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India-WHO Essential Drugs Programme implemented by Delhi Society for Promotion of Rational Use of Drugs (1997 - 2002) Dr Sangeeta Sharma. Delhi State. Population – 14 million Total no. of hospitals beds – 4000 Teaching hospitals – 2 Total number of health centers – 158. - PowerPoint PPT Presentation
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India-WHO Essential Drugs Programme implemented by
Delhi Society for Promotion of Rational Use of Drugs
(1997 - 2002)
Dr Sangeeta Sharma
Delhi State
• Population – 14 million• Total no. of hospitals beds –
4000• Teaching hospitals – 2• Total number of health centers –
158Drug annual budget – $ 8 million
Pooled procurement
Quality assurance
STGs Formulary
Essential Medicines List
ResearchMonitoring
UnbiasedInfo
Rational prescribing
Impact on prices (1):Drugs purchased from essential medicines list, at competitive prices (Rp)Drugs Open
tenderPooled procurement
% cost reduction
Syr amoxycillin 14.65 7.50 50
Tab erythromycin (250 mg)
3.24 1.54 50
Tab atenolol (50mg)
0.42 0.17 60
Inj ranitidine 1.87 1.63 12.50
Inj diazepam 5.53 0.93 80
Impact on prices (2)Holding the price line
02468
101214161820
1995 1996 1997 1999 2000 2001
Amoxycillin Chloroquine Omeprazole Erythromycin
Pri
ces in
(R
s.)
Years
59%
37%
43%
10%
Impact on availability in public facilities:Medicines actually dispensed at various level of health facilities (Delhi state, 2002)
0
10
20
30
40
50
60
70
80
90
100
Teaching
Secondary
PHC
Perc
en
t
Health facilities
Impact on drug quality in public facilities:Results of quality tests (Delhi state)
Total no. of batches tested(July 2000 to October 2001)
2206
Batches not of standard quality
20 (0.91%)
Total expenditure 0.53% of the budget for drugs
Impact on rational prescribing:Medicines prescribed from EML (Delhi, 2002)
0
10
20
30
40
50
60
70
80
90
100Teaching
Secondary
PHC
Perc
en
t
Health facilities
Overall impact (Delhi State, 1995-2000):Pooled availability of drugs, percent prescriptions by generics, from EML
0
20
40
60
80
100
120
1995 1997 1999 2000
Availability
Generics
EDL
Perc
en
t
Year under review
Essential Medicines
List
Pooled procurement
Budget saved
Procured large quantities and more drugs
Enhanced access to drugs
WHO India Essential Drugs Programme: Expansion of Delhi programme into other states, executed through local NGO
Components• State drug policy
• Essential drugs lists by level of care
• Pooled procurement
• Efficient distribution
• Quality assurance • information patients & prescribers• Training in rational prescribing• Studies on drug use, pharmacoeconomics
13 states - total population580 million
Andhra PradeshAndhra Pradesh
BiharBihar
PunjabPunjab
RajasthanRajasthan
MaharashtraMaharashtra
Delhi StateDelhi StateHaryanaHaryana
Himachal PradeshHimachal Pradesh
West West BengalBengal
Madhya Madhya PradeshPradesh
GoaGoa
Tamil NaduTamil Nadu
GujaratGujarat
Conclusions• Wise drug selection underlies
all other improvements in public procurement and supply
• Effective management saves money and improves the performance and accessibility
No extra public funds spent other than on GMP inspections
