Salbutamol is one of 98 medicines under the ‘essential drug list’ that the government provides free of cost from state-run health facilities across the country. The medication is used to manage respiratory conditions, including asthma and chronic obstructive pulmonary disease.

Doctors, however, do not prescribe medication; instead, they prescribe inhalers and nebulisers for patients with respiratory problems.

Aminophylline prevents wheezing, shortness of breath, and difficulty in breathing caused by asthma, chronic bronchitis, and other lung diseases.

Likewise, atenolol helps lower patients’ heart rate and blood pressure, and both medicines are on the essential drug list and distributed free of cost to needy patients. However, physicians generally do not prescribe those medications because more effective options are available in the market.

Health officials acknowledge that some medicines listed as free essential drugs are obsolete and are no longer prescribed by doctors. However, state-run health facilities continue to procure them, and many expire without being used.

“We have been planning to call a meeting of experts to review the medicines included in the free essential drug list,” said Dr Phadindra Prasad Baral, section chief of Basic and Emergency Health Management System at the Curative Service Division. “Some medicines need to be removed from the essential drug list, while some others need to be included.”

State-run health facilities across the country provide up to 98 types of medicines free of cost to ailing patients. Some local units, including the Kathmandu Metropolitan City, provide additional items that include medicines for blood pressure, high blood sugar and asthma free of cost from their own budget.

Drugs on the ‘free essential’ list include medicines for communicable and non-communicable diseases. Earlier, the health ministry provided more than 70 types of medicines for communicable and non-communicable diseases from all district hospitals with at least 25 beds. Patients used to get more than 60 types of essential medicines at primary healthcare centres and 35 types of drugs at health posts.

However, after the country embraced federalism in 2015, the number of medicines on the free list was increased to 98. The health ministry used to purchase medicines and supply them to the districts. The ministry later started allocating budgets for the purpose to provinces and local governments. The list of medicines has not been revised since they were selected years ago.

“We have agreed on the need to revise the medicine of the free essential lists,” said Baral. “Some medicines for non-communicable diseases, including mental health, need to be added, as new compositions and molecules have been developed, which are more effective than what we have been using at present.”

Doctors say due to changing lifestyles—increasing sedentary behaviour, tobacco and alcohol use, and unhealthy diets—the burden of non-communicable disease has increased alarmingly of late.

They say that a lot of people suffering from high blood pressure, diabetes, respiratory diseases, and heart ailments, among others, could not afford to purchase medicines, which is among the reasons for premature deaths.

Out-of-pocket payments are the reason in many cases for discontinuity of the medications, doctors say. Patients suffering from most non-communicable diseases can’t discontinue their medication without consulting their doctors.

Along with revising the medicine of the free essential drug list, Baral said that his office is also assessing minimum service standards of the state-run health facilities to improve the quality of healthcare being provided.

Minimum service standards for hospitals are the service readiness and availability of tools according to the requirements of hospitals.