The government has initiated the process of introducing generic medicines in state-run hospitals by opening fair price shops through public-private partnership (PPP). These outlets are selling generic drugs at a whopping rebate on the maximum retail price (MRP), earning kudos from the people, but annoying a major section of drug sellers. The government has announced that more fair price medicine shops would opened. “If the government can make the switchover, it would ensure cheap medicines for poor people,” said renowned orthopedic surgeon Sunil Thakur. The fair price shop at the Seth Sukhlal Karnani Memorial Hospital (SSKM), the state’s only government-run super-speciality hospital, is selling generic drugs at a 67.25% rebate. It is the eighth such shop in the state. With plans to launch 35 fair price shops in the first phase, the health department has asked the shops to store 142 types of generic medicines.

“Quality control would be an issue, and the government has to be smart about sniffing out spurious medicines,” Thakur warned.

Noted cardiologist Dipankar Mukherjee said: “It’s a challenge mainly because it’s very hard to change one’s natural habits. For long, doctors have been prescribing branded drugs, while the people are also habituated to taking branded medicines.”

“The medicine outlets also lacked adequate trained pharmacists capable of giving the precise medicines to customers if physicians prescribe generic drugs”, he said. There is reason for caution, going by the experience in neighbouring Bangladesh. A senior official at a drug makers’ body in Bangladesh said: “Our country had initiated the process about 30 years ago. But the quality of generic drugs was not up to the mark.”

“When a doctor prescribes a branded medicine the onus is on him, but when he prescribes drugs with generic names, the onus of providing the right medicines shifts to the pharmacist, who is often a mere shopkeeper. Thus it compromises people’s heath,” the official said. West Bengal, however, can draw encouragement from Rajasthan, which successfully implemented the policy of promoting cheap generic medicines. The Mamata Banerjee government has got some success in lowering medicine prices. The state’s druggists association, which was earlier up in arms, has now asked its members to sell generic medicines with a higher rebate than the discounted rates at fair price shops.

Claiming it was not against introducing cheaper drugs, the Bengal Chemists and Druggist Association (BCDA), which has more than 35,000 members across the state under its umbrella, said the government should make the programme more “practicable”. “First, the doctors have to start prescribing generic names. Providing single-molecule generic drugs would not be difficult for a pharmacist, but difficulties would crop up in case of combined products,” BCDA general secretary Tushar Chakraborty said. Chakraborty said doctors of even government-run hospitals were prescribing medicines for critical patients which were currently not available in fair price outlets.

It was difficult to treat critical patients with these 142 specified drugs, while the fair price shops were also selling medicines at varying prices in Kolkata and the districts. A pharmacist at the fair price shop at the SSKM however claimed they were meeting around 97% of the patients’ requirements from the specified generic drugs.

Minister of State for Health Chandrima Bhattacharya parried questions. “I cannot reveal the government programmes in detail,” Bhattacharya said, adding that no government in the state earlier had tried to reduce the price of medicines. On the flip side, the transition attempt could prove costly for a section of medical representatives, as sales of a few branded drugs have shrunk dramatically.”I learnt that recently some drug companies, engaged mainly in manufacturing general pharmaceutical products, are reporting low sales of their branded products. They are even not being able to set sales targets due to a severe demand fall,” said a medical representative working with Zydus Cadila. He said there was ground to fear loss of jobs.

Source: IANS

Increase healthcare coverage from 22% to 52%

Right now only 22% of the country’s 1.17 billion have access to public healthcare. The government estimates this number will reach 52% by 2017. They are aiming to provide generic medicines at 1.6 lakh sub-centres, 23,000 primary health centres, 5,000 community health centres and 640 district hospitals. 

National and State list of Essential Drugs

To achieve this the ministry has sent the National List of Essential Medicines (NELD) 2011 (348 drugs which includes anti-AIDS, analgesics, anti-ulcers, anti-psychotic, sedatives, anaesthetic agents, lipid lowering agents, steroids and anti-platelet drugs) to all the states to use as reference. 

The states have also been asked to create their own lists of essential drugs keeping mind the geography and demographics of the state and the diseases that affects those places. The Centre intends to bear 75% of the costs for the state medicines.  5% of the funds will be used to purchase drugs outside the essential list. The cabinet also approved a proposal to set up a Central Procurement Agency for bulk order of drugs. Additional secretary in the ministry L C Goyal said a scientific committee will have to draw up the EDL list for the states. 

Right now a staggering 78% of health expenditure in India is out of pocket – one of the highest out of pocket procurement numbers in the world – and 72% of this is spent on drugs.

Measures are also being taken to devise standard treatment protocols in order to avoid unnecessary treatments.
Goyal said, “The states will procure drugs directly from manufacturer or importer through an open tender. Companies applying for the tenders will have to have GMP compliance certificate, a no conviction certificate and should have a specified annual turnover. The drugs must carry a not-for-sale label printed on the packaging. We plan to roll out the game changing programme from October.” 

Goyal said a district-level state-of-the-art warehouse will have to be set up by states to store the drugs and a passport driven system will move the medicines to district hospitals, CHCs and PHCs will then send the drugs to the sub centres. 

He added, “It is being made mandatory for all doctors in the public sector to prescribe generic drugs and salt names and not brands. Action will be taken against doctors found prescribing brands.” 

The spotlight has been thrown on generic drugs. Ironically it took a Bollywood actor to educate the public about generic drugs and their availability. Click here to read more about generic drugs.  Some states have been providing free medicines in their public health centres like Tamil Nadu and Rajasthan and Karnataka is supposed to follow suit soon.

Sky-rocketing prices

A Planning Commission panel observed that drug prices have increased by 40% between 1996 and 2006. They also observed that drugs that while the drugs on the EDL rose by 15% the non-essential drugs increased by 137%. This clearly proves that proper legislation can keep the price of drugs down.

No country for the ill

The Commission observed that 39 million India were forced into poverty because of ill-health and the subsequent treatment costs. Around 30% in rural India didn’t go for any treatment for financial constraints in 2004. In urban areas, 20% of ailments were untreated for financial problems the same year. About 47% and 31% of hospital admissions in rural and urban India, respectively, were financed by loans and sale of assets. 

Out of pocket expenditure

A recent Public Health Foundation study threw light upon the staggering amounts of money people have had to pay for increasing medicine and healthcare costs.

• India’s per capita OOP expenditure to pay for healthcare costs has gone up from Rs 41.83 in 2005 to Rs 68.63 in 2010.
• The per capita spending on drugs increased from 29.77% to 46.86%
• During the same period, while hospitalization costs went up from 11.20% to 22.47%. 
• This meant that outpatient expenditure increased from 30% to 46%.
•  A staggering 10% of total household income is spent on health care in states.

India.com Health View

We’d love to believe that all the initiatives will be carried out and alleviate people’s healthcare woes and decrease out of pocket expenditure. But we remain sceptical about whether it’ll be implemented. The government had launched a similar program under the Jan Aushadhi scheme which looked to launch generic drug stores. Though the plan was to have 3000 stores by 2012 only 300 of them were set up. And that’s what worries us that though the intention is there, this scheme will come up against the same logjams that any government initiative faces. There’s also the issue of rampant corruption among the different players involved in this initiative be it – the doctors, pharmaceuticals or even the drug regulation body.

We also need to see how the Indian Medical Association will react to this considering they are already up in arms against the government’s proposed National Human Resource for Healthcare (NHRHC) and has organised a massive protest on June 25. Only time will tell. Watch this space.

Also read: Why the NCHRH bill is not a good idea

From city hospitals to tiny rural clinics, public doctors will soon be able to prescribe free generic drugs to all comers, vastly expanding access to medicine in a country where public spending on health was just $4.50 per person last year.

The plan was quietly adopted last year but not publicised. Initial funding has been allocated in recent weeks, officials said. Under this plan docs will be forced to hand out generic drugs and anyone doing otherwise faces severe punishment.

“Without a doubt, it is a considerable blow to an already beleaguered industry, recently the subject of several disadvantageous decisions in India,” said KPMG partner Chris Stirling, who is European head of Chemicals and Pharmaceuticals. “Pharmaceutical firms will likely rethink their emerging markets strategies carefully to take account of this development, and any similar copycat moves across other geographies,” he added.

This initiative could completely overhaul the system where healthcare is a luxury. Within five years, up to half of India’s 1.2 billion people are likely to take advantage of the scheme, the government says. Others are likely to continue visiting private hospitals and clinics, where the scheme will not operate.

“The policy of the government is to promote greater and rational use of generic medicines that are of standard quality,” said L.C. Goyal, additional secretary at the Ministry of Health and Family Welfare and a key proponent of the policy.

“They are much, much cheaper than the branded ones.”

Global drug makers like Pfizer, GlaxoSmithKline and Merck will be hit. They spend billions of dollars a year researching new treatments and target huge growth for branded medicine in emerging economies such as India, where generics account for around 90 percent of drug sales by value, far more than in developed countries.

U.S.-based Abbott Laboratories, which bought an Indian generics maker in 2010, is the biggest seller of drugs, both branded and generic, in India, followed by GlaxoSmithKline.

BIG PHARMA OUT

In March, India granted its first ever compulsory license, allowing a domestic drugmaker to manufacture a copy-cat version of Nexavar, a cancer drug developed by Germany’s Bayer, unnerving foreign drug makers that fear a lack of intellectual property protection in emerging markets.

That enabled India’s Natco Pharma to sell its generic version of Nexavar at 8,800 rupees per monthly dose, a fraction of the 280,000 rupees Bayer’s version cost.

In another blow to Big Pharma’s emerging market ambitions, China recently overhauled regulations to grant authorities the power to allow domestic drug makers to produce cheap copies of medicines protected by patents.

Emerging markets are on track to make up 28 percent of global pharmaceuticals sales by 2015, up from 12 percent in 2005, according to IMS Health, a healthcare information and services company.

Most sales in emerging markets come from branded generics, which off-patent drugs priced at a premium to those are made by local manufacturers.

The Organisation of Pharmaceutical Producers of India (OPPI), a lobby group for multinational drugmakers in the country, argues that the price of drugs is just one factor in access to healthcare and that the scheme need not be detrimental to manufacturers of branded drugs.

“I think this will hasten overall growth of the pharmaceutical industry, as poor patients who could not afford will now have access to essential medicines,” said Tapan Ray, director general of OPPI.

About 600 billion rupees in drugs are sold each year in India, or 482 billion at wholesale. Drugs covered under the new policy account for about 60 percent of existing sales, or 290 billion rupees at wholesale cost.

The government’s annual cost is likely to be lower due to bulk purchasing and because patients at private clinics would still pay for their own drugs. States will pay for 25 percent of the free drugs and the central government will cover the rest.

Under various existing programmes, around 250 million people, or less than a quarter of India’s population, now receive free medicines, according to the health ministry.

India’s new policy, to be implemented by the end of 2012 and rolled out nationwide within two years, is expected to provide 52 percent of the population with free drugs by April 2017, at a cumulative cost of 300 billion rupees.

That requires a major funding ramp-up from a deficit-strapped government. The scheme has been granted just 1 billion rupees thus far from central government coffers.

Only 5% budget for non essential drugs

Public doctors will be able to spend 5 percent of the budget, equivalent to around $50 million a year, on drugs outside of the government’s list, on branded drugs or on medicines that are not on the list. Beyond that, they can be punished, said Goyal, the health ministry official.

“If doctors are found to be prescribing medicines which are not on the list, or which is branded, then disciplinary action will be initiated,” he said.

Free medicine is just one solution to better healthcare in India, where just getting to a state clinic can require a long journey.

Swapnil Yadav, who runs a clinic in Ambegaon, a village 170 km (105 miles) southeast of Mumbai, said India should set up free drug retailers instead of government clinics.

“Patients can approach a private clinic and then get free medicines from government-run medicine shops,” he said.

The free generics scheme, which mirrors policies in the states of Tamil Nadu and Rajasthan, is expected to be fully operational by the time voters go to the polls for the 2014 general election, when the populist Congress party will seek a third straight victory.

Indian pharmas who make generics like Dr Reddy’s and Cipla are best placed to benefit. 

Also read: Is it feasible?

Report of a working group on drugs and food regulation in the 12th Plan said the plan will be operational from October this year.  An announcement on the prime minister’s official Facebook page Saturday said the Prime Minister’s Office has asked the health ministry to set up a central procurement agency (CPA) for bulk procurement of drugs as early as possible. 

At present, 78 percent of the entire health expenditure in India is from out of pocket (OOP). Purchasing drugs alone accounts for 72 percent of this expenditure.  Public sector provides healthcare to only 22 percent of the country’s population. 

According to health ministry’s estimates, this will increase to 52 percent by 2017 once medicines are provided for free from 1.6 lakh sub-centres, 23,000 primary health centres, 5,000 community health centres and 640 district hospitals. 

A list of medicines has been prepared by the central government, which has 348 drugs including anti-AIDS, anti-psychotic, sedatives, anaesthetic agents, lipid lowering agents, steroids and anti-platelet drugs. States have also been asked to create their own lists, keeping in mind the diseases that worst affect their populations.  The central government will bear 75 percent of the expenditure under the plan. 

Click here to read out in depth analysis.

Source: IANS

Chaired by Cabinet Secretary Ajit Kumar Seth, the meeting was attended, among others, by secretaries from ministry of health and family welfare. ”The cabinet secretary was apprised that there is adequate stock of drugs and vaccines for treatment of people affected by the illness and immunization of health care personnel and whosoever may require it. Vaccine manufactured by indigenous manufacturers is also available,” said a government statement. What’s really worrying is that this meeting took place after after 21 deaths and over 300 cases from across the country. Add to that the fact that the swine flu website hasn’t been updated since 2010 and Maharasthra, the worst-hit state doesn’t even have a helpline.

“A central team has been deputed to Pune to investigate the outbreak of Influenza A H1N1, and their preliminary report shows that the cases and deaths reported from Pune and Pimpri-Chinchiwad are sporadic in nature,” the statement said. ”The medical response system has been put on a state of preparedness. Health & Family Welfare has been asked to monitor the situation on a day-to-day basis and take all possible steps to ensure that the drug and vaccine are available in sufficient stock,” the statement added. 

 Click here to find out how to avoid the disease. 

The latest swine flu news from around the country.

Source: IANS

Tobacco is responsible for 40% of non-communicable diseases like cancer, cardiovascular diseases and lung disorders. 1 out of 3 cancer deaths are due to tobacco usage.

Studies estimate 10% rise in beedi prices would result in a 9.2% reduction in beedi consumption, while a 10% spurt in cigarette prices would reduce cigarette consumption by 3.4%. In India, 10 % deaths are attributed to tobacco use and it is estimated that by 2020, tobacco use will account for 13% of all deaths in India every year. Almost 35% adults (15 years and above) consume tobacco in India (47% men and 21% women). 

Some states have started levying high rates of VAT on tobacco products – Rajasthan (40% VAT on all forms of tobacco), Gujarat (25% VAT), Odisha (25% VAT) and Jammu and Kashmir (30% VAT on all tobacco products). 

Additional secretary in the ministry Keshav Desiraju stated in his letter that, “Tobacco use leads to a huge burden of disease, disability and death thus imposes high healthcare and productivity costs. As per health cost study conducted by the Indian Council of Medical Research, the cost of treatment of just three diseases caused by tobacco – cancer, lung disease and chronic obstructive pulmonary disease (COPD) accounted for roughly 25% of all public spending on health.” 

He added, “One of the effective ways to reduce tobacco consumption is by making the per unit price higher so as to make them unaffordable or the susceptible population such as the poor or children or youth. We are sure that levy of or increase in VAT on all tobacco products/inputs will support to prevent new initiation into tobacco use and encourage tobacco users to quit.” 

Bhavna Mukhopadhyay, executive director of Voluntary Health Association of India, said in the upcoming Union budget all tobacco containing products should be subjected to high rate of excise and VAT “to keep the next generation healthy. If tax on tobacco products is raised, government Income will increase while expenditure on health will go down. Today, tobacco products are affordable and easily accessible to minors.” 

Experts say taxes on tobacco products in India fall well below the rate recommended by the World Bank - from 65% to 80% of retail price. Taxes on beedis are very low, averaging only 9% of retail price, while cigarette taxes account for about 38% of the retail price. About 5,500 people start using tobacco products daily. It is estimated that raising the tax as a percentage of retail price from 7% to 33% for beedis and from 43% to 58% for cigarettes would lead to  14 million smokers quitting and 27 million children never starting. This will save 69 million years of healthy life over the next 40 years. 

 Over 12 crore Indians smoke and almost one in every three Indian consumes some form of tobacco product. Beedi smokers constitute of ove5 85% of all smokers and the tax levied on beedis make it accessible to almost everyone. In stark contrast cigarettes comprise less than 15% of all smoked tobacco, but contribute nearly 85% of tobacco taxes. 

More budget news: 

•  What the healthcare industry wants?
• Tobacco taxes to go up
• Malnutrition to be one of the top five priorities
• Govt to increase spending on child nutrition, health
• President promises free generic drugs, 2.5% GDP expenditure on health
• Better healthcare services for the poor 
• Cheaper drugs, better services 
• AIIMS gets Rs 1,124 cr, highest among hospitals and research institutes

In the programme that is to cover nearly 40 lakh school children, students will be given chewable tablets to clear out worms from the body.

“Children with worms are more likely to suffer from malnutrition and anaemia resulting in sickness and it will have a impact on child’s cognitive growth,” Delhi Chief Minister Sheila Dikshit said. 

“The tablets will be given free of cost to all government, municipal and Delhi cantonment schools,” she said.

The state-wide campaign was launched under Chacha Nehru Sehat Yojna (CNSY). It is a combined effort of Deworm the World (DtW), a NGO which will provide technical and operational support with Delhi’s Health, Education, Social Welfare and Women and Child Development departments.

A recent study covering 3,251 children indicated that 83 percent children from a particular slum had worms in their stomach.

Source: IANS

As reported in the Times of India, a new case of TDR-TB reported in Mumbai, a young boy who apparently contracted the deadly strain from his parent.

According to Dr. Nargis Mestry and studies by the BMC and the Foundation of Medical Research, Mumbai could anticipate 3000-4000 new cases of drug-resistant TB every year. And if each infected patient can infect upto 15 persons each year, this is only getting more serious. 

The Central Govt is now taking this more seriously and has sent medical experts to Mumbai. They have visited the Hinduja Hospital in Mumbai and the TB hospital in Sewree (reopened after 16 years).While they have broadly approved BMC’s Malaria model, they will give their final recommendation on Wednesday. 

According to the Mumbai Mirror, the efforts being taken by the BMC (these steps have worked really well in controlling Malaria cases in Mumbai earlier) in Mumbai include:

a. Door-to-door awareness campaigns and checks for identification of suspected cases.

b. Mapping of more susceptible areas, especially slums where the chances of its spread are higher.

c. BMC’s 165 primary health centres have also been asked to focus on identifying patients with TB symptoms and immediately referring them to public hospitals. They have also been handled booklets about TB symptoms to distribute to the general public.

While the plans seem astute on paper how efficiently they are executed remains to be seen.

How you can prevent Tuberculosis