Transcript Key drug availability before and after pooled procurement system

India-WHO Essential Drugs
Programme
implemented by
Delhi Society for Promotion of
Rational Use of Drugs (since
1997)
Delhi State
 Population – 14 million
 Total no. of hospital beds – 4000
 Teaching hospitals – 2
 Total number of health centers – 158
Drug annual budget – Rs. 400 million
($ 8 million)
Before Drug Policy - 1994
Access
 30-35% of health budget spent on
drugs yet scarcity of drugs in the
hospitals and both patients and
doctors were not satisfied
Before Drug Policy 1994
Access
 Shortage of drugs in the public
health facilities
 Multiple procurement arrangements
leading to sub-optimal utilization
of resources
 Uncertainty of quality of drugs
Before Drug Policy 1994
Quality assurance
 Erratic and unreliable distribution
system –
–
–
–
Drugs nearing expiry drugs
Drugs not needed (combination drugs)
Herbal drugs
 Money wasted on substandard
drugs
After Drug Policy-1997
Principles of procurement
 Procurement restricted to essential
drug list
 90% of drugs budget spent on
essential drugs
After Drug Policy-1997
 Pooling of drug requirement of all
state health facilities
 System of inviting quotations by
each institution independently
abandoned
After Drug Policy-1997
 Level playing field to all bidders
– No special preferences to public
sector undertakings and small scale
units
 Pooled procurement system set up
with a standing Special Purchase
Committee to secure transparency
and objectivity
Standing Purchase
Committee
 Chairperson is a non-government person
 Principal Secretary Health
 State Director Health Services
 State Drugs Controller
 Nominee of the State Finance Department
 Nominee of the State Law Department
 An eminent clinical pharmacologist
 Chairperson, Committee for selection of
essential drugs
 Head of institution
Non officials
 An eminent administrator
 An eminent clinical pharmacologist
 A Finance & contract expert
 A leading private practitioner
This was an innovative move intended to bring
outside expertise, transparency and objectivity
Purchase committee
 Close linkages have been maintained with
drug selection and use
 The chairperson of the Essential drugs
committee is a member of the purchase
committee
 Continual liaison with other agencies like
Defence establishment for feedback
about suppliers performance
Procurement methods
 Empanelment of pre-qualified
bidders
Or
 Open competitive bidding each year
Procurement methods
 Bidding restricted to empanelled
pre-qualified bidders not followed
as it:
– Debars new players albeit for a limited
time
– Leads to sense of complacency
– Possibility of cartels developing
amongst empanelled bidders
Procurement methods
 Open competitive bidding each year
with pre-qualification criteria
introduced
Pooled procurement
system
Selection criteria
 Tenders invited from manufacturers only
in generic names in 2 envelope system
– Technical and price bids
 Price bids of only those manufacturers
are opened who fulfill the technical
criteria
 Unsuccessful bidders are informed and
earnest money returned
Pooled procurement
system
Pre-qualification criteria
 Financial viability - at least annual
turnover of Rs. 120 million ($ 2.5
million)
Pooled procurement
system
Pre-qualification criteria
 Technical qualifications – bidder
should have been
– Manufacturing the drug for at least 3
years
– WHO-GMP certification
Pooled procurement
system
Pre-qualification criteria
 Services of at least one approved
manufacturing chemist and one quality
control chemist
 No case pending against manufacturer
for sub-standard or spurious drugs
 No black listing by any other
procurement agency
Quality assurance
 Careful selection of the tenders
 Criteria of cut off turnover – Rs.
120 million ($ 2.5 million)
 Selective GMP inspections
 Testing of batch samples
 Samples sent for testing by the
prescribers for quality assurance
Quality Assurance – GMP
inspections
 Panel of 12 experienced experts set up for
GMP inspections
 Two experts sent for inspection to any of
the pharmaceutical
 The inspection results of the approved
firms (White list) shared with other states
on request
 Rejection rate is 25%
 Samples sent to approved quality control
laboratories for quality assurance
Quality assurance
results -CPA cell
 Total no. of drug batches tested in
2000-2002
3529
 No. of samples declared not of standard
quality
20
 Total expenditure on testing
Rs. 25,92,750
0.53% of the budget for drugs
Pooled procurement
system
Positive effects
 Maximal use of available resources
 Procurement at lower prices led to
availability of more funds for procuring
more essential drugs
 Increased availability of drugs
 Improved quality of drugs procured,
therefore, building up trust in the system
Conclusions
 Better availability and accessibility
to drugs in the public sector by
savings through an efficient
procurement system
No extra funds spent other than GMP
inspections
Impact of State Drug
Policy - Pooled
procurement
 Cost of procurement reduced
 Holding the price line
 Quality of medicines better
 Access to medicines increased
Pooled availability of drugs,
extent of prescriptions by
generics and adherence to EDL
120
100
Availability
80
60
Generics
40
EDL
20
0
1995
1997
1999
Year under review
2000
Cost Reduction of common
drugs by pooled procurement
(Rs.)
Amoxycillin
Chloroquine
Omeprazole
35
30
25
59%
20
15
37%
10
5
43%
0
1995
1996
1997
Years
1999
2000