Chaudhury R Roy, Parameswar R, Gupta U, Sharma S, Tekur U, Bapna J S
India-WHO Essential Drugs Programme, Delhi Society for Promotion of Rational Use of Drugs, National Institute of Immunology, Aruna Asaf Ali Marg, New Delhi, India.
Health Policy Plan. 2005 Mar;20(2):124-36. doi: 10.1093/heapol/czi015.
Prior to 1994, most Delhi hospitals and dispensaries experienced constant shortages of essential medicines. There was erratic prescribing of expensive branded products, frequent complaints about poor drug quality and low patient satisfaction. Delhi took the lead in developing a comprehensive Drug Policy in 1994 and was the only Indian state to have such a comprehensive policy. The policy's main objective is to improve the availability and accessibility of quality essential drugs for all those in need. The Delhi Society for the Promotion of Rational Use of Drugs (DSPRUD), a non-governmental organization, worked in close collaboration with the Delhi Government and with universities to implement various components of the policy. The first Essential Drugs List (EDL) was developed, a centralized pooled procurement system was set up and activities promoting rational use of drugs were initiated. In 1997, the Delhi Programme was designated the INDIA-WHO Essential Drugs Programme by the World Health Organization. The EDL was developed by a committee consisting of a multidisciplinary group of experts using balanced criteria of efficacy, safety, suitability and cost. The first list contained 250 drugs for hospitals and 100 drugs for dispensaries; the list is revised every 2 years. The pooled procurement system, including the rigorous selection of suppliers with a minimum annual threshold turnover and the introduction of Good Manufacturing Practice inspections, resulted in the supply of good quality drugs and in holding down the procurement costs of many drugs. Bulk purchasing of carefully selected essential drugs was estimated to save nearly 30% of the annual drugs bill for the Government of Delhi, savings which were mobilized for procuring more drugs, which in turn improved availability of drugs (more than 80%) at health facilities. Further, training programmes for prescribers led to a positive change in prescribing behaviour, with more than 80% of prescriptions being from the EDL and patients receiving 70-95% of the drugs prescribed. These changes were achieved by changing managerial systems with minimal additional expenditure. The 'Delhi Model' has clearly demonstrated that such a programme can be introduced and implemented and can lead to a better use and availability of medicines.
1994年以前，德里的大多数医院和诊疗所基本药物一直短缺。存在高价品牌药品乱开处方的情况，药品质量差的投诉频繁，患者满意度低。德里于1994年率先制定了一项全面的药品政策，是印度唯一一个有如此全面政策的邦。该政策的主要目标是提高优质基本药物对所有有需要者的可获得性和可及性。德里促进合理用药协会（DSPRUD），一个非政府组织，与德里政府和大学密切合作以实施该政策的各个组成部分。制定了第一份基本药物清单（EDL），建立了集中采购系统，并启动了促进合理用药的活动。1997年，德里项目被世界卫生组织指定为印度-世卫组织基本药物项目。EDL由一个由多学科专家组成的委员会制定，采用了疗效、安全性、适用性和成本等平衡标准。第一份清单包含250种医院用药和100种诊疗所用药品；该清单每两年修订一次。集中采购系统，包括严格挑选年营业额有最低门槛的供应商以及引入药品生产质量管理规范检查，带来了优质药品的供应，并压低了许多药品的采购成本。据估计，批量采购精心挑选的基本药物为德里政府节省了近30%的年度药品账单，节省的资金被用于采购更多药品，这反过来又提高了医疗机构药品的可获得性（超过80%）。此外，针对开处方者的培训项目导致了处方行为的积极变化，超过80%的处方来自EDL，患者获得了所开处方药品的70 - 95%。这些改变是通过以最少的额外支出改变管理系统实现的。“德里模式”清楚地表明，这样一个项目可以引入并实施，且能带来药品的更好使用和可获得性。
