November 28

John and Dayna in Uganda – Pharmacies and Pharmacists

Over the past few decades there has been a trend in the U.S. toward chain pharmacies being the most prolific distributers of pharmaceutical and over the counter products to the public. While some (like us!) might miss the comfort and service that the “mom and pop” pharmacies provided in the past, the efficiency and safety of modern day pharmacies at home are quite impressive. Mail order, automatic refills, and access to a well trained pharmacist most anytime it is required are a few of the things we take for granted when purchasing our Rx and OTC products.

One of the most intriguing aspects of the health care system here in Uganda relates to how people purchase and receive drugs and over the counter products. An interesting and strange learning came early in this PULSE assignment as we examined the nuances of how products are imported and distributed here. Spending time in the field and visiting the various types of pharmacies, dispensaries, retailers and wholesalers was quite a shock in that the process is relatively convoluted.

To start with, there are many businesses here that do both wholesale and retail at the same time.

It was amazing to learn that there are only about 500 pharmacists in the entire country!! This implies a 1 pharmacist for every 100,000 Ugandans ratio, compared to the recommended ratio of 1:2,000 by the world health organization. To make matters worse, more than 90% of these pharmacists practice in the central region which leaves the rest of the regions lacking.

Anyone can own a pharmacy in Uganda!! It is considered a business and can be run by anyone with “supervision” by a pharmacist. Interestingly, as there are only about 500 pharmacists in Uganda and each one is only allowed to supervise 2 pharmacies, then there should only be 1000 outlets (but there are at least 10 times more).

The counter staff at a pharmacy can consist of a pharmacy technician, a nurse, or a midwife….. no pharmacist seemed to be on the premises in most cases when we visited.

Of interest was that a few pharmacies have a clinical officer on site to assist with basic healthcare services (and then the patient can purchase the products recommended).
There seems to be is no ability to log prescriptions into a computer and electronically create a label. All medications are dispensed in envelopes with a handwritten label.

Prescriptions seem to be optional in many places.

Drug shops are the smallest retail medicine outlets, are supervised by non-pharmacist health-care professionals, and are limited to handling small amounts of over-the-counter medicines
Supply chain issues occur and expiry of medicines can be a threat to access to products. Medicines are sometimes procured with a short shelf life, are expensive so there is slow turnover, or are donated. One study we read described the contributing factors in the supply chain issue to include neglect of stock monitoring, lack of knowledge of basic expiry prevention tools, non participation of clinicians in medicine qualification, and overstocking.

Self diagnosis and medicating is an issue here. For example, anyone can go into the pharmacy and purchase anti-malaria drugs when what they needed was an antibiotic for an infection. Overuse of items that are easily purchased (such as antibiotics) are an issue.

We read about the Pharmaceutical Society of Uganda. It was established by the Pharmacy and Drugs act of 1970. Membership is comprised of pharmacists working in Community Pharmacies, Hospitals, Pharma industries, Regulatory bodies, academia, research organizations, drug procurement and distribution entities among others. The society is governed by the Council of the Pharmaceutical Society of Uganda.
What about hospital pharmacists? It seems to be a big challenge here. For example, Mulago National Referral Hospital in Kampala has only 5 full time pharmacists. Therefore, most of the day to day work of dispensing the proper medications and assuring safe medication use is handled by the pharmacy interns who have graduated from a School of Pharmacy and have passed their eligibility exams to practice pharmacy.

So who regulates this segment of the health care system? There is a Pharmacy Council as part of the Ministry of Health. The overall goal of the Pharmacy council is to ensure National and International pharmacy practice standards and codes of ethics are adhered to, both in the public and private sectors and control the conduct and discipline of registered pharmacists.

How pharmacies are owned and operated here in Uganda was quite a learning experience, and we hope that in the future more pharmacists can be trained and utilized as part of the healthcare system.