Social and Administrative Aspects of Pharmacy in Low- and Middle-Income Countries

Present Challenges and Future Solutions

Mohamed Izham Mohamed Ibrahim, Albert Wertheimer, Zaheer-Ud-Din Babar

• Publisher: Academic Press
• Year: 2017
• ISBN:
  9780128112298
• Topic: Medicine
• Subtopic: Pharmacology

Social and Administrative Aspects of Pharmacy in Low- and Middle-Income Countries: Present Challenges and Future Solutions examines the particularities of low- and middle-income countries and offers solutions based on their needs, culture and available resources. Drawing from the firsthand experience of researchers and practitioners working in these countries, this book addresses the socio-behavioral aspects of pharmacy and health, pharmacoeconomics, pharmaceutical policy, supply management and marketing, pharmacoepidemiology and public health pharmacy specific to low- and middle-income countries.

While some practices may be applied appropriately in disparate places, too often pharmacy practice in low- and middle-income countries is directly copied from successes in developed countries, despite the unique needs and challenges low- and middle-income countries face.

• Examines key issues and challenges of pharmacy practice and the pharmaceutical sector specific to low- and middle-income countries
• Compares pharmacy practice in developed and developing countries to highlight the unique challenges and opportunities of each
• Provides a blueprint for the future of pharmacy in low- and middle-income countries, including patient-centered care, evidence-based care and promoting the role of the pharmacist for primary health care in these settings

Chapter 1

Introduction

Discovering Issues and Challenges in Low- and Middle-Income Countries

Mohamed Izham Mohamed Ibrahim¹, and Albert I. Wertheimer^{2 1}Qatar University, Doha, Qatar ²Nova Southeastern University (NSU), Fort Lauderdale, FL, United States

Abstract

There are gaps and challenges in pharmacy practice in developing countries and possible solutions for various pharmacy stakeholders. Health and public health are essentials for development. The weak global economy has hindered progress toward the sustainable development goals. Many people are still living in poverty with poor health status and inadequate healthcare. Poor health and pharmaceutical sectors in a country will increase the vulnerability of the country and leaves the society at risk. Effective public health interventions can save hundreds of millions of lives. Pharmacy system is one of the core components in a healthcare system, and pharmacists play a very important role. This book sheds light on various topics that individually and in combination determine the status of pharmacy practice in individual countries. This book incorporates multiple data sources and when outliers are discovered, that may be called to the attention of the reader. This book also provides knowledge and understanding about social and administrative aspects of pharmacy in healthcare in low- and middle-income countries.

Keywords

Administrative pharmacy; Developing countries; Pharmacy; Public health; Social pharmacy

Chapter Outline

Introduction

Public Health Pharmacy in Low- and Middle-Income Countries: Issues and Challenges

Social Pharmacy

Why Do We Need This Book?

What Does It Add to the Present Knowledge?

References

Further Reading

What is today greatly depends upon what was yesterday and helps shape the future of what will be tomorrow

Robert V. Evanson et al. (1985)

Introduction

Evanson, McEvilla, Hammel, and DeSalvo (1985) reminded us that the major obstacle to the establishment of pharmacy administration is due to the negative attitudes and imbalanced focus and emphasis between professionalism versus business orientation that are inherent in pharmacy practice. The book that was edited by Fathelrahman, Mohamed Ibrahim, and Wertheimer (2016), explored the pharmacy practice in 19 developing countries in Asia, Africa and Latin America and provided an excellent overview of pharmacy practice. The book also provides us with gaps, challenges and possible solutions for various pharmacy stakeholders in the developing countries. There is a great deal of work that needs to be done by the pharmacy stakeholders in order to improve the pharmaceutical health services for fulfilling the needs of the society. It is understood that under the sustainable development goals (SDGs), every country is in need for development (United Nations, 2017). Yet unfortunately, the weak global economy has hindered progress toward the SDGs, especially for countries with lower economic level. Development is everyone’s problem and everyone’s dream.

There is no clear definition of the terms “developed and developing countries” or no consensus on how to categorize these countries. Developing countries include, in decreasing order of economic growth or size of the capital market: newly industrialized countries, emerging markets, frontier markets, and least developed countries. List of developing countries according to the United Nations (2014) can be classified into three categories: developed economies, economies in transition, and developing economies. Geographical regions for developing economies are as follows: Africa, East Asia, South Asia, Western Asia, and Latin America and the Caribbean. According to the O’Sullivan and Sheffrin (2003, p. 471), a developing country is a country with a relatively low standard of living, undeveloped industrial base, and moderate to low Human Development Index. This index is a comparative measure of poverty, literacy, education, life expectancy, and other factors for countries worldwide. For the sake of the discussion, the book will consider the classification of countries based on per capita gross national income (i.e., low- and middle-income countries (LMICs)).

The political, economic, and pharmaceutical sector conditions differ between the countries; some have to do much more and work harder to improve their situations than others. There are significant social and economic differences between developed countries and LMICs. Many of the underlying causes of these differences are rooted in the long history of the development of such nations and include social, cultural, and economic variables; historical, political, and geographical factors; as well as international relations.

Furthermore, it is not the intention of the book to indicate the level of the inferiority of an LMIC or an undeveloped country compared with a developed country or between East and West, but rather to trigger and stimulate the mind of the people in the LMICs about the challenges and problems the societies are facing for decades. No country in this world is free from problems and challenges, but people in the developing world suffer relatively more. The focus of this book is to highlight, discuss, and document policy issues in LMICs and about having best practices in the pharmaceutical sector. So far, to what extent is the contribution of pharmacists to this matter?

Health and public health are essentials for development. Around 50% of the world’s population are residing in LMICs and they are still living in poverty with poor health status and inadequate healthcare. In any healthcare system, pharmacy system is one of the core components and pharmacists play a very important role. With the dynamic changes happening in healthcare, disease, information communication technology and regulations, and the roles and responsibilities of pharmacists are becoming more important than before. The expectations on the pharmacists are changing; the societal needs and demands are much greater compared with several decades ago. On the other hand, there are growing problems with medicines, the health system, and human resources, especially in the LMICs. There are countries with high prices of medicines, a wide prevalence of nonquality medicines (i.e., substandard and counterfeit), lack of access to medicines, and absence of a national medicines policy (NMP) even with strong encouragement from World Health Organization (WHO). Poor health and pharmaceutical sectors in a country will increase the vulnerability of the country toward several critical problems at micro- and macrolevels and leaves the society at risk. In the medicines supply system, to ensure access to medicines, the following aspects are critical:

• reliable health and supply systems;

• sustainable financing;

• rational selection; and

• affordable prices of medicines.

The importance of a healthcare system must be looked from three angles: the institutions, organizations, and resources; resources include workforce, financial, and infrastructure. To achieve universal health coverage, the system must function well. The three elements, i.e., institutions, organizations, and resources must be brought together to deliver quality health services to meet the demands of the society. Unfortunately, according to Mills (2014), the goals of universal health coverage in LMICs could not be achieved, child and maternal deaths are still high, financial protection is lacking, and people do not seek care because of lack of financial support.

Public Health Pharmacy in Low- and Middle-Income Countries: Issues and Challenges

Even though the rational use and quality use of medicines are worldwide issues, but they are particularly pertinent to LMICs. Access to medicines is still crucial, as 400 children suffering from tuberculosis worldwide die daily, largely because of low access to appropriate treatment (WHO, 2016a, 2016b). Ranganathan and Gazarian (2015) reported that there are several key challenges for delivering rational use of medicines (RUM) to children in the developing countries. Among the problems are as follows:

• lack of coordinated NMP to support RUM;

• availability, affordability, and accessibility to medicines’ issues;

• inappropriate standards of quality, safe, and efficacy of medicines;

• lack of independent, unbiased, and evidence-based information;

• lack of information, knowledge, and skills among healthcare practitioners who are dealing with medication use process among children;

• lack of proper devices and tools (e.g., calculator and weighing machine) used when deciding on the appropriate dosage for the children; and

• retailers selling prescription medicines extensively over the counter.

Dowse (2016) reported that the likelihood of poor health literacy in developing countries is prevalent. Health literacy is fundamental to the effectiveness of health programs and improvement to the quality of life. The United Nations Educational, Scientific and Cultural Organization Institute for Statistics found that around 7% of countries (13/180) indicate an adult literacy rate below 50%. All these countries are from sub-Saharan Africa, and the lowest adult literacy rate is in Mali with a 26.2% (United Nations, 2009). Another issue is corruption. Corruption (e.g., misinformation, bribery, theft, and bureaucratic corruption) is a global problem and negatively affects the medicines supply chain and the overall healthcare system. The backbone of the health system is formed by well-functioning supply chains that deliver various pharmaceutical products (Yadav, 2015). The Corruption Perception Index 2016 illustrated that none of the LMICs listed top 10 of the transparent (i.e., clean) ranking. On the scale of 0 (highly corrupt) to 100 (very clean), over two-thirds of the 176 countries and territories in this index fall below the midpoint (Transparency International, 2016). People also faced with issues related to substandard medicines, counterfeit drugs, nutrition, tobacco consumption, maternal and child health, and environmental hazards (WHO, 2017). WHO (2014) reported that the environmental hazards such air pollution caused around 7 million premature deaths a year. Most areas affected were densely populated LMICs. The conditions in the developing countries become worse when people suffer from various turmoil conditions such as war, humanitarian conflict, and public health crisis, which further collapse completely the healthcare system. These aspects make working in the healthcare system and the practice of pharmacists more challenging.

In short, the LMICs are facing social, economic, environmental, human capital, political, and infrastructure issues that directly or indirectly affecting the health and pharmaceutical health services. Much needs to be done in LMICs. The following are...

Table of contents

• Cover image
• Title page
• Table of Contents
• Copyright
• Dedication
• List of Contributors
• Acknowledgments
• Chapter 1. Introduction: Discovering Issues and Challenges in Low- and Middle-Income Countries
• Section 1. Sociobehavioral Aspects of Medicines use In low- and Middle-income Countries
• Section 2. Pharmaceutical Promotion In low- and Middle-income Countries
• Section 3. Economic Evaluation and medicines Expenditure In low- and Middle-income Countries
• Section 4. Pharmacovigilance and Patient safety In low- and Middle-income Countries
• Section 5. Generic Medicines use In low- and Middle-income Countries
• Section 6. Rational and Responsible Medicine use In low- and Middle-income Countries
• Section 7. Quality of Public health Pharmacy Services in Low- and Middle-income Countries
• Section 8. Medicine quality: Substandard and counterfeit Medicine in Low- and Middle-income Countries
• Section 9. Medicine Information and Health literacy In low- and Middle-income Countries
• Section 10. Good Governance and Pharmaceutical Policy In low- and Middle-income Countries
• Index