Jan Aushadhi, a non-starter in Siruguppa

Capstone Health Political State Taluk

The generic medicine scheme is yet to take off in Siruguppa taluk of Karnataka, forcing the poor to purchase expensive medications

Generic medicines in India aim at providing quality medicines at affordable prices throughout the country. Though the Government has asked doctors to prescribe generic medicines rather than the branded versions, people still do not have access to these medicines.

Begum Jahan, who is about 60 years old from Raravi village in Siruguppa taluk, spends most of her day inside her small hut. She is a homemaker and stays with her husband. Health problems and lack of basic utilities for years have made her weak, as she had developed high blood pressure and weakness for which she need constant medication. Speaking in a low tone and irregular voice, she had questions about the nearby Primary Health Centre (PHC) in Raravi, which is supposed to provide medicines and proper treatments to the poor in the village. Even after the Government’s drive to make generic medicines available to the poorest of the poor, Begum Jahan has no access to generic stores. She has to buy medicines from the nearby PHC or private medical stores which cost her more money.

Begum Jahan with high blood pressure, travels to the Taluk hospital in Siruguppa.

The Modi government had promised to open up generic medicine stores under the name Pradhan Mantri Jan Aushadhi Yojana, but the stores are yet to be opened in Siruguppa or any of the villages that comes under the taluk. As per the latest National Sample Survey Office survey on healthcare, in 2014, medicines emerged as a principal component of total health expenses—72% in rural areas and 68% in urban areas. It is important to understand that people in a dry and dusty place like Siruguppa face a lot of health hazards in the form of breathing and respiratory issues. Health often deteriorates among the older population of the place. Siruguppa is a dry place and it gets hotter during the summer. The main occupation of the region was agriculture, but as agricultural opportunities have begun to shrink, people have shifted to other types of work.  The poor and older generations are often isolated by their families. This forces them to work in mills and factories or even in brick mining sites which is hazardous to their health.  People mostly from the younger generations migrate to cities and towns in search of jobs abandoning the poor.

Siruguppa experiences mostly dry weather with little to no rain during the summers.

Begum Jahan owns about 10 acres of land in the Raravi village, which is uncultivated. She says that the dry weather is not suitable for cultivation. As her husband works as a watchman in the nearby factory, he does not earn much to support the medical expenses of his wife. Jahan says that despite having land, it goes uncultivated. The story of Begum Jahan is similar to many others in that region. Suffering from high blood pressure, Jahan’s husband has to pay for her medication which costs them about Rs. 150 to Rs. 200 if they purchase medicines from private stores. Additionally they also have to pay the fee of the doctor.

Malikharjun. K, a pharmacist in the Raravi PHC and also in charge of the district drug warehouse in Bellary, said that the Primary Health Centers in villages such as this do not receive adequate funds for supply of drugs and medicines.“The fund allocated for acquiring medicines is just Rs 50,000 which is not enough. Medications for TB and people suffering from AIDS are free. Other medicines are generally provided free of cost but most of the drugs are not available or supplied by the central government,” said Malikarjun.

Jan Aushadhi a generic medicine scheme under the Prime Minister Jan Aushadi Yojana (PMJAY) provides drugs and medicines at low cost to the people without compromising on the quality. Generic medicines reduces the burden of expenditure from the shoulders of the poor. It has been in the Indian economy for a long time. Doctors in India are supposed to prescribe generic drugs to patients under the concerned scheme of the government. The Prime Minister Narendra Modi has made it mandatory for prescribing medicines under their generic names. Generic drugs are cheaper as they do not have to go through the same costs and expenditures as manufacturers of branded medicines go through. The manufacturer who invents the drug has to invest a large sum of money to produce these drugs. The patented drugs goes through a period of time, when only the manufacturer can produce and sell the product and make money. When the patent expires, the formula of the drug can be used by other manufacturers to produce the same drug.

As the formula is known and clinical trials are completed, generic manufacturers only has the requirement of proving to the regulators that its versions are as effective as the branded ones. Despite this, the villagers are made to buy expensive and branded drugs. According to The Wire, (https://thewire.in/health/drugs-generics-branded-health) doctors also refrain from recommending generic drugs in India, as there is no international standard drug regulatory mechanism in the country.

Primary Health Centre of Kuruvalli village in Siruguppa.

There are nine Primary Health Centres in the whole Taluk, which comprises more than 75 villages. It is also important to note that the whole of Karnataka only comprises 449 Jan Aushadhi Kendras, which are functional at the moment. The statistics can be accessed from the official website of Jan Aushadhi scheme.  Most of these stores are concentrated in urban areas making it difficult for the poor from several villages to avail quality drugs and medicines at a cheaper cost. Bellary district has just five stores that are functional and are all situated in the town itself. The District Health Officer of Bellary Shivaraj Hede, did not know anything about the generic medicine stores being opened in Bellary. It is striking as the official website suggests there are five functional stores in the district, while the DHO of Bellary had no knowledge of the same.

There are no such stores in Siruguppa or other taluks in Bellary though. Medicines are either availed from the general hospital or private stores. As Siruguppa is a dry place, most of the diseases that occur around the region are related to respiratory illness and asthma. Tuberculosis is also prevalent in the region, with 34 cases registered in the Taluk general hospital in the month of January. The taluk hospital and the Primary Health Centers provide medication for TB without charging the poor. Pharmacist Malikarjun insists that the villagers from Raravi who are suffering from TB get the medication for free. The same cannot be said for the people suffering from other deadly diseases.

Radhe Shyam, a rice mill worker, from Bihar has been working in sweltering heat in one of the rice mill factories in Siruguppa for six years. His red eyes show his deteriorating health condition as he constantly coughs while working in the mill. “I am tired of going to the hospital, as they only give me cough syrup for my condition which is expensive. Sometimes it is very painful to work with such health issues for more than 10 hours every day to earn a living.”

Radhe Shyam has to spend a lot on expensive medicines, in the absence of Jan Aushadhi stores.

Radhe Shyam has respiratory problems and bronchitis. He does not get proper medicines from the Siruguppa general hospital and is only given expensive cough syrups to treat his illness. Shyam pays double the amount of what a generic cough syrup would cost him, which is about Rs 30.  The quality of health care in the villages is also not good as people like them have to wait for long hours to get attended to. Rice mill workers in the taluk get affected by harmful rice husks, which finds a way into their lungs and cause fatal lung diseases such as bronchitis, asthma and chest tightness. The taluk hospital registered 21 cases under asthma for the month of January. Though the number is less than December, 2018, it should be noted that people often choose not to visit hospitals as the treatment is costly. Patients from villages have to travel to Siruguppa. Travelling cost is an additional burden and a normal checkup in a private clinic cost around Rs 200. Moreover, villagers also complain about the lack of adequate facilities in the taluk hospital. Migrants from other states such as Bihar and Uttar Pradesh are also discriminated upon by the hospital authorities, which makes the scenario worse than it already is. Rice mill workers in particular, make up most of the cases of asthma and bronchitis. They do not visit the hospital for checkup unless the condition gets worse. As they are from other states, lack of knowledge about the local language makes them a victim of expensive unnecessary charges for medication.

Radhe Shyam was discriminated upon when he visited the hospital a couple of times with his health issue. “The cough syrup which they provided was around Rs 150. I hardly earn 200 rupees per day. It is quite expensive for me to travel to Siruguppa for a cough syrup which is so expensive,” exclaims Shyam. As Shyam does not know the local language that well, it was easier for the hospital to trick him into paying more. The opening of generic medicine stores or the Pradhan Mantri Bharatiya Jan Aushadhi Kendra (PMBJAK) would pave way for people such as Shyam to avail medicines and treatment at cheap and reasonable cost.

A comparison of branded medicines with their generic versions. | Credit: BPPI

These Kendras or stores provide generic medicines to the people under the generic names of the drugs. According to the Department of Pharmaceuticals, Government of India an amount of Rs 2.5 lakh shall be given to NGOs, individuals establishing PMBJK and any governmental premises such as hospitals, medical colleges and others for setting up a generic medicine store. Chief Medical Officer (CMO), Dr Dasari Jagannatha of the Siruguppa taluk hospital said, “Government has not contacted us for setting up Jan Aushadhi stores in the hospital. We provide most of the medicines and treatments to the poor for free.” Though the CMO acknowledged the fact that there are no such stores in the taluk, he also mentioned that there is no need to set up such a store in the region as the hospital provides treatments and medicines for free and low cost.

 

  • Siruguppa taluk of the Bellary district does not have a Jan Aushadhi store. The taluk has 75 villages and people have to come for treatment in the taluk hospital.

 

The District Health Officer of Bellary failed to comment about the lack of Jan Aushadhi stores. In picture; Bellary District Office.

It is a different situation with workers and labourers such as Radhe Shyam. Most of the rice mill workers are exposed to the heat and harmful rice husks. This develops several types of issues in their health system and needs proper care. The funds allocated to the Primary Health Centers are low as well which adds up on public woes.

Medicine such as iron sucrose tablets which are for anemic patients cost about INR 300. Prostidin injection which is taken for termination of pregnancy is in the range of INR 200-250. These two are the costliest medicines that a Primary Health Center in Kuruvalli, another village in Siruguppa has. Talking to the doctor in charge of the PHC Dr M. Vidyashree, revealed lingering problems in the mechanisms of these PHCs. She explained that most of the PHCs do not have proper infrastructure to tackle the issue of lack of proper medication and treatments for the poor people of the village. “Kuruvalli has a population of only 4000 people, so the funds allocated to the PHC for the supply of medicines is enough. The problem though is in the variety of medicines and drugs. There are lots of drugs which are unavailable in the PHCs for people suffering from different types of illness,” remarked Dr. Vidyashree.

Major distributors of Bureau of Pharma PSUs of India (BPPI) in Bengaluru said, “New stores are opening because BPPI wants to reach to more general public. BPPI never would have assumed having such a big demand in the market. Their analysis under market trends was that they would have assumed a much lesser demand than the actual demand in the market.”

Mahaveer Distributor takes medicines from the Bureau of Pharma PSUs of India (BPPI), as it is the main manufacturer of generic medicines in Bengaluru. The BPPI is a group of 8 PSUs; they manufacture generic medicines on behalf of BPPI. BPPI has opened a lot of stores in a few years from 300 to 5111, since, it’s the only distributor it does not have the manufacturing capability to upkeep the stock. On the other hand, normal pharmacies have a lot of brands that they sell, so they never go out of stock as the same diabetic medicines will be produced by a lot of brands. But generic medicines are only produced by BPPI.

Infographic showing concentration of Jan Aushadhi stores in Karnataka.

The problem so far has been three fold; lack of quality medicines at affordable prices, no knowledge of the scheme of the government to provide generic medicines to all and lack of supply. Pharmacist Malikarjun points out that there are no intentions of opening a generic medicine store in the region. This has to change and people should be made aware of the benefits of the schemes. “To open a generic medicine store, a hospital or an NGO need to seek permission and apply for opening such a store. There are no intentions to do so. Public hospitals and primary health centers should have access to these generic medicines, so that the doctors can prescribe it to the poor.”

Generic medicines has to be prescribed by a doctor to the patients and the pharmacist has to provide the concerned medicine to the people. Due to lack of supply, most PHCs in the taluk prescribe expensive medicines that has to be bought from private medical shops or pharmacies. Begum Jahan who was diagnosed with high blood pressure was prescribed by a PHC of Raravi to some private pharmacy where the cost of medicine is high. The problem with Jahan and her husband was that they do not have any knowledge of the PMBJK scheme of the government. It is therefore imperative to establish and educate people from these villages about such schemes that would ease the pressure and burden of expensive medication.

One of the solutions to this particular problem is the Jan Aushadhi Campaign. It was launched by the Central Public Sector Undertakings (CPSUs) and the Department of Pharmaceuticals. The campaign was supposed to educate and make people aware about the benefits of generic medicines. The campaign however has no effects on the daily lives of public in the Siruguppa region.  It is important to make the concerned campaign relevant in the region by educating every one of their rights in healthcare. It would also ensure that people not only get generic medicines from hospitals but also from any other institutions such as railway, charitable institutions, state government offices, doctors and private clinics. Private sectors are also encouraged to participate in the campaign with the sole purpose of making quality health care accessible to not only urban areas but also to the remote villages of several talukas. It is important to educate the people, as generics are provided at a cheap cost, people might have reservations against using them. According to this particular journal, the general opinion of the poor is that medicines that are cheap lack in efficiency.

Patients are often forced to pay for expensive medications, in the absence of generic medicines.

Saifulla Saabh, another villager from the Raravi village said, “I have not heard about the Government’s scheme of providing generic medicines. It is quite unusual to think that a cheap medicine could cure serious diseases.” The general perception among these people is that generics are not that good in quality and cannot be therefore trusted as they are not costly. This perception needs to be changed by the authorities in the region. Supply is one other problem associated with the generic drugs. Most of the pharmacies have a stock of medicines that are sold at maximum retail price. None of the pharmacies carry generics and they are not motivated to do so either.

The pharmacists also are reluctant to stock generics as the prices of these drugs vary from their original versions. People are also unaware about generics which make it difficult for the private pharmacies to stock such medicines in stores. Stocking the stores and hospitals with generic medicines can be helpful in prescribing it to the common public of Siruguppa. The Department of Pharmaceuticals lists 361 major generic drugs, which are essential in treating several types of diseases and illness.

Deepika Joshi, research coordinator Public Health Research Network, commented on the nature of public health systems and various schemes of the government. “It is not going to improve the healthcare system. Nowhere around the world has been there evidences of studies on insurance model being successful as opposed to a strengthened public health care delivery system.  Insurance model is still being pushed because of international agencies agenda (World Bank etc.). In India, the 1980s and then LPG reforms saw decline in government spending on health. On the contrary, various studies studying insurance have found that patients incur out of pocket expense despite using card.”

People from the poorest backgrounds do not have access to private health care or quality health care treatments. As most health care facilities with quality infrastructure is concentrated around urban areas. According to Joshi, to improve the quality of treatment and making sure about the availability of medication to the poor, the state is supposed to invest enough money as per standards set by WHO, undertake strengthening of public health systems at each level through recruiting Human resources preferably from the communities, providing them with incentives, and providing free medicines etc. Joshi added, “Undertaking strict regulation and accountability of private health institutions can ensure a smooth and quality system that would ensure medication and basic health rights are made accessible to everyone in the country”.

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