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ISLAMABAD: Patients in Pakistan are being prescribed more than twice the medicines recommended by the World Health Organisation (WHO), with generic prescribing also remaining low, a new study found.
The study was carried out by researchers at the Health Services Academy (HSA), Islamabad, and published in the journal Discover Public Health. It reviewed 15 research papers on prescribing practices at hospitals and clinics across Punjab, Khyber Pakhtunkhwa, Sindh, Balochistan and Islamabad, covering the years from 2013 to 2024, to find out whether doctors in Pakistan are following WHO prescribing standards.
On average, patients were given 4.2 medicines in one prescription, against a WHO limit of 1.6 to 1.8. In one tertiary hospital in Peshawar, the average was 10.56 medicines per prescription, nearly six times the recommended number. Even the lowest figure recorded among the 15 studies, from an emergency department in Bahawalpur, was higher than the WHO limit.
Only about 25% of medicines were prescribed by generic name, against a WHO target of 100%. In some hospitals, generic prescribing was close to zero. Only two of the 15 studies found generic prescribing above 50%.
Antibiotics were present in 45% of prescriptions on average, against a WHO limit of 20 to 26.8%. Injections were given in over 27% of prescriptions, also higher than the WHO limit of 13.4 to 24.1%, though this varied sharply between hospitals, from zero to as high as 98%.
Only 72% of medicines prescribed came from Pakistan’s essential medicines list, which should ideally be followed 100% of the time.
Prof Shahzad Ali Khan, Vice Chancellor of the Health Services Academy and one of the study’s authors, said the pattern was found across every type of healthcare facility studied, from small primary care clinics to big teaching hospitals. “This is not the problem of one hospital or one city. It is happening across the country, at every level of healthcare,” Prof Khan said.
He said doctors often prescribe antibiotics and injections without proper testing, partly because patients ask for them, believing they act faster. “Patients think an injection or an antibiotic will cure them quickly. Doctors, under pressure and short of time, often give in,” he said.
The findings add to growing concern over antibiotic misuse in Pakistan. Federal health authorities said earlier this year that antimicrobial resistance in priority bacteria and fungi could kill more than 262,000 people in Pakistan over the next 25 years, according to a report in The News. Pakistan has since prepared a national Priority Pathogen List to guide hospitals on which drug-resistant infections need the most attention.
The Drug Regulatory Authority of Pakistan had earlier directed that antibiotics only be sold against a prescription from a registered doctor, after data showed that antibiotics worth Rs135 billion were consumed in a single year, with 70 to 80% of that used for illnesses that did not need antibiotics at all.
Prof Khan said low use of generic medicines was linked partly to marketing by pharmaceutical companies, and partly to a belief among doctors and patients that generic medicines do not work as well as branded ones, even though there is no proven difference in quality.
He said Pakistan already has prescribing guidelines in place, but they are rarely enforced. “The problem is not a lack of policy. The problem is that the policy is never followed on the ground,” he said.
The study recommends regular checks on what doctors are prescribing, feedback for prescribers, and action against those who repeatedly break the rules. It also calls on the government, drug companies, hospitals and doctors’ associations to work together.
Prof Khan said the health ministry, provincial health departments and the medical profession all needed to act together. “Until this happens, patients will keep taking more medicines than they need, and antibiotics will keep losing their effect against disease,” he said.
