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Interview with Jaha, Pharmacist in Nairobi

Jaha is a trained pharmacist working in a middle class independent pharmacy in Nairobi. We chatted to her about the role of the pharmacist, how antibiotics are bought and dispensed and what could help her do her job more effectively.

Here are some top learnings:

Pharmacists use their judgement to both prescribe and dispense

“If they cough and feel pain, and have blood, it’s a bacterial infection.”
"If I don’t know, I am happy to tell them that they need a test, I tell them to go to the doctor."

If pharmacists are usually happy to diagnose, prescribe and dispense, then it makes sense that patients go directly there. Especially if they trust that the pharmacist will refer them to the doctor if the condition is out of their scope.

There are no laws or regulations that she is aware of around antibiotic dispensing

"When was the last time I read the law? i don’t know the law!"

About pharmacies not being allowed to prescribe:

"If these laws existed there would be no chemists. If everyone had to go to the doctor, by the time you’ve finished with the consultation and the prescription cost, patients have no money left for the medicines"
"Some drugs are OTC, some are POM. Some antibiotics are OTC" (us, which are they?) "It’s hard to say, they don’t always say on the packet."

This demonstrates clearly why the pharmacy is the primary point of care for most people in these markets - there is no perceived difference in the care they receive between the two, expect the pharmacists is much better value for money. Pharmacies (even those like Jaha who do feel a sense of duty of care for patients) do not restrict the drugs they sell - they are not incentivised, trained or directed to. When they are spot checked by the pharmacy board, mystery shoppers will come and ask for Codeine and other psychotropic drugs, but never antibiotics.

On when and how to use antibiotics

"There are many ways to kill a cat - you can poison it, you can use a trap, you need to know the alternatives if one drug has stopped working. There are multiple different antibiotics you can give."
‘It doesn’t matter what the condition or the drug, as long as you take the full course, you will not become resistant.”

Even though Jaha is trained, she still has some misunderstanding of antibiotic usage

Feedback on Doc in Booth concept

"Doctors are told never to prescribe over the phone, it’s not a good thing. You can’t see the context and the person."

Feedback on Smart Prescription concept

"It would be amazing, it’s really important that someone is making sure they're compliant. And that if there is an emergency you can follow up"