Public health faces hazards for unholy drug cartels of some manufacturers of substandard medicines and mushrooming unregulated drugstores, though Bangladesh can boast of world-standard pharmaceuticals that many developed countries import.
A sample survey finds out that almost half the country's medicine stores are operating without licence across the country.
And the number of the non-compliant drugstores keeps rising fast for the lure of high returns in absence of strict and regular monitoring of the lifesaving trade by the regulatory bodies, sector-insiders say.
As a result, medicine shops have found a mushroom growth in Dhaka and elsewhere in recent times, caring little for minimum standard of lifesaving pharmaceutical products.
The scariest part of the matter is the presence of uneducated and semi-educated persons in taking care of highly sensitive products in the shops. It overturns the campaign on 'right medicine, right quality and right price'.
The FE correspondent conducted a mini-survey on 22 medicine outlets at East Rampura and eleven of them failed to show licence.
Talking to the FE, a sales-boy at a drugstore that has no signboard at East Rampura, Nurunnobi, says he has sold drugs to people for the last eight years.
About the signboard, he says the signboard named Unique Medicine Shop was blown away in a storm and has yet to be reinstalled. Asked about licence, the salesman says the owner has appealed for it, but to no avail yet.
Seeking anonymity, a shop owner says there are some outlets selling drugs sans licence even for more than a decade.
"Licensing process is complicated here. You need much more than the official rates, which discourages the shop operators."
He also informed that many of the unlicensed and even licensed outlets often promote low-standard drugs which have higher profitability.
According to the sector-insiders, the licensing cost could go up to Tk 15,000.
According to Rampura Upa-Shakha of Bangladesh Chemists and Druggists Samity, there are 260 medicine shops in Rampura area but maximum 130 have licence and the rest go freewheeling.
General Secretary of the sub-office of the Samity Sheikh Shamsul Haque has a story on licensing hassles. He says they have been pushing the unlicensed drugstores to get authorised.
About the recent growth of the medicine shops, he said job market at home and abroad became volatile after the pandemic hit the planet but there are aspirant and resilient people who want to get involved with some business activities even in the Covid time.
"Medicine stores in the area can open even during lockdown. That's why you see too many drug shops in recent times," he noted about the development as an alternative to regular jobs.
Although none has any data on the actual number of medical stores currently operating in the country, the Directorate General of Drug Administration (DGDA), the licensing authority, has with it only the figures of its registered pharmacies.
But there are a big number of unauthorised dispensaries making business for years to reap benefits of the poor regulations.
According to the DGDA, there are around 152,000 registered drugstores across the country. The number of licence-holders was only 10,700 in 2017.
Seeking anonymity, a DGDA official says an equal number of unlicensed retail drug shops are involved in selling all types of drugs besides the 'over-the-counter (OTC)' drugs.
They have got many reports that a good number of pharma companies, which are not too familiar, are doing medicine shop-based marketing offering good profit margins for their low-quality drugs.
"They (the companies) even do not visit physicians. They largely concentrate on upazila and union levels. This high profit-alluring malpractice is dangerous. It needs to be stopped. We're trying to rein them in," he says about possible action.
DGDA spokesman Ayub Hossain says they have been trying hard to bring all the medicine shops under their regulations with their limited resources.
"We have limitations of manpower and logistics. But if you see the number of drives, cases and the amounts of financial penalty against errant outlets, it keeps gradually increasing," he said.
According to the DGDA annual report, the number of inspected drugstores declined to 55,200 in financial year 2019-2020 compared to 59,883 recorded in the previous year.
The number of cases filed against the non-compliant stores was also on the downturn as a total of 2007 cases were lodged on various charges in mobile, magistrate and medicine courts in FY 2020 against 2081 cases registered in FY'19.
But the volume of financial penalty soared over Tk 230 million in FY'20 from Tk 65 million in the previous fiscal.
According to the law, the persons dispensing drugs at drug retail outlets should at least have a 'Grade-C pharmacist' certificate.
This certificate is given after a short training of 12 weeks covering the basics of dispensing practice without any hands-on training and is being conducted by the Pharmacy Council of Bangladesh (PCB) since 1995, in association with the Bangladesh Chemists and Druggists Samity. Only when this criterion is fulfilled, the shop owner can apply to the Directorate General of Drug Administration for issuance of a drug (pharmacy) licence.
However, most of the salespersons at these retail drug shops do not have training in dispensing drugs or in diagnosing and treating medical conditions-the tasks they frequently perform. Because drugstore salespersons have no other channel of information from the formal sectors open to them, they fall easy prey to the aggressive marketing strategies of the pharmaceutical companies.
Venting concern over the growing number of unregulated and current structure and practice in the existing medicine outlets, experts suggest holistic reform in the licensing procedure.
Chairman at the Department of Pharmacology of Bangabandhu Sheikh Mujib Medical University (BSMMU) Prof Md. Sayedur Rahman says a C-category pharmacist certificate is needed in the existing law to run medicine stores here.
There are three categories of pharmacists: A-grade ones are graduates, B-grade people are those who complete diploma and C-graders are those who received it through a three-month-long training from the PCB.
Based on the C-grade certificate, people are entitled to appeal for a licence, he said.
"There is no other country in the world that allows operation of drug outlets with only three-month training. Without a pharmacist, it cannot be called a pharmacy," says the specialist.
As the shops are not well-equipped or capable of employing pharmacy graduates, there has been a pressure for the last several years for modernizing the outlets. As part of the effort, a new concept styled 'model pharmacy' where pharmacy graduates will be available was launched, he said.
Around 1,000 model pharmacies have already been formed while the rest-either legal or illegal-are medical shops, he said.
The BSMMU professor says operating medicine stores become profitable because all the medicines, excepting sedatives, can easily be bought in OCT sales violating the laws.
"There are 1,300 authorised medicines on the market but only 39 items are legally allowed in OTC sale. But things are not followed here. You can buy almost all the drugs from the shop without a physician's prescription. That's why it has become a profitable venture, causing significant growth in drug business," he says.
The scariest part is that the highly sensitive drug trade goes into the hands of thousands of unskilled, uneducated and semi-educated people, Mr Rahman rues.
"All the strict regulations for ensuring quality drugs will be fruitless if it is delivered through this untrained hands as more than 60-percent people buy drugs as suggested by them," he noted.
"There is no study on how many people get proper medicine, how many receive improper medicines and how many get harmful drugs. So, we can avail the medicine but we cannot term it service. It's just a medicine sale," he says.
For bringing discipline in the area, he suggests continuous reforms in the sector with initiatives to woo pharmacists into the medicine shops.
