Articles

Access to medicines in India: More government, more governance

By on June 3, 2015

Maya Annie Elias is a researcher with the Institute of Public Health, Bangalore. Her interests are in access to medicines and mental health.

Inequitable access to medicines still remains a challenge in most low and middle-income countries (LMICs). The situation in India is no different. Despite being the largest supplier of generic medicines and often referred to as ‘ the worlds pharmacy’, it is unable to ensure access to medicine to its own people. We are still struggling to improve affordability and availability of medicines and to deal with price and quality control of medicines. Flaws in medicine indenting, procurement and frequent stock outs affect the availability of medicines in public facilities significantly. There is an over dependence on private pharmacies for medicines, which results in high out of pocket (OOP) expenditure; It is reported that about 70% of our OOP is for medicines.

The unfavorable community perception about medicines supplied in the public facilities compound the supply side issues. There is a widespread belief that only select medicines are available in the public facilities and   that the medicines supplied there (generic versions) are often of low quality and they do not act so quickly as the branded medicines. Due to this, people prefer branded medicines to the free medicines supplied in the public facilities, though they are much more expensive.

India has a fairly strong, mostly unregulated domestic pharmaceutical market, and the price control of medicines is a matter of concern. Though the recent Drug Price Control Order (2013) has brought more than 600 chemical formulations under price control, it constitutes only less than 20% of the domestic pharmaceutical market. Also on close look you realize that there is no price cap on patented medicines, combination medicines and new formulations (for five years they are exempt from price control). This gives enough room for drug manufacturing companies to shift their attention to combination medicines and/or to non-standard strengths, which are not mentioned in the price list.   The implications of these tactics are manifold and could be detrimental.

If having appropriate regulations is one issue, the implementation is another. While on one side the authorities hesitate to take action due to various constraints, the drug manufacturing companies challenge the government measures and get court exemptions. In a span of just one year of the price control order, they managed to get more than hundred medicines off the price cap.

The financial implications and multiplicity of stakeholders make the pharmaceutical systems more complex and susceptible to malpractices and corruption. We need strong regulations and sound governance in place to effectively manage these systems. The decision makers need to assert themselves; operational processes and guidelines for manufacturing and supply need to be foolproof.  In addition a rigorous oversight mechanism should be ensured to ensure access to medicines.

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