By Abdul Sattar Sohrani
The Alma-Ata Declaration on Primary Health Care (1978) states that “…health is a fundamental human right and that the attainment of the highest possible level of health is a most important world-wide social goal”. In addressing the main health problems in the community, Primary Health Care (PHC) must “provide primitive, preventive, curative and rehabilitative services”.
The Declaration states that PHC includes at least ” … prevention and control of locally endemic diseases, appropriate treatment of common diseases and injuries and the provision of essential drugs”. It recognizes the role played by all health workers and the need for suitable training to enable these people to work as a health team to respond to the expressed needs of the community.
Clearly, an adequate pharmaceutical service, ideally provided by pharmacists, is a vital component of Primary Health Care. This is recognized by the World Health Organization (WHO), and several subsequent publications of the WHO emphasize the role of the in the Health Care System. Standards are an important part in the measurement of quality of service and at the International Pharmaceutical Federation (FIP) Congress in Japan in 1993 the Tokyo Declaration on Good Pharmacy Practice (GPP) was adopted. FIP has drawn up guidelines which can be used as the basis for the setting of national standards for pharmacy practice. The GPP document has been subsequently reviewed by the WHO (primarily the Expert Committee on Specifications for Pharmaceutical Preparations) and it is anticipated that an agreed text on GPP could be included in the WHO Technical Report Series which would give the guidelines more formal status and ensure wider distribution.
The International Pharmaceutical Federation first adopted the guidelines for Good Pharmaceutical Practice in 1993. These guidelines were developed as a reference to be used by national pharmaceutical organizations, governments, and international pharmaceutical organizations to set up nationally accepted standards of Good Pharmacy Practice.
The revised version of this document was endorsed by WHO in 1997 and subsequently approved by the FIP Council in 1997. The GPP Guidelines are based on the pharmaceutical care given by pharmacists.
The guidelines recommend for national standards to be set for
• The promotion of health;
• The supply of medicines, medical devices, patient self-care;
• Improving prescribing and medicine use by pharmacists’ activities.
These guidelines have been subsequently adapted and adopted in a wide number of developed countries. In certain cases, the national professional body has strived to adapt the guidelines and developed, in collaboration with the government, specific regulation/legislation on this matter. Conscious of the need to help developing countries achieve GPP, the FIP Community Pharmacy Section Executive Committee established a working group to produce guidelines in this area in 1992. The paper, entitled “GPP in Developing Countries – Guidelines for Implementation”, was endorsed by the FIP CPS Executive Committee in September 1998. Having realized the importance of continuing to increase awareness of GPP and stimulating its implementation, the FIP Bureau decided to request the BPP to focus on the theme and to develop a specific activity.
PHARMACY PROFESSION
Over the past 60 years, in many parts of the world, the profession has lost three of the four pillars of the structure that has traditionally been the mainstay of its work since the 8th century – that of drug procurement, storage and the compounding of drugs. For many, only the fourth and last function remains – the task of dispensing. A fifth pillar, that of pharmaceutical care, has been added in recent years and will probably define the role of the pharmacist of the future.
Pharmacy has been defined as the science that deals with the study of the functions of the drugs interacting with the human body and pathogens so as to prevent diagnose and treat the diseases; to regulate the physiological mechanism of the human body and to promote human health .The scope of pharmacy would thus include:
• Research and development.
• Production and quality control.
• Distribution and clinical application.
• Pharmaceutical care.
Pharmacogenomics, pharmaceutical bio-technology and bioinformatics are but a few of the emerging technologies that will further change the practice of pharmacy and pharmaceutical sciences. From this, it is clear that although more than 90% of pharmacy students end up in community and hospital pharmacy settings, the education of pharmacists must include all the elements that define the profession. Scientific education and applicable research go hand in hand, and the reality of commercial exploitation of pharmaceutical research has become an accepted fact. Acknowledging this is the only practical means of achieving the desired end-point of all research programmes in the pharmaceutical sciences – achieving patient benefits
A strong scientific background, in areas like genetics, biochemistry, molecular biology and physiology, is thus more important than ever. The pharmacy curriculum should be constructed not only to train students for the current scope of pharmacy practice or a narrow field of expertise, but rather to enable them to be competitive and skilful in various areas of the pharmacist’s job market
EDUCATION
It remains a challenge to develop suitable curricula for the changing environment in a rapidly developing science. should take initiatives to ensure an environment for dynamic education to be able to equip graduates with technical knowledge and skills to fulfill the needs of pharmacy and the changing health-care system 9.. Though most pharmacy students go into community or hospital pharmacy, we have to remember that our graduates should also be able to work effectively in industry and academia – the pharmacy teachers of tomorrow will have to come from the pharmacy students of today.
While disciplinary excellence is vital, multi-disciplinary programmes are increasingly important. The main requirement in the market today is that graduates are well educated and trained in the fundamentals of their field and practiced in applying these skills to real problems10. The challenge is thus to find the delicate balance between education in the basic sciences (the basis on which the recipient can continually question the status quo – life long learners) and training in specific fields (focusing on the currently accepted state of knowledge). Pharmacy graduates should thus be life long learners, able to solve multidisciplinary problems, use technology and apply non-disciplinary skills (communication, teamwork, leadership etc.). To obtain this it is no longer a question of ‘Are we doing things right’ but rather ‘Are we doing the right things 11. The training programme for post-graduate training as suggested by Borchardt 12 can then probably be adapted to form the basis of the outcomes based pharmacy curricula of the future as shown in Figure 1.
The pharmacy programme should thus be aimed at educating for competence and giving graduates the conviction, courage and confidence to champion the cause of pharmacy pharmacy curriculum
RESEARCH
With the phenomenal rate of advances in the pharmaceutical and biomedical sciences, novel approaches to fundamental pharmaceutical issues are of the utmost importance. Here, the ideal situation would be for the university to create the cultural background and supply a constant stream of new ideas and young scientists. Industry should set the aims and offer financial support, as it is easier and cheaper to support ‘basic research’ at the university as an investment in the future than doing it ‘in house’ (Pepue, 1999)13. The development of ß-antagonists and H2-antagonists are examples of Academia supplying the ideas and industry setting the aims. Decades before the development of fluoxetine, the importance of 5-HT in the pathogenesis and therapy of depression was discovered and studied extensively in academic institutions.
ROLE OF ACADEMICS
The role of academia should thus be:
• Education and training of new pharmacists (scientists)
• Promoting development of self-directed and life long learning skills
• Breaking new scientific ground in ‘total’ freedom
• Development and testing of new methods
• To offer flexible, relatively low cost teams for special projects
• To offer the expertise and insight of established scientists and
• The creation of a cultural environment which is favourable to understanding and promoting the role of science in society.
To accomplish all of the above we will need to:
• Interact with clients and understand and address their needs
• Define partnerships between universities and between academia and industry-, hospital- and community pharmacy and government
• Formulate education, research and practice agendas
• Explore and exploit the knowledge market and
• Enhance entrepreneurship to ensure that knowledge is appropriately transferred and applied.
Good pharmacy practice requires inter alia that:
• a pharmacist’s first concern must be the welfare of the patient in all settings and of the public in general;
• the core of pharmacy activity is the supply and distribution of medicines and other health care products, provision of appropriate information and advice to the patient, ensuring the quality use of medicine and monitoring the effects of use of medicines (pharmaceutical care).
With regard to the prescribing of medicines, the applicable legislation is unequivocal in that this function is reserved for certain authorized prescribes, with exceptions being allowed in certain set circumstances. A pharmacist does have a prescribing role in terms of the lower scheduled medicines and is also expected, as far as other prescribing health professionals are concerned, to provide a prescription monitoring service to ensure that both prescribing and administration of medicines are regularly monitored; to ensure compliance with accepted practice and safer systems of work; and to encourage effective prescribing.
CONCLUSION:
Good Pharmacy Practice is a recently emerging branch for the care and welfare of the patient designed in an order, that will give best of its possible services to mankind including, Patient Counseling, VIPPS Program, Online pharmacy and along with other branches like research, quality control, and clinical pharmacy will climb the height of success in the near future. A further insight is needed in this field considering the three criteria’s namely safety, efficacy and economy and the field is further open for changes and development for the care and welfare of the society.