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  • Improving the quality of community pharmacy practice in Ghana: Increasing competition and reducing t
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    The practice of pharmacy in Ghana is currently undergoing reformation with the introduction of many policies from the regulatory bodies. Chief among these policies is the Pharmacy Councils Policy on Supervision of Community Pharmacies. A lot has been said about the merit and demerit of this policy by stakeholders and practitioners already. With over 10,000 over-the-counter medicine outlets (OTCMOs) and only about 2000 community pharmacies, Ghana largely depends on the OTCMO for the provision of pharmaceutical services. It has been hoped by Government and the training institutions that, the training of more pharmacists will continuously reduce the over-reliance on OTCMO and improve the quality of pharmacy practice. However, the gap between community pharmacy providers and Over-the-counter Medicine Sellers (OTCMS) is still wide. This write-up seeks to provide additional or alternative policy suggestions towards improving the quality of community pharmacy practice in Ghana focusing on competition and the over-reliance OTCMS.  

    In Economics, one of the conditions of a perfectly competitive market is the existence of many suppliers. One of the benefits of such a market is the improvement in the quality of services as a result of competition. This is applicable even in the health care market. I believe therefore that increasing the number of pharmacist-owned community pharmacies will naturally improve the quality of pharmacy practice in Ghana. However, am struggling to see how this new policy will increase the number of pharmacies and reduce our over-reliance OTCMS.

    Firstly, it is my understanding that the OTCMO is only needed in locations not adequately served by community pharmacies since the services provided by pharmacies encompass that of OTCMS. So why do we still have OTCMOs in cities of Ghana, where pharmacists are struggling to get locations to open Pharmacies? Do we still need OTCMOs in Kejetia for instance? The ideal situation will be to have enough community pharmacies and no OTCMOs in Ghana. This should be the policy direction of the Pharmacy Council. My policy suggestion, therefore, is that all OTCMOs in the major cities should be upgraded to community pharmacies or closed down over a period. This will not only provide an opportunity for the pharmacist to partner them but will also reduce the OTCMO- Pharmacies ratio and improve the overall quality of pharmacy services.

    Secondly, the pharmacy council has implicitly suggested, over the years, that OTCMOs are substitutes of pharmacies; this has resulted in the disqualification of some sites for retail pharmacy practice. The evidence is in Councils own legal documents. On the application forms for the registration of pharmacies and OTCMOs, one will find these statements: The distance between the proposed site and other retail facilities shall be 400m by radius and the proposed site should be minimum of 1KM (Radius) from the nearest pharmacy or Over-the-counter Medicine Seller respectively. Remember that retail facility in the context of the application for the registration of retail pharmacies is referring to retail and retail pharmacies. So why should the existence of an OTCMO (licensed to provide retail sale of class C/OTC drugs) within 400m radius stop the location of a retail pharmacy? My inference is that, if one exists at a location already you cannot have the other (substitutable). Are we then surprise that OTCMOs sell all classes of drugs? Again, a review of this policy by allowing the siting of community pharmacies even if it shares a building with a OTCMO will increase the number of retail pharmacies and improve the quality of pharmacy practice.

    Finally, I believe the policy that employs distance from existing retail facilities in citing new pharmacies and OTCO does not allow equity distribution services. What will be the population of a 400m radius or 1km radius in Circle, Accra, as compared to Walewale? My point is, by using distance some locations will be oversupplied while others remain undersupplied with pharmaceutical services. I work in a rural town(population of about 40,000) that has about twelve registered OTCMOs instead of probably five (in my estimation) and I believe the story is not different in other rural areas. These shops do not only sell all classes of drugs but are involved in drug peddling in some markets (e.g. Gbintri market) because they do not make enough sales from their shops. I believe using population as an indicator of the need for a pharmaceuticals outlet (OTCMO or pharmacy) is a better way to provide equitable distribution of services which will ultimately improve the quality of pharmacy practice in Ghana.

    In conclusion, whiles admitting that the new policy on the supervision of pharmacies is good, it must be added that it is very narrow, and its success relies so much on the regulatory bodys ability to monitor (we all know how good they are in this regard) and might not change the status quo. Remember Pharmaceutical Society of Ghana (PSGH) is being asked to help in supervision. A better way will be to increase pharmacies, encourage competition, and continuously reduce the gap between the number of OTCMOs and retail pharmacies. This will create a market that will naturally improve the quality of pharmacy practice due to enhanced competition. Competition drives sustained improvement of quality in any sector of the economy including health, lets use it rather than creating more hurdles to community pharmacy market entry.

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    Pharm. Issifu Abugri, MSc, B.Pharm, MPSGH

    The writer is the Head of Pharmacy for Baptist Medical Centre, Nalerugu, Ghana


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