Abstract
BackgroundIndia has the distinction of financing its healthcare mainly through out-of-pocket expenses by individual families contributing to catastrophic health expenditure and impoverishment. Nearly 70 % of the expenditure is on medicines purchased at private pharmacies. Patients with chronic ailments are especially affected, as they often need lifelong medicines. Over the past years in India, there have been several efforts to improve drug availability at government primary health centres. In this study, we aim to understand health system factors that affect utilisation and access to generic medicines for people with non-communicable diseases.MethodsThis study aims to understand if (and how) a package of interventions targeting primary health centres and community participation platforms affect utilisation and access to generic medicines for people with non-communicable diseases in the current district context in India. This study will employ a quasi-experimental design and a qualitative theory-driven approach. PHCs will be randomly assigned to one of three arms of the intervention. In one arm, PHCs will receive inputs to optimise service delivery for non-communicable diseases, while the second arm will receive an additional package of interventions to strengthen community participation platforms for improving non-communicable disease care. The third arm will be the control. We will conduct household and facility surveys, before and after the intervention and will estimate the effect of the intervention by difference-in-difference analysis. Sample size for measuring effects was calculated based on obtaining at least 30 households for each primary health centre spread across three distance-based clusters. Primary outcomes include availability and utilisation of medicines at primary health centres and out-of-pocket expenditure for medicines by non-communicable disease households. Focus group discussions with patients and in-depth interviews with health workers will also be conducted. Qualitative and process documentation data will be used to explain how the intervention could have worked.DiscussionBy taking into consideration several health system building blocks and trying to understand how they interact, our study aims to generate evidence for health planners on how to optimise health services to improve access to medicines.Trial registrationProtocol registered on Clinical Trials Registry of India with registration identifier number CTRI/2015/03/005640 on 17th March 2015.Electronic supplementary materialThe online version of this article (doi:10.1186/s12913-016-1680-3) contains supplementary material, which is available to authorized users.
Highlights
India has the distinction of financing its healthcare mainly through out-of-pocket expenses by individual families contributing to catastrophic health expenditure and impoverishment
In spite of recent efforts through the National Rural Health Mission to improve utilisation of public services and decrease out-of-pocket expenditure (OOP) on medicines, recent estimates of OOP expenditure on medicines continues to be as high as 70 %, with instances of people falling into poverty merely from paying for outpatient care for non-communicable diseases (NCD) [8,9,10]
Objectives and research questions Aim The aim of the study is to understand health system factors for improving equitable access to quality generic medicines for patients suffering from non-communicable diseases in a rural Indian district
Summary
India has the distinction of financing its healthcare mainly through out-of-pocket expenses by individual families contributing to catastrophic health expenditure and impoverishment. We aim to understand health system factors that affect utilisation and access to generic medicines for people with non-communicable diseases. Even in cases where patients obtain outpatient care in government hospitals, they often have to purchase medicines from private pharmacies, either due to frequent stock-out of medicines at primary health centres (PHC), or poor procurement and distribution of drugs at higher levels [6, 7]. In spite of recent efforts through the National Rural Health Mission to improve utilisation of public services and decrease out-of-pocket expenditure (OOP) on medicines, recent estimates of OOP expenditure on medicines continues to be as high as 70 %, with instances of people falling into poverty merely from paying for outpatient care for non-communicable diseases (NCD) [8,9,10]. Recent efforts at making available cheaper generic equivalents of essential drugs through Jan Aushadhi stores (people’s pharmacy in Hindi) have shown promising results; the generic drugs supplied have been reported to be comparable in quality to their proprietary equivalents [16, 17]
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