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Past Scenario . No policy articulation on Drug entitlement
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1. Presentation on Rational Drug Provision and UseA Haryana State Initiative launched on 1st January 2009 1
2. Past Scenario No policy articulation on Drug entitlement – who would get? at what cost?
Almost all OPD medicines were purchased by patients
Indoor and Emergency supplies were thin and erratic
Patients were purchasing some medicines and consumable even for institutional deliveries and EmOC services 2
3. Contd. 3
4. Contd. Govt. spent more than Rs.10 crores annually on procurement of drugs
Procurement was centralized, not in sync with requirements
Drugs being out of stock or overstocked was common
There were instances of expiry, pilferage etc
Doctors were reluctant to prescribe drugs available under Govt. supply
There was also concern about quality of drugs
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5. Addressing the Challenges A clear policy on entitlement put in place
Decision taken to provide free drugs to all OPD patients, casualty cases and institutional deliveries including LSCS
Surgical and non-surgical package system introduced for IPD patients
BPL patients and residents of urban slums entitled for completely free indoor treatment including surgeries and implants, others pay a nominal, fixed charge 5
6. Fixed Cost Surgery Package Launched in all District Hospitals w.e.f. July 1, 2009
Free surgery / IPD for BPL and residents of urban slums
All obstetrics cases, eye surgeries, cleft lip/palate are free for all patients
Very nominal charges for others
All pre-operative investigations, medicines, consumables, blood charges, post-operative medicines covered
Cost effective and hassle free, no running around for medicines/tests
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7. Process Comprehensive Essential Drug List (EDL) prepared for DH, CHCs & PHCs
EDL contains 328 essential drugs for DHs, 112 items for CHCs & 84 items for PHCs
EDL prepared in consultation with specialists
Dynamic & modifiable as per need
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8. Procurement Reforms New Drug Procurement Policy put in place
Policy weeds out Sub Standard Pharma Companies
WHO- GMP Certification, annual turnover of Rs.35 crores for last three years amongst qualifying criteria
About 110 reputed Pharma companies eligible to compete in State RCs
Procurement strictly based on Indian and British Pharmacopoeia 8
9. Broadening of Supply Sources Multiple sources approved for supply to avoid disruption and maintain supply chain
Purchase preference is given to 5 CPSUs for 102 Essential medicines
State RCs finalized at highly competitive rates.
DGS&D and ESIC rate contracts also declared as approved sources
Competitive rates negotiated for local purchases in emergency 9
10. Decentralization of Procurement Procurement completely decentralized
Broad based District Procurement Committee constituted to indent and procure
Specialists are empowered to indent medicines as per need and are part of procurement committee
Procurement done on quarterly basis 10
11. Contd. Special powers given to District Hospitals for procurement under SPP and National Programme
RKS of District Hospitals manages receipts and expenditures
Imprest money given to each surgical specialist for exigencies
Local purchase policy articulated unambiguously
Hospital cost protocol standardized for each surgery
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12. Headquarters' Role clearly delineated
Prepare and review essential drug list
Determine source of supply
Ensure timely release of adequate funds to District Health Societies
Monitor consumption on weekly basis
Mentor districts for smooth procurement
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13. Monitoring & Review Weekly monitoring of per capita cost of drugs separately for OPD & IPD, Casualty & Institutional Deliveries (facility-wise)
Variance analysis is done
Prescription audit carried out where cost deviates
Comprehensive software to monitor indent, issue, consumption, cost, reorder level and inventory
Nodal Officer appointed for each District for monitoring 13
14. Outcomes Highly affordable per capita expenditure on drugs
OPD- DH-Rs.10/-, CHC- Rs.8/-, PHC – Rs.6/-
Normal Deliveries- Rs.250/-
LSCS- Rs.1000/-
Casualty- Rs.50/-
Efficient & effective utilization of State resources
OPD patients in 2008 were about 1.12 crores & the expenditure on drugs was Rs.10 cores
In 2009 OPD likely to be 1.5 crores & state budget allocation is Rs.16 cores
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15. Contd. Enhance public confidence in Govt. health institutions
Steep rise in IPD, OPD & increase in institutional deliveries
Zero prescription of propaganda drugs – elimination of nexus
Guaranteed free health care upto district hospital level for poor patients
Free OPD with medicines for all patients
Highly affordable, hassle-free package treatment to indoor patients including surgeries 15
16. Focus on doctors, drugs & deliverables Recruitment of Doctors taken out of purview of State Public Service Commission
Web enabled rolling system of recruitment of doctors since November 2008
Applications on continuous basis
Interview on 10th of every month (even if it is a holiday)
Immediate appointments – pre verification of antecedents waived off
Merit based criteria and transparency
1300 doctors have been recruited out of which 650 are specialists and more than 500 are LMOs
Doctors from neighboring states are joining Haryana because of hassle free appointment, attractive emoluments, conducive working conditions 16
17. Deliverables An intensive monitoring system introduced
Performance of specialists in district hospitals is reviewed every month against minimum performance bench marks
Quick follow up actions in respect of poor performer
Performance benchmarks for CHC and PHC fixed 17
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