1. Survey of the availability and prices of Children’s Medicine in Chhattisgarh State Dr. Antony K.R. Virendra Jain Puni Kokho Dr. Kamlesh Jain State Health Resource Centre, Raipur, Chhattisgarh in collaboration with WHO, WHO, New Delhi.

2. The Objectives… To document the availability and price of key essential medicines for children in the state of Chhattisgarh, India. To analyze the components of medicine prices. How affordable are medicines ? Methodology 160 outlets were randomly sampled among 28 types of medical dispensing sites in six geography of State. 50 essential medicines surveyed. Data analysis tool- WHO-HAI (Health Action International)workbook.

3. 51 formulations of medicine groups surveyed Antibiotics - Amoxicillin, Amox+Clav., Azithromycin, Benzyl Pen., Ceftriaxone, Chloramphenicol, Co-trimoxazole, Gentamycin, Antimalarial - Chloroquine, Quinine, Sulfadoxine+Pyrimethanine, Artemether +Lumefantrine, Steroids – Prednisolone, Beclomethasone Anti convulsants - Phenobarbital, Diazepam, Carbamazepine,Phenytoin Anti-pyretics/anti-inflammatory - Paracetamol & Ibuprofen Bronchdilators - Salbutamol, Salmetrol+Fluticosone & Spacer device Anti-tubercular - INH Anti-helminthic/Anti-protozoal - Albendazole, Metronidazole Anti-emetic - Promethazine Micronutrients/Vitamins - Ferrous salt, Zinc, Folic acid, Vit. A Electrolytes - ORS

4. Availability of Medicine in Lowest & Highest price

5. Availability of selected antibiotics in public facilities and retail pharmacies (chemist shops)

6. Availability of anti-malarials and Oral Rehydration Solution across sectors

7. Poor availability (<20%) in the private sector of those Medicines not found at all in the public sector. Name Of MedicineAvailability (%) Ferrous salt suspension0 Diazepam rectal suppository0 Phenobarbital injection0 Phenytoin tablet – chewable0 Paracetamol suppository0 Ferrous salt drops1.7 Beclomethasone inhaler1.7 Salmeterol + fluticasone inhaler5.0 Artemether + lumefantrine dispersible tablet8.3 Phenobarbital syrup/oral liquid10.0 Artemether + lumefantrine dry syrup13.3 Phenytoin suspension15.0 Gentamicin injection16.7

8. Median Price Ratio (MPR) in relation to international price-in Lowest & Highest price

9. Medicines with patient prices of over four times the international reference price in all sectors

10. Conclusions and lesson learnt… The average availability of children's medicines was poor in all sectors Specifically for anti-malarials, certain antibiotics, anti-diarrhoeals (zinc) and anti- bacterials in public sector units. – Child friendly formulations like DTs (dispersible tablets),Syrups,drops or suppositories conspicuous by their absence. For originator brand & branded generic products the total cumulative mark-up from MSP to final price ranged from 34% to 46% whereas for unbranded generics it ranged from 376% to 413%. Very high retailer’s mark-up for unbranded generic compared to originator brand/branded generic (well within the Govt.capping of 15% mark ups for wholesalers and 35% for retailers) Public procurement of medicines is at reasonable efficiency of prices that are just under international reference prices (MPR = 0.96). But, in private sector certain medicines cost several times higher.

11. Impact of Study  Strong political will resulting in a good State drug policy is emerging  Two Orientation workshops for stakeholders conducted.  Inclusion of child friendly formulations in State EML (Revised EML 2010) on 31 December 2010. (refer www.cghealth.nic.in)www.cghealth.nic.in  Setting up the Chhattisgarh Medical Services Corporation (CGMSC) for improved procurement and logistics.  Field-based drug research to determine optimum utilization and supply projection.  Why very high mark up for retailers for unbranded generic drugs?  Operational research on mechanisms to prevent flooding of poor-quality and counterfeit drugs.  Comparative study of other State scenario using similar methodology Future Research Agenda