IMPACT OF DRUG POLICY ON IMPROVING ACCESS TO MEDICINES IN DELHI

1. IMPACT OF DRUG POLICY ON IMPROVING ACCESS TO MEDICINES IN DELHI Nilakantha Bhoi, JS Bapna, R Roychaudhury, Naresh Khanna, Uma Tekur Delhi Society for Promotion of Rational Use of Drugs (DSPRUD), Delhi & Indian Institute of Health Management Research (IIHMR), Jaipur

2. Author Name: Nilakantha BhoiEmail: nilakanthabhoi@rediffmail.com Abstract ID: 126 IMPACT OF DRUG POLICY IN IMPROVING ACCESS TO MEDICINES IN DELHI Bhoi NK, Roy Chaudhury R, Bapna JS, Tekur U, Khanna N Delhi Society for Promotion of Rational Use of Drugs (DSPRUD), Delhi, and Indian Institute of Health Management Research (IIHMR), Jaipur, India Problem Statement: In 1994, when efforts for developing a drug policy were made, in spite of spending a huge amount of money, the situation regarding availability and use of medicines in Delhi government hospitals was poor. Most of the prescribed drugs expected to be given free of cost to the patients were not available at the hospital pharmacy. Unneeded medicines such as drug combinations, herbal medicines, and tonics were stocked in the stores. At this time the Delhi Society for Promotion of Rational Use of Drugs (DSPRUD), a Non-Governmental Organization (NGO) consisting of government and non-government members, was formed to improve the situation. This group assisted the government in framing the drug policy and its implementation through support from WHO. Objectives: To assess the impact of the drug policy in Delhi in terms of availability of essential medicines, change in stock out days and expenditure on essential and non essential drugs. Design: Retrospective data were collected through record reviews. The data for two years before (1993-1994, 1994-1995) and two years after (2000-2001, 2001-2002) the drug policy were assessed. Setting and Population: Two public sector hospitals at Delhi that serve a large section of the population, one with 1350 beds (large) and the other with 550 beds (medium), were selected by convenient purposive sampling method. Intervention: Implementation of elements of the drug policy such as selection of essential drugs and an improved procurement system on access to medicines. Outcome Measures: The amount of drugs procured from the Essential Drugs List (EDL) and outside the EDL; money spent on these; and changes in stock out days for the key drugs. Results: After the implementation of the drug policy, the availability of total number of drugs increased by 25% in the large and 98% in the medium hospital. The drugs procured from the EDL increased from 62% to 78% in the large and 74% to 87% in the medium hospital. Of the total expenditure, the money spent on essential drugs increased from 73% to 85% in the large and 87% to 93% in the medium hospital, whereas money spent on nonessential drugs decreased from 27% to 15% in the large and 13% to 7% in the medium hospital. The average number of stock out days for key dugs decreased from 33 to 16 days in the large and from 143 days to 33 days in the medium hospital. Conclusions: The implementation of the drug policy in the state of Delhi has lead to an increased availability of essential rugs. This type of intervention can serve as a model for improving access to medicines by implementing an effective drug policy through an NGO working with the government and involving bureaucratic and political commitment. Study funded by: : Delhi Society for Promotion of Rational Use of Drugs , Delhi . Study Funding: Delhi Society for Promotion of Rational Use of Drugs (DSPRUD), Delhi

3. Introduction • Before Implementation of Drug Policy in Delhi, the situation regarding availability and use of medicines in Delhi Government hospitals was poor. • Unnecessary medicines stocked in large amounts and needed medicines were not available • Intervention of Delhi Society for Promotion of Rational Use of Drugs (DSPRUD), improved the situation. • This is an example of an NGO assisting the government for development and implementation of its drug policy.

4. Objective To assess the impact of the drug policy in Delhi in terms of • availability of essential medicines • change in stock out days and • expenditure on essential and non essential drugs.

5. Methods Study Design • Descriptive and comparative analytical study • Retrospective data collected for two successive years at Govt. hospitals through assessment of records i.e, • before Policy- 1993, 1994 and • after Policy - 2000, 2001 Sampling- Convenient and purposive Setting and Population-Two public sector hospitals at Delhi

6. Methods…….contd. Intervention Implementation of elements of the drug policy such as • Selection of essential drugs and • An improved pooled procurement system Outcome Measures • Amount of drugs procured from the Essential Drugs List (EDL) and outside the EDL • Money spent on these and • Changes in stock out days for the key drugs.

7. Availability of Drugs at Large Hospital After Policy Before Policy Total number of drugs-25% EDL drug-57% Non EDL drugs-28% (Increased from 62% -78%)

8. Availability of Drugs at Medium Hospital Before Policy After Policy Total number of drugs- 98% EDL drugs-133% (Increased from74%- 87%) Non EDL drugs- 2.7%

9. Twelve percent (12%) increase in funds utilized for Essential Drugs in Large Hospital

10. Five percent (5%) increase in funds utilized on Essential Drugs in Medium Hospital

11. Change in average stock outs days – Large Hospital After Policy Before Policy * Stock outs days in decreasing trends

12. Before Policy After Policy Change in average stock outs days – Medium Hospital * Stock outs days in decreasing trends

13. Conclusion…… • Through proper selection of essential drugs funds utilized more judiciously • Costs contained with pooled procurement • Judicious use of funds increased availability of essential drugs • Stock outs of key drugs decreased