My latest column (Dev 360) in The Asian Age, Deccan Chronicle
Science fiction guru Arthur C. Clarke once observed that “new ideas pass through three periods: first, it can’t be done, second, it probably can be done, but it is not worth doing and third, I knew it was a good idea all along!”
In the Indian context, Clarke’s wise words evoke more the dream scenario than the ground reality. Innovative ideas and their originators have to run a gruelling obstacle course, harsher than what Clarke had in mind. The hurdles confronting such ideas are so many that it can take a lifetime to move from phase one to the final. Only the most determined survive to tell the tale.
Indeed, if you want to know if a new idea is a good one, check out if it sparks a storm among entrenched interests. If everyone is happy, then the new idea is unlikely to change anything on the ground. If a word-of-mouth campaign by a vocal few, however, seeks to tarnish the project as it gets off the ground, bet on its potential to do good.
So it is with the Jan Aushadhi programme, an ambitious government initiative to provide unbranded generic drugs at affordable prices to the aam aadmi. The Indian government kicked off the project when it opened the first Jan Aushadhi, or People’s Drug Store, in the holy city of Amritsar in November 2008. On the shelves were only generic drugs. The event was the first step towards operationalising a magnificent vision of a nationwide chain of “Jan Aushadhi” stores.
More than a-year-and-half down the line, adverts on television, radio and the worldwide web proclaim the initiative’s merits. Public health experts laud its bold, crisp message: “Why pay more when you can get the same medicine at much lesser price?”
But, disturbingly, a subtle campaign is under way to discredit this big idea of the department of pharmaceuticals.
Who could possibly oppose the idea of selling good quality medicines at heavily discounted prices in a country with the largest pool of patients in the world, where most citizens pay their own way through diseases, and where 70 per cent of out-of-pocket health expenditures are on medicines?
The short answer: an awful lot of people. The 50-odd 24×7 “generic drug stores” across the country started as part of the Jan Aushadhi programme have their detractors. One of the most vocal critics is the All-India Chemists and Distributors Federation which alleges that the grand plan to sell unbranded generic drugs at low prices through these not-for-profit stores will adversely affect the image of chemists who sell branded products from major manufacturers at much higher prices. A telling example: A pack of 10 ciprofloxacin tablets (250mg), an antibiotic, is sold at Rs 11.10 in a Jan Aushadhi store against Rs 55 in the market.
The chemists are not the only ones carping. Many doctors in government hospitals where Jan Aushadhi stores are located are reluctant to prescribe unbranded generic medicines.
Winning the propaganda war — convincing the public that generics can be as effective as the pricey branded stuff — is critical to Jan Aushadhi’s success. Despite the odds, there is a sliver of hope. Rajneesh Bansal, who runs a non-governmental organisation (NGO) in Mohali, near Chandigarh, is a Jan Aushadhi enthusiast. His NGO is partnering the government in running the 24×7 generic drug store in the local civil hospital. The hospital at Mohali got its Jan Aushadhi store on February 23, 2009. The first week was dismal. Bansal barely sold any medicines. However, he did not give up. Instead, he got onto a combat mode.
“I hired a lady pharmacist because I felt she would have greater credibility. Many of my customers are pregnant women. Then, I initiated dialogue with the doctors in the hospital. I pointed out that those who come to this hospital are poor and cannot afford expensive medicines. They would forego medical care if they had to fork out so much money on expensive medicines. The rich are unlikely to come to my store. They would buy the branded stuff anyway”, he says.
The tactics worked partially. Some doctors started prescribing the unbranded generic medicines. The chemists in the neighbourhood who thrived on selling expensive branded drugs were a tough lot to combat. Mr Bansal alleges that many of them spread canards about the poor quality of the low-priced drugs.
But they had not bargained for his slumdog gene. “I would tell those who walked into my store that if these low-priced generic drugs work for you and you get better, decide for yourself what is right. Over a period, even the sceptics saw the value in these words.”
Today, between 100 and 150 people come to Bansal’s store every day. His daily sale has climbed from Rs 60 in February 2009 to somewhere between Rs 3,000 to Rs 4,000.
Such teething problems are part of the script, only to be expected.
The government’s grand plan envisages the spread of Jan Aushadhi stores to all 626 districts in the country by end of 2011. The pace of implementation has been somewhat slow, as one pink paper recently pointed out. But there are promising signs on the ground. Rajasthan has become the first state to issue guidelines to doctors in government hospitals to prescribe generics, instead of the usual branded formulations of commonly-used drugs. More Indian states are expected to follow the Rajasthan model. The Parliamentary Standing Committee on Health has suggested that it should be made mandatory for the state governments to open Jan Aushadhi outlets in all government hospitals to ensure that the price advantage reaches the wider public. There is also talk about supplying cancer drugs at discounted rates through the Jan Aushadhi stores.
To date these stores are restricted to government hospitals and medicines on sale are sourced from public sector drug manufacturers. However, the government is reportedly considering roping in the private sector. This is a good sign, and would broaden the constituency for the generic drug stores.
Mr Bansal is optimistic about the road ahead. To be on top of this game, he will tap his armoury of skills of persuasion and negotiation, he says. But his best weapon — satisfied customers who spread the word that low prices need not mean low quality.
Patralekha Chatterjee writes on development issues in India and emerging economies and can be reached at firstname.lastname@example.org