Pharmaceutical production in India has been a formidable force for healthcare, so much so that no written report ever fails to eulogise India as the “pharmacy of the world”. Despite the prowess of Indian pharmaceutical industries in manufacturing affordable generic medicines, poor quality and unavailability of essential drugs, vaccines, and consumables at the last mile has been endemic to Indian public health, and it worsened during the COVID-19 pandemic.
The menace of not of standard quality (NSQ) drugs has been a public problem for India. Reports of deaths in India and abroad, caused by the consumption of Indian-manufactured medicines have been recently flagged by the WHO. Therefore, the need to strengthen the pharmaceutical supply chain is acute. This is important for ensuring the quality of drugs. Strengthening the supply chain is also essential to ensuring their availability and affordability at the last mile, as medicines constitute the highest share in out-of-pocket expenditure (OOPE) in India.
Stock-outs have been a common concern even in states with mature supply chain operations. Inventory management, demand forecasting, and breakdown of cold chain infrastructure are some of the perennial issues in pharmaceutical supply chain management. Therefore, streamlining operational processes, competence building of pharmaceutical supply chain professionals, governance of process and accountability, and strengthening infrastructure are essential for a robust supply chain.
Technological solutions for transparent tendering, end-to-end order and inventory management, quality control, smart warehousing, transportation, and cold-chain monitoring have the potential to strengthen the pharmaceutical supply chain systemically. Solutions developed by the Indian government, like e-Aushadhi, Drug Distribution Management System (DDMS), and AKS software, and privately developed solutions, such as Logistimo’s inventory management and demand forecasting software, StaTwig’s blockchain-enabled tracking system for vaccines, and portable refrigeration devices called Emvolio by Blackfrog have the potential to strengthen the pharmaceutical supply chain in public health.
Philanthropic foundations can play a role in enabling the adoption of these solutions by investing in their further development, generating knowledge based on evidence, and helping states pilot these solutions to make essential medicines available at the last mile.
This report explores the state of the pharmaceutical supply chain vis-à-vis Essential Medicines in Indian public health and the ways in which it can be made more resilient to contingencies. While secondary research has informed most of this report, key informant interviews with pharmaceutical supply chain experts provided crucial insights for shaping its narrative. It identifies key challenges in ensuring the availability of essential drugs, vaccines and consumables at the last mile. Further, it explores how technology can lessen the burden of the state in governing non-care services within the public health system. Lastly, it also profiles some of the promising technological solutions and provides recommendations to philanthropists on how to invest in the development of these supply chain solutions for the greater good of public health.
Authors: Ritika Ramasuri, Anushka Anand, Granthika Chatterjee, and Anurag Garg.
We would like to thank the following advisors for providing critical insights that helped shape this perspective.
- Parvathi Malladra
Programme Officer, Karuna Trust
- Rajkumar M Rudrappanavar
Administrator, Idaguru Primary Health Centre, Chikkaballapur District
- Nandish R
Pharmacist, Idaguru Primary Health Centre, Chikkaballapur District
- Krishnakumar Sankaranarayanan
Senior Advisor, Sattva Consulting
- Manuj Purwar
Deputy Director, Health Systems, UPTSU
- Vikas Patil
Ex. Consultant, National Cold Chain Resource Centre, Pune
- Sid Chakravarthy
Founder & CEO, StaTwig