Commercialization of pharmaceuticals outside the public health care system is found in most parts of the world. Over the past few years, OTC drugs have contributed immensely to the
health care delivery system the world over. The sale of non-prescription medications is recognised as the most preferred means of treating majority of common ailments as they are accessible and offer multiple health care options (DeLorme, Hu, Reid, & Ann, 2010). The importance of OTC medications to the overall health care is reflected by the presence of many laws and treatment guidelines, (GFDA, 2013; WHO, 2000c), the high frequency at which the medicine is recommended by health care practitioners, and the increasing use of the products by patients (Pharmacy Today, 2010).
It is widely acknowledged that, in Africa and most developing countries access to medications is hindered by inadequate pharmacists and medical doctors to attend to every patient on the appropriate use of prescription medicines. This is further aggravated by poverty, mass illiteracy and a shortage of health facilities. Consequently, OTC medicines have become a potential option for treatment for most people in the developing world (Afolabi, 2012). Past research reveals that out of 72 percent of care-givers who sought diarrhoea treatment outside home, 59 percent of them relied on OTC medicine sellers for health care (SHOPS Project, 2015). Essentially, OTC drug sellers are recognised as the major health providers of child health care services, especially in rural communities in Ghana.
While, there were only about 1 600 retail pharmacies in Ghana, the number of licensed OTC medicine sellers, excluding herbal medicine sellers, was hovering around 10 000 (Seiter & Gyansa-Lutterodt, 2009) across the entire country. Similarly, there were approximately 54 000 pharmacies in the United States, but the estimated OTC medicine retail outlets exceeded 750 000 (CHPA, 2012).
In Ghana, the estimated retail value of pharmaceutical market was around US$ 300 million in 2008. However, the total share of OTC drug market was around 30% of overall value of the pharmaceutical market (Seiter & Gyansa-Lutterodt, 2009). The steady growth of the OTC pharmaceutical sector in Ghana was attributed mainly to poor access to prescription drugs, the introduction of the National Health Insurance Scheme in 2005 which covered non-prescription medications, the focus of the domestic industry on the production of OTC products at the expense of essential medicines, as well as heavy advertisement (Harper & Gyansa-Lutterodt, 2007).
Although, industrialized countries have enough health care facilities and personnel, many still rely on OTC medications for the treatment of minor health problems. It has been highlighted
that an increasing number of the population in the United States use OTC medicines for the treatment and prevention of many ailments. Mostly, OTC remedies were used for allergy or sinus problems (45%), cough, cold, influenza or sore throat (52%), pain (78%), skin problems (10%), other stomach problems (35%), minor infections (12%), and heartburn, indigestion constipation, diarrhoea and gas (21%) (NCPIE, 2002).
According to Customer Healthcare Products Association (2012), about 81 percent of adults in United States used OTC medicines as the first-line of treatment for common ailments, whilst nearly seven in every ten parents have offered OTC medicines to their children in the night to treat sudden medical symptoms. In addition, the availability of OTC medicine provided symptomatic relief for an estimated population of 60 million who otherwise would not have sought treatment. An empirical evidence also indicates that OTC medicines were the most popular first-line treatment for children and adults with fever and acute illness in three districts in Kenya (Abuya, Mutemi, Karisa, Ochola, Fegan, & Marsh, 2007).
From the perspective of the customer, OTC remedies provide a wide variety of treatment options, greater availability of drugs, direct and rapid access to drugs, convenience as well as a lower cost of treatment in terms of reduction in the cost of medical consultations, while at the community level, OTC drug treatment can save the limited medical resources from being spent on minor ailments and lower community-funded health programmes (WHO, 2000c). This has considerably reduced the expenditure on national health care (Dajani, Dajani, & Shahwan, 2004). Furthermore, OTC medications can reduce absenteeism from work (WHO, 2000c) and ultimately increase productivity.
According to CHPA (2012), OTC medicines provide affordable treatment options for patients in United States and have also reduced the national budget on health care facilities. Moreover, it is estimated that OTC medications saved the United States about US$102 billion annually relative to other alternatives, whiles US$17 billion and US$25 billion were saved on the cost of clinical trials and drugs respectively (ibid).
The volume of OTC medicines was once estimated to be relatively small, but now they account for the majority of all medications in United States. It is estimated that there are over 100 000 OTC health care products dispensed in the United States, comprising almost 1000 significant active ingredients (NCPIE, 2002). It has been highlighted that roughly eighty therapeutic types
of non-prescription medications were retailed in United States of America in 2010 (Delorme et al., 2010).
It has been suggested that the drug market is among the most flourishing markets globally with an estimated world sales revenue of about US$534.8 billion in 2005 (Kim & King, 2009). Meanwhile, the global OTC drug market was valued at 86 billion Euros in 2013, with growth rate of 4.8% in 2014, exceeding the ethical pharmaceutical sub-sector (AESGP, 2015).
Interestingly, the global market for OTC drugs has been expanding rapidly and several factors account for this. First, public interest in self-treatment is increasing (DeLorme et al., 2010) and non-prescription medicines have become the backbone of much of the self-medications of many diseases and their prevention (Brieger, Unwin, Greer, & Meek, 2005). It is also well- acknowledged that OTC medications are more accessible and less expensive means of combating common health problems (DeLorme et al., 2010) which ultimately, supports ever- increasing desire for self-medication.
Secondly, the worldwide transfer of prescription drugs to OTC status is escalating, leading to a rise in the quantity of medicines sold in the OTC market (DeLorme et al., 2010). For example, in Ghana, ACT, the anti-malaria drug has been removed from Prescription-Only Medicine (POM) list and de-classified to OTC to allow for easy access to the medicines and also to promote self-treatment (Harper & Gyansa-Lutterodt, 2007). In the same vein, in the United States of America, products comprising more than eighty active ingredients of different therapeutic groups had been transferred from Prescription-Only status to OTC from period of 1976 to 2000 (WHO, 2000b). Also, the use of OTC medications has been promoted by health care professionals as more affordable health care compared to prescription medications (DeLorme et al., 2010).
Intensive competitive advertisement coupled with the cross-border sale of pharmaceuticals through the internet has created additional demand for self-prescription drugs. For example, it is estimated that the number of medicinal products sold via Yahoo and WebCrawler search engines as of May 7, 2000 amounted to 16 966 and 244 546 respectively (WHO, 2000b).