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Pharmacy practice and Indian healthcare system

Prof. Ambikanandan Misra
Thursday, December 17, 2015, 08:00 Hrs  [IST]

Use of appropriate medication in a safe and effective manner to improve public health is the prime objective in the profession of pharmacy. The role played by a pharmacist is crucial for taking direct responsibility of individual patient’s medicinal needs, and thus making a unique contribution to the outcome of the drug therapy and its associated quality of life.

The traditional role of physician and pharmacist to act of deciding on drug therapy and implementing it, which were relatively simple, safe and inexpensive are now no longer adequate to ensure safety and effectiveness of the drug therapy. The prescription related errors lead to a significant increase in cost of therapy in terms of hospitalization and associated remedial therapy. The incidence of such adverse drug reaction are 5-7 per cent in India mainly due to the use of multiple drug therapy, in the elderly and patients with chronic diseases and lead to death of about five per cent of patients in hospitals. This implies that the outcome of erroneous prescription and therapy not only lead to severe personal and economic disparities but may also lead to loss of precious life of patient. The role of pharmacist thus assumes a key responsibility for management of drug therapy and at the same time provide relevant information to the patients for their use in a safe and efficacious manner.

When it comes to the part of prescription dispensing, the role of community pharmacist is of paramount significance. They offer quality services like:

Processing of prescriptions, care of patients or clinical pharmacy, monitoring of drug utilization, extemporaneous preparation and small-scale manufacture of medicines, traditional and alternative medicines prescriptions, responding to symptoms of minor ailments, informing health care professionals and the public, health promotion etc. However, in developing countries like India their role as health care professional is still underutilized and is not well recognized by either the community or other health care providers. Rather the current community pharmacist has reciprocated to the above responsibilities by becoming a mere mute spectator who are supervising medical distribution only. Therefore, Indian framework for pharmacy practice has to evolve to perform roles addressing a more stretched patient centric approach spanning the areas right from patient counselling to clinical setups and disease prevention services.

Revealing the usefulness and the success of the services of clinical pharmacist in the western countries, its importance for developing countries like India is being realized and is expected to greatly benefit and revolutionize the country’s healthcare system. The need for clinical pharmacist in healthcare is bridging the hospital knowledge for presentation and future investigation purpose so that even the rarest of the ailment or associated effects gets highlighted and is worked upon. In government sector and nongovernmental organizations, clinical pharmacists may have a role in policy framing, drug/poison information centers, health camps, awareness programs, pharmacovigilance center, patient counseling center etc.

This may benefit the Indian healthcare system in the aspects such as reporting of adverse drug reactions along with better pharmacovigilance and epidemiological data; an unbiased and reliable database for improved practice and updating their knowledge; evaluation of prescription for probable drug interaction; maximization of therapeutic efficacy and minimization of toxicity in treatment; cost effectiveness of prescription, and a better therapy.

The current practice of medicine and dispensing is complicated by the multiplicity of the system of medicines for treatment (namely Allopathic, Ayurveda and Homeopathy) and their practice in the urban and rural areas and the selective preference is being determined by the economic status and social belief. The professionals are generally bound by their discipline and its inherent logic of cause and effect and tends to rebate even what work as successful practice. Thus there is a need to ensure relevance and affordability to the disease condition by arriving at a convergence     between the varied notions in the practices between medical practitioners and pharmacists. The rising uncertainty among the professionals and planners in practicing indigenous system of medicine is leading to possible threat of side effects or no therapeutic benefits. Thus, along with stringent rules and regulations needed to alleviate such threats, there is a need to potentiate the role of pharmacist to minimize cross practices.

Foreseeing the projection of India to be an IT hub till year 2020, with the notion of ensuring that government services are available to citizens electronically and people get benefit of the latest information and communication technology, the government has taken a few initiatives for uplifting the awareness among masses through the use of digital media. It is very well perceptible from few government schemes.

To take an example of the initiatives, the Ministry of Communication and Information Technology under the aegis of Government of India have launched “Sehat”, an initiative for health care. One of its initiatives cover imparting knowledge through intervention of digital technologies for quality and affordable health care for the citizens of rural areas. Service centers will also provide diagnostic services and promote sale of generic drugs through collaboration with Ministry of Health – by setting up of the Jan Aushadhi Stores. However, the success of such initiatives will only be evident after complete implementation.

This also indicates the realization of digital media to offer increased public access along with greater patient engagement and better patient outcomes as evidenced from the steady growth of telemedicine market of around 20 per cent a year.

Looking at the current prospects of health care system and the increasing global presence of Indian services which are offered at comparative cost, the market will boom many fold till 2020. But can this market be able to manage the ailments of its country citizen and provide radical solutions to the increasing needs is a question of debate.

 To state a few prominent area of concern: Ensuring a low rate of avoidable morbidity and mortality among Indian men and women and to increase the average life expectancy to achieve an average of 70 years which have trolled down to around 55 years. This decreased life expectancy can be related to the disease burden in communicable and non-communicable diseases and effectiveness of timely vaccination/immunization during adolescence and minimizing disease susceptibility in a population. Moreover, for certain diseases such as cancer and HIV early diagnosis through genetic markers and personalized medicines to treat such life threatening diseases can be undertaken as a preferred approach. It can also be implicated in achieving a higher success in combating diseases such as TB, Swine flu, malaria, and lifestyle diseases like diabetes etc. and minimizing associated mortality.

There is increasing burden of various diseases in Indian population due to the inordinate healthcare expenditure. Indian government need to address several inefficiencies in the healthcare value chain and provide increased healthcare access to citizens, without significantly increasing the spending on the same. It can be apprehended from comparison of the data for cost of the health expenditure per capita income of India with respect to other counties which also determinates expenditures on health services.

The expenditures by Indian government is only US$ 61 compared to US$ 367 and US$9146 in China and United States respectively for the year 2011-2015 . Thus, a critical evaluation of the current lacunae in the Indian healthcare system is required along with necessary reforms in legislative framework and policy framing along with setting up requisite infrastructure facilities for its brisk functioning.

According to a Ficci – KPMG report, India's healthcare sector is seeing a robust growth trajectory and is expected to be $280 billion in size by 2020, growing at a compound annual growth rate of 16 per cent, but it is in "dire need" of right policy framework and infrastructure push. However, the area of major concerns is the inattentiveness to significance of healthcare as an economic development opportunity at national and state levels. India currently spends cumulatively five per cent of its GDP on healthcare, with just one per cent being contributed by the public sector, is amongst the lowest globally. However, effective management of health care sector can augment its impact on country’s economy.

Furthermore, addressing the issue of low percentage of GDP in health care system, much depends also on the ability of the state governments to allocate higher budgetary support to health sector by monitoring public funds effectively.

This can be achieved by sensible regulation of private sector investments in public health sector thus promoting public private partnership spanning all the sector. However, all these challenges pursued to achieve the goals of achieving substantial growth in pharma sector will also require effective political embracement. As witnessed for countries like United States and UK, which have a strong system regulating the transfer of public resources for provision and funding for avoiding the health inequalities among its citizens, Indian politics should organize itself to play a more salient role in engaging to health care system.

Some of the major areas requiring attention are rampant corruption in educational evaluation system, meek control to regulation of quality medicament supply and spurious drug supply, hospital management, working environment in government approved health centers etc. There has also been a need for setting up of system referring irrationality of prescription drugs and availability of banned drug at the pharmacy outlets despite international ban due to potential health threats. Effective legislature is needed for bringing the Indian pharma and health care sector at par with global recognition. Thus, there is an urgent need for a paradigm shift focusing on achieving a complete wellbeing and to adopt healthcare models delivering superior outcomes at minimal affordable cost.                                              

(The author is Professor of Pharmacy at The Maharaja Sayajirao University of Baroda)


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