Prof Ranjit Roy Chaudhury Coordinator INDIA-WHO Essential Drugs Programme

1. Impact of Implementation of the Delhi Drug Policy on Availability, Accessibility, Quality of Drugs and Prescribing Pattern (1995-2002) Prof Ranjit Roy Chaudhury Coordinator INDIA-WHO Essential Drugs Programme Delhi Society for Promotion of Rational Use of Drugs 30th March – 2nd April 2004

2. Profile of health infrastructure in Delhi State • Delhi population (mainly urban) – 17.8 million • Total no. of health facilities: • Teaching hospitals • 3 Super specialty Hospital • 2 Tertiary Hospital • Hospitals with 100-500 beds - 8 • Hospitals with 20- 100 beds -7 • Dispensaries (PHCs) - 158

3. Situation in 1994 • Every hospital had its own list of drugs & purchased its own drugs. • Users had little say in selection of drugs. • Drugs purchased by brand names. • Unnecessary combination drugs and herbal drugs purchased. • Drugs nearing expiry dates supplied • Frequent stock outs of drugs. Stocks sufficient for only 3-4 months in a year.

4. Situation in 1994 • Drugs purchased outside (Local purchase) • Very expensive. • Indeterminate quality. • No System of quality assurance. • No training in rational prescribing. • No Essential Drug List (EDL) /Formulary/Treatment Guidelines. • No monitoring of drug procurement system/impact.

5. Situation in 1997 • All hospitals had one List of Essential Drugs. • Procurement restricted to Essential Drugs List. • 90% of budget spent on Essential Drugs. • All drugs procured centrally from manufacturers in by generic names only by Pooled Procurement System. • No combination drugs procured. • Quality Assurance System set up.

6. Situation in 1997 • Training programmes for prescribers initiated in “Rational prescribing”. • Training programmes for pharmacists initiated in “Good stores management”. Tools produced and distributed: • List of Essential Drugs. • Delhi State Formulary. • Standard Treatment Guidelines. • Monitoring of all programmes.

7. Price line held by pooled procurement system (Rupees) Prices given are per unit

8. Availability of total number of essential medicines - before and after drug policy NA- data before implementation of the Drug Policy not available

9. Average stock-out days before and after Drug Policy Figures in parenthesis denote no. of drugs out of stock

10. Medicines actually dispensed at various level of health facilities – Delhi 2002 Teaching Secondary PHC Percent Health facilities

11. Medicines prescribed from EML – Delhi 2002 PHC Teaching Secondary Percent Health facilities

12. Drug use indicators – tertiary care (LN) hospital

13. Reasons for success • Unwavering Govt support throughout even with change of Government. • Continuous technical support of honorary team of experts. • Leadership of the programme • Support of WHO-EDM • Winning support of doctors

14. Implications • In federal structure programmes initiated in states will succeed better than central programme. • After initial programme on RUD specific programmes to be undertaken. • Private/public partnerships can succeed in this field. • Programmes in private sector have to be planned differently.

15. Specific future studies • Prepare package of essential medicines to be always available for poor. • Plan changes in selection procurement prescribing for delivering the package. • Calculate the cost of delivering this package to all poor. • Assess resources spent today for medicines. • Raise resources to bridge the gap.

16. Acknowledgements • Jeevan Jha • Anita Kotwani • RN Baishya • Abha Dhalla • PD Sheth • KK Sharma • KB Sharma • Raj Gulati • Harsh Vardhan • JS Bapna • R Parameswar • Usha Gupta • PR Pabrai • Uma Tekur • Sangeeta Sharma • Ramesh Chandra Team work • GR Sethi • Gopal K Sachdev