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Bulk Dispensing in Africa: Realities, Concerns, and Solutions

Explore the prevalent practice of dispensing pharmaceuticals from bulk in sub-Saharan Africa, the associated risks, and suggested solutions to improve patient safety, product integrity, and regulatory compliance.

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Bulk Dispensing in Africa: Realities, Concerns, and Solutions

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  1. Bulk dispensing in Africa: The reality and the concerns Stand in presentation Alex Dodoo, President, Pharmaceutical Society of Ghana

  2. The Reality • Dispensing from bulk is the norm rather than the exception for products in sub-Saharan Africa • For products like • Tablets • Capsules • Syrups • Suspensions • Creams and ointments especially in hospitals

  3. The Reality • Even smaller packed products are dispensed from bulk especially when they are expensive • Products for erectile dysfunction • Products for prostate cancer etc • Products like glyceryl trinitrate have been known to be dispensed from bulk! • Exceptions • Inhalers, Injections, Some creams, ointments, lotions

  4. Features of the Dispensing Landscape in Africa • Very poor labelling of dispensed medicines • Poor patient counselling • Dodoo, A.N.O et al., Rational drug use in Korle-Bu: A five day baseline survey of drug use indicators at the Korle-Bu Teaching Hospital, Accra, Ghana. Ghana Pharm. J. 2001, 24(3):14-16 • Presence of counterfeit and sub-standard products in the pharmaceutical supply chain • Dispensing by non-pharmacists and lower qualified personnel • Absence of tablet counters/trays • Counting by hand • Counting cytotoxics as well as other products using “plastic spoons” etc • Dispensing liquid in bulk • Bottles to be brought by parents • No medicine spoons • Illiteracy as well as presence of products with labels in other languages apart from the official national languages

  5. Implications • Patient safety • Errors • Counterfeit • Expired products • Sub-standard products • No labelling so difficult to check • No counselling and no knowledge by patients

  6. Implications • Adherence • Lack of knowledge by patients • Difficulty of patients to know what to take • Patients not returning to pharmacy to buy “remainder of expensive medicines” especially if they “feel” better • Product integrity • Packaging in plastic and paper “envelopes” • Effect of moisture, humidity etc • Regulatory challenge • Checking adherence to existing regulations on dispensing etc • Impossible to sue for negligence

  7. Opportunities • Pharmaceutical industry • To ensure that their products are appropriately packaged to reduce counterfeiting and environmental problems • National governments, especially where there is a national health insurance service • NHIS packs etc • Pharmacy and Medicine Regulators • Insistence on patient packs as well as patient information leaflets as well as proper labelling of all products • Reduction of costs of registering various packs of the same products • Other necessary regulatory measures

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