The Situation of Community Pharmacies in Nepal

Pharmacies opened on a community level to cater to the medication needs of the people living in the nearby area are called community pharmacies. A community pharmacy (aushadhi pasal) is often referred to as a medical shop or chemist store or retail pharmacy in Nepal. In a developing nation like Nepal, where healthcare facilities are scarce, community pharmacies often serve as the first point of interaction between healthcare workers and those seeking healthcare for minor illnesses, since the consultation is easier (no appointment needed) and often free of cost. People drop by at pharmacies with complaints of fever, respiratory infections, diarrhea, and injuries, and for monitoring blood pressure, amongst others.

But alas, most of the pharmacies in Nepal do not have proper healthcare workers. It is rather mostly non-pharmacists who operate community pharmacies, this is especially true in rural areas. The pharmacy services are provided mostly by “aushadhi byawasayis” who have received a meager 45 hours to three months of training from the Department of Drug Administration (DDA) many years back (stopped in 2000 AD) or even their family members instead. Remember, we in Nepal used terms like ‘doctorni’ for a doctor’s wife, or ‘pilotni’ for a pilot’s wife; there wasn’t any such term for a pharmacist’s wife, but then, we have such people in community pharmacies. Certainly, the delivery of healthcare by non-professionals can have detrimental consequences. Many a time, by the time the patient seek a physician’s help, things might have become worse already.

In Nepal, the three-year-long Diploma in Pharmacy course was introduced by CTEVT to produce workforce for the community pharmacies. While some of the pharmacy assistants continue to work in the field, others get into higher studies. The ones who remain in the field are often health assistants (HA) and community medicine auxiliaries (CMA) with a diploma in pharmacy who are running the pharmacies, carrying out minor treatment of the ill, too. They are often in better hands, since they are used to administering injectables and even basic first aid, which the curricula of pharmacy misses out on. The Diploma in Pharmacy course, despite being that long, does not provide the kind of expertise the CMA has when it comes to treating injuries or collecting blood samples for investigation. It is debatable whether the community pharmacist needs such skills. We certainly need to outline the duties and responsibilities of different healthcare professionals for sure, because it could enter into a debate with doctors voicing to be allowed to open a pharmacy with doctor’s degree here in Nepal. Now, the developed world is advancing and hiring Bachelor in Pharmacy and Doctorate in Pharmacy people in community pharmacies, with four-seven years of university education. Ours is totally a different scenario here.

Our pharmacies are still run in the same old ways, with some adding beds for doctor consultation and some adding space for sample collection, too. So, our community pharmacies are trying to turn into small clinics and polyclinics, providing healthcare facilities more than a community pharmacist can cater to. Some no longer are just community pharmacies, but have turned into mini hospitals themselves. We have multiple examples of hospitals that started off as community pharmacies first. Despite our nation producing nearly 1000 pharmacy graduates per year, not much has changed in this field. Either professionals have not been able to get into the profession and let the changes be felt, or the general population is happy getting some percentage off when buying medicines from the pharmacies.

The behavior of the general population in procuring medicine is quite similar to buying food items or general commodities from a grocery store. The population is not aware of the difference it makes in getting medicines from a proper professional. Think for once—if you are to choose a physician, you try and find out the best physician in town, but do you think in the same terms when you try and buy medicines? No, we feel that no matter where we go, we get the same medicine. We just fail to realize that going to the best doctor in town is not going to take our illness away. Seeing the right doctor does not take our illness away, but rather as a patient, we need to get the right medicine and use it in the right manner. Medicines are often a double bladed sword, if we use them properly, they help us cure disease, but when used improperly, they can have detrimental consequences, too. We have been hearing of cases of fake medicines and drugs of abuse being sold from pharmacies here in Nepal, this could be in part because of the lack of professionalism in someone who is not a certified health professional.

In Nepal, four –year-long bachelor pharmacy programs are run by the Tribhuvan University, Kathmandu University, Pokhara University, and Purbanchal University. The cost for the degree is around 7.5 lakhs as per the Medical Education Commission (MEC). Since 2015, the Nepal Pharmacy Council (NPC) has introduced a licensure examination for pharmacists and pharmacy assistants, so as to ascertain the quality of the healthcare force entering the profession. In recent years, a few new pharmacies are being registered that employ bachelor level pharmacists in community settings, this could be a sign of change; but will the change be sustainable? We, the general public, are attracted to pharmacies by the percentage discount they offer, rather than the actual services they could and should be providing, which is knowledge about the proper usage of drugs, and maintaining patient medication record, amongst others.

Worldwide, the pharmacy profession is shifting from product-centered (dispensing of drugs) to patient-centered services, such as preventive screenings, immunizations, and disease management. A lot needs to be changed both in terms of public behavior and laws to encourage university graduates to practice in the community setting. Only then will we be able to avail of better community pharmacy services, such as those offered in other nations.

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