2. Impact of Tamilnadu Medical Services on drug prescribing in primary health care

4. INTRODUCTION  An efficient health care delivery system is an important requisite to achieve health for all.  Access to essential drugs is probably the most important element of health care delivery system.

5. The Government of Tamil Nadu, India realizing this, developed and implemented various strategies under the broad framework of Tamil Nadu Medical Services Corporation to control and monitor drug procurement, storage and distribution to the Public sector hospitals in the state.

6. Tamilnadu Medical Services Corporation(TNMSC )  1994: Efforts to rationalize drug use commence and TNMSC formed; Chain of modern warehouses built  1995: Essential drug list prepared  1997: News Bulletin “TNMSC Times” launched  1998: Training for Doctors and Pharmacists.

7. TNMSC & RUD  EDL  Pharmacist’s handbook  Training of pharmacists in inventory management  Good quality Generic drugs at competitive rates  “TNMSC Times”  Storage under good conditions in modern warehouses  Distribution based on indenting by medical officers  Inventory control at district warehouses

9. TNMSC Web Server H.O Order Placement Form Download & Submission Suppliers Tender Minutes Generation e-Tendering

11. TNMSC Order Placement Suppliers Warehouses MRC & Invoice Linkage Invoice MRC Printing of Cheques AUTOMATED BILL PASSING

12. Quality Control Visual - Physical Defects - Packing - Including Cartoon Samples from Warehouses Eliminating Common Batches Sent to LAB Results thru’ E-Mail Intimate to Warehouses if failed No Compromise on QUALITY

13. Stock Monitoring TNMSCH.O. Internet Warehouses Internet Transferinfo. sent to H.O. Transfer info. to Warehouses Warehouses Monitor the Stocks Internet

14. Warehouse Information System Suppliers TNMSCH.O. Issues under BudgetaryControl MedicalInstitutions Warehouse Passbook & Order info. Submit Indent Supply

15. H.O.Server Warehouse Information System M.I.S. Payroll & Personal CT Scan System Drug Management & Monitoring System Financial Accounts Automated Material Handling Construction Management Supplier Information QC Monitoring System

17. Impact evaluation 1) To study the impact of the TNMSC in primary care centres (PHCs) on a) availability of 15 core essential drugs; b) continuous availability of an adequate quantity of the core essential drugs; and c) rational use of drugs in PHCs; 2) to study the maintenance of quality of drugs by the TNMSC and 3) to study the control of drug expenditures by the TNMSC.

18. Study design  Longitudinal time series with control before and after various TNMSC interventions (20 PHCs Vs 20 Controls).  Time series study of government rural PHCs before and after various TNMSC interventions in 1994-8.

19. RESULTS(preliminary- 5 PHCs Vs 4 Controls)  Tim e series analysis is showing a positive trend in the following indicators in the intervention facilities: 1) % of key drugs available per facility per time period 2) Average number of days of stock-out per year per facility per year 3) % drugs prescribed by generic name 4) % drugs prescribed that belong to the PHC EDL (51 drugs) 5) Average cost per prescription

20.  However no such trend is discernible in the following: 1)% prescriptions containing an antibiotic; 2)% prescriptions containing a vitamin; 3)% prescriptions containing an injection 4) average number of drugs per prescription

21. Results are preliminary and have to be interpreted with caution www.tnmsc.tn.nic.in www.tnmsc.com Study funded by Applied Research in Child Health through the United States Agency for International Development (USAID). Thank you