Embed Size (px)
Citation preview
2011
Dr. S. Barik
Dr. Shahab Ali Siddiqui
Pradeep Tandan
Ministry of Health & Family Welfare
Study on Drugs Availability and
Diagnostic Services in
Tamil Nadu & Kerala
2
Contents
Executive summary .................................................................................................................................. 3
Public Health System ................................................................................................................................ 4
Key Findings ............................................................................................................................................. 5
Approach and methodology ................................................................................................................... 5
Background ............................................................................................................................................... 6
Drug procurement system in Kanyakumari (TNMSC) ............................................................................. 6
Drug procurement system in Trivandrum (KMSCL)................................................................................ 8
Comparative analysis of the Tamil Nadu and Kerala systems of drug procurement and
distribution .............................................................................................................................................. 12
Discussion ................................................................................................................................................. 13
Distribution – .......................................................................................................................................... 13
Availability- ............................................................................................................................................ 13
Accountability- ....................................................................................................................................... 13
Recommendation .................................................................................................................................... 14
Conclusion ................................................................................................................................................ 14
3
Executive summary
A team comprising of consultants from the Ministry of Health and Family Welfare
visited two districts Kanyakumari and Thiruvananthapuram from 3th
July 2011 to 10th
July 2011
with the objective to study the drugs procurement and distribution system in the states of Kerala
& Tamil Nadu. To study the status of diagnostic services in these states was also one of the
objectives of the visit. To understand the channel of distribution and status of diagnostic services,
facilities from District Hospital to Health Sub Centers were visited along with the drug
warehouses. Thorough discussions were held with the officials and the facility in- charges to get
the firsthand account of the processes. The facilities visited along with the name of the officials
met are tabulated below.
Date District/ Block Places/Health
Facilities Visited
Persons
Visited
Activity
4.07.2011 Thiruvananthpuram a)Kerala
District General
Hospital
Thiruvananthpuram
MD NRHM
Dr. Joyce
Discussion on drug
procurement and distribution
system in Kerala
Study of drug distribution
system in District Hospital
5.07.2011 Kanyakumari a) Government
hospital
Kamyakumari
(CHC)
b) Nagarcoil Central
drug warehouse
Dr. Padma
Study of the drug availability
in facility ,Hospital
Information System (HIS)
software, process flow from
prescription writing to
dispensing from the
pharmacy
Study the storage system
and drug distribution from
drug warehouse to District
level
6.07.2011 Kanyakumari a)Government
Headquarter
Hospital
Padmanabhapuram
Dr.
Arunmozhi
Dr. A
.Murughan
Study Local purchases, drug
procurement and distribution
system , drug flow from
hospital store to pharmacy
and wards
Drug availability and
4
b) PHC Pechiparai
c) District head
office
Dr. Sakti,
Dr. Jayanthi
Dr.
Madhusudan
distribution system for both
Pharmacy and Sub Health
Centre of the PHC
Discussion on the drug
distribution system in various
facilities of the District
7.07.2011 Kanyakumari a)Agasthyaeeswaram
CHC
b)Leepuram HSC
Y.Shanti
Drug availability and
distribution system in CHC
Drug availability and
distribution at SHC level
8.07.2011 Thiruvananthpuram a)Head office of
Kerala Medical
Service Corporation
b)District drug
warehouse
Discussion on procurement
and distribution system in
Kerala
Storage and Distribution
system at District level
9.07.2011 Thiruvananthpuram a)Poonthura CHC
b)Katakampally
PHC
Ms. Sakeena
Ms. Bindu
Dr.Gopika
Dr. Dona
Drug availability and
distribution system at CHC
level in Kerala
Drug distribution system at
PHC level
Public Health System
Kanyakumari is the southernmost district of Tamil Nadu. Total population of the district
is 1863174 (Census 2011). Public Health System of the district consists of 1 District hospital
(DH), 12 Community Health Centre (CHC), 36 Primary Health Centre (PHC), 267 Sub Health
Centres (SHC). Nagercoil central drug warehouse is supplying drug to all health facility in the
district except SHCs (Supplied by District Authority).
Thiruvananthpuram is a southern district of Kerala. Total population of the district is
3307284 (Census). Health system of the district consists of 1 District hospital (DH), 1 Women
and Children hospital, 19 Community Health Centre (CHC), 62 Primary Health Centre (PHC),
and 420 Sub Health Centre (SHC). District drug warehouse is supplying drug to all the facilities.
5
Key Findings
Despite of having an essential drug
list (260 in TN and 287 in Kerala) in
both the states it was observed that
most of the facilities were managing
with a very small number of drugs
(50-60). This has an implication on
the number of patients getting
referred to the higher centers and
also on the out of pocket expenditure
on drugs.
Yearly Financial ceiling system for
each level of facilities to procure
medicines in Tamil Nadu is limiting
drug availability.
In Tamil Nadu a stringent
mechanism is in place which restricts
doctors to prescribe medicines from
open market whereas in Kerala
doctors are liberally prescribing from
outside.
In Tamil Nadu a Pilot Project on the
application of Hospital Information
System (HIS) in 5 districts is
underway, Kanyakumari being one
of them. The feedback from users is
that it is resulting in better
management of stock of drugs, better
prescription audit and better record
keeping for patients.
Accountability in drug distribution to
facilities was better in Tamil Nadu.
Drug storage is a major problem both
in Tamil Nadu & Kerala.
Drug stock outs at the lower centers
in the districts are major concern.
Delayed supply of drugs to the PHCs
and SHCs leads to short shelf life
and expired drugs being kept in the
stock.
Diagnostic services are of very basic
nature in most of the facilities;
offering tests such as for malaria,
Sputum for AFB, blood cell count,
Hb% estimation, blood sugar, urine
examination etc. The situation was
somewhat better in Kanyakumari
district where X-ray, ECG and
Ultrasonography services are also
available along with the basic ones in
some of the facilities.
Acute shortage of laboratory
technicians (LT) is a common
feature in almost all the facilities.
Approach and methodology
To study the system of drugs procurement and distribution; Observation and Discussion method
with Inspection approach was adopted during the visits to Thiruvananathapuram and
Kanyakumari districts between 3rd
July2011 to 10th
July 2011.
Secondary Data was collected from the state and district records whereas primary data as
collected from the facilities by the team members during the course of visit.
6
Background
Drug procurement system in Kanyakumari (TNMSC)
The Tamil Nadu Medical Services Corporation Ltd (TNMSC) was set up with the
primary objective of ensuring availability of all essential drugs and medicines in the Government
Medical Institutions throughout the State. It has adopted a streamlined procedure for their
procurement, storage, and distribution. It was incorporated under the Companies Act, 1956 in
1994 and has commenced its functions of purchase, storage and distribution of drugs and
medicines from January 1995. TNMSC’s aim is to make the quality drugs and medicines
available all the times and at all the needy places in the interest of Public. The TNMSC procures
and supplies 268 types of drugs and medicines, 84 varieties of suture items and 63 surgical items
to various government hospitals, Primary health centers and through them to the Health Sub
Centers throughout Tamil Nadu every year.
ASSESSMENT OF QUANTITY AND LIST OF DRUGS:
TNMSC is entrusted with procurement and distribution of Drugs and Medicines, Surgical
and Suture items to the Government Medical Institutions. TNMSC finalize the Essential Drug
List for drugs, surgical and suture items every year by getting the requirements from the
Government Medical Institutions situated throughout the State of Tamil Nadu and these
requirements are placed in the Drug Committee Meeting convened in the month of November
every year. The Drug Committee consists of the following members:
i) Director of Medical Education
ii) Director of Medical and Rural Health Services
iii) Director of Public Health and Preventive Medicine
iv) Director of Medical and Rural Health Services (ESI)
v) Director of Family Welfare
vi) Director of Drugs Control
vii) Chief Physician
viii) Specialists and Surgeons.
The Drug Committee scrutinize the items in the Essential Drugs, Surgical and Suture List
purchased in the previous year and analyze the slow moving, non moving and out-dated items
and recommend for the deletion of these items. In addition, the committee also suggests
including certain items of Drugs, Surgical and Sutures suggested by the institutions based on the
7
essentiality. Final list of Essential Drugs, Surgical and Suture items will be consolidated after the
Drug Committee meeting and the specifications of each item will be arrived along with
Pharmacopeia standards. The Drug Committee will also decide on the procurement of quantity
for the essential drug list items by analyzing the last year purchase and utilization.
II. CALLING UPON TENDERS:
1. Tenders are invited by advertisement in leading newspaper, regional papers and tender
bulletins. Also issue tender notification to state drug controllers, pharmaceuticals
manufacturing association and pharma publications.
2. Two types of bid –
a) Technical bid
(After technical bid teams compulsorily visit to manufacturing
premises for the compliance of good manufacturing practices and
their production capacity.)
b) Price bid opening and selection of L1
III. PROCUREMENT OF DRUGS:
The essential drugs and surgical are classified as fast moving and slow moving items. This
decision has been taken to have more concentration on the fast moving items. The purchase
orders will be placed once in two months for the fast moving items and for the slow moving items
orders will be placed twice in a year.
The orders generation is system based and are verified by the Assistant Manager
(Purchase) and Manager (Purchase) and put up for approval of the Managing Director through the
General Manager. After the approval of the Managing Director the purchase orders will be placed
and sent to the Suppliers through E-mail and hard copy by courier. After receipt of Purchase
Orders the suppliers are requested to upload the confirmation of receipt of the Purchase order
within 3 days from the date of placing the order. The suppliers are also requested to indicate the
schedule of supply by e-mail or Fax within 7 days from the date of receipt of the order so as to
have a better plan of action on the movement of drugs.
As per the tender conditions the supplier has to supply at least 20% of the ordered quantity
within 30 days from the date of the purchase order and to complete at least 70% supply before 60
days. If any defaulted on the above condition, subsequent orders will be placed with the matched
supplier or with the next tenderer at higher rate. The difference of cost will be deducted from the
L1 tenderer. These conditions are incorporated to ensure timely supply of the drug and there by
TNMSC also cater the needs of the institutions in time and after assessing the quantity of the
drugs.
In case of any drug for which the consumption has been reduced in a particular area and
if the drug is not required by them, the drugs will be transferred to the required warehouse and
also letters will be sent to the concerned institutions and hospitals and ask them to utilize the
8
drug. The same way in the case of any excess drawl of the drugs from the warehouses are also
monitored, in case of any epidemic situation, the requirements will be met out immediately by
making inter warehouse transfers.
Once, in a fortnight, the short expiry drugs lying in the warehouses within 6 months are
taken and are analyzed for their movements. Letters will be sent to end users such as
Superintendents, Joint Director of Health Services, and Deputy Director of Health Services etc to
convene a Drug Committee Meeting to utilize the drugs in their Hospitals. If any other Hospital
in the State requires the short expiry drug, those drugs are transferred to the needed warehouses
and try to utilize them before expiry. If it is not possible to utilize the drug within the period, a
letter will be sent to the suppliers and request them to replace the quantity with the fresh batch of
the longer shelf life
Drug procurement system in Trivandrum (KMSCL) -
Introduction
In order to make available quality medicines, supplies, equipments and diagnostic
services to the poorest of poor of the population in the state, Government of Kerala has
constituted Kerala Medical Services Corporation, Ltd, (KMSCL) as a fully Government owned
company with authorized share capital of Rs. 10 crore with its headquarters in
Thiruvananthapuram. The newly formed corporation started functioning with effect from 1st
April, 2008 by establishing District Drug Warehouses in all 14 districts in the State to cater to the
needs of 1316 Health Care Institutions under the State Health Services Department and 16
institutions under six Government Medical Colleges in the State.
The corporation initiated the work of providing drugs and supplies from ‘1st April’
2008’. The Corporation is diversifying its activities by providing Bio-Medical equipments,
computers etc. As a part of a foolproof quality check of medicines, all batches received as a part
of supply have been tested in accredited labs in the country. Through this, the Corporation
ensures providing quality medicines at affordable rates. The process of procurement and
distribution of medicines has been streamlined. Computerization, pass book system and essential
drug list have been established.
9
The Board of Directors of the Corporation are as follows.
Secretary to Government (H & FW) Chairman
Addl. Secretary to Government (Finance) member
State Mission Director (NRHM) member
Director of Health Services member
Director of Medical Education member
Drug Controller member
Expert from Pharmaceutical Sciences member
Managing Director (KMSCL) member
The main objectives of the Corporation
To implement a transparent system for procurement, storage and distribution of quality
Drugs, supplies, equipments etc. required for the hospitals at reasonable competitive
price.
To ensure adequate savings in the Drug budget by scientific forecasting system based on
the preparation of Essential Drug List and its actual consumption.
Monitoring the Budget and drug consumption pattern by introducing pass book system.
To avoid loss due to expiry of Drugs and medical items and to optimize accountability at
all levels.
To achieve constant quality control monitoring of Drugs and medical items by
establishing adequate quality assurance measures.
To adopt a streamlined procedure for procurement, storage and distribution through IT
enabled services like e-tendering & e-procurement
To improve infrastructure of the existing Drug warehouse in District.
Suitable transport system for lifting drugs from drug warehouses to institutions.
10
To provide diagnostics and other miscellaneous services to Government healthcare
institutions.
To enhance public healthcare services, delivery by providing excellent management
control and constant vigil.
To introduce effective feedback system.
Procurement Process
Government have constituted a Technical Committee (Expert Committee) in the
Corporation consisting of Director of Health Services, Director of Medical Education, State
Mission Director (NRHM), Drugs Controller, Senior Doctors nominated by DHS & DME and an
expert in Pharmaceutical Sciences to prepare the list of medicines to be procured by Corporation.
On the basis of the recommendations of the Technical Committee, Corporation has finalized the
List of Essential Drug which consists of 527 items of generic medicines, sutures, surgical and
other items. Based on the annual requirement of medicines & supplies furnished by the DHS and
DME, Corporation does the tender process. KMSCL floated its first tender on 30.01.2008 in
which a record number of 173 reputed companies from all over the country participated.
Factory facilities of 20 new firms, who had participated in the tender for the first time in
the state, were inspected by the team of inspectors appointed by the Corporation and six firms
were rejected as they were not complying Good Manufacturing Practices (GMP) stipulated under
the Drugs and Cosmetic Rules, 1945.
Procurement Cycle
Figure 1 Procurement cycle
11
Figure 2 : Drug Warehouse Management
Figure 3 Drug Distribution & Management System
12
Figure 4 Quality Control Mechanism
Quality Control Mechanism
Comparative analysis of the Tamil Nadu and Kerala systems of drug
procurement and distribution
Tamil Nadu Kerala
1. Managed by Tamil Nadu Medical Services
corporation (TNMSC)
Managed by Kerala Medical Services Corporation
Ltd. (KMSCL)
2. Established in 1995 Established in 2008
3.On line inventory management up to district drug
ware houses
On line inventory management up to district drug
ware houses
4. On line inventory management up to facility level
in 5 pilot districts upto taluka hospital
No On-line inventory management system up to
facility level
5. Final drug quantity assessment is done by an
expert group at the central level on the basis of
facility wise OPD attendance
Drug quantity assessment is done at the facility
level
6. Pass book system provides less flexibility as
there is a monetary ceiling limit on drug purchases
for each facility
A different Passbook system provides more
flexibility in terms of quantity and financial
decision making for drug purchases to the facilities
7. Better accountability of the drug stocks Less accountability of drug stocks
8. Fixed yearly calendar for distribution of drugs Distribution schedule is revised quarterly
9. Strict mechanism against prescription of
medicines from the open market.
No Strict mechanism against prescription of
medicines from the open market at higher centres
10. Distribution up to PHC level is by TNMSC,
PHC subsequently distribute drugs to HSC
Distribution up to HSC level by KMSCL
13
Discussion Distribution –
Tamil Nadu has a very robust mechanism of distribution. Distribution up to PHC is done by
the district central drug warehouses. Vehicles from the respective facilities take the scheduled
quantity of drugs from the ware house, which also provides for the transportation costs. Drug reaches
to the facilities from where it is made available to the beneficiaries through prescriptions. In cases
where there is a need for drugs which are not available in the list, patients are referred to higher
centers. The strict compliance to prescribe only from the list of drugs available in a particular facility
on the one hand lowers the out of pocket expenditure on drugs but on the other hand leads to
increased referrals to higher centers. Since the amount for drug purchase in passbook system is fixed
for each facility, in cases of additional funds requirements, the administrative approvals become a
tedious and time taking exercise.
Amount for of Rs.1000 is fixed for each HSC. Distribution to HSC is through the PHCs. In
the HSC Leepuram (block-Agastheeswaram) visited by the team, funds were already exhausted and
there were only 2 drugs (Albendazole and IFA tablets) available. Similarly in case of Kerala the
distribution of drugs from the district central warehouse is up to the HSCs.
Availability-
There are 260 and 287 drugs in the State essential drug list excluding surgical and other items
in Tamil Nadu and Kerala respectively. Similarly there are total 740 and 527 items in the state lists
of Tamil Nadu and Kerala respectively. The distribution and storage of all the items are meticulously
done by both TNMSC and KMSCL. However, despite of having an exhaustive list of items, most of
the middle and lower level facilities are operating with 50 to 70 items. In both the cases the
availability of reduced number of items defeats the very purpose of having an essential drug list
(EDL).
Accountability-
Keeping the account of inventory levels of items is of paramount importance in any stock
system. Similarly in the case of drug delivery system, accountability is extremely important. The
systems in this regard are appropriately in place in Tamil Nadu. The central drug warehouse has a
computerized inventory management system. There is an On-line HIS system at facilities in 5 Pilot
districts. A system of collection of slips from the patients to counter check the amount of drug
distributed from the pharmacies of the facilities is also in place.
In Kerala also there is a computerized inventory management system in the
warehouses however, not at the facility levels. There is no proper mechanism at pharmacies
of the facilities to keep an account of the amount of drugs distributed, particularly of the low
cost ones.
14
Recommendation
1) The states need to provide a system which ensures 24X7 availability of quality generic
drugs at low price.
2) An alternative system to provide basic as well as advanced diagnostic services at nominal
price is the need of the hour in the states visited.
3) HIS system being piloted in 5 districts seems a step in right direction. Evaluation study and
subsequent scaling on its basis is recommended.
4) There is a need to adopt EDL comprehensively rather than adhering to a short number of
drugs up to the PHC level.
5) There is a need for promotion of rational drug use particularly in Kerala.
6) Standard treatment guidelines should be promoted in Kerala.
7) The ceiling limit for the funds for purchase of medicines at Sub Centers needs flexibility.
8) Drug storage at PHCs and HSCs requires special attention.
9) Supply chain management needs strengthening so as to prevent frequent stock outs and
reduction in short expiry drugs being distributed to facilities.
10) To enhance the accountability of drugs stocks bar code up to primary packing along with
necessary scanning capacities is strongly recommended.
Conclusion
The findings of the study suggest that a system may be developed to supply quality generic
drugs to the patients through 24x7 drug outlets at District Head quarter hospitals at affordable cost
to minimize the out of pocket expenditure especially for the drugs which are not supplied by the
Facilities. Hence there is a need to come up- with an alternative drug delivery system which is both
affordable and sustainable for the provider and the beneficiary.
Keeping in view the emerging challenges in the health care delivery due to changing morbidity
patterns it becomes an imminent need to broaden the the spectrum of both basic and advanced
diagnostic services through a low cost mechanism on a 24 hour basis.
15
Annexure I
Facility visit: Observations
The population of Kanyakumari district is approximately 18.81lakh and there are 9 hospitals
and 9 CHC and 27 PHCs. The total bed strength of the hospitals including the district hospital,
Padma nabhpuram is approximately 850 beds. Total budget on drug procurement of Kanyakumari
district through TNMSC is approximately 06 Crores.
1) Central drug warehouse of the Tamil Nadu Medical Services Corporation
With the objective of analyzing the distribution channel of the drug from top to bottom, the
team visited of the central drug warehouse of the Tamil Nadu Medical Services Corporation at
Nagercoil. Kanyakumari is one of the districts where a pilot project for the implementation of
online Hospital information system is under way. A part from other user interfaces it also has the
pharmacy interface which takes into account the inward and outward flow of drugs.
The team studied the inventory management system and there were approximately 200
items including the speciality drugs meant for District HQ Hospital and Kanyakumari Medical
college Hospital. Details of the supply schedule were seen. This warehouse supplies to 56 health
facilities in the district.The pass book system was also studied. A ceiling limit has been fixed for
each facility centre as per the OPD attendance. For example the ceiling limit for Padmanabhpuram
district hospital is Rs 7,50,000/- per quarter, which means Rs 30.00,000/-per year on drugs and Rs
6,40,000/- per year on surgical items. The copy of the Annual issue schedule for the year 2011-12 is
placed (Attachment- I)
There are issues related to the 2D-bar code used on the drugs cartons. One of the reasons is
that that the bar code is only on the tertiary packing making accountability and distribution of
smaller quantities of drugs difficult as compared to the larger ones.
16
Figure 5 District Drug warehouse Nagarcoil Figure 6 District Drug warehouse Nagarcoil
2) Government district Head Quarters Hospital Padmnabhpuram
The hospital is a 108 bedded facility, with a Bed occupancy rate of 78%. There are 22
doctors posted in the hospital including the General surgeon, General Physician, Gynaecologist,
Paediatrician, Orthopaedic surgeon, Ophthalmologist and Anaesthetist. Besides these specialists
ENT and Skin Specialists visit the hospital twice a week. The details of the posted strength of the
various categories of the staff is placed (Attachment -II)
Availability of Medicines
Average number of OPD cases per day is 800-1000. The pharmacist In Charge of the OPD
counter informed that there were approximately 87 items available for OPD patients. The OPD
counter has been computerized and linked to the OPD registration as well as Doctors module. The
pharmacy counter is being managed by 4 pharmacists round the clock. According to the doctors no
patient is asked to purchase medicines from outside. The detailed list of drugs available in the OPD
counter is placed. (Attachment-III)
The central store is computerized and well maintained. Cold chain management was found
to be very good. Separate cards for each drug were being displayed indicating the batch no, issue
quantity, date of issue, balance stock etc. The same information is also available in the store module
of the computer in the main store. Approximately 200 items were available in the central store
including certain specialty drugs meant for the indoor patients.
17
Laboratory services
There are 3 Lab Technicians posted and the lab is functioning round the clock. All routine
tests are being conducted. For tests like Thyroid functions and Lipid profile patients are referred to
higher centres. On an average 70 patient including IPD and OPD are served daily and 200 tests
being conducted per day. All tests are conducted free of cost. Reports are delivered within 2 hours
for emergency cases , for IPD reports are delivered in the evening of the same day and that for OPD
cases it is next day .Dr Aruna Mozhi, Joint Director Health services, Kanyakumari district informed
that this hospital, has applied for NABH accreditation.
Figure 7 Central Drug Store room District head quarter Hospital Padmnabhpuram Figure 8 Pharmacy room
18
Figure 9 Lab room District Head Quarter Hospital Padmnabhpuram
3) General Hospital Kanyakumari (Taluka level hospital)
Diagnostic Services available
Bed strength of this facility is 36 (12 male, 12 female and 12 pediatrics bed), Average OPD
per day is 200-250. Average No. of deliveries per month is 12. There are 6 Doctors posted in this
facility. 1 MS, 1 DGO, 1 DCH, 1 MBBS, 1 Siddha MO and 1 Dentist. Other paramedical staff are 2
Pharmacist, 2-LT, 8 SN, 1-ANM, Counsellars-3.
Figure 10 Lab room General Hospital Kanyakumari
Out of total 36 beds, 20 were occupied and rest 16 beds were vacant at the time of visit. The
hospital has been computerized since July2009 and prescriptions are being made through the
computerized registration under the pilot project for 5 districts. Only 43 items were available in
OPD counter although there are 260 items in the Essential Drug List. (Attachment –IV)
19
According to the doctors posted at the general hospital the medicines are prescribed
as per the standard treatment guide lines. Standard treatment guide lines are through the
software module. A book containing approximately 700 pages has been issued to each
facility centre for the reference to the Medical Officers. No medicine is being prescribed
which is not in the Essential drug list.
Diagnostic Services available
This facilities offer tests such as TLC, DLC, ESR, Hb%, Blood Sugar, Blood urea,
Cholesterol level, LFT, Malaria tests and Sputum for AFB. Other diagnostic services available are
X-Ray, Ultrasonography, ECG
Surgery
No major surgeries except C-sections are performed. No anesthetist posted however available on
call.
Drug store
Only 60 items present in the pharmacy drug list. Rs. 5 lakh per year is the ceiling limit for the drug
passbook set by TNMSC.
Figure 11 Pharmacy room General Hospital kanyakumari Figure 12 Central Drug store room General Hospital
Kanyakumari
20
4) PHC- Pachhiparey (Block- Thiruvattaru)
Block population-1.32 lakh
There are no IP services in the facility. Average OPD per day is 100. Pechipariey PHC is
approximately 50 km from Kanyakumari. There are two medical officers posted. The post of the
pharmacist is presently vacant and the medicines are being dispensed by the ANM. There were
approximately 35 items available in the PHC. There was space constraint and a new building is
under construction and likely to be completed within one year.
Routine Laboratory tests are being done in the PHC; the average delivery is 4-5 per month
and there are 7 sub centres under this PHC. Doctors are prescribing the medicines as per the
standard treatment guidelines. Considering the distance from block HQ the drug availability is poor
and nearest higher facility centre is approximately 14 km away and there is no chemist shop nearby.
Figure 13 Lab and OPD room PHC Pachhipary Figure 14 ASHA and other health staff PHC Pachhipary
There was space constraint and a new building is under construction and likely to be
completed within one year.Routine Laboratory tests are being done in the PHC; the average
delivery is 4-5 per month and there are 7 sub centres under this PHC. There is no indoor bed in this
PHC, the doctors are prescribing the medicines as per the standard treatment guidelines.
Considering the location, distance from block HQ the drug availability is poor and nearest higher
facility centre is approximately 14 km away and there is no chemist shop nearby.
21
CHC, Agastheswaran
The team visited this CHC on 07 July 2011.This CHC is approximately 5km from Kanya
kumari and it is a thirty bedded hospital. The average daily attendance is approximately 125 and
there was one doctor in the OPD.
There are only 45 items available in the OPD counter and the last indent was received from
TNMSC on 05 July 2011.Only 9 items were received and the pass book value of these nine items
were Rs 1308.00 only. The details of the drugs available in the counter is place
(Attachment –V)
Figure 15 CHC Agastheswaran Figure 16 Pharmacy room CHC Agastheswaran
Figure 17 IPD CHC Agastheswaran
Health Sub centre, Leepuram
22
This sub centre is located by the sea. One ANM is posted in this sub centre and it is under
Kottaram PHC. All the delivery cases are being referred to the PHC and Immunisation is being
carried out under the supervision of Medical officer at the PHC.
Only 2 (Two) medicines Albendazole and Ferrous Sulphate+ Folic Acid are available in
the sub centre. The yearly pass book limit is Rs 1000/-(Rupees one thousand only) for the sub
centre
Figure 18 Health Sub Centre Leepuram
VISIT TO KERALA
The team visited the health facilities namely the PHC, CHC, Women& Child Hospital,
District HQ Hospital and Ware House of KMSCL, Thiruvananthapuram. The team had discussions
with MD (NRHM), Kerala and the General Manager, Kerala Medical Services Corporation
Limited.
Central Drug warehouse
One part of Kerala medical college hospital is presently being used as central district drug
warehouse in Thiruvananathapuram district. This warehouse supplies to all public health facility in
the district. The passbook system implemented in this district is different from that of Kanyakumari
district. In this facility they issue a passbook which includes the record of drug quantity as well as
information like batch number, total value of the drugs issued etc. The storage mechanism of the
drugs at specified temperature was found to be excellent with an alert system in case of failure to
23
maintain the cold chain management. The drugs are stored systematically with rack number, serial
number of the tertiary packing and bar coding.
General hospital, Thiruvananathapuram
This is 146 year old hospital operating primarily in an old structure. This is 747 bedded
facility with 55 doctors posted here. This is a tertiary care hospital. Average OPD number is 2000 -
2500 patients and IPD being50-100 patients per day. 40% of the patients admitted are covered
under RSBY. The OPD corridors were very crowded without proper waiting areas and seating
arrangements. The patient friendly amenities are bare minimum in this hospital.
Pharmacy
There are only two counters for drug distribution. The accounting mechanism is not robust
as it only accounts for the costly drugs and items through patient specific information. There was no
systematic storage of drugs in the pharmacy.
Figure 19 Pharmacy General hospital Thiruvananthapuram
CHC, Poonthura
The team visited Poonthura CHC on 09 July 2011 and this CHC is having 24 beds and 5
Medical officers are posted including a dermatologist and an ENT surgeon. Paramedical staff
includes 4 staff nurses, 3 PHN and two contractual SNs. There is no labour room and delivery cases
are being referred to Women &Child Hospital. The average daily OPD attendance is 600. This
CHC is functioning 24x7 and the doctors are on call for emergency cases.
Availability of medicines
There were 107 items are available in the counter.
24
Laboratory services
There is only 1 lab. Technician posted in the CHC. On an average 15-20 cases per day are served in
the laboratory. However the services offered are limited to only basic tests. No widal test, LFT,
sputum tests are not conducted.
PHC-Katakampally
This is a 6 bedded facility with 3 MOs, 1 pharmacist, 4 SNs and 7 PHNs in position. Average OPD
is 80-100per day and 8-10 per month. This is a 24X7 PHC but without residential facilities for the
staff. No delivery as well as Lab. services are available.
Medicines for chronic diseases such as Hypertension, diabetes etc are dispensed through HSC so
that patients need not come to the PHC.
Women and Children Hospital, Thycaud
This is a 428 bedded facility with 35 MOs in post. Average OPD number in 500. The hospital is
conducting 40 normal deliveries and 8-10 C-sections per day. The bed occupancy rate of the IPD is
70%.
Pharmacy
64 types of drugs are dispensed from the store which runs on 24X7 basis.
There is no fair price drug shop in this facility.
