Why are pharmacists and drug experts being neglected in the health sector reform initiative?

The role of pharmacists in ensuring safe and effective medication use is critical, yet it remains underappreciated in Bangladesh. Photo: TBS

Over the past decade and a half, Bangladesh's public health system has steadily deteriorated due to the lack of a people-centred health policy, weak disease management framework, widespread corruption, and the negative impact of neoliberal policies. These issues have hit the country's poor and marginalised communities the hardest, leaving them with limited access to affordable and effective healthcare.

Given this pressing situation, comprehensive reforms in the health system are vital to ensuring cost-effective and equitable access to treatment. In response, the interim government's Ministry of Health has formed a 12-member reform committee aimed at overhauling the health system. 

The committee is tasked with modernising medical education, ensuring quality healthcare in both urban and rural areas, and strengthening overall health infrastructure. 

However, the composition of this committee—made up exclusively of physicians and clinicians—fails to include pharmacists, whose role is critical in healthcare delivery.

Without the inclusion of clinical and hospital pharmacists, meaningful improvements in patient care in Bangladesh will remain elusive. Their expertise is indispensable to achieving the quality healthcare that the nation so urgently needs.

In globally recognized healthcare systems, effective hospital care is a result of collaboration between doctors, pharmacists, nurses, and technicians. Clinical and hospital pharmacists are vital for ensuring the rational use of medications, from selecting the right drug and dosage to managing therapies and minimising adverse drug reactions. 

Without pharmacists, essential tasks—such as dose calculation for specific conditions, therapy adherence, effective drug delivery, disease management, therapeutic drug monitoring and patient counselling—cannot be properly executed.

The role of pharmacists in ensuring safe and effective medication use is critical, yet it remains underappreciated in Bangladesh. Pharmacists are essential in identifying and managing drug-related problems, such as drug interactions, contraindications and irrational use. Unfortunately, their exclusion from hospitals has deprived patients of this crucial support, hindering the quality of care and disease management to meet international standards.

The absence of pharmacists in healthcare facilities is a significant flaw in the current system, highlighting the need for urgent reform. Without pharmacy experts in the health reform committee, how can the crucial role of pharmacists be properly addressed? True reform requires the recruitment of hospital and clinical pharmacists, supported by the inclusion of pharmacy educators or experts on the committee.

A robust healthcare system relies on ensuring patients have access to high-quality medications. While Bangladesh's 1982 drug policy revolutionised the pharmaceutical sector by promoting the production of quality drugs under Good Manufacturing Practices (GMP), further progress is essential—especially in ensuring the bioequivalence and bioavailability of drug products.

Additionally, the pharmaceutical industry must prepare for the end of patent law exemptions, such as those under the Trips Agreement, which will increase production costs through patent and trademark fees. To address this, companies need to strengthen their research and development (R&D) capabilities to engage in drug discovery or reverse engineering. 

Although the 1982 drug policy prioritised generic drug production to make medications affordable, the focus in 2024 must shift to enhancing the industry's capacity to develop new drug entities. This is crucial for addressing locally prevalent diseases like dengue and the Nipah virus, while also advancing the role of pharmacists within the broader healthcare system.

Pharmaceutical companies should now prioritise the production of larger protein molecules, such as monoclonal antibodies and immunotherapies, alongside developing strong drug discovery programs. Establishing an Active Pharmaceutical Ingredient (API) park is vital to support this shift. 

The Directorate General of Drug Administration (DGDA) also needs to be reformed into a more functional and effective regulatory body for the pharmaceutical sector. Without these reforms, ensuring the quality of drugs in Bangladesh will be impossible, further undermining patient care and disease management.

An updated drug policy is urgently required to improve the quality, efficacy, and potency of medications while encouraging the development of treatments for locally prevalent diseases. This policy must also address the irrational use of medications, particularly antibiotics, which are losing effectiveness due to widespread overuse and misuse. 

To effectively reform the pharmaceutical industry and integrate hospital and clinical pharmacists into Bangladesh's healthcare system, the health reform committee must include experts in pharmacy and pharmaceutical sciences, as well as industrial pharmacists.

Neoliberal policies have pushed Bangladesh's healthcare sector toward privatisation and commercialization, making medical care increasingly expensive and out of reach for many. Under the guise of deregulation and austerity, policymakers have slashed health sector budgets and reduced subsidies, resulting in a lack of state regulation. 

Healthcare costs have risen so much that even the middle class now struggles to afford basic treatment. An urgent overhaul of the public health system is needed, both in policy and implementation in order to build a people-centred healthcare model. 

This transformation needs input from health policy experts, economists, and pharmaceutical specialists. Unfortunately, the interim government's health reform committee lacks representation from these crucial fields.

The committee has also overlooked sociologists specialising in the sociology of medicine, whose insights are essential for crafting effective health policies. The absence of public health experts is a major shortcoming that will likely hinder meaningful reform.

While forming a health reform committee is a step in the right direction, its current structure is too narrow, with physicians dominating the group. Key fields like pharmacy, pharmaceutical sciences, and public health have been left out. To achieve truly comprehensive reform, we need a multidisciplinary approach. We urgently call for a new committee that includes pharmacists, pharmacy educators, drug experts, public health specialists, policy analysts, and pro-people economists—working alongside physicians.
 

Sketch: TBS

Zobaer Al Mahmud is an associate professor in the Department of Clinical Pharmacy and Pharmacology at the University of Dhaka and holds a PhD in pharmacology from the University of Glasgow. 

Disclaimer: The views and opinions expressed in this article are those of the authors and do not necessarily reflect the opinions and views of The Business Standard.