Revolutionising pharmaceutical services 

Challenges and opportunities in the Americas. 

The Pan American Health Organization (“PAHO”) has embarked on a transformative journey aimed at integrating pharmacies into the primary healthcare system in the Americas. At the heart of this initiative lies a groundbreaking assessment tool designed to evaluate pharmaceutical service quality, emphasising the pivotal role pharmacies can play in patient care. However, while this endeavour holds immense potential, several challenges and uncertainties loom large, raising questions about its effective implementation and impact. 

PAHO’s initiative seeks to redefine pharmacies as more than just retail outlets, highlighting their vital contribution to healthcare. Dr. Jarbas Barbosa, PAHO Director, underscores the need for pharmacies to become integral parts of comprehensive health systems, providing not only products but also guidance, health promotion and assistance in health-related issues. A local clinician and university professor agreed, “It is very important for the pharmacist to be part of a country’s comprehensive health system, and this requires a great deal of coordination between the actors involved, including pharmacists.”  

This vision, while noble, faces significant hurdles in the complex healthcare landscape of the Americas. The university professor added, “This programme is not entirely new or original, I remember that there was a similar initiative before, but it did not have much development.” The tool underwent rigorous testing in over 80 pharmacies in Argentina and Peru, providing valuable insights. The clinician highlighted that “controls are going to be fundamental, and that is precisely where one of my doubts lies. Establishing effective controls in Argentina is not easy, it is a challenge.”  

“Establishing effective controls in Argentina is not easy, it is a challenge.”

Clinician, Argentina

However, the true test lies in its scalability and adaptability to diverse markets, especially in regions marked by informality and resource constraints. “I don’t know if the pharmacist’s job is going to be very different, but he/she will have to optimise resources, not only economic or financial, but also human, which are usually scarce.” The local university professor also stated, “Pharmacists are going to have to deepen their scientific and technical knowledge, in communication with patients and customers.” Family-owned pharmacies, despite offering higher quality medical care and advice, are declining. The systemisation proposed by PAHO may inadvertently favour pharmacy chains, potentially sidelining personalised care and community-focused services. 

One of the critical challenges lies in establishing effective controls and regulations. In countries like Argentina, where informality prevails and regulatory frameworks need refinement, ensuring consistent quality across pharmacies becomes a formidable task. “It is going to be necessary to reprioritise pharmacists and give them the necessary tools, because the tools they have today are scarce for the mission that is being asked of them,” cited the university professor. The role of public authorities, particularly ministries of health, is crucial in overseeing this transformation. However, the effectiveness of these entities is often marred by scepticism and doubts about their capabilities, raising concerns about the rigorous implementation of the programme. 

“It is going to be necessary to reprioritise pharmacists and give them the necessary tools, because the tools they have today are scarce for the mission that is being asked of them.”

University professor, Argentina

Moreover, the programme’s success hinges on overcoming public scepticism, avoiding “self-diagnosis and self-medication on the part of the population.” The clinician continued, “The rational use of medicines, pharmacovigilance and monitoring become central issues.” Balancing the drive for efficient healthcare delivery with the need for individualised patient care remains a challenge. 

Additionally, the initiative’s impact could vary significantly across markets, influenced by health and market disparities. Central America presents unique market dynamics that demand tailored responses. Economic factors, market variations and fluctuating demands pose additional challenges that might hinder the programme’s success. 

While PAHO’s initiative is commendable, its execution requires meticulous planning, strong regulatory frameworks, enhanced professional training and a delicate balance between standardisation and personalised care. As the clinician identified, “I think the most important thing is to be very clear about the principle that the misuse of drugs has important consequences for the whole system, and then, what may seem like a programme with very noble purposes, can end up bringing problems on the other hand.” 

“what may seem like a programme with very noble purposes, can end up bringing problems.”

Clinician, Argentina

 Addressing these challenges is essential to realising the vision of integrated pharmacies as pillars of primary healthcare, promoting equitable access to medicines and ensuring the well-being of communities across the Americas. The success of this transformative endeavour rests not only on the innovation of the programme but also on the strategic navigation of these complexities, marking a new chapter in the evolution of pharmaceutical services in the region.  

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