Transcript Bulk dispensing in Africa: The reality and the concerns

Bulk dispensing in Africa: The reality
and the concerns
Stand in presentation
Alex Dodoo, President, Pharmaceutical Society of
Ghana
The Reality
 Dispensing from bulk is the norm rather than the exception
for products in sub-Saharan Africa
 For products like
 Tablets
 Capsules
 Syrups
 Suspensions
 Creams and ointments especially in hospitals
The Reality
 Even smaller packed products are dispensed from bulk
especially when they are expensive
 Products for erectile dysfunction
 Products for prostate cancer etc
 Products like glyceryl trinitrate have been known to be
dispensed from bulk!
 Exceptions
 Inhalers, Injections, Some creams, ointments, lotions
Features of the Dispensing Landscape
in Africa
 Very poor labelling of dispensed medicines
 Poor patient counselling
 Dodoo, A.N.O et al., Rational drug use in Korle-Bu: A five day baseline survey of drug use indicators at the Korle-Bu
Teaching Hospital, Accra, Ghana. Ghana Pharm. J. 2001, 24(3):14-16
 Presence of counterfeit and sub-standard products in the pharmaceutical
supply chain
 Dispensing by non-pharmacists and lower qualified personnel
 Absence of tablet counters/trays
 Counting by hand
 Counting cytotoxics as well as other products using “plastic spoons” etc
 Dispensing liquid in bulk
 Bottles to be brought by parents
 No medicine spoons
 Illiteracy as well as presence of products with labels in other languages apart
from the official national languages
Implications
 Patient safety
 Errors
 Counterfeit
 Expired products
 Sub-standard products
 No labelling so difficult to check
 No counselling and no knowledge by patients
Implications
 Adherence
 Lack of knowledge by patients
 Difficulty of patients to know what to take
 Patients not returning to pharmacy to buy “remainder of expensive
medicines” especially if they “feel” better
 Product integrity
 Packaging in plastic and paper “envelopes”
 Effect of moisture, humidity etc
 Regulatory challenge
 Checking adherence to existing regulations on dispensing etc
 Impossible to sue for negligence
Opportunities
 Pharmaceutical industry
 To ensure that their products are appropriately packaged to
reduce counterfeiting and environmental problems
 National governments, especially where there is a national
health insurance service
 NHIS packs etc
 Pharmacy and Medicine Regulators
 Insistence on patient packs as well as patient information leaflets
as well as proper labelling of all products
 Reduction of costs of registering various packs of the same
products
 Other necessary regulatory measures