Mapping private pharmacies in India

Sabde YD, Diwan V, Saraf VS, Mahadik VK, Diwan VK, De Costa A. Mapping private pharmacies and their characteristics in Ujjain district, Central India. BMC Health Services Research. 2011;11(1):351.

Background: In India, private pharmacies are ubiquitous yet critical establishments that facilitate community access to medicines. These are often the first points of treatment seeking.

Methods: This study of pharmacies was a part of larger cross sectional survey carried out to map all the health care providers in Ujjain district (population 1.9 million), Central India, on a geographic information system. Their location vis-à-vis formal providers of health services were studied, as well as other characteristics like human resources, infrastructure, clients and availability of tracer drugs.

Results: A total 475 private pharmacies were identified in the district. Three-quarter were in urban areas, where they were concentrated around physician practices. In rural areas, pharmacies were located along the main roads. A majority of pharmacies simultaneously retailed medicines from multiple systems of medicine. The proportion of clients without prescription was 39.04%. Only 11.58% of staff had formal pharmacist qualifications. Power outages were a significant challenge. The spatial location of pharmacies in Ujjain district is shown in Figure 2 which shows a concentration in the urban areas. Figure 3 shows the relationship between the location of healthcare providers and the location of private pharmacies in Ujjain city.

Conclusion: This is the first mapping of pharmacies and their characteristics in India. It provides evidence of the urban dominance and close relationship between healthcare provider location and pharmacy location. The implications of this relationship are discussed. The study reports a lack of qualified staff in the presence of a high proportion of clients attending without a prescription. The study highlights the need for the better implementation of regulation. Besides facilitating regulation and partnerships, the data also provides a sampling frame for future interventional studies on these pharmacies.

Improving private pharmacy practice in Vietnam...

Chuc NTK, Larsson M, Do NT, Diwan V, Tomson G, Falkenberg T. Improving private pharmacy practice: a multi-intervention experiment in Hanoi, Vietnam. J Clin Epidemiol. 2002;55(11):1148-55.

The objective of this study was to assess the effects of a multicomponent intervention on private pharmacy practice. From 641 private pharmacies in Hanoi, 68 pharmacies were randomly selected and matched into 34 pairs. Each pair consisted of a control and an intervention pharmacy. Three interventions were applied sequentially: Regulatory enforcement, Education, and peer influence. Four tracer conditions were selected: uncomplicated acute respiratory infection (ARI), sexually transmitted disease (STD), requesting the prescription-only drugs prednisolone, and a short course of cefalexin. Practice was assessed through the Simulated Client Method (SCM). The intervention pharmacies improved significantly compared to the control pharmacies (P <.05) in all tracer conditions. For ARI, antibiotic dispensing decreased (P <.02) and questions regarding breathing increased (P <.01). For STD, advice to go to the doctor and dispensing the correct syndromic treatment increased (P <.01). Dispensing of prednisolone and cefalexin decreased (P <.01) and prescription requests increased (P <.01). Our conclusion is that it is possible to improve private pharmacy practice with a multicomponent intervention.

...and in Lao PDR

A similar study was conducted by Syhakhang L. The Quality of Private Pharmacy Services in a Province of Lao PDR: Perceptions, Practices and Regulatory Enforcements. Karolinska Institutet. 2002.

A randomized trial, pre-experimental and cross sectional study including quantitative and qualitative methods.

“Most private pharmacies were managed by non-pharmacists. The quality of practices was low, with 59% of the encounters not receiving any information on drug use, 47% of purchased drugs had no label and 26% of all drugs were mixed in the same package.”

Improvement of practice of private pharmacies including the provision of better quality drugs through regulatory interventions e.g. inspections, information, and distribution of regulation documents to drug sellers and sanctions.