The quality of private pharmacy services in low and middle-income countries: A systematic review
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Aim of the review In low and middle income countries private pharmacies are considered a valuable resource for health advice and medicines in many communities. However the quality of the service they provide has often been questioned and is unclear. This paper reviews the evidence regarding the quality of professional services from private pharmacies in low and middle-income countries. Method A literature search (computer and hand searches) was undertaken to identify all studies which included an assessment of the quality of some aspect of private pharmacy services in low and middle income countries. Results 30 studies were identified which spanned all regions in the developing world. These included 9 which examined the scope and/or quality of a range of professional services, 14 which assessed the quality of advice provided in response to specific symptoms and 7 which investigated the supply of medicines without a prescription. A range of methods were employed, in particular, questionnaire surveys with staff and/or clients and assessment of practice using simulated client methodology. Whilst many authors identified a potential for pharmacies to contribute more effectively to primary health care, virtually all studies identified deficiencies in the quality of current professional practice. In particular authors highlighted the lack of presence of pharmacists or other trained personnel, the provision of advice for common symptoms which was not in accordance with guidelines and the inappropriate supply of medicines. Conclusion The evidence-base regarding the quality of professional services from pharmacies in low and middle income countries is limited, but indicates that standards are often deficient. If pharmacists are to contribute effectively to health care, the barriers to the provision of higher quality care and ways in which these might be overcome must be identified and examined.
KeywordsLow-income countries Middle-income countries Pharmacy services Quality Systematic review
I would like to thank Joann Hong for her assistance in the literature searching and data extraction for this review.
No external sources of funding for this work were obtained.
Conflicts of interest
There are no conflicts of interest.
- 1.World Health Organisation. The role of the pharmacist in the health care system. Geneva: WHO; 1994. Available at: http://whqlibdoc.who.int/hq/1994/WHO_PHARM_94.569.pdf. Accessed 25 Feb 2009.
- 2.World Health Organisation. Good Pharmacy Practice. Guidelines in community and hospital settings. Geneva: WHO; 1996. Available at: http://whqlibdoc.who.int/hq/1996/WHO_PHARM_DAP_96.1.pdf. Accessed 25 Feb 2009.
- 3.FIP. Standards for quality of pharmacy services. International Pharmaceutical Federation; 1993. Available at http://www.fip.ul/www/uploads/?page=statements. Accessed 25 Feb 2009.
- 4.World Health Organisation. The role of the pharmacist in self-care and self-medication. Geneva: WHO; 1998. Available at: http://whqlibdoc.who.int/hq/1998/WHO_DAP_98.13.pdf. Accessed 25 Feb 2009.
- 5.Owusu-Daaku FTK. Pharmacy in Ghana’s health care system: which way forward? Ghana Pharm J. 2002;25:20–3.Google Scholar
- 9.World Health Organisation. The essential medicines concept: from its beginning until today. Geneva: WHO; 2004. Available at http://whqlibdoc.who.int/hq/1994/WHO_EDM_2004.3.pdf. Accessed 25 Feb 2009.
- 10.UN Millenium Project. Prescription for healthy development: access to essential medicines. London: Earthscan; 2005. ISBN 1 84407 227-4.Google Scholar
- 11.Van der Geest S. The illegal distribution of Western Medicines in developing countries. Med Anthropol. 1982;6:197–219.Google Scholar
- 16.Smith FJ. Pharmacy in developing countries. In: Harding G, Taylor K, editors. Pharmacy practice: chapter 6. Amsterdam: Harwood Academic Publishers; 2001. ISBN 0 415 27159 2.Google Scholar
- 17.Goodman C, Brieger W, Unwin A, Mills A, Meek S, Greer G. Medicine sellers and malaria treatment in sub-Saharan Africa: what do they do and how can their practice be improved? Am J Trop Med Hyg. 2007;77(supplement):213–8.Google Scholar
- 19.Holloway K. Promoting rational use of medicines. International Network for the Rational Use of Drugs. INRUD News, July 2008. Available at: http://www.inrud.org/documents/upload/vol16no1.pdf Accessed 25 Feb 2009.
- 20.World Health Organisation. The World health report 2006: working together for health. Geneva: WHO; 2006. ISBN: 92 4 156 317 6.Google Scholar
- 21.Wuliji T. Global pharmacy workforce and migration report: a call for action. Int Pharm J. 2006;20:2–4.Google Scholar
- 22.DFID. Priority countries. London: Department for International Development; 2008. Available at: http://www.dfid.gov.uk/africa. Accessed 25 Feb 2009.
- 23.Oparah AC, Arigbe-Osula EM. Evaluation of community pharmacists’ involvement in primary health care. Trop J Pharm Res. 2002;1:67–74.Google Scholar
- 24.Oparah CA, Enato EFO, Odili UV, Aghomo OE. Activities of community pharmacy counter staff in Benin City, Nigeria. J Soc Adm Pharm. 2002;19:141–4.Google Scholar
- 25.Benjamin H, Motawi A, Smith F. Community pharmacists in primary health care in Alexandria. J Soc Adm Pharm. 1995;12:3–11.Google Scholar
- 30.Basak SC, Arunkumar A, Masilamani K. Community pharmacists’ attitudes towards use of medicines in rural India. International Pharmacy Journal 2002; 32–5.Google Scholar
- 34.Oladipo OB, Lamikanra A. Patterns of antibiotic purchases in community pharmacies in South Western, Nigeria. J Soc Adm Pharm. 2002;19:33–8.Google Scholar
- 35.Volpato DE, de Souza BV, Rosa LGD, Melo LH, Daudt CAS, Deboni L. Braz J Infect Dis. 2005;3:288–91.Google Scholar
- 44.Erhun WO. Management of sexually transmitted diseases in retail drug outlets in Nigeria. J Soc Adm Pharm. 2002;19:145–50.Google Scholar
- 45.Van Duong D, Le TV, Binns CW. Diarrhoea management by pharmacy staff in retail pharmacies in Hanoi Vietnam. Int J Pharm Pract. 1997;5:97–100.Google Scholar
- 46.Benjamin Sokar-Todd H, Smith FJ. Management of diarrhoea at community pharmacies in Alexandria, Egypt. J Soc Adm Pharm. 2003;20(1):32–8.Google Scholar
- 48.Tumwikirize WA, Ekwaru PJ, Mohammed K, Ogwal-Okeng JW, Aupont O. Management of acute respiratory infections in drug shops and private pharmacies in Uganda: a study of counter-attendants’ knowledge and reported behaviour. East Afr Med J. 2004;81(supplement):S33–40.Google Scholar
- 55.Cerderlof C, Tomson G. Private pharmacies and health sector reform in developing countries—professional and commercial highlights. J Soc Adm Pharm. 1995;12:101–11.Google Scholar
- 58.Benjamin H, Smith FJ, Motawi A. Drugs supplied, with and without a prescription from a conurbation in Egypt. East Mediterr Health J. 1996;2:506–14.Google Scholar