Exploring the Interplay between Policy Texts and Local Realities in Drug Procurement for the NPCDCS Program in Bihar: An Institutional Ethnography

Abstract

India has the largest number of families living below the poverty threshold, resulting in high out-of-pocket expenditure for healthcare, including essential medicines for noncommunicable diseases (NCDs). With the increasing prevalence of NCDs, the role of the Indian government becomes crucial in ensuring that patients have access to essential drugs through public health facilities. This research paper explores the institutional processes of drug procurement in the National Program for Prevention and Control of Diabetes, Cardiovascular Disease, and Stroke in Bihar, India, using institutional ethnography as its methodological approach. The data for the study was collected over a 10-months period in three districts of Bihar and involved collecting data through participant observation, interviews, and reviews of official documents and program guidelines. The findings highlight the influence of various institutional and regulatory texts that shape the implementation of integrated programs in district hospitals and carry the authority and instructions of the Ministry of Health and Family Welfare. Despite their legal entity and autonomous status, the study reveals that the governance, decision-making, and autonomy of health societies involved in the program were restricted through textual practices. The study’s contribution to social science and health system literature lies in illustrating the multiple factors that influence drug procurement at the central, state, and local levels.