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India's Unique Place In The World
When comparisons of affordability and availability of essential medicines are made, efforts of regulator and industry, place India in a different league from comparable low and middle-income countries. This is because of its ability to produce cheap, high-quality generic medicines. Thus India is known as the pharmacy of the developing world.Another uniqueness with India which has nothing to be proud of is that it does not know how many of its citizens have access to medicines. Measures of affordability and availability of essential drugs are not available from government reports.
National health profile of India, 2018 politely documents "To be determined" against the Sustainable Development Goal (SDG) 3.b.1: "Proportion of the population with access to affordable medicines and vaccines on a sustainable basis". National health policy, 2017 talks about various aspects of the pharmaceutical industry and the provision of essential medicines, but has no mention of plans to measure the number of people with access to affordable essential drugs.
Essential Drugs
Medications are the backbone of the health system and to save lives it is required that the right medicine is produced and supplied at the right place, used in the right patient in the right amount at the right time and all this to be done at an affordable cost. When one talks about health systems, the right medicine often means essential medicines.Essential medicines are those medicines that satisfy the priority health care needs of the population rather than individuals and have the highest evidence on beneficial results, safety, and cost-effectiveness. Not all medicines that are available in a pharmacy are considered as essential, and identification of essential drugs is done by experts considering the scientific evidence. For example, while, there is a large number of pain killers available in the market, but only a handful of them are considered essential, on the other hand almost all anti-bacterial drugs are considered as essential by experts.
An oversimplification, for understanding the essential drug concept could be that these are the drugs needed to treat greater than 80% of problems, of greater than 80% of the population. While the total number of drugs available in the market may be in many thousands, the number of drugs that are considered as essential is only less than a few hundred (less than 400-500 on average). Essential drug lists also vary from place to place and from time to time.
Affordability Of Medicines
The most widely accepted definition of affordability of medicines has been given by Health Action International (HAI), a Non-Government Organization from the Netherlands, and it has been universally used in studies, including those done by World Health Organization (WHO). As per the HAI method, the affordability of medicine is measured by estimating the number of days’ wages needed by the lowest-paid unskilled government worker to purchase the medicine.
A drug is considered affordable if, with only one day's wages, the lowest-paid unskilled government worker can buy one month's supplies of the drug. On the other hand, if it takes more than one day's wages to buy a month's supplies the drug is considered expensive. This is confirmed by surveys using WHO/HAI methodology, where the target to be achieved is 80 % or above to qualify as affordable.
Affordability And Availability Of Essential Medicines In India
With the sustained efforts of the National Pharmaceutical Pricing Authority (NPPA), which has been particularly active in the last few years, and the contribution of the Indian Pharmaceutical Industry, some essential medicines in India, may meet the HAI/WHO definition of affordability. This can be studied further by referring to the compendium of prices available at the NPPA website. But once again, the exact statistics have been not made available.
Therefore, to fill this knowledge gap, researchers have tried to estimate the affordability and availability in recent international as well as Indian surveys conducted on very small samples.
The results of such studies have been mixed in nature.
International studies report data for India much better than many other low/middle-income countries. One of the international studies showed good availability and affordability of anti-diabetic oral tablets but poor affordability of insulin. Another international study showed good availability of drugs for heart patients but poor affordability.
Regional studies have focused mostly on availability.
- A study from Punjab and Haryana showed overall availability of medicines was 45.2 % and 51.1 % respectively.
- A study from Chhattisgarh reported availability around 64.5 %.
- A study from Odisha reported a dismal figure of 21.8 %.
- In a study from Maharashtra of the six essential medicines surveyed only one had high availability, and one had 64.5%, availability, the other medicines were available in less than half the pharmacies studied.
Way Forward
We need better official reporting and household surveys to know the exact status of drug availability and affordability in India.This is not only an SDG that needs to be followed up but there is a larger question involved in measuring the impact of all the efforts of regulator and industry and not being directionless and keep on pushing for affordability while the real issue may be availability or vice versa.
Moreover, any claims of governments on improved access to essential drugs would remain unsubstantiated in the absence of data.
About the author: Dr. Naval Asija is a licensed MBBS Physician from India. MBBS is the equivalent of the MD degree offered by international medical schools. He is based in Delhi, India, and works as a medical writer, editor, and consultant. He supports medical researches as an author's editor, medical communication companies involved in medico-marketing activities, and medical technology companies in improving their products. He can be contacted via his LinkedIn Profile: https://www.linkedin.com/in/navalasija/
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