# \[e-drug\] Private sector drug supply in developing countries **URL:** \ **Category:** e-drug\ **Created:** [July 7, 2001, 1:13pm UTC](https://talk.edrugplus.org/t/e-drug-private-sector-drug-supply-in-developing-countries/11836 "2001-07-07T13:13:58Z")\ **Posts on this page:** 1\ **Page:** 1
**Author:** ![did.jms](https://avatars.discourse-cdn.com/v4/letter/d/e68b1a/32.png) [@did.jms](https://talk.edrugplus.org/u/did.jms)\ **Post date:** [July 7, 2001, 1:13pm UTC](https://talk.edrugplus.org/t/e-drug-private-sector-drug-supply-in-developing-countries/11836/1 "2001-07-07T13:13:58Z")
E-drug: Private sector drug supply in developing countries ------------------------------------------------------------------------- Dear E-druggers, I have made some observations on drug supply to patients, with a focus on the private sector. It is an expansion of what I wrote earlier on pharmacy practice in the private sector of developing countries. In my country, drug-outlets prioritise sales that give most profit to the owners. Drug-outlets in Uganda are licensed by at least 2 different governmental institutions and there is overlap and confusion. There is little control or audit of these outlets. You may find the below article useful. I wrote it as a discussion document for health and drug policy professionals in Uganda. Sincerely, George Kibumba, MPS Community and Drug Information Pharmacist/Uganda. [Thanks George for this excellent discussion article, and its attention for the private pharmaceutical sector, an often forgotten spot in pharmaceutical system improvement. Good that you recognise the importance of these facilities in drug supply, and that there is little control over it. You correctly pointed to the fact that there are more varieties of private sector drug outlets than only pharmacies and drug shops. I have a couple of comments on your article: 1) So far, we know little of what actually happens in private sector facilities and comments on these practices are often impressionistic (e.g. selling two caps of penicillin). Drug use indicator surveys have now been carried out in public sector facilities of many countries, but on private sector activities we have remarkably few data. It would be good if such private sector data on prescribing and dispensing would be made available. this would allow us to make better decisions about what to focus on if we really want to change practice. 2) The bottom line of your article is that control of activities in private sector facilities needs to be strengthened. However, control often has its limitations, as people will find ways around control. Although I do agree with you that proper regulation is necessary, have you thought of creating or increasing incentives for appropriate pharmaceutical care? Could private sector organizations be motivated to pay attention to your arguments? Would there really be no interest at all in making an income on providing appropriate pharmaceutical care? 3) What I somewhat missed in your article is what the National Dug Policy of Uganda says about private sector activities and how it is proposed to control it. Maybe you could give us some insight in that? HH] ----------------------- Overview of legislation on drug distribution and its impact on drug use problems By George Kibumba Introduction Before the Ministry of Health abolished cost sharing early this year, 83% of the population used to seek first contact treatment from the private sector3. That trend is not likely to change, as governmental health facilities frequently fail to supply medicines and the quality of care is generally low. The majority of the population will certainly continue to receive drugs and first contact health care from the private sector. In the private sector, health care always involves drug use. Unfortunately, medicines are rarely administered and used properly by health workers and the general public alike. This article � Describes drug distribution to the general public in the Ugandan    private sector � Explains the effects and causes of the current distribution    system � Describes proper control and audit of drug distribution at patient    level � Gives practical recommendations and conclusions on the    subject. Drug distribution in the private sector Drug distribution by professional and non-professional health workers in the private sector is not adequately controlled. Description of non-professional health providers is outside the scope of this article. The article will dwell on professional health workers. In Uganda, drugs can easily be obtained from every professional health provider in the private sector. Infact, there is loose availability and access to essential medicines. Yet uncontrolled access to useful drug substances is more disastrous than controlled access. The sources of drugs to the general public include the following � Clinics � Drug Shops � Pharmacies � Private hospitals (which may be called medical centers, nursing    homes, etc). Note that of all drug outlets in this country, The National Drug Authority (our Drug Regulatory Agency) licenses only drug shops and pharmacies. Yet, even in places where pharmacies exist, clinics are major sources of drug supply to the general public. Clinics are only licensed (by the Medical and Dental Practitioners Council) to provide care to outpatients, and not to supply medicines on a retail basis. Private hospitals are similarly licensed by the Medical and Dental Practitioners Council to provide patient care. However, private hospitals are also important drug outlets. Nevertheless, their drug supply activities are not licensed or controlled by the National Drug Authority. According to The National Drug Policy and Authority Statute of 1993, the responsibility to audit and control activities of drug distribution in Uganda is with the National Drug Authority and not the professional councils. Power to audit and control activities in private clinics and hospitals is held by The Medical and Dental Practitioners Council and Nurses and Midwives Council. Dispensing clinics and private hospitals hardly meet the minimum requirements of operating retail or hospital pharmacies. Meanwhile, The Allied Health Professionals' Council is seeking to license and handle activities of Class C drug shops and expand the list of Class C drugs. The desire is to enact a legislation to allow them to stock and supply antimicrobials and other class B substances. It is clear that all health workers in Uganda claim the right to procure, stock and supply the whole range of drugs to the general public. The effects of the system Because of the obvious overlap and overload of duties, health personnel in the private sector are not properly supervised and controlled. Lack of appropriate control and supervision contributes to irrational diagnosis and prescribing; over prescribing and under prescribing, and incorrect prescribing. Unnecessary prescriptions increase the cost of treatment. While underprescribing and incorrect prescriptions contribute to drug resistance, improper dispensing can result in drug toxicity and treatment failure. What are the causes of the above problems? Health workers incorrectly claim a role of distribution of drugs to the general public. The laws governing drug distribution are not harmonized and health professionals distribute drugs to the general public without control from the Drug Regulatory Agency. In addition, there is a long-standing wish to embed drug distribution in clinics and other outpatient facilities. If such wishes are granted, control of drug distribution in Uganda will remain a myth and there are many countries to learn from. Thailand, for example, has a private sector where every drug outlet diagnoses, prescribes and dispenses. Expenditure on drugs and resistance to infections is enormous in Thailand. Retail pharmacies, with are licensed by the National Drug Authority to handle prescriptions, do not receive them. Such pharmacies will have to dispense without prescriptions, to make enough income to cover their running costs. Alternatively, those retail pharmacies will close to wholesale practice, for lack of retail business. As a result, inappropriately licensed facilities will dispense drugs. Where ethical retail pharmacies exist, their effort to have proper control over access to medicines is frustrated. When such pharmacies refuse to sell 2 capsules of a penicillin (a prescription-only product) over the counter -- patients arrogantly deny advice, since this inappropriate treatment can be easily got from the next drug outlet. Control and auditing of drug supply in the private sector Selling drugs is business, and as the private sector appears to be motivated by profit, as opposed to service, control of drug distribution and appropriate auditing can not be ignored. A meaningful drug supply system in the private sector can only be realized when there is control and auditing. Controlling means ensuring that only appropriately licensed facilities distribute drugs. Auditing activities of drug distribution involves cross--checking, to find out whether the appropriately licensed facilities are really complying with the guidelines and set standards. Auditing and controlling drug distribution is laboursome. That implies that licensing drug distribution should be handed over to The Council of The Pharmaceutical Society of Uganda. That will allow the Regulatory Agency more time to ensure that only appropriately licensed facilities supply quality drugs and that such units are adequately audited. This calls for facilitation and empowerment of The Council of The Pharmaceutical Society of Uganda. At the same time, the desire of health workers in the private sector to license their respective private practices is not bad. However, non-pharmaceutical Professional Councils should not handle licensing drug distribution, which they always embed in their licensing. If licensing drug distribution continues the way it is now, there will be more confusion and disaster to an already faulty system. When Uganda opts for an ill-defined system where every drug-outlet diagnoses, prescribes and dispenses, treating an uncomplicated case of malaria will cost at least Shs 10,000/= (5 USD) in the near future. It will also be impossible to control drug supply and distribution. Therefore, every responsible health worker in Uganda should observe a need to revise desires to retail drugs. Since the 7th Parliament is in place and a new pharmacy and pharmacy practice bill is ready; the Ministry of Health should consider the following conclusions and recommendations. Conclusions and recommendations 1. The National Drug Authority must have the power to audit all units of drug distribution in the private sector. Such units of drug distribution to patients include clinics, nursing homes, hospitals, drug shops or pharmacies. That Regulatory Authority should implement laws governing drug distribution in a phased manner, as described in point 3 below. 2. Licensing units of drug distribution should be handled by The Council of The Pharmaceutical Society of Uganda. Before The Medical and Dental Practitioners Council or Nurses and Midwives Council license nursing homes, medical centers, which function as hospitals, there must be close collaboration with The Council of The Pharmaceutical Society of Uganda. 3. Where retail pharmacies are available, in reasonable distance, clinics and other outpatient facilities should not be allowed to retail medicines. Those facilities should refer prescriptions to the retail pharmacies. This will stop retail pharmacies from dispensing prescription-only and pharmacy-only drugs without prescription. It will also organize the dispensing system in the country and reduce the burden of drug misuse and overuse. 4. The few pharmacists available (about 140!) in Uganda should be kept at supervisory level and given adequate continuing pharmacy education. Employing full-time pharmacists will not stop wholesale pharmacies from selling drugs to clinics and other outpatient outlets. Employing full-time pharmacists in retail pharmacies will not solve the problem of inappropriate drug distribution in the country -- one of the principal factors -- precipitating drug misuse and overuse. References 1. National Drug Policy and Authority Statute, 1993. 2. Pharmacy and Pharmacy Practice Bill, 1999. 3. Home Based Management of Fevers, A Workshop in Grand Imperial Hotel -- Kampala Uganda, 2001. 4. INRUD NEWS, Newsletter of the International Network for Rational Use of Drugs, Vol 10, Number 2, March 2001. 5. The Medical and Dental Practitioners Statute, 1995 6. The Nurses and Midwives Act. -- Send mail for the `E-Drug' conference to `e-drug@usa.healthnet.org'. Information and archive [http://satellife.healthnet.org/programs/edrug.html](http://satellife.healthnet.org/programs/edrug.html) Mail administrative requests to `majordomo@usa.healthnet.org'. 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