Implementing Good Pharmacy Practices to improve appropriate management and dispensing of antimicrobials in private pharmacies in Lao PDR

Context

Lao Peoples Democratic Republic (Lao PDR) is located in Southeast Asia, where antimicrobial resistance (AMR) has been on the rise in recent years. Over the past few years, efforts to mitigate the AMR issues have been put forward by relevant sectors in the country. In most Low and Middle-Income Countries (LMICs), private pharmacies have been found to be the patient’s first point of seeking treatment and preferred channel to purchase medicine. Similarly, in Lao PDR, the private sector provides an important health service to communities, as these pharmacies are often the first point of contact for patients a health service provider. However, it has been reported that the facilities and services received from private pharmacies in Lao PDR are considered of low level, and a previous study has identified substandard antimicrobials.

Problem

Lao PDR faces documented challenges related appropriate dispending of antimicrobials at private pharmacies. The National Strategic Plan for Antimicrobial Resistance has a goal to control sales of antibiotics on prescription by doctors or veterinarians at 30% of all antibiotics sold. Particularly the private pharmacies often do not comply with Good Pharmacy Practices (GPP), which includes how drugs – including antimicrobials are procured, stored, dispensed and disposed., This is despite GPP being required by national regulations. Implementation of national regulations is further challenged by the fact that GPP inspections are done with more qualitative assessment approaches, and without investing the time to assure the quality of inspections. Additionally, pharmacists in private pharmacies may not be aware of AMR and their role in its mitigation. While in many countries pharmacists are regulated by a national body, until recently, there has been no pharmacy professional body in Lao PDR to share the responsibilities with the FDD on educating, supporting and unifying pharmacy practice, and to help influence and monitor pharmacy-related legislation. Despite these challenges, private pharmacies remain a critical access point for medications for most patients in Lao PDR, yet the services are not adequately developed to support the healthcare system.

Project overview

The project aims to improve the appropriate management and dispensing of antimicrobials in private pharmacies by implementing Good Pharmacy Practice (GPP) in Lao PDR. The objectives are:

1. To understand the existing situation (e.g. pharmacist knowledge, practices, attitudes, proportion of unregistered medicines and substandard and falsified (SF) antimicrobials in private pharmacies, as well as relevant policies/regulations/international standards) around private pharmacies dispensing behaviour and practices for antimicrobials in Lao PDR.
2. To develop an appropriate and feasible GPP instrument to update and simplify existing indicators and introduction of new indicators specifically related to antimicrobial dispensing in private pharmacies.
3. To improve inspection capacity for GPP and antimicrobial dispensing practices through certification procedures and inspector training
4. To implement GPP and improve counselling practices and awareness amongst private pharmacies
5. To evaluate the effectiveness for improving antimicrobial management and dispensing practices, cost for scaling, as well as implementation enablers and barriers for the introduction of an antimicrobial GPP intervention in private pharmacies
6. To draft a national strategy for GPP scale up in Lao PDR

Outcomes

Expected outcomes:

• Improvement of draft GPP policy and methods for its implementation, including indicators, guidelines, and certification.
• Improvement of the capacity of GPP inspectors to support effective licensing and oversight of private pharmacies.
• Improvement of the awareness and practices of the pharmacists in the private pharmacies to improve appropriate antimicrobial dispensing.
• Creation and expansion of a pharmacy model to increase the GPP certification of private pharmacies in Lao PDR. The target is to increase KAP by at least 25%. GPP private pharmacies certified in this project will serve as a model for scale-up.