Government hospitals in Tumkur district are facing shortages of drugs today. This was an issue that emerged during a recent field visit to the district in mid-April by the Institute of Public Health (IPH), Bengaluru. While most primary health centres and taluka hospitals are facing shortages, it is the district hospital that continues to suffer the most. This is a problem resulting from the interplay of many factors. Since last year, 100 percent of drugs are being provided by the State government. However, the alleged clampdown on procurement of drugs by the Lokayukta in June 2010, expiry of contracts of pharmaceutical firms and increased allotment of 24×7 PHCs have led to inadequate supply of drugs to the peripheral health facilities which in turn has translated into increased costs for patients. In Tumkur district, around 60% of the allotted drugs only were supplied last year. The remaining budget which lapsed in March 2011 amounts to nearly 1.4 crore rupees. The total shipment was distributed by the district drug warehouse to the PHCs, taluka hospitals and the district hospital based on their indents.
Initially when the required indent was supplied in less quantity, it was mainly the higher antibiotics that ran out of stock. However, now even basic tablets like ferrous sulphate (iron tablets), oral contraceptive pills and Paracetamol have run out of stock. This has made it difficult to provide treatment for minor illnesses, routine antenatal care services to pregnant women, and management of emergencies. To tide over acute crises, the district drug warehouse dipped into its buffer stocks to help provide at least essential drugs to the peripheries. The health centres for their part have been using their Arogya raksha samiti (ARS) fund and untied fund to procure drugs mainly from Janatha Bazaar. Drugs procured this way are purchased at a much higher rate and hence, in lesser quantities than actually needed. Smaller centres like PHCs have still been able to manage but larger institutions like the district hospital is struggling to provide affordable care to its patients as its supply fell short by around 45 per cent (approximately 35 lakh rupees).
Apart from Janatha Bazaar, private pharmacies have also been benefitting from these shortages. While the exact numbers are not available, some PHC medical officers when interviewed state that the number of private prescriptions issued has increased greatly in view of non-availability of common drugs at their centres. This situation has caused more inconvenience to patients and the community has been quite vocal in expressing their dissatisfaction with the health services. Some ANMs expressed concern for poor patients, especially pregnant women and children who mainly rely on government hospitals for care. They stated that for acute conditions patients are still able to purchase short course of drugs from private medical stores, however, the seriously ill patients and the chronic patients that are suffering the most as drugs like Inj.Cefotaxime are short in supply in government hospitals. Without oral contraceptives or intrauterine contraceptive devices being available, the staff is unable to provide family welfare services to the community.
Hence, the drug supply problem in the government health sector needs to be immediately looked into. Diverting funds meant for maintenance of infrastructure or procuring necessary equipment to purchase drugs may temporarily control the drugs problems but will only lead to provision of poor quality of health services at the government health centres.
Dr.H.Sudarshan, Chairman of the Task Force on Health & Family Welfare, accompanied the IPH team during their recent visit and discussed this issue with health staff from the district & taluka levels in Tumkur. He explained that the Lokayukta had tightened the drug procurement procedures in order to check irregularities in the system, however looking at the situation in the district, it appears that the anti-corruption measures are also worsening the credibility and quality of government health care services. Since this is a state wide problem, a similar picture could be expected in the remaining districts.
