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Pharmacy in Ghana: Evolving Towards Universal Health Coverage

"Pharmaceutical quick fixes are not what you need, you must face up to your symptoms and acknowledge this is not just random victimisation. Every symptom has its reasons." Mango Wodzak

Today, the 25th of September is World Pharmacy Day. The day is being celebrated under the theme "Pharmacy: Always trusted for your Health." For me, this theme is poignant. It is because globally, pharmacists and their teams have been in the eye of the storm whilst COVID-19 has ravaged. Through it, a lot has been learnt from the development of several vaccines, testing, and unfortunately the loss of colleagues.

As I write, pharmacists in many countries are actively involved in the vaccination drive to achieve global herd immunity. Locally, colleagues at many times when hospitals were inaccessible, had been the frontiers of access to primary healthcare. In this piece, we will try to chart a course for pharmacy as a profession by 2030 when Ghana will be expected to have achieved Universal Health Coverage (UHC).

According to the World Health Organisation (WHO), 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. A look at the history and evolution of Pharmacy in Ghana suggests that the profession has its origins in the commencement of training of dispensers in the Gold Coast in 1892.

The aim then was to ensure that essential medicines were available to countrymen in the hinterland. In those days when life expectancy was low and infectious diseases were the mainstay of Ghana's disease burden, this approach was acceptable. With the doubling of the country's disease burden due to the uptick in the incidence of chronic diseases as life expectancy increases, the priority of our health system must shift from treating the sick to keeping the citizenry healthy. This is what most health systems that have high chronic disease burdens have had to do. As Yuval Noah Harari states in Homo Deus; "twentieth-century medicine aimed to heal the sick. Twenty-first-century medicine is increasingly aiming to upgrade the healthy."

It is our view that Pharmacy practice in Ghana will have to evolve in a manner that prioritises healthy living.

For many, this will be seen as a misnomer as traditionally, community pharmacy has had a business model that has over-relied on the sale and supply of medicines. This model has been seen to be lucrative; but may not prioritise the health of the society moving towards 2030. This is because the model relies on citizens feeling unwell and seeking solutions from the pharmacy at the first point of call. Unfortunately, the supply of medicines alone is insufficient to promote healthy living, achieve treatment goals, enhance primary healthcare efficiency, or provide cost-effective solutions to citizens health needs.

To make pharmacy relevant to UHC, the profession locally will have to style community practices as havens of healthy living. These havens will be avenues where many chronic diseases in the community could be identified and signposted to the appropriate levels of care in a way that ensures that chronic disease prognosis is improved. The profession will have to leverage our innate health-seeking behaviour and use it to improve the average number of times Ghanaians access primary healthcare. The current situation where many fail to have health checks for years assuming rather wrongly that they are healthy, only to discover that they have been living unknowingly with underlying health conditions, is an area we need to focus on.

In the short term, such a strategy might take a hit on over-the-counter sales. In the medium to long term, the strategy will create lifelong customers whose prescriptions may become regular income stream as their life expectancy is enhanced. We are of this view, because data from the Ghana Health Service indicates that outpatient per capita for Ghana is currently 0.98. This means that on average, Ghanaians are accessing primary healthcare less than once a year. Ideally, this should be between two and four times a year if the chronic disease creep is to be reversed, especially amongst the middle-aged.

Using the recently published population of 30.8 million, if our profession can help to ensure that outpatient per capita is at least doubled, a similar number of primary healthcare visits will result which more than likely will double prescription throughput. This will result in increased community pharmacy footfall, further pharmacist-patient engagement and enhance the quest for a healthy society.

Though some pharmacies, especially in the urban and peri-urban areas of Ghana, are known to be showing proactivity in this regard, we observe that the service level when it comes to health promotion across the community pharmacy landscape is not uniform. This would need to be addressed if our professional contribution to the attainment of UHC is to be significant.

We will conclude by reminding pharmacists and readers that even in countries where health professionals to population ratios are much higher, the profession of pharmacy has moved from a medicine-based approach to an individual patient-centred approach. Our low health professional numbers require that we evolve down this road too. In this evolution, Pharmacy will have to help realign the views of citizens to the range of services that could be accessed at the community level.

Colleagues, we have shown through this pandemic that we have the knowledge, resilience and skill to serve humankind when it matters most. Without your frontline services, many may have been without their essential chronic disease medicines refills. Not forgetting the blood pressure and diabetic screenings many of you engaged in, all aimed to provide reassurance to anxious patients. It is time that we accept that the journey will be devoid of shortcuts or quick fixes. Neither can we continue to say we are being victimized or that society does not give us the recognition we deserve. It is our responsibility to society to evolve and earn the respect we deserve. After all, we are "Friends of the Human Race." Have a very fruitful professional day.

Featured Image Courtesy of Bill Smith

Edited by Winifred Awa