Integration of Community pharmacy and pharmacists in primary health care policies in Argentina

Abstract

Argentina is a federal republic with approximately 44 million people, divided into 23 provinces and an autonomous city, Buenos Aires. The health system is segmented into public, social security and private subsystems. The social security and private sectors cover more than 60% of the population. Total health expenditure in 2017 was 9.4% of gross domestic product. Primary health care (PHC) was considered as the principal strategy for universal coverage policy for health system reform in Latin America at the end of 20th century. The most remarkable characteristics of the Argentinian health system are its fragmentation and disorganization. An increase of public sector demands, due to a socioeconomic crisis, led to the subsequent collapse of the system, caused primarily by a sustained lack of investment. First care level decentralization to the Integral Health Service Delivery Networks (IHSDN) becomes the cornerstone of a PHC-based system. Pharmacists and community pharmacies are not formally mentioned in PHC policies or IHSDN. However, pharmacies are recognized as healthcare establishments as part of the first care level. Community pharmacists are the only health care professional whose profit comes from the margin on product sales. Contracts with social security and private insurances provide small margins which reduce the viability of community pharmacies. There is a preference by community pharmacies to diversify product sales instead of providing professional services. This is driven by marketing and economic pressures rather than patient care and health policies. Dispensing is the main professional activity followed by management of minor illness and associated product recommendations. Currently, there are no national practice guidelines or standard operating procedures for the provision of pharmaceutical services and there is no nationally agreed portfolio of services. National pharmacy organizations appear to have no official strategic statements or plans which would guide community pharmacies. There are some isolated experiences in community pharmacies and in public first care level pharmacies that demonstrate the possibilities and opportunities for implementing pharmaceutical services under the PHC approach. There is a real lack of integration of community pharmacies and pharmacists in the healthcare system.

Contracting retail pharmacies as a source of essential medicines for public sector clients in low- and middle-income countries: a scoping review of key considerations, challenges, and opportunities

“…[ 24 , 34 ]. Argentina does not have a framework for collaboration between regulatory entities and pharmaceutical organizations—seriously hampering the ability to enforce private pharmacy quality standards [ 35 ]. Ghana and Namibia also face challenges, mainly due to the scarcity of financial and human resource (HR) capacity and of sophisticated information systems [ 20 , 36 - 38 ].…”

Insights into clinical pharmacy practice in Latin America

“…Pharmacists were primarily involved in activities such as dispensing and distribution of medicines and biomedical materials. 7,8 T A B L E 1 Main clinical pharmacy associations in Latin America. Pharmacy became a mandatory subject in the pharmacy curriculum at the UBA, with the purpose of ensuring that graduates meet the profile of a health professional focused on comprehensive patient care.…”

“…12 In Argentina, there are two prominent national professional organizations, namely the Asosiaci on Argentina de Farmacéuticos Hospitalarios (AAFH) and the Federaci on Farmacéutica de la República Argentina, both of which emphasize the clinical aspects of the pharmacy profession. 7 The AAFH has played a vital role in advancing Clinical Pharmacy by developing practice models for Hospital Pharmacy that aim to standardize essential processes within the profession. These models consider the unique requirements of the healthcare system and emphasize specialized expertise.…”

“…Traditionally, hospital pharmacy in Argentina focused on the economic management of medications and medical products. Pharmacists were primarily involved in activities such as dispensing and distribution of medicines and biomedical materials 7,8 …”