Outcome of the Programme: 10 years experience
Better availability and accessibility to drugs in the public sector by mobilizing the savings from efficient procurement system. No extra funds spent other than
Wise drug selection together with effective management underlied all other improvements.
Another unique feature of the Programme is the opportunity-based approach, The 'Delhi Model' is being emulated in several other Indian states in a similar way and has spread to 14 other states in India.
Factors which determined the success and sustainability of the Essential Drugs Programme in Delhi:
The success of the 'Delhi Model' so far has been due largely to its comprehensive nature and multi-faceted approach. The biggest gains from the Delhi Model appear to have come from the wise selection of drugs and adoption of a better procurement system, linking EML and STGs to procurement, and continuous monitoring. In several programmes in other countries one or more of these of components are missing, making it difficult to sustain a successful programme
Continuity of policy aims and objective by successive governments and financial sustainability
Clear guidelines, transparency & objectivity in the procurement system
Identification of highly motivated core group. The difference between success and failure has been the availability of a few dedicated persons and powerful people who interface between the political leadership, the bureaucracy and a number of highly motivated health professionals and experts. Funding and employment of staff to undertake this challenging task was unnecessary as all (the many) inputs were undertaken on a voluntary basis without any remuneration.
Flexibility of operation and innovative moves i.e., the establishment of the Special Purchase Committee, headed by a non-official member. The Government of Delhi showed remarkable flexibility in practical terms by giving all authority regarding purchase to a non-official since the beginning of the Programme. However, to give the Committee statutory authority, senior officers of the departments of law and finance were members. This innovative leadership is unique, and is largely responsible for the successful procurement programme.
Committed and motivated government staff. The change in the system hardly cost the Programme anything because the government functionaries who were already carrying out procurement implemented this new Programme. Procurement procedures were clearly specified and closely followed. The change in mind-set and technical training of the staff in good procurement practices were important factors in the programme's success.
Repeated dialogue with the stakeholders. Objectivity in assessment and transparency in the administrative procedures were maintained. Unsuccessful bidders were informed of the reasons for disqualification.
Building technical capacity. As a result of the ongoing training programmes, a large number of experts are now available in all sectors related to procurement, distribution, quality assurance and rational use of drugs. Further, technical expertise in monitoring and research of the Programme on Rational Use of Drugs could also be applied to any other programme.
A "bottom up" approach. This approach has been applied by participatory methods in planning and implementation, particularly with prescribers.
Quality medicines for the poor: experience of the Delhi programme on rational use of drugs
Improving Availability and Accessibility of Medicines: A Tool for Increasing Healthcare Coverage
Impact of a Drug Policy on Cost and Availability of Essential Medicines