Assessment

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India Assessment State of Rajasthan
Rajendra Kumar Garg S. D. Gupta
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Rajasthan, India
Government of Rajasthan
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Health Care Delivery System

• Substantial public and private infrastructure
  (national, state, private, NGO, donors)
• 12,000 public health care facilities distributed
  in urban and rural areas of the state
• Eight vertical programs funded by National
  Government
• 533 private hospitals and nursing homes

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Health Care Delivery System (2)

• Small NGO sector
• 85 hospitals and 3,648 dispensaries for
  Ayurvedic, Unani, homeopathic health services
• Large number of unqualified medical practitioners

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Pharmaceutical Sector

• Massive manufacturing sector
• More than 60,000 drugs (India)
• More than 20,000 manufacturers (India)
• Large centralized public sector in Rajasthan with
  over 12,000 facilities providing drugs
• Essential Drugs Program started in 1999
• 13,000 private pharmacies in Rajasthan mostly
  concentrated in urban areas and near hospitals
• Efficient distribution system
• NGO sector provides limited pharmaceutical
  services

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Geographic Accessibility
Average number of facility operating hours per
day (weekdays)

• Average distance to nearest health care facility
  (rural)
• Primary Health Center 8.9 km
• Hospital (public or private) 12.1 km
• Percentage of people living more than 10km from a
  health care facility (rural)
• Primary Health Center 44.9
• Hospital (public or private) 54.8

hours
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Availability

• Prescribed items that are dispensed
• Public Facilities 63
• Private Hospitals/Clinics 93
• NGO Hospitals/Clinics 85

Percent
Set of unexpired tracer items in stock
Time out of stock
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Affordability

• Number of days worked by lowest paid government
  employee needed to pay for a standard recommended
  course of therapy for tracer conditions

• Private Hospitals/Clinics
• Malaria 0.08
• ARI (pediatric) 0.17

• Private Pharmacies
• Diabetes (30 days) 0.24 0.90
• Asthma (30 days) 0.55 2.13
• Malaria 0.06
• ARI (pediatric) 0.09

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Affordability (2)

• Average unit price differential between most
  expensive and least expensive products
• Private Hospitals/Clinics 49
• Private Pharmacies 83
• Public sector procurement prices compared to
  median international prices for drugs -63

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Acceptability

• Number of drugs from the Essential Drugs List
  that are among the top 25 best selling drugs
• 16 (64)

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Quality of Products and Services

• Percentage of tracer drug samples from facilities
  that failed quality testing (No. of drugs 9 No.
  of samples 125)

• All Facilities 9.60
• Private Facilities 12.70
• Public Facilities 6.00
• NGO Hospitals/Clinics 0.00

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Quality of Products and Services (2)

• Existence of an Essential Drugs List updated in
  the last five years
• Rajasthan Essential Drugs List April 2000

Percentage of Facilities with EDL
Percent
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Quality of Products and Services (3)
Exit Interviews

• Percentage of prescribed drugs that are listed on
  the EDL
• Public Facilities 70
• Private Hospitals/Clinics 63
• NGO Hospitals/Clinics 66
• Number of drugs prescribed per encounter
• Public Facilities 2.7
• Private Hospitals/Clinics 3.2
• NGO Hospitals/Clinics 2.7

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Quality of Products and Services (4)
Percentage of patients who know how to take their
medication
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Quality of Products and Services (5)

• Simulated Client (number of encounters 48)
• Attendant gave instructions 60.4
• Attendant informed patient of possible
  2.1 problems with
  the medication
• Attendant asked for more information 31.3
• Attendant gave other advice or information 10.4

• Attendant recommended antimicrobials 40.4
• Antibiotic was sold to customer 25.4

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Quality of Products and Services (6)

• Percentage of facilities reporting access to at
  least one source of valid information
• Public Facilities 3
• Private Hospitals/Clinics 26
• Private Pharmacies 40

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Access Gaps

• Availability
• Insufficient availability of essential drugs in
  public and private sector
• Affordability
• Population subgroups exist that cannot afford
  essential drugs
• Quality of Products and Services
• Substandard drugs at the consumer level
• Inappropriate treatment recommendations
• Insufficient education of patients by health care
  providers

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Potential Strategy
Manufacturers Prime Vendor
STG
Sub-Center
PHC
EDL
Private Practitioners
Population target 20,000-30,000
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Potential Strategy (2)
Curative Care
Preventive Care
Promotive Care
Disease Surveillance
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Potential Impact of Public-Private Collaboration
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Viability

• Legal
• Political
• Organizational
• Financial
• Human Resources
• Barriers