Last year during his Independence Day speech from the ramparts of the Red Fort, Prime Minister Manmohan Singh had announced free distribution of medicines through government hospitals and health centres. One year down the line, however, the promise is far from being fulfilled and the declaration has made no progress.
Health activists have expressed concern that developments over the past year suggest that the programme would be silently shelved. They have now written a letter to the Prime Minister urging him to deliver on the promise immediately since the programme has a potential not only of ensuring people’s right of access to essential medicines, but also in strengthening the public healthcare system as well as in tackling poverty.
“Following your announcement, the Union Health and Family Welfare Minister had promised to provide Rs. 1,300 crore to the States for the purchase of medicines and setting up of a Central Procurement Agency for bulk procurement of drugs. Unfortunately, these promises have not been realised. Instead, the budgetary allotment for the current year on the medicines scheme was a mere sum of Rs. 100 crore, though a realistic estimate would show an actual requirement of at least Rs. 6,000 crore,” health activists have said in the letter.
“While your announcement was widely appreciated and highlighted in the national and international media, we in the public health community had specific reasons to welcome the announcement as a promising initiative…Various surveys have reported that households in India spend significant amounts on medicines, and expenditure on medicines account for 70 per cent of out-of-pocket expenses incurred by families on medical care. Expenditure on buying medicines, thus, is a major portion of private expenditure on health care. The Planning Commission estimates that out-of-pocket expenditure, which accounts for 70 per cent of all health care expenditure in India, is responsible for pushing over five crore people below the poverty line every year.
Even though India is the world’s third largest producer of medicines and exports medicines to over 200 countries, an estimated 65 per cent of its population is not able to access all the medicines they need. Medicine prices have shot up phenomenally in India over the past decade and this has been one of the main drivers of the multiplying cost of medical care,” the letter said.
While millions of Indian households have limited access to medicines, several State governments have decreased fund allocation for the procurement of medicines over the last few years. Only a tenth of government spending on health is currently set aside for drug procurement, with some States spending even less than five per cent.
A significant increase in the allocation for public procurement of medicines from current level to around 0.5 per cent of GDP over the next few years will improve access to essential drugs in public facilities and will greatly reduce the burden on out-of-pocket expenditures and increase the financial protection for households, said the letter sent under the banner of Jan Swasthya Abhiyan.
Pointing out that the scheme, if implemented, would have significantly changed the healthcare scene in India, the activists said availability of medicines would contribute to the image of public healthcare institutions and renew interest among public in these institutions. “We have experience within our own country that such a scheme can make a huge difference to health outcomes.
Significant progress has been achieved in Tamil Nadu, Kerala, and more recently in Rajasthan, where free medicine schemes have been implemented. The experiences of these States show that medicines procured in bulk by their generic names cost 40-4,000 per cent less to that of the market rates. Reports from Rajasthan suggest that the scheme has led to considerable increase in the number of people accessing public health centres in the State.”