COMMUNITY PHARMACY

According to the WHO (1948), “Health is a state of complete

physical, mental and social well being and not merely an
absence of disease or infirmity, so that each citizen can live a
socially and economically productive life”.
Dimensions (types) of health
According to WHO, there are four major dimensions of
health –
[Link] health
[Link] health
[Link] health
[Link] health

Besides these, many more can be cited;

—Emotional
—Vocational
—Philosophical
—Cultural
—Socio-economical
—Environmental
—Political
—Educational
—Nutritional
Levels of healthcare
Health services are usually organized at three levels, each
level supported by a higher level to which the patient is
referred.
Three levels are –
[Link] health care
[Link] health care (Intermediate level)
[Link] health care (Central level)

Primary health care (grass root level)

First level on contact of individuals, the family and
community with National Health System where essential
health services (primary health care) are provided. This
level of care is most effective within the context of the
area’s needs and limitations because of providing by the
primary health center or other sub center.
Example: Thana Health Complex & their Union sub centers
Secondary health care (Intermediate level)
At this level, more complex problems are dealt with. This care
comprises essentially curative services and is provided by the
district hospital and community health centre. This level is
assigned to provide some specialist services particularly in
internal medicine (general medicine), general surgery,
obstetrics (care of women giving birth), gynecology and
pediatrics.
Example: Dhaka Mohanagar General Hospital, District
Hospitals etc.

Tertiary health care (Central level)

This level offers super specialist care. This care is provided by
the regional or central level institutions. This institutions
provide not only highly specialized care but also planning and
managerial skills and teaching for specialized staff.
Example: Medical college hospital and other specialized
hospital like cancer hospital, eye hospital, mental hospital,
National Institute of Cardiovascular disease, National Institute
Community health
Community health refers to the healthy status of the member
of the community to solve the problems affecting their health,
and to the totality of a health care, provided for the
community. Community health broadly encompasses the
entire gamut of community efforts for maintaining, protecting,
improving the health of the people. Modern community health
seeks to bring together all the available health services (e.g.
medical care, mother & child care, family planning services,
environmental sanitation, laboratory services, disease control
program, health education).
Community pharmacy
A community pharmacy is a community based pharmacy. It is
an important branch of the pharmacy profession and involves
a qualified and pertinent (relevant) pharmacist. Being closely
in contact with general people, the community pharmacists
should have the required education, skills and competence
(ability) to deliver the professional service to the community. A
community pharmacy is a healthcare facility that provides
pharmaceutical services to a specific community.

Main responsibilities
—Appropriate procurement
—Appropriate storage
—Appropriate documentation
—Dispensing of medicine
—Counseling on prescription to the patients with care,
accuracy and legality.
Qualifications required being a community pharmacist
In compliance with the vision of the community pharmacy
section of ‘the International Pharmaceutical Federation’,
community pharmacists should –
—Be experts in pharmaceutical care, pharmacotherapy (the
treatment of disease and especially mental illness with drugs)
and health promotion.
—Be professional communicators with patients, other
healthcare providers, and decision makers.
—Deliver good quality in products, services, and
communication.
—Document their actions and make descriptions and
publications.
Principle/aim of primary health care (PHC)
The PHC approach is based on principles of society equity,
national wide coverage, self reliance, inter-sectorial
coordination and people’s involvement in the planning and
implementation of the health program.
[Link] distribution
[Link] participation
[Link] co-ordination
[Link] technology
Equitable distribution
The first principle of the PHC strategy is equity or equitable
distribution of health services i.e. health services must be
shared equally by all people irrespective of their ability to pay
and all (rich/poor, urban/rural) must have access to health
services. At present, health services are mainly concentrated
in the major towns and cities, resulting an in-equality of health
to the rural people. PHC aims to reduce the imbalance by
shifting the centre of gravity of the health care system from
cities to the rural areas and thus bring services as near
people’s home as possible.

Community participation
The involvement or participation of individuals, families and
communities (social workers, health personnel, school
teachers, religious, political and local leaders) in promotion of
their own health and welfare is an essential ingredient of PHC.
Thus the community should participate in the planning,
implementation & maintenance of health services.
Intersectorial co-ordination
The components of PHC cannot be provided by the health
sector alone. So PHC should involve in addition to the health
sector, all related sectors & aspects of national and community
development; in particularly agriculture, animal husbandry,
food industry, education, housing, public works,
communication and other sectors. To achieve such
cooperation, countries may have to review their administrative
system, reallocated their resources and introduce a suitable
legislation to ensure co-ordination can take place.

Appropriate technology
This applies of using sophisticated technology and medicine in
appropriate way against relevant health problem e.g.,
domiciliary (home) treatment of T.B, ORS therapy in cholera &
diarrhea.
Appropriate technology has been defined as the technology
that is –
—Scientifically sound
—Adaptable to local needs
—Acceptable to those, who apply it and for the users
Elements of PHC
Although specific services provided will vary in different
countries and communities, PHC constitutes eight essential
components are –
[Link]: Education concerning health problems
(prevailing) and the methods of preventing and controlling
them.
[Link]: Prevention and control of locally endemic
diseases.
[Link]: Extended immunization against major
infectious diseases.
[Link] planning: Maternal and child health care including
family planning.
[Link] drugs: Provision/delivery of essentials drugs.
[Link] and nutrition: Promotion of food supply and proper
nutrition.
[Link] treatment: Appropriate treatment of common
Health manpower
The most essential part of health services is health manpower.
The concept of health manpower includes both professional
and auxiliary health personnel, e.g. physicians, health visitors,
auxiliary nurse, midwives, medico-social workers, health
inspectors etc. All these personnel have a vital role to play in
the delivery of preventive (diabetes, blood pressure) and
curative services (chemotherapy). They are all employees in
the health care system.

Manpower requirement for developing infrastructure of

community pharmacy –
Pharmacists 1 person/ 1000 population
Doctors 1 person/ 3500 population
Nurses 1 person/ 5000 population
Auxillary nurse 1 person/ 5000 population
(midwives)
Sanitary inspectors 1 person/ 10,000 population
Lab. Tech. 1 person/ 10,000 population
Healthcare system in Bangladesh
The healthcares are designated to meet the health needs of
the community through the use of available knowledge and
resources. The services provided should be comprehensive
and community based. The resources must be distributed
according to the needs of the community. The final outcome
of good healthcare system is changed health status or
improves health status of the community which is expressed
in terms of lives saved, death averted, disease prevented,
disease treated, prolongation of life etc.

Healthcare delivery system in Bangladesh based on PHC

concept has got various level of service delivery –
[Link] level
[Link] sub centre (USC) or Health and family welfare centre
(HFWC): This is the first health facility level.
[Link] level, Thana Health Complex (THC): This is the first
referral level
[Link] Hospital: This is the secondary referral level.
Healthcare system in Bangladesh
Primary level health care is delivered though USC or HFWC
with one in each union and provides domiciliary care,
integrated healthcare and family planning services through
field workers for every 3000-4000 population and 31 bed
capacities in hospitals.

The secondary level health care is provided through 100 bed

capacities in district hospital. Facilities provide generalized
services in internal medicine, general surgery, gynecology,
pediatrics and obstetrics, eye clinical, pathology, blood
transfusion and public health laboratories.

Tertiary level health care is available at the medical college

hospital, public health and medical institutes and other
specialist hospitals at the national level where a mass wide
range of specialized as well as better laboratory facilities
are available.
Health problems in Bangladesh
The health problems of Bangladesh can be conveniently
grouped into the following classes –
[Link] problem
[Link] disease problem
[Link] problem
[Link] sanitation problem
[Link] health problem

Population problem
Population growth is the great problem of Bangladesh.
Main reasons for excessive population growth are –
—High fertility rates
—Low death rate
—Child marriage
—Illiteracy
Excessive population mainly reasons for educational problem,
unemployment, healthcare problem, economic problem.
Communicable disease problem
Communicable diseases are still the major diseases in
Bangladesh. Mortality & morbidity (unhealthy) due to these
diseases are very high. Infectious diseases like cholera,
typhoid, tuberculosis, leprosy, tetanus, diphtheria, whooping
cough, measles, rabies, venereal diseases (Sexually
Transmitted diseases like gonorrhea, syphilis etc.) and
parasitic diseases like malaria, filariasis (skin disease caused
by mosquito parasites), worm infestations are responsible for
major morbidity. An expanded immunization program against
six major diseases (TB, Tetanus, Diphtheria, Whooping cough,
Measles, Polio) was undertaken for implementation.

Environmental sanitation problem

The most difficult problem to tackle in this country is perhaps
the environmental sanitation problem which is multi-faceted
(directional) and multi-factorial. The twin problems of
environmental sanitation are –
—Lack of safe drinking water in many areas of the country.
Nutritional problem
Bangladesh suffers from some of the most severe malnutrition
problems. According to NHS, a man needs around 2,500 kcal
(2,000 kcal for woman) a day to maintain his healthy status.
Malnutrition results from the convergence of poverty,
inequitable food distribution, disease, illiteracy, rapid
population growth and environmental risks, compounded by
cultural and social inequities. Severe under nutrition exists
mainly among families of landless agricultural laborers and
farmers with small holding.

Specific nutritional problems in the country are –

—Protein Energy Malnutrition (PEM): The chief cause of it is
insufficient food intake.
—Nutritional Anemia: The most frequent cause is iron
deficiency and less frequently folate and vitamin B12
deficiency.
—Xerophthalmia -> eye fails to produce tear: The chief cause
is nutritional deficiency of Vit-A.
—Iodine Deficiency Disorders: Goiter/Gologondo and other
iodine deficiency disorders.
Health problem
Indiscriminate defecation (excreta) resulting in filth (disgusting
dirt) and water pond disease like diarrhoea, dysentery, enteric
fever, hepatitis, hook worm infestations.
—Poor rural housing with no arrangement for proper
ventilation, lighting etc.
—Inadequate drainage, disposal of refuse and animal waste.
—Absence of adequate Maternal and Child Health care
services.
—Absence and/ or adequate health education to the rural
areas.
—Absence and/or inadequate communications and transport
facilities for workers of the public health.
—Absence of control of communicable diseases.