Thesis Report

+
A Survey on Current Scenario of Model Pharmacy

in Bangladesh and Its Development Proposal
A Dissertation submitted to the Department of Clinical

Pharmacy and Pharmacology, University of Dhaka in the
partial fulfillment of the requirements for the M. Pharm.
Degree
Submitted by
Exam Roll No. : Curzon-2909
Registration No. : 2010-312-047
Session : 2015-2016
Examinee, M. Pharm. (Clinical Pharmacy and

Pharmacology) Final Exam-2017
Department of Clinical
Pharmacy and Pharmacology
University of Dhaka
Acknowledgement
At first, I would like to express my sincere gratitude to my respected supervisor Sabiha

Chowdhury, Lecturer, Department of Clinical Pharmacy and Pharmacology, University of
Dhaka for the continuous support of my thesis work, for her patience, motivation, and
immense knowledge. Her guidance helped me in all the time of my thesis. I could not have
envisioned having a better advisor and mentor for my thesis.
I would like to extend my sincere gratitude to Prof. A.B.M. Faroque, Professor, Department
of Pharmaceutical Technology, University of Dhaka for his assistance and guidance in the
preparation of survey questionnaire and in carrying out the survey. I am also thankful for the
contribution he made to this project by providing pertinent data.
I also express my gratitude to Dr. Mohammad Shawkat Ali, Professor and Chairman,
Department of Clinical Pharmacy & Pharmacology, University of Dhaka for giving me his
valuable time and advices.
Again my heartiest thank to all the respected teachers, staffs, and friends at Department of
Clinical Pharmacy and Pharmacology, University of Dhaka for their continuous inspiration
and support to complete my thesis.
Table of contents
Page No.
List of figures iii - vii
List of tables viii
Abstract ix
Chapter 1 Introduction and Literature Review 1 – 10
1.1 Pharmaceutical sector of Bangladesh 1
1.2 Retail Pharmacies in Bangladesh 1
1.2.1 Workforce at the Retail Pharmacies 2
1.3 Counterfeit Medicine 3
1.3.1 Counterfeit Medicine in Bangladesh 3
1.4 Dispensing: 3
1.4.1 Dispensing errors 4
1.4.2 Factors influencing dispensing errors 5
1.5 Patient Counselling 5
1.6 Self-medication 6
1.6.1 Benefits of self-medication 6
1.6.2 Drawbacks of self-medication 7
1.6.3 Effects of self-medication on antibiotic resistance 7
1.7 Model Pharmacy 7
1.7.1 The origin of idea of Model Pharmacy 8
1.7.2 The ADDO model of Tanzania 9
1.7.3 The Accredited Drug Shops (AMS) in Uganda and 9
Accredited Medicine Stores (AMS) in Liberia
1.8 Rationale and objectives 9
1.9 Literature review methods 10
Chapter 2 Methodology 11-15
2.1 Methodology for the field survey 11
2.2 Survey method 11
2.3 Study design 11
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2.4 Survey questionnaire form 12
2.5 Study population, Participant’s profile, and data collection 14
2.6 Evaluation of data 14
Chapter 3 Results 15-64
Chapter 4 Discussion 65-71
Chapter 5 Conclusion 72
Reference 73
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List of figures
List of figures
No. Topic Page No.

Figure A 1(A) Availability of adequate seating facility in the model 15
pharmacies (percentage and number).
Figure A 1(B) Availability of adequate seating facility in the model 15
pharmacies (number) of different districts.
Figure A 2(A) Availability of potable water facility in the model pharmacies 16
(percentage and number).
Figure A 2(B) Availability of potable water facility in the model pharmacies 16
(number) of different districts.
Figure A 3(A) Availability of signboard containing the name of the outlet and 17
logo in the model pharmacies (percentage and number).
Figure A 3(B) Availability of signboard containing the name of the outlet and 17
logo in the model pharmacies (number) of different districts.
Figure A 4(A) Availability of signboard containing the registration number 18
Figure A 4(B) Availability of signboard containing the registration number 18
(number) in the model pharmacies of different districts.
Figure A 5(A) Overall percentage and number of model pharmacies which 19
maintained the temperature under 30oC.
Figure A 5(B) Number of model pharmacies of different districts which 19
maintained the temperature under 30oC.
Figure A 6(A) Availability of toilet/washroom in the model pharmacies 20
Figure A 6(B) Availability of toilet/washroom in the model pharmacies 20
Figure A 7(A) Availability of separate room for patient counseling in the 21
model pharmacies (percentage and number).
Figure A 7(B) Availability of separate room for patient counseling in the 21
model pharmacies (number) of different districts.
Figure A 8(A) Availability of doctor inside the model pharmacies (percentage 22
and number).
Figure A 8(B) Availability of doctor inside the model pharmacies (number) 22
of different districts.
Figure B 1(A) Operating hour of the model pharmacies (percentage and 23
number).
Figure B 1(B) Operating hour of the model pharmacies of different districts. 23
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List of figures
Figure B 2(A) Operating timeline of the model pharmacies (percentage and 24

number).
Figure B 2(B) Operating timeline of model pharmacies of different districts 24
(number).
Figure B 3(A) Operating days in a week of the model pharmacies (percentage 25
and number).
Figure B 3(B) Operating days in a week of the model pharmacies (number) in 25
different districts.
Figure B 4(A) Presence of A grade pharmacists during survey (percentage 26
and number).
Figure B 4(B) Presence of A grade pharmacists in the model pharmacies 26
(number) of different districts during survey.
Figure B 5(A) Number of A grade pharmacists in the model pharmacy 27
Figure B 5(B) Number of A grade pharmacists (number) in model 27
pharmacies of different area.
Figure B 6(A) Number of C grade technicians in the model pharmacies 28
Figure B 6(B) Number of C grade trchnicians in the model pharmacies of 28
Figure B 7(A) Overall percentage and number of model pharmacies which 29
check certain patient conditions.
Figure B 7(B) Number of model pharmacies of different districts which 29
check certain patient condition.
Figure B 8(A) Overall percentage and number of model pharmacies which 30
administer injection.
Figure B 8(B) Number of model pharmacies of different districts which 30
administer injection.
Figure C 1(A) Overall percentage and number of model pharmacies whether 31
they keep prescription medicines separated from OTC drugs or
not.
Figure C 1(B) Number of model pharmacies of different districts whether 31
they keep prescription medicines separated from OTC drugs or
not.
they store “Prescription drugs” well secured or not.
they store “Prescription drugs” well secured or not.
Figure C 3(A) Overall percentage and number of model pharmacies which 33
sell narcotic drugs.
Figure C 3(B) Number of model pharmacies of different districts which sell 33
narcotic drugs.
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List of figures

they store narcotic drugs with higher security or not.
Figure C 4(B) Number model pharmacies of different districts whether they 34
store narcotic drugs with higher security or not.
Figure C 5(A) Overall percentage and number of model pharmacies which 35
have refrigerator.
Figure C 5(B) Number of model pharmacies of different districts which have 35
refrigerator.
they store vaccines and insulin between 2°C to 8°C or not.
they store vaccines and insulin between 2°C to 8°C or not.
they sell physician’s sample or not.
Figure C 7(B) Number of model pharmacies in different districts whether 37
they sell physician’s sample or not.
Figure C 8(A) Overall percentage and number of model pharmacies of which 38
have extemporaneous facility.
Figure C 8(B) Number of model pharmacies of different districts which have 38
extemporaneous facility.
they provide different container in case of dispensing bulk
drug or not.
they provide different container in case of dispensing bulk
drug or not.
they sale non pharmaceutical products and medical supplies
and devices or not.
they sale non pharmaceutical products and medical supplies
and devices or not.
Figure C 11(A) Overall percentage and number of model pharmacies of 41
whether they store therapeutic products and non-therapeutic
products separately or not.
they store therapeutic products and non-therapeutic products
separately or not.
they sale DGDA approved traditional or alternative medicine
or not.
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List of figures

they sale DGDA approved traditional or alternative medicine
or not.
they store traditional medicines separated from allopathic
medicines or not.
they store traditional medicines separated from allopathic
medicines or not.
they return the damaged or expired medicine to the companies
or not.
they return the damaged or expired medicine to the companies
or not.
Figure D 1(A) Overall percentage and number of model pharmacies whether 46
they keep adverse drug reaction (ADR) reporting form or not.
Figure D 1(B) Number of model pharmacies of different districts whether 46
they keep adverse drug reaction (ADR) reporting form or not.
Figure D 2(A) Overall percentage and number of model pharmacies whether 47
they report all the adverse drug reaction or not.
Figure D 2(B) Number of model pharmacies of different districts whether 47
they report all the adverse drug reaction or not.
Figure D 3(A) Overall percentage and number of model pharmacies from 48
where adverse drug reaction (ADR) reported after conversion.
Figure D 3(B) Number of model pharmacies of different districts from where 48
adverse drug reaction (ADR) reported after conversion.
Figure E 1(A) Number and percentage of A grade pharmacists whether they 49
have registration from Pharmacy council of Bangladesh
encountered during survey.
Figure E 1(B) Number of A grade pharmacists whether they have registration 49
from Pharmacy council of Bangladesh encountered during
survey of different districts.
Figure E 2(A) Working hour of A grade pharmacists (percentage and 50
number).
Figure E 2(B) Working hour of A grade pharmacists in model pharmacies of 50
Figure E 3(A) Working day of A grade pharmacist (percentage and number). 51
Figure E 3(B) Working day of A grade pharmacist of different districts. 51
Figure E 4(A) Salary range of A grade pharmacist (percentage and number). 52
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List of figures
Figure E 4(B) Salary range of A grade pharmacist in model pharmacies of 52

Figure E 5(A) Date range of salary confirmation of A grade pharmacists 53
Figure E 5(B) Date range of salary confirmation of A grade pharmacist 53
Figure E 6(A) Percentage and number of A grade pharmacist whether they 54
get salary in the fixed timeline or not.
Figure E 6(B) Number of A grade pharmacist of different district whether 54
they get salary in the fixed timeline or not.
Figure E 7(A) Overall percentage and number of A grade pharmacists 55
whether they get recompense if they have to work more than
the fixed work hour or not.
Figure E 7(B) Number of A grade pharmacists of different districts whether 55
they get recompense if they have to work more than the fixed
work hour or not.
Figure E 8(A) Overall percentage and number of A grade pharmacist in 56
model pharmacies who have completed the 30hours training
from PCB.
Figure E 8(B) Number of A grade pharmacist in model pharmacies of 56
different districts who have completed the 30hours training
from PCB.
Figure E 9(A) Overall percentage and number of A grade pharmacist who 57
have passed after training.
Figure E 9(B) Number of A grade pharmacists in model pharmacies of 57
different districts who have passed after training.
Figure E 10(A) Percentage and number of A grade pharmacists that get help 58
from the owner and other colleagues.
Figure E 10(B) Number of A grade pharmacists of different districts that get 58
help from the owner and other colleagues.
Figure E 11(A) Overall percentage and number of buying tendency of patient’s 59
in terms of full dose in model pharmacies.
Figure E 11(B) Number of buying tendency of patient’s in terms of full dose 59
in model pharmacies of different districts.
Figure E 12(A) Overall percentage and number of model pharmacies that keep 60
medicine purchasing record.
Figure E 12(B) Number of model pharmacies of different districts that keep 60
Figure E 13(A) Overall percentage and number of model pharmacies whether 61
they keep record of medicines sold to customers.
Figure E 13(B) Number of model pharmacies of different districts whether 61
they keep record of medicines sold to customers.
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List of figures
Figure F 1(A) Overall percentage and number of model pharmacies in terms 62

of customer flow.
Figure F 1(B) Number of model pharmacies of different districts in terms of 62
customer flow.
Figure F 2(A) Overall percentage and number of model pharmacies that are 63
being benefitted from the A grade pharmacist.
Figure F 2(B) Number of model pharmacies of different districts that are 63
being benefitted from the A grade pharmacist.
Figure F 3(A) Overall percentage and number of source of buying medicine 64
of the model pharmacies.
Figure F 3(B) Number of source of buying medicine of the model 64
pharmacies of different districts.
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List of Tables
No. Topic Page No.
Table 1 Demographic characteristics of model pharmacies 15
A Survey on Current Scenario of Model Pharmacy in Bangladesh and Its Development Proposal Page | viii
ABSTRACT
Pharmaceutical sector of Bangladesh has enriched profoundly after promulgation of The

Drugs (control) Ordinance, 1982 although the health sector is not well developed because of
improper management of drugs and lack of patient counseling. Adulterated and substandard
drugs, high prices are also the major problems here. Introduction of model pharmacy in
recent time may be a hope for the Bangladeshi people to get safe medicines at a reasonable
cost. In this project, the current status of model pharmacies of Bangladesh has been
evaluated. This work is a survey-based analysis which utilizes a pre-set questionnaire. The
survey was conducted over 90 model pharmacies (level 1) of seven districts (Dhaka,
Chittagong, Comilla, Mymensingh, Tangail, Noakhali and Brahmanbaria) of Bangladesh to
find out the current scenario. Physical condition of the model pharmacies should be improved
as only 51% of the model pharmacies have toilet/washroom facilities and 33% has the sitting
facilities. It was found that all the model pharmacies (100%) had assigned at least 1 A grade
pharmacist, but only 26% pharmacists were present during the survey. 98 % showed
satisfaction with the engagement of A grade pharmacist. Only 38% model pharmacies keep
the information of sold drugs. It is satisfactory that no physician sample was sold in any
model pharmacies. 100% medicines storage in controlled temperature was found. It may
create problems in the counseling of patients. On the other hand, A grade pharmacists are not
available in the holidays. Again, modern and ICT based techniques can be applied to modify
the model pharmacies for better patient care and patient management. As Bangladesh is
developing in the ICT sector, this can be adapted here to modernized model pharmacies in
keeping pace to the developed countries. The aim of the present work was to find out the
current scenario of model pharmacies of Bangladesh and propose modern systems that can be
applied in model pharmacies for better healthcare management and patient’s compliance.
A Survey on Current Scenario of Model Pharmacy in Bangladesh and Its Development Proposal Page | ix
1.Introduction
and
Literature Review
1. Introduction and Literature Review
1.1. Pharmaceutical sector of Bangladesh
The Government of Bangladesh is committed to provide effective health care service for the
people of the country as per the constitution of the People’s Republic of Bangladesh. To meet
this objective a series of drug policies have been published by the Directorate General of
Drug Administration (DGDA) which is the drug regulatory authority functions under the
Ministry of Health and Family Welfare (MOHFW), Government of the People's Republic of
Bangladesh. The principle objectives of the national drug policies are-
1. ensuring people can have easy access to safe, effective and good quality drugs at
affordable prices and
2. ensuring rational and safe use of drugs and proper dispensing [1].
After the independence of Bangladesh, the pharmaceutical market was multinational
company dominated. At that time, to meet the demand, 80% of the drugs were imported.
Bangladesh has seen an unprecedented growth of its pharmaceutical sector since the
promulgation of The Drugs (control) Ordinance, 1982. Now, the pharmaceutical industry of
Bangladesh is meeting 97% of the total demand of drug nationally and exporting to 113
[1]
countries globally including the most regulated market in the world . Currently 269
allopathic pharmaceutical companies have been licensed by DGDA to produce drugs, of
which 221 are functional, 24 are non-functional and 24 have been suspended (as of
10.12.2017). With having the approval from different regulatory authorities across the world
like UKMHRA, TGA, EU, GCC, recently three of the top companies of Bangladesh namely
Square, Beximco and ACI got USFDA approval and already exporting drug to USA which is
the most regulated and lucrative market. Now, the pharmaceutical sector earns the second
highest foreign currency after the readymade garments (RMG) sector. Today, the
pharmaceutical industry is widely considered as a “hi-tech” industry and the most developed
among the manufacturing industries in Bangladesh [2].
1.2. Retail Pharmacies in Bangladesh
Private pharmacies are often seen in both urban and rural areas as a convenient ‘ﬁrst point of
call’ for advice on common health problems [3]. Even these drug shops are the main interface
point after a patient gets a prescription from the physician outside of a non-state health
[1]
facility . These drug shops extend from top of the line outlets, to small, rural, roadside
setup. People in low-and-middle income countries prefer these drug stores to the government
A Survey on Current Scenario of Model Pharmacy in Bangladesh and Its Development Proposal Page | 1
hospitals because of their location in the close vicinity and some other factors like long
operating hours, availability of medicines for buying in small quantities and sometimes in
credit and personal familiarity. Further, a lot patients are not capable of consult a physician in
the private setup. As a result, private medicine retailers have been found to be the principal
players in promoting access to medicines in low-and middle-income countries like
Bangladesh [4].
The number of licensed drug shops in Bangladesh is 107,592 (as of 10.12.2017) according to
DGDA and the equal number of unlicensed shops is involved in selling both over-the-counter
and prescription drugs. Most of the salespeople or dispensers at those retail drug shops do not
have training in dispensing drugs or in diagnosing and treating medical conditions, which are
tasks they frequently do. According to law, the persons dispensing drugs at retail drug shops
should have at least a short training of 12 weeks (grade C pharmacists) before they can apply
for a drug shop (pharmacy) license. This certificate course is conducted by the Bangladesh
Pharmaceutical Society (BPS) in cooperation with the Bangladesh Chemist and Druggist
Samity (Association) (BCDS).
1.2.1. Workforce at the Retail Pharmacies
The shops are attended mostly by a single dispenser (69%), of whom nearly half (49%) do
not receive any training as a pharmacist, although the law (Ordinance 13, rule 2) requires the
presence of at least a grade C pharmacist. Among the professional dispensers are 91% grade
C (certificate) pharmacists, 7% grade B (diploma) pharmacists, and 2% grade A (graduate)
pharmacists in the studied drug shops.
Non-pharmacists learn the trade by working as an apprentice either of someone who has a
MBBS (Bachelor of Medicine and Bachelor of Surgery) degree (10%) or a village doctor
(16%), or they inherit the trade as a family business (18%). A substantial proportion (38%)
receives dispensing training from the representatives of the pharmaceutical companies. Only
a small proportion of the shops maintain sales and stock records (Baseline Study of Private
Drug Shops in Bangladesh: Findings and Recommendations) [5].
1.3. Counterfeit Medicine
According to definition proposed by World Health Organization (WHO) "A counterfeit

medicine is one which is deliberately and fraudulently mislabeled with respect to identity
and/or source. Counterfeiting can apply to both branded and generic products and counterfeit
products may include products with the correct ingredients or with the wrong ingredients,
without active ingredients, with insufficient active ingredients or with fake packaging [6].
1.3.1. Counterfeit Medicine in Bangladesh:
Despite all these extraordinary achievements it’s a harsh reality that fake or substandard
medicines, including lifesaving ones, with an estimated cost of US$ 150 million per year, are
overwhelming the Bangladesh market [7].
Counterfeit or fake medicines have been a grave concern globally for many years. Counterfeit
medicines cause increased morbidity and mortality to the patients as its active pharmaceutical
ingredient (API) is replaced by an inert substance or its expensive excipient is replaced by a
cheap one. The most grievous impact of the counterfeit medicine in Bangladesh was the
death of as many as 300 children in 1990-1992 due to acute renal failure caused by di-
[8]
ethylene glycol used as a diluent in paracetamol elixir . The manufacturer used cheap di-
ethylene glycol as a replacement of glycerol and polyethylene glycol as these ingredients
were costlier. Di-ethylene glycol is a toxic chemical used in textile and leather dying
industries. Again death of 25 children was reported in 2009 in the Brahmanbaria districts [9].
Even a lot of evidence has been reported about the counterfeit and substandard medicine after
the occurrence of these tragic events. In 2004, on the annual testing 300 counterfeit or very
poor quality drugs were detected by the government laboratory out of 5,000 drug samples.
Two of the antibacterial agents (Ampicillin and Trimethoprim + Sulfamethoxazole) being
[10]
classified in the essential drugs have been reported to be counterfeit or substandard . In
Bangladesh, these counterfeit or fake medicines are stored and sold in the retail pharmacies
mainly in the rural and suburban areas outskirts of main city of the districts.
1.4. Dispensing
Dispensing refers to the process of preparing and giving medicine to a named person on the
basis of a prescription. It involves the correct interpretation of the wishes of the prescriber
and the accurate preparation and labeling of medicine for use by the patient. This process
may take place in a public or private clinic, health center, hospital, or in a shop or community
pharmacy setting. It is carried out by many different kinds of people with a variety of training
and backgrounds. No matter where dispensing is done or who does it, any error or failure in
the dispensing process can seriously affect the care of the patient.
Dispensing is one of the vital elements of the rational use of medicines. Programs to improve
rational use have often been concentrated on ensuring rational prescribing habits, overlooking
dispensing and the patient’s use of medicines.
In Bangladesh like some other developing countries, the pharmaceutical companies

manufacture medicines in standardized doses and pre-packed forms unlike in the government
facilities where the tablets comes in a bulk. So, the question arises how much a pharmacist is
needed in a retail pharmacy.
1.4.1. Dispensing errors
The core function of any pharmaceutical care is dispensing medicines to the patients. But
dispensing is a complex process where pharmacy staffs are involved in selecting the right
medicine from the shelves and counting the correct number of the medicine. As it is a
complex process, it has a lot of chance for the occurrence of error in the process. Hence, it
has become a growing body of concern.
Any unintended deviation from an interpretable written prescription or medication order is

termed as dispensing error. Errors can arise at any stage during the dispensing process. The
errors that most frequently occur in the retail drug shops are –
 wrong drug dispensed

 wrong strength dispensed
 wrong dosage form dispensed
 wrong quantity dispensed
 expired/deteriorated drug
In the context of labeling error, there is a little or no chance of error as it has been stated
before that medicines in Bangladesh come in standardized doses and pre-packed. But, the
errors that may occur at the final stage of dispensing are-
 incorrect assembling of the medicines

 dispensed to wrong persons among the waiting customer.
1.4.2. Factors influencing dispensing errors
There are several factors that can affect the dispensing process negatively. The most common
factors that may dictate the dispensing errors include-
 workload
 sound alike products
 look alike products
 staffing levels
 poor handwriting
 design of dispensary
 staff inexperience
 failure to check
 proximity of drugs on shelves
Given the training and knowledge level about drug of the drug retailer it is too much to
expect a good dispensing practice from them.
1.5. Patient Counselling

After dispensing the medication, counseling is a must requirement. Patient counselling is
considered as an important component of pharmaceutical care services. In most of the
developed countries, patient counselling is regarded as an important professional
responsibility of the pharmacists and in some countries it is mandatory.
Bangladesh has a large population of illiterate or semiliterate people who barely knows about
drugs, their usage guidelines and the adverse effects. In a study conducted by WHO, it has
been reported that in India 9% patients knew name, 63% patients knew the purpose, 81%
patients knew how long to take and 8% patient knew the possible adverse effects of the
[11]
medicines dispensed . Not knowing the side effects of the medicine is one of the major
causes of non-compliance to the medication.
Pharmacists can play a crucial role to check prescriptions from physicians before dispensing
the medication to the patients to ensure that the patients don't receive the wrong drugs or take
an incorrect dose of medicine. Dispensing the wrong drugs or giving incorrect usage
instructions can have serious consequences for patients, including death. Pharmacists also
offer guidance on the side effects; medication can have and warn against actions that could be
dangerous while the patient is using the medicine. Much of their work is related to patient
safety, so a pharmacist makes sure the patient isn't prescribed a medication that he might be
allergic to, or that will interact with food or another medication he is already taking. Patients
very often are prescribed different medicines from different doctors, and patients receiving
treatments from multiple specialists for different complaints might be issued drugs that could
make them unwell if combined with other medicines. A pharmacist may offer consultation
services for the management of complex diseases, such as diabetes, hypertension, arthritis,
etc., or give general advice on diet, exercise, and managing stress.
1.6. Self-medication
Self-medication is the selection and use of medicines by individuals to treat self-recognized

illnesses or symptoms. It may include the use of herbs, the retention and re-use of
prescription drugs or the direct purchase of prescription-only drugs without a prescription.
The concept of self-medication which encourages an individual to look after minor ailments
with simple and effective remedies has been adopted worldwide. Several medications have
reportedly been used for this practice. This included antibiotics, analgesics and vitamins,
analgesics, vitamins and oral antibiotics among primary care patients, while for OTC drugs;
the commonly requested were for nervous system, analgesics, cough or cold medications.
1.6.1. Benefits of self-medication:
There are several benefits of self-medication and these are, product safety when used as
recommended in the instructions; acceptable risk, even when used for a longer duration, at a
higher dose, or somewhat differently than recommended in the instructions; wider availability
of medicines; greater choice of treatment; direct, rapid access to treatment; an active role in
his or her own health care; self-reliance in preventing or relieving minor symptoms or
conditions; educational opportunities on specific health issues (i.e. stop-smoking aids and
products to treat heartburn); convenience; economy, particularly since medical consultations
will be reduced or avoided.
1.6.2. Drawbacks of self-medications
Some governments are increasingly encouraging self-care of minor illnesses, including self-
medication. Although responsible self-medication helps to reduce the cost of treatment,
travelling time as well as doctor’s time i.e., consultation time, major problems related to self-
medication are wastage of resources, increased resistance of pathogens and causes serious
health hazards such as adverse reaction and prolonged suffering. Antimicrobial resistance is a
current problem worldwide particularly in developing countries where antibiotics are
available without any prescription. It is documented that such nonprescription dispensing
practice often leads to a wrong choice and/or dispensing insufficient doses to customers with
little history taking and inadequate counseling. This could lead to life threatening adverse
events and masking of underlying infectious disease which otherwise could have been easily
identified and treated at early stage.
1.6.3. Effects of self-medication on antibiotic resistance
Nonprescription sale of antibiotics is one of the major reasons to increasing antibiotic

consumption which facilitates emergence of drug resistance. In Bangladesh, it is very
common to see self-medication practice and which is emerging challenge to health care
providers. In two studies, the reported rate of self-medication of antibiotics in Bangladesh
was 22.5% and 26.69% of the study population [12] [13].
1.7. Model Pharmacy
Given the importance of the retail drug shops in Bangladesh, an accreditation program was
established on 2016 to standardize these shops with a view to safeguard and promote good
public health. The standards for accrediting the retail drug shops has been developed and
published by DGDA with the technical support from Management Sciences for Health
(MSH), with Department for International Development (DFID) funding through Joint Donor
Technical Assistance Fund (JDTAF).
The accredited shops are designated as “Model” outlet once it meets the appropriate
standards. These model outlets have been categorized in two levels i.e. level 1 and 2. The
level 1 outlet is called “Model Pharmacy” and the level 2 outlet is called “Model Medicine
Shop”.
Model Pharmacy (Level I): This level of service will be provided, managed, or supervised
by an A grade pharmacist who is present on the premises. B or C grade pharmaceutical
personnel may assist with dispensing under the supervision of the A grade pharmacist.
Model Medicine Shop (Level II): This level of service will be carried out, at a minimum, by
a person with C grade qualification.
Once these shops are accredited they are allowed to use an officially approved logo from
DGDA in the sign board of the shop. As a pilot project it was planned to be conducted in 30
level 1 pharmacies in Dhaka, Rajshahi, Khulna, Barisal and Sy1het divisional towns and
Gazipur District Town and 2000 level 2 medicine shops. Now the number of level 1
pharmacies and level 2 medicine shop are 128 and 82 respectively according to DGDA
website (as of 10.12.2017) and some model pharmacies in Chittagong are yet to be
inaugurated although they are operating with the logo in their signboard. Yet now, this
program has been introduced to 18 among 64 districts of Bangladesh.
1.7.1. The origin of idea of Model Pharmacy
The idea of the model pharmacy came from the Tanzania based “Accredited Drug Dispensing
Oulet” model also known as, ADDO model. Before 2003, the largest network of licensed
outlets for essential medicines in Tanzania was duka la dawa baridi (DLDB). They were
found all around the country, and their combined inventory turnover value was estimated to
be greater than Ministry of Health and Social Welfare (MOHSW) expenditures on essential
medicines for primary health care. Because pharmacies are located almost exclusively in
major urban areas (60–70% percent in Dar es Salaam alone), while approximately 75% of
Tanzanians live in rural and peri-urban communities, DLDB were often the most convenient
drug outlet [14].
Although important as a source of medicines for a significant proportion of the population,

data from a 2001 assessment indicated that duka la dawa baridi were associated with
problems that included-
 questionable medicine quality
 inadequate storage for medicines
 untrained staff
 inadequate regulatory enforcement and supervision
 authorization to sell only a limited list of over-the-counter medicines
 illegal dispensing of prescription medicines.
To address these issues, Management Sciences for Health’s Strategies for enhancing access to
Medicines Program began working with the government of Tanzania to create a public-
private partnership with the goal of improving access to affordable, quality medicines and
pharmaceutical services where few or no registered pharmacies exist.
1.7.2. The ADDO model of Tanzania
The Tanzanian program for accrediting the drug shop is known as Accrediting Drug
Dispensing Outlet (ADDO) was established to improve access to essential medicines and
pharmaceutical services to the population living in rural and peri-urban areas. The accredited
drug dispensing outlet (ADDO) is the drug outlet registered by the Tanzania Food and Drugs
Authority (TDFA) to store and sell medicines that do not need prescriptions and some
essential medicines that need prescriptions.
1.7.3. The Accredited Drug Shops (AMS) in Uganda and Accredited Medicine
Stores (AMS) in Liberia
Following the success of accreditation program in Tanzania, Management Science for Health
(MSH) has helped some other countries Uganda and Zambia to implement the accreditation
process. Management Sciences for Health worked with national and local stakeholders to
develop an accreditation model based on the Tanzanian experiences, but adapted to the two
countries’ different contexts. Liberia, especially, offered a unique opportunity to build a
sustainable drug seller initiative in an emerging-state context and in an urban rather than rural
area. In Uganda, 520 ADS have been accredited in four districts, and its National Drug
Authority (NDA) has developed a national scale-up strategy. In Liberia, 200 AMS have been
accredited in the most densely populated county in Liberia. In both countries, evaluations
have shown that ADS and AMS have increased the availability of good quality
pharmaceutical products and improved dispensing and business skills [15].
1.8. Rationale and objectives
The pharmaceutical market of Bangladesh is growing with a remarkable pace where its
medicines are being exported and praised all over the world. Although, Bangladesh is self-
sufficient in manufacturing the drug distribution and its access to common people is not is not
well developed. As a result, people are not getting enough benefits despite its huge medicine
production capability. To counteract these distribution related problems The DGDA has
recently adopted an accreditation program of retail pharmacies which are supervised by A
grade pharmacists.
So, from a public health point of view there is a need to study the model pharmacies of
Bangladesh.
This sole objective of this project is to learn the current status of the model pharmacies in
Bangladesh. This study provides the current scenario of the newly adopted model pharmacies
and some development proposal which can be taken into consideration for future
development and sustainability.
The goals of this project are –
 To learn about the current scenario of model pharmacies in Bangladesh.

 To investigate whether these pharmacies are running with the proposed guidelines or
not.
 To propose a suitable and effective management system by the help of current
technology and existing facilities in the pharmacies of developed countries to avail the
best services to the patients.
1.9. Literature review methods
Reliable books on pharmaceutical practices, Medicine, and Disease management; and journal
articles (both original research articles and review articles) about operational characteristics
of retail and accredited pharmacies of different countries from peer-reviewed journal papers
were sought for the purpose of gathering relevant information regarding this project. Journal
articles which provided information about the accreditation program of retail pharmacies of
some countries especially Tanzania, Uganda, Liberia and Zambia and journal articles
associated with the information of drug usage and drug management system in Bangladesh
were prioritized.
2. Methodology
2. Methodology
2. Methodology
2.1. Methodology for the field survey
This project is mainly a survey-based study. In this type of study, information is gathered
from a subset of population by asking them a set of predetermined questions on a specific
topic and recording their feedback. The results of the survey are then generalized to the whole
population.
2.2. Survey method
The field survey was conducted by Questionnaire method using a semi-structured

questionnaire. In a questionnaire method, a form containing a predetermined set of questions
is used to obtain information from the target individuals about the inquiries made. This
project utilized a semi-structured questionnaire.
The data was collected after obtaining consent from the Model Pharmacy (level 1) personnel.
They were informed of all the ethical issues and given assurance of confidentiality of their
data.
2.3. Study design
Study type : Survey-based study.

Number of : 90 (Ninety).
samples
Sampling : Purposive Sampling. In this method, 90 model pharmacies out of 128 were
method selected from 7 districts.
2. Methodology
2.4. Survey questionnaire form
Name of the Model Pharmacy: Name of the Surveyer:

Reigistration Code: Date:
Address: Time:
District:
Division:
Section: A) Questions regarding the physical condition of the Model Pharmacy-

Sl Question Yes No
1 Does this model pharmacy have adequate seating for customer waiting for service?
2 Does this model pharmacy have a source of potable water?
Does this model pharmacy have a signboard containing the name of the outlet and
3
logo according to the DGDA guidelines?
Does this model pharmacy have a signboard containing the registration number
4
according to the DGDA guidelines?
5 Is the temperature maintained under 30°C?
6 Does this model pharmacy have toilet/washroom?
7 Does this model pharmacy have a separate source for patient counseling?
8 Is there any doctor practices inside the pharmacy?
To be Written
Section: B) Questions regarding the service of the Model Pharmacy-
Sl Question Answer
9 How long the model pharmacy remains opened?
10 When the model pharmacy is opened and closed?
11 How many days the model pharmacy is operational in a week?
12 Presence of “A” grade pharmacist during survey?
13 What is the number of “A” grade pharmacist in the model pharmacy?
14 What is the number of “C” grade technician in the model pharmacy?
Yes No
Does the model pharmacy dispenser check or perform certain patient condition
15 (Blood Pressure, Blood Sugar, Body Temp., Body Weight, nebulization, malaria
and pregnancy test) in the pharmacy?
Does the model pharmacy dispenser conduct any medical/clinical services (eg.
16
giving injection) other than listed above?
Section: C) Questions regarding the maintaining the storage of the model pharmacy-
Sl Question Yes No
Are the “Prescription medicines” kept separated from the “OTC medicines” in
17
the model pharmacy?
18 Are the “Prescription drugs” are stored well secured in the model pharmacy?
Does the Model Pharmacy sales Narcotic (the dugs which has potential to be
19
abused) drugs?
2. Methodology
If sold, then are those Narcotic drugs is stored with higher security (key lock or
20 security camera)?
(If not sold, then not applicable)
21 Does the model pharmacy have refrigerator?
22 Are vaccines and insulines stored between 2°C to 8°C?
Does the model pharmacy sales any physicians’s sample which is offered to
23
doctors?
24 Does the model pharmcy make any extemporaneous medicine?
Does the pharmacy purchase any bulk drug that has to be dispensed in a different
25
container?
Does the model pharmacy sale any “Non-pharmaceutical products” and “Medical
26
Supplies and Devices”?
27 If sold, then are those items stored separate from the therapeutic products?
Does the model pharmacy sale any DGDA approved Traditional or Alternative
28
medicine (Ayurvedic/Unani) medicine?
29 If sold, then are those items stored separate from the allopathic medicines?
Does the Model Pharmacy return the “damaged or expired medicines” to the
30
companies according to the DGDA guidelines?
Section: D) Questions regarding adverse drug reaction-

Sl Question Yes No
31 Does the Model Pharmacy keep adverse drug reaction reporting form?
32 Does the Model Pharmacy report all the adverse drug reaction came?
How many adverse drug reaction have been reported after conversion to model
33
pharmacy?
Section: E) Questions for “A” grade pharmacist? (Applicable, if present during survey) To be Written
Sl Question Answer
Does the “A” grade pharmacist have registration
34
from Pharmacy council of Bangladesh?
How many hours the “A” grade pharmacist has to
35
work in a day?
How many days the “A” grade pharmacist has to
36
work in a week?
37 What is the salary of the “A” grade pharmacist?
38 When the “A” grade pharmacist get his salary?
Yes No
39 Does the “A” grade pharmacist get his salary within the fixed timeline?
Does the “A” grade pharmacist get recompense if he has to work more than the
40
fixed work hour?
Does the “A” grade pharmacist have 30 hours training from Pharmacy council of
41
Bangladesh?
42 Did the “A” grade pharmacist pass the after training?
After converting into model pharmacy, it is an obligation to employ you here.
43
After this, do the owner and the other colleagues cooperate with you?
Do all the customers buy all the medicine in a “prescription” coming to this
44
pharmacy?
2. Methodology
45 Does the model pharmacy keep the purchase record?

Does the model pharmacy keep all the record
46
of medicine sold to the customers?
To be Written
Section: F) Questions to the “C” grade technicians-
Sl Question Answer
Has the number of customer increased or decreased after converting this pharmacy
47
into Model Pharmacy?
After converting into Model Pharmacy, an “A” grade pharmacist is working here.
48
Does it help or trouble the operation?
49) Source of purchasing medicine of the Model pharmacy –––––––––, –––––––––, ––––––––––
2.4. Study population, Participant’s profile, and data collection
Study population : Personnel of the model pharmacies including owner, pharmacist

(Grade A, B &C), and other work staff.
District selection : 7 districts were selected which contained the majority of the
population.
The districts are-
1. Dhaka
2. Chittagong
3. Comilla
4. Mymensingh
5. Tangail
6. Noakhali
7. Brahmanbaria
Data collection : Direct interview of the model pharmacy personnel.
Procedure
2.5 Evaluation of data
The data collected from the survey was tabulated, analyzed and graphically presented using
Microsoft Office Excel 2007.
3. Results
3. Results
3. Results
Demographic characteristics
Survey was conducted over 90 model pharmacies (level-1) of different areas of Bangladesh.
The areas were Dhaka, Chittagong, Comilla, Mymensingh, Tangail, Noakhali and
Brahmanbaria. The areas and number of model pharmacies in those individual areas in which
the survey was conducted are as follows (Table 1) -
Table 1: Demographic characteristics of model pharmacies
Area Number of Model Pharmacies

Dhaka 56
Chittagong 5
Comilla 6
Mymensingh 4
Tangail 4
Noakhali 8
Brahmanbaria 7
Total 90
3. Results
Section A: Questions regarding the physical condition of the Model Pharmacy
Does this model pharmacy have adequate seating for customer waiting for service?
The survey result showed that most of the model pharmacies have no facilities of
adequate seating for customer. Only 32% of model pharmacies have this facility where as rest
68% have not.
61
Yes
32%
29
No
68%
Yes No
Figure A 1(A): Availability of adequate seating facility in the model pharmacies

40
35
30
25
20
15
10
5
0
Brahmanbari
Dhaka Chittagong Comilla Mymensingh Tangail Noakhali
a
Yes 20 1 1 2 1 3 1
No 36 4 5 2 3 5 6
Figure A 1(B): Availability of adequate seating facility in the model pharmacies

3. Results
Does this model pharmacy have a source of potable water?
Most of the model pharmacies have the facility of potable water system. The high
percentage of positive response (77%) indicates this evidence. Figure A 2(A) and Figure A
2(B) elaborate the overall scenario.
69
No
23%
21
Yes
77%
Yes No
Figure A 2(A): Availability of potable water facility in the model pharmacies

50
45
40
35
30
25
20
15
10
5
0
Brahmanbari
a
Yes 44 5 3 3 2 7 5
No 12 0 3 1 2 1 2
Figure A 2(B): Availability of potable water facility in the model pharmacies (number)
of different districts.
3. Results
Does this model pharmacy have a signboard containing the name of the outlet and logo
It was satisfactory that almost all the shops have the signboard containing the name of
the outlet and logo according to the DGDA guidelines which is demonstrated in Figure A
3(A) and Figure A 3(B).
88
No
2%
Yes
98%
2
Yes No
Figure A 3(A): Availability of signboard containing the name of the outlet and logo in
the model pharmacies (percentage and number).
60
50
40
30
20
10
0
Brahmanbari
a
Yes 55 4 6 4 4 8 7
No 1 1 0 0 0 0 0
Figure A 3(B): Availability of signboard containing the name of the outlet and logo in
the model pharmacies (number) of different districts.
3. Results
Does this model pharmacy have a signboard containing the registration number according
to the DGDA guidelines?
Around 40% of the model pharmacies which have been surveyed did not have the
signboard containing the registration number according to the DGDA guidelines.
54
No 36
40%
Yes
60%
Yes No
Figure A 4(A): Availability of signboard containing the registration number (percentage

and number).
30
25
20
15
10
0
Brahmanbari
a
Yes 28 3 5 3 3 6 6
No 28 2 1 1 1 2 1
Figure A 4(B): Availability of signboard containing the registration number (number)

in the model pharmacies of different districts.
3. Results
Is the temperature maintained under 30oC?
For this question the model pharmacies were observed to find whether its interior part
were enclosed by glass door or not and whether they had enough cooling equipment. 88% of
the model pharmacies maintained the temperature under 30oC.
No 79
12%
Yes 11
88%
Yes No
Figure A 5(A): Overall percentage and number of model pharmacies which maintained
the temperature under 30oC.
60
50
40
30
20
10
0
Brahmanbari
a
Yes 50 5 5 3 4 7 6
No 6 1 1 1 0 1 1
Figure A 5(B): Number of model pharmacies of different districts which maintained the
temperature under 30oC.
3. Results
Does this model pharmacy have toilet/washroom?
In this question the model pharmacy personnel were asked about the availability of a
toilet or washroom dedicated for that pharmacy. The result was taken as ‘Yes’ for those
facilities also although the washroom was situated a little far but dedicated.
46 44
No
49%
Yes
51%
Yes No
Figure A 6(A): Availability of toilet/washroom in the model pharmacies (percentage and

number).
35
30
25
20
15
10
5
0
Brahmanbari
a
Yes 29 4 1 1 4 3 4
No 27 1 5 3 0 5 3
Figure A 6(B): Availability of toilet/washroom in the model pharmacies (number) of

3. Results
Does this model pharmacy have a separate room for patient counseling?
For this question, the place for counseling were observed. The answer was given
‘Yes’ for those places which were enclosed or open but away from the zone where regular
activities are performed. Only 17% of model pharmacies had the facilities of patient
counseling in separate room and all the facilities were in the Dhaka city only.
75
No
83%
Yes
17% 15
Yes No
Figure A 7(A): Availability of separate room for patient counseling in the model
pharmacies (percentage and number).
45
40
35
30
25
20
15
10
5
0
Brahmanbari
a
Yes 15 0 0 0 0 0 0
No 41 5 6 4 4 8 7
Figure A 7(B): Availability of separate room for patient counseling in the model
pharmacies (number) of different districts.
3. Results
Are there any doctor practices inside the pharmacy?
The model pharmacy personnel were asked was there any doctor who practices inside
the pharmacy. From their responses it was found that no doctor was stationed in the model
pharmacies except in a very minute percent.
88
Yes
2%
No
98%
2
Yes No
Figure A 8(A): Availability of doctor inside the model pharmacies (percentage and
number).
60
50
40
30
20
10
0
Brahmanbari
a
Yes 2 0 0 0 0 0 0
No 54 4 6 4 4 8 7
Figure A 8(B): Availability of doctor inside the model pharmacies (number) of different
districts.
3. Results
Section B: Questions regarding the service of the Model Pharmacy
How long did the model pharmacy remain opened in a day?
The model pharmacy personnel were asked about the operational hour of the
pharmacy. Following figures demonstrate the overall findings.
46
24 hours
13%
16 to 20
hours 28
8 to 12
31% hours
5% 12
13 to 16
4
hours
51%
8 to 12 13 to 16 16 to 20 24 hours
hours hours hours
Figure B 1(A): Operating hour of the model pharmacies (percentage and number).
30
25
20
15
10
5
0
Mymensing Brahmanba
Dhaka Chittagong Comilla Tangail Noakhali
h ria
8 to 12 hours 3 0 0 0 1 0 0
13 to 16 hours 28 2 5 2 2 4 3
16 to 20 hours 18 0 0 2 1 3 4
24 hours 7 3 1 0 0 1 0
Figure B 1(B): Operating hour of the model pharmacies of different districts.
3. Results
When the model pharmacy is opened and closed?
The previous question was followed up by what is the operational timeline of the
pharmacy. Following figures demonstrate the overall findings.
8 am to 46
1 am 24 hours
15% 13%
8 am to
12 pm
21% 19
12 13
8 am to
10 pm
51%
24 hours 8 am to 10 8 am to 12 8am to 1
pm am am
Figure B 2(A): Operating timeline of the model pharmacies (percentage and number).
30
25
20
15 8 to 12 hours
10 13 to 16 hours
16 to 20 hours
5
24 hours
0
Figure B 2(B): Operating timeline of model pharmacies of different districts (number).
3. Results
How many days the model pharmacy is operational in a week?
Following figures demonstrate the overall findings.
88
6 days
2%
7 days
5 days
98%
0%
0 2
5 days 6 days 7 days
Figure B 3(A): Operating days in a week of the model pharmacies (percentage and
number).
60
50
40
30
20
10
0
Brahmanbari
a
5 days 0 0 0 0 0 0 0
6 days 2 0 0 0 0 0 0
7 days 54 5 6 4 4 8 7
Figure B 3(B): Operating days in a week of the model pharmacies (number) in different
districts.
3. Results
Presence of “A” grade pharmacist during survey?
67
Absent
74%
23
Present
26%
Present Absent
Figure B 4(A): Presence of A grade pharmacists during survey (percentage and

number).
45
40
35
30
25
20
15
10
5
0
Brahmanbari
a
Present 17 1 0 1 1 0 0
Absent 39 4 6 3 3 8 7
Figure B 4(B): Presence of A grade pharmacists in the model pharmacies (number) of

different districts during survey.
3. Results
What is the number of “A” grade pharmacist in the model pharmacy?
89
2
1%
1
99%
1 2
Figure B 5(A): Number of A grade pharmacists in the model pharmacy (percentage and
number).
60
50
40
30
20
10
0
Brahmanbari
a
1 55 5 6 4 4 8 7
2 1 0 0 0 0 0 0
Figure B 5(B): Number of A grade pharmacists (number) in model pharmacies of

different area.
3. Results
What is the number of “C” grade technician in the model pharmacy?
7 to 10 31
23% 11 to 20 28
11%
21
10
4 to 6 1 to 3
35% 31%
1 to 3 4 to 6 7 to 10 11 to 20
Figure B 6(A): Number of C grade technicians in the model pharmacies (percentage

and number).
25
20
15
10
5
0
Brahmanbari
a
1 to 3 7 3 1 2 2 6 7
4 to 6 22 0 3 2 2 2 0
7 to 10 17 2 2 0 0 0 0
11 to 20 10 0 0 0 0 0 0
Figure B 6(B): Number of C grade technicians in the model pharmacies of different

districts.
3. Results
Does the model pharmacy dispenser check or perform certain patient condition (Blood
Pressure, Blood Sugar, Body Temp., Body Weight, nebulization, malaria and pregnancy
test) in the pharmacy?
For this question it was asked whether the model pharmacies were providing these
facilities or not. Following figures demonstrate the overall findings.
69
No
23%
21
Yes
77%
Yes No
Figure B 7(A): Overall percentage and number of model pharmacies which check
certain patient conditions.
50
45
40
35
30
25
20
15
10
5
0
Brahmanbari
a
Yes 43 3 3 3 4 6 7
No 13 2 3 1 0 2 0
Figure B 7(B): Number of model pharmacies of different districts which check certain
patient condition.
3. Results
Does the model pharmacy dispenser conduct any medical/clinical services (eg. giving
injection) other than listed above?
53
37
No
41%
Yes
59%
Yes No
Figure B 8(A): Overall percentage and number of model pharmacies which administer
injection.
40
35
30
25
20
15
10
5
0
Brahmanbari
a
Yes 36 4 4 1 4 3 1
No 20 1 2 3 0 5 6
Figure B 8(B): Number of model pharmacies of different districts which administer

injection.
3. Results
Section C: Questions regarding the maintenance of the storage of model pharmacy
Are the “Prescription medicines” kept separated from the “OTC medicines” in the model
pharmacy?
For this question the model pharmacies were observed for how the prescription and
OTC drug were arranged. The answer was taken ‘Yes’ if these two classes of drugs were kept
separated selves and a label pasted on each shelves designated by the words. The response is
elaborated in the figure with percentage and amount.
73
No
19%
17
Yes
81%
Yes No
Figure C 1(A): Overall percentage and number of model pharmacies whether they keep
prescription medicines separated from OTC drugs or not.
50
45
40
35
30
25
20
15
10
5
0
Brahmanbari
a
Yes 45 4 4 4 2 7 7
No 11 1 2 0 2 1 0
Figure C 1(B): Number of model pharmacies of different districts whether they keep
prescription medicines separated from OTC drugs or not.
3. Results
Do the “Prescription drugs” are stored well secured in the model pharmacy?
The answer was taken ‘Yes’ for this question only if the prescription medicines were
away from the patients’ reach. The response is elaborated in the figure with percentage and
amount.
63
No
30%
27
Yes
70%
Yes No
Figure C 2(A): Overall percentage and number of model pharmacies whether they store
“Prescription drugs” well secured or not.
45
40
35
30
25
20
15
10
5
0
Brahmanbari
a
Yes 40 3 4 3 2 6 5
No 16 2 2 1 2 2 2
Figure C 2(B): Number of model pharmacies of different districts whether they store
“Prescription drugs” well secured or not.
3. Results
Does the Model Pharmacy sale Narcotic (the dugs which has potential to be abused)
drugs?
The response is elaborated in the figure with percentage and amount.
79
Yes
12%
No 11
88%
Yes No
Figure C 3(A): Overall percentage and number of model pharmacies which sell narcotic
drugs.
50
45
40
35
30
25
20
15
10
5
0
Brahmanbari
a
Yes 10 0 0 1 0 0 0
No 46 5 6 3 4 8 7
Figure C 3(B): Number of model pharmacies of different districts which sell narcotic
drugs.
3. Results
If sold, then are those Narcotic drugs is stored with higher security (key lock or security
camera)?(If not sold, then not applicable)
No
0% 79
Yes 11
100% 0
Yes No Not Applicable
narcotic drugs with higher security or not.
12
10
0
Brahmanbari
a
Yes 10 0 0 1 0 0 0
No 0 0 0 0 0 0 0
Figure C 4(B): Number model pharmacies of different districts whether they store
narcotic drugs with higher security or not.
3. Results
Does the model pharmacy have refrigerator?
No 90
0%
Yes
100% 0
Yes No
Figure C 5(A): Overall percentage and number of model pharmacies which have
refrigerator.
60
50
40
30
20
10
0
Brahmanbari
a
Yes 56 5 6 4 4 8 7
No 0 0 0 0 0 0 0
Figure C 5(B): Number of model pharmacies of different districts which have

refrigerator.
3. Results
Are vaccines and insulines stored between 2°C to 8°C?
For this question the model pharmacy personnel were asked about how the vaccines
or insulin were stored. The response is elaborated in the figure with percentage and amount.
No 90
0%
Yes
100% 0
Yes No
vaccines and insulin between 2°C to 8°C or not.
60
50
40
30
20
10
0
Brahmanbari
a
Yes 56 5 6 4 4 8 7
No 0 0 0 0 0 0 0
vaccines and insulin between 2°C to 8°C or not.
3. Results
Does the model pharmacy sale any physicians’s sample which is offered to doctors?
83
Yes
8%
No 7
92%
Yes No
Figure C 7(A): Overall percentage and number of model pharmacies whether they sell
physician’s sample or not.
60
50
40
30
20
10
0
Brahmanbari
a
Yes 7 0 0 0 0 0 0
No 49 5 6 4 4 8 7
Figure C 7(B): Number of model pharmacies in different districts whether they sell
physician’s sample or not.
3. Results
Does the model pharmcy make any extemporaneous medicine?
Yes 90
0%
No
100% 0
Yes No
Figure C 8(A): Overall percentage and number of model pharmacies of which have
60
50
40
30
20
10
0
Brahmanbari
a
Yes 0 0 0 0 0 0 0
No 56 5 6 4 4 8 7
Figure C 8(B): Number of model pharmacies of different districts which have

3. Results
Does the pharmacy purchase any bulk drug that has to be dispensed in a different
container?
Yes 90
0%
No
100% 0
Yes No
Figure C 9(A): Overall percentage and number of model pharmacies whether they
provide different container in case of dispensing bulk drug or not.
60
50
40
30
20
10
0
Brahmanbari
a
Yes 0 0 0 0 0 0 0
No 56 5 6 4 4 8 7
Figure C 9(B): Number of model pharmacies of different districts whether they provide
different container in case of dispensing bulk drug or not.
3. Results
Does the model pharmacy sale any “Non-pharmaceutical products” and “Medical Supplies
and Devices”?
No
86
4%
Yes
4
96%
Yes No
Figure C 10(A): Overall percentage and number of model pharmacies whether they sale
non pharmaceutical products and medical supplies and devices or not.
60
50
40
30
20
10
0
Brahmanbari
a
Yes 55 4 6 3 4 8 6
No 1 1 0 1 0 0 1
Figure C 10(B): Number of model pharmacies of different districts whether they sale
non pharmaceutical products and medical supplies and devices or not.
3. Results
If sold, then are those items stored separate from the therapeutic products?
80
No
7%
Yes
93%
6
Yes No
Figure C 11(A): Overall percentage and number of model pharmacies of whether they
store therapeutic products and non-therapeutic products separately or not.
60
50
40
30
20
10
0
Brahmanbari
a
Yes 52 3 5 3 3 8 6
No 3 1 1 0 1 0 0
therapeutic products and non-therapeutic products separately or not.
3. Results
Does the model pharmacy sale any DGDA approved Traditional or Alternative medicine
(Ayurvedic/Unani) medicine?
74
No
17%
16
Yes
83%
Yes No
Figure C 12(A): Overall percentage and number of model pharmacies whether they sale
DGDA approved traditional or alternative medicine or not.
50
45
40
35
30
25
20
15
10
5
0
Brahmanbari
a
Yes 43 3 6 3 4 8 7
No 13 2 0 1 0 0 0
Figure C 12(B): Number of model pharmacies of different districts whether they sale
DGDA approved traditional or alternative medicine or not.
3. Results
If sold, then are those items stored separate from the allopathic medicines?
56
Yes
35%
18
No
65%
Yes No
store traditional medicines separated from allopathic medicines or not.
30
25
20
15
10
0
Brahmanbari
a
Yes 27 1 2 1 1 3 1
No 16 2 4 2 3 5 6
traditional medicines separated from allopathic medicines or not.
3. Results
Does the Model Pharmacy return the “damaged or expired medicines” to the companies
No 90
0%
Yes
100% 0
Yes No
return the damaged or expired medicine to the companies or not.
60
50
40
30
20
10
0
Brahmanbari
a
Yes 56 5 6 4 4 8 7
No 0 0 0 0 0 0 0
Figure C 14(B): Number of model pharmacies of different districts whether they return
the damaged or expired medicine to the companies or not.
3. Results
Section D: Questions regarding adverse drug reaction
Does the Model Pharmacy keep adverse drug reaction (ADR) reporting form?
Asking this question it was most of the personnel were unaware about the term
‘Adverse Drug Reaction’.
Yes 90
0%
No
100% 0
Yes No
Figure D 1(A): Overall percentage and number of model pharmacies whether they keep
adverse drug reaction (ADR) reporting form or not.
60
50
40
30
20
10
0
Brahmanbari
a
Yes 0 0 0 0 0 0 0
No 56 5 6 4 4 8 7
Figure D 1(B): Number of model pharmacies of different districts whether they keep
adverse drug reaction (ADR) reporting form or not.
3. Results
Does the Model Pharmacy report all the adverse drug reaction came?
The survey result showed 100% negative results regarding adverse drug reaction
reporting to DGDA.
Yes 90
0%
No
100% 0
Yes No
Figure D 2(A): Overall percentage and number of model pharmacies whether they
report all the adverse drug reaction or not.
60
50
40
30
20
10
0
Brahmanbari
a
Yes 0 0 0 0 0 0 0
No 56 5 6 4 4 8 7
Figure D 2(B): Number of model pharmacies of different districts whether they report
all the adverse drug reaction or not.
3. Results
How many adverse drug reactions have been reported after conversion into model
pharmacy?
The survey result showed that no adverse drug reactions were reported from any of
the surveyed model pharmacies.
1 or 90
more
0%
Zero
100% 0
Zero 1 or more
Figure D 3(A): Overall percentage and number of model pharmacies from where
adverse drug reaction (ADR) reported after conversion.
60
50
40
30
20
10
0
Brahmanbari
a
Yes 0 0 0 0 0 0 0
No 56 5 6 4 4 8 7
Figure D 3(B): Number of model pharmacies of different districts from where adverse
drug reaction (ADR) reported after conversion.
3. Results
Section E: Questions for “A” grade pharmacist? (Applicable, if present during survey)
Does the “A” grade pharmacist have registration from Pharmacy council of Bangladesh?
Following figures demonstrate the overall scenario-
23
Not
available
0%
Available
100%
0
Available Not available
Figure E 1(A): Number and percentage of A grade pharmacists whether they have
registration from Pharmacy council of Bangladesh encountered during survey.
18
16
14
12
10
8
6
4
2
0
Mymensing Brahmanba
h ria
Available 17 1 0 1 1 1 2
Not available 0 0 0 0 0 0 0
Figure E 1(B): Number of A grade pharmacists whether they have registration from
Pharmacy council of Bangladesh encountered during survey of different districts.
3. Results
How many hours the “A” grade pharmacist has to work in a day?
13
12-13
10-11 hours
hours 4% 8
35% 6-7 hours
4%
14-16 1 1
hours 0
0%
6-7 8-9 10-11 12-13 14-16
8-9 hours
hours hours hours hours hours
57%
Figure E 2(A): Working hour of A grade pharmacists (percentage and number).
12
10
8
6
4
2
0
Mymensing Brahmanbar
h ia
6-7 hours 1 0 0 0 0 0 0
8-9 hours 11 1 0 1 0 0 1
10-11hours 4 0 0 0 1 1 1
12-13 hours 1 0 0 0 0 0 0
14-16 hours 0 0 0 0 0 0 0
Figure E 2(B): Working hour of A grade pharmacists in model pharmacies of different

districts.
3. Results
How many days the “A” grade pharmacist has to work in a week?
22
7days
4%
5 days
0%
6 days
96% 0 1
5 days 6 days 7 days
Figure E 3(A): Working day of A grade pharmacist (percentage and number).
18
16
14
12
10
8
6
4
2
0
Brahmanbari
a
5 days 0 0 0 0 0 0 0
6 days 16 1 0 1 1 1 2
7 days 1 0 0 0 0 0 0
Figure E 3(B): Working day of A grade pharmacist of different districts.
3. Results
What is the salary of the “A” grade pharmacist?
19000- 9
8
20000
20000-
BDT 5
25000
22%
BDT
16000- 4% 1
18000
BDT
39%
13000-
15000
BDT
35%
Figure E 4(A): Salary range of A grade pharmacist (percentage and number).
8
7
6
5
4
3
2
1
0
Mymensin Brahmanb
gh aria
13000 to 15000 BDT 4 1 0 0 1 1 1
16000 to 18000 BDT 7 0 0 1 0 0 1
19000 to 20000 BDT 5 0 0 0 0 0 0
20000 to 25000 BDT 1 0 0 0 0 0 0
Figure E 4(B): Salary range of A grade pharmacist in model pharmacies of different

districts.
3. Results
When the “A” grade pharmacists get his salary?
Date 11
14
to 15
13%
Date 6 to
10 6
61%
Date 1 to
3
5
26%
Date 1 to 5 Date 6 to 10 Date 11 to 15
Figure E 5(A): Date range of salary confirmation of A grade pharmacists (percentage

and number).
10
9
8
7
6
5
4
3
2
1
0
Mymensing Brahmanba
h ria
Date 1 to 5 6 0 0 0 0 0 1
Date 6 to 10 9 1 0 1 0 1 1
Date 11 to 15 2 0 0 0 1 0 0
Figure E 5(B): Date range of salary confirmation of A grade pharmacist (number) of

3. Results
Does the “A” grade pharmacist get his salary within the fixed timeline?
21
No
8%
Yes
92% 2
Yes No
Figure E 6(A): Percentage and number of A grade pharmacist whether they get salary
in the fixed timeline or not.
18
16
14
12
10
8
6
4
2
0
Brahmanbari
a
Yes 16 1 1 1 1 0 2
No 1 0 0 0 0 1 0
Figure E 6(B): Number of A grade pharmacist of different district whether they get
salary in the fixed timeline or not.
3. Results
Does the “A” grade pharmacist get recompense if he has to work more than the fixed work
hour?
23
Yes
0%
No
100%
0
Yes No
Figure E 7(A): Overall percentage and number of A grade pharmacists whether they
get recompense if they have to work more than the fixed work hour or not.
18
16
14
12
10
8
6
4
2
0
Brahmanbari
a
Yes 0 0 0 0 0 0 0
No 17 1 1 1 1 1 2
Figure E 7(B): Number of A grade pharmacists of different districts whether they get
recompense if they have to work more than the fixed work hour or not.
3. Results
Does the “A” grade pharmacist have 30 hours training from Pharmacy council of
Bangladesh?
For this the available A grade pharmacists were asked if they had any training about
model pharmacies from Pharmacy Council of Bangladesh. Following figures demonstrate the
overall scenario-
23
No
0%
Yes
100%
Yes No
Figure E 8(A): Overall percentage and number of A grade pharmacist in model

pharmacies who have completed the 30hours training from PCB.
18
16
14
12
10
8
6
4
2
0
Brahmanbari
a
Yes 17 1 1 1 1 1 2
No 0 0 0 0 0 0 0
Figure E 8(B): Number of A grade pharmacist in model pharmacies of different

districts who have completed the 30hours training from PCB.
3. Results
Did the “A” grade pharmacist pass the after training?
23
No
0%
Yes
100%
Yes No
Figure E 9(A): Overall percentage and number of A grade pharmacist who have passed
after training.
18
16
14
12
10
8
6
4
2
0
Brahmanbari
a
Yes 16 1 1 1 1 1 2
No 1 0 0 0 0 0 0
Figure E 9(B): Number of A grade pharmacists in model pharmacies of different

districts who have passed after training.
3. Results
After converting into model pharmacy, it is an obligation to employ you here. After this, do
the owner and the other colleagues cooperate with you?
Following figures demonstrate the overall scenario.
21
No
9%
2
Yes
91%
Yes No
Figure E 10(A): Percentage and number of A grade pharmacists that get help from the
owner and other colleagues.
16
14
12
10
8
6
4
2
0
Brahmanbari
a
Yes 15 1 0 1 1 1 2
No 2 0 0 0 0 0 0
Figure E 10(B): Number of A grade pharmacists of different districts that get help from
the owner and other colleagues.
3. Results
Do all the customers buy all the medicine in a “prescription” coming to this pharmacy?
85
No
6%
Yes 5
94%
Yes No
Figure E 11(A): Overall percentage and number of buying tendency of patient’s in

terms of full dose in model pharmacies.
60
50
40
30
20
10
0
Brahmanbari
a
Yes 5 0 0 0 0 0 0
No 51 5 6 4 4 8 7
Figure E 11(B): Number of buying tendency of patient’s in terms of full dose in model
pharmacies of different districts.
3. Results
Does the model pharmacy keep the purchase record?
89
No
1%
Yes
99%
1
Yes No
Figure E 12(A): Overall percentage and number of model pharmacies that keep
18
16
14
12
10
8
6
4
2
0
Brahmanbari
a
Yes 16 1 1 1 1 1 1
No 1 0 0 0 0 0 0
Figure E 12(B): Number of model pharmacies of different districts that keep medicine
purchasing record.
3. Results
Does the model pharmacy keep all the record of medicine sold to the customers?
No record 35 35
39%
Others
0% 20
Antibiotic
22%
All 0
39%
All Antibiotic Others No Record
Figure E 13(A): Overall percentage and number of model pharmacies whether they
keep record of medicines sold to customers.
30
25
20
15
10
5
0
h ia
All 27 5 1 2 0 0 0
Antibiotic 17 0 0 1 1 1 0
Others 0 0 0 0 0 0 0
No Record 12 0 5 1 3 7 7
Figure E 13(B): Number of model pharmacies of different districts whether they keep
record of medicines sold to customers.
3. Results
Section F: Question to the dispensers or C grade pharmacists
Does the number of customers have increased after converting the pharmacy into model
pharmacy?
The model pharmacy personnel was asked whether customer flow had increased or
decreased after conversion. The result came out shockingly that personnel of 39% of the
model pharmacies said that were no change.
47
No 35
change
Decrease 39%
d
9%
Increase
8
d
52%
Increased Reduced No Change
Figure F 1(A): Overall percentage and number of model pharmacies in terms of

customer flow.
30
25
20
15
10
5
0
h ia
Increased 27 1 2 2 2 3 2
Reduced 2 0 1 1 1 2 1
No Change 27 4 3 1 1 3 4
Figure F 1(B): Number of model pharmacies of different districts in terms of customer

flow.
3. Results
Are you getting benefits or troubles as an A grade pharmacist is working here after
converting the pharmacy into a model pharmacy?
Benefits have come after employment of an A grade pharmacist into the model
pharmacies. Only a minute number of pharmacies claimed that there have been no change or
they are facing problems.
87
Troubles
1%
No
Change
2%
Benefits
97%
1 2
Benefits Troubles No Change
Figure F 2(A): Overall percentage and number of model pharmacies that are being
benefitted from the A grade pharmacist.
60
50
40
30
20
10
0
h ia
Benefits 55 5 5 4 4 8 6
Troubles 0 0 1 0 0 0 0
No Change 1 0 0 0 0 0 1
Figure F 2(B): Number of model pharmacies of different districts that are being
benefitted from the A grade pharmacist.
3. Results
What is the source of buying medicine of the model pharmacy?
For this question the model pharmacy personnel were asked about the source from
where the medicines purchased. The question was only applicable for medicines that are
produced in Bangladesh.
90
Pharmac
eutical
Company
100%
0
Other
Sources
Pharmaceutical Other Sources
0%
Company
Figure F 3(A): Overall percentage and number of source of buying medicine of the
model pharmacies.
60
50
40
30
20
10
0
Chittagon Mymensin Brahmanb
Dhaka Comilla Tangail Noakhali
g gh aria
Pharmaceutical Company 56 5 6 4 4 8 7
Other Sources 0 0 0 0 0 0 0
Figure F 3(B): Number of source of buying medicine of the model pharmacies of

4. Discussion
4. Discussion
Discussion
In Bangladesh patients suffer a lot because of improper patient counseling and management
of drugs. Drug storage condition is not well developed here which causes the damage of
drugs as well as the medical devices. On the other hand, the amount of fake or spurious drug
is increasing in the market which has to be eliminated. Getting access to the medicines is not
enough, but its proper utilization. So, patient counseling has to be an integral part while
getting drug from the pharmacies. Storage of medicine is a crucial ingredient for treatment
success, because a lot of drugs are heat or sunlight sensitive that may degrade in the harsh
condition. Model pharmacy may be a strong weapon to fight this situation. But many
improvements have to be adapted and laws should be enforced for better patient care and
management. After surveying and analyzing the data, the following suggestions can be taken
under consideration to establish a better model pharmacy for better patient care and
management.
Model pharmacy should have the sign board containing the logo of model pharmacy as well
as the registration number according to the DGDA so that people can distinguish it from the
retail pharmacies and get medicines from a safe and reliable source and other benefits [16].
Figure A 1(A) and Figure A 2(A) show that 32% model pharmacies have adequate seating
and 77% model pharmacies have potable water for the waiting patients. Model pharmacy
should have sufficient amount of place as well as potable water where patients can sit and
have water in case of long queue of line of patients. A hygienic washroom must be available
in the model pharmacies for the convenience of patient and pharmacy work staff, where the
result shows only 49% model pharmacies have a washroom. Journals, books and leaflet
having medical awareness can be kept for spreading the knowledge to the patients.
Counseling should have to be done in separated room of pharmacist as it is very much

personal to any patients. From survey, it was found that most of the model pharmacies (83%)
have not a separated patient counseling room. There may be a lot of patient condition, when
he/she may feel hesitated to discuss in an open place or may not discuss with pharmacist at
all. Again, pharmacist may not feel comfortable to counsel in an open space. This point
should be taken under consideration.
4. Discussion
There should not be any doctor stationed inside a pharmacy as it may influence the
prescription pattern of the doctors which may results in polypharmacy. Although result shows
only 2 model pharmacies where doctors are found practice inside.
In terms of maintaining the temperature below 300c, 88% model pharmacies were found to
maintain it. The rest 12% were not maintaining may be due to the fact that the survey was
conducted in the winter season, although equipments were seen in these the pharmacies that
can be used to maintain the temperature.
Model pharmacy should be run by adequate number of A grade and C grade pharmacist. In
some model pharmacies, B grade pharmacists were found working. In this case, DGDA can
make a policy for the B grade pharmacists for working in the model pharmacies. Lacking of
manpower hampers the proper functioning of the pharmacy. This is why adequate manpower
is very much needed [17].
Proper knowledge and training is the main backbone of dispensing drugs as well as the
[18]
managements of drugs .Counseling is also dependent over that. From the survey it was
found that, almost 100 % pharmacists who are conducting the model pharmacy have the
training of PCB, but it should be performed every definite time period for better patient’s
management and safety.
Storage condition and storage facilities play the most vital role in pharmacy because the
[19]
quality of medicines and drugs depend on the storage condition and facilities . According
to the survey, most of the model pharmacies maintain the temperature for storing drugs and
medicines. It is also mentioned in the guidelines of establishment procedure of model
pharmacies. Besides maintaining temperature and humidity, pharmacists should be taken
under consideration the look-a-like and sound-a-like product (LASA) management. LASA
are those products which have similar name or similar looking or both. LASA may create
confusion (wrong dose or wrong medication) and wrong medicines may be dispensed. Proper
steps should be taken. LASA products should be kept in different areas with proper procedure
like tall man lettering. While procurement of drugs, it should be checked and if possible then
should be avoided. Packaging should be done carefully and guidance should be given to the
patients so that wrong medicines are not taken by the patients [18].
Some sound-a-like and look-a-like products are-[18.20]
4. Discussion
Generic Name Generic Name Brand Name Brand Name

Aminophylline Amitriptyline Naprosyn Maprocyn
Anafranil Enalapril Cosec Carsec
Azithromycin Erthyromycin Prolock Preloc
Beclofen Bactroban Xelpid Xeldrin
Clobazam Clonazepam Ribacid Rifazid
Tramadol Trazodone Procef Procet
Vinblastine Vincristine Losectil Losardil
Allopathic and other drugs like unani as well as traditional drugs should be kept separately.
Special considerations should be given for photo sensitive products.
Supply and availability of medicines in model pharmacy should be ensured from authentic
sources. From the survey it was found that, the main source of medicine is the pharmaceutical
companies. It should be checked that, the selling companies are government authorized or
not. Medicines should be procured from the top pharmaceuticals which have reputation.
Requisition of drugs should be sent to the supplier before they are short in the inventory. Life
saving and fast moving drugs should be available in the model pharmacy all the time. Drugs
should be ordered according to the season also. For example, the demand of antihistamine is
increased in winter.
Inventory should be kept and it may be computerized for convenient use. System analyses
and data processing (SAP) can be used. Digitalized inventory is more convenient than the
manual one. Manual inventory may be lost or error may happen.
From the survey, it was found that, not a single model pharmacy is containing the adverse
drug reactions (ADRs) reporting form. It is a must needed tool for detecting the substandard
4. Discussion
and bad drugs. If any ADRs are found that should be immediately sent to the authority for
checking. It will enrich the health sector and patient’s safety will be ensured. The concerned
authority like Adverse Drug Reaction Monitoring (ADRM) cell can play a vital role in
creating the public awareness about adverse drug reactions and to oblige all the pharmacies to
maintain the adverse drug reaction reporting form.
Digital record keeping of patients and drugs should be kept. According to the survey in model
pharmacies, some model pharmacies keep the records while some not. Some keep only the
antibiotic information. It’s better to keep all the information in a digitalized system for patient
compliance [21].
It is not possible all the time to treat a patient with the available marketed dosage form. It is
more common in pediatrics and geriatrics. For example, pediatrics patients need relatively
low dose and solution based medication whereas the geriatric patients need dose modification
according to their body weight as well as body condition like disease condition (kidney
disease, liver disease etc.) [22]. It is also helpful in case of emergency. In case of vomiting the
medicines can be formulated as suppository or patch system. Extemporaneous section can be
incorporated in model pharmacies by ensuring proper facilities and guidelines. Now a day,
doctors are prescribing individualized treatment rather than traditional treatment. So
introduction of extemporaneous section in model pharmacy will open a new era for patient
compliance.
In developed countries online drug delivery system is very much popular and it is convenient
to the patient. Model pharmacies can introduce online drug delivery system for patient
compliance [21].
It is hard to find out the exact location of pharmacies in an area. Again, it is not sure either all
the medicines will be found or not. Medicine procurement from database system (MPDS) can
be introduced. Through MPDS it is possible to find out the exact location of pharmacies in an
area and the required medicines with costs. Online drug delivery system is also possible
through this system [23].
Figure B 4(A) shows that A grade pharmacist was found in only 26% of the pharmacies. But
it is one the most important factors which make the model pharmacies superior to the retail
pharmacies. The result is very unsatisfactory and the less encounter may be due to the facts
some model pharmacies were surveyed in the public holidays and in the hours when the A
4. Discussion
grade pharmacists’ work hour end. According to the guideline proposed by DGDA, A grade
pharmacist must present in the model pharmacy while it is operational. In this case, more
than one pharmacist can be employed, where at least one of the pharmacists is always present
in the pharmacy by roster schedule. Authority should pay attention in this issue and proper
legal action should be applied.
From the survey, it was found that, most of the model pharmacies have the facilities of
rendering services related medical equipments and tests like diabetes, blood pressure
measurement etc. In these ways, the model pharmacies can be popular and the people will go
and buy medicines from safer source. But it should be kept in mind that patient get these
benefits in proper ways and not for just marketing purpose. These should be handled by
trained up personnel.
A lot of the model pharmacies do not store narcotic drugs and have narcotic license. But drug
administration may encourage the owner to get a license and store and sell because the
regulation of narcotic drugs can be abided rather than in the other retail pharmacies.
Figure E 4(A) shows the salary range paid to A grade pharmacists working in the model
pharmacies. 39% A grade pharmacist get the salary in range between 16000 to 18000 taka,
where 35% get in range between 13000 to 15000 taka and 22% get in range between 19000
to 20000 taka. Government has to focus on this issue more closely because pharmacists
working in the sectors like pharmaceutical companies, private and public universities
generally get much higher remuneration than here. The pharmacists working here must have
to be paid the satisfactory salary to sustain this system. Other than the salary, they must be
paid the bonus like festival bonus, profit share etc. Otherwise, the graduated pharmacists will
neglect this profession and without pharmacist, the morale of model pharmacy will not be
established.
Remunerations of pharmacists should be paid between times. The registration and renew of
the registration should be done in definite period of time. On the other hand, A grade
pharmacist works for 6 days in a week so patients suffer in holiday of week. Again registered
pharmacist is not available for 24 hours. More than one pharmacist can be employed and
roaster system can be applied for better patient compliance.
4. Discussion
From survey, it was obvious that, some pharmacies open for 24 hours and some for 8 to 20
hours. By introducing roaster system of the employee, it is possible to have 24 hours open
model pharmacy which will be more patient friendly.
A very satisfactory result found in Figure F 3(A) shows that 100% of model pharmacies
purchase the medicines from the pharmaceutical companies. One of the main targets of
establishing model pharmacy was to eradicate the fake drugs from the market. By ensuring
purchasing from pharmaceutical companies directly it can be assured that the patients are
quality drugs. But, in Bangladesh except the top 20 to 25 pharmaceutical companies, all of
[24]
them do not produce drugs of standard quality . So, by purchasing directly from the
pharmaceutical companies the fake drugs can be eradicated but not the substandard drugs.
Figure F 1(A) shows the customers’ or patients’ awareness about the model pharmacies. The
result shows that the number of customers has been increased in 52% of the model
pharmacies and the owners or other personnel of 39% of the model pharmacies think that
there is no changes of customer flow and of 8% of the model pharmacies think that the
customer flow has reduced after conversion. One of the persons of 8% of the model
pharmacies where the customer flow has been reduced told that they had stopped selling the
prescription medicine especially some medicines that could be used for recreation purpose
without prescription and that’s why the customer flow has been reduced. The less customer
flow in the model pharmacies is because of the lack of awareness among the people although
all the model pharmacies that have been converted from the regular retail pharmacies in the
urban areas where the people have technological advantages. The DGDA must have to take
prompt action to create public awareness otherwise this concept may deem before shining
because of the fact that these model pharmacies are suffering from higher expenses than the
regular one. The DGDA can take some initiatives like-
 making a budget for the promotional exposures. During the establishment of ADDO
in Tanzania, they had a budget solely for promotional purpose [25]. The promotion can
be done by advertising in the television, radio, newspaper and billboard etc.
 making it illegal for any other retail medicine outlet to sell prescription medicines;
therefore, selling prescription medicines will give model pharmacies a significant
economic advantage over other retail pharmacies.
 providing some loan fund to the owner.
4. Discussion
The pilot program has been completed but no evaluation report is published yet to go for the
roll out program. The evaluation report of the pilot project is required for reconstructing the
program strategies and implement in rolling out this program throughout the country.
These are things which can be taken under considerations for introducing more effective
model pharmacy which will be more developed, patient friendly and safe.
5. Conclusion
5. Conclusion
Conclusion
The study shows that the model pharmacies are maintaining some facilities like enough seat,
potable water, toilet etc for the waiting customers which are found barely in the other retail
pharmacies. These facilities should be maintained in 100% of all the model pharmacies.
Among the 128 inaugurated model pharmacies, almost 50% are in the Dhaka city and a
separated place is found only in those model pharmacies located in Dhaka city. Almost all the
model pharmacies were found with one A grade pharmacist employed except in a model
pharmacy in Dhaka where two A grade pharmacists were employed. But they were not
working in the roster schedule and unfortunately none of them was found during the survey.
The encounter with A grade pharmacist was fairly low during low, although they are the
supervisors of overall operations of the model pharmacies. The study suggests that most of
the model pharmacies are offering and performing some minor tests of certain body
conditions and this is good for acquiring public trust. The overall storage condition of
medicines in the model pharmacies was satisfactory. In terms of keeping records of
purchased drug almost all the model pharmacies keep the invoices for a certain period but the
result was not good while keeping records of the medicines sold. The model pharmacies
which are able to keep all the records of medicines sold due to the availability of digitalized
storage system. Other than this some model pharmacies keeps records of the antibiotics sold
by manually writing in the book. The most satisfactory result is that the model pharmacies are
purchasing medicines directly from DGDA approved pharmaceutical companies. By doing
that they are ensuring quality drugs to customers. The result also suggests that a majority of
the population in the vicinity of the model pharmacies are unaware about the benefits and
facilities that’s why they are not going to model pharmacies. As it is a public private
relationship program, the government and stakeholders must come forward to create
awareness among the public.
This project only encompasses study of some of the features of the model pharmacies in
Bangladesh. Future study is required on the beneficial consequences of model pharmacies
like rationale use of the drugs, patient knowledge on the drugs that they are consuming.
Reference
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A Survey on Current Scenario of Model Pharmacy

A Dissertation submitted to the Department of Clinical

Examinee, M. Pharm. (Clinical Pharmacy and

At first, I would like to express my sincere gratitude to my respected supervisor Sabiha

No. Topic Page No.

Figure B 2(A) Operating timeline of the model pharmacies (percentage and 24

Figure C 4(A) Overall percentage and number of model pharmacies whether 34

Figure C 12(B) Number of model pharmacies of different districts whether 42

Figure E 3(B) Working day of A grade pharmacist of different districts. 51

Figure E 4(A) Salary range of A grade pharmacist (percentage and number). 52

Figure E 4(B) Salary range of A grade pharmacist in model pharmacies of 52

Figure F 1(A) Overall percentage and number of model pharmacies in terms 62

No. Topic Page No.

Table 1 Demographic characteristics of model pharmacies 15

Pharmaceutical sector of Bangladesh has enriched profoundly after promulgation of The

1.1. Pharmaceutical sector of Bangladesh

1.2. Retail Pharmacies in Bangladesh

1.2.1. Workforce at the Retail Pharmacies

1.3. Counterfeit Medicine

According to definition proposed by World Health Organization (WHO) "A counterfeit

1.3.1. Counterfeit Medicine in Bangladesh:

In Bangladesh like some other developing countries, the pharmaceutical companies

1.4.1. Dispensing errors

Any unintended deviation from an interpretable written prescription or medication order is

 wrong drug dispensed

 incorrect assembling of the medicines

1.4.2. Factors influencing dispensing errors

1.5. Patient Counselling

Self-medication is the selection and use of medicines by individuals to treat self-recognized

1.6.1. Benefits of self-medication:

1.6.2. Drawbacks of self-medications

1.6.3. Effects of self-medication on antibiotic resistance

Nonprescription sale of antibiotics is one of the major reasons to increasing antibiotic

1.7. Model Pharmacy

1.7.1. The origin of idea of Model Pharmacy

Although important as a source of medicines for a significant proportion of the population,

 illegal dispensing of prescription medicines.

1.7.2. The ADDO model of Tanzania

1.8. Rationale and objectives

The goals of this project are –

 To learn about the current scenario of model pharmacies in Bangladesh.

1.9. Literature review methods

2.1. Methodology for the field survey

2.2. Survey method

The field survey was conducted by Questionnaire method using a semi-structured

2.3. Study design

Study type : Survey-based study.

2.4. Survey questionnaire form

Name of the Model Pharmacy: Name of the Surveyer:

Section: A) Questions regarding the physical condition of the Model Pharmacy-

Section: D) Questions regarding adverse drug reaction-

45 Does the model pharmacy keep the purchase record?

2.4. Study population, Participant’s profile, and data collection

Study population : Personnel of the model pharmacies including owner, pharmacist

2.5 Evaluation of data

Table 1: Demographic characteristics of model pharmacies

Area Number of Model Pharmacies

Section A: Questions regarding the physical condition of the Model Pharmacy

Figure A 1(A): Availability of adequate seating facility in the model pharmacies

Figure A 1(B): Availability of adequate seating facility in the model pharmacies

Does this model pharmacy have a source of potable water?

Figure A 2(A): Availability of potable water facility in the model pharmacies