Millions of Indians choose not to get medical treatment when ill because they cannot afford it. Read more http://bit.ly/1o9d5HP
Last year, 18-year-old Nabina Bagartee, who lives in village Bagdungari of Junagarh block in Kalahandi district of Odisha, developed a high fever and fainted. Unsure of the treatment their daughter would get at the Community Health Centre (CHC) at Junagarh, the parents took her directly to the District Hospital in Bhawanipatna. Nabina, diagnosed with both jaundice and sickle cell anaemia, was admitted in the hospital, where she stayed for five days.
Nabina’s family spent Rs. 12,000 on her treatment, of which nearly half was spent on medicines, two units of blood and diagnostic tests. The rest was spent on indirect costs such as stay, food, and transportation. Although Nabina got nearly 60 percent of the prescribed medicines free of cost at the hospital, the out-of-pocket expenditure that the family incurred forced them to borrow money on interest. They are now struggling to pay it back.
Nabina’s family is one of many that sink into debt due to unaffordable healthcare costs. Public health spending in India is among the lowest in the world – no more than 1.2 percent of GDP. The unavailability of medicines in government health facilities, preference for relatively expensive branded medicines over generic ones, irrational prescription of medicines, collusion between pharmaceutical companies and medical practitioners, and inadequate control over drug prices have resulted in extremely high out-of-pocket expenditure on healthcare in the country. As many as 23 percent of Indians forgo treatment when sick because they cannot afford it.
A potential measure to correct this inequality is to ensure access to free basic medicines. States such as Tamil Nadu and Rajasthan have implemented programmes to offer free medicines at public health facilities, and have been successful in strengthening the public health system through them.
Since the provision was made in Rajasthan in 2011, there has been a 60 percent increase in utilisation of public health facilities. Rajasthan spends only about Rs. 300 crore a year to provide over 600 essential and speciality medicines to address health needs at various levels. Rajasthan has developed an efficient system of procurement of generic medicines through an autonomous medical services corporation set up for the specific purpose. As a result, the State Medical Services Corporations are able to buy medicines at costs that are 40-4000 percent lower than the retail prices, and provide them to the patients free of cost.
Oxfam India recommends the following measures to improve public health and offer access to medicines.
- A universally applicable free medicines scheme with clear protocols and standard operating procedures based on the Rajasthan model.
- A comprehensive list of essential medicines that has a suitable mix of medicines to take care of common illness and those specific to each state’s context.
- A corporation at the state level to procure, supply and distribute medicines and other supplies to all facilities in the state.
- Infrastructure such as district warehouses, and adequate staffing.
- The use of software like e-Aushadhi for proper and timely management of stocks to be procured and distributed.
- Regular audits through carbon copies of prescriptions
Written By: Oxfam India staff
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