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Wang Q, Dai R, Yu Q, Zhang T. Research on government regulation methods for the spatial layout of retail pharmacies: practice in Shanghai, China. Int J Equity Health 2024; 23:173. [PMID: 39192277 DOI: 10.1186/s12939-024-02254-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2023] [Accepted: 08/14/2024] [Indexed: 08/29/2024] Open
Abstract
BACKGROUND In China, retail pharmacies are critical sources for obtaining medications and play a vital role in residents' daily access to drugs and treatment of common illnesses. Effectively guiding the placement of these pharmacies in areas of need through government regulation is crucial for enhancing medication access. In this study, we used population and retail pharmacy spatial distribution data from Shanghai to design guidance and supplementary methods for optimizing the spatial layout of retail pharmacies and medical insurance designated pharmacies based on regional characteristics. METHODS Population distribution, road traffic network, administrative division and retail pharmacy data from Shanghai in 2018 were collected from relevant government departments. ArcGIS 10.3 was used to map the retail pharmacies and population distribution. Based on the spatial distribution of population and the service standards of pharmacies, service circles with insufficient pharmacies were identified, and supplementary methods for retail pharmacies and medical insurance designated pharmacies were developed. RESULTS In 2018, Shanghai had 3009 retail pharmacies, each serving an average of 6412 residents. The city was divided into 2188 basic pharmaceutical service circles, each within a 15-minute walking distance. The results indicated that there were 1387 service circles without any pharmacies, 151 of which had populations exceeding 5000. Additionally, 356 service circles had pharmacies but lacked medical insurance designated ones. After supplementation, 841 retail pharmacies were planned to be added in residential areas. Compared with before, the coverage area and population served of the pharmacies increased significantly. CONCLUSIONS This study mapped the spatial distribution of population and retail pharmacies in Shanghai, and designed government guidance and supplementary methods for optimizing the layout of retail pharmacies. The findings offer valuable insights for government agencies in low- and middle-income countries to improve the spatial distribution of retail pharmacies.
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Affiliation(s)
- Qian Wang
- School of Nursing, Shanghai Jiao Tong University, Shanghai, China
| | - Ruiming Dai
- School of Public Health, Fudan University, 20 Handan Road, Shanghai, 200433, China
| | - Qianqian Yu
- Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai, China
- School of Management, Shandong Second Medical University, Shandong, China
| | - Tiantian Zhang
- School of Public Health, Fudan University, 20 Handan Road, Shanghai, 200433, China.
- Shanghai Institute of Infectious Disease and Biosecurity, Fudan University, Shanghai, China.
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Nsengimana A, Biracyaza E, Isimbi J, Uwambajimana C, Hategekimana JC, Kagisha V, Asingizwe D, Nyandwi JB. Request for Antimalarial Medicines and Their Dispensing Without a Prescription in Community Pharmacies in Rwanda. INTEGRATED PHARMACY RESEARCH AND PRACTICE 2023; 12:195-212. [PMID: 37928945 PMCID: PMC10625414 DOI: 10.2147/iprp.s428105] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2023] [Accepted: 10/20/2023] [Indexed: 11/07/2023] Open
Abstract
Purpose This study aimed to explore the request and dispensing of antimalarial medicines without a prescription in community pharmacies in Rwanda, as well as factors associated. Methods We employed an embedded mixed-methods design that involved a convenience sample of 235 licensed community pharmacists between February and April 2022. To simultaneously collect qualitative and quantitative data, we used a self-administered questionnaire containing a combination of close and open-ended questions. Bivariate and multivariate regression analyses were performed to examine the relationship between dispensing antimalarial medicines without a prescription and the selected independent variables. Statistical significance was set at p<0.05, and a 95% confidence interval was applied. The factors influencing the dispensing of antimalarial medicines without a prescription were analyzed using thematic content analysis as a qualitative analysis approach. Results Most respondents (88.5%) were asked to dispense antimalarial medicines by clients without a prescription. More than half of them (54%) agreed, but 34.5% refused; instead, they referred clients to malaria diagnostic testing facilities. Those who had rapid diagnostic tests for malaria in stock (OR=2.08, 95% CI:1.1-3.94), and thought that antimalarials were over-the-counter medicines (OR=7.03, 95% CI:2.01-24.5) were more likely to dispense antimalarial medicines without prescriptions. The primary reasons reported by community pharmacists for dispensing antimalarial medicines without prescriptions included their prior knowledge of malaria diagnosis, client pressure, and fear of losing clients. However, non-adherence to negative results obtained from formal health facilities and long queues at these institutions have also been cited as additional factors driving clients to seek antimalarial medicines without prescriptions. Conclusion Dispensing antimalarial medicines without prescriptions is a common practice in community pharmacies in Rwanda. The main factors contributing to this practice include lack of awareness regarding the classification of antimalarials as prescription medicines, the availability of malaria diagnostic tests, client pressure, and fear of losing clients.
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Affiliation(s)
- Amon Nsengimana
- US Agency for International Development Global Health Supply Chain Program, Procurement and Supply Chain Management, Kigali, Rwanda
| | - Emmanuel Biracyaza
- School of Rehabilitation, Faculty of Medicine, Université de Montréal, Québec, Canada
- Centre for Interdisciplinary Research in Rehabilitation of Greater Montreal (CRIR), Montreal, Canada
| | - Joyce Isimbi
- Department of Pharmacy, University of Rwanda, Kigali, Rwanda
| | | | | | - Vedaste Kagisha
- Department of Pharmacy, University of Rwanda, Kigali, Rwanda
| | - Domina Asingizwe
- Department of Physiotherapy; University of Rwanda, Kigali, Rwanda
- East African Community Regional Centre of Excellence for Vaccines, Immunization and Health Supply Chain Management, University of Rwanda, Kigali, Rwanda
| | - Jean Baptiste Nyandwi
- Department of Pharmacy, University of Rwanda, Kigali, Rwanda
- East African Community Regional Centre of Excellence for Vaccines, Immunization and Health Supply Chain Management, University of Rwanda, Kigali, Rwanda
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Kaplan WA, Cellini CM, Eghan K, Pilz K, Harrison D, Wirtz VJ. Contracting retail pharmacies as a source of essential medicines for public sector clients in low- and middle-income countries: a scoping review of key considerations, challenges, and opportunities. J Pharm Policy Pract 2023; 16:60. [PMID: 37131256 PMCID: PMC10153779 DOI: 10.1186/s40545-023-00557-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Accepted: 03/13/2023] [Indexed: 05/04/2023] Open
Abstract
BACKGROUND Insurances in high-income countries (HIC) often contract with private community pharmacies to dispense medicines to outpatients. In contrast, dispensing of medicines in low- and middle-income countries (LMICs) often lacks such contractual arrangements. Furthermore, many LMICs lack sufficient investment in supply chains and financial and human resources to guarantee stock levels and services at public medicine-dispensing institutions. Countries striving to achieve universal health coverage (UHC) can, in principle, incorporate retail pharmacies into their supply chains to expand access to essential medicines (EMs). The objectives of this paper are (a) to identify and analyze key considerations, opportunities and challenges for public payers when contracting out the supply and dispensing of medicines to retail pharmacies and (b) to provide examples of strategies and policies to address these challenges. METHODS A targeted literature strategy was used to conduct this scoping review. We created an analytical framework of key dimensions: (1) governance (including medicine and pharmacy regulation); (2) contracting (3) reimbursement; (4) medicine affordability (5) equitable access; and (6) quality of care (including 'patient-centered' pharmaceutical care). Using this framework, we selected a mix of three HIC and four LMIC case studies and analyzed the opportunities and challenges encountered when contracting retail pharmacies. RESULTS From this analysis, we identified a set of opportunities and challenges that should be considered by public payers considering public-private contracting: (1) balancing business viability with medicine affordability; (2) incentivizing equitable access to medicines; (3) ensuring quality of care and delivery of services; (4) ensuring product quality; (5) task-sharing from primary care providers to pharmacies and (6) securing human resources and related capacity constraints to ensure sustainability of the contract. CONCLUSION Public-private partnerships offer opportunities to improve access to EMs. Nonetheless, managing these agreements is complex and is influenced by a variety of factors. For effective contractual partnerships, a systems approach is needed in which business, industry and regulatory contexts are considered in tandem with the health system. Special attention should be devoted to rapidly changing health contexts and systems, such as changes in patient preferences and market developments brought about by the COVID-19 pandemic.
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Affiliation(s)
- Warren A Kaplan
- Department of Global Health, Boston University School of Public Health, 715 Albany St, Boston, MA, 02118, USA
| | - Carlotta M Cellini
- Department of Global Health, Boston University School of Public Health, 715 Albany St, Boston, MA, 02118, USA.
| | - Kwesi Eghan
- Management Sciences for Health, 4301 North Fairfax Drive, Suite 400, Arlington, VA, 22203, USA
| | - Kevin Pilz
- USAID, 300 Pennsylvania Avenue, Washington, NWDC, 20523, USA
| | - Denise Harrison
- USAID, 300 Pennsylvania Avenue, Washington, NWDC, 20523, USA
| | - Veronika J Wirtz
- Department of Global Health, Boston University School of Public Health, 715 Albany St, Boston, MA, 02118, USA
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Hutchinson E, Hansen KS, Sanyu J, Amonya LP, Mundua S, Balabanova D, Clarke SE, Kitutu FE. Is it possible for drug shops to abide by the formal rules? The structural determinants of community medicine sales in Uganda. BMJ Glob Health 2023; 8:bmjgh-2022-011097. [PMID: 36822666 PMCID: PMC9950907 DOI: 10.1136/bmjgh-2022-011097] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2022] [Accepted: 02/05/2023] [Indexed: 02/25/2023] Open
Abstract
The medicines retail sector is an essential element of many health systems in Africa and Asia, but it is also well known for poor practice. In the literature, it is recognised that improvements in the sector can only be made if more effective forms of governance and regulation can be identified. Recent debate suggests that interventions responsive to structural constraints that shape and underpin poor practice is a useful way forward. This paper presents data from a mixed-methods study conducted to explore regulation and the professional, economic and social constraints that shape rule breaking among drug shops in one district in Uganda. Our findings show that regulatory systems are undermined by frequent informal payments, and that although drug shops are often run by qualified staff, many are unlicensed and sell medicines beyond their legal permits. Most shops have either a small profit or a loss and rely on family and friends for additional resources as they compete in a highly saturated market. We argue that in the current context, drug shop vendors are survivalist entrepreneurs operating in a market in which it is extremely difficult to abide by policy, remain profitable and provide a service to the community. Structural changes in the medicines market, including removing unqualified sellers and making adjustments to policy are likely prerequisite if drug shops are to become places where individuals can earn a living, abide by the rules and facilitate access to medicines for people living in some of the world's poorest countries.
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Affiliation(s)
- Eleanor Hutchinson
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | | | - Jacquellyn Sanyu
- Department of Health Policy, Planning and Management, Makerere University School of Public Health, Kampala, Uganda
| | - Lydia Peace Amonya
- Infectious Diseases Research Collaboration, Kampala, Central Region, Uganda
| | - Sunday Mundua
- Makerere University College of Health Sciences, Kampala, Uganda
| | - Dina Balabanova
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, UK
| | - Sian E Clarke
- Faculty of Infectious and Tropical Diseases, London School of Hygiene and Tropical Medicine Faculty of Infectious and Tropical Diseases, London, UK
| | - Freddy Eric Kitutu
- Makerere University College of Health Sciences, Kampala, Uganda
- Department of Pharmacy, Makerere University School of Health Sciences, Kampala, Uganda
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Santah C, Bröer C. Agency through medicalization: Ghanaian children navigating illness, medicine and adult resistance. Soc Sci Med 2022; 315:115504. [PMID: 36399983 DOI: 10.1016/j.socscimed.2022.115504] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2022] [Revised: 10/29/2022] [Accepted: 11/01/2022] [Indexed: 11/09/2022]
Abstract
Medicalization in the Global North assumes that bottom-up medicalization is driven by increasing consumer power, risk avoidance among professionals, or emancipation. Building on ethnographic work of the first author, this article aimed to explore the existence and conditions of a different and novel mechanism and found children manifesting agency through self-medicalization. We look at how Ghanaian children pragmatically deal with everyday health concerns and argue children are agents of medicalization and medicalization enables agency in children. Through interpretive and collaborative content analysis of structured ethnographic observations of 105 children from different class backgrounds (between June 2016 and December 2017) we found children in Northern Ghana framed situations of feeling ill in markedly biomedical terms and persisted in biomedical treatment even with opposition from adults. We observed that children intentionally navigated opposition from adults, mobilized support through networks, exploited power differences between adults, and organized treatment among themselves if necessary. While girls had an even harder time to muster recognition from adults, we also discovered children from a lower socioeconomic background, with more experience on the street had more leeway in navigating lack of support. So far, children's agency in health and illness has only been discussed in instances where children had already received a professional diagnosis. In our case where children had not yet received a professional diagnosis, we find that agency is enabled through bodily awareness, experience, interactions with peers, family, and the media; all working as tools for children to self-diagnose and to deal with illness in a postcolonial setting.
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Affiliation(s)
- Colette Santah
- University of Amsterdam, Department of Sociology, the Netherlands; University of Milan, Graduate School for Social and Political Sciences, Italy.
| | - Christian Bröer
- University of Amsterdam, Department of Sociology, the Netherlands
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