ToR - Rapid Review Of Pradhan Mantri Bhartiya Jan Aushadhi Pariyojana

BACKGROUND

India has been termed as the ‘Pharmacy of the World’, whilst providing medicines to developed nations even amidst global pandemic and worldwide shortage of medicines. However, the benefits of a developed domestic pharmaceutical industry have not translated into universal access to medicines in India because of the poor capacity and outreach of the public health system, which forces patients to directly pay for medicines while accessing healthcare from private facilities. A major proportion of medicines (around 52%)[1] are procured through out-of-pocket (OOP) payments, which accounts for nearly 62% of total health expenditure (amounting to nearly US$ 60.6 Billion). 

The unavailability of medicines in government health facilities, preference for relatively expensive branded medicines over generic ones, irrational prescription of medicines, collusion between pharmaceutical companies and medical practitioners, and inadequate control over drug prices have resulted in extremely high out-of-pocket expenditure on healthcare in the country. As many as 23 percent of Indians forgo treatment when sick because they cannot afford it. High OOPE results in plunging 55 million Indians into poverty every year[2]. Generic medicine is an important policy option to reduce out-of-pocket expenditure due to medicines and address the inequalities exacerbated by the same. It is important to understand the factors influencing generic drug use, which can help guide future policy, education, and practice interventions to increase generic drug use[3].

To make generic medicines available to population, the Department of Pharmaceuticals (DoP) and GoI launched Jan Aushadhi Scheme (JAS) in 2008. However, many stores became non-functional or closed for various reasons like poor support from state governments, poor supply-chain management, and lack of awareness and non-prescription of generic medicines by doctors[4]. The scheme was later revamped and relaunched as Pradhan Mantri Bhartiya Jan Aushadhi Pariyojana (PMBJP) to provide better support and incentives for Jan Aushadhi Kendras.  Substantial evidence is currently not available on success of these revamped Kendras. However, some success for the program has been reported in media. Under this scheme, 5,222 stores are operational until now with 683 drugs and other products.

Government planned to open 2,500 more by end of 2020. Clearly, the current number of Jan Aushadhi Kendras are inadequate to serve the population. Since the scheme is evolving and expanding, it is extremely important to assess its functioning[1] and recommend strategies to government for strengthening the initiative. Moreover, it is also essential to advocate for swift expansion of the scheme to ensure access to affordable medicines for all as an endeavor to reduce OOPE and prevent the inequalities resulting from catastrophic health expenditure.

AIM: To assess the implementation of PMJBP, identify potential challenges and provide recommendations on improved availability of generic medicines to reduce out of pocket expenditure in four select states of India.

 OBJECTIVES

1. To understand the factors affecting access and utilization of generic medicines under the scheme such as availability of essential medicines, prescription by practitioners, etc.
2. To understand knowledge and awareness barriers of patients/ care-givers and health professionals regarding generic medicines scheme.

METHODOLOGY

In order to carry out rapid assessment of the existing Jan Aushadhi Kendra and to identify current challenges confronting the scheme, we propose a cross-sectional quantitative study in four states, namely Bihar, Chhattisgarh, Odisha and Uttar Pradesh. These four states are selected from the list of 10 worst performing states listed in Niti Aayog[1].

The study is expected to capture the following components and collect related data through surveys:

• Assess availability and supply of key medicines (from the Essential Drugs List) at the store on the day of survey and conduct interviews with pharmacists at JAS to analyze probable factors influencing the scheme.
• Conduct interviews with patients/ care givers to assess their awareness regarding generic medicines under the scheme.
• Conduct interviews of medical practitioners to understand factors influencing prescription of generic drugs available in JAS.

The study will cover

• Random Sampling Method will be used.
• The four states that will be covered in the study are Bihar, Chhattisgarh, Uttar Pradesh and Odisha.
• Aspirational districts will be selected from above mentioned states. The study will cover all the aspirational districts in the proposed states
• 50% JAS Kendra in each aspirational district will be covered.
• For review with doctors/ medical professionals (four in number near each JAS- two from government health facility and two from private)
• Patients/ relatives/ carers (five in numbers near JAS), a convenience sample would be sought from the patients attending the facilities around these Jan Aushadhi Kendras.
• Predictive sample size-

1. Total number of aspirational districts- 43
2. Total number of JAS Kendra that will be covered in aspirational districts- 88
3. Jas Aushadhi Kendra/ Pharmacist- 88
4. Doctors/ Medical Professionals- 88* 2= 176
5. Patients/ Relatives/ Care givers= 5 in 2 Km periphery of each JAS= 5X 88= 440

 

Criteria for selecting JAS, Patients and Doctors

The criteria for selecting JAS for the survey under the study in a district will be based on its distance from the district hospital.  JAS situated closest and farthest from the district hospitals will be selected. Pharmacists from these JAS will be selected as respondents.

Criteria for selecting the patients/ relatives/ care givers who visited the district hospital or any private hospital, on the same day of survey, closest to the JAS being assessed under this study.

Similarly, criteria for selecting medical professionals will be doctor working in district hospital and doctor in private clinic/ hospitals located closest to the JAS selected for the study.

Limitations of the study

The scope of this study is to undertake a rapid assessment of “Jan Aushadhi Scheme”. Although the sample size is comparatively low, yet it is a sample drawn from various district across four states of the country, covering 43 districts. However, it provides significant insights on the lacunae plaguing the access and utilization of the scheme.

Dissemination:

1. The results would be presented as part of a Policy Brief on Generic Medicines. This Policy brief would be disseminated with like-minded CSOs and health network groups at the National level. There is also plan to release the policy brief online and share copy of the brief along with recommendations to relevant stakeholders at national and state level.
2. Based on recommendations, influencing strategy would be designed to press for strengthening of the scheme with Centre and state governments.
3. Media Dissemination of study findings and recommendations would be initiated to address the research-practice gap and encourage law-makers to adopt the evidence-based recommendations for strengthening Jan Aushadhi Scheme.

Key deliverables

1. Framework along with detailed methodology for the study
2. Tools for Study- questionnaires/ checklist Interview question.
3. Filtered Data in Excel and interview report.
4. Draft Study Report
5. Final Report with major findings and recommendations

Skills of consultant- Research:

1. Relevant post graduate background (Public Health, social sciences or other relevant fields)
2. Robust understanding of medicines related schemes
3. Experience in conducting quantitative and qualitative research
4. Excellent verbal and written communication skills in English and Hindi 

The last date to submit the technical and financial proposal for this study is 21^st April 2021.  The agencies or individual consultants can submit their bids to our Procurement Department at Delhi on their Email ID: procurement@oxfamindia.org .    Any email which is having CVs without technical and financial proposal shall not be entertained.  CVs should be part of the technical proposal and financial should be given in the excel file.

Duration: 2 months

Commissioning Manager:  Anjela Taneja

To download the full ToR, click here

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