RETAIL PHARMACIES IN DEVELOPING-COUNTRIES - A BEHAVIOR AND INTERVENTION FRAMEWORK

Retail pharmacies in developing countries are one of the most importan t sources of advice on pharmaceuticals. Among the reasons the clients give are ease of access; availability of medicines; quality of service (no waiting and convenient hours of operation); and cheaper products, availability of credit, or the option to buy drugs in small amounts. However, the appropriateness of prescribing by retail pharmacy staff h as been found to be far from acceptable. In childhood diarrhea, for ex ample, oral rehydration salts (ORS), the appropriate diarrhea treatmen t, are recommended much less than pharmaceuticals of limited value, su ch as antimotility agents, adsorbents, etc. Little information is avai lable for reasons underlying such behaviors. In this paper, we present a conceptual framework in which to analyze factors that may affect re tail pharmacy prescribing, and we suggest strategies for behavior chan ge. We developed this framework after examining relevant literature on retail pharmacy prescribing. We propose that pharmacy factors, client factors, physician practice and regulatory factors are the four sets of important factors for understanding pharmacy prescribing behavior. For intervention, we present four types of interventions which could b e used for changing the behavior of pharmacy staff: information alone, persuasion, incentives and coercion. The behavior and intervention fr ameworks presented in this paper should also help in guiding further r esearch in this area. For example, new information on the effects of o wnership type, availability vs actual role of professional staff and a uthority structure on pharmacy treatment behaviors would be useful are as for future research. Similarly, additional research is needed on th e comparative effects of coercive, persuasive and incentive strategies on pharmacy treatment behaviors.