Photo: UNDP India
Availability and affordability of medicines remains a primary concern in India, given the estimates that 50 to 80 percent of the Indian population have insufficient access to the medicines they need.1 In line with the goal of the National Health Policy (2017) "to achieve universal access to good quality health care services without falling into financial hardship," India rolled out the Ayushman Bharat – India's National Health Protection Scheme (AB-NHPS) in 2018. A significant milestone towards UHC, the AB-NHPS aims at providing free access to health care to half a billion people living in poverty. In conjunction with these steps towards UHC, a major health goal for India is the elimination of TB by 2025. India has the highest burden of TB (and DR-TB) in the world, accounting for a quarter of all TB deaths globally. The Revised National TB Control Programme (RNTCP), in its National Strategic Plan (2017-2025), has highlighted the need to achieve universal drug-susceptibility testing (DST) and rapid scale up of shorter regimens for DR-TB treatment.
As India moves towards achieving its national TB objectives, in line with the TB-free India campaign, ADP is exploring opportunities for collaboration, including with the National Institute for TB Research on operational research to improve TB case detection and case management among children and hard-to-reach populations. As a resource country, the experience and insights of India will enable key South–South knowledge transfer that will be of mutual benefit to India and other ADP focus countries.
With the roll-out of the health insurance scheme and demand for health services increasing, financial sustainability of the national fund is a clear priority. Through its technical partner HITAP, ADP has initiated discussions with the Ministry of Health and Social Welfare (MOHSW) on the development of an institutional framework to enhance use of HTA in health priority-setting for selection of new health technologies. Complementing this work, ADP will also initiate collaboration with AB-NHPS on the use of appropriate mechanisms for decreasing care costs, as a means of increasing coverage.
ADP is actively leveraging the significant policy and programmatic experience of India in the national roll-out of eVIN – an innovative digital technology platform for strengthening the vaccine cold-chain system. In digitizing inventories and record-keeping at all storage sites and cold chain points, eVIN has addressed a number of key infrastructure and information management challenges, including significant improvements in vaccine availability and reductions in wastage.2 Building on this success, UNDP India and MOHSW are partnering to scale up eVIN across the 29 states and 7 Union Territories of the country, to support the Universal Immunization Programme by strengthening the evidence base for improved policy-making in vaccine delivery, procurement and planning.
ADP is collaborating with UNDP India to enable South–South cooperation on replicating the success of eVIN in other LMICs. One key result has been the transfer of knowledge between India and Indonesia, leading to the successful piloting of eVIN in the latter.
The Central Drugs Standard Control Organization (CDSCO) of India, the national regulatory authority, was assessed by WHO using the GBT, and was confirmed to be operating at 'maturity level 3'. There are specific areas for further improvement, particularly at the state level. ADP has supported the continuous improvement and strengthening of the regulatory system through the implementation of an institutional development plan, which has guided ADP's collaboration with CDSCO to address the identified capacity gaps. In this connection, ADP supported CDSCO in strengthening capacities of drug inspectors on good manufacturing practice (GMP) and good distribution practice (GDP), which are essential aspects of quality assurance that ensures pharmaceutical products are regulated across the entire value chain.
|Country profile a|
|Human Development Index ranking||130|
|Population total (millions)||1,339|
|Gross national income per capita (USD)||2,467|
|Working poor at PPP $3.10 a day (% of total employment)||47|
|Public health expenditure (% of GDP)||3|
|Life expectancy at birth (years)||66|
|<5 mortality rate (per 1000 live births)||35|
|TB epidemiology b|
|TB incidence (per 100,000)||204|
|Deaths due to TB (per 100,000)||32|
|TB treatment coverage (%)||65|
|MDR-TB incidence (per 100,000)||10|
|Malaria epidemiology c|
|Cases of malaria (per 100,000)||10|
|Deaths due to malaria (per 100,000)||2|
|NTDs epidemiology d|
|Population in need of PC / coverage of PC||458,854,680 / 77%|
|Population at risk of LF / coverage of PC||337,024,378 / 56%|
|Population at risk of STH / coverage of PC||225,634,363 / 100%|
All data from 2017 unless stated. PC: preventive chemotherapy; STH: soil-transmitted helminths; LF: lymphatic filariasis.