New Delhi: The Union health ministry is rolling out an online database of medicines stocked at government-run health centres and a centralized agency to procure drugs as patient groups and civil society organizations highlight shortages triggering greater drug immunity and higher treatment costs.
The ministry will also digitize various government-run health centres including primary health centres, community health centres and hospitals.
“Through this, (online database) we are trying to monitor usage and wastage of drugs. The process has already started and funding is released for 11 states under the National Health Mission,” a senior health ministry official said, requesting anonymity.
The official added that state and district administrations can monitor the drugs inventory and replenish supply to avoid an out-of-stock situation.
In August, a shortage of first-line (initial), second-line (advanced) and paediatric HIV drugs and diagnostic kits had prompted civil society and patient groups to send a legal notice to the government. The notice highlighted concerns about scarcity and gaps in procurement of medicines.
Over two million people in the country are HIV-infected. Treatment through initial drugs costs about Rs.5,500 a year while advanced and complex therapies cost Rs.20,000-Rs.2 lakh a year.
The health ministry distributes free HIV drugs through 355 government-run centres. A break in treatment could help the virus gain higher resistance to the drug and patients being forced to shift to the next line of drugs that are costlier.
Though civil society groups agree the move to create a medicine database is a positive step, they are sceptical about its effectiveness.
“We have been assured by NACO (National AIDS Control Organisation) that in the next six-eight months, stock-outs will be a thing of the past. But we are still sceptical about steps they will take and their result on the ground. We have been promised many things earlier which unfortunately have not come true,” said Vikas Ahuja, president of Delhi Network of Positive People (DNP+), an organization of HIV/AIDS-affected people in Delhi.
In June 2013, there was a scarcity of tuberculosis drugs across the country.
“Stock-outs happen because of a variety of reasons like shortage of funds, late release of funds to suppliers and poor coordination between frontline facilities and warehouses,” said Sakhtivel Selvaraj, senior public health specialist at Public Health Foundation of India.
In the legal notice in August, civil society groups like DNP+ pointed out that bureaucratic delay in procurement is one of the main reasons for scarcity.
Rail India Technical and Economic Service (RITES) currently handles procurement and distribution of HIV drugs in government-run antiretroviral therapy (ART) centres.
“We have always been against RITES, which was originally formed to do procurement for the railways. Drug procurement is a sensitive issue and needs a different agency to do it,” Ahuja said.
To address this problem, the government is setting up a dedicated body, the Central Medical Services Society (CMSS), for drug procurement and distribution.
“CMSS will procure all medicines except vaccines and it will replace RITES. One-time budget of Rs.50 crore has been allocated and 20 locations have been identified to set up warehouses. They will come out with their first tender soon,” said the senior official cited earlier, who said that CMSS will function more efficiently with less bureaucratic delays.
CMSS will be required to maintain four months of drug supply for the entire country at any point of time, the official added.
“They have been planning to bring a CMSS-kind of agency for a long time. But just bringing it in would not address the problem. The main issue is how well central government monetizes this programme and how they coordinate with state governments which actually look after procurements and distribution of drugs,” Selvaraj said.
Most state governments have poor drug procurement and distribution systems which need to be strengthened. One of the reasons for this is inadequate funding for drug procurement and distribution.
“Distribution system is a day-to-day thing. States such as Tamil Nadu, Kerala and Rajasthan have a good distribution system. They also spend around 14-15% of their entire health budget on this. Most states spend only 5-6% of their health budget on this and some states such as Haryana, Odisha and Punjab spend even less than 5%,” Selvaraj said.
Even as the government is taking steps to prevent stock-outs of life-saving medicines, the situation on the ground remains critical.
“Just a few days back, we had to purchase Tenofovir (an essential antiretroviral drug) because it was not available at an ART centre in Delhi. The government needs to be more sensitive to our situation and troubles. We need to see change on the ground. Just by appointing another agency does not mean that stock-outs will not happen,” Ahuja said.