 "Mass medicine scheme needs a booster dose")
It is around 1.30 in the afternoon and the shutters of Kendriya Bhandar at Shastri Bhawan in Delhi are being lifted after a 30-minute lunch break. The store opens into two shops carelessly demarcated within the same space. In the first half is the Jan Aushadhi store, while in the second is the Kendriya Bhandar. It is hard to distinguish where the first ends and the second begins because on the shelf, packs of Doxycycline and Ibuprofen tablets sit next to toilet-cleaning detergent.
The Shastri Bhawan Jan Aushadhi store is one of the earliest such stores in the country. Opened around 2009, it has its regulars, most of whom are bureaucrats working in the neighbouring ministries. "I come here often," says one who works in the ministry of chemicals and fertilisers. "The medicines here are cheaper than in the market, but I rarely find all of the ones I need. Today, though, I got three of the four medicines I was looking for."
Launched in 2008, the Jan Aushadhi Scheme was initiated by the United Progressive Alliance (UPA) government during its first term. The aim was to achieve three objectives: make generic medicines available in the market; encourage doctors in government hospitals to prescribe generic medicines; and lastly, reduce out-of-pocket expenses for patients. These were to be stores where patients could walk in and buy generic drugs that the government would sell at the lowest possible price.
But, the programme flopped with only a few stores seeing the light of day. Against the target of 626 stores - one in each district - by the end of the 11th Plan period in 2012, the government had managed to open only 157 stores by 2013. Most of these stores too became non-functional as they became non-profitable. Even now, only 99 out of the 176 stores are functional.
Later, based on the report of the Public Health Foundation of India, the government restructured its scheme and developed a new business plan. In the revised plan, it said it would open 3,000 stores between 2013-14 and 2016-17 during the 12th Plan period.
But even after the restructuring, the Jan Aushadhi Scheme continued to struggle. In 2014, the government opened only 11 new stores. As a result, few people became aware of this initiative. And the ones who did either did not have a store near their home or the store didn't have the medicines they needed.
Now the present government is restructuring the scheme again. The revised scheme was to be announced on June 21, but the government failed to meet this deadline. Health experts say that for the Jan Aushadhi programme to be successful, the revised policy would have to correct three fundamental flaws that have crippled its smooth implementation.
First, they argue, there are few Jan Aushadhi stores in the country and the government needs to speed up their opening. One suggestion is to increase the amount granted to those interested in opening these stores from Rs 2.5 lakh to Rs 3.5 lakh. This is also a recommendation of the Parliamentary Standing Committee that submitted its report in March.
Also, these new stores need to be evenly distributed across the country. At present, the majority of the stores are in north India, while almost none has been opened in the southern parts of India. Besides, hardly any of these stores have come up in private hospitals. As a result, the scheme hasn't really helped patients bring down the amount they are forced to spend on their health. That's because 80 per cent of all outpatient care and 60 per cent of all hospitalisation care takes place at private facilities And 70 per cent of the patient's money is spent on buying medicines.
"There is no point in opening Jan Aushadhi stores in government hospitals where the government is mandated to provide free medicines. Instead, these stores should come up in private hospitals," says a senior doctor who has been working to promote generic medicines in the country.
Many hurdles yet to cross
The failure to open enough stores in the country and across all states is a result of the lack of coordination between the central and state governments. For the Jan Aushadhi Scheme to work, this synergy becomes crucial because the state government has to take the lead in providing space for the shops. Once that is done, the central government allots Rs 2.5 lakh to the person who wants to run the store - Rs 2 lakh as establishment cost and Rs 50,000 as start-up cost. However, in states such as Tamil Nadu, Kerala and Karnataka, the governments are already running their own schemes under which they distribute free medicines in government hospitals. Therefore, the governments of these states have little incentive to promote the Jan Aushadhi Scheme aggressively.
"The governments of Odisha, Himachal Pradesh, Jammu and Kashmir, Punjab and of some states in the Northeast have shown a keen interest in the scheme. These governments are forthcoming in their support," says a senior official in the department of pharmaceuticals (DoP). "But then a state like Bihar, which we thought would be interested in such a programme, has shown little interest because it already has its own scheme wherein it distributes free medicines in government hospitals."
Even if the government opens more stores, that will solve only part of the problem. The larger concern is ensuring regular availability of drugs in these stores. In its reply to the standing committee, the department of pharmaceuticals said that the average availability of drugs in stores has been around 170-190, whereas it should have been 361. The situation is worse in states that are located far from the central warehouse of the Bureau of Pharma PSUs of India (BPPI) near Delhi.
A representative from Jammu and Kashmir (non-official) told the standing committee, "Earlier, we received a brochure listing 349 medicines but only 40 medicines were being supplied. Now, the latest list has 261 medicines, but we are supplied only 50." Health experts say because of the lack of availability of all listed medicines customers lose confidence in the Jan Aushadhi stores.
Ensuring regular supply of drugs would require an overhaul of BPPI - an uphill task for the government considering that three of the five pharmaceutical public sector undertakings (PSUs), which combine to form BPPI, are sick. BPPI was formed in 2008 by bringing together five pharmaceutical PSUs: Karnataka Antibiotics and Pharmaceuticals (KAPL), Rajasthan Drugs and Pharmaceuticals (RDPL), Hindustan Antibiotics, Bengal Chemicals and Pharmaceuticals, and Indian Drugs and Pharmaceuticals. Of these, only Indian Drugs and Pharmaceuticals and Karnataka Antibiotics and Pharmaceuticals supply regular drugs. The rest have either negligible or nil production and are sick units under the Bureau for Industrial and Financial Reconstruction.
DoP officials say they have taken steps to reform BPPI and improve its functioning. One of steps includes appointing a fulltime chairman-cum-managing director to head BPPI with powers to recruit his own staff. Second, the government has appointed a private company to manage the warehouse of BPPI to improve the supply chain. The government is also revising the list of 361 medicines that are sold through these stores. Officials in the DoP say this list was being increased to 500, with drugs that customers most often need being included.
"The present list of 361 medicines has few fast-moving drugs. We are expanding this to include medicines from therapeutic segments, which include diabetes, heart diseases, pain killers, gastroenteritis and antibiotics," says an official. "Orders have been placed to procure these medicines." The standing committee has recommended to the DoP to also include items such as essential surgical goods like syringes, dextrose and drip sets in the list of things sold through the Jan Aushadhi stores.
The revised government policy will also need to pump in more resources to publicise this programme. As of now, even seven years after its launch, few people are even aware of the Jan Aushadhi Scheme.
A senior doctor in a central government hospital who has worked on popularising generic medicines says, "The name Jan Aushadhi itself is a problem. How many people would know what it means? And in non-Hindi speaking states, it is even more difficult to sell this idea." The standing committee's recommendation to the DoP is to design a campaign similar to the "Jaago Grahak Jaago" to popularise the scheme.
Even after all this is achieved, there remains another problem, points out Sakthivel Selvaraj, senior health economist at Public Health Foundation of India. Selvaraj co-authored the 2012 report on the Jan Aushadhi Scheme that was submitted to the DoP. This report formed the basis for the restructuring of the programme in 2013. He says issues such as opening of more stores and ensuring adequate medicines can be easily addressed. But, the larger issue is: will doctors prescribe generic medicines?
"India does not have a law that mandates doctors to prescribe generic medicines," says Selvaraj. "So, even if more of these stores come up in private hospitals, little will change unless the doctors are asked to prescribe generic medicines."
That's yet another hurdle in the long road to making generic and cheaply priced medicines easily accessible.
The Shastri Bhawan Jan Aushadhi store is one of the earliest such stores in the country. Opened around 2009, it has its regulars, most of whom are bureaucrats working in the neighbouring ministries. "I come here often," says one who works in the ministry of chemicals and fertilisers. "The medicines here are cheaper than in the market, but I rarely find all of the ones I need. Today, though, I got three of the four medicines I was looking for."
Launched in 2008, the Jan Aushadhi Scheme was initiated by the United Progressive Alliance (UPA) government during its first term. The aim was to achieve three objectives: make generic medicines available in the market; encourage doctors in government hospitals to prescribe generic medicines; and lastly, reduce out-of-pocket expenses for patients. These were to be stores where patients could walk in and buy generic drugs that the government would sell at the lowest possible price.
But, the programme flopped with only a few stores seeing the light of day. Against the target of 626 stores - one in each district - by the end of the 11th Plan period in 2012, the government had managed to open only 157 stores by 2013. Most of these stores too became non-functional as they became non-profitable. Even now, only 99 out of the 176 stores are functional.
Later, based on the report of the Public Health Foundation of India, the government restructured its scheme and developed a new business plan. In the revised plan, it said it would open 3,000 stores between 2013-14 and 2016-17 during the 12th Plan period.
But even after the restructuring, the Jan Aushadhi Scheme continued to struggle. In 2014, the government opened only 11 new stores. As a result, few people became aware of this initiative. And the ones who did either did not have a store near their home or the store didn't have the medicines they needed.
Now the present government is restructuring the scheme again. The revised scheme was to be announced on June 21, but the government failed to meet this deadline. Health experts say that for the Jan Aushadhi programme to be successful, the revised policy would have to correct three fundamental flaws that have crippled its smooth implementation.
First, they argue, there are few Jan Aushadhi stores in the country and the government needs to speed up their opening. One suggestion is to increase the amount granted to those interested in opening these stores from Rs 2.5 lakh to Rs 3.5 lakh. This is also a recommendation of the Parliamentary Standing Committee that submitted its report in March.
Also, these new stores need to be evenly distributed across the country. At present, the majority of the stores are in north India, while almost none has been opened in the southern parts of India. Besides, hardly any of these stores have come up in private hospitals. As a result, the scheme hasn't really helped patients bring down the amount they are forced to spend on their health. That's because 80 per cent of all outpatient care and 60 per cent of all hospitalisation care takes place at private facilities And 70 per cent of the patient's money is spent on buying medicines.
"There is no point in opening Jan Aushadhi stores in government hospitals where the government is mandated to provide free medicines. Instead, these stores should come up in private hospitals," says a senior doctor who has been working to promote generic medicines in the country.
Many hurdles yet to cross
The failure to open enough stores in the country and across all states is a result of the lack of coordination between the central and state governments. For the Jan Aushadhi Scheme to work, this synergy becomes crucial because the state government has to take the lead in providing space for the shops. Once that is done, the central government allots Rs 2.5 lakh to the person who wants to run the store - Rs 2 lakh as establishment cost and Rs 50,000 as start-up cost. However, in states such as Tamil Nadu, Kerala and Karnataka, the governments are already running their own schemes under which they distribute free medicines in government hospitals. Therefore, the governments of these states have little incentive to promote the Jan Aushadhi Scheme aggressively.
"The governments of Odisha, Himachal Pradesh, Jammu and Kashmir, Punjab and of some states in the Northeast have shown a keen interest in the scheme. These governments are forthcoming in their support," says a senior official in the department of pharmaceuticals (DoP). "But then a state like Bihar, which we thought would be interested in such a programme, has shown little interest because it already has its own scheme wherein it distributes free medicines in government hospitals."
Even if the government opens more stores, that will solve only part of the problem. The larger concern is ensuring regular availability of drugs in these stores. In its reply to the standing committee, the department of pharmaceuticals said that the average availability of drugs in stores has been around 170-190, whereas it should have been 361. The situation is worse in states that are located far from the central warehouse of the Bureau of Pharma PSUs of India (BPPI) near Delhi.
A representative from Jammu and Kashmir (non-official) told the standing committee, "Earlier, we received a brochure listing 349 medicines but only 40 medicines were being supplied. Now, the latest list has 261 medicines, but we are supplied only 50." Health experts say because of the lack of availability of all listed medicines customers lose confidence in the Jan Aushadhi stores.
Ensuring regular supply of drugs would require an overhaul of BPPI - an uphill task for the government considering that three of the five pharmaceutical public sector undertakings (PSUs), which combine to form BPPI, are sick. BPPI was formed in 2008 by bringing together five pharmaceutical PSUs: Karnataka Antibiotics and Pharmaceuticals (KAPL), Rajasthan Drugs and Pharmaceuticals (RDPL), Hindustan Antibiotics, Bengal Chemicals and Pharmaceuticals, and Indian Drugs and Pharmaceuticals. Of these, only Indian Drugs and Pharmaceuticals and Karnataka Antibiotics and Pharmaceuticals supply regular drugs. The rest have either negligible or nil production and are sick units under the Bureau for Industrial and Financial Reconstruction.
DoP officials say they have taken steps to reform BPPI and improve its functioning. One of steps includes appointing a fulltime chairman-cum-managing director to head BPPI with powers to recruit his own staff. Second, the government has appointed a private company to manage the warehouse of BPPI to improve the supply chain. The government is also revising the list of 361 medicines that are sold through these stores. Officials in the DoP say this list was being increased to 500, with drugs that customers most often need being included.
"The present list of 361 medicines has few fast-moving drugs. We are expanding this to include medicines from therapeutic segments, which include diabetes, heart diseases, pain killers, gastroenteritis and antibiotics," says an official. "Orders have been placed to procure these medicines." The standing committee has recommended to the DoP to also include items such as essential surgical goods like syringes, dextrose and drip sets in the list of things sold through the Jan Aushadhi stores.
The revised government policy will also need to pump in more resources to publicise this programme. As of now, even seven years after its launch, few people are even aware of the Jan Aushadhi Scheme.
A senior doctor in a central government hospital who has worked on popularising generic medicines says, "The name Jan Aushadhi itself is a problem. How many people would know what it means? And in non-Hindi speaking states, it is even more difficult to sell this idea." The standing committee's recommendation to the DoP is to design a campaign similar to the "Jaago Grahak Jaago" to popularise the scheme.
Even after all this is achieved, there remains another problem, points out Sakthivel Selvaraj, senior health economist at Public Health Foundation of India. Selvaraj co-authored the 2012 report on the Jan Aushadhi Scheme that was submitted to the DoP. This report formed the basis for the restructuring of the programme in 2013. He says issues such as opening of more stores and ensuring adequate medicines can be easily addressed. But, the larger issue is: will doctors prescribe generic medicines?
"India does not have a law that mandates doctors to prescribe generic medicines," says Selvaraj. "So, even if more of these stores come up in private hospitals, little will change unless the doctors are asked to prescribe generic medicines."
That's yet another hurdle in the long road to making generic and cheaply priced medicines easily accessible.