In a meeting on June 1, the ministry of chemicals and fertilisers had announced that it proposed to launch 1,000 stores in one day under a different name.
The Central government’s ambitious proposal to provide affordable medicines through Jan Aushadi medical stores across the country would require thorough planning. The government’s plan is to launch 1,000 Jan Aushadi stores in a day, across the country.
The previous efforts in the direction have not done well. Even at the trial stage expectations were belied.
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What the government needs is a system that would ensure medicines reach both the middle class with some purchasing power and the poor, who depend on the government healthcare sector, points out Sakthivel Selvaraj of Public Health Foundation of India.
In a report submitted to the Department of Pharmaceuticals in 2012, the Foundation had assessed the potential of the Jan Aushadi and found many hiccups.
More than half of the 100 Jan Aushadis are shutting down, says Dr. Sakthivel. That is because there are fundamental flaws such as a weak supply chain system and the huge task of engaging physicians to prescribe generic medicines.
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“Private practitioners will not prescribe generic medicines. And around 80 to 85 per cent of the generic medicines are branded generics,” he says.
Another reason Jan Aushadi may not take off as envisaged is the strong lobby between pharmaceutical distributors and district medical officers, especially in northern states. “If you go to a PHC or a CHC in north India you will see a medical shop near the health centre. Such is the nexus,” Dr. Sakthivel says.
Apart from engaging physicians to prescribe generic medicines, issues with supply chain management from production level to the Jan Aushadi facility also must be addressed. The Foundation found that insufficient planning, including wrong forecasting of demand and supply and not having a road map for the future all led to the JAS overstocking medicines which led to expiry and subsequent financial losses. This did not benefit the patient, the end user; the manufacturers also lost confidence.
Even the Tamil Nadu Medical Services Corporation’s model, with around 23 warehouses across the State and a meticulous system in place, has certain unaddressed concerns.
The Corporation manages to procure medicines and supplies to hospitals at subsidised rates but the State, which spends around seven per cent of its health budget in procuring drugs, could definitely improve services. While the supply of medicines is steady, the lack of sufficient number of pharmacists is a lacuna the state needs to address.
These are definitely small concerns that the State may address soon, it appears. For, the Foundation has recommended the replication of the model in other states as “in Tamil Nadu even the middle class is now visiting the government healthcare facilities,” Dr. Sakthivel points out.
Surgical implantsWhile the basic issue of supplying medicine may have been addressed by Tamil Nadu, it is yet to master the technique of supplying surgical implants.
Under the Chief Minister’s Comprehensive Health Insurance Scheme, cardiology departments in government hospitals are the largest revenue earners and the biggest beneficiaries too.
As of now, only the procurement of heart valves has been streamlined to some extent.
Cardiologists in government hospitals say though the TNMSC currently supplies two types of heart valves in terms of options it is still a far cry from what is available in the private sector. “In a private hospital you will have valves of different sizes but in the government sector you may have to depend on just two different sizes,” rues a senior cardiac surgeon.
Procuring a stent is a different issue though. Some years ago, the Tamil Nadu government permitted hospital deans to make purchases up to the tune of Rs. 4 lakh.
Again the cardiology department benefited the most. “We could place indent for stent and we now have two or three companies supplying them to us now,” says a cardiologist.
Though the funds for the purchase largely come from the revenue earned through the insurance scheme, specialists are concerned about price rise. A company recently opted out of supplying stent citing price rise, the cardiologist says.