The Access to Medicines StudyImproving equitable access to quality generic medicines for patients with NCD in Tumkur, India (July 2013- March 2016)
India finances its healthcare mainly through out-of-pocket expenses (OOP). This results in catastrophic health expenditure and impoverishment. Nearly 70% of OOP is spent on medicines. In the past decade, efforts have been made to improve the drug availability at government primary health centres (PHC). However, various health system factors need to be considered so that the increased supply of medicines could result in improved utilisation and access.
Aim of the study
The aim of this study is to improve equitable access to quality medicines for non-communicable diseases (Diabetes and Hypertension) in Tumkur district of Karnataka state in southern India. We seek to understand the health system factors that affect(either improve or hinder) utilisation and access to medicines for people with NCD.
• To understand if (and how) availability of drugs at government primary health centres (PHC) could be improved through formation of patient groups
• To understand if (and how) utilisation, compliance and quality of care for NCD at government primary health centres could be improved through training PHC staff and optimising existing service-delivery arrangements
• To estimate the additional costs for increasing rational use of medicines and services optimisation at PHCs
• To understand the health system factors that influence utilisation of drugs at government primary health centres
• To document the effects on the private sector of improved drug availability and utilisation in PHCs
The study has been conducted at three talukas (Turvekere, Korategere and Sira) in Tumkur district of Karnataka state. This is a mixed method study, and we use a quasi-experimental design for the quantitative component of the study. All (39) PHCs across these three talukas were randomly assigned to one of three intervention arms of the study; intervention A, intervention A+B or control. A baseline survey and an endline survey of households, PHCs and private pharmacies are planned for the before-after trial (intervention) component (Fig 1). There are two types of intervention, i.e. Health Service Optimization (Training of PHC medical officers, pharmacists, ANMs on NCD care and management, Introduction of patient health records and awareness materials at PHC) and Community Platform Strengthening (ASHA training, mobilization of ARS fund for drug indenting, NCD patient group meeting). The qualitative component of the study includes in-depth interviews with key stakeholders and focus group discussions. This part of the study is using a theory-driven approach to understand and explain the changes if any, and why the intervention worked for some (where it did) and not for others (where it did not) across the three arms of the study.
Fig 1 : Study design of the ATM study.
The study is of three years duration. It commenced in April 2013 and will continue until March 2016.
WHO Alliance for Health Policy and Systems Research (WHO- Alliance).
The study team
Prashanth. N. S
Maya Annie Elias
Manoj Kumar Pati
Munegowda C M
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