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 India - Country Assessment
The state of Rajasthan's pharmaceutical system is complex, with numerous public and private providers located in urban areas, but minimal access in more rural parts of the state. The SEAM assessment found that financing of public-sector facilities is insufficient, resulting in irregular supplies.
Although the Ministry of Health has created a program to provide free drugs to below-poverty-line patients, who are approximately 20 percent of the population, many of them do not have functional access to essential medicines. This lack of access stems in part from the fact that 45 percent of the population lives more than 10 kilometers from a primary health care facility, and 54.8 percent lives at least that far from a hospital, public or private. While there are more than 13,000 pharmacies in Rajasthan, most are concentrated in urban areas and near hospitals, and as late as 1991, only 42 percent of the 38,000 inhabited villages were connected by roads. In the private sector, medicinal products are widely available and appear to be less expensive than in other areas of the region. From a public health standpoint, medicines of choice are not always stocked or prescribed, and excessive or inappropriate prescribing makes drug therapy unaffordable to a large segment of the population. Many consumers enter into debt in order to pay for drugs or may not get needed medicines at all. In Rajasthan, 71 percent of health care expenditures are out-of-pocket. Only some 12 percent of patients are covered by a private risk-sharing or prepayment scheme. Assuring product quality in a country with more than 20,000 manufacturers and 60,000 products is daunting. In a state where a difficult climate and poor storage conditions create extremes in temperature, this challenge is exacerbated. In the SEAM study, 10.4 percent of essential medicines samples collected failed assay analyses (6 percent of those obtained from public-sector facilities and 14.1 percent of those obtained from private retail outlets). Targeted testing by the Rajasthan Drug Control Authority has documented substandard drugs in 13 percent to 18 percent of samples tested between 1996 and 2001. Related Information » View Assessment Report (PDF, 292KB) » View Data Tables (PDF, 390KB) |
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The problem is compounded by management problems, including inadequate forecasting and erratic supply cycles. Those most affected are low-income patients, who are forced to purchase medicines in the private sector when medicines are not available in the public sector.