"Doi moi" and private pharmacies: a case study on dispensing and financialissues in Hanoi, Vietnam

Citation
Ntk. Chuc et G. Tomson, "Doi moi" and private pharmacies: a case study on dispensing and financialissues in Hanoi, Vietnam, EUR J CL PH, 55(4), 1999, pp. 325-332
Citations number
26
Categorie Soggetti
Pharmacology,"Pharmacology & Toxicology
Journal title
EUROPEAN JOURNAL OF CLINICAL PHARMACOLOGY
ISSN journal
00316970 → ACNP
Volume
55
Issue
4
Year of publication
1999
Pages
325 - 332
Database
ISI
SICI code
0031-6970(199906)55:4<325:"MAPPA>2.0.ZU;2-I
Abstract
Vietnam, a developing country: has had comparatively good health and human survival at low cost. The economic reform changed the health care system, a nd private pharmacies during the last 5 years have taken over a majority of the drug distribution. Problems include weaknesses in drug regulation and reported increases in antibiotic resistance. This case study, a purposive sample of two private pharmacies in Hanoi, exp lored management, including dispensing, inventory and financing, using the concept of triangulation. Observations and interviews of customers were com plemented by stock inventory and interviews of the pharmacy staff. Drugs we re classified according to the ATC code and the essential drug list of Viet nam. Pretested protocols were used. In all 1833 encounters were studied during the 2 weeks, out of which 286 we re children. Less than 1% of customers came with prescriptions and 94.9% de cided by themselves which drugs to buy. Antibiotics represented 17%, of whi ch 90% were broad spectrum. Ampicillin dominated, both in children and adul ts. Some 50% of the antibiotics were given for 2.5 days or less. Less than 50% of the drugs were essential drugs (ED) on dispensing and even less on i nventory. Antibiotics and vitamins were the most commonly sold drugs and, o verall, brand names dominated. Little if any drug information was observed. Antibiotics were said to represent the most profitable drugs, according to the pharmacy staff. More than 20% of all products were combination drugs, including irrational and popular products with antibiotics and corticostero ids and combinations of aspirin, phenacetin and caffeine. This study shows an unexpectedly high proportion of customers, being "Tu La m Bac Sy" (their own doctors), deciding themselves which drugs to buy. Alth ough the "Doi moi" renovation has led to much improved drug availability, a t least in urban setting, our case study highlights major problems in need of urgent actions. In particular the prevailing practices regarding antibio tics and combination drugs need to be seriously scrutinized and drug regula tory mechanisms should be enforced.