Retail Drug Outlets in LMICs: Unlocking Their Potential for Equitable Access to Quality Health Care Services

By Tamara Hafner and Martha Embrey, USAID MTaPS 

Retail drug outlets—pharmacies and drug shops—are often the first or only point of contact for health services in many low- and middle-income countries (LMICs), particularly in rural areas (1, 2). Therefore, improving equitable access to quality pharmacy services, whether through universal health coverage or a total market approach, must consider how to effectively leverage retail drug outlets.

Consumer Preferences for the Retail Sector 

We know that consumers, especially the rural poor, often prefer to seek health care at drug shops and pharmacies in their communities (1, 2). This is due to better medicines availability than in the public sector; convenience associated with shorter waiting times; greater geographic accessibility; familiarity with the dispenser; and lower financial barriers, partially from the ability to purchase medicines on credit or obtain a partial course of treatment (4, 5, 6).  

Poor Quality Pharmaceutical Services Can Widen Health Care Inequities 

Despite the community preference for private retailers, the service quality is often suboptimal due to a lack of regulations, standards, and expertise for providing patient-centered care. Across Asia and Sub-Saharan Africa, poor dispensing practices are persistent, including selling prescription-only medicines without a prescription, dispensing medicines that are clinically inappropriate, dispensing incomplete treatment courses, and inadequate history-taking and counselling (4, 5). Shops in urban settings are more likely to provide correct treatments and have more qualified staff, while regulatory lapses are more common in rural areas (5, 7). The overuse and misuse of antimicrobial agents resulting from poor dispensing practices fuels antimicrobial resistance. Further, poor-quality medical products and services can widen health inequities, especially when they are predominantly used by vulnerable and underserved populations.

Barriers to Implementing Accreditation Programs

Accreditation of drug shops has proven to significantly improve their quality of products and services and plays a critical role in increasing equitable access to quality services, particularly in underserved populations (1, 8, 9). However, the extensive body of knowledge on the accreditation of drug shops and other informal vendors points to significant costs and a long time horizon to ensure sustained commitment at all levels of the health system. Further, the increased workload required for inspections and other regulatory tasks can burden oversight bodies (e.g., national pharmaceutical societies and drug regulatory authorities), many of which already have limited resources and capacity (9). As such, very few LMICs have made the necessary legal and regulatory changes to facilitate accreditation; despite their heavy usage, these outlets continue to be excluded from national health strategies and initiatives to improve equitable access to quality-assured medicines and related services.

MTaPS Webinar Series Explores Enhancing Equitable Access through the Private Sector 

With adequate regulation of pharmacy services as a prerequisite, there are a variety of tools and interventions for advancing equitable access through the private sector that are worth highlighting. The USAID Medicines, Technologies, and Pharmaceutical Services (MTaPS) Program will host a five-part webinar series exploring ways to advance equitable access to quality pharmacy services through private retail drug outlets. The objective is to distill a set of effective policies and strategies that can help define a pathway toward more equitable access to quality pharmacy services for vulnerable populations.

WHO defines equity as “the absence of unfair, avoidable or remediable differences among groups of people defined socially, economically, demographically, geographically or by other dimensions of inequality (e.g. sex, gender, ethnicity, disability, or sexual orientation)” (3). For the purposes of this webinar series, we focus primarily on equity with respect to improving access to the rural and urban poor.

The webinar series will convene key voices—representatives from national drug authorities, pharmacy associations, retailers, USAID implementing organizations, researchers, and community-level NGOs from across the globe—to discuss and shape a practical pathway for advancing equitable access to quality pharmacy services through the private sector.

The insights gathered from the series will be supplemented with a targeted literature review to produce a technical brief on essential elements to consider for improving equitable access to quality pharmacy services through the private sector. 

SEE EVENT DETAILS (Webinar subtopics, panelists and dates)

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References

1. Mayora C, Kitutu FE, Kandala N-B, Ekirapa-Kiracho E, Swartling Peterson S, Wamani H. (2018) “Private retail drug shops: what they are, how they operate, and implications for health care delivery in rural Uganda.” BMC Health Services Research 18, no. 1: 532.

2. Oyeyemi AS, Oladepo O, Adeyemi AO, Titiloye MA, Burnett SM, Apera I. (2020). “The potential role of patent and proprietary medicine vendors’ associations in improving the quality of services in Nigeria’s drug shops.” BMC Health Services Research 20, no. 1: 1–12.

3. World Health Organization. (n.d.). Health Equity. Available at: https://www.who.int/health-topics/health-equity#tab=tab_1.

4. Lamba G, Shroff ZC, Babar ZUD, Ghaffar A. (2021). Drug shops for stronger health systems: learning from initiatives in six LMICs. Journal of Pharmaceutical Policy and Practice, 14(1), 1–16.

5. Miller R, Goodman C. (2016). Performance of retail pharmacies in low-and middle-income Asian settings: a systematic review. Health Policy and Planning, 31(7), 940–953.

6. Wafula FN, Miriti EM, Goodman CA. (2012). Examining characteristics, knowledge and regulatory practices of specialized drug shops in Sub-Saharan Africa: a systematic review of the literature. BMC Health Services Research, 12(1), 1–18.

7. Wafula F, Abuya T, Amin A, Goodman C. (2014). The policy-practice gap: describing discordances between regulation on paper and real-life practices among specialized drug shops in Kenya. BMC Health Services Research, 14(1), 1–11.

8. Embrey M, Vialle-Valentin C, Dillip A, Kihiyo B et al. (2016). Understanding the role of accredited drug dispensing outlets in Tanzania’s health system. PloS one, 11(11), e0164332.

9. Rutta E, Liana J, Embrey M, Johnson K et al. (2015). Accrediting retail drug shops to strengthen Tanzania’s public health system: an ADDO case study. Journal of Pharmaceutical Policy and Practice, 8(1), 23.