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[DATE][SPEAKERS NAMES]

10th Global Health Supply Chain Summit, Accra (Ghana); Nov 15-17, 2017

Thanks to our generous sponsors

ManagingFreeSupplyofQualityMedicinesandHealthProductsinRajasthanStateinIndiawithITsupportof

e-Aushadhi Software

NirmalGurbaniProfessor(PharmaceuticalManagement)

IIHMRUniversityJAIPUR(India)


AccessandAffordability

• AccesstohealthstandsasfundamentaltohumanrightsunderUNcharter

• InIndia,healthspendingbytheStateisverylow(nearly1%oftheGDP)

• 79%ofPop.spendonhealthisout-of-pocketwithmajorspendingbeingcostofmedicinalproducts

• Almost30%ofthehouseholdsslideintopovertyduetohightreatmentcosts

• Itisimperativethataccessandaffordabilitytoqualityessentialmedicinesandhealthproductsdirectlyaffectsthehealth


INDIA’S PHARMA INDUSTRY • “Pharmacyofthedevelopingworld”• 3rd in(10%inglobalsales)termsofvolumeand14th (1.5%)

intermsofvalue• ItisamongthetopFiveproducersofbulkdrugsinthe

world• AfterUSA(169),IndiahasthehighestnumberofUSFDA

approved(>500)plantsand>1200plantsWHO/GMP• TotalSale>USD25b(nearlyhalfisexports)• CAGRover11%.Despite“PharmacyoftheGlobalSouth”,Accesstomedicinesisstillelusiveforcommonman

KeyBarrierstoAccesstoMedicines

1. Grossinadequacyofgovernmentspendingonhealthcare2. Inefficientprocurementsystems3. Inefficientmedicinedistributionmechanism4. Unaffordablemarketprices5. Poorregulatorycontrolandhugepricevariationinoff-

patentbrandedgenerics,makestheaffordabilityatthemercyofmanufacturers,prescribers,anddispensers

6. Irrationalprescriptionanduseofmedicines7. Tiltofmarketmainlytowardsbrandeddrugs

Basically,costofproducingessentialmedicinesandhealthproductsarenothigh,but,aremadeexpensivebytheindustrytoencouragepromotion


India:ACountryofCountries

• InIndia,33federalstates/Unionterritoriesareruledbydifferentelectedpoliticalparties- DiversityinPoliticalpartiesstands

• Healthisunderconcurrentlist(CentralaswellasStatesubject)ofIndianConstitution

• Thereby,bothCentralandStateGovts.managehealth• MajorexpectationsarefromStategovernmentsas

implementationagenciesatgrassrootlevels• Oftenlackofconsensusonmajorissuesofnationalinterest• Policyparalysisandadhocdecisionsonpolitical

considerations/favoritism,etc.10th Global Health Supply Chain Summit, Accra (Ghana); Nov

15-17, 2017

Rajasthan,aWesternStateadjoiningPakistanInitiative:ToReachUnreached


RajasthanLargest StatePop. > 70 m

Mumbai

New Delhi

Chennai

Bangalore

AccesstoQualityMedicinesandHealthProductsInitiativeinRajasthan

MUKHYAMANTRI NIHSHULK DAVA YOJNA (MNDY)(Chief Minister’s Free Drug Distribution)

• accessibilitytohealthservicesforall• toreduceout-of-pocketexpenditure• entitledeveryonetoreceivefreemedicinesandhealthproductsfromanygovernmenthealthfacility

• toreachunreachable(unabletoaffordtreatment)• RajasthanMedicalServiceCorporation(RMSC)wasconstitutedforfreedistributionofdrugstoallpatientsvisitinggovernmenthealthfacilitiesthough17648DrugDistributionCentres (DDCs)


A LEAP FORWARD 2nd October 2011 Enhancing RUM andACCESS TO MEDICINES & HEALTH PRODUCT IN RAJASTHAN

Through CHIEF MINISTER’S FREE MEDICINE SCHEME

COMPONENTS OF FREE MEDICINES SCHEMEA. TO MAKE DRUGS AVAILABLE IN

GOVT. HOSPITALS.B. TO CHANGE PRESCRIPTION

BEHAVIOUR OF DOCTORS/HP

1. Establishment of autonomous centralized procurement agency :Rajasthan Medical Services Corporation

1. Sensitization and orientation about rational use of drugs (RUD)

2. Identification of drugs for free essential drug list (EDL)

2. Write prescription on self carbonated prescription slips

3. Procurement through a two-bid transparent e-tendering process

3. Diagnosis must be written

4. Drug Warehouse at every district 4. Write Generic / Salt names5. Empanelled laboratories for quality testing 5. Use out of Essential Drug List 6. System for transportation of drugs 6. Follow Standard Treatment Guidelines

7. System for storage and distribution of drugs in all hospitals

7. Constitution of Drug and Therapeutics Committee (DTC)

8. e-Aushadhi Software for Inventory management

8. Prescription Audit

9. Transparent and prompt payment system 9. Computerized drug dispensing up to PHCs

10. Sufficient funds 10. Patient counselling

AddressingQualityApprehensionsofDoctorsonGenerics

• Thedrugsarenotequivalenttothereferentialbrandmedicationsinqualityandfunctioning

• Thedrugshavepoorefficiencyincomparisontobrandedcounterparts

• Thegenericmedicationsarecostliercomparedtobrandeddrugs

• Shiftingtogenericscanevokeundesiredconsequencesandimpairthecondition

• GenericsarelowpricedbecauseoftheirlowqualityMythswereclearedinthesensitizationprogram


Contract Manufacturing

(turnover 1000 cr.)is manufacturing for

TorrentZydus Cadila

IndocoIPCA

Micro Labs

MankindLupin

AbbottWockhardtPiramal Healthcare

SunCiplaRMSC

Sanofi Aventis

Intas

Contract Manufacturing

Buy drugs from

Mc’leods

Medreich

Hagel Remidex

Sarvothamcare

InstitutionsCovered(Medical&Health/MedicalEducationDepartment)

S. No. Type of Institutions No. of Institutions1 Medical College Hospitals 28

2 District hospitals 36

3 Satellite Hospitals 8

4 Sub-Divisional Hospitals 16

5 CHCs 567

6 PHCs 2133

7 Dispensaries 194

8 Sub Centers 14407

9 Aid Posts 13

10 MCWC 118

11 Mobile surgical units 7Around 17648 DDCs in total


EDL - Provision of Medicines/Surgical and Sutures

CategoryofHealthcareInstitutions

Based on Level of Care

Medicines SurgicalItems Sutures Total

MedicalCollegeHospitals 601 73 77 751

District/Sub-dist/SatelliteHospitals 521 69 37 627

CHCs 446 51 11 508PHCs/Dispensaries 237 34 2 273SubCenters 29 8 0 37


AdvantagesofGenericProcurement

SN Name of the Medicine Packsize

RMSCProcurePrice Rs.

DPCO2013CeilingPrice Rs

MRPs of Selected brands Rs

(ApproxRs65=1$)

1 Cetirizine Tablets 10 mg 10x10 10.43 153 Alerid160.60, Zyncet160.70

2 Cefixime Tablets 100 mg 10x 10 119.71 826 Zifi530, TaximO866.403 Cefixime Tabs 200 mg 10x 10 221.8 1208 Ziprax 890.40

4 Diclofenac Sod Tabs 50 mg 10x10 14.11 182 Dicloran219.5,Reactin225.7

5 Ofloxacin Tabs 200 mg 10x10 82.7 526 Oflox551.5, Zenflox412.8

7 Ceftriaxone Injection 1 g 1 Vial 11.86 47.95 Monocef 50.348 Amlodipine 5 mg Tablets 10x10 9.82 233 Amlogard244.67, Amtas

244.67, Amlopress244.679 Clopidogrel Tablets 75

mg10x10 53.84 644 Plavix676.14, Deplatt 504,

Clopivas478.810 Glibenclamide Tab 5 mg 10x10 11.52 103 Daonil 108.7

AdvantagesofGenericProcurement

SN Name of the Medicine Packsize

RMSCProcurePrice Rs.

DPCO2013CeilingPrice Rs

MRPs of Selected brands Rs

(Approx Rs 65 = 1 $)

11 Domperidone Tablets 10mg

10x10 12.97 224 Domstal235.2, DomDT235.2,Domperi 252.29,

12 Alprazolam Tabs 0.5 mg 10x10 12.94 216 Anxit 226.8, Alprax255.5

13 Losartan Tablets 50 mg 10x10 35.52 462 Losar484.2,Losacar 498.1

14 Azithromycin Tablets500 mg

10x3x3 371.79 1604.7 Azithral 1872,Aziwok1867,Zathrin1870

15 Enalapril Tablets 5 mg 10x10 16.15 297 Envas310,Enam 311

16 Atorvastatin Tabs 10 mg 10x10 25.6 509 Atorva534.5, Atorec534

17 Paclitaxel 260 mg Inj 43.4 ml 637.70 8987.27 Mitotax958818 Imatinib Tablets 400 mg 10x10 1729 21332 Imatib 30242, Veenat 20270

,Zealata 29123

19 Glimepiride 2 mg 10x10 11.67 529 Amaryl555.47

Unique Features of Scheme in RajasthanUsing Educational, Managerial and Regulatory Interventions

1. PolicyentitlementmakingitUniversalinnature2. IssuanceofGovernmentOrdersforprescriptionbygenericname3. Settingupofuniqueinfrastructureathealthcareinstitutions4. SensitizationandOrientationoftheprescribers5. ConstitutionofDTCsforPrescriptionAudits6. AppointmentandTrainingofPharmacistsandInformatics

Assistants7. EffectiveComplaintandFeedbacksystem8. DrugMonitoringthroughnotavailable(NA)drugreportingsystem9. SMSbaseddailymonitoringandfeedbacksystem10.“Nearexpiry” and“dangerzone” drugsmonitoring11.SlowmovingandExcesssupplydrugmanagement12.InventoryManagementthroughe-Aushadhiapplication

e-AushadhiAn Advanced Drug Warehouse Inventory Management Software


NeedofITApplication?

• It is a huge logistic exercise to order, receive, store, quarantine,send for quality check, receive quality clearance- Issue 816 Medicines and Health Products.- 17648 healthcare institutions (depending on level of care) forissuance to approximately 250,000 patients every day

• The challenges of supplying so many products to so many facilitiesfor so many patients could only be handled by “COMPUTER”

•To address this requirement an IT based online advance DrugInventory Management Application was developed by CDAC forproviding complete supply chain management solution for themedicines and health products through “e-Aushadhi” Application•URL : http://www.eaushadhi.rajasthan.gov.in


Resources- HR

• Resources at IT CELL, RMSC HQ1. AGM IT - 12. Software Engineers from CDAC - 43. Informatics Assistants - 4

Resources at DDWs and Healthcare institutions- 3121 Informatics Assistants- Placed at DDWs/MCDWs/Hospital stores/DDCsfor data entry in the e-Aushadhi application


Whatise-Aushadhi?

A web based application which deals with the following:ü Complete SCM Solution for drugs, surgical items and suturesü Provides detailed information from the stage of procurement of products to its

consumption by the end usersü Provides inventory management at all DDWs and at sub stores / DDCs of

Medical college hospitals, District Hospitals, CHCs and PHCsü The application has modules useful for day to day activities like

- Demand Generation- Purchase Order generation- Challan (Delivery note) Process- Quality Control- Inter warehouse transfer- Supplier Payment- Monitoring Reports for better tracking the stock position of supplies, providereplenishments of supplies as and when required and take strategic decisions.

ü It is a complete solution providing transparency in the process of procurement,supply and distribution of supplies


e-Aushadhi hasbeenimplementedat4305(includingDDCs)locationsacrossthestateofRajasthan.

e-Aushadhi

e-Aushadhi Users

39 Drug Warehouses 2255

PHCs & Disp. Inc.

DDCs

RMSCHQ

1 DDC

35 MCHs

298 DDCs

57 DH, SDH & SHs

300 DDCs

555CHCs

766 DDCs

Stakeholders

e-Aushadhi

Head Quarter• RC & PO Processes • Inter DDW Drug Transfer.• Budget Allocation & Supplier Payment

P&C, MS, CMHO, PMO

• All Report access.• Demand Approval Desk

District Drug Warehouses

• Challan Process • Sample Send to QC Cell.• Issue to Hospital store.• Drug Transfer to other DDWs

Empanelled LAB

• Sample Receiving• Sample Test Result Entering and uploading

Report

Suppliers• PO Report with consignee• Supplier Interface Desk & Drug Delivery

StatusDirector PH,PS Med. Edu.

• All Report Access & Demand Approval

Internal Auditor

• Inward and Outward value Reports ,• PO Value Reports etc.

Autonomous centralized procurement agency.ESTABLISHMENT OF RAJASTHAN MEDICAL SERVICES

CORPORATION (RMSC)Procurement Cell

Finance Cell

Logistic Cell

Quality Control Cell

Supply Cell

IT Cell

Equipment Procurement & Maintenance Cell

Sample sent to HQ for Quality assurance Approval from HQ

Laboratory

Annual demand received from M&H Dept. and ME Dept

Contract signed b/w Suppliers and HQ

A purchase order is generated for DDWH as consignee

Drug is

ready for

Issue

RMSC Work Flow ……….

Drugs distributed to patients

Work Flow……….(cont’d)

Indent for Issue

Receive after approval

DHSDHCHCPHCMedical CollegeOthers

Drugs Issued to DDC

Processes of e-Aushadhi

• BudgetProcessing• DemandProcess• RateContractDesk• Purchase Order Generation• Challan (Delivery Note) Process• Quality Control• Payment to Supplier and Penalty Check

q Expired itemsq Broken itemsq Accepted itemsq Ordered items etc. based on which automatic amount calculated willbe paid to the supplier.

• Inter Ware House Transfer• Role Based Access (unique usernames and passwords)


Howe-Aushadhihelps?

Abilitytodefinethedrugsintogroups,subgroups,Categories,CodificationOnlineAnnualDemandgenerationfromHospitalstore

(MC/DH/SDH/SH/CHC/PHCandDispensaries),OnlineCompilationofthatdemandfromDistrictlevelandStateLevel

ReportreadilyavailableforthestockpositionReportreadilyavailableforPreviousconsumptionrecordsTrackexpirydate/shelflifeforthedrugsReorderlevelfeaturealertsImprovedInventoryManagementEasy Access to Information

Ø storage location of drugsØ real time list of expired itemsØ status of pending purchase ordersØ inward/outward recordsØ Quality control reports on drugsØ handling of Quarantine drugs andØ maintenance of current stock positions

Users How e-Aushadhi helps ?

Head Office (Supply)

1. Generate online Purchase Order to make availability of drugs at all DDWs.2. Generate drug Transfer Orders according to the Short/Excess request

of DDWs3. Generates Alert If Quantity of an item reaches below a critical level in

DDW.(Action Taken Report to ensure availability of Drugs at all Districts)

District Drug Warehouse

1. Give the feedback of purchase Order to HQ before issue to supplier.2. Receive the Drugs from Supplier through challan Process3. Send sample to RMSC Quality Control cell for quality check.4. Issue the Drugs to Hospital stores against their indents.5. Assess the quantity to be managed before expiry date according to their

consumption (Stock available based on Ideal Consumption)6. Generate online excess and short request, and• Excess /Short (Report) Detail Report Warehouse wise• Transfer Excess /Short Request Detail Report Drug wise• Transfer Approval Detail Report by HQ & Transfer Detail Report for DDW• Approved but not Transferred & Transferred but not acknowledged.7. Physical Drug Locator (Floor & Rack Wise )and shifting of Drugs Report

Supply Management

Users How e-Aushadhi helps ?

Hospital stores

(MC,DH,SH,SDH,PHC,CHC

,Disp. Etc)

1. Generate the Indents to DDW and receive the Drugs from DDW2. Issue the Drugs to DDC Counters against their Indents3. Return the unusable Drugs to DDW4. View the Stock of DDW ,Hospital store and their DDCs at a

glance through DDW Hospital store DDC Stock Detail Reporta. View the stock of particular Drug at all the hospital stores of aDistrictb. View available Drugs at DDW but not in HospitalStore.(Hospital store Not Available Drugs)

Process for substore

Drug Distribution

Counter (DDC)

1. Generate the Indents to Hospital store and receive the Drugsfrom Hospital store.

2. Issue the Drugs to Patients

All Users can view Stock on Hand Report and Near Expiry Detail Report up to DDC Level

Supply Management

Drug Quality Status

Warehouses

Return to

Supplier

Hide batch no, company name etc.

Quality Control Laboratory

Drug Samples

Test Result

PassRelease to Hospital Stores

Fail

Quality Status

1 2

34

5

Quality Control – Work Flow

MajorActivitiesthrougheAushidhi

• QualityControlManagement• FinanceandSupplierpayments• CapturingPurchaseandIssuedetails• SupplierPerformanceDetailedReport• StateLevelMonitoringofDrug/ProductStatusatall

DDWs/DDCs/SS• Productsgoingtoexpirein180days• SystemSuggestedDistrict-wisePurchaseOrderQuantity• EnsuringAvailabilitytoeliminatestockouts• Non-availability(NA)HitsAlerts/Reports• IndentedandIssueDetails


GenerationofMajorRepotsØ Current Stock Reports for Warehouse, Hospital store, DDCsØ Stock Ledger ReportØ DDW, Hospital store, DDC Stock Details, including those available at DDW but

not at Hospital StoresØ Material Inward Register and Outward Register Reports (Finance)Ø Daily Activity ReportØ Near Expiry Detail ReportØ Purchase Order Register ReportØ Challan (Delivery Note)/Receipt Register ReportØ Issue Register ReportØ Budget Detail ReportØ Drug Transfer Detail ReportØ NA Hits report etc.Ø ABC and FSN Analysis and ReportØ Stock Available based on Ideal ConsumptionØ Action taken report to ensure availability of drugs

“NotAvailable(NAHit)” ProductReportingSystem

NAHitReport:- Everytransactionofdrugissuedtopatientsisrecordedine-Aushadhi,informationonprescriptionlikename,age,sex,diagnosis,name&quantityofdrugs,duration

etcarerecordedinthesoftware.Duringthisnotavailable“NA” drugsarealsorecorded

TheSupplyCellmonitortheseNAreportsdailyandcoordinatebetweenDDW,Sub-storeandDDCstomakedrugavailablefromDDWtosub-store

thantoDDCaswellassuppliertoexpeditethesuppliesifinpipelineorissueafreshpurchaseorderifrequired

“Nearexpiry” &“Dangerzone” drugsmonitoring

The tracking of near expiry medicines is one of the best outcomes ofonline inventory management system. The supply cell of corporationmonitors and intimates Medical Superintendents, PMOs, CMHOs andOIC DDWs about the near expiry and danger zone drugs by monthlyreports so that the drugs may be consumed within their shelf lifeperiod

Near expiry drugs are arbitrarily classified into two major categories:

Near expiry drugs: The drugs which are about to expire within next180 days (6 months)

Danger zone drugs: The drugs which are about to expire within next60 days (2 months)

Slowmoving/ExcesssupplyproductsandShortsupplydrug/productmanagement

Slowmoving(Excessdrugs): ThestockofthedrugatDDWexceedstherequirementforthenextoneyear.(morethanannualconsumption)

ShifttoanotherDDWor

“Sensitizedoctorsforconsumptionoftheexcess/slowmovingdrugs

Shortdrugs:Thestockwhichisnotsufficientfor4monthsatDDWkeepinginviewtheestimateddemandofthatdrugfor4months(lessthanbufferstock)

ShiftfromanotherDDWor

Sensitizedoctorsforthealternativeprescriptionor

“Notavailablecertificate” issuedbyDDWtotherespectivehospitalssothatshortdrugsmadeavailablethroughLocalPurchase(10%additionalbudget

allottedtoeachinstitutesforlocalpurchase)

EffectiveComplaint&Feedbacksystem

24x7complaintandenquirycell

•Toresolvethecomplaintrelatedtoavailabilityofdrugs

•Totakenecessaryactionaccordingtofeedbackfrompeoples

91 66 00 55 00

Regular SMS to various users for important activities

“Vivek Pharma for

PONo.F.(14)/OSD/2014/1

32 Date: 18/12/2014 ,

Ciprofloxacin Tablets only

60% has been supplied.

Provide supply schedule

with in 3 days and supply

immediately to avoid

penal action.”

Suppliers(Delaysupply)

“Dear Dr. Naval

Kishore Gupta, 1

Drug(s) are going to

Expire in 6 Months in

your District Drug

Ware House”

DPC(NearExpiry)

“PONo.F.(14)/OSD/201

4/155 Dated : 25-Dec-

2014 For Supplier :

Biogenetic Drugs Pvt

Ltd Jaipur has been

generated today.”

Supplier,DPC/DDWPharmacist

(POGenerated)

“Dear Dr. Naval

Kishore Gupta, 9

Drug(s) Samples are not

send to RMSC for QC

Check from your

District Drug Ware

House”

DPC (delay sample)

SMS based daily monitoring & feedback system

After OPD hours daily about 7500govt. doctors of the state receivethe SMS everyday which containsthe number of patient he/she hasattended and number ofavailable/not available drugs fromthe prescription. Likewise eachDPC, CMHO, PMO, MS, PrincipalMedical College receives messageregularly about number ofpatients served, NA Hits, NearExpiry drugs etc.

Teams frommanyStateGovernmentshavevisitedRMSC– HQ,Jaipurtoseetheeffectivenessandworkingofe-AushadhiApplication.

Implemented [ 13States] Under MoU Signing stage [5 States]

Not Implemented [ 11 States]

UnderNationWideRollOut

1. Maharashtra2. Punjab3. Orissa4. AndhraPradesh&Telangana5. Gujarat6. MadhyaPradesh7. CMSS(CentreMedicalSupplyServices,NewDelhi)8. Jammu&Kashmir9. Jharkhand10. Bihar11. Uttaranchal12. Manipur13. DamanandDiu14. DadraandNagarHaveli

Discussionsunderway withfollowing States–1. UttarPradesh2. Chhattisgarh3. HimachalPradesh4. Assam5. Meghalaya

e-Aushadhi- Replication

•NHSSPNationalHealthSectorSupportProgramByMinistryofHealthNepal•UNFPA• WHO&PHFITeam• USAID• Deloitte,Delhi• NorthKoreaTeamofGovt.Officials• Nepal– CentreforLabourandSocialStudies•BPPI,Gurgaon•UnitedMultipurposeClub,Assam,Guwahati• Group-B Officers of Central Secretariat Services from Institute ofSecretariat Training and Management, Department of Personnel &Training, GOI

TeamsfromvariousOrganizations/CountriesvisitedRMSCHQ

e-GovernanceAward

RMSCwasawardedthee-Governanceawardfore-Aushadhiapplicationon12th Feb2013in16th Nationale-GovernanceConference

Conclusions

Utilizationoftheavailableappropriateandaccuratepricinginformationsupportedby

• technicalexpertise• strongpoliticalwill/supportand• clearadministrativeandrobustITsupportapproachescoupledwithpropereducational,managerialandregulatoryinterventions cansuccessfullybringapositivechangetowards

ENHANCINGAFFORDABLEACCESSTOQUALITYMEDICINESTOWARDUNIVERSALACCESSTOHEALTH


Allpeopleshouldget

Safeand

Effectivemedicines

ALONGWAYTO

GO…tofillthe

InformationGap

THANKYOUforyourinterest


Thanks to our generous sponsors

Documents

CLICK TO ADD TITLE - ghscs.comghscs.com/wp-content/uploads/2017/12/T10.3-Nirmal.pdf · How e-Aushadhi helps? Ability to define the drugs into groups, sub groups, Categories, Codification