Free Medicines Research Articles

Access to and use of medicines in the Annapurna region of Western Nepal and possible impacting factors

Improving access to medicines is a major healthcare challenge for low-income countries because the problem traverses health systems, society and multiple stakeholders. The Annapurna region of Nepal provides a valuable case study to investigate the interplay between medicines, society and health systems and their effects on access to and use of medicines. Government health facilities and international aid organizations provide some healthcare in the region, communities participate actively in healthcare organization and delivery, there is an important tourism sector and a mostly rural society.This study investigates access to and use of medicines through health facility and household-based studies using standardised tools and through a series of structured key informant interviews with various stakeholders in health.Overall, access to essential medicines at public health facilities was good, but this was not benefitting households as much as it should. People were using the private sector for medicines because of their perception about the quality and limited numbers of government-supplied free medicines. They utilised money from remittances and tourism, and subsidised healthcare from non-government organizations (NGOs) to access healthcare and medicines. A pluralistic healthcare system existed in the villages. Inappropriate use of medicines was found in households and was linked to the inadequate health system, socioeconomic and sociocultural practices and beliefs. Nevertheless, the often disadvantaged Dalit users said that they did not face any discrimination in access to health services and medicines. The government as the main stakeholder of health was unable to meet people’s health services and medicines needs; however, health aid agencies and the local community supported these needs to some extent.This study shows that the interconnectedness between medicines, society and health systems impacts the way people access and use medicines. Improving access to medicines requires an improvement in public’s perception about quality, actual coverage and appropriate use of medicines and health services via collaborative contributions of all stakeholders.

Qualitative Study of Barriers to Adherence to Antihypertensive Medication among Rural Women in India.

Objective There is poor adherence to antihypertensive therapies among women in India. To determine its socioeconomic barriers we performed a qualitative study on Indian rural women with hypertension. Methods In-depth interviews with women having hypertension and presenting to outpatient department at a teaching hospital were performed in 30 women aged 35-65 years, using a questionnaire focused on reasons for nonadherence and poor lifestyle modification. Low to medium adherence was observed in two-thirds of women. Results Majority of women were from low socioeconomic status and were illiterate. Awareness of hypertension and its complications was poor. Knowledge and practices of cessation of smoking and tobacco use and salt restriction in hypertension were low. Efforts to increase physical activity and decrease dietary fat and sugar intake were largely absent. Local follow-up at rural community health centres was not practiced due to physician nonavailability and about half used alternative systems of medicine. None had health insurance or access to free medicines. All the women had to pay out-of-pocket for medicines and were concerned with cost of therapy as well as pill burden. Half of the women borrowed money from relatives or friends to reach the hospital and pay for medicines. Conclusions Socioeconomic barriers for low adherence to antihypertensive medication in women in India are low awareness of hypertension and complications, poor access to care, out-of-pocket payments, borrowing money, lack of insurance, and cost of medicines.

Availability and Affordability of Medicines for the Treatment of Cardiovascular Diseases in Pharmacies in Six Regions of the Russian Federation

Aim. To evaluate the availability and affordability of medicines used to treat of cardiovascular diseases (CVD) in several regions of the Russian Federation with different climatic, geographic, economic and demographic characteristics. Material and methods. The study was conducted in 6 regional capitals, chosen to differ in geographically, economically, and demographically. In each city, 5 pharmacies providing free medicines to certain categories of citizens (beneficiaries) and 5 private pharmacies serving anyone were selected at random. Medicine availability was assessed in all pharmacies, along with price only in the private pharmacies. Data were obtained for both original drug and appropriate generics. A list of 25 of the most frequently prescribed medicines for cardiovascular diseases was compiled. Results. Some general findings emerged. With the existence of a generic drug, the original drug was not available in the pharmacy supplying beneficiaries. Diuretics, as well as some ACE inhibitors, are not available in a number of pharmacies for beneficiaries. Enalapril in most licensed pharmacies is represented by generics, lisinopril in a number of cities is represented by both the original drug and generics. The presence of sartans was much lower than ACE inhibitors. Bisoprolol was most common beta-blocker. Calcium antagonists: if amlodipine was present in all licensed pharmacies, at list as generic, then nifedipine was not available in many licensed pharmacies. Among antiplatelet agents, aspirin was available in most pharmacies, and clopidogrel was mostly represented by generics. As for statins, only simvastatin could be found in almost all pharmacies. When analyzing the cost of drugs in licensed pharmacies, it was found that drugs containing furosemide are the cheapest among generics – about 17 rubles. The most expensive treatment with generics of rosuvastatin – about 4,374 rubles a month. The most expensive original medicine was also rosuvastatin – about 4,500 rubles for 30 tablets, the cheapest – the original drug of furosemide – about 35 rubles. On average, the cost of CVD treatment with major classes of drugs, including ACE inhibitor, beta-blocker, antiplatelet drug and statin, is 1,921.9 rubles per month. Conclusion. The basic cardiovascular medicines were characterized by a relatively high availability in 6 regions of the Russian Federation included in the analysis both by the criterion of the availability of drugs and by the criterion of the minimum price.

Auditing the Efficacy and Safety of Alfacalcidol and Calcium Therapy in Idiopathic Hypoparathyroidism.

Patients with hypoparathyroidism are treated with vitamin D and calcium. PTH is an emerging option because of its physiological action. It is important to assess the efficacy and shortcomings of conventional therapy. We assessed the efficacy and safety of alfacalcidol in a large cohort of patients with idiopathic hypoparathyroidism (IH) and identified a subset who could be treated without oral calcium. Observational study at tertiary care center. We assessed 92 patients with IH who were receiving alfacalcidol and oral calcium to maintain an optimal serum total calcium level of 8.0 to 8.5 mg/dL during routine follow-up. Patients with suboptimal control were provided free medicines and followed up frequently. Oral calcium and alfacalcidol doses were titrated sequentially to determine the minimum doses for optimal calcium control. Serum phosphate level, 1,25-dihydroxyvitamin D, fractional excretion of phosphorus (FEPh), and hypercalciuria (urine calcium-to-creatinine ratio, >0.2) were assessed at each step of titration. Only 38% of patients had optimal calcium control during routine follow-up. With good compliance, all achieved optimal serum calcium and 1,25-dihydroxyvitamin D levels and 43% of patients could stop taking oral calcium. Hyperphosphatemia, hypercalciuria, and low FEPh persisted at all stages of therapy. Serum phosphorus levels normalized when the serum calcium level increased to 9.9 mg/dL, but this level of serum total calcium was associated with hypercalciuria in 90% of patients. Alfacalcidol is effective in achieving calcemic control in IH. Calcemic control without oral calcium was achieved in 43% of patients receiving alfacalcidol. However, optimal calcium control was associated with hyperphosphatemia and hypercalciuria in most patients.

Paying to Normalize Life: Monetary and Psychosocial Costs of Realizing a Normal Life in the Context of Free Antiretroviral Therapy Services in Uganda.

Antiretroviral therapy (ART) is considered the treatment that enables people living with HIV (PLHIV) to lead a “normal life”. In spite of the availability of free treatment, patients in resource-poor settings may continue to incur additional costs to realize a normal and full life. This article describes the monetary expenses and psychosocial distress people on free ART bear to live normally. We conducted in-depth interviews with 50 PLHIV on ART. We found that the demands of treatment, poverty, stigma, and health-system constraints interplay to necessitate that PLHIV bear continuous monetary and psychosocial costs to realize local values that define normal life. In the context, access to free medicines is not sufficient to enable PLHIV in resource-poor settings to normalize life. Policy makers and providers should consider proactively complementing free ART with mechanisms that empower PLHIV economically, enhance their problem-solving capacities, and provide an enabling environment if the objective of normalizing life is to be achieved.

Drug-Related Morbidity in Brazil: A Cost-of-Illness Model

To estimate the proportion of patients with drug-related morbidities (DRMs), DRM preventability, and the cost of illness of the DRMs in Brazil. We used the decision-analytic model initially developed by Johnson and Bootman (Drug-related morbidity and mortality. A cost-of-illness model. J Manag Care Pharm 1996;2:39-47), which was adapted to the reality of the present study. A hypothetical cohort of patients in ambulatory care setting was simulated considering the perspective of the Brazilian public health system. Direct costs related to health care were obtained from the national databases, and the probability of occurrence of DRMs was established by a panel of clinical experts. Sensitivity analyses were conducted. An estimated 59% ± 14% of all patients assisted by the health system suffer some DRMs. Given these cases, 53% ± 18% were considered preventable. The average cost of managing a patient with any DRM was US $155. The cost of illness of the DRMs in Brazil would account for nearly US $18 billion (US $9-$27 billion) (best and worst case scenarium) annually. This amount is 5 times higher than what the Ministry of Health spends to guarantee free medicines in Brazil. Hospitalizations and long-term stays in hospital correspond to 75% of this cost. The sensitivity analysis showed that the model is sensitive to variations in these two outcomes. According to the model, a large proportion of patients experience DRM and the economic impact to solve these problems is substantial for the health system. Considering that more than half of these cases are preventable, it could be possible to achieve an enormous saving of resources through actions that improve the process of medication use.

Variation in Price of Medicines and Free Medicine Availability for Treatment of Non-communicable Diseases in Public Sector of Eastern Nepal

Nepal is witnessing rise in non-communicable chronic diseases. Costs of the medicine, availability of the medicine for free in public health sectors and variation of price of medicines may play an important role in the management of chronic disease. The study was undertaken to find out the variation in price of drugs used for treating non communicable diseases among private pharmacies and availability of free essential medicines in public facilities. Randomly selected 33 public health centers and 13 pharmacies were included for the study. Availability of free essential medicines for treating selected chronic diseases was assessed in public health centers and percentage price variation in various branded drugs used for treating these diseases was assessed at the consumer level. Out of 89 different formulations, variations between maximum and minimum priced brands of more than 100% were observed in 37 formulations and that of > 200% in 22 formulations. Thirty-seven formulations had more than 100% inter-pharmacy variation. The most commonly available free essential medicines was 4 mg salbutamol (88.57%) while the least available free essential drug was levothyroxine 5 mg (9.0%). Considerable variation in prices is seen among similar drugs and in prices of same drug in different pharmacies. These factors may have implications in the management of chronic disease in Nepal offsetting the government's effort to control chronic diseases.

SISTEM INFORMASI GUDANG OBAT PADA UPT PUSKESMAS

The need for medical supplies at a Technical Implementation Unit of the Center for Public Health is of paramount importance. But in reality UPT Puskesmas especially those located in small towns have not been able to control the availability of drugs effectively. Often there is a shortage of even running out of drugs when needed. Distribution of drugs that take a long time also becomes a barrier drug can be used in an effective and efficient. An information system on drug data management is expected to assist officers in the pharmacy to be able to control the stock of drugs that exist in a UPT Puskesmas. A stock drug can be known from the exit and entry of existing drugs. This system uses UML in its design and java as a programming language. With the drug warehouse information system, monthly statements of drug stocks become easier, the availability of drugs can be controlled so that patients who should get free medicines from Puskesmas do not need to redeem or change drugs in pharmacies because of Puskesmas that run out of drug stock.Keywords: Drugs, Java, Puskesmas, UML

Social capital and resilience among people living on antiretroviral therapy in resource-poor Uganda.

BackgroundDespite the national roll-out of free HIV medicines in Uganda and other sub-Saharan African countries, many HIV positive patients on antiretroviral therapy (ART) are at risk of non-adherence due to poverty and other structural and health system related constraints. However, several patients exhibit resilience by attaining and sustaining high levels of adherence amid adversity. Social capital, defined as resources embedded within social networks, is key in facilitating resilience but the mechanism through which it operates remains understudied. This article provides insights into mechanisms through which social capital enables patients on ART in a resource-poor setting to overcome risk and sustain adherence to treatment.MethodologyThe article draws from an ethnographic study of 50 adult male and female HIV patients enrolled at two treatment sites in Uganda, 15 of whom were followed-up for an extended period of six months for narrative interviews and observation. The patients were selected purposively on the basis of socio-demographic and treatment related criteria.FindingsSocial capital protects patients on ART against the risk of non-adherence in three ways. 1) It facilitates access to scarce resources; 2) encourages HIV patients to continue on treatment; and 3) averts risk for non-adherence.ConclusionsSocial capital is a key resource that can be harnessed to promote resilience among HIV patients in a resource-limited setting amid individual, structural and health system related barriers to ART adherence. Invigoration and maintenance of collectivist norms may however be necessary if its protective benefits are to be fully realized.

Universal Health coverage – a reality or mirage

Providing quality health services to everyone and everywhere is the dream of many countries and India is one of them. Universal health coverage means that everyone is able to access essential quality health services without facing financial hardship (1). On the other hand it does not mean that every health service will be provided free of cost to everyone everywhere. With the advancement in medical science the cost of treatment is increasing day by day and it is pushing people specially the marginalized one into poverty. It is has been said that poverty breeds diseases and diseases breeds poverty. If one has to provide minimum plethora of essential quality health services to all in India then one has to make efforts to decrease out of pocket expenditure on health. As per WHO tracking universal health coverage global monitoring report 2017 (2), 17. 3 % Indians spend more than 10% of their annual income for treatment and 3.9 % spend more than 25% of their annual income on treatment. In fact when we look at the data provided by National Sample Survey round 71 (3) it is apparent that expenditure on free medicines for In patients has reduced from 31% to 8.99% and for out-patients from 17.98% to 5.34 % in two decades that’s from 1986 to 2004. While the government spending on health as percentage of GDP is almost stationary. It clearly indicates that either the cost of treatment is increasing or the number of patients have increased tremendously due to increase in population. This issue of increasing population needs to be addressed at war footing otherwise despite increasing the government spending on health it will not be able to reduce out of pocket expenditure.

Does €1 Per Prescription Make a Difference? Impact of a Capped Low-Intensity Pharmaceutical Co-Payment.

Increasing patient contributions and reducing the population exempt from pharmaceutical co-payment and co-insurance rates were one of the most common measures in the reforms adopted in Europe during 2010-2015. We estimated the association between the introduction of a capped co-payment of €1 per prescription and drug consumption of the publicly insured population of Catalonia (Spain). We used administrative data on monthly pharmaceutical consumption (defined daily doses [DDDs]) from January 2012 to December 2014, for a representative sample of 85,000 people. Our results showed that consumption increased in the 2months previous to the introduction of the measure, and fell with the introduction of the 'Euro per prescription' co-payment. The average net response associated with the reform (including anticipation) was a reduction of 4.1 DDDs per person per month, representing a 6.4% reduction. The decrease in pharmaceutical consumption was larger for those individuals who had free medicines prior to the reform compared with those who already paid a co-insurance rate (9.7 vs. 1.4 DDDs per person per month). The largest reduction in DDDs per person occurred in the following groups: dermatologic drugs, antihypertensives, non-insulin antidiabetic drugs, insulin antidiabetic drugs, and laxatives. A uniform capped low co-payment may give rise to a major reduction in drug consumption to a much greater extent among those who previously had free prescriptions.

Economic burden of tuberculosis and its coping mechanism at the household level in Pakistan

Despite the availability of free medicines under the Directly Observed Treatment Short-course (DOTS) strategy, the treatment of tuberculosis (TB) still involves high costs that push people into poverty. This study aims to assess the resulting economic burden of TB and examine the coping mechanisms practiced at the household level in Pakistan. A cross-sectional study was conducted at TB centers by interviewing 269 patients. Statistical tests and binary logistic regression were used to explore the relationship between catastrophic health expenditures (CHE) and socio-economic factors. Results show that the incidence and intensity of CHE were higher for households in the lower income-quintile. Several coping strategies were practiced and varied among the different income-quintiles. The independent determinants of CHE were as follows: age >40years, male-patient, location, earner-ratio, patient as the earner, caretaker visits, treatment delay, and co-morbidity. It is recommended that health policymakers develop post-MDGs TB-control strategies to ensure free TB-services with financial protection around the globe.

SISTEM INFORMASI GUDANG OBAT PADA UPT PUSKESMAS

Kebutuhan persediaan obat pada sebuah Unit Pelaksana Teknis Pusat Kesehatan Masyarakat merupakan hal yang sangat penting. Namun pada kenyataannya UPT Puskesmas khususnya yang berada di kota-kota kecil belum dapat mengontrol ketersediaan obat secara efektif. Sering terjadi kekurangan bahkan kehabisan obat pada saat diperlukan. Distribusi obat yang memerlukan waktu cukup lama juga menjadi penghambat obat tersebut dapat digunakan secara efeketif dan efisien. Sebuah sistem informasi tentang pengelolaan data obat diharapkan mampu membantu petugas pada bagian farmasi untuk dapat mengontrol stock obat yang ada pada sebuah UPT Puskesmas. Stock obat dapat diketahui dari keluar dan masuknya obat yang ada. Sistem ini menggunakan UML dalam perancangannnya dan java sebagai bahasa pemrograman. Dengan sistem informasi gudang obat, laporan bulanan stock obat menjadi lebih mudah, ketersediaan obat dapat terkontrol sehingga pasien yang seharusnya mendapatkan obat gratis dari Puskesmas tidak perlu menebus atau mengganti obat di apotik karena Puskesmas yang kehabisan stock obat.

Access and availability of essential medicines in Chhattisgarh: Situation in public health facilities.

Background:In 2013, the Government of Chhattisgarh announced a policy guaranteeing access to free generic medicines in all the public health facilities. This study was conducted with the objectives of evaluating the prescribing patterns of physicians in public health facilities with regard to generic medicines, and whether the prescribed generic medicines were made available to patients.Materials and Methods:This cross-sectional study was conducting from December 2013-October 2014, using exit interviews of patients. Out of the total 27 districts of the state, 15 districts were selected, and one district hospital, three community health centers, and three primary health centers were selected from each of these districts, as per logistics feasibility. Descriptive statistics in the form of frequencies and percentages were calculated.Results:During the data collection period, a total of 1290 prescriptions were reviewed from 100 public health facilities. Around 68.89% of the medicines prescribed were generic and were from the 2013 generic drugs list. Around 58.28% of the prescribed generic medicines were available to the patients from these public health facilities, and the rest of the medicines were procured from private pharmacies.Conclusion:Chhattisgarh has made considerable progress in increasing access of generic medicines to patients in public health facilities. Our study shows that for the year 2013-14, about 58% of the prescribed medicines were available in various public health facilities. There is opportunity to further improve the state financial allocation for generic medicines, to improve supply chain and logistics for better distribution, and to mandate that physicians in these facilities prescribe generic medicines.

Glimpses of keraleeya ayurveda samajam history

Glimpses of keraleeya ayurveda samajam history

MS 12.04 Sustainable Care System in Philippines

The Philippines is an archipelago composed of more than 7000 islands and is considered one of the emerging economies in Asia. Hence, it is not a surprise that although there is a huge improvement seen in the country, providing sustainable healthcare, even though it is in the list of the government’s priorities, is still a major problem. Cancer, as reported by the Philippine’s Department of Health (DOH) is the third leading cause of mortality behind Infectious and Cardiovascular Diseases. The top malignancy cases reported by the DOH involve the Breast, Lung, Prostate, Cervical and Colorectal. Incidence rates are highest in more developed countries due to early detection of the disease therefore in areas like the Philippines, which lacks access to early diagnosis and treatment, mortality rates remain high. One reason surmised besides lack of financial back up is the geography of the country. With more than 7107 and rising islands, health care delivery is more challenging due to most towns, especially in the southern parts of the country, are difficult to go to or inaccessible by land, air and/or sea. However, in spite of lack thereof, the Department of Health – Philippine Cancer Control Program established in 1990, with Administrative Order 89-A, continue to work hard to bridge the gap. Its mission is to reduce cancer morbidity and mortality in the country operating in a systematic and organized approach utilizing primary and secondary prevention at the community level and tertiary prevention in the different regions of the country through hospitals and community levels. By means of the 6 pillars namely, Epidemiology & Research; Public Information & Health Education; Prevention & Early Detection; Treatment; Training; and Pain Relief (focusing on subprograms involving breast, lung and cervical cancer control, cancer pain relief), a healthcare system that is sustainable was hoped to be established. There are numerous projects formulated using the 6 pillars however due to lack of financial support, stricter implementations of guidelines and slow government approvals into law, mortality from cancer continues to rise. Nonetheless, the program as well as medical societies such as the Philippine Society of Medical Oncology, Philippine Cancer Society, Philippine Society of Oncology, Philippine College of Surgeons and so on, remain confident and continue to work towards the goal. Programs, such as the Philippine Medicines Policy of 2011 employed strategies that would provide free medicines in the hope to address priority diseases such as TB, HIV, Malaria and Cancer. The Philippine Health Insurance Corporation in 2012 provided Benefit Packages in the aim of giving assistance to marginalized sectors of society afflicted with certain malignancies and promote patient empowerment to become active participants in healthcare decision-making by being informed and educated about their illness and adhering to treatment plans. Republic Act 10606 (The Universal Health Care Act of 2013), ensures that all Filipinos, especially the poorest of the poor, will receive health insurance coverage from the Philippine Health Insurance Corporation. The National Center for Disease Prevention and Control-Degenerative Disease Office (2014), developed clinical pathway guidelines for selected non-communicable diseases including cancer in the hope to manage these cases systematically in the country. All these policies and laws are meant to provide a sustainable healthcare in the Philippines but unless properly implemented, followed and financed, the realization of these dreams will remain elusive. There is nevertheless a glimmer of hope with the newly signed law last July 23, 2017, the Executive Order 26, known as the National Tobacco Ban which prohibits smoking in all public places and utility vehicles nationwide. If implemented properly, it would significantly decrease lung cancer incidence and mortality in the country.

A mixed methods study on evaluating the performance of a multi-strategy national health program to reduce maternal and child health disparities in Haryana, India

BackgroundA multi pronged community based strategy, known as National Rural Health Mission (NRHM), was implemented from 2005–06 to 2012–13 in India to curtail maternal and child health (MCH) disparities between poor and rich, rural and urban areas, and boys and girls,. This study aimed to determine the degree to which MCH plans of NRHM implemented, and resulted in improving the MCH outcomes and reducing the inequalities.MethodsAn explanatory sequential mixed methods study was conducted, first to assess the degree of implementation of MCH plans by estimating the budget utilization rates of each MCH plan, and the effectiveness of these plans by comparing demographic health surveys data conducted post (2012–13), during (2007–08) and pre- (2002–04) NRHM implementation period, in the quantitative study. Then, perceptions and beliefs of stakeholders regarding extent and effectiveness of NRHM in Haryana were explored in the qualitative study during 2013. A logistic regression analysis was done for quantitative data, and inductive applied thematic analysis for qualitative data. The findings of the quantitative and qualitative parts of study were mixed at the interpretation level.ResultsThe MCH plans, like free ambulance service, availability of free drugs and logistics, accredited social health activists were fully implemented according to the budget spent on implementing these activities in Haryana. This was also validated by qualitative study. Availability of free medicines and treatment in the public health facilities had benefitted the poor patients the most. Accredited Social Health Activists scheme was also the most appreciated scheme that had increased the institutional delivery rates. There was acute shortage of human resources in-spite of full utilization of funds allocated for this plan. The results of the qualitative study validated the findings of quantitative study of significant (p < 0.05) improvement in MCH indicators and reduction in MCH disparities between higher and lower socioeconomic groups, and rural and urban areas.ConclusionsMCH plans of NRHM might have succeeded in improving the MCH outcomes and reducing the geographical and socioeconomic MCH inequalities by successfully implementing the schemes like accredited social health activists, free ambulance services, free treatment and medicines in hospitals for the poor and in rural areas.

O programa farmácia popular: alcance e limites como alternativa de acesso a medicamentos essenciais

Tendo como premissa que o Estado brasileiro reconhece o direito à saúde como uma das garantias de cidadania, o presente artigo analisa o Programa Farmácia Popular do Brasil, implantado em 2004, como política pública de acesso a medicamentos. Avaliou-se o programa com base em pesquisa documental, bibliográfica e entrevistas com atores-chave, para identificar seus alcances e limites. Ao objetivar a distribuição de medicamentos essenciais para o tratamento de doenças crônicas não transmissíveis, o programa apresentou algumas vantagens na eficiência logística, garantindo a disponibilidade de medicamentos, facilidade de acesso às farmácias conveniadas, mas denotou que os usuários do sistema público de saúde, que deveriam estar utilizando a assistência farmacêutica pública convencional, que distribui gratuitamente remédios à população, necessitavam de outra forma de atendimento, por causa das deficiências nessa assistência pública. Embora o programa tenha sido considerado importante como alternativa, foram sugeridas melhorias operacionais e estratégicas para que este se torne mais efetivo no acesso aos remédios pela população brasileira.

Public Retreat and Changing Access to Inpatient Hospital Care in West Bengal

The post-1991 period in India experienced the implementation of various measures of reform including the social sectors and its effect on both the supply and demand side of the economy. Budgetary allocation in health sector has been reduced. Consequently, it has further reduced the consumers’ purchasing powers of health services and raised the problem of health sector inequity. The present study focuses on the pattern of changes in health care access and how the particular type of population is being adversely affected. The study also examines the distribution of changes in various indicators of access to health care across the various socio-economic groups and the regions over the period from 1986–1987 to 2004–2005. The study revealed that the developed states have recorded higher incidences of hospitalization compared to the poorer states. All kinds of free service facilities have decreased in public hospitals drastically over the period from 1986–1987 to 2004–2005. The high-income states have reported faster decline in access to free medicines and free ward facilities. On the other hand, poorer states have also reported drastic declines in access to free medicine in public hospitals. The demand for public hospital has declined significantly over the period, but the rate of decline is much higher in developed states compared to middle- and low-income states. As far as the figures in West Bengal are concerned, it is noted that the demand for hospitalization has increased among the poor in both the urban and rural areas, whereas it has decreased among the richer section. Access to various free service facilities such as diagnostic test services, X-ray, ECG facilities, free medicine and hospital wards facilities in public hospitals have been reduced drastically across the socio-economic groups in West Bengal. Poor, backward and illiterate households are grossly affected due to the withdrawal of public subsidies. However, access to free surgical operation facilities was less affected compared to other services. On the other hand, the larger towns experience faster exit of public facilities compared to smaller and medium-sized towns. The study also reveals that the households of rural areas are less likely to use private health facilities, but the rate of decline in the use of public facilities seems to be faster in the rural areas compared to medium and larger towns in West Bengal. The study has been organized through both the correlation and cross-tabulation methods using the three rounds of the National Sample Survey Organization (NSSO) unit record data.

Improving Livestock Services Delivery by Mobile Veterinary Units in Odisha

Mobile Veterinary Unit (MVU), an ingenious way of livestock service delivery at the farmers’ doorstep is being operational under the Rastriya Krishi Vikas Yojana (RKVY) in all the 314 blocks of Odisha. The study was carried out in Kandhamal district of Odisha to find out the suggestions from both the stakeholders, farmers who had availed the services of MVU and service providers (Veterinary Surgeon (VS) and Livestock Inspector (LI)) who had delivered the services to improve the efficacy of services of MVU. The analysis shows that most of the respondents expressed homogenous views and suggested more extension activities, adequate supply of free and good quality veterinary medicines, increasing manpower in MVUs, increasing frequency of repeated or follow up visits to villages, increasing salary of MVU professionals and making advanced diagnostic facility at field level to increase the livestock service delivery by MVUs.