July 2015

Mukhyamantri Nishulk Dava Yojana (MNDY) – An initiative by Rajasthan Government to enhance access to medicines

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Mukhyamantri Nishulk Dava Yojana (MNDY) has addressed equity and access to the healthcare for the people of Rajasthan. Dr Sudhir Kumar Sharma, Managing Director, Rajasthan Medical Services Corporation elaborates on MNDY in Conversation with Elets News Network (ENN).

Please throw some light on Mukhyamantri Nishulk Dava Yojana (MNDY)?

Dr Sudhir Kumar Sharma, Managing Director, Rajasthan Medical Services Corporation

Dr Sudhir Kumar Sharma
 Managing Director, Rajasthan Medical Services Corporation

The Mukhyamantri Nishulk Dava Yojana (MNDY) was launched in the state of Rajasthan on October 2, 2011. This was in compliance to the budget announcement for the financial year 2011-12 which said that the Government would make available commonly used essential medicines free of cost to all patients visiting all government healthcare institutions with effect from 2nd October 2011. Another announcement was to establish a central procurement agency for procurement of medicines, surgical and suture items for the Medical & Health Department and Medical Education Department. Thus Rajasthan Medical Services Corporation (RMSC) was established in May 2011 under the Companies Act, 1956. The Corporation has its headquarters at Jaipur, with a set up of different sections to look after supply, logistics, procurement, quality, equipment procurement and maintenance, IT and finance issues.

To advise RMSC on what to purchase and how to purchase, there is an outside body called the Technical Advisory Committee (TAC). This committee is chaired by the Managing Director and comprises of representation of subject experts from medical college hospitals, a representative from Finance Department, GoR, Rajasthan University of Health Sciences, Pharmacology experts and RMSC representatives. The TAC finalizes the Essential Drug List (EDL) in consultation with subject experts. Currently, the EDL has 612 drugs, 73 surgical and 77 suture items.

Free medicine scheme has dual benefits of delivering healthcare services and filling in the disparity gap at the same time

For the implementation of the scheme, basic infrastructure was set up at the level of institutions to facilitate drug distribution to the end users. At the district level, the District Drug Warehouses (DDWs) were strengthened in terms of infrastructure and manpower and today the corporation owns 34 DDWs and 6 Medical College Drug Warehouses. At the institutional level the Sub-stores were strengthened for the purpose of drug storage and based on the patient load of individual healthcare facility, the Drug Distribution Centres (DDCs) were set up for distribution of medicines to the patients. For a patient load of 150, one DDC was considered to be the norm. Pursuant to the launch of the scheme in view of the increased patient load, the institutions were directed to revisit the requirement of DDCs. For effective service delivery, the department recruited about 1400 pharmacists for management of DDCs in the year 2012 and this was augmented by deputation of Informatics Assistants in 2013 from DoIT for management of entries into the e-Aushadhi software.

The development of the e-Aushadhi application as a complete supply chain management solution by C-DAC aided the headquarter and field level implementation of MNDY. It’s a complete inventory management solution for the medicines capturing all processes right from the forecasting of the annual demand to the issuance of supplies for distribution to patients. The application has been rolled out at more than 3500 institutions across the state. The e-Aushadi application has been acclaimed nationally and is under the nation-wide roll out for various other states in the country.

Looking to the patient welfare centric nature of the scheme the quality mechanism has been inbuilt very strong in the corporation. Samples are received from the DDWs at the headquarters and sent to empanelled laboratories for quality test. The empanelled laboratories report online in the e-Aushadhi software, pursuant to which the medicines are shifted from the quarantine area to the main storage section to be issued to the institutions.

We have had our share of bottlenecks and challenges during the implementation because of the State’s geographical vastness and the large number of institutions (more than 17,500) to be covered under the scheme. However, because of political and administrative willingness and a very strongly lead team at RMSC with a focused vision the scheme could be implemented successfully in a very short span of time. Over a period of three and half years, MNDY has achieved success with national and international recognition. The corporation has been visited by a number of other states to study the processes for replicability purpose as also by teams from number of development partners, NGOs and countries like Nepal and North Korea. The state has been represented at national and international forums for the scheme’s presentation by the then Managing Directors and other officials from the corporation. As Managing Director, RMSC, I look forward to a bright future for the corporation and the scheme in times to come.

Are the commonly used essential medicines being distributed free of cost to only below poverty line (BPL) category people?

No, we are providing commonly used essential generic medicines free of cost to all patients visiting all government healthcare institutions, irrespective of their financial status. The uniqueness of this scheme is that it is universal in nature and benefits extend to the entire population of the state. No card or identification of any sort is required to avail free medicines at public healthcare institutions in the state of Rajasthan. Although the supply chain is quite strong and medicines are being made available round the year, however, at times there are shortages and to cover that period, we have a provision of 10 per cent of the budget for local purchase by institutions.

We have had our share of bottlenecks and challenges during the implementation because of the state’s geographical vastness and the large number of institutions

Please mention the funds allocated for this scheme by the government? What are the major challenges you encountering?

Since the inception of the scheme in the year 2011, the state government has been provisioning adequate budget every year to meet requirements under the scheme in the range of `280- 300 crore. The state has been receiving funds from NRHM in the range of `60 -150 crores as well; this aids the state ex-chequer and saves the state resources. Thus, as far as the availability of funds is concerned RMSC faces no bottlenecks on account of funds for procurement of medicines under the scheme.

The challenge of providing generic medicines free of cost to a large population of 7 crore was big and an uphill task; however RMSC could achieve the same with pre-defined guidelines, adherence to timelines and teamwork under expert leadership. Major challenges being encountered are management of increased OPD and IPD loads pursuant to launch of the scheme, the implementation resulted in huge footfall in numbers of patients visiting government healthcare institutions but the available infrastructure and manpower remains an issue of concern. There have been episodes of stock-outs of medicines on account of various reasons which have lead to breaks in supply chain and resulted in increased utilization of local purchase funds, the receipt of timely and validated annual demand from the medical departments has been an area of concern, this leads to shortages and expires at times. Rajasthan being a desert predominant area, temperatures in summer are often high; hence cold chain maintenance for heat sensitive drugs also is a critical issue in the supply chain. Then there are issues related to pilferage, breakage, deterioration, drugs becoming obsolete etc, leading to adverse media reports at times.

What are the parameters to select an agency to provide medicines to the Government?

There are stringent procurement criteria and only a manufacturer or an importer can participate in the bid. The firm should have a turnover of more than `20 crore, it should not have been blacklisted anywhere across the country and should have a market standing of three years for that particular product. The firm should also mandatorily participate through e-procurement. Of late some changes have been made in the parameters to enhance the quality of drugs.

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