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Table 1 Multiple Approaches to improve community pharmacy operation and practice of pharmacists

From: Multiple policy approaches in improving community pharmacy practice: the case in Indonesia

Approaches (initiating bodies, year introduced/updated); References Objective Process to achieve objective
Type of approaches: Incentivization
Minimum rates for pharmacists’ remuneration (branches of IAIa, introduced in 2015); [29,30,31] Ensuring pharmacists receive adequate and fair income Pharmacy employer must pay employee pharmacists based on the minimum rate. The amount and composition of the income must be validated by IAI and become the consideration for issuing recommendation letter for pharmacists to practice
Payment for pharmacy services (MoH, updated in 2016); [32] Reimbursing pharmaceuticals and incentives for pharmacy services Community pharmacies working under the JKNb scheme receive payment for dispensing prescribed medicines and incentives for delivering pharmacy services. The method for distribution, the amount and the coverage of the payment can vary depending on the classification of pharmacy i.e. pharmacy affiliated with primary care providers, contracted by BPJS Health or both.
Type of approaches: Campaigns and communication
Gema Cermat - Community awareness campaign in using medicines (MoH, introduced in 2015); [33] Raising peoples’ awareness on proper use of medicines National campaign including workshops, group discussions and distribution of information e.g. books, posters, modules and audio-videos. Certain pharmacies and community pharmacists are invited to deliver public education such as talks, lectures and community outreach.
Dagusibu - Pharmacists campaign on self-management of medicines (IAI, introduced in 2014); [34] Public education on self-management of medicines Community pharmacies are encouraged to provide educational materials such as leaflets, brochures and posters in the pharmacy. With the phrase “Ask your pharmacist”, consumers are educated to obtain, use, store and dispose of medicines as advised by pharmacists. Participating pharmacists are rewarded with credits (SKPc) for license renewal.
Gerakan Keluarga Sadar Obat (GKSO) - Campaign for raising family awareness in using medicines (IAI, introduced in 2014); [34] Raising family awareness on self-management of medicines Run in tandem with Dagusibu program, GKSO targets the health of family through lectures, simulation and role play, CBIAd (active individual learning), training of pharmacists as trainers and recruitment of family members as health advocates. Topics for learning also include safe and proper use of cosmetics, food, beverages and narcotics/psychotropics. Participating pharmacists are rewarded with credits (SKP) to count towards their license renewal.
Image building of pharmacists (IAI, introduced in 2014); [35] Increasing pharmacists’ recognition Pharmacists are encouraged to wear pharmacist coat and name badge during practice in community pharmacy. The pharmacy must also display a sign board showing pharmacists’ names and practice hours. Credits (SKP) are awarded for pharmacist’s license renewal.
Type of approaches: Standard, policy and regulation
Registration, certification and licensure of pharmacists (MoH, updated in 2016); [36] Ensuring that pharmacists practice in a professional and ethical manner Community pharmacists are required to obtain four legal documents to practice; certificate of competence and recommendation letter issued by IAI, registration letter (STRAe) from the National Board of Pharmacy (KFNf) and license to practice (SIPAg) from the MoH. In order to obtain certificate of competence, new graduate pharmacists must pass a competency exam while registered pharmacists must collect a quantum amount of credits (SKP) during each five years of practice. The certificate is a pre-requisite to obtain STRA. Once the STRA has been issued, pharmacists must apply for a recommendation letter. The letter of recommendation and STRA are part of the application for SIPA. The license is valid for five years and a pharmacist can practice in up to three different pharmacies. Prior to expiration, pharmacists must renew the license by firstly obtaining a new certificate of competence. The updated regulation has allowed pharmacists to practice in up to three community pharmacies.
Collection of SKP (IAI, introduced in 2014); [37] Indicator for pharmacists’ participation in practice Pharmacists must collect minimum of 150 credits (SKP) during each five years of practice as a requirement for license renewal. In general, the credits are distributed to participation in continuing education program (e.g. CPD, workshop and peer group discussion) minimum 60 credits, undertaking professional practice (indicated by attendance report and record of providing services) minimum 60 credits, involvement in community outreach program (e.g. public campaign) minimum 7.5 credits, and voluntary participation in publishing ideas and knowledge development (e.g. conducting research, writing book and article) maximum 37.5 credits.
Pharmacy Practice Act (MoH, introduced in 2009); [38] Legislating pharmacy practice The Act which underpins pharmacy practice in Indonesia regulates different settings of pharmacy practice from manufacturing and distribution to service provision including community pharmacy. It also classifies the pharmacy workforce into two main groups: pharmacists and pharmacy technicians, with their designated responsibilities. The act legislates that pharmacy practice can only be conducted under responsibility and supervision of pharmacists.
Standard of pharmacy services in community pharmacy (MoH, updated in 2016); [39] Setting minimum services delivered in pharmacy The standard describes two main roles conducted by community pharmacists: management of pharmaceuticals and healthcare devices, and provision of clinical pharmacy services. The first role relates to the management cycle of pharmacy items from planning and procurement to disposal, record keeping and reporting. The second role covers pharmacy services which should be provided by pharmacists such as prescription assessment, dispensing, drug information, counselling, home pharmacy care, drug use monitoring and surveillance for adverse drug reactions.
Standard for pharmacy practice (IAI, introduced in 2014); [40] Developing standard for pharmacists to practice The standard consists of 9 (nine) key activities which must be conducted during practice: (1) providing fundamental pharmacy practice, (2) conducting drug assessment and review, (3) dispensing medicines and health devices, (4) compounding dosage form (specific to pharmacists in the pharmaceutical industries), (5) providing drug information and counselling, (6) delivering health promotion, (7) management of pharmaceuticals and health devices, (8) management of pharmacy settings, (9) maintaining skills and competencies. The standard sets minimum activities for pharmacists in the practice site.
Standard competency of pharmacists (IAI-APTFI-KFN, updated in 2016); [41] Setting the minimum competency of practicing pharmacists The standard comprises 10 (ten) main competencies which means pharmacists must be competent in: (1) delivering the practice of pharmacy in an ethical and professional manner, (2) optimising the use of medicines, (3) dispensing medicines and health devices, (4) providing information about the medicines and health devices, (5) mastering skills and knowledge of formulation and production of pharmaceuticals, (6) contributing to preventive and promotive community health, (7) management of medicines and health devices, (8) delivering effective communication, (9) active involvement in the organization and maintaining inter-personal relationship, (10) striving to improve competency. Graduate pharmacists must meet the minimum competency as defined by the standard.
Community pharmacy Decree (MoH, updated in 2017); [42] Establishing regulation for community pharmacy operation The decree is the main framework regulating the opening, license issuance and operation of community pharmacy. A community pharmacy can be opened by pharmacists with or without investment from other parties (individual, group or organization). An approval from the MoH, which can be delegated to the district government, is required before opening a pharmacy. In addition, district government has the right to manage the location and distribution of community pharmacy. Premises, facilities, and equipment of the pharmacy must meet certain standards and be approved prior to operation. The practice of pharmacy must comply with the regulation as similarly stated in the Pharmacy Practice Act and Standard of Pharmacy Services in Community Pharmacy. Each pharmacy must have a First-pharmacist as pharmacist in-charge for the operation and practice of pharmacy who can be assisted by other pharmacists (as second-pharmacist), technician and/or administrative employee.
Type of approaches: education and training
Continuing Professional Development (IAI, introduced in 2014); [43] Improving pharmacists’ competence and knowledge Pharmacists are encouraged to participate in CPD program. Pharmacists undertaking CPD program are rewarded with credits (SKP) which are essential for license renewal
Pharmacists Competency Examination (KFN, updated in 2016); [44, 45] Entrance to practice as pharmacists Graduate pharmacists must undertake the Competency Examination comprising a Computer Based Test (CBT) followed by an Objective Structured Clinical Examination (OSCE). The exam assesses pharmacists’ knowledge, cognitive skills and professional, legal and ethical decision-making. An alternative was given for pharmacists who graduated before 2011 who did not have a certificate of competence to undertake the OSCE (for pharmacists working in community pharmacy and hospital) or OSPE (Objective Structured Pharmaceutical Examination) for pharmacists working in pharmaceutical industries and wholesalers.
  1. aIkatan Apoteker Indonesia; bJaminan Kesehatan Nasional = Universal healthcare coverage program; cSatuan Kredit Partisipasi; dCara Belajar Insan Aktif; eSurat Tanda Registrasi Apoteker; fKomite Farmasi Nasional; gSurat Ijin Praktek Apoteker