PSK annual scientific conferences and/or symposia have recently attracted increasing attention of the Pharmacists at the policy making levels in the Pharmacy and Poisons Board (PPB) unlike in the past. Together with the increase in subscription membership to the PSK that has been achieved due to cooperation by PPB in issuing licenses only to Pharmacists who participate in Continuous Professional Development (CPD), PSK have become a soft and probably effective pressure on the Authorities to institute desired changes and attitudes among the Pharmacists.
A symposium of such a stature cannot be successful without the participation of Pharmacists who have less than 10 years experience post registration, the ones I will call young. The kinds who have fresh ideas and motivation to pursue the value addition practice, a pharmacy service that has become elusive for the several decade old profession in Kenya. These are the pharmacists who see themselves practicing in the next 20 years or more in the only trade that they know and have everything to gain from implementation of the new National Pharmacy Policy. Of course that will only be possible if the policy makers consult widely and make policies in the interest of the pharmacy profession.
Unfortunately this group of young pharmacists, who have seen non-professional competition too many, and whose future is in grievous danger, do not have resources that participation in such forums demand. It is however noteworthy that some of the pharmacists in the public sector and especially those at the PPB, the National Quality Control Laboratories (NQCL), and Government Chemist successfully get backing from their pharmacists led departments to make their contribution in such forums. Those working for the programmes may also be able to secure the support of their non-pharmacists directors because of the close working relationships among the lean staff and availability of funds for travel activities in the programmes. The mainstream civil service is a sea of push and shove and professional rivalries stand in the way of ambitious pharmacists in the sector and so it would be difficult for the hospitals to devote their precious travel and accommodation cost sharing funds for the benefit of pharmacist, even for only once every two years.
The pharmacists in the private sector may or may not be able to secure such sponsorships from their employers if it was not negotiated as part of their contracts. It might be now important for me to point out to those young pharmacists who will want to seek greener pastures that they should talk about professional development as part of the employment benefits. Professional development includes sponsorships to PSK scientific conferences. Those in private hospitals also depend on the benevolence of their administrators, and may sometimes not participate in the annual symposia because of work constraints, and not necessarily lack of funds, either private or employer provided. This leaves such forums to older pharmacists who may have made substantial investment outside pharmacy and do not put so much stakes in the improvement of pharmacy professional environment.
The branding of pharmacy concept that I had helped develop in my PSK branch must find itself in the floor of the hospital and community sector sessions. The branding concept allows for an interim measure of collaboration with lower tier pharmaceutical professionals who have been enrolled and are members of the Kenya Pharmaceutical Association (KPA) to fill the gaps that have been exploited by quacks for far too long. The branding will recognize these two groups of professionals who are recognised by the law effective from the year 2000 or so. The signatories of the branding concept in PSK and KPA must however accept to allow the branding concept to make a clear differentiation between a registered and licensed pharmacist and a pharmaceutical technologist by use of colour codes. Some of the suggestions are green colour theme for pharmacist run pharmacies and blue colour theme for pharmaceutical technologists run pharmacies. The onus will then be on the pharmacists to acquire new skills that will clearly them in the leadership position and be associated with quality.
The pharmacist must be seen to add value to the current practice and all over the world this has been through more patients and health care providers’ information. It is also a good practice to select and carry out medication use reviews (MURs) of, may be, ten or more prescriptions or a day. The concept started in UK, allows a pharmacist to intentionally go into much more detail of the select patients’ condition, biodata and treatments prescribed and advice on the medication as well as related lifestyle changes or preventive or prophylactic measures that may fit for the individual patient. It may even require contacting the patient’s doctor, this time not to request for prescription changes, but to show concern on the general health of the patient. MUR data is then documented by the pharmacist for the sake of follow up and/or learning. MURs are known to take up to four times longer than the normal prescription filling time, and may jeopardize the revenues in a busy pharmacy. They however guarantee more long term benefits to the pharmacies that have made it part of the work requirements because the image that the patient gets is that of a professional and not just a businessman. Such measures may need the superintendent pharmacists discuss with their employers or partners to achieve wider acceptance and to justify for the additional costs that such a measure may put on the business when an additional staff member may need to be hired.
PHARMACY BRANDING: IS IT ACHIEVABLE? WHAT ARE THE BENEFITS?
Yes it is achievable; and now more than before very necessary. The regulation of community pharmacy practice in Kenya poses great challenges to the relevant authorities. Remember private hospital pharmacies must also meet the same licencing requirements as the community pharmacies. This is due to the proliferation of unauthorized drug outlets all over the country manned by untrained and unscrupulous individuals. A survey by the pharmacy and poisons board in 2006 showed that there are over 15,000 outlets of which only about 3000 are licensed.
The PPB has in the few years tried various intervention measures but has borne no fruits so far.
These include inter alia:
a) Annual licensing of pharmacies and use of professional bodies to vet the licensees i.e. PSK and KPA.
b) Increasing the number of officers and professionalizing the drug inspectorate.
Despite the measures, Kenyans still access most of their medications from individuals who cannot bear any professional responsibility whatsoever. Part of these is the issuing of licenses by culpable PPB officials or low cadre and poorly remunerated drug inspectors who find fortune in the discipline of endangering patients’ lives and betray the same cause in which they were hired for. Unfair competition to qualified persons and the defeat of the purpose of years of pharmaceutical training, registration and annual licensing at a huge cost to the professional is just but one of the effects of this. Other more grievous effects are a wide open window for drugs abuse and misuse and incredible endangering of patient’s life.
Branding is not a new concept in the world of business and it thrives on giving a certain product unmistakable identity. This has worked out very well for the clients of banks, petroleum companies, telephony service providers and retail shops like Bata Shoe Company and Nakumatt and Uchumi supermarkets. This is what I propose to be done in all outlets run by professionals and has the physical presence of the professional or hired professional locum pharmacists at all times.
A brand allows us, the pharmacists and the stakeholders to police ourselves, with little regard to who gets phony licenses or is allowed to practice by the PPB. The distinct symbols, emblems and insignia are then widely advertised and publicized in all the PSK forums and KPA can then choose to fund their own publicity campaigns. In other words, it frees the drug inspectors from the responsibilities of allowing who remains open or not and rightfully transfers that responsibility to the sensitized and well informed public. The brand is then registered as a trademark and the users are then protected from infringement by unwelcome elements by making such act a criminal offence. Such individuals will be prosecuted by the State as criminals. The pooled subscriptions by members can then provide substantial resources to support legal proceedings against such offenders, with the support of the government.
THE BRANDING PROCESS
The principle behind the branding process should be sold to both PSK and KPA. This will involve the following activities:
i. Establishment of a PSK/KPA Joint task force
Upon approval by the PSK Council, the largest decision making organ in PSK, the national chairman will initiate the process of appointment of a joint task force with KPA which will implement the concept.
ii. Identification of brand mark
The task force seeks out for sponsorship of the exercise. The activities will include the advertisement to paid-up members and to the associate members like pharmacy students for suitable designs and offer cash awards for the winning designs. That includes the 1st runners up and the 2nd runners up. The participant will also be issued with a certificate of participation in or contribution to the development of suitable design of the pharmacy brand.
iii. Registration of the approved design
The winning design is presented to the PPB, which as a body corporate can register the emblem with the relevant government body and then publish it in the Kenya Gazette. This will make it a legal entity for use in all outlets approved by the Board.
iv. Branding of outlets
The branding costs can be shouldered by the individual pharmacies or a sponsor is sought to contract the services of a firm that can make unique branding that must only be done to members. An allowance can be made for individual pharmacies to have their own identity but must embrace the new mark of quality. A mix of the two can be achieved with much consultation.
v. Aggressive print and electronic media publicity campaign
It will most likely be a two tier process, with contribution of a sponsoring pharmacy advocacy initiative and the stakeholder pharmacies. All information sources to the public are flooded with the insistence on only obtaining medications from the branded pharmacies. This will include the use of radio, television, print media (newspapers and niche magazines), internet, billboards, road shows and other modes of public information for the benefit of the pharmacists run pharmacies. This is the point where the two cadres solicit for their own support as permitted by the law.
vi. PSK policing of pharmacies
This is to ensure that the brand does not end up at the doors of a mark of quality pharmacy. The professional manning the facility will be expected to exceed the ethical and professional expectations expected of a registered pharmacist. The pharmacy must never be left to be under the control of any lesser individual. The patient will then have a right to complain to the PSK about the quality of service of a pharmacist through the toll free number that will be available within the premises.
CHALLENGES TO THE OPERATIONALISATION OF SUCH BRAND
UNSCRUPULOUS PHARMACISTS
It is well known that some of the quacks that have infiltrated the pharmacy practice thrive because of support by unethical pharmacists. A system that allows the acceptance of the photocopied credentials of a pharmacist prominently displayed for all to see, mean nothing if the individual offering the service is not that pharmacist or equally competent employee of the pharmacist. It is a fact that a copy of academic and professional certificates given to the benevolence of a quack does not photocopy the acquired knowledge, skills and attitudes of the real owner of the certificates. But how can we handle such a situation for pharmacists who have made this habit a way of life and a source of easy income? That will clearly continue to be a challenge because the resistance will come from the ‘quack reincarnate’, the pharmacist who has put selfish, short-term, personal matters before the profession. This will be addresses by an effective PSK policing
INCREASED PHARMACISTS DEMAND
There may be increased demand for qualified personnel that might not be satisfied by the training of new entry level pharmacists and pharmaceutical technologists for this matter. If this demand is not met, then the quackery system may rear its head again. This will be partially mitigated by the involvement of pharmaceutical technologists for more reach, especially in rural areas.
UNCOOPERATIVE PPB
There might be resistance by some elements in the PPB who thrive in the chaotic state of Community Pharmacy practice. The PSK as an influential institution with four of its members being appointed to the Board every three years should be able to overcome such hurdles in the long term. The change agents can then be rewarded by their terms of service being extended at the expiry of three years.
DISPENSING DOCTORS
It is now a growing trend among the doctors in private practice to have fully fledged pharmacies in their clinics and surgeries in Kenya without the pain of seeking and paying for the licence costs at the PPB. We all know that it is illegal but it seems that no law enforcement agency is acting like it would if a pharmacist opened a clinic. The reasons are varied with some just being plain ignorance of what is happening by the PPB and the police. Such doctor will continue to threaten the brand concept because the design of their clinics and surgeries is in such a way that the patients are cajoled to buy medications that are sold at unusually high margins, sometimes almost 100% of the trade price. Such doctors have been reported also to direct patients to buy drugs from non-pharmacists run pharmacies betraying the professional referral systems expected of a doctor.
CONCLUSION
It is my hope and belief that this concept will be given serious consideration. PPB alone cannot effectively enforce the law. A well informed public will give us the best support than we have ever imagined. I’m yet to find a human being who does not go for the best service possible if they know where and from whom to get that service. Take up the challenge and use it.
