Muhammad Atif
COMMUNITY pharmacists have been dubbed as ‘the first port of call’ among the healthcare professionals because of their easy access to the public. Globally, they are considered as major healthcare site being quick source of advice, referral, medicine and information for patients. However, in Pakistan they are a comparatively underappreciated asset whose potential remains to be navigated. Their existence is almost denied in health care policies of the country as well as in the healthcare delivery system. It seems imperative to delineate a set of factors which have restrained the establishment of community pharmacy services in Pakistan.
Firstly, the community pharmacy services are poorly implemented in Pakistan because of deficits at the government level, especially, when regulators tend to regulate community pharmacies just like an ordinary commercial entity, rather than a fundamental part of the healthcare delivery system. The rules and regulations in the form of Drug and Pharmacy Act have failed in catering the needs of this community. Breaches in existing rules of the country are clearly witnessed. The proprietors of the pharmacies do not ensure pharmacist’s presence at the pharmacy though implied by the law. Moreover, the pharmacists rent out their pharmacy licenses to these proprietors at very low rates and without assuring their own presence at that very pharmacy. Enhanced pharmacy services defined under the Drug Regulatory Authority of Pakistan (DRAP) Act 2012 are non-existent due to many pharmacist-related and policy-related barriers. Regarding financial support, government is yet to devise a remuneration model for community pharmacies and hesitates to subsidize facilities for proprietors of community pharmacies. Issues allied to low cost electricity, non-profit loans, reasonable profit margins, and thus the low salary and low profit debate between all the parties continues to linger on. It seems quite challenging not only for community pharmacists to introduce themselves with a zing, integrity and accountability into the healthcare system, but also for drug retail owners to conform with the existing rules and regulations.
Secondly, are the issues related to general public/and patients. In Pakistan, majority of the population lacks an adequate level of health literacy. Customers, hence, seldom ask pharmacists for clinical services at community pharmacy settings, which in turn decreases the awareness about the existence of this sector. People of Pakistan majorly regard physicians as competent and trustworthy healthcare professionals (which surely they are), while consider the pharmacists as mere storekeepers/dispensers. Owing to this disrespectful status of pharmacists and low salaries in the field, this profession is losing its charm. In brief, pharmacist in community pharmacy is penalized owing to public related factors, his/her identity is questioned, his/her skills are deemed unsatisfactory, and is perceived as a dispenser of pre-packaged medicines. In this status quo, it seems difficult for community pharmacists to gain ground as a confident healthcare professional.
The deficits in academic curricula of Pharmacy degree programs and field issues of pharmacists are yet another conundrum. Though, the pharmacy degree in Pakistan has seen a transition from the four-year B.Pharm program in 1979 to a ?ve-year Pharm-D program in 2004, the content of curriculum does not meet the requirements of advanced pharmacy services. The under-graduate level clinical sessions/research are adopted merely as a formality and have nothing to do with hands-on learning. Therefore, pharmacy students are deficient in appropriate knowledge and expertise about many advanced pharmacy services, including but not confined to pharmaco vigilance, pharmaco economics, pharmaco epidemiology, posology, drug utilization review and adverse drug reactions reporting.
Additionally, the lack of expertise to work as a clinical service provider is major impetus in deterioration of pharmacists’ self-confidence. However, despite recognizing these shortcomings, even newly graduated pharmacists are unwilling to gain experience by working at community pharmacies only because of sub par remuneration. In doing so, pharmacists are missing the chance to connect with the public and help people recognize their proactive role. Currently, pharmacy profession in Pakistan is swarming with females because of extensive student enrollments, but their availability at community settings is sparse due to lack of women-friendly environment, wage discrimination and disrespectful mindset of the orthodox society. This gender imbalance is also one of the bothersome barricades effecting representation and recognition of community pharmacy services in Pakistan.
Community pharmacy services are also being curtailed due to a number of factors at drug-store proprietor level. In Pakistan, the drug store-owners are earning nominal profit due to low-profit margin between retail and trade price. Consequently, they cannot meet high salary expectations of pharmacists, which is one of the major reasons for pharmacists not opting for community pharmacies as a full-time profession. Abysmally high sale of “prescription only drugs” and unregistered and substandard medicines in the absence of pharmacist is a plus for proprietors in terms of earning a massive profit. Therefore, many of the drug store proprietors breach the law and resist hiring a pharmacist. Besides this, a pharmacy-owner never wants to pay a person merely because of his/her qualification. This is because pharmacists either do not want to handle the prescription on counter and find it humiliating after studying a nerve racking five-year professional course, or they are not adequately competent to identify medicines in store shelves, fill prescriptions and counsel patients. If a pharmacist is unable to identify medicines, fill prescription and counsel properly and does not want to work on low wages, then why would a proprietor employ him/her?
In a nutshell, the community pharmacy services are confronted with interlinked challenges, which should be addressed on many fronts by all the stakeholders. The formation of a multi-stakeholder committee headed by pharmaceutical regulators specialized in pharmacy services seems a dire need of time in Pakistan. The Pharmacy Council of Pakistan needs to take radical steps to uplift, overhaul and align pharmacy education and practices. Pharmacists not only need to collaborate to deter professional malpractice, but they also need to recognize that their power resides in aiming for identity rather than authority. We await success stories and iconic figures in this neglected field.
—The writer is Prof at Islamia University of Bahawalpur.
