Shamshad Khan’s research while affiliated with The University of Texas at San Antonio and other places

Objective With the ongoing push for greater digitalization of healthcare in low- and middle- income countries (LMICs), the larger questions around who will benefit most from such efforts and what elements of disparities and inequities may further be created or reinforced are often overlooked. This study was undertaken to assess a pioneering e-pharmacy initiative in Ghana that aimed to explore issues of access and disparities in relation to pharmaceutical services. Method The study used a qualitative research design where semi-structured interviews were conducted virtually with 21 licensed community pharmacists recruited through purposive and snowball sampling techniques. The data were analyzed using inductive thematic analysis approach. Results Pharmacists recognized the transformative potential of e-pharmacies, particularly in resource constrained regions that face issues of pharmacy and healthcare deserts. However, drawing on their experiential knowledge, they highlighted the paradoxes and challenges of promoting digitalization of healthcare in a country characterized by poor infrastructure, poverty, and multiple intersecting layers of inequities, as well as digital divides and low digital/health literacy. In the absence of adequate infrastructure, funding support and regulation, the possibility of local pharmacies, often the first point of care, being replaced by big corporations was feared. Participants also cautioned to steer the discourse of e-pharmacy away from access, pricing, and convenience to safety and quality. Conclusion Digitalization of healthcare and e-pharmacies holds tremendous potential in the LMICs. However, such technological initiatives, if implemented without proper groundwork and adequate support, would run the risk of creating and exacerbating health disparities, especially in sub-Saharan Africa. A bottom-up approach, through grassroot engagement and implementation science, tethered to building safe, affordable, and equitable infrastructure and access to care will be essential for the success of e-pharmacy and other digitalization initiatives in the region and beyond. This research has direct implications for public health, policy, and pharmaceutical care.

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. However, 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 specifically 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 literacy, 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 irrational use of medications, if not properly regulated. Government, policy makers, and leaders in the field of digital health and pharmacy must also address poor infrastructure and inequities in digital access.