OBJECTIVES: ADRs are known to be a major cause of morbidity and mortality. However, only a very little proportion is reported. ADRs contribute to the incidence of adverse events, resulting in increased health care costs. METHODS: The first part of this project was to review the ADRs reporting system in Pakistani hospitals, to determine the factors contributing to the ADR reporting rate and benchmark with developed countries. Data was collected by self-administered questionnaire.   24 (80%) hospitals have no proper ADRs system; five (16.7%) hospitals are targeting few of the drugs for ADRs reporting while only one (3.3%) hospital has a proper ADRs policy including online reporting system as well. Only seven (23.3%) hospitals have a policy of ADRs reporting. The next part of the project was a survey of 84 doctors and 52 Pharmacists selected from Lahore, Pakistan to evaluate their involvement, understanding and reasons for reporting ADRs. A self-administered questionnaire was used to collect the data. RESULTS: Response rate obtained for the doctors was (39.3% n=33) and (67.3% n=35) for hospital pharmacists. Thirty three (39.3%) doctors and thirty four (65.4%) pharmacists knew how to report ADRs within the hospital while 9 (10.7%) doctors and 13 (25%) Pharmacists knew about the ADRs reporting to Ministry of Health. Factors that would encourage respondents to report ADRs included seriousness of reaction (75.8%), unusual reaction (63.6%), reaction to a new product (66.6%) and confidence in the diagnosis of ADR (31.5%). Similarly, the discouraging factors are uncertain association (65.7%), awareness (57.6%), and concern about legal liability (51.4%). CONCLUSIONS: It is observed that awareness of ADRs program need special attention with some concrete steps should be taken for the improvement of ADRs system in Pakistan. Continuing medical education, training and integration of ADRs reporting into the clinical activities would definitely improve the patient outcome.