Role of the community pharmacy in the control of pandemics in South Sudan
Recently, special attention has been given to the community pharmacy and how ready it is to meet the growing demand for health care at times of pandemics. Several studies have discussed the roles and contributions of the community pharmacy amid COVID-19.
An online assessment among pharmacy personnel in South Sudan showed that 57.5% of respondents had answered correctly to at least 60% of knowledge questions on the COVID-19 pandemic. The attitudes were a mix of neutral and positive. Physical distance (“social distancing”) and hand hygiene practices (95%) were the most often preventive measures used at the community pharmacy. In conclusion, the pharmacy is the first and, often, the last point of contact for patients. Therefore, it can play a role in identifying suspected infectious diseases and advising and instructing the public against any health emergency.
On March 20th, 2020 in Juba, South Sudan, “Republican Order No.08/2020 for the formation of a high-level Task Force Committee to take Extra Precautionary Measures in combating the spread of Coronavirus Disease (COVID-19) into the Republic of South Sudan, 2020 A.D.”, increased the alert level for COVID 19. There was a series of instructions for the temporary closure of all educational institutions and health science institutions, suspension of all planned sports activities, religious, socio-cultural, and political events.
More than two years since the emergence of COVID-19 in Wuhan, China, the pandemic, that is still challenging the global health system, has affected our socio-economic activities and health service delivery at different levels.[1,2] While community pharmacies remain accessible to patients, service at clinics and hospitals was restricted during the pandemic due to the facility being overwhelmed or unavailable.
In some developing countries, like South Sudan, with fragile health systems, economic challenges, and logistical constraints, health care seekers are forced to go directly to a community pharmacy for medication. This was despite the regulations putting restrictions on dispensing without a proper diagnosis or prescription. This became worse during the pandemic, increasing the number of patients who do not get the correct treatment resulting in deterioration in public health.[3,4,5]
A community pharmacy or retail pharmacy is categorized according to the Drug and Food Control Authority Act 2012 as license C among the four categories of licenses for pharmaceutical premises in South Sudan. Their functions include, but are not limited to, ensuring appropriate stocks of pharmaceutical products and devices, dispensing medicines and health-related commodities in line with the guidelines, advising on drug-drug interaction/drug-food interaction, triaging, and referring. The pharmacy workforce is in contact with patients or clients and comprises non-health professionals, pharmacists, pharmacy technicians, and occasionally nurses. The team works under the supervision of a registered pharmacist “whose name is in the registry of pharmacists in accordance with the pharmacy profession and practitioners’ regulations as shall be determined by the South Sudan General Medical Council.”
Recently, special attention has been given to the community pharmacy and how ready it is in terms of regulation and structure to meet the growing demand for health care during pandemics. Several studies have discussed the roles of the community pharmacy amid COVID-19 and its contribution toward clarifying misconceptions, screening patients for COVID-19, minor ailment consultations, monitoring and managing chronic conditions, telehealth services, and chronic medication renewal.[6,7] For example, “in France and Portugal, pharmacists have been authorized to repeat dispensing of prescribed medicines for patients with long-term conditions”. Spain used community pharmacies to support victims of domestic violence.
Knowledge, Attitude, and Practices toward COVID-19 pandemic
In 2021, a descriptive cross-sectional survey was conducted with the support of the Pharmaceutical Society of South Sudan (PSSS) to assess the knowledge, attitude, and practices of community pharmacy health personnel in South Sudan in relation to the COVID-19 pandemic. The Survey used an online questionnaire in the Google form between August and September, with an appropriate sampling technique. The assessment showed that 57.5% of the respondents had answered correctly to at least 60% of knowledge questions on the COVID-19 pandemic. The attitudes were positive towards wearing a face mask and practicing social distancing within the community pharmacy premises. While it was neutral towards the personnel measures such as short hair or beard recommended by the International Pharmaceutical Federation (FIP) to improve mask fit, and also towards the use of community pharmacies as testing or immunization centres for COVID-19.
However, the findings showed that 62.5% of respondents had not received any training related to COVID-19 infection prevention or proper use of Personnel Protective Equipment (PPE). Physical distancing and hand hygiene practices were the preventive measures (95%) most often used at the community pharmacy. Also, 42.5% indicated no changes in working hours, whereas 15% of respondents increased their hours during the pandemic; 32.5% applied mitigation procedures that led to referring a suspected case of COVID-19 to specialized care. This limited study has highlighted gaps and capabilities in terms of workflow and practices at community pharmacies during COVID-19 that could be utilized in support of other health facilities.
A community pharmacy is the most readily available health facility. Therefore, it has a role in combating pandemics in the country. First, by disseminating the correct information and practicing all precautionary measures recommended by the World Health Organization and Ministry of Health to prevent the spread of disease. Secondly, a pharmacy is the first, and often the last, point of contact for patients. Pharmacy personnel can play a vital role in identifying suspected infectious diseases and directing the patients to the next step, advising and instructing the public against any health emergency.
In order to maximise the use of community pharmacies in combating future pandemics, guidelines on the protection and operation of pharmacy teams during pandemics as well as adopting appropriate legislation on pharmacy practice are some of the plans that need to be put in place.
- Li Q, Guan X, Wu P, et al. Early Transmission Dynamics in Wuhan, China, of Novel Coronavirus-Infected Pneumonia. N Engl J Med. 2020;382(13):1199-1207. https://doi.org/10.1056/NEJMoa2001316
- United Nations Population Fund. Global response Appeal: Safe Delivery Even Now UNFPA Coronavirus disease (COVID-19). https://www.unfpa.org/updates/global-response-appeal-safe-delivery-even-now-unfpa-coronavirus-disease-covid-19.
- The World Bank. South Sudan Economic Update, Pathways to Sustainable Food Security - 4th edition. . https://www.worldbank.org/en/country/southsudan/publication/south-sudan-economic-update-support-to-agricultural-investment-and-economic-reforms-critical-for-sustainable-food-securi.
- United Nations Office for the Coordination of Humanitarian Affairs. Humanitarian needs overview South Sudan. Humanitarian programme cycle . https://reliefweb.int/sites/reliefweb.int/files/resources/south_sudan_2021_humanitarian_needs_overview.pdf
- Ministry of Health. National COVID-19 Response Plan. Ministry of Health, Juba-South Sudan; 2020:5-6. https://www.humanitarianresponse.info/sites/www.humanitarianresponse.info/files/documents/files/national_covid-19_response_plan_south_sudan_moh_20200624_.pdf
- Elbeddini A, Prabaharan T, Almasalkhi S, Tran C. Pharmacists and COVID-19. BMC Public Health 2020; 13:36 DOI. https://doi.org/10.1186/s40545-020-00241-3
- Bukhari N, Rasheed H, Nayyer B, Babar Z-U-D. Pharmacists at the frontline beating the COVID-19 pandemic. BMC Public Health 2020; 13:8. DOI. https://doi.org/10.1186/s40545-020-00210-w
- Pharmaceutical Group of European Union. Position Paper on the Role of Community Pharmacists in COVID-19 - Lessons Learned from the Pandemic. https://www.pgeu.eu/wp-content/uploads/2020/03/PGEU-Position-Paper-on-on-the-Lessons-Learned-from-COVID-19-ONLINE.pdf
- International Pharmaceutical Federation. Covid-19 Information Hub. FIP Guidance & summaries. https://www.fip.org/publications?publicationCategory=97&publicationYear=2020&publicationKeyword