‘Pharmacy shops- the unaccounted pillar of primary Healthcare.

I visited to a local pharmacy shop yesterday for some prescribed medicines. It was around 10.30pm, when I observed an elderly man of 55yrs age came asking for “pandhari choti goli (small white pill) ani rantac dya (Give white small pill and rantac). The pharmacist gave them away. Till then a teenager girl came slightly afraid state of mind. The shopkeeper asked “Kae pahije tumhala? (What do you want?)”. She said “Daant mein dard hai( I have toothache)”.He took out combiflam (white tablet strip) but she said “nai nai who dusra pila goli do (No, No Give me another yellow colored tablet) ”.  And then so he opened the drawer showed another strip which she bought. These incidents flashed series of questions in my mind beginning from medical history, who might be actually patient, what would be the patient demographics etc. We faced challenging times of pandemic and lockdown recently. During those difficult times, the only social contact convenient and without much fear other than for household needs was pharmacy shop. So, I read some literature and tried to understand the whole process policy making. Luckily, all this it befell on day on union budget announcements.

The reason for seeking self-medication would be due to the lack of decision making in treatment. This encourages us to consider patient’s view during the policy making process. The economic interests at different levels challenge the aim of achieving health. The righteous manner of policy practice and the ethical healthcare will help to enhance the indicators of health along with overall good performance. The market consideration of health as commodity needs to rectified.

ThemeStrategic goal
Helping people to gain better outcomes from medicinesTo ensure that throughout life, in accordance with their clinical needs, people have access to timely, safe, quality assured medicines supplied with appropriate advice and support to help them gain the best outcomes from their treatment and avoid harm.
Helping people to live longer, healthier livesTo provide people with access to advice and support from pharmacists in the community promoting, public health, self-care, improved health and wellbeing and preventing illness.
Helping people to safely avail of care closer to homeTo provide improved access to clinical expertise and interventions for patients closer to home by making the best use of the skills of pharmacists working together with/alongside other healthcare professionals in the community.
Helping people to benefit from advances in treatment and technologyTo support better health outcomes for patients through advances in medicines treatments and technology.

(Source: Department of Health, Social Services and Public Safety for Northern Ireland. 2013).

National medicines policies:

The national medicine policy making and its implementation has certain key factors which need to be taken in account which are as follows:

1.Country-specific and complicated process: The complexities occur due to the variation of public-private sector involvement in the healthcare. There are regional difference in the demographic characteristics of the population, the utilization of insurance schemes, change in pattern or morbidity and mortality and the foremost is the financial contribution for the healthcare.

2.Black box process and time span: The process of coherence is difficult while policy making as a result of varying interests. The various stakeholders in the process such as patients, regulators, pharmaceutical companies, NGOs, health care professionals etc have different approach. The time duration for giving value to issues raised and inclusion of the solutions towards the problems shown by the whistle blowers depends on the political will. Therefore, a clear political willingness is necessary to have broader engagement to have equitable health goal.

3.Monitoring of implementation: The practice of new policy needs to have sufficient resources and motivation to take it up forward. There are instances of policies been failed during implementation due to lack of monitoring.

In 2012 a ministerial summit was held between ministry of Health Netherlands and senior policy makers. They emphasized on the benefits of responsible use of medicines. They also had put forth the idea of utility of range of healthcare personnel including nurse, doctors and pharmacists. But the question remains how to tackle pharmaceutical policy in practice. There is need to ensure that the right medicine goes to the right patient at the right dose/time and at the right cost. Because, the medicine provided should be protective from risk/danger as well as cost effective. In India the third largest foreign exchange earner sector is pharmaceutical industry.

Much attention in past has been given to procurement and prescribing medicines but its high time we should focus on patient utilization, self-medication and decision making in their treatment. There is brighter side to this which is of health literacy. The pharmacists can become a bridge to become a well-trained and cost-effective healthcare personnel. It has been identified in UK government where pharmacists are acting as link between clinician and patient. They are promoting them for managing chronic diseases. This will reduce burden on healthcare professionals and avoid the long waiting time for patients in follow up queue. Obviously, it will reduce the exposure of asymptomatic patients to various hospital born infections and save their absentee wages loss. Therefore, a pharmacist in our neighborhood can be similar to double edged sword. In India, National health policy 2017,also mentions the pharmacist role as medicine provider. However, the stronger regulation for margin profits needs to be stringently followed. As there are varying prices for same drug with different brand name. Even though, there was a National list of essential medicines prepared by ministry of health but the department of pharmacy comes under ministry of chemicals and fertilizers. This organizational structure makes implementation more complex. The novel coronavirus pandemic has made changes worldwide. This worked for budget allocations in India as well. Finally after waiting for many years the focus was on ‘public expenditure on healthcare’. There will be increase in its spending to 2.5% of GDP by 2025 (as per the targets under the National Health Policy, 2017). Also, it is proposed to have the public-private partnership model to strengthen the primary healthcare infrastructure in the country.

References:

1.George B. (2017). India’s Draft Pharmaceutical Policy — A Game Changer.Biosimilar development.

2. Sharma A. (2021). Union Budget 2021-22: Reforms in healthcare and pharmaceuticals.Financial Express.

3.Department of Health, Social Services and Public Safety for Northern Ireland. Making it better through pharmacy in the community. 2013. Available on: http://www.dhsspsni.gov.uk/pharmaceutical_services_in_the_community__2_.pdf.

4. Morrow, N.C. (2015). Pharmaceutical policy Part 1 The challenge to pharmacists to engage in policy development. J of Pharm Policy and Pract 8, 4. Available on: https://doi.org/10.1186/s40545-015-0027-5

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