Enhancing Access to Essential Medicines and Diagnostic services in Rajasthan

1. Enhancing Access to Essential Medicines/Diagnostic Exploring the Rajasthan Free Medicine & Diagnosis Scheme initiative for improved healthcare access. Dr. Mohammad Rafique MBBS, PGDHM, PGDPPHC, M.Phil. Hos, Health system Management, Ph.D. Scholar Public Health

2. Free Medicine & Diagnostic Scheme Timeline Key Health Initiatives in Rajasthan 1st April 2022 Launch of Mukhyamantri Nishulk Nirogi Rajasthan Yojna 2013 On 1st April 2022, the Mukhyamantri Nishulk Nirogi Rajasthan Yojna was introduced, further expanding the state's commitment to public health. This scheme not only continued the provision of free medicines but also aimed to offer a more comprehensive healthcare service, integrating preventive and promotional healthcare initiatives to improve overall health outcomes in the community. Launch of Mukhyamantri Nishulk Janch Yojana The Mukhyamantri Nishulk Janch Yojana was officially launched on 7th April 2013 at District and Medical College level. 01.07.2013 at CHC level. 15/05/2013 at PHC level. 2nd October 2011 Launch of Mukhyamantri Nishulk Dava Yojana The Mukhyamantri Nishulk Dava Yojana was officially launched on 2nd October 2011, marking a significant step towards enhancing the accessibility of essential medicines for all residents of Rajasthan. This initiative aimed to provide free medicines to citizens, ensuring that financial constraints do not hinder their access to necessary healthcare.

3. Mukhyamantri Nishulk Nirogi Rajasthan Yojana A Revolutionary Healthcare Scheme for Rajasthan's Population Introduction of MMNRY Free OPD/IPD Services Universal Coverage Provision of Free Medicines and Diagnostic services Estimated Daily Beneficiaries The Mukhyamantri Nishulk Nirogi Rajasthan Yojana (MMNRY) was launched on April 1, 2022, aiming to enhance healthcare access for all citizens of Rajasthan. The 2022-23 budget allocation includes provisions for free outpatient (OPD) and inpatient department (IPD) services in all government healthcare institutions across Rajasthan. This scheme is designed to cover the entire population of Rajasthan, ensuring that healthcare services are accessible to everyone without any financial burden. Under MMNRY, beneficiaries receive free medicines, surgical items, and sutures, and Lab services significantly reducing out-of-pocket expenses for healthcare. The scheme is expected to benefit approximately more than 4 lakh individuals daily, indicating a significant impact on public health in the region.

4. RMSCL Stricture Chairman The Chairman of RMSCL is the ACS/PS/Secretary of the Ministry of Health and Family Welfare (M,H&FW), providing strategic leadership and oversight. Managing Director The Managing Director, an IAS officer, plays a crucial role in the day-to-day operations and strategic direction of the organization. Other Key Roles Key roles within RMSCL include the OSD and Executive Directors overseeing Equipment, Supply Section, Quality Control, Procurement, Logistics, and Finance, ensuring efficient operational management.

5. Logistic, IT, Procurement & Supply Officers Specialized officers in IT and Logistic, Procurement & supply are instrumental in supporting the technological and logistical needs of RMSCL. CDAC Team The CDAC Team supports RMSCL's technology and data management needs, facilitating efficient communication and information flow within the organization.

6. Essential Drug List Category wise data as on 06.09.2024 EDL Nirogi Rajasthan Level Drug Surgical Suture Total Surgical Suture Total Grand Total Drug MCH 694 174 79 947 547 254 77 878 1825 DH 648 157 46 851 126 101 21 248 1099 CHC 551 125 38 714 53 5 1 59 773 PHC 428 86 16 530 14 3 1 18 548 SC (HWC) 106 10 116 6 6 122 SC 40 10 50 50

7. Financial Overview Detailed Analysis of Funds Received and Utilized for Fiscal Years 2023-24 and 2024-25 Particulars (Rs. in Cr.) Budget Received Budget Utilized (Rs. in Cr.) Utilization Certificates Sent (Rs. in Cr.) F.Y 2023-24 STATE PLAN BE 800.00 789.08 800.00 UDAN YOJNA 347.97 520.96 553.52 NHM –A & F amount 687.98 673.00 400.00 Total = 1835.95 1547.97 1983.04 1753.52 2024-25 (AS ON 31-08-2024) STATE PLAN BE 900.00 384.77 225.00 UDAN YOJNA - 85.55 - NHM –A & F amount 1187.07 300.00 195.00 Total = 2087.07 645.00 770.32 420.00

8. Strengths and Challenges A Comprehensive Overview of Internal Strengths and External Challenges Extensive Medicine Inventory RMSCL boasts the highest number of medicines compared to all other corporations and states in the country, ensuring comprehensive healthcare access. Quality Procurement Standards Procurement is conducted from WHO-GMP certified companies, guaranteeing high-quality medicines for patients. Robust Quality Testing Mechanism A three-tier mechanism for quality testing, including a double testing system for drugs deemed 'Not of Standard Quality', ensures patient safety. Competitive Pricing Strategy Utilizing a two-bid process to secure competitive rates for procurement, maximizing budget efficiency.

9. Work Flow and Logistics Understanding the Process and Personnel Involved Annual Demand Assessment Preparation of Drugs for Use 01 05 The RMSC begins its workflow by receiving annual demand from various departments including the Medicine & Health (M&H) Department, Mechanical Engineering (ME) Department, and RUHS. This initial step is crucial as it sets the foundation for inventory planning and procurement. Time to time using EDL and updating medicine Manpower Structure at DDW/MCDW 06 DDW/MCDW 02 The manpower at DDW/MCDW includes an officer in charge of DDW, two pharmacists responsible for medication management, and 1-3 informatics assistants who support data management and tracking. Additional helpers are allocated based on the number of institutions served. DDW/MCDW for storage and capacities building . Support Personnel 07 Quality Assurance 03 Helpers are employed according to the number of institutions to ensure efficiency in operations. Moreover, security personnel are deployed as needed to safeguard the facilities and ensure a secure environment. This step is vital to ensure that the products meet health and safety standards so there are direct contact with All doctors medical and health department. New Medicine 04 New medicine proposal received and analyses there effect .

10. Equipped District Drug Warehouses Essential Equipment for Efficient Drug Distribution Heavy-Duty Racks Hand Pallet Trucks Walk-In Coolers The warehouses are outfitted with robust heavy-duty racks designed to store a large volume of pharmaceuticals safely and efficiently, ensuring easy access and organization. Hand pallet trucks are available to facilitate the movement of goods within the warehouse, allowing for swift transportation of inventory and enhancing operational efficiency. Each warehouse includes walk-in coolers that maintain the necessary temperature for sensitive medications, ensuring product integrity and compliance with storage regulations. Electric Stackers Fire Extinguishers Ice-Lined Refrigerators Electric stackers help in lifting and stacking heavy pallets, reducing manual labor and minimizing the risk of injury, thus promoting a safer working environment. Fire extinguishers are strategically placed throughout the warehouses, ensuring immediate access in case of emergencies, thereby enhancing safety for personnel and inventory. Ice-lined refrigerators are utilized for the storage of temperature-sensitive vaccines and pharmaceuticals, maintaining optimal conditions for effective product preservation.

11. Expiry and Supply Management Overview of Expired Medicines and Supply Management Processes S.No F.Y Value of Expired Medicines % Expiry 1 2020-21 Rs. 50,93,254 0.08% 2 2021-22 Rs. 1,50,35,113 0.16% 3 2022-23 Rs. 58,21,967 0.031% 4 2023-24 Rs. 36,67,011 (As per e-Aushadhi)

12. Procurement Process Understanding the Framework and Requirements Open Tender Process Mandatory Certifications 01 04 The procurement begins with an open tender process conducted on the eProcurement portal focused on rate contracts for medicines, surgical supplies, and sutures. This ensures transparency and competitiveness among suppliers. All participating firms must possess a WHO GMP Certificate and have a minimum of three years of market standing for the products they intend to supply. This certification guarantees compliance with global quality standards. Eligibility Criteria for Participation Non-Blacklisting Condition 02 05 Eligible participants include manufacturers, importers, loan licensees, or co-marketers who hold sole marketing rights for the products. This criterion ensures that only qualified entities can offer their products. Firms or products must not be blacklisted, debarred, or convicted in any part of the country. This condition protects the integrity of the procurement process and ensures that only reputable suppliers can participate. Minimum Turnover Requirements 03 Access to Information 06 To qualify for participation, firms must demonstrate a minimum average annual turnover of Rs. 20 Crore for drugs and medicines, Rs. 10 Crore for surgical supplies, and Rs. 20 Crore for sutures. This requirement helps to ensure that only established players are involved. Detailed information regarding rate contracts, tender conditions, and supplier contact details is accessible on the RMSCL website. This resource is vital for potential suppliers to prepare their bids effectively.

13. Quality Control and e-Aushadhi Application Quality Control Yearly Overview and e-Aushadhi Application Features S. No Fin. Year Total Reports No. of Failed Reports Failure % No. of Passed Reports 1 2021-22 15570 141 0.91% 15429 2 2022-23 23875 238 0.99% 23637 3 2023-24 27617 191 0.69% 27426 4 2024-25 11682 63 0.54% 11619

14. Equipment Procurement and Management Understanding the Process and Maintenance of Medical Equipment Equipment Procurement Process The procurement of equipment within medical institutions is conducted through contracted firms that adhere to rates established via open bidding. This systematic approach ensures transparency and fairness in the acquisition of medical equipment. Current Tender Status As of now, there are 80 rate contracts available for medical equipment procurement, while 12 tenders are currently under process. Additionally, there are plans to float 39 more tenders, indicating an active and ongoing procurement strategy. Biomedical Equipment Maintenance The maintenance responsibility encompasses 563 types of equipment for the Medical Education Department and 140 types for the Medical and Health Department. This highlights the extensive range of biomedical equipment that requires regular upkeep to ensure operational efficiency. Maintenance Provider The maintenance and repair of the biomedical equipment are currently managed by M/s Kirloskar Technologies Pvt. Ltd. Their expertise is crucial in maintaining the functionality and safety of medical devices. Complaint Registration System The e-Upkaran Software is utilized for logging complaints and monitoring the subsequent actions taken. This digital tool streamlines the process, ensuring timely responses and accountability in equipment maintenance.

15. Role Models and Achievements Exploring Collaborations and Partnerships Across Sectors Collaboration with BPPI Discussion with USAID The team visited the Bureau of Pharma PSUs of India (BPPI) in Gurgaon to explore collaborative opportunities in the pharmaceutical sector, enhancing access to quality medicines. A strategic meeting with USAID was held to discuss funding opportunities and collaborative projects aimed at sustainable development. Engagement with Deloitte Interaction with Group-B Officers A visit to Deloitte’s office in Delhi focused on understanding best practices in consulting services, aiming to improve organizational efficiency and effectiveness. The Group-B Officers of Central Secretariat Services engaged in discussions to enhance administrative capabilities and governance efficiency. United Multipurpose Club Interaction Engagement with Open Society Foundation The visit to the United Multipurpose Club in Guwahati, Assam was aimed at engaging local communities and understanding their needs for better service delivery. The visit from the Open Society Foundation focused on promoting democratic governance and enhancing civil society engagement. Academic Engagement with Indian Universities Dialogue with North Korea Officials Students from Indian Universities and Tufts University, USA, participated in discussions aimed at fostering international academic collaboration. The North Korea Team of Government Officials met to discuss international collaboration and knowledge exchange in governance and public health. Collaboration with Chhattisgarh Health Department Collaboration with Nepal's Centre for Labour and Social Studies The Chhattisgarh Team from the Ministry of Health engaged in discussions to improve health service delivery and policy implementation. Engagement with the Centre for Labour and Social Studies in Nepal focused on labor issues and social development, fostering regional partnership. Medicines Procurement in Nepal Partnership with UNFPA Meetings with the Medicines Procurement Department of the Government of Nepal focused on improving procurement processes for essential medicines. Collaboration with the United Nations Population Fund (UNFPA) aimed at addressing global health and population challenges through shared initiatives. Engagement with WHO & PHFI Team Collaboration with the World Health Organization (WHO) and Public Health Foundation of India (PHFI) to enhance public health strategies and initiatives.

16. Challenges and Future Plans Addressing Current Challenges and Future Initiatives Increased Workload New Construction Initiatives 01 04 The journey has been marked by a significant increase in workload, primarily due to the growing number of medicines and items needing management. This surge necessitates more resources and careful planning to ensure that all items are accounted for and distributed efficiently. To address the challenges posed by increased workload and storage constraints, plans for new construction and renovations have been proposed. Utilizing funds from the National Health Mission (NHM) Program Implementation Plan (PIP), 28 districts will see enhancements to their storage and distribution capabilities. Storage Space Constraints 02 Expansion of Drug Distribution Warehouses 05 The existing storage facilities at the Drug Distribution Warehouses (DDWs) and Medical Supply Distribution Warehouses (MCDWs) are under strain. As the volume of medicines and supplies increases, the lack of adequate storage space can lead to challenges in inventory management and distribution. As part of the strategic response to logistics challenges, there will be the establishment of DDWs in 17 new districts. This expansion aims to improve access to essential medicines and streamline distribution networks. Construction of New RMSCL Building 06 Timely Procurement Challenges 03 Plans are underway for the construction of a new Rajasthan Medical Services Corporation Limited (RMSCL) building. Additionally, new facilities are set to be built for the MCDW in Ajmer and Kota, enhancing the capacity to manage healthcare supplies efficiently. Procurement processes have faced hurdles, impacting the ability to obtain medicines and supplies in a timely manner. Delays can result in shortages that disrupt service delivery and compromise patient care.

17. e-Aushadhi Application A Comprehensive Overview of the e-Aushadhi Application's Functions and Benefits Web-Based Application 01 The e-Aushadhi application is a web-based inventory and supply chain management system that enhances the efficiency of drug management processes. Procurement and Distribution Management 02 This system is specifically designed to manage the procurement and distribution of drugs, ensuring timely availability and accessibility. Multiple Support Modules 03 It includes various modules that support efficient operations, allowing users to navigate through different functions seamlessly. Recognition and Awards 04 The e-Aushadhi application has been recognized and awarded for its successful implementation, showcasing its impact on healthcare logistics. Enhancing Healthcare Delivery 05 By streamlining the supply chain, the application plays a crucial role in enhancing healthcare delivery and improving patient outcomes.

18. e-Upkaran Application A Comprehensive Solution for Equipment Management 01 02 03 04 Web-Based Platform URL Access Enhanced Equipment Safety Maximized Operational Life The e-Upkaran Application is a comprehensive web-based Equipment Inventory & Maintenance Management System that streamlines the management of equipment across various sectors. Access the application directly through the URL: https://emmsrmsc.prd.dcservices.in, enabling users to manage their equipment efficiently from anywhere. The application prioritizes equipment safety by implementing systematic checks and balances, ensuring that all equipment is in optimal working condition. By facilitating regular maintenance and timely interventions, e-Upkaran helps in maximizing the operational life of equipment, thereby reducing replacement costs. 05 06 07 08 Cost Minimization Mobile Application Features Complaint Management QR Code Scanning The system is designed to minimize costs associated with equipment management through efficient resource allocation and predictive maintenance strategies. In addition to the web platform, the e- Upkaran Application includes a mobile app that allows for on-the-go complaint management and facilitates QR code scanning for quick access to equipment data. Users can easily log and track complaints through the mobile application, enhancing response times and improving overall service delivery. The QR code scanning feature enables users to quickly retrieve equipment information and maintenance history, streamlining operations and improving efficiency.

19. Health & Hygiene Launch of Health & Hygiene Initiative 01 On April 1, 2022, a significant health initiative was launched aimed at enhancing women's health and hygiene by providing free sanitary napkins. This initiative is particularly important in promoting menstrual hygiene management and ensuring that all women have access to necessary sanitary products. Initiative Role of RMSCL in Procurement 02 The Rajasthan Medical Services Corporation Limited (RMSCL) plays a crucial role in managing the procurement of sanitary napkins. By implementing a two-tier system for procurement, RMSCL ensures efficiency and accountability in the distribution process, ultimately benefiting the end-users. Wide Distribution Network 03 Approximately 99,000 centers are involved in the distribution of sanitary napkins under this initiative. This extensive network ensures that the products reach women in various locations, enhancing accessibility and convenience. Conclusion

20. Awards and Achievements Recognizing Excellence in Public Service e-Gov Rajasthan Award-2013 01 This prestigious award recognizes outstanding contributions to e-governance in Rajasthan, highlighting innovative practices and improvements in service delivery to citizens. Government PSU Leadership & Excellence Awards 2024 02 Awarded for exceptional leadership and excellence in public sector undertakings, this accolade emphasizes commitment to efficiency and service quality in government operations. Technology Sabha Excellence Award 2024 03 This award celebrates technological innovations that significantly enhance governmental and public service operations, showcasing best practices and advancements in technology. Paper Publication: Implementation of FREE MEDICINES & FREE DIAGNOSTIC SCHEMES 04 A significant contribution to the field of healthcare policy, this publication discusses the strategies and outcomes of implementing free medicines and diagnostic services, promoting health equity. First Rank in India on DVDMS Portal 05 Achieving first rank nationally on the DVDMS portal demonstrates excellence in digital governance and service delivery, positioning the organization as a leader in utilizing technology for public service.

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