People's Democracy

Data compiled from the price lists & other relevant documents of  RMSC (Rajasthan Medical Service corporation) Ltd., TNMSC( Tamil Nadu Medical Service Corporation) Ltd ,Jan Aushadhi , Public Sector Unit(PSU)’s and www.mydawaai.com

PROMOTION OF

PRIVATE SECTOR

The department of health and family welfare, government of West Bengal,  through its circular dated 7th March, 2013 (No. H/TDE/198/5S-01/13) instructed the concerned hospital authorities to procure medicines and medical consumables (like cotton, bandage, syringe, infusion set) for Janani Sishu Suraksha Karyakram (JSSK) from fair price shops instead of procuring it through open tender. The said circular reads as follows: ‘Since these medicines shops have been set up through open tender, the concerned MSVPs of all medical college & hospitals and Superintendents of hospitals where such fair price shops are located shall procure drugs and consumables under JSSK from these shops’

We need to know if this government has any obligation for promoting the business of its Private Sector Partners (PSPs) .

Essential medicines are no longer available free of cost at government hospitals today. During the entire period under Left Front rule, essential medicines were distributed to common people free of cost. In the 1980s and 1990s around 132 types of medicines were available at the hospitals in the state. This number dropped to 70-75 by the end of 2010.

Now, essential medicines are not freely available at government hospital drug stores. Absorbent gauze, absorbent cotton, cotton bandage, syringe, infusion equipments, orthopaedic dressings, plaster etc. were always provided free of cost in the past by hospital authorities. Presently, a patient is asked to purchase these materials and medicines from a fair price shop.

This government is spending money wastefully in organising feasts and festivals, whereas the ailing millions in the state continue to suffer in distress. Should any sensible government shed its responsibility about healthcare? This state government does. It is pampered by big business, and dares to wash its hand off healthcare responsibilities.

NO QUALITY

MONITORING

Unlike the close monitoring of medicine quality or standard in Tamilnadu, medicines sold at the fair price shops  in Bengal do not have any monitoring of quality. Many physicians believe (not without reason) that the medicines available at fair price shops are of questionable quality. In the pack-shot of many of the drugs, names of the companies that market or manufacture, is printed either illegibly or in unreadable small letters and at times, incorrectly.

Amoxicillin (strip of 250mg Caps.,10’s), when purchased with the strength of a prescription written in generic name, a brand was supplied by fair price shop (MS Life Drug House Pvt. Ltd., SSKM, Kolkata; Invoice No :SSKM -24832, Date : 21/04/13). The brand name Mormox is printed boldly in the strip. On the strip of this medicine, again, it is printed that the medicine is marketed by Pharma Concept, Delhi and manufactured by G S Pharmaceuticals Pvt. Ltd. Haridwar, (U.K) in technical co-operation with Morepen Laboratories, New Delhi.

When Metronidazole 400mg was purchased (Invoice no and date:MED 145473 & 16/09/2013) , providing  prescription in generic, from MS Life Drug House Pvt. Ltd. Medical College, Kolkata, a brand ‘Denagyl’ was supplied. We have heard that generic can alleviate all woes, so we wanted to purchase a true generic. Our epitomised desire was sorely defeated. Besides, we found an exquisite knowledge that the said medicine is being simultaneously ‘manufactured in India by Denizen Pharmaceuticals (India) Pvt. Ltd., New Delhi’ and ‘manufactured by Nikvin Healthcare India (P) Ltd. Baddi, H.P’. Probably it will be considered as some kind of extraordinary and wonderful feat of manufacturing activity, hitherto unknown in the business of medicine manufacturing in the world, when one part of a tablet is manufactured at Delhi and another part manufactured at Himachal Pradesh!

If this is not so, then, as one can easily guess, it is possible that ‘U.K’ has been printed instead of U.P, or names of two simultaneous manufacturers have been mentioned, by mistake. Such mistakes and lapses (regarding the statement about manufacturera) are in print and on record.

The concerned manufacturer knows quite well that they can be held responsible by the authorities for providing such misleading or, at least, incorrect information. But still, it appears that, they do not care.

If they are so casual or so careless in relation to issues on record, then it is no wonder that their unrecorded activities during the process of manufacture can very well be equally careless or even more irresponsible.

The percentage offered at fair price shops varies from place to place. In National Medical Collage and Hospital, Kolkata, it is 66.25 per cent. In MR Bangur Hospital, in the same city, it is 54 per cent. At Bankura Medical Collage and Hospital it is 51 per cent but at Raigunj District Hospital it stoops to 38 per cent.

It is further surprising that the percentage offered by the same shop belonging to the same owner also varies as the premises  changes. MS Life Drug House offers differential discount at  SSKM Hospital, Kolkata  (67.25 per cent), at RG Kar Medical Collage & Hospital, Kolkata (66.25  per cent). How the same medicine, procured from a given source by the same proprietor (MS Life) can be sold justifiably at different prices?

This is a riddle worth solving.

AVAILABILITY OF

ESSENTIAL MEDICINES

Even though the government of West Bengal has prepared a list of 142 specified medicines that a fair price shop should mandatorily stock and supply, many of the listed medicines are not always available in these shops. Essential medicines like Albendazole Tabs. &  Susp., Metronidazole Tabs. Amoxicillin Caps. 250mg, Ciprofloxacin Tabs. 250 mg, Diazepam Tabs., Metformin 500 mg Tabs. are frequently in a state of short-supply in these shops.

Besides, many of the most essential medicines required in a tropical country like ours are not listed in the mandatory list. Therefore, fair price shop owners are at liberty not to stock and supply them.

Taking advantage of the anarchy in the list and freedom of selling any and every medicine they choose, fair price shop owners are selling highly-profitable inessential and irrational medicines.

The list of 142 mandatory medicines do contain certain medicine that is not considered as essential as per National List Essential Medicines (NLEM), 2011. On the other hand, some essential medicines included in NLEM 2011 do not feature in this list. The medicines like Aceclofenac Gel, Cough Syrup, Ofloxacin & Ornidazole combination Tab., Vitamin B Complex (with Vitamin C) Caps. did not get place in NLEM 2011, but got listed  in this mandatory list. Some of these medicines like Cough Syrup or Vitamin B Complex  Caps., are widely and also wisely, considered as inessential medicine and not worth enlistment. A medicine like Ofloxacin-Ornidazole combination is not famous enough as rational combination of medicine.

Certain medicines which were dropped after careful consideration from the National List Essential Medicines (while the NLEM 2003 was updated during preparation of NLEM 2011) also feature in this specified list prepared by the state government. These dropped or deleted medicines are as follows: Aminophylline Inj., Menadione tab. and Inj., Pentazocine Lactate Inj., Theophylline Tab. Aminophylline also features in the ‘Consolidated List of Products Whose Consumption And/or Sale Have Been Banned ,Withdrawn or Severely Restricted or not Approved by Governments, eighth issue’ published by United Nations. Keeping stock of such medicines should be disallowed, not the amazing opposite. This state government requires to justify the presence of these medicines in the mandatory list.

Certain essential medicines featuring in NLEM 2011 are not listed by the state government. Even though, malaria, filariasis, tuberculosis, leprosy or AIDS (HIV) are among the most  significant disease burden in the state as well as in the country, none of the medicines for these diseases have been enlisted in this mandatory list prepared by the state government. Anti-leprosy medicines like Dapsone and Clofazimine has not been listed (Central Medical Store in West Bengal also did not procure Dapsone in recent times). One cannot explain as to why Dapsone (so economic and so essential in the treatment of Leprosy) is not mandated to stock and sell? How one can explain that an essential antimalarial like Chloroquine phosphate does not find its place in the list? Why essential anti-TB drugs like Ethambutol or Rifampicin should not be mandatorily available in a government-sponsored chemist shops opened in the premises of major government hospitals? Why Diethylcarbamazine citrate, essential for the treatment of  filariasis (very much  prevalent in a tropical country like ours) should be missed out? Why anti-retroviral drugs like Acyclovir (antiviral), Lamivudine (HIV/AIDS and Hepatitis B) or Zidovudine (HIV/AIDS) should not be compulsorily stocked? Why inessential Vitamin B-complex is listed and Pyridoxine (Vitamin B₆ )which is very much essential in the drug therapy of tuberculosis is not listed ? Do these medicines give less profitability?

Asking valid questions is an invitation to rouse the anger of the chief minister and her regulars. Asking reasonable question is not considered as a good habit in the state of West Bengal, these days. The government doesn’t need you to think very much. Ms Banerjee and her government will think on your behalf. You only raise hand or clap hands when required. This is Bengal. Call it ‘Golden Bengal’ (Sonar Bangla). Don’t call it authoritarian. If you call it authoritarian, we’ll call out our militia and you will be called to your last account.