The Common Review Mission (CRM) on the National Rural Health Mission (NRHM) has called for a better system to handle the expenditure on drugs and supplies, supported by a logistic system in the states.

The report of the CRM said the annual public health expenditure on drugs and supplies should be linked to total patient loads handled and it should be taken care through a better system. The recommendation comes against the backdrop of reports of lopsided distribution patterns and unequal spending on drugs by the states.

“The centre could incentivise this by picking up a percentage of this expenditure in those states where adequate systems for essential drug list and benchmarked logistics are in place,” the report said, commending the model practised by Tamil Nadu in this regard. The third review mission covered 17 States.

“As the utilization of the public health facilities by the care seekers is showing increasing trend over the years, availability of essential drugs in the facilities need to be ensured. The essential drug list supported by a logistics system that ensures that facilities receive all the essential drugs and supplies that are required there should be put in place,” the review pointed out.

“Prioritisation for infrastructural upgradation should also take into consideration, the capacities of the facilities in the private not-for-profit sector as against the gaps in the public facilities, and enlist them for provision of services and trainings, as done with Mission hospitals by some states. Contracting out of service provisioning to the for-profit, commercial health care providers, may also become necessary to fill the service gaps in some areas, but as the experience of such partnerships (eg. the Chiranjeevi scheme) shows, these need to be entered into under only extremely strictly chosen conditions and with a number of cautions in place,” it said.

“Where the private sector is non-existent or weak, strengthening of the public sector facilities is the approach to be adopted. Where both the sectors are in parallel, the public sector must be strengthened to fulfil the objectives of public health and ensure equity in access to quality services. Where the public sector is weak (specially on HR) and the private sector is more active, contracting in of services may be the option, while the efforts to strengthen HR in the public sector is also pursued actively. Such partnerships should expand net access to services, not merely shift public clientele into private sector, leading to weakening the public sector without significantly adding to total coverage. Robust contract management systems are needed, for monitoring quality in private sector delivery could be even more problematic than monitoring it in the public sector,” the report said.