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303Introduction to Health Systems
conducted over the years in high-risk areas. Over 170 million
children are immunized during each NID and 77 million in
SNID. The last reported cases of wild polio in India were in
West Bengal and Gujarat on 13 January 2011. On 27 March
2014, WHO declared India a polio-free country, since no cases
of wild polio were reported for five years. At present in routine
immunization, bivalent oral polio vaccine (OPV) drops are
given to all children under the age of 5 years, and inactivated
polio vaccine (IPV) to children less than one year of age.
Strategies for polio eradication are as follows:
1. The Pulse Polio Immunization (PPI): It aims at
reaching and immunizing every child in the country
through improved social mobilization and the setting
up of vast networks of booths in all parts of the country
leaving no chance of polio occurrence.
2. Mop-up immunization: Performance of good mop-up
operations in areas where polio has almost dis-
appeared, and to maintain a high level of morale among
the public.
3. Acute flaccid paralysis (AFP) surveillance: Acute
flaccid paralysis (AFP) is defined as a sudden onset of
paralysis/weakness in any part of the body of a child
less than 15 years of age. AFP surveillance allows the
detection of paralytic poliomyelitis due to wild
poliovirus transmission in the population. Maintaining
a high level of surveillance for AFP is critical for
documenting the absence of poliovirus circulation for
poliomyelitis eradication. Cases of AFP are to be
immediately reported in time and stool specimens of
them are to be collected within 14 days. Outbreak
response immunization (ORI) is to be conducted as
early as possible.
4. Publicity: Extensive publicity by replacing the national
telecoms’ authority ringtone with a vaccination day
awareness message, posters, TV and cinema spots,
parades, rallies, and one-to-one communication from
volunteers.
304 Social Pharmacy
REVISION QUESTIONS
Long Answer Questions (10 Marks)
1. Discuss various barriers to healthcare access in rural areas.
2. Describe levels of healthcare.
3. Discuss rural healthcare services.
4. Discuss the services provided by the Sub-Health Centre
(SHC).
5. How is primary healthcare provided at the village level?
6. Explain the Indian Public Health Standards (IPHS) for
PHC.
7. Explain the functions of the PHC.
8. Discuss the salient features of the National Health Mission.
9. What are the roles and responsibilities of ASHA?
10. What are the salient features of ongoing national health
programs?
Short Answer Questions (5 Marks)
1. Mention the elements of primary health care.
2. What is the duration of training for village health?
3. Discuss the role and responsibilities of traditional birth
attendants (TBA).
4. Discuss the role of anganwadi workers (AWW) at the
village level under the rural health scheme.
5. What is a health centre? Write its functions.
6. What is a primary health centre? Write its functions.
7. What are the goals of the National Health Mission?
8. Write a note on the job responsibilities of ASHA under
NHM.
9. Enumerate functions of multipurpose worker (female).
10. What is a three-tier system of healthcare delivery?
Very Short Answer Questions (2 Marks)
1. Define community services.
2. Define community health.
305Introduction to Health Systems
3. What are the duties of health guides under the Village
Health Guides Scheme?
4. What is the role of traditional birth attendants (TBAs)?
5. What is SHC?
6. What is NHM?
7. What is Urban-Primary Health Centre (U-PHC)?
8. What is Urban-Community Health Centre (U-CHC)?
9. What is the role of traditional birth attendants (TBA?
10. What is the role of ASHA?
Multiple Choice Questions [answers are in bold]
1. The World Health Organization (WHO) defined the
concept of primary healthcare (PHC) as:
a. Geneva
b. India
c. Alma Ata conference
d. France
2. The Rural Health Scheme was launched by the Govern-
ment of India in:
a. 1970
b. 1980
c. 1998
d. 1977
3. Which is true regarding an Anganwadi worker?
a. Part-time worker
b. Undergo four-month training
c. Selected from the community itself
d. All of the above
4. Anganwadis are under:
a. Ministry of Health and Family Welfare
b. Ministry of Labor
c. ICDS scheme
d. None of above
5. Each Local Dai undergoes a training for:
a. 2 Months
b. 1 month
306 Social Pharmacy
c. 3 months
d. 1 year
6. Which is true regarding Primary Health Centre?
a. Provide basic laboratory workers.
b. Educate the community about health.
c. Provide maternal-child health including family
planning.
d. All of the above
7. As per the norm, one U-PHC is required for approxi-
mately:
a. 10,000–20,000 urban populations
b. 50,000–60,000 urban populations
c. 10,000–20,000 rural population
d. 50,000–60,000 rural populations
8. The first contact point between the community and the
primary healthcare system is:
a. Village health guide
b. Subcentre
c. Childcarecentre
d. None of above
9. How does the World Health Organization (WHO) define
community health?
a. Providing specialized care in urban areas
b. Sustaining emotional and physical well-being in
unique environments
c. Focusing solely on individual health
d. Offering tertiary care to populations
10. What is the primary focus of primary healthcare?
a. Specialized consultations
b. Rehabilitation and palliative care
c. First level of contact and comprehensive care
d. Tertiary health interventions
11. Which level of healthcare serves as the first referral point
for complex health problems?
a. Primary Healthcare
b. Secondary Healthcare
307Introduction to Health Systems
c. Tertiary Healthcare
d. Community health centers
12. What is the primary function of a sub-centre in rural
healthcare?
a. In-patient care
b. Tertiary care
c. First contact point for primary healthcare
d. Specialized surgeries
13. What is the recommended population norm for establish-
ing a sub-centre in plain areas?
a. One for every 5000 population
b. One for every 20,000 population
c. One for every 8000 population
d. One for every 6000 population
14. What is the staffing pattern for a sub-centre?
a. One female health assistant
b. One male health assistant
c. One female ANM and one male MPW
d. One male ANM and one female MPW
15. How many sub-centers are typically under each primary
health centre (PHC)?
a. 1 to 4
b. 4 to 6
c. 8 to 12
d. 12 to 16
16. What is the main criterion for classifying a PHC as Type A
or Type B?
a. Number of beds
b. Number of nurses
c. Load of delivery cases
d. Presence of surgical facilities
17. Which type of health program focuses on specific health
conditions and is frequently found in areas with poverty
and epidemics?
a. Horizontal health program
b. Integrated health program
308 Social Pharmacy
c. Vertical health program
d. Comprehensive health program
18. What is the purpose of the Integrated Disease Surveillance
Project (IDSP)?
a. Improving water quality
b. Controlling non-communicable diseases
c. Strengthening disease surveillance and response
d. Enhancing agricultural productivity
19. Which type of surveillance involves active search and
collection of information during outbreaks?
a. Passive surveillance
b. Sentinel surveillance
c. Active surveillance
d. Laboratory surveillance
20. What is the main focus of the National Health Mission
(NHM) in India?
a. Controlling non-communicable diseases
b. Achieving universal access to healthcare services
c. Promoting international collaboration in health
d. Implementing education programs for health profes-
sionals
21. Which organization supports the National Leprosy
Eradication Programme (NLEP) as a partner?
a. Pharmacy Council of India
b. International Red Cross
c. WHO
d. UNESCO
22. What is GIS Mapping used for in the National Leprosy
Eradication Programme?
a. Treatment of leprosy cases
b. Planning, implementation, and monitoring activities
c. ASHA training
d. Mental health awareness
23. When was the National Mental Health Program (NMHP)
implemented?
a. 1985
b. 2002
309Introduction to Health Systems
c. 1992
d. 1982
24. What are the main strategies of the NMHP?
a. Increasing stigmatization
b. Integrating mental health services with primary
healthcare
c. Ignoring regulatory institutions
d. Establishing mental health hospitals only
25. When was the National Programme for Prevention and
Control of Deafness (NPPCD) launched?
a. 2006
b. 1997
c. 2011
d. 20002
310 Social Pharmacy
INTRODUCTION
Medicines constitute a major portion of the expenditure from
the pocket of a patient. But medicines are statutorily recognized
as ‘essential commodity’ and all essential commodities should
always be available to the general public at a reasonable price.
In the absence of any statutory control, a manufacturer could
sell his drugs at exorbitant prices, which is not only against
the public interest but also against the concept of a welfare
State. Under the Essential Commodities Act, of 1955 the Central
Government is empowered to control the production, supply,
distribution, etc. of essential commodities, including drugs.
In 2012, the Government of India realized the need to put
an end to soaring prices of medicines. The Government notified
the National Pharmaceutical Pricing Policy (NPPP), 2012 with
its main objective being the establishment of a regulatory
framework for the pricing of drugs to ensure the availability
of ‘essential medicines’ at affordable prices.
The Drugs (Prices Control) Order, 2013 ensures equitable
distribution of essential bulk drugs and fixes the maximum
retail prices of drug formulations to curb the exorbitant
profiteering in drug manufacturing and distribution.
The demand and the cost of healthcare is increasing day by
day due to:
i. Increased life expectance.
ii. Advanced technology.
iii. Increased standard of living.
iv. Increased demand for healthcare quality and services.
Pharmacoeconomics
6
311Pharmacoeconomics
The increasing cost of medicines and health care is a matter
of concern to the people especially those in need of medical
services with limited financial resources. Healthcare providers
are also struggling to meet the rising costs.
History
Pharmacy was finally recognized as a clinical discipline within
the healthcare system in the early 1960s. At this time, disciplines
within the pharmaceutical sciences such as clinical pharmacy,
drug information, and pharmacokinetics became an important
part of pharmacy education and sciences. The term
Pharmacoeconomics was coined by Ray Townsend in 1986 in
Canada. The pharmacoeconomics started with a study of the
cost-effectiveness of AZT (azidothymidine, also known as
zidovudine) for the treatment of persons with AIDS.
Pharmacoeconomics is a sub-discipline of health economics
that applies the principles and methodology of health
economics to the field of pharmaceutical policy. It evaluates
the cost and benefits of different drugs/pharmaceutical
products, services, and programs so that the choice of an
efficient drug or service provider can be made economically. It
uses cost-benefit, cost-effectiveness, cost-minimization, cost-
of-illness, and cost-utility techniques to compare one pharma-
ceutical drug or drug therapy to another. Pharmacoeconomics
is defined as “a branch of health economics, which particularly
focuses upon the costs and benefits of drug therapy”.
Pharmacoeconomics compares the therapeutic value of one
pharmaceutical drug or drug therapy to another. Pharmaco-
economics has been defined as the description and analysis of
the cost of drug therapy to healthcare systems and society. It is
the application of economics to assess pharmaceutical and
healthcare products that help evaluate economic, clinical, and
humanistic outcomes of healthcare products and interventions.
The National Pharmaceutical Pricing Authority (NPPA) was
set up as an office of the Department of Pharmaceuticals on 29
August 1997. NPPA is a government regulatory agency that
controls the prices of pharmaceutical drugs in India. It ensures
312 Social Pharmacy
the availability and accessibility of medicines at affordable
prices in India.
The main goal of pharmacoeconomics is to find the cheapest
alternative.
Components of Pharmacoeconomics
A. Economic components
1. Cost-benefit
2. Cost-effectiveness
3. Cost minimization
4. Cost-Utility
B. Humanistic components
1. Quality of life
2. Patient preferences
3. Patient satisfaction
A full pharmacoeconomic analysis should address the
following two questions:
i. Are two or more alternatives being considered?
ii. Are both costs and consequences of each alternative
being considered?
Basic Terminologies
Economics: It is the study of the allocation of limited
resources or inputs among alternative users to satisfy unlimited
wants for outputs as follows.
Health economics: It is the field of study that evaluates the
behavior of individuals, firms, and markets in healthcare. It
usually focuses on the inputs (cost) and outcomes (conse-
quences) of healthcare interventions, such as the use of drugs,
devices, procedures, services, and programs.
Efficiency: Efficiency means how to buy the greatest amount
of benefit for a given resource use. Pharmaceutically, efficiency
is a means to promote the efficiency and effectiveness of
prescribing. In simple language efficiency measures whether
healthcare resources are being used to get the best value for
money.