Pharmacy World & Science

, Volume 31, Issue 3, pp 351–361 | Cite as

The quality of private pharmacy services in low and middle-income countries: A systematic review

Review Article

Abstract

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.

Keywords

Low-income countries Middle-income countries Pharmacy services Quality Systematic review 

Notes

Acknowledgement

I would like to thank Joann Hong for her assistance in the literature searching and data extraction for this review.

Funding

No external sources of funding for this work were obtained.

Conflicts of interest

There are no conflicts of interest.

References

  1. 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. 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. 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. 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. 5.
    Owusu-Daaku FTK. Pharmacy in Ghana’s health care system: which way forward? Ghana Pharm J. 2002;25:20–3.Google Scholar
  6. 6.
    Smith FJ. Community pharmacy in Ghana: enhancing the contribution to primary health care. Health Policy Plan. 2004;19:234–41. doi:10.1093/heapol/czh028.PubMedCrossRefGoogle Scholar
  7. 7.
    Kumari RP, Raman R, Sharma T. Physicians, pharmacists, and people with diabetes in India. Pharm World Sci. 2008;30:750–2. doi:10.1007/s11096-008-9225-4.CrossRefGoogle Scholar
  8. 8.
    Yousef AMM, Al-Bakri AG, Bustanji Y, Wazaify M. Self-medication practices in Jordan. Pharm World Sci. 2008;30:24–30. doi:10.1007/s11096-007-9135-x.PubMedCrossRefGoogle Scholar
  9. 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. 10.
    UN Millenium Project. Prescription for healthy development: access to essential medicines. London: Earthscan; 2005. ISBN 1 84407 227-4.Google Scholar
  11. 11.
    Van der Geest S. The illegal distribution of Western Medicines in developing countries. Med Anthropol. 1982;6:197–219.Google Scholar
  12. 12.
    Van der Geest S. Pharmaceuticals in the third world: the local perspective. Soc Sci Med. 1987;25:273–6. doi:10.1016/0277-9536(87)90230-9.Google Scholar
  13. 13.
    Fabricant SJ, Hirschhorn N. Deranged distribution, perverse prescription, unprotected use: irrationality of pharmaceuticals in the developing world. Health Policy Plan. 1987;2:204–13. doi:10.1093/heapol/2.3.204.CrossRefGoogle Scholar
  14. 14.
    Le Grand A, Hogerzeil HV, Haaijer-Ruskamp FM. Interventional research in rational use of drugs: a review. Health Policy Plan. 1999;14:89–102. doi:10.1093/heapol/14.2.89.PubMedCrossRefGoogle Scholar
  15. 15.
    Preux PM, Tiemagni F, Fodzo L, Kandem P, Ngouafong P, Ndonko F, et al. Antiepileptic therapies in the Mifi province in Cameroon. Epilepsia. 2000;41:432–9. doi:10.1111/j.1528-1157.2000.tb00185.x.PubMedCrossRefGoogle Scholar
  16. 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. 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
  18. 18.
    Buabeng KO, Duwiejua M, Matowe LK, Smith F, Enlund H. Availability and choice of anti-malarials at medicine outlets in Ghana: the question of access to effective medicines for malaria control. Clin Pharmacol Ther. 2008;84:613–9. doi:10.1038/clpt.2008.130.PubMedCrossRefGoogle Scholar
  19. 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. 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. 21.
    Wuliji T. Global pharmacy workforce and migration report: a call for action. Int Pharm J. 2006;20:2–4.Google Scholar
  22. 22.
    DFID. Priority countries. London: Department for International Development; 2008. Available at: http://www.dfid.gov.uk/africa. Accessed 25 Feb 2009.
  23. 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. 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. 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
  26. 26.
    Anyama N, Adome RO. Community pharmaceutical care: an 8-month critical review of two pharmacies in Kampala. Afr Health Sci. 2003;3:87–93.PubMedGoogle Scholar
  27. 27.
    Chuc NTK, Tomson G. ‘Doi moi’ and private pharmacies: a case study on dispensing and financial issues in Hanoi, Vietnam. Eur J Clin Pharmacol. 1999;55:325–32. doi:10.1007/s002280050636.PubMedCrossRefGoogle Scholar
  28. 28.
    Stenson B, Syhakhang L, Eriksson B, Tomson G. Real world pharmacy: assessing the quality of private pharmacy practice in the Lao People’s Democratic Republic. Soc Sci Med. 2001;52:393–404. doi:10.1016/S0277-9536(00)00142-8.PubMedCrossRefGoogle Scholar
  29. 29.
    Syhakhang L, Stenson B, Wahlstrom R, Tomson G. The quality of public and private pharmacy practices: a cross-sectional study in the Savannakhet province, Lao PDR. Eur J Clin Pharmacol. 2001;57:221–7. doi:10.1007/s002280100295.PubMedCrossRefGoogle Scholar
  30. 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
  31. 31.
    Abula T, Worku A, Thomas K. Assessment of the dispensing practices of drug retail outlets in selected towns, North West Ethiopia. Ethiop Med J. 2006;44:145–50.PubMedGoogle Scholar
  32. 32.
    Duong DV, Binns CW, Le TV. Availability of antibiotics as over-the-counter drugs in pharmacies: a threat to public health in Vietnam. Trop Med Int Health. 1997;2:1133–9. doi:10.1046/j.1365-3156.1997.d01-213.x.PubMedCrossRefGoogle Scholar
  33. 33.
    Wachter DA, Joshi MP, Rimal B. Antibiotic dispensing by drug retailers in Kathmandu, Nepal. Trop Med Int Health. 1999;4:782–8. doi:10.1046/j.1365-3156.1999.00476.x.PubMedCrossRefGoogle Scholar
  34. 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. 35.
    Volpato DE, de Souza BV, Rosa LGD, Melo LH, Daudt CAS, Deboni L. Braz J Infect Dis. 2005;3:288–91.Google Scholar
  36. 36.
    Nyazema N, Viberg N, Khoza S, Vyas S, Kumaranayake L, Tomson G, et al. Low sales of antibiotics without a prescription: a cross-sectional study in Zimbabwean private pharmacies. J Antimicrob Chemother. 2007;59:718–26. doi:10.1093/jac/dkm013.PubMedCrossRefGoogle Scholar
  37. 37.
    Apisarnthanarak A, Tunpornchai J, Tanawitt K, Mundy LM. Nonjudicious dispensing of antibiotics by drug stores in Pratumthani, Thailand. Infect Control Hosp Epidemiol. 2008;29:572–5. doi:10.1086/587496.PubMedCrossRefGoogle Scholar
  38. 38.
    Mac TL, Le VT, Vu AN, Preux PM, Ratsimbazafy V. AEDs availability and professional practices in delivery outlets in a city centre in Vietnam. Epilepsia. 2006;47:300–4. doi:10.1111/j.1528-1167.2006.00425.x.CrossRefGoogle Scholar
  39. 39.
    Mayhew S, Nzambi K, Pepin J, Adjei S. Pharmacists’ role in managing sexually transmitted infections: policy issues and options for Ghana. Health Policy Plan. 2001;16:152–60. doi:10.1093/heapol/16.2.152.PubMedCrossRefGoogle Scholar
  40. 40.
    Chalker J, Chuc NTK, Falkenberg T, Do NT, Tomson G. STD management by private pharmacies in Hanoi: practice and knowledge of drug sellers. Sex Transm Infect. 2000;76:299–302. doi:10.1136/sti.76.4.299.PubMedCrossRefGoogle Scholar
  41. 41.
    Leiva A, Shaw M, Paine K, Manneh K, McAdam K, Mayaud P. Management of sexually transmitted disease in urban pharmacies in The Gambia. Int J STD AIDS. 2001;12:442–52. doi:10.1258/0956462011923471.CrossRefGoogle Scholar
  42. 42.
    Ramos MC, da Silva RDC, Gobbato RO, da Rocha FC, de Lucca G, Vossky J, et al. Pharmacy clerks’ prescribing practices for STD patients in Porto Alegre, Brazil. Int J STD AIDS. 2004;15:333–6. doi:10.1258/095646204323012832.PubMedCrossRefGoogle Scholar
  43. 43.
    Turner AN, Ellertson C, Thomas S, Garcia S. Diagnosis and treatment if presumed STIs at Mexican pharmacies: survey results from a random sample of Mexico City pharmacy attendants. Sex Transm Infect. 2003;79:224–8. doi:10.1136/sti.79.3.224.PubMedCrossRefGoogle Scholar
  44. 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. 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. 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
  47. 47.
    Igun UA. Reported and actual prescription of oral rehydration therapy for childhood diarrhoeas by retail pharmacists in Nigeria. Soc Sci Med. 1994;39:797–806. doi:10.1016/0277-9536(94)90041-8.PubMedCrossRefGoogle Scholar
  48. 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
  49. 49.
    Chuc NT, Larsson M, Falkenburg T, Do NT, Binh NT, Tomson GB. Management of childhood infections at private pharmacies in Vietnam. Ann Pharmacother. 2001;35:1283–8. doi:10.1345/aph.10313.PubMedCrossRefGoogle Scholar
  50. 50.
    Rajeswari R, Balasubramanian R, Bose SC, Rahman SF. Private pharmacies in tuberculosis control: a neglected link. Int J Tuberc Lung Dis. 2002;6:171–3.PubMedGoogle Scholar
  51. 51.
    Lonnroth K, Lambregts K, Nhien DTT, Quy HT, Diwan VK. Private pharmacies and tuberculosis control: a survey of case detection skills and reported anti-tuberculosis drug dispensing in private pharmacies in Ho Chi Minh City, Vietnam. Int J Tuberc Lung Dis. 2000;4:1052–9.PubMedGoogle Scholar
  52. 52.
    Van Sickle D. Management of asthma at private pharmacies in India. Int J Tuberc Lung Dis. 2006;10:1386–92.PubMedGoogle Scholar
  53. 53.
    Madden JM, Quick JD, Ross-Degnan D, Kafle KK. Undercover care-seekers: simulated clients in the study of health provider behaviour in developing countries. Soc Sci Med. 1997;45:1465–82. doi:10.1016/S0277-9536(97)00076-2.PubMedCrossRefGoogle Scholar
  54. 54.
    Watson MC, Norris P, Granas AG. A systematic review of the use of simulated patients and pharmacy practice research. Int J Pharm Pract. 2006;14:83–93. doi:10.1211/ijpp.14.2.0002.CrossRefGoogle Scholar
  55. 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
  56. 56.
    Gastelurrutia MA, Benrimoj SIC, Castrillon CC, Casado de Amezua MJ, Fernandez-Llimos F, Faus MJ. Facilitators for practice change in Spanish community pharmacy. Pharm World Sci. 2009;31:32–9.PubMedCrossRefGoogle Scholar
  57. 57.
    Babar ZUD, Jamshed S. Social Pharmacy strengthening clinical pharmacy: why pharmaceutical policy research is needed in Pakistan. Pharm World Sci. 2008;30:617–9. doi:10.1007/s11096-008-9246-z.PubMedCrossRefGoogle Scholar
  58. 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

Copyright information

© Springer Science+Business Media B.V. 2009

Authors and Affiliations

  1. 1.Department of Practice and Policy, School of PharmacyUniversity of LondonLondonUK

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