JOIN USIn 2004, the World Health Organisation’s world medicines report highlighted the plight of India’s 600 million rural and urban poor without adequate access to essential medicines.
The very next year, prime minister Manmohan Singh responded by establishing a task force headed by Pronob Sen to address pharmaceutical pricing and access issues. Among its original recommendations were options to set up bulk purchasing mechanisms to permit better non-branded generic drug supply to poorer populations. It also focused attention on the issue of drug price controls.
Six years on, despite the government’s good intentions, drug access in poor communities has not improved. In fact, it may have worsened. Consequently, the effectiveness of the implementation of these recommendations warrants close
scrutiny.
By any measure, India’s approach to drug access and availability for low income populations reveals that drug policy in India is failing the poor. According to the most recent WHO world medicines report (2011), “The inequity in medicines access is widely perceived as symptomatic of weaknesses in the healthcare system and represents a failure on the part of national governments to fulfill their obligations towards their citizens in terms of their right to health.”
India is home to the most robust pharmaceutical industry in the world. It produces quality cheap medicines and has the world’s lowest drug prices, yet access to medicines is appallingly low for hundreds of millions of Indians living in poor communities.
The fact remains that no matter how cheap medicines in India may be, the poor simply can’t afford them. Yet despite this, the current focus of India’s drug policy is dominated by a discussion over further drug price controls that will have little or no impact on drug access and affordability for the poor.
Since the introduction of Drug Price Control Orders (DPCO), access to medicines in class II to class IV towns has actually declined. Current proposals for further price controls that focus on only the most expensive drugs in each class of medicines will not benefit the poor and may actually lead to higher prices for other generics.
No doubt, it is for these reasons that India has looked to the bulk purchasing and distribution of low-cost generic medicines through community-based outlets as an effective means to improve medicines access for the poor.
The Department of Pharmaceuticals (DOP), has launched the ‘Jan Aushadhi Campaign.’ Jan Aushadhi is a network of stores in low-income communities where non-branded quality generic medicines are sold at the lowest available prices but are equivalent in potency to branded, more-expensive drugs. The government runs 113 Jan Aushadhi stores and sells 348 medicines that are currently under the National List of Essential Medicines.
Better capacity
No other country in the world has a better capacity to make such a programme succeed. Unfortunately however, it is proving to be ineffective and is failing because of major deficiencies in procurement and distribution, and a failure to incentivise or mandate low cost generic prescribing by the doctors.
Recent media reports have highlighted the Jan Aushadhi shortcomings, including the account of a 74-year-old diabetic patient with high blood pressure and renal problems who was found running from store to store for medicines.
After visiting three stores, he left empty-handed because there were no stocks of the medicines he needed. In Chandigarh, five Jan Aushadhi stores were opened to provide generic medicines at cheaper rates but they have been lying without any stock for months while a couple had closed down due to short supply of medicine.
Stories on the ineffectiveness of Jan Aushudhi stores are widespread and the problems are serious. But they are also solvable through a commitment of political will. The fundamental principle for building a health system is to pool risk and share the burden through combinations of private and public insurance that are usually structured to take into account variances in the ability of vulnerable populations to pay.
A pilot project started by the Central government and some state governments under the Rashtriya Swasthya Bima Yojana (RSBY) has shown improvement in access to healthcare for vulnerable citizens. If the government wishes to truly tackle the problem of access to health, then the best way to improve the situation is not only through increasing the number of generic stores and price controls, but also through healthcare financing reform.
The relevant government agencies should not only seek views from all stakeholders before finalising any changes to the drug policies, but should consider engaging these stakeholders in developing a game-changing approach.
India has proclaimed itself as the leader among the BRIC nations in the global battle against non-communicable diseases. To be credible in this endeavour we need to lead by example when it comes to non-communicable disease control through access to affordable medicines.
It also needs to demonstrate that it can overcome its challenges in drug procurement and distribution, that it can build adequate health infrastructure in communities with great health needs, and that it can build a sustainable model of health system financing. More importantly it needs to demonstrate real progress in ensuring that India’s poor get access to affordable essential medicines.
(The writer is a public health analyst)