Assessment of the Pharmaceutical-Related Scope of Practice of Community Healthcare Workers

Community Health Workers (CHWs) have an important role in delivering healthcare services within their communities through their shared language and cultural familiarity to improve health outcomes. They serve as links between community members and the formal healthcare system. CHWs undertake a broad range of responsibilities in African countries. This study aimed to assess the pharmaceutical-related scope of practice of CHWs in Africa, with a focus on medicine management, distribution, and adherence support, amongst many other roles. A review of available data from all 54 African countries was conducted between March and June 2023 and revealed a variation in the delegation of pharmaceutical tasks to CHWs. Among the 26 countries (48%) with accessible data, the regional distribution included 11% from North Africa, 35% from East Africa, 4% from Central Africa, 23% from Southern Africa, and 27% from Western Africa. Descriptive statistical analysis was used to summarise the distribution of countries per region and the extent of CHW involvement in pharmaceutical tasks. The mean number of countries per region was 4.8 (SD = 3.63). An analysis of variance (ANOVA) was conducted to compare the mean involvement of CHWs in medicine-related versus non-medicine-related roles, yielding a statistically significant difference (F = 9.41, p < 0.01). In addition, a chi-square test was used to determine whether the pharmaceutical scope of CHWs varied significantly by region; the result (χ² = 0.7963) indicated no statistically significant regional association. The findings highlighted disparities in the pharmaceutical-related responsibilities of CHWs. Some countries demonstrated more formalised roles, while others exhibited more limited scopes of practice. These were constrained by weaker regulatory frameworks or limited health infrastructure. In many contexts, CHWs were found to be performing pharmaceutical-related tasks beyond their formal scope, including dispensing medications and supporting treatment adherence without sufficient training or regulatory oversight. While this form of task-shifting has helped to alleviate workforce shortages, particularly in rural and underserved settings, it also raises ethical and safety concerns. The lack of standardised policies and supervision mechanisms limits the potential impact of CHWs and poses risks to medication safety and patient care. These findings indicate the urgent need for policy reforms that formally recognise CHWs’ pharmaceutical roles and equip them with the skills and support needed to perform these functions safely and effectively. This study contributes to the evidence base on task-shifting in low- and middle-income countries and reaffirms the role of CHWs in strengthening primary healthcare systems and expanding access to essential medicines. Future research should focus on developing and evaluating effective training models and enhancing the role of pharmacy professionals in mentoring CHWs. By addressing current limitations, health systems in Africa can more effectively harness the potential of CHWs to deliver safe, accessible, and community-responsive pharmaceutical care.