- Tamil Nadu’s tremendous success in ensuring a steady supply of free medicines to patients at govt-run clinics and hospitals has been a source of envy for many states which are struggling to achieve that.
- Factors contributing to this:
- TN employs a reliable system of bottom-up indenting which allows Primary Health Centres (PHC) to request for the drugs needed on a quarterly basis, with rolling stocks on the steady and the tenders are completed on time.
- PHCs hardly utilize the provision of buying drugs in the open market during emergency situations, despite catering to more than 1 lakh patients per year.
- Health being a political subject, politicians fight tooth and nail to deliver the best possible working system. Granting of autonomy to the Tamil Nadu Medical Services Corporation and fast-tract decisions by dynamic leaders also played a role in its devp.
- This meticulous system came to existence only recently and has led to systemic transparency, quality control and prompt-delivery that have become a benchmark for other states.
- Teams from other states such as Karnataka, Kerala, Himachal Pradesh, and Jammu & Kashmir have visited TN to study their model.
- Situation in Karnataka:
- Transfers and recent elections have contributed to the stock out of many drugs.
- Procurement process for essential drugs wasn’t finalized until Dec 2013, nearly 8 months post the actual date.
- Budget constraints and poor judgment in annual indenting.
- 760 vacancies in pharmacists jobs despite the state having the highest number of pharmacy colleges nationwide.
- Even Biocon foundation, which runs 9 community health centres, independently sources its generic drugs rather than depending on the erratic govt supply.
- However, changes are happening as there are plans of replicating the gains in Rajasthan and Tamil Nadu.
- The list of approved items of drugs and equipments has been reduced to 377 from 570 to focus on the most essential and fast-moving medicines.
- Fresh consultations are on with vendors to sort out contractual issues.
- Teams have been dispatched to TN to study their model.
- Bulk supplies for state medical colleges will be procured by the State govt.
- Situation in other states:
- With no direct political manifestations, health is often not considered to be a priority in most states.
- For years, activists have been attempting to politicize the issue in an attempt to increase the seriousness of the State govt towards effective management of the procurement process.
- In Odisha, despite the formation of a new State Drug Management, tenders were stalled for a shocking 2 yrs.
- In Kerala and Rajasthan, the system has bettered following the installation of a software called “e-Aushadhi,” developed by the Center for Development of Advanced Computing (C-DAC) boosted the transparency.
- The software enables the tracking of supplies in all PHCs and even individual prescription handed out by doctors. It has coloured alerts for shortage of particular stocks and approaching expiry dates of many drugs.
- The prodding of State govt also led to Gujarat setting up an autonomous drug procurement agency and installation of the same software employed by Rajasthan to track its supplies.
- In many other states, stalled tenders, expired products and drug shortages, known as “stock-outs” resulting from a top-down indenting leads to the dumping of products in PHCs irrespective of their requirements. This causes extreme wastage and shortage of other essential drugs.
- Problems facing health sector:
- Each state has its own list of essential drugs which is very often influenced by lobbying by pharmaceutical companies providing room for corruption.
- Reliability is also affected by the effect of bureaucratic developments and political events on health care services.
- As a result, a large segment of the people ending up spending nearly 70% of their income on medicines which are supposed be free of cost for them.
- The health care system in India is also edging towards private sector as only 35% of the population relies on govt health care systems. Reasons for this are:
- Dearth of doctors that accept rural postings.
- Shortage of quality drugs and services in public sector.
- Falling standards of health and health-related services.
- This is ironical considering that India is playing a pivotal role in providing low-cost drugs to developing countries.
- A safety net that empowers PHCs to use certain emergency funds to buy drugs in the open market is in place. But this escalates costs of simple drugs.
- Common drugs like iron and vitamin pills, and disposable syringes are bought in piecemeal as opposed to bulk purchasing.
- Sometimes, transparency translates to increase in footfall (the number of people entering the place) which in turns throws light on the dearth of doctors and pharmacists.
- Steps to increase access to free medicine:
- Transparency, efficiency and delivering tangible gains.
- Updated software installations that enable effective monitoring and tracking of drugs.
- Bulk purchases that would save money squandered on piece-meal sourcing.
Exams Perspective:
- Healthcare in Tamil Nadu
- State of Healthcare in India