**5. Healthcare personnel**

Healthcare providers include prescribers, pharmacists and nurses who comprise the triad of patient-care and share a common interface with the end-users of medicines i.e., the patients. They are the primary stakeholders in ensuring rational prescribing, rational dispensing and rational use of safe and effective medicines in any settings. Irrespective of what kind of drugs are made available by the manufacturers and drug regulators in the market, doctors continue to be the pivots who choose on behalf of patients what drugs they must consume whereas pharmacists and nurses can ensure proper use of medicines through patient counseling and promote their adherence to the prescribed medications. Similarly well-informed and well-educated patients can ensure an appropriate use of medicines prescribed and thereby therapeutic outcomes and benefits of the pharmacotherapy can be maximized whereas their harms and risks can be minimized leading to a positive benefit-harm ratio.

Implementation of generic drug policies has faced several impediments and even stiff opposition from doctors, pharmacists and pharmaceutical traders in many countries as a result of certain perverse incentives offered by pharmaceutical companies through their sales promotion agents. Doctors often cite empirical evidence generated through years of experience in support of prescribing branded medicines and even

#### *Stakeholders in Pharmaceutical Policy Development DOI: http://dx.doi.org/10.5772/intechopen.105606*

go to the extent of terming generic drugs as a big risk to their reputation owing to their perceived low quality and effectiveness. They also cite substitution of generics by unqualified and inadequately trained pharmacists as a reason to their skepticism towards prescribing generics. Their faith and belief in the quality and effectiveness of branded medicines seems to be as firm and unshakeable as their suspicion about the quality and effectiveness of generics.

It goes without saying that pharmaceutical companies spend heavily upon the promotion of branded medicines and offer huge financial incentives to doctors for prescribing the same that are often disproportionate and unjustified. That is the reason why WHO too has listed avoidance of perverse financial incentives as one of twelve core policies to promote more rational use of medicines [9]. No definite mechanism or regulations to curb unethical prescribing by doctors or to control unjustified distribution of exorbitant gifts by pharmaceutical companies are in place in many developing countries. Thus the aim of policy-makers should be to consult health-workers during the process of policy development seeking their cooperation and support in promoting generics, following ethical practices in drug promotion and prescribing, avoiding perverse incentives and instilling confidence for prescribing generics accompanied by an assurance to regulate their quality.

Pharmacists are critical to the medicines management process, yet are often largely detached from policy development. Logically, they should inform government policies which impact on their work or where their skills could be best applied to implement health care policy and medicines utilization in particular. It therefore becomes critically important that the pharmaceutical profession engages with national policy makers and in the strategic planning for health care [10]. Role of pharmacists assumes importance in observing good storage practices, good distribution and dispensing practices, efficient inventory control, demand forecasting and medication management practices, providing professional clinical pharmacy and pharmaceutical care services, drug and poison information services, offering patient counseling and promoting rational use of medicines besides ensuring drug safety through pharmacovigilance, adverse drug reaction monitoring and therapeutic drug monitoring services in all health system pharmacy settings. Of late pharmacist's role in social and administrative pharmacy, managed care and specialty care pharmacy including pediatric, geriatric, obstetric and palliative care has increased significantly. Similarly, nurses are responsible for ensuring administration of right drug to the right patient at the right time in its right dose and formulation. Together pharmacists and nurses can help a great deal in minimizing medication errors and other drug-related problems including inappropriate indication, unaddressed indication, inappropriate dose, duration or frequency of medication, drug interaction, adverse drug reaction, need for laboratory test or a compliance problem. While devising policy provisions for all these activities in consonance with the local needs and demands, due consultation with healthcare workers mentioned above can prove to be fruitful in addressing ground realities and concerns and evolving a framework that is best suited to the procedures and practices in vogue at the ground level.

One-size-fits-all approach is least likely to work in such matters as legislations vary from region to region and so do the roles, responsibilities and functions of pharmacists and nurses. While in most of the countries pharmacists are not legally authorized to prescribe medicines or make changes in the therapeutic regimen of the patients on their own, in some countries they can prescribe drugs as consulting pharmacists or assume full responsibility of patient's medication management as required for the practice of pharmaceutical care. In countries like India a qualified and trained

pharmacist can at best make a suggestion for a change in the therapeutic regimen to the patient's attending physician but cannot make any change in the prescription on his own thus considerably limiting his role in providing pharmaceutical care. This aspect needs to be kept in mind in pharmaceutical policy development vis-à-vis clinical pharmacy and pharmaceutical care services by qualified and trained pharmacists. Use of the terms "qualified" and "trained" is deliberate in light of the fact that in many developing countries unqualified and inadequately trained professionals are also designated as "pharmacists". Future policy direction should be in consonance with the concept of seven-star pharmacist, introduced by WHO and adopted by the International Pharmaceutical Federation (FIP) in 2000 in its policy statement on Good Pharmacy Practice that sees the pharmacist as a caregiver, communicator, decision-maker, teacher, life-long learner, leader and manager [11].
