Does your Health Intervention Include Private Pharmacies?
Photo courtesy of HealthPlus Nigeria
Today is International Self-Care Day. What does that mean? The World Health Organization (WHO) defines self-care as individuals, families and communities’ promoting and maintaining their own health, preventing disease, and coping with illness and disability, with or without the support of a health worker. Having such a day is acknowledging that a) many health systems around the world are not able to adequately meet everyone’s needs; and b) we have overmedicalized some parts of healthcare, creating unnecessary barriers to timely care in the form of multiple, expensive clinic visits with lengthy wait times.
The global public health bodies have been increasingly rallying behind more self-care initiatives, from the first over-the-counter contraceptive pill approved by the FDA in the US earlier this month; to self-testing for Covid-19, HIV, and malaria; and self-managed abortions and ART for HIV. As you can see from this list, many self-care initiatives require access to medicines and/or devices. One ideal channel for distributing these items is private pharmacies; as they tend to be open more days and hours than clinics, have less waiting time, and are generally staffed by trained pharmacists who can provide supportive advice. In addition, they provide a stigma-free environment where it is easier to solicit support for sensitive health issues since it is socially acceptable to be seen in a pharmacy.
Funded by the @Bill & Melinda Gates Foundation and partnering with @Catalyst Global, Propelevate recently completed a private pharmacy market assessment to understand the potential of using the private pharmacy sector to expand the reach and use of the HIV prevention medication, PrEP in Africa. In each of the 18 prioritized countries we conducted desk research and key informant interviews with industry experts and representatives to understand sector structure, supply-chain players and types of regulated drug sellers to calculate potential reach of target groups - including adolescent girls and young women - through private pharmacies. We also identified key trends and insights to inform recommendations about the potential challenges and opportunities of private pharmacies for PrEP distribution.
We found some interesting trends that speak to why public health programs should be integrating private pharmacies:
In most of the countries, pharmacies are already offering self-care options; including HIV tests (in 13 out of 18 countries), condoms and pills (18/18), and ART (10/18) as well as services such as blood pressure monitoring (18/18).
Unreliable supply in the public sector is driving clients to private pharmacies. This was amplified during Covid-19-related supply chain issues but also generally reflected the larger situation of public sector clinics struggling to expand rapidly enough to match the increase in populations. We saw evidence of this in eight of the countries.
Rapid growth of private pharmacies. Public services are struggling to keep up with rapid population growth and migration patterns, and Covid-19 has increased desire for self-care options that don’t require in-person clinic visits. As a result, we’re seeing stark upturns in the numbers of private pharmacies in at least nine of the countries.
Advent of e-pharmacies and other innovative delivery models. Over half the research countries have launched e-pharmacies and other online or delivery innovations that greatly expand access.
The more stigmatized the person or the product is, the more people prefer pharmacies. Adolescent girls and young women are key pharmacy clients for sexual and reproductive health products as are members of the LGBTQ+ communities. Pharmacists we interviewed almost always listed condoms, emergency contraceptives or sexual enhancement products as the top sellers.
Pharmacists are interested in being more involved. Research in five of the countries indicated that the vast majority of pharmacists were interested in dispensing ART, in addition to the 10 countries where this is already happening. This is supported by the larger movement into clinical pharmacy across the continent that includes evolving university curricula and government policies and programs.
No solution is the right fit for every project in every geography, and in fact in 3 of the 18 countries, private pharmacies did not appear to be as important as a potential distribution channel. We were quite struck by the overwhelming potential and readiness of pharmacies to reach and support large numbers of people with their self-care needs. In Nigeria, South Africa and Tanzania alone private pharmacies have the potential to reach over 9 million people who would benefit from PrEP.
If you’re interested in exploring pharmacies or other private-sector channels for your project, contact Propelevate at info@propelevate.global to set up a free consultation.