Changing role of pharmacists: Indian scenario
Atul K Nasa, President, Indian Pharmacy Graduates'
Association (IPGA), writes about the evolution of pharmacy practices in India
and provides a peek into the future of the pharmacy profession, while suggesting
the changes that the profession needs to implement at various levels
Indian pharmaceutical sector has come a long way from being an almost non-existent
industry before 1970 to a prominent provider of healthcare products now, meeting
almost 95 per cent of the country's pharma needs. The industry today is in the
forefront of Indias science-based industries, with wide ranging capabilities
in the complex field of drug manufacturing and technology. It ranks very high
in the third world in terms of technology, quality and range of medicines manufactured.
From simple headache pills to sophisticated antibiotics and complex cardiac
compounds, almost every type of medicine is now made indigenously. Playing a
key role in promoting and sustaining development in the vital field of medicines,
the Indian pharma industry boasts of quality producers and many units approved
by regulatory authorities in the USand UK. International companies associated
with this sector have stimulated, assisted and spearheaded this dynamic development
in the past 53 years and helped to put India on the pharma map of the world.
Over the years, the industry has been gaining momentum worldwide.
Redefining the role of pharmacists
Pharmacists play a crucial role in any health system as they are responsible
for providing solution related to medication. The rapid growth and diversification
of the pharma industry, coupled with the growth of the health sector has thrown
open a sea of opportunities for pharmacists. These emerging opportunities have
prompted a deeper look into the human resources for the pharmacy sector. The
spectrum of pharmacy profession in India is very wide, as it covers a myriad
of opportunities in the pharma industryR&D, manufacturing and retail,
healthcare sector, pharmacy education and regulatory bodies. The current availability
of pharmacists in terms of pharmacist to population ratio compares favourably
with that in a developed country. However, the number of registered pharmacists
does not reflect the actual number of pharmacists currently involved in pharmacy
practice. The actual number is likely to be much lower due to migration, death,
retirement, those getting into other areas of pharmacy profession such as industrial,
regulatory, marketing etc.
The demand of pharmacists is further growing with the growth of the industry
within the country and outsourcing from abroad. Among the biggest factors fuelling
the growth are contract research for pharma R&D and contract manufacturing
for global pharma companies. Associated with these are requirement of professionals
with expertise in national and international regulatory affairs. The retail
sector is witnessing growth due to entry of major retail chains. The growth
of national healthcare spending to more than 12 per cent per annum will impact
the availability, accessibility and the demand for drugs, which in turn will
have a direct impact on the requirement of pharmacists. This will also have
an impact on the requirement of hospital pharmacists and those getting into
the insurance sector. The shortfall in supply of pharmacists in developed countries
such as the US, Canada, Europe etc and lucrative opportunities for employment
will give rise to migration of Indian pharmacists to these countries. This will
get a further boost with pharmacy institutions getting accredited by foreign
bodies. These factors will push the demand for pharmacists.
Besides the demand and supply issues, there are several other areas affecting
the pharmacy profession in the country. Pharmacists in India do not have any
laid down norms on competencies and quality of services. Unlike many developed
countries, there is no system of evaluating a pharmacists competency.
Hence, the level of competencies and the quality of services provided are likely
to vary among Indian pharmacists.
Pharmacists have the potential to fill the gap created due shortage/unavailability
of doctors and nursing personnel in health facilities in rural areas. This can
be achieved through a policy initiative to redefine the role of pharmacists
in the Indian healthcare system so as to better utilise their capabilities.
Pharmacist in the society: Traditional vs modern role
pharmacy profession is in its transitional state. The health care delivery pattern
has been completely transformed and has acquired an all-together different image
than what we have been observing traditionally. The present of pharmacy does
not lie merely in dispensing of medication, but in the provision of relevant
drug information and drug therapy recommendation to the people in the society.
Over a period of time, the pharmacy profession has greatly changed from being
focused on managing the production and dispensing of drugs, to being primarily
concerned with the safe, effective and appropriate use of medication and enhanced
pharmacy services to patients. High technological advancement and information
explosion have significantly raised the knowledge and quality level, due to
which the pharmacists are now ready to shoulder bigger responsibilities with
appreciable sense of sincerity and dedication. The role of pharmacists is now
no longer a fixed and rigid one, but has been continuously changing and redefining
its meaning and significance in the changing scenario, which is why the bond
between a pharmacist and society is becoming stronger day-by-day and acquiring
Pharmacy, as a profession, has been able to make a room for it in the present
day society. There are numerous reasons, which are responsible for greater impact
and penetration of pharmacists into the societal network irrespective of geographical
boundaries. Whether it is a metro city or a remotely located rural area, pharmacists
are everywhere, discharging their duties to serve the humanity. The factors
responsible for the influential role of pharmacists in the society may be summarised
1. Thrust on pharmaceutical care to patients - Pharmacists
have begun to concentrate on patient care specifically after pharma care had
been mandated as a patient centered practice model for pharmacy. Many pharmacists
have found themselves challenged by a paradigm shift in their daily practices
from product to the patient. Pharma care addresses the patients drug-related
needs comprehensively through a scheduled outline of tasks, in which the practitioner
makes sure that a drug therapy is appropriately indicated, effective, safe,
and convenience. Shifting from a dispensing focus to a patient focus has been
particularly challenging, which has included offering expanded patient counseling,
immunisations, and medication-dependent disease management for persons with
certain chronic conditions. Pharmacists are now covering a wide range of clinical
and management functions like tracking adverse drug effects, participating in
programmes to reduce medication errors, monitoring patients compliance
with medication use, and conducting medication management programmes.
2. Redesigning the medication-use system - Pharmacists
have taken into consideration the need to 're-engineer the medication use system'
to reduce preventable drug therapyrelated adverse outcomes; to identify
well-functioning models and to develop strategies to evaluate and implement
additional models; and to encourage inter-professional collaboration. The task
is not so easy and they may come across certain kind of problems like lack of
patient medical information, patient confidentiality concerns, limited professional
communication, multiple approved formularies etc.
3. Continuing professional development (CPD) - Todays
pharmacist believes that professional attitude is an indispensable tool to make
the profession just as significant for the society. A pharmacist must maintain
his/her competence and effectiveness by keeping up-to-date with changes in pharmacy
practice and with relevant knowledge and technology. CPD has been able to bring
the society nearer to pharmacists when there comes a question about society
4. Adherence to pharma code of ethics - Sticking to
ethical rules has helped a lot to establish the pharmacy profession as a noble
one among the society, and pharmacists are advocating the adherence to the pharma
code of ethics more strongly and loudly in the present scenario.
5. Authentic source of pharma information - The information
pharmacists give plays a vital role in providing relevant and up-to-date drug
information to people as and when required.
6. Adopting new concepts - The changing global scenario
has prompted pharmacists to adopt new concepts for the welfare of society. Such
concepts include antibiotic pharmacist, retail pharmacist, academic pharmacist,
pharmaceutical journalist etc.
Societal network: Enhancing penetration
The need of the hour is that the reflection of the extraordinary good work being
performed by pharma professionals should reach the common man, and every segment
of society should realise, experience and recognise the beneficial implications
of such efforts for the well being of society. Significant strategies and alternatives
may be to frequently organise exhibitions and pharmacy fairs for the general
public, organise more discussions, talks, seminars and symposia and cover topics
directly catering to the society's needs, adequately and appropriately publicise
and advertised each and every mass-movement/societal mission launched by pharma
professionals so that the rest of the society may also participate and contribute
to them, and establish new Pharmaceutical Information Centres (PICs) throughout
the nation to impart information about significant pharmaceutical activities
to the society.
As it has been proposed that chemist shops should have a graduate pharmacist,
the existing diplomas should give pharmacists an opportunity to upgrade their
knowledge and skills to the level of graduate pharmacists. This task can be
undertaken by securing seats in degree courses for those who opt for regular
programmes or by developing specifically designed long duration, part-time programmes.
Going by the experience of several countries, pharmacy technicians or assistants
will be required to assist graduate pharmacists. Therefore, the existing diploma
courses should be re-oriented for pharmacy assistants with reduced duration
of training. The existing institutions conducting diploma courses should be
given the option of upgrading to degree courses or to conduct technician/assistant
courses in a phased manner.
In order to cater to both industrial and healthcare aspects of pharmacy, graduate
level courses should be separated as B PharmIndustrial and B Pharm-Healthcare.
The curriculum should be re-oriented to fulfill practice requirements in both
industrial, as well as healthcare settings.
There exists a mechanism to regularly monitor infrastructure, manpower and other
critical inputs for delivering quality education and training, however, Pharmacy
Council of India (PCI) and All India Council for Technical Education (AICTE)
need to strengthen the implementation of the monitoring mechanism. There also
exists a system of teachers training and skill enhancement to develop teaching
faculty for short and long-term requirement implemented by AICTE and University
Grants Commission (UGC). However, it should be ensured that all teachers in
the pharmacy sector should undergo training and skill enhancement on a regular
basis. The PCI should initiate measures to make Continuing Pharmacy Education
(CPE) programmes mandatory for all practicing pharmacists. This should be linked
to periodic renewal of license for practice. PCI should also develop accredited
CPE programmes at select centres. The involvement of professional bodies associated
with pharmacy besides the PCI will be crucial in establishing and sustaining
CPE activities on a long-term basis.
Demand, supply and existing numbers
The government should institute a comprehensive study to map out the existing
pharmacy manpower in the country. This data will help in understanding the existing
manpower and plan future human resource development. PCI should undertake a
drive to update the practice status of registered pharmacists.
Further, licensing should be made compulsory and should be renewed every year
or every two years. The renewal would be granted on the basis of certain minimum
level of CPE undertaken. This, when enforced strictly, will also help in maintaining
and updating data on workforce status in the pharmacy sector. This will help
in maintaining an active register of practicing pharmacists.
The orientation of pharmacy courses based on feedback from the industry and
health sector professionals should be undertaken on a continuous basis. Promoting
affiliation with foreign institutions will also help in updating the curriculum
and bringing it to international standards.
PCI should undertake educational planning in order to promote setting up pharmacy
institutions in underserved areas so as to remove regional imbalances.
There is a need for establishing benchmarks for availability of pharmacists
in different areas of practice, for example, community pharmacists vis-a-vis
population, hospital pharmacists as per number of beds etc. This will help in
forecasting the future demand. There is also a need for benchmarking performance
parameters for services and competency of pharmacists. These benchmarks should
be publicised so as make people aware regarding expectations from a pharmacists.
This should be supported by a system of monitoring and audit.
Indian healthcare is witnessing a rapid growth and managing the human resources
to support this growth will be very critical. The pharmacist is a key component
of healthcare and touches patients at every level, from high ended hospitals
to the doorstep, where they provide medications in the community. Further, many
of them work behind the scenes in areas such as drug research, drug distribution,
in regulatory, and teaching and training roles. In order to cater to the growing
demand for quality healthcare services in the country, there is a need for concerted
efforts from all stakeholder to promote community practice and change peoples
perception of a pharmacist from being a trader or shopkeeper to that that of
a true health professional as in many developed countries. The pharmacy profession
is proving itself as the backbone of the society as far as health aspects are
concerned. Pharmacists are establishing new standards of pharma care and redefining
their role towards the society. The impact and influence of pharmacy profession
has never been recognised and identified so significantly as it is today. The
entire credit goes to pharmacists who are now more aware and concerned for the
welfare of the society, adopting modern concepts and professional attitude,
but not at the cost of pharma ethics, and thus, have been able to penetrate
the society, maintaining the traditional sanctity of pharmacy profession.