Characteristics of community pharmacists

Of 242 sampled community pharmacists contacted to participate, only 200 participated yielding a response rate of 83%. Our results showed that 58% (n = 116) of the participants were single, and the majority, 90.5% (n = 181) were between the age of 25 and 35, with an overall average age of 31 (SD = 5.2). Of the 200 participants, 74% of them (n = 148) were male, while 26% (n = 52) were female. The majority, 90.5% (n = 181) had a bachelor’s degree, and a few, 9.5% (n = 19) had a master’s. Participants enrolled in this study graduated between 1987 and 2021, with the majority, 74% (n = 148) graduating between 2016 and 2021. The majority of community Pharmacists, 71% (n = 142) had less than six years of experience working in community pharmacy (Table 1).

Table 1 Characteristics of community pharmacists (n = 200)Characteristics of community pharmacies

More than half of the participants, 56% (n = 112) were employed in Kigali city, the capital city of Rwanda. Among the participants, 79%(n = 158) were employees in community pharmacies, while only 21%(n = 42) were pharmacy owners. A large proportion, 91%(n = 182) of the participants reported having nurses as other healthcare providers available in their community pharmacies (Table 2).

Table 2 Characteristics of community pharmacies (n = 200)Availability and request of of m-RDTs in community pharmacies in Rwanda

Table 3 shows that 73% (n = 146) of community Pharmacists did not have m-RDTs in stock, while only 27% (n = 54) had them in stock. Despite this, 69% (n = 138) of community Pharmacists were consulted by clients requesting to purchase m-RDTs. Of those consulted, 72% (n = 99) were requested to sell m-RDTs more than once a week.with at least 59% (n = 118) of the clients further requesting Pharmacists to perform m-RDT from the community pharmacy settings.

Table 3 Availability and request of malaria rapid Diagnostic test (n = 200)Knowledge and familiarity of community pharmacists on using m-RDTs

Table 4 shows the knowledge of community pharmacists on the use of m-RDTs. Of the 200 participants, 18.5% (n = 37) were not at all familiar with the use of m-RDTs, while 66.5% (n = 133) reported that they did not receive any training on the use of m-RDTs. However, 33.5% (n = 67) of the study participants had received training on the use of m-RDTs. The mean score of familiarity stood at 2.23 (with a standard deviation of 1.42), placing it below the midpoint of 3 on the five-level Likert scale. This suggests a lower level of familiarity.

Table 4 Knowledge and familiarity of Community Pharmacists on using m-RDTs (n = 200)Association between participants’ characteristics and availability of m-RDTs

The Chi-square analysis conducted revealed several factors that were significantly associated with the availability of m-RDTs. Specifically,the Chi-square results indicated that a significantly higher proportion of community pharmacists working in Kigali City (59.3%) stocked m-RDTs compared to those in the provinces, (x2 = 9.13, p = 0.048). Additionally, community pharmacists who worked with nurses in their pharmacies (79.6%) had significantly higher availability of m-RDTs in their stock, (x2 = 11.68, p < 0.001). Furthermore, community pharmacists who were requested to sell m-RDTs (74.1%) had a significantly higher stock of m-RDTs than those who were not, (x2 = 6.95, p = 0.008). Similarly, community pharmacists who were moderately familiar with using m-RDTs (38.9%) significantly had m-RDTs in stock, (x2 = 17.24, p = 0.002) (Table 5).

Table 5 Association between participants’ characteristics and availability of m-RDTsPerceived advantages of licensing use m-RDT in community pharmacies

Table 6 shows the level of acceptance of the advantages of licensing m-RDTs in community pharmacies. Of the participants, 91.5% (n = 183) were in agreement that using these tests in community pharmacies could promote the rational use of antimalarial medicines, provide patients with alternative treatment options in the case of a negative test, and decrease the use of malaria medicines for other conditions with similar symptoms. The mean score for the stated advantages ranged from 1.86 (SD = 0.35) to 1.92 (SD = 0.28), indicating a high level of positive acceptance among the participants.

Table 6 Perceived advantages of licensing use of m-RDT in community pharmaciesPerceived disadvantages of licensing use of m-RDT in community pharmacies

Between 52% and 78% of participants disagreed with 8 of the 10 stated disadvantages, considering them to be unlikely disadvantages of using malaria rapid diagnostic tests in community pharmacies. However, over half of the participants, 53.5% (n = 107) expressed doubts that private clinics would not like it, while 51% (n = 102) believed that it would require more time and effort to educate patients about the necessity of undergoing a test before taking antimalarial medicines.The mean score of the stated disadvantages varied between 1.22 (SD = 0.42) and 1.53 (SD = 0.50) (Table 7).

Table 7 Disadvantages of licensing use of m-RDT in community pharmaciesPharmacists’ views on what is needed to improve their contribution to malaria management

Community pharmacists have expressed their views on what is needed to increase their role in malaria management. These views were classified into the following five categories: [1] Licensing the use of malaria rapid diagnostic tests in Community Pharmacies, [2] improving the availability of malaria rapid diagnostic tests in community Pharmacies, [3] improving public-private sector collaboration, and [4] providing malaria training to community Pharmacists.

Licensing the use of malaria rapid diagnostic tests in Community pharmacies

In Rwanda, the use of m-RDTs in community pharmacies remains unlicensed. However, community pharmacists have recommended that licensing their use could have several advantages. For instance, it could help prevent the presumptive treatment of malaria and promote evidence-based treatment, ultimately leading to a reduction in antimalarial drug resistance. Some of the participants explained that:

“Regulatory authorities should allow community pharmacists to perform rapid malaria diagnostic tests because many clients are seeking to buy antimalarial drugs in community pharmacies which may lead to the irrational use, hence antimalarial resistance “(Female Community Pharmacist, aged 28 years).

Although community pharmacists indicated a need to be allowed to perform malaria diagnostic tests. However, some also highlighted that severe malaria cases should be treated at the hospital. One participant stated:

“I think RDT can be legally used in community pharmacies. This will minimize the over-the-counter use of antimalarial medicines which is common in our daily practice. Though not allowed, it’s done by many pharmacies. This will minimize resistance, increase adherence, increase evidence-based treatment, and minimize treatment failures. But in case of severe malaria, pharmacists should immediately refer the patients to the hospital for further management (“Male community Pharmacist, aged 33 years).

Another one has put it:

“My view is that m-RDT should officially and legally be used in community pharmacies. However, we should reserve treatment of severe malaria to the hospital settings which have all the necessities” (male Community Pharmacist, aged 28 years).

Improving the availability of malaria rapid diagnostic tests in community pharmacies

Even though m-RDTs are currently not licensed for use in community pharmacies, community pharmacists have suggested that making them more widely available could increase their usage. This, in turn, could lead to evidence-based malaria treatment, which would ultimately result in improved accessibility for the public and help prevent antimalarial drug resistance. One participant expressed that:

“Availability of rapid diagnostic tests could help a pharmacist to provide good pharmacy practice and evidence-based treatment hence reduction of antimalarial drug resistance and increased adherence by a patient as well as an increase in confidence to the pharmacist” (Male community Pharmacist, aged 25 years).

Improving public-private sector collaboration

Community pharmacists have suggested that the national malaria program could collaborate with them to raise public awareness about the importance of dispensing antimalarial medicines only after a diagnostic test has been conducted. To facilitate this, pharmacists have proposed that the national malaria program and its partners could provide free malaria diagnostic tests to community pharmacies. This would help to improve the early detection of malaria at the community level. Some participants explained that:

“There is a need for collaboration between the public and private sector by sensitizing the public that a malaria test is important before asking for antimalarial medicines in community pharmacies” (Female Community Pharmacist, aged 29 years).

“Rwanda has a malaria program that offers malaria diagnostic tests to community health workers. I think it will be better if the government/partners also offer these tests to community pharmacies free of charge, then patients will only have to pay for the services of testing and the medication.” (Male community Pharmacist, aged 28 years).

“Community Pharmacy should be introduced in the national healthcare strategic plan and be given necessary training on malaria management as those from the public health sector.”(Male community Pharmacist, aged 30 years).

“If Community Health Workers can perform malaria tests and provide malaria treatment, community Pharmacists should also be trusted as healthcare professionals. It should be noted Pharmacists are more knowledgeable in mechanisms of medicines than any other healthcare professionals.” (Male Community Pharmacist, aged 34 years).

Providing malaria training to community pharmacists

Community Pharmacists have acknowledged that they need training on malaria diagnostic tools. They have suggested to the Ministry of Health to organize training programs for community pharmacists to help them better manage malaria cases. They have also stressed that they are an underutilized resource in healthcare and could play a vital role in the proper management of malaria. By enhancing their knowledge and skills through training, community pharmacists could make even greater contribution to the fight against malaria and improve public health outcomes in their communities. Some participants stated that:

“Community Pharmacists are unutilized human resources in the management of malaria. The Ministry of Health should include them in training on such simple rapid tests including malaria.” (male community Pharmacist, aged 31 years).

“My view is that community pharmacists must be able to distinguish the severity of malaria, simple to severe,and know how to help, knowing that they cannot treat a severe form of malaria. Secondly, if possible be reminded about Malaria treatment protocols which are up to date. Those are my opinions because pharmacists are healthcare professionals with huge knowledge.”(Male community Pharmacist, aged 33 years).

“Where deemed necessary, training should be provided to community Pharmacists on effective use of RDTs. Therefore, new policies to train them must be put in place.” (Female Community Pharmacist, aged 30 years).