Free medicines as a mission

The Centre's move to introduce an experimental universal health package in at least one district per State under the National Rural Health Mission, with access to free generic drugs, is a welcome measure. But the larger mission to provide free essential medicines to all citizens need not await the results of such pilot studies. It should be rolled out for poor and non-poor alike quickly. There is no time to be lost because medicines make up an alarming 71 per cent of all out-of-pocket spending on health. The time for experimental schemes is therefore long past. What is more, efficient models of drug procurement and distribution by State governments involving low costs and improved access are readily available. Tamil Nadu is a leading example, having demonstrated this over the last 15 years. Kerala has replicated it and some other States are in the process of doing so. Clearly, it is feasible to provide carefully chosen essential drugs free, with higher government spending. Some reform is of course needed, and it should include an expanded National Essential Drug List, elimination of irrational drugs from prescriptions, priority for generic medicines and, crucially, a good centralised procurement system. The issues involved have been analysed by the High Level Expert Group (HLEG) of the Planning Commission on Universal Health Coverage. A quarter century of National Sample Survey data from households on availability of free medicines to patients reveals depressing trends. From about 32 per cent of drugs supplied free to in-patients in1986-87, the figure fell to 9 per cent in 2004. Data on free drug supply for all patients indicate weak controls and escalating price pressure from the mid-1990s. This has severely affected affordability and thus access. It is here that the role of government assumes importance. The Tamil Nadu Medical Services Corporation has been able to deliver results because State-level procurement has ensured competitive pricing and control over prescription of irrational medicines. Such a system works better because it meets the key principle of efficient financing, which is pre-payment. Obviously, half-measures will only slow the process down and give room for manoeuvring by special interests. The HLEG has provided two scenarios for partial and full drug security that can be achieved in the dramatic time-frame of two and seven years. Scaling up government spending from about 0.1 per cent of GDP at present to 0.5 per cent is essential to achieving this outcome. The Centre must show the political will necessary. Keywords: universal health package, National Rural Health Mission, free generic drugs, Universal Health Coverage