Pharmacists in Government Health Services of Nepal

Pharmacists in Government Health Services of Nepal
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Pharmacists in Government Health Services of Nepal

Pharmacy is the profession of ensuring quality control, proper storage, sale and management and proper use from pharmaceutical production to pharmacy and the expert manpower who has acquired proficiency in these functions is called pharmacist. In Nepal, too, this profession and the characteristics of professionals have been legally established by law.

What is the condition of pharmacy profession in Nepal?

Only half a century since the beginning of the modern pharmacy profession in Nepal. However, this profession is mostly limited to drug production.

According to the latest statistics of the Department of Drug Administration, there are currently 78 Pharmaceutical Industry registered. Of those registered, 52 are currently in operation while others are in the process of being commissioned. It is estimated that the products of pharmaceutical companies operating in Nepal currently meet only about 50 percent of the country’s demand for medicines. Therefore, there is potential for substantial development in this area as well.

There has been some improvement in the field of drug production, there is a need for significant improvement in the field of proper use of drugs. Even in the context of adequate manpower of expert pharmacists who have acquired expertise in pharmacology, the use of drugs has not been possible due to the non-inclusion of such manpower in the role of drug distribution and management in the state machinery.

Pharmacists have an important role to play in the healthcare flows from the government sector, quality pharmacy services have not been provided due to very low vacancies.

Role and Challenges of Pharmacists in Government Healthcare

After the implementation of the Drugs Act 2035 in Nepal, the Department of Drug Administratio – DDA has been established under the Ministry of Health, Government of Nepal to implement the Act. The main objectives of the Drugs Act are to to prevent the misuse or abuse of drugs and  allied pharmaceutical substances and false or misleading information relating to the efficacy and use of drugs and to control the production, sale, distribution, export, import, storage and  consumption of those drugs which are not safe for public consumption, efficacious and of standard quality. Pharmacists in the Department of Drug Administratio – DDA should be involved in the following activities.

  • Pharmacy Registration, Renewal, Inspection
  • Drug and Drug industry Registration, Renewal, Inspection
  • Drug Import Export Management
  • Other drug related work

Today date, the jurisdiction of the Department of Drug Administratio – DDA  has been expanded, but due to limited organizational structure and manpower, the control and regulatory roles of the Department of Drug Administratio – DDA have not been effective.

According to the latest statistics of the department, the number of pharmacies across the country has reached 21,000, while 52 pharmaceutical industries are in operation and 26 more are in the process of being registered.All these pharmacies and industries are regulated and controlled by the Kathmandu-based department and three branch offices. The office in Nepalgunj has 26 districts, Birgunj has 11 districts and Biratnagar has 14 districts.

Due to the limited workload of the limited manpower of the department, the shop monitoring activities have not been carried out effectively. It has been found that drug stores are run by unauthorized persons and it is easy to buy even medicines that are listed as not to be sold without a doctor’s prescription.

This type of practice has led to the negative effects of civic medicine and some are suffering from various health problems. Therefore, in order to achieve the objectives of the Drug Act 2035 BS by providing quality pharmacy services to the citizens, there is a need to expand the organizational structure of the Department of Drug Administration and provide adequate manpower.

It is a sad situation that the structure of the Department of Drug Administration could not be expanded without realizing this need even during the state restructuring. The political and administrative leadership, concerned professionals and conscious citizens should all take responsibility for this. Unless the empowered office of the Department of Drug Administration is expanded to every district or at least to every state, the effectiveness of its work cannot be maintained.

The National Medicine Laboratory is the main organ of the Government of Nepal for quality testing and analysis of medicines and pharmaceutical products. The laboratory run by the Department of Drug Administration is responsible for quality testing and analysis of medicines manufactured by 52 pharmaceutical industries operating in Nepal and around 300 foreign pharmaceutical companies, and the pharmacist manpower has a role to play in this.

In addition, it seems that the department has published several notices in recent times to recall the medicines approved by the department for quality test once and for marketing.In addition to this, it is necessary to collect samples from the market from time to time as the quality of the marketed drugs, which have been passed by the official body after fulfilling various quality standards, will become unusable due to improper supply and storage. Due to the lack of effective monitoring by the department, the situation of mis-supply and storage is even worse when the pharmacy is run by unauthorized persons.

Therefore, in the current context of the need for rapid monitoring of the drugs that have reached the market, it does not seem appropriate to expect such monitoring from the current structure of the National Laboratory, which has not been able to carry out its regular work effectively with only about 40 pharmacy manpower.

The National Health Policy 2071, Drug Act 2035, Drug Policy 2051 also emphasizes the need to increase the capacity of the National Pharmaceutical Laboratory and expand the organizational structure to ensure the availability of quality medicines to the citizens. It is too late to expand it, at least regionally.

  • Government Hospitals and other Health Institutions

It is the responsibility of the pharmacist to distribute the medicine to the patients from the hospital pharmacy by giving the necessary advice as per the doctor’s prescription. It is very important to ensure that the patient has complete knowledge about the medication. Even if the right medicine is recommended after getting the right diagnostic service, if the patient does not take the medicine properly, the disease will not be cured and he will have to suffer from the negative effects of the medicine.

In this context, the Health Policy 2071 has also emphasized on the need to arrange for the sale and distribution of medicines from the skilled pharmacy manpower through the hospital’s own pharmacy. In line with the spirit of the policy, the government has issued the Hospital Pharmacy Directive 2072, in which the hospital has given importance to the need for hospitals to operate their own pharmacy and operate hospital pharmacy services through skilled pharmacy manpower.

Even with such policy and legal grounds, pharmacies in government hospitals across the country have been operating for a long time without skilled pharmacy manpower through privately owned pharmacies.Some conscious people knocked on the door of the Supreme Court saying that such a situation had adversely affected the health of the patients. The Supreme Court then issued an interim order directing government hospitals to remove the rented pharmacies and run their own pharmacies.

After that, some big hospitals including Kati Children’s, Bir Hospital, Western Regional Hospital Including 52 hospitals have managed the hospital pharmacy services, but most of the hospitals were operating privately owned pharmacies for a long time.At present, many government hospitals are trying to run hospital-owned hospital pharmacies. But due to lack of manpower, the effectiveness of these pharmacies has been questioned time and again. Lack of adequate posts of pharmacy manpower in government hospitals has made it difficult to start and operate hospital pharmacies.

The health insurance program has been equally affected due to non-operation of hospital pharmacy. Officer level pharmacy manpower is available in only three government hospitals across the country.

Pharmacy manpower Crieteria According to Hospital Pharmacy Guideline 2072

Above 100 bedded Hospital 
  • Clinical Pharmacist – 1
  • Pharmacist – 3 
  • Assistant Pharmacist – 6
  • Helper – 2
51 – 100 bedded Hospital
  • Clinical Pharmacist – 1
  • Pharmacist – 2
  • Assistant Pharmacist – 4
  • Helper -1 
26- 50 bedded Hospital
  • Pharmacist – 1 
  • Assistant Pharmacist – 2 
  • Helper – 1
15- 25 bedded Hospital
  • Assistant Pharmacist – 2
  • Helper – 1

Due to limited pharmacy manpower, government health institutions including hospitals are selling medicines from unauthorized persons. Due to this, citizens cannot get quality health care.

In the past, the posts of pharmacists in the Department of Health Services under the Ministry of Health, which is a structure to work at various policy levels, have been removed. This seems to have created problems at the level of drug policy implementation. This position should be restored as much as possible.

  • State Government, Ministry of Social Development

The Ministry of Social Development has been formed in the structure of the state government formed after the country entered into federalism. Under which a post of a pharmacist has also been established. This is welcome, but the Ministry’s mandate in the field of drug regulation needs to be gradually clarified with appropriate legal provisions.

  • State Health Directorate

The Regional Health Directorate, which used to be the guardian structure of the health institutions under its jurisdiction, has now been transformed into the Provincial Health Directorate. The number of pharmacists in this structure, which has posts for the entire service group, is zero. Due to this, the issue of directing, inspecting and monitoring of pharmacy related issues in the health institutions under the state has come up sharply.

  • State Supply Management Center

The structure of the regional medical store, which carries out scientific estimation, procurement, storage and distribution of medicines required in the health institutions of the region, has recently been restructured as a provincial supply management center. The National Health Policy stipulates the involvement of skilled pharmacy manpower to make the system of estimation, procurement and distribution of medicines more effective. The fact that the expert manpower is the pharmacist in all the above-mentioned tasks is legally established.

  • Local level

According to the current system, the local government has the right to register, monitor and regulate pharmacies. In the current context, there is no vacancy for pharmacists in the metropolitan, sub-metropolitan, municipal and village structures. As a result, contrary to the spirit of federalism, the people will still be forced to go to the center for basic work such as registration and renewal of general drug stores.

Others

In addition to the areas mentioned above, the role of pharmacists in the field of pharmaceutical research and production needs to be managed in various government agencies. The role of the pharmacist in the Department of Botany still needs to be highlighted and an organization like Nepal Aushadhi Limited needs to be further organized and expanded.

Nepal Aushadhi Limited needs to be developed as a generic pharmaceutical company in the country to provide access to basic medicines to all the people. If at least this company can produce a large portion of the medicine distributed free of cost by the Government of Nepal, it will be a great boost to the health system of the country. For this, under the leadership of skilled and experienced pharmacists, this company needs to be revived once again.

Conclusion

Thus, in the current situation where the administrative machinery of the country is being restructured according to the spirit of the new constitution, it seems that the field of highly sensitive medicine management such as public health has not been given priority. It seems that all the stakeholders at the leadership level should pay special attention to this as soon as possible.

The government is set to abolish the Department of Drug Administration and establish a powerful Food and Drug Authority (FDA). Announcing the policy and program for the fiscal year 2077/78, President Vidyadevi Bhandari informed that the Department of Drug Administration will be abolished and FDA will be established. Now it remains to be seen what will happen accordingly

The policy and program states that the Food and Drug Authority (FDA) will be established as an autonomous regulatory body by dismissing the department.


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