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

Document Type : Original Article


Department of Clinical Pharmacy and Pharmacy Administration, Obafemi Awolowo University, Ile-Ife, Nigeria


Achieving 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.
A descriptive cross-sectional survey of 321 community pharmacies and 642 clients was undertaken between April and August, 2019. 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 5-point ordinal scales and chi-square tests were used to identify weights and associations between variables respectively at P < .050.
Response rates of pharmacists and clients were 74.7% (N = 321) and 100% (N = 642); while their median ages were 39.41 and 51.20 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] = 4.59), and disease prevention (4.54) but least of vaccine administration (2.39). Blood glucose screening devices were the most adopted technology with significant impact on service quality (χ2 6.86, P = .030). Major challenges to management of PHC services were poor awareness of pharmacists’ roles (4.31) and lack of integration with the PHC infrastructure (4.31). Capacity constraints in finances (4.11), technologies (4.09), and human resources (3.99) were significant. However, major facilitators were pharmacists’ managerial skills (4.35), and strong client relationships (4.27).
In 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.


  1. Melton BL, Lai Z. Review of community pharmacy services: what is being performed, and where are the opportunities for improvement? Integr Pharm Res Pract. 2017;6:79-89. doi:10.2147/iprp.s107612
  2. FIP. Vision of a Community-based Pharmacist: Community Pharmacy Section. International Pharmaceutical Federation, 2015.  www.fip.org/community_pharmacy.  Accessed April 28, 2020.
  3. Veillard J, Cowling K, Bitton A, et al. Better measurement for performance improvement in low- and middle-income countries: the Primary Health Care Performance Initiative (PHCPI) experience of conceptual framework development and indicator selection. Milbank Q. 2017;95(4):836-883. doi:10.1111/1468-0009.12301
  4. Law MR, Dijkstra A, Douillard JA, Morgan SG. Geographic accessibility of community pharmacies in Ontario. Healthc Policy. 2011;6(3):36-46. doi:10.12927/hcpol.2011.22097
  5. Fatai A. Small and medium scale enterprises in Nigeria: the problems and prospects. The Collegiate Journal of Economics. 2011;5(6):1-22.
  6. Afolabi MO, Olayiwola G, Erhun WO. Partnership patterns of general practice pharmacy in Nigeria. Nigerian Journal of Pharmacy. 1999;30(3):28-30.
  7. Adeloye D, David RA, Olaogun AA, et al. Health workforce and governance: the crisis in Nigeria. Hum Resour Health. 2017;15(1):32. doi:10.1186/s12960-017-0205-4
  8. World Health Organization (WHO), United Nations Children’s Fund (‎UNICEF)‎. A Vision for Primary Health Care in the 21st Century: Towards Universal Health Coverage and the Sustainable Development Goals. WHO; 2018. https:// www.who.int/primary-health/conference-phc.  Accessed March 20, 2019.
  9. Olaposi TO. Introduction to Healthcare Technological Innovation. Ile-Ife, Nigeria: Obafemi Awolowo University Press; 2017:82-89.
  10. World Health Organization (WHO). World Health Organization Model List of Essential In Vitro Diagnostics. WHO; 2018. http://www.who.int/medical_devices/diagnostics/WHO_EDL_2018.pdf.  Accessed April 20, 2020.
  11. Davis FD. Perceived usefulness, perceived ease of use, and user acceptance of information technology. MIS Q. 1989;13(3):319-340. doi:10.2307/249008
  12. Venkatesh V, Davis FD. A theoretical extension of the technology acceptance model: four longitudinal field studies. Manage Sci. 2000;46(2):186-204. doi:10.1287/mnsc.
  13. Hsiao CH, Tang KY. Examining a model of mobile healthcare technology acceptance by the elderly in Taiwan. J Glob Inf Technol Manag. 2015;18(4):292-311. doi:10.1080/1097198x.2015.1108099
  14. Ekpenyong A, Udoh A, Kpokiri E, Bates I. An analysis of pharmacy workforce capacity in Nigeria. J Pharm Policy Pract. 2018;11:20. doi:10.1186/s40545-018-0147-9
  15. Ekpeyong D, Nyang MO. Small and Medium-Scale Enterprises in Nigeria: Their Characteristics, Problems, And Sources of Finance. Nairobi: African Economic Research Consortium; 1992.
  16. Pharmacists Council of Nigeria. List of Registered Community Pharmacies in Nigeria. http://www,pcn.gov.ng.  Accessed January 10, 2020. Published 2019
  17. World Bank. Rural population (% of Total Population) estimates based on the United Nations Population Division’s World Urbanization Prospects 2018 Revision. https://data.worldbank.org/indicator/SP.RUR.TOTL.ZS. Accessed December 14, 2019
  18. Oseni YO. Pharmacists’ distribution in Nigeria; implication in the provision of safe medicines and pharmaceutical care. Int J Pharm Pharm Sci. 2017;9(10):49-54. doi:10.22159/ijpps.2017v9i10.20454
  19. Cochran WG. Sampling Techniques. 3rd ed. New York: John Wiley & Sons Inc; 1977.
  20. Osemene KP, Erhun WO. Evaluation of community pharmacists’ involvement in public health activities in Nigeria. Bra J Pharm Sci. 2018;54(3):e17447. doi:10.1590/s2175-97902018000317447 
  21. Kolodziejak L, Rémillard A, Neubauer S. Integration of a primary healthcare pharmacist. J Interprof Care. 2010;24(3):274-284. doi:10.3109/13561820903130149
  22. Dos Santos Júnior GA, Ramos SF, Pereira AM, et al. Perceived barriers to the implementation of clinical pharmacy services in a metropolis in Northeast Brazil. PLoS One. 2018;13(10):e0206115. doi:10.1371/journal.pone.0206115
  23. Butt MM, de Run EC. Private healthcare quality: applying a SERVQUAL model. Int J Health Care Qual Assur. 2010;23(7):658-673. doi:10.1108/09526861011071580
  24. Arafat SMY. Psychometric validation of the Bangla version of the patient-doctor relationship questionnaire. Psychiatry J. 2016;2016:9385364. doi:10.1155/2016/9385364
  25. Israel GD. Determining Sample Size. Program Evaluation and Organizational Development, IFAS, University of Florida. PEOD-6. November 2013. http://edis.ifas.ufl.edu.  Accessed November 4, 2019
  26. Alenoghena I, Aigbiremolen A, Abejegah C, Eboreime E. Primary health care in Nigeria: strategies and constraints in implemntation. Int J Community Res. 2014;3(3):74-79.
  27. Van Balen H. Disease control in primary health care: a historical perspective. Trop Med Int Health. 2004;9(6):A22-26. doi:10.1111/j.1365-3156.2004.01261.x
  28. Henry D. Pharmaceutical pricing policy. In: MDS-3: Managing Access to Medicines and Health Technologies. Arlington, VA: Management Sciences for Health; 2012:324-327.
  29. Moullin JC, Sabater-Hernández D, Fernandez-Llimos F, Benrimoj SI. Defining professional pharmacy services in community pharmacy. Res Social Adm Pharm. 2013;9(6):989-995. doi:10.1016/j.sapharm.2013.02.005
  30. Manolakis PG, Skelton JB. Pharmacists' contributions to primary care in the United States collaborating to address unmet patient care needs: the emerging role for pharmacists to address the shortage of primary care providers. Am J Pharm Educ. 2010;74(10):S7. doi:10.5688/aj7410s7
  31. Grosios K, Gahan PB, Burbidge J. Overview of healthcare in the UK. EPMA J. 2010;1(4):529-534. doi:10.1007/s13167-010-0050-1
  32. Buss VH, Shield A, Kosari S, Naunton M. The impact of clinical services provided by community pharmacies on the Australian healthcare system: a review of the literature. J Pharm Policy Pract. 2018;11(1):22. doi:10.1186/s40545-018-0149-7
  33. Bradley H, Lehmann U, Butler N. Emerging roles and competencies of district and sub-district pharmacists: a case study from Cape Town. Hum Resour Health. 2015;13(1):88. doi:10.1186/s12960-015-0081-8
  34. Bheekie A, Bradley H. Re-engineering of South Africa’s primary health care system: where is the pharmacist? S Afr Fam Pract. 2016;58(6):242-248. doi:10.1080/20786190.2016.1186365
  35. Oparah AC, Arigbe-Osula EM. Evaluation of community pharmacists' involvement in primary health care. Trop J Pharm Res. 2002;1(2):67-74. doi:10.4314/tjpr.v1i2.14586
  36. Rezapour R, Tabrizi JS, Farahbakhsh M, Saadati M, Abdolahi HM. Developing Iranian primary health care quality framework: a national study. BMC Public Health. 2019;19(1):911. doi:10.1186/s12889-019-7237-8
  37. Hashemian F, Emadi F, Roohi E. Collaboration between pharmacists and general practitioners in the health care system in the Islamic Republic of Iran. East Mediterr Health J. 2016;22(6):375-382. doi:10.26719/2016.22.6.375
  38. Macinko J, Harris MJ. Brazil's family health strategy--delivering community-based primary care in a universal health system. N Engl J Med. 2015;372(23):2177-2181. doi:10.1056/NEJMp1501140
  39. Puspitasari HP, Aslani P, Krass I. Challenges in the care of clients with established cardiovascular disease: lessons learned from Australian community pharmacists. PLoS One. 2014;9(11):e113337. doi:10.1371/journal.pone.0113337
  40. Ilardo ML, Speciale A. The community pharmacist: perceived barriers and patient-centered care communication. Int J Environ Res Public Health. 2020;17(2). doi:10.3390/ijerph17020536
  41. Miner JB, Smith NR. Decline and stabilization of managerial motivation over a 20-year period. J Appl Psychol. 1982;67(3):297-305. doi:10.1037/0021-9010.67.3.297
  42. Avong YK, Aliyu GG, Jatau B, et al. Integrating community pharmacy into community based anti-retroviral therapy program: a pilot implementation in Abuja, Nigeria. PLoS One. 2018;13(1):e0190286. doi:10.1371/journal.pone.0190286
  43. Osemene KP, Ihekoronye RM. Relationship marketing practices in community pharmacies in south-western Nigeria. East and Central African Journal of Pharmaceutical Sciences. 2019;22(1):13-19.
Volume 11, Issue 6
June 2022
Pages 829-839
  • Receive Date: 13 June 2020
  • Revise Date: 01 November 2020
  • Accept Date: 01 November 2020
  • First Publish Date: 25 November 2020