Essential medicines for cardiovascular diseases in India: Rapid appraisal of policies and processes at the subnational level

Author:

GARG ANKUR1,MURPHY ADRIANNA2,KRISHNA ASHISH3,SAHOO SWAGATA KUMAR3,HUFFMAN MARK D.45,KISHORE SANDEEP P.6,SHIVASHANKAR ROOPA13

Affiliation:

1. Centre for Chronic Disease Control, New Delhi, India

2. Centre for Global Chronic Conditions, London School of Hygiene and Tropical Medicine, London, UK

3. Resolve to Save Lives, Gurugram, Haryana, India

4. Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago

5. Division of Food Policy, The George Institute for Global Health, University of New South Wales, Sydney, Australia

6. University of California San Francisco, California, USA

Abstract

Background The burden of cardiovascular diseases (CVDs) and response to health systems vary widely at the subnational level in India. Our study aimed to assess the variation in state-level access to medicines for CVDs by comparing the essential medicines lists (EMLs) at the national and subnational levels in India and by rapid appraisal of the existing policies and processes of drug procurement. Methods We assessed the inclusion of six classes of medicines for CVDs in the recent and publicly available national and subnational EMLs from July to September 2018 in the states of Telangana and Madhya Pradesh. We examined the drug procurement and distribution policies and processes using documentary review and five key informant interviews between March and June 2018. Results The WHO’s EML, India’s national EML, and 21 of 28 publicly available (75%) Indian state and Union Territory EMLs included all six classes of essential medicines for CVDs. However, some medicines were not included in the policy packages of essential medicines meant for primary health centres. Both the states used centralized tendering and decentralized distribution as part of the public sector drug procurement process. The requirement was based on the previous year’s consumption. The approximate time between procurement planning and distribution was 7–8 months in both the states. Conclusion Substantial variation exists in the selection of drugs for CVDs in EMLs at the subnational level in India. Improving forecasting techniques for requirement of medicines and reducing time lags between forecasting and distribution to health facilities may allow for better access to essential medicines.

Publisher

Scientific Scholar

Subject

General Medicine

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