| Child Health | Diagnostics | Hospitals | Maternal & Rep. Health | Pharmacy | Primary Care | Public Health | Traditional Healer Definition Pharmacy services are the provision or sale of pharmaceutical products by drug retailers. In developing countries, drug retailers include pharmacists and drug sellers. Pharmacists are individuals who have had formal training in dispensing pharmaceutical products. In contrast, drug sellers include individuals who are associated with pharmacies, but do not have formal training in dispensing pharmaceutical products. Moreover, drug sellers encompass individuals that provide access to pharmaceutical products outside of the pharmacy, such as in food markets. Top Status of Pharmacy Services In many developing countries, drug retailers not only provide access to pharmaceutical products, but also provide advice as to which medicine to take. Furthermore, drug retailers often serve as the first health care contact for sick individuals, making them a significant component of a health system.  · In Cambodia, PATH noted that community drug sellers were the first point of health care contact for seventy-five percent of mothers whose children suffered from Diarrhea and Acute Respiratory Infection.
Top Issues in Pharmacy Services In developing countries, several issues undermine the quality and equity of pharmacy services. These issues include inappropriate prescribing practices and inadequate regulation of the qualification and practices of drug sellers. In addition, the use of pharmacists or drug sellers for actual health care (eg identifying illness and appropriate treatment) often leads to poor health outcomes. Provision of care -- Although many pharmacists are not trained in health care provision, patients often use them as their first health care contact. Thus, patients may receive inappropriate care from pharmacists, prolonging their disease burden and reducing their household savings. Prescribing -- If prescribing practices are inappropriate, it may prolong or aggravate a patient's illness. Furthermore, medicines may be used unnecessarily, creating an unwarranted financial burden for patients. - Kroeger (2001) studied urban pharmacies in Guatemala and Mexico and analyzed the scale of inadequate drug advice. Results showed that much of the pharmacy advice for diarrhea or ARI was poor.
- Hogerzeil (1995) broadly discussed the problems associated with irrational prescribing.
- Stenson (1998) reviewed the provision of drugs through private pharmacies in the Lao Republic, and documented poor dispensing practices.
Regulation -- If regulatory standards regarding qualifications do not exist or are inappropriate, or are not complied with, it leads to low quality services. Effective regulations require active collaboration between government and self-regulatory bodies such as pharmacy associations. - WHO: The Role of the Pharmacist in Self-Care and Self-Medication recognizes this need for collaboration and promotes National Pharmacy Associations to develop certain performance standards.
Top Trends in Pharmacy Services Past and current experiences with pharmacy service have identified factors that promote the efficiency and quality of this service. Training and regulation are two mechanisms identified by WHO: The Role of the Pharmacist in Self-Care and Self-Medication. The following are some articles that have reviewed these two mechanisms. - Laing (2001) reviewed the experiences of educational and administrative approaches to improve prescribing practices during the last decade.
- Ross-Degnan (1996) concluded that face-to-face training of pharmacists can lead to significant improvements in product sales and communication with customers.
- Haak (1996) evaluated the regulatory actions of pharmacy services across sixteen countries.
In addition, another mechanism that contributes to successful pharmacy service is standardized prescribing guidelines. According to Laing (2001) this use of approach led to improved consultation and prescribing for malaria and diarrhea in Uganda. Top Key References World Bank To be added in the near future... Top External - Chuc, N. T., M. Larsson, N. T. Do, V. K. Diwan, G. B. Tomson and T. Falkenberg (2002). "Improving private pharmacy practice: a multi-intervention experiment in Hanoi, Vietnam." J Clin Epidemiol, 55(11): 1148-55.
Assesses the effects of a multicomponent intervention on private pharmacy practice. Three interventions were applied sequentially: regulation, education, and peer influence. Results show that this type of intervention was efficacious in improving prescribing practices. - Hogerzeil, H. V. (1995). "Promoting rational prescribing: an international perspective." Br-J-Clin_Pharmacol, 39(1): 1-6.
Discusses the global problem of irrational prescribing. Describes interventions that promote rational prescribing, which include face-to-face education, structured order forms, educational campaigns, etc. - Laing, R., H. Hogerzeil and D. Ross-Degnan (2001). "Ten recommendations to improve use of medicines in developing countries." Health Policy Plan, 16(1): 13-20.
Reviews the experience during the 1990s in order to identify effective interventions in developing countries. Recommends several approaches, including standard treatment guidelines, essential drug list, basic training, etc. - Ross-Degnan, D., S. B. Soumerai, P. K. Goel, J. Bates, J. Makhulo, N. Dondi, Sutoto, D. Adi, L. Ferraz-Tabor and R. Hogan (1996). "The impact of face-to-face educational outreach on diarrhoea treatment in pharmacies." Health Policy Plan, 11(3): 308-18.
Conducts controlled trials to determine the efficacy of a face-to-face educational outreach intervention. Results show that this type of intervention leads to significant short term improvements in communication with clients. - World Health Organization (1998). Report of a WHO consultative group on the role of the pharmacist in Self-Care and Self-Medication. Geneva, World Health Organization.
Discusses the role of the pharmacist in public health. Identifies the responsibilities and fuctions of pharmacists towards consumers. Recommends mechanisms to improve pharmacy services, including education/training and peer audit.
Top Resource People World Bank External - Albert Wertheimmer, Professor, Temple University
Top Useful Websites Additional References Berih, A. A., L. McIntyre and A. D. Lynk (1989). "Pharmacy dispensing practices for Sudanese children with diarrhoea." Public Health, 103(6): 455-8. Chuc, N. T., M. Larsson, T. Falkenberg, N. T. Do, N. T. Binh and G. B. Tomson (2001). "Management of childhood acute respiratory infections at private pharmacies in Vietnam." Ann Pharmacother, 35(10): 1283-8. Goel, P., D. Ross-Degnan, P. Berman and S. Soumerai (1996). "Retail pharmacies in developing countries: a behavior and intervention framework." Soc Sci Med, 42(8): 1155-61. Goel, P. K., D. Ross-Degnan, T. J. McLaughlin and S. B. Soumerai (1996). "Influence of location and staff knowledge on quality of retail pharmacy prescribing for childhood diarrhea in Kenya." Int J Qual Health Care, 8(6): 519-26. Igun, U. A. (1987). "Why we seek treatment here: retail pharmacy and clinical practice in Maiduguri, Nigeria." Soc Sci Med, 24(8): 689-95. Kroeger, A., H. Ochoa, B. Arana, A. Diaz, N. Rizzo and W. Flores (2001). "Inadequate drug advice in the pharmacies of Guatemala and Mexico: the scale of the problem and explanatory factors." Ann Trop Med Parasitol, 95(6): 605-16. Passmore, P. R. and S. G. Kailis (1994). "In pursuit of rational drug use and effective drug management: clinical and public health pharmacy viewpoint." Asia Pac J Public Health, 7(4): 236-41. Rabbani, F., F. H. Cheema, N. Talati, S. Siddiqui, S. Syed, S. Bashir, L. Z. Zuberi, A. Shamim and Q. Mumtaz (2001). "Behind the counter: pharmacies and dispensing patterns of pharmacy attendants in Karachi." J Pak Med Assoc, 51(4): 149-53. Stenson, B., L. Syhakhang, B. Eriksson and G. Tomson (2001). "Real world pharmacy: assessing the quality of private pharmacy practice in the Lao People's Democratic Republic." Soc Sci Med, 52(3): 393-404. World Health Organization (1997). The role of the pharmacist in the fight against the HIV-AIDS Pandemic. Geneva, World Health Organization. World Health Organization (1997). Reprt of a WHO consultative group on the role of the pharmacist; preparing the future pharmacist. Geneva, World Health Organization. Top |
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