Community pharmacist slowly transforming from a trader to a professional
As everyone knows professionals involved in the healthcare delivery system will never cry over recession as community pharmacy is a lucrative career and is a very well developed and well respected setting. However, the true community pharmacy concept has yet to develop in India. Manjiri Gharat, Vice-President and Chairperson, Indian Pharmaceutical Association-Community Pharmacy Division (IPA CPD) speaks about the reforms needed and the positive happenings in the Indian community pharmacy system with Usha Sharma
Recently you were elected as the Vice-President and Chairperson, Indian Pharmaceutical Association-Community Pharmacy Division (IPA CPD) and also as the Executive Committee Member of Community Pharmacy Section of International Pharma-ceutical Federation (FIP). What are your responsibilities?
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| Manjiri Gharat |
At IPA CPD, we have been working as a team and our focus is to work towards improving the professional standards of the retail (community) pharmacy practice and encourage the realisation of the social aims of the pharmacy profession as a contribution to public health. We strongly believe that collaborative working can yield a lot of results. We work with chemist associations, academia, corporate sector, government authorities and other organisations. As the chairperson of IPA CPD, I lead IPA’s community pharmacy and public health activities and try to have a spread across the country. Reaching out to maximum pharmacists from different corners of the country and educating them, sensitising them for their healthcare professional role is one of the main agenda. I must say that IPA provides an excellent platform for working at local, national as well as international level. Being a pharmacy academician, it provides me with a unique opportunity to work with budding as well as practicing pharmacists.
Let me describe some of the major activities and achievements of CPD.
At IPA CPD we already had several unique initiatives. For the first time we have developed country- specific Good Pharmacy Practices Guidelines based on FIP guidelines 2002 and followed it up with a GPP training manual (in collaboration with WHO India Country Office and CDSCO) 2005. CPD’s immediate past chairman Raj Vaidya has been the leader for our GPP Project. We continue to conduct GPP training programmes across the country. We also had a pilot project on accreditation of retail pharmacies, again a first of its kind initiative. Engaging pharmacists in Revised National TB Control Programme (RNTCP) is another innovative work of IPA CPD. This Public Private Partnership (PPP) is well established now in Mumbai. This project of IPA CPD is in collaboration with RNTCP, MSCDA, SEARPharm Forum and is supported by Lilly MDR TB Partnership. We followed up with Central TB Division (CTD), Ministry of Health, Government of India (GoI) for national expansion of this initiative and in April, 2012 CTD has signed a MoU with IPA, AIOCD, SEARPharm Forum and PCI for inclusion of pharmacies in RNTCP at a national level. IPA’s work and advocacy for pharmacist’s role acted as an agent of change and contributed to the policy change. It is a historic development for the pharmacy profession and marks the first time entry of pharmacists in a National Health Programme. This pharmacist PPP model is also recognised by WHO. High TB burden countries are consulting IPA CPD, visiting Mumbai to learn the model for replication in their countries. Vietnam MoH delegates visited us this July and delegates from the US, Tanzania and Pakistan are coming in March, 2013. So it is a matter of pride for pharmacy profession in India that our pharmacies have become model internationally in public health work. I have been leading this initiative with our team and we are in the process of spreading this model in other parts of the country, as well as are helping the international spread of it. At CPD, we strongly wish and encourage pharmacists to attend national congresses and FIP congresses to take the global experience. Attending international conference such as FIP Congress and learning the global pharmacy practices, meeting people from 100 plus countries itself is a great inspiration and learning. I am glad to inform that at least a handful of pharmacists from Maharashtara have attended last two FIP Congresses and are even presenting papers. Maharashtra State Chemist and Druggist Association (MSCDA) is very supportive to the pharmacists for this activity. This is a new trend setting which will further contribute to professionalise pharmacies. Medicine literacy in the community is essential and CPD works hard for consumer education. Myself and my colleagues regularly write consumer educative articles related to medicines and health in local papers and magazines. We also conduct exhibitions on “Safe Use of Medicines”. We have also begun a campaign “Aushadh Saakharata” since last few years.
I have been associated with FIP for attending congresses, as symposium speaker or for paper presentations, for FIP surveys/ projects etc. It is always a great pleasure to work with FIP in any capacity. As regards to CPS Ex Co, I am a new entrant and learning the systematic functioning of CPS. This is a four-year term. I need to attend two ExCo meetings every year and one of the meetings is during Annual FIP Congress and the other one in mid-of year. There is a lot to learn from FIP CPS experts. To make FIP more visible among community pharmacists in this part of the world, not only India but also in SEAR countries, will be one of the major responsibilities. Also contributing to FIP Congress programme and projects is another responsibility. We already work closely with SEARPharm Forum (WHO-FIP Forum in SEAR Countries) and now with FIP ExCO, it is a great opportunity to contribute to global pharmacy practice development through FIP and which also brings opportunities for Indian pharmacists.
Being a part of FIP, what changes would you like to recommend in India and how are you going to proceed?
As part of FIP we will get more support from FIP in our work, FIP has a lot of expertise and initiatives for taking the pharmacy profession to its pinnacle, across the globe. I will draw ideas from there and adapt them to our country, and try to introduce them one by one, with guidance and support from FIP – by this I hope we will be able to build in the much needed respect and recognition amongst the pharmacists in the country.
Do you think the Indian pharmacy community is facing any problems?
Globally, the role of the pharmacists have expanded and they are considered as healthcare professionals and serves as a link between the doctor and the patient. Pharmacists offer all sorts of patient care services from patient counselling to even immunisation. Prescription audits, monitoring ADRs, de-addiction services, health promotion, use of drug information resources for patient consultation, as well as for advice to medical professionals, home medication reviews by visiting patient’s home and so on. Good pharmacy practices are followed by pharmacists. National standards, scope of pharmacy practice etc are well defined. Pharmacist gets the relevant knowledge, skills and confidence through pharmacy education. Also, continuing education through classroom training or web based is common and mandatory in many countries. Now, there is a trend of specialist pharmacists, i e a pharmacists who will be specialised in a particular therapeutic area. Remuneration and working conditions/ set up are quite conducive. Of course, in the recent times, pharmacists do feel pressure of litigation etc but overall community pharmacy is a lucrative career and is a very well developed and well respected setting. In several public opinion polls, pharmacists have been rated by the society as the most trusted professional, above doctors, teachers etc.
When you look into our country, things are totally different. Honestly it is very disturbing. More or less, with very few exceptions, pharmacies are the drug selling shops and not yet healthcare settings. We do have the true community pharmacy concept developed yet. There are multiple reasons for this situation. In the pharma industry we have made huge strides but unfortunately not in the practice sector. We can’t recognise who is a pharmacist in our pharmacy shops. Sometimes, we don’t find pharmacists in many shops especially in some states. Then where the question of professional patient care service arises? And does our pharmacy education – either D Pharm or B Pharm oriented, give adequate knowledge to the budding pharmacists? A diploma holder or most university graduates will come out of college without much concept and confidence of patient care services. When they start practicing, they face a plethora of problems from lack of hands on knowledge and professionalism, cut throat competition, thousands of formulations, many issues such as strip cutting, doctors dispensing, shortage of staff etc. The list is endless. Overall, the setup is not very lucrative and we need to do a lot to change this situation.
Why did this situation come about?
There have been multiple reasons including lack of required policies for pharmacy practice, lack of patient riented education, no compulsory continuing education, weak enforcement of laws. No recognition of pharmacists in Government/ public/ other stakeholders, lack of public awareness about role of pharmacist. We are a huge country, with more than six lakh pharmacies, complex socio-economic conditions and that complicates the situation further.
But in recent years, there have been many positive happenings and a wave of upliftment of professionalism has set in. In Maharashtra, a one-week Patient Counseling Course (PCC) by MSCDA and MSPC has been a unique effort of educating pharmacists intensely for their counselor role. We can slowly see some positive changes in few pharmacies and can see that professional services have been initiated, including educating patients on dosage, use of devices such as inhaler techniques, measurement of height-weight-BI, blood pressure, blood sugar checks. There have been improvements in computerisation and infrastructure with growth in patient counselling areas. Patient leaflets and stickers for counselling have also been developed. Pharmacists are starting to make themselves and their expertise visible with signs about the availability of counselling in the local language. So these new generation pharmacies and pharmacists are the ray of hope for us. I appreciate their efforts and encourage to take the step to change.
What changes would you like to recommend on an immediate basis to overcome the current unstable picture of the Indian pharmacy community?
India is a huge country and any change requires long time. It is very challenging . As I said earlier, the efforts have started by different stakeholders and it is showing some positive results. As per WHO, It is clear that the pharmacy has an important role to play in the health sector’s reform process. To do so, however, the role of pharmacists need to be redefined and re-oriented. This is where we need to act upon immediately. All stakeholders need to be at one table to develop a white paper/ vision statement regarding community pharmacy practice. IPA CPD will make strong effort to initiate this process. We need to clearly say what is the role of the pharmacist and scope of pharmacy practice. Accordingly, reorient, revamp the education, develop/modify legislation/s, ensure law enforcement, sensitise consumers and medical professionals. FIP CPS has recently developed Vision 2020 for community pharmacy and will soon be on the FIP website. It will be a guiding document for us. Also, there is an urgent requirement to bring GPP under a legal framework and that’s CPD’s immediate agenda too. So overall it is a very challenging situation, where ground realities are quite complex.
What other new initiatives has IPA planned on its ‘To Do’ list and how soon will it be implemented?
IPA has started a bi-monthly E-bulletin (the second issue is already out) to increase the outreach and to update pharmacists with relevant knowledge and information. It has got excellent response and will serve as a connect for us to the entire country. It is also reaching across the globe thanks to the FIP CPS newsletter carries a link to this bulletin. In the CPD team, we have members from different parts of the country. Through them we try to organise training programmes and regional conventions. Recently, we had a convention in Farmagudi, Goa and GPP training programmes at Anantpur, as well as at Nagpur and Chandrapur. We wish to continue working closely with chemist associations at all levels for GPP training programmes. We wish to conduct ToT (training of trainers) programmes to develop a larger pool of faculty for training of pharmacists. Many pharma giants are approaching IPA CPD and wish to utilise IPA’s experience and expertise for training of pharmacists, this is a very welcoming development and we are in dialogue with the pharma industry and we hope soon some of the partnerships may develop soon.
Can Indian pharmacists prescribe medicines? What are their other responsibilities?
In India, we are still far away from prescribing medicines. We can best limit ourselves to recommend OTC medicines for simple ailments and giving advice. We have a lot things to do – providing patient instructions to the prescribed medications, counselling on the prescribed medicines and illness, follow-ups, etc.
What is your outlook about the Indian pharmacist community in a broader sense?
Indian pharmacists are hard working and they work for more than 12 hours, catering to the medicinal needs of the society day and night. Positive change towards professionalism has begun and the Indian pharmacist is slowly transforming from a trader to a professional. Indian pharmacists have a great opportunity to play an active role in public health and you can see that the pharmacists are already working for TB care and control. Similarly, pharmacists can be part of several other national health programmes. With illiteracy and poverty in our country, pharmacists have all the more responsibility to educate consumers about medicines and health issues and I am sure that in the years to come, we will see our pharmacists as a health care professional advancing patient care. Of course it won’t be a revolution but rather an evolution. I am hopeful that with all the stakeholders joining hands, the day is not far when Indian pharmacists will be at par with their global counterparts.
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