Quality of Pharmacies in Pakistan
Drugs and vaccines are important tools in combating diseases worldwide, but may also cause adverse events, with severity depending upon patient- and product-specific factors. This reality is even more important in developing countries where most medications can be purchased over the counter, including those with a high incidence of side effects or adverse reactions. When coupled with a greater propensity towards self-medication, this may have serious consequences for public health in developing countries.
National data on self-medication are not available in Pakistan, but local studies reveal that this may vary between 6.3% and 51.3% depending on the setting. However, self-medication with appropriate guidance can also be beneficial, keeping in mind the limited resources and health facilities available in developing countries. In this context the role of pharmacies has broadened, incorporating not only dispensing, but also health education, and sometimes even diagnosis. In the developing world, drug sellers operating in the informal sector are often the first source of health care, especially in settings where self-medication is the norm. Reasons cited by patients include expediency, convenience, efficacy of medicines, dependability of supply, and cost reduction. This has important implications for the role of drug sellers, more so for those with no qualifications in pharmacy. Unfortunately many drug sellers tend to recommend medicines with lucrative profit margins without sufficient concern for the appropriateness (indications, efficacy, and safety) of the drug. A preliminary study conducted in Pakistan reported that many drug sellers have minimal formal education and little or no professional training; of those with training, most were absent from pharmacies, a practice also observed in other developing countries. Given the limited knowledge of sellers regarding indications, contraindications, and side effects, their dispensing practices may have undesired effects. Although there is a network of health services in Pakistan’s public sector, and a plethora of private sector initiatives, 45% of the population still lacks access to health services. The physician: population ratio is 57 per 100 000 people as compared with 85 in Iran or 311 in developed countries like Sweden. To meet health needs and to reduce personal costs, people rely on alternative health care systems such as chemists, traditional medicine practitioners, faith healers, and homeopaths. Large gaps in the formal health sector encourage self-medication; hence the knowledge and practices of drug sellers becomes critically important in Pakistan. There are an estimated 45 000-50 000 retail and wholesale drug outlets in Pakistan (population 145 million). However, only about 800 individuals per annum graduate as Bachelors of Pharmacy, which translates to very few qualified personnel available to staff these outlets. A majority of drug stores, therefore, have persons with little or no professional training. The Government of Pakistan (GOP) has established preconditions for issuing a pharmacy license.
The drug laws of Pakistan require that:
- Pharmacy premises should have proper and adequate facilities for drug storage including refrigeration.
- Premises be clean and in a hygienic and tidy condition.
- Drug sales should be under continuous personal supervision of a pharmacist (Pharmacy Act, 1967). Given that Pakistan has insufficient data on the operation of pharmacies, this study was undertaken to estimate the proportion of Rawalpindi pharmacies meeting GOP licensing requirements, and to identify factors associated with meeting these requirements.
Bahria Foundation is figuring out to improve productivity, and it is key to free these “star personnel” from routine tasks. How does this apply to retail pharmacy? Deploying these talented difference makers to creative, innovative roles is one way to improve productivity. I envision using these employees to help expand pharmacy as a cost-effective solution in the broader healthcare arena. Implementing collaborative practice agreements (where state laws permit) and to work with local Accountable Care hospital like PNS Shifa and other reputable organization to help improve the use of prescription drugs are a few cutting-edge ideas to expand pharmacy’s role in healthcare.