
==== Front
BMC Health Serv Res
BMC Health Serv Res
BMC Health Services Research
1472-6963
BioMed Central London

39278935
11537
10.1186/s12913-024-11537-4
Research
The remote provision of pharmaceutical products and services by retail pharmacies in Kampala, Uganda; practices and challenges
Fauzi Ibrahim Ali fauziibrahimali@gmail.com

Kintu Jafari
Luyima Martin
Kyeyune Henry
Rajab Kalidi
Kutyabami Paul
Asiimwe Lydia Irene
Bukenya Isah
Kitutu Freddy Eric
Mwawule Fredrick Wadulo
https://ror.org/03dmz0111 grid.11194.3c 0000 0004 0620 0548 Department of Pharmacy, School of Health Sciences, College of Health Sciences, Makerere University, University Rd, Kampala, 10218 Uganda
16 9 2024
16 9 2024
2024
24 106917 3 2024
3 9 2024
© The Author(s) 2024
2024
https://creativecommons.org/licenses/by-nc-nd/4.0/ Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to share adapted material derived from this article or parts of it. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by-nc-nd/4.0/.
Background

The COVID-19 pandemic significantly increased the demand for remote healthcare services delivery, including remote access to medications. This study explored the practices and challenges associated with remote provision of pharmaceutical products and services in Kampala, Uganda.

Methods

A cross-sectional study was conducted from July to September 2022, enrolling 174 out of 198 sampled retail pharmacies. Data was collected using a pre-tested questionnaire on remote service provision, platforms used, products offered, delivery methods, and challenges faced.

Results

Over 58% of pharmacies provided remote services, primarily through social media (especially WhatsApp) and phone calls. OTCs and POMs were the most commonly dispensed products remotely. Key challenges identified included high internet costs, labor shortages, poor internet quality, and a lack of specific regulations for remote provision of pharmaceutical products and services.

Conclusion

The proportion of retail pharmacies providing pharmaceutical products and services remotely is significant in Kampala, but they face challenges that need to be addressed. Regulations are crucial to ensure responsible dispensing practices and rational medicine use. Addressing internet affordability and quality, staffing issues, and delivery logistics is essential for sustainable and effective remote pharmaceutical products and services.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-024-11537-4.

Keywords

Remote provision of pharmaceutical products
Online platforms
Regulations
Medication access
Internet
issue-copyright-statement© BioMed Central Ltd., part of Springer Nature 2024
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pmcIntroduction

Technology has revolutionized communication and trade, making it easier for people to connect and access goods and services, including healthcare. Access to mobile telecommunication, internet services, and online platforms empowers people to leverage these technologies to effectively communicate and trade. Technology-driven platforms such as; the use of phone calls, Short Message Service (SMS), websites, and social media offer safer, faster, and more convenient means to connect. Perhaps not surprisingly, patients are increasingly turning to these channels for health information and services [1].

While remote healthcare was already in use globally, COVID-19 accelerated its adoption [2, 3]. Movement restrictions, curfews, and limitations on physical contact necessitated the adoption of contactless solutions to facilitate access to essential services like healthcare as well as to curtail the spread of COVID-19. This led to a surge in patients seeking medical services remotely, prompting medical systems to adapt [2, 3]. In Uganda, there is a lack of specific data to show this trend. However, similar patterns may be observed based on global trends, especially in countries where there was a restriction on the movement of people. Today, patients can obtain various medical services without needing physical interaction with the practitioner. Notably, the remote provision of pharmaceutical products and services such as medications both POMs and OTCs, and medical consultations saw a significant rise, as physical contact isn’t always crucial for these transactions [4].

Several retail pharmacies have adopted or expanded the remote provision of pharmaceutical products and services to stay financially viable amidst a declining number of walk-in customers [5, 6]. The move to provide pharmaceutical services and products remotely makes business sense and limits the spread of infectious diseases.

However, the rapid increase in the remote provision of pharmaceutical products and services hasn’t allowed for the parallel development of guidelines and regulatory systems to ensure the maintenance of professional dispensing of pharmaceuticals and the rational use of medicines. In Uganda, the National Drug Authority (NDA), lacks specific regulations for the remote provision of pharmaceutical products and services [7]. Existing regulations designed for the physical interaction between pharmaceutical care providers and the patients, neglect addressing the significant differences between physical and remote good dispensing practices and implications for rational medicine use and, patient safety [4–7].

Physical interaction between pharmaceutical care providers and patients allows for a more comprehensive service, enabling providers to authenticate prescriptions accurately, manage common illnesses with appropriate over-the-counter (OTC) medicines, and offer direct patient education and concern response. While these services can also be effectively provided remotely, the physical presence of the patient enhances the care quality by incorporating multiple forms of communication beyond verbal interaction, including body language, environmental cues, and unconscious expressions. This multifaceted communication helps in accurately assessing and addressing patient needs [4, 8, 9]. Such opportunities to ensure rational medicines can be missed by the remote provision of pharmaceutical services. Sun et al. [10] noted that the online sale of antibiotics without prescriptions increases public access to these medicines which is an additional challenge for antimicrobial Stewardship. While remote practices offer advantages, they have the potential to expose patients to irrational use of medicines if not well-regulated.

Despite the continued existence of remote provision of pharmaceutical products and services post-COVID-19, little is known about how remote services are being implemented in retail pharmacies in Uganda. Understanding the extent of the practice of remote services, the safeguards implemented (if any), restrictions on dispensed products, remote services’ share of the pharmacy business, and the challenges faced by pharmacies in providing remote services is crucial for designing an effective regulatory framework to streamline practices and ensure rational medicine use. This study aimed to explore the practices and challenges of remote provision of pharmaceutical products and services by retail pharmacies in Kampala.

Methods

Study design and study setting

A cross-sectional study was carried out, from July to September 2022, to explore the practices and challenges associated with the remote provision of pharmaceutical products and services by retail pharmacies in Kampala, Uganda. Kampala, the capital city of Uganda, has a land area of approximately 189 square kilometers. Kampala has a night population estimated at 1,680,600 in 2020 and 4,050,826 during the day [11, 12]. The city is administratively divided into five divisions: Central Division, Kawempe Division, Rubaga Division, Makindye Division, and Nakawa Division. The city had a total of 353 licensed retail pharmacies as of March 2022, making up 22.7% of licensed retail pharmacies in Uganda. At the time of the study, the central division had 99 retail pharmacies, the Kawempe division had 57, the Makindye division had 76, the Nakawa division had 58, and the Rubaga division had 63 [13].

Determination of sample size and selection of study participants

The sample size was estimated using the Yamane simplified formula [14]. With a 5% sampling error and 95% level of confidence, 198 participants would be required to answer the study objectives after a 5% adjustment for non-responsiveness. The study area was divided into strata composed of the five divisions that make up the city. Proportionate sampling was done to determine the number of participating retail pharmacies per division. The Central division had 56 retail pharmacies, the Kawempe division had 32, the Makindye division had 43, the Nakawa division had 32, and the Rubaga division had 35. Retail pharmacies in each division were selected by simple random sampling. The names of pharmacies were fed into Microsoft Office Excel, the formula for randomization was used to randomize the data, and the required number of pharmacies per division was selected.

Data collection

A pre-tested, structured questionnaire to gather information from key personnel at randomly selected retail pharmacies in Kampala, Uganda was employed [15]. Pre-testing was done two weeks before conducting the study to ensure that it collected the intended data. The pre-testing was done by carrying out the interviews in ten randomly selected retail pharmacies in Wakiso district. Respondents were the pharmacy manager, pharmacist, dispenser, or other pharmacy auxiliary staff who had worked at the pharmacy for at least six months. The Respondents were interviewed by the researchers and their assistants. Data was collected on the remote provision of pharmaceutical products and services; the communication platforms employed; the products and services provided remotely; the proportion of business carried out online and the infrastructural; human resource and challenges experienced due to the remote provision of pharmaceutical products and services. Respondents were enrolled at their respective retail pharmacies by the research team, ethical considerations were put into effect. The collected data underwent careful review to ensure completeness and was then stored securely in box files within a locker.

Data management and statistical analysis

The data was analyzed using SPSS version 26. Basic descriptive statistics such as frequency, mean, modes, standard deviations, and ranges were generated. Data was presented using tables and charts.

Results

Out of the 198 retail pharmacies sampled, 174 retail pharmacies participated in the study representing a response rate of 88%.

The proportion of retail pharmacies providing products and services remotely

As seen in Fig. 1 and 58.6% (102) of retail pharmacies reported providing pharmaceutical products and services remotely.Fig. 1 Proportion of retail pharmacies retail pharmacies providing products and services remotely

Communication platforms used

Retail pharmacies in Kampala use a variety of platforms to provide pharmaceutical products and services remotely. The most frequently used platform is social media, with 85 (83.3%) of the retail pharmacies reporting its use. Of the social media platforms, WhatsApp 83 (97.6%) is the most frequently used of the social media platform followed by Facebook 23 (27.1%) and Twitter 14 (16.5%).

Other reported platforms include phone calls 68 (66.7%) and websites 33 (17.6%). Fewer pharmacies are employing the use of delivery apps 16 (10.8%) for this purpose as shown in Fig. 2.Fig. 2 Proportions of platforms employed by the retail pharmacies for remote provision of pharmaceutical products and services

Products and services provided

Retail pharmacies provide several products and services to clients remotely. These include; OTCs provided by 95 (93.1%) retail pharmacies, which were the most provided, Prescription-Only-Medicines (POMs) 70 (68.6%), Cosmetics 67 (65.7%), and Reproductive Health services 47 (46.1%). Supplements 39 (38.2%) were the least provided products as shown in Fig. 3.

Fig. 3 Type of pharmaceutical products or services provided

Results for the number of dedicated staff, daily orders, and deliveries done for remote business

Only 40% of the retail pharmacies that provided remote services had no dedicated staff to manage the orders made remotely. Orders made remotely were handled by the same staff members that handled walk-in customers. Over 73% of these pharmacies received less than 10 remote orders in a day (Mean daily orders both remote and physical 95+, ±115.8 SD) and 87% offered delivery services for the pharmaceutical products ordered remotely as shown in Table 1 below.Table 1 Results for the number of dedicated staff, daily orders, and deliveries done for remote business

Parameter		Frequency n = 102	Percentage	
Dedicated Staff for the remote business	Yes	39	38.23	
No	61	59.80	
Not sure	2	1.96	
Number of remote daily orders	No response	1	0.98	
1–3	37	36.27	
4–6	31	30.39	
7–10	7	6.86	
> 10	26	25.49	
Provision of delivery services for products purchased remotely	Yes	89	87.25	
No	13	12.75	
The mean number of daily orders both physical and remote 95, 115.8 Standard Deviation (SD)

The mean number of dedicated staff is 4, 5.422 SD

Challenges in remote provision of pharmaceutical products and services by retail pharmacies in Kampala

The remote provision of pharmaceutical products and services faces several challenges mainly, high internet costs 64 (40.8%), labor shortage 49 (31.2%), and poor-quality internet 40 (25.5%).

Retail Pharmacies also reported other challenges 54 (34.4%) like insufficient capital and poor facilitation of delivery persons, Customers not paying for delivery, unsafe public transportation, and high fuel costs as shown in Fig. 4. Poor facilitation of delivery persons in this case refers to inadequate support and resources provided to individuals responsible for delivering pharmaceutical products.

Fig. 4 Challenges faced by retail pharmacies in the remote provision of pharmaceutical products and services

Discussion

This study found a significant percentage of retail pharmacies in Kampala, Uganda offering remote pharmaceutical services, likely driven by the COVID-19 pandemic’s demand for innovative remote healthcare solutions that enabled non-physical access to services using technology amidst restrictions on movements to curb the spread of the highly contagious coronavirus [5]. The remote provision of pharmaceutical products and services is now seen as a way to improve accessibility to healthcare, especially for individuals who cannot physically visit pharmacies due to various reasons including long distances, privacy, and limited time among others [16, 17].

In Uganda, remote provision of pharmaceutical products and services includes delivering pharmaceutical care through technology-driven platforms. This encompasses remote consultations, medication prescribing, and medication delivery to enhance accessibility and minimize the need for in-person visits. Pharmacy practice needs to adjust to accommodate the shift to remote services to ensure rational medicine use.

Social media platforms and phone calls were reported to be the most frequently used platforms for the remote provision of pharmaceutical products and services by retail pharmacies. This could be due to faster communication between customers and their suppliers, improved service levels, and reduced logistics costs when compared with other platforms [18, 19].

OTCs and POMs were reported as the most frequently provided products by the retail pharmacies remotely. While OTCs can be issued without a prescription, POMs require a valid prescription to be presented to the dispenser before the drugs are dispensed [7].

Another notable finding from the study was that about 60% of the retail pharmacies that provided remote services had no dedicated staff to handle the orders made remotely. This finding may imply that the pharmacies are relying on any of their existing staff to handle both physical and remote orders. For improved efficiency of the service, pharmacies need to have dedicated staff (whether new or existing) tasked to majorly handle remote orders to ensure efficient service delivery.

Some countries have restricted online pharmaceutical platforms to those meeting regulatory criteria to ensure monitoring and compliance with national medicines regulations, while others are in the process of implementing similar restrictions to facilitate the remote provision of pharmaceutical products [16, 17, 20–22]. These countries also stipulate how the medicines are delivered to the patients. From the study, most of the retail pharmacies providing remote services could provide delivery services to their customers. However, the basis upon which delivery personnel were appointed and their knowledge about drugs was not studied. It is noteworthy that the mode of delivery has a large bearing on the integrity of the medicines supplied to the patients [23].

One of the main challenges of remote provision of pharmaceutical products and services is the high cost of the internet, reported by 28% of retail pharmacies, which can limit access for those unable to afford it. Poor internet quality and labor shortages may also potentially impact service delivery. To address these challenges, it is essential to implement regulations or policies that reduce internet costs through subsidies or partnerships with telecom providers, improve internet infrastructure to ensure reliable and high-speed connectivity, and invest in training programs to alleviate labor shortages. Such measures will maximize the advantages of remote pharmaceutical services and mitigate issues that could undermine their effectiveness.

Finally, while this study offers valuable insights into the remote provision of pharmaceutical products and services in Kampala, Uganda during the study period, it is important to note the broader context of the retail pharmacy sector’s response to COVID-19. The pandemic necessitated rapid innovations and adaptations, which could serve as valuable insights for developing future retail pharmacy models [2, 3, 5, 6]. These innovations include enhanced remote communication, improved logistics for medicine delivery, and the integration of digital tools for patient care [24, 25]. Although our study did not specifically explore these changes, their impact on the sector is undeniable and warrants further investigation to optimize remote pharmaceutical services. Future studies should consider a comparative analysis of pre-and post-COVID-19 operations to better understand these transformations.

Conclusion

This study revealed significant practice of remote provision of pharmaceutical products and services in Kampala (58%), primarily utilizing social media and phone calls. While offering increased access to pharmaceutical products and services, concerns surrounding the remote dispensing of prescription medications necessitate regulatory interventions to ensure responsible dispensing practices, proper verification, and adherence to rational medicine use. Additionally, the study identified internet costs, labor shortages, and inadequate delivery logistics as significant concerns among participating pharmacies.

Study limitations

While this study offers valuable insights into the remote provision of pharmaceutical products and services in Kampala, Uganda, it focuses on the extent of the provision of pharmaceutical products and services, neglecting the impact of delivery services and the factors informing delivery costs. The study is also limited to Kampala, which restricts generalizability to other regions. Furthermore, it does not capture respondent characteristics (e.g., manager, pharmacist, or owner), limiting deeper analysis of their perspectives. Finally, this study offers groundwork data rather than an in-depth understanding of the remote provision of pharmaceutical products and services.

Recommendations

To optimize the remote provision of pharmaceutical products and services, regulations that ensure responsible dispensing practices, address prescription verification concerns, promote rational medicine use, while ensuring robust business-viable innovative remote healthcare solutions should be developed. Additionally, initiatives to improve internet affordability and quality would enhance accessibility and service delivery. Investing in dedicated staff trained in online consultations and safe delivery practices would further improve service efficiency and safety. Finally, future research exploring patient experiences and treatment adherence using remote services and rigorous research about the impact of delivery services and what informs delivery costs would provide valuable insights for optimizing these services and ensuring their responsible and sustainable implementation.

Supplementary Information

Supplementary Material 1.

Abbreviations

NDA National Drug Authority

OTC Over-the-counter

POMs Prescription-only-medicines

SD Standard deviation

Acknowledgements

The author acknowledges Husn Hussein N. for his invaluable professional advice and guidance in data analysis. His expertise significantly contributed to the quality and rigor of this article. The author also acknowledges all the research assistants who played a huge role in data collection.

Authors’ contributions

IAF conceived the idea for the study, led the statistical analysis, participated in the literature review, drafted the first version of the manuscript, and contributed to subsequent revisions. JK participated in the design of the study, coordinated the data collection process, and contributed to the data analysis and the drafting of the manuscript. ML participated in the design of the study, assisted with the literature review, and contributed to the drafting of the manuscript. HK and KR participated in the design of the study and contributed to the drafting and revising of the manuscript. PK, LIA, and IB contributed to the drafting and revising of the manuscript. FEK and FWM contributed to the revising of the manuscript. All authors reviewed the manuscript.

Funding

The author(s) did not receive any financial assistance for conducting the research, writing, or publishing this article.

Availability of data and materials

The datasets used and/or analyzed during the current study are available from the corresponding author upon reasonable request.

Data availability

The data supporting the findings of this study is available from the corresponding author upon reasonable request. Due to the sensitive nature of the data and potential privacy concerns, the data has not been deposited in a public repository. Access will be granted to qualified researchers who can provide a valid reason for their request, ensuring that the data is used responsibly and ethically.

Declarations

Ethics approval and consent to participate

This study was conducted after ethical clearance from the Makerere University School of Health Sciences Institutional Review Board (MakSHSIRB). Written informed consent was obtained and each of the participants was provided with an explanation of the purpose of the study.

Consent for publication

Not applicable.

Competing interests

The authors declare no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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