Deprecated (16384): The ArrayAccess methods will be removed in 4.0.0.Use getParam(), getData() and getQuery() instead. - /home/brlfuser/public_html/src/Controller/ArtileDetailController.php, line: 73
 You can disable deprecation warnings by setting `Error.errorLevel` to `E_ALL & ~E_USER_DEPRECATED` in your config/app.php. [CORE/src/Core/functions.php, line 311]
Code Context


        trigger_error($message, E_USER_DEPRECATED);

    }
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 You can disable deprecation warnings by setting `Error.errorLevel` to `E_ALL & ~E_USER_DEPRECATED` in your config/app.php.'
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deprecationWarning - CORE/src/Core/functions.php, line 311
Cake\Http\ServerRequest::offsetGet() - CORE/src/Http/ServerRequest.php, line 2421
App\Controller\ArtileDetailController::printArticle() - APP/Controller/ArtileDetailController.php, line 73
Cake\Controller\Controller::invokeAction() - CORE/src/Controller/Controller.php, line 610
Cake\Http\ActionDispatcher::_invoke() - CORE/src/Http/ActionDispatcher.php, line 120
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Cake\Http\Runner::__invoke() - CORE/src/Http/Runner.php, line 65
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Cake\Http\Runner::__invoke() - CORE/src/Http/Runner.php, line 65
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Cake\Http\Runner::__invoke() - CORE/src/Http/Runner.php, line 65
Cake\Error\Middleware\ErrorHandlerMiddleware::__invoke() - CORE/src/Error/Middleware/ErrorHandlerMiddleware.php, line 96
Cake\Http\Runner::__invoke() - CORE/src/Http/Runner.php, line 65
Cake\Http\Runner::run() - CORE/src/Http/Runner.php, line 51
Cake\Http\Server::run() - CORE/src/Http/Server.php, line 98

Deprecated (16384): The ArrayAccess methods will be removed in 4.0.0.Use getParam(), getData() and getQuery() instead. - /home/brlfuser/public_html/src/Controller/ArtileDetailController.php, line: 74
 You can disable deprecation warnings by setting `Error.errorLevel` to `E_ALL & ~E_USER_DEPRECATED` in your config/app.php. [CORE/src/Core/functions.php, line 311]
Code Context


        trigger_error($message, E_USER_DEPRECATED);

    }
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 You can disable deprecation warnings by setting `Error.errorLevel` to `E_ALL & ~E_USER_DEPRECATED` in your config/app.php.'
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deprecationWarning - CORE/src/Core/functions.php, line 311
Cake\Http\ServerRequest::offsetGet() - CORE/src/Http/ServerRequest.php, line 2421
App\Controller\ArtileDetailController::printArticle() - APP/Controller/ArtileDetailController.php, line 74
Cake\Controller\Controller::invokeAction() - CORE/src/Controller/Controller.php, line 610
Cake\Http\ActionDispatcher::_invoke() - CORE/src/Http/ActionDispatcher.php, line 120
Cake\Http\ActionDispatcher::dispatch() - CORE/src/Http/ActionDispatcher.php, line 94
Cake\Http\BaseApplication::__invoke() - CORE/src/Http/BaseApplication.php, line 235
Cake\Http\Runner::__invoke() - CORE/src/Http/Runner.php, line 65
Cake\Routing\Middleware\RoutingMiddleware::__invoke() - CORE/src/Routing/Middleware/RoutingMiddleware.php, line 162
Cake\Http\Runner::__invoke() - CORE/src/Http/Runner.php, line 65
Cake\Routing\Middleware\AssetMiddleware::__invoke() - CORE/src/Routing/Middleware/AssetMiddleware.php, line 88
Cake\Http\Runner::__invoke() - CORE/src/Http/Runner.php, line 65
Cake\Error\Middleware\ErrorHandlerMiddleware::__invoke() - CORE/src/Error/Middleware/ErrorHandlerMiddleware.php, line 96
Cake\Http\Runner::__invoke() - CORE/src/Http/Runner.php, line 65
Cake\Http\Runner::run() - CORE/src/Http/Runner.php, line 51
Cake\Http\Server::run() - CORE/src/Http/Server.php, line 98

Warning (512): Unable to emit headers. Headers sent in file=/home/brlfuser/public_html/vendor/cakephp/cakephp/src/Error/Debugger.php line=853 [CORE/src/Http/ResponseEmitter.php, line 48]
Code Context
            if (Configure::read('debug')) {

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&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;&lt;em&gt;Insufficiency and prescribing medicines from outside continues&amp;nbsp; &lt;/em&gt;&lt;/font&gt;
&lt;/p&gt;
&lt;p align=&quot;justify&quot;&gt;
&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;&lt;em&gt;CRM draws attention to &amp;lsquo;irrational&amp;rsquo; use and non-availability of essential medicines&lt;/em&gt;&lt;/font&gt;
&lt;/p&gt;
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&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;&lt;em&gt;Supplies are mostly top-down, based on availability instead of being demand-based&lt;/em&gt;&lt;/font&gt;
&lt;/p&gt;
&lt;p align=&quot;justify&quot;&gt;
&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;No State provides free medicines to below the poverty line (BPL) patients under the National Rural Health Mission (NRHM). &lt;/font&gt;
&lt;/p&gt;
&lt;p align=&quot;justify&quot;&gt;
&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;&amp;ldquo;The insufficiency of drugs and thereby the imperative of prescribing medicines from outside continue widely. This could also be linked to insufficiency of understanding of the essential drug concept,&amp;rdquo; says the third report of the Common Review Mission (CRM) on the NRHM. &lt;/font&gt;
&lt;/p&gt;
&lt;p align=&quot;justify&quot;&gt;
&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;Showering praise on the NRHM for strengthening the public health service system, the CRM points out while most States seem sensitive to the issue of availability of drug especially for BPL patients, irrational prescribing higher order medicines, instead of basic generic preparations, has been reported. &lt;/font&gt;
&lt;/p&gt;
&lt;p align=&quot;justify&quot;&gt;
&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;It has emphasised the need for combining free provisioning with promotion of rational drug use. This will lower the cost to the system and households.&lt;/font&gt;
&lt;/p&gt;
&lt;p align=&quot;justify&quot;&gt;
&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;&lt;em&gt;Pharmacies on hospital campus &lt;/em&gt;&lt;/font&gt;
&lt;/p&gt;
&lt;p align=&quot;justify&quot;&gt;
&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;Though almost all States report improved availability of drugs and supplies, the CRM draws attention to &amp;ldquo;irrational&amp;rdquo; use and non-availability of &amp;ldquo;essential&amp;rdquo; medicines. In several facilities &amp;ldquo;co-operative&amp;rdquo; pharmacy shops were seen on hospital premises selling drugs. A number of States are introducing or have in place commercial pharmacy shops within public hospitals. &lt;/font&gt;
&lt;/p&gt;
&lt;p align=&quot;justify&quot;&gt;
&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;&lt;em&gt;Increase in availability &lt;/em&gt;&lt;/font&gt;
&lt;/p&gt;
&lt;p align=&quot;justify&quot;&gt;
&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;The CRM teams also observed an increase in the availability of drugs and supplies across various levels of health facilities, but say there is still a gap in terms of stock-outs, oversupply, lack of tracking of inventory, delay in supplies and procurement, and lack of a robust quality control system. &lt;/font&gt;
&lt;/p&gt;
&lt;p align=&quot;justify&quot;&gt;
&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;Almost all States experienced both oversupply and undersupply of different items, especially for the peripheral level health institutions. &lt;/font&gt;
&lt;/p&gt;
&lt;p align=&quot;justify&quot;&gt;
&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;&amp;ldquo;It seems that supplies are mostly top-down, based on availability and whatever had been procured, instead of being demand-based. There is an acute need for training the storekeepers and pharmacists in inventory management and the facility-in-charge in making evidence-based demand estimations for drugs and supplies.&amp;rdquo; &lt;/font&gt;
&lt;/p&gt;
&lt;p align=&quot;justify&quot;&gt;
&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;&lt;em&gt;Stop outside prescription &lt;/em&gt;&lt;/font&gt;
&lt;/p&gt;
&lt;p align=&quot;justify&quot;&gt;
&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;The CRM has also highlighted the need for elimination of &amp;lsquo;outside prescription&amp;rsquo; except when absolutely unavoidable, and for popularising and ensuring use of essential drugs lists in procurement and prescription. &lt;/font&gt;
&lt;/p&gt;
&lt;p align=&quot;justify&quot;&gt;
&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;As for user-friendly services, it is a mixed bag. Clean toilets with lighting, curtains in examination rooms of out-patient departments and in labour wards, ensuring privacy to patients, were observed with appreciation, even while noting their absence in a large number of facilities.&lt;/font&gt;
&lt;/p&gt;
&lt;p align=&quot;justify&quot;&gt;
&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;&lt;em&gt;No respect to patients &lt;/em&gt;&lt;/font&gt;
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&lt;p align=&quot;justify&quot;&gt;
&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;However, service providers showing no respect to patients in their interaction is still a pervasive phenomenon that discourages use of public facilities. &lt;/font&gt;
&lt;/p&gt;
&lt;p align=&quot;justify&quot;&gt;
&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;Lack of dignity in the conduct of sterilisation camps has also been reported, says the CRM. &lt;/font&gt;
&lt;/p&gt;
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&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;The mandate of the annual CRM is to review changes in the health systems since the launch of the NRHM, to examine and document progress and identify key constraints limiting the pace of architectural correction in the health system and to recommend policy to overcome this problem. &lt;br /&gt;
&lt;/font&gt;
&lt;/p&gt;
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Insufficiency and prescribing medicines from outside continues&amp;nbsp; 


CRM draws attention to &amp;lsquo;irrational&amp;rsquo; use and non-availability of essential medicines


Supplies are mostly top-down, based on availability instead of being demand-based


No State provides free medicines to below the poverty line (BPL) patients under...&#039;,
	&#039;disp&#039; =&gt; &#039;&lt;p align=&quot;justify&quot;&gt;&lt;font &gt;&lt;em&gt;Insufficiency and prescribing medicines from outside continues&amp;nbsp; &lt;/em&gt;&lt;/font&gt;&lt;/p&gt;&lt;p align=&quot;justify&quot;&gt;&lt;font &gt;&lt;em&gt;CRM draws attention to &amp;lsquo;irrational&amp;rsquo; use and non-availability of essential medicines&lt;/em&gt;&lt;/font&gt;&lt;/p&gt;&lt;p align=&quot;justify&quot;&gt;&lt;font &gt;&lt;em&gt;Supplies are mostly top-down, based on availability instead of being demand-based&lt;/em&gt;&lt;/font&gt;&lt;/p&gt;&lt;p align=&quot;justify&quot;&gt;&lt;font &gt;No State provides free medicines to below the poverty line (BPL) patients under the National Rural Health Mission (NRHM). &lt;/font&gt;&lt;/p&gt;&lt;p align=&quot;justify&quot;&gt;&lt;font &gt;&amp;ldquo;The insufficiency of drugs and thereby the imperative of prescribing medicines from outside continue widely. This could also be linked to insufficiency of understanding of the essential drug concept,&amp;rdquo; says the third report of the Common Review Mission (CRM) on the NRHM. &lt;/font&gt;&lt;/p&gt;&lt;p align=&quot;justify&quot;&gt;&lt;font &gt;Showering praise on the NRHM for strengthening the public health service system, the CRM points out while most States seem sensitive to the issue of availability of drug especially for BPL patients, irrational prescribing higher order medicines, instead of basic generic preparations, has been reported. &lt;/font&gt;&lt;/p&gt;&lt;p align=&quot;justify&quot;&gt;&lt;font &gt;It has emphasised the need for combining free provisioning with promotion of rational drug use. This will lower the cost to the system and households.&lt;/font&gt;&lt;/p&gt;&lt;p align=&quot;justify&quot;&gt;&lt;font &gt;&lt;em&gt;Pharmacies on hospital campus &lt;/em&gt;&lt;/font&gt;&lt;/p&gt;&lt;p align=&quot;justify&quot;&gt;&lt;font &gt;Though almost all States report improved availability of drugs and supplies, the CRM draws attention to &amp;ldquo;irrational&amp;rdquo; use and non-availability of &amp;ldquo;essential&amp;rdquo; medicines. In several facilities &amp;ldquo;co-operative&amp;rdquo; pharmacy shops were seen on hospital premises selling drugs. A number of States are introducing or have in place commercial pharmacy shops within public hospitals. &lt;/font&gt;&lt;/p&gt;&lt;p align=&quot;justify&quot;&gt;&lt;font &gt;&lt;em&gt;Increase in availability &lt;/em&gt;&lt;/font&gt;&lt;/p&gt;&lt;p align=&quot;justify&quot;&gt;&lt;font &gt;The CRM teams also observed an increase in the availability of drugs and supplies across various levels of health facilities, but say there is still a gap in terms of stock-outs, oversupply, lack of tracking of inventory, delay in supplies and procurement, and lack of a robust quality control system. &lt;/font&gt;&lt;/p&gt;&lt;p align=&quot;justify&quot;&gt;&lt;font &gt;Almost all States experienced both oversupply and undersupply of different items, especially for the peripheral level health institutions. &lt;/font&gt;&lt;/p&gt;&lt;p align=&quot;justify&quot;&gt;&lt;font &gt;&amp;ldquo;It seems that supplies are mostly top-down, based on availability and whatever had been procured, instead of being demand-based. There is an acute need for training the storekeepers and pharmacists in inventory management and the facility-in-charge in making evidence-based demand estimations for drugs and supplies.&amp;rdquo; &lt;/font&gt;&lt;/p&gt;&lt;p align=&quot;justify&quot;&gt;&lt;font &gt;&lt;em&gt;Stop outside prescription &lt;/em&gt;&lt;/font&gt;&lt;/p&gt;&lt;p align=&quot;justify&quot;&gt;&lt;font &gt;The CRM has also highlighted the need for elimination of &amp;lsquo;outside prescription&amp;rsquo; except when absolutely unavoidable, and for popularising and ensuring use of essential drugs lists in procurement and prescription. &lt;/font&gt;&lt;/p&gt;&lt;p align=&quot;justify&quot;&gt;&lt;font &gt;As for user-friendly services, it is a mixed bag. 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	&#039;id&#039; =&gt; (int) 830,
	&#039;title&#039; =&gt; &#039;No free drugs under rural health mission by Aarti Dhar&#039;,
	&#039;subheading&#039; =&gt; &#039;&#039;,
	&#039;description&#039; =&gt; &#039;&lt;p align=&quot;justify&quot;&gt;
&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;&lt;em&gt;Insufficiency and prescribing medicines from outside continues&amp;nbsp; &lt;/em&gt;&lt;/font&gt;
&lt;/p&gt;
&lt;p align=&quot;justify&quot;&gt;
&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;&lt;em&gt;CRM draws attention to &amp;lsquo;irrational&amp;rsquo; use and non-availability of essential medicines&lt;/em&gt;&lt;/font&gt;
&lt;/p&gt;
&lt;p align=&quot;justify&quot;&gt;
&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;&lt;em&gt;Supplies are mostly top-down, based on availability instead of being demand-based&lt;/em&gt;&lt;/font&gt;
&lt;/p&gt;
&lt;p align=&quot;justify&quot;&gt;
&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;No State provides free medicines to below the poverty line (BPL) patients under the National Rural Health Mission (NRHM). &lt;/font&gt;
&lt;/p&gt;
&lt;p align=&quot;justify&quot;&gt;
&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;&amp;ldquo;The insufficiency of drugs and thereby the imperative of prescribing medicines from outside continue widely. This could also be linked to insufficiency of understanding of the essential drug concept,&amp;rdquo; says the third report of the Common Review Mission (CRM) on the NRHM. &lt;/font&gt;
&lt;/p&gt;
&lt;p align=&quot;justify&quot;&gt;
&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;Showering praise on the NRHM for strengthening the public health service system, the CRM points out while most States seem sensitive to the issue of availability of drug especially for BPL patients, irrational prescribing higher order medicines, instead of basic generic preparations, has been reported. &lt;/font&gt;
&lt;/p&gt;
&lt;p align=&quot;justify&quot;&gt;
&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;It has emphasised the need for combining free provisioning with promotion of rational drug use. This will lower the cost to the system and households.&lt;/font&gt;
&lt;/p&gt;
&lt;p align=&quot;justify&quot;&gt;
&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;&lt;em&gt;Pharmacies on hospital campus &lt;/em&gt;&lt;/font&gt;
&lt;/p&gt;
&lt;p align=&quot;justify&quot;&gt;
&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;Though almost all States report improved availability of drugs and supplies, the CRM draws attention to &amp;ldquo;irrational&amp;rdquo; use and non-availability of &amp;ldquo;essential&amp;rdquo; medicines. In several facilities &amp;ldquo;co-operative&amp;rdquo; pharmacy shops were seen on hospital premises selling drugs. A number of States are introducing or have in place commercial pharmacy shops within public hospitals. &lt;/font&gt;
&lt;/p&gt;
&lt;p align=&quot;justify&quot;&gt;
&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;&lt;em&gt;Increase in availability &lt;/em&gt;&lt;/font&gt;
&lt;/p&gt;
&lt;p align=&quot;justify&quot;&gt;
&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;The CRM teams also observed an increase in the availability of drugs and supplies across various levels of health facilities, but say there is still a gap in terms of stock-outs, oversupply, lack of tracking of inventory, delay in supplies and procurement, and lack of a robust quality control system. &lt;/font&gt;
&lt;/p&gt;
&lt;p align=&quot;justify&quot;&gt;
&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;Almost all States experienced both oversupply and undersupply of different items, especially for the peripheral level health institutions. &lt;/font&gt;
&lt;/p&gt;
&lt;p align=&quot;justify&quot;&gt;
&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;&amp;ldquo;It seems that supplies are mostly top-down, based on availability and whatever had been procured, instead of being demand-based. There is an acute need for training the storekeepers and pharmacists in inventory management and the facility-in-charge in making evidence-based demand estimations for drugs and supplies.&amp;rdquo; &lt;/font&gt;
&lt;/p&gt;
&lt;p align=&quot;justify&quot;&gt;
&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;&lt;em&gt;Stop outside prescription &lt;/em&gt;&lt;/font&gt;
&lt;/p&gt;
&lt;p align=&quot;justify&quot;&gt;
&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;The CRM has also highlighted the need for elimination of &amp;lsquo;outside prescription&amp;rsquo; except when absolutely unavoidable, and for popularising and ensuring use of essential drugs lists in procurement and prescription. &lt;/font&gt;
&lt;/p&gt;
&lt;p align=&quot;justify&quot;&gt;
&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;As for user-friendly services, it is a mixed bag. Clean toilets with lighting, curtains in examination rooms of out-patient departments and in labour wards, ensuring privacy to patients, were observed with appreciation, even while noting their absence in a large number of facilities.&lt;/font&gt;
&lt;/p&gt;
&lt;p align=&quot;justify&quot;&gt;
&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;&lt;em&gt;No respect to patients &lt;/em&gt;&lt;/font&gt;
&lt;/p&gt;
&lt;p align=&quot;justify&quot;&gt;
&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;However, service providers showing no respect to patients in their interaction is still a pervasive phenomenon that discourages use of public facilities. &lt;/font&gt;
&lt;/p&gt;
&lt;p align=&quot;justify&quot;&gt;
&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;Lack of dignity in the conduct of sterilisation camps has also been reported, says the CRM. &lt;/font&gt;
&lt;/p&gt;
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Insufficiency and prescribing medicines from outside continues&amp;nbsp; 


CRM draws attention to &amp;lsquo;irrational&amp;rsquo; use and non-availability of essential medicines


Supplies are mostly top-down, based on availability instead of being demand-based


No State provides free medicines to below the poverty line (BPL) patients under...&#039;
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Insufficiency and prescribing medicines from outside continues&nbsp; 


CRM draws attention to &lsquo;irrational&rsquo; use and non-availability of essential medicines


Supplies are mostly top-down, based on availability instead of being demand-based


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                <strong>No free drugs under rural health mission by Aarti Dhar</strong></h1>
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                <p align="justify"><font ><em>Insufficiency and prescribing medicines from outside continues&nbsp; </em></font></p><p align="justify"><font ><em>CRM draws attention to &lsquo;irrational&rsquo; use and non-availability of essential medicines</em></font></p><p align="justify"><font ><em>Supplies are mostly top-down, based on availability instead of being demand-based</em></font></p><p align="justify"><font >No State provides free medicines to below the poverty line (BPL) patients under the National Rural Health Mission (NRHM). </font></p><p align="justify"><font >&ldquo;The insufficiency of drugs and thereby the imperative of prescribing medicines from outside continue widely. This could also be linked to insufficiency of understanding of the essential drug concept,&rdquo; says the third report of the Common Review Mission (CRM) on the NRHM. </font></p><p align="justify"><font >Showering praise on the NRHM for strengthening the public health service system, the CRM points out while most States seem sensitive to the issue of availability of drug especially for BPL patients, irrational prescribing higher order medicines, instead of basic generic preparations, has been reported. </font></p><p align="justify"><font >It has emphasised the need for combining free provisioning with promotion of rational drug use. This will lower the cost to the system and households.</font></p><p align="justify"><font ><em>Pharmacies on hospital campus </em></font></p><p align="justify"><font >Though almost all States report improved availability of drugs and supplies, the CRM draws attention to &ldquo;irrational&rdquo; use and non-availability of &ldquo;essential&rdquo; medicines. In several facilities &ldquo;co-operative&rdquo; pharmacy shops were seen on hospital premises selling drugs. A number of States are introducing or have in place commercial pharmacy shops within public hospitals. </font></p><p align="justify"><font ><em>Increase in availability </em></font></p><p align="justify"><font >The CRM teams also observed an increase in the availability of drugs and supplies across various levels of health facilities, but say there is still a gap in terms of stock-outs, oversupply, lack of tracking of inventory, delay in supplies and procurement, and lack of a robust quality control system. </font></p><p align="justify"><font >Almost all States experienced both oversupply and undersupply of different items, especially for the peripheral level health institutions. </font></p><p align="justify"><font >&ldquo;It seems that supplies are mostly top-down, based on availability and whatever had been procured, instead of being demand-based. There is an acute need for training the storekeepers and pharmacists in inventory management and the facility-in-charge in making evidence-based demand estimations for drugs and supplies.&rdquo; </font></p><p align="justify"><font ><em>Stop outside prescription </em></font></p><p align="justify"><font >The CRM has also highlighted the need for elimination of &lsquo;outside prescription&rsquo; except when absolutely unavoidable, and for popularising and ensuring use of essential drugs lists in procurement and prescription. </font></p><p align="justify"><font >As for user-friendly services, it is a mixed bag. Clean toilets with lighting, curtains in examination rooms of out-patient departments and in labour wards, ensuring privacy to patients, were observed with appreciation, even while noting their absence in a large number of facilities.</font></p><p align="justify"><font ><em>No respect to patients </em></font></p><p align="justify"><font >However, service providers showing no respect to patients in their interaction is still a pervasive phenomenon that discourages use of public facilities. </font></p><p align="justify"><font >Lack of dignity in the conduct of sterilisation camps has also been reported, says the CRM. </font></p><p align="justify"><font >The mandate of the annual CRM is to review changes in the health systems since the launch of the NRHM, to examine and document progress and identify key constraints limiting the pace of architectural correction in the health system and to recommend policy to overcome this problem. <br /></font></p>               </font>
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&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;&lt;em&gt;Insufficiency and prescribing medicines from outside continues&amp;nbsp; &lt;/em&gt;&lt;/font&gt;
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&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;&lt;em&gt;CRM draws attention to &amp;lsquo;irrational&amp;rsquo; use and non-availability of essential medicines&lt;/em&gt;&lt;/font&gt;
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&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;&lt;em&gt;Supplies are mostly top-down, based on availability instead of being demand-based&lt;/em&gt;&lt;/font&gt;
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&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;No State provides free medicines to below the poverty line (BPL) patients under the National Rural Health Mission (NRHM). &lt;/font&gt;
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&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;&amp;ldquo;The insufficiency of drugs and thereby the imperative of prescribing medicines from outside continue widely. This could also be linked to insufficiency of understanding of the essential drug concept,&amp;rdquo; says the third report of the Common Review Mission (CRM) on the NRHM. &lt;/font&gt;
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&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;Showering praise on the NRHM for strengthening the public health service system, the CRM points out while most States seem sensitive to the issue of availability of drug especially for BPL patients, irrational prescribing higher order medicines, instead of basic generic preparations, has been reported. &lt;/font&gt;
&lt;/p&gt;
&lt;p align=&quot;justify&quot;&gt;
&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;It has emphasised the need for combining free provisioning with promotion of rational drug use. This will lower the cost to the system and households.&lt;/font&gt;
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&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;&lt;em&gt;Pharmacies on hospital campus &lt;/em&gt;&lt;/font&gt;
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&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;Though almost all States report improved availability of drugs and supplies, the CRM draws attention to &amp;ldquo;irrational&amp;rdquo; use and non-availability of &amp;ldquo;essential&amp;rdquo; medicines. In several facilities &amp;ldquo;co-operative&amp;rdquo; pharmacy shops were seen on hospital premises selling drugs. A number of States are introducing or have in place commercial pharmacy shops within public hospitals. &lt;/font&gt;
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&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;&lt;em&gt;Increase in availability &lt;/em&gt;&lt;/font&gt;
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&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;The CRM teams also observed an increase in the availability of drugs and supplies across various levels of health facilities, but say there is still a gap in terms of stock-outs, oversupply, lack of tracking of inventory, delay in supplies and procurement, and lack of a robust quality control system. &lt;/font&gt;
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&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;Almost all States experienced both oversupply and undersupply of different items, especially for the peripheral level health institutions. &lt;/font&gt;
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&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;&amp;ldquo;It seems that supplies are mostly top-down, based on availability and whatever had been procured, instead of being demand-based. There is an acute need for training the storekeepers and pharmacists in inventory management and the facility-in-charge in making evidence-based demand estimations for drugs and supplies.&amp;rdquo; &lt;/font&gt;
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&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;&lt;em&gt;Stop outside prescription &lt;/em&gt;&lt;/font&gt;
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&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;The CRM has also highlighted the need for elimination of &amp;lsquo;outside prescription&amp;rsquo; except when absolutely unavoidable, and for popularising and ensuring use of essential drugs lists in procurement and prescription. &lt;/font&gt;
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&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;As for user-friendly services, it is a mixed bag. Clean toilets with lighting, curtains in examination rooms of out-patient departments and in labour wards, ensuring privacy to patients, were observed with appreciation, even while noting their absence in a large number of facilities.&lt;/font&gt;
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&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;&lt;em&gt;No respect to patients &lt;/em&gt;&lt;/font&gt;
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&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;However, service providers showing no respect to patients in their interaction is still a pervasive phenomenon that discourages use of public facilities. &lt;/font&gt;
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&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;Lack of dignity in the conduct of sterilisation camps has also been reported, says the CRM. &lt;/font&gt;
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&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;The mandate of the annual CRM is to review changes in the health systems since the launch of the NRHM, to examine and document progress and identify key constraints limiting the pace of architectural correction in the health system and to recommend policy to overcome this problem. &lt;br /&gt;
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Insufficiency and prescribing medicines from outside continues&amp;nbsp; 


CRM draws attention to &amp;lsquo;irrational&amp;rsquo; use and non-availability of essential medicines


Supplies are mostly top-down, based on availability instead of being demand-based


No State provides free medicines to below the poverty line (BPL) patients under...&#039;,
	&#039;disp&#039; =&gt; &#039;&lt;p align=&quot;justify&quot;&gt;&lt;font &gt;&lt;em&gt;Insufficiency and prescribing medicines from outside continues&amp;nbsp; &lt;/em&gt;&lt;/font&gt;&lt;/p&gt;&lt;p align=&quot;justify&quot;&gt;&lt;font &gt;&lt;em&gt;CRM draws attention to &amp;lsquo;irrational&amp;rsquo; use and non-availability of essential medicines&lt;/em&gt;&lt;/font&gt;&lt;/p&gt;&lt;p align=&quot;justify&quot;&gt;&lt;font &gt;&lt;em&gt;Supplies are mostly top-down, based on availability instead of being demand-based&lt;/em&gt;&lt;/font&gt;&lt;/p&gt;&lt;p align=&quot;justify&quot;&gt;&lt;font &gt;No State provides free medicines to below the poverty line (BPL) patients under the National Rural Health Mission (NRHM). &lt;/font&gt;&lt;/p&gt;&lt;p align=&quot;justify&quot;&gt;&lt;font &gt;&amp;ldquo;The insufficiency of drugs and thereby the imperative of prescribing medicines from outside continue widely. This could also be linked to insufficiency of understanding of the essential drug concept,&amp;rdquo; says the third report of the Common Review Mission (CRM) on the NRHM. &lt;/font&gt;&lt;/p&gt;&lt;p align=&quot;justify&quot;&gt;&lt;font &gt;Showering praise on the NRHM for strengthening the public health service system, the CRM points out while most States seem sensitive to the issue of availability of drug especially for BPL patients, irrational prescribing higher order medicines, instead of basic generic preparations, has been reported. &lt;/font&gt;&lt;/p&gt;&lt;p align=&quot;justify&quot;&gt;&lt;font &gt;It has emphasised the need for combining free provisioning with promotion of rational drug use. This will lower the cost to the system and households.&lt;/font&gt;&lt;/p&gt;&lt;p align=&quot;justify&quot;&gt;&lt;font &gt;&lt;em&gt;Pharmacies on hospital campus &lt;/em&gt;&lt;/font&gt;&lt;/p&gt;&lt;p align=&quot;justify&quot;&gt;&lt;font &gt;Though almost all States report improved availability of drugs and supplies, the CRM draws attention to &amp;ldquo;irrational&amp;rdquo; use and non-availability of &amp;ldquo;essential&amp;rdquo; medicines. In several facilities &amp;ldquo;co-operative&amp;rdquo; pharmacy shops were seen on hospital premises selling drugs. A number of States are introducing or have in place commercial pharmacy shops within public hospitals. &lt;/font&gt;&lt;/p&gt;&lt;p align=&quot;justify&quot;&gt;&lt;font &gt;&lt;em&gt;Increase in availability &lt;/em&gt;&lt;/font&gt;&lt;/p&gt;&lt;p align=&quot;justify&quot;&gt;&lt;font &gt;The CRM teams also observed an increase in the availability of drugs and supplies across various levels of health facilities, but say there is still a gap in terms of stock-outs, oversupply, lack of tracking of inventory, delay in supplies and procurement, and lack of a robust quality control system. &lt;/font&gt;&lt;/p&gt;&lt;p align=&quot;justify&quot;&gt;&lt;font &gt;Almost all States experienced both oversupply and undersupply of different items, especially for the peripheral level health institutions. &lt;/font&gt;&lt;/p&gt;&lt;p align=&quot;justify&quot;&gt;&lt;font &gt;&amp;ldquo;It seems that supplies are mostly top-down, based on availability and whatever had been procured, instead of being demand-based. There is an acute need for training the storekeepers and pharmacists in inventory management and the facility-in-charge in making evidence-based demand estimations for drugs and supplies.&amp;rdquo; &lt;/font&gt;&lt;/p&gt;&lt;p align=&quot;justify&quot;&gt;&lt;font &gt;&lt;em&gt;Stop outside prescription &lt;/em&gt;&lt;/font&gt;&lt;/p&gt;&lt;p align=&quot;justify&quot;&gt;&lt;font &gt;The CRM has also highlighted the need for elimination of &amp;lsquo;outside prescription&amp;rsquo; except when absolutely unavoidable, and for popularising and ensuring use of essential drugs lists in procurement and prescription. &lt;/font&gt;&lt;/p&gt;&lt;p align=&quot;justify&quot;&gt;&lt;font &gt;As for user-friendly services, it is a mixed bag. Clean toilets with lighting, curtains in examination rooms of out-patient departments and in labour wards, ensuring privacy to patients, were observed with appreciation, even while noting their absence in a large number of facilities.&lt;/font&gt;&lt;/p&gt;&lt;p align=&quot;justify&quot;&gt;&lt;font &gt;&lt;em&gt;No respect to patients &lt;/em&gt;&lt;/font&gt;&lt;/p&gt;&lt;p align=&quot;justify&quot;&gt;&lt;font &gt;However, service providers showing no respect to patients in their interaction is still a pervasive phenomenon that discourages use of public facilities. &lt;/font&gt;&lt;/p&gt;&lt;p align=&quot;justify&quot;&gt;&lt;font &gt;Lack of dignity in the conduct of sterilisation camps has also been reported, says the CRM. &lt;/font&gt;&lt;/p&gt;&lt;p align=&quot;justify&quot;&gt;&lt;font &gt;The mandate of the annual CRM is to review changes in the health systems since the launch of the NRHM, to examine and document progress and identify key constraints limiting the pace of architectural correction in the health system and to recommend policy to overcome this problem. &lt;br /&gt;&lt;/font&gt;&lt;/p&gt;&#039;,
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	&#039;id&#039; =&gt; (int) 830,
	&#039;title&#039; =&gt; &#039;No free drugs under rural health mission by Aarti Dhar&#039;,
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	&#039;description&#039; =&gt; &#039;&lt;p align=&quot;justify&quot;&gt;
&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;&lt;em&gt;Insufficiency and prescribing medicines from outside continues&amp;nbsp; &lt;/em&gt;&lt;/font&gt;
&lt;/p&gt;
&lt;p align=&quot;justify&quot;&gt;
&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;&lt;em&gt;CRM draws attention to &amp;lsquo;irrational&amp;rsquo; use and non-availability of essential medicines&lt;/em&gt;&lt;/font&gt;
&lt;/p&gt;
&lt;p align=&quot;justify&quot;&gt;
&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;&lt;em&gt;Supplies are mostly top-down, based on availability instead of being demand-based&lt;/em&gt;&lt;/font&gt;
&lt;/p&gt;
&lt;p align=&quot;justify&quot;&gt;
&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;No State provides free medicines to below the poverty line (BPL) patients under the National Rural Health Mission (NRHM). &lt;/font&gt;
&lt;/p&gt;
&lt;p align=&quot;justify&quot;&gt;
&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;&amp;ldquo;The insufficiency of drugs and thereby the imperative of prescribing medicines from outside continue widely. This could also be linked to insufficiency of understanding of the essential drug concept,&amp;rdquo; says the third report of the Common Review Mission (CRM) on the NRHM. &lt;/font&gt;
&lt;/p&gt;
&lt;p align=&quot;justify&quot;&gt;
&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;Showering praise on the NRHM for strengthening the public health service system, the CRM points out while most States seem sensitive to the issue of availability of drug especially for BPL patients, irrational prescribing higher order medicines, instead of basic generic preparations, has been reported. &lt;/font&gt;
&lt;/p&gt;
&lt;p align=&quot;justify&quot;&gt;
&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;It has emphasised the need for combining free provisioning with promotion of rational drug use. This will lower the cost to the system and households.&lt;/font&gt;
&lt;/p&gt;
&lt;p align=&quot;justify&quot;&gt;
&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;&lt;em&gt;Pharmacies on hospital campus &lt;/em&gt;&lt;/font&gt;
&lt;/p&gt;
&lt;p align=&quot;justify&quot;&gt;
&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;Though almost all States report improved availability of drugs and supplies, the CRM draws attention to &amp;ldquo;irrational&amp;rdquo; use and non-availability of &amp;ldquo;essential&amp;rdquo; medicines. In several facilities &amp;ldquo;co-operative&amp;rdquo; pharmacy shops were seen on hospital premises selling drugs. A number of States are introducing or have in place commercial pharmacy shops within public hospitals. &lt;/font&gt;
&lt;/p&gt;
&lt;p align=&quot;justify&quot;&gt;
&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;&lt;em&gt;Increase in availability &lt;/em&gt;&lt;/font&gt;
&lt;/p&gt;
&lt;p align=&quot;justify&quot;&gt;
&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;The CRM teams also observed an increase in the availability of drugs and supplies across various levels of health facilities, but say there is still a gap in terms of stock-outs, oversupply, lack of tracking of inventory, delay in supplies and procurement, and lack of a robust quality control system. &lt;/font&gt;
&lt;/p&gt;
&lt;p align=&quot;justify&quot;&gt;
&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;Almost all States experienced both oversupply and undersupply of different items, especially for the peripheral level health institutions. &lt;/font&gt;
&lt;/p&gt;
&lt;p align=&quot;justify&quot;&gt;
&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;&amp;ldquo;It seems that supplies are mostly top-down, based on availability and whatever had been procured, instead of being demand-based. There is an acute need for training the storekeepers and pharmacists in inventory management and the facility-in-charge in making evidence-based demand estimations for drugs and supplies.&amp;rdquo; &lt;/font&gt;
&lt;/p&gt;
&lt;p align=&quot;justify&quot;&gt;
&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;&lt;em&gt;Stop outside prescription &lt;/em&gt;&lt;/font&gt;
&lt;/p&gt;
&lt;p align=&quot;justify&quot;&gt;
&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;The CRM has also highlighted the need for elimination of &amp;lsquo;outside prescription&amp;rsquo; except when absolutely unavoidable, and for popularising and ensuring use of essential drugs lists in procurement and prescription. &lt;/font&gt;
&lt;/p&gt;
&lt;p align=&quot;justify&quot;&gt;
&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;As for user-friendly services, it is a mixed bag. Clean toilets with lighting, curtains in examination rooms of out-patient departments and in labour wards, ensuring privacy to patients, were observed with appreciation, even while noting their absence in a large number of facilities.&lt;/font&gt;
&lt;/p&gt;
&lt;p align=&quot;justify&quot;&gt;
&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;&lt;em&gt;No respect to patients &lt;/em&gt;&lt;/font&gt;
&lt;/p&gt;
&lt;p align=&quot;justify&quot;&gt;
&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;However, service providers showing no respect to patients in their interaction is still a pervasive phenomenon that discourages use of public facilities. &lt;/font&gt;
&lt;/p&gt;
&lt;p align=&quot;justify&quot;&gt;
&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;Lack of dignity in the conduct of sterilisation camps has also been reported, says the CRM. &lt;/font&gt;
&lt;/p&gt;
&lt;p align=&quot;justify&quot;&gt;
&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;The mandate of the annual CRM is to review changes in the health systems since the launch of the NRHM, to examine and document progress and identify key constraints limiting the pace of architectural correction in the health system and to recommend policy to overcome this problem. &lt;br /&gt;
&lt;/font&gt;
&lt;/p&gt;
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Insufficiency and prescribing medicines from outside continues&amp;nbsp; 


CRM draws attention to &amp;lsquo;irrational&amp;rsquo; use and non-availability of essential medicines


Supplies are mostly top-down, based on availability instead of being demand-based


No State provides free medicines to below the poverty line (BPL) patients under...&#039;
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Insufficiency and prescribing medicines from outside continues&nbsp; 


CRM draws attention to &lsquo;irrational&rsquo; use and non-availability of essential medicines


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                <strong>No free drugs under rural health mission by Aarti Dhar</strong></h1>
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                <p align="justify"><font ><em>Insufficiency and prescribing medicines from outside continues&nbsp; </em></font></p><p align="justify"><font ><em>CRM draws attention to &lsquo;irrational&rsquo; use and non-availability of essential medicines</em></font></p><p align="justify"><font ><em>Supplies are mostly top-down, based on availability instead of being demand-based</em></font></p><p align="justify"><font >No State provides free medicines to below the poverty line (BPL) patients under the National Rural Health Mission (NRHM). </font></p><p align="justify"><font >&ldquo;The insufficiency of drugs and thereby the imperative of prescribing medicines from outside continue widely. This could also be linked to insufficiency of understanding of the essential drug concept,&rdquo; says the third report of the Common Review Mission (CRM) on the NRHM. </font></p><p align="justify"><font >Showering praise on the NRHM for strengthening the public health service system, the CRM points out while most States seem sensitive to the issue of availability of drug especially for BPL patients, irrational prescribing higher order medicines, instead of basic generic preparations, has been reported. </font></p><p align="justify"><font >It has emphasised the need for combining free provisioning with promotion of rational drug use. This will lower the cost to the system and households.</font></p><p align="justify"><font ><em>Pharmacies on hospital campus </em></font></p><p align="justify"><font >Though almost all States report improved availability of drugs and supplies, the CRM draws attention to &ldquo;irrational&rdquo; use and non-availability of &ldquo;essential&rdquo; medicines. In several facilities &ldquo;co-operative&rdquo; pharmacy shops were seen on hospital premises selling drugs. A number of States are introducing or have in place commercial pharmacy shops within public hospitals. </font></p><p align="justify"><font ><em>Increase in availability </em></font></p><p align="justify"><font >The CRM teams also observed an increase in the availability of drugs and supplies across various levels of health facilities, but say there is still a gap in terms of stock-outs, oversupply, lack of tracking of inventory, delay in supplies and procurement, and lack of a robust quality control system. </font></p><p align="justify"><font >Almost all States experienced both oversupply and undersupply of different items, especially for the peripheral level health institutions. </font></p><p align="justify"><font >&ldquo;It seems that supplies are mostly top-down, based on availability and whatever had been procured, instead of being demand-based. There is an acute need for training the storekeepers and pharmacists in inventory management and the facility-in-charge in making evidence-based demand estimations for drugs and supplies.&rdquo; </font></p><p align="justify"><font ><em>Stop outside prescription </em></font></p><p align="justify"><font >The CRM has also highlighted the need for elimination of &lsquo;outside prescription&rsquo; except when absolutely unavoidable, and for popularising and ensuring use of essential drugs lists in procurement and prescription. </font></p><p align="justify"><font >As for user-friendly services, it is a mixed bag. Clean toilets with lighting, curtains in examination rooms of out-patient departments and in labour wards, ensuring privacy to patients, were observed with appreciation, even while noting their absence in a large number of facilities.</font></p><p align="justify"><font ><em>No respect to patients </em></font></p><p align="justify"><font >However, service providers showing no respect to patients in their interaction is still a pervasive phenomenon that discourages use of public facilities. </font></p><p align="justify"><font >Lack of dignity in the conduct of sterilisation camps has also been reported, says the CRM. </font></p><p align="justify"><font >The mandate of the annual CRM is to review changes in the health systems since the launch of the NRHM, to examine and document progress and identify key constraints limiting the pace of architectural correction in the health system and to recommend policy to overcome this problem. <br /></font></p>               </font>
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Insufficiency and prescribing medicines from outside continues&amp;nbsp; 


CRM draws attention to &amp;lsquo;irrational&amp;rsquo; use and non-availability of essential medicines


Supplies are mostly top-down, based on availability instead of being demand-based


No State provides free medicines to below the poverty line (BPL) patients under...&#039;,
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This could also be linked to insufficiency of understanding of the essential drug concept,&amp;rdquo; says the third report of the Common Review Mission (CRM) on the NRHM. &lt;/font&gt;&lt;/p&gt;&lt;p align=&quot;justify&quot;&gt;&lt;font &gt;Showering praise on the NRHM for strengthening the public health service system, the CRM points out while most States seem sensitive to the issue of availability of drug especially for BPL patients, irrational prescribing higher order medicines, instead of basic generic preparations, has been reported. &lt;/font&gt;&lt;/p&gt;&lt;p align=&quot;justify&quot;&gt;&lt;font &gt;It has emphasised the need for combining free provisioning with promotion of rational drug use. This will lower the cost to the system and households.&lt;/font&gt;&lt;/p&gt;&lt;p align=&quot;justify&quot;&gt;&lt;font &gt;&lt;em&gt;Pharmacies on hospital campus &lt;/em&gt;&lt;/font&gt;&lt;/p&gt;&lt;p align=&quot;justify&quot;&gt;&lt;font &gt;Though almost all States report improved availability of drugs and supplies, the CRM draws attention to &amp;ldquo;irrational&amp;rdquo; use and non-availability of &amp;ldquo;essential&amp;rdquo; medicines. In several facilities &amp;ldquo;co-operative&amp;rdquo; pharmacy shops were seen on hospital premises selling drugs. A number of States are introducing or have in place commercial pharmacy shops within public hospitals. &lt;/font&gt;&lt;/p&gt;&lt;p align=&quot;justify&quot;&gt;&lt;font &gt;&lt;em&gt;Increase in availability &lt;/em&gt;&lt;/font&gt;&lt;/p&gt;&lt;p align=&quot;justify&quot;&gt;&lt;font &gt;The CRM teams also observed an increase in the availability of drugs and supplies across various levels of health facilities, but say there is still a gap in terms of stock-outs, oversupply, lack of tracking of inventory, delay in supplies and procurement, and lack of a robust quality control system. &lt;/font&gt;&lt;/p&gt;&lt;p align=&quot;justify&quot;&gt;&lt;font &gt;Almost all States experienced both oversupply and undersupply of different items, especially for the peripheral level health institutions. &lt;/font&gt;&lt;/p&gt;&lt;p align=&quot;justify&quot;&gt;&lt;font &gt;&amp;ldquo;It seems that supplies are mostly top-down, based on availability and whatever had been procured, instead of being demand-based. There is an acute need for training the storekeepers and pharmacists in inventory management and the facility-in-charge in making evidence-based demand estimations for drugs and supplies.&amp;rdquo; &lt;/font&gt;&lt;/p&gt;&lt;p align=&quot;justify&quot;&gt;&lt;font &gt;&lt;em&gt;Stop outside prescription &lt;/em&gt;&lt;/font&gt;&lt;/p&gt;&lt;p align=&quot;justify&quot;&gt;&lt;font &gt;The CRM has also highlighted the need for elimination of &amp;lsquo;outside prescription&amp;rsquo; except when absolutely unavoidable, and for popularising and ensuring use of essential drugs lists in procurement and prescription. &lt;/font&gt;&lt;/p&gt;&lt;p align=&quot;justify&quot;&gt;&lt;font &gt;As for user-friendly services, it is a mixed bag. 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	&#039;title&#039; =&gt; &#039;No free drugs under rural health mission by Aarti Dhar&#039;,
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&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;&lt;em&gt;Insufficiency and prescribing medicines from outside continues&amp;nbsp; &lt;/em&gt;&lt;/font&gt;
&lt;/p&gt;
&lt;p align=&quot;justify&quot;&gt;
&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;&lt;em&gt;CRM draws attention to &amp;lsquo;irrational&amp;rsquo; use and non-availability of essential medicines&lt;/em&gt;&lt;/font&gt;
&lt;/p&gt;
&lt;p align=&quot;justify&quot;&gt;
&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;&lt;em&gt;Supplies are mostly top-down, based on availability instead of being demand-based&lt;/em&gt;&lt;/font&gt;
&lt;/p&gt;
&lt;p align=&quot;justify&quot;&gt;
&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;No State provides free medicines to below the poverty line (BPL) patients under the National Rural Health Mission (NRHM). &lt;/font&gt;
&lt;/p&gt;
&lt;p align=&quot;justify&quot;&gt;
&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;&amp;ldquo;The insufficiency of drugs and thereby the imperative of prescribing medicines from outside continue widely. This could also be linked to insufficiency of understanding of the essential drug concept,&amp;rdquo; says the third report of the Common Review Mission (CRM) on the NRHM. &lt;/font&gt;
&lt;/p&gt;
&lt;p align=&quot;justify&quot;&gt;
&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;Showering praise on the NRHM for strengthening the public health service system, the CRM points out while most States seem sensitive to the issue of availability of drug especially for BPL patients, irrational prescribing higher order medicines, instead of basic generic preparations, has been reported. &lt;/font&gt;
&lt;/p&gt;
&lt;p align=&quot;justify&quot;&gt;
&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;It has emphasised the need for combining free provisioning with promotion of rational drug use. This will lower the cost to the system and households.&lt;/font&gt;
&lt;/p&gt;
&lt;p align=&quot;justify&quot;&gt;
&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;&lt;em&gt;Pharmacies on hospital campus &lt;/em&gt;&lt;/font&gt;
&lt;/p&gt;
&lt;p align=&quot;justify&quot;&gt;
&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;Though almost all States report improved availability of drugs and supplies, the CRM draws attention to &amp;ldquo;irrational&amp;rdquo; use and non-availability of &amp;ldquo;essential&amp;rdquo; medicines. In several facilities &amp;ldquo;co-operative&amp;rdquo; pharmacy shops were seen on hospital premises selling drugs. A number of States are introducing or have in place commercial pharmacy shops within public hospitals. &lt;/font&gt;
&lt;/p&gt;
&lt;p align=&quot;justify&quot;&gt;
&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;&lt;em&gt;Increase in availability &lt;/em&gt;&lt;/font&gt;
&lt;/p&gt;
&lt;p align=&quot;justify&quot;&gt;
&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;The CRM teams also observed an increase in the availability of drugs and supplies across various levels of health facilities, but say there is still a gap in terms of stock-outs, oversupply, lack of tracking of inventory, delay in supplies and procurement, and lack of a robust quality control system. &lt;/font&gt;
&lt;/p&gt;
&lt;p align=&quot;justify&quot;&gt;
&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;Almost all States experienced both oversupply and undersupply of different items, especially for the peripheral level health institutions. &lt;/font&gt;
&lt;/p&gt;
&lt;p align=&quot;justify&quot;&gt;
&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;&amp;ldquo;It seems that supplies are mostly top-down, based on availability and whatever had been procured, instead of being demand-based. There is an acute need for training the storekeepers and pharmacists in inventory management and the facility-in-charge in making evidence-based demand estimations for drugs and supplies.&amp;rdquo; &lt;/font&gt;
&lt;/p&gt;
&lt;p align=&quot;justify&quot;&gt;
&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;&lt;em&gt;Stop outside prescription &lt;/em&gt;&lt;/font&gt;
&lt;/p&gt;
&lt;p align=&quot;justify&quot;&gt;
&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;The CRM has also highlighted the need for elimination of &amp;lsquo;outside prescription&amp;rsquo; except when absolutely unavoidable, and for popularising and ensuring use of essential drugs lists in procurement and prescription. &lt;/font&gt;
&lt;/p&gt;
&lt;p align=&quot;justify&quot;&gt;
&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;As for user-friendly services, it is a mixed bag. Clean toilets with lighting, curtains in examination rooms of out-patient departments and in labour wards, ensuring privacy to patients, were observed with appreciation, even while noting their absence in a large number of facilities.&lt;/font&gt;
&lt;/p&gt;
&lt;p align=&quot;justify&quot;&gt;
&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;&lt;em&gt;No respect to patients &lt;/em&gt;&lt;/font&gt;
&lt;/p&gt;
&lt;p align=&quot;justify&quot;&gt;
&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;However, service providers showing no respect to patients in their interaction is still a pervasive phenomenon that discourages use of public facilities. &lt;/font&gt;
&lt;/p&gt;
&lt;p align=&quot;justify&quot;&gt;
&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;Lack of dignity in the conduct of sterilisation camps has also been reported, says the CRM. &lt;/font&gt;
&lt;/p&gt;
&lt;p align=&quot;justify&quot;&gt;
&lt;font face=&quot;arial,helvetica,sans-serif&quot; size=&quot;3&quot;&gt;The mandate of the annual CRM is to review changes in the health systems since the launch of the NRHM, to examine and document progress and identify key constraints limiting the pace of architectural correction in the health system and to recommend policy to overcome this problem. &lt;br /&gt;
&lt;/font&gt;
&lt;/p&gt;
&#039;,
	&#039;credit_writer&#039; =&gt; &#039;The Hindu, 2 January, 2010, http://www.hindu.com/2010/01/02/stories/2010010260841200.htm&#039;,
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Insufficiency and prescribing medicines from outside continues&amp;nbsp; 


CRM draws attention to &amp;lsquo;irrational&amp;rsquo; use and non-availability of essential medicines


Supplies are mostly top-down, based on availability instead of being demand-based


No State provides free medicines to below the poverty line (BPL) patients under...&#039;
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There is an acute need for training the storekeepers and pharmacists in inventory management and the facility-in-charge in making evidence-based demand estimations for drugs and supplies.&amp;rdquo; &lt;/font&gt;&lt;/p&gt;&lt;p align=&quot;justify&quot;&gt;&lt;font &gt;&lt;em&gt;Stop outside prescription &lt;/em&gt;&lt;/font&gt;&lt;/p&gt;&lt;p align=&quot;justify&quot;&gt;&lt;font &gt;The CRM has also highlighted the need for elimination of &amp;lsquo;outside prescription&amp;rsquo; except when absolutely unavoidable, and for popularising and ensuring use of essential drugs lists in procurement and prescription. &lt;/font&gt;&lt;/p&gt;&lt;p align=&quot;justify&quot;&gt;&lt;font &gt;As for user-friendly services, it is a mixed bag. 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Insufficiency and prescribing medicines from outside continues&nbsp; 


CRM draws attention to &lsquo;irrational&rsquo; use and non-availability of essential medicines


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                <strong>No free drugs under rural health mission by Aarti Dhar</strong></h1>
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                <p align="justify"><font ><em>Insufficiency and prescribing medicines from outside continues&nbsp; </em></font></p><p align="justify"><font ><em>CRM draws attention to &lsquo;irrational&rsquo; use and non-availability of essential medicines</em></font></p><p align="justify"><font ><em>Supplies are mostly top-down, based on availability instead of being demand-based</em></font></p><p align="justify"><font >No State provides free medicines to below the poverty line (BPL) patients under the National Rural Health Mission (NRHM). </font></p><p align="justify"><font >&ldquo;The insufficiency of drugs and thereby the imperative of prescribing medicines from outside continue widely. This could also be linked to insufficiency of understanding of the essential drug concept,&rdquo; says the third report of the Common Review Mission (CRM) on the NRHM. </font></p><p align="justify"><font >Showering praise on the NRHM for strengthening the public health service system, the CRM points out while most States seem sensitive to the issue of availability of drug especially for BPL patients, irrational prescribing higher order medicines, instead of basic generic preparations, has been reported. </font></p><p align="justify"><font >It has emphasised the need for combining free provisioning with promotion of rational drug use. This will lower the cost to the system and households.</font></p><p align="justify"><font ><em>Pharmacies on hospital campus </em></font></p><p align="justify"><font >Though almost all States report improved availability of drugs and supplies, the CRM draws attention to &ldquo;irrational&rdquo; use and non-availability of &ldquo;essential&rdquo; medicines. In several facilities &ldquo;co-operative&rdquo; pharmacy shops were seen on hospital premises selling drugs. A number of States are introducing or have in place commercial pharmacy shops within public hospitals. </font></p><p align="justify"><font ><em>Increase in availability </em></font></p><p align="justify"><font >The CRM teams also observed an increase in the availability of drugs and supplies across various levels of health facilities, but say there is still a gap in terms of stock-outs, oversupply, lack of tracking of inventory, delay in supplies and procurement, and lack of a robust quality control system. </font></p><p align="justify"><font >Almost all States experienced both oversupply and undersupply of different items, especially for the peripheral level health institutions. </font></p><p align="justify"><font >&ldquo;It seems that supplies are mostly top-down, based on availability and whatever had been procured, instead of being demand-based. There is an acute need for training the storekeepers and pharmacists in inventory management and the facility-in-charge in making evidence-based demand estimations for drugs and supplies.&rdquo; </font></p><p align="justify"><font ><em>Stop outside prescription </em></font></p><p align="justify"><font >The CRM has also highlighted the need for elimination of &lsquo;outside prescription&rsquo; except when absolutely unavoidable, and for popularising and ensuring use of essential drugs lists in procurement and prescription. </font></p><p align="justify"><font >As for user-friendly services, it is a mixed bag. Clean toilets with lighting, curtains in examination rooms of out-patient departments and in labour wards, ensuring privacy to patients, were observed with appreciation, even while noting their absence in a large number of facilities.</font></p><p align="justify"><font ><em>No respect to patients </em></font></p><p align="justify"><font >However, service providers showing no respect to patients in their interaction is still a pervasive phenomenon that discourages use of public facilities. </font></p><p align="justify"><font >Lack of dignity in the conduct of sterilisation camps has also been reported, says the CRM. </font></p><p align="justify"><font >The mandate of the annual CRM is to review changes in the health systems since the launch of the NRHM, to examine and document progress and identify key constraints limiting the pace of architectural correction in the health system and to recommend policy to overcome this problem. <br /></font></p>               </font>
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<font face="arial,helvetica,sans-serif" size="3"><em>Insufficiency and prescribing medicines from outside continues&nbsp; </em></font>
</p>
<p align="justify">
<font face="arial,helvetica,sans-serif" size="3"><em>CRM draws attention to &lsquo;irrational&rsquo; use and non-availability of essential medicines</em></font>
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<p align="justify">
<font face="arial,helvetica,sans-serif" size="3"><em>Supplies are mostly top-down, based on availability instead of being demand-based</em></font>
</p>
<p align="justify">
<font face="arial,helvetica,sans-serif" size="3">No State provides free medicines to below the poverty line (BPL) patients under the National Rural Health Mission (NRHM). </font>
</p>
<p align="justify">
<font face="arial,helvetica,sans-serif" size="3">&ldquo;The insufficiency of drugs and thereby the imperative of prescribing medicines from outside continue widely. This could also be linked to insufficiency of understanding of the essential drug concept,&rdquo; says the third report of the Common Review Mission (CRM) on the NRHM. </font>
</p>
<p align="justify">
<font face="arial,helvetica,sans-serif" size="3">Showering praise on the NRHM for strengthening the public health service system, the CRM points out while most States seem sensitive to the issue of availability of drug especially for BPL patients, irrational prescribing higher order medicines, instead of basic generic preparations, has been reported. </font>
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<p align="justify">
<font face="arial,helvetica,sans-serif" size="3">It has emphasised the need for combining free provisioning with promotion of rational drug use. This will lower the cost to the system and households.</font>
</p>
<p align="justify">
<font face="arial,helvetica,sans-serif" size="3"><em>Pharmacies on hospital campus </em></font>
</p>
<p align="justify">
<font face="arial,helvetica,sans-serif" size="3">Though almost all States report improved availability of drugs and supplies, the CRM draws attention to &ldquo;irrational&rdquo; use and non-availability of &ldquo;essential&rdquo; medicines. In several facilities &ldquo;co-operative&rdquo; pharmacy shops were seen on hospital premises selling drugs. A number of States are introducing or have in place commercial pharmacy shops within public hospitals. </font>
</p>
<p align="justify">
<font face="arial,helvetica,sans-serif" size="3"><em>Increase in availability </em></font>
</p>
<p align="justify">
<font face="arial,helvetica,sans-serif" size="3">The CRM teams also observed an increase in the availability of drugs and supplies across various levels of health facilities, but say there is still a gap in terms of stock-outs, oversupply, lack of tracking of inventory, delay in supplies and procurement, and lack of a robust quality control system. </font>
</p>
<p align="justify">
<font face="arial,helvetica,sans-serif" size="3">Almost all States experienced both oversupply and undersupply of different items, especially for the peripheral level health institutions. </font>
</p>
<p align="justify">
<font face="arial,helvetica,sans-serif" size="3">&ldquo;It seems that supplies are mostly top-down, based on availability and whatever had been procured, instead of being demand-based. There is an acute need for training the storekeepers and pharmacists in inventory management and the facility-in-charge in making evidence-based demand estimations for drugs and supplies.&rdquo; </font>
</p>
<p align="justify">
<font face="arial,helvetica,sans-serif" size="3"><em>Stop outside prescription </em></font>
</p>
<p align="justify">
<font face="arial,helvetica,sans-serif" size="3">The CRM has also highlighted the need for elimination of &lsquo;outside prescription&rsquo; except when absolutely unavoidable, and for popularising and ensuring use of essential drugs lists in procurement and prescription. </font>
</p>
<p align="justify">
<font face="arial,helvetica,sans-serif" size="3">As for user-friendly services, it is a mixed bag. Clean toilets with lighting, curtains in examination rooms of out-patient departments and in labour wards, ensuring privacy to patients, were observed with appreciation, even while noting their absence in a large number of facilities.</font>
</p>
<p align="justify">
<font face="arial,helvetica,sans-serif" size="3"><em>No respect to patients </em></font>
</p>
<p align="justify">
<font face="arial,helvetica,sans-serif" size="3">However, service providers showing no respect to patients in their interaction is still a pervasive phenomenon that discourages use of public facilities. </font>
</p>
<p align="justify">
<font face="arial,helvetica,sans-serif" size="3">Lack of dignity in the conduct of sterilisation camps has also been reported, says the CRM. </font>
</p>
<p align="justify">
<font face="arial,helvetica,sans-serif" size="3">The mandate of the annual CRM is to review changes in the health systems since the launch of the NRHM, to examine and document progress and identify key constraints limiting the pace of architectural correction in the health system and to recommend policy to overcome this problem. <br />
</font>
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Insufficiency and prescribing medicines from outside continues&nbsp; 


CRM draws attention to &lsquo;irrational&rsquo; use and non-availability of essential medicines


Supplies are mostly top-down, based on availability instead of being demand-based


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<font face="arial,helvetica,sans-serif" size="3"><em>Insufficiency and prescribing medicines from outside continues&nbsp; </em></font>
</p>
<p align="justify">
<font face="arial,helvetica,sans-serif" size="3"><em>CRM draws attention to &lsquo;irrational&rsquo; use and non-availability of essential medicines</em></font>
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<p align="justify">
<font face="arial,helvetica,sans-serif" size="3"><em>Supplies are mostly top-down, based on availability instead of being demand-based</em></font>
</p>
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<font face="arial,helvetica,sans-serif" size="3">No State provides free medicines to below the poverty line (BPL) patients under the National Rural Health Mission (NRHM). </font>
</p>
<p align="justify">
<font face="arial,helvetica,sans-serif" size="3">&ldquo;The insufficiency of drugs and thereby the imperative of prescribing medicines from outside continue widely. This could also be linked to insufficiency of understanding of the essential drug concept,&rdquo; says the third report of the Common Review Mission (CRM) on the NRHM. </font>
</p>
<p align="justify">
<font face="arial,helvetica,sans-serif" size="3">Showering praise on the NRHM for strengthening the public health service system, the CRM points out while most States seem sensitive to the issue of availability of drug especially for BPL patients, irrational prescribing higher order medicines, instead of basic generic preparations, has been reported. </font>
</p>
<p align="justify">
<font face="arial,helvetica,sans-serif" size="3">It has emphasised the need for combining free provisioning with promotion of rational drug use. This will lower the cost to the system and households.</font>
</p>
<p align="justify">
<font face="arial,helvetica,sans-serif" size="3"><em>Pharmacies on hospital campus </em></font>
</p>
<p align="justify">
<font face="arial,helvetica,sans-serif" size="3">Though almost all States report improved availability of drugs and supplies, the CRM draws attention to &ldquo;irrational&rdquo; use and non-availability of &ldquo;essential&rdquo; medicines. In several facilities &ldquo;co-operative&rdquo; pharmacy shops were seen on hospital premises selling drugs. A number of States are introducing or have in place commercial pharmacy shops within public hospitals. </font>
</p>
<p align="justify">
<font face="arial,helvetica,sans-serif" size="3"><em>Increase in availability </em></font>
</p>
<p align="justify">
<font face="arial,helvetica,sans-serif" size="3">The CRM teams also observed an increase in the availability of drugs and supplies across various levels of health facilities, but say there is still a gap in terms of stock-outs, oversupply, lack of tracking of inventory, delay in supplies and procurement, and lack of a robust quality control system. </font>
</p>
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<font face="arial,helvetica,sans-serif" size="3">Almost all States experienced both oversupply and undersupply of different items, especially for the peripheral level health institutions. </font>
</p>
<p align="justify">
<font face="arial,helvetica,sans-serif" size="3">&ldquo;It seems that supplies are mostly top-down, based on availability and whatever had been procured, instead of being demand-based. There is an acute need for training the storekeepers and pharmacists in inventory management and the facility-in-charge in making evidence-based demand estimations for drugs and supplies.&rdquo; </font>
</p>
<p align="justify">
<font face="arial,helvetica,sans-serif" size="3"><em>Stop outside prescription </em></font>
</p>
<p align="justify">
<font face="arial,helvetica,sans-serif" size="3">The CRM has also highlighted the need for elimination of &lsquo;outside prescription&rsquo; except when absolutely unavoidable, and for popularising and ensuring use of essential drugs lists in procurement and prescription. </font>
</p>
<p align="justify">
<font face="arial,helvetica,sans-serif" size="3">As for user-friendly services, it is a mixed bag. Clean toilets with lighting, curtains in examination rooms of out-patient departments and in labour wards, ensuring privacy to patients, were observed with appreciation, even while noting their absence in a large number of facilities.</font>
</p>
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<font face="arial,helvetica,sans-serif" size="3"><em>No respect to patients </em></font>
</p>
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<font face="arial,helvetica,sans-serif" size="3">However, service providers showing no respect to patients in their interaction is still a pervasive phenomenon that discourages use of public facilities. </font>
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<font face="arial,helvetica,sans-serif" size="3">Lack of dignity in the conduct of sterilisation camps has also been reported, says the CRM. </font>
</p>
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</font>
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Insufficiency and prescribing medicines from outside continues&nbsp; 


CRM draws attention to &lsquo;irrational&rsquo; use and non-availability of essential medicines


Supplies are mostly top-down, based on availability instead of being demand-based


No State provides free medicines to below the poverty line (BPL) patients under...'
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No free drugs under rural health mission by Aarti Dhar

Insufficiency and prescribing medicines from outside continues  CRM draws attention to ‘irrational’ use and non-availability of essential medicines Supplies are mostly top-down, based on availability instead of being demand-based No State provides free medicines to below the poverty line (BPL) patients under the National Rural Health Mission (NRHM). “The insufficiency of drugs and thereby the imperative of prescribing medicines from outside continue widely. This could also be linked to insufficiency of understanding of the essential drug concept,” says the third report of the Common Review Mission (CRM) on the NRHM. Showering praise on the NRHM for strengthening the public health service system, the CRM points out while most States seem sensitive to the issue of availability of drug especially for BPL patients, irrational prescribing higher order medicines, instead of basic generic preparations, has been reported. It has emphasised the need for combining free provisioning with promotion of rational drug use. This will lower the cost to the system and households. Pharmacies on hospital campus Though almost all States report improved availability of drugs and supplies, the CRM draws attention to “irrational” use and non-availability of “essential” medicines. In several facilities “co-operative” pharmacy shops were seen on hospital premises selling drugs. A number of States are introducing or have in place commercial pharmacy shops within public hospitals. Increase in availability The CRM teams also observed an increase in the availability of drugs and supplies across various levels of health facilities, but say there is still a gap in terms of stock-outs, oversupply, lack of tracking of inventory, delay in supplies and procurement, and lack of a robust quality control system. Almost all States experienced both oversupply and undersupply of different items, especially for the peripheral level health institutions. “It seems that supplies are mostly top-down, based on availability and whatever had been procured, instead of being demand-based. There is an acute need for training the storekeepers and pharmacists in inventory management and the facility-in-charge in making evidence-based demand estimations for drugs and supplies.” Stop outside prescription The CRM has also highlighted the need for elimination of ‘outside prescription’ except when absolutely unavoidable, and for popularising and ensuring use of essential drugs lists in procurement and prescription. As for user-friendly services, it is a mixed bag. Clean toilets with lighting, curtains in examination rooms of out-patient departments and in labour wards, ensuring privacy to patients, were observed with appreciation, even while noting their absence in a large number of facilities. No respect to patients However, service providers showing no respect to patients in their interaction is still a pervasive phenomenon that discourages use of public facilities. Lack of dignity in the conduct of sterilisation camps has also been reported, says the CRM. The mandate of the annual CRM is to review changes in the health systems since the launch of the NRHM, to examine and document progress and identify key constraints limiting the pace of architectural correction in the health system and to recommend policy to overcome this problem.