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[BANGALORE] India, dubbed as the ‘pharmacy of the developing world’ due to its vast generic drug exports, may not be doing enough to ensure availability of essential medicines in its domestic market, a new Indo-British study suggests. 
Scheduled for publishing in the June edition of the Journal of Global Health, the study surveyed the availability of six medicines at 124 private retail outlets in four districts of Maharashtra state, a drug-manufacturing hub. It found that artemisinin (malaria), fluoxetine (mental health), oxytocin (reproductive health), and lamivudine (HIV/AIDS) are only available in less than half of the private drugstores. Only metformin (diabetes) was easily available at 91 per cent of the pharmacies, followed by rifampicin (tuberculosis) at 65 per cent.
The six diseases were selected due to their high prevalence in the country. India has the world’s highest rate of tuberculosis; the second highest number of diabetes cases after China; the third largest incidence of HIV, with 2.1 million cases; and very high numbers of reported malaria cases at over 2 million; and millions affected by some form of psychiatric disorder. Maternal mortality rate, at 178 per 100,000 live births, is also a concern.
The research also reported that there were shortages in terms of availability of various brands. Although there were a total of 2,186 approved products or brands for the six drugs — all listed as essential by the World Health Organization and the Indian government — only a few of these dominated the market.

“The results of the study imply that it is up to the government to make sure that essential medicines are available and affordable”

Colin Millard, Newcastle University

“The study implies that a number of Indian patients can’t rely on competition in the pharmaceutical market to ensure that essential medicines will be available in private retail pharmacies,” says Colin Millard, lecturer in medical anthropology at Newcastle University and lead author of the study.
The survey did not cover hospital-based government pharmacies which are supposed to dispense medicines for free. According to the study, there is 80 per cent dependence on private health care as the government sector is hampered by low budgetary allocations for health.
India exported US$16.4 billion worth of pharmaceutical products during the 2016—2017 fiscal year, according to the Pharmaceutical Exports Promotion Council. India is the world’s largest supplier of generic medicines, accounting for 20 per cent of global export volume.  
“We can only speculate about why there was low availability of the four medicines at the private pharmacies,” says Millard. “The results of the study imply that it is up to the government to make sure that essential medicines are available and affordable.'' Amitava Guha, national co-convenor of the Jan Swasthya Abhiyan, a healthcare-focused civil society group, explains that there are various reasons for the shortages of certain drugs.
He cites the shortage of lamivudine in government hospitals several years ago due to delays in the procurement process, as an example. This he believes could have prompted people to rely heavily on private stores for this medication. In the case of oxytocin, he notes there are “restrictions on its sale due to misuse, making pharmacists reluctant to stock it”, he says. He also suggests that too much dependence on China for raw materials for 90 per cent of the drugs makes India vulnerable to shortages.
Meanwhile, Mira Shiva, founder coordinator of the All India Drug Action Network, a network of non-government organisations working on public health, finds no issue with the limited number of available brands and even questions the need for multiple brands for the same drug. “We have over 60,000 brands — no doctor can remember so many,” she argues.
This piece was produced by SciDev.Net’s Asia & Pacific desk.