Access to medicines in the Indian Public Health System – what works and what does not? A review of the National Health Mission Common Review Mission Reports (2007-2021)

Since the inception of India’s flagship “National Health Mission” (formerly known as the National Rural Health Mission), considerable efforts have been made to ensure access to quality and affordable healthcare, including medicines. Over time, there has been a differential, yet noticeable improvement in the availability and access to medicines across states. This underscores the need to review and analyse various state-specific practices in India supported or recommended by the NHM, to identify key enablers and barriers. Consequently, a review of NHM’s Common Review Mission (CRM) reports between 2007 and 2021 was undertaken. All findings relevant to medicines were identified, retrieved and analysed. Core themes pertaining to medicines included: mechanisms adopted by states for procurement and supply chain management, health system factors influencing the supply chain, the convergence of national health programs, the rollout of the Free Drugs Service Initiative and Comprehensive Primary Health Care, and awareness among the healthcare providers and community. The article further expounds on these themes in the Indian context, highlighting the determinants of access to medicines as well as their interlinkages. In conclusion, it underscores the need to strengthen the overall health system to accelerate universal access to free essential medicines at public health facilities.