Union Government of India unveiled New Free Drug Policy- Will it Be Effective

In one of the bold steps for reforming the countrys healthcare scenario, Indian Government recently launched its new Free Drug Policy which is being considered a game changer for the healthcare sector. The main features of the policy are as follows: Every citizen of the country will be entitled to free medicines in all public health centers spread across the country Only generic drugs will be provided and branded drugs have been kept out of the policy The policy will be effective over the next five years The total cost for the policy will be around US $5.4 billion

Now in order to understand the full impact of this policy lets have a look at the current scenario of health care in India. Presently, India spends only 1.2% of its GDP on public healthcare which, as per the report by Organization for Economic Co-operation, is higher in terms of % share of GDP from just 7 countries in the world Around 40% of the population lives below the poverty line ($1.25 per day) and an average citizen spend a meager $4.50 per year on health Right now only 22% of the total population have access to public healthcare A staggering 78% of health expenditure is out of pocket which is one of the highest numbers in the world and 72% of this is spent on drugs Around 30% of rural India dont go for any treatment because of financial constraints and 20% of the ailments in urban India are untreated due to the same reason About 47% of hospital admission in rural India and 31% of hospital admissions in urban India are financed by loans and sale of assets

A glance at the above mentioned statistics clearly point out towards the deplorable public health care scenario in India and how health care is seen as a luxury for the masses in India. In these prevailing conditions any step which plans to bring down the total cost of healthcare and increase its accessibility is definitely in the right direction and this is exactly what the new free drug policy is aiming at. However, one needs to closely evaluate the free drug policy from the point of view of its implementation process and the various nuances associated with it. To begin with, it is being made mandatory for all doctors in public sectors to prescribe generic drugs and salt names and not brands. Also, action will be taken against the doctor who is found prescribing brands. Now this step clearly highlights the fact that successful

implementation of free drug policy is majorly depended on the doctors. Knowing about the conditions that most of the public sector doctors work in and also the benefits provided to them by the private brands in lieu of them prescribing the branded medicine to patients, it will be quite difficult a task to monitor all the doctors and implement this step comprehensively just by making punishment a key driver. The doctor who is a major stakeholder in any healthcare policy has to be brought completely on board for the success of such policies through other drivers which are positive in nature. Already the medical community of India is at loggerheads with the Government on decisions like NCHRH bill and Clinical Establishment Act etc. and giving them one more reason to be disgruntled is not at all advisable. Apart from the above requirement, other primary activities will also be undertaken to implement this policy. A national list of essential medicines comprising of 348 drugs has been compiled by the ministry of health and have been sent to all the states as a reference list so that all the states can create their own list of essential drugs keeping in mind the geography, the demographics and the diseases that affect those places. The center will bear 75% of the cost for state medicines and 5% of the fund will be used to purchase drug outside the essential list. A scientific committee will be required to draw out the essential drug list for the state. The state will procure drugs directly from manufacturer or importer through an open tender by the companies who meet certain criteria. Also the drugs must carry a not for sale label printed on packaging. A district level state of the art warehouse will have to be set up by states to store drugs and a passport driven system will move the medicines to district hospitals, CHCs and PHCs will then send the drug to sub centers. Seeing the number of activities involved for successful implementation of scheme, the chances of major operational roadblocks and inefficiencies crippling the project are quite high. The entire process of selecting the company for procurement of drugs through a tender process has wide scope for corruption and irregularities taking place. Also with the center bearing 75% of the cost, there are chances of standoff between the center and state for reasons such as insufficient fund allocation or funds not reaching on time etc. which might hit the supply and availability of drugs. A rigorous system for assuring the quality of the drugs being delivered, right storage conditions, regular check for discarding the expired stock etc. has to be in place to ensure that appropriate drug in the right condition is provided to the consumer who will mainly comprise of people unable to ascertain the correctness of product themselves. The policy clearly focusses on generic drugs which are more easily available and much cheaper than the branded products. Also the list covers almost 60 percent of the drugs sold in India. Hence this move will surely benefit the India generic drug makers and will act as a booster for Indian Pharmaceutical sector encouraging them to further come out with better, newer and cheaper products.

Overall, if the spirit in which this policy has been made is followed in its implementation as well then it will surely aid in alleviating healthcare woes of at least 52% of the population by 2017 as per the estimates. The policy will definitely cut down the out of pocket expenditure on healthcare and increase accessibility thereby improving the overall healthcare standard in India. However, it still needs to be seen that this scheme doesnt go on the lines of Jan Aushadhi scheme which planned to launch 3000 generic drug store by 2012 but only 300 were set up. At the end of the day, effectiveness of any public policy is depended on how well it is implemented and accepted by all the stakeholders involved.