Health Policy Issues and Health Programmes in ... - Amazon S3

Streamlining the Drug Procurement and Supply System in UttaranchalThe World Health Organization (WHO) has defined the rational use of drugs as“that the patients receive medication appropriate to their clinical needs, in the dosesthat meet their individual requirements for an adequate period of time, and at thelowest cost to them and their community.” 2It is in this context that there is a priority to review the present procurement and supply systemin the state, identify its bottlenecks, and provide possible solutions which, if implemented, willstreamline the public procurement system of drugs.Issues in a Drug Procurement SystemIn most states, the health system has a drug procurement system. However, there are a numberof shortcomings in the system presently adopted. In the absence of a state drug policy, thestructure, systems, and processes are not properly spelt out. The drug needs are worked out onan ad hoc basis depending upon the past consumption of drugs at a particular health unit. Onthe basis of the information supplied by different levels of health units, the district health officercollates the information and projects drug requirements for the district. Accordingly, the statelevel handles central procurement. The identified drugs could be generic as well as branded.They could be a single molecule or formulations. There might be inadequacy in working out thedosages and formats.The second problem is the limitation of budget allocations for procuring drugs. Traditionally,drugs have been provided free in all public health facilities in India. Unfortunately, over theyears, this has not been sustainable, and, as a consequence, the policy of free drug supply isbeing reviewed in many states. In large hospitals, generally 30%-35% of the budget is meant forthe procurement of drugs and other supplies. However, with a decreasing allocation to healthbudgets and a higher proportion being allocated to salaries and maintenance, the availability offunds for drug supplies has been significantly reduced. Similarly, the rising cost of drugs hasreduced the amount of drugs that can be procured through the provided health budget. Underthese circumstances, the number of drugs that are now being made available through the publichealth system has come down significantly. For example, in the state of Rajasthan, the number ofdrugs that are presently supplied at different health institutions has come down to 63 for districthospitals, 76 for medical colleges, and 26 for primary health centres. Even these supplies ofdrugs are not regular or adequate. This is in spite of the fact that the Essential Drugs List hasaround 300 drugs that need to be made available at different levels for the appropriate treatmentof diseases prevalent in a state.218Procurement is defined as a “process of acquiring supplies from private and public suppliers,manufacturers, distributors, or agencies”. The key indicators of a good procurement system arethe assurance of continuous supply, avoidance of duplication and waste, maintenance ofrequirements and quality, and maximum savings in the procurement process.Procurement MethodThere are both centralized and decentralized systems of drug procurement. Generally, drugs arepurchased through open tenders whereby quotations are invited, subject to terms and