Barriers and facilitators to adherence to national drug policies on antibiotic prescribing and dispensing in Bangladesh

Background The National Drug Policy in Bangladesh prohibits the sale and distribution of antibiotics without prescription from a registered physician. Compliance with this policy is poor; prescribing antibiotics by unqualified practitioners is common and over-the-counter dispensing widespread. In Bangladesh, unqualified practitioners such as drug shop operators are a major source of healthcare for the poor and disadvantaged. This paper reports on policy awareness among drug shop operators and their customers and identifies current dispensing practices, barriers and facilitators to policy adherence. Methods We conducted a qualitative study in rural and urban Bangladesh from June 2019 to August 2020. This included co-design workshops (n = 4) and in-depth interviews (n = 24) with drug shop operators and customers/household members, key informant interviews (n = 12) with key personnel involved in aspects of the antibiotic supply chain including pharmaceutical company representatives, and model drug shop operators; and a group discussion with stakeholders representing key actors in informal market systems namely: representatives from the government, private sector, not-for-profit sector and membership organizations. Results Barriers to policy compliance among drug shop operators included limited knowledge of government drug policies, or the government-led Bangladesh Pharmacy Model Initiative (BPMI), a national guideline piloted to regulate drug sales. Drug shop operators had no clear knowledge of different antibiotic generations, how and for what diseases antibiotics work contributing to inappropriate antibiotic dispensing. Nonetheless, drug shop operators wanted the right to prescribe antibiotics based on having completed related training. Drug shop customers cited poor healthcare facilities and inadequate numbers of attending physician as a barrier to obtaining prescriptions and they described difficulties differentiating between qualified and unqualified providers. Conclusion Awareness of the National Drug Policy and the BPMI was limited among urban and rural drug shop operators. Poor antibiotic prescribing practice is additionally hampered by a shortage of qualified physicians; cultural and economic barriers to accessing qualified physicians, and poor implementation of regulations. Increasing qualified physician access and increasing training and certification of drug shop operators could improve the alignment of practices with national policy.

A Study on the National Drug Policies of Bangladesh to Ensure Health for All

Bangladesh approved the proposal for a National Drug Policy on May 29, 1982. We know that such drug policies are developed gradually over a period of time and may contain a lot of comprehensive documents. But in Bangladesh, the expert committee worked out the policy, based on 16 standards within 15 days. This vital document, almost unchanged, was made a law on 12 June 1982. A few years later, it can be observed that despite opposition from many concerns, the output of essential drugs has increased from about 30 to about 80 percent, prices have in almost all cases gone down considerably, the domestic industry has grown rapidly, the quality of its production has increased dramatically, and people’s awareness about quality medicines has been steadily growing. The World Health Organization (WHO) has stressed the need of a formulated drug policy in every country of the world in 1986. Bangladesh responded very early to this respect. Subsequently, two more national drug policies were promulgated in 2005 and 2016 respectively. Experience over the decades has shown that the said policies could not fulfill the declared objective of ensuring health for all. Our aim is to describe some of the lacunae for which total implementation of drug policy is still struggling. To find the root causes, a total of five hundred volunteers were surveyed by supplying a questionnaire on drug policy. It was observed that most of the participants opined that the incumbent government needs to be more stringent to implement the drug policy into reality by utilizing the public servants and public sectors, especially health personnel to ensure health for all. Dhaka Univ. J. Pharm. Sci. 20(1): 41-48, 2021 (June)

Management of the National Drug Administration Through the Use of Biosimilar Medicines. Expenditures, Numbers of Reimbursed Packages and Shares of Biosimilar Products in the Infliximab Market a Year Prior to and a Year after the Introduction of the National Drug Policy 2018–2022

Management of the National Drug Administration Through the Use of Biosimilar Medicines. Expenditures, Numbers of Reimbursed Packages and Shares of Biosimilar Products in the Infliximab Market a Year Prior to and a Year after the Introduction of the National Drug Policy 2018–2022

Prevalence and Perception of Pharmacists on Dispensing Prescription Only Medication without Prescription in Makurdi, Benue State, Nigeria

Background: Currently in Nigeria, prescription only medicines are supposed to be dispensed only with a prescription. The study aimed to reveal the prevalence of prescription only medicine without a prescription and the perception of community pharmacist in Makurdi, Benue State Nigeria towards the phenomenon. Method: The study was carried out between February–April 2019 using simulated patient approach and administration of questionnaire on the pharmacists. Result: Forty pharmacies were surveyed and 100% (29) of the respondents were willing to dispense prescription only medicines without a prescription. Among the respondents, 93% (27) said they do see up to an estimated 30% of POMs without a prescription daily. While 19.2% (5) of the pharmacists do dispense POM without a prescription, 42.3% (11) said they do so depend on the level of education or prior exposure of the client to the medication. Only 38.5% (10) said they will not dispense a POM without a prescription. Most of the pharmacists, 93% (27) agreed that dispensing POM without with a prescription holds potentials for drug abuse, drug misuse, drug dependence with attendant economic consequences. Conclusion: A vast majority of practicing community pharmacists in Nigeria are willing and do dispense prescription-only medications without a valid prescription; for a variety of reasons. This is against existing Nigerian pharmacy laws and the national drug policy.

Harm reduction programs and policy in Australia: barriers and enablers to effective implementation

Background: Harm reduction is an integral component of Australia’s overall national drug policy. Harm reduction policy and interventions can be applied to any legal or illegal drug to mitigate harm without necessarily reducing use, but harm reduction is traditionally conceptualised in relation to injecting drug use. Early and comprehensive adoption of many innovative harm reduction interventions has meant that Australia has had significant success in reducing a number of drug related harms, avoided disease epidemics experienced in other countries, and established programs and practices that are of international renown. However, these gains were not easily established, nor necessarily permanent. Aim: In this paper we explore the past and present harm reduction policy and practice contexts that normalised and facilitated harm reduction as a public health response, as well as those converse contexts currently creating opposition to additional or expanded interventions. Importantly, this paper discusses the intersection between various interventions, such as needle and syringe distribution and drug treatment programs. Finally, we detail some of the practical lessons that have been learned via the Australian experience, with the hope that these lessons will assist to inform and improve international harm reduction implementation.