Paper Title
Quality and Availability of Medicines in Public Health Facilities of Kerala, Indian State An Analysis!

Abstract
In spite of Kerala being known for its developmental indicators, there are reports of poor quality and non-availability of medicines in the public health facilities affecting the quality of healthcare. In order to redress these issues, Kerala government strengthened the pharmaceutical management system through establishing a centralized drug procurement and distribution agency known as Kerala Medical Services Corporation Ltd. (KMSCL). The present study is done to analyze the availability of the medicines and its quality. An exploratory research is accomplished using health systems perspective and utilizing the Rapid Pharmaceutical Management Assessment: An Indicator Based Approach. Methods involved key informant interviews with officials of drug quality control department and collect data regarding substandard medicines and to check patient access and drug utilization we reviewed prescriptions (n = 400) in health facilities to calculate standard indicators of appropriate medicines use. There has been gradual decrease of percentage of substandard drugs: 7.79% (2011), 4.07 % (2012) and 3.60% (2013). Only one case of counterfeit drug was reported. On the other hand, the percentage of dispensed medications (about 60%) clearly shows the non-availability of medicines in health facilities. These results should inform health policy makers to improve affordable access to essential medicines under the current health care reform. Though the incidences of NSQ report raises concern, gradual decrease in their incidences over the study period is a promising sign.