Community pharmacies don’t need to prove their value. They need a place in the system.

*This article was first published by Results for Development (R4D) as part of ongoing work to share learnings and experiences in mainstreaming Community Pharmacies into Primary Healthcare Systems.

Three insights from the front lines of integrating community pharmacies into primary health care

Community pharmacies are already deeply integrated into the communities they serve. People trust them because they are accessible, familiar, and meet people where they are. The harder question is why they have not yet been fully integrated into national health systems.

That question was at the center of Agora’s first global working session, which brought together practitioners to explore what it will take to move beyond isolated innovations and make pharmacies and drug shops a formal part of primary health care.

Agora is a global learning initiative dedicated to integrating private pharmacies and drug shops into primary health care systems and building the community, evidence and momentum to take innovations to scale. Agora aims to create a community of champions who are advocating for the integration of pharmacies and drug shops in primary healthcare systems and who are working together to support that integration at scale. The first working session featured findings from the landscape report that informed the development of Agora, presented by the Results for Development Managing Director Cheryl Cashin, followed by insights from my experience as the Executive Director of the African Pharmaceutical Network (APN).

Insight 1: We know community pharmacies matter, the challenge is integrating them

For me, this isn’t just a policy discussion. It’s personal. I grew up in western Kenya — Siaya to be specific — a malaria hotbed, and suffered from malaria many times. When I needed medicine, I did not go to a public health facility; I went to a pharmacy, whether for myself or for a family member. Yet because national reporting systems capture only public sector and hospital data, those visits never appear in the record. The providers that millions of people rely on remain invisible to the very system meant to plan for them.

So, this issue is very close to my heart and why I am pleased to lead the African Pharmaceutical Network. One of our key projects is the Community Pharmacy Partnership — which is designed to professionalize community pharmacy services and advocate for the integration of community pharmacies into national health programs.

APN’s initiatives are grounded in evidence generated through research. And the evidence is clear — community pharmacies are uniquely positioned to improve health care access because they are deeply integrated into their communities.

For example, research conducted after the COVID-19 pandemic highlighted the resilience and the vulnerability of community pharmacies. They remained accessible when many parts of the health system were under strain, yet because they sat outside formal financing arrangements, many struggled to sustain their operations. A key takeaway was the urgent need to mainstream these pharmacies into national healthcare systems and provide alternative financial instruments to support their operations. There is also a need to prepare them to provide the necessary care within communities in emergency situations, leveraging their accessibility and the trust placed in them by the communities.

A second piece of research explored the role of pharmacies in mental health and the gaps that exist. While 89% of the public believed pharmacists had a role in mental health support, most felt that pharmacists lacked the necessary training to provide these services.

At the same time, APN is working on transforming practice in the field and is already seeing success through targeted interventions in Kenya. For World Malaria Day, we facilitated a capacity building program focused on community engagement, therapeutic management, and the policy imperatives for involving pharmacists in malaria care. That training was built on a shift that had already permitted community pharmacies to use rapid diagnostic tests to confirm malaria and to dispense the recommended treatment, so what we were strengthening was not a pilot but a role the system had formally opened to them.

Insight 2: Integration requires more than policy change

These examples point to a broader lesson. Countries are not struggling because pharmacies lack potential.

They are struggling because integration requires several changes to happen together, including clear scopes of practice, training and quality assurance, referral and reporting systems, financing and reimbursement, appropriate physical space, and incentives that align the realities that pharmacists face with public health goals.

However, barriers such as out-of-pocket payment constraints, limited space for confidential consultations, and time pressures, all shape what pharmacies can realistically deliver. Without addressing these practical conditions, promising models are likely to remain pockets of innovation rather than become part of the health system at scale.

Part of this is physical and part is perception. If a pharmacy is seen as a shop rather than a place to receive care, and if it has no private space for confidential consultation, then even a well-trained pharmacist cannot deliver the service a patient needs.

Kenya’s experience with family planning shows how this plays out. The government has recognized pharmacies as service provision points for family planning, including injectable contraceptives, and pharmacists and pharmaceutical technologists who complete the required training can now provide them. The policy has changed and the capability is in place. Yet in the project I currently lead, the live challenge is getting the public to recognize the pharmacy as a place to seek these services, and to trust them. In other words, integration isn’t complete when policy changes. It’s complete when patients change their behavior too.

Financing makes the point sharpest. If the pharmacy where I actually seek care is not among the providers covered by the national insurance scheme, I have little reason to enroll or contribute. I will simply pay out of pocket at the pharmacy.

Insight 3: Networks can help countries move from promising examples to scalable implementation

No country is starting from scratch. Across Africa and beyond, governments are testing new approaches to regulation, financing, digital reporting, referral systems, and quality assurance. The challenge isn’t a lack of innovation — it’s making sense of what’s working, sharing those lessons, and adapting them to different contexts. That’s where networks like Agora have the greatest value.

We can draw lessons from successful global models such as the UK’s “Pharmacy First” model. And through continued collaboration and innovation, the goal of a healthy, medicine-secure Africa is within reach.

We’ve demonstrated that community pharmacies can improve access, expand services, and strengthen health outcomes. Now we must translate that evidence into policy, financing, and implementation so that community pharmacies become an intentional part of primary health care rather than an informal one.