Measures Needed to Streamline Health Care System

To Contain Black Marketing of Pharmacy Drugs; To Contain Fake Pharmacy Drugs

To Ensure Rational Prescriptions by Doctors; To Contain Extortion by Private Hospitals
To Ensure Transparency in Hospital Bed Allocation; To Ensure Health Care for All at All Times

Unfortunately, India facing the unprecedented situation of crumbling of the health care system, and people are
subjected to exploitation by vested interests- viz middlemen, some pharmacy retailers, and most private hospitals
are using helplessness and desperation of people to save their loved ones. Shocking the hospital beds in Govt/private
hospitals are available only at the recommendation of some influential persons in the govt or business or society,
common people a treated like third-rated citizens in their own country in private hospitals.

People feel, left at mercy of God i.e Ram Bharose by Govts, amid temporary course corrections initiated by Govt are
too late and too small, as people are asked to bring oxygen, bring their life-saving medicines by hook or by crook to
get treatment at hospitals, patient's attendants made to run pillar to post to get medicines, never seen this kind of
utter chaos anywhere in the world.

An open secret that some pharmacy retailers are indulging in hoarding and black marketing of essential pharmacy
drugs, and selling at skyrocket prices at the whims and fancies exploiting people, shocking apathy, when essential
medicines which are administered in hospitals, must be available /sold to hospitals are asked to brought by patients'
attendants, so as Oxygen supply to patients should be the responsibility of Hospitals, not patients' attendants.

I have specifically mentioned in my document, "Simple and effective reforms for Controlling Corruption" Year 2011,
in the Health care and Pharmacy sector reforms subheading Pg no 30 to 34 emphasizing the need for Digitalisation
of Health Care System, and Centralisation and Real-Time Data Monitoring, starting with doctor prescriptions to
medicines - sale to the stock position of every single pharmacy drug in every pharmacy retail store to distributor to
manufacture, details of every single bed occupant, date of discharge and availability of bed in every hospital and
charges for treatment, to bring in required transparency and to contain possible frauds by any vested interests.

Thanks to GOI for the initiation of digitalization of healthcare records in 2016, (e-health care records in the name of
Digital Kranthi- Digital India) on a pilot basis, but unfortunately, it did not scale up to cover all states.

Also, in my document, "Simple & effective… I emphasized the need for GOI to establish "Central Pharmacy Network
Authority" connecting all pharmacy retailers, all pharmacy distributors, all pharmacy C&F agents, and all pharmacy
manufacturers in a single network with real-time monitoring by Govt, from production in manufacturing unit,
distribution from manufacture to C&F agents/ distributors and from distributors to retailers and sale of every single
strip/bottle/ tube/vial at retailer be recorded live and auto sharing in the network enable better planning /
redistribution, in addition, can contain unauthored sale, duplicates of the same brand, ensure entire production at
manufacture is authorized and taxed., and easy withdrawal of expiry date medicines, improve revenues of Govt. too.

Since a majority of pharmacy retailers in urban areas and some in rural areas maintain computer records, and in cities
most of the pharmacy retailers are a chain of retail stores, implementation of this measure (Centralised monitoring
of real-time data by Central Pharmacy Network Authority) is simple, and in rural areas, where the power supply and
also mobile internet network is an issue, they too can have a computer system with UPS, solar-based, (GOI must
provide subsidy) and they can record every single sale in the computer system and upload once in a week to central
pharmacy network authority data by copying their weekly sale data in mini storage devices like pen drive or portable
hard disks and the data will be uploaded through designated pharmacy retailer in that Mandal/ vicinity who is having
strong mobile /internet data network. GOI initiative of broadband to every village once made functional then this
issue of internet data may not arise.

It is an open secret that even most of the pharmacy retailers despite maintaining the computerized billing system do
not issue computer bills for all sales and also most of the pharmacy retailers maintain small hand notebooks, in-spite
computerization, handwritten notes of sale/ stock, etc are in general maintained by the proprietor or owner or their
trusted persons of the owner. People opinion this is an indication that there exists some unauthored stock/sale and
the same brand /low-quality API- Active Pharma Ingredients to save costs of same brands by manufacturers for more

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profits, especially the long term medication pharmacy drugs used for diabatic control, heart, anti-depressants,
cancers, etc, where people need to use for years, even contra brands sale, all these illegal sales can't be entered in
regular books of accounts (so maintain chit notebooks), all this may be in connivance/nexus with the manufacturer
or only retailers doing an illegal sale of contrabands.

People feel there is every possibility of an organized pharmacy corruption mafia ring from the manufacture, the Govt
excise officials, allowing excess production, but excise bills show only standard production and the same excise
permits be used for excess production, and the same will be distributed by the same network of distributors and C&F
and retailers and they may not be shown in the books of accounts and run parallel illegal accounts. There exist several
cases of substandard/low-quality pharmacy products in govt findings or importers in the foreign country rejected.

I suggested in my document – “Simple effective reforms to control corruption”- year 2011, measures needed to
contain sub-standard/excess production by manufacturers - by Govt making it mandatory to disclose the quantity of
raw material procured, quantity of wastage in each type of production process by all manufacturers, quality analysis
by the same type of manufactures association, in addition to Govt quality checks. This measure on implementation
in the pharma sector ensure quality & standard quantity of API's are used in every batch of production of pharmacy
drugs, also suggested the establishment of Central Materials Movement Authority to monitor the transport of raw
material and finished goods - thanks GOI implemented the same as E-way Bills in the GST recently.

All Pharmacy sector frauds can be contained to great extent by establishing Central Pharmacy Network Authority via
monitoring real-time sales with the mandatory all sales against doctor’s prescription or authorization from a doctor
who suggested such medicines. But this idea/ reform does not see the light of the day.

Recently GOI intended to bring measures to regulate App based / E-commerce based/ online sale of medicines i.e-
retailing of pharma, all this when the pharmacy retailers’ associations raised their objections to the online sale of
pharmacy products, but failed to induce a mechanism as suggested in my document to know the online real-time
sale/ stick position of evet scheduled drug.

In my document "Health Care for All"- Year 2012, I suggested a slew of integrated measures to ensure health care
for all, where I specifically suggested the need for increasing Govt Spending on Health Care to ensure the availability
of at least One Hospitals for 1000 people and 5.64 Hospital Beds for 1000 people, (with all necessary medical
equipment including oxygen point at bed, not just bed!?) as recommended in 1946 by Sir Joseph Bhore Committee
or Health Survey and Development Committee, in a fixed time frame. Also retreated need for digitalization of all
hospital data with details patient's admission, discharge, availability of beds/operation theatre dates, etc with online
real-time data as was suggested in my document "Simple Effective Reforms …" - the year 2011.

This measure not only enables patients/ doctors to plan to get admitted in the hospitals where beds are available in
case of emergency on the suggestion of the doctors, rather than waiting for hospital bed/ operation theatre vacancy.
This data of patient admissions if integrated with Crime and Criminal Tracking Network & Systems (CCTNS) ensure
criminals who are evading police be brought to justice.

Also suggested Bar Coding of Doctor Prescription forms to eliminate Quacks/fakes, to ensure rational prescriptions,
to contain self-medication and monitor the use/ issue of medicines and ascertain the epidemics outbreaks and also
to contain duplicate/contra brand drugs sale by making it a mandatory issue of medicine on reading/ validating bar
coded prescription, in case of tele constancy/ emergency they can issue medicine by following stand checks and
balances, authentication of doctor for oral/ prescription of medicine in an emergency, and to contain self-medication,
to ensure the patients are in constant touch with doctors, rather than the use of old prescriptions to procure
medicines with the wrong notion, their new illness is similar to earlier as identified by doctor and old treatment
works, when this wrong step and self-medication, make patients prone to severe long term illness.

Also proposed Bar-coded Doctor prescriptions enable pharmacy manufacturers to continue incentivizing doctor's
every time doctor recommend a medicine when patients source /use, (GOI may legalize incentivization of doctors by
pharmacy manufacturers with fixing a limit on incentives, to ensure ethical practice by doctors), sale of medicine at
pharmacy retail only against bar coded prescription will enable doctors to know the patient's conditions better due
to less self-medication, and also useful in analyzing the effectiveness of medicines by pharmacy manufactures/ drug
regulators due to large volumes of data, also enable doctors to ethical practices and contain irrational prescriptions,
suggested establishing medical ombudsman system which will further ensure doctors adhere to ethical practices.
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Suggested need for fixing "Uniform charges for all Diagnosis & all Treatments in all Hospital & Diagnostic Centres"
of the same grade by grading the private hospitals by making them provide details online real-time in a standard
format by all hospitals and nursing homes, this provides transparency accountability and affordability and contain
exploitation of patients by private hospitals. Govts fixed price cap on only a few services, and not all
services/treatments, leaving private hospitals to act according to their whims and fancies exploiting patients in one
other name of medical service. Govts must fix the cap on all diagnostics and treatment costs both in Govt and private.

Ideal GOI should take over all existing Private Hospitals and pay the capital investment of the promoters, bank loans
with interest in EMI's stretched over 20 years. Health care should be 100% under Govt control, then only all sections
of people can get health care, the best way forward for sustained development and inclusive growth, as the progress
of the Nation, is proportionate to the health of the population.

Also suggested the need for setting up of Medical Ombudsman System a dispute resolution mechanism to deal with
the disputes due to failure / wrong diagnosis/ wrong treatment by the hospitals.

Also suggested for Medical Insurance for All sections of people, to ensure no put of pocket expenses by any section
of people, whether employees of Govt or private or PSU or MNREGA or farmers, I have provided best possible
methods without much burden on people or Govts making health care a collective responsivity of Employee,
employer, and Govt., this shared measure reduce the financial burden of paying the insurance premium on all.

Also suggested to make it mandatory for by every large employer whether PSU or Private Industry /Business
establish Captive Hospitals for their employees and their families, from initial capital investment / turnovers, in the
vicinity of residential premises of their employees or provide capital to private hospitals/govt hospitals for capacity
addition, as a collective responsibility of all stakeholders rather than only depending on Govt., and use of the ideal
capacity of diagnostics/beds/ operation theatres for general public/ swap with nearby other Govt/ private hospitals,
had this made a reality the ratio of patients to beds could have improved near good position, this measure could
reduce the load on govt hospitals/ private hospitals, especially situated in cities, cater rural population needs, as most
industries are situated near to rural areas. When setting up of industry with hundreds/ thousands of crores of rupees
investment, and receiving Corporate tax rate cuts by Govt to the tune of lakhs of crores of rupees, can't they set up
with a fraction of capital for hospitals for captive use for health care of their employees and their family members!?

Thanks to Prime Minister for the rollout of the Ayushman Bharat- Health care for Poor, but the reality is without
capacity addition in medical infrastructure i.e hospitals, hospital beds, doctors, supporting staff ensuring 1000
population has at least 5 beds and the corresponding ratio of doctors/ medical staff in Govt/ Private implementation
of health care for all is a mirage, it is appears Ayushman Bharat scheme deviated from its original purpose of serving
the poor became, a "cash cow" to enrich the select few private hospitals in the name of treatment of poor by Govt.

Thanks to GOI for increasing the number of medical seats recently, but needs further scaling up, I suggested in my
document for the Four-Year Basic Medicine Course, unfortunate that the NEP 2020 did not focus on creating Four-
Year Medical Degree course only for general medicine without surgery, and for surgery five-year regular course, to
enable scaling up of medical doctors to maintain an optimal ratio of doctor to patient is a reality.!

I suggested for Mandatory "Manufacture of Essential Medical Consumables by Govt", especially "Manufacturing of
Medical Oxygen in every District", and given a detailed description with a need for the establishment of oxygen
plants by Govt in every district with a capacity based on the population and also mandatory every major hospital has
an oxygen plant within the hospital premises and supply of oxygen in piped oxygen gas directly to the hospital
beds/ventilators, instated of heavy cylinders which costs more and rifling is an issue and provided the costings.

Thanks to Prime Minister, at last, intervened and expressed that GOI install over 550 oxygen plants in every district,
after the loss of thousands of people due to lack of oxygen, and, till the supply-demand mismatched may persist, till
every major hospital has its oxygen plant and online real-time audit of oxygen usage/ demand. Every life matters.!
Had Govt established Oxygen Manufacture Plants in every district as suggested in My Doc year 2012, earlier,
thousands of lives Could be saved! Good some of the state govts announced to establish oxygen plants in hospitals.

Suggested "Regulating Cost of All Medicines” Manufactured / Sold in India to contain exploitation by
manufacturers/retailers chagrining 1000% to 5000 % markup price to the cost of production, by GOI fixing the markup
price to a maximum of 100% on all scheduled pharmacy drugs, GOI had fixed cap on price and reducing the cost of

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few of essential medicines only, bringing Jan Aushadi, the low-cost medicines, it needs appreciation, as few sections
of people are benefitting, high time GOI fix markup price on all medical drugs manufactured/sold in India in the larger
interest of all sections of people and Nation.

Suggested "Centralised Purchase of Medicines and Distribution", to ensure more transparency, accountability in the
Govt, also buying in bulk will be certainly cost-effective and save tax-paid money of states/ central govt., need for
states to procure medicines or vaccines does not arise!?

Also, it is certainly a matter of great concern for millions of people due to Govts' enforcing people to download and
use hurriedly developed App-based for registration of beds/slots for consultation /oxygen needs, etc putting the
personal data of the patients at risk due to lack of robust testing/system for protecting personal data of patients.

My two documents

1) “Simple and Effective Reforms for Controlling Corruption” Year 2011

- Health Care & Pharmacy Sector Reforms Pg 30-34
https://www.scribd.com/document/113775082/CORRUPTION-CONTROL-CURBING-BLACK-MONEY

http://pradeepkunche.blogspot.com/2011/12/simple-and-effective-reforms-for.html

2) “Health Care for All” Year 2012

https://www.scribd.com/document/113777090/HEALTH-CARE-FOR-ALL

http://pradeepkunche.blogspot.com/2012/09/suggestions-for-needed-reforms-in.html
were shared with all Ministers in UPA-2 GOI and all Chief Ministers in Congress Ruled States with official
acknowledgments from most of the Ministers in GOI/ CM's, confirmed circulation, NDA GOI implemented some of
the ideas, as suggested, but most, unfortunately, core suggestions to fix lacunas in Health Care System have not seen
the light of the day

High time GOI and State Govts Synergy and implement the suggested measures in my documents on Health Care in
toto, especially core ideas/suggestions to fix the lacunas in Health Care System like "Central Pharmacy Network
Authority", "Centralisation of Data and Real-Time Data of Availability of Hospital Beds", "Bar Coding of Doctor
Prescription", "Uniform Charges for All Diagnosis & Treatments", "Regulating Cost of All Medicines Sold in India"
etc on priority bases, a permanent solution, in addition, to the existing measures to prevent further crumbling of
Health Care System in India and ensure Health for All prevail in all circumstances.

In addition, keeping in view of the population of India, with present Health Infrastructure, vaccination giving only
partial relief for COVID (in spite full dose vaccination, virus is infecting), mutated variants of virus escape the anti-
bodies generated by vaccines making vaccines ineffective, High time rather than only depending on Rushed Vaccines
GOI exhibit sagacity, should focus and support all "Treatment Based Solutions" for COVID, especially AYUSH/Applied
AYUSH - Phyto Pharma (Edible Food / Plant) based Solutions with scientific evidence, having SARS-CoV-2
neutralising/inhabiting capacity, (I suggested & shared technical details & pre-clinical study details, with all concerned
in GOI, State Govts, since March 2020, requesting them from time to time seeking support in the larger interest of
People, Nation, Humanity) which are suitable for all ages, people with comorbidities, Over the Counter Medicines.

Jai Hind.

Pradeep Kumar Kunche

Think Social Engineering Think Me
[email protected]
www.Scribd.com/Pradeep_kunche
www.pradeepkunche.blogspot.com
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Note: Salute to all COVID Warrior Frontline Workers, Nursing Staff, Doctors - IMA & Pharmacists- AIOCD, Pharma Manufactures Employees for their Stupendous Service

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