Pharmacy Practice in Developing
Countries:
Gaps and Challenges
Mohamed Izham M.I., PhD
Professor of Social & Administrative Pharmacy
College of Pharmacy, Qatar University
Doha, Qatar
Congress of Scientific Association of the Pharmacy Colleges in the Arab World
Acknowledgement
Omdurman Islamic University, Faculty of
Pharmacy
2. Academic Press, Elsevier Inc. (Book:
Pharmacy Practice in Developing
Countries, 2016)
3. Co-editors: Dr. Ahmed Fathelrahman &
Professor Albert I. Wertheimer
4. All contributors from 19 LMICs
1.
Presentation Outlines
Background
 How was the analysis done?
 Findings
 Gaps and challenges
 Recommendations
 Conclusions

Introduction
People across the globe are living longer
 Positive development of the health care
system

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◦
◦
◦
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technology advancement
new cost-effective medicines
better lifestyles
better understanding of diseases
various research discoveries
better trained health care personnel

At the same time, we could also observe:
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◦
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growth in population
increase in life expectancy
more people experiencing chronic diseases
people consume more medicines

The improvement in the quality and
responsible use of medicines in society is
very much dependent on the overall
quality of the health care and
pharmaceutical system

There is a great need for an effective
pharmacy practice to ensure responsible
and quality use of medicines from all
perspectives
The question is:
ARE WE/PHARMACISTS
READY WITH THESE
DEMANDS AND
CHALLENGES?

Good pharmacy practice (GPP)
◦ FIP first adopted the guidelines in 1993
◦ WHO then endorsed a revised version in
1997
◦ In 2011, both the FIP and the WHO adopted
an updated version of GPP
◦ WHO in addition produced guidelines in
relation to community and hospital practice
HOW FAR SINCE 1993 (AFTER
MORE THAN 2 DECADES) HAS
PHARMACY PRACTICE
IN THE DEVELOPING COUNTRIES
IMPROVED AND RESPONDED TO
THE PROPOSAL AND
GUIDELINES?
Study on 19 LMI countries

Critically analyze the status of the 19
countries in terms of the practice of
pharmacy in each country and to
compare between them

Objectives:
◦ to find, via comparisons, which countries are
practicing well based on satisfying community
needs and making use of resources;
◦ to identify the gaps (present situations vs
recommended conditions); and
◦ to recommend the way forward
How was the analysis done?

We divided countries into categories
based on the World Bank list of countries
by income classifications

A list of variables was used to compare
the pharmacy practice, policy and
regulation, and education and training
aspects

Performance was then compared to see how
well a country was doing generally and
compared to other countries of similar
wealth

Scores were assigned to positive practices in
countries (maximum of 14)

Data were analyzed descriptively (i.e.,
frequency (%), mean (SD), and median (IQR))
using IBM SPSS Statistics® version 22
Findings
Table 1: Country – Economies by per capita GNI in 2012
UN category based
on income
Low income
Income bracket
Country
$1,035 or less
Burkina Faso, Nepal
Lower middle
income
$1,036 to $4,085
Upper middle
income
$4,086 to $12,615
Egypt, India, Indonesia,
Nigeria, Pakistan,
Palestine, Sri Lanka,
Sudan,Yemen
China, Iraq, Jordan,
Malaysian, Thailand
High income
$12,616 or more
Chile, Qatar, Saudi
Arabia
Source: World Bank. World development indicators: size of the economy. 2014
Table 2: Criteria in low income country
Criteria for comparison
Country
Burkina Faso
Nepal
18,365,123 (2014)
1,700 (2014 est)
30,986,975
(2014)
2,400 (2014 est)
54.78
409 (0.2)
67.19
1200* (0.387)
No
No
What is the popular areas of practice?
Community pharmacy
Pharmaceutical industry
Any unique services?
How controlled substances are handled?
None
Only with prescription
None
Only with prescription
Is continuing education for pharmacist required?
Yes
No
Is there enough pharmacists to cover the community needs?
No
No
Does practice matching available resources?
No
No
Using e-health technologies in pharmacy practice
No
No
Country background
Population (million)**
GDP per capita ($, ppp)**
Life expectancy (years)**
Number of licensed pharmacist (per 10,000 of population)
Practice criteria
Is selling medicines outside of pharmacies allowed?
Policy and regulation
Is state licensure is required to practice?
Yes
Is a non-pharmacy degree holder allowed to operate a retail pharmacy without a
Yes (but under the
pharmacist?
license of a pharmacist)
Yes
Yes
Must a pharmacy shop have a registered/licensed pharmacist present to operate?
Yes
Yes (due to the lack of
pharmacists license is given
to pharmacy assistant)
Are there location requirements for opening a community pharmacy?
Yes
No
Is there regulation to handle controlled substances?
Yes
Yes
Yes
9/14
Yes
7/14
Does NDP exist?
Score
Table 3: Criteria in lower middle income country
Criteria
for
compari
son
Palestine
7/14
Yemen
6/14
Sri Lanka
Pakistan
12/14 11/14
Nigeria
8/14
Sudan
9/14
Indonesia
Score
India
Egypt
Country
10/14
9/14
12/14
Table 4: Criteria in upper middle income country
Criteria
for
compari
son
Score
Country
China
9/14
Iraq
10/14
Jordan
12/14
Malaysia
10/14
Thailand
8/14
Table 5: Criteria in high income country
Criteria for
comparison
Score
Country
Chile
Saudi Arabia
Qatar
7/14
13/14
10/14
Number of Arab countries above average = 6/8
More critical analysis…..
Population: India – Qatar
 LE: Chile & Qatar – Nigeria
 GDP per capita: Qatar – Burkina faso
 Number of pharmacists per 10,000
population ratio: Jordan – Burkina Faso

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Five (26%) countries do not allow selling
of medicines outside of pharmacies
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Most popular area of practice is
community pharmacy (n = 10; 53%)

Majority of the countries do not have any
unique service in the pharmacy practice
(n = 12; 63%)
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All countries have laws that regulate
controlled substances
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Pharmacists in 13 (68%) countries are not
required to do their CE; only one country
require pharmacists to attend CE for
their renewal of registration

17 (90%) countries do not have enough
pharmacists

14 (74%) countries are not matching
available resources

6 (32%) countries use e-health
technologies to a certain extent
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Only four (21%) countries allow a nonpharmacy degree holder to operate a
retail pharmacy
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Only three (16%) countries do not require a
pharmacy shop to have a registered/licensed
pharmacist present to operate

42% (n = 8) of the countries put a
requirement on the location for opening a
community pharmacy
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All countries have regulations on handling
controlled substances
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Only four (21%) countries are without a
national medicines (drug) policy

Scores ranged from 6.0 to 14.0 (mean
score (SD) = 9.4 (2.0))
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low income countries = 8.0 (1.4)
lower middle income countries = 9.3 (2.0)
upper middle income countries = 9.8 (1.5)
high income countries = 10.0 (3.0)
 a clear upward trend; the higher the income
category, the higher the mean score, which indicates
more positive practices
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Many countries have a national medicines
policy and pharmaceutical acts and
regulations, but
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ineffective policies
weaknesses in enforcement
lack of punitive action
lack of motivated and dedicated authorities
Low salaries of employees
◦ vulnerable to corruption
◦ lack of motivation & commitment

Lack of human resources
All these will contribute to poor
pharmaceutical sector
 In addition, the market possibly be
exposed to

◦ substandard and counterfeit drugs
◦ illegal distribution of Western medicines
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There are countries with few (earlier was
none) colleges of pharmacy
◦ allowing non-pharmacy graduates with few or
no qualifications to operate a retail pharmacy
or drugstore
◦ controlled medicines that can be bought easily
without prescription

Plus countries with lack of enforcement,
matters get worse

Lack of ethical practices and
professionalism plus the conditions
explained above:
◦ makes the pharmaceutical sector weak, and
◦ places the society at risk

In many of the developing countries,
prices of medicines are not effectively
controlled
◦ medicine availability and affordability are a
major concern
◦ unhealthy business – “price wars”

In many of the developing countries,
issues of medicine production,
procurement, and consumption are
critical
◦ domestic medicines production is not
sufficient for the country
◦ medicines have to be imported
◦ none or ineffective generic medicines policy
◦ high public out-of-pocket expenditures
◦ inefficient of procurement process
Ill health and poverty are closely
associated
 Ineffective financing systems have placed a
high burden on the poor people
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What else are we suffering from?
◦ Quality of the pharmacy colleges
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Lack of faculty members
Lack of qualified and quality faculty and staff
Lack of quality infrastructure
Lack of quality graduates
Lack of quality curriculum
Mismatch between curriculum content & knowledge and
skills needed in practice
◦ Quality of the government
 Weak, incompetent, inexperienced
◦ Continuous crisis…..
Gaps and Challenges
How far is the gap?
 Gap analysis: a technique for identifying
needed improvements by comparing the
current environment and current
processes against an envisioned future
state

◦ the gap between current practice and the
desired practice
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Benchmark countries with a high score
◦ better practice standards, within the same
category of economy, environment, or
geographical type
◦ look for best practices
 learn, adopt, and adapt a set of best practices
Few considerations:
1. Professionalism—How far is the professionalism factor built in the pharmacy
practice?
2. Decision-making—Are pharmacists the main players and key decision-makers in
matters related to medicine use?
3. Health care team—Are pharmacists key players on the health care team? And
how is the pharmacist’s relationship with other members of the health care team?
4. Patient information—Do pharmacists have access to patient information, e.g.,
medication profile, in order to perform effective pharmaceutical care?
5. Academic programs—Does the country have adequate pharmacy colleges? And
what is the quality of the pharmacy program and the credentials of the faculty members
in the pharmacy colleges?
6. CE—Do pharmacists have the opportunity to upgrade or improve their knowledge,
skill, and competency throughout their career?
7. Standard of practice—Does the country has a minimum standard of practice in all
pharmacy settings?
8. Scholarly activity—How far is the pharmacy practice research? How many
publications in quality journals? And what is the impact on pharmacy practice and
pharmaceutical policy?
What is next? A way forward

Brodie (1981): pharmacists must identify
the boundaries of duty and
responsibilities and he encouraged the
practice of pharmacy to move toward the
patient and fulfill the needs of the society

In 1980, the American Public Health
Association recognized pharmacy as a
profession with major responsibilities for
public health

FIP and the WHO (2011) reemphasized
the importance of the role of pharmacists
through their GPP guidelines

Albanese and Rouse (2009) in their
article “Scope of contemporary pharmacy
practice: roles, responsibilities, and
functions of pharmacists and pharmacy
technicians” concluded that
◦ the evolution of health care and pharmacy
practice has created excellence opportunities
for pharmacists to serve the society beyond
the traditional roles
Conduct quality studies to evaluate the
status of pharmacy practice and the
overall pharmaceutical sector in the
country
 Build more evidence-based information
and research
 Effort is critically needed to narrow the
gap of practice within a country, and
between countries
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Pharmacy education in each developing
country should be directed toward
addressing local needs and making use of
the available opportunities
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Hospital pharmacy
Community pharmacy
Public health pharmacy
Industrial pharmacy
Examine guidelines and best practices
from most advanced countries
 Develop and strengthen the national
medicines policy
 Ensure an essential medicines list exists
and benefits the society
 Ensure an effective drug regulatory
system exists
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Review the quality of pharmacy education
and build a competence-based education
 Build a quality CE program and
progressively implement compulsory CE
points for registration renewal of
pharmacists
 Strengthen the research capacity in the
area of pharmacy practice
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Conclusions…take home message !
It is clearly indicate that for many
countries, gaps, barriers, and challenges to
effective pharmacy practice still exist
 The role of pharmacists still has a long
way to go
 The pressure on the whole health care
system worldwide will continue; there is
no escape for the pharmaceutical sector
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The pain of the pressure is felt more by
the low- and middle-income countries
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Further work and effort in the developing
countries is warranted to bring the
pharmacy practice and profession to
another level and standard
References
World Bank (2014)
 Brodie (1981)
 American Public Health Association
(1980)
 FIP-WHO (2011)
 Albanese and Rouse (2009)
