Promoting Efficiencies in Pharmaceutical Systems

“Deriving maximum value out of every investment is the core of efficiencies. In healthcare then it translates to ensuring that every investment serves it’s purpose, delivers on the intended impact with minimal waste.”

Towards the end of 2020 I did a three part series to conclude the year where I wrote about my passions one being healthcare and improving access to healthcare. Based on this, I am on an extensive reading phase keen on acquiring as much knowledge as possible to be able to optimize health systems through the skills I’ll have amassed. My focus today has been on efficiencies especially looking at health economics and specifically pharmaco-economics which looks at the rationale behind every investment in the pharmaceutical systems and how that investment translates to value instead of alternative options. With this we’ve also had heated discussions as pharmacists on some of the critical challenges affecting the sector especially in ensuring patients get optimum value out of our care as professionals. This has been fueled by a campaign dubbed “Bei Ya Ukweli” which claims to compare prices of medicines in different outlets in Nairobi. In the comparison, some of the concerns we have as professionals revolve around ensuring patients get the right quality medicines, for the right conditions, in the right dosages for an appropriate period of time coupled with the correct instructions on how to use the same medicines. This is the concept of rational medicines use. Unfortunately, when an individual focuses on the price of medicine at face value, all these other parameters are not put to consideration especially when the individual doing the comparison doesn’t understand the details.

One of the most critical challenge that the pharmaceutical sector faces globally is with falsified, substandard and counterfeit medicines (Fake medicines) as we commonly know them. These are drugs which do not have the active ingredient claimed to be in it, have inappropriate quantities of the active ingredient if it does, have not been made under the right manufacturing conditions thus have risk of complications or are presented to be those of a legitimate pharmaceutical manufacturer when in reality they are not (infringement of trademarks and intellectual property rights). These are concerns that when a patient presents themselves to the a pharmacy outlet to buy medication they will never know thus are at risk of being duped. This is where as pharmacists we come in. There are pharmacies where you may find the prices of medicines to be slightly higher and if your query there are professionals willing to give you the facts. In the market, not much information is available and with girth in information everybody drives there agenda. Unfortunately, for the pharmaceutical sector the patient who is an innocent player gets to suffer the consequences. This is where I now bring in the concept of efficiency and call on each of the players to improve on their efficiencies as follows:

• Economic efficiency: Pharmaceutical sector is a highly regulated industry however in Kenya like most developing countries, leakages do exist. With regulators, inspectors and law enforcement agencies being paid & facilitated to secure the integrity of supplies in the market. It’s high time they focus on ensuring the allocated funds are put to good use whether through track & trace systems and related. Aim should be to ensure that all medicines in the market are of prescribed quality, standards & effective in the management of conditions for which they are made to manage. On the same note, as pharmacists we have to ensure patients get value for their money when they but medicines from us.
• Technical efficiency: As pharmacists we are trained for five (5) years coupled with a year of internship and successive assessments prior to registration. These are to ensure competency which I believe that pharmacists in the market are competent enough to deliver quality pharmaceutical care to patients. It’s high time these skills & competencies are put to maximum use by ensuring pharmacists offer care to patients and not only sell medicines. These are prescribed in the Pharmaceutical Society of Kenya (PSK) Pharmacy Practice Guidelines for the different settings. To ensure standardization of pharmacy practice then these should be enforceable and be adopted to guide practice in all settings in the country. This will weed out quacks who pose danger to patients through substandard & unethical dispensing practices.
• Social efficiency: Patients and communities served by pharmacies have a role to ensure that they are actively involved in their care. This starts by adopting the basic requirements of confirming registration of a premise & the staff by the Pharmacy and Poisons Board (PPB) before buying medicines, asking questions about their condition, choice of medicines and how to take them including any probable side effects and how to manage them in case they arise. With this extra due diligence, the practice will be optimized and there will be an assurance that beyond ensuring economic and technical efficiency there is uptake of the quality healthcare services that we have committed to provide to patients.

Finally, in order to promote and ensure efficiency in systems any communication and comparative studies that are presented to infer a concern with pharmaceutical services should be reviewed and validated through an independent review board constituted by technical matter experts with the ability to decipher the underlying details that a layman may not understand. This is one of the reasons as to why advertising and promotional materials touching on medicines and health products are reviewed by the PPB before being sent out to the public. Ensuring efficiency in our healthcare and pharmaceutical systems is our shared responsibility and unless we do it right, we are bound to suffer the consequences of substandard, unaffordable and inaccessible care.