Competition watchdog raises red flag on hospital sponsorships
Different brands of formula milk for infants and young children seen selling in GIANT, Suntec City, on 9 May 2017. TODAY file photo
SINGAPORE — The Competition Commission of Singapore (CCS) has flagged concerns over sponsorships and milk rotation programmes in hospitals here, which give the major formula milk brands a “first mover advantage”, and called for these practices to be reviewed.
The commission found that sponsorships and contributions have been increasing, with manufacturers paying for pregnancy and parenting talks, training materials for hospital staff, shuttle buses for staff and discharge gift bags. These manufacturers also have tie-ups with hospitals for milk rotation programmes, where the hospital offers a brand of formula milk for newborns at any one time, and regularly rotates between the various brands.
An estimated 15 to 60 per cent of newborns drink formula milk in hospitals, either exclusively or supplementing breast milk. Around 70 per cent of parents who use formula milk in private hospitals have no preferred brand, and will use the default brand on rotation. They tend to stay loyal to the brand, making hospitals an important sales channel for manufacturers, the CCS said in a report released yesterday on the rising prices of formula milk sold here.
Milk rotation programmes differ in public and private hospitals: In public hospitals, the various brands are rotated equally throughout the year, regardless of the amount of support received. For instance, KK Women’s and Children’s Hospital (KKH) invites manufacturers to take part in their milk rotation programme each year.
“At any one time, only one brand of infant formula is made available, and the duration of each rotation is determined by the number of companies that opt to participate in this rotation,” said Dr Chua Mei Chien, head and senior consultant at KKH’s Department of Neonatology.
Dr Chua stressed that formula milk is only used when a mother is unable to produce or express breast milk due to medical complications or conditions.
In contrast, the rotation periods at private hospitals are not evenly distributed among participating brands, the commission found. Instead, the duration commensurates with the level and quality of support given to hospitals.
When it comes to tie-ups or sponsorships, hospitals could initiate contact by indicating their needs to manufacturers, or the latter could approach hospitals and offer to contribute. Some manufacturers have also paid to be part of the milk rotation programme in private hospitals.
Hospitals explained that such payments and sponsorship help to defray the costs of running activities and training nurses, and allow them to prepare more parents for parenthood.
The CCS noted that in Singapore, a majority of babies (59.2 per cent) were born in private hospitals as compared to public hospitals in 2014.
“Given that more babies are delivered in private hospitals, majority of parents who use ready-to-feed formula milk in private hospitals do not have a preferred brand in mind, and a large proportion of parents generally do not switch away from the brand they have used in hospitals, this could become a significant barrier to entry for new brands in term of brand exposure,” said the CCS. In its recommendations, the commission proposed reviewing the sponsorships and payments that manufacturers can provide to hospitals, and the link between these contributions to milk rotation schedules.
It suggested making the formula milk in hospitals “brand-free” or anonymised, and delinking rotation schedules from sponsorship.
Last year, the World Health Organization’s World Health Assembly laid out recommendations for infant food companies to avoid conflicts of interest in health facilities, and for healthcare workers and professional associations to do likewise.
The CCS questioned if the sponsorship practice here was “keeping with the spirit’ with these guidelines.
“CCS recognises that the sponsorship activities by the manufacturers benefit the hospitals and parents in terms of defraying the costs of training, educational talks and seminars.
“Nonetheless, the escalating relationship between such activities and the milk rotation schedule could be of concern. These will need to be weighed carefully in the review,” said the commission. VALERIE KOH
