Universal access to medicines: evidence from Rajasthan, India

Abstract

India has outlined its commitment to achieving universal health coverage and several states in India are rolling out strategies to support this aim. In 2011, Rajasthan implemented an ambitious universal access to medicines programme based on a centralized procurement and decentralized distribution model. In terms of the three dimensions of universal health coverage, the scheme has made significant positive strides within a short period of implementation. The key objectives of this paper are to assess the likely implications of providing universal access to essential medicines in Rajasthan, which has a population of 70 million. Primary field-level data were obtained from 112 public health-care facilities using multistage random sampling. National Sample Survey Organization data and health system data were also analysed. The per capita health expenditure during the pre-reform period was estimated to be ₹5.7 and is now close to ₹50. Availability of essential medicines was encouraging and utilization of public facilities had increased. With additional per capita annual investment of ₹43, the scheme has brought about several improvements in the delivery of essential services and increased utilization of public facilities in the state and, as a result, enhanced efficiency of the system. Although there was an attempt to convert the scheme into a targeted one with the change in government, strong resistance from the civil society resulted in such efforts being defeated and the universality of the scheme has been retained.

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“…Nearly, 55% of both mothers and fathers of the children are educated more than primary, while nearly 14% of mothers work outside the house. According to 90% of the mothers of the sample, there is sufficient food at their house, thus representing a food-secure environment.Applying the above mentioned concept ofSelvaraj et al (2014), we have found that overall 48.46% of children go to ICDS and the rest do not. However, in terms of depth of services, it is found that even after reaching AWCs, not all services, which are expected to be provided, are actually received by the children(Table 1).…”

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“…According to 90% of the mothers of the sample, there is sufficient food at their house, thus representing a food-secure environment.Applying the above mentioned concept ofSelvaraj et al (2014), we have found that overall 48.46% of children go to ICDS and the rest do not. The fourth variable identifies coverage and regular receipt of eggs (as reported by the caregivers).…”