Pharmacy Education in Bangladesh:

Past, Present and Future

Prof. Dr. A. K. Azad Chowdhury

Former Vice Chancellor, University of Dhaka

Professor, Dept. of Clinical Pharmacy & Pharmacology, University of Dhaka

BAPA Convention, New York August 8-9, 2008

Pharmacy education: past, present and future

Department of Pharmacy started its journey in 1964
With 20 students and with a few teachers and fewer physical facilities, lecture rooms, labs and utilities.

1964 to 1966, Both the Dept of Biochemistry and the Dept of Pharmacy were virtually sharing the same class rooms and labs Same batch of teachers use to teach the pharmacy and biochemistry under graduates.
Prof Kamaluddin Ahmed was the first Chairman of the Dept. of Pharmacy and Dept. of Biochemistry

Faculty members at the initial period of the Dept. of Pharmacy

Prof A. Jabbar became the chairman of the Dept. of Pharmacy in 1966, though he was at the core of the department of pharmacy since its inception in 1964 The Faculty members were Prof Kamal Ahmed & Dr. A Jabbar, Dr. N.H.Khan, Dr. Golam Haider, Dr Atiqur Rahman, Dr. Akhter Hossain, Mr. Parvez Ahmed, Late Dr. Anwarul Azim Choudhury, part time, Late Dr.Abdur Rahman and Sree Nirmal Chakraborti,. Prof. Ali Nawab ,part time ( Chemistry), Dr. Farid Uddin Ahmed, Part time, from DMCH. Mr Ansari, part time from Albert David.

Dr. Rashid Purakaystha, Mr Sukkur Khan and Dr. S.A. Talukder, Prof. Ghani, joined the department during the period

Department started its M Pharm course only for the thesis students
In 1969 the Dept first started its M Pharm Course for thesis students, limited to 3 to 4 students. Others were not allowed to pursue their M Pharm degrees.
In 1st Feb1969 a group of young talented teachers( AKAC, SNK and BKD) joined the dept. and took the maximium load of theoretical and practical classes in Pharmaceutical Chemistry, Physical Pharmacy and Microbiology.

In 1970 the B.Pharm graduates got the chance to do Pharm both in the thesis and non thesis groups

The curriculum of B Pharm (Hons)

The course curriculum was heavily tilted towards Pharmaceutical Chemistry and Pharmacognosy and little on Pharmaceutics and industrial pharmacy and none about the clinical pharmacy & pharmacy practice.

Most researches were conducted in phytochemistry and that too without bioactivity directed.
Some works were done on isolation of antimicrobial principles from soil fungi.

Limited studies on the stability and quality control of the compounds in pharmaceutical preparations ( basically determination of conc. of active principles in preparations by chemical & spectrophotometric methods)

Constrains of the new department

Limitation of space for class rooms, labs and equipments Scarcity of properly trained permanent teachers Employment opportunity of the fresh graduates in pharmacy Scopes and avenues for higher education in the country and abroad were limited Rivalry between the graduates of related disciplines in the job market

New spurt of activities after liberation war Young teachers went abroad for higher studies leading to Ph D degrees in different fields of pharmacy. Better scopes for pharmacists to join the pharmaceutical industries, academia and research in the country In mid seventies a revolution took place in the profession of pharmacy and pharmacy education when the US government opened the door for immigration for pharmacists. In the preceding years pharmacists went to Middle East countries with reasonably good jobs

Deficiency in pharmacy course curriculum

Pharmacists in USA, the Middle Eastern countries and elsewhere outside the country were mostly employed: In retail pharmacy chains In hospital pharmacy In industries But the pharmacy programme still maintained the same old syllabus not geared to need of the time. The pharmacists got the job and achieved enviable success due their won potential and hard work.

Pharmacy Council Ordinance in 1976

The Pharmacy Council Ordinance was passed in Feb 1976 with the initiative of the President and executive council of Bangladesh Pharmaceutical Society But it was made effective from March1976 and the pharmacy is recognised as a profession after the promulgation of the ordinance.

New National Drug Policy of 1982 Drug Control Ordinance of 1982 promulgated
Banned harmful, useless and doubtful efficacy drugs Local production of drugs encouraged Essential drugs production encouraged Under license drug production banned Made mandatory to have a pharmacist in each pharmaceutical industry

As a result local industries share of market rose sharply. Drug price remained fairly stable, Pharmacists role in industry recognised, rational use of drugs increased

Dhaka Universitys rating 1998-2000

Dhaka University was ranked as the 44th among 65 best universities of Asia and Oceania ( it was top among South Asian Universities) in 1998 In 1999 it improved its position by places (37th), ahead of many well known universities of the region such as Macquaire University( Australia), University of Philippines, University of Delhi, Gadjah Mada University (Indonesia), Ritsemeikan and Doshisha Universities (Japan), the Science and the National Universities of Malaysia and Vietnam National University It is only natural to expect that the Dept. of Pharmacy equally well placed In 2000 ranking it was among few Best University of Asia ( Ranking done by Hong Kong Asia Week and often cited by the World Bank Education Report)

Up gradation of the Dept. of Pharmacy into the Faculty of Pharmacy

The long arduous struggle to up grade the Dept. of Pharmacy into the Faculty of Pharmacy was postponed time and again in the Bio Science Faculty Meeting, Academic Committee Meetings and finally in the Syndicate When AKAC was elected to the syndicate the up gradation was approved in the syndicate. When AKAC left for Europe to avail EU Fellowship Prof. Nurun Nahar was appointed Acting Dean of the Faculty in 1995 by the then Vice Chancellor Prof Emajuddin Ahmed After few months Prof A. K. Azad Chowdhury become the first elected Dean of the Faculty of Pharmacy.

Three departments under the Faculty of Pharmacy

Since its inception the faculty striving hard to open three departments to impart proper teaching & conducting research in Pharm Chem, Clinical Pharmacy, Pharm Technology but with little success. In the last academic council meeting as the Vice Chancellor of the University Prof. A. K. Azad Chowdhury passed the resolution of establishing three departments on 12 Nov 2001. Finally in 2003 the syndicate approved the academic council resolution paving the way for establishment of the Departments

Present state of pharmacy education

Department of Pharmacy has become a full-fledged Faculty of Pharmacy now with 35 faculty members and yearly students in take of 65. The best boys and girls securing the top positions in the admission test and HSC exams seek admission in to the faculty. DU Pharmacy Faculty has produced 2, 500 graduate pharmacists who are engaged in the profession at home and abroad. Their field of work as diverse as the academia, pharmaceutical research, pharmaceutical industry, retail pharmacy and hospital pharmacy, drug administration and even countrys civil service. Not conforming to the present day demand, the thrust area in the pharmacy education in the faculty remains pharmaceutical Chemistry. Most openings in foreign countries are in the retail pharmacy, hospital pharmacy and community pharmacy

Bangladeshi Pharmacists at work in Different Countries

Total No of Pharmacists turned out was 2,500 since 1967 Employed in pharmaceutical industries in Bangladesh 800-1000 ( MDs to Sales Reps) In different Universities in Bangladesh 150 (V.C. to young faculty members) Drugs Administration of Bangladesh 27 ( Senior positions) Employed in USA 500-700 ( President, CEO, Vice President, Senior Hospital positions, Retail Chain leaders, owner of retail pharmacies) Employed in Middle East 100 ( Mostly in Hospital Pharmacy & Retail chain) Employed in Canada 100 Serving in retail and hospital in Bangladesh 25 (Hospitals & Retails)

Current and Projected Need for Pharmacist

Category Dispensing Patient Care Other Total Need Total Supply Projected Shortfall
Ref: Azad AK, 2007. BAPA Journal, Aug, 10-14

Estimated Deployment Forecast for 2020 for 2001 need 136,400 48,000 12,300 196,700 100,000 295,000 22,000 417,000 260,000 157,000

Eligibility Problem of Bangladeshi Pharmacist in USA

Comparison of US and Bangladeshi Degrees Schooling High School Intermediate College Bangladesh 10 years 2 years USA 12 years 0

Pre-Pharmacy College 0 years

B Pharm Pharm D Total * It was 3 years before 4 years* Not available 16 years

2-4 years
3 years 3 years 17-19 years

Proposal for introduction of five-year Pharmacy course in Dhaka University

Considering the socioeconomic condition and demands for patient care activities of pharmacist in our country, a Five-year Pharmacy Program proposed to be introduced in Pharmacy education. The university may also offer a four-year B.Pharm (Hons.) degree for those students wanting to follow the traditional route to registration and service. The academic content of this course should be very similar to the five-year course up to fourth year. Moreover, all pharmacy graduates holding a four-year pharmacy degree should be given the opportunity to upgrade to the five-year pharmacy degree by allowing them to get admitted into the final year of the five-year course. The final year of the five-year course should include extensive training and internship in hospital pharmacy, industry and retail pharmacy. The graduate pharmacy association very recently has highlighted the necessity of hospital pharmacy and retail pharmacy through a round table in national press club. BIRDEM, Square and Apollo, Community hospitals have agreed and initiated hospital pharmacy training and internship programme. Some of the pharmacist have already been employed. Studying and implementing the monitoring-training-planning strategy to ensure the rational use of injections in the hospitals of the Upazila Health Complexes of Bangladesh

Institutions of Pharmacy Education in Bangladesh

The no. of pharmacy department in public university is only 4 (DU,JU,KU & RU) The no. of pharmacy department in private university at present is 14 (Stamford, East West, Asia pacific, North South, Southeast, USTC, Primesia, Atish Dipankar, Daffodil, UODA, Northern). Public universities follow yearly system of four years degree course and one year masters. Private universities follows semester system. Course curriculum generally follows DU syllabus. The faculty members are drawn mostly from DU and other public university pharmacy departments, medical institutions and from related disciplines from other universities.

The problems of pharmacy education

The major problem is in course curriculum. Major thrust is given in pharm chem. and other related subjects. Even in Pharm Chem, stress is not given on combinatorial chemistry, computational chemistry and facile synthetic routes to active pharmaceutical ingredients Practice of pharmacy and health care delivery system, pharmacoepidemiology, professional ethics, social & behavioural pharmacy are ignored.
Pharmaceutical care, quality of care in the hospital and community settings, drug information and adverse drug reactions monitoring, medications safety are virtually not existing. Rational drug use is taught but the emphasis on different intervention strategies to promote it is poor.

Pharmaceutical biotechnology, recombinant DNA technology and the genetically engineered medicines are not given due importance in the course curriculum. In fact the molecular biology syllabus is not comprehensive and is of rudimentary nature.
Pharmacogenomics is not given due importance, in country research in the field is very limited. Practical course design is poor and the facilities are even poorer.

Internship Program
Too short and ill defined, pharmacy graduates usually having 3 to 4 weeks training in pharmaceutical industry is too insufficient and not properly graded. The internship should be at least two months and indicators should be used for grading. There is no provision for internship in the hospital which is at the core of pharmacy practice. There is no provision for retail pharmacy training though it is the main avenue for employment of pharmacist outside the country.

As the pharmaceutical sector specially the production and factory job are becoming saturated proper training in pharmaceutical marketing should be included in the internship program.
The industrial training, hospital training, retail pharmacy training are not been welcome by pharmaceutical company, hospitals and retail shops. The very culture of imparting training in those ogranizations has not been developed, though some of the pharmaceutical companies are enthusiastic about the internship.

Clinical Trials
Exposure to clinical trials virtually not existing in Bangladesh. There is a great opportunity of clinical trials being conducted in the developing world at a cheaper cost. Some of the countries like India and China are reaping the benefit. If Bangladeshi pharmacist are exposed the methodology of clinical trials (new chemical entity or old generic drugs in new formulations) that can generate great employment opportunities for the pharmacist. Bangladesh can conduct clinical trials from phase-1 to phase-4 if hospital facilities are developed and clinical pharmacist and doctors are properly trained.

Research activities in clinical pharmacy & pharmacology

Effect of Aqueous Extracts of Black and Green Tea (Camellia sinensis) in ArsenicInduced Toxicity in Rabbits. Antibacterial activity of two limonoids from Swietenia mahagoni against multipledrugs-resistant (MDR) bacterial strains Pachypodol, a Flavonol from the Leaves of Calycopteris floribunda, Inhibits the Growth of CaCo 2 Colon Cancer Cell Line in vitro Isolation, Identification and Antimicrobial Susceptibility of Optochin Resistant Streptococcus pneumoniae by Conventional And Molecular Techniques Isolation, Identification and Antimicrobial Susceptibility of Optochin Resistant Streptococcus pneumoniae by Conventional And Molecular Techniques Antibiotic Susceptibility and Molecular Characterization of Salmonella Paratyphi A Isolated in Bangladesh Excessive use of avoidable therapeutic injections in the upazilla health complexes of Bangladesh Studying and implementing the monitoring-training-planning strategy to ensure the rational use of injections in the hospitals of the Upazila Health Complexes of Bangladesh Modulation of Insulin Secretion and Insulin Sensitivity in Bangladeshi Type 2 Diabetic Subjects by an Insulin Sensitizer Pioglitazone and its Pharmacokinetics Study Comparison of Three DNA Fingerprinting Methods as Tools for Epidemiological Studies of Mycobacterium tuberculosis

Future of pharmacy profession in Bangladesh

The practice of pharmacy will become ever more important in the developed and developing country with more potent drugs coming to the market. Pharmaceutical care will be an important component of health care as the awareness of adverse drug reaction, pharmacogenomics and pharmacoeconoics and socioeconomics factors associated with health and diseases are being recognised. Rising longevity will increase dependence on medicines and hereby on the pharmacists Regulatory affairs and Drug Administration will play more important role in the country Waiver of WTO regulations and restrictions has given an important opportunity to export drugs to developed and developing countries. Countries own drug consumption will see a phenomenal increase with the rise in purchasing power of the people So the pharmaceutical industries will witness a rapid increase in growth resulting in more demand of manpower in the industries. Global concern for better health care at an affordable price involving all types health personnel, doctors, pharmacists, nurses, social scientists, economists will favour the developing countries having knowledge and skill in the areas mentioned above.

Updating of knowledge and skill of pharmacists

Introduction of five years Pharm D courses giving more emphasis on the practice of pharmacy, pharmaceutical care, rational use of medicine, out come studies to improve health care services Internship programme should be redesigned and period of internship be increase to 4-6 months in hospital/ retail pharmacy/ industries depending on the field of specialisation Training in clinical trials methodology involving new molecules/ old molecules in new formulations be given to the graduates Use of molecular biology techniques in health and pharmacy be given proper emphasis Pharmacogenomics should be properly taught and researched upon Adverse drug reaction monitoring should be introduced in the course curriculum Administrative and social pharmacy should be taught with proper emphasis A holistic approach to health care involving all the issues and disciplines be included in the course curriculum.

Average % of injection use in six divisions

70.92 60.15

83.05

94.18

75.42

83.89

Dhaka

Khulna

Sylhet

Barisal

Chittagong

Rajshahi

Comparison between previous & present data

100 95 90 85
% of injection use

94.18

80 75 70 65 60.15 60 55 50 45 40
2006-2007 Dhaka 2007-2008 2006-2007 Chittagong 2007-2008

72.5

63.5

Comparison among the UHCs in terms of average no. of injection per person in Chittagong

Sitakunda

2.33

Upazila Health Complex

Manikchari

3.3

Rangunia

4.34

Anoara

5.72

No of injections per person

Underlying Causes of Injection Practices

1. Perceived Seriousness of the disease
2. Patients demand in physical assault for litigation & compensation

3. Patients demand
4. Doctors effort to boost professional image 5. Quick release of the admitted patients to make room for the new patients` 6. Prescription by nurses & medical assistants in absence of the doctors 7. Promotional activities of the pharmaceutical companies

Safety of the Recipient

Do they follow adverse events after injection (AEFI) ( In terms of %)

Parameters

Do they use new syringe and new needle each time of injection also for reconstitution Do they prepare the injection on a clean table or tray Do they wipe the injection place with rectified spirit before injection( In terms of Do the health providers wash their hands with antiseptic soap ( In terms of %) 0 20 40 60 % 80 100 120 Yes No

Safety of the Health Providers

Have they completed primary hepatitis B immunization (3 doses) ( In terms of %) 91.67% 8.33%

Parameters

Are they trained in injection safety practices? ( In terms of %)

33.33% 66.67%

No Yes

Do they report needle stick injury in the previous 6 months ( In terms of %)

75% 25% 0% 20% 40% % 60% 80% 100%

Safety of the Waste Handlers

60 50 40 30 20 10 0 1 2 Parameters 3 4 0 24.6 19.81 12.3 2.5 % of facilities in w hich w aste is segregated at a piont of generation % of facilities w ith safe final disposal methods % of w aste handlers w ho report a needlestick injury in the previous 6 months
%

50

% of w aste handlers interview ed w ho have been trained in the management of health care w aste % of w aste handlers w ho have completed primary hepatitis B immunization (3 doses) % of w aste handlers interveiw ed w ho use personal protective equipment