Role of Pharmacist in Malaria Control 15th Roll Back Malaria Partnership Board Meeting New Delhi Mrs Manjiri S Gharat Hon. Secretary, Community Pharmacy Division, Indian Pharmaceutical Association

Role of Pharmacist: African Experience Malaria Fact Card Project (Year 2001-2004) Project of Commonwealth Pharmaceutical Association (CPA), International Pharmaceutical Federation (FIP) & World Health Organisation (WHO) Aimed to disseminate reliable and relevant consumer information through community pharmacies on the prevention and early treatment of malaria in various malaria-endemic regions- Zimbabwe ,Tanzania & Ghana Pharmacists were provided with the training and resources to develop, produce and implement intervention strategies

Malaria Fact Card Project (Year 2001-2004) Malaria Fact Card-Consumer Education tool - easy to understand ,in local language Focused on prevention, treatment & complied with Malaria Control Strategies in each country Training of pharmacists in use of Fact Card as Counseling tool Focused Group discussion for evaluation of project

Project Outcome Fact Card had increased awareness of the prevention and early treatment of malaria in more than 60% of survey respondents in the target groups Increased pharmacist/patient interaction not only informed patients but also promoted the potential for real change in consumer behaviour Project was successful in achieving its objectives

Typical Indian Retail Pharmacy

Pharmacists participating in Tuberculosis (TB) Control TB Fact Card Project Pharmacists participating in Tuberculosis (TB) Control Objectives: To involve community pharmacists in: Promoting community awareness of TB Monitoring TB treatment prescribed by private physicians Providing patient support Implemented through 50 trained community pharmacists in Mumbai & Navi Mumbai

TB Fact Card Project Special Achievements Improvement in trader image Pharmacists’ commitment Successful Collaborations Improvement in trader image TB Fact Card Project Rise of Concept of DOTS Pharmacist

DOTS Provider pharmacist with TB patient

It has been (pharmacist services) mostly untapped potential till date Positive experiences of TB Fact Card project in Indian Settings & Malaria Fact Card in African settings suggest: Pharmacist has potential in participation of various health programmes of Governments It has been (pharmacist services) mostly untapped potential till date Pharmacists can add to trained workforce & with their involvement there could be wider outreach of malaria control programme

Advantages of using Community Pharmacy Services Pharmacist-first port of call health professional Easy accessibility of pharmacies Pharmacist skills in communication Friendly relation with consumers Knowledge about medicines Better patient care & support Provision of free advice 500,000 (half a million ) community pharmacies in the country

Malaria Control: Issues to be addressed Shortage of trained manpower Drug use problems at community level Insufficient awareness in the community leading to high morbidity & mortality in certain States

Observations by pharmacists Informal discussion with experienced community pharmacists brought up following points Incorrect use of medicines by patients (incomplete treatment, wrong timings of dosages ,fear of side effects etc) Suggests-Scope to improve the situation-Role of pharmacist Low level of awareness & concern about vector control, especially in rural areas Variations in treatment seen in prescriptions (deviations from standard guidelines?)

Envisioned Role of pharmacist Early Case Detection and Prompt Referral for Treatment Identifying symptomatic cases & directing suspected cases for medical check up Referring to diagnostic centers, Drug Distribution Centers (DDCs) and Fever Treatment Depots (FTDs) in the rural areas Counseling: Community awareness about causes, preventive measures ,symptoms, diagnosis (emphasis on importance of blood smear examination), treatment Rational use of prescribed medicines Counseling to improve Community Participation by sensitizing and involving the community for detection of Anopheles breeding places and their elimination Sensitizing consumers for various ways of vector control emphasizing personal prophylactic measures

Envisioned Role of pharmacist contd Presumptive treatment in high transmission areas? Pharmacovigilance –reporting of ADRs Participation in Evaluation of prescriptions/Prescription audits Counseling for Travelers malaria World Malaria Day –IEC campaigns

Way ahead… Pharmacist centric model for Malaria control Consumer health information & other IEC material on malaria in compliance with National malaria control policies ,for distribution/display through pharmacies Disseminate the information about planned project to pharmacists Selection of willing pharmacists Training of pharmacists about disease & use of Information tools Follow up & monitoring of the activities Evaluation Pilot project in one District of any high disease burden State & then nation wide implementation after refining the model

Possible collaborations-Public-Private Mix activity Collaborating organizations at national, regional & local level National Pharmaceutical Association (Indian Pharmaceutical Association) Chemist Associations Government Vector Borne Disease Control Department WHO ?? Challenges : Capacity building for training of pharmacists Funding support (sustainability …)

To summarise: Counseling Community awareness Case detection & referral With appropriate training & supervision, community pharmacists can complement and supplement the government efforts to make a significant dent in the malaria burden

Thank You CPA Secretariat,London Prafull D Sheth,Vice-President ,FIP Acknowledgements CPA Secretariat,London Prafull D Sheth,Vice-President ,FIP Thank You