Availability of essential medicines: A primary health care perspective.

The present study was undertaken to assess the availability of the essential medicines to the people of Kunijarla, Khammam district, AP. This was done in two steps: 1) Comparison of PHC-EML (primary health care essential medicines list) with AP-EML (Andhra Pradesh essential medicines list) and NEML (National essential medicines list); and 2) Assessment of availability of the listed medicines in adequate quantity to meet the needs of people of kunijarla. Results showed that the PHC-EML is on par with AP-EML and NEML. The hospital has 100% availability of the listed medicines; however, there was a need for certain add-on drugs like phenytoin tablets, valproic acid, and activated charcoal since they were prescribed frequently and were not included in PHC-EML. All the drugs which were listed in PHC-EML were being used and none were considered as non-utility supply. Suggestions were given for the revision of PHC-EML according to the criteria for identifying medicines for inclusion in the revised list which was mentioned in NEML.

Introduction

Primary health care (PHC) addresses the main health problems in the community, providing promotive, preventive, curative, and rehabilitative services accordingly. The Alma-Ata declaration has outlined the eight essential components of PHC and provision of essential medicines is one among them.[1] World Health Organization (WHO) introduced the concept of essential medicines. “Essential medicines are those that satisfy the priority health care needs of the population. They are selected with due regard to public health relevance, evidence on efficacy and safety, and comparative cost-effectiveness. Essential medicines are intended to be available within the context of functioning health systems at all times in adequate amounts, in the appropriate dosage forms, with assured quality and adequate information, and at a price the individual and the community can afford”.[2]

Hence, it was thought that an attempt be made to assess the availability of the essential medicines to the people of kunijarla, Khammam district, AP. This can be done in two steps. First step is to know whether the drugs listed in PHC formulary or PHC-Essential Medicines List (PHC-EML) is sufficient to treat the common ailments at the primary care level. It can be done by comparing PHC-EML with some known standards like Andhra Pradesh Essential Medicines List (AP-EML) and National Essential Medicines List (NEML). Second step is to know whether the listed medicines are procured in adequate quantity to meet the needs of people of Kunijarla.

Aims and Objectives

The primary aim of the study was to compare PHC-EML with AP-EML and NEML to know the differences and shortcomings, if any. The study was also extended to check the availability of the listed essential medicines at the primary health center, Kunijarla, Khammam district, A.P.

Materials and Methods

Existing hospital formulary was obtained from chief pharmacist of the PHC. AP-EML[3] and NEML[4] were downloaded from the respective official websites which were used as a guide for comparison.

The percent availability of the medicines from those listed in hospital formulary was noted at the time of visit and the reason for non availability, if any was explored. Also, with the help of chief pharmacist and medical officer, it was explored whether the hospital needs any additional supply or add-on supply of medicines. Additional supply of medicines was considered those among the PHC-EML which was prescribed very often and hence was required in more quantities. Add-on supply of medicines was those which were needed very often but not included in the PHC-EML. The non-utility medicines (i.e., medicines not needed/essential but were on the PHC-EML) in the hospital if any, were also checked.

Results

The PHC-EML just lists all the essential medicines, but has not classified them into various therapeutic classes as done by AP-EML and NEML. For the sake of convenience of comparison, the drugs in PHC-EML are being grouped into categories similar to that of AP-EML and NEML. Complete comparison of these three documents is a tedious job and out of the scope of this work. Hence, only the important differences are explored. Table 1 show the comparison between PHC-EML, AP-EML, and NEML.

Table 1

Comparison between PHC EML, EML in Andhra Pradesh and National EML

The PHC-EML includes 187 medicines which is equal to only 50.13% and 52.82% of drugs in AP-EML and NEML, respectively, but the common therapeutic categories includes most of the drugs in AP-EML and NEML and in certain categories it includes more than those listed in AP-EML and NEML. Hence, PHC-EML is on par with AP-EML and NEML.

All the drugs included in the PHC-EML were available at the time of visit (i.e., 100% availability). Further, drugs like ciprofloxacin, amoxicillin, ibuprofen, diclofenac, paracetamol, and B-complex were among the PHC-EML which was frequently prescribed and hence they required an additional supply. There was a need for certain add-on drugs like phenytoin tablets, valproic acid, and activated charcoal since they were not included in PHC-EML. All the drugs which were listed in PHC-EML were being used and hence were not considered as non-utility supply.

Discussion and Conclusion

The availability of medicines in developing countries is undermined by several factors and one among them is poor medicine supply and distribution systems. The EML can help countries rationalize the purchasing and distribution of medicines, thereby reducing costs to the health system. So it is critical that any health care system (especially PHCs) must take the issue of availability of essential medicines to the patients in the right quantity very seriously.[5] The result shows that the people of Kunijarla have 100% access to essential medicines since the PHC-EML is on par with AP-EML and NEML and also the PHC has adequate supply of most of the essential medicines to the community, but they are in need of certain add-on supply of medicines for which suggestion was given for the revision of PHC-EML according to the criteria for identifying medicines for inclusion in the revised list[4] which was mentioned in NEML and a copy of NEML was given for their reference. Similar studies are needed which would help policy makers and planners.