Delhi Program - Pre-Requisites and Success Factors
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Transcript of Delhi Program - Pre-Requisites and Success Factors
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Delhi State
Population 14 million
Total no. of hospital beds 4000
Teaching hospitals 2
Total number of health centers 158
Drug annual budget Rs. 400 million
($ 8 million)
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Before Drug Policy - 1994
Access30-35% of health budget spent ondrugs yet scarcity of drugs in thehospitals and both patients and
doctors were not satisfied
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AccessShortage of drugs in the publichealth facilities
Multiple procurement arrangementsleading to sub-optimal utilizationof resources
Uncertainty of quality of drugs
Before Drug Policy -
1994
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Before Drug Policy -
1994Quality assurance Erratic and unreliable distribution
system Drugs nearing expiry drugs Drugs not needed (combination drugs)
Herbal drugs Money wasted on substandard
drugs
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After Drug Policy-1997
Principles of procurementProcurement restricted to essentialdrug list
90% of drugs budget spent onessential drugs
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After Drug Policy-1997
Pooling of drug requirement of allstate health facilities
System of inviting quotations byeach institution independentlyabandoned
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After Drug Policy-1997
Level playing field to all bidders No special preferences to public
sector undertakings and small scaleunits
Pooled procurement system set up
with a standing Special PurchaseCommittee to secure transparencyand objectivity
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Standing Purchase
CommitteeChairperson is a non-government person Principal Secretary Health
State Director Health ServicesState Drugs ControllerNominee of the State Finance DepartmentNominee of the State Law DepartmentAn eminent clinical pharmacologistChairperson, Committee for selection of
essential drugs
Head of institution
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Non officials
An eminent administrator
An eminent clinical pharmacologist
A Finance & contract expertA leading private practitioner
This was an innovative move intended to bringoutside expertise, transparency and objectivity
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Purchase committee
Close linkages have been maintained withdrug selection and use
The chairperson of the Essential drugscommittee is a member of the purchasecommittee
Continual liaison with other agencies like
Defence establishment for feedbackabout suppliers performance
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Procurement methods
Empanelment of pre-qualifiedbidders
Or
Open competitive bidding each year
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Bidding restricted to empanelledpre-qualified bidders not followed
as it: Debars new players albeit for a limitedtime
Leads to sense of complacency Possibility of cartels developingamongst empanelled bidders
Procurement methods
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Procurement methods
Open competitive bidding each yearwith pre-qualification criteria
introduced
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Pooled procurement
systemSelection criteriaTenders invited from manufacturers only
in generic names in 2 envelope system Technical and price bids
Price bids of only those manufacturersare opened who fulfill the technical
criteriaUnsuccessful bidders are informed and
earnest money returned
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Pre-qualification criteriaFinancial viability - at least annualturnover of Rs. 120 million ($ 2.5million)
Pooled procurement
system
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Pre-qualification criteriaTechnical qualifications biddershould have been Manufacturing the drug for at least 3years
WHO-GMP certification
Pooled procurement
system
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Pre-qualification criteriaServices of at least one approved
manufacturing chemist and one qualitycontrol chemist
No case pending against manufacturerfor sub-standard or spurious drugs
No black listing by any otherprocurement agency
Pooled procurement
system
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Quality assurance
Careful selection of the tenders
Criteria of cut off turnover Rs.
120 million ($ 2.5 million)Selective GMP inspections
Testing of batch samples
Samples sent for testing by theprescribers for quality assurance
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Quality Assurance GMPinspections
Panel of 12 experienced experts set up forGMP inspections
Two experts sent for inspection to any of
the pharmaceuticalThe inspection results of the approved
firms (White list) shared with other states
on requestRejection rate is 25%
Samples sent to approved quality controllaboratories for quality assurance
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Quality assurance
results -CPA cellTotal no. of drug batches tested in
2000-20023529
No. of samples declared not of standardquality
20
Total expenditure on testingRs. 25,92,750
0.53% of the budget for drugs
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Positive effectsMaximal use of available resources
Procurement at lower prices led toavailability of more funds for procuringmore essential drugs
Increased availability of drugsImproved quality of drugs procured,
therefore, building up trust in the system
Pooled procurement
system
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Better availability and accessibilityto drugs in the public sector by
savings through an efficientprocurement system
Conclusions
No extra funds spent other than GMPinspections
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Impact of State DrugPolicy - Pooledprocurement
Cost of procurement reduced
Holding the price lineQuality of medicines better
Access to medicines increased
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Pooled availability of drugs,extent of prescriptions by
generics and adherence to EDL
0
20
40
60
80
100
120
1995 1997 1999 2000
Availability
Generics
EDL
Year under review
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0
5
10
15
20
25
30
35
1995 1996 1997 1999 2000
Amoxycillin Chloroquine Omeprazole
Years
59%
37%43%
Cost Reduction of commondrugs by pooled procurement
(Rs.)