Response to 26 March 2012 Daily Nation article titled 'Policing the drugs business'

This post is a reply to an article on Daily Nation of 26th of March 2012.

The original article can be accessed via this link: http://www.nation.co.ke/Features/DN2/Policing+the+drugs+business+/-/957860/1373432/-/item/0/-/137y6o7/-/index.html

I have not read the print version of this article, but the author had not declared any potential conflict of interest that we the readers should consider when reading this article. Other than that I think the writer has a valid point, and Pharmacy and Poisons Board (PPB), the beneficiary of the TruScan technology needs to consider this as they go ahead and use this 'donation'. The Board members, who generally represent larger pharmaceutical sector, with heavy representation from the Pharmaceutical Society of Kenya (PSK), should be clear on what this scan technology can do and what it can't. That is why the PPB employs experienced pharmacists who should be able to use intuition, common sense, practice knowledge, well thought out drug policing strategies with a wide reach and finally the TruScan to identify the true counterfeits. I'm a pharmacist, and naturally I'm interested in knowing what technology the TruScan machine uses. Does it use infra red, MRI, UV or rapid chemical tests to identify active ingredients in a drug? If it does that, and that can be validated, then it is able to scan for the presence of the active medicine in any drug, brand or 'generic'. Is the 'analysis' that it does quantitative or qualitative? You need to know both attributes to declare a medicine a 'counterfeit'. In pharmaceutical science, too little of the right medicine is a bad thing and too much of it is still a bad thing.


 If the TruScan is not looking for an active ingredient, then is it scanning the primary and the secondary packages of the medicines to identify 'genuine packs'? And is knowing that just the pack is genuine good enough?


 Does TruScan just 'scan' Pfizer products, all the branded products, or it 'scans' all licenced for use and registered for trading pharmaceutical products? Who is the inventor of this technology? This is the kind of information that I was looking for when I chanced on this article, but did not find.


Remember, there is also competition between branded product manufacturers, and Pfizer here does seem to take up the burden of 'funding' an initiative that benefits all the multinationals whose products get faked. Why is it that it is only Pfizer which is purchasing this TruScan? Why would Pfizer fear generic products more than other manufacturers of branded pharmaceutical products, yet it has a wider range of medicines and still a respectable market share of each, and absolute market share for some? The article should either address Pfizer directly or generalize only when there is involvement of other multinational companies, otherwise the message will be construed to be views that are not necessarily objective.

It is my considered opinion that a counterfeit is that which claims to be what it is not. As a pharmacist, I do not perceive generics as counterfeits. I almost daily have to reassure a nervous client who has a mistaken idea of what generic drugs are, and educate them on the concept at the same time. I also know that it is the branded drugs, that many of us tend to rush to, that are the targets of the counterfeiters and not the generic brands.

I would then understand if the big pharmaceutical companies come together to address the problem that is unique to them. They lose the most to counterfeits, and gain the most if counterfeits are wiped off the pharmacy shelves. If people were to shift en masse and buy generic brands, the counterfeiters will go there. In Kenya now, generic brands, suffer the least when it comes to counterfeiting, and when it comes to fighting these counterfeits, it will make sense to focus on the branded products and get the companies affected on the board because they have everything to gain from such an initiative and so do the public.
A good every day example of counterfeiting are the paper currency notes counterfeiters and their motivation. They do not bother with a fifty shillings note: but they do fake the one thousand note where they are assured of higher returns if not, or before they are detected.

A survey preferably funded with public funds or by companies without their direct involvement in the processes, is welcome as the writer has suggested, identifying the true extent of the influence of counterfeit products in the market, its supply channels and its effect on public health. The survey should not just end there, but also suggest actions required to address the menace once and for all.

Pharmacists also know that just having a genuine product is not good enough. Before it gets to the right patient at the right dose and for the right medical condition, it must also be stored right. If a pharmacy does not store products in a way to preserve chemical integrity, buys from suppliers who don't do so, or worse still, buys from suppliers who they have no idea how they handle and store medicines, then the patients will still suffer, even when presented with a 'genuine product'.



Finally, I feel very uncomfortable with conversations that happen in virtually almost every pharmacy that this one medicine is 'original' that one 'is not'. Who will take up a product that is 'not original' even if the intention was to say this one is 'branded' and the other is a 'generic brand'? It is very unprofessional and not a priority conversation, when there are so many things to talk about that will benefit the patient the more: like the patient's medical condition; how to use the medicine and what to expect from the medicine. The patient is also supposed to be equipped with the knowledge on what to do if an expected positive outcome of the medicine does not occur or an expected negative outcome does occur!

A Challenge to 21st Century Kenyan Pharmacists who are still Sitting on the Fence

Pharmacy of today appears as a collection of disputatious factions and splinter groups still ‘a profession in search of a role’and a profession unable to choose from a bewildering variety of functions and unable to overcome a variety of ‘barriers to clinical practice’.


We will not solve this problem by introspection. It will not help to clarify, list, or debate more functions for pharmacy. The element that is missing as we define our role during this period of transition is our conception of our responsibility to the patient. Some pharmacists have not yet identified patient-care responsibilities commensurate with their extended functions, and the profession as a whole has not made CLEAR SOCIAL COMMITMENT that reflects its clinical functions. Some pharmacists will remain mired in the transitional period of professional adolescence until this step is taken.


Pharmaceutical practice must restore what has been missing for years: a clear emphasis on the patient’s welfare. Professional maturity has much in common with maturity as a person. One attribute common to both is a word view, an expectation that one thrives best by using one’s power t serve something bigger than oneself. Another attribute common to both is acceptance of responsibility for one’s actions.
Drugs do not have doses, patients have doses.



(Charles D. Hepler and Linda M. Strand statement back in March 1990 in an American Journal of Hospital Pharmacy)

LET US TALK PHARMACEUTICAL CARE!

BUILDING YOURSELF AS AN EFFECTIVE PROBLEM SOLVER

Pharmacy is built firmly on the concept of technical rationality. The idea states that practitioners are primarily problem solvers who select rational ways to serve particular purposes.

If I can use two words to describe what pharmaceutical care is, then I will say it is a RESPONSIBLE PROVISION. We provide treatment when we dispense medicines; it does not become pharmaceutical care until when we ensure that our dispensing is done responsibly. I do not want to bore you with the long definition of pharmaceutical care that has been repeated over and over, and has been ringing in the years of all pharmacists who want to understand what pharmaceutical care is; and how it can be implemented in their daily practice so that they can make the difference they have always striven to. It goes like this: Pharmaceutical Care is the responsible provision of drug therapy for the purpose of achieving definite outcomes that improve a patient’s quality of life.

Pharmaceutical care is essentially a process and is as follows:

Step ONE: Identify any DRUG-RELATED PROBLEM (actual or potential);

Step TWO: Resolve the DRUG-RELATED PROBLEMS that actually develop.

STEP THREE: Prevent all potential DRUG-RELATED PROBLEMS from developing


We usually start out with a lot of energy as rigorous ‘young’ practitioners, who are ready to solve well-formed problems (those that should be straight forward if all other practitioners did their part right) by applying theory and technique from systematic and scientifically derived knowledge. However as we become oriented to the ‘fuzzy” problems of daily practice, we find that the problems we encounter are not that straight-forward but rather “messy indeterminate situations”.

It does not take long for us, novice practitioners, to learn that we really don’t know how to solve many problems we face in practice. We learn quickly that defining the actual problem that needs to be solved is difficult and sometimes results in no clear solution.

Working Groups have been used in medicine (and pharmacy) for a long time to crack very important issues of practice that were not clear-cut from the outset. All of us know that all Cancer Chemotherapy protocols/regimens are product of focused Working Groups (or if you like Study Groups). A Pharmaceutical Care Working Group is an idea that has already taken off, and a handful of dedicated volunteer pharmacists will see to it that it changes the practice of clinical pharmacy in Kenya.

We will start from scratch and build working systems that pharmacists will rely on to practice. The moment we realized that no one but us can build our practice was the moment we decided to bid farewell to ambiguity. If only the vigour shown by these patriotic Kenyans can have a snowballing effect on every Kenyan pharmacist involved in patient care, and shake each and every barrier that has stood on our road to Pharmaceutical care!

The Pharmaceutical Care Working Group will provide a systematic method to collect and assess the clinical information used to determine patient’s problems and health needs. With repetition and practice, you can become proficient at “framing” the patient’s problems, achieving concordance with your own professional viewpoint and the patient. That is why it is called Pharmacy Practice!

HOW I WILL CONTRIBUTE TO ATTAIN THIS VISION FOR PHARMACY IN KENYA (See the vision in the immediate older post of this blog)

How can i contribute as an individual to attain this vision?

Individual level

 Ensure that all chronic care patients who are sent to me have an implementation (pharmaceutical care) plan for their treatment, follow up on them and track their future appointments so that I use that opportunity to evaluate treatment outcomes and set new goals.

 I will keep a register of all the patients I provide chronic care to be available for scrutiny by my peers and colleagues, so as to achieve a sustainable continuity of care.

 I will encourage the people who I will have the privilege to mentor, to embrace pharmaceutical care so that we can be members of a larger team who we can hand over care of our patients between us whenever we are not available to offer the essential service, with the goal of making sure that chronic care of patients is not an intermittent process but a long term continuous commitment.

 I will keep records of my interventions for scrutiny by me and my peers both for accountability and for opportunity for me and my peers to learn and improve our practice.

 I will teach, mentor and grow pharmacists younger than me to reach where I have not reached, to offer services that make more impact than I was able to, with or without compensation or remuneration of any kind.

 When my time comes I will provide leadership to pharmacists that will ensure that they realize their goals and have professional satisfaction.


As a member of team

 I will accept to carry out assignments and responsibilities assigned to me by my peers and professional colleagues that aim to improve the practice of pharmacy.

 I will be part of the process that ensures that there is a lifelong learning process going on for me and my fellow practitioners.

 I will take advantage of all opportunities to generate new knowledge in my area of practice and specialization, and target to carry at least one research or clinical audit each year which can be appraised by my supervisor.

 I will participate actively participate in a society, working group or an association that works to further the interests of the profession.


In the Regulation of Pharmacy Practice

 I will push for creation of working groups to come up with standards of practice for all the different specializations in pharmacy.

 I will call for the hospital pharmacy representative to the Pharmacy and Poisons Board (PPB) to buy the idea that regulation should always promote the provision of pharmaceutical care and ensure that the Board makes advancement of pharmacy practice a priority.

 I will mobilize the pharmacy practitioners and other stakeholders to keep the laws regulating pharmacy practice up to date and make the medicines that were registered after the last revision of Poisons List legal to be prescribed in Kenya.

o I will make my colleagues aware that the Poisons List Confirmation Order-which gave rise to a Poisons List [5] with two parts, (Part 1 and 2), in the Subsidiary Legislation to section 25 (Order under section 25) of the Pharmacy and Poisons Act-is now obsolete and need revision.

o That the revision of the list (addition or removal of medicines) together with its schedules be revised on an annual basis by pharmacists who have significant knowledge base and skills, and spend most of their time providing care directly to patients.

o That the reclassification of medicines from one prescription status to another is done in a structured way and the changes communicated efficiently to all pharmacists and other interested practitioners.


REFERENCES

1. New Statesman, 21 April 1917, article by Sidney Webb and Beatrice Webb quoted with approval at paragraph 123 of a report by the UK Competition Commission, dated 8 November 1977, entitled Architects Services (in Chapter 7).
2. Pharmaceutical Society of Australia: National Competency Standards Framework for Pharmacists in Australia 2010. http://www.psa.org.au/site.php?id=6782
3. Board of Pharmacy Specialties http://www.bpsweb.org/about/vision.cfm
4. Graham Copeland. A Practical Handbook for Clinical Audit. Clinical Audit Support Team, NHS http://www.wales.nhs.uk/sites3/Documents/501/Practical_Clinical_Audit_Handbook_v1_1.pdf
5. Pharmacy and Poisons Act, CAP 244 of the Laws of Kenya

MY VISION FOR THE CLINICAL PHARMACY PROFESSION

A pharmacy professional

A profession [1] is a vocation founded upon specialised educational training, the purpose of which is to supply disinterested counsel and service to others, for a direct and definite compensation, wholly apart from expectation of other business gain (Webb S, 1997).

Pharmacists are professionals who have the abilities and skills which are necessary to achieve outcomes related to:
• Providing pharmaceutical care to patients
• Developing and managing medication distribution and control systems
• Managing the pharmacy
• Promoting public health
• Providing drug information and education

While these outcomes seem easy to achieve, there is still a huge gap between what is expected of pharmacists [2] and what pharmacists actually achieve.

Clinical Pharmacist Training

The clinical component of pharmacist’s work need to improve the most and training for this role must meet the following objectives:
• to develop students' communication skills for effective interaction with patients and with practitioners of other health professions,
• to help students develop a patient awareness in the practice of pharmacy
• to enable students to integrate the knowledge acquired in course work prior to clinical exposure, and to apply it to the solution of real problem
• to develop students' awareness of their responsibility for monitoring the drugs taken by patients and,
• to help students become more aware of the general methods of diagnosis and patient care specifically related to drug therapy


Lifelong learning and professional growth

A good training in clinical pharmacy and the subsequent qualification as a practitioner is just but the beginning of a long journey towards developing competent professionals who will make an impact to the society. My desire is that pharmacists themselves will find it in their interest to develop, implement and sustain an internal mechanism where pharmacists’ knowledge, skills and attitudes are evaluated and improved.


Specialization

My vision for clinical pharmacy and pharmacy profession as a whole is that one day pharmacists will realize that it is not possible for an individual to accumulate enough knowledge in a lifetime to be an authority on all aspects of clinical pharmacy or general pharmacy. Some pharmacists have already realized this and are trying their best to fill the gap in the health care provision. The areas of specializations must however be relevant to the current needs, and must be continually reviewed to go with the times.


Certification

From patient to provider, the value of a certified practitioner registers throughout the health care continuum. This provides a legal basis and right to provide care in any clinical environment. For pharmacy professionals, documentation of specialized experience and skills yields the additional benefits of personal satisfaction, financial rewards and career advancement.


How do we get there?

• The current clinical pharmacy training undergraduates are receiving in the University of Nairobi is much better than a decade ago; this is obvious when one engages a student on a clinical approach discussion. This needs to be sustained and even improved further.

• The undergraduate students in pharmacy should spend an extra year in training to be in line with internationally accepted standards for pharmacy training for students who have spent four years in high school or less than twelve years of pre-university education. This will give the pharmacists in training more time to accumulate knowledge, skills and attitude required to practice top level pharmacy.

• The internship should be done in areas where there is at least one preceptor per intern. The preceptor must have at least three years of experience in pharmacy practice post-registration and must be available at all times for consultation during the entire period of internship. The preceptor must demonstrate to have the knowledge, skills and attitudes required to train a highly motivated intern to have a successful professional life after registration before recertification.

• The pharmacist should be registered only if they pass pre-registration assessment that focuses on competencies expected of an entry level pharmacist. After that, annual practicing licence can be issued to a registered pharmacist without the need to sit for an exam, so long as there is evidence of continuous professional development (CPD) and the required CPD threshold has been achieved or exceeded.

• Only registered pharmacists should be allowed to practice pharmacy. Peer-led professional audits can be done on a regular basis to ensure that minimum standards required of a practice are maintained in all pharmacies.

• The current advanced training in clinical pharmacy needs to take at least 3 years with the pharmacist getting full residency status as their medical colleagues. The classes should be peripheral in term of time allocation, and real work environment practice to take the centre stage.

 The first half of the first year, can be fully academic, where an emphasis is placed on physiology, epidemiology, evidence-based healthcare and biostatistics. The second-half can the concentrate on pathophysiology, biopharmaceutics, pharmacokinetics, drug information and pharmacy management, toxicology, patient assessment, clinical chemistry and introduction to therapeutics and pharmaceutical care.
 The second year can be a year of problem-based learning where students need to build relationship with patients, other health care professionals and more importantly other pharmacists. The emphasis will be on the continuum of care, where there are multiple contacts between a student and an individual patient and student must have a plan for the patient who will be both in patient records and school of pharmacy records. The classes during this time will be mainly therapeutics, with numerous student presentations and faculty moderation. An adjunct class of advanced pharmacokinetics will be useful during this period. Some exposure to research methods can also be useful at this time
 The final year will concentrate on individual research work completion, more exposure to clinical areas of sub-specialization, and some level of participation in teaching more junior members so as to learn more. Communication and presentation skills, together with clinical audit [4] skills need to be enhanced at this stage. There should be evidence that the expected activities were actually carried out. Short-term exposure to other hospitals which are regional centres of excellence should be encouraged during this period.

• The newly qualified clinical pharmacists should practice for one year in the areas of their sub-specialty (residency) before they are awarded a board certification.

• The pharmacists to patient ratio should increase, and there should be presence of clinical pharmacists in all major specialties in major hospitals first, then to all other hospitals. The pharmacy specialist skills should not be spread thin, as there will be little or no overall impact. These specialists should be concentrated where they are needed most and should not be involved in primary care which registered pharmacists can provide with the help of lower cadre pharmaceutical professionals (technologists and technicians).

• The clinical pharmacists can harness their skills and knowledge by sharing information and experiences. They must have forums where they can communicate and influence the growth of the profession. Associations will leverage the growth of the profession by growing the capacity of the profession from within, and also by the lobbying forces outside the profession to further their interests.

• There must be a certification and recertification regulatory board [3] to certify pharmacists who meet the requirements to practice in their specialty areas, and prevent those who do not qualify from practicing.

• The clinical pharmacists should be able to motivate others to advance the practice of pharmacy. They should carry out clinical audits on a regular basis to demonstrate that the practice has improved. A clinical audit [4] is a cyclical process, involving the identification of a process to intervene, setting or adopting already available standards, comparing practice with the standards, implementing changes and monitoring the effect of those changes. Its purpose is to improve the quality of clinical care.

• There must be a standards body to force all healthcare providing institutions to meet certain minimum standards to be allowed to operate. Pharmacy practice can only excel if the pharmacists are well equipped to provide care.

REFERENCES
1. New Statesman, 21 April 1917, article by Sidney Webb and Beatrice Webb quoted with approval at paragraph 123 of a report by the UK Competition Commission, dated 8 November 1977, entitled Architects Services (in Chapter 7).
2. Pharmaceutical Society of Australia: National Competency Standards Framework for Pharmacists in Australia 2010. http://www.psa.org.au/site.php?id=6782
3. Board of Pharmacy Specialties http://www.bpsweb.org/about/vision.cfm
4. Graham Copeland. A Practical Handbook for Clinical Audit. Clinical Audit Support Team, NHS http://www.wales.nhs.uk/sites3/Documents/501/Practical_Clinical_Audit_Handbook_v1_1.pdf
5. Pharmacy and Poisons Act, CAP 244 of the Laws of Kenya

Thoughts for those who embrace March 13th 2010 Public Sector Pharmacists meeting

Pharmacy is about drug delivery/outcomes. When there are no drugs, the clinical pharmacist or any pharmacist for that matter finds no use for his skills. Let the pharmacists take over everything about drugs-including being the main signatories for all funds available for purchase of drugs. A professional is that who can make decisions and/or solve problems. Let the pharmacists solve drugs supply, drug use, drug misuse, drugs abuse, drug underuse and drug overuse problems. You cant put to task a pharmacist for what they he (sorry for the use of one gender) is not responsible for in his performance appraisal-he is not responsible for the perennial stock outs! In the same breath you cant squeeze the juice out of somebody's profession, curtail his job satisfaction and and go ahead and expect him to deliver. It consummately baffles me when the system lets someone who is not a pharmacist take over the most pleasant, most innovative, most outstanding and most progressive part of my job, and leaves me to do the most mechanical and repetitive (read boring) part of the job; a part that does not give me the chance to grow and take more responsibility before my retirement.
This meeting is very timely and the record needs to be set straight. The 'local arrangement' management of the public sector where one person is everything has to stop. Everything we do from now henceforth has to be supported by the law. If the law as it is has in any way derailed or has attempted to derail and threatened the survival of the pharmacy profession, then we must act and fast. We must not engage without putting conditions. We have to tell them what needs to be done, or ask them to stop training pharmacists altogether. No office must curtail and abruptly bring to an end to the dreams of any Kenyan child. Even more importantly, no individual should ever be allowed to have such powers.

On that score, this is the most irresponsible, most corrupted and and the most confused health system that has ever been in the world.
Everyone wants to play your role, qualifications notwithstanding, when there is money and blame you for their mess when the money runs out or where there is no money.

Please allow those pharmacists who are still in public sector to have something to do and be happy about, or the average age for those who can still stomach those issues will always be below 30. Need I say that pharmacists in public sector are all young and 'inexperienced', and that this will go on for as long as there is nothing to do 'for pharmacy' there? Who wants to grow old in such a system?

That meeting, I will attend; not for me, but for others who need me. I would want to return to the public sector as a 'Director' or as a PS, not as a spineless 'Chief' who cannot even be allowed to manage his own secretary by a guy who makes up for his lack of eloquence with hate and tyranny.

If the way forward of that meeting does not tackle the autonomy and clear career progression of pharmacists; one that will make an individual pharmacist plan his career life by saying 'I will go back to school, to do this so that I become this...et cetera et cetera'..., then we are doing nothing. We must say if we are not able to achieve to this end over a certain time-frame, then lets all resign from this job with false sense of security, we venture out there together and take over the pharmaceutical economy, because even that we have let others to. Then we start managing all drug issues, in all pharmacy specialties and sub-specialties that we will define, and in our own terms. Who said pharmacists can only achieve the health ministry goals by remaining as their employees? So long as we keep a few in the critical areas and pray to God; and pray really hard that they stop being part of the problem that is already undermining them anyway, then we are set. I hope they see that point and realize that the day pharmacists are empowered, they too will gain but ten-fold, and PPB might just become the most powerful institution in the health or even the larger social sector. Somebody needs to open their eyes, and take them back to the day they decided as a high school graduates to pursue pharmacy. That nostalgic feeling has to come back. They should be allowed to take their minds through on wild journey of the reason they were born.

So what is this thing that pharmacists can do in their own right without reference to anybody else? Everything. Did you know that the only way you can shape legislative process is by being a strong and visible lobby group and with money to boot? Our lawmakers can only debate on your issues when they are pampered and taken for some luxurious retreat somewhere, at your cost

A new post on Pharmacy solutions blog

The excerpts are...

....Now Kenya usually has two rules-the one on paper and the one that carries the day. Pharmacists are the only health professionals who zealously protect what is on paper; the 8-5pm working hours rule, and as it goes, it takes a pharmacist to enforce this work ethic among the other pharmacists.....

....I do not know if there is a pharmacy version of open professional ‘rebellion’ that is only good to the pharmacists and is protected to death by our bosses. In short, our work is quantitative and not qualitative. We are not allowed to make ‘extra money’ on the side lest we lose focus on the ‘very important job’ we were employed for. This is a very good rule, but look where it has taken us?
No wonder everyone is going public health.

Check it out on http://timkopussolutions.blogspot.com/ and send in your comments

What I want to take to the floor of the PSK sympossium

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.

A very disappointing PPB!

If you trained in University of Nairobi, its time chest thumping stopped and we admit that our training did not meet the minimum competencies required for a pharmacist. If you dont agree with me, engage a randomn pharmacist on any issue you think is within the realmn of a pharmacist and you will see for yourself the results.

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Now that aside lets go to PPB issues, we are incompetent on the average, and thats not negotiable. I will expect DMS to fill in the gap that we created. I do not expect the Chief Pharmacist to even have an idea of what a cough syrup is, and the more reason why he must voluntarily relinquish his registrar post to PPB as we are awaiting for clarification to some contentious clauses in Pharmacy and Poisons Act of 2003. A vigilant pharmacist pointed out that that Act, which effectively repealed the older statute sneaked in a clause that the registrar shall be a Chief Pharmacist, (who is basically the administrator of public sector pharmacists and a technocrat in the parent ministry so many grades lower than the ministry's chief executive). No one knows if the clause was passed by the parliament or was sneaked in by the mover or was sneaked in at the printing stage effectively making it a typo error.

Someone please investigate, because it is that clause that brought in fundamental change in the operations of PPB and the overall management of the pharmaceutical sector. We have a Board that we elect representatives but have no control at all in its running. PSK elects/nominates 4 people for three years who absolutely have no control on what they were nominated to do.

The learning curve for pharmacists end with them being declared BPharm graduates.
There are no serious tutors who force pharmacist interns to put what they learnt in school (if any) into practice, worsening the already fragile situation. We do not have predecessors worth mentioning; the serious pharmacists are almost all under 35 and with less than 10yrs of experience and hardly possess anything much more than the first degree. Kenya is almost devoid of specialist pharmacists.

If we delinked PPB from the parent ministry, make it an Authority and give the Board the power to hire and fire its employees, there will be fundamental changes in Kenya pharmaceutical sector. The Board should not be staffed by the Ministry of Health employees, they should all be sent out to carry out service delivery. If I'm not competent to discharge regualtory functions with my current training and expereince, which I rank to be in the top quartile among the Kenyan pharmacists, no one in that Board has. Tell me one you believe is and I will give you a reward. Most of them are entry level pharmacists or even interns-what do they know? Regulatory activity is not about filling forms and dusting files and drinking tea, no. It is a well thought out process from an experienced specialist pharmacists who shoul dbe issuing weekly or monthly bulletins to be circulated to all stakeholders.

The Board members and the technical staff must have post graduate qualifications and have more than 10 years experience post registration, in all the represented areas in the Board's mandate unless they are secretaries (like the one who's upstairs and has issues in the upstairs) or accountants or sweepers or messengers or drivers or guards. The CEO must be selected in a competitive process. He must not be the sitting Chief Pharmacist. He must possess postgraduate qualifications in pharmacy as well as an advanced management degree because the Board draws a huge budget. He (and that also stands for she) must have excellent presentation skills and must have made significant contributions in the relevant publications. He must be compensated well and must not serve for more than two terms of four years each. He may serve in an advisory role for another four years if he successfully completes two-four year terms. Its only such a Board that can confirm or rubbish any drug claims and we listen.
As for now I will only trust my own independent research.

Without that, the DMS or the PS or the Minister or even the President can comment on the cough syrups. As things are now, they are all more competent than that Board, I'm sorry to say that.

Vacation

The blogger apologizes to all esteemed readers for non-publishing of your favourite blog so many months after the lapse of the two weeks 'vacation' period. I'm happy to inform you that the long standing legal issues that made it difficult to publish your favourite blog have been solved.

Post your comments on how your favourite blog can be improved.