Disparities in Access to Essential Medicines in India: A Systematic Review of Availability, Affordability and Policy Challenges

Ensuring access to essential medicines in an equitable manner continues to be an important challenge in India’s diverse healthcare ecosystem. Even though it is a world leader in drug manufacture, there are still wide gaps in medicine supply between regions and types of healthcare. This review summarizes evidence on the availability of essential medicines in public and private health facilities from studies during 2003–2017. The findings show stark geographic differences, as to availability – Punjab, Tamil Nadu and Jharkhand had high availability, whereas states, especially in rural and underdeveloped areas showed severe lack. In general, private sector facilities have a higher availability of essential medicines than public facilities, yet low-income populations are restricted in accessing them as they are often unable to cover associated costs incurred to access the services. Supply chains that are not efficient, procurement policies that are not standardized, and high out-of-pocket spending, are major issues for governments. The NHAM (National Health Assurance Mission) also has a government commitment, and is on the models of the Essential Medicines List (EML), which is a good sign of greater promises, but it must go for better coverage and better implementation. Policy implications include strengthening public health care infrastructure, supply chain in the management of the taxpayer, promotion of generics and improvement in budgetary allocations for basic medications. Addressing these systemic issues is the key to achieve universal health coverage for all Indian citizens and ensuring that all citizens have equitable access to life-saving medicines and treatments.