Jan Aushadhi Hindered By Hurdles

The Government was supposed to launch a policy for the ‘Jan Aushadhi Scheme’ in September 15. However, it has been delayed due to implementation challenges. Key industry stakeholders express their views on the delay and share measures to overcome the challenges that beset the policy launch. By Usha Sharma

Involvement of pharma SMEs, as part of their CSR activities, could help in revival of the scheme

Jan Aushadhi scheme (JAS) was launched with the aim of making generic (unbranded) medicines that are equivalent therapeutically to the more costly branded medicines available to the public . Similar efforts were taken by the Rajasthan Medical Services Corporation for procurement and distribution of medicines at reasonable prices in Rajasthan. They have around 50 stores in the state, known as ‘Life Line Drug Stores’ for making medicines available at affordable prices.

Under JAS so far, out of the 182 stores that have been opened, only 111 stores are operational in various parts of the country. The drawback of the earlier scheme was lack of quality medicines, shortage and unavailability of critical medicines most of the time etc. The scheme has potential, however, it requires proper execution and dedication by those involved in its implementation.

I feel that involvement of small and medium scale pharma manufacturers, as part of their CSR activities, could help in revival of the scheme. Involvement of the pharma industry will serve dual purpose. Since SMEs are already in production of pharma medicines they will have the necessary quality certifications. This will ensure quality of medicines and achieve added trust of patients. Another advantage is that direct involvement of pharma SMEs will ensure timely availability of medicines for distribution and
sale.

Once trust is established with the patients on the quality of medicines, the scheme will automatically pick up and more and more doctors will also prescribe generic versions of the medicine. Awareness of masses about availability of good quality affordable medicines should also be encouraged. Television and print media, social networking websites etc. can help spread such awareness.

– Suresh Pareek, Managing Director, Ideal Cures

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Responsible healthcare has to become the norm in India and patients must be guaranteed quality medicine

We welcome the Indian government’s effort to breathe new life into the somewhat stagnant Jan Aushadhi initiative. It is a big challenge to ensure consistent supply of quality medicines, in well-stocked outlets, evenly distributed across the country. A professional approach is required and, among other things, this would entail: a motivated leader heading the initiative; appropriate focus on supply chain, logistics and warehousing; and awareness building efforts to change existing perceptions. The pharma industry will cooperate to support the government’s efforts in this area.

In a recent assessment of the Indian economy, the Organization for Economic Co-operation and Development (OECD) identified India’s poor health outcomes as one of our major developmental challenges. Today, we have among the highest disease burdens in the world. Responsible healthcare has to become the norm in India and patients must be guaranteed quality medicine. OPPI’s recent Fourth Healthcare Access Summit, also showcased the successful bulk procurement mechanisms used by the Tamil Nadu Medical Services Corporation, which guarantees access to quality medicines at affordable costs. The proposed Jan Aushadhi stores could augment such state-operated schemes to ensure the availability of generic medicines to those in need.

– Ranjana Smetacek, Director General, (OPPI)

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Over dependence on support from state government for these schemes would be unproductive

The state government typically spends around 10 per cent of its annual budget on healthcare. It runs hospitals and allopathic dispensaries. In addition, the state health department also runs mobile dispensaries, school health scheme, centralised accident and trauma services (CATS) and its AYUSH department administers ayurveda, unani and homoeopathic dispensaries and hospitals. The department is also responsible for executing several public health programmes. At the national level, Government of India spends a measly four per cent of its budget on health. Given that, a state spending 10 per cent looks healthier, but it still leaves a lot to be desired. India’s burgeoning population, large clusters of slums, the healthcare system remains overwhelmed. In many hospitals, we will observe the lack of resources, overcrowding and lack of cleanliness. Poor political will, bureaucratic apathy and inertia have contributed to the sorry state of affairs. Many of the rural healthcare facilities are dysfunctional and a burden on the state exchequer because of the gross under- utilisation. State governments are already laden with such several plights so over dependence on support from state government for these schemes would be unproductive.

Poor supply chain management

With shorter product life cycles and changing market demands, companies are forced to embark on a lean journey. It is important to note that the supply strategies in a lean environment support the operations strategy. The challenge is always to find not just a lean concept, but a working lean solution.

Non-prescription of generic medicines by the doctors

The majority of the physicians from private medical centres has negative perceptions about safety, quality and the efficacy of generic medicines. These negative perceptions could be the cause of the limited use of generic medicines in the private medical centres. Therefore, in order to facilitate their use, it is recommended that the physicians need to be reassured and educated about the drug regulatory authority approval system of generic medicines with regard to their bio equivalence, quality, efficacy and safety.

State governments launching free supply of drugs

State government distributes free medicines for all diseases, including cancer, at state-run health facilities, for instance Odisha Chief Minister declared that his government would distribute quality essential medicines through its procurement agency Odisha State Medical Corporation. Tertiary-level medicines for cancer and heart diseases will be part of the free drugs in government hospitals. The Chief Minister directed the district collectors to personally supervise the initiative for its successful execution.

Lack of awareness among the public

Education plays an important role in spreading awareness regarding health, wellness and sanitation. Educating woman in particular is extremely important, as an educated woman can take care of hygiene and sanitary issues of her family. Lack of education and awareness has resulted in epidemic of HIV/ AIDS which has become one of the greatest social challenges. The Government has mapped out a number of remedial measures for its prevention and treatment, but its outreach and effect has been limited. India needs to spend more on educational and awareness campaigns.

UK spends an estimated two million pounds on its no-smoking campaigns, whereas India spends a dismal amount on such campaigns, which play an important role in health education.

– Bhavin Mukund Mehta, Director, Kilitch Drugs India

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Supply chain management from source needs to be improved

The prime reason for lack of success with the earlier JAS was due to the limited number of exclusive retail outlets of Jan Aushadhi. This can be rectified by ensuring that Jan Aushadhi generic products are available in all retail shops in India. AIOCD has already offered its support to DOP for stocking Jan Aushadhi generic products. This, along with, increased awareness amongst the public, about availability of Jan Aushadhi generics in the retail stores can increase access. Supply chain management from source also need to be improved in order to ensure that the right products are available in the right places as per market requirements.

– SV Veerramani, President, IDMA

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Jan Aushadhi seems to be failing probably under the influence of vested interests

While a large number of well meaning schemes has been initiated with high degree of nationalistic posture and in public interest by the Modi Government, it is unfortunate that not much has changed in the coterie culture in the capital. The middlemen continue to have a field day and the benefits are still delayed in reaching the needy. In most initiatives, the real stakeholders are not taken on board, leading to serious planning and implementation lapses. JAS is no exception. While JAS providing low cost medicines to public is laudable, people due to vested interests, don’t want the scheme to be a success.

• First and foremost, the decision of the government to only rely on public sector undertakings to make the drugs available for Jan Aushadhi makes the scheme a deceased programme to start with. The deceased state of public health undertakings automatically and contagiously contaminates the otherwise healthy potential of this scheme. The government should have invited WHO/GMP (or higher qualified) certified generic manufacturing pharma companies to participate in the programme. This would have given a wide range, including lifesaving and critical care medicines, in the Jan Aushadhi bracket.
• Most patients approaching the Jan Aushadhi shops do not receive pharmacist support for generic options, as well as generic options themselves, as against the costly branded medicines they are prescribed. This leads to poor supply chain management issues since it has only poor supply chain available to them. To improve the scenario, one needs to increase the supply, both in range, depth and options. As it stands today, the JAS is built on poor supply chain, with not much to manage.
• There are no generic prescriptions being prescribed by the doctors directed towards JAS as the medical professionals do not know what is available under the scheme which are at faraway places and are very few in number. The medical professionals cannot be blamed for this. The ‘What, Where’ data and dissemination is missing. The medical professionals or their associates or councils are not in the loop.

Presently, the octogenarian patients and the downtrodden are running from one Jan Aushadhi store to another with branded prescriptions from consultants and specialists, seeking generic options. They often return disappointed after ‘chasing a mirage or will-o’-the-wisp’. This is the primary reason for failure of Jan Aushadhi. While there is a need and while there are needy, Jan Aushadhi seems to be failing probably under the influence of vested interests.

Consequently, the government is reported to have opened 175 Jan Aushadhi stores across 16 states out of which almost 81 are reported to be non-functional. Among the remaining, more than 50 per cent are deficient in stocks.

• State government launching free supply of drugs is not an option for two reasons. Anything free is considered to be cheap and unwelcome, especially for treatment of near and dear ones. Secondly, anything launched and distributed free would land with the greedy rather than the needy.
• There is no lack of awareness among the public as far as the scheme is considered. However, the public do not know how, where and which way to go to avail the benefits of cheaper generic options through JAS with nobody to guide on the right generic options for the branded products which is often not available in the public sector undertakings, shopping cart or catalogues.

– DR Gopakumar G Nair, Chief Executive Officer, Gopakumar Nair Associates

u.sharma@expressindia.com