Transcript Evidence on Availability and Stock-Outs of Essential

Sakthivel Selvaraj, Habib Hasan
Public Health Foundation of India, India
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Background
 Provision of safe and effective medicines to patients is
one of the central goals of a public health system.
 However, inefficiencies in public procurement and
distribution of pharmaceuticals due to poor
governance and lack of transparency impede the
process of access at every stage, from procurement and
distribution to the dispensing of drugs.
 This may be seen in developing countries in general
and India in particular.
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Background
 India’s government health care system is diverse, given
the diversity of practices, strategies and policies
pursued in the health care system by various states in
India.
 The heterogeneity in drug procurement and
distribution models in various states of India reflects
this phenomenon.
 This has implication for availability and stock-outs of
essential drugs in frontline public health facilities.
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Background
 In order to generate evidence on availability and stock-
outs of essential medicines in public health facilities
and also on effectiveness and efficiency of two diverse
government drug procurement and distribution
systems this research was conducted in India.
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Objective
 To examine the availability and stock-outs of essential
drugs in public health facilities in the state of Bihar
and Tamil Nadu, India.
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Methodology
 Design: Cross-sectional analytic study.
 Setting: The study was conducted across 60 public health
facilities.
 Study Population: The public health facilities were
selected through a stratified random sampling procedure
which accounted for regional and economic diversity in
each state.
 Sampling: The selected health facilities are first level
referral units (called as Referral Hospitals in Bihar and
Upgraded PHCs in the state of Tamil Nadu) and are
essentially 30-beded hospitals which cater to about 100,000
populations.
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Methodology
 Sampling: Of the total 38 districts in Bihar, 30 health
facilities located in 17 districts (roughly 45 %) were visited
for primary data collection. Similarly, in Tamil Nadu 30
health facilities, located across 18 districts, accounting for
60% of the total number of districts, were visited.
 Data Sources: Data on drug availability on the day of the
survey, medicine stock-out position for the last 6 months
and other indicators were collected during the facility
survey through a structured questionnaire.
 Outcome Measure(s): Availability/unavailability of
essential medicines on the day of survey, stock-outs during
previous 6 months and average duration of stock-outs.
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Results
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Results
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Results
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Results
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Results
 Our findings reveal that the mean availability of “basket of
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drugs” for Bihar was about 43% as against roughly 88% for
Tamil Nadu.
Also, in terms of the stock-outs, Bihar’s health facilities
registered an average of about 42% stock-outs of drugs with
a mean duration of 105 days in the previous 6 months of
the survey period.
The proportion of stock-out for Tamil Nadu stood at
around 17% with a mean duration of 50 days.
Also, the availability of the most important class of drugs,
namely, Antibiotic’s and Antipyretic’s was low at 40% in
Bihar.
However, the evidence from Tamil Nadu suggests that
almost all the broad therapeutic categories had more than
80% availability.
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Conclusions
 The key to improving access to medicines depends not
only on high public expenditure on medicines but also
on robust procurement and distribution system.
 Best practices should be learned from Tamil Nadu’s
procurement and distribution system and should be
replicated in Bihar to improve its drug supply system
and enhance access to medicines across the facilities.
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Conclusions
 Tamil Nadu follows centralized procurement and
decentralized distribution system whereas Bihar
follows decentralized procurement with ‘cash and
carry’ model.
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 Funding Support: This work would not have been
possible without the financial support from Results for
Development Institute (R4D), Washington, under the
Transparency and Accountability Program, 2009-10.
Their constant encouragement and support to this
study are highly appreciated.
 Institutional Affiliation Disclaimer: This research
report is based on a study conducted by researchers
based at Public Health Foundation of India, New
Delhi. The views expressed in this report do not reflect
the views of the institution. Any errors and omissions
are those of the researchers themselves.
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