Medicines In Public Health Facilities Research Articles

Procurement process and shortages of essential medicines in public health facilities: A qualitative study from Nepal.

Ensuring access to essential medicines remains a formidable challenge in Nepal. The specific reasons for the shortage of essential medicines within Nepal have not been extensively investigated. This study addresses challenges associated with access to essential medicines, procurement process difficulties, and functionality of inventory management systems at different levels of public health facilities. Fifty-nine semi-structured in-depth interviews were conducted with health managers and service providers at provincial and local levels in six randomly selected districts of Bagmati province, Nepal. Interviews were audiotaped and transcribed verbatim, and the results were analyzed using the inductive approach and were later mapped within the four domains of "Procurement of essential medicines". The major barriers for the effective management of essential medicines included delays in the procurement process, primarily locally, leading to frequent stock-out of essential drugs, particularly at the health post level. Additionally, challenges arise from storage problems, mainly due to insufficient storage space and the need to manage additional comorbidities related to COVID-19. Other identified challenges encompass the absence of training on logistics management information systems, a lack of information technology resources in primary health facilities, inadequate qualified human resources to operate the IT system, and insufficient power backup. Moreover, unrealistic demand estimation from the service points, inadequate transportation costs, and manual inventory management systems further contributed to the complex landscape of challenges. This study identified procurement delays as the primary cause of essential medicine shortages in Bagmati Province, Nepal. We recommend implementing comprehensive procurement guidelines, collaborative training, and dedicated budgets to address this issue. Improving the procurement and inventory management process in low-resource settings requires a well-trained workforce, suitable storage spaces, and enhanced coordinated administrative tiers within health facilities at different levels to ensure the year-round availability of essential medicines in these settings.

Inventory Management Performance for Tracer Medicines in Public Health Facilities of Southwest Shewa Zone Oromia Region, Ethiopia: A mixed study.

Tracer medicines are medicines that must be available in sufficient quantities at all times to satisfy the priority health care needs of the population. Inventory mismanagement of these medicines poses significant challenges to public health systems, especially in countries like Ethiopia, where access to healthcare services is already limited. This study aims to assess inventory management performance for tracer medicines at public health facilities of the southwest Shewa zone, Oromia region, Ethiopia. Concurrent triangulation mixed-method study was conducted from 1 to 30 June 2022. The quantitative data were collected using interviewer-administered semistructured questionnaires and observational checklists. The qualitative data were gathered through in-depth interviews with key informants. The quantitative data were analyzed using the SPSS version 26 and Excel spreadsheet version 16. We calculated the stock-out rate, inventory accuracy rate, percentage of facilities that fulfill appropriate storage conditions, percentage of facilities that submitted reports on time, and received the exact quantity of drugs they ordered. Qualitative data were analyzed manually using the thematic content analysis technique. The inventory accuracy rate for tracer medicines was 76% for hospitals and 72.5% for health centers. The overall mean stock-out rate was 24.99%. Bin card updating practice was 93.3%, and only 25% health facilities met the acceptable storage conditions criteria. Among submitted reports, 88.8% were timely reported, 72.2% were accurate, and 75% were complete. Inventory management challenges include a shortage of supplies from the supplier and in the market, price inflation, inadequate training, lack of supportive supervision, insufficient IT and storage infrastructures, lack of communication, and budget constraints. From this finding, we concluded that facilities' report quality, inventory record accuracy, storage conditions, and logistics management information system needs improvements. Therefore, Ministry of Health, assessed facilities and Ethiopian pharmaceuticals Supply Services should take measures to improve them.

Patients Access to Medicines - A Critical Review of the Healthcare System in Kenya.

Access to affordable, safe, effective, and quality-assured medicines by a patient is important for good health outcomes. Unfortunately, there is sparse literature published on the pharmaceutical enablers that may increase the sale of a substandard and falsified (SF) medicine to a patient in Kenya. The review highlights some of the factors that may facilitate the entry of SF medicines into the legitimate pharmaceutical supply chain and discusses their impact on patient access to medicines. Lack of essential medicines in public health facilities is an important factor that may contribute to increased demand for medicine-related out-of-pocket expenses from private health facilities, thus a likelihood for a patient purchasing SF medicine from unlicensed and illegal medicine outlets or unregulated websites. The need to increase medicine availability in the public sector by the Ministry of Health (MOH) is emphasized in addition to the strengthening of public procurement to cushion it from corruption and mismanagement. In addition, the MOH should promote local pharmaceutical manufacturing and implement a medicine pricing containment policy to avoid abuse and prevent overexploitation of patients, increase medicine price transparency, and reduce pharmaceutical supply chain distortion. Recommended regulatory reviews include accreditation of unlicensed illegal medicine outlets to facilitate accountability, regulatory oversight, and active surveillance. The national post-market surveillance regulatory capacity should be strengthened to improve rational medicine use. A 3-year diploma course should be replaced with a shorter 1- or 2-year pharmaceutical support staff training not eligible to superintend a pharmacy. The recommended legislative review includes a mandatory clause to enforce generic prescribing and the implementation of generic substitution by health workers. Unethical manipulative pharmaceutical marketing practices should carry stiffer penalties to deter malpractice. Future research areas include investigation of medicine prescribing and dispensing practices, medicine consumption studies, medicine price differences within different health sub-sectors, and between licensed pharmacies and unlicensed illegal medicine outlets.

AVAILABILITY OF ESSENTIAL MEDICINES IN PUBLIC HEALTH FACILITIES OF JIMMA ZONE, SOUTHWEST ETHIOPIA

Background: Availability is the relationship between the type and quantity of product or services needed and the type and quantity of product or services provided. Availability of essential medicines at facility level is an important factor to address patients' satisfaction and increase their health seeking behavior. The objective of this study is to determine the availability and associated factors of essential medicines in public health facilities of Jimma zone, South West Ethiopia. Methods: Facility-based cross-sectional study design was employed. Based on WHO recommendation, thirty health facilities were selected from five districts and six health facilities were chosen from each district of the zone. Availability of 29 key essential medicines that were selected from 2014 Ethiopian national essential medicine list were checked in stores and dispensaries as well as the store keepers, head of health facilities and dispensaries were selected for interview. The data were checked for completeness, edited, and coded then entered and analyzed using excels 2016 and SPSS version 23. Descriptive statistics were computed and tables, graphs and numerical summary presented results. Result: Average availability of selected core essential medicines (n=29) was 78.6% in surveyed health facilities. With regard to stock level, 8% of the surveyed medicines were in critical level, 55.2% were in safe level and 36.8% were in over stock level. Six hundred six patients were participated in the study with a response rate of 97%. Among total respondents, 77.7% left the facility with all of their prescribed medicines while 22.3% received only part of their prescribed medicines. Conclusion: The availability of essential medicines was fairly high in surveyed health facilities during the study period. In this study, many patients seeking treatment in public health facilities failed to obtain significant proportion of prescribed medicines. Peer Review History: Received: 4 November 2021; Revised: 10 December; Accepted: 22 December, Available online: 15 January 2022 Academic Editor: Dr. A.A. Mgbahurike, University of Port Harcourt, Nigeria, amaka_mgbahurike@yahoo.com UJPR follows the most transparent and toughest ‘Advanced OPEN peer review’ system. The identity of the authors and, reviewers will be known to each other. This transparent process will help to eradicate any possible malicious/purposeful interference by any person (publishing staff, reviewer, editor, author, etc) during peer review. As a result of this unique system, all reviewers will get their due recognition and respect, once their names are published in the papers. We expect that, by publishing peer review reports with published papers, will be helpful to many authors for drafting their article according to the specifications. Auhors will remove any error of their article and they will improve their article(s) according to the previous reports displayed with published article(s). The main purpose of it is ‘to improve the quality of a candidate manuscript’. Our reviewers check the ‘strength and weakness of a manuscript honestly’. There will increase in the perfection, and transparency. Received file: Reviewer's Comments: Average Peer review marks at initial stage: 5.0/10 Average Peer review marks at publication stage: 7.0/10 Reviewers: Dr. A.A. Mgbahurike, University of Port Harcourt, Nigeria, amaka_mgbahurike@yahoo.com Dr. George Zhu, Tehran University of Medical Sciences, Tehran, Iran, sansan4240732@163.com Similar Articles: ACCESS TO MEDICINES STRATEGIES OF THE NATIONAL CANCER CONTROL PROGRAMME IN CAMEROON THE EFFICIENCY OF INEFFICIENCY: MEDICINE DISTRIBUTION IN SUDAN

Availability of Key Essential Medicines in Public Health Facilities of South Indian Union Territory: One of the Crucial Components of Universal Health Coverage.

IntroductionThe supply of essential medicines is one of the vital components of primary health care. One of the important objectives of Indian health policy is to provide all the essential medicines at an affordable cost for the public. The performance of healthcare facilities is directly affected by the supply of essential medicines. This study was conducted to check the availability of key essential medicines in selected public healthcare facilities of the South Indian Union Territory.MethodsA snapshot survey was conducted between March 2019 and February 2020 in 10 selected public health facilities to assess the availability of 50 key essential medicines. Percentage availability for all surveyed medicines for the individual facility as well as percentage availability of individual medicines in all surveyed health facilities was calculated.ResultsPercentage availability of 50 key essential medicines in 10 surveyed public health facilities was found in a range of 66 to 80%. Out of 50 medicines, 26 (52%) medicines were available in more than 80% of health facilities while six (12%) medicines were available in less than 30% of surveyed facilities.ConclusionThis study reported the high availability of essential medicines in public health facilities as compared to similar studies done in other parts of India but the availability of some essential medicines was found sub-optimal and needs to be improved.

Effect of Universal Health Coverage on the Availability of Medicines in Public Health Facilities in Kisumu County, in Kenya

BackgroundStock outs of medicines and unaffordable cost are two major barriers of access to healthcare. Universal Health Coverage (UHC) seeks to ensure that all people have access to quality essential health services without suffering financial hardship.ObjectiveThe main objective of the study was to determine the effect and challenges of UHC program on the availability of medicines in public health facilities in Kisumu County.MethodologyThe study used a Pretest - posttest research design. The study was carried out in twenty-nine health facilities that were selected using stratified random sampling. Data was collected using key informant interviews with a health worker in each facility. Participants also involved four hundred and forty-four patients selected from the chosen facilities using consecutive sampling. Data from patients was collected using researcher administered questionnaires.ResultsThe availability of medicines improved by 3.4% for 20 tracer medicines since the introduction of the pilot UHC in Kisumu County. This was also supported from the patient’s perspective (n= 444; 79.5%).
 conclusion
 In spite of this, health workers experienced challenges which included inadequate supply, delays and stock out of some medicines. Other challenges were overworking, shortage of qualified staff and inconsistent supplies.
 Rwanda J Med Health Sci 2021;4(2): 269-280

Inventory management performance for family planning, maternal and child health medicines in public health facilities of West Wollega zone, Ethiopia

BackgroundInventory management is the heart of the supply system in improving availability of medicines, reducing the cost, and improving patient care quality. However, in the government facilities’ supply system, inventory management is poor. So, the purpose of this research is to assess inventory management performance for family planning, maternal and child health medicines in public health facilities of West Wollega zone, Oromia region, Ethiopia.MethodFacility-based descriptive cross-sectional quantitative study was conducted using checklist, structured and semi-structured questionnaire, and triangulated with qualitative method. Quantitative data were coded and analyzed using SPSS Version 20 and Microsoft excel spreadsheet. Qualitative data were analyzed manually, using thematic analysis technique. Different indicators were used to measure variables.ResultsAmong 23 health facilities assessed, availability of family planning/maternal and child health medicines ranged from 0 to 100%. Average availability of medicines was 14 (61.30%) with mean stock-out duration of 70.71 days. Bin cards were available for 559 (78.40%) of medicines, and 374 (52.45%) bin cards were accurate. Report submission rate was 116 (84.06%), with 47 (40.52%) report and resupply forms reported on time, 73 (62.93%) of them were complete and 69 (59.48%) were accurate. Supplier-related problem, lack of human resource, administrative problem, and lack of computer infrastructure were inventory management challenges identified.ConclusionInventory management performance for Family planning/maternal and child health medicines was poor as indicated by low availability, high stock-out duration, and poor LMIS performance. Efforts should be undertaken by concerned bodies to improve it.

Rational use of medicines

Rational use of drugs can be defined as prescribing the right drug, in sufficient dose for the adequate duration and suitable to the clinical requirements of the patients at least cost. Causes of irrational use comprise not have of knowledge, skills or self-determining information, unhampered accessibility of medicines, overburden of health personnel, unsuitable promotion of medicines and earnings motives from selling medicines. Inappropriate drug use can have dire consequences; it has been associated with hospitalization and even caused deaths of inpatients in health care facilities. A variety of situations and circumstances promote irrational use of medicines. Rational use of medication saves lives, confines undesired toxicity, adverse events and maximize on the benefits that can be imitative from best use of medications. According to surveys conducted in 2004 by HAI Africa and WHO in 11 Sub-Saharan Africa countries in 2004, the average accessibility of the essential medicines in public health facilities was below 70%.Communication between professionals and consumers is essential to the enhancement of rational use of medicines. It is essential to recommence collaboration of physicians and pharmacists concerning accurate and competent drugs prescribing. Governments, private health care institutions, entity health care providers and patients all have an accountability to endorse rational use of medicines. Professionals should provide information to the customers about the name of the medicine, the intention for which the medicine is being taken, dose, frequency of use, and duration of use.

Reasons of Generic Medicines avoidance by Patients in India: A Quantitative Investigation

The high cost of healthcare is a major concern for patients in India, and one of the ways to reduce this burden is by increasing the use of generic medicines. However, despite the availability and affordability of generic medicines, their usage remains low in the country. This study aims to investigate the reasons behind the avoidance of generic medicines by patients in India. This can highlight the need for improving the perception and trust in the quality of generic medicines among patients and healthcare professionals in India. Furthermore, policymakers could also introduce regulations that mandate the use of generic medicines in public health facilities and incentivize doctors and pharmacists to prescribe and dispense generic medicines. By addressing the factors contributing to this issue, policymakers, healthcare professionals, and pharmaceutical companies can work together to increase the use of generic medicines and improve access to affordable healthcare for all.

Logistics Management Information System Performance of Program Medicines in Public Health Facilities of East Gojjam Zone, Northwest Ethiopia: A Cross-Sectional Study.

BackgroundLogistics management information system enables the users to gain the right data, in the right quantity, in the right quality, at the right time, to the right place, and for the right cost. Without a logistics management information system, programs inevitably waste valuable resources.MethodsA facility-based descriptive cross-sectional study supplemented with a qualitative method was conducted in selected public health facilities of East Gojjam zone from March 21 to April 23, 2018. Twenty health facilities (15 health centers and 5 hospitals) were included in the study, and we selected randomly health facilities in proportion to their size. Data collectors were collected quantitative data through a physical count and document review. Key informants were selected using the purposive sampling technique and one of the researchers conducted an in-depth interview. Semi-structured questionnaires and observational checklists were used to collect relevant data. Quantifiable data entered EpiData software version 3.1 and exported to SPSS version 20 for analysis. The qualitative data were analyzed using a thematic analysis method.ResultsThe result showed that the availability and utilization of bin card records and report and requisition reports were 20 (100%). Out of 640 bin card records reviewed, 408 (63.8%) had accurate data ranged from 40 to 100% at hospitals and 20 to 86.6% at health centers. Likewise, 1089 (61.9%) of report and requisition form reports data were accurate ranged from 31 to 100% that 49 (89%) were complete and 51 (92.7%) were timely reported with health facilities reporting rate of 55 (91.7%). Poor facility setup and lack of organizational supports identified as principal bottlenecks of logistics management information system performance.ConclusionThe data accuracy of bin card records and report and requisition form reports were under an ideal condition while others were promising. The average data accuracy of bin card records of anti-malaria drugs was the highest with the lowest accurate report, and there is a need for improvement in data quality, organizational support, and facility setups.

Availability, price, and affordability of WHO priority maternal and child health medicine in public health facilities of Dessie, north-East Ethiopia

BackgroundAccess to health care is a fundamental human right, and the provision of affordable, high-quality, and appropriate medicines for maternal and child health is a vital component of a well-functioning health system. The study assessed the availability, price, and affordability of WHO priority maternal and child medicines in public health facilities, Dessie, North-East Ethiopia.MethodsA retrospective cross-sectional study design was conducted in Dessie town from November 2018 to February 2019. A standard checklist adapted from the Logistics Indicator Assessment Tool and WHO/HAI was used to collecting data on the availability, affordability, and price of 45 priority life-saving medicines from eight public health centers and two public hospitals. Descriptive statistics (percent and median) were computed for availability and prices. Affordability was reported in terms of the daily wage of the lowest-paid unskilled government worker.ResultsTwenty-two medicines were not found at all in public health facilities. The overall availability of WHO priority maternal and child medicines was 34.02%. The mean number of stock-outs was 3.9, and the mean number was 128.9 days. The mean average point availability was 33.5%, and 7 medicines stock out on the days of assessment. From WHO priority maternal and child medicines, 4 (40%) of the products were unaffordable and 5 (55.5%) had higher prices than international prices. Ceftriaxone 1 g, ceftriaxone 500 mg, and hydralazine 20 mg injection required wages of 6.58, 8.01, and 5.02 to cover specific maternal health problems respectively. The median price ratio of priority lifesaving maternal and child medicines in public health facilities ranged from 0.65 to 3.19.ConclusionsThe average mean period and point mean availability was very low. The available products were encountered with a high number of stock-outs and unaffordable. The strict control of inventory is recommended to have a steady supply of these essential medicines and improve the quality of health services.

Influence of health care financing on availability of medicines in public health facilities in Bungoma County, Kenya

Influence of health care financing on availability of medicines in public health facilities in Bungoma County, Kenya

Stock-outs of antiretroviral and tuberculosis medicines in South Africa: A national cross-sectional survey.

BackgroundHIV and TB programs have rapidly scaled-up over the past decade in Sub-Saharan Africa and uninterrupted supplies of those medicines are critical to their success. However, estimates of stock-outs are largely unknown. This survey aimed to estimate the extent of stock-outs of antiretroviral and TB medicines in public health facilities across South Africa, which has the world’s largest antiretroviral treatment (ART) program and a rising multidrug-resistant TB epidemic.MethodsWe conducted a cross-sectional telephonic survey (October—December 2015) of public health facilities. Facilities were asked about the prevalence of stock-outs on the day of the survey and in the preceding three months, their duration and impact.ResultsNationwide, of 3547 eligible health facilities, 79% (2804) could be reached telephonically. 88% (2463) participated and 4% (93) were excluded as they did not provide ART or TB treatment. Of the 2370 included facilities, 20% (485) reported a stock-out of at least 1 ARV and/or TB-related medicine on the day of contact and 36% (864) during the three months prior to contact, ranging from 74% (163/220) of health facilities in Mpumalanga to 12% (32/261) in the Western Cape province. These 864 facilities reported 1475 individual stock-outs, with one to fourteen different medicines out of stock per facility. Information on impact was provided in 98% (1449/1475) of stock-outs: 25% (366) resulted in a high impact outcome, where patients left the facility without medicine or were provided with an incomplete regimen. Of the 757 stock-outs that were resolved 70% (527) lasted longer than one month.InterpretationThere was a high prevalence of stock-outs nationwide. Large interprovincial differences in stock-out occurrence, duration, and impact suggest differences in provincial ability to prevent, mitigate and cope within the same framework. End-user monitoring of the supply chain by patients and civil society has the potential to increase transparency and complement public sector monitoring systems.

Jazia prime vendor system- a public-private partnership to improve medicine availability in Tanzania: from pilot to scale

BackgroundThe availability of medicines in public health facilities in Tanzania is problematic. Medicines shortages are often caused by unavailability at Medical Stores Department, the national supplier for public health facilities. During such stock-outs, districts may purchase from private suppliers. However, this procedure is intransparent, bureaucratic and uneconomic.ObjectivesTo complement the national supply chain in case of stock-outs with a simplified, transparent and efficient procurement procedure based on a public-private partnership approach with a prime vendor at the regional level. To develop a successful pilot of a Prime Vendor system with the potential for national scale-up.MethodsA public-private partnership was established engaging one private sector pharmaceutical supplier as the Prime Vendor to provide the complementary medicines needed by public health facilities in Tanzania. The Dodoma pilot region endorsed the concept involving the private sector, and procedures to procure complementary supplies from a single vendor in a pooled regional contract were developed. A supplier was tendered and contracted based on Good Procurement Practice. Pilot implementation was guided by Standard Operating Procedures, and closely monitored with performance indicators. A 12-step approach for national implementation was applied including cascade training from national to facility level. Each selected vendor signed a contract with the respective regional authority.ResultsIn the pilot region, tracer medicines availability increased from 69% in 2014 to 94% in 2018. Prime vendor supplies are of assured quality and average prices are comparable to prices of Medical Stores Department. Procurement procedures are simplified, shortened, standardized, transparent and well-governed. Procurement capacity was enhanced at all levels of the health system. Proven successful, the Prime Vendor system pilot was rolled-out nationally, on government request, to all 26 regions of mainland Tanzania, covering 185 councils and 5381 health facilities.ConclusionThe Prime Vendor system complements regular government supply through a regional contract approach. It is anchored in the structures of the regional health administration and in the decentralisation policy of the country. This partnership with the private sector facilitates procurement of additional supplies within a culture of transparency and accountability. Regional leadership, convincing pilot results and policy dialogue have led to national roll-out. Transferring this smaller-scale supply chain intervention to other regions requires country ownership and support for sustainable operations.

Availability of Essential Antihypertensive and Antidiabetic Medicines in Public Health Facilities in Lusaka District, Zambia

Background: The non-communicable disease (NCD) burden in Zambia remains quite high. Providing access to essential medicines for hypertension and diabetes remains a major challenge in low-middle income countries, Zambia is no exception in this regard.
 Aim: The aim of this study was to determine and describe the availability of essential antihypertensive and antidiabetic medicines in selected public health facilities in Lusaka district.
 Methods: A descriptive, cross-sectional study was undertaken in Lusaka district involving 15 randomly selected public health facilities. Data on availability of five (5) essential antihypertensive medicines and three (3) essential antidiabetic medicines was collected for the period January to June 2016 at each health facility, including the central Medical Stores. Quantitative data was analyzed using SPSS version 22.
 Results: In the 15 public health facilities surveyed, overall availability of essential antihypertensive and antidiabetic medicines in public health facilities was 58.2% and 44.7% respectively during the period reviewed. Stock-outs were high for parenteral Frusemide (92%), Hydralazine (83%), Insulin short-acting (83%) and long acting (69%) preparations, respectively. Parenteral Frusemide and Hydralazine were only available in less than 40% of facilities while less than 40% of facilities did not have any Insulin preparations available. About 40% of facilities did not have a medical doctor present, 86.7% did not have a pharmacist and 80% did not have medical licentiates present. Majority of facilities had at least Nurses, Clinical Officers, Pharmacy Technologists and Pharmacy Assistants.
 Conclusion: Availability of essential antihypertensive and antidiabetic medicines in public health facilities in Lusaka district continues to be a challenge with less than 60% of facilities surveyed experiencing stock-outs over six months. This could be significantly affecting effective management of patients with hypertension and diabetes mellitus in the district and requires to be addressed.

Availability of Essential Antihypertensive and Antidiabetic Medicines in Public Health Facilities in Lusaka District, Zambia

Background: The non-communicable disease (NCD) burden in Zambia remains quite high. Providing access to essential medicines for hypertension and diabetes remains a major challenge in low-middle income countries, Zambia is no exception in this regard.Aim: The aim of this study was to determine and describe the availability of essential antihypertensive and antidiabetic medicines in selected public health facilities in Lusaka district.Methods: A descriptive, cross-sectional study was undertaken in Lusaka district involving 15 randomly selected public health facilities. Data on availability of five (5) essential antihypertensive medicines and three (3)essential antidiabetic medicines was collected for the period January to June 2016 at each health facility, including the central Medical Stores. Quantitative data was analyzed using SPSS version 22.Results: In the 15 public health facilities surveyed, overall availability of essential antihypertensive and antidiabetic medicines in public health facilities was 58.2% and 44.7% respectively during the period reviewed. Stock-outs were high for parenteral Frusemide (92%), Hydralazine (83%), Insulin shortacting (83%) and long acting (69%) preparations, respectively. Parenteral Frusemide and Hydralazine were only available in less than 40% of facilities while less than 40% of facilities did not have any Insulin preparations available. About 40% of facilities did not have a medical doctor present, 86.7% did not have a pharmacist and 80% did not have medical licentiates present. Majority of facilities had at least Nurses, Clinical Officers, Pharmacy Technologists and Pharmacy Assistants.Conclusion: Availability of essential antihypertensive and antidiabetic medicines inpublic health facilities in Lusaka district continues to be a challenge with less than 60% of facilities surveyed experiencing stock-outs over six months. This could be significantly affecting effective management of patients with hypertension and diabetes mellitus in the district and requires to be addressed.

Rational use of medicines – Indian perspective!

India, the largest democracy in the world, is with a federal structure of 29 states and 7 union territories. With a population of more than 1.2 billion, resource is always a constraint and so is in the health system too. In the federal structure, providing healthcare is largely the responsibility of state governments. Medicines are important component of health care delivery system and quality care is dependent on the availability and proper use of quality medicines. In spite of being known as pharmacy of the third world, poor access to medicines in the country is always a serious concern. Realizing the need of quality use of medicines, several initiatives have been initiated. As early as 1994, seeds of rational use of medicines were sown in the country with two initiatives: establishment of a civil society, Delhi Society for Promoting Rational Use of Drugs (DSPURD) and establishment of government agency in Tamil Nadu, a southern state, called Tamil Medical Services Corporation Limited (TNMSCL). DSPUD was in official association with World Health Organization Country Office for implementing essential medicine programme in the country for two biennia. In addition to organizing sensitising and training programme for healthcare professionals throughout the country, it looked after the procurement and appropriate use of medicines in Delhi government health facilities. TNMSCL has made innovations in medicine management including procurement directly from manufacturers as a part of pooled procurement, establishing warehouses with modern storage facilities and Information Technology enabled management of whole process. TNMSCL Model is now replicated in almost the entire country and even in some small other countries as it is successful in improving access to medicines.The National Government and the State Governments have developed strategies to promote rational use of medicines as a part of improving access and quality care in public health facilities. National Government developed policies and regulations for combating antimicrobial resistance, controlling the prices of medicines, establishing generic medicines stores and advocating for the need for improvement of medicine logistics at state level and prescription auditing system. There is wide variation in medicine procurement and management system among the states. Spending on medicines ranges from as small as 2% of health budget to as high as 17%. The procurement system varies from individual facilities to partial pooled procurement to complete centralised system.There are attempts of developing essential medicine lists, standard treatment guidelines and costing of treatment of common illnesses. Except for the few states, essential medicine list remains an ornamental showpiece. However, with apex court's intervention, the prices are now controlled for all 348 medicines listed in national list. The pharmaceutical companies continue to violate price regulations either through making the medicines at different strengths or new fixed dose combinations (FDCs). Perhaps the largest number of FDCs and many of them with no valid justification are available in the country. Decisions on compulsory licensing have made the new anticancer medicines affordable. Other countries have also benefited from this decision. While some progress has been made for appropriate use of medicines in public health facilities, there are little efforts in private sectors and at community levels. Availability of prescription medicines without much control and free drug advertising are other concerns. Like all other countries irrational use of medicines continues to be of concern in India despite of several attempts of improving use of medicines both in the health system as well as in community. But efforts continue to be made for improving the use of medicines!

What Causes Medicine Shortages in Primary Health Centres?

Availability of essential medicines in public health facilities is one of the issues of concern for effective health care delivery in Maharashtra. There are several implications of unavailability of medicines, such as unwarranted out-of-pocket expenditures and consequent indebtedness in some cases. Medicine unavailability is also one of the major reasons for lower utilization of the public health system. Thus, present study was undertaken to enhance understanding of the problem of medicine unavailability, as well as the process of indent and supply from the primary health centre (PHC) and other functional aspects linked with availability, such as inventory management and different sources of medicine supply. Using case study method, the study examines data from two PHCs in Pune district, Maharashtra. Findings of the study indicate several lacunae in the existing indent and supply system of medicines in Maharashtra. Some of the medicines were supplied through multiple sources and yet, these medicines were NIL in stock. Inventory management of the medicines was rather inadequate. Medicine supply system is not demand responsive. Hence, major reforms in the current medicine indent–supply system are essential to ensure adequate supply of medicines to the patients in the public health system.

The crisis in access to essential medicines in India: key issues which call for action

The government is planning to introduce free generic and essential medicines in public health facilities. Most people in India buy healthcare from the private sector, a compulsion that accounts for a high proportion of healthcare-related expenditure. To reduce the burden of healthcare costs, the government must improve availability and affordability of generic and essential medicines in the market. It can do so because India's large pharmaceutical industry is a major source of generic medicines worldwide. In this article, we discuss three factors that have impeded access to generic and essential medicines: (1) mistaken notions among policymakers, prescribers and patients about branded drugs and generic drugs in India; (2) high prices of medicines due to the progressive dismantling of the system of regulation of medicine prices, and (3) a drug approval and regulatory system that allows medicines (including fixed dose combinations) of doubtful efficacy, rationale, safety and public health relevance to dominate the market at the cost of access to affordable generic and essential medicines. The consequences of ill-health and wasted expenditure on drugs raise issues of public health ethics.Improving access to essential medicines in India is an urgent public health and ethical imperative. This should include improved public provisioning, a system of regulation of drug prices, and an evidence-based drug approval process.