Abstract
BackgroundAccess to free essential medicines is a critical component of universal health coverage. However availability of essential medicines is poor in India with more than two-third of the people having limited or no access. This has pushed up private out-of-pocket expenditure due to medicines. The states of Punjab and Haryana are in the process of institutionalizing drug procurement models to provide uninterrupted access to essential medicines free of cost in all public hospitals and health centres. We undertook this study to assess the availability of medicines in public sector health facilities in the 2 states. Secondly, we also ascertained the quality of storage and inventory management systems in health facilities.MethodsThe present study was carried out in 80 public health facilities across 12 districts in Haryana and Punjab states. Overall, within each state 1 MC, 6 DHs, 11 CHCs and 22 PHCs were selected for the study. Drug procurement mechanisms in both the states were studied through document reviews and in-depth interviews with key stakeholders. Stock registers were reviewed to collect data on availability of a basket of essential medicines −92 at Primary Health Centre (PHC) level, 132 at Community Health Centre (CHC) level and 160 at tertiary care (District Hospital/Medical College) level. These essential medicines were selected based on the Essential Medicine List (EML) of the Department of Health (DOH).ResultsOverall availability of medicines was 45.2 % and 51.1 % in Punjab and Haryana respectively. Availability of anti-hypertensives was around 60 % in both the states whereas for anti-diabetics it was 44 % and 47 % in Punjab and Haryana respectively. Atleast one drug in each of the categories including analgesic/antipyretic, anti-helminthic, anti-spasmodic, anti-emetic, anti-hypertensive and uterotonics were nearly universally available in public sector facilities. On the contrary, medicines such as thrombolytics, anti-cancer and endocrine medicines were available in less than 30 % in public sector facilities. Among the medicines which were not available at the time of survey in Haryana, nearly 60 % of them were out of stock for 3–6 months whereas 8 % of them were out of stock for more than 6 months.ConclusionHealth system needs to be strengthened by making essential medicines available for patients. Ensuring access to free medicines is likely to reduce private expenditure on medicines, which is a long-term, sustainable way to towards universal health coverage in India.Electronic supplementary materialThe online version of this article (doi:10.1186/s40360-015-0043-8) contains supplementary material, which is available to authorized users.
Highlights
Access to free essential medicines is a critical component of universal health coverage
The Community Health Centres (CHCs) and District Hospitals make up the secondary level, and the Medical Colleges are at the tertiary level
Primary Health Centres (PHCs) which are manned by medical officer provide primary care to a population of around 30000.Community Health Centres (CHCs) provide secondary care services to a population of around 1, 20,000
Summary
Access to free essential medicines is a critical component of universal health coverage. Availability of essential medicines is poor in India with more than two-third of the people having limited or no access. This has pushed up private out-of-pocket expenditure due to medicines. According to a World Health Organization (WHO) report, almost 68 % of the people in India have limited or no access to essential medicines [2]. Another study in the three North Indian states of Haryana, Punjab and Chandigarh reported that medicines constituted 19-47 % of hospitalization expenditure and 59 to 86 per cent outpatient department (OPD) expenditure borne out-ofpocket by households in public sector [7]
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