Free drugs plan gets a quiet burial

Joint secretary (policy) in the health ministry Manoj Jhalani confirmed that there will be no separate central scheme for free drugs and diagnostics anymore.
It was in 2012 that the Centre first promised to provide free drugs in public health facilities. The first budgetary provision was made in 2013. Last year, the promise was crystallized to providing 348 essential drugs free. This was later whittled down to just 50 drugs. And now, the entire idea of a central scheme for free drug distribution has been given a quiet burial.

Joint secretary (policy) in the health ministry Manoj Jhalani confirmed that there will be no separate central scheme for free drugs and diagnostics anymore. “Free drug provision will be done by the states under the National Health Mission (NHM). The Centre will financially incentivize states to start the free drug scheme. If a state initiates a free drug schemes and fulfils the condition of putting in place a quality assurance system, prescription audits and so on, it will be given 5% of its NHM allocation as incentive. A large number of states have agreed to this,” said Jhalani.

In his budget speech last year, finance minister Arun Jaitley stated: “To move towards ‘Health for All‘, the two key initiatives i.e. the Free Drug Service and Free Diagnosis Service would be taken up on priority.” However, there was no provision in the budget. In his budget speech this year, the words medicine, drugs and diagnostics do not figure anywhere.

In September last year the health ministry had brought out a document titled Free Essential Drugs Scheme- Base paper for Discussion. It said: “Government intervention for better access to essential medicines is urgently required as expenditure on drugs constitutes about 67% of out of pocket expenditure on health care and out of pocket expenditure is one of the leading causes of impoverishment.” The document also stated that free provision of essential drugs to all patients accessing public health facilities, while not costing so much to the government, brings huge savings to the patients, and is the easiest and quickest option to improve access to essential medicines and reducing out of pocket expenses. Harsh Vardhan had stated that the free medicines scheme would go a long way toward fulfilling the promise of reducing out-of-pocket expenditure on healthcare.

Reacting to the central free drug scheme being scrapped Dr T Sundararaman, visiting professor at the Centre for Social Medicine and Community Health in JNU and former director of government’s National Health System Resource Centre said: “It is a complete withdrawal of the state in a major way from public health. There is a reason why the health sector industry has shown the highest growth in sensex. The state withdrawal is a predatory opportunity for the private sector.” Jan Swasthya Abhiyan’s co-convenor Dr Amit Sengupta said that it was unfortunate that what started off as central scheme was being pushed onto the states so that the centre could absolve itself of all responsibility. “Rajasthan has shown how free drug scheme increased the usage of public health facilities. Given such obvious benefits, why is the central government not committing to this level of spending? The only plausible explanation is that this is in conflict with the government’s idea of promoting the private sector.”

In June last year the government had claimed that the free drugs programme was a part of the National Health Assurance Mission which would also include free diagnostics and free health services. The health ministry had sought Rs 500 crore budgetary support for the scheme. Under the programme, 348 drugs in the National List of Essential Medicines (NLEM) were to be provided free from 1.6 lakh sub-centres, 23,000 primary health centres, 5,000 community health centres and 640 district hospitals.

In 2011, the Planning Commission had estimated that the free drugs scheme would cost the centre about Rs 28,675 crore over the period of the 12th five year plan (2012-17). The centre was supposed to bear 85% of the cost and the states were to contribute the remaining 15%.