PHM-Exch> India prepares to supply free generic medicines

[Claudio Schuftan]

From: South Centre <south at southcentre.org>

*India prepares to supply free generic medicines
*
*By Zofeen Ebrahim     EXCERPTS
*
As the northern Indian state of Rajasthan rolls out an ambitious universal
healthcare plan, the discontent of the state's doctors stands in stark
contrast to the joys of the 68 million people who will benefit from the
scheme.

Just a little over a year ago, the state government began supplying free
generic drugs to its massive population, effectively stripping doctors of
the ability to prescribe more expensive branded medicine.

Some 350 essential generic drugs are now being distributed free of cost. As
a result, outpatient visits have jumped 60 percent and inpatient admissions
are up 30 percent, despite the fact that public health facilities are
overcrowded and understaffed, and many people have to travel long distances
to reach one.

According to news reports, over 200,000 people are currently taking
advantage of the programme.

 The ‘Rajasthan model' is being used as pilot for a similar scheme
throughout India, which could bring free drugs to the country's 1.2 billion
residents.

One of the programme's goals is to end price manipulations of private
pharmacies and manufacturers.

"Cipla, for example, produces three kinds of ‘cold' tablets, which all have
the same chemical ingredients. It sells the generic drugs to pharmacies at
a wholesale price of about two Indian rupees (0.03 dollars) per pack (of
ten tablets) but sells the branded drugs for 23 rupees (0.42 dollars) per
pack.

"The chemist then sells all three drugs for anything between 27 to 39
rupees (0.50 to 0.72 dollars) as per the printed price. Thus the patient is
at the mercy of the doctor or the pharmacy, and will take whichever drug is
recommended to him.

To counter this practice, the government now buys generic drugs directly
from the manufacturers and has "developed infrastructure to hand them over
to patients through the 13,874 (approved) drug distribution centres,"

Patients that are obliged to embark on lifelong drug courses - for
conditions like diabetes or heart disease - have hitherto struggled to make
their payments.

"A particular brand of medicine used for diabetes costs 117 rupees (2.17
dollars), but we purchase 10 tablets of generic medicines for diabetes at
1.97 rupees (0.036 dollars),"
Medical expenses are the second most common cause of rural indebtedness in
India.  More than 40 percent of those hospitalised in India needed to
borrow money or sell assets in order to afford treatment.

The cost of a single hospitalisation has pushed 35 percent of patients
below the poverty line. In fact, unaffordable healthcare has prevented over
23 percent of the sick from consulting a doctor.

The expenditure on drugs alone constitutes between 50 to 80 percent of
healthcare costs in India. And all this in a country regarded as the
"world's pharmacy",  And yet, "two-thirds of the population do not have
regular access to essential drugs."

Dr. Ravi Narayan, an Indian public health academic who is also part of the
All India Drug Action Network, was full of praise for the Rajasthan
government's initiative.  Rajasthan has a very strong people's movement.

With India moving towards universal health coverage (UHC) in the next two
years, it has budgeted nearly 300 billion rupees (55.9 million dollars) to
fund the programme. It hopes to be able to provide free drugs to 52 percent
of the population by April 2017.  The central government will fund 75
percent of the programme, with states doling out the rest.

With the country's public health system already under-resourced and
struggling to meet the needs of 1.2 billion people, 40 percent of whom live
below the poverty line, there are serious challenges to expanding the
programme nationwide.


  Some have raised thorny questions about the mammoth infrastructure this
process will require, hinting that some states may not yet be in a position
to set up warehouses and cold storage facilities, or test all the drugs
made by roughly 12,000 manufacturers across India.


*Author: Zofeen Ebrahim is a journalist with Inter Press Service (IPS),
from where this article was taken.*
*For more information, please contact Vicente Paolo Yu of the South Centre:
Email yu at southcentre.org*
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