Time for Pharmacy Practice in Kenya to Catch Up with the World

Pharmacists are the health care professionals responsible for providing patient care that ensures optimal medication therapy outcomes. They do this by taking responsibility in the quality of medicines supplied to patients; ensuring that the supply of medicines is within the law; ensuring that the medicines prescribed to patients are suitable; advising patients about medicines, including how to take them, what reactions may occur and answering patients' questions. They achieve these objectives with the assistance of pharmacy technicians who perform non-core tasks that include receiving, arranging, assembling medicines for prescription, labelling and ordering of medications.

The Pharmacy and Poisons Act (Cap. 244) came into force in 1956 to control of the profession of pharmacy. At the commencement of the Act, only the holders of at least a bachelor of pharmacy degree or persons previously registered as ‘pharmacist’ by the Pharmacy and Poisons Ordinance (Cap. 128 (1948) (now repealed) irrespective of the qualifications held ('compounders', 'druggists', 'apothecarists', 'dispensers' etc), qualified to be registered as pharmacists. Between 1949 and 1978, only foreign trained persons could be registered as pharmacists, as there was no local university offering the training. In 2002, as an intervention to improve access to pharmaceutical services in underserved areas, an amendment was made to the Act to allow the Board to enroll ‘pharmaceutical technologists’ (Kenyan term Pharmacy Technicians). Under this intervention, the Board allowed pharmaceutical technologists of a certain experience to establish independent sole proprietor dispensing outlets.

The recent Health Laws (Amendment) Bill of 2018 published on 10^th of April 2018, initially appeared to the stakeholders (as it should) that it was making administrative changes to Pharmacy and Poisons Board, aligning it with MWONGOZO – The Code of Governance for State Corporations. It was not to be. Last week, the National Assembly at the committee stage of the Bill, essentially redefined the profession of pharmacy by introducing a ‘pharmaceutical practitioner’.

World over, only two cadres are known in pharmacy: a pharmacist and a pharmacy technician. Both of these cadres have routinely and erroneously been referred by the members of the public (and even the media) as ‘pharmacists’. The ‘pharmaceutical technologist’ title is a misnomer because a pharmaceutical technologist is a graduate-level industrial application scientist that in pharmaceutical manufacturing. It is worth noting that some jurisdictions, like the Republic of Uganda have ‘pharmacists’ and ‘pharmacy technicians’ but only pharmacists are mentioned in the law.

The title of a ‘pharmaceutical practitioner’ if passed, introduces ambiguity in law subject to varied interpretation. If it was intended to simplify the definition of a person authorised to practice pharmacy in Kenya and not to unify the pharmacist and ‘pharmaceutical technologist’ as one profession, it will fail because the title ‘pharmaceutical practitioner’ legally denotes equivalence and a ‘pharmacist’ is the professional in pharmacy practice. It casts the role and the legality of the para-professional into doubt during implementation.

If the purpose of the amendment was to increase access, the law already provided for this 2002. In any case this increased access has had its problems. There has been a rampant illegal licence renting to quacks since then (some are even published in social media). As the focus of these practices have been sales by any means to anyone, some of these medicines have ended up being used to ‘drug’ unsuspecting people and rampant abuse of prescription drugs by teens and young people.

The new law also expands, without applying any caution, a wholesale licence to the so called ‘pharmaceutical practitioner’. As much as Section 27 (1) and (2) still gives the Board the discretion to issue a licence, the amendment failed to recognize the regulatory role of a wholesale pharmacy practice. A wholesale practice performs pharmacovigilance, drug recalls and control of dangerous drugs; some which may have been observed by casual observers as ‘movement of boxes from one place to another’. It therefore defeats the purpose to licence such a function to a ‘pharmaceutical practitioner’, but require the practice to employ pharmacists to fulfil its objectives.

What will then be the future of enrolled ‘pharmaceutical technologists’? 

Going forward, we need to align pharmacy laws with the existing policies. The first Kenya National Drug Policy (KNDP) of 1994 sought develop pharmacy specialists to direct pharmacy practice, provide pharmacists who primarily delivers patient care and reintroduce pharmacy technicians to assist the pharmacist by carrying out non-clinical duties in a pharmacy. The policy spelt out provisions to allow the existing ‘pharmaceutical technologists’ to proceed to University and attain standards registerable by the Pharmacy and Poisons Board for practice as pharmacists. KNDP was succeeded by the Sessional Paper Number 4 on the National Pharmaceutical Policy which reaffirmed that pharmacy delivers to the Kenyan health system two outcomes: integrity of a pharmaceutical supply system and appropriate medicines use. These are the essential roles of a pharmacist – leadership and clinical – in pharmacy practice and healthcare in general.