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Study Assessing Prices, Availability and Affordability of Children's Study assessing prices, availability and affordability of children’s medicine in Chhattisgarh, India Part of the Better Medicine for Children project Authors Dr Antony KR Virendra Jain Puni Kokho Dr Kamlesh Jain The salient findings and views expressed in this report are solely those of the authors. Please direct correspondence to the authors: ([email protected], [email protected] [email protected], [email protected]). This publication does not necessarily represent the decisions or policies of the World Health Organization. ii Contents Acknowledgements ........................................................................................... v Abbreviations ................................................................................................... vi Executive summary ......................................................................................... vii Medicine availability .............................................................................................vii Medicine costs ................................................................................................... viii Affordability of standard treatment regimens ........................................................... ix Price components survey ...................................................................................... ix Conclusion .......................................................................................................... x 1. Introduction .................................................................................................. 1 Objectives of the survey ........................................................................................ 2 The National Rural Health Mission ........................................................................... 2 2. India’s health system: an overview ............................................................... 3 Insurgency .......................................................................................................... 5 Economy ............................................................................................................. 6 Health ................................................................................................................ 7 Pharmaceutical sector ........................................................................................... 7 3. Methodology of the surveys ........................................................................... 8 Sampling and data collection ............................................................................... 10 Medicines surveyed ............................................................................................ 11 Data collection, data entry, and quality assurance ................................................ 13 Survey on price components ................................................................................ 13 4. Results ........................................................................................................ 14 Medicine availability ............................................................................................ 14 Availability of different products surveyed ........................................................... 14 Availability of medicines by therapeutic class ....................................................... 16 Medicine prices .................................................................................................. 22 Public sector procurement prices ....................................................................... 22 Private sector patient prices .............................................................................. 22 Patient prices in other private profit-making medicine outlets ................................ 23 Patient prices of individual medicines ................................................................. 24 Affordability of standard treatment regimens .......................................................... 25 Price components in the private sector .................................................................. 26 5. Conclusion ................................................................................................... 31 Recommendations .............................................................................................. 33 6. References .................................................................................................. 34 Annex 1. Availability of individual medicines ................................................... 35 Annex 2. Ratio of government procurement prices to MSH international reference prices, as median MPR ..................................................................... 39 Annex 3. Ratio of median patient prices to MSH international reference prices, as median MPR ..................................................................... 41 iii iv Acknowledgements This study was the result of the teamwork of many people. The authors would like to thank the Department of Health Services and the Medical College, Raipur, for their consent and support in pursuing this study, as well as the WHO Regional Office for South‐East Asia, New Delhi, for its technical and financial support. Several people provided valuable technical support in the execution of this study: Dr G. Batmanabane and Dr A. Kotwani, Technical Consultants for the Essential Medicines List survey; departmental heads and officials, such as Dr A.T. Dabke, Vice Chancellor, Ayush & Health Science University; Dr S. Agrawal, Head of Pharmacology, JN Medical College, Raipur; and Dr A. Verma, Indian Academy of Paediatrics, Raipur. The authors would like to thank the survey team who diligently procured authentic data from the field, including S. Bafna, S. Siromar, R. Srivas, K. Dewangan, and R.T. Verma. Sincere thanks also to the colleagues of the State Health Resource Centre, Raipur, for their continuous support in times of need. Finally, we are grateful to the Bill and Melinda Gates Foundation for its financial support of this project. v Abbreviations ASHA Accredited Social Health Activist CCDA Chhattisgarh Chemists and Druggists Association CGMSC Chhattisgarh Medical Service Corporation CHC Community health centre DHS Directorate of Health Services DLHS District Level Health Survey EML Essential Medicines List HAI Health Action International IMNCI Integrated Management of Neonatal and Childhood Illnesses MDG Millennium Development Goals MPR Median price ratio MSH Management Sciences for Health MSP Manufacturer’s selling price NGO Nongovernmental organization NRHM National Rural Health Mission ORS Oral rehydration solution PHC Primary health care Rs Rupees SHC Sub health centre SHRC State Health Resource Centre Tab Tablet VAT Value added tax vi Executive summary An estimated 9 million children worldwide die each year from preventable and treatable causes (1). More than half of these deaths are caused by diseases which could be treated with safe, child‐specific medicines. Yet child‐specific medicines are often lacking where they are most needed. This is the case in Chhattisgarh State, India, where conditions such as acute respiratory infections, neonatal sepsis, malaria, measles, tuberculosis, and malnutrition are widespread. For example, two thirds of the children with diarrhoea in the State do not receive oral rehydration solution (ORS) and one third do not receive treatment for acute respiratory infection. Further, 81% of children aged 6 months to three years in the State are anaemic. These conditions can be ameliorated through timely treatment with relatively inexpensive medicines. Focused interventions to improve access to essential medicines for children require baseline data, however: assessing and documenting the gaps in medicine supply and the costs of available medicines to the government and patients. Such a study is part of the Better Medicines for Children project in Chhattisgarh, the overall goal of which is improving the availability and affordability of essential medicines through the development of evidence‐ based policies and programmes. The study was undertaken using a standardized methodology developed by the World Health Organization (WHO) and Health Action International (HAI). Data on the prices and availability of 50 paediatric medicines were collected from a sample of health facilities in the public, private and nongovernmental organization sectors. This included data on government procurement prices and data on the highest‐priced and lowest‐priced products found at each facility. Medicine prices are expressed as median price ratios (MPRs), which are ratios relative to the Management Sciences for Health (MSH) international reference prices for 2009. Using the salary of the lowest‐paid government worker, affordability was calculated as the number of daysʹ wages needed to purchase medicines for standard treatments of common conditions. A price components survey was also conducted to identify the add‐on costs in the supply chain that contribute to final patient prices. Medicine availability The average availability of paediatric medicines was suboptimal in all sectors. In the public sector and NGO/mission sectors average availability was only 17%. In the public sector more than half (29/50) of the study medicines were not available in any of the facilities surveyed. Of the 29 medicines not found in the public sector, several also had poor or no availability in vii the private sector. In retail pharmacies and other private profit‐making
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