Free Generic Drugs To All

Highlights

• India has put in place a $5.4 billion policy to provide free medicines to its people
• India’s public health sector caters to only 22 per cent of the population
• On an average, 78 per cent of health expenditure is paid by patients themselves
• Medical treatment is the second most common cause of rural indebtedness in India

India has put in place a $5.4 billion policy to provide free medicines to its people. Under the plan, doctor’s prescription will be limited to a generics-only drug list and face punishment for prescribing branded medicines.

The initiative is expected to overhaul a system where healthcare is often luxury and private clinics account for four times as much spending as state hospitals. Within five years, up to half of India’s 1.2 billion people are likely to take advantage of the scheme.

The cost of a generic drug is 80 to 85 per cent lower than the branded product, according to data from the US Food and Drug Administration. In case of health insurance, medicines account for 15-20 per cent of healthcare costs in India. This component is higher in rural areas, which generally have poor hospitalisation facilities. Also, in the case of several critical diseases, the cost of medicines is much higher than the hospitalisation cost.

Health Scenario In India

The 11th Plan had set six health outcome indicators as time-bound ‘goals’. These included lowering maternal and infant mortality, malnutrition among children, anemia among women and girls, and fertility, and raising the child sex ratio. Though, there has been progress on all these fronts, except child sex ratio, the goals have not been fully met.

Report of the steering committee on health for the 12th Plan period has identified several problems that plague Indian health sectors. These are:

• Low public spending on health (1% of GDP)
• High out-of-pocket payments (71%) leading to impoverishment
• High levels of anaemia (56% among ever-married women aged 15-45 years) reflect in high levels of malnutrition among children (wasting 22.9%, stunting 44.9%)
• High infant mortality (47/1000 live births) and maternal mortality (212 per 1 lakh live births).

According to the report, India trails in health outcomes behind its South Asian neighbours like Sri Lanka and Bangladesh which have a comparable per capita income. Large variations within the country suggest that the health status of disadvantaged groups is even worse. Equally worrying  is  the  growing  reliance  on  private  providers,  which  currently  service  78 per cent  of outpatients and 60 per cent of in-patients. For those who cannot afford private services, illness translates  into  high  out-of-pocket  expenditure  as  a  proportion  of  total  household expenditure, reaching catastrophic proportions at times (i.e. equal to or greater than 40% of a  household’s  non-subsistence  income.

The Planning Commission’s working group on drugs and food for the 12th Five-Year Plan estimated that the country’s public health sector caters to only 22 per cent of the population.

Out-of-pocket expenses on health can have catastrophic effects on households. On an average, 78 per cent of health expenditure is paid by patients themselves, of which 72 per cent goes on buying drugs.

Unsurprisingly, therefore, about 30 per cent of India’s rural population and 20 per cent of its urban population have to endure common ailments without, for financial reasons, any treatment. Worse still, close to half of all hospitalisation cases in rural areas are financed through loans or the sale of assets.

As a result, medical treatment has emerged as the second most common cause of rural indebtedness. Equally disquietingly, some 39 million people are pushed into poverty every year because of illness.

The working group in its report suggests that during the 12th Five Year Plan, a provision should be made for ‘free medicines for all’ in Public Health Facilities under the National Rural Health Mission (NRHM) for facilities upto the District Hospital in those districts which are/ would not be covered under the  National Urban Health Mission (NUHM) and in the District Hospitals and other tertiary care centres under the NUHM.

As part of the provisions all State Governments will be encouraged to set up medical supplies corporations on the lines of Tamil Nadu Medical Supplies Corporation(TNMSC) to supply free, quality generic medicines – essential medicines to both indoor and outdoor patients who seek care in Public Health Facilities (about ‐ 52% of the total number of patients, including the erstwhile 20% of unreached, very poor people). The total cost on this account during the plan period would be Rs 28675 crores for running costs and an additional Rs 1293 crores as one‐time capital costs.  The Centre’s contribution at 85 % would be Rs 25667 crores for the entire Plan period.

Public Health In Tamil Nadu

In Tamil Nadu, since 1995 all patients visiting Public Health Facilities (which in Tamil Nadu, constitute 40% of the total number of patients as per NSSO 60th round figures) get all medicines free. This has been possible because of setting up of an autonomous corporation in the Public Sector, the Tamil Nadu Medical Services Corporation (TNMSC), which procures in bulk directly from manufacturers, quality generic medicines through a transparent bidding process. TNMSC then supplies these to the Public Health Facilities (PHFs) through a demand sensitive passbook system instead of the traditional ‘supply driven’ inflexible system of distribution. It supplies about 260 drugs to Public Health Facilities as per its Essential Drug List and 192 ‘specialty’ drugs for secondary and tertiary care as per need.

Working Group’s Recommendations

National List of Essential Medicines (NLEM) Having a national list of essential drugs (NLEM) makes it easier both to quantify needs and to procure and manage drugs more efficiently. An essential drugs list provides a firm foundation on which to introduce standard treatment guidelines which play a crucial role in rational prescription and use of medicines.

Irrational drugs and fixed dose combinations (FDCs): Irrational FDCs, nonessential vitamins/tonics, cough syrups feature in the top selling pharmaceuticals in terms of value and volume but they harm public health and patients by increasing adverse effects, imposing higher financial burden on patients and facilitating – emergence of drug resistance (in the case of FDCs of antibiotics). Therefore, stricter criteria for registration and – regulatory review of medicines by CDCSO should be a  priority.

Irrational prescription and a corresponding rise in drug: With hardly any new antibiotics, anti-TB, anti-malarial being developed, the control of drug resistance to currently available medicines has become crucial.

Essential Medicines

Essential medicines are those that satisfy the priority healthcare needs of majority of the population. The essential medicines list needs to be country specific addressing the disease burden of the nation and the commonly used medicines at primary, secondary and tertiary healthcare levels. The Government of India, Ministry of Health & Family Welfare (MOHFW) is mandated to ensure the quality healthcare system by assuring availability of safe and efficacious medicines for its population.

The National list of essential medicines is one of the key instruments in balanced healthcare delivery system of a country which inter alia includes accessible, affordable quality medicine at all the primary, secondary, tertiary levels of healthcare. Realizing this GOI, MOHFW decided to have its own essential medicines list. The first National List of Essential Medicines of India was prepared and released in 1996. This list was subsequently revised in 2003.