Surgical and Medical Instruments Industry of Pakistan (JR 145)

Surgical and Medical Instruments Industry of Pakistan (JR 145)

How the industry developed

Scottish surgeon broke his instrument in 1905, this was repaired by a lohar from Kotli Loharan, near Sialkot, The lohar was commissioned to repair and manufacture these instruments. The industry started and slowly shifted to Sialkot. Surgical industry of Pakistan dates, back to 19th century when some British doctors got their surgical instruments repaired from the skilled workers of Sialkot and thus it laid foundation to the Sialkot Surgical Industry. In 1930 the first export of surgical instruments was made to the UK. Since then the industry has expanded but has existed only as a cottage industry. In the 60s some modern techniques like: drop forging; sand blasting; electrolytic polishing; heat treatment etc. were introduced, these were readily adopted by the local industry. Presently the industry has progressed as a well mechanized sub sector in Pakistan, concentrated in the industrial city of Sialkot.

Raw Materials

Stainless steel and steel forgings both imported as well as local are major industrial inputs. The other material required is processed chemicals. The manufacturers have concerns about the quality of the local steel as it reportedly doesn’t conform to health grade steel. Steel is mainly imported from Japan, France, Germany & Taiwan. Due to volatile prices of imported raw material the Sialkot based firms find it difficult to do long term forecasting. There is a shortage of good quality Titanium because Titanium import is ban. Therefore the Titanium is being taken from ship breaking which caused air bubbles in the material.

Current Status

The surgical instrument industry performed brilliantly, but this was not due to any government assistance, they had no access to bank sector funds and were able to survive and grow on their own. Germen and Dutch help was made available though, but this resulted in reverse technology transfer as the technology was passed on to surgical manufacturing industry in Ludhiana in East Punjab India.

Surgical instrument industry is one of remarkable trade source working in our multi products manufacturing city Sialkot which is famous for exporting the surgical instrument. These instruments are exported around the globe and 250million US dollar worth surgical instrument are exported to various international markets which is big show of trade source of Pakistan.

More than 3000 firms are associated with this business and more than five hundred thousand employees are working in manufacturing of surgical instruments industries to meet the export orders as well as local demands. In Sialkot over ten thousand different medical instrument covering all the sections of surgery and basics are being manufactured, this type of assortment of instruments is not available anywhere else in the world. The surgical Industry represents manufacturers and exporters of surgical Instruments: Electro medical instruments; Body external fixation system; Implants micro surgery instruments; Cardio vascular instruments; Endoscopic and gynecological instrument; ENT instruments respirators aid instrument; Personal beauty care items; Orthopedic instruments; Anesthesia products; Hospital furniture and dental instruments etc.

The Internationally reputed companies of surgical Instruments are building joint venture with Pakistani companies reflecting the confidence of multi nationals in the abilities of Pakistan surgical manufacturer. According to SIMAP (surgical instrument manufacturer association of Pakistan) the competitive edge of the sector is: competitive prices; Shortest delivery time; Varieties of thousands of surgical instruments are available; and Industry has its own material testing laboratory

They also said that the current world market of medical products is estimated at US $ 30 billion and it is growing gradually, keeping in view the constant developments and innovations in this sector a major share of such huge market can be captured. 

In Sialkot over 10,000 different medical instruments, covering all basic and surgical segments, are being manufactured. Over 99pc of production is centered at Sialkot. The sector comprises of around 3,000 companies with the labor force ranging from (15-450) per unit, of which around 30 can be considered large units, and 150 as medium sized enterprises.

The industry produces on average over 170m pieces a year. Of the total production, over 95pc is exported, which includes 60pc of disposable and 40pc of reusable surgical instruments. A wide range of industries including steel, chemicals, and machine parts also have strong linkages with the surgical segment.

The sector comprises of around 3,000 companies with production over 10,000 various medical instruments having the labour force ranging from (15-450) per unit, of which around 30 can be considered large units, and 150 as medium sized enterprises. The industry produces on average over 170 million pieces a year. Of the total production, over 95 percent is exported, which includes 60 percent of disposable and 40 percent of reusable surgical instruments.

Availability or raw material is an essential element for any manufacturing industry. In case of Pakistan surgical industry, besides having large number of process sub-contractors also includes the suppliers, importers and traders of inputs such as stainless steel, chemicals and other raw materials. The presence of such input suppliers guarantee the availability of raw materials therefore saving a lot of hassle for the manufacturers, which in absence of such suppliers have to import raw materials individually. This not only provides inputs at lower costs due to competition but also saves transportation and pre-operating costs

    The production of the industry can be broadly classified into two categories, i.e. disposable instruments and the reusable instruments (or instruments). The largest market for Pakistani disposable instruments is USA. Majority of the reusable instruments, manufactured in Sialkot, are exported to the European countries. Industry at a glance: 

Total number of units	Approx. 2400
Installed Capacity	200 Million Pieces/annum
Total Capital Investment	Rs. 12.0 billion
No. of worker	100,000-150,000
No. of people involved (Direct/indirect)	350,000-450,000
Export	US $ 156 Million
World market of surgical instrument	US $ 30 billion
Production	100 million Nos.
Source of Machinery	Germany, UK, USA, China

Exports

Surgical goods and medical instruments worth US$ 221.298 million were exported from the country in first seven months of the financial year (2018) as compared the corresponding period of previous year. During the period from July-January, 2017-18, the exports of medical goods and surgical instruments grew by 15.27 percent as above mentioned commodities worth $221.298 million exported as compared the exports of $191.979 million of the same period last year. Meanwhile, cutlery goods valuing $52.200 million exported in last seven months as compared the exports of $46.224 million, showing an increase of 12.93 percent during the period under review, said data of Pakistan Bureau of Statistics (PBS).

Year	Value (US$)
2015-2016	358.00
2014-2015	339.00
2013-2014	335.00
2012-2013	303.00
2011-2012	297.00
2010-2011	259.00

This is a sector where Pakistan enjoys specialized skills. Products are exported into high income markets of USA, Germany & France. Total world market is estimated at 30 billion USD. During 2010-2011 Pakistan exported Surgical & Medical instruments worth USD 260.60 million. This shows an increase of 13.7% over 2009-2010 export figures of 229.20 million.

The world trade in medical and surgical industry is huge which goes up to 30 billion dollar. Although Pakistan fetches a very small share in the world trade, still the local industry possesses specialized skills and workers expertise which carry a century old experience in producing these sophisticated items. Pakistani products are sold in highly developed market of Germany, France, USA, Belgium etc which are also bracketed as high income markets.

The average export price of Sialkot made surgical items is between dollar 1.5 to 2.5 USD per item (for disposable products) which is higher than the Chinese export price of USD 0.35 per item. Pakistan has no competitor in Opthalmic handheld instruments.

Range of Production

The surgical equipment, optical and photographic equipment is described under HS Code 90 and includes.

Ø    Irrigation and injection needles, tips and tubs, for introducing fluid

Ø    Tyndale's, to help “wedge” open damaged issues in the brain

Ø    Powered devices, such as drills, dermatomes

Ø    Scopes and probes, including fiber optic endoscopes and tactile probes

Ø    Carriers and appliers for optical, electronic and mechanical devices

Ø    Ultrasound tissue disruptors, cryotomes and cutting laser guides

Ø    Measurement devices, such as rulers and clippers

Ø     

The city of Sialkot is very well known particularly in Europe for its surgical industry. There are around 2300 companies engaged in this industry which produce on average 150 million pieces per year with an estimated value of around Rs. 22 billion. Almost 95% production is export oriented.

Pakistan basically produces basic disposable instruments. The growth in this industry segment is low. As compared there is demand of devises and apparatus components using computer aided electronics which are fetching higher per unit prices.

Therefore the shift of emphasis in the global leading manufacturers is on high value added products. Practically Sialkot has no competitor on basic component and most of the production from Germany has shifted to Pakistan. The result is that Pakistan produces semi-finished goods which are repackaged in Germany, Europe & USA and then sold internationally at higher prices. The very low quantity is consumed locally due to low demand by public health entities and private sector hospitals. In fact, this Sialkot based industry has limited contacts with the local end users, they normally operate through bulk buyers/traders.

Out of 2300 major companies 30 units are large integrated units. These bigger companies are technically advanced with lot of mechanization in their production processes. They have also diversified products into medical mechanized devices. Second category is of medium type of firms which are around 150 in numbers and they handle exports of above 100 million. The small units are 2000 in numbers and they handle export of up to 80 million.

The details of surgical instrument which are being exported is as under

ü  Instruments and appliances used in medical or veterinary sciences

ü  Instruments and appliances, used in dental sciences

ü  Needles, catheters, cannulae

ü  Syringes, with or without needles

ü  Oxygen therapy, artificial respiration/ therapeutic respiration

ü  Dentists, barbers or similar chairs and parts thereof

ü  Medical, surgical, dental or veterinary furniture and parts

ü  Dental drill engines,  

ü  Ophthalmic drill engines, and appliances

ü  Breathe appliances & gas masks, protective masks

3           Tubular metal needles and needles for sutures

4           Mechano-therapy application; massage app; psychological aptitude test apparatus

ü   

Labor Conditions in the Surgical Instrument Manufacture Sector

The initial manufacture of surgical instruments involves die making, forging, filing, grinding, machining, electroplating, and heat treatment. Most of these processes are subcontracted to countless small process specific workshops, with the final finishing (chemical cleaning and polishing) and quality checking by the final producers. The use of subcontractors became common in the mid-1970s after a period of labor unrest and strikes. Subcontracting minimizes company overheads and lowers costs, but, because subcontractors are not employees of the company and competition is aggressive, it drives down wages and health and safety standards. Subcontracted manual laborers are paid per instrument, and the average worker earns around

$2 a day (personal communication). They have no job security or guarantee of income and no medical insurance or provision of education for their children. Nearly all subcontractors are forced to seek wages in advance from the firms that employ them, further disadvantaging these workers' position in arguing for a fair wage.

Manufacturing Standards:

Surgical industry is the sector where quality is major issue of concern. Recently its importance has  increased  manifolds  given  the  increasing global  competition  and  new  regulations  being enforced by the developed countries. These regulations require the exporters of the developing   countries   to   introduce   systems focusing on the improvement of management, labor, technology, and all the other fields which in any way affect the firm.

The surgical instrument standards must be in conformance with WTO standards.  Over 300 Companies have ISO-9002 Certification and about 250 have Certification of Good Manufacturing Practices5. Sialkot Material Testing Laboratory (SIMTEL) A UNIDO assisted material testing laboratory has been   set   up   in   Sialkot   in   the   year   2000 comprising of three laboratories:

Spectro Lab

Metallographic Lab

Chemical Testing Lab

Manufacture and Supply in Sialkot:

Manufacturers of surgical instruments in Sialkot need to minimize costs to remain competitive. To reduce overheads, most firms subcontract the initial production of instruments to workers employed in a small workshop or their own home, with finishing and quality checking of the product in house before export, quality is checked against European Union or US standards. Manufacturing firms in Pakistan, however, rarely have the infrastructure or marketing presence to allow direct trade with the end users in the destination countries. Most therefore sell to suppliers and retailers in the developed world with only a small profit margin. These “middle men” (mostly in Tuttlingen) then trade with end users, predominantly in the US or Western Europe, usually after a considerable mark up. For example, a pair of fine surgical scissors will cost

$1.00 to produce, will be exported from Pakistan to Germany at a price of $1.25 (personal communication), and will probably be sold to a hospital for nearer $80.00. In 1999, instruments costing a total of $27.5 million were exported in this way from Sialkot.

Problems Faced by the Industry

Pakistan is the leading exporter of surgical instruments, but local manufacturers receive only 2pc, or $359m, of the $17bn global trade, as most of it is lost to outsourcing importers. This is due to the inability of the industry to develop international brands. Basically, local producers are suppliers to international brands based in the US and Western Europe, who outsource manufacturing to artisans concentrated in Sialkot. Some international brands are reported to have shut down manufacturing facilities in their home countries as they get the best products from Pakistan’s world class artisans. Internationally, social movement of fair trade is initiated to help producers in developing countries get a fair value for products such as coffee, sugar, fruit juices etc. Why can’t a fair trade demand be raised for surgical instruments? Some international brands are reported to have shut down manufacturing facilities in their home countries as they get the best products from Pakistani world class artisans

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Top 10 buyers are the US, Germany, the UK, France, Italy, UAE, Japan, Brazil, Mexico, and Russia. America is the largest market for disposable instruments, while a majority of reusable instruments are exported to the EU. Former . Pakistan is working as a vendor for other exporting countries. He said these countries sourced products to Sialkot and then stamped their logo on them for export to the world market. We can’t even directly export to Islamic countries because of the excessive registration procedure. , as also the same products are landing in their markets from Germany and US under international brand names .The ministry of commerce is a silent spectator to this whole set of affairs of unfair trade practices.  Ironically, the ministry of commerce has failed to help the sector in developing brands. In the previous trade policy, the government allocated funds for brand acquisition rather than development. Sialkot caters to 90pc of the global demand. The government has also failed to secure direct market access for these products under its so-called preferential trade agreements. Some industrialists say Germany has closed down its own industries and is now outsourcing manufacturing to Sialkot.

New mediators are also emerging. Pakistan’s direct exports of surgical instruments to China and India are also on the rise. According to a study of the Sustainable Development Policy Institute, Pakistan’s exports of surgical products rose to $9.6m in 2014 from $7.6m a year earlier. The study indicates a huge potential exists for increasing direct exports of surgical instruments.

The goods outsourced for manufacturing in Sialkot by German and UAE based companies find their way into Indian markets. The US is the larger exporter of surgical instruments to India. Germany, China and Japan come after. There is a wide margin in import value of these products from Pakistan for re-export to India.

The surgical sector, according to industrialists, is facing several problems. These range from marketing to adoption of new technology. Marketing is a basic problem owing to a failure to develop local brands. Energy supply is another major handicap.

Neither industrialists nor the government allocates funds for R&D to innovate new products in order to stay updated with changing patterns in medical sciences. There is no training institute to train human resource. As 95pc of the surgical industry operates in the SME sector, there is a need for a common facility centre to reduce the cost of production.

Sialkot’s position as a leading exporter of surgical instruments may also come under threat from upcoming competition from China and Mexico. These countries not only have cheap labor, but also use superior technologically for innovation and better materials for manufacturing.

The surgical sector, one of the five prime export-oriented sectors of the country has been facing multiple problems. The leakage of production technology, rise in production cost of surgical instruments and the export of steel scrap are causing havoc for the metal-related industries as scrap is the major source of locally produced stainless steel, which fulfils approximately 45 percent of the requirement. Representatives of Surgical Instrument Manufacturers Association of Pakistan (SIMAP) were of the view export of surgical forgings and semi and unfinished products were the most critical components for decline in surgical instruments exports.“If these products will be exported to other countries, then local industry will suffer heavily in shape of loss of export orders”.

The government should check the export of scrap from the country. Surgical Instrument Manufacturers Association of Pakistan urged Commerce Ministry and Federal Board of Revenue to immediately impose a ban on export of forgings, semi-finished and unfinished products.“Both India and China, only repack or stamp Pakistan-made instruments and sell them as their own brands.” Lack of brand development is another major issue concerning this industry. Brand development is such an exercise, which cannot be done by a company due to the fact it requires huge resources and expertise and support of the government. India and China, which actually have no manufacturing or technical skills in this field, are rapidly penetrating in surgical business, only by doing branding with full support and assistance from their respective governments. If India could earn huge foreign exchange by brand promotion only, then why can’t we when we produce world-class medical instruments.

Surgical industry could start earning at least $1 billion within three years, provided, it is given due attention by the concerned government departments. The rising utilities costs, increasing prices of raw materials, high banking service charges, high export refinance rates of central bank and uneven taxation system are added barriers to the falling exports.“We are the largest suppliers of medical instruments to United States of America (25 percent) of total export, Germany (20 percent), United Kingdom (10 percent), Italy (5.0 percent) and United Arab Emirates (5.0 percent).In India, where due to realistic and practical policies prepared in consultation with the business community the exports are touching over $140 billion mark. Trade organisations are not consulted during the preparation of policies and neither are their recommendations included in the policies.

Exporters of Pakistan share merely over 2 percent ($450 million), of the $21 billion global trade, as most of it is lost to outsourcing importers. Basically, local producers are suppliers to international brands based in the United States and Western Europe, who outsource manufacturing to artisans concentrated in Sialkot.

United States, United Kingdom, France, Italy, Germany, United Arab Emirates, Japan, Russia, Mexico and Brazil are main exports destinations. America is the largest market for disposable instruments, while a majority of reusable instruments are exported to European Union. The Ministry of Commerce has failed to help the sector in developing brands.

Pakistan’s direct exports of surgical instruments to China and India are also on satisfactory level. Pakistan’s exports of surgical products remained to $9 million in 2016.The surgical sector has been facing bottleneck in marketing to adoption of new technology. There is no training institute to train human resource. 95 percent surgical industry operates in small and medium enterprises sector. There is a need to increase common facility centers to reduce the cost of production.

Surgical industry is technology based, but in Pakistan this industry has flourished without sophisticated technology.  There is a lack of qualified and trained engineers in factories. The process supervision and operations management is done by non-technical personnel. The process of new product development is done by using reverse engineering, without following proper procedures such as preparing technical drawings. At this stage of development, to grow further the industry needs technical assistance in process improvement, operations management and also for new product development. Latest developments in the industry are threat to the industry as well as an excellent opportunity at the same time. It all depends on the availability or resources. The Pakistani surgical instrument industry, in order to develop on sustainable basis needs to have a strong research and development base which facilitates the introduction of new materials and latest processing techniques

In today’s dynamic world technology plays vital role in the development of any field. Keeping in view   the   surgical   industry   of   Pakistan,   in beginning   the   instruments   manufactured   in Pakistani surgical industry was handmade; but with the passage of time, the industry adopted to change but this change is so gradual that we are still lagging behind in the field of technology. These days’ new technologies are taking place of the old ones, for example:

− CNC Machines (Computer Numeric Control)

− MIS (Medical Invasive Surgery) Instruments These technologies are adopted by Germany but not here in Sialkot yet. Its reasons are:

− Unawareness of industrialists about these technologies

− These are very expensive and our people are unable to adopt these technologies

− There are no trained people to work according to these technologies.

One of the basic elements for the growth of any business is marketing. Unfortunately, Pakistani surgical industry is far behind in this field. There is no strategy to deal with the local market. Major portion   of   the   production   is   sold   to   the international wholesalers and distributors, who sell these products under their own brand name. When we talk about the exports, there is bad luck for the cluster that it has a deep history but it has no own “Brand” developed yet. We are working as  vendors  for  the  other  exporting  countries. However, some entrepreneurs are aware of this problem and they are trying to develop their own brand.

Research & Development Constraint: Research & Development is the need of today’s business   for   its   survival.   Non-adoption   of research and development by manufacturers and exporters is also a major problem of surgical industry of Pakistan. No attention is given on development          and      betterment     of         medical instruments.   There   is   an   urgent   need   that businesses establish research and development cells in their premises and allocate a certain percentage of their profits precisely on research and development.   

Organizations are made up of people, who are the building block of that organization.  But the human resources of our surgical industry are not properly managed because people are not well aware of the resource management. The entrepreneurs themselves execute every function of HR. They consider placement of a professional or business graduate as a waste of money; moreover, the professionals are misconceived as another exploitation tool that might steal their business secrets. There is an emergent need of a surgical training institute/centre, where current labor force could be     trained     for     enhancement     of     their manufacturing skills and new entrants could also be trained in this institute.

Financial Constraint:

Finance is another issue of the cluster, especially for small enterprises. There is large number of financial institutions and leasing companies present in Sialkot which are providing financial services. Majority of the manufacturers consist of vendors, who have small setup. Most of them have no reach to the banks. They are unaware of how to avail the loan facility. However, large firms have good relation with the financial institutes and leasing companies.

Recommendations:

Out of the total production surgical instruments in Sialkot, approximately over 95% is exported, approximately 100 million instruments annually. It shows the importance of our surgical goods, it has  the  grand  contribution  in  our  export  and  foreign exchange earnings. But still it has been a big scope for more contribution and development in this field;

The burning issue of this industry is “skilled labor” availability and this problem can be resolved by the mutual efforts of government and businessmen by providing technical courses, on job training courses and machinery handling courses etc. related to this field because there is a threat of losing the skilled labor due to no proper transfer of skills to the next generation.   

Sialkot is the hub of surgical industry so govt. must establish the new training and vocational centers under TEVTA and other boards in Sialkot and its nearby areas e.g. Narowal, Pasroor etc. to attracting the labor and new comers in the field and provide them the up to date knowledge to enhance their skills. And recognize the importance of the degrees of TEVTA and other such institutions to realize the labor their worth. With such efforts, deficiency of skilled labor can be controlled in coming years.

In surgical field, the production procedure comprises of series of processes, and it involves the use of latest and expensive technology therefore the need is to establish “Common Facility Center” in Sialkot to facilitate the export of surgical items. Govt. should realize this need and start a project of “Common Facility Center” with the help of businessmen. It will reduce the cost of production, enhance profit margins and prove fruitful for boosting export.

In surgical field, there is a crucial need for developing “R & D Department” to work for the betterment of the production process as well as for the product development. On the other hand, R&D departments must establish to explore new markets for boosting the export of our surgical instruments because our major customers are USA & Europe but still there is a large scope for us e.g. Iran and Japan is the potential market but our share of export in these markets are only 0.1%.

With the vital need of “Human Resource” in surgical industry, there is also a crucial need of “Financial Resources”. In Sialkot, most businesses are related to cottage industry so, finance is the basic need but SME’s faces a lot of problems and issues at the time of getting finance (loans) from financial institutions.  

For promoting our global business of surgical  items,  we  must  have  complete awareness about quality standards e.g. ISO and CGMPs etc. and must try to implement them fully to  build  up  the  trust  on  our foreign customers to sustain in such a competitive world.

In surgical industry, businessmen must focus on new methodologies of production and must try to adopt the latest technology (e.g. CNC machines and MIS etc.) in different sections of manufacturing process. They can do this by maintaining the reserves for this purpose from their profits.

Despite the fact that we produce an immense quantity of surgical items but still we are far behind in case of “Marketing” of our products to increase the trade round the globe. There is lack of presentation in our products in every aspect. Especially, in trade fairs and exhibitions, TDAP must facilitate our Pakistani traders to present their products in attractive way to retain the customers.

Exporters   of   Sialkot   are   the   foreign exchange earner for the country, so the concerned authorities must take steps to communicate with government to reduce the anxiety of the traders related to tax issue In Sialkot surgical industry , SME’s have lack of proper management hierarchy. In such firms, there must be some proper advisory and supervisory authorities to handle the different production departments. In this way, there is more chance of efficiency in all departments.

Infrastructure Development: Transportation is the backbone of export and industrial sector as a heavy portion of the product cost of an exporters include the transportation expenses and cargo charges. This issue must be resolved through; Roads linked with rural areas and main cities must be properly constructed for better   approach   and   smoothing   the internal trade directly and export indirectly.

Check & balance of dry port and airport fair system for controlling the cost and improving the quality of products. Government must invest heavily in the improvement of physical and financial structure including shipment, clearance, cargo system, handling at the ports and airports for smooth flow of export.

To acquire affordable and quality technical assistance at home, an excellent engineering university should be established in Sialkot to give boost to the trade.

Today, China and other competitive countries are entertaining with long term trade deals at reasonably low rates to sustain their customer for long-run. But Pakistani exporters fails to adopt such strategies because of constant fluctuation in prices of oil, gas, electricity, material’s cost etc. Therefore our exporters could not reach out to their real potential. In this regard Govt. and other trade related bodies must perform their role by framing some long term projects on the extraction and usage of natural resources as well as electricity plants.

Surgical   instruments   can   be   generally divided into six classes by function. These classes are:

Cutting instruments

Grasping or holding instruments

Haemostatic forceps (instruments used to stop blood flow)

Retractors

Clamps and distractors

Accessories and implants

So, there is a need of product diversification in the international market time to time in order to capture the new foreign markets. We cannot ignore that our 80% surgical export is depending on single-use products. But we should focus on the pricing of them collectively to make the strength of our products in international market. There is need to reconsider our pricing strategies of re-useable products and single-use products.

The leading manufacturers and exporters of surgical items should be encouraged to develop their own brands and labels for their products. The highest level of value addition occurs when products are sold under a brand name. Sialkot is the major export oriented city in Pakistan. Sialkot based export goods are highly appreciated in International markets. It’s high time for Pakistan to use the opportunities available at international level. Govt. should encourage and support the leading manufacturers and exporters of surgical instruments to develop their own brands and labels for their products. Such steps will ultimately flourish our trade.

Conclusion:

Pakistan has great potential to exploit the international market of surgical instruments as it has great workforce, talent, skills, resources, strengths and opportunities to make the way to success. Moreover, there is large scope of success in this market. But, need of the time is for government and large players to support this industry .