Healthcare Landscape in Pakistan – Pharmacists and Pharmacies – Asrar Qureshi’s Blog Post 979

Healthcare Landscape in Pakistan – Pharmacists and Pharmacies – Asrar Qureshi’s Blog Post 979

Dear Colleagues! This is Asrar Qureshi’s Blog Post 979 for Pharma Veterans. Pharma Veterans Blogs are published by Asrar Qureshi on its dedicated site https://pharmaveterans.com. Please email to aq.pharmaveterans@gmail.com for publishing your contributions here.

Credit: BYB BYB

Credit: Gustavo Fring

Credit: Maria Orlova

Pharmacists

There has been an exponential increase in the number of pharmacy departments all over the country. Every private university and medical college are now offering pharmacy degree also. The number of pharmacy graduates qualifying every year has therefore increased greatly.

Pharmacy Council is the legal body that registers pharmacists which makes them eligible to practice pharmacy and seek a job as pharmacist. Pharmacy Council website says the number of registered pharmacists in their record is 59,586; pharmacy technicians are 16,769, which is a diploma level education.

Pakistan Pharmacists Association has done a great job for the pharmacists fraternity over the years. They have increased the awareness about pharmacy education and the role of pharmacists. They have also got many new jobs created for pharmacists. For example:

• Every retail pharmacy needs Category-A license to open a pharmacy which can sell all drugs without restrictions. Category-A license is issued only to a qualified pharmacist. If the pharmacy owner is not a pharmacist himself, he should employ a pharmacist to use his license. Such a pharmacist charges for use of his license in addition to his salary. Practical situation is that most pharmacies rent the license without hiring the pharmacist; they pay for the license only on monthly/yearly basis.

• Every retail pharmacy must always have a pharmacist present in the pharmacy, when the pharmacy is working. A 24-hour pharmacy should have three pharmacists doing 8-hour shift. Probably, very few pharmacies are following this rule, because laws are made but never applied in our country. I saw a variant of this in Kyrgyzstan where most pharmacies work 24/7. A pharmacist works for 24 hours and then gets two days off. She (most are females) returns after two days to do another 24-hour shift, which completes 48-hours work week. The pharmacist did not have any helper and worked all alone. In Pakistan, the pharmacist does not even bother to take out a medicine from the shelf, she/he needs an army of helpers. 

• Every hospital pharmacy, every pharma distributor, every warehouse officer in a pharma plant, must be a pharmacist. This is largely followed at the plants but not at the other places.

• Every public and private hospital should have one pharmacist for every 50-beds. For example, Mayo Hospital Lahore has 2,500 beds and should have 50 pharmacists only in this category. No one is following it due to cost factor.

• The entire regulatory structure at the federal and provincial level needs to employ large number of pharmacists.

• There may be some more employment avenues for pharmacists which I might have missed.

The sum up is that Pharmacists have plenty of opportunities for employment. Their main issue is not status, not employment.

Pharmacies

Pharmacies in Pakistan have come a long way. They have grown in number, quality, and scope. Some interesting facts are given below:

• Total number of retail pharmacies in Pakistan could not be ascertained because the data is not available on any official site. 

• Statista.com tells us that the current density of retail pharmacies is 74.06 per 100,000 population. Based on this, the figure comes to 185,150 pharmacies all over the country. To me, this seems like a more logical figure. 

• During the 12-months period, from April 2023 to March 2024, over 500 billion rupees business was done through retail pharmacies. Please note that it is only about pharmaceutical products, according to IQVIA. 

• To increase revenue-per-customer, almost all pharmacies now sell a whole range of healthcare products, healthcare disposable, home care gadgets, infant food, childcare items, elderly care items, herbal products, syrups, drinks and whatever else they can manage. Many have extended shops to include an optical shop, and more ambitious ones have added a fully-fledged supermarket to the pharmacy.

• Pharmacies in major urban centers have undergone transformation for the better. The shops are better, medicines are stocked properly, cold chain is applied down to the customer level, and temperature control in the pharmacy is observed. 

• Changes in pharmacies appearance have come mainly due to market competitiveness, and very little due to regulatory pressure.

• In few major cities, the concept of chain-pharmacies has evolved during the last two decades, but the numbers are very small. Chain pharmacies generated just over 30 billion rupees business during 12 months, according to IQVIA. It is nowhere near Saudi Arabia where Al-Nahdi has over a 1,000 outlets, or Philippines where United controls about 90% of the retail market.

• Online pharmacy business in Pakistan is in infancy and struggling because too many street pharmacies are offering free home delivery of medicine. Real E-pharmacies did just over 80 million rupees business in a year which is nothing. Big progress does not seem to be on the cards.

• Pharmacies in suburban and rural areas do not reflect the same trend. The shops there are still small, shabby, and not following regulatory compliance.

• Most pharmacies are involved in promoting self-medication and unqualified medical practice. The pharmacy owners in suburban and rural areas run full time medical practice for most ailments. Pharmacies in major urban areas don’t do so, but they don’t refuse if a patient asks for medication for some common ailment.

• Any medicine can be purchased from any pharmacy without a prescription. Some pharmacies discourage some people to the extent of selling tranquilizing drugs.

• The effort to enforce prescription-based dispensing at pharmacies, like any developed country, could never be done in Pakistan despite grand statements and rhetoric. True, it is very convenient for patients, and cost-saving also because the patient does not have to go and pay to a doctor to get a prescription. Every poor country, like ours, puts up the same argument and gets away with it.

Sum Up

Pharmacists and Pharmacies are an integral part of healthcare system all over the world; we have the same situation. However, while attention is paid to healthcare parameters like number of healthcare professionals, hospitals, hospital beds, and medicines availability at the public hospitals, there is no discussion on pharmacists and pharmacies. It is about time that it is done. 

Concluded.

Disclaimers: Pictures in these blogs are taken from free resources at Pexels, Pixabay, Unsplash, and Google. Credit is given where available. If a copyright claim is lodged, we shall remove the picture with appropriate regrets.

For most blogs, I research from several sources which are open to public. Their links are mentioned under references. There is no intention to infringe upon anyone’s copyrights. If, however, it happens unintentionally, I offer my sincere regrets.