Tropical Medicine and International Health doi:10.1111/tmi.

12062

volume 18 no 4 pp 426–434 april 2013

Strengthening pharmacy practice in vietnam: findings of a

training intervention study
Pham Duc Minh1, Dinh Thi Mai Huong1, Ramona Byrkit1 and Marjorie Murray2
1 PATH, Hanoi, Vietnam
2 PATH, Seattle, Washington, USA

Abstract objective To assess the effectiveness of a training and supportive supervision intervention in
strengthening the capacity of pharmacy staff in Vietnam to deliver client-oriented, accurate healthcare
information and appropriate services for childhood diarrhoea and emergency contraceptive pills
(ECP).
methods Pre- and post-intervention study using a cross-sectional design. Pharmacy staff
participated in 3 days of training on customer relations, good pharmacy practice, childhood
diarrhoea and ECP over a period of 1 month, consisting of lectures, discussion, question-and-answer
sessions and role-playing. We compared baseline and 6-month post-intervention surveys to ascertain
changes in knowledge, attitudes and practice of pharmacists, using univariate statistics to find
significant differences.
results More than 1200 pharmacists received training and supportive supervision. After
interventions, pharmacy staff knowledge was significantly improved on most of the measured
indicators. Knowledge of dehydration symptoms for diarrhoea increased from 19% to 88%, and for
side effects of ECP increased from 27% to 77%. While assessment of actual practice revealed that
this knowledge was not always used, significant improvement was observed. Before interventions,
12% gave information on dehydration symptoms but 45% did so afterwards. The proportion giving
information on side effects of ECP increased from 13% to 54%.
conclusions Providing a programme of training and supportive supervision is an effective way to
improve knowledge and practice of pharmacists at private pharmacies in Vietnam. These
improvements have the potential to lead to better community health care.

keywords Vietnam, pharmacist, training, community health care, childhood diarrhoea, emergency
contraceptive pills, mystery clients

services and a high degree of discrepancy between

Introduction
Pharmacies in low- and middle-income countries provide
quick access to medicines and health advice – they are
ubiquitous, have convenient hours and locations, require
no appointment and offer anonymity (Goel et al. 1996).
Consumers in these countries often make pharmacies their
first, and sometimes only, healthcare visit for common ail-
ments (Kamat & Nichter 1998; Smith 2009a; Hoa et al.
2011); however, staff at these shops do not always recom-
mend appropriate or adequate medicines or treatment
regimens, causing concerns about public health issues
such as antibiotic resistance, incorrect treatment of
sexually transmitted infections (STIs) and complications
from diarrhoea in children. Studies on the quality of
pharmacies in low-resource settings also have raised
concerns about their limited involvement in preventive
pharmacy staff stated intentions and practice (Smith
2009a).
Reviews of pharmacy intervention studies in low- and
middle-income countries in Asia, Central and South
America, and sub-Saharan Africa indicate that most
researchers and public health officials have used educa-
tional and/or training methods. A review of 18 articles in
low and middle-income countries worldwide (Smith
2009a,b) noted that all focused on educational methods,
while three also included regulatory (coercive) compo-
nents. Another review analysed 10 intervention studies in
sub-Saharan Africa (Wafula & Goodman 2010) and
found that all used educational interventions. Both
reviews concluded that the training provided in these
studies had resulted in some improvements in
practice but that more rigorous studies are needed before

426 © 2013 Blackwell Publishing Ltd

Tropical Medicine and International Health
Minh et al. Strengthening pharmacy practice in Vietnam
recommendations on the most effective types of interven-
tions can be made.
The estimated number of drug outlets in Vietnam was
more than 40 000 in 2011, excluding drug stores within
commune health stations, with private pharmacies com-
prising nearly 12 000 of the total (Drug Administration
of Vietnam 2012). Self-treatment is common, and phar-
macies are the most frequently used healthcare facilities,
accounting for approximately two-thirds of all health
service contacts (World Bank et al. 2001). Several
observational studies of pharmacies in Vietnam have
been reported. A study in Hanoi observed more than
1800 customers at pharmacies and found that 95%
decided themselves which treatments to purchase and
17% of these were antibiotics (Chuc & Tomson 1999).
Other studies on the quality of pharmacy practice
report that improvements are needed, especially in pri-
mary healthcare areas such as supplying antibiotics,
managing STIs, treating diarrhoea in children, achieving
tuberculosis care and control and managing childhood
acute respiratory infection (van Duong et al. 1997;
Chalker et al. 2000; Chuc et al. 2001; Lonnroth et al.
2003).
Among the few intervention studies reported from
Vietnam, a randomised trial in Hanoi (Chalker et al.
2002; Chuc et al. 2002) showed that knowledge and
reported practice of pharmacists who received training
and support improved significantly for syndromic treat-
ment of STIs and acute respiratory infections, appropriate
referrals and rational dispersal of drugs compared with a
group that had no interventions. The interventions also
included regulatory enforcement and a peer-influence
component.
In 2008, the international non-governmental organisa-
tion PATH began a project with the ultimate goal of
improving health outcomes among community members
in five provinces in Vietnam through a public–private
partnership among provincial health authorities, pharma-
cies and public and private health facilities in the inter-
vention area. Objectives of the project included
strengthening the capacity of pharmacy staff to deliver
client-oriented primary healthcare information, services
and referrals; and increasing community awareness of
and demand for pharmacy-based primary healthcare ser-
vices for two health issues of community concern, child-
hood diarrhoea and use of emergency contraceptive pills
(ECP). While under-five mortality in general and deaths
from childhood diarrhoea have fallen in Vietnam, 10%
of under-five deaths still were attributed to diarrhoea in
2010 (World Health Organization 2012). According to a
2009 report, only 41% of children with diarrhoea
received increased fluids for the condition and 26%
© 2013 Blackwell Publishing Ltd
volume 18 no 4 pp 426–434 april 2013
received an oral rehydration solution packet (UNICEF &
World Health Organization 2009).
In regard to use of emergency contraception, data on
abortions in recent years in Vietnam show that the rate is
very high. About 1.4 million are performed annually and
the rate among married women aged 25–29 years is 0.40
(Nguyen 2012). Surveys do not measure the rate for
unmarried women, but data from national surveys sug-
gest that young people in Vietnam are engaging more fre-
quently in premarital sexual relationships, with nearly
14% doing so in 2008 compared with 11% in 2003,
although their knowledge on reproductive health and
pregnancy remained limited and unchanged (General Sta-
tistics Office of Vietnam 2009). The surveys also have
suggested that ECP is among the ‘best sellers’ of over-
the-counter drugs at private pharmacies. According to a
report on incidence and trends in legal abortion world-
wide from the Guttmacher Institute, ‘Where the abortion
rate is high, it likely reflects that levels of contraceptive
use are not sufficient to meet the fertility desires and fam-
ily planning needs of women and couples’ (Sedgh et al.
2007).
This article reports on strengthening the knowledge
and practice of pharmacists in delivering client-oriented,
accurate healthcare information and appropriate services
for childhood diarrhoea and ECP through a programme
of training and supportive supervision.
Methods
Study design and setting
This was a pre- and post-intervention study using a
cross-sectional design. The interventions were training
and supportive supervision of pharmacists, carried out in
selected urban areas in five provinces in Vietnam repre-
senting a diversity of geographical settings: Thai Nguyen,
Thua Thien Hue, Da Nang, Khanh Hoa and Vinh Long.
Urban areas were chosen because the majority of private
pharmacies are found in these locations. Effects of inter-
ventions were measured by comparing knowledge, atti-
tudes and practice of pharmacists assessed in two types
of surveys before and after the interventions. Two coordi-
nators – one from the medical professional section and
one from the pharmaceutical management unit of the
provincial health department – in each province served as
liaisons between the PATH team (two authors of this
article and two other staff) and all provincial partners.
Licensed private pharmacies in each province were
mapped, and owners of all identified pharmacies were
invited to participate in 1-day technical update and orien-
tation workshops. Those who subsequently decided to
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Tropical Medicine and International Health
Minh et al. Strengthening pharmacy practice in Vietnam
participate in the training programme signed informed
consent documents and were registered for the study.
Others invited to the orientations were key stakeholders
from the provincial health departments, district health
departments, medical schools, pharmacy schools, public
and private clinical health services, the Women’s Union
and the Youth Union.
Intervention content and implementation
We worked with local partners to develop training tools,
drawing on materials developed in Vietnam and else-
where on similar issues, and we incorporated information
from the baseline surveys into training plans and materi-
als. In discussions with local partners, we identified teams
of provincial-level trainers with experience leading work-
shops and conducted 5-day training-of-trainers sessions.
Pharmacy staff then participated in 3 days of training on
customer relations, good pharmacy practice, childhood
diarrhoea and ECP over a period of 1 month, with meth-
odology including lectures, discussion, question-and-
answer sessions and role-playing. At the end of training,
each pharmacy was provided reference materials, such as
job aids and information, education and communication
(IEC) materials on childhood diarrhoea and ECP, as well
as leaflets on diarrhoea and ECP for client distribution.
To further strengthen the capacity of pharmacy staff,
PATH and partners developed a system of supportive
supervision to provide on-the-job guidance, staff orienta-
tions and tools to help ensure the quality of pharmacy
staff work on an ongoing basis. The team of supervisors
consisted of 11–13 pharmacists and physicians in each
province who visited all participating pharmacies
quarterly.
Sample selection and size
A simple random sampling technique was applied to
identify subjects for pharmacy staff surveys, in which the
sampling unit was an individual staff member. The mini-
mum sample size was calculated using WHO’s recom-
mended formula (Lwanga & Lemeshow 1991) to detect
the difference in staff knowledge before and after the
interventions at a level of significance (a) of 5% and
power of test (1- b) of 80%. The calculated sample size
was 270; a 4% non-response rate for the baseline survey
and 2% for the post-intervention survey were taken into
account, giving a final sample size of 281 and 275 for the
two surveys, respectively. A similar method was applied
to calculate the sample size for the mystery client survey,
in which the sampling unit was one pharmacy; the
required sample size was 220 for each survey (Figure 1).
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volume 18 no 4 pp 426–434 april 2013
Pharmacy staff questionnaires
For baseline and post-intervention surveys of pharmacy
staff, we developed questionnaires to gather demo-
graphic data as well as information on general attitudes
and practices, and on knowledge, attitudes and practices
of pharmacy staff for diarrhoea in children and emer-
gency contraception issues. The questions for childhood
diarrhoea were developed by the PATH team in consul-
tation with clinical experts. The questionnaire and sce-
nario for ECP were adapted from another PATH
project (PATH 2006) that had been used in Vietnam
and several other countries (Cambodia, Nicaragua and
Kenya). Both questionnaires were piloted in two prov-
inces in Vietnam (Vinh Long and Thai Nguyen), and
revisions were made to adapt them for local terminol-
ogy and context.
Mystery client assessment of pharmacy staff
In order to further assess pharmacy staff knowledge and
practice before and after interventions, we trained a
group of eight men and women in each province, selected
from the Youth and Women’s Unions, as simulated cli-
ents (Chuc et al. 2001; Garcia et al. 2003) who went to
project pharmacies to seek health care. These simulated
or ‘mystery clients’ were aged 20–30 years and had no
medical or pharmaceutical background, but expressed
interest and enthusiasm for the work. They participated
in a 2-day training programme where scenarios involving
clients visiting pharmacies for issues of childhood diar-
rhoea and need for emergency contraception were pre-
sented and explained. Mystery clients practiced
observation, memorisation skills and role-playing and
participated in a ‘pilot survey’ on at least one of the two
scenarios at a real pharmacy that was not included in the
formal surveys.
For the baseline and post-intervention surveys, mys-
tery clients visited selected pharmacies in pairs, with one
performing the diarrhoea scenario and the other the
need for ECP. Both men and women could enact the
ECP scenario, with men asking for medicine for a girl-
friend or partner, and women asking for themselves.
Each pair of mystery clients was assigned three to four
pharmacies to visit per day for 3 days; thus, four pairs
of clients visited a total of 44 pharmacies in each prov-
ince. Mystery clients were instructed to buy medicines
recommended by the pharmacy staff, observe staff atti-
tudes and actions and remember recommendations and
guidance. No later than one hour after mystery clients
visit a pharmacy, an interviewer debriefed them and
recorded their observations.
© 2013 Blackwell Publishing Ltd
Tropical Medicine and International Health
Minh et al. Strengthening pharmacy practice in Vietnam
Baseline
707 pharmacies registered
in project area
Randomly
selected
1245 individual
staff listed
Randomly
selected
220 pharmacies visited
(Mystery client surveys)
281 individuals interviewed
Figure 1 Sampling process for pharmacy staff and mystery client surveys.
*During the time from registration until training started, a number of new pharmacies opened and asked to participate in the study.
After consultations with the Provincial Health Departments, these pharmacies gave written consent to participate and were included.
In each province, one supervisor was recruited from
the provincial health department to attend the training
and to supervise the performance of the mystery clients.
Supervisors were responsible for seeing that all mystery
clients visited their assigned pharmacies each day and for
screening all questionnaires completed by these clients.
Timeline of interventions and surveys
After pharmacies registered for the project, we conducted
baseline surveys to ascertain the knowledge level and ser-
vice quality among pharmacy personnel. The baseline
survey was conducted in June 2008 and the post-inter-
vention survey in January 2010. Training for pharmacy
staff on the selected topics concluded 6 months before
the post-intervention survey (June 2009) (Table 1).
Data entry and analysis
We computerised collected data using Microsoft Access
2003 and transferred data to Stata, version 11.0 (College
Station, TX, USA), for analysis. We used univariate
© 2013 Blackwell Publishing Ltd
volume 18 no 4 pp 426–434 april 2013
Post - intervention
734* pharmacies participated
in project
Randomly
selected 789 individual staff
listed
Randomly
selected
220 pharmacies visited
(Mystery client surveys)
275 individuals interviewed
statistics (descriptions, frequencies, cross-tabulations, chi-
squared test) to describe the characteristics of pharmacy
staff as well as to look for significant differences in the
knowledge level, attitudes and practice of pharmacy staff
between the baseline and post-intervention evaluations.
Statistical tests used an alpha of 0.05.
Because at least 90% of the pharmacy staff respon-
dents were either intermediate or assistant pharmacists,
we did not perform subanalyses of results for participants
with different levels of education.
Ethical issues
PATH’s Research Determination Committee approved
the survey protocols for non-research determination. We
asked all participants in the project to take part voluntar-
ily and gave all the right to withdraw at any time with-
out threat or disadvantage. PATH conducted the project
in collaboration with officials from the five provincial
health departments and the medical schools of each prov-
ince. In Vietnam, for this type of study where the major
interventions are training and supportive supervision or
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Minh et al. Strengthening pharmacy practice in Vietnam

Table 1 Timing and sequence of intervention and surveys

Mapping pharmacies;
orientation workshops; Baseline Developing and printing Training of trainers; Supportive Post-interven-tion
Activity registration survey training and IEC materials training pharmacists supervision survey

Timeline January–May 08 June 08 July 08–February 09 April–June 09 September 09 January 10

quality assurance on public health issues for healthcare intervention survey across the five provinces. For the
professionals, there is no requirement for ethical approval baseline survey, numbers of respondents in each province
at the national level. In each of the five provinces, the were as follows: Da Nang: 53; Thua Thien Hue: 53;
project protocol was assessed for both technical and ethi- Thai Nguyen: 59; Vinh Long: 61; Khanh Hoa: 55. In the
cal aspects and received approval from the Provincial post-intervention survey, the number was 55 in each
People’s Committee for implementation. province.
Data showed a statistically significant improvement in
knowledge on childhood diarrhoea in all five provinces.
Results As can be seen in Table 3, the proportion of respondents
who knew dehydration symptoms after the interventions
Profiles of pharmacists
was more than four times that in the baseline evalua-
A total of 734 pharmacies in the five provinces partici- tions, increasing from 19% to 88%. Improvements were
pated in the project, with 396 owners and an additional observed in the proportions of post-intervention intervie-
890 staff trained, for a total of 1286 people working in wees with good knowledge on danger signs of diarrhoea
pharmacies who received training. Table 2 presents char- and diarrhoea prevention, reaching 94% and 93%,
acteristics of pharmacy staff who were interviewed. respectively. Only half as many respondents post-inter-
In the baseline and post-intervention surveys, grade 1- vention recommended antibiotics, a positive trend.
specialised pharmacists (post-graduate degree) and pharma- Table 3 also presents results of the two surveys regard-
cists (degree from a 4-year medical and pharmacy university ing ECP, showing that pharmacy staff knowledge
programme) comprised fewer than 10% of the interviewees. improved significantly after the interventions. After train-
80% of respondents were female, and the average length of ing, 77% of staff could name at least three side effects of
time staff had worked in pharmacy was 14 years. ECP compared with 27% at baseline. The number of
staff knowing when to use ECP after training more than
doubled.
Pharmacy staff surveys on knowledge of childhood
diarrhoea and ECP
Mystery client surveys of pharmacy staff for attitudes
We used structured questionnaires to gather information
and practice for childhood diarrhoea and ECP
from 281 pharmacy staff at baseline and 275 at the post-
Mystery client surveys allowed comparison of what phar-
Table 2 Characteristics of pharmacists surveyed macy staff said they were doing in direct questionnaires
with what they practiced when interacting with custom-
Participant Baseline Post-intervention
ers. For these measurements, mystery clients assessed 220
Gender N (%) N (%) staff at baseline and 220 after interventions (44 per prov-
Female 225 (80) 223 (81) ince). While 220 assessments were conducted, 3 question-
Male 56 (20) 52 (19) naires at baseline and 4 in the post-intervention survey
Professional degree
had missing or inconsistent information and were deemed
Pharmacist (post-graduate) 9 (3.2) 1 (0.3)
Pharmacist (university) 14 (5) 3 (1.1) invalid; these were excluded from the analyses. Table 4
Intermediate pharmacist 155 (55.2) 154 (56) shows changes in knowledge, attitude and skills among
Assistant pharmacist 99 (35.2) 114 (41.5) pharmacy staff after programme interventions. Overall,
Others 4 (1.4) 3 (1.1) 73% of mystery clients at the post-intervention evalua-
Age and experience Years Years tion reported that pharmacy staff had a positive attitude
Average age 41.6 40.8 (defined as ‘friendly, helpful, welcoming, or attentive’)
Average experience in 14.5 13.7
when asked about childhood diarrhoea, an improvement
pharmacy sector
from 59% at baseline. In regard to knowledge levels of

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Minh et al. Strengthening pharmacy practice in Vietnam

Table 3 Knowledge of pharmacy staff on childhood diarrhoea and ECP at baseline and post-intervention evaluations

Average in five provinces

Post-intervention%
Index Baseline% (n = 281) (n = 275) OR (95% CI)

Childhood diarrhoea
Knew  2 symptoms indicating diarrhoea 22 43 2.7 (1.8–4.0)
Knew  3 dehydration symptoms 19 88 32.4 (19.7–53.7)
Knew  3 danger signs of diarrhoea 49 94 15.9 (9.1–29.1)
Knew  3 means to prevent diarrhoea 57 93 10 (5.8–17.8)
Would recommend ORS* 97 99 2.6 (0.6–15.6)†
Would recommend antibiotics 15 7 2.3 (1.3–4.2)
Emergency contraception
Knew  3 side effects of ECP 27 77 9.2 (6.2–13.9)
Knew when to use ECP 41 85 8.4 (5.5–12.9)
Knew time to use ECP after unprotected sex 61 72 1.7 (1.2–2.4)

OR, Odds Ratio; CI, Confidence Interval.

*ORS: oral rehydration solution.
†Result is not statistically significant at P < 0.05.

Table 4 Mystery client evaluation of pharmacy staff attitudes and practice for childhood diarrhoea and ECP at baseline and
post-intervention evaluations

Average in five provinces

Baseline% Post-intervention%
Index (n = 217) (n = 216) OR (95% CI)

Childhood diarrhoea
Pharmacist had positive attitude 59 73 1.8 (1.2–2.8)
Client understood information fromPharmacist 61 67 1.3 (0.9–1.9)†
Pharmacist asked about other symptoms 47 77 3.8 (2.4–5.9)
Pharmacist gave information on dehydration 12 45 5.8 (3.5–9.9)
Pharmacist gave information on danger signs 23 60 5.2 (3.3–8.1)
Pharmacist gave information on prevention 1 18 15.2 (4.7–78.0)
Pharmacist offered ORS* 42 88 10.1 (6.0–17.2)
Pharmacist offered antibiotic 15 4 3.9 (1.8–9.7)
Emergency contraception
Positive attitude 48 66 2.0 (1.4–3.0)
Client understood information from pharmacy staff 57 63 1.3 (0.9–1.9)†
Pharmacist gave information on side effects of ECP 13 54 8.3 (4.9–14.2)
Pharmacist warned ECP cannot protect against STIs 1 18 22.4 (5.6–193.2)
Pharmacist recommended regular contraception 8 46 10.4 (5.7–19.7)
methods instead of frequent use of ECP

OR, Odds Ratio; CI, Confidence Interval.

*ORS: oral rehydration solution.
†Result is not statistically significant at P < 0.05.

pharmacy staff on childhood diarrhoea, more than 75%
of mystery clients were asked by staff at the post-inter-
vention evaluation about symptoms indicating diarrhoea
in the child for whom they sought help, compared with
47% at baseline. In comparison with baseline informa-
tion, the practice of providing advice to prevent diar-
rhoea in children improved significantly, from 1% at
baseline to 18% post-intervention, although this is still
very low. Notably, while staff self-reporting of recom-
mending ORS was much higher than that found by mys-
tery client survey, it did increase substantially after
intervention (Tables 3 and 4). Recommendations for anti-

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Tropical Medicine and International Health
Minh et al. Strengthening pharmacy practice in Vietnam
biotic use were low in both staff survey and survey by
mystery client at baseline and decreased after training
as well.
Mystery client surveys on ECP across the five provinces
are also reported in Table 4 and showed a trend towards
improved attitude and skill in providing information. The
proportion of staff with a positive attitude towards these
clients rose to 66% from a baseline of 48%. Among
other significant improvements were giving information
on side effects of ECP and advising use of regular contra-
ception methods instead of frequent use of ECP.
Discussion and Conclusions
Because of the ubiquity of pharmacies in developing
countries and the number of people who obtain
medicines and advice there, these enterprises have a
substantial impact on public health. According to a
review by authors from WHO and the World Bank,
‘The private sector exerts a significant and critical
influence on child health outcomes in developing
countries, including the health of poor children …
Pharmacies, drug sellers, private suppliers, and food
producers … have an impact on the health of children
… governments and programmes that fail to integrate
these actors in child health policy and programmes will
be seriously constrained’ (Bustreo et al. 2003). The arti-
cle calls out training of pharmacists as a good strategy
for contributing to child health outcomes. Other
publications from World Health Organization (1994)
and the International Pharmaceutical Federation (1998)
emphasise the role of pharmacists in the healthcare
system. It follows that strengthening the knowledge and
practice of pharmacists could improve public health,
although measuring the latter in large populations is
difficult.
The study reported here is one of a few pre- and
post-intervention studies that have compared knowledge
and practice reported by staff as well as actual practice
and attitude of pharmacy staff measured by client
assessment in a developing country. Another study in
Vietnam (Chalker et al. 2002) trained pharmacists in 22
control and 22 matched intervention pharmacies and
showed significant improvement in the intervention
group as measured by direct questionnaire, but had no
assessment for actual practice. We saw considerable dis-
crepancies between pharmacists’ answers to direct ques-
tions and their practice assessed by mystery clients in
our study, so it seems important not to rely only on
reported practice. Our results add to evidence (Ross-De-
gnan et al. 1996; Chalker et al. 2002; Chuc et al. 2002;
Garcia et al. 2003; Qidwai et al. 2006) that providing
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volume 18 no 4 pp 426–434 april 2013
training to staff at private pharmacies is an effective
way to improve pharmacy practice, which has the
potential, ultimately, to improve community health
outcomes.
In our study, pharmacy staff improved their knowledge
of how best to care for clients with concerns about child-
hood diarrhoea or ECP after participating in training and
a programme of supportive supervision. Staff were also
significantly more likely to put this knowledge into prac-
tice when approached by customers after training,
although at a lower rate than indicated by direct ques-
tioning.
Questions arose in regard to some of our findings; for
example, in the assessment of pharmacy staff knowledge
on childhood diarrhoea, knowledge improved substan-
tially for identifying danger signs and dehydration symp-
toms after training, but not so impressively for
identifying ‘symptoms indicating diarrhea’. The reason
for this discrepancy is unclear, but in the mystery client
assessment of practice for childhood diarrhoea, pharma-
cists were significantly more likely to ask about symp-
toms and give information on dehydration and danger
signs after training, so the training clearly had a positive
impact.
Our study had some limitations. First, there was no
control group of pharmacies that received minimal train-
ing such as provision of printed information, or training
on another topic (Garcia et al. 2003). Further, we did
not arrange to assess the same individual staff via direct
questionnaire and mystery client survey: while a pharma-
cist who answered a questionnaire also may have been
the subject of a mystery client visit, these coincidences, if
any, were not recorded purposively. However, the large
number of observations for both surveys provides confi-
dence that the interventions strengthened pharmacy prac-
tice in the survey populations. The questions in our
surveys were all open-ended – there were no questions
with response options involving confirming a statement
and no prompting by interviewers – minimising the possi-
bility of acquiescence response bias (Saris et al. 2010).
Another limitation of the study was that we chose to
work with urban pharmacies, as the majority of pharma-
cies in Vietnam are located in urban areas. The results
thus may not be generalisable to rural and mountainous
areas of the country.
The fact that Vietnam has more than 40 000 drug out-
lets makes the task of improving practices at these facili-
ties daunting. While our study showed that interventions
at the private pharmacy level can produce change, clearly
the efforts must expand to improve pharmacy curricula
in colleges, thereby building correct practice into the
profession from the beginning.
© 2013 Blackwell Publishing Ltd
Tropical Medicine and International Health
Minh et al. Strengthening pharmacy practice in Vietnam
Acknowledgements
The study reported in this article was part of the project
‘Enhancing the Role of Pharmacies as Community Health
Care Providers’ funded by the Atlantic Philanthropies.
We would like to thank all pharmacists/pharmacy staff
who participated in this study. Special thanks go to lead-
ers and officials of the five provincial health departments
for their cooperation and support; PATH staff, provincial
trainers, supervisors and data collectors who involved in
trainings of pharmacy staff and data collections in the
field. We also thank Molly Derrick and Kate Bagshaw
for proofreading the article.
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Corresponding Author Pham Duc Minh, PATH, 2nd floor, Hanoi Towers, 49 Hai Ba Trung Street, Hoan Kiem District, Hanoi,
Vietnam. E-mail: minhp1974@gmail.com
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