1. Stand in presentation Alex Dodoo, President, Pharmaceutical Society of Ghana Bulk dispensing in Africa: The reality and the concerns

2. The Reality Dispensing from bulk is the norm rather than the exception for products in sub-Saharan Africa For products like Tablets Capsules Syrups Suspensions Creams and ointments especially in hospitals

3. The Reality Even smaller packed products are dispensed from bulk especially when they are expensive Products for erectile dysfunction Products for prostate cancer etc Products like glyceryl trinitrate have been known to be dispensed from bulk! Exceptions Inhalers, Injections, Some creams, ointments, lotions

4. Features of the Dispensing Landscape in Africa Very poor labelling of dispensed medicines Poor patient counselling Dodoo, A.N.O et al., Rational drug use in Korle-Bu: A five day baseline survey of drug use indicators at the Korle-Bu Teaching Hospital, Accra, Ghana. Ghana Pharm. J. 2001, 24(3):14-16 Presence of counterfeit and sub-standard products in the pharmaceutical supply chain Dispensing by non-pharmacists and lower qualified personnel Absence of tablet counters/trays Counting by hand Counting cytotoxics as well as other products using “plastic spoons” etc Dispensing liquid in bulk Bottles to be brought by parents No medicine spoons Illiteracy as well as presence of products with labels in other languages apart from the official national languages

5. Implications Patient safety Errors Counterfeit Expired products Sub-standard products No labelling so difficult to check No counselling and no knowledge by patients

6. Implications Adherence Lack of knowledge by patients Difficulty of patients to know what to take Patients not returning to pharmacy to buy “remainder of expensive medicines” especially if they “feel” better Product integrity Packaging in plastic and paper “envelopes” Effect of moisture, humidity etc Regulatory challenge Checking adherence to existing regulations on dispensing etc Impossible to sue for negligence

7. Opportunities Pharmaceutical industry To ensure that their products are appropriately packaged to reduce counterfeiting and environmental problems National governments, especially where there is a national health insurance service NHIS packs etc Pharmacy and Medicine Regulators Insistence on patient packs as well as patient information leaflets as well as proper labelling of all products Reduction of costs of registering various packs of the same products Other necessary regulatory measures