Monday, February 16, 2009

Medical Tokenism

The Jan Aushadhi initiative is ineffective in its current form

Even after 63 long years of independence and hundreds of pro-poor strategy, the expedition for the Holy Grail of “anti-poverty schemes” still lingers on. As the general elections are approaching, Chemicals and Fertiliser Minister, Ram Vilas Paswan extends the existing pro-poor programs of UPA, by recently inaugurating the first `Jan Aushadhi' store in New Delhi. The shop is meant to provide people with high quality generic medicines at cheaper rates. The Ministry has further roped in doctors, NGOs, Indian Medical Association and civil societies to spread awareness about the benefits of generic and non-branded drugs. The Jan Aushadhi shop will be selling popular drugs at a very nominal price. Take for instance the anti-allergic drug Cetirizine. It is priced at Rs 20 per strip in the market while it would be sold for just Rs 2.50 at the Jan Aushadhi store. Similarly Paracetamol will be sold at Rs 2.30, cough syrup at just Rs 12.50 and Ciprofloxacin at Rs 20. The store will also, in general, offer medicines at a price that is 20 per cent to 60 per cent less than the current market price.

In a country, where medicines alone account for around 80 per cent of total healthcare expenditure, and where every year due to health care expenses almost around 20-25 per cent of hospitalised patients are pushed towards bankruptcy, this initiative will not only be a blessing for poor but will lead to greater access to healthcare. But then here lies the catch. Just like almost all other pro–poor flagship programs of the UPA, this initiative too is highly perforated. Like others, this program too will soon become a victim of corruption and black marketing. Since the number of stores is limited and the demand obviously will be very high, it would leave the consumers with no other option but to end up in serpentine queues. Moreover, there are no checks and measures in place that would prevent the not-so-poor customers and other retail outlets from availing services from these stores that are meant especially for the economically challenged population. And then there is this obvious threat of medicines finding its way into the black market.

This new initiative finds its semblance with the existing PDS, where more than 40 per cent of products meant for poor families’ usage is sidetracked for non-PDS use, or the manner in which the agriculture subsidy is engulfed by the middle-men, or just like the mid-day meal scheme where meal itself is missing or just like the NREGA, where phantom employment rules the book. Consider this: as per the last few years' budget documents, presently there are more than 150 anti-poverty schemes which entails more than Rs 1,50,000 crore of expenditure. A back of the envelope calculation indicates that if one directly distributes this sum among 450 million poor, each of them would receive more than Rs 3,000! Juxtapose this with the reality, where it is very rare that a poor gets even a fraction of this amount via any of the poverty-eradication programs.

If this initiative is meant for mere tokenism then in its current state it is absolutely fine. But if this initiative has to make any real impact then these drug stores cannot remain confined to a particular region, but has to reach out to the entire length and breadth of the nation. One needs to discard the loopholes and incorporate strategies that promise to deliver and benefit 450 million Indians for whom modern yet affordable medicine is still an alien concept! But so long as this tokenism helps in winning elections, who cares?


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