Discussions served as a platform for healthy brainstorming
Healthcare Sabha 2016, a two-day conference on public healthcare organised by Express Healthcare, also saw two power discussions, presented by Glenmark Pharmaceuticals. The discussions offered several insights and food for thought. The first one kicked off with AG Prasad, Vice President – Sales and Marketing, Glenmark Pharmaceuticals welcoming nearly 15 dignitaries from Mumbai. The topic before the house was ‘Partnering in Quality Procurement.’
The discussion began with Dr Suresh Saravdekar, Ex-Assistant Director and Consultant (hospital supplies procurement), Ministry of Medical Education & Health, State of Maharashtra pointing out the need for quality medicine procurement processes within public hospitals. He went on to say, “Equity in quality of medicine is of utmost importance. We, as key stakeholders working in the public health domain, need to come up with solutions that can harmonise the standards for medical procurement. Today, we have gathered here to come up with those solutions that can make a difference.” This comment got the ball rolling for the rest of the interaction.
Tarun Goel, Assistant Manager, KPMG, and Advisor to Maharashtra government said, “To ensure quality drug procurement, it is necessary to revisit the tenders that come in. Apart from this, quality checks is a must without which medicine procurement process is incomplete.”
Dr KBK Dora, Additional Chief Medical Director, Central Railways immediately responded to this suggestions and said, “We need to have a filtration process in place for (purchases of) all kinds of medicine and surgical equipment. This will ensure quality procurement.” Agreeing with this view, Dr Nirmala Barse, Deputy Dean, LTMG Sion, said, “This needs a change in mindset.”
Dr Prateek Rathi, Special Executive Officer and Surgeon, Employees State Insurance Scheme, Public Health Department, Government of Maharashtra then emphasised that the medical procurement process must be kept transparent. “Transparency can be maintained by bringing in a third party to check for quality and then uploading the results on the net for everyone to see.”
Sanjay Deshmukh, Additional Municipal Commissioner W S, Mumbai Municipal Corporation agreed with Rathi. He also endorsed the idea of using e-commerce to maintain transparency. Ram Bhau Dhas, Dy Municipal Commissioner (Z-III), Mumbai Municipal Corporation, replied saying, “We have to find all the loopholes in the current procurement mechanism and fix them so that we can improve the quality of drugs and equipment supplied to public healthcare institutes.”
Further, Dr Avinash Supe, Dean, KEM Hospital, Mumbai recommended that a random inspection system be introduced by the government to ensure quality procurement processes. He also suggested that the price control mechanism should be reviewed once again. This suggestion by Supe was lauded by all.
Dr Alaka Despande, Former HOD – Dept of Medicine & Director, Center of Excellence, HIV/AIDS Management, JJ Hospital, said, “Quality is maintained within public hospitals as qualified doctors and healthcare staff conduct the procurement of medicines and surgical equipment.” Nevertheless, she pointed out that there is an urgent need to have a cap mechanism to ensure highest standards.
Dr Yogesh Patil, Co-Founder & Director, Biosense Technologies, also criticised the raised turnover criteria in the medicine procurement process. He was of the opinion that there is a need to find a new mechanism (other than turnover) to identify innovation-based companies to provide high quality products at affordable rates.
To add more insight to the discussion and inform the dignitaries about the developments at the state government level, Dr Pravin Shingare, Directorate of Medical Education & Research, Government of Maharashtra, said, “Decentralisation of medical procurement should be stopped. There should be one agency who will look after the standardisation of the procurement process. Also, post procurement scrutiny is also required to ensure quality maintenance. Currently there is no control on the aging of drugs.” He also pointed out that pharmacovigilance is crucial to provide good quality drugs to the people.
Goel chipped in,“Maharashtra will soon come up with its HMIS model to maintain transparency. The government is also adopting 5S and Kaizen for process improvement.” This news was appreciated by all at the discussion.
The next suggestions came from Ganesh Kanate, General Manager- Corporate Affairs, Glenmark. He urged the need for a dedicated PRO for each public health facility/hospital as negative news about public hospitals is highlighted often, while positive news seldom get covered in the media. He therefore felt that if an agency is hired or committee is formed, this could help disseminate the right information on the state of affairs within the public healthcare sector.
Prasad concluded the discussion by thanking all the dignitaries for sharing their views on this extremely sensitive subject and coming up with ideas that can give rise to apt solutions.
The success of the first power discussion set the tone for the second panel discussion which attracted state government officials from various states. The conversation was once again led by Dr Saravdekar, who asked the other dignitaries to talk about the drug procurement process in their own states. Dr Manjunath B, Medical Superintendent, KC General Hospital, Malleshwaram, Bengaluru under Govt of Karnataka, spoke about the drugs procurement mechanism maintained within his state. He also highlighted the problems which his organisation is faced with currently and requested for a solution to overcome it. “Money is allocated for increasing access to medicine; however, we are not able to utilise it properly,” he added.
Prasad agreed that under-utilisation of funds by state health departments is a real concern. He then touched upon the budget allocation for the healthcare industry in the Union Budget 2016-17 and made a point that in India we whine about scarcity of funds but it is equally important to know whether these funds are efficiently utilised. “Most of the funds allotted to either state or national programmes do not even get utilised. So to avoid such situations, both government as well as private players should identify how to utilise it,” he replied.
Moving on, Dr Pradeep Naik, Dean, Goa Medical College explained the procurement mechanism being followed by his hospital. He informed that in 2014, the Goa government formed a common drug purchase committee to ensure quality drug procurement process and maintain high standards. “The core responsibility of the committee was to follow the National List of Essential Medicines (NLEM) list and procure medicines. However, the committee has also prepared non-NLEM drugs list and shared this with all public hospitals located in Maharashtra”.
Adding in, Dr Shankar L Vig, Deputy Medical Commissioner, ESIC, briefed about the criteria adopted and followed by the ESIC for ‘Not of Standard Quality’ drugs and non supply of drugs. “We have a centralised committee that looks after this process. We follow a two-step standardisation process for quality checks,” he informed.
During the discussion panelists also discussed how pharma manufacturers are not willing to manufacture certain drugs under price control which leads to scarcity of medicines in the market. For instance, Dr Atul Kharate, State TB Officer & Joint Director Health Services, Government of Madhya Pradesh raised concerns on the drug procurement process for TB treatment. He revealed that some TB drugs are not available in Madhya Pradesh and hence even the RNTCP is facing many problems when arranging for certain drugs for TB. Dr PK Devadass, Dean and Director, Bangalore Medical College and Research Institute echoed Kharate’s point that he and his institution finds it difficult to procure drugs.
At the end of discussion, the participants were unanimous in their conclusion that functional integration is key to quality drug procurement in India. Dr Prathajyoti Gogoi, Director, Regional Drug Testing Laboratory, CDSCO, DGHS, Ministry of Health & Family Welfare, Government of India, summed up the discussion saying, “Healthcare Sabha has highlighted several problems being faced by stakeholders working in the public health domain. I assure you that I will discuss these issues at the ministerial level and present some solutions that have surfaced during our discussion.”
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