Free medicine for all

India’s ambitious policy to provide free medicines to all patients attending a government health facility across the country will be rolled out from October. Strongly backed by Prime Minister Dr Manmohan Singh himself, the free-medicines -for-all scheme — being referred to as the “real game changer” — has received its first financial allocation of Rs 100 crore from the Planning Commission for 2012-13. 
The entire programme, however, is estimated to cost Rs28,560 crore over the 12th  five year plan. At present, the public sector provides healthcare to only 22% of the country’s population. The health ministry estimates that this will increase to 52% by 2017 once medicines are provided for free from 1.6 lakh sub-centres, 23,000 primary health centres, 5,000 community health centres and 640 district hospitals. 
The health ministry has sent the National List of Essential Medicines, 2011, (348 drugs which includes anti-AIDS, analgesics, anti-ulcers, anti psychotic,sedatives, anesthetic agents, lipid lowering agents, steroids and anti platelet drugs) to all the states to use as reference. The states, however, have 
been asked to create their own Essential Drugs List (EDL), keeping in mind the diseases that worst affect them. 
Around 75% of the funds under the scheme will be borne by the Centre, while the rest will be the state’s responsibility. Around 5% of the district funds will be allowed to purchase drugs outside the EDL. The Cabinet has approved the setting up of a Central Procurement Agency (CPA) for bulk procurement of drugs. The PMO has asked the health ministry to set up the CPA as early as possible. At 
present, 78% of the entire health expenditure in India is from out of pocket (OOP). Purchasing drugs alone accounts for 72% of this OOP expenditure.
Additional secretary in the ministry L C Goyal said a scientific committee will have to draw up the EDL list for the states. They have also been asked to devise standard treatment protocols in order to avoid unnecessary and irrational treatments. Goyal said, “The states will procure drugs directly from manufacturer or importer through an open tender. Companies applying for the tenders will have to have GMP compliance certificate, a no conviction certificate and should have a specified annual turnover. The drugs must carry a not-for-sale label printed on the packaging.” Goyal said a district-level state-ofthe-art warehouse will have to be set up by states to store the drugs and a passport-driven system will move the medicines to district hospitals, and CHCs and PHCs will then send the drugs to the sub centres. He added, “It is being made mandatory for all doctors in the public sector to prescribe generic drugs and salt names and not brands. Action will be taken against doctors found prescribing brands.” 
A Planning Commission panel had said around 39 million Indians are pushed to poverty because of ill health every year. Around 30% in rural India didn’t go for any treatment for financial constraints in 2004. In urban areas, 20% of ailments were untreated for financial problems the same year. About 47% and 31% of hospital admissions in rural and urban India, respectively, were financed by loans and sale of assets. States have also cut down on spending to purchase drugs, adding to aam aadmi’s woes. 

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