Adopt Tamil Nadu Model - Medicine Procurement

Adopt Tamil Nadu Model - Medicine Procurement

Greetings,

Respected Sir



The decision of the Maharashtra government to employ e-tender system for procurement of generic medicines for the government health facilities is a step forward. But it is too inadequate. The real need is to adopt fully the renowned, successful, tried and tested ‘Tamil Nadu model’ for procurement and distribution of medicines, which is in place since 1995. In TN, all indoor, outdoor patients in govt. health facilities get all medicines free and hence now 40% of patients seek care in these centres. The per capita government expenditure on medicines in Maharashtra and Tamil Nadu is – Rs. 20 and Rs. 29 respectively. However despite five years of NRHM, Maharashtra’s performance about supply of medicines to patients is not even one third of TN!!



Tamil Nadu State Government set up the Tamil Nadu Medical Services Corporation (TNMSC) in 1994 to be the sole purchaser and distributor of drugs to government medical institutions in the state, in an effort to make significant cost-savings and ensure a regular supply of quality drugs to its health facilities. Items available from TNMSC are listed in a booklet and follow an Essential Drugs List, based on the World Health Organisation model, which is distributed to all doctors, nurses, pharmacists and to post graduate institutions. The items are available from a warehouse designated for each district. In addition, doctors hold an emergency fund to purchase other drugs. The institution is given a pass book which details the funds it is allowed to spend that year on medicines and surgical items, based on the previous year’s outpatient and inpatient attendance and also the number of surgeries performed. If they need additional supplies, additional funds can be requested from TNMSC.



The success of the TN procurement system has not been merely due to e-tendering but also due to other main factors like Full professional autonomy to the Tamil Nadu Medical Service Corporation (TNMSC) which is full transparent in it’s procurement and distribution system. Procurement from a limited list of medicines (260 Essential Medicines and 200 other ‘Speciality Medicine’ (compared to a big list of 1800 medicines in Maharashtra)

In Maharashtra, mainly e-tendering will be adopted. This is proposed to be done by a set of officials from various departments (who will not be able to give time and justice for this work which requires professional devotion). The Committee for selecting medicines for procurement of medicines would include five-six private practitioners also. (two each from ‘renowned’ private hospitals and from Maharashtra Medical Council, and two ‘experts’). Why should so many private sector doctors be on this Committee? Why renowned civil society health groups, who have no conflict of interest, not represented in this Committee?

There is a demand-responsive system of medicine distribution in TN. For example each PHC can choose the medicines and their quantity as per need within the budget of Rs. 1 lakh by using a ‘passbook’ in which entries are made as medicines are lifted by the PHC from the stock. On the contrary in Maharashtra, PHCs are supplied medicines irrespective of their needs. This supply driven system leads to unused stocks of some medicines in some PHCs and their shortage in other PHCs. This will continue even now. Moreover, now, in the new system of distribution that is being planned, private contractors would supply medicines from regional warehouses to PHCs. This experiment of privatization is likely fail or run into problems and hence the chronic gross shortage of medicines in PHCs, Rural Hospitals is likely to continue.. When Kerala has adopted it and other states like Rajasthan, Bihar are in the process, why Maharashtra is indulging in experiments? The system for procurement and distribution of medicines in Maharashtra requires complete overhaul and not half baked, ill conceived experiments.



WE DEMAND -



Maharashtra should fully adopt the tried and tested, renowned system of medicine procurement and distribution in Tamil Nadu N (with minor modifications if needed)





Sincerely



Ms Kamayani Bali Mahabal and Mr Ram Adsule



Convenors-Jan Swasthya Abhiyan Mumbai



Dr Anant Phadke- Convenor, Jan Aarogya Abhiyan- Maharashtra

Sincerely,

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