Availability of registered pharmaceutical structures in South Africa : 2003 until 2008
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Despite the deteriorated state of health care in South Africa, the government remains committed to realising the right of every citizen to access health care, including good, quality and essential drugs. In recognising the availability of pharmaceutical facilities as a major component of access to health care, and the previous imbalances in the distribution of pharmaceutical structures and services, laws pertaining to the licensing and ownership of pharmacies were amended and promulgated in 2003 to address the distribution problem. In addition, regulations relating to a transparent pricing system on medicines and related substances were introduced in 2004. These, coupled with factors influencing the choice of a pharmacy location, and the deficiencies in human resources exercising an impact on both pharmacy and other health care personnel, have influenced the distribution and availability of pharmaceutical structures in South Africa from the year 2003 to 2008. OBJECTIVE: The main objective of this study was to investigate the availability and distribution of pharmaceutical structures registered with the South African Pharmacy Council, in South Africa, as of 2003 until 2008. METHOD: Data on the total number and geographical distribution of registered pharmaceutical structures in South Africa were obtained from the South African Pharmacy Council's register of pharmacies of August 2003, 2004, 2005, 2006, 2007 and 2008. The registered pharmaceutical structures were categorised according to their nature of services to the patient into "direct service" and "indirect service" (support) pharmacies. Availability was taken to refer to the actual presence of the pharmaceutical structures in relation to the demand for the services and measured quantitatively using population: provider ratios. The 'population' for indirect service pharmacies was taken as the direct service pharmacies and, the 'population' for direct service pharmacies was taken as the estimated population of the different geographical regions. RESULTS: The results revealed a 12% increase in the total number of registered pharmaceutical structures between the study years, to a total of 4227 pharmaceutical structures in 2008. Gauteng was identified as the province with the highest number of registered pharmaceutical structures, while the Northern Cape province contained the lowest number of registered pharmaceutical structures throughout the entire study period. The percentage of municipalities without any registered pharmaceutical structures decreased from 23% in 2003 to 19% in 2008. The indirect service pharmacies constituted 14% of the total number of registered pharmaceutical structures in South Africa. Most of these structures were situated in the province of Gauteng throughout the study period. National availability of these structures only improved for the manufacturing pharmacies. The registered direct service pharmacies increased by 13.2% to total 3642 pharmacies in 2008. Approximately 20% of the municipalities in the country (respectively 5.5% of the population) did not contain any registered direct service pharmacy in 2008. Most of these municipalities were situated in the KwaZulu-Natal province. The province of Gauteng contained the highest proportion (32%) of the direct service pharmaceutical structures. The decrease in the pharmacy per population ratio of the structures from 1: 14 547 people in 2003 to 1: 13 615 people in 2008 indicated an improvement in the availability of the structures. However, the improved availability did not take effect within each province as the Northern Cape, Mpumalanga and Gauteng provinces experienced an increase in the pharmacy per population ratio. CONCLUSION: The availability of registered pharmaceutical structures in South Africa improved between 2003 and 2008. However, the distribution of these structures remains geographically uneven and inequitable to the population of the country.
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