E-DRUG: Improving community pharmacy practice (4)
This is an interesting topic. In my opinion, the proliferation of medicine
dispensing outlets is a reflection of the increasing demand for pharmaceutical
services. Unfortunately, the availability of competent human resource does not
match this growth, hence the encroachment by petty traders.
So, should there be a "modest" increase in petty trader functional
competence/basic knowledge? Yes, but I think modest is an understatement.
If the Ugandan version of 'petty traders' is to be the barometer, these cadres
are blatantly ignorant! However, we cannot bury our heads in the sand like
ostriches and pretend we can do away with petty trade in pharmacy at the
moment. We'd rather have non-pharmacists who know their science and are capable
of rendering fairly good evidence-based service rather than have profit-driven
businessmen who treat every fever as
malaria, and cannot refer patients appropriately either out of ignorance or for
However, any capacity building in this regard will only succeed if there are
regulations enforced to ensure: only 'petty traders' with some background
training in medical sciences are trained and authorized to operate (I strongly
doubt every Tom, Dick and Harry can be sufficiently trained to render competent
services in a pharmacy unless they have the relevant background); that the
training is comprehensive and mandatory for
all medicine outlet operators/dispensers e.g. by making it a requirement for
operation; and that a mechanism is put in place for support supervision and
mandatory refresher courses/CPD.
In Uganda, the Pharmaceutical Society of Uganda conducts an annual course for
pharmacy auxiliary staff at a modest cost. This is done on consecutive weekends
and covers a wide range of topics in case management of common illnesses,
medicine management and rational drug use. The Council of the Society also does
support supervision, but these are infrequent.
I believe capacity building in the sector must be multi-pronged. Regulatory
agencies must make it mandatory for any "petty trader" to get trained before
they are allowed to operate. Public-private partnerships are required to ensure
whatever training programmes are in place are affordable, accessible and
sustainable. Given the dire situation in many
countries, I think the initial attempt should be a pilot project in selected
areas followed by a nationwide roll-out to ensure all "petty traders" (I feel
jittery using that phrase!) get baseline training.
Subsequently, refresher programmes can be put in place to augment this. Also,
seeing is believing; so the importance of IEC materials in this regard should
not be underestimated.
The other approach could be increasing public awareness about rational drug
use. An informed population will question the decisions of quack operators and
check their uninformed practices.
One obvious challenge to any capacity building effort is the time. Most of the
"petty traders" would not like to be away on a course for a long time as this
will affect their business. The model I'm currently developing for testing in
Uganda takes this into account and proposes a blended course with initial
intensive contact course followed by a distance learning package.
Another issue will be the cost. Who will foot the bills? The "petty trader" in
a developing country will most likely be a peasant trying to eke out a living.
He will not readily understand the essence of such trainings and hence refuse
to part with any tuition fees. If advocates for rational drug use are committed
to making real difference in this area, they should consider funding such
capacity building endeavours. Talk and
more talk will yield nothing. It is time they put their money where their
I hope this helps the discussion.
Makerere University/Walter Reed Project
Plot 42, Nakasero Road, Kampala
P. O. Box 16524, Kampala
Tel: +256-414-534588 (office); +256-392-948649 (mobile)