Pharmaceutical Education

Review of Pharmacy Professionals and Drug

Jurisprudence to Achieve the Millennium
Development Goals in Punjab Province of Pakistan
Taha Nazir1*, Azharul Islam2, Nida Taha3, Saeed Urasheed Nazir4, Muhammad Ather Chaudhary5 and
Muhammad Iqbal5
1
University Medical & Research Centre (UMDC), Biochemistry, Chemical Pathology, Molecular & Microbiology Research Group,
University Medical & Research Centre, University of Sargodha, Sargodha 40100 Pakistan.
2
VIDO-Inter Vaccine and Infectious Disease Organization-International Vaccine Centre (VIDO-InterVac), University of Saskatchewan,
SK, Canada.
3
Research & Publication Division Intellectual Consortium of Drug Discovery & Technology Development Incorporation, Saskatoon SK
Canada S7L3E4.
4
Department of Pharmaceutics Faculty of Pharmacy, University of Sargodha, 40100 Sargodha, Pakistan.
5
Office of Research, Innovation and Commercialization (ORIC) Offices of Research, Innovation and Commercialization, University of
Sargodha, 40100 Sargodha, Pakistan.

ABSTRACT
The current health practice of Punjab Province of Pakistan needs a serious attention to
control the unnecessary drug usage, improve pharmaceutical care and establish excellent
public health system. Hence, the health officials of Govt. of Pakistan have established
“Drug Regulatory Authority”, and Punjab Health Department has chalked out Punjab Drug
Rule, 2007 to deployed a revised health structure in Punjab. But, unluckily, the medical
physicians, drug store owners and bureaucracy have not put it into actual practice. Punjab
Health Department has made amendments in the Drug Rules, 2007; substituted the word
“three” by the “ten” and suspended it until 2017 via notification printed in the official
weekly gazette dated February 10, 2010. This potential confliction of interest can also be
noticed in hospital settings, community clinical practice and other allied health institutions. Submission Date : 08-05-2015
The most awful part the current scenario is the insufficient aspirations to share the Revision Date : 15-07-2015
clinical burden to provide the health facilities for patients presented in hospital/ clinical Accepted Date : 19-07-2015
setting. The consultant physicians and medical practitioners are very much reluctant to
involve the pharmacy professionals to perform their primary professional role. They want
them to stay away from their actual scientific job and keep doing the administrative
and clerical work. Therefore, the current health system and drug jurisprudence needs DOI: 10.5530/ijper.50.1.4
a serious attention to address the health problem. That will help to minimize avoidable Correspondence Address
Dr. Taha Nazir
mortalities, wrong medication, irrational prescription and development of drug resistance. Biochemistry, Chemical
Moreover, a conclusive prescribing guidelines and appropriate drug jurisprudence will Pathology, Molecular & Mi-
expedite the achievement of MDG of WHO. crobiology Research Group,
University Medical &
Key words: Drug resistance, Millennium Development Goals, Drug rule, Pharmaceutical Research Centre,
care, Clinical pharmacy. University of Sargodha,
Sargodha-40100 Pakistan.
E Mail:
taha.nazir@uos.edu.pk
BACKGROUND
After the partition of subcontinent, in 1947 in 1971.1 A massive people were displaced,
Indian Muslims got an independent state of particularly the children, women and fami-
Pakistan. That was broke out, leading to the lies affected second time after 1947. That
separation of East Pakistan (now Bangla- posed a potential health hazards. Moreover,
desh) because of poor governance, politi- the “war on terror” that arose after the 9/11
www.ijper.org
cal conflicts and violent military operation attacks, forced many people of tribal areas
24 Indian Journal of Pharmaceutical Education and Research | Vol 50 | Issue 1 | Jan-Mar, 2016
 Taha et al., Current health system to achieve the Millennium Development Goals

and Afghanistan to migrate from the affected areas. As macist. Instead, they are mostly attended by nontechni-
a result, ≥ 2,000,000 people were displaced, 234,589 cal salesman. In legitimacy, these pharmacies generally
people forced to live in refugee camps and 2087160 are registered by hiring a pharmacist, but in reality, they
individuals shifted outside the camps in rented accom- only rent a pharmacist degree or category-A registration
modations or host families. Particularly, the women and license.4 The diploma holders in pharmacy, assistants
children made up a large share of the Internal Displace pharmacists, pharmacy technicians and/ or dispens-
People (IDPs). In addition of that, Pakistan was hit by ers are responsible to work as storekeeper, accountant,
natural disaster in 2005 and 2010. This first severe earth- inventory manager, a dispenser, patient counsellor and
quake made ≥80000 dead and millions of displacement. information provider.5
Then heavy floods with a dead toll of ≥2000 people and Hence, the major challenges to Pharmacy practice to
2,000,000 indirect victims pose serious health threats for achieve the millennium development goals are multitu-
local and international health organizations. The role of dinous in versatile environments. The decision regarding
pharmacist in clinical setting is very poorly recognized the selection of medication is influenced by the biased
as compared to other health professionals in Pakistan. source of information. That mainly is acquired from
Hence, the pharmacy profession lacks an interface in neighbouring pharmacies, physicians, job experience,
society and is still in developing phase.2 The pharma- suppliers, newsletters, magazines, internet and leaflets.6
ceutical care and process through which the medication The regulations regarding the drugs prescription are gen-
delivered to the patients does not comply with the inter- erally not respected. Even, narcotics, control and potent
national standards to assure the safety. However, the drugs are dispensed without appropriate procedure and
pharmacies are licensed by Executive District Officer recording the patient’s informations. The drug sellers
(EDO) on behalf of the Health Department, Govern- hardly ever ask questions to maintain patient’s profile,
ment of the Punjab, Pakistan. The outlets are registered record the illness, and obtained inadequate history to
with the certificate of registration, but the quality of determine the severity or nature of disorder to assure the
clinical and/ or pharmaceutical care has been reported appropriateness of treatment.7 The’ retail medical stores,
to be poor.3 We are lacking the major components of drug stores, chemist shops, medicose or pharmacies are
patient’s pharmaceutical care i.e. prescribing, admin- most convenient accessible places to get healthcare facil-
istering, documenting and reviewing the drug usage. ities in Pakistan’s Punjab.8 They are very diverse in their
Whereas, the patient’s counseling, therapeutical consul- role and setups. These can be noticed like market place
tation and prevention of medication errors are poten- around the public and private hospitals. Even some exist
tially needed to improve the overall pharmaceutical care. in the grocery stores. The attending customer patients
Moreover, the current health care system is missing the usually come without an appropriate prescription. The
drug information, utilization and selection. That may technicians or dispensers are mostly observed work-
potentially help to rationalize the therapy plans, handle ing as pharmacist, physician, laboratory technicians and
the disease state management and apply the Electronic paramedics.9 Although, the drugs dispensing is a signifi-
Data Processing (EDP). In addition of that, tertiary cant part of rational drug usage, but it has been ignored
care hospitals, teaching institutions and other clinical by researchers in Pakistan’s Punjab. Very limited research
settings can improve their services by offering standards work and intervening studies are available to explain the
pharamcovigilance, pharmaco-economics, therapeutical pharmacy practices in Pakistan.10 All literary work high-
monitoring, bio-safety, drug informations, and aseptic light the limited area dimensions, poor quality of prem-
dispensary in Pakistan’s Punjab. Unluckily, the major ises, lack of dispenser’s basic education and knowledge.
part of pharmacy graduates are employed in pharma- That should ideally be improved to assure the targeted
ceutical production and very limited percentage join the health care facilities and achievement of MDG’s.
community pharmacy practice in Pakistan. Whereas, in
community pharmacy practice the standard health care Health care system
facilities are not offered appropriately. The pharmacies There is a three tiered health care delivery system in Paki-
are controlled by diverse types of pharmacy technicians stan. That comprised of primary, secondary and tertiary
and dispensers in terms of their knowledge, qualification care system. Health system strengthening mechanism
and experience. Although the licensing requirement, the start at grass roots level,11 health houses provide com-
persons usually found managing pharmacies are often munity health care services through Lady Health Visitors
salesmen, owners or clerks, but not the licensee phar- (LHV’s) and are connected to basic health units with an
macist. Even in the physical presence of the licensee or upward referral pathway to Rural Health Centres, Teh-
pharmacist, patients are often unlikely to reach the phar- sil Hospitals and District Hospitals. There are also well
Indian Journal of Pharmaceutical Education and Research | Vol 50 | Issue 1 | Jan-Mar, 2016 25
 Taha et al., Current health system to achieve the Millennium Development Goals

Table 1: Comparison of pharmacists yearly addition, gender (%), population Vs pharmacist, % addition and
yearly population growth of with last thirty four years early statistical analysis of pharmacist with gender distri-
bution, pharmacist
Pharmacist Yearly
Yearly per % population
Year Yearly total Male Male % Female Female %
addition 1000000 Addition growth
population (X100000)
1972 122 122 117.00 95.90 5.00 4.09 3.06 - 39.83
1973 113 235 108.00 95.58 5.00 4.43 5.76 48.09 40.83
1974 57 292 55.00 96.49 2.00 3.51 6.98 19.52 41.84
1975 38 330 35.00 92.11 3.00 7.99 7.71 11.52 42.82
1976 58 388 53.00 91.38 5.00 8.62 8.87 14.95 43.77
1979 31 419 30.00 96.77 1.00 3.23 8.78 7.40 47.72
1981 38 457 35.00 92.11 3.00 7.99 8.97 8.32 50.95
1982 30 487 28.00 93.33 2.00 6.67 9.24 6.16 52.69
1984 98 585 86.00 87.76 12.00 12.24 10.51 16.75 55.64
1985 60 645 54.00 90.00 6.00 10.00 11.28 9.30 57.16
1986 37 682 34.00 91.89 3.00 8.11 11.57 5.43 58.93
1987 21 703 18.00 85.71 3.00 14.29 11.56 2.99 60.81
1988 119 822 110.00 92.44 9.00 7.56 13.10 14.48 62.73
1989 126 948 104.00 82.54 22.00 17.46 14.67 13.29 64.63
1990 132 1080 105.00 79.55 27.00 20.45 16.23 12.22 66.54
1991 70 1150 59.00 84.29 11.00 15.71 16.80 6.09 68.46
1992 128 1278 109.00 85.16 19.00 14.84 18.26 10.02 69.98
1993 100 1378 78.00 78.00 22.00 22.00 19.29 7.26 71.44
1994 95 1473 76.00 80.00 19.00 20.00 20.12 6.45 73.22
1995 112 1585 87.00 77.68 25.00 22.32 21.09 7.07 75.14
1996 119 1704 84.00 70.59 35.00 29.41 22.06 6.99 77.23
1997 55 1759 36.00 65.46 19.00 34.55 22.21 3.13 79.21
1998 158 1917 106.00 67.09 52.00 32.91 23.63 8.24 81.14
1999 256 2173 167.00 65.23 89.00 34.77 26.15 11.78 83.09
2000 112 2285 78.00 69.64 34.00 30.36 26.77 4.90 85.36
2001 256 2541 165.00 64.45 91.00 35.55 28.94 10.07 87.81
2002 190 2731 117.00 61.58 73.00 38.42 30.43 6.96 89.75
2003 244 2975 157.00 64.34 87.00 35.66 32.56 8.20 91.37
2004 287 3262 160.00 55.75 127.00 44.25 35.04 8.80 93.09
2005 571 3833 469.00 82.14 102.00 17.86 41.18 14.90 93.09
2006 415 4248 271.00 65.30 144.00 34.70 44.01 9.77 96.53
2007 467 4715 280.00 59.96 187.00 40.04 47.98 9.91 98.28
2008 470 5185 263.00 55.96 207.00 44.04 51.88 9.07 99.95
2009 697 5882 393.00 56.39 304.00 43.62 57.89 11.85 101.62
Total 34 34 34 34 34 34 34 33 34
Mean 173.00 1772.62 121.38 78.6050 51.62 21.4015 21.61 10.6630 70.67
Median 116.00 1328.00 95.50 81.0700 20.50 18.9300 18.78 9.0700 70.71
Grouped
115.00 1328.00 95.50 81.0700 20.80 18.9300 18.78 9.0700 70.71
Median
Std. Error
28.691 263.106 17.789 2.33114 12.127 2.33025 2.418 1.34306 3.289
of Mean
Sum 5882 60269 4127 2672.57 1755 727.65 735 351.88 2403
Minimum 21 122 18 55.75 1 3.23 3 2.99 40

26 Indian Journal of Pharmaceutical Education and Research | Vol 50 | Issue 1 | Jan-Mar, 2016
 Taha et al., Current health system to achieve the Millennium Development Goals

Maximum 697 5882 469 96.77 304 44.25 58 48.09 102

Range 676 5760 451 41.02 303 41.02 55 45.10 62
First 122 122 117 95.90 5 4.09 3 48.09 40
Last 697 5882 393 56.39 304 43.62 58 11.85 102
Std.
167.295 1534.16 103.725 13.59275 70.712 13.58755 14.101 7.71527 19.178
Deviation
Variance 27987.636 2353645.880 10758.910 184.763 5000.183 184.621 198.850 59.525 367.782
Kurtosis 2.406 .661 3.669 -1.368 4.220 -1.367 .325 17.778 -1.185
Std. Error
.788 .788 .788 .788 .788 .788 .788 .798 .788
of Kurtosis
Skewness 1.712 1.189 1.895 -.273 2.020 .273 1.007 3.754 -.054
Std.
Error of .403 .403 .403 .403 .403 .403 .403 .409 .403
Skewness
Harmonic
81.07 736.02 68.15 76.1716 6.98 11.8017 13.68 8.1080 65.20
Mean
Geometric
116.74 1185.30 90.37 77.4089 19.23 16.4835 17.44 9.1833 67.98
Mean

equipped tertiary level teaching hospitals associated with or sub-national parliament to controlling individual
medical/ health teaching institutions. However, this or collective behavior. In commonwealth countries,
extensive health care infrastructure has not been trans- the term is used both in a narrow sense, as the formal
lated into optimal health care delivery due to a number description of a law passed in certain territories, and
of issues related to the health system.12 This includes in a wider sense for primary legislation passed in coun-
the poor motivation of the health workforce due to lack try.14 That can be taken in many forms: a) medico-legal
of good career structures and work environments, mal restrictions promulgated by a government authority, b)
distribution of resources between urban and rural areas, self-regulation by a pharmaceutical industry through a
and the lack of a national human resources for health trade association, c) social regulation, d) co-regulation
policy. Only 0.5% of gross domestic product (GDP) is and e) market regulation. One can consider regulation as
spent on health. That is very low and leads to an inability actions of conduct imposing sanctions. Hence; adminis-
of the government to provide the required medicine and trative drug law, or implementing pharmaceutical regu-
laboratory support to health care delivery resulting in an latory law, may be contrasted with statutory or case law.
out-of-pocket expenditure on health of around 80%. The regulations, policies and ordinance are enforced to
Furthermore, the miserable part of current scenario is optimize the health practice, clinical and/ or pharma-
the poor health information system, which does not pro- ceutical care.15 The health professional and regulatory
duce the quality data required for planning.13 authority works to resolve legal discrepancies, correct
clinical care and assure the safety of patients. That col-
Drug jurisprudence
laborate the individual and institutional working and
A strategic support for health care system may poten- provide standard guidelines for health professionals.
tially help to improve the pharmaceutical care, clini- Drug Act, 1976 was promulgated on 11th May, 1976 in
cal facilities and control the infectious superbugs in Pakistan to regulate the drug administration, enforce-
Pakistan. Whereas, the accomplishment of drug juris- ment, prohibition, offences, penalties and procedures.
prudence may also assure the rationalization of pharma- There were certain pharmaceutical discrepancies; drug
cotherapy and clinical practice. We may than minimize related complication and worldwide changes in health
the avoidable mortalities. Moreover, the therapeuti- scenario has posed potential challenges. That needs an
cal drug monitoring, pharmaceutical care and patient accurate and urgent response. Hence; the pharmaceuti-
awareness/ counseling will play a key role to establish cal professionals and drug experts work hard to provide
health standards and achieve the Millennium Develop- high quality legislation Punjab Drug Rule, 2007. The
ment Goals (MDG’s) of World Health Organization Governor of the Punjab, Pakistan has notified this Pun-
(WHO). Hence, the establishment, bureaucracy, civil jab Drugs Rules 2007 under section 44 of the Drugs
society and health professional have to design a collec- Act 1976. The rules were revised after a gap of 19 years.
tive effort to assure the achievement of MDG’s. Thus, Under this rules, the licensing authority will issue the
Drug Act is enacted as primary legislation by a national drug sale license on basis of the report of the drug
Indian Journal of Pharmaceutical Education and Research | Vol 50 | Issue 1 | Jan-Mar, 2016 27
 Taha et al., Current health system to achieve the Millennium Development Goals

Figure 1: Chronological review of male, female and yearly addition of pharmacists during last thirty four (34) years; 1972-2009;
in Punjab province of Pakistan

inspection of that area of jurisprudence to make sure under the Act or rules and may allow an inspector to
the clean and hygienic premises of a pharmacy or medi- institute prosecution against such person. According to
cal store, adequate facility for storage of drugs and for the rules, no person shall be appointed as an inspector
their protection from direct sunlight and dust. More- unless he holds a degree in pharmacy from a university
over; the period of renewal of the license reduced from or an institution recognized by the Pharmacy Council
two to one year. Particularly; these rules barred the drug of Pakistan and has at least one-year experience in man-
store that not hired the pharmacist for the purpose of ufacture, sale, testing and analysis of drugs.
pharmaceutical community services to sell a total one
Punjab Drug Rule, 2007
hundred and forty five (145) life-saving controlled, nar-
cotics or potent drugs. It is enforced to accomplish with Clinical and pharmaceutical Role
the internationally accredited standards and provide
The health system of Pakistan lacks the appropriate
quality health services. It becomes especially important
clinical and pharmaceutical services. The major com-
to promote the rational drug usage and encourage phar-
macy culture in Punjab province of Pakistan. Hence; in ponents of pharmaceutical care; patient counseling,
this way approximately 50,000 drug stores in Punjab are prescription review, therapeutical drug monitoring have
requested to comply with the internationally accredited not been correctly included in health care system of the
criteria to improve the health standards in province. province. The role of pharmacist has not been officially
Furthermore; a nine-member Provincial Quality Con- notified in hospital and clinical settings. Hence; the drug
trol Board (PQCB), headed by the provincial health sec- experts or pharmacists are intentionally (or may be
retary, has been constituted. The board may constitute a unintentionally) placed into non-professional adminis-
committee in a district to be known as the district qual- trative and managerial positions. The more terrible part
ity control board. Both boards may meet at least once a of this scenario is the absence of ambitions and poten-
month to review the situation of drugs’ quality control. tial to correct the role of qualified pharmacist. The role
Before referring a case to a drug court, the provincial or of pharmacist has been modified worldwide. He sup-
district board shall ascertain the name of the director, posed to be more responsible to review and correct the
partner, and employee of the company who is prima dose,16,17 regimen, therapy plan and treatment protocols
facie responsible for the commission of the offence to assure quality health services. The new z
28 Indian Journal of Pharmaceutical Education and Research | Vol 50 | Issue 1 | Jan-Mar, 2016
 Taha et al., Current health system to achieve the Millennium Development Goals

Figure 2: Comparison of male (%), female (%), pharmacist/1000,000 population and % addition of pharmacists with time (last
thirty four years) 1972-2009; in Punjab province of Pakistan

Pharmaceutical Profession Intervention conferred upon him under Section 44 of the Drug
There are very limited numbers of chemist shops in Act. 1976 (XXXI of 1976) which empower govern-
Pakistan offering the patient counseling, guidance and ment to make rules under Act subjected to previous
information facilities. There are not proper arrange- publication. The governor of the Punjab has made
ments to guide the patient regarding the therapeuti- amendments in the Punjab Drug Rules, 2007 after
cal, clinical and pharmaceutical information of drug previous publication of these amendments. In rule 1,
and disease. Especially; the professional intervention sub rule (3) for the word “three” is substituted by the
of pharmacist produces a compatibility of drugs with word “ten”. Thus the drug rule enforced in 2007 and
the patient’s medical profile,10 social constraints and
supposed to be fully implemented in July, 2010 is now
personal obtained data. Thus; Punjab drug Rule 2007
endows professional services along with the coverage enforced in 2017. The enforcement is delayed because
enforcement worldwide accepted clinical services. of the arguments as under;
• There are no sufficient numerical pharmacists
Control over the Potent and Control Drugs
available to place at each and every drug stores of
Drugs are quite different than food, grocery, appli- province. This rule may affect about 50,000 drug
ances and daily utensil. These are delivered in an
stores in Punjab province of Pakistan.4
appropriate scientific way with standard procedure
• Current health system needs such practice to serve
to avoid any health hazard.11 But unluckily; there in
no control over the potent drugs to assure health ser- the non-affording community; particularly in rural
vices. A clear distinction of over the counter drugs areas of the province.
and scheduled drugs are described under this Punjab • Pharmaceutical business organizations (retail med-
drug rule, 2007. These definitions also referred as ical stores, wholesale drug stores, pharmaceutical
schedule G drugs. distributers etc) of province can’t afford the mini-
Suspension of Drug Rule 2007 mum salary package that could be offered to quali-
fied registered category-A pharmacists.
The drug rule 2007 was suspended by Governor Pun-
jab, Pakistan because of some ambiguous reasons. The • Current health structure can’t match with standard
secretary to the Governor of the Punjab has issued addressed in Punjab Drug Rule, 2007.
notification by the order of the governor of the Pun- • The attitude of civil society, individual behaviors
jab; printed in the Punjab weekly gazette dated Feb- of patients and official bureaucratic structure hav-
ruary 10, 2010, page No. 951. In exercise of power ing insufficient potential to enforce the changes.
Indian Journal of Pharmaceutical Education and Research | Vol 50 | Issue 1 | Jan-Mar, 2016 29
 Taha et al., Current health system to achieve the Millennium Development Goals

• That may cause a big trouble for patients’ maintain Tubocuraine, Suxamethonium and Neostigmine - for
a regular therapy of diseases i.e. diabetes, hyperten- antibiotics - Spectinomycin, Teicoplanon, Sodium Fusi-
sion, AIDS, gout, allergy etc. date, Vancomycin, Colistin and Impenem - for inotro-
• Unclear role of wholesalers and distributors. pics - Primacor, Enoximone and Milrinone - for injection
Thus; the chemist association has not accepted this prostaglandins - Dinoprotone, Gemeprost AND Car-
rule and protest the government to withdraw/ delay boprost - for alpha blocker - Prazosin Hcl, Daxazosing,
implementation. The pharmaceutical merchandisers, Indramine and Alfuzosin - for biotechnological prod-
manufacturers, druggists and chemist associations are ucts - Interferon and Erythropoetin - for narcotics,
working effectively to preserve their privilege of gigan- psychotropic and tri cyclic ant-depressant - Morphine,
tic profit, legal exemptions and untrained working prac- Buprenorphine, Nalbuphine, Fantanil, Pethidine, Loraz-
tice. This potential confliction of interest can be noticed epam, Temazepam, Chlorpromazine, Melprobamate,
in community pharmacies, hospital settings and official Chlordiazepoxide, Alprozolam, Clonazepam, Fluraz-
health institutions. The business community is seemed epam, Loprazolam, Oxazepam, Amoxapine, Iprine Dole
to be dominant over skilled, qualified and profession- Codine, Pentazocine, Lithium, Dextropropoxyphene,
ally competent drug experts or pharmacists. They have Clomipramine, Mianserin, Maprotiline, Dothiepin, Dox-
excellent resources, efficient political influence, good epin, Nortriptyline, Trimiprammine, Tranycypromine,
team work and loyalty with their violation. Flupenthixol, Tryptophan, Imipramine and Amipriptyline
Impact of suspension of Drug Rule 2007 - for anti-viral - Acyclovir, Amantadine Hcl, Famciclovir,
Punjab Drug Rule, 2007 was an important document for Inosine Pranolsex, Zidovudine, Ganciclovir, Idoxuridine,
society, health professional and pharmaceutical business Riavirin, Vidarabrin, Trifluridine and Methisozone - for
community. That may impact the community pharmacy thrombolytic enzymes - Alteplase, Streptokinase, Anislre-
practice, pharmaceutical supplies and official procure- plase and Urokinase - for dialysis - Peritoneal, Haemodi-
ments. The physicians and pharmaceutical companies alysis, Hyper tonic solution, Lysine solution and Isotonic
also like to change the rule to establish a harmony. The solution - for creams and aerosols steroidal preparations
over impact of Punjab Drug Rule, 2007 is as under; Methylprednislone, Dexamethasone, Hydrocortisone,
Prednisolone, Tramcionolone and Beclomethasone -
Community Pharmacy practice
for hormones - Vasopressin, Desmopressin, Stanozolol,
The actual role of pharmacist may introduced by the Nandrolone, Mesterlolone, Finasteride, Finasteriode,
enforcement of drug rule 2007. As the drug rules 2007 Somatropin, Testosterone and Progestrogens.
has reduced the period of renewal of drug sale license The administrative function of pharmacist most prob-
from two to one year. The licensing authority also not ably is converted into his actual professional role
probably issues the license without the consent of drug required by the system. Responsibilities of pharma-
inspector. The drug rule 20 (1) (e) says: “A licensee of cist will become more versatile and critical.18 Presently
a medical store shall not sell or store a drug mentioned drug sale license is awarded to pharmacist assistant,
in the schedule G”. The drugs included in this schedule category-B holders and pharmacy technicians and will
are; for anti-leprosy - Rifampicin Injection, Dapsone, be declined. As the pharmaceutical merchandisers hire
Clofamazine, Ethionamide and Prothionemide, for the degree (or his Category A) and pay Rs1,000-10,000
immunological products, vaccines, sera\ant-sera - Vac- per monthly or yearly basis, depending upon agreement
cines of Anthrax, BCG, Botulisms Antitoxin, Cholera, reached or understanding between two parties.
Influenza, Measles, MMR, Rubella, Pneumococcal, Polio-
General physician practice
myelitis, Smallpox, Typhoid, Rabiies and Homophiles
Influenza Type B, and Immunoglobulins, for products Presently the marketing strategies of considerable num-
related with malignant diseases and immunosupression ber of pharmaceutical companies do not qualify the
- Folinic Acid, Doxorubicin HCI, Mercaptopurine, Thio- moral criteria. The unethical promotion schemes award
guanine, Vincristine, Cisplastin, Busulphan, Carmustine, sufficient benefits to physicians in the form of renovat-
Lomustine, Cyclophosphamide, Melphalan, Fluorouracil, ing the clinics, gifting expensive equipments, providing
Mitozantrone, Methottrexate, Vinblastine, Carboplatin, home appliances (from juicer machine to motor car),
Bleoimycin, Chlorambucil, Dacarbazine, Amasascrine, offering the printing/ stationary facilities, financing for
Azathioprine and Cyclosporin - for anesthesia and touring abroad, funding for diners and extending the
inhalation anesthetics - Propofol, Enfluran, Isofluran, limits of courtesy by paying their utility bills. Moreover;
Halotha ne, Bupivacain, Thiopentone, Benzodiazepine, some companies offered the hard cash commission for
Mitazolam, Naloxone Hcl, Vancuronium, Pancuronium, successful achievement of the agreed sale targets. This
30 Indian Journal of Pharmaceutical Education and Research | Vol 50 | Issue 1 | Jan-Mar, 2016
 Taha et al., Current health system to achieve the Millennium Development Goals

criminal understanding might be disturbed by enforcing withdrawal of the new regulations. Selling the life saving
the Punjab drug rule 2007. Therefore; their represent- drugs by the way of whole sale has imposed hazardous
ing body the Pakistan Medical Association (PMA) has effects as under; 1). The regulatory control over the nar-
recorded the protest in Lahore on Wednesday, August cotics and potent drugs (benzodiazepines, opiate alka-
01, 2007. They rejected the Punjab Drug Rules 2007 and loids, vaccine, anticancer, tranquilizers) undermined. 2).
said that amendments were not favorable for people. In The chances of breaching of the cool chain increased.
a press release, PMA General Secretary and Finance Thus; the over or under temperature preservation dete-
Secretary said the amendments in the Punjab Drug riorate the efficacy of drugs. 3). Record keeping, invoic-
Rules 2007 would promote nepotism. Few affluent peo- ing, warranting and regularizing the inventory become
ple would get benefit while thousands of medical stores ambiguous and difficult. 4). Chanced of introduction of
would be closed down. Furthermore; the PMA office- substandard, non-warranted, spurious and misbranded
bearers criticized the government for not implementing increased. Thus; the overall quality of pharmaceutical
the Punjab Drug Rules 1988 in its true spirit and alleged care and health standards deteriorated. 5). The pres-
that the drug mafia had brought about these amend- ent whole sale business procedures in Pakistan; Lohari
ments with the connivance of drug inspectors to spread market Lahore, Bohar Bazar Rawalpinidi etc is totally
its business across the Punjab. They demanded that the wrong practice as per criteria of health sciences. These
government abrogate the amendments in the best inter- are places for smugglers, rule violators and corrupt mer-
est of the people. chandisers. Such places and business kinds supply the
Clinical pharmacy practice illegal, banned and withdrawn drugs directly into the
A standard clinical pharmacy practice offer drug infor- society through the quacks, dispensers (category B hold-
mation, quality medicines, pharmaceutical care, com- ers or pharmacy technicians), retailers (having drug sale
prehensive knowledge of treatment19 and therapeutical license without hiring services of pharmacist).
skills. Being a part of clinical practice; pharmacy is the Potential risk factors
rapidly growing discipline of health sciences. There- The potential risk factors of Punjab drug rules 2007
fore; Punjab drug rule 2007 facilitate its implication and are included in either sense of the business damages,
rationalize the scientific approach. The basic apprehen- extra pharmaceutical legal restrictions, limited health
sions of this segment of pharmaceutical care are to product ranges and hiring specific skilled workforce.
understand the chemotherapy protocols, accuracy of While in other way; the benefits are include the busi-
regimens and professional obligations. The overwhelm- ness improvement, exemptions of the legal restrictions,
ing scientific information explosively changing the usual extension of the business size and running company
concepts regarding the mechanism, bioavailability and
with raw handed workers. The rapidly growing pharma-
half life that ultimate have introduced the new thera-
cist community was excited for getting the chance to
peutical orientation; pharmacogenetic, pharmacomet-
prove their professional expertise. They were ambitious
rics and pharmacodynamic.20 It is therefore particularly
to exhibit their all theoretical learning’s into actual phar-
tried to clear scientific conceptual ambiguities.
maceutical practice. A total more ≥ 6000 registered with
Pharmaceutical merchandisers the Punjab Pharmacy Council and ≥ 3000 graduating
The whole sale or massive uncontrolled selling of phar- pharmacists in Pakistan definitely wish to improve their
maceuticals is the major source of unnecessary drug professional worth. In other way; the raw workers and
usage and poor clinical practice.21 There are so many pharmaceutical business merchandisers strive to grab
protests of chemist associations recorded during last gigantic profit, exemptions from the legal restrictions,
five years. In Multan, Aug 12, 2007 chemists held a improvement of business size/ range with untrained
protest demonstration against Punjab Drug Rules 2007 workers. This confliction of interest can be observed
at Clock Tower Chowk. The protesters led by Multan in national/ provincial assemblies, health departments,
Wholesale Chemists Council and blocked the road and pharmaceutical market places (Lohari market Lahore,
chanted slogans for the withdrawal of rules. Speak- Bohar Bazar Rawalpindi etc) and academic institutions.
ing on the occasion said the new regulations would The professional struggle of pharmacist community
be economically disastrous for chemists. They would is not effectual because of the lack of the mandated
not accept one-sided amendments to drug rules. The leadership and influence of government officials
Punjab government had changed the drug rules with- over conclusive procedures. Moreover, the individual
out consultation. They would set up huger-strike camps pharmaceutical professional bodies don’t have com-
and hold demonstrations in each city of Punjab till the mon agenda and professionally preferred objectives.
Indian Journal of Pharmaceutical Education and Research | Vol 50 | Issue 1 | Jan-Mar, 2016 31
 Taha et al., Current health system to achieve the Millennium Development Goals

Whereas; the efforts of business community are more pharmacometrics should also be implicated to achieve
effective, collective and successful.22 They have more the MDG’s of World Health Organization.
reliable political connections, better financial resources
and excellent professional commitments. Hence, the ACKNOWLEDGEMENT
current pharmaceutical situation and drug jurispru- The authors acknowledge the kind support of Muham-
dence need attention to establish a balanced clinical and mad Shamoon Chaudhary, Secretary Punjab Pharmacy
health care system.23 That may potentially improve the Council and Prof. Dr. Nadeem Irfan Bukhari, Univer-
public health and assure the achievement of MDG’s in sity College of Pharmacy, University of the Punjab,
Punjab Province of Pakistan. Lahore, Pakistan.

CONCLUSION CONFLICT OF INTEREST

Current health system needs serious attention to address The authors declare no conflict of interest.
the potential health problem in Punjab province of Pak-
istan. A prospective jurisprudential support may help to ABBREVIATIONS
improve the clinical and pharmaceutical care. Moreover, DRAP : Drug Regulatory Authority of Pakistan.
there is an insufficient aspiration in health officials to PCP : Pharmacy Council of Pakistan
assign the more relevant, professional and clinical role HEC : Higher Education of Pakistan
i.e. dose correction, regimen rationalization, prescrip- DTL’s : Drug Testing Laboratories
tion review, patient counseling, therapeutical drug EDO’s : Executive District Officers
monitoring to pharmacy professionals, instead of cur- BEMS : Bachelor of Eastern Medicine & Surgery
rent clerical and administrative work. Additionally; the BHMS : Bachelor of Homeo Medicine & Surgery
pharmacacovigilance, ADR’s, pharmacoecnomics and PPA : Pakistan Pharmacists Association

SUMMARY
• Description of most current situation of pharmacy profession in Pakistan.
• Impact of promulgation of 18th constitutional amendment in June 2011 and dissolution of Federal Ministry of
Health, Govt. of Pakistan.
• Depiction of current clinical and pharmaceutical care of patient i.e. prescription reviewing, therapeutical moni-
toring, patient’s counseling and drug information.
• Envision of academic situation, to determine an integrated opponent lobby in academic institutions and in
professional body of Pakistan Pharmacists Association (PPA). They have good control and connection with
Drug Regulatory Authority (DRAP), Pharmacy Council of Pakistan (PCP), Higher Education Commission (HEC),
provincial health departments, Drug Testing Laboratories (DTL’s) and pharmaceutical manufacturers.
• Justification of an appropriate intervention of government agencies, health authorities, and professional asso-
ciations in clinical settings.
• Narration of collective effort needed to introduce the therapeutical drug monitoring, phramcovigilance, pre-
scription review and patient’s counseling to mitigate the mortalities. It may potentially work like a safety valve
and assure the correct medication at right time, right dose through proper route.
About Authors
I was awarded the Ph.D degree in Microbiology by the Quid -I-Azam University, Islamabad. While;
the degrees of M. Phil (Pharmacology) and Bachelor of Pharmacy were awarded two different
Pakistani universities-University of Agriculture, Faisalabad, and University of the Punjab, Lahore,
Pakistan. I have more than thirteen year’s research, academic and professional experience
along with exceptional exposure of miscellaneous biological techniques. I have good command
over his disciplines of pharmacological, clinical pharmacy, epidemiology, microbiological and pharmaceutical
biotechnology. Moreover; I have sufficient teaching experience to the student of Pharm D and M.Phil in different
universities along with other professional expertise includes drug design, manufacturing, marketing and product
development.

32 Indian Journal of Pharmaceutical Education and Research | Vol 50 | Issue 1 | Jan-Mar, 2016
 Taha et al., Current health system to achieve the Millennium Development Goals

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