The quality of private pharmacy services in a province of Lao PDR : Perceptions, practices and regulatory enforcements

Abstract: Aim: To study the practices of private pharmacies, the quality of drugs and the effectiveness of government regulations. To explore drug sellers' and consumers' knowledge and perceptions about drug quality. Methods: All 214 licensed private pharmacies and 14 public pharmacies (only analysed in study 111) in the 14 districts of the Savannakhet province constitute the study population. The study design was a randomised trial (II), pre-experimental (IV) and cross sectional study (1, 111, V). Both qualitative and quantitative methods were applied using structured interviews with drug sellers, exit interviews with customers, inspections of drug purchases, sampling and analysis of four essential drugs, and focus group discussions with drug sellers and community members. The measurement of quality of pharmacy services was based on the concept of Good Pharmacy Practice (GPP) using different types of indicators. The applied regulatory intervention package (11) was part of the quality assurance of the National Drug Policy Programme (NDPP) with inspections, information, distribution of regulation documents to drug sellers and sanctions. Two different intervention levels with "higher intensity" in the "active" districts and "lower intensity" in the "regular" districts were used to test the effectiveness of government regulations on pharmacy services. Main findings: Most private pharmacies were managed by non-pharmacists. The quality of practices was low, with 59% of the encounters not receiving any information on drug use, 47% of purchased drugs had no label and 26% of all drugs were mixed in the same package. Forty-six percent of drug samples from the baseline study were substandard largely due to poor manufacturing practice. After 11/2 years of regulatory intervention, the pharmacies in the active intervention districts showed statistically significant improvements for order, essential material and information indicators. When compared the differences of the means of these indicators from pre- to post- intervention, between the active and the regular intervention districts only essential material indicator differed statistically significant. There was no significant difference between the public and private pharmacies in relation to order, information and labelling. Essential drugs and essential materials were significantly more available in private than in public pharmacies. More antibiotics and injections were dispensed in public pharmacies. The number of substandard drug samples in private pharmacies was reduced significantly from 46% in 1997 to 22% in 1999 (p<0.001), yet the numbers remain high. There was inadequate scientific drug knowledge among drug sellers and only a few consumers were aware of the existence of low quality drugs. The majority trust the drug companies and authorities to provide them with good quality drugs. Most sellers did not know what constitutes a good quality drug or of correct storage conditions. Conclusions and recommendations: The quality of private pharmacies was low including the dispensing of substandard drugs in high proportions. It was possible to improve the practice of private pharmacies including the provision of better quality drugs through regulatory interventions. The limited knowledge and awareness of drug sellers and consumers about drug quality may contribute to the low quality of drugs and services. Further interventions are needed.