procure any drugs outside the list except for 10 per cent of the budget spent on drugs which was decided earlier. Any infringement of this order issued by the Minister of Health and Family Welfare in June 1995 would be looked into carefully. This change from obtaining drugs without any common list to obtaining those only on the list was carried out even before the new procurement system had been introduced. It was so done to convince the prescribers that once a common list had been prepared by them it was important not to prescribe any more drugs outside this list as that would be irrational. A further List of Drugs to be used at the Primary Health Centre and Dispensary level has also been prepared. This contains seventy five drugs. Only these seventy five are being supplied to these primary health centre and dispensaries and they necessarily have to use only these drugs. Standard Treatment Schedules are being prepared for use at this level and deals only with these limited drugs will be described.

The selection of the Essential List of Drugs is a dynamic process and already, before the second procurement cycle begins meetings have been held to modify the first list as necessary. Some drugs from the first list have been dropped because the committee feels there is no need for these. Others were dropped because these were not available in the market.

The only one change made during the implementation of this programme from what was stated in the Drug Policy Statement was that for one highly specialised hospital in the Delhi State the quantum of drugs to be purchased outside the list was raised from 10 per cent to 20 per cent in view of their need, in limited quantities, for special drugs for high sophisticated procedures. Experience in limiting prescribing to the drugs on the list is most satisfactory - drugs not in the list are not obtained and not available at the hospitals.

References

1.	Rational Drug Policy for the People. Calcutta: Rational Drug Campaign Committee, 1992. pp.28.
2.	Indian Pharmaceutical Guide, New Delhi: Pamposh Publications, 1994. pp.7. Also Report of the Working Group on Drugs and Pharmaceuticals for the 9th Five-Year Plan Period, cited in IDMA Thirty-Fifth Annual Publication, 1997, Bombay.
3.	The Selection of Essential Drugs. Technical Report Series 615. Geneva: WHO, 1977.
4.	ibid.
5.	The Use of Essential Drugs: Model List of Essential List (Tenth List). WHO Technical Report Series 825. Geneva: World Health Organization, 1996.
6.	A Rational Drug Policy: Problems, Perspective and Recommendations. New Delhi: AIDAN/VHAI, 1986.
7.	Huss, Carol, ed. The Banyan Tree: a Textbook for Holistic Health Practitioners, Vol.I. Pune: Sahaj/Medical Mission Sisters, 1989. See also Chowdhury, Zafarullah. The Politics of Essential Drugs. New Delhi, Vistaar Publications, 1995.
	8. Indian Pharmaceutical Guide. op cit. pp.5. and IDMA, op.cit.
9.	Memorandum - Review of National Drug Policy and Views on the 1986 Drug Policy. New Delhi: VHAI/AIDAN, 1993.
10.	Bhagat, Mukarram. Aspects of Drug Industry in India. Bombay: CED, 1982.
11.	Phadke, Anant et al. A Study of Supply and Use of Pharmaceuticals in Satara District. Pune: Foundation for Research in Community Health, 1995.
	See also: Phadke, Anant. Drug Supply and Use:Towards a Rational Drug Policy in India. New Delhi: Sage Publications, 1998.
12.	Beardshaw, V. Prescription for Change. Penang: IOCU/HAI, 1983.

Annexure 1

Criteria for Withdrawal of Irrational and Hazardous Drugs:
the Bangladesh Example

Bangladesh used the following 16 criteria to rationalise its drugs in its country in 1982. The criteria resulted in Bangladesh having 150 drugs for tertiary care, 45 drugs for primary health care and 12 drugs for village health care workers. The policy included preparation of a national drugs formulary, price control. These with other measures, most important of which was strong support from the government, have actually resulted in the reduction of drug prices over the last decade. (For a detailed analysis of the policy and subsequent developments, see Chowdhury, Zafarullah. The Politics of Essential Drugs, op.cit.)

 

1.	The combination of an antibiotic with another antibiotic, or antibiotics with corticosteroid, or other active substances will be prohibited.
	The manufacture in liquid form of antibiotics harmful to children (e.g. tetracycline) will not be allowed.
2.	The combination of analgesics in any form is not allowed as there is no therapeutic advantage and it only increases toxicity, especially in the case of kidney damage. The combination of analgesics with iron, vitamins or alcohol is not allowed.
3.	The use of codeine in any combination form is not allowed as it causes addiction.
4.	In general, no combination drugs will be used unless there is absolutely no alternative single drug available for treatment or if no alternative single drug is cost-effective for the purpose.
	Certain exceptions will be made in the cases of eye, skin, respiratory and haemorrhoidal preparations, co-trimoxazole, oral rehydration salts, antimalarial, iron-folic, etc., as well as certain vitamin preparations, allowing combinations of more than one active ingredient in one product.
5.	Vitamins should be prepared as single ingredient products with the exception of B complex. Members of vitamin B complex, with the exception of B12, may be combined into one product. B12 should always be produced as a single-ingredient injectable product. Other members of B complex may also be produced as a single-ingredient product (e.g. B1, B2, B6, etc). The combining of Vitamins with any other ingredient such as minerals, glycerophosphate, etc. will not be allowed. Vitamins may be produced in tablet, capsule and injectable form only.
	No liquid forms will be permitted because of wastage of financial resources and the tremendous misuse involved. However, the manufacture of paediatric liquid multivitamins (with no B12, E, K and/or minerals) will be allowed in bottles of 15 ml size with droppers. The manufacture of paediatric liquid preparations of single ingredient vitamins will also be allowed in bottles of upto 15 ml with droppers.