India’s ambitious plan of achieving Universal Health Coverage (UHC) during the 12th five year plan period (2012-2017) is a significant step promoting health of the people of this country. The Prime Minister’s announcement of increased allocation of health sectors to three times during the plan period for over all improvements in the health system is another measure in this direction. Though the origin of Universal Health Coverage goes back to the Universal Declaration of Human Rights in 1948; there have been many plans and strategies,  we are yet to achieve Health for All.  As a follow up of World Health Assembly’s resolution on Universal Health Coverage in 2005, the Government of India proposes to attain this essential component of human rights for the people of this country.  

While around 50 countries in the world have almost achieved UHC, India has still a wide gap to be filled up. The country’s public spending on health as per cent of total public spending is at a dangerously low level: just 4.1 per cent compared to seven per cent for even neighbouring country, Sri Lanka (2009). This leads to extremely high burden of private out of pocket expenditure. Medicines accounts for 72 per cent of the total private out of pocket expenditure. The steep price increase of medicines over the years further escalated the healthcare costs. The medicines’ prices have reported to be more than tripled between 1993 -1994 and 2006-2007.

Medicines are the major component of the current health system. Despite India being known as Pharmacy of Third World for exporting / supplying medicines to more than 200 countries, millions of Indian households do not have access to essential medicines. The reasons for this poor show ranges: from lack of purchasing power to non-availability of the required medicines in public hospitals. Ensuring the availability of free medicines in public health facilities is thus a prerequisite to achieve Universal Health Coverage.

 The free drug supply to out - patients has fallen sharply from 18 per cent  in 1986-1987 to just 5.3 per cent in 2004. The planning commission has recognized the unreliable medicine supply system as one of the main reasons of poor availability of essential medicines in public health facilities. Even the best system available in the country, Tamil Nadu Medical Service Corporation Limited (TNMSCL) model, is not able to ensure the complete availability of essential medicines in all government health facilities. While TNMSCL model has significantly improved the medicines’ scenario in public health facilities, the study showed free medicines’ availability is only to the extent of 24 per cent  to the public.  The recent report showed the medicines’ stock out in Tamil Nadu stands at around 17 per cent with an average duration of about 50 days.

The financial resource is not the only constraint ensuring uninterrupted availability of free essential medicines in public health facilities. The many states are reported to have failed utilizing total medicines’ allocation under National Rural Health Mission. Improvement of supply chain management system along with good governance is recognized as the essential component for improving the availability of quality essential medicines at affordable cost for public system.

The logistic activities contribute directly to the system’s ability to deliver the medicines to serve the patients. For any health programme to deliver high quality, comprehensive services, it must build and maintain a robust logistic system. The pharmacists are generally employed in key position to look after or manage the medicines’ supply system. But the pharmacy curriculum at different level does not include supply chain management and because of this, the pharmacists working especially in public health system find difficult to manage medicines appropriately.

The country has three tier pharmacy programmes: Diploma in Pharmacy, Bachelor of Pharmacy and Master of Pharmacy. None of the above programmes have a separate component as medicine or pharmaceutical supply chain management. It has mere a hospital pharmacy paper with lot of topics and many of them are not at all relevant in the present context. It has topics like manufacturing of parenteral and non-parenteral preparations for hospital use. Now it is mandatory to have Good Manufacturing Practice (GMP) compliance for obtaining manufacturing license. With this it is impossible for a hospital to invest the large amount to have GMP compliance manufacturing units. At the same time, the topics relevant to supply chain management like forecasting or estimating medicine requirements, procurement methods, and distribution have little or no place in the hospital pharmacy subject. This is true even for hospital pharmacy paper in recently launched hospital oriented pharmacy programme, Doctor of Pharmacy. The academics involved in development of Hospital Pharmacy curriculum have ignored or failed to identify the topics which are really important.

There has been tremendous change in medicine procurement practice in government health facilities.  Witnessing the benefit of pooled procurement practices of Tamil Nadu government, many states like Kerala, Karnataka have initiated the pooled procurement for their territories. The individual hospitals are not permitted to procure bulk of their requirements of medicines and they get supply directly from their warehouses. The bulk procurement process allows the governments to procure medicines at most competitive prices leading to substantial savings. With the same budget, more medicines can be procured. The government procurement process with tender never becomes a part of pharmacy course.  However, a new trend is initiated. The Kerala Medical Service Corporations has started recruiting PG pharmacists with pharmacy practice specialization for pursuing research on medicines supply chain system in an attempt to absorb them later as trained pharmacy professionals to manage medicines and other health commodities logistics.

It is a matter of  concern “whether there are sufficient qualified and trained staff available to handle the huge logistics required to handle free medicine programme under Universal Health Coverage plan”. Heath programmes like Universal Health Coverage cannot succeed unless the supply chain delivers a reliable and continuous supply of quality essential free medicines. Investment in logistics is necessary. As a part of improving logistics governments need to develop manpower to handle the huge quantity of essential medicines.

Pharmacists being the professionals for handling medicines in various stages of procurement, distribution and uses, they need a comprehensive training on medicines logistics. Inclusion of the supply chain management of medicines as a part of pharmacy curriculum at different levels is perhaps the most cost -effective way of developing supply chain experts to handle huge logistics of medicines in pooled procurement system. The building up of institutions and development of manpower are prerequisites to implement or facilitate the policy for achieving universal health coverage.