Access to medicines

Access to essential medicines is an integral, and often crucial, component of health care. The World Medicine Report of the World Health Organization finds that India is the country with the largest number of people (649 million) without access to essential medicines. Given that India today is one of the largest producers of drugs (by volume) in the world and exports medicines to over 200 countries, this is clearly an unacceptable situation. In an ideal situation all medicines that are researched and marketed should enhance therapeutic goals and should be available to all those who require these medicines. Unfortunately the actual situation in the medicines market is much more complex. There are several issues that need to be addressed in order to ensure access to all medicines that people need. The drug industry is rapidly transforming with increasing mergers and takeovers by multinational corporations. The government’s new policy of allowing 100% FDI in the drug industry has become an instrument to acquire Indian companies. Without investing anything for manufacturing or establishing any plants the MNCs are capturing the existing Indian drug companies. While this may be in line with the Government’s ‘make in India policy’ (where the only consideration is that companies shift production to India irrespective of ownewrship of the companies involved), it is starting to choke the domestic industry built and nurtured over decades. Medicine costs are the major component of out of pocket expenses that we talked of earlier. Changes in the Drug Price Control order in 2012 have converted the price control of medicines into a cruel joke. Essential drug prices are now fixed on the basis of their price in the market, which is inflated, rather than on actual production costs. Many studies have shown that market prices of drugs are often 10 or even a 100 times that of the production cost
Patients in India are also affected by a huge market, promoted by unethical marketing practices of drug companies, by the marketing of irrational and harmful medicines. Doctors are bribed by companies to prescribe such medicines. Following adverse comments by the Parliamentary Committee on Health the government, in early 2016, issued notifications banning over 300 irrational medicines. The medicines of many large companies, including top selling products of multinational corporations were affected. The major reason why people in India cannot access medicines is that they are forced to buy them from the market. Even public facilities often do not stock all essential medicines and ask patients to buy them. A few state governments have started free medicines schemes to supply all essential medicines free of cost to patients attending public facilities. The schemes are running successfully in a few states, notably Tamilnadu and Rajasthan. However, most states are yet to effectively implement such schemes. Neither has the central government lived up to an earlier promise to support such schemes in all states