Past Scenario

1. Presentation onRational Drug Provision and UseA Haryana State Initiative launched on 1st January 2009

2. Past Scenario • No policy articulation on Drug entitlement – who would get? at what cost? • Almost all OPD medicines were purchased by patients • Indoor and Emergency supplies were thin and erratic • Patients were purchasing some medicines and consumable even for institutional deliveries and EmOC services

3. Contd. • Prescription of propaganda drugs was rampant • Injudicious prescription of excessive and high cost drugs was common • Out of pocket expenses by patients were very high • Nexus between Chemists and Pharma companies was flourishing at patients’ cost • Quality of medical care was compromised resulting in erosion of credibility of Public Health Institutions • OPD & IPD patients were declining- in some districts bed occupancy was as low as 30-35%

4. Contd. • Govt. spent more than Rs.10 crores annually on procurement of drugs • Procurement was centralized, not in sync with requirements • Drugs being out of stock or overstocked was common • There were instances of expiry, pilferage etc • Doctors were reluctant to prescribe drugs available under Govt. supply • There was also concern about quality of drugs

5. Addressing the Challenges • A clear policy on entitlement put in place • Decision taken to provide free drugs to all OPD patients, casualty cases and institutional deliveries including LSCS • Surgical and non-surgical package system introduced for IPD patients • BPL patients and residents of urban slums entitled for completely free indoor treatment including surgeries and implants, others pay a nominal, fixed charge

6. Fixed Cost Surgery Package Launched in all District Hospitals w.e.f. July 1, 2009 Free surgery / IPD for BPL and residents of urban slums All obstetrics cases, eye surgeries, cleft lip/palate are free for all patients Very nominal charges for others All pre-operative investigations, medicines, consumables, blood charges, post-operative medicines covered Cost effective and hassle free, no running around for medicines/tests

7. Process • Comprehensive Essential Drug List (EDL) prepared for DH, CHCs & PHCs • EDL contains 328 essential drugs for DHs, 112 items for CHCs & 84 items for PHCs • EDL prepared in consultation with specialists • Dynamic & modifiable as per need

8. Procurement Reforms • New Drug Procurement Policy put in place • Policy weeds out Sub Standard Pharma Companies • WHO- GMP Certification, annual turnover of Rs.35 crores for last three years amongst qualifying criteria • About 110 reputed Pharma companies eligible to compete in State RCs • Procurement strictly based on Indian and British Pharmacopoeia

9. Broadening of Supply Sources • Multiple sources approved for supply to avoid disruption and maintain supply chain • Purchase preference is given to 5 CPSUs for 102 Essential medicines • State RCs finalized at highly competitive rates. • DGS&D and ESIC rate contracts also declared as approved sources • Competitive rates negotiated for local purchases in emergency

10. Decentralization of Procurement • Procurement completely decentralized • Broad based District Procurement Committee constituted to indent and procure • Specialists are empowered to indent medicines as per need and are part of procurement committee • Procurement done on quarterly basis

11. Contd. • Special powers given to District Hospitals for procurement under SPP and National Programme • RKS of District Hospitals manages receipts and expenditures • Imprest money given to each surgical specialist for exigencies • Local purchase policy articulated unambiguously • Hospital cost protocol standardized for each surgery

12. Headquarters' Role • Headquarters' Role clearly delineated • Prepare and review essential drug list • Determine source of supply • Ensure timely release of adequate funds to District Health Societies • Monitor consumption on weekly basis • Mentor districts for smooth procurement

13. Monitoring & Review Weekly monitoring of per capita cost of drugs separately for OPD & IPD, Casualty & Institutional Deliveries (facility-wise) Variance analysis is done Prescription audit carried out where cost deviates Comprehensive software to monitor indent, issue, consumption, cost, reorder level and inventory Nodal Officer appointed for each District for monitoring

14. Outcomes • Highly affordable per capita expenditure on drugs • OPD- DH-Rs.10/-, CHC- Rs.8/-, PHC – Rs.6/- • Normal Deliveries- Rs.250/- • LSCS- Rs.1000/- • Casualty- Rs.50/- • Efficient & effective utilization of State resources • OPD patients in 2008 were about 1.12 crores & the expenditure on drugs was Rs.10 cores • In 2009 OPD likely to be 1.5 crores & state budget allocation is Rs.16 cores

15. Contd. • Enhance public confidence in Govt. health institutions • Steep rise in IPD, OPD & increase in institutional deliveries • Zero prescription of propaganda drugs – elimination of nexus • Guaranteed free health care upto district hospital level for poor patients • Free OPD with medicines for all patients • Highly affordable, hassle-free package treatment to indoor patients including surgeries

16. Focus on doctors, drugs & deliverables • Recruitment of Doctors taken out of purview of State Public Service Commission • Web enabled rolling system of recruitment of doctors since November 2008 • Applications on continuous basis • Interview on 10th of every month (even if it is a holiday) • Immediate appointments – pre verification of antecedents waived off • Merit based criteria and transparency • 1300 doctors have been recruited out of which 650 are specialists and more than 500 are LMOs • Doctors from neighboring states are joining Haryana because of hassle free appointment, attractive emoluments, conducive working conditions

17. Deliverables • An intensive monitoring system introduced • Performance of specialists in district hospitals is reviewed every month against minimum performance bench marks • Quick follow up actions in respect of poor performer • Performance benchmarks for CHC and PHC fixed

18. Thank You