Pharmacovigilance Patterns of Unsafe Medicines and Health Products in Communities, and Community Participation in Northern Thailand: A Case Study of Border Medicines, Community Medicines, and Antibiotic Use in Aquatic Animals

Abstract

Background and rationale: The distribution of unsafe medicines and health products in communities in Thailand’s Northern region remains a persistent problem with widespread public health impacts. Surveillance management is implemented in line with the national strategy to promote rational drug use. This study aimed to examine the implementation patterns of community surveillance for unsafe medicines and health products, as well as the roles of network partners in addressing three key drug-related problems in the North: border medicines, community medicines, and antibiotic use in aquatic animals.

Methodology: This qualitative study collected data through focus group discussions to extract lessons learned from stakeholders involved in surveillance implementation. Data were collected from November 2023 to May 2024. Informants comprised 56 representatives, including primary care pharmacist leaders and local network partners. The border-medicine case was studied in Chiang Rai and Phayao provinces; the community-medicine case in Chiang Mai and Mae Hong Son provinces; and antibiotic use in aquatic animals in Phayao province. Data were analyzed qualitatively, and inductive conclusions were drawn.

Results: Three distinct surveillance implementation patterns were identified across the case studies. All patterns comprised four main themes representing the surveillance process: (1) situational survey in the area, (2) communication of situational information to the network, (3) development of tools and operational guidelines for surveillance, and (4) coordination to jointly address problems with the community. In the case of unsafe medicine at border, the primary care pharmacist team assessed the situation and found the smuggling of dangerous drugs and products without Thai FDA (Food and Drug Administration) approval, with incorrect labeling, passing border checkpoints, reaching border markets, and then distributed via mobile vendors and online channels. Information on unsafe products and their impacts was communicated to network partners. Tools were developed targeting various product types and using LINE chats for rapid risk alerts. Coordination with communities and security and authoritative officers was undertaken to confiscate at informal crossing points and issuing local ordinances as the control measures. In the case of unsafe medicine in community, primary care pharmacists assessed the situations by reviewing complaints received by the Council of Consumer Organizations (CCO) Thailand, conducting inspections of groceries and patient home visiting with multidisciplinary teams. The information was presented as distribution route maps of unsafe medicines and disseminated to network partners to reflect the problems to maintain shared surveillance roles and responsibilities. Tools were developed to help data collection and generate context-appropriate communication materials and registered as trigger tools. Coordination with communities was carried out through the district health system (DHS) policy board, and the Rational Drug Use (RDU) Community mechanisms, along with community leader strengthening for household-level surveillance. In the case of unsafe antibiotic use in aquatic animals, primary care pharmacists, together with the CCO and the provincial health office, conducted an in-depth assessment of antibiotic use and water management at the tilapia farms, including antibiotic residue tests in fish, water, and feed. Findings were communicated to the provincial fisheries office, the cooperatives, and farmer groups, to formulate systemic corrective measures. Tools were developed as supporting documents and manuals for good agricultural practice (GAP) standards. Coordination with communities used cooperative mechanisms for quality control, promoting safe-food policy, and providing “chemical-free” certification to establish market mechanism. This served as a model of community-based management of antimicrobial resistance example.

Conclusion: Across the three Northern case studies on community surveillance of unsafe medicines and health products, the implementation patterns differed depending on the context, while the key operational steps were similar. Public health agencies were the main drivers, with primary care pharmacists serving as coordinators. Administrative and security agencies, local administrative organizations, civil society networks, education institutions, and private sectors jointly participated.