IMPACT OF MARKETING STRATEGIES AND TECHNIQUES ON

PHARMACEUTICAL MARKET OF BANGLADESH

PhD DISSERTATION
BY
JESMIN SULTANA

A DISSERTATION SUBMITTED TO THE DEPARTMENT OF MARKETING, UNIVERSITY OF

DHAKA IN PARTIAL FULFILMENT OF THE REQUIREMENTS FOR THE DEGREE OF DOCTOR
OF PHILOSOPHY
IN
MARKETING

FACULTY OF BUSINESS STUDIES

UNIVERSITY OF DHAKA
BANGLADESH
December, 2020

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IMPACT OF MARKETING STRATEGIES AND TECHNIQUES ON

PHARMACEUTICAL MARKET OF BANGLADESH

PhD DISSERTATION
BY
JESMIN SULTANA
DEPARTMENT OF MARKETING
UNIVERSITY OF DHAKA

UNDER THE SUPERVISION OF

MD. ZAKIR HOSSAIN BHUIYAN PhD
PROFESSOR
DEPARTMENT OF MARKETING
UNIVERSITY OF DHAKA

FACULTY OF BUSINESS STUDIES

UNIVERSITY OF DHAKA
BANGLADESH
December, 2020

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Dedicated

To my beloved family

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DECLARATION
I do hereby declare that the thesis entitled “Impact of Marketing Strategies and Techniques on

Pharmaceutical Market of Bangladesh” submitted to the Department of Marketing, University of Dhaka,

Bangladesh for the degree of Doctor of Philosophy (PhD) in Marketing, is an original and independent

research work. No part of this thesis has been submitted to any other University or Institution for the

award of any other degree or diploma.

Dhaka, 2020
JESMIN SULTANA

Registration No:28

(2015-2016)
Department of Marketing
University of Dhaka
And
Associate Professor
Department of Business Administration
University of Asia Pacific, Dhaka
Bangladesh

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CERTIFICATE

I do hereby certify that the thesis entitled “Impact of Marketing Strategies and Techniques on

Pharmaceutical Market of Bangladesh” submitted by Jesmin Sultana Registration no: 28, Session: 2015-

2016, a PhD research fellow of the Department of Marketing, University of Dhaka, Bangladesh, for the

degree of Doctor of Philosophy (PhD) in Marketing, has been done under my supervision and guidance.

The thesis is an original piece of research work done by the researcher. I, therefore, recommend its

submission for examination.

Supervisor:

Md. Zakir Hossain Bhuiyan PhD

Professor
Department of Marketing
University of Dhaka
Date: December,2020

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ACKNOWLEDGEMENT
At first, I would like to thank the Almighty creator, the most kind and merciful for giving me the
capability and patience to complete my PhD dissertation.

It is a great pleasure to acknowledge and express my gratitude and thanks from the core of my heart to
my supervisor Prof. Dr. Md. Zakir Hossain Bhuiyan. He has helped in every possible way to complete
my doctoral program.

I want to give very special thanks to the Chairman Prof. Dr. Md. Mizanur Rahman and all faculty
members in the Department of Marketing, University of Dhaka, for their presence in all my seminars
and providing me valuable, thoughtful feedback and suggestions.

I am greatly indebted to the Marketing Professionals of different Pharmaceutical companies such as

Aristo Pharma, Unimed and Unihealth, Renata, ACI, Square, Beximco, Incepta, Servier, Oposnin,
ACME, Popular etc. Name of the Marketing Professionals are Shibtosh Sarker (Aristopharma), Shamim
Alam (Unimed and Unihealth), Dr. Md. Abu Zafor Sadek (Popular Pharma), Majedul islam (Incepta),
Ananta Saha (Renata) and Anwarul Amin Rumi (Servier).

I would like to express my gratitude to the members of Faculty of Pharmacy, Prof. Dr. Md. Abdur
Rashid, Prof. Dr. Muniruddin Ahmed, Prof. A.B.M Faroque, Prof. Dr. Md. Selim Reza, Prof. Dr. Syed
Shabbir Haider, Prof. Dr. Abdul Muhit, Prof. Dr. Elias Al Mamun and Ikramul Hasan for their constant
support and encouragement which helped me to carry out the PhD thesis work successfully.

My special thanks are for Dr. Mahfuzur Rahman, Dr. MG Azom and Dr. Tania Nasrin of Dhaka Medical
College Hospitals, National Institute of Cardiovascular Disease Hospital, Ibrahim Cardiac Hospital,
respectively for their tireless effort and cooperation for the survey work.

I was privileged to form a data collection team with the M. Pharm Students from the Department of
Pharmacy, University of Dhaka and University of Asia Pacific who worked sincerely as a data collection
team with me for my Pilot and final survey.

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I wish to express my gratitude to Mr. Mohammad Saifuddin, a Lecturer, Department of Statistics,

Bangladesh University of Business and Technology who helped me with data analysis.

Finally, I would like to thank my beloved family members, my husband, son and daughter, whose
unconditional love, inspiration and cooperation in all level enabled me to complete this dissertation.

Dhaka JESMIN SULTANA

December, 2020 Registration No: 28 (2015-2016)
Department of Marketing
University of Dhaka

and

Associate Professor
Department of Business Administration
University of Asia Pacific
Dhaka, Bangladesh

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ABSTRACT

The Pharmaceutical industry is one of the promising sectors and the second largest contributor to the
economy of Bangladesh. The Pharmaceutical Market of Bangladesh in 2019 was valued at about BDT
twenty-three thousand crore. There are 15 therapeutic segments of the Pharmaceutical market like
alimentary and metabolism, systemic anti-infective, cardiovascular system, nervous system, respiratory
system, muscular-skeletal system, genitourinary system & sex hormones, blood & blood forming
organs, dermatological, sensory organs, systemic hormones, parasitology, hospital solutions,
antineoplastic plus immune module and others.

Segmentation, Targeting and Positioning (STP) Strategies were applied to select the cardiac market
segment in the present study as a model to represent the Pharmaceutical market as a whole. Doctors,
Patients and Marketers are considered as the important components of the Pharmaceutical market.

The cardiac market segment has 10.56% of the market share and 15.53% of the market growth in the
pharmaceutical products growth-share matrix which represents star position among different market
segments.

The aim of the study is to explore the impact of different variables of Marketing Strategies and
Techniques on Stakeholders’ Satisfaction and Sales. A Conceptual Model was developed by exploring
the cardiac market segment in the context of Bangladeshi Pharmaceutical Market using Customer
Satisfaction theories and Marketing Mix Strategies. Both qualitative and quantitative methods were
adopted to explore the perspective of different Stakeholders, such as Cardiologists, Cardiac patients and
Marketing Professionals. Furthermore, the impact of Marketing Strategies and Techniques (MST),
offered by the Marketing Professionals, on the satisfaction of Cardiologists (Customers) and Cardiac
patients (Consumers) were analyzed using Exploratory Factor Analysis. Marketing Professionals
evaluated the variables of Marketing Strategies and Techniques (MST) based on Sales performance of
the Pharmaceutical companies. These attributes of Marketing Strategies and Techniques were then used
to develop structured questionnaires to evaluate the impact of the variables on the Stakeholders’
Satisfaction.

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Majority of the Cardiac Hospitals and Pharmaceutical companies are situated in Dhaka, the capital of
Bangladesh. A sample size of Cardiologists (156), Cardiac patients (200) and Marketing Professionals
(180) were selected from the city of Dhaka. Random sampling method was used in this study. Data was
collected using drop off and collect method by distributing self-explanatory questionnaires among the
stakeholders.

A total of 536 respondents were asked to rate the importance of variables/attributes of Marketing
Strategies and Techniques (MST) indicating their degree of agreement with satisfaction statement using
a 5-point Likert scale (1= Strongly disagree, 2 = Disagree,3 = Neutral, 4 = Agree and 5 =Strongly agree).
Factor Analysis by SPSS version 20 was used for managing most correlated variables by reducing it to
a manageable few factors which are labeled as Medicinal, Economic, Convenience and Communication
relationship benefits.

Exploratory Factor analysis was applied to evaluate the impact of Marketing Strategies and Techniques
on Stakeholders’ Satisfaction as a whole and also separately for each stakeholder. The first important
factor extracted from Rotated Factor Matrix labeled as Medicinal benefit, includes Awareness Campaign
to prevent cardiovascular diseases (p = 0.000), Price Quality relationship (p = 0.000), Safety Information
(p=0.000) and Efficacy (p = 0.000). It was found to have a positive impact on Stakeholders’ Satisfaction.
Affordable price (p=0.000), Company Reputation (p=0.000), Selling Skill of Medical Representatives
(p=0.000), Promotional Policies (p=0.000) and Continuous Medical Education for doctors (p=0.000)
were grouped under second important factor labeled as Communication benefit. The second factor has
significant effect on the Satisfaction of the Stakeholders. The third factor labeled as Convenience
benefit, includes Facility of Model pharmacy (p=0.089), Location of Pharmacy (p=0.089), Brand Image
(0.089) and New Cardiac Medicine (p=0.089). The third factor was found to have an insignificant impact
on Stakeholders’ Satisfaction. The fourth factor tagged as Economic benefit was found to be significant
and contains the variables Competitive price (p=0.000) and Availability (p=0.000).

The impacts of relative influential factors on the satisfaction of the individual category stakeholder were
found to be different.

If the factors are sequenced according to the relative importance for the Cardiologists, then the
Economic-Medicinal (p=0.000) benefit is of top most priority. The followers are Medicinal
Communication (p=0.000), Communication (p=0.000) and Medicinal benefits (p=0.03) respectively.

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Like the Cardiologists, the Patients also prioritize the economic-medicinal issue. The second most
important factor is Medicinal Communication rather than Convenience benefit.

The Factors loaded to Rotated Matrix that impact on Marketing Professionals’ Satisfaction about Sales
are Convenience Medicinal benefit (p=0.001), Communication benefit (p=0.025), Medicinal (p=0.009)
benefit and Economic benefit (p=0.004) respectively.

It was observed that the gap between the Overall Satisfaction about Marketing Strategies and Techniques
and Stakeholders were significantly different. Cardiologists, the direct customers of medicine suppliers
are moderately satisfied (Mean score = 3.89) and Patients (the consumers) are not satisfied. The mean
score of Patients’ Satisfaction is 2.88. Interestingly, Marketing Professionals are very satisfied about
their Sales performance (Mean score = 4.06).

The assessment of cardiac patients (200) regarding their satisfaction of medicine quality, affordability,
availability and communication relation which impact on sales were found to be different depending on
the market shares and reputation of pharmaceutical companies.

Recently, Model Pharmacy has added a new dimension in Distribution (Place) Strategies of medicines
in 2017.

Patients’ Satisfaction about the four variables regarding the Facilities of Model Pharmacy such as
Quality of medicines, Reasonable price of medicines, Data-based system and Counseling by ‘A’ grade
pharmacists were found satisfactory than retail conventional pharmacy in Dhaka city.

The Regression Analysis of Factors indicates that most of the hypotheses of the Conceptual Model have
statistical significance. As the study was conducted on three categories of stakeholders, the findings may
give policy makers the chance to compare relative importance of variables from viewpoint of doctors
and patients. This can lead to development of better Marketing Strategies and Techniques resolving
medicinal, economic, convenience and communication issues.

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TABLE OF CONTENTS

Sl. No CONTENTS Page No

Title i

Title Page ii

Declaration iv

Certificate v

Acknowledgement vi

Abstract viii

Table of Contents xi

List of Tables xviii

List of Figures xxii

List of abbreviations xxiv

1 CHAPTER 1: INTRODUCTION 1-24

1.1 Introduction 1

1.2 Background of the study 2

1.3 Overview of Pharmaceutical Market in Bangladesh 4

1.4 Overview of Cardiovascular Market Segment 10

1.5 Justification for the study 22

1.6 Problem Statement 23

1.7 Research Questions 23

1.8 Research Objectives 24

1.9 Synoptic view of the thesis 24

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 2 CHAPTER 2: LITERATURE REVIEW 26-61

2.1 Doctors ( Customers) ,Patients ( Consumers) and Marketing 26

Professionals (Sellers or Marketers)

2.2 Relevant Theories 30

2.2.1 Theory of Customer/Consumer Satisfaction (Doctors/Patients) 30

2.2.2 Expectancy Disconfirmation theory 31

2.2.3 Kano Model 32

2.2.4 Cognitive Dissonance Theory 33

2.2.5 Teboul Model 34

2.3 Pharmaceutical Marketing Strategies and Techniques/Tactics 35

2.3.1 Push-Pull Strategies of Pharmaceutical Market 36

2.3.2 Segmentation, Targeting, Positioning Strategies (STP) 37

2.3.2.1 Segmentation Strategies 37

2.3.2.2 Targeting Strategies 38

2.3.2.3 Positioning Strategies 39

2.3.4 Marketing Mix Strategies 39

2.3.5 Competitive Strategies to gain Competitive Advantages 42

2.4 Research Gap 44

2.5 Hypothesis Development 48

2.5.1 Medicinal issues of Product Strategies 48

2.5.2 Economic issues of Price Strategies 51

2.5.3 Convenience issues of Place Strategies 52

2.5.4 Communication issues of Promotion Strategies 54

2.6 Conceptual Framework and Selected Variables 57

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2.6.1 Conceptual Model including Hypotheses 59

2.6.2 Hypotheses related to Medicinal, Economic, Convenience and 59

Communication issues

2.6.3 Hypotheses related to Overall Satisfaction about MST and 61

Stakeholders

2.6.4 Hypotheses related to Patients’ Satisfaction about Model 61

pharmacy newly introduced Place Strategy(2017)

3 CHAPTER 3: METHODOLOGY OF STUDY 62 - 73

3.1 Research Design 62

3.1.1 Information needed for the Research 62

Design for Exploratory Research
3.1.2 62

3.1.3 Design for Descriptive Research 63

Development of Questionnaires for Data Collection
3.1.4 63
Pilot Survey of Pretesting Questionnaires
3.1.5 64
Validity and Reliability of the Data Set
3.1.5.1 66

3.1.6 Sample size determination from Target Population, Sample 66

Element and Sampling Frame

3.1.7 Sampling Techniques of Data Collection 68

3.1.7.1 Sampling Techniques for Doctors 70

3.1.7.2 Sampling Techniques for Marketing Professionals 70

3.1.7.3 Sampling Techniques for Patients 71

3.1.8 Tools for Data Analysis 72

4 CHAPTER 4: DATA ANALYSIS AND DISCUSSIONS 74-137

4.1 Measurement Model 74

4.2 Impact of Marketing Strategies and Techniques on Stakeholders’ 74

Satisfaction

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4.2.1 Descriptive Analysis (Stakeholders’ Satisfaction) 76

4.2.2 Sample Adequacy (Stakeholders’ Satisfaction) 79

4.2.3 Correlation Matrix(Stakeholders’ Satisfaction) 79

4.2.4 Communalities(Stakeholders’ Satisfaction) 80

4.2.5 Factor Extraction(Stakeholders’ Satisfaction) 81

4.2.6 Rotated Component Matrix(Stakeholders’ Satisfaction) 84

4.2.7 Test of Hypothesis(Stakeholders’ Satisfaction) 85

4.2.8 Relationship of Independent Variables of Marketing Strategies 86

and Techniques with Dependent Variable Stakeholders’
Satisfaction

4.3 Impact of Marketing Strategies and Techniques on Doctors’ 87

Satisfaction to prescribe

4.3.1 Descriptive Analysis (Doctors’ Satisfaction to prescribe) 88

4.3.2 Sample adequacy(Doctors’ Satisfaction to prescribe) 91

4.3.3 Correlation Matrix(Doctors’ Satisfaction to prescribe) 92

4.3.4 Communalities(Doctors’ Satisfaction to prescribe) 93

4.3.5 Factor Extraction(Doctors’ Satisfaction to prescribe) 93

4.3.6 Rotated Component Matrix(Doctors’ Satisfaction to prescribe) 94

4.3.7 Test of Research Hypotheses (Doctors’ Satisfaction to prescribe) 97

4.3.8 Relationship of Independent Variables of Marketing Strategies 98

and Techniques with Dependent Variable Doctors’ Satisfaction
to prescribe

4.4 Impact of Marketing Strategy and Techniques on Marketing 100

Professionals’ Satisfaction about Sales

4.4.1 Descriptive Analysis ( Marketing Professionals’ Satisfaction 100

about Sales)

4.4.2 Sample Adequacy ( Marketing Professionals’ Satisfaction about 103

Sales)

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4.4.3 Correlation Matrix(Marketing Professionals’ Satisfaction about 103
Sales)

4.4.4 Communalities(Marketing Professionals’ Satisfaction about 105

Sales)

4.4.5 Factor Extraction(Marketing Professionals’ Satisfaction about 105

Sales)

4.4.6 Rotated Component Matrix (Marketing Professionals’ 106

Satisfaction about Sales)

4.4.7 Test of Research Hypotheses (Marketing Professionals’ 110

Satisfaction about Sales)

4.4.8 Relationship of Independent variables of Marketing Strategies 111

and Techniques with dependent variable Marketing
Professionals’ Satisfaction about sales.

4.4.9 Practice of Marketing Strategies and Techniques in different 112

Pharmaceutical companies

4.5 Impact of Marketing Strategies and Techniques on Patients’ 113

Satisfaction to consume

4.5.1 Descriptive Analysis ( Patients’ Satisfaction to consume ) 114

4.5.2 Sample Adequacy ( Patients’ Satisfaction to consume ) 116

4.5.3 Correlation Matrix( Patients’ Satisfaction to consume ) 115

4.5.4 Communalities( Patients’ Satisfaction to consume ) 118

4.5.5 Factor Extraction( Patients’ Satisfaction to consume ) 119

4.5.6 Rotated Component Matrix( Patients’ Satisfaction to consume ) 119

4.5.4 Test of Research Hypotheses(Patients’ Satisfaction to consume ) 121

4.5.5 Relationship of Independent variables of Marketing Strategies 123

and Techniques with dependent variable Patients’ Satisfaction to
consume.

4.6 Patients’ Satisfaction about Model Pharmacy recent Place 123

Strategy introduced by New Drug Policy 2016

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4.7 Patients’ Satisfaction about Cardiac medicines of Market 126
Leader, Challengers, Followers and Niches from the survey.

4.8 Gap Analysis between Overall Satisfaction about Marketing 131

Strategies and Techniques and Stakeholders (Managers, Doctors
and Patients)

4.9 Demographic Profile or Sample Characteristics of Stakeholders 133

5 CHAPTER 5 : FINDINGS ,CONCLUSION AND 138-159

RECOMMENDATIONS

5.1 Introduction 138

5.2 Discussion on the findings of Relationship between Variables of 138

Marketing Strategies and Techniques and Stakeholders’
Satisfaction

5.2.1 Relationship between Medicinal Variables and Stakeholders’ 143

Satisfaction

5.2.2 Relationship between Economic Variables and Stakeholders’ 144

Satisfaction

5.2.3 Relationship between Convenience Variables and Stakeholders’ 145

Satisfaction

5.2.4 Relationship between Communication Variables and 146

Stakeholders’ Satisfaction

5.3 Discussion on the findings of Relationship between Variables of 148

Marketing Strategies and Techniques and Marketing
Professionals’ Satisfaction about Sales

5.3.1 Relationship between Medicinal Variables and Marketing 148

Professionals’ Satisfaction about Sales

5.3.2 Relationship between Economic Variables and Marketing 149

Professionals’ Satisfaction about Sales

5.3.3 Relationship between Convenience Variables and Marketing 150

Professionals’ Satisfaction about Sales

5.3.4 Relationship between Communication Variables and Marketing 151

Professionals’ Satisfaction about Sales

5.4 Conclusion 152

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5.5 Recommendations 153

5.5.1 Theoretical Implications 153

5.5.2 Managerial Implications 154

5.5.3 Governmental Implications 156

5.6 Contribution of the research 157

5.7 Limitations of the Study 158

5.8 Direction for Future Research 159

References 160

Appendices 174

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 LIST OF TABLES
Table Table Description Page No
No
1.1 Top 20 Pharmaceutical companies, with market share and market 5
growth in Bangladesh

1.2 Top therapeutic segments of Bangladesh with market share and 7

market growth in 2018

1.3 Top therapeutic segments of Bangladesh with market share and 9

market growth in 2019

1.4 Top 20 companies of cardiovascular market with market size, share 11

and growth (2019) in Bangladesh.

1.5 Top 20 companies of cardiovascular market with market size, share 12

and growth (2018) in Bangladesh.

1.6 Total sales of cardiovascular medicines from 2011 to 2018 13

1.7 Sales of different types of cardiovascular medicines available in 15

Bangladeshi pharmaceutical market (year 2014 to 2018)

1.8 Sales of ARBs plain and combination drugs from 2010 to 2018 17

1.9 Sales of ACEI, plain and combination drug 18

1.10 Sales of CCBs plain and combination drug from 2010 to 2018 19

1.11 List of Top 50 Brands of Cardiovascular medicines in cardiac 21

market of Bangladesh with generic name, company name, and
market share and market price

2.1 Pharmaceutical Strategies and Techniques 36

2.2 Components and Description of Marketing Mix Strategies for 41

medicines

2.3 Selected Variables and References 57

3.1 Sample size determination from each Stakeholder (Cardiologists, 68

Marketing Professionals and Cardiac patients)

3.2 List of Hospitals and Sample size of Doctors. 70

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3.3 List of Pharmaceutical Companies and Sample size of Marketing 71
Professionals.

3.4 List of Hospitals and Sample size of Patients 72

4.1 Mean Scores of Stakeholders’ Satisfaction about MST 76

4.2 KMO and Bartlett’s test of Stakeholders’ Satisfaction 79

4.3 Correlation Matrix (Stakeholders’ Satisfaction) 80

4.4 Communalities ((Stakeholders’ Satisfaction) 81

4.5 Total variance explained of factors of Stakeholders’ Satisfaction. 82

4.6 Rotated Component Matrix (Stakeholders’ Satisfaction) 84

4.7 Summary of Regression Analysis (Stakeholders’ Satisfaction) 85

4.8 Coefficients of Factors (Stakeholders’ Satisfaction) 86

4.9 Results of Research Hypotheses for Stakeholders’ Satisfaction 87

4.10 Descriptive Analysis: Impact of Marketing Strategies and Techniques 89

on Doctors’ Satisfaction

4.11 KMO and Bartlett’s Test (Doctors’ Satisfaction) 91

4.12 Correlation Matrix of Data Set (Doctors’ Satisfaction) 92

4.13 Communalities of Variables (Doctors’ Satisfaction) 93

4.14 Extracted Communalities by principal component analysis 94

(Doctors’ Satisfaction)

4.15 Rotated Factors Matrix (Doctors’ Satisfaction) 96

4.16 Summary of Regression Analysis (Doctors’ Satisfaction) 97

4.17 Coefficients of factors (Doctors’ Satisfaction) 98

4.18 Result of Research Hypothesis (Doctors’ Satisfaction) 99

4.19 Mean Scores of Marketing Professionals’ Satisfaction about 101

Marketing Strategies and Techniques on Sales

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4.20 KMO and Bartlett’s Test of Data (Marketing Professionals’ 103
Satisfaction)

4.21 Correlation Matrix of Variables of MST (Marketing 104

Professionals’ Satisfaction)

4.22 Communalities (Marketing Professionals’ Satisfaction) 105

4.23 Factor Extraction for Total Variance Explained (Marketing 106

Professionals’ Satisfaction)

4.24 Rotated Factor Matrix (Marketing Professionals’ Satisfaction) 109

4.25 Regression Analysis of Hypotheses of Marketing Professionals’ 111

Satisfaction

4.26 Coefficient of factors (Marketing Professionals’ Satisfaction) 111

4.27 Results of Hypothesis Testing of Marketing Professionals’ 112

Satisfaction

4.28 Marketing Professionals’ Assessment about 4Ps 113

4.29 Mean Scores of Patients’ Satisfaction about MST to purchase the 114
medicines

4.30 KMO and Bartlett’s Test (Patients’ Satisfaction) 116

4.31 Correlation Matrix of Variables of MST (Patients’ Satisfaction) 117

4.32 Communalities (Patients’ Satisfaction) 118

4.33 Total Variance explained (Patients’ Satisfaction) 119

4.34 Rotated Component Matrix (Patients’ Satisfaction) 120

4.35 Summary of Regression Analysis for Patients’ Satisfaction 121

4.36 Coefficients of Factors (Patients’ Satisfaction) 122

4.37 Results of Hypothesis Testing of Patients’ Satisfaction about 123

Marketing Strategies and Techniques

4.38 Regression analysis of Patients’ satisfaction about Model Pharmacy 125

4.39 Summary of Regression Analysis of Model Pharmacy 125

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4.40 Coefficients of Variables of Model Pharmacy 125
4.41 Results of Hypothesis Testing of Patients’ Satisfaction about Model 126
Pharmacy

4.42 Mean scores of Patients’ Satisfaction about Variables of Marketing 130

Strategies Techniques of Top Ranking Pharmaceutical Companies
from the primary survey

4.43 Patients’ Satisfaction (Mean Scores) regarding 4Ps of cardiac 131

medicines of four categories suppliers according to market share July
2017 to July 2018 from the primary survey

4.44 Comparison of Overall Satisfaction about MST and Stakeholders by 132

one-way ANOVA

4.45 F test (ANOVA) 132

4.46 Multiple Comparison of Overall Satisfaction about MST and 129

Stakeholders

4.47 Demographic Profile of Doctors 134

4.48 Demographic profile of Patients 135

4.49 Demographic profile of Marketing Professionals 137

5.1 Impact of Marketing Strategies and Techniques on Stakeholders’ 140

Satisfaction combined and individual.

5.2 Results of Rotated Factor Matrix of Overall Satisfaction of 142

Stakeholders combined and Individual (Doctors, Patients and
Marketing Professionals)

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 LIST OF FIGURES
Figure No Description Page No

1.1 Market share of all Therapeutic Segments in Bangladesh (2018) 8

1.2 Market share of all Therapeutic segments in Bangladesh (2019) 10

1.3 Total Sales of Cardiovascular medicines from 2011 to 2018 14

1.4 Sales of different types of Cardiovascular medicines from 2011 16

to 2018
1.5 Comparison of Sales of ARBs plain and Combination drugs 17
from 2010 to 2018

1.6 Comparison of Sales of ACEIs plain and Combination drugs 19

from 2010 to 2018

1.7 Comparison of Sales of CCBs plain and Combination drugs from 20

2010 to 2018

2.1 Expectancy Disconfirmation Theory 31

2.2 Kano Model of Customer Satisfaction 32

2.3 Cognitive Dissonance Theory 33

2.4 Teboul Model 35

2.5 Conceptual Model 58

2.6 Conceptual Model including hypotheses 59

4.1 Mean Scores of Stakeholders’ Satisfaction about Marketing 77

Strategies and Techniques

4.2 Scree Plot of Eigen value and Variable Components 82

(Stakeholders’ Satisfaction)

4.3 Mean Scores of Doctors’ Satisfaction about the Variables of 90

Marketing Strategies and Techniques

4.4 Scree plot of Eigen value and Variable Components (Doctors’ 95

Satisfaction)

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4.5 Mean Scores of Marketing Professionals’ Satisfaction of MST 102
about Sales

4.6 Scree plot of Eigen value and Variable Components (Marketing 108
Professionals’ Satisfaction)

4.7 Mean Scores of Patients’ Satisfaction about MST 115

4.8 Scree plot of Eigen value and Variable components (Patients’ 119
Satisfaction)

4.9 Number of Cardiac Patients using Cardiac medicines of different 127

Pharmaceutical companies

4.10 Overall Satisfaction about MST and Stakeholders 132

xxiii
 LIST OF ABBREVIATIONS
Abbreviation Description

AAB Alpha Adrenergic Blocker

ACEI Angiotensin Converting Enzyme Inhibitor
ADDO Accredited Drug Dispensing Outlet
ANOVA Analysis of Variance
ARB Angiotensin Receptor Blockers
AWC Awareness Campaign
BB Beta Blocker
BI Brand Image
BIRDEM Bangladesh Institute of Research and Rehabilitation in Diabetes,
Endocrine and Metabolic Disorders
BSMMU Bangabandhu Sheikh Mujib Medical University
CCB Calcium Channel Blocker
CME Continuous Medical Education
CMH Combined Military Hospital (Dhaka)
CP Competitive Pricing
CPV Customer Perceived Value
CR Company Reputation
CS Customer Satisfaction
CVD Cardiovascular Diseases
DFID Department for International Development
DGDA Directorate Government of Drug Administration
DIMS Drug Information Management System
DMCH Dhaka Medical College and Hospital
EDT Expectancy Disconfirmation Theory
EF Efficacy
EFA Exploratory Factor Analysis
FM Facilities of Model Pharmacy
GUS Gastro-Urinary System

xxiv
IMS Intercontinental Medical Statistics
KMO Kaiser-Meyer-Olkin
LDC Least Developed Country
LP Location of Pharmacy
MR Medical Representatives
MSH Management Science for Health
MST Marketing Strategies and Techniques
NICVD National Institute of Cardiovascular Diseases
NM New Medicine
OTC Over The Counter Drugs
PLC Product Life Cycle
PP Promotional Policies
PQ Price-Quality
4Ps Product, Price, Place, Promotion
SHSMC Shaheed Suhrawardy Medical College Hospital
SI Safety Information
SPSS Statistical Package for the Social Sciences
SSMCH Sir Salimulla Medical College Hospital
SSMR Selling Skill of Medical Representatives
STP Segmenting, Targeting and Positioning
WHO World Health Organization
WTO World Trade Organization

xxv
 CHAPTER- ONE
INTRODUCTION
1.1 Introduction
The structure of the pharmaceutical industry has undergone significant changes over the
last 20 years. This fast-growing, knowledge driven industry is devoted to research,
development, manufacturing and marketing of drugs that safely cures a wide range of
diseases and improves the health and quality of life of human beings. According to
Intercontinental Medical Statistics (IMS) report 2016, the global pharmaceutical market
size is increasing significantly. The scenario of Bangladesh is also very promising. The
total pharmaceutical market of Bangladesh is about taka 21,000 crores in 2018, which was
only taka 9169 crores in 2013. Bangladesh is now producing medicine of all therapeutic
classes which include alimentary and metabolism, systemic anti-infective, nervous system,
cardiovascular system, muscular-skeletal system, genitourinary system (G.U) and sex
hormones, dermatological, blood forming organs and sensory organs. The rationale for
this segmentation was based on a broad classification of IMS data (2013-2018) available
in Bangladesh.

Unlike most LDC, Bangladesh has a fairly strong manufacturing base even though it does
not have a strong capital. The situation of Pharmaceutical market during the post-liberation
period was not so good. 75% of the total market was captured by a few multinational
companies like Pfizer, Ciba-Geigy, Squibb, Fisons, Hoescht etc. Consequently,
Bangladeshi companies like Pharmadesh, Square, Albert David, Gaco, Alco, Edruc,
ACME etc. fulfilled the rest 25%. After the promulgation of local industry friendly
National Drug Policy in 1982, the scenario started to change positively for Bangladesh. At
present, 98% (DGDA report 2018) of overall national drug demand are being fulfilled by
local companies. Not only that, Bangladesh is now exporting medicine to 100 countries
including the USA.

It is evident that the cardiovascular drug market is getting increasing attention because of
its high growth rate (from taka 927 cr in 2013 to taka 2227 cr in 2018). Incepta and Square

1
are the leaders of cardiac market. Beximco, Opsonin, ACI are the market challengers and
Aristo Pharma, ACME and others are market followers.

Globally, the total cardiovascular drug market has grown to $ 186,901 million in 2016 from
$ 170109 million in 2013 (Business insight, 2016).

Pharmaceutical companies are facing fierce competition worldwide. Their rivalry depends
on their capability to cope with multiple challenges to control cost, enhance product quality
and provide superior customer service (Lee, 2007).

In a global changing scenario in the pharmaceutical world, there is an urgent need of the
pharmaceutical sector of Bangladesh to satisfy the needs of the demand nationally and
internationally. According to the WTO (World Trade Organization) TRIP (Trade Related
Aspect of Intellectual Property) agreements, Least Developed countries (LDCs) are
exempted from patent protection until 2033 (at.capital.com). The policy will be allowing
LDCs to reverse engineer formulation of patented drugs and sale legally. This provides a
unique opportunity for Bangladesh over India and China who are already under the patent
regime.

1.2 Background of the Study

The impact of 4Ps Marketing Strategies on sales growth and competitive advantages have
not significantly been found to be documented and made available for the pharmaceutical
industry in Bangladesh. However, these strategies are vital for creating more opportunities
in Bangladeshi Pharmaceutical Market.

The present empirical study will highlight impact of Marketing Strategies and Techniques
(MST) of market leaders, challengers and followers of cardiac market (a particular
segment) among other therapeutic groups in Bangladeshi pharmaceutical industry taking
as a case study or an example which has high rising trend of market growth rate over the
few years (IMS 2013-2018).
Strategy is a game plan to achieve the goal in a better way than competitors. Marketing
Strategy combines all of its marketing goals into one comprehensive plan. It should be
2
drawn from market research and focus on the right product mix in order to achieve the
maximum profit potential for sustaining the business (Dimitris, 2002). McCarthy (1960)
presented marketing mix strategy which includes 4Ps such as product, price, place and
promotional tools.

Robert Lauterborn recommended that sellers’ 4 Ps should correspond to buyers’ four Cs

such as customer benefit, customer cost, and convenient place and communication
techniques (Lauterborn, 1990). Philip Kotler highlighted that Segmentation, Targeting and
Positioning is the core of Strategic Marketing. Marketing Techniques are the tactics that
require a blend of activities over time to achieve strategy (Kotler, 2003).

A marketing manager designs marketing activities of marketing plan and implements

these at many levels. The first technique is to segment market and select target customer
and then position the product in customer’s mind. It is to communicate the value or benefits
by utilizing sales force, sales promotion, advertising and other techniques in order to
deliver the product for end users. Winning companies can meet customer needs
economically, conveniently and with effective communication (ir.amu.ac.in).

Philip Kotler and Kevin Keller suggested the 4 Ps of modern marketing technique are
people, processes, programs and performance of sales growth in market. Here, the People
of 4Ps in the context of pharmaceutical company indicates employees in marketing
department (managers and medical representatives). Their knowledge, selling skill and
efficiency are critical for marketing success in a highly competitive environment (Kotler
and Keller, 2016). At the same time, marketing people must view customers’ (doctor)
perspective in order to understand their psychology behind why they prescribe medicine
for their patients from a particular supplier or company.

Process reflects the right set of tactics or techniques such as creativity, discipline, action
programs in detail. They must be integrated with 4Ps strategies to create an impact on sales
performance positively. Profitable market opportunities of market segment need to be
assessed continually for market potential and market (forecasted) demand. The players of

3
the microenvironment are suppliers, marketing people, doctors, patients, distributors and
competitors who affect its ability to produce and sell medicines.

1.3 Overview of Pharmaceutical Market in Bangladesh

The pharmaceutical sector is highly competitive. There are over 450 registered
pharmaceutical companies in Bangladesh actively involved in the manufacturing and
marketing of pharmaceutical products (IMS2019). The top ten pharmaceutical companies
such as Square, Incepta, Beximco, Healthcare, Renata, Drug International, Aristo Pharma,
ACI, Eskayef make up 68.63% of the total market share and top 20 companies add up to
88.98% of the total market share (IMS data 2019), including 15 different therapeutic
market segments.

Table 1.1 shows the top 20 pharmaceutical companies’ individual market share. It can be
clearly inferred that Square pharmaceutical company is the market leader, followed by two
other leaders such as Incepta and Beximco, which are named as market challengers. The
next seven companies, Healthcare, Renata, Opsonin, Drug International, Aristopharma,
ACI and Eskayef can be named as second category market challengers. Consequently, the
next 20 companies can be categorized as market followers and market niche depending on
their market performance, market share and market growth.

4
Table 1.1 Top 20 Pharmaceutical companies with market share and market growth:

Rank in market Pharmaceutical company % Market share %Market growth rate

1 Square 16.59 10.00
2 Incepta 11.11 12,63
3 Beximco 8.24 13.27
4 Healthcare 5.66 22.81
5 Renata 5.25 13.41
6 Opsonin 5.19 14.69
7 Drug International 4.36 70.31
8 Aristo pharma 4.12 12.70
9 ACI 4.11 5.45
10 Eskyef 4.00 2.85
11 ACME 3.85 22.97
12 Radiant 2.89 13.46
13 General 2.30 4.12
14 Unimed and Unihealth 2.24 18.42
15 Popular 2.17 17.35
16 Novo Nordisk 1.88 10.80
17 Sanofi 1.52 -3.21
18 Ibnsina 1.25 16.64
19 Ziska 1.14 17.62
20 Sun pharma 1.11 15.65
(Source: Source: Prepared by Researcher from IMS data,2019)

The Bangladesh Association of Pharmaceutical Industries (BAPI) is an important

professional association and has 173 companies (DGDA, 2018). BAPI works for the
interest of pharmaceutical companies, promotes policies, changes the government policies
if required and performs other activities. This industry has been the 2nd largest contributor
to the economy of Bangladesh since independence. This industry has a huge prospect in
the near future as the health care infrastructure and health awareness of the Bangladeshi
people has increased and at the same time, the purchasing capacity of the people is also
increasing. (sultana J, 2016) This can help pharmaceutical companies to take opportunities
to develop their Marketing Strategies and Techniques to maximize their market
performance to get competitive advantages.

5
The Directorates of Drug Administration (DDA) under the Ministry of Health and Family
welfare of Bangladesh maintain regulations and work as counterpart of Food and Drug
Administration (FDA) with USA.

It monitors and controls the purchasing of raw materials, manufacturing practice, import,
export, distributions and sales of medicines in Bangladesh. One way of maintaining and
controlling ethical practice and fair competition is to implement rules and regulations from
time to time by Drug Act and Drug policies. The examples of these policies are National
Drug Policy of 1982, The Drug Control Ordinance 1982, Drug Control ordinance 2004,
National Drug Policy 2005 and newly introduced National Drug Policy 2016. The revised
new policy will ensure the transparency of all transaction, quality practice in manufacturing
marketing and distribution network, and implementation of Model Pharmacy concept in
Bangladesh to remove substandard medicines from the pharmaceutical market. As global
competition is intensively increasing, Bangladesh needs to develop effective corporate and
Marketing Strategies and Techniques to achieve sustainable competitive advantages both
nationally and internationally.

The pharmaceutical distribution is retail oriented. There are118,867 retailers and 1169
wholesalers (DGDA, 2018) in Bangladesh. The pharmaceutical companies distribute their
products by themselves to retailers from their warehouse located in different parts of the
country. There are a large number of illegal, unlicensed drug stores in the cities and towns,
which sell poorly manufactured, conducted and substandard medicines. There are 15
therapeutic segments in the pharmaceutical market of Bangladesh. The position of the
cardiovascular market segment in the year 2018 was 4 with sales of Tk. 2104.00 crores in
2018 and a market share of 10.16% and a growth rate of 13.17% in the table 1.2 and figure
1.1.

6
Table 1.2: Top Therapeutic Segments in Bangladesh 2018(IMS data)

Total Yearly Market Share Market Growth

Sl Therapeutic group
Sales (BDT) (%) (%)
1 Alimentary T.& Metabolism 73,740,306,459 36.56% 8.44
2 Systemic Anti-Infectives 31,840,824,843 15.79% 3.79
3 Nervous system 21,491,946,111 10.65% 6.34
4 Cardiovascular system 20,496,433,680 10.16% 13.17
5 Respiratory system 17,550,470,546 8.70% 5.64
6 Musculo-skeletal system 10,499,713,765 5.21% 6.90
7 G.U.system & sex hormones 6,512,135,692 3.23% 16.01
8 Dermatologicals 5,113,102,842 2.53% 7.29
9 Blood + B.Forming organs 4,802,186,294 2.38% 13.97
10 Sensory organs 3,051,846,645 1.51% 8.47
11 Systemic hormones 2,415,258,601 1.20% -3.11
12 Parasitology 1,592,451,510 0.79% 8.56
13 Hospital solutions 1,413,378,071 0.70% -1.73
14 Antineoplast+immunomodul 671,483,795 0.33% 19.01
15 Others 514,792,640 0.26% 20.88
16 Diagnostic agents 5,415,905 0.003% -75.36
Total market 201,711,747,397 100 7.72
Source: Prepared by Researcher from IMS Data

7
Figure 1.1: Market Share of All Therapeutic Segments of Bangladeshi
Pharmaceutical Market in 2018(IMS data)

1.20% 0.79%
Market Share (%)
0.33%
1.51% 0.70% 0.26% 0.00%
2.53% 2.38%
3.23%
5.21%

36.56%
8.70%

10.16%

10.65% 15.79%

Alimentary T.& Metabolism Systemic Anti-Infectives Nervous system

Cardiovascular system Respiratory system Musculo-skeletal system
G.U.system & sex hormones Dermatologicals Blood + B.Forming organs
Sensory organs Systemic hormones Parasitology
Hospital solutions Antineoplast+immunomodul Others
Diagnostic agents

Source: Prepared by Researcher

In the ranking of 15 therapeutic segments in 2019, it was observed that the cardiovascular
segment had overtaken the position of Nervous system segment which was in position 3 in
2018. Currently, the ranking position of the cardiovascular segment is 3 with a high market
share 10.56% and a high market growth 15.53% in the table1.3 and figure1.2 which
represents the star position of market growth- share matrix. This study shows the evidence
of the market attractiveness and opportunities of the cardiac market in Bangladesh.

8
 Table 1.3: Top Therapeutic Segments in Bangladeshi Pharmaceutical Market
(IMS-2019)

Total Yearly Market Share

Sl. Therapeutic Group Market Growth (%)
Sales (BDT) (%)
1 Alimentary T.& Metabolism 84,635,201,062 36.78 12.38
2 Systemic anti-infectives 36,544,627,741 15.88 14.40
3 Cardiovascular system 24,309,943,178 10.56 15.53
4 Nervous system 23,249,740,474 10.10 7.54
5 Respiratory system 21,742,107,868 9.45 22.00
6 Musculo-skeletal system 11,395,133,745 4.95 6.77
7 G.U.system & sex hormones 7,391,154,287 3.21 10.93
8 Blood + B.forming organs 5,563,066,015 2.42 12.07
9 Dermatologicals 5,152,709,838 2.24 1.20
10 Sensory organs 3,260,751,488 1.42 5.51
11 Systemic hormones 2,661,950,636 1.16 10.59
12 Parasitology 1,475,990,937 0.64 -6.01
13 Hospital solutions 1,393,373,540 0.61 1.33
14 Antineoplast+Immunomodul 681,029,966 0.30 -0.63
15 Others 640,963,331 0.28 18.82
16 Diagnostic agents 5,211,402 0.00 -32.08
Total market 230,102,955,509 100 12.35
Source: Prepared by Researcher

9
Figure1.2: Market Share of All Therapeutic Segments of Bangladeshi Pharmaceutical
Market in 2019 (IMS data)

Market Share (%) 1% 0% 0%

2% 1%1% 1% 0%
2%
3%

5%
37%
9%

10%

11%
16%

Alimentary T.& Metabolism Systemic anti-infectives

Cardiovascular system Nervous system
Respiratory system Musculo-skeletal system
G.U.system & sex hormones Blood + B.forming organs
Dermatologicals Sensory organs
Systemic hormones Parasitology
Hospital solutions Antineoplast+Immunomodul
Others Diagnostic agents

Source: Prepared by Researcher

1.4 Overview of Cardiovascular Market Segment
The Targeting of Cardiac Market Selection is to use this market segment as a model for the
present research for the evaluation of the impact of MST on Stakeholders’ Satisfaction and
Sales. This study can be used to represent the scenario of the total pharmaceutical market
and stimulate further research on other market segments as well.

Targeting (Court, DC 1994) is to select specific market segments on which to concentrate

the marketing effort. Four aspects need to be analyzed for targeting segment such as
market, customer, competition and company’s capability. Among the 15 different
therapeutic segments, Bangladeshi companies want to pursue the cardiac market as the
cardiac market growth is very high (219%) over the last seven years (Table 1.6). Cardiac
medicines are used life-long. Cardiac disease is the number one cause of death in
Bangladesh (WHO 2015). Hence, companies will assess the capability to obtain sustainable
competitive advantage within this cardiac segment. The cardiac market is growing with

10
significant potential where cardiologists are the customers and cardiac patients are the
consumers. The questions that need to be answered by STP model include what are the
needs, wants, attitude and belief of customers (doctors and patients) about the company,
who their competitors are and what are their capabilities and performance in the market.
The STP model (Segmenting, Targeting and Positioning) is used in the pharmaceutical
market according to segment importance and chance of success like cardiac markets. The
market share (10.13%) and market growth rate (13.17%) in 2018 is more promising and is
positioning the segment in the star quadrant in the market growth –share matrix than other
segments. The sale of cardiovascular medicines was recorded T658.00 cr. in 2011 and has
increased to Tk. 2104.00 cr. in 2018 at a growth of 219% over the seven years.

Table 1.4: Top 20 Companies and Cardiovascular Market of Bangladesh

Year 2019(IMS data)
Sl Company Name Market Size (BDT) Market Share (%) Market Growth (%)

Cardiovascular market 24,309,943,178 100.00 15.53

1 Beximco 4,067,926,644 16.73 21.41
2 Incepta pharma 3,731,769,932 15.35 4.35
3 Square 3,516,800,533 14.47 18.10
4 Opsonin pharma 1,841,576,082 7.58 16.49
5 Drug international 1,629,775,712 6.70 64.40
6 A.C.I 1,585,683,385 6.52 18.98
7 Unimed &Unihealth 868,100,136 3.57 6.42
8 Aristopharma 827,736,983 3.40 14.12
9 Healthcare pharma 788,040,363 3.24 12.74
10 ACME 756,584,001 3.11 6.31
11 Servier 580,215,616 2.39 -8.65
12 Popular pharma 531,330,792 2.19 8.68
13 Renata 528,685,070 2.17 10.44
14 Sun pharma 464,758,492 1.91 31.31
15 Orion pharma ltd. 384,480,055 1.58 10.62
16 General 360,081,252 1.48 25.33
17 Eskayef 344,433,980 1.42 6.46
18 Radiant pharma 242,143,919 1.00 39.74
19 Novartis 239,598,068 0.99 15.18
20 Delta pharma 144,826,506 0.60 8.36
21 Others 875,395,657 3.60 -
Source: Prepared by Researcher

11
 Table 1.5: Top 20 Companies and Cardiovascular Market of Bangladesh
Year 2018 (IMS data)

Sl. Company Name Market Size (BDT) Market Share (%) Market Growth (%)

Cardiovascular Market 22,032,985,508 100.00 15.24

1 Incepta pharma 3,684,951,413 16.72% 14.88

2 Beximco 3,553,979,166 16.13% 17.14

3 Square 3,126,560,682 14.19% 11.41

4 Opsonin pharma 1,645,814,899 7.47% 14.29

5 A.C.I 1,386,529,283 6.29% 17.21

6 Drug international 1,152,180,837 5.23% 69.16

7 Unimed &Unihealth 821,118,455 3.73% 11.25

8 Aristopharma 742,617,466 3.37% 6.40

9 ACME 724,716,388 3.29% -0.23

10 Healthcare pharma 716,519,521 3.25% 15.53

11 Servier 646,037,763 2.93% 6.26

12 Popular pharma 517,191,361 2.35% 17.44

13 Renata 502,389,844 2.28% 18.14

14 Orion pharma ltd. 364,967,635 1.66% 9.94

15 Sun pharma 361,458,509 1.64% -5.27

16 ESKAEF 330,369,273 1.50% 17.09

17 General 322,409,641 1.46% 29.11

18 Novartis 222,109,038 1.01% 24.15

19 Radiant pharma 194,118,570 0.88% 103.11

20 Sanofi Bangladesh 156,398,903 0.71% -8.19

21 Others 860,546,861 3.91% -

Source: Prepared by Researcher

The top 20 pharmaceutical companies holding market size, market share and market
growth of cardiac market segments in 2018 and 2019 are shown in Table 1.4 and 1.5. The
tables depict that the competition among the competitors is very high. The ranking
positions of the three companies have been changing over the years. The tables 1.4 and 1.5
show data of two recent years indicating that Beximco is ranked as the market leader in
2019, whereas Incepta was ranked 1st in 2018. Square pharmaceutical was in third position
12
over the two years although it is the market leader in total market segments of Bangladeshi
pharmaceutical market. This analysis infers the intense competition of the top three
companies that have a combined market share of about 46%.

Opsonin, Drug International, A.C.I, Unimed & Unhealth, Healthcare and ACME can be
categorized as market challengers that face high competition among them and have been
changing their position over the past two years as well. The next 20 companies among the
30 pharmaceutical companies can be categorized as followers and niches. The total market
share of the 30 companies is about 98%. The researchers selected 18 companies holding
82% (approx.) of the market share including large, medium and small.

Table 1.6 and figure1.3 show that total sales of cardiovascular medicines were recorded as
Taka 658.00 Cr in year 2011 and have been increased to Taka 2104.00 Cr in 2018.

Table1.6 : Total Sales of CVD Medicine (Cr. Taka)

Year Total Sales of CVD Medicine
2011 658
2012 812
2013 928
2014 1023
2015 1183
2016 1599
2017 1866
2018 2104
Source: Prepared by Researcher from (IMS data)

13
 Figure1.3: Total Sales of CVD Medicines (Cr.TK) From Year
2011 to 2018
2500

2000

1500

1000

500

0
2011 2012 2013 2014 2015 2016 2017 2018

Source: Prepared by Researcher

Cardiovascular disorders are the causes of cardiovascular diseases. The cardiovascular

diseases can be categorized by the indications related to heart and blood circular networks.
Cardiac diseases are hypertension, dyslipidemia, stroke, atherosclerosis thrombosis,
myocardial infraction, congestive heart failure, disease of coronary artery and stroke. The
two risk factors of cardiovascular diseases are non-manageable and manageable factors.
The non-manageable factors are age, sex, heredity and race. The manageable factors are
diet, smoking, physical inactivity, stress and drug abuse which are lifestyle related (Source:
Business Insight 2016). According to WHO (2016), stroke was one of the leading causes
of death.

Arteriosclerosis is the thickening of the arteries and causes loss of vessel wall flexibility
and reduces blood supply to tissues and organs. These lead to coronary artery disease,
peripheral artery disease and stroke.

Thrombosis forms blood clot inside the blood vessels which obstructs the flow of blood in
the brain, lungs, gastrointestinal tract and limbs.

Cardiac arrhythmias may stem from a heart rhythm problem which is too fast and too slow.
Frequent occurrence may lead the risks of stroke and congestive heart failure.

14
Myocardial infarction or heart attack occurs due to the disruption of blood supply to a part
of the heart.

Angina pectoris is the lack of blood supply and oxygen to the myocardium that causes chest
pain due to ischemia. When brain cells die owing to a lack of blood supply, a stroke occurs.
Sales of different types of Cardiovascular medicines available in pharmaceutical market of
Bangladesh (2014-2018) have been given in the following table 1.7 and figure 1.4. The
table1.11 shows the top 50 Brands of Cardiovascular medicines in Cardiac Market of
Bangladesh with generic name, company name, and market share and market Price

Table1.7 Sales of different types of Cardiovascular medicines available in

Pharmaceutical Market of Bangladesh (2014-2018)

Different types of Market size (Cr)

Cardiovascular Y 2018 Y 2017 Y 2016 Y 2015 Y 2014
Medicines
Angiotensin receptor 638.95 614.53 557.14 398.8 317.43
blockers (ARB)
Lipid Lowering 420.88 408.1 348.4 262.8 216.7
Agents
Anticoagulant 242.98 233.8 200.1 136.4 109.4
Calcium channel 233.32 232.8 221.8 182.6 163.2
Blocker(CCB)
Beta Blocker(BB) 227.96 220.1 188.6 138 109.8
Antiarrhythmic 218.41 204 160.8 132.3 102.3
Diuretics 88.98 88 78.3 59.7 52.7
ACEI 58.24 57.38 54.36 45.78 43.84
Anti haemorrhoidal 36.64 36.3 33.3 25.5 22.8
Alpha Adrenergic 29.12 27.7 22.2 14.3 11.1
Blocker
Peripheral 28.79 28.6 26 22.8 19
Vasodilators
Others 4.25 3.8 2.2 1.8 1.5
Source: Prepared by Researcher from IMS data

15
 Figure1.4 : Sales of different Types of CVD Medicine From 2018 to
2014
700
600
500
400
300
200
100
0

Source: Prepared by Researcher from IMS data

Angiotensin Receptor Blockers (ARB) are a drug class of antihypertensive which were the
most commonly prescribed therapeutic groups from the years 2014 to 2018.

The key brands of the cardiac market are B1ZORAN, OSARTK, ANGILOCK, BISOLOL,
FIXOCARD, OSARTIL PLUS etc. The lipid lowering category of cardiac drugs remained
the second largest in sales which was Taka 216.7cr in 2011 and Taka 420.88 in 2018.
ATOVA & ROSUVA are the two block busters supplied by Beximco and Servier
Pharmaceutical companies respectively.

Anticoagulants recorded Tk. 109.4 Cr and Tk. 242.98 Cr in sales in the years 2014 and
2018 respectively. The sale of CLOPID produced by Drug International is number one in
this segment (Taka 28Cr) in 2018. Calcium Channel Blockers, and Beta Blockers are in
the 4th and 5th positions respectively according to sales in the cardiac market. The sales of
different types of cardiovascular medicines such as Angiotensin Receptor Blockers
(ARP), anticoagulant, lipid lowering agents, calcium channel blockers, Beta Blockers,
Antiarrhythmic, Diuretics, Angiotensin Converting Enzyme Inhibitors (ACEI),

Anti haemorrhoidal, alpha Adrenergic Blocker vasodilators & others have been shown in
the tables1.8,1.9,1.10 and figures 1.5,1.6,1.7 respectively.

16
Combination cardiovascular medicines such as ARB combination, ACEI combination and
CCB combination have found an increasing sales trend in comparison to the plain ARB,
ACEI & CCBs. The tables1.8,1.9,1.10 and figures1.5,1.6,1.7 are shown below from year
2010 to 2018. Reasons behind the increased sales of combination medicines are dual action
or effectiveness. (ZARB, BACEI, HCCB).

Table 1.8 : ARBs plain and combination drug market size

Year ARB plain (Cr. Taka) ARB Combination (Cr. Taka)
2010 65 46
2011 87 70
2012 115 102
2013 136 138
2014 154 163
2015 169 194
2016 241 286
2017 278 323
2018 313 382
Source: Prepared by Researcher from IMS data

Figure1.5: Comparison of ARBs plain and combination drug

market size
450

400

350

300

250

200

150

100

50

0
2,010 2,011 2,012 2,013 2,014 2,015 2,016 2,017 2,018
ARB Plain ARB Combination

17
 Table 1.9: Comparison between ACEIs Plain and combination drug market size
Year ACEI Plain(Cr. Taka) ACEI Combination(Cr. Taka)
2010 5 27
2011 6 31
2012 7 31
2013 7 31
2014 7 30
2015 7 30
2016 8 37
2017 9 38
2018 10 39
Source: Prepared by Researcher from IMS data

18
Figure 1.6: Comparison between ACEIs Plain and combination drug market size

45

40

35

30

25

20

15

10

0
2,010 2,011 2,012 2,013 2,014 2,015 2,016 2,017 2,018

ACEI Plain ACEI Combination

Table 1.10 : Comparison between CCBs Plain and combination drug market size
Year CCB Plain(Cr. Taka) CCB Combination(Cr. Taka)
2010 43 60
2011 51 75
2012 57 92
2013 61 99
2014 57 105
2015 61 113
2016 74 139
2017 90 143
2018 97 142
Source: Prepared by Researcher from IMS data

19
Figure 1.7: Comparison between CCBs Plain and combination drug market size

160

140

120

100

80

60

40

20

0
2,010 2,011 2,012 2,013 2,014 2,015 2,016 2,017 2,018

CCB Plain CCB Combination

20
 Table 1.11: List of Top 50 Brands of Cardiovascular medicines in Cardiac Market of
Bangladesh with generic name, company name, and market share and market Price
per tablet (Average weight:10-75mg) from IMS data and DIMS (2019)

Market Price
Market Share
Si. Brand Name Generic Name Company per tablet
(%)
(BDT)
1 ATOVA Atorvastatin Beximco 3.88% 18
2 BIZORAN Amlodipine+Olmesartan Beximco 3.37% 8
3 OSARTIL Losartan Incepta 3.36% 8
4 ANGILOCK Losartan Square 2.57% 3.52
5 BISLOL Bisoprolol Opsonin 2.53% 16
6 FIXOCARD Amlodipine + Atenolol Incepta 2.31% 5.2
7 OSARTIL PLUS Losartan + Hydrochlorothiazide Incepta 2.22% 8
8 ANGILOCK-PLUS Losartan + Hydrochlorothiazide Square 1.87% 12
9 ROSUVA Rosuvastatin Square 1.82% 30
10 VASTAREL Trimetazidine Servier 1.58% 8.83
11 AMDOCAL Amlodipine Beximco 1.54% 7
12 ABECAB Amlodipine+Olmesartan ACI 1.33% 11
13 CLOPID Clopidogrel Drug International 1.24% 12.05
14 AMDOCAL-PLUS Amlodipine + Atenolol Beximco 1.14% 5.23
15 ABETIS Olmesartan ACI 1.13% 9
16 NIDOCARD Nitroglycerine Drug International 1.11% 7.05
17 TIGINOR Atorvastatin Incepta 1.09% 18
18 METACARD MR Trimetazidine Aristropharma 1.07% 7
19 ROSUTIN Rosuvastatin Beximco 1.05% 20
20 OLMESAN Olmesartan Beximco 0.91% 8
21 FRULAC Frusemide+Spironolactone Orion 0.84% 3
22 NITRIN Nitroglycerine Healthcare 0.81% 5
23 AVAS Atorvastatin Opsonin 0.81% 18.07
24 AMLOSARTAN Amlodipine + Valsartan Incepta 0.79% 9
25 CLOPID-AS Clopidogrel+Aspirin Drug International 0.79% 12
26 TENOCAB Amlodipine + Atenolol ACI 0.71% 5.27
27 ANZITOR Atorvastatin Square 0.70% 12
28 CILDIP Cilnidipine Opsonin 0.68%
29 LOPIREL PLUS Clopidogrel+Aspirin Incepta 0.66% 12
30 BISOCOR Bisoprolol Square 0.65% 10
31 OLMEZEST Olmesartan SPI 0.64% 8.07
32 PRAZOPRESS Prazosin Unimed Unihealth 0.63% 6
33 BISOPRO Bisoprolol Incepta 0.61% 10
34 INDEVER Propanolol ACI 0.61% 1.50
35 LOPIREL Clopidogrel Incepta 0.59% 12
36 CAMLODIN-PLUS Amlodipine + Atenolol Square 0.58% 5.02
37 ATASIN Atorvastatin ACI 0.57% 18.12
38 ANCOR Bisoprolol Aristropharma 0.57% 16
39 RAMORIL Ramipril Incepta 0.55% 12
40 CAMLOSART Amlodipine+Olmesartan Square 0.55% 8.03
41 CALNOR Amlodipine+Olmesartan Opsonin 0.54% 8
42 PLADEX Clopidogrel Unimed Unihealth 0.53% 12
43 ROCOVAS Rosuvastatin Incepta 0.51% 15
44 ANCLOG Clopidogrel Square 0.51% 12.03
45 ABETIS PLUS Olmesartan + Hydrochlorothiazide ACI 0.50% 9.05
46 ATV Atorvastatin Delta 0.50% 10
47 ROSU Rosuvastatin Popular 0.50% 30
48 BETALOC Metoprolol Drug International 0.49% 1.55
49 CARVISTA Carvedilol Incepta 0.48% 8
50 PROSAN Losartan Beximco 0.46% 4.5
Source: Prepared by Researcher

21
1.5 Justification for the study
Impact of Marketing Strategies and Techniques offered by Pharmaceutical companies for
customers’ satisfaction and sales performance, is very essential for survival in highly
competitive market today. However, the perception or satisfaction level of customers is not
the same as how the managers perceive them. Marketing managers often think in term of
the company’s point of view to attract their customers in the management of diseases and
to outcompete their competitors. If the customers are not satisfied about the attributes of
4Ps’ strategies that are important for them, they can help the company to figure out how to
deploy 4Ps’ strategies to satisfy them. Strategy development of an optimal Marketing Mix
is a combination of four marketing variables. These are product, price, place and promotion
which help to achieve marketing goals providing the right product at the right price, at the
right place with right information.

Among the 15 different therapeutic segments of the Pharmaceutical market, the cardiac
market segment has been selected for research to analyze because the impact of Marketing
Strategies and Techniques on all different therapeutic segments will be time consuming,
costly and will involve huge manpower. Generally, the number of cardiac patients is
increasing due to changing food habit, stress in workplace, and life style of people in
Bangladesh and all over the world.

According to Health bulletin statistics from year 2012 to 2016 cardiovascular disease is
number one cause of death in Bangladesh. Current prevalence of hypertension, coronary
artery disease, rheumatic heart disease and stroke is 20-25%, 4-6%, and 0.3-1%
respectively (Bangladesh Heart Journal, 2016). Sales of cardiac medicines were TK.
658cr. in 2011 which has been increased to TK. 2104 cr. in 2018. Thus, high market growth
of cardiovascular medicines over the last few years has made the cardiac market attractive
to invest for the suppliers (IMS data2011-18). In the present study, gap analysis between
customers’ satisfaction level and Marketing Strategies and Techniques offered by
Pharmaceutical companies has been conducted.
Recommendation will be given to minimize the dissatisfaction of customers regarding
Marketing Strategies and Techniques of Pharmaceutical companies for a better health care
service to the cardiac patients.
22
Government can develop policies about the current situation from the point of view of the
cardiac patients and other stakeholders

1.6 Problem statement:

For Cardiac Disease Management, the doctors try to diagnosis the type of disease first then
prescribe cardiac medicines to cardiac patients. As the number of cardiac patients increase,
it creates a demand for medicines and doctors’ prescription encourage the retailers to stock
the medicines for the patients.

However, poor Marketing Strategies and Techniques effect on Doctors’ Dissatisfaction to

prescribe cardiac medicines for cardiac patients. Dissatisfaction of Doctors regarding the
poor quality of cardiac medicines, high price, lack of communication of Pharmaceutical
companies with doctors and unavailability of cardiac medicines in retail pharmacy affects
doctors’ selection of cardiac medicine negatively. Patients are the ultimate end users who
face the problem of purchasing the right medicine at the right place at a reasonable price
to get relief from cardiac diseases. As a result, Marketing Strategies have an impact on
Sales of Pharmaceutical companies.

1.7 Research Questions

 To what extent Product Strategies affect Stakeholders’ Satisfaction and Sales?
 To what extent Pricing Strategies impact on Stakeholders’ Satisfaction and Sales
performance?
 To what extent Promotional Strategies impact on Stakeholders’ Satisfaction and
Sales growth?
 To what extent distribution network effect on Stakeholders’ Satisfaction and Sales
growth?
 Is there any gap between the Overall Satisfaction about Marketing Strategies and
Techniques and Stakeholders?
 Are the impacts of Marketing Strategies and Techniques of different
Pharmaceutical companies same?

23
1.8 Objectives of the study:
The broad objective of the research is to evaluate the impact of Marketing Strategies and
Techniques on the Pharmaceutical Cardiac market in Bangladesh to represent whole
Pharmaceutical market as a model.

Specific objective of this research study includes

 To evaluate the impact of Product Strategies of cardiac medicines on Stakeholders’
Satisfaction and Sales.
 To assess the impact of Pricing Strategies of cardiac medicines on Stakeholders’
Satisfaction and Sales.
 To find out the impact of Place Strategies of cardiac medicine on Stakeholders’
Satisfaction and Sales.
 To determine the impact of Promotional Strategies of cardiac medicines on
Stakeholders’ Satisfaction and Sales.
 To compare the Satisfaction of Stakeholders about Marketing Strategies and
Techniques of market leaders, challengers, followers and niches in Pharmaceutical
market.
 To analyze the gap between the Overall Satisfaction about MST and Stakeholders

1.9 Synoptic View of the Study

This study is divided into five chapters as follows-
Chapter 1 includes the introduction to the study, background of the study, Overview of
Pharmaceutical Market of Bangladesh, Overview of Cardiac Market Segment, Justification
of Study, Problem Statement, Research Questions and Research Objectives.
Chapter 2 covers relevant Literatures Review. The objectives of this chapter are to clarify
the Customers (Doctors), Consumers (Patients) and Marketing Professionals (Sellers) of
Pharmaceutical market and important stakeholders. They represent main components of
Pharmaceutical market. It conveys different relevant theories like theory of Customer
Satisfaction, Expectancy Disconfirmation theory, Kano Model, Cognitive Dissonance
24
theory and Teboul model. This chapter also discusses on Pharmaceutical Marketing
Strategies and Techniques, Push-Pull Strategies, Market Segmentation, Targeting and
Positing Strategies, Marketing Mixed Strategies and Competitive Strategies to gain
competitive advantages. This chapter highlights the necessity of the present study in the
form of the Research Gap that have found from the literature review. Based on the Research
Gap specified the Conceptual framework/model of the study is drawn and hypotheses of
the research are fixed.

Chapter 3 includes the Research Design, Description of the whole research process. It
includes Research Methodology, Sample Size determination from Target Population of
three categories Stakeholders and Sampling Techniques for Doctors, Marketing
Professionals and Patients. It describes Qualitative Exploratory Research through in-depth
interviews with doctors, marketers, patients and academicians to gain a deeper
understanding of Stakeholders’ Satisfaction about Marketing Strategies and Techniques
and its impact on Sales performance of the Pharmaceutical companies. On the basis of
Exploratory Research, Literature Review and Pilot survey, Questionnaires for the Research
were developed. Reliability and Validity of the Questionnaires were mentioned.

Chapter 4 presents the Factors Analysis, interpretation of Rotated Component Matrix

result to answer the objectives of this research. The analysis of process has been detailed
out and usage of SPSS has been highlighted to arrive at the factors which have been
interpreted in details. This chapter includes various tests like KMO, Bartlett’s tests,
goodness of fit of the model and concludes with Research Hypothesis testing by Regression
Analysis for Statistical Significance.

Chapter 5 proposes Conclusions and Recommendation on the basis of the results retrieved
from the survey questionnaires of the study. The factors were named as Medicinal benefit,
Economic benefit, Convenience benefit and Communication relationship benefit that
impact on Stakeholders’ Satisfaction and Marketing Professionals’ Satisfaction about Sales
of Pharmaceutical companies. Next to all these, it includes contribution of the research,
limitation of the study, and future scope for research. At the end of this thesis there are
references and appendices.
25
 CHAPTER TWO
LITERATURE REVIEW

2. Literature Review
The literatures relevant to the theories and concepts for developing conceptual model and
hypotheses for this study are divided into five sections.
1. Doctors(Customers), Patients (Consumers) and Marketing Professionals
(Sellers)
2. Relevant theories of Customers’ Satisfaction (Kano model, Expectancy theory,
Disconfirmation theory and Teboul model)
3. Pharmaceutical Marketing Strategies and Techniques, Push-Pull Strategies,
Segmentation, Targeting, and Positioning Strategies (STP Strategies), Marketing
Mix Strategies, Competitive Strategies.
4. Research Gap
5. Hypothesis Development and Conceptual Framework (Medicinal issues,
Economic Issues, Convenience Issues and Communication Relationship Issues)

2.1. Doctors (Customers), Patients (Consumers) and Marketing Professionals

(Sellers)

Customers are primarily of two types- those who buy for their own consumption and those
who buy for the consumption of someone else. Marketers usually position their messages
to target either of the aforementioned types of customers. Given the unique role of the
physician as a customer, the Marketing Strategies used by the pharmaceutical industry
radically differ from that of other industries. The primary reason is that the physician acts
as an intermediary on the patient’s behalf. The physician here is the decision maker who
diagnoses the patient and accordingly, identifies the product category (segment or plan)
and selects a specific brand among a vast array of alternatives in the market. But even
though the physician is the agent who makes the decision on the patient’s behalf, in the
end, it is the patient who has to use the selected product and takes responsibility of paying
26
for it (Gonul,2001). Their indirect reward for prescribing a specific product may be through
the perceptible improvements of the patient’s health. In some cases, doctors receive
promotional incentives from manufacturers of that specific product.

Physicians have thus, due to their role as intermediaries and key decision makers, have
become the chief targets of the marketing activities of pharmaceutical companies. The very
metric against which pharmaceutical companies’ measure their marketing success is by the
volumes of medicines sold as a consequence of the frequency of prescriptions written down
by physicians prescribing their products. Prescriptions in actuality indicate the recognition
of a physician that the said product is the best alternative to treat the patient or is at least a
good alternative, worthy of a closer appraisal.

Marketing has a clear effect on the practice of physicians. The marketers have to interact
with the pharmaceutical industry frequently and in diverse settings and fashions. That is,
in the form of CMEs, conference travels, research funding etc. (Wazan, 2000). However,
it is not easy to evaluate the extent to which the interaction between doctors and Medical
Representatives will benefit the interests of the patients. However, notifying physicians
about the clinical efficacy data, interactions and safety data and cost effectiveness data of
their available pharmaceutical products is very important. These fall under the legitimate
marketing factors of pharmaceutical companies. Thus it is necessary for doctors to get
access to these clinical data which will help them undertake better decisions.

The application of irrational and unethical factors pertaining to patient care should be
avoided by pharmaceutical marketing. These unethical factors include incentives like gifts,
biased information and activities of motivation or maintaining relationship with physicians
(Biswas K et al., 2016). Even though these are standard and acceptable practices within the
field of marketing, it clearly goes against the demands of medical ethics and therefore,
should be excluded. WHO (2004) estimates most of the medicines are inappropriately and
irrationally prescribed in developing countries (Richard and Agyeman, 2016). These may
ultimately lead to the prescription of costly and unnecessary medicines. It may influence
irrational prescription of drugs. The main purpose of marketing visits should be to inform
physicians about the recent information about the companies. The physicians have the
27
option to listen to the marketing pitch of sales representatives that aim to advertise the
positive sides of the medicines. However, physicians are not bound by any regulations
inflicted upon them through these marketing visits and are allowed to independently
prescribe rational medication. But at the same time, the physicians must also display
prudence by taking the extra time to review all the accompanying safety and contra
indication data as well (Jibson, 2007).

These interactions should be governed primarily by the regulatory body. However,

companies have also the duty of forming policies that ensure their employees operate
within the regulatory laws.

Physicians and Pharmaceutical industries have convergent interests when it comes to

providing safe and effective medication to patients even though they differ in their
practices. Interactions between them are therefore, almost unavoidable, but at times, can
lead to conflicts of interests (Kerridge, 2008).

Pharmaceutical manufacturers and their proponents demand that it educates doctors and
patients about health condition and availability of treatments. It improves the compliancy
of medical care through a number of relevant diagnosis and treatment of diseases (Batchlor,
2003). There is a fundamental difference between marketing and medical education and
they should not be conflated with one another.

Gifts (Promotional incentives) have been the topic of extensive controversy and research.
Occasional guidelines or policy actions have been formulated against it as a preventive
measure. There is an overwhelming consensus among researchers that gifts do indeed have
a clear effect on physicians’ decision-making process even when they do not believe it to
be so and even when the said gifts are of negligible value (Katz et al., 2003). Patients have
a negative perception of gifts to doctors. Therefore, physicians request something more
ambiguous like free samples. This does not benefit physicians directly but can be of
tremendous value to the relatively non affluent patients who are unable to afford a
potentially helpful medication (Jibson, 2007). If necessary, free samples of legally

28
available drugs may be provided on request to prescribers, in modest quantities of course
(WHO: criteria for medicinal drug promotion, 1986).

Marketing Professionals (Sellers or marketers), the employees who are working in the
department of Pharmaceutical Marketing are organized according to the organizational
structure. Country General Manager is the top authority in the marketing management
system. Under this position, the marketing manager works. Assistant managers, managers
of different strategic business unit or therapeutic units, business development manager,
communication manager, market research analyst work under the supervision of the
marketing manager as a team (Dogramatzis, 2002). They develop Marketing Strategies and
Techniques to achieve the targeted market share through the implementation of a set of
action plans (Hoo, 2017). The product managers of Strategic Business Unit lead the
Marketing Professionals to work together to achieve the goals of therapeutic unit. The
Marketing Professionals are medical affairs manager, product managers and sales manager.
Sales manager leads and coordinates the activities of Medical Representatives (MR) to
communicate with the doctors (Garofalo,1998). Product or Brand managers are the key
personnel who actively work for the development of the product, premarketing, marketing
and management of the different stages of the Product Life Cycle (Dogramatzis, 2002).

The organizational structure of the marketing department is more or less the same
worldwide and in Bangladesh. The responsibilities of product managers include managing
and improving existing products, developing new product, monitoring the feedback of
product performance from doctors and patients’ satisfaction (Wilson, 1998). They develop
a Pricing Strategy by monitoring the sales of different stages of the PLC and prepare a sales
forecasting by taking into account the internal and external factors that may affect sales
(Smith, 1991). The product managers have to maintain liaison with the production
department, be involved in public relation, promotional activities, and communication
relation with opinion leaders (Professors of Medical colleges), supervising the trial and
testing of product launching and provide training and support of medical representatives
(Dimitris, 2002).

29
The present study represents the Marketing Professionals who are general managers,
product managers, brand managers, marketing executive officers, sales managers and
medical representatives of cardiac therapeutic segment.

2.2. Relevant Theories

2.2.1 Customer Satisfaction (Doctor Satisfaction)
The most important and popular research topic is Customer Satisfaction (CS) which has
received wide spread attention (Swenson,1997; Farayabi et al., 2010). The importance of
Customer Satisfaction in Marketing Strategies is a prominent issue which cannot be
overlooked (Yang and Peterson et al., 1997) Customer Satisfaction is one of the customer
retention strategies which companies need to follow (Guo and Xiao, 2009). In this era of
global competition, it is evident that all pharmaceutical companies are facing fierce
competition. To gain competitive advantage over competitors, pharmaceutical companies
can use physician’s satisfaction as a vital tool (Raza et al.,2012). In Bangladesh, the
significance of Customer Satisfaction is a new topic of marketing.

According to several researchers, Customer Satisfaction can be explained as an evaluative

outcome of perceived value of a customer’s consumption experience. (Cadott et al.,1987).
Customer Satisfaction is described as the overall evaluation of local medicines by the
physicians’ experience of consumption by patients through prescription for a prolonged
period of time (Formell,1992). Therefore, Satisfaction is defined as the overall assessment
of every aspect of a medicinal product in the field of Pharmaceutical industry. Direct
customers of Pharmaceutical companies are physicians who primarily interact with
Medical Representatives (Kalaskar et al., 2012). It is not an exaggeration to imply that
physicians are extremely powerful who have the legal authority to control access of the
medicine to the patients. Customer Satisfaction is a significant criterion for doctors’ loyalty
towards Pharmaceutical companies. It is necessary to comprehend the needs and behavior
of physicians and companies. Perceived value leads to physicians’ satisfaction and there is
a correlation between the two variables. Wood D F believed that perceived value represents
the higher and more abstract level of evaluation of satisfaction regarding the quality of
medicinal products (Wood, 1997). This particular concept facilitates the development of
marketing techniques which builds the image of a company which ultimately leads to a
30
better market share and sales growth (Tsiotsou, 2005). Product quality is the antecedent of
customer satisfaction (Cronin, et al. 2000). Positive value is received by physicians that
reflect their satisfaction whereas negative value represents their dissatisfaction (Haque et
al., 2003).

2.2.2 Theory of Expectancy Disconfirmation (EDT)

Disconfirmation of expectation represents the difference between two values- initial
expectations and perceived experience. Disconfirmation will be positive when perceived
performance is higher than expectation and disconfirmation will be negative when it is
lower (Oliver, 1999).

Figure 2.1: Expectancy Disconfirmation (EDT)

Expectation 

 Disconfirmation Satisfaction  Repurchase

intention

Perceived 
Performan
ce


Repurchase intention is another important factor which is influenced by the customer’s

satisfaction or dissatisfaction. If the customer is satisfied, then the customer will be
motivated to repurchase and if the customer is dissatisfied then he or she will be de-
motivated to repurchase. Therefore, it can be said that ultimately satisfaction affects the
loyalty behavior of the customers (Oliver, 1999). The figure2.1 represents the Expectancy
Disconfirmation (EDT) theory.
Hence several factors can affect the expectation and real perceived performance of the
pharmaceutical companies which will affect the doctors and patients’ disconfirmation
31
positively or negatively. In this way, it will affect their level of satisfaction and ultimately,
the prescription generation for sales of prescribed medicines.

2.2.3 Kano Model of Customer Satisfaction

Among the most relevant theories, Kano model nicely represents customer satisfaction
from the organizational perspective. This model was developed in 1980 by Noriaki Kano
and his colleagues. In the model customer satisfaction, they classify attributes based on
customer perception and its relation with the given extent of satisfaction (Kano et al. 1984).
Kano model mainly highlights three different attributes that ranges from basic attribute to
spoken or performance attributes to delight attributes (Bilsen and Sevtap, 2011). Kano
model represents the satisfaction of customers for performance, excitement and threshold
attributes which is a reflection of how well each function is executed. Competitive
advantage over competitors can be achieved via excitement attributes which depicts the
greatest customer satisfaction. Kano Model of Customer Satisfaction has been shown in
the figure 2.2.
Figure 2.2 Kano Model of Customer Satisfaction

Very satisfied

Need executed poorly Need executed well

Time

Very dissatisfied
In addition, in the Kano Model, customer satisfaction against the perception of attribute
performance is determined. In the current study Kano Model validates the idea of

32
comparison between the levels satisfaction of three different types of Stakeholders
(Doctors, Patients and Managers) in the Pharmaceutical industry.

2.2.4 Cognitive Dissonance Theory

By holding two different sorts of factors in determining the satisfaction, cognitive
dissonance arises in the mind of the consumer as an uncomfortable feeling. Cognitive
dissonance theory suggests that dissonance can be reduced by the motivation of customers
in a way that it alters belief and behavior and ultimately, justifies them. The figure 2.3
represents the Model of Cognitive Dissonance Theory.

Festinger explained the theory of cognitive dissonance which can be incorporated into the
research of consumer behavior. It is indicated as a psychological phenomenon which is not
comfortable in nature and highlights the mutual relatedness of contradictory (non-fitting
and/or dissonant) relations among the constituting relationships. In addition, the theory is
useful to highlight the discomfort zone or area of the consumers particularly by analyzing
their post purchase behavior (Festinger, 1957).

Figure 2.3 Model of Cognitive Dissonance Theory

Consistency

Anxiety &
Inconsistency

It is not always possible A new consonant element

to change importance of added that act as buffer
element

33
Similar to the cognitive dissonance theory, the present study configures the level of
Stakeholders’ Satisfaction and the relative importance of these factors towards that
satisfaction. In other words, the study also observes if stakeholders have contradictory
feelings about the constituting factors when compared to one another.

In addition to this, in light of the cognitive dissonance theory, the present study observes
the rationale of Stakeholders’ Satisfaction towards the prescribing behavior as a post
purchase action. In this way, the study finds the key points where the stakeholders are
simultaneously satisfied and not quite satisfied with. The results give the key points to the
policy makers to take necessary action to improve the overall Stakeholders’ Satisfaction.

2.2.5 Teboul Model

Customers are an important asset to any organization. It could be a manufacturing or a
service organization. Total Quality Management describes that the quality of a product can
be assessed by customer satisfaction. Edward Deming mentioned that quality can be
defined as meeting or exceeding the customer expectation and analyzing future
requirement of the customers. The primary goal of the organization should be satisfying
their customers as satisfied customers can only lead to increased sales and profit (Deming,
1982).

In Teboul theory, Customer Satisfaction Model is depicted by two symbols. Customer

needs is represented by a circle and the product or service offered by the organization is
represented by a square. If the circle and square coincide, this means that total customer
satisfaction has been achieved and the aim is to cover the required performance better than
their competitors. The square which lies within the circle is perceived as satisfying
customer and the part outside the circle is considered as unnecessary. Customer feedback
enables the organization to listen to the voice of the customer to identify customer
dissatisfaction and the relative priority of requirements for improvement. The present study
aims to understand the impact of Marketing Strategies and Techniques (MST) on
Pharmaceutical cardiac market where cardiologists are direct customers, cardiac patients
are consumers and Marketing Professionals are the sellers. The offers of the pharmaceutical
companies are the attributes of the MST that can either satisfy or dissatisfy the doctors to
34
prescribe the cardiac medicines for their patients if they meet or do not meet the needs of
the patients’ cardiac disorder for a better life for themselves. The study focuses on the gap
between the satisfaction level (Mean Score above 3) of stakeholders (Doctors, Patients and
Marketing Professionals) and attributes of MST. The Teboul Model is given in figure 2.4.

Figure 2.4 Teboul Model

Company offers

Customer needs

2.3.1 Pharmaceutical Marketing Strategies and Techniques

The definition of strategy given by Johnson and Scholes is “as the direction and scope of
an organization over long term which achieves advantages for the organization through its
configuration of resources within challenging environment, to meet the needs of market
and to fulfill stakeholder’s expectations.”

Robert et.al described that an organizational strategy intends to create values for its
stakeholders, customers and citizens (Robert et al., 2004). S.R Chaganti described strategy
like a route or road that helps organizations to reach objectives that involves all aspects
such as target customers, product attributes, allocation of resource mix and segment the
organization on win attack (Chaganti,2005).

Tactics are the techniques that help to take the strategy to its desired destination. They are
the specific action plans which include entire Marketing Mix Strategies, Product, Price,
Place and Promotional (PPPP) attributes that impacts customer satisfaction (i.e., doctors)
to prescribe medicines for patient’s use.

To reduce competition, a company develops competitive strategy by designing, planning

and implementing company’s strategic activities that influence the marketing strategy of

35
the product (Day et al., 1988). Table 2.1 shows that Pharmaceutical Marketing Strategy
and Tactics or Techniques.

Table2.1: Pharmaceutical Marketing Strategy and Tactics or Techniques

Marketing Strategies Tactics or Techniques
Become market share leader 15 new sales representatives are hired and
trained
Aim to increase sales by 20% every year Visit key accounts once weekly

10% penetration of market in launch year Prepare 3 new detail aids per year
Product awareness campaign to be Organize launch symposium
achieved by 75%
Aim to achieve Top 5 ranked sales force Conduct 4 prescriber focus group
Market share to be captured by 40% within Conduct campaign
next year.
Try to achieve fast product Distribute 1000 new product gimmicks
reimbursement
(Source: Dogramatzis D, Pharmaceutical Marketing ,2002)

2.3.2 Push- Pull Strategies

Push-Pull strategies have been found to be successful for all kinds of products and are very
useful for prescription drugs like cardiovascular medicines (Chaganti,2005).
Manufacturers of cardiac medicine attempt to create a demand for their medicines by
persuading the cardiologists and doctors through their sales team (Medical
Representatives). They do this by assuring doctors about the benefits of the medicines and
providing them promotional incentives like free samples, gifts, funding for attending
seminars, conferences (home and abroad) on the exposition of the function, efficacy, mode
of action and other features of the drugs they want to sell (Kumar, 2013). These policies
help to generate prescription for the patients. The patients in turn, buy the medicines from
the retail pharmacies. So pharmaceutical manufacturers pull the demand for the medicines
from the doctors and at the same time Marketing professionals persuade wholesalers and
36
retailers to make sure that the stock of the prescribed medicines are available for the
patients. The Push Strategy of manufacturers involve urging members of the distribution
channels to sell drugs to consumers (i.e. patients) through promotional policies like
discounts, gifts and displaying adequate samples in their store.

That is why a combination of the Push-Pull Strategies is useful for marketing medicines
(Chaganti SR, 2005 and Kumar P 2016). It is applicable for cardiovascular medicines too.
Pull (Doctors) Customers Retailers Wholesaler Manufacturers
Push Manufacturers Wholesalers Retailers Customers (Doctors)

2.3.3 Segmentation, Targeting and Positioning (STP) Strategies

2.3.3.1 Market Segmentation Strategies
Pharmaceutical markets are very complex in their nature. According to S. R. Chaganti,
market segmentation is the method by which pharmaceutical companies may gain a
competitive advantage over their rivals. A marketing segment consists of a group of
consumers with similar needs. This way, sellers will not only pay attention to what they
produce but also to what the customer wants. Companies will thereby practice market
segmentation through differentiated marketing to reach their target customers. There are
four ways to segment a pharmaceutical market by considering demographic factors such
as - age, sex, education and socioeconomic background of the consumers (Chaganti, 2005).

Market segmentation can also be achieved by considering the usage rate of drugs by
consumers. There are heavy users, medium users, light users and non-users. Each category
of users has separate needs from the others.

Perceived medicinal benefits are another way for market segmenting. According to
marketing expert Levitt T, what the customer is looking for is not a product but bundle of
benefits that it offers (Levitt, 1975). A target marketing strategy is formulated by market
segmentation. This powerful tool or technique depends on how the companies gather,
analyze and interpret the collected information in a meaningful way.

37
Dogramatzis D, described that segment strategies depend on marketing environment,
regulatory environment, and product and company characteristics. The marketing
environment represents the size and growth of the market, type of competition, number of
physicians and patients in the Pharmaceutical market. The regulatory environment controls
the cost and pricing policies, system of reimbursement and ethical issues of the medicine
business. Product in different stages of the Product Life Cycle, branding and differential
advantage are the components of product strategies that are also used for market
segmentation. Corporate strategy, portfolio priority, company marketing expertise,
resources and therapeutic categories are the elements of company characteristics for
segmenting market (Dogramatzis ,2002).

Pharmaceutical marketing has two major potential target groups with different needs.
Patients, even though they are the end users, have no decision-making power to purchase
the medicine as consumers. On the other hand, doctors are the intermediate customers but
it is they who are the ones who decide and advise patients through their prescriptions to
purchase a specific drug. Segmentation in pharmaceutical markets consists of two steps.

Patients can be segmented by a) similar illness b) age group c) gender. Similar illness
patients fall under the same therapeutic group. Such as- diabetic patients, cardiac patients,
asthmatic patients, tubercular patients etc. Patients categorized by age group are pediatric
patients, geriatric patients etc. Patients divided into sex categories are male and female
patients. Diseases can be categorized by communicable diseases (Infectious, e.g. Diarrhea)
and non-communicable diseases (e.g. Cardiac disease).

Doctors are segmented by specialty (e.g., surgeons, cardiologists, gynecologists etc.).

Doctors can also be segmented by the location of their practice e.g., urban, rural,
government, private etc.(Dogramatzis,2002). Cardiac market segments are rapidly growing
and holding number 3 and star position in Market share- Growth matrix (IMS 2019).

2.3.3.2 Targeting Strategy for Market Segment Selection

Each company should analyze the situation and then target to select specific market
segment by the process on which marketing efforts need to focus (Sollner and Rese, 2001).
38
Type of market, customer, competition and company’s capability are the four aspects that
require to be analyzed for targeting. Among the 15 different therapeutic segments, it is the
cardiac market that is of special interest to Bangladeshi Pharmaceutical industries. This is
because it has an astonishingly high market growth from Taka 658 crore at 2011 to Taka
2104 crore at 2018 over the previous five years (IMS data). Again, cardiac drugs are for
lifelong usage. Cardiac diseases and related health issues are the number one cause of death
in our country (WHO 2015). To gain a sustainable competitive advantage a company has
to assess its resources and capabilities within this cardiac segment. This rapidly growing
cardiac market has significant potential where cardiologists are its customers and cardiac
patients are its consumers.

Doctors prescribe a particular brand of medicine of a specific company on the basis of their
needs, wants, beliefs and impression about the company and also considering their
capabilities, competition and performance in the general market. The STP model
(Segmenting, Targeting and Positioning) is used in accordance with segment importance
and chances of success. This is also applicable to pharmaceutical markets in general and
cardiac markets in particular.

2.3.3.3 Positioning Strategy

More than 30 Bangladeshi Pharmaceutical companies produce cardiac medicines.
Efficacy, Safety Information, Brand Image, Reputation of the company and New
Medicines are the attributes of cardiac medicines to be evaluated to assess the satisfaction
of the customers’ needs. The company offer must occupy a unique and valuable position
in the mind of target customers (Kotler, 1980). Cardiac market segment has a promising
future in the Pharmaceutical market of Bangladesh. It is in the star position of Market
Share-Growth Matrix. Marketing Mix Strategies, which are strategies and tactics employed
to attract customers, should also match the needs of end users (cardiac patients).

2.3.4 Marketing Mix Strategy

In Modern Marketing theory, one of the most basic concepts that has attracted important
attention from the academy and the business industry is Marketing Mix Strategy (Kotler,

39
1980). Customers, Competitors and Companies are the three factors that are required to
define Marketing Strategy (Ohmae, 1982).

McCarthy defined Marketing Mix by 4Ps which are Product, Price, Place and Promotion.
These are used by an organization to fulfill the requirements of its target customers. The
elements of 4Ps are so important that the absence of any one may lead to the failure of the
business (McCarthy, 1971). The objectives of Marketing Mix Strategies are to offer more
values to the customers to develop a long term relationship (Kotler, P. Armstrong G, 2010).
Marketing Mix can be considered as tools or techniques as well as strategies which are
employed by Pharmaceutical companies to satisfy the requirements of physicians,
pharmacists and patients (Prashant and, Kalaskar, 2012).

According to Kasic the Marketing Strategies applied by Pharmaceutical companies

through 4Ps Strategies are: i) strategy of product helps to achieve market share and sales
growth through promotional activities, research and development process to innovate new
medicines which include market research and sales ii) place strategy of products expand
geographic location of the market iii) pricing strategy includes acceptable and affordable
price and iv) in order to compete in the market, the implementation of sales activities
through promotional strategies(Kasic ,2009).

The components of Marketing Mix Strategies and the description of components are given
in short for pharmaceutical medicines in table 2.2. The 4Ps are the important variables of
Marketing Strategies and Techniques(MST) which help to attain marketing goals. The
proper applications of product, price, place and promotional strategies on different stages
of Product Life Cycle can lead to the success of the products and profit for the organization.
Therefore, Marketing Mix Strategy is used as an essential element both for developing
Marketing Strategy and Techniques.

40
Table 2.2: Components and Description of Marketing Mix Strategies for
Pharmaceutical medicines
Product Component Description
Strategy
Product To reduce disease symptoms and hospitalization, to
objectives work efficiently and enjoy quality of life.
Quality To ensure active ingredient amount, efficacy,
tolerability, packaging
Safety To warn about side effect, drug interaction,
contraindication, Over dosage, existence of antidote
Attributes Formulation, taste, ease of use

Price strategy Pricing To satisfy customer need and meet to competition. To

objectives abide by regulation and increase sales volume
Customer To develop customer perception and demand for
demand increasing adoption rate and cover cost and make
profit at different stages of product life cycle
Competitive To compete with competitor pricing considering
pricing discounts, pricing leadership, price war and entry
barriers
Place Distribution To make medicines available, delivery frequency,
Strategy Channel condition of preserved medicines, inventory
objective management and customer service
Channel Distributors (stockiest), wholesalers, retailers, agents,
structure web dispensing
Promotion Promotion To inform and persuade doctors for reminding and
Strategy objective prescribing about medicines. To apply push-pull
strategy for target segment of the market
Personal Medicine detailing, to meet doctors’ need,
selling negotiation, maintaining relationship with doctors by
regular visits
Public Awareness campaign events, press conference,
relations exhibition, speeches, philanthropy activities
Incentives, display, coupons, promotion fulfillment,
Sales refunds, free samples etc.
promotion
(Source: Dogramatzis D, Pharmaceutical Marketing, 2002)

41
2.3.5 Competitive Strategies to Gain Competitive Advantage
Competitive Strategies that the company develops are programs designed to satisfy the
needs of its customers. Customers (Stakeholders) evaluate them and form a perception of
the product and its medicinal value. Competitive strategies seek a superior perceived value
of their products in the eyes of their customers to gain a competitive advantage over their
competitors. (Dimitris, 2002). This should be sustainable in the long-term and not be easily
imitable. Sustaining competitive advantage depends on a company’s resource and
capabilities.

Elements required for gaining sustainable competitive advantages include superior

company resources, superior company market position (reputation), superior knowledge
and communication relationship in the market place. Product characteristics may serve as
a base for sustainable competitive advantage. The benefit is twofold- customer satisfaction
and increased sales.

Porter identified five competitive forces acting in the pharmaceutical industry which
includes supplier’s bargaining power, customer’s bargaining power, the threat of substitute
products and internal rivalry, the threat of new entrants (Porter, 1985). McCarthy
introduced the 4P Marketing Mix Strategy which includes product, place and promotional
strategies (McCarthy, 1971). 4Ps strategies are developed by marketing managers to attract
customers and compete with rivals to increase sales growth and market share. It was
suggested by Robert Lauterborn that the 4Ps of sellers should correspond to the 4Cs of the
buyers (customer benefits, customer costs, convenient place and communication
relationship techniques) in order to achieve sales goals (Lauterborn, 1990).

Philip Kotler and Keller suggested that the modern marketing techniques are people,
process, program and performance of sale growth. Market people should also view their
customers (doctors) as human beings in order to understand the psychology behind their
prescribing decisions. The right set of tactics or techniques such as creativity, discipline,
action programs are reflected in detail in the process. In order to create an impact on the
sales performance positively, the process must be integrated with the 4Ps strategies. One

42
must continually assess profitable market opportunities of cardiac market segment in order
to ascertain market potential and market forecasted demand (Kotler and Keller, 2009).

In order to survive in today’s highly competitive market, the impact of Marketing

Strategies and Techniques which represent 4Ps strategies offered by Pharmaceutical
companies for Customer Satisfaction and Sales performance, is crucial. Their primary
focus is on the customer’s perspective. The customer’s (Doctor) assessment of their
strategies is reflected on their (Doctor) satisfaction level and the volume of sales of
medicine.

Perception or satisfaction level of customers is not the same as how the managers assume
the perception or satisfaction level of the customer to be. Marketing managers often
mistakenly think in the terms of the company’s point of view in order to manage disease
and gain a competitive advantage over their competitors. But if the customers are not
satisfied with the attributes or variables of their Marketing Strategies and Techniques, the
company should alter their strategies and deploy new strategies in their place in order to
match the demand and satisfaction level of its customers.

Pharmaceutical markets in Bangladesh are facing tough competition in each therapeutic

segment for ever-increasing sales and market share. The current research is a quantitative
and exploratory study of the Market Strategies of Pharmaceutical markets. The
Pharmaceutical industry is a market driven, knowledge intensive and highly regulated
sector (Dogramatzis, 2001). Here, the lack of innovation, short Product Life Cycle and
cutthroat competition have made the industry challenging. That’s why the marketers or
marketing managers are becoming more competitive in each market segment. They have
varied Marketing Strategies and Techniques to gain a competitive advantage over their
rivals to capture different market shares each consisting of different Product Life Cycle
(PLC) stages (Sharma, 2013)

43
2.4 Research Gap

In the last few years, there has been remarkable growth in the Pharmaceutical industry
globally (Murshid et al., 2014). Pharmaceutical manufacturers are facing intensive
competition to gain market share in this inventive and profit making high tech industry
(Kesic, 2009). Unlike general consumer market, the pharmaceutical market is very
complex and competitive (Chaganti, 2005). There are different stakeholders with different
interests.

Consumers of the general consumer market buy different products such as food, cloth,
soap, drinks, car etc. according to their needs. They take their own decisions depending on
the affordability, availability and quality of the products (Dogramatzis, 2000 and Kumar,
2013) explained that pharmaceutical companies produce medicines as products for
healthcare of patients who are consumers. Patients purchase medicines mostly with the
advice of doctors if these are prescription drugs and without doctor’s advice if it is
nonprescription or Over The Counter (OTC) drugs.

Although OTC drug can be purchased by the patient without a prescription but in
Bangladesh, people mostly rely on doctors’ advice to buy any kind of drug.

According to the International Medical Statistics (IMS 2018), medicines of 15 different

therapeutic segments of the Pharmaceutical market are being prescribed by doctors, the
direct or intermediate stakeholders, who mediate sales through prescription.

Patients are indirect customers and important stakeholders who have no authority to take
decisions to purchase medicines but rather follow the advice of doctors and purchase
prescribed medicines (Smith,2002). So, the ultimate target customers of Pharmaceutical
market are doctors who could be endocrinologists, cardiologist, nephrologists, oncologists,
pediatric, geriatric, ophthalmologist etc. (Dogramatzis,2000).

Ango Hoo explained that the Marketing Professionals of Pharmaceutical companies are the
Stakeholders who develop Marketing Strategies and Tactics to increase sales for achieving
targeted market share. He found the positive impact of product quality, availability of drug,
branding awareness, packaging services and distribution on market share considering
marketing representatives as respondents in Malaysia (Hoo, 2009). But because of the
44
multifactorial dependency of the Pharmaceutical market, it is not only the marketers, but
also some more influential stakeholders like doctors, patients etc.

There is little research on Marketing Strategies and Techniques containing Marketing Mix
variables in Bangladesh. This type of research may be required to investigate the impact in
differences in different countries and cultures like Bangladesh.

Kumar P and Sudhir S tried to explore the impact of Marketing Mix (4Ps) on existing and
potential customers (Doctors) for Pharmaceutical products in the Indian Pharmaceutical
industry. There are 10 known therapeutic segments in the Indian Pharmaceutical market
which includes prescription drugs (82.2%) and nonprescription drugs (18.8%).
Pharmaceutical companies used two models of distributions to market their products
(Kumar and Sudhir, 2006). Firstly, push strategies by influencing doctors by marketing
team to prescribe the medicines to the patients. Secondly, pulling the demand persuading
wholesalers, retailers and by promotional strategies to keep medicines which are sold to
patients. The study was carried out only as a qualitative research. There are a few empirical
researches to find the impact of marketing mix strategies on doctors and patients
satisfaction. There is a scarcity of this type of research in Bangladesh as well.

Rizwan, R.A and Jolita, V studied the relationship between physician prescription behavior
and promotional tools such as detailed knowledge and skills of medical representatives,
incentives, Continuous Medical Education (CME) for doctors in the context of Pakistan.
Patients are paying for the medicines for their treatment (Rizwan and Jolita, 2014).
Although patient’s wellbeing is the center of any healthcare initiative, but because of
unethical promotional practices it is very commonly compromised. In the context of
Bangladesh, Biswas and Ferdousy also found similar results that the different promotional
tools offered by pharmaceutical companies have an impact on a doctor’s satisfaction to
prescribe the medicines of a particular company (Biswas and Ferdousy, 2016).

Conor, G.E mentioned that promotional and pricing strategies have a significant impact on
the pharmaceutical market in European countries (Conor, 2017).

4Ps theories of McCarthy are well accepted worldwide and a lot of empirical studies have
revealed the impact of Marketing Strategies and Techniques on the Pharmaceutical market

45
that represent doctors’ satisfaction and marketers’ satisfaction in developed and developing
countries. But there is still the need of developing a model which can be applied in the
context of different countries. These types of researches are not sufficient to find the fact
that is required to be found in Bangladesh. There have been a few published papers that
provide a Conceptual Model of Marketing Strategies and Techniques from the point of
view of the customers’ perspective like doctors and patients in Bangladesh.

There are a number of researches and literatures in the perspective of developed countries.
Stephen, P. R and Charles, E. P explained the Pharmaceutical Drug Marketing Strategies
and Tactics in the United States. They analyzed the Pharmaceutical Drug Marketing
Strategies and Tactics in the United States. They analyzed the pull strategy supplemented
push strategy where direct-to-consumer (patients) advertising and sales promotions
increasingly attracted patients to request the advertised brand drug from their physicians.
A difference in perception regarding ethical considerations was found between doctors and
sales representatives (Stephen and Charles, 2006).

There is little research in Bangladesh where two stakeholders like Doctors and Medical
Representatives or Marketing Professionals were asked to evaluate the effectiveness of
Marketing Strategies for further reexamination of Strategies.

Connor, E.G explained a variety of promotion tactics for the US pharmaceutical market
such as detailing of the product by sales representatives, direct-consumer advertising,
building product champions, rebranding and educational awareness programs and
optimizing pricing for patients to achieve estimated market share in this qualitative
research (Connor,2014).

Dean C.H. and Wilkee et al. stated in an empirical study of Marketing Strategies that it was
to develop a defend strategy for pharmaceutical brands from generics in Australia. They
suggested implementing strategies in reaction to competitors’ strategies in advance of their
entry (Dean et al.,2010).

The researchers conducted their studies in developed countries and Western settings that
can be applied in other developing non-Western countries like Bangladesh.

46
The aims of the present study are to address these gaps of Product, Price, Place and
Promotional Strategies of literatures to further explore the relationship of variables of 4Ps
Strategies and Stakeholders’ (Doctors, Patients, Marketing Professionals) Satisfaction and
Sales in the context of Bangladeshi Pharmaceutical Market.

Neil, B. and Lyndon, S. suggested the development of mutually acceptable past marketing
mix for effectiveness of Business to Business (B2B) like small and medium enterprises
(SME) practitioners. This should be used as a basis for future marketing planning and a
better understanding of the strategic linkage between marketing mix elements and customer
groups in the United Kingdom (Neil and Lyndon, 2011). The elements of Marketing Mix
are advertising, brochures, direct marketing, sales force, telephone, sales promotion, press,
web, exhibition, conference, sales channels which were ranked as communicating offer for
existing and potential customers.

Separate researches are conducted on different issues such as problems in Marketing

Promotional Strategies, Pricing Policies, Doctors’ Satisfaction and Factors affecting Sales
etc. in Bangladesh.

There is insufficient research on the Marketing Strategies and Techniques that impact
Stakeholders’ Satisfaction and Sales in Bangladesh. Hence Stakeholders, especially the
Doctors, Patients and Marketing Professionals who are involved directly in the
Pharmaceutical Marketing process are to be taken for consideration for empirical studies
to investigate the impact.

There is also a lack of research regarding Patients’ Satisfaction about MST in the context
of Bangladesh. Immediate empirical research is needed to overcome shortcomings in this
field.

The Research Gap has been identified from an extensive literature review are given below:

 No study has focused on factors of Marketing Strategies and Techniques that

impact Stakeholders’ Satisfaction combined and individually (Doctors, Patients
and Marketers)
 No study has focused on the Gap between the Overall Satisfaction about Marketing
Strategies and Techniques and Stakeholders
47
  Study of impact of Marketing Strategies and Techniques on Sales in Bangladesh is
very few
 Comparison of 4Ps Strategies of market leaders, challengers, followers and niches
from the point view of the patients is not sufficient.

Consequently, the Research Gap has helped to develop Conceptual Model and conducting
empirical research on these issues.

The impact of variables of Marketing Strategies and Techniques on Stakeholders’

Satisfaction and Sales of Cardiac Market Segment have been considered for this study to
present the whole Bangladeshi Pharmaceutical Market as a case. Cardiologists
(Customers), Cardiac Patients (Consumers) and Marketing Professionals (Marketers) were
considered as Stakeholders and major components of the Pharmaceutical Cardiac Market
in Bangladesh.

2.5 Hypothesis Development

The hypothesis of the present study has been developed from the attributes or variables of
Marketing Mix Strategies to represent Marketing Strategies and Techniques from different
literatures. Moreover, the impact of the said variables on Stakeholders’ Satisfaction (i.e.,
Doctors, Patients and Marketing Professionals) in the Bangladeshi Pharmaceutical Market
was evaluated. The four issues considered for the Marketing Strategies and Techniques of
the Cardiac Market Segment are:
i) Medicinal issues of Product Strategies
ii) Economic issues of Price Strategies
iii) Convenience issues of Place Strategies
iv) Communication issues of Promotional Strategies

2.5.1 Medicinal Issues of Product Strategies:

Medicinal issues to manage cardiac diseases are the disorder of the body and heart that
causes high blood pressure, electrolyte imbalances, constrictive pericarditis, ventricular
arrhythmia, hepatic failure, hypothyroidism, myocardial infraction, heart block etc.
(Goodman and Gilman, 1990). Pharmacological benefits of cardiac medicines are
48
prescribed by the cardiologists and used by the cardiac patients for the management of
cardiac problems. The benefits of the cardiac medicines are evaluated by the outcomes of
increase cardiac output, increase renal perfusion, reduction of peripheral resistance,
vasodilation, decrease central and peripheral sympathetic nerve activities to reduce blood
pressure and other symptoms.

Pharmaceutical manufacturers offer efficacious, safe medication with affordable price to

manage disease that helps patients’ quality of life (Dogramatzis, 2004). Perceived quality
and value of medicine has significant relationship with physicians’ satisfaction (Murshid
et al., 2014)

According to Mansfield to fulfill the needs of quality, efficacy and safety, it is of vital
importance to license drugs meant for prescription. Company reputation has an indirect
significant impact on satisfaction and loyalty of the customers (Mansfield, 2001).
Physicians preference in drug prescription are influenced by quality, company reputation,
communication with company, availability and price of medicines respectively (Elahi, et
al., 2016).

Customers’ satisfaction and loyalty is driven by both confirmations of expectation and

company image (Ehrengberg and Barhand, 2000). Customers apply their decision making
strategy while selecting alternative brands to counter it. According to Fadel, product value
is the total benefit of using the product (Fadel,2010). Borden thinks that product is
characterized by design, quality, features, brand names and different size (Borden,1980).
Product can be viewed as a bundle of perceived intrinsic and extrinsic attributes. The
intrinsic attributes of a product include its physical composition. While the extrinsic
attributes are related to its performance, such as, efficacy and safety (Zeithaml,1988).

Customer satisfaction can be derived from a product which is related to the evaluation of
its product attributes (Churchill et al., 1982; Oliver,1999). Lapierre, J. identified the
benefits of a product as its quality customization (segmentation), responsiveness, efficacy,
reliability, safety, flexibility (ease of usage) and technical competence (Lapierre, 2000). A
set of expectations formed by the patients, prescribers and payers are called medicinal
benefits at the existing level of a therapeutic segment (Orville ,1995).

49
This study focuses on how exactly attributes or variables of Marketing Strategies and
Techniques (MST) cause an impact on a doctor’s satisfaction to prescribe and a patient’s
satisfaction to purchase a particular drug. Applied in the context of the Bangladeshi
pharmaceutical market, the independent variables of product strategies which were selected
from journal articles and Marketing Mix Strategies are efficacy, brand image, safety
information, company reputation and new medicines which impact the doctor’s satisfaction
(dependent variable).

From the reviewed literatures the following attributes have been considered as variables
under medicinal issues for hypothesis development. The variables are:

 Efficacy
 Safety information
 Brand image
 Company reputation
 New medicine

The hypotheses developed under medicinal issues from above mentioned literatures are as
follows:

H0: Efficacy of medicine has no positive impact on Stakeholders’ Satisfaction.

H1: Efficacy of medicine has positive impact on Stakeholders’ Satisfaction.
H0: Brand image of medicine has no positive impact on Stakeholders’ Satisfaction.
H1: Brand image of medicine has positive impact on Stakeholders’ Satisfaction.
H0: Safety information of medicine has no positive impact on Stakeholders’ Satisfaction.
H1: Safety information of medicine has positive impact on Stakeholders’ Satisfaction.
H0: Company reputation has no positive impact on Stakeholders’ Satisfaction.
H1: Company reputation has positive impact on Stakeholders’ Satisfaction.
H0: New medicine has no positive impact on Stakeholders’ Satisfaction.
H1: New medicine has positive impact on Stakeholders’ Satisfaction.

50
2.5.2 Economic issues of Price Strategies

Price represents the value of a product that is attributed for the fairness of the economic
benefit relationship between buyers and sellers. If the price is set for high profit earning
from the seller’s side only, then it may be unfairly high for purchasing price of the
customer. On the other hand, buyers may seek budget price that might not be the optimal
profit making price for the producers (Dogramatzis, 2002). From buyer’s viewpoint, a
product price perception is a mix of quality and effectiveness of the drug, the product prices
offered by their rivals and the personal economic benefits they expect from the purchase
(Kotler et al., 2010).

On the other hand, proper price selection by the sellers determines the financial stability
and profit making capacity for long term survival. Each pharmaceutical product is
produced with the intention of successfully competing with the strategies offered by its
competitors and hence carry product and economic benefits (Lehmann et al., 1997). These
are efficacy, safety, tolerability, quality and cost. Economic benefits include actual pricing,
competitive pricing, price signal quality, discounts and return on investment (Juredini,
2000).

One of the essential components of Marketing Mix is pricing strategy. It can help to make
profit of the company but regulated by many factors such as government policy, intensity
of market competition, product attributes, promotional effort, resources, cost, sales force
skill, distribution network, stages of product life cycle (Chaganti, 2005).

Price elasticity of demand represents change in the price effect on the demand of the
quantity of products. If price decreases, demand will increase. On the other hand, if
medicine is inelastic, price increases will not affect the demand of medicines like cardiac
medicines. Cost has an influence on price setting. Cost of fixed and variables and cost of
competitors that impact on doctors’ prescription decision (West, 2002; Freemantle and
Eastaugh,2002).

Demand of medicines for elastic and inelastic pricing depends on many factors that are
product positioning, product differentiation, number of competitors, branding, substitution
products, importance of products for treatment (Dogramatzis, 2002). Benefits or perceived

51
value of medicine influences the purchasing decision rather than pricing (Richarme, 2001).
Philip Kotler described the important factors of pricing as the attributes of the product and
its benefit (Kotler, 1984). Doctors prefer Pharmaceutical companies that consider the
affordability of patients to improve their quality of life by reducing the symptoms of
diseases.

From the above mentioned literature review the following variables have been considered
for hypothesis development under economic issues-

 Price signal quality

 Competitive price

The hypotheses are given below:

H0: Price signal quality has no positive impact on Stakeholders’ Satisfaction.

H1: Price signal quality has positive impact on Stakeholders’ Satisfaction.
H0: Competitive pricing has no positive impact on Stakeholders’ Satisfaction.
H1: Competitive pricing has positive impact on Stakeholders’ Satisfaction

2.5.3 Convenience issues of Distribution Network (Place) Strategy

According to Philip Kotler et al., the distribution of a product means the availability of the
product to its target customers (Kotler et al.,1999). According to Copley, organizations
should put more emphasis on the decisions of distribution because of the
interconnectedness of distribution of the product and its immediate consumption
(Copley,2004). In addition, organizations should also pay attention on how the product can
be delivered on the right time and place, and the channels used to deliver the product to
customers.

According to the description of Barden, N.H. the dimensions of the distribution channel
are distribution coverage, location assortment, inventories and transport (Barden,1984).
These channels could either be direct or indirect. Keller, K.L. emphasized on the choice of
channel distribution as it has a strong effect on sales and customer satisfaction (Keller,
1984).

52
Ang Hoo stated that importance of competitive factors varied between manufacturers and
wholesalers/distributors (Hoo,2011).

Supply chain management is defined by John B Houlihan as the design, implementation

and control of efficient supply chain systems. It has usage in both strategic: design and
evaluation of outcome, and operational: location determination, production, inventory and
transport of goods across the chain management (Houlihan,1985). Purchasing, sales
forecasting, controlling production, handling materials, managing inventory, distribution
and customer service are the main activities of the Supply Chain Management (Hoque et al.,
2012).

Logistic management represents effective flow and storage of raw materials, in-process
inventory and finished goods to fulfill customers’ requirement from manufacturers to
consumers through different stages of distribution channels (Council of logistics
management, www.clml.org).

S.R Chaganti mentioned the five basic members of Pharmaceutical distribution channel are
manufacturers, doctors, wholesalers, retailers and patients. The place strategy offers
effective management of distribution to get competitive advantage making medicines
available in different type of Pharmacies (retail, hospital and model) for the patients
(Chaganti,2005).

Model Pharmacy is new place strategy introduced in Bangladesh for Pharmaceutical

medicines distribution channel (DGDA, 2017). To evaluate the patient’ satisfaction and
perception about the Facilities of Model Pharmacies in comparison to conventional retail
pharmacies was carried out. S.R., Chaganti described that retail pharmacies are market
places where patients purchase medicines from when they need (Chaganti,2005). Although
the Pharmaceutical sector is uprising but health care is still not well developed (Sultana J,
2018). Lack of modern facilities, improper management of medicines, no counselling of
‘A’ grade pharmacists and selling poor quality medicines are the major causes of poor
health care service. Due to low middle income of the people and shortage of physicians in
developing countries, pharmacists of B and C grades play an important role in promoting
access to medicines (Wafula et al., 2012). Considering these problems, the government of
Bangladesh has promulgated the National Drug Policy 2016 to introduce Model pharmacy.
53
So that it will ensure a rational and safe use of quality medicines with dispensing and
counselling by ‘A’ grade pharmacists with a reasonable price. The standards of facilities
for Model Pharmacy are, Counseling patients ‘A’ grade pharmacists, standard location,
modern environment, Good Dispensing practice, database systems etc.

The variables selected from the above mentioned literatures for hypothesis development
are
 Availability
 Location of Retail Pharmacies
 Facilities of Model Pharmacies

The hypotheses are given below under convenience issues.

H0: Availability of Medicines has no positive impact on Stakeholders’ Satisfaction.

H1: Availability of Medicines has positive impact on Stakeholders’ Satisfaction.
H0: Location of Pharmacy has no positive impact on Stakeholders’ Satisfaction.
H1: Location of Pharmacy has positive impact on Stakeholders’ Satisfaction.
H0: Facilities of Model Pharmacy have no positive impact on Stakeholders’ Satisfaction.
H1: Facilities of Model Pharmacy have positive impact on Stakeholders’ Satisfaction.

2.5.4 Communication Relationship issues of Promotional Strategies:

Pharmaceutical marketing differs from other forms of marketing. Because, the end user is
not the sole decision maker, nor do they determine the products they will consume. The
end users (Patients) consult their physicians whose duty is to ensure the safe administration
of the medicine. Because of these influence processes, pharmaceutical companies
campaign their products chiefly to physicians and occasionally to the end users (patients)
as well.

Pharmaceutical industries employ Marketing Strategies that are markedly different from
consumer goods that are usually adopted by other industries. There are multiple reasons
for these. First, the Pharmaceutical industry is regulated by government rules and
regulation intensively. Second, they deal with health care and credence goods (i.e.,
physicians prescribe and patients consume them). Finally, manufacturers are bound to

54
obtain approval from the government by law (by FDA in the United States, by DDA in
Bangladesh) before a drug/medicine can be marketed (Carter et al., 2009).

The Pharmaceutical industry disseminates marketing information of the company to its

target market using marketing communications irrespective of the diverse media used. That
is why companies use different marketing strategies and tactics to market their products.
Marketing strategies, additionally, are often used as the source of competitive advantage
as well (Anderson, 2003). The empirical study on Marketing Mix variables such as product,
price, place and promotion showed significant impact on physicians’ satisfaction (Murshid
et al., 2014).

Ang Hoo Bee mentioned that the Selling Skill of Medical Representatives (MR) is the
ability to persuade doctors about the scientific information regarding safety and efficacy of
medicines (Hoo, 2004). They maintain personal relationship that influences doctors to
prescribe a specific brand of medicines in favor of a particular pharmaceutical company.
Physicians often have a hard time sorting out what is of value for their patients amidst this
heap of overwhelming information (Chren, 1994). Medical schools too, do very little to
train physicians to differentiate between marketing and medical education. It is important
to interact with industry representatives either as individuals or in professional groups in
an ethical and responsible manner (Jibson, 2007).

Taneja G conducted empirical research on personal Selling Skill of Medical

Representatives and found regular visit to doctors, medicine detailing through visual aids,
product literatures, free samples that impact on doctors’ prescribing behavior positively
(Taneja, 2008). MC Smith, S.R Chaganti, D. Dimitris and S.S Andaleeb et al. explained
the importance of scientific knowledge of MR regarding medicines, communication skill,
objection handling influence on Doctors’ Satisfaction and Sales performance.
(Smith, 2002; Chaganti ,2005; Dimitris,2002; Andaleeb et al.,2014)

Taneja, Rizwan and Dimitris mentioned that Continuous Medical Education(CME)

programs for doctors sponsored by Pharmaceutical companies for private practitioners,
such as sponsoring national/international conferences regarding medicines that influence
55
doctors to prescribe and increase sales of Pharmaceutical companies (Taneja,2008)
(Rizwan,2014; Dimitris,2002). The researchers conducted empirical research to investigate
the impact of promotional policies or incentives like text book, journals of medicines, free
samples, small gifts with brand name for doctors prescribing behavior and sales (Murshid
et al., 2014; Bee,2014; Sayandhan,2008).

Dogramatzis and Chaganti explained Awareness Campaign for Patients’ education

regarding prevention of disease which is public relation attempts to convey key message
by electronic media and organize seminar involving doctors have found positive influence
on doctors and patients’ satisfaction and sales (Dogramatzis,2002; Chaganti,2005). The
Marketing Mix Strategy is controllable marketing techniques that impact on targeted
market (Kotler et al.,2012). The variables of the Marketing Communication relationship
issues of the present study selected from the above mentioned literatures are:
 Selling Skill of Medical Representatives
 Continual Medical Education for Doctors
 Awareness Campaign to prevent cardiac problems
 Promotional Policies/ incentives

Hypotheses developed from the selected variables are as follows:

H0: Selling Skill of Medical Representative has no positive impact on Stakeholders’
Satisfaction.
H1: Selling Skill of Medical Representative has positive impact on Stakeholders’
Satisfaction.
H0: Continuous Medical Education (CME) program for doctors’ has no positive impact on
Stakeholders’ Satisfaction.
H1: Continuous Medical Education (CME) program for doctors’ has positive impact on
Stakeholders’ Satisfaction.
H0: Awareness Campaign to prevent cardiac disease has no positive impact on
Stakeholders’ Satisfaction.
H1: Awareness Campaign to prevent cardiac disease has positive impact on Stakeholders’
Satisfaction.
H0: Promotional Policies have no positive impact on Stakeholders’ Satisfaction.
H1: Promotional Policies have positive impact on Stakeholders’ Satisfaction.

56
2.6 Conceptual Frame Work and Selected Variables: To develop research Conceptual
Model, the variables of MST were selected from extensive literatures review. Selected
Variables and References are shown in the table 2.3

Table 2.3: Selected Variables and References

Variables Source of References
Physician/Doctors’ satisfaction and sales. Murshid et al.,(2014),Asian Social Science
Efficacy, Quality and Price ,10(16)
Factor analysis of 4Ps Strategies and Murshid et al., (2014), Asian Social Science
physicians satisfaction 10(16),
Relationship between marketing mix strategy Murshid et al., (2014) Advance in
& physicians’ satisfaction Environmental Biology,8(9)
Location of pharmacy Guhl et al., (2016),Health policy, 120
Product attributes and patient needs Puraea, et al., Farmacia, 2009, vol. 57,(3)
Pricing Panteli et al., (2015), Health Research Policy
and System ,13(39)
Impact of promotion mix (communication Girish,(2008), Asia Pacific Business
reaction) on doctors prescribing behavior Review,4(4)
Influence of marketing mix in prescribing by Sayandhan et al.,(2008), Tropical Agricultural
ophthalmologists(Quality, efficacy, brand, Research, 20.
company image, price, availability,
Awareness campaign, Selling Skill of Medical
Representatives, gifts, samples)
Sales and marketing mix strategies Franklin et al., (2009), Journal of Personal
Selling and Sales Management
Marketing Skill development Butter, et al., International Journal of Medical
Marketing,3(1)
Brand image, Safety, Efficacy Bednark et al.,(2005), Neuroendocrinology
letter, 26
New medicine Anthony, Drug Information Journal, 1999,33
Physician perceived value and satisfaction Murshid et al., (2014)Asia Social Science, 10
(16)
Distribution network (Supply chain) Hoque et al., (2012), International Journal
Model Pharmacy Bangladesh New Drug Policy (2016)
Source: Prepared by Researcher

57
Figure 2.5 shows the variables of Marketing Strategies and Techniques selected from
theories which are applied in the conceptual model.

Figure 2.5 Conceptual Model

Product Strategy
Efficacy

Safety
Medicinal issue
Brand image

Reputation

New medicines
medicines......
Price Strategy
Price- Quality
Competitive- Economic issue Factors Sales of
Price impact on prescribed
medicines
Place Strategy Stakeholders’
Satisfaction
Availability
Location Convenience
issue
Facilities Model
Pharmacy

Promotion Strategy
Selling Skill of
Communication
MR
Relationship
CME
issue
Promotion Policy
Awareness
Campaign
Source: Prepared by Researcher

58
 2.6.1 Conceptual Model with hypotheses
Figure 2.6 Conceptual Model including hypotheses

Efficacy Availability

H1 H8 Location
Brand Image
H2 H9 Facility model
Safety Pharmacy
Stakeholders’ H10
IInforma H3
Satisfaction Selling Skill of
New Medicine about MST
H4 H11 MR

Company H12 CME for

H5 Doctors
Reputation
H6 H13
Awareness
Price Quality
campaign
H14
H7
Competitive Sales performance Promotional
Price Policies

2.6.2 Hypotheses related to Medicinal, Economic, Convenience and Communication

issues
Hypotheses: Stakeholders’ Satisfaction is considered as dependent variable. Variables of
Marketing Strategies and Techniques are independent variables.

H0: Efficacy of medicine has no positive impact on Stakeholders’ Satisfaction.

H1: Efficacy of medicine has positive impact on Stakeholders’ Satisfaction.
H0: Brand Image of medicine has no positive impact on Stakeholders’ Satisfaction.
H2: Brand Image of medicine has positive impact on Stakeholders’ Satisfaction.
H0: Safety Information of medicine has no positive impact on Stakeholders’ Satisfaction.
H3: Safety Information of medicine has positive impact on Stakeholders’ Satisfaction.

59
H0: Company Reputation has no positive impact on Stakeholders’ Satisfaction.
H4 Company Reputation has positive impact on Stakeholders’ Satisfaction.
H0: New Medicine has no positive impact on Stakeholders’ Satisfaction.
H5: New Medicine has positive impact on Stakeholders’ Satisfaction.
H0: Price signal Quality has no positive impact on Stakeholders’ Satisfaction.
H6: Price signal Quality has positive impact on Stakeholders’ Satisfaction.
H0: Competitive Pricing has no positive impact on Stakeholders’ Satisfaction.
H7: Competitive Pricing has positive impact on Stakeholders’ Satisfaction.
H0: Availability of Medicines has no positive impact on Stakeholders’ Satisfaction.
H8: Availability of Medicines has positive impact on Stakeholders’ Satisfaction.
H0: Location of Pharmacy has no positive impact on Stakeholders’ Satisfaction.
H9: Location of Pharmacy has positive impact on Stakeholders’ Satisfaction.
H0: Facilities of Model Pharmacy have no positive impact on Stakeholders’ Satisfaction.
H10: Facilities of Model Pharmacy have positive impact on Stakeholders’ Satisfaction.
H0: Selling Skill of Medical Representative has no positive impact on Stakeholders’
Satisfaction.
H11: Selling Skill of Medical Representative has positive impact on stakeholders’
satisfaction.
H0: Continuous Medical Education (CME) program for doctors’ has no positive impact on
Stakeholders’ Satisfaction.
H12: Continuous Medical Education (CME) program for doctors’ has positive impact on
Stakeholders’ Satisfaction.
H0: Awareness Campaign to prevent cardiac disease has no positive impact on
Stakeholders’ Satisfaction.
H13: Awareness Campaign to prevent cardiac disease has positive impact on Stakeholders’
Satisfaction.
H0: Promotional Policies have positive impact on Stakeholders’ Satisfaction.
H14: Promotional Policies have positive impact on Stakeholders’ Satisfaction.

60
2.6.3 Hypotheses related Overall Satisfaction about MST and Stakeholders
H0: There is no significance relationship between Overall Satisfaction about Marketing
Strategies and Techniques and Stakeholders
H1: There is significance relationship between Overall Satisfaction about Marketing
Strategies and Techniques and Stakeholders

2.6.4 Hypotheses related Patients’ Satisfaction about Model Pharmacy newly

introduced Place Strategy (2017)

H0: Location of Model Pharmacy has no positive impact on Patients’ Satisfaction.

H1: Location of Model Pharmacy has positive impact on Patients’ Satisfaction.
H0: Quality of medicine has no positive impact on Patients’ Satisfaction.
H2: Quality of medicine has positive impact on Patients’ Satisfaction
H0: Modern environment of Model Pharmacy has no positive impact on Patients’
Satisfaction.
H3: Modern environment of Model Pharmacy has positive impact on Patients’ Satisfaction
H0: Variety of stock has no positive impact on Patients’ Satisfaction.
H4: Variety of stock has positive impact on Patients’ Satisfaction.
H0: Database system has no positive impact on Patients’ Satisfaction.
H5: Database system has positive impact on Patients’ Satisfaction.
H0: Reasonable price has no positive impact on Patients’ Satisfaction.
H6: Reasonable price has positive impact on Patients’ Satisfaction.
H0: Counseling by ‘A’ grade pharmacists have no positive impact on Patients’ Satisfaction.
H7: Counseling by ‘A’ grade pharmacists have positive impact on Patients’ Satisfaction.

61
 CHAPTER THREE
METHODOLOGY OF THE STUDY

3.1 Research Design

It is an outline and a kind of framework that includes the methods and processes of data
collection and analysis of the research problem. Both exploratory and descriptive research
designs are employed in the current research. Deductive research approach is used in the
present study where the variables of Marketing Strategies and Techniques (MST) were
taken from established theories and literatures. The variables of these established theories
have been tested and accepted as significant variables in previous research work. The
research design of the present study includes the following tasks -
 Information needed for the research
 Design for Exploratory research
 Design for Descriptive research
 Development of Questionnaires for data collection
 Pilot Survey of Pretesting Questionnaires
 Sample size determination from Target Population, Sample element
and Sampling frame
 Sampling techniques of data collection
 Tools for Data analysis

3.1.1 Information needed for the research

Extensive literature review on marketing strategies and tactics in developed and developing
countries as well as secondary data of market analysis have helped to find out the research
gap in the Bangladeshi pharmaceutical market. Therefore, the information needed in this
study includes identification of the relationship between variables of MST and satisfaction
of stakeholders. Moreover, the issues regarding the medicinal, economical, convenience
and communication needed to be thoroughly evaluated. Thus, the impact of medicinal,
economic, convenience and communication issues of MST were defined from extensive
literature reviews and other secondary source of information. Hence, variables of MST that

62
influence the Stakeholders’ Satisfaction and sales need to be analyzed for improvement of
MST of Pharmaceutical companies.

3.1.2 Design for Exploratory Research

Exploratory research was used to provide insight on the research problem to gain additional
information before developing hypotheses. This research process is flexible, unstructured
questions were asked to small a sample of respondents who are non-representative of
population. Analysis of the primary data is qualitative. The findings of exploratory research
are tentative and generally followed by further exploration or are verified and quantified
by descriptive research. The present exploratory research was conducted with 10
cardiologists, 20 cardiac patients, 10 marketing managers and 11 academicians.
Exploratory research in the form of secondary data analysis and in-depth interview were
conducted. Questions were asked to set the variables of MST, understand the perception of
stakeholders and identify the impact of medicinal, economic, convenience and
communication issues of MST on stakeholders’ satisfaction. This was achieved by
interviewing group of experts, managers, cardiologists and long term cardiac medicines
using cardiac patients. Questions were enclosed in Appendix A.

3.1.3 Design for Descriptive Research

The objective of descriptive research design is to test specific hypotheses of the present
study and examine the relationship of variables of MST and stakeholders’ satisfaction. It
is based on large representative sample size of target population which is 536. Data
obtained were subjected to quantitative analysis while the findings were used as input into
managerial decision making. Both analytical and descriptive methods were adopted for the
present research. The information, facts, figures are analyzed and evaluated. In the
descriptive study, well-structured questionnaires were developed out of an extensive
literature review and survey method was used for data collection. Descriptive research
design requires a clear specification of questions such as who, what, when, where, why and
way of research.
 Who should be considered as stakeholders? – Cardiologists, Cardiac Patients and
Marketing Professionals.

63
 What information should be obtained from the respondents? –Information that need to
be evaluated to determine the impact of variables of MST on Stakeholders’ Satisfaction
and Sales.
 When should be the information collected? - During office hours
 Where should be the information collected? – Department of Cardiology both Public
and Private hospitals and Pharmaceutical companies producing cardiac medicines
 Why is the present study conducted? - To improve the Marketing Strategies and
Techniques for satisfaction of doctors and patients, minimize the gap between the
stakeholders’ satisfaction about MST and stakeholders.
 Way to obtain information from respondents by distributing self-explanatory
questionnaires among the respondents by survey method

3.1.4 Development of Questionnaires

The questionnaires contained the demographic information of the respondents, a 5-point
Likert scale and general questions. The contents of demographics information were gender,
age, academic qualification, years of experience dealing with cardiac medicines. Scale
based questionnaires were prepared where respondents need to put tick marks against each
satisfaction statement. This was done to evaluate the impact of Marketing Strategies and
Techniques on Doctors’ satisfaction, Patients’ satisfaction and Marketing Professionals’
satisfaction and sales. Scale was based on 1-5 points where 1-represents strongly disagree,
2- disagree, 3-neither agree nor disagrees or neutral, 4-agree and 5-strongly agree.

The three set questionnaires were developed for the three types of stakeholders such as
Marketing Professionals, Doctors and Patients and distributed among the respective
Stakeholders. The general questions contained open-end, multiple choice questions and
other questions relevant to the research.

3.1.5 Pilot Survey of Pre-Testing Questionnaires

The main objective of pilot survey was to understand whether the set questionnaire was
comprehensive enough or not. Certain parameters of questionnaires were analyzed during
pretesting. These parameters include clarity of questions, relevance of questions to the

64
research topic, appropriateness of variables decided, answering time of entire questionnaire
and attention span of respondents.

During this pilot survey, self-administered questionnaires were distributed among 11

cardiologists, 18 marketing professionals of different pharmaceutical companies and 20
cardiac patients taking treatment from private and public hospitals. A total of 56
satisfaction statements were filtered out according to the responses of respondents of the
pilot survey in order to avoid ambiguity. Among this initially set 56 statements, the
questionnaires for doctors contained 20 satisfaction statements about Marketing Strategies
and Techniques, 20 statements for Marketing Professionals and 16 statements for Patients.
For the final survey, the number of questions were filtered out and reduced down to 38
which were very much relevant to theories, literatures and expert opinions and easy to
understand for the stakeholders.

It was observed during the pilot survey, that respondents seemed to be annoyed to answer
questions that were irrelevant to the stakeholder, sensitive or time consuming. The
structured questionnaires have been distributed among different respondents to gain their
satisfaction, perceptions and demographic characteristics. To study the impact of
Marketing Strategies and Techniques on Stakeholders’ Satisfaction, the Cardiologists,
Cardiac patients and Marketing Professionals of different cardiac hospitals and
pharmaceutical companies were included for data collection in Dhaka city.

SPSS software version 20 was applied to observe the outcomes of the independent variable
or items of statements with the dependent variable of stakeholders’ satisfactions. The
impact of independent variables of Marketing Strategies and Techniques on Overall
Satisfaction of customers (Doctors), consumers (Patients) and sellers (Marketing
Professionals) of F-test was found significant where p value was less than 0.05 by Multiple
Regression analysis. Hence, for the final survey, the total number of statements were
reduced down to 38 (14 for doctors, 13 for marketing professionals and 11 for patients).
Total 1000 questionnaires were distributed in 2018. Out of 1000 only 560 questionnaires
were received back. Out of 560 only 536 responses were complete in all aspects and were
found eligible for analysis.
65
3.1.5.1 Validity and Reliability of the Questionnaires
Validity and Reliability of the data were analyzed to satisfy one aspect of good fit of the
method.
Validity – The degree to which a measurement accurately represents what is supposed to
measure and content of an indicator reflects the intended concept. Scale development for
measurement should produce accurate result for which it is designed (Zikmund, 2003). The
degree of consistency was evaluated by using two different measurement scales to measure
the same concept (Davis and Cosenza,1993). The degree of the scale represents 1= Strongly
Disagree, 2=Disagree, 3= Neither agree nor disagree, 4= Agree and 5=Strongly Agree
which was used for satisfaction statements of the present study. Variables of the statements
were selected from different literatures mentioned in the previous chapter. The validity of
the questionnaires was assessed and proved by literature reviews.

Reliability- A measure is considered reliable when the proper conceptualization of

variables is able to produce consistent results (Cooper and Schindler, 2011). Cronbach’s
alpha of reliability ranging from 0.5 to 0.9, represents that the questionnaire or instrument
is satisfactory and consistent. The questionnaires of the present study were found reliable
as the Cronbach’s alpha within the acceptable limit (0.82) which is provided in appendix
C.

3.1.6. Sample Size Determination from Target Population, Sample Element and
Sampling Frame
The present research is descriptive in nature which is applicable for factor analysis.
Sampling design process includes defining the target population, sample element,
identifying sampling frame, determining sample size and selecting sampling techniques.
Target population is collections of elements that possess the information sought by the
researcher from which inferences are to be made.

Target population consists of three categories of stakeholders who possess the information
sought by the researcher. Hence, inferences are to be made on the basis of the obtained
information. The sample elements are the respondents of the target population. For the
66
present study, doctors (cardiologists), patients (cardiac patients) and marketing
professionals are the sample elements of cardiac market segment and possess the required
information. Sampling frame consists of a list of direction for identifying the target
population. A list of total number of cardiologists was collected from Bangladesh
Cardiologists Association (BCA) and Bangladesh Medical Association (BMA) to find out
the addresses of hospitals and telephone numbers. To collect information from the cardiac
patients, the list of departments of cardiology in both public and private hospitals were
used. The sampling frame for Marketing Professional’s population was selected from
Bangladesh Pharmaceutical Industries Association (BPIA) to conduct the Marketing
Professionals.

Sample Size Determination

The total population consists of three stakeholders (sub-population). Hence total
population (N) is divided into three parts, Mathematically N = N1+N2+N3
Where N1 = Number of Cardiologists
N2 = Number of Marketing Professionals
N3 = Number of Cardiac Patients
From each population; sample size Ni is determined by following conventional formula
with 95% confidence interval and 7% margin of error.
z / 2  P(1  P)
Ni  e2
1
z / 2  P(i  p) i = 1, 2, 3

Nie 2
The following table 3.1 shows the sample size from each stakeholder (sub population) in
Dhaka City of Bangladesh Cardiologists Association (BCA), and Bangladesh
Pharmaceutical Industries Association (BPIA).

67
Table 3.1: Sample Size Determination of Cardiologists, Cardiac Patients and
Marketing Professionals
Stakeholder Population size Estimated Final Source of
(Target Population) sample size sample Information
size
Cardiologists 750 (approx.) 156 156 BCA
Marketing 1,500 (approx.) 174 180 BPIA
professionals
Cardiac patients 30,00,000(approx.) 196 200 Journal
&WHO
Total 30,02,250 526 536
Source: Prepared by Researcher

Cardiologists of 15 hospitals, Marketing Professionals of 18 companies, cardiac patients

of 15 hospitals were the respondents. If the sample size is too large it can give erroneous
result and on the other hand, if that is too small it may fail in consideration of generalizing
the result. The type of research is an important determining factor for calculation of sample
size (Sekaran and Bougie,2010). Sample size between 30 and 500 are considered
appropriate depending on the type of sampling design used and the proposed research
questions (Sekaran, 2003).

In social science, for multivariate analysis, the sample size is to be analyzed is 2:1 of 20:1.
The minimum number can be five respondents per variable, denoted by 5:1 (Byrne 2010).
Here, the ration 5:1 means that the number of respondents is 5 when independent variable
is 1.

3.1.7 Sampling Techniques of Data collection

Target population is divided into sub-groups from mutually exclusive and collectively
exhaustive populations called clusters according to Malhotra (2015). Here the target
population is divided into three groups (stakeholders):
1st group cardiologists (N1 = 750, n1 = 156)
2nd group marketing professionals (N2 = 15000, n2 = 180)

68
3rd cardiac patients (N3 = 3,000,000, n3 = 200)
Cluster Sampling Techniques (2 stages) were used in each group to select final sampling
units. The hospitals, both private and public, have been selected where cardiologists of
cardiac departments were found. Here, cardiac patients are being treated as sampling unit
of those hospitals.

Among all hospitals in Dhaka city, 15 hospitals were selected (proportionate to size) as 1st
stage cluster sampling was carried out at random from the sampling frame (BCA). First
group consists of all cardiologists that were obtained from a representative sample of 156
cardiologists. A random sampling was performed from 15 hospitals in Dhaka city. No
cardiologists were selected from other hospitals. Similarly, from each selected hospital,
200 cardiac patients were selected by two-stage cluster sampling.

Sampling design for 2nd group consists of Marketing Professionals in 18 companies that
holds 82% of the total market share. So, a total of 180 Marketing Professionals had been
selected.

The researchers targeted 536 populations which consists of three sub population:
Marketing Professionals holding 82% of the market share (180), Cardiologists (156) and
Cardiac patients (200). Marketing Professionals were selected by stratified random
sampling from the Bangladesh Pharmaceutical Industry Association (BPIA) producing
cardiac medicines (30+) in Dhaka city at different areas. They were asked to evaluate their
satisfaction about sales distributing the self-administered questionnaires. In the 2nd stage,
the researcher targeted 156 cardiologists and 200 cardiac patients randomly selected from
department of Cardiology both public and private hospitals with the help of Bangladesh
Cardiologist Association (BCA) and Bangladesh Medical Association (BMA) in different
areas of Dhaka city. The samples of research questionnaires are given in the Appendix B.
The researcher selected Cardiologists and Cardiac patients from each participating
hospitals distributing the self-administered questionnaire during office hours. Each
respondent was asked to evaluate their satisfaction about the variables / attributes of
Marketing Strategies and Techniques.

69
3.1.7.1 Sampling Techniques for Doctors (1stgroup)
First group consists of doctors. Approximately thirty hospitals were considered as target
population of clusters. At the 1st stage, 15 hospitals were randomly selected. Then 2 to 30
doctors were randomly selected from each hospital. Thus, the total sample size of doctors
comprises 156 according to proportion to size (Table 3.2).

Table 3.2: List of Hospitals and Sample size of Doctors

Hospital’s name No. of Doctors
NICVDH 30
BSMMU 20
DMCH 25
BIRDEM 25
SHSHCH 15
MIRPUR HEART FOUNDATION 4
UROBANGLA HEART FOUNDATION 4
MOGDDAMCH 4
IBNSINA HOSPITAL 6
ANWARKHAN MEDICAL COLLEGE 4
LABAID HOSPITAL 8
NATIONAL HEART FOUNDATION 5
CMH 5
BANGLADESH MEDICAL COLLEGE 6
CITY HOSPITAL 2
Total number of Doctors 156

Source: Prepared by Researcher

3.1.7.2 Sampling Techniques for Marketing Professionals (2ndgroup):

Second group consists of 30 cardiac medicine producing companies based on market share.
A total of 18 companies out of these 30 were selected as they cover more than 80% market
share (Source: IMS data, 2018). To obtain a representative sample, Marketing
Professionals have been selected by stratified random sampling without replacement, 10
from each company. Theoretically, each company is treated as stratum. So, a total of 180
marketing professionals have been selected by stratified random sampling with equal
allocation which is summarized below in the table 3.3.
70
Table 3.3: List of Pharmaceutical Companies and Sample size of Marketing
Professionals
Sl. no. Company Market share (%) No. Marketing Professionals
1 Healthcare 2.50 10
2 Square 18.0 10
3 General Pharmaceuticals 1.46 10
4 Radiant 0.22 10
5 SKF 1.3 10
6 Unimed 3.18 10
7 Incepta 16.5 10
8 Aristo Pharma 3.87 10
9 Servier 3.03 10
10 Orion 2.04 10
11 Acme 3.74 10
12 Bio Pharma 0.60 10
13 Beacon 0.15 10
14 Beximco 15.07 10
15 Popular 2.21 10
16 Renata 2.04 10
17 Nuvista 0.16 10
18 ACI 5.78 10
180
Total 81.85
Source: Prepared by Researcher

3.1.7.3 Sampling Techniques for Patients(3rdgroup): The hospitals selected for doctors
in the 1st stage group is the same for patients. From each hospital, 13 to 14 patients were
selected randomly. So, a total of 200 patients are selected by random sampling in the
following table 3.4.

71
Table 3.4: Name of Hospitals and sample size of the patients

Name of Hospitals No. of patients

NICVDH 14
BSMMU 14
DMCH 14
BIRDEM 14
SSMCH 13
SHSMCH 13
MIRPURHEART FOUNDATION 13
UROBANGLA HEART FOUNDATION 13
IBNSINA 13
ANWAR KHAN MCH 13
LABAID HOSPITAL 13
NATIONAL HEART 13
CMH 13
BANGLADESH MEDICAL COLLEGE HOSITAT 14
CITY HOSPITAL 13
Total Cardiac Patients 200
Source: Prepared by Researcher

3.1.8 Tools for Data analysis

Statistical tools for data analysis chosen were SPSS software, version 20. Descriptive
analysis, sample t-test, one-way ANOVA, Exploratory Factor Analysis and Regression
Analysis for hypotheses testing were applied for analyzing data received by the survey
method. The purpose of the Factor Analysis is to manage many variables into a few factors
to avoid multi collinearity effect of highly correlated variables. The Factor analysis used
by Murshid et al., (2014) for Physician Satisfaction and Sales was applied for the present
study. Factor Analysis allows us to look at groups of variables that tend to be correlated to
each other and is used to eliminate the multi-collinearity effect of the variable for data
reduction and summarization.

72
The procedures for conducting Factor Analysis (William D N) include problem
formulation, construction of correlation matrix, and determination of factors, exploratory
rotation and interpretation.

73
 CHAPTER FOUR
DATA ANALYSIS AND DISCUSSIONS

4.1 Measurement Model

It is to determine a particular group of variables where related variables fall under specific
construct called as a factor (Anglim, 2007). According to Hair et.al (2011) Exploratory
Factor Analysis helps to show the possible relationship or interdependence association of
variables. In this Exploratory Analysis, researcher do not need to try to confirm relationship
among variables; rather the researcher has tried to explore the relationships. Exploratory
Factor Analysis (EFA) has been used in this study to measure the relationships of variables
of Marketing Strategies and Techniques which affect Stakeholders’ Satisfaction and Sales
in the Pharmaceutical Cardiac Segment. If the factor loading is greater than 0.40 and
component with eigenvalue equal or greater than 1.0 is extracted as factor that can be
treated as significant variable within one factor. The reliability of the test can be considered
from the value of Cronbach’s alpha coefficient. The range of Cronbach’s alpha coefficient
is 0.6 to 0.8 (Hair et.al,1998). This Exploratory Factor Analysis requires correlation or
communalities test, KMO and Bartlett test of Adequacy to prove the goodness of the fit of
the model (Malhotra 2006).

4.2. Impact of Marketing Strategies and Techniques (MST) on Stakeholders’

Satisfaction
Major stakeholders of Pharmaceutical companies are patients, patients’ family, prescribers,
hospitals, clinics, influencers (opinion leaders, pharmacists, wholesalers, nurses, suppliers)
financers, regulators (Ministry of health, Drug Administrator) employees and competitors.
These parties have an interest or stake in the company’s success. From these stakeholders,
three types of stakeholders have been selected for this present research due to time, cost
and man-power limitation. They are Doctors, Patients and Marketing Professionals who
represent the important components of Pharmaceutical Market. A total of 536 respondents
were interviewed in this study; out of them 156 were Doctors, 200 were Patients and 180
were Marketing Professionals who have been simply defined as Stakeholders. They were
asked to opine their satisfactions about several variables of Marketing Strategies and
Techniques of Pharmaceutical companies. Since Stakeholders are completely different and
74
independent in many aspects; they were provided with same items of questions about
Marketing Strategies and Techniques (MST). The three set questionnaires containing
fourteen items were provided to doctors; while 13 items were distributed to Marketing
Professionals and 11 items were given to patients. They were also asked to rate their
overall satisfaction. It is mentioned in method section that all questions (items of
statements) were measured in 5-point Likert scale. The samples of three sets questionnaires
have been given in the appendix B (I, II and III) respectively.

So, to investigate the effect of Marketing Strategies on Overall Satisfaction of Stakeholders

without taking into account of the categorization of stakeholders and to overcome
multicollinearity among variables and identify correlation structure among variables (if
any); Exploratory Factor Analysis had been applied. After extracting factor scores, they
were used as independent variables to see whether there is any significant effect of
Marketing Strategies and Techniques on overall satisfaction or not.

As presented in table 4.2, KMO test for the impact of variables of MST on Overall
Satisfaction of Stakeholders was 0.721. The Bartlett’s test of Sphericity was significant at
Chi-square= 468.709 with p=0.00 which is α<0.05. Thus the Exploratory analysis for
variables of MST indicated suitable to conduct Factor analysis. The Eigen values for each
factor exceeding or equal to one are 3.325, 2.000, 1.329 and 1.177 respectively, that
explained 56% of the total variance in the table 4.5. Factor 1 labeled as Medicinal benefit
accounted for 23.748% of the total variance explained. The variables loaded into the factors
are from 0.621 to 0.805. Factor 2 named as Communication benefit in which variables
loaded range from 0.431 to 0.781. The variables loaded in Factor 3 represented as
convenience benefit range from 0.40 to 0.766. Factor 4 labeled as Economic benefit in
which variables loaded range from 0.780 to 0.876 in the table 4.6. Moreover, the result of
Correlation Matrix of all variables shows in the Table 4.3 significant association within the
variables loaded into the factors. The result of Exploratory Factor Analysis for impact of
MST on Stakeholders’ Satisfaction was very statistically appropriate for this research.
Regression analysis of the factors had been conducted for hypothesis testing. The table 4.8
shows that the most of the variables have significant impact on Stakeholders’ Satisfaction.

75
4.2.1 Descriptive Analysis of the impact of MST on Stakeholders’ Satisfaction
To evaluate the efficacy of MST of cardiac medicine suppliers, 536 stakeholders
participated to express their satisfaction statements on 5 point Likert scale from 1-5 where
1= Strongly Disagree and 5= Strongly Agree
Table 4.1: Mean score of Stakeholders’ Satisfaction about Variables of Marketing
Strategies and Techniques (MST)

Variables of MST Strongly Disagree Somehow Agree Strongly Mean SD

disagree agree agree

Efficacy Count 4 8 69 196 259 4.30 0.81

Row N % (.7) (1.5) (12.9) (36.6) (48.3)

Brand Image Count 13 32 163 189 139 3.76 0.98
Row N % (2.4) (6.0) (30.4) (35.3) (25.9)
Safety information Count 13 39 153 199 132 3.74 0.99
Row N % (2.4) (7.3) (28.5) (37.1) (24.6)
Company reputation Count 4 35 122 215 160 3.92 0.92
Row N % (.7) (6.5) (22.8) (40.1) (29.9)
New cardiac Count 12 77 160 171 116 3.56 1.05
medicines
Row N % (2.2) (14.4) (29.9) (31.9) (21.6)
Price-Quality Count 35 158 157 138 48 3.01 1.08
Row N % (6.5) (29.5) (29.3) (25.7) (9.0)
Competitive pricing Count 6 43 104 155 48 3.55 0.93
Row N % (1.7) (12.1) (29.2) (43.5) (13.5)
Availability Count 8 37 120 216 155 3.88 0.95
Row N % (1.5) (6.9) (22.4) (40.3) (28.9)
Location of Pharmacy Count 10 43 139 169 175 3.85 1.03
Place
Row N % (1.9) (8.0) (25.9) (31.5) (32.6)
Facilities of Model Count 15 63 73 117 68 3.48 1.14
Pharmacy
Row N % (4.5) (18.8) (21.7) (34.8) (20.2)
Selling skill of Medical Count 11 20 68 119 118 3.93 1.04
Representatives
Row N % (3.3) (6.0) (20.2) (35.4) (35.1)
Continuous Medical Count 2 8 47 116 163 4.28 0.84
Education program
Row N % (.6) (2.4) (14.0) (34.5) (48.5)
Awareness campaign Count 52 141 111 140 92 3.15 1.26
Row N % (9.7) (26.3) (20.7) (26.1) (17.2)
Promotional policies Count 5 29 77 120 105 3.87 1.00
Row N % (1.5) (8.6) (22.9) (35.7) (31.3)
Overall satisfaction Count 19 49 189 166 113 3.57 1.03
Row N % (3.5) (9.1) (35.3) (31.0) (21.1)

76
Figure 4.1 Mean Score of Stakeholders’ Satisfaction about variables of Marketing strategies
and Techniques (MST)

300 5.00
4.50
250 4.30 4.28
3.92 3.88 3.85 3.93 4.00
3.76 3.74 3.87
3.56 3.55 3.48 3.573.50
200
3.01 3.15 3.00
150 2.50
2.00
100
1.50
1.00
50
0.50
0 0.00

Srongly disagree Disagree Somehow agree

Agree Strongly agree Mean

Table 4.1 and figure 4.1 shows that 48% stakeholders strongly agreed and 36% agreed
about the efficacy issue, 2% disagreed and 12% were undecided. Mean score of satisfaction
regarding efficacy was 4.30 with standard deviation 0.81 whereas other mean scores of
variables of MST range from 3.01 to 4.28. It is seen that 25% stakeholders strongly agreed
and 35% agreed about the Brand Image of cardiac medicines being an important
consideration for their satisfaction. Only 8% disagreed about the statement. Other 30%
neither agreed nor disagreed. Mean score was 3.76 and SD was 0.98. Among 536
stakeholders 61% answered positively that safety information about the cardiac medicines
supplied by the companies impact on their satisfaction while 10% stated opposite opinion
and 28% were undecided. Mean score of the item was 3.74 with SD 0.99.
77
Company Reputation of cardiac medicine suppliers is an imperative criterion that matters
for satisfaction. About 69% gave assertive answer to the statement, 7% gave negative
opinion. Other 22% was found neutral. Mean score of the item was 3.92 with SD 0.92.
New cardiac medicines impact on satisfaction was more than old medicines. Around 21%
strongly agreed and 31% agreed with the statement. Only16% did not agree and 30% were
undecided. The item has a mean score of 3.56 with a SD of 1.05. Price of cardiac medicines
is a crucial issue for economic consideration of MST as it is for lifelong usage. Stakeholders
(36%) did not agree that they were satisfied with the price of MST, 34% agreed and 30%
were found neither agreed nor disagreed. Mean score was 3.01 with SD 1.08 and indicates
the lower range of satisfaction. Availability of cardiac medicines in retail, model
pharmacies is an important issue for stakeholders as it is life-saving medicines. Almost
69% of stakeholders agreed about the issue; 8% disagreed and 22% was found to be neutral.
Mean Score of the item was 3.88 and SD was 0.95. The Stakeholders of three categories
were asked to express their opinion regarding the location of pharmacy place is imperative
for stakeholders’ satisfaction. Around 64.1% of the stakeholders agreed but 25.9% was
found neutral and only 9.1% disagreed about the issue. The mean score was 3.85 with SD
1.03. Facilities of Model Pharmacy are satisfactory in the context of Bangladesh. The
stakeholders agreed that the impact of facilities of model pharmacy is more satisfactory
than retail pharmacy is 55%; 21.7% of the respondents neither agreed nor disagreed about
the statement and 23% of the stakeholders disagreed. The mean score of the element was
3.48 with SD 1.14.

Selling or Communication Skills of Medical Representatives (MR) play an important role

to create an impact on doctor’s satisfaction to prescribe medicines for sales. A total 70.6%
of stakeholders replied in favor of the statement and 20.2% of the stakeholders neither
agreed nor disagreed about the statement. Only 9.3% of the respondents disagreed. The
mean score was 3.93 with a SD of 1.04 about the statement.

Continuous Medical Education for doctors through seminar, conference is a crucial factor
that impacts on doctors’ satisfaction to prescribe medicines for a particular pharmaceutical
company. Almost 83% of the stakeholders agreed to the statement; 14% of them were
found neutral and 3% disagreed about the statement. The mean score and SD were 4.28
and 0.84 respectively.
78
An Awareness Campaign to prevent cardiac diseases by the Pharmaceutical companies is
satisfactory. The stakeholders agreed with the statement is 43%; 36% disagreed and 20.7%
was found neither agreed nor disagreed. Mean score was 3.15 which represent lower range
of the satisfaction means scores.

Promotional Policies include incentives like free samples, gift items for doctors which are
very effective tools to motivate doctors for reminding the medicines of the particular
company to prescribe. Around 66% of the stakeholders agreed, 10.1% disagreed and
22.9% were found neither agreed nor disagreed. The mean score and SD were 3.87 and
1.00 respectively. Figure 4.1 shows the mean scores of Overall Satisfaction of Stakeholders
about Marketing Strategies and Techniques (MST) is 3.57.

4.2.2 Sample Adequacy (Stakeholders’ Satisfaction)

Table 4.2 shows the sample is adequate as KMO value is more than 0.60 and significant value of
Bartlett’s test of Sphericity is good enough that indicate sample of the study can be carried on for
factor analysis.

Table 4.2 : KMO and Bartlett's Test

Kaiser-Meyer-Olkin Measure of Sampling Adequacy. 0.721
Approx. Chi-Square 468.709
Bartlett's Test of Sphericity df 91
Sig. 0.000
Source: Prepared by Researcher

4.2.3 Correlation Matrix (Stakeholders’ Satisfaction)

Table 4.3 of Correlation matrix shows the inter correlation among the independent
variables of MST such as Efficacy, Brand Image, Safety Information, Company
Reputation, New Cardiac Medicine, Price-Quality, Competitive Price, Place of Location,
Facility of Model Pharmacy, Continuous Medical Education for doctors, Awareness
Campaign and Promotional Policies with dependent variable Stakeholders’ Satisfaction.

79
 Table 4.3 Correlation Matrix (Stakeholders’ Satisfaction)
EF BI SF CR NM PR AF AV PL FM SSM CME AWC PP
R

Efficacy 1 .140** .382** .182** -.012 .311** .175** .294** -.119** .014 -.009 .201** .375** .074
Brand .140** 1 .189** .307** .157** .113** .190** .118** .308** .268** .314* .283** .075 .165
* **

Safety .382** .189** 1 .141** -.009 .355** .208** .372** -.016 .154** .078 .224** .422** .076
Company .182** .307** .141** 1 .067 .241** .206** .267** .125** .022 .326* .296** .135** .149
* **
reputation
New -.012 .157** -.009 .067 1 -.025 .177** .070 .314** .191** .246* .113* -.106* .305
* **
cardiac
medicines
Price- .311** .113** .355** .241** -.025 1 .271** .363** -.106* .324** .278* .245** .557** .066
*
quality
Competitive .175** .190** .208** .206** .177** .271** 1 .743** .217** .218** .397* .306** .149** .238
* **
price
Availability .294** .118** .372** .267** .070 .363** .743** 1 .064 .003 .348* .332** .342** .167
* **

Place - .308** -.016 .125** .314** -.106* .217** .064 1 .363** .246* .204** -.194** .100
.119** *

Facilities of .014 .268** .154** .022 .191** .324** .218** .003 .363** 1 -.003 .167** .287** -
Model .098
Pharmacy
Selling skill -.009 .314** .078 .326** .246** .278** .397** .348** .246** -.003 1 .362** .298** .380
**
of Medical
Representat
ives
Continuous .201** .283** .224** .296** .113* .245** .306** .332** .204** .167** .362* 1 .425** .141
* **
Medical
Education
program
Awareness .375** .075 .422** .135** -.106* .557** .149** .342** -.194** .287** .298* .425** 1 .205
* **
campaign
Promotiona .074 .165** .076 .149** .305** .066 .238** .167** .100 -.098 .380* .141** .205** 1
*
l policies
**. Correlation is significant at the 0.01 level (2-tailed).

*. Correlation is significant at the 0.05 level (2-tailed).

Source: Prepared by Researcher

4.2.4 Communalities (Stakeholders’ Satisfaction)

Communalities define the estimation of shared variance of the variables. The variance in a
variable is explained by the extracted factors. For each variable the value of the
communality is expected to be more than 0.40. It has been shown in the table 4.4 of
Communalities (Stakeholders’ Satisfaction).

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Table 4.4: Communalities (Stakeholders’ Satisfaction)
Independent Variables Initial Extraction
Efficacy 1.000 0.409
Brand Image 1.000 0.473
Safety Information 1.000 0.468
Company reputation 1.000 0.420
New Cardiac medicines 1.000 0.412
Price-Quality 1.000 0.573
Competitive Price 1.000 0.803
Availability 1.000 0.807
Location of Pharmacy 1.000 0.650
Facilities of Model pharmacy 1.000 0.698
Selling Skill of Medical Representatives 1.000 0.636
Continuous Medical Education program 1.000 0.407
Awareness Campaign 1.000 0.672
Promotional Policies 1.000 0.561
Source: Prepared by Researcher

4.2.5 Factor Extraction (Stakeholders’ Satisfaction)

Factor extraction is defined as a cluster of grouping of variables in distinctive factor. Eigen
value is used as the most common criteria in order to choose the appropriate number of
factors. Eigen value or latent root value 1 or greater determines the expected number of
factors in the study (Malhotra, 2010). After running the factor analysis, the final table has
been shown below where total four factors are extracted. About 56% of variance is
explained with the help of the extracted factors from the dataset in the table 4.5.

81
 Table 4.5: Extracted Communalities from Extraction Method by Principal
Component Analysis (Total Variance Explained)

Component Initial Eigenvalues Extraction Sums of Squared Rotation Sums of Squared Loadings
Loadings

Total % of Cumulative % Total % of Cumulative Total % of Variance Cumulative

Variance Variance % %

1 3.325 23.748 23.748 3.325 23.748 23.748 2.573 18.379 18.379

2 2.000 14.284 38.032 2.000 14.284 38.032 1.910 13.645 32.023
3 1.329 9.491 47.523 1.329 9.491 47.523 1.751 12.509 44.532

4 1.177 8.410 55.934 1.177 8.410 55.934 1.596 11.401

56.000
Source: Prepared by Researcher ( Extraction Method: Principal Component Analysis.)

Scree Plot of Eigen value and Component numbers (14 Variables) in the figure 4.2 depicts
that factors one, two, three and four have Eigen values equal and more than one and
extracted 56% variance can be explained by the F1, F2, F3, and F4.

Figure 4.2: Scree Plot of Eigen value and Component numbers (14 Variables)

Most of authors (Like Hair et al.) suggest a factor would be considered as important if
Eigen value is greater than 1. From Table 4.5 it is seen that, first two components have
Eigen values greater than 1 (3.325and 2.000 respectively); but they both explain only

82
38.032% variation of the 14 variables/items. Since the third and fourth components’ Eigen
value is 1.329 and 1.177 respectively. These factors explained variation to 56% along with
first two components.14 Items of satisfaction statements were evaluated by 536
stakeholders including Cardiologists, Cardiac patients of 15 different Hospitals and
Marketing Professionals of 18 Pharmaceutical companies producing cardiac medicines.

According to Factor analysis, Awareness Campaign (AWC13), Price signal Quality (PQ6),
Safety Information (SI3), and Efficacy (EF1) are highly correlated variables grouped into
Factor1. The Factor1 was defined as ‘Medicinal benefit’. The relative important variable
is Awareness Campaign helps to prevent the occurrence of diseases. So, preventive
measures are better than sufferings from the cardiac problem. Price signals the quality of
the cardiac drug. Since cardiac medicines are lifesaving drugs, patients tend to overlook
the price in favor of its quality. Price and Quality of the cardiac medicines has got second
priority item by the evaluation of the stakeholders. Price-Quality relationship is an
important economic consideration that needs to be considered while prescribing and selling
the medicines to the end-users, patients.

Safety Information about the cardiac medicines should be supplied by the companies in the
form of leaflets as it has been considered an important variable in Factor 1. Success of
disease management depends on efficacy of cardiac medicines which was also loaded in
Factor 1. If the medicines do not perform properly to reduce cardiac problem, patient’s
complaints can influence doctors to select alternative medicines of other companies. Factor
1 was labeled as ‘Medicinal benefit’. The variables that are highly correlated have loaded
in Factor 2 are Selling Skill of Medical Representatives (SSMR11), Promotional Policies
(PP14), Continuous Medical Education (CME12) and Company Reputation (CR7).

As cardiac medicines are lifesaving medicines, items of F2 impact on the prescribing

decision of the doctors. Factor 3 labeled as ‘Convenience benefit’ containing four variables
such as Facilities of Model Pharmacy (FMP10), Location of Pharmacy(LP9), Brand
Image(BI2) and New medicines(NM5). Factor 4 labeled as ‘Economic benefit’ which
includes satisfaction of the cardiac patients depends on Availability (AV8) of prescribed
medicines in the retail, model and hospital pharmacies. Interaction and relation of end-
users and medicines suppliers occur on the basis of availability of particular prescribed

83
medicines. The patients purchase medicines for the benefit to get rid of cardiac problem
within a Competitive Price (CP7). Unless they feel the effectiveness of the medicine for
the purpose of its use and the utility of their money, they complain to the doctors about the
outcome of the medicines. The doctors look for other alternatives of the competitors’
products.

4.2.6 Rotated Component Matrix (Stakeholders’ Satisfaction)

The table 4.6 of Rotated Component Matrix shows the meaningful factor rotation in the
matrix. To avoid the cross loading less than 0.40 must be suppressed (Sekran1994). As
each factor needs to be unique and distinct after running of factor analysis the Rotated
Matrix shows the ultimate demonstration of independent variables associated to respective
factors. Some of the variables excluded because of cross loading. Based on the theories
and literatures the final factors are named as Medicinal, Economic, Convenience and
Communication Relationship Benefits.

Table4.6 Rotated Component Matrix( Stakeholders’ Satisfaction)

Factor Name Component variables Factor loading on rotated component
of statement matrix
Medicinal Benefit 1 2 3 4
AWC13 Awareness campaign 0.805
PQ6 Price-quality 0.736
SI3 Safety Information 0.648
EF1 Efficacy 0.621
Communication
Relationship Benefit
SSMR11 Selling Skill of 0.781
Medical
Representatives
PP14 Promotional policies 0.735
CME9 Continuous Medical 0.476
Education
CP7 Company Reputation 0.431
Convenience Benefit
FMP10 Facilities of Model 0.766
Pharmacy
LP9 Location of Pharmacy 0.701
BI2 Brand Image 0.573
NM5 New medicine 0.393
Economic Benefit
CP7 Competitive Price 0.876
AV8 Availability 0.780
Source: Prepared by Researcher

84
Research Hypotheses (Stakeholders’ Satisfaction)
H1: Efficacy of medicine has positive impact on Stakeholders’ Satisfaction.
H2: Brand image of medicine has positive impact on Stakeholders’ Satisfaction.
H3: Safety information of medicine has positive impact on Stakeholders’ Satisfaction.
H4 Company reputation has positive impact on Stakeholders’ Satisfaction.
H5: New medicine has positive impact on Stakeholders’ Satisfaction.
H6: Price signal quality has positive impact on Stakeholders’ Satisfaction.
H7: Competitive pricing has positive impact on Stakeholders’ Satisfaction.
H8: Availability of medicines has positive impact on Stakeholders’ Satisfaction.
H9: Location of Pharmacy Place has positive impact on Stakeholders’ Satisfaction.
H10: Facilities of Model Pharmacy have positive impact on Stakeholders’ Satisfaction.
H11: Selling Skill of Medical Representative has positive impact on Stakeholders’
Satisfaction.
H12: Continuous Medical Education (CME) program for doctors’ has positive impact on
Stakeholders’ Satisfaction.
H13: Awareness Campaign to prevent cardiac disease has positive impact on Stakeholders’
Satisfaction.
H14: Promotional Policies have positive impact on Stakeholders’ Satisfaction.

4.2.7 Test of Hypothesis (Stakeholders’ Satisfaction)

To investigate whether the variables of MST have significant impact on overall
satisfaction. Factor scores are used as independent variables in regression analysis.
Summary of regression analysis is shown in table 4.7.
Table: 4.7 Summary of Regression analysis (Stakeholders’ Satisfaction)

R 0.643

R Square 0.414

Adjusted R square 0.410

F statistic (df1,df2) 93.804

Sig 0.000
(Dependent Variable: Overall satisfaction, Predictors: (constant) Factor 4, Factor 3, Factor 2, Factor 1)
Source: Prepared by Researcher

85
Table 4.8: Coefficients of Factors (Stakeholders’ Satisfaction)

Coefficients
Model Unstandardized Coefficients Standardized t Sig.
Coefficients
Beta Std. Error Beta
(Constant) 3.569 0.034 104.237 0.000
Factor 1 0.567 0.034 0.549 16.541 0.000
Factor 2 0.268 0.034 0.260 7.820 0.000
Factor 3 0.058 0.034 0.057 1.702 0.089
Factor 4 0.210 0.034 0.204 6.130 0.000
a. Dependent Variable: Overall satisfaction
Source: Prepared by Researcher

4.2.8 Relationship of Independent variables of MST with Dependent Variable

Stakeholders’ Satisfaction
The table 4.7 it is seen that overall impact of 4 factors is significant (Fd f1, df2= 93.84,
p=0.000) and Coefficient table 4.8 indicates that factor 1 and 2 have significant effect on
overall satisfaction. Hence, Awareness Campaigns, Price signal Quality, Safety and
Efficacy of F1 have significant effect on Overall Satisfaction of Stakeholders with Beta
coefficient 0.567 and p value 0.000. Similarly, the variables loaded factor 2 named
Communication Relationship benefit have Beta coefficient 0.268 and p value 0.000. The
variables Facilities of Model Pharmacy, Location of Pharmacy Place, Brand Image and
New cardiac medicines loaded factor 3 named Convenience benefit have no significant
impact on overall satisfaction of stakeholders where Beta coefficient is 0.058 and p value
0.089. Factor 4 named as Economic Benefit includes competitive price and availability and
have significant effect on Stakeholders’ Satisfaction with Beta coefficient 0.210 and p
value 0.000. The summary of the variables of factors that impact on Stakeholders’
Satisfaction was given in the table 4.9.

86
Table 4.9. Summary of Results of Research Hypothesis: Impact of Marketing
Strategies and Techniques on Stakeholders’ Satisfaction
S1 Research Hypotheses P Result
value
H1 Efficacy of cardiac medicine has impact on Stakeholders’ 0.000 Accepted
Satisfaction
H2 Brand Image of cardiac medicine has insignificant impact 0.089 Rejected
on Stakeholders’ Satisfaction
H3 Safety Information of cardiac medicine has significant 0.000 Accepted
impact on Stakeholders’ Satisfaction
H4 Company Reputation has significant impact on 0.000 Accepted
Stakeholders’ Satisfaction
H5 New Cardiac Medicine has no significant impact on 0.089 Rejected
Stakeholders’ Satisfaction
H6 Price signal Quality of cardiac Medicine has positive impact 0.000 Accepted
on Stakeholders’ Satisfaction
H7 Competitive Pricing has significant impact on Stakeholders’ 0.000 Accepted
Satisfaction
H8 Availability of cardiac medicine has positive impact on 0.000 Accepted
Stakeholders’ Satisfaction
H9 Location of Retail Pharmacy has no significant impact on 0.089 Rejected
Stakeholders’ Satisfaction
H10 Facilities of Model Pharmacy has no significant impact on 0.089 Rejected
Stakeholders’ Satisfaction
H11 Selling Skill of Medical Representatives has significant 0.000 Accepted
impact on Stakeholders’ Satisfaction
H12 Continuous Medical Education(CME) program for doctors 0.000 Accepted
have significant impact on Stakeholders’ Satisfaction
H13 Awareness Campaign to prevent cardiac disease has 0.000 Accepted
positive impact on Stakeholders’ Satisfaction
H14 Promotional Policies( incentives )have significant impact on 0.000 Accepted
Stakeholders’ Satisfaction.
Source: Prepared by Researcher

The Normal P-P plot of Regression standardized Residual, Scatter plot and Reliability of
data set are given in the appendix C

4.3 Impact of Marketing Strategies and Techniques on Overall Satisfaction of

individual Stakeholder:
The motivation to conduct Regression Analysis for 3 stakeholders separately is due to the
fact that the three stakeholders are completely different from each other and hence, it is
demanded to explore the impact of Marketing Strategies and Techniques on overall
satisfaction of each stakeholder separately. Thereby, the impacts of Marketing Strategies
and Techniques on overall satisfaction of doctors to prescribe, patients to consume and
87
Marketing Professionals to sell the medicines are evaluated. In the upcoming section, it
has been attempted to investigate whether the impact of Marketing Strategies and
Techniques on overall satisfaction differ among stakeholders or not.

4.3.1 Descriptive Analysis: Impact of Marketing Strategies and Techniques on

Doctors’ Satisfaction to prescribe
Doctors (cardiologists) are the direct customers of health care who provide treatment to the
patients (cardiac patients) who are the consumers but not decision makers like consumer
goods. Doctors are the decision makers who prescribe medicine for the patients according
to their medical knowledge and follow some cost-benefit logic for the patients.
Pharmaceutical companies are the suppliers of different categories of therapeutic
medicines and communicate to the various categories of doctors according to their
professional academic rank such as lecturers, assistant professors, associate professors and
professors of hospitals for prescribing. In this research, cardiologists of different academic
positions in cardiac departments and hospitals have participated to express their opinion
about the importance of relative factors that impact their satisfaction to prescribe cardiac
medicines for the patients. The doctors involved in the medical service ranks of consultants,
registrars and directors also participated in the survey. The opinion leaders are the
professors or leaders of Medical Association who have long years of experience on
successful practice act as influencers for the junior doctors. They are the main target
customers for the marketing managers. Pyramid of influencers are the opinion leaders, head
of department, director of hospital specialists and general practitioners. The stakeholders
of pharmaceutical companies are many. Three types of stakeholders have been selected
for the study. They are doctors (cardiologists), patients (cardiac patients) and Marketing
professionals of pharmaceutical companies. The managers formulate the strategies and
techniques to create an impact on customers (doctors and patients) satisfaction to sell the
cardiac medicines in order to compete with competitors and increase sales. The customer’s
preference depends on the benefits of medicinal, economic, convenience and
communicational relationship. The key issues are the variables of the factors that affect
customers’ satisfaction. In the pharmaceutical industry, doctors are the direct customers
and the indirect end users are the patients. The literatures and theories of doctors’
satisfaction have been discussed in this study. The table 4.10 and figure 4.3 show

88
descriptive analysis of Impact of Marketing Strategies and Techniques on Doctors’
Satisfaction.
Table 4.10: Descriptive Analysis: Impact of Marketing Strategies and Techniques
on Doctors’ Satisfaction
Variables of MST Strongly Disagree Somewhat Agree Strongly Mean SD
disagree agree agree
Efficacy 1 0 10 43 102 4.57 .673

(.64) (.00) (6.41) (27.56) (65.38)

Brand Image 8 6 34 52 56 3.91 1.092
(5.13) (3.85) (21.79) (33.33) (35.90)
Safety Information 2 1 33 60 60 4.12 .853
(1.28) (.64) (21.15) (38.46) (38.46)
Company Reputation 2 14 25 70 45 3.91 .960
(1.28) (8.97) (16.03) (44.87) (28.85)
New cardiac medicines 8 26 51 43 28 3.37 1.113
(5.13) (16.67) (32.69) (27.56) (17.95)
Price- Quality 1 21 44 66 24 3.58 .930
(.64) (13.46) (28.21) (42.31) (15.38)
Competitive Pricing 3 15 35 80 23 3.67 .910
(1.92) (9.62) (22.44) (51.28) (14.74)
Availability 4 6 23 68 55 4.05 .942
(2.56) (3.85) (14.74) (43.59) (35.26)
Location of Pharmacy 3 6 56 63 28 3.69 .878
Place
(1.92) (3.85) (35.90) (40.38) (17.95)
Facilities of Model 1 8 17 76 54 4.12 .842
Pharmacy
(.64) (5.13) (10.90) (48.72) (34.62)
Selling skill of Medical 9 14 41 43 49 3.70 1.172
Representatives
(5.77) (8.97) (26.28) (27.56) (31.41)
Continuous Medical 1 5 19 54 77 4.29 .850
Education program

(.64) (3.21) (12.18) (34.62) (49.36)

Awareness Campaign 2 11 23 70 50 3.99 .933
(1.28) (7.05) (14.74) (44.87) (32.05)
Promotional policies 4 25 49 34 44 3.57 1.137
(2.56) (16.03) (31.41) (21.79) (28.21)
Overall satisfaction 2 11 40 52 51 3.89 .987
(1.28) (7.05) (25.64) (33.33) (32.69)
Source: Prepared by Researcher

89
 Figure 4.3: Mean Scores of Doctors' satisfaction about the variables of
Marketing Strategies and Techniques
Srongly
120 5.00 disagree
4.57 4.50 Disagree
100 4.12 4.29
4.05 4.12 3.99 4.00
3.91 3.91 3.89
3.58 3.67 3.69 3.70 3.57 Somehow
80 3.37 3.50
agree
3.00
Agree
60 2.50
2.00 Strongly
40 1.50 agree
20 1.00 Mean
0.50
0 0.00

Marketing managers attempt to create a demand for their cardiac medicine by directly
influencing intermediary customers (doctors) to generate prescription for cardiac medicine.
So, a combination of push and pull strategies are effective for prescription of cardiac
medicines. Doctors are valuable stakeholders and customers who prescribe cardiac drugs
for cardiac patients. Perception of doctors towards the Marketing Strategies and
Techniques need to be considered by the cardiac medicine suppliers. In this study, 156
cardiologists were requested to evaluate the attributes of marketing strategies. Table 4.10
shows that 93% doctors agreed that efficacy and quality are important for their satisfaction
to prescribe the medicines, 6% did not agree about it. 1% was found neutral (Mean
score=4.57). About 69% of doctors answered that brand name matters more than generic
name of the cardiac medicines and 22% gave no decision, 9% disagreed (Mean
score=3.91). Doctors opined that company reputation influences them to prescribe cardiac
medicines were 77% where as 21% were neutral and 2% disagreed (Mean score=3.91).
About 46% doctors agreed that newer medicines sell more than older drugs, 21% disagreed
in this statement and 23% were neutral (Mean score=3.37). Almost 58% cardiologists
agreed that price is reflected to quality ;14% of them disagreed and 28% were undecided
90
(Mean score=3.58). The physicians agreed that they consider the competitive price of
cardiac medicines while prescribing is 65% (Mean score=3.67). Around 79% cardiologist
thought availability of medicine is very important and 6% disagreed (Mean score=4.05).
Among them 59% agreed that Location of retail pharmacy (Mean score=3.69) that make
availability of cardiac medicines every places of Dhaka City is important for the doctors to
prescribe the medicines. The percent of physicians neither agreed nor disagreed totaled
36%. For evaluating communication strategies, 58% of cardiologists agreed that
knowledge and Selling Skill of Medical Representatives influence prescribing decision
(Mean score=3.70). Most of the doctors (83%) expressed their satisfaction about the newly
introduced concept of Model pharmacy and to them its facility is important for prescribing
cardiac medicine. While 6% of them disagreed and others were found neutral (Mean
score=4.12). Continuous Medical Education for doctors through seminar and conference
has impact on prescription of cardiac medicine suppliers, agreed by 84% doctors (Mean
score=4.29). About 77% doctors agreed that the Awareness Campaign for cardiac patient
is very crucial to prevent the cardiac problem, 15% were undecided (Mean score=3.99).
Only 50% of cardiologists agreed that Promotional Policies influence them to prescribe
medicines, 31% physicians were neutral in this regard (Mean score=3.57). Mean Score of
overall satisfaction about the variables of Marketing Strategies and Techniques was 3.89
which indicates the doctors are moderately satisfied.

4.3.2 Sample Adequacy (Doctors’ Satisfaction)

Table 4.11 KMO value is 0.821 more than 0.60 and significant value of Bartlett’s test of
sphericity is good enough. All these indicate the study can carry on Factor analysis.

Table 4.11 KMO and Bartlett’s Test (Doctors’ Satisfaction)

KMO and Bartlett’s Test
Kaiser-Meyer-Olkin Measure of Sampling 0.821

Approximate chi-Square 570.685

df 91
Sig 0.000
Source: Prepared by Researcher

91
 4.3.3 Correlation Matrix (Doctors’ satisfaction)
Perception about Marketing Strategies and Techniques was undertaken to determine the
factors underlying satisfaction statements. A set of 14 variables which are the items
measuring the doctors’ satisfaction were constructed. Doctors (Cardiologists) of different
ranks were asked to express their degree of agreement with the 14 items on a 5-point Likert
scales. The data was collected by distributing self-administered questionnaires to doctors
of cardiology departments in different hospitals in Dhaka city. A total of 156 questionnaires
containing responses about satisfaction statement were obtained.

Table 4.12 Correlation Matrix (Doctors’ satisfaction).

EF BR SF CR NM PR CP AV PL FM SMR CME AW PP

Efficacy 1 .211** .193* -.010 .150 .156 -.083 -.046 .000 .179* -.116 .150 .150 .069
Brand .211** 1 .247** .300** .293** .357** .412** .274** .388** .250** .483** .271** .215** .338**
Safety .193* .247** 1 .195* .313** .211** .093 .281** .232** .169* .076 .165* .058 .094
Company -.010 .300** .195* 1 .103 .392** .469** .440** .250** .268** .377** .332** .187* .195*
reputation
New cardiac .150 .293** .313** .103 1 .198* .233** .154 .309** .237** .327** .113 .176* .461**
medicines

Price .156 .357** .211** .392** .198* 1 .326** .378** .305** .342** .387** .365** .309** .190*
Competitors’ -.083 .412** .093 .469** .233** .326** 1 .419** .339** .218** .397** .306** .157 .238**
Pricing
Availability -.046 .274** .281** .440** .154 .378** .419** 1 .324** .245** .312** .352** .176* .105
Place .000 .388** .232** .250** .309** .305** .339** .324** 1 .285** .490** .286** .155 .271**
Facilities of .179* .250** .169* .268** .237** .342** .218** .245** .285** 1 .232** .359** .354** .173*
Model
Pharmacy
Selling skill -.116 .483** .076 .377** .327** .387** .397** .312** .490** .232** 1 .295** .340** .435**
of Medical
Representati
ves
Continuous .150 .271** .165* .332** .113 .365** .306** .352** .286** .359** .295** 1 .433** .116
Medical
Education
Program
Awareness .150 .215** .058 .187* .176* .309** .157 .176* .155 .354** .340** .433** 1 .326**
campaign
Promotional .069 .338** .094 .195* .461** .190* .238** .105 .271** .173* .435** .116 .326** 1
policies
**. Correlation is significant at the 0.01 level (2-tailed).
*. Correlation is significant at the 0.05 level (2-tailed).

Source: Prepared by Researcher

To explore the response, patterns between items and dimension of satisfaction statements
were reduced to a manageable number of variables for analysis. Principal Component
Factor Analysis with Varimax Rotation was applied. Four factors have been extracted with
Eigen value greater than 1 and equal to 1. Variables with higher loading were loaded on

92
respective factors. The table 4.12 shows the interdependent of independent 14 variables of
MST and dependent variable Doctors’ satisfaction

4.3.4 Communalities (Doctors’ Satisfaction)

The variance in a variable is explained by the extracted factors. For each variable the value
of the communality is expected to be more than 0.40. It has been shown in table 4.13 of
Communalities.
Table 4.13: Communalities (Doctors’ Satisfaction)
Initial Extraction
Efficacy 1.000 0.668
Brand 1.000 0.488
Safety 1.000 0.699
Company reputation
1.000 0.552
New cardiac medicines
1.000 0.655
Price 1.000 0.489
Competitors’ pricing
1.000 0.563
Availability 1.000 0.609
Place 1.000 0.465
Facilities of Model Pharmacy
1.000 0.463
Selling skill of Medical
Representatives 1.000 0.701
Continuous Medical Education
1.000 0.605
program
Awareness campaign
1.000 0.705
Promotional policies 1.000 0.687
Extraction Method: Principal Component Analysis.

4.3.5 Factor Extraction by Principal Component Analysis

Table 4.14 indicates that 4 factors with Eigen values greater than 1 explain 59.64
%variation of the total14 variables. The communalities of present data set are perfect
enough to go for further analysis according to the table 4.13 as all the variables are greater
than 0.40. The principal components method using Varimax Rotation reduced the 14
explanatory variables into 4 factors having Eigen values greater than 1.0. It has been shown
in figure 4.4.
93
 For the purpose of interpretation, each factor was composed of variables that loaded 0.40
or higher on that factor. Factor analysis helps reducing the number of total items and selects
the relevant ones under the specific factors. It measures the interrelationships among the
variables. On the contrary, a few assumptions and preconditions are supposed to confirm
the fitness of data for applying the analysis. The objective of factor analysis is to find the
appropriate variables of the specific factors included in MST.

Table 4.14: Extracted Communalities from Extraction Method by Principal Component Analysis
Total Variance Explained (Doctors’ satisfaction)

Extraction Sums of Squared Rotation Sums of Squared

Initial Eigenvalues Loadings Loadings
% of Cumulative % of Cumulative % of Cumulative
Component Total Variance % Total Variance % Total Variance %
1 4.428 31.630 31.630 4.428 31.630 31.630 2.703 19.310 19.310
2 1.427 10.196 41.826 1.427 10.196 41.826 2.271 16.219 35.528
3 1.334 9.532 51.358 1.334 9.532 51.358 1.995 14.248 49.777
4 1.160 8.283 59.641 1.160 8.283 59.641 1.381 9.864 59.641(60)
Source: Prepared by Researcher (Extraction Method: Principal Component Analysis)

4.3.6 Rotated Component Matrix (Doctors’ Satisfaction)

Table 4.15 implies that the items of satisfaction statements AV8, CR4, CP7, and PQ6 are
related to Factor 1. These items actually indicate medicinal economic consideration of the
doctors while prescribing the medicines. So, Factor 1 was defined as Economic -Medicinal
benefit.
Availability, Company Reputation, Competitive Price and Price-Quality relationship have
attracted doctors’ preference for the economic consideration of the patients’ affordability.
Company Reputation plays an important role in their prescribing decision and satisfaction.
Competitive price for the cardiac patients to purchase cardiac medicines have an impact on
doctors’ satisfaction. Another variable loaded in Factor1 Price signal the Quality of
medicines. Marketing Professionals of Pharmaceutical companies who formulate the

94
Marketing Strategies and Techniques need to consider the variables as the most important
items for selling medicines.

Factor 2 labeled as Medicinal- Communication relation benefit consists of items PP14,

NC5, SSMR11, BI2 and LP9. Factor 3 is labeled as Communication benefit and contains
variables AC13, CME12, FM10. Medicinal benefit tagged as Factor 4 comprises of SI3
and EF1.

Figure 4.4 Scree plot of Eigenvalue and variable components (Doctors)

Scree plot
5.00
4.50
4.00
3.50
Eigen Value

3.00
2.50
2.00
1.50
1.00
0.50
0.00
1 2 3 4 5 6 7 8 9 10 11 12 13 14
Comonent number

Factor 3 was interpreted as communication benefit in the sense that it deals with the items
such as AWC13, CME9, and FMP10 that influences doctors to prescribe medicine.
Awareness Campaigns to prevent cardiac diseases for patients and the public, Continuous
Medical Education about new and existing medicine for doctors and Facilities of newly
introduced Model Pharmacy for ensuring the quality of the medicines are the crucial
variables for the doctors that impact on their satisfaction to prescribe the medicines.

95
Table 4.15: Rotated Factor Matrix (Doctors’ Satisfaction)
Factor Name Component variables of Factor loading on rotated component
statement matrix (components)
Economic- 1 2 3 4
medicinal Benefit
AV 8 Availability 0.754
CR 4 Company Reputation 0.708
CP 7 Competitive Price 0.683
PQ 6 Price signal Quality 0.483
Medicinal-
communication
Benefit
PP14 Promotional Policies 0.806
NC5 New Cardiac Medicines 0.726
SSMR 11 Selling Skill Of MR 0.628
BI 2 Brand Image 0.505
LP 9 Location of Pharmacy 0.480
Communication
Benefit
AWC 13 Awareness Campaign 0.786
CME 9 Continuous Medical 0.664
Education
FMP 10 Facilities 0f Model 0.599
Pharmacy
Medicinal Benefit
S13 Safety information 0.770
NM5 Efficacy 0.643
Source: Prepared by Researcher

Factor 4 was presented as Medicinal benefit that includes the items SI13 and NM5. The
safety of medicines is an imperative issue and has a very important impact on doctors’
decision-making process while prescribing. The safety information of the medicine and
new medicines in the market attract doctors for the trial of new medicines. So, the items
loaded in factor 4 have been considered as ‘Medicinal benefit’. Table 4.15 shows the
loading of items were ranged from 0.643 to 0.770.

The objective of the study was to evaluate the impact of Marketing Strategies and
Techniques of Pharmaceutical companies on the cardiac market and to assess the overall
satisfaction on the relative importance of the variables. Factor analysis was performed on
the explanatory variables with the primary goal of dimension reduction.

96
4.3.7 Test of Research Hypotheses of Doctors’ Satisfaction
To achieve the research objectives for illustrating the impact of Marketing Strategies and
Techniques on Doctors’ Satisfaction to prescribe medicines for sales performance of
Pharmaceutical companies, the following research hypotheses were constructed and tested
by Regression analysis which are presented in the tables 4.16, 4.17 and 4.18 respectively.

H1: Efficacy of medicine has positive impact on Doctors’ Satisfaction.

H2: Brand image of medicine has positive impact on Doctors’ Satisfaction.
H3: Safety information of medicine has positive impact on Doctors’ Satisfaction.
H4: Company reputation positive impact on Doctors’ Satisfaction.
H5: New medicine has positive impact on Doctors’ Satisfaction.
H6: Price signal quality has positive impact on Doctors’ Satisfaction.
H7: Competitive pricing has positive impact on Doctors’ Satisfaction.
H8: Availability of medicines has positive impact on Doctors’ Satisfaction.
H9: Location of Pharmacy has positive on Doctors’ Satisfaction.
H10: Facilities of Model Pharmacy have positive impact on Doctors’ Satisfaction.
H11: Selling Skill of Medical Representative has positive impact Doctors’ Satisfaction.
H12: Continuous Medical Education (CME) program has positive impact Doctors’
Satisfaction.
H13: Awareness Campaign to prevent cardiac disease has positive impact Doctors’
Satisfaction.
H14: Promotional Policies have positive impact on Doctors’ Satisfaction.

Table 4.16: Summary of Regression Analysis (Doctors’ Satisfaction)

R 0.663
R Square 0.440
Adjusted R Square 0.425
F-test 29.653
P value 0.000
Source: Prepared by Researcher

Predictors: F4, F3, F2, F1 and Dependent Variable: Overall Satisfaction

97
Table 4.17: Coefficients of Factors
Unstandardized Standardized
Coefficients Coefficients
Std.
Model Beta Error Beta t Sig.
1 (Constant) 3.891 0.060 64.908 0.000
F1 0.337 0.060 0.341 5.601 0.000
F2 0.456 0.060 0.462 7.579 0.000
F3 0.301 0.060 0.304 5.000 0.000
F4 0.132 0.060 0.134 2.193 0.030
Source: Prepared by Researcher (Dependent Variable: Overall satisfaction)

4.3.9 Relationship of independent variables of MST with Doctors’

Satisfaction (Dependent Variable)

The table 4.16 shows that the value of R, 0.663 represents a moderate relationship between
dependent and independent variables. R2 value is 0.44 implies 44% change in dependent
variable which is Doctors’ satisfaction about MST can be explained by the changes in the
independent variables (Factors), F1= Economic-Medicinal benefit, F2= Medicinal-
Communication Relationship Benefit, F3= Communication Benefit, F4= Medicinal Benefit.
The summary of Coefficients of the factors and Research Hypothesis for Doctors’
Satisfaction to prescribe cardiac medicines are given in the table 4.17 and 4.18 respectively.

98
Table 4.18: Results of Research Hypotheses for Doctors’ Satisfaction about MST
S1 Research Hypotheses P Results
values
H1 Efficacy of Cardiac Medicine has positive impact on 0.030
Doctors’ Satisfaction Accepted
H2 Brand Image of cardiac medicine has positive impact on 0.000 Accepted
Doctors’ Satisfaction
H3 Safety Information of cardiac medicine has significant 0.030
impact on Doctors’ Satisfaction Accepted
H4 Company Reputation has significant impact on Doctors’ 0.000 Accepted
Satisfaction
H5 New Cardiac Medicine has positive impact on Doctors’ 0.000
Satisfaction Accepted
H6 Price signal Quality of cardiac Medicine has positive 0.000 Accepted
impact on Doctors’ Satisfaction
H7 Competitors’ Pricing has significant impact on Doctors’ 0.000 Accepted
Satisfaction
H8 Availability of Cardiac Medicine has positive impact on 0.000 Accepted
Doctors’ Satisfaction
H9 Location of Pharmacy place has significant impact on 0.000 Accepted
Doctors’ Satisfaction
H10 Facilities of Model Pharmacy has significant impact on 0.000 Accepted
Doctors’ Satisfaction
H11 Selling Skill of Medical Representatives has significant 0.000 Accepted
impact on Doctors’ Satisfaction
H12 Continuous Medical Education(CME) program for doctors 0.000 Accepted
have significant impact on Doctors’ Satisfaction
H13 Awareness Campaign to prevent cardiac disease has 0.000 Accepted
positive impact on Doctors’ Satisfaction
H14 Promotional Policies ( incentives) has significant impact on 0.000 Accepted
Doctors’ Satisfaction
Source: Prepared by Researcher

99
4.4 Impact of Marketing Strategies and Techniques on Marketing Professionals’
Satisfaction about sales

Impact of Marketing Strategies and Techniques on Marketing Professionals’ Satisfaction

about Sales was carried out for the study. A total of 180 marketing professionals of different
Pharmaceutical companies were made to participate to answer the satisfaction statement
questionnaires of the research. The table 4.19 shows the frequency distribution of the
Marketing Professionals evaluation about the attributes of MST.

4.4.1 Descriptive analysis (Marketing Professionals’ Satisfaction):

It is found that 90% of the marketing professionals agreed that the efficacy of cardiac
medicine is an important attribute for the doctors to prescribe the medicines, 4% of the
respondents disagreed about the statement (Mean score=4.53). About 72% of the
Marketing Managers and Officers agreed that companies supplied enough safety
information about the cardiac medicine; 24% were undecided or neutral. (Mean
score=4.02). Mean Scores of Marketing Professionals’ Satisfaction about Marketing
Strategies and Techniques (MST) about Sales Performance are given in the table 4.19 and
figure 4.5 respectively.

Managers expressed their positive response in the statement that Company Reputations
really influence doctors to prescribe and sales of cardiac medicine is 76% (Mean
score=4.06). While 41% Managers replied that newer cardiac medicine are more preferable
than existing (older) medicines (Mean score=3.36). Only 18% marketing people disagreed
and 41% neither disagree nor disagrees about the statement.

To assess the attributes of Pricing Strategy, Marketing Professionals responded the

statements according their perception. Regarding the Pricing Strategy, 52% of Managers
agreed that price of cardiac medicines is reflected in quality and 28% were neutral about
the statement.

100
Table 4.19: Mean Scores of Marketing Professionals’ Satisfaction about Marketing
Strategies and Techniques on Sales Performance
Variables of MST Strongly Disagree Neutral Agree Strongly Mean SD
disagree Agree
Efficacy 2 5 10 41 122 4.53 0.81
(1.11) (2.78) (5.56) (22.78) (67.78)
Brand Image 5 15 65 60 35 3.58 0.99
(2.78) (8.33) (36.11) (33.33) (19.44)
Safety Information 2 4 44 68 62 4.02 0.88
(1.11) (2.22) (24.44) (37.78) (34.44)
Company Reputation 2 7 35 71 65 4.06 0.90
(1.11) (3.89) (19.44) (39.44) (36.11)
New cardiac Medicines 3 29 74 48 26 3.36 0.97
(1.67) (16.11) (41.11) (26.67) (14.44)
Price-Quality 7 30 50 69 24 3.41 1.04
(3.89) (16.67) (27.78) (38.33) (13.33)
Availability 1 3 28 73 75 4.21 0.80
(0.56) (1.67) (15.56) (40.56) (41.67)
Location of Pharmacy 7 31 52 60 30 3.42 1.08
(3.89) (17.22) (28.89) (33.33) (16.67)
Facilities of Model 14 55 56 41 14 2.92 1.08
Pharmacy (7.78) (30.56) (31.11) (22.78) (7.78)
Selling Skill of Medical 2 6 27 76 69 4.13 0.87
Representatives (1.11) (3.33) (15.00) (42.22) (38.33)
Continuous Medical 1 3 28 62 86 4.27 0.82
Education program (.56) (1.67) (15.56) (34.44) (47.78)
Awareness Campaign 0 8 60 70 42 3.81 0.84
(.00) (4.44) (33.33) (38.89) (23.33)
Promotional Policies 1 4 28 86 61 4.12 0.79
(.56) (2.22) (15.56) (47.78) (33.89)
Overall satisfaction 1 2 42 75 60 4.06 0.81
(.56) (1.11) (23.33) (41.67) (33.33)
Source: Prepared by Researcher

statement and 20% disagreed (Mean score=3.41). When they were asked about the impact
place or distribution networks strategy has on customer’s satisfaction and sales, a total
number of 82% respondents replied in favor of the statement that availability of cardiac
medicine in retail pharmacy provide better satisfaction and sale. Only 2% of them
disagreed (Mean score=4.21) and 16% of respondents were found to be neutral.

101
 Figure 4.5 :Satisfaction level of Marketing Professional about
Sales
Strongly disagree
140 5.00
4.53 4.50
120 4.21 4.13 4.27 4.12 4.06 Disagree
4.02 4.06 4.00
3.81
100 3.58 3.42 3.50
3.36 3.41
2.92 3.00 Somewhat
80
2.50 disagree
60 2.00 Agree
40 1.50
1.00 Strongly agree
20
0.50
0 0.00 Mean

Managers are highly concerned about the Availability of medicine at retail pharmacies and
hospital pharmacies as cardiac medicine is life-saving and required daily. About 50% of
respondents replied that the location of pharmacy affects sales; 21% disagreed and 29%
were neutral (Mean score=3.42). When asked about whether the Facilities of Model
Pharmacy affect sales, 31% of Marketing Professionals agreed on the statement and 38%
disagreed while 31% remain neutral (Mean score=2.92).

Impact of Promotional strategies was observed from the survey among different elements
of Promotional Mixed Strategies. Promotion has the highest level of influence on
customer’s satisfaction that influence doctors to prescribe and sale cardiac medicine.
Amongst different attributes of Promotion Strategies, knowledge and Selling Skill of
Medical Representatives were found to be the most effective tool to influence doctors to
prescribe cardiac medicines. Managers and officers (81%) agreed to this statement, only
4% disagreed (Mean score=4.13). Another most important attribute of Promotion Strategy
is Continuous Medical Education through seminar and conference for the doctors. 82% of
the respondents agreed that CME influences doctors to prescribe cardiac medicine and has
a significant impact on sales (Mean score=4.27). The respondents agreed that Awareness
102
Campaign for the cardiac patients to prevent cardiac disease is crucial for publicity and
goodwill is 62% and 33% of them were found to be neutral (Mean score=3.81). Almost
82% of Managers acknowledge that Promotional incentives impact doctors’ satisfaction to
prescribe; 11% were neutral and 7 % disagreed to this statement (Mean score=4.12). Mean
score of Overall satisfaction of Marketing Professionals about sales is 4.06 which indicates
high satisfaction.

4.4.2. Sample Adequacy (Marketing Professionals’ Satisfaction)

Table 4.20 KMO value is 0.746 which is more than 0.60 and significant value of Bartlett’s
test of sphericity is good enough. All these indicate the study can carry on Factor analysis.

Table 4.20 KMO and Bartlett’s Test (Marketing Professionals’ Satisfaction)

KMO and Bartlett’s Test
Kaiser-Meyer-Olkin Measure of Sampling 0.746

Approximate chi-Square 414.357

df 78
Sig 0.000
Source: Prepared by Researcher

4.4.3: Correlation Matrix (Marketing Professionals’ Satisfaction about Sales)

Correlation Matrix of Marketing Professionals shows interdependence of independent

variables of MST and dependent variable Marketing Professionals’ satisfaction in the
table 4.21.

103
Table 4.21 Correlation Matrix (Marketing Professionals)

Effic Bra Saf Comp New Pri Availa Pla Facilit SM Contin Aware Promot
acy nd ety any cardia ce bility ce ies of R uous ness ional
reput c Model Medic camp policie
ation medic Phar al aign s
ines macy Educa
tion
progra
m
Efficacy 1 .19 .28 .309** -.040 .11 .253** .00 -.099 .10 .240** .172* .107
5** 6** 3 0 4
Brand .195 1 .31 .259** .134 .04 .217** .31 .207** .20 .299** .227** .059
**
9** 6 2** 3**
Safety .286 .31 1 .118 .192** .08 .307** .24 .131 .11 .275** .223** .100
**
9** 1 2** 3
Company .309 .25 .11 1 .041 .19 .376** .10 -.065 .24 .265** .190* .053
**
reputatio 9** 8 0* 3 8**
n
New - .13 .19 .041 1 .23 .159* .24 .219** .15 .114 .247** .117
cardiac .040 4 2** 0** 5** 4*
medicine
s

Price .113 .04 .08 .190* .230** 1 .117 .14 .318** .23 .151* .183* -.006
6 1 8* 1**
** * ** *
Availabilit .253 .21 .30 .376 .159 .11 1 .18 -.084 .37 .317 .191 .214**
**
y 7** 7** 7 8* 5**
Place .000 .31 .24 .103 .245** .14 .188* 1 .380** .10 .148* .345** .025
2** 2** 8* 2
Facilities - .20 .13 -.065 .219** .31 -.084 .38 1 .04 .074 .224** -.055
of Model .099 7** 1 8** 0** 1
Pharmac
y
Selling .104 .20 .11 .248** .154* .23 .375** .10 .041 1 .472** .317** .188*
skill of 3** 3 1** 2
Medical
Represen
tatives

Continuo .240 .29 .27 .265** .114 .15 .317** .14 .074 .47 1 .419** .198**
**
us 9** 5** 1* 8* 2**
Medical
Educatio
n
program
Awaren .17 .22 .22 .190* .247* .1 .191* .34 .224* .31 .419** 1 .136
ess 2* 7** 3** * 83* 5** * 7**
campaig
n
Promoti .10 .05 .10 .053 .117 - .214** .02 -.055 .18 .198** .136 1
onal 7 9 0 .0 5 8*
policies 06
**. Correlation is significant at the 0.01 level (2-tailed).

*. Correlation is significant at the 0.05 level (2-tailed).

104
4.4.4 Communalities (Marketing Professionals’ satisfaction about sales)
Communalities define the estimation of shared variance of the overall variables. The
variable is explained by the extracted factors. For each variable of MST, the value of the
communality is expected to be 0.40 or more. (Table4.22)

Table 4.22: Communalities

Variables Initial Extraction

Efficacy 1.000 .543
Brand 1.000 .521
Safety 1.000 .556
Company reputation 1.000 .588

New cardiac medicines

1.000 .411

Price 1.000 .691

Availability 1.000 .496
Place 1.000 .569
Facilities of Model Pharmacy
1.000 .659

Selling skill of Medical

Representatives 1.000 .620

Continuous Medical Education

1.000 .520
program
Awareness campaign 1.000 .450
Promotional policies 1.000 .591
Source: Prepared by Researcher (Extraction Method: Principal
Component Analysis.)

4.4.5 Factor Extraction (Marketing Professionals’ Satisfaction about Sales)

After running the Factor Analysis, the table 4.23 has been shown below where total four
factors are extracted. About 55.488% variance is explained with the help of extracted
factors in the dataset.

105
Table 4.23. Factor Extraction (Marketing Professionals’ Satisfaction)

Total Variance Explained

Extraction Sums of Squared Rotation Sums of Squared
Initial Eigenvalues Loadings Loadings
% of Cumulative % of Cumulative % of Cumulative
Component Total Variance % Total Variance % Total Variance %
1 3.282 25.243 25.243 3.282 25.243 25.243 2.065 15.886 15.886
2 1.695 13.040 38.283 1.695 13.040 38.283 1.928 14.827 30.713
3 1.161 8.935 47.218 1.161 8.935 47.218 1.897 14.590 45.303
4 1.075 8.271 55.488 1.075 8.271 55.488 1.324 10.185 55.488

Source: Prepared by Researcher (Extraction Method: Principal Component Analysis.)

4.4.6 Rotated Factor Matrix (Marketing Professionals’ Satisfaction about Sales)

The Marketing Professionals develop Marketing Strategies to persuade doctors to prescribe
cardiac medicines. The attributes or variables of Marketing Strategies do not hold the same
impact on doctors’ preferences. The strategies that the managers find appropriate do not
necessarily serve the purpose of the doctors’ need. It has been found in this research that
certain variables of Marketing Strategies loaded in the significant factors are well-accepted
by the doctors but not all. For example, factor-1 is accepted by both doctors and managers
alike whereas factor-3 was found to be highly significant for doctors’ satisfaction but only
moderately significant for the managers.

Factor 1 consists of items or variables LP8, FMP9, BI2, SI3, AC12, and NM5. The
variables are Location of Pharmacy, Facilities of Model Pharmacy, Brand Image, Safety
Information, Awareness Campaign for the patients and New Medicines. It has been shown
in the table 4.24. In the pharmaceutical market, there is intense competition to capture
market shares. The Pharmaceutical companies try their level best to invent new medicines
with better effectiveness through research. Pharmaceutical companies of Bangladesh try to
import new medicine molecules for increasing sales. New medicine (NM5) has positive
loading on this factor. These variables are related to Convenience and Medicinal Strategies.
Opinion and perception of Marketing Professionals about the satisfaction statements of
these variables were evaluated as important attributes of Marketing Strategies and
Techniques that impact doctors’ preference to prescribe a medicine of the respective
106
company and sales. Hence Factor 1 can be labeled as Convenience-Medicinal benefit
because most of product and place variables have been loaded on Factor 1.

Factor 2 states that variables PP13, SSMR10, CME11 and AV7 are related to Promotional
Policy, Selling Skill of Medical Representatives, Continuous Medical Education for the
doctors, and Availability of medicines. These are very important consideration for the
doctors while prescribing the medicines. In table 4.24, Factor 2 represents variables of
Satisfaction statements that are related to Communication relationship of Marketing. Thus,
Factor 2 is labeled as Communication relationship benefit.

Factor 3 implies the items of Satisfaction statement questions are EF1 and CR4. These
variables are Efficacy and Company Reputation related to Medicinal benefit.

Factor 4 contains variable Price - Quality relationship which is labeled as Economic benefit
of Marketing Strategy. The figure 4.6 of Scree Plot Eigenvalue and Variable components
of Marketing Professionals shows the four factors having Eigen values greater than one.
13 explanatory variables were reduced into 4 factors having Eigen values greater than 1.0
by the Varimax Rotation.

Each factor was composed of variables that loaded 0.4 or higher on that factor. About 56%
of the total variation can be explained by the four factors which has been shown in table
4.23.

The dependent variable is Marketing Professionals’ Satisfaction about sales. 5 point Likert
scale was used to evaluate the satisfaction statement of MST. It is already mentioned that
the objective of factor analysis is to find the appropriate variables of the specific factors
included in Marketing Strategies that have significant impact on overall satisfaction of
Marketing Professionals about sales

Table 4.22 shows that the communalities of the present data set are perfect enough to go
for further analysis according to the table as all the variables are greater than 0.40.

107
 Figure 4.6: Scree plot Eigenvalue and Variable
components
3.500
3.000
2.500
Eigen value

2.000
1.500
1.000
0.500
0.000
1 2 3 4 5 6 7 8 9 10 11 12 13
Component number

The entire variables are loaded in the Rotated Component Matrix into four factors are given
in the table 4.24. Additionally, few of the items were also cross loaded under more than
one factor. The rotated factor loading defines the possibility of the consequential factors.

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Table 4.24. Rotated Factor Matrix (Marketing Professionals’ Satisfaction about
Sales)
Factor Name Component variable Factor loading on rotated
of statements component matrix

Factor1: Convenience- 1 2 3 3 4
Medicinal benefit
LP 8 Location of 0.74
Pharmacy
FMP 9 Facilities of Model 0.64
Pharmacy
BI2 Brand Image 0.58
SI 3 Safety information 0.57
AC 12 Awareness Campaign 0.44

NCM 5 New Cardiac 0.43

Medicines

Factor 2:Communication
relationship benefit
PP 13 Promotional Policies 0.70

SSMR 10 Selling Skill of MR 0.68

CME 11 Continuous Medical 0.58

Education
AV 7 Availability 0.49
Factor3: Medicinal benefit
Efficacy 0.73

Company Reputation 0.69

Factor4: Economic benefit
PQ 6 Price signal Quality 0.81
of Product
Source: Prepared by Researcher

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4.4.7 Test of Research Hypotheses (Marketing Professionals’ Satisfaction about Sales)
To achieve the research objective for illustrating the impact of Marketing Strategies and
Techniques on Marketing Professionals’ Satisfaction about Sales performance of
Pharmaceutical companies, the following research hypotheses were constructed.

H1: Efficacy of medicine has positive impact on Marketing Professionals’ Satisfaction

about Sales.
H2: Brand Image of medicine has positive impact on Marketing Professionals’ Satisfaction
about Sales.
H3: Safety Information of medicine has positive impact on Marketing Professionals’
Satisfaction about Sales.
H4: Company Reputation has positive impact on Marketing Professionals’ Satisfaction
about Sales.
H5: New Medicine has positive impact on Marketing Professionals’ Satisfaction about
Sales.
H6: Price signal Quality has positive impact on Marketing Professionals’ Satisfaction
about Sales.
H7: Availability of medicine has positive impact on Marketing Professionals’ Satisfaction
about Sales.
H8: Location of Pharmacy has positive impact on Marketing Professionals’ Satisfaction
about Sales.
H9: Facilities of Model Pharmacy have positive impact on Marketing Professionals’
Satisfaction about Sales.
H10: Selling Skill of Medical Representative has positive impact on Marketing
Professionals’ Satisfaction about Sales.
H11: Continuous Medical Education (CME) program for doctors has positive impact on
Marketing Professionals’ Satisfaction about Sales.
H12: Awareness Campaign to prevent cardiac disease and Sales has positive impact on
Marketing Professionals’ Satisfaction about Sales.
H13: Promotional Policies have positive impact on Marketing Professionals’ Satisfaction
about Sales.

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The factors of exploratory factor analysis were tested by Regression analysis. The results
of the analysis were shown in the tables 4.25 and 4.26 respectively.

Table 4.25: Summary Regression Analysis (Marketing Professionals’ Satisfaction)

R 0.392
R Square 0.154
Adjusted R Square 0.135
F Statistics 7.956
P value 0.000
Source: Prepared by Researcher (Predictors: F4, F3, F2, F1

Dependent Variable: Overall Satisfaction)

Table: 4.26. Coefficients of Factors (Marketing Professionals)

Unstandardized Coefficients Standardized Coefficients

Model Beta Std. Error Beta t Sig.
(Constant) 4.061 0.056 72.034 0.000
F1 0.190 0.057 0.233 3.356 0.001
F2 0.128 0.057 0.157 2.259 0.025
F3 0.149 0.057 0.183 2.629 0.009
F4 0.165 0.057 0.203 2.924 0.004
Source: Prepared by Researcher (Dependent Variable: Overall satisfaction)

4.4.8 Relationship of Independent variables of MST with dependent variable

Marketing Professionals’ Satisfaction about sales:
Relationship of Independent variables of MST with dependent variable Marketing
Professionals’ Satisfaction about Sales has been shown in the table 4.27

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Table: 4.27: Results of Hypothesis testing of Marketing Professionals’ Satisfaction
about Sales

Sl Research Hypotheses p value less Result

than 0.05
H1 Efficacy of cardiac medicine has positive impact on Marketing 0.009
Professionals’ Satisfaction about Sales. Accepted
H2 Brand Image of cardiac medicine has positive impact on 0.001 Accepted
Marketing Professionals’ Satisfaction about sales.
H3 Safety Information of cardiac medicine has significant impact on 0.001 Accepted
Marketing Professionals’ Satisfaction about Sales.
H4 Company Reputation has significant impact on Marketing 0.009 Accepted
Professionals’ Satisfaction about Sales.
H5 New Cardiac Medicine has positive impact Marketing 0001 Accepted
Professionals’ Satisfaction about Sales.
H6 Price signal Quality of cardiac medicine has positive impact on 0.004 Accepted
Marketing Professionals’ Satisfaction about Sales.
H7 Availability of cardiac medicine has positive impact on 0.025 Accepted
Marketing Professionals’ Satisfaction about Sales.
H8 Location of Pharmacy has significant impact on Marketing 0.001 Accepted
Professionals’ Satisfaction about Sales.
H9 Facilities of Model Pharmacy have significant impact on 0.001
Marketing Professionals’ Satisfaction about Sales. Accepted
H10 Selling Skill of Medical Representatives has significant impact 0.025 Accepted
on Marketing Professionals’ Satisfaction about Sales.
H11 Continuous Medical Education (CME) program for doctors has 0.025 Accepted
significant impact on Marketing Professionals’ Satisfaction
about Sales.
H12 Awareness Campaign to prevent cardiac disease has positive 0.001 Accepted
impact on Marketing Professionals’ Satisfaction about Sales.
H13 Promotional Policies( incentives )have significant impact on 0.025 Accepted
Marketing Professionals’ Satisfaction about Sales..
Source: Prepared by Researcher

4.4.9. Assessment of practice of MST in different Pharmaceutical companies

according to Marketing Professionals
The approach of Pharmaceutical companies setting the marketing strategies are not same.
In this research, it has been revealed that 42% companies follow a top-down approach
where top company executives design the marketing strategies and communicate it directly
to the sales team. The marketing professionals out of 186 surveyed, expressed their opinion
that skilled marketing and sales managers formulate strategies for everyone to follow a
bottom-up approach is16%. Both top-down and bottom up approach are followed by 42%
companies to ensure a both way communication for a better performance. The research has
112
found that the marketing strategies of the pharmaceutical companies are based on to
becoming the market share leaders (40%) and to penetrate the market (16.5%) and to
achieve product branding (43.5%).

The question was asked to different marketing professionals about the tactics or techniques
that are helpful to implement the strategies. About 40.6% of respondents responded to
prepare efficient sales force; 43.4% replied to provide CME for doctors through seminar
and conference and 14.2% of respondents gave opinion about cardiac disease awareness
campaigns for the cardiac patient to prevent cardiac disease are the main tactics to convince
doctors to prescribe their medicines.

The main objectives of the marketing professionals of pharmaceutical companies that were
discovered are that 30.1% of the respondents want to be a top-five national companies in
cardiac market, 39% want to be a cardiac market leader in Bangladesh whereas 9.6%
responded to adjust with competitors’ marketing mix activities.

The mean scores about the MST of 180 Marketing Professionals of the 18 companies are
given below where it has been revealed that there is scope to further improve the 4Ps
strategies to attract customers (Doctors & Patients) for sustainable profitability of the
companies. Mean scores of Marketing Professionals’ about 4Ps of MST are quality,
affordability, availability and communication relationship are 4.2, 3.8, 3.4 and 3.6
respectively which is shown in the table 4.28.

Table 4.28: Marketing Professionals’ Satisfaction about 4Ps

4Ps of Marketing strategies Mean scores of Marketing Professionals’ Satisfaction
Quality 4.2
Affordability 3.8
Availability 3.4
Communication 3.6
Source: Prepared by Researcher

4.5. Impact of Marketing Strategies and Techniques on Patients’ Satisfaction

Cardiac patients are the end users of cardiac medicines and pay for it. They go to
cardiologists for the treatment of cardiac diseases. Doctors prescribe the cardiac medicines

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for curing or managing the cardiac problems. The table 4.29 and figure 4.7 of descriptive
Analysis show the Patients’ Satisfaction about MST.

4.5.1 Descriptive Analysis of Patients’ Satisfaction about MST

Efficacy and Quality of the medicine helps to manage the cardiac problem. Cardiac
patients are the most valuable customers for the doctors and Pharmaceutical companies.
200 cardiac patients were requested to express their opinion about the attributes or 11
elements of Marketing Strategies and Techniques. The table 4.29 and figure 4.7 show that
73% agreed that efficacy and quality is well accepted(Mean=3.89). Around 63% agreed
that Brand name of cardiac medicine attract patients and doctors (Mean=3.81).

Table: 4.29 Descriptive Analysis: Mean Scores of Patients’ Satisfaction about MST
Variables of MST Strongly Disagree Somehow Agree Strongly Mean SD
disagree agree agree

Efficacy 1 3 49 112 35 3.89 0.72

(.50) (1.50) (24.50) (56.00) (17.50)

Brand 0 11 64 77 48 3.81 0.86
(.00) (5.50) (32.00) (38.5) (24.00)
Safety 9 34 76 71 10 3.20 0.93
(4.50) (17.00) (38.00) (35.50) (5.00)
Company reputation 0 14 62 74 50 3.80 0.90
(.00) (7.00) (31.00) (37.0) (25.00)
New cardiac 1 22 35 80 62 3.90 0.98
medicines
(.50) (11.00) (17.50) (40.00) (31.00)
Price 27 107 63 3 0 2.21 0.68
(13.50) (53.50) (31.50) (1.50) (.00)
Affordability 9 55 89 47 0 2.87 0.82
(4.50) (27.50) (44.50) (23.5) (.00)
Availability 3 28 69 75 25 3.46 0.93
(1.50) (14.00) (34.50) (37.5) (12.50)
Location/place 0 6 31 46 117 4.37 0.85
(.00) (3.00) (15.50) (23.0) (58.50)
Communication 76 118 6 0 0 1.65 0.54
(38.00) (59.00) (3.00) (.00) (.00)
Awareness campaign 50 122 28 0 0 1.89 0.62
(25.00) (61.00) (14.00) (.00) (.00)
Overall satisfaction 16 36 107 39 2 2.88 0.85
(8.00) (18.00) (53.50) (19.5) (1.00)

Source: Prepared by Researcher

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Figure 4.7 Patients' Satisfaction about MST

Patients' Satisfaction about MST

140 5.00
Srongly
4.50 disagree
120 4.37
4.00 Disagree
3.89 3.81 3.80 3.90
100 3.50
3.46
3.20 Somehow
3.00 agree
80 2.87 2.88
2.50 Agree
60 2.21
1.89 2.00
1.65 Strongly agree
40 1.50

1.00 Mean
20
0.50

0 0.00

About 40% agreed that Pharmaceutical Companies provide enough safety information
about the medicine (Mean=3.20). Almost 62% respondent replied affirmative in favor of
Company Reputation (Mean=3.80). Around 71% agreed that newer drugs attract more
than older ones (Mean=3.90). Cardiac patients disagreed that price is reflected in quality
of cardiac medicine was 67% (Mean=2.21). Only 32% patients did not agree that the
company considers the affordable price of the cardiac the patients (Mean=2.87).
Respondents found neutral about competitive price of cardiac medicines were 45.%. While
51% cardiac patients agreed and 15.2% of them disagreed about the statement availability
of medicines in retail pharmacy is satisfactory (Mean=3.46). About 33.8% respondent
neither agreed nor disagreed in this regard.

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When the cardiac patients were asked about the place or distribution network strategies,
81% replied in favor of location being important for retail pharmacy in Dhaka City
(Mean=4.37). Promotional strategy is a very effective tool to attract customers to use the
product of the producers. For pharmaceutical products, doctors and retailers are direct
customers who get the benefit of promotional incentives but for healthcare patients, the
ultimate buyers who pay for the medicines, are not influenced by the tools. They were
invited to express their opinion about the statement that companies communicate to know
the benefits of the medicines for promotion. Almost 97% disagreed that MR of the
companies communicate with them (Mean=1.65). The cardiac patients were asked about
the Awareness Campaign of the Pharmaceutical companies to prevent the cardiac disease
is noticed for the patients. Around 74.1% disagreed that the Pharmaceutical companies do
not offer any awareness campaign for the cardiac patients. Only 6.6% of the respondents
agreed ;19.2% somewhat agreed (Mean=1.89). Overall satisfaction of Patients about MST
is 2.88.

4.5.2 Sample Adequacy (Patients’ Satisfaction to consume)

Table 4.30 shows that the sample is adequate for Factor Analysis as KMO value is more
than 0.60 and significant value of Bartlett’s test of Sphericity is good enough. All these
indicate the study can carry on Factor analysis.

Table 4.30: KMO and Bartlett’s Test

KMO and Bartlett’s Test
Kaiser-Meyer-Olkin Measure of Sampling Adequacy = 0.604
Approximate chi-Square = 246.678
Bartlett’s Test of Sphericity
df = 55
Sig = 0.000
Source: Prepared by Researcher

4.5.3: Correlation Matrix (Patients’ Satisfaction about MST)

The important issues are taken as basic factors of the research like Medicinal benefit,
Economic benefit, Convenience benefit and Communication benefit.

116
Relative important factors of Marketing Strategies and Techniques for Patients’
satisfaction were identified by order of entry into Factor analysis.

The objective of the study was to evaluate the impact of Marketing Strategies and
Techniques of Pharmaceutical companies on cardiac patients’ satisfaction on the relative
importance of variables. The figure 4.8 of Scree plot of Eigen value and Variables Components
(Patients). The four factors explained 57.246% of the total variance in the table 4.33.

The dependent variable is Patients’ satisfaction and independent variables of MST which
are shown in the tables 4.31 and 4.32 respectively as Correlation Matrix and
Communalities.

Table 4.31: Correlation Matrix (Patients’ satisfaction)

Effi Bra Saf Compa New Pric Afforda Availab Locati Communi Awareness
cac nd ety ny cardiac e bility ility on cation campaign
y reputa pharm
tion medicin acy
es
Efficacy 1.0 0.1 .26 0.136 .198** 0.0 .196** .296** 0.127 -0.027 -0.006
00 02 6** 60
Brand 0.1 1.0 0.1 .417** 0.019 0.0 0.022 -0.029 .232** -0.090 -0.039
02 00 15 59
Safety .26 0.1 1.0 0.047 -0.121 .17 .262** .232** 0.073 0.007 .195**
6** 15 00 9*
Company 0.1 .41 0.0 1.000 0.137 0.1 -.165* -0.017 .235** -0.136 -0.122
reputation 36 7** 47 18
New .19 0.0 - 0.137 1.000 - -0.060 .198** .194** 0.048 -0.035
cardiac 8** 19 0.1 0.0
medicines 21 21
Price 0.0 0.0 .17 0.118 -0.021 1.0 .209** .196** -0.022 0.138
60 59 9* 00 .187**
Affordabilit .19 0.0 .26 -.165* -0.060 .20 1.000 .319** 0.033 0.067 0.091
y 6** 22 2** 9**
Availability .29 - .23 -0.017 .198** .19 .319** 1.000 .236** -0.042 0.026
6** 0.0 2** 6**
29
Location/ 0.1 .23 0.0 .235** .194** - 0.033 .236** 1.000 - -0.056
place 27 2** 73 0.0 .166*
22
Communic - - 0.0 -0.136 0.048 .18 0.067 -0.042 -.166* 1.000 .262**
ation 0.0 0.0 07 7**
27 90
Awareness - - .19 -0.122 -0.035 0.1 0.091 0.026 -0.056 1.000
campaign 0.0 0.0 5** 38 .262**
06 39
**. Correlation is significant at the 0.01 level (2-tailed).

*. Correlation is significant at the 0.05 level (2-tailed).

Source: Prepared by Researcher

117
 4.5.4 Communalities (Patients’ Satisfaction to consume)
Estimation of shared variance of the overall variables are explained by the extracted
factors. For each variable of MST, the value of the communality is expected to be 0.40 or
more. (Table4.32)

4.5.4 Communalities (Patients’ Satisfaction to consume)

Table 4.32: Communalities (Patients)
Variables Initial Extraction
Efficacy 1.000 0.430
Brand 1.000 0.643
Safety 1.000 0.571
Company reputation 1.000 0.703

New cardiac medicines 1.000 0.778

Price 1.000 0.439

Affordability 1.000 0.548

Availability 1.000 0.638

Location/place 1.000 0.427

Communication 1.000 0.667

Awareness campaign 1.000 0.454

Extraction Method: Principal Component Analysis.
Source: Prepared by Researcher

4.5.5 Factor Extraction (Patients’ Satisfaction)

From table 4.33 and figure 4.8 it is found that first and second components have Eigen
values greater than 1 which are 2.066 and 1.801 respectively. These two components
explained only 32.001% variation. Third and fourth components with Eigen values are
1.271 and 1.159 respectively explained variation to 57.246% along with first and second
components.

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Table 4.33: Extracted Communalities by Principal Component Analysis(Patients)
Extraction Sums of Squared Rotation Sums of Squared
Initial Eigenvalues Loadings Loadings
% of Cumulative % of Cumulative % of Cumul
Component Total Variance % Total Variance % Total Variance ative %
1 2.066 18.781 18.781 2.066 18.781 18.781 1.881 17.097 17.097
2 1.801 16.372 35.153 1.801 16.372 35.153 1.649 14.994 32.091
3 1.271 11.556 46.709 1.271 11.556 46.709 1.458 13.251 45.342
4 1.159 10.537 57.246 1.159 10.537 57.246 1.309 11.903 57.246
Source: Prepared by Researcher (Extraction Method: Principal Component Analysis.)

Figure 4.8 : Scree plot of Eigen value and Variables

Components (Patients)
2.500

2.000
Eigen value

1.500

1.000

0.500

0.000
1 2 3 4 5 6 7 8 9 10 11
Component number

4.5.6 Rotated Component Matrix (Patients’ Satisfaction)

The Rotated Factor Matrix of Patients’ Satisfaction is shown in the table 4.34. The factor
consists of items AV8, CP7, SI3 and EF1 and is labeled as Economic Medicinal benefit.
Loading items were ranged from 0.561-0.714. Factor 2 states CR4, BI2, LP9 which is

119
labeled as Medicinal convenience benefit and loading were ranged from 0.408 to 0.819.
Factor 3 represents PP10, AC11, PQ6 and is named as Medicinal-Communication
relationship benefit (items loading from 0.556-0.774). Factor 4 is labeled as Medicinal
benefit which contains item loading is 0.879 and item NM5.

Table 4.34: Rotated Factor Matrix (Patients’ Satisfaction)

Factor Name Rotated Component Matrix

Patients’ Satisfaction

F1:Economic- Component
Medicinal Benefit 1 2 3 4
Av 8 Availability 0.714
CP 7 Competitive Price 0.694
SI 3 Safety 0.626
EF 1 Efficacy 0.561
F2: Medicinal-
Convenience Benefit
CR 4 Company Reputation 0.819
BI 2 Brand Image 0.796
LP 9 Location of Place 0.408
F3:Medicinal-
Communication
Benefit
PP 10 Promotional Policy 0.774

AC 11 Awareness campaign 0.659

PQ 6 Price Quality 0.556
F4: Medicinal benefit
NM 5 New cardiac 0.879
medicines

Source: Prepared by Researcher

120
4.5.7 Test of Research Hypotheses Patients’ Satisfaction about MST

Hypothesis Testing by Regression Analysis of Factors (Patients) and Coefficients

(Patients’ Satisfaction) are given in the table 4.35 and 4.36 respectively.

H1: Efficacy of medicine has positive impact on Patients’ Satisfaction.

H2: Brand Image of medicine has positive impact on Patients’ Satisfaction.
H3: Safety Information of medicine has positive impact on Patients’ Satisfaction.
H4: Company Reputation has positive impact on Patients’ Satisfaction.
H5: New medicine has positive impact on Patients’ Satisfaction.
H6: Price signal Quality has positive impact on Patients’ Satisfaction.
H7: Competitive pricing has positive impact on Patients’ Satisfaction.
H8: Availability of medicines has positive impact on Patients’ Satisfaction.
H9: Location of Pharmacy has positive impact on Patients’ Satisfaction.
H10: Promotional Policies of Medical Representative has positive impact on Patients’
Satisfaction.
H11: Awareness Campaign to prevent cardiac disease has positive impact on Patients’
Satisfaction.

Table 4.35: Summary of Regression Analysis of (Patients’ Satisfaction)

R 0.521
R Square 0.271
Adjusted R Square 0.256
F-test 18.150
P value 0.000

Source: Prepared by Researcher (Predictors: F4, F3, F2, F1

Dependent Variable: Overall Satisfaction)

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 Table 4.36: Coefficients ( Patients’ Satisfaction)

Standardized
Unstandardized Coefficients Coefficients
Model Beta Std. Error Beta t Sig.
(Constant) 2.875 .052 55.450 .000
F1 .384 .052 .451 7.385 .000
F2 .063 .052 .074 1.210 .228
F3 .167 .052 .196 3.209 .002
F4 .131 .052 .153 2.511 .013
Source: Prepared by Researcher ( Dependent Variable: Overall satisfaction)

From the table 4.35 it is seen that overall impact of 3 factors is significant (Fdf1df2=18.150
and p value =0.000). The Coefficient table 4.36 indicates that F1, F3 and F4 have
significant effect on Overall Satisfaction of Patients. The variables loaded Factor1 named
Economic-Medicinal benefit are Availability, Competitive price, Safety Information and
Efficacy have β value 0.384 with p value 0.000. The variables Company Reputation, Brand
Image, Location of Pharmacy loaded Factor 2 named as Medicinal –Convenience benefit
have insignificant impact on Patients’ Satisfaction where β coefficient is 0.063 and p value
is 0.228. Factor3 named Medicinal- Communication benefit includes variables
Promotional Policy, Awareness Campaign and Price Signal Quality have significant
impact on Patients’ satisfaction with β coefficient 0.167 and p value 0.002. Factor 4
labelled as Medicinal benefit includes variable New Medicine which has positive impact
on Patients’ Satisfaction (β value= 0.131 and p value=0.013)

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4.5.8: Relationship between independent variables of MST and Patients’ Satisfaction

Results of test of research hypotheses with p-values are given in the table 4.37

Table 4.37 Results of Hypotheses Testing of Patients’ Satisfaction about MST

S1 Research Hypotheses p value Result

H1 Efficacy of cardiac medicine has positive impact on 0.000 Accepted

patients’ satisfaction
H2 Brand Image of cardiac medicine has no positive impact 0.228 Rejected
on patients’ satisfaction
H3 Safety Information of cardiac medicine has significant 0.000 Accepted
impact on patients’ satisfaction
H4 Company Reputation has no significant impact on 0.228 Rejected
patients’ satisfaction
H5 New Cardiac medicine has positive impact on patients’ 0.013 Accepted
satisfaction
H6 Price signal Quality of cardiac Medicine has positive 0.002 Accepted
impact on patients’ satisfaction
H7 Competitive pricing has positive impact on patients’ 0.000 Accepted
satisfaction
H8 Availability of cardiac medicine has positive impact on 0.000 Accepted
patients’ satisfaction
H9 Location of Pharmacy has no positive impact on patients’ 0.228 Rejected
satisfaction
H10 Promotional Policies of company MR has positive impact 0.002 Accepted
on patients’ satisfaction
H11 Awareness campaign to prevent cardiac disease has 0.002 Accepted
positive impact on patients’ satisfaction

4.6 Patients’ Satisfaction about Model Pharmacy Recent Place Strategy introduced
by New Drug Policy 2016

Model pharmacy is a new place strategy introduced by the new drug policy 2016 which
maintains specific standards or attributes different from conventional retail pharmacies. To
evaluate the impact of model on patients’ satisfaction to purchase medicines instead of
retail pharmacies, an empirical research was carried out in Dhaka city in 2017. The
123
important seven independent variables of Model Pharmacies that impact on Patients’
Satisfaction (dependent variable) to purchase medicines are location, quality of medicine,
modern environment, variety of stock, data base system and reasonable price of medicine.

The result of the Correlation Matrix and stepwise multiple linear regression is found to be
statistically significant. Four independent variables out of seven that have found significant
impact on Patients’ Satisfaction to purchase medicines from Model Pharmacy are
counseling by ‘A’ grade pharmacists, quality of medicines, data base system and
reasonable price. Findings of this research motivate researcher to add an element into the
Place Strategy of Model Pharmacy to evaluate the impact of the Facilities of Model
Pharmacies on Stakeholders’ Satisfaction and Sales.

Structured Questionnaires were created which includes 5-point Likert scale based
statements having seven variables that represent the satisfaction level of patients to select
Model Pharmacy instead of retail pharmacy. Research Questions were asked about how
the patient’s purchasing decisions are being influenced by concept of Model Pharmacy,
what are the important Facility attributes of Model Pharmacies that impact on Patient’s
Satisfaction to buy medicines.

Reputed national and international journals, books, websites, articles and discussions with
‘A’ grade pharmacists of Model Pharmacies and legal bodies of Model Pharmacies were
collected as secondary source of information.

4.6.1 Test of Research hypotheses (Model Pharmacy)

H1: Location of Model Pharmacy has positive impact on patients’ satisfaction.
H2: Quality of medicine has positive impact on patients’ satisfaction.
H3: Modern environment of model pharmacy has positive impact on patients’ satisfaction.
H4: Variety of stock has positive impact on patients’ satisfaction.
H5: Database system has positive impact on patients’ satisfaction.
H6: Reasonable price has positive impact on patients’ satisfaction.
H7: Counseling by ‘A’ grade pharmacists have positive impact on patients’ satisfaction.

The SPSS output of final result of step-wise regression is shown below.

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Table 4.38: Regression Analysis of Patients’ Satisfaction about Model
Pharmacy
Std. Error of the
Model R R Square Adjusted R Square Estimate
0.743 0.552 0.533 0.46479

Predictors: (Constant), Counseling by A grade pharmacist, Quality medicines,

Data Base System, Reasonable price. Dependent Variable: Overall
satisfaction

Table 4.39: ANOVA table of Regression Analysis

Mean
Sum of Squares df Square F Sig.
Regression 25.317 4 6.329 29.299 0.000
Residual 20.523 95 0.216
Total 45.840 99
Dependent Variable: Overall satisfaction
Predictors: (Constant), Counseling by A grade pharmacist, Quality medicines, Data Base System,
Reasonable price

Table 4.40: Coefficients of Variables of Model Pharmacy

Standardized
Unstandardized Coefficients Coefficients
Model Beta Std. Error Beta t Sig.
(Constant) 1.419 0.467 3.041 0.003
Counseling by A grade 0.182 0.049 0.379 3.697 0.000
pharmacist
Quality medicines 0.209 0.090 0.178 2.313 0.023
Data Base System 0.138 0.060 0.211 2.282 0.025
Reasonable price 0.178 0.084 0.171 2.113 0.037
Source: Prepared by Researcher

Dependent Variable: Overall satisfaction Predictors: Counseling by A grade pharmacist, Quality medicines, Data
Base System, Reasonable price

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Although overall model is significant but individual effects of all independent variables are
not significant. Quality of medicine, counseling by A grade pharmacist, data base system
and reasonable price have positive impact on patient’s satisfaction which p values are less
than 0.05. Summary of Results of Research Hypothesis for patients’ satisfaction to
purchase cardiac medicines from Model Pharmacy has been given in the table 4.41 below:

Table 4.41: Summary of Results of Research Hypothesis for Patients’ Satisfaction

about Facilities of Model Pharmacy to purchase cardiac medicines has been given
below:
S1 Research Hypotheses Results

H1 Location of Model Pharmacy has positive impact on Patients’ Rejected

Satisfaction
H2 Quality of medicines has positive impact on Patients’ Accepted
Satisfaction
H3 Modern environment of Model pharmacy has positive impact on Rejected
Patients’ Satisfaction
H4 Variety of stocks has significant impact on Patients’ Satisfaction Rejected
H5 Data base system has positive impact on Patients’ Satisfaction Accepted
H6 Reasonable price of Medicine has positive impact on Patients’ Accepted
Satisfaction
H7 Counseling by ‘A’ grade pharmacists has significant impact on Accepted
Patients’ Satisfaction
Source: Prepared by Researcher

4.7 Patients’ Satisfaction about Cardiac Medicines of Market Leader, Challengers,

Followers and Niches according to survey of 200 Cardiac patients.
The study of patient’s needs, wants and rights is a very important issue. Medicine
compliance and noncompliance, not filling or refilling a prescription, taking too much or
too little medication, not completing treatment, self-medication are also very crucial issues
that need serious attention. To remove these barriers, good compliance, “holistic” or good
healthcare system including disease management initiative by healthcare and
pharmaceutical companies are necessary which improve treatment guidelines, compliance
improving tools, education, information, products and service. From this research, it has
been found that there exists significant gap between the company offers and the patient’s
need and wants. Satisfaction level of patients about the 4Ps strategies is not satisfactory.

126
The most important attributes of MST that impacts patients’ satisfaction are efficacy,
safety, affordability, communication and availability of cardiac medicines which are found
need to be improved to achieve satisfactory level in Bangladesh. Pharmacists in developed
countries play an important role to maintain communication with pharmaceutical
companies about the price and pharmaceutical co-equivalence data that can meet the
requirements of their patients’ satisfaction. In our country these services are not sufficient.
The figure 4.9 of number of Cardiac Patients using cardiac medicines of different
companies are given below.

Figure 4.9: Number of Cardiac Patients using cardiac medicine of

different companies (n=200)
120
107
100
83
80

60 51

40
25 23 22 22
20 16 15 15
12 10 9
6 5 4 4 3 3 2 2 2 1 1 1 1
0
ACI
Square

GSK
Popular
Beximco

Acme

Ibn Sina
Drug. Int

Novertis

Bio Pharma

Beacon

Servier
Jayson
ASP
Eskayef

Sanofi

Rediant

Orion
Incepta

Aristo Pharma
Renata

Opsonin

Unimed

General Pharm

Pacific Pharma
Healthcare Pharmaceu.

Leader
The highest percentage of market share belongs to the market leader. Generally, the leader
holds 20% market share while the nearest competitors called challengers hold 60% market
share. Remaining shares (20%) are captured by followers & niches. Marketing Strategies
(4Ps) are mainly influenced by the market leader while strong contestants challenge the
leader’s position. The market leader tends to maintain its position by following competitive
strategic objectives such as attract new users, discover new uses and encourage more usage.

127
Another major motive of the leader is to expand market share by product modification,
marketing mix modification & market modification. To defend market share, they limit
competitor possibilities to attack the main product. The leader might launch a counterattack
before being attacked by challengers for example, massive sales for expansion, price cut
or new product launching.

Challengers like Beximco, Incepta , ACI, ACME, have similar resources & capabilities to
challenge the leader (Square) to gain market share by following tactics such as front attack
leapfrog, flaunt encircle & guerilla attack.

Followers such as Aristro Pharma Drug International, Renata, Eskayef, Opsonin, Ibnsina,
AristoPharma, HealthCare, focus mainly on survival by following competitive strategies
like cloning which focuses on cost leadership imitating identical strengths and formulation
of products.

Specialists (Niches) in accordance to cardiac market companies such as Radiant, Servier,

Novertis can be labeled as Niches as they focus on a specific market segment chosen on
the basis of cost or innovation differentiation. They produce specific products with limited
resource offering superior quality of customized cardiac medicine for specific
cardiologists.

Mean scores Patients satisfaction about variables of MST of different categories of

Pharmaceutical companies (July 2017-July2018) and 4Ps have been shown in the tables
4.36 and 4.37 respectively. From the present primary research, it has been found the
consumption of cardiac medicines of different Pharmaceutical companies is not the same.
The ranking of the Pharmaceutical companies is made by findings of surveyed patients
(n=200).
Leader = Square
Challengers = Beximco, Incepta, ACME, ACI
Followers = Drug International, Renata, SK&F, Opsonin, Ibnsina,
Aristopharma, HealthCare
Niches= Unimed and Unihealth, Novertis, Popular, General, Radiant, Sanofi, GSK,
Biopharma, Eskayef, Pacific, Jayson, Servier, ASP

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The mean scores 3.85 and 3.84 of patients’ satisfactions about niche and follower
companies regarding the quality of product were found to be better than that of the leader
and challengers which are 3.73 and 3.74 respectively. Similarly, the cardiac medicines of
niche and follower companies were found more affordable than the leader and challenger
companies which is shown in the table 4.47. The mean scores of patients’ satisfaction about
the availability of medicines of niches and followers were more appreciated than leader
and challengers which are 4.16 and 3.99 respectively. The research revealed that the leader
and challengers of pharmaceutical companies maintain less communicative relationship
with patients than niches and followers that impact on patients’ satisfaction level. Mean
scores are shown in the table 4.43 which is the summary of the table 4.42.

129
Table: 4.42: Mean Score of Patients’ Satisfaction about 4Ps of the Top Ranking
Pharmaceutical companies according to 200 Patients’ perception.

Rank Company Product Price Place Promotion

Leader Square 3.73 2.51 3.88 1.78
Beximco 3.76 2.59 3.92 1.78
Incepta 3.73 2.46 4.02 1.74
Challengers
ACME 3.78 2.54 3.96 1.74
ACI 3.70 2.63 4.00 1.91
Renata 3.91 2.75 4.11 1.84
Drug. Int 3.63 2.55 3.77 1.93
Aristo
Pharma 4.07 2.83 4.13 2.07
Opsonin 3.99 2.63 3.90 1.87
Followers SKF 3.66 2.50 4.07 1.68
Healthcare
Pharmaceu. 4.02 2.71 3.75 1.54
Ibn Sina 3.58 3.05 3.85 2.30
Unimed 3.80 2.61 3.94 1.72
Novertis 3.93 3.08 4.42 2.08
Sanofi 3.72 2.30 4.10 1.60
Popular 3.80 2.63 4.25 1.88
General
Pharm 3.90 2.50 4.25 1.88
Radiant 3.87 2.67 3.83 1.67
GSK 3.80 2.83 3.67 2.00
Eskayef 3.70 2.50 3.75 1.75
Niches Bio Pharma 3.50 3.50 4.50 2.25
Pacific
Pharma 4.20 3.00 4.75 2.00
Orion 4.00 2.50 4.00 2.00
Jayson 4.20 3.50 4.50 1.00
Beacon 3.40 3.50 3.50 1.50
Servier 4.40 3.00 5.00 2.00
ASP 3.60 2.00 4.00 2.50
Source: Prepared by Researcher

Table 4.43 Summary: Mean Scores of Patients’ Satisfaction perception regarding

quality, affordability, availability and communication relationship of cardiac
medicines of four categories companies according to market shares July2017-
July2018

130
 Category of Quality Affordability Availability Communication
Companies (Product) (Price) (Place) (Promotion)
Leader 3.73 2.51 3.88 1.78
Challengers 3.74 2.56 3.98 1.79
Followers 3.84 2.75 3.99 1.89
Niches 3.85 2.80 4.16 1.85
Source: Prepared by Researcher

4.8 Gap Analysis between Overall Satisfactions about MST and Stakeholders
Marketing Strategies and Techniques are activities designed by the team of Marketing
Professionals that can be considered as successful when the needs of the target customers
are fulfilled by the strategic offers of the pharmaceutical companies. The research has been
carried out to analyze the overall satisfaction level of three categories of stakeholders of
the cardiac market in the pharmaceutical sector about the attributes of the Marketing
Strategies and Techniques. The satisfaction of doctors, patients and managers were found
to be significantly different.

The gap was analyzed by one-way ANOVA test. Null hypothesis of means regarding
overall satisfaction of 3 stakeholders is rejected.

F (df1, df2) =100.640, p=0.000 (Table 4.44). The Overall Satisfaction score of Marketing
Professionals (MP) is found highest (mean=4.06, SD=0.81) while it is lowest for Patients’
Satisfaction (mean=2.88 and SD=0.85). The Overall Satisfaction score of doctors is
moderate (mean=3.89, SD=0.99) which are given in the table 4.44 and figure 4.10.

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Table 4.44: Comparison of Overall Satisfaction of Stake-holders about MST by one-way ANOVA
Overall satisfaction
95% Confidence Interval
for Mean
Std. Lower Upper
N Mean SD Error Bound Bound Minimum Maximum
Doctors
156 3.8910 0.9874 .07906 3.7348 4.0472 1.00 5.00

Patients 200 2.8750 0.8502 .06012 2.7564 2.9936 1.00 5.00

Marketing
180 4.0611 0.8130 .06060 3.9415 4.1807 1.00 5.00
Professionals
Total 536 3.5690 1.03169 .04456 3.4815 3.6566 1.00 5.00

Source: Prepared by Researcher

Table 4.45 : F test ( ANOVA)

Overall satisfaction
Sum of Squares df Mean Square F Sig.
Between Groups 156.096 2 78.048 100.640 .000
Within Groups 413.350 533 0.776
Total 569.446 535
Source: Prepared by Researcher

Table 4.46: Multiple Comparisons Overall Satisfaction about MST and Stakeholders
Dependent Variable: Overall satisfaction

Tukey HSD
95% Confidence Interval
Mean Lower
(I) Stakeholder (J) Stakeholder Difference (I-J) Std. Error Sig. Bound Upper Bound
Doctors Patients 1.01603* .09407 .000 .7949 1.2371
MP -.17009 .09633 .182 -.3965 .0563
Patients Doctors -1.01603* .09407 .000 -1.2371 -.7949
MP -1.18611* .09048 .000 -1.3988 -.9735
MP Doctors .17009 .09633 .182 -.0563 .3965
Patients 1.18611* .09048 .000 .9735 1.3988
Source: Prepared by Researcher (*. The mean difference is significant at the 0.05 level.)

132
Figure 4.10 Mean difference of Overall Satisfaction and Stakeholders

If the managers of Pharmaceutical companies seek to increase sales, they should emphasize
on the variables of 4Ps for the customers’ satisfaction. Patients’ care needs to be improved
by considering their needs such as affordability, availability, efficacy and safety of cardiac
medicines. Patients are the ultimate end users of cardiac medicines. If they are not satisfied
and cured, that also has an effect on our national health and productivity as well.
Pharmaceutical companies should ensure they put ethical principles of the healthcare
business into practice.

4.9: Demographic Characteristics of Respondents

Data were collected from three groups of stakeholders. First group is cardiologists and
direct customers who prescribe medicines for the patients. Second group is cardiac patients
who are consumers but not decision makers to purchase. Third group is Marketing
Professionals who sell the medicines in the pharmaceutical market. The details of sample
characteristics are separately presented for discussion into demographic profile in the table
4.47, 4.48 and 4.49 respectively. Out of 536 total respondents 156 are cardiologists, 200
cardiac patients of the hospitals providing cardiac treatment and 180 marketing
professionals of the pharmaceutical companies. The demographic characters of three

133
categories stakeholders consist of Gender, Age, and Academic qualification and
Experience.
4.9.1 Demographic profile of Doctors (n=156)
Majority of the cardiologists are males comprising 76.6% of the total 156 and the rest 23.4
are females. Most of the cardiologists who participated in the survey fall below 30 years is
7%. Next major group between 30-40 years is 44.9%. On the other hand, age group 41-50
years is 37.2%, above 50 years is 10.3% respectively. Mean of overall satisfaction about
MST represents that young and senior cardiologists are more satisfied than medium age
group of 30-40 years.
Table 4.47: Demographic profile of Doctors
Demographic Characteristics Frequency Percent Mean of overall
of Doctors (N) (%) Satisfaction
Gender
Male 121 76.6 3.84
Female 35 23.4 4.06
Age
Below 30 12 7.7 4.17
30-40 70 44.9 3.19
41-50 58 37.2 3.94
Above 50 16 10.3 3.89
Education

MBBS 60 38.5 3.87

FCPS 24 15.4 4.04
MD 44 28.2 3.57
D.CARD and other 28 17.9 4.32
Experience
Less than 10 92 59 3.92
Above 10 64 41 3.84
Source: Prepared by Researcher

Academic Qualification of the cardiologists who are participated was found to be 38.5%
MBBS,15.4% FCPS,28.2% MD, D. CARD and others17.9%. Overall satisfaction having
academic qualification FCPS and D. CARD are found higher than MBBS and MD about
the Marketing Strategies and Techniques of Pharmaceutical companies. Cardiologists who
have experience prescribing cardiac medicines less than 10 years show higher satisfaction
than experience group more than above 10 years.

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4.9.2: Demographic profile of Patients (n=200)
A total of 200 patients who participated in the survey are 59.5% male and 4.5 % female.
Majority of the cardiac patients suffering from Cardiac disease are females. Among the
participants 20-30 years and 41-51years moderately satisfied about the marketing
strategies of pharmaceutical companies than age group 31-40 years. Patients with higher
education qualification are less satisfied with the marketing strategies of pharmaceutical
companies rather than patients with lower educational qualification. Patients who had been
using cardiac medicines for a longer period of time are less satisfied with the marketing
strategies of pharmaceutical companies than the patients with fewer years of cardiac
medicine usage.

Table 4.48: Demographic profile of Patients

Demographic Frequency Percent Mean of overall
Characteristics (N) (%) Satisfaction
of Patients
Gender
Male 119 59.5 2.88
Female 81 40.5 2.86
Age
20-24 7 3.5 3.0
25-30 5 2.5 3.0
31-35 14 7 2.93
36-40 21 10 2.67
41-50 57 28 2.82
Above 51 96 48 2.93
Education
qualification
S.S.C 27 13.5 2.93
H.S.C 40 20 3.00
Honors 81 40.5 2.89
Others 52 26 2.73
Experience
using cardiac
medicine
2-3 years 73 36.5 4.03
4-7 years 73 36.5 4.09
Above 8 years 54 27 4.00
Source: Prepared by Researcher

135
A total of 200 patients who participated in the survey are 59.5% male and 40.5 % female.
Majority of the cardiac patients suffering from Cardiac disease are females. Among the
participants 20-30 years and 41-51years moderately satisfied about the Marketing
Strategies of Pharmaceutical companies than age group 31-40 years.

Patients with higher education qualification are less satisfied with the Marketing Strategies
of Pharmaceutical companies rather than patients with lower educational qualification.
Patients who had been using cardiac medicines for a longer period of time are less satisfied
with the Marketing Strategies of Pharmaceutical companies than the patients with fewer
years of cardiac medicine usage.

4.9.3 Demographic characteristics of Marketing Professionals (n=180)

A total of 180 Marketing Professionals participated in the survey. Among them, 85% are
male and 15 % are female. Majority of the Marketing Professionals dealing with cardiac
medicines are male. Among the participants, the age group of 36-40 years is highly
satisfied about the Marketing Strategies of Pharmaceutical companies. Marketing
Professionals of other age groups are also satisfied to a good extent regarding these
strategies.

Marketing Professionals with education qualification of MS. Pharm Tech are more
satisfied with the Marketing Strategies of Pharmaceutical companies rather than Marketing
Professionals with other educational qualification.

Professionals who had been dealing with cardiac medicines for 11-15 years are more
satisfied with the Marketing Strategies than the Marketing Professionals with below 10
years and above 15 years’ experience of selling cardiac medicine.

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Table 4.49: Demographic Profile of Marketing
Professionals
Demographic Frequency Percent Mean of overall
Characteristics (N) (%) Satisfaction
Gender
Male 153 85 4.03
Female 27 15 4.26
Age
Below 25 5 2.78 4.0
25-30 93 51.63 4.0
31-35 56 31.11 4.04
36-40 19 10.56 4.42
Above 40 7 3.88 4.06
Education
qualification
MS. Pharm Tech 144 80 2.93
B.Pharm 25 14 3.00
MBBS, MBA, 11 6.11 2.89
BSS, MPH
Experience of
selling cardiac
medicine
Below 5 years 123 68 4.03
5-10 years 45 25 4.09
11-15 years 8 4.4 4.38
Above 15 years 4 2.2 4.00
Source: Prepared by Researcher

List of hospitals in Dhaka city surveyed for cardiologists and cardiac patients are NICVD,
BSMMU, DMCH, BIRDEM, SSMCH, SHSHCH, Mirpur Heart Foundation, Urobangla
Heart Foundation, IBN SINA Hospital, Anwar Khan modern Medical College, Labaid,
National Heart Foundation, CMH, Bangladesh Medical College Hospital, Mugdda Medical
Hospital.

List of Pharmaceutical companies where this survey has been conducted are as follows-
Unimed, Popular, Nuvista, Renata, Incepta, Aristopharma, Biopharma, Radiant, General
Pharmaceutical, ACI, ACME, Square, Beximco, Beacon, SKF, Sevier, Healthcare
Pharmaceutical, Orion.
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 CHAPTER 5

FINDINGS, CONCLUSION & RECOMMENDATIONS

5.1 Introduction

Finding of the present study will be discussed in two sections. In the first section, the
discussion will be on the impact of variables of MST on Overall Satisfaction of
Stakeholders and the second section will represent the impact of variables of MST on
Marketing Professionals’ Satisfaction about Sales of cardiac medicines.

The main findings of the research within the conceptual frame and relevant literatures have
been explained based on established theories. The present research has revealed the impact
of variables of Marketing Strategies and Techniques on Pharmaceutical Market (e.g.
cardiac market segment) where the Cardiologists, Cardiac Patients and Marketing
Professionals are considered as important components of the market. They are the three
Stakeholders out of many and the main influential elements of the Pharmaceutical Market
where the Sellers are the Marketing Professionals and the Customers and Consumers are
the Doctors and Patients respectively.

5.2 Discussion on the findings of relationship between variables of MST with

Stakeholders’ Satisfaction

Firstly, the comparative analysis of the impact of the variables of MST on Stakeholders’
Satisfaction combined and individual stakeholder’s satisfaction is presented here.
Secondly, the major findings of the research include hypotheses which have been analyzed
by Factor Analysis and Regression Analysis. The variables of the hypotheses have been
loaded into four factors such as Medicinal, Economic, Convenience and Communication
Benefits. Results of test of hypotheses have been given below in table no. 5.1 where most
of the hypotheses were found to have significant impact on Stakeholders’ Satisfaction and
a few hypotheses have insignificant impact on Stakeholders’ Satisfaction (Facility of
Model Pharmacy, Location of Pharmacy Place, Brand Image and New Cardiac Medicines)

138
Conversely, the magnitude of the effects is not the same for each independent variable on
Stakeholders’ Satisfaction. This can be found clearly by the value of β. Among the four
factors, Medicinal issue is the most significant for Stakeholders’ Satisfaction as it has the
highest β value (0.567).

The second important factor is the Communication issue which has second highest β value
(0.268). The Economic issue was found to be the third important significant factor with the
lower β value (0.210) than first two significant factors. These three factors have good value
and have significant effect on Stakeholders’ Satisfaction. Medicinal benefit is found as
most important factor because Stakeholders are highly concerned about the efficacy, safety,
price quality relation of the medicine as it is a lifesaving medicine. At the same time,
communicational relationship is crucial to them where Selling Skill of Medical
Representatives, Promotional incentive policies, Continuous Medical Education program
and Company Reputation are considered as important attributes of the MST that impact
Stakeholders’ Satisfaction. Similarly, they take the economic issue very seriously as it is a
lifelong medication. So, the important variables of affordable price and availability of
cardiac medicines have an impact on Stakeholders’ Satisfaction.

The factor labeled as Convenience benefit has insignificant impact on Stakeholders’

Satisfaction which has lowest β value (0.058) with greater p value 0.089 than 0.05 of alpha
level of significance. Impact of MST on Pharmaceutical Cardiac Market and findings of
Satisfaction of Stakeholders combined and individual Stakeholder (Doctors, Marketing
Professionals and Patients) have been given in the table 5.1. Relative important variables
of MST according to Stakeholders combined and individual Stakeholder (Doctors, Patients
and Marketing professionals) were found to be different. The fourteen variables such as
Efficacy, Brand Image, Safety Information, Company Reputation, New Medicines, Price-
Quality relation, Competitive Price, Availability, Location of Pharmacy, Facility of Model
Pharmacy, Selling Skill of Medical Representatives, Continuous Medical Education,
Awareness Campaign to prevent cardiac disease, and Promotional Policies are loaded into
four factors (F1, F2, F3 and F4) according to correlation.

139
Table 5.1: Impact of Marketing Strategies and Techniques on Stakeholders’
Satisfaction Combined and Individual (Doctors, Marketing Professionals and
Patients)

Sl. Marketing
Research hypotheses Stakeholders Doctors Patients
no Professionals
combined

H1 Relationship between Significant Significant Significant Significant

Efficacy and
Stakeholders’ (p=0.000) (p = 0.030) (p = 0.009) (p=0.000) Accepted
Satisfaction Accepted Accepted
Accepted

H2 Relationship between Insignificant Significant Significant Insignificant

Brand Image and
Stakeholders (p = 0.089) (p = 0.000) (p = 0.001) (p=0.228) Rejected
Satisfaction Rejected Accepted Accepted

H3 Relationship between Significant Significant Significant (p = Significant(p=0.000)

Safety Information impact (p = (p = 0.030) 0.001)
and Stakeholders 0.000) Accepted Accepted Accepted
Satisfaction
Accepted

H4 Relationship between Significant Significant Significant Insignificant

Company Reputation (p = 0.000)
and Stakeholders (p = 0.000) Accepted (p = 0.009) (p=0.228) Rejected
Satisfaction Accepted Accepted

H5 Relationship between Insignificant Significant Significant Significant

New medicine & (p = 0.089)
Stakeholder Rejected (p = 0.000) (p = 0.001) (p=0.013) Accepted
Satisfaction Accepted
Accepted

H6 Relationship between Significant Significant Significant Significant

Price -Quality relation impact (p = (p=0.002) Accepted
and Stakeholders’ 0.000) (p = 0.000) (p = 0.004)
Satisfaction Accepted
Rejected Accepted

H7 Relationship between Significant Significant Significant

Competitive pricing
and Stakeholder (p = 0.000) (p = 0.000) (p=0.000) Accepted
Satisfaction Accepted
Accepted

H8 Relationship between Significant Significant Significant Significant

Availability and
Stakeholders’ (p = 0.000) (p = 0.000) (p = 0.025) (p=0.000) Accepted
Satisfaction Accepted Accepted Accepted

140
 Sl. Marketing
Research hypotheses Stakeholders Doctors Patient
no Professionals
combined

H9 Relationship between Insignificant Significant Significant Insignificant

Locations of impact (p = (p = 0.000) (P=0.001) (p=0.228) Rejected
Pharmacy Place & 0.089) Accepted Accepted
Stakeholders Rejected
Satisfaction

H10 Relationship between Insignificant significant significant significant impact

Facilities of Model impact impact impact
Pharmacy and (p=0.003)
Stakeholders (p = 0.089) (p = 0.000) (p = 0.001)
Satisfaction Rejected Accepted Accepted Accepted

H11 Relationship between Significant Significant Significant

Selling Skill of MR (p = 0.000)
and Stakeholders (p =0.000) Accepted (p = 0.025)
Satisfaction Accepted
Accepted

H12 Relationship between Significant Significant Significant (p =

Continuous Medical (p = 0.000) 0.025)
Education for doctors (p = 0.000) Accepted Accepted
and Stakeholders Accepted
Satisfaction
Significant Significant Significant
H13 Relationship between Significant (p = 0.000) (p = 0.001) (p = 0.002)
Awareness Campaign Accepted Accepted Accepted
to prevent cardiac (p = 0.000)
disease and Accepted
Stakeholders
Satisfaction
Significant Significant
H14 Relationship between Significant (p = 0.000) (p = 0.025) Significant
Promotional Policies Accepted (p=0.002) accepted
and Stakeholders (p = 0.000) Accepted
Satisfaction Accepted
Source: Prepared by Researcher

The factors are labelled as Medicinal, Economical, Convenience and Communication

benefits. Result of Rotated Factor Matrix has been shown in the table 5.2.

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Table 5.2: Results of Rotated Factor Matrix on Satisfaction of Stakeholders combined
and individual (Doctors, Marketing Professionals and Patients.)

Stakeholders combined(536) Doctors (156) Marketing Patients (200)

Professionals(180)

F1* =Medicinal Benefit F1*=Economic-Medicinal F1*=Convenience F1*=Economic-medicinal

Benefit Medicinal Benefit Benefit

Awareness Campaign Availability Location of Pharmacy Availability

Price -Quality Company reputation Facilities of Model pharmacy Competitive Price

Safety Information Competitive price Brand Image Safety Information

Efficacy Price-quality Safety Information Efficacy

Awareness Campaign

New Cardiac medicine

F2*=Communication F2*=Medicinal- F2*= Communication F2=Medicinal-Convenience

relationship Benefit Communication Benefit Benefit Benefit

Selling Skill of Medical Promotional Policies Promotional Policies Company reputation

Representative

Promotional Policies New cardiac medicines Continuous Medical Brand Image

Education

Continuous Medical Selling Skill of Medical Availability Location of Pharmacy

Education Representatives

Company Reputation Brand Image Selling Skill of Medical

Representatives

Location of Pharmacy

F3=Convenience Benefit F3*=Communication Benefit F3*= Medicinal Benefit F3*= Medicinal-

Communication Benefit

Facilities of Model pharmacy Awareness campaign Efficacy Promotional Policies

Location of Pharmacy Continuous Medical Company Reputation Awareness Campaign

Education

Brand Image Facilities of Model pharmacy Price-Quality

New Cardiac medicine

F4* = Economic benefit F4*= Medicinal Benefit F4*= Economic benefit F4*= Medicinal Benefit

Competitive Price Safety Information Price -Quality New Medicine

Availability Efficacy
Source: Prepared by Researcher (* indicates that the factors have significant impact on overall satisfaction)

142
The factor 3 labeled as Convenience benefit was found to have an insignificant impact on
Stakeholders’ Satisfaction and has the smallest β value. Convenience issues are Facilities
of Model Pharmacy, Location of Pharmacy Place, New Medicine and Brand Image. The
dependent variable of the study is Stakeholders’ Satisfaction and 14 attributes of MST
loaded into four factors have been considered as independent variables. Individual
Stakeholder’s Satisfaction was found to be different.

5.2.1. Relationship between Medicinal Variables and Stakeholders’ Satisfaction

H1: Relationship between Efficacy and Stakeholders’ Satisfaction:
Efficacy of medicine is vital for all level of Stakeholders and accepted in this research (p
= 0.001 & β =0.567). This is matched with relevant literatures Murshed AM (2014)
mentioned the main element of product strategy is efficacy and effectiveness that results in
the remedy of the disease and has an effect on doctor’s satisfaction. Kalaskar et al., (2012),
Sultana et al., (2011) and Obaridat et al., (2011) carried out empirical study and found
positive influence on physicians’ satisfaction. It was tested through quantitative analysis
and was found to have a significant impact on stakeholders’ satisfaction of 3 categories
(Doctors, Patients and Marketing professionals).

H2: Relationship between Brand Image and Stakeholders’ Satisfaction:

Regression analysis test shows the p value is 0.089 for this case that demonstrates that this
is not statistically significant. Therefore, the hypothesis is rejected. Generic name is more
accepted than brand name, Ang Hoo Bee (2009) explained that strong brands build loyal
customers but consumers look for generic drugs with similar function at a lower price.
Guhl et al., (2015) and Irina P et al., (2009) found generic medicines are more preferred
than branded ones.

H3: Relationship between Safety Information and Stakeholders’ Satisfaction

Safety Information has a direct positive influence on Stakeholders’ Satisfaction, which

includes both combined and individual stakeholders (Doctors, Patients and Marketing
Professionals). It was developed on relevant literatures and is supported by the recent study.
The Doctors try to get Safety Information regarding the side effect, contradiction with other
drugs, frequency of use, dosage form and formulation standard of the cardiac medicines.
143
The Cardiac Patients who are ultimate users of medicines need to know about Safety
Information regarding medicines in the form of leaflets. The main responsibility of
Marketing Professionals is to inform all of these information to Cardiologists and Cardiac
Patients. Use of medicines depend on Safety Information (Bednark et al., 2005). Therefore,
it is clear that the Safety Information of cardiac medicines affects the satisfaction of
stakeholder. There are several studies which support the hypothesis. In this study, this
hypothesis is accepted (p = 0.000 and β =0.567).

H4: Relationship between Company Reputation and Stakeholders’ Satisfaction

Company Reputation has been found to exert a significant influence on Stakeholders’

Satisfaction as the beta value of 0.567 with a ρ value of 0.000. Company Reputation is a
very important element of MST for Cardiologists and creates a point of difference,
especially for a lifesaving cardiac medicine which is supplied by the company to the
patients under a doctor’s prescription. Patients are not aware about the company. Therefore,
this hypothesis is accepted for stakeholders’ satisfaction of both doctor and managers
combined with the exception of patients. Murshid, AM (2014) mentioned in his empirical
study that Company Reputation has strong relationship with physicians’ satisfaction.

H5: Relationship between New Medicine and Stakeholders’ Satisfaction.

H5 was not supported. Impact of New Medicines on Stakeholders’ Satisfaction is found to

be insignificant as New Medicines face challenges for acceptance due to effectiveness and
safety reasons. But this hypothesis is supported by individual Stakeholder’s Satisfaction.
Relationship between Satisfaction of Doctor, Manager and patient, regarding New
Medicine shows the significant p value, which is statistically significant. This is shown in
table5.1. Therefore, the hypothesis is accepted. This finding was consistent indirectly with
the study conducted by Anthony C et al., (1999)

5.2.2 Relationship between Economic Variables and Stakeholders’ Satisfaction

H6: Relationship between Price Quality Relationship and Stakeholders’ Satisfaction.

One of the most important objectives of the study is to find the impact of Price Quality
relationship of Pricing Strategy on Stakeholders’ Satisfaction. This hypothesis is strongly
144
supported by significant p value=0.001 and β value= 0.567, based on previous study
conducted by Murshid, et al., (2014). The Price Quality relationship has a positive
influence on Stakeholders’ (doctors) satisfaction and individual stakeholder’s satisfaction.

H7: Relationship between Competitive Price and Stakeholders’ Satisfaction.

This hypothesis is developed based on a certain literature where it is shared that the
affordable price or competitive price has a positive impact on Stakeholders’ Satisfaction
that is also validated for individual Stakeholder’s Satisfaction (Doctors, Patients). The
Regression analysis shows that p = 0.000, and β =0.567 based on these results. Therefore,
H7 is supported and accepted which is statistically significant. Kalaskar et al., (2012),
Sultana et al., (2011), Kotler and Amonstrong (2008), Sayandhan et al., (2008) explained
that the Price Quality relationship has positive impacts on customers’ satisfaction which is
accepted worldwide for all type of industries.

5.2.3 Relationship between Convenience Variables and Stakeholders’ Satisfaction.

H8: Relationship between Availability and Stakeholders’ Satisfaction.

The study also investigated the impact of Availability of cardiac medicines on

Stakeholders’ Satisfaction and found a positive relationship between these two variables.
(As shown in table 5.1)

The coefficient of overall satisfaction (β =0.210, p-value = 0.000) demonstrates that

Availability of medicines is one of the strong attributes of MST that impacts the
Satisfaction of the Stakeholders combined and individual Stakeholder (Doctor, Patient and
Marketing Professional). Thus, the hypothesis is accepted. Sayandhan et al. (2008)
investigated the empirical study and found that the Availability of medicines has a positive
influence on physicians’ (Ophthalmologists’) satisfaction.

H9: Relationship between Location of Pharmacy Place and Stakeholders’ Satisfaction.

The study as shown in table 5.1 demonstrates that the impact of Location on Stakeholders’
Satisfaction is found to have no strong effect as coefficient of β is found to be 0.058 with
p value=0.089. This hypothesis is not accepted. In the case of Patients’ Satisfaction, it is

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also not accepted as cardiac medicines are lifesaving drugs, patients will purchase it from
anywhere it is available. The p value is 0.228 which is greater than α value of 0.05.

In case of individual stakeholder like Doctors and Marketing Professionals, the hypothesis
is accepted. This study has found that the Location of Pharmacy Place is an important
variable of MST that impacts the Satisfaction of Doctors and Marketing Professionals. The
p value is 0.000 for both doctors and Marketing Professionals. However, the doctors and
Marketing professionals are not actual customers as the patients are the main consumers
who purchase the quality medicine wherever they can get it. Guhl et al. (2016) found the
positive relationship between Location of Pharmacy Place and Customers’ Satisfaction.

H10: Relationship between Facility of Model Pharmacy and Stakeholders’ Satisfaction.

The comparative study, as shown in table 5.1, that β is 0.058 and ρ value is 0.089 for
satisfaction of stakeholders (combined). The hypothesis regarding Impact of Model
Pharmacy on combined Stakeholders’ Satisfaction is rejected. But impact of Facility of
Model Pharmacy newly introduced Place Strategy in Bangladesh is found to have a
significant influence on quality management of medicines in all aspect. Therefore, this
hypothesis is accepted by each individual stakeholder. The values of p for satisfaction of
doctors, managers and patients are found to be 0.000, 0.001 and 0.003 respectively. In this
study, it is clear that there is a strong effect of Model Pharmacy on the Satisfaction of the
3 categories of stakeholders separately.

5.2.4 Relationship between Communication Relationship Variables and

Stakeholders’ Satisfaction.

H11: Relationship between Selling Skill of Medical representatives and Stakeholders’

Satisfaction.

Selling or Communication Skill of Medical Representatives (MR) is very important for

both Doctors and Pharmaceutical Companies because MRs work as a bridge between them
to convey all types of medicinal information from companies to doctors who prescribe
medicines on the basis of the information. This study found that the impact of the Selling
Skill of Medical Representatives has a very strong relation with Stakeholders’ Satisfaction

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and Doctor’s satisfaction with p value = 0.000 and p value = 0.000 respectively. Whereas
the table 5.1 has shown the relationship in the case of Marketing Professionals to be, p =
0.025 and for patients’ satisfaction, it is found to be p = 0.000. This hypothesis is accepted.
The result of the findings is consistent with the past literature by Sayandhan et al., (2008)

H12: Relationship between Continuous Medical Education program for the

Doctors(CME) and Stakeholders’ Satisfaction

CME plays an important role on the prescribing behavior of Doctors. It has a positive
impact on Doctors’ mind and Satisfaction. Taneja et al., (2008) investigated the impact
of promotional mix on doctors’ prescribing behavior and found a positive relationship with
CME and prescribing behavior. Wang and Wallander (2006) revealed that CME has a
positive influence on doctors to prescribe. This hypothesis is accepted by the Stakeholder’s
Satisfaction, Doctors and Managers, with the p value is 0.000, 0.000 and 0.025
respectively. CME has exerted a positive relation in Stakeholders’ Satisfaction.

H13: Relationship between Awareness Campaign to prevent cardiac disease and

Stakeholders’ Satisfaction.

Awareness Campaign has shown a significant influence on Stakeholders’ Satisfaction and

Satisfaction of individual Stakeholder. H13 was supported this finding and was consistent
with that of previous literature mentioned by Sayandhan et al., (2008). It asserted a positive
correlation with β=0.567 and p value= 0.000.

H14: Relationship between Promotional Policies and Stakeholders’ Satisfaction.

This study found that Promotional Policy which represents promotional incentive has
exerted a positive correlation with stakeholders’ satisfaction. The value of p is 0.000 with
β=0.268 for all stakeholders’ satisfaction. This finding is important for Pharmaceutical
industry and consistent with the past literature by Sayandhan et al., (2008)

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5.3 Discussion on the findings of relationship between variables of MST and
Marketing Professionals’ Satisfaction about Sales

Section Two: Findings of Impact of MST on Sales Performance of Cardiac medicines in

Bangladeshi Pharmaceutical Market according to Marketing Professionals satisfaction.

5.3.1 Relationship between Medicinal variables of MST and Marketing Professionals’

Satisfaction about Sales

H1: Efficacy of cardiac medicine has positive impact on Marketing Professionals’

Satisfaction about Sales.

In this research, the hypothesis is accepted. It was tested by quantitative analysis and was
statistically significant where p value is 0.009 and β value is 0.183 The Efficacy of cardiac
medicine has positive impact on Sales and Market Share. It has been accepted in this
research and validated by previous literatures. Ang Hooi Bee (2008) emphasized that the
quality and efficacy of medicines are the crucial elements that need to match with certain
specific standards and is the only way to get rid of the cardiac problem. It has a positive
impact on Sales and Market Share.

H2: Brand Image of cardiac medicines have positive impact on Marketing Professionals’
Satisfaction about Sales.

Brand Image has direct positive impact on Sales of cardiac medicines. It is developed based
on few relevant literatures which is significantly supported by this study. The p value is
0.001 and β value is 0.190. It is clear that in this study there is strong relationship of Brand
Image and Sales. Guhl et a.,l (2015) studied the impact of Brand and Generic drugs on
Doctors’ prescribing behavior and Sales and it is found to have a significant effect.

H3: Safety Information of cardiac medicine has positive impact on Marketing

Professionals’ Satisfaction about Sales.

It is similar with the findings of other relevant literatures. Safety Information regarding
side effects, contra indication, frequency of uses, are very important elements for the
doctors and the patients (Dimitris,2004). Cardiac medicines are lifesaving. In this study, it
is clear that there is a strong correlation between Safety Information supplied by the
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pharmaceutical companies and sales. Thus, the hypothesis is accepted and p value is 0.001
with β value 0.190

H4: Company Reputation has significant impact on Marketing Professionals’ Satisfaction

about Sales.

Company Reputation exerts a significant influence on sales as β value 0.190 and p value
0.001. Company Reputation creates a difference for the cardiac medicines. This finding is
also supported by other relevant literatures. The hypothesis is accepted by quantitative
regression analysis. Sayandhan etal., (2008) revealed the influence of organizational image
on physicians’ prescribing decision and sales.

H5: New Cardiac Medicine has significant impact Marketing Professionals’ Satisfaction
about Sales.

New Cardiac Medicines which add new alternative and better efficacy and dual effect
attract cardiologists to prescribe new medicines for quick effectiveness. New medicine is
the most significant variable with the highest β value 0.190 and p value 0.001. This
hypothesis is accepted in previous study mentioned by Chaganti SR (2005) and Dogramatiz
D (2004) that new medicine with better outcomes is a major contributing element that
impacts doctors’ prescription and sales.

5.3.2 Relationship between Economic Variables of MST and Marketing

Professionals’ Satisfaction about Sales

H6: Price signal quality has positive impact on Marketing Professionals’ Satisfaction
about Sales.

That price quality relationship directs a positive influence on sales that was developed in
relevant literatures. The hypothesis is significantly supported by this present study. Price
is an economic issue and cardiac medicines are life- saving drugs. Quality is important
element for effectiveness of medicine and price signals quality of the medicines. β value is
0.165 and p value is 0.004 This hypothesis is accepted and can be explained by the fact
that patients look for affordable price for cardiac treatment. Ang Hooi Bee (2008) carried

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out an exploratory empirical research on impact of marketing mix on market share and
found that price-quality relation has a positive influence on sales and market share.

5.3.3 Relationship between Convenience variables of MST and Marketing

Professionals’ Satisfaction about Sales

H7: Availability of cardiac medicines has positive impact on Marketing Professionals’

Satisfaction about sales.

This study investigated the impact of availability of cardiac medicines found positive on
sales according to Marketing Professionals of the Pharmaceutical Companies. The
coefficient of overall satisfaction about sale is β =0.128 and p= 0.025. This hypothesis is
accepted and indicates that there is moderate relationship between availability of cardiac
medicines and sales performance. Ang Hooi Bee (2008) and T.sayandhan et al., (2008)
found that availability has positive impact on sales and market share.

H8: Location of Pharmacy has positive impact on Marketing Professionals’ Satisfaction

about Sales.

The study as shown in table 5.1 illustrates the impact of Location of Pharmacy has strong
positive correlation with the sales performance. The value of β is found to be 0.190 and p
value is 0.001 which is less than α value 0.05. Thus the hypothesis is accepted by
quantitative regression analysis which is statistically significant. Kotler P (2002), Mc
Carthy (1999) explained that the Location of Retail shop has significant impact on sales
for any kinds of products.

H9: Facility of Model Pharmacy has positive impact Marketing Professionals’ Satisfaction
about Sales.

Facility of Model Pharmacy newly introduced Place Strategy in Bangladesh (2017) is

found to have a significant impact on distribution network and sales. To maintain quality,
availability, researchable price and consulting by ‘A’ grade pharmacists, the role of Model
Pharmacy has shown a positive impact on patients’ perception (Sultana, 2018). In this
present study, it has been found that the Facility of Model Pharmacy has significant impact
on sales. The β and p value are 0.190 and 0.001 respectively.

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5.3.4 Relationship between Communication variables of MST and Marketing
Professionals’ Satisfaction about Sales

H10: Selling or Communication Skill of Medical Representatives has positive impact

Marketing Professionals’ Satisfaction about Sales.

In this study, the Selling Skill of MR was found to have a moderate relationship with sales
performance of cardiac medicines. MR plays an important role to convey the medicinal
information from pharmaceutical companies to doctors for the decision process of
prescribing medicines. The hypothesis is supported by previous study. The value of β is
0.128 and p is 0.025 which are within the significant limit of α<0.05.

Rizwan, et al., (2014) studied on Marketing Mix Strategy in the Pharmaceutical industry
and found Promotional Policies and spending on skill development have a positive
influence on the selling of medicines.

H11: Continuous Medical Education program for doctors has positive impact Marketing
Professionals’ Satisfaction about Sales.

Continuous Medical Education program through seminar conference for the doctors has a
significant impact on doctors’ prescribing decision and helps to position medicines in
doctors’ mind to prescribe. The researchers Rizwan et al., (2014) revealed that it is one of
the important elements of MST to motivate doctors to prescribe medicines of certain
Pharmaceutical Companies. Thus, it helps to influence Sales Performance of the medicines.
It has been found that CME has positive impact on sales. The value β is 0.128 and p value
is 0.025. Thus the hypothesis is accepted.

H12: Awareness Campaign to prevent cardiac disease has positive impact on Marketing
Professionals’ Satisfaction about Sales.

This hypothesis is supported and has a significant influence on sales. The finding is found
to be consistent with the previous literature. It exerted a positive strong correlation on
Sales. It was found that the β value is 0.190 and p value is 0.001 which are statistically
significant. Sayandhan et al., (2008) revealed the influence of awareness campaign on
prescription decision and sales.

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H13: Promotional Policies have positive impact Marketing Professionals’ Satisfaction
about Sales.

This study has shown that there is moderate positive correlation between promotional
incentives and sales. The p value is 0.025 and β value is 0.128. This finding is also
consistent with past research carried out by Ang Hooi Bee (2008), Rizwan RA et al., (2014)
and Sayandhan, T. et al., (2008).

5.4 Conclusion
This study has been conducted in order to meet some objectives. These objectives may
include finding out the significant factors that affect stakeholders’ satisfaction and sales of
Pharmaceutical cardiac market segment in Bangladesh. The research has measured the
significant level of relationship between Stakeholders’ Satisfaction and variables of
Marketing Strategies and Techniques offered by the Pharmaceutical companies. As the
study was conducted on three categories of stakeholders such as Cardiologists, Cardiac
Patients and Marketing Professionals of cardiac market segment, it gives us opportunities
to compare the relative important variables of MST with different influential stakeholders
on the medicinal, economic, convenience and communication issues. From this, it is easy
to find out whether there is any significant difference among the three categories of
Stakeholders’ Satisfaction or not. By using Factor Analysis several results have been
achieved. Based on several statistical scientific researches and results found by this study,
a conclusion can be made-

It is found by the study that there is significant correlation of satisfaction level of the three
categories of stakeholders (combined) with three out of the four factors. These three factors
are medicinal, economic and communication relationship benefits with the exception of
the convenience benefit factor. There is a significant difference between mean scores of
Overall Satisfaction about MST and Stakeholders. The impact of variables of MST on
Sales according to Marketing Professionals’ Satisfaction was found to have statistical
significance.

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5.5 Recommendation
Recommendations have been based on the findings of this current research. The most
important attributes of MST have a significant impact on Stakeholders’ Satisfaction and
Sales of cardiac medicines. The variables are loaded into four factors labeled as medicinal,
communication, economic and convenience benefits. Analysis via Rotated Factor Matrix
have found significant impact of three of these factors (medicinal, communication,
economic benefit) on stakeholders’ satisfaction. The relative important variables are
Awareness campaign to prevent cardiac disease, Price Quality relationship, Safety
information, Efficacy of cardiac medicines, Selling Skill or Communication Skill of
Medical Representatives, Promotional Policy, Continuous Medical Education for the
doctors, Company Reputation, Affordability and Availability.

Model Pharmacy, a relatively new concept introduced into Place Strategy in 2017 in
Bangladesh, has been found to have a significant impact on Patients’ Satisfaction regarding
quality, reasonable price, data base system and counseling by “A” grade pharmacists.

Overview of overall discussion in this study and conclusions that were derived from the
statistical analysis of research hypotheses are presented here. The implications of the
research outcomes can be recommended in the following perspectives:

5.5.1 Theoretical Implications

This research was undertaken to understand the impact of factors of Marketing Strategies
and Techniques on Pharmaceutical Market in Bangladesh. The Pharmaceutical industry is
one of the most promising and second largest sectors that contribute to the national income.
The sales growth of the pharmaceutical companies depends on Marketing Strategies and
Techniques to gain competitive advantages over competitors. This study aimed to find the
factors relevant to Stakeholders’ Satisfaction and develop relationship between them. The
current study has found important factors such as medicinal, economic, convenience and
communication relationship benefits that impact on satisfaction of doctors, patients and
marketers and sales. This research has used factor analysis which has given more credible
evidence in the analysis of the relationship between the independent variables of Marketing

153
Strategies and Techniques and the satisfaction of three categories stakeholders in the
pharmaceutical cardiac market. This research may inspire further study of other therapeutic
segments of the pharmaceutical market. This research could guide the researchers to better
understand how MST, benefits and stakeholders’ satisfaction interact in pharmaceutical
industry in Bangladesh. Collaborative researches of Pharmaceutical companies and
Universities of home and abroad for new medicines and Pharmaceutical Marketing are very
much needed in order to compete in highly competitive markets, both nationally and
internationally.

The present study has revealed that marketers have lack of information about their
customers and consumers (e.g. Doctors and Patients). This result indicates that important
factors evaluated by managers were not always very good at recognizing the major causes
of dissatisfaction of doctors and patients. The researchers carry out the market research,
particularly in Bangladesh, to identify the customers’ perception towards MST and
recommend the managers to revise Marketing Strategies from the point of view of doctors
and patients

5.5.2 Managerial Implications

Awareness campaigns to prevent cardiac disease is the number one finding among all
variables of MST that need to be practiced in Bangladesh. All stakeholders unanimously
agree that it will help to reduce death, and alleviate overall health quality of the masses.

Pharmaceutical companies can take initiative to prevent the occurrence of cardiac diseases
through media advertisement, sponsoring sports or physical activities through games and
competition. Media advertisement on changing the food habit and life styles that causes
cardiac diseases can help to create an impact on the mind of the Bangladeshi people. Social
Media Marketing is a cost effective alternative that can be used for creating awareness
about the diseases to reach the large number of people and educate them easily. The use of
internet based marketing, e-detailing, sale analytical software can help them to optimize
the use of Medical Representatives and decrease the cost of the product. Animated videos,
research articles, advertisements on journals and awareness campaigns can have a positive

154
impact on doctors, patients and other stakeholders that helps them to understand the
information in a very simple way.

Price Signal Quality represents the relationship of price and quality, efficacy and safety
information of cardiac medicines as lifesaving drugs which are prescribed for lifelong
medication. Premium pricing strategy which indicates high quality medium price adopting
flexible approach to pricing will be suitable. Pharmacological effectiveness of the
medicines and affordable pricing exert a significant impact on the satisfaction of doctors
and patients. Brand image is not preferable more than generic low price medicines. Cardiac
medicines are prescribed by the doctors to cardiac patients who are the end consumers and
in turn, they (patients) accept the doctors’ prescription in good faith. The doctor should
also consider the affordability of the drugs they prescribe by taking into account the
purchasing power of his individual patient and follow ethical practice while prescribing.

Perceived value or benefits of Marketing Strategies and Techniques impact doctors’

satisfaction which influences the sales of medicines. So the positive effect of medicine
quality, efficacy, low price, availability and promotional policies make cardiologists
satisfied. Managers of pharmaceutical companies should have planning to ensure medicine
quality within an affordable price. It is crucial to create value of money for the patients’
treatment along with other stakeholders.

Managers of pharmaceutical companies can use the current findings to develop their
strategies that will enhance doctors’ perceived value regarding the benefits of MST and to
improve their satisfaction.

The significant impact of promotional policies (Product samples, product literature, gift
items or gimmicks), Selling Skill of Medical Representatives and Continuous Medical
Education (CME) program for doctors through seminar and conference on doctors’
satisfaction have been found in the current study. Pharmaceutical companies should ensure
ethical practice in marketing medicine at all times. They need to innovate new ways to deal
with the customers’ and consumers’ requirements. The impact of social media is very
effective now-a-days and a very powerful promotional tool which has reshaped the whole
pharmaceutical industry in Bangladesh.

155
The Selling Skills and Scientific Knowledge regarding medicines of Medical
Representatives play an important role to persuade doctors to prescribe medicines and
maintain relationships with pharmaceutical companies and impacts their satisfaction.
Regular visits of Medical Representatives to doctors is an important tool or technique for
Pharmaceutical companies to keep a vigilant eye on the requirements of doctors and
patients.

Cardiac medicines are lifelong medications yet cardiac patients are not satisfied about the
price of cardiac medicines. Pharmaceutical companies can reduce the promotional budget
for doctors and price for patients. They invest more on Awareness Campaigns to prevent
causes of cardiac diseases for the public.

The current study has found the important factors, medicinal and economic, that impact
patients’ dissatisfaction so that policy makers such as the Government and Marketing
Managers can invest their effort to improve those issues. The findings of the present study
indicate that patients are more prone to buying medicines which have high efficacy and
have affordable price. Marketers need to deploy new forms of Strategy with experimental
features that can exert positive impact on patients’ perception and satisfaction. Marketing
managers can enhance the satisfaction of doctors and patients by improving efficacy,
offering affordable price and extending communication relationship to both doctors and
patients.

5.5.3 Governmental Implications

Government should monitor the implementation of New Drug Policy 2016 by increasing
manpower and drug testing laboratories in the Drug Administration to regulate standard
quality of medicines. Government should also monitor the pricing policies of
pharmaceutical companies ensuring the transparency of costs of inputs producing and
marketing medicines.

The new concept of Place Strategy “Model Pharmacy”, introduced by the new drug policy,
can solve many problems by ensuring quality, availability, affordability and safety use of
medicines through the counseling of “A” grade pharmacists. Monitoring of implementation
of new concepts by DGDA authority will be helpful for patients’ benefit.
156
Government can introduce health insurance policies for cardiac patients to reduce the cost
of cardiac treatments.

Government through DGDA will encourage and support Pharmaceutical companies to take
initiative for producing raw materials at API Parks in Munsigonj in Bangladesh to reduce
the price of medicines.

Government of Bangladesh can provide support in collaboration researches of

Pharmaceutical companies and Universities of home and abroad for new medicines better
efficacy and dual effectiveness.

5.6 Contribution of the Research

This empirical study on the impact of Marketing Strategies and Techniques on
Stakeholders’ Satisfaction and Sales of Pharmaceutical Market is the first initiative so far
known to researchers in a Bangladeshi context.

The research has evaluated a gap between the offer of Marketing Strategies and Techniques
with overall satisfaction of stakeholders that were not done before in Bangladesh
quantitatively for the cardiac market segment and other therapeutic segments.

The study has contributed to the theory as dissatisfaction of patients was not measured
before in the context of Bangladesh. This research may contribute to the literature of
developing countries.

Again, the research on the recent concept of Model Pharmacy under the newly introduced
drug policy (2016), has shown important factors such as quality of medicines, data base
systems, reasonable price counseling by “A” grade pharmacists of Model Pharmacies
better than conventional retail pharmacy which was not quantitatively analyzed before in
Bangladesh. This concept of Model pharmacy is rare in Bangladesh and other developing
countries. These findings may contribute to the literatures.

On the other hand, this research has used factor analysis which has given more credible
evidence in the analysis of the relationship between the independent variables of Marketing
Strategies and Techniques on the satisfaction of three categories stakeholders in the

157
Pharmaceutical Cardiac market. This research may inspire further study of other
therapeutic segments of the pharmaceutical market.

This study has tried to focus on the important attributes of Marketing Strategies and
Techniques that impact on the satisfaction of doctors, patients and marketers. The Strategy
makers of Pharmaceutical companies can revise their policies and take into consideration
the relatively important factors needed to satisfy the needs of cardiac patients since the
Pharmaceutical industry is a healthcare business which separates it from the industries of
other consumer goods.

The present study has revealed the lack of detailed information of marketers about needs
of their customers and consumers (e.g. Doctors and Patients). The relative important factors
of MST evaluated by doctors and patients were found to be different from that of the
Marketing Professionals of Pharmaceutical companies. This result indicates that important
factors evaluated by managers were not always very good at recognizing the major causes
of dissatisfaction of doctors and patients. The Managers of Pharmaceutical companies,
particularly in Bangladesh, should better understand the customers’ perception towards
MST. The companies need to revise their perspective from the point of view of doctors and
patients. These findings may contribute to the literatures of Pharmaceutical Marketing
Research in Bangladesh and development of Marketing Strategies and Techniques for the
Pharmaceutical companies.

5.7 Limitations of the Study

 Only cardiac segment of Pharmaceutical market in Bangladesh has been
selected to evaluate the impact of MST using exploratory factor analysis due
to constraint of resources.
 Only three categories of Stakeholders, such as Cardiologists, Cardiac patients
and Marketing Professionals, have been selected as respondents. Other
Stakeholders like wholesalers, retailers, regulators competitors etc. haven’t
been considered due to time constraints.
 Only Dhaka based Hospitals and Pharmaceutical companies were considered
highlighting its geographical limitations.
 The respondents did not want to disclose all information due to confidentiality.
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 The respondents like doctors, managers were found to be too busy with work
pressure and not available for data collection. Constant reminders may have
irritated to fill up the questionnaires in non-serious mood. Despite best efforts
reluctance of respondents and response bias may have come.
 Results of the cardiac market cannot be generalized to other segments of
industries like food, agriculture etc.

5.8 Direction for Future Research

This type of study is very important since the Pharmaceutical market produces medicinal
products which are crucial for treatment regimen of patients. However, not sufficient work
has been conducted in this context in Bangladesh although this type of research work is
very common in the West and other developed nations. Gradually, Bangladesh has
achieved a competitive and respectable position for producing and marketing different
therapeutic groups of medicines home and abroad. Cardiologists, Cardiac patients and
Marketing Professionals have only been surveyed in the context of Bangladesh. This can
also be considered in the context of South East Asia for further studies. The topic of the
study is to evaluate the impact of Marketing Strategies and Techniques on the satisfaction
of doctors and patients. In order to improve this sector and sustain the credibility in the
competitive world market, stakeholders’ satisfaction and sales are two of the most
important issues.

The study has identified the factors that are crucial to the doctors and patients for their
satisfaction. So policy makers like pharmaceutical companies and the government of
Bangladesh can invest their time, money and effort for the improvement of those factors.
On the other hand, the study involves the cardiac market segment which has achieved the
third position in sales in comparison to other the therapeutic segments of the Bangladeshi
Pharmaceutical Market. By involving the cardiac market segment, a good comparison can
be made on this issue and the outcome of the research may lead to proper guidelines for
other therapeutic segments of the Pharmaceutical Market in Bangladesh.

The study has both theoretical and practical significance as the findings of the research
may fill in the important research gaps that were identified in the literature.

159
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Appendix A

i. Questions for expert opinion of Doctors:

1. Do you think that Pharmaceutical companies provide quality efficacious medicines to

cure cardiac diseases?
2. How do the Pharmaceutical companies develop brand image to satisfy your need better
than generic name?
3. Does Company reputation influence you to prescribe?
4. Do Pharmaceutical companies supply you enough safety information about the
medicines?
5. How do the Pharmaceutical companies introduce new medicines with better benefits
which outsell old medicines?
6. How do the Pharmaceutical companies try to position medicine in your mind
successfully?
7. Do you think that Prescription survey plays a vital role in understanding the sales
performance?
8. Is quality of the medicines reflected actually in Price?
9. Are knowledge and communication skill of medical representatives about medicines
important factors to you?
10. Does Medical representative’s (MR) regular visit effect on your prescription?
11. How do seminars, new product launch program and study tour help doctors?
12. Is E-detailing of cardiac drug information very effective?
13. How do Continuous Medical Education program for doctors regarding medicine
Impact on prescribing decision?
14. Do you think that Free samples, gifts with company’s name, monographs help to
remind doctors’ the medicines to prescribe?
15. Do you think that public relation and publicity through awareness campaign for cardiac
patients is essential? Why?

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 ii. Questions for expert opinion of Marketing Professionals:

1. How does Product portfolio analysis help to find the product position in BCG Matrix?
2. Do you set price on the basis of cost per unit of the medicines?
3. Is competitive price an important consideration for setting price?
4. Are Medicines available when needed at retail and hospital pharmacies?
5. Do you think Locations of retail pharmacies are imperative to reduce customer
transportation cost?
6. Is Regular assessment of sales data crucial for the companies’ sales performance?
7. Is Term of payment important to attract retailers to keep the medicines of the
companies?
8. Are Discount methods helpful for selling medicines?
9. Do you think that Distributors’ feedback regarding competitors’ strategies is very
important?
10. Do you think that Company’s own distribution system is crucial for sales
performance?
11. How does training of marketing people help on sale?
12. Does Marketing budget (expenses) have an impact on sales?
13. Is Motivation of MR very important for sales?
14. What do you think that outsourcing of foreign investors to produce cardiac medicines
in Bangladesh will increase the sales growth nationally and internationally?
15. Do your marketing department post in-detail marketing plans in its internal website to
allow managers, employees in different locations to consult and change?
16. Please tell your company’s strategies to compete with your competitors by
 Expanding market by new uses, new doctors
 Position defense
 Flank defense
 Counter offensive
 Diversification

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  Contraction defense
 Specific attack
17. Does your company carry out market research to get up-to-date information about
competitors and doctors to adjust its 4ps strategies?
18. Does your company apply the research finding to develop strategies to
 Segment
 Target
 Differentiate
 Positioning
 other
19. Is your marketing department organized by-
 Function
 Geography
 Product
 Doctors
 other
20. What percentage of their sales does your company spend on marketing?
21. Does year company practice total quality management (TQM) in team work of
marketing department to share knowledge, experience and problem solving skill to
satisfy their customers (doctors, retailers)?
22. Do you segment cardiologists according to -
 Experience
 Reputation
 Qualification
 Age
 Gender
 Area of practice
 Number of prescription
 psychology
23. Do you segment patients according to
 Income
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 Education
 Age
 Sex
 Psychology
24. How do you survey of patient’s reaction to a change in price and why?

iii. Questions for expert opinion of Academicians:

1. The recent concept of model retail pharmacy in important places of Dhaka which have
a huge stock of a wide range of medicines will be helpful for patients and companies.
What do you think?
2. Collaboration program with pharmaceutical companies and universities will be helpful
for market research and developing marketing strategies. What do you think?
3. API parks will produce the raw materials and reduce cost and price of medicines. What
is your opinion?
4. Do you think the access and interaction of MRs with doctors without following code
of ethics is making them lose the trust of public?
5. Health insurance policies can help patients’ affordability of cardiac treatment.
6. New drug policy 2016 will assure the transparency of all transaction regarding
medicine quality and pricing.
7. Patients can influence doctors to prescribe medicines of their choice through internet
information and company reputation. What is your opinion?

iv. Questions for patients

1. What do you think about efficacy of cardiac medicines for your treatment?
2. What safety information do you get from the company in medicine package?
3. What information retailer gives you if you do not get prescribed medicines?
4. Will you purchase medicine of other company? Why?
5. Do you think reputation of the company influences on your purchasing?
6. Do you think the price of the medicines is affordable according to your income?
7. Brand names of medicines influence you to buy medicine. What is your opinion?

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8. The location of retail pharmacies near your residence influences you to buy prescribed
medicines to reduce your transportation cost.
9. Facilities of the recent concept of model pharmacies have impacted on your purchasing
decision to purchase from model pharmacies than from retail pharmacies.
10. Do you think pharmaceutical companies provide awareness campaign to prevent causes
of cardiac disease?
11. Do you think government rules and regulation is effective to reduce price of the
medicine?
12. Do the pharmaceutical companies communicate with you about the outcome of
medicine?
13. Do you get health insurance support for the treatment of cardiac disease from your
employers and government?
14. Do you request doctors to prescribe medicines of your choice through internet
information about cardiac medicines and company reputation?

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APPENDIX B (Final Questionnaires)

i. Questionnaire for Doctors
a) Demographic information
1. Gender: 2. Age: 3. Academic Qualification:
4. Years of Experience dealing with cardiac medicines: 5. Designation:
b) Scale based Questionnaire: Please put tick (✓) marks against each statement to
evaluate the impact of Marketing Strategies and Techniques of Bangladeshi
Pharmaceutical companies on your satisfaction to prescribe the cardiac medicines.
[1. Strongly disagree , 2. Disagree, 3. Neutral, 4. Agree, 5. Strongly agree]

Statement 1 2 3 4 5

1. Efficacy of cardiac medicine is an important factor for your 1 2 3 4 5

satisfaction.

2. Brand Image matters for selection of cardiac medicines on 1 2 3 4 5

your prescription.

3. Safety Information about cardiac medicines supplied by the 1 2 3 4 5

company is a key factor for your satisfaction.

4. Company reputation impacts your satisfaction. 1 2 3 4 5

5. New cardiac medicines are more acceptable than older ones. 1 2 3 4 5

6. Pricing is reflected in quality of cardiac medicines. 1 2 3 4 5

7. Competitors’ pricing of cardiac medicines have an effect on 1 2 3 4 5

your prescription.

8. Availability of cardiac medicines by company’s distributors is 1 2 3 4 5

important for your satisfaction.

9. Location of Retail pharmacy store is an imperative factor for 1 2 3 4 5

your satisfaction to prescribe.

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10. Facilities of Model Pharmacy effect on your prescribing 1 2 3 4 5

decision.

11. Selling Skill of Medical Representatives impacts on your 1 2 3 4 5

satisfaction to prescribe.

12. Continuous Medical Education program like 1 2 3 4 5

seminar/conference about cardiac medicines is important factor
for your satisfaction.

13. Awareness campaign to prevent cardiac disease by the 1 2 3 4 5

company is an imperative factor for your satisfaction.

14. Promotional policies of companies impact your prescription 1 2 3 4 5

of cardiac medicines.

15. Overall perception about product, price, place and 1 2 3 4 5

promotional strategies of cardiac medicine suppliers is highly
satisfactory.

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ii. Questionnaire for Marketing Professionals

a) Demographic Information
1. Gender: 2. Age: 3. Academic Qualification:
4. Designation: 5. Years of Experience dealing with cardiac drugs:

b. Scale based Information: Please put tick (✓) marks against each statement to
evaluate the impact of Marketing Strategies and Techniques of your company on your
satisfaction about sales performance.

[1. Strongly disagree, 2. Disagree, 3. Neutral, 4. Agree, 5. Strongly agree]

Statement 1 2 3 4 5

1. Efficacy of cardiac medicine is an important factor for your 1 2 3 4 5

satisfaction about sales.

2. Brand Image matters for selection of cardiac medicines on 1 2 3 4 5

doctor’s prescription for selling.

3. Safety Information about cardiac medicines supplied by the 1 2 3 4 5

company is a key factor for your satisfaction about sales
performance.

4. Company Reputation impacts your satisfaction about sales. 1 2 3 4 5

5. New cardiac medicines are more acceptable than older ones 1 2 3 4 5

that influence sales.

6. Pricing is reflected in quality of cardiac medicines which 1 2 3 4 5

impact on sales.

7. Availability of cardiac medicines is important for your 1 2 3 4 5

satisfaction about sales.

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8. Location of Retail pharmacy store is an imperative factor for 1 2 3 4 5

your satisfaction to sell the cardiac medicines.

9. Facilities of Model Pharmacy effect on your satisfaction 1 2 3 4 5

about sales.

10. Selling Skill of Medical Representatives impacts on your 1 2 3 4 5

satisfaction to sell the cardiac medicines.

11. Continuous Medical Education program like 1 2 3 4 5

seminar/conference for doctors about cardiac medicines is
important factor for your satisfaction about sales.

12. Awareness campaign to prevent cardiac disease by the 1 2 3 4 5

company is an imperative factor for your satisfaction about sales

13. Promotional Policies of company impact doctors’ 1 2 3 4 5

prescription of cardiac medicines for sales.

14. Overall Product, Price, Place and Promotional Strategies for 1 2 3 4 5

cardiac medicine of your company is highly satisfactory for
sales.

c) General Information: Please tick (✓) according to your practice in the organization.
1. Which approach sets the Marketing Strategies in your Organization?
 Top- down approach (Top company executives design the marketing strategies
and communicate directly to sales force)
 Bottom-up approach (Skilled marketing and sales managers design marketing
strategies for everyone to follow)
 Both Top-Down and Bottom Up approaches
 Other, Please Specify
2. What are your Marketing Strategies?
 To be a Market share leader
 To penetrate the market
 To achieve product Branding
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 Other, please specify

3. What are your Marketing techniques?
 To prepare efficient Sales force
 To provide Continuous Medical Information on medicines by seminar/ conference
 To create Cardiac Disease Awareness Campaign among customers
 Other, please specify
4. What are your objectives?
 To be a Top Five National companies in Cardiac Market
 To be a cardiac market leader in Bangladesh
 To adjust with competitors’ marketing mix activities plan
 Other, please specify
5. Please rate (1-5) the following attributes of 4Ps strategies of your company according
to your satisfaction.
(1=Very Dissatisfied, 2=Dissatisfied, 3= Neutral, 4= Satisfied and 5= Very Satisfied)
( ) Quality ( ) Affordability () Availability ( ) Communication
method

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iii. Survey Questionnaire for Patients

Thank you for your opinions on the quality, price, availability and promotion of
cardiovascular medicines provided by Pharmaceutical companies in our healthcare service.
Your time and effort will contribute to the present research.
1.  Male  Female
2. Age:  20-24,  25-30,  31-35,  36-40,  41-50,  51-Above
3. Educational Qualification:  S.S.C.  H.S.C.  Graduate  Others, Write.................
4. How many years are you taking medication for high blood pressure and cardiovascular
diseases  2-3  4-7  8-Above
5. Which companies do you buy your cardiac medicines from?

6. Where does your doctor prescribe the medicines?  Government Hospital

 Private Hospital

7. Please put tick (✓) marks against each statement to evaluate the impact of Marketing
Strategies and Techniques of the Pharmaceutical companies on your satisfaction to
purchase the cardiac medicines.

[1. Strongly disagree, 2. Disagree, 3. Neutral, 4. Agree, 5. Strongly agree]

7.1 You are satisfied with the efficacy of the cardiac medicines 1 2 3 4 5
7.2 Brand Image effects your satisfaction to purchase medicines 1 2 3 4 5
7.3 The company provides adequate Safety Information of the 1 2 3 4 5
cardiac medicines that impact on your satisfaction
7.4 Company Reputation influences your satisfaction on 1 2 3 4 5
purchasing decisions
7.5 You prefer new medicines over old medicines if it is 1 2 3 4 5
prescribed by your doctor
7.6 The price of the cardiac medicines reflects quality that satisfy 1 2 3 4 5
you

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7.7 Doctors take into account the competitive price that are 1 2 3 4 5
affordable for your satisfaction
7.8 The doctor’s prescribed medicine is easily available that 1 2 3 4 5
impact on your satisfaction
7.9 Location of pharmacy stores are near residential areas that 1 2 3 4 5
satisfy you
7.10 Medical Representatives communicate with you to promote 1 2 3 4 5
the benefits of the medicines for your satisfaction.
7.11 The Pharmaceutical company arrange awareness campaign 1 2 3 4 5
to prevent cardiac disease that impact on your satisfaction
7.12 Quality, Price, Availability and Promotion of the medicines 1 2 3 4 5
of the Pharmaceutical company are satisfactory.

8. Please tick (1-5) in the following variables of facilities for selecting Model Pharmacies instead
of conventional retail pharmacies according to your level of satisfaction. 1=Very Dissatisfied,
2=Dissatisfied, 3= Neutral, 4= Satisfied & 5= Very satisfied
Variables Very Dissatisfied Neutral Satisfied Very
Dissatisfied 2 3 4 satisfied
1 5
Proper Location

Quality Medicines

Modern environment

Counseling by A grade
pharmacist
Variety of stock

Data based system

Reasonable price

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APPENDIX C
i. Reliability Testing (Stakeholders).

Cronbach's N of Items
Alpha
0.827 14

ii. Reliability Testing (Doctors)

Cronbach’s alpha Number of items
0.83 14

iii. Reliability Test (Marketing Professionals’ Satisfaction):

Cronbach’s alpha N of items
0.733 13

iv. Reliability Testing(Patients)

Cronbach’s alpha N of items
0.67 11

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v. Normality of Regression Residual

The standardized residual of regression model is approximately bell shaped/normally

distributed implies good fit of the model

vi. Normal P-P plot of Regression Standardized Residual

Normal P-P plot of standardized residual also suggest normality of model residual since
all points lie on a diagonal straight line (Figure 4.3)

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vii. Scatter Plot

The scatter plot of standardized predicted value versus standardized residual shows no
systematic pattern indicates that residual variance is homoscedastic (Figure 4.4)

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Appendix D: Process Flow Chart of PhD Activities (Year 2015-2020)

Study on courses and Journals Literature Survey

 Pharmaceutical Marketing (June 15-Feb 17)
 Marketing Management
 Business Statistics
 Marketing Research Problem Identification
 National & International Journals &
Research Gap Analysis

Objectives Selection

Final Dissertation
06/12/ 2020 Conceptual Frame work
Development

PhD Dissertation writing Hypothesis Development

Preparation of Questionnaires
Presentation of data analysis for
2nd Seminar (06/06/19)
Pharmaceutical Market Analysis
from IMS data, DIMS&
Regression Analysis for test of Selection of Cardiac Market
hypothesis Research

Selection of Stakeholders
(Doctors, Patients, Marketing
Exploratory Factor Analysis Professionals) and In-depth
Interview

Data Entry Pilot survey of Pretesting

Questionnaires

Revised Questionnaires by
Sorting of usable 536 filtering
Questionnaires

Presentation of Research Work in

1st Seminar on 18/04//18
Data collection
Final Questionnaire Preparation
from the feedback of 1st
Seminar

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