Why Social Protection is Not Enough to Effectively Address Poverty Reduction in Pakistan

Pakistan is behind many other countries in the Asia region in reducing poverty. Dedicated poverty reduction Programmes so far were mainly done by NGOs using livelihood and microfinance approaches and since 2008 through the Benazir Income Support Programme’s cash transfer scheme. Recently, the office of the Prime Minister established Ehsaas Strategy which combines the various poverty reduction and social protection approaches in the country under one Programme. This paper argues that a stronger focus on effective income generating poverty reduction Programmes would be needed to make poverty reduction more successful.

Evaluating the Perception of Healthcare Providers Regarding the Quality of Pharmaceutical Care Services in Khyber Pakhtunkhwa

Pharmaceutical care is “the responsible provision of drug therapy for the purpose of achieving definite outcomes which improve a patient''s quality of life”. It is a patientoriented approach where the pharmacist is responsible for identifying, resolving and preventing the actual and potential drug-related problems. It needs good cooperation between physician, pharmacists, patients and other healthcare professionals to design, implement and monitor the drug therapy management to achieve desired healthcare outcomes. The pharmacists are responsible to gather information regarding medication factors and patients that lead to the drug-related problems. It requires a conversation with patients, attendants, and the healthcare professionals and reviewing the patient’s medical as well as clinical records. Finally, the pharmacists develop and implement the care plan which should be evaluated for the desired therapeutic outcomes and should be reviewed as required. The present study was aimed to evaluate and document the current status of pharmaceutical care in the healthcare system of Khyber Pakhtunkhwa (KPK) province, Pakistan. We evaluated the perception of healthcare providers including; hospital pharmacists, community pharmacists, doctors and nurses regarding the quality of pharmaceutical care services. Mixed-method approach (qualitative and quantitative research) was adopted to get an overall account of findings. The qualitative research (phase I) was carried out by conducting semi-structured one-to-one interviews for the data collection. Four interview guides were developed for four categories of respondents including; hospital pharmacists, community pharmacists, doctors and nurses. Snowball sampling technique was adopted to identify the potential participants for the study. The interviews were conducted till the saturation point was reached where no new theme emerged in the last two interviews. The interviews were conducted in English and audio-taped. The tape-recording was transcribed verbatim and validated including both, the interviewer questions and the interviewee responses. Quantitative research was carried out by conducting cross-sectional surveys by using self-administered questionnaires. Four close-ended questionnaires were developed and used. The questionnaires were developed on the basis of findings of qualitative part of study (phase 1) and by extensively reviewing the literature. Convenient sampling technique was adopted to collect data from all of the respondents (hospital pharmacists, community pharmacists, doctors and nurses). Seven major public hospitals were targeted in all seven divisions (one main public hospital in each division) of KPK province. Rao Soft Sample Size Calculator was used to calculate the sample size for doctors and nurses. A total of 128 hospital pharmacists were located within the 18 hospitals and a total of 22 community pharmacists were identified and approached. The responses of the participants were coded and entered into SPSS. A Pearson chisquare test was applied to check the level of association between various independent and dependent variables. At 95 % confidence interval, p-value ≤ 0.05 was considered to be significant. The study was ethically approved by the Research Ethical Committee of Department of Pharmacy, COMSATS Institute of Information Technology Abbottabad (Pakistan). The key findings of the qualitative part of research are as follows; (1) hospital and community pharmacists were not completely involved in patients’ counseling activities. (2) A number of barriers were identified by the pharmacists including; lack of patients’ reporting of adverse drug reactions, lack of active participation in the health awareness programs and insufficient number of pharmacists. (3) The majority of hospital pharmacists were of the view that prescribing errors can be reduced by pharmacists’ participation. (4) Unavailability of pharmaceutical care guidelines, lack of documentation and lack of collaboration with other health professionals were reported by the community pharmacists. (5) The findings further revealed that doctors did not find the proper time for patient counseling activities and they have weak collaboration with pharmacists. (6) Doctors agreed with the separation of prescribing and counseling services and agreed with the benefits of pharmaceutical care implementation. (7) Nurses were less familiar with term pharmaceutical care that may be due to the lack of nurses’ collaboration with pharmacists. However, nurses agreed that pharmacists can reduce the prescribing errors and can counsel the patients but unfortunately the pharmacists were not doing so. The results from the qualitative part were used to develop the questionnaires for quantitative part of study. A total of 128 hospital pharmacists were approached and 112 hospital pharmacists agreed and participated in the study giving the response rate of 87.5 %. Only 8.9 % of the hospital pharmacists contacted the doctors and 57.1 % of pharmacists-doctors interaction was to ensure availability of drugs in the hospital pharmacy. About 68.8 % of pharmacists told that patients did not inform them about adverse drug reactions (ADRs) occurrence. Moreover, 74.1 % of the hospital pharmacists responded that the health awareness programs were organized by the hospitals. While, 67.9 % of the respondents were unsatisfied with their participation in these programs, which is statistically significant (p = 0.027) with respect to gender only. A total of 22 community pharmacists were contacted and 18 questionnaires were returned showing the response rate of 81.8 %. All of the respondents were male and no female community pharmacists found. Only 11.1 % community pharmacists had daily interaction with doctors; the major reason of interaction was to confirm the drug availability. About 38.9 % community pharmacists sometimes provided the pharmaceutical care and made an effort to improve their patients’ outcomes that is statistically significant with respect to age (p = 0.044) and type of pharmacy (p = 0.027). Almost 94.4 % of the community pharmacists agreed that patients were in need of counseling by pharmacists, however, only 38.9 % spent time enough for proper counseling with each patient. The poor perception was found among the participants regarding the documentation and collaboration with other professionals. A total of 283 questionnaires were returned from a sample of 384 doctors giving the response rate of 73.6 %. Only 12.4 % of doctors had a daily contact with pharmacists and about 50.5 % of doctors-pharmacists interaction involved the queries about the availability of the drugs. About 37.1 % of doctors agreed that they found enough time for patients counseling and 48.1 % of doctors agreed that pharmacists can better counsel the patients regarding drugs that was statistically significant with age (p = 0.044). Only 42.0 % of doctors expected the pharmacists to take responsibility to resolve drug-related problems and 37.8 % of doctors wanted the pharmacists to be available during the wardrounds. About 47.7 % of the doctors agreed that pharmacists were a reliable source of drug information that was statistically significant with respect to age (p = 0.013). While, 46.3 % of doctors agreed to collaborate with pharmacists. These findings showed that improvement in the inter-professional collaboration will make the doctors’ perception more positive. A total 281 questionnaires were returned from a sample of 334 nurses (response rate of 84.13 %). About 31.0 % of the nurses contacted to pharmacists once a day or more and the main reason for interaction was drug availability in the hospital pharmacy. Only 10 % of nurses told that pharmacist provided pharmaceutical care to patients that showed a significant relationship with dependent variable age (p = 0.013). About 56.2 % of nurses strongly agreed that pharmacists should be a part of the healthcare team and 56.9 % of nurses agreed and accepted the pharmacists as a reliable source of general drug information for patients. Moreover, 54.1 % of the nurses told that the pharmacists did not spend enough time on each patient and showed a statistical significant relationship with the current position of the respondents (p = 0.016). Overall, this study provided a comprehensive picture of the quality of pharmaceutical care services provided to patients at hospitals as well as community pharmacies. The study adopted mixed methodology approach to extensively evaluate the perception of the health professionals. The doctors and nurses have positive perception regarding the pharmacists and consider the pharmacists as a member of the healthcare team. Limited interaction among the healthcare professionals was observed suggesting the need of improving the inter-professional communication and collaboration to make the good quality of life and improved health outcomes possible. Moreover, the study findings suggested the need of increasing the number of pharmacists especially the community pharmacists." xml:lang="en_US