Are interventions for improving the quality of services provided by specialized drug shops effective in sub-Saharan Africa? A systematic review of the literature

Abstract

PurposeWe set out to determine effectiveness of interventions for improving the quality of services provided by specialized drug shops in sub-Saharan Africa.Data sourcesWe searched PubMed, CAB Abstracts, Web of Science, PsycINFO and Eldis databases and websites for organizations such as WHO and Management Sciences for Health. Finally, we searched manually through the references of retrieved articles.Study selectionOur search strategy included randomized trials, time-series studies and before and after studies evaluating six interventions; education, peer review, reorganizing administrative structures, incentives, regulation and legislation.Data extractionWe extracted information on design features, participants, interventions and outcomes assessed studies for methodological quality, and extracted results, all using uniform checklists.Results of data synthesisWe obtained 10 studies, all implementing educational interventions. Outcome measures were heterogeneous and included knowledge, communication and dispensing practices. Education improved knowledge across studies, but gave mixed results on communication between sellers and clients, dispensing of appropriate treatments and referring of patients to health facilities. Profit incentives appeared to constrain behaviour change in certain instances, although cases of shops adopting practices at the expense of sales revenue were also reported.ConclusionEvidence suggests that knowledge and practices of pharmacies and drug shops can be improved across a range of diseases and countries/regions, although variations were reported across studies. Profit incentives appear to bear some influence on the level of success of interventions. More work is required to extend the geographical base of evidence, investigate cost-effectiveness and evaluate sustainability of interventions over periods longer than 1 year.

Do chain pharmacies perform better than independent pharmacies? Evidence from a standardised patient study of the management of childhood diarrhoea and suspected tuberculosis in urban India

“…Intervention initiatives reported in the literature include training, intensification of regulatory controls, peer review and accreditation. [45][46][47] Some strategies, such as peer review and performance management, may have more impact within the structure of a chain. 'League tables' and 'naming and shaming' have been used in high-income settings to influence prescribing behaviour of doctors working within a common organisation.…”

Sale and provision of injectable contraceptives in drug shops in developing countries: conclusions from a technical consultation

“…Social marketers have built on the ubiquity of drug shops to reach the poor and other underserved groups with condoms, oral rehydration solution, malaria medications and insecticide-treated bed nets. In recent years, health services researchers have assessed the safety and feasibility of drug shop operators' ability to take on a more advanced set of activities, such as diagnosing the severity of malaria and referring clients for clinical care [2,3].…”

Combating inappropriate use of medicines

“…They also noted that the effects of educational strategies were not sustained in the long term. Another review of ten studies conducted in sub-Saharan Africa on the effectiveness of interventions for improving the quality of services provided by specialized pharmacies concluded that education could improve knowledge, but that this did not translate into changed behavior, which appears to be constrained by profit incentives [56].…”