Delhi Program - Pre-Requisites and Success Factors

8/3/2019 Delhi Program - Pre-Requisites and Success Factors

1/26


2/26

Delhi State

Population 14 million

Total no. of hospital beds 4000

Teaching hospitals 2

Total number of health centers 158

Drug annual budget Rs. 400 million

($ 8 million)


3/26

Before Drug Policy - 1994

Access30-35% of health budget spent ondrugs yet scarcity of drugs in thehospitals and both patients and

doctors were not satisfied


4/26

AccessShortage of drugs in the publichealth facilities

Multiple procurement arrangementsleading to sub-optimal utilizationof resources

Uncertainty of quality of drugs

Before Drug Policy -

1994


5/26

Before Drug Policy -

1994Quality assurance Erratic and unreliable distribution

system Drugs nearing expiry drugs Drugs not needed (combination drugs)

Herbal drugs Money wasted on substandard

drugs


6/26

After Drug Policy-1997

Principles of procurementProcurement restricted to essentialdrug list

90% of drugs budget spent onessential drugs


7/26


Pooling of drug requirement of allstate health facilities

System of inviting quotations byeach institution independentlyabandoned


8/26


Level playing field to all bidders No special preferences to public

sector undertakings and small scaleunits

Pooled procurement system set up

with a standing Special PurchaseCommittee to secure transparencyand objectivity


9/26

Standing Purchase

CommitteeChairperson is a non-government person Principal Secretary Health

State Director Health ServicesState Drugs ControllerNominee of the State Finance DepartmentNominee of the State Law DepartmentAn eminent clinical pharmacologistChairperson, Committee for selection of

essential drugs

Head of institution


10/26

Non officials

An eminent administrator

An eminent clinical pharmacologist

A Finance & contract expertA leading private practitioner

This was an innovative move intended to bringoutside expertise, transparency and objectivity


11/26

Purchase committee

Close linkages have been maintained withdrug selection and use

The chairperson of the Essential drugscommittee is a member of the purchasecommittee

Continual liaison with other agencies like

Defence establishment for feedbackabout suppliers performance


12/26

Procurement methods

Empanelment of pre-qualifiedbidders

Or

Open competitive bidding each year


13/26

Bidding restricted to empanelledpre-qualified bidders not followed

as it: Debars new players albeit for a limitedtime

Leads to sense of complacency Possibility of cartels developingamongst empanelled bidders

Procurement methods


14/26

Procurement methods

Open competitive bidding each yearwith pre-qualification criteria

introduced


15/26

Pooled procurement

systemSelection criteriaTenders invited from manufacturers only

in generic names in 2 envelope system Technical and price bids

Price bids of only those manufacturersare opened who fulfill the technical

criteriaUnsuccessful bidders are informed and

earnest money returned


16/26

Pre-qualification criteriaFinancial viability - at least annualturnover of Rs. 120 million ($ 2.5million)

Pooled procurement

system


17/26

Pre-qualification criteriaTechnical qualifications biddershould have been Manufacturing the drug for at least 3years

WHO-GMP certification

Pooled procurement

system


18/26

Pre-qualification criteriaServices of at least one approved

manufacturing chemist and one qualitycontrol chemist

No case pending against manufacturerfor sub-standard or spurious drugs

No black listing by any otherprocurement agency

Pooled procurement

system


19/26

Quality assurance

Careful selection of the tenders

Criteria of cut off turnover Rs.

120 million ($ 2.5 million)Selective GMP inspections

Testing of batch samples

Samples sent for testing by theprescribers for quality assurance


20/26

Quality Assurance GMPinspections

Panel of 12 experienced experts set up forGMP inspections

Two experts sent for inspection to any of

the pharmaceuticalThe inspection results of the approved

firms (White list) shared with other states

on requestRejection rate is 25%

Samples sent to approved quality controllaboratories for quality assurance


21/26

Quality assurance

results -CPA cellTotal no. of drug batches tested in

2000-20023529

No. of samples declared not of standardquality

20

Total expenditure on testingRs. 25,92,750

0.53% of the budget for drugs


22/26

Positive effectsMaximal use of available resources

Procurement at lower prices led toavailability of more funds for procuringmore essential drugs

Increased availability of drugsImproved quality of drugs procured,

therefore, building up trust in the system

Pooled procurement

system


23/26

Better availability and accessibilityto drugs in the public sector by

savings through an efficientprocurement system

Conclusions

No extra funds spent other than GMPinspections


24/26

Impact of State DrugPolicy - Pooledprocurement

Cost of procurement reduced

Holding the price lineQuality of medicines better

Access to medicines increased


25/26

Pooled availability of drugs,extent of prescriptions by

generics and adherence to EDL

0

20

40

60

80

100

120

1995 1997 1999 2000

Availability

Generics

EDL

Year under review


26/26

0

5

10

15

20

25

30

35

1995 1996 1997 1999 2000

Amoxycillin Chloroquine Omeprazole

Years

59%

37%43%

Cost Reduction of commondrugs by pooled procurement

(Rs.)

Documents

Delhi Program - Pre-Requisites and Success Factors