Access to medicine and impending issues for Indian population at large

The Covid-19 crisis has shown the unpreparedness of Indian healthcare systems to tackle a public health disaster. It was reflected in the lack of availability of medicines, access to healthcare and treatment facilities, and even shortage of functional ambulances.

The availability of essential medicines has been a topic of discussion for a long time in our country. Medicine is a key prerequisite in fighting diseases since time immemorial for any sensitive nation-state for the improvement of citizens' health. A health system can be built up perfectly by the provision of medications to its citizens as a continuum of care. With the advent of modern medical technology, the countries work hard for innovation and the discovery of new drugs can help their citizens live longer along with immense productivity in the economic system.

The disease mortality and morbidity can be reduced with good access to medicines by reducing overall suffering among millions. Access to medicine is a concept explaining the continuous supply of affordable medications within an hour from the home of a patient irrespective of private or public facilities.

Literature across the countries reveals that almost half of the patients lack access to medicines across globe, which is a matter of grave concern for the sensitive and functional institutions. Essential medicines also have the feature of satisfying the priority health care needs of a given community. At the time of preparing a list of essential medicines in a country, some of the public health concepts were taken into consideration to address the immediate issues. The factors like disease prevalence in the country, public health emergencies, safety features, nature of efficacy of the medication, and cost-effectiveness play an important role in the process of preparing an effective and workable list of essential medicines.

The share of medicines in Out of Pocket (OOP) Expenditure was around 51% in 2013-14. A decline of 8% was seen in 2015-16, however, it still remained the major contributor to the OOP for households in India. Furthermore, out of the total pharmaceutical cost, 18% is spent on in-house treatment, whereas 82% on out-patient care. These costs show the importance of the availability of affordable medicines at all times.

World Health Organization (WHO) also provides a model list of essential medicines to be used by the countries for the maintenance of the health of their citizen. Defining essential medicines, WHO writes that “Essential medicines are those that satisfy the priority health care needs of a population in a given geography. They are selected with due regard to disease prevalence and public health relevance, evidence of efficacy and safety and comparative cost-effectiveness.” These medicines should be available in functional health systems at all times, in appropriate dosage forms, of assured quality, and at prices, individuals and health systems can afford. The WHO Model list of essential medicines and model list of essential medicines for children are updated and published every two years.

Many countries repurpose according to their need and prepare their own list of essential medicines. India has its own National List of Essential Medicines (NLEM) declared by the Ministry of Health and Family Welfare. The list is increasing from its inception with 279 medicines in 1996 to 354 in 2003 and revised to 348 in 2011. However, the politics of inclusion and exclusion of drugs from essential medicines has been a regular activity with pharmaceuticals lobby many a time found to be overpowering the public health concerns of the population.

The fixing of the price ceiling on medicines could save $1.80 billion in a year for the public based on the NLEM list as an effort by the government. But in reality, the pharmaceutical companies and industry stakeholders work for their benefit. The government through its wings has to protect the people by providing low-cost essential medicines. It was found that there is a massive difference between costs of production and current prices pertaining to NLEM. This has been bridged by the competent authorities and governments from time to time. Overall, the prices have gone up across drug portfolios in India despite the price regulator being heavily monitored by the government of India.

The current government has started Jan Aushadhi Kendras where several, not all, essential medicines are available at a cheaper cost than the private pharmacies. Take for example, a 10-15 tablets pack of paracetamol can cost between Rs. 15-20 in any pharmacy, however the same is available for Rs. 6-7 in these centers run by the government. It is yet to be seen what percentage of population has knowledge of such centers, and how many of them go there for buying medicines.

The people of India especially those suffering from communicable diseases have every right to access to essential medications by any means. Government must come as a savior through different schemes and opening chemists’ shops and reviving the government supply for the vulnerable communities.

The disease burden of India is also increasing due to lifestyle and environmental factors with diseases such as cancer, coronary artery diseases, obesity, and old age issues irrespective of rural and urban areas. Affordable medicines reduce the burden on households, easy accessibility decreases the dependence on expensive alternatives, and good quality medicine is essential for treatment to be effective.

Hence the political will to increase the access to essential medications has to be there. Further, in an emergency situation such as Covid 19, the system has to be fully handled with contingency plans to save millions. The supply of medicines and corruption are common issues that hamper the common man's reach to essential medicines in many states of India. The corruption and mis-governance/not-enough-governance have to be firmly dealt with to save the vulnerable citizens. Overall, the government agencies and industry stakeholders have to understand and act upon the functionality of the National List of Essential Medicines in India for the welfare of suffering millions.

(Ashish Kumar Singh is a doctoral candidate of political science at the NRU-HSE, Moscow, Russia. Dr Ranjit Kumar Dehury teaches at the University of Hyderabad, Telangana in the area of healthcare management)