Engaging Nigerian community pharmacists in public health programs: assessment of their knowledge, attitude and practice in Enugu metropolis

Knowledge, attitude and practice of public health

This study showed that although community pharmacists had a positive attitude towards
the practice of public health, their knowledge and practice level was poor. The findings
did not differ among community pharmacists with higher number of years of practice,
higher qualification or those with prior public health work experience. Positive attitude
of community pharmacists observed in this study is an indication that community pharmacists
may be willing to offer public health services. Our finding is similar to another
Nigerian based survey which showed that 84 % of Nigerian community pharmacists indicated
a favorable attitude towards health promotion 9]. Similar findings of positive attitude of community pharmacists towards practice
of public health have been reported in other developing country 19] and developed countries 15], 20].

Educational interventions for better public health practice

Poor knowledge in public health issues as evidenced by the results of this study could
have resulted in low level of engagement in public health activities. Our findings
highlight the importance of educational interventions targeted towards practicing
pharmacists to improve their knowledge level on public health issues. In a similar
study conducted elsewhere in Nigeria, many community pharmacists agreed that their
participation in primary healthcare could be further improved through continuous education
and training 10]. This may not be peculiar to Nigeria as a UK based study indicated that training
and support is needed in order to increase pharmacist’s confidence in providing public
health services 15]. As a suggestion, training in public health could be delivered through the mandatory
continuing professional development (MCPD) organized by the Pharmacists Council of
Nigeria (PCN), as pharmacists of greater than 5 years in practice are mandated to
undertake update courses as part of their licensure requirement. Another cost-effective
initiative could be an online learning platform for practicing community pharmacists
on public health topics. To motivate pharmacists to take the e-courses, the courses
could be accredited by PCN as part of the fulfillment for licensure requirement.

Reported barriers: need for incentive

Perceived barriers to public health practice in the community pharmacy according to
the respondents were inadequate funds, inadequate staff, government regulation, insufficient
knowledge, lack of time, lack of space, and cooperation of clients. These perceived
barriers are not peculiar to the Nigerian scenario as they have been reported in other
studies 15], 19]. In our opinion, these reported barriers are connected to lack of incentive. Most
community pharmacists would be interested in making sales to improve business profitability
rather than offering free public health services. They may not consider it necessary
to find solutions to the reported barriers if not properly incentivized. Pharmacy
in Nigeria is not yet formally classified as a profession within the public health
workforce and also the public health role of the pharmacist is yet to be sufficiently
recognized and promoted by public health agencies, pharmacy educators, or other healthcare
professionals. This may explain why community pharmacists are not officially part
of public health programs and thus are not reimbursed for services offered.

Strengthening pharmacists as public health partners

Community pharmacists could be positioned to promote and deliver various public health
interventions. Unfortunately lack of preparedness results in missed opportunities
to intervene in both infectious and non infectious diseases plaguing the country.
Our findings showed that screening for diabetes and hypertension were the public health
activities mostly carried out in community pharmacies. Community pharmacists could
be useful in screening and detection of other disease states. For instance, to boost
the number of health workers involved in provision of maternal, newborn and child
health (MNCH) in the country, community pharmacists could be positioned as promoters,
facilitators and implementers of maternal, newborn and child health 21]. Community pharmacists are easily accessible in the community and are often the first
point of call for majority of Nigerians. A baseline study of the community pharmacists’
participation in MNCH in Nigeria revealed a considerable client load of pregnant and
nursing mothers with children under 5 years in contact with the community pharmacists
daily 22]. Specifically, over 15 % of community pharmacists see between 5 and 10 pregnant women
and 10–20 children per day 22].

Strengthening pharmacists as public health partners will require combined effort of
pharmacy practice administrators, academic pharmacists and practicing pharmacists
to evolve policies supported by evidence showing positive impact of pharmacy-based
public health activities. This will aid pharmacists to be formally classified as professionals
within the public health workforce and their role in public health recognized by public
health agencies. Strengthening pharmacists as public health partners will also require
meaningful integration of pharmacy and public health in practice and education. Example
of such integration include dual-degree programs and integrated curricula which offers
rich avenues for thoughtful integration, local departments and pharmacies partnering
to provide HIV testing for instance, educational integration by appointing public
health faculty to schools of pharmacy and vice versa etc. 6].

Study limitations

One major limitation to be considered while interpreting the result of the findings
is the generalizability of the result. However, as stated earlier, and effort was
made to choose a city which presents a fair representation of community pharmacy practice
in Nigeria as all the cadres of community pharmacies in terms of size operates in
Enugu. Also, the small sample size of the community pharmacists studied may have not
permitted detection of significant differences where expected. For instance, prior
experience of public health showed no significant effect on the public health knowledge
of the community pharmacists.