CoChat
Sign Up
Cited by 225Pharmacy and Medical PracticesPharmaceutical Quality and CounterfeitingPharmaceutical Economics and Policy

Performance of retail pharmacies in low- and middle-income Asian settings: a systematic review

Open access
Miller, Rosalind, Goodman, Catherine·2016·Health Policy and Planning
DOI 10.1093/heapol/czw007PMC PMC4977427
Open this paper in CoChat — free accountOpen PDF

Abstract

In low- and middle-income countries (LMIC) in Asia, pharmacies are often patients' first point of contact with the health care system and their preferred channel for purchasing medicines. Unfortunately, pharmacy practice in these settings has been characterized by deficient knowledge and inappropriate treatment. This paper systematically reviews both the performance of all types of pharmacies and drug stores across Asia's LMIC, and the determinants of poor practice, in order to reflect on how this could best be addressed. Poor pharmacy practice in Asia appears to have persisted over the past 30 years. We identify a set of inadequacies that occur at key moments throughout the pharmacy encounter, including: insufficient history taking; lack of referral of patients who require medical attention; illegal sale of a wide range of prescription only medicines without a prescription; sale of medicines that are either clinically inappropriate and/or in doses that are outside of the therapeutic range; sale of incomplete courses of antibiotics; and limited provision of information and counselling. In terms of determinants of poor practice, first knowledge was found to be necessary but not sufficient to ensure correct management of patients presenting at the pharmacy. This is evidenced by large discrepancies between stated and actual practice; little difference in the treatment behaviour of less and more qualified personnel and the failure of training programmes to improve practice to a satisfactory level. Second, we identified a number of profit maximizing strategies employed by pharmacy staff that can be linked to poor practices. Finally, whilst the research is relatively sparse, the regulatory environment appears to play an important role in shaping behaviour. Future efforts to improve the situation may yield more success than historical attempts, which have tended to concentrate on education, if they address the profit incentives faced by pharmacy personnel and the regulatory system.

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Integrity signals

Registry

Crossref · 10.1093/heapol/czw007

Cites

1 of 1 references verified0 citation errors · 0 not checkable

Statistics

Claims the paper makes

The claims and statistics of this paper haven’t been checked yet.

Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.

A few free checks a day · papers already verified open instantly · results are public

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

  • Primary healthcare providers in urban informal settlements are less likely to refer patients who require medical care to seek treatment.

    “These individuals are less likely to refer patients who require medical care to seek treatment 23 .”

    From Urban informal settlements as hotspots of antimicrobial resistance and the need to curb environmental transmission. (2020) · cites this paper as [23]

    In Results, Part one (page unavailable), the review reports that retail pharmacists in low- and middle-income Asian settings referred only 7%–37% of simulated patients with several conditions requiring medical attention. This supports the concern about inadequate referral, but the passage does not establish the claim specifically for primary healthcare providers in urban informal settlements or identify a comparison group for “less likely.” (LLM, conf=0.85)

    Experimental — accuracy not yet measured

  • Incomplete courses and counterfeit or substandard antibiotics accelerate the selection of antimicrobial resistance.

    “Such antibiotics may be consumed or sold as incomplete courses and a substantial portion may be counterfeit or of substandard quality 23,25 , which also accelerates the selection of AMR.”

    From Urban informal settlements as hotspots of antimicrobial resistance and the need to curb environmental transmission. (2020) · cites this paper as [23]

    The Results (Part one; page unavailable) report incomplete antibiotic courses, and the Discussion says antibiotic misuse has led to the selection and spread of resistant bacteria. The Methods (Scope of review; page unavailable) recognize substandard and counterfeit medicines but place them beyond the review’s scope; the paper does not establish that a substantial portion of antibiotics are of poor quality or specifically link their quality to resistance selection. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

Self-check

Percentages, sums and reported differences re-computed from the paper’s own numbers.

The self-check needs the paper’s full text.

Cites

Flagged first, then by citations

Research works printed but not linked: 88

  1. Al-Faham Z Habboub G Takriti F. 2011 The sale of antibiotics without prescription in pharmacies in Damascus, Syria. Journal of Infection in Developing Countries 5: 396– 9. 21628818
  2. Anderson S. 2002 The state of the world's pharmacy: a portrait of the pharmacy profession. Journal of Interprofessional Care 16: 391– 404. 12487847
  3. Apisarnthanarak A Tunpornchai J Tanawitt K Mundy LM. 2008 Nonjudicious dispensing of antibiotics by drug stores in Pratumthani, Thailand. Infection Control and Hospital Epidemiology 29: 572– 5. 18510468
  4. Basak SC Sathyanarayana D. 2010 Evaluating medicines dispensing patterns at private community pharmacies in Tamil Nadu, India. Southern Medicine Review 3: 27– 31.
  5. Bista KP Chaudhary P Slanger TE Khan MH. 2002 The practice of STI treatment among chemists and druggists in Pokhara, Nepal. Sex Transmitted Infections 78: 223 PMC1744481 12238660
  6. Blair RD Kaserman DL. 1994 A Note on Incentive Incompatibility under Franchising. Review of Industrial Organization 9: 323– 30.
  7. Bloom G Standing H Lloyd R. 2008 Markets, information asymmetry and health care: towards new social contracts. Social Science and Medicine 66: 2076– 87. 18316147
  8. Chalker J Chuc N Falkenberg T Do N Tomson G. 2000 STD management by private pharmacies in Hanoi: practice and knowledge of drug sellers. Sexually Transmitted Infections 76: 299– 302. 11026888 PMC1744190
  9. Chalker J Ratanawijitrasin S Chuc N Petzold M Tomson G. 2005 Effectiveness of a multi-component intervention on dispensing practices at private pharmacies in Vietnam and Thailand—a randomized controlled trial. Social Science and Medicine 60: 131– 41. 15482873
  10. Chua SS Lim KP Lee HG 2013 Utilisation of community pharmacists by the general public in Malaysia. The International Journal of Pharmacy Practice 21: 66– 9. 23301536
  11. Chuc N Larsson M Falkenberg T 2001 Management of childhood acute respiratory infections at private pharmacies in Vietnam. Annals of Pharmacotherapy 35: 1283– 8. 11675861
  12. Chuc NT Larsson M Do NT 2002 Improving private pharmacy practice: a multi-intervention experiment in Hanoi, Vietnam. Journal of Clinical Epidemiology 55: 1148– 55. 12507680
  13. Chuc NTK Tomson G. 1999 “Doi moi” and private pharmacies: a case study on dispensing and financial issues in Hanoi, Vietnam. European Journal of Clinical Pharmacology 55: 325– 32. 10424327
  14. Cockburn R Newton PN Agyarko EK Akunyili D White NJ. 2005 The global threat of counterfeit drugs: why industry and governments must communicate the dangers. PLoS Medicine 2: e100 15755195 PMC1062889
  15. Cong LD Yen PT Nhu TV Binh LN. 1998 Use and quality of antimalarial drugs in the private sector in Viet Nam. Bull World Health Organisation 76: 51– 8. PMC2305575 9763723
  16. Cross J Macgregor HN. 2010 Knowledge, legitimacy and economic practice in informal markets for medicine: a critical review of research. Social Science and Medicine 71: 1593– 600. 20855143
  17. Dineshkumar B Raghuram TC Radhaiah G Krishnaswamy K. 1995 Profile of drug use in urban and rural India. Pharmacoeconomics 7: 332– 46. 10155322
  18. Dua V Kunin CM White LV. 1994 The use of antimicrobial drugs in Nagpur, India. A window on medical care in a developing country. Social Science and Medicine 38: 717– 24. 8171350
  19. Duong D Le T Binns CW. 1997a Diarrhoea management by pharmacy staff in retail pharmacies in Hanoi, Vietnam. International Journal of Pharmacy Practice 5: 97– 100.
  20. Duong DV Binns CW Le TV. 1997b Availability of antibiotics as over‐the‐counter drugs in pharmacies: a threat to public health in Vietnam. Tropical Medicine and International Health 2: 1133– 9. 9438468
  21. Ferguson AE. 1981 Commercial pharmaceutical medicine and medicalization: a case study from El Salvador. Culture, Medicine and Psychiatry 5: 105– 34. 7261658
  22. Frant H. 1996 High-powered and low-powered incentives in the public sector. Journal of Public Administration Research and Theory 6: 365– 81.
  23. Goel P Ross-Degnan D Berman P Soumerai S. 1996 Retail pharmacies in developing countries: a behavior and intervention framework. Social Science and Medicine 42: 1155– 61. 8737433
  24. Greenhalgh T. 1987 Drug prescription and self-medication in India: an exploratory survey. Social Science and Medicine 25: 307– 18. 3629304
  25. Haak H. 1988 Pharmaceuticals in two Brazilian villages: lay practices and perceptions. Social Science and Medicine 27: 1415– 27. 3238460
  26. Hadi U Broek PVD Kolopaking EP 2010 Cross-sectional study of availability and pharmaceutical quality of antibiotics requested with or without prescription (over the counter) in Surabaya, Indonesia. BMC Infectious Diseases 10: 203. 20618975 PMC2914770
  27. Huda FA Ngo TD Anisuddin A Anadil A Reichenbach AL 2014 Availability and provision of misoprostol and other medicines for menstrual regulation among pharmacies in Bangladesh via mystery client survey. International Journal of Gynecology and Obstetrics 124: 164– 8. 24268354
  28. Hussain A Ibrahim MI. 2011 Medication counselling and dispensing practices at community pharmacies: a comparative cross sectional study from Pakistan. International Journal of Clinical Pharmacy 33: 859– 67. 21853362
  29. Hussain A Ibrahim MI. 2012 Management of diarrhoea cases by community pharmacies in 3 cities of Pakistan. Eastern Mediterranean Health Journal 18: 635– 40. 22888622
  30. Igun U. 1987 Why we seek treatment here: retail pharmacy and clinical practice in Maiduguri, Nigeria. Social Science and Medicine 24: 689– 95. 3603091
  31. Institute of Medicines 2013 Countering the Problem of Falsified and Substandard Drugs. Washington DC: The National Academies Press. 24872973
  32. Kafle K Karkee S Shrestha N 2013 Improving private drug sellers’ practices for managing common health problems in Nepal. Journal of Nepal Health Research Council 11: 198– 204. 24362611
  33. Kafle KK Madden JM Shrestha AD 1996 Can licensed drug sellers contribute to safe motherhood? A survey of the treatment of pregnancy-related anaemia in Nepal. Social Science and Medicine 42: 1577– 88. 8771641
  34. Kamat VR Nichter M. 1998 Pharmacies, self-medication and pharmaceutical marketing in Bombay, India. Social Science and Medicine 47: 779– 94. 9690824
  35. Khan MM Grubner O Kramer A. 2012 Frequently used healthcare services in urban slums of Dhaka and adjacent rural areas and their determinants. Journal of Public Health 34: 261– 71. 22241915
  36. Khan MM Wolter S Mori M. 2006 Post-training quality of syndromic management of sexually transmitted infections by chemists and druggists in Pokhara, Nepal: is it satisfactory? International Journal of Quality in Health Care 18: 66– 72. 16254006
  37. Klein B. 1980 Transaction cost determinants of” unfair” contractual arrangements. The American Economic Review 70: 356– 62.
  38. Kloos H Chama T Abemo D Tsadik KG Belay S. 1986 Utilization of pharmacies and pharmaceutical drugs in Addis Ababa, Ethiopia. Social Science and Medicine 22: 653– 72. 3715505
  39. Kotwani A Wattal C Joshi PC Holloway K. 2012 Irrational use of antibiotics and role of the pharmacist: an insight from a qualitative study in New Delhi, India. Journal of Clinical Pharmacy and Therapeutics 37: 308– 12. 21883328
  40. Krishnaswamy K Kumar BD Radhaiah G. 1985 A drug survey—precepts and practices. European Journal of Clinical Pharmacology 29: 363– 70. 4076333
  41. Lansang MA Lucas-Aquino R Tupasi TE 1990 Purchase of antibiotics without prescription in Manila, the Philippines. Inappropriate choices and doses. Journal of Clinical Epidemiology 43: 61– 7. 2319282
  42. Larsson M Tomson G Binh N Chuc N Falkenberg T. 2006 Private pharmacy staff in Hanoi dispensing steroids-theory and practice. Pharmacy Practice 4: 60– 7. 25247001 PMC4166145
  43. Li STT Grossman DC Cummings P. 2007 Loperamide therapy for acute diarrhea in children: systematic review and meta-analysis. PLoS Medicine 4: e98 17388664 PMC1831735
  44. Lowe RF Montagu D. 2009 Legislation, regulation, and consolidation in the retail pharmacy sector in low-income countries. Southern Med Review 2: 35– 44.
  45. Mac TL Le VT Vu AN Preux PM Ratsimbazafy V. 2006 AEDs Availability and Professional Practices in Delivery Outlets in a City Center in Southern Vietnam. Epilepsia 47: 330– 4. 16499757
  46. Mamun KZ Tabassum S Shears P Hart CA. 2006 A survey of antimicrobial prescribing and dispensing practices in rural Bangladesh. Mymensingh Medical Journal 15: 81– 4. 16467769
  47. Mayhew S Nzambi K Pepin J Adjei S. 2001 Pharmacists’ role in managing sexually transmitted infections: policy issues and options for Ghana. Health Policy and Planning 16: 152– 60. 11358916
  48. Minh PD Huong DTM Byrkit R Murray M. 2013 Strengthening pharmacy practice in Vietnam: findings of a training intervention study. Tropical Medicine and International Health 18: 426– 34. 23294473
  49. Minton N Smith P. 1987 Loperamide toxicity in a child after a single dose. British Medical Journal (Clinical Research Ed.) 294: 1383 3109665 PMC1246550
  50. Modal T Lamba L. 1994 Practices of chemist regarding diarrhoea management. Indian Pediatrics 31: 1535– 6. 7875814
  51. Morris SS Black RE Tomaskovic L. 2003 Predicting the distribution of under-five deaths by cause in countries without adequate vital registration systems. International Journal of Epidemiology 32: 1041– 51. 14681271
  52. Munos MK Walker CLF Black RE. 2010 The effect of oral rehydration solution and recommended home fluids on diarrhoea mortality. International Journal of Epidemiology 39: i75– 87. 20348131 PMC2845864
  53. Nakajima R Takano T Urnaa V Khaliun N Nakamura K. 2010 Antimicrobial use in a country with insufficient enforcement of pharmaceutical regulations: a survey of consumption and retail sales in Ulaanbaatar, Mongolia. Southern Med Review 3: 19– 23. 23093879 PMC3471171
  54. Newton PN Green MD Fernández FM Day NP White NJ. 2006 Counterfeit anti-infective drugs. The Lancet Infectious Diseases 6: 602– 13. 16931411
  55. Ngo TD Park MH Nguyen TH. 2012 Pharmacy workers' knowledge and provision of abortifacients in Ho Chi Minh City, Vietnam. International Journal of Gynaecology and Obsteterics 117: 187– 8. 22342054
  56. Pham DM Byrkit M van Pham H Pham T Nguyen CT 2013 Improving pharmacy staff knowledge and practice on childhood diarrhea management in Vietnam: are educational interventions effective? PLoS One 8: e74882 24098355 PMC3789740
  57. Podhipak A Varavithya W Punyaratabandhu P Vathanophas K Sangchai R. 1993 Impact of an educational program on the treatment practices of diarrheal diseases among pharmacists and drugsellers. Southeast Asian Journal of Tropical Medicine Public Health 24: 32– 9. 8362303
  58. Price LJ. 1989 In the shadow of biomedicine: self medication in two Ecuadorian pharmacies. Social Science and Medicine 28: 905– 15. 2711226
  59. Puspitasari HP Faturrohmah A Hermansyah A. 2011 Do Indonesian community pharmacy workers respond to antibiotics requests appropriately? Tropical Medicine and International Health 16: 840– 6. 21545380
  60. Qidwai W Krishanani M Hashmi S Afridi M Ali R. 2006 Private drug sellers' education in improving prescribing practices. Journal of the College of Physicians and Surgeons–Pakistan 16: 743– 6. 17125630
  61. Radyowijati A Haak H. 2003 Improving antibiotic use in low-income countries: an overview of evidence on determinants. Social Science and Medicine 57: 733– 44. 12821020
  62. Ratanajamit C Chongsuvivatwong V. 2001 Survey of knowledge and practice on oral contraceptive and emergency contraceptive pills of drugstore personnel in Hat Yai, Thailand. Pharmacoepidemiology Drug Safety 10: 149– 56. 11499854
  63. Ratanajamit C Chongsuvivatwong V Geater AF. 2002 A randomized controlled educational intervention on emergency contraception among drugstore personnel in southern Thailand. Journal of the American Medical Womens Association 57: 196– 9. 207. 12405236
  64. Rathnakar UP Sharma NK Garg R Unnikrishnan B Gopalakrishna HN. 2012 A study on the sale of antimicrobial agents without prescriptions in pharmacies in an urban area in south India. Journal of Clinical and Diagnostic Research 6: 951– 4.
  65. Ross-Degnan D Soumerai SB Goel PK 1996 The impact of face-to-face educational outreach on diarrhoea treatment in pharmacies. Health Policy and Planning 11: 308– 18. 10160376
  66. Roy J. 1997 Health status, treatment and drug use in rural Bangladesh: a case study of a village. Australian Journal of Rural Health 5: 70– 5. 9444124
  67. Saengcharoen W Lerkiatbundit S. 2010 Practice and attitudes regarding the management of childhood diarrhoea among pharmacies in Thailand. International Journal of Pharmacy Practice 18: 323– 31. 21054592
  68. Saengcharoen W Lerkiatbundit S. 2013 Migraine management in community pharmacies: practice patterns and knowledge of pharmacy personnel in Thailand. Headache 53: 1451– 63. 23808927
  69. Saradamma RD Higginbotham N Nichter M. 2000 Social factors influencing the acquisition of antibiotics without prescription in Kerala State, south India. Social Science and Medicine 50: 891– 903. 10695985
  70. Seeberg J. 2012 Connecting pills and people: an ethnography of the pharmaceutical nexus in Odisha, India. Medical Anthropology Quarterly 26: 182– 200. 22905436
  71. Seeberg J Pannarunothai S Padmawati RS 2014 Treatment seeking and health financing in selected poor urban neighbourhoods in India, Indonesia and Thailand. Social Science and Medicine 102: 49– 57. 24565141
  72. Smith F. 2009a Private local pharmacies in low‐and middle‐income countries: a review of interventions to enhance their role in public health. Tropical Medicine and International Health 14: 362– 72. 19207171
  73. Smith F. 2009b The quality of private pharmacy services in low and middle-income countries: a systematic review. Pharmacy World and Science 31: 351– 61. 19343530
  74. Sreeramareddy CT Shankar RP Sreekumaran BV 2006 Care seeking behaviour for childhood illness-a questionnaire survey in western Nepal. BMC International Health and Human Rights 6: 7 16719911 PMC1543657
  75. Stenson B Syhakhang L Eriksson B Tomson G. 2001a Real world pharmacy: assessing the quality of private pharmacy practice in the Lao People's Democratic Republic. Social Science and Medicine 52: 393– 404. 11330774
  76. Stenson B Syhakhang L Lundborg CS Eriksson B Tomson G. 2001b Private pharmacy practice and regulation. A randomized trial in Lao P.D.R. International Journal of Technology Assessment in Health Care 17: 579– 89. 11758301
  77. Syhakhang L Stenson B Wahlström R Tomson G. 2001 The quality of public and private pharmacy practices. European Journal of Clinical Pharmacology 57: 221– 7. 11497337
  78. Thamlikitkul V. 1988 Antibiotic dispensing by drug store personnel in Bangkok, Thailand. Journal of Antimicrobial Chemotherapy 21: 125– 31. 3356619
  79. Tomson G Sterky G. 1986 Self-prescribing by way of pharmacies in three Asian developing countries. The Lancet 328: 620– 2. 2875329
  80. Tuladhar SM Mills S Acharya S 1998 The role of pharmacists in HIV/STD prevention: evaluation of an STD syndromic management intervention in Nepal. AIDS 12: S81– 7. 9792365
  81. Valimb AR Liana J Joshi M 2014 Engaging private sector drug dispensers to improve antimicrobial use in the community: Experience from the Piloted ADDO AMR Initiative in Tanzania. Journal of Pharmaceutical Policy and Practice 7: 11. 25298887 PMC4177420
  82. Van Doorslaer E O'donnell O Rannan‐Eliya RP 2007 Catastrophic payments for health care in Asia. Health Economics 16: 1159– 84. 17311356
  83. Van Sickle D. 2006 Management of asthma at private pharmacies in India. International Journal of Tuberculosis and Lung Disease 10: 1386– 92. 17167957
  84. Vu DH van Rein N Cobelens FG 2012 Suspected tuberculosis case detection and referral in private pharmacies in Viet Nam. International Journal of Tuberculosis and Lung Disease 16: 1625– 9. 23131260
  85. Wachter DA Joshi MP Rimal B. 1999 Antibiotic dispensing by drug retailers in Kathmandu, Nepal. Tropical Medicine and International Health 4: 782– 8. 10588773
  86. Wafula FN Goodman CA. 2010 Are interventions for improving the quality of services provided by specialized drug shops effective in sub-Saharan Africa? A systematic review of the literature. International Journal for Quality in Health Care 22: 316– 23. 20430823 PMC2908156
  87. Wafula FN Miriti EM Goodman CA. 2012 Examining characteristics, knowledge and regulatory practices of specialized drug shops in Sub-Saharan Africa: a systematic review of the literature. BMC Health Services Research 12: 223 22838649 PMC3520114
  88. Wolffers I. 1987 Drug information and sale practices in some pharmacies of Colombo, Sri Lanka. Social Science and Medicine 25: 319– 21. 3629305

Cited by

Sorted by citations

Authors
Miller, R., & Goodman, C.
Affiliations
London School of Hygiene & Tropical Medicine (GB)
Corresponding author
Miller, Rosalind
ORCID
Venue
Health Policy and Planning
Publisher
Oxford University Press (OUP)
Published
2016-03-08
Volume
31
Issue
7
Pages
940-953
ISSN
  • 0268-1080 (ISSN-L)
  • 1460-2237
DOI
10.1093/heapol/czw007
PMC
PMC4977427
OpenAlex
W2296706167
Cited by
225
References
1
Citations by year
2026: 22 · 2025: 20 · 2024: 19 · 2023: 29 · 2022: 22 · 2021: 27 · 2020: 29 · 2019: 23 · 2018: 18 · 2017: 14 · 2016: 2
FWCI
3.36
Type
journal article
Language
en
Open access
Locations
  • Health Policy and Planning (publishedVersion)
  • Europe PMC (PubMed Central) (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • LSHTM Research Online (London School of Hygiene and Tropical Medicine) (acceptedVersion)
  • HighWire Press Open Archive (submittedVersion)
Funders
Economic and Social Research Council (1355659)
Topics
  • Life Sciences › Pharmacology, Toxicology and Pharmaceutics › Pharmacology › Pharmacy and Medical Practices
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Pharmaceutical Quality and Counterfeiting
  • Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Pharmaceutical Economics and Policy
Keywords
drugstores, low- and middle-income countries, Asia, inappropriate prescribing, prescription-only medicines, antibiotic misuse, incomplete antibiotic courses, patient counseling, medical history, pharmacy staff training, profit incentives, drug regulation

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review