India = Bangladesh x 10

Just finished reading a fantastic piece of research by Samhita and funded by Cipla bringing to light the opportunities and challenges of using retail pharmacists as health providers in India. So much of this is similar to the Bangladesh context and resonates strongly with us at Jeeon — when we started 7 years ago, there was no recognition for the role of pharmacies as trusted primary health providers — just at a much larger scale. As this report also concludes, we MUST find ways to integrate pharmacies into public health if we are to reach the last mile and leave no one behind.

Image credit: Samhita (from report)

Key highlights and reflections from reading the report:

• Pharmacists think of themselves as more than dispensers, as do patients. 61% are interested to improve their knowledge, although there are very few reliable sources of training and continuing education. They are also interested to broaden their services, and serve their communities better, especially around NCDs like diabetes and hypertension, which is a key focus area for Jeeon as well (great to see this validated across markets).
• Owning and running a pharmacy is the primary business occupation of pharmacists, and so it is extremely important to align any public health interventions with their business goals and incentives. Much of the failures we see around engaging pharmacists stems from a lack of understanding of their unique incentive structures as private providers.
• 95% of pharmacists in the study were male, which is very similar in Bangladesh. The space is also highly fragmented, with 91% of owners only running one pharmacy, and 96% of all pharmacies being in the “unorganized” segment (a clearer definition would have been useful).
• It was surprising to me that pharmacists in this survey said only 9% patients come to get antibiotics. In Bangladesh this number is much higher. I wonder how much of this is under-reporting related to regulatory risks.
• Pharmacists are being increasingly mainstreamed as holistic health providers across many markets, but India (just like Bangladesh) is far behind, including w.r.t. COVID response, testing and vaccinations.
• I was surprised that 43% of pharmacies mention using WhatsApp and 33% use social media as marketing tools. I have not seen a similar use of Facebook or other social media in Bangladesh for marketing purposes. Or maybe it is there and we just don’t know?
• Interesting insights about loans was that 88% pharmacies reported rarely or never taking loans, yet 37% said they would take loans for business. There clearly is a gap in trusted providers of non-collateralized micro-loans for pharmacies, something we also noticed in Bangladesh and are working to address through a micro-investment model.
• Pharmacists mentioned that recordkeeping is a challenge. However, my experience in Bangladesh is that given the small ticket size of most transactions, the burden of documenting each transaction would impose very high transaction costs on pharmacies. I wonder what the experience has been of pharmacy digitization platforms.
• This report did not fully go there, but I wonder what pharmacists would feel about introducing clinical decision support, rapid diagnostics, etc. for improving their quality of care, and what would be the degree of uptake if they were introduced.