Procurement issues, lack of funds are major hurdles

The Health Department’s ambitious project to screen the State’s entire population for non-communicable diseases (NCD) like diabetes, hypertension and cardiovascular diseases and to distribute medicines free of cost, is falling flat on its nose as the government is unable to ensure regular, uninterrupted supply of drugs.

NCD drugs are in short supply across the State and in many districts, there are no stocks available anymore. Even the basic drug for diabetes, metformin, and glucometer test strips for blood glucose monitoring are totally out of stock in many places.

Beyond estimates

The shortage has resulted because of the drug procurement issues of Kerala Medical Services Corporation Ltd., as well as the State’s difficulty in finding funds to sustain free drug distribution for a target population which has grown way beyond the initial projections.

Apart from NCD drugs, some 150 commonly used drugs are also totally out of stock in most districts.

Objective defeated

The inability of the State to provide uninterrupted supply of the drugs defeats the very objective of the NCD control programme because strict and uninterrupted adherence to prescription medications and regular follow-ups are crucial for keeping all NCD-related complications under check.

The erratic supply of NCD drugs in PHCs/CHCs would result in people either discontinuing their treatment or buying only those drugs which they can afford.

Huge commitment

“This is the first time that we have had a nil-balance situation of drugs after we launched the NCD control programme. The decision to provide NCD drugs for free to all those detected with diabetes or hypertension had been ill-conceived and several senior Health officials had warned the government that this was a huge commitment which will be difficult to sustain,” a senior Health official said.

NPCDCS

The National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke (NPCDCS) is being carried out in five districts in the State since 2012.

There is no free drug distribution under NPCDCS. But the State took a decision to extend the scheme across the State and to use State’s funds to screen the entire population and provide drugs free of cost.

Huge drain

The decision has proved to be a huge drain on the exchequer because all the funds allocated for the programme – both Central and State funds – are now being spent on purchasing drugs while the other components of the programme, like activities to promote primary prevention of the disease in the community, have not taken off at all.

12 drugs

The State is procuring through KMSCL and distributing for free, 12 drugs including insulin for the treatment of diabetes, hypertension and cardiovascular diseases.

The list of drugs had been drawn up by an expert committee, which also drew up the State’s first treatment protocol for diabetes and hypertension.

In 2012-13, State NCD funds of Rs.12 crore was spent on procuring drugs.

In the second year, Rs. 4 crore was handed over to KMSCL for purchasing NCD drugs. By then, it was clear that the way the drug component was sucking up all the funds, the NCD control programme could not be sustained.

Technical glitches

Hence, a directive was issued to all PHCs/CHCs to calculate their individual requirement of NCD drugs, so that it can be included in the general indent for drugs being sent to KMSCL by every hospital.

Though the list was sent to KMSCL before the current financial year, the Corporation could not initiate the purchase process because of some technical glitches in the tender process.

Rise in cases

“This year, though the programme has not received any funds yet, we managed to find Rs.4.3 crore from State Plan funds for purchasing NCD drugs. Through screening programmes, we have till now detected about 4 lakh new cases of hypertension, about 3.6 lakh cases of diabetes and about 2 lakh new cases with both diabetes and hypertension. Taking into account the existing number of persons with these conditions who are currently being treated at the taluk or district or medical college hospitals, we estimate that the State will require at least Rs.80 crore annually just for purchasing NCD drugs – which is staggering, to say the least,” the official said.

Risk reduction

“In the long-term, the focus should be on encouraging people to adopt risk reduction strategies and adopting policies that encourage healthy living. Apart from a few basic drugs, no government can afford to offer statins or expensive insulins free to the people for a lifetime. This was a populist measure which has gone horribly wrong,” the Health official added.

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