Preprint / Version 1

Private pharmacies as healthcare providers in Odisha, India: analysis and implications for universal health coverage

Authors

  • Anuska Kalita Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
  • Bijetri Bose Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
  • Liana Woskie Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
  • Annie Haakenstad Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
  • Jan Cooper Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA
  • Winnie Yip Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA

Keywords:

Health systems, Health policy, Health services research, Health systems evaluation

Abstract

Introduction In India, as in many low-income and middle-income countries, the private sector provides a large share of health care. Pharmacies represent a major share of private care, yet there are few studies on their role as healthcare providers. Our study examines: (1) What are the characteristics of and services provided by private pharmacies and how do these compare with other outpatient care providers? (2) What are the characteristics of patients who opted to use private pharmacies? (3) What are the reasons why people seek healthcare from private pharmacies? (4) What are the quality of services and cost of care for these patients? Based on our findings, we discuss some policy implications for universal health coverage in the Indian context. Methods We analyse data from four surveys in Odisha, one of India’s poorest states: a household survey on health-seeking behaviours and reasons for healthcare choices (N=7567), a survey of private pharmacies (N=1021), a survey of public sector primary care facilities (N=358), and a survey of private-sector solo-providers (N=684). Results 17% of the households seek outpatient care from private pharmacies (similar to rates for public primary-care facilities). 25% of the pharmacies were not registered appropriately under Indian regulations, 90% reported providing medical advice, and 26% reported substituting prescribed drugs. Private pharmacies had longer staffed hours and better stocks of essential drugs than public primary-care facilities. Patients reported choosing private pharmacies because of convenience and better drug stocks; reported higher satisfaction and lower out-of-pocket expenditure with private pharmacies than with other providers. Conclusion This is the first large-scale study of private pharmacies in India, with a comparison to other healthcare providers and users’ perceptions and experiences of their services. To move towards universal health coverage, India, a country with a pluralistic health system, needs a comprehensive health systems approach that incorporates both the public and private sectors, including private pharmacies. Keywords: Health systems, Health policy, Health services research, Health systems evaluation

Author Biographies

Liana Woskie, Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA

Tufts University School of Arts and Sciences, Medford, MA, USA

Annie Haakenstad, Global Health and Population, Harvard T.H. Chan School of Public Health, Boston, MA, USA

Institute of Health Metrics and Evaluation, University of Washington, Seattle, Washington, USA

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