3 consumer health

Unit 3: Consumer Health
Draft Version 4
(12 hrs.)
Upendra Raj Dhakal
Lecturer: Valley College of Technical Sciences, Kathmandu

Meaning, Concept of consumer health and
right
• Consumers are those who finally utilize the information, products or
services.
• When the information, products and services are related to health,
than it is known as consumers health.
• Consumers Health refers to our decisions that we make during
purchase and use those information and services that will have direct
effect on our health.
• Consumer Right is the reference to a body by law that protects
service utilizers
Draft Version 4 (Feedback Welcomed) 2

Features of consumers
• Seasonal consumers (umbrella in rainy season)
• Personal consumers (purchasing personal materials)
• Organizational consumers (organization, government, business, …)
• Impulse buyers (unplanned buying decisions – chocolates, buying eye
catchy materials)
• Need based consumers: (air mask in Kathmandu)
• Discount driven consumers (buy only when there is discount, or force to
discount)
• Habitual consumers: smokers search for same brand in different stores,
same beer …)
(https://toughnickel.com/industries/Types-Of-Consumers)

Elements of consumers health and right
• The right to basic needs (universally acceptable food, clothing and shelter)
• The Right to safety (quality and its guarantee, special hallmarked, banning
unsafe, …)
• The right to information (summary, purity, quality, quantity, price, expiry, ….)
• The right to choose (variety, fair price, quality, quantity, competition, …)
• The Right to education (simple language, representable, easily understood,
…)
• The Right to redress (restore or correct from feedbacks, )
• The Right to be heard (Consumers forum, consumers court, ….)
• The Right to healthy environment (eco friendly products, symbols like
recyclable)
(http://lifestyle.inquirer.net/1386/the-eight-basic-consumer-rights/)Draft Version 4 (Feedback Welcomed) 4

These elements can also be defined under
components of consumer health as:
• Health Information: Seeking information from reliable source,
Identifying professionals, pseudo professionals and non professionals,
Skeptical towards social marketing,
• Health Products: Drugs, foods, reagents, cosmetics, in-house
consumables, hazardous substances, identifying real material from
the crowd, …
• Health services: Approach to services, communication, nursing care,
health insurance, …

Consumer Exploitation
• Consumers are exploited by a large number of restrictive and unfair
trade practices.
• Misleading, false or deceptive advertisements are quite common.
• Advertisement many times promotes false information, giving a
mislead.
• Factors for exploitation: Limited information, Limited supplies,
Limited competition, Illiteracy, ….

Duties of Consumers
• Buying quality product at reasonable price
• Check Weight and measures before making purchase
• Reading the level carefully
• To produce the bill, cash received warranty, etc.
• Shopping carefully and wisely
• Understanding the terms of the sale
• Reading and following instructions
• Buy legal products, do not promote black and gray market.
• File a complain in an appropriate consumer forums
• Respect environment

Consumer Health issues
• Quackery and Health Fraud
• Problems with Products
• Problems with Services
• Problems with Costs and Access
• Problems with Risk Perception
• The need for Consumer Protection (Protective forces)
• Intelligent Consumer Behavior
• ………………

Major Consumers health issues in Nepal
• Service Related
• Health Related
• Consumer Behavior Issues

Consumers Health Issues – Service Related
• Misleading Information: Empty MRP, Charging above MRP, Altering
expiry date, wrong levels of integrant, 10 गुणा तक ज्यादा शक्ती in
Duracell advertisement. (Must be saying 10 %, not 10 times)
• Issues in Healthy Products: No expiry dates, unacceptable integrant.
• Issues in Accessible of Health Services: Distance, cost, time.
• Problems with cost and Access: Charge for the service, technology,
socio – cultural factors interfering the access,

Consumers Health Issues – Health Related
• Disease related issues: Disable/gender/child friendly, patient friendly sites, e.g.
OPD at top floor creating difficulty for patients with arthritis to walk, increased
waiting time increases the risk of intragenic/nosocomial infection.
• Hygiene and Sanitation: Wrong levelling in Soap and toothpastes as 99.9%
effective. Promoting the role of disinfectants used in soap when they have no
role. 100% बेहत्तर सुरक्षा in the advertisement of Dettol soap, which is
overlapping 99.9% effectiveness, though it must be 95%.
• Vulnerability and hazards: No sugar added, but sugar occurs naturally in that
product, Immune booster has lawsuit, Sugar free does not mean calorie free and
no trans fat does not mean 0 amount of trans-fat
• Quality service and product and their effect on public health: Made with real fruit
does not specify if is only real fruit or mixed. Food made up of flavors and colors
only.

Consumers Health Issues – Consumer
Behavior
• Need for consumer protection: Protection and Exploitation,
Consumer Education, Redress of Complaints, A connecting Link,
Quality Life for consumer, Ethical Obligations.
• Objectives of Consumer Protection: Protection against unfair trade
practices and protection of enjoying the rights
• Importance of Consumer Protection: Public Image, Social
Responsibility, Increasing Awareness, Customer Satisfaction,
Government Intervention.

Contd …
Intelligent consumer behavior: (Behaviors)
• They seek reliable sources of information.
• They maintain a healthy lifestyle.
• They select practitioners with great care.
• They undergo appropriate screening tests and, when illness strikes, use self-care and
professional care as needed.
• They communicate effectively.
• When a health problem arises, they take an active role in its management.
• They understand the logic of science and why scientific testing is needed to test and to
determine which theories and practices are valid.
• They dislike less scientific treatment and experiments upon themselves.
• They are familiar with the economic aspects of health care.
• They report frauds, quackery, and other wrong doing to appropriate agencies and law
enforcement officials.
(https://www.quackwatch.org/02ConsumerProtection/intell.html)

Contd ….
Unhealthy behavior: Compromise in the sense of feeding, clothing,
other lifestyles, self medication and quackery practice, googling,
shoplifting, effect of social marketing, unnatural bargaining, falsifying
bills.
These type of behavior is even promoted organizationally in the name
of sales and discount, escaping tax - bill payments.
Not only with the self, they help promoting unhealthy behavior in the
community. Some consumers even behave as laggards.

Contd …
Psychological manipulation: It is social influencing technique for BCC
through abusive, deceptive, or underhanded tactic.
It is the exercise of undue influence through mental distortion and emotional
exploitation, with the intention to seize power, control, benefit and/or
privileges at the victims expense.
Psychological manipulators are self centered
It is not necessary always negative, e.g.. During rehabilitation of drug
abusers. Drugs are not stopped instantly.

Character/Sign of manipulators
1. Hearing their story
2. Information overloaded
3. Exude (Convey) negative emotions
4. Make feel insecure or try to feel insecure
5. Play dumb
6. Manipulate facts
7. Place undue pressure

What is quality
• National Association of Quality Assurance Professionals (NAQAP)
described quality as: The level of excellence produced and
documented in the process of patient care, based on the best
knowledge available and achievable at a particular facility.
• The Community Health Accreditation Program (CAP) defined quality
as: The degree to which consumers progress toward a desired
outcome.

Quality of Care
“Health care services that produce desired health outcomes and fulfill
consumer’s needs, with optimum use of available resources, provided by
trained and competent providers as per the national norms and standards
with minimizing risk for service providers as well as consumers.”

Quality Assurance
“Quality Assurance is a continuous process which includes series of
activities for improving and maintaining optimum level of quality of
health care services that includes mainly; setting standards and
protocols, communicating standards, developing indicators, monitoring
compliance with standard and solving problems by team approach.”

Quality is evaluated on the basis of: Input, Process and Output
Input : (Knowledge, Qualification, Skill, Resources, level of HF, skill,
referral system, ….)
Process : (Attitude, Behavior, Technology, Facilities, SOPs, CP,
waiting time, social audits, MnE, data audit, ….)
Output: Satisfaction of customers, Nosocomial infection rate,
Mortality rate, Recovery rate, Complication rate, average length of
stay in hospital, Post operative death rate, Quality Control of
Drugs: ………………………………., Misleading Impact on Consumers:
……………………………

Customer Protection
• Production/Manufacture.
• Distribution channel.
• Storage of material
• Supply chain up to last consumer
• Pay back for faulty supplies
• Discouraging gray/black market
• Legislation and Customers court
• Awareness in customers as their rights

Consumer Protection in Nepal
• Quality control of health service, quality of drug, misleading impact
on consumer
• Overview of consumer protection law of Nepal and its implication
• Quality assurance department of DoHS
• Other government agency for controlling mechanism of quality goods
(Roles and responsibility of Department of commerce, Department of
quality assurance and weight measurement)
• Industry Self-Regulation

Quality under Essential Health Care Services (EHCS)
In 1st phase, quality guidelines will be developed for:
• Reproductive Health: Safe Motherhood and new born care/Family
planning
• Child Health: National Immunization Program, Community based
Integrated Management of Childhood Illnesses, Malnutrition and
nutritional deficiency disorders in children
• Communicable Disease Control: TB, Leprosy, HIV/AIDS and STD,
Malaria, Kala-azar and Japanese Encephalitis, and
• OPD Services: and for other health services in subsequently. Emphasis
will be given on proper implementation of these standards, guidelines
and protocols through routine monitoring and supervision.

QA Steering Committee at Ministry (Central) level
• Chair : Chief Specialist, Curative Division, MoHP
• Member (3) : Director General, DoHS, DoA, DoDA
• Member : NHRC Representative
• Member (2) : Different Council Representatives
• Member : Legal Officer, MoHP
• Member : Representatives from Consumers Forum
• Member : Representative of APHIN
• Member Secretary : Chief, MnE and PHA Division, MoHP

QA Steering Committee at District level
• Chair : Chief D/PHO
• Member : Medical Superintendent
• Member : Nursing In charge
• Member : Lab Technician
• Member : Health Assistant
• Member : HA - DHO/PHN - DPHO
• Member : SA
• Member : Representatives from I/NGO, Nursing Homes
• Member : Representative from Consumers forum
• Member Secretary : PHO/PHI
Similarly, QA committee is formed below district level.

How quality is evaluated
• MSS is being measured at district level and below, but MSS above
district level is still under development.
• MSS uses SBMR tool for evaluating the quality
• MSS follows SOP and has planned for contingencies

Consumer Protection Act, 2054
• Considered as milestone in safeguarding the rights of Nepalese consumers
• It protects from the irregularities in quality, quantity and prices
• It prevents monopolies and unfair trade practices.
• It has provisions of selling, supplying, importing, exporting and storing of
materials with protecting consumer rights and establishment of agency for
redress.
• There is even the provision of making Appeal in court within 35 days if is
dissatisfied with the decision taken by compensation committee under
section 24 from the date of decision.
• The act has defined sealing of prices as punishment, which needs
reviewing.

Features (and implications) of … CPA 2054
• It has focused in forming a council of member of 7
• The functions, duties and powers of the council has been defined.
• Procedure relating to meeting of the council has been defined
• It has protected and promoted consumers right
• It has prohibited to influence Demand, Supply or Price
• It has power to systematize and control supply of consumer good and
services
• It has defined particulars to be mentioned in consumer goods
• It has prohibited actions regarding consumer goods or services

Contd …
• It has standardized customer good and services
• Price list must be kept
• It has given power to government to conduct inquiry and inspect
• It has given power to appoint or designate inspection officer.
• It has given powers of inspection officers to Inspect, Inquiry or Search
• Testing of consumers good
• Sub – standard consumer goods to be confiscated
• Penalties
• Government of Nepal as Plaintiff

Contd …
• Investigation and filling of lawsuits
• Summary trial procedure to be adopted
• Claims for compensation may be made
• Compensation committee
• Realization of compensation
• Appeal
• Power to initiate lawsuits under the prevailing laws
• Power to form sub committees
• Delegation of powers
• Immunity for actions taken with Bona Fide Motives
• Power to frame rules

Other Acts and Laws
Food Act, 2052 (1996) Drug Act, 2035
Nepal Standard Act, 1980 Black Market and Some Social Crime and Punishment Act, 1997
Consumer Protection Act 2054 (1998) Animal Slaughterhouse and meat inspection act, 2055
Copyright Act, 2002 Competition Promotion and Market Protection Act, 2063 and regulation,
2066
Nepal standard (Certification mark0 act, 2037 Iodized Salt (Production, Sales and Distribution) act, 2055
Black Marketing and some other social crime and
punishment act, 2032
Environment Protection Act, 2053
Standard Measurement and Weight Act, 2025 Nepal Health Service Act, 2053
Consumer Protection Act, 2054 and Regulation,
2056
Breast Feed Substitute (control of sales and distribution) act, 2049
Food Act, 2023 (1967) Water Resource Act, 2049
Patent, Design and trademark Act (PPDTA) Electricity Act, 2049
Nepal Milk Product Development Board Act, 2048

QA Assurance department of DoHS
• QA is established as a section under Management Division in DoHS
which will monitor QA related operations activities
• Though there are QA team under each departments and centers
internally in DoHS.
• Presently, QA team has been formed to see the overall performance
of Health Facility at HF level, but not as per the departments.

Other Government agencies …..
• Ministry of Commerce and Supply
• Department of quality assurance and weight measurement
(Standards and Meteorology)
• Consumer Protection Council
• Department of Food Technology and Quality Control
• DDA
• Nepal Rastra Bank
• Ministry of Foreign Affairs and Local Development
• ……

Department of Commerce and Supply Management
(Now - Department Of Supply Management And Protection Of Consumers Interest under Mo Supplies)
• Activities related to corporations and companies
• Policies and programs related to productivity improvement
• Activities related to technology transfer and development
• Research
• Decision related to import export trade and operation of international
supply
• Policy implementation on supply of consumable commodities
• Management for regular and balanced supply of essential edible materials
to the common people
• Protection of consumers right and walfare.

Contd …
Government of Nepal ((Allocation of Business) Rules, 2069 (2012) has defined scope of work for
the Ministry of Commerce and Supplies as follows:-
• Formulation, implementation, monitoring and evaluation of policy, plan and programmes relating
to commerce, trade and supply.
• Study, research and survey of the internal (domestic) and international trade.
• Formulation, implementation, monitoring and evaluation of policy, plan and programmes relating
to export and import
• Regulation and supply of essential goods and commodities.
• Export promotion.
• Operation of government and public trade.
• Operation of corporations, Boards, enterprises, companies etc. relating to commerce and supply.
• Liaison with international institution relating to commerce, trade and transit.
• Liaison, coordination, negotiation, agreement and commitment with multilateral trade
organizations including world Trade Organization.
• Implementation and monitoring of relation, coordination, negotiation, agreement and
commitment with regional trade agreement organizations including SAFTA, BIMSTAC

Contd …
• Bilateral and multilateral trade treaty and agreements.
• Transit, warehouse and management of international transportation.
• Multimode carriage of goods.
• Formulation, implementation, monitoring and evaluation of policy, plan and programmes
relating to food and other consumer and essential goods and commodities.
• Import, processing, storage, supply and regulation of petroleum products.
• Protection of rights and interests of the consumers,
• Control of syndicate and carteling.
• Internal market management and competition promotion
• Regulation and promotion of international trade diplomacy.
• Establishment and management of infrastructure such as dry ports, container fret
station, warehouse etc.

Contd …
Based on the work area of this ministry, following are the main
objectives.
• Making sure that the supply of consumable goods even during the
time of the disaster, making market system competitive and
responsible for the consumer.
• Making the supply system sustainable, reliable, quality and effective.
• Conserving the rights of consumers, to make arrangements for
regular and easy supply of daily consumables goods and services.

Contd …
Working Area of Ministry
• Supply policy, planning and planning, implementation, monitoring, and evaluation,
• Supply, research and survey related supply,
• Supply and regulation of essential goods,
• Operations of supply related public institutions, committees, establishments, companies
etc.
• Planning, implementation, monitoring and evaluation of policy, planning and program
related to food and other consumables and essential items,
• Processing, storage, supply and regulation of petroleum products,
• Consumer rights, interests and rights protection,
• Syndicate and cartelling control,
• Internal market management and competitiveness.

Nepal Bureau of Standards & Metrology
(NBSM)
• Nepal Bureau of Standards & Metrology (NBSM) is the National
Standard Body in Nepal.
• It is a Government organization under the Ministry of Industry.
• It is also the national enquiry point / nodal point for WTO (TBTs &
NTMs) and focal point for National Authority on Disarmement Affairs
(NADA).
Vision:
- To provide efficient and timely service.
- To satisfy the customer's need for quality goods and services.
- To raise awareness in the field of standardization & metrology.

Contd …
• Objectives:
- Harmonious development of standardization, marking and quality
certification.
- Harmonious development of scientific and legal metrology.
- To facilitate development of production and exports.

Contd …
The main activities of NBSM are to:
• Formulate national standards
• Operate the product certification mark
• Provide testing facilities and technical services in the fields of SMQC
• Work as the third party guaranteeing agency
• Provide service for lot certification and pre-shipment inspection, as well as
laboratory recognition.
• Launching of consumer awareness programmes on quality.
• Provide laboratory services for testing of various commodities.
• Involve in environment protection.
• Additional activities include legal metrology and calibration services for weighing
and measuring devices. Initiation on industrial and scientific metrology is in
progress.

DoQA and Wt Measurement (Standards and Meterology)
under Mo Industry Commerce and Suppliy
• Giving Nepal Standard (NS) sign to the materials that are produced
using SoP and maintaining MSS
• Manage and control measurements using Standards
• Technical support for maintaining quality in materials that are
exported out of country
• Assure quality product and services for customers
• Assure quality of standards, frequencies, for laboratories, calibrations,
Informations and library support related to Measurements

Industry self regulation
• Monitoring its own adherence to legal, ethical, or safety standards,
rather than have an outside, independent agency such as a third
party entity monitor and enforce those standards.
• Cost of outsourcing 3rd party is decreased.
• Difficult to do comparison when external agents are not used.
• Organization directly rewards or punishes its members.
• There are different code of conduct to support self regulation like …
• Self Regulation can be done by the organization itself

3 consumer health

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