Elsevier

Social Science & Medicine

Volume 42, Issue 8, April 1996, Pages 1155-1161
Social Science & Medicine

Retail pharmacies in developing countries: A behavior and intervention framework

https://doi.org/10.1016/0277-9536(95)00388-6Get rights and content

Abstract

Retail pharmacies in developing countries are one of the most important sources of advice on pharmaceuticals. Among the reasons the clients give are ease of access; availability of medicines; quality of service (no waiting and convenient hours of operation); and cheaper products, availability of credit, or the option to buy drugs in small amounts. However, the appropriateness of prescribing by retail pharmacy staff has been found to be far from acceptable. In childhood diarrhea, for example, oral rehydration salts (ORS), the appropriate diarrhea treatment, are recommended much less than pharmaceuticals of limited value, such as antimotility agents, adsorbents, etc. Little information is available for reasons underlying such behaviors.

In this paper, we present a conceptual framework in which to analyze factors that may affect retail pharmacy prescribing, and we suggest strategies for behavior change. We developed this framework after examining relevant literature on retail pharmacy prescribing.

We propose that pharmacy factors, client factors, physician practice and regulatory factors are the four sets of important factors for understanding pharmacy prescribing behavior. For intervention, we present four types of interventions which could be used for changing the behavior of pharmacy staff: information alone, persuasion, incentives and coercion.

The behavior and intervention frameworks presented in this paper should also help in guiding further research in this area. For example, new information on the effects of ownership type, availability vs actual role of professional staff and authority structure on pharmacy treatment behaviors would be useful areas for future research. Similarly, additional research is needed on the comparative effects of coercive, persuasive and incentive strategies on pharmacy treatment behaviors.

References (50)

  • A Ferguson

    Commercial pharmaceutical medicine and medicalization: a case study from El Salvador

  • A Hardon et al.

    Hazards of self-medication

    Wld Hlth Forum

    (1987)
  • S Van der Geest

    The illegal distribution of western medicines in developing countries: pharmacist, drug peddlers, injection doctors and others: a bibliographic exploration

    Med. Anthropol.

    (1982)
  • A Mills et al.

    Drugs for the poor of the Third World: consumption and distribution

    J. Trop. Med. Hygiene

    (1983)
  • H Kloss et al.

    Utilization of pharmacies and pharmaceutical drugs in Adis Ababa, Ethiopia

    Soc. Sci. Med.

    (1986)
  • Management Science for Health

    Investigation of the health service delivery in three elements of the Peruvian private sector

  • D Ross-Degnan et al.

    Drug sellers, pharmaceuticals, and diarrhoeal disease: I. A review from developing countries about private sector drug use practices

    Draft

    (11 January, 1991)
  • World Helath Organization

    The Rational use of Drugs in the Management of Acute Diarrhea in Children

    (1990)
  • P.M Barron et al.

    Dispensing habits of Johannesburg pharmacists in treating acute infantile diarrhea

    S. Afr. Med. J.

    (1989)
  • WHO/Action Programme on Essential Drugs, and Unit of Pharmaceuticals, Geneva

    The Role of Pharmacist in the Health Care System: Report of a Consultative Group, New Delhi

    (13–16 December 1988)
  • World Health Organization

    The World Drug Situation

    (1988)
  • G Tomson et al.

    Drug information to prescribers in developing countries

    SIDA, NU Nyatt om U-landshalsovard

    (1990)
  • U.S. Congress, Office of Technology Assessment

    Drug labelling in developing countries

    (February 1993)
  • A.L Raynal

    Use of over-the-counter medications in rural Matabeleland, Zimbabwe: the case for upgrading dispensing skills of rural shopkeepers

    Centr. Afr. J. Med.

    (1985)
  • S van der Geest

    Village health workers as medicine sellers?

    Int. J. Hlth Plan. Mgmt

    (1992)
  • Cited by (168)

    • Providing medical abortion services through pharmacies: Evidence from Nepal

      2020, Best Practice and Research: Clinical Obstetrics and Gynaecology
      Citation Excerpt :

      Although abortion law in Nepal and the WHO do not currently allow/recommend pharmacy provision of MA, our review suggests that pharmacy workers are often the first contact point for women seeking abortion and serve as an important source of information and referral [17,18]. They are more accessible and affordable and may offer increased privacy compared to public facilities [17,19,20]. Although limited, studies conducted in Nepal have demonstrated that trained pharmacy workers who adhere to the standard of care set forth in national guidelines can safely and effectively provide MA including performance of bimanual exam.

    • Pharmacist Workforce Issues

      2019, Encyclopedia of Pharmacy Practice and Clinical Pharmacy: Volumes 1-3
    View all citing articles on Scopus

    This work was partially supported by a contract from the World Health Organization Control of Diarrhoeal and Respiratory Diseases Program, the UNICEF-Kenya Country Office, and the Harvard Community Health Plan Foundation.

    View full text