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Long queues for medicines

Last Updated 29 November 2015, 01:54 IST

Nazmun (name changed), in her early 40s, has been waiting in a queue at Delhi government’s Lok Nayak Hospital pharmacy for over two hours on a Monday morning for medicines for her mother Noor Fatima.

At the jam-packed pharmacy, the queue only seems to get longer, say patients.

Some of them squat on the floor, knowing that their turn wouldn’t come anytime soon. A few scuffles break out before the security guards bring the situation under control. Some people in the crowd murmur there is no point in losing patience.

“It does not look like we will get done before another two hours,” mutters a young woman, holding her newborn in her arms.

What turns out to be the most disappointing for the patients after the long wait is the unavailability of medicines. “My mother is undergoing treatment for thyroid at the hospital. Most of the medicines have to be purchased from outside. I still wait in the queue for hours hoping that we get some free medicines,” says Nazmun.

Radha, who has come from Khurja in Uttar Pradesh for her child’s treatment, has had similar experiences. “The doctors prescribe medicines which are not available at the hospital. We are forced to buy the medicines from outside. We do not mind waiting if we get all the medicines here.”

A woman who came to the gynaecology department for a follow-up on Monday says the medicines and consumables during her child delivery a fortnight back had to be purchased from outside. “The care was otherwise good, so we have nothing to complain about. But the medicines were not available at the hospital.”

Patients at GB Pant Hospital, another Delhi government hospital, have similar woes. “The availability of drugs has become poorer than before. I am undergoing treatment at the hospital for the last two years,” says Preeti, a resident of Swarupnagar.

“The hospital authorities should open multiple windows so that collecting free medicines does not turn into such a time-consuming process,” says Mohini Saini, a resident of Punjabi Bagh.

Shortage of drugs has been a longstanding problem at government hospitals. Doctors have repeatedly protested against the non-availability of drugs at the hospitals. They often bear the brunt of non-availability of drugs and other essentials like cotton, bandages with the patients’ families holding them responsible for it.

When doctors across the government hospitals launched a strike in June, the state government had promised to improve drug availability through centralised purchase by August 15. Doctors at hospitals say little has changed even though it is well past the deadline now. Currently, local purchases of medicines across hospitals are being discouraged.

Centralised procurement
“There has been a massive change of policy. With the procurement being done centrally now, there are some teething problems,” says Dr Y K Sarin, medical superintendent, Lok Nayak Hospital.

“There is some flexibility in procuring items locally and the bills are being paid through the CPA (Central Procurement Agency). This is a transition phase in which the hospitals are facing some crunch. There is confusion in this phase and we are trying to resolve the issues.”

According to doctors, the hospitals have also been asked to go slow on procuring high-end equipment in this transition phase. The Delhi government’s CPA is a single window to procure medicines and surgical consumables. Hospital equipment undergoing maintenance will also come under the ambit of the CPA. Hospitals will not be allowed to outsource maintenance work individually.

“It is difficult to procure medicines locally in the interim period. The CPA is not in place yet and hospitals are facing an acute shortage of drugs. The hospitals should have some flexibility in procuring medicines independently so that patients are not turned away. It is yet to be seen if centralised purchasing can address to non-availability of drugs in the long run,” says a senior doctor at Lal Bahadur Shastri Hospital.

At GTB Hospital, where doctors were assaulted earlier this year over non-availability of drugs, the situation remains the same. “We are still fighting an acute shortage of life-saving drugs and items like needles, cotton and bandages. This is almost six months after the government promised us time-bound implementation of our demands,” says Dr Anshuman Raheja, secretary, resident doctors’ association, GTB Hospital.

“In the interim period, the government is facilitating some purchases through the CPA. Otherwise, we are relying on alternative arrangements to procure the medicinal supply,” says Dr Punita Mahajan, medical superintendent, Baba Saheb Ambedkar Hospital.

The government is now planning to come up with three warehouses where drugs will be stocked so that medicines can be supplied to hospitals even if they do not place their demands well in advance.

“The CPA is not in place yet and so the hospitals are facing problems with medicine supply at the moment. It will take at least another three months before the entire process is sorted. The CPA is evaluating drugs under the Essential Medicines List and consumables for surgery, ENT, anaesthesia, orthopaedic and gynaecology, among other departments. In many cases, hospitals are demanding drugs and consumables at short notice which makes it impossible for the CPA to make the supplies in that short span. The hospitals should give the CPA a minimum window of two-three months,” says a senior official at CPA in the Directorate of Health Services (DHS).

Overcrowding
With poor doctor-to-patient ratio, overcrowding at government hospitals continues to be the other major problem. “I turn up at 7 am at the hospital on every OPD date. But it is impossible to avoid the rush in any case. My turn comes only around noon… there is one doctor checking the patients. How can you blame her?” says Sona Devi, who had come for a check-up at LNJP’s gynaecology department. However, the Aam Aadmi Party government is not looking at fresh recruits and instead wants to maximise the utilisation with the existing doctors. “This may not prove to be a successful model as the first step should be to boost the support system,” says a medical superintendent at a state-run hospital.

The government is now planning to open mohalla clinics and polyclinics across the city to streamline the healthcare system. “The polyclinics will offer specialised services at a local level. The existing dispensaries will be turned into polyclinics.

People do not have to travel long distances for OPD services,” said state Health Minister Satyendar Jain.

But the government’s step to convert an existing maternity centre into a polyclinic in Kanti Nagar may lead to a drop in institutional delivery rates, according to doctors.

“The idea should be to improve facilities at the dedicated maternity centres and the hospitals on the periphery to improve the rate of institutional deliveries. The government needs to give more doctors to the maternity homes to improve the delivery rates at these centres,” says a senior doctor at Hedgewar Hospital.

The government should also look at boosting the healthcare system for critical patients on a priority basis, say doctors. Patients are regularly turned away from one hospital to the other due to lack of intensive care units.

“There is a need to augment the intensive care units across hospitals. According to international standards, 10-20 per cent of the total number of beds at every hospital should be turned into beds with ventilators. This will help improve the overall healthcare system,” says a senior doctor at Lok Nayak Hospital.

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(Published 29 November 2015, 01:53 IST)

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