Skip to content


  • Poster presentation
  • Open Access

Cross sectional study of drug substitution in community pharmacies in the Ugandan capital city

  • 1, 2,
  • 2 and
  • 2
BMC Health Services Research201414 (Suppl 2) :P84

  • Published:


  • Community Pharmacy
  • Generic Medicine
  • Generic Substitution
  • Essential Medicine
  • Data Collection Tool


The escalating cost of pharmaceuticals is a global challenge and major hindrance to access to medicines in developing countries. Half of the Ugandan population lacks reliable access to essential medicines and out of pocket expenditure by patients is as high as 80% [1]. Generic medicines provide an opportunity for savings on medicine expenditure due to their cheaper price [2, 3]. Generic substitution has been recommended by World Health Organisation and is widely practised in Africa as long as the prescriber does not forbid nor the patient decline [4]. Therefore, this study was conducted to determine the nature and prevalence of drug substitution in community pharmacies in Kampala, the capital city of Uganda. Dispensers’ perceptions were also explored.

Materials and methods

It was a cross sectional descriptive study employing two data collection tools; a structured questionnaire administered to dispensers in a random sample of community pharmacies and simulated patients presenting with prescriptions developed and validated by the research team.


Up to 133 community pharmacies in Kampala city were included in the study. Almost all (n=127, 96%) community pharmacies practised drug substitution. The most common forms of drug substitution were innovator medicine to generic medicine (85%) and generic medicine to other generic medicine (82%). Up to 92% of the pharmacies substitute “over the counter” drugs while 56% substitute medicines on prescription. Only 24% of the pharmacies did not consult the prescriber before drug substitution and majority (75%) considered the price of the drug before drug substitution. Knowledge of drug substitution policy was low and many (61%) dispensers thought Uganda has no national policy on drug substitution.


Drug substitution involving both innovator medicine to generic medicine and generic to generic medicines is wide spread in community pharmacies in Kampala city.

The drug regulatory authority should focus on therapeutic equivalence studies and safety profile of approved generic products to better protect the public from substandard medicines.

Authors’ Affiliations

Pharmacy Department, International Hospital of Kampala, Kampala, Uganda
Pharmacy Department, Makerere University College of Health Sciences, Kampala, Uganda


  1. The World Medicines Situation WHO/EDM/PAR/ (2004.5). 2004, Geneva, Switzerland: World Health Organization, []
  2. Haas JS, Phillips KA, Gerstenberger EP, Seger AC: Potential savings from substituting generic drugs for brand-name drugs: medical expenditure panel survey, 1997-2000. Annals of Internal Medicine. 2005, 142: 891-897. 10.7326/0003-4819-142-11-200506070-00006.View ArticlePubMedGoogle Scholar
  3. King DR, Kanavos P: Encouraging the use of generic medicines: implications for transition economies. Croatian Medical Journal. 2002, 43: 462-469.PubMedGoogle Scholar
  4. Kjoenniksen I, Lindbaek M: Patients’ attitudes towards and experiences of generic drug substitution in Norway. Pharmacy World and Science. 2006, 28: 284-289. 10.1007/s11096-006-9043-5.View ArticlePubMedGoogle Scholar


© Nabbale et al; licensee BioMed Central Ltd. 2014

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver ( applies to the data made available in this article, unless otherwise stated.