Bitter Pills:Medicines & The Third World Poor | Page 133
Dr. Chowdhury takes up the sequence of events: "We did not win the tender.
It went to a national company which had bid at 80 paisa per capsule. The retail
price of the same company's ampicillin is 159 paisa. For the Government this was
the cheapest ampicillin they had ever purchased and giving credit where credit is
due, some officials thanked us, requesting us to keep up the good work." "2)
VOLUNTARY HEALTH ORGANISATIONS
The voluntary health organisations in both India and Bangladesh have set up
associations to look after their members' interests and act as forums for discussion
and information sharing on a broad range of health issues. Both use their own
monthly newsletters, seminars and training workshops to exchange ideas and
information. For instance, women health workers attending a workshop in
Bangladesh were able to pool ideas on how to handle the problem of uneducated
villagers who take a whole course of tablets at once because they do not understand
the instructions. (l3)
The voluntary health sector in India is very big, providing a third of organised
health services in the country. Although the public health service infrastructure
covers most of the population, in the rural areas tjiere is a desperate shortage both
of personnel and resources. Funds allocated to medicines for primary health care
were increased b y tenfold in 1975, but still account for only 6p a head. (l4) The
Voluntary Health Association of India (VHAI) collects and disseminates
information and advice to both health personnel and patients. As VHAI explains:
"Education and awareness as to how to avoid disease and then how to handle
it appropriately at the lowest possible cost is the crux of our approach in low-cost
appropriate health care." " 5)
To help reduce costs, VHAI is encouraging its members to standardise prescribing
for specific health problems and prescribe only single-ingredient drugs by generic
name. For example tetracycline formulated with vitamin C is widely sold in India,
but costs twice as much as straight tetracycline. One member, the Deenabandu
Medical Mission in Tamil Nadu in the south, has found that by rationalising
prescribing along these lines, and using herbal medicines as the first line of
treatment, overall health care costs can be reduced by almost a third. (l6)
VHAI is also keen to influence the attitudes of the general public to discourage
the over-use of medicines. So they stress to patients the dangers of misusing
injections, tonics and steroids and try to encourage people to adopt a positive
attitude of "self-responsibility" towards their health. (l7>
The difficulties of obtaining regular supplies of reliable drugs at competitive prices
is shared by members of both associations. In Bangladesh The Voluntary Health
Services Society (VHSS) has been collecting information on comparative prices
of drugs on the local market. The intention is to issue price guides to help members
and avoid duplicated effort on market intelligence work. VHSS has also succeeded
in reducing drug costs by organising pooled procurement for its members. For
example, it was able to bulk-buy mebendazole (deworming tablets) from a local
manufacturer and pay only half the standard wholesale price.