Community pharmacies need government support in future public health emergencies

PINTAR press release, 1 July 2022

The Indonesian government must strengthen measures to ensure the safety, operation and involvement of pharmacy personnel in future pandemic response efforts, a new study in Indonesia has revealed.

Researchers from Indonesia, Australia, and the UK interviewed pharmacists and pharmacy technicians to explore their experiences, safety concerns, and attitudes during the COVID-19 outbreaks in Indonesia, a country recording more than six million cases and 150 thousand deaths due to COVID-19. The results were published today in PLOS Global Public Health.

“We conducted 21 in-depth interviews with staff recruited from 16 provinces,” says lead author Dr Luh Putu Lila Wulandari. “Most participants were pharmacists that had been working in the same establishment, including large retail chain and independent small pharmacies, for at least three years.”

Pharmacists and pharmacy technicians reported increased demand for their services because people were worried about being forced into hospital quarantine if they were found to be infected with COVID-19 when visiting clinics and hospitals. Some community pharmacies also managed to maintain, and even increase, their services through remote sales.

Community pharmacies reported significant challenges. Pharmacists and pharmacy technicians not only felt highly exposed to the virus, but they also reported higher costs and frequent stockouts of face masks, hand sanitizers, and medicines. Although this was a worldwide problem during the acute phases of the outbreak, it was particularly challenging in low- and middle-income countries where supply chains are more vulnerable to stockouts.

Community pharmacies as key players in the health system

Community pharmacies are traditionally the first point of contact between clients and the health system in many countries, especially where the availability of public health services is limited.

COVID-19 has highlighted the critical role that these providers play in the health system, especially as many primary health centres (so-called puskesmas) were forced to shut down due to high infection rates among health workers. At the start of the outbreak, the Indonesian government urged pharmacies to stay open and ensure access to medicines and personal protective equipment (PPE), disseminate information on COVID-19 and refer clients to health facilities.

In addition to the large number of community pharmacies, informal drug outlets are also prolific in Indonesia. However, the study could only focus on licensed pharmacies, as Dr Luh Putu Lila Wulandari explains:

“At the time of data collection, lockdown measures prevented us from capturing the views and experiences of informal drug outlets. It is important to recognise the critical of these providers as sources of medicines and PPE in Indonesia.”

Providing health advice and promoting appropriate use of antibiotics

Most participants were interested in receiving regular updates about COVID-19 and listed the Ministry of Health, the District Health Office, and the Indonesian Pharmacist Associations as reliable information sources. By contrast, some participants were concerned that information spread via social media could be false or inaccurate.

“Another concerning finding from this study is the steep increase in the demand for antibiotics, even if these medicines are not recommended for the management of COVID-19,” explains Dr Marco Liverani from the London School of Hygiene & Tropical Medicine, who co-led the study.

The inappropriate use of these precious medicines leads to antimicrobial resistance. As such, the government should implement additional regulatory measures to monitor antibiotic use and raise awareness about the importance of using such medicines appropriately during this pandemic and in future emergencies.

This research is part of PINTAR (Protecting Indonesia from the Threat of Antibiotic Resistance), a larger study that aims to improve antibiotic dispensing in the community and combat the spread of antimicrobial resistance. Both studies are led by the Kirby Institute of Australia’s University of New South Wales (UNSW) in collaboration with Universitas Gadjah Mada and Universitas Sebelas Maret in Indonesia, the Indonesian Ministry of Health, the London School of Hygiene & Tropical Medicine and the University College London in the UK, and The George Institute for Global Health at UNSW Sydney.

The study is supported by a grant from the Indo-Pacific Centre for Health Security (DFAT) under the Australian Government’s Health Security Initiative.

Read the paper in PLOS Global Public Health

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