Evaluation of the Participation of Community Pharmacists in Primary Healthcare Services in Nigeria: A Mixed-Method Survey

BackgroundAchieving universal health coverage in poorly-resourced settings like Nigeria demands optimal mobilization of all healthcare resources including community pharmacists. Such efforts are hampered by insufficient data on primary healthcare (PHC) contributions by community pharmacists. The study aimed to identify PHC services offered by community pharmacists; assess impact of technologies on PHC service quality; and evaluate factors influencing management of PHC services in Nigeria. MethodsA descriptive cross-sectional survey of ۳۲۱ community pharmacies and ۶۴۲ clients was undertaken between April and August, ۲۰۱۹. Semi-structured pre-tested questionnaires were administered on randomly-selected community pharmacists and clients. Interviews were conducted with key informants. Data were summarized using frequency and percentages while weighted averages on ۵-point ordinal scales and chi-square tests were used to identify weights and associations between variables respectively at P < .۰۵۰. ResultsResponse rates of pharmacists and clients were ۷۴.۷% (N = ۳۲۱) and ۱۰۰% (N = ۶۴۲); while their median ages were ۳۹.۴۱ and ۵۱.۲۰ years respectively. Community pharmacists offered services in all eight domains of PHC, especially supply of medicines for treating of endemic diseases (mean weighted average [MWA] = ۴.۵۹), and disease prevention (۴.۵۴) but least of vaccine administration (۲.۳۹). Blood glucose screening devices were the most adopted technology with significant impact on service quality (χ۲ ۶.۸۶, P = .۰۳۰). Major challenges to management of PHC services were poor awareness of pharmacists’ roles (۴.۳۱) and lack of integration with the PHC infrastructure (۴.۳۱). Capacity constraints in finances (۴.۱۱), technologies (۴.۰۹), and human resources (۳.۹۹) were significant. However, major facilitators were pharmacists’ managerial skills (۴.۳۵), and strong client relationships (۴.۲۷). ConclusionIn Nigeria, community pharmacists offered important PHC services. Deploying technologies were associated with improved service quality. If community pharmacists are integrated in the national PHC architecture and financial incentives are provided, their competences and goodwill would enhance the achievement of universal health coverage.

Keywords:

Community Pharmacy Practice , Primary Healthcare , Service Quality , Pharmacy Service Management , Nigeria