E-DRUG: Availability of medicines in public sector health facilities of 2 North Indian States
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E-Druggers,
Can I draw your attention to a very new paper published in BMC Pharmacology and Toxicology. The full reference is Shankar Prinja, Pankaj Bahuguna, Jaya Prasad Tripathy and Rajesh Kumar. Availability of medicines in public sector health facilities of two North Indian States BMC Pharmacology and Toxicology 2015 16:43 DOI: 10.1186/s40360-015-0043-8
URL
http://bmcpharmacoltoxicol.biomedcentral.com/articles/10.1186/s40360-015-0043-8
The abstract reads
Background
Access to free essential medicines is a critical component of universal health coverage. However availability of essential medicines is poor in India with more than two-third of the people having limited or no access. This has pushed up private out-of-pocket expenditure due to medicines. The states of Punjab and Haryana are in the process of institutionalizing drug procurement models to provide uninterrupted access to essential medicines free of cost in all public hospitals and health centres. We undertook this study to assess the availability of medicines in public sector health facilities in the 2 states. Secondly, we also ascertained the quality of storage and inventory management systems in health facilities.
Methods
The present study was carried out in 80 public health facilities across 12 districts in Haryana and Punjab states. Overall, within each state 1 MC, 6 DHs, 11 CHCs and 22 PHCs were selected for the study. Drug procurement mechanisms in both the states were studied through document reviews and in-depth interviews with key stakeholders. Stock registers were reviewed to collect data on availability of a basket of essential medicines −92 at Primary Health Centre (PHC) level, 132 at Community Health Centre (CHC) level and 160 at tertiary care (District Hospital/Medical College) level. These essential medicines were selected based on the Essential Medicine List (EML) of the Department of Health (DOH).
Results
Overall availability of medicines was 45.2 % and 51.1 % in Punjab and Haryana respectively. Availability of anti-hypertensives was around 60 % in both the states whereas for anti-diabetics it was 44 % and 47 % in Punjab and Haryana respectively. At least one drug in each of the categories including analgesic/antipyretic, anti-helminthic, anti-spasmodic, anti-emetic, anti-hypertensive and uterotonics were nearly universally available in public sector facilities. On the contrary, medicines such as thrombolytics, anti-cancer and endocrine medicines were available in less than 30 % in public sector facilities. Among the medicines which were not available at the time of survey in Haryana, nearly 60 % of them were out of stock for 3–6 months whereas 8 % of them were out of stock for more than 6 months.
Conclusion
Health system needs to be strengthened by making essential medicines available for patients. Ensuring access to free medicines is likely to reduce private expenditure on medicines, which is a long-term, sustainable way to towards universal health coverage in India.
I do have some questions about the methods used but this is a good attempt to develop a standard method to look at public sector availability and to include a retrospective stock analysis. No costing data unfortunately. It will be interesting to see if the survey is repeated after interventions have been undertaken. They mention that they did not use the WHO/HAI method but do not justify this choice in the discussion section. I am left wondering why as it would have made life easier for them and allowed direct comparisons to other surveys that were done previously in India.
But for E-Druggers the significance of the paper is that this is new literature on measuring Public Sector Availability of Essential Medicines.
Happy New year to you all!
Richard
Richard Laing
Professor International Health
Boston University School of Public Health,
801 Massachusetts Avenue Boston MA 02118
Tel 617 414 1445 (Office) 617 435 7860 (Mobile)
E mail richardl@bu.edu