The Inside story of Jan Aushadhi Kendras

The centre’s PMBJP is an ambitious scheme which certainly provides generics at affordable rates but more efforts are required to make it really successful

A month ago, Rajiv Sharma (49), a resident of Ghaziabad, visited a Jan Aushadhi Kendra (JAK) to get clobazam and sodium valproate tablets. The storekeeper, however, told him that the medicines were out of stock. He then asked for thyroxine sodium tablets for his wife, but was unfortunate to even get that. Quite disappointed, he returned home empty-handed as he could not afford branded tablets.

Sangeeta (24), also a resident of Ghaziabad, visited Dr Bhimrao Ambedkar multi-speciality hospital in Noida to get antidiabetics for her mother. She said, “We will be going to our village in two-three days. So, keeping her medicines in stock for next 15 days is a must because I do not know where to get the same medicines in Bihar.” Additionally, she wasn’t able to get any medicines for her infant, who was suffering from fever and cough.

Similarly, Yoginder Kumar (35) had come to get a cough syrup for his one-year old child at the same JAK. The note on the window there read, “Bacchon ki dawaiyan 28 tareekh ke baad milengi (the medicines for kids will be available after 28th September).” He too left with a sad face. Most of the parents had to do the same that day. Next in line was 50-years-old Urmila Devi from one of the villages in Noida, who often visits this JAK to get calcium carbonate 500 mg + calcitriol 0.25MCG + zinc 7.5 mg capsules. However, the tablets were not available on that particular day. A little disheartened, she said, “I frequently come here to get medicines as they keep me healthy and are available at a very cheap rate. Every time I get it, but it is sad that it is out of stock this time.”

This has been one of the oft-repeated problems with Prime Minister Narendra Modi’s Pradhan Mantri Bharatiya Janaushadhi Pariyojana (PMBJP). To understand where the challenges in the scheme lie, we have to understand how these centres are set up and operate.

How do JAKs operate?

A JAK can be opened by an NGO, charitable institutions/ hospitals, private hospitals, trusts, societies, self help groups, etc, as per the guidelines given on the website of BPPI. The process is clear and transparent. As per the instructions of BPPI, PMBJK operators are allowed to sell allied medical products, commonly sold in chemist shops. NGOs/charitable institutions/reputed professional bodies/organisations are allowed to sell generic medicines which are not included in the list of medicines supplied by BPPI with prior information and approval of BPPI.

According to the guidelines by Bureau of Pharma Public Sector Units of India (BPPI) – the implementing agency for JAKs since 2008 – the operating agency is provided 20 per cent margin on MRP (excluding taxes) of each drug. In addition, the guideline says, JAKs that are linked with BPPI headquarters through internet (using BPPI provided software) will get incentive upto Rs 2.5 lakhs. This will be given at 15 per cent of monthly sales subject to a ceiling of Rs 10,000 per month upto total limit of 2.5 lakhs. In the North Eastern states, naxal affected areas and tribal areas, the rate of incentive will be 15 per cent and subject to monthly ceiling of Rs 15,000 upto total limit of Rs 2.5 lakhs. Thus, its operating model is quite simple.However, the actual challenges are quite different.

Noble intent, sloppy execution

63-year-old Jairam Dhama gives us some insights into these challenges. He runs Dhamaji Pradhanmantri Bhartiya Jan Aushadhi Kendra in Delhi. Opened in 2017, the products that are sold the most at this store include antibiotics, diclofenac gel, tamsulosin hydrochloride, pantoprazole and telmisartan, among others. The shop is visited by around 30-50 people daily.

While speaking to Dhama, he agrees that these centres are indeed a good endeavour to buy affordable medicines and cites, “One packet of pantoprazole here costs Rs 18, while the branded one costs Rs 120.” However, there is a demand-supply gap, and Dhama gives the example of clobazam, which hasn’t been supplied for the past two months. Also, the syrups for children are also in short supply. Similarly, he complains that though the government recently launched sanitary napkins at Rs 1 per pad, his centre was given only 50 units though he had asked for 1,000 units. “Humne 1,000 pieces ka order diya tha, par mile humko kewal 50 pieces. Phir humne apne expenses pe Gurugram wale warehouse se inko khareeda,” he laments.

On the other hand, some of the other medicines that he had stocked up were are not sold as much. “For instance, we have kept inhalers here but only four pieces have been sold in the past two years and these will expire soon, and one unit costs Rs 268.” He had a similar experience with tuberculosis (TB) drugs. He said, “I used to keep three types of medicines for TB but those were never sold. So, I stopped buying. On the contrary, I have been selling anticancer anastrozole tablets to a few of my regular customers since the opening of this store. The reason they keep coming back is that these medicines are approximately three times cheaper than the branded ones.”

Dhama doesn’t have any doubts that the scheme is good and effective, but feels that if the medicines can be delivered on time, it would be better. “Hafta-dus din late ho jaaye koi baat nahin, lekin agar samay pe aa jaye to log apna routine se dawai khaa sakte hain” (If it takes seven to 10 days, one can adjust, but still if it could be delivered on time, patients can continue with their routine).

Likewise, other centres too have faced their own set of problems, for example, inventory management.
The staff at the Jan Aushadhi Kendra at Dr Bhimrao Ambedkar multi-speciality hospital in Noida also throw some light on this particular problem. The store opens at 9.30 am every morning except on Sundays and closes at 5.30 pm on most days and recieves a lot of footfall. “Around 300-400 patients visit in a day here,” the staff inform. But keeping a tab of the availability of stock, sales and profits have caused quite a few glitches. To give a case in point, staff members at this JAK, while reading a prescription, often ask patients, “Ye jo likha hai, iska tablet du, syrup du, injection du? Kya doon?” (Should I give you a tablet, syrup, capsule or what?). Explaining why this question arises, staff members inform, “The reason behind asking this is keeping the sales updates in the BPPI software in sync with the actual sales. Doctors hardly mention the category of the medicine they have asked the patient to buy, whether it’s a tablet, capsule, syrup or injection. We have to update our product sales periodically in the system. For instance, we sold one tablet to a patient and updated in the system. However, after two-three days, he/she comes back saying ‘Madam, doctor ne to injection maanga tha‘. Since prices of these products differ, there happens to be a discrepancy or mismanagement, which should not happen.”

They also inform that while updating daily sales amount in the BPPI software, they mention profits and losses too, be it for Rs 5 or Rs 50. One of the other troubles is that “order for only one product can be placed at a time, and unless it gets delivered, we can’t place another order. In addition, we are not informed if a particular medicine is available or not and whether it will be supplied within a stipulated time,” the staff complains. Incidentally, this centre too highlights that clobazam hasn’t been supplied for a long time. They also inform that a few other medicines like diethylcarbamazine, metformin 500+ glimpiride 2 mg and syrup vitamin D3 200 IU + vitamin B12 2.5 mcg + calcium phosphate, too were short in supply.

Of late, the Government of India has launched ‘Jan Aushadhi Sugam’, a mobile application wherein one can search medicines available and the nearby stores. While it was meant to be beneficial to patients, this too has its own share of problems.

The store managers at JAKs inform, “Launching a mobile application is good for both, the storekeepers as well as the patients. However, if a patient comes to buy a particular medicine and we tell him/her that the stock is over, he/she tends to quarrel with us by searching the name of the same medicine in the mobile application, saying that it’s showing here in the mobile application, how can you say it’s unavailable? For instance, if you search clobazam in the app, the results show that it is available. However, it becomes difficult to make them understand that it is out of stock here. Until two months ago, products were supplied absolutely on time, but recently, the process suddenly became slow and we are completely unable to understand the reason behind it.

“We do feel that the Government of India is doing a good job, but they can really make it better and more workable,” they conclude.Thus, there seems to be operational challenges galore that seems to be derailing this noteworthy initiative by the government. But, apart from these, several other factors too are adversely affecting the endeavour.

Demotivated stakeholders: Cause for concern

Several other factors too are adversely affecting the endeavour. One major problem has been that the stakeholders have been feeling that they are not deriving proper value from the venture.

Take the case of this pharma company that has been catering to JAKs for the past six years. It has participated in 11 tenders and was awarded with two tenders for 14 products, and the value of products supplied till date is Rs 2.10 crores. However, it claims to have repeatedly faced problems in receiving payments from the BPPI. Shedding light on this issue, the company informs that BPPI has to make the payment within 90 days after receiving the products. However, it would never receive payments on time even after a lot of follow-up. Another company also informed that payment always gets delayed. These companies also state that the delay in payments dent their margins. Suresh Gupta, President — Domestic Branded Business, Cadila Pharma, informs that as per the rules and regulations, the payment terms in tenders is usually 60 days.

No tracking mechanisms

Pharma companies also highlight that there is no way to track products beyond the BPPI warehouse upto the Jan Aushadhi Kendras (JAKs). Gupta informs, “We use the system of continuous feedback to continuously improve our processes and forecasting. In the case of JAKs, we do retail-level surveys at their kendras to get proper feedback.”

Company representatives also mention that they have no information about the number of JAKs their medicines are supplied to. “No such data is available because no such system is in place,” add the sources.

Mounting pressures

One of the other major challenges include the pressure on supply timelines. According to Gupta, the packaging guidelines and requirements for JAK products are different, and therefore takes up significant time. “We work closely with the BPPI team and warehouses in order to make our deliveries on time,” he informs. But, he also suggests, “In a country like India, where the demand and supply gap is significant, there will always be challenges. As a responsible organisation, it is important for us to understand this and support initiatives like PMBJP. Given that we have a diversified product portfolio in multiple markets, helps. Further, the focus should not be solely on meeting the demands, but also to maintain quality of medicines. For this, we propose that only those companies with more than Rs 50 crores turnover be allowed to participate in tenders. To focus on quality supply, only US FDA approved or WHO cGMP-certified plants should participate. This way substandard/spurious drugs don’t reach the patients. Apart from it, improving the forecasting and relaxing the supply timelines can help in getting more organisations to participate in BPPI tenders and help meet the demand requirements.”

Cadila Pharma has been catering to the JAKs for the past four years. “We have participated in multiple tenders and have signed 10 product rate contracts with BPPI already. Moving forward, we will continue to participate in upcoming tenders,” says Gupta.

One of the other sources also state, “As a responsible partner, we are always committed to supply the product as per the orders received. However, in some situations which are beyond our control like non-availability of any particular API in India may lead to some delay. India is mainly dependent on other countries for the raw material and any such shortage is beyond the control of the manufacturer.”

A third pharma company, talking to Express Pharma, informs, “We have been trying to get in touch with BPPI for quite some time because PMBJP is a great scheme that gives us an opportunity to serve the society. Unfortunately, we have been unable to get any response.”

Thus, these glitches have had adverse effects on the stakeholders’ belief in the scheme. It needs to be restored to make the PMBJP successful completely.

As one of the sources opines, “PMBJP is a nobel cause of making medicines available to the public at affordable prices and citizens of India have high expectations from BPPI. We hope BPPI would put in more efforts to fulfill the expectations of the people of India.” Some of the major pharma companies catering to JAKs were reluctant to talk about their roles at these stores.

Express Pharma approached Sachin Singh, CEO, BPPI, to get his views on the entire scheme and shared the issues that were raised by the stakeholders. In his response, he says, “No comments, as I can’t say about behavioural aspects of others.” But, regarding the unavailability of drugs like clobazam, thyroxine sodium tablets, sodium valproate, diethylcarbamazine and zinc syrup at JAKs, he states, “We have a good stock of all the drugs except sodium valproate and zinc syrup. For these drugs, we had issued tender but no bids were received. We are going to retender in October.”

The way forward

PMBJP is definitely an ambitious project which can have far reaching impact if it can be executed succesfully. The intent of PMBJP is clear and noble – Ensuring access to quality medicines at affordable costs. However, better planning and better systems need to be brought and implemented at the earliest to plug the gaps that threaten to derail the whole intiative. BPPI CEO, Singh also admits this when he says, “We improved a lot in the last two years but there are miles to go.” It is to be hoped that the chinks in the whole chain will be ironed out and addressed soon as any endeavour is only as strong as its weakest link.

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