From Prescription to Medicine Packet: The Next Step in Digital Healthcare
In Bangladesh, paper prescriptions and retail pharmacies remain the main channels through which medicines move from a doctor’s advice to the patient. Yet no integrated system has been established to verify the doctor’s identity, the authenticity of the prescription, the accuracy of the medicine supplied, and the legitimacy of the medicine packet throughout this process. As a result, these critical steps in treatment depend largely on mutual trust among doctors, pharmacists, and patients. Patients and pharmacists cannot always be certain whether a doctor is registered, whether a prescription is genuine and unaltered, whether the pharmacy has supplied the prescribed medicine, or whether the medicine in the packet has come from a legitimate source. Discussions about digital healthcare generally remain confined to telemedicine, health apps, and artificial intelligence. Yet the next important step in healthcare could be to make the entire process from doctor to pharmacy and from pharmacy to patient verifiable.
Data from the World Health Organization alone is enough to illustrate the scale of the problem. A 2017 study by the organization found that approximately 10.5 percent of medical products circulating in low- and middle-income countries were substandard or falsified. This estimate was based on a review of nearly 100 research papers covering more than 48,000 samples from 88 countries. Meanwhile, a model-based estimate by the University of Edinburgh suggests that substandard and falsified antibiotics may cause between 72,000 and 169,000 child deaths from pneumonia worldwide each year. In addition, medication-related errors such as taking the wrong medicine, the wrong dose, or medicine at the wrong time cause an estimated US$42 billion in financial losses globally each year, equivalent to around 1 percent of total global health expenditure. According to the WHO, although medication-error rates in low- and middle-income countries are close to those in high-income countries, the amount of healthy life lost because of these errors is nearly twice as high.
These issues are particularly significant in Bangladesh because people still pay a large share of healthcare costs out of their own pockets. According to the National Health Accounts 2020, household out-of-pocket spending accounted for 68.5 percent of total health expenditure in the country. The WHO puts this figure at 74 percent. Medicines account for approximately 64.6 percent of household out-of-pocket health spending. Meanwhile, pharmacies handle around 88.5 percent of medicine distribution in Bangladesh. In other words, for most people, pharmacies are the most accessible entry point into the healthcare system. If the accuracy of medicines cannot be ensured at this stage, even the right advice from a doctor may ultimately fail to deliver the desired outcome.
Non-compliance with rules governing medicine sales at pharmacies is increasing this risk. An observational study conducted at 246 pharmacies in Dhaka between September and December 2024 found that only 36.24 percent of antibiotics sold were supported by prescriptions from registered doctors. Around 45 percent of antibiotics were sold at the customer’s own discretion, while a further 19.17 percent were sold on the basis of informal advice from sellers. Another study published in 2022 found that 50.9 percent of 642 antibiotic purchases were made without a prescription. According to a figure cited in that study, Bangladesh has approximately 118,901 retail pharmacies, nearly half of which are unlicensed.
The National Drug Policy prohibits the sale of antibiotics without a prescription. The gap between policy and practice, however, shows that the existence of paper prescriptions has not made them an effective tool for verification and enforcement. Beyond checking whether a prescription exists, a system is needed to verify the identity of the prescribing doctor and ensure that the correct medicine has been supplied. Otherwise, it will remain difficult to enforce the rules effectively, even when they are in place.
The consequences of these weaknesses extend beyond the treatment of an individual patient. The uncontrolled use of antibiotics, in particular, increases the risk of microorganisms becoming resistant to medicines, posing a long-term threat to public health. A global study published in The Lancet estimated that antibiotic-resistant infections directly caused around 1.2 million deaths in 2019 and were associated with a further 4.95 million deaths. Based on the same study, reports published in Bangladeshi media stated that antibiotic-resistant infections directly caused approximately 26,200 deaths in Bangladesh that year and were associated with around 98,000 additional deaths. Researchers project that more than 39 million people worldwide could die directly from antimicrobial resistance between 2025 and 2050, including more than 11.8 million in South Asia. The implications are clear: preventing irregularities in medicine use is not merely a matter of pharmacy management; it is an essential part of protecting public health.
Illegible prescriptions make the problem even more complex. In January 2017, the High Court directed doctors to write prescriptions clearly in capital letters or provide printed prescriptions. The Bangladesh Medical and Dental Council (BMDC) and the Directorate General of Health Services subsequently issued instructions on the matter. Nevertheless, pharmacy workers have continued to tell the media in later years that many prescriptions remain difficult to read. Because research methods and samples vary, studies have reported rates of illegible handwriting ranging from around 6 percent to more than 50 percent. According to a University of Dhaka professor, the names of around 150 medicines in Bangladesh are so similar that identifying the correct medicine from an unclear prescription can be difficult. When handwriting is illegible and medicine names are similar, the risk of dispensing the wrong medicine increases further. Digitising prescriptions, therefore, should not simply be about reducing paper use; it should also reduce identification errors and the risk of dispensing the wrong medicine.
Fake prescriptions in Bangladesh generally take several forms:
Forging a doctor’s signature;
Writing or changing the medicine’s dose incorrectly;
Changing the date to reuse an old prescription;
Using the same prescription to purchase the same medicine from multiple pharmacies in order to obtain a lethal or prohibited dose.
Paper prescriptions offer no effective way to verify these cases. One pharmacy cannot know what another pharmacy has already supplied against the same prescription. Recording every dispensing transaction in a digital system could close this gap.
Making healthcare verifiable essentially means ensuring answers to four fundamental questions. First, was the prescription issued by a registered doctor? Second, is it genuine, unaltered, and intended for a specific patient? Third, has the pharmacy supplied the medicine and dosage specified in the prescription? Fourth, did the medicine packet received by the patient come through a legitimate supply chain, and can it be identified as an authentic product? An integrated digital system could provide quick and reliable answers to these questions.
A signature alone cannot establish whether a signed prescription genuinely came from a doctor, because signatures can be forged. To verify a prescription, it should include the doctor’s BMDC registration number, and pharmacies should be able to check that number against a register of registered doctors. If each digital prescription carries the doctor’s digital signature and a unique QR code, pharmacists will be able to verify it immediately.
International experience shows that such a system is feasible. The first electronic prescription in England was transmitted in February 2005. The service was subsequently expanded nationwide and reached full implementation in November 2019. In the 2021–22 financial year, more than 996 million prescription items were transmitted electronically, accounting for approximately 95 percent of all prescription items. The figure was around 532 million in 2016–17. Today, approximately 11,400 pharmacies are connected to the system. This experience shows that, with adequate infrastructure, institutional coordination, and user-friendly technology, large numbers of prescriptions can be brought into a digital system.
Estonia’s experience is also relevant to Bangladesh. The country introduced a centralised, paperless e-prescription system in January 2010. Within a year and a half, around 80 percent of prescriptions had moved to the digital system; the figure later rose to approximately 99 percent. Using a patient’s identification number, pharmacists can view the active ingredient, form, and instructions for use of the medicine prescribed. A user survey also found a satisfaction rate of around 97 percent. Estonia offers an important lesson: digital healthcare development should begin with a service that people use regularly and whose benefits they can experience directly. Digital prescriptions could provide an effective starting point. Other services, including patient health records, could then be brought into the same framework gradually.
Verifying the authenticity of medicine packets is just as important as verifying prescriptions. The European Union has developed a useful framework in this regard. Since 9 February 2019, prescription medicines there have been required to carry a two-dimensional barcode containing a unique identifier, along with a mechanism to detect whether the package has been opened. Before dispensing a medicine, a pharmacy must verify the packet’s validity against the relevant database and mark the code as used after dispensing. This reduces the opportunity to reuse the same code to supply medicines more than once. Various surveys have estimated the rate of falsified medicines in Europe’s legitimate supply chain at around 0.005 percent. However, this system should not be regarded as a solution to every problem. Risks remain, particularly for medicines purchased online outside the legitimate supply chain. The key lesson is that verification should be possible at every important stage, from medicine production to delivery to the patient.
The existing limitations must also be considered when introducing such a system in Bangladesh. A review of the country’s e-health and telemedicine services found that many digital platforms operate separately and are not fully integrated with the national health-record system. The review also highlighted the absence of a unified national strategy and digital health legislation, while noting that more than 70 percent of projects depend on external funding. It further reported that fewer than 30 percent of rural households have access to reliable internet. Launching a centralised digital system without addressing these limitations could widen the existing divide between urban and rural communities.
There have, however, been some positive developments. The Personal Data Protection Ordinance issued in 2025 treats health information as sensitive personal data and places importance on consent for data use. It also provides for an institutional framework to oversee data management and protection. Such legal safeguards are essential when patients’ prescriptions and medical information are exchanged among doctors, pharmacies, and relevant databases. The law’s practical effectiveness, however, will depend on the necessary rules, technical capacity, protection of data privacy, and effective enforcement.
At the same time, it is important to remember that digital systems are not error-free. Software can select the wrong medicine, confuse medicines with similar names, or specify an incorrect dose. Alongside introducing the technology, it is therefore necessary to ensure sound system design, security testing, alerts, pharmacist training, and an effective process for correcting errors when they are identified. Preventing unauthorised use of patients’ personal information must also be a priority from the outset.
For Bangladesh, a risk-based, phased approach would be more realistic than bringing the entire medicine market into a digital framework at once. The first phase could focus on antibiotics and other high-risk medicines. Each digital prescription for these medicines would carry a unique code delivered to the patient by SMS or QR code. The pharmacy would verify the code before dispensing the medicine and record the prescription as used after dispensing. This would reduce the opportunity to obtain medicines repeatedly using the same prescription and make it easier to identify patterns of sales without prescriptions.
In the second phase, reliable registers of registered doctors and licensed pharmacies should be created and connected to the verification system. This would allow both patients and pharmacists to verify doctors’ registration and pharmacies’ legitimacy. At the same time, unlicensed pharmacies could be encouraged to enter the formal system through simplified registration, necessary training, and incentives to comply with the rules.
Third, alternative arrangements must be available for areas with limited internet access. Offline functionality and later data synchronisation could be considered so that prescriptions can be verified even when connectivity is weak. Initiatives are also needed to train rural pharmacy workers and reduce the cost of using the technology. Otherwise, the benefits of the digital system will remain concentrated in cities, leaving patients in remote areas behind.
Fourth, a long-term plan is needed to introduce unique identification codes on medicine packets. Coordination among medicine manufacturers, distributors, pharmacies, and regulatory authorities will be essential. In the initial phase, packet verification could be piloted with high-risk medicines. Based on the results and practical experience, other medicines could be brought into the system over time.
Finally, specific indicators should be established from the outset to measure the initiative’s success. The 36.24 percent rate of antibiotic sales supported by prescriptions from registered doctors, found in the 2024 study, could serve as a baseline. Progress should then be monitored regularly: how much this rate increases, how long prescription verification takes, how much the incidence of dispensing the wrong medicine declines, and how many pharmacies use the system regularly. Publishing these data would make it easier to evaluate the initiative’s effectiveness and make necessary adjustments.
Technology alone cannot eliminate every weakness in Bangladesh’s medicine-management system. Effective regulation, responsible medical practice, trained pharmacists, informed patients, and a strong medicine supply chain are all necessary. However, where many critical steps currently depend on mutual trust, digital verification can establish an effective framework for accountability. Verifiable prescriptions would make it possible to confirm doctors’ identities, control the sale of antibiotics without prescriptions, reduce the risk of dispensing the wrong medicine, and verify the authenticity of medicine packets.
The next priority for Bangladesh’s digital healthcare system should therefore be to adopt technologies that improve patient safety and ensure accountability at every critical stage of care. If the entire process from a doctor’s advice to the delivery of the correct medicine to the patient can be made verifiable, digital healthcare will move beyond technology-driven services and become an effective means of safeguarding people’s right to safe treatment.
