No State provides free medicines to below the poverty line (BPL) patients under the National Rural Health Mission (NRHM).

“The insufficiency of drugs and thereby the imperative of prescribing medicines from outside continue widely. This could also be linked to insufficiency of understanding of the essential drug concept,” says the third report of the Common Review Mission (CRM) on the NRHM.

Showering praise on the NRHM for strengthening the public health service system, the CRM points out while most States seem sensitive to the issue of availability of drug especially for BPL patients, irrational prescribing higher order medicines, instead of basic generic preparations, has been reported. It has emphasised the need for combining free provisioning with promotion of rational drug use. This will lower the cost to the system and households.

Though almost all States report improved availability of drugs and supplies, the CRM draws attention to “irrational” use and non-availability of “essential” medicines. In several facilities “co-operative” pharmacy shops were seen on hospital premises selling drugs. A number of States are introducing or have in place commercial pharmacy shops within public hospitals.

The CRM teams also observed an increase in availability of drugs and supplies across various levels of health facilities, but say there is still gap in terms of stock-outs, oversupply, lack of tracking of inventory, delay in supplies and procurement, and lack of a robust quality control system. Almost all States experienced both oversupply and undersupply of different items, especially for peripheral level health institutions. “It seems that supplies are mostly top-down, based on availability and whatever had been procured, instead of being demand-based. There is an acute need for training the storekeepers and pharmacists in inventory management and the facility-in-charge in making evidence-based demand estimations for drugs and supplies.”

Stop outside prescription

The CRM has also highlighted the need for elimination of ‘outside prescription’ except when absolutely unavoidable, and for popularising and ensuring use of essential drugs lists in procurement and prescription.

As for user-friendly services, it is a mixed bag. Clean toilets with lighting, curtains in examination rooms of out-patient departments and in labour wards, ensuring privacy to patients, were observed with appreciation, even while noting their absence in a large number of facilities.

However, service providers showing no respect to patients in their interaction is still a pervasive phenomenon that discourages use of public facilities. Lack of dignity in the conduct of sterilisation camps has also been reported, says the CRM.

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