Prescription challenges facing community medicine outlets in delivery of pharmaceutical services in Dar es salaam region.

Abstract

Background: The city of Dar es Salaam is growing very rapidly in all sectors. The increase of the population in the city also reflects the need of pharmaceutical services. However, delivery of pharmaceuticals to the society should be in accordance to direction given in the prescription, except for over the counter drugs (OTC). But, there has been a tendency for prescription medicines being dispensed without prescription order. Study Objective: To investigate prescription challenges facing community medicine outlets in delivery of pharmaceutical services in Dar es Salaam region. Materials and methods: A descriptive cross-sectional study design was conducted from October 2012 to June 2013. A total of 228 participants were interviewed (where 140 pharmacies and 88 DLDM), obtained by calculating 30% of eligible participants within the strata population plus 10% for attrition rate. They were selected by simple random sampling technique using computer software package from a strata population list, to have equal representation from Pharmacy and DLDM. Questionnaires, simulated client who was appeared at medicines outlet to buy prescription medicines without a prescription and physical observation of prescription book and prescriptions retained for the whole year 2012, were used to interview medicines dispenser in the pharmacy and in the DLDM. The views of the stakeholders (i.e. MSH and PST) and specific organizations (i.e. MoHSW and Regulatory authorities) relevant to this study were sought.

Results: Among 228 respondents participated in the study, 61.4% (140) were from the pharmacies and 38.6% (88) from DLDM. The majority of them 82.9% (189) being female while male being only 17.1% (39). Professionally, 10.5% (24) of respondents were pharmacists, 9.7% (22) were pharmaceutical technicians, 4.4% (10) pharmaceutical assistants and the rest 75.4% (172) were none-pharmaceutical professions (i.e. medical doctor, clinical officers, nurse midwifes and nurse assistants). Among the none-pharmaceutical personnel carders who are medicine dispensers 65.8% (150) were nurse assistants. However, 47.7% (82) of all non pharmaceutical personnel participants received training on ADDO while the majority that is 52.3% (90) was not. The majority of the medicine outlets i.e. 90% (126) of pharmacies and 97.7% (86) of DLDM sell prescription only medicines without a prescription. However, among 6 respondents who did an in-depth interview, they all agreed on having a prescription challenges in the health system. Out of all medicine outlets 228 participated in the study, 38.2% (87) that prior have shown to have prescription book, only 25.9% (59) that kept record in their prescription book. However, 32% (73) of medicine outlets that retained prescription copies for the whole year 2012, only 22% (50) that had real stored prescription copies.

Conclusion: Despite the existing effort to alleviate the problem of selling prescription medicines without prescription at the level of medicine outlets, yet there is a significant problem of malpractice which has been continued within the health system, it has now developed into being a character within the entire health sector. This study has found to be like treating symptoms while the causative agent left untreated. Pharmacy Council should strengthen its inspection on the medicines delivery points in private health facilities both by type of medicines stored and by level of medicine dispensers, should enforce the existing laws in order to keep balance between enforcing regulation and performance of the dispensers. Yet, how profit aspirations and internet services contribute to self medication is still not known.

Recommendations: The government in collaboration with other stakeholders should train more qualified medicine dispensers. To develop an agency that will be responsible for preparation, distribution and monitoring the use of prescription at all levels by using its number and also it will be overseeing the conduct of all professions as well as to use multi-sector approach within the health sector to sensitize use of prescription for prescription only medicines.

And to establish health guidelines that directing private hospitals and dispensaries to prepare and use duplicated prescription copies.

Key words: Prescription, Prescription Medicines, Community Medicine Outlets, and Medicine Dispensers.