Primary health care roles of community pharmacists in low- and middle-income countries: a mixed methods systematic review

Community pharmacists (CPs) play vital roles in primary healthcare (PHC), yet they are not officially recognised as PHC providers, particularly in low- and middle-income countries (LMICs). This review aims to uncover the provision of PHC services by CPs in LMICs and identify barriers to these services, as well as strategies to overcome them. Medline, CINAHL, Google Scholar, and others were searched for articles published between 2000 and 2022 that reported on CPs' provision of PHC services in LMICs. Eligible studies were evaluated, and data were extracted and assessed for quality using the mixed methods appraisal tool (MMAT). Only 13 studies had a high quality rating, less than a quarter (n = 23) of the articles were of considerable quality while 34 had moderate quality. Additionally, 10 articles met the low-quality rating at the same time, four articles were considered to be of very low quality. The most common PHC services reported were health education, referral to GPs, medication review, point-of-care testing, screening, self-care for chronic illnesses (n = 41 studies), and promoting access to sexual and reproductive health as well as essential medicines (n = 16 studies). The major hindrances to PHC activities included unfriendly government policies (n = 25 studies), lack of time and effective collaboration (n = 13 studies), physical barriers and limited knowledge in patient care (n = 11 studies). The majority of studies recommended enacting pharmacy-friendly policies to designate CPs as PHC providers (n = 20 studies) and continuous professional development programmes (n = 16 studies). Pharmacists in LMICs play a vital role in PHC despite the presence of some barriers. Policies that recognise pharmacists as PHC providers and continuous training could improve their services.