With state hospitals’ essential medicine stock at less than 40%, Centre sounds alarm bells

Several states and Union territories (UTs)–including populous ones such as Uttar Pradesh, Maharashtra, Delhi, Gujarat, West Bengal and Bihar, among many others–have less than 40% levels of essential medicines and diagnostic services available in government-run hospitals and health centres, said an official aware of the matter and as shown by a document reviewed by Mint. 

At the same time, the Centre has conveyed its unhappiness to states and UTs about consumers being unaware of a key central government scheme to provide free drugs at public healthcare centres.

Gaps in implementation

A communication from the Union health ministry on 7 May to the states and UTs, seen by Mint, pointed to gaps in the implementation of its FDSI (free drugs and diagnostics service initiative) program under the national health mission (NHM). 

“These include gaps in the notification by state of the average number of drugs and diagnostics available across facilities, as compared to the recommended numbers outlined in the National Essential Drugs and Diagnostics Lists as per IPHS (Indian Public Health Standards)," the communication noted, adding that there is also a noticeable gap between data reported in state reports and data updated in the government’s monitoring dashboard.

However, the official cited above, who spoke on the condition of anonymity, said the matter of data gap is not worrisome. “The states/UT governments have to update the data on the government’s portal for effective monitoring and evaluation of FDSI," this person said. “This is not a big issue; (it is) a regular matter." 

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At present, a diagnostic module is being piloted in the DVDMS (drugs and vaccines distribution management system) to monitor the availability of diagnostic reagents and consumables. The DVDMS is an IT application that facilitates the implementation of the FDSI and improves the supply chain of drugs, sutures, and surgical items for district drug warehouses across India. 

The health ministry has now told states and UTs to update their lists of essential drugs and diagnostic tools to match national guidelines. They also need to evaluate their specific needs and provide feedback on any drug or diagnostic service.

Queries emailed to the office of Union health minister J.P. Nadda, health secretary Punya Salila Srivastava, and health ministry spokesperson remained unanswered till press time.

Prof Dr K Srinath Reddy, former, President of Public Health Foundation of India (PHFI): “Availability of essential drugs and diagnostics at all public healthcare facilities is pivotal for meeting both major indicators of universal health coverage, which are financial protection and service coverage. 

Drugs and diagnostics contribute to a very high level of out of pocket expenditure, resulting in financial hardship to those who need healthcare, especially for chronic conditions. Health outcomes will be poor if healthcare providers are handicapped by absence of essential drugs and diagnostic aids. All efforts must be made by state and central governments to urgently fill these gaps."

What are the minimum thresholds?

The Centre has been trying to implement the Indian Public Health Standards (IPHS) 2022 guidelines to provide uniform, high quality health services across all states. IPHS are essential benchmarks that ensure the delivery of minimum essential services through public healthcare facilities, including district hospitals, sub-district hospitals, community health centers, primary health centers, and sub health centres.

In 2015, the Union health ministry launched the FDSI to provide free essential medicine at all public health facilities, with an aim to reduce out-of-pocket expenditure (OOPE). Both the marquee initiatives are being implemented under the National Health Mission (NHM) to achieve Universal Health Coverage (UHC), providing equitable, affordable and quality healthcare.

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According to the guidelines, a district hospital should have at least 375 essential medicines such as anti-infectives, cardiovascular medicines, anti-diabetic medicines, antidepressants, pain relievers, antineoplastic drugs, vitamin and mineral supplements, anticonvulsants, etc. A sub-district hospital needs to stock 325 medicines, community health centres 299 medicines, primary health centres at least 171 medicines, and sub-health centres need to store 105 medicines. 

As for free diagnostic services, a district hospital should have at least 134 diagnostic services, sub-district hospital (111), community health centre (97), primary health centre (63) and a sub-health centre must provide 14 services. 

Where are the gaps?

According to information reviewed by Mint, states and UTs that have been red flagged by the Centre for having less than 40% availability of medicines as on 25 April 2025 are: Chhattisgarh, Kerala, Maharashtra, Mizoram, Nagaland, Punjab, Arunachal Pradesh, Assam, Bihar, Dadra and Nagar Haveli and Daman and Diu (DNH&DD), Delhi, Gujarat, Haryana, J&K, Jharkhand, Manipur, Meghalaya, Rajasthan, Sikkim, Uttar Pradesh, Uttarakhand and West Bengal.

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Further, the following have less than 40% availability of diagnostic services at the government health facilities: Andaman & Nicobar Island, Arunachal Pradesh, Assam, Bihar, Chhattisgarh, Delhi, DNH&DD, Kerala, Maharashtra, Mizoram, Nagaland, Punjab, Assam, Bihar, DNH&DD, Delhi, Goa, Gujarat, Haryana, Himachal Pradesh, Jammu & Kashmir, Jharkhand and Karnataka, Ladakh, Lakshadweep, Madhya Pradesh, Maharashtra, Manipur, Meghalaya, Nagaland, Odisha, Puducherry, Punjab, Rajasthan, Sikkim, Uttar Pradesh, Uttarakhand and West Bengal

Getting the message across

The Centre has also raised concerns about common citizens and local public representatives often remaining unaware of FDSI, which limits their ability to fully utilize these essential services. 

The health ministry has directed the states and UTs to develop comprehensive strategies to promote awareness campaigns, and mandatory display of available drugs and diagnostic services at all health facilities.

Dr Rajeev Jayadevan, public health expert & former past president, Indian Medical Association (IMA), Cochin Chapter, remarked that despite its goal to provide essential medicines and tests free of cost at public health facilities, many citizens — even in urban areas — apparently remain unaware of these entitlements. 

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“This has resulted in a gap between planning and implementation," Jayadevan said. “Limited public awareness and logistical hurdles are major barriers. While media coverage, posters and displays can improve visibility, real impact requires trained personnel, accurate data reporting, and digital integration via systems like DVDMS. Health equity starts with access — and access begins with awareness, supported by reliable systems that deliver."