Medicines shortages in Pakistan: a qualitative study to explore current situation, reasons and possible solutions to overcome the barriers

Abstract

ObjectiveThis study was conducted to assess current situation of medicines shortages in Pakistan and to identify its impact, reasons and possible solutions to overcome the barriers.DesignA qualitative study.SettingThe study was conducted between May 2018 and July 2018 in three cities of Pakistan including Islamabad, Karachi and Bahawalpur, depending on the availability of most relevant key informants.ParticipantsHealth regulators, pharmaceutical manufacturers, pharmaceutical distributors and pharmacists.Primary and secondary outcome measureStudy primarily explored current situation, reasons and potential solutions of medicines shortages in Pakistan. Secondary outcome was the issue of particular brand shortage.MethodSemistructured interviews were conducted. Sample size was determined by using saturation point criteria. Convenient sampling techniques were used to recruit the participants. The interviews were audiorecorded and transcribed verbatim. Data were analysed using inductive thematic analysis.ResultsA total of 41 stakeholders including 12 health regulators, 6 pharmaceutical manufacturers, 8 pharmaceutical distributors and 15 pharmacists participated in this study. Data analysis yielded 4 themes, 16 subthemes, 51 categories. Essential and life-saving medicines were in short supply. The major reasons of short supply of medicines were active pharmaceutical ingredient and raw material availability issues, lack of traditional distribution system and sudden demand fluctuation. Among proposed solutions, three most common were the facilitation and regulation of manufacturers, reasonable price fixation and improvements in the inventory control system.ConclusionMedicines were short in supply, and this may have clinical and financial impact on the patients in Pakistan. There were multiple and complex reasons of medicines shortages. Mandatory government leadership is required to resolve the issue on priority basis for improving the access of medicines to the patients.

Young Medical Doctors’ Perspectives on Professionalism: A Qualitative Study Conducted in Public Hospitals in Pakistan

“…In addition, medical colleges exist in a kind of environment where their students have always been considered more successful than students who are studying in other fields. In such a scenario, medical students feel themselves superior to others, although a lesser amount of money is spent on the healthcare sector, particularly for medicines (22). This is supported by our study results, because the young doctors believe themselves to be a superior person who knows better than patients.…”

Why is Pakistan vulnerable to COVID‐19 associated morbidity and mortality? A scoping review

“…93 As of 29 April 2020, the total number of infected medical workers in the country has risen to 444 (i.e., 216 doctors, 67 nurses and 161 healthcare staff). 94 Due to fear of being infected, some healthcare professionals have shown reluctance to handle presumptive COVID-19 patients. In view of the increasing number of infected cases and lack of occupational safety measures and crucial protective suits for healthcare personnel, 40,93 a further shortage of emergency response teams is anticipated in the near future.…”

Pharmacy Services beyond the Basics: A Qualitative Study to Explore Perspectives of Pharmacists towards Basic and Enhanced Pharmacy Services in Pakistan

“…Pakistan is struggling with a number of threats to the optimal use of medicines, including high prevalence of medication errors (causing deaths of 0.5 million people annually [13]) and adverse drug reactions (detected in 60% adults and 40% children [14]), misuse of controlled substances (by 6.7 million individuals [15]), and excessive self-medication [16]. There is also a growing list of medicine-related issues that demand immediate participation of pharmacists in the patient's welfare, including over-the-counter (OTC) availability of prescription medicines, inappropriate use of medicines, formulation issues, unsafe storage and disposal of medicines, and poor availability of medicines [16][17][18][19][20][21]. Additionally, poor health in the female population, elderly, and medically underserved rural populations in Pakistan need scalable and affordable community pharmacy services, such as health screening (e.g., diabetes, cholesterol, osteoporosis), timely immunizations, pain control, and home-based care delivery and family planning services [22,23].…”

“…The pharmacy degree has seen a transition from the four year B.Pharm program in 1979 to the five year Pharm-D program in 2004 [24]. Along with the improvements in the pharmacy curriculum, the goal of implementing enhanced cognitive pharmacy services and the recruitment of pharmacists in hospitals was also called for in Pakistan's National Drug Policy 2003 [20,24]. Moreover, in recognition of the importance of delivering pharmacy services, the Federal Government of Pakistan introduced the Drug Regulatory Authority of Pakistan (DRAP) Act 2012 to provide the legislative impetus to develop high quality pharmacy services throughout the country [25].…”

“…Despite these ongoing government-level efforts, as well as literature and policy calling for the implementation of pharmacy services, lack of recognition of the full scope of pharmacy services has remained a significant impediment for pharmacists to gain a foothold as competent and recognized healthcare professionals in Pakistan [24]. With very few exceptions, advanced patient-oriented pharmacy services are not offered at hospitals or in the private sector drug retail outlets (community pharmacies) in Pakistan [19,20,27]. Barriers to the recognition and expansion of pharmacy services in both hospital and community settings include suboptimal enforcement of rules and regulations, administrative barriers, inadequate number of pharmacy workers (only 0.06 pharmacists available for about 10,000 people-6/1,000,000), lack of academic capability of the pharmacist in terms of patient-oriented clinical services, lack of collaboration with other healthcare professionals, and lack of awareness regarding the existence and role of the pharmacist amongst the Pakistani public [20,24].…”