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Leveraging roles of community pharmacists towards achieving universal health coverage in Africa

According to the World Health Organisation, universal health coverage (UHC) means that all individuals and communities receive the health services they need without suffering financial hardship. It includes the full spectrum of essential, quality health services, from health promotion to prevention, treatment, rehabilitation, and palliative care across the life course. For UHC to be truly universal, a shift is needed from health systems designed around diseases and institutions towards health systems designed for people, with people.

A primary health care approach is required, which focuses on organizing and strengthening health systems so that people can access services for their health and wellbeing based on their needs and preferences, at the earliest, and in their everyday environments. Primary Health Care (PHC) is the cornerstone of a sustainable health system and provides the ‘programmatic engine’ for UHC, the health-related SDGs and health security.

However, achieving UHC depends strongly on the availability and accessibility of adequate and competent healthcare workers with optimal skills mix at facility, outreach and community level, who can deliver quality, essential healthcare. Unfortunately, the deficit in skilled professionals and the entire health workforce in Africa continues to be a massive set back on the pathway to achieving UHC on the continent.

…achieving UHC depends strongly on the availability and accessibility of adequate and competent healthcare workers with optimal skills mix at facility, outreach and community level, who can deliver quality, essential healthcare

With the ease of access community pharmacists have to patients, the profession is well-positioned to play a critical role in the provision of PHC for the attainment of UHC. Leveraging the roles of community pharmacists by ensuring their active participation in the delivery of primary healthcare services will therefore serve as a needed link in the sustained global push towards providing increased access to essential medicines in developing communities and improving health coverage.

Community pharmacists and their critical role in achieving UHC

Community pharmacists play a crucial role as they are mostly the first point of call for individuals trying to access PHC. Community pharmacies are multi-product, multi-service facilities that are essential to a health care system. Pharmacists’ knowledge and skill set, accessibility, and extended trade hours further reflects the capacity of the profession to contribute toward enhancing and complementing access and primary healthcare coverage under UHC. Increasing the involvement of community pharmacists at the PHC level would consequently benefit other public health sector establishments by relieving the workload and pressure on staff at these facilities, especially for patients that have been stabilized for treatment of chronic non-communicable diseases.

Among other healthcare services, community pharmacists play an essential role in these key areas:

• Medicines supply chain management: Community pharmacists have critical roles in medicines supply chain management from selection, procurement, and distribution, to quality assurance, dispensing and monitoring. They play an important role in preventing frequent stock outs and loss of stock and health technology assessment.

Prevention and control of non-communicable diseases (NCDs): The WHO has predicted that by 2030, NCDs will become the leading cause of death in Africa, exceeding deaths caused by communicable, maternal, perinatal, and nutritional diseases combined. Community pharmacists have critical roles to play in preventing and controlling NCDs at three levels. Level one is primary prevention; promotion of healthy lifestyles for NCDs prevention through health education. Level two is early detection; contributing to early detection through measurement of blood pressure, blood sugar, BMI, and referring suspected cases to physicians. Level three is the management of treatment for patients with chronic NCDs; monitoring treatment, referral, compliance, lifestyle modifications, advice on treatment, and training on self-measurement.

Health promotion: Community pharmacists are well-positioned to identify health conditions prominent in the community and initiate health promotion campaigns. Health promotion interventions driven by pharmacists, in addition to other health professionals, raise awareness levels about adverse effects of medicines and disease outbreaks.

Strategies to leverage the roles of community pharmacists towards UHC

In contrast to many high-income countries, community pharmacists are an underutilized resource for patient care in low- and middle-income countries (LMICs). There is a critical need for introduction of skills that have been previously underutilized by this group of health professionals. If pharmacists are to be integrated with the broader primary health care system, greater strides in improving the training and early certification for providing these services at an undergraduate level would be beneficial.

Also, gaps in the supply of and demand for health workers are concentrated in LMICs like those in Africa, the WHO estimates that to meet the health workforce requirements of the SDGs and UHC targets, over 18 million additional health workers are needed by 2030. Community pharmacists can leverage these gaps in the supply and demand for healthcare workers by strengthening their capacity to provide quality PHC services.

Conclusion

UHC affords pharmacists the opportunity to evolve in their roles and become more engaged at community and system levels. A change in attitude regarding the pharmacy profession is therefore essential by those practicing it, by patients utilizing the services, and by other health professionals collaborating in the future of shared patient care.

Anyakora is the CEO of Bloom Public Health and a public health expert & Odibeli is a pharmacist and the research and communications coordinator at Bloom Public Health

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