Achieving Universal Health Coverage (UHC) in SA necessitates substantial improvements in healthcare infrastructure, expansion of preventive healthcare at the community level, effective use of technology and innovation, implementation of collaborative care models, and rigorous measurement of both performance and quality of care to ensure positive health outcomes. This vision places pharmacists and their teams, alongside other primary healthcare professionals, at the forefront of a reimagined healthcare model, writes ICPA deputy chairperson, Dr Sham Moodley.

The imperative to enhance healthcare services is deeply rooted in the South African Constitution and aligns with the 1948 WHO Constitution, which defines health as a fundamental human right.¹ Universal, equitable access to high-quality primary healthcare, regardless of race, gender, income, or geographical location, is a priority for all citizens. Achieving this goal, however, requires a financial model that emphasises affordability and sustainability, ensuring that the healthcare system remains efficient and maintains strict cost control.

Political debates surrounding this issue are likely to persist and may ultimately reach the Constitutional Court, reflecting the strength of SA’s democratic principles and the independence of its legal system. However, this process alone will not address the fundamental question: “What changes are necessary to guarantee equitable access to quality, affordable healthcare in SA? This critical issue has been brought to the forefront of public discourse by the Independent Community Pharmacy Association (ICPA) on behalf of the organised pharmacy sector. Community pharmacies have the potential to serve as pivotal institutions, delivering essential health promotion programmes aimed at combating the prevalence of preventable diseases.

The epidemic of non-communicable diseases (NCDs) accounts for approximately half of all deaths in SA, with 20 million adults classified as overweight or obese.² When coupled with high levels of alcohol consumption, smoking, and the prevalence of HIV and tuberculosis infections, these health challenges underscore the necessity for each sector to assess its potential contributions – whether within individual professional domains or through collaborative initiatives.³

At a recent workshop attended by prominent community pharmacists, participants identified a basket of services that could address these issues at the primary care level. These services span acute and chronic care, as well as pharmaceutical services, offering practical strategies to enhance health literacy, immunisation coverage, medication management, public health promotion, disease prevention and management, and point-of-care solutions. The workshop also highlighted gaps in pharmacists' confidence and competency, underscoring the need for standardised protocols and remuneration frameworks to better integrate pharmacists into primary healthcare (PHC).

The pharmacy sector holds a distinct advantage in possessing a workforce of knowledgeable, skilled, and competent pharmacists, pharmaceutical scientists, and educators. By expanding pharmaceutical services, the profession is well-positioned to support the healthcare system’s objectives and advance towards achieving universal health coverage (UHC).

Although the pharmacist qualification provides the necessary training for a significant role in primary healthcare (PHC), it remains under recognised and underutilised. The current remuneration model, which is primarily product-focused, is insufficient even for the essential function of dispensing. The National Health Insurance (NHI) framework needs to go beyond by offering adequate incentives for professional pharmaceutical services. International models⁴ demonstrate that integrating pharmacists into PHC systems enhances healthcare delivery. These examples underscore the value of pharmacists as initial points of contact in healthcare. It is crucial for the regulatory body to fully recognise the contributions of pharmacists and their teams and to ensure their integration into PHC service offerings.

REFERENCES 

1. https://www.who.int/about/governance/constitution 
2. https://www.dailymaverick.co.za/article/2024-08-18-for-universal-healthcare-and-nhi-to-succeed-sa-needs-effective-health-promotion-programmes-and-institutions/ 
3. Nagykaldi ZJ, Scheid D, Zhao D, Mishra B, Greever-Rice T. An Innovative Community-based Model for Improving Preventive Care in Rural Counties. J Am Board Fam Med. 2017 Sep-Oct;30(5):583-591. doi: 10.3122/jabfm.2017.05.170035. PMID: 28923810; PMCID: PMC5606150 
4. Karampatakis GD, Patel N, Stretch G, Ryan K. Integration and impact of pharmacists in general practice internationally: A rapid review. J Health Serv Res Policy. 2024 Jan;29(1):56-67. doi: 10.1177/13558196231179831. Epub 2023 Jun 17. PMID: 37329256; PMCID: PMC10729538.