ROSENBERG DIALOG SERIES
Access to pharmaceutical products and
services for underserved populations:
Public and Private sector roles in India
Siva Prasada Reddy M. V.
Taastrup Pharmacy, Denmark
31 March 2012
Healthcare system in India
• Healthcare is provided by both private and public sectors
• Center’s (Federal) responsibility to establish healthcare
institutions accessible to all sections of the population
• Treatment facilities provided by the Government through
primary, secondary or tertiary levels of state healthcare
institutions
• In Central (Federal) and State Governments setups, medicines
are supplied free of cost or against token payment to the
weaker sections
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Healthcare statistics in India
• Expected GDP growth rates of around 10%, as against the
figures of 7.9% from 2000 – 2008
• Total expenditure on health is one of the highest in the world –
84% as compared to just 16% public expenditure
• The share of drugs in total outpatient treatment is 83% in rural
and 77% in urban areas
• The share of drugs in total inpatient treatment is 56% in rural
and 47% in urban areas
• Share of drug in health budget in central govt. is around 12 %
• States ranging from 15% (southern) and less than 5% (Assam,
Bihar, UP, Orissa)Q
• Government committed to increase spending on public health
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from less than 1% to 3% of GDP
INDIA VISION 2020
“…improving access to health services to meet the health care
needs…” - Planning Commission of India
DOMINANT POLICIES OF HEALTH CARE
National Health Policy “…an acceptable standard of good health
amongst the general population of the country …”
National Pharmaceuticals Policy: “…making available good
quality medicines at reasonable prices….”
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INDIAN PHARMA INDUSTRY
• Indian pharma market ca. 20 bn. USD and expected to expand
to 40b USD by 2015, with projected exports of 8.2b USD
• Over 20,000 manufacturers, but only 250 are in “organized”
sector, and account for 70% of total country's output
• India exports medicine to over 200 countries and also boasts
of having the largest USFDA approved facilities outside USA
• India is the 4th largest manufacturer of pharmaceuticals in the
global market in terms of volume of sales. 14th globally in
terms of value.
• 85% of drugs in India were sold through retail outlets and
institutional sales account for 15%
• India has one the lowest medicines prices in the world
Deployment of pharmacists
Untapped potential


Retail + Wholesale Outlets
Pharmacists registered
Probotation off. In
banks
0.25%
Appraisers & DRA
0.25%
Higher Studies
7.63%
ca. 600,000
ca. 700,000
Mfg.
7.63%
• Density of health care workers
in India is a little over 8 per
10,000 population
Mktg.
5%0
Analytical Chem.
1.27%
Teaching
1.27%
Hospital Pharmacy
26%
Of total health workers:
• Allopathic physicians 31%
• Nurses and midwives 30%
• Traditional medicine
practitioners 9%
• Pharmacists 11%
By 2020, the demand of
pharmacists and pharmaceutical
scientists is expected to grow from
700,000 to almost 1.5 million
Retail Pharmacy
51.08%
Every year nearly:
• 20,000 D. Pharm. (2 years),
• 30,000 B. Pharm. (4 years),
• 6000 M. Pharm., and
• 700 Pharm. D (6 years). students
graduate in the country.
Pharmacy Practice Issues
• Insufficient data on distribution of
pharmacists in urban, rural and
backward areas
• No
Continuing
Professional
Development
(CPD)
and
Continuing Education (CE) program
• Migration of pharmacists
Pharmacy Practice Issues
• Historically, pharmacists have not found mention in government's
health and pharmaceutical policies, perhaps due to lack of clarity of
their role and their potential beyond supply of pharmaceutical
products.
• The service levels of patient care require substantial improvement.
• The curriculum needs a change as the current curriculum is not
patient oriented, but has a strong bias towards industry. The ideal
would be to upgrade minimum qualification for registration as
pharmacist to a level capable of developing countries (e.g. USA).
LARGE PRESENCE
NO RECOGNITION!
Policy makers should view pharmacies as part of the
health care sector and pharmacists as health care
professionals providing health care services and focus
on them as they do with other health care professionals
Pharmacists Remuneration
• Many retail outlets/PHCs do not have pharmacist employed and
many pharmacy owners do not see need for it
• Pharmacists’ remuneration does not reimburse pharmacist cost
• Pharmacist’s salary most lucrative in Industry and Teaching.
Salaries in hospital and retail pharmacy outlets are sub-minimal
• Retail pharmacy owners consider costs of hiring pharmacists
very high
Pharmacist initiatives to improve
Pharmaceutical Services
• GPP was introduced in the country in 2002, and there is awareness about
the same across the country
• Various associations are involved in providing continuing professional
development to pharmacists from time-to-time
• Many pharmacy colleges in South India started Masters in Pharmacy
Practice Program following the recommendations of the Mysore
Declaration
• To strengthen pharmacy practice in India, in 2008, PCI started the 6 year
Pharm. D. including 3 year post baccalaureate program for the pharmacy
graduates. These pharmacists are trained to offer pharmaceutical care
services to patients both in hospital and community pharmacies.
• 50 drug information centers functioning across the country
• In 2005, Government of India started the pharmacovigilance program
Pharmacist initiatives to improve
Access to Medicines in India
• India’s flagship National Rural Health Mission (NRHM), one of the biggest
interventions of its kind in the health sector in the world and is expected to cover
more than 600 million people, especially women and children in rural areas.
• In spite of the low cost of medicines, they (medicine) account for up to 50-80% of
healthcare costs in India. There is this pressing need to improve access to quality
medicines & make them more affordable to the masses.
• To bring all 354 drugs named in the National List of Essential Medicines (NLEM)
under price cap.
• The government has initiated a host of programs including setting up of generic
stores (Jan Aushadhi) that would provide generic unbranded medicines.
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NATIONAL HEALTH PROGRAMME
RNTCP
•
•
•
•
Increase access at community level
Improve quality of DOTS in the private sector
Establish pharmacies as key stakeholders
Promote IEC (Info. Edu. Comm.) on TB and DOTS through
private pharmacies
• Deploy Pharmacists and pharmacy students
DOTS: Directly Observed, Short Course
PHARMACISTS as part of
RNTCP
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DOTS: Directly Observed, Short Course
NATIONAL HEALTH PROGRAMME
ROLLBACK MALARIA
• Improved and prompt access to effective treatment
• Early detection of and response to malaria epidemics
• Malaria Fact Cards for use in urban areas
• Flip Charts or Pictograms for use in rural areas
NATIONAL HEALTH PROGRAMME
FAMILY PLANNING
• Displaying contraceptives at prominent place in pharmacy with
appropriate signage
• Distributing literature freely
• Being counsellors next door
• Spreading the message of small family norm and its
advantages
NATIONAL HEALTH PROGRAMME
HIV/AIDS
• Blood safety
• Condom Programming
• IEC and Social mobilization
• Care, support and treatment of people living with HIV/AIDS
• Training on HIV/AIDS/STD prevention and control
• Prevent of HIV from Mother to Child
• Integrated Counselling and Testing
PHARMACOVIGILANCE
National Centre
CDSCO
National Pharmacovigilance
Advisory Committee
2 Zonal Centers
5 Regional Centers
N
N
N
N
N
E
E
E
E
E
S
S
S
S
S
W
W
W
W
W
24 Peripheral centers
National Pharmacovigilance Programme
0.074 % (8 out of 10,743 samples)
0.046 % (11 out of 24,136 samples)
National Medical Insurance Schemes
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Thank you