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2 Center of Public Health Intervention Technology – NIHRD – Ministry of Health RI, Jl. Percetakan Negara 23 A Jakarta 10560
Alamat korespondensi: E-mail: max_jh@litbang.depkes.go.id
AN ANALYSIS OF PHARMACY SERVICES BY PHARMACIST IN
COMMUNITY PHARMACY
(Kajian Praktek Kefarmasian oleh Apoteker di Apotek Komunitas)
Max Joseph Herman2, Andi Leny Susyanty2
ABSTRACT
Background: Up to now there are more than 60 schools of pharmacy with a variety of accreditation level in Indonesia.
Previous study found that the standard of pharmaceutical services at various service facilities (hospitals, primary health
care and community pharmacy) can not be fully implemented because of the limited competency of pharmacist. This study
was conducted to identify the qualifi cation of pharmacist who delivers services in community pharmacy in compliance with
the Indonesian Health Law No. 36 of 2009. As mandated in the Health Law No. 36 of 2009, the government is obliged to
establish minimum requirements that must be possessed. Methods: This cross sectional study was conducted in 2010
at 2 community pharmacies in each of 3 cities, i.e. Bandung, DI Yogyakarta and Surabaya. Other than ten pharmacists
delivering services in community pharmacies, there were pharmacists as informants from 4 institutions in each city selected,
i.e. six pharmacists from two Schools of Pharmacy, three pharmacists from three Regional Indonesian Pharmacists
Association,six pharmacists from three District Health Offi ces and three Provincial Health Offi ces. Primary data collection
through in-depth interviews and observation as well as secondary data collection concerning standard operating procedures,
monitoring documentation and academic curricula has been used. Descriptive data were analysed qualitatively. Results:
The fi ndings indicate that pharmacists' qualifi cation to deliver services in a community pharmacy in accordance with the
Government Regulation No. 51 of 2009, Standards of Pharmacy Services in Community Pharmacy and Good Pharmaceutical
Practices (GPP) was varied. Most pharmacists have already understood their roles in pharmacy service, but to practice
it in accordance with the standards or guidelines they are still having problems. It is also acknowledged by pharmacists
in other institutions, including School of Pharmacy, Regional Indonesian Pharmacists Association, Provincial and District
Health Offi ces. To practise such as stated by the Indonesian Health Law No. 36 of 2009, the Government Regulation No.
51 of 2009. Conclusion: The Standards of Pharmaceutical Services and GPP requires prevailing role of pharmacists in
community pharmacy in terms of time and capability. Training or continuing development is also needed through upgrading,
seminars, socialization and supervision in the community pharmacy practices which may involve cooperation with professional
organizations needs to be improved.
Key words: Pharmacist, Qualifi cation, Community Pharmacy, Pharmacy Practices
ABSTRAK
Latar Belakang: Di Indonesia sampai saat ini terdapat lebih dari 60 Perguruan Tinggi Farmasi dengan berbagai tingkat
akreditasi. Penelitian sebelumnya menemukan bahwa Standard Pelayanan Farmasi belum dapat dilaksanakan sepenuhnya
pada berbagai fasilitas pelayanan kesehatan (rumah sakit, puskesmas dan apotek) karena keterbatasan kompetensi
apoteker. Studi ini bertujuan mengidentifi kasi kualifi kasi apoteker yang melakukan pelayanan farmasi di apotek komunitas
dalam rangka memenuhi ketentuan Undang-Undang RI No. 36 tahun 2009 tentang Kesehatan. Sebagaimana diamanatkan
oleh Undang-Undang pemerintah berkewajiban persyaratan mimimum yang harus dimiliki. Metode: Penelitian potong lintang
ini dilaksanakan dalam tahun 2010 pada masing-masing 2 apotek komunitas di 3 kota, yaitu Bandung, DI Yogyakarta dan
Surabaya. Sebagai responden penelitian selain 10 orang apoteker apotek komunitas juga diambil 6 apoteker dari 6 PT
Farmasi, 3 apoteker dari Pengurus Ikatan Apoteker Indonesia dan 6 apoteker dari Dinas Kesehatan Provinsi dan Kota. Di
samping data primer dikumpulkan melalui wawancara mendalam dan observasi dengan menggunakan daftar tilik di unit
apotek, juga dikumpulkan data sekunder tentang SOP pelayanan farmasi, dokumentasi monitoring dan kurikulum PT Farmasi.
Hasil: Analisis data secara kualitatif deskriptif menunjukkan bahwa kualifi kasi apoteker yang memberikan pelayanan farmasi
di apotek komunitas dalam rangka memenuhi ketentuan Peraturan Pemerintah No. 51 tahun 2009, Standard Pelayanan
Buletin Penelitian Sistem Kesehatan – Vol. 15 No. 3 Juli 2012: 271–281
272
Farmasi di Apotek dan Good Pharmacy Practice bervariasi. Pada umumnya apoteker memahami perannya dalam pelayanan
farmasi, tetapi untuk melaksanakannya sesuai dengan standard atau pedoman masih menghadapi berbagai kendala. Hal
ini juga diakui oleh apoteker dari PT Farmasi, Pengurus IAI dan Dinas Kesehatan. Pelaksanaan sesuai dengan Undang-
Undang RI No. 36 tahun 2009, Peraturan Pemerintah No. 51 tahun 2009. Kesimpulan: Standard Pelayanan Farmasi di
Apotek dan GPP menuntut peran yang dominan dari apoteker di apotek komunitas dalam hal waktu dan kemampuan.
Pelatihan dan pendidikan berkelanjutan juga dibutuhkan, antara lain melalui penataran, seminar, sosialisasi dan supervisi
praktik farmasi di apotek komunitas yang mungkin melibatkan kerja sama dengan organisasi profesi dan PT Farmasi.
Kata kunci: Apotek, Kualifi kasi, Apotek Komunitas, Praktek Kefarmasian
Naskah Masuk: 4 April 2012, Review 1: 12 April 2012, Review 2: 12 April 2012, Naskah layak terbit: 1 Maret 2012
INTRODUCTION
The objectives of health development are to build
awareness, motivation and capability to realize healthy
living and to have access to quality, proportional, and
fa ir distr ibu tio n of heal th ser vices as a n invest ment of
socially and economically productive human resource
development. For the purpose of achieving health
development goals stated in the Indonesian Health
Law No. 36 of 2009 (Undang-Undang Kesehatan
RI No. 36, 2009), the government shall establish
planning, recruitment, procurement, utilization, control
and supervision of health providers in delivering health
care including those practising in health facilities who
should have minimum qualification such as stated in
Minister Decree.
One of health facilities where pharmacists deliver
pharmacy services is a community pharmacy. As
a health care provider a pharmacist shall have
qualification such as mandated in the Indonesian Health
Law No. 36 of 2009. Nowadays, the government has
issued pharmacist qualification in practising pharmacy
services through the Government Regulation No. 51
of 2009 on Pha rmac y Pra ctic e (Pe rat uran Pem erint ah
RI No. 51, 2009). In the Indonesian Health Law it is
also mentioned that pharmacy practices which include
dispensing and quality control of pharmaceutical
products, safety assurance, procurement, storage and
distribution of drugs, supply of physician prescribed
drug, drug information provision and development
of drug, medical product and traditional medicine
should be provided by competent and authorized
personnel.
The development in health technologies and the
changing of life-style have brought changes in the
community expectations conc erning pharmacy services
in hospitals, primary health care and pharmacies.
Convenient and timely access to care, patient safety
and health outcomes, financial sustainability and the
scope of pratice of health professionals are recent
challenges. Pharmacists should move from behind the
counter and start serving the community by providing
pharmaceutical care instead of merely supplying
medicines. A comprehensive pharmacy service
involves activities both to secure good health and to
avoid ill-health in the population. Health promotion and
health maintenance are key components of pharmacy
practice and effective drug therapy management.
When ill-health is treated, it is necessary to assure
quality in the process of using medicines in order to
achieve maximum therapeutic benefit and to avoid
untoward-effects (FIP, 2009).
Other than in the Government Regulation No.
51 of 2009, guidelines on pharmacy service was
introduced in the Decree of Minister of Health No.
1027 of 2004 (Depkes RI, 2006) and Good Pharmacy
Practice (WHO, 1996), a joint document from WHO
and FIP (International Pharmaceutical Federation).
The Indonesian Pharmacist Association (IPA) had
also established the pharmacy competency framework
(BPP ISFI, 2004) and to support that the Indonesian
Association of Pharmacy Higher Education developed
pharmacist professional standards requirements
(APTFI, 2010).
The pharmacist professional standards
requirements in community pharmacy (PKPA) aims
to achieve the following competencies:
1. Ability to make professional decision based on
knowledge, evidence, standards, regulation and
ethics in community pharmacy.
2. Ability to implement pharmaceutical care to
ensure patients derive maximum benefit from
their treatment with medicines.
3. Ability to communicate with patients and other
health care professionals.
An Analysis of Pharmacy Services by Pharmacist (Max Joseph Herman, Andi Leny Susyanty)
273
4. Ability to plan either drug, fi nance, human resource
or business management.
5. Ability to plan and implement professional
development strategies based on good pharmacy
practice.
According to the Indonesian Pharmacist
Association all pharmacist practising in a community
pharmacy shall be capable of:
1. Managing pharmaceutical products and medical
devices adhering to the rules.
2. Professional provision of effective medication
therapy management.
3. Provision of patient counseling, information and
education.
4. Recording and reporting in compliance with the
rules.
5. Monitoring effi cacy and safety of pharmaceutical
products and medical devices.
6. Acting as a management and pharmacy service
leader in community pharmacy.
7. Active participating in preventive and promotive
public health program.
This study was conducted to identify the
qualification of pharmacist who delivers services
in community pharmacy in compliance with the
Indonesian Health Law No. 36 of 2009. Up to now
there are more than 60 schools of pharmacy with
a variety of accreditation level, i.e A, B, C and even
not accredited yet (http://aptfi.or.id/?p=15, 2009).
Furthermore, facilities and process of professional
ph armac ist e duc ati on var y wi del y suc h tha t qua lity o r
competencies of their graduates differ too. A previous
study on the readiness of pharmacy providers to
anticipating globalization in pharmacy services in
2009 (Sasanti, 2009) found that the standard of
pharmaceutical services at various service facilities
(hospitals, primary health care and community
pharmacy) can not be fully implemented because of
the limited competency of pharmacist and general
pharmaceutical knowledge obtained from school.
METHODS
Conceptual framework
This qualitative descriptive study was done
cross sectionally in three cities in Indonesia, namely
Bandung, DI Yogyakarta and Surabaya. Informants
were six full-time pharmacists from six Community
Pharmacies (CP), six pharmacists from six Schools of
Pharmacy (SP), three pharmacists from three regional
IPA, six pharmacists from three Provincial and three
District Health Offices. Cities are purposively selected
based on the existence of A and/or B accredited school
of pharmacy in Java. Primary data collections through
in-depth interviews and observation using check-list
in community pharmacy as well as secondary data
collection concerning standard operating procedures,
Indonesian Health Law No. 36/2009
Government Regulation No. 51/2009
Pharmacists’ qualification in community
pharmacy
Pharmacy practice by pharmacist in
community pharmacy
IPA
School of Pharmacy
GPP/WHO
1996
FIP 2009
APTFI
Provincial/District
Health Office
Gap & training
content
Buletin Penelitian Sistem Kesehatan – Vol. 15 No. 3 Juli 2012: 271–281
274
monitoring documentation and academic curricula
have been used.
RESULTS AND DISCUSSION
Characteristics of pharmacists practicing in
community pharmacy
Table 2 shows that pharmacists' graduation year
and practicing experience as full time pharmacist
in a community pharmacy varies greatly among
respondents.
Qualifi cation of pharmacist practising in
community pharmacy
The qualification of pharmacist was viewed from
several aspects like the main focus of pharmacy
service and practice in a community pharmacy, the
ro le of phar maci st in mana gem ent and adm ini stra tion
of pharmaceutical products, the role of pharmacist
in supply and the use of medicines, the role and
knowledge of pharmacist in counseling, patient
education and provision of drug information, home care
and self-care, standards and guidelines on pharmacy
practice in community pharmacy, communication with
other health professionals and promotion of rational
prescribing as well as the contribution of pharmacy
service in health care.
Main focus of pharmacy service in community
pharmacy
Most pharmacists said that the main focus of
pharmacy service was a patient-oriented one and
to support that there should be no service whenever
no pharmacists stand-by. To ensure the outcome
of therapy, a pharmacist has to assess rational and
appropriate use of drugs or by complying with the
guidelines of pharmacy service in a community
pharmacy just like the expectations from the standards,
namely a comprehensive pharmacy service that
involves activities to improve or maintain a patient’s
quality of life (Depkes RI, 2006). Nonetheless there
was a pharmacist that did not define the focus for his
pharmacy was a new one such as this statement:
"The main focus of pharmacy service has just
been recognized and undefined yet, whilst we supply
drugs including OTC and ethical drugs"
WHO/FIP in Good Pharmacy Practice set the
welfare of patient as a pharmacist's first concern in all
settings and the core of the pharmacy activity is the
supply of medication and other healthcare products
of assured quality, appropriate information and advice
for the patient as well as monitoring the effects of use
(WHO, 1996).
Pharmacist's role in pharmaceutical products
management
According to the Standards of Pharmacy Services
in Community Pharmacy, pharmacists have direct
responsibilities in managing resources in a pharmacy
like human resources, facilities and equipments,
medication and other healthcare products, starting from
planning, procurement, storage and administration
(Depkes RI, 2006).
Table 1. Visited Insitution in Each City
No Cities SP IPA CP Provincial
Health Offi ce
District
Health Offi ce
1 Bandung 2 1 2 1 1
2 DI Yogyakarta 2 1 2 1 1
3 Surabaya 2 1 2 1 1
TOTAL 6 3 6 3 3
Table 2. Characteristics of pharmacists practicing in community pharmacy
No Characteristics Bandung DIY Surabaya
CP 1 CP 2 CP 1 CP 2 CP 1 CP 2
1 Grad. year 2009 1985 1997 2005 2001 1982
2 Pract. Exp.(yr) 1 25 10 2 3 25
An Analysis of Pharmacy Services by Pharmacist (Max Joseph Herman, Andi Leny Susyanty)
275
In this study most pharmacists well-played this
role although not all the tasks in the pharmacy were
performed by them but other personnel did too
(Herman, 2010) just like these statements:
"A pharmacist in community setting has the
responsibility in all aspects like service, marketing,
finance and administration, human resources and
training, logistic management and inventory"
"As a manager, I decide and order what drugs to be
purchased. Soon after delivery from the distributors,
a pharmacy staff will enter them into the computer.
For each task there is a pharmacy staff responsible"
This finding shows that the function of
pharmaceutical products management had been
done by most pharmacists, especially the full-
time pharmacists. Whilst for a firm pharmacy the
management is under a certain division with a
monitoring system like in the following statements:
"The processes of planning, procurement,
storage, documentation and evaluation are all under
the authority of logistic division"
"The pharmacist is responsi ble for the management
of other pharmaceutical and health products from the
pl anni ng u p to thei r evaluati on…… Eac h ac tivi t y done
in the pharmacy is under the supervision of Head of
Branch Office"
Pharmacist's role in drug therapy management
Pharmacists should assume greater responsibility
than they currently do for the management of drug
therapy because many tasks were still done by
pharmacy assist ant, except for full time pharmacists,
such as these statements:
"The pharmacy assistant is reponsible for OTC
drugs under supervision of the pharmacist…..the
pharmacist himself is responsible for ethical drugs
from receiving the prescription to monitoring the drug
use, helped by his assistant"
"The pharmacy assistant serves at the front
counter for OTC drugs….prescription drugs are
dispensed by pharmacy assistant"
"Full time pharmacist practices all activities,
helped by pharmacy students now and then"
"This community pharmacy does not have any
pharmacy assistant such that all practices are done
by the pharmacist himself"
Pharmacist's role in communication,
information and education
This beyond the supply of pharmaceutical
products role of pharmacists is played by a full
time pharmacist or a co-pharmacist practising in
an education pharmacy, either to other health care
providers or to the patients they serve.
"The responsible pharmacist works full time,
this community pharmacy is also an education
pharmacy. Drug information given to patients covers
up indication, dose, administration and probable
adverse events of drugs. The essential role of
pharmacist is communication with patients regarding
their medicines"
"The pharmacist's role is prevailing….
communication, information and education to the
patient or others is done by the pharmacist. Counseling
starts from 8 am until 10 pm. The information given
includes indication, dose, administration and probable
side effects of drugs"
"This pharmacy does not have any pharmacy
assistant……Information is given by the pharmacist
depending on the result of patient assessment,
disease, and drug used"
This role, especially for drug therapy in chronic
diseases, differs from a pharmacy with a full time
pharmacist than the one with a pharmacy assistant
as an information provider in details.
"Interaction of drugs mostly asked by consumers
– unanswered…Information and education on anti
diabetes – unanswered…. Information and education
on drugs for uric acid – unanswered….antibiotics use
is not a problem"
Home care and self medication
In the Standards of Pharmacy Services in
Community Pharmacy a pharmacist, as a care giver,
should consider home care service too, especially
for the elderly, mothers and children, or chronically
ill patients. This activity includes documentation of
professional activities such as medication record
(DepKes RI, 2007). Nevertheless, the implementation
of home care by pharmacists was not so easy, like
this statement:
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276
"Homecare at times can not be done for not all
patients needs or pleased to be visited. Homecare
may be done via telephone. Trial for homecare is
required for it is not well-known or recognized by
the community. Technical preparation is difficult, the
pharmacist is not ready and the cost resulted from it
should be expected"
There were pharmacists who did it in educational
program, but there were pharmacists who ever did
not either.
“Visiting patients, especially those with chronic
diseases, has been done to assure compliance, to
check their latest condition and when they should
visit their physician again, to count and check their
medicines, to ask for the problem they faced including
symptoms of drug side effects. Homecare is also
documented’
“Yes, it has been carried out by pharmacist together
with practicing pharmacy students, documented in
Patient Medication Record”
"Direct visitation by pharmacist has not been
conducted, for the response from monitoring by
telephone is still very low. So, we make card and
whenever they need us they can call us'
Good Pharmacy Practice addressed activities
of pharmacists associated with self care, including
advice about and, where appropriate, the supply of
a medicine or other treatment for the symptoms of
ailments that can be properly self treated (WHO, 1996).
In this study activities concerning self care was hardly
done because of precaution taken by pharmacists
regarding the ongoing relationship with other health
professionals, particularly physicians, though it should
be seen as a therapeutic partnership.
“Beware of crossing the physician. OTC drugs,
physicians, referrals. A great number of self-medication
for acute diarrhea, patients should better see their
physician”
“Yes, it has been carried out by pharmacist together
with practicing professional pharmacy students”
“It has been done on the 5th day every month,
together with practicing professional pharmacy
students in the surrounding area, preparing leaflets
to be distributed”
Standards of Pharmacy Services in Community
Pharmacy
Standards of Pharmacy Services in Community
Pharmacy is essential in the practice of pharmacy
that responds to the needs of those who use the
pharmacists' services by providing optimal, evidence-
based care (WHO, 1996). It should be adhered to by
capable pharmacists. Most of the pharmacists knew
and understood the standards well but there were
still obstacles in practice, especially concerning the
implementation of Government Regulation No. 51 of
2009 like these two pharmacists said:
"Concerning the Indonesian Health Law No. 36 of
2009 and the Government Regulation No. 51 of 2009,
a pharmacist should have been familiar with them. In
general the Government Regulation No. 51 of 2009
rules a pharmacist in his professional practice and it
may become refreshment in spite of contradiction here
and there. Difficulties to improvement towards GPP
lie on the pharmacists themselves, they need more
knowledge to practice according to GPP" nonsense
"Government Regulation No. 51 of 2009, there
has to be a co-pharmacist for it's not possible to work
for 24 hours"
Communication with other health professionals
and assessment of prescription rationality
In the Standards of Pharmacy Services in
Com mun ity Ph arma cy is sued by t he Mi nist ry of H ealth
pharmacists should collaborate with other health
care providers in their efforts to promote rational
drug use and to improve health outcomes (DepKes
RI, 2007).
It was found that most pharmacists did not have
any problem in communicating with other pharmacists,
but at times with other health care providers like
physicians there might be difficulties.
"There are communications with other pharmacists
especially on drug use, with physician concerning
prescription rationality, unclear writing, available
dr ugs a nd dr ug su bsti tuti on ei the r dir ectly or by ph one.
Response of physician is usually very good".
"It's not easy sometime to communicate with
physician"
An Analysis of Pharmacy Services by Pharmacist (Max Joseph Herman, Andi Leny Susyanty)
277
Assessment of rational prescription that should
cover legal validity, appropriate dosage form and
route of administration, therapeutic dosage range,
appropriateness to patients' condition, parameters
and previous medication, compatibility with other
medicines and possible side effects was not exclusively
do ne i n overal l ph arma cies yet. Som e di d it by rou tin e
habit when screening prescription. The followings
are pharmacists' opinion on rational prescription in
a pharmacy:
"In general, it's okay. Polypharmacy occurs
usually for the elderly and children, antibiotics and
analgesics are common. To support the policy of
rational prescription, a clear government regulation
is needed, besides socialization through mass media
or seminars on rational drug use".
"Full time pharmacists find many irrational
prescriptions, for example Hiperkol was given together
with Lipitor eventhough they have similar indication
as anticholesterol. Another example is prescription
of Biogesic and paracetamol. To support the policy
of rational prescription, socialization through mass
media or television to the public should be considered
and to pharmacist and physician is a must".
“Although most prescriptions are rational, there
are still some inappropriate ones, for example one that
contained powdered sustained-release tablets which
should first be confirmed by the prescriber. To promote
rational drug use policy, some product limitation may
be required. Pharmacist’s role in communicating with
physician should be enhanced and evidence derived
from PMR. Patient safety in community pharmacy
setting is also needed”.
The contribution of pharmacy services in health
care
WHO in Good Pharmacy Practice stated that the
contribution of pharmacy services in health care was
to improve heath outcomes by maintaining access to
an appropriate evidence relating to the safe, rational
and cost effective use of medicines (WHO, 1996).
Indepth interviews reveal that pharmacists realized
their services' contribution to health care in different
aspects and understandings.
“The contribution of pharmacy ser vices in health
care consists of accessibility to affordable drugs and
availability of appropriate drug information”.
“Improvement of general health status will come
along with the achievement of the objectives of drug
therapy”.
”It is very impor tant for the goal of therapy is not
merely determined by appropriate diagnose but also
by the success of drug treatment which is certainly
influenced by the control of pharmacist”.
Observation of pharmacy practice in community
pharmacy
Observations show that activities in pharmacy
practice differed widely, depending on the presence
of the pharmacists and their role in a community
pharmacy. These main differences lie in the activities
of filling prescription of the medicines used, the role
and knowledge of pharmacist in counseling, patient
education and provision of drug information, providing
effective medication therapy. On the other hand,
activities concerning drug and human resources
management in a community pharmacy were nearly
alike in accordance with the standards.
Matrix 1. Pharmacy Practice in Community Pharmacy
Pharmacists' qualifi cation Implementation Training Content
Drug supply and management as
regulated
Pharmacist is responsible in all
aspects eventhough he is not the
actor, obstacles towards GPP are
limited number of pharmacist, different
regulation perception, other profession
and pharmacist himself
Regulations, behavioral science
Drug, including OTC and ethical drug
services
Mostly done by pharmacist assistant Clinical pharmacy, communication
skill, DRP, drug interaction especially
oral drugs
Buletin Penelitian Sistem Kesehatan – Vol. 15 No. 3 Juli 2012: 271–281
278
The qualifi cation of pharmacists practising in
community pharmacy according to School of
Pharmacy, Indonesian Pharmacist Association
and Health Offi ce School of Pharmacy
Sc hool o f Pha r macy as a n in stit uti on in edu cati on
world that produce pharmacists surely has an important
role. Their education equips pharmacists to play a key
role in providing assistance, information and advice
to members of the public about medicines available.
Thi s re qui res t hem t o keep ab reas t of develop ment s in
pharmacy practice and the pharmaceutical sciences,
professional standards requirements and advances
in knowledge and technology.
Determining the functions of pharmacists that
are desired by stakeholders (patients, physicians,
policy makers, insurers, payers and other health care
professionals) will result in pharmacists' qualifications
that agree with the market demand. It is also
considered important to describe key competencies
that the profession brings to the continuum of health
care delivery. For that purpose the pharmacist
professional standards requirements in community
pharmacy (PKPA) which describe the implementation
of pharmaceutical sciences in globalization era is
essential (Syukri, 2009).
Interview with school of pharmacy shows that
the conditions of practice in community pharmacy
vary widely. Educational programmes for entry to the
profession should appropriately address both current
and foreseeable future changes in pharmacy practice.
The school of pharmacy has deliver knowledge and
competencies such as required by their association,
but pharmacists should maintain their competencies
as health care professionals who have relevant and
up-to-date skills and expertise through continuing
professional development activities. The success
of pharmacists practising in community pharmacy
depends on their willingness and commitment to
continuing professional development, other than that
obtained from formal education.
"Pharmacies are going towards what is demanded
by the Government Regulation No. 51 of 2009, if
patients are not satisfied surely pharmacies will
collapse".
”.....Nevertheless, I s ee generally that in many other
areas in Indonesia pharmacy practice in community
setting is not done as expected....I see that there is a
lack of commitment of pharmacist himself to practice
professionally in a community pharmacy that resulted
among other things in their scarce attendance”.
”……. I think that those responsible for education
have given their students knowledge and skill as much
as possible, such that a pharmacist should be capable
of practicing professionally. Nonetheless, continuing
education should be followed to cope with recent
developments”.
Indonesian Pharmacists Association
Rubiyanto in his writing, Rekonstruksi Profesi
Apoteker Sebuah Upaya Membuat Peta Jalan Menuju
Apoteker Sebagai Tenaga Kesehatan, said that the
Health Law No. 36 of 2009 and the Government
Regulation No. 51 of 2009 will surely inspire
pharmacists to make great changes starting from
the school of pharmacy, pattern and performace of
pharmacy pratice in all settings to their attitude and
behaviour as health professionals in improving health
in the community (Rubiyanto, 2010). Interviewee
underlined pharmacy education like this:
"Fresh graduates can not meet users' demand and
need adaptation. Pharmacist is a health professional
but not ready for use because of their inappropriate
curricula. At school everything has to be learned. A
great number of pharmacists in community setting just
Pharmacists' qualifi cation Implementation Training Content
Counseling, information and education
- patients
- other health professional
Still done a lot by pharmacist
assistant, information limited to drug
indication, application and conta-
indication
Drug information service (PIO),
product knowledge, reference
evaluation
Recording and reporting as regulated Well done Regulations
Active participation in drug safety
monitoring
Medication record still unavailable
except in education pharmacy
PMR, pharmaceutical science
Other leaders' function like fi nance
and human resource manager
Especially at pharmacy owned by non-
pharmacist cannot be implemented
Pharmacoeconomic, fi nancial and
human resource management
An Analysis of Pharmacy Services by Pharmacist (Max Joseph Herman, Andi Leny Susyanty)
279
only manage the drug supply and hardly involved in
clinical pharmacy and pharmaceutical care"
According to Rubiyanto the implementation of
the afore mentioned Health Law and Government
Regulation needs struggle, for there are different
perceptions and paradigm among the pharmacists
themselves regarding their background interests.
Besides other health professionals often undermine
the role of pharmacists and relatively resistant to
their existence, public awareness of the added value
of the pharmacists still has to be raised up. Even in
some cases the political will of the government to
empower pharmacists as required is still lacking.
This is a golden chance that can not be repeated
(Rubiyanto, 2010). The presence of pharmacist in a
community pharmacy is in fact a barrier according to
the following interviews:
“The presence of pharmacist to serve in certain
pharmacies is undebatable, but in others pharmacist
is present if only they are the owners too and just not
more than five percents of pharmacies are owned by
pharmacist”
“Although referring to the competence standards,
knowledge of a pharmacist is adequate, they lack
professional attitude and behavior, especially those
in cooperation with the owner of the pharmacy”
Interviewee also emphasized government
commitment to improve pharmacy services by
pharmacists like this:
"Regarding the presence of pharmacist,it depends
on the government policy, there should be a reward
and punishment mechanism. The government
should make a kind of law enforcement. Until now
the Indonesian Pharmacist Association (IPA) has not
an authority to cancel a pharmacy license and needs
support from the government to be empowered".
For the sake of changes in pharmacy practice,
the IPA attempts to organize activities which
enhancing pharmacists improvement of quality in
their professional practice:
".........IPA recommends the implementation
of a standard operating procedure in conducting
GPP in community setting..... Designing pharmacist
stratification system through professional practicing
program for fresh graduated pharmacists, collecting
portofolio for at least five years to follow CPD
(Continuing Profession Development) and using
credit system to assess by means of PMR (Patient
Medication Record) as tools of the National Pharmacy
Committee (KFN)".
“To improve quality and to upgrade the
competencies of pharmacist as mandated in the
Indonesian Health Law No. 36 of 2009 and the
Government Regulation No. 51 of 2009, CPD
(Continuing Professional Development) or CPE
(Continuing Professional Education) is essential.
Fu ncti ona l sta tus of p harm acis t pra ctic ing in hos pital s,
community pharmacies and public health centers
should be developed”.
Health Offi ce
With the coming of Government Regulation No. 51
of 2009 into effect, pharmacists have to implement the
Standards of Pharmacy Services (chapter 21, v.1) and
filling prescription have to be done only by pharmacists
(chapter 21, v.2). This means that pharmacists must be
present as long as health care facilities are opened.
Up to now nearly 95% who render pharmacy services
are not pharmacists (pharmacy assistants, nurses,
midwives, owners, non medical technician), whereas
the pharmacists themselves usually have a job outside
health care facilities. Following this obligation the
quality of pharmacy services in near future will make
a vital contribution to patient care. The actions taken
by the District Health Office as regulator were:
1. Socialization of Government Regulation No 51 of
2009 to IPA, PAFI, the association of pharmacy
owner, hospitals, community health center, clinic,
drug wholesaler, and local government. Particularly
to hospitals, socialization is done continually
regarding the issue of Law No. 44 of 2009 on
Hospitals.
2. Analyze the need of pharmacists and pharmacy
technicians required so as to establish
standards.
3. Organizing seminars or workshops with school of
pharmacy or IPA.
4. Planning and recruitment of pharmacists and
pharmacy technicians in private or public
hospitals.
5. Monitoring and evaluating performance of
pharmacy services in health facilities.
6. Facilitating registration of pharmacists to the
Ministry of Health and pharmacy establishment.
Buletin Penelitian Sistem Kesehatan – Vol. 15 No. 3 Juli 2012: 271–281
280
7. Issuing and controlling of pharmacists' practice
license (SIPA).
8. Collaboration with regional IPA and PAFI to control
pharmacies as early as possible.
9. Supporting pharmacists and their technicians on
their rights and liabilities.
What the Health Office had already done
in preparing the implementation of Government
Regulation No. 51 of 2009 is as follows:
”Referring to the Government Regulation No 51
of 2009 which has certainly to be obeyed, preparation
has to be made. The regional health office has to
control that a pharmacy should only be opened
whenever the pharmacist is present. For the time
being, a new pharmacy has to employ at least two
pharmacists, one as a co-pharmacist".
The Health Office said that there was
barrier to implement the Government Regulation
comprehensively, especially from the pharmacists:
"Pharmacy practice in community setting at this
time varies widely, particularly in direct service to
patients.......We have a lot number of pharmacists
now, but their quality and competence are inadequate
to improve the overall quality of pharmacy services.
The resposibilities of some pharmacists are lacking
such that their profession is underestimated and not
recognized yet compared with physicians".
Apart from the pharmacists site in order to
improve their qualification in the implementation of
Government Regulation No. 51 of 2009, support from
school of pharmacy and IPA is also needed.
”Pharmacist is still not confident to run a pharmacy
on their own for the reason of lack of knowledge
and fund, communication and management skill.
Meanwhile, there are still schools of pharmacy with
inadequate curricula in order to practice professionally
and lack of education facilities......Professional
organization plays an important role and has to have
a clear concept to improve pharmacist’s competence,
the Provincial Health Office will facilitate in terms
of policy through intersectoral meeting and inviting
stakeholders involved”.
CONCLUSIONS AND RECOMMENDATIONS
Conclusions
This study finds that the qualific ation of pharmacists
practising in a community pharmacy in compliance
with the Government Regulation No. 51 of 2009,
the Standards of Pharmacy Services in Community
Pharmacy and the Good Pharmaceutical Practice
still vary. Most of the pharmacists have understand
their roles in pharmacy practice in a community
pharmacy, but to do it according to the regulations
there are still hindrances in competence and time.
Proper information and training in these aspects will
help creating the awareness and motivation to do it in
their pharmacy, and its subsequent advantages.
Recommendations
Education and continuing education through
seminars, socialization and control of pharmacy
practice in community pharmacy should be enhanced
in cooperation with professional organization as
necessary.
Matrix 2. Perception of institution on pharmacists' qualifi cation at community pharmacy
Informant Pharmacists' qualifi cation Development content
School of Pharmacy Pharmacy practice done variedly by
pharmacist among CPs, especially in
pharmacotherapy and communication,
still in transition period
Clinical pharmacy, commit- ment,
pharmacotherapy, humaniora, communication,
behavioral science, marketing and management
Regional IPA Appropriate number and quality of
pharmacist, attitude and behavior is
important
No pharmacist no service, appropriate
competence system, continuing education,
behavior, PMR, periodic certifi cation
Provincial Health Offi ce Pharmacy practice still not as expected
by Government regulation no.51/2009
At least 2 pharmacists in a CP, collaboration with
professional organization, clinical pharmacy,
communi- cation and management
District Health Offi ce Pharmacy practice varies widely Control, registration and licensing of pharmacist,
at 2 pharmacist in a CP, pharmacology, PMR,
clinical pharmacy
An Analysis of Pharmacy Services by Pharmacist (Max Joseph Herman, Andi Leny Susyanty)
281
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