Survey of the availability and prices of Children’s Medicine in Chhattisgarh State

Dr. Antony K.R.Virendra JainPuni KokhoDr. Kamlesh Jain

State Health Resource Centre, Raipur,

Chhattisgarh in collaboration with WHO, WHO, New Delhi.

The Objectives… • To document the availability and price of key

essential medicines for children in the state of Chhattisgarh, India.

• To analyze the components of medicine prices.• How affordable are medicines ?

Methodology• 160 outlets were randomly sampled among 28 types

of medical dispensing sites in six geography of State.• 50 essential medicines surveyed .• Data analysis tool- WHO-HAI (Health Action

International)workbook .

51 formulations of medicine groups surveyed• Antibiotics - Amoxicillin, Amox+Clav., Azithromycin , Benzyl Pen., Ceftriaxone,

Chloramphenicol, Co-trimoxazole, Gentamycin,

• Antimalarial - Chloroquine, Quinine, Sulfadoxine+Pyrimethanine, Artemether +Lumefantrine,

• Steroids – Prednisolone, Beclomethasone

• Anti convulsants - Phenobarbital , Diazepam, Carbamazepine,Phenytoin

• Anti-pyretics/anti-inflammatory- Paracetamol & Ibuprofen

• Bronchdilators- Salbutamol, Salmetrol+Fluticosone & Spacer device

• Anti-tubercular- INH

• Anti-helminthic/Anti-protozoal- Albendazole, Metronidazole

• Anti-emetic- Promethazine

• Micronutrients/Vitamins- Ferrous salt, Zinc, Folic acid, Vit. A

• Electrolytes - ORS

Availability of Medicine in Lowest & Highest price

Public (N=75)

Private (Chemist

Shop) (N=60)

Other Private

for Profit (N=21)

Other Pri-vate Non

Profit (N=4)

0

10

20

30

40

50

60

70

80

90

100

17

46

35

17

Availability of Medicine in Lowest Price

Name of Sector

Valu

e in

%

Public (N=75)

Private (Chemist

Shop) (N=60)

Other Private

for Profit (N=21)

Other Pri-vate Non

Profit (N=4)

0

10

20

30

40

50

60

70

80

90

100

0

14

71

Availability of Medicine in Highest Price

Name of Sector

Valu

e of

%

Availability of selected antibiotics in public facilities and retail pharmacies (chemist shops)

0102030405060708090

100

Public Sector (N=75)Private Sector (Chemist Shop) (N=60)

Name of Medicine

Valu

e in

%

Availability of anti-malarials and Oral Rehydration Solution across sectors

Oral rehydration solution (200ml)

Oral rehydration solution (for 1L)

0

10

20

30

40

50

60

70

80

90

100

Availability of oral rehydration solu-tion across sectors

Public Sector

Private Sector (Chemist Shop

Other Private for Profit Sector

Other Private Non Profit Sector

Valu

e in

%

0

10

20

30

40

50

60

70

80

90

100Availability of Anti Malaria across sectors

Public Sector (N=75) Private Sector (Chemist Shop) (N=60)

Other Private for Profit Sector (N=21) Other Private Non Profit Sector (N=4)

Valu

e in

%

Poor availability (<20%) in the private sector of those Medicines not found at all in the public sector .

Name Of Medicine Availability (%)

Ferrous salt suspension 0

Diazepam rectal suppository 0

Phenobarbital injection 0

Phenytoin tablet – chewable 0

Paracetamol suppository 0

Ferrous salt drops 1.7

Beclomethasone inhaler 1.7

Salmeterol + fluticasone inhaler 5.0

Artemether + lumefantrine dispersible tablet 8.3

Phenobarbital syrup/oral liquid 10.0

Artemether + lumefantrine dry syrup 13.3

Phenytoin suspension 15.0

Gentamicin injection 16.7

Public Sector (n=71)

Private Sector (n=60)

Private profit sector (n=21)

0.0

0.5

1.0

1.5

2.0

2.5

3.0

0.96

1.38 1.46

Median Price Ratio (MPR) in relation to international price-in lowest price

Median Price Ratio (MPR) in relation to international price-in Lowest & Highest price

Public Sector (n=71)

Private Sector (n=60)

Private profit sector (n=21)

Private Non profit

sector (n=4)

0.0

0.5

1.0

1.5

2.0

2.5

3.0

0.00

1.82

2.59

0.00

Median Price Ratio (MPR) in relation to international price-in Highest price

Medicines with patient prices of over four times the international reference price in all sectors

0.00

5.00

10.00

15.00

20.00

25.00

Folic acid tab Albendazoletablet -

chewable

Amoxicillindispersible

tablet

Amoxicillinsuspension

Highest-priced, privatepharmacies (n=60)

Highest-priced, other private for-profit (n=21)

Lowest-priced, privatepharmacies (n=60)

Lowest-priced, other private for-profit (n=21)

Lowest-priced, other private non-profit (n=4)

Conclusions and lesson learnt…• The average availability of children's medicines was poor in all sectors

Specifically for anti-malarials, certain antibiotics, anti-diarrhoeals (zinc) and anti-bacterials in public sector units.– Child friendly formulations like DTs (dispersible tablets),Syrups,drops or

suppositories conspicuous by their absence.

• For originator brand & branded generic products the total cumulative mark-up from MSP to final price ranged from 34% to 46% whereas for unbranded generics it ranged from 376% to 413%.

• Very high retailer’s mark-up for unbranded generic compared to originator brand/branded generic (well within the Govt.capping of 15% mark ups for wholesalers and 35% for retailers)

• Public procurement of medicines is at reasonable efficiency of prices that are just under international reference prices (MPR = 0.96).

• But, in private sector certain medicines cost several times higher.

Impact of Study

Strong political will resulting in a good State drug policy is emerging

Two Orientation workshops for stakeholders conducted.

Inclusion of child friendly formulations in State EML (Revised EML 2010) on 31 December 2010. (refer www.cghealth.nic.in)

Setting up the Chhattisgarh Medical Services Corporation (CGMSC) for improved procurement and logistics.

Field-based drug research to determine optimum utilization and supply projection.

Why very high mark up for retailers for unbranded generic drugs?

Operational research on mechanisms to prevent flooding of poor-quality and counterfeit drugs.

Comparative study of other State scenario using similar methodology

Future Research Agenda

Thank You…