Manjiri Gharat, Vice President and Chairperson, The Indian Pharmaceutical Association, speaks on the role of community pharmacists in effective healthcare delivery, highlights the fact that the concept has not evolved in India and recommends involving pharmacists in national health programmes for improved results
Case 1: A medical shop in a rural area. One early morning, as soon as it opened, a customer walked in and asked for a painkiller. Instead of simply handing over some tablets, the pharmacist enquired more about the symptoms and understood that the patient had pain on left side of his shoulder, and his back. He also had some uneasy feeling as well as numbness in the extremities. The pharmacists asked the patient to sit inside the shop for a few minutes and then checked his blood pressure. On finding it to be very high, he counselled the patient to visit a nearby district hospital. Subsequently, the patient was diagnosed as hypertensive and a few days later he came back to thank the pharmacist for diagnosing his condition.
CASE 2: A chemist shop in a busy metropolitan city. A TB patient walked into a pharmacy along with a family member. Pharmacist saw the patient and took out the patient’s medicine box from an inside shelf. He gave the tablets to the patient and offered him water. The patient consumed the tablets and the pharmacist made some entry in the patient’s card. He also interacted with the patient about the current status of his health. He also checked the patient’s weight on a weighing scale. The patient thanked the pharmacist and left.
It might be a little surprising to read the above cases, but they are real life incidents. One can clearly see the active role that the above two pharmacists have taken up and their positive intervention in the lives of the patients. How many pharmacists take up such roles in our country? Well, it will be a challenge to find such ‘healthcare pharmacies in our country. The usual scenario is where a patient walks into the pharmacy, asks for medicines with or without prescription, makes the purchase and leaves the pharmacy. For years together, this has been the scenario in seven to eight lakh pharmacies across the country. We hardly even know if a pharmacist is present at all pharmacies of the country. This is the grim reality of the pharmacy practice in our country. On one side, we are making incredible strides in the pharma industry but on the other side, the pharmacy practice has not seen the same rate of progress. It has turned out to be a trade rather than a part of the healthcare profession. The Drugs and Cosmetics Act, which was made way back in 1940, could not be enforced in the practice sector. As a result, ensuring a registered pharmacist in all shops remains a struggle and the role of the pharmacist has hardly developed. In fact, it is disheartening that in some states across the country, there is an increasing demand that the Act should be modified and the clause demanding a full-time pharmacist in each pharmacy should be deleted from the Act.
Globally, the concept of a community pharmacy is well developed and except for a few countries from the South East Asian region and Africa, the pharmacist is a link between the doctor and the patient, and a true patient counsellor. The pharmacists’ duties and responsibilities have advanced and expanded to such an extent that they have become a key component of the healthcare team. Health advice, medication therapy management, immunisations, home medicine reviews, emergency prescribing, clinical measurements, and health advice are just a few of the services which a pharmacist provides to the society. In several Gallup polls, pharmacists have bagged first or second positions as most trusted professional among various professionals such as doctors, lawyers, bankers, teachers etc. Optimum utilisation of this human resources for health definitely makes a positive contribution in healthcare.
Clinically oriented education, appropriate educational and drug policies and its effective enforcement, excellent leadership and advocacy, good remuneration, well aware consumers and strong political will are important factors which have helped to develop the pharmacists’ role. In our country, we have lagged behind, resulting in the current situation.
Awareness is very low among our consumers. Medicines’ misuse is rampant in the country. Overuse, underuse, wrong use of medicines lead to adverse drug reactions, therapeutic failures, relapse of the diseases, and of course increased expenses. Problems like antibiotic resistance have emerged due to such incorrect use and India has
become the country with highest drug resistance. There is no one to guide the patient about medicine usage. Medical professionals are busy and so are health experts and diagnosis experts. Relevant information for patients is, by and large, not available with the medicines. The concept of package insert has not evolved in the country and unlike many other countries, it’s not a mandatory requirement for pharma companies. The pharmacists’ role is still just that of a drug seller than of a medicine counsellor. This situation leads to a state of confusion among the patients. Health literacy is anyway not great in India and overall there is a casual attitude in this regard. Self – medication is very common and easy availability of medicines over the counter due to lack of strict enforcement of drug laws encourages self-medication. The situation is further complicated by the fact that more than 100,000 formulations are available in the market, and there exist a variety of wrong practices for profitability by pharma companies and the supply chain. Overall, the situation is chaotic. Rising graphs of non-communicable as well as infectious diseases clearly show the unhealthy condition of the country. In a recent report by World Economic Forum on the health status of the countries, India is way behind and is ranked at the 103rd position. A significant percentage of population is pushed below the poverty line due to out of pocket expenditure on healthcare.
There are around seven lakh pharmacies in the country. Just imagine for a moment that every pharmacy has a registered pharmacist and the pharmacy offers patient care services as exemplified by the cases described in the beginning of the article. If this happens, in a country where poverty and illiteracy are major concerns, it could make a huge difference in the lives of the people. Pharmacists are the first point of contact for most patients. Hence, they can play a vital role in health promotion and disease prevention. A few pharmacists who have taken up such a role have proved that their contribution can make a significant difference.
Till now, the most positive example in the community pharmacy is the participation of pharmacists in the Revised National Tuberculosis Control Programme (RNTCP) by the Govt. of India. Started as a small initiative in Mumbai in 2006 by Indian Pharmaceutical Association (IPA), over a period of time, it has grown to a national level with the support of other partners and the encouragement of the Central TB Division, Ministry of Health and Family Welfare. In this pharmacist-centric model for TB care and control, trained pharmacists refer the chest symptomatic cases for diagnosis and help in early detection of TB as well as provide Directly Observed Treatment, Short Couse (DOTS) medicines to the patients and monitor the treatment. It helps to increase the outreach of DOTS services and thus increase access to free medicines. Positive evidence of their work and advocacy led to the entry of pharmacists in the national health programme. This PPP is slowly spreading across the country. This model has set an example and shown that even in the existing ‘trade’ scenario of pharmacy practice, pharmacists can be engaged and utilised for patient care. It has shown the importance of training and including community pharmacists in other national health programmes to start utilising this untapped human resource for improving public health. To progress towards Sustainable Millennium Goals, we must start utilising every healthcare resource.
The pharmacy practice in India needs an overall revamp to progress and be at par with the global pharmacists. However, it may take several years if at all the process starts.