key: cord-0967953-kh5lu19v
authors: Hedima, Erick Wesley; Okoro, Roland Nnaemeka
title: Telepharmacy: An opportunity for community pharmacists during the COVID-19 pandemic in Sub Saharan Africa
date: 2020-11-04
journal: Health Policy Technol
DOI: 10.1016/j.hlpt.2020.10.013
sha: 09d61d98cdcc1dd4ea4da5d48b663d1c817f4439
doc_id: 967953
cord_uid: kh5lu19v

nan

coronavirus 2 (SARS-CoV-2), the causative agent of coronavirus disease 2019 (COVID-19) that originated from China has since been considered a global public health emergency [1] . The impact of this pandemic has been profound and the difficulties individuals face receiving healthcare services are aggravated by the higher risk of infection among healthcare workers and ensuing staff absences due to illness or the need to self-isolate [2] .

Pharmacies that currently practice in remote areas are faced with problems of service sustainability because of the hiring and retention of pharmacists, leading to difficulties in creating lasting impacts. As such, residents have to either seek healthcare from the nearest community pharmacy or use mail order or online services to fill their prescriptions, which is a particular concern for the elderly who have a much higher risk of infection and limited support or without internet connection/low competence in the use of modern technology [3] . This could lead to an increase in COVID-19 cases. This paper highlights the concept of telepharmacy as a cost-effective strategy for the continuity of pharmaceutical services for remote community members as well as in preparedness for a future pandemic.

Telepharmacy is defined as "the provision of pharmacist care by registered pharmacists and pharmacies through the use of telecommunications to patients located at a distance" [4] .

Remote services that can be delivered via telepharmacy include, patient assessment, prior and refill authorization of prescribed medications, patient education, and counseling, surveillance of preparation of antineoplastic agents, monitoring of formulary compliance and drug information services. Others are diagnostic and disease prevention services, therapeutic drug monitoring, and assessment of clinical outcomes.

Telepharmacy models have been implemented in various countries of the world despite variations in healthcare systems. For example, it has been implemented in Australia as far back as 1942 [5] . Here some medical chests with equipment and medications are put in the remote communities, and members of the community receive medications and consultations through telehealth. Additionally, pharmaceutical reviews in remote hospitals that do not have pharmacists were done via telepharmacy. Similarly, in the United States of America (USA), the lack of pharmacists in remote areas in most of the states led to the adoption of telepharmacy in the year 2000 [5] . In the USA, pharmacists use videoconferencing to communicate with patients and other healthcare providers and conduct remote retailing and medication delivery.

Furthermore, due to an insufficient number of pharmacists nationwide, the Canadian government adopted telepharmacy which was first implemented in the year 2003 [5] . Remote patient counseling and medication dispensing were done through videoconferencing. The United Kingdom and Hong Kong started their telepharmacy project in 2010 [5] . Other countries that have implemented telepharmacy include Belgium, Cuba, Guam, Germany, France, Japan, Denmark, Italy, Venezuela, Spain, Bahrain, and Egypt. Regrettably, to the knowledge of the authors, there is no official implementation of telepharmacy in Sub-Saharan African countries.

As the COVID-19 reaches regions with weaker health systems and emerging economies, the impact on the healthcare needs of the general population is enormous. African countries particularly Ghana, Uganda, Sudan, Zambia, and Zimbabwe have been the most impacted by COVID-19 pandemic, in terms of closure of clinics and health posts [6] . This situation translates into the scaling down of HIV testing and limited access to contraceptive care services. Disruption in essential reproductive health services and medication supply in low-and middle-income countries (LMICs) could lead to millions of women with unmet need for modern contraception, according to estimates from Guttmacher Institute [7] .

It is worth noting that the health challenges presented by COVID-19 have also presented some opportunities. One of these may be the long-term health benefits people in Sub-Sahara Africa can experience from telehealth's improvements to medication adherence, disease prevention and consequently overall health. At the same time, this will present community pharmacies and pharmaceutical companies even public hospitals with an important opportunity.

Innovations in pharmaceutical services in respect of telepharmacy are gradually gaining acceptability in Africa due to the lockdown of cities, transportation, and markets [8] . Individuals seek healthcare advice via telephone calls with trained pharmacists, who provide counseling, education, and pharmaceutical care. These innovative pharmacy practices not only reduce the number of individuals in hospitals seeking healthcare, but they also reduce nosocomial infections. Community pharmacies in Nigeria have risen to the challenge by utilizing modern technology to reach their clients.

A report by the World Health Organization (WHO) Global Pharmacy Workforce indicates a lower number of pharmacists worldwide, and that this trend is augmented in countries with emerging economies. The current pharmacist-patient ratio of 1 per 10, 000 in Ghana falls short of the World Health Organization's recommendation of 1:2,000 for a nation trying to achieve universal health coverage [9] . This has made an ingenious community pharmacist come up with a smartphone-based telepharmacy application (app) that allows pharmacists to review medication order and counsel patients as well as monitor therapy in several facilities in different locations at once and in real-time. This app also allows clients to check for the availability of medications. Tele-pharmacy has proven to save time and money in South Africa by increasing 6 access to pharmaceutical care, adherence to therapy as well as reducing the risk of being infected with an infectious disease [9] .

Finally, in spite of numerous benefits of telepharmacy including improved drug therapeutic monitoring, and a decrease in the number of adverse drug events [10] , major issues remain confidentiality, privacy, and security threats of health information. The professional duties to maintain confidentiality, privacy, and security of health information is supported by professional association codes of ethics, as prescribed in the code of ethics for pharmacists. The accumulation of huge amounts of personal health data in electronic form increases the threat to confidentiality, privacy, and security of such data. Therefore, appropriate laws and regulations must be put in place by every nation contemplating the adoption of telepharmacy in order to guarantee unwarranted access and disclosures.

Authors have no conflict of interest to declare

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