Weak planning and Malpractice Threaten the pharmacy profession- Two Studies Conducted by BAU

07 April 2021


The Faculty of Pharmacy at Beirut Arab University revealed worrying results about the reality of the pharmacy profession in Lebanon, its future, and the challenges it faces, according to figures that showed increase in pharmacists' rates relative to the population and a narrow horizon of practice in the absence of health planning and the necessary legislation for that.
The faculty relied on two joint studies about the profession of pharmacy sector in Lebanon. They were published in two prestigious scientific journals performed by two researchers from Beirut Arab University and the American University of Beirut. They were based on analyzing the database of pharmacists registered in the order from 1954 to 2018 and interviews with people who are sources of information and decision-makers in the pharmacy sector.
The first study which was performed by Dr. Mohamad Ali Hijazi from the Faculty of Pharmacy at Beirut Arab University and Dr. Mohamad Alameddine from the American University of Beirut and published in the Journal of Human Resources for Health. It alerted the challenges that the pharmacy profession is facing due to the lack of proper planning and the practices that were not based on societal and population needs .
The analysis of data shows that Lebanon has the highest rate of pharmacists relative to the population in the world, as it exceeded 20 pharmacists per ten thousand citizens, while the global average recorded in 2017 was five pharmacists per ten thousand citizens. At this rate, Lebanon surpasses most of the Organization for Economic Co-operation and Development (OECD) countries showing a big difference between it and developed countries such as France (11.2), United States (9.2), Canada (10.4), United Kingdom (8.3) and Germany (6.4).
The study also revealed an unbalanced accumulation of pharmacies, where the ratio reached 7.3 pharmacies per ten thousand persons (i.e. one pharmacy per 1,350 citizens). This rate is three times higher than global averages, as the average in OECD countries is 2.5 pharmacies per 4000 citizens, and in France (3.4), Canada (2.6), Germany (2.2) and the United Kingdom (2.2).
Among the anomalies that the study showed is the absence of the clinical role of pharmacists where the percentage of pharmacists in hospitals is very low (1.7 pharmacists per 100 beds), which raises questions about who supervises dispensing medication inside hospitals and the risks that may result to the health of patients.
These questions also apply to community pharmacists, as the numbers show that there is an average of one pharmacist inside each pharmacy who work long work shifts that are full of burdens and challenges. This may affect the ability of the pharmacist to provide health, educational and counseling care to patients and do only the typical role such as dispensing medicines.
According to the results of the study, pharmacists need to re-plan and organize the profession and develop the health system with rapid and modern laws and procedures in which all effective governmental authorities, unions and health organizations cooperate, so that the patient's health is the priority and achieving health and drug security for the community.
A second study performed by the same researchers (Dr. Mohamad Ali Hijazi from Beirut Arab University and Mohamad Alameddine from the American University of Beirut) published in the scientific journal PLOS ONE showed that the practice of pharmacy in Lebanon was reduced and stifled in only two sectors: pharmacies (64%) and pharmaceutical companies. (24%), which shows the urgent need to expand investment in various pharmaceutical sectors such as the pharmaceutical industry, clinical and hospital pharmacy, education and scientific research which has positive repercussions on the community’s health and safety.
The study attributed the imbalance of supply and demand in the pharmaceutical sector to the poor planning of the health workforce in Lebanon, the easy integration of pharmacists from outside Lebanon (they make up 30% of pharmacists) and giving them the right to practice the profession after undergoing only a simple exam that is easy to pass with the absence of any agreements or understandings to facilitate the work of pharmacists outside Lebanon (only 8% of pharmacists work abroad) knowing that pharmacy education in Lebanon is of high quality having prestigious International Accreditation.
According to the study, the poor organization of the profession is due to the weakness of laws and the absence of necessary legislation, as they are either very old laws or they are not well implemented or need to be developed to keep pace with the transformation and development of health practice around the world. In addition to that, there is no control over pharmaceutical practices, presence of a defect in the government sector, and maybe a conflict of interest that may prevent these legislations.
Both studies noted high pressures and a challenging environment for pharmacists in Lebanon, which threatens the future of the profession and the pharmacists' mission in Lebanon. These pressures have been burdened recently with new challenges such as the COVID -19 Pandemic, the collapse of the exchange rate, the reduction in medication prices with no planning, the interruption of medicines and other security risks, which led to the closure of more than 600 pharmacies in the year 2020 (according to the Order of Pharmacists in Lebanon). The crisis is expected to worsen more in the coming months, unless the necessary reforms are undertaken. Most pharmacists in Lebanon have a feeling of resentment and frustration in light of the inability to bear operational and living costs with the great increase in the dollar exchange rate (exceeding 13,000 Lebanese pounds to one dollar), while their commission is still calculated at 1500 Lebanese pounds to the dollar, which threatens their ability to continue carrying out their duties and health responsibilities towards patients and community.
The study called for concerted efforts of the persons involved in this sector to develop laws, organize the management of workforce, direct investments towards the pharmaceutical sectors, expand the horizon of professional practice and address the aforementioned challenges. They may contribute not only to the development of a profession that forms the guardian of the health gateway to the community which has become threatened by the core of its mission, but to the development of the health system and raise the level of health and drug safety in the Lebanese society. This will positively affect the health of the citizen, reduce the cost of the medication bill, and reduce the pharmaceutical health risks that threaten the Lebanese Entity.