Who is behind your pharmacy counter?

Pharmacies operating in the Kampala City Centre and have earned professional credit from their customers are surprisingly those open spaces that have fairly shown incompetence in their response towards self-medication.

Research also shows that along off the road- marram locations of Mukono District, over the counter medical supplies are being issued out by interns or volunteers that are lacking in experience and have less information about the prescribed medications and this is in the event that one requires cheap labour.

Some pharmacies are employing fresh graduates as volunteers who are expected to learn on job to gain at least two years of experience before they receive licenses. A professional dispenser in an established pharmaceutical unit is paid about Shs 5,500 per hour for about eight hours which amounts to Shs 880,0000 monthly wages whereas a pharmacist earns about Shs1.5m that is Shs6,400 per hour for eight hours. However, in city outskirts, a volunteer with basic pharmaceutical knowledge is paid about Shs250,000 monthly stipend.

These personnel that are identified as dispensers are more familiar with the most commonly used over the counter drugs except for those medications that are for chronic illnesses and require medical prescriptions. Even worse, some behind the counter personnel are replacing initially prescribed drugs with available stock in order to manage short shelf life of those drugs due for expiry.

The lay man however, looks up to these staff behind the counter as all knowing about their ailments and would consider without hesitation to adhere to their medical advice whether it involves change in prescription or in purchase of available medicines to treat common disease symptoms.

What this means, however, is that the personnel behind the counter in drug stores or pharmaceutical units are the game changers when it comes to self-medication as a self-care intervention and their ability to do their job rightfully can potentially influence possible health outcomes of the population in Uganda. Which brings us to the question; who is behind your pharmacy counter?

Behind the counter

Daily Monitor conducted an undercover survey over the last three weeks to establish the state of personnel behind the counter and our reporter found out that they are rather laid back on some government guidelines such as issuing drugs to clients with medically authorised prescriptions among other practices such as misinformation and gainful motives.

Some of the famous pharmacies in Kisaasi, Naalya are definitely the places visited. 

Our reporter casually walks through one of the malls in Naalya and approaches pharmacy, inspects the shelves and moves over the counter .

The cashier says, “Please spell that name again,” before entering the spelling of the drug in his computer. 

Without giving a care to why the reporter is making this particular purchase, he quickly informs her that the drug is out of stock!

In the meantime, his colleagues are swamped in conversation on the other end of the counter and trying to work on some deliveries. Since the pharmacy has no cues at this point, the reporter picks on a conversation with the cashier.

“Is it okay if I order for melatonin (sleeping pill) without a doctor’s prescription?” she asks him. Without hesitation, he serves her the drug and his argument is that, “Yes of course that is how it is meant to be however, it is the government’s mission to ensure that medicines are accessible to all people.”

At this point, I have been given the power to make any health decision in regard to any over the counter purchases regardless of whether I best understand it or not.

I carry forward this mentality to my next stop along Kisaasi road, and although the facility is fairly stocked I try my luck!

“We do not have that drug in stock. However, I can recommend a related drug that will work for you. This is the last of this stock and I do not plan to restock it for the next three months because some of these products are hardly purchased by customers,” the lady behind the counter clad in a floral casual dress says.

It sounded to me like she wanted to get the stock off her shoulders and while I am skeptical to purchase the drug, a man coincidentally walks in to buy antibiotics for a skin reaction and she promptly recommends the same last order standing to him and closes the sale.

When the reporter brutally fails at all attempts to make a purchase including a pharmacy visit in Mukono where she noticed that the staff was either volunteering and could only identify commonly purchased over the counter drugs such as paracetamol, ibuprofen among others, she later opts to make contact with an online store.

The online drug shop which classifies itself to offer services around the clock as per their website presents with options among which are speak to a doctor, pharmacy, laboratory which she opts for pharmacy and is notified of receiving a call from a pharmacist but the timeframe is indefinite.

This reporter grows impatient and immediately calls a personal contact at the online drug store.

“ Sorry about the delays but currently we are closed until tomorrow at about 8am. However, you can go to a nearby facility in case you are in a bad state,” the lady on the other side of the call advices her.

The reporter still inquires about whether she can access over the counter medicines from the online pharmacy or speak with the doctor before anything.

The lady shares that most over the counter medicines do not require a doctor’s prescription when ordered online.

“However, it is better to speak to the doctor to rule out any adverse side effects which the pharmacist might not have the time to share except for information concerning drug usage and amounts of dosage,” she adds.

Case of Misuse

Over time, pharmacists, doctors and health care professionals are faced with increasing numbers of people making over the counter purchases without any prescriptions. However, this is related to a number of ills in self-medicating. Most end users of over the counter drugs are trying to treat common disease symptoms and can be found in situations of self-prescription, sharing drugs that treat common coughs, allergies, headaches among others or even drug dependency especially when disease symptoms are recurrent or progress from mild to severe.

Mariam Nassejje, a lupus warrior struggled to get right diagnosis for a rare auto immune condition. All the while, she assumed to be treating symptoms associated with Malaria , thyophoid,brucella such as headaches, fevers, joint pains. However, she shares, 

“As the symptoms progressed to severe, I found myself increasing the dosage every day especially pain killers until my body could not take it anymore.” 

At some point I was advised to start on ARVs as there seemed no possible explanation for my symptoms apart from undercovered HIV

Nasejje experienced the stages of drug dependency and drug resistance until she had to follow responsible self-medication after prescription from professional medical personnel that had in-depth knowledge on rare disease.

Govt response

According to Dr Charles Olaro, the director in charge of curative services at the Ministry of Health, such practices should be discouraged among health care givers to ensure safe self-care interventions.

“Now that is the aspect of quality of care that we need to emphasise on self-care whereas we are giving self-care we have to be cognizant of the products and so even when you do an HIV self-test, it should still be confirmed in the health facility,” Dr Olaro said during the commemoration of self- care day in Kayunga District.

He also cautions the end users on self-medicating and urges communities to engage trained VHTs or community health workers in integrated management of childhood illnesses to achieve better health outcomes adding that,

“We do not encourage self-medication which means you only take the treatment for which diagnosis has been made. Self-care is not a stand-alone and is linked to the health system and once you already know your diagnosis and then can get the drug you want but you do not just go purchase the over the counter drugs such as septrin or antibiotics.”

However, an exception is made for products that are already consumed such as self-injections and family planning, he notes that such self-care purchases can be done over the counter.

Dr Ahmed Matovu, the District Health Officer of Kayunga says self-care is implemented on different district levels of health facilities and communities.

“We have VHTs that manage preventive illnesses in communities and also dispensers and pharmacies work with NDA to improve professional practices as well as supervision of drug shops and pharmacies,” he explains.

According Abiaz Rwamwiri, the NDA spokesperson, the treatment decision for most people is driven by their ability to pay for their medical needs given that approximately 70 percent of people in developing countries pay for their health by out of pocket.

He however, asks practitioners to observe critical roles to ensure an independent review of prescription before dispensing to avoid any medication errors.

He says, “There should be a clear separation of prescription and dispensing. A clinician is supposed to diagnose and prescribe whereas a pharmacist is supposed to review the prescription and dispense the drug. However, in most cases you find the clinician doing diagnosis, prescription and dispensing.”

Intervention 

Uganda has developed selfcare guidelines in accordance with WHO Guidelines and Recommendations on selfcare, states Mr Seth Nimwesiga, a Policy Advocacy Officer at the Center for Health, Human Rights and Development (CEHURD). 

«Health Service Providers are obliged to provide accurate information, and products of good quality to ensure that persons accessing services take the right prescriptions and are well guided to manage their health,» he says.

Mr. Nimwesiga advocates for institutionalisation of guidelines, «as this will ensure that selfcare is aligned with the entire health care system and will give a level of autonomy for Ugandans to benefit from technological advancement and reduce the burden of flooding health facilities.

According to Dr Olaro, the government is focusing on investing in self-care which means less numbers crowding in hospitals and less burden on health workers hence productivity and better health outcomes.

He shares, “Govt has come up with guidelines and an investment case to ensure that people are empowered in aspect of awareness and also looking at commodities of self- care and the quality to meet required standards. We are also interested to collect information and know how many people are accessing and benefiting from self-care.”

Early this year, a mobile health application (Mosmiles) was commissioned in Masaka District to enable patients suffering from chronic illnesses to take charge of their health.

Mr Nkobwa Peter, the app developer of Mosmiles says, “The app helps people living with HIV, diabetes, and cancer to adhere to medications with time and appointment reminders and related health information through chat room interactions with health expert