Findings from a baseline study of drug shops in the private sector 2015

Drug shops are the preferred first point of contact for majority of population in developing countries including Bangladesh. In Bangladesh, currently, there are approximately 76,000 licensed retail drug shops and an estimated 125,000 unregistered retail drug shops involved in selling drugs ‘over-the-counter’. Most of the sales people/dispensers at these retail drug shops do not have training in dispensing of drugs, not to speak of diagnoses and treatment which they frequently do. Irrational use of drugs such as over prescribing, multi-drug prescribing, use of unnecessary expensive drugs, dispensing drugs without prescription and overuse of antibiotics and injections have been the most common problems found with these retailers for long time. Given the importance of the informal sector including retail drug shops in Bangladesh, improved regulation of this sector offers an important opportunity to improve community health. Experiences in other parts of world have demonstrated that private-sector drug seller initiatives based on an accreditation and regulation model are feasible, improve access to medicines, and can be scaled up.

A facility (drug shop)-based cross-sectional study was conducted to fill-in the knowledge gaps on these unregulated drug shops in the private sector and its management for informed designing of an accredited drug shop model in Bangladesh. A variety of methods (quan survey of drug shops, FGDs, in-depth interviews) was used to elicit relevant data. Respondents included the salesperson/dispenser/owner of each of the drug shops present at the time of survey, a sample of community people (for Focus Group Discussions), relevant stakeholders e.g., DGDA people at the district and central level, association representatives and experts in the field (in-depth interview). A total of 111 drug shops (90 rural and 21 urban) from the seven divisions were included in the survey.

Almost all the drug shops had trade license (issued by local bodies such as Union Council in rural areas and City Corporations/ Municipalities in urban areas) (96%) but only around 80% had drug license (issued by DGDA under MOHFW). The shops were mostly attended by a single dispenser (69%) of whom nearly half did not receive any training as pharmacist (49%), though the law (Ordinance 13 Rule 2) requires the presence of at least a grade ‘C’ pharmacist. Among the professional dispensers, there were 91% Grade C (Certificate) pharmacists, 7% Grade B (Diploma) pharmacists and 2% Grade A (Graduate) pharmacists in the studied drug shops. The non-pharmacists learned the trade by working as apprentice either of an MBBS (10%) or village doctor (16%) or inherited the trade as a family business (18%). A substantial proportion received dispensing training from the representatives of the pharmaceutical companies (38%).

Majority of the clients visiting the drug shops came by self-referral (68%) and dispensing drugs based on patient’s request (83%) or patient’s symptoms of illness (59%) was quite common. Other than selling medicines, the drug shops also provided additional services such as pushing injection (60%), basic diagnostic services (63%), burn and wound dressing (63%) and vaccination (31%) which are not sanctioned by the drug license. Lack of availability of essential drugs (e.g., varying from as low as 22% for benzyl benzoate to a max. of 43% for Cotrim tablets) was a common phenomenon and the price range for the same drug varied widely from brand to brand.

According to the respondents, applying for and getting a drug license appeared to be a cumbersome, lengthy and costly process. Due to shortage of required manpower, the inspection and checking process of the drug shops appeared to be superficial, few and far between, and not compliant with stipulated laws. Resentments were echoed uniformly by the drug shop dispensers/owners regarding both the licensing and the inspection process. All tiers of the regulators were of the opinion that the existing system is not adequate. They emphasized that the existing regulatory system need to be improved in areas such as logistics, available manpower, budget for shop visits and inspection, regular visits for inspection, and reducing the lead time for the licensing process. They also emphasized on updating the Drug Act to conform to current realities.

According to the regulators, a model drug shop run by registered pharmacists (graduate or diploma pharmacists) will reduce the margin of error and also promote rational use of drugs (“if even a doctor makes a mistake, the pharmacist can correct it”!). In the short term, these can be run by Grade C pharmacists but they suggested extensive review of the current course with respect to content and form, besides revisiting student recruitment criteria. According to them, basic PHC topics should be covered in the curriculum, and addition of some job placement/internship facilities for gaining practical experiences. For awareness building among the consumers and dispensers they suggested organizing “Drug day” or “Drug Week” campaigns, and arranging ‘Drug Fair’’. The consumers’ associations or pressure groups such as CAB can also play a critical role in helping DGDA to take remedial measures.

Source: a forthcoming report on drug shop survey