During the last 50 years since Drugs and Cosmetics Act 1940 and Pharmacy Act 1948 were enacted, pharmacy profession of India is subjected to many reforms and developments. The number of qualified pharmacists has gone up considerably during this period, though it is yet to match the actual requirement. The minimum qualification needed for a practicing pharmacist has been upgraded from that of a certificate course (compounder) to a diploma in pharmacy.
Over the years, statutory bodies like Pharmacy Council of India and All India Council for Technical Education have come in place to ensure educational and professional discipline among pharmacists. Drug regulatory authorities have also developed the system of registration of chemist outlets at state level. There has been a significant growth of qualified pharmacists, drug stores and pharmacy educationalists during this period. However, figures show a deficit for qualified personnel in every field of pharmaceutical activity. For instance, for 7,00,000 licensed chemist shops, there are only 5,00,000 pharmacists, among which only 4,00,000 are registered with the statutory authority in the country. Likewise, the number of pharmacy teachers (5,000) at present is also much less when compared to the actual requirement (8,000).
Current issues
All these have led to a situation where scaling up of interventions like Good Pharmacy Practices or Good Storage Practices has become difficult to be exercised as it is being done in developed countries. Indian pharmacists are yet to assert themselves due to lack of knowledge. When appropriate skills and knowledge are not present, the delivery cannot be effective.
Indian pharmacists should realize that diploma as the minimum qualification with minimal or no training are negative factors for their image. We yet lack adequate number of appropriately qualified and motivated staff to work in the right place, at the right time, with correct remuneration. Pharmacists in India do not have any laid down norms on productivity, quality of services and overall sustainability.
A closer look at the current pharmacy practices would make it clear that there are either very slow or no reforms in laws affecting pharmacy profession in the country. There is no separation between prescribing and dispensing. The consumer education on generics and OTC medicine is very low. Emphasis on clinical effectiveness on health outcomes of bio-equivalent products or combinations needs to be strengthened. India is far behind when it comes to the promotion of the concept of rational use of drugs or essential drugs through pharmacists. Our registration norms and licensing procedures are also outdated. Formalized CPD programmes and accreditation of drug stores are still dreams.
There is an urgent need for integrating pharmacy training, education and human resource planning. Such a move can bring in the dignity and equity to pharmacy profession on par with other health care professionals. Such a dignity would automatically sensitize the population on the ''legitimate need" for having pharmacists as an integral part of the health care system.
Lack of focus on quality of service and continuous improvement is causing much harm for the professional growth of Indian pharmacist. There is hardly any ongoing dialogue between policy makers and health-labour market for neutralizing the demand and
supply proportion.
Pharmacists should be given incentives and motivation for the work they do. Better working conditions, higher salaries and other benefits, service provisions and other incentives are also important to improve the output of Indian pharmacist. Right knowledge, skills, motivation and job opportunities would inculcate in qualified pharmacist, a desire to grow as an important input to health system.
International trends
Having stated the needs and aspirations of our pharmacists, let's try to understand the global scenario. While PCI is responsible for pharmacist registration in India, it is state boards (USA, Australia, Thailand), pharmacy schools / colleges (Denmark), medical council (Sri Lanka) and Health Ministry (Indonesia, Malaysia) in many other countries. The responsibility for licensing of chemist / drug stores also varies with state boards (Australia, USA), schools / colleges (Denmark), Ministry of Health (India, Malaysia, Sri Lanka) etc are fulfilling the duties in different countries.
There are also countries where there is no systemized registration procedure. For example, in Indonesia, one needs a work permit letter from the health ministry to open a pharmacy. The pharmacist will also receive an "Assignment Letter" along with the work permit, which calls for compulsory service for 3 years in the permitted institution.
Another important component where other countries have gone ahead with respect to Indian pharmacist is continuing education (CE). While there are no requirements for imparting CE credit in India, a number of organizations are involved in this process in countries like USA. The State Pharmaceutical Association provides CE credit to professional pharmacists in Australia. It should be noted that almost all developed countries insist on CE for continued practice in pharmacy profession. Countries like Australia, Austria, Canada, Denmark, Germany, Great Britain, Italy, USA have all made accreditation or approval of CE for pharmacists a formal requirement. India needs to learn a lot from their experience.
Future strategies
In order to tap the global opportunities, Indian pharmacist should learn how to enhance the quality of drug therapy through their effective intervention. The pharmacist should be able to identify inappropriate prescribing, improve pharmaceutical delivery, improve patient compliance, identify patient idiosyncrasy and carryout appropriate monitoring of drug therapy.
The role of pharmacist in the society should be made more visible by relating them directly to national health policies. Pharmacist should be the key person in the promotion of EDMs, primary health care programmes, campaigns against HIV/AIDS, TB, malaria, tobacco etc and also have a well defined role in the implementation of the National Population policy.
The country should see that future pharmacists are given appropriate education and relevant training. Adoption and development of global standards of GPP, integration in the national health care team, harmonization of the registration process of pharmacy and pharmacist, formalized CPD based programmes for re-registration, accreditation of drug stores and chemist shops are all to be of immense help in this attempt towards progress. Indian pharmacist can also think of linking up with the global pharmacy community through JV agreements between associations and institutions for Continuous Professional Development and Accreditation and student exchange programmes to understand and adopt the best pharmacy practices that are being followed else where in the world.
-- The author is President, Indian Pharmaceutical Association