The Centre's move to introduce an experimental universal health package in at least one district per State under the National Rural Health Mission, with access to free generic drugs, is a welcome measure. But the larger mission to provide free essential medicines to all citizens need not await the results of such pilot studies. It should be rolled out for poor and non-poor alike quickly. There is no time to be lost because medicines make up an alarming 71 per cent of all out-of-pocket spending on health. The time for experimental schemes is therefore long past. What is more, efficient models of drug procurement and distribution by State governments involving low costs and improved access are readily available. Tamil Nadu is a leading example, having demonstrated this over the last 15 years. Kerala has replicated it and some other States are in the process of doing so. Clearly, it is feasible to provide carefully chosen essential drugs free, with higher government spending. Some reform is of course needed, and it should include an expanded National Essential Drug List, elimination of irrational drugs from prescriptions, priority for generic medicines and, crucially, a good centralised procurement system. The issues involved have been analysed by the High Level Expert Group (HLEG) of the Planning Commission on Universal Health Coverage.
A quarter century of National Sample Survey data from households on availability of free medicines to patients reveals depressing trends. From about 32 per cent of drugs supplied free to in-patients in1986-87, the figure fell to 9 per cent in 2004. Data on free drug supply for all patients indicate weak controls and escalating price pressure from the mid-1990s. This has severely affected affordability and thus access. It is here that the role of government assumes importance. The Tamil Nadu Medical Services Corporation has been able to deliver results because State-level procurement has ensured competitive pricing and control over prescription of irrational medicines. Such a system works better because it meets the key principle of efficient financing, which is pre-payment. Obviously, half-measures will only slow the process down and give room for manoeuvring by special interests. The HLEG has provided two scenarios for partial and full drug security that can be achieved in the dramatic time-frame of two and seven years. Scaling up government spending from about 0.1 per cent of GDP at present to 0.5 per cent is essential to achieving this outcome. The Centre must show the political will necessary.
Keywords: universal health package, National Rural Health Mission, free generic drugs, Universal Health Coverage
I doubt that this policy may further cripple our economic system as it requires lions share of our exchequer.govt should slash the share of allocations to infrastructure developments to meet this requirements.in one hand govt is planning for free food supply to 70% of people,another hand it's planning for universal health care.for implementing universal health care also they have to augment the infrastructural availabilities.Hope govt will go ahead with the appropriate policy,so that the up coming policy shouln't dishearten the economic develoment and well being of the country.
It's the duty of government to take steps for facilitating the access to
essential medicines and so is the right of every citizen to enjoy the basic
healthcare. Distribution of generic medicines is praised but we also need the quality personnel who holds the ability to prescribe such medicines and no need to say about the condition of government hospitals. Those having the money and resources to seek treatment from other places will always seek treatment at any place and cost but not at government hospital. Given poor people a choice to have treatment at private hospitals they will definitely choose that over government facilities in hope of better treatment.
As the editorial argues it is a laudable first step and steps should be taken to provide free medicines to all sections of the population. During the time it takes to roll out the scheme for all at least the central and state governments should abolish all taxes on medicines. In Karnataka the state government makes more money on medicines sold than the manufacturers make by producing them, a whopping 14 Percent
Cenral Govt. already have a lot of program such as nrega and PMGSY but
a little part of that that expenditure is only available to Poors, So
Think what will be Condiation of UHC.
If the central govt. begins to give free medical aid to poor people,
where will the selfless MPs and MLAs go to increase their well deserved
emoluments. After all they are all serving the nation 24/7.At least one
western country provides free medical aid to all of its citizens. We
can, if we have the will and genuinely concerned rulers.
The High Level Expert Group (HLEG) of the Planning Commission on
Universal Health Coverage has given very good reasoning how the
availability of free medicines will relieve the general public. The
Universal Health Coverage (UHC) should be integrated in the existing
National Rural Health Mission and such other health related drives and
mission. An expanded National Essential Drug List is badly needed for
the elimination of irrational drugs from prescriptions by government
doctors, priority for generic medicines and, crucially, a good
centralised procurement system should be developed at national level.
Government should promote indigenous drugs and medicine companies
should be given incentive so that we can become self dependent for
medicines as a good percentage of high quality drugs are imported from
other countries or the foreign companies deliver in India. The
percentage of GDP expenditure on medicine need a review. Creating a
healthy environment is also necessary for all citizens.
The article has clearly highlighted our urgent need to reform the procurement and delivery system in the nation.With malnourishment and poverty hindering people's life at one side,non-availability of medicine at reachable cost is a pathetic situation.With the prime minister himself quoted on the importance of medical care for all sector of people,a breakthrough reform is been expected from the government.With state governments like Tamil Nadu been already started with insurance schemes for people at low income range,more states should come forward to enact such schemes to ensure their people's medical needs
Writer says the fall in availability of free medicines to patients from
1986-87 to 1990s are depressing fact and the reason behind this
,probably is the price rise and weak control over the projects.
The government is responsible for failure or success of the project or
mission it launch. If global pressure is preventing its success who shall be blamed,if procurement and supply have mismatch who shall be blamed .If poor are dying and have indigent access to generic medicines who shall be blamed here too.The Government!.Than its improper to say reason for failure of a project is unknown.
Poor people are the most affected by the costly health care available in our country. So instead of studying the working of the scheme district wise it is time that the poor people are provided with free medicines.
I am a great supporter of UHC and I firmly believe that a well governed Universal Health Care framework can well address the health inequalities in the country. However, I genuinely doubt how can that be operationalised limited to district settings. We know that district health systems in India are yet to be realised. There are no district governments as such, and decentralisation yet has not touched the district level, though we have PRI act (even there, the district Panchayats cover only rural areas and urban governance is separate). The district administrations as of now are playing the role limited to "state agents". Therefore, if we have to realise a district level UHC should not we empower first the districts with adequate legal/policy/ programme/ financing/ managerial autonomy? Are we prepared of doing that? will it be feasible? Else, is not important to try it out in 2-3 states as a whole whole wherein all those desired autonomies are readily available? Needs serious thinking.
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