The World Health Organization convened a meeting of a consultative group on the role of the pharmacist in the health care system, in New Delhi, at the WHO Regional Office for South-East Asia, from 13-16 December 1988. The objectives of the meeting were:
• to delineate the body of knowledge and expertise upon which the contribution of pharmacists to health care is based;
• to review the contributions of pharmacists to the acquisition, control, distribution and rational use of drugs, and other health-related functions of pharmacists;
• to formulate proposals regarding:
- necessary developments in undergraduate, postgraduate and continuing education of pharmacists, and in the training of supportive staff;
- action that is necessary to optimize the use of pharmacists in health care systems;
- arrangements for monitoring the above developments and action.
The meeting was opened on behalf of Dr H. Nakajima, Director-General of the World Health Organization, by Dr U Ko Ko, Regional Director, WHO Regional Office for South-East Asia, who emphasized that efforts to rationalize health care, to establish priorities for allocation of resources and to upgrade the necessary institutional and other facilities, are without consequence wherever the delivery of services is frustrated by lack of an integrated infrastructure.
Nowhere is the need for this infrastructure more evident in the day-to-day management of patients than in the provision of essential drugs. Indeed, effective medicine can be practised only where there is efficient drug management. This is an axiom that applies with equal validity to both developed and developing countries. Yet, time and again, in less affluent settings, inadequacies in the provision of primary health care are attributable to shortcomings within the drug distribution chain. Only when the pharmacist has been accepted as a vital member of the health care team can the necessary supporting services be organized with the professionalism that they demand. In highly industrialized countries, acceptance of the need for professionalism in the supply and dispensing of drugs and health appliances has long since been indispensable because of the complexity of modern health care technology. Recently, however, a striving for economy engendered by the ever burgeoning costs of health care within the public sector has lent much credence and immediacy to arguments that a redefinition of the role of the pharmacist could serve the interests of both individual patients and the public at large.
The day-to-day activities of the pharmacist in these two starkly different settings may appear, superficially, to be very different. But, everywhere, the call for pharmaceutical expertise is founded upon the same precepts. Pharmacists are uniquely qualified because:
• they understand the principles of quality assurance as they are applied to medicines;
• they appreciate the intricacies of the distribution chain and the principles of efficient stock-keeping and stock turnover;
• they are familiar with the pricing structures applied to medicinal products that obtain within the markets in which they operate;
• they are the custodians of much technical information on the products available on their domestic market;
• they are able to provide informed advice to patients with minor illnesses and often to those with more chronic conditions who are on established maintenance therapy;
• and not least, they provide an interface between the duties of prescribing and selling medicines and, in so doing, they dispose of any perceived or potential conflict of interest between these two functions.
This inventory of activities identifies the dispensing of medicines as the pivotal responsibility of the pharmaceutical services. This is, without question, destined to remain the case in virtually every national setting. However, the distinctive expertise of the pharmacist provides members of the profession with a suitable background to assume diverse responsibilities in both public administration and drug manufacture and supply. The competence of the pharmacist is already proven and evident:
• in the direction and administration of pharmaceutical services;
• in drug regulation and control;
• in the formulation and quality control of pharmaceutical products;
• in the inspection and assessment of drug manufacturing facilities;
• in the assurance of product quality throughout the distribution chain;
• in drug procurement agencies;
• and in national and institutional formulary committees.
In these activities, the pharmacist serves as a member of a multidisciplinary team rather than in an autonomous capacity; but in any particular country the profession can only be an efficiently organized element of the health care system when it has gained representation within the senior ranks of administration in both government and industry, and when pharmaceutical education has become established at university level.
A voice in national administration is of vital importance from the outset, since this not only promotes the potential of the profession and exerts influence upon training curricula and the academic standards required for registration - and for certification of ancillary staff - but also provides the best available assurance that policy considerations, including resource allocation, will be attuned meaningfully to national requirements.
Similarly, the pharmacist has indisputable functions at various levels in national drug registration and regulation. The responsibilities of the regulatory authority are to ensure that all products subject to its control conform to acceptable standards of quality, safety and efficacy; and that all premises and practices employed to manufacture, store and distribute these products comply with requirements to assure the continued conformity of the products to these standards, until such time as they are delivered to the end user. A small regulatory authority will rarely, if ever, undertake independent, comprehensive assessments of the safety and efficacy of individual products. In this case, the administrative and technical responsibilities that fall within its ambit are largely of a pharmaceutical nature and they are directed primarily to quality assurance.
In the last analysis, however, wherever pharmacy establishes its roots as a profession, it is within the health care institutions and in the community itself that pharmacists will serve in greatest numbers and with the most immediate effect on patient welfare. Pharmacists’ specialized knowledge of the management and properties of medicines in an increasingly sophisticated health care environment brings them closer to prescribing doctors as a source of independent information about therapeutic options and about the consequences - both positive and negative - of treatment. It also brings them closer to patients in the community as readily accessible dispensers not only of medicines but also of health-related information. Their basic training should aim to confer upon them competence to offer skilled advice on the treatment of minor illness and the adoption of healthy lifestyles, and it should endow them with the insight necessary to recognize when the best interests of the patient are served by prompt referral to a medical practitioner.