Why raising the standard of pharmaceutical care for every Kenyan is good practice

Wairimu Njuki Mbogo, medical doctor and President of the Pharmaceutical Society of Kenya. [Courtesy]

Something important is happening in pharmacy, both here at home and across the world.

This week, pharmacists, pharmaceutical scientists, educators, regulators and health system leaders from across the world are gathered for the 84th World Congress of the International Pharmaceutical Federation (FIP), discussing patient safety, stronger primary healthcare, medicines optimisation and how the pharmaceutical workforce can respond to increasingly complex patient needs.

Kenya is having its own version of that conversation.

At the recently concluded Kenya Health Summit, the Pharmacy and Poisons Board unveiled the Good Pharmacy Practice (GPP) Standards, marking an important step in defining the standard of pharmaceutical care Kenyans should expect.

As pharmacists, and through the Pharmaceutical Society of Kenya, we welcome this direction.

Does that mean every provision is perfect? No. There will be areas requiring clarification, genuine implementation challenges and provisions that may require refinement. We should have those conversations. But we should not allow disagreement with individual provisions to obscure the bigger question:

What standard of pharmaceutical care does the Kenyan patient deserve?

Article 43(1)(a) of our Constitution guarantees every Kenyan the right to the highest attainable standard of health. That constitutional promise means that pharmaceutical care, as an important component of healthcare delivery, must itself be offered at the highest attainable standard.

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Pharmacy has too often been understood primarily through the product: the medicine, premises, license, supply chain and dispensing transaction. But pharmacy is a healthcare practice. Behind every medicine is a patient.

It is not enough that a medicine is available and of good quality. We must also ask: Is it the right medicine for this patient? Is the dose appropriate? Is it working? Is it safe alongside their other medicines? Is the patient experiencing adverse effects? Do they understand their treatment? Could their therapy be optimised?

This is where the pharmacist becomes indispensable.

Pharmacists are trained to assess and optimise medication therapy; identify interactions, contraindications and medicine-related problems; monitor treatment outcomes and adverse drug reactions; promote adherence; support antimicrobial stewardship; and collaborate with other healthcare professionals in managing increasingly complex patients.

Put simply, the pharmacist is the healthcare professional whose expertise is the medicine in the context of the patient.

This is why scope of practice must ultimately be understood as a patient-safety issue. Kenya needs pharmacists. Kenya needs pharmaceutical technologists. Kenya needs doctors, nurses, clinical officers, Community Health Promoters and the many other cadres that collectively make our health system work.

Healthcare is a team effort. But being members of the same team does not mean everybody performs the same role.

Different professionals undergo different education and training, develop different competencies and consequently carry different scopes and levels of professional accountability.

Recognising those distinctions does not diminish anyone. Complementarity should not mean interchangeability.

This principle was recently considered by the High Court in Kenya Pharmaceutical Association v Pharmacy and Poisons Board & another; Pharmaceutical Society of Kenya (Interested Party).

The Court recognised that pharmacists and pharmaceutical technologists are both authorised to practise within pharmacy while acknowledging differences in their levels of training and experience, alongside the increasing complexity of services at higher levels of care. It further held that differentiated requirements for superintendence at higher-level hospitals were based on professional standards required to guarantee the highest attainable standard of healthcare under Article 43(1).

The principle is important: professional standards should follow training, competence, complexity of care and responsibility to the patient.

Nor should pharmacist expertise begin only when a patient reaches a major referral hospital.

Kenya's existing health-facility regulatory framework already recognises pharmacist involvement further down the system. The Medical Institutions Rules provide staffing requirements according to the level and complexity of care, including pharmacist and pharmaceutical-technologist positions within the prescribed workforce at Level 3. This becomes even more important as Kenya develops Primary Care Networks.

Consider a Community Health Promoter who identifies a patient whose blood pressure remains uncontrolled despite treatment; an older person taking six medicines from different points of care; or a patient with diabetes struggling to understand their medication.

A strong referral pathway cannot simply move that patient to another place where medicines are handed to them. The referral must connect the patient to the expertise they need.

Having pharmacists accessible closer to the patient means CHP referrals and Primary Care Networks can connect patients to medication review, identification of drug-related problems, adherence assessment, medicines reconciliation, adverse-effect monitoring, patient education and appropriate medication optimisation and referral.

This is how pharmaceutical care becomes part of primary healthcare.

International experience offers useful lessons. In England, pharmacists have increasingly been integrated into general practice and Primary Care Networks, including structured medication reviews for patients with complex polypharmacy and other higher-risk medication needs. Canada has similarly expanded pharmacists' contributions in primary and community care. Research evaluating pharmacist interventions has reported benefits in identifying medicine-related problems, supporting adherence and improving aspects of patient safety and healthcare utilisation.

Kenya does not need to copy another health system wholesale. But the underlying lesson is relevant: Bringing pharmacist expertise closer to patients is not simply a workforce decision. It is a health-system intervention.

That is why the discussions taking place at the FIP World Congress are so relevant to Kenya. Across the global profession, pharmacists are considering how they can contribute more effectively to primary healthcare, medicines optimisation, prevention, patient safety and sustainable health systems.

The world is asking how pharmacists can be better utilised to improve health outcomes. Kenya should be asking the same question.

At its best, GPP should help us answer an ambitious question: how do we deploy the different competencies within our pharmaceutical workforce so that every Kenyan can access the highest attainable standard of pharmaceutical care as close to home as possible?

That means pharmaceutical technologists practising fully within their defined scope, pharmacists practising fully within theirs, and specialist pharmacists being available where complexity demands specialist pharmaceutical expertise. The same evolution should happen in community pharmacy.

Our ambition cannot simply be to have more places selling medicines. We should envision pharmacies where patients living with chronic diseases receive comprehensive pharmaceutical care; medicine-related problems are identified before they cause harm; adverse drug reactions are recognised; adherence is supported; antimicrobial stewardship occurs within the community; and pharmacists participate meaningfully within Primary Care Networks.

Our ambition must be to give more Kenyans access not only to medicines, but to pharmaceutical care. This also requires us to confront illegal pharmaceutical practice.

Quackery is a genuine public-safety problem, but quackery and scope of practice are not the same issue. Pharmacists and pharmaceutical technologists are legitimate regulated healthcare professionals. Those operating outside the appropriate regulatory framework are a different matter altogether.

One practical intervention PSK believes deserves consideration is stronger integration between county business licensing and PPB pharmaceutical licensing.

A business seeking to operate as a pharmacy or pharmaceutical outlet should not obtain or renew a County Single Business Permit without verification of the appropriate valid PPB premises licence.

Connecting these regulatory systems would create another important enforcement checkpoint, alongside stronger inspections, professional licence verification and action against illegal pharmaceutical supply chains.

We should be capable of doing two things simultaneously: deal decisively with quackery and uphold appropriate scopes of practice among legitimate professionals. Both protect Wanjiku.

There is also a wider national context. Kenya is strengthening its medicines regulatory system as PPB works towards higher regulatory maturity and WHO Maturity Level 3.

But regulatory maturity cannot stop with the product. A medicine can leave a manufacturing facility having met the highest quality standards and still fail the patient if the system around its use is weak.

Who reviews the therapy? Who identifies the interaction? Who recognises the adverse reaction? Who intervenes when treatment is failing? Who takes professional responsibility for optimising the patient's medicines?

Good medicines require good pharmacy practice.

As Kenya raises the standards by which medicines are regulated, we must simultaneously raise the standards by which pharmaceutical care is delivered.

Supporting GPP therefore does not mean declaring every provision perfect. Where clarification is required, let us clarify. Where implementation presents genuine challenges, let us find practical solutions. Where evidence demonstrates that something can be improved, let us improve it. But refinement should not become a race towards the lowest common denominator. Progressive health systems raise standards as knowledge, capability and patient needs evolve.

As pharmacists, and through the Pharmaceutical Society of Kenya, we support that direction and stand ready to work with Government, PPB, pharmaceutical technologists and their professional bodies, fellow healthcare professionals, counties, training institutions and the public to make these Standards practical, evidence-based and beneficial to patients.

Because ultimately this should never be about the different healthcare professionals. It is about the public; it is about Wanjiku.

The mother collecting medicine for her child. The older Kenyan taking six medicines every morning. The patient whose hypertension remains uncontrolled. The person managing diabetes from home. The cancer patient receiving specialised medicines. And the patient identified by a Community Health Promoter who should find the pharmaceutical expertise they need as close to home as reasonably possible.

Article 43 does not promise Kenyans the lowest healthcare standard we can accommodate. It guarantees the highest attainable standard of health.

Our ambition therefore cannot be to preserve the lowest permissible standard. It must be to progressively raise it.

Professional scope must correspond to education, competence and accountability. Patients must have access to the appropriate pharmaceutical expertise when they need it. Different cadres should work collaboratively within their competencies. Illegal practice must be confronted. And pharmacists must be enabled, and equally held accountable, to provide the comprehensive pharmaceutical care for which they are trained.

The Good Pharmacy Practice Standards will not be the final word on pharmacy practice in Kenya. Nor should they be. Standards must evolve as healthcare evolves.

But clearer scopes, stronger accountability and progressively higher standards of pharmaceutical care are a step in the right direction.

The world is raising the conversation about what pharmacists can contribute to better health. Kenya should not lower its ambition.

For Wanjiku, the direction must be forward towards safer medicines, stronger pharmaceutical care and the highest attainable standard of health.

The writer is a medical doctor and the President of the Pharmaceutical Society of Kenya