Unlocking the Power of Community Pharmacies to Strengthen Primary Health Care Systems

Community pharmacies, though often the most frequently accessed point of care in many countries, remain insufficiently regulated and underintegrated into formal primary health systems despite their growing clinical roles. Strengthening regulation, expanding scope of practice, and aligning remuneration models could unlock their full potential to advance universal health coverage.

Research from institutions including the World Health Organization, Abt Associates, and leading university public health programmes reveals the pivotal yet undervalued role of community pharmacies across health systems. These privately owned outlets are often the most visited point of care, particularly in low- and middle-income countries where a designated family doctor is uncommon. Evidence shows that people interact with pharmacists far more frequently than with physicians, especially older adults and those with chronic illnesses. Despite this, pharmacies remain poorly integrated into formal primary care frameworks, prompting calls for greater recognition of their essential service contributions.

A Vital but Poorly Regulated Healthcare Gateway

The report highlights a troubling mismatch between pharmacies’ real-world function and the governance structures meant to oversee them. In Brazil, pharmacy activity data remains sparse despite the sector’s massive workforce. In India, pharmacies serve millions but also drive high out-of-pocket spending and antibiotic misuse, contributing to antimicrobial resistance. Across many LMICs, regulation is weak, enforcement is inconsistent, and operators often prioritize consumer satisfaction over public health needs, sometimes influenced by bribery or commercial pressures. Meanwhile, expanding pharmacy chains, particularly dominant in countries like Argentina, reshape markets in ways that can undermine universal health coverage efforts. In Mexico, the surge of doctors’ offices attached to pharmacies has increased prescriptions and patient spending, diverting care away from public-sector pathways.

Growing Recognition and Expanding Roles

As health systems confront rising chronic disease burdens and shifting consumer expectations, pharmacies are increasingly recognized as strategic partners in primary care. Spain has developed standardized clinical pharmacy protocols, while Canada and Australia have advanced reforms to harmonize pharmacists’ roles within health networks. Thailand, supported by a strong evidence base, has integrated pharmacies into its national insurance system for managing hypertension and diabetes. In LMICs, donor-funded initiatives have enabled pharmacies to deliver family planning, malaria testing, TB screening, and HIV prevention services. In higher-income settings, pharmacists frequently offer immunizations, minor ailment care, medication reviews, and chronic condition monitoring. Yet these expanded roles require restructured policies and incentives to ensure pharmacies balance commercial aims with public health priorities.

Strengthening Governance Through Accreditation and Smart Regulation

To better integrate pharmacies into primary care, countries are increasingly deploying policy tools such as accreditation, regulation reform, and digital oversight. Tanzania’s Accredited Drug Dispensing Outlets model, supported by training, supervision, and consumer education, improved medicine safety and access in underserved areas. Regulation, however, remains a widespread challenge due to underfunded inspection systems and limited technical capacity. This has led to experimentation with e-regulation, self-regulation, and leveraging pharmacy chains’ organizational structures. The rise of e-pharmacies presents both opportunities for greater traceability and risks related to unchecked online drug sales. Effective governance, the brief stresses, must evolve alongside rapid market changes.

Paying for What Pharmacies Actually Do

One of the most significant barriers to integrating pharmacies into primary care is remuneration. Most payment models continue to treat pharmacies as medicine retailers rather than providers of clinical services. Without financial incentives for preventive care, patient counselling, or chronic disease management, pharmacies have little reason to move beyond high-margin product sales. Countries are exploring new contracting mechanisms, insurance-linked payments, and incentives to align pharmacy services with public health goals. Yet finding the right balance, ensuring affordability for patients, sustainability for providers, and value for the health system, remains a persistent challenge.

Community pharmacies hold enormous, still largely untapped potential to strengthen primary care and advance universal health coverage. As telemedicine expands and patient expectations evolve, their accessibility and community embeddedness position them uniquely to support integrated, patient-centered care. Realizing this potential, the WHO brief emphasizes, will require modernized regulation, expanded scopes of practice, and remuneration systems that reward pharmacies’ full contributions. When effectively supported, community pharmacies can become a cornerstone of resilient, equitable, and responsive primary health care systems.