Islamabad: At a time when Pakistan is already struggling with rampant self-medication and the unchecked use of powerful antibiotics, steroids and even new generation therapies without consulting qualified doctors, a renewed push by some pharmacists seeking prescribing rights has sparked a serious policy debate in the country.
Senior healthcare professionals, public health experts, medical regulators and even senior pharmacists warn that such a move could further compromise patient safety.
The debate has resurfaced following public advocacy by some pharmacists who argue that allowing them to prescribe medicines for minor illnesses would ease pressure on doctors and improve access to healthcare.
Critics, however, say the proposal overlooks Pakistan’s weak regulatory environment, fragile patient safety mechanisms and the widespread misuse of medicines already taking place at pharmacy counters across the country.
Senior pharmacist and health policy expert Abdul Latif Sheikh, who has been closely monitoring the discussion, questioned whether the profession itself is prepared to shoulder such responsibility.
“We are witnessing long winded narrations about pharmacists prescribing medicines at pharmacy counters, but no one seems willing to ask the most basic and uncomfortable questions,” he said.
Sheikh cautioned against attempting to replicate models from Western or advanced healthcare systems without adapting them to Pakistan’s realities and questioned whether the current pharmacy curriculum equips graduates with the clinical competence required to diagnose patients, conduct examinations, order investigations and prescribe medicines while ensuring patient safety.
“Upon acquiring a degree, pharmacists become qualified to dispense and sell medicines. Are we actually trained for direct clinical responsibility? Are there role models in academia or practice who can mentor young pharmacists for the role that is now being advocated?” he asked.
He also highlighted a deep structural disconnect between pharmacy education and practice in Pakistan, noting that many academics have never practised in real clinical settings, while many practitioners have never taught.
“The entire spectrum of pharmacy education and practice would have to be rebuilt from the ground up. For the sake of vanity, we should not be playing with the lives of patients by leaving them at the mercy of medicine sellers at counters,” Sheikh warned.
Medical regulators have taken an equally firm position, with Pakistan Medical and Dental Council President Dr Rizwan Taj saying the law clearly restricts prescribing authority to registered medical practitioners.
“As per law, only a registered practitioner can prescribe medicines. Pharmacists do not have the expertise to diagnose, examine patients, order investigations and then prescribe treatment,” Dr Taj said.
He warned that granting prescribing rights would raise serious patient safety concerns and could further aggravate Pakistan’s already alarming culture of overprescribing.
“This will inevitably lead to overprescribing and misuse of controlled substances,” he added.
Renowned paediatrician Prof Jamal Raza, Executive Director of Sindh Institute of Child Health and Neonatology Karachi, described the proposal as completely unacceptable.
“It will open a huge door to malpractice, illegal practices and other serious problems,” he said.
Drawing a sharp analogy, Prof Raza compared the idea to superficial administrative measures that fail to address deeper systemic issues.
“This is like banning double sawari to control crime in cities,” he remarked, stressing that the real need is to improve medical practice standards through effective regulation rather than diluting prescribing authority.
“The solution lies in gradually improving doctors’ practices through healthcare commissions and stronger accountability, not by creating parallel prescribers,” he said.
Health policy expert Prof Shahzad Ali Khan, Vice Chancellor of Health Services Academy Islamabad, said the proposal is unlikely to move forward given Pakistan’s political and professional landscape.
“First of all, it will never be allowed in Pakistan,” he said.
He pointed out that doctors’ associations are powerful and well connected, while the pharmacy sector remains divided and suffers from a poor public image.
“So don’t worry. Status quo will prevail,” he remarked.
The opposition comes at a time when Pakistan is already facing a public health crisis driven by irrational drug use. Experts warn that third generation antibiotics, steroids and potent cardiovascular drugs are freely available without prescriptions, fuelling antimicrobial resistance, adverse drug reactions and avoidable hospitalisations.
However, Sardar Shabbir Ahmed, Secretary of the Islamabad Capital Territory Quality Control Board and a former secretary of the Pakistan Pharmacy Council, said pharmacists are already allowed to prescribe medicines for minor ailments in countries such as the United Kingdom and Canada, and argued that Pakistan should move in the same direction after putting proper training and safeguards in place.
He said Pakistan faces a severe shortage of healthcare professionals, with a doctor to population ratio of around one doctor for every 8,000 people, making access to quality and affordable healthcare a major challenge.
“People are already going to pharmacies for minor ailments and seeking medicines from pharmacists,” he said, adding that widespread quackery has further complicated the situation. Allowing trained pharmacists to prescribe limited medicines, he argued, could help discourage unqualified practitioners who currently exploit patients.
Sardar Shabbir Ahmed said Pakistan has more than 70,000 trained pharmacists, a number expected to exceed 200,000 in the coming years, who could play an important role in managing chronic conditions such as diabetes and hypertension. However, he stressed that no blanket permission should be granted.
“Only properly trained and qualified pharmacists, with additional education and certification, should be allowed to prescribe within a clearly defined scope,” he said.
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