Why is the Jan Aushadhi Scheme an utter failure?

How it all began?

Union minister Sri Ram Vilas Paswan launched Jan Aushadhi Scheme in April 2008 with great fanfare. The objective was to make generic drugs available to poor at substantially lower prices than branded drugs which are almost unaffordable. Shops were opened in big hospital complexes, supply of drugs arranged from big manufacturers. The intention was to set up one Jan Aushadhi shop in each district head quarters. The table given below compares prices of branded drugs and generic ones of a few typical drugs:

Where are we now?

So far, 113 Jan Aushadhi Stores have been opened in the States of Punjab, Haryana, Rajasthan, Uttarakhand, Andhra Pradesh, Odisha, West Bengal, Jammu & Kashmir, Himachal Pradesh, NCT of Delhi & UT of Chandigarh. Sri Srikant Kumar Jena, Minister for Chemicals and Fertilizers laments: “Since opening up of Jan Aushadhi Stores mainly depends upon the health policies followed by State Government, besides the support and cooperation they extend to open such stores, in the identification of agencies to manage such stores, allotment of space etc., it is difficult to prescribe any timeline for launching stores in the remaining States.”. The official website for Janaushadhi scheme http://janaushadhi.gov.in gives prices of some 320 essential medicines in generic form available in these shops. In reality, almost all shops set up so far, display empty shelves. In NIMS, Hyderabad the Jan Aushadhi shop always says No Stock, while a next door chemist has a roaring daily turn over of more than 4 lakhs!

Problems and issues:

All kinds of problems have cropped up: Shops have no stocks as already indicated. Doctors refuse to prescribe generics though they have been directed to do so, especially in the case of govt hospitals. IMA has advised that doctors need to prescribe generics only if so requested by patients or write out equivalents as a substitute. Hand in glove with manufacturers, doctors take their commission / cut and leave poor patients to be exploited, by prescribing only branded products. Competitors in trade threaten generic only shops to close down through unfair means. 

Supply chain from manufacturer to retailers is mismanaged; moreover the suppliers hitherto have only been large scale public sector companies who are so big that the requirements of a few Generic shops is peanuts for them and are not interested in doing business coming through Jan Aushadhi chain. Now Govt has started looking into Middle level players too.  Most importantly there is no awareness among public and doctors – Most doctors do not know what / how to prescribe generics! Many Doctors also harbor wrong belief that low priced medicines are useless, forgetting that the drugs are produced by reputed manufacturers  in the same factory adopting same methods and controls applicable both for branded ones as well for generic ones!. Another reason is that Health is in concurrent list – so many State governments have to co-operate for any scheme to be successful.

Andhra Pradesh holds out hope!

In the case of Andhra Pradesh, AP Medical Services and Infrastructure Development Corporation (APMSIDC) is keenly interested in making availability of generics a reality. They plan to set up more than 175 generic shops under the brand “Jeevanadhara” through out the state. Reputed NGOs like Red Cross, Andhra Pradesh Senior Citizens Confederation (APSCCON) have been approached to implement the scheme. Govt would provide space, support for procuring drugs, publicity for shops opened under this plan. As there appears to be some political will to make it a success, there is every hope that Jeevanadhara would succeed. Let us wait and see.

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Generics for Generation Old

Generics for Generation Old

All of you know that medicines are cheap when bought under their generic name rather than certain brand names. For example, a strip of Ten Crocin (Paracetamol 500 mg tablets) costs RS 10 while non branded plain Paracetamol costs only Rs 2.50 per strip. At times the difference could be even ten times. Though there is huge price difference, there are a couple of issues in using Generic drugs.

First and foremost, most doctors prefer to prescribe only branded drugs of leading big manufacturers.While reliability of quality may be point of concern, mostly it is the bribe the doctor gets that induces him to prescribe brand named drugs. Large companies spend very heavy amounts to promote their products. This is a fact and reported many times through several market studies and surveys.

In view of the cost benefits to the public and patients, the governments of Karnataka and Andhra Pradesh have made rules that in government hospitals only generics may be prescribed by government doctors. How about private medical practioners? They can not be forced to prescribe only generics, sacrificing their lucrative earnings. We have identified a few family physicians who are senior friendly and they have agreed to re-write the prescription translating brand names to generics thus helping the patients greatly. This kind of circumvention is necessary as our pharmacy regulations insist that scheduled drugs may be dispensed only strictly according to prescription and the pharmacist has no permission to sunbstitute one for the other. Senior citizens organizations should come forward to identify such family physicians in every locality.

Among senior citizens also many entertain the idea that costly medicines are of good quality and cheap medicines are of poor quality. This is not a fact. There may be a few bad manufacturers who may sacrifice quality. Even among generic manufacturers there are many competing firms and a good doctor can identify reputed generic manufacturers easily through his experience. Another way to ease the situation is to request the doctor to give alternatives in the prescription itself.

As Sri Harinarayan Chairman of IRDA pointed out recently, there is nothing preventing senior citizens associations coming together and setting up medical shops to sell generics exclusively. This has already started happening, as such shops in Vijayawada and Guntur have come up. Recently the government of Andhra Pradesh has decided to set up about 170+ medical shops only to sell generics through out AP. The central government's Jan Aushadhi Scheme is an utter flop due to large scale mis-management. Let us hope the state government scheme is run properly and proves useful.With a dynamic and committed bureaucrat like Dr Ramesh (Principal Secretary, Health, AP) at the helm of affairs, this is not impossible.

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