Amid the drain of Africa’s trained healthcare workers to the West, pharmacists are increasingly playing a frontline role that goes beyond dispensing drugs.
Across Africa, community pharmacies are often the first – and sometimes only – accessible points of care, particularly in rural and underserved regions. In Nigeria, for example, pharmacies comprise ~50% of the primary healthcare facilities that cater to 70% of registered care visits.1 Similar trends are seen in Ghana and Cote d’Ivoire, where pharmacies are a vital channel for sexual and reproductive health.2,3
Given Africa’s physician shortage and the ongoing exodus of healthcare professionals, expanding the role of pharmacists can address health needs of local communities and serve as a critical buffer that enables basic patient access.4
This is already happening globally, as pharmacists’ roles evolve beyond dispensing. In France and the UK, pharmacists consult with patients and provide treatment for certain chronic conditions without a physician’s involvement, potentially reducing physician workloads and minimizing the impact of physician shortages.5,6,7 Pharmacists in the USA, Australia, Canada, and Portugal are also being utilized to provide vaccinations for flu and COVID-19. 8,9,10 While in Canada, pharmacists support doctors and nurses to help drive treatment adherence, conduct follow-up consultations, and manage chronic diseases. 11 Moreover, in France, pharmacists are setting up teleconsulting cabins to provide patients with easy access to specialists. 12
Similar shifts are also underway in Africa, with Nigeria and South Africa having adopted task-sharing and task-shifting policies that empower pharmacists to administer contraceptives, support maternal and child health, and combat infectious and non-communicable diseases. 13 Community pharmacists in these countries have also participated in vaccination campaigns, including for COVID-19. 14 However, the incorporation of pharmacies in healthcare delivery remains limited across Africa.
Equipping the next generation of pharmacists to help deliver care at scale will require key actions to evolve pharmacy practice:
- evolved approaches to education
- new compensation and collaboration models
- creating enabling regulatory frameworks; and
- embracing local technology-enabled solutions to advance the impact of pharmacy-based care.
Evolving education, compensation & collaboration
Like pharmacy schools in the US and UK, pharmacy schools across Africa can incorporate competencies in multi-disciplinary patient care and digital health technologies into the standard training curricula. Pharmacy compensation models should also evolve to cover an expanded set of public health services beyond dispensing. Models like ‘fee-for-service,’ performance-based compensation, value-based payments, capitation, or combinations of the above, can ensure pharmacists are paid for critical preventive and promotive care.
Intra- and cross-competency collaboration with other healthcare providers is also paramount. Pharmacists can bring unique perspectives to the development of collaborative care plans, ensuring seamless continuity of care, fewer medication errors, enhanced patient adherence, and better patient outcomes. Formalized health screenings, vaccination drives, and patient education programs can help entrench trust-based pharmacist-community relationships.
Creating enabling regulatory frameworks
Governments must establish enabling policy and regulatory frameworks such as the NHS Long Term Plan and the French Law on Hospital Reform that allow pharmacists and pharmacies to provide a broader range of healthcare services and integrate them into the primary healthcare infrastructure. 15
Ghana offers a great model to follow; in 2022, as part of its regulatory digitization drive, the Pharmacy Council of Ghana launched the National Electronic Pharmacy Platform (NEPP), a centralized platform that integrates hospitals, pharmacies, and other health players, maintaining a closed-loop system for prescription management, medication dispensing, and product visibility.
Separately, a few countries are also updating pharmacy-related regulatory frameworks, with Nigeria, Kenya and Rwanda all publishing new guidance to govern the operations and adoption of online pharmacy solutions. 16 However, more needs to be done as a 2023 review of e-Pharmacy regulatory frameworks showed that nearly 70% of featured African countries have no e-Pharmacy regulations in place. 17
Embracing tech-driven solutions
Pharmacies aren’t just uniquely positioned near patients – in some locations they’re also more likely to be digitally-enabled. A 2023 study showed that 54% of pharmacies in Lagos already use digital solutions, outpacing other primary health providers. 18
However, today, pharmacies mostly use digital platforms for payments and accounting. We know that globally tech solutions are emerging to help transform pharmacy practice. In the US, Saudi Arabia and South Africa, automated dispensing systems such as Right ePharmacy are streamlining medication dispensing, minimizing human errors, and thus allowing pharmacists to focus more on patient care. 19,20 Smart pill dispensers and adherence packaging also ensure appropriate medication use by patients.
Pharmacy-based innovations are also emerging across Africa. Companies like Grinta (Egypt) and Remedial Health (Nigeria) use data-driven systems that enable pharmacies to monitor, restock and finance inventory, reducing fewer stockouts. Online pharmacies like Yodawy in Egypt are also expanding access to pharmacy services for underserved and remote populations while AI-powered chatbots like Nivi (operating in India, Kenya, Nigeria and South Africa), and patient support program platforms such as Maisha Meds (operating in Kenya, Nigeria, Tanzania and Uganda) are also democratizing access to accurate health information and reimbursement, respectively.
While these innovations are achieving some traction, reaching 50,000 providers across the continent, more adoption is required to accelerate their impact on health outcomes. 21
What does the future hold?
Pharmacists are starting to recognize their multi-faceted potential as clinical professionals, businesspeople, and healthtech innovators; governments are also recognizing the latent potential of community pharmacies as key players in the drive toward patient-centered care; and donors/NGOs are starting to integrate traditional and online pharmacies into regular healthcare programming activities.
Optimizing pharmacies as points of primary care delivery will require concerted efforts from key stakeholders: governments need to reshape policies, training systems need to be updated, and investors need to support promising tech-driven models that can transform access to healthcare and health products while national, regional and global health agencies must proactively include pharmacies and pharmacists in healthcare programs and agendas.
Africa’s health system challenges are well-documented and while there is no silver bullet to leapfrog long-running challenges around primary healthcare access, community pharmacies may yet prove to be a vital solution lying in plain sight.
This article was first published on African Arguments on October 8th, 2024.
