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Exploratory Research in Clinical and Social Pharmacy 13 (2024) 100395
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Prospects and challenges of online pharmacy in post-Covid world: A
qualitative study of pharmacists’ experiences in Ghana
Naessiamba Eab-Aggrey
a
, Shamshad Khan
b
,
*
a
Department of Communication, George Mason University, 4400 University Drive, Horizon Hall Suite 5200, Fairfax, VA 22030, USA
b
Department of Communication, University of Texas at San Antonio, One UTSA Circle, San Antonio, TX 78249, USA
ARTICLE INFO
Keywords:
Online pharmacy
Pharmacist
Ghana
Qualitative research
E-pharmacy
Health communication
ABSTRACT
Background: Online pharmacies continue to grow worldwide, especially in the wake of the COVID-19 pandemic.
Ghana is experiencing this growth in an unprecedented way since its government initiated an online pharmacy
pilot in December 2021, which was followed by the launch of the National Electronic Pharmacy Platform in July
2022. This pioneering initiative calls for extensive research with pharmacists to gain their perspectives. How-
ever, there is a dearth of such studies in the sub-Saharan African countries.
Objective: This study sought to understand how pharmacists in Ghana perceive online pharmacies in terms of the
larger socio-cultural and policy implications, as well as the challenges they face in its implementation.
Methods: Using a qualitative research design, local licensed pharmacists were recruited through purposive
sampling and by specically combining the maximum variation and snowball sample techniques. Semi-
structured interviews were conducted virtually with 21 pharmacists over the months of February and March
2022. The data were analyzed by using interpretive thematic analysis.
Results: Pharmacists perceived that online pharmacies would transform the pharmaceutical industry in Ghana by
making it convenient for people to access medication easily and at a reasonable price, while also offering them
privacy. However, concerns were expressed around existing poor infrastructure and inequities, low health lit-
eracy, and inadequate regulatory practices that could pose major challenges in the operation of this platform.
Engagement of stakeholders was deemed essential for success.
Conclusion: Online pharmacy in Ghana and much of the developing world has the potential to transform and
advance the pharmaceutical industry to better serve people. However, it could also lead to increased and irra-
tional use of medications, if not properly regulated. Government, policy makers, and leaders in the eld of digital
health and pharmacy must also address poor infrastructure and inequities in digital access.
1. Introduction
Online pharmacies have been growing for decades in the Western
world, and in recent times, it has picked up pace globally, with the
COVID-19 pandemic acting as a major catalyst.
1
Online pharmacies
operate over the Internet to offer clients various pharmaceutical ser-
vices, including the delivery of medications, and are often preferred by
people for its easy access.
2,3
This became most evident during the
COVID-19 pandemic when access to health care services was signi-
cantly impacted by the rapid spread of the virus and the mitigating
measures that were adopted.
1,4
Signicant disruptions in supply of
pharmaceuticals and the enforced public health measures during the
pandemic, such as the stay-at-home order, are known to have
particularly worsened the complexities and load of chronic disease
management that required a specic medicine regimen.
4
Furthermore,
with store pharmacies limiting the number of patients they could attend
to at a time, to follow public health protocols, many clients moved to-
wards the use of online pharmacies to tap on the benets of its greater
accessibility and to protect themselves from the virus.
5
Online pharmacies take different forms that can range from exten-
sion of a physical location to an independent cyberspace with no
physical site for clients to visit, or a consolidation of several independent
community pharmacies that are brought together on a platform to
represent themselves.
2
In the case of Ghana, online pharmacy began as
an extension of existing brick-and-mortar pharmacies where medica-
tions in the physical pharmacy were listed on an online platform to be
* Corresponding author.
E-mail addresses: neabaggr@gmu.edu (N. Eab-Aggrey), Shamshad.khan@utsa.edu (S. Khan).
Contents lists available at ScienceDirect
Exploratory Research in Clinical and Social Pharmacy
journal homepage: www.elsevier.com/locate/rcsop
https://doi.org/10.1016/j.rcsop.2023.100395
Received 25 September 2023; Received in revised form 6 December 2023; Accepted 6 December 2023
Exploratory Research in Clinical and Social Pharmacy 13 (2024) 100395
2
seen virtually and bought by clients that would be home delivered at a
cost. While it started gradually, with just a couple of online pharmacies,
the numbers multiplied rapidly in 2021 when several pharmacies joined
in to offer pharmaceutical care through online platforms and some
through social media platforms such as WhatsApp.
6
Although these
practices were not initially endorsed by the Pharmacy Council of Ghana,
it later offered to host a common platform, likened to Amazon, for
various pharmacies to display their medications and to make it acces-
sible to clients all over the country.
7
The National Electronic Pharmacy
Platform (NEPP) was thus designed in December 2021 to serve as a
common platform for 45 pharmacies to pilot test the feasibility and
effectiveness of this approach to address unmet pharmaceutical care
needs in Ghana.
7
This launch of an online pharmacy pilot by the gov-
ernment of Ghana was one of the most signicant interventions pro-
moted as an alternative to help people access qualied pharmacists,
without having to visit a physical pharmacy, against the backdrop of the
pandemic.
7,8
This initiative was closely followed by the national launch of the
NEPP in July 2022 and was deemed as a pioneering innovation that
would bring about a signicant digital transformation of pharmaceutical
care in the entire African region.
7,8
The NEPP is a technological platform
commissioned by the Pharmacy Council of Ghana, with multi-sectoral
support and partners, as a way to facilitate safe access to medications
for the public of Ghana through approved electronic pharmacies, web-
sites, social media and e-commerce platforms.
8,9
Since the nationwide
launch of NEPP, the enrolment of pharmacies has swelled from 45 to
over 226, although the distribution has not been uniform across all re-
gions of Ghana.
10
Considering the enormity of these pioneering initiatives in a region
where pharmacists have always played a critical role in the provision of
health and pharmaceutical services, working closely with people (and
sometimes as their go-to “doctors”),
11
it is important to understand their
perspectives as they would be directly engaged and responsible for
operating these online platforms. However, there is a complete dearth of
such studies on online pharmacies in Ghana or even in the context of the
sub-Saharan African countries. Given this critical gap in literature, this
study was undertaken to explore the role of online pharmacies in Ghana
from the pharmacists’ perspective. In particular, it sought to understand
how pharmacists perceived online pharmacies in Ghana in terms of their
larger socio-cultural, policy, and communication dimensions, as well as
challenges that they faced in implementing online pharmacies in the
context of the country’s poor resource settings. Given that these phar-
macists worked and lived in communities, drawing on their experiences
and insights is important to understand the state of public healthcare in
Ghana and the potential for expansion of digital health within the local
realities of prevailing low health literacy and digital access. This study
will help online pharmacy industry stakeholders in Ghana and in other
developing countries to understand the industry’s general scope, its
benets, pitfalls, challenges, and the way forward.
2. Methods
A qualitative methodology was adopted to explore the opinions and
experiences of licensed pharmacists in different regions of Ghana. The
study was reported using the Consolidated Criteria for Reporting Qual-
itative Research (COREQ) (see Appendix A). Ethics approval was sought
and received from the Institutional review board (IRB) of the University
of Texas at San Antonio, with an IRB approval identication number of
FY21–22-93, before the commencement of the research. The rst
author, who is a pharmacist from Ghana, conducted semi-structured
interviews on the Zoom platform. At the time of the data collection,
she was a master’s student, having gained prociency in qualitative
research and conducting in-depth interviews.
2.1. Research setting and data collection
The duration of data collection lasted from February to March 2022.
Participants were recruited using a purposive sampling technique and,
specically, using a combination of the maximum variation and snow-
balling sample techniques.
12,13
Further, to bring diversity to the study
sample, an effort was made to include pharmacists from different re-
gions in Ghana, those with or without experience with the online
pharmacy, those working in communities as well as with hospitals, new
hires, and those with years of working experiences, as well as pharma-
cists who are owners or are staff. Having a maximum variation sample,
according to Suri (2011),
13
helps to get different perspectives on the
topic of interest and brings out holistic, detailed, and nuanced views. For
this study, some participants (like pharmacy owners) were recruited
using the snowball sampling technique as they were difcult to reach.
Most pharmacists in Ghana work as community and hospital pharma-
cists, with some working as industrial pharmacists, academicians, reg-
ulators, or medical representatives. Ghana is divided into ten main
geographical regions, namely: Western, Eastern, Central, Northern,
Brong-Ahafo, Volta, Ashanti, Upper West, Upper East, and Greater Accra
regions. Licensed retail community pharmacists practicing in Ghana are
grouped into these ten main groups in accordance with geographical
locations that they practice in as a way of regulating the community
pharmacist practice. For the purpose of recruitment for this study,
practicing licensed retail community pharmacists were drawn from
these ten groups to ensure adequate representation. The inclusion cri-
terion for participants was anyone who is a practicing licensed com-
munity pharmacist in Ghana. As such, Ghanaian pharmacists who lived
abroad or were not practicing in Ghana were excluded from the study.
The leaders of these ten geographical groups were contacted in
January 2022, and permission was sought to invite their members to
participate in the study. These groups had at least one WhatsApp group
that served as a virtual platform for sharing information among these
professionals. The study researcher sought approval to be added to all
the WhatsApp platforms for two weeks, starting from February 1st to the
14th of March 2022. A short description about the study and the
researcher, along with an invitation for pharmacists to participate, was
sent out to these platforms. Thirty-nine pharmacists expressed an initial
interest, who were then sent a follow-up text message or email, with
more details about the study including about the voluntary nature of
participation, the consent process and condentiality, and to check their
availability for an online or phone appointment. In all, 26 pharmacists
agreed for a virtual interview, however, ve interviews could not be
completed due to poor internet connectivity. Furthermore, as data
saturation was reached, no more recruitment efforts were made.
Twenty-one interviews were successfully conducted (in English)
using the Zoom platform. The consent form was reviewed with the
participants prior to the start of each interview, any concerns were
claried, and permission was sought to record the interviews. On
average, the interviews lasted for 50 min, with the longest time being 78
min and the least being 45 min. An interview guide was used to conduct
the interviews that included open-ended questions on how pharmacists
perceived online pharmacies, the socio-cultural dimensions involved,
the issues around online pharmacy interactions, advertising, privacy,
regulation, and medication usage. The interviews were transcribed
verbatim and eldnotes jotted during the interview were typed out in
detail as soon as possible after the interview. To ensure the anonymity of
participants, number codes were initially assigned to identify each
participant which was then replaced with a pseudonym (as shared in this
paper) that did not link participants’ information to them. The
researcher offered to share the interview transcript with each partici-
pant, if they so desired, but none of the participants showed an interest
in the same.
N. Eab-Aggrey and S. Khan
Exploratory Research in Clinical and Social Pharmacy 13 (2024) 100395
3
2.2. Data analysis
The interview data were analyzed using an interpretive thematic
analysis technique.
12,14
First, the research team, comprising of a grad-
uate student and a PhD prepared professor/researcher, familiarized
themselves with the data by repeated reading of a set of interview
transcripts. An initial list of codes was generated that reected on the
emerging themes in the interviews such as the perceived benets and
challenges related to communication, politics and ethical issues associ-
ated with online pharmacy in Ghana. Following this process, individual
codes were meaningfully grouped to rene and further develop the
themes reected in the interview data and were netuned over several
readings of the transcripts.
14
2.3. Study rigor
The trustworthiness of a study lies in the research process followed
before, during, and after data analysis.
12
It was ensured that a journal
was kept throughout the duration of this study, and the researcher’s
reection on the process, the interviews, and the analysis were docu-
mented. Also, a thick description of the process of conducting this
research was maintained. To ensure the transferability of the research, a
purposive variation sampling was done where pharmacists from
different geographical locations and practices in Ghana were sampled,
helping to yield diverse perspectives on the topic under investigation.
3. Results
Of the 21 pharmacists interviewed, nine were females and 12 were
males in the age group of 25 to 55 years old, with a mean age of 40 years.
They belonged to different regions in Ghana, with majority (38.1%)
from the Greater Accra region, followed by the Volta Region (19.1%)
and most (N =17) worked in the urban centers, while eight of them
practiced in the community. Table 1 provides further details about the
demographic characteristics of these participants. Findings indicate that
while online pharmacies were in a nascent stage in Ghana, most phar-
macists in the study perceived them as benecial, offering convenience
and enhanced accessibility to medications. Also, online pharmacies were
perceived to bridge the gap in care between the hospitals and the
community pharmacies and in addressing some of the cultural barriers
that have long impeded clients from accessing care. On the other hand,
some respondents pointed to the lack of adequate infrastructure such as
internet connectivity, loss of face-to-face communication with clients,
and a host of other problems that could arise from poor regulatory
practices and be a hindrance to Ghana’s online pharmacy.
3.1. Online pharmacy as an inevitable outcome in Ghana
Acknowledging the reality of digital and networked age, the online
pharmacy was described in various ways by participants, ranging from
“a wonderful initiative” and “a good idea” to a “game-changer”:
Looking at the way everything is normally online…the e-pharmacy is
certainly going to be the game-changer; not just that, but it is going to
cause a serious disruption in space because this whole brick-and-mortar
kind of pharmacy practice is gradually going to become a thing of the past.
[Pharm Dan, 32 years old, managing director of an online
pharmacy].
A similar tone was reected by another participant who felt that the
transition to online pharmacy is an inevitable one that should turn out to
be seamless as well:
Now, Ghana is becoming… very, very online…People just stay at home,
and they are ordering…It has become a norm. So, I don’t think when
pharmacy ventures into the online space, it will be any different to the
consumers. It would literally be like, oh, okay, so pharmacy; we can now
get drugs, also the same way. It will be seamless, I think. [Pharm Yaa, 30
years old, community pharmacist].
Several pharmacists recognized that the proliferation of online ser-
vices in Ghana could be translated to pharmacies as well, which
particularly gained traction during the COVID-19 pandemic, “After
COVID came, we realized that we need to have other means that people can
get their medicine, without having to necessarily come to the pharmacy”(-
Pharm Yaa). The increasing presence of digital technology and social
media in people’s lives further served as major motivating factors for
online pharmacy pioneers in Ghana to make the shift:
What we realized is that…the internet has changed a lot of things…People
sit down in their homes, try to browse, look at what is available- conve-
nience, comparing prices…as a company for us to have a future, for us to
have a continuous ow of customers- it is an area we need to invest in.
[Pharm Lord, a 48-year-old, pharmacy owner)].
Most online pharmacy owners saw the need to present their busi-
nesses in a way that their clients will appreciate by moving with the
trend, staying relevant, and offering convenience to their clients in order
to stay in business and be protable. The relative advantage of engaging
in online pharmacy was especially felt during the pandemic and it made
Table 1
Demographic characteristics of study participants.
Demographics Frequency Percentage (%)
Gender
Female 9 42.9
Male 12 57.1
Age (in years)
25–30 8 38.1
31–35 5 23.8
36–40 5 23.8
41–45 1 4.8
46–50 1 4.8
51–55 1 4.8
Location
Ashanti region 1 4.8
Brong Ahafo 1 4.8
Central 3 14.3
Greater Accra 8 38.1
Northern 3 14.3
Volta 4 19.1
Western 1 4.8
Years of Practice
1 to 5 years 10 47.6
5 to 10 years 6 28.6
11–15 years 3 14.3
16 to 20 years 1 4.8
21 to 25 years 1 4.76
Experience with online pharmacy
No 6 28.6
Yes 14 66.7
Not stated 1 4.8
Education
Bachelor’s degree 14 66.7
Master’s degree 5 23.8
Other 2 9.5
Area of Practice
Hospital Pharmacy 5 23.8
Community Pharmacy 8 38.1
Hospital and community 4 19.0
Community and Academia 2 9.5
Regulatory Pharmacist 1 4.8
Community and Pharmaceutical
Representative 1 4.8
Positions
Pharmacist 12 57.1
Pharmacy owners 4 19.0
Specialist Pharmacist 2 9.5
Sales Manager 1 4.8
Lecturer 1 4.8
Regulatory Lead 1 4.8
N. Eab-Aggrey and S. Khan
Exploratory Research in Clinical and Social Pharmacy 13 (2024) 100395
4
sense to these pharmacists to conform to the trend of online commerce to
sustain their business. However, a few of them cautioned that the shift
from traditional face-to-face commerce to virtual will have to be a
gradual process to include several required transformations in Ghana’s
pharmaceutical industry.
3.2. Perceived benets of Online pharmacy
3.2.1. Convenience: “Pharmacy at your doorstep!”
One of the major ideas conveyed by the research participants was
that online pharmacy offered many benets to their clients. For
example, participants felt that online pharmacies made the process of
getting medications much easier and faster, particularly for those clients
living in areas without any pharmacy stores nearby. As noted by Pharm
Jesse (a 26-year-old pharmacist), “not everybody wants to walk to phar-
macy, and having the pharmacy at your doorstep! I think it’s a very good
idea.” In Ghana, it is common to nd people walk to do their errands,
especially at market centers where vehicular and human trafc makes it
difcult to use any other form of transportation. So, for someone to be
spared walking, often in the sun at a high temperature, is a big relief.
This convenience became vital in the case of elderly clients and/or those
with chronic conditions, particularly in pandemic times when this group
was deemed to be the most vulnerable to the virus.
I realized that certain groups of patients really do not need to come to the
pharmacy. For instance, patients who have chronic conditions and are
coming for a rell…why would I want like a 60 or 70-year-old client to
walk through the sun, come to the pharmacy for one month (supply)…
when all this [medications] can be sent to the person…and things can be
done online. [Pharm Yaa].
The shift towards online pharmacy was thus much appreciated by
clients who were able to avoid both an arduous trip to the pharmacy as
well as exposure to the virus. It also meant that the pharmacy owners
could continue with their business with less efforts involved in man-
aging people inside the store, particularly with stringent public health
measures during the COVID-19 pandemic.
3.2.2. Better pricing and ease of access to medications
Participants outlined other advantages of online pharmacies, such as
easy access to medication, better communication with pharmacists and
comparative pricing of medications. Some emphasized the importance
of accessibility of medications (a major challenge in Ghana) as a huge
potential benet of online pharmacies. Pharm Sally concisely summa-
rized the issue of lack of adequate physical pharmacy stores and of
pharmacists in rural areas:
For people like us in less privileged areas, medications can be more
accessible [with online pharmacy] because I’ve seen villages where there
are no pharmacists around….[also] some people make themselves phar-
macists, while they haven’t gone to school…I think with online pharma-
cies, at least getting access to pharmacists will become more possible.
[Pharm Sally, 27 years old pharmacist practicing in a rural
community].
3.2.3. Privacy
Some pharmacists talked about certain situations under which it
became convenient for clients to use online pharmacies. For example,
many of them said it offered clients, who were reluctant to go to a
pharmacy store, an opportunity to make their orders for certain health
problems from the comfort of their homes. Pharm Mina described it in
this way:
I think it’s a great initiative… it helped people, those that couldn’t come all
the way with their issues. Those that were too shy to come when con-
cerning sexually related issues. And those that, you know, just needed
something quick…It helps save time; it helps people to freely discuss
whatever issue that they can’t discuss face to face with other community
pharmacists. [Pharm Mina, 25-year-old community pharmacist].
Pharm Mina brought up a sensitive and an important issue that
sometimes limits some Ghanaians from accessing care. Sexuality is one
area that is frequently not discussed in public spaces, especially in a
conservative society like Ghana. Sexual discussions are usually done in
private, and so it is common to nd people struggling to disclose such
issues at a pharmacy when there are other customers present. The idea
that one can have conversations about their sexual health, and other
issues they may consider embarrassing, on a medium that may protect
their identities or just prevent a face-to-face interaction is hugely ad-
vantageous and it also helps to break the cultural norms that engulf the
people.
3.3. Challenges in operation of online pharmacy
3.3.1. Communication issues: Digital/information literacy
Those pharmacists who were operating online pharmacies talked
about the layout of their website or App that offered clients the oppor-
tunity to look at the products displayed with their prices and to choose
what they wanted. Clients also had an option to talk to the pharmacy
staff or pharmacist regarding their order. As outlined by Pharm Mina:
It was everything; there was a place you could upload a prescription, a
place you can ask a question, a place you can request the drug. And then
we had the drugs that you can just select, and then you know if you want
to purchase, you purchase them…So, it had everything.
Some acknowledged that given the restrictions on medication
advertisement in Ghana, the online pharmacy offers them the opportu-
nity to advertise their pharmacies and medications without any breach
of laws. However, Pharm Laura had concerns about the effects that these
advertisements may have on patients.
In our country, we see that, especially over-the-counter medicines, those
ones that are advertised. You see that people come in, and then they ask
for it readily…. So, for sure, once medication is advertised, it creates
awareness and sometimes people come in for it sometimes without needing
it. [Pharm Laura, 42 years old pharmacist].
This became a highlight during the COVID-19 pandemic when a lot
of misinformation about prevention and treatment of the virus was
rampant causing many to experiment with drugs and often resulting in
serious health consequences. In the context of Ghana, this is particularly
relevant as the levels of digital and health literacy are still quite low,
more so in rural areas where the need for online pharmacy is also high.
Pharm Dan emphasized the need for clients to engage with pharmacists
and to seek expert advice regarding their medications rather than to
navigate the website or App on their own. He stressed that by engaging
the pharmacist, clients get the chance to understand their health needs
and how to take the prescribed medications as it’s one thing to read the
health content and another to understand it. However, if the online
pharmacy in Ghana gets set up that makes talking to a pharmacist
optional in purchase of medications, then it can result in inappropriate
use of drugs (intentional or unintentional) and could cause serious
health consequences.
Pharm Yaa, further reiterated the importance of pharmacists to
communicate with clients, even post-delivery of medications, high-
lighting the gap in skills of people to understand and navigate infor-
mation online, even if they have digital access:
I observed it when I was working in a community pharmacy…we could
deliver to patients, so patients could just send their drug request through
WhatsApp. And then we chat and come up with what you are going to
prescribe…But then you realize that even after delivery, the person still
needs to understand how to take the drugs… So, I think the online
pharmacy design shouldn’t deviate from this…[otherwise]in my opinion,
it is not at a pharmacy but a shopping mall.
N. Eab-Aggrey and S. Khan
Exploratory Research in Clinical and Social Pharmacy 13 (2024) 100395
5
Another communication challenge pointed out by some pharmacists
was the difculty to track nonverbal cues of clients online as compared
to face-to-face interaction. Some pharmacists stated that nonverbal cues
were instrumental to the discharge of their duties since these cues
inform pharmacists about their clients and the lack thereof in case with
online pharmacy would make them feel they are missing out on some
vital information on clients. According to Pharm Jesse, “there’s a limi-
tation when we don’t get to … actually see the client, because sometimes what
the person may be saying is not really the whole story until you actually see
the person.” Some participants felt that the inclusion of certain features
online like videos could mimic face-to-face interaction making it easier
to identify certain nonverbal cues. Pharm Yaa shared:
The design of an online pharmacy should factor in these kinds of in-
teractions that happen in the pharmacy, like a physical pharmacy,
because these interactions and communication are important for the
service we render. …in pharmacy practice we interact with patients, we
need to know why they are taking this so that we can counsel.
3.3.2. Lack of effective regulations and the unintended consequences
Some participants were worried if online pharmacies will be well
regulated and expressed concern about the implications of having un-
regulated ones. Pharm Sophie aptly summarized the concerns:
Aah…I don’t know… Because for the kind, the kind of country we nd
ourselves (in), where people like to self-medicate. I don’t think the e-
pharmacy will do us a lot of good… I think it is going to bring a lot of
issues…because I don’t think the regulation will be done properly. I really
doubt.
Pharm Sophie worried that online pharmacy, instead of discouraging
self-medication, may worsen the situation already at hand. The issue of
self-medication is a major problem in Ghana, where there is a low
medical practitioner-to-patient ratio creating long waiting times at
hospitals and other healthcare facilities. In addition, with the extensive
use of Google in everyday lives, including for assessing one’s health and
related medications for it, an unregulated online pharmacy could
potentially cause major harm in a country like Ghana where health lit-
eracy rates are low. In a similar vein, Pharm Ellie narrated how a
colleague of hers easily managed to get a restricted medicine online
without a prescription:
I think …medicines are not just commodities, that can be used anyhow by
anybody… there is this pharmacy online… someone just ordered Tra-
madol without a prescription…they just messaged the pharmacy…and
within an hour the medicine was delivered to them, no questions asked!
[Pharm Ellie, 37-year-old community pharmacist and academician].
Pharm Ellie worried if the safety of clients could be compromised
when they patronize online pharmacy, despite its convenience, and was
not sure if she would recommend online pharmacy to her clients. Tra-
madol, over the years has caused a lot of addiction in the country
15
and
to Ellie, the notion that it could be obtained easily was a bit unsettling.
With no regulations set up yet (for the pilot venture), pharmacies,
going for online business, have needed to create their own code of
conduct and ethics on how they operate. For some participants, this
raised the question whether some pharmacists would sacrice code of
ethics in favor of a protable business. Pharm Sally argued:
It comes down to the pharmacists, because they would have to decide, is it
ethics? Or is it money? Because I think with this (online) form, a lot of
people would… their abuse will be more… It is the pharmacists who will
have to say that oh, no, this one, I can’t give without a doctor’s pre-
scription for this one is a controlled drug so I can’t give it to you.
The urgent need for proper regulation of online pharmacies in Ghana
and the anticipated inadequacies and challenges echoed through the
narratives of most pharmacist participants of this study. While they saw
online pharmacy as a future of pharmaceutical care industry, the lack of
efforts on the part of the government to regulate and engage pharmacists
in the regulatory process, raised some serious concerns for them, at a
time when people needed it the most.
4. Discussion
This research sought to explore the experiences of pharmacists per-
taining to online pharmacies in the wake of the Ghanian government’s e-
pharmacy pilot program in early 2022.
7
This qualitative study, to the
best of our knowledge, is among the rst to be conducted in Ghana and
contributes to research on online pharmacy in a developing country
based on perspectives of the pharmacists, instead of only client/patient’s
perspective. The narratives shared by the participants in this study
revealed several interesting views on the growth of online pharmacy in
the background of the social context of Ghanaian lives. While most felt
the inevitability of online pharmacy in Ghana and noted its several
advantages, including easy access to medicines, they also expressed
concerns about inappropriate use of medications, if it is poorly regu-
lated. Many Ghanaians draw on pharmacies for quick access to medi-
cations for several reasons; for some, it is less expensive as compared to
seeking medical attention at a hospital, while others may get deterred by
the long waiting time at the doctor’s ofce or just lack of availability of
health care facilities near them.
11
With pharmacy often being the rst
port of call for most Ghanaians with non-urgent medical conditions, it
places a huge responsibility on the shoulders of pharmacists as their role
becomes critical in provision of healthcare.
The surge in digital networking, online commerce and the fast-
changing consumer culture in Ghana has prompted the need for phar-
macies to adopt e-pharmacy to keep their businesses running and
protable for future. With the increase in use of social media by phar-
macists, there is likelihood that it may pave the way for other people to
also engage in the medication trade on other social media platforms.
16
A
study by Awari and Suryawanshi (2020)
17
discussed how in the case of
India, the lack of proper regulation of telemedicine and e-pharmacy
results in fraud, unethical practices, and inappropriate use of medica-
tions and with potential for this issue to grow with the increased use of e-
pharmacy by people during the COVID-19 pandemic. In a similar tone,
pharmacists in our study noted how it would be more protable to run
an online pharmacy (rather than a store pharmacy) in the future and
how the COVID-19 pandemic has hastened this process, especially in the
urban areas. For some participants, the pandemic made it necessary for
them to nd new ways of reaching out to their customers amidst the
lockdown, birthing the e-pharmacy initiative of offering pharmaceutical
services on social media platforms.
Much of the anticipated challenges in the future of online pharmacy
in Ghana seem to be in the ability of government to regulate these
pharmacies. Pharmacy in Ghana is regulated by laws, however, there
were no existing laws regulating online pharmacy in Ghana at the time
of online pilot policy initiative. The pharmacist is supposed to be the rst
line mandated to self-regulate its online pharmacy. The pharmacist
oversees how medications are transferred from the pharmacy to the
client. Even as the pharmacist plays this self-regulatory role, there is the
Pharmacy Council of Ghana that is commissioned to ensure that only
qualied pharmacists operate each online pharmacy and that online
pharmacies conform to the standards.
8,9
The recently launched NEPP is
promoted as a platform that only includes “approved electronic phar-
macies and pharmacy providers who meet the standards of safety” but
beyond that there are no specic regulatory frameworks outlined.
18
While standards for pharmaceutical care have been laid out by the
Pharmacy Council of Ghana and other regulatory bodies like the Food
and Drugs Authority, more work needs to be done for these regulations
to be effective and duly enforced. Other developing countries, like
Kenya, India and Nigeria, are also at similar stages of adapting their
regulating bodies to the expansion of online pharmacy.
1,17
In the context
of Ghana, the Pharmacy Council of Ghana would need to work closely
with pharmacists, incorporating their suggestions in the e-pharmacy
N. Eab-Aggrey and S. Khan
Exploratory Research in Clinical and Social Pharmacy 13 (2024) 100395
6
guidelines, to ensure a smooth transition from traditional to online
pharmacy and for maintenance of strict safety standards. Further, with
engagement of pharmacists, they may then act as opinion leaders who
speak favorably about the online pharmacy innovation and are able to
inuence others to join, given that the growth of online pharmacy has
been slow and uneven.
10
Globally, the COVID-19 pandemic has resulted in many pharmacy
organizations outlining guidelines to support pharmacists in carrying
out their core responsibilities (like patient education, referral to other
health care providers, provision of vaccinations, and medication
dispensing at a time of increased prescription volumes), yet in many
cases the pharmacists found these guidelines to be inadequate and
ambiguous where they would be directed to other websites for infor-
mation, without any clear and specic guidelines.
19
While this was
primarily the case with the developed world where online pharmacies
have been in action for a while, in case of developing countries, the
overall lack of proper regulation, despite a growing need for online
pharmacies, left pharmacists grappling in dark and often resulting in
inappropriate use of medications.
20
This study highlights the potential
of online pharmacy and the urgent need for regulatory bodies to engage
pharmacists in outlining clear and adequate guidelines for the smooth
functioning of online pharmacies in a country like Ghana.
This study is not without its limitation. First, there was a lack of in-
person face-to-face interaction with participants since interviews were
done virtually. In-person interviews would have offered the opportunity
to observe more social cues; however, given the nature of the study,
virtual interviews also helped assess the relevance of the phenomenon
under investigation as well as added diversity to the study sample.
Second, it was an exploratory study designed to examine the perspec-
tives of pharmacists on the evolving situation of pharmaceutical care in
Ghana. While the study is rst of its kind and yielded rich data, more in-
depth research is needed in this area to capture the development of
pharmaceutical care in Ghana (and the African region) with increased
digital networking and expansion of the NEPP.
5. Conclusion
Online pharmacy in Ghana has the potential to transform existing
structures and to enable the advancement of the pharmaceutical in-
dustry to better serve the people. On the other hand, it could also lead to
irrational use of medication, if not properly regulated, given the pre-
vailing low levels of digital and health literacy as well as digital access.
Although limited and exploratory in nature, this qualitative study is
among the rst on online pharmacy in Ghana that particularly explores
the experiment and policy initiatives from the point of view of phar-
macists. This new wave of introduction to online pharmacy and its
benets and challenges will help other pharmacists better understand
the new dimensions in pharmacy.
CRediT authorship contribution statement
Naessiamba Eab-Aggrey: Conceptualization, Data curation, Inves-
tigation, Methodology, Writing – original draft. Shamshad Khan:
Conceptualization, Data curation, Formal analysis, Methodology, Su-
pervision, Writing – original draft, Writing – review & editing.
Declaration of Competing Interest
The authors declare that they have no known competing nancial
interests or personal relationships that could have appeared to inuence
the work reported in this paper.
Appendix A. Supplementary data
Supplementary data to this article can be found online at https://doi.
org/10.1016/j.rcsop.2023.100395.
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N. Eab-Aggrey and S. Khan
