Context:

Rajasthan has fared at the top in 16 State-chart detailing implementations of the free medicine scheme, being run under the National Health Mission.

About National Health Mission (NHM):

The National Health Mission (NHM) encompasses its two Sub-Missions, the National Rural Health Mission (NRHM) and the newly launched National Urban Health Mission (NUHM).

The main programmatic components include Health System Strengthening in rural and urban areas – Reproductive – Maternal- Neonatal- Child and Adolescent Health (RMNCH+A), and Communicable and Non-Communicable Diseases.

The NHM envisages achievement of universal access to equitable, affordable & quality health care services that are accountable and responsive to people’s needs.

About Rajasthan Free Medicine Scheme:

Mukhyamantri Nishulk Dava Yojana (MNDY), the Chief Minister’s Free Medicine Scheme, this Scheme provides quality, generic drugs at no expense to all and helps to ease the significant out of pocket expenditures on health care that the current national health system demands.

Background:

In Rajasthan, on average before MNDY, 89.4 percent of household expenditures on health care was spent on medicine.

According to the World Health Organization in 2010, 65 percent of patients were unable to access the essential medicines they needed to recover from an illness.

In an evaluation of the Free Medicine Scheme, the World Health Organization and Public Health Foundation of India reported that the combined outpatient and inpatient care visits rose from 3.5 million in July 2010 to 7.8 million in July 2013, more than doubling the access and reach of health care.

Administration in Scheme:

To implement the scheme, Rajasthan Medical Services Corporation Limited (RMSCL) was incorporated on May 4, 2011, as a Public Limited Company, and obtained its Certificate of Commencement of Business on June 13, 2011.

RMSCL was established as a centralised procurement agency for procuring generic medicines, surgical equipment, sutures and medical equipment for the department of Medical, Health and Family Welfare, Medical Education department, among others.

About 1,400 pharmacists were recruited for the new system. In 2013, computer operators were added for the management of and entries into the e-Aushadhi software.

E-Aushadhi is the digital system designed to track the supplies. Since its successful implementation in Rajasthan, the application has been replicated by many other states in the country.

Features of Scheme:

• The scheme consists of two components — free medicine and free tests.
• The Rajasthan Medical Services Corporation (RMSC) was created and given the responsibility for centralized purchasing, quality control and providing medicines to all health facilities in the state.
• Generic medicines and this centralized system of procurement allowed the efficient distribution of quality drugs.
• RMSC procures the items in generic names by finalizing the rates and supplies through an open tender process.
• All medicines and surgical needles are procured based on the need and consumption pattern of the items by the state medical institutions.
• The procurement orders are placed four months out with two months stock likely to be in transit and under quarantine, so stocking is a year-round affair.
• One of the most challenging aspects of this is to be able to predict the needs of the health facilities for any given year. To contend with this, ten percent of the budget is allocated for decentralized purchasing of medicines as needed.
• The strength of the scheme is that it is working not just in the major cities but also in the parts of Rajasthan that are remote and had few health care facilities.

How Many Have Benefitted from The Scheme So Far?

• The number of free medicine beneficiaries stood at 52.4 crore.
• A lot of patients revisit the dispensaries, hence the high number of beneficiaries.
• Some also manage to get a second course of prescribed medicines on the same day, for example, those staying far from the hospital or the dispensary.

Issue with Generic Drugs Under Scheme:

• Doctors’ opposition to the Free Medicine Scheme centered around their suspicions about the quality of ‘cheap’ drugs and their skepticism about the inclusion of the necessary or most used and effective drugs, as well as the loss of personal income.
• This was addressed this by making doctors part of the decision-making process for the Essential Drug List and Standard Drug Protocol, forming an advisory committee for the purchase and updating of the Essential Medicines List, which lists all the medicines available under the Scheme.
• Sensitization program to appeal to physicians’ emotional side, showing how the program would alleviate the suffering of people.
• Doctors are now trained to understand that all versions of the branded medication, post its patent period, have the same active ingredients. The quality of the drugs was a critical component, for the patients and for the doctors, to ensure buy-in to the whole Scheme. To maintain the quality of the medicines, a random sample of products is taken from each batch and then sent to one of six empanelled and impartial labs throughout the country.

Other Scheme Related to Medicine:

Pradhan Mantri Bhartiya Jan Aushadhi Pariyojana Kendra (PMBJP)

Objectives of the scheme:

• Making quality medicines available at affordable prices for all, particularly the poor and disadvantaged, through exclusive outlets “Pradhan Mantri Bhartiya Janaushadhi Kendras”, so as to reduce out of pocket expenses in healthcare.

Implementation Agency:

• BPPI (Bureau of Pharma PSUs of India), under the administrative control of the Department of Pharmaceuticals, Ministry of Chemicals& Fertilizers, Government of India will be the implementation agency for the PMBJP.

Key Features:
State Governments or any organization / reputed NGOs / Trusts / Private hospitals / Charitable institutions / Doctors / Unemployed pharmacist/ individual entrepreneurs are eligible to apply for new Pradhan Mantri Bhartiya Janaushadhi Kendras.

The applicants shall have to employ one B Pharma / D Pharma degree holder as Pharmacist in their proposed store. Pradhan Mantri Bhartiya Janaushadhi Kendras can be located within Government hospital premises as well as Private hospital premises or anywhere outside.

Financial support to applicants: An amount of Rs.2.5 lakhs shall be extended to NGOs/agencies/individuals establishing Pradhan Mantri Bhartiya Janaushadhi Kendras in Government hospital premises where space is provided free of cost by Government to operating agency: Rs. 1 lakh reimbursement of furniture and fixtures Rs. 1 lakh by way of free medicines in the beginning Rs. 0.50 lakh as reimbursement for computer and peripherals, internet, etc.