RESUMO
Background: In India, access to medicine in the public sector is significantlyaffected by the efficiency of the drug procurement system and allied processesand policies. This study was conducted in two socioeconomically different states:Bihar and Tamil Nadu. Both have a pooled procurement system for drugs butfollow different models. In Bihar, the volumes of medicines required are pooledat the state level and rate contracted (an open tender process invites biddersto quote for the lowest rate for the list of medicines), while actual invoicing andpayment are done at district level. In Tamil Nadu, medicine quantities are alsopooled at state level but payments are also processed at state level upon receiptof laboratory quality-assurance reports on the medicines.Methods: In this cross-sectional survey, a range of financial and non-financial datarelated to procurement and distribution of medicine, such as budget documents,annual reports, tender documents, details of orders issued, passbook details andpolicy and guidelines for procurement were analysed. In addition, a so-called ABCanalysis of the procurement data was done to to identify high-value medicines.Results: It was observed that Tamil Nadu had suppliers for 100% of the drugson their procurement list at the end of the procurement processes in 2006, 2007and 2008, whereas Bihar’s procurement agency was only able to get suppliersfor 56%, 59% and 38% of drugs during the same period. Further, it was observedthat Bihar’s system was fuelling irrational procurement; for example, fluconazole(antifungal) alone was consuming 23.4% of the state’s drug budget and was beingprocured by around 34% of the districts during 2008–2009. Also, the ratios ofprocurement prices for Bihar compared with Tamil Nadu were in the range of 1.01to 22.50. For 50% of the analysed drugs, the price ratio was more than 2, that is,Bihar’s procurement system was procuring the same medicines at more than twicethe prices paid by Tamil Nadu.Conclusion: Centralized, automated pooled procurement models like that ofTamil Nadu are key to achieving the best procurement prices and highest possibleaccess to medicines
Assuntos
Acessibilidade aos Serviços de Saúde , Preço de MedicamentoRESUMO
India has outlined its commitment to achieving universal health coverage andseveral states in India are rolling out strategies to support this aim. In 2011,Rajasthan implemented an ambitious universal access to medicines programmebased on a centralized procurement and decentralized distribution model. Interms of the three dimensions of universal health coverage, the scheme hasmade significant positive strides within a short period of implementation. The keyobjectives of this paper are to assess the likely implications of providing universalaccess to essential medicines in Rajasthan, which has a population of 70 million.Primary field-level data were obtained from 112 public health-care facilities usingmultistage random sampling. National Sample Survey Organization data andhealth system data were also analysed. The per capita health expenditure duringthe pre-reform period was estimated to be `5.7 and is now close to `50. Availabilityof essential medicines was encouraging and utilization of public facilities hadincreased. With additional per capita annual investment of `43, the scheme hasbrought about several improvements in the delivery of essential services andincreased utilization of public facilities in the state and, as a result, enhancedefficiency of the system. Although there was an attempt to convert the schemeinto a targeted one with the change in government, strong resistance from the civilsociety resulted in such efforts being defeated and the universality of the schemehas been retained.
