cost 0is 0of 0concern. 0The
0new 0technology 0will 0be 0adopted 0if 0the 0true 0cost 0of 0funding 0is 0equal 0or 0lower 0than
0the 0cost 0of 0current 0treatment.
0This 0review 0has 0five 0main 0objectives: 0
1. 0To 0identify 0and 0describe 0the 0role 0of 0health 0technology 0assessment 0(HTA) 0in 0the
0price 0setting 0and 0reimbursement 0of 0pharmaceuticals 0with 0a 0focus 0on 0its 0use 0in 0low-
0and 0middle-income 0countries;
02. 0To 0identify 0and 0describe 0the 0prerequisites 0necessary 0for 0implementation 0of 0HTA; 0
3. 0To 0consider 0issues 0relevant 0to 0the 0appraisal 0of 0HTA 0and 0how 0to 0use 0HTA
0undertaken 0by 0others;
04. 0To 0identify 0and 0describe 0the 0available 0evidence 0on 0the 0impact 0of 0HTA 0on 0pricing
0and 0access 0to 0medicines; 05. 0To 0assess 0the 0evidence 0concerning 0the 0impact 0of 0HTA
0on 0pricing 0and 0access 0to 0medicines 0in 0developing 0countries

EFFECT 0
 No 0clear 0pattern 0of 0the 0impact 0of 0HTA 0on 0prices 0could 0be 0determined.
0However, 0given 0that 0recommendations 0based 0on 0HTA 0can 0be 0conditional 0or
0limited 0to 0certain 0indications 0or 0patient 0sub-groups, 0the 0recommendations
 0following 0HTA 0potentially 0reward 0innovation 0while 0considering 0value 0for 0money.
0
 The 0paper 0indicates 0that 0reference 0pricing 0alone 0does 0not 0represent 0a 0viable
0policy 0for 0obtaining 0value 0for 0money 0from 0pharmaceuticals; 0
 HTA 0represents 0a 0much 0better 0approach 0given 0the 0reward 0for 0innovation 0and
0value 0for 0money 0consideration. 0The 0authors 0suggest 0that 0a 0dual 0policy 0may 0be
0emerging, 0in 0which 0the 0primary 0policy 0for 0obtaining 0value 0for 0money 0from 0new
0medicines 0is 0based 0on 0HTA 0and 0supported 0by 0internal 0reference 0pricing 0or
0another 0approach.
 In 0a 02010 0study 0of 0middle-income 0countries 0where 0HTA 0activities 0are 0evident, 0it
0was 0found 0that 0the 0role 0of 0HTA 0differed 0from 0country 0to 0country
 HTA 0is 0developing 0at 0uneven 0speeds 0and 0the 0reimbursement 0of 0pharmaceuticals
0is 0arranged 0differently 0ranging 0from 0the 0highly 0centralized 0(e.g. 0Turkey) 0to 0the
0fragmented 0(e.g. 0Argentina).

FEASIBILITY 0
Various 0health 0care 0bodies 0(regulatory, 0health 0technology 0assessment, 0academia, 0health
0care 0providers, 0and 0scientific 0journals) 0request 0patient 0input 0in 0their 0decision-making
0processes. 0This 0represents 0a 0shift 0from 0disease-centered 0to 0patient-centered 0approaches
0to 0health 0care. 0What 0does 0this 0“patient 0centricity 0“mean 0for 0the 0pharmaceutical
0industry? 0A 0panel 0of 0senior 0pharmaceutical 0industry 0representatives 0discussed 0the
0following 0key 0issues: 0why 0the 0pharmaceutical 0industry 0needs 0to 0be 0part 0of 0the
0patient-centric 0movement; 0how 0the 0industry 0can 0become 0patient-centric; 0and 0what 0a
0patient-centric 0company 0actually 0does. 0We 0summarize 0the 0panel’s 0point 0of 0view 0on
0these 0key 0questions. 0The 0industry’s 0role 0has 0been 0to 0develop 0the 0science 0and
0medicines 0for 0prevention 0or 0treatment 0of 0disease. 0In 0response 0to 0changes 0in 0the
0current 0health 0care 0environment, 0the 0industry 0should 0focus 0its 0efforts 0on 0initiatives
0that 0will 0improve 0impact 0and 0value 0for 0patients 0and 0careers. 0True 0patient 0centricity
0requires 0a 0change 0in 0the 0industry’s 0cultural 0mindset, 0an 0increase 0in 0public 0trust,
0clearer 0roles 0and 0responsibilities 0within 0pharmaceutical 0organizations, 0openness 0to 0learn
0from 0others, 0and 0a 0framework 0to 0measure 0success. 0There 0are 0examples 0of 0industry
0engagement 0with 0patients 0throughout 0the 0drug 0discovery 0and 0development 0process.
0Patient-reported 0outcomes 0are 0becoming 0increasingly 0important 0endpoints 0in 0trials; 0they
0capture 0information 0of 0relevance 0to 0patients, 0identify 0preferences, 0and 0better 0inform
0treatment 0decision 0making. 0Understanding 0the 0patient 0experience 0can 0improve 0disease
0management 0at 0critical 0points 0in 0the 0disease 0course. 0The 0future 0of 0patient 0centricity
0lies 0in 0coordinated 0efforts 0by 0and 0alignment 0of 0multiple 0health 0care 0stakeholders,
0which 0can 0only 0be 0achieved 0through 0collaborations 0and 0consortia, 0with 0the 0industry
0playing 0a 0key 0role.