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
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.