Rajasthan: The Medicine of Life

The free medicine project in government hospitals, including life-saving drugs, has arrived as a life-giving miracle for the people of Rajasthan, especially the poor, who were hitherto devastated by the huge cost of healthcare

Sadiq Naqvi and Akash Bisht Baran/Jaipur

 

“Nobody comes to us now. We have lost all business since the government launched this free medicine scheme for all,” said Ramesh Jain, owner of Arogya Medicine, a private pharmacy outside Gangori Hospital, a multi-specialty government facility in Jaipur. Similarly, scores of other pharmacies are waiting for that elusive customer. Not long back, this used to be a buzzing market, with a throng of patients or their relatives.

Inside the hospital, the staffer manning the free medicine kiosk is having a hard time dealing with the rush. “Every day, more than 500 patients come to me. This excludes the number of patients admitted in the hospital who are also entitled to free medicine,” he says. Under the Mukhyamantri Nishulk Dawa Yojana, people in Rajasthan are now getting more than 400 drugs free in all government hospitals and dispensaries. 

“The inflow of patients in the hospital too has increased by a good 50 per cent,” says the Chief Medical Superintendent, Dr Ajay Mathur. With patients from across the social strata thronging the government facility, quite visibly the trust in the State’s health apparatus is growing. “Now, the people who would never consider going to a doctor for paucity of money, choose to come to the hospital without worrying about money,” says Dr Rajesh Rajawat, Chief Doctor at the Community Health Centre at Kelawada village in Baran. “Earlier, a doctor was not sure if the patient would even buy the medicines which had been prescribed. Now, we are confident that the patient is taking the medicines without worrying about the cost.”

“It’s a boon. My husband is suffering from cancer. The entire treatment would have cost thousands of rupees. Instead, I have spent a few hundred rupees on medicines and travel costs,” said Sundari Devi of Jaipur. 

The scheme is already being hailed as a gamechanger of sorts for the beleaguered Ashok Gehlot-led Congress government in Rajasthan. So much so, even the opposition accepts that the scheme is working wonders. “It’s a good scheme. It’s very helpful to the poor. However, there are problems with monitoring and implementation of several other schemes,” Arun Chaturvedi, chief of the state unit of the BJP, told Hardnews.  

Meanwhile, inside Swasthya Bhawan, the headquarters of the state health ministry, Dr Samit Sharma, chairman of the Rajasthan State Health Corporation, is on the job. In his office, a man from Jodhpur hands over a prescription slip and narrates how some government doctors are still prescribing costly medicines 
for patients.

Dr Sharma, a doctor before he joined the administrative services, takes a good look at the slip and straightaway tells his personal assistant to connect him to the principal of the medical college. “Cefixime 500 does not exist. How can a doctor make this mistake,” he exclaims.

“We should strive to make the Jodhpur Medical College an example for others to follow,” the principal is told. “Please look into the matter and tell the doctors to stop engaging in such practices,” he adds, before hanging up.

“Monitoring is not really within the ambit of my job. People who feel strongly about issues keep coming to my office with such complaints. In turn, I keep apprising the senior doctors since I am constantly in touch with them,” he explains. 

‘Every day, more than 500 patients come to me. And this excludes the number of patients who are admitted in the hospital who are also entitled to free medicine’ 

Sensitising the doctors to switch to generic medicines has been a protracted campaign which Dr Sharma has been spearheading in the state since his first appointment. He is a part of the global campaign to ensure that drugs are made available to all at a nominal price and there is no barrier of cost when it comes to the well-being of people. 

“As a probationer in 2003, I was posted in Jhalawar in Rajasthan. This is where I started this experiment and ensured that 45 essential drugs were procured directly from the companies and given at a nominal cost to patients,” he narrates. The experiment continued in subsequent postings in Jodhpur, Chittorgarh, Nagaur and Alwar where Dr Sharma served as the district collector. 

Drug manufacturing is a lucrative business with windfall profits. “This is one industry where profit margins range from 50 per cent to even 2,000 per cent. This is crazy when you are dealing with life-saving drugs and you know that thousands die for want of proper medication,” says Dr Sharma, even as he pulls out some top brands from his attaché case which the government is procuring directly from multinationals at different price bands, some even at one-fifth or less of their printed prices.

“The manufacturers who engage in propaganda and don’t match up to the quality must be suffering. The rest of the manufacturers are making up for their sales deficit by going for bulk supply to the government,” says Dr Sharma. “It’s a direct loss of Rs 1,500 crore in terms of the amount of medicines which have been distributed through government facilities. And if you include the amount of useless medicines which the doctors are in a habit of prescribing, the loss is even more,” he says, explaining that drugs like Becosules or other multivitamins prescribed by the doctors are not always useful.

Activists claim that most Indians spend exorbitant amounts of money seeking healthcare, pushing more than 30 million citizens below the poverty line every year. A single instance of hospitalisation or a major ailment in a family compels 40 per cent of patients to sell their assets or get into a debilitating debt trap. About 70 per cent of this expense is on medicines. 

‘A doctor wouldn’t be sure if the patient would even buy the medicines which had been prescribed. Now, we are confident that the patient is taking the medicines without worrying about the cost’

According to the Coverage Evaluation Survey (CES), 2009, a survey done by UNICEF, about 29 per cent of patients cannot afford any kind of medical care. The cost of medicines hits people most, apart from the cost of getting admitted to a hospital, inaccessibility of quality healthcare, and so on. In addition, the spiralling rise of prices of medicines is making them inaccessible to the majority of Indians. About 65 per cent of Indians do not have access to essential medicines while India exports drugs to about 200 countries.

“Even in pre-liberalisation India, till 1979, there was a list of essential drugs under strict price control. However, after the free market scenario, the government allowed the private drug companies a free run. This has caused much distress in a poor country like ours,” says Dr Sharma.

Predictably, Dr Sharma’s proposal was not taken kindly by sections of doctors. Sharma recounts:  “Even the chief doctor at the medical college was sceptical. He would say that I am mad, and ask how we could be sure of the quality of the medicine when the market cost is Rs 35, and we are procuring and giving it to the patients at just Rs 3.”

The move infuriated the doctors. They stopped working and went to meet Vasundhara Raje, the then chief minister. “I used to get disturbed when people were so opposed to what I was doing,” says Dr Sharma.

When Chief Minister Ashok Gehlot launched the scheme officially on Gandhi Jayanti in 2011, the doctors again went on a strike. “Interestingly, among other things, they were also demanding that their salaries be hiked since this scheme has taken a toll on their earnings,” says a top official in the state health ministry. 

“Getting the doctors on board has been the most daunting task,” says Dr Sharma. Enamoured of gifts in cash and in kind from the pharmaceutical companies, some doctors saw the free medicine scheme as a threat to their extra source of income. Senior doctors point out that these companies, through their medical representatives, have been showering government doctors with all kinds of benefits and commissions. “Earlier, they used to come with gifts. They would get pens, photo frames and such things. Now, things have changed. They maintain a record of how much sale they get from a particular doctor. In turn, the doctor is rewarded with a fixed commission which can be as high as 30 per cent,” a senior doctor at Gangori Hospital said. 

Even at the Gangori Hospital, where Dr Ajay Mathur started a drug store to provide cheap medicines, the opposition was fierce. “The doctors would say that since we are dealing with serious cases, we should prescribe the best medicines,” says Dr Mathur.

Undeterred, he, along with four senior doctors, decided to experiment. “We used these generic drugs and the antibiotics available in the market at the same time and the results were similar,” he explained. “This silenced our critics.”  

Indians spend exorbitant amounts of money on healthcare, pushing more than 30 million citizens below the poverty line every year. As per a survey done by UNICEF, 29 per cent of patients cannot afford to seek any kind of medical care  

While most government doctors have fallen in line, there are some who have devised novel arguments to puncture the social welfare plank of the Rajasthan government. “The doctors argue that not all medicines of the same salt content have the same effect on the patient.” Others are even more blunt. “They tell us that if we want to get healed faster then we should not take the medicines given free by the government. Instead, we should buy ‘high quality’ medicines from outside,” says a patient. 

Dr Sharma does not agree with these claims. He says that, sooner or later, such doctors will have no option but to switch to prescribing generic drugs. “This is rubbish. How can two medicines of the same salt content have a different effect unless there is a problem in quality? One should ask these doctors if they were taught different brand names in the text books which they studied,” he says. 

Even in remote corners of the state, as in the poverty-stricken Sahariya-dominated villages in Baran district, the scheme has touched the lives of the poorest of the poor. “At least we get medicines now,” says a villager. The newly-launched scheme of free medicines for livestock has also brought in cheer in the hinterland. “It’s an even bigger boon,” says Dr Mathur. “It will have a major impact; our cattle are precious to us. Most people are dependent on cattle,” says Matadeen Pareek, a Congress functionary.

However, there are some teething troubles. These reporters visited a village in Baran district where villagers complained that the Auxillary Nurse and Midwife (ANM) does not turn up regularly. In Kelawada, Dr Rajawat said that villagers demand medicines even when they are not needed. “People tell me that a dog has scratched them. Often, there is no visible wound and hence no need for an anti-rabies injection. But they still insist that I should give them one. Such cases keep happening,” he says, even as a long queue of patients waits outside his residence.

The rising popularity of the scheme has led to an extra burden on the existing infrastructure. This problem is set to magnify once the government commences its other ambitious venture of providing free diagnosis to the people. “Earlier, we had stored supplies for six months. Now, even a three-month supply storage is not possible,” says Rafiq, in-charge of the drug warehouse at Jaipur.

“The whole scheme is running on auto-correction mode. All these problems will be sorted out with time,” says Dr Mathur, reflecting hope and resilience. “Soon, you will see, all the people will choose to come to government hospitals.”

This story is from the print issue of Hardnews: JANUARY 2013