1. Pharmacy Practices Provided by Dispensing Doctors in Zimbabwe
Hansen EH and Trap B
Danish University of Pharmaceutical Sciences, Copenhagen, Denmark & Euro Health Group, Denmark
c o n s u l t a n t s

2. Background
In many countries, an individual is not allowed to serve as both doctor and pharmacist at the same time
The number of DDs has increased in several countries
While pharmacy services are highly regulated in most countries, there is little regulation of DDs
Study from South Africa identified various quality problems in pharmacy practices related to the dispensing of medicines by doctors
But empirical data on the performance of DDs are generally scarce
Regardless of who is doing the dispensing, it is important to ensure the quality of the practice

3. Study Aims
To examine
The quality of pharmacy practices (PPs) provided by DDs
The study explored the quality of
1. Services
2. Medicine management
3. Dispensing and care

4. Method Data collection
Design
Cross-sectional, observational and interview study based on PP indicators
Setting
Zimbabwe, Harare
Population
170 DDs, 1635 NDDs and about 200 pharmacies
Sample
29 DDs/215 patients, 28 NDDs and 20 pharmacies
Inclusion rate
of selected and reachable
76% DDs, 74% NDDs
and 91% pharmacies
Data collection
Questionnaire based interviews with: DDs, the person dispensing in the DD’s practices, pharmacists and patient exit interviews
Observations
Data collected by 3 data collection teams
Each team surveyed 17 to 21 practices equally distributed between DDs and NDDs

5. Indicators for assessing PP quality to be developed
Service 14
Medicine
Management 11
Dispensing & care 9
Price structure
Time aspects
Patient facilities
Medicine availability
Competence
Confidentiality
Stock management
Storage facilities
Medicine quality
Recording practice
Packaging
Information
Labelling
Appropriate medicine use

6. Results 1. Service Quality (SQ) NDDs prioritise SQ higher than DDs
PP by DDs was poor in all three areas
1. Service Quality (SQ)
PP indicators in %
NDDs prioritise SQ higher than DDs
Price structure
Price setting by DDs less structured, resulting in major price variations
Up to 75% possible saving by buying at pharmacies
Only 4% of DDs dispense to make money

7. 2. Medicine Management Quality
DDs have insufficient administrative procedures, poor stock management, storage conditions and poor labelling
Dispensing information not recorded properly
Lack of dispensing books problematic especially where the doctor is not dispensing the drugs
Lack of batch number recording does not allow for recalls

8. Stock management and storage facilities:
Improper storage can render the medicines:
ineffective
deteriorated
contaminated

9. 3. Dispensing and care quality
Availability and use of packaging materials by DDs (%):

10. Labelling information (% of DDs):

11. Conclusions
An indicator-based method for assessing the quality of pharmacy practices among DDs was developed.
The method was practical and applicable
DDs quality of pharmacy practices was inadequate with regard to:
Service quality of DDs lower than NDDs
Medicine management quality was not adequate
Dispensing and care quality generally poor among DDs compared to NDDs

12. Policy implications and recommendations
Independent of who provides the services it is essential to public health that supply, dispensing and use of medicines are of high quality
It is essential that dispensing of medicines is provided in accordance with good quality standards
Most countries regulate and inspect pharmacies, DDs are regulated to a much lesser degree
The pharmacy practices of DDs need to be better legislated and regulated if they are to become an acceptable part of the health care system
WHO should consider developing recommendations re DDs
Need for further development of universal indicators for assessing Pharmacy Practices