RWANDA, like many other developing countries, still faces a shortage of medical doctors in both public and private health facilities. The Doctor Population Ratio was 1 to 10,055 in 2016 as of Rwandas fourth health sector strategic plan (July 2018-June 2024). The Rwandan government has put measures in place to increase the doctor to patient ratio and improve the quality of healthcare being delivered. Incentivizing the establishment of educational facilities that can train medical students is a commendable place to start. However, the task of training enough medical doctors to bridge the existing gap will require time and extensive resources. Meanwhile, the Rwandan population continues to rise and with it, the demand for professional medical services. Alternatively, private retail pharmacies are increasing widely in the country. Rwanda Food and Drug Administration (FDA) currently counts 612 private retail pharmacies. Highly trained pharmacists are in charge of regulated healthcare services provision in these pharmacies. However private retail pharmacies are still believed as a place where only services like drug dispensing, counselling, health supply chain and logistics services can be provided. On the other hand, pharmacists are uniquely qualified for providing patient care, have extensive knowledge of pharmacotherapy and useful clinical skills for common medical conditions. Undoubtedly, pharmacists can be the solution to the doctors’ shortage that has several times resulted in long queues from many health facilities. Pharmacists are able to manage most of the common illnesses like pain, cold, allergic diseases, uncomplicated malaria, diarrhoea, constipation just to mention a few that still today take most people to the hospitals. Pharmacists are most often the first point of contact when people need medications and basic healthcare services. They are usually in closer proximity to the patients than health facilities, especially in urban areas. Interestingly, Patients who seek health services from a pharmacist are not usually charged a consultation fee, which potentially reduces the cost of healthcare services incurred by the patient. The Covid-19 pandemic has caused additional strain to the Rwandan health system, stretching thin the resources that were already insufficient. Patients too, relatively feel safer walking in a pharmacy than in a hospital where the risk of transmission is assumed to be higher. Policies that allow pharmacists to provide more health services to patients with uncomplicated conditions can address this challenge too. Otherwise, still getting treatment from the pharmacy has its own set of challenges. Patients who choose to forego seeking treatment from a health post or a health centre and go directly to the pharmacy will most likely be subject to paying for the cost of the medications out of pocket. Majority of medical insurances today don’t refund medications recommended by a pharmacist to the clients. To play a role in extending universal health coverage, medical insurances can initiate the ability to refund pharmacist prescribed medications which would in the end encourage patients to visit pharmacies in case of uncomplicated complaints and lighten the load for the medical doctors and medical facilities. There are as many arguments as there are challenges for private retail pharmacies and pharmacists to take on some responsibilities previously only fulfilled by medical doctors in Rwanda. It is clear however; that an urgent solution to the doctors’ shortage is needed to prevent further delays in advancing the Rwandan healthcare system. The government, the pharmacy professional bodies, the medical insurance companies and other relevant healthcare stakeholders need to start this much needed conversation, and look at countries in the region like Kenya where pharmaceutical care has revolutionised the healthcare industry. Amon Nsengimana is a registered pharmacist and Public Health enthusiast.
