This study evaluated the attitudes and practices of community pharmacists regarding their participation in public health activities and the barriers preventing their participation in these activities in the Aden governorate of Yemen. The community pharmacists had a positive attitude to involvement in public health activities. They were engaged in educational activities related to personal life style practices, along with health monitoring tests. Barriers noted were lack of time to consult with clients and lack of teamwork with their colleagues.
Almost two-thirds of community pharmacists felt that people will accept pharmacists’ participation in public health activities, and they were ready to be involved with these activities. Armstrong et al. [21] stressed that community pharmacists can play an important role in public health and they need to be competent in different areas of practice. There are three domains that community pharmacists can be involved in i.e. health protection and prevention, health and social care, and health improvement [22]. Walker referred to these practices as ‘pharmaceutical public health’ [23]. The number of skilled and educated community pharmacists available for counseling patients about specific issues related to the prescribed medication, and reporting common adverse effects, was low according to a previous study conducted in Aden, Yemen [24].
The feedback obtained from the majority of the community pharmacists showed positive attitude toward involvement in public health activities and recognition of its vital contribution. The results of a study by Offu and coworkers was similar to our study and demonstrated positive attitude among the community pharmacists towards public health practices even though the knowledge and practice level were not satisfactory [25]. Other studies and a systematic review showed a similar situation [26,27,28]. Many community pharmacists were willing to be a part of public health activities, having knowledge about the importance of practicing health promotion activities and they were interested in supporting public health activities as a part of the health care team. A study in Ethiopia indicated a low level of participation of community pharmacists in public health activities [29]. In this study, fourth-fifth of respondents claimed that the other health workers do not allow pharmacists to carry out public health activities. Hence, good communication and cooperation between different health care professionals should be established [30]. However, the public acceptance of the participation of community pharmacists in public health activities is perceived as positive. All these findings suggest that there is an acceptance from both the community pharmacists and patients toward changing from the traditional role of dispensing medication to more effective involvement in health care activities.
The community pharmacists felt it was important for pharmacists to practice health promotion activities. They also had a positive opinion regarding providing health education beyond drug-related issues, and believed that public health activities are not just the responsibility of doctors and nurses. They also were of the opinion that community pharmacists have enough knowledge to advice patients on health promotion and disease prevention. They claimed that they have been practicing various public health activities such as oral health; educating the clients on matters related to chamna, alcohol drinking, khat chewing, smoking, health nutrition, healthy lifestyle; providing information on immunodeficiency syndrome; providing information on contraceptives, cancer drugs, matters related to expired and unused medicines, the use of medical devices, weight reduction and cholesterol. Among the medical tests commonly conducted by community pharmacists were blood pressure, glucose and pregnancy tests. The educational activities conducted by community pharmacists for their patients as part of the public health activities were consistent with the activities provided by the community pharmacists in other low- and middle-income countries [31]. Agomo et al. reported that the literature revealed that services such as smoking cessation, health promotion, provision of hormonal contraceptives and preventive activities provided by pharmacists have benefited the community [32]. Community pharmacists carried out medical tests such as blood pressure measurement and blood glucose test. By offering these screening tests, the community pharmacists may assist patients with diagnosis and therapy. The provided medical tests were similar to the services offered by community pharmacists in Dhaka, Bangladesh [31].
The community pharmacists stated several barriers hindering their involvement in public health activities. Among them were lack of time, lack of understanding of the concept of teamwork among the different healthcare professionals, lack of understanding of the concept of public health, shortage of funds and capital to implement improvements, lack of training, recognition, specialty and experience. The last part of the current study related to the obstacles and difficulties facing the community pharmacists with regard to effective contribution to public health activities. The major obstacles reported in the current survey were lack of time, and of the concept of teamwork followed by shortage of external funds and lack of official recognition of participation in public health activities. Comparable barriers have also been reported in some developing countries like Ethiopia and southeast Nigeria [29, 32]. The reported barriers can be partly overcome if there is willingness to provide free public health services rather than charging services to improve business profitability by the community pharmacists. In addition, the healthcare professionals must embrace the concept of collaborative care i.e. teamwork between physician and pharmacist. Public health activities can be performed and enhanced by working together. There are key areas such as interprofessional collaborative care, working with and for communities that community pharmacists should consider as initial steps for their involvement in public health activities [33].
Even though the study provided some insights on the pharmacy public health activities in Yemen, it has a few limitations. The study was conducted with a small sample and only part of the registered community pharmacists; thus, the findings may not represent the actual perspective of community pharmacists in the entire country. Furthermore, the study was only conducted in one of the governorates of Yemen due to the war and safety issue. Thirdly, self-perception of community pharmacists i.e. relying on self-reported information may contribute to bias.
The authors wish to recommend the following actions. First, from the research angle, future studies need to be carried out on a larger geographical area and sample size, as well as using different methods such as simulated patient method. There should be more researches that study the current situation, identify possible problems and suggest solutions. Secondly, from the policy and practice viewpoints, the basic core services provided by pharmacists to the public should be strengthened especially when state is at crisis [34, 35]. In order to improve the provision of pharmaceutical care, Farris and Schopflocher recommended accessibility of qualified and cooperative staff for dispensing activities [36]. Pharmacists need to be well-trained, competent and confident in order to have positive outcome [26]. Offering specific training is a necessary requirement to boost community pharmacists’ involvement in the health care services. Community pharmacists should have time to participate in continuing professional education to upgrade the level of the provided services. However, the quality and impact of the services on the individuals and public are not known; thus, it need to be investigated. Evaluation of the community pharmacist’s contribution must be carried out to strengthen their contribution to public health activities. Various stakeholders should collaborate for improving the services and enhancing the competency of the community pharmacists. Community pharmacists must be accepted as an important member of the health care team. Policymakers should develop appropriate policies to improve the involvement of community pharmacists in public health activities in Yemen.