E-DRUG: Pharmacist role in India
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[This sort of situation is probably common in more countries than India - often in the presence of laws that prohibit such practices. It would be interesting to hear success stories about controlling such pharmacy practice. (Active Pharmacy Boards? More active licensed inspectors, penalties actually imposed??) BS]
Recently in one of the provincial states of India (Maharashtra) there were crack downs on retail pharmacy stores by drug Inspectors, for not finding pharmacists present during opening times of retail pharmacies. In many of the stores, pharmacists were absent out on leave/lunch/ toilet etc. where as sales were carried on by non pharmacist workers. In some pharmacies there were insufficient number of pharmacies appointed. (mostly pharmacies here run for 12 hours a day.)
The Indian scenario regarding the role of pharmacists in retail pharmacy is highly deplorable, given the fact that the drugs and cosmetic act allows non pharmacists to be given license for opening and running pharmacies. Further the pharmacists are under the control/mercy of non pharmacist owners, which in turn leads to no professional respect, working conditions, salary level, etc commensurate with the role they are expected to play.
CK Aiyer,
EX Professor, Pharma Management, India
chandrasekar kalyanram <chandrarobert@yahoo.com.au>
E-DRUG: Pharmacist role in India (2)
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[It would be interesting to hear about initiatives undertaken to address such situations. BS]
The case in Nigeria is similar
Dr. (Mrs.) B.A. Aina
Dept. of Clinical Pharmacy and Biopharmacy
Faculty of Pharmacy
University of Lagos
CMUL Campus, Idi Araba,
Lagos, NIGERA
bolajoko aina <bolajokoaina@yahoo.com>
E-DRUG: Pharmacist role in India (3)
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Dear All
Certainly the finding that pharmacists were not present at pharmacies is
not a finding unique to India - and it not usually that they are are
just "on leave/lunch/toilet" but that they are running more than one
pharmacy or, in some countries, they have 'rented' out their licence to
a non-pharmacist who is running the business. While we would like to
believe that others in our profession (whether medicine, pharmacy,
nursing, etc.) are professional people, the truth is that there are many
who are not as dedicated to professional practice, honesty, etc.
The laws with regard to pharmacy and pharmacists actually vary quite a
bit between countries and it can be surprising to learn what happens in
other countries. In some, only pharmacists can own pharmacies (if a
company, a pharmacist must be a shareholder or board member). In others,
to encourage competition and prevent pharmacists protecting their own
interests over those of the public (or for other reasons), anyone can
own a pharmacy provided they employ a pharmacist to run it. Usually a
pharmacist has to be present at all times (the toilet should be inside
and they eat their lunch inside or else close up shop or employ a
stand-in pharmacist). In some cases, more pharmacists must be employed
(professional or legal requirement) when workloads exceed a certain
level.
In some European countries, there are limits to the number of
pharmacies in a town, region or even the whole country - and there is a
waiting list for someone to retire or die so that somebody new can start
up their own business. Some countries put limits on how close one
pharmacy can be to another (to protect them from too much competition?)
whereas in many developing countries it is not uncommon to see rows of
private pharmacies outside of government and private hospitals (patients
have to pay directly for medicines and the hospital pharmacy may not
have the medicine or may be more expensive than the pharmacies outside).
In some countries I have encountered government hospitals which don't
have their own pharmacy - they rent out space in the hospital to a
private pharmacy, or their pharmacy has so few medicines due to
restricted budgets that they also sell medicines either as part of a
revolving fund or as a fund raising measure.
In my opinion, well done to the inspection department for the 'crack
down' - it is by application of the laws that the public can be
protected from unprofessional practice (provided the laws are
proportionate and appropriate). If the laws and penalties are not
adequate to ensure owners and/or pharmacists meet expectations then that
is an issue that needs attention.
Regards
Douglas
--
Douglas Ball
Pharmaceutical consultant
Public Health and Development
Manila, Philippines
E-mail: douglasball[AT]yahoo.co.uk
E-DRUG: Pharmacist role in India (3)
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Thanks for this update. The situation in Uganda is a replica of the same practice.!
Several Uganda Pharmacists were trained in India equally the biggest % of Pharmacy owners are Indians, could it be the reason?
Gordon Katende Sematiko
Executive Secretary/Registrar
National Drug Authority
P.o.Box 23096 Kampala
Plot 46-48 Lumumba Avenue
UGANDA
+256414255704 mob+256772404302
gsematiko@nda.or.ug/ esr@nda.or.ug
E-DRUG: Pharmacist role in India (4)
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[Response to comment from Pharmacist role in India (3) ' Until systems are established.. water will always find a course' and last line here 'What is the benchmark of 21 century pharmacy practice? What we should be doing at individual or at the level of professional society nationally or internationally?'
It seems clear that, as explained by Douglas Ball, a strong regulatory framework must be in place to control all aspects of pharmacy practice. Legislative provisions are needed for the appointment of a suitable body such as a Pharmacy Board (for example). That body must be empowered to oversee matters concerning management of medicinal products and all aspects of pharmacy professional activities as well as to provide advice, as and when required. The body would responsible for registration of pharmacy personnel and for maintaining standards of practice. Authorised inspectors are needed to monitor practice and to report to the body. It is crucial that penalties are imposed when necessary. In Australia the Pharmacy Board publishes a regular circular that includes reports of Pharmacists being brought before the Board for misconduct and the penalties imposed if needed - the strongest is de-registration. Surely the shame must be a deterrent as well as the penalty? BS Moderator]
The case is similar (in Nepal) despite some administrative interventions made to ensure that pharmacists are actually engaged personally in dispensing. Registration of any new pharmacy is possible if pharmacist is the sole owner or is in partnership with non-pharmacist or when pharmacist is employed by a firm registered as Pvt Ltd company or as a section of a registered health institution or hospital. In all three situations, pharmacists and their certificate sit separately. This is clearly a inspection / compliance or law and order or ethical issue. Pharmacist and pharmacy assistants are not only away on launch or refreshment but also on study course / another job away from duty station and sometime are even non-resident.
Unlike other health care professionals like nurse, surgeon, radiologist, medical officer etc pharmacist's job can be done by anybody else! Pharmacists are replaceable! This need to be evaluated from professional, people's health right, health need and safety, accountability, and pharmaco-legal perspective? Is pharmacy care or service a luxuary or society simply not recognising it? The missing link between pharmacist and the society look like
1. The way it is, medicines are tradeable commodity and inaccessible because it is people's out of pocket responsibility.
2. Pharmacy care and service is not as a part of formal health care structure and process.
3. Society's pharmacy care needs not established or understood or even not addressed by pharmacist's job description /qualification / education.
I would like to close with these two curosities -
What is the benchmark of 21 century pharmacy practice? What we should be doing at individual or at the level of professional society nationally or internationally?
Balkrishna Khakurel
Kathmandu, Nepal
"balkrishna khakurel" <bkhakurel@yahoo.com>
E-DRUG: Pharmacist role in India (4)
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Dear E-druggers,
The situation is not different from many developing countries and resource poor settings
where access to professional practice and medicines is a major concern. All the observations
listed in your mail below are present in most of these areas and this affects the delivery of quality
pharmaceutical care to patients or clients.
Though not a good practice, I guess governments and professional bodies should look at the factors or incentives that make trained people behave the way they do, then we shall begin to address these short falls to improve on the delivery of pharmaceutical care.
We should also remember that, pharmacy practice is both business and profession guided by ethics. There is a thin line between what we do as business and upholding professional standards.
When managers of health systems disregard pertinent issues such as remuneration, professional fees, ownership and practice of pharmacy, access to professional services, regulator not upholding its own laws, coverage etc,
These problems as stated by Douglas are bound to persist.
Until systems are established, water will always find its course.
Some thoughts
Kind regards
George K Hedidor
(MPH, B.Pharm, MPSGH)
DI Pharmacist (Snr)
National Drug Information Resource Centre
Pharmacy Council Building (HQ)
Adjabeng Yard,
P O Box AN 10344
Accra, Ghana
"George Hedidor" <khedidor@yahoo.com>
E-DRUG: Pharmacist role in India (6)
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Could it be that some of these pharmacists, not only in India but in most developing countries are not professionally challenged in the models of community pharmacy they work in. Most would have spent years at universities training and to find themselves counting tablets and generating labels on the computer could be very unfulfilling. If community pharmacy is operating as a commodity broker, just like selling bananas at the market, then one does not need a degree.
In environments where regulation and policing are weak, those with a degree will wise up and employ less qualified, but literate to process a prescription. There is very little extemporaneous manufacturing and most medicines are dose packaged. Dispensing software will produce labels and advise of interactions.
Patients are more literate than in the past and medicines information is no longer the monopoly of health professionals but in public domain. This type of scenario makes it easy for pharmacists to find themselves de-skilled and frustrated and prefer to spend time doing what challenges them. Some will be playing golf or enterprising in other trades they are less trained in while receiving the income from their pharmacies operated by less expensive staff. This model of pharmacy is jurassic and common in developing countries.
Pharmacy must evolve to a more professionally challenging and exciting model. Dispensing chores, stock management, staff rotas and holidays and accuracy checking of dispensed products should be delegated to dispensers and healthcare assistants. The pharmacist will find it more professionally challenging and fulfilling to be interacting with patients. Pharmacists could offer Medicine use reviews and and screening services for hypertension, cholesterolaemia, type 2 diabetes and offer support to stop smoking. Pharmacists could also spend time training pharmacy staff on product knowledge, communication skills and technical roles. The range of such clinical pharmacy services on offer is extensive. For the pharmacist to engage in these activities, the rules of engagement have to change.
Regulation should evolve to enable such changes to the traditional model. This is a pharmacy model which is more outcomes oriented, educating and supporting patients to get the best out of their medicines. Surely in such an engaging community pharmacy model, the pharmacist is less likely to leave the pharmacy in the hands of non-pharmacists.
Dr Farai Chinyanganya. MRPharmGB, MSc, PhD golf
Pharmacy Intelligence & Logistics
+447870260730
UK
"farai chinyanganya" <fchinyanganya@hotmail.com>