Zane Dzirkale

The health care system is based on several pillars. We all see and notice the work that doctors, hospital staff and emergency medical specialists do every day. But do we see and appreciate pharmacists? In large cities, pharmacies are on almost every corner and are often associated with retail outlets. But most of the time, the work done by pharmacists – highly educated professionals with knowledge of both health care and drug manufacturing – takes place behind the scenes. who are not only ready to advise patients on their treatment, but also to prepare medicines when they are needed or unavailable due to production stoppages, supply chain disruptions or geopolitical events.

Pharmacists are the most accessible health care professionals for the public, but at the same time they are the least valued. These professionals are currently not entitled to any remuneration for their advice.

Similarly, a number of services that could be entrusted to pharmacists in order to improve the efficiency of the health care system are still not being delegated. Experience in other countries shows that pharmacists can successfully provide seasonal vaccinations, such as against influenza, compiling medication reviews, repeating prescriptions for chronic patients, and other support services related to the safe use of medicines and the promotion of public health, which in the Latvian context would significantly ease the workload of overburdened family doctors. It is positive that a specially created working group is currently working on this issue, but industry experts are waiting for clarity as soon as possible.

The manufacture of medicines, which has historically been one of the main responsibilities and specialities of pharmacists, is another area that should be purposefully developed and strengthened. Although this service is currently provided in most pharmacies, it is used relatively infrequently. One of the reasons for this is that it relies more on the enthusiasm of pharmacists. The price that can be charged for manufactured medicines is limited and does not cover either the costs of technical equipment or the work invested by specialists. At the same time, the manufacture of medicines in pharmacies can become an indispensable service in a potential crisis situation.

We cannot pretend that there is no threat of a crisis. The role of pharmacists and other healthcare professionals in a potential crisis is invaluable. This is also demonstrated by the experience of Ukraine. The challenges faced by Ukraine at the beginning of the war are a lesson that we must also learn from. Clear guidelines and an action plan are needed to guide us in specific circumstances. At present, there is no such clarity. There is only a vague idea, and until it affects them directly, many people are reluctant to even think about it. Industry experts need to sit down together and agree on specific steps to take, while also listening to the opinions, experiences, and perspectives of pharmacists and other healthcare professionals. Given that the pharmaceutical sector, including the activities of pharmacists and pharmacies, is strictly regulated, clear and understandable guidelines on how and whether it is possible to deviate from regulatory requirements in a crisis situation are equally important.

I believe that both now and in times of crisis, the role of pharmacies, especially in rural areas, will be invaluable. Pharmacists act as intermediaries between doctors and patients. They fulfill not only their professional role, but often also a significant social role, especially in rural areas. They are experts whom people trust, listen to, and turn to when a doctor is not available or urgent help is needed. Access to reliable information is essential for people’s sense of security, and pharmacies and pharmacists are the direct point of contact with the public, providing both information and access to medicines. Although pharmacists have mostly remained invisible heroes until now, the experience of Covid-19 in Ukraine and our own country has shown that in times of crisis, these are the professionals who are on the front line. The sector must therefore do everything possible to prepare these specialists for possible crisis scenarios and provide them with maximum support, rather than throwing them into yet another vague reform with unpredictable results, which requires significant additional involvement from pharmacists in their already busy daily routine.

The author is an associate professor and one of the founders of the think tank Resilience of Healthcare Systems.