Community pharmacy in our country is known as retail pharmacy because they operate under license from drugs control authorities to sell medicines or medical products. There are three types of terminologies used to describe these sales units: Drug store; Chemists and Druggists; Pharmacy/pharmacist/dispensing chemist/pharmaceutical chemist. Drug store does not require the service of registered pharmacist and thus does not fall within the domain of pharmacists’ professional activities. Chemists and Druggists employ the service of registered pharmacist but does not maintain a pharmacy for compounding. On the other hand, pharmacy/pharmacist/dispensing chemist/pharmaceutical chemist employs the service of registered pharmacist and maintains a pharmacy as described under Schedule N. In addition, we have online pharmacy who supply medicines and regulatory aspects are not very clear. The current regulation, Drugs & Cosmetics Act 1940 and the Drugs Rule 1945, is silent about online pharmacy.
There are many chain stores running pharmacy in different parts of the country: Apollo, MedPlus, Tata1 mg and Netmeds are just few examples. Chain pharmacies are reported to be good business ventures. There are popular government promoted Jan Aushadhi Kendras too selling generic medicines at much affordable price than the branded ones.
The genesis of community pharmacy in India goes back to British period when the first pharmacy called Bathgate & Co was established by a Scotch Chemist in 1811. There have been many transformations: From compounding being the main responsibility to selling the readymade products. In the earlier phase pharmacists were called as compounders. They were working with doctors or had different establishments. The public were able to see the person making medicine. They had perhaps better image as the publics were appreciative of their skills. The present-day pharmacists at community pharmacy are better qualified and with vast knowledge on medicines. They have little scope impressing the customers because their work involves procuring medicines and delivering medicines based on prescription. There is little scope of offering true pharmaceutical service beyond procuring, storing and selling medical products. As our enforcement of drug regulation is not strict the pharmacy does not insist on prescription. Pharmacy dispenses even the prescription only medicines without prescription. The registered pharmacists are only authorised persons to handle medicines. Diploma in Pharmacy is the minimum qualification specified for registration as registered pharmacist.
Community pharmacy is regulated by Drugs Control Department of State/Union Territory government through licensing and monitoring compliance of licensing conditions. There is no community pharmacy terminology in Drugs Rule. Pharmacy Practice Regulation 2015 of Pharmacy Act first time defined community pharmacist as pharmacy practitioner. A community pharmacist is an individual currently registered and who works according to legal and ethical guidelines to ensure the correct and safe supply of medical products to the general public. They are involved in maintaining and improving people's health by providing advice and information as well as supplying prescription medicines. The pharmacy practice regulation defines the job responsibilities of community pharmacists too. There is a conflict: Licensing conditions under Drugs and Cosmetics Act for establishing and operating a community pharmacy; and the provision of pharmacy practice regulation. Often the drugs inspector is openly objecting to value added service provided in pharmacy. This is happening and community pharmacists are in difficult situation utilising their full potential in public health interest.
Our country has a very ambitious plan to achieve the status of a developed nation by 2047, the centenary year of India’s independence from British. The Government’s terminology to see Viksit Bharat a dream of every citizen of the country at least by 2027. The different approaches are being carried out: economic development, healthcare development and social equity. India is progressing well and may achieve the status of USD 30-40 trillion economy by the year 2047. With current growth rate it is feasible. There have been many schemes initiated to remove the social disparity. Coming to healthcare development: One of the important targets is to achieve the universal access to healthcare. Key to this is availability of qualified and trained health care professionals. India has very low doctor to population ratio which requires expanding the role of other health professionals.
Pharmacists are skilled and trained by education but are underutilised due to government policies. In government sector, in health facilities, pharmacy professionals are often utilised to provide healthcare not just dispensing medicines. The community pharmacists are never looked from this angle and are definitely worth empowering to provide healthcare as they are first encountered healthcare professionals.
No profession can sustain without a reasonable earning by them. Unfortunately, there is no system for remunerating the community pharmacists for their professional services. At present, the source of remuneration is based on earning by the pharmacy from selling medical products. Though pharmacy practice regulation specifies the services the community pharmacists can provide but it is silent on quantum of payment. Another issue worth introspecting is viability of community pharmacies in village and semiurban areas where sales volume is not substantial.
The following developments are expected to happen to think of community pharmacy in Viksit Bharat. When India is inching towards described as Viksit Bharat in every field, it is obvious to think of changing legal and public perception on community pharmacy. Community pharmacy being the face of pharmacy profession, it must get first face lift to have due recognition in public eye. The initiative to achieve:
• Change of name from retail pharmacy unit to community pharmacy – the necessary legislative change should be brought. The Drugs and Cosmetics Act, the colonial legislation, needs to be replaced with new one to meet the aspiration of professionals and public as well. Good practices in community pharmacy should be included in the legislation itself as we are currently making mandatory revised Schedule M for manufacturing.
• Synchronization of the provision of Pharmacy Act with that of Drugs and Cosmetics Act. Pharmacy practice regulation should be made part of the licensing procedure.
• Massive sensitisation to all the concerned people including the regulatory officials be carried out to utilise the community pharmacists as public health functionaries. The provision should be made for expanding the role of pharmacists beyond just dispenser of medicines like treatment providers for minor illnesses and vaccinator.
• E-commerce needs to be regulated looking at the interest of pharmacists and public at large.
• Ensuring reasonable remuneration to community pharmacists: Though they have been serving the community/society but there is no provision of remuneration for their service. At present, they manage with the margin they get from selling the products. Medicine selling is not like selling other products. The community pharmacist is responsible for the medical products supplied and it is the minimum responsibility of counselling for safe and effective use of medical products.
The list may not be exhaustive but are important. These should be kept in mind while deliberations in different forums when discussions are held on future of community pharmacy in our country.
(Authors are with OM Sai Institute of Paramedical Sciences, Ambadali, Mayurbhanj, Odisha 757 075) |