Proliferation of Retail Pharmacies in Major Cities: The Good, the Bad and the Ugly

The number of new pharmacies being established in the country has been increasing immensely. In 2011, the Pharmacy Council (PC) reported that it had registered 2,007 community pharmacies. Currently, the pharmacy practice regulator has published on its website that there are 3,860 pharmacies in its register. In the early part of this year, Honorable Kennedy Agyapong, a Member of Parliament (MP), on a tv show—a snippet of which later became viral on pharmacy platforms—complained about the number of pharmacies dotted across every corner of the capital city. On the program, the MP questioned why the increasing rate of establishing pharmacies was becoming a feature of his ruling party whilst filling station proliferation marked the era of the administration of the current opposition party. Implicitly, the honorable member was making an interesting observation, which seems to suggest that the uptick in the number of pharmacies currently being witnessed is politically motivated. The existence of this association, if any at all, is a topic for another debate.

Ordinarily, an increase in the number of pharmacies should not be considered a strange phenomenon since almost every facet of the country appears to be witnessing growth as the economy breaks new frontiers. It may be argued that the growth in the number of pharmacies should not be a cause for concern when the number of practitioners is factored into the equation.

According to information available on the PC’s website, 5,101 pharmacists are currently registered to practice in the country. According to the International Pharmaceutical Federation’s (FIP) Global Pharmacy Workforce and Migration Report published almost a decade and half ago, the PC reported a figure of 2,162 as the total number of registered pharmacists in the year 2005. If these numbers are anything to go by, then it can be concluded that the country has made tremendous improvement in pharmacy workforce growth. This is against the back drop that the patient-to-pharmacist ratio has been remarkably reduced from 13,000:1 to approximately 6000:1 in just over the last decade! Indeed, the total number of practitioners (5,101) far outstrips the reported number of pharmacies (3,860). Consequently, one might be tempted into thinking that concerns over pharmacy proliferation are tempered by the disproportion in the ratio of practitioners to facilities. If the number of pharmacies is lower compared to the number of practitioners, why worry, when more pharmacies are rather required to be established to ensure a balance, is achieved?

The figures being reported by the PC must be subjected to careful scrutiny before one can come to a careful conclusion and decide which side of the argument to take. It should be highlighted that the over 5000 practitioners currently being reported by the PC have diverse practice backgrounds. Some work in hospitals, academia, regulatory bodies, etc. Although the Council fails to provide the needed insight on its webpage, by accounting for the proportion of pharmacists working in the public sector as well as those in the diaspora, the ratio of pharmacies to pharmacists is not as lopsided as one might have thought from a cursory glance. In other words, by matching the number of full-time community pharmacists to the number of pharmacies reported by the PC, it can be realized that indeed some imbalances might be existing after all and that truly dedicated full-time community pharmacists do not outnumber pharmacies.

Granting approval for the opening of new pharmacies means opening up the job market for the dizzying number of pharmacy graduates being churned out yearly from pharmacy schools. Nevertheless, questions remain concerning the processes leading to the regulatory body’s approvals for establishing new pharmacies. Are approvals being granted in accordance with any established regulatory guideline, if any currently exists at all? The PC is mandated by Act 857 Part 4 section 80 (d) to “ensure the equitable and accessible distribution of pharmaceutical premises”. But over the years, their guidelines and requirements guiding the siting of new pharmacies can best be described as a moving target, oscillating between the realm of what is publicly known and what is unknown. For example, at one moment the famous 400-meter rule is in enforcement, at another moment it is blithely overruled for reasons held closed to the chest of the Council’s committee tasked with reviewing and granting the approvals. This is an unhealthy practice which only serves to cast clouds of suspicions over the regulator’s handling of applications for new pharmacies.

Over the last 5 years, it is commonplace to find new pharmacies in the capital towns of the country springing up just a step away from one another, a phenomenon which defeats the Council’s mandate of ensuring equitable distribution of pharmacies and high-quality pharmaceutical services across the country. Already, more than half of pharmacies in the country, according to the 2020 FIP Global Pharmacy Workforce and Migration Report, are disproportionately distributed in the Greater Accra and Ashanti regions. In view of this, one would have thought that the PC would find it prudent to live up to its mandate and ensure prospective pharmacy owners are encouraged to move to underserved areas of the country. This is where a critical stakeholder such as the professional body of pharmacists, PSGH, needs to step in with its advocacy efforts otherwise things will get out of control.

For a start, transparency needs to be infused into the approval processes culminating in the establishment of new pharmacies. It is important for the PC to develop a compendious document that details the guidelines for siting a new pharmacy with the object of ensuring equitable distribution of pharmacies across the country. These standards can be a product of consensus among the pharmaceutical stakeholders and should be widely accessible to the general public, and not just the regulatory body’s committee charged with adjudicating the approval process. For example, if population density or distance from an already existing pharmacy will be used as a criterion, then the specific standards that one needs to meet ought to be made known publicly. Additionally, the periods for reviewing the guideline should be publicized and efforts should be made to solicit stakeholder input so that their views could be considered for incorporation into the final document.

In conclusion, the PC is the institution charged with ensuring equitable distribution of pharmacies across Ghana. However, emerging trends clearly indicate that the regulator is reneging on this key object, resulting in what seems like overcrowding of pharmacies in our major cities. The PC, PSGH, and pharmacy stakeholders as a matter of urgency need to institute measures to curb this development.

About the Author: Pharm. Frank Kumi is a Clinical Pharmacy Practitioner and researcher with special interest in cardiovascular health and pharmaceutical technology. He is a former editor of the Pharmaceutical Society of Ghana. He is currently the Head of Pharmacy Unit at the Kings Medical Centre in Bontanga, Northern Region.