CGD consultant Alix Beith interviewed Ton Hoek (FIP General Secretary and CEO) and Xuan Hao Chan (FIP Manager for Public Health Partnerships)
Founded in 1912, the International Pharmaceutical Federation (FIP) is the global federation of national associations of pharmacists and pharmaceutical scientists. It has official status on their behalf at the World Health Organisation (WHO). Through its 122 Member Organisations, FIP represents and serves almost two million pharmacy practitioners and scientists around the world.
1. Can you please briefly describe what FIP is and how it works? What do you feel are its major strengths in developing countries?
As the global Federation representing the world’s pharmacists and pharmaceutical scientists, FIP works with pharmacists, pharmacy technicians and medicine dispensers to promote good health and the well being of citizens, while also building community capacity to address the social determinants of health and common behavioural risk factors for the prevention and control of non-communicable diseases.
FIP also supports secretariat offices in six regions. These regional pharmaceutical forums bring together national pharmacy associations, the WHO regional offices and FIP. The forums support regional partnerships and dialogue on improving pharmaceutical services and health.
Our major strengths in developing countries are to document and analyse pharmacy workforce trends and to develop guidance for national pharmacist associations, governments, donors and other stakeholders on how to address challenges in pharmacy workforce development to support access to and rational use of medicines. This is achieved through country-led activities, inter alia, assistance in the development of protocols for accreditation/certification of dispensing establishments and pharmacy staff; guidance in the revision of national legislation and regulatory controls, training of staff and facilitation of dialogue at political and technical levels with relevant stakeholders.
2. What are the primary resistance-related concerns in the countries where FIP works?
In general, pharmacists and pharmacy workers have a clear understanding of the existence (and emergence of new) resistance profiles of different types of antimicrobials to antibiotics and other drugs. The problem with health professionals is not a lack of knowledge on how drug resistance can develop, but rather a lack of awareness about the extent of resistance in their countries and of knowledge that they need to take up responsibilities to halt its spread. For example, widespread irrational dispensing behavior is a huge driver of resistance. In most countries in the Western Pacific region, methicillin-resistant Staphylococcus aureus (MRSA) is of most concern, followed by resistant strains of gonorrhea. Some countries cannot afford the newer and more expensive antibiotics and have to rely on the older and cheaper antibiotics to which resistant strains do not respond. Many countries in this region show 70-80% resistance to first- and second-line general antibiotics. This problem is not helped where antibiotics are easy to come by: in those countries with weaker regulatory systems, where antibiotics are sold over the counter by pharmacists and other medicine sellers and where they are widely available in community markets. Currently, in the region, Cambodia, Laos and Mongolia may be the countries worst affected by irrational dispensing.
In South East Asia, antibiotics are prescribed rampantly for high grade fevers with headache and myalgia (which may not be typhoid), for upper respiratory tract infections, for GI upsets and for vomiting and low grade fevers (which may be tuberculosis). Many community practitioners give antibiotics even in viral fever case scenarios. The problem n some developing countries are the financial incentives that private pharmacy shop owners and private doctors have to sell medicines - and this is often accompanied by uncontrolled pharmaceutical promotion. If the formal sector is busy making money by selling medicines, can one really expect the informal sector to do differently?
Overall, we think that the occurrence of antimicrobial resistance in each country is linked to a large and diverse group of factors. It is practically impossible to establish quantitatively the degree of responsibility of each of the multiple factors involved in the development of microbial resistance. It is the collective pressure of all of them that determines resistance and, therefore, any action taken that does not address this problem as a whole is necessarily bound to failure.
3. What are FIP’s thoughts on how it and other organizations can and should become more engaged in tackling resistance?
In recent years FIP, in collaboration with our member organizations, has taken the initiative to explore possibilities to provide technical assistance to improve drug distribution and drug utilisation standards and practice in developing and transitional countries. From 2005 to 2007, pilot projects were supported in Thailand, Uruguay, Vietnam and Moldova. We intend to continue supporting new projects in India, Indonesia, Nigeria, Macedonia, and Paraguay, while further strengthening ongoing efforts in Thailand and Uruguay.
It is important to recognize that any accreditation of pharmacies is primarily a political decision that must be combined and coordinated with regulatory and legislative support, especially for institutional or public sector pharmacies. FIP is very keen to support the concept (recommended by CGD’s DRWG) of establishing a Global Partnership of Medicine Providers which focuses on rational drug use, particularly in developing country settings. This partnership could provide, inter alia:
- A centralized resource for evidence about improving drug prescribing and dispensing practices (for prescribers and both formal and informal dispensers) through use of incentives, education, training, certification, accreditation, and other relevant models;
- Technical assistance to countries considering implementation of models to improve drug prescribing and dispensing;
- Model drug dispenser checklists and other tools adaptable to country and industry contexts; and
- Links to financial resources to pilot and transfer to other countries sound dispenser certification programs.
We need to build a coalition of transnational organisations whose work will have a direct impact on the use of medicines at the country level. A range of stakeholders should be involved, including industry partners and key governmental representatives who may serve as facilitators to access adequate funding in order to sustain a long term program in antimicrobial medicines resistance reduction strategy. FIP and its regional pharmaceuticals fora look forward to playing an active role in helping this Partnership come to fruition.