Patients in Pakistan are being prescribed more than twice the number of medicines recommended by the World Health Organization (WHO), while generic prescribing also remains far below recommended levels, according to a new study.
The study, conducted by researchers at the Health Services Academy (HSA), Islamabad, and published in Discover Public Health, reviewed 15 research papers on prescribing practices at hospitals and clinics across Punjab, Khyber Pakhtunkhwa, Sindh, Balochistan, and Islamabad between 2013 and 2024.
The findings showed that patients received an average of 4.2 medicines per prescription, compared with the WHO-recommended limit of 1.6 to 1.8.
At one tertiary hospital in Peshawar, the average reached 10.56 medicines per prescription, nearly six times the recommended level. Even the lowest figure recorded among the 15 studies, from an emergency department in Bahawalpur, remained above the WHO limit.
Only around 25% of medicines were prescribed by generic name against the WHO target of 100%. In some hospitals, generic prescribing was close to zero, while only two of the 15 studies recorded rates above 50%.
Antibiotics appeared in 45% of prescriptions on average, compared with the WHO-recommended range of 20% to 26.8%.
Injections were used in more than 27% of prescriptions, exceeding the recommended range of 13.4% to 24.1%, although their use varied sharply between hospitals from zero to as high as 98%.
Only 72% of prescribed medicines came from Pakistan’s essential medicines list, compared with the recommended target of 100%.
Prof. Shahzad Ali Khan, Vice Chancellor of the Health Services Academy and one of the study’s authors, said the prescribing pattern was found across different levels of healthcare.
“This is not the problem of one hospital or one city. It is happening across the country, at every level of healthcare,” he said.
According to Prof. Khan, doctors often prescribe antibiotics and injections without proper testing, partly because patients request them in the belief that they work faster.
“Patients think an injection or an antibiotic will cure them quickly. Doctors, under pressure and short of time, often give in,” he said.
He also linked the low use of generic medicines partly to pharmaceutical marketing and the belief among some doctors and patients that generic medicines are less effective than branded alternatives, despite there being no proven difference in quality.
Prof. Khan said Pakistan already has prescribing guidelines, 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 monitoring of prescribing practices, feedback for prescribers, and action against those who repeatedly violate the rules. It also calls for coordinated efforts by the government, pharmaceutical companies, hospitals, and doctors’ associations.
“Until this happens, patients will keep taking more medicines than they need, and antibiotics will keep losing their effect against disease,” Prof. Khan said.
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