Universal accessibility of essential medicines is a persistent problem in India. The problem is more acute for the economically marginalised sections. Over the years, India’s healthcare policy has evolved to benefit the private sector and the affluent sections rather than focusing on the vulnerable masses. In order to improve the healthcare sector, steps need to be taken to ensure easy availability of medicines for the common man in cities as well as in villages.
What are Essential Medicines?
The concept of essential medicines was formulated in 1977 and was one the main areas of focus of the World Health Organisation (WHO). WHO defines essential medicines “as those drugs that satisfy the health care needs of the majority of the population; they should therefore be available at all times in adequate amounts and in appropriate dosage forms at a price the community can afford.”
Millions of Indian households do not have access to drugs as a result of financial (lack of necessary purchasing power) or physical barriers. A vital component of healthcare is medicines and in India, the budget allocated for medicines varies from state to state. The expenditure pattern on medicines shows that it varies from less than 2% in Punjab to 17% in Kerala. The southern states spend 15% of their health budget on medicines whereas states like UP, Bihar, Odisha, and Assam spend about 5%. The central government spends around 12% of its total healthcare budget on medicines and overall 10% of the health budget goes into procuring medicines.
In 2016, the overall healthcare market in India was approximately $80 billion with medicines accounting for $16 billion, which accounted for one fifth of the healthcare market. About 60% of the healthcare expenditure is spent on delivery services such as hospitals and clinics. According to WHO, India has 0.7 beds per 1,000 people, compared to 2.5 beds in China and 3.6 in Brazil. The inadequate services infrastructure leads to poor accessibility and availability of medicines. The government has not played its part either, spending just 1% (as percentage of GDP) on health care as compared to 3-4% in most developing countries.
The lack of access to essential medicines is the result of inadequate budgetary provisions for healthcare and the lack of a comprehensive policy on medicines. A weak regulatory framework results in medicines being produced, promoted and prescribed without any assurance of their quality.
The Chinese Model
China introduced a number of reforms to improve accessibility of essential medicines and reduce high out-of-pocket medicine expenditure. The main areas of healthcare reform in China were social security, insurance, service delivery, public health and public hospital reform. This led to an increase in the number of people covered in insurance programmes from 294 million in 2003 to 1.28 billion by 2011. Patient insurance reimbursement rates rose steadily too, averaging 46.9% in 2011. The primary care system was refurbished which included 2200 country hospitals and 33000 rural and primary care facilities.
How to solve the problem?
Over the last decade, India’s out-of-pocket (OOP) expenditure has gone down from 80% to 60% but is still high compared to Nepal’s OOP health expenditure which stands at 49%, Sri Lanka (44%), Indonesia (41%), Maldives (28%), Thailand (15%) and Bhutan (13%) in 2009. This is worrying because more than two-thirds of the country’s population is not affluent. The underprivileged population, living in remote rural areas, depends largely on public facilities for access to essential medicines and if health related problems is to be improved, cashless access to health services at all delivery points is essential.
Free provisions of essential medicines to all patients would not only provide huge savings for the patients but also reduce the OOP expenditure in India. In addition to this, the non-availability of medicines in remote areas can be tackled with the help of Information Technology (IT) and through Mobile Health Units (MHU). Another innovative strategy could be considered where medicines can dispensed free of cost by local pharmacies against a voucher issued to the patient by the doctor of a public health facility based on the Standard Treatment Guidelines. The local pharmacy can be reimbursed the money by the governmental authorities. Such innovative approaches can work in increasing the accessibility of essential medicines in India.