By: Mohammad Omar & Munira Ahmed Al-Tayyar
The profession of pharmacy in Yemen has become a rewarding business dominated by outsiders into the industry which is controlled by owners of capital, while the pharmacist with a scientific degree is exploited by drug dealers and profit seekers at the expense of people's health. Thus, the scientific certificates are useless for those who do not have experience, and the official license to practice the profession is useless if you do not own the capital to run the business.
This prompted many pharmacists to leave the profession and work in other fields, and some leased their certificates and business licenses for 30 to 50 thousand riyals, and sometimes it reaches 100 thousand, whereas other druggists work 12 hours a day for a salary that does not exceed 90 thousand Yemeni riyals a month.
"They want someone with experience"; With these words, Amjad Saif began his talk about his journey in searching for a job in a pharmacy in the capital, Sana'a, for a whole year, but unfortunately he did not find an opportunity. Amjad, 25 years old, who comes from Taiz governorate, is a graduate of the pharmacy department from a private university in Sana’a, has been dreaming of opening his own pharmacy to practice his profession, for which he had worked for many years.
Amjad talks to the “Khuyut” platform about the difficulties he faced during his journey, which lasted for a year, from wandering around the doors of drug companies, with hopes of finding a job. However, in practice, he discovered that the world of pharmacy is very different from what he learned in textbooks, according to him.
"I thought about opening a pharmacy, and I shared the idea with my family, but I faced numerous challenges, including: the difficulty in finding an appropriate location, the large number of pharmacies opened in the city, in addition to the lack of capital that would enable me to purchase all the pharmaceutical items that the pharmacy needs." Amjad said.
He continued by saying: "Merchants who have capital seek to exploit many pharmacy graduates by persuading them to rent their professional certificates and licenses and open a pharmacy in their names, in return for a sum of money ranging from 50 to 100 thousand Yemeni riyals deposited in their accounts monthly. An agreement is concluded between the two parties, the most prominent clauses of the contract is that: the holder of the certificate and license must attend to the pharmacy in the event of inspection by the health authority".
According to the survey conducted by the article's reporters, the percentage of those who agree to rent their medical certificates for a monthly sum is 14.3%, and the percentage of those who see renting a medical certificate as normal is 20%, while those who believe that the criterion for acceptance in pharmacies is mediation at a rate of 42.9%, whereas 20% % believe that a medical degree is essential to obtaining a job in pharmacies.
He asserted that "I know people and colleagues who have been working in pharmacies for years, and despite that, they rented their pharmacy profession certificates to business men who have capital in order to benefit from the financial lease returns paid by the leaser in order to obtain additional income without any efforts."
Amjad concluded his statement by saying: “Connections are key factor to be accepted to work in pharmacies or drug stores, and if you find work somewhere, you are required to bring a commercial warranty, in addition to five to three years of work experience. Such challenges prompt some to give up looking for job at a pharmacy and seek to work in other fields".
Hajj Nasser, a business man, preferred to invest his money in opening two large pharmacies after he rented two medical certificates of two pharmacists for a small lease amount, in exchange for huge profits that he reaps at the end of each month. Later, he decided to raise his net profits up to 100% by enrolling his son in a private university – pharmacology department, and after his son graduates and becomes a pharmacist, he will no longer need to hire any certificates for his project.
Sponsored ads on social media
While investigating the details of the phenomenon of renting certificates and licenses, we found many advertisements on social media some read as: A diploma or bachelor’s degree in pharmacy is required to be rented, with a contact number, and another ad reads: “A license is required to open a pharmacy in Sana’a, for those wishing to rent a license, contact the following number ".
We did not stop at these advertisements, but the authors of the investigation contacted some people who are engaged in leasing medical certificates, as if we are looking for license to rent in order to open a pharmacy.
Licensing: It is the document issued by the competent official authority for the establishment and operation of a private medical or health facility.
It is not easy for someone who wants to get a license or certificate for rent, you need people who have connections in the pharmaceutical market and know how to defraud the law. After searching and communicating, we found one of the dealers - who stipulated that his name not be mentioned in the report – who is familiar with leasing the licenses in addition to renting the medical certificates. We asked him about the financial fees, and he answered us that: the document can be leased for 50 thousand Yemeni riyals per month, whether for the license or the certificate. And about how the lease takes place, he responded by saying: There must be a contract between the two parties to be signed, and one of the most important conditions is that the tenant have to pay a full year’s rent.
In the same context, we contacted an office specialized in selling medical real estate and public services, after we found an advertisement on its page that a rental license is needed. We offered him a license for rent, but the surprise was that he asked us for a profession certificate, a license, and a medical syndicate ID in order to rent it to a person in Ammran governorate.
Jamil Al-Qatabri, who works as Director General of Planning and Policies at the Ministry of Higher Education and Scientific Research, believes that students’ demand for a pharmacy diploma instead of a bachelor’s degree lies in guaranteeing them a job opportunity after graduation, even with a low salary, either in pharmacies or in medical factories that have recently spread in abundance. With regard to leasing a pharmacy degree to business men, Al-Qatabri said: “I think this practice was widespread in the past, because the number of people with a bachelor’s degree in pharmacy was very limited and one of the conditions for opening a pharmacy was that it has to be in the name of a person who holds a bachelor’s degree, and this person bears full responsibility towards the competent authorities. The same was the case with those who obtained a bachelor’s degree in laboratories from public universities, but now the situation may have changed, and I have no information about the continuation of renting these documents or that it has flourished from what was previously."
Seasonal inspection campaigns
On October 19, 2019, the Ministry of Public Health and Population in the capital, Sana'a, announced, in a press conference, the results of the evaluation of pharmacies in the capital, Sana'a. The Ministry stated that the total number of pharmacies visited was: 1732; of which, 1,562 pharmacies were inspected, and 170 pharmacies were closed during the visit, and a decision was issued that these pharmacies to remain closed until all required papers are submitted to the Ministry of Health office in the capital.
According to the evaluation results, there are 1,335 pharmacies whose owners do not have licenses, 1,122 pharmacies whose staff do not have licenses to practice the profession, and 199 pharmacies with unqualified staff, while the number of violations reached 3,603.
Goods and levies
The irregularity of buying medicines without medical prescriptions opened the door to the spread of epidemics and diseases. You can explain the symptoms to your child and then he goes to the nearest pharmacy, only to return with a bag of medicine in his hands. This has become common after those who are not entitled to practice the profession become professional, and the most important goal of the oversight and inspection committees of pharmacies and drug stores is to collect levies and get monthly allowances.
The Secretary-General of the Yemeni Society for Consumer Protection, Saleh Ghaylan, confirmed to the “Khuyut” platform that: “There are some supervisory authorities in health offices that visit some pharmacies but they do not care about the inspection as much as they care about the monthly amounts or the bribes they will get from the pharmacies".
Although the Yemeni Society for Consumer Protection sent letters and notes to the Ministry of Health, and other competent authorities, not to grant licenses, and to prevent renting medical certificates, but it did not change anything, so that medicine became more like a commodity rather than a health service.
In addition, it was found that there are many pharmacists and those who hold a qualification in pharmacy, rent their certificates or licenses, and some go to the medical council to obtain the license and then rent it, until pharmacy has become a commodity store in which anyone can work, and in most cases, medicines are dispensed without a prescription, according to Ghaylan.
Painful Tales
There are many complaints by pharmacists describing their suffering in obtaining licenses to open pharmacies, due to blackmailing, which they say the ministry is practicing by exploiting them to pay large sums of money to obtain the license.
Selling and renting medical certificates to non-specialists has become commonplace, as 57.8% confirmed hearing about this matter, according to the survey conducted by the article reporters.
Ali Al-Hamdani recounts his story on his Facebook page, saying: "I spent more than a year searching for a job. I graduated in 2012 with a very good grade from the University of Science and Technology, after obtaining a two-year diploma, and I have a profession license, which I got after paying an amount of 100 thousand. However, they told me that my certificate is not accepted, and that I had to pay the fees.
Although I graduated from the largest university in Yemen, and in the end they say to me: "The certificate is not acceptable!”, Al-Hamdani wonders: “Why do you give me a license for the university, and grant me a profession license to practice a profession if my degree is not acceptable?!”. His colleague, Fatwan Al-Aghbari agrees with his statement by saying: “Yes, it is true.” It cost me 500,000 riyals to obtain the license along with the professional certificate.
For his part, Ziyad Al-Mohaya said: "The license costs you about one million riyals. This is in case you have a connection or dealer, and only God knows when you will get it, as it will take a long time."
Abdullah Al-Hussam is not much different from his colleagues, as he said: "I opened a pharmacy, and the length of the place was 5.80 CM. I went to get a license. I contacted a person who promised me that he would submit my file and obtain a license for me, but it turned out that he is just a blackmailer, as I paid him huge sum of money, more than 150,000 YRs but in vain. After that I went myself and submitted a request to open a pharmacy and obtain a license, but the responsible employee’s response was, “The shop’s area does not match the standard size of a pharmacy, and there is still 20 cm missing until your request will be approved.” I replied that, as soon as the tenant in the neighborhood comes out, I will rent his place and expand the area of the pharmacy by (20) centimeters. I have a bachelor's degree in pharmacy and I have a license of profession".
The pressure exerted by the competent authorities to deplete the money of the pharmacist who wants to work, and the obstacles he is experiencing make him give up in the end, as Al-Hussam did, he closed the pharmacy shop and sold it at a low price.
In a related context, Muhammad Aslan commented by saying: "A tenant came to me for the license, and I agreed with him to share with me the costs of the procedures for opening the pharmacy. In the end, I lost more than a million riyals, and I paid 120 thousand share."
According to the survey conducted by the article's reporters, the percentage of those who agree to rent their medical certificates for a monthly sum is 14.3%, and the percentage of those who see renting a medical certificate as normal is 20%, while those who believe that the criterion for acceptance in pharmacies is mediation at a rate of 42.9%, whereas 20% % believe that a medical degree is essential to obtaining a job in pharmacies.
Lack of Law application
Dr. Mohammad Al-Nuzaili, head of the Community Pharmacies Owners Syndicate, believes that the biggest problem lies in circumventing the application of the law. As the law stipulates the necessity of obtaining a license to manage and work in the health facility, and doing otherwise is a deliberate violation of the law, whether it is a nurse, pharmacist, or any medical specialty, as all of them bear a great responsibility towards the public.
He explained that the holder of the pharmacy certificate can obtain a license to open a pharmacy. Therefore, some pharmacists rent their license to another person, and this phenomenon does not exist in all countries of the world - only in Yemen. Some countries can allow the license to be rented, but it is not allowed to be rented to anyone who has nothing to do with the profession, rather it shall be rented to a peer pharmacist who has financial ability.
Al-Nuzaily clarifies the issue of renting a license by saying: "It was not mentioned in any law, and this is forbidden because the conditions for practicing the profession are clear; that whoever provides the service must have an academic qualification to ensure that the patients health are protected against any risks."
Moreover, he indicated that there is a clear defect on the part of the official authorities in the management of the pharmaceutical vision, and this shortcoming is represented in the absence of the technical specialists, and this is considered an intentional negligence that makes the pharmacist stumble and unable to work in the pharmacy or hire another pharmacist.
"Whoever works in a pharmacy must be a licensed pharmacist and not a student, but if he surrenders it to an unlicensed pharmacist, merchant, or others, then he is committing a major violation, and the objectives of medical laws and the legal conditions for licensing must be abided by." He added.
Al Nuzaili referred to the disagreement of the Community Pharmacies Owners Syndicate with officials in the health offices, regarding the poor implementation of the law, as stated in Articles (4, 5, and 6) of the Private Health Facilities Law issued in 1999. He added that the Syndicate cannot prevent or activate a role against pharmacy intruders.; Because they enjoy protection in return for paying monthly sums to the officials of the health offices, as the fine for each violator is 15,000 riyals per month.
Despite the hazards arising from the random work of Yemeni pharmacies, 71.1% of the respondents had not heard of the closure of pharmacies due to their violation of standards, according to the questionnaire conducted by the reporters of the story.
On August 21, 2019, the Syndicate of Pharmacy Owners stated that nearly 2,800 female pharmacists are reluctant to work, in addition to more than 1,600 pharmacists working in drug promotion, approximately 1,200 pharmacists who have left the country to work in neighboring countries, and 400 pharmacists of various degrees practicing academic work.
The syndicate added that 800 pharmacists are involved in government administrative work, and more than 100 pharmacists practice pharmaceutical manufacturing. This means that a total of 5,200 pharmacists do not practice their work in community pharmacy. So where are the concerned authorities and where is the planning and development in terms of optimal and service employment for the pharmacist in community pharmacies that are teeming with “intruders” and threatened with bankruptcy?!
Further, on August 29, 2019, the Syndicate of Pharmacy Owners called on the health and local authorities in Sana'a to close all unlicensed pharmacies and drug stores. In its statement, the syndicate said that the total number of unlicensed pharmacies in Sana'a has reached about 800, in addition to about 500 private clinics that own pharmacies, and that about 200 merchants sell medicines directly to patients, and about 600 drug stores sell medicines without controls.
Ahmed Mohammad Al-Sobati, Dean of the College of Pharmacy - Sana’a University, and professor of clinical and professional pharmacology, believes that the problem facing graduates of the College of Pharmacy is the same problem that faces any graduate from the university. Where the graduate moves from the academic life to the practical life and the reality field which he may not have imagined. However, there is a great advantage for the graduates of the College of Pharmacy, which is that there are many job opportunities in front of them, so we find some of them finish the final exams in the last level of the bachelor’s degree and they are really confused because of the large number of options in front of them.
That is why the graduate's mind is filled with many questions that he needs to ask, so he begins to ask his old colleagues what they did and who is more fortunate in his work after graduation. And he added, “Of course, we find that most pharmacy graduates tend to work in drug marketing, and this is the shortest path for a graduate who cannot open a pharmacy. Although this trend transforms a pharmacy graduate from a pharmacist, who has studied drug formulations and everything related to medicine for five years, to a promoter or a marketer for one or two products or a company’s products, and tries to convince doctors and pharmacies of the drug he is promoting in order to increase sales for the company he works with. Thus, he tries to convince others of this drug even if he knows its risks and harms or knows its ineffectiveness, and that there is a better drug in the market, but he is forced to say contrary to what he knows for the sake of a living, and this is contrary to the ethics of the profession and the oath that he took on graduation day".
He also emphasized that certificates and licenses are not rented, because they are given to the concerned person only, and it may not be rented to whoever or to any party, because it gives professional authority to the pharmacist himself, and no one else can work under those documents.
He added: "The holder of the certificate can obtain a license to open a pharmacy, and therefore there are some pharmacists who rent their licenses to another person, and this phenomenon does not exist in all countries of the world - only in Yemen. In some countries, it may allow the license to be rented, but not to any trader, rather it is leased to a pharmacist who has capital and wants to open another pharmacy. In all cases, even if the license is leased, it is stipulated that whoever will work in the pharmacy shall be a pharmacist (a pharmacist is anyone who holds a bachelor’s degree in pharmacy), and he is responsible for managing the pharmacy and accountable for supervising the technician who works in this pharmacy, and he is responsible for any error in dispensing any medicine, a full responsibility before God and before the law.”
Al-Sabbati stresses that “the harmed are the pharmacists and the citizens, because the merchant who hires graduates of agriculture, science, or commerce to work in the pharmacy, in this case, he will cause unemployment of a specialized pharmacist. And the most dangerous thing is that the one who will dispense the medicine from the pharmacy under the same leased license, will be a non-specialized person, and this will lead to catastrophes and serious mistakes that may lead to severe damage to patients and society. In fact, there are many disasters that have happened, knowing that a qualified pharmacist has the right to dispense some medications without a prescription, and these drugs that are allowed to be dispensed are approved by the US Food and Drug Administration. Therefore, it is not permissible to dispense it without a prescription except through the pharmacist, so what do we expect if an unqualified person dispenses it?!"
Malak (a pseudonym), a female student who dreamed of becoming a doctor since she was a child, and in fact she became a pharmacist with a suspended execution, as her father allowed her to study at the university in the pharmacy department, although she was not inclined to specialize in pharmacy, but her father had other plans. As soon as she graduated, her father opened a pharmacy for her brother Qasim (a pseudonym) using her certificate, and she was married to her cousin, and Qasim, who merely completed high school with a poor rate, became the pharmacist and the person in charge of the pharmacy!
Despite Malak's opposition to the idea, no one listened to her, or paid any attention to her opinion.
Dr. Musleh Abbasa, a former Director General of Pharmacy and Medical Supply at the Ministry of Health for 33 years, during which he served the community, two court verdicts were issued against him. Therefore, he appeals to the President to investigate the corruption of health management and to preserve the prestige of the state through the application of the law and respect for the judiciary.
Abbasa added, "Opening a private pharmacy is not an area of investment at all, and for the High Authority for Medicines to use public money to invest in opening private pharmacies is contrary to the constitution and the laws in force."
The percentage of people who rely on the opinion of a pharmacist for a prescription without referring to a doctor because they do not have money is 31.1%, and the percentage of people who doubt the work of pharmacists who are not specialized in pharmacology increased to 40%, while the percentage of medical errors committed by pharmacists when dispensing medicines is 31.1 %.
And he asserts: “We, Yemeni pharmacists, have three judicial rulings and an order on a petition, all of which prohibit the opening of a pharmacy inside the campuses of government hospitals, and prevent the granting of any legal person to open a private pharmacy, because a private pharmacy is a right of the pharmacist alone.” The Yemeni Company for the manufacture and trade of medicines was banned from opening a commercial pharmacy on the campus of Al-Jumhuri Hospital in Sana’a, and the administration of the Al-Jumhuri Hospital in the capital secretariat was also prevented from opening a private commercial pharmacy on the campus of Al-Jumhuri Hospital".
As for opening private commercial pharmacies that sell medicine and medical supplies, it is a shameful, a disgraceful and a harmful act, and a violation of the laws in force, and it violates the legitimate rights and interests of Yemeni pharmacists.”
He pointed out that: "The license to open a private pharmacy is granted to the pharmacist only, and shall not be granted to any investor or to any legal person, and the Supreme Medicines Authority is a legal person, and the private pharmacy is a health service, not a commercial service, and the evidence for this is that the license to open a private pharmacy is granted by the Ministry of Health only, not by the Ministry of Commerce and Industry".
According to Article No. (51) of Cabinet Resolution No. (132) of 2004 regarding the executive regulations of Law No. 60 of 1999 regarding private medical and health facilities, private pharmacies shall never be an area of investment.
Lawyer Abdulraqeeb Hammoud confirmed that renting certificates is in order to obtain a license to open a pharmacy given that only those who hold a doctor’s or pharmacist’s certificate, as well as a profession license, can obtain a license, and whoever violates this is considered a violation of the law.
Lawyer Khaled Al-Akwa’a agrees with him on this, adding that Law No. (26) of 2002, regarding the practice of medical and pharmaceutical professions, stipulates a penalty of imprisonment for a period of no less than three years or a fine of no less than 700,000 Yemeni riyals against anyone who claims or practices the medical profession (medicine, surgery, or pharmacy profession of non-specialists).
Anonymous robber
Pharmacist Dr. Adel Al-Jumaei speaks to the “Khuyut” platform, saying: “Leasing a license to a pharmacy means one thing; that the owner of the pharmacy is not a pharmacist, otherwise he himself would have opened the pharmacy in his name. Therefore, this often causes injustice to the patient and a betrayal of scientific and religious trust, because when renting the license, errors and disasters may occur caused by the non-pharmaceutical person who rented the certificate, and the lessor is responsible for that.
Al-Jumaei pointed out that there are many blackmails that pharmacy owners are subjected to by the General Authority for Drugs, by focusing on very superficial matters such as the requirement of a glass door, Spanish tiles in the pharmacy, a thermometer, or “lap coat” to be worn by the pharmacist. They neglect the important aspects that may harm the citizen, such as investigating if the person working in the pharmacy may not a pharmacist, or the medicine being counterfeited, smuggled, expired, or wrongly described. This is in addition to the high costs of licensing, renewal and other official procedures, which is considered extortionate, especially in light of the lack of jobs in general and low income.
Employing children under the age of 15 in pharmacies is disastrous. If a pharmacist’s assistant, who has studied for two years, is not considered qualified to deal with medicine and patients, underage child will certainly not be qualified, and this is a crime, as the wrong medical prescription or selling improper medicines leads to the death of the patient. According to the survey conducted by the authors of the report, 40% of sample confirmed that they encountered children under the age of 18 working in pharmacies.
Likewise, the percentage of people who rely on the opinion of a pharmacist for a prescription without referring to a doctor because they do not have money reached 31.1%, and the percentage of people who doubt the work of pharmacists who are not specialized in pharmacology increased to 40%, while the percentage of medical errors committed by pharmacists when dispensing medicines is 31.1 %.
The Secretary-General of the Yemeni Society for Consumer Protection, Saleh Ghaylan, agrees with him regarding some people's reliance on the pharmacist to dispense medicine without any diagnosis or examinations. The result is noticeable to everyone through the high number of patients who travel to Jordan and Cairo to be treated for medicines that were taken here with wrong prescriptions, and the reason is also the employment of non-specialists in this profession. Even specialists consider this profession purely commercial, as there are no bodies that regulate or supervise this profession.
Difficulties and problems
Al-Jumaei also believes that those entering the profession compete with pharmacists for their livelihood without any qualifications or experience, in addition to the huge sums of money amounting to 500 thousand Yemeni riyals to obtain a license. There are also influential parties that open pharmacies inside government hospitals, which negatively affects the income of external pharmacies, and many laws have been introduced in recent years that have greatly restricted pharmacists in their work due to problematic requirements or high fees, in addition to deadly taxes that directly affect their monthly income as owners of pharmacies and affect attempts to competition to reduce drug prices.
In addition, companies manipulate prices, so they sell at different prices to customers according to their purchasing power. As a result, the small pharmacist is harmed as he buys at a high price, then he is forced to face loss or problems with patients because of the difference in the price of the medicine that is sold to other pharmacies at a cheaper price. In addition, there are also problems related to the lack of vital medicines, the fluctuation of prices, and the deterioration of the country's situation in general, which cast a shadow on everyone.
Results of the survey
The authors of the report conducted a short questionnaire to cast the opinion of the Yemeni citizen about the performance of Yemeni pharmacists for a random sample of 45 people. The percentage of patients who did not trust the pharmacist’s opinion about a prescription and who only bought medicine with a doctor’s prescription was 44.4%.
The results also showed that the percentage of people with chronic disease represented 86.7%, whereas the percentage of those who feel satisfied with the performance of pharmacies reached 37.8% only and those who were dissatisfied reached 62.2%, with pharmacies receiving a poor evaluation of 42.2%. This problem comes from the fact that the citizen does not verify the identity of the pharmacist when purchasing the drug, as they go in a hurry, as indicated in the questionnaire. The percentage of those who go in a hurry to get a medication reached 51.1%, while 53.3% prefer to buy from well-known pharmacies and do not resort to verification, since that is not their duty.
In the questionnaire dedicated for pharmacists, a sample of Yemeni pharmacists consisting of 35 pharmacists; 68.6% of them have bachelor’s degrees, 31.4% have diplomas, 25.7% graduated from public universities, and 74.3% graduated from private universities.
Furthermore, 40%, of the surveyed pharmacists believe that the role of the syndicate was poor and useless, as well as the role of the Syndicate of Owners of Community Pharmacies, 42.9%, while 77.1% of pharmacists were dissatisfied with the services provided by the Ministry of Health and the Medical Council.
