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Jan Swasthya Abhiyan and Jan Arogya Abhiyan say state requires transparent, professional body like the Tamil Nadu Medical Services Corporation which is demand-responsive and not supply-based
The Maharashtra government's decision to introduce the e-tender system to procure medicines for state public health institutions has been appreciated by some public interest groups. But they feel it is inadequate and that the state government should adopt the 'Tamil Nadu model' that has been successful over the past one and a half decade.
Jan Swasthya Abhiyan and Jan Arogya Abhiyan, both working towards better and more affordable health care for disadvantaged people, have in an online petition to chief minister Prithviraj Chavan and health minister Suresh Shetty, said that in Tamil Nadu, all indoor and outdoor patients in government health facilities get medicines free and as a result about 40% of patients in the state seek care at these centres.
However, after five years of the National Rural Health Mission (NRHM) in Maharashtra, the supply of medicines to people in the state has not been even one-third that of Tamil Nadu.
The per capita government expenditure on medicines in Tamil Nadu is Rs29 as compared with Rs20 in Maharashtra, they have pointed out.
Last week, the Maharashtra state cabinet approved the e-tendering system for procurement of medicines, putting an end to the decade-old rate-contract system. The government has explained that aside from curbing corruption, the new system would help to get better quality medicines and at a cheaper rate.
Previously, purchasing medicines for state-run institutions was the responsibility of the Directorate of Medical Education and Research. The state buys about Rs300 crore worth of medicines annually, Rs75 crore of this for hospitals attached to medical colleges.
In Tamil Nadu, the state government set up the Tamil Nadu Medical Services Corporation (TNMSC) in 1994 as the sole purchaser and distributor of drugs to government medical institutions, with the aim of reducing the cost and ensuring regular supply of quality drugs to health facilities.
The items available from the TNMSC are listed in a booklet which contains an essential drugs list, based on the guidelines of the World Health Organisation, and is available with doctors, nurses and pharmacists, as well as post-graduate institutions.
These items are available from a warehouse designated for each district. In addition, doctors have an emergency fund to purchase other drugs. The institution is given a passbook which details the funds it is allowed to spend on medicines and surgical items, based on the previous year's outpatient and inpatient attendance and the number of surgeries performed. Additional supplies or additional funds can be requested from the TNMSC.
Kamayani Bali Mahabal and Ram Adsule, convenors of Jan Swasthya Abhiyan, and Dr Anant Phadke, convenor of Jan Aarogya Abhiyan believe that the success of the system in Tamil Nadu has not been merely due to e-tendering, but also other factors like the complete professional autonomy to the TNMSC which maintains transparency in procurement and distribution.
They said that the e-tendering adopted in Maharashtra is proposed to be done by a set of officials from various departments who will not be able to give enough time and justice to this work which requires professional devotion. The committee which will select the medicines to be procured will include five or six private practitioners, two each from renowned private hospitals and from the Maharashtra Medical Council, and two experts. They have questioned why so many private sector doctors are on the committee, but no renowned civil society health groups with any conflict of interest are represented in this committee.
The letter further explains that the distribution system in Tamil Nadu is demand-responsive. For example, each primary health centre (PHC) can choose the medicines and the quantity according to their need within the budget of Rs1 lakh by using the passbook in which entries are made as medicines are lifted from the stock. However, in Maharashtra the PHCs are supplied medicines irrespective of their needs. This leads to unused stocks of some medicines in some PHCs and shortage at other PHCs.
What is probably worse, according to a new system of distribution being planned, private contractors would supply medicines from regional warehouses to PHCs. But this privatisation experiment would likely fail, or run into problems and result in chronic shortage of medicines at PHCs and rural hospitals.
The health activists wondered why Maharashtra was seeking to experiment with a new system when the Tamil Nadu model was working successfully also in Kerala and is being adopted also in Rajasthan and Bihar. They said that half-baked, ill-conceived experiments would only be harmful and that the system of procurement and distribution of medicines in Maharashtra required nothing less than a complete overhaul.