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PPR: What prevents it? What to do next?

Prof. S. Balasubramanian
Wednesday, January 25, 2023, 08:00 Hrs  [IST]

The Pharmacy Council of India had announced Pharmacy Practice Regulations (PPR) in 2015. Since then, seven long years have passed and it is yet to be implemented to any appreciable extent in India. Why is such a wonderful regulation not coming into practice? Who or what prevents it? What to do next?

Toothless tigers!
Our legislation and regulations are with good intentions, no doubt. They become mere rituals when the agency which brought it has no powers either to implement them forcefully or punish the violators severely.

We know our society is getting harder, selfish and immoral day by day. When it becomes tougher to earn money for a livelihood, people start thinking of shortcuts and unethical ways. Pharmacy field is not an exemption. Hence, we should amend and give extra teeth to existing laws or enact new laws with extra powers to the authorities. That is to say, be up to date, change yourself according to changed times, otherwise you will perish. Only the fittest will survive, that's all.

That's what happened in this case of PPR. Pharmacy Inspectors proposed in PPR are yet to be appointed in majority of Indian states and even inspectors appointed in a few states are powerless as they have no mandate to prosecute the offenders. That's why we call the PPR a paper panther!

Even the PCI has no power to correct the state governments who dodge the PCI's direction or regulations for not one or two months but for seven years! Some people may think we are finding fault with PCI for everything. It is not our intention, but bettering its functions, thereby bringing appreciation to it and the best services to the people are behind our well-intended criticisms.

No improvement
Anybody can find our community pharmacies, why even government dispensaries, for that matter, have seen no improvement in the last 75 years since independence. The same old 'compounder' or 'somebody in formal dress' is giving medicine and murmuring how to take it "two or three times a day, after or before food". Only these eight or nine words are told repeatedly like a gramophone record with scratch!  That's all our existing pharmacy services are!

What to do?
What must the PCI and government do, if they are sincere in implementing PPR? What extra teeth is it required to streamline or regulate Pharmacy Practice? This author and many others have pointed out all those steps many times earlier. No harm in repeating them until its acceptance and implementation. We, the advocates of the reforms, are not in the utopian world, we know the realities and ground conditions of our pharmacies. Hence, we have suggested a few simple things.

Firstly, to grade the existing pharmacies into A, B and C grades according to the qualification of pharmacist employed and services offered there. Pharmacists with post-graduation (M. Pharm or Pharm. D) as grade A, B. Pharm graduate with grade B and D. Pharm holders with grade C. It doesn't require crores of rupees for the government to put them into practice.

Then what is the problem with implementing it? Displaying the grade both in front of the pharmacy and inside, prominently, will have a positive effect on the minds of customers. The market forces will do the rest of the work the government wants to do.( Every pharmacy will upgrade automatically, to get business)

How to pay higher salaries to highly qualified pharmacists? Allow or even make it mandatory to collect service charges (say five to 10% of bill amount) by the pharmacists employed there. Patients will not mind, we believe, as they are paying a few hundred rupees as a consultation fee to doctors. Only when they pay, they will question the quality of service. Anything offered free of cost cannot be questioned! This is reform number one.

Dispensing by non-pharmacists
There is no meaning for thousands of pharmacy colleges, lakhs of teachers and millions of pharmacists, when non-pharmacists are allowed to dispense and we shut our eyes to that glaring reality slapping on our face. It makes all the above people fools!

Dear pharmacists, is it not your blood boiling? Hundreds of Drug Inspectors (DIs) have not been able to prevent it for the last 50 years and more! Even if a DI wants to take action, he is prevented by corrupt higher ups or politicians and he is humiliated thereafter by the same pharmacy owner. I know a few DIs who resigned their millions-worth government job due to self-respect and consciousness. Hence, I hope DIs will not misunderstand the following suggestions.

The government should insist on fixing CC cameras over each dispensing counter of the pharmacy to record who is dispensing. The recordings should be preserved for at least a year to act as evidence in court, to make the DI's job easy for winning the case and punishing the guilty. We know a DI cannot monitor each and every pharmacy personally 24x7 for 365 days of a year.

Hence, fixing CC cameras is the practical solution to the problem. Hope everyone will agree.

Just like getting two mangoes with one stone, we can also prevent the bad practice of lending pharmacist certificates by some pharmacists. Camera recordings will act as a deterrent. The lending of certificates is encouraged or brought into practice by greedy pharmacy owners who, by offering very low salaries, force poor, unemployed pharmacists to lend the certificate and go for other jobs to supplement their income to meet their family expenses. Though we are sympathetic to those poor people, the solution is not lending certificates but forcing pharmacy owners to offer full-time jobs and salary to pharmacists and thereby not allowing non-pharmacists to dispense and cheat people.

Thus, fixing CCTV cameras is the second reform we demand. Here again, there are no expenses involved for PCI or the Government or Drugs control department. In fact, it saves money for the latter required for frequent inspections. Also, it makes their job easy and appreciable. Tell us a good reason why it cannot be implemented.

Third reform
Repeatedly Repeated Reform (RRR!) is making community and hospital pharmacists compulsorily wear a white apron with PCI photo ID while on duty. This reform alone will change the situation to a considerable extent. As in the above two demands, this third reform also involves no expenditure. Obviously, the lack of this rule and its implementation favour unscrupulous pharmacy owners, requiring no other proof. If we reveal this simple demand to pharmacists of developed countries, they will laugh at us! The prestige of India is at stake!

The final action
The proverbial final straw on the back of the camel to break it, is completely banning non-pharmacist salesmen behind the counters of pharmacies, as in the Gulf and other developed countries. If found, they should be punished. We know there will be big objections from pharmacy owners to this demand with many justifications. Ask them, then, how to prevent non-pharmacist salesmen from receiving prescriptions and dispensing. They will give empty promises.

If the salesmen cannot be banned immediately, as an interim arrangement, direct them to wear khaki or blue uniforms, so as to distinguish them from pharmacists. Then customers themselves will avoid them, and will not give prescriptions to them or want to receive their medicines from those third-grade servants.

Thus, all these four reforms will change the face and body of our community and hospital pharmacies completely and PCI can implement its PPR comfortably. But for this to be successful, the general public should be educated and made aware of their rights as well as the sub-standard services prevailing now in our pharmacies.

Hence, all the above reforms should be given wide publicity in the media. Journalists, consumer organisations, courts and socially conscious writers should do their part. If the government is not responding to these just demands, we can approach anyone of the High Courts and let the government answer there! We have full faith and hope the court will reprimand the government and direct it to implement all the above reforms immediately!
(The author is ex-President, Indian Pharmacy Graduates Association, Madurai, Tamil Nadu)


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