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Bulk dispensing in Africa: The reality and the concerns

Bulk dispensing in Africa: The reality and the concerns. Stand in presentation Alex Dodoo, President, Pharmaceutical Society of Ghana. The Reality. Dispensing from bulk is the norm rather than the exception for products in sub-Saharan Africa For products like Tablets Capsules Syrups

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Bulk dispensing in Africa: The reality and the concerns

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  1. Bulk dispensing in Africa: The reality and the concerns Stand in presentation Alex Dodoo, President, Pharmaceutical Society of Ghana

  2. The Reality • Dispensing from bulk is the norm rather than the exception for products in sub-Saharan Africa • For products like • Tablets • Capsules • Syrups • Suspensions • Creams and ointments especially in hospitals

  3. The Reality • Even smaller packed products are dispensed from bulk especially when they are expensive • Products for erectile dysfunction • Products for prostate cancer etc • Products like glyceryl trinitrate have been known to be dispensed from bulk! • Exceptions • Inhalers, Injections, Some creams, ointments, lotions

  4. Features of the Dispensing Landscape in Africa • Very poor labelling of dispensed medicines • Poor patient counselling • Dodoo, A.N.O et al., Rational drug use in Korle-Bu: A five day baseline survey of drug use indicators at the Korle-Bu Teaching Hospital, Accra, Ghana. Ghana Pharm. J. 2001, 24(3):14-16 • Presence of counterfeit and sub-standard products in the pharmaceutical supply chain • Dispensing by non-pharmacists and lower qualified personnel • Absence of tablet counters/trays • Counting by hand • Counting cytotoxics as well as other products using “plastic spoons” etc • Dispensing liquid in bulk • Bottles to be brought by parents • No medicine spoons • Illiteracy as well as presence of products with labels in other languages apart from the official national languages

  5. Implications • Patient safety • Errors • Counterfeit • Expired products • Sub-standard products • No labelling so difficult to check • No counselling and no knowledge by patients

  6. Implications • Adherence • Lack of knowledge by patients • Difficulty of patients to know what to take • Patients not returning to pharmacy to buy “remainder of expensive medicines” especially if they “feel” better • Product integrity • Packaging in plastic and paper “envelopes” • Effect of moisture, humidity etc • Regulatory challenge • Checking adherence to existing regulations on dispensing etc • Impossible to sue for negligence

  7. Opportunities • Pharmaceutical industry • To ensure that their products are appropriately packaged to reduce counterfeiting and environmental problems • National governments, especially where there is a national health insurance service • NHIS packs etc • Pharmacy and Medicine Regulators • Insistence on patient packs as well as patient information leaflets as well as proper labelling of all products • Reduction of costs of registering various packs of the same products • Other necessary regulatory measures

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