Amidst the jostling crowd at the Guru Teg Bahadur Hospital in Shahdara, Delhi, is 68-year-old Suresh Chandra, holding his medical files on one hand and prescription letter on the other. Chandra, who is a lung disease patient, moves towards the Jan Aushadhi store, situated in the hospital premises.
Chandra hopes that the government-run medical store which is supposed to sell medicines at an affordable price, much lower than the market price, will be able to provide him the medicines he requires. However, he finds that the store has not stocked any of the medicines in his prescription. A disappointed Chandra says he cannot afford to buy the medicines from private stores.
In the 30 minutes that the TEHELKA correspondent waited outside the store, around 10-15 people visited the store and returned dissatisfied.
As per the World Health Organisation (WHO) and Health Action International Survey in 2004-2005, only 30 percent of essential medicines are available in the government-run hospitals.
The sheer apathy, however, is at a time when India is one of the major exporters of medicines. Every fifth tablet, capsule or injection consumed anywhere in the world is manufactured in India.
Establishing Jan Aushadhi stores was an attempt made by the UPA (United Progressive Alliance) government in 2008 to provide quality generic medicines at a lower price than the branded drugs available in the market. The Department of Pharmaceuticals, under the Ministry of Chemicals opened these generic medicine stores along with various state governments, Red Cross Society and few other ngos. Almost 200 such stores were initially opened.
The then government had announced that it would open stores in 660 districts of the country. However, only 98 stores are functional today, as they started incurring losses due to the unavailability of medicines and lack of awareness among masses regarding the quality and the therapeutic properties of generic medicines in comparison to branded drugs.
For instance, the Jan Aushadhi store in Srinagar, located in the building of the regional chapter of Indian Red Cross Society (IRCS) , has only 100 medicines stocked. IRCS’s general secretary Roma Wani says that only few people visit the store as there is not enough awareness.
Despite the ground realities, the ruling government is planning to upgrade Jan Aushadhi campaign by announcing the setting up of thousands of such stores across the country.
Recently, Minister of Chemicals and Fertilisers, Ananth Kumar claimed in a press conference that the number of the stores will be expanded to 3000 by signing mous with seven states initially and covering all the district hospitals via a new comprehensive plan.
The proposal sounds ambitious. Making this a reality would mean less dependency on branded drugs manufactured by large Indian companies, easy availability of affordable medicines and a radical change in the public healthcare sector.
Currently, the operational Jan Aushadhi stores provide only few drugs such as antibiotics, analgesics, anti-pyretics and combination of analgesics and anti-inflammatory drugs, manufactured by five public sector drug companies— Indian Drugs and Pharmaceuticals Limited, Hindustan Antibiotics Limited, Bengal Chemicals and Pharmaceuticals Limited, Karnataka Antibiotics and Pharmaceuticals Limited and Rajasthan Drugs and Pharmaceuticals Limited.
According to sources in the ministry, these PSUs are in dire need of revival. “Since there has been no upgradation in the technology, these units are either nonfunctional or have minimum supply,” says the source, who preferred anonymity. Apparently, the government has been merely running these companies for namesake without bothering to implement their actual motive of providing quality generic medicine at affordable prices to the poor.
The medicine stock that should be available at the Jan Aushadhi stores should have all essential medicines of the national list or the state list. However, the medicines which are being sold at these stores are determined by the inventory of these PSUs.
People have also developed a belief that it is better to buy expensive branded medicines than cheap generic ones, thanks to government policy, manufacturers, retailers and doctors.
“Patients seem to have little or no faith in the quality of generic medicines available at the public facility. They appear to be reluctant to purchase generic medicines at drug stores because they question the quality,” says Anita Kotwani, associate professor, Department of Pharmacology, VP Chest Institute, University of Delhi.
Kotwani along with a team of pharmacologists did a study to judge the quality of the medicines available in the Jan Aushadhi store. The study done on four medicines revealed that the generic drugs were at par with their respective counterpart branded medicines available in the market. Generic medicines manufactured at these PSUs were found to be Good Manufacturing Practice (GMP) compliant.
The study raises several pertinent questions. If the generic drugs are just as good as the branded ones, then why are people flocking to buy the more expensive branded drugs? In government hospitals when free medicines are unavailable, do doctors suggest the patient to purchase medicines from the generic store? Secondly, are doctors prescribing drugs with generic names? The Indian Medical Council (Professional Conduct, Etiquette and Ethics) Regulations, 2002, states that every physician should, as far as possible, prescribe drugs with generic names and he/she shall ensure that there is a rational prescription and use of medicine.