The majority of India's one billion plus population (72.2 per cent) lives in rural areas. People in rural India have limited access and little capacity to pay for modern healthcare. This is particularly true in remote rural areas, where public healthcare facilities are less developed, doctors are reluctant to work, and the people's knowledge regarding health and medicines are poor. Most of the urban educated physicians are not willing to serve in rural areas, where infrastructure and payment are poor. In rural India, most basic illnesses are treated by self medication. In absence of full-fledged public facilities, private community pharmacies may be the only source of medicines. This has meant that these pharmacies (medicines retail outlets) serve as the patients' first point of contact with the healthcare system.
I (author of this article) wish to illustrate easy access and availability of medicines from private community pharmacies in two different rural areas of our country.
I was born in Dhupguri, a beautiful small town at the foot of the Himalayas with surrounding tea gardens and hills in the Jalpaiguri district of West Bengal. I graduated D Pharm from Jalpaiguri Institute of Pharmacy in 1978. Being a pharmacy student, I was curious to see regularly sales and supply of medicines to consumers from five to six private community pharmacies in the town.
Today I am a faculty and involved in teaching various pharmacy programmes at our University in Annamalainagar, the outskirts of a town - Chidambaram - of Tamil Nadu State. Chidambaram, a coastal town of south east coast of Indian peninsula, is a famous place for it's about 1000-year-old temple dedicated to Lord Nataraja - God Shiva in the form of cosmic dancer. The way of life in terms of devotion in this temple remains unchanged for the past millennium despite the inroads of modern technological advances. Although Annamalainagar is a rural area but it has a University teaching hospital that provides improved healthcare facilities. Nonetheless, many private community pharmacies around the campus cater the need of medicines to more than 15000 students and the residents of nearby remote areas.
Role of community pharmacists & pharmacy assistants in remote, rural areas
In both remote and rural areas, community pharmacists and pharmacy assistants play an important role in fostering self-medication among the consumers. They contribute to the easy access and availability of all medicines to the consumers. Self-medication has a positive impact on a society (Table 1 shows the details). Although it allows access of the patients to a wider range of medications but at the same time it has negative implications due to inappropriate self-medication.
At Dhupguri, the community pharmacists hold no formal pharmacy qualifications, generally have very little or no training in medicines management and some of them have not even graduated from high school. A 'pharmacist' in this context is defined as someone who has a pharmacist registration certificate that can be obtained currently by acquiring minimum D Pharm (diploma trained pharmacist) or, prior to 1984, by having five years of experience in dispensing of medicines (non diploma pharmacist).
At Annamalainagar, consumer may buy medicines from a community pharmacy operated by a diploma trained pharmacist, who graduated from one of the many self financed institutions. However, once qualified they receive no additional training and there is no exposure of up-to-date information. I wish to mention a private pharmacy in
Annamalainagar to illustrate the methods of medicines sale.
The community pharmacist provides medicines as remedies for both trivial and common ailments to the students and local residents. He sells prescription medicines without prescription and also sells medicines against an old prescription. He provides first aid and sells medicines with low mark-up and also provides other services without any additional fees. He makes available all the medicines needed in the area at an affordable price. He is fulfilling World Health Organization's objective in making more and more medicines available to patients of disadvantage sections of the society.
The author of this article relates the above two personal observations for two reasons:
(1) Community pharmacists (non diploma and diploma trained) and pharmacy assistants are easily accessible providers of medicines in such rural areas in India
(2) There are broad concerns important to us all. Can the medicines be misused and therefore dangerous to an unsuspecting patient?
Pharmacists need to have better education about rational use of medicines. There is a need of a philosophy of medicine use that allows bringing together scientific principles and societal responsibilities with an approach that benefits consumers. In fact, given the reliance of the medicines on pharmacists, improvements in their training and education are likely to affect the proper use of medicines.
(The author is Reader in Pharmacy, Annamalai University, Annamalainagar 608 002, Tamil Nadu)