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Sourish Bhattacharyya
There used to be a time when no news was good news. As we prepare for the next millennium, media gatekeepers have turned this bit of received wisdom on its head today, good news is no news, unless it's a no-news day. One such piece of good news that never got reported has got the World Health Organisation excited like never before. The Delhi Model, in fact, is the new buzzword in Geneva, apart, of course, in Chandigarh, Chennai and Calcutta.
What is this Delhi Model all about, and why is it going to be replicated in Thailand, Myanmar, Vietnam, Laos and Kampuchea? Well, simply because it is a common-sense solution to a chronic malady of our healthcare delivery system.
Just one out of five people going to government-run hospitals for treatment get the free medicines that is due to them. It really doesn't matter, then, if the state provides them free treatment, for the money they spend on drugs and what hospitals call consumables (which can be a syringe or a stent) is enough to drive them back to theclutches of their village fatcat or factory foreman. No wonder each cycle of illness pushes the unseen, unheard majority farther into the morass of poverty. Even in Delhi, before 1992, though 30-35 percent of the national capital territory's health budget was being spent on medicines to be distributed free, chronic shortages were forcing patients to make their own arrangements.
The system of hospital-based procurement of medicines, in fact, was riddled with all the flaws that are present at all levels of the public health-care delivery system. Medicines were being procured a couple of months before their expiry dates so that they could be junked and the endless flow of orders to manufacturers mai-ntained; expensive alternatives were invariably preferred and prescribed; non-essential drugs were being stocked up in numbers that had no basis in the demand for them; traditional medicines were being bought just because the government had said so and not because doctors were prescribing them; and reputed firmswere being discouraged because clerks sat over bills to extract their cuts. Public money, in other words, was being despatched down the tubes -- the same money that could be spent buying drugs that never seem to be around at hospital stores.
Today, the Delhi government saves 30 percent of its budget for medicines and this money is ploughed back into procuring more medicines. Translated into money, it means a budget of Rs 40 crore getting you medicines worth Rs 50 crore, something unimaginable in a government set-up. In people terms, it means that the money saved on the purchase of 250 mg amoxycillin capsules enabling government hospitals to procure nine million chloroquin tablets for their malaria control programmes. Similarly, for every ten tablets of the anti-tubercular drug rifampicin (450 mg) that the Delhi hospitals bought this year, they saved Rs 6.30, which meant they had Rs 2.8 lakh more in their kitty to get more of this chronically scarce medicine.
One can keep listing examples, but the point ofthis good news is that it takes just a couple of people with clear intentions and a clear head to make a difference to a system we keep writing off.
But how did this become possible? It took just one public-spirited medical administrator, Ranjit Roy Chaudhury, Emeritus Scientist at the National Institute of Immunology, New Delhi, who doubles as health adviser to the Delhi government, to make it happen. Teaming up with C. R. Vaidyanathan, a former Union Health Secretary, and R. Parameswar, former Deputy Comptroller and Auditor General, he set in motion a system that cut waste and struck at the vested interests that allowed it to fester. All that this troika did was prepare a list of 250 essential drugs good enough for 90 percent of the ailments treated at public hospitals; shortlist companies for the supply of these medicines (any firm with a turnover of less than Rs 8 crore, the mohalla manufacturer, in other words, was kept out of the bidding process); fix rates for the drugs to be purchased; and encouragedoctors to prescribe only these medicines so that they were easily available to the intended beneficiaries.
The new system had two implications. One, it was easier for the government to flex its bargaining muscle because now the companies were talking bulk orders. Two, drug purchases from now on were to be both need-based and people-oriented, and not governed by whimsical circulars or corrupt clerks. The list was transparent and the rules were clear, which is why the Delhi high court refused to entertain a petition moved by aggrieved manufacturers thriving in the old system. And the confidence the system created among top drug companies was evident in their participation in the centralised bidding process, encouraged by the new rule making it mandatory for hospitals to clear their bills within a month.
An exercise by the Delhi government to assess the new system's success has exposed some shocking examples of waste that need reiteration. The study, conducted by an independent agency, revealed startlingdifferences in prices at which drugs had been purchased by the Delhi government and the Central government respectively for amoxycillin syrup, for instance, the price differential was Rs 3.95, and it shot up to Rs 15.60 when a comparison was made with the government-owned Super Bazar. It's a pity, really, that in four years the Delhi Model has found more takers abroad than in India. Maybe even the Health Ministry believes good news is no news.
Copyright © 1998 Indian Express Newspapers (Bombay) Ltd.
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