LEAD STORY. In the shadow of a stock-out

Last month, pro-patient groups called for an emergency intervention, as buffer stocks of HIV/AIDS medicines dipped to critical levels.

By late October they feared centres providing these medicines free to patients across the country, as part of ongoing Government programmes, could be staring at a stock-out.

Just 15 odd months ago, a similar call had been sent out on tuberculosis (TB) medicines for children. And the Government had scrambled emergency stocks in the nick of time.

Even as donors, Government, drug companies and patient-groups pull out all stops to avert a disaster – the recurrence of shortages raises an uncomfortable question.

Should a country that prides itself as being pharmacy to the world be staring at medicine shortages, and repeatedly?

“If all the efforts (undertaken over several months) come through we might be able to avoid a disaster,” says Loon Gangte, regional co-ordinator (South Asia) with the International Treatment Preparedness Coalition.

“With the ARV (anti-retroviral drugs), I see a small light at the end of the tunnel. But on paediatric early infant diagnostics, and viral load kits, I see no light at the end of the tunnel,” he adds.

Even the emergency efforts to scramble medicines are short-term, says Gangte, making the long-standing plea to reform the Government’s procurement and distribution process.

Systemic ills India can ill afford to have erratic drug supply and stock-outs in diseases like TB and HIV, as it increases the risk of drug-resistance, says Dr Madhukar Pai, Director of Global Health at McGill University, Montreal. India already grapples with resistance, where medicines don’t work effectively on patients due to possibly erratic compliance to treatment regimes in the past.

Pointing out the irony, he observes, India is both a major supplier of generic drugs, and has strengths in information technology (IT), that is used in handling supply chain issues. And yet, drug procurement issues persist. This suggests poor management, he adds.

Drug stockouts happen all the time at public facilities, but there is a tacit acceptance that the public system will not have medicines and people move to more expensive private healthcare institutions, says Amit Sengupta, with the Jan Swasthya Abhiyan. The problem in India is of too many suppliers, the demand is lower than capacity and there is no planning to keep track of who is making what and what is required when, he explains.

Add to this, payment glitches and delays in releasing money. Though the national AIDS and TB control programmes are digitized, there are shortages because of systemic problems, he says.

A participant in Government programmes, vaccine-maker Serum Institute’s Executive Director Suresh Jadhav, says that the Government needs to improve its forecasting to be able to map its product requirements. Besides, the Government also needs to have more than one supplier on its programmes, to prevent last minute hitches.

Admitting to procurement glitches in the past, Government representatives say that they are moving towards an IT- driven procurement system.

Display stock-lists Rajasthan implemented an efficient procurement and distribution system, it’s not rocket science, says Sengupta, adding that all it needed was efficient Government officials.

“All public facilities must display a list of essential drugs available with them and their stock situation,” he says, voicing a longstanding suggestion from healthcare workers.

Gangte urges the Government to go in for two year tenders, to

allow for the bureaucracy of files requiring several approvals and finance sanctions, besides the turnaround time for companies to make the medicines.

In a one year scenario, if one cycle is missed, there is a stock-out situation, he points out. The Government also needs a dynamic and transparent online procurement system that reflects medicine stocks across the country, he says.

India has made a success of making inexpensive medicines, its time now to repeat that success in distribution and getting the medicines to people, says a healthcare worker closely involved with patient agitations, but unwilling to be named.

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