Why are healthcare providers opposing prescription audit in India?

August 04, 2011

A day-long strike called by the All India Chemist and Distributors Federation was observed on 1st August. It was also supported by the All India Organisation of Chemists and Druggists (AIOCD) – the association that virtually controls drug trade in India. Many chemist shops particularly those around hospitals remained closed in few states including Delhi, Rajasthan and Haryana. The chemists were opposing a recent government move, which requires them to retain prescriptions (to facilitate prescription audit for antibiotics), to check abuse of antibiotics in the country. Strikes in other states are also scheduled later this month, and a hartal being planned by the AIOCD.

The central government swung into action last year after the controversy surrounding the ‘Superbug’ (multi-drug resistant bacteria) broke-out posing grave potential hazards for public health in the country. In reaction to this, earlier this year the Government issues a national Antibiotic Policy, which recommends prescription audit of antibiotic usage. Medical experts say at the moment there are more than 130 antibiotics available in the market, and are often available over-the-counter. Standard dosage of antibiotics has increased fourfold in recent times because of enhanced bacterial resistance, not only affecting antibiotic usage but also increasing the expenses associated with it for consumers.

Why has the government’s proposal not gone down well with chemists across the country? According to the proposal (amendments to the Drugs and Cosmetics Act 1940), doctors have to write prescriptions in duplicate for antibiotics, one for patients and other to be retained by chemists. Chemists have to keep a record of these prescriptions for the subsequent prescription audit to be done for sale of antibiotics. According to the Federation, maintaining such detailed records is practically impossible for chemists and will also cause inconveniences for consumers. Prescription audit would be undertaken by the Drug Controller General of India and State Drug Controllers and violators are liable to fine of Rs. 20,000 or upto 2 years imprisonment.

As a consumer organisation working on various issues of public interest including healthcare, CUTS feels that this step by the government will not only reduce indiscriminate use of antibiotics but also help in stopping irrational drug use. In addition to making retail chemists answerable, audit of prescriptions would also help scrutinise prescription patterns of doctors.

A recent study by CUTS in two states (Assam and Chhattisgarh, available at: www.cuts-ccier.org/COHED revealed that prescription pattern of doctors is often influenced by commercial motives. Further, in most cases (both public and private healthcare) prescriptions do not have any evidence of preliminary diagnosis that is obligatory according to standard treatment protocol. It is unfortunate how ‘unholy alliances’ in healthcare affect consumers’ access to healthcare – especially in our country where social protection measures are seldom in place. Consumers have no choice and end up spending much more on medicines/healthcare, than they should. The existence of concerted arrangements/practices between providers increases the cost of healthcare services and makes it unaffordable, especially for the poor and the disadvantaged.

CUTS strongly advocates the introduction of prescription audit to cover all drugs, not only antibiotics as the current legislation mandates. This system (of retaining prescriptions) is prevalent in many countries and has been effective in curbing irrational drug use effectively. It is true that the government faces an uphill task of implementing the system of prescription audit, as some observers also feel. However, it is a positive step in the right direction to operationalise ‘right to health’ as enshrined in Constitutional commitments in India and also in the pending National Health Bill.