Sick Ghanaians favour pharmacies over hospitals

Many Ghanaians now consult a pharmacist over their medical problems in lieu of visiting a doctor, according to a new nationwide report, with community pharmacies filling the gaps left by a still inadequate healthcare system.

The change is most apparent amongst the poorest sections of society, according to Patterns and trends of poverty in Ghana, 1991-2006, which was published by the Ghana Statistical Service last month. Based on a series of nationwide Ghana Living Standards Surveys, the report uses access to healthcare as one of the criteria by which to access poverty trends in the country.

In the poorest 20 percent of the urban population, the report shows, 38 percent of people now say they consult a pharmacist or chemical seller when they are sick, compared to just 2 percent in 1998-9.

Of the poorest 20 percent of the rural population, 19 percent now say they consult a pharmacist, compared to 1 percent in 1998-9.

Meanwhile, the report shows that the percentage of Ghanaians using doctor facilities actually fell between 1991-2 and 1998-9, the dates of the previous two GLS surveys, and in 2005-6 was little changed from the 1991-2 level.

Amongst the poorest group of urban Ghanaians, the proportion of ill or injured individuals consulting a doctor fell from 48 percent in 1991-2 to 23 percent in 1998-9. For the wealthiest group of urbanites, the change was less marked although still noticeable: a drop from 47 percent to 42 percent for the top quintile of urban dwellers.

In rural areas, the percentage of all income groups consulting a doctor or using hospital facilities is lower: Whilst in 1991-2, 13 percent of the poorest group of rural dwellers consulted a doctor, in 1998-9, this had fallen by half to just 7 percent.

On hospital facilities, the pattern is more complicated: in urban areas, there has been a general increase in the percentage of ill or injured people visiting the hospitals throughout the 15-year survey period. For the poorest group of urban Ghanaians, this has increased from 17 to 20 to 21 percent across the three survey periods; for those in the richest quintile, it has increased from 29 to 31 percent.

In the rural areas, meanwhile, access to hospital facilities suffered the same fate as doctor consultations between 1991-2 and 1998-9, with every one of the five income groups showing a reduced use of hospitals. However, by 2005-6, hospital use was increasing again.

Indeed, in the last seven years, more Ghanaians have also started visiting doctors again, although the increase is uneven across disparate income groups. Urban residents are more likely to visit a doctor than rural, and there is a direct correlation between income and likelihood of visiting a doctor.

The real change, across every population group, is in the use and consultation of local pharmacists. But why is this the case?

What the pharmacists say

Margaret Schandorf Wood, a pharmacist at the Vicdoris Pharmacy on Ring Road Central, believes it has to do with the superior patient care at pharmacies compared to the nation's clinics and hospitals.

"We have more time for the patient," she said in an interview with The Statesman. "There are no long queues and pharmacists tend to be more friendly and more concerned. Most pharmacies are run as private businesses, so we have to go the extra mile to keep our customers."

The Vicdoris Pharmacy has a private consultation room where customers can discuss health issues with the pharmacist, and the business has a policy of taking customers" phone numbers and making follow-up phone calls.

Ms Schandorf Wood contributes the growing use of pharmacies to not only improving customer care, but also increasing publicity. "Now, people know more about the role of pharmacists; we don't just know about drugs, but also about sicknesses. Many of the courses we study in our four years' training are the same as those taken by doctors, and we even spend time in hospital."

Another pharmacist in Osu, who asked not to be named, explained that pharmacists are trained to diagnose and treat many common sicknesses, such as cold and flu, malaria, diarrhea and stomach problems, and mild skin infections. "Before, pharmacists were not allowed to make prescriptions - but I think the current system is taking pressure off the doctors. Our training teaches us everything about drugs – so why shouldn't we have more rights?"

For more complicated cases, however, patients would still be advised to go to the hospital for further testing.

Others are concerned about the lack of control in the industry, however, claiming that some practitioners have a poor understanding of the drugs they issue. Sviltana Amponsah, a Ukranian pharmacist, has been working in Ghana for the past 9 years and now runs the Tropic Pharmacy at Danquah Circle.

She says that the cost of drugs has gone up significantly since 2000, so that, although more people may consult pharmacists, less can afford the drugs. Whilst Chinese or Indian brands use to be an inexpensive alternative to Western drugs, now the cost is going up – and the issue is not helped by doctors selling drugs in their own hospitals and clinics.

"It is easier for them to only stock a few brands; so hospitals will prescribe the same kind of antibiotic for many different illnesses, for example, and charge more for them, in order to make a profit. It is damaging the independent pharmacists."

Explaining the growth in pharmacies

Where the growth in hospital and clinic-based care has been slow and sometimes even backward, the growth in pharmaceutical advise and care has been explosive; a reflection, perhaps, of a new focus on community-based pharmacies as an alternative to medical centres, particularly for minor ailments and common sicknesses.

A March 2004 report published by the Institute of Statistical, Social and Economic Research at the University of Ghana, Legon, offers several explanations for the sudden growth in pharmaceutical care. It points out that one in four Ghanaians lives outside a 15km radius from a doctor: little wonder that community pharmacists and self-medication is a growing trend. "Medicines that are affordable and of certified quality could thus play a key supplementary role in health sector development," it notes, explaining how self-medication enables ill or injured Ghanaians to economise on consultation and transport fees, put citing UNICEF's concern about the sometimes questionable knowledge of those dispensing the drugs.

In 2000, it was estimated that there were 1,100 pharmacists and 6,000 licensed chemical sellers in the country. The latter are not professionally trained, though they are supposedly supervised by the Pharmacy Council – and the ISSER believes further training and education could be at least a partial solution to Ghana's healthcare woes.

"One option would be to put more emphasis on the quality of self-medication, say through certification and by training of chemical sellers, traditional healers, unsupervised druggists and medicine peddlers. Training could focus on a limited number of commonly used drugs that the trainees currently sell without prescription of a practitioner."

Lower consultation rates in the rural areas, and higher use of traditional health providers, are explained by more limited access.