For Quality, Essential, Generic Medicines
Chapter 2 Essential Drugs    

The overall conclusions of this study were:

  1) The drug-supply to the public sector in Satara District was a mere Rs. 5.6 million, as compared to the most minimum, reliable estimate of a drug sale of Rs. 212.8 million in the private sector during 1991-92. The drug supply especially to PHC and RHs suffers from chronic gross shortages and haphazardousness.
The overall quality of prescriptions of doctors both in public and private sector is low. There is very high proportion of use of unnecessary, irrational, hazardous drugs and unnecessary injections especially in the private sector. Public sector prescriptions are more rational than private sector prescriptions. Proportion of rational prescriptions increases with educational qualifications.
There is very little of proper Continuing Medical Education (CME) of doctors. This along with the influence of the Medical Representatives, increasing prices drugs and competition amongst doctors, influence the prescriptions of doctors in the private sector, whereas in the public sector, the chronic shortage of drugs affects prescriptions, apart from lack of proper CME.
  4) Knowledge of PHC-nurses about the drugs they use is satisfactory as regards indications and dosage but quite unsatisfactory as regards precautions and side-effects.  

Due to irrational prescribing, 69 per cent and 55 per cent of the money spent on prescriptions in the private and public sector respectively, is a waste, with an average of 63 per cent. Projected to the Satara district level, this wastage amounts to Rs.17.7 crores out of the total drug supply of Rs.22 crores.

  6) Patients visiting government clinics in Satara district have to buy 15 per cent of the drugs prescribed to them, instead of getting all drugs free.  
  7) If all the patients coming to the six PHC under study, were to be adequately and rationally treated, there would be a drug-shortfall of Rs. 30525.92 per PHC. This shortfall can be met by a mere 8.42 per cent increase in the annual recurring expenditure of Rs. 0.363 million per PHC.  
  8) If all the patients in Satara district were to be adequately and rationally treated and if all children and women were to be fully covered in the Mother and Child Health Programme in 1991-92, the drug-expenditure would have been Rs. 20.61 crores, compared to the total drug expenditure of Rs. 21.84 crores in Satara district. It is thus, not lack of resources, but its irrational, wasteful use, which is responsible for the unmet drug needs of the Satara district.  
    The overall drug situation in Satara district is that of 'Poverty Amidst Plenty' - poor drug supply to the public sector, poor quality of prescriptions, a lot of wastage of the adequate drug-expenditure incurred by the people in Satara district.
Source: Phadke et al. (1995)  

Implementation of Essential Drugs Idea in Two States of India

Atleast two states are known to have taken initiative and implemented the essential drugs concept in India: they are Delhi and Tamil Nadu.

Tamil Nadu Initiative in Essential Drugs1

A major Government initiative was to set up Tamil Nadu Medical Services Corporation (TNMSC), a Government company, to provide necessary services to Government hospitals. One of the main objectives of the Corporation is to organise an efficient, centralised drug procurement and distribution system. The Corporation has a Board of Director, with the State's Secretary for Health as an ex-officio Chairman, and a full-time Managing Director.

Promoting the Essential Drugs Concept

Under the previous system, hospitals put in requisitions for drugs and then tenders were invited. It was soon evident that the total of 960 drugs procured in this way could be.