Delhi Program - Pre-Requisites and Success Factors

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

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    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)

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    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

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    AccessShortage of drugs in the publichealth facilities

    Multiple procurement arrangementsleading to sub-optimal utilizationof resources

    Uncertainty of quality of drugs

    Before Drug Policy -

    1994

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    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

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    After Drug Policy-1997

    Principles of procurementProcurement restricted to essentialdrug list

    90% of drugs budget spent onessential drugs

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    After Drug Policy-1997

    Pooling of drug requirement of allstate health facilities

    System of inviting quotations byeach institution independentlyabandoned

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    After Drug Policy-1997

    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

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    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

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    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

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    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

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    Procurement methods

    Empanelment of pre-qualifiedbidders

    Or

    Open competitive bidding each year

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    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

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    Procurement methods

    Open competitive bidding each yearwith pre-qualification criteria

    introduced

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    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

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

    Pooled procurement

    system

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

    WHO-GMP certification

    Pooled procurement

    system

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    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

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    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

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    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

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    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

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    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

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    Better availability and accessibilityto drugs in the public sector by

    savings through an efficientprocurement system

    Conclusions

    No extra funds spent other than GMPinspections

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    Impact of State DrugPolicy - Pooledprocurement

    Cost of procurement reduced

    Holding the price lineQuality of medicines better

    Access to medicines increased

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    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

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    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.)