The pharmacists represent the third largest health care professionals in the world. As medicines are integral parts of health care delivery, so is the custodian of medicines - the pharmacists - with health care team. Pharmacists were traditionally recognized as medicine suppliers, both at community and health facilities. Their initial role was to make medicine and supply them to the patients - a patient specific professional role. Later on, due to scientific and industrial development, the preparations of medicines were completely taken over from the individual practicing pharmacist to the industry, which now make almost all medicines available in ready to dispense forms. This reduced the pharmacists' responsibility as just dispensers or drug sellers.
However, the situation has changed and improved dramatically worldwide. In order to face the challenges created by almost complete non-necessity of compounding of professional practice, the concept of pharmaceutical care has emerged. Now, pharmacists have a chance to establish direct link with patients in the community through patient counselling for improving the use of medicines and promoting community health. Similarly in hospital setting, in addition to counselling they concentrate on managing the pharmaceutical supply system to improve availability of quality medicines at competitive rate.
The concept of pharmaceutical care is new and differs completely from what pharmacists have been doing for years. The scope of pharmacy practice has been redefined to include patient cantered care with all cognitive functions of counselling, providing drug information and monitoring drug therapy, apart from providing all technical aspects of pharmaceutical services, including supply management.
In order to cope up with the new situation and responsibility of providing improved pharmacy practice, the World Health organization (WHO) has suggested the concept of seven star pharmacists. In the third consultative committee report on the role of pharmacists, it has advocated that curriculum should be designed in such a way as to impart adequate knowledge, attitude, skills and behaviours to pharmacists to support the expanded role. A pharmacist should be a care giver, decision maker, communicator, leader, manager, life long learner and teacher. In addition, in the present scenario a pharmacist should also be a researcher.
The pharmacy profession in India is quite old and matured. But, unfortunately, the minimum qualification and training of pharmacists remains almost same as that of when pharmacy act was enacted in 1948. The changes brought in are minimal, barring the upgradation of curriculum of diploma in pharmacy. Even though, the curriculum was revised in 1991, it is still outdated one. In all other countries, the minimum qualification is degree in pharmacy. India is the only country to continue with the provision of diploma in pharmacy as minimum qualification for practicing pharmacy. The training and knowledge provided by the Indian institutes are highly inadequate to work in hand to hand with a team of highly skilled, competent and knowledgeable health professionals like doctors.
Two important policies - National Health Policy and National Drug Policy - are relevant to the pharmacists and pharmacy professionals in the country. These policies are guiding force for implementation of programmes. It is unfortunate that the pharmacists did not figure in current health policy of 2002, though it has provision for paramedical and other heath workforce. This clearly indicates that the government does not recognise the functioning of pharmacists as health workforce. The public perception is not too different.
The salary of pharmacists in the government sector is lower than that of similar qualified professionals. Usually, society judges the professionals based on the service they provide and the salary they earn. Neither the council nor the professional associations could impress the V pay commission for a good salary structure. Now, at least, steps should be initiated to impress the VI pay commission to rectify the anomaly existing. The remuneration of the pharmacists working in community pharmacy is dismal. There is no legislation to regulate the wages of community pharmacists except the shops and establishment act. The wages prescribed under this act is even lower than that of the daily wage earner.
In spite of all these challenges and difficulties, pharmacists have been doing a yeoman's service to the society both at community and health facility level, especially in rural areas. The evidences are plenty. The TB card project of Mumbai, improving medicine use through patient information leaflets, participation in HIV/AIDS care through FIP (International Pharmaceutical Federation) project and discussion in solution exchange programme on pharmacists' involvement in reproductive and child health programme are just few examples to cite.
The Indian Pharmaceutical Association's (IPA) initiative in promoting good pharmacy practice (GPP) at community pharmacy level is commendable. The development of the training module on GPP is a significant mile stone in the profession. More recently, the attempt on accreditation of pharmacies by the community pharmacy division of IPA has been well received by the pharmacies participated. Many of the pharmacists have expressed their happiness as their volume of business improved because of compliance with accreditation criteria. Apart, the Maharashtra State Pharmacy Council in association with Maharashtra State Chemists and Druggists Association has started a regular course on patient counselling for community pharmacists. This clearly indicates the interest of community pharmacists on equipping themselves through training to serve the community in a batter way.
The first clinical pharmacy service in government sector was initiated at Trivandrum medical college hospital in Kerala. They too have community pharmacy services, where patients get their medicines at a cheaper rate than the market price. The counselling centre of the clinical service department is well received and benefits many consumers. There are many other post graduate centres in pharmacy practice, where the clinical pharmacy services like prescription monitoring, adverse drug reaction monitoring, drug information services are offered to improve medicine use. It is learnt that Medical Council of India is interested to develop some sorts of standards for hospital pharmacy services in teaching hospitals in line with other clinical departments. This would be an important development in the hospital pharmacy practice in the country.
Often there are complains of lack of pharmacists in the country to serve the community and health sector. Citing this as an issue, government has attempted to train unqualified sales persons of the pharmacies and offer them certificates to serve as pharmacists. AS per the statistics available, India has 559408 registered pharmacists with a ratio of 1 pharmacist to 1909 persons. Though actual number of practicing pharmacists may be much lower, this figure is comparable with the pharmacist-population ratio in industrialized countries (1:2300).
The government has set up four more national institutes on an equal footing with National Institute of Pharmaceutical Education and Research (NIPER). With these developments, there would be no shortage of either pharmacists or initiatives in providing leadership in pharmaceutical education, including in area of pharmacy practice.
The recent initiative of SEARPharm forum held in association with WHO focussed on challenges and opportunities for pharmacists in health care in India. The national health programme representatives appreciated the pharmacists' effort and contribution in health care delivery and assured to integrate pharmacists further in the system. The Indian pharmacists must realize the need for change for facing the challenges of demands at both community and health facility pharmacy practice setting. Every threat is an opportunity. A little extra effort by every sensible pharmacist will go in a long way in improving the pharmacy practice scenario in the country.
(The authors are with department of pharmacy, Annamalai University, Annamalai Nagar, Tamil Nadu)