Last week, a doctor interviewed at New Delhi’s All India Institute of Medical Sciences (AIIMS), the country’s premium government hospital, said he always doubted the efficacy of drugs used in surgeries and sourced from the Central government dispensaries.
Last year, an anti-tuberculosis batch of drugs supplied by Nestor Pharmaceuticals Ltd to the Jharkhand government was found to be substandard. But by the time it was discovered, they had already been disbursed to various government agencies. Nestor no longer supplies drugs to any government, but chairman Rahul Sehgal blames business rivals for the allegations even while refuting all charges. And in 2003, part of a drug consignment meant for Municipal Corporation of Delhi-run dispensaries and sold by Unisule Laboratories, was found to be low on therapeutic quality in sample testing initiated by an association of large drug makers. A Unisule executive denies the charge.
India’s sprawling public health-care system—inadequate in scope and scale, yet the only source of hospital services for millions of people—sometimes distributes drugs that are substandard or fake. That doesn’t come as a surprise to experts who say that despite its elaborate nature, the process of drug procurement, quality checks, and distribution is so riddled with gaps that some suppliers of the Rs4,000 crore worth of medicines bought every year by central and state governments find it easy to slip in low-quality or spurious drugs.
Procurement is always through a public tender that awards the contract to the lowest bidder—a practice that most doctors, drug makers and health-care experts blame for making the public health-care system vulnerable.
This “lowest cost” approach keeps away reputed manufacturers, who will not compromise with quality for fear of diluting the value of their brands, and lures the ones who participate to pull down costs even at the cost of losing quality, say critics of the system such as Harinder S. Sikka, a director with drug maker Nicholas Piramal India Ltd. Sikka is leading a litigation against the government on spurious drugs, as reported by Mint on 30 April in a page-one story on a thriving market for fake drugs in Delhi.
Most government agencies have a drug purchase committee, with consultants and specialists on it. This panel sifts through medicine lists prepared by in-house doctors and calculates the likely total demand for the coming year. A tender is floated thereafter, with technical requirements outlined, and bids invited. The lowest bidder walks away with the supply contract. “The government agencies have to buy in bulk and disburse it to as many people as may be in need of these medicines. Hence, the stress is on procuring cheaper drugs,” says Anil Bansal, former president of Delhi Medical Association, who is also a doctor with New Delhi Municipal Corporation (NDMC) that operates 13 dispensaries and two hospitals in the Capital.