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[e-drug] Pharmacist To Population Ratio (cont'd)

  • From: Kirsten Myhr <myhr@online.no>
  • Date: Sun, 6 Feb 2000 23:23:52 -0500 (EST)

E-drug: Pharmacist To Population Ratio (cont'd)

I have not seen that figure in any WHO document on the pharmacist's
role, but maybe in another place? To me that sounds unlikely,
because, as many has mentioned, it is almost impossible to give such
a figure as the situation is so different worldwide. I also find the
mentioned figure rather high. The WHO report "The role of the
pharmacist in the health care system (WHO/PHARM/DAP/90.1) says
about manpower imbalances:

quote: Throughout the Third World, wherever there are severe
shortages of medical services there are corresponding shortages of
pharmaceutical services and of pharmacists, and most of the people
have no access to basic lifesaving drugs. At the same time, medicinal
drugs, many of which are useless or dangerous and unnecessary, are
available in extensive, open, unregulated markets. In some of the more
advanced developing countries, the ratio of pharmacists to population
is relatively high in urban areas but extremely low in rural areas. In
general, however, ratios of less than 1:100,000 are common and
some countries have very much lower ratios. Within countries, ratios
may vary from 1:12,000 in the capital city to 1:700,000 or less in the
provinces, reflecting, and associated with, the shortage and
maldistribution of professional health manpower in general, and the
very low levels of socioeconomic development. This must be
compared with an average of around 1:2,300 in the industrialised
countries. end quote

Anyone interested in the effect of privatisation on pharmacies and the
role of professions should read the following article - abstract quoted

Morgall JM, Almarsdottir AB. No struggle, no strength: how
pharmacists lost their monopoly. Soc Sci Med 1999;48:1247-58.

Research accounts of the struggle of profession to attain and maintain
a monopoly, strategies of exclusion and usurpation, make for
interesting and often exciting reading. The purpose of this article is to
present a less frequently reported phenomenon - the study of a
profession that had a monopoly and lost it. The authors attempt to
answer the question: under what circumstances will a profession
support the state in breaking their own monopoly? The study looked
at the pharmacy profession in Iceland in the light of the recent change
in drug legislation. Interviews with key actors in the pharmacy
profession were conducted to gain an understanding of how they
interpreted and experienced this change.Three factors contributed to
the break in the professional monopoly: (1) political desire to take
advantage of new competition and deregulation policy, (2) desire to
cut the health budget and (3) internal division within the profession.
The results of the study revealed at least four internal divisions within
the pharmacy profession: (1) urban/rural, (2) employer/employee, (3)
lower/higher education and (4) young/old.The article illustrates how a
profession weakened by internal strife became prey to the
government's cost cutting activities. This study is an example of how
internal conflicts not only weakened the profession, but created a
climate conducive to losing its monopoly. Our findings raise
fundamental questions about the future of professions in society

Foppe van der Mil rightly corrected Natalia on the situation in the
Nordic countries. It should be added that the Swedish government had
proposed to privatise the pharmacies in Sweden, but lost and the state
monopoly will continue. A victory for those of us who sees
pharmacies not as a shop but as an important part of health care. A
Norwegian white paper has proposed to loosen up government control
of the pharmaceutical sector in Norway and allow free establishment
of pharmacies. The Parliamentary Committee on Health and Social
Affairs is expected to give its comments 15 February and the paper
will then go to Parliament. In Denmark a liberalisation is now being

Finally, I do hope pharmacists will occupy themselves more with
utilising their skills and expertise to prove their value to society.
Presenting figures to governments does not release the necessary
resources unless politicians and other health professionals value our
role. By violating national regulations such as selling prescription only
drugs without prescription, charging more than the fixed margin,
promoting use of drugs of dubious quality or efficacy, avoid public
sector jobs etc. we will soon disappear as health professionals ......

Regards Kirsten

Kirsten Myhr, MScPharm, MPH
Bygdøy alle 58B
0265 Oslo, Norway
Tel.: +47 22 56 05 85

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