By: Dr. Samit Sharma IAS Managing Director Rajasthan Medical Services Corporation, Jaipur
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By:Dr. Samit Sharma IASManaging DirectorRajasthan Medical Services Corporation, JaipurImprovingACCESS TO MEDICINES INRAJASTHANTragedy As per WHO 65% of the Indian population lacks regular access to essential medicines.
The expenditure on health is the second most common cause for rural indebtedness.
Over 23% of the sick dont seek treatment because they are not having enough money to spend.
Over 40% of hospitalized patients has to borrow money or sell their assets to get them treated.Problem : 1 Medicines are beyond the reach of our peoples.Sare Janha se achhaWhere does the money for health expenditure (in India) come from?
Private out of pocket
expenditure79%State govt.14%Central govt.4%Private investment3%Private insurance0 1%Problem : 2 Medicine makes people poor.Expenditure on drug constitute about 50-80% of the health care cost.Expenditure on health is responsible for 2% shift from APL to BPL every year.A study by World Bank shows that as a result of single hospitalization 24% of people fall below poverty line in India.
(COMPARATIVE PRICES OF GENERIC AND BRANDED DRUGS)Use Name of DrugPack sizeRMSC Tender price (In Rs.)Equivalent Popular BrandMRP (Rs.)ANALGESICDICLOFENAC SODIUM TABLET IP 50 MG10 TAB STRIP1.24VOVERAN31.73CHOLESTEROL LOWERINGATORVASTATIN TABLET IP 10 MG10 TAB STRIP2.98ATROVA (ZYDUS)103.74BLOOD THINNING DRUGCLOPIDOGREL TABLET IP 75 MG14 TAB STRIP8.54PLAVIX (SANOFI AVENTIS)1615.88DIABETESGLIMEPIRIDE TABLET IP 2 MG10 TAB STRIP1.95AMARYL (AVENTIS)125.00Problem: 3 Medicines are overpriced.Problem : 4 Promotion of Non essential drugs
I did take the tonic, sir! But had to starve for days to buy it.Irrational use of drugsABP NewsRs. 27.50
ManufacturerisCipla for all the three brands
One branded&Two genericRs. 39.30Rs. 31.50MRP for 10 tabsPurchase price for 10 tabsRs. 2.02Rs. 23.70Rs. 2.27ESSENTIAL COMPONENTS OF FREE ESSENTIAL DRUGS SCHEMEA. (HARDWARE COMPONENT) AVAILABILITY OF DRUGS IN GOVT. HOSPITALS.B. (SOFTWARE COMPONENT) PROMOTION OF RATIONAL USE OF DRUGS AMONG DOCTORS.1. Autonomous centralized procurement agency.1. Sensitization and orientation about rational use of drugs.2. A two-bid open transparent tendering process.2. Write prescription on self carbonated double prescription slip.3. Procurement of all essential and life saving drugs.3. Diagnosis must be written 4. Warehouse at every district.4. Write Generic / Salt names.5. Empanelled laboratories for quality testing.5. Use out of Essential Drug List.6. Drug distribution centers in Govt. hospitals.6. Follow Standard Treatment Guidelines.7. Transparent and prompt payment system.7. Constitution of Drug and Therapeutics Committee.8. Sufficient funds.8. Prescription Audit.MUKHYAMANTRI NIHSHULK DAVA YOJNAAN INITIATIVE TO SAVE LIVES
(HARDWARE COMPONENT) AVAILABILITY OF DRUGS IN GOVT. HOSPITALS.1. Autonomous centralized procurement agency.
PROCUREMENTSUPPLIESQUALITY CONTROLIT CELL
ESTABLISHMENT OFRAJASTHAN MEDICAL SERVICES CORPORATION
2. A two-bid open transparent tendering process.Only manufacturer/importer can participate.
Only those bidder can participate who have annual turnover more than Rs.20 Cr.
Only e-procurement from 1st April 2012.
3. Procurement of all essential and life saving drugs.Technical Advisory Committeehas developedthe procurement list of RMSC (EDL).
4. Warehouse at every district.
5. Empanelled laboratories for quality testing.
Drugs are received at DDW with manufacturers test report.They are stored in quarantine area.Sample are sent to QC cell at RMSC head office.Samples are coded & sent to empanelled labs.RMSC has empanelled 6 NABL accredited / schedule L1 compliant labs.Examination of samples is carried out as per pharmacopeias.If sample is found as of standard quality then only drugs are issued to hospitals.6. Drug distribution centers in Govt. hospitals.
7. Transparent and prompt payment system.Payment either through CBS (Core banking solution, anywhere banking), or NEFT (National Electronic Transfer) up to 1.00 Lac or RTGS (Real Time Gross Settlement) if more than 1.00 Lac.e- Processing of suppliers payment through e- Aushdhi Software.Physical Cheques are not issued to any suppliers.Centralized payment to all stakeholders viz suppliers, H.Q./DDWs staffers. TDS and other statutory dues etc through e-payment.
8. Sufficient funds.FY 2011-12 - Rs.200 Cr.FY 2012-13 - Rs.300 Cr.
(SOFTWARE COMPONENT) Promotion of Rational use of drugs among Doctors.1. Sensitization about the poor and orientation of Doctors about rational use of drugs.
Seminars,Conferences&Review meetings2. Write prescription on self carbonated double prescription slip.3. Diagnosis must be written
4. Write Generic / Salt names.
5. Use out of Essential Drug List.6. Follow Standard Treatment Guidelines.
7.Constitution of Drug and Therapeutics Committee.8.Prescription Audit.
WHAT DO WE GIVE CURRENTLY ? 325 Drugs
42 Surgical & Sutures
71 National Health Programme drugs30 types of ANTIBIOTICS
Inj. Meropenam 500 mg (1 vial)Price Rs.113.74
Tab. Azithromycin 500 mg (10 Tabs)Price Rs.58.80Name of DrugPrice (in Rs.)Cap. Cyclosporin 25 mg (1 pack)602.18Inj. L-Asparginase (1 vial)712.9821 ANTICANCER DRUGS
Inj. Paclitaxel 260 mg (1 vial)Price Rs. 714.40Name of DrugPrice(in Rs.)Inj. Streptokinase 15 Lac units (1 vial)470Inj. RH-Erythropoetin 10000 IU (1 vial)447.76Inj. Human Albumin 20% (1 bottle)200035 DRUGS FOR HEART DISEASEDIABETES
Inj. Biphasic Insulin 30/70 (10 ml vial)Price Rs. 46.5Inj. Insulin regular(10 ml vial)Price 46.93
For PREGNANT WOMENInj. Human Anti D Immunoglobulin150 mgPrice Rs.1207.50Dinoprostone Gel 0.5 mg(in syringe)Price Rs.173.25
12 drugs for RESPIRATORY DISEASE & ASTHAMA
Beclomethasone Inhaler (200 doses)Price Rs. 129.95
Salbutamol Inhaler (200 doses)Price Rs. 52.34
Budesonide NebulizerSuspension (2 ml amp)Price Rs. 11Name of DrugPrice(in Rs.)Rabies Vaccine Human 2.5 IU (1 ml vial)185.64Rabies Antiserum IP (Equine) (5 ml vial)303.45Human Anti rabies Immunoglobulin Inj. 150 IU (2 ml vial)4640Anti Snake Venom (10 ml vial)207.90ANTI RABIES & ANTI SNAKE InjectionsSURGICALS & SUTURE ITEMS
Disposable SyringeIV SetSurgical CapGlovesDisposable Syringe
RMSCIMPACTINCREASE IN NUMBER OF PATIENTS IN GOVT. INSTITUTESFrom 2nd Oct 2011 to 31st March 2012BeforeAfter MNDY44 Lac patients per month62 Lac patients per month
DECREASE IN OUT OF POCKET EXPENDITUREEveryday we are giving drugs to more than 2 Lac patients
The average cost per patient is around Rs.30
Otherwise the cost of drugs purchased from the market use to cost around Rs.300 to 500.
RMSCIMPACTIMPACTSMILING PATIENTS & THOUSANDS OF LIVES SAVED
What about remaining drugs ?FAIR PRICE MEDICINE SHOPsLife Line Drug Stores
Drugs which are not in the
free category are provided at
low price compared to
Jan Aushadhi Kendras
Co-operative Medical Stores
Market competition ensures that private medical shops also reduce their prices.
RECENT DEVELOPMENTS AT GOVERNMENT OF INDIA LEVEL1. Scheme for Free Medicines for All in Public Health Facilities 12th Five year plan Centrally aided scheme. Quality Generic Medicines. * Essential Medicines Total cost Rs.29,968 Crores for five years.
3. Decision of Indian Patent Office Compulsory license issued for generic version. Sorafanib Tosylate allowed to be manufactured for Rs.8,800 instead of Rs. 2,84,000RECENT DEVELOPMENTS AT GOVERNMENT OF INDIA LEVELVideo
RECENT DEVELOPMENTS AT GOVERNMENT OF INDIA LEVEL2. Supreme Court has directed to frame policy to keep all essential drug under price controlNew pharmaceutical pricing policy is being framed.
RMSC profile7 Best MedicinesGandhi ji Video
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