A Study on Availability and Prices of Medicines in India
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A Study on Availability and Prices of
Medicines in India
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A Study on Availability and Prices of
Medicines in India
1st Quarter 2002
Conducted by
VOICE
Voluntary Organisation in Interest of Consumer Education
(VOICE)
F-71, Lajpat Nagar-ll, New Delhi-110024
Ph; (011) 6918969, 6315375 Fax: (011) 4620455
E-mail: cvoice@vsnl.net; Website: www.consumer-voice.org
Supported by
National Pharmaceutical Pricing Authority,
Department of Chemical and Petrochemicals,
Ministry of Chemicals and Fertilizers,
Government of India
Author
Bejon Misra, Adviser, Consumer VOICE
E-mail: consumeralert@id.eth.net
Assisted by Prof. Sanjay K. Jain, Marketing Research Consultant
And Mr.Yuvraj Mehta, Consultant
1st Quarter 2002
Study is available at: http://nppaindia.nic.in/report/voicerep.html
(accessed April 3, 2006 at 1.34 pm 1ST)
ACKNOWLEDGEMENT
This study could not have taken place without the active support of many key players involved in the
Regulatory Mechanism involving the availability of medicines in India. We wish to thank each and every one
involved in making this study possible. We also seek similar support in future from all organizations involved
in making medicines accessible at affordable prices to consumers especially the poor and disadvantaged
citizens in the developing world.
We wish to record our special thanks to
Mr Vasanth Kumar Parigi. Managing Trustee. Consumer Education Centre, Bangalore. Mr.Kishan Parmar,
Secretary General, UP Upbhokta Kalyan Parishad, Agra and Mr.Arun Kumar Misra. President, Indian
National Consumer's Federation, Lucknow for assisting in conducting the field survey in Karnataka and Uttar
Pradesh respectively.
AND
The officials in the Department of Chemicals and Petrochemicals,
Ministry of Chemicals and Fertilizers, Government of India.
Mr. Arun Kumar, IAS (Retd.) Past Chairman, NPPA; Mr. B.S.Baswan, IAS
Chairman, NPPA; Mr. Pradip Mehra Member Secretary, NPPA; Dr. P.V.Appaji
Director (Tech ); Mr. G.G.Mitra Asst. Director (Cost); To all the office bearers
and staff of VOICE
New Delhi, India,
Date: 29.8.2002
FOREWORD
The National Pharmaceutical Pricing Authority (NPPA) has been
established in August 1997 under the Ministry of Chemicals &
Fertilizers as an expert body on pricing of medicines. Its
responsibilities include monitoring the availability of medicines in
the country and to fix/revise the prices of medicines falling under
the "Price Controlled" category. The manufacturers of medicines
are required to sell the price controlled drugs at the prices
fixed/revised by NPPA. It is estimated that there are about
60,000 medicines sold by over 2,30,000 retail chemists in trade
channel. NPPA does not have its own field force for enforcing of
Drugs (Price Control) Order under which the price of controlled
medicines are fixed.
In this background, NPPA thought it worthwhile to assess the
field position by assigning a study to a Non-Government
Organisation (NGO) and has chosen "Voice" for this purpose.
The study has been conducted in two states; i.e., Uttar Pradesh
and Karnataka. It has thrown up many interesting findings.
It is necessary for NPPA to enhance its visibility. In the time to
come. NPPA should launch a national campaign to educate civil
society about its role in protecting the interests of the consumer
and also the pharmaceutical industry, in order to make essential
medicines available at affordable prices. As a regular, we have a
responsible role not only to regulate market conditions and
practices as per our existing laws but also to bring about the
neccessary changes in an appropriate manner in consultation
with teh consumer and the industry.
We appreciate the efforts made by "VOICE" in successfully
completing the project.
(P. K. MISHRA)
Chairman
TABLE OF CONTENTS
CHAPTER NO.
About VOICE
Executive Summary
1.
Indian Healthcare Sector and
Drug Policies: An Introduction
2.
Objectives of the Study
3.
Research Methodology
4.
Uttar Pradesh
Executive Summary Relating to
4(a).
Pradesh
Findings Relating to Uttar
4(b).
Field Staffs Observations on
Uttar Pradesh
4(c).
Pradesh
Summary Findings of Uttar
5.
Karnataka
Executive Summary Relating to
5(a).
Findings Relating to Karnataka
5(b).
Field Staffs Observations on
Karnataka
5(c).
Summary Findings of Karnataka
6.
Executive Summary Relating All
53
6(a).
Findings of All India
6(b).
Summary Findings of All India
7.
Conclusions
8.
Recommendations
India
Annexures
(a)
(a)
(b) (b)
Questionnaire
Terms of Reference
/I bout VOICE
(Voluntary Organization in Interest of Consumer
Education)
Our Vision
VOICE works towards protecting consumer rights by
creating synergy between technological advances,
traditional knowledge and right policies through its
educational and research activities. VOICE believes that
forging beneficial links amongst consumers, market and
government interests will promote sustainable and ethical
consumption and production now and in future.
Our Mission
To promote right choices in a volatile and dynamic market
place by providing consumer education for all through
integrating experiential good practices and scientific
knowledge for the safety and health of consumers and the
environment.
VOICE is actively involved in the Comparative Testing of
Consumer Products for consumer awareness and education.
VOICE generates and disseminates the information to
Indian consumers for informed decisions while buying
consumer products. VOICE was established in 1983 with
the help of Professors and Students of Delhi University. It
was registered in 1986 as a voluntary non-profit, non
political consumer group. It was registered as a public
charitable trust and subsequently registered as a
"Recognised Consumer Association" under the MRTP Act.
Other main activities at present are :
• • Promoting consumer education through awareness
programs.
•
•
•
•
•
•
Scientific interventions to make the market place
better and consumer oriented.
• Mobilize public opinion to change the laws for the
benefit of the consumers.
• Providing legal advocacy and guidance.
• Networking with other consumer groups on public
interest issues.
• Spreading the consumer movement to new areas to
benefit the poor and disadvantaged patients.
• • Empowering women consumers to exercise their
rights.
As a full member of Consumers International, VOICE has
been actively involved on various consumer issues globally
and at the national level in India.
It has shown
demonstrative results in the area of food safety for nearly a
decade. VOICE is a member of various sub-committees set
up under Central Committee for Food Standards by
Ministry of Health, Government of India. VOICE is also
working actively on Codex related issues and
biotechnology.
VOICE was commissioned by the World Bank and various
Government of India Ministries to conduct studies on
various issues concerning consumers concerns on delivery
of health services, accessibility of medicines for the poor
and implementation of the national laws on food safety,
labeling and packaging. Similarly VOICE has been working
in the telecommunication sector with the Ministry of
Communication and the Telecom Regulatory Authority of
India. Since 1999 VOICE has been working with Consumer
Co-ordination Council (CCC) New Delhi and Ford
Foundation on the Electricity sector with Delhi Vidyut
Board as the part of the ongoing programme on Good
Governance and Citizen’s Charter. A new area for VOICE
has emerged in the area of human resource development by
training public service organisations on customer care and
complaints handling.
EXECUTIVE SUMMARY
BACKGROUND
The National Pharmaceutical Pricing Authority (NPPA) during
the last two years has tried to perform its main task of
fixing/revising the prices of Scheduled Formulations and also
tried to make the drug available at reasonable prices to the
consumers. As part of its regular interaction with consumers and
to understand the availability and prices of drugs in the respective
regions, NPPA commissioned VOICE to undertake a study on
the prices and availability of essential, life saving and
prophylactic medicines of good quality in India. The objective of
this study is to look for a viable solution in effectively monitoring
the prices of essential medicines and make them available to the
patients at affordable prices.
RESEARCH METHODOLOGY
In order to understand the problems pertaining to availability,
price variation and drug quality, VOICE carried out a study of
three types of respondents: first, patients visiting hospitals and
chemist shops; secondly, retailers selling medicines and thirdly,
service providers such as hospitals/nursing homes both in the
private and public sectors.
The study was carried out in two major regions of India, viz.,
southern and northern regions In each region, a state was
identified as per the advice of experts and NPPA. In northern
zone, the survey was carried out in Uttar Pradesh, and for the
southern zone, Karnataka was the selected state. VOICE in
mutual understanding with NPPA identified one city, one town
and one block in both these states. The selected cities and towns
in these two states were Gorakhpur and Deoria respectively in
Uttar Pradesh, Hubli and Mandya respectively in Karnataka. In
Uttar Pradesh the total sample size covered was 352 and for
Karnataka it was 371.
RESULTS
The study finds that almost fifty percent of the patients avoid
seeking service from government hospitals due to poor quality of
service and non-accountable practices, even though the facilities
are highly subsidized and at times free to the users. 97% patients
confirmed that drug availability is not a problem and the chemists
keeps the consumers duly informed about the medicines being
substituted. There is a constant mistrust prevailing between the
service providers and the patients. The study also points towards
the sale of drugs without proper prescription. More than 60% of
the patients consult chemists rather the doctors to decide as to
which medicine(s) to buy. Such practice establishes the fact that
the consumers find it difficult to access professional medical
counseling which compels the consumers to seek advice from
chemists. This is a serious barrier for the consumers and could
lead to the growth of unsafe medical practices. The interesting
data is only 4% patients said that the drugs are sold at more than
the maximum retail price (MRP) but as high as 24% chemists
admitted that they overcharge due to various market conditions.
They are also aware about the price differences in some
medicines of the same brand in the same town.
The study reveals that awareness about the role of NPPA is non
existent, as 98.5% of the surveyed patients are not aware about
NPPA. The incidence of such unawareness among the chemists
and doctors are also as high as 76% and 64% respectively. The
lack of infrastructure is also a serious problem in proper
dispensation of medicines to the customers, as 30% chemists in
UP still do not invest in mandatory requirements like
refrigeration facilities. The scene concerning knowledge about
spurious drugs is alarming as 43% doctors did mention about
instances of spurious drugs in the market place. But only 7%
patients reported to have experienced the same. This implies that
due to lack of testing facilities and awareness among the
consumers on spurious drugs, consumers are unable to detect and
report on sub-standard medicines. The fact emerges that there is a
need for consumer education supported by adequate support
facilities for detecting spurious drugs.
The need for encouraging traditional medical practices gets
highlighted in this study as 99% patients have mentioned that
they opted for allopathic science of medical practice but at the
same time they also showed willingness to opt for the traditional
form of medicines. They all have felt that the Government must
focus on providing alternate medical facilities based on
traditional forms of medical science in all the towns and villages
of India. It is disconcerting to note that only 40% patients visit
local doctors for consultation. Furthermore, only 20% visit the
doctors attached to hospitals. It means the health facilities are still
not easily accessible and affordable to the patients, even though
the government is investing huge resources in providing medical
facilities to the citizens in India. Last but not the least is the
concern regarding the pricing of medicines.
RECOMMENDATIONS
A number of recommendations have been made in the study.
Benchmarking service standards of healthcare and monitoring it
regularly by ensuring accountability of the existing system to
provide minimum standards defined by NPPA in consultation
with other service providers is one such recommendation. The
study also recommends that availability and accessibility of
medicines should be a priority item in the Government’s agenda
and it should not be looked at simply the business proposition for
investment by the private sector. The private sector should be
given encouragement, but not at the cost of the poor and
disadvantaged consumers. The business of manufacturing
medicines can encourage profiteering, as it is evident today in
many developing countries. There is also a need to standardize
the prices of medicine by incorporating the applicable sales tax in
the printed label to display the total price to be charged to the
customers, instead of the existing practice of charging taxes as
extra on the agreed printed Maximum Retail Price (MRP). Most
of the customers feel cheated with the existing law as very little
can be done on sale of medicines in the same location with higher
price in the grab of sales tax. Patients do not find price
differences in the same medicine, in case the dealer charges the
applicable sales tax.
The study also recommends attracting investment from the
private sector on developing quality infrastructure facilities like
cold chain, testing facilities for the medicine, training of various
levels dealing with medicine distribution and prescription
dissemination and similar activities. Any loss or damage caused
to the patients due to medical negligence or ignorance should be
adequately compensated. Above all, a mass education campaign
needs to be undertaken to make the Indian patients aware about
their rights on medical information in an easy and understandable
language. The study elaborates the role and responsibilities that
the NPPA should take to protect the consumer interest and also
urges the Government to implement the recommendations of the
study so as to empower the citizens of India to protect their
health interests.
Chapter 1
INDIAN HEALTH CARE SECTOR AND DRUG
POLICIES: AN INTRODUCTION
1.1
INDIAN HEAL TH CARE SECTOR
India’s development cannot be complete until it develops
its social and healthcare sector. For this a strong
regulatory mechanism is required to monitor prices and
availability of essential medicines. It also needs to ensure
quality service in the healthcare sector especially so
when 40% of India’s population are illiterate and 30%
living below the poverty line. Unfortunately in India the
health care deliveries are not only inadequate but also
antagonistic to patient.
Indian pharmaceutical industry today is one of the largest
and most advanced industries among the developing
countries. During nineties it has been steadily growing at
a rate of 18% from Rs. 4,600 crore in 1991 to Rs. 15,000
crore in 1998 with over 20,000 player in the market. It
has manufacturing facilities of bulk drugs belonging to
several major therapeutic groups, requiring complex
manufacturing processes. The industry has developed
excellent facilities for production of all dosage forms like
tablets, capsules, liquids, orals and injectables. Added to
this achievement is the assurance with regard to quality
of products.
Over the last several years, various policy inputs have
been directed towards promoting the growth of the
industry and in helping it to achieve a broad base in
terms of the range of the products and technologies
needed to produce them from as basic a stage as possible.
The results have been very encouraging. As on date,
there are about 250 large units and about 8000 smallscale units in operation, which form the core of the
industry.
These units produce complete range of
formulations and about 350 bulk drugs.
Although today’s patients are highly health conscious
and know importance of health, but many a times in rural
and semi-urban town due to lack of knowledge and
medical care resources, non-availability of medicines and
high amount of money required for treatment, patient
face many problems. As a strategy to tackle the problems
of poor Indian patients who are unable to access quality
medicines at affordable price and easy and assured
availability, it is hoped that the study conducted by
VOICE will go a long way in building awareness within
the patient groups in India and also among the
government agencies to tackle the problems faced by
Indian patients.
1.2
INDIAN DRUG POLICY
The development of Indian pharmaceutical industry
during the protected regime from seventies to nineties is
much due to the drug policy in which the report of the
Hathi Committee (1975) is an important landmark. The
Hathi Committee in particular emphasized the need for
achieving self-sufficiency in medicines and ensuring
abundant availability of essential medicines at reasonable
prices. Since 1975, the Indian Pharmaceutical Industry
has grown to be the most diversified and vertically
integrated pharmaceutical industry in the entire Third
World. The country has achieved self-sufficiency in
formulations and also in a large number of bulk drugs.
The main objectives of the Drug Policy of 1986 which
was titled as "Measures for Rationalization, Quality
Control and Growth of Drugs Pharmaceuticals Industry
in India" were:
>
> Ensuring abundant availability, at reasonable prices,
of essential and life saving and prophylactic medicines of
good quality;
> > Strengthening the system of quality control over drug
production and promoting the rational use of drugs in the
country;
> > Creating an environment conducive to channelising
new investments into the pharmaceutical industry with a
view to encourage cost-effective production with
economic sizes and introducing new technologies and
new drugs; and
> >
Strengthening the indigenous capability for
production of drugs.
1.3
HISTORY OF DRUG (PRICES CONTROL) ORDER
(DPCO)
Drug prices have been under government control since
1970 under the Drug (Prices Control) Order 1970.
Successive orders have been issued in 1979, 1987 and
1995 with more liberalized and industry oriented view.
While issuing these orders, it was also kept in the mind
that the Indian pharmaceutical industry undergoes
transformation from process to patent era. On this date,
only 74 drugs are covered under DPCO.
DPCO controls the domestic prices of major bulk drugs
and their formulations with an aim to provide patients
with medicines at affordable prices. It is applicable only
to allopathic drugs where DPCO ascertains the bulk
drugs (and their formulations) to be kept under price
control.
DPCO came into being for the first time in 1970. At that
time, the Indian pharmaceutical industry predominantly
comprised of multinational (MNC) affiliates and
subsidiaries. In its introductory form, DPCO was more of
a control on the profitability of a pharmaceutical
business, and thereby it indirectly sought to control the
prices of pharmaceuticals. Also, with individual product
prices not requiring approval from the government,
bureaucratic hurdles were relatively low. The Indian
Patents Act 1970 gave an impetus to local players to
reverse engineer drugs and foray into various therapeutic
segments. Overall, the Indian pharmaceutical industry
prospered from 1970 to the next DPCO in 1979.
In its 1979-revised version, the DPCO stipulated ceiling
prices for controlled categories of bulk drugs and their
formulation. In fixing the price, the Government
continued to advocate profitability ceiling. In the case of
bulk drugs, this was through a limit on the company’s
return on networth or capital employed.
The Drugs Prices Control Order, 1995 is an order issued
by the Government of India under Section 3 of the
Essential Commodities Act, 1955 to regulate the prices
of drugs. Its basic structure remains same as that under
the prior two orders of ’79 and ’87, but it did liberalize
the span of control considerably. For the purpose of
implementing provisions of DPCO, powers of the
government have been vested in National Pharmaceutical
Pricing Authority (NPPA) as per notification S.O. 637(E)
dated 04.09.1997.
1.4
ROLE
OF NATIONAL
PRICING A UTHORITY
PHARMA CEUTICAL
National Pharmaceutical Pricing Authority (NPPA) was
established on 29th August 1997 as an independent body
of experts as per the decision taken by the Cabinet
Committee in September 1994 while reviewing Drug
Policy. The Authority, inter alia, has been entrusted with
the task of fixation/revision of prices of pharmaceutical
products (bulk drugs and formulations), enforcement of
provisions of the Drugs (Prices Control) Order and
monitoring of the prices of controlled and decontrolled
drugs in the country. The organization is also entrusted
with the task of recovering the amounts overcharged by
the manufacturers for the controlled drugs. The main
functions of NPPA are to:
>
Implement and enforce the provisions of the Drugs
(Prices Control) Order in accordance with the powers
delegated to it;
>
Deal with all legal matters arising out of the decisions
of the Authority;
>
Monitor the availability of drugs, identify shortages, if
any, and to take remedial steps;
>
Collect/maintain data on production, exports and
imports, market share of individual companies, profitability
of companies etc., for bulk drugs and formulations;
>
Undertake and/or sponsor relevant studies in respect
of pricing of drugs/ pharmaceuticals;
>
Recruit/ appoint the officers and other staff members
of the Authority, as per rules and procedures laid down by
the Government;
>
Render advice to the Central Government on changes/
revisions in the drug policy; and
>
Render assistance to the Central Government in the
parliamentary matters relating to the drug pricing.
Chapter 2
OBJECTIVES OF THE STUDY
The National Pharmaceutical Pricing Authority (NPPA) during the last two years has tried to
perform its main task of fixing/revising the prices of Scheduled Formulations and making the
drugs available at reasonable prices in the country. As part of its regular interaction with
consumers and to gain understanding about the availability and prices of drugs in select regions, it
appointed VOICE to undertake market survey on the prices and availability of essential life
saving and prophylactic medicines of good quality in India. The idea underlying this study has
been to get a feedback from the patients, doctors and chemists so as to effectively monitor the
prices of essential medicines and make then available to the patients at affordable prices. The
need for such a study primarily arose from the paucity of knowledge about the current system.
More specifically, the terms of reference (see Appendix - I for details) include the following
aspects:
2.1
A VAILIBILITY OF MEDICINE
(a) (a) Whether, the medicines normally required are available or not? In case of non
avail ability/shortage, collecting names of the medicines, which are not available.
Investigating whether shortage is temporary or continues for prolonged periods?
(b) (b) Whether substitute medicines of same drug or other therapeutic equivalent available
in the case of shortages?
2.2
PRICE OF MEDICINE
(a) (a) Comparison of prices of some medicines at different locations. Whether they are
available at same price or not (after adjustment for variations due to local taxes)?
(b) (b) Whether medicines are sold as per the maximum retail price (MRP) printed on the
label of the medicine? In the case of overcharging, details of such instances.
(c) (c) Whether in the perception of the qualified medical practitioners, the drugs are
available at reasonable and affordable prices? If some medicines are found to be high
priced, identifying names of some reputed brands indicating the pack size and their MRP.
(d) (d) Are there any instances of frequent, substantial price increases effected by the
manufactures in the perception of pharmacists?
(e) (e) Whether doctors/hospitals are charging prices in excess of printed prices on labels of
medicines used during the course of hospitalization?
2.3
QUALITY OF MEDICINE AND AL TERNA TIVE MEDICINE PRA CTICES
(a) (a) Prevalence of other systems of medicines in the area, and if so, collecting the details
like percentage of people opting for such systems and reasons for it.
(b) (b) Determining instances of spurious/substandard drugs being sold in the market? If so,
collecting details in consultation with the practicing doctors, medical representatives and
trade.
(c) (c) Collecting other relevant information and observations like:
• Types of doctors (general physicians/specialists) available in the surveyed localities
in the private and government hospitals.
• Nature of availability of medical aid in the area.
• Facilities available for refrigeration with chemists in the rural areas.
•
Whether drugs like antibiotics, injections, IV fluids, etc., used rationally or
indiscriminately?
• Quality of drugs marketed in the area. In case drugs of suspected quality (spurious or
of substandard nature) are reported, collecting samples.
• Availability of licensed manufacturing units in the local areas and making a visit to
such units.
•
Endemic diseases of the area and the extent of use of appropriate medicines.
Chapter 3
RESEARCH METHODOLOGY
3.1
SAMPLE DESIGN
In order to understand the problems pertaining to availability, price variation and drug
quality, three separate surveys were conducted:
•
•
•
Survey of patients visiting hospitals and chemist shops.
Survey of retailers selling medicines.
Survey of service providers such as doctors and key officials of the
hospitals/nursing homes both in the private and public sectors.
To reduce biasedness in sample selection, the respondents were selected from two major
zones of India, i.e., southern and northern zones. In each zone, a state was identified as
per the advice of NPPA. In northern zone, the survey was carried out in Uttar Pradesh,
and for the southern zone, Karnataka was the selected state. VOICE in mutual
understanding with NPPA identified one city and one town in both these states. VOICE
also identified a block in each of the states for conducting the field survey. The selected
city and town in these two states are: Gorakhpur and Deoria respectively in Uttar
Pradesh, Huble and Mandya respectively in Karnataka. In Uttar Pradesh, the total
sample size covered was 352 and for Karnataka it was 371. The category-wise sample for
each state is given in the Table 1. The details of hospitals selected for study in each state
are given in Table 2. Interviews were conducted with the patients, chemists, private
practitioners and doctors in the nursing homes and hospitals.
TABLE 1: DISTRIBUTION OF SAMPLE: STATE-WISE PROFILE
Category
Patient
Chemist
Doctor
Hospital/NH
TOTAL
_______ City
Gorakhpur
Huble
126
120
45
25
20
52
25
28
216
225
_____ Town
Peoria Mandya
50
54
20
21
15
17
10
12
95
104
VP
25
5
6
5
7T
Block
Karnataka
26
6
4
6
42
UP
201
70
46
35
352
Total_____
Karnataka
200
79
46
46
371
In Uttar Pradesh, 201 patients were contacted, out of which 126 patients were contacted
in city, 50 in town and 25 in block. 70 chemists were contacted, out of which 45 were at
city level, 20 at town level and 5 at block level. A total of 35 hospitals/ nursing homes
were contacted in Uttar Pradesh out of which 20 at city level, 10 at town level and 5 at
block level. It was always kept in mind to collect the data from all the types of hospitals
such as private, government and nursing homes. A total of 46 doctors were contacted at
Uttar Pradesh, out of which 25 at city level, 15 at town level and 6 at block level.
In Karnataka, 200 patients were contacted out of which 120 patients were contacted in
city, 54 in town and 26 in block. In all, a total of 79 chemists were contacted, 52 at city
level, 21 at town level and 6 at the block level. A total of 46 hospitals in Karnataka were
surveyed for the study, out of which 28 at the city level, 12 at the town level and 6 at the
block level. A total of 46 doctors were contacted out of which 25 at the city level, 17 at
the town level and 4 at the block level.
TABLE 2: DISTRIBUTION OF HOSPITAL SAMPLE: STATE-WISE PROFILE
Sector
City
Town
Block
Total
3.2
Nursing
Home
17
4
1
22
Uttar Pradesh
Private
Govt.
Hospital
Hospital
___ 1
2
6
1
3_
8
5
Total
20
10
5
35
Nursing
Home
24
9
2
35
Karnataka
Private
Govt.
Hospital
Hospital
2
2
2
1
3
1
7
4
Total
28
12
6
46
QUESTIONNAIRE DEVELOPMENT AND FIELD SURVEY
The complete study was divided into three phases as outlined below:
STAGE 1: To begin with, a detailed list of all the information required for the study was
drawn up. Once all the information necessary to attain the objectives was listed, experts
were identified in each of the segments and discussions were held with them. Three sets
of the questionnaires were prepared in December 2000 for pilot testing with the Nursing
Homes / Hospitals, Doctors, Chemists and Patients.
STAGE II: In the second stage, the questionnaires were suitably modified based on pilot
testing and expert suggestions received, face to face interviews were carried out in
February 2001 among the targeted respondents on the basis of structured questionnaire
(see Appendix - II).
STAGE HI : In the third stage, the consultant and the field staff were asked to make their
observations. This observational study was done during February-March 2001 in order to
further reduce the discrepancies that might have crept in during the field survey and
assess the reliability of the responses given by the respondents in Stage-IL
Chapter 4
EXECUTIVE SUMMARY RELATING TO UTTAR PRADESH
In Uttar Pradesh, 201 patients, 70 chemists, 35 hospitals/ nursing homes and 46 doctors were
contacted. It was always kept in mind to collect the data from city, town and block level.
The study shows that patients avoid going to government hospital. Dirtiness, lack of facilities,
presence of fewer doctors and absence of even the primary treatment related facilities deter the
patients from availing the service of government hospital. This practice is highly prevalent at
block level where more than 67% patients said that they avoid going to government hospital.
There is only one hospital at Deoria block of Uttar Pradesh and that too is in a very bad shape.
Even private hospitals are shying away from investing at block level because of low return on
investment and lack of proper incentives from government. 83% doctors at block level said that
there are no private hospitals or nursing home in their area. All these only deprive the block level
patients from availing basic healthcare facilities.
There is no shortage of any prescribed medicine from the manufacturers. At the block level
although some temporary shortages are seen but those are purely due to the lack of fund.
Although few chemists also complained that frequently new drugs are introduced in the market
and it is really difficult to stock all of them. Incase the prescribed medicines are not available
chemists normally substitute them after informing the patients.
There is that rarely price change by the manufacturer neither there is any incidence of printing
different price of same medicine at different locations. But it is seen that price of some drugs
differ location to location and that is purely because of high demand and short supply, which is
temporary phenomenon. Few patients felt that the drugs are costly and the prices are neither
reasonable nor affordable.
Patients have the habit of avoiding doctors and consulting chemists for the medicine. These are
highly prevalent at block level. They also seek alternative therapy and other than allopathic
medicine patients also go for homeopathic and ayurvedic system of therapy. Patients of city and
block level have difference in opinion on the importance of price and quality. City patients are
more concerned about the quality of drugs than that of price, whereas at town and block levels
patients are more prices sensitive than the quality. But over all the awareness about healthcare
services are low. Awareness about the NPPA is also at its dismal low. Most of the doctors,
patients and chemists are totally unaware about NPPA and its role.
Drugs are normally used rationally except vitamins and injectable minerals that are seen more as
treatment for any ailment. So there are some cases of vitamin tablets and injectable minerals used
irrationally.
The most alarming thing in this study is that most of the chemists avoid issuing of cash memo.
Clearly violating drug policy norms they also agreed that refrigerator is not available in their shop
for storage of medicines and at block level refrigeration of medicine was not done in most of the
shops. There are incidences of spurious drugs but neither the patients, the chemists nor the
doctors are willing to divulge any information about the shops that are selling such medicines.
Chapter 4(a)
4.1
FINDINGS RELATING TO UTTAR PRADESH
PATIENTS’ VIEW POINT
4.1.1
PA TIENTS DEMOGRAPHIC PROFILE
In all, 201 patients were contacted out of which 126 patients were contacted in city, 50 in
town and 25 in block in Uttar Pradesh. The demographic profile of patients contacted is
given in Table 3.
TABLE 3: DEMOGRAPHIC PROFILE OF PATIENTS CONTACTED
IN UTTAR PRADESH*
Characteristic of patients surveyed
Age
Sex
Occupation
Education
Monthly Family Income
18-25 yr.______
26 - 35 yr.______
36 - 45 yr.______
45 + yr._________
Male___________
Female_________
Service_________
Business________
Professional_____
Agriculture______
Housewife_______
Others
Illiterate________
Upto Sth_____
Upto 12 th_______
Graduate & above
< Rs.6,000_______
Rs.6,000- 12,000
Rs. 12,000-20,000
>Rs.20.000
City (126)
Percentage of respondents
Town
Block
(50)
(25)
29
38
20
13
73
27
24
21
9
10
15
21
5
14
27
54
40
58
2
0
28
24
20
28
94
6
24
14
8
32
4
18
18
24
36
22
84
14
2
0
44
24
16
16
56
44
20
8
0
16
44
12
28
20
44
8
92
8
0
0
Total
(201)
34
28
19
19
74
26
23
14
6
19
21
17
17
19
36
28
72
27
1
0
*Figures in parentheses are actual number
As seen in the above table, respondents were selected in the age group of 18 to 45+ years with
74% of them being male and 26% female. Patients from all walks of life such as service class,
business class, professionals, agriculturist and housewives have been included in this study. They
were either illiterates or above graduates, with monthly income varying from less than Rs. 6,000
to more than Rs. 20, 000 per month.
4.1.2
DOCTOR/HOSPITAL VISITING HABIT OF PA TIENTS
Out of 201 patients contacted for the study, 42% of patients consult doctors in the case of
illness, 22% of them go to hospitals and 36% patients go to both doctors and hospitals
(see Table 4). This is same across city, town and block. So far as the frequency of visit to
government hospital is concerned, city patients visit the government hospital more often
than the block patients. 51% of city patients said they visit government hospital whereas
only 33% at the block level reported that they visit government hospital. Lack of
responsiveness towards patients, non-availability of doctors and medicines, and poor
empathy towards the patients in the government hospitals deter the patients from availing
the existing facility.
TABLE 4: DOCTOR CONSULTATION: PROFILE OF CONSUMERS*
Questions
______ Percentage of respondents_________
City | Town | Block | Total |
(126)
(50)
(25)
(201)
44
36
18
46
44
24
32
42
22
36
33
17
11
34
22
16
18
25
49
8
Whom do you visit in case of illness?
Doctor
Clinic
•
•
Hospital
________________________ • •
Both
If visiting hospital, how often you go to govt, hospital?
• • Always
•
• Mostly
Sometimes
23
33
3
48
45
4
67
0
Never
♦Figures in parentheses are actual number
4.1.3
A VAILABILITY OF MEDICINE
As the survey shows, there are absolutely no problems in getting the medicines
prescribed by doctors. These are readily available with the chemists of that particular
area. Around 95% of patients replied that medicines prescribed by the doctors are readily
available as and when required (see Table 5 and Figure I).
TABLE 5: AVAILABILITY OF MEDICINE *
_______________________________ ________ _______ Percentage of respondents
Question
City
Town
Block (25) Total (201)
(126)
(50)
Are the medicines prescribed readily available?
96
94
88
95
Yes
4
6
12
5
No_____________________________
♦Figures in parentheses are actual number
If the prescribed medicines are not available in their area, doctors do mention the name of
the shop from where the patients can get it easily. Overall, only in 2% cases patients
reported that they came back to doctor when they did not get the prescribed medicine.
Chemists do suggest substitution for the prescribed medicines but the incidence of
substitution is interestingly more in city than either in town or block as seen in Table 6.
Forty one per cent of the respondents in the city said that the chemists mostly suggest
buying substitute medicines whereas at the town and block levels the incidence of such
cases was only 10% and 8% respectively. More than 50% respondents at the town and
block levels said that chemists never suggest them the substitute medicines, but at the city
level only 18% of the respondents reported on the substitution.
TABLE - 6: SUBSTITUTION OF MEDICINE *
________ ________ Percentage of respondents
Questions
City
Town
(126)
(50)
Chemist suggests you to buy substitute medicines?
Always
1
40
41
Mostly
Sometim
es
18
4
6
32
58
Block
(25)
Total
(201)
0
8
40
52
28
39
32
1
__________________________________________Never
Does chemist give you substitute without informing you?
0
2
45
53
Always
Mostly
0
2
14
84
0
0
20
80
0
2
34
64
Sometimes
____ Never______________________
* Figures in parentheses are actual number
Although chemists suggestion for substitute is there, but whenever they substitute the
medicine they clearly inform the patients about the substitution. While at the town and
block levels more than 80% respondents said that the chemists inform them when they
give substitute medicines, however only 53% respondents said so at the city level. When
asked about the names of the medicines that are in short supply and name of medicines
whose substitute are not available respondents did not endowed our field staff with any
Figure I: Availability of Medicine
9^^^94
100
□) 90
(U
80
70
c 60
50
0)
</)
40
c
o 30
Q.
20
W
6
o 10
4
a: 0 i—
CD
City
useful information.
95
88
0
i12 II 5
3
Town Block
Sectors
Total
□ Yes
HNo
4.1.4
PRICE OF MEDICINES
In the opinion of respondents, drug manufacturers do not resort to frequent price changes
(see Table 7). Almost 98% of the respondents said that manufacturers do not frequently
change prices. Only 2% patients replied that they find frequent and substantial increases
in medicine prices by the manufacturers. During this study, there were no reported cases
of manufacturers printing different prices for the same medicine at different locations.
TABLE 7 : PRICE OF MEDICINE *
_____________________________ ________ Percentage of respondents
Question
City
Town
Block
Total (201)
(126)
(25)
(50)
Is there a frequent price change by manufacturers?
Yes
3
2
0
2
97
No
98
100
98
* Figures in parentheses are actual number
But the instances of price differences for the same medicine at different locations as well
as different shops in the same location were reported. 25% of the patients reported of
such differences. The prices were reported to be higher in those areas where fewer
numbers of chemist shops were set up.
So far as the appropriateness of medicine prices is concerned, majority of the respondents
felt that prices are reasonable and affordable. While 69% consumers said that prices are
both reasonable and affordable, only 11% of felt that medicine prices are not affordable
and 20% felt those prices are not reasonable.
4.1.5
PROCUREMENT AND PURCHASING PA TTERN OF MEDICINE
There is a wide variation among respondents regarding availability of medicine free of
cost at the place of treatment (see Table 8). Whereas 78% and 83% of the patients at the
town and block levels respectively reported that they get medicine free of cost, only 35%
said so at the city level. It implies that hospitals in the cities often avoid giving medicines
to the patients and leave that task to the chemists.
There are only limited instances of doctors giving medicines to the patients. Furthermore,
90% patients in the city reported that in case doctors give them medicines they do charge
extra. But the scene is opposite at the block level where only 25% respondents said that
doctors charge for the medicines, presumably because of low awareness.
TABLE 8: MEDICINE PROCUREMENT BEHAVIOUR OF CONSUMERS*
Questions
Are medicines available free of cost at the hospital
(government or private) where you visit for illness?
Yes
___________________________________________ No
Does private practicing doctor gives you medicines?
Yes
No
If yes, is it charged or free?
City
(126)
Percentage of respondents
Town
Block
Total
(25)
(50)
(201)
35
65
78
22
83
17
65
35
27
73
33
67
36
64
32
68
90
50
25
65
Charged
10
75
50
35
Free
*Figures in parentheses are actual number
4.1.6
A VAILABILITY OFALTENATIVE THERAPY
Patients do go for alternative therapy and many of them adopt more than one medication
system. Among 201 patients surveyed, almost 99% are adopting allopathic medicines,
56% adopting homeopathic medicines and 27% following auryvedic systems (see Table
9). City patients are more open in using other systems of medicine than the block or town
patients. While 68% patients in city said that they use homeopathic system, at the town
and block levels only 36% and 32% respectively said to be using homeopathic system.
TABLE 9 : AVAILABILITY OF ALTERNATIVE MEDICINE *
Question
City
(126)
Percentage of respondents
Town
Block
Total (201)
(50)
(25)
System of medicines prevalent in area
100
Allopathic
Homeopathic
68
37
0
2
98
36
12
0
0
100
32
4
0
0
99
56
27
0
1
Ayurvedic
Unani
Traditional
* Figures in parentheses are actual number
4.1.7
4.1.7 INCIDENCE OF SPURIOUS DRUGS
The instances of spurious and sub-standard drugs noticed by the patients are very rare
(see Table 10). Around 90% patients across the city, town and block said that they have
never noticed any spurious drugs in the market. The majority of the respondents also said
that in case they notice any shop selling spurious and substandard drugs, they never go to
that particular shop again for purchasing the medicines.
TABLE 10 : INCIDENCE OF SPURIOUS DRUGS*
____________________________________ ________ Percentage of respondents
Question
City
Town
Block
Total
(126)
(50)
(25)
(201)
Any instance of spurious drugs noticed by you?
0
0
4
Many a
1
times
2
8
8
4
4
8
4
5
Sometime
94
84
84
90
Rarely
Never
4.1.8
PA TIENTS'A WARENESS
All the surveyed patients reported that they are not only well aware of the chemist shops
in their area but also aware of 24-hour open chemist shops. But patients are hardly aware
about any patient forums, consumer organizations or NPPA. So in the case of any
problem of spurious drugs or high priced drugs, they do not know whom to approach.
Around 99% of the patients do not even know what NPPA is and what is its role. NPPA
needs to promote social marketing and advertising to increase the awareness about its
role in curbing discrepancies in drug prices and controlling supply ofspurious drugs.
A very interesting point, which emerged from this study, is that around 58% patients do
not demand the chemist to give the bills or cash memos. This shows that there is no
interest among the patients to check whether the extra money, which is being charged
from them, is in the form of tax or the chemists are over-charging them. This also shows
lack of awareness among the patients on the importance of cash memo and how it can be
used to create evidence in case of litigation or complaints concerning consumer rights.
The various suggestions given by the patients to bring the desired changes in the medical
care sector are:
♦ Government should control prices of medicines and price list of life saving drugs should
be prominently displayed at the chemist shops.
♦ Quality of medicines must be improved by introducing the latest technology.
♦ Choice of same variety of medicines should be made available at all the chemist shops.
♦ Medicine should be distributed free to the poor consumers living below the poverty line.
♦ Competent doctors should be encouraged to work in the rural areas.
♦ Medicines should be sold by prescriptions only.
♦ License for chemist shops should be given to adequately educated and knowledgeable
persons and regular checks should be conducted to ensure adherence of our rules and
regulations as per the existing national laws.
4.2
CHEMISTS VIEW POINT IN UTTAR PRADESH
4.2.1
A VAILABILITY OF MEDICINE
Chemists are the most important link between the patients and doctors. They ensure
availability of medicines to the patients by stocking adequate amount of all different
types of medicines. With the number of pharmaceutical manufactures increasing daily, it
is becoming difficult for the chemists to stock all the types and brands of medicines
which are being prescribed by different doctors. The ultimate sufferer is the patient.
TABLE 11 : AVAILABILITY OF PRESCRIBED MEDICINE *
______ _________________________ ____________ _____________
Question
City
Town
(45)
(20)
Required medicine available
4
10
Always
89
80
Mostly
7
10
_____ Sometimes_________________
* Figures in parentheses are actual number
Percentage of respondents
Block
Total
(5)
(70)
0
60
40
6
84
10
Out of 70 chemists surveyed, 90% chemists reported that medicines demanded by the patients are
mostly available (see Table 11 and Figure II). At the block level there seems some shortage of
prescribed medicines. 40% chemists responded that there are sometimes shortages of prescribed
medicines. They also agreed that there is no problem in the medicine supply from the
28
manufacturers but they are not stocking all the medicines. Majority of them, 94% said that the
main reason for not stocking all the medicines are :
>
>
>
Lack of funds
Frequent introduction of new medicines in the market and its difficulty to stock all of them.
They stock only those medicines, which the doctors in their area generally prescribe.
Figure II: Availability of Medicine
100 -|
90 w 80 c
o 70 c
o
60 Q.
(Z)
(D
or 50 40 o 30 CD
OJ
20 10 0 ■O
□ Alw ays
■ Mostly
□ Sometimes
City
Town
Sectors
Block
But 57% chemists said that they do have substitutes of the prescribed medicines available
with them. They also reported that in their opinion around 63% of patients do take
substitutes in case the prescribed medicines are not available. The chemists reported that
they stock only those medicines, which are being prescribed by the doctors practicing in
their area. But if a patient comes to them with the prescription of doctors practicing in
other area, chemists are unable to provide the medicines. Although they do guide the
patients to the right shop where the prescribed medicine will be available.
4.2.2
A VAILABILITY OF OVER THE COUNTER (OTC) DRUGS
Chemists reported that there are a number of medicines that are being sold in high
volume without prescription. The most commonly sold medicines without prescription
are: Combiflam, Zinetac, Crocin, Disprin, Navalgin, Becosules, Ultragin, Amclox,
Flexon, Enteroquinol and similar. These are the drugs that provide faster relief, are easily
available over the counter (OTC) and are common ailment medicines.
4.2.3
INCIDENCE OF SPURIOUS DRUGS
Hardly 2% of city chemists reported that they noticed instances of spurious drugs. But at
the town and block levels the reported incidence of spurious dug is high. 35% chemists in
the town and 20% at the block level reported that they have noticed spurious and sub
standard drugs (see Table 12). They were, however, reluctant to share their experiences in
this respect. This clearly reflects the fear existing among patients of town and block and
how they are ill-informed patients and become an easy prey to spurious and sub-standard
drugs.
TABLE 12: INCIDENCE OF SPURIOUS DRUGS*
_____________________________________________ _______ Percentage of respondents____
Question
City
Town
Block
Total
(45)
(20)
(5)
(70)
29
Instances of spurious drugs?
• Many a times
• Sometimes
• Rarely
_________________________ • Never
♦Figures in parentheses are actual number
4.2.4
2
0
0
98
15
20
10
55
20
0
0
80
7
6
4
83
CONSULTING CHEMISTS FOR MEDICINES
It has also been observed during the study that patients do consult chemists for the
medicine especially for common ailments. This is true for all the three levels, viz., city,
town and block. As can be seen from Table 13, 71% of the city chemists, 40% of the
town chemists and 80% of the block level chemists replied that patients do consult them
for medicines. In case of common ailments, patients try to avoid doctors and consult
chemists because it not only saves doctor's consultation fee but also the hassle of waiting
for the turn for meeting the doctor. In the case of block, the poor presence of doctors also
forces the patients to consult chemists.
TABLE 13 : CONSULT CHEMIST FOR MEDICINE*
____________________________________________ _______ Percentage of respondents
Question
City
Town
Block
Total
(45)
(20)
(5)
(70)
Does the customer consult chemist for medicines?
18
10
Many a
20
16
times
53
30
60
47
11
45
0
20
Sometimes
18
15
20
17
Rarely
Never
♦Figures in parentheses are actual number
4.2.5
PRICE OFMEDICINE
As per the responses of chemists, there is hardly any price variation in MRP printed on
the label for the same medicine sold at different locations (see Table-14). Out of 70
chemists surveyed, 84% of them replied that there is no difference in price of the same
medicine at different locations. Out of rest 16% who agreed on price difference, 82% said
that even if there is a difference in price, it is only in respect of few medicines. These are
those medicines that are either less stocked due to non-availability or are critical life
saving drugs. There is hardly any difference in the responses of chemists at the city, town
and block levels.
30
o>
C)
tu
O)
100
1 n
60
□ At MRP
□ <MRP
□ >MRP
60
40 -
cn
20 -
(D
75
80
(/>
c
o
CL
Figure IV: Medicines Sold at MRP
98
88
0
II
6 6
0 2
i
City
*
|
Town
Total
Sectors
88% chemists replied that medicines are sold at MRP (see Figure IV). (As per the DPCO
norms, during the study MRP has been taken as maximum retail price plus sales tax.). At
the town and block levels, some chemists reported that medicines are being sold at prices
either more than MRP or less than MRP. While at the city level, 98% chemists replied
that medicines are sold at MRP, at the town and block levels the corresponding figures
were 75% and 60% respectively.
093 11
•1
r.
The chemists are thus found to be overcharging the town and block level patients over
and above the sales tax and exploiting the poor consumers who are medically unaware
about the law. 10% chemists at the town level and 20% at the block level said that the
chemists charge more than MRP and sales tax. There are also incidence of chemists
charging less than MRP at the town and block levels. 15% town level chemists and 20%
block level chemists said that they charge less than MRP. High competition prevalent in
the concerned areas might be the reason compelling the chemists to give discounts to
customers.
TABLE
14: PRICE DIFFERENCE OF PRESCRIBED MEDICINE
Percentage of respondents*
Questions
City
Town
Block
(45)
(20)
(5)
Does price differ from location to location?
Yes
13
20
20
No
87
80
80
Is difference is in all or some medicines?
Some
83
75
100
All
17
25
0
At what price are the medicines sold?
98
75
•
•
At MRP (MRP + S.
60
Tax)
0
15
20
2
10
20
•
•
Less than MRP
______________________ •
•
More than MRP
*Figures in parentheses are actual number
4.2.6
Total
(70)
16
84
82
18
88
6
6
DRUGS USAGE AND DISTRIBUTION PATTERN
Most of the chemists agreed that drug usages are rational. 97% chemists replied that
usage of antibiotic is rational, 99% replied that usage of injection is rational and 97%
replied that usage of IV fluid is rational. But there are a few reported cases of irrational
drug usage in the case of vitamins and minerals. 19% chemists replied that usage of
vitamins is irrational and 11% found the usage of injectable minerals as irrational. This is
largely due to the usage pattern of these types of drugs. Vitamins and minerals are widely
recommended and used with any antibiotics. They also find wide application for any type
of diseases and weakness.
The distribution system of medicine is very simple. It is either through distributor or
company salesmen or directly from the distributor. Chemists mostly procure the required
medicines themselves because of the irregular visits of the manufacturer and distributor's
salesmen making them highly non-reliable. 81% chemists said that they themselves
procure the required medicines and hardly depend on the manufacturer or the distributor's
salesmen. Only 19% chemists said that they fully depend on the manufacturer or the
distributor's salesmen for the supply of medicine.
4.2.7
CHEMISTS A WARENESS AND SELLING PRA CTICES
Awareness about NPPA is at dismal low across city, town and block levels (see Table
15). Out of 70 chemists surveyed, only 2% chemist was aware of NPPA. NPPA needs
promote a national mass campaign to increase the awareness about their role and
responsibilities.
TABLE 15: AWARNESS ABOUT NPPA*
32
Question
City
(45)
Percentage of respondents
Town
Block (5)
Total (70)
(20)
Awareness about NPPA?
Yes
No
0
100
5
95
0
100
2
98
♦Figures in parentheses are actual number
So far as the practice of issuing bills and cash memos is concerned, only 8% shops were
always issuing the bills or cash memos. In 78% shops, bills or cash memos were issued
either in some cases or not issued at all (se Table 16).
TABLE 16 : CASH MEMO ISSUED WITH THE SALE OF MEDICINE*
Question
City
(45)
Percentage of respondent
Town
Block
Total (70)
(20)
(5)
Is cash memo issued?
•
•
•
•
Always
Some
•
None
•
No
cases
7
40
38
15
15
40
40
5
0
20
40
40
8
39
39
14
Response__________________________________________ _______ ________
♦Figures in parentheses are actual number
The situation with regard to the issuance of bills and cash memos is quite disconcerting at
the city as well as town and block levels. About 40% of chemists have themselves
reported that they do not issue the bills or cash memos at all. This clearly indicates that
chemists take the advantage of the lack of awareness among patients who have no
mechanism to check whether chemists are selling sub-standard or the expired drugs at
arbitrary prices. If in case any unfortunate incidence happens, the patients can never
claim the compensation because of lack of evidence on account of non issuance of bills
or cash memos by the retailer.
During the study it was also observed that in most of the chemist shops, prescribed
medicines are properly stored. Around 94% chemist shops stored medicines in proper
cupboard. But clearly violating the drug policy norms, around 30% chemists said that
refrigerator is not available for storage of medicines and at block level refrigeration of
medicine was not done in most of the shops. The reason cited by the chemists are:
•
•
•
•
4.2.8
•
•
•
•
Poor power supply.
Low awareness.
Extra cost.
No servicing available for refrigerator.
PATIENTS9 A WARNESS: CHEMISTS9 VIEWPOINT
City and town level patients are more aware than block level patients. About 90% to
100% city chemists replied that their customers check MRP before buying the prescribed
medicines, whereas only 40% block level chemists said so (see Table 17).
Patients are also aware of the benefits linked with the batch number and the expiry date
as most of the consumers check these aspects before buying medicines. At the aggregate
level, 72% of the chemists replied that customers do check batch number and the expiry
date before buying medicines. This clearly indicates that patients are aware about their
rights although the percentage is not yet hundred per cent. Some ways should be found to
33
further educate the patients and make them aware about the need for checking the MRP
especially at block level.
TABLE 17 : PATIENTS AWARNESS*
Questions
Percentage of respondents__________
City
Town
Block
Total
(45)
(20)
(5)
(70)
Do the patients check MRP?
• • Always
• • Mostly
• • Sometimes
___________________________________ • • Never
Do the patients check batch no/expiry date?
• • Always
• • Mostly
• • Sometimes
• • Never
*Figures in parentheses are actual number
36
64
0
0
45
45
10
0
20
20
60
0
37
56
7
0
62
36
2
0
25
45
30
0
5
40
55
0
31
41
28
0
Chemists’ response also points towards one interesting phenomenon. City patients are
more concerned about the quality of drug than that ofprice, whereas at town and block
levels patients are more concerned about price than the quality. While only 36% city
patients said that they always check MRP but 62% of them reported that they check batch
number and the expiry date. In the case of town, 45% reported that they always check
MRP and only 25% always check the batch number and the expiry date. The figure goes
down further at the block level where only 20% always check the MRP and only 5%
always check the batch number and the expiry date.
4.3
HOSPITAL DOCTORS1 VIEW POINT IN UTTAR PRADESH
In all 35 hospitals were contacted in Uttar Pradesh. Doctors in these hospitals reported
that they prefer to prescribe medicines keeping patients economic conditions in mind.
74% doctors in hospital replied that they keep the patients economic condition in mind
while prescribing the medicine. But doctors are not happy with the government hospital
services and feel that it is not adequate to meet the demands of the local patients. More
than 57% said that number of government hospitals are not adequate and 52% replied that
numbers of government dispensaries are not adequate. Lack of government ambulances
and vans only makes the matter worse. Around 86% doctors replied that the government
vans are not adequate. But the scene relating to private hospitals and nursing home is
different. Hardly 17% doctors replied that private practitioners are not adequate and 34%
doctors replied that nursing homes not adequate.
Poor management, low priority to healthcare, lack of proper vigilance and lack of funds
aggravate the matter. With poor management and maintenance of government hospitals,
private nursing homes and hospitals become the only providers of healthcare services and
start charging the poor consumers arbitrarily. Ultimately it is the patients who bear the
burnt of the government’s apathy and lackluster performance.
According to the doctors, there do exist cases of sub-standard and spurious drugs. 45%
doctors said that they had heard of spurious and substandard drugs sold in the market.
None of the doctors reported awareness about any licensed drugs manufacturing units
located in the local areas. Although awareness about NPPA is low among the doctors
also, but compared to patients and chemists the awareness level is slightly higher among
the doctors. 28% doctors replied that they are aware of NPPA. This low awareness about
34
NPPA among the doctors clearly indicates the lack of publicity by NPPA about their
activities. Lack of knowledge among doctors also implies that it will be a daunting task
for NPPA to reach the common citizens and make them conscious of the role of NPPA in
enforcing their rights to safe and affordable medicines.
98% of doctors replied that all the medicines that they prescribe are easily available in the
market. Furthermore, as many as 93% doctors opined that medicines are sold at the same
price at different locations. Only 17% said that there is difference in price of medicine
and this might be due to the pricing policy of the manufacturers. 82%, agreed that
medicines are being sold at the MRP.
4.4
GENERAL DOCTORS' VIEW POINT IN UTTAR PRADESH
4.4.1
PRESCRIPTION AS PER PA TIENTS’ ECONOMIC CONDITION
In Uttar Pradesh, out of 46 doctors surveyed only 65% doctors replied that they always
keep patients’ economic condition in mind before prescribing medicines for them.
Excepting the case of city where only 48% doctors said yes, majority of doctors, 93% and
67% respectively, at the town and block levels said that they keep patients’ economic
condition in mind before prescribing medicines. This difference might be there because
of the reason that the city patients are economically more well off than their town and
block counterparts.
TABLE 18: MEDICNE AS PER PATIENTS’ ECONOMIC CONDITION*
Question
Do you keep the patients’ economic condition in mind
while prescribing medicines?
Percentage of respondents
Town
Block
Total
(46)
(15)
(6)
City
(25)
48
52
93
7
67
33
65
35
* Figures in parentheses are actual number.
4.4.2
A VAILABILITY OF MEDICAL AID IN THE AREA
Mixed responses turned out when the doctors were asked about the adequacy of various
service providers in the area (see Table 19).
TABLE 19 : DOCTORS’ OPINION ABOUT MEDICAL AID*
______________________________________________________ Percentage of respondents
Question
City
Town
Town
Block
(25)
(15)
(6)
Opinion about medical aid in area?
Govt. Hospital
32
Yes
53
67
43
___________ No
68
47
57
33
Govt. Dispensary
44
Yes
33
33
39
___________ No
56
67
67
61
Govt. Vans
Yes
16
13
0
13
84
___________ No_
87
100
87
Pvt. Hospital
64
Yes
67
17
59
36
33
___________ No^
83
41
Nursing Homes
Yes
88
100
17
83
12
No
83
17
0
35
Private Practitioners
Yes
No
96
4
100
0
83
17
96
4
♦Figures in parentheses are actual number
The survey shows an opposite trend in the case of distribution of public and private
hospitals in the city and in block. In the case of city, about 68% and 56% doctors said that
the government hospital and government dispensaries respectively are not adequate. But
around 60% to 80% doctors said that private hospital and private nursing home are
adequately available in the city. It shows that private doctors and businessman are taking
the advantage of insufficient government hospitals in the city and investing more. But the
scenario is opposite at the block level where private parties are shying away from
investing because of low return on investment. At the block level, 67% doctors said that
the government hospital facility is adequate, but 83% said that the number of private
hospitals and private nursing homes is inadequate. Government should come out with
incentives and policies to promote private investments in these areas.
So far as the availability of government vans at the city, town and block levels, majority
of the doctors (more than 80 per cent) said that the government vans are not available in
adequate number. Apropos the availability of private practitioners, the response pattern is
just opposite. 96% doctors in city, 100% doctors in town and 83% doctors in the block
said that there are adequate numbers of private practitioners. Especially at the block level
where the private nursing home and hospitals are few in numbers, the private
practitioners fill the gap.
4.4.3
PREVALENT DISEASES OF THE AREA AND MEDICINES PRESCRIPTION
The most prevalent diseases of the area include Gastro Entritis, TB, Gastritus, High and
Low Blood Pressure, Malaria, etc. The detail list is given in Table 20.
_____ TABLE 20: PREVELANT DISEASES AND THE MEDICINES PRESCIRBED*
S. No. Endemic Disease
Medicine Prescribed
1.
Gastroenteritis
2.
3.
4.
Gastritis
Goitre
Filariasis
5.
Sugar
Fractures
Liver Pain
HBP/LBP
TB
Viral Fever
6.
7.
8.
9.
10.
11.
12.
13.
14.
15.
16.
Malaria
Dysentry
Headache
Cold/Vomitting
Diarrhoea
R.T.I
IV Fluid, Oxytetracycline, Tinidazole, Metrogyl, Ciprofloxacin,
Norfloxacin, Tetracycline
IV Fluid, Antacid
Oral Iodine
Hetrazan, Unicarbazan, Banocide forte, Banocide Syrup
Euglucon, Protamine Zinc
Combiflam, Flexon,
Protamine Zinc
Beptazine-H, Cimetin, Clodex, Tenelol, Timizol
Combutol, Tab. INH, Tab. IHD, Pyrazinamide, Isonex,
Isoniazid
Amclox, Calpol Syrup, Indomethacin, Ciprofloxacin
Chloroquine, Metacin, Paracetamol, Quinine
Blumox, Metronidazole Amaebecide,
Brufen
Benadyle, Ceff-250, Siquil
Metrogyl, Norfloxacin, Ciprofloxacin, Ringerlactate, Electrol
Amoxycillin, Cephalexin, Ampicillin, Cioxacillin
36
17.
Eczema
Enchephelities
Typhoid
18.
19.
20.
21.
22.
Pneumonia
Amoebiasis
Conjunctivitis
Entrocolitis
23.
24.
25.
Viral Hepatitis
Stomach Pain
Headache
Migrane
Cancer
Jaundice
URTI
Hydrosyel
26
27
28
29
Betnovate-N
Destrose, Dexona, Monocef
Ciprofloxacin, Calpol, Paraxin, Chloramphenicol, Septran,
Ofloxacin,
Amoxycillin, Ceff-250 / 500, Cetazone, Cephalexin
Anti-M, Tinidazole
Ciplox eye drop, Mycin eye drop
Tinidazole, Metrogyl, Ciprofloxacin
Paracetamol, Crocin
Spasmizol-K
Brufen
Ibumax, Calpol
Vincristine Sulphate, Methotrexate, Bleomycin
Liv 52, Livoerb, Glucose Powder
Cephalexin
Banocide
30
31
* The prescribed medicines against the respective disease are as per the views ofthe respondents. Although on actual
checking with some senior doctors it is found that some medicines are wrongly prescribed.
•
•
•
•
•
4.4.4
Although almost 98% doctors replied that they use the drugs rationally, yet there are few
instances of indiscriminate usage of Vitamins, Minerals and IV Fluids. The main reasons
sited for the high usage of the drugs are:
• Making money through prescription of these medicines.
• Wide usage especially for anemia, weakness, etc.
• These medicines go with any antibiotic and are widely recommended.
• Quacks prescribe such medicines irrationally
• Lack of knowledge and education among the patients.
A VAILABILITY AND PRICE OF MEDICINE
There is no problem in the availability of medicines in the opinion of the doctors. 97% of
doctors replied that all the prescribed medicines are easily available. In the same vein,
87% opined that medicines being sold at the same price at different locations and 85% said
that medicines are sold at the MRP. 13% doctors said that the difference in price at
different locations is because of pricing policy of manufacturers.
4.4.5
A VAILABILITY OF SPURIOUS DRUGS
43% doctors said that they have heard of spurious/substandard drugs being sold in the
market. As can be seen from Table 21, incidence of spurious and sub-standard drugs is
reportedly more at the block level where around 67% doctors confirmed the incidence of
spurious drugs. But it is slightly low in both the town and city where around 40% doctors
confirmed the incidence of spurious drugs. The low quality checking by the respective
drug authorities, lack of proper drug awareness campaign and low literacy rate make the
spurious/fake drugs market flourish. Especially the block level patients are more
vulnerable to spurious drugs. It may be noted that in the present study it is the doctors
rather than the patients and chemists who have in greater proportion identified the
problem of spurious. As the doctors are medically more informed, they can identify the
incidence of spurious and sub-standard drugs more easily than the patients and chemists.
Whereas around 43% doctors said that there are instances of spurious drugs in the
market, only 17% chemists and 10% patients felt so.
37
TABLE 21 : AVAILIBILITY OF SPURIOUS DRUGS*
____________________________________________
Question
Are there any instances of spurious drugs marketed in the area?
• • Always
• • Mostly
• • Sometimes
• • Never
City
(25)
0
4
36
60
Percentage of respondents
Town
Block
Total
(15)
(46)
(6)
0
13
27
60
17
0
50
33
2
6
35
57
*Figures in parentheses are actual number.
4.4.6
DOCTORS A WARENESS
Only 15% doctors are aware ofNPPA (see Table 22) and the awareness is more or less
the same across the city, town and block. With such a low awareness among the doctors,
NPPA needs to increase its presence among the doctors and make them one of the media
for promoting its role among the common patients.
TABLE 22 : AWARNESS OF DOCTORS*
Questions
City
(25)
Percentage of respondents
Town
Block
Total
(46)
(15)
(6)
Aware of licensed drug manufacturing unit in local area?
Yes
No
0
100
0
100
0
100
0
100
Yes
No
20
80
7
93
17
83
15
85
Yes
No
100
0
87
13
67
33
91
9
Aware ofNPPA
Any idea on prices of drugs?
* Figures in parentheses are actual number
None of the doctors was found aware about any licensed drug-manufacturing units in the
locality. Almost all of them have thorough knowledge about the prevailing market prices
of the medicines.
Chapter 4(b)
EXPERTS AND FIELD STAFF'S OBSERVATIONS
ON UTTAR PRADESH
Following are the observations made by field staff during the course of the survey
conducted in Deoria Sadar (Town), Rampur, Karkhana and Baitalpur (Block) in Uttar
Pradesh
4.1
DUPLICA TE MEDICINES
38
Deoria Sadar is a backward area in Uttar Pradesh adjoining Bihar. Duplicate and pirated
medicines of reputed brands are available freely. Many respondents reported that these
medicines are manufactured and sold through district Siwan of Bihar. In the duplicate
medicines, they mix atta, besan and similar food products. These medicines are available
at cheap prices and patients do get diverted to these medicines and buy them frequently.
Price differences and fluctuations happen because of these medicines.
4.2
SHORTAGE OF CAPABLE DOCTORS
In Deoria Sadar, there are shortages of qualified and competent doctors. 80% doctors are
either quarks or those who are just BUMS and similar degrees. These doctors also give
consultancy on sexual problems and sometimes taking the advantage of illiteracy even
black mail the patients.
4.3
LACK OF A WARENESS AMONG CONSUMERS
In Deoria Sadar, about 50% of patients are not aware of their rights. These patients go to
quacks and buy the medicines prescribed by them just to save money. It also came as a
surprise to the experts and field staff that even well educated people does take duplicate
medicines prescribed by these doctors. Above all there is no voluntary organization in
this area working to educate the patients on their rights.
BAD SHAPE OF GOVERNMENT HOSPITAL
4.4
There is only one government hospital in Deoria and that too is in a very poor condition,
few doctors, unhygienic conditions and lack of facilities, which compels the patients from
not visiting such hospitals. Even the primary treatment facilities are not available in this
hospital.
4.5
MISUSAGE OF SAMPLED MEDICINES
During the survey it came to light that doctors do misuse the medicines given to them as
samples by the pharmaceutical companies. Pharmaceuticals companies might be selling
the medicines under the guise of samples just to save tax. And perhaps it is due to this
practice that the price difference has been existing for some medicines in the area.
Chapter 4(c)
SUMMARY FINDINGS OF UTTAR PRADESH
PATIENTS VIEW POINT
POSITIVE ASPECT:
4
>
>
> 95% patients said that the prescribed medicines are available.
> 98% patients said that in case the prescribed medicine is not available chemists give
them substitute medicine only after informing them.
y > 98% patients said that there is no frequent price change in the medicine by the
manufacturer.
> > 99% adept allopathic system.
> > 90% patients said that there is no incidence of spurious drugs and 5% said it’s a rare
phenomenon.
39
NEGATIVE ASPECT:
>
>
>
>
>
>
>
>
> 67% of patients at block level said that they rarely visit govt, hospitals during their
illness.
> 57% patients at city level visit government hospital regularly.
> 12% said that the prescribed medicines are not regularly available at the block level.
> 57% adopt homeopathic system and 27% adopt ayurvedic therapy.
> 25% patients said that medicines are not available at same price at different locations.
> 20% patients found that the price of medicine is not reasonable
> 11% patients felt that the medicines are not affordable.
> 99% patients are unaware about NPPA and its role.
CHEMISTS VIEW POINT
POSITIVE ASPECT:
> 100% respondents agreed that medicines are available in the market and there is no
problem in the supply of medicine from the manufacturers
> > 82% chemists said that there is no difference in the price of the same medicine at
different locations.
> > 100% chemists said that there is no price variation in MRP printed on the label for
same medicine sold at different locations.
NEGATIVE ASPECT:
> > 40% chemists at the block level said that sometimes there are shortages of medicines,
which are due to the lack of fund.
> > 57% chemists said that they do have substitute of prescribed medicine available with
them.
> > 45% chemists at town level and 20% at block level reported instances of spurious
drugs but were reluctant to divulge any further information on it.
> > 80% chemists at block level said that patients consult them for medicine.
> > 10% chemists at town level and 20% at block level said that medicines are sold at
MRP plus Sales tax.
> > 19% chemists said that usage of vitamins and 11% said that usages of injectable
minerals are irrational.
> > 98% chemists said that they are not aware about NPPA.
> > 39% chemists said that they do not issue bills or cash memo during the sale of
medicine
> > 30% chemists said that refrigerator is not available at their shop for storage of
medicines.
> > 60% chemists at block level said that sometime patients check MRP, batch number
and the expiry date.
DOCTORS VIEW POINT
POSITIVE ASPECT:
40
>
>
> 98% doctors replied that they use the drugs rationally.
> 97% doctors replied that all the prescribed medicines are easily available.
> > 87% doctors said that medicines being sold at the same price at different locations.
> > 85% doctors said that medicines are sold at MRP.
NEGATIVE ASPECT:
>
> 83% doctors at block level said that there are no private hospitals or nursing home in
their area.
> > 67% doctors at block level confirmed the incidence of spurious drugs but refused to
divulge any further information.
> > 85% doctors are not aware of NPPA.
Chapter 5
EXECUTIVE SUMMAR Y RELA TING TO KARNA TAKA
In Karnataka, 200 patients, 79 chemists, 46 hospitals and 46 doctors were contacted from city,
town and block level. The survey shows that contrary to Uttar Pradesh, in Karnataka both the
government and private hospitals are in good shape and are sufficient in number. Almost 96%
doctors agreed that there are private nursing homes in their area. Even most of the patients avail
the facilities of government hospital.
Almost all the doctors, chemists and patients agreed that all the prescribed medicines are easily
available and incase of some shortage chemists give them substitute medicine after informing the
patients.
There is no frequent price change by the manufacturers and neither there is any incidence of
printing different price of same medicine at different locations. Medicines are normally available
at the same price at different location. All the chemists and doctors said that medicines are sold at
MRP plus Sales tax only. None of the patients complained of any high priced medicine and they
found prices of medicine both reasonable and affordable.
Patients have the habit of avoiding doctors and consulting chemists for the medicine. These are
highly prevalent at block level where 67% chemists said that patients sometime consult them for
medicine. Alternative medicine therapy is almost non-prevalent in Karnataka and all the patients
only prefer allopathic system of therapy. Contrary to Uttar Pradesh, patients of Karnataka are
highly conscious about their rights and majority of them checks the MRP, the batch number and
the expiry date of the. medicine. Awareness about the NPPA is again at its dismal low especially
among common patients, but its recall among doctors and chemists are slightly better.
Drugs are normally used rationally except vitamins and injectable mineral that are seen more as
treatment for any ailment. Hence, there are some cases of irrational usage of vitamin tablets and
injectable minerals. The most alarming finding in this study is that most of the chemists avoid
issuing cash memo after the sale of medicine. Overall, in total 53% chemists said that they rarely
issue cash memo but at the block level the figure is as high as 83%. Being socially developed
state, incidences of spurious drugs are found to be very negligible.
Chapter 5(a)
41
FINDINGS RELATING TO KARNATAKA
5.1
PATIENTS' VIEWPOINT
5.1.1
PA TIENTS DEMOGRAPHIC PROFILE
In all, 200 patients were contacted out of which 120 patients were contacted in city, 54 in
town and 26 in block in Karnataka. Demographic profiles of the contacted patients are
given in Table 23.
TABLE 23: DEMOGRAPHIC PROFILE OF PATIENTS CONTACTED
IN KARNATAKA*
Characteristics of patients surveyed
Age
18-25 yr.______
26-35 yr.______
36 - 45 yr._______
45 + yr._________
Male___________
Female_________
Service_________
Business________
Professional_____
Agriculture______
Housewife______
Others__________
Illiterate________
Upto 8th
Upto 12th
Graduate & above
Sex
Occupation
Education
Monthly
Income
Family
< Rs.6,000_____
Rs.6,000- 12,000
Rs. 12,000-20,000
>Rs.20,000
City (120)
18
29
22
31
79
21
32
14
4
14
18
18
18
30
23
29
74
19
3
4
_____ Percentage of respondents
Town
Block
Total
(54)
11
11
24
54
76
24
11
9
2
50
20
8
35
37
15
13
98
2
0
0
(26)
31
19
23
27
65
35
8
25
4
37
27
15
23
38
27
12
96
4
0
0
(200)
20
20
23
37
73
27
17
16
3
34
22
14
25
35
22
18
89
8
1_
1
♦Figures in parentheses are actual number
As can be observed from the table, respondents were selected in the age group of 18 to
45+ years with 73% of them being male and 27% female. Patients from all walks of life
have been taken for this study. These include service class, business class, professionals,
agriculturist, housewives, etc. They were both illiterates or above graduates, with
monthly income varying from less than Rs. 6,000 to more than Rs. 20, 000 per month.
5.1.2
DOCTOR/HOSPITAL VISITING HABITS OF PA TIENTS
Out of 200 patients contacted for the study in the hospitals and at the chemist shops, 39%
patients said that they go to private doctor clinic, 18% of them go to hospital and 43%
patients go to both doctor clinic and hospital in case of illness (see Table 24). The
percentage of patients visiting hospitals in the case of illness is hardly 19% at the block
level and 6% at the town level, although at city the situation is slightly better at 24%.
This shows that there is lack of proper hospital facility at the block and town levels and
government should look into this matter. Majority of patients visiting hospitals prefers
government hospitals during illness. Around 60% patients reported that they often visit
42
government hospitals during illness. Government should also encourage private parties to
set up hospitals at the block and town levels.
TABLE 24 : DOCTOR CONSULTATION PROFILE OF CONSUMERS*
____________________________________ Percentage of respondents
Questions
City
Town
Block
(120)
(54)
(26)
Whom do you visit in case of illness?
Doctor
30
37
81
Clinic
24
6
19
46
57
0
Hospital
_____________________________________ • • Both
If visiting hospital, how often you go to government hospital?
• • Always
31
• • Mostly
67
0
28
0
60
41
0
20
Sometimes
0
33
20
Never
♦Figures in parentheses are actual number.
5.1.3
Total
(200)
39
18
43
33
29
20
18
A VAILABILITY OF MEDICINES
As the survey shows, there are absolutely no problems in getting the medicines
prescribed by the doctors. These are readily available with the chemists of that particular
area. Around 99% of patients replied that medicines prescribed by the doctors are readily
available as and when required as shown in Table 25.
TABLE 25 : AVAILABILITY OF MEDICINE *
____________________________________ _______
Question
City
(120)
Are the medicines prescribed readily available?
Yes
100
No
0
♦Figures in parentheses are actual number
Percentage of respondents
Town
Block
Total
(54)
(26)
(200)
100
0
92
8
97
3
If the medicines which doctors prescribe are not available in the area, doctors do mention
the name of the shops from where the patients can easily get them. Overall only in 5%
cases patients come back to doctor when they do not get the prescribed medicines.
43
Figure-V : Availability of Medicine
100
—
100 i
0)
O)
(U
.E
0)
Q.
20
o
Di
97
92
•
■
□ Yes
60
40 -
(ft
1
■
80 -
w
c
o
100
sNo
0
0
8
3
0
City
Town Block
Sectors
Total
Chemists do sometimes suggest the patients to buy substitute medicines and the incidence of this
practice is more or less same across the city, town and block levels (see Table 26). 66% of the
patients in the city said that the chemists sometimes suggest buying substitute medicines whereas
in town and block the corresponding percentages are 74% and 92% respectively.
TABLE 26 : SUBSTITUTION OF MEDICINE *
____________________________________ ________
Questions
City
(120)
Chemist suggests you to buy substitute medicines?
0
• • Always
0
• • Mostly
66
• • Sometimes
34
______________________ • • Never
Does chemist give you substitute without informing you?
0
• • Always
0
• • Mostly
11
• • Sometimes
89
• • Never
*Figures in parentheses are actual number
Percentage of respondents
Town
Block
Total
(54)
(26)
(200)
0
4
74
22
0
0
92
8
0
1
72
27
2
0
2
96
0
0
0
100
1
0
7
92
It can also be seen that the chemists never give substitutes without informing the patients.
Although in city 11 percent patients said that chemists do sometimes give substitute medicines
without informing them, but almost 100% patients at the block level and 96% at town level said
that whenever chemists substitute the medicines they clearly inform them about the substitution.
5.1.4
PRICE OF MEDICINE
In the opinion of the patients, drug manufacturers do not frequently change their prices
(see Table 27). The result is same as found in Uttar Pradesh and Karnataka. Almost 94%
patients said that manufacturers do not frequently change prices. Only 6% patients
replied that they find frequent/substantial price increases in the medicines by the
manufacturers.
TABLE 27 : PRICE OF MEDICINE*
Questions
City
(120)
Percentage of respondents
Town
Block
Total
(54)
(26)
(200)
44
Is there a frequent price change by manufacturers?
Yes
_______________________________________________ No
Is there any price difference for same medicine at different
locations?
Yes
No
0
100
2
98
15
85
6
94
5
95
2
98
4
96
96
4
*Figures in parentheses are actual number
There are also no reported cases of manufacturers printing different price for the same
medicine at different locations and majority of them adhere to this practice in Uttar
Figure-VI: Frequent Price Change by
Manufacturers
tn
c
o
*□
c
100 q
Q.
tn
60 -
a:
40
o
98
94
II
80
111
o
H-
O
0)
o
ra
20<
□ Yes
SNo
2
0
U.P
Kar.
States
Pradesh as well as in Karnataka (see Figure VI).
Again patients hardly find any price differing for the same medicine at different locations.
96% of patients replied that they never found any price difference in medicine at difference
locations and the scene is same across city, town and block levels. 4% who said that the
shortages are there, is mostly in the case of those medicines that are in short supply. But there
is no reported incidence of manufacturers printing different price for different locations.
In respect of reasonableness of prices, all the patients felt that prices are both reasonable and
affordable. The general opinion, which patients shared, was that they have to take medicines
prescribed by the doctors and reasonable price do help them to afford fully prescribed
medicines.
5.7.5
PROCUREMENT AND PURCHASING PA TTERN OF MEDICINES
There are some differences found in response in regard to the question whether the
patients get the medicines free of cost at the place of treatment (see Table 28). Whereas
100% and 80% patients at the town and block levels respectively said that they get
medicine free of cost, at the city level only 69% said so.
TABLE 28 : MEDICINE PURCHASING BEHAVIOUR OF CONSUMERS*
Percentage of respondents
45
Questions
Are medicines available free of cost at the hospital
(Government or Private), where you visit for illness?
Yes
No
Does doctor give you medicines?
Yes
No
If yes, is it charged or free?
Charged
Free
If charged, do you get the bill or cash memo?
Yes
No
Do you check the prices?
Yes
No
*Figures in parentheses are actual number
City
(120)
Town
(54)
Block
(26)
Total
(200)
69
31
100
0
80
20
83
17
22
78
0
100
0
100
7
93
50
50
0
0.
0
0
50
50
75
25
0
0
0
0
75
25
67
33
0
0
0
0
67
33
The table also shows that hospitals often avoid giving medicines and leave that task to the
chemists. At the city level, 22% patients said that doctors do give them medicine. But
both at town and block levels, 100% patients reported that doctors never give them
medicines. 50% patients in city said that in case doctors give them the medicines they do
charge for that.
5.1.6
A VAILABILITY OF AL TERNA TIVE THERAPY
Unlike patients of Uttar Pradesh, patients in Karnataka avoid going for alternative
therapy. Among 200 patients surveyed, 100% of them at the city, town and block levels
said that they are adopting allopathic medicines (see Table 29).
TABLE 29 : AVAILABILITY OF ALTERNATIVE MEDICINE *
Question
City
(120)
Percentage of respondents
Town
Block
Total
(54)
(26)
(200)
System of medicines prevalent in area.
100
0
0
0
0
Allopathic
Homeopathic
100
0
0
0
0
100
0
0
0
0
100
0
0
0
0
Auryvedic
Unani
Traditional__________________________________________
♦Figures in parentheses are actual number
5.1.7
INCIDENCE OF SPURIOUS DRUGS
The instances of spurious and sub-standard drugs noticed by patients are very rare (see
Table 30). Around 100% patients in city said that they have never noticed any instance of
spurious drugs. There are few reported instances of spurious and sub-standard drugs at
the town and block levels. 94% and 96% patients at the town and block levels
respectively said that they have rarely noticed spurious drugs in the market. In case they
have noticed any shop selling the spurious/substandard drugs, they have never gone to
that particular shop again for purchasing the medicines.
46
TABLE 30 : INCIDENCE OF SPURIOUS DRUGS*
_____________________________________________ Percentage of respondents
Question
City
Town
Block
Total
(120)
(54)
(26)
(200)
Any instance of spurious drugs noticed by you?
Many a
times
Sometime
Rarely
Never
0
0
0
100
2
0
4
94
0
0
4
96
1
0
3
96
*Figures in parentheses are actual number
5.1.8
PA TIENTS' A WARENESS
79% patients are well aware of number of chemist shops in their area. Out of these,
however, only 13% of them are aware of 24 hour opened chemist shop. Patients are
hardly aware about any Patients Forums or NPPA (see Table 31). So in the case of any
problem of spurious drugs or charging higher price for medicines, they do not know
whom to approach. Around 98% of the patients do not even know what NPPA is and
what is its role. NPPA needs to do a lot to increase awareness about its role in curbing
discrepancies in drug pricing and sale of spurious drugs.
A very interesting point, which comes out from this study is that more than 50% patients
either sometime or never ask for the bill/cash memos and the same is true across block,
town and city levels. This shows that there is no interest among the patients to check
whether the extra money that is being charged from them is in the form of taxes or just
chemists are over-charging them, as they want. This also shows lack of awareness among
the patients of the importance of cash memo and how it can be used if something goes
wrong.
TABLE 31 : AWARENESS ABOUT NPPA AND CASH MEMO
DEMANDING PRACTICE*
Questions
City
(120)
Percentage of respondents
Town
Block
Total
(54)
(26)
(200)
Awareness about NPPA?
Yes
No
2
98
0
100
96
4
12
4
9
37
50
4
0
46
50
2
98
Does patients ask for cash memo on buying medicines?
•
•
•
•
Always
Mostly
Sometimes
22
50
16
9
16
46
29
Never
♦Figures in parentheses are actual number
Various suggestions given by the patients to bring the changes in medical care sector are:
• • Medicines should be made available at reasonable prices.
• • Medicine quality should be good and should keep on improving.
• • Medicines should be made easily available at far-flung villages.
5.2
CHEMISTS' VIEW POINT IN KARNATAKA
47
5.2.1
•
•
•
A VAILABILITY OF MEDICINES
Chemists ensure the availability of medicine to patients by the amount of vast stock of
medicines they carry. Out of 79 chemists surveyed, majority of the chemists, i.e., 96%
reported that medicines.demanded by the patients are always or mostly available (see
Table 32 and Figure VII). At the block level, however, there seems to be slight shortage
of prescribed medicines. 17% chemists reported that there are sometimes shortages of
prescribed medicines. The main reasons reported by the chemists for not stocking all the
medicines are:
Less demanded medicines are not stocked.
• Daily one or other medicine is coming to the market and it’s difficult to stock all of
them.
• We don’t keep the stock because of expiry problem and no proper exchange is done
from the company to those expired medicines.
• Huge funds are required to stock all the medicines.
TABLE 32 : AVAILABILITY OF PRESCRIBED MEDICINES*
Question
Required medicines available
• • Always
• • Mostly
_________________ • • Sometimes
* Figures in parentheses are actual number
City
(52)
______________
Town
(21)
73
23
4
62
38
0
Percentage of respondents
Block
Total
(79)
(6)
50
33
17
68
28
4
Table: 33 (a) NAME OF MEDICINES WHOSE SUBSTITITE ARE AVAILABLE
S.No
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
Name ofMedicines That Are In Shortage And Whose Substitutes Are Available
Ceftum 250______
Norfloxacin______
Nimotas - CD
Syrup Ossidos - T
R - Butol________
Flugraine
~ PNA
Flozen__________
Vidaylin - M Drops
Hycal Forte______
Sormo__________
Monopark
Monicor_________
IHD____________
Ciplox__________
Cefadyl__________
Pyrodex_________
| Novamox
There are few medicines that are in short supply and for which substitute are also not
available are given in Table 61 (b).
Table: 33 (b) NAME OF MEDICINES WHOSE SUBSTITITE ARE NOT AVAILABLE
48
S.No
Name of Medicines That Are In Shortage And Whose Substitutes Are Not
Available
1
2
3
4
5
Enthro___________
Ranitidine________
Scoline__________
Helex____________
Adelphane - Esidrex
Pyridactil_________
Pantodac - 40
Inj. Clexane_______
Angised Tab.______
Disulfiram
6
7
8
9
10
Figure-VII: Availability of Medicine
_ 100 -|
<D
D)
80 - 73
— 60-1 n
■
0)
c
o
Q.
V)
0>
al
40 20 0
23
3
68
62
~|
I38
50
n
ED Always
2S
O Mostly
L
□ Sometime
1^4
II
City
Town Block Total
0
I i -i—i
□ Never
Sectors
68% chemists said that the substitutes of the prescribed medicines are available and
around 63% of patients do take substitutes in case the prescribed medicines are not
available. Like found in Uttar Pradesh, chemists of Karnataka also stock only those
medicines which are being prescribed by the doctors practicing in their area. But if the
patients come to them with the prescription by the doctor of some other area and the
chemists are unable to provide the medicines, they do guide the patients to the right shop
where the prescribed medicines will be available.
5.2.2
A VAILABILITY OF OVER THE COUNTER DRUGS
In this study, it was also observed that there are number of medicines which are being
sold in high volume without prescription. The most commonly sold medicines without
prescription are: Crocin, Saridon, Disprin, Navalgin, Vicks Action 500, Brufen, etc. These
are those drugs that provide faster relief, easily available over the counter (OTC) and are
common ailment medicines sold without prescription.
5.2.3
INCIDENCE OF SPURIOUS DRUGS
49
Unlike Uttar Pradesh, none of the chemists in Karnataka at the city, town and block
levels have noticed any instances of spurious drugs.
5.2.4
CHEMIST CONSULTA TION FOR MEDICINE
It has also been observed during the study that patients do consult chemists for the
medicines especially for common ailments. This is true for all the three areas, viz., city,
town and block. As seen in Table 34, 46% city chemists, 24% town chemists and 67%
block chemists replied that patients sometimes consult them for medicines. In case of
common ailments, patients avoid doctors and consult chemists because it not only saves
doctor consultation fees but also avoids the hassles of visiting the doctors. In the case of
blocks, the poor presence of doctors also forces the patient to consult the chemists.
TABLE 34 : CONSULTING CHEMIST FOR MEDICINES*
___ _________________________________________ _______ Percentage of respondents
Question
City
Town
Block
Total
(52)
(21)
(79)
(6)
Customer consults chemist for medicines?
4
Many a
0
0
3
times
46
24
67
42
71
35
33
44
Sometimes
15
5
0
11
Rarely
Never
*Figures in parentheses are actual number
5.2.5
PRICE OF MEDICINE
As seen in Table35, there is hardly any price variation of same medicine at different
locations especially at the town and block levels.
TABLE 35 : PRICE DIFFERENCE OF PRESCRIBED MEDICINE*
__________________________________________________ t_______
Questions
City
(52)
Price difference at different location.
Yes
31
No
69
Is difference is in all or some medicines.
Some
87
All
13
What price medicines are sold?
96
• • At MRP (MRP + S.Tax)
0
• • Less than MRP
4
________________________ • • More than MRP
* Figures in parentheses are actual number
Percentage of respondents
Town
Block
Total
(21)
(6)
(79)
5
95
0
100
22
78
100
0
0
0
88
12
100
0
0
100
0
0
98
0
2
Out of 79 chemists surveyed, 78% of them in general replied that there is no price
difference for the same medicine at different locations. However, at the city level, 31%,
said that there is price variation for same medicine at different locations. But the price
difference has been found only for select medicines. 87% chemists at city level and 100%
chemists at the town level said that even if there is difference in price, it is only for few
selected medicines. These are those medicines that are either less stocked due to non
availability or are critical life saving drugs.
50
There is hardly any difference in the responses of chemists at the city, town and block
levels regarding whether the medicines are sold at MRP. Around 100% chemists across
the city, town and block levels agreed that medicines are sold at MRP (see Figure-VIII).
Figure-VIII: Medicine Available at MRP
100
05 80 -
100
100
96
98
n
□ At MRP
i(D 60W
C
o
Q.
0)
0)
ai
fl<MRP
40 -
□ >MRP
20 0 -
4
City
0
0
0
Town
0
Block
I cr 2
Total
Sectors
5.2.6
DRUG USAGE AND DISTRIBUTION PATTERN
It was again unanimous opinion on the usage of various types of drugs with regard to
which most of the chemists said that the drug usage is rational. 99% chemists replied that
usage of antibiotic is rational, 98% chemists replied that usage of injection and IV fluid is
rational. 90% chemists replied that usage of vitamins is rational and 92% chemists replied
that usage of injection minerals is rational. The negligible instances of irrational drug
usage in the case of vitamins and injection minerals are largely due to the wide usage
pattern of these drugs. Vitamins and minerals are widely recommended as it can be used
with antibiotics, and any type of diseases and weakness.
The distribution system of medicine is again two ways. It is either through
distributor/company salesmen or directly from the distributor. But contrary to Uttar
Pradesh, chemists of Karnataka mostly procure the required medicines through
company/distributor salesmen. 92% chemists depend on company/distributor salesmen
for the supply of medicine. Only 4% chemists said that they collect the medicine directly
from the distributor.
5.2.7
CHEMISTS A WARNESS AND SELLING PRA CTICES
Awareness about NPPA is better in Karnataka than Uttar Pradesh. As seen in Table - 36,
out of 79 chemists surveyed, 43% chemists from city, 44% chemists from town and 33%
chemists from block are aware of NPPA.
TABLE -36: AWARNESS ABOUT NPPA*
__ ______________________________ _________ Percentage of respondents
Questions
City
Town
Block
Total
(52)
(79)
(21)
(6)
Awareness about NPPA?
Yes
44
43
33
43
f’v' 51
08371 P*
)
H
I
No |
56
57
67
57
♦Figures in parentheses are actual number
In 38% shops bill/cash memo are being always issued and in 43% shops bills/cash memo
were either issued in some cases or were not issued at all (see Table-37).
TABLE -37: CASH MEMO ISSUED WITH THE SALE OF MEDICINE*
f__________________________ _________________________ _______ Percentage of respondents_____
Questions
City
Town
Block
Total
(52)
(21)
(79)
(6)
Cash memo issued?
56
0
17
38
All cases
27
71
83
43
Some cases
4
29
0
10
None
13
0
0
9
No customer
present_____________________________________________ _______ ________
♦Figures in parentheses are actual number
The scene is worse at the town and block levels where 71% and 83% chemists
respectively replied that they issue cash memo only in some cases. This clearly indicates
that chemists take the advantage of poorly medically aware patients at the town and block
levels and might be selling the sub-standard or the expired drugs at arbitrary prices. If in
case any untold incidence happens, the patients can never claim the compensation.
During the study it was observed that in all the 79-chemist shops, prescribed medicines
are properly stored in cupboard and refrigerator. Unlike Uttar Pradesh, almost all the
shops in Karnataka at the city, town and block levels are equipped with refrigerators.
5.2.8
PATIENTS AWARENESS: CHEMISTS VIEWPOINT
The city and town patients are more aware than their counter part at block level (See
Table-38). 85% city and 86% town chemists said that patient always or mostly check
MRP before purchasing the prescribed medicine, but at block level it is only 50%.
According to chemists, patients are also aware of batch no/expiry date and mostly check
them before buying the medicine. 32% of chemists replied that customer always check
and 50% said that patients mostly check batch no/ expiry date before buying the
medicine.
Although in Karnataka patients are more aware about their rights, yet government should
try to educate the patients and make them more aware about their medical rights.
TABLE-38: PATIENTS AWARNESS*
_______________________________ ________ Percentage of respondents
Questions
City
Town
Block
Total
(52)
(21)
(79)
(6)
Does customer check MRP?
37
24
33
33
• • Always
48
62
17
49
• • Mostly
15
14
50
18
0
0
0
0
Sometimes
• • Never
Customer checks batch no/expiry date?
35
24
33
32
• • Always
48
57
50
50
• • Mostly
17
19
17
18
0
0
0
0
Sometimes
• • Never
♦Figures in parentheses are actual number
52
5.3
HOSPITAL DOCTORS VIEW POINT IN KARNATAKA
In all, 46 hospitals were contacted in Karnataka and all of them reported that medicines
are normally prescribed keeping patients economic conditions in mind. Like Uttar
Pradesh, doctors of Karnataka hospitals are also not happy with the government hospital
services and feel that it is not adequate to meet the demand of the local patients. More
than 59% percent doctors said that number of government hospitals is not adequate and
61% said that number of government dispensaries is not adequate. Lack of government
ambulances and vans only makes the matter worse. Around 72% doctors replied that the
government vans are not adequate. But the case of private hospitals and nursing homes
are totally opposite. Hardly 17% doctors replied that private hospitals are not adequate
and only 3% doctors said that private nursing homes are not adequate.
Poor management, low priority to healthcare, lack of proper vigilance and lack of fund
only aggravates the matter. This is clearly visible from the response as 100% doctors
agreed that there are adequate numbers of private practitioners. With poor condition and
maintenance of government hospitals, private nursing homes and hospitals become free
to charge what they want. Ultimately patients bear the burnt of the governmental
lackluster.
According to the doctors, there are reported cases of sub-standard and spurious drugs.
60% doctors said that they had heard of spurious/substandard drugs being sold in the
market and this is more or less same across city, town and block level. None of the doctor
is aware about licensed drugs manufacturing units in the local areas. Although awareness
about NPPA is low among the doctors also, but compared to patients and chemists they
are slightly more aware. More doctors of Karnataka are aware of NPPA then that of Uttar
Pradesh. Whereas only 28% doctors of Uttar Pradesh said that they are aware of NPPA,
incase of Karnataka it is 50%. But still NPPA needs to boost up their publicity campaign
and doctors can be one of the effective medium.
100% of doctors replied that all the medicines which they prescribe, are easily available
and all agreed upon medicine being sold at same price in different locations. 100%
doctors agreed that medicines are sold at MRP.
5.4
GENERAL DOCTORS VIEW POINT IN KARNATAKA
5.4.1
PRESCRIPTIONAS PER PA TIENT'S ECONOMIC CONDITION
In Karnataka out of a total of 46 doctors surveyed, more than 96% doctors across city,
town and block levels, replied that they always keep patients economic condition in mind
before prescribing medicines to them, (See Table-39).
TABLE -39: MEDICINE AS PER PATIENTS ECONOMIC CONDITION*
Questions
City
(25)
Do you keep see patient’s economic condition while
prescribing medicines?
Yes
No
96
4
Percentage of respondents
Town
Block
Total
(4)
(46)
(17)
94
6
100
0
96
4
53
* Figures in parentheses are actual number
5.4.2
A VAILABILITY OF MEDICAL AID IN THE AREA
Mixed response came out with regard to whether the number of various service providers
is adequate or not (See Table-40).
TABLE -40: DOCTORS OPINION ABOUT MEDICAL AID*
_____________________________________________________ Percentage of respondents
Questions
City
Town
Block
Total
(25)
(17)
(46)
(4)
Opinion about medical aid in area?
Govt. Hospital
Yes
44
88
75
63
12
25
___________ No
56
37
Govt. Dispensary
25
44
70
52
Yes
56
75
___________ No
48
30
Govt. Vans
32
59
43
Yes
50
50
41
68
___________ No
57
Pvt. Hospital
84
65
Yes
75
76
24
25
16
35
___________ No
Nursing Homes
88
Yes
100
100
96
12
0
0
4
No
Private Practitioners
Yes
No
96
4
100
0
100
0
99
1
* Figures in parentheses are actual number
The survey shows that there are adequate number of government and private hospitals in
town and block but fewer numbers of government hospitals and dispensaries in city. In
the case of city, 56% doctors said that the government hospitals and government
dispensaries are not adequate. But 84% doctors said that private hospitals and 88% said
that private nursing homes are adequate in the city. It shows that private doctors and
businessman are taking the advantage of insufficient government hospitals in the city and
investing more. But the scenario is balanced at the block and town levels. At the block
levels 75% doctors and at the town levels 88% doctors said that there are adequate
numbers of government hospitals, but 75% doctors at block level feels that the
government dispensaries are in inadequate numbers. Government should come out with
incentives and policies to promote private party investments in these areas.
There is consensus regarding availability of government vans at the city, town and block
levels. On an aggregative level 57% doctors said that government vans are not adequate.
Although the scenario in Karnataka is better than Uttar Pradesh where there is hardly any
proper government van or government hospital at the city level. In the case of private
practitioners the response seems to be the same across city, town and block levels, as
around 99% feel that there are adequate numbers of private practitioners. Especially at
the block level where the government dispensaries are fewer in number, the private
practitioners fulfill this gap. Unlike Uttar Pradesh there is no dearth of either private
hospitals or private nursing homes at the city, town and block levels in Karnataka. 76%
54
doctors said that there is adequate number of private hospitals and 96% doctors said that
there is adequate number of private nursing homes in their area.
5.4.3
PREVALENT DISESASES IN AREA AND MEDICINE PRESCRIBED
The prevalent diseases of this area as per the doctors are: Malaria, Gastroentritis,
Respiratory Infections, Tuberculosis, Entritic Fever, Typhoid etc. The detail list is given
in the Table- 41, alongwith the list of medicine prescribed for those diseases.
TABLE-41: PREVELANT DISEASE AND THE MEDICINES PRESCIRBED*
Sn.
Endemic Disease
Medicine Prescribed
1
Gastroenteritis
2.
Malaria
3.
Respiratory
Infections
4.
Entric Fever
5.
Typhoid
6.
7.
8.
9.
10.
ARI
Viral Fever
TB
Dental Disease
Upper Respiratory
Tract Infection
Lower Respiratory
Tract Infection
Anaemic
Amebic Dysentry
Infection Disease
Hepatities
Helmenthis
Acidpeptic Disease
UT1
Artherities
Jaundice
Flu
Diarrhoea
Tinidazole, Metronidazole, Ciprofloxacin, Ranitidine,
Norfloxacin, Taxim-O, Oframax, Meganeg, Tetracycline, Norflox,
Metrogyl, Metromidazole, Nalidixic acid, Furoxone,
Cotrimoxazole, Gelusil, Lanzol, Rantac
Chloroquine, Amalar, Paraquin, Quinine,
Lariago, Reziz, Primodil, Nivaquine, Imol,
Amoxycillin, Penicillin, Analgesic, Vepen,
Sparfloxacin, Roxithromycin, Cotrimoxazole, Ampicillin,
Cioxacillin
Ciprofloxacin, Chloromycetin, Analgin, Ciplox 500mg,
Perinorm, Ofloxmacin, Sparfloxacin, Paraxin, Alcipro, Norflox,
Ofloxmacin, Ciprofloxacin, Chloramphenicol, Cepetroxic
Sparfloxacin, Paraxin, Paracetamol Ceftrioxane, Cefixime
Co-Trimoxazole, Ampicillin, Amoxycillin
Inj. PFT, Dexona, Quintor
Refobacin, INH, Ethanhite, Ethambutol, Pyrazinamide, Isoniazid
Amoxycillin, Aeromox
Ampidil, Tab Restyl, Paracetamol, Amoxycillin,
Cotrimoxazole
Paracetamol, Amoxycillin, Cephalexin
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
Ziferrin-TR, Fezee
Tinidazole, Ciplox-TZ, Inj.Garamycin, I.V.Dextros
Ciprofloxacin, Zentamysin
Analiv, Vitamin B.Complex, Tonics, Liv-52
Albendazole
Ranitidine, Omeprazole, Lansoprazole
Syproxin, Amikacin
Doliprane, Ibuprofen, Profentol
Liv-52, Cap.Hepin, Livomyn
Paracetamol, Crocin, Alcipro
Lopamide, Norfloxacin, Flagyl, Ciplox-TZ, Norflox-TZ,
Cefuroxime
Ceftriaxone, Cefuroxime, Amoxycillin,
Roxythromycin, Amoxycillin
Amotid, Novamox
23.
Bronchopneumonia
24.
Bronchitis
25.
Tonsil
* The prescribed medicines against the respective disease are as per the views ofthe respondents. Although on actual
checking with some senior doctors it is found that some medicines are wrongly prescribed.
55
5.4.4
A VAILABILITY AND PRICE OF MEDICINE
There is no problem in the availability of medicine and 100% doctors replied that all the
medicines, which they prescribe, are easily available. Again all the doctors agreed upon
medicine being sold at same price at different locations and are, moreover, sold at MRP.
There are rarely any instances of medicines being sold above MRP.
5.4.5
INCIDENCE OF SPURIOUS DRUG
44% doctors said that they had heard of spurious/substandard drugs sold in the market.
As seen in Table-42, the incidence of spurious and sub-standard drugs is more at block
level where around 75% doctors confirmed the incidences of spurious drugs. But it is
slightly lower at town and city level where only 35% and 40% respectively doctors
confirmed the incidence. The low quality checking by the drug companies and NPPA,
lack of drug awareness campaign and low literacy rate makes these markets, especially at
the block level vulnerable to spurious drugs. It is clearly observable from this study that
doctors have identified the spurious drugs more than that of patients and chemists.
TABLE -42: AVAILIBILITY OF SPURIOUS DRUGS*
____________________________________________________ _______ Percentage of respondents
Questions
Town
City
Block
Total
(25)
(17)
(46)
(4)
Are there any instance spurious drugs marketed in the area?
4
0
0
2
12
0
9
25
Always
28
50
35
33
56
65
25
56
Mostly
Sometimes
Never
*Figures in parentheses are actual number
5.4.6
As doctors are medically more informed, they can identify the spurious and sub-standard
drugs more easily than the patients and chemists. Whereas around 44% doctors said that
there are instances of spurious drugs in the market, only 1% chemists and 4% patients felt
so.
DOCTORS A WARENESS
Unlike Uttar Pradesh, doctors of Karnataka are more aware about NPPA.
TABLE - 43: AWARNESS OF DOCTORS*
____________________________________________________________ Percentage of respondents
Questions
Town
Block
City
Total
(25)
(46)
(4)
(17)
Aware of licensed drug manufacturing unit in local area?
24
Yes
28
24
0
72
No
76
100
76
Aware of NPPA
48
Yes
65
75
57
52
No
25
43
35
Any idea on prices of drugs?
88
88
75
87
Yes
12
No
12
25
13
*Figures in parentheses are actual number
As seen in Table-43, 57% doctors are aware of NPPA and surprisingly doctors at block level are
more aware than that of city level. Where 75% doctors at block level said that they are aware of
56
NPPA, at city only 48% said so. So, NPPA has to concentrate more at city to increase its
awareness.
Only some doctors of city and town are aware of licensed drug manufacturing units in their
locality as 24%city doctors and 28% town doctors confirmed this. But 100% block doctors said
that they have no idea about any licensed drug manufacturing units in their locality. More than
88% doctors across city, town and block said that they have adequate knowledge about the drug
prices.
Chapter 5(b)
EXPERTS AND FIELD STAFF’S OBSERVATIONS IN KARNATAKA
Following are the findings based on the personal observations of the experts and the field staff on
the drug availability, price, distribution and patient awareness made by them during the survey
conducted in Hubli (city), Chikkaballapur (block) and Mandya (town) in Karnataka.
5.1
PA TIENT A WARENESS
Most of the patients do not clearly or correctly remember the names of medicines they
buy. However, old aged patients and those suffering from chronic diseases such as
arthritis, asthma, diabetes, cardiac diseases etc., know the names of the prescribed
medicines. But none of them are aware of any substitute drugs. Sometimes, chemists
suggest them the substitute medicine or inform them about the latest arrivals. Patients
then consult the doctors on the information provided by the chemists about substitute or
the latest arrived drugs before they use it. This is the case with educated patients, but
others take the advice of the chemist without going back to the doctors. Patients consult
chemists for common ailments such as flu, dysentery, headache, bodyaches, fever,
stomach pain and other such routine illnesses including cough and cold. All chemists sell
these drugs across the counter without demanding doctors prescription.
5.2
CHEMIST A WARENESS
Chemists said that doctors and hospitals get supply of several drugs directly from
manufacturers at prices 60 to 80 per cent less than the MRP. It is not unusual to find
these drugs finding their way into the retail market and thus the prices of some drugs vary
in the market. Some doctors also dispense free drug sample to their patients and charge,
as they like. They also don’t give any cash memo for those drugs. According to the
version given by some patients in Hubli, the doctors remove the foil/packing/cover of the
medicines and pack the medicine in ordinary white paper or newspaper bits and sell it to
them
Chemists get supply of drugs through distributors appointed by the manufacturers. Few
manufacturers also supply to the to the retailers directly. Atleast in 30% of chemist
shops, the services of advice of trained pharmacists are is available. These shops are run
with absentee chemist, who lends their certificate to the shop owner for a price.
All chemists and patients are unanimous in their opinion that MRP of drugs should
include all taxes. The present practice of making extra taxes on MRP is creating
57
confusion in the retail prices of drugs. Retailers are the ultimate gainers as they arbitrarily
charge higher prices on MRP. It was found that the same generic drug manufactured by
different companies was available at a difference of 500 percent. A few examples are
given in Table 44:
TABLE-44: PRICE DIFFERENCE OF SAME MEDICINE
Manufacturers Name
Drug Name
Weight
MRP (Rs.)
Cipla
Salbutamol
4 mg
0.54 each
Eros Pharma Bangalore
Salbid
4 mg
0.17 each
Cipla
Ciplox
500 mg
8.00 each
Ciprofloxacin
(Generics)
500 mg
3.00 each
Bluecross
Cadila
Blumox
2.50 each
Amoxycillin
(Generics)
0.50 each
Wormin
A11 indazole
(Generics)
12.00 each
3.25 each
\t is seen that in case of several non-controiled drugs i.e., vitamins, minerals and tonics, the
difference between the price charged by the manufacturer to the retailer and the price to the
patient is well over 400%. For example:
Drug Name:
Price to Retailer:
MRP to Patient:
Nimesulide
Rs. 6 per 10 tablets
Rs.24.00 per 10 tables
Some of the chemists observed that a cartel exists among major drug manufacturers in the
country. They also complained on lack of accountability and transparency at the drug control
department due to which rules and regulations as used to take undue favors from the business
community on flimsy grounds. Shops dealing with medicine sale are harassed by the Government
machinery on such grounds that are legally not maintainable. Some percentage of drugs
manufactured by the small-scale sector also comes into the market that avoids excise duty.
Through the distributor network, these get into the retail market or supplied to the hospitals at
varying MRP leading to price variation and unhealthy competition.
Medicines required by the patients are “mostly” available and non-availability is temporary.
Medicines that generally are not available and for which any substitute is also not available are:
58
ANDISED TAB and DISULFURAN. The commonly sold OTC medicines in high volume are
shown in Table-45:
TABLE-45: COMMONLY SOLD OTC MEDICNES IN HIGH VOLUME
Name
Crocin
Anacin
Gelusil
Saridon
Atenolol
Anlodepine
Daonil
Glyciphage
Price
No.
Rs.6.70
Rs.3.80
Rs.7.30
Rs. 10.50
10 tab
Rs.22.75
Rs.24.95
Rs.7.20
Rs.8.50
10 tab
10 tab
10 tab
14 tab
10 tab
10 tab
10 tab
Knowledgeable and experienced chemists have remarked that doctors indiscriminately prescribe
antibiotics, vitamins and mineral supplements and tonics. It has also been observed that all the
chemist shops were crowded throughout their business hours. The chemists complained about the
lack knowledge of new drugs that are being introduced in the market. According to
Mr.C.Gundurao, President, Karnataka Pharmacy Council, Bangalore, ua programme of
continuos education by the drug manufacturer is a must for the chemists in the retail shops.
This will regularly update them with new developments in the drug market.
5.3
DOCTORS / HOSPITALS
While at Chikkaballapur and Mandya, doctors and hospitals cooperated with the survey;
doctors and hospitals in Hubli were difficult to handle.
Several doctors complained of adulteration in I.V. fluids, enzyme preparations,
antibiotics, vitamins and tonics. They are of the opinion that there exists a manufacturer
- distributor mafia in the drug industry who is continuously engaged in distributing
adulterated drugs throughout the country. The doctors felt that the present drug control
laws need to be amended and should provide confiscation of assets of such manufacturers
and distributors besides imposing death penalty to those proved guilty of adulteration of
drugs.
Manufacturers generally supply drugs to the hospitals directly. Both the MNC’s and
medium or small manufacturers supply drugs to this segment at special prices which
could be 20% to 60% less than the MRP. But the hospitals / doctors charge the patients
at MRP and thus make huge profits.
59
Chapter 5(c)
SUMMARY OF THE FINDINGS OF KARNATAKA
PATIENTS VIEW POINT
POSITIVE ASPECT:
>
>
>
>
>
>
> 97% patients said that the prescribed medicines are available.
> 94% patients said that there is no frequent price change in the medicine by the
manufacturer.
> 100% patients agreed that medicines are available in the market and there is no
problem in the supply of medicine from the manufacturers.
> 96% patients said that medicines are available at same price at different locations.
> 99% patients said that in case the prescribed medicine is not available chemists give
them substitute medicine only after informing them.
> 100% patients found the price of medicine reasonable and affordable.
NEGATIVE ASPECT
> > 100% patients said they adopt only allopathic system of therapy.
> > 62% patients said that they visit govt, hospitals during their illness.
> > 98% patients are unaware about NPPA and its role.
CHEMISTS VIEW POINT
POSITIVE ASPECT
>
>
>
>
>
>
> 100% chemists said that medicines are sold at MRP plus Sales tax.
> 100% chemists said that there is no price variation in MRP printed on the label for
same medicine sold at different locations.
> 96% chemists said that required medicines are available.
> 96% patients said that there is no incidence of spurious drugs.
> 100% chemists said that there had been no instances of spurious drugs.
> 82% chemists at said that patients check MRP and batch/ expiry date during the
purchase of medicine.
NEGATIVE ASPECT
> > 67% chemists at block level said that patients consult them for medicine.
> > 68% chemists said that they do have substitute of prescribed medicine available with
them.
> > 78% chemists said that there is no difference in the price of the same medicine at
different locations.
60
> 10% chemists said that usage of vitamins and 8% said that usages of injectable
minerals are irrational.
> > 83% chemists at block level said that they issue bills/ cash memo during the sale of
medicine only in some cases.
> > 57% chemists said that they are not aware about NPPA.
>
DOCTORS VIEW POINT
POSITIVE ASPECT
>
>
>
>
>
> 100% doctors at block level said that there are private hospitals / nursing home in
their area.
> 98% doctors replied that they use the drugs rationally.
> 100% doctors replied that all the prescribed medicines are easily available.
> 100% doctors said that medicines being sold at the same price at different locations.
> 100% doctors said that medicines are sold at MRP.
NEGATIVE ASPECT
> > 11 % doctors confirmed the incidence of spurious drugs but refused to divulge any
further information.
> > 57% doctors are not aware of NPPA.
Chapter 6
EXECUTIVE SUMMARY RELATING TO ALL INDIA
At All India level, 401 patients, 149 chemists, 81 hospitals and 92 doctors were contacted from
city, town and block level. The survey shows that both government and private hospitals are just
matching patients need and hardly 52% patients visits govt, hospitals during their illness. Almost
90% doctors agreed that there are private hospitals / nursing home in their area but majority of
them said that government hospitals and government vans are not adequate.
More than 95% of chemists, doctors and patients said that the prescribed medicines are available
in the market and there is no problem in the supply of medicine from the manufacturers. They
also said that in case the prescribed medicines are not available chemists give them substitute
medicine only after informing them.
There is no frequent change in the price by the manufacturer, neither there is any incidence of
printing different price of same medicine at different locations. There are very few cases of price
difference of same medicine at different locations. They are those medicines that are in high
demand and costly. Sometime, it also happens due to shortage of fund with the chemists and is
purely temporary in nature. Majority of the respondents agreed that medicines are sold at MRP
plus Sales tax only. In this survey hardly any patient complained of high priced medicine, as they
all found medicine prices both reasonable and affordable.
Although 98% doctors said that they use drugs very rationally but few chemists complained of
irrational usage of vitamins and injectable mineral that are seen more as common treatment for
any ailment. 15% chemists said that usage of vitamins and 10% said that usages of injectable
61
minerals are irrational. The most alarming thing in this study is that around 65% chemists said
that they do not issue cash memo after the sale of medicine.
In the backward areas and less developed state like Uttar Pradesh, chemists are found violating
drug policy norms of storing medicine in the refrigerators. There are few reported incidences of
spurious drugs by the doctors, but neither the patients nor the chemists nor the doctors are willing
to divulge any information on the shops that are selling those medicines.
Patients have the habit of avoiding doctors and consulting chemists for the medicine. 54%
chemists agreed that patients consult them for medicine. Although allopathic form of therapy is
widely prevalent but patients are also exploring the facilities of homeopathic and auyurvedic form
of medicine. Awareness about NPPA is at its dismal low especially among common patients
where 98% said that they have never heard about NPPA. But its recall among doctors was
slightly better where 64% of them recognized the name and role of NPPA. But over all the
patients are more aware about their rights and around 87% chemists said that patients check
maximum retail price (MRP), batch number and expiry date during the purchase of medicine.
Chapter 6(a)
FINDINGS RELATING TO ALL INDIA
In order to have a holistic view, the data collected for the two states were consolidated, and these
are presented and analyzed in this chapter. This chapter not only provides an all India view, but it
also enables us to have a comparative look at the state of the health care services in the two states.
6.1
PATIENTS’ VIEWPOINT
6.. 1.1
PA TIENT’S DEMOGRAPHIC PROFILE
The separate profiles of the surveyed respondents in the two states along with the
consolidated picture for the country as a whole are presented in Table 46. Baring a few
categories, it can be observed that the percentages of the respondents belonging to
different age, sex, occupation, education and monthly income groups are more or less
same for the two states.
TABLE 46 : ALL INDIA DEMOGRAPHIC PROFILE OF CONSUMERS*
Characteristic of patients
surveyed
Age
Sex
Occupation
18-25 yr.
26 - 35 yr,
36-45 yr.
45 +yr.
Male
Female
Service
Business
City
u. P.
(126)
KAR
(120)
29
38
20
13
73
27
24
18
29
22
21
31
79
21
32
14
Town
U. P.
KAR
(50)
(54)
28
24
20
28
94
6
24
24
11
11
24
54
76
24
11
9
Percentage of respondents
Block___
Total
U. P
KAR
U. P
KAR
All
(25)
(26)
(201)
(200)
India
Avg.
44
24
16
16
56
44
20
8
31
19
23
27
65
35
8
25
34
28
19
19
74
26
23
14
20
20
23
37
73
27
17
16
27
24
21
28
74
26
20
15
62
Education
Monthly
Family
Income
Professional______
Agriculture______
Housewife_______
Others
Illiterate_________
Upto 8th________
Upto 12th_______
Graduate & above
< Rs. 6,000______
Rs. 6,000- 12,000
Rs. 12,000-20,000
>Rs. 20,000
9
10
15
21
5
14
27
54
40
58
2
0
4
14
18
18
18
30
23
29
74
19
3
4
8
32
4
18
18
24
36
22
84
14
2
0
2
50
20
8
35
37
15
13
98
2
0
0
0
16
44
12
28
20
44
8
92
8
0
0
4
37
27
15
23
38
27
12
96
4
0
0
6
19
4
27
21
13
21
27
29
23
80
18
1
1
3
34
22
14
25
35
22
18
89
8
1
1
21
17
17
19
36
28
72
27
1
0
Figures in parentheses are actual number.
6.1.2
DOCTOR/HOSPITAL VISITING HABIT OF PA TIENTS
There is a tendency among the people to avoid visiting the government hospitals to the
extent possible. While 48% respondents at the all India level reported that they either
sometimes or never go to government hospitals, the respective percentages of such
respondents in UP and Karnataka are 57 and 38 (see Table 47).
TABLE 47: PATIENTS’ HABIT OF CONSULTING DOCTORS AND VISITING
HOSPITALS
Percentage of respondents
Total
UP
KAR.
All India
. Questions
Whom do you visit in the case of illness?
• • Doctor Clinic
• • Hospital
___________ _________________________ • • Both_______
If visiting hospital, how often do you go to government hospital?
• • Always
• • Mostly
• • Sometimes
•
6.1.3
•
Never
42
22
36
39
18
43
40
20
40
18
25
49
8
33
29
20
18
25
27
35
13
A VAILABILITY OF MEDICINES
There is absolutely no problem in the availability of medicine as 97% patients at an all
India level reported that they get their required medicines (see table 48). There,
moreover, does not exist much difference in the responses from the two states.
TABLE 48 : AVAILABILITY OF MEDICINE
___________________________________________
Question
Percentage of respondents
Total
UP
KAR
All
India
Are the medicines prescribed readily available?
Yes
No
6.1.4
95
5
99
1
97
3
SUBSTITUTION OF MEDICINES
63
In the opinion of about 70% patients, chemists suggest substitution of medicine in case
the prescribed medicine is not available (see Table 49). But majority of the respondents
(i.e., around 78%) at the all India level said that the chemists never inform them about
such substitution.
64
TABLE 49 : SUBSTITUTION OF MEDICINES
________________________________________ Percentage of respondents
Questions
Total
UP
KAR
Does chemist suggest substitute medicine?
1
0
Always
28
I
Mostly
Sometimes
__________________________________________ •
•
Never
Does chemist give medicine substitutes without informing you?
•
• Always
•
• Mostly
Sometimes
39
32
72
27
0
2
34
64
1
0
7
92
All India
1
15
55
29
1
1
20
78
Never
6.1.5
PRICES OF MEDICINES
A big majority of the respondents both at the all India level and individual state levels
reported that the prices of the medicines are not frequently changed by the manufactures.
TABLE 50: CHANGE IN THE PRICES OF MEDICINES
__________________________________________________________Percentage of respondents
Questions
Total
KAR
UP
All India
Is there a frequent price change by manufacturers?
2
6
4
Yes
94
98
96
No
6.1.6
MEDICINE PROCUREMENT PA TTERN OF PA TIENTS
74% patients replied that medicines are available free of cost at the hospital (see Table
51). The percentage of respondents saying that doctors give them medicines was only 20
at the all India level. There exists, however, substantial difference in this respect at the
state levels. While 32% respondents in UP said that doctors give them medicines, only
7% said so in the case of Karnataka. So far as the question of doctors charging prices for
the medicine they give, respondents appear divided in their opinion. While at the all India
level 57% said that doctors do charge them for the medicines they give, the respective
percentages of such respondents for the states of UP and Karnataka are 65 and 50.
TABLE 51: MEDICINE PROCUREMENT BEHAVIOUR OF PATIENTS
____________ ._____________________________________________________ Percentage of respondents
Total
Questions
UP
KAR.
All
India
Are medicines available free of cost at hospital (government or private)
where you visit during illness?
74
Yes
65
83
35
17
26
No
Does doctor give you medicines?
20
Yes
32
7
80
68
93
No
If yes, is it charged or free?
65
57
50
• • Charged
50
35
43
• • Free
65
6.1.7 A VAILABILITY OF ALTERNATIVE THERAPY
At the all India level, the study shows that although patients also go in for alternative
medicine systems like homeopathic and ayurvedic, almost everybody, i.e., 99% of them,
go for allopathic medicine system based therapy.
TABLE 52: AVAILABILITY OF ALTERNATIVE MEDICINE SYSTEMS
________________________________________________________ __________ Percentage of respondents
Question
Total
UP
KAR.
All India
System of medicines prevalent in area :
99
100
99
56
0
28
Allopathic
27
0
14
0
0
0
Homeopathic
1
0
1
Auryvedic
•
Unani
Traditional
6.1.8
INSTANCES OF SPURIOUS DRUGS
At the all India level. 93% patients replied that they have never come across any instance
of spurious drugs (see Table 53).
TABLE 53: PREVAILING MALPRACTICES IN MEDICINE DELIVERY
___________________________________________________________________ Percentage of respondents
Question
Total
UP
KAR.
All India
Any instance of spurious drugs noticed by you?
1
1
1
Many a
4
0
2
times
4
3
5
90
96
93
Sometime
Rarely
Never
6.2
CHEMISTS’ VIEWPOINT
6.2.1
A VAILABILITY OF MEDICINES
Chemists at the all India level are found to be unequivocal regarding the availability of
medicines. 93% replied that the prescribed medicines are always available (see Table
54).
TABLE 54: AVAILABILITY OF PRESCRIBED MEDICINE
_______________________________________________________ Percentage of respondents
Questions
Total
KAR.
UP
All India
Required medicine available
6
68
37
• •Always
84
28
56
• •Mostly
10
4
7
• • Sometimes
66
6.2.2
CHEMISTS’ CONSUL TA TION FOR MEDICINES
54% chemists said that patients consult them for medicines many a times or sometimes
(see table 55). But the incidence of such consultation differs across the states. While 63%
chemists in UP reported that the patients consult them, the incidence of such consultation
in the state of Karnataka is found to be 45%.
TABLE 55: CONSULTING CHEMISTS FOR MEDICINES
________________________________________________ ______ Percentage of respondents
Question
Total
UP
KAR.
All India
Customer consults chemist for medicines?
16
3
10
Many a
47
42
44
time
20
32
44
17
11
14
Sometimes
Rarely
Never
6.2.3
CHEMISTS’A WARENESS ABOUT NPPA
Awareness among the chemists at the all India level is very low, with 76% of them
agreeing that they have never heard about the NPPA and its role.
TABLE 56 : AWARENESS ABOUT NPPA
Percentage of respondents
Total
KAR
All India
Question
UP
Awareness about NPPA?
Yes
No
6.2.4
4
43
57
96
24
76
PRICE DIFFERENCES IN PRESCRIBED MEDICINES
Majority of the chemists at the all India level are of the opinion that prices of medicines
across different locations do not vary. As many as 81% chemists held this opinion.
Furthermore, 73% chemists replied that medicines are sold at MRP (see Table 57). So
far as the question of charging local taxes over MRP is concerned, 57% chemists said
local taxes are charged. But the incidence of such practices differs across the states.
While in UP 20% said so, the corresponding percentage figure for the state of Karnataka
turns out to be as high as 94%.
TABLE 57: DIFFERENCES IN PRICES OF PRESCRIBED MEDICINES
Percentage of respondents
Questions
UP
KAR.
All India
16
84
22
78
81
82
88
18
12
88
6
6
59
0
Price difference at different location.
Yes
No
19
Do prices differ for all or some medicines?
Some
All
85
15
At what prices are medicines sold?
• • At MRP
• • Less than MRP
• • More than MRP
41
73
3
24
67
Are local taxes charged over MRP?
Yes
No
6.2.5
20
80
94
6
57
43
PRACTICE OF ISSUING CASH MEMOS
There is tendency among the chemists of not issuing the cash memos at the time of sale
of the medicines to the customers. Only 23% chemists at the all India level reported that
the cash memos are always issued at the time of sale of medicines (see Table 58). There
prevails a substantial difference across the two states in this respect. While only 8%
chemists in UP reported that the cash memos are issued in all the cases, 38% chemists
subscribed to this view in the case of Karnataka.
TABLE 58 : CASH MEMO ISSUED WITH THE SALE OF MEDICINE
_________ ___ __________________________________________ __________ Percentage of respondents
Question
Total
UP
KAR.
All India
Cash memo issued?
38
8
• • All cases
23
39
43
41
• • Some cases
39
10
24
• • None
14
9
12
• • No response
6.2.6
AWARENESS AMONG THE PATIENTS: CHEMISTS' VIEWPOINT
85% to 86% of the chemists said that the patients always or mostly are both price and
quality conscious, and they do check the price, expiry date and the batch number of
medicines purchased (see table 59).
TABLE 59 : PATIENTS’ AWARENESS
Questions
UP
Percentage of respondents
Total
KAR.
All India
Does customer check MRP?
•
•
•
•
Always
Mostly
Sometimes
37
56
7
0
33
49
18
0
53
12
0
50
39
11
0
32
41
50
45
18
0
14
0
35
Never
Customer checks batch no/expiry date?
•
•
•
•
Always
Mostly
Sometimes
Never
6.3
DOCTORS' VIEWPOINT
6.3.1 PRESCRIBING MEDICINES AS PER PA TIENTS' ECONOMIC CONDITIONS
The conclusion that emerges from this study is that 80% of the doctors prescribe
medicines keeping the patients’ economic condition in mind (see table 60).
68
TABLE 60: MEDICINE AS PER PATIENTS ECONOMIC CONDITION
_________________________________________________________________ Percentage of respondents
Question
Total
UP
KAR
All India
Do you keep patients’ economic condition while prescribing medicines?
Yes
No
65
96
80
35
6.3.2
4
20
DOCTORSf OPINION ABOUT THE MEDICAL AID
Doctors are of the view that there is in general shortage of government hospital,
dispensaries and vans, but the number of private nursing homes, hospitals and private
practicing doctors is adequate.
TABLE 61: DOCTORS OPINION ABOUT MEDICAL AID
_________________________________ Percentage of respondents
Total
Questions
UP
KAR
All India
Opinion about medical aid in area?
Government Hospital
Yes
________________ No
Government Dispensary
Yes
________________ No
Government Vans
Yes
________________ No
Private Hospital
Yes
________________ No_
Nursing Homes
Yes
________________ No^
Private Practitioners
Yes
No
6.3.3
43
57
63
37
53
47
39
61
52
48
45
55
13
87
43
57
28
72
59
41
76
24
68
32
83
17
96
4
90
10
96
4
99
1
98
2
PRESENCE OF SPURIOUS DRUGS
Doctors are better equipped to identify the availability of spurious drugs and around 43%
of them at the all India level agreed that there are incidences of spurious drugs (see Table
62).
TABLE 62: PRESENCE OF SPURIOUS DRUGS
___________________________________________ _____ Percentage of respondents
Question
Total
UP
KAR
All India
Are there any instance spurious drugs marketed in the area?
Always
•
•
Mostly
2
6
35
57
2
9
33
56
2
7
34
57
Sometimes
Never
69
6.3.4
DOCTORS ’ A WARENESS
Although the awareness about NPPA is higher among the doctors, but it is still low as
compared to the patients and chemists (see Table 63). At the all India level, 36% doctors
said that they are aware of NPPA. But the percentages of doctors saying so in the two
surveyed states differ substantially. While as many as 57% doctors in Karnataka said that
they are aware of NPPA, only 15% said so in the case of UP. But so far as the question of
knowledge about the drug prices, about 90% of the doctors at the all India as well as the
individual state levels reported that they have idea about the prices of drugs.
TABLE 63: AWARENESS OF DOCTORS
Questions
HP
Percentage of respondents
Total
KAR
All India
Aware of licensed drug manufacturing unit in local area?
Yes
No
0
100
24
76
12
88
Yes
No
15
85
57
43
36
64
Yes
No
91
9
87
13
89
11
Aware of NPPA
Any idea on prices of drugs?
Chapter 6(b)
SUMMARY OF THE FINDINGS OF ALL INDIA
PATIENTS VIEW POINT
POSITIVE ASPECT
> > 97% patients said that the prescribed medicines are available.
> > 98% patients said that in case the prescribed medicine is not available chemists give
them substitute medicine only after informing them.
> > 96% patients said that there is no frequent price change in the medicine by the
manufacturer
> > 99% patients adopt allopathic system,
> > 97% patients said that there is no incidence of spurious drugs.
NEGATIVE ASPECT
>
>
> >
> >
> >
>
>
52% patients visit govt, hospitals during their illness.
98% patients are unaware about NPPA and its role.
28% adopt homeopathic system and 14% adopt ayurvedic system of therapy.
60% patients said that medicines are available at same price at different locations.
60% patients found the price of medicine reasonable and affordable.
CHEMISTS VIEW POINT
70
POSITIVE ASPECT
> > 93% chemists said that required medicines are available.
> > 100% respondents agreed that medicines are available in the market and there is no
problem in the supply of medicine from the manufacturers.
> > 81 % chemists said that there is no difference in the price of the same medicine at
different locations.
> 100% chemists said that there is no price variation in MRP printed on the label for
same medicine sold at different locations.
73% chemists said that medicines are sold at MRP plus Sales tax.
> > 94% chemists said that there had been no instances of spurious drugs.
> > 87% chemists said that patients check MRP, batch number and expiry date prior to
the purchase of medicine.
NEGATIVE ASPECT
> > 54% chemists said that patients consult them for medicine.
> > 24% chemists said that medicines are sold at more than MRP plus Sales Tax.
> > 15% chemists said that usage of vitamins and 10% said that usages of injectable
minerals are irrational.
> > 78% chemists said that they are not aware about NPPA.
> > 65% chemists said that they rarely issue bills or cash memo during the sale of
medicine.
> > 60% chemists said that they do have substitute of prescribed medicine available with
them.
DOCTORS VIEW POINT
POSITIVE ASPECT
>
>
> >
> >
> >
> >
90% doctors said that there are private nursing homes in their area.
98% doctors replied that they use the drugs rationally.
100% doctors replied that all the prescribed medicines are easily available.
94% doctors said that medicines being sold at the same price at different locations.
93% doctors said that medicines are sold at MRP.
NEGATIVE ASPECT
> > 72% doctors said that government vans are not adequate in their area.
> 43% doctors confirmed the incidence of spurious drugs but refused to divulge any
further information.
> > 64% doctors are not aware of NPPA.
>
71
Chapter 7
CONCLUSION
MAJOR FINDINGS OF THE STUDY:
7.1
AVAILABILITY OF MEDICINES AND ITS SUBSITUTES
7.1.1
Medicines normally required by the patients are “mostly” available and non-availability
is temporary as replied by more than 93% Chemists and Patients. But at the block level
some shortages of medicines were reported. They are mostly temporary in nature except
of few costly life saving drugs like anti-cancer drugs. Most of the chemists said they
could not store all the required medicines because of the shortage of funds. They also
complained that new drugs are launched in the market frequently and it is not possible for
them to store all the medicines. Lack of proper mechanism to exchange the expired drugs
and replacement on time by the manufacturers, medical representatives and distributors
also aggravates the problem of availability and sale of expired drugs.
7.1.2
Substitutes of prescribed medicines of either same drug or other therapeutic values are
available, and they are given to the patients only after properly informing them. A
comprehensive list of medicines that are in short supply but for which substitutes are
available is given in Table 64(a).
Table: 64 (a) NAME OF MEDICINES WHOSE SUBSTITITE ARE AVAILABLE
S.No Name ofMedicines That Are In Shortage And Whose Substitutes Are Available
Ceftum 250__________________________________________
Norfloxacin___________________________________________________
Nimotas - CD
4
Syrup Ossidos - T_______________________________________
5
R - Butol
6
Flugraine
7
PNA
8
Flozen_______
9
Vidaylin - M Drops_______________________________
10
Hycal Forte_______________________________
11
Sormo_________________________________________
12
Monopark___________________________________________________
13
Monicor
14
IHD___________________________________________________________
15
Ciplox______
16
Cefadyl_________________________ _______________________________
17
Pyrodex____________ ____________________________________
18
Novamox________________ _______________________________________
But there are few medicines whose substitutes are not available. A comprehensive list of
medicines that are in short supply but for which substitutes are not available is given in
Table 64(b).
1
2
3
Table: 64 (b) NAME OF MEDICINES WHOSE SUBSTITITE ARE NOT
AVAILABLE
72
S.No
Name of Medicines That Are In Shortage And Whose Substitutes Are Not
Available
1
2
3
4
5
6
7
8
9
10
Enthro___________
Ranitidine________
Scoline__________
Helex____________
Adelphane - Esidrex
Pyridactil_________
Pantodac - 40 .
Inj. Clexane_______
Angised Tab.______
Disulfiram
7.2
PRICE OF MEDICINE
7.2.1
Most of the respondents agreed that there is no difference in the price of same medicine
at different locations and medicines are sold at MRP. In few places, the difference in
price of medicine occurred either due to sales taxes or because of short supply or due to
heavy competition. According to the survey price differences were found to be existing in
the case of either the medicines meant for T.B and Cancer or Vaccines. If has also been
observed by our field staff/ experts that in the case of several non-controlled drugs, i.e.,
vitamins, minerals and tonics, the difference between the price charged by the
manufacturer to the retailer and the price to the patient is well over 400%. For example:
Drug Name:
Price to Retailer:
MRP to Patient:
Nimesulide
Rs. 6 per 10 tablets
Rs.24.00 per 10 tables
The reputed brands have been found to be charging more and the differences in price of
same generic drugs can go upto 500 percent. As observed by our field staff/expert, the
name of few drugs where the price difference was found to be very high is shown in the
Table 65. For instance, it can be observed from table that in the case of Ciprofloxacin,
Cadila charges Rs. 8/- for Ciplox 500 mg whereas the same generic drug Ciprofloxacin
500 mg is available at Rs. 3/- only.
TABLE-65: PRICE DIFFERENCE OF SAME MEDICINE
Manufacturers Name
(Rs.)
Drug Name
Weight
MRP
Cipla
each
Salbutamol
4 mg
0.54
73
Eros Pharma Bangalore
each
Salbid
4 mg
0.17
Cipla
each
Ciplox
500 mg
8.00
Ciprofloxacin
500 mg
3.00
each
(Generics)
Bluecross
each
Blumox
2.50
Amoxycillin
0.50
each
(Generics)
Cadila
each
Wormin
Allindazole —
(Generics)
12.00
3.25 each
7.2.2
Only 7% doctors and 24% chemists reported that medicines are sold at more than MRP
inclusive of taxes. Few cases of overcharging in the lifesaving medicines like the
medicines for TB have also been observed because of short supply.
7.2.3
The survey shows that almost 80% doctors normally prescribe medicines keeping the
economic conditions of the patients in mind. Hence, 60% respondents found the price of
medicines as being both reasonable and affordable.
7.2.4
100% Chemists, and 96% Patients agreed that there are no incidences of printing
different price on the label for same medicines sold at different locations. They also said
that there is no frequent substantial price increase in the medicine by the manufacturer.
7.2.5
93% doctors agreed that medicines sold during the course of hospitalization are sold at
MRP. But in the case of a few hospitals in Uttar Pradesh our field staff and experts
observed that doctors sell the medicines given free of cost to them as samples and charge
arbitrary prices from the patients.
7.3
7.3
QUALITY OF MEDICINE AND ALTERNATIVE MEDICINE
PRACTICES
7.3.1
The study shows that availability and usage of allopathic medicines is much better as
compared to that of our traditional forms of medicines. Patients still opt for alternative
therapies. Because of high awareness, almost 99% patients adopt allopathic therapy, but
74
it is also seen that among them 28% go for homeopathic and 14% adopt ayurvedic system
of therapy.
'132
3% patients, 6% chemists and 43% doctors reported a few instances of spurious drugs in
the market. But when probed further, none of them came forward to divulge any
information about the shops that were selling those drugs.
7.3.3
As high as 30% chemists in the state of Uttar Pradesh (especially at block level) were
found not using refrigerator. They are storing critical medicines and injectables on the
selves. Lack of fund, erratic electric supply and non-availability of refrigerator,
maintenance staff are some of the main reasons cited for not storing drugs and injectables
in the refrigerator.
7.3.4
Drugs are normally used rationally as found in this study. But in the case of vitamins,
injections and minerals, their usage is found to be erratic and irrational. Data reported in
Tables 66 and 66(a) also are a pointer to the irrational usage of medicines in India. The
tables contain information provided by the doctors in response to the questions as to
which are the major diseases and which medicines are for such diseases. It was observed
by the VOICE experts and also was pointed out explicitly by NPPA in its meeting with
VOICE, that most of the medicines prescribed for various diseases are actually not meant
for those diseases, thus indicating irrational usage of such medicines.
7.3.5
7.3.5 This study shows that there are no licensed manufacturing units in the surveyed
area of Uttar Pradesh, but in Karnataka few respondents said that there are some licensed
manufacturing units. But even in the case of latter, the respondents were not aware of the
exact names and addresses of such units.
7.3.6
7.3.6 The widely prevalent diseases are Gastroentritis, TB, High and Low Blood
Pressures, Malaria, Viral Fever, Diahoerra, Typhoid, Pneumonia and Respiratory
Infections. But when asked about the medicines prescribed against these diseases it has
been found that wrong medicines are prescribed (see para 7.3.4 above).
TABLE 66: PREVELANT DISEASES AND THE MEDICINES PRESCRIBED*
S. No.
Endemic Disease
Medicine Prescribed
1.
Gastroenteritis
2.
3.
4.
Gastritis
Goitre
Filariasis
IV Fluid, Oxytetracycline, Tinidazole, Metrogyl,
Ciprofloxacin, Norfloxacin, Tetracycline
IV Fluid, Antacid
Oral Iodine
Hetrazan, Unicarbazan, Banocide forte, Banocide Syrup
5.
6.
7.
8.
Sugar
Fractures
Liver Pain
HBP/LBP
Euglucon, Protamine Zinc
Combiflam, Flexon,
Protamine Zinc
Beptazine-H, Cimetin, Clodex, Tenelol, Timizol
9.
TB
Combutol, Tab. INH, Tab. IHD, Pyrazinamide, Isonex, Isoniazid
Amclox, Calpol Syrup, Indomethacin, Ciprofloxacin
10.
Viral Fever
75
11.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
30.
31.
Malaria
Dysentry
Headache
Cold/Vomitting
Diarrhoea
R.T.I
Eczema
Enchephelities
Typhoid
Pneumonia
Amoebiasis
Conjunctivitis
Entrocolitis
Viral Hepatitis
Stomach Pain
Headache
Migrane
Cancer
Jaundice
URTI
Hydrosyel
Chloroquine, Metacin, Paracetamol, Quinine
Blumox, Metronidazole Amaebecide,
Brufen
Benadyle, Ceff-250, Siquil
Metrogyl, Norfloxacin, Ciprofloxacin, Ringer lactate, Electrol
Amoxycillin, Cephalexin, Ampicillin, Cloxacillin
Betnovate-N
Destrose, Dexona, Monocef
Ciprofloxacin, Calpol, Paraxin, Chloramphenicol, Septran,
Ofloxacin,
Amoxycillin, Ceff-250 / 500, Cetazone, Cephalexin
Anti-M, Tinidazole
Ciplox eye drop, Mycin eye drop
Tinidazole, Metrogyl, Ciprofloxacin
Paracetamol
Spasmizol-K
Brufen
Ibumax, Calpol
Vincristine Sulphate, Methotrexate, Bleomycin
Liv 52, Livoerb, Glucose Powder
Cephalexin
Banocide
* The prescribed medicines against the respective disease are as per the views ofthe respondents. Although on actual
checking with some senior doctors it is found that some medicines are wrongly prescribed.
TABLE-66(a): DOCTORS OPINION: PREVELANT DISEASE OF THE AREA AND
THE MEDICINES PRESCRIBED*
Sn.
Endemic Disease
Medicine Prescribed
1
Gastroenteritis
2.
Malaria
3.
Respiratory
Infections
4.
Entric Fever
5.
Typhoid
6.
7.
8.
9.
10.
ARI
Viral Fever
TB
Dental Disease
Upper Respiratory
Tract Infection
Lower Respiratory
Tihidazole, Metronidazole, Ciprofloxacin, Ranitidine,
Norfloxacin, Taxim-O, Oframax, Meganeg, Tetracycline, Norflox,
Metrogyl, Metromidazole, Nalidixic acid, Furoxone,
Cotrimoxazole, Gelusil, Lanzol, Rantac
Chloroquine, Amalar, Paraquin, Ciprofloxacin, Quinine,
Lariago, Reziz, Primodil, Nivaquine, Imol,
Amoxycillin, Penicillin, Analgesic, Vepen,
Sparfloxacin, Roxithromycin, Cotrimoxazole, Ampicillin,
Cloxacillin
Ciprofloxacin, Chloromycetin, Analgin, Ciplox 500mg,
Perinorm, Ofloxmacin, Sparfloxacin, Paraxin, Alcipro, Norflox,
Ofloxmacin, Ciprofloxacin, Chloramphenicol, Cepetroxic
Sparfloxacin, Paraxin, Paracetamol Ceftrioxane, Cefixime
Co-Trimoxazole, Ampicillin, Amoxycillin
Inj. PFT, Dexona, Quintor
Refobacin, INH, Ethanhite, Ethambutol, Pyrazinamide, Isoniazid
Amoxycillin, Aeromox
Ampidil, Tab Restyl, Paracetamol, Amoxycillin,
Cotrimoxazole
Paracetamol, Amoxycillin, Cephalexin
11.
76
21.
22.
Tract Infection
Anaemic
Amebic Dysentry
Infection Disease
Hepatities
Helmenthis
Acidpeptic Disease
UTI
Artherities
Jaundice
Flu
Diarrhoea
23.
24.
25.
Bronchopneumonia
Bronchitis
Tonsil
12.
13.
14.
15.
16.
17.
18.
19.
20.
Ziferrin-TR, Fezee
Tinidazole, Ciplox-TZ, Inj.Garamycin, I.V.Dextros
Ciprofloxacin, Zentamysin
Analiv, Vitamin B.Complex, Tonics, Liv-52
Albendazole
Ranitidine, Omeprazole, Lansoprazole
Syproxin, Amikacin
Doliprane, Ibuprofen, Profentol
Liv-52, Cap.Hepin, Livomyn
Paracetamol, Crocin, Alcipro
Lopamide, Norfloxacin, Flagyl, Ciplox-TZ, Norflox-TZ,
Cefuroxime
Ceftriaxone, Cefuroxime, Amoxycillin,
Roxythromycin, Amoxycillin
Amotid, Novamox
* The prescribed medicines against the respective disease are as per the views ofthe respondents. Although on actual
checking with some senior doctor/experts, it is found that some medicines are wrongly prescribed.
Chapter 8
RECOMMENDATIONS
Based on the findings of the study VOICE recommends following measures to be adopted by
NPPA and other concerned organizations dealing with healthcare issues for ensuring better
availability of medicines at affordable prices.
8.1
AVAILABILITY OF MEDICINES
8.1. J
8.1.1
MAKING FUNDS OR LOANS A VAILABLE TO THE CHEMISTS
Chemists complained that due to lack of resources they are unable to provide quality
service to the customers and also minimum infrastructures like equipment for proper
storage of medicine are not affordable. Government, banks and other financial
institutions should form a task force and conduct a study in this area and then suggest a
solution by writing a white paper on how to arrange resources. The focus has to be on
raising funds at the most cost-effective price, for chemists to stock and store medicines in
the most scientific manner. Once an effective money lending mechanism is in place, the
chemists will have more funds at their disposal and thus they will be able to maintain
better inventory of the required medicines. This will also help them to buy and maintain
their basic equipments like refrigerators, invertors etc. to store the injections and other
sensitive medicines at proper temperatures.
8.1.2
8.1.2
MAKING DISTRIBUTION CHANNELS MORE ACCOUNTABLE
Availability of medicines is also affected by the erratic visits of medical representatives
and company distributors and dealers especially in the case of the far-flung block areas.
There are also complaints of not properly changing the expired drugs. The
pharmaceutical companies need to ensure that their representatives and distributors make
regular visits and check the availability of medicines. They should also take note that if
77
expired drugs are not properly and timely removed, the local retailers will try to sell
them. The persons from the concerned government departments should also make regular
and sudden visits to ensure that quality medicines are timely available to the patients.
8.1.3
8.1.3
DOCTORS SHOULD PRESCRIBE SUBSTITUTE MEDICINES
In the case of non-availability of drugs, patients are totally left at the discretion of
chemists and it is he who suggests the substitute medicines. It is, therefore, recommended
that the prescription should also mention the names of substitutes in case the prescribed
medicine is not available. NPPA with institutions like Indian Medical Association and
Indian Medical Council should develop a code of conduct for the medical practitioners of
all sciences to prescribe medicines to the patients with atleast two to three alternatives.
This would facilitate consumers as in case prescribed medicines are not available then the
patients can opt for the prescribed substitutes. This will also help to bridge the mistrust,
which is existing today between the doctors and patients.
8.2
PRICE OF MEDICINES
(8.2.1) (8.2.1) PEOPLE BELOW PROVERTY LINE SHOULD GET MEDICAL SERVICES
AND MEDICINES FREE OF COSTAND A T SUBSIDISED PRICES
Government should control prices of life saving drugs and price lists of such drugs should
be prominently displayed at the chemist shops. Medicines should be distributed free or at
subsidized prices to the poor consumers living below the poverty line. The mechanism to
detect citizens living below the poverty line can be determined through several
instruments, which have been suggested by the consumer organizations to the
Government at several consultations. One such example is identity cards with photograph
of the family and making such documents and names public to check misuse.
(8.2.2) (8.2.2) INFORMING PATIENTS ABOUT MEDICINES AND THEIR COSTS
The study has indicated that there is no information available to the patients (even to the
educated citizens) about the medicine availability, prices and other similar information,
which the patients should be kept updated. Due to lack of such information, consumers
are solely dependent on the local chemists for the information on substitution, cost
effectiveness and other parameters for the selection of right drugs. It has also been
observed during the study that even whatever little communication that exists with the
patients it is not in an understandable language. NPPA along with the drug manufacturers
should try to find a solution by publishing the retail prices of essential medicines along
with their substitutes and generic forms. It could be done with the help of doctors and
paramedical workers verbally for the illiterate and for others in all the leading
newspapers or other form of communication like radio, TV and public announcement, to
protect the rights of the consumers on price information and choice.
(8.2.3) (8.2.3) PRINTED MRP SHOULD INCLUDE THE SALES TAX
The study shows that due to differing sales tax across the states, patients are confused on
the actual price of the medicines. There is a constant mistrust that prevails between the
service providers and the users. NPPA should look into this matter and formulate a
strategy to make uniform pricing of the same medicine throughout the country. The
printed MRP should include sales taxes so that patient can just look at the medicine pack
78
and pay the price that is printed on it. This will stop the confusion that is created in the
mind of patients on actual MRP of medicines and will also go a long way in preventing
the retailers from charging extra in the name of sales taxes and build the desired
confidence between the retailer and the consumer.
(8.2.4) (8.2.4) KEEPING STRICT VIGILANCE ON THE REASON FOR CHARGING
HIGH PRICE
As observed by our field experts, drugs with same molecule and weight are available at
different prices. The reputed brands with better brand image charge more and this price
difference sometimes goes upto 500 percent. NPPA needs to explore the possibility of
reducing the price difference between the branded and generic formulation of the given
medicine, and also take necessary steps to promote the prescription and usage of the
generic formulations of the medicines among the doctors and patients.
(8.2.5) (8.2.5) ENSURING PROPER USAGE OF SAMPLED DRUGS BY THE DOCTORS
In the block areas our field staff has observed that doctors do sell the free samples of
medicines given to them by the manufacturers and charge arbitrary prices from the
patients. Pharmaceutical companies should strictly restrict the number of free samples
that is to be given to the doctors and very prominently and legibly display on the labels in
local language regarding all the sample packs. Innovative ideas can emerge from
consultations between the manufacturers, doctors and the consumer organisations for
supply of such sampled medicines to the poor consumers with the help of consumer
organizations, hospitals and nursing homes. Companies joining such schemes may be
given wide publicity by publicizing their names in the newspapers, TV and also on
hoarding, banners and other promotional tools at the hospitals and nursing homes.
8.3
QUALITY OF
PRACTICES
MEDICINES
AND
ALTERNATIVE
MEDICINE
(8.3.1) (8.3.1) POPULARISING TRADITIONAL MEDICAL TREATMENT
As expected, the study reflected a strong popularity among patients towards the
allopathic therapy. The influence of private sector in the pharmaceutical industry and
especially the role of multinational corporations have almost driven away our traditional
forms of medicines. There is a great need for the Health Ministry to look into this issue
and formulate policies to encourage the growth of our traditional forms of medicines. A
comprehensive study needs to be immediately carried out by the consumer organizations
to investigate various existing barriers undermining the usage of traditional medical
science. It is an immediate priority for all of us to understand the gravity of the situation
and encourage the policy makers to bring in large amount of investments in traditional
health care areas. The Ministry of Health along with NPPA should formulate incentives
for investments in the traditional medicines and farming of medicinal plants. It is also
observed that very few students are also opting to study the traditional medical science,
as it has not received the adequate recognition from the Government and the community.
(8.3.2) (8.3.2) STRICT VIGILENCE FROM THE CONCERNED DRUG DEPARTMENT
79
To stop the sale of spurious drugs, surprise checks should be conducted time to time at
the chemist shops and strict vigilance should be exercised in the case of smuggling of
medicines from one state to another. The concerned State health department should
conduct regular checks on whether the doctors who are practicing have a recognized
certificate or degree in association with the State Medical Association and consumer
organizations. If any doctors are found guilty then strong action should be taken against
them. There should also be a similar autonomous agency in every State to keep strict
vigilance on the medicines sold in the market. The study shows that patients consult
chemists for medication and medicines are sold without any prescription and all rules and
regulations concerning the code of conduct to be adopted by chemists are violated
without any hesitation. Government should evolve some mechanism to curb such
practices. It is also recommended that all the state governments should conduct a survey
immediately on all such cases filed in the various courts disposed or pending on all such
violations under the DPCO for the last ten years and the reasons for delay and judgment
obtained. The survey will throw open a healthy debate within the community on the
effectiveness of DPCO and involve the key stakeholders like various institutions and
organizations representing doctors, chemists, pharmaceutical companies and consumer
organizations to formulate strategies to check the quality of drugs and implement a viable
solution.
8.4
OTHER SUGGESTIONS
(8.4.1) (8.4.1) DEVELOPMENT OF QUALITY INFRASTRUCTURE
This study substantiates the regular reports that appear in newspapers and other media on
the impotency of drugs made available to the consumers. The study reveals that it is due
to lack of infrastructures like cold chain, testing facilities on the quality of medicine,
training at various levels dealing with medicine distribution and prescription
dissemination. The recent incidences, which were reported in the media regarding the
polio infection even after the immunization program, the loss of eyesight due to wrong
medicine at the time of eye operations always raised doubts on our existing infrastructure.
The competence of medical practitioners and the service providers gets questioned due to
such deficiencies and poor infrastructure. The study showed that drugs are not stored in
refrigerators in block areas. The regulatory authorities like NPPA should initiate efforts
to ensure that all the state level drug regulating and monitoring bodies conduct regular
tests, third party surveys and evaluate the available infrastructure for upgrading the
technology and the skills of the implementing agencies at the cutting edge. All the state
governments must prepare a framework and an action plan to implement effectively the
entire existing infrastructure and ensure upgradation of the infrastructure wherever
required. The resources required for such activities should be made available on a priority
basis by the planning commission or the financial institutions. NPPA should also make
the service providers accountable to the citizens in the case of negligence or sub-standard
quality of service delivery.
(8.3.5) (8.3.5) BENCHMARKING SERVICE STANDARDS OF PUBLIC SERVICES
One of the key highlights of the study is that the citizens do not have the requisite health
care facilities at the block and town levels for immediate as well as subsequent
treatments. Government should try to identify the gaps and should either on its own or in
collaboration with the private sector try to build the necessary health care facilities in the
towns and villages. There is also an immediate need for developing the minimum service
80
standards to be made available to the citizens availing government supported health
programmes. NPPA should authorize a State nodal agency to monitor the quality of these
services from time to time and ensure accountability of the existing system to the citizens
by providing minimum standards defined by NPPA in consultation with the service
providers and the consumer organizations.
(8.3.6) INCREASE A WARNESS AMONG PA TIENTS
Educating consumers and service providers regarding the various existing rules and
regulations have to become one of the most important components of NPPA by
documenting the various violations and its remedies. Till date the citizens are not clear
about the redressal mechanisms available in the country. Whatever system exists in the
country is not user friendly. Through advertisement and other promotional methods like
monthly newsletter in local languages in association with consumer organizations,
awareness must be built among the patients on how to examine and differentiate original
from duplicate medicines. Education must be given on labeling information and testing
facilities should be provided to check quality at random. All these measures will ensure
quality products and provide the right choice to the consumers. In backward areas where
menace of quacks is very high, concerned health departments should take necessary steps
to educate the patients on the dangers of going to quacks. The health department should
make public all information on all such quacks who are practicing in rural and urban
areas as professional medical practitioners to educate the consumers and seek support
from consumer organizations to make all such information more public and protect the
consumers from exploitation.
(8.3.6) (8.3.6) PUBLICISING THE ROLE OF NPPA AND STRENGTHENING ITS
EFFECTIVENESS
The study reveals that the patients are not aware about the various control and monitoring
mechanisms on drug prices and the role of NPPA in making certain essential drugs
affordable to the common citizens. There is an absolute need to publicize the role of
NPPA in a much larger magnitude throughout the country. The role of the regulators like
NPPA has to be strengthened by the Government by making them autonomous and fully
insulated from political and Government bureaucracy.
(8.3.7) REGULAR CONSULTATION WITH CONSUMER ORGANISATIONS
As there is a strong relationship existing between the practicing doctors, chemists and drug
manufacturers, there is an equal need to induce a similar relationship between the patients,
consumer organizations and the regulatory agencies into this relationship. The consumer
organisations also need to take up responsibilities to regularly evaluate the existing systems and
the role of the regulators at the state and national levels. They should also from time to time
investigate the lapses like ineffective health care delivery system and the infrastructure
bottlenecks. The manufacturing costs of essential medicines have to be controlled and if necessary
supported by the Government for the poor and disadvantaged sections of the society. Such subsidy
should continue till such time the market is matured and the regulators are fully empowered to
take strong action against the violators in the interest of the consumers. The consumer
organizations also need to seek the services of experts to be able to intellectually intervene on all
such subjects. All such activities concerning monitoring of prices and availability of medicines by
consumer organizations must be supported by NPPA. NPPA should create a fund either by
imposing a cess on the manufacturers’ turnover or by inviting voluntary contributions from
industry for financing such activities.
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