pharmacists in the public health care system in india

7/30/2019 Pharmacists in the Public Health Care System in India

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Pharmacists in the Public Health Care System inIndia

Mr Krishnendu Ray Assistant Professor, Calcutta Institute of Pharmaceutical Sciences& AHS

Pharmacists in the public health sector in India is a huge topic for exploration andaction. Pharmacists in our country are neither in the spotlight, nor much withinhearing distance. This is quite evident by various incidences and facts. The wordPharmacist is missing from the National Health Policy of the country (2002), inspite of voices of protests raised by the fraternity; the HLEG (High Level ExpertGroup) and the advisory members, a total of 130 odd in all, which formulated thehealth plan for the XIIth Five Year Plan has no Pharmacist. There have beenattempts to prove and thus eliminate the need for presence of a Pharmacist in apharmacy, and even though legally it has not been successful, the Pharmacist is stillmissing from plenty of pharmacies in the country. Pharmacists form an importantcomponent of the health workforce in most countries. However, if one sees the

structure and hierarchy of the public health services (under MOHFW and the publicsector undertakings including the defence services, railways,etc.) in India, thePharmacists have low priority. In many centres, the post of Pharmacist is notcreated, but dispensing of medicines goes on (obviously by unqualified personsincluding by attendants / helpers / etc). The Pharmacist, where existent, is restrictedto therole of inventory control (and at times of furniture, equipments also), recordkeeping and handing out medicines against prescriptions, with limited scope ofwork expansions even if given promotions;and the vast areas of public health activities are handled by every other worker,even with no formal qualifications.Some of the observations (related to pharmacy) picked up from the Universal

Health Coverage for India Report by the High Level Expert Group (HLEG) institutedby the Planning Commission to finalize the 12th Five Year Plan on health are:

It is mentioned that 36,000 pharmacists (diploma holders) areproduced annually. There is no mention of degree pharmacists.

There is no mention of the number of pharmacy colleges, butsomething to the effect that there seems to be no apparentshortage of the same. The numbers of Medicine, Nursing &ANM Colleges is mentioned / number listed.

The career trajectories (experience and training basedpromotion) are shown / proposed in detail for Nurses, ASHAs,ANMs, Public Health Managers (a cadre which has gained newentry into the system), Lab Technicians, Health Workers, butnot for Pharmacists.

Nurses and ANMs are projected to take over many of theclinical functions of the doctor to reduce their work load andabsenteeism from rural areas. However, Pharmacists, whoare also suited (only we Pharmacists feel so) to perform manyclinical functions, are overlooked.

Of the recommendations to train various health staff to furtherdevelop their skills, Pharmacist is mentioned as one of them.


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Besides the SHC/PHC/CHC/ District Hospitals, in the public sector, Pharmacists areemployed in the Railways, Air India, Coal India, CGHS, Defence services, ESIS, etc.

There is a need to step in and explore these areas also for Pharmacists potential,job descriptions, training, etc.For example, in the defence services there are only around 150 pharmacists, whilethe rest of the dispensing is done by Jawans trained by the defense services. There

is thus a potential for at least 5000 Pharmacists to work in this sector. If expertise inmedicine handling and Clinical aspects of Pharmacists are promoted to ensurerational use of medicines which can further lower the cost of medicine use andmisuse it could get support from Ministry of Defence and Health.Similarly, in the Railways, the Pharmacists; deployment is as under:a. They have 3 grades of Pharmacists, with a work force of 2400, across the country in Railway hospitals and dispensaries.[Doctors2500, Para Medical staff - 54,337, Hospitals: 125(total 14000 beds), Health Units: 586 (spread over entire length& breadth of India),at an average of 1 per 100 Kms track length.b. The role of Pharmacist is clearly documented (however it is restricted to handling

of medicines). Clinical/patient counseling role is not defined, nor performed.

c. There is no replacement pharmacist in case of absenteeism. Pharmacists have todo various clerical duties also since no clerk is appointed in the health unit.Pharmacists in Decision Making Positions :It is very important that the decision making process of procurement and handlingof drugs both at centre and the state level be in the hands of pharmacyprofessionals, of the level of at least a Deputy Director in the health services.Besides, these officers should also be able to guide and supervise the pharmacymanagement aspects of pharmacies in health centres, pharmaciststraining/upgradation,promoting rational use of medicines, prescription audits, advising the Govt. onmedicine related matters. Unfortunately, in a physician dominated health sector,the Pharmacists have failed to make

their impact in decision making posts. Pharmacists have also yet to make anyinroads to get higher degrees in public health through the various institutes offeringPG diplomas/degrees in public health(e.g. PHFI - www.phfi.org., IIHP (Indian Institutes of Public Health,etc.), and thusprofessionals from other medical, dental, social and other health sciences areoccupying policy decision making/influencing positions in public health!

Education standards :Presently, most of the Pharmacists working in the public sector are Diploma inPharmacy. Thebasic inputs / training in the curriculum are poor and too less for developing aprofessional Pharmacist, and thus the services provided by Pharmacists arerestricted to dispensing medicines.On the other hand, we are seeing in the last few years that there is anoverproduction B. Pharm. graduates, higher percentages of female degree students,reduced takers for diploma and rigors ofIndustry/working in shifts, etc. If pharmacy graduates are given clinical orientationin their curriculum, working as Pharmacists in the public sector could be a lucrativeoption and also, with


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brief training, they could be equipped for clinically oriented jobs in PHCs, CHCs, andDistrict Hospitals. Furthermore, the VI Pay Commission salaries for pharmacists arehigher than what is offered in community pharmacy, and also higher than whatsome industries pay to B.Pharm graduates. Once Pharmacists begin to play a moreuseful role in the public health sector, better salariescould be bargained for.

Albeit the competency level of pharmacists needs to be enhanced as the currentstandards of training are inadequate and the education system of trainingpharmacists is needed to be revamped with robust continuing professionaldevelopment programs. The Pharmacy Council of India has proposed a BridgeCourse for practicing diploma pharmacists to upgrade them to degree level. Thebridge course is expected to be different from the conventional degree course asthe focus of the course will beon practice and clinical aspects. But the problem is that the course is yet to see thelight of day.

For the profession to develop, major initiatives should be established by settingpractice standards, qualification and registration of pharmacists at all levels and

quality assurance standards for practice of pharmacy in the National HealthPrograms. This step will go a long way in ensuring the access to safe and effectivesupply of medicines and counseling patients on the rightuse of medicines.Moreover, pharmacists will participate in patient education and work collaborativelywith prescribers. At the same time the pharmacists will be put to a useful service forthe healthcare in the country. Pharmacists, who are experts in handling andknowledge of medicines will go a long way towards promoting rational use ofmedicines, thus reducing wastes and cost of healthcare. There is thus a need forserious contemplation by the PCI, professional pharmacy associations, pharmacyeducational institutions and pharmacy professionals to work towards creatingspaces and proving the worth of the pharmacists in the public health sector!

pharmacists in the public health care system in india

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