The State of the World’s Pharmacy: A Portrait of the Pharmacy Profession

Stuart Anderson
London School of Hygiene and Tropical Medicine

Introduction
Today, therapeutic medicines are the cornerstone of much of health care throughout the world.
Indeed, they have been described as the ‘personal technology’ of our time (Davis, 1997). They play
a major part in the alleviation of suffering and the suppression of pain, and they offer the promise of
treatment or cure to millions of people. A vast global industry now exists to develop, produce and
market pharmaceuticals. There are, however, enormous variations between medicine use in
developed and developing countries. Whilst spending on pharmaceuticals represents less than ten
per cent of health spending in most developed countries, it represents between fifteen and thirty per
cent in transitional economies, and between twenty five and sixty six per cent in developing
countries (WHO, 2001a).

Responsibility for ensuring the safe, effective and rational use of medicines lies with pharmacists.
Pharmacists stand at the interface between the developer and producer of pharmaceuticals on the
one hand, and the consumer of their products on the other: they are society’s experts on medicines.
Pharmacy is the health profession concerned with therapeutic medicines. According to the 1968
Medicines Act, a therapeutic substance is ‘any substance or article (not being an instrument,
apparatus or appliance) administered to human beings or animals for a medicinal purpose’. Such a
purpose may include ‘the diagnosis, treatment or prevention of disease, and otherwise preventing or
interfering with the normal function of the body processes, either permanently or temporarily’. This
definition covers a broad range of items, including not only over the counter and prescription
medicines but also blood products and vitamins. It has recently been extended to include
homeopathic and herbal products.

The pharmacist’s involvement in therapeutic drugs extends from the initial development of new
chemical entities, their formulation into medicines, their testing, marketing and distribution, their
supply to patients, and ultimately to the monitoring of patients taking them.

Today, pharmacists practice in a situation of rapid development, where it is difficult for health
professionals to keep up with all the latest knowledge, where patients themselves increasingly go to
their doctor armed with information gleaned from the internet, and where the consequences of error
are increasingly great. Pharmacy, no less than medicine or nursing, is a profession in which lack of

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care can result in patient harm or death. This may result, for example, through failure to spot a
dosage error, or through the supply of the wrong drug (Barber, Smith and Anderson, 1994).

The Functions of the Pharmacist

The role of pharmacists is to promote and support the safe, effective and rational use of medicines
amongst the people that they serve. However, this role takes different forms in different parts of the
world. In recent years the orientation of the pharmacist in many countries has shifted from the
product to the patient. The focus of attention is now firmly on the pharmaceutical needs of the
patient rather than the preparation of an elegant product. These patient-focused activities have
evolved into the concept of ‘pharmaceutical care’, which has been defined as ‘the responsible
provision of drug therapy for the purpose of achieving definite outcomes that improve a patient’s
quality of life’ (Hepler and Strand, 1990). Pharmaceutical care involves pharmacists being directly
accountable to patients for the outcomes of drug therapies.

The developing clinical role of the pharmacist has been one of the most exciting and encouraging
developments in recent years. The pharmacist has shifted from a focus on the preparation and
supply of medicines to a focus on the sharing of pharmaceutical expertise and knowledge with
doctors, nurses and patients. This has placed greater emphasis on the clinical training of
pharmacists, and ensures that they make the greatest possible contribution to the rational use of
medicines. Developments in pharmaceutical care are occurring in both the hospital and community
settings. In some countries it is acknowledged that this responsibility is shared with other health
professionals, and the term ‘medicines management’ is preferred (Panton and Chapman, 1998).
Despite these developments, however, both pharmaceutical care and medicines management remain
largely aspirational in many parts of the world.

Pharmacy Practice in the Community

In the community, the precise role of pharmacists is dictated largely by the economic, regulatory
and organisational frameworks in which they operate, and hence differs from country to country.
For example, pharmacy practice is strongly influenced by the way in which medicines are
controlled: whether all medicines are freely available through any outlet, whether some are
restricted to sale from registered pharmacies only, and whether some are only available on
prescription. Such regulation varies widely. The economic framework of health care is also a key
determinant of the nature of pharmacy practice. Most countries have a mix of public and private
provision of health care, and this is reflected in the provision of pharmacy services. There are also
fundamental differences in how medicines are paid for, and specifically whether patients pay for

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their medicines in full, in part, or not at all. Countries differ widely as to who can own pharmacies.
Some allow corporate ownership, resulting in chains and multiples: some restrict pharmacy
ownership to pharmacists alone, and some allow individual pharmacists to own one pharmacy only.

Within these constraints the pharmacist’s contribution to health care in the community centres
around five broad themes (RPSGB, 1997). These are summarised in Table 1. In the management of
prescribed medicines, pharmacists work to help patients gain maximum benefit from their
medication, and are involved in every stage of the chain from drug development and manufacture to
providing medicines, information and support. In the management of long-term conditions, they not
only supply the medicines and support that patients need, but are increasingly involved in the
development of locally agreed shared care protocols, ensuring that patients use prescribed
medicines to best advantage, and helping them to improve the outcomes of treatment.

In the management of common ailments, pharmacists play a vital role in supporting responsible
self-medication, by giving people advice and re-assurance, supplying non-prescription medicines
when appropriate, and referring people to other health care professionals where necessary. In the
promotion and support of healthy lifestyles, they help people to maintain good health by providing
health screening, advice on healthy living, and other services. Pharmacists are now involved in a
range of such services, including blood pressure measurement, testing body fluids, cholesterol
testing, pregnancy testing, smoking cessation advice and diabetes guidance (RPSGB, 2001).
Finally, pharmacists contribute their expert knowledge of medicines and their use for the benefit of
other health care workers, including both doctors and nurses.

Pharmacy Practice in the Hospital Setting

Around the world substantial numbers of pharmacists are employed in hospitals. Here too the
service has become increasingly patient focussed, although the essence of the service provided
remains the provision of the medicines needed by inpatients. Many will also supply the medicines
for outpatients, together with advice and information about their use. Larger hospital pharmacy
departments often have manufacturing units for both sterile and non-sterile products, which have
the facilities to make those items that are not commercially available. Others will have supporting
services such as quality control laboratories and computer services. As hospital pharmacists have
become increasingly involved in the development of new drugs, and the rational and effective use
of existing ones, so their role in bigger hospitals has become more specialised. Individual
pharmacists now specialise in such areas as medicines information, formulary development, and

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clinical trials. The range of activities undertaken within hospital pharmacies in many countries is
illustrated in Table 2.

One of the most significant events in the development of hospital pharmacy has been the shift in the
location of practice, from within the confines of the pharmacy, to the ward or clinic setting.
Pharmacists began visiting wards to check prescription sheets, and to initiate supply, to avoid the
need for prescriptions having to be sent to the pharmacy, and hence not being available at all times
on the ward. As pharmacists became more involved on the wards, in advising doctors on what
might be prescribed, and helping nurses with problems in drug administration, this ‘ward pharmacy’
evolved into a more patient-orientated ‘clinical pharmacy’. Indeed, pharmacy in virtually all
developed countries has progressively shifted from product-orientation to patient-orientation.

Pharmacists in the pharmaceutical industry

The range of opportunities available to pharmacists in the pharmaceutical industry is as diverse as
the industry itself. However, the main areas in which pharmacists are employed are listed in Table
3. Many new graduates entering the industry choose a post where the pharmacist’s skills and
knowledge are of direct relevance and value (Ecclestone, 1998). These include research,
formulation development, quality control and production. Later on, having gained in experience and
confidence, some choose to move on to areas such as product registration, medical information and
clinical trials, and a small number move into the more commercial areas of sales and marketing.

Other occupations of pharmacists

Pharmacists are also to be found in a wide range of institutions such as prisons, and in some
countries substantial numbers of pharmacists are employed in the armed forces, in naval, military
and air force establishments. A more recent development in some developed countries has been the
growth in the number of pharmacies providing advice to local health authorities, usually developing
local formularies and monitoring doctors prescribing. A few are now employed directly by general
practitioners to advice on the rational and cost-effective use of drugs.

Most countries now have agencies dealing with drug safety and control, including licensing and
regulation. These include the Food and Drugs Agency in the United States, the Medicines Control
Agency in Great Britain, and multi-national agencies such as the European Medicines Evaluation
Agency. All employ substantial numbers of pharmacists. Indeed, the pharmacy degree provides a
sound training in medical science, and pharmacists are to be found scattered across a wide range of

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less obvious activities. These include medical publishing, such as journal and newsletters, as well as
national formularies and pharmacopoeias.

The Education of the Pharmacist

In most countries prospective pharmacists are trained to degree standard, followed by a period of
pre-registration training, typically of one year’s duration. The degree course is science based, with a
strong emphasis on the pharmaceutical sciences, social and administrative pharmacy, and forensic
pharmacy. These are summarised in Table 4. The exact syllabus varies substantially from country to
country.

In recent years the period of study has tended to become longer, and the competencies required for
registration have become more rigorous. In the United Kingdom there are currently sixteen schools
of pharmacy. These now offer a four-year undergraduate degree course leading to the Master of
Pharmacy degree. The pre-registration year is now highly structured, and at the end of it candidates
sit a pre-registration examination. In the United States a professional doctorate qualification, the
Pharm.D. programme, has become the norm, and this qualification is now being offered by a
number of institutions within Europe. American students also undertake a period of pre-registration
training, which in the institutional setting is known as a residency programme. This is usually a
one-year programme of formal education and training in all aspects of pharmacy practice.

Education in Continental Europe

There remain substantial differences in the education and training of pharmacists within the
European Union. In the Netherlands, for example, it takes six years to qualify as a pharmacist.
There is no formal pre-registration year: instead, there is a six month period of practical experience
which is undertaken during the final year of pharmacy school. The first two years of study have a
strong emphasis on basic and pharmaceutical sciences. Practical skills are taught during the last two
years. Students can take an interim examination after four years, leading to the award of a master’s
degree. However, most opt to complete the six-year programme and qualify as pharmacists. They
are awarded a diploma similar to the US Pharm.D qualification. Once qualified, community
pharmacists can legally be in charge, although in practice most complete at least two years as an
assistant pharmacist first. However, Dutch pharmacists must complete at least three years of on-the-
job training before being in charge of a hospital pharmacy.

In Germany federal law regulates the pharmacy curriculum, and any change needs to be agreed by
all sixteen federal states. However, clinical pharmacy and pharmacotherapy have recently entered

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the curriculum, and pharmacists are being encouraged to develop critical thinking and clinical
problem solving skills. The Scandinavian countries, including Norway, Sweden and Finland, offer
two pharmaceutical qualifications. The master of pharmacy degree takes from five to six years to
complete, and includes six months of practical experience in a pharmacy (Mason, 2000). The other
qualification is the bachelor of pharmacy degree, which takes three years to complete. In Norway
and Sweden this is the qualification of prescriptionists. Pharmacists with masters and bachelors
degrees have the same responsibilities in relation to the dispensing of prescriptions and the giving
of advice to patients and customers, but those with the bachelor’s degree cannot own and run a
pharmacy.

Pharmacy Education Elsewhere

Pharmacy education in the former soviet countries has undergone substantial development in recent
years. In Slovakia, for example, pharmacists are educated in the faculty of pharmacy at Comenius
University in Bratislava. This is the only pharmacy faculty in Slovakia, and was the only one in the
whole of Czechoslovakia between 1960 and 1969. Of the thousand students in the faculty, most are
from Slovakia. Pharmacy is studied in English (Mason, 1998). The undergraduate degree course
lasts five years. After completion of the course pharmacists are qualified to practice as assistants in
either community or hospital pharmacy, but they cannot be in sole charge of a pharmacy. To be in
change of a community pharmacy, the pharmacist must work as an assistant for two years, and then
take a further examination. To be in change of a hospital pharmacy five years postgraduate
experience are required, together with successful completion of a second examination.

Many developing countries now have the capacity to train their own pharmacists (WHO, 1997)). In
Indonesia, for example, the pharmacy undergraduate course has recently been reduced from five to
four years duration (Tan and Aslam, 2000). The course is followed by a year’s pre-registration
training. The pharmacy curriculum is heavily biased towards pharmaceutics (the preparation of
appropriate dosage forms), pharmacognosy (the study of medicinal substances of natural origin),
and laboratory work. Pre-registration trainees have to attend lectures as well as gaining experience
in all spheres of pharmacy practice, including hospital, community, industry, and with the ministry
of health. Indonesian pharmacists therefore tend to have a wide knowledge of all areas of pharmacy
practice but insufficient experience of any one branch of practice. Pre-registration trainees then
have to complete both written and oral examinations. There are sixteen faculties of pharmacy in
Indonesia, of which eight are part of private universities. Pharmacy education is regulated by the
ministry of education.

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Post-graduate and Continuous Education
Most countries now provide opportunities for the post-graduate education of pharmacists, leading to
a variety of higher qualifications such as certificates, diplomas, and master’s courses in clinical and
community pharmacy, as well as professional doctorates. Other specialist qualifications are
available for pharmacists choosing a specific area of practice such as information management,
production and quality control.

Continuing professional development has become a feature of pharmacy practice in most countries.
In Great Britain the Royal Pharmaceutical Society expects its members to undertake at least thirty
hours of continuing professional development per year (RPSGB, 2001). A College of Pharmacy
Practice was established in 1981 to promote the highest professional standards in pharmacy. The
College exists ‘to promote professional and personal development through education, examination,
practice and research, benefiting patients and health care provision’ (CPP, 2001).

The Regulation of Pharmacy

In virtually all countries pharmacy is a self-regulating profession with its own regulatory and
disciplinary bodies. In Great Britain, for example, the Royal Pharmaceutical Society combines three
roles: it acts as registration authority, representative body and inspection service. The Society’s
powers are embodied in statutes, and registration with the Society is a legal requirement in order to
practice pharmacy. It publishes an annual Register of Pharmaceutical Chemists. The Society’s
second role is to promote the profession of pharmacy and to represent its members. Finally, it has
statutory responsibilities with regard to the inspection of pharmacy premises and the testing of
medicines. The Society itself is governed by a Council, which includes elected members together
with Privy Council nominees.

The cornerstone of the pharmacist’s professional status is educational attainment. Although there
remain considerable discrepancies between the educational attainment of pharmacists in different
countries, there is increasing mobility of pharmacists between them. There are, for example,
mobility agreements between the countries of the European Union, subject to competence in the
relevant language, although the actual number of pharmacists who have taken advantage of this
facility is so far low. Pharmacists who have qualified in other countries can apply for registration
with the Royal Pharmaceutical Society of Great Britain, for example, in order to work in the United
Kingdom. This usually involves attendance at a course lasting up to one year. There are also
reciprocal agreements operating between a number of countries, such as that between Great Britain,
Australia, New Zealand and Northern Ireland.

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Most countries now have written standards of practice for pharmacists, usually established by the
appropriate professional body. The Royal Pharmaceutical Society of Great Britain, for example,
issues such guidance to its members at regular intervals (RPSGB, 2001). Those who contravene
these standards may find themselves before the Statutory Committee, which has the power to
remove individuals from the Register of Pharmaceutical Chemists. Similar arrangements, including
registration and inspection of premises, exist in most other countries, although the extent to which
they are enforced is variable. Problems of enforcement tend to be greater in developing countries.
Less than one in three developing countries have fully functioning drug regulatory authorities, and
between ten and twenty per cent of sampled drugs fail quality control tests (WHO, 2001a).

The International Context of Pharmacy

The World Health Organisation (WHO) has played an important part in promoting and supporting
the role of pharmacists in improving health world-wide. Indeed, the important contribution which
pharmacists can make to effective health care has long been recognised at the international level. In
1988 the WHO identified particular problems in relation to the supply and use of drugs in
developing countries, and it encouraged governments to make the best use of pharmacists in
promoting the safe and appropriate use of medicines (WHO, 1988). Later, at the forty eighth World
Health Assembly held in Geneva in 1994, WHO called on pharmacists throughout the world to
support its drug strategy. It urged governments to more clearly define the role of pharmacists, and to
make full use of their skills in national drug strategies (WHO, 1994).

WHO has also played an important part in emphasising the importance of pharmacy education,
ensuring that it is designed to equip pharmacists for their future roles in both hospital and
community settings. Their document on Good Pharmacy Practice (WHO, 1996) emphasised the
need for training of pharmacists in health promotion, disease prevention, the supply and use of
prescribed medicines, and skills in influencing prescribing and promoting the rational use of
medicines. WHO has been keen to emphasise that the potential contribution of pharmacists extends
far beyond simply the supply of medicines, to all levels of planning and provision of services.

In practice, pharmacy internationally is characterised by diversity and variability. In carrying out

the duties outlined by the WHO, countries are hampered by limited access to the services of
pharmacists. There are enormous disparities between the numbers of pharmacists per 100,000
population in developed versus developing countries. Even within Europe there are large
differences between countries in the numbers of pharmacists available. The number of pharmacists
per 100,000 population for a range of higher income countries is shown in Table 5.

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Pharmacy Practice in Europe
In their detailed review of the role and function of both community and hospital pharmacists in the
health care systems of Europe, Lunde and Dukes (1989) found large variations in both. In the
decade since, pharmacy practice in Europe has undergone rapid change. Current information about
the state of the pharmacy profession in all fifty-one countries of the WHO European Region is
available at the European Observatory on Health Care Systems (WHO, 2001b). The key drivers of
change have been commercial pressures, government policy, and therapeutic advances (van Mil,
2001). Governments are increasingly looking at ways of controlling the costs of medicines, and of
passing these onto the consumer. In the United Kingdom, foe example, several hundred medicines
have been deregulated from prescription-only status to pharmacy sale status in recent years. Patients
are now able to purchase for themselves items that were previously only available on a doctor’s
prescription. This policy has been repeated in most European countries. Its impact on the practice of
pharmacy has been substantial: patients are increasingly seeking advice from the pharmacist about
medical conditions where previously they would have visited the doctor.

The implementation of competition directives has also had an impact. In the UK, resale price
maintenance (which meant that medicines available without prescription had to be sold at the same
price through all outlets) has ended, with the result that many pharmacy chains and supermarkets
now offer ‘three for the price of two’ and related offers. Together with the fact that many general
sales list medicines can be sold through any retail outlet, this imposes a financial strain on small
independent pharmacies, and it is likely that the numbers of these will diminish. Other countries are
moving in a similar direction. From October 2001 a selected list of 250 medicines became available
in Denmark from a number of retail outlets, including petrol stations. Pharmacists in Germany are
fortunate in having a near monopoly in relation to the supply of medicines. Only three per cent of
medicine turnover is outside of pharmacies, and there are no dispensing doctors. However,
Germany operates a strict one-pharmacy one-pharmacist owner rule, so multiples are unlikely to
become established in the foreseeable future (Mason, 1999).

Pharmacy Practice in North America

Pharmacy practice in the United States today is characterised by its diversity (Serradell and
Wertheimer, 2001). Community pharmacy in the US is a small but important component of the
overall health care system, and its recent development has been most influenced by the rapid
increase in the use of prescription drugs. In the US there are only two categories of pharmaceutical:
those that require a prescription from a medical practitioner, and those which may be sold
anywhere, without any professional supervision. This last group may be sold in any type of store,

9
from vending machines, by mail order, and from service stations. As in most countries, drugs such
as narcotics are controlled more stringently than others. Unlike some others, such as the UK, there
is no category of pharmacy only medicines, which can only be sold through registered pharmacies.
Nevertheless, US independent pharmacies continue to thrive.

Pharmacy is practised differently in every state of North America, reflecting different social,
political and economic characteristics, as well as differences in customs and traditions. There are
substantial differences in both regulation and efficiency, but there remains a firm commitment to
development of the role. Independent pharmacies on both sides of the Atlantic face similar
problems. Both find it hard to obtain payment for providing care rather than products, and both face
intense retail competition. Both face increasing costs and lower margins, making them less
profitable than other retail businesses. The challenge for all pharmacists is to meet the ever-
increasing expectations of the public everywhere, and to demonstrate a significant added value to
medicine usage.

Pharmacy Practice in Developing Countries

In most developing countries health care is a mixture of public and private provision. Pharmacists
are usually small businessmen, making a living out of the sale of medicines. In developing countries
urban populations tend to be wealthier those living in the countryside. As a result, health
professionals such as pharmacists tend to prefer to work in cities, and private sector health care
tends to be concentrated in urban rather than rural areas (Smith, 2001). In Ghana, for example,
eighty per cent of all registered pharmacists live and work in Greater Accra. In many urban areas of
developing countries retail pharmacies are numerous. Pharmacists have an important role to play in
promoting safe and appropriate use of products. Characteristics of pharmacies shown to be
important include ease of access, the ready availability of medicines, affordable products, and the
availability of credit (Goel et al, 1996).
In many rural areas pharmacists are scarce, and pharmaceutical services are denied to these
populations. For example, eighty per cent of the population of Tanzania does not have access to
pharmaceutical services. Eritrea in East African, which has a population of around 3,500,000, is
served by a total of just fifty-three pharmacists, a ratio of one pharmacist per 60,000 population
(Health Action International, 1997). The number of pharmacists per 100,000 population for a range
of middle and lower income countries is shown in Table 6.

From Table 6 it can be seen that least developed countries rarely have more than one or two
registered pharmacists per 100,000 population. However, these figures need to be treated with some

10
caution. Firstly, the figures are taken from registration lists, and give no indication of the actual
number of practising pharmacists. Secondly, the numbers of pharmacists is no indication of the
numbers or distribution of pharmacies. Thirdly, in some countries pharmaceutical expertise is
substantially supported by pharmacists from other countries. The Gambia, for example, has recently
had the services of six Nigerian pharmacists providing technical support. Fifthly, the contribution
that pharmacists can make is largely determined by the availability of pharmaceuticals, and where
these are not available, for whatever reason, the need for pharmacists is reduced. Finally, many
countries make substantial use of traditional remedies, and have large numbers of traditional healers
involved with the making and supply of medicines. These are not of course reflected in figures for
numbers of registered pharmacists.

In many developing countries pharmacists play a crucial role in the procurement of

pharmaceuticals. The importance of appropriate procurement practices has been emphasised by
WHO’s Essential Drugs and Medicines Policy Department, which has shown that some developing
countries routinely pay 150 per cent to 250 per cent of world market prices for essential drugs
(WHO, 2000). With their specialist knowledge, pharmacists are in an excellent position to ensure
that the most cost-effective drugs are bought in the most appropriate quantities from reputable
suppliers, and that they are delivered where and when they are required. By arranging purchases at
the lowest possible total cost, making use of generic rather than branded products where
appropriate, they can help to ensure that as many people as possible benefit from the limited
resources available for the acquisition of medicines.

Poor people spend a higher proportion of their income on drugs than do other groups. In promoting
rational drug use by giving appropriate advice, pharmacists are able to reduce purchases of
unnecessary and inappropriate products. There has however, been criticism in the past of
pharmacists and their staff, both trained and untrained, for selling pharmaceuticals without
questioning or advising clients on the suitability of particular products. There is still some way to go
before the practice of the best becomes the practice of the majority.

Conclusions
Pharmacists are society’s experts on medicines. This paper has described some of the many
medicines-related activities with which pharmacists are involved. It has highlighted some of the
areas of divergence of pharmacy education and practice around the world, but has also
demonstrated the increasing convergence of pharmacy practice, education and training around the
rational use of drugs, medicines management and pharmaceutical care.

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Pharmacists have long occupied an indeterminate terrain in health and welfare, falling somewhere
between business and professionalism, and between professional care and lay care (Anderson and
Berridge, 2000) and this tension between business and profession continues today. The exact
location of pharmacists in the health care system continues to change, and varies from country to
country. In some they act as ‘gatekeepers’ to primary care: in others they are increasingly taking on
roles previously undertaken by general medical practitioners.

Patients in many countries are today exhorted to ‘ask the pharmacist’ in relation to a whole host of
minor conditions. In some countries medicines which were formerly available only on prescription
are now available from local pharmacies. This gradual transfer of responsibility for the prescribing
as well as the supply of medicines continues, and pharmacists are increasingly being given
prescribing rights in their own right. At the beginning of the twenty- first century the profession of
pharmacy faces many challenges, but there are also many opportunities. This paper has
demonstrated that pharmacy around the world is well placed to take them.

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 Table 1: Range of Services and Activities; Community Pharmacy

Service Activity

The management of Pharmacists dispense prescribed medicines and advice patients

prescribed medicines: on their use: pharmacists sometimes monitor this use over time

The management of Many patients seek advice from pharmacists on how to take or
long-term conditions: use their medicine, and on avoiding unwanted side effects

The management of Many people make use of pharmacists for a wide variety of
common ailments: healthcare advice and help, as pharmacies are usually conveniently
located and pharmacists can usually be seen without an appointment.

The promotion and Both well and ill people visit pharmacies, so pharmacists are
support of healthy lifestyles: well placed to offer health information and advice, and to refer people
to specialist support and help when needed

Advice and support for other Pharmacists provide medicines information and advice to a wide
healthcare professionals: range of health care personnel

Source: RPSGB (1997)

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 Table 2: Areas of Specialist Practice; Hospital Pharmacy

Area Function Role

Product services: sterile products making injections and infusions
non-sterile products making mixtures, creams, drops
pre-packaging packing tablets, capsules, liquids
radiopharmacy preparing diagnostic radioisotopes
parenteral nutrition preparing intravenous feeds
quality control testing manufactured products
quality assurance testing manufacturing processes

Support services: purchasing acquiring drugs from suppliers

inpatient services supplying drugs for inpatients
outpatient services supplying drugs for outpatients
education and training supporting pharmacy staff
formulary services list of recommended drugs
computer services supporting pharmacy systems
research and development developing knowledge

Clinical pharmacy: medical specialties advising doctors and nurses

medicines information providing drug information
therapeutic drug monitoring optimising drug therapy

Source: Stone and Curtis (1995)

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 Table 3: Areas of Activity; Industrial Pharmacists

Area Function Role

Technical: Research discovery and design of new drugs
Development formulation of final product
Production manufacture and packaging of medicines
Quality control testing of processes and products

Technical Support: Product registration registration with licensing authority

Regulatory affairs on-going safety monitoring
Medical information support to health professionals
Clinical trials management of study protocols

Commercial: Wholesaling ensuring effective distribution processes

Distribution maintaining adequate supplies
Marketing bringing to consumers attention
Sales maintaining competitiveness

Source: Ecclestone (1998)

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 Table 4: The Pharmacists’ Education; Core Pharmaceutical Subjects

Subject Description

Pharmaceutical chemistry Study of the chemistry of medicinal substances

including their synthesis and analysis

Pharmacology Study of the actions and uses of medicines

including absorption, distribution and excretion
from the body

Pharmaceutics The conversion of medicinal substances into

suitable dosage forms such as tablets, injections and
inhalers

Pharmacognosy The study of medicinal substances of natural

origin

Social and administrative pharmacy Study of the social, political and economic
aspects of the use of medicines

Forensic pharmacy The law in relation to medicines and pharmacy

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 Table 5: Number of Registered Pharmacists per 100,000 Population for
25 Higher Income Countries
Country number of population pharmacists
registered (000) per 100,000
pharmacists population

Finland 7,500 5,172 145

Belgium 11,145 10,249 138
Iceland 340 279 122
Spain 29,820 39,910 119
France 62,800 59,238 106
Italy 60,340 57,530 105
Japan 132,180 127,096 104
South 45,340 46,740 97
Greece 8,920 10,610 84
Ireland 2,970 3,803 78
Portugal 7,165 10,016 76
United Kingdom 44,427 59,415 75
United States 201,095 283,230 71
Luxembourg 305 437 69
Sweden 6,100 8,842 69
New Zealand 2,460 3,778 65
Canada 19,070 30,757 62
Australia 11,485 19,138 60
Germany 51,050 88,017 58
Austria 4,440 8,080 55
Poland 21,235 38,605 55
Denmark 2,450 5,320 46
Hungary 4,385 9,968 44
Norway 1,925 4,469 43
Czeck Republic 4,315 10,272 42

Sources: All population figures are from ‘World Population Prospects: The 2000 Revision’, United Nations
Population Division (2001). Figures for numbers of pharmacists or ratio of pharmacists to population are
taken from the OECD Data Base (2001); ‘The Compendium of Health Statistics’, thirteenth edition (2001),
Office of Health Economics; the WHO Europe ‘Health for All’ Data Base (2001); or from the registration
authorities of specific countries. Some figures relate to 1999.

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 Table 6: Number of Registered Pharmacists per 100,000 Population
for 25 Middle and Lower Income Countries
Country number of population pharmacists
registered (000) per 100,000
pharmacists population

Slovenia 695 1,988 35

Jamaica 860 2,576 33
Belarus 3,230 10,187 32
Azerbaijan 2,505 8,041 31
India 300,000 1,008,937 30
Singapore 1,135 4,018 28
Thailand 15,478 62,806 25
South Africa 10,690 43,309 23
Chile 3,000 15,211 20
Bulgaria 1,315 7,949 17
Malaysia 3,560 22,218 16
TFYR Macedonia 320 2,034 16
Tajikistan 730 6,087 12
Bosnia and Herzegovinia 440 3,977 11
Georgia 438 5,262 8.3
Romania 1,600 22,438 7.1
Russia 9,340 145,491 6.4
Krgyzstan 275 4,921 5.6
Armenia 136 3,787 3.6
Uzbekistan 755 24,881 3.0
Albania 85 3,134 2.7
Zimbabwe 335 12,627 2.7
*UR of Tanzania 850 35,119 2.2
*Eritrea 53 3,659 1.4
*Gambia 10 1,303 0.8
 Included in United Nations list of 48 least developed countries

Sources: All population figures are from ‘World Population Prospects: The 2000 Revision’, United Nations Population
Division (2001). Figures for numbers of pharmacists or ratio of pharmacists to population are taken from the OECD
Data Base (2001); ‘The Compendium of Health Statistics’, thirteenth edition (2001), Office of Health Economics; the
WHO Europe ‘Health for All’ Data Base (2001); or from the registration authorities of specific countries. Some figures
relate to 1999.

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