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Rational use of drugs_ An overview

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					           Presentation
               on
Rational Drug Provision and Use
     A Haryana State Initiative
             launched
                on
        1st January 2009

                                  1
 Past Scenario
 No policy articulation on Drug entitlement – who
  would get? at what cost?
 Almost all OPD medicines were purchased by
  patients
 Indoor and Emergency supplies were thin and
  erratic
 Patients were purchasing some medicines and
  consumable even for institutional deliveries and
  EmOC services


                                                 2
    Contd.
 Prescription of propaganda drugs was rampant
 Injudicious prescription of excessive and high
    cost drugs was common
   Out of pocket expenses by patients were very
    high
   Nexus between Chemists and Pharma
    companies was flourishing at patients’ cost
   Quality of medical care was compromised
    resulting in erosion of credibility of Public
    Health Institutions
   OPD & IPD patients were declining- in some
    districts bed occupancy was as low as 30-35%
                                                    3
Contd.
 Govt. spent more than Rs.10 crores annually on
  procurement of drugs
 Procurement was centralized, not in sync with
  requirements
 Drugs being out of stock or overstocked was
  common
 There were instances of expiry, pilferage etc
 Doctors were reluctant to prescribe drugs
  available under Govt. supply
 There was also concern about quality of drugs

                                                   4
 Addressing the Challenges
 A clear policy on entitlement put in place
 Decision taken to provide free drugs to all OPD
  patients, casualty cases and institutional
  deliveries including LSCS
 Surgical and non-surgical package system
  introduced for IPD patients
 BPL patients and residents of urban slums
  entitled for completely free indoor treatment
  including surgeries and implants, others pay a
  nominal, fixed charge

                                                5
Fixed Cost Surgery Package
 Launched in all District Hospitals w.e.f. July 1,
  2009
 Free surgery / IPD for BPL and residents of
  urban slums
 All obstetrics cases, eye surgeries,        cleft
  lip/palate are free for all patients
 Very nominal charges for others
 All pre-operative investigations, medicines,
  consumables, blood charges, post-operative
  medicines covered
 Cost effective and hassle free, no running
  around for medicines/tests                6
 Process

 Comprehensive Essential Drug List (EDL)
  prepared for DH, CHCs & PHCs
 EDL contains 328 essential drugs for DHs,
  112 items for CHCs & 84 items for PHCs
 EDL     prepared in consultation with
  specialists
 Dynamic & modifiable as per need



                                              7
 Procurement Reforms

 New Drug Procurement Policy put in place
 Policy weeds out Sub Standard Pharma
  Companies
 WHO- GMP Certification, annual turnover of
  Rs.35 crores for last three years amongst
  qualifying criteria
 About 110 reputed Pharma companies eligible
  to compete in State RCs
 Procurement strictly based on Indian and British
  Pharmacopoeia


                                                     8
 Broadening of Supply Sources

 Multiple sources approved for supply to avoid
  disruption and maintain supply chain
 Purchase preference is given to 5 CPSUs for
  102 Essential medicines
 State RCs finalized at highly competitive rates.
 DGS&D and ESIC rate contracts also declared
  as approved sources
 Competitive rates negotiated for local purchases
  in emergency

                                                 9
Decentralization of Procurement
 Procurement completely decentralized
 Broad   based     District  Procurement
  Committee constituted to indent and
  procure
 Specialists are empowered to indent
  medicines as per need and are part of
  procurement committee
 Procurement done on quarterly basis


                                        10
Contd.

 Special powers given to District Hospitals for
  procurement   under    SPP     and   National
  Programme
 RKS of District Hospitals manages receipts and
  expenditures
 Imprest money given to each surgical specialist
  for exigencies
 Local purchase policy articulated unambiguously
 Hospital cost protocol standardized for each
  surgery
                                                11
Headquarters' Role
 Headquarters' Role clearly delineated
    Prepare and review essential drug list
    Determine source of supply
    Ensure timely release of adequate funds to
     District Health Societies
    Monitor consumption on weekly basis
    Mentor districts for smooth procurement



                                                  12
   Monitoring & Review
 Weekly monitoring of per capita cost of drugs
  separately for OPD & IPD, Casualty &
  Institutional Deliveries (facility-wise)
     Variance analysis is done
     Prescription audit carried out where cost deviates
 Comprehensive software to monitor indent,
  issue, consumption, cost, reorder level and
  inventory
 Nodal Officer appointed for each District for
  monitoring
                                                           13
Outcomes
 Highly affordable per capita expenditure on
  drugs
   OPD- DH-Rs.10/-, CHC- Rs.8/-, PHC – Rs.6/-
   Normal Deliveries- Rs.250/-
   LSCS- Rs.1000/-
   Casualty- Rs.50/-
 Efficient &      effective    utilization   of   State
  resources
     OPD patients in 2008 were about 1.12 crores &
      the expenditure on drugs was Rs.10 cores
     In 2009 OPD likely to be 1.5 crores & state budget
      allocation is Rs.16 cores
                                                           14
Contd.
 Enhance public confidence in Govt. health
  institutions
 Steep rise in IPD, OPD & increase in
  institutional deliveries
 Zero prescription of propaganda drugs –
  elimination of nexus
 Guaranteed free health care upto district
  hospital level for poor patients
 Free OPD with medicines for all patients
 Highly affordable, hassle-free package
  treatment to indoor patients including
  surgeries
                                          15
Focus on doctors, drugs & deliverables
 Recruitment of Doctors taken out of purview of State
    Public Service Commission
   Web enabled rolling system of recruitment of doctors
    since November 2008
   Applications on continuous basis
   Interview on 10th of every month (even if it is a holiday)
   Immediate appointments         –    pre verification of
    antecedents waived off
   Merit based criteria and transparency
   1300 doctors have been recruited out of which 650
    are specialists and more than 500 are LMOs
   Doctors from neighboring states are joining Haryana
    because of hassle free appointment, attractive
    emoluments, conducive working conditions
                                                           16
Deliverables
 An intensive monitoring system introduced
 Performance of specialists in district
  hospitals is reviewed every month against
  minimum performance bench marks
 Quick follow up actions in respect of poor
  performer
 Performance benchmarks for CHC and
  PHC fixed


                                               17
Thank You

            18

				
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posted:11/20/2012
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