Use of WHO ATC DDD methodology in procurement

Dr Nilima Kshirsagar, National Chair, Clinical Pharmacology, ICMR, GoI, deliberated on access to medicines. In her presentation, she reinforced the need for rational use of medicines and procurement of medicines for universal coverage, highlighting the issues relating to access to health, many issues ranging from regulations to drug approval processes. She pointed out, “If you look at both national as well as global data, 50 per cent of the medicines are either prescribed, dispensed or sold inappropriately, and even the majority of patients fail to comply.”

She added, “Most of the medicines are either overused, underused or incorrectly used, which results in serious morbidity and mortality.”

The decision making related to prescription made by the doctors leads to grave issues for diseases like TB and AMR. She pointed out that NLEM list has been prepared by the Government of India and updated in 2017, along with standard treatment guidelines which are published by the government and ICMR, but there are still measures to be taken to ensure that medicines are provided to patients at public health facilities. Identifying that medicines form at least 10 per cent of the budget of any particular state, she explains about the procurement process. She states that the quantity of medicine to be procured increases by 10 per cent in comparison to the last year which still means that there is a shortage or surplus. She suggests that there is a need to plan the strategy and assess the budget involved in procurement. One example to set the priority right during in procurement is by using WHO Anatomical Therapeutic Classification (ATC) Defined Daily Dose (DDD) methodology. She cited a few examples of the medicines that have been procured less as opposed to the ones that have been procured in abundance which leads to misuse of funds, thus suggesting a need for formulation of proper policies. She further highlighted various malpractices and shortcomings in our current systems and urged the public health officials to put an effective strategy in place to mitigate them. She said we are still taking baby steps to universal access to the medicines.