One of the stellar initiatives in the health sector launched by the Government of India during the year 2013-14 is the "National Health Mission – Free Drug Service". It is aimed at providing effective healthcare support to the needy and giving them access to essential medicines free of cost at Government Health Institutions and Hospitals.
Over the years, cost of healthcare in the country has gone up significantly putting tremendous strain on the public, particularly the rural populace. In order to ease the financial burden of the common people seeking relief from various ailments, National Health Mission Assam has implemented the scheme of providing essential drugs & surgicals free of cost at all Government Health Institutions. Now in accordance with General ailments, NHM, Assam has also being committed for taking care of their patient from the life threatening diseases like cancer, hemophilia, neonatal, thelesemia, neurological, cardiological, nephrological disorders etc.
The essential drugs are procured in generic form and provided free of cost to all OPD and IPD patients in Government hospitals in Assam. It would be relevant to state that OPD and IPD patients numbered 2,45,51,877 (till December) and 9,07,555 (till December) respectively during the last financial year 2016-17. Both the Central and State Government provide budgetary support for this initiative of providing essential drugs free of cost to patients visiting Government hospitals.
In view of Sustainable Development Goals of GoI to achieve universal health coverage, including financial risk protection, access to quality essential health-care services and access to safe, effective, quality and affordable essential medicines and vaccines for all categories of patient , Assam State has notified the modified Essential Drugs List (EDL) where nos. of free drugs has been increased from 238 to 731 (as per strength & dosage form 731 against 407 category) to treat communicable and non-communicable diseases with a broader view to ease the all financial burden of the common people seeking relief from various ailments as well as those diseases where the drug-treatment therapy is found too costly for a BPL as well as APL family. Hence, Government of Assam had implemented the scheme of providing essential drugs & surgicals almost of all categories free of cost at all Government Health Institutions including PHC/CHC/DH/Medical colleges spread over 27 districts of the State and a new EDL has been notified taking the standard of National Essential Drug List (NELM).
The State has its own Essential Drugs List (EDL) on the basis of which procurement action is taken. The facility wise details of the EDL notified by the Govt. of Assam on 05.09.2016 are as under:
|Primary Care Hospital (PHC/CHC)||348 items|
|Secondary Care Hospital (District Hospital/Model Hospital/Sub divisional Civil Hospital)||577 items|
|Tertiary Care Hospital (Medical College)||731 items|
|Sub Centre||26 items|
Procurement of drugs in their generic form is primarily handled by the National Health Mission and the Directorate of Health Services. Tenders for drugs are based on the Essential Drugs List (EDL) notified by the State Government for different categories of Health Institutions. Annual demand of essential drugs is derived from the projected requirements of the districts communicated to the Procurement Agency by all the District Drugs Stores Managers (DDSM), on the basis of which procurement action is initiated. The DDSMs collates information on expected demand from past consumption data reflected in their stock ledgers and feedback on expected consumption received from the peripheral health institutions where Block Pharmacist are posted to collect & compile the requirements of Peripheral Health Facilities.
A scientific system of e-Tendering has been adopted in the state of Assam. A two bid system (Technical Bid & Price Bid "BOQ") is generally used for evaluation of various technical and commercial parameters. The methodology of "open tendering" is predominantly used for procurement of drugs. Tender notice is uploaded in NIC website:www.assamtenders.gov.in and also NHM website and also published in local as well as at least one national newspaper.
Bids are evaluated in accordance to the terms and conditions specified in the Bid Document. In case of two-bid system, techno-commercial analysis of the Technical (Un-priced) Bids is done first and Price Bids of only the techno-commercially qualified bidders are opened.
Price Bids are evaluated on the basis of landed cost at destination inclusive of taxes & duties, packing & forwarding charges, transportation & transit insurance charges and any other incidental charges.
After satisfactory technical and commercial evaluation of bids, a proposal for procurement is prepared for award of order on the lowest technically acceptable bidder. For order value up to Rs 50.00 Lakhs, the approving authority is the Mission Director. For value beyond Rs 50.00 Lakhs approval is to be obtained from the Chairperson, Executive Committee, State Health Society and Co-Chairman Governing body, NHM, Assam cum Minister Health & FW Deptt.
Currently Technical Experts/official of e-Tendering system of NHM/DME/DHS are being attached with the AMSC by the Govt. of Assam to execute all the necessary procurement and adopt a systematic and scientific supply chain setup with the help of CDAC new drug software.
Expenditure incurred in procurement of goods and services is booked under the relevant FMR in the approved ROP of the particular financial year.
Ordered drugs are generally delivered by vendors directly at the different District Drug Stores in accordance to the distribution plan finalized at the State level. The goods are received, inspected and stock-charged at the District Drug Stores on the basis of which payments are released to vendors. The District Drug Stores Manager (DDSM) arranges further distribution of goods to the peripheral health institutions by utilizing the service of Block Pharmacists on the basis of demands. Adequate funds are made available to the districts for movement of drugs from warehouse to different health institutions including District Hospitals, CHCs, PHCs and Sub Centres. The DDSM is also responsible for timely replenishment of stocks and management of inventory.
At present in State HQ 3 DDSMs are posted, where as in 27 district 27 DDSMs are posted who are all Pharmacy Graduate (B. Pharma) and in 149 Block- 149 Nos. of Block Pharmacists are posted who are D. Pharma.
The five regional warehouses in the State are equipped with slotted angle steel racks with pallets for storage, mechanized stackers and pallet trolleys for handling/movement. Ramps have been built to facilitate receipt of incoming goods and dispatch of outgoing consignments. Goods are stored in a systematic manner on the racks in a dry environment. For drugs and consumables, the system of "first expiry, first out" is followed. Transactions (receipts & issues) are recorded in the stock ledger in computerized format at district warehouses.
The hired warehouses in most of the other districts have severe space constraints and generally inadequate for proper preservation of drugs & pharmaceuticals. To remedy this situation, NHM Assam has almost completed construction of 20 new warehouses with proper layout which are equipped with heavy duty racks etc.
Recently CDAC has signed MoA for taking care of the total drugs-supply chain management of the state including district drug store to peripheral hospitals.
NHM Assam also has developed its own on-line Drugs Stock Monitoring System for management of essential drugs. The District Drugs Stores Manager collates drugs stock from the peripheral health institutions each week and uploads the same in the system, which can be viewed at State and District level.
The online Drugs Stock Monitoring System serves the limited purpose of ascertaining stock position of various drugs in different health institutions and for initiating action for replenishing stocks as and when needed. Action is taken at state level for replenishment of stock either through fresh infusion or through diversion of stock from a location with a surplus to a location with a deficit. The status of availability of stock of essential medicines at different health institutions is in the public domain and can be accessed through a link provided in the official website of NHM Assam.
NHM Assam follows a regulatory and quality assurance framework related to supply of drugs. Some of the essential ingredients of such a framework include, inter-alia, the following: