Here is another example of the crumbling state of India’s healthcare infrastructure and the reason behind lack of access to essential, life-saving drugs.
India has a shortage of an estimated 600,000 doctors and two million nurses, claims a study conducted by the Centre for Disease Dynamics, Economics & Policy (CDDEP), titled “Access Barriers to Antibiotics.”
With the objective of identifying reasons behind lack of access to appropriate treatment with antibiotics, which not only contributes to high rates of preventable deaths but also increases drug resistance, the study identifies three main barriers:
- “Weak drug discovery, difficulties in market entry and poor stewardship leading to the irrational selection and use of antibiotics
- Affordability of antibiotics and inadequate government funding for health resulting in high out-of-pocket (OOP) spending by patients
- Weak health systems, unreliable supply chains, and poor quality control prevent delivery of antibiotics to patients in need”
In India, the driver of poor antibiotic stewardship depends is lack of access. “Lack of access to antibiotics kills more people currently than does antibiotic resistance, but we have not had a good handle on why these barriers are created,” said Ramanan Laxminarayan, director at CDDEP told The Economic Times
“Healthcare providers without formal training provide more than seventy percent of primary care in India. Only 58 percent of those referring to themselves as doctors in India’s cities have a medical degree; in rural areas the proportion is just 19 percent, and a third of ‘doctors’ have only a secondary school education.”
64 percent of unapproved antibiotic fixed-dose combinations are prescribed despite no evidence of an advantage over single compounds. India’s drug regulator, the Central Drugs Standard Control Organization, banned 328 products in 2018; however, past bans have been challenged by the pharmaceutical industry.
Healthcare providers without formal training provide more than seventy percent of primary care in India. Only 58 percent of those referring to themselves as doctors in India’s cities have a medical degree; in rural areas the proportion is just 19 percent, and a third of ‘doctors’ have only a secondary school education.
Public health facilities lack adequate medicine stocks, and antibiotic availability is fifty to sixty percent in some states. Meanwhile, eighty percent of urban healthcare provision comes from the private sector. Private retail pharmacies may sell antibiotics at prices higher than the public procurement price, potentially driving up out-of-pocket costs for patients.
The prices charged by private pharmaceutical companies vary significantly, depending on the customer. The lowest-priced generic version of ciprofloxacin – an antibiotic medication used to treat a number of bacterial infections – in the private sector was three and a half times the price at which the company supplied it to government facilities.
“Many health facilities run out of essential antibiotics, forcing patients to purchase high-cost, poor-quality antibiotics from uncertified vendors.”
Pharmacists may substitute the generic drug on a doctor’s prescription with a more profitable branded generic or originator drug, to generate a higher profit. Practitioners may prescribe antibiotics for which they receive a commission, raising prices and hospitals purchase medicines and devices in bulk, sometimes with margins as high as 1,737 percent.
Purchasing drugs locally leads to avoidable expenses of Rs 410 million for the Medical Stores Organization (96). Many health facilities run out of essential antibiotics, forcing patients to purchase high-cost, poor-quality antibiotics from uncertified vendors.
This clearly signifies the importance of fundamental changes, more government spending, and better regulation is required for improved access to medicines. The Government must make accessibility an important feature in its healthcare agenda. The study has highlighted the necessity of national health insurance schemes that can reduce out-of-pocket payments by patients, adequately fund health agencies and departments and dedicate funding for essential medicines, including antibiotics – an outright and necessary support for India’s Ayushman Bharat scheme for health for all.