The pharmacy profession in Jammu and Kashmir has been the most ignored and underutilised since its inception. Professional pharmacy services have never been accepted in hospitals or taught in the educational curriculum. Despite the department of Pharmaceutical Sciences at University of Kashmir imparting professional training and education to students since its inception in 1985, this profession has been overtaken and ruled by non-pharmacy professionals such as medical assistants. Only qualified retail pharmacists/ community pharmacists should practise pharmacy.
Implementation of Central Pharmacy Act of 1948 in Jammu and Kashmir following Abrogation of Article 370 generated a ray of hope among the pharmacy fraternity of the valley for restoration of the integrity, mission and prestige of pharmacy profession and to bring it at par with national and international standards. The desired goal can be achieved by incorporating the following necessary reforms in Jammu and Kashmir:
The first step is for the Central Pharmacy Act of 1948 along with Pharmacy Practice Regulations of 2015 to be implemented in Jammu and Kashmir in letter and spirit, without any dilution, so that only professionally qualified pharmacists get retail licenses to operate as retail and community pharmacists.
Our society has so far witnessed only the traditional role of pharmacy, i.e. dispensing, but modern roles like clinical pharmacy services are still a distant dream in this age of globalisation and advancement. Modern pharmacy services are urgently required to improve the healthcare system especially in the rural areas where there isn’t even access to basic medical facilities. Modern roles need to be incorporated in all the hospitals from sub-district level to tertiary-care, as only professionally trained and legally qualified pharmacy personnel can assist doctors in counselling and disseminating information to patients, like indication of drug, contraindications, adverse effects, precautions, dosage, etc., and can also play their legitimate and decisive role in procurement, testing, storage and dispensing of standard quality drugs in every hospital and primary health centre.
Re-designating hierarchy in pharmacy: All J&K Hospitals need to have a department of pharmacy with adequate infrastructure, manpower, equipment and funding. Clinical and hospital pharmacist posts should be created in PHCs (Primary Health Centres) and CHCs (Community Health Centres) at Panchayat level and block/ tehsil level, respectively. There should be presence of Pharmacy Officer (PO) working under medical officer at PHC level and Block Pharmacy Officer (BPO) working under block medical officer at CHC level. Similarly, each district should have Chief Pharmacy Officer (CPO) working under chief medical officer. There should be a promotion channel and proper hierarchy for pharmacists as proposed by Pharmacy Council of India. Starting from the post of Pharmacist, it should rise up to Pharmacy Officer (PO), Block Pharmacy Officer (BPO), Chief Pharmacy Officer (CPO), Assistant Deputy Director of Pharmacy (ADDP), Deputy Director of Pharmacy (DDP) and Director of Pharmacy (DP).
Creation of Drug Inspector posts at tehsil level: In the past few decades there has been enormous growth of retail and wholesale pharmacies due to lack of adequate manpower in the form of drug inspectors and robust testing mechanism. Jammu and Kashmir has become hub of spurious and substandard drugs and a hot market for quacks to carry out illegal sale, storage and distribution of drugs. As per Section 51 of Drugs and Cosmetics Rules 1945, it shall be duty of the drug inspector authorised to inspect premises licensed for the sale of drugs to inspect not less than once a year all the establishments for the sale of drugs within the area assigned to him. Data available on official website of Drugs & Food Control Organisation (DFCO) Jammu and Kashmir says that there are 22,693 retail and wholesale drug dealers in union territory of Jammu and Kashmir with only 80 drug inspectors to monitor and inspect them. Of these inspectors, 7 are currently discharging their duties as in-charge additional drug controllers. It puts a huge burden of approximately 360 sale premises for each drug inspector whereas the internationally accepted norms require one drug inspector for every 100 drug sale outlets. It is pertinent to mention here that this figure of 22,693 outlets does not include sub-centres, primary health centres, community health centres, sub-district and district hospitals, and allopathic dispensaries that exist in every district in addition to blood banks, manufacturing establishments and unauthorised drug stores. Thus, the workforce currently available with the drug control department is not sufficient to fully cater to the actual field requirements. Therefore, drug inspectors should be appointed at tehsil level in addition to their appointment at district and regional level for proper regulation in order to curb the menace of improper regulation, spurious and substandard drugs, unauthorised sale and storage of drugs. In order for the drug inspectorate staff to be able to book the culprits found to be overcharging patients on sale of medicine, medicines need to be notified under Essential Commodities Act, without which they cannot enforce the provisions of drugs price control order, 1995. It is also necessary to accord drug inspectors gazetted status in order to make them eligible to be notified as authorised officers under EC Act.
AYUSH drug inspectors: Currently, drugs falling under AYUSH, an acronym for Ayurveda,Yoga and Naturopathy, Unani, Siddha, Sowa-Rigpa and Homeopathy, represents the alternative system of medicine but it is not regulated by any legal framework so far as the sale, storage, or distribution of medicines is concerned. Though provisions relating to these types of drugs have been outlined in the drugs and cosmetic act 1940, these provisions have not been enforced unlike other provisions relating to drugs belonging to allopathic system of medicine. As a result, anyone feels free to open an Ayurvedic or Homeopathic drug store anywhere in Jammu and Kashmir and sell, store or distribute such drugs without any license, regular monitoring and supervision from drug control authorities. Therefore, it should be a priority of the current administration to immediately enforce provisions relating to the manufacture, sale, storage and distribution of such drugs as provided under Chapter IV-A of the Drugs and Cosmetics Act of 1940 and thereby bringing drug sale, storage and distribution of alternative system of medicine under the ambit of Drug and Food Control Organisation. People can easily fool the concerned department by getting registration for alternative system of medicine and practice allopathic medicine without getting noticed by the department. There should be separate cadre for drug inspector/ AYUSH drug inspector posts to monitor and inspect drug sale premises dealing with alternative system of medicine at tehsil level so that patients at the receiving end get effective and standard drug therapy regimens.
One more important area which needs proper regulation is diagnostic laboratories, which exist in every nook and corner of Jammu and Kashmir without license or proper registration because of non-implement of clinical establishment act. Appointment of drug inspectors at tehsil level can pave way for the regular inspection and statutory control of these laboratories, provided relevant powers and authority is vested unto them.
Similarly, provisions of Drugs and Cosmetics Act 1940 dealing with manufacture, sale, storage and distribution of cosmetics need to be enforced so that the flourishing cosmetic industry is brought under regulatory control to prevent flooding of markets with spurious and substandard cosmetics. Currently there is no regulatory framework in place.
Establishment of modern drug testing laboratories: To develop robust testing mechanism and prevent the entry of spurious and substandard drugs which are gaining easy access to Jammu and Kashmir due to inadequacy of testing laboratories, drug testing laboratories should be established in each district with modern equipment, manpower in the form of scientific officers, drug analysts/ chemical analysts, and infrastructure besides central regional testing laboratories so as to make sure that only quality drugs enter Jammu and Kashmir. Private sector should be also be involved in drug testing and establishment of modern testing laboratories. One more important aspect which needs proper attention is establishment of in-house quality control units within hospitals for testing the hospital drug supplies on regular basis by qualified pharmacists.
Food inspectors: Over the past years the food industry has grown manifold and many are entering it on daily basis to earn their livelihood. With increasing growth of food entrepreneurs it is essential that the concerned department should have enough manpower in the form of food inspectors to inspect, regulate and implement food safety standards. To attain this goal, the government should recruit adequate number of food inspectors and eligibility for the same should be preferably set by the Drug and Food Control department.
Establishment of drug information and Pharmaco-vigilance centres: Drug information centres refer to the facility specially set aside for, and specialising in, the provision of drug information and related issues. The purpose of DIC is to provide authentic individualised, accurate, relevant and unbiased drug information to patients and to meet needs of practising physicians, pharmacists and other healthcare professionals. Qualified pharmacists can carry out their professional role in delivering these services and all the teaching hospitals should have DIC for rational use of drugs. Similarly, Pharmaco-vigilance units should be established in all the major hospitals to monitor adverse drug reactions.
Role of pharmacy professionals in health education: In all our healthcare settings, nursing orderlies get promoted to community health officers without having proper qualification and expertise. The role of pharmacists in health education should be encouraged and pharmacy qualification should be kept as eligibility criteria for health educator and community health officer posts.
Training of human resource as per Education Regulations and Central Pharmacy Act: If we compare J&K with its neighbouring states as far as number of degree and diploma institutions is concerned, the figure is dismal and bleak, as we have only four institutions imparting pharmacy training and education to students compared to 90 in Punjab, 78 in Haryana, 41 in Uttarakhand and 170 in Uttar Pradesh. The department of pharmaceutical sciences at University of Kashmir is the lone institute in the entire Jammu and Kashmir offering bachelors course in pharmacy. In order to impart professional training in pharmacy education, B. Pharmacy course should be started in all the medical colleges across J&K. The PCI approved diploma in pharmacy should be started in all poly-technical colleges and B. Pharmacy and M. Pharmacy should be qualification criteria for teaching posts in these colleges, as per Pharmacy Practice Regulations 2015. Medical Assistant course should not be confused with diploma in pharmacy and should be disbanded and stopped across Jammu Kashmir and Ladakh.
Private colleges offering medical assistant courses should start diploma in pharmacy instead, as per Pharmacy Council of India guidelines. As we know, our part of globe has not received the professional pharmacy services due to underutilisation of pharmacy professionals and inclusion of non-pharmacy qualification as per previous laws governed by Jammu and Kashmir Pharmacy Council.
We pharmacy professionals urge the governor’s administration to make pharmacy profession in J&K at par with national and international standards so that common masses get access to safe, effective, quality and affordable medicines and professional pharmacy services. It is the best way to achieve desired therapeutic outcome and thereby improve the quality of life.
—The writer has an M.Pharma degree from University of Kashmir and is working as Pharmacist at SDH Sopore. [email protected]