In Bangladesh, whether in a city or remote village, drug shops are often the first point of contact for people when they get sick. Most have been there for decades and it is common to hear people in the neighborhood recall their interaction with the shops since their childhood. Besides basic over-the-counter drugs, they sell all types of medication, even ones you may not have a prescription for. But when going to these shops, you will most likely be served by a salesperson with barely any formal training.
According to the law, dispensing drugs at any retail outlets requires at least a ‘Grade C pharmacist’ Certificate (attained after attending a training covering the basics practices). If the salesperson meets this criterion, then only can the shop owner apply to the Directorate General of Drug Administration (DGDA) for issuance of a proper drug license. At the moment, there are 106,919 drug shops that are licensed by the DGDA; however it is estimated that there are also an equal number of unlicensed shops across Bangladesh.
More than 80 per cent of people in Bangladesh seek care from untrained or poorly trained village doctors or drug shop retailers. As a result, these largely unregulated and unaccountable private retail drug shops are giving rise to irrational use of drugs and high out-of-pocket expenditures. About two thirds of people’s total health expenditure is from out-of-pocket, and of this, 65 per cent is spent at the private drug retail shops.
Given the general importance of these drug shops to people’s health and wellness, improving regulatory standards will improve pharmaceutical services essential for reducing healthcare costs. A study conducted in 2015 explored the status of these retail private drug shops in Bangladesh by examining facilities in both urban and rural areas. The aim was to determine how to develop a better and accredited model for drug shops in Bangladesh.
There is a distinct difference between regular drug shops and an accredited shop, or the ‘accredited drug dispensing outlet’ model. Unlike most unlicensed drug shops, the accredited model provides a comprehensive public-private initiative based on strong regulatory enforcement. They sell products and provide services within the criteria set and approved by the Government authority. Accredited drug shops appoint graduate or diploma-holding pharmacists, who can give customers brief but informed advice about the drugs they sell. Overall, model pharmacy initiatives could enhance capacity building on how to monitor product sales through drug retail software. This way, retailers can learn what type of products to stock to improve their business and keep track of product expiration dates, and even track those purchasing the medicine. The availability of such records allows for supervision and inspection to review and assess the shop’s performance and compliance with regulations.
The goal of the accredited model initiative is to improve access to affordable, quality pharmaceutical services in retail drug shops in urban and rural areas. Through this method, drug retailers could supplement the health care workforce and improve access to basic primary care. After receiving the right training, retailers can offer cost-effective and quality drugs that reduce out-of-pocket expenditure among the patients. Such an initiative would be indispensable for ensuring access to essential health services and achieving universal health coverage in Bangladesh.
Currently the numbers of unlicensed shops are large and regulators at the central and district levels were unanimous about the necessity of developing an accredited model of a drug shop to improve the situation in Bangladesh. In Tanzania, the Accredited Drug Shop model has already been tested by staffing shops with appropriately trained dispensers, strictly enforcing regulations, and providing supportive supervision. In Bangladesh, the study revealed that the model could be adapted and made feasible according to the country’s context. Although the study provides key action points to help overcome the challenges presented in the drug shop market in Bangladesh, it is still up to advocating to policymakers in order to see these changes through.
Read the full study here: https://joppp.biomedcentral.com/articles/10.1186/s40545-017-0108-8
This blog was written by Muhammad Shaikh Hassan, Senior Research Associate with the Centre of Excellence for Universal Health Coverage at BRAC School of Public Health, and Anushka Zafar, Communications and Knowledge Manager at BRAC School of Public Health.