All is surely not well with the Health Administration of the country. The other day two shocking revelations were made in the press. One of them related to detection of serious irregularities by the Parliamentary Standing Committee on health and family welfare in respect of advices and letters of recommendations from some experts submitted to the Drug Controller General of India (DCGI) regarding several drugs. These recommendations, apparently, read the same, word-for-word, as those submitted by the drug companies concerned. Experts’ endorsements are crucial testimony for country’s Central Drugs Standard Control Organisation for allowing launch of drugs in the market.
The disclosure revealed a nexus between some experts and a few drug companies enabling unquestioned endorsement of the scientific recommendations of their own products for onward transmission to DGCI. These are required to be submitted by the experts after due consideration of the drugs’ content and their efficacy. Evidence, however, has been unearthed indicating that the experts merely affixed their signatures to the recommendations submitted by the companies concerned. Worse, some were submitted on the day of their receipt by the experts, obviously without according to them due consideration. More alarming was the fact that the experts are from a few iconic medical institutions of the country and some of them happen to be working as professors in these institutions.
The innocent, ignorant and unwary patients will be at the receiving end if drugs are pushed in such a manner by the drug companies in collusion with highly placed medical experts without being evaluated in regard to their therapeutic potential. Suspect efficacy of drugs will hit all classes of people across the board and with high drug prices it would be a sort of double whammy for them. Already, people are suffering under the weight of their medical bills. A recent report said that the “out-of-pocket” expenditure – the percentage of expenditure incurred by households on medicines – has increased by 75% during the past couple of years. High medical costs, along with rising prices of essentials, are biting the common man. According to 2011 World Health Organisation estimates about 70% Indians spend their entire income on health-care and purchase of drugs. With the prices of drugs for common ailments like cardiac disease, hypertension, diabetes creeping up northwards, market watchers are asking for State intervention. Poor are simply unable to afford many drugs. Decrying the ineffectiveness of the National Pharmaceutical Pricing Policy even ruling party politicians are concerned about common man’s woes.
Such improperly evaluated medicines can also adversely impact exports once they fail to live up to their claims. India is considered the pharmacy of the world. While the domestic retail market in 2008 was estimated to be valued at more than Rs. 55000 crores ($10 billion app.), exports were worth around Rs. 38000 crores ($6 billion app). Unless checked, corrupt practices at the stage of approving and launching a drug in the market would amount to shooting oneself in the foot.
The health sector is somehow saturated with corruption, whether at the Centre or in the states. A former central minister of Health & Family Welfare was involved in several scandals during his tenure, including what is known as the “vaccines scam”. He ordered the public sector units to discontinue manufacture of various essential vaccines only to throw open the entire market to one of his cronies for easy pickings. Ultimately, the other day he was charged by the Central Bureau of Investigations (CBI) in a Delhi court for abusing his authority and permitting a medical college to admit students without having necessary faculty and clinical facilities. Establishment of medical colleges has become a very paying proposition. Politicians, in collusion with money bags, bribe their way into acquiring prime lands for establishing such colleges, the approval and later recognition for which is easily obtained by pulling strings and money changing hands. The President of the Indian Medical Council, Dr. Ketan Desai, and two others were arrested last year for taking hefty bribes for granting recognition to a medical college. No wonder, the quality of medical education leaves much to be desired. Barring a few reputed hospitals, medical institutions and (elderly) private physicians, the general quality of medical attention to the patients is poor, more so to those belonging to the economically weaker sections.
The National Rural Health Mission (NRHM) appears to have become a goldmine for corrupt politicians, doctors and administrations. The ambitious goal of the Mission is to “improve the availability of and access to quality health-care by people, especially for those residing in rural areas, the poor, women and children”. The second news report was about the sleaze detected NRHM in Madhya Pradesh where, one after the other, two directors of health services have been caught with huge amounts of liquid and fixed assets - all disproportionate to their respective incomes. In the earlier case even the minister in-charge was involved along with the principal secretary of the department of health, an IAS officer, who, mercifully, is being prosecuted. The minister resigned but escaped prosecution. In the recent case, the director was found to be in possession of assets worth more than Rs. 100 crores (Rs.1 billion app). Serious irregularities were detected in the process of tendering and procurement of medicines, mosquito-nets, etc. During the raid at the director’s residence his wife reportedly advised the Lokayukta (Ombudsman) officials to raid the houses of ministers to whom a crore (Rs. 10 million) of rupees was required to be delivered every month.
One can imagine the astronomical sums that have been poured into the Mission from the fact that in Uttar Pradesh alone Rs 10000/- crores are believed to have been siphoned off. Two chief medical officers and three other officials were murdered and scores of engineers, doctors, administrators and ministers have been charge-sheeted by the CBI.
Conscious of the abysmal level of public expenditure on health (1.4% of GDP) the government has been allocating huge amounts of tax-payers’ money to the states in an effort to achieve universal health coverage, including cashless treatment. The Centre’s resolve to boost government spending can potentially make high-quality care accessible to all. It has not shied away from making necessary allocations as can be imagined by the way the system has been milked by the powers-that-be at the Centre and in the states, especially, in MP and UP. No wonder, despite the (now waning) growth story India ranks below the Sub-Saharan Africa in many international health-related indices. While the corrupt, cannibalistic predators do not allow the benefits of outlays to reach the needy, high drug prices and raging inflation prevent millions from buying essential medicines because of pervasive poverty – a significant facet of the Indian growth story.
Clearly, the corrupt hordes in the government wouldn't allow it to achieve its own “goal” of building a healthy and strong India.
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|Timothy V. Gatto|