P H A R M A C Y P R A C T I C E

Pharmacy practice in MalaysiaMohamed A. Hassali1, Vivienne M. S. Li2, Ooi G. See1

1 Discipline of Social and Administrative Pharmacy, School of Pharmaceutical Sciences, Universiti Sains Malaysia, Pulau Pinang, Malaysia2 Discipline of Pharmacy, Monash University Malaysia, Selangor, Malaysia

Abstract

Background:The pharmacists’ roles have been expanding around the globe in the recent years. InMalaysia, healthcare system is a two-tiersystem consisting of the public and private sectors. Pharmacy service in Malaysia came into existence in 1951 with the enactment of threemain legislations governing its profession, namely, theRegistrationofPharmacistAct 1951, PoisonAct 1952 andDangerousDrugAct 1952.However, the absence of dispensing right has limited the community pharmacists’ professional roles to deliver pharmaceutical care, opti-mise their clinical knowledge and utilise their skill.Aims: To describe the overview of pharmacy practice in Malaysia, by discussing on the history, challenges and future of this profession.Methods: Electronic databasesMEDLINE and PUBMEDwere searched for articles published in English. The keywords community phar-macy, pharmacy practice,Malaysia and pharmaceutical care were usedwith each database. The articles were independently identified byeach researcher.Results: A total of 8 full papers and 9 government reports were retrieved and critically summarised for this review.Conclusions: There is a need of transformation to bring improvement in pharmacy practice. Besides the policymakers, community phar-macists play a pivotal role to transform the current practice to a more comprehensive, clinically inclined and quality practice.

Keywords: community pharmacy, pharmacy practice, pharmaceutical care.

OVERVIEW OF THE MALAYSIANHEALTHCARE SYSTEM

Malaysia's healthcare system is a two-tier system consist-ing of the public and private sectors. The public healthcaresystem established in the early 1960s is funded by thegovernment and financed mainly from taxes on earnedincome and provide services to everyone through a net-work of general hospitals, district hospitals and healthclinics.1,2 As at December 2012, there were 140 publichospitals, 1025 health clinics which includes maternaland child health clinics and 1831 community clinicsnationwide.2

The privatisation of healthcare services in the 1980s inan effort to reduce the government's financial burdenresulted in an increase in the number of private hospitalsand health clinics. The private sector provides health ser-vices on a non-subsidised, fee-for-service basis through a

large network of private clinics and hospitals. As atDecember 2012, there were 209 private hospitals, 363 hae-modialysis centres and 6675 privatemedical clinics nation-wide.2 The private healthcare sector mainly caters for theurban population or those who can afford to pay. Privatesector health expenditure is funded by private healthinsurance, managed care organisations, out-of-pocketspending by people, private corporations and non-profitinstitutions.1

With such extensive coverage of health facilities, basichealth care is highly accessible in Malaysia. The SecondNational Health and Morbidity Survey in 1996 reportedthat 88.5% of the population stays within 5 km of a healthfacility.3 Meanwhile, the issue of equity in health careremains a concern especially for the indigenous, ruraland hard core poor. Between the years 1997 and 2002, theproportion of public to private sector healthcare expendi-ture ranged from 50:50 to 50:44 of the total expenditureon health.4 In recent years, public out-of-pocket healthcareexpenditure has increased steadily and this has led the gov-ernment to examine in greater details the possibility of ahealthcare transformation that will turn the current two-tier system to one that will be funded by a national healthfinancing scheme.2,3

Address for correspondence: Ooi Guat See, Discipline of Social andAdministrative Pharmacy, School of Pharmaceutical Sciences, Univer-siti Sains Malaysia, Pulau Pinang, MalaysiaE-mail: guatsee_ooi@yahoo.com

Official Journal of the Society of Hospital Pharmacists of Australia

© 2014 Society of Hospital Pharmacists of Australia Journal of Pharmacy Practice and Research (2014) 44, 125–128doi: 10.1002/jppr.1024

PHARMACY SERVICE WITHIN PUBLICHEALTHCARE SYSTEM

Pharmacy service in Malaysia came into existence in 1951with the enactment of three main legislations governing itsprofession, namely, the Registration of Pharmacist Act1951, Poison Act 1952 and Dangerous Drug Act 1952. Theestablishment of the basic structure of pharmacy serviceswithin the public healthcare system in Malaysia can beexplained in part by the history of the country. During theBritish colonisation, pharmacy services in Malaysia wererestricted primarily to the procurement, storage and distri-bution of drugs from the UK through the Crown Agents.5

Following independence, pharmaceutical services inMalaysia have grown from being the nation's supply ofpharmaceuticals to regulating and ensuring quality, safetyand efficacy of pharmaceuticals. The establishment of aDrug Control Authority (DCA) and its executive arm,National Pharmaceutical Control Bureau (NPCB), estab-lished under the Control of Drugs and Cosmetics Regula-tions 1984, gave rise to a more systematic pharmaceuticalregulatory system in Malaysia.5

In the 1990s, further expansionofpharmacy serviceswashampered by the shortage of pharmacists in the publicworkforce. Hence, in order to raise the number of pharma-cists in the country to World Health Organisation (WHO)standards of recommended pharmacist to general popula-tion ratio of 1:2000 by the year 2020, theMalaysian govern-ment has taken measures to increase the number of localacademic institutionsofferinganundergraduatepharmacycourse. In addition, the Ministry of Health (MOH) andPharmacy Board amended the pharmacist registrationprocess in 2005 to include a period of 4 years mandatorygovernment service in order to retain sufficient manpowerwithin the public sector. The increase in the number ofpharmacists in the public sector had allowed the establish-ment and expansion of clinical pharmacy services withinthe MOH.

PHARMACY SERVICES WITHIN THE PRIVATEHEALTHCARE SYSTEM

Pharmacy serviceswithin the private healthcare systemaremade up of primarily community pharmacists in pharma-cies who dispense and provide consultations on prescrip-tion and over-the-counter medications, vitamins andsupplements. There are approximately 2600 communitypharmacies in Malaysia and are mainly in urban areas.However, in the absence of dispensing separation, the onusof prescribing and dispensing medicines still lies withthe private general practitioners through the network ofprivate clinics. Hence, the role of community pharmacists

in Malaysia is severely limited under this orientation. Ascommunity pharmacies continue to mushroom throughthe years coupled with the lack of regulation in pharmacyzoning, the issue of unhealthy business competition (suchas price undercutting and unfair bonus scheme) amongthe pharmacy owners arises.6

Over the last decade, in an effort to uphold the profes-sion, community pharmacists in Malaysia have adoptedthe pharmaceutical care concept in transforming currentpractice from being product-oriented to that of patient-oriented services. The number of community pharmacistsproviding services beyond the traditional dispensing ofmedication has flourished to include services includingchronic disease management, medication managementreviews, smoking cessation and weight management pro-grams.However, at present, theprovisionof such extendedservices is voluntary and is not standardised across prac-tice. Nevertheless, efforts are underway to define the serv-ice framework.

CHALLENGES OF PHARMACY SERVICEIN MALAYSIA

Under theMalaysian PoisonAct 1952 (Section 7) andPoisonRegulation1952 (Regulation 3), privategeneral practitionersinMalaysia can prescribe and are also given the right to dis-pense medications from their healthcare clinics.7 Theabsenceofdispensing righthas limited thecommunityphar-macist's professional roles in the delivery of pharmaceuticalcare.8,9 The limited chance to dispense prescription medi-cines has also driven community pharmacists to diversetheir role into supplying health supplements and foods,homecare, personal hygiene and beauty products.9–11

The community pharmacists in Malaysia have limitedopportunity tooptimise their clinical knowledgeandutilisetheir skill. Community pharmacies are functioning muchlike a retail store while community pharmacists seldominvolve themselves in primary healthcare activities, butinstead, as suppliers of medicines or ‘retail assistants’ pro-viding advice on medications.12 The rise of the ‘price war’phenomenon also brings a negative impact on the phar-macy profession in Malaysia, through the unhealthy busi-ness competition among community pharmacies by priceundercutting of pharmaceutical products.13 Malaysiancommunity pharmacists also face challenges from profes-sional organisations. There are strong opposing views bytheMalaysianMedical Association (MMA) and consumerson the implementation of dispensing separation.14 In addi-tion, theperceived shortageof communitypharmacists andthe possibility of an increase in patients’health expenditureor out-of-pocket costs were the common reasons for the

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parties to oppose the separation of prescribing and dispen-sing practices in Malaysia.11

Another concern that has been raised recently amongcommunity pharmacists is the distribution of pharmaciesinMalaysia.There isa lackofcommunitypharmaciesdistrib-uted in small towns and rural places compared with theurban areas. The lack of regulation of pharmacy ownershiphas led to community pharmacies being controlled by non-pharmacists where the main motivation is profit making.

PHARMACY EDUCATION IN MALAYSIA

Pharmacy education also plays an important part in thepro-fession's shift towards a patient-centred focus profession.Both public and private universities in Malaysia offer a4-year pharmacy course. As of 31 October 2013, there are19 universities/institutions in Malaysia that offer under-graduate and postgraduate pharmacy programs, 5 ofwhichare public universities.15 Postgraduate pharmacy programs(i.e. by research or coursework) are offered in six majordisciplines, namely, Clinical Pharmacy, PharmaceuticalChemistry, Pharmaceutical Technology, Pharmacology,Physiology and Social and Administrative Pharmacy.16

Upon the undergraduate pharmacy graduation, phar-macygraduatesmust complete a 1-year internship as apro-visional registered pharmacist in any premises accreditedand approved by the Pharmacy Board Malaysia and passthe Pharmacy Jurisprudence Examination prior to beingfully registered as a pharmacist.17

In amove to ensure professional competence and to sup-port the educational needs of practising pharmacists inMalaysia, pharmacists are required tomeet the ContinuingProfessional Development requirements to ensure renewalof their Annual Retention Certificate as a registered phar-macist.18 In the private sector, aminimumof 30ContinuingProfessional Development points is required every 2years.18 In the public sector of the MOH, Continuing Pro-fessional Development is also viewed as an essentialelement of the pharmacist's performance evaluation, pro-motion and career advancement in MOH.19

FUTURE OF PHARMACY SERVICESIN MALAYSIA

The MOH Malaysia is currently reviewing all possiblepharmacy practice models for healthcare transformationwith a technical working group comprised of various sta-keholders in health care.While the exact scheme of the uni-versal healthcare model has yet to be finalised as of 2013,the pharmacy profession in Malaysia is positively antici-patinga shift inpractice specifically in the separationofpre-scribing and dispensing of medications. Recently, the

Pharmaceutical Services Division, MOH Malaysia, pro-posedanewPharmacyBill to replace thepre-independencelegislations (namely the Registration of Pharmacists Act1951, Poisons Act 1952 and Sale of Drugs Act 1952). Someof the important transformation initiatives that is set in theproposed bill include reclassification of medicines, liberal-isation of pharmacists’ practice license to more than onepremise and more deterrent penalties.20

Meanwhile, while awaiting this cornerstone legislativechange on dispensing separation, community pharmacistsin Malaysia are shifting their professional responsibilitiesfrom merely dispensing to providing extended services.While at present these services are provided free of charge,community pharmacists are now requesting for these pro-fessional services to be remunerated. However, severalissues regarding the provision of non-dispensing phar-macy services are yet to be systematically evaluated.

CONCLUSION

Transformation of the healthcare system is essential inMalaysia in order to bring improvement in pharmaceuticalcare providedbycommunitypharmacists to thepopulation,as dispensing will be totally entrust to pharmacists in thereformed system. Community pharmacists have to trans-form their current practice to a more comprehensive, clini-cally inclined and quality practice. There is a need for thetransformed healthcare system to optimise patient safety.As the most accessible healthcare professional, communitypharmacists play a pivotal role in themain streamof the pri-mary healthcare system. Thus, it is crucial to develop andimplement critical strategies to optimise the current andextended pharmacy services provided to the general public.

Competing interests

None declared.

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Received: 11 June 2014Revised version received: 07 August 2014Accepted: 12 August 2014

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