The Path to Affordable Healthcare: Evaluating Nepal's 'Sulav Pharmacy' Initiative

Nepal is a developing nation where the lack of basic services and access to healthcare remain significant challenges. Due to geographical diversity, economic inequality, and political instability, a large portion of the population is deprived of basic health services and affordable medicines.

The Constitution of Nepal, 2072, establishes health as a fundamental right. Under this constitutional provision, every citizen has the right to receive basic health services free of charge, making it the state's responsibility to provide quality medicine at affordable prices.

Currently, most medicines in Nepal are marketed under brand names, and doctors often prescribe these instead of generic alternatives. Despite the Public Health Service Act, 2075, requiring generic prescriptions and government-run pharmacies, these provisions remain largely unimplemented, forcing the public to pay exorbitant prices set by pharmaceutical companies.

• The Concept of Sulav Pharmacy

The 'Sulav Pharmacy' (Affordable Pharmacy) concept aims to increase citizen access to quality medicine at minimum costs in government hospitals and health institutions, thereby reducing 'out-of-pocket' expenses.

In neighboring India, the Pradhan Mantri Bhartiya Janaushadhi Pariyojana has been operating since 2008, with over 16,000 pharmacies providing medicines at 50-90% lower costs than branded versions, saving citizens over 30,000 crore rupees. Similarly, Sri Lanka's State Pharmaceuticals Corporation, established in 1971, serves as a global model for affordable medicine, recognized by the World Health Organization. Nepal must learn from these practices.

The newly elected government has included the operation of Sulav Pharmacies in its 100-day governance reform agenda. However, before implementation, the government must undertake significant structural reforms in the healthcare sector.

Effective implementation could prove to be a milestone for Nepal's pharmaceutical sector, providing economic relief to low-income families, curbing black marketing, and ensuring uniform quality and pricing of medicines.

• Risks and Challenges

Existing public procurement laws, quality control mechanisms, and supply chain management issues pose significant hurdles. The current procurement law, which prioritizes the 'lowest bidder,' is ill-suited for sensitive items like medicine. Furthermore, regulatory bodies like the Department of Drug Administration and the National Medicines Laboratory currently lack the capacity to effectively regulate and test quality.

Resistance from doctors, who prefer brand-name prescriptions, and potential opposition from wholesale and retail traders, whose livelihoods may be impacted, are also major challenges that the government must address through policy safeguards.

• Roadmap for Policy Reform

To make healthcare accessible, Nepal must shift its perspective on health from a mere business to a vital service sector. Key reforms include defining medicine as a 'special commodity' rather than a construction material, implementing the Quality and Cost-Based Selection (QCBS) model for procurement, and strictly enforcing generic prescriptions as per the Public Health Service Act, 2075.

The government should initiate the Sulav Pharmacy program as a pilot project in high-density areas before a nationwide rollout. Additionally, establishing state-of-the-art government drug storage centers in all seven provinces and ensuring transparent bulk procurement directly from manufacturers is essential.

• Conclusion

The success of the Sulav Pharmacy initiative depends on the timely amendment of procurement laws and a robust quality control framework. If implemented correctly, this could be a historic step for Nepal's public health sector. The government must integrate this with existing insurance programs and local health post improvements to create a comprehensive, sustainable, and exemplary public health system.

(The author is a public health professional and the focal person for the Kathmandu Metropolitan City's Sulav Pharmacy.)