Care or Cash: Assessing Quality of Care Provided by Drug Retailers in Nepal

Abstract

Staff in the pharmacies of urban Lalitpur, Nepal, were interviewed, observed in their work, and tested through the use of a researcher posing as a client to assess the quality of care they provide, and their potential as health informants to the general public. Note was made of advice given to clients describing cough symptoms and diarrhoea, symptoms underlying two major causes of morbidity and mortality in Nepal. Data were also collected on the uses made of pharmacies by the general public, in terms of the provision of health care. Results show that people do indeed frequently use pharmacies as a primary care service. However, staff have minimal training. The quality of the advice they provide is varied, but many ask for no additional information on symptoms, and give average or poor advice on the use of the drugs they recommend. Drug retailers are particularly weak on giving explanations to clients about possible side effects and contraindications and rarely refer clients to health professionals. Most “consultations” last less than two minutes. Drug retail staff perceive the provision of health information to be an important and necessary part of their work, and many express a desire for further training. One obvious constraint to developing their health care role, however, would be the undoubted conflict between the financial interests of the drug retailer and the importance for the vast majority of clients of receiving adequate treatment but at limited cost. An important question is whether much higher priority is to provide the drug retailer with more training on drug use and control.