Background

All through history, drugs [medicines] have been a commodity essential to human survival and health. The availability and affordability of drugs is a major social issue though it does not always attract the attention it should. India, as is the case with many other developing countries, has been witnessing a steady increase in drug prices across most therapeutic categories. The situation is true not just for newly introduced drugs but also for old established ones. Consumers here pay for their healthcare largely from their own pockets. The extent of medical insurance coverage is still miniscule. Against this backdrop, there is the danger that prices of multiple drugs, including life-saving ones, may go beyond the paying capacity of a large section of the populace leaving the dream of 'Health for All' just a dream.

Another worrisome issue is inappropriate or irrational use of medicines that are available, which at best, leads to wastage of drugs and, at worst, can kill the patient. To compound things further, there is the problem of substandard and spurious drugs which, of late, has been proliferating at an alarming rate in many parts of the country.

Genesis and Growth

Community Development Medicinal Unit [CDMU] West Bengal, as an independent not-for-profit healthcare organization, has been striving to achieve the basic societal need of facilitating access to essential medicines ever since its inception in 1984. It runs a project for supply of quality assured essential primary-care medicines at affordable price to its member-organizations [MOs] and thereby allows the poorest of  poor people of different communities to have access to essential medicines. A team of experts forms a Pharmaceutical Selection Committee centrally selects and updates CDMU's medicine list in conformity to WHO and India Essential Drug List and the suppliers every year after reviewing quotations submitted by various medicine companies. Medicines are purchased in bulk directly from the manufacturers and can therefore be supplied to member organizations, even in remote areas, like hills of Darjeeling to delta of sunderbans at prices substantially lower than in the open market. CDMU membership (organizations to which CDMU supplies drugs on a regular or periodic basis) has grown from 15 in 1985 to over 645 currently. Most of these members are voluntary organizations or tea gardens providing free or subsidized healthcare to marginalized sections of the community.

Many experts and eminent personalities in the field of healthcare are now associated with the activities of CDMU either directly or in an advisory capacity. Our common mission is to achieve equity in healthcare through rational drug use.

Table 1. District-wise distribution of 645 member organizations affiliated to CDMU

Name of district	No. of members	Percentage of total
24 Parganas North	39	6.05
24 Parganas South	75	11.63
Bankura	3	0.47
Bardhaman	9	1.40
Birbhum	2	0.31
Coochbehar	2	0.31
Darjeeling	101	15.66
Dinajpur [North]	3	0.47
Dinajpur [South]	1	0.16
Hooghly	16	2.48
Howrah	31	4.81
Jalpaiguri	101	15.66
Kolkata	204	31.63
Medinipur East & West	34	5.27
Murshidabad	9	1.40
Nadia	7	1.09
Purulia	8	1.24
TOTAL	645	100.00

Encouraged by the activities of CDMU, organizations in Bihar and Orissa have sought our guidance and commenced work along similar lines.

Objectives

The following are the goals of CDMU:

• To provide quality essential drugs to member-partners at affordable cost and assist them in maintaining their health programs.
• To provide unbiased drug information to health professionals and consumers.
• To organize seminars, workshops and training programs on 'Rational Drug Use'.
• To publish journals, handouts and booklets on various aspects of health and drugs in the context of rational therapeutics.
• To negotiate with the Government to formulate people-oriented drug policies and weed out irrational and hazardous drugs from the Indian market.
• To conduct community-oriented research on drugs.
• Overall, to contribute positively to the health scenario in the country through judicious use of drugs.

Strength

CDMU reaches to 20000000 people through its 645 member organization. Additionally, there is the yeoman's service rendered by our staff at times of natural calamities. These figures are awe-inspiring and herein lies CDMU's strength. The humanitarian impact of CDMU's service to the community has never been formally evaluated and is unlikely to be done so in the near future. Nevertheless, we are aware of our potential and we draw our motivation from this strength. It is our earnest request to all of you to extend your fullest cooperation to us in this noble mission. In one hand we had our suppliers who supplies medicines through out the year and in other hand we had our members who relentlessly carry on their healthcare activities for the poor. The economy that CDMU offer in price are as follows:

Name of the medicines	Pack size	Branded price [INR]	CDMU price [INR]	Price difference
Tab Paracetamol 500 mg	10's	5.21	3.00	73.66
Tab Ciprofloxacin 500 mg	10's	79.50	16.50	381.80
Inj Gentamycin    8 mg/mL vial	1's	7.60	4.25	78.82

Acknowledgement

World Health Organization Regional Office for South East Asia
[WHO-SEARO]
World Health House, Indraprastha Estate
Ring Road, New Delhi 110 002