title: Availability of medicines in public sector health facilities of two North Indian States.
abstract: BACKGROUND
  Access to free essential medicines is a critical component of universal health coverage. However availability of essential medicines is poor in India with more than two-third of the people having limited or no access. This has pushed up private out-of-pocket expenditure due to medicines. The states of Punjab and Haryana are in the process of institutionalizing drug procurement models to provide uninterrupted access to essential medicines free of cost in all public hospitals and health centres. We undertook this study to assess the availability of medicines in public sector health facilities in the 2 states. Secondly, we also ascertained the quality of storage and inventory management systems in health facilities.
  
  
  METHODS
  The present study was carried out in 80 public health facilities across 12 districts in Haryana and Punjab states. Overall, within each state 1 MC, 6 DHs, 11 CHCs and 22 PHCs were selected for the study. Drug procurement mechanisms in both the states were studied through document reviews and in-depth interviews with key stakeholders. Stock registers were reviewed to collect data on availability of a basket of essential medicines -92 at Primary Health Centre (PHC) level, 132 at Community Health Centre (CHC) level and 160 at tertiary care (District Hospital/Medical College) level. These essential medicines were selected based on the Essential Medicine List (EML) of the Department of Health (DOH).
  
  
  RESULTS
  Overall availability of medicines was 45.2% and 51.1% in Punjab and Haryana respectively. Availability of anti-hypertensives was around 60% in both the states whereas for anti-diabetics it was 44% and 47% in Punjab and Haryana respectively. Atleast one drug in each of the categories including analgesic/antipyretic, anti-helminthic, anti-spasmodic, anti-emetic, anti-hypertensive and uterotonics were nearly universally available in public sector facilities. On the contrary, medicines such as thrombolytics, anti-cancer and endocrine medicines were available in less than 30% in public sector facilities. Among the medicines which were not available at the time of survey in Haryana, nearly 60% of them were out of stock for 3-6 months whereas 8% of them were out of stock for more than 6 months.
  
  
  CONCLUSIONS
  Health system needs to be strengthened by making essential medicines available for patients. Ensuring access to free medicines is likely to reduce private expenditure on medicines, which is a long-term, sustainable way to towards universal health coverage in India.
authors.affiliation: School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India. shankarprinja@gmail.com.
authors.forename: Shankar
authors.initials: S
authors.lastname: Prinja
authors.affiliation: School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India. pankajbahuguna08@gmail.com.
authors.forename: Pankaj
authors.initials: P
authors.lastname: Bahuguna
authors.affiliation: School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India. ijay.doc@gmail.com.
authors.forename: Jaya Prasad
authors.initials: JP
authors.lastname: Tripathy
authors.affiliation: School of Public Health, Post Graduate Institute of Medical Education and Research, Chandigarh, 160012, India. dr.rajeshkumar@gmail.com.
authors.forename: Rajesh
authors.initials: R
authors.lastname: Kumar
mesh_terms: D000465:Algorithms; D016527:Drug Costs; D004358:Drug Therapy / Q000191:economics / Q000706:statistics & numerical data*; D018954:Drugs, Essential / Q000145:classification / Q000191:economics / Q000627:therapeutic use*; D019538:Health Care Surveys / Q000379:methods / Q000706:statistics & numerical data; D006268:Health Facilities / Q000706:statistics & numerical data*; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006801:Humans; D007194:India; D017150:Public Sector
chemical_list: D018954:Drugs, Essential