Amrahi Buang, president of the Malaysian Pharmaceutical Society details the ‘lack’ of recognition and integration of pharmacists in Malaysia. He also explains the complex dual healthcare system and the governmental reforms needed to improve it.
You took position as president of the Malaysian Pharmaceutical Society in May 2016. Can you introduce yourself as well as the Society to our international audience?
“We are experiencing a more opened democracy and citizens are willing to learn about their rights. In only a couple of months, the changes have also been visible in the media and the reforms put in place can be seen.”
The Malaysian Pharmaceutical Society (MPS) is a non-governmental organisation and a national professional body for pharmacists headquartered in Kuala Lumpur, Malaysia. Today, 5,000 pharmacists are part of MPS and the Society represents all the registered pharmacists of the country, which accounts for around 16,300 registered professionals under the nation’s Pharmacy Board. MPS is the voice of these pharmacists covering their interests from their daily operational issues to the challenges they experience in regard to medicines.
I started in the MPS as a deputy in 2014, before being elected President in 2016 and re-elected for a second mandate in 2018. With more than 35 years of experience in a teaching hospital ( a statutory body) and it’s pharmacies, I am able to understand the needs of both public and private sectors which is crucial to comprehend and solve our members’ requests.
MPS holds the ambition to promote the profession of pharmacist and assist in improving health in the country. What has been the current priority for the MPS considering the unique governmental change that happened this year?
The change of government was very important for the country as it was the first time since Independence Day in 1957 that the majority changed, and it has brought in something new in Malaysia. We are experiencing a more opened democracy and citizens are willing to learn about their rights. In only a couple of months, the changes have also been visible in the media and the reforms put in place can be seen.
The healthcare sector will not be left aside and will also be impacted. Indeed, one of the new government’s priorities has been to tackle the country’s dual healthcare system challenge. To sum up, our national system is divided between the public and the private sector which both include primary care, secondary care and tertiary care. However, there is no integration between the public and the private sector making it more complicated for pharmacists to practice efficiently. 61 percent of the registered pharmacies are public while 39 percent are private and the latter would struggle more to dispense primary care as Malaysia does not have a dispensing separation, authorizing only the doctors to dispense drugs to their patients. Therefore, the Government has been working on a new Pharmacy Bill to answer this issue, but they have been struggling for more than twenty years to come up with a new regulation. The MPS hopes that with the historical change in the government will come the new Pharmacy Bill.
In this regard, you recently met Dr. Dzulkefly, the new Minister of Health, specifically to discuss the upcoming Pharmacy Bill. Can you tell us more about this meeting and its outcomes?
The main purpose of the meeting was to meet with the new Minister of Health and inform him of the pharmacists’ situation as well as highlight their issues in the country. MPS created a Manifesto detailing our members’ main challenges in the current healthcare sector and what reforms the Society would like to see from the incoming government. Some of the key topics raised were the national healthcare financing program, the Peduli Sihat program in charge of covering households with the lowest income, as well as the upcoming pharmacy bill that MPS is not supporting due to the bill’s maintain of the dispensing separation and the nonexistent system of itemized billing.
However, despite the Pharmacy Bill and all actions done by the Ministry around it being done in a transparent and truly democratic manner, the MPS regrets to see that the new regulations doesn’t recognize the pharmacists work for the society while they are also a part of the population in need of a better handling of their welfare.
MPS is aware of all the processes and issues the government has to go through but we think that they have the capabilities to make faster decisions so that changes can be implemented within their five years mandate. As a key stakeholder, MPS is participating in the discussion and in our Manifesto, we have requested a national health policy that would cover all citizens from womb to tomb which would include other Ministry such as Education and Women & Family for prevention and education services that complements healthcare. This policy would help support the already existing national medicines policy. The healthcare sector is looking forward to impactful changes and waiting for every stakeholder to be given a chance whether they are from the private or the public sector.
What are the main challenges that pharmacists are facing in the industry at the moment?
One of the first challenges is that nowadays, we cannot run away from the digital world, the 4th Industrial Revolution and Artificial Intelligence. Therefore, while prescription items are not allowed to be sold online, any pharmacy can sell its non-prescription products on a website as long as they follow a special system where products can be monitored and tracked. In that case, only the delivery system is different as it is made through the online channel. It can be a challenge for pharmacists and the new Pharmacy Bill, described earlier, will supposedly address the issue to ensure the regulations cover all cases of online sale.
However, one of the most tangible issues is that currently no price control system has been established in the private sector mainly due to a lack of communication between the different stakeholders involved such as the Ministry of Finance, the Ministry of Domestic Trade and Consumers Affairs, the NPRA (National Pharmaceuical Regulatory Agency) and the IPO (Intellectual Property Organization). The Malaysian Competition Commission (MYCC) has been tasked to study the open competition and price control environment in Malaysia in order to find a balance ground to work on and it recently published in December 2017 a market review of the Healthcare sector in Malaysia, showcasing the very complex structure of the Malaysian healthcare system which could explain the communication issue. Medicine pricing was also a part of our discussion with the Ministry of Health, as some form of control in the public sector does exist while nothing is in place in the private sector which is unfair for pharmacists. The current Ministry of Health is gathering all the information to study the possibility of a future price control scheme before making any decision.
Looking forward, how do you envision the role of pharmacists in the healthcare sector in Malaysia?
The pharmacists in Malaysia have to be looked at from two different angles. When talking about the public sector, the pharmacies are visible. Their role and importance is known and recognized. On the contrary, in the private sector, the role of the pharmacists has to be redefined and progress has to be made. We do not want to be seen as only a drug seller but as medicine experts, guardians of medicine and healthcare providers.
The distribution in rural areas and suburbs is not perfect yet, even though the fact that doctors can prescribe and provide medicines directly to the patients can be very useful when the pharmacy is farther away. In this regard, governmental actions have to be taken step by step to improve the situation and ensure all patients have the same access to quality healthcare. The new Malaysian government is bringing hope to the pharmacists’ community, but the citizens and patients’ education on what role the pharmacist takes in healthcare plays a crucial part in the recognition of the pharmacist profession. Therefore, the Malaysian Pharmaceutical Society will keep fighting for a better recognition of the profession in Malaysia.