Authored by Mohiuddin AK*
Abstract
Currently, coronavirus COVID-19 has affected 210 countries around the world, killed more than 146,000 and infected more than 2.1 million, according to worldometer, April 17, 2020. Home-care is especially important in these situations because hospitals are not seemingly safe during pandemic outbreaks. Also, the chance to get out of the home during the lockdown period is limited. Telemedicine and telehealth technologies are especially effective during epidemic outbreaks, when health authorities recommend implementing social distance systems. Telephone-based measures improve efficiency by linking appropriate information and feedback. In addition to increasing access to healthcare, telemedicine is a fruitful and proactive way to provide a variety of benefits to patients seeking healthcare; diagnose and monitor critical and chronic health conditions; improve healthcare quality and reduce costs.
Keywords: IEDCR-Institute of Epidemiology, Disease Control and Research
Bangladesh’s health care services are becoming unusually concentrated in a small fraction of costly critical health-demanding patients. A large part of these complex-patients suffers from multiple chronic diseases and are spending a lot of money. Tele-pharmacy includes patient counselling, medication review and prescription review by a qualified pharmacist for the patients who are located at a far distance from the pharmacy. The most common way to use telemedicine is a responsive model, primarily physician-led with virtual visits stimulated by alerts using interactive services, which facilitates real-time interaction between the patient and provider [1]. It delivers resilience to services and enables pharmacists to work remotely, reducing the need for long journeys and increasing job satisfaction [2]. The rise of pharmacists in epidemic situations has become increasingly popular in developed countries such as the United States, Australia, Canada and the United Kingdom. According to information from recent published articles in several ongoing journals, books, newsletters, magazines, etc., the duties, authority and responsibilities of pharmacists are completely different from doctors and nurses, although there are some similarities. Along with doctors, pharmacists can serve as frontline healthcare workers during epidemics. The profession is developed and highly praised in both developed and underdeveloped countries. Millions of professional pharmacists worldwide work in various organizations, and according to data from the International Pharmaceutical Federation (FIP), nearly 75% of them work in patient care [3]. Even in the United States, the continued lacking of primary health providers and medical specialists has made it possible for pharmacists to care for ambulatory patients with chronic diseases in a variety of treatment services [4,5] Figure 1.
Present Socio-Economic and Healthcare Situation
Bangladesh is the seventh most populous country in the world and population of the country is expected to be nearly double by 2050 [6], where communicable diseases are a major cause of death and disability [7]. A recent Dengue outbreak in 2019, more than 100,000 people was affected in more than 50 districts in Bangladesh in the first 6 months of 2019 [8, 9]. According to World Bank’s Country Environmental Analysis (CEA) 2018 report, air pollution lead to deaths of 46,000 people in yearly in Bangladesh [10]. Although a riverine country, 65% of the population in Bangladesh do not have access to clean water [11]. Both surface water and groundwater sources are contaminated with different contaminants like toxic trace metals, coliforms as well as other organic and inorganic pollutants [5]. Studies in capital Dhaka and Khulna also found that about 80% of fecal sludge from on-site pit latrines is not safely managed [12]. Nearly half of all slum dwellers of the country live in Dhaka division [13] and 35% of Dhaka’s population are thought to live in slums [14]. A recent research demonstrates widespread poor hygiene and food-handling practices in restaurants and among food vendors [15]. Less than 10% hospitals of this country follow the Medical Waste Management Policies [16]. In 2017, 26 incidents of disease outbreak were investigated by National Rapid Response Team (NRRT) of IEDCR [17]. Economic development and academic flourishment do not represent development in health sector. Out of the pocket treatment cost raised nearly 70% in the last decade [18]. Although, officially 80% of population has access to affordable essential drugs, there is plenty of evidence of a scarcity of essential drugs in government healthcare facilities [19]. Surprisingly, the country’s pharmaceutical sector is flourishing, exports grew by more than 7% in last 8 months although total export earnings of the country drop to nearly 5% [20]. It has been found in Bangladesh that more than 80% of the population seeks care from untrained or poorly trained village doctors and drug shop retailers [21]. According to WHO, the current doctor-patient ratio in Bangladesh is only 5.26 to 10,000 that places the country at second position from the bottom, among the South Asian countries [22]. According to World Bank data, Bangladesh has 8 hospital beds for every 10,000 people; by way of comparison, the US has 29 while China has 42 [23]. Tobacco is responsible for 1 in 5 deaths in Bangladesh, according to the WHO, kills more than 161,000 people on average every year. Around 85% population of age group 25-65 never checks for diabetes [24, 25].
Pharmacy Education in Bangladesh
Pharmacy Education in many developing countries, including Bangladesh, is still limited to didactic learning that produce theoretically ‘skilled’ professionals with degrees. Pharmacy curriculum in Bangladesh do not satisfy the minimal requirement for appropriate education in clinical, hospital and community pharmacy, since they are still linked to an old model of pharmacy activity e.g. based on chemistry and basic sciences. That is present curriculum produces Pharmacist only to work in the pharmaceutical industry and jobs in this field of work is going to be saturated. No university so far have modified their curriculum including topics as epidemiology, pharmaco-economics, clinical medicines, community skills. Manpower development for community pharmacies in Bangladesh is not systematically regulated and constitute an important public health issue. Three levels of pharmacy education are currently offered in Bangladesh leading to either a university degree, a diploma or a certificate. Graduates with degrees work in industry while those with diplomas work in hospitals [26]. Pharmacy is taught in about 100 public and private universities in Bangladesh and about 8000 pharmacy students graduate every year [27]. Hospital, community and clinical pharmacy in Bangladesh have not been well developed due to lack of government policy [28]. In real conditions of Bangladesh pharmacy practice areas for graduate pharmacist is limited in industry i.e., industrial pharmacy practices, in the marketing or regulatory sections. The educational system of pharmacy is one of the major reasons for bounded pharmacy practices because the courses included in bachelor degree principally emphasize on industrial practices [29]. Over 90% of B. Pharm curriculum emphasizes on product-oriented knowledge whereas only around 5% of the total course credits are allocated toward clinical pharmacy. This curricular framework indicates a minimum emphasis on patient care education [30]. However, the graduates who pass out do not get employment easily due to their poor training, lack of in-depth knowledge of fundamental concepts and practical skills [17]. Consequently, skilled graduates leave for overseas where they find more prosperous jobs. Researchers argued that Pharmacy Education can be able to contribute for both public and private benefits if a realistic pattern is ensured on its operation [31]. This system could be more beneficial to the public if the good hospital and community practices are introduced properly and also by involving the pharma professionals e.g. pharmacists and other skilled health care providers.
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