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How pharmacists can help tackle antimicrobial resistance in the African region

By guest contributor Tumaini Makole

When I was pursuing my advanced-level studies at Tabora Boys Secondary School – Tabora region, United Republic of Tanzania, my dream was to become a doctor. One day a former student visited us, and we had a career-like discussion. He advised us about different courses that we could pursue at the university, and he mentioned that he was pursuing a Bachelor of Pharmacy at the Muhimbili University of Health and Allied Sciences (MUHAS). It was the first time for me to hear and learn about pharmacy. I was curious to pursue pharmacy studies and become an expert in medicine, but the worry was why such an important field of health is not known among the community compared to nurses and doctors.

I joined the School of Pharmacy at MUHAS and now I am a registered Pharmacist in Tanzania.  Though time has passed, and things have changed, pharmaceutical personnel and their roles remain less known among members of the community. The pharmacy profession has expanded significantly in recent years, offering professional services, and is now recognized by many disciplines as an essential profession in the delivery of healthcare. However, unlike many high income countries, some low- and middle-income countries do not use pharmacists to their fullest potential, and the public and other healthcare professionals do not recognize their importance as healthcare experts.

Most African nations have lower- or middle-income status and face the highest challenge in dealing with antimicrobial resistance due to their limited resources, inadequate laboratory and diagnostic capabilities, weak surveillance infrastructure, and insufficient efforts in antimicrobial stewardship and infection control strategies. Antimicrobial agents are crucial in reducing the impact of communicable diseases. Unfortunately, the effectiveness of these agents is being undermined by the emergence and spread of resistance.

In the African region, surveillance of drug resistance is limited to a few countries, which leads to incomplete and inadequate data on the true extent of the problem. Despite limited laboratory capacity, data suggests that drug resistance is increasing, following a worldwide trend. Sub-Saharan Africa has the highest mortality rate worldwide due to antimicrobial resistance, with 99 deaths per 100 000 people.

The shortage of health workers in Africa and around the world is growing, and the World Health Organization estimates a projected shortfall of 10 million health workers by 2030, mostly in low- and lower-middle-income countries. Shortage of pharmaceutical personnel is pervasive and persistent across Africa. Most African countries have fewer than one pharmacist per 10,000 people, according to a global workforce review. According to the World Health Organization, there should be at least one healthcare professional for every 439 people.

Access to health services in Africa is still a challenge, especially the availability of health commodities in peri-urban and rural areas. A study conducted by WHO found that participants were concerned about the inadequacy of drugs at health facilities, poor attitudes of health personnel, and health workers’ attitudes to emergency situations.

The provision of healthcare services relies heavily on the availability of essential medicines. To ensure successful disease management, it is crucial to maintain a consistent supply of these medicines at all healthcare service points. Unfortunately, in many regions of African countries, the provisioning of essential medicines is problematic. A majority of Africans, mostly the poor and those in the middle-income bracket, rely on underfunded public health facilities while a small minority has access to well-funded, quality private health care. This is evident by the occurrence of public health sector stock-outs, where patients are unable to obtain all the prescribed medicines for their health conditions during their visits to healthcare services.

Community pharmacists play a crucial role in providing advice to patients on minor ailments and referring them to their physicians when necessary. They are typically the primary point of contact for the public, serving as the gateway to the healthcare system due to their convenient accessibility.

Because of this, people tend to visit the community pharmacy for health services because is well positioned among the community and easily accessible to pharmacists and other pharmaceutical personnel. This is supported by research that concluded patients visit their community pharmacies almost twice as often as they visit their physicians or other Qualified Health Practitioners.

Most pharmacists have good knowledge about antibiotics and Antimicrobial Resistance (AMR).  Pharmacists in community pharmacies and health facilities have great potential in the fight against Antimicrobial Resistance. In the pharmacy community, pharmacists and other pharmaceutical personnel have the role of encouraging their clients to visit health facilities for diagnostic tests and further consultation for conditions that can not be managed in a pharmacy and avoid empirical treatment.

Medicine adherence is another challenge that contributes to the emergence of AMR. Pharmacists have the role of insisting on and advising patients to comply with their prescribed medications and report any adverse event.

Community pharmacies can be an important source of health information including distribution of antimicrobial resistance awareness materials. The need for antimicrobials can be decreased by enhancing population immunity and resilience to illnesses through events and programs that promote community health. As advocates for healthy living, pharmacists have taken part in several health promotions efforts, including those that promote decisions that support a strong immune system.

Pharmacists protect the integrity of the supply chain and procure medical products only from reputable sources. They are alert to differences in quality of packaging, labeling, or leaflets and in physical appearance of medicinal products. Pharmacists are a vital asset in assuring the safety of patients through their active participation in the fight against counterfeit medicines.

African countries tend to have a greater tendency for fewer pharmacists and pharmacy technicians per country population. Most pharmacists in Africa work in the private health sector in community pharmacies (40%), followed by public or private hospitals (20%). It is high time for policymakers and decision-makers to see the potential of pharmacists in the fight against AMR, increase their number and provide incentives for their work.

Tumaini J. Makole is a registered pharmacist in the United Republic of Tanzania and currently pursuing Master of Pharmacy in Quality Control and Quality Assurance at Muhimbili University of Health and Allied Sciences. He has previously worked at the Office of Chief Pharmacist at The Ministry of Health and Kondoa District Council in Dodoma Region. He is a public health advocate and is interested in Public Health Policy, Global Health, and Medicines Regulatory Affairs. He tweets at @TumainiMakole


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