A representative study conducted by Delhi based Voluntary Organisation in Interest of Consumer Education (VOICE) has revealed that the awareness of the role of National Pharmaceutical Pricing Authority (NPPA) is almost non-existent among the patients and doctors of India. The lack of infrastructure and presence of spurious drugs were also found to be serious issues that hamper proper dispensation of medicines to the customers.

The study was commissioned by NPPA in order to have a proper assessment on the field position of the availability and prices of medicines in rural India. The study, conducted in the states of Uttar Pradesh and Karnataka revealed that awareness about the role of NPPA is non-existent, as 98.5 per cent of the surveyed patients are not aware about NPPA. The incidence of such unawareness among the chemists and doctors are also as high as 76 per cent and 64 per cent respectively.

The study has stressed the need to enhance the visibility of NPPA and to launch a national campaign to educate civil society about NPPA's role in protecting the interests of the consumer and also the pharmaceutical industry, in order to make essential medicines available at affordable prices. VOICE findings suggest that NPPA has responsible role not only to regulate market conditions and practices as per the existing laws but also to bring about the necessary changes in an appropriate manner in consultation with the consumer and the industry.

The study has identified lack of infrastructure as a serious problem in proper dispensation of medicines to the customers, as 30 per cent chemists in UP still do not invest in mandatory requirements like refrigeration facilities. "The scene concerning knowledge about spurious drugs is alarming as 43 per cent doctors did mention about instances of spurious drugs in the market place. But only 7 per cent patients reported to have experienced the same. This implies that due to lack of testing facilities and awareness among the consumers on spurious drugs, consumers are unable to detect and report on sub-standard medicines. The fact emerges that there is a need for consumer education supported by adequate support facilities for detecting spurious drugs," it said.

The study finds that almost 50 per cent of the patients avoid seeking service from government hospitals due to poor quality of service and non-accountable practices, even though the facilities are highly subsidized and at times free to the users. "Almost 97 per cent patients confirmed that drug availability is not a problem and the chemists keeps the consumers duly informed about the medicines being substituted. There is a constant mistrust prevailing between the service providers and the patients."

The study also points towards the sale of drugs without proper prescription. More than 60 per cent of the patients consult chemists rather the doctors to decide as to which medicine(s) to buy. Such practice establishes the fact that the consumers find it difficult to access professional medical counseling which compels the consumers to seek advice from chemists. This is a serious barrier for the consumers and could lead to the growth of unsafe medical practices, it said.

Interestingly, only 4 per cent patients said that the drugs are sold at more than the maximum retail price (MRP) but as high as 24 per cent chemists admitted that they overcharge due to various market conditions. They are also aware about the price differences in some medicines of the same brand in the same town.

The need for encouraging traditional medical practices gets highlighted in the study as 99 per cent patients mentioned that they opted for allopathic science of medical practice but at the same time they also showed willingness to opt for the traditional form of medicines. Respondents felt that the Government must focus on providing alternate medical facilities based on traditional forms of medical science in all the towns and villages of India.

The study pointed out "only 40 per cent patients visit local doctors for consultation. Furthermore, only 20 per cent visit the doctors attached to hospitals." It means the health facilities are still not easily accessible and affordable to the patients, even though the government is investing huge resources in providing medical facilities to the citizens.

The study has recommended for benchmarking service standards of healthcare and monitoring it regularly by ensuring accountability of the existing system to provide minimum standards defined by NPPA in consultation with other service providers. It also recommends that availability and accessibility of medicines should be a priority item in the Government's agenda and it should not be looked at simply the business proposition for investment by the private sector. Need to standardize the prices of medicine by incorporating the applicable sales tax in the printed label to display the total price to be charged to the customers, instead of the existing practice of charging taxes as extra on the agreed printed Maximum Retail Price (MRP) was also highlighted.

The study also recommends attracting investment from the private sector on developing quality infrastructure facilities like cold chain, testing facilities for the medicine, training of various levels dealing with medicine distribution and prescription dissemination and similar activities. "Any loss or damage caused to the patients due to medical negligence or ignorance should be adequately compensated. Above all, a mass education campaign needs to be undertaken to make the Indian patients aware about their rights on medical information in an easy and understandable language," it said.

The National Pharmaceutical Pricing Authority (NPPA) has been established in August 1997 under the Ministry of Chemicals & Fertilizers as an expert body on pricing of medicines. Its responsibilities include monitoring the availability of medicines in the country and to fix/revise the prices of medicines falling under the "Price Controlled" category. The manufacturers of medicines are required to sell the price-controlled drugs at the prices fixed/revised by NPPA. It is estimated that there are about 60,000 medicines sold by over 2,30,000 retail chemists in trade channel. NPPA does not have its own field force for enforcing of Drugs (Price Control) Order under which the price of controlled medicines is fixed.

It was in this background, NPPA thought it worthwhile to assess the field position by assigning a study to a Non-Government Organisation (NGO) two years ago.