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

Streamlining the Drug Procurement and Supply System in Uttaranchalmanufacturers, and from the essential drug list; the average time of payment; the percentage ofdrugs sent for quality control testing and those that failed; the restriction of use of genericnames; and so forth. However, in general, such standard indicators are rarely adopted in theprocurement system.220Under legal provisions, there has to be a state drug control system that has an authorized drugcontroller and drug inspectors to collect samples and certified drug testing units to look intothe quality of drugs available in the market as well as those supplied through a procurementsystem. The prevailing system is weak and inadequate. The procedures set down for thecollection of samples of drugs supplied to various institutions for testing has not beenadopted. Very few samples are collected and not all collected samples are sent to laboratoriesfor quality testing. The results of these tests are often delayed and follow-up actions areinvariably absent.Drug Supply SystemThere are a number of approaches for organizing the drug supply in the government healthsystem. These include central medical stores, autonomous supply agencies, and directdelivery systems. Most states have mixed supply arrangements. For example, there are fourmain channels of supply in Maharashtra. (1) The health units purchase selected items fromone of the approved suppliers. (2) A limited number of vital items are purchased for the healthunit by the State Stores Organization. (3) The health units have a small budget for direct localpurchase for emergency items. (4) Drugs under various national disease control programmesare distributed to health facilities by the State Stores Organization. There have been points infavour of decentralization of drug selection, procurement, and distribution. Decentralizationaims to improve the response and efficiency of health services through greater localinvolvement, direct public accountability, increased flexibility, and quicker adoption. However,there are problems with adopting decentralization in drug management including lack ofcapacity, lack of financial resources, increased corruption, increased costs, and decreasingdrug quality.Recommendations for Improving Drug Procurement Systems1. Development of a State Policy The state of Uttaranchal should take the initiative fordeveloping a drug policy at the earliest. State drug policies have been formulated inKarnataka, Delhi, Tamil Nadu, West Bengal, and Andhra Pradesh. A drug policy formulationcommittee, composed of the health minister, senior officials of the state medical directorate,and senior faculty members of the medical colleges, if any, should be constituted.2. Adoption of an Essential Drug List Rajasthan, Delhi, Tamil Nadu and many other stateshave already developed their essential drug lists. The essential drug list for the state shouldbe developed along the lines of states referred to above. The state may also aim to developstandard treatment guidelines for different diseases at the level of primary health centres andhospitals, leading to the development of formularies and an essential drug list. There shouldbe political commitment to adopt an essential drug list for procurement and supply.3. Promotion of the Rational Use of Drugs The ultimate goal of rationalizing drug use is toimprove the quality of health care through effective and safer drug use and to improve the