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Troubles beset ‘Jan Aushadhi’ plan to broaden access to generics

In November 2008, the Indian government The Kolkata seminar, which was organized in the Jan Aushadhi program, attendees of the kicked off an ambitious project when it part by an association of sales representatives, seminar recommended a total exemption of opened the first not-for-profit medicine identified other problems as well. “There is taxes and duties on all generic drugs sold in shop, at Amritsar in Punjab, selling only a need for doctors to develop the culture of India. generic drugs, with no branded versions on generic use, which will clash with conflict Chandra Gulhati, editor of Monthly Index the shelves. The opening was part of a grand of interest,” said seminar organizer Amitava of Medical Specialties, an industry watchdog, plan to establish a countrywide chain of such Guha, who heads the federation of medical says the Jan Aushadhi stores represent only ‘Jan Aushadhi’, a Hindi term that translates as representatives. a small step, albeit a welcome one, toward ‘people’s drug stores’. But several speakers at “I have asked all government doctors to improving access to generics. “The stores that a national seminar on pharmaceutical Policy prescribe generics from now onwards,” says are supposed to sell [only generic] medicines held in Kolkata in February said this plan to West Bengal state health minister Surjyakanta are a drop in the ocean, considering that there bring quality medicines at affordable price has Mishra, who spoke at the February conference. are more than 300,000 retail drug outlets in the hit roadblocks. “I hope other states will do so.” To promote country” selling branded drugs. At the recent meeting, a few people went so Killugudi Jayaraman, Bangalore, India far as to speculate that corrupt officials and foreign-owned multinational corporations— whose products account for more than a quarter of India’s 392 billion rupees ($8.7 India moves toward creating a new billion) drug sales by some estimates—are conspiring to scuttle the scheme. “Of course [the cadre of rural doctors multinationals] are trying their best to protect their market share,” Ramesh Jha, spokesman In an effort to get medicines and health care cities and one for villages,” he told Nature for Department of Pharmaceuticals, which to remote regions, India plans to create an Medicine. is implementing the Jan Aushadhi program, army of rural doctors to serve exclusively Prakash says that instituting a one- told Nature Medicine. “But our scheme is on in villages. Some 300 medical schools to year compulsory rural posting for all track.” be specially set up for this purpose will new doctors after they complete their The Jan Aushadhi stores are the brainchild provide high school graduates a three- internships and earn their degrees, of Ram Vilas Paswan, who formerly headed and-a-half year crash course in medicine increasing the number of seats in existing the government ministry that oversees (against the usual five-and-a-half years), medical colleges and additional short-term pharmaceuticals. The plan requires that awarding them Bachelor of Rural Medicine obligatory rural service for all doctors public-sector drug companies supply and Surgery (BRMS) degrees. wishing to serve within government essential low-priced generics on demand to After a short training in district institutes would be a better alternative. the Jan Aushadhi stores planned to open in hospitals, they will be deployed in any “But,” he adds, “the government did not all 612 districts in India. These will be run by of the 145,000 government-run health ask our opinion.”

© 2010 Nature America, Inc. All rights reserved. All rights Inc. America, Nature © 2010 government entities, charitable organizations centers in villages. They cannot practice Killugudi Jayaraman, Bangalore, India or nongovernmental organizations on the in urban areas. principle of generating minimal profits The plan, introduced by the Medical and eventually become self sustaining. “If Council of India in consultation with implemented as planned, this could be a the health ministry, aims to address a Newscom model for the entire developing world,” says shortage of doctors in villages, where 60% Guruprasad Mohanta, a pharmacy professor of Indians live. As Nature Medicine went to at Annamalai University in Chidambaram, press, the cabinet had yet to clear it, but a Tamil Nadu. parliamentary committee on health, after That remains a distant dream, considering a meeting on 18 February, has given its that hardly 40 stores have come up so far—in nod of approval. just four out of 28 states—against the target Health Minister Ghulam Nabi Azad of 275 stores in 12 states by March 2010. Jha says individuals who hold a BRMS degree blames this on a weak drug supply chain. will be an “additional workforce,” and the However, Lalit Jain, vice-chairman of the shortened training will not compromise Small and Medium Enterprises (SME) Pharma health care quality. Industries Confederation, says that companies However, his predecessor, Anbumani exclusively producing generic drugs have had Ramadoss, says that in addition to creating a tough time contributing their discount-rate “a brigade of qualified quacks,” the scheme meds. “Although 175 of our member companies is discriminatory. Dharam Prakash, expressed their willingness to supply the secretary general of the Indian Medical essential drugs and also run the Jan Aushadhi Association, agrees. “We are opposed to Under pressure: India pushes for more stores, [the Department of Pharmaceuticals] creation of two classes of doctors—one for pastoral physicians. does not want us [to],” he says.

350 volume 16 | number 4 | april 2010 nature medicine