India-WHO Essential Drugs Programme implemented by
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India-WHO Essential Drugs Programme implemented by
Delhi Society for Promotion of Rational Use of Drugs
(1997 - 2002)
Dr Sangeeta Sharma
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Delhi State
• Population – 14 million• Total no. of hospitals beds –
4000• Teaching hospitals – 2• Total number of health centers –
158Drug annual budget – $ 8 million
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Pooled procurement
Quality assurance
STGs Formulary
Essential Medicines List
ResearchMonitoring
UnbiasedInfo
Rational prescribing
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Impact on prices (1):Drugs purchased from essential medicines list, at competitive prices (Rp)Drugs Open
tenderPooled procurement
% cost reduction
Syr amoxycillin 14.65 7.50 50
Tab erythromycin (250 mg)
3.24 1.54 50
Tab atenolol (50mg)
0.42 0.17 60
Inj ranitidine 1.87 1.63 12.50
Inj diazepam 5.53 0.93 80
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Impact on prices (2)Holding the price line
02468
101214161820
1995 1996 1997 1999 2000 2001
Amoxycillin Chloroquine Omeprazole Erythromycin
Pri
ces in
(R
s.)
Years
59%
37%
43%
10%
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Impact on availability in public facilities:Medicines actually dispensed at various level of health facilities (Delhi state, 2002)
0
10
20
30
40
50
60
70
80
90
100
Teaching
Secondary
PHC
Perc
en
t
Health facilities
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Impact on drug quality in public facilities:Results of quality tests (Delhi state)
Total no. of batches tested(July 2000 to October 2001)
2206
Batches not of standard quality
20 (0.91%)
Total expenditure 0.53% of the budget for drugs
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Impact on rational prescribing:Medicines prescribed from EML (Delhi, 2002)
0
10
20
30
40
50
60
70
80
90
100Teaching
Secondary
PHC
Perc
en
t
Health facilities
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Overall impact (Delhi State, 1995-2000):Pooled availability of drugs, percent prescriptions by generics, from EML
0
20
40
60
80
100
120
1995 1997 1999 2000
Availability
Generics
EDL
Perc
en
t
Year under review
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Essential Medicines
List
Pooled procurement
Budget saved
Procured large quantities and more drugs
Enhanced access to drugs
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WHO India Essential Drugs Programme: Expansion of Delhi programme into other states, executed through local NGO
Components• State drug policy
• Essential drugs lists by level of care
• Pooled procurement
• Efficient distribution
• Quality assurance • information patients & prescribers• Training in rational prescribing• Studies on drug use, pharmacoeconomics
13 states - total population580 million
Andhra PradeshAndhra Pradesh
BiharBihar
PunjabPunjab
RajasthanRajasthan
MaharashtraMaharashtra
Delhi StateDelhi StateHaryanaHaryana
Himachal PradeshHimachal Pradesh
West West BengalBengal
Madhya Madhya PradeshPradesh
GoaGoa
Tamil NaduTamil Nadu
GujaratGujarat
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Conclusions• Wise drug selection underlies
all other improvements in public procurement and supply
• Effective management saves money and improves the performance and accessibility
No extra public funds spent other than on GMP inspections