Gaps in Drug Accessibility in Rural India

Nearly 65% ​​of the Indian population residing in rural India has access to only 30% of the total available health infrastructure. In India, while affordability has received political attention, in the form of price controls; the availability of drugs, especially in rural areas, remains a serious concern. “Physical reach” is a parameter used to assess access and is defined as “the presence of a pharmacy within 5 km of the place of residence or work”. Using this definition, a 2012 study found that in rural India, 63% of people were unable to access pharmaceutical facilities within 5 km. Due to limited access, patients often tend to delay routine checkups or avoid treatment, leading to late detection of health issues or lack of treatment in the early stages. This, together with the epidemiological shift towards NCDs, presents us with a huge challenge.

The inaccessibility of medicines in rural India is a multi-faceted problem. Organized pharmacy businesses are reluctant to open outlets in rural areas because their growth is largely driven by urban demand. The top 2 pharmacies in India cover less than 10% of the Indian population. To top it off, low margins, pharmacy operational problems and security concerns have ensured only limited penetration of pharmaceutical companies in the villages. However, with drug sales increasing by 17% in rural areas and with more than a third of the national annual sales of almost ₹80,000 crore coming from rural and semi-urban markets; this represents a huge opportunity for pharmaceutical companies to expand into rural markets, which will be the growth engines of the domestic pharmaceutical industry in the years to come.

Another major challenge in improving drug accessibility in rural India is poor medical assistance. The pharmacist-to-patient ratio in rural India stands at 1 pharmacist for every 4000 people – well below the WHO recommended level. Therefore, efforts should be made to ensure that pharmacies are adequately staffed with competent pharmacists who can dispense the correct drugs. This can be done by training pharmacists in rural areas and having them certified. Additionally, they should also be trained to screen and refer patients to secondary and tertiary health care facilities, in case of escalation. Digital adoption of training, as in the education technology space, can be embraced for skills upgrading and assistance when in doubt.

Frequent stock-outs are another major fault line. The current ecosystem is designed to have detailed systems in place to prevent such crises. Drug stocks in the public health system are supposed to be checked regularly and suppliers are kept informed of future needs. Therefore, whenever such drug stock-outs occur, they are man-made, either through negligence or self-interest. There must be a system of checks and balances to hold every member involved in the supply chain accountable, so that stock-outs, when they occur, can be stopped, at their source. According to a study, about 60% of drugs in public health facilities are out of stock for 6 months, which poses a huge risk of disease progression.

Other factors such as uneven distribution networks, lack of storage facilities and poor infrastructure for the movement of medicines from source to final consumer also affect accessibility of medicines. India spends less than 4% of its GDP on health care. In order to address these infrastructure issues, this amount should be doubled, and states that allocate less allocations to health care should be encouraged and supported to increase spending on improving health infrastructure.

If India is not to see itself in the ironic position of acting as a pharmacy for the world, but neglecting its own rural pockets, the issue of affordability of medicines must receive immediate attention and things must move on field.



The opinions expressed above are those of the author.


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