The pharmacist plays an important role in delivering health services. The pharmacist is part of the clinical team in primary care settings and is the backbone of primary healthcare delivery. They ensure that patients derive maximum therapeutic benefit from the treatments by stocking medicines appropriately and dispensing them as advised by the clinician. At the back end, the pharmacist manages the clinic’s pharmaceutical inventory and the linkages to supply chain management. Any systemic challenges and incompetency in this pathway, from procurement of medicines to dispensing, impacts the role of pharmacists and the quality of care.

Further, several commentators observe that pharmacists in resource-poor settings lack essential professional competencies impacting patient outcomes. We understand from the PHCPI Conceptual framework that provider competence is one of the key drivers of improving primary healthcare performance. Provider competence entails having and demonstrating the “knowledge, skills, abilities, and traits” to successfully and effectively deliver high-quality services that an individual develops through education, training, and work experience. Competence is one of the critical determinants of improving health outcomes and Client Satisfaction.

Discussion on increasing the competencies of providers at the primary care level, including pharmacists, is critical to achieving the goals of the comprehensive primary healthcare component of Ayushman Bharat. India is witnessing the double burden of communicable and non-communicable diseases and chronic diseases. Hence, it is expected to lead to an increased workload on primary health systems. With the government’s commitment to expanding service coverage at various levels, the role of a pharmacist must be enhanced to meet the demand and improve health outcomes.

Learnings from competency-building programs for pharmacists suggest that the role-based competencies significantly improve pharmacists’ competencies in primary healthcare settings. In economic terms, it has been estimated in Australia that adequately trained and remunerated pharmacists would save the health care system a year 15 million Australian dollars (approx. US$100 million) . A review of the available literature globally shows that programs/ initiatives directed at improving pharmacist’s performance at the primary care level should ensure enhancing the following competencies –

• Role as a Store Manager- To know the layout, infrastructure of the store, knowledge about good storage practices and inventory management practices; knowledge about drug forecasting and indenting and procurement processes as per Government procurement protocol; ability to manage stock registers, working knowledge of computers for daily office work to manage drugs, vaccines, consumables.
• Dispensing Drugs- Knowledge about reviewing prescriptions for accuracy and dispensing or supervising the dispensation of medications and related supplies, according to physicians’ prescriptions, including generic/brand names, formulation/compounding, dosage, frequency and route of administration, drug interaction/compatibility, knowledge on rational use of medicines including antibiotics.
• Community Outreach – Ability to organize community outreach camps and educate the catchment population about preventive and promotive measures for prevalent diseases, including TB, malaria, Non-communicable diseases (NCDs), Nutritional deficiency disorders, vaccine-preventable diseases, Neglected tropical diseases (NTDs) etc.; able to support the primary care team in preparedness for disaster management and epidemic control, vaccination drive and for rolling out of various National Public Health Programmes and WASH program at the community level.
• Compliance to Regulation – Capacity to guide the primary care team to ensure compliance with laws and regulations that apply to medicines, consumables, and equipment, biomedical waste management in the health facilities etc.
• Communication – Patient counselling skills including knowhow to communicate clearly, precisely, and effectively in a normal situation and during conflicts with health and social care staff, support staff, patients and their family and relatives
• Workplace Management-Know how to manage the workplace
• Emergency Role - Ability to conduct the basic tests in the absence of other health professionals; able to assemble the Oxygen Cylinders and devices for use and minor repairing of equipment for smooth functioning of health facilities, able to handle minor ailments, emergency medical situations in the absence of a medical officer and staff nurse.
• Continuing Professional Development - Able to participate in programs to continuously upgrade professional and practical knowledge

Way forward

For low-resource settings like India, it is crucial to develop Primary Health Care Pharmacist competencies based on local needs. Identifying primary health care pharmacist competencies, assessment, and follow-up competency-based capacitation will be a significant step towards improving primary care performance.

Authors:

Sanjeev Kumar is currently working as a Research Specialist in the Health Systems Transformation Platform (HSTP). Currently, he is working on Improving Health Outcomes by Developing Competencies for Primary Health Care Workers in Odisha.

Nilkantha Bhoi is a Pharmacist and Ex-Executive Director (Procurement and Supply Chain), Uttar Pradesh Medical Supplies Corporation. Currently, working with UNOPS. He has worked Nationally and Internationally on strengthening pharmaceutical procurement and supply chain systems and access to Essential Medicines.