Transcript Poster presentation

IMPACT OF DRUG POLICY ON
IMPROVING ACCESS TO
MEDICINES IN DELHI
Nilakantha Bhoi, JS Bapna, R Roychaudhury,
Naresh Khanna, Uma Tekur
Delhi Society for Promotion of Rational Use of
Drugs (DSPRUD), Delhi &
Indian Institute of Health Management Research
(IIHMR), Jaipur
IMPACT
DRUG POLICY
IN IMPROVING
TO MEDICINES
IN DELHI
Author
Name:OF
Nilakantha
Bhoi
Email: [email protected]
Abstract ID:ACCESS
126
Bhoi NK, Roy Chaudhury R, Bapna JS, Tekur U, Khanna N
Delhi Society for Promotion of Rational Use of Drugs (DSPRUD), Delhi, and Indian Institute of Health
Management Research (IIHMR), Jaipur, India
Problem Statement: In 1994, when efforts for developing a drug policy were made, in spite of spending a huge
amount of money, the situation regarding availability and use of medicines in Delhi government hospitals was poor.
Most of the prescribed drugs expected to be given free of cost to the patients were not available at the hospital
pharmacy. Unneeded medicines such as drug combinations, herbal medicines, and tonics were stocked in the stores.
At this time the Delhi Society for Promotion of Rational Use of Drugs (DSPRUD), a Non-Governmental
Organization (NGO) consisting of government and non-government members, was formed to improve the situation.
This group assisted the government in framing the drug policy and its implementation through support from WHO.
Objectives: To assess the impact of the drug policy in Delhi in terms of availability of essential medicines, change
in stock out days and expenditure on essential and non essential drugs.
Design: Retrospective data were collected through record reviews. The data for two years before (1993-1994, 19941995) and two years after (2000-2001, 2001-2002) the drug policy were assessed.
Setting and Population: Two public sector hospitals at Delhi that serve a large section of the population, one with
1350 beds (large) and the other with 550 beds (medium), were selected by convenient purposive sampling method.
Intervention: Implementation of elements of the drug policy such as selection of essential drugs and an improved
procurement system on access to medicines.
Outcome Measures: The amount of drugs procured from the Essential Drugs List (EDL) and outside the EDL;
money spent on these; and changes in stock out days for the key drugs.
Results: After the implementation of the drug policy, the availability of total number of drugs increased by 25% in
the large and 98% in the medium hospital. The drugs procured from the EDL increased from 62% to 78% in the
large and 74% to 87% in the medium hospital. Of the total expenditure, the money spent on essential drugs increased
from 73% to 85% in the large and 87% to 93% in the medium hospital, whereas money spent on nonessential drugs
decreased from 27% to 15% in the large and 13% to 7% in the medium hospital. The average number of stock out
days for key dugs decreased from 33 to 16 days in the large and from 143 days to 33 days in the medium hospital.
Conclusions: The implementation of the drug policy in the state of Delhi has lead to an increased availability of
essential rugs. This type of intervention can serve as a model for improving access to medicines by implementing an
effective drug policy through an NGO working with the government and involving bureaucratic and political
commitment.
Study funded by: : Delhi Society for Promotion of Rational Use of Drugs , Delhi .
Study Funding: Delhi Society for Promotion of Rational Use of Drugs (DSPRUD), Delhi
Introduction
• Before Implementation of Drug Policy in Delhi,
the situation regarding availability and use of
medicines in Delhi Government hospitals was
poor.
• Unnecessary medicines stocked in large amounts
and needed medicines were not available
• Intervention of Delhi Society for Promotion of
Rational Use of Drugs (DSPRUD), improved the
situation.
• This is an example of an NGO assisting the
government for development and implementation
of its drug policy.
Objective
To assess the impact of the drug policy in Delhi
in terms of
 availability of essential medicines
 change in stock out days and
 expenditure on essential and non essential
drugs.
Methods
Study Design
• Descriptive and comparative analytical study
• Retrospective data collected for two successive years at
Govt. hospitals through assessment of records i.e,
– before Policy- 1993, 1994 and
– after Policy - 2000, 2001
Sampling- Convenient and purposive
Setting and Population-Two public sector hospitals at Delhi
Methods…….contd.
Intervention
Implementation of elements of the drug policy such as
 Selection of essential drugs and
 An improved pooled procurement system
Outcome Measures
 Amount of drugs procured from the Essential Drugs
List (EDL) and outside the EDL
 Money spent on these and
 Changes in stock out days for the key drugs.
Availability of Drugs at Large Hospital
400
352
352
350
No. of Drugs
•
300
282
280
280
274
250
200
150
174
179
106
103
100
78
72
50
0
1993-94
1994-95
Before Policy
2000-01
2001-02
After Policy
Total number of drugs-25%
EDL drug-57%
Non EDL drugs-28%
(Increased from 62% -78%)
Availability of Drugs at Medium Hospital
350
300
256
256
250
No. of Drugs
298
286
200
150
150
144
113
107
100
50
37
37
30
42
1993-1994
1994-1995
2000-2001
2001- 2002
0
Before Policy
After Policy
Total number of drugs- 98%
Non EDL drugs- 2.7%
EDL drugs-133%
(Increased from74%- 87%)
Twelve percent (12%) increase in funds
utilized for Essential Drugs in Large
Hospital
Percentage of total budget spent on EDL
100
90
80
70
60
50
40
30
20
10
0
77.93
83.44
86.77
2000-2001
2001-2002
68.13
1993-1994
1994-1995
Five percent (5%) increase in funds
utilized on Essential Drugs in Medium
Hospital
Percentage of total budget spent on EDL
96
94.09
94
91.43
92
89.1
90
88
86
85.63
84
82
80
1993-1994
1994-1995
2000-2001
2001-2002
Average stock outs days
Change in average stock outs days
– Large Hospital
60.00
50.00
49.58
40.00
30.00
20.00
16.58
10.00
22.92
8.92
0.00
1993-94
1994-95
Before Policy
* Stock outs days in decreasing trends
2000-01
2001-02
After Policy
Average stock outs dats
Change in average stock outs days –
Medium Hospital
200.00
180.83
150.00
105.33
100.00
58.00
50.00
8.67
0.00
1993-94
1994-95
Before Policy
* Stock outs days in decreasing trends
2000-01
2001-02
After Policy
Conclusion……
• Through proper selection of essential
drugs funds utilized more judiciously
• Costs contained with pooled procurement
• Judicious use of funds increased
availability of essential drugs
• Stock outs of key drugs decreased