Community Pharmacy

Objectives
• To know brief history of allopathy and
retail/community pharmacy in Nepal
• Scope
• Health human resource: Community Pharmacy
• Roles and responsibilities of a community pharmacist
• Procedure to start a community pharmacy
• Policy that addresses community pharmacy in Nepal
• Accreditation
• Future directions
 Pharmacy
• Art and science of preparing and dispensing
medications and the provision of drug related
information to the public.

Involves
• interpretation and evaluation of a prescription,
• the selection,
• manipulation or compounding of the medicine,
 Involves

• the labeling and supply of the medicine in an

appropriate container according to the medicine act
and
• Drug product selection
• Drug utilization review
• Patient monitoring and intervention
• the provision of information and instructions by a
pharmacist to ensure the safe and effective use of
medicine by the patient
 History of allopathy medicine in Nepal
• 1740 A.D king Ranjit Malla
• 1766/67 A.D But the first reference
to the modern system of
medicine or to
allopathic practitioners in
Nepal occurs in an
account of the siege of
Kirtipur by King Prithvi
Narayan Shah
• 1850 Dr. Oldfield was transferred to the
British residence. He stayed in
Nepal till 1863 and his duty was
mainly medical.

• But Jung Bahadur also patronised ayurvedic

medicine which is proved by the fact that the
Vaidyakhana set up at Hanuman Dhoka during
Malla times was shifted to Thapathali.
• 1857 A.D The first health institution to be
set locally by Nepali authorities
was the Khokna Leprosy Asylum
in 1857.
• Jai Prithvi Bahadur Singh established the
"Khaga dispensary" which had doctors in
deputation from Calcutta Medical College.
• 1890 (1947BS)
Prithvi Bir Hospital Kathmandu .
The total number of beds was however only 30.
• Besides this central hospital in the capital, a
number of other hospitals were opened in
administrative headquarters of a number of
districts.
• These other health institutions, to be called
Prithvi Bir Hospitals were set up at Birgunj,
Jaleshwar, Hanumanagar (Rajbiraj), Nepalgunj
and Taulihawa.
• 1890 A.D
The Cholera Hospital, which became succession in
the infectious diseases unit of Bir Hospital and finally
the Sukra Raj Tropical and Infectious Disease Hospital
was also initially built in 1890 A.D (1947 BS).
• It was shifted to its present site at Teku in 1950 A.D
(2007 BS).
• 1902 Dr. Ratna Das Baidhya( First doctor of Nepal)
• 1904 A.D One of the initial hospitals to be built was
the Chandra Loka Hospital at Bhaktapur, which
opened its doors in 1904 A.D.
• 1917 To make medicines more freely
available, the Chandra Sale
dispensary was set up at Bir
Hospital.
• 1924 Lalitpur Hospital

• 1927 Leprosy department and

Khokana Leprosarium in 1927
• 1929 Ramghat Dispensary
• 1933 Establishment of Department of
Health Services (DoHS)
- Formation of Nepal Rajkiya Ayurved
Vidyalaya for the training of baidhyas and
other categories of ayurvedic personnel.

• Between 1933 A.D and 1951 A.D the facilities installed by

the new government under the DoHS were thirty three
HMG hospitals, several ayurvedic dispensaries, Nepal
Rajakiya Ayurved Vidyalaya, Singha Durbar Baidya Khana
and Civil Medical School.
• 2020 Nepal Medical Council

• 2028 B.S Nepal Pharmaceutical Association

was established.
• 1956 Formation of nursing school
nursing course and HA course started
1958 Training of cadre to provide
midwifery care was started
1962 AHW school (43 HA were trained)
1972 IOM (Origins in the civil medical
school of 1934 by way of the Health
assistants school of 1956 and the
AHW school of 1962)
• 1974 NCDA
• 1978 Start of the MBBS course in
Nepal
• 1979 Establishment of DDA (Under
ministry of forest)
• 1972 Certificate Level Pharmacy course
was initiated at the Institute of
Medicine (TU) Maharajgung, in 1972 with
the advice of Dr. Purussottam Narayan Suwal,
Late Dr.Amir Bahadur Shrestha and Mr. Paul
Spivey, then Pharmacist of Shanta Bhawan (At
present Patan Hospital)
 -under ministry of Health
1980 /81 NCDA arranged two Orientation
Course for Drug Wholesalers and
Retailers successively in Kathmandu and in
Biratnagar
• 2050 B.S National Medicine Laboratory and regional
offices in Biratnagar, Birgunj and Nepalgunj.
• 2051 B.S National Medicine Policy
• 2000 A.D NPC

• Nepali Pharmacist, Mr. Madan Raj Rajbhandari was a

first to work as a Hospital pharmacist at Kanti children
hospital in 1968
COMMUNITY PHARMACY
 Definition
• What is community pharmacy?
 Definition
• What is community pharmacy?
- community-based pharmacy.
• It is a pharmacy set up in a community to meet the
public’s medicine and other healthcare needs.
• It includes stocking and dispensing prescription and over-
the-counter medicines, and professional services such as
patient counselling and health screening services.
• It is also a term used to describe the provision of
pharmaceutical care by pharmacists in primary
healthcare settings.
• Due to easy accessibility without a need for an
appointment and free advice, pharmacists are
often the first point of contact in the
healthcare system.
• Community pharmacy practice varies between
different countries depending on history,
government regulations, funding sources,
professional education and the overall
healthcare system.
 Human resource for health in Nepal
• Health post
- a Health Assistant or a Senior Auxiliary Health
Worker,
- an Auxiliary Nurse Midwife,
- 3 Community Medical Assistants (CMA) and VHW for
each area of village development committee(VDC).
• Sub-health post
- a CMA,
- a maternal and child health worker (MCHW) and
- a village health worker (VHW)
• Female Community Health volunteers (FCHVs)
and Traditional Birth Attendants (TBAs).
• There are around 4000 VDCs and each is
divided into 9 wards. In each ward there is
FCHV.
• There are more than 48000 FCHVs in Nepal.
• There are around 15,000 trained TBAs under
the MOH
• Paramedical staffs (e.g.ANMs, AHWs and HAs)
often are engaged in private practice providing
necessary services in under several areas.
• Such practice is illegal. There is no control
over the quality of services provided in their
private practices.
 Human resource situation in community
pharmacy
• 35 pharmacists are involved in community and hospital
pharmacy [*].
• Where are pharmacists working then?
• Who is working in community as dispenser ?
Orientation holders, CMA, ANM, HA, all other with
qualifications other than health.

*NPC Newsletter Vol. 3 Issue 1 2010. Pharmacist registered with Nepal Pharmacy
Council.(http://www.nepalpharmacycouncil.org.np/downloads/Newsletter_vol_2010.pdf) (3 rd February, 2011).
 *Qualification of dispensers
CMA 24.03 %
DPharm 20.19 %
Orientation holders 16.34%.

A considerable number of dispensers 14 out of 104 were from the

educational background other than health.

Four C.M.A's also had D. Pharm qualification which shows the

tendency of C.M.A to enroll the diploma education.
*Thesis.K.C Badri. Dispensing practice in the retail pharmacies of
Kathmandu Metropolitan and the impact of training on such
practice.2011.
• Minimum qualification to enroll in DPharm
NEPAL : S.L.C
 NPC registration book
• Pharmacist 800
• Pharmacy assistant 1800

• Yearly production : Bachelor ---- 500

Diploma ----1000
 Pharmacy Number
Kathmandu
• Kathmandu district 1300
Population per retail pharmacy 584

• Whole Nepal 20000 +

• NPC recommends
• Metropolitan --- One pharmacist
• Sub-metropolitan --- One Pharmacy Assistant
• Municipality & district headquarter it recommends one
pharmacy assistant per pharmacy.
• In Nepal, approximately 90% of drug sales
occur in the private sector, predominantly
through retailers not trained in pharmacy
(Joshi & Khakurel 1997).
• BPharm 1994
• DPharm 2003
• Mpharm 2001
• PharmD 2010
• The district hospital is manned with 2-3 doctors, 4 nurses
and other paramedical staff.
• A PHC center is staffed with a Medical Officer, two staff
Nurses, Two Auxiliary Nurse Midwives (ANM), two
Community Health Assistants (CMA) and other helping
staff.
 Pharmacy number
• India 600,000
 Scope
• Preparation of compounded pharmaceuticals
• Good Compounding Practice standard should
be developed.
• Blood pressure monitoring
• Health screenings
• Immunizations
• Diabetes care
ROLE AND RESPONSIBILITIES
OF
COMMUNITY PHARMACISTS
 Community pharmacists should
• Through their education and licensure
- assume an ethical obligation to the public to
maximize the intended benefits of drug
therapy
- minimize the unintended side effects,
adverse reactions and other medication
misadventures.
 Community pharmacists must assess
• Appropriateness of dose for this patient.
• Patient allergies to this medication or similar medications.
• Potential interactions with other prescribed and non-
prescription medications.
• Contraindications of the medication with the patient’s
other known diseases.
• Appropriate dose scheduling to maximize effect and
minimize adverse events.
• Appropriateness of this medication for this patient’s health
condition
 The pharmacist must also
• Ensure accuracy of dispensing and labeling
• Provide the patient with information on proper
storage of the medication
• Advise the patient on potential risks and benefits.
• Advise the patient on how to deal with missed
doses and adverse events.
• Assess the patient’s understanding of the
prescription instructions to maximize compliance
and adherence to the instructions.
 Responsibilities
• compounding, counseling, and dispensing of
drugs on prescription to the patients with
care, accuracy, and legality.
• Appropriate procurement, storage, dispensing
and documentation of medicines are within
the purview of its professional responsibilities.
• It is an important branch of the pharmacy
profession and should involve a qualified and
pertinent pharmacist.
• In Today’s market oriented, economics-driven
society, all professions face the question.
• What do I do for my customers that makes my
contribution unique?
• Community Pharmacy- the added value to
supplying the customer with an appropriate drug is
a service that consciously makes the customer
healthier lifestyle as well as teaches customers the
most effective use of the medication they buy.
• Nepalese pharmacists should take keen
interest in health outcomes, developing new
scientific field such as pharmacoeconomics
and pharmacoepidemiology.
• Western pharmacists have demonstrated their
competence in performing this type of
research to government and insurers, thereby
justifying their expandable role in the system.
• Given various treatment options, with their
associated side effects and costs, pharmacies are
beginning to act as information centres while the
patient is empowered to make the final decision.
• Pharmaceutical care : the premise is simple: the
pharmacist has a role in all aspects of drug
therapy, from evaluating a prescription written
by a physician to monitoring the effectiveness of
a patient’s treatment.
 Orientation holders
and
community pharmacy
• 1981
- A training course of 45 hours
- opened to the graduates of tenth grade
- emphasis on practical training as well as
formal teaching on pharmacology, ethics,
storage of drugs, and legal issues.
 72-h ‘drug retailer orientation course’
• open to graduates of the tenth grade.
• The course consisted of 64 lecture hours and 8 hours of hands-on
training in proper storage and dispensing techniques.

• The following specific goals are addressed:

• To accurately interpret and dispense prescriptions written by
qualified medical practitioners;
• to advise customers about the correct use of common drugs,
including essential precautions;
• to preserve the quality of drugs through proper storage and
handling.
• Certification is based on a 3-h post course exam.
 Minimum competencies of a community
pharmacist in Nepal in present scenario

• Good blood pressure measuring skills

• Responding to symptoms :
- Most people come for consultation regarding
diseases.
- Grab this opportunity to establish yourself
- Condition which can be managed by OTC
medicines can be effectively managed by
Pharmacist
• Should have a good knowledge of chronic
diseases like Hypertension and diabetes
• Healthy life style related knowledge
- bad impact of Obesity , Blood pressure
- How to reduce blood pressure
- how to prevent diabetes and blood pressure
 Barrier for full implementation of a
changed role
• A proper price carrier for the competence of a
pharmacist has not been developed.
• The competence is in an unsuitable way
bundled to the delivery of a tangible product-
the drug.
• Community pharmacy practice is a subject
that, when taught in a formal accreditated
manner, earns a curiously mixed reputation.
Community pharmacy regulation in Nepal

• Ownership: can be owned by

pharmacist/pharmacy assistant and non-
health professional in collaboration or
pharmacist or pharmacy assistant alone.
• Number that can be owned by a pharmacist
• Location rules: x (a new pharmacy can only
gain approval to operate based in community
need.
• Registration of premises: a pharmacy is registered with DDA.
• Registration of pharmacist : Pharmacist registered with Nepal
Pharmacy Council

• CHAPTER IV : manufacture, sale, distribution and export-

import of drugs
10. Registration of name for the sale and distribution of drugs:

Any person who sells and distributes the drugs shall have to
register owns name and shop or firm in the department as
specified on payment the specified fee and shall obtain a
certificate.
 Drug act 1978 section 34.
Penalty:

(1) Any person who contravenes any of the

provisions of chapter 4 or commits an offence
contrary to the order made pursuant to
Section 25, shall be punished with
imprisonment up to three years or fine up to
rupees twenty five thousand or with both.
Procedure to start a community pharmacy

• If you are a pharmacist/pharmacy

assistant/orientation holder
You alone can go ahead

If you are not either of the above you can be a

partner and legalise your retail/community
pharmacy
-
 Criterias to be fulfilled

* Must be registered in NPC

* Submit the form available in DDA for which
following documents are needed
1. photocopy of NPC registration
2. Citizenship
3. Contract with the owner for the space
4. Location Map
 Points that should be filled
• Tentative investment cost
• For wholesale or retail
• Will you keep vaccine or not
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 Community pharmacist’s role in
preventative and therapeutic care
• Pharmaceutical care is a patient-centred,
outcome-oriented pharmacy practice that
requires community pharmacists to work in
concert with the patient and other healthcare
providers to promote health, prevent disease
and to assess, monitor, initiate and modify
medication use to ensure that drug therapy is
safe and effective.
• Pharmaceutical care in communities includes both
preventative and therapeutic approaches.
• Preventative area: actively participate in health
education, health promotion, immunization and
vaccination programs with other healthcare
providers.
• Therapeutic area: professional dispensing,
counselling, drug information services, ADR
reporting and monitoring, drug utilisation review
(DUR) and HMR.
• Counselling and drug therapy monitoring
services offered by pharmacists in community
pharmacies can improve medication
adherence and therapeutic outcomes, and
have a positive impact on the patients’ quality
of life.
 Accreditation
• It is voluntary process by which the quality of
care provided by a community
pharmacy/hospital is assessed by an outside
accrediting body on a routine basis.
• Accreditation organizations have no authority
to impose or bring forth legal action.