Expanding access to NCD services via community retail pharmacies in LMICs: a systematic review of the literature.

Abstract

Background: Non-communicable diseases (NCDs) pose a significant global health challenge. In LMICs, NCDs are an incresing driver of premature deaths and have substantial economic impacts, particularly on working-age adults. The World Health Organization has identified four priority NCDs - cardiovascular diseases, diabetes, asthma/chronic obstructive pulmonary disease, and cancer - which are included in its Package of Essential Non-Communicable Disease Interventions for low-resource primary care settings. However, a shortage of healthcare professionals further compounds the problem. Pharmacists, who could play a pivotal role in NCD care, remain underutilised.

Methods: We conducted a systematic literature review to identify studies on the role of community pharmacies and pharmacists in delivering NCD services in low- and middle-income settings and assessed their risk of bias. Searches were performed in PubMed, MEDLINE via Ovid, and CINAHL from 1990 to 2022, including English, French, or Spanish publications.

Results: Out of 1,284 articles, 23 met inclusion criteria, predominantly focusing on diabetes (65%), followed by cardiovascular diseases (22%), cancer (9%), and asthma (4%). Most studies were conducted in Asia (52%), followed by South America (22%) and Africa (13%). Significant improvements were observed in glycaemic control and medication adherence for diabetes, and in blood pressure management and adherence for hypertension. Positive outcomes were also seen in health behaviours for breast cancer, asthma, and cardiovascular disease risk management. Interventions were cost-effective for managing diabetes and hypertension in elderly patients. However, accessibility challenges were noted in vaccination programmes, and concerns about bias were identified, particularly in observational studies.

Conclusions: Expanding NCD services through community pharmacies in low and middle-income countries can significantly improve health outcomes. Pharmacists can enhance education, screening, and management for NCDs, leading to better disease control and patient satisfaction. Addressing resource constraints, legal barriers, and disease focus disparities is essential. Adequate training, financial incentives, and collaboration among stakeholders are crucial for integrating pharmacists into NCD care frameworks.